hospital_name,last_updated_on,version,location_name,hospital_address,type_2_npi,license_number|KS,attester_name,"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula."
"Southwest Medical Center",10/16/2026,3.0.0,"Southwest Medical Center","315 W 15th st Liberal, KS 67901",,480684878,,TRUE
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"TELENEUROLOGY ORIG SITE FEE",70000,"CDM ",780,RC,Q3014,HCPCS,OUTPATIENT,,,46,36.8,,22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.38,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.2,70,,25.76,,,0,"percent of total billed charges ","70% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",42.78,93,,34.22,,,0,"percent of total billed charges ","93% of total billed charges ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.1,85,,31.28,,,0,"percent of total billed charges ","85% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.02,87,,32.02,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.2,70,,25.76,,,0,"percent of total billed charges ","70% of total billed charges ",22.88,42.78,
"TELENEUROLOGY ORIG SITE FEE",70010,"CDM ",780,RC,Q3014,HCPCS,OUTPATIENT,,,46,36.8,,22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.38,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.2,70,,25.76,,,0,"percent of total billed charges ","70% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",42.78,93,,34.22,,,0,"percent of total billed charges ","93% of total billed charges ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.1,85,,31.28,,,0,"percent of total billed charges ","85% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.02,87,,32.02,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.2,70,,25.76,,,0,"percent of total billed charges ","70% of total billed charges ",22.88,42.78,
"TELENEUROLOGY ORIG SITE FEE",70020,"CDM ",780,RC,Q3014,HCPCS,OUTPATIENT,,,46,36.8,,22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.38,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.2,70,,25.76,,,0,"percent of total billed charges ","70% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",42.78,93,,34.22,,,0,"percent of total billed charges ","93% of total billed charges ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.1,85,,31.28,,,0,"percent of total billed charges ","85% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.02,87,,32.02,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.2,70,,25.76,,,0,"percent of total billed charges ","70% of total billed charges ",22.88,42.78,
"TELENEUROLOGY ORIG SITE FEE",70030,"CDM ",780,RC,Q3014,HCPCS,OUTPATIENT,,,46,36.8,,22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.38,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.2,70,,25.76,,,0,"percent of total billed charges ","70% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",42.78,93,,34.22,,,0,"percent of total billed charges ","93% of total billed charges ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.1,85,,31.28,,,0,"percent of total billed charges ","85% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.02,87,,32.02,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.2,70,,25.76,,,0,"percent of total billed charges ","70% of total billed charges ",22.88,42.78,
"TELENEUROLOGY ORIG SITE FEE",70040,"CDM ",780,RC,Q3014,HCPCS,OUTPATIENT,,,46,36.8,,22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.38,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.2,70,,25.76,,,0,"percent of total billed charges ","70% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",42.78,93,,34.22,,,0,"percent of total billed charges ","93% of total billed charges ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.1,85,,31.28,,,0,"percent of total billed charges ","85% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.02,87,,32.02,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.2,70,,25.76,,,0,"percent of total billed charges ","70% of total billed charges ",22.88,42.78,
"TELESTROKE ORIG SITE FEE",70050,"CDM ",780,RC,Q3014,HCPCS,OUTPATIENT,,,46,36.8,,22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.38,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.2,70,,25.76,,,0,"percent of total billed charges ","70% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",42.78,93,,34.22,,,0,"percent of total billed charges ","93% of total billed charges ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.1,85,,31.28,,,0,"percent of total billed charges ","85% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.02,87,,32.02,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.2,70,,25.76,,,0,"percent of total billed charges ","70% of total billed charges ",22.88,42.78,
"TELESTROKE ORIG SITE FEE",70060,"CDM ",780,RC,Q3014,HCPCS,OUTPATIENT,,,46,36.8,,22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.38,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.2,70,,25.76,,,0,"percent of total billed charges ","70% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",42.78,93,,34.22,,,0,"percent of total billed charges ","93% of total billed charges ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.1,85,,31.28,,,0,"percent of total billed charges ","85% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.02,87,,32.02,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.2,70,,25.76,,,0,"percent of total billed charges ","70% of total billed charges ",22.88,42.78,
"TELESTROKE ORIG SITE FEE",70070,"CDM ",780,RC,Q3014,HCPCS,OUTPATIENT,,,46,36.8,,22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.38,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.2,70,,25.76,,,0,"percent of total billed charges ","70% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",42.78,93,,34.22,,,0,"percent of total billed charges ","93% of total billed charges ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.1,85,,31.28,,,0,"percent of total billed charges ","85% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.02,87,,32.02,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.2,70,,25.76,,,0,"percent of total billed charges ","70% of total billed charges ",22.88,42.78,
"TELESTROKE ORIG SITE FEE",70080,"CDM ",780,RC,Q3014,HCPCS,OUTPATIENT,,,46,36.8,,22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.38,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.2,70,,25.76,,,0,"percent of total billed charges ","70% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",42.78,93,,34.22,,,0,"percent of total billed charges ","93% of total billed charges ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.1,85,,31.28,,,0,"percent of total billed charges ","85% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.02,87,,32.02,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.2,70,,25.76,,,0,"percent of total billed charges ","70% of total billed charges ",22.88,42.78,
"TELESTROKE ORIG SITE FEE",70090,"CDM ",780,RC,Q3014,HCPCS,OUTPATIENT,,,46,36.8,,22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.38,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.2,70,,25.76,,,0,"percent of total billed charges ","70% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",42.78,93,,34.22,,,0,"percent of total billed charges ","93% of total billed charges ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.1,85,,31.28,,,0,"percent of total billed charges ","85% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.02,87,,32.02,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.2,70,,25.76,,,0,"percent of total billed charges ","70% of total billed charges ",22.88,42.78,
"SPECIAL EQUIP ROBOT",1100550,"CDM ",360,RC,S2900,HCPCS,OUTPATIENT,,,1280.5,1024.4,,,,,,,,0,"other ","not separately reimbursment ",,,,3724.85,3724.85,3724.85,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",896.35,70,,717.08,,,0,"percent of total billed charges ","70% of total billed charges ",1152.45,90,,921.96,,,0,"percent of total billed charges ","90% of total billed charges ",1190.87,93,,952.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1088.43,85,,870.74,,,0,"percent of total billed charges ","85% of total billed charges ",1152.45,90,,921.96,,,0,"percent of total billed charges ","90% of total billed charges ",1152.45,90,,921.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1114.04,87,,891.23,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",896.35,70,,717.08,,,0,"percent of total billed charges ","70% of total billed charges ",896.35,1190.87,
"SUTURE REMOVAL",1700540,"CDM ",761,RC,S0630,HCPCS,OUTPATIENT,,,161,128.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.7,70,,90.16,,,0,"percent of total billed charges ","70% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",149.73,93,,119.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.85,85,,109.48,,,0,"percent of total billed charges ","85% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",140.07,87,,112.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.7,70,,90.16,,,0,"percent of total billed charges ","70% of total billed charges ",112.7,149.73,
"OBSERVATION PER HOUR",1700720,"CDM ",762,RC,G0378,HCPCS,OUTPATIENT,,,60.5,48.4,,5.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1985.5,,,,,,0,"case rate ","pays based on per visit rate ",,,,,,,0,"other ","not separately reimbursment ",42.35,70,,33.88,,,0,"percent of total billed charges ","70% of total billed charges ",54.45,90,,43.56,,,0,"percent of total billed charges ","90% of total billed charges ",56.27,93,,45.02,,,0,"percent of total billed charges ","93% of total billed charges ",5.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",51.43,85,,41.14,,,0,"percent of total billed charges ","85% of total billed charges ",54.45,90,,43.56,,,0,"percent of total billed charges ","90% of total billed charges ",54.45,90,,43.56,,,0,"percent of total billed charges ","90% of total billed charges ",6.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",52.64,87,,1536.51,868.38,1816.06,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",42.35,70,,33.88,,,0,"percent of total billed charges ","70% of total billed charges ",5.2,1985.5,
"OBSERVATION DIRECT ADMIT",1700730,"CDM ",762,RC,G0379,HCPCS,OUTPATIENT,,,336.5,269.2,,,,,,,,0,"other ","not separately reimbursment ",1986.51,,,2570.08,2570.08,2570.08,"1 through 10","case rate ","pays based on per visit rate ",,,,,,,0,"other ","not separately reimbursment ",235.55,70,,188.44,,,0,"percent of total billed charges ","70% of total billed charges ",302.85,90,,242.28,,,0,"percent of total billed charges ","90% of total billed charges ",312.95,93,,250.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",286.03,85,,228.82,,,0,"percent of total billed charges ","85% of total billed charges ",302.85,90,,242.28,,,0,"percent of total billed charges ","90% of total billed charges ",302.85,90,,242.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",292.76,87,,222.05,222.05,2014.91,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",547.66,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",235.55,70,,188.44,,,0,"percent of total billed charges ","70% of total billed charges ",235.55,1986.51,
"OBS PER HOUR NON-BILLABLE",1701250,"CDM ",762,RC,G0378,HCPCS,OUTPATIENT,,,,,,,,,,,,0,"other ","not separately reimbursment ",1985.5,,,,,,0,"case rate ","pays based on per visit rate ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,1536.51,868.38,1816.06,"1 through 10",other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1985.5,1985.5,
"SOTROVIMAB INFUSE POST MONITOR",1703072,"CDM ",771,RC,M0247,HCPCS,OUTPATIENT,,,920.5,736.4,,,,,,,,0,"other ","not separately reimbursment ",497.56,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",644.35,70,,515.48,,,0,"percent of total billed charges ","70% of total billed charges ",828.45,90,,662.76,,,0,"percent of total billed charges ","90% of total billed charges ",856.07,93,,684.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",782.43,85,,625.94,,,0,"percent of total billed charges ","85% of total billed charges ",828.45,90,,662.76,,,0,"percent of total billed charges ","90% of total billed charges ",828.45,90,,662.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",800.84,87,,640.67,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",644.35,70,,515.48,,,0,"percent of total billed charges ","70% of total billed charges ",497.56,856.07,
"TOCILIZUMAB INFUSE POST MNTR",1703074,"CDM ",771,RC,M0249,HCPCS,OUTPATIENT,,,920.5,736.4,,,,,,,,0,"other ","not separately reimbursment ",497.56,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",644.35,70,,515.48,,,0,"percent of total billed charges ","70% of total billed charges ",828.45,90,,662.76,,,0,"percent of total billed charges ","90% of total billed charges ",856.07,93,,684.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",782.43,85,,625.94,,,0,"percent of total billed charges ","85% of total billed charges ",828.45,90,,662.76,,,0,"percent of total billed charges ","90% of total billed charges ",828.45,90,,662.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",800.84,87,,640.67,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",405.52,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",644.35,70,,515.48,,,0,"percent of total billed charges ","70% of total billed charges ",405.52,856.07,
"BAMLAN/ETESEV INFUSION/MONITOR",1703080,"CDM ",771,RC,M0245,HCPCS,OUTPATIENT,,,920.5,736.4,,,,,,,,0,"other ","not separately reimbursment ",342.32,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",644.35,70,,515.48,,,0,"percent of total billed charges ","70% of total billed charges ",828.45,90,,662.76,,,0,"percent of total billed charges ","90% of total billed charges ",856.07,93,,684.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",295.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",782.43,85,,625.94,,,0,"percent of total billed charges ","85% of total billed charges ",828.45,90,,662.76,,,0,"percent of total billed charges ","90% of total billed charges ",828.45,90,,662.76,,,0,"percent of total billed charges ","90% of total billed charges ",292.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",800.84,87,,640.67,,,0,"percent of total billed charges ","87% of total billed charges ",292.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",644.35,70,,515.48,,,0,"percent of total billed charges ","70% of total billed charges ",292.83,856.07,
"TIXAGEVIMAP/CILGAVIMAB INJ/MON",1703086,"CDM ",771,RC,M0220,HCPCS,OUTPATIENT,,,267.5,214,,,,,,,,0,"other ","not separately reimbursment ",829.26,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",248.78,93,,199.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",227.38,85,,181.90,,,0,"percent of total billed charges ","85% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",232.73,87,,186.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",187.25,829.26,
"BEBTELOVIMAB INJ/MONITOR",1703087,"CDM ",771,RC,M0222,HCPCS,OUTPATIENT,,,267.5,214,,,,,,,,0,"other ","not separately reimbursment ",387.55,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",248.78,93,,199.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",227.38,85,,181.90,,,0,"percent of total billed charges ","85% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",232.73,87,,186.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",187.25,387.55,
"*PLATELET CONC APHERESIS",2002129,"CDM ",390,RC,P9034,HCPCS,OUTPATIENT,,,2344,1875.2,,25.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2006.85,2006.85,2006.85,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1640.8,70,,1312.64,,,0,"percent of total billed charges ","70% of total billed charges ",2109.6,90,,1687.68,,,0,"percent of total billed charges ","90% of total billed charges ",2179.92,93,,1743.94,,,0,"percent of total billed charges ","93% of total billed charges ",25.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.4,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1992.4,85,,1593.92,,,0,"percent of total billed charges ","85% of total billed charges ",2109.6,90,,1687.68,,,0,"percent of total billed charges ","90% of total billed charges ",2109.6,90,,1687.68,,,0,"percent of total billed charges ","90% of total billed charges ",32.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2039.28,87,,1631.42,,,0,"percent of total billed charges ","87% of total billed charges ",32.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",308.95,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1640.8,70,,1312.64,,,0,"percent of total billed charges ","70% of total billed charges ",25.5,2179.92,
"*PRBC X 1",2002434,"CDM ",390,RC,P9016,HCPCS,OUTPATIENT,,,947.5,758,,87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",534.34,100,,635.82,635.82,635.82,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",663.25,70,,530.60,,,0,"percent of total billed charges ","70% of total billed charges ",852.75,90,,682.20,,,0,"percent of total billed charges ","90% of total billed charges ",881.18,93,,704.94,,,0,"percent of total billed charges ","93% of total billed charges ",87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",110.54,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",805.38,85,,644.30,,,0,"percent of total billed charges ","85% of total billed charges ",852.75,90,,682.20,,,0,"percent of total billed charges ","90% of total billed charges ",852.75,90,,682.20,,,0,"percent of total billed charges ","90% of total billed charges ",109.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",824.33,87,,382.05,382.05,382.05,"1 through 10","percent of total billed charges ","87% of total billed charges ",109.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.91,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",663.25,70,,530.60,,,0,"percent of total billed charges ","70% of total billed charges ",87,881.18,
"*CRYOPRECIPITATE X1",2020310,"CDM ",390,RC,P9012,HCPCS,OUTPATIENT,,,281.5,225.2,,17.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",197.05,70,,157.64,,,0,"percent of total billed charges ","70% of total billed charges ",253.35,90,,202.68,,,0,"percent of total billed charges ","90% of total billed charges ",261.8,93,,209.44,,,0,"percent of total billed charges ","93% of total billed charges ",17.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",239.28,85,,191.42,,,0,"percent of total billed charges ","85% of total billed charges ",253.35,90,,202.68,,,0,"percent of total billed charges ","90% of total billed charges ",253.35,90,,202.68,,,0,"percent of total billed charges ","90% of total billed charges ",22.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",244.91,87,,195.93,,,0,"percent of total billed charges ","87% of total billed charges ",22.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",71.95,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",197.05,70,,157.64,,,0,"percent of total billed charges ","70% of total billed charges ",17.5,261.8,
"*THAW CRYOPRECIPITATE",2020320,"CDM ",390,RC,P9012,HCPCS,OUTPATIENT,,,36.5,29.2,,17.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.55,70,,20.44,,,0,"percent of total billed charges ","70% of total billed charges ",32.85,90,,26.28,,,0,"percent of total billed charges ","90% of total billed charges ",33.95,93,,27.16,,,0,"percent of total billed charges ","93% of total billed charges ",17.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",31.03,85,,24.82,,,0,"percent of total billed charges ","85% of total billed charges ",32.85,90,,26.28,,,0,"percent of total billed charges ","90% of total billed charges ",32.85,90,,26.28,,,0,"percent of total billed charges ","90% of total billed charges ",22.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.76,87,,25.41,,,0,"percent of total billed charges ","87% of total billed charges ",22.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",71.95,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",25.55,70,,20.44,,,0,"percent of total billed charges ","70% of total billed charges ",17.5,71.95,
"*FFP X1",2020330,"CDM ",390,RC,P9059,HCPCS,OUTPATIENT,,,241,192.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",168.7,70,,134.96,,,0,"percent of total billed charges ","70% of total billed charges ",216.9,90,,173.52,,,0,"percent of total billed charges ","90% of total billed charges ",224.13,93,,179.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",204.85,85,,163.88,,,0,"percent of total billed charges ","85% of total billed charges ",216.9,90,,173.52,,,0,"percent of total billed charges ","90% of total billed charges ",216.9,90,,173.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",209.67,87,,167.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",73.77,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",168.7,70,,134.96,,,0,"percent of total billed charges ","70% of total billed charges ",73.77,224.13,
"*BLOOD (SPLIT UNIT) EACH",2023930,"CDM ",390,RC,P9011,HCPCS,OUTPATIENT,,,297.5,238,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",208.25,70,,166.60,,,0,"percent of total billed charges ","70% of total billed charges ",267.75,90,,214.20,,,0,"percent of total billed charges ","90% of total billed charges ",276.68,93,,221.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",252.88,85,,202.30,,,0,"percent of total billed charges ","85% of total billed charges ",267.75,90,,214.20,,,0,"percent of total billed charges ","90% of total billed charges ",267.75,90,,214.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",258.83,87,,207.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",155.84,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",208.25,70,,166.60,,,0,"percent of total billed charges ","70% of total billed charges ",155.84,276.68,
"*PRBC IRRADIATED X 1",2026160,"CDM ",390,RC,P9040,HCPCS,OUTPATIENT,,,902.5,722,,25.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,91.89,91.89,91.89,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",631.75,70,,505.40,,,0,"percent of total billed charges ","70% of total billed charges ",812.25,90,,649.80,,,0,"percent of total billed charges ","90% of total billed charges ",839.33,93,,671.46,,,0,"percent of total billed charges ","93% of total billed charges ",25.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.4,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",767.13,85,,613.70,,,0,"percent of total billed charges ","85% of total billed charges ",812.25,90,,649.80,,,0,"percent of total billed charges ","90% of total billed charges ",812.25,90,,649.80,,,0,"percent of total billed charges ","90% of total billed charges ",32.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",785.18,87,,628.14,,,0,"percent of total billed charges ","87% of total billed charges ",32.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",265.41,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",631.75,70,,505.40,,,0,"percent of total billed charges ","70% of total billed charges ",25.5,839.33,
"*IRRADIATED PLATELET APHERESIS",2027100,"CDM ",390,RC,P9037,HCPCS,OUTPATIENT,,,1789.5,1431.6,,25.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1252.65,70,,1002.12,,,0,"percent of total billed charges ","70% of total billed charges ",1610.55,90,,1288.44,,,0,"percent of total billed charges ","90% of total billed charges ",1664.24,93,,1331.39,,,0,"percent of total billed charges ","93% of total billed charges ",25.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.4,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1521.08,85,,1216.86,,,0,"percent of total billed charges ","85% of total billed charges ",1610.55,90,,1288.44,,,0,"percent of total billed charges ","90% of total billed charges ",1610.55,90,,1288.44,,,0,"percent of total billed charges ","90% of total billed charges ",32.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1556.87,87,,1245.50,,,0,"percent of total billed charges ","87% of total billed charges ",32.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",680.61,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1252.65,70,,1002.12,,,0,"percent of total billed charges ","70% of total billed charges ",25.5,1664.24,
"PSA SCREENING TEST",2028550,"CDM ",301,RC,G0103,HCPCS,OUTPATIENT,,,188.5,150.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.95,70,,105.56,,,0,"percent of total billed charges ","70% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",175.31,93,,140.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",160.23,85,,128.18,,,0,"percent of total billed charges ","85% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",164,87,,18.93,18.93,163.35,13,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",19.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",131.95,70,,105.56,,,0,"percent of total billed charges ","70% of total billed charges ",19.3,175.31,
"*CULTURE FUNGUS OTH SRC EX BLD",2040625,"CDM ",306,RC,87102,HCPCS,OUTPATIENT,,,88,70.4,,8.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.6,70,,49.28,,,0,"percent of total billed charges ","70% of total billed charges ",79.2,90,,63.36,,,0,"percent of total billed charges ","90% of total billed charges ",81.84,93,,65.47,,,0,"percent of total billed charges ","93% of total billed charges ",8.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",74.8,85,,59.84,,,0,"percent of total billed charges ","85% of total billed charges ",79.2,90,,63.36,,,0,"percent of total billed charges ","90% of total billed charges ",79.2,90,,63.36,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",76.56,87,,61.25,,,0,"percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.41,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",61.6,70,,49.28,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,81.84,
"*FLUOR STAIN BACTERIA",2040630,"CDM ",306,RC,87206,HCPCS,OUTPATIENT,,,15,12,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.95,93,,11.16,,,0,"percent of total billed charges ","93% of total billed charges ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",12.75,85,,10.20,,,0,"percent of total billed charges ","85% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.05,87,,121.54,121.54,121.54,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,13.95,
"*NM XENON XE 133 20 MCI",3600814,"CDM ",343,RC,A9558,HCPCS,OUTPATIENT,,,583.5,466.8,,,,,,,,0,"other ","not separately reimbursment ",215.13,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",408.45,70,,326.76,,,0,"percent of total billed charges ","70% of total billed charges ",525.15,90,,420.12,,,0,"percent of total billed charges ","90% of total billed charges ",542.66,93,,434.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",495.98,85,,396.78,,,0,"percent of total billed charges ","85% of total billed charges ",525.15,90,,420.12,,,0,"percent of total billed charges ","90% of total billed charges ",525.15,90,,420.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",507.65,87,,406.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",408.45,70,,326.76,,,0,"percent of total billed charges ","70% of total billed charges ",215.13,542.66,
"*NM TECH-SESTAMIBI CARDIOLITE",3600822,"CDM ",343,RC,A9500,HCPCS,OUTPATIENT,,,325,260,,,,,,,,0,"other ","not separately reimbursment ",215.13,100,,133.71,133.71,133.71,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",227.5,70,,182.00,,,0,"percent of total billed charges ","70% of total billed charges ",292.5,90,,234.00,,,0,"percent of total billed charges ","90% of total billed charges ",302.25,93,,241.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.25,85,,221.00,,,0,"percent of total billed charges ","85% of total billed charges ",292.5,90,,234.00,,,0,"percent of total billed charges ","90% of total billed charges ",292.5,90,,234.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.75,87,,563.75,563.75,563.75,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.5,70,,182.00,,,0,"percent of total billed charges ","70% of total billed charges ",215.13,302.25,
"*NM TECH-MEDRONATE OSTEOLITE",3600830,"CDM ",343,RC,A9503,HCPCS,OUTPATIENT,,,311,248.8,,,,,,,,0,"other ","not separately reimbursment ",215.13,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",217.7,70,,174.16,,,0,"percent of total billed charges ","70% of total billed charges ",279.9,90,,223.92,,,0,"percent of total billed charges ","90% of total billed charges ",289.23,93,,231.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",264.35,85,,211.48,,,0,"percent of total billed charges ","85% of total billed charges ",279.9,90,,223.92,,,0,"percent of total billed charges ","90% of total billed charges ",279.9,90,,223.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",270.57,87,,216.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.7,70,,174.16,,,0,"percent of total billed charges ","70% of total billed charges ",215.13,289.23,
"*NM TECH-DISOFENIN HEPATOLITE",3600848,"CDM ",343,RC,A9510,HCPCS,OUTPATIENT,,,311,248.8,,,,,,,,0,"other ","not separately reimbursment ",215.13,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",217.7,70,,174.16,,,0,"percent of total billed charges ","70% of total billed charges ",279.9,90,,223.92,,,0,"percent of total billed charges ","90% of total billed charges ",289.23,93,,231.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",264.35,85,,211.48,,,0,"percent of total billed charges ","85% of total billed charges ",279.9,90,,223.92,,,0,"percent of total billed charges ","90% of total billed charges ",279.9,90,,223.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",270.57,87,,242.83,221.25,264.41,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.7,70,,174.16,,,0,"percent of total billed charges ","70% of total billed charges ",215.13,289.23,
"*NM TECH-PYROPHOSPHATE/MCI",3600855,"CDM ",343,RC,A9538,HCPCS,OUTPATIENT,,,127.5,102,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",89.25,70,,71.40,,,0,"percent of total billed charges ","70% of total billed charges ",114.75,90,,91.80,,,0,"percent of total billed charges ","90% of total billed charges ",118.58,93,,94.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",108.38,85,,86.70,,,0,"percent of total billed charges ","85% of total billed charges ",114.75,90,,91.80,,,0,"percent of total billed charges ","90% of total billed charges ",114.75,90,,91.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",110.93,87,,88.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",89.25,70,,71.40,,,0,"percent of total billed charges ","70% of total billed charges ",89.25,118.58,
"*NM TECH-MACROAG ALBU PULMOLIT",3600863,"CDM ",343,RC,A9540,HCPCS,OUTPATIENT,,,545,436,,,,,,,,0,"other ","not separately reimbursment ",219.72,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",381.5,70,,305.20,,,0,"percent of total billed charges ","70% of total billed charges ",490.5,90,,392.40,,,0,"percent of total billed charges ","90% of total billed charges ",506.85,93,,405.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",463.25,85,,370.60,,,0,"percent of total billed charges ","85% of total billed charges ",490.5,90,,392.40,,,0,"percent of total billed charges ","90% of total billed charges ",490.5,90,,392.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",474.15,87,,379.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",381.5,70,,305.20,,,0,"percent of total billed charges ","70% of total billed charges ",219.72,506.85,
"*NM TECH-SULFUR CLLD/MCI",3600871,"CDM ",343,RC,A9541,HCPCS,OUTPATIENT,,,290,232,,,,,,,,0,"other ","not separately reimbursment ",173.14,100,,292.00,292.00,292.00,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",203,70,,162.40,,,0,"percent of total billed charges ","70% of total billed charges ",261,90,,208.80,,,0,"percent of total billed charges ","90% of total billed charges ",269.7,93,,215.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",246.5,85,,197.20,,,0,"percent of total billed charges ","85% of total billed charges ",261,90,,208.80,,,0,"percent of total billed charges ","90% of total billed charges ",261,90,,208.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",252.3,87,,201.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",203,70,,162.40,,,0,"percent of total billed charges ","70% of total billed charges ",173.14,269.7,
"NM GALLIUM GA 67 6MCI",3600889,"CDM ",343,RC,A9556,HCPCS,OUTPATIENT,,,179,143.2,,,,,,,,0,"other ","not separately reimbursment ",215.13,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",125.3,70,,100.24,,,0,"percent of total billed charges ","70% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",166.47,93,,133.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",152.15,85,,121.72,,,0,"percent of total billed charges ","85% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",155.73,87,,124.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.3,70,,100.24,,,0,"percent of total billed charges ","70% of total billed charges ",125.3,215.13,
"*NM TECH 99M PEMTETATE (DTPA)",3600897,"CDM ",343,RC,A9539,HCPCS,OUTPATIENT,,,435.5,348.4,,,,,,,,0,"other ","not separately reimbursment ",118.21,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",304.85,70,,243.88,,,0,"percent of total billed charges ","70% of total billed charges ",391.95,90,,313.56,,,0,"percent of total billed charges ","90% of total billed charges ",405.02,93,,324.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",370.18,85,,296.14,,,0,"percent of total billed charges ","85% of total billed charges ",391.95,90,,313.56,,,0,"percent of total billed charges ","90% of total billed charges ",391.95,90,,313.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",378.89,87,,303.11,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",304.85,70,,243.88,,,0,"percent of total billed charges ","70% of total billed charges ",118.21,405.02,
"*NM TECH 99M MERTIATIDE HYPER",3600905,"CDM ",343,RC,A9562,HCPCS,OUTPATIENT,,,974,779.2,,,,,,,,0,"other ","not separately reimbursment ",215.13,100,,217.56,217.56,217.56,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",681.8,70,,545.44,,,0,"percent of total billed charges ","70% of total billed charges ",876.6,90,,701.28,,,0,"percent of total billed charges ","90% of total billed charges ",905.82,93,,724.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",827.9,85,,662.32,,,0,"percent of total billed charges ","85% of total billed charges ",876.6,90,,701.28,,,0,"percent of total billed charges ","90% of total billed charges ",876.6,90,,701.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",847.38,87,,677.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",681.8,70,,545.44,,,0,"percent of total billed charges ","70% of total billed charges ",215.13,905.82,
"NM I131 SERUM ALBUM UPTAKE",3600913,"CDM ",343,RC,A9524,HCPCS,OUTPATIENT,,,214,171.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.8,70,,119.84,,,0,"percent of total billed charges ","70% of total billed charges ",192.6,90,,154.08,,,0,"percent of total billed charges ","90% of total billed charges ",199.02,93,,159.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",181.9,85,,145.52,,,0,"percent of total billed charges ","85% of total billed charges ",192.6,90,,154.08,,,0,"percent of total billed charges ","90% of total billed charges ",192.6,90,,154.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",186.18,87,,148.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.8,70,,119.84,,,0,"percent of total billed charges ","70% of total billed charges ",149.8,199.02,
"NM INDIUM 111-IN PENTETRE",3600921,"CDM ",343,RC,A9572,HCPCS,OUTPATIENT,,,3567.5,2854,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2497.25,70,,1997.80,,,0,"percent of total billed charges ","70% of total billed charges ",3210.75,90,,2568.60,,,0,"percent of total billed charges ","90% of total billed charges ",3317.78,93,,2654.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3032.38,85,,2425.90,,,0,"percent of total billed charges ","85% of total billed charges ",3210.75,90,,2568.60,,,0,"percent of total billed charges ","90% of total billed charges ",3210.75,90,,2568.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3103.73,87,,2482.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2000.94,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2497.25,70,,1997.80,,,0,"percent of total billed charges ","70% of total billed charges ",2000.94,3317.78,
"*NM TECH-PERTECHNETATE GENERAT",3600939,"CDM ",343,RC,A9512,HCPCS,OUTPATIENT,,,435.5,348.4,,,,,,,,0,"other ","not separately reimbursment ",20.38,100,,48.77,48.77,48.77,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",304.85,70,,243.88,,,0,"percent of total billed charges ","70% of total billed charges ",391.95,90,,313.56,,,0,"percent of total billed charges ","90% of total billed charges ",405.02,93,,324.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",370.18,85,,296.14,,,0,"percent of total billed charges ","85% of total billed charges ",391.95,90,,313.56,,,0,"percent of total billed charges ","90% of total billed charges ",391.95,90,,313.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",378.89,87,,303.11,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",304.85,70,,243.88,,,0,"percent of total billed charges ","70% of total billed charges ",20.38,405.02,
"NM THALLIUM PER MCI",3600960,"CDM ",343,RC,A9505,HCPCS,OUTPATIENT,,,129.5,103.6,,,,,,,,0,"other ","not separately reimbursment ",52.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",90.65,70,,72.52,,,0,"percent of total billed charges ","70% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",120.44,93,,96.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",110.08,85,,88.06,,,0,"percent of total billed charges ","85% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",112.67,87,,90.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.65,70,,72.52,,,0,"percent of total billed charges ","70% of total billed charges ",52.52,120.44,
"NM ULTRATAG",3600970,"CDM ",343,RC,A9560,HCPCS,OUTPATIENT,,,452,361.6,,,,,,,,0,"other ","not separately reimbursment ",215.13,100,,257.48,257.48,257.48,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",316.4,70,,253.12,,,0,"percent of total billed charges ","70% of total billed charges ",406.8,90,,325.44,,,0,"percent of total billed charges ","90% of total billed charges ",420.36,93,,336.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",384.2,85,,307.36,,,0,"percent of total billed charges ","85% of total billed charges ",406.8,90,,325.44,,,0,"percent of total billed charges ","90% of total billed charges ",406.8,90,,325.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",393.24,87,,314.59,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",316.4,70,,253.12,,,0,"percent of total billed charges ","70% of total billed charges ",215.13,420.36,
"FILTERED SULFUR COLLOID",3601100,"CDM ",343,RC,A9541,HCPCS,OUTPATIENT,,,510,408,,,,,,,,0,"other ","not separately reimbursment ",173.14,100,,292.00,292.00,292.00,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",357,70,,285.60,,,0,"percent of total billed charges ","70% of total billed charges ",459,90,,367.20,,,0,"percent of total billed charges ","90% of total billed charges ",474.3,93,,379.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",433.5,85,,346.80,,,0,"percent of total billed charges ","85% of total billed charges ",459,90,,367.20,,,0,"percent of total billed charges ","90% of total billed charges ",459,90,,367.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",443.7,87,,354.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",357,70,,285.60,,,0,"percent of total billed charges ","70% of total billed charges ",173.14,474.3,
"NM I123 200uCi CAPSULE",3601160,"CDM ",343,RC,A9516,HCPCS,OUTPATIENT,,,187,149.6,,,,,,,,0,"other ","not separately reimbursment ",122.03,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",173.91,93,,139.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",158.95,85,,127.16,,,0,"percent of total billed charges ","85% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",162.69,87,,130.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",122.03,173.91,
"MRA ABDOMEN ANGIO WO CONTRAST",3800380,"CDM ",618,RC,C8901,HCPCS,OUTPATIENT,,,5048,4038.4,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3533.6,70,,2826.88,,,0,"percent of total billed charges ","70% of total billed charges ",4543.2,90,,3634.56,,,0,"percent of total billed charges ","90% of total billed charges ",4694.64,93,,3755.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4290.8,85,,3432.64,,,0,"percent of total billed charges ","85% of total billed charges ",4543.2,90,,3634.56,,,0,"percent of total billed charges ","90% of total billed charges ",4543.2,90,,3634.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4391.76,87,,3513.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3533.6,70,,2826.88,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,4694.64,
"MRI BREAST RIGHT W/O CONT",3800430,"CDM ",610,RC,77046,HCPCS,OUTPATIENT,,,4392.5,3514,,,,,,,,0,"other ","not separately reimbursment ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",470.58,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3074.75,70,,2459.80,,,0,"percent of total billed charges ","70% of total billed charges ",3953.25,90,,3162.60,,,0,"percent of total billed charges ","90% of total billed charges ",4085.03,93,,3268.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",151.36,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3733.63,85,,2986.90,,,0,"percent of total billed charges ","85% of total billed charges ",3953.25,90,,3162.60,,,0,"percent of total billed charges ","90% of total billed charges ",3953.25,90,,3162.60,,,0,"percent of total billed charges ","90% of total billed charges ",149.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3821.48,87,,3057.18,,,0,"percent of total billed charges ","87% of total billed charges ",149.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3074.75,70,,2459.80,,,0,"percent of total billed charges ","70% of total billed charges ",149.86,4085.03,
"MRA ABDOMEN ANGIO W/CONTRAST",3800794,"CDM ",618,RC,C8900,HCPCS,OUTPATIENT,,,5403,4322.4,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",4322.4,80,,3457.92,,,0,"percent of total billed charges ","80% of total billed charges ",3782.1,70,,3025.68,,,0,"percent of total billed charges ","70% of total billed charges ",4862.7,90,,3890.16,,,0,"percent of total billed charges ","90% of total billed charges ",5024.79,93,,4019.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4592.55,85,,3674.04,,,0,"percent of total billed charges ","85% of total billed charges ",4862.7,90,,3890.16,,,0,"percent of total billed charges ","90% of total billed charges ",4862.7,90,,3890.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4700.61,87,,3760.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3782.1,70,,3025.68,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,5024.79,
"MRA ABDOMEN ANGIO W&WO CONTRAS",3800802,"CDM ",618,RC,C8902,HCPCS,OUTPATIENT,,,5779,4623.2,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",4623.2,80,,3698.56,,,0,"percent of total billed charges ","80% of total billed charges ",4045.3,70,,3236.24,,,0,"percent of total billed charges ","70% of total billed charges ",5201.1,90,,4160.88,,,0,"percent of total billed charges ","90% of total billed charges ",5374.47,93,,4299.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4912.15,85,,3929.72,,,0,"percent of total billed charges ","85% of total billed charges ",5201.1,90,,4160.88,,,0,"percent of total billed charges ","90% of total billed charges ",5201.1,90,,4160.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5027.73,87,,4022.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4045.3,70,,3236.24,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,5374.47,
"MRA CHEST W CONTRAST",3801453,"CDM ",618,RC,C8909,HCPCS,OUTPATIENT,,,4617,3693.6,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",3693.6,80,,2954.88,,,0,"percent of total billed charges ","80% of total billed charges ",3231.9,70,,2585.52,,,0,"percent of total billed charges ","70% of total billed charges ",4155.3,90,,3324.24,,,0,"percent of total billed charges ","90% of total billed charges ",4293.81,93,,3435.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3924.45,85,,3139.56,,,0,"percent of total billed charges ","85% of total billed charges ",4155.3,90,,3324.24,,,0,"percent of total billed charges ","90% of total billed charges ",4155.3,90,,3324.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4016.79,87,,3213.43,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3231.9,70,,2585.52,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,4293.81,
"MRA CHEST + WO CONTRAST",3801461,"CDM ",618,RC,C8910,HCPCS,OUTPATIENT,,,3573.5,2858.8,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",2858.8,80,,2287.04,,,0,"percent of total billed charges ","80% of total billed charges ",2501.45,70,,2001.16,,,0,"percent of total billed charges ","70% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",3323.36,93,,2658.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3037.48,85,,2429.98,,,0,"percent of total billed charges ","85% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3108.95,87,,2487.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2501.45,70,,2001.16,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,3323.36,
"MRA CHEST W/WO CONTRAST",3801479,"CDM ",618,RC,C8911,HCPCS,OUTPATIENT,,,5680,4544,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",4544,80,,3635.20,,,0,"percent of total billed charges ","80% of total billed charges ",3976,70,,3180.80,,,0,"percent of total billed charges ","70% of total billed charges ",5112,90,,4089.60,,,0,"percent of total billed charges ","90% of total billed charges ",5282.4,93,,4225.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4828,85,,3862.40,,,0,"percent of total billed charges ","85% of total billed charges ",5112,90,,4089.60,,,0,"percent of total billed charges ","90% of total billed charges ",5112,90,,4089.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4941.6,87,,3953.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3976,70,,3180.80,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,5282.4,
"MRA LOWER EXT W/CONTRAST RIGHT",3801495,"CDM ",616,RC,C8912,HCPCS,OUTPATIENT,,,2935,2348,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",2348,80,,1878.40,,,0,"percent of total billed charges ","80% of total billed charges ",2054.5,70,,1643.60,,,0,"percent of total billed charges ","70% of total billed charges ",2641.5,90,,2113.20,,,0,"percent of total billed charges ","90% of total billed charges ",2729.55,93,,2183.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2494.75,85,,1995.80,,,0,"percent of total billed charges ","85% of total billed charges ",2641.5,90,,2113.20,,,0,"percent of total billed charges ","90% of total billed charges ",2641.5,90,,2113.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2553.45,87,,2042.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2054.5,70,,1643.60,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,2729.55,
"MRA LOWER EXT WO CONTRAST RIGH",3801503,"CDM ",616,RC,C8913,HCPCS,OUTPATIENT,,,2668,2134.4,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",2134.4,80,,1707.52,,,0,"percent of total billed charges ","80% of total billed charges ",1867.6,70,,1494.08,,,0,"percent of total billed charges ","70% of total billed charges ",2401.2,90,,1920.96,,,0,"percent of total billed charges ","90% of total billed charges ",2481.24,93,,1984.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2267.8,85,,1814.24,,,0,"percent of total billed charges ","85% of total billed charges ",2401.2,90,,1920.96,,,0,"percent of total billed charges ","90% of total billed charges ",2401.2,90,,1920.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2321.16,87,,1856.93,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1867.6,70,,1494.08,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,2481.24,
"MRA LOWER EXT W/WO CONTRAST RI",3801511,"CDM ",616,RC,C8914,HCPCS,OUTPATIENT,,,3573.5,2858.8,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",2858.8,80,,2287.04,,,0,"percent of total billed charges ","80% of total billed charges ",2501.45,70,,2001.16,,,0,"percent of total billed charges ","70% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",3323.36,93,,2658.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3037.48,85,,2429.98,,,0,"percent of total billed charges ","85% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3108.95,87,,2487.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2501.45,70,,2001.16,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,3323.36,
"MRA LOWER EXT W/CONTRAST LEFT",3801529,"CDM ",616,RC,C8912,HCPCS,OUTPATIENT,,,2935,2348,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",2348,80,,1878.40,,,0,"percent of total billed charges ","80% of total billed charges ",2054.5,70,,1643.60,,,0,"percent of total billed charges ","70% of total billed charges ",2641.5,90,,2113.20,,,0,"percent of total billed charges ","90% of total billed charges ",2729.55,93,,2183.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2494.75,85,,1995.80,,,0,"percent of total billed charges ","85% of total billed charges ",2641.5,90,,2113.20,,,0,"percent of total billed charges ","90% of total billed charges ",2641.5,90,,2113.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2553.45,87,,2042.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2054.5,70,,1643.60,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,2729.55,
"MRA LOWER EXT WO CONTRAST LEFT",3801537,"CDM ",616,RC,C8913,HCPCS,OUTPATIENT,,,2668,2134.4,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",2134.4,80,,1707.52,,,0,"percent of total billed charges ","80% of total billed charges ",1867.6,70,,1494.08,,,0,"percent of total billed charges ","70% of total billed charges ",2401.2,90,,1920.96,,,0,"percent of total billed charges ","90% of total billed charges ",2481.24,93,,1984.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2267.8,85,,1814.24,,,0,"percent of total billed charges ","85% of total billed charges ",2401.2,90,,1920.96,,,0,"percent of total billed charges ","90% of total billed charges ",2401.2,90,,1920.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2321.16,87,,1856.93,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1867.6,70,,1494.08,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,2481.24,
"MRA LOWER EXT W/WO CONTRAST LE",3801545,"CDM ",616,RC,C8914,HCPCS,OUTPATIENT,,,3573.5,2858.8,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",2858.8,80,,2287.04,,,0,"percent of total billed charges ","80% of total billed charges ",2501.45,70,,2001.16,,,0,"percent of total billed charges ","70% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",3323.36,93,,2658.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3037.48,85,,2429.98,,,0,"percent of total billed charges ","85% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3108.95,87,,2487.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2501.45,70,,2001.16,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,3323.36,
"TRAUMA ACT W/CRT CARE CLASS I",4600239,"CDM ",684,RC,G0390,HCPCS,OUTPATIENT,,,,,,,,,,,,0,"other ","not separately reimbursment ",1.01,,,,,,0,"case rate ","pays based on per visit rate ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.01,1.01,
"SUTURE REMOVAL",4604300,"CDM ",450,RC,S0630,HCPCS,OUTPATIENT,,,123.5,98.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.45,70,,69.16,,,0,"percent of total billed charges ","70% of total billed charges ",111.15,90,,88.92,,,0,"percent of total billed charges ","90% of total billed charges ",114.86,93,,91.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",104.98,85,,83.98,,,0,"percent of total billed charges ","85% of total billed charges ",111.15,90,,88.92,,,0,"percent of total billed charges ","90% of total billed charges ",111.15,90,,88.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",107.45,87,,85.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.45,70,,69.16,,,0,"percent of total billed charges ","70% of total billed charges ",86.45,114.86,
"TELESTROKE ORIG SITE FEE",4604440,"CDM ",780,RC,Q3014,HCPCS,OUTPATIENT,,,70.5,56.4,,22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.38,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",65.57,93,,52.46,,,0,"percent of total billed charges ","93% of total billed charges ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",59.93,85,,47.94,,,0,"percent of total billed charges ","85% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",61.34,87,,49.07,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",22.88,65.57,
"TELENEUROLOGY ORIG SITE FEE",4604450,"CDM ",780,RC,Q3014,HCPCS,OUTPATIENT,,,70.5,56.4,,22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.38,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",65.57,93,,52.46,,,0,"percent of total billed charges ","93% of total billed charges ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",59.93,85,,47.94,,,0,"percent of total billed charges ","85% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",61.34,87,,49.07,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",22.88,65.57,
"TOCILIZUMAB INFUSE POST MNTR",4605182,"CDM ",771,RC,M0249,HCPCS,OUTPATIENT,,,920.5,736.4,,,,,,,,0,"other ","not separately reimbursment ",497.56,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",644.35,70,,515.48,,,0,"percent of total billed charges ","70% of total billed charges ",828.45,90,,662.76,,,0,"percent of total billed charges ","90% of total billed charges ",856.07,93,,684.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",782.43,85,,625.94,,,0,"percent of total billed charges ","85% of total billed charges ",828.45,90,,662.76,,,0,"percent of total billed charges ","90% of total billed charges ",828.45,90,,662.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",800.84,87,,640.67,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",405.52,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",644.35,70,,515.48,,,0,"percent of total billed charges ","70% of total billed charges ",405.52,856.07,
"SOTROVIMAB INFUSE POST MONITOR",4605185,"CDM ",771,RC,M0247,HCPCS,OUTPATIENT,,,920.5,736.4,,,,,,,,0,"other ","not separately reimbursment ",497.56,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",644.35,70,,515.48,,,0,"percent of total billed charges ","70% of total billed charges ",828.45,90,,662.76,,,0,"percent of total billed charges ","90% of total billed charges ",856.07,93,,684.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",782.43,85,,625.94,,,0,"percent of total billed charges ","85% of total billed charges ",828.45,90,,662.76,,,0,"percent of total billed charges ","90% of total billed charges ",828.45,90,,662.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",800.84,87,,640.67,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",644.35,70,,515.48,,,0,"percent of total billed charges ","70% of total billed charges ",497.56,856.07,
"ECHOCARDIOGRAM COMP W/CONTRAST",5200410,"CDM ",483,RC,C8929,HCPCS,OUTPATIENT,,,3071,2456.8,,,,,,,,0,"other ","not separately reimbursment ",1532.17,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2149.7,70,,1719.76,,,0,"percent of total billed charges ","70% of total billed charges ",2763.9,90,,2211.12,,,0,"percent of total billed charges ","90% of total billed charges ",2856.03,93,,2284.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2610.35,85,,2088.28,,,0,"percent of total billed charges ","85% of total billed charges ",2763.9,90,,2211.12,,,0,"percent of total billed charges ","90% of total billed charges ",2763.9,90,,2211.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2671.77,87,,2137.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",720.93,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2149.7,70,,1719.76,,,0,"percent of total billed charges ","70% of total billed charges ",720.93,2856.03,
DERMABOND,5917580,"CDM ",960,RC,A4364,HCPCS,OUTPATIENT,,,27.5,22,,2.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",2.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,2.2,
"ACE BANDAGE < 3 INCHES",5917590,"CDM ",960,RC,A6448,HCPCS,OUTPATIENT,,,4,3.2,,0.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",0.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.86,0.86,
"ACE BANDAGE >3 BUT <5 INCHES",5917595,"CDM ",960,RC,A6449,HCPCS,OUTPATIENT,,,4,3.2,,1.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.31,1.31,
"HYDRALAZINE 20MG",5917750,"CDM ",960,RC,J0360,HCPCS,OUTPATIENT,,,56,44.8,,5.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,5.46,5.46,5.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",5.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5,5.2,
"PENG BENZATHINE/PROCAINE INJ",5917755,"CDM ",960,RC,J0558,HCPCS,OUTPATIENT,,,122,97.6,,11.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",11.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.79,11.79,
"PENICILLIN G BENZATHINE",5917760,"CDM ",960,RC,J0561,HCPCS,OUTPATIENT,,,122,97.6,,14.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",14.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.95,14.95,
"BOTOX 1 UNIT",5917765,"CDM ",960,RC,J0585,HCPCS,OUTPATIENT,,,13,10.4,,6.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",6.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.09,6.09,
"CEFTRIAXONE 250MG (ROCEPHIN)",5917780,"CDM ",960,RC,J0696,HCPCS,OUTPATIENT,,,25.5,20.4,,0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1.83,0.39,41.08,12,other,"not separately reimbursment ",0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.5,0.5,
"BETAMETHASONE SOLUSPAN 3MG",5917785,"CDM ",960,RC,J0702,HCPCS,OUTPATIENT,,,68,54.4,,8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.04,8.04,
"COLLAGENASE XIAFLEX 0.01MG",5917790,"CDM ",960,RC,J0775,HCPCS,OUTPATIENT,,,61.5,49.2,,56.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",56.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.66,56.66,
"DEPO PROVERA 1MG",5917805,"CDM ",960,RC,J1050,HCPCS,OUTPATIENT,,,1,0.8,,0.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,63.00,63.00,63.00,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",0.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.57,0.57,
"DEXAMETHASONE 1MG",5917810,"CDM ",960,RC,J1100,HCPCS,OUTPATIENT,,,4.5,3.6,,0.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,0.24,0.24,0.24,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,0.08,0.01,37.21,14,other,"not separately reimbursment ",0.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.12,0.12,
"DIPHENHYDRAMINE HCL 50MG",5917815,"CDM ",960,RC,J1200,HCPCS,OUTPATIENT,,,12.5,10,,0.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",0.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.98,0.98,
"DMSO RIMSO 50 ML INJ",5917820,"CDM ",960,RC,J1212,HCPCS,OUTPATIENT,,,708,566.4,,637.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",637.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",637.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",637.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",637.11,637.11,
"ERTAPENEM/IVANZ 500MG",5917825,"CDM ",960,RC,J1335,HCPCS,OUTPATIENT,,,67.5,54,,28.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",28.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.24,28.24,
"GENTAMYCIN UP TO 80MG",5917830,"CDM ",960,RC,J1580,HCPCS,OUTPATIENT,,,23,18.4,,1.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1.46,1.46,2.24,"1 through 10",other,"not separately reimbursment ",1.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.68,1.68,
"HEPARIN 1000UN",5917835,"CDM ",960,RC,J1644,HCPCS,OUTPATIENT,,,17,13.6,,0.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",0.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.25,0.25,
"LOVENOX 10MG",5917840,"CDM ",960,RC,J1650,HCPCS,OUTPATIENT,,,52.5,42,,0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2.74,2.74,2.74,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,37.24,33.93,40.55,"1 through 10",other,"not separately reimbursment ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.76,0.76,
"IRON DEXTRAN 50MG",5917845,"CDM ",960,RC,J1750,HCPCS,OUTPATIENT,,,84,67.2,,15.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,3.45,3.45,3.45,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,10.14,10.14,10.14,"1 through 10",other,"not separately reimbursment ",15.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.84,15.84,
"TORADOL/KETOROLAC 15MG",5917850,"CDM ",960,RC,J1885,HCPCS,OUTPATIENT,,,24.5,19.6,,0.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,0.98,0.98,0.98,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,35.86,1.27,44.82,17,other,"not separately reimbursment ",0.48,100,,0.49,0.49,0.49,"1 through 10","fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.48,0.48,
"LINCOMYCIN UP TO 300MG",5917855,"CDM ",960,RC,J2010,HCPCS,OUTPATIENT,,,72.5,58,,10.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,3.96,2.40,5.51,"1 through 10",other,"not separately reimbursment ",10.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.33,10.33,
"MORPHINE SULFATE UP TO 10MG",5917860,"CDM ",960,RC,J2270,HCPCS,OUTPATIENT,,,12.5,10,,3.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,37.24,33.93,40.55,"1 through 10",other,"not separately reimbursment ",3.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.39,3.39,
"ZOFRAN 1MG",5917870,"CDM ",960,RC,J2405,HCPCS,OUTPATIENT,,,16,12.8,,0.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,39.65,21.78,39.65,14,other,"not separately reimbursment ",0.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.09,0.09,
"PAPAVERINE HCL UP TO 60MG",5917875,"CDM ",960,RC,J2440,HCPCS,OUTPATIENT,,,23,18.4,,38.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",38.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.87,38.87,
"PHENERGAN UP TO 50MG",5917880,"CDM ",960,RC,J2550,HCPCS,OUTPATIENT,,,34,27.2,,2.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",2.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.37,2.37,
"RHO(D) IMMUNE GLOBULIN 1500IU",5917890,"CDM ",960,RC,J2790,HCPCS,OUTPATIENT,,,204,163.2,,75.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,61.73,61.73,61.73,"1 through 10",other,"not separately reimbursment ",75.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.54,75.54,
"REGLAN METOCLOPRAMIDE HCL 10MG",5917892,"CDM ",960,RC,J2765,HCPCS,OUTPATIENT,,,13,10.4,,1.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1.26,1.26,1.26,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,40.95,25.14,40.95,"1 through 10",other,"not separately reimbursment ",1.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.13,1.13,
"RHO(D) IMMUNE GLOBULIN 100IU",5917895,"CDM ",960,RC,J2791,HCPCS,OUTPATIENT,,,204,163.2,,4.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",4.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4,4.7,
"DEMEROL MEPERIDINE 100MG",5917912,"CDM ",960,RC,J2175,HCPCS,OUTPATIENT,,,16,12.8,,6.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,71.55,43.55,99.54,"1 through 10",other,"not separately reimbursment ",6.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.48,6.48,
"B12 UP TO 1000MCG",5917915,"CDM ",960,RC,J3420,HCPCS,OUTPATIENT,,,23,18.4,,2.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,0.85,0.75,0.99,"1 through 10",other,"not separately reimbursment ",2.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.12,2.12,
"KYLEENA 19.5MG IUD CONTRACEP",5917920,"CDM ",960,RC,J7296,HCPCS,OUTPATIENT,,,1494.5,1195.6,,999.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",999.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",999.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1214.63,1214.63,1214.63,"1 through 10",other,"not separately reimbursment ",999.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",999.28,999.28,
"MIRENA LEVONORGESTREL 52MG IUD",5917925,"CDM ",960,RC,J7298,HCPCS,OUTPATIENT,,,1304.5,1043.6,,999.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",999.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",999.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",999.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",999.28,999.28,
"PARAGARD IUD",5917930,"CDM ",960,RC,J7300,HCPCS,OUTPATIENT,,,1097.5,878,,884.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",884.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",884.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1050.00,1050.00,1050.00,"1 through 10",other,"not separately reimbursment ",884.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",884.5,884.5,
"SKYLA LEVONORGEST 13.5MG IUD",5917935,"CDM ",960,RC,J7301,HCPCS,OUTPATIENT,,,1087,869.6,,832.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",832.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",832.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1001.75,994.05,1009.45,"1 through 10",other,"not separately reimbursment ",832.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",832.07,832.07,
"NEXPLANON CONTRACEPT IMPLANT",5917940,"CDM ",960,RC,J7307,HCPCS,OUTPATIENT,,,1439,1151.2,,1030.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1350.00,1350.00,1350.00,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1030.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1030.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1251.07,1251.07,1251.07,"1 through 10",other,"not separately reimbursment ",1030.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,1030.64,
"DUROLANE 1MG",5917945,"CDM ",960,RC,J7318,HCPCS,OUTPATIENT,,,27.5,22,,17.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.22,17.22,
"SUPARTZ HYALGAN VISCO3",5917950,"CDM ",960,RC,J7321,HCPCS,OUTPATIENT,,,131,104.8,,77.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",77.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.24,77.24,
"SYNVISC ONE 1MG",5917955,"CDM ",960,RC,J7325,HCPCS,OUTPATIENT,,,73.5,58.8,,11.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",11.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.24,11.24,
"XOPENEX LEVABLBUTEROL 0.5MG",5917965,"CDM ",960,RC,J7614,HCPCS,OUTPATIENT,,,12.5,10,,0.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,0.18,0.18,0.18,"1 through 10",other,"not separately reimbursment ",0.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.06,0.06,
"DUONEB INHALE 2.5MG/0.5MG",5917970,"CDM ",960,RC,J7620,HCPCS,OUTPATIENT,,,12.5,10,,0.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",0.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.12,0.12,
"PULMICORT 0.5MG",5917975,"CDM ",960,RC,J7626,HCPCS,OUTPATIENT,,,45,36,,1.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.05,1.05,
"BCG VACCINE 1MG",5917980,"CDM ",960,RC,J9030,HCPCS,OUTPATIENT,,,338.5,270.8,,2.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",2.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.85,2.85,
"LEUPROLIDE ACETATE 7.5 MG",5917985,"CDM ",960,RC,J9217,HCPCS,OUTPATIENT,,,1069,855.2,,139.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",139.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.09,139.09,
"METHOTREXATE SODIUM 50MG",5917990,"CDM ",960,RC,J9250,HCPCS,OUTPATIENT,,,16,12.8,,0.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",0.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.22,0.22,
"KNEE IMMOBILIZER",5917995,"CDM ",960,RC,L1830,HCPCS,OUTPATIENT,,,110,88,,54.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",54.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.99,54.99,
"CLAVICLE STRAP PREFAB",5918000,"CDM ",960,RC,L3650,HCPCS,OUTPATIENT,,,16,12.8,,41.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",41.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.57,41.57,
"CLAVICLE STRAP CANVAS/WEBBING",5918005,"CDM ",960,RC,L3660,HCPCS,OUTPATIENT,,,16,12.8,,76.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",76.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7,76.01,
"ACROMIO/CLAVICAL IMMOBILIZER",5918010,"CDM ",960,RC,L3670,HCPCS,OUTPATIENT,,,17,13.6,,89.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",89.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",89.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",89.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8,89.03,
"WRIST/HAND/FINGER PREFAB",5918015,"CDM ",960,RC,L3809,HCPCS,OUTPATIENT,,,44,35.2,,146.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",146.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",146.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",146.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",146.13,146.13,
"WRIST/HAND/FINGER ORTH PREFAB",5918020,"CDM ",960,RC,L3908,HCPCS,OUTPATIENT,,,17,13.6,,35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.95,35.95,
"WALKER CAM BOOT",5918025,"CDM ",960,RC,L4387,HCPCS,OUTPATIENT,,,183,146.4,,101.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",101.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.83,101.83,
"WET MOUNT / WET PREP",5918050,"CDM ",960,RC,Q0111,HCPCS,OUTPATIENT,,,17.5,14,,4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4,4.2,
"KOH PREPARATION",5918055,"CDM ",960,RC,Q0112,HCPCS,OUTPATIENT,,,17,13.6,,4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4,4.2,
"CLINDAMYCIN 300MG",5918220,"CDM ",960,RC,S0077,HCPCS,OUTPATIENT,,,13.5,10.8,,0.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",0.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.77,0.77,
"VITAMIN K 10MG",5918340,"CDM ",960,RC,J3430,HCPCS,OUTPATIENT,,,10.5,8.4,,3.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",3.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.56,3.56,
"ANKLE FOOT SUPPORT/BRACE PREFA",5918480,"CDM ",960,RC,L1906,HCPCS,OUTPATIENT,,,57.5,46,,72.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",72.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.57,72.57,
"ACTIVASE CATHFLO 1MG",5919065,"CDM ",960,RC,J2997,HCPCS,OUTPATIENT,,,94.5,75.6,,87.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",87.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.75,87.75,
"HYLENEX UP TO 150 UNITS",5919175,"CDM ",960,RC,J3470,HCPCS,OUTPATIENT,,,110,88,,20,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,20,
"SOLUTION NS 0.9% 1000ML BAG",5919525,"CDM ",960,RC,J7030,HCPCS,OUTPATIENT,,,16,12.8,,2.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,51.72,32.28,64.65,"1 through 10",other,"not separately reimbursment ",2.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,2.6,
"SOLUTION NS 0.9% 500ML BAG",5919530,"CDM ",960,RC,J7040,HCPCS,OUTPATIENT,,,16,12.8,,1.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.65,64.65,70.17,"1 through 10",other,"not separately reimbursment ",1.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,1.3,
"SOLUTION LACT RINGERS 1000ML",5919535,"CDM ",960,RC,J7120,HCPCS,OUTPATIENT,,,16,12.8,,2.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.65,51.72,64.65,15,other,"not separately reimbursment ",2.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.51,2.51,
"PESSARY REUSABLE NONRUBBER",5919685,"CDM ",960,RC,A4562,HCPCS,OUTPATIENT,,,99.5,79.6,,15.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.24,15.24,
"GRAFT GRAFIX PRIME DISC 16MM",6000014,"CDM ",636,RC,Q4133,HCPCS,OUTPATIENT,,,905.1,724.08,,,,,,,,0,"other ","not separately reimbursment ",188.87,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",633.57,70,,506.86,,,0,"percent of total billed charges ","70% of total billed charges ",814.59,90,,651.67,,,0,"percent of total billed charges ","90% of total billed charges ",841.74,93,,673.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",769.34,85,,615.47,,,0,"percent of total billed charges ","85% of total billed charges ",814.59,90,,651.67,,,0,"percent of total billed charges ","90% of total billed charges ",814.59,90,,651.67,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",787.44,87,,629.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",633.57,70,,506.86,,,0,"percent of total billed charges ","70% of total billed charges ",114.44,841.74,
"SLING ARM LG",6000048,"CDM ",271,RC,A4565,HCPCS,OUTPATIENT,,,11.68,9.344,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.18,70,,6.54,,,0,"percent of total billed charges ","70% of total billed charges ",10.51,90,,8.41,,,0,"percent of total billed charges ","90% of total billed charges ",10.86,93,,8.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.93,85,,7.94,,,0,"percent of total billed charges ","85% of total billed charges ",10.51,90,,8.41,,,0,"percent of total billed charges ","90% of total billed charges ",10.51,90,,8.41,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.16,87,,8.13,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.18,70,,6.54,,,0,"percent of total billed charges ","70% of total billed charges ",8.18,10.86,
"IMMOB UNIV KNEE ADULT",6000050,"CDM ",274,RC,L1830,HCPCS,OUTPATIENT,,,106.19,84.952,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.33,70,,59.46,,,0,"percent of total billed charges ","70% of total billed charges ",95.57,90,,76.46,,,0,"percent of total billed charges ","90% of total billed charges ",98.76,93,,79.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",55.54,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",90.26,85,,72.21,,,0,"percent of total billed charges ","85% of total billed charges ",90.26,85,,72.21,,,0,"percent of total billed charges ","85% of total billed charges ",95.57,90,,76.46,,,0,"percent of total billed charges ","90% of total billed charges ",54.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",92.39,87,,73.91,,,0,"percent of total billed charges ","87% of total billed charges ",54.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",90.97,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",74.33,70,,59.46,,,0,"percent of total billed charges ","70% of total billed charges ",54.99,98.76,
"CATH COUDE 16FR STR",6000149,"CDM ",272,RC,C1729,HCPCS,OUTPATIENT,,,14.64,11.712,,,,,,,,0,"other ","not separately reimbursment ",,,,93.87,93.87,93.87,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.25,70,,8.20,,,0,"percent of total billed charges ","70% of total billed charges ",13.18,90,,10.54,,,0,"percent of total billed charges ","90% of total billed charges ",13.62,93,,10.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.44,85,,9.95,,,0,"percent of total billed charges ","85% of total billed charges ",13.18,90,,10.54,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,90,,10.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.74,87,,10.19,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.25,70,,8.20,,,0,"percent of total billed charges ","70% of total billed charges ",10.25,13.62,
"SPLINT ANKLE AIR CAST LEFT",6000238,"CDM ",274,RC,L4350,HCPCS,OUTPATIENT,,,75.48,60.384,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.84,70,,42.27,,,0,"percent of total billed charges ","70% of total billed charges ",67.93,90,,54.34,,,0,"percent of total billed charges ","90% of total billed charges ",70.2,93,,56.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",54.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",64.16,85,,51.33,,,0,"percent of total billed charges ","85% of total billed charges ",64.16,85,,51.33,,,0,"percent of total billed charges ","85% of total billed charges ",67.93,90,,54.34,,,0,"percent of total billed charges ","90% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.67,87,,52.54,,,0,"percent of total billed charges ","87% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.84,70,,42.27,,,0,"percent of total billed charges ","70% of total billed charges ",52.84,70.2,
"TAPE CAST 4"" BLUE",6000245,"CDM ",272,RC,A4590,HCPCS,OUTPATIENT,,,18.3,14.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.81,70,,10.25,,,0,"percent of total billed charges ","70% of total billed charges ",16.47,90,,13.18,,,0,"percent of total billed charges ","90% of total billed charges ",17.02,93,,13.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.56,85,,12.45,,,0,"percent of total billed charges ","85% of total billed charges ",16.47,90,,13.18,,,0,"percent of total billed charges ","90% of total billed charges ",16.47,90,,13.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.92,87,,12.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.81,70,,10.25,,,0,"percent of total billed charges ","70% of total billed charges ",12.81,17.02,
"SPLINT ANKLE AIR CAST RIGHT",6000246,"CDM ",274,RC,L4350,HCPCS,OUTPATIENT,,,76.37,61.096,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.46,70,,42.77,,,0,"percent of total billed charges ","70% of total billed charges ",68.73,90,,54.98,,,0,"percent of total billed charges ","90% of total billed charges ",71.02,93,,56.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",54.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",64.91,85,,51.93,,,0,"percent of total billed charges ","85% of total billed charges ",64.91,85,,51.93,,,0,"percent of total billed charges ","85% of total billed charges ",68.73,90,,54.98,,,0,"percent of total billed charges ","90% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.44,87,,53.15,,,0,"percent of total billed charges ","87% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",53.46,70,,42.77,,,0,"percent of total billed charges ","70% of total billed charges ",53.46,71.02,
"IMMOBILIZER KNEE SMALL",6000263,"CDM ",274,RC,L1830,HCPCS,OUTPATIENT,,,36.21,28.968,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.35,70,,20.28,,,0,"percent of total billed charges ","70% of total billed charges ",32.59,90,,26.07,,,0,"percent of total billed charges ","90% of total billed charges ",33.68,93,,26.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",55.54,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",30.78,85,,24.62,,,0,"percent of total billed charges ","85% of total billed charges ",30.78,85,,24.62,,,0,"percent of total billed charges ","85% of total billed charges ",32.59,90,,26.07,,,0,"percent of total billed charges ","90% of total billed charges ",54.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.5,87,,25.20,,,0,"percent of total billed charges ","87% of total billed charges ",54.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",90.97,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",25.35,70,,20.28,,,0,"percent of total billed charges ","70% of total billed charges ",25.35,90.97,
"PURAPLY AM 1.6CM DISC",6000300,"CDM ",636,RC,Q4196,HCPCS,OUTPATIENT,,,969.75,775.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",901.87,93,,721.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",843.68,87,,674.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",114.44,901.87,
"TAPE CAST 3"" PINK",6000404,"CDM ",272,RC,A4590,HCPCS,OUTPATIENT,,,14.29,11.432,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,70,,8.00,,,0,"percent of total billed charges ","70% of total billed charges ",12.86,90,,10.29,,,0,"percent of total billed charges ","90% of total billed charges ",13.29,93,,10.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.15,85,,9.72,,,0,"percent of total billed charges ","85% of total billed charges ",12.86,90,,10.29,,,0,"percent of total billed charges ","90% of total billed charges ",12.86,90,,10.29,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.43,87,,9.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,70,,8.00,,,0,"percent of total billed charges ","70% of total billed charges ",10,13.29,
"SLING ARM CHILD",6000428,"CDM ",271,RC,A4565,HCPCS,OUTPATIENT,,,12.79,10.232,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.95,70,,7.16,,,0,"percent of total billed charges ","70% of total billed charges ",11.51,90,,9.21,,,0,"percent of total billed charges ","90% of total billed charges ",11.89,93,,9.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.87,85,,8.70,,,0,"percent of total billed charges ","85% of total billed charges ",11.51,90,,9.21,,,0,"percent of total billed charges ","90% of total billed charges ",11.51,90,,9.21,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.13,87,,8.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.95,70,,7.16,,,0,"percent of total billed charges ","70% of total billed charges ",8.95,11.89,
"SLING ARM SMALL",6000429,"CDM ",271,RC,A4565,HCPCS,OUTPATIENT,,,11.68,9.344,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.18,70,,6.54,,,0,"percent of total billed charges ","70% of total billed charges ",10.51,90,,8.41,,,0,"percent of total billed charges ","90% of total billed charges ",10.86,93,,8.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.93,85,,7.94,,,0,"percent of total billed charges ","85% of total billed charges ",10.51,90,,8.41,,,0,"percent of total billed charges ","90% of total billed charges ",10.51,90,,8.41,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.16,87,,8.13,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.18,70,,6.54,,,0,"percent of total billed charges ","70% of total billed charges ",8.18,10.86,
"SLING ARM MED",6000430,"CDM ",271,RC,A4565,HCPCS,OUTPATIENT,,,11.68,9.344,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.18,70,,6.54,,,0,"percent of total billed charges ","70% of total billed charges ",10.51,90,,8.41,,,0,"percent of total billed charges ","90% of total billed charges ",10.86,93,,8.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.93,85,,7.94,,,0,"percent of total billed charges ","85% of total billed charges ",10.51,90,,8.41,,,0,"percent of total billed charges ","90% of total billed charges ",10.51,90,,8.41,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.16,87,,8.13,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.18,70,,6.54,,,0,"percent of total billed charges ","70% of total billed charges ",8.18,10.86,
"COLLAR CERVICAL UNIV",6000431,"CDM ",274,RC,L0120,HCPCS,OUTPATIENT,,,32.25,25.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.58,70,,18.06,,,0,"percent of total billed charges ","70% of total billed charges ",29.03,90,,23.22,,,0,"percent of total billed charges ","90% of total billed charges ",29.99,93,,23.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",27.41,85,,21.93,,,0,"percent of total billed charges ","85% of total billed charges ",27.41,85,,21.93,,,0,"percent of total billed charges ","85% of total billed charges ",29.03,90,,23.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",28.06,87,,15.50,15.50,15.50,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.58,70,,18.06,,,0,"percent of total billed charges ","70% of total billed charges ",22.58,29.99,
"COLLAR CLAVICAL LG ADULT",6000433,"CDM ",274,RC,L3650,HCPCS,OUTPATIENT,,,26.08,20.864,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.26,70,,14.61,,,0,"percent of total billed charges ","70% of total billed charges ",23.47,90,,18.78,,,0,"percent of total billed charges ","90% of total billed charges ",24.25,93,,19.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",41.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",22.17,85,,17.74,,,0,"percent of total billed charges ","85% of total billed charges ",22.17,85,,17.74,,,0,"percent of total billed charges ","85% of total billed charges ",23.47,90,,18.78,,,0,"percent of total billed charges ","90% of total billed charges ",41.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.69,87,,18.15,,,0,"percent of total billed charges ","87% of total billed charges ",41.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",18.26,70,,14.61,,,0,"percent of total billed charges ","70% of total billed charges ",18.26,41.99,
"IMMOBILIZER KNEE LRG",6000434,"CDM ",274,RC,L1830,HCPCS,OUTPATIENT,,,35.41,28.328,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.79,70,,19.83,,,0,"percent of total billed charges ","70% of total billed charges ",31.87,90,,25.50,,,0,"percent of total billed charges ","90% of total billed charges ",32.93,93,,26.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",55.54,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",30.1,85,,24.08,,,0,"percent of total billed charges ","85% of total billed charges ",30.1,85,,24.08,,,0,"percent of total billed charges ","85% of total billed charges ",31.87,90,,25.50,,,0,"percent of total billed charges ","90% of total billed charges ",54.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.81,87,,24.65,,,0,"percent of total billed charges ","87% of total billed charges ",54.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",90.97,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",24.79,70,,19.83,,,0,"percent of total billed charges ","70% of total billed charges ",24.79,90.97,
"CATH BILIARY PROBE 6FR",6000605,"CDM ",272,RC,C1876,HCPCS,OUTPATIENT,,,152.24,121.792,,,,,,,,0,"other ","not separately reimbursment ",13938,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",106.57,70,,85.26,,,0,"percent of total billed charges ","70% of total billed charges ",137.02,90,,109.62,,,0,"percent of total billed charges ","90% of total billed charges ",141.58,93,,113.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",129.4,85,,103.52,,,0,"percent of total billed charges ","85% of total billed charges ",137.02,90,,109.62,,,0,"percent of total billed charges ","90% of total billed charges ",137.02,90,,109.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",132.45,87,,105.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.57,70,,85.26,,,0,"percent of total billed charges ","70% of total billed charges ",106.57,13938,
"CONT MED VISIPAQUE 320MG 100ML",6000635,"CDM ",636,RC,Q9967,HCPCS,OUTPATIENT,,,520,416,,,,,,,,0,"other ","not separately reimbursment ",5.05,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",364,70,,291.20,,,0,"percent of total billed charges ","70% of total billed charges ",468,90,,374.40,,,0,"percent of total billed charges ","90% of total billed charges ",483.6,93,,386.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",442,85,,353.60,,,0,"percent of total billed charges ","85% of total billed charges ",468,90,,374.40,,,0,"percent of total billed charges ","90% of total billed charges ",468,90,,374.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",452.4,87,,358.59,260.46,448.24,15,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",364,70,,291.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.05,483.6,
"CONT MED VISIPAQUE 320MG 50ML",6000646,"CDM ",255,RC,Q9967,HCPCS,OUTPATIENT,,,260,208,,,,,,,,0,"other ","not separately reimbursment ",5.05,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",182,70,,145.60,,,0,"percent of total billed charges ","70% of total billed charges ",234,90,,187.20,,,0,"percent of total billed charges ","90% of total billed charges ",241.8,93,,193.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",221,85,,176.80,,,0,"percent of total billed charges ","85% of total billed charges ",234,90,,187.20,,,0,"percent of total billed charges ","90% of total billed charges ",234,90,,187.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",226.2,87,,358.59,260.46,448.24,15,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",182,70,,145.60,,,0,"percent of total billed charges ","70% of total billed charges ",5.05,241.8,
"SHOE POST OP WOMENS SMALL",6000671,"CDM ",271,RC,A9270,HCPCS,OUTPATIENT,,,19.66,15.728,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.76,70,,11.01,,,0,"percent of total billed charges ","70% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",18.28,93,,14.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.71,85,,13.37,,,0,"percent of total billed charges ","85% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.1,87,,13.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.76,70,,11.01,,,0,"percent of total billed charges ","70% of total billed charges ",13.76,18.28,
"SHOE POST OP WOMEN MEDIUM",6000672,"CDM ",271,RC,A9270,HCPCS,OUTPATIENT,,,19.66,15.728,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.76,70,,11.01,,,0,"percent of total billed charges ","70% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",18.28,93,,14.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.71,85,,13.37,,,0,"percent of total billed charges ","85% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.1,87,,13.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.76,70,,11.01,,,0,"percent of total billed charges ","70% of total billed charges ",13.76,18.28,
"TAPE CAST 4"" BLACK",6000744,"CDM ",272,RC,A4590,HCPCS,OUTPATIENT,,,17,13.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.9,70,,9.52,,,0,"percent of total billed charges ","70% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.81,93,,12.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.45,85,,11.56,,,0,"percent of total billed charges ","85% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.79,87,,11.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.9,70,,9.52,,,0,"percent of total billed charges ","70% of total billed charges ",11.9,15.81,
"IMMOBILIZER KNEE UNIVERSAL",6000773,"CDM ",274,RC,L1830,HCPCS,OUTPATIENT,,,69.03,55.224,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.32,70,,38.66,,,0,"percent of total billed charges ","70% of total billed charges ",62.13,90,,49.70,,,0,"percent of total billed charges ","90% of total billed charges ",64.2,93,,51.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",55.54,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",58.68,85,,46.94,,,0,"percent of total billed charges ","85% of total billed charges ",58.68,85,,46.94,,,0,"percent of total billed charges ","85% of total billed charges ",62.13,90,,49.70,,,0,"percent of total billed charges ","90% of total billed charges ",54.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60.06,87,,48.05,,,0,"percent of total billed charges ","87% of total billed charges ",54.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",90.97,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",48.32,70,,38.66,,,0,"percent of total billed charges ","70% of total billed charges ",48.32,90.97,
"SLING ARM X-LARGE",6000908,"CDM ",271,RC,A4565,HCPCS,OUTPATIENT,,,11.68,9.344,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.18,70,,6.54,,,0,"percent of total billed charges ","70% of total billed charges ",10.51,90,,8.41,,,0,"percent of total billed charges ","90% of total billed charges ",10.86,93,,8.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.93,85,,7.94,,,0,"percent of total billed charges ","85% of total billed charges ",10.51,90,,8.41,,,0,"percent of total billed charges ","90% of total billed charges ",10.51,90,,8.41,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.16,87,,8.13,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.18,70,,6.54,,,0,"percent of total billed charges ","70% of total billed charges ",8.18,10.86,
"BOOT CAST-MED",6001403,"CDM ",274,RC,L3260,HCPCS,OUTPATIENT,,,17.5,14,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",16.28,93,,13.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",50.5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",14.88,85,,11.90,,,0,"percent of total billed charges ","85% of total billed charges ",14.88,85,,11.90,,,0,"percent of total billed charges ","85% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",50,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.23,87,,12.18,,,0,"percent of total billed charges ","87% of total billed charges ",50,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",12.25,50.5,
"CONT MEDIA MULTIHANCE 20ML",6001423,"CDM ",255,RC,A9579,HCPCS,OUTPATIENT,,,197.5,158,,,,,,,,0,"other ","not separately reimbursment ",9.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",138.25,70,,110.60,,,0,"percent of total billed charges ","70% of total billed charges ",177.75,90,,142.20,,,0,"percent of total billed charges ","90% of total billed charges ",183.68,93,,146.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",167.88,85,,134.30,,,0,"percent of total billed charges ","85% of total billed charges ",177.75,90,,142.20,,,0,"percent of total billed charges ","90% of total billed charges ",177.75,90,,142.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",171.83,87,,120.80,96.64,171.65,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",138.25,70,,110.60,,,0,"percent of total billed charges ","70% of total billed charges ",9.5,183.68,
"TAPE CAST 3"" GREEN",6001436,"CDM ",272,RC,A4590,HCPCS,OUTPATIENT,,,19.46,15.568,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.62,70,,10.90,,,0,"percent of total billed charges ","70% of total billed charges ",17.51,90,,14.01,,,0,"percent of total billed charges ","90% of total billed charges ",18.1,93,,14.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.54,85,,13.23,,,0,"percent of total billed charges ","85% of total billed charges ",17.51,90,,14.01,,,0,"percent of total billed charges ","90% of total billed charges ",17.51,90,,14.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.93,87,,13.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.62,70,,10.90,,,0,"percent of total billed charges ","70% of total billed charges ",13.62,18.1,
"CONT MEDIA MULTIHANCE 15ML",6001527,"CDM ",255,RC,A9579,HCPCS,OUTPATIENT,,,147.5,118,,,,,,,,0,"other ","not separately reimbursment ",9.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",103.25,70,,82.60,,,0,"percent of total billed charges ","70% of total billed charges ",132.75,90,,106.20,,,0,"percent of total billed charges ","90% of total billed charges ",137.18,93,,109.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",125.38,85,,100.30,,,0,"percent of total billed charges ","85% of total billed charges ",132.75,90,,106.20,,,0,"percent of total billed charges ","90% of total billed charges ",132.75,90,,106.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",128.33,87,,120.80,96.64,171.65,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.25,70,,82.60,,,0,"percent of total billed charges ","70% of total billed charges ",9.5,137.18,
"TAPE CAST 4"" PINK",6001561,"CDM ",272,RC,A4590,HCPCS,OUTPATIENT,,,18.3,14.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.81,70,,10.25,,,0,"percent of total billed charges ","70% of total billed charges ",16.47,90,,13.18,,,0,"percent of total billed charges ","90% of total billed charges ",17.02,93,,13.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.56,85,,12.45,,,0,"percent of total billed charges ","85% of total billed charges ",16.47,90,,13.18,,,0,"percent of total billed charges ","90% of total billed charges ",16.47,90,,13.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.92,87,,12.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.81,70,,10.25,,,0,"percent of total billed charges ","70% of total billed charges ",12.81,17.02,
"BOOT CAST LARGE",6001568,"CDM ",274,RC,L3260,HCPCS,OUTPATIENT,,,17.5,14,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",16.28,93,,13.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",50.5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",14.88,85,,11.90,,,0,"percent of total billed charges ","85% of total billed charges ",14.88,85,,11.90,,,0,"percent of total billed charges ","85% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",50,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.23,87,,12.18,,,0,"percent of total billed charges ","87% of total billed charges ",50,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",12.25,50.5,
"TAPE CAST 3"" BLUE",6001630,"CDM ",272,RC,A4590,HCPCS,OUTPATIENT,,,14.29,11.432,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,70,,8.00,,,0,"percent of total billed charges ","70% of total billed charges ",12.86,90,,10.29,,,0,"percent of total billed charges ","90% of total billed charges ",13.29,93,,10.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.15,85,,9.72,,,0,"percent of total billed charges ","85% of total billed charges ",12.86,90,,10.29,,,0,"percent of total billed charges ","90% of total billed charges ",12.86,90,,10.29,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.43,87,,9.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,70,,8.00,,,0,"percent of total billed charges ","70% of total billed charges ",10,13.29,
"OSTOMY PASTE",6001636,"CDM ",272,RC,A4405,HCPCS,OUTPATIENT,,,5.23,4.184,,,,,,,,0,"other ","not separately reimbursment ",8.84,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3.66,70,,2.93,,,0,"percent of total billed charges ","70% of total billed charges ",4.71,90,,3.77,,,0,"percent of total billed charges ","90% of total billed charges ",4.86,93,,3.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4.45,85,,3.56,,,0,"percent of total billed charges ","85% of total billed charges ",4.71,90,,3.77,,,0,"percent of total billed charges ","90% of total billed charges ",4.71,90,,3.77,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4.55,87,,3.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.66,70,,2.93,,,0,"percent of total billed charges ","70% of total billed charges ",3.66,8.84,
"CATH COUDE 14FR STR",6001657,"CDM ",272,RC,C1729,HCPCS,OUTPATIENT,,,14.64,11.712,,,,,,,,0,"other ","not separately reimbursment ",,,,93.87,93.87,93.87,"1 through 10","other ","not separately reimbursment ",11.71,80,,9.37,,,0,"percent of total billed charges ","80% of total billed charges ",10.25,70,,8.20,,,0,"percent of total billed charges ","70% of total billed charges ",13.18,90,,10.54,,,0,"percent of total billed charges ","90% of total billed charges ",13.62,93,,10.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.44,85,,9.95,,,0,"percent of total billed charges ","85% of total billed charges ",13.18,90,,10.54,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,90,,10.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.74,87,,10.19,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.25,70,,8.20,,,0,"percent of total billed charges ","70% of total billed charges ",10.25,13.62,
"COMPONENT PATELLA 26M",6001734,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1026,820.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",820.8,80,,656.64,,,0,"percent of total billed charges ","80% of total billed charges ",718.2,70,,574.56,,,0,"percent of total billed charges ","70% of total billed charges ",923.4,90,,738.72,,,0,"percent of total billed charges ","90% of total billed charges ",954.18,93,,763.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",872.1,85,,697.68,,,0,"percent of total billed charges ","85% of total billed charges ",872.1,85,,697.68,,,0,"percent of total billed charges ","85% of total billed charges ",923.4,90,,738.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",892.62,87,,714.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",718.2,70,,574.56,,,0,"percent of total billed charges ","70% of total billed charges ",718.2,954.18,
"CONT MED ISOVUE 300/100ML",6001754,"CDM ",255,RC,Q9967,HCPCS,OUTPATIENT,,,520,416,,,,,,,,0,"other ","not separately reimbursment ",5.05,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",364,70,,291.20,,,0,"percent of total billed charges ","70% of total billed charges ",468,90,,374.40,,,0,"percent of total billed charges ","90% of total billed charges ",483.6,93,,386.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",442,85,,353.60,,,0,"percent of total billed charges ","85% of total billed charges ",468,90,,374.40,,,0,"percent of total billed charges ","90% of total billed charges ",468,90,,374.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",452.4,87,,358.59,260.46,448.24,15,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",364,70,,291.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.05,483.6,
"CATH THORASIC 28F STRAIGHT",6001764,"CDM ",272,RC,C1757,HCPCS,OUTPATIENT,,,127.13,101.704,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.99,70,,71.19,,,0,"percent of total billed charges ","70% of total billed charges ",114.42,90,,91.54,,,0,"percent of total billed charges ","90% of total billed charges ",118.23,93,,94.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",108.06,85,,86.45,,,0,"percent of total billed charges ","85% of total billed charges ",114.42,90,,91.54,,,0,"percent of total billed charges ","90% of total billed charges ",114.42,90,,91.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",110.6,87,,88.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.99,70,,71.19,,,0,"percent of total billed charges ","70% of total billed charges ",88.99,118.23,
"CATH COUDE 16FR 5CC",6001781,"CDM ",272,RC,C1729,HCPCS,OUTPATIENT,,,52.67,42.136,,,,,,,,0,"other ","not separately reimbursment ",,,,93.87,93.87,93.87,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.87,70,,29.50,,,0,"percent of total billed charges ","70% of total billed charges ",47.4,90,,37.92,,,0,"percent of total billed charges ","90% of total billed charges ",48.98,93,,39.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",44.77,85,,35.82,,,0,"percent of total billed charges ","85% of total billed charges ",47.4,90,,37.92,,,0,"percent of total billed charges ","90% of total billed charges ",47.4,90,,37.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",45.82,87,,36.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.87,70,,29.50,,,0,"percent of total billed charges ","70% of total billed charges ",36.87,48.98,
"CATH THORASIC SILICONE 32F STR",6001788,"CDM ",272,RC,C1757,HCPCS,OUTPATIENT,,,47.49,37.992,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.24,70,,26.59,,,0,"percent of total billed charges ","70% of total billed charges ",42.74,90,,34.19,,,0,"percent of total billed charges ","90% of total billed charges ",44.17,93,,35.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.37,85,,32.30,,,0,"percent of total billed charges ","85% of total billed charges ",42.74,90,,34.19,,,0,"percent of total billed charges ","90% of total billed charges ",42.74,90,,34.19,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.32,87,,33.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.24,70,,26.59,,,0,"percent of total billed charges ","70% of total billed charges ",33.24,44.17,
"CATH THORASIC PVP 24F STRAIGHT",6001790,"CDM ",272,RC,C1757,HCPCS,OUTPATIENT,,,19.46,15.568,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.62,70,,10.90,,,0,"percent of total billed charges ","70% of total billed charges ",17.51,90,,14.01,,,0,"percent of total billed charges ","90% of total billed charges ",18.1,93,,14.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.54,85,,13.23,,,0,"percent of total billed charges ","85% of total billed charges ",17.51,90,,14.01,,,0,"percent of total billed charges ","90% of total billed charges ",17.51,90,,14.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.93,87,,13.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.62,70,,10.90,,,0,"percent of total billed charges ","70% of total billed charges ",13.62,18.1,
"CATH THORASIC 32F STRAIGHT",6001791,"CDM ",272,RC,C1757,HCPCS,OUTPATIENT,,,19.21,15.368,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.45,70,,10.76,,,0,"percent of total billed charges ","70% of total billed charges ",17.29,90,,13.83,,,0,"percent of total billed charges ","90% of total billed charges ",17.87,93,,14.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.33,85,,13.06,,,0,"percent of total billed charges ","85% of total billed charges ",17.29,90,,13.83,,,0,"percent of total billed charges ","90% of total billed charges ",17.29,90,,13.83,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.71,87,,13.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.45,70,,10.76,,,0,"percent of total billed charges ","70% of total billed charges ",13.45,17.87,
"CATH THORASIC PVP 24F ANGLE",6001792,"CDM ",272,RC,C1757,HCPCS,OUTPATIENT,,,29.59,23.672,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.71,70,,16.57,,,0,"percent of total billed charges ","70% of total billed charges ",26.63,90,,21.30,,,0,"percent of total billed charges ","90% of total billed charges ",27.52,93,,22.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.15,85,,20.12,,,0,"percent of total billed charges ","85% of total billed charges ",26.63,90,,21.30,,,0,"percent of total billed charges ","90% of total billed charges ",26.63,90,,21.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",25.74,87,,20.59,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.71,70,,16.57,,,0,"percent of total billed charges ","70% of total billed charges ",20.71,27.52,
"CATH THORASIC PVP 28F R/ANGLE",6001794,"CDM ",272,RC,C1757,HCPCS,OUTPATIENT,,,29.49,23.592,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.64,70,,16.51,,,0,"percent of total billed charges ","70% of total billed charges ",26.54,90,,21.23,,,0,"percent of total billed charges ","90% of total billed charges ",27.43,93,,21.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.07,85,,20.06,,,0,"percent of total billed charges ","85% of total billed charges ",26.54,90,,21.23,,,0,"percent of total billed charges ","90% of total billed charges ",26.54,90,,21.23,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",25.66,87,,20.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.64,70,,16.51,,,0,"percent of total billed charges ","70% of total billed charges ",20.64,27.43,
"CATH THORASIC PVP 28F STRAIGHT",6001799,"CDM ",272,RC,C1757,HCPCS,OUTPATIENT,,,19.21,15.368,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.45,70,,10.76,,,0,"percent of total billed charges ","70% of total billed charges ",17.29,90,,13.83,,,0,"percent of total billed charges ","90% of total billed charges ",17.87,93,,14.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.33,85,,13.06,,,0,"percent of total billed charges ","85% of total billed charges ",17.29,90,,13.83,,,0,"percent of total billed charges ","90% of total billed charges ",17.29,90,,13.83,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.71,87,,13.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.45,70,,10.76,,,0,"percent of total billed charges ","70% of total billed charges ",13.45,17.87,
"TAPE CAST 2"" GREEN",6001861,"CDM ",272,RC,A4590,HCPCS,OUTPATIENT,,,10.63,8.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.44,70,,5.95,,,0,"percent of total billed charges ","70% of total billed charges ",9.57,90,,7.66,,,0,"percent of total billed charges ","90% of total billed charges ",9.89,93,,7.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.04,85,,7.23,,,0,"percent of total billed charges ","85% of total billed charges ",9.57,90,,7.66,,,0,"percent of total billed charges ","90% of total billed charges ",9.57,90,,7.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.25,87,,7.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.44,70,,5.95,,,0,"percent of total billed charges ","70% of total billed charges ",7.44,9.89,
"CONT MED ISOVUE 300/50ML",6001965,"CDM ",255,RC,Q9967,HCPCS,OUTPATIENT,,,260,208,,,,,,,,0,"other ","not separately reimbursment ",5.05,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",182,70,,145.60,,,0,"percent of total billed charges ","70% of total billed charges ",234,90,,187.20,,,0,"percent of total billed charges ","90% of total billed charges ",241.8,93,,193.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",221,85,,176.80,,,0,"percent of total billed charges ","85% of total billed charges ",234,90,,187.20,,,0,"percent of total billed charges ","90% of total billed charges ",234,90,,187.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",226.2,87,,358.59,260.46,448.24,15,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",182,70,,145.60,,,0,"percent of total billed charges ","70% of total billed charges ",5.05,241.8,
"TAPE CAST 2"" RED",6002171,"CDM ",272,RC,A4590,HCPCS,OUTPATIENT,,,11.63,9.304,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.14,70,,6.51,,,0,"percent of total billed charges ","70% of total billed charges ",10.47,90,,8.38,,,0,"percent of total billed charges ","90% of total billed charges ",10.82,93,,8.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.89,85,,7.91,,,0,"percent of total billed charges ","85% of total billed charges ",10.47,90,,8.38,,,0,"percent of total billed charges ","90% of total billed charges ",10.47,90,,8.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.12,87,,8.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.14,70,,6.51,,,0,"percent of total billed charges ","70% of total billed charges ",8.14,10.82,
"TAPE CAST 2"" PURPLE",6002225,"CDM ",272,RC,A4590,HCPCS,OUTPATIENT,,,11.63,9.304,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.14,70,,6.51,,,0,"percent of total billed charges ","70% of total billed charges ",10.47,90,,8.38,,,0,"percent of total billed charges ","90% of total billed charges ",10.82,93,,8.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.89,85,,7.91,,,0,"percent of total billed charges ","85% of total billed charges ",10.47,90,,8.38,,,0,"percent of total billed charges ","90% of total billed charges ",10.47,90,,8.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.12,87,,8.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.14,70,,6.51,,,0,"percent of total billed charges ","70% of total billed charges ",8.14,10.82,
"PROBE ULTRASOUND ELITE 10G",6002397,"CDM ",270,RC,A4648,HCPCS,OUTPATIENT,,,484.36,387.488,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",339.05,70,,271.24,,,0,"percent of total billed charges ","70% of total billed charges ",435.92,90,,348.74,,,0,"percent of total billed charges ","90% of total billed charges ",450.45,93,,360.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",411.71,85,,329.37,,,0,"percent of total billed charges ","85% of total billed charges ",435.92,90,,348.74,,,0,"percent of total billed charges ","90% of total billed charges ",435.92,90,,348.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",421.39,87,,337.11,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",339.05,70,,271.24,,,0,"percent of total billed charges ","70% of total billed charges ",339.05,450.45,
"TAPE CAST 2"" PINK",6002439,"CDM ",272,RC,A4590,HCPCS,OUTPATIENT,,,11.63,9.304,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.14,70,,6.51,,,0,"percent of total billed charges ","70% of total billed charges ",10.47,90,,8.38,,,0,"percent of total billed charges ","90% of total billed charges ",10.82,93,,8.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.89,85,,7.91,,,0,"percent of total billed charges ","85% of total billed charges ",10.47,90,,8.38,,,0,"percent of total billed charges ","90% of total billed charges ",10.47,90,,8.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.12,87,,8.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.14,70,,6.51,,,0,"percent of total billed charges ","70% of total billed charges ",8.14,10.82,
"SPLINT CAST 4X30",6002453,"CDM ",271,RC,A4570,HCPCS,OUTPATIENT,,,75.61,60.488,,,,,,,,0,"other ","not separately reimbursment ",,,,14.59,14.59,14.59,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.93,70,,42.34,,,0,"percent of total billed charges ","70% of total billed charges ",68.05,90,,54.44,,,0,"percent of total billed charges ","90% of total billed charges ",70.32,93,,56.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",64.27,85,,51.42,,,0,"percent of total billed charges ","85% of total billed charges ",68.05,90,,54.44,,,0,"percent of total billed charges ","90% of total billed charges ",68.05,90,,54.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",65.78,87,,52.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.93,70,,42.34,,,0,"percent of total billed charges ","70% of total billed charges ",52.93,70.32,
"SPLINT CAST 3X12",6002454,"CDM ",271,RC,A4570,HCPCS,OUTPATIENT,,,38.36,30.688,,,,,,,,0,"other ","not separately reimbursment ",,,,14.59,14.59,14.59,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.85,70,,21.48,,,0,"percent of total billed charges ","70% of total billed charges ",34.52,90,,27.62,,,0,"percent of total billed charges ","90% of total billed charges ",35.67,93,,28.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.61,85,,26.09,,,0,"percent of total billed charges ","85% of total billed charges ",34.52,90,,27.62,,,0,"percent of total billed charges ","90% of total billed charges ",34.52,90,,27.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.37,87,,26.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.85,70,,21.48,,,0,"percent of total billed charges ","70% of total billed charges ",26.85,35.67,
"BRACE AFO LEFT MEN",6002494,"CDM ",274,RC,L1930,HCPCS,OUTPATIENT,,,125.57,100.456,,,,,,,,0,"other ","not separately reimbursment ",317.87,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",87.9,70,,70.32,,,0,"percent of total billed charges ","70% of total billed charges ",113.01,90,,90.41,,,0,"percent of total billed charges ","90% of total billed charges ",116.78,93,,93.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",106.73,85,,85.38,,,0,"percent of total billed charges ","85% of total billed charges ",106.73,85,,85.38,,,0,"percent of total billed charges ","85% of total billed charges ",113.01,90,,90.41,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",109.25,87,,87.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.9,70,,70.32,,,0,"percent of total billed charges ","70% of total billed charges ",87.9,317.87,
"CAST PLASTER 2""",6002861,"CDM ",272,RC,A4580,HCPCS,OUTPATIENT,,,4.19,3.352,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.93,70,,2.34,,,0,"percent of total billed charges ","70% of total billed charges ",3.77,90,,3.02,,,0,"percent of total billed charges ","90% of total billed charges ",3.9,93,,3.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3.56,85,,2.85,,,0,"percent of total billed charges ","85% of total billed charges ",3.77,90,,3.02,,,0,"percent of total billed charges ","90% of total billed charges ",3.77,90,,3.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3.65,87,,2.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.93,70,,2.34,,,0,"percent of total billed charges ","70% of total billed charges ",2.93,3.9,
"TAPE CAST 4"" GREEN",6002896,"CDM ",272,RC,A4590,HCPCS,OUTPATIENT,,,17.05,13.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.94,70,,9.55,,,0,"percent of total billed charges ","70% of total billed charges ",15.35,90,,12.28,,,0,"percent of total billed charges ","90% of total billed charges ",15.86,93,,12.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.49,85,,11.59,,,0,"percent of total billed charges ","85% of total billed charges ",15.35,90,,12.28,,,0,"percent of total billed charges ","90% of total billed charges ",15.35,90,,12.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.83,87,,11.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.94,70,,9.55,,,0,"percent of total billed charges ","70% of total billed charges ",11.94,15.86,
"SHOE POST OP MENS LG",6003433,"CDM ",271,RC,A9270,HCPCS,OUTPATIENT,,,19.66,15.728,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.76,70,,11.01,,,0,"percent of total billed charges ","70% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",18.28,93,,14.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.71,85,,13.37,,,0,"percent of total billed charges ","85% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.1,87,,13.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.76,70,,11.01,,,0,"percent of total billed charges ","70% of total billed charges ",13.76,18.28,
"MARKER BREAST BIOPSY 15G T4",6003464,"CDM ",278,RC,A4648,HCPCS,OUTPATIENT,,,300.47,240.376,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.33,70,,168.26,,,0,"percent of total billed charges ","70% of total billed charges ",270.42,90,,216.34,,,0,"percent of total billed charges ","90% of total billed charges ",279.44,93,,223.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",255.4,85,,204.32,,,0,"percent of total billed charges ","85% of total billed charges ",255.4,85,,204.32,,,0,"percent of total billed charges ","85% of total billed charges ",270.42,90,,216.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",261.41,87,,209.13,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.33,70,,168.26,,,0,"percent of total billed charges ","70% of total billed charges ",210.33,279.44,
"MAKER BREAST BIOPSY 15G T5",6003465,"CDM ",278,RC,A4648,HCPCS,OUTPATIENT,,,345.53,276.424,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.87,70,,193.50,,,0,"percent of total billed charges ","70% of total billed charges ",310.98,90,,248.78,,,0,"percent of total billed charges ","90% of total billed charges ",321.34,93,,257.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",293.7,85,,234.96,,,0,"percent of total billed charges ","85% of total billed charges ",293.7,85,,234.96,,,0,"percent of total billed charges ","85% of total billed charges ",310.98,90,,248.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",300.61,87,,240.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.87,70,,193.50,,,0,"percent of total billed charges ","70% of total billed charges ",241.87,321.34,
"COLLAR STIFNECK REG",6003563,"CDM ",274,RC,L0150,HCPCS,OUTPATIENT,,,25.02,20.016,,,,,,,,0,"other ","not separately reimbursment ",,,,21.27,21.27,21.27,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.51,70,,14.01,,,0,"percent of total billed charges ","70% of total billed charges ",22.52,90,,18.02,,,0,"percent of total billed charges ","90% of total billed charges ",23.27,93,,18.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.27,85,,17.02,,,0,"percent of total billed charges ","85% of total billed charges ",21.27,85,,17.02,,,0,"percent of total billed charges ","85% of total billed charges ",22.52,90,,18.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.77,87,,18.27,13.27,23.27,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.51,70,,14.01,,,0,"percent of total billed charges ","70% of total billed charges ",17.51,23.27,
"COLLAR STIFNECK SHORT",6003564,"CDM ",274,RC,L0150,HCPCS,OUTPATIENT,,,38.16,30.528,,,,,,,,0,"other ","not separately reimbursment ",,,,21.27,21.27,21.27,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.71,70,,21.37,,,0,"percent of total billed charges ","70% of total billed charges ",34.34,90,,27.47,,,0,"percent of total billed charges ","90% of total billed charges ",35.49,93,,28.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.44,85,,25.95,,,0,"percent of total billed charges ","85% of total billed charges ",32.44,85,,25.95,,,0,"percent of total billed charges ","85% of total billed charges ",34.34,90,,27.47,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.2,87,,18.27,13.27,23.27,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.71,70,,21.37,,,0,"percent of total billed charges ","70% of total billed charges ",26.71,35.49,
"COLLAR STIFNECK TALL",6003565,"CDM ",274,RC,L0150,HCPCS,OUTPATIENT,,,45.14,36.112,,,,,,,,0,"other ","not separately reimbursment ",,,,21.27,21.27,21.27,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.6,70,,25.28,,,0,"percent of total billed charges ","70% of total billed charges ",40.63,90,,32.50,,,0,"percent of total billed charges ","90% of total billed charges ",41.98,93,,33.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.37,85,,30.70,,,0,"percent of total billed charges ","85% of total billed charges ",38.37,85,,30.70,,,0,"percent of total billed charges ","85% of total billed charges ",40.63,90,,32.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.27,87,,18.27,13.27,23.27,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.6,70,,25.28,,,0,"percent of total billed charges ","70% of total billed charges ",31.6,41.98,
"COLLAR STIFNECK NO-NECK",6003566,"CDM ",274,RC,L0150,HCPCS,OUTPATIENT,,,38.16,30.528,,,,,,,,0,"other ","not separately reimbursment ",,,,21.27,21.27,21.27,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.71,70,,21.37,,,0,"percent of total billed charges ","70% of total billed charges ",34.34,90,,27.47,,,0,"percent of total billed charges ","90% of total billed charges ",35.49,93,,28.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.44,85,,25.95,,,0,"percent of total billed charges ","85% of total billed charges ",32.44,85,,25.95,,,0,"percent of total billed charges ","85% of total billed charges ",34.34,90,,27.47,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.2,87,,18.27,13.27,23.27,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.71,70,,21.37,,,0,"percent of total billed charges ","70% of total billed charges ",26.71,35.49,
"COLLAR STIFNECK PEDI",6003567,"CDM ",274,RC,L0150,HCPCS,OUTPATIENT,,,37.71,30.168,,,,,,,,0,"other ","not separately reimbursment ",,,,21.27,21.27,21.27,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.4,70,,21.12,,,0,"percent of total billed charges ","70% of total billed charges ",33.94,90,,27.15,,,0,"percent of total billed charges ","90% of total billed charges ",35.07,93,,28.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.05,85,,25.64,,,0,"percent of total billed charges ","85% of total billed charges ",32.05,85,,25.64,,,0,"percent of total billed charges ","85% of total billed charges ",33.94,90,,27.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",32.81,87,,18.27,13.27,23.27,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.4,70,,21.12,,,0,"percent of total billed charges ","70% of total billed charges ",26.4,35.07,
"COLLAR STIFNECK BABY",6003568,"CDM ",274,RC,L0150,HCPCS,OUTPATIENT,,,44.63,35.704,,,,,,,,0,"other ","not separately reimbursment ",,,,21.27,21.27,21.27,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.24,70,,24.99,,,0,"percent of total billed charges ","70% of total billed charges ",40.17,90,,32.14,,,0,"percent of total billed charges ","90% of total billed charges ",41.51,93,,33.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",37.94,85,,30.35,,,0,"percent of total billed charges ","85% of total billed charges ",37.94,85,,30.35,,,0,"percent of total billed charges ","85% of total billed charges ",40.17,90,,32.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",38.83,87,,18.27,13.27,23.27,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.24,70,,24.99,,,0,"percent of total billed charges ","70% of total billed charges ",31.24,41.51,
"CONT MED GASTRO 367MG/ML 30ML",6003672,"CDM ",255,RC,Q9963,HCPCS,OUTPATIENT,,,45,36,,,,,,,,0,"other ","not separately reimbursment ",0.91,100,,176.00,176.00,176.00,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.15,87,,31.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",0.91,41.85,
"CAST PLASTER 5""",6003727,"CDM ",272,RC,A4580,HCPCS,OUTPATIENT,,,13.39,10.712,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.37,70,,7.50,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,90,,9.64,,,0,"percent of total billed charges ","90% of total billed charges ",12.45,93,,9.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.38,85,,9.10,,,0,"percent of total billed charges ","85% of total billed charges ",12.05,90,,9.64,,,0,"percent of total billed charges ","90% of total billed charges ",12.05,90,,9.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.65,87,,9.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.37,70,,7.50,,,0,"percent of total billed charges ","70% of total billed charges ",9.37,12.45,
"CAST PLASTER 4""",6003728,"CDM ",272,RC,A4580,HCPCS,OUTPATIENT,,,6.42,5.136,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.49,70,,3.59,,,0,"percent of total billed charges ","70% of total billed charges ",5.78,90,,4.62,,,0,"percent of total billed charges ","90% of total billed charges ",5.97,93,,4.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.46,85,,4.37,,,0,"percent of total billed charges ","85% of total billed charges ",5.78,90,,4.62,,,0,"percent of total billed charges ","90% of total billed charges ",5.78,90,,4.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5.59,87,,4.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.49,70,,3.59,,,0,"percent of total billed charges ","70% of total billed charges ",4.49,5.97,
"CAST PLASTER 3""",6003730,"CDM ",272,RC,A4580,HCPCS,OUTPATIENT,,,5.29,4.232,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.7,70,,2.96,,,0,"percent of total billed charges ","70% of total billed charges ",4.76,90,,3.81,,,0,"percent of total billed charges ","90% of total billed charges ",4.92,93,,3.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4.5,85,,3.60,,,0,"percent of total billed charges ","85% of total billed charges ",4.76,90,,3.81,,,0,"percent of total billed charges ","90% of total billed charges ",4.76,90,,3.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4.6,87,,3.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.7,70,,2.96,,,0,"percent of total billed charges ","70% of total billed charges ",3.7,4.92,
"BRACE WRIST W/THUMB SPICA LS",6004077,"CDM ",274,RC,L3908,HCPCS,OUTPATIENT,,,62.54,50.032,,52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.78,70,,35.02,,,0,"percent of total billed charges ","70% of total billed charges ",56.29,90,,45.03,,,0,"percent of total billed charges ","90% of total billed charges ",58.16,93,,46.53,,,0,"percent of total billed charges ","93% of total billed charges ",52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",53.16,85,,42.53,,,0,"percent of total billed charges ","85% of total billed charges ",53.16,85,,42.53,,,0,"percent of total billed charges ","85% of total billed charges ",56.29,90,,45.03,,,0,"percent of total billed charges ","90% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.41,87,,43.53,,,0,"percent of total billed charges ","87% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",43.78,70,,35.02,,,0,"percent of total billed charges ","70% of total billed charges ",35.95,58.16,
"BRACE WRIST W/THUMB SPICA RS",6004078,"CDM ",274,RC,L3908,HCPCS,OUTPATIENT,,,62.54,50.032,,52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.78,70,,35.02,,,0,"percent of total billed charges ","70% of total billed charges ",56.29,90,,45.03,,,0,"percent of total billed charges ","90% of total billed charges ",58.16,93,,46.53,,,0,"percent of total billed charges ","93% of total billed charges ",52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",53.16,85,,42.53,,,0,"percent of total billed charges ","85% of total billed charges ",53.16,85,,42.53,,,0,"percent of total billed charges ","85% of total billed charges ",56.29,90,,45.03,,,0,"percent of total billed charges ","90% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.41,87,,43.53,,,0,"percent of total billed charges ","87% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",43.78,70,,35.02,,,0,"percent of total billed charges ","70% of total billed charges ",35.95,58.16,
"BRACE WRIST W/THUMB SPICA LM",6004085,"CDM ",274,RC,L3908,HCPCS,OUTPATIENT,,,62.54,50.032,,52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.78,70,,35.02,,,0,"percent of total billed charges ","70% of total billed charges ",56.29,90,,45.03,,,0,"percent of total billed charges ","90% of total billed charges ",58.16,93,,46.53,,,0,"percent of total billed charges ","93% of total billed charges ",52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",53.16,85,,42.53,,,0,"percent of total billed charges ","85% of total billed charges ",53.16,85,,42.53,,,0,"percent of total billed charges ","85% of total billed charges ",56.29,90,,45.03,,,0,"percent of total billed charges ","90% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.41,87,,43.53,,,0,"percent of total billed charges ","87% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",43.78,70,,35.02,,,0,"percent of total billed charges ","70% of total billed charges ",35.95,58.16,
"BRACE WRIST W/THUMB SPICA RM",6004086,"CDM ",274,RC,L3908,HCPCS,OUTPATIENT,,,62.54,50.032,,52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.78,70,,35.02,,,0,"percent of total billed charges ","70% of total billed charges ",56.29,90,,45.03,,,0,"percent of total billed charges ","90% of total billed charges ",58.16,93,,46.53,,,0,"percent of total billed charges ","93% of total billed charges ",52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",53.16,85,,42.53,,,0,"percent of total billed charges ","85% of total billed charges ",53.16,85,,42.53,,,0,"percent of total billed charges ","85% of total billed charges ",56.29,90,,45.03,,,0,"percent of total billed charges ","90% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.41,87,,43.53,,,0,"percent of total billed charges ","87% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",43.78,70,,35.02,,,0,"percent of total billed charges ","70% of total billed charges ",35.95,58.16,
"BRACE WRIST W/THUMB SPICA LL",6004087,"CDM ",274,RC,L3908,HCPCS,OUTPATIENT,,,62.54,50.032,,52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.78,70,,35.02,,,0,"percent of total billed charges ","70% of total billed charges ",56.29,90,,45.03,,,0,"percent of total billed charges ","90% of total billed charges ",58.16,93,,46.53,,,0,"percent of total billed charges ","93% of total billed charges ",52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",53.16,85,,42.53,,,0,"percent of total billed charges ","85% of total billed charges ",53.16,85,,42.53,,,0,"percent of total billed charges ","85% of total billed charges ",56.29,90,,45.03,,,0,"percent of total billed charges ","90% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.41,87,,43.53,,,0,"percent of total billed charges ","87% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",43.78,70,,35.02,,,0,"percent of total billed charges ","70% of total billed charges ",35.95,58.16,
"BRACE WRIST W/THUMB SPICA RL",6004088,"CDM ",274,RC,L3908,HCPCS,OUTPATIENT,,,62.54,50.032,,52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.78,70,,35.02,,,0,"percent of total billed charges ","70% of total billed charges ",56.29,90,,45.03,,,0,"percent of total billed charges ","90% of total billed charges ",58.16,93,,46.53,,,0,"percent of total billed charges ","93% of total billed charges ",52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",53.16,85,,42.53,,,0,"percent of total billed charges ","85% of total billed charges ",53.16,85,,42.53,,,0,"percent of total billed charges ","85% of total billed charges ",56.29,90,,45.03,,,0,"percent of total billed charges ","90% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.41,87,,43.53,,,0,"percent of total billed charges ","87% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",43.78,70,,35.02,,,0,"percent of total billed charges ","70% of total billed charges ",35.95,58.16,
"SPLINT WRIST COCK-UP LS",6004093,"CDM ",274,RC,L3908,HCPCS,OUTPATIENT,,,27.58,22.064,,52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.31,70,,15.45,,,0,"percent of total billed charges ","70% of total billed charges ",24.82,90,,19.86,,,0,"percent of total billed charges ","90% of total billed charges ",25.65,93,,20.52,,,0,"percent of total billed charges ","93% of total billed charges ",52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",23.44,85,,18.75,,,0,"percent of total billed charges ","85% of total billed charges ",23.44,85,,18.75,,,0,"percent of total billed charges ","85% of total billed charges ",24.82,90,,19.86,,,0,"percent of total billed charges ","90% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.99,87,,19.19,,,0,"percent of total billed charges ","87% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.31,70,,15.45,,,0,"percent of total billed charges ","70% of total billed charges ",19.31,52.43,
"SPLINT WRIST COCK-UP RS",6004094,"CDM ",274,RC,L3908,HCPCS,OUTPATIENT,,,27.58,22.064,,52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.31,70,,15.45,,,0,"percent of total billed charges ","70% of total billed charges ",24.82,90,,19.86,,,0,"percent of total billed charges ","90% of total billed charges ",25.65,93,,20.52,,,0,"percent of total billed charges ","93% of total billed charges ",52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",23.44,85,,18.75,,,0,"percent of total billed charges ","85% of total billed charges ",23.44,85,,18.75,,,0,"percent of total billed charges ","85% of total billed charges ",24.82,90,,19.86,,,0,"percent of total billed charges ","90% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.99,87,,19.19,,,0,"percent of total billed charges ","87% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.31,70,,15.45,,,0,"percent of total billed charges ","70% of total billed charges ",19.31,52.43,
"SPLINT WRIST COCK-UP LM",6004095,"CDM ",274,RC,L3908,HCPCS,OUTPATIENT,,,27.58,22.064,,52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.31,70,,15.45,,,0,"percent of total billed charges ","70% of total billed charges ",24.82,90,,19.86,,,0,"percent of total billed charges ","90% of total billed charges ",25.65,93,,20.52,,,0,"percent of total billed charges ","93% of total billed charges ",52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",23.44,85,,18.75,,,0,"percent of total billed charges ","85% of total billed charges ",23.44,85,,18.75,,,0,"percent of total billed charges ","85% of total billed charges ",24.82,90,,19.86,,,0,"percent of total billed charges ","90% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.99,87,,19.19,,,0,"percent of total billed charges ","87% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.31,70,,15.45,,,0,"percent of total billed charges ","70% of total billed charges ",19.31,52.43,
"SPLINT WRIST COCK-UP RM",6004098,"CDM ",274,RC,L3908,HCPCS,OUTPATIENT,,,27.58,22.064,,52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.31,70,,15.45,,,0,"percent of total billed charges ","70% of total billed charges ",24.82,90,,19.86,,,0,"percent of total billed charges ","90% of total billed charges ",25.65,93,,20.52,,,0,"percent of total billed charges ","93% of total billed charges ",52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",23.44,85,,18.75,,,0,"percent of total billed charges ","85% of total billed charges ",23.44,85,,18.75,,,0,"percent of total billed charges ","85% of total billed charges ",24.82,90,,19.86,,,0,"percent of total billed charges ","90% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.99,87,,19.19,,,0,"percent of total billed charges ","87% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.31,70,,15.45,,,0,"percent of total billed charges ","70% of total billed charges ",19.31,52.43,
"SPLINT WRIST COCK-UP LL",6004099,"CDM ",274,RC,L3908,HCPCS,OUTPATIENT,,,27.58,22.064,,52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.31,70,,15.45,,,0,"percent of total billed charges ","70% of total billed charges ",24.82,90,,19.86,,,0,"percent of total billed charges ","90% of total billed charges ",25.65,93,,20.52,,,0,"percent of total billed charges ","93% of total billed charges ",52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",23.44,85,,18.75,,,0,"percent of total billed charges ","85% of total billed charges ",23.44,85,,18.75,,,0,"percent of total billed charges ","85% of total billed charges ",24.82,90,,19.86,,,0,"percent of total billed charges ","90% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.99,87,,19.19,,,0,"percent of total billed charges ","87% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.31,70,,15.45,,,0,"percent of total billed charges ","70% of total billed charges ",19.31,52.43,
"SPLINT WRIST COCK-UP RL",6004100,"CDM ",274,RC,L3908,HCPCS,OUTPATIENT,,,27.58,22.064,,52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.31,70,,15.45,,,0,"percent of total billed charges ","70% of total billed charges ",24.82,90,,19.86,,,0,"percent of total billed charges ","90% of total billed charges ",25.65,93,,20.52,,,0,"percent of total billed charges ","93% of total billed charges ",52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",23.44,85,,18.75,,,0,"percent of total billed charges ","85% of total billed charges ",23.44,85,,18.75,,,0,"percent of total billed charges ","85% of total billed charges ",24.82,90,,19.86,,,0,"percent of total billed charges ","90% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.99,87,,19.19,,,0,"percent of total billed charges ","87% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.31,70,,15.45,,,0,"percent of total billed charges ","70% of total billed charges ",19.31,52.43,
"WALKER CAM HIGH SMALL",6004103,"CDM ",274,RC,L4360,HCPCS,OUTPATIENT,,,104.1,83.28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.87,70,,58.30,,,0,"percent of total billed charges ","70% of total billed charges ",93.69,90,,74.95,,,0,"percent of total billed charges ","90% of total billed charges ",96.81,93,,77.45,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",88.49,85,,70.79,,,0,"percent of total billed charges ","85% of total billed charges ",88.49,85,,70.79,,,0,"percent of total billed charges ","85% of total billed charges ",93.69,90,,74.95,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",90.57,87,,72.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.87,70,,58.30,,,0,"percent of total billed charges ","70% of total billed charges ",72.87,96.81,
"WALKER CAM HIGH MEDIUM",6004104,"CDM ",274,RC,L4360,HCPCS,OUTPATIENT,,,104.1,83.28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.87,70,,58.30,,,0,"percent of total billed charges ","70% of total billed charges ",93.69,90,,74.95,,,0,"percent of total billed charges ","90% of total billed charges ",96.81,93,,77.45,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",88.49,85,,70.79,,,0,"percent of total billed charges ","85% of total billed charges ",88.49,85,,70.79,,,0,"percent of total billed charges ","85% of total billed charges ",93.69,90,,74.95,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",90.57,87,,72.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.87,70,,58.30,,,0,"percent of total billed charges ","70% of total billed charges ",72.87,96.81,
"WALKER CAM HIGH LARGE",6004106,"CDM ",274,RC,L4360,HCPCS,OUTPATIENT,,,104.1,83.28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.87,70,,58.30,,,0,"percent of total billed charges ","70% of total billed charges ",93.69,90,,74.95,,,0,"percent of total billed charges ","90% of total billed charges ",96.81,93,,77.45,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",88.49,85,,70.79,,,0,"percent of total billed charges ","85% of total billed charges ",88.49,85,,70.79,,,0,"percent of total billed charges ","85% of total billed charges ",93.69,90,,74.95,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",90.57,87,,72.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.87,70,,58.30,,,0,"percent of total billed charges ","70% of total billed charges ",72.87,96.81,
"WALKER CAM LOW SMALL",6004107,"CDM ",274,RC,L4360,HCPCS,OUTPATIENT,,,95.39,76.312,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.31,80,,61.05,,,0,"percent of total billed charges ","80% of total billed charges ",66.77,70,,53.42,,,0,"percent of total billed charges ","70% of total billed charges ",85.85,90,,68.68,,,0,"percent of total billed charges ","90% of total billed charges ",88.71,93,,70.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",81.08,85,,64.86,,,0,"percent of total billed charges ","85% of total billed charges ",81.08,85,,64.86,,,0,"percent of total billed charges ","85% of total billed charges ",85.85,90,,68.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.99,87,,66.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.77,70,,53.42,,,0,"percent of total billed charges ","70% of total billed charges ",66.77,88.71,
"WALKER CAM LOW MEDIUM",6004108,"CDM ",274,RC,L4360,HCPCS,OUTPATIENT,,,95.39,76.312,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.31,80,,61.05,,,0,"percent of total billed charges ","80% of total billed charges ",66.77,70,,53.42,,,0,"percent of total billed charges ","70% of total billed charges ",85.85,90,,68.68,,,0,"percent of total billed charges ","90% of total billed charges ",88.71,93,,70.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",81.08,85,,64.86,,,0,"percent of total billed charges ","85% of total billed charges ",81.08,85,,64.86,,,0,"percent of total billed charges ","85% of total billed charges ",85.85,90,,68.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.99,87,,66.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.77,70,,53.42,,,0,"percent of total billed charges ","70% of total billed charges ",66.77,88.71,
"WALKER CAM LOW LARGE",6004109,"CDM ",274,RC,L4360,HCPCS,OUTPATIENT,,,95.39,76.312,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.31,80,,61.05,,,0,"percent of total billed charges ","80% of total billed charges ",66.77,70,,53.42,,,0,"percent of total billed charges ","70% of total billed charges ",85.85,90,,68.68,,,0,"percent of total billed charges ","90% of total billed charges ",88.71,93,,70.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",81.08,85,,64.86,,,0,"percent of total billed charges ","85% of total billed charges ",81.08,85,,64.86,,,0,"percent of total billed charges ","85% of total billed charges ",85.85,90,,68.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.99,87,,66.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.77,70,,53.42,,,0,"percent of total billed charges ","70% of total billed charges ",66.77,88.71,
"WALKER CAM LOW LARGE",6004109,"CDM ",274,RC,L4360,HCPCS,OUTPATIENT,,,95.39,76.312,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.31,80,,61.05,,,0,"percent of total billed charges ","80% of total billed charges ",66.77,70,,53.42,,,0,"percent of total billed charges ","70% of total billed charges ",85.85,90,,68.68,,,0,"percent of total billed charges ","90% of total billed charges ",88.71,93,,70.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",81.08,85,,64.86,,,0,"percent of total billed charges ","85% of total billed charges ",81.08,85,,64.86,,,0,"percent of total billed charges ","85% of total billed charges ",85.85,90,,68.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.99,87,,66.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.77,70,,53.42,,,0,"percent of total billed charges ","70% of total billed charges ",66.77,88.71,
"SPLINT FINGER FROG SM",6004116,"CDM ",274,RC,A4570,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,14.59,14.59,14.59,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"SPLINT FINGER FROG MED",6004121,"CDM ",274,RC,A4570,HCPCS,OUTPATIENT,,,7.5,6,,,,,,,,0,"other ","not separately reimbursment ",,,,14.59,14.59,14.59,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.25,70,,4.20,,,0,"percent of total billed charges ","70% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",6.98,93,,5.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6.38,85,,5.10,,,0,"percent of total billed charges ","85% of total billed charges ",6.38,85,,5.10,,,0,"percent of total billed charges ","85% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.53,87,,5.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.25,70,,4.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,6.98,
"SPLINT FINGER FROG LG",6004127,"CDM ",274,RC,A4570,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,14.59,14.59,14.59,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"COT FINGER ROLYAN SM",6004128,"CDM ",274,RC,A4570,HCPCS,OUTPATIENT,,,6,4.8,,,,,,,,0,"other ","not separately reimbursment ",,,,14.59,14.59,14.59,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.2,70,,3.36,,,0,"percent of total billed charges ","70% of total billed charges ",5.4,90,,4.32,,,0,"percent of total billed charges ","90% of total billed charges ",5.58,93,,4.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.1,85,,4.08,,,0,"percent of total billed charges ","85% of total billed charges ",5.1,85,,4.08,,,0,"percent of total billed charges ","85% of total billed charges ",5.4,90,,4.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5.22,87,,4.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.2,70,,3.36,,,0,"percent of total billed charges ","70% of total billed charges ",4.2,5.58,
"COT FINGER ROLYAN MED",6004137,"CDM ",274,RC,A4570,HCPCS,OUTPATIENT,,,6,4.8,,,,,,,,0,"other ","not separately reimbursment ",,,,14.59,14.59,14.59,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.2,70,,3.36,,,0,"percent of total billed charges ","70% of total billed charges ",5.4,90,,4.32,,,0,"percent of total billed charges ","90% of total billed charges ",5.58,93,,4.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.1,85,,4.08,,,0,"percent of total billed charges ","85% of total billed charges ",5.1,85,,4.08,,,0,"percent of total billed charges ","85% of total billed charges ",5.4,90,,4.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5.22,87,,4.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.2,70,,3.36,,,0,"percent of total billed charges ","70% of total billed charges ",4.2,5.58,
"COT FINGER ROLYAN LG",6004140,"CDM ",274,RC,A4570,HCPCS,OUTPATIENT,,,6,4.8,,,,,,,,0,"other ","not separately reimbursment ",,,,14.59,14.59,14.59,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.2,70,,3.36,,,0,"percent of total billed charges ","70% of total billed charges ",5.4,90,,4.32,,,0,"percent of total billed charges ","90% of total billed charges ",5.58,93,,4.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.1,85,,4.08,,,0,"percent of total billed charges ","85% of total billed charges ",5.1,85,,4.08,,,0,"percent of total billed charges ","85% of total billed charges ",5.4,90,,4.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5.22,87,,4.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.2,70,,3.36,,,0,"percent of total billed charges ","70% of total billed charges ",4.2,5.58,
"COT FINGER ROLYAN XLG",6004142,"CDM ",274,RC,A4570,HCPCS,OUTPATIENT,,,6,4.8,,,,,,,,0,"other ","not separately reimbursment ",,,,14.59,14.59,14.59,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.2,70,,3.36,,,0,"percent of total billed charges ","70% of total billed charges ",5.4,90,,4.32,,,0,"percent of total billed charges ","90% of total billed charges ",5.58,93,,4.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.1,85,,4.08,,,0,"percent of total billed charges ","85% of total billed charges ",5.1,85,,4.08,,,0,"percent of total billed charges ","85% of total billed charges ",5.4,90,,4.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5.22,87,,4.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.2,70,,3.36,,,0,"percent of total billed charges ","70% of total billed charges ",4.2,5.58,
"SPLINT FINGER MALLET SMALL",6004144,"CDM ",274,RC,L3925,HCPCS,OUTPATIENT,,,22.5,18,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.75,70,,12.60,,,0,"percent of total billed charges ","70% of total billed charges ",20.25,90,,16.20,,,0,"percent of total billed charges ","90% of total billed charges ",20.93,93,,16.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",37.9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",19.13,85,,15.30,,,0,"percent of total billed charges ","85% of total billed charges ",19.13,85,,15.30,,,0,"percent of total billed charges ","85% of total billed charges ",20.25,90,,16.20,,,0,"percent of total billed charges ","90% of total billed charges ",37.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.58,87,,15.66,,,0,"percent of total billed charges ","87% of total billed charges ",37.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15.75,70,,12.60,,,0,"percent of total billed charges ","70% of total billed charges ",15.75,37.9,
"SPLINT FINGER MALLET MEDIUM",6004145,"CDM ",274,RC,L3925,HCPCS,OUTPATIENT,,,22.5,18,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.75,70,,12.60,,,0,"percent of total billed charges ","70% of total billed charges ",20.25,90,,16.20,,,0,"percent of total billed charges ","90% of total billed charges ",20.93,93,,16.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",37.9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",19.13,85,,15.30,,,0,"percent of total billed charges ","85% of total billed charges ",19.13,85,,15.30,,,0,"percent of total billed charges ","85% of total billed charges ",20.25,90,,16.20,,,0,"percent of total billed charges ","90% of total billed charges ",37.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.58,87,,15.66,,,0,"percent of total billed charges ","87% of total billed charges ",37.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15.75,70,,12.60,,,0,"percent of total billed charges ","70% of total billed charges ",15.75,37.9,
"SPLINT FINGER MALLET LARGE",6004148,"CDM ",274,RC,L3925,HCPCS,OUTPATIENT,,,22,17.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.4,70,,12.32,,,0,"percent of total billed charges ","70% of total billed charges ",19.8,90,,15.84,,,0,"percent of total billed charges ","90% of total billed charges ",20.46,93,,16.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",37.9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",18.7,85,,14.96,,,0,"percent of total billed charges ","85% of total billed charges ",18.7,85,,14.96,,,0,"percent of total billed charges ","85% of total billed charges ",19.8,90,,15.84,,,0,"percent of total billed charges ","90% of total billed charges ",37.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.14,87,,15.31,,,0,"percent of total billed charges ","87% of total billed charges ",37.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15.4,70,,12.32,,,0,"percent of total billed charges ","70% of total billed charges ",15.4,37.9,
"SPLINT FINGER MALLET XLG",6004149,"CDM ",274,RC,L3925,HCPCS,OUTPATIENT,,,22,17.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.4,70,,12.32,,,0,"percent of total billed charges ","70% of total billed charges ",19.8,90,,15.84,,,0,"percent of total billed charges ","90% of total billed charges ",20.46,93,,16.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",37.9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",18.7,85,,14.96,,,0,"percent of total billed charges ","85% of total billed charges ",18.7,85,,14.96,,,0,"percent of total billed charges ","85% of total billed charges ",19.8,90,,15.84,,,0,"percent of total billed charges ","90% of total billed charges ",37.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.14,87,,15.31,,,0,"percent of total billed charges ","87% of total billed charges ",37.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15.4,70,,12.32,,,0,"percent of total billed charges ","70% of total billed charges ",15.4,37.9,
"FLUID MEDI-DUCT",6004194,"CDM ",272,RC,A4384,HCPCS,OUTPATIENT,,,23.82,19.056,,,,,,,,0,"other ","not separately reimbursment ",47.83,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",16.67,70,,13.34,,,0,"percent of total billed charges ","70% of total billed charges ",21.44,90,,17.15,,,0,"percent of total billed charges ","90% of total billed charges ",22.15,93,,17.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.25,85,,16.20,,,0,"percent of total billed charges ","85% of total billed charges ",21.44,90,,17.15,,,0,"percent of total billed charges ","90% of total billed charges ",21.44,90,,17.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.72,87,,16.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.67,70,,13.34,,,0,"percent of total billed charges ","70% of total billed charges ",16.67,47.83,
"CUP HEEL DUAL STYLE LG",6004201,"CDM ",274,RC,L4350,HCPCS,OUTPATIENT,,,15.05,12.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.54,70,,8.43,,,0,"percent of total billed charges ","70% of total billed charges ",13.55,90,,10.84,,,0,"percent of total billed charges ","90% of total billed charges ",14,93,,11.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",54.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",12.79,85,,10.23,,,0,"percent of total billed charges ","85% of total billed charges ",12.79,85,,10.23,,,0,"percent of total billed charges ","85% of total billed charges ",13.55,90,,10.84,,,0,"percent of total billed charges ","90% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.09,87,,10.47,,,0,"percent of total billed charges ","87% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",10.54,70,,8.43,,,0,"percent of total billed charges ","70% of total billed charges ",10.54,54.48,
"CATH THORACIC 32FR",6004202,"CDM ",272,RC,C1757,HCPCS,OUTPATIENT,,,27.38,21.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.17,70,,15.34,,,0,"percent of total billed charges ","70% of total billed charges ",24.64,90,,19.71,,,0,"percent of total billed charges ","90% of total billed charges ",25.46,93,,20.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.27,85,,18.62,,,0,"percent of total billed charges ","85% of total billed charges ",24.64,90,,19.71,,,0,"percent of total billed charges ","90% of total billed charges ",24.64,90,,19.71,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",23.82,87,,19.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.17,70,,15.34,,,0,"percent of total billed charges ","70% of total billed charges ",19.17,25.46,
"TRAY HSG/HSG CATH 7FR",6004263,"CDM ",621,RC,C1758,HCPCS,OUTPATIENT,,,205.8,164.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.06,70,,115.25,,,0,"percent of total billed charges ","70% of total billed charges ",185.22,90,,148.18,,,0,"percent of total billed charges ","90% of total billed charges ",191.39,93,,153.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",174.93,85,,139.94,,,0,"percent of total billed charges ","85% of total billed charges ",185.22,90,,148.18,,,0,"percent of total billed charges ","90% of total billed charges ",185.22,90,,148.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",179.05,87,,143.24,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.06,70,,115.25,,,0,"percent of total billed charges ","70% of total billed charges ",144.06,191.39,
"BRACE KNEE WRAP AROUND REGULAR",6004265,"CDM ",274,RC,L1810,HCPCS,OUTPATIENT,,,158.06,126.448,,,,,,,,0,"other ","not separately reimbursment ",107.6,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",110.64,70,,88.51,,,0,"percent of total billed charges ","70% of total billed charges ",142.25,90,,113.80,,,0,"percent of total billed charges ","90% of total billed charges ",147,93,,117.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",134.35,85,,107.48,,,0,"percent of total billed charges ","85% of total billed charges ",134.35,85,,107.48,,,0,"percent of total billed charges ","85% of total billed charges ",142.25,90,,113.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.51,87,,110.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.64,70,,88.51,,,0,"percent of total billed charges ","70% of total billed charges ",107.6,147,
"BRACE KNEE WRAP AROUND LARGE",6004266,"CDM ",274,RC,L1810,HCPCS,OUTPATIENT,,,158.06,126.448,,,,,,,,0,"other ","not separately reimbursment ",107.6,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",110.64,70,,88.51,,,0,"percent of total billed charges ","70% of total billed charges ",142.25,90,,113.80,,,0,"percent of total billed charges ","90% of total billed charges ",147,93,,117.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",134.35,85,,107.48,,,0,"percent of total billed charges ","85% of total billed charges ",134.35,85,,107.48,,,0,"percent of total billed charges ","85% of total billed charges ",142.25,90,,113.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.51,87,,110.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.64,70,,88.51,,,0,"percent of total billed charges ","70% of total billed charges ",107.6,147,
"BRACE KNEE WRAP AROUND X-LARGE",6004267,"CDM ",274,RC,L1810,HCPCS,OUTPATIENT,,,158.06,126.448,,,,,,,,0,"other ","not separately reimbursment ",107.6,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",110.64,70,,88.51,,,0,"percent of total billed charges ","70% of total billed charges ",142.25,90,,113.80,,,0,"percent of total billed charges ","90% of total billed charges ",147,93,,117.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",134.35,85,,107.48,,,0,"percent of total billed charges ","85% of total billed charges ",134.35,85,,107.48,,,0,"percent of total billed charges ","85% of total billed charges ",142.25,90,,113.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.51,87,,110.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.64,70,,88.51,,,0,"percent of total billed charges ","70% of total billed charges ",107.6,147,
"CATH FOLEY COUDE 20FR 5CC",6004371,"CDM ",272,RC,C1729,HCPCS,OUTPATIENT,,,79.5,63.6,,,,,,,,0,"other ","not separately reimbursment ",,,,93.87,93.87,93.87,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.65,70,,44.52,,,0,"percent of total billed charges ","70% of total billed charges ",71.55,90,,57.24,,,0,"percent of total billed charges ","90% of total billed charges ",73.94,93,,59.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",67.58,85,,54.06,,,0,"percent of total billed charges ","85% of total billed charges ",71.55,90,,57.24,,,0,"percent of total billed charges ","90% of total billed charges ",71.55,90,,57.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",69.17,87,,55.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.65,70,,44.52,,,0,"percent of total billed charges ","70% of total billed charges ",55.65,73.94,
"CATH FOLEY COUDE 22FR 5CC",6004372,"CDM ",272,RC,C1729,HCPCS,OUTPATIENT,,,79.5,63.6,,,,,,,,0,"other ","not separately reimbursment ",,,,93.87,93.87,93.87,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.65,70,,44.52,,,0,"percent of total billed charges ","70% of total billed charges ",71.55,90,,57.24,,,0,"percent of total billed charges ","90% of total billed charges ",73.94,93,,59.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",67.58,85,,54.06,,,0,"percent of total billed charges ","85% of total billed charges ",71.55,90,,57.24,,,0,"percent of total billed charges ","90% of total billed charges ",71.55,90,,57.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",69.17,87,,55.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.65,70,,44.52,,,0,"percent of total billed charges ","70% of total billed charges ",55.65,73.94,
"CATH FOLEY COUDE 24FR 5CC",6004373,"CDM ",272,RC,C1729,HCPCS,OUTPATIENT,,,79.5,63.6,,,,,,,,0,"other ","not separately reimbursment ",,,,93.87,93.87,93.87,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.65,70,,44.52,,,0,"percent of total billed charges ","70% of total billed charges ",71.55,90,,57.24,,,0,"percent of total billed charges ","90% of total billed charges ",73.94,93,,59.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",67.58,85,,54.06,,,0,"percent of total billed charges ","85% of total billed charges ",71.55,90,,57.24,,,0,"percent of total billed charges ","90% of total billed charges ",71.55,90,,57.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",69.17,87,,55.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.65,70,,44.52,,,0,"percent of total billed charges ","70% of total billed charges ",55.65,73.94,
"SPLINT WRIST PEDI LS",6004438,"CDM ",274,RC,L3906,HCPCS,OUTPATIENT,,,83,66.4,,344.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",344.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",299.9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",296.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",72.21,87,,57.77,,,0,"percent of total billed charges ","87% of total billed charges ",296.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",58.1,344.25,
"SPLINT WRIST PEDI RS",6004439,"CDM ",274,RC,L3906,HCPCS,OUTPATIENT,,,81,64.8,,344.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.7,70,,45.36,,,0,"percent of total billed charges ","70% of total billed charges ",72.9,90,,58.32,,,0,"percent of total billed charges ","90% of total billed charges ",75.33,93,,60.26,,,0,"percent of total billed charges ","93% of total billed charges ",344.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",299.9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",68.85,85,,55.08,,,0,"percent of total billed charges ","85% of total billed charges ",68.85,85,,55.08,,,0,"percent of total billed charges ","85% of total billed charges ",72.9,90,,58.32,,,0,"percent of total billed charges ","90% of total billed charges ",296.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.47,87,,56.38,,,0,"percent of total billed charges ","87% of total billed charges ",296.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",56.7,70,,45.36,,,0,"percent of total billed charges ","70% of total billed charges ",56.7,344.25,
"SPLINT WRIST PEDI LM",6004440,"CDM ",274,RC,L3906,HCPCS,OUTPATIENT,,,83,66.4,,344.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",344.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",299.9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",296.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",72.21,87,,57.77,,,0,"percent of total billed charges ","87% of total billed charges ",296.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",58.1,344.25,
"SPLINT WRIST PEDI RM",6004441,"CDM ",274,RC,L3906,HCPCS,OUTPATIENT,,,83,66.4,,344.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",344.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",299.9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",296.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",72.21,87,,57.77,,,0,"percent of total billed charges ","87% of total billed charges ",296.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",58.1,344.25,
"SPLINT WRIST PEDI LL",6004442,"CDM ",274,RC,L3906,HCPCS,OUTPATIENT,,,87.5,70,,344.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.25,70,,49.00,,,0,"percent of total billed charges ","70% of total billed charges ",78.75,90,,63.00,,,0,"percent of total billed charges ","90% of total billed charges ",81.38,93,,65.10,,,0,"percent of total billed charges ","93% of total billed charges ",344.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",299.9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",74.38,85,,59.50,,,0,"percent of total billed charges ","85% of total billed charges ",74.38,85,,59.50,,,0,"percent of total billed charges ","85% of total billed charges ",78.75,90,,63.00,,,0,"percent of total billed charges ","90% of total billed charges ",296.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",76.13,87,,60.90,,,0,"percent of total billed charges ","87% of total billed charges ",296.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",61.25,70,,49.00,,,0,"percent of total billed charges ","70% of total billed charges ",61.25,344.25,
"SPLINT WRIST PEDI RL",6004443,"CDM ",274,RC,L3906,HCPCS,OUTPATIENT,,,87.5,70,,344.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.25,70,,49.00,,,0,"percent of total billed charges ","70% of total billed charges ",78.75,90,,63.00,,,0,"percent of total billed charges ","90% of total billed charges ",81.38,93,,65.10,,,0,"percent of total billed charges ","93% of total billed charges ",344.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",299.9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",74.38,85,,59.50,,,0,"percent of total billed charges ","85% of total billed charges ",74.38,85,,59.50,,,0,"percent of total billed charges ","85% of total billed charges ",78.75,90,,63.00,,,0,"percent of total billed charges ","90% of total billed charges ",296.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",76.13,87,,60.90,,,0,"percent of total billed charges ","87% of total billed charges ",296.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",61.25,70,,49.00,,,0,"percent of total billed charges ","70% of total billed charges ",61.25,344.25,
"BAG OSTOMY 2""",6004548,"CDM ",272,RC,A4377,HCPCS,OUTPATIENT,,,17.3,13.84,,,,,,,,0,"other ","not separately reimbursment ",10.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.11,70,,9.69,,,0,"percent of total billed charges ","70% of total billed charges ",15.57,90,,12.46,,,0,"percent of total billed charges ","90% of total billed charges ",16.09,93,,12.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.71,85,,11.77,,,0,"percent of total billed charges ","85% of total billed charges ",15.57,90,,12.46,,,0,"percent of total billed charges ","90% of total billed charges ",15.57,90,,12.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.05,87,,12.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.11,70,,9.69,,,0,"percent of total billed charges ","70% of total billed charges ",10.02,16.09,
"SET DRAINAGE CATH 10.2FR/25CM",6004598,"CDM ",272,RC,C1729,HCPCS,OUTPATIENT,,,307.78,246.224,,,,,,,,0,"other ","not separately reimbursment ",,,,93.87,93.87,93.87,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",215.45,70,,172.36,,,0,"percent of total billed charges ","70% of total billed charges ",277,90,,221.60,,,0,"percent of total billed charges ","90% of total billed charges ",286.24,93,,228.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.61,85,,209.29,,,0,"percent of total billed charges ","85% of total billed charges ",277,90,,221.60,,,0,"percent of total billed charges ","90% of total billed charges ",277,90,,221.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.77,87,,214.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",215.45,70,,172.36,,,0,"percent of total billed charges ","70% of total billed charges ",215.45,286.24,
"TAPE CAST 3"" BLACK",6004648,"CDM ",272,RC,A4590,HCPCS,OUTPATIENT,,,30.04,24.032,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.03,70,,16.82,,,0,"percent of total billed charges ","70% of total billed charges ",27.04,90,,21.63,,,0,"percent of total billed charges ","90% of total billed charges ",27.94,93,,22.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.53,85,,20.42,,,0,"percent of total billed charges ","85% of total billed charges ",27.04,90,,21.63,,,0,"percent of total billed charges ","90% of total billed charges ",27.04,90,,21.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.13,87,,20.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.03,70,,16.82,,,0,"percent of total billed charges ","70% of total billed charges ",21.03,27.94,
"SLING UNIVERSAL LG",6004731,"CDM ",271,RC,A4565,HCPCS,OUTPATIENT,,,58.01,46.408,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.61,70,,32.49,,,0,"percent of total billed charges ","70% of total billed charges ",52.21,90,,41.77,,,0,"percent of total billed charges ","90% of total billed charges ",53.95,93,,43.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",49.31,85,,39.45,,,0,"percent of total billed charges ","85% of total billed charges ",52.21,90,,41.77,,,0,"percent of total billed charges ","90% of total billed charges ",52.21,90,,41.77,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",50.47,87,,40.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.61,70,,32.49,,,0,"percent of total billed charges ","70% of total billed charges ",40.61,53.95,
"SLING UNIVERSAL MED",6004732,"CDM ",271,RC,A4565,HCPCS,OUTPATIENT,,,58.01,46.408,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.61,70,,32.49,,,0,"percent of total billed charges ","70% of total billed charges ",52.21,90,,41.77,,,0,"percent of total billed charges ","90% of total billed charges ",53.95,93,,43.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",49.31,85,,39.45,,,0,"percent of total billed charges ","85% of total billed charges ",52.21,90,,41.77,,,0,"percent of total billed charges ","90% of total billed charges ",52.21,90,,41.77,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",50.47,87,,40.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.61,70,,32.49,,,0,"percent of total billed charges ","70% of total billed charges ",40.61,53.95,
"BRACE HAND/WRIST LIBERTY LM",6004757,"CDM ",274,RC,L3908,HCPCS,OUTPATIENT,,,88,70.4,,52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.6,70,,49.28,,,0,"percent of total billed charges ","70% of total billed charges ",79.2,90,,63.36,,,0,"percent of total billed charges ","90% of total billed charges ",81.84,93,,65.47,,,0,"percent of total billed charges ","93% of total billed charges ",52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",74.8,85,,59.84,,,0,"percent of total billed charges ","85% of total billed charges ",74.8,85,,59.84,,,0,"percent of total billed charges ","85% of total billed charges ",79.2,90,,63.36,,,0,"percent of total billed charges ","90% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",76.56,87,,61.25,,,0,"percent of total billed charges ","87% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",61.6,70,,49.28,,,0,"percent of total billed charges ","70% of total billed charges ",35.95,81.84,
"BRACE HUMERAL MED",6004859,"CDM ",274,RC,L3980,HCPCS,OUTPATIENT,,,216.52,173.216,,317.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",259.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",151.56,70,,121.25,,,0,"percent of total billed charges ","70% of total billed charges ",194.87,90,,155.90,,,0,"percent of total billed charges ","90% of total billed charges ",201.36,93,,161.09,,,0,"percent of total billed charges ","93% of total billed charges ",317.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",276.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",184.04,85,,147.23,,,0,"percent of total billed charges ","85% of total billed charges ",184.04,85,,147.23,,,0,"percent of total billed charges ","85% of total billed charges ",194.87,90,,155.90,,,0,"percent of total billed charges ","90% of total billed charges ",273.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",188.37,87,,150.70,,,0,"percent of total billed charges ","87% of total billed charges ",273.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",151.56,70,,121.25,,,0,"percent of total billed charges ","70% of total billed charges ",151.56,317.08,
"BRACE HUMERAL LG-7253",6004860,"CDM ",274,RC,L3980,HCPCS,OUTPATIENT,,,286.7,229.36,,317.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",259.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",200.69,70,,160.55,,,0,"percent of total billed charges ","70% of total billed charges ",258.03,90,,206.42,,,0,"percent of total billed charges ","90% of total billed charges ",266.63,93,,213.30,,,0,"percent of total billed charges ","93% of total billed charges ",317.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",276.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",243.7,85,,194.96,,,0,"percent of total billed charges ","85% of total billed charges ",243.7,85,,194.96,,,0,"percent of total billed charges ","85% of total billed charges ",258.03,90,,206.42,,,0,"percent of total billed charges ","90% of total billed charges ",273.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",249.43,87,,199.54,,,0,"percent of total billed charges ","87% of total billed charges ",273.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",200.69,70,,160.55,,,0,"percent of total billed charges ","70% of total billed charges ",200.69,317.08,
"BRACE HUMERAL EXTENDED SM-7262",6004861,"CDM ",274,RC,L3980,HCPCS,OUTPATIENT,,,298.17,238.536,,317.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",259.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",208.72,70,,166.98,,,0,"percent of total billed charges ","70% of total billed charges ",268.35,90,,214.68,,,0,"percent of total billed charges ","90% of total billed charges ",277.3,93,,221.84,,,0,"percent of total billed charges ","93% of total billed charges ",317.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",276.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",253.44,85,,202.75,,,0,"percent of total billed charges ","85% of total billed charges ",253.44,85,,202.75,,,0,"percent of total billed charges ","85% of total billed charges ",268.35,90,,214.68,,,0,"percent of total billed charges ","90% of total billed charges ",273.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",259.41,87,,207.53,,,0,"percent of total billed charges ","87% of total billed charges ",273.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",208.72,70,,166.98,,,0,"percent of total billed charges ","70% of total billed charges ",208.72,317.08,
"BRACE HUMERAL EXTENDED MED-726",6004862,"CDM ",274,RC,L3980,HCPCS,OUTPATIENT,,,298.17,238.536,,317.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",259.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",208.72,70,,166.98,,,0,"percent of total billed charges ","70% of total billed charges ",268.35,90,,214.68,,,0,"percent of total billed charges ","90% of total billed charges ",277.3,93,,221.84,,,0,"percent of total billed charges ","93% of total billed charges ",317.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",276.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",253.44,85,,202.75,,,0,"percent of total billed charges ","85% of total billed charges ",253.44,85,,202.75,,,0,"percent of total billed charges ","85% of total billed charges ",268.35,90,,214.68,,,0,"percent of total billed charges ","90% of total billed charges ",273.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",259.41,87,,207.53,,,0,"percent of total billed charges ","87% of total billed charges ",273.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",208.72,70,,166.98,,,0,"percent of total billed charges ","70% of total billed charges ",208.72,317.08,
"BRACE HUMERAL EXTENDED LG-7264",6004863,"CDM ",274,RC,L3980,HCPCS,OUTPATIENT,,,286.7,229.36,,317.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",259.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",200.69,70,,160.55,,,0,"percent of total billed charges ","70% of total billed charges ",258.03,90,,206.42,,,0,"percent of total billed charges ","90% of total billed charges ",266.63,93,,213.30,,,0,"percent of total billed charges ","93% of total billed charges ",317.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",276.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",243.7,85,,194.96,,,0,"percent of total billed charges ","85% of total billed charges ",243.7,85,,194.96,,,0,"percent of total billed charges ","85% of total billed charges ",258.03,90,,206.42,,,0,"percent of total billed charges ","90% of total billed charges ",273.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",249.43,87,,199.54,,,0,"percent of total billed charges ","87% of total billed charges ",273.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",200.69,70,,160.55,,,0,"percent of total billed charges ","70% of total billed charges ",200.69,317.08,
"CONT MED CYSTOGRAFIN 85/300ML",6004893,"CDM ",255,RC,Q9958,HCPCS,OUTPATIENT,,,580,464,,,,,,,,0,"other ","not separately reimbursment ",1.92,100,,429.43,429.43,429.43,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",406,70,,324.80,,,0,"percent of total billed charges ","70% of total billed charges ",522,90,,417.60,,,0,"percent of total billed charges ","90% of total billed charges ",539.4,93,,431.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",493,85,,394.40,,,0,"percent of total billed charges ","85% of total billed charges ",522,90,,417.60,,,0,"percent of total billed charges ","90% of total billed charges ",522,90,,417.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",504.6,87,,403.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",406,70,,324.80,,,0,"percent of total billed charges ","70% of total billed charges ",1.92,539.4,
"POUCH COLOSTOMY 2 3/4""",6005618,"CDM ",272,RC,A5063,HCPCS,OUTPATIENT,,,11.53,9.224,,,,,,,,0,"other ","not separately reimbursment ",3.91,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.07,70,,6.46,,,0,"percent of total billed charges ","70% of total billed charges ",10.38,90,,8.30,,,0,"percent of total billed charges ","90% of total billed charges ",10.72,93,,8.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.8,85,,7.84,,,0,"percent of total billed charges ","85% of total billed charges ",10.38,90,,8.30,,,0,"percent of total billed charges ","90% of total billed charges ",10.38,90,,8.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.03,87,,8.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.07,70,,6.46,,,0,"percent of total billed charges ","70% of total billed charges ",3.91,10.72,
"POUCH DRAIN SUREFIT",6005823,"CDM ",272,RC,A4377,HCPCS,OUTPATIENT,,,23,18.4,,,,,,,,0,"other ","not separately reimbursment ",10.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",16.1,70,,12.88,,,0,"percent of total billed charges ","70% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",21.39,93,,17.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.55,85,,15.64,,,0,"percent of total billed charges ","85% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.01,87,,16.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.1,70,,12.88,,,0,"percent of total billed charges ","70% of total billed charges ",10.02,21.39,
"RING BARRIER 40MM",6005928,"CDM ",272,RC,A4402,HCPCS,OUTPATIENT,,,18.61,14.888,,,,,,,,0,"other ","not separately reimbursment ",2.14,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",13.03,70,,10.42,,,0,"percent of total billed charges ","70% of total billed charges ",16.75,90,,13.40,,,0,"percent of total billed charges ","90% of total billed charges ",17.31,93,,13.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.82,85,,12.66,,,0,"percent of total billed charges ","85% of total billed charges ",16.75,90,,13.40,,,0,"percent of total billed charges ","90% of total billed charges ",16.75,90,,13.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.19,87,,12.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.03,70,,10.42,,,0,"percent of total billed charges ","70% of total billed charges ",2.14,17.31,
"RING BARRIER 50MM",6005929,"CDM ",272,RC,A4402,HCPCS,OUTPATIENT,,,18.46,14.768,,,,,,,,0,"other ","not separately reimbursment ",2.14,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.92,70,,10.34,,,0,"percent of total billed charges ","70% of total billed charges ",16.61,90,,13.29,,,0,"percent of total billed charges ","90% of total billed charges ",17.17,93,,13.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.69,85,,12.55,,,0,"percent of total billed charges ","85% of total billed charges ",16.61,90,,13.29,,,0,"percent of total billed charges ","90% of total billed charges ",16.61,90,,13.29,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.06,87,,12.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.92,70,,10.34,,,0,"percent of total billed charges ","70% of total billed charges ",2.14,17.17,
"BAG COLOSTOMY 64MM",6005930,"CDM ",272,RC,A4377,HCPCS,OUTPATIENT,,,2.41,1.928,,,,,,,,0,"other ","not separately reimbursment ",10.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1.69,70,,1.35,,,0,"percent of total billed charges ","70% of total billed charges ",2.17,90,,1.74,,,0,"percent of total billed charges ","90% of total billed charges ",2.24,93,,1.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2.05,85,,1.64,,,0,"percent of total billed charges ","85% of total billed charges ",2.17,90,,1.74,,,0,"percent of total billed charges ","90% of total billed charges ",2.17,90,,1.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2.1,87,,1.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.69,70,,1.35,,,0,"percent of total billed charges ","70% of total billed charges ",1.69,10.02,
"ODOR ELIMINATOR DROP .5OZ",6005932,"CDM ",272,RC,A4394,HCPCS,OUTPATIENT,,,66.59,53.272,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.61,70,,37.29,,,0,"percent of total billed charges ","70% of total billed charges ",59.93,90,,47.94,,,0,"percent of total billed charges ","90% of total billed charges ",61.93,93,,49.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",56.6,85,,45.28,,,0,"percent of total billed charges ","85% of total billed charges ",59.93,90,,47.94,,,0,"percent of total billed charges ","90% of total billed charges ",59.93,90,,47.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",57.93,87,,46.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.61,70,,37.29,,,0,"percent of total billed charges ","70% of total billed charges ",46.61,61.93,
"POWDER PREMIUM STOMA",6005938,"CDM ",272,RC,A4421,HCPCS,OUTPATIENT,,,20.36,16.288,,,,,,,,0,"other ","not separately reimbursment ",5.04,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",14.25,70,,11.40,,,0,"percent of total billed charges ","70% of total billed charges ",18.32,90,,14.66,,,0,"percent of total billed charges ","90% of total billed charges ",18.93,93,,15.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.31,85,,13.85,,,0,"percent of total billed charges ","85% of total billed charges ",18.32,90,,14.66,,,0,"percent of total billed charges ","90% of total billed charges ",18.32,90,,14.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.71,87,,14.17,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.25,70,,11.40,,,0,"percent of total billed charges ","70% of total billed charges ",5.04,18.93,
"POUCH OSTOMY 11"" K",6005941,"CDM ",272,RC,A4377,HCPCS,OUTPATIENT,,,16.95,13.56,,,,,,,,0,"other ","not separately reimbursment ",10.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",11.87,70,,9.50,,,0,"percent of total billed charges ","70% of total billed charges ",15.26,90,,12.21,,,0,"percent of total billed charges ","90% of total billed charges ",15.76,93,,12.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.41,85,,11.53,,,0,"percent of total billed charges ","85% of total billed charges ",15.26,90,,12.21,,,0,"percent of total billed charges ","90% of total billed charges ",15.26,90,,12.21,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.75,87,,11.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.87,70,,9.50,,,0,"percent of total billed charges ","70% of total billed charges ",10.02,15.76,
"PASTE PREMIUM OSTOMY",6005942,"CDM ",272,RC,K0138,HCPCS,OUTPATIENT,,,47.56,38.048,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.29,70,,26.63,,,0,"percent of total billed charges ","70% of total billed charges ",42.8,90,,34.24,,,0,"percent of total billed charges ","90% of total billed charges ",44.23,93,,35.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.43,85,,32.34,,,0,"percent of total billed charges ","85% of total billed charges ",42.8,90,,34.24,,,0,"percent of total billed charges ","90% of total billed charges ",42.8,90,,34.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.38,87,,33.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.29,70,,26.63,,,0,"percent of total billed charges ","70% of total billed charges ",33.29,44.23,
"BELT LG OSTOMY",6005943,"CDM ",272,RC,A4367,HCPCS,OUTPATIENT,,,24.47,19.576,,,,,,,,0,"other ","not separately reimbursment ",10.45,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.13,70,,13.70,,,0,"percent of total billed charges ","70% of total billed charges ",22.02,90,,17.62,,,0,"percent of total billed charges ","90% of total billed charges ",22.76,93,,18.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.8,85,,16.64,,,0,"percent of total billed charges ","85% of total billed charges ",22.02,90,,17.62,,,0,"percent of total billed charges ","90% of total billed charges ",22.02,90,,17.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.29,87,,17.03,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.13,70,,13.70,,,0,"percent of total billed charges ","70% of total billed charges ",10.45,22.76,
"FLANGE 2 1/4"" J",6005944,"CDM ",272,RC,A4384,HCPCS,OUTPATIENT,,,22.62,18.096,,,,,,,,0,"other ","not separately reimbursment ",47.83,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15.83,70,,12.66,,,0,"percent of total billed charges ","70% of total billed charges ",20.36,90,,16.29,,,0,"percent of total billed charges ","90% of total billed charges ",21.04,93,,16.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.23,85,,15.38,,,0,"percent of total billed charges ","85% of total billed charges ",20.36,90,,16.29,,,0,"percent of total billed charges ","90% of total billed charges ",20.36,90,,16.29,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.68,87,,15.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.83,70,,12.66,,,0,"percent of total billed charges ","70% of total billed charges ",15.83,47.83,
"POUCH OSTOMY 11"" J",6005945,"CDM ",272,RC,A4377,HCPCS,OUTPATIENT,,,22.57,18.056,,,,,,,,0,"other ","not separately reimbursment ",10.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15.8,70,,12.64,,,0,"percent of total billed charges ","70% of total billed charges ",20.31,90,,16.25,,,0,"percent of total billed charges ","90% of total billed charges ",20.99,93,,16.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.18,85,,15.34,,,0,"percent of total billed charges ","85% of total billed charges ",20.31,90,,16.25,,,0,"percent of total billed charges ","90% of total billed charges ",20.31,90,,16.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.64,87,,15.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.8,70,,12.64,,,0,"percent of total billed charges ","70% of total billed charges ",10.02,20.99,
"SURE CLEANSE 20ML",6006059,"CDM ",272,RC,A4214,HCPCS,OUTPATIENT,,,7.27,5.816,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.09,70,,4.07,,,0,"percent of total billed charges ","70% of total billed charges ",6.54,90,,5.23,,,0,"percent of total billed charges ","90% of total billed charges ",6.76,93,,5.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6.18,85,,4.94,,,0,"percent of total billed charges ","85% of total billed charges ",6.54,90,,5.23,,,0,"percent of total billed charges ","90% of total billed charges ",6.54,90,,5.23,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.32,87,,5.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.09,70,,4.07,,,0,"percent of total billed charges ","70% of total billed charges ",5.09,6.76,
"FLANGE 2"" K",6006207,"CDM ",272,RC,A4384,HCPCS,OUTPATIENT,,,23.12,18.496,,,,,,,,0,"other ","not separately reimbursment ",47.83,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",16.18,70,,12.94,,,0,"percent of total billed charges ","70% of total billed charges ",20.81,90,,16.65,,,0,"percent of total billed charges ","90% of total billed charges ",21.5,93,,17.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.65,85,,15.72,,,0,"percent of total billed charges ","85% of total billed charges ",20.81,90,,16.65,,,0,"percent of total billed charges ","90% of total billed charges ",20.81,90,,16.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.11,87,,16.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.18,70,,12.94,,,0,"percent of total billed charges ","70% of total billed charges ",16.18,47.83,
"FLANGE 2 1/2"" D",6006208,"CDM ",272,RC,A4385,HCPCS,OUTPATIENT,,,22.47,17.976,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.73,70,,12.58,,,0,"percent of total billed charges ","70% of total billed charges ",20.22,90,,16.18,,,0,"percent of total billed charges ","90% of total billed charges ",20.9,93,,16.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.1,85,,15.28,,,0,"percent of total billed charges ","85% of total billed charges ",20.22,90,,16.18,,,0,"percent of total billed charges ","90% of total billed charges ",20.22,90,,16.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.55,87,,15.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.73,70,,12.58,,,0,"percent of total billed charges ","70% of total billed charges ",15.73,20.9,
"FLANGE 1 1/2"" H",6006209,"CDM ",272,RC,A4385,HCPCS,OUTPATIENT,,,28.74,22.992,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.12,70,,16.10,,,0,"percent of total billed charges ","70% of total billed charges ",25.87,90,,20.70,,,0,"percent of total billed charges ","90% of total billed charges ",26.73,93,,21.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",24.43,85,,19.54,,,0,"percent of total billed charges ","85% of total billed charges ",25.87,90,,20.70,,,0,"percent of total billed charges ","90% of total billed charges ",25.87,90,,20.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",25,87,,20.00,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.12,70,,16.10,,,0,"percent of total billed charges ","70% of total billed charges ",20.12,26.73,
"FLANGE COLOSTOMY L",6006221,"CDM ",272,RC,A4373,HCPCS,OUTPATIENT,,,32.1,25.68,,,,,,,,0,"other ","not separately reimbursment ",7.11,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.47,70,,17.98,,,0,"percent of total billed charges ","70% of total billed charges ",28.89,90,,23.11,,,0,"percent of total billed charges ","90% of total billed charges ",29.85,93,,23.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",27.29,85,,21.83,,,0,"percent of total billed charges ","85% of total billed charges ",28.89,90,,23.11,,,0,"percent of total billed charges ","90% of total billed charges ",28.89,90,,23.11,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",27.93,87,,22.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.47,70,,17.98,,,0,"percent of total billed charges ","70% of total billed charges ",7.11,29.85,
"POUCH OSTOMY L",6006222,"CDM ",272,RC,A4377,HCPCS,OUTPATIENT,,,13.99,11.192,,,,,,,,0,"other ","not separately reimbursment ",10.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",9.79,70,,7.83,,,0,"percent of total billed charges ","70% of total billed charges ",12.59,90,,10.07,,,0,"percent of total billed charges ","90% of total billed charges ",13.01,93,,10.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.89,85,,9.51,,,0,"percent of total billed charges ","85% of total billed charges ",12.59,90,,10.07,,,0,"percent of total billed charges ","90% of total billed charges ",12.59,90,,10.07,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.17,87,,9.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.79,70,,7.83,,,0,"percent of total billed charges ","70% of total billed charges ",9.79,13.01,
"FLANGE 1 3/4"" I",6006236,"CDM ",272,RC,A4385,HCPCS,OUTPATIENT,,,22.37,17.896,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.66,70,,12.53,,,0,"percent of total billed charges ","70% of total billed charges ",20.13,90,,16.10,,,0,"percent of total billed charges ","90% of total billed charges ",20.8,93,,16.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.01,85,,15.21,,,0,"percent of total billed charges ","85% of total billed charges ",20.13,90,,16.10,,,0,"percent of total billed charges ","90% of total billed charges ",20.13,90,,16.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.46,87,,15.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.66,70,,12.53,,,0,"percent of total billed charges ","70% of total billed charges ",15.66,20.8,
"POUCH 1 3/4"" I",6006237,"CDM ",272,RC,A4377,HCPCS,OUTPATIENT,,,17.45,13.96,,,,,,,,0,"other ","not separately reimbursment ",10.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.22,70,,9.78,,,0,"percent of total billed charges ","70% of total billed charges ",15.71,90,,12.57,,,0,"percent of total billed charges ","90% of total billed charges ",16.23,93,,12.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.83,85,,11.86,,,0,"percent of total billed charges ","85% of total billed charges ",15.71,90,,12.57,,,0,"percent of total billed charges ","90% of total billed charges ",15.71,90,,12.57,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.18,87,,12.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.22,70,,9.78,,,0,"percent of total billed charges ","70% of total billed charges ",10.02,16.23,
"COLLECTOR FECAL INCONTINENCE",6006238,"CDM ",272,RC,A4330,HCPCS,OUTPATIENT,,,35.96,28.768,,,,,,,,0,"other ","not separately reimbursment ",11.12,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",25.17,70,,20.14,,,0,"percent of total billed charges ","70% of total billed charges ",32.36,90,,25.89,,,0,"percent of total billed charges ","90% of total billed charges ",33.44,93,,26.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",30.57,85,,24.46,,,0,"percent of total billed charges ","85% of total billed charges ",32.36,90,,25.89,,,0,"percent of total billed charges ","90% of total billed charges ",32.36,90,,25.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",31.29,87,,25.03,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.17,70,,20.14,,,0,"percent of total billed charges ","70% of total billed charges ",11.12,33.44,
"POUCH NEWIMAGE 1 3/4""",6006288,"CDM ",272,RC,A4377,HCPCS,OUTPATIENT,,,13.74,10.992,,,,,,,,0,"other ","not separately reimbursment ",10.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",9.62,70,,7.70,,,0,"percent of total billed charges ","70% of total billed charges ",12.37,90,,9.90,,,0,"percent of total billed charges ","90% of total billed charges ",12.78,93,,10.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.68,85,,9.34,,,0,"percent of total billed charges ","85% of total billed charges ",12.37,90,,9.90,,,0,"percent of total billed charges ","90% of total billed charges ",12.37,90,,9.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.95,87,,9.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.62,70,,7.70,,,0,"percent of total billed charges ","70% of total billed charges ",9.62,12.78,
"POUCH NEWIMAGE 2 3/4""",6006289,"CDM ",272,RC,A4377,HCPCS,OUTPATIENT,,,10.78,8.624,,,,,,,,0,"other ","not separately reimbursment ",10.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",7.55,70,,6.04,,,0,"percent of total billed charges ","70% of total billed charges ",9.7,90,,7.76,,,0,"percent of total billed charges ","90% of total billed charges ",10.03,93,,8.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.16,85,,7.33,,,0,"percent of total billed charges ","85% of total billed charges ",9.7,90,,7.76,,,0,"percent of total billed charges ","90% of total billed charges ",9.7,90,,7.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.38,87,,7.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.55,70,,6.04,,,0,"percent of total billed charges ","70% of total billed charges ",7.55,10.03,
"FLANGE NEWIMAGE 1 3/4""",6006290,"CDM ",272,RC,A4386,HCPCS,OUTPATIENT,,,26.38,21.104,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.47,70,,14.78,,,0,"percent of total billed charges ","70% of total billed charges ",23.74,90,,18.99,,,0,"percent of total billed charges ","90% of total billed charges ",24.53,93,,19.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",22.42,85,,17.94,,,0,"percent of total billed charges ","85% of total billed charges ",23.74,90,,18.99,,,0,"percent of total billed charges ","90% of total billed charges ",23.74,90,,18.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.95,87,,18.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.47,70,,14.78,,,0,"percent of total billed charges ","70% of total billed charges ",18.47,24.53,
"FLANGE NEWIMAGE 2 3/4""",6006291,"CDM ",272,RC,A4386,HCPCS,OUTPATIENT,,,20.91,16.728,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.64,70,,11.71,,,0,"percent of total billed charges ","70% of total billed charges ",18.82,90,,15.06,,,0,"percent of total billed charges ","90% of total billed charges ",19.45,93,,15.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.77,85,,14.22,,,0,"percent of total billed charges ","85% of total billed charges ",18.82,90,,15.06,,,0,"percent of total billed charges ","90% of total billed charges ",18.82,90,,15.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.19,87,,14.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.64,70,,11.71,,,0,"percent of total billed charges ","70% of total billed charges ",14.64,19.45,
"BAG 1 3/4"" STOMA",6006304,"CDM ",272,RC,A4377,HCPCS,OUTPATIENT,,,7.5,6,,,,,,,,0,"other ","not separately reimbursment ",10.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",5.25,70,,4.20,,,0,"percent of total billed charges ","70% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",6.98,93,,5.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6.38,85,,5.10,,,0,"percent of total billed charges ","85% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.53,87,,5.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.25,70,,4.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,10.02,
"FLANGE 1 3/4"" COLOSTOMY",6006327,"CDM ",272,RC,A4385,HCPCS,OUTPATIENT,,,53.74,42.992,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.62,70,,30.10,,,0,"percent of total billed charges ","70% of total billed charges ",48.37,90,,38.70,,,0,"percent of total billed charges ","90% of total billed charges ",49.98,93,,39.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",45.68,85,,36.54,,,0,"percent of total billed charges ","85% of total billed charges ",48.37,90,,38.70,,,0,"percent of total billed charges ","90% of total billed charges ",48.37,90,,38.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",46.75,87,,37.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.62,70,,30.10,,,0,"percent of total billed charges ","70% of total billed charges ",37.62,49.98,
"FLANGE 2 3/4"" COLOSTOMY",6006328,"CDM ",272,RC,A4385,HCPCS,OUTPATIENT,,,53.74,42.992,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.62,70,,30.10,,,0,"percent of total billed charges ","70% of total billed charges ",48.37,90,,38.70,,,0,"percent of total billed charges ","90% of total billed charges ",49.98,93,,39.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",45.68,85,,36.54,,,0,"percent of total billed charges ","85% of total billed charges ",48.37,90,,38.70,,,0,"percent of total billed charges ","90% of total billed charges ",48.37,90,,38.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",46.75,87,,37.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.62,70,,30.10,,,0,"percent of total billed charges ","70% of total billed charges ",37.62,49.98,
"FLANGE 1 1/2""",6006329,"CDM ",272,RC,A4385,HCPCS,OUTPATIENT,,,33.5,26.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",31.16,93,,24.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.48,85,,22.78,,,0,"percent of total billed charges ","85% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.15,87,,23.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",23.45,31.16,
"POUCH 1 1/2"" OPAQUE",6006330,"CDM ",272,RC,A4377,HCPCS,OUTPATIENT,,,12.39,9.912,,,,,,,,0,"other ","not separately reimbursment ",10.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,70,,6.94,,,0,"percent of total billed charges ","70% of total billed charges ",11.15,90,,8.92,,,0,"percent of total billed charges ","90% of total billed charges ",11.52,93,,9.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.53,85,,8.42,,,0,"percent of total billed charges ","85% of total billed charges ",11.15,90,,8.92,,,0,"percent of total billed charges ","90% of total billed charges ",11.15,90,,8.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.78,87,,8.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,70,,6.94,,,0,"percent of total billed charges ","70% of total billed charges ",8.67,11.52,
"POUCH 1 3/4"" OPAQUE",6006331,"CDM ",272,RC,A4377,HCPCS,OUTPATIENT,,,12.14,9.712,,,,,,,,0,"other ","not separately reimbursment ",10.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.5,70,,6.80,,,0,"percent of total billed charges ","70% of total billed charges ",10.93,90,,8.74,,,0,"percent of total billed charges ","90% of total billed charges ",11.29,93,,9.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.32,85,,8.26,,,0,"percent of total billed charges ","85% of total billed charges ",10.93,90,,8.74,,,0,"percent of total billed charges ","90% of total billed charges ",10.93,90,,8.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.56,87,,8.45,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.5,70,,6.80,,,0,"percent of total billed charges ","70% of total billed charges ",8.5,11.29,
"FLANGE OSTOMY 1 3/4"" I",6006344,"CDM ",272,RC,A4373,HCPCS,OUTPATIENT,,,25.18,20.144,,,,,,,,0,"other ","not separately reimbursment ",7.11,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.63,70,,14.10,,,0,"percent of total billed charges ","70% of total billed charges ",22.66,90,,18.13,,,0,"percent of total billed charges ","90% of total billed charges ",23.42,93,,18.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.4,85,,17.12,,,0,"percent of total billed charges ","85% of total billed charges ",22.66,90,,18.13,,,0,"percent of total billed charges ","90% of total billed charges ",22.66,90,,18.13,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.91,87,,17.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.63,70,,14.10,,,0,"percent of total billed charges ","70% of total billed charges ",7.11,23.42,
"FLANGE AUTOLOC 1 3/4""",6006348,"CDM ",272,RC,A4409,HCPCS,OUTPATIENT,,,24.57,19.656,,,,,,,,0,"other ","not separately reimbursment ",8.81,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.2,70,,13.76,,,0,"percent of total billed charges ","70% of total billed charges ",22.11,90,,17.69,,,0,"percent of total billed charges ","90% of total billed charges ",22.85,93,,18.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.88,85,,16.70,,,0,"percent of total billed charges ","85% of total billed charges ",22.11,90,,17.69,,,0,"percent of total billed charges ","90% of total billed charges ",22.11,90,,17.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.38,87,,17.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.2,70,,13.76,,,0,"percent of total billed charges ","70% of total billed charges ",8.81,22.85,
"POUCH DRAINABLE TRANSPARENT 2",6006365,"CDM ",272,RC,A4377,HCPCS,OUTPATIENT,,,44.13,35.304,,,,,,,,0,"other ","not separately reimbursment ",10.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30.89,70,,24.71,,,0,"percent of total billed charges ","70% of total billed charges ",39.72,90,,31.78,,,0,"percent of total billed charges ","90% of total billed charges ",41.04,93,,32.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",37.51,85,,30.01,,,0,"percent of total billed charges ","85% of total billed charges ",39.72,90,,31.78,,,0,"percent of total billed charges ","90% of total billed charges ",39.72,90,,31.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",38.39,87,,30.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.89,70,,24.71,,,0,"percent of total billed charges ","70% of total billed charges ",10.02,41.04,
"FLANGE 1 1/2"" J",6006406,"CDM ",272,RC,A4409,HCPCS,OUTPATIENT,,,39.87,31.896,,,,,,,,0,"other ","not separately reimbursment ",8.81,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",27.91,70,,22.33,,,0,"percent of total billed charges ","70% of total billed charges ",35.88,90,,28.70,,,0,"percent of total billed charges ","90% of total billed charges ",37.08,93,,29.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.89,85,,27.11,,,0,"percent of total billed charges ","85% of total billed charges ",35.88,90,,28.70,,,0,"percent of total billed charges ","90% of total billed charges ",35.88,90,,28.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",34.69,87,,27.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.91,70,,22.33,,,0,"percent of total billed charges ","70% of total billed charges ",8.81,37.08,
"FLANGE NEWIMAGE 1 3/4",6006408,"CDM ",272,RC,A4385,HCPCS,OUTPATIENT,,,22.62,18.096,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.83,70,,12.66,,,0,"percent of total billed charges ","70% of total billed charges ",20.36,90,,16.29,,,0,"percent of total billed charges ","90% of total billed charges ",21.04,93,,16.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.23,85,,15.38,,,0,"percent of total billed charges ","85% of total billed charges ",20.36,90,,16.29,,,0,"percent of total billed charges ","90% of total billed charges ",20.36,90,,16.29,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.68,87,,15.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.83,70,,12.66,,,0,"percent of total billed charges ","70% of total billed charges ",15.83,21.04,
"FLANGE 2 1/4"" AUTOLOCK",6006463,"CDM ",272,RC,A4409,HCPCS,OUTPATIENT,,,21,16.8,,,,,,,,0,"other ","not separately reimbursment ",8.81,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",14.7,70,,11.76,,,0,"percent of total billed charges ","70% of total billed charges ",18.9,90,,15.12,,,0,"percent of total billed charges ","90% of total billed charges ",19.53,93,,15.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.85,85,,14.28,,,0,"percent of total billed charges ","85% of total billed charges ",18.9,90,,15.12,,,0,"percent of total billed charges ","90% of total billed charges ",18.9,90,,15.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.27,87,,14.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.7,70,,11.76,,,0,"percent of total billed charges ","70% of total billed charges ",8.81,19.53,
"POUCH 12""",6006464,"CDM ",272,RC,A5063,HCPCS,OUTPATIENT,,,7.5,6,,,,,,,,0,"other ","not separately reimbursment ",3.91,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",5.25,70,,4.20,,,0,"percent of total billed charges ","70% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",6.98,93,,5.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6.38,85,,5.10,,,0,"percent of total billed charges ","85% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.53,87,,5.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.25,70,,4.20,,,0,"percent of total billed charges ","70% of total billed charges ",3.91,6.98,
"FLANGE 1 3/4"" UROSTOMY",6006523,"CDM ",272,RC,A5073,HCPCS,OUTPATIENT,,,43.88,35.104,,,,,,,,0,"other ","not separately reimbursment ",4.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30.72,70,,24.58,,,0,"percent of total billed charges ","70% of total billed charges ",39.49,90,,31.59,,,0,"percent of total billed charges ","90% of total billed charges ",40.81,93,,32.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",37.3,85,,29.84,,,0,"percent of total billed charges ","85% of total billed charges ",39.49,90,,31.59,,,0,"percent of total billed charges ","90% of total billed charges ",39.49,90,,31.59,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",38.18,87,,30.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.72,70,,24.58,,,0,"percent of total billed charges ","70% of total billed charges ",4.53,40.81,
"FLANGE 2 3/4"" UROSTOMY",6006524,"CDM ",272,RC,A5073,HCPCS,OUTPATIENT,,,44.23,35.384,,,,,,,,0,"other ","not separately reimbursment ",4.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30.96,70,,24.77,,,0,"percent of total billed charges ","70% of total billed charges ",39.81,90,,31.85,,,0,"percent of total billed charges ","90% of total billed charges ",41.13,93,,32.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",37.6,85,,30.08,,,0,"percent of total billed charges ","85% of total billed charges ",39.81,90,,31.85,,,0,"percent of total billed charges ","90% of total billed charges ",39.81,90,,31.85,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",38.48,87,,30.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.96,70,,24.77,,,0,"percent of total billed charges ","70% of total billed charges ",4.53,41.13,
"OSTOMY BAG 70MM",6006533,"CDM ",272,RC,A5063,HCPCS,OUTPATIENT,,,3.51,2.808,,,,,,,,0,"other ","not separately reimbursment ",3.91,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2.46,70,,1.97,,,0,"percent of total billed charges ","70% of total billed charges ",3.16,90,,2.53,,,0,"percent of total billed charges ","90% of total billed charges ",3.26,93,,2.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2.98,85,,2.38,,,0,"percent of total billed charges ","85% of total billed charges ",3.16,90,,2.53,,,0,"percent of total billed charges ","90% of total billed charges ",3.16,90,,2.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3.05,87,,2.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.46,70,,1.97,,,0,"percent of total billed charges ","70% of total billed charges ",2.46,3.91,
"OSTOMY KIT 2-3/4""",6006534,"CDM ",272,RC,A4409,HCPCS,OUTPATIENT,,,3.39,2.712,,,,,,,,0,"other ","not separately reimbursment ",8.81,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2.37,70,,1.90,,,0,"percent of total billed charges ","70% of total billed charges ",3.05,90,,2.44,,,0,"percent of total billed charges ","90% of total billed charges ",3.15,93,,2.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2.88,85,,2.30,,,0,"percent of total billed charges ","85% of total billed charges ",3.05,90,,2.44,,,0,"percent of total billed charges ","90% of total billed charges ",3.05,90,,2.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2.95,87,,2.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.37,70,,1.90,,,0,"percent of total billed charges ","70% of total billed charges ",2.37,8.81,
"GRAFT NUSHIELD 6CM X 6CM",6006570,"CDM ",636,RC,Q4160,HCPCS,OUTPATIENT,,,4038.38,3230.704,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2826.87,70,,2261.50,,,0,"percent of total billed charges ","70% of total billed charges ",3634.54,90,,2907.63,,,0,"percent of total billed charges ","90% of total billed charges ",3755.69,93,,3004.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3432.62,85,,2746.10,,,0,"percent of total billed charges ","85% of total billed charges ",3634.54,90,,2907.63,,,0,"percent of total billed charges ","90% of total billed charges ",3634.54,90,,2907.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3513.39,87,,2810.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2826.87,70,,2261.50,,,0,"percent of total billed charges ","70% of total billed charges ",114.44,3755.69,
"DRESSING RESTORE 4X4 CX",6006573,"CDM ",272,RC,A4372,HCPCS,OUTPATIENT,,,18.41,14.728,,,,,,,,0,"other ","not separately reimbursment ",13.84,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.89,70,,10.31,,,0,"percent of total billed charges ","70% of total billed charges ",16.57,90,,13.26,,,0,"percent of total billed charges ","90% of total billed charges ",17.12,93,,13.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.65,85,,12.52,,,0,"percent of total billed charges ","85% of total billed charges ",16.57,90,,13.26,,,0,"percent of total billed charges ","90% of total billed charges ",16.57,90,,13.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.02,87,,12.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,70,,10.31,,,0,"percent of total billed charges ","70% of total billed charges ",12.89,17.12,
"BAG COLOSTOMY OPAQUE 1 1/",6006755,"CDM ",272,RC,A4377,HCPCS,OUTPATIENT,,,10.63,8.504,,,,,,,,0,"other ","not separately reimbursment ",10.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",7.44,70,,5.95,,,0,"percent of total billed charges ","70% of total billed charges ",9.57,90,,7.66,,,0,"percent of total billed charges ","90% of total billed charges ",9.89,93,,7.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.04,85,,7.23,,,0,"percent of total billed charges ","85% of total billed charges ",9.57,90,,7.66,,,0,"percent of total billed charges ","90% of total billed charges ",9.57,90,,7.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.25,87,,7.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.44,70,,5.95,,,0,"percent of total billed charges ","70% of total billed charges ",7.44,10.02,
"POUCH OPAQUE CUT TO FIT",6006872,"CDM ",272,RC,A4388,HCPCS,OUTPATIENT,,,13.29,10.632,,,,,,,,0,"other ","not separately reimbursment ",5.45,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",9.3,70,,7.44,,,0,"percent of total billed charges ","70% of total billed charges ",11.96,90,,9.57,,,0,"percent of total billed charges ","90% of total billed charges ",12.36,93,,9.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.3,85,,9.04,,,0,"percent of total billed charges ","85% of total billed charges ",11.96,90,,9.57,,,0,"percent of total billed charges ","90% of total billed charges ",11.96,90,,9.57,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.56,87,,9.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.3,70,,7.44,,,0,"percent of total billed charges ","70% of total billed charges ",5.45,12.36,
"POUCH UNIT W/FLANGE",6006877,"CDM ",272,RC,A4389,HCPCS,OUTPATIENT,,,35.31,28.248,,,,,,,,0,"other ","not separately reimbursment ",7.72,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24.72,70,,19.78,,,0,"percent of total billed charges ","70% of total billed charges ",31.78,90,,25.42,,,0,"percent of total billed charges ","90% of total billed charges ",32.84,93,,26.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",30.01,85,,24.01,,,0,"percent of total billed charges ","85% of total billed charges ",31.78,90,,25.42,,,0,"percent of total billed charges ","90% of total billed charges ",31.78,90,,25.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.72,87,,24.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.72,70,,19.78,,,0,"percent of total billed charges ","70% of total billed charges ",7.72,32.84,
"POUCH J CUT TO FIT",6006893,"CDM ",272,RC,A4409,HCPCS,OUTPATIENT,,,19.51,15.608,,,,,,,,0,"other ","not separately reimbursment ",8.81,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",13.66,70,,10.93,,,0,"percent of total billed charges ","70% of total billed charges ",17.56,90,,14.05,,,0,"percent of total billed charges ","90% of total billed charges ",18.14,93,,14.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.58,85,,13.26,,,0,"percent of total billed charges ","85% of total billed charges ",17.56,90,,14.05,,,0,"percent of total billed charges ","90% of total billed charges ",17.56,90,,14.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.97,87,,13.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.66,70,,10.93,,,0,"percent of total billed charges ","70% of total billed charges ",8.81,18.14,
"WRAP WRIST/THUMB SM",6007335,"CDM ",271,RC,L3908,HCPCS,OUTPATIENT,,,42.63,34.104,,52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.84,70,,23.87,,,0,"percent of total billed charges ","70% of total billed charges ",38.37,90,,30.70,,,0,"percent of total billed charges ","90% of total billed charges ",39.65,93,,31.72,,,0,"percent of total billed charges ","93% of total billed charges ",52.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",36.24,85,,28.99,,,0,"percent of total billed charges ","85% of total billed charges ",38.37,90,,30.70,,,0,"percent of total billed charges ","90% of total billed charges ",38.37,90,,30.70,,,0,"percent of total billed charges ","90% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.09,87,,29.67,,,0,"percent of total billed charges ","87% of total billed charges ",35.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",29.84,70,,23.87,,,0,"percent of total billed charges ","70% of total billed charges ",29.84,52.43,
"PURAPLY AM 3X4 CM",6007915,"CDM ",636,RC,Q4196,HCPCS,OUTPATIENT,,,2268.75,1815,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",2109.94,93,,1687.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1973.81,87,,1579.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",114.44,2109.94,
"PURAPLY AM 3X4 CM",6007915,"CDM ",636,RC,Q4196,HCPCS,OUTPATIENT,,,2268.75,1815,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",2109.94,93,,1687.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1973.81,87,,1579.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",114.44,2109.94,
"PURAPLY AM 6X9CM",6008003,"CDM ",636,RC,Q4195,HCPCS,OUTPATIENT,,,9310.95,7448.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6517.67,70,,5214.14,,,0,"percent of total billed charges ","70% of total billed charges ",8379.86,90,,6703.89,,,0,"percent of total billed charges ","90% of total billed charges ",8659.18,93,,6927.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7914.31,85,,6331.45,,,0,"percent of total billed charges ","85% of total billed charges ",8379.86,90,,6703.89,,,0,"percent of total billed charges ","90% of total billed charges ",8379.86,90,,6703.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",8100.53,87,,6480.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",6517.67,70,,5214.14,,,0,"percent of total billed charges ","70% of total billed charges ",114.44,8659.18,
"PURAPLY AM 5X5 CM",6008047,"CDM ",636,RC,Q4196,HCPCS,OUTPATIENT,,,4719,3775.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3303.3,70,,2642.64,,,0,"percent of total billed charges ","70% of total billed charges ",4247.1,90,,3397.68,,,0,"percent of total billed charges ","90% of total billed charges ",4388.67,93,,3510.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4011.15,85,,3208.92,,,0,"percent of total billed charges ","85% of total billed charges ",4247.1,90,,3397.68,,,0,"percent of total billed charges ","90% of total billed charges ",4247.1,90,,3397.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4105.53,87,,3284.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3303.3,70,,2642.64,,,0,"percent of total billed charges ","70% of total billed charges ",114.44,4388.67,
"CONT MEDIA SINOGRAFIN 10 ML",6008097,"CDM ",255,RC,Q9963,HCPCS,OUTPATIENT,,,25,20,,,,,,,,0,"other ","not separately reimbursment ",0.91,100,,176.00,176.00,176.00,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.5,70,,14.00,,,0,"percent of total billed charges ","70% of total billed charges ",22.5,90,,18.00,,,0,"percent of total billed charges ","90% of total billed charges ",23.25,93,,18.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.25,85,,17.00,,,0,"percent of total billed charges ","85% of total billed charges ",22.5,90,,18.00,,,0,"percent of total billed charges ","90% of total billed charges ",22.5,90,,18.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.75,87,,17.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.5,70,,14.00,,,0,"percent of total billed charges ","70% of total billed charges ",0.91,23.25,
"CONT MEDIA GASTROGRAFIN 120 ML",6008098,"CDM ",255,RC,Q9963,HCPCS,OUTPATIENT,,,125,100,,,,,,,,0,"other ","not separately reimbursment ",0.91,100,,176.00,176.00,176.00,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",87.5,70,,70.00,,,0,"percent of total billed charges ","70% of total billed charges ",112.5,90,,90.00,,,0,"percent of total billed charges ","90% of total billed charges ",116.25,93,,93.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",106.25,85,,85.00,,,0,"percent of total billed charges ","85% of total billed charges ",112.5,90,,90.00,,,0,"percent of total billed charges ","90% of total billed charges ",112.5,90,,90.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",108.75,87,,87.00,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.5,70,,70.00,,,0,"percent of total billed charges ","70% of total billed charges ",0.91,116.25,
"CONT PEFLUTREN LIP MICROSPHERE",6008230,"CDM ",255,RC,Q9957,HCPCS,OUTPATIENT,,,305.04,244.032,,,,,,,,0,"other ","not separately reimbursment ",96.86,100,,9.91,9.91,9.91,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",213.53,70,,170.82,,,0,"percent of total billed charges ","70% of total billed charges ",274.54,90,,219.63,,,0,"percent of total billed charges ","90% of total billed charges ",283.69,93,,226.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",259.28,85,,207.42,,,0,"percent of total billed charges ","85% of total billed charges ",274.54,90,,219.63,,,0,"percent of total billed charges ","90% of total billed charges ",274.54,90,,219.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",265.38,87,,212.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",213.53,70,,170.82,,,0,"percent of total billed charges ","70% of total billed charges ",96.86,283.69,
"KIT PLEURX CATH PERITONEAL",6008242,"CDM ",272,RC,C1729,HCPCS,OUTPATIENT,,,1403.38,1122.704,,,,,,,,0,"other ","not separately reimbursment ",,,,93.87,93.87,93.87,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",982.37,70,,785.90,,,0,"percent of total billed charges ","70% of total billed charges ",1263.04,90,,1010.43,,,0,"percent of total billed charges ","90% of total billed charges ",1305.14,93,,1044.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1192.87,85,,954.30,,,0,"percent of total billed charges ","85% of total billed charges ",1263.04,90,,1010.43,,,0,"percent of total billed charges ","90% of total billed charges ",1263.04,90,,1010.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1220.94,87,,976.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",982.37,70,,785.90,,,0,"percent of total billed charges ","70% of total billed charges ",982.37,1305.14,
"CONT MEDIA ISOVUE 370MG 100ML",6008253,"CDM ",255,RC,Q9967,HCPCS,OUTPATIENT,,,520,416,,,,,,,,0,"other ","not separately reimbursment ",5.05,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",364,70,,291.20,,,0,"percent of total billed charges ","70% of total billed charges ",468,90,,374.40,,,0,"percent of total billed charges ","90% of total billed charges ",483.6,93,,386.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",442,85,,353.60,,,0,"percent of total billed charges ","85% of total billed charges ",468,90,,374.40,,,0,"percent of total billed charges ","90% of total billed charges ",468,90,,374.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",452.4,87,,358.59,260.46,448.24,15,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",364,70,,291.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.05,483.6,
"PURAPLY AM 2X2 CM",6008280,"CDM ",636,RC,Q4196,HCPCS,OUTPATIENT,,,1074.48,859.584,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",752.14,70,,601.71,,,0,"percent of total billed charges ","70% of total billed charges ",967.03,90,,773.62,,,0,"percent of total billed charges ","90% of total billed charges ",999.27,93,,799.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",913.31,85,,730.65,,,0,"percent of total billed charges ","85% of total billed charges ",967.03,90,,773.62,,,0,"percent of total billed charges ","90% of total billed charges ",967.03,90,,773.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",934.8,87,,747.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",752.14,70,,601.71,,,0,"percent of total billed charges ","70% of total billed charges ",114.44,999.27,
"PURAPLY AM 2X2 CM",6008280,"CDM ",636,RC,Q4196,HCPCS,OUTPATIENT,,,1074.48,859.584,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",752.14,70,,601.71,,,0,"percent of total billed charges ","70% of total billed charges ",967.03,90,,773.62,,,0,"percent of total billed charges ","90% of total billed charges ",999.27,93,,799.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",913.31,85,,730.65,,,0,"percent of total billed charges ","85% of total billed charges ",967.03,90,,773.62,,,0,"percent of total billed charges ","90% of total billed charges ",967.03,90,,773.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",934.8,87,,747.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",752.14,70,,601.71,,,0,"percent of total billed charges ","70% of total billed charges ",114.44,999.27,
"GRAFT GRAFIX PRIME 5CM X 5CM",6008443,"CDM ",636,RC,Q4133,HCPCS,OUTPATIENT,,,4473.97,3579.176,,,,,,,,0,"other ","not separately reimbursment ",188.87,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3131.78,70,,2505.42,,,0,"percent of total billed charges ","70% of total billed charges ",4026.57,90,,3221.26,,,0,"percent of total billed charges ","90% of total billed charges ",4160.79,93,,3328.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3802.87,85,,3042.30,,,0,"percent of total billed charges ","85% of total billed charges ",4026.57,90,,3221.26,,,0,"percent of total billed charges ","90% of total billed charges ",4026.57,90,,3221.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3892.35,87,,3113.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3131.78,70,,2505.42,,,0,"percent of total billed charges ","70% of total billed charges ",114.44,4160.79,
"CONT MEDIA ISOVUE M 200/20ML",6008499,"CDM ",255,RC,Q9967,HCPCS,OUTPATIENT,,,110,88,,,,,,,,0,"other ","not separately reimbursment ",5.05,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",77,70,,61.60,,,0,"percent of total billed charges ","70% of total billed charges ",99,90,,79.20,,,0,"percent of total billed charges ","90% of total billed charges ",102.3,93,,81.84,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",93.5,85,,74.80,,,0,"percent of total billed charges ","85% of total billed charges ",99,90,,79.20,,,0,"percent of total billed charges ","90% of total billed charges ",99,90,,79.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",95.7,87,,358.59,260.46,448.24,15,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77,70,,61.60,,,0,"percent of total billed charges ","70% of total billed charges ",5.05,102.3,
"GRAFT GRAFIX PRIME 2CM X 3CM",6008503,"CDM ",636,RC,Q4133,HCPCS,OUTPATIENT,,,1860.38,1488.304,,,,,,,,0,"other ","not separately reimbursment ",188.87,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1302.27,70,,1041.82,,,0,"percent of total billed charges ","70% of total billed charges ",1674.34,90,,1339.47,,,0,"percent of total billed charges ","90% of total billed charges ",1730.15,93,,1384.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1581.32,85,,1265.06,,,0,"percent of total billed charges ","85% of total billed charges ",1674.34,90,,1339.47,,,0,"percent of total billed charges ","90% of total billed charges ",1674.34,90,,1339.47,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1618.53,87,,1294.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1302.27,70,,1041.82,,,0,"percent of total billed charges ","70% of total billed charges ",114.44,1730.15,
"GRAFT GRAFIX PRIME 3CM X 4CM",6008504,"CDM ",636,RC,Q4133,HCPCS,OUTPATIENT,,,2277.83,1822.264,,,,,,,,0,"other ","not separately reimbursment ",188.87,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1594.48,70,,1275.58,,,0,"percent of total billed charges ","70% of total billed charges ",2050.05,90,,1640.04,,,0,"percent of total billed charges ","90% of total billed charges ",2118.38,93,,1694.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1936.16,85,,1548.93,,,0,"percent of total billed charges ","85% of total billed charges ",2050.05,90,,1640.04,,,0,"percent of total billed charges ","90% of total billed charges ",2050.05,90,,1640.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1981.71,87,,1585.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1594.48,70,,1275.58,,,0,"percent of total billed charges ","70% of total billed charges ",114.44,2118.38,
"MARKER BREAST BIOPSY 15G",6008565,"CDM ",270,RC,C1819,HCPCS,OUTPATIENT,,,275.32,220.256,,,,,,,,0,"other ","not separately reimbursment ",,,,261.60,261.60,261.60,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.72,70,,154.18,,,0,"percent of total billed charges ","70% of total billed charges ",247.79,90,,198.23,,,0,"percent of total billed charges ","90% of total billed charges ",256.05,93,,204.84,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",234.02,85,,187.22,,,0,"percent of total billed charges ","85% of total billed charges ",247.79,90,,198.23,,,0,"percent of total billed charges ","90% of total billed charges ",247.79,90,,198.23,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",239.53,87,,191.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.72,70,,154.18,,,0,"percent of total billed charges ","70% of total billed charges ",192.72,256.05,
"MARKER TISSUE CARBON 13G 2X4MM",6008566,"CDM ",278,RC,C1819,HCPCS,OUTPATIENT,,,213.13,170.504,,,,,,,,0,"other ","not separately reimbursment ",,,,261.60,261.60,261.60,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.19,70,,119.35,,,0,"percent of total billed charges ","70% of total billed charges ",191.82,90,,153.46,,,0,"percent of total billed charges ","90% of total billed charges ",198.21,93,,158.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",181.16,85,,144.93,,,0,"percent of total billed charges ","85% of total billed charges ",181.16,85,,144.93,,,0,"percent of total billed charges ","85% of total billed charges ",191.82,90,,153.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",185.42,87,,148.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.19,70,,119.35,,,0,"percent of total billed charges ","70% of total billed charges ",149.19,198.21,
"MARKER BREAST BIOPSY 10G",6009650,"CDM ",278,RC,C1819,HCPCS,OUTPATIENT,,,384.71,307.768,,,,,,,,0,"other ","not separately reimbursment ",,,,261.60,261.60,261.60,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",269.3,70,,215.44,,,0,"percent of total billed charges ","70% of total billed charges ",346.24,90,,276.99,,,0,"percent of total billed charges ","90% of total billed charges ",357.78,93,,286.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",327,85,,261.60,,,0,"percent of total billed charges ","85% of total billed charges ",327,85,,261.60,,,0,"percent of total billed charges ","85% of total billed charges ",346.24,90,,276.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",334.7,87,,267.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",269.3,70,,215.44,,,0,"percent of total billed charges ","70% of total billed charges ",269.3,357.78,
"FEMUR NRRW LT SZ 3",6100015,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"SCR CANN 4.0X36MM PT LONG",6100083,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"SCR CANN 4.0 X 40MM PT LONG",6100090,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"SCR CANN 4.0 X 42MM PT LONG",6100100,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"SCR CANN 4.0 X 44MM PT LONG",6100104,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"SCR CANN 4.0 X 46MM PT LONG",6100109,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"SCR CANN 4.0 X 48MM PT LONG",6100110,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"SCR CANN 4.0 X 54MM PT LONG",6100146,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"FEMUR PPS STD RT SZ 6",6100147,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR PPS STD RT SZ 7",6100148,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"CATH COUDE 16FR STR",6100149,"CDM ",272,RC,C1729,HCPCS,OUTPATIENT,,,20,16,,,,,,,,0,"other ","not separately reimbursment ",,,,93.87,93.87,93.87,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14,70,,11.20,,,0,"percent of total billed charges ","70% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",18.6,93,,14.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17,85,,13.60,,,0,"percent of total billed charges ","85% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.4,87,,13.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14,70,,11.20,,,0,"percent of total billed charges ","70% of total billed charges ",14,18.6,
"SCR CANN 4.0X58MM PT LONG",6100164,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,447.72,358.176,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",313.4,70,,250.72,,,0,"percent of total billed charges ","70% of total billed charges ",402.95,90,,322.36,,,0,"percent of total billed charges ","90% of total billed charges ",416.38,93,,333.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",380.56,85,,304.45,,,0,"percent of total billed charges ","85% of total billed charges ",380.56,85,,304.45,,,0,"percent of total billed charges ","85% of total billed charges ",402.95,90,,322.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",389.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",313.4,70,,250.72,,,0,"percent of total billed charges ","70% of total billed charges ",313.4,416.38,
"SCR CANN 4.0 X 68MM PT LONG",6100173,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"FEMUR NRRW LT SZ 4",6100175,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"SCR CANN 4.0 X 72MM PT LONG",6100176,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"PLT HOOK 3.5MM 3H",6100192,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1075.39,860.312,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",752.77,70,,602.22,,,0,"percent of total billed charges ","70% of total billed charges ",967.85,90,,774.28,,,0,"percent of total billed charges ","90% of total billed charges ",1000.11,93,,800.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",914.08,85,,731.26,,,0,"percent of total billed charges ","85% of total billed charges ",914.08,85,,731.26,,,0,"percent of total billed charges ","85% of total billed charges ",967.85,90,,774.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",935.59,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",752.77,70,,602.22,,,0,"percent of total billed charges ","70% of total billed charges ",752.77,1000.11,
"FEMUR PPS STD RT SZ 8",6100201,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR PPS STD RT SZ 9",6100202,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR PPS STD RT SZ 10",6100207,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR PPS STD RT SZ 11",6100209,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"NAIL FEMORAL 14MM*38CM",6100210,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1618,1294.4,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1132.6,70,,906.08,,,0,"percent of total billed charges ","70% of total billed charges ",1456.2,90,,1164.96,,,0,"percent of total billed charges ","90% of total billed charges ",1504.74,93,,1203.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1375.3,85,,1100.24,,,0,"percent of total billed charges ","85% of total billed charges ",1375.3,85,,1100.24,,,0,"percent of total billed charges ","85% of total billed charges ",1456.2,90,,1164.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1407.66,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1132.6,70,,906.08,,,0,"percent of total billed charges ","70% of total billed charges ",1132.6,1504.74,
"FEMUR PPS STD LT SZ 4",6100211,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR PPS STD LT SZ 5",6100215,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"WIRE GUIDE 3.0*100CM",6100222,"CDM ",272,RC,C1769,HCPCS,OUTPATIENT,,,379.75,303.8,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",265.83,70,,212.66,,,0,"percent of total billed charges ","70% of total billed charges ",341.78,90,,273.42,,,0,"percent of total billed charges ","90% of total billed charges ",353.17,93,,282.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",322.79,85,,258.23,,,0,"percent of total billed charges ","85% of total billed charges ",341.78,90,,273.42,,,0,"percent of total billed charges ","90% of total billed charges ",341.78,90,,273.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",330.38,87,,264.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",265.83,70,,212.66,,,0,"percent of total billed charges ","70% of total billed charges ",265.83,353.17,
"WIRE GUIDE 3.0*100CM BULLETTIP",6100223,"CDM ",272,RC,C1769,HCPCS,OUTPATIENT,,,275.84,220.672,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",193.09,70,,154.47,,,0,"percent of total billed charges ","70% of total billed charges ",248.26,90,,198.61,,,0,"percent of total billed charges ","90% of total billed charges ",256.53,93,,205.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",234.46,85,,187.57,,,0,"percent of total billed charges ","85% of total billed charges ",248.26,90,,198.61,,,0,"percent of total billed charges ","90% of total billed charges ",248.26,90,,198.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",239.98,87,,191.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",193.09,70,,154.47,,,0,"percent of total billed charges ","70% of total billed charges ",193.09,256.53,
"FEMUR NRRW LT SZ 5",6100224,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR NRRW LT SZ 6",6100237,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR NRRW LT SZ 7",6100252,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR NRRW LT SZ 8",6100261,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR NRRW LT SZ 9",6100277,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR NRRW LT SZ 10",6100279,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR NRRW LT SZ 11",6100285,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR NRRW RT SZ 3",6100287,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"CATH THORACIC 36FR",6100304,"CDM ",272,RC,C1757,HCPCS,OUTPATIENT,,,23.67,18.936,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.57,70,,13.26,,,0,"percent of total billed charges ","70% of total billed charges ",21.3,90,,17.04,,,0,"percent of total billed charges ","90% of total billed charges ",22.01,93,,17.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.12,85,,16.10,,,0,"percent of total billed charges ","85% of total billed charges ",21.3,90,,17.04,,,0,"percent of total billed charges ","90% of total billed charges ",21.3,90,,17.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.59,87,,16.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.57,70,,13.26,,,0,"percent of total billed charges ","70% of total billed charges ",16.57,22.01,
"CATH THORACIC 24FR",6100306,"CDM ",272,RC,C1757,HCPCS,OUTPATIENT,,,60.76,48.608,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.53,70,,34.02,,,0,"percent of total billed charges ","70% of total billed charges ",54.68,90,,43.74,,,0,"percent of total billed charges ","90% of total billed charges ",56.51,93,,45.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51.65,85,,41.32,,,0,"percent of total billed charges ","85% of total billed charges ",54.68,90,,43.74,,,0,"percent of total billed charges ","90% of total billed charges ",54.68,90,,43.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",52.86,87,,42.29,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.53,70,,34.02,,,0,"percent of total billed charges ","70% of total billed charges ",42.53,56.51,
"CATH THORACIC 28FR",6100307,"CDM ",272,RC,C1757,HCPCS,OUTPATIENT,,,20.06,16.048,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.04,70,,11.23,,,0,"percent of total billed charges ","70% of total billed charges ",18.05,90,,14.44,,,0,"percent of total billed charges ","90% of total billed charges ",18.66,93,,14.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.05,85,,13.64,,,0,"percent of total billed charges ","85% of total billed charges ",18.05,90,,14.44,,,0,"percent of total billed charges ","90% of total billed charges ",18.05,90,,14.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.45,87,,13.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.04,70,,11.23,,,0,"percent of total billed charges ","70% of total billed charges ",14.04,18.66,
"GUIDEWIRE J TIP 0.81MMX60CM",6100308,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,45.87,36.696,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.11,70,,25.69,,,0,"percent of total billed charges ","70% of total billed charges ",41.28,90,,33.02,,,0,"percent of total billed charges ","90% of total billed charges ",42.66,93,,34.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.99,85,,31.19,,,0,"percent of total billed charges ","85% of total billed charges ",38.99,85,,31.19,,,0,"percent of total billed charges ","85% of total billed charges ",41.28,90,,33.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.91,87,,31.93,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.11,70,,25.69,,,0,"percent of total billed charges ","70% of total billed charges ",32.11,42.66,
"WARMER LAPAROSCOPIC SCOPE",6100317,"CDM ",270,RC,C1713,HCPCS,OUTPATIENT,,,46.27,37.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.39,70,,25.91,,,0,"percent of total billed charges ","70% of total billed charges ",41.64,90,,33.31,,,0,"percent of total billed charges ","90% of total billed charges ",43.03,93,,34.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.33,85,,31.46,,,0,"percent of total billed charges ","85% of total billed charges ",41.64,90,,33.31,,,0,"percent of total billed charges ","90% of total billed charges ",41.64,90,,33.31,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.25,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.39,70,,25.91,,,0,"percent of total billed charges ","70% of total billed charges ",32.39,43.03,
"FEMUR NRRW RT SZ 4",6100321,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR NRRW RT SZ 5",6100335,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR NRRW RT SZ 6",6100336,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR NRRW RT SZ 7",6100343,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR NRRW RT SZ 8",6100345,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"SWIVELOCK BC KNOTLESS 5.5MM",6100351,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1040.86,832.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",832.69,80,,666.15,,,0,"percent of total billed charges ","80% of total billed charges ",728.6,70,,582.88,,,0,"percent of total billed charges ","70% of total billed charges ",936.77,90,,749.42,,,0,"percent of total billed charges ","90% of total billed charges ",968,93,,774.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",884.73,85,,707.78,,,0,"percent of total billed charges ","85% of total billed charges ",884.73,85,,707.78,,,0,"percent of total billed charges ","85% of total billed charges ",936.77,90,,749.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",905.55,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",728.6,70,,582.88,,,0,"percent of total billed charges ","70% of total billed charges ",728.6,968,
"FEMUR NRRW RT SZ 9",6100354,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR NRRW RT SZ 10",6100374,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR NRRW RT SZ 11",6100377,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"TAPE CAST 3"" PINK",6100404,"CDM ",272,RC,A4590,HCPCS,OUTPATIENT,,,21.5,17.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.05,70,,12.04,,,0,"percent of total billed charges ","70% of total billed charges ",19.35,90,,15.48,,,0,"percent of total billed charges ","90% of total billed charges ",20,93,,16.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.28,85,,14.62,,,0,"percent of total billed charges ","85% of total billed charges ",19.35,90,,15.48,,,0,"percent of total billed charges ","90% of total billed charges ",19.35,90,,15.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.71,87,,14.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.05,70,,12.04,,,0,"percent of total billed charges ","70% of total billed charges ",15.05,20,
"SLING ARM CHILD",6100428,"CDM ",271,RC,A4565,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"SLING ARM SMALL",6100429,"CDM ",271,RC,A4565,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"SLING ARM MED",6100430,"CDM ",271,RC,A4565,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"CATH ERCP 1-LMT",6100463,"CDM ",272,RC,C1729,HCPCS,OUTPATIENT,,,206.96,165.568,,,,,,,,0,"other ","not separately reimbursment ",,,,93.87,93.87,93.87,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.87,70,,115.90,,,0,"percent of total billed charges ","70% of total billed charges ",186.26,90,,149.01,,,0,"percent of total billed charges ","90% of total billed charges ",192.47,93,,153.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",175.92,85,,140.74,,,0,"percent of total billed charges ","85% of total billed charges ",186.26,90,,149.01,,,0,"percent of total billed charges ","90% of total billed charges ",186.26,90,,149.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",180.06,87,,144.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.87,70,,115.90,,,0,"percent of total billed charges ","70% of total billed charges ",144.87,192.47,
"NAIL TIBIAL 8MM*30CM",6100509,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2813.25,2250.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1969.28,70,,1575.42,,,0,"percent of total billed charges ","70% of total billed charges ",2531.93,90,,2025.54,,,0,"percent of total billed charges ","90% of total billed charges ",2616.32,93,,2093.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2391.26,85,,1913.01,,,0,"percent of total billed charges ","85% of total billed charges ",2391.26,85,,1913.01,,,0,"percent of total billed charges ","85% of total billed charges ",2531.93,90,,2025.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2447.53,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1969.28,70,,1575.42,,,0,"percent of total billed charges ","70% of total billed charges ",1969.28,2616.32,
"SCREW CORTICAL SHAFT 16M",6100533,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,53.5,42.8,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",49.76,93,,39.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",45.48,85,,36.38,,,0,"percent of total billed charges ","85% of total billed charges ",45.48,85,,36.38,,,0,"percent of total billed charges ","85% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",46.55,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",37.45,49.76,
"TIBIA NATURAL STMD 5 DEG LT H",6100537,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2268.75,1815,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",2109.94,93,,1687.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1973.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",1588.13,2109.94,
"CATH CHALANGIOGRAM",6100572,"CDM ",272,RC,C1729,HCPCS,OUTPATIENT,,,94.86,75.888,,,,,,,,0,"other ","not separately reimbursment ",,,,93.87,93.87,93.87,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.4,70,,53.12,,,0,"percent of total billed charges ","70% of total billed charges ",85.37,90,,68.30,,,0,"percent of total billed charges ","90% of total billed charges ",88.22,93,,70.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.63,85,,64.50,,,0,"percent of total billed charges ","85% of total billed charges ",85.37,90,,68.30,,,0,"percent of total billed charges ","90% of total billed charges ",85.37,90,,68.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.53,87,,66.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.4,70,,53.12,,,0,"percent of total billed charges ","70% of total billed charges ",66.4,88.22,
"NAIL TIBIAL 11MM*34CM",6100582,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1497,1197.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1047.9,70,,838.32,,,0,"percent of total billed charges ","70% of total billed charges ",1347.3,90,,1077.84,,,0,"percent of total billed charges ","90% of total billed charges ",1392.21,93,,1113.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1272.45,85,,1017.96,,,0,"percent of total billed charges ","85% of total billed charges ",1272.45,85,,1017.96,,,0,"percent of total billed charges ","85% of total billed charges ",1347.3,90,,1077.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1302.39,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1047.9,70,,838.32,,,0,"percent of total billed charges ","70% of total billed charges ",1047.9,1392.21,
"CATH EMBOLECTOMY 4FR",6100631,"CDM ",272,RC,C1757,HCPCS,OUTPATIENT,,,174.42,139.536,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.09,70,,97.67,,,0,"percent of total billed charges ","70% of total billed charges ",156.98,90,,125.58,,,0,"percent of total billed charges ","90% of total billed charges ",162.21,93,,129.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",148.26,85,,118.61,,,0,"percent of total billed charges ","85% of total billed charges ",156.98,90,,125.58,,,0,"percent of total billed charges ","90% of total billed charges ",156.98,90,,125.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",151.75,87,,121.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.09,70,,97.67,,,0,"percent of total billed charges ","70% of total billed charges ",122.09,162.21,
"MESH SURGICAL SM  3*6",6100668,"CDM ",278,RC,C1781,HCPCS,OUTPATIENT,,,163.58,130.864,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.51,70,,91.61,,,0,"percent of total billed charges ","70% of total billed charges ",147.22,90,,117.78,,,0,"percent of total billed charges ","90% of total billed charges ",152.13,93,,121.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",139.04,85,,111.23,,,0,"percent of total billed charges ","85% of total billed charges ",139.04,85,,111.23,,,0,"percent of total billed charges ","85% of total billed charges ",147.22,90,,117.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",142.31,87,,113.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.51,70,,91.61,,,0,"percent of total billed charges ","70% of total billed charges ",114.51,152.13,
"FEMUR PPS NRRW RT SZ 4",6100776,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR PPS NRRW RT SZ 5",6100778,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR PPS NRRW RT SZ 6",6100780,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR PPS NRRW RT SZ 7",6100783,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR PPS NRRW RT SZ 8",6100804,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR PPS NRRW RT SZ 9",6100806,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR PPS NRRW RT SZ 10",6100840,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR PPS NRRW RT SZ 11",6100864,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR PPS NRRW LT SZ 4",6100874,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR PPS NRRW LT SZ 5",6100875,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR PPS NRRW LT SZ 6",6100880,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR PPS NRRW LT SZ 7",6100898,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR PPS NRRW LT SZ 8",6100899,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"BINDER ABDOMINAL XLGE",6100909,"CDM ",274,RC,L0630,HCPCS,OUTPATIENT,,,73.5,58.8,,,,,,,,0,"other ","not separately reimbursment ",163,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",51.45,163,
"FEMUR PPS NRRW LT SZ 9",6100911,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"SCREW INTERFERENCE 20MM",6100916,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,280,224,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",196,70,,156.80,,,0,"percent of total billed charges ","70% of total billed charges ",252,90,,201.60,,,0,"percent of total billed charges ","90% of total billed charges ",260.4,93,,208.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",238,85,,190.40,,,0,"percent of total billed charges ","85% of total billed charges ",238,85,,190.40,,,0,"percent of total billed charges ","85% of total billed charges ",252,90,,201.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",243.6,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",196,70,,156.80,,,0,"percent of total billed charges ","70% of total billed charges ",196,260.4,
"FEMUR PPS NRRW LT SZ 10",6101003,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"PIN FIXATION 3.2 X 80MM",6101016,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,269.38,215.504,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.57,70,,150.86,,,0,"percent of total billed charges ","70% of total billed charges ",242.44,90,,193.95,,,0,"percent of total billed charges ","90% of total billed charges ",250.52,93,,200.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",228.97,85,,183.18,,,0,"percent of total billed charges ","85% of total billed charges ",228.97,85,,183.18,,,0,"percent of total billed charges ","85% of total billed charges ",242.44,90,,193.95,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.36,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.57,70,,150.86,,,0,"percent of total billed charges ","70% of total billed charges ",188.57,250.52,
"FEMUR PPS NRRW LT SZ 11",6101061,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"SCREW CORTICAL 1.5MM*8MM",6101092,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,97,77.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",90.21,93,,72.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",82.45,85,,65.96,,,0,"percent of total billed charges ","85% of total billed charges ",82.45,85,,65.96,,,0,"percent of total billed charges ","85% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",84.39,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",67.9,90.21,
"SCREW CORTICAL 2.7MM*12MM",6101119,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,71,56.8,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.7,70,,39.76,,,0,"percent of total billed charges ","70% of total billed charges ",63.9,90,,51.12,,,0,"percent of total billed charges ","90% of total billed charges ",66.03,93,,52.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",60.35,85,,48.28,,,0,"percent of total billed charges ","85% of total billed charges ",60.35,85,,48.28,,,0,"percent of total billed charges ","85% of total billed charges ",63.9,90,,51.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",61.77,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.7,70,,39.76,,,0,"percent of total billed charges ","70% of total billed charges ",49.7,66.03,
"STEM KNEE SPLINED V2 14X80MM",6101177,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,3527.45,2821.96,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2469.22,70,,1975.38,,,0,"percent of total billed charges ","70% of total billed charges ",3174.71,90,,2539.77,,,0,"percent of total billed charges ","90% of total billed charges ",3280.53,93,,2624.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2998.33,85,,2398.66,,,0,"percent of total billed charges ","85% of total billed charges ",2998.33,85,,2398.66,,,0,"percent of total billed charges ","85% of total billed charges ",3174.71,90,,2539.77,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3068.88,87,,2455.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2469.22,70,,1975.38,,,0,"percent of total billed charges ","70% of total billed charges ",2469.22,3280.53,
"K-WIRE 1.1MM",6101191,"CDM ",272,RC,C1769,HCPCS,OUTPATIENT,,,18.05,14.44,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.64,70,,10.11,,,0,"percent of total billed charges ","70% of total billed charges ",16.25,90,,13.00,,,0,"percent of total billed charges ","90% of total billed charges ",16.79,93,,13.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.34,85,,12.27,,,0,"percent of total billed charges ","85% of total billed charges ",16.25,90,,13.00,,,0,"percent of total billed charges ","90% of total billed charges ",16.25,90,,13.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.7,87,,12.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.64,70,,10.11,,,0,"percent of total billed charges ","70% of total billed charges ",12.64,16.79,
"TIBIA NATURAL STMD 5 DEG LT F",6101207,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2268.75,1815,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",2109.94,93,,1687.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1973.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",1588.13,2109.94,
"CATH FILIFORM STRAIGHT 3FR",6101224,"CDM ",272,RC,C1758,HCPCS,OUTPATIENT,,,237.19,189.752,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",166.03,70,,132.82,,,0,"percent of total billed charges ","70% of total billed charges ",213.47,90,,170.78,,,0,"percent of total billed charges ","90% of total billed charges ",220.59,93,,176.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",201.61,85,,161.29,,,0,"percent of total billed charges ","85% of total billed charges ",213.47,90,,170.78,,,0,"percent of total billed charges ","90% of total billed charges ",213.47,90,,170.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",206.36,87,,165.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",166.03,70,,132.82,,,0,"percent of total billed charges ","70% of total billed charges ",166.03,220.59,
"CATH FILIFORM SPIRAL 3FR",6101226,"CDM ",272,RC,C1758,HCPCS,OUTPATIENT,,,106.72,85.376,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.7,70,,59.76,,,0,"percent of total billed charges ","70% of total billed charges ",96.05,90,,76.84,,,0,"percent of total billed charges ","90% of total billed charges ",99.25,93,,79.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",90.71,85,,72.57,,,0,"percent of total billed charges ","85% of total billed charges ",96.05,90,,76.84,,,0,"percent of total billed charges ","90% of total billed charges ",96.05,90,,76.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",92.85,87,,74.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.7,70,,59.76,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,99.25,
"CATH THORACIC W/TROCAR 12FR",6101278,"CDM ",272,RC,C1757,HCPCS,OUTPATIENT,,,62.9,50.32,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.03,70,,35.22,,,0,"percent of total billed charges ","70% of total billed charges ",56.61,90,,45.29,,,0,"percent of total billed charges ","90% of total billed charges ",58.5,93,,46.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",53.47,85,,42.78,,,0,"percent of total billed charges ","85% of total billed charges ",56.61,90,,45.29,,,0,"percent of total billed charges ","90% of total billed charges ",56.61,90,,45.29,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",54.72,87,,43.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.03,70,,35.22,,,0,"percent of total billed charges ","70% of total billed charges ",44.03,58.5,
"GUIDE PIN",6101420,"CDM ",278,RC,C1764,HCPCS,OUTPATIENT,,,86.77,69.416,,,,,,,,0,"other ","not separately reimbursment ",10945.89,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",60.74,70,,48.59,,,0,"percent of total billed charges ","70% of total billed charges ",78.09,90,,62.47,,,0,"percent of total billed charges ","90% of total billed charges ",80.7,93,,64.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",73.75,85,,59.00,,,0,"percent of total billed charges ","85% of total billed charges ",73.75,85,,59.00,,,0,"percent of total billed charges ","85% of total billed charges ",78.09,90,,62.47,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",75.49,87,,60.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.74,70,,48.59,,,0,"percent of total billed charges ","70% of total billed charges ",60.74,10945.89,
"TAPE CAST 3"" GREEN",6101436,"CDM ",272,RC,A4590,HCPCS,OUTPATIENT,,,21.5,17.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.05,70,,12.04,,,0,"percent of total billed charges ","70% of total billed charges ",19.35,90,,15.48,,,0,"percent of total billed charges ","90% of total billed charges ",20,93,,16.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.28,85,,14.62,,,0,"percent of total billed charges ","85% of total billed charges ",19.35,90,,15.48,,,0,"percent of total billed charges ","90% of total billed charges ",19.35,90,,15.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.71,87,,14.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.05,70,,12.04,,,0,"percent of total billed charges ","70% of total billed charges ",15.05,20,
"K-WIRE .028  .7MX5",6101437,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,30.44,24.352,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",24.35,80,,19.48,,,0,"percent of total billed charges ","80% of total billed charges ",21.31,70,,17.05,,,0,"percent of total billed charges ","70% of total billed charges ",27.4,90,,21.92,,,0,"percent of total billed charges ","90% of total billed charges ",28.31,93,,22.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.87,85,,20.70,,,0,"percent of total billed charges ","85% of total billed charges ",25.87,85,,20.70,,,0,"percent of total billed charges ","85% of total billed charges ",27.4,90,,21.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.48,87,,21.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.31,70,,17.05,,,0,"percent of total billed charges ","70% of total billed charges ",21.31,28.31,
"TAPE CAST 4"" PINK",6101561,"CDM ",272,RC,A4590,HCPCS,OUTPATIENT,,,28,22.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.6,70,,15.68,,,0,"percent of total billed charges ","70% of total billed charges ",25.2,90,,20.16,,,0,"percent of total billed charges ","90% of total billed charges ",26.04,93,,20.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.8,85,,19.04,,,0,"percent of total billed charges ","85% of total billed charges ",25.2,90,,20.16,,,0,"percent of total billed charges ","90% of total billed charges ",25.2,90,,20.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",24.36,87,,19.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.6,70,,15.68,,,0,"percent of total billed charges ","70% of total billed charges ",19.6,26.04,
"CATH FOLEY 24FR 5CC",6101576,"CDM ",272,RC,C1729,HCPCS,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",,,,93.87,93.87,93.87,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",33.6,44.64,
"TAPE CAST 4"" RED",6101618,"CDM ",272,RC,A4590,HCPCS,OUTPATIENT,,,29,23.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.3,70,,16.24,,,0,"percent of total billed charges ","70% of total billed charges ",26.1,90,,20.88,,,0,"percent of total billed charges ","90% of total billed charges ",26.97,93,,21.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",24.65,85,,19.72,,,0,"percent of total billed charges ","85% of total billed charges ",26.1,90,,20.88,,,0,"percent of total billed charges ","90% of total billed charges ",26.1,90,,20.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",25.23,87,,20.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.3,70,,16.24,,,0,"percent of total billed charges ","70% of total billed charges ",20.3,26.97,
"PLATE SELF-COMP NAR'W 10H 172M",6101654,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,240,192,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",168,70,,134.40,,,0,"percent of total billed charges ","70% of total billed charges ",216,90,,172.80,,,0,"percent of total billed charges ","90% of total billed charges ",223.2,93,,178.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",204,85,,163.20,,,0,"percent of total billed charges ","85% of total billed charges ",204,85,,163.20,,,0,"percent of total billed charges ","85% of total billed charges ",216,90,,172.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",208.8,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",168,70,,134.40,,,0,"percent of total billed charges ","70% of total billed charges ",168,223.2,
"CATH COUDE  14FR SRT",6101657,"CDM ",272,RC,C1729,HCPCS,OUTPATIENT,,,20.5,16.4,,,,,,,,0,"other ","not separately reimbursment ",,,,93.87,93.87,93.87,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.35,70,,11.48,,,0,"percent of total billed charges ","70% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",19.07,93,,15.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.43,85,,13.94,,,0,"percent of total billed charges ","85% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.84,87,,14.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.35,70,,11.48,,,0,"percent of total billed charges ","70% of total billed charges ",14.35,19.07,
"MENISCUS ARROW 10MM",6101713,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,314.63,251.704,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.24,70,,176.19,,,0,"percent of total billed charges ","70% of total billed charges ",283.17,90,,226.54,,,0,"percent of total billed charges ","90% of total billed charges ",292.61,93,,234.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.44,85,,213.95,,,0,"percent of total billed charges ","85% of total billed charges ",267.44,85,,213.95,,,0,"percent of total billed charges ","85% of total billed charges ",283.17,90,,226.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",273.73,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.24,70,,176.19,,,0,"percent of total billed charges ","70% of total billed charges ",220.24,292.61,
"MENISCUS ARROW 13MM",6101719,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,314.63,251.704,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.24,70,,176.19,,,0,"percent of total billed charges ","70% of total billed charges ",283.17,90,,226.54,,,0,"percent of total billed charges ","90% of total billed charges ",292.61,93,,234.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.44,85,,213.95,,,0,"percent of total billed charges ","85% of total billed charges ",267.44,85,,213.95,,,0,"percent of total billed charges ","85% of total billed charges ",283.17,90,,226.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",273.73,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.24,70,,176.19,,,0,"percent of total billed charges ","70% of total billed charges ",220.24,292.61,
"PLT 1/3 TBLR 3.5X33MM 3H",6101770,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"CATH COUDE 16FR 5CC",6101781,"CDM ",272,RC,C1729,HCPCS,OUTPATIENT,,,53.5,42.8,,,,,,,,0,"other ","not separately reimbursment ",,,,93.87,93.87,93.87,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",49.76,93,,39.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",45.48,85,,36.38,,,0,"percent of total billed charges ","85% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",46.55,87,,37.24,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",37.45,49.76,
"PLATE CALCONEL LRG",6101802,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,867.5,694,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",607.25,70,,485.80,,,0,"percent of total billed charges ","70% of total billed charges ",780.75,90,,624.60,,,0,"percent of total billed charges ","90% of total billed charges ",806.78,93,,645.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",737.38,85,,589.90,,,0,"percent of total billed charges ","85% of total billed charges ",737.38,85,,589.90,,,0,"percent of total billed charges ","85% of total billed charges ",780.75,90,,624.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",754.73,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",607.25,70,,485.80,,,0,"percent of total billed charges ","70% of total billed charges ",607.25,806.78,
"K-WIRE 2.0MM",6101827,"CDM ",272,RC,C1769,HCPCS,OUTPATIENT,,,18.05,14.44,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.64,70,,10.11,,,0,"percent of total billed charges ","70% of total billed charges ",16.25,90,,13.00,,,0,"percent of total billed charges ","90% of total billed charges ",16.79,93,,13.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.34,85,,12.27,,,0,"percent of total billed charges ","85% of total billed charges ",16.25,90,,13.00,,,0,"percent of total billed charges ","90% of total billed charges ",16.25,90,,13.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.7,87,,12.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.64,70,,10.11,,,0,"percent of total billed charges ","70% of total billed charges ",12.64,16.79,
"PLATE CALCONEL X-LRG",6101828,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,867.5,694,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",607.25,70,,485.80,,,0,"percent of total billed charges ","70% of total billed charges ",780.75,90,,624.60,,,0,"percent of total billed charges ","90% of total billed charges ",806.78,93,,645.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",737.38,85,,589.90,,,0,"percent of total billed charges ","85% of total billed charges ",737.38,85,,589.90,,,0,"percent of total billed charges ","85% of total billed charges ",780.75,90,,624.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",754.73,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",607.25,70,,485.80,,,0,"percent of total billed charges ","70% of total billed charges ",607.25,806.78,
"TAPE CAST 2"" GREEN",6101861,"CDM ",272,RC,A4590,HCPCS,OUTPATIENT,,,18.5,14.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.95,70,,10.36,,,0,"percent of total billed charges ","70% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",17.21,93,,13.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.73,85,,12.58,,,0,"percent of total billed charges ","85% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.1,87,,12.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.95,70,,10.36,,,0,"percent of total billed charges ","70% of total billed charges ",12.95,17.21,
"SCREW ANCHOR LACTOSORB 5.5",6101881,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,568.92,455.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",398.24,70,,318.59,,,0,"percent of total billed charges ","70% of total billed charges ",512.03,90,,409.62,,,0,"percent of total billed charges ","90% of total billed charges ",529.1,93,,423.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",483.58,85,,386.86,,,0,"percent of total billed charges ","85% of total billed charges ",483.58,85,,386.86,,,0,"percent of total billed charges ","85% of total billed charges ",512.03,90,,409.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",494.96,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",398.24,70,,318.59,,,0,"percent of total billed charges ","70% of total billed charges ",398.24,529.1,
"SCREW ANCHOR LACTOSORB 3.5",6101882,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,561.89,449.512,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",393.32,70,,314.66,,,0,"percent of total billed charges ","70% of total billed charges ",505.7,90,,404.56,,,0,"percent of total billed charges ","90% of total billed charges ",522.56,93,,418.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",477.61,85,,382.09,,,0,"percent of total billed charges ","85% of total billed charges ",477.61,85,,382.09,,,0,"percent of total billed charges ","85% of total billed charges ",505.7,90,,404.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",488.84,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",393.32,70,,314.66,,,0,"percent of total billed charges ","70% of total billed charges ",393.32,522.56,
"PLT VOLR 2.4X45MM 6H/2H LT",6101937,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1745.12,1396.096,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1221.58,70,,977.26,,,0,"percent of total billed charges ","70% of total billed charges ",1570.61,90,,1256.49,,,0,"percent of total billed charges ","90% of total billed charges ",1622.96,93,,1298.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1483.35,85,,1186.68,,,0,"percent of total billed charges ","85% of total billed charges ",1483.35,85,,1186.68,,,0,"percent of total billed charges ","85% of total billed charges ",1570.61,90,,1256.49,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1518.25,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1221.58,70,,977.26,,,0,"percent of total billed charges ","70% of total billed charges ",1221.58,1622.96,
"PLT VOLR 2.4X45MM 6H/2H RT",6101945,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1745.12,1396.096,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1221.58,70,,977.26,,,0,"percent of total billed charges ","70% of total billed charges ",1570.61,90,,1256.49,,,0,"percent of total billed charges ","90% of total billed charges ",1622.96,93,,1298.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1483.35,85,,1186.68,,,0,"percent of total billed charges ","85% of total billed charges ",1483.35,85,,1186.68,,,0,"percent of total billed charges ","85% of total billed charges ",1570.61,90,,1256.49,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1518.25,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1221.58,70,,977.26,,,0,"percent of total billed charges ","70% of total billed charges ",1221.58,1622.96,
"MENISCUS ARROW 16MM",6101957,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,314.63,251.704,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.24,70,,176.19,,,0,"percent of total billed charges ","70% of total billed charges ",283.17,90,,226.54,,,0,"percent of total billed charges ","90% of total billed charges ",292.61,93,,234.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.44,85,,213.95,,,0,"percent of total billed charges ","85% of total billed charges ",267.44,85,,213.95,,,0,"percent of total billed charges ","85% of total billed charges ",283.17,90,,226.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",273.73,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.24,70,,176.19,,,0,"percent of total billed charges ","70% of total billed charges ",220.24,292.61,
"CATH HICKMAN 9.6FR",6102038,"CDM ",278,RC,C1788,HCPCS,OUTPATIENT,,,341.89,273.512,,,,,,,,0,"other ","not separately reimbursment ",,,,129.19,129.19,129.19,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",239.32,70,,191.46,,,0,"percent of total billed charges ","70% of total billed charges ",307.7,90,,246.16,,,0,"percent of total billed charges ","90% of total billed charges ",317.96,93,,254.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",290.61,85,,232.49,,,0,"percent of total billed charges ","85% of total billed charges ",290.61,85,,232.49,,,0,"percent of total billed charges ","85% of total billed charges ",307.7,90,,246.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",297.44,87,,453.26,453.26,453.26,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",239.32,70,,191.46,,,0,"percent of total billed charges ","70% of total billed charges ",239.32,317.96,
"SCREW MALLEOLAR 4.5MM*40MM",6102056,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.76,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",33.6,44.64,
"SCREW CANCELLOUS 6.5MM*90MM",6102107,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,52.5,42,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",48.83,93,,39.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",44.63,85,,35.70,,,0,"percent of total billed charges ","85% of total billed charges ",44.63,85,,35.70,,,0,"percent of total billed charges ","85% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",45.68,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",36.75,48.83,
"BRNG TIBIA VE PS 16X63/67MM",6102147,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"BRNG TIBIA VE PS 18X63/67MM",6102148,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"WIRE GUIDE BULLET 3.0",6102159,"CDM ",272,RC,C1769,HCPCS,OUTPATIENT,,,256.45,205.16,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",179.52,70,,143.62,,,0,"percent of total billed charges ","70% of total billed charges ",230.81,90,,184.65,,,0,"percent of total billed charges ","90% of total billed charges ",238.5,93,,190.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",217.98,85,,174.38,,,0,"percent of total billed charges ","85% of total billed charges ",230.81,90,,184.65,,,0,"percent of total billed charges ","90% of total billed charges ",230.81,90,,184.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",223.11,87,,178.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",179.52,70,,143.62,,,0,"percent of total billed charges ","70% of total billed charges ",179.52,238.5,
"LINER CUP BIPOLAR 38MM",6102166,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,818.9,655.12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",573.23,70,,458.58,,,0,"percent of total billed charges ","70% of total billed charges ",737.01,90,,589.61,,,0,"percent of total billed charges ","90% of total billed charges ",761.58,93,,609.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",696.07,85,,556.86,,,0,"percent of total billed charges ","85% of total billed charges ",696.07,85,,556.86,,,0,"percent of total billed charges ","85% of total billed charges ",737.01,90,,589.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",712.44,87,,569.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",573.23,70,,458.58,,,0,"percent of total billed charges ","70% of total billed charges ",573.23,761.58,
"TAPE CAST 2"" RED",6102171,"CDM ",272,RC,A4590,HCPCS,OUTPATIENT,,,16.5,13.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.55,70,,9.24,,,0,"percent of total billed charges ","70% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",15.35,93,,12.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.03,85,,11.22,,,0,"percent of total billed charges ","85% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.36,87,,11.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.55,70,,9.24,,,0,"percent of total billed charges ","70% of total billed charges ",11.55,15.35,
"TAPE CAST 3"" RED",6102179,"CDM ",272,RC,A4590,HCPCS,OUTPATIENT,,,14.29,11.432,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,70,,8.00,,,0,"percent of total billed charges ","70% of total billed charges ",12.86,90,,10.29,,,0,"percent of total billed charges ","90% of total billed charges ",13.29,93,,10.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.15,85,,9.72,,,0,"percent of total billed charges ","85% of total billed charges ",12.86,90,,10.29,,,0,"percent of total billed charges ","90% of total billed charges ",12.86,90,,10.29,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.43,87,,9.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,70,,8.00,,,0,"percent of total billed charges ","70% of total billed charges ",10,13.29,
"BRNG TIBIA PS 10X59MM",6102222,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1633.5,1306.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",1519.16,93,,1215.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1421.15,87,,1136.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,1519.16,
"TRAY TIBIA FIXED CRUCIATE 63MM",6102224,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2268.75,1815,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",2109.94,93,,1687.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1973.81,87,,1579.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",1588.13,2109.94,
"TAPE CAST 2"" PURPLE",6102225,"CDM ",272,RC,A4590,HCPCS,OUTPATIENT,,,17,13.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.9,70,,9.52,,,0,"percent of total billed charges ","70% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.81,93,,12.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.45,85,,11.56,,,0,"percent of total billed charges ","85% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.79,87,,11.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.9,70,,9.52,,,0,"percent of total billed charges ","70% of total billed charges ",11.9,15.81,
"CATH HICKMAN 9FR PEEL-APART",6102357,"CDM ",272,RC,C1788,HCPCS,OUTPATIENT,,,542.52,434.016,,,,,,,,0,"other ","not separately reimbursment ",,,,129.19,129.19,129.19,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",379.76,70,,303.81,,,0,"percent of total billed charges ","70% of total billed charges ",488.27,90,,390.62,,,0,"percent of total billed charges ","90% of total billed charges ",504.54,93,,403.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",461.14,85,,368.91,,,0,"percent of total billed charges ","85% of total billed charges ",488.27,90,,390.62,,,0,"percent of total billed charges ","90% of total billed charges ",488.27,90,,390.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",471.99,87,,453.26,453.26,453.26,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",379.76,70,,303.81,,,0,"percent of total billed charges ","70% of total billed charges ",379.76,504.54,
"GUIDE WIRE HYPERFLEX",6102418,"CDM ",272,RC,C1769,HCPCS,OUTPATIENT,,,75.57,60.456,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.9,70,,42.32,,,0,"percent of total billed charges ","70% of total billed charges ",68.01,90,,54.41,,,0,"percent of total billed charges ","90% of total billed charges ",70.28,93,,56.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",64.23,85,,51.38,,,0,"percent of total billed charges ","85% of total billed charges ",68.01,90,,54.41,,,0,"percent of total billed charges ","90% of total billed charges ",68.01,90,,54.41,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",65.75,87,,52.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.9,70,,42.32,,,0,"percent of total billed charges ","70% of total billed charges ",52.9,70.28,
"SCREW SHANTZ 4.0/3.0 M",6102433,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,266.5,213.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",186.55,70,,149.24,,,0,"percent of total billed charges ","70% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",247.85,93,,198.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",226.53,85,,181.22,,,0,"percent of total billed charges ","85% of total billed charges ",226.53,85,,181.22,,,0,"percent of total billed charges ","85% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",231.86,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",186.55,70,,149.24,,,0,"percent of total billed charges ","70% of total billed charges ",186.55,247.85,
"TAPE CAST 2"" PINK",6102439,"CDM ",272,RC,A4590,HCPCS,OUTPATIENT,,,17,13.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.9,70,,9.52,,,0,"percent of total billed charges ","70% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.81,93,,12.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.45,85,,11.56,,,0,"percent of total billed charges ","85% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.79,87,,11.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.9,70,,9.52,,,0,"percent of total billed charges ","70% of total billed charges ",11.9,15.81,
"ART SURF NEXGEN C-11/3-4 10M",6102448,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2178,1742.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",2025.54,93,,1620.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1894.86,87,,1515.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1524.6,2025.54,
"ART SURF NEXGEN C-11/3-4 14MM",6102451,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2178,1742.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",2025.54,93,,1620.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1894.86,87,,1515.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1524.6,2025.54,
"ART SURF NEXGEN C-H/3-4 17M",6102457,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2512.78,2010.224,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1758.95,70,,1407.16,,,0,"percent of total billed charges ","70% of total billed charges ",2261.5,90,,1809.20,,,0,"percent of total billed charges ","90% of total billed charges ",2336.89,93,,1869.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2135.86,85,,1708.69,,,0,"percent of total billed charges ","85% of total billed charges ",2135.86,85,,1708.69,,,0,"percent of total billed charges ","85% of total billed charges ",2261.5,90,,1809.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2186.12,87,,1748.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1758.95,70,,1407.16,,,0,"percent of total billed charges ","70% of total billed charges ",1758.95,2336.89,
"ART SURF NEXGEN C-H/2-3 20M",6102462,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2512.78,2010.224,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2010.22,80,,1608.18,,,0,"percent of total billed charges ","80% of total billed charges ",1758.95,70,,1407.16,,,0,"percent of total billed charges ","70% of total billed charges ",2261.5,90,,1809.20,,,0,"percent of total billed charges ","90% of total billed charges ",2336.89,93,,1869.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2135.86,85,,1708.69,,,0,"percent of total billed charges ","85% of total billed charges ",2135.86,85,,1708.69,,,0,"percent of total billed charges ","85% of total billed charges ",2261.5,90,,1809.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2186.12,87,,1748.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1758.95,70,,1407.16,,,0,"percent of total billed charges ","70% of total billed charges ",1758.95,2336.89,
"ART SURF NEXGEN C-H/5-6 10MM",6102497,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2178,1742.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1742.4,80,,1393.92,,,0,"percent of total billed charges ","80% of total billed charges ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",2025.54,93,,1620.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1894.86,87,,1515.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1524.6,2025.54,
"ART SURF NEXGEN C-H/5-6 12MM",6102502,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2613.29,2090.632,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2090.63,80,,1672.50,,,0,"percent of total billed charges ","80% of total billed charges ",1829.3,70,,1463.44,,,0,"percent of total billed charges ","70% of total billed charges ",2351.96,90,,1881.57,,,0,"percent of total billed charges ","90% of total billed charges ",2430.36,93,,1944.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2221.3,85,,1777.04,,,0,"percent of total billed charges ","85% of total billed charges ",2221.3,85,,1777.04,,,0,"percent of total billed charges ","85% of total billed charges ",2351.96,90,,1881.57,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2273.56,87,,1818.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1829.3,70,,1463.44,,,0,"percent of total billed charges ","70% of total billed charges ",1829.3,2430.36,
"ART SURF NEXGEN C-H/5-6 14MM",6102505,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2512.78,2010.224,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2010.22,80,,1608.18,,,0,"percent of total billed charges ","80% of total billed charges ",1758.95,70,,1407.16,,,0,"percent of total billed charges ","70% of total billed charges ",2261.5,90,,1809.20,,,0,"percent of total billed charges ","90% of total billed charges ",2336.89,93,,1869.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2135.86,85,,1708.69,,,0,"percent of total billed charges ","85% of total billed charges ",2135.86,85,,1708.69,,,0,"percent of total billed charges ","85% of total billed charges ",2261.5,90,,1809.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2186.12,87,,1748.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1758.95,70,,1407.16,,,0,"percent of total billed charges ","70% of total billed charges ",1758.95,2336.89,
"ART SURF NEXGEN C-H/5-6 17MM",6102506,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2512.78,2010.224,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2010.22,80,,1608.18,,,0,"percent of total billed charges ","80% of total billed charges ",1758.95,70,,1407.16,,,0,"percent of total billed charges ","70% of total billed charges ",2261.5,90,,1809.20,,,0,"percent of total billed charges ","90% of total billed charges ",2336.89,93,,1869.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2135.86,85,,1708.69,,,0,"percent of total billed charges ","85% of total billed charges ",2135.86,85,,1708.69,,,0,"percent of total billed charges ","85% of total billed charges ",2261.5,90,,1809.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2186.12,87,,1748.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1758.95,70,,1407.16,,,0,"percent of total billed charges ","70% of total billed charges ",1758.95,2336.89,
"ART SURF NEXGEN C-H/5-6 20MM",6102514,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2512.78,2010.224,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2010.22,80,,1608.18,,,0,"percent of total billed charges ","80% of total billed charges ",1758.95,70,,1407.16,,,0,"percent of total billed charges ","70% of total billed charges ",2261.5,90,,1809.20,,,0,"percent of total billed charges ","90% of total billed charges ",2336.89,93,,1869.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2135.86,85,,1708.69,,,0,"percent of total billed charges ","85% of total billed charges ",2135.86,85,,1708.69,,,0,"percent of total billed charges ","85% of total billed charges ",2261.5,90,,1809.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2186.12,87,,1748.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1758.95,70,,1407.16,,,0,"percent of total billed charges ","70% of total billed charges ",1758.95,2336.89,
"ART SURF NEXGEN C-H/7-10 10M",6102521,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2178,1742.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1742.4,80,,1393.92,,,0,"percent of total billed charges ","80% of total billed charges ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",2025.54,93,,1620.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1894.86,87,,1515.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1524.6,2025.54,
"ART SURF NEXGEN C-H/7-10 12M",6102524,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2799.35,2239.48,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2239.48,80,,1791.58,,,0,"percent of total billed charges ","80% of total billed charges ",1959.55,70,,1567.64,,,0,"percent of total billed charges ","70% of total billed charges ",2519.42,90,,2015.54,,,0,"percent of total billed charges ","90% of total billed charges ",2603.4,93,,2082.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2379.45,85,,1903.56,,,0,"percent of total billed charges ","85% of total billed charges ",2379.45,85,,1903.56,,,0,"percent of total billed charges ","85% of total billed charges ",2519.42,90,,2015.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2435.43,87,,1948.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1959.55,70,,1567.64,,,0,"percent of total billed charges ","70% of total billed charges ",1959.55,2603.4,
"SCREW REVO 4MM",6102528,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,265.07,212.056,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",212.06,80,,169.65,,,0,"percent of total billed charges ","80% of total billed charges ",185.55,70,,148.44,,,0,"percent of total billed charges ","70% of total billed charges ",238.56,90,,190.85,,,0,"percent of total billed charges ","90% of total billed charges ",246.52,93,,197.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",225.31,85,,180.25,,,0,"percent of total billed charges ","85% of total billed charges ",225.31,85,,180.25,,,0,"percent of total billed charges ","85% of total billed charges ",238.56,90,,190.85,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",230.61,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",185.55,70,,148.44,,,0,"percent of total billed charges ","70% of total billed charges ",185.55,246.52,
"ART SURF NEXGEN C-H/7-10 14M",6102531,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2512.78,2010.224,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2010.22,80,,1608.18,,,0,"percent of total billed charges ","80% of total billed charges ",1758.95,70,,1407.16,,,0,"percent of total billed charges ","70% of total billed charges ",2261.5,90,,1809.20,,,0,"percent of total billed charges ","90% of total billed charges ",2336.89,93,,1869.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2135.86,85,,1708.69,,,0,"percent of total billed charges ","85% of total billed charges ",2135.86,85,,1708.69,,,0,"percent of total billed charges ","85% of total billed charges ",2261.5,90,,1809.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2186.12,87,,1748.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1758.95,70,,1407.16,,,0,"percent of total billed charges ","70% of total billed charges ",1758.95,2336.89,
"ART SURF NEXGEN C-H/7-10 17M",6102532,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2512.78,2010.224,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2010.22,80,,1608.18,,,0,"percent of total billed charges ","80% of total billed charges ",1758.95,70,,1407.16,,,0,"percent of total billed charges ","70% of total billed charges ",2261.5,90,,1809.20,,,0,"percent of total billed charges ","90% of total billed charges ",2336.89,93,,1869.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2135.86,85,,1708.69,,,0,"percent of total billed charges ","85% of total billed charges ",2135.86,85,,1708.69,,,0,"percent of total billed charges ","85% of total billed charges ",2261.5,90,,1809.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2186.12,87,,1748.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1758.95,70,,1407.16,,,0,"percent of total billed charges ","70% of total billed charges ",1758.95,2336.89,
"ART SURF NEXGEN C-H/7-10 20M",6102533,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2512.78,2010.224,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2010.22,80,,1608.18,,,0,"percent of total billed charges ","80% of total billed charges ",1758.95,70,,1407.16,,,0,"percent of total billed charges ","70% of total billed charges ",2261.5,90,,1809.20,,,0,"percent of total billed charges ","90% of total billed charges ",2336.89,93,,1869.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2135.86,85,,1708.69,,,0,"percent of total billed charges ","85% of total billed charges ",2135.86,85,,1708.69,,,0,"percent of total billed charges ","85% of total billed charges ",2261.5,90,,1809.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2186.12,87,,1748.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1758.95,70,,1407.16,,,0,"percent of total billed charges ","70% of total billed charges ",1758.95,2336.89,
"ART SURF NEXGEN C-11/3-4 12M",6102570,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2178,1742.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1742.4,80,,1393.92,,,0,"percent of total billed charges ","80% of total billed charges ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",2025.54,93,,1620.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1894.86,87,,1515.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1524.6,2025.54,
"GRAFT TENDON W/ QUADRICEPS",6102589,"CDM ",278,RC,C1762,HCPCS,OUTPATIENT,,,5082,4065.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4065.6,80,,3252.48,,,0,"percent of total billed charges ","80% of total billed charges ",3557.4,70,,2845.92,,,0,"percent of total billed charges ","70% of total billed charges ",4573.8,90,,3659.04,,,0,"percent of total billed charges ","90% of total billed charges ",4726.26,93,,3781.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4319.7,85,,3455.76,,,0,"percent of total billed charges ","85% of total billed charges ",4319.7,85,,3455.76,,,0,"percent of total billed charges ","85% of total billed charges ",4573.8,90,,3659.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4421.34,87,,3537.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3557.4,70,,2845.92,,,0,"percent of total billed charges ","70% of total billed charges ",3557.4,4726.26,
"GRAFT TENDON HEMI",6102593,"CDM ",278,RC,C1762,HCPCS,OUTPATIENT,,,3993,3194.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3194.4,80,,2555.52,,,0,"percent of total billed charges ","80% of total billed charges ",2795.1,70,,2236.08,,,0,"percent of total billed charges ","70% of total billed charges ",3593.7,90,,2874.96,,,0,"percent of total billed charges ","90% of total billed charges ",3713.49,93,,2970.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3394.05,85,,2715.24,,,0,"percent of total billed charges ","85% of total billed charges ",3394.05,85,,2715.24,,,0,"percent of total billed charges ","85% of total billed charges ",3593.7,90,,2874.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3473.91,87,,2779.13,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2795.1,70,,2236.08,,,0,"percent of total billed charges ","70% of total billed charges ",2795.1,3713.49,
"CATH ERCP 1-ST",6102601,"CDM ",272,RC,C1729,HCPCS,OUTPATIENT,,,206.96,165.568,,,,,,,,0,"other ","not separately reimbursment ",,,,93.87,93.87,93.87,"1 through 10","other ","not separately reimbursment ",165.57,80,,132.46,,,0,"percent of total billed charges ","80% of total billed charges ",144.87,70,,115.90,,,0,"percent of total billed charges ","70% of total billed charges ",186.26,90,,149.01,,,0,"percent of total billed charges ","90% of total billed charges ",192.47,93,,153.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",175.92,85,,140.74,,,0,"percent of total billed charges ","85% of total billed charges ",186.26,90,,149.01,,,0,"percent of total billed charges ","90% of total billed charges ",186.26,90,,149.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",180.06,87,,144.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.87,70,,115.90,,,0,"percent of total billed charges ","70% of total billed charges ",144.87,192.47,
"CATH THERMOD'N ARROW",6102642,"CDM ",272,RC,C1757,HCPCS,OUTPATIENT,,,388,310.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",310.4,80,,248.32,,,0,"percent of total billed charges ","80% of total billed charges ",271.6,70,,217.28,,,0,"percent of total billed charges ","70% of total billed charges ",349.2,90,,279.36,,,0,"percent of total billed charges ","90% of total billed charges ",360.84,93,,288.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",329.8,85,,263.84,,,0,"percent of total billed charges ","85% of total billed charges ",349.2,90,,279.36,,,0,"percent of total billed charges ","90% of total billed charges ",349.2,90,,279.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",337.56,87,,270.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",271.6,70,,217.28,,,0,"percent of total billed charges ","70% of total billed charges ",271.6,360.84,
"ART SURF MC EF 6-7 RT 14MM",6102731,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"SCREW COMPRESSION 1/2""X12.7MM",6102754,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,84.63,67.704,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",67.7,80,,54.16,,,0,"percent of total billed charges ","80% of total billed charges ",59.24,70,,47.39,,,0,"percent of total billed charges ","70% of total billed charges ",76.17,90,,60.94,,,0,"percent of total billed charges ","90% of total billed charges ",78.71,93,,62.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",71.94,85,,57.55,,,0,"percent of total billed charges ","85% of total billed charges ",71.94,85,,57.55,,,0,"percent of total billed charges ","85% of total billed charges ",76.17,90,,60.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",73.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.24,70,,47.39,,,0,"percent of total billed charges ","70% of total billed charges ",59.24,78.71,
"SEPRA MESH IP",6102816,"CDM ",278,RC,C1781,HCPCS,OUTPATIENT,,,1053.8,843.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",843.04,80,,674.43,,,0,"percent of total billed charges ","80% of total billed charges ",737.66,70,,590.13,,,0,"percent of total billed charges ","70% of total billed charges ",948.42,90,,758.74,,,0,"percent of total billed charges ","90% of total billed charges ",980.03,93,,784.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",895.73,85,,716.58,,,0,"percent of total billed charges ","85% of total billed charges ",895.73,85,,716.58,,,0,"percent of total billed charges ","85% of total billed charges ",948.42,90,,758.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",916.81,87,,733.45,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",737.66,70,,590.13,,,0,"percent of total billed charges ","70% of total billed charges ",737.66,980.03,
"PLATE VOLAR LEFT/SHORT",6102834,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1344.92,1075.936,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1075.94,80,,860.75,,,0,"percent of total billed charges ","80% of total billed charges ",941.44,70,,753.15,,,0,"percent of total billed charges ","70% of total billed charges ",1210.43,90,,968.34,,,0,"percent of total billed charges ","90% of total billed charges ",1250.78,93,,1000.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1143.18,85,,914.54,,,0,"percent of total billed charges ","85% of total billed charges ",1143.18,85,,914.54,,,0,"percent of total billed charges ","85% of total billed charges ",1210.43,90,,968.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1170.08,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",941.44,70,,753.15,,,0,"percent of total billed charges ","70% of total billed charges ",941.44,1250.78,
"PORT POWER PORT-A-CATH",6102839,"CDM ",278,RC,C1788,HCPCS,OUTPATIENT,,,538.75,431,,,,,,,,0,"other ","not separately reimbursment ",,,,129.19,129.19,129.19,"1 through 10","other ","not separately reimbursment ",431,80,,344.80,,,0,"percent of total billed charges ","80% of total billed charges ",377.13,70,,301.70,,,0,"percent of total billed charges ","70% of total billed charges ",484.88,90,,387.90,,,0,"percent of total billed charges ","90% of total billed charges ",501.04,93,,400.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",457.94,85,,366.35,,,0,"percent of total billed charges ","85% of total billed charges ",457.94,85,,366.35,,,0,"percent of total billed charges ","85% of total billed charges ",484.88,90,,387.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",468.71,87,,453.26,453.26,453.26,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",377.13,70,,301.70,,,0,"percent of total billed charges ","70% of total billed charges ",377.13,501.04,
"PLATE VOLAR LEFT/LONG",6102840,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1859.47,1487.576,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1487.58,80,,1190.06,,,0,"percent of total billed charges ","80% of total billed charges ",1301.63,70,,1041.30,,,0,"percent of total billed charges ","70% of total billed charges ",1673.52,90,,1338.82,,,0,"percent of total billed charges ","90% of total billed charges ",1729.31,93,,1383.45,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1580.55,85,,1264.44,,,0,"percent of total billed charges ","85% of total billed charges ",1580.55,85,,1264.44,,,0,"percent of total billed charges ","85% of total billed charges ",1673.52,90,,1338.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1617.74,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1301.63,70,,1041.30,,,0,"percent of total billed charges ","70% of total billed charges ",1301.63,1729.31,
"PLATE VOLAR RIGHT/SHORT",6102842,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2043.69,1634.952,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1634.95,80,,1307.96,,,0,"percent of total billed charges ","80% of total billed charges ",1430.58,70,,1144.46,,,0,"percent of total billed charges ","70% of total billed charges ",1839.32,90,,1471.46,,,0,"percent of total billed charges ","90% of total billed charges ",1900.63,93,,1520.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1737.14,85,,1389.71,,,0,"percent of total billed charges ","85% of total billed charges ",1737.14,85,,1389.71,,,0,"percent of total billed charges ","85% of total billed charges ",1839.32,90,,1471.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1778.01,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1430.58,70,,1144.46,,,0,"percent of total billed charges ","70% of total billed charges ",1430.58,1900.63,
"PLATE VOLAR RIGHT/LONG",6102843,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1980.17,1584.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1584.14,80,,1267.31,,,0,"percent of total billed charges ","80% of total billed charges ",1386.12,70,,1108.90,,,0,"percent of total billed charges ","70% of total billed charges ",1782.15,90,,1425.72,,,0,"percent of total billed charges ","90% of total billed charges ",1841.56,93,,1473.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1683.14,85,,1346.51,,,0,"percent of total billed charges ","85% of total billed charges ",1683.14,85,,1346.51,,,0,"percent of total billed charges ","85% of total billed charges ",1782.15,90,,1425.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1722.75,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1386.12,70,,1108.90,,,0,"percent of total billed charges ","70% of total billed charges ",1386.12,1841.56,
"PLATE T 2.4MM 3H HEAD/4H SHAFT",6102850,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1050.56,840.448,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",840.45,80,,672.36,,,0,"percent of total billed charges ","80% of total billed charges ",735.39,70,,588.31,,,0,"percent of total billed charges ","70% of total billed charges ",945.5,90,,756.40,,,0,"percent of total billed charges ","90% of total billed charges ",977.02,93,,781.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",892.98,85,,714.38,,,0,"percent of total billed charges ","85% of total billed charges ",892.98,85,,714.38,,,0,"percent of total billed charges ","85% of total billed charges ",945.5,90,,756.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",913.99,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",735.39,70,,588.31,,,0,"percent of total billed charges ","70% of total billed charges ",735.39,977.02,
"PLATE L -90 DEG 2H HD/4H SHAFT",6102854,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1016.85,813.48,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",813.48,80,,650.78,,,0,"percent of total billed charges ","80% of total billed charges ",711.8,70,,569.44,,,0,"percent of total billed charges ","70% of total billed charges ",915.17,90,,732.14,,,0,"percent of total billed charges ","90% of total billed charges ",945.67,93,,756.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",864.32,85,,691.46,,,0,"percent of total billed charges ","85% of total billed charges ",864.32,85,,691.46,,,0,"percent of total billed charges ","85% of total billed charges ",915.17,90,,732.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",884.66,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",711.8,70,,569.44,,,0,"percent of total billed charges ","70% of total billed charges ",711.8,945.67,
"PLATE L +90 DEG 2H HD/4H SHAFT",6102857,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,924.5,739.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",739.6,80,,591.68,,,0,"percent of total billed charges ","80% of total billed charges ",647.15,70,,517.72,,,0,"percent of total billed charges ","70% of total billed charges ",832.05,90,,665.64,,,0,"percent of total billed charges ","90% of total billed charges ",859.79,93,,687.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",785.83,85,,628.66,,,0,"percent of total billed charges ","85% of total billed charges ",785.83,85,,628.66,,,0,"percent of total billed charges ","85% of total billed charges ",832.05,90,,665.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",804.32,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",647.15,70,,517.72,,,0,"percent of total billed charges ","70% of total billed charges ",647.15,859.79,
"PLATE L +90 DEG 3H HD/4H SHAFT",6102860,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,924.5,739.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",739.6,80,,591.68,,,0,"percent of total billed charges ","80% of total billed charges ",647.15,70,,517.72,,,0,"percent of total billed charges ","70% of total billed charges ",832.05,90,,665.64,,,0,"percent of total billed charges ","90% of total billed charges ",859.79,93,,687.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",785.83,85,,628.66,,,0,"percent of total billed charges ","85% of total billed charges ",785.83,85,,628.66,,,0,"percent of total billed charges ","85% of total billed charges ",832.05,90,,665.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",804.32,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",647.15,70,,517.72,,,0,"percent of total billed charges ","70% of total billed charges ",647.15,859.79,
"PLATE L -90 DEG 3H HD/4H SHAFT",6102863,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,924.5,739.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",739.6,80,,591.68,,,0,"percent of total billed charges ","80% of total billed charges ",647.15,70,,517.72,,,0,"percent of total billed charges ","70% of total billed charges ",832.05,90,,665.64,,,0,"percent of total billed charges ","90% of total billed charges ",859.79,93,,687.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",785.83,85,,628.66,,,0,"percent of total billed charges ","85% of total billed charges ",785.83,85,,628.66,,,0,"percent of total billed charges ","85% of total billed charges ",832.05,90,,665.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",804.32,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",647.15,70,,517.72,,,0,"percent of total billed charges ","70% of total billed charges ",647.15,859.79,
"PLATE L +20 DEG 3H HD/4H SHAFT",6102864,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1083.56,866.848,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",866.85,80,,693.48,,,0,"percent of total billed charges ","80% of total billed charges ",758.49,70,,606.79,,,0,"percent of total billed charges ","70% of total billed charges ",975.2,90,,780.16,,,0,"percent of total billed charges ","90% of total billed charges ",1007.71,93,,806.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",921.03,85,,736.82,,,0,"percent of total billed charges ","85% of total billed charges ",921.03,85,,736.82,,,0,"percent of total billed charges ","85% of total billed charges ",975.2,90,,780.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",942.7,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",758.49,70,,606.79,,,0,"percent of total billed charges ","70% of total billed charges ",758.49,1007.71,
"PLATE L -20 DEG 3H HD/4H SHAFT",6102865,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,924.5,739.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",739.6,80,,591.68,,,0,"percent of total billed charges ","80% of total billed charges ",647.15,70,,517.72,,,0,"percent of total billed charges ","70% of total billed charges ",832.05,90,,665.64,,,0,"percent of total billed charges ","90% of total billed charges ",859.79,93,,687.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",785.83,85,,628.66,,,0,"percent of total billed charges ","85% of total billed charges ",785.83,85,,628.66,,,0,"percent of total billed charges ","85% of total billed charges ",832.05,90,,665.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",804.32,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",647.15,70,,517.72,,,0,"percent of total billed charges ","70% of total billed charges ",647.15,859.79,
"SCREW LOCKING SELF-TAP 6MM",6102866,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,224.12,179.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",179.3,80,,143.44,,,0,"percent of total billed charges ","80% of total billed charges ",156.88,70,,125.50,,,0,"percent of total billed charges ","70% of total billed charges ",201.71,90,,161.37,,,0,"percent of total billed charges ","90% of total billed charges ",208.43,93,,166.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",190.5,85,,152.40,,,0,"percent of total billed charges ","85% of total billed charges ",190.5,85,,152.40,,,0,"percent of total billed charges ","85% of total billed charges ",201.71,90,,161.37,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",194.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.88,70,,125.50,,,0,"percent of total billed charges ","70% of total billed charges ",156.88,208.43,
"SCREW LOCKING SELF-TAP 8MM",6102867,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,349.11,279.288,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",279.29,80,,223.43,,,0,"percent of total billed charges ","80% of total billed charges ",244.38,70,,195.50,,,0,"percent of total billed charges ","70% of total billed charges ",314.2,90,,251.36,,,0,"percent of total billed charges ","90% of total billed charges ",324.67,93,,259.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",296.74,85,,237.39,,,0,"percent of total billed charges ","85% of total billed charges ",296.74,85,,237.39,,,0,"percent of total billed charges ","85% of total billed charges ",314.2,90,,251.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",303.73,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",244.38,70,,195.50,,,0,"percent of total billed charges ","70% of total billed charges ",244.38,324.67,
"SCREW LOCKING SELF-TAP 10MM",6102873,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,349.11,279.288,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",279.29,80,,223.43,,,0,"percent of total billed charges ","80% of total billed charges ",244.38,70,,195.50,,,0,"percent of total billed charges ","70% of total billed charges ",314.2,90,,251.36,,,0,"percent of total billed charges ","90% of total billed charges ",324.67,93,,259.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",296.74,85,,237.39,,,0,"percent of total billed charges ","85% of total billed charges ",296.74,85,,237.39,,,0,"percent of total billed charges ","85% of total billed charges ",314.2,90,,251.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",303.73,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",244.38,70,,195.50,,,0,"percent of total billed charges ","70% of total billed charges ",244.38,324.67,
"SCREW LOCKING SELF-TAP 12MM",6102876,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,292.54,234.032,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",234.03,80,,187.22,,,0,"percent of total billed charges ","80% of total billed charges ",204.78,70,,163.82,,,0,"percent of total billed charges ","70% of total billed charges ",263.29,90,,210.63,,,0,"percent of total billed charges ","90% of total billed charges ",272.06,93,,217.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",248.66,85,,198.93,,,0,"percent of total billed charges ","85% of total billed charges ",248.66,85,,198.93,,,0,"percent of total billed charges ","85% of total billed charges ",263.29,90,,210.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",254.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",204.78,70,,163.82,,,0,"percent of total billed charges ","70% of total billed charges ",204.78,272.06,
"SCREW LOCKING SELF-TAP 14MM",6102877,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,292.54,234.032,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",234.03,80,,187.22,,,0,"percent of total billed charges ","80% of total billed charges ",204.78,70,,163.82,,,0,"percent of total billed charges ","70% of total billed charges ",263.29,90,,210.63,,,0,"percent of total billed charges ","90% of total billed charges ",272.06,93,,217.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",248.66,85,,198.93,,,0,"percent of total billed charges ","85% of total billed charges ",248.66,85,,198.93,,,0,"percent of total billed charges ","85% of total billed charges ",263.29,90,,210.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",254.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",204.78,70,,163.82,,,0,"percent of total billed charges ","70% of total billed charges ",204.78,272.06,
"SCREW LOCKING SELF-TAP 16MM",6102878,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,292.54,234.032,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",234.03,80,,187.22,,,0,"percent of total billed charges ","80% of total billed charges ",204.78,70,,163.82,,,0,"percent of total billed charges ","70% of total billed charges ",263.29,90,,210.63,,,0,"percent of total billed charges ","90% of total billed charges ",272.06,93,,217.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",248.66,85,,198.93,,,0,"percent of total billed charges ","85% of total billed charges ",248.66,85,,198.93,,,0,"percent of total billed charges ","85% of total billed charges ",263.29,90,,210.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",254.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",204.78,70,,163.82,,,0,"percent of total billed charges ","70% of total billed charges ",204.78,272.06,
"SCREW LOCKING SELF-TAP 18MM",6102879,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,292.54,234.032,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",234.03,80,,187.22,,,0,"percent of total billed charges ","80% of total billed charges ",204.78,70,,163.82,,,0,"percent of total billed charges ","70% of total billed charges ",263.29,90,,210.63,,,0,"percent of total billed charges ","90% of total billed charges ",272.06,93,,217.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",248.66,85,,198.93,,,0,"percent of total billed charges ","85% of total billed charges ",248.66,85,,198.93,,,0,"percent of total billed charges ","85% of total billed charges ",263.29,90,,210.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",254.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",204.78,70,,163.82,,,0,"percent of total billed charges ","70% of total billed charges ",204.78,272.06,
"SCREW LOCKING SELF-TAP 20MM",6102884,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,292.54,234.032,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",234.03,80,,187.22,,,0,"percent of total billed charges ","80% of total billed charges ",204.78,70,,163.82,,,0,"percent of total billed charges ","70% of total billed charges ",263.29,90,,210.63,,,0,"percent of total billed charges ","90% of total billed charges ",272.06,93,,217.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",248.66,85,,198.93,,,0,"percent of total billed charges ","85% of total billed charges ",248.66,85,,198.93,,,0,"percent of total billed charges ","85% of total billed charges ",263.29,90,,210.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",254.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",204.78,70,,163.82,,,0,"percent of total billed charges ","70% of total billed charges ",204.78,272.06,
"SCREW LOCKING SELF-TAP 22MM",6102886,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,292.54,234.032,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",234.03,80,,187.22,,,0,"percent of total billed charges ","80% of total billed charges ",204.78,70,,163.82,,,0,"percent of total billed charges ","70% of total billed charges ",263.29,90,,210.63,,,0,"percent of total billed charges ","90% of total billed charges ",272.06,93,,217.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",248.66,85,,198.93,,,0,"percent of total billed charges ","85% of total billed charges ",248.66,85,,198.93,,,0,"percent of total billed charges ","85% of total billed charges ",263.29,90,,210.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",254.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",204.78,70,,163.82,,,0,"percent of total billed charges ","70% of total billed charges ",204.78,272.06,
"SCREW LOCKING SELF-TAP 24MM",6102888,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,292.54,234.032,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",234.03,80,,187.22,,,0,"percent of total billed charges ","80% of total billed charges ",204.78,70,,163.82,,,0,"percent of total billed charges ","70% of total billed charges ",263.29,90,,210.63,,,0,"percent of total billed charges ","90% of total billed charges ",272.06,93,,217.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",248.66,85,,198.93,,,0,"percent of total billed charges ","85% of total billed charges ",248.66,85,,198.93,,,0,"percent of total billed charges ","85% of total billed charges ",263.29,90,,210.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",254.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",204.78,70,,163.82,,,0,"percent of total billed charges ","70% of total billed charges ",204.78,272.06,
"SCREW LOCKING SELF-TAP 26MM",6102890,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,349.11,279.288,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",279.29,80,,223.43,,,0,"percent of total billed charges ","80% of total billed charges ",244.38,70,,195.50,,,0,"percent of total billed charges ","70% of total billed charges ",314.2,90,,251.36,,,0,"percent of total billed charges ","90% of total billed charges ",324.67,93,,259.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",296.74,85,,237.39,,,0,"percent of total billed charges ","85% of total billed charges ",296.74,85,,237.39,,,0,"percent of total billed charges ","85% of total billed charges ",314.2,90,,251.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",303.73,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",244.38,70,,195.50,,,0,"percent of total billed charges ","70% of total billed charges ",244.38,324.67,
"SCREW LOCKING SELF-TAP 28MM",6102898,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,349.11,279.288,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",279.29,80,,223.43,,,0,"percent of total billed charges ","80% of total billed charges ",244.38,70,,195.50,,,0,"percent of total billed charges ","70% of total billed charges ",314.2,90,,251.36,,,0,"percent of total billed charges ","90% of total billed charges ",324.67,93,,259.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",296.74,85,,237.39,,,0,"percent of total billed charges ","85% of total billed charges ",296.74,85,,237.39,,,0,"percent of total billed charges ","85% of total billed charges ",314.2,90,,251.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",303.73,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",244.38,70,,195.50,,,0,"percent of total billed charges ","70% of total billed charges ",244.38,324.67,
"SCREW LOCKING SELF-TAP 30MM",6102899,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,349.11,279.288,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",279.29,80,,223.43,,,0,"percent of total billed charges ","80% of total billed charges ",244.38,70,,195.50,,,0,"percent of total billed charges ","70% of total billed charges ",314.2,90,,251.36,,,0,"percent of total billed charges ","90% of total billed charges ",324.67,93,,259.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",296.74,85,,237.39,,,0,"percent of total billed charges ","85% of total billed charges ",296.74,85,,237.39,,,0,"percent of total billed charges ","85% of total billed charges ",314.2,90,,251.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",303.73,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",244.38,70,,195.50,,,0,"percent of total billed charges ","70% of total billed charges ",244.38,324.67,
"K-WIRE .035(.9MM)X9""(22.9CM)",6102900,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,30.44,24.352,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",24.35,80,,19.48,,,0,"percent of total billed charges ","80% of total billed charges ",21.31,70,,17.05,,,0,"percent of total billed charges ","70% of total billed charges ",27.4,90,,21.92,,,0,"percent of total billed charges ","90% of total billed charges ",28.31,93,,22.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.87,85,,20.70,,,0,"percent of total billed charges ","85% of total billed charges ",25.87,85,,20.70,,,0,"percent of total billed charges ","85% of total billed charges ",27.4,90,,21.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.48,87,,21.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.31,70,,17.05,,,0,"percent of total billed charges ","70% of total billed charges ",21.31,28.31,
"K-WIRE .045(1.1MM) 9""(22.9CM)",6102903,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,30.44,24.352,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",24.35,80,,19.48,,,0,"percent of total billed charges ","80% of total billed charges ",21.31,70,,17.05,,,0,"percent of total billed charges ","70% of total billed charges ",27.4,90,,21.92,,,0,"percent of total billed charges ","90% of total billed charges ",28.31,93,,22.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.87,85,,20.70,,,0,"percent of total billed charges ","85% of total billed charges ",25.87,85,,20.70,,,0,"percent of total billed charges ","85% of total billed charges ",27.4,90,,21.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.48,87,,21.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.31,70,,17.05,,,0,"percent of total billed charges ","70% of total billed charges ",21.31,28.31,
"SCREW CORTEX SELF-TAP 6MM",6102905,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,273.19,218.552,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",218.55,80,,174.84,,,0,"percent of total billed charges ","80% of total billed charges ",191.23,70,,152.98,,,0,"percent of total billed charges ","70% of total billed charges ",245.87,90,,196.70,,,0,"percent of total billed charges ","90% of total billed charges ",254.07,93,,203.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",232.21,85,,185.77,,,0,"percent of total billed charges ","85% of total billed charges ",232.21,85,,185.77,,,0,"percent of total billed charges ","85% of total billed charges ",245.87,90,,196.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",237.68,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",191.23,70,,152.98,,,0,"percent of total billed charges ","70% of total billed charges ",191.23,254.07,
"K-WIRE .062(1.6MM)*9(22.9CM)",6102907,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,30.44,24.352,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",24.35,80,,19.48,,,0,"percent of total billed charges ","80% of total billed charges ",21.31,70,,17.05,,,0,"percent of total billed charges ","70% of total billed charges ",27.4,90,,21.92,,,0,"percent of total billed charges ","90% of total billed charges ",28.31,93,,22.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.87,85,,20.70,,,0,"percent of total billed charges ","85% of total billed charges ",25.87,85,,20.70,,,0,"percent of total billed charges ","85% of total billed charges ",27.4,90,,21.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.48,87,,21.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.31,70,,17.05,,,0,"percent of total billed charges ","70% of total billed charges ",21.31,28.31,
"K-WIRE 3/32(2.4MM)X9""(229MM)",6102912,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,43.48,34.784,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",34.78,80,,27.82,,,0,"percent of total billed charges ","80% of total billed charges ",30.44,70,,24.35,,,0,"percent of total billed charges ","70% of total billed charges ",39.13,90,,31.30,,,0,"percent of total billed charges ","90% of total billed charges ",40.44,93,,32.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",36.96,85,,29.57,,,0,"percent of total billed charges ","85% of total billed charges ",36.96,85,,29.57,,,0,"percent of total billed charges ","85% of total billed charges ",39.13,90,,31.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",37.83,87,,30.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.44,70,,24.35,,,0,"percent of total billed charges ","70% of total billed charges ",30.44,40.44,
"K-WIRE 1/8(3.2MM)X9""(229MM)",6102916,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,43.48,34.784,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",34.78,80,,27.82,,,0,"percent of total billed charges ","80% of total billed charges ",30.44,70,,24.35,,,0,"percent of total billed charges ","70% of total billed charges ",39.13,90,,31.30,,,0,"percent of total billed charges ","90% of total billed charges ",40.44,93,,32.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",36.96,85,,29.57,,,0,"percent of total billed charges ","85% of total billed charges ",36.96,85,,29.57,,,0,"percent of total billed charges ","85% of total billed charges ",39.13,90,,31.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",37.83,87,,30.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.44,70,,24.35,,,0,"percent of total billed charges ","70% of total billed charges ",30.44,40.44,
"K-WIRE 9/64(3.6MM)X9""(229MM)",6102918,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,61.07,48.856,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",48.86,80,,39.09,,,0,"percent of total billed charges ","80% of total billed charges ",42.75,70,,34.20,,,0,"percent of total billed charges ","70% of total billed charges ",54.96,90,,43.97,,,0,"percent of total billed charges ","90% of total billed charges ",56.8,93,,45.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51.91,85,,41.53,,,0,"percent of total billed charges ","85% of total billed charges ",51.91,85,,41.53,,,0,"percent of total billed charges ","85% of total billed charges ",54.96,90,,43.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",53.13,87,,42.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.75,70,,34.20,,,0,"percent of total billed charges ","70% of total billed charges ",42.75,56.8,
"SCREW CORTEX SELF-TAP 8MM",6102920,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,215.58,172.464,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",172.46,80,,137.97,,,0,"percent of total billed charges ","80% of total billed charges ",150.91,70,,120.73,,,0,"percent of total billed charges ","70% of total billed charges ",194.02,90,,155.22,,,0,"percent of total billed charges ","90% of total billed charges ",200.49,93,,160.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",183.24,85,,146.59,,,0,"percent of total billed charges ","85% of total billed charges ",183.24,85,,146.59,,,0,"percent of total billed charges ","85% of total billed charges ",194.02,90,,155.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",187.55,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",150.91,70,,120.73,,,0,"percent of total billed charges ","70% of total billed charges ",150.91,200.49,
"SCREW CORTEX SELF-TAP 10MM",6102922,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,215.58,172.464,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",172.46,80,,137.97,,,0,"percent of total billed charges ","80% of total billed charges ",150.91,70,,120.73,,,0,"percent of total billed charges ","70% of total billed charges ",194.02,90,,155.22,,,0,"percent of total billed charges ","90% of total billed charges ",200.49,93,,160.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",183.24,85,,146.59,,,0,"percent of total billed charges ","85% of total billed charges ",183.24,85,,146.59,,,0,"percent of total billed charges ","85% of total billed charges ",194.02,90,,155.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",187.55,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",150.91,70,,120.73,,,0,"percent of total billed charges ","70% of total billed charges ",150.91,200.49,
"SCREW CORTEX SELF-TAP 12MM",6102925,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,217.97,174.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",174.38,80,,139.50,,,0,"percent of total billed charges ","80% of total billed charges ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",202.71,93,,162.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",189.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",152.58,202.71,
"SCREW CORTEX SELF-TAP 14MM",6102931,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,217.97,174.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",174.38,80,,139.50,,,0,"percent of total billed charges ","80% of total billed charges ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",202.71,93,,162.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",189.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",152.58,202.71,
"SCREW CORTEX SELF-TAP 16MM",6102934,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,217.97,174.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",174.38,80,,139.50,,,0,"percent of total billed charges ","80% of total billed charges ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",202.71,93,,162.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",189.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",152.58,202.71,
"SCREW CORTEX SELF-TAP 18MM",6102942,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,217.97,174.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",174.38,80,,139.50,,,0,"percent of total billed charges ","80% of total billed charges ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",202.71,93,,162.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",189.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",152.58,202.71,
"SCREW CORTEX SELF-TAP 20MM",6102943,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,217.97,174.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",174.38,80,,139.50,,,0,"percent of total billed charges ","80% of total billed charges ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",202.71,93,,162.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",189.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",152.58,202.71,
"SCREW CORTEX SELF-TAP 22MM",6102944,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,217.97,174.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",174.38,80,,139.50,,,0,"percent of total billed charges ","80% of total billed charges ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",202.71,93,,162.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",189.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",152.58,202.71,
"SCREW CORTEX SELF-TAP 24MM",6102953,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,258.66,206.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",206.93,80,,165.54,,,0,"percent of total billed charges ","80% of total billed charges ",181.06,70,,144.85,,,0,"percent of total billed charges ","70% of total billed charges ",232.79,90,,186.23,,,0,"percent of total billed charges ","90% of total billed charges ",240.55,93,,192.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",219.86,85,,175.89,,,0,"percent of total billed charges ","85% of total billed charges ",219.86,85,,175.89,,,0,"percent of total billed charges ","85% of total billed charges ",232.79,90,,186.23,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",225.03,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",181.06,70,,144.85,,,0,"percent of total billed charges ","70% of total billed charges ",181.06,240.55,
"SCREW CORTEX SELF-TAP 26MM",6102959,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,258.66,206.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",206.93,80,,165.54,,,0,"percent of total billed charges ","80% of total billed charges ",181.06,70,,144.85,,,0,"percent of total billed charges ","70% of total billed charges ",232.79,90,,186.23,,,0,"percent of total billed charges ","90% of total billed charges ",240.55,93,,192.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",219.86,85,,175.89,,,0,"percent of total billed charges ","85% of total billed charges ",219.86,85,,175.89,,,0,"percent of total billed charges ","85% of total billed charges ",232.79,90,,186.23,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",225.03,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",181.06,70,,144.85,,,0,"percent of total billed charges ","70% of total billed charges ",181.06,240.55,
"SCREW CORTEX SELF-TAP 28MM",6102962,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,300.31,240.248,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",240.25,80,,192.20,,,0,"percent of total billed charges ","80% of total billed charges ",210.22,70,,168.18,,,0,"percent of total billed charges ","70% of total billed charges ",270.28,90,,216.22,,,0,"percent of total billed charges ","90% of total billed charges ",279.29,93,,223.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",255.26,85,,204.21,,,0,"percent of total billed charges ","85% of total billed charges ",255.26,85,,204.21,,,0,"percent of total billed charges ","85% of total billed charges ",270.28,90,,216.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",261.27,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.22,70,,168.18,,,0,"percent of total billed charges ","70% of total billed charges ",210.22,279.29,
"GUIDE WIRE 5.9",6102971,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,102.24,81.792,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",81.79,80,,65.43,,,0,"percent of total billed charges ","80% of total billed charges ",71.57,70,,57.26,,,0,"percent of total billed charges ","70% of total billed charges ",92.02,90,,73.62,,,0,"percent of total billed charges ","90% of total billed charges ",95.08,93,,76.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",86.9,85,,69.52,,,0,"percent of total billed charges ","85% of total billed charges ",86.9,85,,69.52,,,0,"percent of total billed charges ","85% of total billed charges ",92.02,90,,73.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",88.95,87,,71.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.57,70,,57.26,,,0,"percent of total billed charges ","70% of total billed charges ",71.57,95.08,
"SCREW CORTEX SELF-TAP 30MM",6102977,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,273.19,218.552,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",218.55,80,,174.84,,,0,"percent of total billed charges ","80% of total billed charges ",191.23,70,,152.98,,,0,"percent of total billed charges ","70% of total billed charges ",245.87,90,,196.70,,,0,"percent of total billed charges ","90% of total billed charges ",254.07,93,,203.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",232.21,85,,185.77,,,0,"percent of total billed charges ","85% of total billed charges ",232.21,85,,185.77,,,0,"percent of total billed charges ","85% of total billed charges ",245.87,90,,196.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",237.68,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",191.23,70,,152.98,,,0,"percent of total billed charges ","70% of total billed charges ",191.23,254.07,
"SCREW CORTEX 2.7 SLF-TAP 10MM",6102984,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,183.62,146.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",146.9,80,,117.52,,,0,"percent of total billed charges ","80% of total billed charges ",128.53,70,,102.82,,,0,"percent of total billed charges ","70% of total billed charges ",165.26,90,,132.21,,,0,"percent of total billed charges ","90% of total billed charges ",170.77,93,,136.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",156.08,85,,124.86,,,0,"percent of total billed charges ","85% of total billed charges ",156.08,85,,124.86,,,0,"percent of total billed charges ","85% of total billed charges ",165.26,90,,132.21,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",159.75,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.53,70,,102.82,,,0,"percent of total billed charges ","70% of total billed charges ",128.53,170.77,
"COMP FEM PS OPEN 55MM RT",6102989,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,4168.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"STEM KNEE SPLINED V2 10X80MM",6102990,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,3527.45,2821.96,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2821.96,80,,2257.57,,,0,"percent of total billed charges ","80% of total billed charges ",2469.22,70,,1975.38,,,0,"percent of total billed charges ","70% of total billed charges ",3174.71,90,,2539.77,,,0,"percent of total billed charges ","90% of total billed charges ",3280.53,93,,2624.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2998.33,85,,2398.66,,,0,"percent of total billed charges ","85% of total billed charges ",2998.33,85,,2398.66,,,0,"percent of total billed charges ","85% of total billed charges ",3174.71,90,,2539.77,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3068.88,87,,2455.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2469.22,70,,1975.38,,,0,"percent of total billed charges ","70% of total billed charges ",2469.22,3280.53,
"TRAY TIBIA FIXED CRUCIATE 59MM",6102993,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2268.75,1815,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1815,80,,1452.00,,,0,"percent of total billed charges ","80% of total billed charges ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",2109.94,93,,1687.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1973.81,87,,1579.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",1588.13,2109.94,
"STEM KNEE SPLINED V2 16X80MM",6102994,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,3527.45,2821.96,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2821.96,80,,2257.57,,,0,"percent of total billed charges ","80% of total billed charges ",2469.22,70,,1975.38,,,0,"percent of total billed charges ","70% of total billed charges ",3174.71,90,,2539.77,,,0,"percent of total billed charges ","90% of total billed charges ",3280.53,93,,2624.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2998.33,85,,2398.66,,,0,"percent of total billed charges ","85% of total billed charges ",2998.33,85,,2398.66,,,0,"percent of total billed charges ","85% of total billed charges ",3174.71,90,,2539.77,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3068.88,87,,2455.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2469.22,70,,1975.38,,,0,"percent of total billed charges ","70% of total billed charges ",2469.22,3280.53,
"CUP ACETABULAR 28 X 53MM",6102995,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1851.3,1481.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1481.04,80,,1184.83,,,0,"percent of total billed charges ","80% of total billed charges ",1295.91,70,,1036.73,,,0,"percent of total billed charges ","70% of total billed charges ",1666.17,90,,1332.94,,,0,"percent of total billed charges ","90% of total billed charges ",1721.71,93,,1377.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1573.61,85,,1258.89,,,0,"percent of total billed charges ","85% of total billed charges ",1573.61,85,,1258.89,,,0,"percent of total billed charges ","85% of total billed charges ",1666.17,90,,1332.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1610.63,87,,1288.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1295.91,70,,1036.73,,,0,"percent of total billed charges ","70% of total billed charges ",1295.91,1721.71,
"COMP MDLR HEAD 28 MM +6MM NK",6102996,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1089,871.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",871.2,80,,696.96,,,0,"percent of total billed charges ","80% of total billed charges ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",1012.77,93,,810.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",947.43,87,,757.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",762.3,1012.77,
"SCREW CORTEX 2.7 SLF-TAP",6102998,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,170.02,136.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",136.02,80,,108.82,,,0,"percent of total billed charges ","80% of total billed charges ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",158.12,93,,126.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",147.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",119.01,158.12,
"COMP FEM PS OPEN 57.5MM RT",6103001,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,4168.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"BAR TIBIAL LOCKING",6103002,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,336.18,268.944,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",268.94,80,,215.15,,,0,"percent of total billed charges ","80% of total billed charges ",235.33,70,,188.26,,,0,"percent of total billed charges ","70% of total billed charges ",302.56,90,,242.05,,,0,"percent of total billed charges ","90% of total billed charges ",312.65,93,,250.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",285.75,85,,228.60,,,0,"percent of total billed charges ","85% of total billed charges ",285.75,85,,228.60,,,0,"percent of total billed charges ","85% of total billed charges ",302.56,90,,242.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",292.48,87,,233.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",235.33,70,,188.26,,,0,"percent of total billed charges ","70% of total billed charges ",235.33,312.65,
"BRNG TIBIA VE PS+ 10X63/67MM",6103003,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2904,2323.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2323.2,80,,1858.56,,,0,"percent of total billed charges ","80% of total billed charges ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",2700.72,93,,2160.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2526.48,87,,2021.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2032.8,2700.72,
"STEM KNEE SPLINED V2 18X80MM",6103006,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,3527.45,2821.96,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2821.96,80,,2257.57,,,0,"percent of total billed charges ","80% of total billed charges ",2469.22,70,,1975.38,,,0,"percent of total billed charges ","70% of total billed charges ",3174.71,90,,2539.77,,,0,"percent of total billed charges ","90% of total billed charges ",3280.53,93,,2624.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2998.33,85,,2398.66,,,0,"percent of total billed charges ","85% of total billed charges ",2998.33,85,,2398.66,,,0,"percent of total billed charges ","85% of total billed charges ",3174.71,90,,2539.77,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3068.88,87,,2455.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2469.22,70,,1975.38,,,0,"percent of total billed charges ","70% of total billed charges ",2469.22,3280.53,
"COMP MDLR HEAD 28 MM 0MM NK",6103008,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1089,871.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",871.2,80,,696.96,,,0,"percent of total billed charges ","80% of total billed charges ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",1012.77,93,,810.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",947.43,87,,757.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",762.3,1012.77,
"BRNG TIBIA VE PS+ 12X63/67MM",6103009,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2904,2323.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2323.2,80,,1858.56,,,0,"percent of total billed charges ","80% of total billed charges ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",2700.72,93,,2160.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2526.48,87,,2021.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2032.8,2700.72,
"COMP FEM PS OPEN 60MM RT",6103010,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,4168.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"TRAY TIBIA FIXED CRUCIATE 67MM",6103011,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2268.75,1815,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1815,80,,1452.00,,,0,"percent of total billed charges ","80% of total billed charges ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",2109.94,93,,1687.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1973.81,87,,1579.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",1588.13,2109.94,
"TRAY TIBIA FIXED CRUCIATE 71MM",6103014,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2268.75,1815,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1815,80,,1452.00,,,0,"percent of total billed charges ","80% of total billed charges ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",2109.94,93,,1687.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1973.81,87,,1579.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",1588.13,2109.94,
"SCREW CORTEX 2.7 SLF-TAP 14MM",6103015,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,170.02,136.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",136.02,80,,108.82,,,0,"percent of total billed charges ","80% of total billed charges ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",158.12,93,,126.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",147.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",119.01,158.12,
"COMPONENT FEMORAL",6103016,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,4168.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"SCREW CORTEX 2.7 SLF-TAP 16MM",6103024,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,170.02,136.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",136.02,80,,108.82,,,0,"percent of total billed charges ","80% of total billed charges ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",158.12,93,,126.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",147.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",119.01,158.12,
"SCREW CORTEX 2.7 SLF-TAP 18MM",6103028,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"SCREW CORTEX 2.7 SLF-TAP 20MM",6103032,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,170.02,136.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",136.02,80,,108.82,,,0,"percent of total billed charges ","80% of total billed charges ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",158.12,93,,126.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",147.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",119.01,158.12,
"SCREW CORTEX 2.7 SLF-TAP 22MM",6103035,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,170.02,136.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",136.02,80,,108.82,,,0,"percent of total billed charges ","80% of total billed charges ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",158.12,93,,126.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",147.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",119.01,158.12,
"SCREW CORTEX 2.7 SLF-TAP 24MM",6103037,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,183.62,146.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",146.9,80,,117.52,,,0,"percent of total billed charges ","80% of total billed charges ",128.53,70,,102.82,,,0,"percent of total billed charges ","70% of total billed charges ",165.26,90,,132.21,,,0,"percent of total billed charges ","90% of total billed charges ",170.77,93,,136.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",156.08,85,,124.86,,,0,"percent of total billed charges ","85% of total billed charges ",156.08,85,,124.86,,,0,"percent of total billed charges ","85% of total billed charges ",165.26,90,,132.21,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",159.75,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.53,70,,102.82,,,0,"percent of total billed charges ","70% of total billed charges ",128.53,170.77,
"TRAY TIBIA FIXED CRUCIATE 75MM",6103038,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2268.75,1815,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1815,80,,1452.00,,,0,"percent of total billed charges ","80% of total billed charges ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",2109.94,93,,1687.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1973.81,87,,1579.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",1588.13,2109.94,
"TRAY TIBIA FIXED CRUCIATE 79MM",6103039,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2268.75,1815,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1815,80,,1452.00,,,0,"percent of total billed charges ","80% of total billed charges ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",2109.94,93,,1687.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1973.81,87,,1579.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",1588.13,2109.94,
"SCREW CORTEX 2.7 SLF-TAP 26MM",6103044,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,144.46,115.568,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",115.57,80,,92.46,,,0,"percent of total billed charges ","80% of total billed charges ",101.12,70,,80.90,,,0,"percent of total billed charges ","70% of total billed charges ",130.01,90,,104.01,,,0,"percent of total billed charges ","90% of total billed charges ",134.35,93,,107.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",122.79,85,,98.23,,,0,"percent of total billed charges ","85% of total billed charges ",122.79,85,,98.23,,,0,"percent of total billed charges ","85% of total billed charges ",130.01,90,,104.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",125.68,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.12,70,,80.90,,,0,"percent of total billed charges ","70% of total billed charges ",101.12,134.35,
"COMP FEM PS OPEN 67.5MM RT",6103046,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,4168.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"SCREW CORTEX 2.7 SLF-TAP 28MM",6103051,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,144.46,115.568,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",115.57,80,,92.46,,,0,"percent of total billed charges ","80% of total billed charges ",101.12,70,,80.90,,,0,"percent of total billed charges ","70% of total billed charges ",130.01,90,,104.01,,,0,"percent of total billed charges ","90% of total billed charges ",134.35,93,,107.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",122.79,85,,98.23,,,0,"percent of total billed charges ","85% of total billed charges ",122.79,85,,98.23,,,0,"percent of total billed charges ","85% of total billed charges ",130.01,90,,104.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",125.68,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.12,70,,80.90,,,0,"percent of total billed charges ","70% of total billed charges ",101.12,134.35,
"SCREW CORTEX 2.7 SLF-TAP 30MM",6103052,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"K-WIRE TROCAR TIP 1.25MM*150MM",6103055,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,44.38,35.504,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",35.5,80,,28.40,,,0,"percent of total billed charges ","80% of total billed charges ",31.07,70,,24.86,,,0,"percent of total billed charges ","70% of total billed charges ",39.94,90,,31.95,,,0,"percent of total billed charges ","90% of total billed charges ",41.27,93,,33.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",37.72,85,,30.18,,,0,"percent of total billed charges ","85% of total billed charges ",37.72,85,,30.18,,,0,"percent of total billed charges ","85% of total billed charges ",39.94,90,,31.95,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",38.61,87,,30.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.07,70,,24.86,,,0,"percent of total billed charges ","70% of total billed charges ",31.07,41.27,
"PLATE XTRA-ARTIC RIGHT",6103058,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1655.08,1324.064,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1324.06,80,,1059.25,,,0,"percent of total billed charges ","80% of total billed charges ",1158.56,70,,926.85,,,0,"percent of total billed charges ","70% of total billed charges ",1489.57,90,,1191.66,,,0,"percent of total billed charges ","90% of total billed charges ",1539.22,93,,1231.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1406.82,85,,1125.46,,,0,"percent of total billed charges ","85% of total billed charges ",1406.82,85,,1125.46,,,0,"percent of total billed charges ","85% of total billed charges ",1489.57,90,,1191.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1439.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1158.56,70,,926.85,,,0,"percent of total billed charges ","70% of total billed charges ",1158.56,1539.22,
"PLATE XTRA-ARTIC RIGHT/LONG",6103059,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1804.56,1443.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1443.65,80,,1154.92,,,0,"percent of total billed charges ","80% of total billed charges ",1263.19,70,,1010.55,,,0,"percent of total billed charges ","70% of total billed charges ",1624.1,90,,1299.28,,,0,"percent of total billed charges ","90% of total billed charges ",1678.24,93,,1342.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1533.88,85,,1227.10,,,0,"percent of total billed charges ","85% of total billed charges ",1533.88,85,,1227.10,,,0,"percent of total billed charges ","85% of total billed charges ",1624.1,90,,1299.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1569.97,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1263.19,70,,1010.55,,,0,"percent of total billed charges ","70% of total billed charges ",1263.19,1678.24,
"PLATE XTRA-ARTIC LEFT",6103060,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1487.85,1190.28,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1190.28,80,,952.22,,,0,"percent of total billed charges ","80% of total billed charges ",1041.5,70,,833.20,,,0,"percent of total billed charges ","70% of total billed charges ",1339.07,90,,1071.26,,,0,"percent of total billed charges ","90% of total billed charges ",1383.7,93,,1106.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1264.67,85,,1011.74,,,0,"percent of total billed charges ","85% of total billed charges ",1264.67,85,,1011.74,,,0,"percent of total billed charges ","85% of total billed charges ",1339.07,90,,1071.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1294.43,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1041.5,70,,833.20,,,0,"percent of total billed charges ","70% of total billed charges ",1041.5,1383.7,
"PLATE XTRA-ARTIC LEFT/LONG",6103063,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1426.59,1141.272,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1141.27,80,,913.02,,,0,"percent of total billed charges ","80% of total billed charges ",998.61,70,,798.89,,,0,"percent of total billed charges ","70% of total billed charges ",1283.93,90,,1027.14,,,0,"percent of total billed charges ","90% of total billed charges ",1326.73,93,,1061.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1212.6,85,,970.08,,,0,"percent of total billed charges ","85% of total billed charges ",1212.6,85,,970.08,,,0,"percent of total billed charges ","85% of total billed charges ",1283.93,90,,1027.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1241.13,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",998.61,70,,798.89,,,0,"percent of total billed charges ","70% of total billed charges ",998.61,1326.73,
"PLATE XTRA-ARTIC 4H HEAD/RIGHT",6103064,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1704.74,1363.792,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1363.79,80,,1091.03,,,0,"percent of total billed charges ","80% of total billed charges ",1193.32,70,,954.66,,,0,"percent of total billed charges ","70% of total billed charges ",1534.27,90,,1227.42,,,0,"percent of total billed charges ","90% of total billed charges ",1585.41,93,,1268.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1449.03,85,,1159.22,,,0,"percent of total billed charges ","85% of total billed charges ",1449.03,85,,1159.22,,,0,"percent of total billed charges ","85% of total billed charges ",1534.27,90,,1227.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1483.12,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1193.32,70,,954.66,,,0,"percent of total billed charges ","70% of total billed charges ",1193.32,1585.41,
"PLATE XTRA-ARTIC 4H HD/RT-LONG",6103065,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1426.59,1141.272,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1141.27,80,,913.02,,,0,"percent of total billed charges ","80% of total billed charges ",998.61,70,,798.89,,,0,"percent of total billed charges ","70% of total billed charges ",1283.93,90,,1027.14,,,0,"percent of total billed charges ","90% of total billed charges ",1326.73,93,,1061.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1212.6,85,,970.08,,,0,"percent of total billed charges ","85% of total billed charges ",1212.6,85,,970.08,,,0,"percent of total billed charges ","85% of total billed charges ",1283.93,90,,1027.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1241.13,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",998.61,70,,798.89,,,0,"percent of total billed charges ","70% of total billed charges ",998.61,1326.73,
"PLATE XTRA-ARTIC 4H HEAD/LEFT",6103066,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1704.74,1363.792,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1363.79,80,,1091.03,,,0,"percent of total billed charges ","80% of total billed charges ",1193.32,70,,954.66,,,0,"percent of total billed charges ","70% of total billed charges ",1534.27,90,,1227.42,,,0,"percent of total billed charges ","90% of total billed charges ",1585.41,93,,1268.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1449.03,85,,1159.22,,,0,"percent of total billed charges ","85% of total billed charges ",1449.03,85,,1159.22,,,0,"percent of total billed charges ","85% of total billed charges ",1534.27,90,,1227.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1483.12,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1193.32,70,,954.66,,,0,"percent of total billed charges ","70% of total billed charges ",1193.32,1585.41,
"PLATE XTRA-ARTIC 4H HD/LT-LONG",6103067,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1804.56,1443.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1443.65,80,,1154.92,,,0,"percent of total billed charges ","80% of total billed charges ",1263.19,70,,1010.55,,,0,"percent of total billed charges ","70% of total billed charges ",1624.1,90,,1299.28,,,0,"percent of total billed charges ","90% of total billed charges ",1678.24,93,,1342.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1533.88,85,,1227.10,,,0,"percent of total billed charges ","85% of total billed charges ",1533.88,85,,1227.10,,,0,"percent of total billed charges ","85% of total billed charges ",1624.1,90,,1299.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1569.97,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1263.19,70,,1010.55,,,0,"percent of total billed charges ","70% of total billed charges ",1263.19,1678.24,
"PLATE T 2.4MM 3H HEAD/3H SHAFT",6103068,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,973.24,778.592,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",778.59,80,,622.87,,,0,"percent of total billed charges ","80% of total billed charges ",681.27,70,,545.02,,,0,"percent of total billed charges ","70% of total billed charges ",875.92,90,,700.74,,,0,"percent of total billed charges ","90% of total billed charges ",905.11,93,,724.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",827.25,85,,661.80,,,0,"percent of total billed charges ","85% of total billed charges ",827.25,85,,661.80,,,0,"percent of total billed charges ","85% of total billed charges ",875.92,90,,700.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",846.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",681.27,70,,545.02,,,0,"percent of total billed charges ","70% of total billed charges ",681.27,905.11,
"PLATE L -90 DEG 2H HD/3H SHAFT",6103071,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,879.24,703.392,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",703.39,80,,562.71,,,0,"percent of total billed charges ","80% of total billed charges ",615.47,70,,492.38,,,0,"percent of total billed charges ","70% of total billed charges ",791.32,90,,633.06,,,0,"percent of total billed charges ","90% of total billed charges ",817.69,93,,654.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",747.35,85,,597.88,,,0,"percent of total billed charges ","85% of total billed charges ",747.35,85,,597.88,,,0,"percent of total billed charges ","85% of total billed charges ",791.32,90,,633.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",764.94,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",615.47,70,,492.38,,,0,"percent of total billed charges ","70% of total billed charges ",615.47,817.69,
"PLATE L +90 DEG 2H HD/3H SHAFT",6103072,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,970.57,776.456,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",776.46,80,,621.17,,,0,"percent of total billed charges ","80% of total billed charges ",679.4,70,,543.52,,,0,"percent of total billed charges ","70% of total billed charges ",873.51,90,,698.81,,,0,"percent of total billed charges ","90% of total billed charges ",902.63,93,,722.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",824.98,85,,659.98,,,0,"percent of total billed charges ","85% of total billed charges ",824.98,85,,659.98,,,0,"percent of total billed charges ","85% of total billed charges ",873.51,90,,698.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",844.4,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",679.4,70,,543.52,,,0,"percent of total billed charges ","70% of total billed charges ",679.4,902.63,
"PLATE L +90 DEG 3H HD/3H SHAFT",6103073,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,879.24,703.392,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",703.39,80,,562.71,,,0,"percent of total billed charges ","80% of total billed charges ",615.47,70,,492.38,,,0,"percent of total billed charges ","70% of total billed charges ",791.32,90,,633.06,,,0,"percent of total billed charges ","90% of total billed charges ",817.69,93,,654.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",747.35,85,,597.88,,,0,"percent of total billed charges ","85% of total billed charges ",747.35,85,,597.88,,,0,"percent of total billed charges ","85% of total billed charges ",791.32,90,,633.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",764.94,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",615.47,70,,492.38,,,0,"percent of total billed charges ","70% of total billed charges ",615.47,817.69,
"PLATE L -90 DEG 3H HD/3H SHAFT",6103074,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,879.24,703.392,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",703.39,80,,562.71,,,0,"percent of total billed charges ","80% of total billed charges ",615.47,70,,492.38,,,0,"percent of total billed charges ","70% of total billed charges ",791.32,90,,633.06,,,0,"percent of total billed charges ","90% of total billed charges ",817.69,93,,654.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",747.35,85,,597.88,,,0,"percent of total billed charges ","85% of total billed charges ",747.35,85,,597.88,,,0,"percent of total billed charges ","85% of total billed charges ",791.32,90,,633.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",764.94,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",615.47,70,,492.38,,,0,"percent of total billed charges ","70% of total billed charges ",615.47,817.69,
"PLATE L +20 DEG 3H HD/3H SHAFT",6103075,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,958.05,766.44,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",766.44,80,,613.15,,,0,"percent of total billed charges ","80% of total billed charges ",670.64,70,,536.51,,,0,"percent of total billed charges ","70% of total billed charges ",862.25,90,,689.80,,,0,"percent of total billed charges ","90% of total billed charges ",890.99,93,,712.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",814.34,85,,651.47,,,0,"percent of total billed charges ","85% of total billed charges ",814.34,85,,651.47,,,0,"percent of total billed charges ","85% of total billed charges ",862.25,90,,689.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",833.5,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",670.64,70,,536.51,,,0,"percent of total billed charges ","70% of total billed charges ",670.64,890.99,
"PLATE L -20 DEG 3H HD/3H SHAFT",6103076,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,879.24,703.392,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",703.39,80,,562.71,,,0,"percent of total billed charges ","80% of total billed charges ",615.47,70,,492.38,,,0,"percent of total billed charges ","70% of total billed charges ",791.32,90,,633.06,,,0,"percent of total billed charges ","90% of total billed charges ",817.69,93,,654.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",747.35,85,,597.88,,,0,"percent of total billed charges ","85% of total billed charges ",747.35,85,,597.88,,,0,"percent of total billed charges ","85% of total billed charges ",791.32,90,,633.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",764.94,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",615.47,70,,492.38,,,0,"percent of total billed charges ","70% of total billed charges ",615.47,817.69,
"FEMORAL CR FLEX E LT",6103084,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5798.93,4639.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4639.14,80,,3711.31,,,0,"percent of total billed charges ","80% of total billed charges ",4059.25,70,,3247.40,,,0,"percent of total billed charges ","70% of total billed charges ",5219.04,90,,4175.23,,,0,"percent of total billed charges ","90% of total billed charges ",5393,93,,4314.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4929.09,85,,3943.27,,,0,"percent of total billed charges ","85% of total billed charges ",4929.09,85,,3943.27,,,0,"percent of total billed charges ","85% of total billed charges ",5219.04,90,,4175.23,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5045.07,87,,4036.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4059.25,70,,3247.40,,,0,"percent of total billed charges ","70% of total billed charges ",4059.25,5393,
"FEMORAL CR FLEX E RT",6103089,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5798.93,4639.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4639.14,80,,3711.31,,,0,"percent of total billed charges ","80% of total billed charges ",4059.25,70,,3247.40,,,0,"percent of total billed charges ","70% of total billed charges ",5219.04,90,,4175.23,,,0,"percent of total billed charges ","90% of total billed charges ",5393,93,,4314.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4929.09,85,,3943.27,,,0,"percent of total billed charges ","85% of total billed charges ",4929.09,85,,3943.27,,,0,"percent of total billed charges ","85% of total billed charges ",5219.04,90,,4175.23,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5045.07,87,,4036.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4059.25,70,,3247.40,,,0,"percent of total billed charges ","70% of total billed charges ",4059.25,5393,
"FEMORAL CR FLEX E LT MINUS",6103091,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,7349.86,5879.888,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5879.89,80,,4703.91,,,0,"percent of total billed charges ","80% of total billed charges ",5144.9,70,,4115.92,,,0,"percent of total billed charges ","70% of total billed charges ",6614.87,90,,5291.90,,,0,"percent of total billed charges ","90% of total billed charges ",6835.37,93,,5468.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6247.38,85,,4997.90,,,0,"percent of total billed charges ","85% of total billed charges ",6247.38,85,,4997.90,,,0,"percent of total billed charges ","85% of total billed charges ",6614.87,90,,5291.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6394.38,87,,5115.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5144.9,70,,4115.92,,,0,"percent of total billed charges ","70% of total billed charges ",5144.9,6835.37,
"FEMORAL CUP",6103092,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1101,880.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",880.8,80,,704.64,,,0,"percent of total billed charges ","80% of total billed charges ",770.7,70,,616.56,,,0,"percent of total billed charges ","70% of total billed charges ",990.9,90,,792.72,,,0,"percent of total billed charges ","90% of total billed charges ",1023.93,93,,819.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",935.85,85,,748.68,,,0,"percent of total billed charges ","85% of total billed charges ",935.85,85,,748.68,,,0,"percent of total billed charges ","85% of total billed charges ",990.9,90,,792.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",957.87,87,,766.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",770.7,70,,616.56,,,0,"percent of total billed charges ","70% of total billed charges ",770.7,1023.93,
"COMP MDLR HEAD 28 MM -3MM NK",6103094,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1089,871.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",871.2,80,,696.96,,,0,"percent of total billed charges ","80% of total billed charges ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",1012.77,93,,810.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",947.43,87,,757.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",762.3,1012.77,
"FEMORAL CR FLEX E RT MINUS",6103098,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,7349.86,5879.888,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5879.89,80,,4703.91,,,0,"percent of total billed charges ","80% of total billed charges ",5144.9,70,,4115.92,,,0,"percent of total billed charges ","70% of total billed charges ",6614.87,90,,5291.90,,,0,"percent of total billed charges ","90% of total billed charges ",6835.37,93,,5468.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6247.38,85,,4997.90,,,0,"percent of total billed charges ","85% of total billed charges ",6247.38,85,,4997.90,,,0,"percent of total billed charges ","85% of total billed charges ",6614.87,90,,5291.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6394.38,87,,5115.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5144.9,70,,4115.92,,,0,"percent of total billed charges ","70% of total billed charges ",5144.9,6835.37,
"CUP ACETABULAR 28 X 41MM",6103106,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1851.3,1481.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1481.04,80,,1184.83,,,0,"percent of total billed charges ","80% of total billed charges ",1295.91,70,,1036.73,,,0,"percent of total billed charges ","70% of total billed charges ",1666.17,90,,1332.94,,,0,"percent of total billed charges ","90% of total billed charges ",1721.71,93,,1377.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1573.61,85,,1258.89,,,0,"percent of total billed charges ","85% of total billed charges ",1573.61,85,,1258.89,,,0,"percent of total billed charges ","85% of total billed charges ",1666.17,90,,1332.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1610.63,87,,1288.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1295.91,70,,1036.73,,,0,"percent of total billed charges ","70% of total billed charges ",1295.91,1721.71,
"CUP ACETABULAR 28 X 42MM",6103107,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1851.3,1481.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1481.04,80,,1184.83,,,0,"percent of total billed charges ","80% of total billed charges ",1295.91,70,,1036.73,,,0,"percent of total billed charges ","70% of total billed charges ",1666.17,90,,1332.94,,,0,"percent of total billed charges ","90% of total billed charges ",1721.71,93,,1377.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1573.61,85,,1258.89,,,0,"percent of total billed charges ","85% of total billed charges ",1573.61,85,,1258.89,,,0,"percent of total billed charges ","85% of total billed charges ",1666.17,90,,1332.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1610.63,87,,1288.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1295.91,70,,1036.73,,,0,"percent of total billed charges ","70% of total billed charges ",1295.91,1721.71,
"CUP ACETABULAR 28X43MM",6103113,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1851.3,1481.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1481.04,80,,1184.83,,,0,"percent of total billed charges ","80% of total billed charges ",1295.91,70,,1036.73,,,0,"percent of total billed charges ","70% of total billed charges ",1666.17,90,,1332.94,,,0,"percent of total billed charges ","90% of total billed charges ",1721.71,93,,1377.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1573.61,85,,1258.89,,,0,"percent of total billed charges ","85% of total billed charges ",1573.61,85,,1258.89,,,0,"percent of total billed charges ","85% of total billed charges ",1666.17,90,,1332.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1610.63,87,,1288.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1295.91,70,,1036.73,,,0,"percent of total billed charges ","70% of total billed charges ",1295.91,1721.71,
"FEMORAL CR FLEX F LT",6103118,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,8893.5,7114.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7114.8,80,,5691.84,,,0,"percent of total billed charges ","80% of total billed charges ",6225.45,70,,4980.36,,,0,"percent of total billed charges ","70% of total billed charges ",8004.15,90,,6403.32,,,0,"percent of total billed charges ","90% of total billed charges ",8270.96,93,,6616.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7559.48,85,,6047.58,,,0,"percent of total billed charges ","85% of total billed charges ",7559.48,85,,6047.58,,,0,"percent of total billed charges ","85% of total billed charges ",8004.15,90,,6403.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7737.35,87,,6189.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6225.45,70,,4980.36,,,0,"percent of total billed charges ","70% of total billed charges ",6225.45,8270.96,
"FEMORAL CR FLEX F RT",6103119,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,7873.16,6298.528,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6298.53,80,,5038.82,,,0,"percent of total billed charges ","80% of total billed charges ",5511.21,70,,4408.97,,,0,"percent of total billed charges ","70% of total billed charges ",7085.84,90,,5668.67,,,0,"percent of total billed charges ","90% of total billed charges ",7322.04,93,,5857.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6692.19,85,,5353.75,,,0,"percent of total billed charges ","85% of total billed charges ",6692.19,85,,5353.75,,,0,"percent of total billed charges ","85% of total billed charges ",7085.84,90,,5668.67,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6849.65,87,,5479.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5511.21,70,,4408.97,,,0,"percent of total billed charges ","70% of total billed charges ",5511.21,7322.04,
"TAPE CAST 2"" BLUE",6103121,"CDM ",272,RC,A4590,HCPCS,OUTPATIENT,,,11.63,9.304,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.14,70,,6.51,,,0,"percent of total billed charges ","70% of total billed charges ",10.47,90,,8.38,,,0,"percent of total billed charges ","90% of total billed charges ",10.82,93,,8.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.89,85,,7.91,,,0,"percent of total billed charges ","85% of total billed charges ",10.47,90,,8.38,,,0,"percent of total billed charges ","90% of total billed charges ",10.47,90,,8.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.12,87,,8.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.14,70,,6.51,,,0,"percent of total billed charges ","70% of total billed charges ",8.14,10.82,
"CUP ACETABULAR 28 X 44MM",6103123,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1851.3,1481.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1295.91,70,,1036.73,,,0,"percent of total billed charges ","70% of total billed charges ",1666.17,90,,1332.94,,,0,"percent of total billed charges ","90% of total billed charges ",1721.71,93,,1377.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1573.61,85,,1258.89,,,0,"percent of total billed charges ","85% of total billed charges ",1573.61,85,,1258.89,,,0,"percent of total billed charges ","85% of total billed charges ",1666.17,90,,1332.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1610.63,87,,1288.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1295.91,70,,1036.73,,,0,"percent of total billed charges ","70% of total billed charges ",1295.91,1721.71,
"FEMORAL CR FLEX F LT MINUS",6103124,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,7349.86,5879.888,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5144.9,70,,4115.92,,,0,"percent of total billed charges ","70% of total billed charges ",6614.87,90,,5291.90,,,0,"percent of total billed charges ","90% of total billed charges ",6835.37,93,,5468.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6247.38,85,,4997.90,,,0,"percent of total billed charges ","85% of total billed charges ",6247.38,85,,4997.90,,,0,"percent of total billed charges ","85% of total billed charges ",6614.87,90,,5291.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6394.38,87,,5115.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5144.9,70,,4115.92,,,0,"percent of total billed charges ","70% of total billed charges ",5144.9,6835.37,
"FEMORAL CR FLEX F RT MINUS",6103125,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,7349.86,5879.888,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5144.9,70,,4115.92,,,0,"percent of total billed charges ","70% of total billed charges ",6614.87,90,,5291.90,,,0,"percent of total billed charges ","90% of total billed charges ",6835.37,93,,5468.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6247.38,85,,4997.90,,,0,"percent of total billed charges ","85% of total billed charges ",6247.38,85,,4997.90,,,0,"percent of total billed charges ","85% of total billed charges ",6614.87,90,,5291.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6394.38,87,,5115.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5144.9,70,,4115.92,,,0,"percent of total billed charges ","70% of total billed charges ",5144.9,6835.37,
"FEMORAL CR FLEX G LT",6103126,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,7873.16,6298.528,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5511.21,70,,4408.97,,,0,"percent of total billed charges ","70% of total billed charges ",7085.84,90,,5668.67,,,0,"percent of total billed charges ","90% of total billed charges ",7322.04,93,,5857.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6692.19,85,,5353.75,,,0,"percent of total billed charges ","85% of total billed charges ",6692.19,85,,5353.75,,,0,"percent of total billed charges ","85% of total billed charges ",7085.84,90,,5668.67,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6849.65,87,,5479.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5511.21,70,,4408.97,,,0,"percent of total billed charges ","70% of total billed charges ",5511.21,7322.04,
"FEMORAL CR FLEX G RT",6103129,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5798.93,4639.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4059.25,70,,3247.40,,,0,"percent of total billed charges ","70% of total billed charges ",5219.04,90,,4175.23,,,0,"percent of total billed charges ","90% of total billed charges ",5393,93,,4314.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4929.09,85,,3943.27,,,0,"percent of total billed charges ","85% of total billed charges ",4929.09,85,,3943.27,,,0,"percent of total billed charges ","85% of total billed charges ",5219.04,90,,4175.23,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5045.07,87,,4036.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4059.25,70,,3247.40,,,0,"percent of total billed charges ","70% of total billed charges ",4059.25,5393,
"FEMORAL CR FLEX B LT",6103131,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,7349.86,5879.888,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5144.9,70,,4115.92,,,0,"percent of total billed charges ","70% of total billed charges ",6614.87,90,,5291.90,,,0,"percent of total billed charges ","90% of total billed charges ",6835.37,93,,5468.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6247.38,85,,4997.90,,,0,"percent of total billed charges ","85% of total billed charges ",6247.38,85,,4997.90,,,0,"percent of total billed charges ","85% of total billed charges ",6614.87,90,,5291.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6394.38,87,,5115.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5144.9,70,,4115.92,,,0,"percent of total billed charges ","70% of total billed charges ",5144.9,6835.37,
"CUP ACETABULAR 28 X 45MM",6103132,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1851.3,1481.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1295.91,70,,1036.73,,,0,"percent of total billed charges ","70% of total billed charges ",1666.17,90,,1332.94,,,0,"percent of total billed charges ","90% of total billed charges ",1721.71,93,,1377.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1573.61,85,,1258.89,,,0,"percent of total billed charges ","85% of total billed charges ",1573.61,85,,1258.89,,,0,"percent of total billed charges ","85% of total billed charges ",1666.17,90,,1332.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1610.63,87,,1288.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1295.91,70,,1036.73,,,0,"percent of total billed charges ","70% of total billed charges ",1295.91,1721.71,
"FEMORAL CR FLEX B RT",6103133,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,7349.86,5879.888,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5144.9,70,,4115.92,,,0,"percent of total billed charges ","70% of total billed charges ",6614.87,90,,5291.90,,,0,"percent of total billed charges ","90% of total billed charges ",6835.37,93,,5468.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6247.38,85,,4997.90,,,0,"percent of total billed charges ","85% of total billed charges ",6247.38,85,,4997.90,,,0,"percent of total billed charges ","85% of total billed charges ",6614.87,90,,5291.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6394.38,87,,5115.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5144.9,70,,4115.92,,,0,"percent of total billed charges ","70% of total billed charges ",5144.9,6835.37,
"CUP ACETABULAR 28 X 46MM",6103135,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1851.3,1481.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1295.91,70,,1036.73,,,0,"percent of total billed charges ","70% of total billed charges ",1666.17,90,,1332.94,,,0,"percent of total billed charges ","90% of total billed charges ",1721.71,93,,1377.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1573.61,85,,1258.89,,,0,"percent of total billed charges ","85% of total billed charges ",1573.61,85,,1258.89,,,0,"percent of total billed charges ","85% of total billed charges ",1666.17,90,,1332.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1610.63,87,,1288.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1295.91,70,,1036.73,,,0,"percent of total billed charges ","70% of total billed charges ",1295.91,1721.71,
"CUP ACETABULAR 28 X 47MM",6103136,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1851.3,1481.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1295.91,70,,1036.73,,,0,"percent of total billed charges ","70% of total billed charges ",1666.17,90,,1332.94,,,0,"percent of total billed charges ","90% of total billed charges ",1721.71,93,,1377.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1573.61,85,,1258.89,,,0,"percent of total billed charges ","85% of total billed charges ",1573.61,85,,1258.89,,,0,"percent of total billed charges ","85% of total billed charges ",1666.17,90,,1332.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1610.63,87,,1288.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1295.91,70,,1036.73,,,0,"percent of total billed charges ","70% of total billed charges ",1295.91,1721.71,
"FEMORAL CR FLEX C RT",6103139,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,7349.86,5879.888,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5144.9,70,,4115.92,,,0,"percent of total billed charges ","70% of total billed charges ",6614.87,90,,5291.90,,,0,"percent of total billed charges ","90% of total billed charges ",6835.37,93,,5468.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6247.38,85,,4997.90,,,0,"percent of total billed charges ","85% of total billed charges ",6247.38,85,,4997.90,,,0,"percent of total billed charges ","85% of total billed charges ",6614.87,90,,5291.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6394.38,87,,5115.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5144.9,70,,4115.92,,,0,"percent of total billed charges ","70% of total billed charges ",5144.9,6835.37,
"CUP ACETABULAR 28 X 48MM",6103141,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1851.3,1481.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1295.91,70,,1036.73,,,0,"percent of total billed charges ","70% of total billed charges ",1666.17,90,,1332.94,,,0,"percent of total billed charges ","90% of total billed charges ",1721.71,93,,1377.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1573.61,85,,1258.89,,,0,"percent of total billed charges ","85% of total billed charges ",1573.61,85,,1258.89,,,0,"percent of total billed charges ","85% of total billed charges ",1666.17,90,,1332.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1610.63,87,,1288.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1295.91,70,,1036.73,,,0,"percent of total billed charges ","70% of total billed charges ",1295.91,1721.71,
"ACETABULAR SHELL 64MM",6103144,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1615.97,1292.776,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1131.18,70,,904.94,,,0,"percent of total billed charges ","70% of total billed charges ",1454.37,90,,1163.50,,,0,"percent of total billed charges ","90% of total billed charges ",1502.85,93,,1202.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1373.57,85,,1098.86,,,0,"percent of total billed charges ","85% of total billed charges ",1373.57,85,,1098.86,,,0,"percent of total billed charges ","85% of total billed charges ",1454.37,90,,1163.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1405.89,87,,1124.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1131.18,70,,904.94,,,0,"percent of total billed charges ","70% of total billed charges ",1131.18,1502.85,
"FEMORAL CR FLEX C LT",6103145,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,7349.86,5879.888,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5144.9,70,,4115.92,,,0,"percent of total billed charges ","70% of total billed charges ",6614.87,90,,5291.90,,,0,"percent of total billed charges ","90% of total billed charges ",6835.37,93,,5468.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6247.38,85,,4997.90,,,0,"percent of total billed charges ","85% of total billed charges ",6247.38,85,,4997.90,,,0,"percent of total billed charges ","85% of total billed charges ",6614.87,90,,5291.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6394.38,87,,5115.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5144.9,70,,4115.92,,,0,"percent of total billed charges ","70% of total billed charges ",5144.9,6835.37,
"CUP ACETABULAR 28X51MM",6103146,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1851.3,1481.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1295.91,70,,1036.73,,,0,"percent of total billed charges ","70% of total billed charges ",1666.17,90,,1332.94,,,0,"percent of total billed charges ","90% of total billed charges ",1721.71,93,,1377.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1573.61,85,,1258.89,,,0,"percent of total billed charges ","85% of total billed charges ",1573.61,85,,1258.89,,,0,"percent of total billed charges ","85% of total billed charges ",1666.17,90,,1332.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1610.63,87,,1288.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1295.91,70,,1036.73,,,0,"percent of total billed charges ","70% of total billed charges ",1295.91,1721.71,
"BRNG TIBIA VE PS+14X63/67MM",6103149,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2904,2323.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",2700.72,93,,2160.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2526.48,87,,2021.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2032.8,2700.72,
"COMP MDLR HEAD 28 MM +3MM NK",6103151,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1089,871.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",1012.77,93,,810.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",947.43,87,,757.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",762.3,1012.77,
"FEMORAL CR FLEX C LT MINUS",6103152,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,7349.86,5879.888,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5144.9,70,,4115.92,,,0,"percent of total billed charges ","70% of total billed charges ",6614.87,90,,5291.90,,,0,"percent of total billed charges ","90% of total billed charges ",6835.37,93,,5468.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6247.38,85,,4997.90,,,0,"percent of total billed charges ","85% of total billed charges ",6247.38,85,,4997.90,,,0,"percent of total billed charges ","85% of total billed charges ",6614.87,90,,5291.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6394.38,87,,5115.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5144.9,70,,4115.92,,,0,"percent of total billed charges ","70% of total billed charges ",5144.9,6835.37,
"FEMORAL CR FLEX C RT MINUS",6103158,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,7349.86,5879.888,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5144.9,70,,4115.92,,,0,"percent of total billed charges ","70% of total billed charges ",6614.87,90,,5291.90,,,0,"percent of total billed charges ","90% of total billed charges ",6835.37,93,,5468.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6247.38,85,,4997.90,,,0,"percent of total billed charges ","85% of total billed charges ",6247.38,85,,4997.90,,,0,"percent of total billed charges ","85% of total billed charges ",6614.87,90,,5291.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6394.38,87,,5115.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5144.9,70,,4115.92,,,0,"percent of total billed charges ","70% of total billed charges ",5144.9,6835.37,
"FEMORAL HEAD",6103161,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,4168.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMORAL CR FLEX D LT",6103162,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,7643.85,6115.08,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5350.7,70,,4280.56,,,0,"percent of total billed charges ","70% of total billed charges ",6879.47,90,,5503.58,,,0,"percent of total billed charges ","90% of total billed charges ",7108.78,93,,5687.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6497.27,85,,5197.82,,,0,"percent of total billed charges ","85% of total billed charges ",6497.27,85,,5197.82,,,0,"percent of total billed charges ","85% of total billed charges ",6879.47,90,,5503.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6650.15,87,,5320.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5350.7,70,,4280.56,,,0,"percent of total billed charges ","70% of total billed charges ",5350.7,7108.78,
"CUP ACETABULAR 28 X 52MM",6103168,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1851.3,1481.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1295.91,70,,1036.73,,,0,"percent of total billed charges ","70% of total billed charges ",1666.17,90,,1332.94,,,0,"percent of total billed charges ","90% of total billed charges ",1721.71,93,,1377.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1573.61,85,,1258.89,,,0,"percent of total billed charges ","85% of total billed charges ",1573.61,85,,1258.89,,,0,"percent of total billed charges ","85% of total billed charges ",1666.17,90,,1332.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1610.63,87,,1288.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1295.91,70,,1036.73,,,0,"percent of total billed charges ","70% of total billed charges ",1295.91,1721.71,
"FEMORAL CR FLEX D RT",6103169,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,7873.16,6298.528,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5511.21,70,,4408.97,,,0,"percent of total billed charges ","70% of total billed charges ",7085.84,90,,5668.67,,,0,"percent of total billed charges ","90% of total billed charges ",7322.04,93,,5857.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6692.19,85,,5353.75,,,0,"percent of total billed charges ","85% of total billed charges ",6692.19,85,,5353.75,,,0,"percent of total billed charges ","85% of total billed charges ",7085.84,90,,5668.67,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6849.65,87,,5479.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5511.21,70,,4408.97,,,0,"percent of total billed charges ","70% of total billed charges ",5511.21,7322.04,
"FEMORAL CR FLEX D LT MINUS",6103180,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,8893.5,7114.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6225.45,70,,4980.36,,,0,"percent of total billed charges ","70% of total billed charges ",8004.15,90,,6403.32,,,0,"percent of total billed charges ","90% of total billed charges ",8270.96,93,,6616.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7559.48,85,,6047.58,,,0,"percent of total billed charges ","85% of total billed charges ",7559.48,85,,6047.58,,,0,"percent of total billed charges ","85% of total billed charges ",8004.15,90,,6403.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7737.35,87,,6189.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6225.45,70,,4980.36,,,0,"percent of total billed charges ","70% of total billed charges ",6225.45,8270.96,
"FEMORAL CR FLEX D RT MINUS",6103181,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,7349.86,5879.888,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5144.9,70,,4115.92,,,0,"percent of total billed charges ","70% of total billed charges ",6614.87,90,,5291.90,,,0,"percent of total billed charges ","90% of total billed charges ",6835.37,93,,5468.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6247.38,85,,4997.90,,,0,"percent of total billed charges ","85% of total billed charges ",6247.38,85,,4997.90,,,0,"percent of total billed charges ","85% of total billed charges ",6614.87,90,,5291.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6394.38,87,,5115.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5144.9,70,,4115.92,,,0,"percent of total billed charges ","70% of total billed charges ",5144.9,6835.37,
"FEMORAL CR FLEX G LT MINUS",6103182,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,8893.5,7114.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6225.45,70,,4980.36,,,0,"percent of total billed charges ","70% of total billed charges ",8004.15,90,,6403.32,,,0,"percent of total billed charges ","90% of total billed charges ",8270.96,93,,6616.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7559.48,85,,6047.58,,,0,"percent of total billed charges ","85% of total billed charges ",7559.48,85,,6047.58,,,0,"percent of total billed charges ","85% of total billed charges ",8004.15,90,,6403.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7737.35,87,,6189.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6225.45,70,,4980.36,,,0,"percent of total billed charges ","70% of total billed charges ",6225.45,8270.96,
"FEMORAL CR FLEX G RT MINUS",6103183,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5798.93,4639.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4059.25,70,,3247.40,,,0,"percent of total billed charges ","70% of total billed charges ",5219.04,90,,4175.23,,,0,"percent of total billed charges ","90% of total billed charges ",5393,93,,4314.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4929.09,85,,3943.27,,,0,"percent of total billed charges ","85% of total billed charges ",4929.09,85,,3943.27,,,0,"percent of total billed charges ","85% of total billed charges ",5219.04,90,,4175.23,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5045.07,87,,4036.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4059.25,70,,3247.40,,,0,"percent of total billed charges ","70% of total billed charges ",4059.25,5393,
"ART SURF MC GH 8-11 RT 13MM",6103185,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"SURFACE LPS FLEX C-D 1.2 23MM",6103187,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2449.96,1959.968,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1959.97,80,,1567.98,,,0,"percent of total billed charges ","80% of total billed charges ",1714.97,70,,1371.98,,,0,"percent of total billed charges ","70% of total billed charges ",2204.96,90,,1763.97,,,0,"percent of total billed charges ","90% of total billed charges ",2278.46,93,,1822.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.47,85,,1665.98,,,0,"percent of total billed charges ","85% of total billed charges ",2082.47,85,,1665.98,,,0,"percent of total billed charges ","85% of total billed charges ",2204.96,90,,1763.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.47,87,,1705.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1714.97,70,,1371.98,,,0,"percent of total billed charges ","70% of total billed charges ",1714.97,2278.46,
"SURFACE LPS FLEX A+B 3.4 10M",6103188,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2624.38,2099.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2099.5,80,,1679.60,,,0,"percent of total billed charges ","80% of total billed charges ",1837.07,70,,1469.66,,,0,"percent of total billed charges ","70% of total billed charges ",2361.94,90,,1889.55,,,0,"percent of total billed charges ","90% of total billed charges ",2440.67,93,,1952.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2230.72,85,,1784.58,,,0,"percent of total billed charges ","85% of total billed charges ",2230.72,85,,1784.58,,,0,"percent of total billed charges ","85% of total billed charges ",2361.94,90,,1889.55,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2283.21,87,,1826.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1837.07,70,,1469.66,,,0,"percent of total billed charges ","70% of total billed charges ",1837.07,2440.67,
"ART SURF MC GH 8-11 RT 14MM",6103190,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC GH 8-11 RT 16MM",6103196,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC GH 12 RT 10MM",6103199,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC GH 12 RT 11MM",6103200,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"SURFACE LPS FLEX A-B 3.4 23M",6103209,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2449.96,1959.968,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1959.97,80,,1567.98,,,0,"percent of total billed charges ","80% of total billed charges ",1714.97,70,,1371.98,,,0,"percent of total billed charges ","70% of total billed charges ",2204.96,90,,1763.97,,,0,"percent of total billed charges ","90% of total billed charges ",2278.46,93,,1822.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.47,85,,1665.98,,,0,"percent of total billed charges ","85% of total billed charges ",2082.47,85,,1665.98,,,0,"percent of total billed charges ","85% of total billed charges ",2204.96,90,,1763.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.47,87,,1705.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1714.97,70,,1371.98,,,0,"percent of total billed charges ","70% of total billed charges ",1714.97,2278.46,
"ART SURF MC GH RT 12MM",6103210,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"MESH PLUG MARLEX LG",6103214,"CDM ",278,RC,C1781,HCPCS,OUTPATIENT,,,306.23,244.984,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",244.98,80,,195.98,,,0,"percent of total billed charges ","80% of total billed charges ",214.36,70,,171.49,,,0,"percent of total billed charges ","70% of total billed charges ",275.61,90,,220.49,,,0,"percent of total billed charges ","90% of total billed charges ",284.79,93,,227.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",260.3,85,,208.24,,,0,"percent of total billed charges ","85% of total billed charges ",260.3,85,,208.24,,,0,"percent of total billed charges ","85% of total billed charges ",275.61,90,,220.49,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",266.42,87,,213.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.36,70,,171.49,,,0,"percent of total billed charges ","70% of total billed charges ",214.36,284.79,
"ART SURF MC GH 12 RT 13MM",6103215,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC GH 12 RT 14MM",6103216,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC GH 12 RT 16MM",6103221,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"TIBIA NATURAL STMD 5 DEG LT B",6103227,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2268.75,1815,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1815,80,,1452.00,,,0,"percent of total billed charges ","80% of total billed charges ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",2109.94,93,,1687.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1973.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",1588.13,2109.94,
"TIBIA NATURAL STMD 5 DEG LT C",6103229,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2268.75,1815,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1815,80,,1452.00,,,0,"percent of total billed charges ","80% of total billed charges ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",2109.94,93,,1687.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1973.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",1588.13,2109.94,
"SURFACE LPS FLEX C-D 1.2 10M",6103230,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2624.38,2099.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2099.5,80,,1679.60,,,0,"percent of total billed charges ","80% of total billed charges ",1837.07,70,,1469.66,,,0,"percent of total billed charges ","70% of total billed charges ",2361.94,90,,1889.55,,,0,"percent of total billed charges ","90% of total billed charges ",2440.67,93,,1952.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2230.72,85,,1784.58,,,0,"percent of total billed charges ","85% of total billed charges ",2230.72,85,,1784.58,,,0,"percent of total billed charges ","85% of total billed charges ",2361.94,90,,1889.55,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2283.21,87,,1826.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1837.07,70,,1469.66,,,0,"percent of total billed charges ","70% of total billed charges ",1837.07,2440.67,
"SURFACE LPS FLEX C-D 1.2 12MM",6103231,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2449.96,1959.968,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1959.97,80,,1567.98,,,0,"percent of total billed charges ","80% of total billed charges ",1714.97,70,,1371.98,,,0,"percent of total billed charges ","70% of total billed charges ",2204.96,90,,1763.97,,,0,"percent of total billed charges ","90% of total billed charges ",2278.46,93,,1822.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.47,85,,1665.98,,,0,"percent of total billed charges ","85% of total billed charges ",2082.47,85,,1665.98,,,0,"percent of total billed charges ","85% of total billed charges ",2204.96,90,,1763.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.47,87,,1705.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1714.97,70,,1371.98,,,0,"percent of total billed charges ","70% of total billed charges ",1714.97,2278.46,
"TIBIA NATURAL STMD 5 DEG LT D",6103232,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2268.75,1815,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1815,80,,1452.00,,,0,"percent of total billed charges ","80% of total billed charges ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",2109.94,93,,1687.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1973.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",1588.13,2109.94,
"TIBIA NATURAL STMD 5 DEG LT 3",6103233,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2268.75,1815,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1815,80,,1452.00,,,0,"percent of total billed charges ","80% of total billed charges ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",2109.94,93,,1687.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1973.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",1588.13,2109.94,
"FEMORAL LPS FLEX C LF",6103234,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,6859.88,5487.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5487.9,80,,4390.32,,,0,"percent of total billed charges ","80% of total billed charges ",4801.92,70,,3841.54,,,0,"percent of total billed charges ","70% of total billed charges ",6173.89,90,,4939.11,,,0,"percent of total billed charges ","90% of total billed charges ",6379.69,93,,5103.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5830.9,85,,4664.72,,,0,"percent of total billed charges ","85% of total billed charges ",5830.9,85,,4664.72,,,0,"percent of total billed charges ","85% of total billed charges ",6173.89,90,,4939.11,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5968.1,87,,4774.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4801.92,70,,3841.54,,,0,"percent of total billed charges ","70% of total billed charges ",4801.92,6379.69,
"FEMORAL LPS FLEX C RT",6103235,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,6859.88,5487.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5487.9,80,,4390.32,,,0,"percent of total billed charges ","80% of total billed charges ",4801.92,70,,3841.54,,,0,"percent of total billed charges ","70% of total billed charges ",6173.89,90,,4939.11,,,0,"percent of total billed charges ","90% of total billed charges ",6379.69,93,,5103.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5830.9,85,,4664.72,,,0,"percent of total billed charges ","85% of total billed charges ",5830.9,85,,4664.72,,,0,"percent of total billed charges ","85% of total billed charges ",6173.89,90,,4939.11,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5968.1,87,,4774.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4801.92,70,,3841.54,,,0,"percent of total billed charges ","70% of total billed charges ",4801.92,6379.69,
"TAPE CAST 5"" PINK",6103237,"CDM ",272,RC,A4590,HCPCS,OUTPATIENT,,,45.34,36.272,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.74,70,,25.39,,,0,"percent of total billed charges ","70% of total billed charges ",40.81,90,,32.65,,,0,"percent of total billed charges ","90% of total billed charges ",42.17,93,,33.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.54,85,,30.83,,,0,"percent of total billed charges ","85% of total billed charges ",40.81,90,,32.65,,,0,"percent of total billed charges ","90% of total billed charges ",40.81,90,,32.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.45,87,,31.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.74,70,,25.39,,,0,"percent of total billed charges ","70% of total billed charges ",31.74,42.17,
"FEMORAL LPS FLEX D LF",6103238,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,7348.3,5878.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5143.81,70,,4115.05,,,0,"percent of total billed charges ","70% of total billed charges ",6613.47,90,,5290.78,,,0,"percent of total billed charges ","90% of total billed charges ",6833.92,93,,5467.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6246.06,85,,4996.85,,,0,"percent of total billed charges ","85% of total billed charges ",6246.06,85,,4996.85,,,0,"percent of total billed charges ","85% of total billed charges ",6613.47,90,,5290.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6393.02,87,,5114.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5143.81,70,,4115.05,,,0,"percent of total billed charges ","70% of total billed charges ",5143.81,6833.92,
"FEMORAL LPS FLEX D RT",6103239,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,6859.88,5487.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4801.92,70,,3841.54,,,0,"percent of total billed charges ","70% of total billed charges ",6173.89,90,,4939.11,,,0,"percent of total billed charges ","90% of total billed charges ",6379.69,93,,5103.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5830.9,85,,4664.72,,,0,"percent of total billed charges ","85% of total billed charges ",5830.9,85,,4664.72,,,0,"percent of total billed charges ","85% of total billed charges ",6173.89,90,,4939.11,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5968.1,87,,4774.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4801.92,70,,3841.54,,,0,"percent of total billed charges ","70% of total billed charges ",4801.92,6379.69,
"TAPE CAST 3"" PURPLE",6103241,"CDM ",272,RC,A4590,HCPCS,OUTPATIENT,,,14.29,11.432,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,70,,8.00,,,0,"percent of total billed charges ","70% of total billed charges ",12.86,90,,10.29,,,0,"percent of total billed charges ","90% of total billed charges ",13.29,93,,10.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.15,85,,9.72,,,0,"percent of total billed charges ","85% of total billed charges ",12.86,90,,10.29,,,0,"percent of total billed charges ","90% of total billed charges ",12.86,90,,10.29,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.43,87,,9.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,70,,8.00,,,0,"percent of total billed charges ","70% of total billed charges ",10,13.29,
"TAPE CAST 4"" PURPLE",6103242,"CDM ",272,RC,A4590,HCPCS,OUTPATIENT,,,13.89,11.112,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.72,70,,7.78,,,0,"percent of total billed charges ","70% of total billed charges ",12.5,90,,10.00,,,0,"percent of total billed charges ","90% of total billed charges ",12.92,93,,10.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.81,85,,9.45,,,0,"percent of total billed charges ","85% of total billed charges ",12.5,90,,10.00,,,0,"percent of total billed charges ","90% of total billed charges ",12.5,90,,10.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.08,87,,9.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.72,70,,7.78,,,0,"percent of total billed charges ","70% of total billed charges ",9.72,12.92,
"FEMORAL LPS FLEX E LT",6103248,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,8893.5,7114.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6225.45,70,,4980.36,,,0,"percent of total billed charges ","70% of total billed charges ",8004.15,90,,6403.32,,,0,"percent of total billed charges ","90% of total billed charges ",8270.96,93,,6616.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7559.48,85,,6047.58,,,0,"percent of total billed charges ","85% of total billed charges ",7559.48,85,,6047.58,,,0,"percent of total billed charges ","85% of total billed charges ",8004.15,90,,6403.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7737.35,87,,6189.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6225.45,70,,4980.36,,,0,"percent of total billed charges ","70% of total billed charges ",6225.45,8270.96,
"FEMORAL LPS FLEX E RT",6103250,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5798.93,4639.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4059.25,70,,3247.40,,,0,"percent of total billed charges ","70% of total billed charges ",5219.04,90,,4175.23,,,0,"percent of total billed charges ","90% of total billed charges ",5393,93,,4314.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4929.09,85,,3943.27,,,0,"percent of total billed charges ","85% of total billed charges ",4929.09,85,,3943.27,,,0,"percent of total billed charges ","85% of total billed charges ",5219.04,90,,4175.23,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5045.07,87,,4036.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4059.25,70,,3247.40,,,0,"percent of total billed charges ","70% of total billed charges ",4059.25,5393,
"FEMORAL LPS FLEX F LF",6103259,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5798.93,4639.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4059.25,70,,3247.40,,,0,"percent of total billed charges ","70% of total billed charges ",5219.04,90,,4175.23,,,0,"percent of total billed charges ","90% of total billed charges ",5393,93,,4314.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4929.09,85,,3943.27,,,0,"percent of total billed charges ","85% of total billed charges ",4929.09,85,,3943.27,,,0,"percent of total billed charges ","85% of total billed charges ",5219.04,90,,4175.23,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5045.07,87,,4036.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4059.25,70,,3247.40,,,0,"percent of total billed charges ","70% of total billed charges ",4059.25,5393,
"FEMORAL LPS FLEX F RT",6103260,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5798.93,4639.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4059.25,70,,3247.40,,,0,"percent of total billed charges ","70% of total billed charges ",5219.04,90,,4175.23,,,0,"percent of total billed charges ","90% of total billed charges ",5393,93,,4314.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4929.09,85,,3943.27,,,0,"percent of total billed charges ","85% of total billed charges ",4929.09,85,,3943.27,,,0,"percent of total billed charges ","85% of total billed charges ",5219.04,90,,4175.23,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5045.07,87,,4036.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4059.25,70,,3247.40,,,0,"percent of total billed charges ","70% of total billed charges ",4059.25,5393,
"FEMORAL LPS FLEX G LF",6103296,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,7348.3,5878.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5143.81,70,,4115.05,,,0,"percent of total billed charges ","70% of total billed charges ",6613.47,90,,5290.78,,,0,"percent of total billed charges ","90% of total billed charges ",6833.92,93,,5467.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6246.06,85,,4996.85,,,0,"percent of total billed charges ","85% of total billed charges ",6246.06,85,,4996.85,,,0,"percent of total billed charges ","85% of total billed charges ",6613.47,90,,5290.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6393.02,87,,5114.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5143.81,70,,4115.05,,,0,"percent of total billed charges ","70% of total billed charges ",5143.81,6833.92,
"FEMORAL LPS FLEX G RT",6103307,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,7348.3,5878.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5143.81,70,,4115.05,,,0,"percent of total billed charges ","70% of total billed charges ",6613.47,90,,5290.78,,,0,"percent of total billed charges ","90% of total billed charges ",6833.92,93,,5467.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6246.06,85,,4996.85,,,0,"percent of total billed charges ","85% of total billed charges ",6246.06,85,,4996.85,,,0,"percent of total billed charges ","85% of total billed charges ",6613.47,90,,5290.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6393.02,87,,5114.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5143.81,70,,4115.05,,,0,"percent of total billed charges ","70% of total billed charges ",5143.81,6833.92,
"STEM KNEE SPLINED V2 20X80MM",6103360,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,3527.45,2821.96,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2469.22,70,,1975.38,,,0,"percent of total billed charges ","70% of total billed charges ",3174.71,90,,2539.77,,,0,"percent of total billed charges ","90% of total billed charges ",3280.53,93,,2624.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2998.33,85,,2398.66,,,0,"percent of total billed charges ","85% of total billed charges ",2998.33,85,,2398.66,,,0,"percent of total billed charges ","85% of total billed charges ",3174.71,90,,2539.77,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3068.88,87,,2455.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2469.22,70,,1975.38,,,0,"percent of total billed charges ","70% of total billed charges ",2469.22,3280.53,
"COMP MDLR HEAD 28 MM -6MM NK",6103364,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1089,871.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",1012.77,93,,810.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",947.43,87,,757.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",762.3,1012.77,
"STEM EXT 30MM*15MM",6103373,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2261.49,1809.192,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1583.04,70,,1266.43,,,0,"percent of total billed charges ","70% of total billed charges ",2035.34,90,,1628.27,,,0,"percent of total billed charges ","90% of total billed charges ",2103.19,93,,1682.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1922.27,85,,1537.82,,,0,"percent of total billed charges ","85% of total billed charges ",1922.27,85,,1537.82,,,0,"percent of total billed charges ","85% of total billed charges ",2035.34,90,,1628.27,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1967.5,87,,1574.00,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1583.04,70,,1266.43,,,0,"percent of total billed charges ","70% of total billed charges ",1583.04,2103.19,
"FEMORAL LPS GENDER SZ C, LT",6103389,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,7873.56,6298.848,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5511.49,70,,4409.19,,,0,"percent of total billed charges ","70% of total billed charges ",7086.2,90,,5668.96,,,0,"percent of total billed charges ","90% of total billed charges ",7322.41,93,,5857.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6692.53,85,,5354.02,,,0,"percent of total billed charges ","85% of total billed charges ",6692.53,85,,5354.02,,,0,"percent of total billed charges ","85% of total billed charges ",7086.2,90,,5668.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6850,87,,5480.00,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5511.49,70,,4409.19,,,0,"percent of total billed charges ","70% of total billed charges ",5511.49,7322.41,
"FEMORAL LPS GENDER SZ C, RT",6103398,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,8434.16,6747.328,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5903.91,70,,4723.13,,,0,"percent of total billed charges ","70% of total billed charges ",7590.74,90,,6072.59,,,0,"percent of total billed charges ","90% of total billed charges ",7843.77,93,,6275.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7169.04,85,,5735.23,,,0,"percent of total billed charges ","85% of total billed charges ",7169.04,85,,5735.23,,,0,"percent of total billed charges ","85% of total billed charges ",7590.74,90,,6072.59,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7337.72,87,,5870.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5903.91,70,,4723.13,,,0,"percent of total billed charges ","70% of total billed charges ",5903.91,7843.77,
"FEMORAL LPS GENDER SZ D, LT",6103402,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,6252.68,5002.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",5814.99,93,,4651.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5439.83,87,,4351.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",4376.88,5814.99,
"FEMORAL LPS GENDER SZ D, RT",6103404,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,6252.68,5002.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",5814.99,93,,4651.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5439.83,87,,4351.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",4376.88,5814.99,
"FEMORAL LPS GENDER SZ E, LT",6103406,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,6252.68,5002.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",5814.99,93,,4651.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5439.83,87,,4351.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",4376.88,5814.99,
"FEMORAL LPS GENDER SZ E, RT",6103407,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,6252.68,5002.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",5814.99,93,,4651.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5439.83,87,,4351.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",4376.88,5814.99,
"FEMORAL LPS GENDER SZ F, LT",6103408,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,6252.68,5002.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",5814.99,93,,4651.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5439.83,87,,4351.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",4376.88,5814.99,
"FEMORAL LPS GENDER SZ F, RT",6103413,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,6252.68,5002.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",5814.99,93,,4651.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5439.83,87,,4351.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",4376.88,5814.99,
"FEMORAL LPS GENDER SZ G, LT",6103416,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,8893.5,7114.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6225.45,70,,4980.36,,,0,"percent of total billed charges ","70% of total billed charges ",8004.15,90,,6403.32,,,0,"percent of total billed charges ","90% of total billed charges ",8270.96,93,,6616.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7559.48,85,,6047.58,,,0,"percent of total billed charges ","85% of total billed charges ",7559.48,85,,6047.58,,,0,"percent of total billed charges ","85% of total billed charges ",8004.15,90,,6403.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7737.35,87,,6189.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6225.45,70,,4980.36,,,0,"percent of total billed charges ","70% of total billed charges ",6225.45,8270.96,
"FEMORAL LPS GENDER SZ G, RT",6103417,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,8434.16,6747.328,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5903.91,70,,4723.13,,,0,"percent of total billed charges ","70% of total billed charges ",7590.74,90,,6072.59,,,0,"percent of total billed charges ","90% of total billed charges ",7843.77,93,,6275.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7169.04,85,,5735.23,,,0,"percent of total billed charges ","85% of total billed charges ",7169.04,85,,5735.23,,,0,"percent of total billed charges ","85% of total billed charges ",7590.74,90,,6072.59,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7337.72,87,,5870.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5903.91,70,,4723.13,,,0,"percent of total billed charges ","70% of total billed charges ",5903.91,7843.77,
"FEMORAL CR-FLX GNDR C, LT",6103426,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,8385.48,6708.384,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5869.84,70,,4695.87,,,0,"percent of total billed charges ","70% of total billed charges ",7546.93,90,,6037.54,,,0,"percent of total billed charges ","90% of total billed charges ",7798.5,93,,6238.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7127.66,85,,5702.13,,,0,"percent of total billed charges ","85% of total billed charges ",7127.66,85,,5702.13,,,0,"percent of total billed charges ","85% of total billed charges ",7546.93,90,,6037.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7295.37,87,,5836.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5869.84,70,,4695.87,,,0,"percent of total billed charges ","70% of total billed charges ",5869.84,7798.5,
"FEMORAL CR-FLX GNDR C, RT",6103428,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,8385.48,6708.384,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5869.84,70,,4695.87,,,0,"percent of total billed charges ","70% of total billed charges ",7546.93,90,,6037.54,,,0,"percent of total billed charges ","90% of total billed charges ",7798.5,93,,6238.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7127.66,85,,5702.13,,,0,"percent of total billed charges ","85% of total billed charges ",7127.66,85,,5702.13,,,0,"percent of total billed charges ","85% of total billed charges ",7546.93,90,,6037.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7295.37,87,,5836.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5869.84,70,,4695.87,,,0,"percent of total billed charges ","70% of total billed charges ",5869.84,7798.5,
"FEMORAL CR-FLX GNDR C,LT MINUS",6103429,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,8385.48,6708.384,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5869.84,70,,4695.87,,,0,"percent of total billed charges ","70% of total billed charges ",7546.93,90,,6037.54,,,0,"percent of total billed charges ","90% of total billed charges ",7798.5,93,,6238.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7127.66,85,,5702.13,,,0,"percent of total billed charges ","85% of total billed charges ",7127.66,85,,5702.13,,,0,"percent of total billed charges ","85% of total billed charges ",7546.93,90,,6037.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7295.37,87,,5836.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5869.84,70,,4695.87,,,0,"percent of total billed charges ","70% of total billed charges ",5869.84,7798.5,
"STEM FEMORAL9.0 X 150MM",6103435,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,3527.45,2821.96,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2469.22,70,,1975.38,,,0,"percent of total billed charges ","70% of total billed charges ",3174.71,90,,2539.77,,,0,"percent of total billed charges ","90% of total billed charges ",3280.53,93,,2624.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2998.33,85,,2398.66,,,0,"percent of total billed charges ","85% of total billed charges ",2998.33,85,,2398.66,,,0,"percent of total billed charges ","85% of total billed charges ",3174.71,90,,2539.77,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3068.88,87,,2455.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2469.22,70,,1975.38,,,0,"percent of total billed charges ","70% of total billed charges ",2469.22,3280.53,
"FEMORAL CR-FLX GNDR C,RT MINUS",6103436,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,8385.48,6708.384,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5869.84,70,,4695.87,,,0,"percent of total billed charges ","70% of total billed charges ",7546.93,90,,6037.54,,,0,"percent of total billed charges ","90% of total billed charges ",7798.5,93,,6238.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7127.66,85,,5702.13,,,0,"percent of total billed charges ","85% of total billed charges ",7127.66,85,,5702.13,,,0,"percent of total billed charges ","85% of total billed charges ",7546.93,90,,6037.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7295.37,87,,5836.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5869.84,70,,4695.87,,,0,"percent of total billed charges ","70% of total billed charges ",5869.84,7798.5,
"FEMORAL CR-FLX GNDR D, LT",6103437,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,6252.68,5002.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5002.14,80,,4001.71,,,0,"percent of total billed charges ","80% of total billed charges ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",5814.99,93,,4651.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5439.83,87,,4351.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",4376.88,5814.99,
"FEMORAL CR-FLX GNDR D, RT",6103438,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,8982.53,7186.024,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7186.02,80,,5748.82,,,0,"percent of total billed charges ","80% of total billed charges ",6287.77,70,,5030.22,,,0,"percent of total billed charges ","70% of total billed charges ",8084.28,90,,6467.42,,,0,"percent of total billed charges ","90% of total billed charges ",8353.75,93,,6683.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7635.15,85,,6108.12,,,0,"percent of total billed charges ","85% of total billed charges ",7635.15,85,,6108.12,,,0,"percent of total billed charges ","85% of total billed charges ",8084.28,90,,6467.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7814.8,87,,6251.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6287.77,70,,5030.22,,,0,"percent of total billed charges ","70% of total billed charges ",6287.77,8353.75,
"FEMORAL CR-FLX GNDR D,LT MINUS",6103444,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,8720.89,6976.712,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6976.71,80,,5581.37,,,0,"percent of total billed charges ","80% of total billed charges ",6104.62,70,,4883.70,,,0,"percent of total billed charges ","70% of total billed charges ",7848.8,90,,6279.04,,,0,"percent of total billed charges ","90% of total billed charges ",8110.43,93,,6488.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7412.76,85,,5930.21,,,0,"percent of total billed charges ","85% of total billed charges ",7412.76,85,,5930.21,,,0,"percent of total billed charges ","85% of total billed charges ",7848.8,90,,6279.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7587.17,87,,6069.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6104.62,70,,4883.70,,,0,"percent of total billed charges ","70% of total billed charges ",6104.62,8110.43,
"FEMORAL CR-FLX GNDR D,RT MINUS",6103451,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,8385.48,6708.384,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6708.38,80,,5366.70,,,0,"percent of total billed charges ","80% of total billed charges ",5869.84,70,,4695.87,,,0,"percent of total billed charges ","70% of total billed charges ",7546.93,90,,6037.54,,,0,"percent of total billed charges ","90% of total billed charges ",7798.5,93,,6238.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7127.66,85,,5702.13,,,0,"percent of total billed charges ","85% of total billed charges ",7127.66,85,,5702.13,,,0,"percent of total billed charges ","85% of total billed charges ",7546.93,90,,6037.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7295.37,87,,5836.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5869.84,70,,4695.87,,,0,"percent of total billed charges ","70% of total billed charges ",5869.84,7798.5,
"FEMORAL CR-FLX GNDR E, LT",6103454,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,6252.68,5002.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5002.14,80,,4001.71,,,0,"percent of total billed charges ","80% of total billed charges ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",5814.99,93,,4651.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5439.83,87,,4351.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",4376.88,5814.99,
"FEMORAL CR-FLX GNDR E, RT",6103455,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,8982.53,7186.024,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7186.02,80,,5748.82,,,0,"percent of total billed charges ","80% of total billed charges ",6287.77,70,,5030.22,,,0,"percent of total billed charges ","70% of total billed charges ",8084.28,90,,6467.42,,,0,"percent of total billed charges ","90% of total billed charges ",8353.75,93,,6683.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7635.15,85,,6108.12,,,0,"percent of total billed charges ","85% of total billed charges ",7635.15,85,,6108.12,,,0,"percent of total billed charges ","85% of total billed charges ",8084.28,90,,6467.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7814.8,87,,6251.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6287.77,70,,5030.22,,,0,"percent of total billed charges ","70% of total billed charges ",6287.77,8353.75,
"SCREW INTERFERENCE 8MM X 25MM",6103456,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,257.5,206,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",206,80,,164.80,,,0,"percent of total billed charges ","80% of total billed charges ",180.25,70,,144.20,,,0,"percent of total billed charges ","70% of total billed charges ",231.75,90,,185.40,,,0,"percent of total billed charges ","90% of total billed charges ",239.48,93,,191.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",218.88,85,,175.10,,,0,"percent of total billed charges ","85% of total billed charges ",218.88,85,,175.10,,,0,"percent of total billed charges ","85% of total billed charges ",231.75,90,,185.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",224.03,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.25,70,,144.20,,,0,"percent of total billed charges ","70% of total billed charges ",180.25,239.48,
"COMP FEM PS OPEN 70MM RT",6103458,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,4168.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"PATELLA STD 3 PEG 34X8.5MM",6103460,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,969.75,775.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",775.8,80,,620.64,,,0,"percent of total billed charges ","80% of total billed charges ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",901.87,93,,721.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",843.68,87,,674.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",678.83,901.87,
"TRAY TIBIA FIXED CRUCIATE 83MM",6103461,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2268.75,1815,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1815,80,,1452.00,,,0,"percent of total billed charges ","80% of total billed charges ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",2109.94,93,,1687.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1973.81,87,,1579.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",1588.13,2109.94,
"FEMORAL CR-FLX GNDR E,LT MINUS",6103477,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,6252.68,5002.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5002.14,80,,4001.71,,,0,"percent of total billed charges ","80% of total billed charges ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",5814.99,93,,4651.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5439.83,87,,4351.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",4376.88,5814.99,
"FEMORAL CR-FLX GNDR E,RT MINUS",6103478,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,8982.53,7186.024,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7186.02,80,,5748.82,,,0,"percent of total billed charges ","80% of total billed charges ",6287.77,70,,5030.22,,,0,"percent of total billed charges ","70% of total billed charges ",8084.28,90,,6467.42,,,0,"percent of total billed charges ","90% of total billed charges ",8353.75,93,,6683.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7635.15,85,,6108.12,,,0,"percent of total billed charges ","85% of total billed charges ",7635.15,85,,6108.12,,,0,"percent of total billed charges ","85% of total billed charges ",8084.28,90,,6467.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7814.8,87,,6251.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6287.77,70,,5030.22,,,0,"percent of total billed charges ","70% of total billed charges ",6287.77,8353.75,
"FEMORAL CR-FLX GNDR F, LT",6103481,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,8982.53,7186.024,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7186.02,80,,5748.82,,,0,"percent of total billed charges ","80% of total billed charges ",6287.77,70,,5030.22,,,0,"percent of total billed charges ","70% of total billed charges ",8084.28,90,,6467.42,,,0,"percent of total billed charges ","90% of total billed charges ",8353.75,93,,6683.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7635.15,85,,6108.12,,,0,"percent of total billed charges ","85% of total billed charges ",7635.15,85,,6108.12,,,0,"percent of total billed charges ","85% of total billed charges ",8084.28,90,,6467.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7814.8,87,,6251.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6287.77,70,,5030.22,,,0,"percent of total billed charges ","70% of total billed charges ",6287.77,8353.75,
"FEMORAL CR-FLX GNDR F, RT",6103483,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,6252.68,5002.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5002.14,80,,4001.71,,,0,"percent of total billed charges ","80% of total billed charges ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",5814.99,93,,4651.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5439.83,87,,4351.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",4376.88,5814.99,
"FEMORAL CR-FLX GNDR F,LT MINUS",6103485,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,8893.5,7114.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7114.8,80,,5691.84,,,0,"percent of total billed charges ","80% of total billed charges ",6225.45,70,,4980.36,,,0,"percent of total billed charges ","70% of total billed charges ",8004.15,90,,6403.32,,,0,"percent of total billed charges ","90% of total billed charges ",8270.96,93,,6616.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7559.48,85,,6047.58,,,0,"percent of total billed charges ","85% of total billed charges ",7559.48,85,,6047.58,,,0,"percent of total billed charges ","85% of total billed charges ",8004.15,90,,6403.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7737.35,87,,6189.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6225.45,70,,4980.36,,,0,"percent of total billed charges ","70% of total billed charges ",6225.45,8270.96,
"FEMORAL CR-FLX GNDR F,RT MINUS",6103486,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,6252.68,5002.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5002.14,80,,4001.71,,,0,"percent of total billed charges ","80% of total billed charges ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",5814.99,93,,4651.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5439.83,87,,4351.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",4376.88,5814.99,
"FEMORAL CR-FLX GNDR G, LT",6103489,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,6252.68,5002.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5002.14,80,,4001.71,,,0,"percent of total billed charges ","80% of total billed charges ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",5814.99,93,,4651.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5439.83,87,,4351.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",4376.88,5814.99,
"FEMORAL CR-FLX GNDR G, RT",6103490,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,6252.68,5002.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5002.14,80,,4001.71,,,0,"percent of total billed charges ","80% of total billed charges ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",5814.99,93,,4651.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5439.83,87,,4351.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",4376.88,5814.99,
"FEMORAL CR-FLX GNDR G,LT MINUS",6103491,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,6252.68,5002.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5002.14,80,,4001.71,,,0,"percent of total billed charges ","80% of total billed charges ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",5814.99,93,,4651.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5314.78,85,,4251.82,,,0,"percent of total billed charges ","85% of total billed charges ",5627.41,90,,4501.93,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5439.83,87,,4351.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4376.88,70,,3501.50,,,0,"percent of total billed charges ","70% of total billed charges ",4376.88,5814.99,
"FEMORAL CR-FLX GNDR G,RT MINUS",6103492,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,8385.48,6708.384,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6708.38,80,,5366.70,,,0,"percent of total billed charges ","80% of total billed charges ",5869.84,70,,4695.87,,,0,"percent of total billed charges ","70% of total billed charges ",7546.93,90,,6037.54,,,0,"percent of total billed charges ","90% of total billed charges ",7798.5,93,,6238.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7127.66,85,,5702.13,,,0,"percent of total billed charges ","85% of total billed charges ",7127.66,85,,5702.13,,,0,"percent of total billed charges ","85% of total billed charges ",7546.93,90,,6037.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7295.37,87,,5836.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5869.84,70,,4695.87,,,0,"percent of total billed charges ","70% of total billed charges ",5869.84,7798.5,
"BRNG TIBIA VE PS+ 16X63/67MM",6103540,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2904,2323.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2323.2,80,,1858.56,,,0,"percent of total billed charges ","80% of total billed charges ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",2700.72,93,,2160.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2526.48,87,,2021.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2032.8,2700.72,
"STEM KNEE SPLINED V2 24X80MM",6103543,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,3527.45,2821.96,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2821.96,80,,2257.57,,,0,"percent of total billed charges ","80% of total billed charges ",2469.22,70,,1975.38,,,0,"percent of total billed charges ","70% of total billed charges ",3174.71,90,,2539.77,,,0,"percent of total billed charges ","90% of total billed charges ",3280.53,93,,2624.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2998.33,85,,2398.66,,,0,"percent of total billed charges ","85% of total billed charges ",2998.33,85,,2398.66,,,0,"percent of total billed charges ","85% of total billed charges ",3174.71,90,,2539.77,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3068.88,87,,2455.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2469.22,70,,1975.38,,,0,"percent of total billed charges ","70% of total billed charges ",2469.22,3280.53,
"ACETABULAR LINER 28MM",6103547,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1338.5,1070.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1070.8,80,,856.64,,,0,"percent of total billed charges ","80% of total billed charges ",936.95,70,,749.56,,,0,"percent of total billed charges ","70% of total billed charges ",1204.65,90,,963.72,,,0,"percent of total billed charges ","90% of total billed charges ",1244.81,93,,995.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1137.73,85,,910.18,,,0,"percent of total billed charges ","85% of total billed charges ",1137.73,85,,910.18,,,0,"percent of total billed charges ","85% of total billed charges ",1204.65,90,,963.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1164.5,87,,931.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",936.95,70,,749.56,,,0,"percent of total billed charges ","70% of total billed charges ",936.95,1244.81,
"STEM 6 1/2"" X 14MM",6103576,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1026.5,821.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",821.2,80,,656.96,,,0,"percent of total billed charges ","80% of total billed charges ",718.55,70,,574.84,,,0,"percent of total billed charges ","70% of total billed charges ",923.85,90,,739.08,,,0,"percent of total billed charges ","90% of total billed charges ",954.65,93,,763.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",872.53,85,,698.02,,,0,"percent of total billed charges ","85% of total billed charges ",872.53,85,,698.02,,,0,"percent of total billed charges ","85% of total billed charges ",923.85,90,,739.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",893.06,87,,714.45,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",718.55,70,,574.84,,,0,"percent of total billed charges ","70% of total billed charges ",718.55,954.65,
"BRNG TIBIA VE PS+ 12X71/75MM",6103577,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2904,2323.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2323.2,80,,1858.56,,,0,"percent of total billed charges ","80% of total billed charges ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",2700.72,93,,2160.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2526.48,87,,2021.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2032.8,2700.72,
"BONE PLUG 22MM",6103578,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,308.17,246.536,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",246.54,80,,197.23,,,0,"percent of total billed charges ","80% of total billed charges ",215.72,70,,172.58,,,0,"percent of total billed charges ","70% of total billed charges ",277.35,90,,221.88,,,0,"percent of total billed charges ","90% of total billed charges ",286.6,93,,229.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.94,85,,209.55,,,0,"percent of total billed charges ","85% of total billed charges ",261.94,85,,209.55,,,0,"percent of total billed charges ","85% of total billed charges ",277.35,90,,221.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",268.11,87,,214.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",215.72,70,,172.58,,,0,"percent of total billed charges ","70% of total billed charges ",215.72,286.6,
"SCREW COMPRESSION 3/4"" X 19.0",6103580,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,187.18,149.744,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",149.74,80,,119.79,,,0,"percent of total billed charges ","80% of total billed charges ",131.03,70,,104.82,,,0,"percent of total billed charges ","70% of total billed charges ",168.46,90,,134.77,,,0,"percent of total billed charges ","90% of total billed charges ",174.08,93,,139.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",159.1,85,,127.28,,,0,"percent of total billed charges ","85% of total billed charges ",159.1,85,,127.28,,,0,"percent of total billed charges ","85% of total billed charges ",168.46,90,,134.77,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",162.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.03,70,,104.82,,,0,"percent of total billed charges ","70% of total billed charges ",131.03,174.08,
"FEMUR PPS STD LT SZ 8",6103583,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR PPS STD LFT SZ 9",6103610,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"ACETABULAR LINER 28-25",6103611,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1070.5,856.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",856.4,80,,685.12,,,0,"percent of total billed charges ","80% of total billed charges ",749.35,70,,599.48,,,0,"percent of total billed charges ","70% of total billed charges ",963.45,90,,770.76,,,0,"percent of total billed charges ","90% of total billed charges ",995.57,93,,796.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",909.93,85,,727.94,,,0,"percent of total billed charges ","85% of total billed charges ",909.93,85,,727.94,,,0,"percent of total billed charges ","85% of total billed charges ",963.45,90,,770.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",931.34,87,,745.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",749.35,70,,599.48,,,0,"percent of total billed charges ","70% of total billed charges ",749.35,995.57,
"TIBIAL BEARING 14MM X 7 1/75MM",6103625,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1010,808,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",808,80,,646.40,,,0,"percent of total billed charges ","80% of total billed charges ",707,70,,565.60,,,0,"percent of total billed charges ","70% of total billed charges ",909,90,,727.20,,,0,"percent of total billed charges ","90% of total billed charges ",939.3,93,,751.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",858.5,85,,686.80,,,0,"percent of total billed charges ","85% of total billed charges ",858.5,85,,686.80,,,0,"percent of total billed charges ","85% of total billed charges ",909,90,,727.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",878.7,87,,702.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",707,70,,565.60,,,0,"percent of total billed charges ","70% of total billed charges ",707,939.3,
"COMPFEM PS OPEN 72.5MM RT",6103631,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,4168.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"MESH VICRYL",6103640,"CDM ",278,RC,C1781,HCPCS,OUTPATIENT,,,254.68,203.744,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",203.74,80,,162.99,,,0,"percent of total billed charges ","80% of total billed charges ",178.28,70,,142.62,,,0,"percent of total billed charges ","70% of total billed charges ",229.21,90,,183.37,,,0,"percent of total billed charges ","90% of total billed charges ",236.85,93,,189.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",216.48,85,,173.18,,,0,"percent of total billed charges ","85% of total billed charges ",216.48,85,,173.18,,,0,"percent of total billed charges ","85% of total billed charges ",229.21,90,,183.37,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",221.57,87,,177.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.28,70,,142.62,,,0,"percent of total billed charges ","70% of total billed charges ",178.28,236.85,
"FEMORAL HEAD W/COLLAR 110X160M",6103651,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2690,2152,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2152,80,,1721.60,,,0,"percent of total billed charges ","80% of total billed charges ",1883,70,,1506.40,,,0,"percent of total billed charges ","70% of total billed charges ",2421,90,,1936.80,,,0,"percent of total billed charges ","90% of total billed charges ",2501.7,93,,2001.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2286.5,85,,1829.20,,,0,"percent of total billed charges ","85% of total billed charges ",2286.5,85,,1829.20,,,0,"percent of total billed charges ","85% of total billed charges ",2421,90,,1936.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2340.3,87,,1872.24,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1883,70,,1506.40,,,0,"percent of total billed charges ","70% of total billed charges ",1883,2501.7,
"CATH LAPROSCOPE CHOLANGIOGRAPH",6103656,"CDM ",272,RC,C1729,HCPCS,OUTPATIENT,,,263.5,210.8,,,,,,,,0,"other ","not separately reimbursment ",,,,93.87,93.87,93.87,"1 through 10","other ","not separately reimbursment ",210.8,80,,168.64,,,0,"percent of total billed charges ","80% of total billed charges ",184.45,70,,147.56,,,0,"percent of total billed charges ","70% of total billed charges ",237.15,90,,189.72,,,0,"percent of total billed charges ","90% of total billed charges ",245.06,93,,196.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",223.98,85,,179.18,,,0,"percent of total billed charges ","85% of total billed charges ",237.15,90,,189.72,,,0,"percent of total billed charges ","90% of total billed charges ",237.15,90,,189.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",229.25,87,,183.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",184.45,70,,147.56,,,0,"percent of total billed charges ","70% of total billed charges ",184.45,245.06,
"FEMUR PS NRRW RT SZ 7",6103669,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,6352.5,5082,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",5082,80,,4065.60,,,0,"percent of total billed charges ","80% of total billed charges ",4446.75,70,,3557.40,,,0,"percent of total billed charges ","70% of total billed charges ",5717.25,90,,4573.80,,,0,"percent of total billed charges ","90% of total billed charges ",5907.83,93,,4726.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5399.63,85,,4319.70,,,0,"percent of total billed charges ","85% of total billed charges ",5399.63,85,,4319.70,,,0,"percent of total billed charges ","85% of total billed charges ",5717.25,90,,4573.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5526.68,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4446.75,70,,3557.40,,,0,"percent of total billed charges ","70% of total billed charges ",4446.75,5907.83,
"FEMUR PS NRRW RT SZ 9",6103682,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,6352.5,5082,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",5082,80,,4065.60,,,0,"percent of total billed charges ","80% of total billed charges ",4446.75,70,,3557.40,,,0,"percent of total billed charges ","70% of total billed charges ",5717.25,90,,4573.80,,,0,"percent of total billed charges ","90% of total billed charges ",5907.83,93,,4726.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5399.63,85,,4319.70,,,0,"percent of total billed charges ","85% of total billed charges ",5399.63,85,,4319.70,,,0,"percent of total billed charges ","85% of total billed charges ",5717.25,90,,4573.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5526.68,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4446.75,70,,3557.40,,,0,"percent of total billed charges ","70% of total billed charges ",4446.75,5907.83,
"CENTERING SLEEVE 11.0MM",6103686,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,379,303.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.2,80,,242.56,,,0,"percent of total billed charges ","80% of total billed charges ",265.3,70,,212.24,,,0,"percent of total billed charges ","70% of total billed charges ",341.1,90,,272.88,,,0,"percent of total billed charges ","90% of total billed charges ",352.47,93,,281.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",322.15,85,,257.72,,,0,"percent of total billed charges ","85% of total billed charges ",322.15,85,,257.72,,,0,"percent of total billed charges ","85% of total billed charges ",341.1,90,,272.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",329.73,87,,263.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",265.3,70,,212.24,,,0,"percent of total billed charges ","70% of total billed charges ",265.3,352.47,
"SCREW INTERFERENCE 8 X 20MM",6103701,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,392,313.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",313.6,80,,250.88,,,0,"percent of total billed charges ","80% of total billed charges ",274.4,70,,219.52,,,0,"percent of total billed charges ","70% of total billed charges ",352.8,90,,282.24,,,0,"percent of total billed charges ","90% of total billed charges ",364.56,93,,291.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",333.2,85,,266.56,,,0,"percent of total billed charges ","85% of total billed charges ",333.2,85,,266.56,,,0,"percent of total billed charges ","85% of total billed charges ",352.8,90,,282.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",341.04,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.4,70,,219.52,,,0,"percent of total billed charges ","70% of total billed charges ",274.4,364.56,
"NAIL ITST FEMORAL 14X36 LEFT",6103707,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,6352.5,5082,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",5082,80,,4065.60,,,0,"percent of total billed charges ","80% of total billed charges ",4446.75,70,,3557.40,,,0,"percent of total billed charges ","70% of total billed charges ",5717.25,90,,4573.80,,,0,"percent of total billed charges ","90% of total billed charges ",5907.83,93,,4726.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5399.63,85,,4319.70,,,0,"percent of total billed charges ","85% of total billed charges ",5399.63,85,,4319.70,,,0,"percent of total billed charges ","85% of total billed charges ",5717.25,90,,4573.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5526.68,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4446.75,70,,3557.40,,,0,"percent of total billed charges ","70% of total billed charges ",4446.75,5907.83,
"PLATE 60MM",6103710,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,540,432,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",432,80,,345.60,,,0,"percent of total billed charges ","80% of total billed charges ",378,70,,302.40,,,0,"percent of total billed charges ","70% of total billed charges ",486,90,,388.80,,,0,"percent of total billed charges ","90% of total billed charges ",502.2,93,,401.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",459,85,,367.20,,,0,"percent of total billed charges ","85% of total billed charges ",459,85,,367.20,,,0,"percent of total billed charges ","85% of total billed charges ",486,90,,388.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",469.8,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",378,70,,302.40,,,0,"percent of total billed charges ","70% of total billed charges ",378,502.2,
"SCREW 6.5 X 40 MM",6103721,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,316.5,253.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",253.2,80,,202.56,,,0,"percent of total billed charges ","80% of total billed charges ",221.55,70,,177.24,,,0,"percent of total billed charges ","70% of total billed charges ",284.85,90,,227.88,,,0,"percent of total billed charges ","90% of total billed charges ",294.35,93,,235.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",269.03,85,,215.22,,,0,"percent of total billed charges ","85% of total billed charges ",269.03,85,,215.22,,,0,"percent of total billed charges ","85% of total billed charges ",284.85,90,,227.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",275.36,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",221.55,70,,177.24,,,0,"percent of total billed charges ","70% of total billed charges ",221.55,294.35,
"SCREW 6.5 X 20 MM",6103722,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,316.5,253.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",253.2,80,,202.56,,,0,"percent of total billed charges ","80% of total billed charges ",221.55,70,,177.24,,,0,"percent of total billed charges ","70% of total billed charges ",284.85,90,,227.88,,,0,"percent of total billed charges ","90% of total billed charges ",294.35,93,,235.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",269.03,85,,215.22,,,0,"percent of total billed charges ","85% of total billed charges ",269.03,85,,215.22,,,0,"percent of total billed charges ","85% of total billed charges ",284.85,90,,227.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",275.36,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",221.55,70,,177.24,,,0,"percent of total billed charges ","70% of total billed charges ",221.55,294.35,
"PAPILLOTOME WIRE GUIDED",6103725,"CDM ",272,RC,C1769,HCPCS,OUTPATIENT,,,274.5,219.6,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",219.6,80,,175.68,,,0,"percent of total billed charges ","80% of total billed charges ",192.15,70,,153.72,,,0,"percent of total billed charges ","70% of total billed charges ",247.05,90,,197.64,,,0,"percent of total billed charges ","90% of total billed charges ",255.29,93,,204.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",233.33,85,,186.66,,,0,"percent of total billed charges ","85% of total billed charges ",247.05,90,,197.64,,,0,"percent of total billed charges ","90% of total billed charges ",247.05,90,,197.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",238.82,87,,191.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.15,70,,153.72,,,0,"percent of total billed charges ","70% of total billed charges ",192.15,255.29,
"FEMUR PS STD RT SZ 7",6103736,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,6352.5,5082,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",5082,80,,4065.60,,,0,"percent of total billed charges ","80% of total billed charges ",4446.75,70,,3557.40,,,0,"percent of total billed charges ","70% of total billed charges ",5717.25,90,,4573.80,,,0,"percent of total billed charges ","90% of total billed charges ",5907.83,93,,4726.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5399.63,85,,4319.70,,,0,"percent of total billed charges ","85% of total billed charges ",5399.63,85,,4319.70,,,0,"percent of total billed charges ","85% of total billed charges ",5717.25,90,,4573.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5526.68,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4446.75,70,,3557.40,,,0,"percent of total billed charges ","70% of total billed charges ",4446.75,5907.83,
"FEMUR PS STD RT SZ 8",6103741,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,6352.5,5082,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",5082,80,,4065.60,,,0,"percent of total billed charges ","80% of total billed charges ",4446.75,70,,3557.40,,,0,"percent of total billed charges ","70% of total billed charges ",5717.25,90,,4573.80,,,0,"percent of total billed charges ","90% of total billed charges ",5907.83,93,,4726.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5399.63,85,,4319.70,,,0,"percent of total billed charges ","85% of total billed charges ",5399.63,85,,4319.70,,,0,"percent of total billed charges ","85% of total billed charges ",5717.25,90,,4573.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5526.68,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4446.75,70,,3557.40,,,0,"percent of total billed charges ","70% of total billed charges ",4446.75,5907.83,
"BRNG TIB VE PS+ 18X63/67MM",6103750,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2904,2323.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2323.2,80,,1858.56,,,0,"percent of total billed charges ","80% of total billed charges ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",2700.72,93,,2160.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2526.48,87,,2021.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2032.8,2700.72,
"BRNG TIB VE PS+ 18X71/75MM",6103751,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2904,2323.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2323.2,80,,1858.56,,,0,"percent of total billed charges ","80% of total billed charges ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",2700.72,93,,2160.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2526.48,87,,2021.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2032.8,2700.72,
"FEMUR PS STD RT SZ 9",6103760,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"WIRE GUIDE",6103771,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,301.01,240.808,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",240.81,80,,192.65,,,0,"percent of total billed charges ","80% of total billed charges ",210.71,70,,168.57,,,0,"percent of total billed charges ","70% of total billed charges ",270.91,90,,216.73,,,0,"percent of total billed charges ","90% of total billed charges ",279.94,93,,223.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",255.86,85,,204.69,,,0,"percent of total billed charges ","85% of total billed charges ",255.86,85,,204.69,,,0,"percent of total billed charges ","85% of total billed charges ",270.91,90,,216.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",261.88,87,,209.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.71,70,,168.57,,,0,"percent of total billed charges ","70% of total billed charges ",210.71,279.94,
"COMP FEM PS OPEN 62.5MM RT",6103796,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,4168.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"ART SURF CPS GH 10-12 LFT 10",6103818,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"BARRIER 1 5/8"" CONVEX",6103828,"CDM ",272,RC,A4390,HCPCS,OUTPATIENT,,,28.5,22.8,,,,,,,,0,"other ","not separately reimbursment ",11.88,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.95,70,,15.96,,,0,"percent of total billed charges ","70% of total billed charges ",25.65,90,,20.52,,,0,"percent of total billed charges ","90% of total billed charges ",26.51,93,,21.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",24.23,85,,19.38,,,0,"percent of total billed charges ","85% of total billed charges ",25.65,90,,20.52,,,0,"percent of total billed charges ","90% of total billed charges ",25.65,90,,20.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",24.8,87,,19.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,70,,15.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.88,26.51,
"NAIL ITST FEMORAL 10MMX34CM LT",6103859,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3488.88,2791.104,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2442.22,70,,1953.78,,,0,"percent of total billed charges ","70% of total billed charges ",3139.99,90,,2511.99,,,0,"percent of total billed charges ","90% of total billed charges ",3244.66,93,,2595.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2965.55,85,,2372.44,,,0,"percent of total billed charges ","85% of total billed charges ",2965.55,85,,2372.44,,,0,"percent of total billed charges ","85% of total billed charges ",3139.99,90,,2511.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3035.33,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2442.22,70,,1953.78,,,0,"percent of total billed charges ","70% of total billed charges ",2442.22,3244.66,
"NAIL TFNA TI CANN 11 X 235MM L",6103860,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3488.88,2791.104,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2442.22,70,,1953.78,,,0,"percent of total billed charges ","70% of total billed charges ",3139.99,90,,2511.99,,,0,"percent of total billed charges ","90% of total billed charges ",3244.66,93,,2595.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2965.55,85,,2372.44,,,0,"percent of total billed charges ","85% of total billed charges ",2965.55,85,,2372.44,,,0,"percent of total billed charges ","85% of total billed charges ",3139.99,90,,2511.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3035.33,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2442.22,70,,1953.78,,,0,"percent of total billed charges ","70% of total billed charges ",2442.22,3244.66,
"NAIL TFNA TI CANN 12X235MM L",6103861,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3488.88,2791.104,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2442.22,70,,1953.78,,,0,"percent of total billed charges ","70% of total billed charges ",3139.99,90,,2511.99,,,0,"percent of total billed charges ","90% of total billed charges ",3244.66,93,,2595.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2965.55,85,,2372.44,,,0,"percent of total billed charges ","85% of total billed charges ",2965.55,85,,2372.44,,,0,"percent of total billed charges ","85% of total billed charges ",3139.99,90,,2511.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3035.33,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2442.22,70,,1953.78,,,0,"percent of total billed charges ","70% of total billed charges ",2442.22,3244.66,
"NAIL TFNA TI CANN 10 X 235MM R",6103890,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3488.88,2791.104,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2442.22,70,,1953.78,,,0,"percent of total billed charges ","70% of total billed charges ",3139.99,90,,2511.99,,,0,"percent of total billed charges ","90% of total billed charges ",3244.66,93,,2595.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2965.55,85,,2372.44,,,0,"percent of total billed charges ","85% of total billed charges ",2965.55,85,,2372.44,,,0,"percent of total billed charges ","85% of total billed charges ",3139.99,90,,2511.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3035.33,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2442.22,70,,1953.78,,,0,"percent of total billed charges ","70% of total billed charges ",2442.22,3244.66,
"NAIL TFNA TI CANN 11X235MM R",6103891,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3488.88,2791.104,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2442.22,70,,1953.78,,,0,"percent of total billed charges ","70% of total billed charges ",3139.99,90,,2511.99,,,0,"percent of total billed charges ","90% of total billed charges ",3244.66,93,,2595.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2965.55,85,,2372.44,,,0,"percent of total billed charges ","85% of total billed charges ",2965.55,85,,2372.44,,,0,"percent of total billed charges ","85% of total billed charges ",3139.99,90,,2511.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3035.33,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2442.22,70,,1953.78,,,0,"percent of total billed charges ","70% of total billed charges ",2442.22,3244.66,
"NAIL TFNA TI CANN 12X235MM R",6103892,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3488.88,2791.104,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2442.22,70,,1953.78,,,0,"percent of total billed charges ","70% of total billed charges ",3139.99,90,,2511.99,,,0,"percent of total billed charges ","90% of total billed charges ",3244.66,93,,2595.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2965.55,85,,2372.44,,,0,"percent of total billed charges ","85% of total billed charges ",2965.55,85,,2372.44,,,0,"percent of total billed charges ","85% of total billed charges ",3139.99,90,,2511.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3035.33,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2442.22,70,,1953.78,,,0,"percent of total billed charges ","70% of total billed charges ",2442.22,3244.66,
"BONE PLUG 8C/16 FL",6104064,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,420.23,336.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",294.16,70,,235.33,,,0,"percent of total billed charges ","70% of total billed charges ",378.21,90,,302.57,,,0,"percent of total billed charges ","90% of total billed charges ",390.81,93,,312.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",357.2,85,,285.76,,,0,"percent of total billed charges ","85% of total billed charges ",357.2,85,,285.76,,,0,"percent of total billed charges ","85% of total billed charges ",378.21,90,,302.57,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",365.6,87,,292.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",294.16,70,,235.33,,,0,"percent of total billed charges ","70% of total billed charges ",294.16,390.81,
"BONE PLUG 10C/20 FL",6104065,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,310,248,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217,70,,173.60,,,0,"percent of total billed charges ","70% of total billed charges ",279,90,,223.20,,,0,"percent of total billed charges ","90% of total billed charges ",288.3,93,,230.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.5,85,,210.80,,,0,"percent of total billed charges ","85% of total billed charges ",263.5,85,,210.80,,,0,"percent of total billed charges ","85% of total billed charges ",279,90,,223.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.7,87,,215.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217,70,,173.60,,,0,"percent of total billed charges ","70% of total billed charges ",217,288.3,
"BONE PLUG 12C/24 FL",6104066,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,310,248,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217,70,,173.60,,,0,"percent of total billed charges ","70% of total billed charges ",279,90,,223.20,,,0,"percent of total billed charges ","90% of total billed charges ",288.3,93,,230.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.5,85,,210.80,,,0,"percent of total billed charges ","85% of total billed charges ",263.5,85,,210.80,,,0,"percent of total billed charges ","85% of total billed charges ",279,90,,223.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.7,87,,215.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217,70,,173.60,,,0,"percent of total billed charges ","70% of total billed charges ",217,288.3,
"GUIDEWIRE ANGELED .038 X 150",6104170,"CDM ",272,RC,C1769,HCPCS,OUTPATIENT,,,200.5,160.4,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.35,70,,112.28,,,0,"percent of total billed charges ","70% of total billed charges ",180.45,90,,144.36,,,0,"percent of total billed charges ","90% of total billed charges ",186.47,93,,149.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",170.43,85,,136.34,,,0,"percent of total billed charges ","85% of total billed charges ",180.45,90,,144.36,,,0,"percent of total billed charges ","90% of total billed charges ",180.45,90,,144.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",174.44,87,,139.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.35,70,,112.28,,,0,"percent of total billed charges ","70% of total billed charges ",140.35,186.47,
"CATH COUDE 18FR 5CC",6104187,"CDM ",272,RC,C1729,HCPCS,OUTPATIENT,,,52.67,42.136,,,,,,,,0,"other ","not separately reimbursment ",,,,93.87,93.87,93.87,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.87,70,,29.50,,,0,"percent of total billed charges ","70% of total billed charges ",47.4,90,,37.92,,,0,"percent of total billed charges ","90% of total billed charges ",48.98,93,,39.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",44.77,85,,35.82,,,0,"percent of total billed charges ","85% of total billed charges ",47.4,90,,37.92,,,0,"percent of total billed charges ","90% of total billed charges ",47.4,90,,37.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",45.82,87,,36.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.87,70,,29.50,,,0,"percent of total billed charges ","70% of total billed charges ",36.87,48.98,
"ART SURF MC EF 8-11 RT 14MM",6104196,"CDM ",278,RC,C2617,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC EF 8-11 RT 16MM",6104199,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC GH 8-11 RT 10MM",6104203,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"CATHETER URETERAL 8FR CONE TIP",6104215,"CDM ",272,RC,C1758,HCPCS,OUTPATIENT,,,61.65,49.32,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.16,70,,34.53,,,0,"percent of total billed charges ","70% of total billed charges ",55.49,90,,44.39,,,0,"percent of total billed charges ","90% of total billed charges ",57.33,93,,45.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",52.4,85,,41.92,,,0,"percent of total billed charges ","85% of total billed charges ",55.49,90,,44.39,,,0,"percent of total billed charges ","90% of total billed charges ",55.49,90,,44.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",53.64,87,,42.91,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.16,70,,34.53,,,0,"percent of total billed charges ","70% of total billed charges ",43.16,57.33,
"STENT SOFT-FLEX 7X24",6104223,"CDM ",278,RC,C2617,HCPCS,OUTPATIENT,,,377,301.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.9,70,,211.12,,,0,"percent of total billed charges ","70% of total billed charges ",339.3,90,,271.44,,,0,"percent of total billed charges ","90% of total billed charges ",350.61,93,,280.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",320.45,85,,256.36,,,0,"percent of total billed charges ","85% of total billed charges ",320.45,85,,256.36,,,0,"percent of total billed charges ","85% of total billed charges ",339.3,90,,271.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",327.99,87,,262.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.9,70,,211.12,,,0,"percent of total billed charges ","70% of total billed charges ",263.9,350.61,
"STENT SOFT-FLEX 7X26",6104224,"CDM ",278,RC,C2617,HCPCS,OUTPATIENT,,,377,301.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.9,70,,211.12,,,0,"percent of total billed charges ","70% of total billed charges ",339.3,90,,271.44,,,0,"percent of total billed charges ","90% of total billed charges ",350.61,93,,280.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",320.45,85,,256.36,,,0,"percent of total billed charges ","85% of total billed charges ",320.45,85,,256.36,,,0,"percent of total billed charges ","85% of total billed charges ",339.3,90,,271.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",327.99,87,,262.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.9,70,,211.12,,,0,"percent of total billed charges ","70% of total billed charges ",263.9,350.61,
"STENT SOFT-FLEX 7X28",6104225,"CDM ",278,RC,C2617,HCPCS,OUTPATIENT,,,325.5,260.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.85,70,,182.28,,,0,"percent of total billed charges ","70% of total billed charges ",292.95,90,,234.36,,,0,"percent of total billed charges ","90% of total billed charges ",302.72,93,,242.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.68,85,,221.34,,,0,"percent of total billed charges ","85% of total billed charges ",276.68,85,,221.34,,,0,"percent of total billed charges ","85% of total billed charges ",292.95,90,,234.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",283.19,87,,226.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.85,70,,182.28,,,0,"percent of total billed charges ","70% of total billed charges ",227.85,302.72,
"STENT SOFT-FLEX 7X30",6104226,"CDM ",278,RC,C2617,HCPCS,OUTPATIENT,,,236,188.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",165.2,70,,132.16,,,0,"percent of total billed charges ","70% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",219.48,93,,175.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",200.6,85,,160.48,,,0,"percent of total billed charges ","85% of total billed charges ",200.6,85,,160.48,,,0,"percent of total billed charges ","85% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",205.32,87,,164.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",165.2,70,,132.16,,,0,"percent of total billed charges ","70% of total billed charges ",165.2,219.48,
"STENT SOFT-FLEX 8.2 X 24",6104227,"CDM ",278,RC,C2617,HCPCS,OUTPATIENT,,,369,295.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",258.3,70,,206.64,,,0,"percent of total billed charges ","70% of total billed charges ",332.1,90,,265.68,,,0,"percent of total billed charges ","90% of total billed charges ",343.17,93,,274.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",313.65,85,,250.92,,,0,"percent of total billed charges ","85% of total billed charges ",313.65,85,,250.92,,,0,"percent of total billed charges ","85% of total billed charges ",332.1,90,,265.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",321.03,87,,256.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",258.3,70,,206.64,,,0,"percent of total billed charges ","70% of total billed charges ",258.3,343.17,
"STENT SOFT-FLEX 8.2 X 26",6104228,"CDM ",278,RC,C2617,HCPCS,OUTPATIENT,,,368.5,294.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",257.95,70,,206.36,,,0,"percent of total billed charges ","70% of total billed charges ",331.65,90,,265.32,,,0,"percent of total billed charges ","90% of total billed charges ",342.71,93,,274.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",313.23,85,,250.58,,,0,"percent of total billed charges ","85% of total billed charges ",313.23,85,,250.58,,,0,"percent of total billed charges ","85% of total billed charges ",331.65,90,,265.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",320.6,87,,256.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",257.95,70,,206.36,,,0,"percent of total billed charges ","70% of total billed charges ",257.95,342.71,
"CATH EDLEMAN 16 FRENCH",6104243,"CDM ",272,RC,C1758,HCPCS,OUTPATIENT,,,166.69,133.352,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.68,70,,93.34,,,0,"percent of total billed charges ","70% of total billed charges ",150.02,90,,120.02,,,0,"percent of total billed charges ","90% of total billed charges ",155.02,93,,124.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",141.69,85,,113.35,,,0,"percent of total billed charges ","85% of total billed charges ",150.02,90,,120.02,,,0,"percent of total billed charges ","90% of total billed charges ",150.02,90,,120.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",145.02,87,,116.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.68,70,,93.34,,,0,"percent of total billed charges ","70% of total billed charges ",116.68,155.02,
"CATH OPEN-END 5FR X 70CM",6104260,"CDM ",272,RC,C1758,HCPCS,OUTPATIENT,,,39.62,31.696,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.73,70,,22.18,,,0,"percent of total billed charges ","70% of total billed charges ",35.66,90,,28.53,,,0,"percent of total billed charges ","90% of total billed charges ",36.85,93,,29.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.68,85,,26.94,,,0,"percent of total billed charges ","85% of total billed charges ",35.66,90,,28.53,,,0,"percent of total billed charges ","90% of total billed charges ",35.66,90,,28.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",34.47,87,,27.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.73,70,,22.18,,,0,"percent of total billed charges ","70% of total billed charges ",27.73,36.85,
"CATH OPEN-END 6FR X 70CM",6104261,"CDM ",272,RC,C1758,HCPCS,OUTPATIENT,,,40.42,32.336,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.29,70,,22.63,,,0,"percent of total billed charges ","70% of total billed charges ",36.38,90,,29.10,,,0,"percent of total billed charges ","90% of total billed charges ",37.59,93,,30.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34.36,85,,27.49,,,0,"percent of total billed charges ","85% of total billed charges ",36.38,90,,29.10,,,0,"percent of total billed charges ","90% of total billed charges ",36.38,90,,29.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",35.17,87,,28.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.29,70,,22.63,,,0,"percent of total billed charges ","70% of total billed charges ",28.29,37.59,
"TAPE CAST 5"" PURPLE",6104277,"CDM ",272,RC,A4590,HCPCS,OUTPATIENT,,,28,22.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.6,70,,15.68,,,0,"percent of total billed charges ","70% of total billed charges ",25.2,90,,20.16,,,0,"percent of total billed charges ","90% of total billed charges ",26.04,93,,20.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.8,85,,19.04,,,0,"percent of total billed charges ","85% of total billed charges ",25.2,90,,20.16,,,0,"percent of total billed charges ","90% of total billed charges ",25.2,90,,20.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",24.36,87,,19.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.6,70,,15.68,,,0,"percent of total billed charges ","70% of total billed charges ",19.6,26.04,
"GUIDE PIN 3.2MM*230MM",6104280,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,78.68,62.944,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.08,70,,44.06,,,0,"percent of total billed charges ","70% of total billed charges ",70.81,90,,56.65,,,0,"percent of total billed charges ","90% of total billed charges ",73.17,93,,58.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",66.88,85,,53.50,,,0,"percent of total billed charges ","85% of total billed charges ",66.88,85,,53.50,,,0,"percent of total billed charges ","85% of total billed charges ",70.81,90,,56.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",68.45,87,,54.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.08,70,,44.06,,,0,"percent of total billed charges ","70% of total billed charges ",55.08,73.17,
"GUIDEWIRE STRAIGHT 0.35X150",6104303,"CDM ",272,RC,C1769,HCPCS,OUTPATIENT,,,195,156,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136.5,70,,109.20,,,0,"percent of total billed charges ","70% of total billed charges ",175.5,90,,140.40,,,0,"percent of total billed charges ","90% of total billed charges ",181.35,93,,145.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",165.75,85,,132.60,,,0,"percent of total billed charges ","85% of total billed charges ",175.5,90,,140.40,,,0,"percent of total billed charges ","90% of total billed charges ",175.5,90,,140.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",169.65,87,,135.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136.5,70,,109.20,,,0,"percent of total billed charges ","70% of total billed charges ",136.5,181.35,
"CATH LEONARD DUAL LUMEN 10FR",6104322,"CDM ",272,RC,C1751,HCPCS,OUTPATIENT,,,329.72,263.776,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",230.8,70,,184.64,,,0,"percent of total billed charges ","70% of total billed charges ",296.75,90,,237.40,,,0,"percent of total billed charges ","90% of total billed charges ",306.64,93,,245.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",280.26,85,,224.21,,,0,"percent of total billed charges ","85% of total billed charges ",296.75,90,,237.40,,,0,"percent of total billed charges ","90% of total billed charges ",296.75,90,,237.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",286.86,87,,229.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",230.8,70,,184.64,,,0,"percent of total billed charges ","70% of total billed charges ",230.8,306.64,
"STENT URETERAL 8.5 FR X 22CM",6104330,"CDM ",278,RC,C2617,HCPCS,OUTPATIENT,,,448,358.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",313.6,70,,250.88,,,0,"percent of total billed charges ","70% of total billed charges ",403.2,90,,322.56,,,0,"percent of total billed charges ","90% of total billed charges ",416.64,93,,333.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",380.8,85,,304.64,,,0,"percent of total billed charges ","85% of total billed charges ",380.8,85,,304.64,,,0,"percent of total billed charges ","85% of total billed charges ",403.2,90,,322.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",389.76,87,,311.81,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",313.6,70,,250.88,,,0,"percent of total billed charges ","70% of total billed charges ",313.6,416.64,
"STENT URETERAL 8.5 FR X 24CM",6104331,"CDM ",278,RC,C2617,HCPCS,OUTPATIENT,,,448,358.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",313.6,70,,250.88,,,0,"percent of total billed charges ","70% of total billed charges ",403.2,90,,322.56,,,0,"percent of total billed charges ","90% of total billed charges ",416.64,93,,333.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",380.8,85,,304.64,,,0,"percent of total billed charges ","85% of total billed charges ",380.8,85,,304.64,,,0,"percent of total billed charges ","85% of total billed charges ",403.2,90,,322.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",389.76,87,,311.81,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",313.6,70,,250.88,,,0,"percent of total billed charges ","70% of total billed charges ",313.6,416.64,
"STENT URETERAL 8.5 FR X 26 CM",6104332,"CDM ",278,RC,C2617,HCPCS,OUTPATIENT,,,448,358.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",313.6,70,,250.88,,,0,"percent of total billed charges ","70% of total billed charges ",403.2,90,,322.56,,,0,"percent of total billed charges ","90% of total billed charges ",416.64,93,,333.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",380.8,85,,304.64,,,0,"percent of total billed charges ","85% of total billed charges ",380.8,85,,304.64,,,0,"percent of total billed charges ","85% of total billed charges ",403.2,90,,322.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",389.76,87,,311.81,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",313.6,70,,250.88,,,0,"percent of total billed charges ","70% of total billed charges ",313.6,416.64,
"HEMOSTAT VITAGEL SURGICAL",6104334,"CDM ",272,RC,C1760,HCPCS,OUTPATIENT,,,981.5,785.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",687.05,70,,549.64,,,0,"percent of total billed charges ","70% of total billed charges ",883.35,90,,706.68,,,0,"percent of total billed charges ","90% of total billed charges ",912.8,93,,730.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",834.28,85,,667.42,,,0,"percent of total billed charges ","85% of total billed charges ",883.35,90,,706.68,,,0,"percent of total billed charges ","90% of total billed charges ",883.35,90,,706.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",853.91,87,,683.13,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",687.05,70,,549.64,,,0,"percent of total billed charges ","70% of total billed charges ",687.05,912.8,
"SPRAY SET VITAGEL",6104338,"CDM ",272,RC,C1760,HCPCS,OUTPATIENT,,,387,309.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",270.9,70,,216.72,,,0,"percent of total billed charges ","70% of total billed charges ",348.3,90,,278.64,,,0,"percent of total billed charges ","90% of total billed charges ",359.91,93,,287.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",328.95,85,,263.16,,,0,"percent of total billed charges ","85% of total billed charges ",348.3,90,,278.64,,,0,"percent of total billed charges ","90% of total billed charges ",348.3,90,,278.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",336.69,87,,269.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",270.9,70,,216.72,,,0,"percent of total billed charges ","70% of total billed charges ",270.9,359.91,
"GUIDEWIRE J TIP 3MM X 145CM",6104348,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,66.68,53.344,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.68,70,,37.34,,,0,"percent of total billed charges ","70% of total billed charges ",60.01,90,,48.01,,,0,"percent of total billed charges ","90% of total billed charges ",62.01,93,,49.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",56.68,85,,45.34,,,0,"percent of total billed charges ","85% of total billed charges ",56.68,85,,45.34,,,0,"percent of total billed charges ","85% of total billed charges ",60.01,90,,48.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",58.01,87,,46.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.68,70,,37.34,,,0,"percent of total billed charges ","70% of total billed charges ",46.68,62.01,
"INDERMIL SKIN ADHESIVE",6104444,"CDM ",272,RC,G0168,HCPCS,OUTPATIENT,,,115.57,92.456,,,,,,,,0,"other ","not separately reimbursment ",141.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",30.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",80.9,70,,64.72,,,0,"percent of total billed charges ","70% of total billed charges ",104.01,90,,83.21,,,0,"percent of total billed charges ","90% of total billed charges ",107.48,93,,85.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",98.23,85,,78.58,,,0,"percent of total billed charges ","85% of total billed charges ",104.01,90,,83.21,,,0,"percent of total billed charges ","90% of total billed charges ",104.01,90,,83.21,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.55,87,,80.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.9,70,,64.72,,,0,"percent of total billed charges ","70% of total billed charges ",30.87,141.4,
"BAG 2"" OSTOMY",6104548,"CDM ",272,RC,A4377,HCPCS,OUTPATIENT,,,19,15.2,,,,,,,,0,"other ","not separately reimbursment ",10.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",13.3,70,,10.64,,,0,"percent of total billed charges ","70% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.67,93,,14.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.15,85,,12.92,,,0,"percent of total billed charges ","85% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.53,87,,13.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.3,70,,10.64,,,0,"percent of total billed charges ","70% of total billed charges ",10.02,17.67,
"PATCH HERNIA PARASTOMA 28-35MM",6104603,"CDM ",278,RC,C1781,HCPCS,OUTPATIENT,,,2333,1866.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1633.1,70,,1306.48,,,0,"percent of total billed charges ","70% of total billed charges ",2099.7,90,,1679.76,,,0,"percent of total billed charges ","90% of total billed charges ",2169.69,93,,1735.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1983.05,85,,1586.44,,,0,"percent of total billed charges ","85% of total billed charges ",1983.05,85,,1586.44,,,0,"percent of total billed charges ","85% of total billed charges ",2099.7,90,,1679.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2029.71,87,,1623.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1633.1,70,,1306.48,,,0,"percent of total billed charges ","70% of total billed charges ",1633.1,2169.69,
"PATCH HERNIA PARASTOMA 35-45MM",6104604,"CDM ",278,RC,C1781,HCPCS,OUTPATIENT,,,2333,1866.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1633.1,70,,1306.48,,,0,"percent of total billed charges ","70% of total billed charges ",2099.7,90,,1679.76,,,0,"percent of total billed charges ","90% of total billed charges ",2169.69,93,,1735.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1983.05,85,,1586.44,,,0,"percent of total billed charges ","85% of total billed charges ",1983.05,85,,1586.44,,,0,"percent of total billed charges ","85% of total billed charges ",2099.7,90,,1679.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2029.71,87,,1623.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1633.1,70,,1306.48,,,0,"percent of total billed charges ","70% of total billed charges ",1633.1,2169.69,
"CATH BALLOON 16FR 30CC",6104626,"CDM ",272,RC,C1729,HCPCS,OUTPATIENT,,,11,8.8,,,,,,,,0,"other ","not separately reimbursment ",,,,93.87,93.87,93.87,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",10.23,93,,8.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.35,85,,7.48,,,0,"percent of total billed charges ","85% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.57,87,,7.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.7,10.23,
"CATH 18FR 30CC",6104627,"CDM ",272,RC,C1729,HCPCS,OUTPATIENT,,,13.09,10.472,,,,,,,,0,"other ","not separately reimbursment ",,,,93.87,93.87,93.87,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.16,70,,7.33,,,0,"percent of total billed charges ","70% of total billed charges ",11.78,90,,9.42,,,0,"percent of total billed charges ","90% of total billed charges ",12.17,93,,9.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.13,85,,8.90,,,0,"percent of total billed charges ","85% of total billed charges ",11.78,90,,9.42,,,0,"percent of total billed charges ","90% of total billed charges ",11.78,90,,9.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.39,87,,9.11,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.16,70,,7.33,,,0,"percent of total billed charges ","70% of total billed charges ",9.16,12.17,
"CATH FILIFORM 5FR",6104631,"CDM ",272,RC,C1758,HCPCS,OUTPATIENT,,,254.08,203.264,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.86,70,,142.29,,,0,"percent of total billed charges ","70% of total billed charges ",228.67,90,,182.94,,,0,"percent of total billed charges ","90% of total billed charges ",236.29,93,,189.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",215.97,85,,172.78,,,0,"percent of total billed charges ","85% of total billed charges ",228.67,90,,182.94,,,0,"percent of total billed charges ","90% of total billed charges ",228.67,90,,182.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",221.05,87,,176.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.86,70,,142.29,,,0,"percent of total billed charges ","70% of total billed charges ",177.86,236.29,
"CATH FILIFORM 6FR",6104632,"CDM ",272,RC,C1758,HCPCS,OUTPATIENT,,,237.19,189.752,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",166.03,70,,132.82,,,0,"percent of total billed charges ","70% of total billed charges ",213.47,90,,170.78,,,0,"percent of total billed charges ","90% of total billed charges ",220.59,93,,176.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",201.61,85,,161.29,,,0,"percent of total billed charges ","85% of total billed charges ",213.47,90,,170.78,,,0,"percent of total billed charges ","90% of total billed charges ",213.47,90,,170.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",206.36,87,,165.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",166.03,70,,132.82,,,0,"percent of total billed charges ","70% of total billed charges ",166.03,220.59,
"TAPE CAST 3"" BLACK",6104648,"CDM ",272,RC,A4590,HCPCS,OUTPATIENT,,,21.5,17.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.05,70,,12.04,,,0,"percent of total billed charges ","70% of total billed charges ",19.35,90,,15.48,,,0,"percent of total billed charges ","90% of total billed charges ",20,93,,16.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.28,85,,14.62,,,0,"percent of total billed charges ","85% of total billed charges ",19.35,90,,15.48,,,0,"percent of total billed charges ","90% of total billed charges ",19.35,90,,15.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.71,87,,14.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.05,70,,12.04,,,0,"percent of total billed charges ","70% of total billed charges ",15.05,20,
"CATH THORACIC 20FR",6104670,"CDM ",272,RC,C1757,HCPCS,OUTPATIENT,,,23.67,18.936,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.57,70,,13.26,,,0,"percent of total billed charges ","70% of total billed charges ",21.3,90,,17.04,,,0,"percent of total billed charges ","90% of total billed charges ",22.01,93,,17.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.12,85,,16.10,,,0,"percent of total billed charges ","85% of total billed charges ",21.3,90,,17.04,,,0,"percent of total billed charges ","90% of total billed charges ",21.3,90,,17.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.59,87,,16.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.57,70,,13.26,,,0,"percent of total billed charges ","70% of total billed charges ",16.57,22.01,
"CATH BILIARY PROBE 5FR",6104692,"CDM ",272,RC,C1729,HCPCS,OUTPATIENT,,,320.81,256.648,,,,,,,,0,"other ","not separately reimbursment ",,,,93.87,93.87,93.87,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",224.57,70,,179.66,,,0,"percent of total billed charges ","70% of total billed charges ",288.73,90,,230.98,,,0,"percent of total billed charges ","90% of total billed charges ",298.35,93,,238.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",272.69,85,,218.15,,,0,"percent of total billed charges ","85% of total billed charges ",288.73,90,,230.98,,,0,"percent of total billed charges ","90% of total billed charges ",288.73,90,,230.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",279.1,87,,223.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",224.57,70,,179.66,,,0,"percent of total billed charges ","70% of total billed charges ",224.57,298.35,
"ANCHOR ROTATOR CUFF",6104695,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,747.79,598.232,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",523.45,70,,418.76,,,0,"percent of total billed charges ","70% of total billed charges ",673.01,90,,538.41,,,0,"percent of total billed charges ","90% of total billed charges ",695.44,93,,556.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",635.62,85,,508.50,,,0,"percent of total billed charges ","85% of total billed charges ",635.62,85,,508.50,,,0,"percent of total billed charges ","85% of total billed charges ",673.01,90,,538.41,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",650.58,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",523.45,70,,418.76,,,0,"percent of total billed charges ","70% of total billed charges ",523.45,695.44,
"MESH SURGICAL SM",6104786,"CDM ",278,RC,C1781,HCPCS,OUTPATIENT,,,110.86,88.688,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.6,70,,62.08,,,0,"percent of total billed charges ","70% of total billed charges ",99.77,90,,79.82,,,0,"percent of total billed charges ","90% of total billed charges ",103.1,93,,82.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",94.23,85,,75.38,,,0,"percent of total billed charges ","85% of total billed charges ",94.23,85,,75.38,,,0,"percent of total billed charges ","85% of total billed charges ",99.77,90,,79.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",96.45,87,,77.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.6,70,,62.08,,,0,"percent of total billed charges ","70% of total billed charges ",77.6,103.1,
"MESH SURGICAL LG",6104787,"CDM ",278,RC,C1781,HCPCS,OUTPATIENT,,,262.85,210.28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.28,80,,168.22,,,0,"percent of total billed charges ","80% of total billed charges ",184,70,,147.20,,,0,"percent of total billed charges ","70% of total billed charges ",236.57,90,,189.26,,,0,"percent of total billed charges ","90% of total billed charges ",244.45,93,,195.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",223.42,85,,178.74,,,0,"percent of total billed charges ","85% of total billed charges ",223.42,85,,178.74,,,0,"percent of total billed charges ","85% of total billed charges ",236.57,90,,189.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",228.68,87,,182.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",184,70,,147.20,,,0,"percent of total billed charges ","70% of total billed charges ",184,244.45,
"SCREW BIO 7 X 20",6104800,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,280,224,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",224,80,,179.20,,,0,"percent of total billed charges ","80% of total billed charges ",196,70,,156.80,,,0,"percent of total billed charges ","70% of total billed charges ",252,90,,201.60,,,0,"percent of total billed charges ","90% of total billed charges ",260.4,93,,208.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",238,85,,190.40,,,0,"percent of total billed charges ","85% of total billed charges ",238,85,,190.40,,,0,"percent of total billed charges ","85% of total billed charges ",252,90,,201.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",243.6,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",196,70,,156.80,,,0,"percent of total billed charges ","70% of total billed charges ",196,260.4,
"SCREW BIO 8 X 25",6104801,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,373.5,298.8,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",298.8,80,,239.04,,,0,"percent of total billed charges ","80% of total billed charges ",261.45,70,,209.16,,,0,"percent of total billed charges ","70% of total billed charges ",336.15,90,,268.92,,,0,"percent of total billed charges ","90% of total billed charges ",347.36,93,,277.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",317.48,85,,253.98,,,0,"percent of total billed charges ","85% of total billed charges ",317.48,85,,253.98,,,0,"percent of total billed charges ","85% of total billed charges ",336.15,90,,268.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",324.95,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",261.45,70,,209.16,,,0,"percent of total billed charges ","70% of total billed charges ",261.45,347.36,
"SCREW BIO 9 X 20",6104802,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,244,195.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",195.2,80,,156.16,,,0,"percent of total billed charges ","80% of total billed charges ",170.8,70,,136.64,,,0,"percent of total billed charges ","70% of total billed charges ",219.6,90,,175.68,,,0,"percent of total billed charges ","90% of total billed charges ",226.92,93,,181.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",207.4,85,,165.92,,,0,"percent of total billed charges ","85% of total billed charges ",207.4,85,,165.92,,,0,"percent of total billed charges ","85% of total billed charges ",219.6,90,,175.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",212.28,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.8,70,,136.64,,,0,"percent of total billed charges ","70% of total billed charges ",170.8,226.92,
"SCREW BIO 9 X 25",6104803,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,244,195.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",195.2,80,,156.16,,,0,"percent of total billed charges ","80% of total billed charges ",170.8,70,,136.64,,,0,"percent of total billed charges ","70% of total billed charges ",219.6,90,,175.68,,,0,"percent of total billed charges ","90% of total billed charges ",226.92,93,,181.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",207.4,85,,165.92,,,0,"percent of total billed charges ","85% of total billed charges ",207.4,85,,165.92,,,0,"percent of total billed charges ","85% of total billed charges ",219.6,90,,175.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",212.28,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.8,70,,136.64,,,0,"percent of total billed charges ","70% of total billed charges ",170.8,226.92,
"SCREW INTERFERENCE 9X25MM",6104815,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,280,224,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",224,80,,179.20,,,0,"percent of total billed charges ","80% of total billed charges ",196,70,,156.80,,,0,"percent of total billed charges ","70% of total billed charges ",252,90,,201.60,,,0,"percent of total billed charges ","90% of total billed charges ",260.4,93,,208.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",238,85,,190.40,,,0,"percent of total billed charges ","85% of total billed charges ",238,85,,190.40,,,0,"percent of total billed charges ","85% of total billed charges ",252,90,,201.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",243.6,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",196,70,,156.80,,,0,"percent of total billed charges ","70% of total billed charges ",196,260.4,
"K-WIRE 1.6X150MM(SYNTHES)",6104842,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,44.38,35.504,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",35.5,80,,28.40,,,0,"percent of total billed charges ","80% of total billed charges ",31.07,70,,24.86,,,0,"percent of total billed charges ","70% of total billed charges ",39.94,90,,31.95,,,0,"percent of total billed charges ","90% of total billed charges ",41.27,93,,33.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",37.72,85,,30.18,,,0,"percent of total billed charges ","85% of total billed charges ",37.72,85,,30.18,,,0,"percent of total billed charges ","85% of total billed charges ",39.94,90,,31.95,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",38.61,87,,30.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.07,70,,24.86,,,0,"percent of total billed charges ","70% of total billed charges ",31.07,41.27,
"SCREW CONICAL 2.7MM X 12MM",6104847,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,199.14,159.312,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",159.31,80,,127.45,,,0,"percent of total billed charges ","80% of total billed charges ",139.4,70,,111.52,,,0,"percent of total billed charges ","70% of total billed charges ",179.23,90,,143.38,,,0,"percent of total billed charges ","90% of total billed charges ",185.2,93,,148.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",169.27,85,,135.42,,,0,"percent of total billed charges ","85% of total billed charges ",169.27,85,,135.42,,,0,"percent of total billed charges ","85% of total billed charges ",179.23,90,,143.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",173.25,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.4,70,,111.52,,,0,"percent of total billed charges ","70% of total billed charges ",139.4,185.2,
"SCREW CONICAL 2.7MM X 14MM",6104853,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,199.14,159.312,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",159.31,80,,127.45,,,0,"percent of total billed charges ","80% of total billed charges ",139.4,70,,111.52,,,0,"percent of total billed charges ","70% of total billed charges ",179.23,90,,143.38,,,0,"percent of total billed charges ","90% of total billed charges ",185.2,93,,148.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",169.27,85,,135.42,,,0,"percent of total billed charges ","85% of total billed charges ",169.27,85,,135.42,,,0,"percent of total billed charges ","85% of total billed charges ",179.23,90,,143.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",173.25,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.4,70,,111.52,,,0,"percent of total billed charges ","70% of total billed charges ",139.4,185.2,
"SCREW Z LCK 2.7MM X 18MM",6104854,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,333.64,266.912,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",266.91,80,,213.53,,,0,"percent of total billed charges ","80% of total billed charges ",233.55,70,,186.84,,,0,"percent of total billed charges ","70% of total billed charges ",300.28,90,,240.22,,,0,"percent of total billed charges ","90% of total billed charges ",310.29,93,,248.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",283.59,85,,226.87,,,0,"percent of total billed charges ","85% of total billed charges ",283.59,85,,226.87,,,0,"percent of total billed charges ","85% of total billed charges ",300.28,90,,240.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",290.27,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",233.55,70,,186.84,,,0,"percent of total billed charges ","70% of total billed charges ",233.55,310.29,
"GRAFT 20M X 10M",6104856,"CDM ",278,RC,C1768,HCPCS,OUTPATIENT,,,2014.65,1611.72,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1611.72,80,,1289.38,,,0,"percent of total billed charges ","80% of total billed charges ",1410.26,70,,1128.21,,,0,"percent of total billed charges ","70% of total billed charges ",1813.19,90,,1450.55,,,0,"percent of total billed charges ","90% of total billed charges ",1873.62,93,,1498.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1712.45,85,,1369.96,,,0,"percent of total billed charges ","85% of total billed charges ",1712.45,85,,1369.96,,,0,"percent of total billed charges ","85% of total billed charges ",1813.19,90,,1450.55,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1752.75,87,,1402.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1410.26,70,,1128.21,,,0,"percent of total billed charges ","70% of total billed charges ",1410.26,1873.62,
"PLATE Z LCK 4H 80MM RT",6104858,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1001.15,800.92,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",800.92,80,,640.74,,,0,"percent of total billed charges ","80% of total billed charges ",700.81,70,,560.65,,,0,"percent of total billed charges ","70% of total billed charges ",901.04,90,,720.83,,,0,"percent of total billed charges ","90% of total billed charges ",931.07,93,,744.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",850.98,85,,680.78,,,0,"percent of total billed charges ","85% of total billed charges ",850.98,85,,680.78,,,0,"percent of total billed charges ","85% of total billed charges ",901.04,90,,720.83,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",871,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",700.81,70,,560.65,,,0,"percent of total billed charges ","70% of total billed charges ",700.81,931.07,
"SCREW Z CORT 1.7MM X 14MM ST",6104864,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,80.9,64.72,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",64.72,80,,51.78,,,0,"percent of total billed charges ","80% of total billed charges ",56.63,70,,45.30,,,0,"percent of total billed charges ","70% of total billed charges ",72.81,90,,58.25,,,0,"percent of total billed charges ","90% of total billed charges ",75.24,93,,60.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",68.77,85,,55.02,,,0,"percent of total billed charges ","85% of total billed charges ",68.77,85,,55.02,,,0,"percent of total billed charges ","85% of total billed charges ",72.81,90,,58.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",70.38,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.63,70,,45.30,,,0,"percent of total billed charges ","70% of total billed charges ",56.63,75.24,
"SCREW Z CORT 2.7MM X 26MM ST",6104865,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,80.9,64.72,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",64.72,80,,51.78,,,0,"percent of total billed charges ","80% of total billed charges ",56.63,70,,45.30,,,0,"percent of total billed charges ","70% of total billed charges ",72.81,90,,58.25,,,0,"percent of total billed charges ","90% of total billed charges ",75.24,93,,60.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",68.77,85,,55.02,,,0,"percent of total billed charges ","85% of total billed charges ",68.77,85,,55.02,,,0,"percent of total billed charges ","85% of total billed charges ",72.81,90,,58.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",70.38,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.63,70,,45.30,,,0,"percent of total billed charges ","70% of total billed charges ",56.63,75.24,
"SCREW Z PERI CORT 3.5X30MM",6104866,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,130.68,104.544,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",104.54,80,,83.63,,,0,"percent of total billed charges ","80% of total billed charges ",91.48,70,,73.18,,,0,"percent of total billed charges ","70% of total billed charges ",117.61,90,,94.09,,,0,"percent of total billed charges ","90% of total billed charges ",121.53,93,,97.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",111.08,85,,88.86,,,0,"percent of total billed charges ","85% of total billed charges ",111.08,85,,88.86,,,0,"percent of total billed charges ","85% of total billed charges ",117.61,90,,94.09,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",113.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.48,70,,73.18,,,0,"percent of total billed charges ","70% of total billed charges ",91.48,121.53,
"SCREW Z LCK 2.7MM X 16MM",6104867,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,333.64,266.912,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",266.91,80,,213.53,,,0,"percent of total billed charges ","80% of total billed charges ",233.55,70,,186.84,,,0,"percent of total billed charges ","70% of total billed charges ",300.28,90,,240.22,,,0,"percent of total billed charges ","90% of total billed charges ",310.29,93,,248.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",283.59,85,,226.87,,,0,"percent of total billed charges ","85% of total billed charges ",283.59,85,,226.87,,,0,"percent of total billed charges ","85% of total billed charges ",300.28,90,,240.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",290.27,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",233.55,70,,186.84,,,0,"percent of total billed charges ","70% of total billed charges ",233.55,310.29,
"SCREW CORTICAL 3.5MM X 32MM ST",6104869,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,96.68,77.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",77.34,80,,61.87,,,0,"percent of total billed charges ","80% of total billed charges ",67.68,70,,54.14,,,0,"percent of total billed charges ","70% of total billed charges ",87.01,90,,69.61,,,0,"percent of total billed charges ","90% of total billed charges ",89.91,93,,71.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",82.18,85,,65.74,,,0,"percent of total billed charges ","85% of total billed charges ",82.18,85,,65.74,,,0,"percent of total billed charges ","85% of total billed charges ",87.01,90,,69.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",84.11,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.68,70,,54.14,,,0,"percent of total billed charges ","70% of total billed charges ",67.68,89.91,
"SCREW CORTICAL 3.5MM X 36MM ST",6104870,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,96.68,77.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",77.34,80,,61.87,,,0,"percent of total billed charges ","80% of total billed charges ",67.68,70,,54.14,,,0,"percent of total billed charges ","70% of total billed charges ",87.01,90,,69.61,,,0,"percent of total billed charges ","90% of total billed charges ",89.91,93,,71.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",82.18,85,,65.74,,,0,"percent of total billed charges ","85% of total billed charges ",82.18,85,,65.74,,,0,"percent of total billed charges ","85% of total billed charges ",87.01,90,,69.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",84.11,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.68,70,,54.14,,,0,"percent of total billed charges ","70% of total billed charges ",67.68,89.91,
"PLATE Z LCK 8H 132MM RT",6104873,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1148.53,918.824,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",918.82,80,,735.06,,,0,"percent of total billed charges ","80% of total billed charges ",803.97,70,,643.18,,,0,"percent of total billed charges ","70% of total billed charges ",1033.68,90,,826.94,,,0,"percent of total billed charges ","90% of total billed charges ",1068.13,93,,854.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",976.25,85,,781.00,,,0,"percent of total billed charges ","85% of total billed charges ",976.25,85,,781.00,,,0,"percent of total billed charges ","85% of total billed charges ",1033.68,90,,826.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",999.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",803.97,70,,643.18,,,0,"percent of total billed charges ","70% of total billed charges ",803.97,1068.13,
"SCREW Z LCK 2.7MM X 14MM",6104884,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,333.64,266.912,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",266.91,80,,213.53,,,0,"percent of total billed charges ","80% of total billed charges ",233.55,70,,186.84,,,0,"percent of total billed charges ","70% of total billed charges ",300.28,90,,240.22,,,0,"percent of total billed charges ","90% of total billed charges ",310.29,93,,248.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",283.59,85,,226.87,,,0,"percent of total billed charges ","85% of total billed charges ",283.59,85,,226.87,,,0,"percent of total billed charges ","85% of total billed charges ",300.28,90,,240.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",290.27,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",233.55,70,,186.84,,,0,"percent of total billed charges ","70% of total billed charges ",233.55,310.29,
"SCREW Z CORT 2.7MM X 16MM ST",6104886,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,80.9,64.72,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",64.72,80,,51.78,,,0,"percent of total billed charges ","80% of total billed charges ",56.63,70,,45.30,,,0,"percent of total billed charges ","70% of total billed charges ",72.81,90,,58.25,,,0,"percent of total billed charges ","90% of total billed charges ",75.24,93,,60.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",68.77,85,,55.02,,,0,"percent of total billed charges ","85% of total billed charges ",68.77,85,,55.02,,,0,"percent of total billed charges ","85% of total billed charges ",72.81,90,,58.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",70.38,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.63,70,,45.30,,,0,"percent of total billed charges ","70% of total billed charges ",56.63,75.24,
"CATH THORACIC 16FR",6104887,"CDM ",272,RC,C1757,HCPCS,OUTPATIENT,,,66.01,52.808,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.81,80,,42.25,,,0,"percent of total billed charges ","80% of total billed charges ",46.21,70,,36.97,,,0,"percent of total billed charges ","70% of total billed charges ",59.41,90,,47.53,,,0,"percent of total billed charges ","90% of total billed charges ",61.39,93,,49.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",56.11,85,,44.89,,,0,"percent of total billed charges ","85% of total billed charges ",59.41,90,,47.53,,,0,"percent of total billed charges ","90% of total billed charges ",59.41,90,,47.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",57.43,87,,45.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.21,70,,36.97,,,0,"percent of total billed charges ","70% of total billed charges ",46.21,61.39,
"SCREW Z PERI CORT 3.5X50MM",6104892,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,130.68,104.544,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",104.54,80,,83.63,,,0,"percent of total billed charges ","80% of total billed charges ",91.48,70,,73.18,,,0,"percent of total billed charges ","70% of total billed charges ",117.61,90,,94.09,,,0,"percent of total billed charges ","90% of total billed charges ",121.53,93,,97.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",111.08,85,,88.86,,,0,"percent of total billed charges ","85% of total billed charges ",111.08,85,,88.86,,,0,"percent of total billed charges ","85% of total billed charges ",117.61,90,,94.09,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",113.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.48,70,,73.18,,,0,"percent of total billed charges ","70% of total billed charges ",91.48,121.53,
"SCREW Z PERI CORT 3.5X14MM",6104894,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,130.68,104.544,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",104.54,80,,83.63,,,0,"percent of total billed charges ","80% of total billed charges ",91.48,70,,73.18,,,0,"percent of total billed charges ","70% of total billed charges ",117.61,90,,94.09,,,0,"percent of total billed charges ","90% of total billed charges ",121.53,93,,97.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",111.08,85,,88.86,,,0,"percent of total billed charges ","85% of total billed charges ",111.08,85,,88.86,,,0,"percent of total billed charges ","85% of total billed charges ",117.61,90,,94.09,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",113.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.48,70,,73.18,,,0,"percent of total billed charges ","70% of total billed charges ",91.48,121.53,
"PLATE Z LCK 10H 158MM LT",6104895,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1223.49,978.792,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",978.79,80,,783.03,,,0,"percent of total billed charges ","80% of total billed charges ",856.44,70,,685.15,,,0,"percent of total billed charges ","70% of total billed charges ",1101.14,90,,880.91,,,0,"percent of total billed charges ","90% of total billed charges ",1137.85,93,,910.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1039.97,85,,831.98,,,0,"percent of total billed charges ","85% of total billed charges ",1039.97,85,,831.98,,,0,"percent of total billed charges ","85% of total billed charges ",1101.14,90,,880.91,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1064.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",856.44,70,,685.15,,,0,"percent of total billed charges ","70% of total billed charges ",856.44,1137.85,
"SCREW Z CORT 2.7 X 2.0 MM ST",6104896,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,80.9,64.72,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",64.72,80,,51.78,,,0,"percent of total billed charges ","80% of total billed charges ",56.63,70,,45.30,,,0,"percent of total billed charges ","70% of total billed charges ",72.81,90,,58.25,,,0,"percent of total billed charges ","90% of total billed charges ",75.24,93,,60.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",68.77,85,,55.02,,,0,"percent of total billed charges ","85% of total billed charges ",68.77,85,,55.02,,,0,"percent of total billed charges ","85% of total billed charges ",72.81,90,,58.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",70.38,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.63,70,,45.30,,,0,"percent of total billed charges ","70% of total billed charges ",56.63,75.24,
"SCREW Z LCK 2.7 X 2.0 MM",6104897,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,333.64,266.912,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",266.91,80,,213.53,,,0,"percent of total billed charges ","80% of total billed charges ",233.55,70,,186.84,,,0,"percent of total billed charges ","70% of total billed charges ",300.28,90,,240.22,,,0,"percent of total billed charges ","90% of total billed charges ",310.29,93,,248.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",283.59,85,,226.87,,,0,"percent of total billed charges ","85% of total billed charges ",283.59,85,,226.87,,,0,"percent of total billed charges ","85% of total billed charges ",300.28,90,,240.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",290.27,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",233.55,70,,186.84,,,0,"percent of total billed charges ","70% of total billed charges ",233.55,310.29,
"K-WIRE 1.6MM X 150MM(SYNTHES)",6104898,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,48.36,38.688,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",38.69,80,,30.95,,,0,"percent of total billed charges ","80% of total billed charges ",33.85,70,,27.08,,,0,"percent of total billed charges ","70% of total billed charges ",43.52,90,,34.82,,,0,"percent of total billed charges ","90% of total billed charges ",44.97,93,,35.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.11,85,,32.89,,,0,"percent of total billed charges ","85% of total billed charges ",41.11,85,,32.89,,,0,"percent of total billed charges ","85% of total billed charges ",43.52,90,,34.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.07,87,,33.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.85,70,,27.08,,,0,"percent of total billed charges ","70% of total billed charges ",33.85,44.97,
"SCREW Z CORT 2.7 X 24 MM ST",6104899,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,80.9,64.72,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",64.72,80,,51.78,,,0,"percent of total billed charges ","80% of total billed charges ",56.63,70,,45.30,,,0,"percent of total billed charges ","70% of total billed charges ",72.81,90,,58.25,,,0,"percent of total billed charges ","90% of total billed charges ",75.24,93,,60.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",68.77,85,,55.02,,,0,"percent of total billed charges ","85% of total billed charges ",68.77,85,,55.02,,,0,"percent of total billed charges ","85% of total billed charges ",72.81,90,,58.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",70.38,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.63,70,,45.30,,,0,"percent of total billed charges ","70% of total billed charges ",56.63,75.24,
"SCREW Z CORT 2.7 X 18 MM ST",6104900,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,80.9,64.72,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",64.72,80,,51.78,,,0,"percent of total billed charges ","80% of total billed charges ",56.63,70,,45.30,,,0,"percent of total billed charges ","70% of total billed charges ",72.81,90,,58.25,,,0,"percent of total billed charges ","90% of total billed charges ",75.24,93,,60.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",68.77,85,,55.02,,,0,"percent of total billed charges ","85% of total billed charges ",68.77,85,,55.02,,,0,"percent of total billed charges ","85% of total billed charges ",72.81,90,,58.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",70.38,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.63,70,,45.30,,,0,"percent of total billed charges ","70% of total billed charges ",56.63,75.24,
"KIT MPFL IMPLANT SYSTEM",6104905,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3801.97,3041.576,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3041.58,80,,2433.26,,,0,"percent of total billed charges ","80% of total billed charges ",2661.38,70,,2129.10,,,0,"percent of total billed charges ","70% of total billed charges ",3421.77,90,,2737.42,,,0,"percent of total billed charges ","90% of total billed charges ",3535.83,93,,2828.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3231.67,85,,2585.34,,,0,"percent of total billed charges ","85% of total billed charges ",3231.67,85,,2585.34,,,0,"percent of total billed charges ","85% of total billed charges ",3421.77,90,,2737.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3307.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2661.38,70,,2129.10,,,0,"percent of total billed charges ","70% of total billed charges ",2661.38,3535.83,
"GRAFT 16 X 8",6104907,"CDM ",278,RC,C1768,HCPCS,OUTPATIENT,,,1397.55,1118.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1118.04,80,,894.43,,,0,"percent of total billed charges ","80% of total billed charges ",978.29,70,,782.63,,,0,"percent of total billed charges ","70% of total billed charges ",1257.8,90,,1006.24,,,0,"percent of total billed charges ","90% of total billed charges ",1299.72,93,,1039.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1187.92,85,,950.34,,,0,"percent of total billed charges ","85% of total billed charges ",1187.92,85,,950.34,,,0,"percent of total billed charges ","85% of total billed charges ",1257.8,90,,1006.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1215.87,87,,972.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",978.29,70,,782.63,,,0,"percent of total billed charges ","70% of total billed charges ",978.29,1299.72,
"GRAFT 18 X 9",6104908,"CDM ",278,RC,C1768,HCPCS,OUTPATIENT,,,1397.55,1118.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1118.04,80,,894.43,,,0,"percent of total billed charges ","80% of total billed charges ",978.29,70,,782.63,,,0,"percent of total billed charges ","70% of total billed charges ",1257.8,90,,1006.24,,,0,"percent of total billed charges ","90% of total billed charges ",1299.72,93,,1039.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1187.92,85,,950.34,,,0,"percent of total billed charges ","85% of total billed charges ",1187.92,85,,950.34,,,0,"percent of total billed charges ","85% of total billed charges ",1257.8,90,,1006.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1215.87,87,,972.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",978.29,70,,782.63,,,0,"percent of total billed charges ","70% of total billed charges ",978.29,1299.72,
"GRAFT 16 X 60",6104909,"CDM ",278,RC,C1768,HCPCS,OUTPATIENT,,,958.98,767.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",767.18,80,,613.74,,,0,"percent of total billed charges ","80% of total billed charges ",671.29,70,,537.03,,,0,"percent of total billed charges ","70% of total billed charges ",863.08,90,,690.46,,,0,"percent of total billed charges ","90% of total billed charges ",891.85,93,,713.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",815.13,85,,652.10,,,0,"percent of total billed charges ","85% of total billed charges ",815.13,85,,652.10,,,0,"percent of total billed charges ","85% of total billed charges ",863.08,90,,690.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",834.31,87,,667.45,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",671.29,70,,537.03,,,0,"percent of total billed charges ","70% of total billed charges ",671.29,891.85,
"GRAFT 22 X 11",6104910,"CDM ",278,RC,C1768,HCPCS,OUTPATIENT,,,2014.65,1611.72,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1611.72,80,,1289.38,,,0,"percent of total billed charges ","80% of total billed charges ",1410.26,70,,1128.21,,,0,"percent of total billed charges ","70% of total billed charges ",1813.19,90,,1450.55,,,0,"percent of total billed charges ","90% of total billed charges ",1873.62,93,,1498.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1712.45,85,,1369.96,,,0,"percent of total billed charges ","85% of total billed charges ",1712.45,85,,1369.96,,,0,"percent of total billed charges ","85% of total billed charges ",1813.19,90,,1450.55,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1752.75,87,,1402.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1410.26,70,,1128.21,,,0,"percent of total billed charges ","70% of total billed charges ",1410.26,1873.62,
"GRAFT 18 X 50",6104911,"CDM ",278,RC,C1768,HCPCS,OUTPATIENT,,,958.98,767.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",767.18,80,,613.74,,,0,"percent of total billed charges ","80% of total billed charges ",671.29,70,,537.03,,,0,"percent of total billed charges ","70% of total billed charges ",863.08,90,,690.46,,,0,"percent of total billed charges ","90% of total billed charges ",891.85,93,,713.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",815.13,85,,652.10,,,0,"percent of total billed charges ","85% of total billed charges ",815.13,85,,652.10,,,0,"percent of total billed charges ","85% of total billed charges ",863.08,90,,690.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",834.31,87,,667.45,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",671.29,70,,537.03,,,0,"percent of total billed charges ","70% of total billed charges ",671.29,891.85,
"GRAFT 20 X 50",6104912,"CDM ",278,RC,C1768,HCPCS,OUTPATIENT,,,1049.49,839.592,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",839.59,80,,671.67,,,0,"percent of total billed charges ","80% of total billed charges ",734.64,70,,587.71,,,0,"percent of total billed charges ","70% of total billed charges ",944.54,90,,755.63,,,0,"percent of total billed charges ","90% of total billed charges ",976.03,93,,780.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",892.07,85,,713.66,,,0,"percent of total billed charges ","85% of total billed charges ",892.07,85,,713.66,,,0,"percent of total billed charges ","85% of total billed charges ",944.54,90,,755.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",913.06,87,,730.45,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",734.64,70,,587.71,,,0,"percent of total billed charges ","70% of total billed charges ",734.64,976.03,
"GRAFT 22 X 50",6104913,"CDM ",278,RC,C1768,HCPCS,OUTPATIENT,,,958.98,767.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",767.18,80,,613.74,,,0,"percent of total billed charges ","80% of total billed charges ",671.29,70,,537.03,,,0,"percent of total billed charges ","70% of total billed charges ",863.08,90,,690.46,,,0,"percent of total billed charges ","90% of total billed charges ",891.85,93,,713.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",815.13,85,,652.10,,,0,"percent of total billed charges ","85% of total billed charges ",815.13,85,,652.10,,,0,"percent of total billed charges ","85% of total billed charges ",863.08,90,,690.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",834.31,87,,667.45,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",671.29,70,,537.03,,,0,"percent of total billed charges ","70% of total billed charges ",671.29,891.85,
"GRAFT 24 X 50",6104914,"CDM ",278,RC,C1768,HCPCS,OUTPATIENT,,,1049.49,839.592,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",839.59,80,,671.67,,,0,"percent of total billed charges ","80% of total billed charges ",734.64,70,,587.71,,,0,"percent of total billed charges ","70% of total billed charges ",944.54,90,,755.63,,,0,"percent of total billed charges ","90% of total billed charges ",976.03,93,,780.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",892.07,85,,713.66,,,0,"percent of total billed charges ","85% of total billed charges ",892.07,85,,713.66,,,0,"percent of total billed charges ","85% of total billed charges ",944.54,90,,755.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",913.06,87,,730.45,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",734.64,70,,587.71,,,0,"percent of total billed charges ","70% of total billed charges ",734.64,976.03,
"SPORT MESH",6104961,"CDM ",278,RC,C1781,HCPCS,OUTPATIENT,,,3176.25,2541,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2541,80,,2032.80,,,0,"percent of total billed charges ","80% of total billed charges ",2223.38,70,,1778.70,,,0,"percent of total billed charges ","70% of total billed charges ",2858.63,90,,2286.90,,,0,"percent of total billed charges ","90% of total billed charges ",2953.91,93,,2363.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2699.81,85,,2159.85,,,0,"percent of total billed charges ","85% of total billed charges ",2699.81,85,,2159.85,,,0,"percent of total billed charges ","85% of total billed charges ",2858.63,90,,2286.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2763.34,87,,2210.67,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2223.38,70,,1778.70,,,0,"percent of total billed charges ","70% of total billed charges ",2223.38,2953.91,
"WEDGE ILIAC CREST 9MM",6104962,"CDM ",278,RC,C1762,HCPCS,OUTPATIENT,,,1225.12,980.096,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",980.1,80,,784.08,,,0,"percent of total billed charges ","80% of total billed charges ",857.58,70,,686.06,,,0,"percent of total billed charges ","70% of total billed charges ",1102.61,90,,882.09,,,0,"percent of total billed charges ","90% of total billed charges ",1139.36,93,,911.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1041.35,85,,833.08,,,0,"percent of total billed charges ","85% of total billed charges ",1041.35,85,,833.08,,,0,"percent of total billed charges ","85% of total billed charges ",1102.61,90,,882.09,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1065.85,87,,852.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",857.58,70,,686.06,,,0,"percent of total billed charges ","70% of total billed charges ",857.58,1139.36,
"ANCHOR SUTURE ANKLE ZIP TIGHT",6105022,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1266.6,1013.28,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1013.28,80,,810.62,,,0,"percent of total billed charges ","80% of total billed charges ",886.62,70,,709.30,,,0,"percent of total billed charges ","70% of total billed charges ",1139.94,90,,911.95,,,0,"percent of total billed charges ","90% of total billed charges ",1177.94,93,,942.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1076.61,85,,861.29,,,0,"percent of total billed charges ","85% of total billed charges ",1076.61,85,,861.29,,,0,"percent of total billed charges ","85% of total billed charges ",1139.94,90,,911.95,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1101.94,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",886.62,70,,709.30,,,0,"percent of total billed charges ","70% of total billed charges ",886.62,1177.94,
"ANCHOR JUGGERKNOT SIZE 1",6105024,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,550.5,440.4,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",440.4,80,,352.32,,,0,"percent of total billed charges ","80% of total billed charges ",385.35,70,,308.28,,,0,"percent of total billed charges ","70% of total billed charges ",495.45,90,,396.36,,,0,"percent of total billed charges ","90% of total billed charges ",511.97,93,,409.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",467.93,85,,374.34,,,0,"percent of total billed charges ","85% of total billed charges ",467.93,85,,374.34,,,0,"percent of total billed charges ","85% of total billed charges ",495.45,90,,396.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",478.94,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",385.35,70,,308.28,,,0,"percent of total billed charges ","70% of total billed charges ",385.35,511.97,
"ANCHOR JUGGERKNOT SZ 1",6105029,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,500,400,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",400,80,,320.00,,,0,"percent of total billed charges ","80% of total billed charges ",350,70,,280.00,,,0,"percent of total billed charges ","70% of total billed charges ",450,90,,360.00,,,0,"percent of total billed charges ","90% of total billed charges ",465,93,,372.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",425,85,,340.00,,,0,"percent of total billed charges ","85% of total billed charges ",425,85,,340.00,,,0,"percent of total billed charges ","85% of total billed charges ",450,90,,360.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",435,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",350,70,,280.00,,,0,"percent of total billed charges ","70% of total billed charges ",350,465,
"ANCHOR SUTURE 5.5MM",6105047,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,581.85,465.48,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",465.48,80,,372.38,,,0,"percent of total billed charges ","80% of total billed charges ",407.3,70,,325.84,,,0,"percent of total billed charges ","70% of total billed charges ",523.67,90,,418.94,,,0,"percent of total billed charges ","90% of total billed charges ",541.12,93,,432.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",494.57,85,,395.66,,,0,"percent of total billed charges ","85% of total billed charges ",494.57,85,,395.66,,,0,"percent of total billed charges ","85% of total billed charges ",523.67,90,,418.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",506.21,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",407.3,70,,325.84,,,0,"percent of total billed charges ","70% of total billed charges ",407.3,541.12,
"BRNG TIBIA VE PS+ 14X71/75MM",6105053,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2904,2323.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2323.2,80,,1858.56,,,0,"percent of total billed charges ","80% of total billed charges ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",2700.72,93,,2160.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2526.48,87,,2021.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2032.8,2700.72,
"CLIP FILSHIE",6105083,"CDM ",278,RC,A4264,HCPCS,OUTPATIENT,,,237.05,189.64,,,,,,,,0,"other ","not separately reimbursment ",,,,107.15,107.15,107.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",165.94,70,,132.75,,,0,"percent of total billed charges ","70% of total billed charges ",213.35,90,,170.68,,,0,"percent of total billed charges ","90% of total billed charges ",220.46,93,,176.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",201.49,85,,161.19,,,0,"percent of total billed charges ","85% of total billed charges ",201.49,85,,161.19,,,0,"percent of total billed charges ","85% of total billed charges ",213.35,90,,170.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",206.23,87,,164.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",165.94,70,,132.75,,,0,"percent of total billed charges ","70% of total billed charges ",165.94,220.46,
"SCREW Z CORT 2.7MM X 12MM ST",6105093,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,80.9,64.72,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.63,70,,45.30,,,0,"percent of total billed charges ","70% of total billed charges ",72.81,90,,58.25,,,0,"percent of total billed charges ","90% of total billed charges ",75.24,93,,60.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",68.77,85,,55.02,,,0,"percent of total billed charges ","85% of total billed charges ",68.77,85,,55.02,,,0,"percent of total billed charges ","85% of total billed charges ",72.81,90,,58.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",70.38,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.63,70,,45.30,,,0,"percent of total billed charges ","70% of total billed charges ",56.63,75.24,
"SCREW Z PERI CORT 3.5X10MM",6105098,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,130.68,104.544,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.48,70,,73.18,,,0,"percent of total billed charges ","70% of total billed charges ",117.61,90,,94.09,,,0,"percent of total billed charges ","90% of total billed charges ",121.53,93,,97.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",111.08,85,,88.86,,,0,"percent of total billed charges ","85% of total billed charges ",111.08,85,,88.86,,,0,"percent of total billed charges ","85% of total billed charges ",117.61,90,,94.09,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",113.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.48,70,,73.18,,,0,"percent of total billed charges ","70% of total billed charges ",91.48,121.53,
"SCREW Z PERI CORT 3.5X12MM",6105102,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,130.68,104.544,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.48,70,,73.18,,,0,"percent of total billed charges ","70% of total billed charges ",117.61,90,,94.09,,,0,"percent of total billed charges ","90% of total billed charges ",121.53,93,,97.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",111.08,85,,88.86,,,0,"percent of total billed charges ","85% of total billed charges ",111.08,85,,88.86,,,0,"percent of total billed charges ","85% of total billed charges ",117.61,90,,94.09,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",113.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.48,70,,73.18,,,0,"percent of total billed charges ","70% of total billed charges ",91.48,121.53,
"SCREW Z CORT 2.7MM X 10MM ST",6105110,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,80.9,64.72,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",64.72,80,,51.78,,,0,"percent of total billed charges ","80% of total billed charges ",56.63,70,,45.30,,,0,"percent of total billed charges ","70% of total billed charges ",72.81,90,,58.25,,,0,"percent of total billed charges ","90% of total billed charges ",75.24,93,,60.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",68.77,85,,55.02,,,0,"percent of total billed charges ","85% of total billed charges ",68.77,85,,55.02,,,0,"percent of total billed charges ","85% of total billed charges ",72.81,90,,58.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",70.38,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.63,70,,45.30,,,0,"percent of total billed charges ","70% of total billed charges ",56.63,75.24,
"SCREW Z PERI CORT 3.5X16MM",6105111,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,130.68,104.544,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",104.54,80,,83.63,,,0,"percent of total billed charges ","80% of total billed charges ",91.48,70,,73.18,,,0,"percent of total billed charges ","70% of total billed charges ",117.61,90,,94.09,,,0,"percent of total billed charges ","90% of total billed charges ",121.53,93,,97.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",111.08,85,,88.86,,,0,"percent of total billed charges ","85% of total billed charges ",111.08,85,,88.86,,,0,"percent of total billed charges ","85% of total billed charges ",117.61,90,,94.09,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",113.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.48,70,,73.18,,,0,"percent of total billed charges ","70% of total billed charges ",91.48,121.53,
"TRAY TIBIA STEMMED CEMENT 67MM",6105112,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5568.42,4454.736,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4454.74,80,,3563.79,,,0,"percent of total billed charges ","80% of total billed charges ",3897.89,70,,3118.31,,,0,"percent of total billed charges ","70% of total billed charges ",5011.58,90,,4009.26,,,0,"percent of total billed charges ","90% of total billed charges ",5178.63,93,,4142.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4733.16,85,,3786.53,,,0,"percent of total billed charges ","85% of total billed charges ",4733.16,85,,3786.53,,,0,"percent of total billed charges ","85% of total billed charges ",5011.58,90,,4009.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4844.53,87,,3875.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3897.89,70,,3118.31,,,0,"percent of total billed charges ","70% of total billed charges ",3897.89,5178.63,
"PLATE Z LCK 4H 80MM LT",6105116,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1001.15,800.92,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",800.92,80,,640.74,,,0,"percent of total billed charges ","80% of total billed charges ",700.81,70,,560.65,,,0,"percent of total billed charges ","70% of total billed charges ",901.04,90,,720.83,,,0,"percent of total billed charges ","90% of total billed charges ",931.07,93,,744.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",850.98,85,,680.78,,,0,"percent of total billed charges ","85% of total billed charges ",850.98,85,,680.78,,,0,"percent of total billed charges ","85% of total billed charges ",901.04,90,,720.83,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",871,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",700.81,70,,560.65,,,0,"percent of total billed charges ","70% of total billed charges ",700.81,931.07,
"SCREW Z PERI CORT 3.5X26MM",6105118,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,130.68,104.544,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",104.54,80,,83.63,,,0,"percent of total billed charges ","80% of total billed charges ",91.48,70,,73.18,,,0,"percent of total billed charges ","70% of total billed charges ",117.61,90,,94.09,,,0,"percent of total billed charges ","90% of total billed charges ",121.53,93,,97.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",111.08,85,,88.86,,,0,"percent of total billed charges ","85% of total billed charges ",111.08,85,,88.86,,,0,"percent of total billed charges ","85% of total billed charges ",117.61,90,,94.09,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",113.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.48,70,,73.18,,,0,"percent of total billed charges ","70% of total billed charges ",91.48,121.53,
"SCREW Z PERI CORT 3.5X38MM",6105126,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,130.68,104.544,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",104.54,80,,83.63,,,0,"percent of total billed charges ","80% of total billed charges ",91.48,70,,73.18,,,0,"percent of total billed charges ","70% of total billed charges ",117.61,90,,94.09,,,0,"percent of total billed charges ","90% of total billed charges ",121.53,93,,97.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",111.08,85,,88.86,,,0,"percent of total billed charges ","85% of total billed charges ",111.08,85,,88.86,,,0,"percent of total billed charges ","85% of total billed charges ",117.61,90,,94.09,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",113.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.48,70,,73.18,,,0,"percent of total billed charges ","70% of total billed charges ",91.48,121.53,
"SCREW Z CANC 4.0 X40 MM FT",6105127,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,71.56,57.248,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",57.25,80,,45.80,,,0,"percent of total billed charges ","80% of total billed charges ",50.09,70,,40.07,,,0,"percent of total billed charges ","70% of total billed charges ",64.4,90,,51.52,,,0,"percent of total billed charges ","90% of total billed charges ",66.55,93,,53.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",60.83,85,,48.66,,,0,"percent of total billed charges ","85% of total billed charges ",60.83,85,,48.66,,,0,"percent of total billed charges ","85% of total billed charges ",64.4,90,,51.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",62.26,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.09,70,,40.07,,,0,"percent of total billed charges ","70% of total billed charges ",50.09,66.55,
"SCREW CONICAL 2.7MM X 16MM",6105130,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,199.14,159.312,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",159.31,80,,127.45,,,0,"percent of total billed charges ","80% of total billed charges ",139.4,70,,111.52,,,0,"percent of total billed charges ","70% of total billed charges ",179.23,90,,143.38,,,0,"percent of total billed charges ","90% of total billed charges ",185.2,93,,148.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",169.27,85,,135.42,,,0,"percent of total billed charges ","85% of total billed charges ",169.27,85,,135.42,,,0,"percent of total billed charges ","85% of total billed charges ",179.23,90,,143.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",173.25,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.4,70,,111.52,,,0,"percent of total billed charges ","70% of total billed charges ",139.4,185.2,
"SCREW CONICAL 2.7MM X 18MM",6105131,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,199.14,159.312,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",159.31,80,,127.45,,,0,"percent of total billed charges ","80% of total billed charges ",139.4,70,,111.52,,,0,"percent of total billed charges ","70% of total billed charges ",179.23,90,,143.38,,,0,"percent of total billed charges ","90% of total billed charges ",185.2,93,,148.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",169.27,85,,135.42,,,0,"percent of total billed charges ","85% of total billed charges ",169.27,85,,135.42,,,0,"percent of total billed charges ","85% of total billed charges ",179.23,90,,143.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",173.25,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.4,70,,111.52,,,0,"percent of total billed charges ","70% of total billed charges ",139.4,185.2,
"SCREW HEX 25.4",6105136,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,88.01,70.408,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",70.41,80,,56.33,,,0,"percent of total billed charges ","80% of total billed charges ",61.61,70,,49.29,,,0,"percent of total billed charges ","70% of total billed charges ",79.21,90,,63.37,,,0,"percent of total billed charges ","90% of total billed charges ",81.85,93,,65.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",74.81,85,,59.85,,,0,"percent of total billed charges ","85% of total billed charges ",74.81,85,,59.85,,,0,"percent of total billed charges ","85% of total billed charges ",79.21,90,,63.37,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",76.57,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.61,70,,49.29,,,0,"percent of total billed charges ","70% of total billed charges ",61.61,81.85,
"SCREW PERI 3.5 MM X 20MM ST",6105137,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,130.68,104.544,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",104.54,80,,83.63,,,0,"percent of total billed charges ","80% of total billed charges ",91.48,70,,73.18,,,0,"percent of total billed charges ","70% of total billed charges ",117.61,90,,94.09,,,0,"percent of total billed charges ","90% of total billed charges ",121.53,93,,97.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",111.08,85,,88.86,,,0,"percent of total billed charges ","85% of total billed charges ",111.08,85,,88.86,,,0,"percent of total billed charges ","85% of total billed charges ",117.61,90,,94.09,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",113.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.48,70,,73.18,,,0,"percent of total billed charges ","70% of total billed charges ",91.48,121.53,
"PLATE Z LCK 6H 106MM LT",6105138,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1074.84,859.872,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",859.87,80,,687.90,,,0,"percent of total billed charges ","80% of total billed charges ",752.39,70,,601.91,,,0,"percent of total billed charges ","70% of total billed charges ",967.36,90,,773.89,,,0,"percent of total billed charges ","90% of total billed charges ",999.6,93,,799.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",913.61,85,,730.89,,,0,"percent of total billed charges ","85% of total billed charges ",913.61,85,,730.89,,,0,"percent of total billed charges ","85% of total billed charges ",967.36,90,,773.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",935.11,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",752.39,70,,601.91,,,0,"percent of total billed charges ","70% of total billed charges ",752.39,999.6,
"SCREW CANCELLOUS 6.5X55MM",6105140,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,99,79.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",79.2,80,,63.36,,,0,"percent of total billed charges ","80% of total billed charges ",69.3,70,,55.44,,,0,"percent of total billed charges ","70% of total billed charges ",89.1,90,,71.28,,,0,"percent of total billed charges ","90% of total billed charges ",92.07,93,,73.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",84.15,85,,67.32,,,0,"percent of total billed charges ","85% of total billed charges ",84.15,85,,67.32,,,0,"percent of total billed charges ","85% of total billed charges ",89.1,90,,71.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",86.13,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.3,70,,55.44,,,0,"percent of total billed charges ","70% of total billed charges ",69.3,92.07,
"BRNG TIBIA VE PS+ 10X71/75MM",6105147,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2904,2323.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2323.2,80,,1858.56,,,0,"percent of total billed charges ","80% of total billed charges ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",2700.72,93,,2160.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2526.48,87,,2021.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2032.8,2700.72,
"PLATE TI CALCANEAL 60MM",6105183,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,612,489.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",489.6,80,,391.68,,,0,"percent of total billed charges ","80% of total billed charges ",428.4,70,,342.72,,,0,"percent of total billed charges ","70% of total billed charges ",550.8,90,,440.64,,,0,"percent of total billed charges ","90% of total billed charges ",569.16,93,,455.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",520.2,85,,416.16,,,0,"percent of total billed charges ","85% of total billed charges ",520.2,85,,416.16,,,0,"percent of total billed charges ","85% of total billed charges ",550.8,90,,440.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",532.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",428.4,70,,342.72,,,0,"percent of total billed charges ","70% of total billed charges ",428.4,569.16,
"SCREW Z PERI CORT 3.5X18MM",6105196,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,130.68,104.544,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",104.54,80,,83.63,,,0,"percent of total billed charges ","80% of total billed charges ",91.48,70,,73.18,,,0,"percent of total billed charges ","70% of total billed charges ",117.61,90,,94.09,,,0,"percent of total billed charges ","90% of total billed charges ",121.53,93,,97.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",111.08,85,,88.86,,,0,"percent of total billed charges ","85% of total billed charges ",111.08,85,,88.86,,,0,"percent of total billed charges ","85% of total billed charges ",117.61,90,,94.09,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",113.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.48,70,,73.18,,,0,"percent of total billed charges ","70% of total billed charges ",91.48,121.53,
"PLATE A LCK 6H 106MM RT",6105210,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1074.84,859.872,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",859.87,80,,687.90,,,0,"percent of total billed charges ","80% of total billed charges ",752.39,70,,601.91,,,0,"percent of total billed charges ","70% of total billed charges ",967.36,90,,773.89,,,0,"percent of total billed charges ","90% of total billed charges ",999.6,93,,799.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",913.61,85,,730.89,,,0,"percent of total billed charges ","85% of total billed charges ",913.61,85,,730.89,,,0,"percent of total billed charges ","85% of total billed charges ",967.36,90,,773.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",935.11,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",752.39,70,,601.91,,,0,"percent of total billed charges ","70% of total billed charges ",752.39,999.6,
"SCREW Z CORT 2.7MM X 22MM ST",6105211,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,80.9,64.72,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",64.72,80,,51.78,,,0,"percent of total billed charges ","80% of total billed charges ",56.63,70,,45.30,,,0,"percent of total billed charges ","70% of total billed charges ",72.81,90,,58.25,,,0,"percent of total billed charges ","90% of total billed charges ",75.24,93,,60.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",68.77,85,,55.02,,,0,"percent of total billed charges ","85% of total billed charges ",68.77,85,,55.02,,,0,"percent of total billed charges ","85% of total billed charges ",72.81,90,,58.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",70.38,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.63,70,,45.30,,,0,"percent of total billed charges ","70% of total billed charges ",56.63,75.24,
"SCREW Z LCK 2.7MM X 12MM",6105212,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,333.64,266.912,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",266.91,80,,213.53,,,0,"percent of total billed charges ","80% of total billed charges ",233.55,70,,186.84,,,0,"percent of total billed charges ","70% of total billed charges ",300.28,90,,240.22,,,0,"percent of total billed charges ","90% of total billed charges ",310.29,93,,248.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",283.59,85,,226.87,,,0,"percent of total billed charges ","85% of total billed charges ",283.59,85,,226.87,,,0,"percent of total billed charges ","85% of total billed charges ",300.28,90,,240.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",290.27,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",233.55,70,,186.84,,,0,"percent of total billed charges ","70% of total billed charges ",233.55,310.29,
"SCREW LOCKING 3.5MM X 16MM",6105214,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,309.23,247.384,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",247.38,80,,197.90,,,0,"percent of total billed charges ","80% of total billed charges ",216.46,70,,173.17,,,0,"percent of total billed charges ","70% of total billed charges ",278.31,90,,222.65,,,0,"percent of total billed charges ","90% of total billed charges ",287.58,93,,230.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",262.85,85,,210.28,,,0,"percent of total billed charges ","85% of total billed charges ",262.85,85,,210.28,,,0,"percent of total billed charges ","85% of total billed charges ",278.31,90,,222.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.03,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",216.46,70,,173.17,,,0,"percent of total billed charges ","70% of total billed charges ",216.46,287.58,
"SCREW Z PERI CORT 3.5X22MM",6105216,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,130.68,104.544,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",104.54,80,,83.63,,,0,"percent of total billed charges ","80% of total billed charges ",91.48,70,,73.18,,,0,"percent of total billed charges ","70% of total billed charges ",117.61,90,,94.09,,,0,"percent of total billed charges ","90% of total billed charges ",121.53,93,,97.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",111.08,85,,88.86,,,0,"percent of total billed charges ","85% of total billed charges ",111.08,85,,88.86,,,0,"percent of total billed charges ","85% of total billed charges ",117.61,90,,94.09,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",113.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.48,70,,73.18,,,0,"percent of total billed charges ","70% of total billed charges ",91.48,121.53,
"SCREW PERI 3.5MM X 26MM LCKING",6105228,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,336.35,269.08,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",269.08,80,,215.26,,,0,"percent of total billed charges ","80% of total billed charges ",235.45,70,,188.36,,,0,"percent of total billed charges ","70% of total billed charges ",302.72,90,,242.18,,,0,"percent of total billed charges ","90% of total billed charges ",312.81,93,,250.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",285.9,85,,228.72,,,0,"percent of total billed charges ","85% of total billed charges ",285.9,85,,228.72,,,0,"percent of total billed charges ","85% of total billed charges ",302.72,90,,242.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",292.62,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",235.45,70,,188.36,,,0,"percent of total billed charges ","70% of total billed charges ",235.45,312.81,
"SCREW PERI 3.5MM X 28MM LCKING",6105231,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,248.34,198.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",198.67,80,,158.94,,,0,"percent of total billed charges ","80% of total billed charges ",173.84,70,,139.07,,,0,"percent of total billed charges ","70% of total billed charges ",223.51,90,,178.81,,,0,"percent of total billed charges ","90% of total billed charges ",230.96,93,,184.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",211.09,85,,168.87,,,0,"percent of total billed charges ","85% of total billed charges ",211.09,85,,168.87,,,0,"percent of total billed charges ","85% of total billed charges ",223.51,90,,178.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",216.06,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.84,70,,139.07,,,0,"percent of total billed charges ","70% of total billed charges ",173.84,230.96,
"SCREW CANNULATED 5.0 X 55PT",6105242,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,277,221.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",221.6,80,,177.28,,,0,"percent of total billed charges ","80% of total billed charges ",193.9,70,,155.12,,,0,"percent of total billed charges ","70% of total billed charges ",249.3,90,,199.44,,,0,"percent of total billed charges ","90% of total billed charges ",257.61,93,,206.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",235.45,85,,188.36,,,0,"percent of total billed charges ","85% of total billed charges ",235.45,85,,188.36,,,0,"percent of total billed charges ","85% of total billed charges ",249.3,90,,199.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",240.99,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",193.9,70,,155.12,,,0,"percent of total billed charges ","70% of total billed charges ",193.9,257.61,
"K-WIRE 7/64",6105245,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,45.14,36.112,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",36.11,80,,28.89,,,0,"percent of total billed charges ","80% of total billed charges ",31.6,70,,25.28,,,0,"percent of total billed charges ","70% of total billed charges ",40.63,90,,32.50,,,0,"percent of total billed charges ","90% of total billed charges ",41.98,93,,33.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.37,85,,30.70,,,0,"percent of total billed charges ","85% of total billed charges ",38.37,85,,30.70,,,0,"percent of total billed charges ","85% of total billed charges ",40.63,90,,32.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.27,87,,31.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.6,70,,25.28,,,0,"percent of total billed charges ","70% of total billed charges ",31.6,41.98,
"BONE PLUG 26MM",6105265,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,318.5,254.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",254.8,80,,203.84,,,0,"percent of total billed charges ","80% of total billed charges ",222.95,70,,178.36,,,0,"percent of total billed charges ","70% of total billed charges ",286.65,90,,229.32,,,0,"percent of total billed charges ","90% of total billed charges ",296.21,93,,236.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",270.73,85,,216.58,,,0,"percent of total billed charges ","85% of total billed charges ",270.73,85,,216.58,,,0,"percent of total billed charges ","85% of total billed charges ",286.65,90,,229.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",277.1,87,,221.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",222.95,70,,178.36,,,0,"percent of total billed charges ","70% of total billed charges ",222.95,296.21,
"BRNG TIBIA VE PS+ 16X71/75MM",6105266,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2904,2323.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2323.2,80,,1858.56,,,0,"percent of total billed charges ","80% of total billed charges ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",2700.72,93,,2160.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2526.48,87,,2021.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2032.8,2700.72,
"BRNG TIBIA VE PS+ 10X79/83MM",6105267,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2904,2323.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2323.2,80,,1858.56,,,0,"percent of total billed charges ","80% of total billed charges ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",2700.72,93,,2160.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2526.48,87,,2021.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2032.8,2700.72,
"BRNG TIBIA VE PS+ 12X79/83MM",6105268,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2904,2323.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2323.2,80,,1858.56,,,0,"percent of total billed charges ","80% of total billed charges ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",2700.72,93,,2160.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2526.48,87,,2021.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2032.8,2700.72,
"BRNG TIBIA VE PS+ 14X79/83MM",6105269,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2904,2323.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2323.2,80,,1858.56,,,0,"percent of total billed charges ","80% of total billed charges ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",2700.72,93,,2160.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2526.48,87,,2021.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2032.8,2700.72,
"BRNG TIBIA VE PS+ 16X79/83MM",6105270,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2904,2323.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2323.2,80,,1858.56,,,0,"percent of total billed charges ","80% of total billed charges ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",2700.72,93,,2160.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2526.48,87,,2021.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2032.8,2700.72,
"ACETABULAR CUP BIPOLAR 28MX52M",6105273,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1270.5,1016.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1016.4,80,,813.12,,,0,"percent of total billed charges ","80% of total billed charges ",889.35,70,,711.48,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,90,,914.76,,,0,"percent of total billed charges ","90% of total billed charges ",1181.57,93,,945.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1079.93,85,,863.94,,,0,"percent of total billed charges ","85% of total billed charges ",1079.93,85,,863.94,,,0,"percent of total billed charges ","85% of total billed charges ",1143.45,90,,914.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1105.34,87,,884.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",889.35,70,,711.48,,,0,"percent of total billed charges ","70% of total billed charges ",889.35,1181.57,
"STEM FEMORAL STR/SLD 6.5X16",6105274,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,955,764,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",764,80,,611.20,,,0,"percent of total billed charges ","80% of total billed charges ",668.5,70,,534.80,,,0,"percent of total billed charges ","70% of total billed charges ",859.5,90,,687.60,,,0,"percent of total billed charges ","90% of total billed charges ",888.15,93,,710.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",811.75,85,,649.40,,,0,"percent of total billed charges ","85% of total billed charges ",811.75,85,,649.40,,,0,"percent of total billed charges ","85% of total billed charges ",859.5,90,,687.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",830.85,87,,664.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",668.5,70,,534.80,,,0,"percent of total billed charges ","70% of total billed charges ",668.5,888.15,
"FEMORAL HEAD W/COLLAR 9.0X150M",6105275,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2690,2152,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2152,80,,1721.60,,,0,"percent of total billed charges ","80% of total billed charges ",1883,70,,1506.40,,,0,"percent of total billed charges ","70% of total billed charges ",2421,90,,1936.80,,,0,"percent of total billed charges ","90% of total billed charges ",2501.7,93,,2001.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2286.5,85,,1829.20,,,0,"percent of total billed charges ","85% of total billed charges ",2286.5,85,,1829.20,,,0,"percent of total billed charges ","85% of total billed charges ",2421,90,,1936.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2340.3,87,,1872.24,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1883,70,,1506.40,,,0,"percent of total billed charges ","70% of total billed charges ",1883,2501.7,
"FEMORAL HEAD W/COLLAR 13.0X170",6105276,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2690,2152,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2152,80,,1721.60,,,0,"percent of total billed charges ","80% of total billed charges ",1883,70,,1506.40,,,0,"percent of total billed charges ","70% of total billed charges ",2421,90,,1936.80,,,0,"percent of total billed charges ","90% of total billed charges ",2501.7,93,,2001.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2286.5,85,,1829.20,,,0,"percent of total billed charges ","85% of total billed charges ",2286.5,85,,1829.20,,,0,"percent of total billed charges ","85% of total billed charges ",2421,90,,1936.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2340.3,87,,1872.24,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1883,70,,1506.40,,,0,"percent of total billed charges ","70% of total billed charges ",1883,2501.7,
"COMP MDLR HEAD 28 MM +9MM NK",6105277,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1089,871.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",871.2,80,,696.96,,,0,"percent of total billed charges ","80% of total billed charges ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",1012.77,93,,810.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",947.43,87,,757.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",762.3,1012.77,
"COMP MDLR HEAD 28 MM +12MM NK",6105278,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1089,871.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",871.2,80,,696.96,,,0,"percent of total billed charges ","80% of total billed charges ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",1012.77,93,,810.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",947.43,87,,757.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",762.3,1012.77,
"FEMORAL SLEEVE CENTERING 9MM",6105279,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,379,303.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.2,80,,242.56,,,0,"percent of total billed charges ","80% of total billed charges ",265.3,70,,212.24,,,0,"percent of total billed charges ","70% of total billed charges ",341.1,90,,272.88,,,0,"percent of total billed charges ","90% of total billed charges ",352.47,93,,281.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",322.15,85,,257.72,,,0,"percent of total billed charges ","85% of total billed charges ",322.15,85,,257.72,,,0,"percent of total billed charges ","85% of total billed charges ",341.1,90,,272.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",329.73,87,,263.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",265.3,70,,212.24,,,0,"percent of total billed charges ","70% of total billed charges ",265.3,352.47,
"FEMORAL SLEEVE CENTERING 15.0M",6105280,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,366.5,293.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",293.2,80,,234.56,,,0,"percent of total billed charges ","80% of total billed charges ",256.55,70,,205.24,,,0,"percent of total billed charges ","70% of total billed charges ",329.85,90,,263.88,,,0,"percent of total billed charges ","90% of total billed charges ",340.85,93,,272.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",311.53,85,,249.22,,,0,"percent of total billed charges ","85% of total billed charges ",311.53,85,,249.22,,,0,"percent of total billed charges ","85% of total billed charges ",329.85,90,,263.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",318.86,87,,255.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",256.55,70,,205.24,,,0,"percent of total billed charges ","70% of total billed charges ",256.55,340.85,
"SCREW HIP 6.5X15M",6105281,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,290,232,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",232,80,,185.60,,,0,"percent of total billed charges ","80% of total billed charges ",203,70,,162.40,,,0,"percent of total billed charges ","70% of total billed charges ",261,90,,208.80,,,0,"percent of total billed charges ","90% of total billed charges ",269.7,93,,215.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",246.5,85,,197.20,,,0,"percent of total billed charges ","85% of total billed charges ",246.5,85,,197.20,,,0,"percent of total billed charges ","85% of total billed charges ",261,90,,208.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",252.3,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",203,70,,162.40,,,0,"percent of total billed charges ","70% of total billed charges ",203,269.7,
"SCREW HIP 6.5 X 25M",6105282,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,346.5,277.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",277.2,80,,221.76,,,0,"percent of total billed charges ","80% of total billed charges ",242.55,70,,194.04,,,0,"percent of total billed charges ","70% of total billed charges ",311.85,90,,249.48,,,0,"percent of total billed charges ","90% of total billed charges ",322.25,93,,257.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",294.53,85,,235.62,,,0,"percent of total billed charges ","85% of total billed charges ",294.53,85,,235.62,,,0,"percent of total billed charges ","85% of total billed charges ",311.85,90,,249.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",301.46,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",242.55,70,,194.04,,,0,"percent of total billed charges ","70% of total billed charges ",242.55,322.25,
"SCREW HIP 6.5 X 35 M",6105283,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,346.5,277.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",277.2,80,,221.76,,,0,"percent of total billed charges ","80% of total billed charges ",242.55,70,,194.04,,,0,"percent of total billed charges ","70% of total billed charges ",311.85,90,,249.48,,,0,"percent of total billed charges ","90% of total billed charges ",322.25,93,,257.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",294.53,85,,235.62,,,0,"percent of total billed charges ","85% of total billed charges ",294.53,85,,235.62,,,0,"percent of total billed charges ","85% of total billed charges ",311.85,90,,249.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",301.46,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",242.55,70,,194.04,,,0,"percent of total billed charges ","70% of total billed charges ",242.55,322.25,
"FEMORAL HEAD W/COLLAR 15.0 X 1",6105284,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2406.5,1925.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1925.2,80,,1540.16,,,0,"percent of total billed charges ","80% of total billed charges ",1684.55,70,,1347.64,,,0,"percent of total billed charges ","70% of total billed charges ",2165.85,90,,1732.68,,,0,"percent of total billed charges ","90% of total billed charges ",2238.05,93,,1790.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2045.53,85,,1636.42,,,0,"percent of total billed charges ","85% of total billed charges ",2045.53,85,,1636.42,,,0,"percent of total billed charges ","85% of total billed charges ",2165.85,90,,1732.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2093.66,87,,1674.93,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1684.55,70,,1347.64,,,0,"percent of total billed charges ","70% of total billed charges ",1684.55,2238.05,
"ACETABULAR RINGLOCK 22M",6105286,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,221.5,177.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.2,80,,141.76,,,0,"percent of total billed charges ","80% of total billed charges ",155.05,70,,124.04,,,0,"percent of total billed charges ","70% of total billed charges ",199.35,90,,159.48,,,0,"percent of total billed charges ","90% of total billed charges ",206,93,,164.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",188.28,85,,150.62,,,0,"percent of total billed charges ","85% of total billed charges ",188.28,85,,150.62,,,0,"percent of total billed charges ","85% of total billed charges ",199.35,90,,159.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",192.71,87,,154.17,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.05,70,,124.04,,,0,"percent of total billed charges ","70% of total billed charges ",155.05,206,
"ACETABULAR RINGLOCK 23M",6105287,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,221.5,177.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.2,80,,141.76,,,0,"percent of total billed charges ","80% of total billed charges ",155.05,70,,124.04,,,0,"percent of total billed charges ","70% of total billed charges ",199.35,90,,159.48,,,0,"percent of total billed charges ","90% of total billed charges ",206,93,,164.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",188.28,85,,150.62,,,0,"percent of total billed charges ","85% of total billed charges ",188.28,85,,150.62,,,0,"percent of total billed charges ","85% of total billed charges ",199.35,90,,159.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",192.71,87,,154.17,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.05,70,,124.04,,,0,"percent of total billed charges ","70% of total billed charges ",155.05,206,
"ACETABULAR RINGLOCK 24M",6105288,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,221.5,177.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.2,80,,141.76,,,0,"percent of total billed charges ","80% of total billed charges ",155.05,70,,124.04,,,0,"percent of total billed charges ","70% of total billed charges ",199.35,90,,159.48,,,0,"percent of total billed charges ","90% of total billed charges ",206,93,,164.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",188.28,85,,150.62,,,0,"percent of total billed charges ","85% of total billed charges ",188.28,85,,150.62,,,0,"percent of total billed charges ","85% of total billed charges ",199.35,90,,159.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",192.71,87,,154.17,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.05,70,,124.04,,,0,"percent of total billed charges ","70% of total billed charges ",155.05,206,
"ACETABULAR RINGLOCK 25M",6105289,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,221.5,177.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.2,80,,141.76,,,0,"percent of total billed charges ","80% of total billed charges ",155.05,70,,124.04,,,0,"percent of total billed charges ","70% of total billed charges ",199.35,90,,159.48,,,0,"percent of total billed charges ","90% of total billed charges ",206,93,,164.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",188.28,85,,150.62,,,0,"percent of total billed charges ","85% of total billed charges ",188.28,85,,150.62,,,0,"percent of total billed charges ","85% of total billed charges ",199.35,90,,159.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",192.71,87,,154.17,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.05,70,,124.04,,,0,"percent of total billed charges ","70% of total billed charges ",155.05,206,
"TRAY TIBIA STEMMED CEMENT 71MM",6105290,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5568.42,4454.736,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4454.74,80,,3563.79,,,0,"percent of total billed charges ","80% of total billed charges ",3897.89,70,,3118.31,,,0,"percent of total billed charges ","70% of total billed charges ",5011.58,90,,4009.26,,,0,"percent of total billed charges ","90% of total billed charges ",5178.63,93,,4142.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4733.16,85,,3786.53,,,0,"percent of total billed charges ","85% of total billed charges ",4733.16,85,,3786.53,,,0,"percent of total billed charges ","85% of total billed charges ",5011.58,90,,4009.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4844.53,87,,3875.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3897.89,70,,3118.31,,,0,"percent of total billed charges ","70% of total billed charges ",3897.89,5178.63,
"TRAY TIBIA STEMMED CEMENT 75MM",6105291,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5568.42,4454.736,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4454.74,80,,3563.79,,,0,"percent of total billed charges ","80% of total billed charges ",3897.89,70,,3118.31,,,0,"percent of total billed charges ","70% of total billed charges ",5011.58,90,,4009.26,,,0,"percent of total billed charges ","90% of total billed charges ",5178.63,93,,4142.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4733.16,85,,3786.53,,,0,"percent of total billed charges ","85% of total billed charges ",4733.16,85,,3786.53,,,0,"percent of total billed charges ","85% of total billed charges ",5011.58,90,,4009.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4844.53,87,,3875.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3897.89,70,,3118.31,,,0,"percent of total billed charges ","70% of total billed charges ",3897.89,5178.63,
"TRAY TIBIA STEMMED CEMENT 79MM",6105292,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5568.42,4454.736,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4454.74,80,,3563.79,,,0,"percent of total billed charges ","80% of total billed charges ",3897.89,70,,3118.31,,,0,"percent of total billed charges ","70% of total billed charges ",5011.58,90,,4009.26,,,0,"percent of total billed charges ","90% of total billed charges ",5178.63,93,,4142.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4733.16,85,,3786.53,,,0,"percent of total billed charges ","85% of total billed charges ",4733.16,85,,3786.53,,,0,"percent of total billed charges ","85% of total billed charges ",5011.58,90,,4009.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4844.53,87,,3875.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3897.89,70,,3118.31,,,0,"percent of total billed charges ","70% of total billed charges ",3897.89,5178.63,
"TRAY TIBIA STEMMED CEMENT 83MM",6105293,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,970,776,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",776,80,,620.80,,,0,"percent of total billed charges ","80% of total billed charges ",679,70,,543.20,,,0,"percent of total billed charges ","70% of total billed charges ",873,90,,698.40,,,0,"percent of total billed charges ","90% of total billed charges ",902.1,93,,721.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",824.5,85,,659.60,,,0,"percent of total billed charges ","85% of total billed charges ",824.5,85,,659.60,,,0,"percent of total billed charges ","85% of total billed charges ",873,90,,698.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",843.9,87,,675.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",679,70,,543.20,,,0,"percent of total billed charges ","70% of total billed charges ",679,902.1,
"BRNG TIBIA PS 20X59MM",6105294,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1633.5,1306.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1306.8,80,,1045.44,,,0,"percent of total billed charges ","80% of total billed charges ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",1519.16,93,,1215.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1421.15,87,,1136.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,1519.16,
EPIDISC,6105300,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,314.63,251.704,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",251.7,80,,201.36,,,0,"percent of total billed charges ","80% of total billed charges ",220.24,70,,176.19,,,0,"percent of total billed charges ","70% of total billed charges ",283.17,90,,226.54,,,0,"percent of total billed charges ","90% of total billed charges ",292.61,93,,234.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.44,85,,213.95,,,0,"percent of total billed charges ","85% of total billed charges ",267.44,85,,213.95,,,0,"percent of total billed charges ","85% of total billed charges ",283.17,90,,226.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",273.73,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.24,70,,176.19,,,0,"percent of total billed charges ","70% of total billed charges ",220.24,292.61,
"EPIDISC OTOLOGIC LAMINA",6105301,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,340.49,272.392,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",272.39,80,,217.91,,,0,"percent of total billed charges ","80% of total billed charges ",238.34,70,,190.67,,,0,"percent of total billed charges ","70% of total billed charges ",306.44,90,,245.15,,,0,"percent of total billed charges ","90% of total billed charges ",316.66,93,,253.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",289.42,85,,231.54,,,0,"percent of total billed charges ","85% of total billed charges ",289.42,85,,231.54,,,0,"percent of total billed charges ","85% of total billed charges ",306.44,90,,245.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",296.23,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",238.34,70,,190.67,,,0,"percent of total billed charges ","70% of total billed charges ",238.34,316.66,
"TIBIA NATURAL STMD 5 DEG LT G",6105306,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2268.75,1815,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1815,80,,1452.00,,,0,"percent of total billed charges ","80% of total billed charges ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",2109.94,93,,1687.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1973.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",1588.13,2109.94,
"SCREW BIO 8 X 20",6105320,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,373.5,298.8,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",298.8,80,,239.04,,,0,"percent of total billed charges ","80% of total billed charges ",261.45,70,,209.16,,,0,"percent of total billed charges ","70% of total billed charges ",336.15,90,,268.92,,,0,"percent of total billed charges ","90% of total billed charges ",347.36,93,,277.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",317.48,85,,253.98,,,0,"percent of total billed charges ","85% of total billed charges ",317.48,85,,253.98,,,0,"percent of total billed charges ","85% of total billed charges ",336.15,90,,268.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",324.95,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",261.45,70,,209.16,,,0,"percent of total billed charges ","70% of total billed charges ",261.45,347.36,
"SCREW CANNULATED 5.0MX28M PT",6105322,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,275.5,220.4,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",220.4,80,,176.32,,,0,"percent of total billed charges ","80% of total billed charges ",192.85,70,,154.28,,,0,"percent of total billed charges ","70% of total billed charges ",247.95,90,,198.36,,,0,"percent of total billed charges ","90% of total billed charges ",256.22,93,,204.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",234.18,85,,187.34,,,0,"percent of total billed charges ","85% of total billed charges ",234.18,85,,187.34,,,0,"percent of total billed charges ","85% of total billed charges ",247.95,90,,198.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",239.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.85,70,,154.28,,,0,"percent of total billed charges ","70% of total billed charges ",192.85,256.22,
"SCREW CANCELLOUS REVO MINI",6105329,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,301.7,241.36,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",241.36,80,,193.09,,,0,"percent of total billed charges ","80% of total billed charges ",211.19,70,,168.95,,,0,"percent of total billed charges ","70% of total billed charges ",271.53,90,,217.22,,,0,"percent of total billed charges ","90% of total billed charges ",280.58,93,,224.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",256.45,85,,205.16,,,0,"percent of total billed charges ","85% of total billed charges ",256.45,85,,205.16,,,0,"percent of total billed charges ","85% of total billed charges ",271.53,90,,217.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",262.48,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",211.19,70,,168.95,,,0,"percent of total billed charges ","70% of total billed charges ",211.19,280.58,
"SCREW CORTICAL 4.5M X 54M",6105331,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,54,43.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",43.2,80,,34.56,,,0,"percent of total billed charges ","80% of total billed charges ",37.8,70,,30.24,,,0,"percent of total billed charges ","70% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",50.22,93,,40.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",45.9,85,,36.72,,,0,"percent of total billed charges ","85% of total billed charges ",45.9,85,,36.72,,,0,"percent of total billed charges ","85% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",46.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.8,70,,30.24,,,0,"percent of total billed charges ","70% of total billed charges ",37.8,50.22,
"SCREW D CORT 2.7 X 10MM NL",6105339,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,212.5,170,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",170,80,,136.00,,,0,"percent of total billed charges ","80% of total billed charges ",148.75,70,,119.00,,,0,"percent of total billed charges ","70% of total billed charges ",191.25,90,,153.00,,,0,"percent of total billed charges ","90% of total billed charges ",197.63,93,,158.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",180.63,85,,144.50,,,0,"percent of total billed charges ","85% of total billed charges ",180.63,85,,144.50,,,0,"percent of total billed charges ","85% of total billed charges ",191.25,90,,153.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",184.88,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.75,70,,119.00,,,0,"percent of total billed charges ","70% of total billed charges ",148.75,197.63,
"SCREW Z LCK 2.7MM X 22MM",6105363,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,333.64,266.912,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",266.91,80,,213.53,,,0,"percent of total billed charges ","80% of total billed charges ",233.55,70,,186.84,,,0,"percent of total billed charges ","70% of total billed charges ",300.28,90,,240.22,,,0,"percent of total billed charges ","90% of total billed charges ",310.29,93,,248.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",283.59,85,,226.87,,,0,"percent of total billed charges ","85% of total billed charges ",283.59,85,,226.87,,,0,"percent of total billed charges ","85% of total billed charges ",300.28,90,,240.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",290.27,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",233.55,70,,186.84,,,0,"percent of total billed charges ","70% of total billed charges ",233.55,310.29,
"SCREW 1.8MM LOCKING",6105375,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,95,76,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",76,80,,60.80,,,0,"percent of total billed charges ","80% of total billed charges ",66.5,70,,53.20,,,0,"percent of total billed charges ","70% of total billed charges ",85.5,90,,68.40,,,0,"percent of total billed charges ","90% of total billed charges ",88.35,93,,70.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.75,85,,64.60,,,0,"percent of total billed charges ","85% of total billed charges ",80.75,85,,64.60,,,0,"percent of total billed charges ","85% of total billed charges ",85.5,90,,68.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.65,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.5,70,,53.20,,,0,"percent of total billed charges ","70% of total billed charges ",66.5,88.35,
"SCREW Z PERI CORT 3.5X24MM",6105404,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,130.68,104.544,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",104.54,80,,83.63,,,0,"percent of total billed charges ","80% of total billed charges ",91.48,70,,73.18,,,0,"percent of total billed charges ","70% of total billed charges ",117.61,90,,94.09,,,0,"percent of total billed charges ","90% of total billed charges ",121.53,93,,97.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",111.08,85,,88.86,,,0,"percent of total billed charges ","85% of total billed charges ",111.08,85,,88.86,,,0,"percent of total billed charges ","85% of total billed charges ",117.61,90,,94.09,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",113.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.48,70,,73.18,,,0,"percent of total billed charges ","70% of total billed charges ",91.48,121.53,
"SCREW Z PERI CORT 3.5X56MM",6105405,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,184.91,147.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",147.93,80,,118.34,,,0,"percent of total billed charges ","80% of total billed charges ",129.44,70,,103.55,,,0,"percent of total billed charges ","70% of total billed charges ",166.42,90,,133.14,,,0,"percent of total billed charges ","90% of total billed charges ",171.97,93,,137.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",157.17,85,,125.74,,,0,"percent of total billed charges ","85% of total billed charges ",157.17,85,,125.74,,,0,"percent of total billed charges ","85% of total billed charges ",166.42,90,,133.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",160.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.44,70,,103.55,,,0,"percent of total billed charges ","70% of total billed charges ",129.44,171.97,
"SCREW 4.0 X 14MM EXPANSION HEA",6105406,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,401,320.8,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",320.8,80,,256.64,,,0,"percent of total billed charges ","80% of total billed charges ",280.7,70,,224.56,,,0,"percent of total billed charges ","70% of total billed charges ",360.9,90,,288.72,,,0,"percent of total billed charges ","90% of total billed charges ",372.93,93,,298.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",340.85,85,,272.68,,,0,"percent of total billed charges ","85% of total billed charges ",340.85,85,,272.68,,,0,"percent of total billed charges ","85% of total billed charges ",360.9,90,,288.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",348.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",280.7,70,,224.56,,,0,"percent of total billed charges ","70% of total billed charges ",280.7,372.93,
"SCREW 4.35 X 14 EXPANSION HEAD",6105407,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,311.5,249.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",249.2,80,,199.36,,,0,"percent of total billed charges ","80% of total billed charges ",218.05,70,,174.44,,,0,"percent of total billed charges ","70% of total billed charges ",280.35,90,,224.28,,,0,"percent of total billed charges ","90% of total billed charges ",289.7,93,,231.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",264.78,85,,211.82,,,0,"percent of total billed charges ","85% of total billed charges ",264.78,85,,211.82,,,0,"percent of total billed charges ","85% of total billed charges ",280.35,90,,224.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",271.01,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",218.05,70,,174.44,,,0,"percent of total billed charges ","70% of total billed charges ",218.05,289.7,
"SCREW 4.0 X 12MM EXPANSION HEA",6105408,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,401,320.8,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",320.8,80,,256.64,,,0,"percent of total billed charges ","80% of total billed charges ",280.7,70,,224.56,,,0,"percent of total billed charges ","70% of total billed charges ",360.9,90,,288.72,,,0,"percent of total billed charges ","90% of total billed charges ",372.93,93,,298.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",340.85,85,,272.68,,,0,"percent of total billed charges ","85% of total billed charges ",340.85,85,,272.68,,,0,"percent of total billed charges ","85% of total billed charges ",360.9,90,,288.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",348.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",280.7,70,,224.56,,,0,"percent of total billed charges ","70% of total billed charges ",280.7,372.93,
"SCREW Z PERI CORT 3.5X60MM",6105409,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,130.68,104.544,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",104.54,80,,83.63,,,0,"percent of total billed charges ","80% of total billed charges ",91.48,70,,73.18,,,0,"percent of total billed charges ","70% of total billed charges ",117.61,90,,94.09,,,0,"percent of total billed charges ","90% of total billed charges ",121.53,93,,97.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",111.08,85,,88.86,,,0,"percent of total billed charges ","85% of total billed charges ",111.08,85,,88.86,,,0,"percent of total billed charges ","85% of total billed charges ",117.61,90,,94.09,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",113.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.48,70,,73.18,,,0,"percent of total billed charges ","70% of total billed charges ",91.48,121.53,
"SCREW 4.0 X 16MM EXPANSION HEA",6105410,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,401,320.8,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",320.8,80,,256.64,,,0,"percent of total billed charges ","80% of total billed charges ",280.7,70,,224.56,,,0,"percent of total billed charges ","70% of total billed charges ",360.9,90,,288.72,,,0,"percent of total billed charges ","90% of total billed charges ",372.93,93,,298.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",340.85,85,,272.68,,,0,"percent of total billed charges ","85% of total billed charges ",340.85,85,,272.68,,,0,"percent of total billed charges ","85% of total billed charges ",360.9,90,,288.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",348.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",280.7,70,,224.56,,,0,"percent of total billed charges ","70% of total billed charges ",280.7,372.93,
"SCREW 4.35 X 16MM EXPANSION HE",6105411,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,311.5,249.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",249.2,80,,199.36,,,0,"percent of total billed charges ","80% of total billed charges ",218.05,70,,174.44,,,0,"percent of total billed charges ","70% of total billed charges ",280.35,90,,224.28,,,0,"percent of total billed charges ","90% of total billed charges ",289.7,93,,231.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",264.78,85,,211.82,,,0,"percent of total billed charges ","85% of total billed charges ",264.78,85,,211.82,,,0,"percent of total billed charges ","85% of total billed charges ",280.35,90,,224.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",271.01,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",218.05,70,,174.44,,,0,"percent of total billed charges ","70% of total billed charges ",218.05,289.7,
"SCREW Z PERI CORT 3.5X65MM",6105412,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,163.58,130.864,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",130.86,80,,104.69,,,0,"percent of total billed charges ","80% of total billed charges ",114.51,70,,91.61,,,0,"percent of total billed charges ","70% of total billed charges ",147.22,90,,117.78,,,0,"percent of total billed charges ","90% of total billed charges ",152.13,93,,121.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",139.04,85,,111.23,,,0,"percent of total billed charges ","85% of total billed charges ",139.04,85,,111.23,,,0,"percent of total billed charges ","85% of total billed charges ",147.22,90,,117.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",142.31,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.51,70,,91.61,,,0,"percent of total billed charges ","70% of total billed charges ",114.51,152.13,
"SCREW Z PERI CORT 3.5X70MM",6105413,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,163.58,130.864,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",130.86,80,,104.69,,,0,"percent of total billed charges ","80% of total billed charges ",114.51,70,,91.61,,,0,"percent of total billed charges ","70% of total billed charges ",147.22,90,,117.78,,,0,"percent of total billed charges ","90% of total billed charges ",152.13,93,,121.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",139.04,85,,111.23,,,0,"percent of total billed charges ","85% of total billed charges ",139.04,85,,111.23,,,0,"percent of total billed charges ","85% of total billed charges ",147.22,90,,117.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",142.31,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.51,70,,91.61,,,0,"percent of total billed charges ","70% of total billed charges ",114.51,152.13,
"PLATE Z LCK 10H 158MM RT",6105415,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1223.49,978.792,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",978.79,80,,783.03,,,0,"percent of total billed charges ","80% of total billed charges ",856.44,70,,685.15,,,0,"percent of total billed charges ","70% of total billed charges ",1101.14,90,,880.91,,,0,"percent of total billed charges ","90% of total billed charges ",1137.85,93,,910.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1039.97,85,,831.98,,,0,"percent of total billed charges ","85% of total billed charges ",1039.97,85,,831.98,,,0,"percent of total billed charges ","85% of total billed charges ",1101.14,90,,880.91,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1064.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",856.44,70,,685.15,,,0,"percent of total billed charges ","70% of total billed charges ",856.44,1137.85,
"PLATE Z LCK 8H 132MM LT",6105416,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1148.53,918.824,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",918.82,80,,735.06,,,0,"percent of total billed charges ","80% of total billed charges ",803.97,70,,643.18,,,0,"percent of total billed charges ","70% of total billed charges ",1033.68,90,,826.94,,,0,"percent of total billed charges ","90% of total billed charges ",1068.13,93,,854.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",976.25,85,,781.00,,,0,"percent of total billed charges ","85% of total billed charges ",976.25,85,,781.00,,,0,"percent of total billed charges ","85% of total billed charges ",1033.68,90,,826.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",999.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",803.97,70,,643.18,,,0,"percent of total billed charges ","70% of total billed charges ",803.97,1068.13,
"SCREW Z LCK 2.7 X 10MM",6105417,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,333.64,266.912,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",266.91,80,,213.53,,,0,"percent of total billed charges ","80% of total billed charges ",233.55,70,,186.84,,,0,"percent of total billed charges ","70% of total billed charges ",300.28,90,,240.22,,,0,"percent of total billed charges ","90% of total billed charges ",310.29,93,,248.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",283.59,85,,226.87,,,0,"percent of total billed charges ","85% of total billed charges ",283.59,85,,226.87,,,0,"percent of total billed charges ","85% of total billed charges ",300.28,90,,240.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",290.27,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",233.55,70,,186.84,,,0,"percent of total billed charges ","70% of total billed charges ",233.55,310.29,
"SCREW Z CANC 4.0X36MM FT",6105418,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,71.56,57.248,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",57.25,80,,45.80,,,0,"percent of total billed charges ","80% of total billed charges ",50.09,70,,40.07,,,0,"percent of total billed charges ","70% of total billed charges ",64.4,90,,51.52,,,0,"percent of total billed charges ","90% of total billed charges ",66.55,93,,53.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",60.83,85,,48.66,,,0,"percent of total billed charges ","85% of total billed charges ",60.83,85,,48.66,,,0,"percent of total billed charges ","85% of total billed charges ",64.4,90,,51.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",62.26,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.09,70,,40.07,,,0,"percent of total billed charges ","70% of total billed charges ",50.09,66.55,
"SCREW Z CANC 4.0 X 45MM FT",6105419,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,71.56,57.248,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",57.25,80,,45.80,,,0,"percent of total billed charges ","80% of total billed charges ",50.09,70,,40.07,,,0,"percent of total billed charges ","70% of total billed charges ",64.4,90,,51.52,,,0,"percent of total billed charges ","90% of total billed charges ",66.55,93,,53.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",60.83,85,,48.66,,,0,"percent of total billed charges ","85% of total billed charges ",60.83,85,,48.66,,,0,"percent of total billed charges ","85% of total billed charges ",64.4,90,,51.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",62.26,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.09,70,,40.07,,,0,"percent of total billed charges ","70% of total billed charges ",50.09,66.55,
"SCREW D CANC 4.0 X 14MM LCK",6105426,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,310.5,248.4,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",248.4,80,,198.72,,,0,"percent of total billed charges ","80% of total billed charges ",217.35,70,,173.88,,,0,"percent of total billed charges ","70% of total billed charges ",279.45,90,,223.56,,,0,"percent of total billed charges ","90% of total billed charges ",288.77,93,,231.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.93,85,,211.14,,,0,"percent of total billed charges ","85% of total billed charges ",263.93,85,,211.14,,,0,"percent of total billed charges ","85% of total billed charges ",279.45,90,,223.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",270.14,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.35,70,,173.88,,,0,"percent of total billed charges ","70% of total billed charges ",217.35,288.77,
"SCREW D CANC 4.0 X 46MM LCK",6105444,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,310.5,248.4,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",248.4,80,,198.72,,,0,"percent of total billed charges ","80% of total billed charges ",217.35,70,,173.88,,,0,"percent of total billed charges ","70% of total billed charges ",279.45,90,,223.56,,,0,"percent of total billed charges ","90% of total billed charges ",288.77,93,,231.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.93,85,,211.14,,,0,"percent of total billed charges ","85% of total billed charges ",263.93,85,,211.14,,,0,"percent of total billed charges ","85% of total billed charges ",279.45,90,,223.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",270.14,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.35,70,,173.88,,,0,"percent of total billed charges ","70% of total billed charges ",217.35,288.77,
"SCREW D CORT 3.5 X 10MM NL",6105451,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,147.5,118,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",118,80,,94.40,,,0,"percent of total billed charges ","80% of total billed charges ",103.25,70,,82.60,,,0,"percent of total billed charges ","70% of total billed charges ",132.75,90,,106.20,,,0,"percent of total billed charges ","90% of total billed charges ",137.18,93,,109.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",125.38,85,,100.30,,,0,"percent of total billed charges ","85% of total billed charges ",125.38,85,,100.30,,,0,"percent of total billed charges ","85% of total billed charges ",132.75,90,,106.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",128.33,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.25,70,,82.60,,,0,"percent of total billed charges ","70% of total billed charges ",103.25,137.18,
"CATH THORACIC RIGHT 16FR",6105474,"CDM ",272,RC,C1757,HCPCS,OUTPATIENT,,,35.51,28.408,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.41,80,,22.73,,,0,"percent of total billed charges ","80% of total billed charges ",24.86,70,,19.89,,,0,"percent of total billed charges ","70% of total billed charges ",31.96,90,,25.57,,,0,"percent of total billed charges ","90% of total billed charges ",33.02,93,,26.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",30.18,85,,24.14,,,0,"percent of total billed charges ","85% of total billed charges ",31.96,90,,25.57,,,0,"percent of total billed charges ","90% of total billed charges ",31.96,90,,25.57,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.89,87,,24.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.86,70,,19.89,,,0,"percent of total billed charges ","70% of total billed charges ",24.86,33.02,
"ADHESIVE SKIN DERMABOND",6105605,"CDM ",272,RC,G0168,HCPCS,OUTPATIENT,,,40.92,32.736,,,,,,,,0,"other ","not separately reimbursment ",141.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",30.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",28.64,70,,22.91,,,0,"percent of total billed charges ","70% of total billed charges ",36.83,90,,29.46,,,0,"percent of total billed charges ","90% of total billed charges ",38.06,93,,30.45,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34.78,85,,27.82,,,0,"percent of total billed charges ","85% of total billed charges ",36.83,90,,29.46,,,0,"percent of total billed charges ","90% of total billed charges ",36.83,90,,29.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",35.6,87,,28.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.64,70,,22.91,,,0,"percent of total billed charges ","70% of total billed charges ",28.64,141.4,
"ADHESIVE SKIN DERMABOND",6105605,"CDM ",272,RC,G0168,HCPCS,OUTPATIENT,,,40.92,32.736,,,,,,,,0,"other ","not separately reimbursment ",141.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",30.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",28.64,70,,22.91,,,0,"percent of total billed charges ","70% of total billed charges ",36.83,90,,29.46,,,0,"percent of total billed charges ","90% of total billed charges ",38.06,93,,30.45,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34.78,85,,27.82,,,0,"percent of total billed charges ","85% of total billed charges ",36.83,90,,29.46,,,0,"percent of total billed charges ","90% of total billed charges ",36.83,90,,29.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",35.6,87,,28.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.64,70,,22.91,,,0,"percent of total billed charges ","70% of total billed charges ",28.64,141.4,
"POUCH COLOSTOMY 2 3/4""",6105618,"CDM ",272,RC,A4377,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",10.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"FLANGE COLOSTOMY 2 3/4""",6105619,"CDM ",272,RC,A4385,HCPCS,OUTPATIENT,,,24.5,19.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.15,70,,13.72,,,0,"percent of total billed charges ","70% of total billed charges ",22.05,90,,17.64,,,0,"percent of total billed charges ","90% of total billed charges ",22.79,93,,18.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.83,85,,16.66,,,0,"percent of total billed charges ","85% of total billed charges ",22.05,90,,17.64,,,0,"percent of total billed charges ","90% of total billed charges ",22.05,90,,17.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.32,87,,17.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.15,70,,13.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.15,22.79,
"GRAFT VASCULAR 6MM X 80",6105621,"CDM ",278,RC,C1768,HCPCS,OUTPATIENT,,,1452,1161.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1016.4,70,,813.12,,,0,"percent of total billed charges ","70% of total billed charges ",1306.8,90,,1045.44,,,0,"percent of total billed charges ","90% of total billed charges ",1350.36,93,,1080.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1234.2,85,,987.36,,,0,"percent of total billed charges ","85% of total billed charges ",1234.2,85,,987.36,,,0,"percent of total billed charges ","85% of total billed charges ",1306.8,90,,1045.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1263.24,87,,1010.59,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1016.4,70,,813.12,,,0,"percent of total billed charges ","70% of total billed charges ",1016.4,1350.36,
"WEDGE ILIAC CREST 10-12MM",6105648,"CDM ",278,RC,C1762,HCPCS,OUTPATIENT,,,1339.47,1071.576,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",937.63,70,,750.10,,,0,"percent of total billed charges ","70% of total billed charges ",1205.52,90,,964.42,,,0,"percent of total billed charges ","90% of total billed charges ",1245.71,93,,996.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1138.55,85,,910.84,,,0,"percent of total billed charges ","85% of total billed charges ",1138.55,85,,910.84,,,0,"percent of total billed charges ","85% of total billed charges ",1205.52,90,,964.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1165.34,87,,932.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",937.63,70,,750.10,,,0,"percent of total billed charges ","70% of total billed charges ",937.63,1245.71,
"STEM KNEE SPLINED V2 12X80MM",6105688,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,3527.45,2821.96,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2469.22,70,,1975.38,,,0,"percent of total billed charges ","70% of total billed charges ",3174.71,90,,2539.77,,,0,"percent of total billed charges ","90% of total billed charges ",3280.53,93,,2624.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2998.33,85,,2398.66,,,0,"percent of total billed charges ","85% of total billed charges ",2998.33,85,,2398.66,,,0,"percent of total billed charges ","85% of total billed charges ",3174.71,90,,2539.77,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3068.88,87,,2455.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2469.22,70,,1975.38,,,0,"percent of total billed charges ","70% of total billed charges ",2469.22,3280.53,
"ANCHOR JUGGERKNOT SZ 1.5",6105694,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,536,428.8,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",375.2,70,,300.16,,,0,"percent of total billed charges ","70% of total billed charges ",482.4,90,,385.92,,,0,"percent of total billed charges ","90% of total billed charges ",498.48,93,,398.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",455.6,85,,364.48,,,0,"percent of total billed charges ","85% of total billed charges ",455.6,85,,364.48,,,0,"percent of total billed charges ","85% of total billed charges ",482.4,90,,385.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",466.32,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",375.2,70,,300.16,,,0,"percent of total billed charges ","70% of total billed charges ",375.2,498.48,
"SCREW CANNULATED 7.0X50MM",6105725,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,381.5,305.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",267.05,70,,213.64,,,0,"percent of total billed charges ","70% of total billed charges ",343.35,90,,274.68,,,0,"percent of total billed charges ","90% of total billed charges ",354.8,93,,283.84,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",324.28,85,,259.42,,,0,"percent of total billed charges ","85% of total billed charges ",324.28,85,,259.42,,,0,"percent of total billed charges ","85% of total billed charges ",343.35,90,,274.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",331.91,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",267.05,70,,213.64,,,0,"percent of total billed charges ","70% of total billed charges ",267.05,354.8,
"CATH FILIFORM ST 4FR",6105749,"CDM ",272,RC,C1758,HCPCS,OUTPATIENT,,,170.47,136.376,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.33,70,,95.46,,,0,"percent of total billed charges ","70% of total billed charges ",153.42,90,,122.74,,,0,"percent of total billed charges ","90% of total billed charges ",158.54,93,,126.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",144.9,85,,115.92,,,0,"percent of total billed charges ","85% of total billed charges ",153.42,90,,122.74,,,0,"percent of total billed charges ","90% of total billed charges ",153.42,90,,122.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",148.31,87,,118.65,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.33,70,,95.46,,,0,"percent of total billed charges ","70% of total billed charges ",119.33,158.54,
"PLATE TI-CALCANEAL 87MM",6105762,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,636.5,509.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",445.55,70,,356.44,,,0,"percent of total billed charges ","70% of total billed charges ",572.85,90,,458.28,,,0,"percent of total billed charges ","90% of total billed charges ",591.95,93,,473.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",541.03,85,,432.82,,,0,"percent of total billed charges ","85% of total billed charges ",541.03,85,,432.82,,,0,"percent of total billed charges ","85% of total billed charges ",572.85,90,,458.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",553.76,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",445.55,70,,356.44,,,0,"percent of total billed charges ","70% of total billed charges ",445.55,591.95,
"PLATE CALCANEAL 70MM",6105763,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,553.5,442.8,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",387.45,70,,309.96,,,0,"percent of total billed charges ","70% of total billed charges ",498.15,90,,398.52,,,0,"percent of total billed charges ","90% of total billed charges ",514.76,93,,411.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",470.48,85,,376.38,,,0,"percent of total billed charges ","85% of total billed charges ",470.48,85,,376.38,,,0,"percent of total billed charges ","85% of total billed charges ",498.15,90,,398.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",481.55,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",387.45,70,,309.96,,,0,"percent of total billed charges ","70% of total billed charges ",387.45,514.76,
"PLATE TI-CALCANEAL 70MM",6105764,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,636.5,509.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",445.55,70,,356.44,,,0,"percent of total billed charges ","70% of total billed charges ",572.85,90,,458.28,,,0,"percent of total billed charges ","90% of total billed charges ",591.95,93,,473.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",541.03,85,,432.82,,,0,"percent of total billed charges ","85% of total billed charges ",541.03,85,,432.82,,,0,"percent of total billed charges ","85% of total billed charges ",572.85,90,,458.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",553.76,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",445.55,70,,356.44,,,0,"percent of total billed charges ","70% of total billed charges ",445.55,591.95,
"GRAFT VASCULAR TW 8MMX8CM",6105768,"CDM ",278,RC,C1768,HCPCS,OUTPATIENT,,,1798.67,1438.936,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1259.07,70,,1007.26,,,0,"percent of total billed charges ","70% of total billed charges ",1618.8,90,,1295.04,,,0,"percent of total billed charges ","90% of total billed charges ",1672.76,93,,1338.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1528.87,85,,1223.10,,,0,"percent of total billed charges ","85% of total billed charges ",1528.87,85,,1223.10,,,0,"percent of total billed charges ","85% of total billed charges ",1618.8,90,,1295.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1564.84,87,,1251.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1259.07,70,,1007.26,,,0,"percent of total billed charges ","70% of total billed charges ",1259.07,1672.76,
"GRAFT VASCULAR TW 10MMX80CM",6105769,"CDM ",278,RC,C1768,HCPCS,OUTPATIENT,,,1608.73,1286.984,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1126.11,70,,900.89,,,0,"percent of total billed charges ","70% of total billed charges ",1447.86,90,,1158.29,,,0,"percent of total billed charges ","90% of total billed charges ",1496.12,93,,1196.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1367.42,85,,1093.94,,,0,"percent of total billed charges ","85% of total billed charges ",1367.42,85,,1093.94,,,0,"percent of total billed charges ","85% of total billed charges ",1447.86,90,,1158.29,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1399.6,87,,1119.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1126.11,70,,900.89,,,0,"percent of total billed charges ","70% of total billed charges ",1126.11,1496.12,
"K-WIRE .062X4""",6105902,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,23.42,18.736,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.39,70,,13.11,,,0,"percent of total billed charges ","70% of total billed charges ",21.08,90,,16.86,,,0,"percent of total billed charges ","90% of total billed charges ",21.78,93,,17.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.91,85,,15.93,,,0,"percent of total billed charges ","85% of total billed charges ",19.91,85,,15.93,,,0,"percent of total billed charges ","85% of total billed charges ",21.08,90,,16.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.38,87,,16.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.39,70,,13.11,,,0,"percent of total billed charges ","70% of total billed charges ",16.39,21.78,
"PATCH HERNIA SM OVAL",6105923,"CDM ",278,RC,C1781,HCPCS,OUTPATIENT,,,504.5,403.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",353.15,70,,282.52,,,0,"percent of total billed charges ","70% of total billed charges ",454.05,90,,363.24,,,0,"percent of total billed charges ","90% of total billed charges ",469.19,93,,375.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",428.83,85,,343.06,,,0,"percent of total billed charges ","85% of total billed charges ",428.83,85,,343.06,,,0,"percent of total billed charges ","85% of total billed charges ",454.05,90,,363.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",438.92,87,,351.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",353.15,70,,282.52,,,0,"percent of total billed charges ","70% of total billed charges ",353.15,469.19,
"POUCH OSTOMY 11"" K",6105941,"CDM ",272,RC,A4377,HCPCS,OUTPATIENT,,,18.5,14.8,,,,,,,,0,"other ","not separately reimbursment ",10.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.95,70,,10.36,,,0,"percent of total billed charges ","70% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",17.21,93,,13.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.73,85,,12.58,,,0,"percent of total billed charges ","85% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.1,87,,12.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.95,70,,10.36,,,0,"percent of total billed charges ","70% of total billed charges ",10.02,17.21,
"PASTE PREMIUM OSTOMY",6105942,"CDM ",272,RC,A4370,HCPCS,OUTPATIENT,,,51.5,41.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.05,70,,28.84,,,0,"percent of total billed charges ","70% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",47.9,93,,38.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.78,85,,35.02,,,0,"percent of total billed charges ","85% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.81,87,,35.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.05,70,,28.84,,,0,"percent of total billed charges ","70% of total billed charges ",36.05,47.9,
"FLANGE 2 1/4"" I",6105944,"CDM ",272,RC,A4384,HCPCS,OUTPATIENT,,,25,20,,,,,,,,0,"other ","not separately reimbursment ",47.83,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.5,70,,14.00,,,0,"percent of total billed charges ","70% of total billed charges ",22.5,90,,18.00,,,0,"percent of total billed charges ","90% of total billed charges ",23.25,93,,18.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.25,85,,17.00,,,0,"percent of total billed charges ","85% of total billed charges ",22.5,90,,18.00,,,0,"percent of total billed charges ","90% of total billed charges ",22.5,90,,18.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.75,87,,17.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.5,70,,14.00,,,0,"percent of total billed charges ","70% of total billed charges ",17.5,47.83,
"PATCH HERNIA SM CIRCLE",6105946,"CDM ",278,RC,C1781,HCPCS,OUTPATIENT,,,554,443.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",387.8,70,,310.24,,,0,"percent of total billed charges ","70% of total billed charges ",498.6,90,,398.88,,,0,"percent of total billed charges ","90% of total billed charges ",515.22,93,,412.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",470.9,85,,376.72,,,0,"percent of total billed charges ","85% of total billed charges ",470.9,85,,376.72,,,0,"percent of total billed charges ","85% of total billed charges ",498.6,90,,398.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",481.98,87,,385.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",387.8,70,,310.24,,,0,"percent of total billed charges ","70% of total billed charges ",387.8,515.22,
"CATH DUAL LUMEN 10FR",6105949,"CDM ",272,RC,C1757,HCPCS,OUTPATIENT,,,530,424,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",371,70,,296.80,,,0,"percent of total billed charges ","70% of total billed charges ",477,90,,381.60,,,0,"percent of total billed charges ","90% of total billed charges ",492.9,93,,394.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",450.5,85,,360.40,,,0,"percent of total billed charges ","85% of total billed charges ",477,90,,381.60,,,0,"percent of total billed charges ","90% of total billed charges ",477,90,,381.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",461.1,87,,368.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",371,70,,296.80,,,0,"percent of total billed charges ","70% of total billed charges ",371,492.9,
"SCREW 3.7MM X 25MM",6105971,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,301,240.8,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.7,70,,168.56,,,0,"percent of total billed charges ","70% of total billed charges ",270.9,90,,216.72,,,0,"percent of total billed charges ","90% of total billed charges ",279.93,93,,223.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",255.85,85,,204.68,,,0,"percent of total billed charges ","85% of total billed charges ",255.85,85,,204.68,,,0,"percent of total billed charges ","85% of total billed charges ",270.9,90,,216.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",261.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.7,70,,168.56,,,0,"percent of total billed charges ","70% of total billed charges ",210.7,279.93,
"BRNG TIBIA PS 18X63/67MM",6105981,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1633.5,1306.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",1519.16,93,,1215.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1421.15,87,,1136.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,1519.16,
"ANCHOR ARTHRO GII CUFF",6105998,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,668.05,534.44,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",467.64,70,,374.11,,,0,"percent of total billed charges ","70% of total billed charges ",601.25,90,,481.00,,,0,"percent of total billed charges ","90% of total billed charges ",621.29,93,,497.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",567.84,85,,454.27,,,0,"percent of total billed charges ","85% of total billed charges ",567.84,85,,454.27,,,0,"percent of total billed charges ","85% of total billed charges ",601.25,90,,481.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",581.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",467.64,70,,374.11,,,0,"percent of total billed charges ","70% of total billed charges ",467.64,621.29,
"POUCH DRAINABLE 1 3/4",6106057,"CDM ",272,RC,A4377,HCPCS,OUTPATIENT,,,7.5,6,,,,,,,,0,"other ","not separately reimbursment ",10.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",5.25,70,,4.20,,,0,"percent of total billed charges ","70% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",6.98,93,,5.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6.38,85,,5.10,,,0,"percent of total billed charges ","85% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.53,87,,5.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.25,70,,4.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,10.02,
"CATH DUAL LUMEN 7.5FR",6106070,"CDM ",272,RC,C1757,HCPCS,OUTPATIENT,,,339.76,271.808,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",237.83,70,,190.26,,,0,"percent of total billed charges ","70% of total billed charges ",305.78,90,,244.62,,,0,"percent of total billed charges ","90% of total billed charges ",315.98,93,,252.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",288.8,85,,231.04,,,0,"percent of total billed charges ","85% of total billed charges ",305.78,90,,244.62,,,0,"percent of total billed charges ","90% of total billed charges ",305.78,90,,244.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",295.59,87,,236.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",237.83,70,,190.26,,,0,"percent of total billed charges ","70% of total billed charges ",237.83,315.98,
"CATH THORACIC ANGLED 32FR",6106086,"CDM ",272,RC,C1757,HCPCS,OUTPATIENT,,,42.13,33.704,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.49,70,,23.59,,,0,"percent of total billed charges ","70% of total billed charges ",37.92,90,,30.34,,,0,"percent of total billed charges ","90% of total billed charges ",39.18,93,,31.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",35.81,85,,28.65,,,0,"percent of total billed charges ","85% of total billed charges ",37.92,90,,30.34,,,0,"percent of total billed charges ","90% of total billed charges ",37.92,90,,30.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",36.65,87,,29.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.49,70,,23.59,,,0,"percent of total billed charges ","70% of total billed charges ",29.49,39.18,
"CATH THORACIC ANGLED 36FR",6106087,"CDM ",272,RC,C1757,HCPCS,OUTPATIENT,,,35.51,28.408,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.86,70,,19.89,,,0,"percent of total billed charges ","70% of total billed charges ",31.96,90,,25.57,,,0,"percent of total billed charges ","90% of total billed charges ",33.02,93,,26.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",30.18,85,,24.14,,,0,"percent of total billed charges ","85% of total billed charges ",31.96,90,,25.57,,,0,"percent of total billed charges ","90% of total billed charges ",31.96,90,,25.57,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.89,87,,24.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.86,70,,19.89,,,0,"percent of total billed charges ","70% of total billed charges ",24.86,33.02,
"GENERATOR NEURO PROSTHESIS",6106215,"CDM ",278,RC,C1767,HCPCS,OUTPATIENT,,,15769.5,12615.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11038.65,70,,8830.92,,,0,"percent of total billed charges ","70% of total billed charges ",14192.55,90,,11354.04,,,0,"percent of total billed charges ","90% of total billed charges ",14665.64,93,,11732.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13404.08,85,,10723.26,,,0,"percent of total billed charges ","85% of total billed charges ",13404.08,85,,10723.26,,,0,"percent of total billed charges ","85% of total billed charges ",14192.55,90,,11354.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13719.47,87,,10975.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11038.65,70,,8830.92,,,0,"percent of total billed charges ","70% of total billed charges ",11038.65,14665.64,
"FLANGE COLOSTOMY L",6106221,"CDM ",272,RC,A4385,HCPCS,OUTPATIENT,,,35,28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.5,70,,19.60,,,0,"percent of total billed charges ","70% of total billed charges ",31.5,90,,25.20,,,0,"percent of total billed charges ","90% of total billed charges ",32.55,93,,26.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",29.75,85,,23.80,,,0,"percent of total billed charges ","85% of total billed charges ",31.5,90,,25.20,,,0,"percent of total billed charges ","90% of total billed charges ",31.5,90,,25.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.45,87,,24.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.5,70,,19.60,,,0,"percent of total billed charges ","70% of total billed charges ",24.5,32.55,
"POUCH OSTOMY L",6106222,"CDM ",272,RC,A4377,HCPCS,OUTPATIENT,,,15.5,12.4,,,,,,,,0,"other ","not separately reimbursment ",10.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",10.85,70,,8.68,,,0,"percent of total billed charges ","70% of total billed charges ",13.95,90,,11.16,,,0,"percent of total billed charges ","90% of total billed charges ",14.42,93,,11.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.18,85,,10.54,,,0,"percent of total billed charges ","85% of total billed charges ",13.95,90,,11.16,,,0,"percent of total billed charges ","90% of total billed charges ",13.95,90,,11.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.49,87,,10.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.85,70,,8.68,,,0,"percent of total billed charges ","70% of total billed charges ",10.02,14.42,
"FLANGE 1 3/4"" I",6106236,"CDM ",272,RC,A4385,HCPCS,OUTPATIENT,,,24.5,19.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.15,70,,13.72,,,0,"percent of total billed charges ","70% of total billed charges ",22.05,90,,17.64,,,0,"percent of total billed charges ","90% of total billed charges ",22.79,93,,18.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.83,85,,16.66,,,0,"percent of total billed charges ","85% of total billed charges ",22.05,90,,17.64,,,0,"percent of total billed charges ","90% of total billed charges ",22.05,90,,17.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.32,87,,17.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.15,70,,13.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.15,22.79,
"POUCH 1 3/4"" I",6106237,"CDM ",272,RC,A4377,HCPCS,OUTPATIENT,,,19,15.2,,,,,,,,0,"other ","not separately reimbursment ",10.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",13.3,70,,10.64,,,0,"percent of total billed charges ","70% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.67,93,,14.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.15,85,,12.92,,,0,"percent of total billed charges ","85% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.53,87,,13.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.3,70,,10.64,,,0,"percent of total billed charges ","70% of total billed charges ",10.02,17.67,
"PLATE CALCANEAL 5M",6106249,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,851.5,681.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",596.05,70,,476.84,,,0,"percent of total billed charges ","70% of total billed charges ",766.35,90,,613.08,,,0,"percent of total billed charges ","90% of total billed charges ",791.9,93,,633.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",723.78,85,,579.02,,,0,"percent of total billed charges ","85% of total billed charges ",723.78,85,,579.02,,,0,"percent of total billed charges ","85% of total billed charges ",766.35,90,,613.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",740.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",596.05,70,,476.84,,,0,"percent of total billed charges ","70% of total billed charges ",596.05,791.9,
"PLATE CALCANEAL LG",6106250,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,802.5,642,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",561.75,70,,449.40,,,0,"percent of total billed charges ","70% of total billed charges ",722.25,90,,577.80,,,0,"percent of total billed charges ","90% of total billed charges ",746.33,93,,597.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",682.13,85,,545.70,,,0,"percent of total billed charges ","85% of total billed charges ",682.13,85,,545.70,,,0,"percent of total billed charges ","85% of total billed charges ",722.25,90,,577.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",698.18,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",561.75,70,,449.40,,,0,"percent of total billed charges ","70% of total billed charges ",561.75,746.33,
"BAG 1 3/4""STOMA",6106304,"CDM ",272,RC,A4377,HCPCS,OUTPATIENT,,,8.5,6.8,,,,,,,,0,"other ","not separately reimbursment ",10.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",5.95,70,,4.76,,,0,"percent of total billed charges ","70% of total billed charges ",7.65,90,,6.12,,,0,"percent of total billed charges ","90% of total billed charges ",7.91,93,,6.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7.23,85,,5.78,,,0,"percent of total billed charges ","85% of total billed charges ",7.65,90,,6.12,,,0,"percent of total billed charges ","90% of total billed charges ",7.65,90,,6.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7.4,87,,5.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.95,70,,4.76,,,0,"percent of total billed charges ","70% of total billed charges ",5.95,10.02,
"FLANGE 1 3/4"" COLOSTOMY",6106327,"CDM ",272,RC,A4386,HCPCS,OUTPATIENT,,,59,47.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.3,70,,33.04,,,0,"percent of total billed charges ","70% of total billed charges ",53.1,90,,42.48,,,0,"percent of total billed charges ","90% of total billed charges ",54.87,93,,43.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",50.15,85,,40.12,,,0,"percent of total billed charges ","85% of total billed charges ",53.1,90,,42.48,,,0,"percent of total billed charges ","90% of total billed charges ",53.1,90,,42.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",51.33,87,,41.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.3,70,,33.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.3,54.87,
"FLANGE 2 3/4"" COLOSTOMY",6106328,"CDM ",272,RC,A4384,HCPCS,OUTPATIENT,,,59,47.2,,,,,,,,0,"other ","not separately reimbursment ",47.83,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",41.3,70,,33.04,,,0,"percent of total billed charges ","70% of total billed charges ",53.1,90,,42.48,,,0,"percent of total billed charges ","90% of total billed charges ",54.87,93,,43.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",50.15,85,,40.12,,,0,"percent of total billed charges ","85% of total billed charges ",53.1,90,,42.48,,,0,"percent of total billed charges ","90% of total billed charges ",53.1,90,,42.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",51.33,87,,41.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.3,70,,33.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.3,54.87,
"FLANGE 1 1/2""",6106329,"CDM ",272,RC,A4386,HCPCS,OUTPATIENT,,,37,29.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.9,70,,20.72,,,0,"percent of total billed charges ","70% of total billed charges ",33.3,90,,26.64,,,0,"percent of total billed charges ","90% of total billed charges ",34.41,93,,27.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",31.45,85,,25.16,,,0,"percent of total billed charges ","85% of total billed charges ",33.3,90,,26.64,,,0,"percent of total billed charges ","90% of total billed charges ",33.3,90,,26.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",32.19,87,,25.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.9,70,,20.72,,,0,"percent of total billed charges ","70% of total billed charges ",25.9,34.41,
"POUCH 1/2"" OPAQUE",6106330,"CDM ",272,RC,A4377,HCPCS,OUTPATIENT,,,14,11.2,,,,,,,,0,"other ","not separately reimbursment ",10.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",13.02,93,,10.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.9,85,,9.52,,,0,"percent of total billed charges ","85% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.18,87,,9.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",9.8,13.02,
"FLANGE ANTOLOC 1 3/4""",6106348,"CDM ",272,RC,A4409,HCPCS,OUTPATIENT,,,27.5,22,,,,,,,,0,"other ","not separately reimbursment ",8.81,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.25,70,,15.40,,,0,"percent of total billed charges ","70% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",25.58,93,,20.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.38,85,,18.70,,,0,"percent of total billed charges ","85% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",23.93,87,,19.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.25,70,,15.40,,,0,"percent of total billed charges ","70% of total billed charges ",8.81,25.58,
"BRNG TIBIA VE PS 16X79/83MM",6106420,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"FLANGE 2 3/4 UROSTOMY",6106524,"CDM ",272,RC,A5073,HCPCS,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",4.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",4.53,44.64,
"OSTOMY BAG 70MM",6106533,"CDM ",272,RC,A5063,HCPCS,OUTPATIENT,,,8.5,6.8,,,,,,,,0,"other ","not separately reimbursment ",3.91,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",5.95,70,,4.76,,,0,"percent of total billed charges ","70% of total billed charges ",7.65,90,,6.12,,,0,"percent of total billed charges ","90% of total billed charges ",7.91,93,,6.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7.23,85,,5.78,,,0,"percent of total billed charges ","85% of total billed charges ",7.65,90,,6.12,,,0,"percent of total billed charges ","90% of total billed charges ",7.65,90,,6.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7.4,87,,5.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.95,70,,4.76,,,0,"percent of total billed charges ","70% of total billed charges ",3.91,7.91,
"OSTOMY FLANGE 57MM",6106534,"CDM ",272,RC,A4409,HCPCS,OUTPATIENT,,,24.5,19.6,,,,,,,,0,"other ","not separately reimbursment ",8.81,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.15,70,,13.72,,,0,"percent of total billed charges ","70% of total billed charges ",22.05,90,,17.64,,,0,"percent of total billed charges ","90% of total billed charges ",22.79,93,,18.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.83,85,,16.66,,,0,"percent of total billed charges ","85% of total billed charges ",22.05,90,,17.64,,,0,"percent of total billed charges ","90% of total billed charges ",22.05,90,,17.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.32,87,,17.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.15,70,,13.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.81,22.79,
"COMP FEM PS OPEN 75MM RT",6106584,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,4168.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"COMP FEM PS OPEN 57.5MM LT",6106585,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,4168.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"COMP FEM PS OPEN 55MM LT",6106586,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,4168.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"COMP FEM PS OPEN 60MM LT",6106587,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,4168.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"COMP FEM PS OPEN 62.5MM LT",6106589,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,4168.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMORAL COMPONET, CR SZ H, LT",6106598,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,4338.47,3470.776,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3036.93,70,,2429.54,,,0,"percent of total billed charges ","70% of total billed charges ",3904.62,90,,3123.70,,,0,"percent of total billed charges ","90% of total billed charges ",4034.78,93,,3227.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3687.7,85,,2950.16,,,0,"percent of total billed charges ","85% of total billed charges ",3687.7,85,,2950.16,,,0,"percent of total billed charges ","85% of total billed charges ",3904.62,90,,3123.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3774.47,87,,3019.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3036.93,70,,2429.54,,,0,"percent of total billed charges ","70% of total billed charges ",3036.93,4034.78,
"COMP FEM PS OPEN 65MM LT",6106599,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,4168.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"ART SURF MC CD 4-5 LT 10MM",6106600,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC CD 4-5 LT 11MM",6106601,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC CD 4-5 LT 12MM",6106603,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC CD 4-5 LT 13MM",6106604,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC CD 4-5 LT 14MM",6106605,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ARTICULATING SURFACE PURPLE 10",6106606,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC CD 6-7 LT 11MM",6106607,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC CD 6-7 LT 12MM",6106608,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC CD 6-7 LT 13MM",6106609,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ARTICULATING SURFACE CR PURPLE",6106610,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"BRNG TIBIA VE PS 14X63/67MM",6106613,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC CD 6-7 LT 16MM",6106614,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC CD 8-9 LT 10MM",6106615,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC CD 8-9 LT 11MM",6106616,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1291.5,1033.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",904.05,70,,723.24,,,0,"percent of total billed charges ","70% of total billed charges ",1162.35,90,,929.88,,,0,"percent of total billed charges ","90% of total billed charges ",1201.1,93,,960.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1097.78,85,,878.22,,,0,"percent of total billed charges ","85% of total billed charges ",1097.78,85,,878.22,,,0,"percent of total billed charges ","85% of total billed charges ",1162.35,90,,929.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1123.61,87,,898.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",904.05,70,,723.24,,,0,"percent of total billed charges ","70% of total billed charges ",904.05,1201.1,
"ARTICULATING SURFACE YELLOW 17",6106617,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC CD 8-9 LT 12MM",6106618,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC CD 8-9 LT 13MM",6106619,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC CD 8-9 LT 14MM",6106620,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC CD 8-9 LT 16MM",6106621,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC EF 4-5 LT 10MM",6106622,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC EF 4-5 LT 11MM",6106623,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC EF 4-5 LT 12MM",6106624,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURG MC EF 4-5 LT 13MM",6106627,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC EF 4-5 LT 14MM",6106628,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC EF 4-5 LT 16MM",6106629,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC EF 6-7 LT 10MM",6106630,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC EF 6-7 LT 11MM",6106631,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC EF 6-7 LT 12MM",6106634,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC EF 6-7 LT 13MM",6106635,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC EF 6-7 LT 14MM",6106636,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC EF 6-7 LT 16MM",6106637,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC EF 8-11 LT 10MM",6106638,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC EF 8-11 LT 11MM",6106639,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"PATELLA COMPONENT 29MM",6106644,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,969.75,775.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",775.8,80,,620.64,,,0,"percent of total billed charges ","80% of total billed charges ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",901.87,93,,721.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",843.68,87,,674.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",678.83,901.87,
"PATELLA COMPONET 32MM",6106645,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,969.75,775.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",775.8,80,,620.64,,,0,"percent of total billed charges ","80% of total billed charges ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",901.87,93,,721.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",843.68,87,,674.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",678.83,901.87,
"PATELLA COMPONET 35MM",6106646,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,969.75,775.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",775.8,80,,620.64,,,0,"percent of total billed charges ","80% of total billed charges ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",901.87,93,,721.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",843.68,87,,674.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",678.83,901.87,
"PATELLA COMPONET 38MM",6106647,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,969.75,775.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",775.8,80,,620.64,,,0,"percent of total billed charges ","80% of total billed charges ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",901.87,93,,721.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",843.68,87,,674.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",678.83,901.87,
"PATELLA COMPONET 41MM",6106648,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,969.75,775.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",775.8,80,,620.64,,,0,"percent of total billed charges ","80% of total billed charges ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",901.87,93,,721.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",843.68,87,,674.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",678.83,901.87,
"BRNG TIBIA PS 10X63/67MM",6106649,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1633.5,1306.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1306.8,80,,1045.44,,,0,"percent of total billed charges ","80% of total billed charges ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",1519.16,93,,1215.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1421.15,87,,1136.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,1519.16,
"TIBIA COMPONET STEM'D SZ 2",6106650,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2722.5,2178,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2178,80,,1742.40,,,0,"percent of total billed charges ","80% of total billed charges ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",2531.93,93,,2025.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2368.58,87,,1894.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",1905.75,2531.93,
"TIBIA COMPONET STEM'D SZ 3",6106651,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2722.5,2178,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2178,80,,1742.40,,,0,"percent of total billed charges ","80% of total billed charges ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",2531.93,93,,2025.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2368.58,87,,1894.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",1905.75,2531.93,
"TIBIA COMPONET STEM'D SZ4",6106652,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2722.5,2178,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2178,80,,1742.40,,,0,"percent of total billed charges ","80% of total billed charges ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",2531.93,93,,2025.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2368.58,87,,1894.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",1905.75,2531.93,
"TIBIA COMPONET STEM'D SZ 5",6106653,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2722.5,2178,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2178,80,,1742.40,,,0,"percent of total billed charges ","80% of total billed charges ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",2531.93,93,,2025.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2368.58,87,,1894.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",1905.75,2531.93,
"TIBIA COMPONET STEM'D SZ 6",6106654,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2722.5,2178,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2178,80,,1742.40,,,0,"percent of total billed charges ","80% of total billed charges ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",2531.93,93,,2025.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2368.58,87,,1894.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",1905.75,2531.93,
"TIBIA COMPONET STEM'D SZ 7",6106655,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2722.5,2178,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2178,80,,1742.40,,,0,"percent of total billed charges ","80% of total billed charges ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",2531.93,93,,2025.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2368.58,87,,1894.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",1905.75,2531.93,
"TIBIA COMPONET STEM'D SZ 8",6106656,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2748.56,2198.848,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2198.85,80,,1759.08,,,0,"percent of total billed charges ","80% of total billed charges ",1923.99,70,,1539.19,,,0,"percent of total billed charges ","70% of total billed charges ",2473.7,90,,1978.96,,,0,"percent of total billed charges ","90% of total billed charges ",2556.16,93,,2044.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2336.28,85,,1869.02,,,0,"percent of total billed charges ","85% of total billed charges ",2336.28,85,,1869.02,,,0,"percent of total billed charges ","85% of total billed charges ",2473.7,90,,1978.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2391.25,87,,1913.00,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1923.99,70,,1539.19,,,0,"percent of total billed charges ","70% of total billed charges ",1923.99,2556.16,
"TIBIA COMPONET STEM'D SZ 9",6106657,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2858.5,2286.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2286.8,80,,1829.44,,,0,"percent of total billed charges ","80% of total billed charges ",2000.95,70,,1600.76,,,0,"percent of total billed charges ","70% of total billed charges ",2572.65,90,,2058.12,,,0,"percent of total billed charges ","90% of total billed charges ",2658.41,93,,2126.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2429.73,85,,1943.78,,,0,"percent of total billed charges ","85% of total billed charges ",2429.73,85,,1943.78,,,0,"percent of total billed charges ","85% of total billed charges ",2572.65,90,,2058.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2486.9,87,,1989.52,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2000.95,70,,1600.76,,,0,"percent of total billed charges ","70% of total billed charges ",2000.95,2658.41,
"BRNG TIBIA PS 16X63/67MM",6106658,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1633.5,1306.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1306.8,80,,1045.44,,,0,"percent of total billed charges ","80% of total billed charges ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",1519.16,93,,1215.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1421.15,87,,1136.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,1519.16,
"COMP FEM PS OPEN 67.5MM LT",6106659,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,4168.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"COMP FEM PS OPEN 70MM LT",6106660,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,4168.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"COMP FEM PS OPEN 72.5MM LT",6106662,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,4168.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"COMP FEM PS OPEN 75MM LT",6106670,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,4168.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"BRNG TIMBIA PS 10X71/75MM",6106671,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1633.5,1306.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1306.8,80,,1045.44,,,0,"percent of total billed charges ","80% of total billed charges ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",1519.16,93,,1215.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1421.15,87,,1136.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,1519.16,
"BRNG TIBIA PS 12X71/75MM",6106673,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1633.5,1306.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1306.8,80,,1045.44,,,0,"percent of total billed charges ","80% of total billed charges ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",1519.16,93,,1215.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1421.15,87,,1136.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,1519.16,
"ART SURF MC EF 8-11 LT 12MM",6106674,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC EF 8-11 LT 13MM",6106675,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC GH 8-11 LT 11MM",6106676,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC EF 8-11 LT 14MM",6106677,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC EF 8-11 LT 16MM",6106678,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC GH 8-11 LT 12MM",6106679,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC EF 6-7 RT 16MM",6106680,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC GH 8-11 LT 14MM",6106681,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC GH 8-11 LT 14MM",6106682,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC GH 8-11 LT 16MM",6106684,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"BRNG TIBIA PS 12X63/67MM",6106685,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1633.5,1306.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1306.8,80,,1045.44,,,0,"percent of total billed charges ","80% of total billed charges ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",1519.16,93,,1215.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1421.15,87,,1136.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,1519.16,
"BRNG TIBIA VE PS 18X79/83MM",6106686,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ARTICULATING SURFACE CD YEL'W",6106687,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2178,1742.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1742.4,80,,1393.92,,,0,"percent of total billed charges ","80% of total billed charges ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",2025.54,93,,1620.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1894.86,87,,1515.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1524.6,2025.54,
"ARTICULATING SURFACE CD YEL'W",6106688,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2178,1742.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1742.4,80,,1393.92,,,0,"percent of total billed charges ","80% of total billed charges ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",2025.54,93,,1620.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1894.86,87,,1515.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1524.6,2025.54,
"ARTICULATING SURFACE CD YEL'W",6106689,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2178,1742.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1742.4,80,,1393.92,,,0,"percent of total billed charges ","80% of total billed charges ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",2025.54,93,,1620.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1894.86,87,,1515.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1524.6,2025.54,
"ART SURF MC EF 8-11 RT 10MM",6106690,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC CD 4-5 RT 10MM",6106691,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC GH 12 LT 10MM",6106692,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC GH 12 LT 11MM",6106693,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC GH 12 LT 12MM",6106694,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ARTICULAT'G SURF EF GREEN 10MM",6106695,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2178,1742.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1742.4,80,,1393.92,,,0,"percent of total billed charges ","80% of total billed charges ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",2025.54,93,,1620.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1894.86,87,,1515.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1524.6,2025.54,
"ARTICULT'G SURF EF GREEN 12MM",6106696,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2178,1742.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1742.4,80,,1393.92,,,0,"percent of total billed charges ","80% of total billed charges ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",2025.54,93,,1620.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1894.86,87,,1515.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1524.6,2025.54,
"ARTICULT'G SURF EF GREEN 14MM",6106697,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2178,1742.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1742.4,80,,1393.92,,,0,"percent of total billed charges ","80% of total billed charges ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",2025.54,93,,1620.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1894.86,87,,1515.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1524.6,2025.54,
"ART SURF MC CD 4-5 RT 11MM",6106698,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC CD 4-5 RT 12MM",6106699,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC GH 12 LT 13MM",6106700,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ARTICULT'G SURF CD GREEN STRP",6106701,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1343.74,1074.992,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1074.99,80,,859.99,,,0,"percent of total billed charges ","80% of total billed charges ",940.62,70,,752.50,,,0,"percent of total billed charges ","70% of total billed charges ",1209.37,90,,967.50,,,0,"percent of total billed charges ","90% of total billed charges ",1249.68,93,,999.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1142.18,85,,913.74,,,0,"percent of total billed charges ","85% of total billed charges ",1142.18,85,,913.74,,,0,"percent of total billed charges ","85% of total billed charges ",1209.37,90,,967.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1169.05,87,,935.24,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",940.62,70,,752.50,,,0,"percent of total billed charges ","70% of total billed charges ",940.62,1249.68,
"ART SURF MC CD 4-5 RT 13MM",6106702,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ARTICULTING SURF CD GR'N STRP",6106703,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2178,1742.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1742.4,80,,1393.92,,,0,"percent of total billed charges ","80% of total billed charges ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",2025.54,93,,1620.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1894.86,87,,1515.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1524.6,2025.54,
"ART SURF MC CD 4-5 RT 14MM",6106704,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC CD 4-5 RT 16MM",6106705,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC CD 6-7 RT 10MM",6106706,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC GH 12 LT 14MM",6106707,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC GH 12 LT 16MM",6106708,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ARTICULATING SURFACE CH BLUE 1",6106709,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2624.38,2099.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2099.5,80,,1679.60,,,0,"percent of total billed charges ","80% of total billed charges ",1837.07,70,,1469.66,,,0,"percent of total billed charges ","70% of total billed charges ",2361.94,90,,1889.55,,,0,"percent of total billed charges ","90% of total billed charges ",2440.67,93,,1952.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2230.72,85,,1784.58,,,0,"percent of total billed charges ","85% of total billed charges ",2230.72,85,,1784.58,,,0,"percent of total billed charges ","85% of total billed charges ",2361.94,90,,1889.55,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2283.21,87,,1826.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1837.07,70,,1469.66,,,0,"percent of total billed charges ","70% of total billed charges ",1837.07,2440.67,
"ART SURF MC CD 6-7 RT 11MM",6106710,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC CD 6-7 RT 12MM",6106711,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC CD 6-7 RT 13MM",6106712,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC CD 6-7 RT 14MM",6106713,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC CD 6-7 RT 16MM",6106714,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC CD 8-9 RT 10MM",6106715,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ARTICULATING SURF EF BLUE STRP",6106716,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2795.1,2236.08,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2236.08,80,,1788.86,,,0,"percent of total billed charges ","80% of total billed charges ",1956.57,70,,1565.26,,,0,"percent of total billed charges ","70% of total billed charges ",2515.59,90,,2012.47,,,0,"percent of total billed charges ","90% of total billed charges ",2599.44,93,,2079.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2375.84,85,,1900.67,,,0,"percent of total billed charges ","85% of total billed charges ",2375.84,85,,1900.67,,,0,"percent of total billed charges ","85% of total billed charges ",2515.59,90,,2012.47,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2431.74,87,,1945.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1956.57,70,,1565.26,,,0,"percent of total billed charges ","70% of total billed charges ",1956.57,2599.44,
"ART SURF MC CD 8-9 RT 11MM",6106717,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC CD 8-9 RT 12MM",6106718,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC CD 8-9 RT 13MM",6106719,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC CD 8-9 RT 14MM",6106720,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC CD 8-9 RT 16MM",6106721,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"HEAD FEMUR (RED CROSS)",6106727,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1660.73,1328.584,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1328.58,80,,1062.86,,,0,"percent of total billed charges ","80% of total billed charges ",1162.51,70,,930.01,,,0,"percent of total billed charges ","70% of total billed charges ",1494.66,90,,1195.73,,,0,"percent of total billed charges ","90% of total billed charges ",1544.48,93,,1235.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1411.62,85,,1129.30,,,0,"percent of total billed charges ","85% of total billed charges ",1411.62,85,,1129.30,,,0,"percent of total billed charges ","85% of total billed charges ",1494.66,90,,1195.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1444.84,87,,1155.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1162.51,70,,930.01,,,0,"percent of total billed charges ","70% of total billed charges ",1162.51,1544.48,
"PLATE RECON STR'T 3.5 8 HOLE",6106778,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,600.5,480.4,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",480.4,80,,384.32,,,0,"percent of total billed charges ","80% of total billed charges ",420.35,70,,336.28,,,0,"percent of total billed charges ","70% of total billed charges ",540.45,90,,432.36,,,0,"percent of total billed charges ","90% of total billed charges ",558.47,93,,446.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",510.43,85,,408.34,,,0,"percent of total billed charges ","85% of total billed charges ",510.43,85,,408.34,,,0,"percent of total billed charges ","85% of total billed charges ",540.45,90,,432.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",522.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",420.35,70,,336.28,,,0,"percent of total billed charges ","70% of total billed charges ",420.35,558.47,
"SLING SHOULDER LARGE",6106857,"CDM ",271,RC,A4565,HCPCS,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,111.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"POUCH UNIT W/FLANGE",6106877,"CDM ",272,RC,A4389,HCPCS,OUTPATIENT,,,38.5,30.8,,,,,,,,0,"other ","not separately reimbursment ",7.72,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,93,,28.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.73,85,,26.18,,,0,"percent of total billed charges ","85% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.5,87,,26.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",7.72,35.81,
"PATCH HERNIA LG OVAL 14CMX18CM",6106895,"CDM ",278,RC,C1781,HCPCS,OUTPATIENT,,,3994,3195.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2795.8,70,,2236.64,,,0,"percent of total billed charges ","70% of total billed charges ",3594.6,90,,2875.68,,,0,"percent of total billed charges ","90% of total billed charges ",3714.42,93,,2971.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3394.9,85,,2715.92,,,0,"percent of total billed charges ","85% of total billed charges ",3394.9,85,,2715.92,,,0,"percent of total billed charges ","85% of total billed charges ",3594.6,90,,2875.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3474.78,87,,2779.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2795.8,70,,2236.64,,,0,"percent of total billed charges ","70% of total billed charges ",2795.8,3714.42,
"MESH PLUG MARLEX MED",6106896,"CDM ",278,RC,C1781,HCPCS,OUTPATIENT,,,300.19,240.152,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.13,70,,168.10,,,0,"percent of total billed charges ","70% of total billed charges ",270.17,90,,216.14,,,0,"percent of total billed charges ","90% of total billed charges ",279.18,93,,223.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",255.16,85,,204.13,,,0,"percent of total billed charges ","85% of total billed charges ",255.16,85,,204.13,,,0,"percent of total billed charges ","85% of total billed charges ",270.17,90,,216.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",261.17,87,,208.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.13,70,,168.10,,,0,"percent of total billed charges ","70% of total billed charges ",210.13,279.18,
"MESH PLUG MARLEX X-LG",6106897,"CDM ",278,RC,C1781,HCPCS,OUTPATIENT,,,377.13,301.704,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.99,70,,211.19,,,0,"percent of total billed charges ","70% of total billed charges ",339.42,90,,271.54,,,0,"percent of total billed charges ","90% of total billed charges ",350.73,93,,280.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",320.56,85,,256.45,,,0,"percent of total billed charges ","85% of total billed charges ",320.56,85,,256.45,,,0,"percent of total billed charges ","85% of total billed charges ",339.42,90,,271.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",328.1,87,,262.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.99,70,,211.19,,,0,"percent of total billed charges ","70% of total billed charges ",263.99,350.73,
"CUP ACETABULAR MULTIHOLE 44MM",6106952,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2261.67,1809.336,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1583.17,70,,1266.54,,,0,"percent of total billed charges ","70% of total billed charges ",2035.5,90,,1628.40,,,0,"percent of total billed charges ","90% of total billed charges ",2103.35,93,,1682.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1922.42,85,,1537.94,,,0,"percent of total billed charges ","85% of total billed charges ",1922.42,85,,1537.94,,,0,"percent of total billed charges ","85% of total billed charges ",2035.5,90,,1628.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1967.65,87,,1574.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1583.17,70,,1266.54,,,0,"percent of total billed charges ","70% of total billed charges ",1583.17,2103.35,
"CUP ACETABULAR MULTIHOLE 46MM",6106953,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2350.04,1880.032,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1645.03,70,,1316.02,,,0,"percent of total billed charges ","70% of total billed charges ",2115.04,90,,1692.03,,,0,"percent of total billed charges ","90% of total billed charges ",2185.54,93,,1748.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1997.53,85,,1598.02,,,0,"percent of total billed charges ","85% of total billed charges ",1997.53,85,,1598.02,,,0,"percent of total billed charges ","85% of total billed charges ",2115.04,90,,1692.03,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2044.53,87,,1635.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1645.03,70,,1316.02,,,0,"percent of total billed charges ","70% of total billed charges ",1645.03,2185.54,
"LINER ACETAB STAND 44MMX28MM",6106969,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1962.02,1569.616,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1373.41,70,,1098.73,,,0,"percent of total billed charges ","70% of total billed charges ",1765.82,90,,1412.66,,,0,"percent of total billed charges ","90% of total billed charges ",1824.68,93,,1459.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1667.72,85,,1334.18,,,0,"percent of total billed charges ","85% of total billed charges ",1667.72,85,,1334.18,,,0,"percent of total billed charges ","85% of total billed charges ",1765.82,90,,1412.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1706.96,87,,1365.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1373.41,70,,1098.73,,,0,"percent of total billed charges ","70% of total billed charges ",1373.41,1824.68,
"LINER ACETAB STAND 46MMX28MM",6106970,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1962.02,1569.616,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1373.41,70,,1098.73,,,0,"percent of total billed charges ","70% of total billed charges ",1765.82,90,,1412.66,,,0,"percent of total billed charges ","90% of total billed charges ",1824.68,93,,1459.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1667.72,85,,1334.18,,,0,"percent of total billed charges ","85% of total billed charges ",1667.72,85,,1334.18,,,0,"percent of total billed charges ","85% of total billed charges ",1765.82,90,,1412.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1706.96,87,,1365.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1373.41,70,,1098.73,,,0,"percent of total billed charges ","70% of total billed charges ",1373.41,1824.68,
"LINER ACETAB 10 DEG 44MMX28MM",6106981,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2050.95,1640.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",1907.38,93,,1525.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1784.33,87,,1427.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1435.67,1907.38,
"LINER ACETAB 10 DEG 46MMX28MM",6106982,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2050.95,1640.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",1907.38,93,,1525.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1784.33,87,,1427.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1435.67,1907.38,
"SCREW BONE TRILOGY 15MM X 6.5M",6107045,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,517.2,413.76,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",362.04,70,,289.63,,,0,"percent of total billed charges ","70% of total billed charges ",465.48,90,,372.38,,,0,"percent of total billed charges ","90% of total billed charges ",481,93,,384.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",439.62,85,,351.70,,,0,"percent of total billed charges ","85% of total billed charges ",439.62,85,,351.70,,,0,"percent of total billed charges ","85% of total billed charges ",465.48,90,,372.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",449.96,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",362.04,70,,289.63,,,0,"percent of total billed charges ","70% of total billed charges ",362.04,481,
"SCREW BONE TRILOGY 20MM X 6.5M",6107048,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,517.2,413.76,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",362.04,70,,289.63,,,0,"percent of total billed charges ","70% of total billed charges ",465.48,90,,372.38,,,0,"percent of total billed charges ","90% of total billed charges ",481,93,,384.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",439.62,85,,351.70,,,0,"percent of total billed charges ","85% of total billed charges ",439.62,85,,351.70,,,0,"percent of total billed charges ","85% of total billed charges ",465.48,90,,372.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",449.96,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",362.04,70,,289.63,,,0,"percent of total billed charges ","70% of total billed charges ",362.04,481,
"SCREW BONE TRILOGY 25MM X 6.5M",6107049,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,387.5,310,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",310,80,,248.00,,,0,"percent of total billed charges ","80% of total billed charges ",271.25,70,,217.00,,,0,"percent of total billed charges ","70% of total billed charges ",348.75,90,,279.00,,,0,"percent of total billed charges ","90% of total billed charges ",360.38,93,,288.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",329.38,85,,263.50,,,0,"percent of total billed charges ","85% of total billed charges ",329.38,85,,263.50,,,0,"percent of total billed charges ","85% of total billed charges ",348.75,90,,279.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",337.13,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",271.25,70,,217.00,,,0,"percent of total billed charges ","70% of total billed charges ",271.25,360.38,
"SCREW BONE TRILOGY 30MM X 6.5M",6107050,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,387.5,310,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",310,80,,248.00,,,0,"percent of total billed charges ","80% of total billed charges ",271.25,70,,217.00,,,0,"percent of total billed charges ","70% of total billed charges ",348.75,90,,279.00,,,0,"percent of total billed charges ","90% of total billed charges ",360.38,93,,288.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",329.38,85,,263.50,,,0,"percent of total billed charges ","85% of total billed charges ",329.38,85,,263.50,,,0,"percent of total billed charges ","85% of total billed charges ",348.75,90,,279.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",337.13,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",271.25,70,,217.00,,,0,"percent of total billed charges ","70% of total billed charges ",271.25,360.38,
"SCREW BONE TRILOGY 35MM X 6.5M",6107051,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,219.34,175.472,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",175.47,80,,140.38,,,0,"percent of total billed charges ","80% of total billed charges ",153.54,70,,122.83,,,0,"percent of total billed charges ","70% of total billed charges ",197.41,90,,157.93,,,0,"percent of total billed charges ","90% of total billed charges ",203.99,93,,163.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",186.44,85,,149.15,,,0,"percent of total billed charges ","85% of total billed charges ",186.44,85,,149.15,,,0,"percent of total billed charges ","85% of total billed charges ",197.41,90,,157.93,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",190.83,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.54,70,,122.83,,,0,"percent of total billed charges ","70% of total billed charges ",153.54,203.99,
"SCREW BONE TRILOGY 40MM X 6.5M",6107093,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,387.5,310,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",310,80,,248.00,,,0,"percent of total billed charges ","80% of total billed charges ",271.25,70,,217.00,,,0,"percent of total billed charges ","70% of total billed charges ",348.75,90,,279.00,,,0,"percent of total billed charges ","90% of total billed charges ",360.38,93,,288.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",329.38,85,,263.50,,,0,"percent of total billed charges ","85% of total billed charges ",329.38,85,,263.50,,,0,"percent of total billed charges ","85% of total billed charges ",348.75,90,,279.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",337.13,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",271.25,70,,217.00,,,0,"percent of total billed charges ","70% of total billed charges ",271.25,360.38,
"SCREW BONE TRILOGY 50MM X 6.5M",6107094,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,271.53,217.224,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",217.22,80,,173.78,,,0,"percent of total billed charges ","80% of total billed charges ",190.07,70,,152.06,,,0,"percent of total billed charges ","70% of total billed charges ",244.38,90,,195.50,,,0,"percent of total billed charges ","90% of total billed charges ",252.52,93,,202.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",230.8,85,,184.64,,,0,"percent of total billed charges ","85% of total billed charges ",230.8,85,,184.64,,,0,"percent of total billed charges ","85% of total billed charges ",244.38,90,,195.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",236.23,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",190.07,70,,152.06,,,0,"percent of total billed charges ","70% of total billed charges ",190.07,252.52,
"SCREW BONE TRILOGY 60MM X 6.5M",6107095,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,271.53,217.224,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",217.22,80,,173.78,,,0,"percent of total billed charges ","80% of total billed charges ",190.07,70,,152.06,,,0,"percent of total billed charges ","70% of total billed charges ",244.38,90,,195.50,,,0,"percent of total billed charges ","90% of total billed charges ",252.52,93,,202.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",230.8,85,,184.64,,,0,"percent of total billed charges ","85% of total billed charges ",230.8,85,,184.64,,,0,"percent of total billed charges ","85% of total billed charges ",244.38,90,,195.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",236.23,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",190.07,70,,152.06,,,0,"percent of total billed charges ","70% of total billed charges ",190.07,252.52,
"STEM CEMENTED 11MM",6107096,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2813.25,2250.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2250.6,80,,1800.48,,,0,"percent of total billed charges ","80% of total billed charges ",1969.28,70,,1575.42,,,0,"percent of total billed charges ","70% of total billed charges ",2531.93,90,,2025.54,,,0,"percent of total billed charges ","90% of total billed charges ",2616.32,93,,2093.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2391.26,85,,1913.01,,,0,"percent of total billed charges ","85% of total billed charges ",2391.26,85,,1913.01,,,0,"percent of total billed charges ","85% of total billed charges ",2531.93,90,,2025.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2447.53,87,,1958.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1969.28,70,,1575.42,,,0,"percent of total billed charges ","70% of total billed charges ",1969.28,2616.32,
"STEM CEMENTED 13MM",6107098,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2813.25,2250.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2250.6,80,,1800.48,,,0,"percent of total billed charges ","80% of total billed charges ",1969.28,70,,1575.42,,,0,"percent of total billed charges ","70% of total billed charges ",2531.93,90,,2025.54,,,0,"percent of total billed charges ","90% of total billed charges ",2616.32,93,,2093.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2391.26,85,,1913.01,,,0,"percent of total billed charges ","85% of total billed charges ",2391.26,85,,1913.01,,,0,"percent of total billed charges ","85% of total billed charges ",2531.93,90,,2025.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2447.53,87,,1958.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1969.28,70,,1575.42,,,0,"percent of total billed charges ","70% of total billed charges ",1969.28,2616.32,
"STEM CEMENTED 14MM",6107099,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2813.25,2250.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2250.6,80,,1800.48,,,0,"percent of total billed charges ","80% of total billed charges ",1969.28,70,,1575.42,,,0,"percent of total billed charges ","70% of total billed charges ",2531.93,90,,2025.54,,,0,"percent of total billed charges ","90% of total billed charges ",2616.32,93,,2093.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2391.26,85,,1913.01,,,0,"percent of total billed charges ","85% of total billed charges ",2391.26,85,,1913.01,,,0,"percent of total billed charges ","85% of total billed charges ",2531.93,90,,2025.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2447.53,87,,1958.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1969.28,70,,1575.42,,,0,"percent of total billed charges ","70% of total billed charges ",1969.28,2616.32,
"CENTRALIZER DISTAL 9MM",6107115,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,329.38,263.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.5,80,,210.80,,,0,"percent of total billed charges ","80% of total billed charges ",230.57,70,,184.46,,,0,"percent of total billed charges ","70% of total billed charges ",296.44,90,,237.15,,,0,"percent of total billed charges ","90% of total billed charges ",306.32,93,,245.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",279.97,85,,223.98,,,0,"percent of total billed charges ","85% of total billed charges ",279.97,85,,223.98,,,0,"percent of total billed charges ","85% of total billed charges ",296.44,90,,237.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",286.56,87,,229.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",230.57,70,,184.46,,,0,"percent of total billed charges ","70% of total billed charges ",230.57,306.32,
"CENTRALIZER DISTAL 10MM",6107116,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,356.5,285.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",285.2,80,,228.16,,,0,"percent of total billed charges ","80% of total billed charges ",249.55,70,,199.64,,,0,"percent of total billed charges ","70% of total billed charges ",320.85,90,,256.68,,,0,"percent of total billed charges ","90% of total billed charges ",331.55,93,,265.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",303.03,85,,242.42,,,0,"percent of total billed charges ","85% of total billed charges ",303.03,85,,242.42,,,0,"percent of total billed charges ","85% of total billed charges ",320.85,90,,256.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",310.16,87,,248.13,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",249.55,70,,199.64,,,0,"percent of total billed charges ","70% of total billed charges ",249.55,331.55,
"CENTRALIZER DISTAL 11 MM",6107117,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,329.38,263.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.5,80,,210.80,,,0,"percent of total billed charges ","80% of total billed charges ",230.57,70,,184.46,,,0,"percent of total billed charges ","70% of total billed charges ",296.44,90,,237.15,,,0,"percent of total billed charges ","90% of total billed charges ",306.32,93,,245.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",279.97,85,,223.98,,,0,"percent of total billed charges ","85% of total billed charges ",279.97,85,,223.98,,,0,"percent of total billed charges ","85% of total billed charges ",296.44,90,,237.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",286.56,87,,229.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",230.57,70,,184.46,,,0,"percent of total billed charges ","70% of total billed charges ",230.57,306.32,
"CENTRALIZER DISTAL 12 MM",6107118,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,329.38,263.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.5,80,,210.80,,,0,"percent of total billed charges ","80% of total billed charges ",230.57,70,,184.46,,,0,"percent of total billed charges ","70% of total billed charges ",296.44,90,,237.15,,,0,"percent of total billed charges ","90% of total billed charges ",306.32,93,,245.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",279.97,85,,223.98,,,0,"percent of total billed charges ","85% of total billed charges ",279.97,85,,223.98,,,0,"percent of total billed charges ","85% of total billed charges ",296.44,90,,237.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",286.56,87,,229.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",230.57,70,,184.46,,,0,"percent of total billed charges ","70% of total billed charges ",230.57,306.32,
"CENTRALIZER DISTAL 13MM",6107119,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,329.38,263.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.5,80,,210.80,,,0,"percent of total billed charges ","80% of total billed charges ",230.57,70,,184.46,,,0,"percent of total billed charges ","70% of total billed charges ",296.44,90,,237.15,,,0,"percent of total billed charges ","90% of total billed charges ",306.32,93,,245.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",279.97,85,,223.98,,,0,"percent of total billed charges ","85% of total billed charges ",279.97,85,,223.98,,,0,"percent of total billed charges ","85% of total billed charges ",296.44,90,,237.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",286.56,87,,229.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",230.57,70,,184.46,,,0,"percent of total billed charges ","70% of total billed charges ",230.57,306.32,
"CENTRALIZER DISTAL 14MM",6107120,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,329.38,263.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.5,80,,210.80,,,0,"percent of total billed charges ","80% of total billed charges ",230.57,70,,184.46,,,0,"percent of total billed charges ","70% of total billed charges ",296.44,90,,237.15,,,0,"percent of total billed charges ","90% of total billed charges ",306.32,93,,245.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",279.97,85,,223.98,,,0,"percent of total billed charges ","85% of total billed charges ",279.97,85,,223.98,,,0,"percent of total billed charges ","85% of total billed charges ",296.44,90,,237.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",286.56,87,,229.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",230.57,70,,184.46,,,0,"percent of total billed charges ","70% of total billed charges ",230.57,306.32,
"CENTRALIZER DISTAL 15MM",6107122,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,329.38,263.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.5,80,,210.80,,,0,"percent of total billed charges ","80% of total billed charges ",230.57,70,,184.46,,,0,"percent of total billed charges ","70% of total billed charges ",296.44,90,,237.15,,,0,"percent of total billed charges ","90% of total billed charges ",306.32,93,,245.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",279.97,85,,223.98,,,0,"percent of total billed charges ","85% of total billed charges ",279.97,85,,223.98,,,0,"percent of total billed charges ","85% of total billed charges ",296.44,90,,237.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",286.56,87,,229.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",230.57,70,,184.46,,,0,"percent of total billed charges ","70% of total billed charges ",230.57,306.32,
"CENTRALIZER DISTAL 16MM",6107123,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,332.94,266.352,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",266.35,80,,213.08,,,0,"percent of total billed charges ","80% of total billed charges ",233.06,70,,186.45,,,0,"percent of total billed charges ","70% of total billed charges ",299.65,90,,239.72,,,0,"percent of total billed charges ","90% of total billed charges ",309.63,93,,247.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",283,85,,226.40,,,0,"percent of total billed charges ","85% of total billed charges ",283,85,,226.40,,,0,"percent of total billed charges ","85% of total billed charges ",299.65,90,,239.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",289.66,87,,231.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",233.06,70,,186.45,,,0,"percent of total billed charges ","70% of total billed charges ",233.06,309.63,
"CENTRALIZER DISTAL 17MM",6107124,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,307.83,246.264,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",246.26,80,,197.01,,,0,"percent of total billed charges ","80% of total billed charges ",215.48,70,,172.38,,,0,"percent of total billed charges ","70% of total billed charges ",277.05,90,,221.64,,,0,"percent of total billed charges ","90% of total billed charges ",286.28,93,,229.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.66,85,,209.33,,,0,"percent of total billed charges ","85% of total billed charges ",261.66,85,,209.33,,,0,"percent of total billed charges ","85% of total billed charges ",277.05,90,,221.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.81,87,,214.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",215.48,70,,172.38,,,0,"percent of total billed charges ","70% of total billed charges ",215.48,286.28,
"CENTRALIZER DISTAL 18MM",6107125,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,303.03,242.424,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",242.42,80,,193.94,,,0,"percent of total billed charges ","80% of total billed charges ",212.12,70,,169.70,,,0,"percent of total billed charges ","70% of total billed charges ",272.73,90,,218.18,,,0,"percent of total billed charges ","90% of total billed charges ",281.82,93,,225.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",257.58,85,,206.06,,,0,"percent of total billed charges ","85% of total billed charges ",257.58,85,,206.06,,,0,"percent of total billed charges ","85% of total billed charges ",272.73,90,,218.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",263.64,87,,210.91,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",212.12,70,,169.70,,,0,"percent of total billed charges ","70% of total billed charges ",212.12,281.82,
"CENTRALIZER DISTAL 19MM",6107126,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,303.03,242.424,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",242.42,80,,193.94,,,0,"percent of total billed charges ","80% of total billed charges ",212.12,70,,169.70,,,0,"percent of total billed charges ","70% of total billed charges ",272.73,90,,218.18,,,0,"percent of total billed charges ","90% of total billed charges ",281.82,93,,225.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",257.58,85,,206.06,,,0,"percent of total billed charges ","85% of total billed charges ",257.58,85,,206.06,,,0,"percent of total billed charges ","85% of total billed charges ",272.73,90,,218.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",263.64,87,,210.91,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",212.12,70,,169.70,,,0,"percent of total billed charges ","70% of total billed charges ",212.12,281.82,
"HEAD FEM 28MM -3.5MM NK",6107127,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1089,871.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",871.2,80,,696.96,,,0,"percent of total billed charges ","80% of total billed charges ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",1012.77,93,,810.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",947.43,87,,757.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",762.3,1012.77,
"FEMORAL HEAD 28 MM X +0",6107128,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1089,871.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",871.2,80,,696.96,,,0,"percent of total billed charges ","80% of total billed charges ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",1012.77,93,,810.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",947.43,87,,757.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",762.3,1012.77,
"HEAD FEM 28MM +3.5MM NK",6107129,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1089,871.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",871.2,80,,696.96,,,0,"percent of total billed charges ","80% of total billed charges ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",1012.77,93,,810.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",947.43,87,,757.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",762.3,1012.77,
"HEAD FEM 28MM +10.5MM NK",6107131,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1051.42,841.136,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",841.14,80,,672.91,,,0,"percent of total billed charges ","80% of total billed charges ",735.99,70,,588.79,,,0,"percent of total billed charges ","70% of total billed charges ",946.28,90,,757.02,,,0,"percent of total billed charges ","90% of total billed charges ",977.82,93,,782.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",893.71,85,,714.97,,,0,"percent of total billed charges ","85% of total billed charges ",893.71,85,,714.97,,,0,"percent of total billed charges ","85% of total billed charges ",946.28,90,,757.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",914.74,87,,731.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",735.99,70,,588.79,,,0,"percent of total billed charges ","70% of total billed charges ",735.99,977.82,
"FEMORAL HEAD 32 MM * 3.5",6107132,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1270.5,1016.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1016.4,80,,813.12,,,0,"percent of total billed charges ","80% of total billed charges ",889.35,70,,711.48,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,90,,914.76,,,0,"percent of total billed charges ","90% of total billed charges ",1181.57,93,,945.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1079.93,85,,863.94,,,0,"percent of total billed charges ","85% of total billed charges ",1079.93,85,,863.94,,,0,"percent of total billed charges ","85% of total billed charges ",1143.45,90,,914.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1105.34,87,,884.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",889.35,70,,711.48,,,0,"percent of total billed charges ","70% of total billed charges ",889.35,1181.57,
"FEMORAL HEAD 32 MM X +0",6107133,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1270.5,1016.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1016.4,80,,813.12,,,0,"percent of total billed charges ","80% of total billed charges ",889.35,70,,711.48,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,90,,914.76,,,0,"percent of total billed charges ","90% of total billed charges ",1181.57,93,,945.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1079.93,85,,863.94,,,0,"percent of total billed charges ","85% of total billed charges ",1079.93,85,,863.94,,,0,"percent of total billed charges ","85% of total billed charges ",1143.45,90,,914.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1105.34,87,,884.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",889.35,70,,711.48,,,0,"percent of total billed charges ","70% of total billed charges ",889.35,1181.57,
"FEMORAL HEAD 32 MM X +3.5",6107134,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1270.5,1016.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1016.4,80,,813.12,,,0,"percent of total billed charges ","80% of total billed charges ",889.35,70,,711.48,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,90,,914.76,,,0,"percent of total billed charges ","90% of total billed charges ",1181.57,93,,945.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1079.93,85,,863.94,,,0,"percent of total billed charges ","85% of total billed charges ",1079.93,85,,863.94,,,0,"percent of total billed charges ","85% of total billed charges ",1143.45,90,,914.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1105.34,87,,884.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",889.35,70,,711.48,,,0,"percent of total billed charges ","70% of total billed charges ",889.35,1181.57,
"FEMORAL HEAD 32 MM X +7",6107135,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1270.5,1016.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1016.4,80,,813.12,,,0,"percent of total billed charges ","80% of total billed charges ",889.35,70,,711.48,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,90,,914.76,,,0,"percent of total billed charges ","90% of total billed charges ",1181.57,93,,945.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1079.93,85,,863.94,,,0,"percent of total billed charges ","85% of total billed charges ",1079.93,85,,863.94,,,0,"percent of total billed charges ","85% of total billed charges ",1143.45,90,,914.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1105.34,87,,884.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",889.35,70,,711.48,,,0,"percent of total billed charges ","70% of total billed charges ",889.35,1181.57,
"FEMORAL HEAD 32 MM X + 10.5",6107136,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1051.42,841.136,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",841.14,80,,672.91,,,0,"percent of total billed charges ","80% of total billed charges ",735.99,70,,588.79,,,0,"percent of total billed charges ","70% of total billed charges ",946.28,90,,757.02,,,0,"percent of total billed charges ","90% of total billed charges ",977.82,93,,782.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",893.71,85,,714.97,,,0,"percent of total billed charges ","85% of total billed charges ",893.71,85,,714.97,,,0,"percent of total billed charges ","85% of total billed charges ",946.28,90,,757.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",914.74,87,,731.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",735.99,70,,588.79,,,0,"percent of total billed charges ","70% of total billed charges ",735.99,977.82,
"PLATE BONE CABLE READY 6-HOLE",6107179,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1354.99,1083.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1083.99,80,,867.19,,,0,"percent of total billed charges ","80% of total billed charges ",948.49,70,,758.79,,,0,"percent of total billed charges ","70% of total billed charges ",1219.49,90,,975.59,,,0,"percent of total billed charges ","90% of total billed charges ",1260.14,93,,1008.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1151.74,85,,921.39,,,0,"percent of total billed charges ","85% of total billed charges ",1151.74,85,,921.39,,,0,"percent of total billed charges ","85% of total billed charges ",1219.49,90,,975.59,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1178.84,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",948.49,70,,758.79,,,0,"percent of total billed charges ","70% of total billed charges ",948.49,1260.14,
"PLATE BONE CABLE READY 8-HOLE",6107180,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1317.51,1054.008,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1054.01,80,,843.21,,,0,"percent of total billed charges ","80% of total billed charges ",922.26,70,,737.81,,,0,"percent of total billed charges ","70% of total billed charges ",1185.76,90,,948.61,,,0,"percent of total billed charges ","90% of total billed charges ",1225.28,93,,980.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1119.88,85,,895.90,,,0,"percent of total billed charges ","85% of total billed charges ",1119.88,85,,895.90,,,0,"percent of total billed charges ","85% of total billed charges ",1185.76,90,,948.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1146.23,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",922.26,70,,737.81,,,0,"percent of total billed charges ","70% of total billed charges ",922.26,1225.28,
"PLATE BONE CABLE READY 10-HOLE",6107181,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1817.38,1453.904,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1453.9,80,,1163.12,,,0,"percent of total billed charges ","80% of total billed charges ",1272.17,70,,1017.74,,,0,"percent of total billed charges ","70% of total billed charges ",1635.64,90,,1308.51,,,0,"percent of total billed charges ","90% of total billed charges ",1690.16,93,,1352.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1544.77,85,,1235.82,,,0,"percent of total billed charges ","85% of total billed charges ",1544.77,85,,1235.82,,,0,"percent of total billed charges ","85% of total billed charges ",1635.64,90,,1308.51,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1581.12,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1272.17,70,,1017.74,,,0,"percent of total billed charges ","70% of total billed charges ",1272.17,1690.16,
"LINER ACETAB STAND 48MM X 28MM",6107185,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1962.02,1569.616,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1569.62,80,,1255.70,,,0,"percent of total billed charges ","80% of total billed charges ",1373.41,70,,1098.73,,,0,"percent of total billed charges ","70% of total billed charges ",1765.82,90,,1412.66,,,0,"percent of total billed charges ","90% of total billed charges ",1824.68,93,,1459.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1667.72,85,,1334.18,,,0,"percent of total billed charges ","85% of total billed charges ",1667.72,85,,1334.18,,,0,"percent of total billed charges ","85% of total billed charges ",1765.82,90,,1412.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1706.96,87,,1365.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1373.41,70,,1098.73,,,0,"percent of total billed charges ","70% of total billed charges ",1373.41,1824.68,
"LINER ACETAB STAND 50-54X28MM",6107186,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1962.02,1569.616,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1569.62,80,,1255.70,,,0,"percent of total billed charges ","80% of total billed charges ",1373.41,70,,1098.73,,,0,"percent of total billed charges ","70% of total billed charges ",1765.82,90,,1412.66,,,0,"percent of total billed charges ","90% of total billed charges ",1824.68,93,,1459.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1667.72,85,,1334.18,,,0,"percent of total billed charges ","85% of total billed charges ",1667.72,85,,1334.18,,,0,"percent of total billed charges ","85% of total billed charges ",1765.82,90,,1412.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1706.96,87,,1365.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1373.41,70,,1098.73,,,0,"percent of total billed charges ","70% of total billed charges ",1373.41,1824.68,
"LINER ACETAB STAND 56MMX28MM",6107187,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1962.02,1569.616,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1569.62,80,,1255.70,,,0,"percent of total billed charges ","80% of total billed charges ",1373.41,70,,1098.73,,,0,"percent of total billed charges ","70% of total billed charges ",1765.82,90,,1412.66,,,0,"percent of total billed charges ","90% of total billed charges ",1824.68,93,,1459.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1667.72,85,,1334.18,,,0,"percent of total billed charges ","85% of total billed charges ",1667.72,85,,1334.18,,,0,"percent of total billed charges ","85% of total billed charges ",1765.82,90,,1412.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1706.96,87,,1365.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1373.41,70,,1098.73,,,0,"percent of total billed charges ","70% of total billed charges ",1373.41,1824.68,
"LINER ACETAB STAND 58MM X 28MM",6107188,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1962.02,1569.616,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1569.62,80,,1255.70,,,0,"percent of total billed charges ","80% of total billed charges ",1373.41,70,,1098.73,,,0,"percent of total billed charges ","70% of total billed charges ",1765.82,90,,1412.66,,,0,"percent of total billed charges ","90% of total billed charges ",1824.68,93,,1459.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1667.72,85,,1334.18,,,0,"percent of total billed charges ","85% of total billed charges ",1667.72,85,,1334.18,,,0,"percent of total billed charges ","85% of total billed charges ",1765.82,90,,1412.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1706.96,87,,1365.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1373.41,70,,1098.73,,,0,"percent of total billed charges ","70% of total billed charges ",1373.41,1824.68,
"LINER ACETAB STAND 60MM X 28MM",6107189,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1962.02,1569.616,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1569.62,80,,1255.70,,,0,"percent of total billed charges ","80% of total billed charges ",1373.41,70,,1098.73,,,0,"percent of total billed charges ","70% of total billed charges ",1765.82,90,,1412.66,,,0,"percent of total billed charges ","90% of total billed charges ",1824.68,93,,1459.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1667.72,85,,1334.18,,,0,"percent of total billed charges ","85% of total billed charges ",1667.72,85,,1334.18,,,0,"percent of total billed charges ","85% of total billed charges ",1765.82,90,,1412.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1706.96,87,,1365.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1373.41,70,,1098.73,,,0,"percent of total billed charges ","70% of total billed charges ",1373.41,1824.68,
"LINER ACETAB STAND 62MMX28MM",6107190,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1962.02,1569.616,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1569.62,80,,1255.70,,,0,"percent of total billed charges ","80% of total billed charges ",1373.41,70,,1098.73,,,0,"percent of total billed charges ","70% of total billed charges ",1765.82,90,,1412.66,,,0,"percent of total billed charges ","90% of total billed charges ",1824.68,93,,1459.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1667.72,85,,1334.18,,,0,"percent of total billed charges ","85% of total billed charges ",1667.72,85,,1334.18,,,0,"percent of total billed charges ","85% of total billed charges ",1765.82,90,,1412.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1706.96,87,,1365.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1373.41,70,,1098.73,,,0,"percent of total billed charges ","70% of total billed charges ",1373.41,1824.68,
"LINER ACETAB STAND 64MMX28MM",6107191,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1962.02,1569.616,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1569.62,80,,1255.70,,,0,"percent of total billed charges ","80% of total billed charges ",1373.41,70,,1098.73,,,0,"percent of total billed charges ","70% of total billed charges ",1765.82,90,,1412.66,,,0,"percent of total billed charges ","90% of total billed charges ",1824.68,93,,1459.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1667.72,85,,1334.18,,,0,"percent of total billed charges ","85% of total billed charges ",1667.72,85,,1334.18,,,0,"percent of total billed charges ","85% of total billed charges ",1765.82,90,,1412.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1706.96,87,,1365.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1373.41,70,,1098.73,,,0,"percent of total billed charges ","70% of total billed charges ",1373.41,1824.68,
"LINER ACETAB STAND 66MM X 28MM",6107192,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1962.02,1569.616,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1569.62,80,,1255.70,,,0,"percent of total billed charges ","80% of total billed charges ",1373.41,70,,1098.73,,,0,"percent of total billed charges ","70% of total billed charges ",1765.82,90,,1412.66,,,0,"percent of total billed charges ","90% of total billed charges ",1824.68,93,,1459.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1667.72,85,,1334.18,,,0,"percent of total billed charges ","85% of total billed charges ",1667.72,85,,1334.18,,,0,"percent of total billed charges ","85% of total billed charges ",1765.82,90,,1412.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1706.96,87,,1365.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1373.41,70,,1098.73,,,0,"percent of total billed charges ","70% of total billed charges ",1373.41,1824.68,
"LINER ACETAB STAND 68MMX28MM",6107193,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1962.02,1569.616,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1569.62,80,,1255.70,,,0,"percent of total billed charges ","80% of total billed charges ",1373.41,70,,1098.73,,,0,"percent of total billed charges ","70% of total billed charges ",1765.82,90,,1412.66,,,0,"percent of total billed charges ","90% of total billed charges ",1824.68,93,,1459.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1667.72,85,,1334.18,,,0,"percent of total billed charges ","85% of total billed charges ",1667.72,85,,1334.18,,,0,"percent of total billed charges ","85% of total billed charges ",1765.82,90,,1412.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1706.96,87,,1365.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1373.41,70,,1098.73,,,0,"percent of total billed charges ","70% of total billed charges ",1373.41,1824.68,
"LINER ACETAB STAND 70MMX28MM",6107194,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1962.02,1569.616,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1569.62,80,,1255.70,,,0,"percent of total billed charges ","80% of total billed charges ",1373.41,70,,1098.73,,,0,"percent of total billed charges ","70% of total billed charges ",1765.82,90,,1412.66,,,0,"percent of total billed charges ","90% of total billed charges ",1824.68,93,,1459.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1667.72,85,,1334.18,,,0,"percent of total billed charges ","85% of total billed charges ",1667.72,85,,1334.18,,,0,"percent of total billed charges ","85% of total billed charges ",1765.82,90,,1412.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1706.96,87,,1365.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1373.41,70,,1098.73,,,0,"percent of total billed charges ","70% of total billed charges ",1373.41,1824.68,
"LINER ACETAB 10DEG 48MMX28MM",6107195,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2050.95,1640.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1640.76,80,,1312.61,,,0,"percent of total billed charges ","80% of total billed charges ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",1907.38,93,,1525.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1784.33,87,,1427.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1435.67,1907.38,
"LINER ACETAB 10DEG 50-54MMX28M",6107196,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2050.95,1640.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1640.76,80,,1312.61,,,0,"percent of total billed charges ","80% of total billed charges ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",1907.38,93,,1525.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1784.33,87,,1427.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1435.67,1907.38,
"LINER ACETAB 10DEG 56MMX28MM",6107197,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2050.95,1640.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1640.76,80,,1312.61,,,0,"percent of total billed charges ","80% of total billed charges ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",1907.38,93,,1525.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1784.33,87,,1427.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1435.67,1907.38,
"LINER ACETAB 10DEG 58MMX28MM",6107198,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2050.95,1640.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1640.76,80,,1312.61,,,0,"percent of total billed charges ","80% of total billed charges ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",1907.38,93,,1525.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1784.33,87,,1427.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1435.67,1907.38,
"LINER ACETAB 10DEG 60MMX28MM",6107199,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2050.95,1640.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1640.76,80,,1312.61,,,0,"percent of total billed charges ","80% of total billed charges ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",1907.38,93,,1525.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1784.33,87,,1427.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1435.67,1907.38,
"LINER ACETAB 10DEG 62MMX28MM",6107200,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2050.95,1640.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1640.76,80,,1312.61,,,0,"percent of total billed charges ","80% of total billed charges ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",1907.38,93,,1525.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1784.33,87,,1427.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1435.67,1907.38,
"LINER ACETAB 10DEG 64MMX28MM",6107201,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2050.95,1640.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1640.76,80,,1312.61,,,0,"percent of total billed charges ","80% of total billed charges ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",1907.38,93,,1525.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1784.33,87,,1427.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1435.67,1907.38,
"LINER ACETAB 10DEG 66MMX28MM",6107202,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2050.95,1640.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1640.76,80,,1312.61,,,0,"percent of total billed charges ","80% of total billed charges ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",1907.38,93,,1525.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1784.33,87,,1427.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1435.67,1907.38,
"LINER ACETAB 10DEG 68MMX28MM",6107203,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2050.95,1640.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1640.76,80,,1312.61,,,0,"percent of total billed charges ","80% of total billed charges ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",1907.38,93,,1525.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1784.33,87,,1427.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1435.67,1907.38,
"LINER ACETAB 10DEG 70MMX28MM",6107204,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2050.95,1640.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1640.76,80,,1312.61,,,0,"percent of total billed charges ","80% of total billed charges ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",1907.38,93,,1525.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1784.33,87,,1427.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1435.67,1907.38,
"LINER ACETAB 20DEG 48MMX28MM",6107205,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2050.95,1640.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1640.76,80,,1312.61,,,0,"percent of total billed charges ","80% of total billed charges ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",1907.38,93,,1525.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1784.33,87,,1427.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1435.67,1907.38,
"LINER ACETAB 20DEG 50-54MMX28M",6107206,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1845.86,1476.688,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1476.69,80,,1181.35,,,0,"percent of total billed charges ","80% of total billed charges ",1292.1,70,,1033.68,,,0,"percent of total billed charges ","70% of total billed charges ",1661.27,90,,1329.02,,,0,"percent of total billed charges ","90% of total billed charges ",1716.65,93,,1373.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1568.98,85,,1255.18,,,0,"percent of total billed charges ","85% of total billed charges ",1568.98,85,,1255.18,,,0,"percent of total billed charges ","85% of total billed charges ",1661.27,90,,1329.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1605.9,87,,1284.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1292.1,70,,1033.68,,,0,"percent of total billed charges ","70% of total billed charges ",1292.1,1716.65,
"LINER ACETAB 20DEG 56MMX28MM",6107207,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2050.95,1640.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1640.76,80,,1312.61,,,0,"percent of total billed charges ","80% of total billed charges ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",1907.38,93,,1525.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1784.33,87,,1427.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1435.67,1907.38,
"LINER ACETAB 20DEG 58MMX28MM",6107208,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2050.95,1640.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1640.76,80,,1312.61,,,0,"percent of total billed charges ","80% of total billed charges ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",1907.38,93,,1525.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1784.33,87,,1427.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1435.67,1907.38,
"LINER ACETAB 20DEG 60MMX28MM",6107209,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2050.95,1640.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1640.76,80,,1312.61,,,0,"percent of total billed charges ","80% of total billed charges ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",1907.38,93,,1525.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1784.33,87,,1427.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1435.67,1907.38,
"LINER ACETAB 20DEG 62MMX28MM",6107210,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2050.95,1640.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1640.76,80,,1312.61,,,0,"percent of total billed charges ","80% of total billed charges ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",1907.38,93,,1525.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1784.33,87,,1427.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1435.67,1907.38,
"LINER ACETAB 20DEG 64MMX28MM",6107211,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2050.95,1640.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1640.76,80,,1312.61,,,0,"percent of total billed charges ","80% of total billed charges ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",1907.38,93,,1525.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1784.33,87,,1427.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1435.67,1907.38,
"LINER ACETAB 20DEG 66MMX28MM",6107212,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2050.95,1640.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1640.76,80,,1312.61,,,0,"percent of total billed charges ","80% of total billed charges ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",1907.38,93,,1525.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1784.33,87,,1427.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1435.67,1907.38,
"LINER ACETAB 20DEG 68MMX28MM",6107213,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2050.95,1640.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1640.76,80,,1312.61,,,0,"percent of total billed charges ","80% of total billed charges ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",1907.38,93,,1525.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1784.33,87,,1427.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1435.67,1907.38,
"LINER ACETAB 20DEG 70MMX28MM",6107214,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2050.95,1640.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1640.76,80,,1312.61,,,0,"percent of total billed charges ","80% of total billed charges ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",1907.38,93,,1525.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1743.31,85,,1394.65,,,0,"percent of total billed charges ","85% of total billed charges ",1845.86,90,,1476.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1784.33,87,,1427.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1435.67,70,,1148.54,,,0,"percent of total billed charges ","70% of total billed charges ",1435.67,1907.38,
"CUP BIPOLAR 28ID X 44 OD",6107273,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1496.47,1197.176,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1197.18,80,,957.74,,,0,"percent of total billed charges ","80% of total billed charges ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",1391.72,93,,1113.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1301.93,87,,1041.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1047.53,1391.72,
"CUP BIPOLAR 28ID X 45OD",6107274,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1496.47,1197.176,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1197.18,80,,957.74,,,0,"percent of total billed charges ","80% of total billed charges ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",1391.72,93,,1113.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1301.93,87,,1041.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1047.53,1391.72,
"CUP BIOPLAR 28ID X 46OD",6107275,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1496.47,1197.176,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1197.18,80,,957.74,,,0,"percent of total billed charges ","80% of total billed charges ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",1391.72,93,,1113.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1301.93,87,,1041.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1047.53,1391.72,
"CUP BIPOLAR 28ID X 47OD",6107276,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1496.47,1197.176,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1197.18,80,,957.74,,,0,"percent of total billed charges ","80% of total billed charges ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",1391.72,93,,1113.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1301.93,87,,1041.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1047.53,1391.72,
"CUP BIPOLAR 28ID X 48OD",6107277,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1496.47,1197.176,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1197.18,80,,957.74,,,0,"percent of total billed charges ","80% of total billed charges ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",1391.72,93,,1113.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1301.93,87,,1041.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1047.53,1391.72,
"CUP BIPOLAR 28ID X 49OD",6107278,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1496.47,1197.176,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1197.18,80,,957.74,,,0,"percent of total billed charges ","80% of total billed charges ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",1391.72,93,,1113.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1301.93,87,,1041.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1047.53,1391.72,
"CUP BIPOLAR 28ID X 50OD",6107279,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1496.47,1197.176,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1197.18,80,,957.74,,,0,"percent of total billed charges ","80% of total billed charges ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",1391.72,93,,1113.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1301.93,87,,1041.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1047.53,1391.72,
"CUP BIPOLAR 28ID X 51OD",6107280,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1496.47,1197.176,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1197.18,80,,957.74,,,0,"percent of total billed charges ","80% of total billed charges ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",1391.72,93,,1113.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1301.93,87,,1041.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1047.53,1391.72,
"CUP BIPOLAR 28ID X 52OD",6107281,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1496.47,1197.176,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1197.18,80,,957.74,,,0,"percent of total billed charges ","80% of total billed charges ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",1391.72,93,,1113.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1301.93,87,,1041.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1047.53,1391.72,
"CUP BIPOLAR 28ID X 53OD",6107282,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1496.47,1197.176,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1197.18,80,,957.74,,,0,"percent of total billed charges ","80% of total billed charges ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",1391.72,93,,1113.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1301.93,87,,1041.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1047.53,1391.72,
"CUP BIPOLAR 28ID X 54OD",6107283,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1496.47,1197.176,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1197.18,80,,957.74,,,0,"percent of total billed charges ","80% of total billed charges ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",1391.72,93,,1113.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1301.93,87,,1041.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1047.53,1391.72,
"CUP BIPOLAR 28ID X 55OD",6107284,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1496.47,1197.176,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1197.18,80,,957.74,,,0,"percent of total billed charges ","80% of total billed charges ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",1391.72,93,,1113.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1301.93,87,,1041.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1047.53,1391.72,
"CUP BIPOLAR 28ID X 57OD",6107285,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1496.47,1197.176,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1197.18,80,,957.74,,,0,"percent of total billed charges ","80% of total billed charges ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",1391.72,93,,1113.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1301.93,87,,1041.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1047.53,1391.72,
"CUP BIPOLAR HIP 28ID X 58OD",6107286,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1496.47,1197.176,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1197.18,80,,957.74,,,0,"percent of total billed charges ","80% of total billed charges ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",1391.72,93,,1113.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1301.93,87,,1041.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1047.53,1391.72,
"CUP BIPOLAR 28ID X 60OD",6107287,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1496.47,1197.176,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1197.18,80,,957.74,,,0,"percent of total billed charges ","80% of total billed charges ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",1391.72,93,,1113.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1272,85,,1017.60,,,0,"percent of total billed charges ","85% of total billed charges ",1346.82,90,,1077.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1301.93,87,,1041.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1047.53,70,,838.02,,,0,"percent of total billed charges ","70% of total billed charges ",1047.53,1391.72,
"FEMORAL STEM CEM LD/FX SZ11",6107288,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2595.45,2076.36,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2076.36,80,,1661.09,,,0,"percent of total billed charges ","80% of total billed charges ",1816.82,70,,1453.46,,,0,"percent of total billed charges ","70% of total billed charges ",2335.91,90,,1868.73,,,0,"percent of total billed charges ","90% of total billed charges ",2413.77,93,,1931.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2206.13,85,,1764.90,,,0,"percent of total billed charges ","85% of total billed charges ",2206.13,85,,1764.90,,,0,"percent of total billed charges ","85% of total billed charges ",2335.91,90,,1868.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2258.04,87,,1806.43,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1816.82,70,,1453.46,,,0,"percent of total billed charges ","70% of total billed charges ",1816.82,2413.77,
"FEMORAL STEM CEM LD/FX SZ12",6107289,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2904,2323.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2323.2,80,,1858.56,,,0,"percent of total billed charges ","80% of total billed charges ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",2700.72,93,,2160.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2526.48,87,,2021.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2032.8,2700.72,
"FEMORAL STEM CEM LD/FX SZ14",6107290,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2595.45,2076.36,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2076.36,80,,1661.09,,,0,"percent of total billed charges ","80% of total billed charges ",1816.82,70,,1453.46,,,0,"percent of total billed charges ","70% of total billed charges ",2335.91,90,,1868.73,,,0,"percent of total billed charges ","90% of total billed charges ",2413.77,93,,1931.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2206.13,85,,1764.90,,,0,"percent of total billed charges ","85% of total billed charges ",2206.13,85,,1764.90,,,0,"percent of total billed charges ","85% of total billed charges ",2335.91,90,,1868.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2258.04,87,,1806.43,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1816.82,70,,1453.46,,,0,"percent of total billed charges ","70% of total billed charges ",1816.82,2413.77,
"FEMORAL STEM CEM LD/FX SZ16",6107291,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2390.66,1912.528,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1912.53,80,,1530.02,,,0,"percent of total billed charges ","80% of total billed charges ",1673.46,70,,1338.77,,,0,"percent of total billed charges ","70% of total billed charges ",2151.59,90,,1721.27,,,0,"percent of total billed charges ","90% of total billed charges ",2223.31,93,,1778.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2032.06,85,,1625.65,,,0,"percent of total billed charges ","85% of total billed charges ",2032.06,85,,1625.65,,,0,"percent of total billed charges ","85% of total billed charges ",2151.59,90,,1721.27,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2079.87,87,,1663.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1673.46,70,,1338.77,,,0,"percent of total billed charges ","70% of total billed charges ",1673.46,2223.31,
"FEMORAL STEM CEM LD/FX SZ18",6107292,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2298.72,1838.976,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1838.98,80,,1471.18,,,0,"percent of total billed charges ","80% of total billed charges ",1609.1,70,,1287.28,,,0,"percent of total billed charges ","70% of total billed charges ",2068.85,90,,1655.08,,,0,"percent of total billed charges ","90% of total billed charges ",2137.81,93,,1710.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1953.91,85,,1563.13,,,0,"percent of total billed charges ","85% of total billed charges ",1953.91,85,,1563.13,,,0,"percent of total billed charges ","85% of total billed charges ",2068.85,90,,1655.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1999.89,87,,1599.91,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1609.1,70,,1287.28,,,0,"percent of total billed charges ","70% of total billed charges ",1609.1,2137.81,
"FEMORAL STEM PRSFIT LD/FX SZ11",6107293,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2904,2323.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2323.2,80,,1858.56,,,0,"percent of total billed charges ","80% of total billed charges ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",2700.72,93,,2160.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2526.48,87,,2021.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2032.8,2700.72,
"FEMORAL STEM PRSFIT LD/FX SZ12",6107294,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2904,2323.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2323.2,80,,1858.56,,,0,"percent of total billed charges ","80% of total billed charges ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",2700.72,93,,2160.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2526.48,87,,2021.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2032.8,2700.72,
"FEMORAL STEM PRSFIT LD/FX SX13",6107295,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2904,2323.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2323.2,80,,1858.56,,,0,"percent of total billed charges ","80% of total billed charges ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",2700.72,93,,2160.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2526.48,87,,2021.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2032.8,2700.72,
"FEMORAL STEM PRSFIT LD/FX SZ14",6107296,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2390.66,1912.528,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1912.53,80,,1530.02,,,0,"percent of total billed charges ","80% of total billed charges ",1673.46,70,,1338.77,,,0,"percent of total billed charges ","70% of total billed charges ",2151.59,90,,1721.27,,,0,"percent of total billed charges ","90% of total billed charges ",2223.31,93,,1778.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2032.06,85,,1625.65,,,0,"percent of total billed charges ","85% of total billed charges ",2032.06,85,,1625.65,,,0,"percent of total billed charges ","85% of total billed charges ",2151.59,90,,1721.27,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2079.87,87,,1663.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1673.46,70,,1338.77,,,0,"percent of total billed charges ","70% of total billed charges ",1673.46,2223.31,
"FEMORAL STEM PRSFIT LD/FX SZ15",6107297,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2904,2323.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2323.2,80,,1858.56,,,0,"percent of total billed charges ","80% of total billed charges ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",2700.72,93,,2160.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2468.4,85,,1974.72,,,0,"percent of total billed charges ","85% of total billed charges ",2613.6,90,,2090.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2526.48,87,,2021.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2032.8,70,,1626.24,,,0,"percent of total billed charges ","70% of total billed charges ",2032.8,2700.72,
"FEMORAL STEM PRSFIT LD/FX SZ16",6107298,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2595.45,2076.36,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2076.36,80,,1661.09,,,0,"percent of total billed charges ","80% of total billed charges ",1816.82,70,,1453.46,,,0,"percent of total billed charges ","70% of total billed charges ",2335.91,90,,1868.73,,,0,"percent of total billed charges ","90% of total billed charges ",2413.77,93,,1931.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2206.13,85,,1764.90,,,0,"percent of total billed charges ","85% of total billed charges ",2206.13,85,,1764.90,,,0,"percent of total billed charges ","85% of total billed charges ",2335.91,90,,1868.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2258.04,87,,1806.43,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1816.82,70,,1453.46,,,0,"percent of total billed charges ","70% of total billed charges ",1816.82,2413.77,
"PATCH HERNIA COMPOSITE 10X13IN",6107299,"CDM ",278,RC,C1781,HCPCS,OUTPATIENT,,,3775.2,3020.16,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3020.16,80,,2416.13,,,0,"percent of total billed charges ","80% of total billed charges ",2642.64,70,,2114.11,,,0,"percent of total billed charges ","70% of total billed charges ",3397.68,90,,2718.14,,,0,"percent of total billed charges ","90% of total billed charges ",3510.94,93,,2808.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3208.92,85,,2567.14,,,0,"percent of total billed charges ","85% of total billed charges ",3208.92,85,,2567.14,,,0,"percent of total billed charges ","85% of total billed charges ",3397.68,90,,2718.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3284.42,87,,2627.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2642.64,70,,2114.11,,,0,"percent of total billed charges ","70% of total billed charges ",2642.64,3510.94,
"SHELL BIPOLAR CUP 48MM",6107319,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1161.6,929.28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",929.28,80,,743.42,,,0,"percent of total billed charges ","80% of total billed charges ",813.12,70,,650.50,,,0,"percent of total billed charges ","70% of total billed charges ",1045.44,90,,836.35,,,0,"percent of total billed charges ","90% of total billed charges ",1080.29,93,,864.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",987.36,85,,789.89,,,0,"percent of total billed charges ","85% of total billed charges ",987.36,85,,789.89,,,0,"percent of total billed charges ","85% of total billed charges ",1045.44,90,,836.35,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1010.59,87,,808.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",813.12,70,,650.50,,,0,"percent of total billed charges ","70% of total billed charges ",813.12,1080.29,
"LINER ASSEMBLY 47-49OD X 28ID",6107320,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,818.9,655.12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",655.12,80,,524.10,,,0,"percent of total billed charges ","80% of total billed charges ",573.23,70,,458.58,,,0,"percent of total billed charges ","70% of total billed charges ",737.01,90,,589.61,,,0,"percent of total billed charges ","90% of total billed charges ",761.58,93,,609.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",696.07,85,,556.86,,,0,"percent of total billed charges ","85% of total billed charges ",696.07,85,,556.86,,,0,"percent of total billed charges ","85% of total billed charges ",737.01,90,,589.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",712.44,87,,569.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",573.23,70,,458.58,,,0,"percent of total billed charges ","70% of total billed charges ",573.23,761.58,
"ART SURF MC EF 4-5 RT 10MM",6107321,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC EF 4-5 RT 11MM",6107322,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC EF 4-5 RT 12MM",6107323,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC EF 4-5 RT 13MM",6107324,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ARTICL'G SURF EF YEL'W STRP 10",6107325,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2178,1742.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1742.4,80,,1393.92,,,0,"percent of total billed charges ","80% of total billed charges ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",2025.54,93,,1620.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1894.86,87,,1515.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1524.6,2025.54,
"ARTICL'G SURF EF YEL'W STRP 12",6107326,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2795.1,2236.08,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2236.08,80,,1788.86,,,0,"percent of total billed charges ","80% of total billed charges ",1956.57,70,,1565.26,,,0,"percent of total billed charges ","70% of total billed charges ",2515.59,90,,2012.47,,,0,"percent of total billed charges ","90% of total billed charges ",2599.44,93,,2079.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2375.84,85,,1900.67,,,0,"percent of total billed charges ","85% of total billed charges ",2375.84,85,,1900.67,,,0,"percent of total billed charges ","85% of total billed charges ",2515.59,90,,2012.47,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2431.74,87,,1945.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1956.57,70,,1565.26,,,0,"percent of total billed charges ","70% of total billed charges ",1956.57,2599.44,
"ARTICL'G SURF EF YEL'W STRP 14",6107327,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2795.1,2236.08,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2236.08,80,,1788.86,,,0,"percent of total billed charges ","80% of total billed charges ",1956.57,70,,1565.26,,,0,"percent of total billed charges ","70% of total billed charges ",2515.59,90,,2012.47,,,0,"percent of total billed charges ","90% of total billed charges ",2599.44,93,,2079.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2375.84,85,,1900.67,,,0,"percent of total billed charges ","85% of total billed charges ",2375.84,85,,1900.67,,,0,"percent of total billed charges ","85% of total billed charges ",2515.59,90,,2012.47,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2431.74,87,,1945.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1956.57,70,,1565.26,,,0,"percent of total billed charges ","70% of total billed charges ",1956.57,2599.44,
"ART SURF MC EF 8-11 RT 11MM",6107328,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC EF 4-5 RT 14MM",6107329,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC EF 4-5 RT 16MM",6107330,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"SHELL BIPOLAR METAL 40MM",6107344,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,964.87,771.896,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",771.9,80,,617.52,,,0,"percent of total billed charges ","80% of total billed charges ",675.41,70,,540.33,,,0,"percent of total billed charges ","70% of total billed charges ",868.38,90,,694.70,,,0,"percent of total billed charges ","90% of total billed charges ",897.33,93,,717.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",820.14,85,,656.11,,,0,"percent of total billed charges ","85% of total billed charges ",820.14,85,,656.11,,,0,"percent of total billed charges ","85% of total billed charges ",868.38,90,,694.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",839.44,87,,671.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",675.41,70,,540.33,,,0,"percent of total billed charges ","70% of total billed charges ",675.41,897.33,
"SHELL BIPOLAR METAL 41MM",6107345,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1179.75,943.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",943.8,80,,755.04,,,0,"percent of total billed charges ","80% of total billed charges ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",1097.17,93,,877.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1002.79,85,,802.23,,,0,"percent of total billed charges ","85% of total billed charges ",1002.79,85,,802.23,,,0,"percent of total billed charges ","85% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1026.38,87,,821.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",825.83,1097.17,
"SHELL BIPOLAR METAL 42MM",6107346,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1179.75,943.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",943.8,80,,755.04,,,0,"percent of total billed charges ","80% of total billed charges ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",1097.17,93,,877.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1002.79,85,,802.23,,,0,"percent of total billed charges ","85% of total billed charges ",1002.79,85,,802.23,,,0,"percent of total billed charges ","85% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1026.38,87,,821.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",825.83,1097.17,
"SHELL BIPOLAR METAL 43MM",6107347,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1161.6,929.28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",929.28,80,,743.42,,,0,"percent of total billed charges ","80% of total billed charges ",813.12,70,,650.50,,,0,"percent of total billed charges ","70% of total billed charges ",1045.44,90,,836.35,,,0,"percent of total billed charges ","90% of total billed charges ",1080.29,93,,864.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",987.36,85,,789.89,,,0,"percent of total billed charges ","85% of total billed charges ",987.36,85,,789.89,,,0,"percent of total billed charges ","85% of total billed charges ",1045.44,90,,836.35,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1010.59,87,,808.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",813.12,70,,650.50,,,0,"percent of total billed charges ","70% of total billed charges ",813.12,1080.29,
"LINER ASSEMBLY 40/41 OD X 22ID",6107348,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,851.23,680.984,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",680.98,80,,544.78,,,0,"percent of total billed charges ","80% of total billed charges ",595.86,70,,476.69,,,0,"percent of total billed charges ","70% of total billed charges ",766.11,90,,612.89,,,0,"percent of total billed charges ","90% of total billed charges ",791.64,93,,633.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",723.55,85,,578.84,,,0,"percent of total billed charges ","85% of total billed charges ",723.55,85,,578.84,,,0,"percent of total billed charges ","85% of total billed charges ",766.11,90,,612.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",740.57,87,,592.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",595.86,70,,476.69,,,0,"percent of total billed charges ","70% of total billed charges ",595.86,791.64,
"LINER ASSEMBLY 42/43 OD X 22ID",6107349,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,818.9,655.12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",655.12,80,,524.10,,,0,"percent of total billed charges ","80% of total billed charges ",573.23,70,,458.58,,,0,"percent of total billed charges ","70% of total billed charges ",737.01,90,,589.61,,,0,"percent of total billed charges ","90% of total billed charges ",761.58,93,,609.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",696.07,85,,556.86,,,0,"percent of total billed charges ","85% of total billed charges ",696.07,85,,556.86,,,0,"percent of total billed charges ","85% of total billed charges ",737.01,90,,589.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",712.44,87,,569.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",573.23,70,,458.58,,,0,"percent of total billed charges ","70% of total billed charges ",573.23,761.58,
"HEAD FEM 22MM 0MM NK",6107350,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1089,871.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",871.2,80,,696.96,,,0,"percent of total billed charges ","80% of total billed charges ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",1012.77,93,,810.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",947.43,87,,757.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",762.3,1012.77,
"HEAD FEM 22MM -2MM NK",6107351,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1270.5,1016.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1016.4,80,,813.12,,,0,"percent of total billed charges ","80% of total billed charges ",889.35,70,,711.48,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,90,,914.76,,,0,"percent of total billed charges ","90% of total billed charges ",1181.57,93,,945.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1079.93,85,,863.94,,,0,"percent of total billed charges ","85% of total billed charges ",1079.93,85,,863.94,,,0,"percent of total billed charges ","85% of total billed charges ",1143.45,90,,914.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1105.34,87,,884.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",889.35,70,,711.48,,,0,"percent of total billed charges ","70% of total billed charges ",889.35,1181.57,
"HEAD FEM 22MM +3MM NK",6107352,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1119.75,895.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",895.8,80,,716.64,,,0,"percent of total billed charges ","80% of total billed charges ",783.83,70,,627.06,,,0,"percent of total billed charges ","70% of total billed charges ",1007.78,90,,806.22,,,0,"percent of total billed charges ","90% of total billed charges ",1041.37,93,,833.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",951.79,85,,761.43,,,0,"percent of total billed charges ","85% of total billed charges ",951.79,85,,761.43,,,0,"percent of total billed charges ","85% of total billed charges ",1007.78,90,,806.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",974.18,87,,779.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",783.83,70,,627.06,,,0,"percent of total billed charges ","70% of total billed charges ",783.83,1041.37,
"LINER BIPOLAR CUP 47MM",6107359,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1161.6,929.28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",929.28,80,,743.42,,,0,"percent of total billed charges ","80% of total billed charges ",813.12,70,,650.50,,,0,"percent of total billed charges ","70% of total billed charges ",1045.44,90,,836.35,,,0,"percent of total billed charges ","90% of total billed charges ",1080.29,93,,864.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",987.36,85,,789.89,,,0,"percent of total billed charges ","85% of total billed charges ",987.36,85,,789.89,,,0,"percent of total billed charges ","85% of total billed charges ",1045.44,90,,836.35,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1010.59,87,,808.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",813.12,70,,650.50,,,0,"percent of total billed charges ","70% of total billed charges ",813.12,1080.29,
"LINER ASSEMBLY 53-55OD X 28ID",6107361,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,818.9,655.12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",655.12,80,,524.10,,,0,"percent of total billed charges ","80% of total billed charges ",573.23,70,,458.58,,,0,"percent of total billed charges ","70% of total billed charges ",737.01,90,,589.61,,,0,"percent of total billed charges ","90% of total billed charges ",761.58,93,,609.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",696.07,85,,556.86,,,0,"percent of total billed charges ","85% of total billed charges ",696.07,85,,556.86,,,0,"percent of total billed charges ","85% of total billed charges ",737.01,90,,589.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",712.44,87,,569.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",573.23,70,,458.58,,,0,"percent of total billed charges ","70% of total billed charges ",573.23,761.58,
"SHELL BIPOLAR CUP 54MM",6107362,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1179.75,943.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",943.8,80,,755.04,,,0,"percent of total billed charges ","80% of total billed charges ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",1097.17,93,,877.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1002.79,85,,802.23,,,0,"percent of total billed charges ","85% of total billed charges ",1002.79,85,,802.23,,,0,"percent of total billed charges ","85% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1026.38,87,,821.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",825.83,1097.17,
"SCREW BIO 7MM X 25MM",6107368,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,280,224,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",224,80,,179.20,,,0,"percent of total billed charges ","80% of total billed charges ",196,70,,156.80,,,0,"percent of total billed charges ","70% of total billed charges ",252,90,,201.60,,,0,"percent of total billed charges ","90% of total billed charges ",260.4,93,,208.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",238,85,,190.40,,,0,"percent of total billed charges ","85% of total billed charges ",238,85,,190.40,,,0,"percent of total billed charges ","85% of total billed charges ",252,90,,201.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",243.6,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",196,70,,156.80,,,0,"percent of total billed charges ","70% of total billed charges ",196,260.4,
"CUP BIPOLAR SHELL 49MM",6107369,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,969.75,775.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",775.8,80,,620.64,,,0,"percent of total billed charges ","80% of total billed charges ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",901.87,93,,721.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",843.68,87,,674.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",678.83,901.87,
"SCREW SCHANZ 4.0MM X 120MM",6107372,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,226.5,181.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",181.2,80,,144.96,,,0,"percent of total billed charges ","80% of total billed charges ",158.55,70,,126.84,,,0,"percent of total billed charges ","70% of total billed charges ",203.85,90,,163.08,,,0,"percent of total billed charges ","90% of total billed charges ",210.65,93,,168.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",192.53,85,,154.02,,,0,"percent of total billed charges ","85% of total billed charges ",192.53,85,,154.02,,,0,"percent of total billed charges ","85% of total billed charges ",203.85,90,,163.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",197.06,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",158.55,70,,126.84,,,0,"percent of total billed charges ","70% of total billed charges ",158.55,210.65,
"SCREW SCHANZ 4.0MM X 100MM",6107373,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,226.5,181.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",181.2,80,,144.96,,,0,"percent of total billed charges ","80% of total billed charges ",158.55,70,,126.84,,,0,"percent of total billed charges ","70% of total billed charges ",203.85,90,,163.08,,,0,"percent of total billed charges ","90% of total billed charges ",210.65,93,,168.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",192.53,85,,154.02,,,0,"percent of total billed charges ","85% of total billed charges ",192.53,85,,154.02,,,0,"percent of total billed charges ","85% of total billed charges ",203.85,90,,163.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",197.06,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",158.55,70,,126.84,,,0,"percent of total billed charges ","70% of total billed charges ",158.55,210.65,
"SCREW SCHANZ 4.0MM X 80MM",6107374,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,214,171.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",171.2,80,,136.96,,,0,"percent of total billed charges ","80% of total billed charges ",149.8,70,,119.84,,,0,"percent of total billed charges ","70% of total billed charges ",192.6,90,,154.08,,,0,"percent of total billed charges ","90% of total billed charges ",199.02,93,,159.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",181.9,85,,145.52,,,0,"percent of total billed charges ","85% of total billed charges ",181.9,85,,145.52,,,0,"percent of total billed charges ","85% of total billed charges ",192.6,90,,154.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",186.18,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.8,70,,119.84,,,0,"percent of total billed charges ","70% of total billed charges ",149.8,199.02,
"SCREW SCHANZ 4.0MMX60MM",6107375,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,214,171.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",171.2,80,,136.96,,,0,"percent of total billed charges ","80% of total billed charges ",149.8,70,,119.84,,,0,"percent of total billed charges ","70% of total billed charges ",192.6,90,,154.08,,,0,"percent of total billed charges ","90% of total billed charges ",199.02,93,,159.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",181.9,85,,145.52,,,0,"percent of total billed charges ","85% of total billed charges ",181.9,85,,145.52,,,0,"percent of total billed charges ","85% of total billed charges ",192.6,90,,154.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",186.18,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.8,70,,119.84,,,0,"percent of total billed charges ","70% of total billed charges ",149.8,199.02,
"SCREW SCHANZ 4.0/3.0MMX80MM",6107376,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,226.5,181.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",181.2,80,,144.96,,,0,"percent of total billed charges ","80% of total billed charges ",158.55,70,,126.84,,,0,"percent of total billed charges ","70% of total billed charges ",203.85,90,,163.08,,,0,"percent of total billed charges ","90% of total billed charges ",210.65,93,,168.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",192.53,85,,154.02,,,0,"percent of total billed charges ","85% of total billed charges ",192.53,85,,154.02,,,0,"percent of total billed charges ","85% of total billed charges ",203.85,90,,163.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",197.06,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",158.55,70,,126.84,,,0,"percent of total billed charges ","70% of total billed charges ",158.55,210.65,
"K-WIRE 2.5X150MM (SYNTHES0",6107377,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,253.5,202.8,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",202.8,80,,162.24,,,0,"percent of total billed charges ","80% of total billed charges ",177.45,70,,141.96,,,0,"percent of total billed charges ","70% of total billed charges ",228.15,90,,182.52,,,0,"percent of total billed charges ","90% of total billed charges ",235.76,93,,188.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",215.48,85,,172.38,,,0,"percent of total billed charges ","85% of total billed charges ",215.48,85,,172.38,,,0,"percent of total billed charges ","85% of total billed charges ",228.15,90,,182.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",220.55,87,,176.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.45,70,,141.96,,,0,"percent of total billed charges ","70% of total billed charges ",177.45,235.76,
"LINER ASSEMBLY 44-46OD X28ID",6107392,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,818.9,655.12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",655.12,80,,524.10,,,0,"percent of total billed charges ","80% of total billed charges ",573.23,70,,458.58,,,0,"percent of total billed charges ","70% of total billed charges ",737.01,90,,589.61,,,0,"percent of total billed charges ","90% of total billed charges ",761.58,93,,609.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",696.07,85,,556.86,,,0,"percent of total billed charges ","85% of total billed charges ",696.07,85,,556.86,,,0,"percent of total billed charges ","85% of total billed charges ",737.01,90,,589.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",712.44,87,,569.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",573.23,70,,458.58,,,0,"percent of total billed charges ","70% of total billed charges ",573.23,761.58,
"SHELL BIPOLAR CUP 44MM",6107393,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1161.6,929.28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",929.28,80,,743.42,,,0,"percent of total billed charges ","80% of total billed charges ",813.12,70,,650.50,,,0,"percent of total billed charges ","70% of total billed charges ",1045.44,90,,836.35,,,0,"percent of total billed charges ","90% of total billed charges ",1080.29,93,,864.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",987.36,85,,789.89,,,0,"percent of total billed charges ","85% of total billed charges ",987.36,85,,789.89,,,0,"percent of total billed charges ","85% of total billed charges ",1045.44,90,,836.35,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1010.59,87,,808.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",813.12,70,,650.50,,,0,"percent of total billed charges ","70% of total billed charges ",813.12,1080.29,
"CUP BIPOLAR SHELL 46MM",6107394,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1161.6,929.28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",929.28,80,,743.42,,,0,"percent of total billed charges ","80% of total billed charges ",813.12,70,,650.50,,,0,"percent of total billed charges ","70% of total billed charges ",1045.44,90,,836.35,,,0,"percent of total billed charges ","90% of total billed charges ",1080.29,93,,864.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",987.36,85,,789.89,,,0,"percent of total billed charges ","85% of total billed charges ",987.36,85,,789.89,,,0,"percent of total billed charges ","85% of total billed charges ",1045.44,90,,836.35,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1010.59,87,,808.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",813.12,70,,650.50,,,0,"percent of total billed charges ","70% of total billed charges ",813.12,1080.29,
"ART SURF MC GH 8-11 RT 11MM",6107408,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC GH 8-11 RT 12MM",6107409,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"CATH PLEURAL PLEURX KIT",6107419,"CDM ",272,RC,C1729,HCPCS,OUTPATIENT,,,1084.26,867.408,,,,,,,,0,"other ","not separately reimbursment ",,,,93.87,93.87,93.87,"1 through 10","other ","not separately reimbursment ",867.41,80,,693.93,,,0,"percent of total billed charges ","80% of total billed charges ",758.98,70,,607.18,,,0,"percent of total billed charges ","70% of total billed charges ",975.83,90,,780.66,,,0,"percent of total billed charges ","90% of total billed charges ",1008.36,93,,806.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",921.62,85,,737.30,,,0,"percent of total billed charges ","85% of total billed charges ",975.83,90,,780.66,,,0,"percent of total billed charges ","90% of total billed charges ",975.83,90,,780.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",943.31,87,,754.65,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",758.98,70,,607.18,,,0,"percent of total billed charges ","70% of total billed charges ",758.98,1008.36,
"LINER ASSEMBLY 50-52OD X 28IDM",6107420,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,818.9,655.12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",655.12,80,,524.10,,,0,"percent of total billed charges ","80% of total billed charges ",573.23,70,,458.58,,,0,"percent of total billed charges ","70% of total billed charges ",737.01,90,,589.61,,,0,"percent of total billed charges ","90% of total billed charges ",761.58,93,,609.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",696.07,85,,556.86,,,0,"percent of total billed charges ","85% of total billed charges ",696.07,85,,556.86,,,0,"percent of total billed charges ","85% of total billed charges ",737.01,90,,589.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",712.44,87,,569.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",573.23,70,,458.58,,,0,"percent of total billed charges ","70% of total billed charges ",573.23,761.58,
"SHELL BIPOLAR CUP 50MM",6107421,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1161.6,929.28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",929.28,80,,743.42,,,0,"percent of total billed charges ","80% of total billed charges ",813.12,70,,650.50,,,0,"percent of total billed charges ","70% of total billed charges ",1045.44,90,,836.35,,,0,"percent of total billed charges ","90% of total billed charges ",1080.29,93,,864.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",987.36,85,,789.89,,,0,"percent of total billed charges ","85% of total billed charges ",987.36,85,,789.89,,,0,"percent of total billed charges ","85% of total billed charges ",1045.44,90,,836.35,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1010.59,87,,808.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",813.12,70,,650.50,,,0,"percent of total billed charges ","70% of total billed charges ",813.12,1080.29,
"SHELL DIPOLAR METAL 45MM",6107423,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1161.6,929.28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",929.28,80,,743.42,,,0,"percent of total billed charges ","80% of total billed charges ",813.12,70,,650.50,,,0,"percent of total billed charges ","70% of total billed charges ",1045.44,90,,836.35,,,0,"percent of total billed charges ","90% of total billed charges ",1080.29,93,,864.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",987.36,85,,789.89,,,0,"percent of total billed charges ","85% of total billed charges ",987.36,85,,789.89,,,0,"percent of total billed charges ","85% of total billed charges ",1045.44,90,,836.35,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1010.59,87,,808.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",813.12,70,,650.50,,,0,"percent of total billed charges ","70% of total billed charges ",813.12,1080.29,
"SHELL BIPOLAR METAL 51MM",6107424,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1179.75,943.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",943.8,80,,755.04,,,0,"percent of total billed charges ","80% of total billed charges ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",1097.17,93,,877.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1002.79,85,,802.23,,,0,"percent of total billed charges ","85% of total billed charges ",1002.79,85,,802.23,,,0,"percent of total billed charges ","85% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1026.38,87,,821.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",825.83,1097.17,
"SHELL BIPOLAR METAL 52MM",6107425,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1161.6,929.28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",929.28,80,,743.42,,,0,"percent of total billed charges ","80% of total billed charges ",813.12,70,,650.50,,,0,"percent of total billed charges ","70% of total billed charges ",1045.44,90,,836.35,,,0,"percent of total billed charges ","90% of total billed charges ",1080.29,93,,864.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",987.36,85,,789.89,,,0,"percent of total billed charges ","85% of total billed charges ",987.36,85,,789.89,,,0,"percent of total billed charges ","85% of total billed charges ",1045.44,90,,836.35,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1010.59,87,,808.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",813.12,70,,650.50,,,0,"percent of total billed charges ","70% of total billed charges ",813.12,1080.29,
"SHELL BIPOLAR METAL 53MM",6107426,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1161.6,929.28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",929.28,80,,743.42,,,0,"percent of total billed charges ","80% of total billed charges ",813.12,70,,650.50,,,0,"percent of total billed charges ","70% of total billed charges ",1045.44,90,,836.35,,,0,"percent of total billed charges ","90% of total billed charges ",1080.29,93,,864.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",987.36,85,,789.89,,,0,"percent of total billed charges ","85% of total billed charges ",987.36,85,,789.89,,,0,"percent of total billed charges ","85% of total billed charges ",1045.44,90,,836.35,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1010.59,87,,808.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",813.12,70,,650.50,,,0,"percent of total billed charges ","70% of total billed charges ",813.12,1080.29,
"SHELL BIPOLAR METAL 55MM",6107427,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1179.75,943.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",943.8,80,,755.04,,,0,"percent of total billed charges ","80% of total billed charges ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",1097.17,93,,877.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1002.79,85,,802.23,,,0,"percent of total billed charges ","85% of total billed charges ",1002.79,85,,802.23,,,0,"percent of total billed charges ","85% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1026.38,87,,821.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",825.83,1097.17,
"SHELL BIPOLAR METAL 57MM",6107428,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1161.6,929.28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",929.28,80,,743.42,,,0,"percent of total billed charges ","80% of total billed charges ",813.12,70,,650.50,,,0,"percent of total billed charges ","70% of total billed charges ",1045.44,90,,836.35,,,0,"percent of total billed charges ","90% of total billed charges ",1080.29,93,,864.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",987.36,85,,789.89,,,0,"percent of total billed charges ","85% of total billed charges ",987.36,85,,789.89,,,0,"percent of total billed charges ","85% of total billed charges ",1045.44,90,,836.35,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1010.59,87,,808.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",813.12,70,,650.50,,,0,"percent of total billed charges ","70% of total billed charges ",813.12,1080.29,
"SHELL BIPOLAR METAL 58MM",6107429,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,972.75,778.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",778.2,80,,622.56,,,0,"percent of total billed charges ","80% of total billed charges ",680.93,70,,544.74,,,0,"percent of total billed charges ","70% of total billed charges ",875.48,90,,700.38,,,0,"percent of total billed charges ","90% of total billed charges ",904.66,93,,723.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",826.84,85,,661.47,,,0,"percent of total billed charges ","85% of total billed charges ",826.84,85,,661.47,,,0,"percent of total billed charges ","85% of total billed charges ",875.48,90,,700.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",846.29,87,,677.03,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",680.93,70,,544.74,,,0,"percent of total billed charges ","70% of total billed charges ",680.93,904.66,
"SHELL BIPOLAR METAL 60MM",6107430,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,917.94,734.352,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",734.35,80,,587.48,,,0,"percent of total billed charges ","80% of total billed charges ",642.56,70,,514.05,,,0,"percent of total billed charges ","70% of total billed charges ",826.15,90,,660.92,,,0,"percent of total billed charges ","90% of total billed charges ",853.68,93,,682.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",780.25,85,,624.20,,,0,"percent of total billed charges ","85% of total billed charges ",780.25,85,,624.20,,,0,"percent of total billed charges ","85% of total billed charges ",826.15,90,,660.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",798.61,87,,638.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",642.56,70,,514.05,,,0,"percent of total billed charges ","70% of total billed charges ",642.56,853.68,
"SHELL BIPOLAR METAL 62MM",6107431,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1003.46,802.768,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",802.77,80,,642.22,,,0,"percent of total billed charges ","80% of total billed charges ",702.42,70,,561.94,,,0,"percent of total billed charges ","70% of total billed charges ",903.11,90,,722.49,,,0,"percent of total billed charges ","90% of total billed charges ",933.22,93,,746.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",852.94,85,,682.35,,,0,"percent of total billed charges ","85% of total billed charges ",852.94,85,,682.35,,,0,"percent of total billed charges ","85% of total billed charges ",903.11,90,,722.49,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",873.01,87,,698.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",702.42,70,,561.94,,,0,"percent of total billed charges ","70% of total billed charges ",702.42,933.22,
"SHELL BIPOLAR METAL 64MM",6107432,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,917.94,734.352,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",734.35,80,,587.48,,,0,"percent of total billed charges ","80% of total billed charges ",642.56,70,,514.05,,,0,"percent of total billed charges ","70% of total billed charges ",826.15,90,,660.92,,,0,"percent of total billed charges ","90% of total billed charges ",853.68,93,,682.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",780.25,85,,624.20,,,0,"percent of total billed charges ","85% of total billed charges ",780.25,85,,624.20,,,0,"percent of total billed charges ","85% of total billed charges ",826.15,90,,660.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",798.61,87,,638.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",642.56,70,,514.05,,,0,"percent of total billed charges ","70% of total billed charges ",642.56,853.68,
"SHELL BIPOLAR METAL 66MM",6107433,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,917.94,734.352,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",734.35,80,,587.48,,,0,"percent of total billed charges ","80% of total billed charges ",642.56,70,,514.05,,,0,"percent of total billed charges ","70% of total billed charges ",826.15,90,,660.92,,,0,"percent of total billed charges ","90% of total billed charges ",853.68,93,,682.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",780.25,85,,624.20,,,0,"percent of total billed charges ","85% of total billed charges ",780.25,85,,624.20,,,0,"percent of total billed charges ","85% of total billed charges ",826.15,90,,660.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",798.61,87,,638.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",642.56,70,,514.05,,,0,"percent of total billed charges ","70% of total billed charges ",642.56,853.68,
"LINER ASSEMBLY 60/62OD X 28ID",6107434,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,733.73,586.984,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",586.98,80,,469.58,,,0,"percent of total billed charges ","80% of total billed charges ",513.61,70,,410.89,,,0,"percent of total billed charges ","70% of total billed charges ",660.36,90,,528.29,,,0,"percent of total billed charges ","90% of total billed charges ",682.37,93,,545.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",623.67,85,,498.94,,,0,"percent of total billed charges ","85% of total billed charges ",623.67,85,,498.94,,,0,"percent of total billed charges ","85% of total billed charges ",660.36,90,,528.29,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",638.35,87,,510.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",513.61,70,,410.89,,,0,"percent of total billed charges ","70% of total billed charges ",513.61,682.37,
"LINER ADDEMBLY 64/66OD X 28ID",6107435,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,670.42,536.336,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",536.34,80,,429.07,,,0,"percent of total billed charges ","80% of total billed charges ",469.29,70,,375.43,,,0,"percent of total billed charges ","70% of total billed charges ",603.38,90,,482.70,,,0,"percent of total billed charges ","90% of total billed charges ",623.49,93,,498.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",569.86,85,,455.89,,,0,"percent of total billed charges ","85% of total billed charges ",569.86,85,,455.89,,,0,"percent of total billed charges ","85% of total billed charges ",603.38,90,,482.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",583.27,87,,466.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",469.29,70,,375.43,,,0,"percent of total billed charges ","70% of total billed charges ",469.29,623.49,
"ART SURF MC EF 6-7 RT 10MM",6107436,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"SCREW SCHANZ 4.0MM X 125MM",6107451,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,366.5,293.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",293.2,80,,234.56,,,0,"percent of total billed charges ","80% of total billed charges ",256.55,70,,205.24,,,0,"percent of total billed charges ","70% of total billed charges ",329.85,90,,263.88,,,0,"percent of total billed charges ","90% of total billed charges ",340.85,93,,272.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",311.53,85,,249.22,,,0,"percent of total billed charges ","85% of total billed charges ",311.53,85,,249.22,,,0,"percent of total billed charges ","85% of total billed charges ",329.85,90,,263.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",318.86,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",256.55,70,,205.24,,,0,"percent of total billed charges ","70% of total billed charges ",256.55,340.85,
"CATH DBL LUMEN SWAN-GANZ",6107465,"CDM ",272,RC,C1751,HCPCS,OUTPATIENT,,,177.8,142.24,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.24,80,,113.79,,,0,"percent of total billed charges ","80% of total billed charges ",124.46,70,,99.57,,,0,"percent of total billed charges ","70% of total billed charges ",160.02,90,,128.02,,,0,"percent of total billed charges ","90% of total billed charges ",165.35,93,,132.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",151.13,85,,120.90,,,0,"percent of total billed charges ","85% of total billed charges ",160.02,90,,128.02,,,0,"percent of total billed charges ","90% of total billed charges ",160.02,90,,128.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",154.69,87,,123.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.46,70,,99.57,,,0,"percent of total billed charges ","70% of total billed charges ",124.46,165.35,
"TAPE VAGINAL TENSION FREE",6107480,"CDM ",278,RC,C1771,HCPCS,OUTPATIENT,,,2526.53,2021.224,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2021.22,80,,1616.98,,,0,"percent of total billed charges ","80% of total billed charges ",1768.57,70,,1414.86,,,0,"percent of total billed charges ","70% of total billed charges ",2273.88,90,,1819.10,,,0,"percent of total billed charges ","90% of total billed charges ",2349.67,93,,1879.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2147.55,85,,1718.04,,,0,"percent of total billed charges ","85% of total billed charges ",2147.55,85,,1718.04,,,0,"percent of total billed charges ","85% of total billed charges ",2273.88,90,,1819.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2198.08,87,,1758.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1768.57,70,,1414.86,,,0,"percent of total billed charges ","70% of total billed charges ",1768.57,2349.67,
"STEM FEM FIBER TAPER MC STD 14",6107491,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5959.55,4767.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4767.64,80,,3814.11,,,0,"percent of total billed charges ","80% of total billed charges ",4171.69,70,,3337.35,,,0,"percent of total billed charges ","70% of total billed charges ",5363.6,90,,4290.88,,,0,"percent of total billed charges ","90% of total billed charges ",5542.38,93,,4433.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5065.62,85,,4052.50,,,0,"percent of total billed charges ","85% of total billed charges ",5065.62,85,,4052.50,,,0,"percent of total billed charges ","85% of total billed charges ",5363.6,90,,4290.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5184.81,87,,4147.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4171.69,70,,3337.35,,,0,"percent of total billed charges ","70% of total billed charges ",4171.69,5542.38,
"ART SURF MC EF 8-11 RT 12MM",6107513,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC EF 8-11 RT 13MM",6107514,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"BRNG TIBIA PS 14X71/75MM",6107518,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1633.5,1306.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1306.8,80,,1045.44,,,0,"percent of total billed charges ","80% of total billed charges ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",1519.16,93,,1215.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1421.15,87,,1136.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,1519.16,
"BRNG TIBIA PS 15X71/75MM",6107519,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1633.5,1306.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1306.8,80,,1045.44,,,0,"percent of total billed charges ","80% of total billed charges ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",1519.16,93,,1215.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1421.15,87,,1136.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,1519.16,
"BRNG TIBIA PS 18X71/75MM",6107520,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1633.5,1306.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1306.8,80,,1045.44,,,0,"percent of total billed charges ","80% of total billed charges ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",1519.16,93,,1215.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1421.15,87,,1136.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,1519.16,
"BRNG TIBIA PS 20X71/75MM",6107521,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1633.5,1306.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1306.8,80,,1045.44,,,0,"percent of total billed charges ","80% of total billed charges ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",1519.16,93,,1215.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1421.15,87,,1136.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,1519.16,
"COMPONET CR ART SURF BLUE 10MM",6107523,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1573.61,1258.888,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1258.89,80,,1007.11,,,0,"percent of total billed charges ","80% of total billed charges ",1101.53,70,,881.22,,,0,"percent of total billed charges ","70% of total billed charges ",1416.25,90,,1133.00,,,0,"percent of total billed charges ","90% of total billed charges ",1463.46,93,,1170.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1337.57,85,,1070.06,,,0,"percent of total billed charges ","85% of total billed charges ",1337.57,85,,1070.06,,,0,"percent of total billed charges ","85% of total billed charges ",1416.25,90,,1133.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1369.04,87,,1095.23,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1101.53,70,,881.22,,,0,"percent of total billed charges ","70% of total billed charges ",1101.53,1463.46,
"BRNG TIBIA PS 10X79/83MM",6107524,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1633.5,1306.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1306.8,80,,1045.44,,,0,"percent of total billed charges ","80% of total billed charges ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",1519.16,93,,1215.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1421.15,87,,1136.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,1519.16,
"BRNG TIBIA PS 12X79/83MM",6107525,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1633.5,1306.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1306.8,80,,1045.44,,,0,"percent of total billed charges ","80% of total billed charges ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",1519.16,93,,1215.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1421.15,87,,1136.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,1519.16,
"BRNG TIBIA PS 14X79/83MM",6107526,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1633.5,1306.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1306.8,80,,1045.44,,,0,"percent of total billed charges ","80% of total billed charges ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",1519.16,93,,1215.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1421.15,87,,1136.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,1519.16,
"BRNG TIBIA PS 16X79/83MM",6107527,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1633.5,1306.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1306.8,80,,1045.44,,,0,"percent of total billed charges ","80% of total billed charges ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",1519.16,93,,1215.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1421.15,87,,1136.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,1519.16,
"COMPONET CR ART SURF 14MM YELL",6107530,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1633.5,1306.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1306.8,80,,1045.44,,,0,"percent of total billed charges ","80% of total billed charges ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",1519.16,93,,1215.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1421.15,87,,1136.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,1519.16,
"BRNG TIBIA PS 20X79/83MM",6107531,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1633.5,1306.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1306.8,80,,1045.44,,,0,"percent of total billed charges ","80% of total billed charges ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",1519.16,93,,1215.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1421.15,87,,1136.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,1519.16,
"BRNG TIBIBA PS+ 10X59MM",6107532,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2087.25,1669.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1669.8,80,,1335.84,,,0,"percent of total billed charges ","80% of total billed charges ",1461.08,70,,1168.86,,,0,"percent of total billed charges ","70% of total billed charges ",1878.53,90,,1502.82,,,0,"percent of total billed charges ","90% of total billed charges ",1941.14,93,,1552.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1774.16,85,,1419.33,,,0,"percent of total billed charges ","85% of total billed charges ",1774.16,85,,1419.33,,,0,"percent of total billed charges ","85% of total billed charges ",1878.53,90,,1502.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1815.91,87,,1452.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1461.08,70,,1168.86,,,0,"percent of total billed charges ","70% of total billed charges ",1461.08,1941.14,
"COMPONET CR ART SURF 10M Y'L S",6107533,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1770.1,1416.08,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1416.08,80,,1132.86,,,0,"percent of total billed charges ","80% of total billed charges ",1239.07,70,,991.26,,,0,"percent of total billed charges ","70% of total billed charges ",1593.09,90,,1274.47,,,0,"percent of total billed charges ","90% of total billed charges ",1646.19,93,,1316.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1504.59,85,,1203.67,,,0,"percent of total billed charges ","85% of total billed charges ",1504.59,85,,1203.67,,,0,"percent of total billed charges ","85% of total billed charges ",1593.09,90,,1274.47,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1539.99,87,,1231.99,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1239.07,70,,991.26,,,0,"percent of total billed charges ","70% of total billed charges ",1239.07,1646.19,
"COMPONET CR ART SURF 12M Y'L S",6107534,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1417.06,1133.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1133.65,80,,906.92,,,0,"percent of total billed charges ","80% of total billed charges ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",1317.87,93,,1054.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1232.84,87,,986.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",991.94,1317.87,
"COMPONET CR ART SURF 14M Y'L S",6107535,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1417.06,1133.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1133.65,80,,906.92,,,0,"percent of total billed charges ","80% of total billed charges ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",1317.87,93,,1054.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1232.84,87,,986.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",991.94,1317.87,
"COMPONET CR ART SURF 17M Y'L S",6107536,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1417.06,1133.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1133.65,80,,906.92,,,0,"percent of total billed charges ","80% of total billed charges ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",1317.87,93,,1054.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1232.84,87,,986.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",991.94,1317.87,
"COMPONET CR ART SURF 20M Y'L S",6107537,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1417.06,1133.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1133.65,80,,906.92,,,0,"percent of total billed charges ","80% of total billed charges ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",1317.87,93,,1054.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1232.84,87,,986.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",991.94,1317.87,
"COMPONET CR ART SURF 10M PURPL",6107538,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1417.06,1133.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1133.65,80,,906.92,,,0,"percent of total billed charges ","80% of total billed charges ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",1317.87,93,,1054.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1232.84,87,,986.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",991.94,1317.87,
"COMPONET CR ART SURF 12M PURPL",6107539,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1417.06,1133.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1133.65,80,,906.92,,,0,"percent of total billed charges ","80% of total billed charges ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",1317.87,93,,1054.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1232.84,87,,986.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",991.94,1317.87,
"COMPONET CR ART SURF 14M PURPL",6107540,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1417.06,1133.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1133.65,80,,906.92,,,0,"percent of total billed charges ","80% of total billed charges ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",1317.87,93,,1054.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1232.84,87,,986.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",991.94,1317.87,
"COMPONET CR ART SURF 17M PURPL",6107541,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1417.06,1133.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1133.65,80,,906.92,,,0,"percent of total billed charges ","80% of total billed charges ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",1317.87,93,,1054.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1232.84,87,,986.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",991.94,1317.87,
"COMPONET CR ART SURF 20M PURPL",6107542,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1417.06,1133.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1133.65,80,,906.92,,,0,"percent of total billed charges ","80% of total billed charges ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",1317.87,93,,1054.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1232.84,87,,986.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",991.94,1317.87,
"COMPONET CR ART SURF 10M PUR'L",6107543,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1417.06,1133.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1133.65,80,,906.92,,,0,"percent of total billed charges ","80% of total billed charges ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",1317.87,93,,1054.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1232.84,87,,986.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",991.94,1317.87,
"COMPONET CR ART SURF 12M PUR'L",6107544,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1417.06,1133.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1133.65,80,,906.92,,,0,"percent of total billed charges ","80% of total billed charges ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",1317.87,93,,1054.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1232.84,87,,986.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",991.94,1317.87,
"COMPONET CR ART SURF 14M PURPL",6107545,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1417.06,1133.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1133.65,80,,906.92,,,0,"percent of total billed charges ","80% of total billed charges ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",1317.87,93,,1054.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1232.84,87,,986.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",991.94,1317.87,
"COMPONET CR ART SURF 17M PURPL",6107546,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1417.06,1133.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1133.65,80,,906.92,,,0,"percent of total billed charges ","80% of total billed charges ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",1317.87,93,,1054.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1232.84,87,,986.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",991.94,1317.87,
"COMPONET CR ART SURF 20M PURPL",6107547,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1417.06,1133.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1133.65,80,,906.92,,,0,"percent of total billed charges ","80% of total billed charges ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",1317.87,93,,1054.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1204.5,85,,963.60,,,0,"percent of total billed charges ","85% of total billed charges ",1275.35,90,,1020.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1232.84,87,,986.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",991.94,70,,793.55,,,0,"percent of total billed charges ","70% of total billed charges ",991.94,1317.87,
"TAPER VERSYS 13X130 LM BODY",6107551,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5959.55,4767.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4767.64,80,,3814.11,,,0,"percent of total billed charges ","80% of total billed charges ",4171.69,70,,3337.35,,,0,"percent of total billed charges ","70% of total billed charges ",5363.6,90,,4290.88,,,0,"percent of total billed charges ","90% of total billed charges ",5542.38,93,,4433.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5065.62,85,,4052.50,,,0,"percent of total billed charges ","85% of total billed charges ",5065.62,85,,4052.50,,,0,"percent of total billed charges ","85% of total billed charges ",5363.6,90,,4290.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5184.81,87,,4147.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4171.69,70,,3337.35,,,0,"percent of total billed charges ","70% of total billed charges ",4171.69,5542.38,
"IMPLANT FLEX HINGE TOE REGULAR",6107569,"CDM ",278,RC,L8641,HCPCS,OUTPATIENT,,,1470.15,1176.12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1176.12,80,,940.90,,,0,"percent of total billed charges ","80% of total billed charges ",1029.11,70,,823.29,,,0,"percent of total billed charges ","70% of total billed charges ",1323.14,90,,1058.51,,,0,"percent of total billed charges ","90% of total billed charges ",1367.24,93,,1093.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1249.63,85,,999.70,,,0,"percent of total billed charges ","85% of total billed charges ",1249.63,85,,999.70,,,0,"percent of total billed charges ","85% of total billed charges ",1323.14,90,,1058.51,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1279.03,87,,1023.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1029.11,70,,823.29,,,0,"percent of total billed charges ","70% of total billed charges ",1029.11,1367.24,
"COMPONET LPS ART SURF 10MM",6107570,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2178,1742.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1742.4,80,,1393.92,,,0,"percent of total billed charges ","80% of total billed charges ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",2025.54,93,,1620.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1894.86,87,,1515.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1524.6,2025.54,
"COMPONET LPS ART SUF 12MM",6107571,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2178,1742.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1742.4,80,,1393.92,,,0,"percent of total billed charges ","80% of total billed charges ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",2025.54,93,,1620.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1851.3,85,,1481.04,,,0,"percent of total billed charges ","85% of total billed charges ",1960.2,90,,1568.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1894.86,87,,1515.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1524.6,70,,1219.68,,,0,"percent of total billed charges ","70% of total billed charges ",1524.6,2025.54,
"ART SURF MC EF 6-7 RT 11MM",6107572,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC EF 6-7 RT 12MM",6107573,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"ART SURF MC EF 6-7 RT 13MM",6107574,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"BRNG TIBIA PS+ 12X59MM",6107575,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2087.25,1669.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1669.8,80,,1335.84,,,0,"percent of total billed charges ","80% of total billed charges ",1461.08,70,,1168.86,,,0,"percent of total billed charges ","70% of total billed charges ",1878.53,90,,1502.82,,,0,"percent of total billed charges ","90% of total billed charges ",1941.14,93,,1552.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1774.16,85,,1419.33,,,0,"percent of total billed charges ","85% of total billed charges ",1774.16,85,,1419.33,,,0,"percent of total billed charges ","85% of total billed charges ",1878.53,90,,1502.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1815.91,87,,1452.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1461.08,70,,1168.86,,,0,"percent of total billed charges ","70% of total billed charges ",1461.08,1941.14,
"KNEE CR FEMORAL POR'S SLB,LT",6107620,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,4446.3,3557.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3557.04,80,,2845.63,,,0,"percent of total billed charges ","80% of total billed charges ",3112.41,70,,2489.93,,,0,"percent of total billed charges ","70% of total billed charges ",4001.67,90,,3201.34,,,0,"percent of total billed charges ","90% of total billed charges ",4135.06,93,,3308.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3779.36,85,,3023.49,,,0,"percent of total billed charges ","85% of total billed charges ",3779.36,85,,3023.49,,,0,"percent of total billed charges ","85% of total billed charges ",4001.67,90,,3201.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3868.28,87,,3094.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3112.41,70,,2489.93,,,0,"percent of total billed charges ","70% of total billed charges ",3112.41,4135.06,
"KNEE CR POR'S SLB,RT",6107621,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,4537.05,3629.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3629.64,80,,2903.71,,,0,"percent of total billed charges ","80% of total billed charges ",3175.94,70,,2540.75,,,0,"percent of total billed charges ","70% of total billed charges ",4083.35,90,,3266.68,,,0,"percent of total billed charges ","90% of total billed charges ",4219.46,93,,3375.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3856.49,85,,3085.19,,,0,"percent of total billed charges ","85% of total billed charges ",3856.49,85,,3085.19,,,0,"percent of total billed charges ","85% of total billed charges ",4083.35,90,,3266.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3947.23,87,,3157.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3175.94,70,,2540.75,,,0,"percent of total billed charges ","70% of total billed charges ",3175.94,4219.46,
"KNEE CR FEMORAL POR'S SLH,RT",6107633,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"PATELLA STD 3 PEG 25X8MM",6107658,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,969.75,775.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",775.8,80,,620.64,,,0,"percent of total billed charges ","80% of total billed charges ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",901.87,93,,721.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",843.68,87,,674.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",678.83,901.87,
"PATELLA MICRO POLY 29MM",6107659,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,909.95,727.96,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",727.96,80,,582.37,,,0,"percent of total billed charges ","80% of total billed charges ",636.97,70,,509.58,,,0,"percent of total billed charges ","70% of total billed charges ",818.96,90,,655.17,,,0,"percent of total billed charges ","90% of total billed charges ",846.25,93,,677.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",773.46,85,,618.77,,,0,"percent of total billed charges ","85% of total billed charges ",773.46,85,,618.77,,,0,"percent of total billed charges ","85% of total billed charges ",818.96,90,,655.17,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",791.66,87,,633.33,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",636.97,70,,509.58,,,0,"percent of total billed charges ","70% of total billed charges ",636.97,846.25,
"PATELLA MICRO POLY 32MM",6107660,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,909.95,727.96,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",727.96,80,,582.37,,,0,"percent of total billed charges ","80% of total billed charges ",636.97,70,,509.58,,,0,"percent of total billed charges ","70% of total billed charges ",818.96,90,,655.17,,,0,"percent of total billed charges ","90% of total billed charges ",846.25,93,,677.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",773.46,85,,618.77,,,0,"percent of total billed charges ","85% of total billed charges ",773.46,85,,618.77,,,0,"percent of total billed charges ","85% of total billed charges ",818.96,90,,655.17,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",791.66,87,,633.33,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",636.97,70,,509.58,,,0,"percent of total billed charges ","70% of total billed charges ",636.97,846.25,
"PATELLA MICRO POLY 35MM",6107661,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,526.36,421.088,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",421.09,80,,336.87,,,0,"percent of total billed charges ","80% of total billed charges ",368.45,70,,294.76,,,0,"percent of total billed charges ","70% of total billed charges ",473.72,90,,378.98,,,0,"percent of total billed charges ","90% of total billed charges ",489.51,93,,391.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",447.41,85,,357.93,,,0,"percent of total billed charges ","85% of total billed charges ",447.41,85,,357.93,,,0,"percent of total billed charges ","85% of total billed charges ",473.72,90,,378.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",457.93,87,,366.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",368.45,70,,294.76,,,0,"percent of total billed charges ","70% of total billed charges ",368.45,489.51,
"BRNG TIBIA PS+ 14X59MM",6107668,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2087.25,1669.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1669.8,80,,1335.84,,,0,"percent of total billed charges ","80% of total billed charges ",1461.08,70,,1168.86,,,0,"percent of total billed charges ","70% of total billed charges ",1878.53,90,,1502.82,,,0,"percent of total billed charges ","90% of total billed charges ",1941.14,93,,1552.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1774.16,85,,1419.33,,,0,"percent of total billed charges ","85% of total billed charges ",1774.16,85,,1419.33,,,0,"percent of total billed charges ","85% of total billed charges ",1878.53,90,,1502.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1815.91,87,,1452.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1461.08,70,,1168.86,,,0,"percent of total billed charges ","70% of total billed charges ",1461.08,1941.14,
"FEMORAL STEM VERSYS SL 13",6107677,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,7844.07,6275.256,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6275.26,80,,5020.21,,,0,"percent of total billed charges ","80% of total billed charges ",5490.85,70,,4392.68,,,0,"percent of total billed charges ","70% of total billed charges ",7059.66,90,,5647.73,,,0,"percent of total billed charges ","90% of total billed charges ",7294.99,93,,5835.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6667.46,85,,5333.97,,,0,"percent of total billed charges ","85% of total billed charges ",6667.46,85,,5333.97,,,0,"percent of total billed charges ","85% of total billed charges ",7059.66,90,,5647.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6824.34,87,,5459.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5490.85,70,,4392.68,,,0,"percent of total billed charges ","70% of total billed charges ",5490.85,7294.99,
"STEM VERSYS CRC 13MX170M",6107709,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,10676.74,8541.392,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8541.39,80,,6833.11,,,0,"percent of total billed charges ","80% of total billed charges ",7473.72,70,,5978.98,,,0,"percent of total billed charges ","70% of total billed charges ",9609.07,90,,7687.26,,,0,"percent of total billed charges ","90% of total billed charges ",9929.37,93,,7943.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9075.23,85,,7260.18,,,0,"percent of total billed charges ","85% of total billed charges ",9075.23,85,,7260.18,,,0,"percent of total billed charges ","85% of total billed charges ",9609.07,90,,7687.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9288.76,87,,7431.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7473.72,70,,5978.98,,,0,"percent of total billed charges ","70% of total billed charges ",7473.72,9929.37,
"STEM VERSYS CRC 13MX210M",6107710,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,7374.42,5899.536,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5899.54,80,,4719.63,,,0,"percent of total billed charges ","80% of total billed charges ",5162.09,70,,4129.67,,,0,"percent of total billed charges ","70% of total billed charges ",6636.98,90,,5309.58,,,0,"percent of total billed charges ","90% of total billed charges ",6858.21,93,,5486.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6268.26,85,,5014.61,,,0,"percent of total billed charges ","85% of total billed charges ",6268.26,85,,5014.61,,,0,"percent of total billed charges ","85% of total billed charges ",6636.98,90,,5309.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6415.75,87,,5132.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5162.09,70,,4129.67,,,0,"percent of total billed charges ","70% of total billed charges ",5162.09,6858.21,
"STEM VERSYS CRC 13MX250M",6107711,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,7374.42,5899.536,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5899.54,80,,4719.63,,,0,"percent of total billed charges ","80% of total billed charges ",5162.09,70,,4129.67,,,0,"percent of total billed charges ","70% of total billed charges ",6636.98,90,,5309.58,,,0,"percent of total billed charges ","90% of total billed charges ",6858.21,93,,5486.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6268.26,85,,5014.61,,,0,"percent of total billed charges ","85% of total billed charges ",6268.26,85,,5014.61,,,0,"percent of total billed charges ","85% of total billed charges ",6636.98,90,,5309.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6415.75,87,,5132.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5162.09,70,,4129.67,,,0,"percent of total billed charges ","70% of total billed charges ",5162.09,6858.21,
"STEM VERSYS CRC 13MX300M",6107712,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,7374.42,5899.536,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5899.54,80,,4719.63,,,0,"percent of total billed charges ","80% of total billed charges ",5162.09,70,,4129.67,,,0,"percent of total billed charges ","70% of total billed charges ",6636.98,90,,5309.58,,,0,"percent of total billed charges ","90% of total billed charges ",6858.21,93,,5486.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6268.26,85,,5014.61,,,0,"percent of total billed charges ","85% of total billed charges ",6268.26,85,,5014.61,,,0,"percent of total billed charges ","85% of total billed charges ",6636.98,90,,5309.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6415.75,87,,5132.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5162.09,70,,4129.67,,,0,"percent of total billed charges ","70% of total billed charges ",5162.09,6858.21,
"STEM VERSYS CRC 15MX180M",6107713,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,7374.42,5899.536,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5899.54,80,,4719.63,,,0,"percent of total billed charges ","80% of total billed charges ",5162.09,70,,4129.67,,,0,"percent of total billed charges ","70% of total billed charges ",6636.98,90,,5309.58,,,0,"percent of total billed charges ","90% of total billed charges ",6858.21,93,,5486.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6268.26,85,,5014.61,,,0,"percent of total billed charges ","85% of total billed charges ",6268.26,85,,5014.61,,,0,"percent of total billed charges ","85% of total billed charges ",6636.98,90,,5309.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6415.75,87,,5132.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5162.09,70,,4129.67,,,0,"percent of total billed charges ","70% of total billed charges ",5162.09,6858.21,
"STEM VERSYS CRC 15MX220M",6107714,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,7374.42,5899.536,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5899.54,80,,4719.63,,,0,"percent of total billed charges ","80% of total billed charges ",5162.09,70,,4129.67,,,0,"percent of total billed charges ","70% of total billed charges ",6636.98,90,,5309.58,,,0,"percent of total billed charges ","90% of total billed charges ",6858.21,93,,5486.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6268.26,85,,5014.61,,,0,"percent of total billed charges ","85% of total billed charges ",6268.26,85,,5014.61,,,0,"percent of total billed charges ","85% of total billed charges ",6636.98,90,,5309.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6415.75,87,,5132.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5162.09,70,,4129.67,,,0,"percent of total billed charges ","70% of total billed charges ",5162.09,6858.21,
"STEM VERSYS CRC 15MX250M",6107715,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,7374.42,5899.536,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5899.54,80,,4719.63,,,0,"percent of total billed charges ","80% of total billed charges ",5162.09,70,,4129.67,,,0,"percent of total billed charges ","70% of total billed charges ",6636.98,90,,5309.58,,,0,"percent of total billed charges ","90% of total billed charges ",6858.21,93,,5486.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6268.26,85,,5014.61,,,0,"percent of total billed charges ","85% of total billed charges ",6268.26,85,,5014.61,,,0,"percent of total billed charges ","85% of total billed charges ",6636.98,90,,5309.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6415.75,87,,5132.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5162.09,70,,4129.67,,,0,"percent of total billed charges ","70% of total billed charges ",5162.09,6858.21,
"STEM VERSYS CRC 15MX300M",6107716,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,7374.42,5899.536,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5899.54,80,,4719.63,,,0,"percent of total billed charges ","80% of total billed charges ",5162.09,70,,4129.67,,,0,"percent of total billed charges ","70% of total billed charges ",6636.98,90,,5309.58,,,0,"percent of total billed charges ","90% of total billed charges ",6858.21,93,,5486.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6268.26,85,,5014.61,,,0,"percent of total billed charges ","85% of total billed charges ",6268.26,85,,5014.61,,,0,"percent of total billed charges ","85% of total billed charges ",6636.98,90,,5309.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6415.75,87,,5132.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5162.09,70,,4129.67,,,0,"percent of total billed charges ","70% of total billed charges ",5162.09,6858.21,
"BRNG TIBIA PS+ 16X59MM",6107717,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2087.25,1669.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1669.8,80,,1335.84,,,0,"percent of total billed charges ","80% of total billed charges ",1461.08,70,,1168.86,,,0,"percent of total billed charges ","70% of total billed charges ",1878.53,90,,1502.82,,,0,"percent of total billed charges ","90% of total billed charges ",1941.14,93,,1552.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1774.16,85,,1419.33,,,0,"percent of total billed charges ","85% of total billed charges ",1774.16,85,,1419.33,,,0,"percent of total billed charges ","85% of total billed charges ",1878.53,90,,1502.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1815.91,87,,1452.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1461.08,70,,1168.86,,,0,"percent of total billed charges ","70% of total billed charges ",1461.08,1941.14,
"BRNG TIBIA PS+ 18X59MM",6107718,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2087.25,1669.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1669.8,80,,1335.84,,,0,"percent of total billed charges ","80% of total billed charges ",1461.08,70,,1168.86,,,0,"percent of total billed charges ","70% of total billed charges ",1878.53,90,,1502.82,,,0,"percent of total billed charges ","90% of total billed charges ",1941.14,93,,1552.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1774.16,85,,1419.33,,,0,"percent of total billed charges ","85% of total billed charges ",1774.16,85,,1419.33,,,0,"percent of total billed charges ","85% of total billed charges ",1878.53,90,,1502.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1815.91,87,,1452.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1461.08,70,,1168.86,,,0,"percent of total billed charges ","70% of total billed charges ",1461.08,1941.14,
"BRNG TIBIA PS+ 20X59MM",6107719,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2087.25,1669.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1669.8,80,,1335.84,,,0,"percent of total billed charges ","80% of total billed charges ",1461.08,70,,1168.86,,,0,"percent of total billed charges ","70% of total billed charges ",1878.53,90,,1502.82,,,0,"percent of total billed charges ","90% of total billed charges ",1941.14,93,,1552.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1774.16,85,,1419.33,,,0,"percent of total billed charges ","85% of total billed charges ",1774.16,85,,1419.33,,,0,"percent of total billed charges ","85% of total billed charges ",1878.53,90,,1502.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1815.91,87,,1452.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1461.08,70,,1168.86,,,0,"percent of total billed charges ","70% of total billed charges ",1461.08,1941.14,
"ACETABULAR SHELL TR/LOGY 54MM",6107726,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2769.4,2215.52,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2215.52,80,,1772.42,,,0,"percent of total billed charges ","80% of total billed charges ",1938.58,70,,1550.86,,,0,"percent of total billed charges ","70% of total billed charges ",2492.46,90,,1993.97,,,0,"percent of total billed charges ","90% of total billed charges ",2575.54,93,,2060.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2353.99,85,,1883.19,,,0,"percent of total billed charges ","85% of total billed charges ",2353.99,85,,1883.19,,,0,"percent of total billed charges ","85% of total billed charges ",2492.46,90,,1993.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2409.38,87,,1927.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1938.58,70,,1550.86,,,0,"percent of total billed charges ","70% of total billed charges ",1938.58,2575.54,
"FEMORAL HEAD 32M - 3.5",6107727,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1939.09,1551.272,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1551.27,80,,1241.02,,,0,"percent of total billed charges ","80% of total billed charges ",1357.36,70,,1085.89,,,0,"percent of total billed charges ","70% of total billed charges ",1745.18,90,,1396.14,,,0,"percent of total billed charges ","90% of total billed charges ",1803.35,93,,1442.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1648.23,85,,1318.58,,,0,"percent of total billed charges ","85% of total billed charges ",1648.23,85,,1318.58,,,0,"percent of total billed charges ","85% of total billed charges ",1745.18,90,,1396.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1687.01,87,,1349.61,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1357.36,70,,1085.89,,,0,"percent of total billed charges ","70% of total billed charges ",1357.36,1803.35,
"FEMORAL HEAD 12/14 NECK TAPE",6107728,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,8062.56,6450.048,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6450.05,80,,5160.04,,,0,"percent of total billed charges ","80% of total billed charges ",5643.79,70,,4515.03,,,0,"percent of total billed charges ","70% of total billed charges ",7256.3,90,,5805.04,,,0,"percent of total billed charges ","90% of total billed charges ",7498.18,93,,5998.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6853.18,85,,5482.54,,,0,"percent of total billed charges ","85% of total billed charges ",6853.18,85,,5482.54,,,0,"percent of total billed charges ","85% of total billed charges ",7256.3,90,,5805.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7014.43,87,,5611.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5643.79,70,,4515.03,,,0,"percent of total billed charges ","70% of total billed charges ",5643.79,7498.18,
"FEMORAL STEM 12/14 NECK TAPER",6107740,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,6449.6,5159.68,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5159.68,80,,4127.74,,,0,"percent of total billed charges ","80% of total billed charges ",4514.72,70,,3611.78,,,0,"percent of total billed charges ","70% of total billed charges ",5804.64,90,,4643.71,,,0,"percent of total billed charges ","90% of total billed charges ",5998.13,93,,4798.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5482.16,85,,4385.73,,,0,"percent of total billed charges ","85% of total billed charges ",5482.16,85,,4385.73,,,0,"percent of total billed charges ","85% of total billed charges ",5804.64,90,,4643.71,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5611.15,87,,4488.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4514.72,70,,3611.78,,,0,"percent of total billed charges ","70% of total billed charges ",4514.72,5998.13,
"HEAD FEM 28MM +7MM NK",6107782,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1119.75,895.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",895.8,80,,716.64,,,0,"percent of total billed charges ","80% of total billed charges ",783.83,70,,627.06,,,0,"percent of total billed charges ","70% of total billed charges ",1007.78,90,,806.22,,,0,"percent of total billed charges ","90% of total billed charges ",1041.37,93,,833.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",951.79,85,,761.43,,,0,"percent of total billed charges ","85% of total billed charges ",951.79,85,,761.43,,,0,"percent of total billed charges ","85% of total billed charges ",1007.78,90,,806.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",974.18,87,,779.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",783.83,70,,627.06,,,0,"percent of total billed charges ","70% of total billed charges ",783.83,1041.37,
"MESH PLUG X-LRG",6107834,"CDM ",278,RC,C1781,HCPCS,OUTPATIENT,,,368.51,294.808,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",294.81,80,,235.85,,,0,"percent of total billed charges ","80% of total billed charges ",257.96,70,,206.37,,,0,"percent of total billed charges ","70% of total billed charges ",331.66,90,,265.33,,,0,"percent of total billed charges ","90% of total billed charges ",342.71,93,,274.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",313.23,85,,250.58,,,0,"percent of total billed charges ","85% of total billed charges ",313.23,85,,250.58,,,0,"percent of total billed charges ","85% of total billed charges ",331.66,90,,265.33,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",320.6,87,,256.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",257.96,70,,206.37,,,0,"percent of total billed charges ","70% of total billed charges ",257.96,342.71,
"CLIP ENDO II ML 10MM",6107862,"CDM ",272,RC,C1819,HCPCS,OUTPATIENT,,,754.38,603.504,,,,,,,,0,"other ","not separately reimbursment ",,,,261.60,261.60,261.60,"1 through 10","other ","not separately reimbursment ",603.5,80,,482.80,,,0,"percent of total billed charges ","80% of total billed charges ",528.07,70,,422.46,,,0,"percent of total billed charges ","70% of total billed charges ",678.94,90,,543.15,,,0,"percent of total billed charges ","90% of total billed charges ",701.57,93,,561.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",641.22,85,,512.98,,,0,"percent of total billed charges ","85% of total billed charges ",678.94,90,,543.15,,,0,"percent of total billed charges ","90% of total billed charges ",678.94,90,,543.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",656.31,87,,525.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",528.07,70,,422.46,,,0,"percent of total billed charges ","70% of total billed charges ",528.07,701.57,
"PHYSIOMESH 10 X 15CM OVAL",6107878,"CDM ",278,RC,C1781,HCPCS,OUTPATIENT,,,775.8,620.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",620.64,80,,496.51,,,0,"percent of total billed charges ","80% of total billed charges ",543.06,70,,434.45,,,0,"percent of total billed charges ","70% of total billed charges ",698.22,90,,558.58,,,0,"percent of total billed charges ","90% of total billed charges ",721.49,93,,577.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",659.43,85,,527.54,,,0,"percent of total billed charges ","85% of total billed charges ",659.43,85,,527.54,,,0,"percent of total billed charges ","85% of total billed charges ",698.22,90,,558.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",674.95,87,,539.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",543.06,70,,434.45,,,0,"percent of total billed charges ","70% of total billed charges ",543.06,721.49,
"PHYSIOMESH 15 X 20CM OVAL",6107880,"CDM ",278,RC,C1781,HCPCS,OUTPATIENT,,,1297.73,1038.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1038.18,80,,830.54,,,0,"percent of total billed charges ","80% of total billed charges ",908.41,70,,726.73,,,0,"percent of total billed charges ","70% of total billed charges ",1167.96,90,,934.37,,,0,"percent of total billed charges ","90% of total billed charges ",1206.89,93,,965.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1103.07,85,,882.46,,,0,"percent of total billed charges ","85% of total billed charges ",1103.07,85,,882.46,,,0,"percent of total billed charges ","85% of total billed charges ",1167.96,90,,934.37,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1129.03,87,,903.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",908.41,70,,726.73,,,0,"percent of total billed charges ","70% of total billed charges ",908.41,1206.89,
"PHYSIOMESH 20X20 CM OVAL",6107881,"CDM ",278,RC,C1781,HCPCS,OUTPATIENT,,,2359.5,1887.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1887.6,80,,1510.08,,,0,"percent of total billed charges ","80% of total billed charges ",1651.65,70,,1321.32,,,0,"percent of total billed charges ","70% of total billed charges ",2123.55,90,,1698.84,,,0,"percent of total billed charges ","90% of total billed charges ",2194.34,93,,1755.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2005.58,85,,1604.46,,,0,"percent of total billed charges ","85% of total billed charges ",2005.58,85,,1604.46,,,0,"percent of total billed charges ","85% of total billed charges ",2123.55,90,,1698.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2052.77,87,,1642.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1651.65,70,,1321.32,,,0,"percent of total billed charges ","70% of total billed charges ",1651.65,2194.34,
"GUIDE WIRE J TIP 0.035X145 CM",6107931,"CDM ",272,RC,C1769,HCPCS,OUTPATIENT,,,47.69,38.152,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",38.15,80,,30.52,,,0,"percent of total billed charges ","80% of total billed charges ",33.38,70,,26.70,,,0,"percent of total billed charges ","70% of total billed charges ",42.92,90,,34.34,,,0,"percent of total billed charges ","90% of total billed charges ",44.35,93,,35.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.54,85,,32.43,,,0,"percent of total billed charges ","85% of total billed charges ",42.92,90,,34.34,,,0,"percent of total billed charges ","90% of total billed charges ",42.92,90,,34.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.49,87,,33.19,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.38,70,,26.70,,,0,"percent of total billed charges ","70% of total billed charges ",33.38,44.35,
"SYSTEM REVEAL LINQ",6107934,"CDM ",278,RC,C1764,HCPCS,OUTPATIENT,,,9610.43,7688.344,,,,,,,,0,"other ","not separately reimbursment ",10945.89,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",7688.34,80,,6150.67,,,0,"percent of total billed charges ","80% of total billed charges ",6727.3,70,,5381.84,,,0,"percent of total billed charges ","70% of total billed charges ",8649.39,90,,6919.51,,,0,"percent of total billed charges ","90% of total billed charges ",8937.7,93,,7150.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8168.87,85,,6535.10,,,0,"percent of total billed charges ","85% of total billed charges ",8168.87,85,,6535.10,,,0,"percent of total billed charges ","85% of total billed charges ",8649.39,90,,6919.51,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",8361.07,87,,6688.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6727.3,70,,5381.84,,,0,"percent of total billed charges ","70% of total billed charges ",6727.3,10945.89,
"MESH MATRIX HD 2CM X 3 CM",6107936,"CDM ",278,RC,C1781,HCPCS,OUTPATIENT,,,387.9,310.32,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",310.32,80,,248.26,,,0,"percent of total billed charges ","80% of total billed charges ",271.53,70,,217.22,,,0,"percent of total billed charges ","70% of total billed charges ",349.11,90,,279.29,,,0,"percent of total billed charges ","90% of total billed charges ",360.75,93,,288.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",329.72,85,,263.78,,,0,"percent of total billed charges ","85% of total billed charges ",329.72,85,,263.78,,,0,"percent of total billed charges ","85% of total billed charges ",349.11,90,,279.29,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",337.47,87,,269.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",271.53,70,,217.22,,,0,"percent of total billed charges ","70% of total billed charges ",271.53,360.75,
"MESH MATRIX HD 4X5 CM",6107937,"CDM ",278,RC,C1781,HCPCS,OUTPATIENT,,,3513.84,2811.072,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2811.07,80,,2248.86,,,0,"percent of total billed charges ","80% of total billed charges ",2459.69,70,,1967.75,,,0,"percent of total billed charges ","70% of total billed charges ",3162.46,90,,2529.97,,,0,"percent of total billed charges ","90% of total billed charges ",3267.87,93,,2614.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2986.76,85,,2389.41,,,0,"percent of total billed charges ","85% of total billed charges ",2986.76,85,,2389.41,,,0,"percent of total billed charges ","85% of total billed charges ",3162.46,90,,2529.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3057.04,87,,2445.63,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2459.69,70,,1967.75,,,0,"percent of total billed charges ","70% of total billed charges ",2459.69,3267.87,
"MESH MATRIX HD 5X8 CM",6107938,"CDM ",278,RC,C1781,HCPCS,OUTPATIENT,,,1633.5,1306.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1306.8,80,,1045.44,,,0,"percent of total billed charges ","80% of total billed charges ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",1519.16,93,,1215.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1421.15,87,,1136.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,1519.16,
DERMAGRAFT,6107961,"CDM ",278,RC,Q4106,HCPCS,OUTPATIENT,,,2132.63,1706.104,,,,,,,,0,"other ","not separately reimbursment ",36.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1492.84,70,,1194.27,,,0,"percent of total billed charges ","70% of total billed charges ",1919.37,90,,1535.50,,,0,"percent of total billed charges ","90% of total billed charges ",1983.35,93,,1586.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1812.74,85,,1450.19,,,0,"percent of total billed charges ","85% of total billed charges ",1812.74,85,,1450.19,,,0,"percent of total billed charges ","85% of total billed charges ",1919.37,90,,1535.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1855.39,87,,1484.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1492.84,70,,1194.27,,,0,"percent of total billed charges ","70% of total billed charges ",36.75,1983.35,
"SWIVELOCK C 4.75MM X 19.1MM",6107986,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,862,689.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",603.4,70,,482.72,,,0,"percent of total billed charges ","70% of total billed charges ",775.8,90,,620.64,,,0,"percent of total billed charges ","90% of total billed charges ",801.66,93,,641.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",732.7,85,,586.16,,,0,"percent of total billed charges ","85% of total billed charges ",732.7,85,,586.16,,,0,"percent of total billed charges ","85% of total billed charges ",775.8,90,,620.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",749.94,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",603.4,70,,482.72,,,0,"percent of total billed charges ","70% of total billed charges ",603.4,801.66,
"SWIVELOCK TENO 7MM X 19.5MM",6107987,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,937.43,749.944,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",656.2,70,,524.96,,,0,"percent of total billed charges ","70% of total billed charges ",843.69,90,,674.95,,,0,"percent of total billed charges ","90% of total billed charges ",871.81,93,,697.45,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",796.82,85,,637.46,,,0,"percent of total billed charges ","85% of total billed charges ",796.82,85,,637.46,,,0,"percent of total billed charges ","85% of total billed charges ",843.69,90,,674.95,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",815.56,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",656.2,70,,524.96,,,0,"percent of total billed charges ","70% of total billed charges ",656.2,871.81,
"SWIVELOCK TENO 8MM X 19.5MM",6107988,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,937.43,749.944,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",656.2,70,,524.96,,,0,"percent of total billed charges ","70% of total billed charges ",843.69,90,,674.95,,,0,"percent of total billed charges ","90% of total billed charges ",871.81,93,,697.45,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",796.82,85,,637.46,,,0,"percent of total billed charges ","85% of total billed charges ",796.82,85,,637.46,,,0,"percent of total billed charges ","85% of total billed charges ",843.69,90,,674.95,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",815.56,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",656.2,70,,524.96,,,0,"percent of total billed charges ","70% of total billed charges ",656.2,871.81,
"CATH MAHURKAR 10FR X 15CM",6108027,"CDM ",278,RC,C1751,HCPCS,OUTPATIENT,,,203.05,162.44,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.14,70,,113.71,,,0,"percent of total billed charges ","70% of total billed charges ",182.75,90,,146.20,,,0,"percent of total billed charges ","90% of total billed charges ",188.84,93,,151.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.59,85,,138.07,,,0,"percent of total billed charges ","85% of total billed charges ",172.59,85,,138.07,,,0,"percent of total billed charges ","85% of total billed charges ",182.75,90,,146.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.65,87,,141.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.14,70,,113.71,,,0,"percent of total billed charges ","70% of total billed charges ",142.14,188.84,
"MESH XENMATRIX AB 8X8CM",6108049,"CDM ",278,RC,C1781,HCPCS,OUTPATIENT,,,2811.07,2248.856,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1967.75,70,,1574.20,,,0,"percent of total billed charges ","70% of total billed charges ",2529.96,90,,2023.97,,,0,"percent of total billed charges ","90% of total billed charges ",2614.3,93,,2091.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2389.41,85,,1911.53,,,0,"percent of total billed charges ","85% of total billed charges ",2389.41,85,,1911.53,,,0,"percent of total billed charges ","85% of total billed charges ",2529.96,90,,2023.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2445.63,87,,1956.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1967.75,70,,1574.20,,,0,"percent of total billed charges ","70% of total billed charges ",1967.75,2614.3,
"STENT URETERAL 4.5FR X 26CM",6108111,"CDM ",278,RC,C2617,HCPCS,OUTPATIENT,,,252.96,202.368,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.07,70,,141.66,,,0,"percent of total billed charges ","70% of total billed charges ",227.66,90,,182.13,,,0,"percent of total billed charges ","90% of total billed charges ",235.25,93,,188.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",215.02,85,,172.02,,,0,"percent of total billed charges ","85% of total billed charges ",215.02,85,,172.02,,,0,"percent of total billed charges ","85% of total billed charges ",227.66,90,,182.13,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",220.08,87,,176.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.07,70,,141.66,,,0,"percent of total billed charges ","70% of total billed charges ",177.07,235.25,
"STENT URETERAL 6FR X 22CM",6108112,"CDM ",278,RC,C2617,HCPCS,OUTPATIENT,,,252.96,202.368,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",202.37,80,,161.90,,,0,"percent of total billed charges ","80% of total billed charges ",177.07,70,,141.66,,,0,"percent of total billed charges ","70% of total billed charges ",227.66,90,,182.13,,,0,"percent of total billed charges ","90% of total billed charges ",235.25,93,,188.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",215.02,85,,172.02,,,0,"percent of total billed charges ","85% of total billed charges ",215.02,85,,172.02,,,0,"percent of total billed charges ","85% of total billed charges ",227.66,90,,182.13,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",220.08,87,,176.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.07,70,,141.66,,,0,"percent of total billed charges ","70% of total billed charges ",177.07,235.25,
"STENT URETERAL 6FR X 24CM",6108113,"CDM ",278,RC,C2617,HCPCS,OUTPATIENT,,,252.96,202.368,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",202.37,80,,161.90,,,0,"percent of total billed charges ","80% of total billed charges ",177.07,70,,141.66,,,0,"percent of total billed charges ","70% of total billed charges ",227.66,90,,182.13,,,0,"percent of total billed charges ","90% of total billed charges ",235.25,93,,188.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",215.02,85,,172.02,,,0,"percent of total billed charges ","85% of total billed charges ",215.02,85,,172.02,,,0,"percent of total billed charges ","85% of total billed charges ",227.66,90,,182.13,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",220.08,87,,176.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.07,70,,141.66,,,0,"percent of total billed charges ","70% of total billed charges ",177.07,235.25,
"STENT URETERAL 6FR X 26CM",6108114,"CDM ",278,RC,C2617,HCPCS,OUTPATIENT,,,252.96,202.368,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",202.37,80,,161.90,,,0,"percent of total billed charges ","80% of total billed charges ",177.07,70,,141.66,,,0,"percent of total billed charges ","70% of total billed charges ",227.66,90,,182.13,,,0,"percent of total billed charges ","90% of total billed charges ",235.25,93,,188.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",215.02,85,,172.02,,,0,"percent of total billed charges ","85% of total billed charges ",215.02,85,,172.02,,,0,"percent of total billed charges ","85% of total billed charges ",227.66,90,,182.13,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",220.08,87,,176.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.07,70,,141.66,,,0,"percent of total billed charges ","70% of total billed charges ",177.07,235.25,
"STENT URETERAL 7FR X 22CM",6108115,"CDM ",278,RC,C2617,HCPCS,OUTPATIENT,,,252.96,202.368,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",202.37,80,,161.90,,,0,"percent of total billed charges ","80% of total billed charges ",177.07,70,,141.66,,,0,"percent of total billed charges ","70% of total billed charges ",227.66,90,,182.13,,,0,"percent of total billed charges ","90% of total billed charges ",235.25,93,,188.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",215.02,85,,172.02,,,0,"percent of total billed charges ","85% of total billed charges ",215.02,85,,172.02,,,0,"percent of total billed charges ","85% of total billed charges ",227.66,90,,182.13,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",220.08,87,,176.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.07,70,,141.66,,,0,"percent of total billed charges ","70% of total billed charges ",177.07,235.25,
"STENT URETERAL 7FR X 24CM",6108116,"CDM ",278,RC,C2617,HCPCS,OUTPATIENT,,,252.96,202.368,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",202.37,80,,161.90,,,0,"percent of total billed charges ","80% of total billed charges ",177.07,70,,141.66,,,0,"percent of total billed charges ","70% of total billed charges ",227.66,90,,182.13,,,0,"percent of total billed charges ","90% of total billed charges ",235.25,93,,188.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",215.02,85,,172.02,,,0,"percent of total billed charges ","85% of total billed charges ",215.02,85,,172.02,,,0,"percent of total billed charges ","85% of total billed charges ",227.66,90,,182.13,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",220.08,87,,176.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.07,70,,141.66,,,0,"percent of total billed charges ","70% of total billed charges ",177.07,235.25,
"STENT URETERAL 7FR X 26CM",6108117,"CDM ",278,RC,C2617,HCPCS,OUTPATIENT,,,252.96,202.368,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",202.37,80,,161.90,,,0,"percent of total billed charges ","80% of total billed charges ",177.07,70,,141.66,,,0,"percent of total billed charges ","70% of total billed charges ",227.66,90,,182.13,,,0,"percent of total billed charges ","90% of total billed charges ",235.25,93,,188.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",215.02,85,,172.02,,,0,"percent of total billed charges ","85% of total billed charges ",215.02,85,,172.02,,,0,"percent of total billed charges ","85% of total billed charges ",227.66,90,,182.13,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",220.08,87,,176.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.07,70,,141.66,,,0,"percent of total billed charges ","70% of total billed charges ",177.07,235.25,
"STENT URETERAL 7FR X 90CM",6108273,"CDM ",278,RC,C2617,HCPCS,OUTPATIENT,,,409.62,327.696,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",327.7,80,,262.16,,,0,"percent of total billed charges ","80% of total billed charges ",286.73,70,,229.38,,,0,"percent of total billed charges ","70% of total billed charges ",368.66,90,,294.93,,,0,"percent of total billed charges ","90% of total billed charges ",380.95,93,,304.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",348.18,85,,278.54,,,0,"percent of total billed charges ","85% of total billed charges ",348.18,85,,278.54,,,0,"percent of total billed charges ","85% of total billed charges ",368.66,90,,294.93,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",356.37,87,,285.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",286.73,70,,229.38,,,0,"percent of total billed charges ","70% of total billed charges ",286.73,380.95,
"CEMENT BONE PALACO R+G ANTIBI",6108321,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,419.6,335.68,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",335.68,80,,268.54,,,0,"percent of total billed charges ","80% of total billed charges ",293.72,70,,234.98,,,0,"percent of total billed charges ","70% of total billed charges ",377.64,90,,302.11,,,0,"percent of total billed charges ","90% of total billed charges ",390.23,93,,312.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",356.66,85,,285.33,,,0,"percent of total billed charges ","85% of total billed charges ",356.66,85,,285.33,,,0,"percent of total billed charges ","85% of total billed charges ",377.64,90,,302.11,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",365.05,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",293.72,70,,234.98,,,0,"percent of total billed charges ","70% of total billed charges ",293.72,390.23,
"ANCHOR SUT BIO-COMP PUSH LOCK",6108353,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,862,689.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",689.6,80,,551.68,,,0,"percent of total billed charges ","80% of total billed charges ",603.4,70,,482.72,,,0,"percent of total billed charges ","70% of total billed charges ",775.8,90,,620.64,,,0,"percent of total billed charges ","90% of total billed charges ",801.66,93,,641.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",732.7,85,,586.16,,,0,"percent of total billed charges ","85% of total billed charges ",732.7,85,,586.16,,,0,"percent of total billed charges ","85% of total billed charges ",775.8,90,,620.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",749.94,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",603.4,70,,482.72,,,0,"percent of total billed charges ","70% of total billed charges ",603.4,801.66,
"ANCHOR SUTURE CORKSCREW MICRO",6108369,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,614.18,491.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",491.34,80,,393.07,,,0,"percent of total billed charges ","80% of total billed charges ",429.93,70,,343.94,,,0,"percent of total billed charges ","70% of total billed charges ",552.76,90,,442.21,,,0,"percent of total billed charges ","90% of total billed charges ",571.19,93,,456.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",522.05,85,,417.64,,,0,"percent of total billed charges ","85% of total billed charges ",522.05,85,,417.64,,,0,"percent of total billed charges ","85% of total billed charges ",552.76,90,,442.21,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",534.34,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",429.93,70,,343.94,,,0,"percent of total billed charges ","70% of total billed charges ",429.93,571.19,
"PLATE VOLAR VA LCP 54MM RT",6108395,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1814.55,1451.64,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1451.64,80,,1161.31,,,0,"percent of total billed charges ","80% of total billed charges ",1270.19,70,,1016.15,,,0,"percent of total billed charges ","70% of total billed charges ",1633.1,90,,1306.48,,,0,"percent of total billed charges ","90% of total billed charges ",1687.53,93,,1350.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1542.37,85,,1233.90,,,0,"percent of total billed charges ","85% of total billed charges ",1542.37,85,,1233.90,,,0,"percent of total billed charges ","85% of total billed charges ",1633.1,90,,1306.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1578.66,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1270.19,70,,1016.15,,,0,"percent of total billed charges ","70% of total billed charges ",1270.19,1687.53,
"PLT VOLR 2.4 X 54MM 6H/3H LT",6108396,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1814.55,1451.64,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1451.64,80,,1161.31,,,0,"percent of total billed charges ","80% of total billed charges ",1270.19,70,,1016.15,,,0,"percent of total billed charges ","70% of total billed charges ",1633.1,90,,1306.48,,,0,"percent of total billed charges ","90% of total billed charges ",1687.53,93,,1350.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1542.37,85,,1233.90,,,0,"percent of total billed charges ","85% of total billed charges ",1542.37,85,,1233.90,,,0,"percent of total billed charges ","85% of total billed charges ",1633.1,90,,1306.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1578.66,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1270.19,70,,1016.15,,,0,"percent of total billed charges ","70% of total billed charges ",1270.19,1687.53,
"PLATE VOLAR VA LCP 66MM RT",6108397,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1882.61,1506.088,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1506.09,80,,1204.87,,,0,"percent of total billed charges ","80% of total billed charges ",1317.83,70,,1054.26,,,0,"percent of total billed charges ","70% of total billed charges ",1694.35,90,,1355.48,,,0,"percent of total billed charges ","90% of total billed charges ",1750.83,93,,1400.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1600.22,85,,1280.18,,,0,"percent of total billed charges ","85% of total billed charges ",1600.22,85,,1280.18,,,0,"percent of total billed charges ","85% of total billed charges ",1694.35,90,,1355.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1637.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1317.83,70,,1054.26,,,0,"percent of total billed charges ","70% of total billed charges ",1317.83,1750.83,
"PLATE VOLAR VA LCP 66MM LT",6108398,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2221.56,1777.248,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1777.25,80,,1421.80,,,0,"percent of total billed charges ","80% of total billed charges ",1555.09,70,,1244.07,,,0,"percent of total billed charges ","70% of total billed charges ",1999.4,90,,1599.52,,,0,"percent of total billed charges ","90% of total billed charges ",2066.05,93,,1652.84,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1888.33,85,,1510.66,,,0,"percent of total billed charges ","85% of total billed charges ",1888.33,85,,1510.66,,,0,"percent of total billed charges ","85% of total billed charges ",1999.4,90,,1599.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1932.76,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1555.09,70,,1244.07,,,0,"percent of total billed charges ","70% of total billed charges ",1555.09,2066.05,
"PLT VOLR 2.4 X 75MM 6H/5H RT",6108399,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1952.03,1561.624,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1561.62,80,,1249.30,,,0,"percent of total billed charges ","80% of total billed charges ",1366.42,70,,1093.14,,,0,"percent of total billed charges ","70% of total billed charges ",1756.83,90,,1405.46,,,0,"percent of total billed charges ","90% of total billed charges ",1815.39,93,,1452.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1659.23,85,,1327.38,,,0,"percent of total billed charges ","85% of total billed charges ",1659.23,85,,1327.38,,,0,"percent of total billed charges ","85% of total billed charges ",1756.83,90,,1405.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1698.27,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1366.42,70,,1093.14,,,0,"percent of total billed charges ","70% of total billed charges ",1366.42,1815.39,
"PLT VOLR 2.4X75MM 6H/5H LT",6108400,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1952.03,1561.624,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1561.62,80,,1249.30,,,0,"percent of total billed charges ","80% of total billed charges ",1366.42,70,,1093.14,,,0,"percent of total billed charges ","70% of total billed charges ",1756.83,90,,1405.46,,,0,"percent of total billed charges ","90% of total billed charges ",1815.39,93,,1452.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1659.23,85,,1327.38,,,0,"percent of total billed charges ","85% of total billed charges ",1659.23,85,,1327.38,,,0,"percent of total billed charges ","85% of total billed charges ",1756.83,90,,1405.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1698.27,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1366.42,70,,1093.14,,,0,"percent of total billed charges ","70% of total billed charges ",1366.42,1815.39,
"SCREW INTERFERENCE 8MM X 28MM",6108411,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,506.43,405.144,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",405.14,80,,324.11,,,0,"percent of total billed charges ","80% of total billed charges ",354.5,70,,283.60,,,0,"percent of total billed charges ","70% of total billed charges ",455.79,90,,364.63,,,0,"percent of total billed charges ","90% of total billed charges ",470.98,93,,376.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",430.47,85,,344.38,,,0,"percent of total billed charges ","85% of total billed charges ",430.47,85,,344.38,,,0,"percent of total billed charges ","85% of total billed charges ",455.79,90,,364.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",440.59,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",354.5,70,,283.60,,,0,"percent of total billed charges ","70% of total billed charges ",354.5,470.98,
"SCREW INTERFERENCE 9MM X 28MM",6108412,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,506.43,405.144,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",405.14,80,,324.11,,,0,"percent of total billed charges ","80% of total billed charges ",354.5,70,,283.60,,,0,"percent of total billed charges ","70% of total billed charges ",455.79,90,,364.63,,,0,"percent of total billed charges ","90% of total billed charges ",470.98,93,,376.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",430.47,85,,344.38,,,0,"percent of total billed charges ","85% of total billed charges ",430.47,85,,344.38,,,0,"percent of total billed charges ","85% of total billed charges ",455.79,90,,364.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",440.59,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",354.5,70,,283.60,,,0,"percent of total billed charges ","70% of total billed charges ",354.5,470.98,
"SCREW INTERFERENCE 10MM X 28MM",6108413,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,506.43,405.144,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",405.14,80,,324.11,,,0,"percent of total billed charges ","80% of total billed charges ",354.5,70,,283.60,,,0,"percent of total billed charges ","70% of total billed charges ",455.79,90,,364.63,,,0,"percent of total billed charges ","90% of total billed charges ",470.98,93,,376.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",430.47,85,,344.38,,,0,"percent of total billed charges ","85% of total billed charges ",430.47,85,,344.38,,,0,"percent of total billed charges ","85% of total billed charges ",455.79,90,,364.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",440.59,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",354.5,70,,283.60,,,0,"percent of total billed charges ","70% of total billed charges ",354.5,470.98,
"SCREW INTERFERENCE 11MM X 28MM",6108414,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,506.43,405.144,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",405.14,80,,324.11,,,0,"percent of total billed charges ","80% of total billed charges ",354.5,70,,283.60,,,0,"percent of total billed charges ","70% of total billed charges ",455.79,90,,364.63,,,0,"percent of total billed charges ","90% of total billed charges ",470.98,93,,376.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",430.47,85,,344.38,,,0,"percent of total billed charges ","85% of total billed charges ",430.47,85,,344.38,,,0,"percent of total billed charges ","85% of total billed charges ",455.79,90,,364.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",440.59,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",354.5,70,,283.60,,,0,"percent of total billed charges ","70% of total billed charges ",354.5,470.98,
"PERMCATH 14.5FR X 36CM",6108434,"CDM ",278,RC,C1751,HCPCS,OUTPATIENT,,,323.25,258.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",258.6,80,,206.88,,,0,"percent of total billed charges ","80% of total billed charges ",226.28,70,,181.02,,,0,"percent of total billed charges ","70% of total billed charges ",290.93,90,,232.74,,,0,"percent of total billed charges ","90% of total billed charges ",300.62,93,,240.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",274.76,85,,219.81,,,0,"percent of total billed charges ","85% of total billed charges ",274.76,85,,219.81,,,0,"percent of total billed charges ","85% of total billed charges ",290.93,90,,232.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",281.23,87,,224.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",226.28,70,,181.02,,,0,"percent of total billed charges ","70% of total billed charges ",226.28,300.62,
"PERMCATH 14.5FR X 40CM",6108435,"CDM ",278,RC,C1751,HCPCS,OUTPATIENT,,,323.25,258.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",258.6,80,,206.88,,,0,"percent of total billed charges ","80% of total billed charges ",226.28,70,,181.02,,,0,"percent of total billed charges ","70% of total billed charges ",290.93,90,,232.74,,,0,"percent of total billed charges ","90% of total billed charges ",300.62,93,,240.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",274.76,85,,219.81,,,0,"percent of total billed charges ","85% of total billed charges ",274.76,85,,219.81,,,0,"percent of total billed charges ","85% of total billed charges ",290.93,90,,232.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",281.23,87,,224.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",226.28,70,,181.02,,,0,"percent of total billed charges ","70% of total billed charges ",226.28,300.62,
"TIBIA NATURAL STMD 5 DEG RT H",6108454,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2268.75,1815,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1815,80,,1452.00,,,0,"percent of total billed charges ","80% of total billed charges ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",2109.94,93,,1687.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1973.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",1588.13,2109.94,
"FEMUR STD LT SZ 3",6108455,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR STD LEFT SZ4",6108456,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5898.5,4718.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4718.8,80,,3775.04,,,0,"percent of total billed charges ","80% of total billed charges ",4128.95,70,,3303.16,,,0,"percent of total billed charges ","70% of total billed charges ",5308.65,90,,4246.92,,,0,"percent of total billed charges ","90% of total billed charges ",5485.61,93,,4388.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5013.73,85,,4010.98,,,0,"percent of total billed charges ","85% of total billed charges ",5013.73,85,,4010.98,,,0,"percent of total billed charges ","85% of total billed charges ",5308.65,90,,4246.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5131.7,87,,4105.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4128.95,70,,3303.16,,,0,"percent of total billed charges ","70% of total billed charges ",4128.95,5485.61,
"FEMUR STD LT SZ 5",6108457,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR STD LT SZ 6",6108458,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR STD LT SZ 7",6108459,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR STD LT SZ 8",6108460,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR STD LT SZ 9",6108461,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR STD LT SZ 10",6108462,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR STD LT SZ 11",6108463,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR STD RT SZ 3",6108464,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR STD RT SZ 4",6108465,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR STD RT SZ 5",6108466,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR STD RT SZ 6",6108467,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR STD RT SZ 7",6108468,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR STD RT SZ 8",6108469,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR STD RT SZ 9",6108470,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR STD RT SZ 10",6108471,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR STD RT SZ 11",6108472,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"FEMUR PPS STD RT SZ 4",6108474,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"TIBIA NATURAL STMD 5 DEG RT B",6108475,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2268.75,1815,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1815,80,,1452.00,,,0,"percent of total billed charges ","80% of total billed charges ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",2109.94,93,,1687.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1973.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",1588.13,2109.94,
"TIBIA NATURAL STMD 5 DEG RT C",6108476,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2268.75,1815,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1815,80,,1452.00,,,0,"percent of total billed charges ","80% of total billed charges ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",2109.94,93,,1687.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1973.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",1588.13,2109.94,
"TIBIA NATURAL STMD 5 DEG RT D",6108477,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2268.75,1815,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1815,80,,1452.00,,,0,"percent of total billed charges ","80% of total billed charges ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",2109.94,93,,1687.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1973.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",1588.13,2109.94,
"TIBIA NATURAL STMD 5 DEG RT E",6108478,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2268.75,1815,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1815,80,,1452.00,,,0,"percent of total billed charges ","80% of total billed charges ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",2109.94,93,,1687.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1973.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",1588.13,2109.94,
"TIBIA NATURAL STMD 5 DEG RT F",6108479,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2268.75,1815,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1815,80,,1452.00,,,0,"percent of total billed charges ","80% of total billed charges ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",2109.94,93,,1687.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1973.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",1588.13,2109.94,
"TIBIA NATURAL STMD 5 DEG RT G",6108480,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2268.75,1815,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1815,80,,1452.00,,,0,"percent of total billed charges ","80% of total billed charges ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",2109.94,93,,1687.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",1928.44,85,,1542.75,,,0,"percent of total billed charges ","85% of total billed charges ",2041.88,90,,1633.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1973.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1588.13,70,,1270.50,,,0,"percent of total billed charges ","70% of total billed charges ",1588.13,2109.94,
"GRAFT STRAVIX 3CM X 6CM",6108481,"CDM ",636,RC,Q4133,HCPCS,OUTPATIENT,,,4851.5,3881.2,,,,,,,,0,"other ","not separately reimbursment ",188.87,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3396.05,70,,2716.84,,,0,"percent of total billed charges ","70% of total billed charges ",4366.35,90,,3493.08,,,0,"percent of total billed charges ","90% of total billed charges ",4511.9,93,,3609.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4123.78,85,,3299.02,,,0,"percent of total billed charges ","85% of total billed charges ",4366.35,90,,3493.08,,,0,"percent of total billed charges ","90% of total billed charges ",4366.35,90,,3493.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4220.81,87,,3376.65,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3396.05,70,,2716.84,,,0,"percent of total billed charges ","70% of total billed charges ",114.44,4511.9,
"GRAFT STRAVIX 2CM X 4CM",6108482,"CDM ",636,RC,Q4133,HCPCS,OUTPATIENT,,,3054.65,2443.72,,,,,,,,0,"other ","not separately reimbursment ",188.87,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2138.26,70,,1710.61,,,0,"percent of total billed charges ","70% of total billed charges ",2749.19,90,,2199.35,,,0,"percent of total billed charges ","90% of total billed charges ",2840.82,93,,2272.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2596.45,85,,2077.16,,,0,"percent of total billed charges ","85% of total billed charges ",2749.19,90,,2199.35,,,0,"percent of total billed charges ","90% of total billed charges ",2749.19,90,,2199.35,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2657.55,87,,2126.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2138.26,70,,1710.61,,,0,"percent of total billed charges ","70% of total billed charges ",114.44,2840.82,
"FEMUR PPS STD RT SZ 5",6108530,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,5989.5,4791.6,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",4791.6,80,,3833.28,,,0,"percent of total billed charges ","80% of total billed charges ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",5570.24,93,,4456.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5091.08,85,,4072.86,,,0,"percent of total billed charges ","85% of total billed charges ",5390.55,90,,4312.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5210.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4192.65,70,,3354.12,,,0,"percent of total billed charges ","70% of total billed charges ",4192.65,5570.24,
"SCREW INTERFERENCE 6MM X 23MM",6108538,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,506.42,405.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",405.14,80,,324.11,,,0,"percent of total billed charges ","80% of total billed charges ",354.49,70,,283.59,,,0,"percent of total billed charges ","70% of total billed charges ",455.78,90,,364.62,,,0,"percent of total billed charges ","90% of total billed charges ",470.97,93,,376.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",430.46,85,,344.37,,,0,"percent of total billed charges ","85% of total billed charges ",430.46,85,,344.37,,,0,"percent of total billed charges ","85% of total billed charges ",455.78,90,,364.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",440.59,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",354.49,70,,283.59,,,0,"percent of total billed charges ","70% of total billed charges ",354.49,470.97,
"SCREW INTERFERENCE 7MMX23MM",6108539,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,506.42,405.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",405.14,80,,324.11,,,0,"percent of total billed charges ","80% of total billed charges ",354.49,70,,283.59,,,0,"percent of total billed charges ","70% of total billed charges ",455.78,90,,364.62,,,0,"percent of total billed charges ","90% of total billed charges ",470.97,93,,376.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",430.46,85,,344.37,,,0,"percent of total billed charges ","85% of total billed charges ",430.46,85,,344.37,,,0,"percent of total billed charges ","85% of total billed charges ",455.78,90,,364.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",440.59,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",354.49,70,,283.59,,,0,"percent of total billed charges ","70% of total billed charges ",354.49,470.97,
"SCREW INTERFERENCE 8 X 23MM",6108540,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,506.43,405.144,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",405.14,80,,324.11,,,0,"percent of total billed charges ","80% of total billed charges ",354.5,70,,283.60,,,0,"percent of total billed charges ","70% of total billed charges ",455.79,90,,364.63,,,0,"percent of total billed charges ","90% of total billed charges ",470.98,93,,376.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",430.47,85,,344.38,,,0,"percent of total billed charges ","85% of total billed charges ",430.47,85,,344.38,,,0,"percent of total billed charges ","85% of total billed charges ",455.79,90,,364.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",440.59,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",354.5,70,,283.60,,,0,"percent of total billed charges ","70% of total billed charges ",354.5,470.98,
"SCREW INTERFERENCE 9MM X 23MM",6108541,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,506.43,405.144,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",405.14,80,,324.11,,,0,"percent of total billed charges ","80% of total billed charges ",354.5,70,,283.60,,,0,"percent of total billed charges ","70% of total billed charges ",455.79,90,,364.63,,,0,"percent of total billed charges ","90% of total billed charges ",470.98,93,,376.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",430.47,85,,344.38,,,0,"percent of total billed charges ","85% of total billed charges ",430.47,85,,344.38,,,0,"percent of total billed charges ","85% of total billed charges ",455.79,90,,364.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",440.59,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",354.5,70,,283.60,,,0,"percent of total billed charges ","70% of total billed charges ",354.5,470.98,
"SCREW INTERFERENCE 10MM X 23MM",6108542,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,506.43,405.144,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",405.14,80,,324.11,,,0,"percent of total billed charges ","80% of total billed charges ",354.5,70,,283.60,,,0,"percent of total billed charges ","70% of total billed charges ",455.79,90,,364.63,,,0,"percent of total billed charges ","90% of total billed charges ",470.98,93,,376.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",430.47,85,,344.38,,,0,"percent of total billed charges ","85% of total billed charges ",430.47,85,,344.38,,,0,"percent of total billed charges ","85% of total billed charges ",455.79,90,,364.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",440.59,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",354.5,70,,283.60,,,0,"percent of total billed charges ","70% of total billed charges ",354.5,470.98,
"CS INSERT SZ 4 10MM RT",6108557,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2722.5,2178,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2178,80,,1742.40,,,0,"percent of total billed charges ","80% of total billed charges ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",2531.93,93,,2025.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2368.58,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",1905.75,2531.93,
"SCREW PASS THRU REVISION",6108592,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,377.13,301.704,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",301.7,80,,241.36,,,0,"percent of total billed charges ","80% of total billed charges ",263.99,70,,211.19,,,0,"percent of total billed charges ","70% of total billed charges ",339.42,90,,271.54,,,0,"percent of total billed charges ","90% of total billed charges ",350.73,93,,280.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",320.56,85,,256.45,,,0,"percent of total billed charges ","85% of total billed charges ",320.56,85,,256.45,,,0,"percent of total billed charges ","85% of total billed charges ",339.42,90,,271.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",328.1,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.99,70,,211.19,,,0,"percent of total billed charges ","70% of total billed charges ",263.99,350.73,
"SCR CRTX 2.0 X 6MM ST",6108618,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,157.49,125.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.99,80,,100.79,,,0,"percent of total billed charges ","80% of total billed charges ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",146.47,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",110.24,146.47,
"SCR CRTX 2.0 X 7MM ST",6108619,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,157.49,125.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.99,80,,100.79,,,0,"percent of total billed charges ","80% of total billed charges ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",146.47,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",110.24,146.47,
"SCR CRTX 2.0 X 8MM ST",6108620,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,157.49,125.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.99,80,,100.79,,,0,"percent of total billed charges ","80% of total billed charges ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",146.47,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",110.24,146.47,
"SCR CRTX 2.0 X 9MM ST",6108621,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,157.49,125.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.99,80,,100.79,,,0,"percent of total billed charges ","80% of total billed charges ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",146.47,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",110.24,146.47,
"SCR CRTX 2.0 X 10MM ST",6108622,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,157.49,125.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.99,80,,100.79,,,0,"percent of total billed charges ","80% of total billed charges ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",146.47,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",110.24,146.47,
"SCR CRTX 2.0 X 11MM ST",6108623,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,157.49,125.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.99,80,,100.79,,,0,"percent of total billed charges ","80% of total billed charges ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",146.47,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",110.24,146.47,
"SCR CRTX 2.0 X 12MM ST",6108624,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,157.49,125.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.99,80,,100.79,,,0,"percent of total billed charges ","80% of total billed charges ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",146.47,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",110.24,146.47,
"SCR CRTX 2.0 X 13MM ST",6108626,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,157.49,125.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.99,80,,100.79,,,0,"percent of total billed charges ","80% of total billed charges ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",146.47,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",110.24,146.47,
"SCR CRTX 2.0 X 14MM ST",6108627,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,157.49,125.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.99,80,,100.79,,,0,"percent of total billed charges ","80% of total billed charges ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",146.47,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",110.24,146.47,
"SCR CRTX 2.0 X 16MM ST",6108628,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,157.49,125.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.99,80,,100.79,,,0,"percent of total billed charges ","80% of total billed charges ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",146.47,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",110.24,146.47,
"SCR CRTX 2.0 X 18MM ST",6108629,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,157.49,125.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.99,80,,100.79,,,0,"percent of total billed charges ","80% of total billed charges ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",146.47,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",110.24,146.47,
"SCR CRTX 2.0 X 20MM ST",6108630,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,157.49,125.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.99,80,,100.79,,,0,"percent of total billed charges ","80% of total billed charges ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",146.47,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",110.24,146.47,
"SCR CRTX 2.0 X 22MM ST",6108631,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,157.49,125.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.99,80,,100.79,,,0,"percent of total billed charges ","80% of total billed charges ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",146.47,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",110.24,146.47,
"SCR CRTX 2.0 X 24MM ST",6108632,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,157.49,125.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.99,80,,100.79,,,0,"percent of total billed charges ","80% of total billed charges ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",146.47,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",110.24,146.47,
"SCR CRTX 2.7 X 10MM ST",6108692,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145.84,116.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116.67,80,,93.34,,,0,"percent of total billed charges ","80% of total billed charges ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",135.63,93,,108.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.88,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",102.09,135.63,
"SCR CRTX 2.7 X 12MM ST",6108693,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145.84,116.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116.67,80,,93.34,,,0,"percent of total billed charges ","80% of total billed charges ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",135.63,93,,108.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.88,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",102.09,135.63,
"SCR CRTX 2.7 X 14MM ST",6108694,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145.84,116.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116.67,80,,93.34,,,0,"percent of total billed charges ","80% of total billed charges ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",135.63,93,,108.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.88,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",102.09,135.63,
"SCR CRTX 2.7 X 16MM ST",6108695,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145.84,116.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116.67,80,,93.34,,,0,"percent of total billed charges ","80% of total billed charges ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",135.63,93,,108.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.88,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",102.09,135.63,
"SCR CRTX 2.7 X 18MM ST",6108696,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145.84,116.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116.67,80,,93.34,,,0,"percent of total billed charges ","80% of total billed charges ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",135.63,93,,108.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.88,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",102.09,135.63,
"SCR CRTX 2.7 X 20MM ST",6108697,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145.84,116.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116.67,80,,93.34,,,0,"percent of total billed charges ","80% of total billed charges ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",135.63,93,,108.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.88,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",102.09,135.63,
"SCR CRTX 2.7 X 22MM ST",6108698,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145.84,116.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116.67,80,,93.34,,,0,"percent of total billed charges ","80% of total billed charges ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",135.63,93,,108.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.88,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",102.09,135.63,
"SCR CRTX 2.7 X 24MM ST",6108699,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145.84,116.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116.67,80,,93.34,,,0,"percent of total billed charges ","80% of total billed charges ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",135.63,93,,108.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.88,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",102.09,135.63,
"SCR CRTX 2.7 X 26MM ST",6108700,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145.84,116.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116.67,80,,93.34,,,0,"percent of total billed charges ","80% of total billed charges ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",135.63,93,,108.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.88,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",102.09,135.63,
"SCR CRTX 2.7 X 28MM ST",6108701,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145.84,116.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116.67,80,,93.34,,,0,"percent of total billed charges ","80% of total billed charges ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",135.63,93,,108.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.88,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",102.09,135.63,
"SCR CRTX 2.7 X 30MM ST",6108702,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145.84,116.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116.67,80,,93.34,,,0,"percent of total billed charges ","80% of total billed charges ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",135.63,93,,108.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.88,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",102.09,135.63,
"SCR CRTX 2.7 X 32MM ST",6108703,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145.84,116.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116.67,80,,93.34,,,0,"percent of total billed charges ","80% of total billed charges ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",135.63,93,,108.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.88,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",102.09,135.63,
"SCR CRTX 2.7 X 34MM ST",6108704,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145.84,116.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116.67,80,,93.34,,,0,"percent of total billed charges ","80% of total billed charges ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",135.63,93,,108.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.88,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",102.09,135.63,
"SCR CRTX 2.7 X 36MM ST",6108705,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145.84,116.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116.67,80,,93.34,,,0,"percent of total billed charges ","80% of total billed charges ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",135.63,93,,108.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.88,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",102.09,135.63,
"SCR CRTX 2.7 X 38MM ST",6108706,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145.84,116.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116.67,80,,93.34,,,0,"percent of total billed charges ","80% of total billed charges ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",135.63,93,,108.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.88,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",102.09,135.63,
"SCR CRTX 2.7 X 40MM ST",6108707,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145.84,116.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116.67,80,,93.34,,,0,"percent of total billed charges ","80% of total billed charges ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",135.63,93,,108.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.88,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",102.09,135.63,
"SCR CRTX 2.7 X 45MM ST",6108708,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145.84,116.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116.67,80,,93.34,,,0,"percent of total billed charges ","80% of total billed charges ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",135.63,93,,108.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.88,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",102.09,135.63,
"SCR CRTX 2.7 X 50MM ST",6108709,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145.84,116.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116.67,80,,93.34,,,0,"percent of total billed charges ","80% of total billed charges ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",135.63,93,,108.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.88,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",102.09,135.63,
"SCR CRTX 2.7 X 55MM ST",6108710,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145.84,116.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116.67,80,,93.34,,,0,"percent of total billed charges ","80% of total billed charges ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",135.63,93,,108.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",123.96,85,,99.17,,,0,"percent of total billed charges ","85% of total billed charges ",131.26,90,,105.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.88,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.09,70,,81.67,,,0,"percent of total billed charges ","70% of total billed charges ",102.09,135.63,
"SCR CRTX 3.5 X 10MM ST",6108711,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.15,75.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.32,80,,60.26,,,0,"percent of total billed charges ","80% of total billed charges ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",87.56,93,,70.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.91,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",65.91,87.56,
"SCR CRTX 3.5 X 12MM ST",6108712,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.15,75.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.32,80,,60.26,,,0,"percent of total billed charges ","80% of total billed charges ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",87.56,93,,70.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.91,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",65.91,87.56,
"SCR CRTX 3.5 X 14MM ST",6108713,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.15,75.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.32,80,,60.26,,,0,"percent of total billed charges ","80% of total billed charges ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",87.56,93,,70.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.91,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",65.91,87.56,
"SCR CRTX 3.5 X 16MM ST",6108714,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.15,75.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.32,80,,60.26,,,0,"percent of total billed charges ","80% of total billed charges ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",87.56,93,,70.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.91,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",65.91,87.56,
"SCR CRTX 3.5 X 18MM ST",6108715,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.15,75.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.32,80,,60.26,,,0,"percent of total billed charges ","80% of total billed charges ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",87.56,93,,70.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.91,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",65.91,87.56,
"SCR CRTX 3.5 X 20MM ST",6108716,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.15,75.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.32,80,,60.26,,,0,"percent of total billed charges ","80% of total billed charges ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",87.56,93,,70.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.91,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",65.91,87.56,
"SCR CRTX 3.5 X 22MM ST",6108717,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.15,75.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.32,80,,60.26,,,0,"percent of total billed charges ","80% of total billed charges ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",87.56,93,,70.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.91,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",65.91,87.56,
"SCR CRTX 3.5 X 24MM ST",6108718,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.15,75.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.32,80,,60.26,,,0,"percent of total billed charges ","80% of total billed charges ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",87.56,93,,70.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.91,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",65.91,87.56,
"SCR CRTX 3.5 X 26MM ST",6108719,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.15,75.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.32,80,,60.26,,,0,"percent of total billed charges ","80% of total billed charges ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",87.56,93,,70.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.91,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",65.91,87.56,
"SCR CRTX 3.5 X 28MM ST",6108720,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.15,75.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.32,80,,60.26,,,0,"percent of total billed charges ","80% of total billed charges ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",87.56,93,,70.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.91,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",65.91,87.56,
"SCR CRTX 3.5 X 30MM ST",6108721,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.15,75.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.32,80,,60.26,,,0,"percent of total billed charges ","80% of total billed charges ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",87.56,93,,70.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.91,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",65.91,87.56,
"SCR CRTX 3.5 X 32MM ST",6108722,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.15,75.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.32,80,,60.26,,,0,"percent of total billed charges ","80% of total billed charges ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",87.56,93,,70.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.91,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",65.91,87.56,
"SCR CRTX 3.5 X 34MM ST",6108723,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.15,75.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.32,80,,60.26,,,0,"percent of total billed charges ","80% of total billed charges ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",87.56,93,,70.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.91,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",65.91,87.56,
"SCR CRTX 3.5 X 36MM ST",6108724,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.15,75.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.32,80,,60.26,,,0,"percent of total billed charges ","80% of total billed charges ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",87.56,93,,70.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.91,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",65.91,87.56,
"SCR CRTX 3.5 X 38MM ST",6108725,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.15,75.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.32,80,,60.26,,,0,"percent of total billed charges ","80% of total billed charges ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",87.56,93,,70.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.91,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",65.91,87.56,
"SCR CRTX 3.5 X 40MM ST",6108726,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.15,75.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.32,80,,60.26,,,0,"percent of total billed charges ","80% of total billed charges ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",87.56,93,,70.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.91,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",65.91,87.56,
"SCR CRTX 3.5 X 45MM ST",6108727,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.15,75.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.32,80,,60.26,,,0,"percent of total billed charges ","80% of total billed charges ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",87.56,93,,70.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.91,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",65.91,87.56,
"SCR CRTX 3.5 X 50MM ST",6108728,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.15,75.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.32,80,,60.26,,,0,"percent of total billed charges ","80% of total billed charges ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",87.56,93,,70.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.91,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",65.91,87.56,
"SCR CRTX 3.5 X 55MM ST",6108729,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.15,75.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.32,80,,60.26,,,0,"percent of total billed charges ","80% of total billed charges ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",87.56,93,,70.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.91,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",65.91,87.56,
"SCR CRTX 3.5 X 60MM ST",6108730,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.15,75.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.32,80,,60.26,,,0,"percent of total billed charges ","80% of total billed charges ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",87.56,93,,70.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",80.03,85,,64.02,,,0,"percent of total billed charges ","85% of total billed charges ",84.74,90,,67.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.91,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.91,70,,52.73,,,0,"percent of total billed charges ","70% of total billed charges ",65.91,87.56,
"SCR LCKG 3.5 X 10MM ST",6108731,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,269.91,215.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",215.93,80,,172.74,,,0,"percent of total billed charges ","80% of total billed charges ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",251.02,93,,200.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.82,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",188.94,251.02,
"SCR LCKG 3.5 X 12MM ST",6108732,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,269.91,215.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",215.93,80,,172.74,,,0,"percent of total billed charges ","80% of total billed charges ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",251.02,93,,200.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.82,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",188.94,251.02,
"SCR LCKG 3.5 X 14MM ST",6108733,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,269.91,215.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",215.93,80,,172.74,,,0,"percent of total billed charges ","80% of total billed charges ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",251.02,93,,200.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.82,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",188.94,251.02,
"SCR LCKG 3.5 X 16MM ST",6108734,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,269.91,215.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",215.93,80,,172.74,,,0,"percent of total billed charges ","80% of total billed charges ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",251.02,93,,200.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.82,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",188.94,251.02,
"SCR LCKG 3.5 X 18MM ST",6108735,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,269.91,215.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",215.93,80,,172.74,,,0,"percent of total billed charges ","80% of total billed charges ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",251.02,93,,200.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.82,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",188.94,251.02,
"SCR LCKG 3.5 X 20MM ST",6108736,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,269.91,215.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",215.93,80,,172.74,,,0,"percent of total billed charges ","80% of total billed charges ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",251.02,93,,200.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.82,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",188.94,251.02,
"SCR LCKG 3.5 X 22MM ST",6108737,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,269.91,215.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",215.93,80,,172.74,,,0,"percent of total billed charges ","80% of total billed charges ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",251.02,93,,200.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.82,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",188.94,251.02,
"SCR LCKG 3.5 X 24MM ST",6108738,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,269.91,215.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",215.93,80,,172.74,,,0,"percent of total billed charges ","80% of total billed charges ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",251.02,93,,200.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.82,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",188.94,251.02,
"SCR LCKG 3.5 X 26MM ST",6108739,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,269.91,215.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",215.93,80,,172.74,,,0,"percent of total billed charges ","80% of total billed charges ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",251.02,93,,200.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.82,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",188.94,251.02,
"SCR LCKG 3.5 X 28MM ST",6108740,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,269.91,215.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",215.93,80,,172.74,,,0,"percent of total billed charges ","80% of total billed charges ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",251.02,93,,200.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.82,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",188.94,251.02,
"SCR LCKG 3.5 X 30MM ST",6108741,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,269.91,215.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",215.93,80,,172.74,,,0,"percent of total billed charges ","80% of total billed charges ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",251.02,93,,200.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.82,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",188.94,251.02,
"SCR LCKG 3.5 X 32MM ST",6108742,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,269.91,215.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",215.93,80,,172.74,,,0,"percent of total billed charges ","80% of total billed charges ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",251.02,93,,200.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.82,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",188.94,251.02,
"SCR LCKG 3.5 X 34MM ST",6108743,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,269.91,215.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",215.93,80,,172.74,,,0,"percent of total billed charges ","80% of total billed charges ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",251.02,93,,200.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.82,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",188.94,251.02,
"SCR LCKG 3.5 X 35MM ST",6108744,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,269.91,215.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",215.93,80,,172.74,,,0,"percent of total billed charges ","80% of total billed charges ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",251.02,93,,200.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.82,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",188.94,251.02,
"SCR LCKG 3.5 X 36MM ST",6108745,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,269.91,215.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",215.93,80,,172.74,,,0,"percent of total billed charges ","80% of total billed charges ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",251.02,93,,200.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.82,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",188.94,251.02,
"SCR LCKG 3.5 X 38MM ST",6108746,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,269.91,215.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",215.93,80,,172.74,,,0,"percent of total billed charges ","80% of total billed charges ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",251.02,93,,200.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.82,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",188.94,251.02,
"SCR LCKG 3.5 X 40MM ST",6108747,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,269.91,215.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",215.93,80,,172.74,,,0,"percent of total billed charges ","80% of total billed charges ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",251.02,93,,200.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.82,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",188.94,251.02,
"SCR LCKG 3.5 X 45MM ST",6108748,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,269.91,215.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",215.93,80,,172.74,,,0,"percent of total billed charges ","80% of total billed charges ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",251.02,93,,200.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.82,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",188.94,251.02,
"SCR LCKG 3.5 X 50MM ST",6108749,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,269.91,215.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",215.93,80,,172.74,,,0,"percent of total billed charges ","80% of total billed charges ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",251.02,93,,200.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.82,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",188.94,251.02,
"SCR LCKG 3.5 X 55MM ST",6108750,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,269.91,215.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",215.93,80,,172.74,,,0,"percent of total billed charges ","80% of total billed charges ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",251.02,93,,200.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.82,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",188.94,251.02,
"SCR LCKG 3.5 X 60MM ST",6108751,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,269.91,215.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",215.93,80,,172.74,,,0,"percent of total billed charges ","80% of total billed charges ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",251.02,93,,200.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",229.42,85,,183.54,,,0,"percent of total billed charges ","85% of total billed charges ",242.92,90,,194.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.82,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.94,70,,151.15,,,0,"percent of total billed charges ","70% of total billed charges ",188.94,251.02,
"SCR CANC 4.0 X 10MM FT",6108752,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,77.48,61.984,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",61.98,80,,49.58,,,0,"percent of total billed charges ","80% of total billed charges ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",72.06,93,,57.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",67.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",54.24,72.06,
"SCR CANC 4.0 X 12MM FT",6108753,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,77.48,61.984,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",61.98,80,,49.58,,,0,"percent of total billed charges ","80% of total billed charges ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",72.06,93,,57.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",67.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",54.24,72.06,
"SCR CANC 4.0 X 14MM FT",6108754,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,77.48,61.984,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",61.98,80,,49.58,,,0,"percent of total billed charges ","80% of total billed charges ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",72.06,93,,57.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",67.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",54.24,72.06,
"SCR CANC 4.0 X 16MM FT",6108755,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,77.48,61.984,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",61.98,80,,49.58,,,0,"percent of total billed charges ","80% of total billed charges ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",72.06,93,,57.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",67.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",54.24,72.06,
"SCR CANC 4.0 X 18MM FT",6108756,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,77.48,61.984,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",61.98,80,,49.58,,,0,"percent of total billed charges ","80% of total billed charges ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",72.06,93,,57.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",67.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",54.24,72.06,
"SCR CANC 4.0 X 20MM FT",6108757,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,77.48,61.984,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",61.98,80,,49.58,,,0,"percent of total billed charges ","80% of total billed charges ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",72.06,93,,57.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",67.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",54.24,72.06,
"SCR CANC 4.0 X 22MM FT",6108758,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,77.48,61.984,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",61.98,80,,49.58,,,0,"percent of total billed charges ","80% of total billed charges ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",72.06,93,,57.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",67.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",54.24,72.06,
"SCR CANC 4.0 X 24MM FT",6108759,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,77.48,61.984,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",61.98,80,,49.58,,,0,"percent of total billed charges ","80% of total billed charges ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",72.06,93,,57.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",67.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",54.24,72.06,
"SCR CANC 4.0 X 26MM FT",6108760,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,77.48,61.984,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",61.98,80,,49.58,,,0,"percent of total billed charges ","80% of total billed charges ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",72.06,93,,57.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",67.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",54.24,72.06,
"SCR CANC 4.0 X 28MM FT",6108761,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,77.48,61.984,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",61.98,80,,49.58,,,0,"percent of total billed charges ","80% of total billed charges ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",72.06,93,,57.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",67.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",54.24,72.06,
"SCR CANC 4.0 X 30MM FT",6108762,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,77.48,61.984,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",61.98,80,,49.58,,,0,"percent of total billed charges ","80% of total billed charges ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",72.06,93,,57.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",67.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",54.24,72.06,
"SCR CANC 4.0 X 35MM FT",6108763,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,77.48,61.984,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",61.98,80,,49.58,,,0,"percent of total billed charges ","80% of total billed charges ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",72.06,93,,57.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",67.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",54.24,72.06,
"SCR CANC 4.0 X 40MM FT",6108764,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,77.48,61.984,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",61.98,80,,49.58,,,0,"percent of total billed charges ","80% of total billed charges ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",72.06,93,,57.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",67.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",54.24,72.06,
"SCR CANC 4.0 X 45MM FT",6108765,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,77.48,61.984,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",61.98,80,,49.58,,,0,"percent of total billed charges ","80% of total billed charges ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",72.06,93,,57.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",67.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",54.24,72.06,
"SCR CANC 4.0 X 50MM FT",6108766,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,77.48,61.984,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",61.98,80,,49.58,,,0,"percent of total billed charges ","80% of total billed charges ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",72.06,93,,57.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",67.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",54.24,72.06,
"SCR CANC 4.0 X 55MM FT",6108767,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,77.48,61.984,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",61.98,80,,49.58,,,0,"percent of total billed charges ","80% of total billed charges ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",72.06,93,,57.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",67.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",54.24,72.06,
"SCR CANC 4.0 X 60MM FT",6108768,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,77.48,61.984,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",61.98,80,,49.58,,,0,"percent of total billed charges ","80% of total billed charges ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",72.06,93,,57.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",65.86,85,,52.69,,,0,"percent of total billed charges ","85% of total billed charges ",69.73,90,,55.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",67.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.24,70,,43.39,,,0,"percent of total billed charges ","70% of total billed charges ",54.24,72.06,
"SCR CANC 4.0 X 10MM PT",6108770,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,73.34,58.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",58.67,80,,46.94,,,0,"percent of total billed charges ","80% of total billed charges ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",68.21,93,,54.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",51.34,68.21,
"SCR CANC 4.0 X 12MM PT",6108771,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,73.34,58.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",58.67,80,,46.94,,,0,"percent of total billed charges ","80% of total billed charges ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",68.21,93,,54.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",51.34,68.21,
"SCR CANC 4.0 X 14MM PT",6108772,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,73.34,58.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",58.67,80,,46.94,,,0,"percent of total billed charges ","80% of total billed charges ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",68.21,93,,54.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",51.34,68.21,
"SCR CANC 4.0 X 16MM PT",6108773,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,73.34,58.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",58.67,80,,46.94,,,0,"percent of total billed charges ","80% of total billed charges ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",68.21,93,,54.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",51.34,68.21,
"SCR CANC 4.0 X 18MM PT",6108774,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,73.34,58.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",58.67,80,,46.94,,,0,"percent of total billed charges ","80% of total billed charges ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",68.21,93,,54.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",51.34,68.21,
"SCR CANC 4.0 X 20MM PT",6108775,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,73.34,58.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",58.67,80,,46.94,,,0,"percent of total billed charges ","80% of total billed charges ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",68.21,93,,54.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",51.34,68.21,
"SCR CANC 4.0 X 22MM PT",6108776,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,73.34,58.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",58.67,80,,46.94,,,0,"percent of total billed charges ","80% of total billed charges ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",68.21,93,,54.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",51.34,68.21,
"SCR CANC 4.0 X 24MM PT",6108777,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,73.34,58.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",58.67,80,,46.94,,,0,"percent of total billed charges ","80% of total billed charges ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",68.21,93,,54.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",51.34,68.21,
"SCR CANC 4.0 X 26MM PT",6108778,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,73.34,58.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",58.67,80,,46.94,,,0,"percent of total billed charges ","80% of total billed charges ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",68.21,93,,54.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",51.34,68.21,
"SCR CANC 4.0 X 28MM PT",6108779,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,73.34,58.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",58.67,80,,46.94,,,0,"percent of total billed charges ","80% of total billed charges ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",68.21,93,,54.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",51.34,68.21,
"SCR CANC 4.0 X 30MM PT",6108780,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,73.34,58.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",58.67,80,,46.94,,,0,"percent of total billed charges ","80% of total billed charges ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",68.21,93,,54.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",51.34,68.21,
"SCR CANC 4.0 X 35MM PT",6108781,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,73.34,58.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",58.67,80,,46.94,,,0,"percent of total billed charges ","80% of total billed charges ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",68.21,93,,54.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",51.34,68.21,
"SCR CANC 4.0 X 40MM PT",6108782,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,73.34,58.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",58.67,80,,46.94,,,0,"percent of total billed charges ","80% of total billed charges ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",68.21,93,,54.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",51.34,68.21,
"SCR CANC 4.0 X 45MM PT",6108783,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,73.34,58.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",58.67,80,,46.94,,,0,"percent of total billed charges ","80% of total billed charges ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",68.21,93,,54.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",51.34,68.21,
"SCR CANC 4.0 X 50MM PT",6108784,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,73.34,58.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",58.67,80,,46.94,,,0,"percent of total billed charges ","80% of total billed charges ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",68.21,93,,54.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",51.34,68.21,
"PLT 3.5 X 72MM 5H",6108785,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,631.95,505.56,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",505.56,80,,404.45,,,0,"percent of total billed charges ","80% of total billed charges ",442.37,70,,353.90,,,0,"percent of total billed charges ","70% of total billed charges ",568.76,90,,455.01,,,0,"percent of total billed charges ","90% of total billed charges ",587.71,93,,470.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",537.16,85,,429.73,,,0,"percent of total billed charges ","85% of total billed charges ",537.16,85,,429.73,,,0,"percent of total billed charges ","85% of total billed charges ",568.76,90,,455.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",549.8,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",442.37,70,,353.90,,,0,"percent of total billed charges ","70% of total billed charges ",442.37,587.71,
"PLT 3.5 X 85MM 6H",6108786,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,672.36,537.888,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",537.89,80,,430.31,,,0,"percent of total billed charges ","80% of total billed charges ",470.65,70,,376.52,,,0,"percent of total billed charges ","70% of total billed charges ",605.12,90,,484.10,,,0,"percent of total billed charges ","90% of total billed charges ",625.29,93,,500.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",571.51,85,,457.21,,,0,"percent of total billed charges ","85% of total billed charges ",571.51,85,,457.21,,,0,"percent of total billed charges ","85% of total billed charges ",605.12,90,,484.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",584.95,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",470.65,70,,376.52,,,0,"percent of total billed charges ","70% of total billed charges ",470.65,625.29,
"PLT 3.5 X 111MM 8H",6108787,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,735.39,588.312,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",588.31,80,,470.65,,,0,"percent of total billed charges ","80% of total billed charges ",514.77,70,,411.82,,,0,"percent of total billed charges ","70% of total billed charges ",661.85,90,,529.48,,,0,"percent of total billed charges ","90% of total billed charges ",683.91,93,,547.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",625.08,85,,500.06,,,0,"percent of total billed charges ","85% of total billed charges ",625.08,85,,500.06,,,0,"percent of total billed charges ","85% of total billed charges ",661.85,90,,529.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",639.79,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",514.77,70,,411.82,,,0,"percent of total billed charges ","70% of total billed charges ",514.77,683.91,
"PLT 3.5 X 124MM 9H",6108788,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,764.49,611.592,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",611.59,80,,489.27,,,0,"percent of total billed charges ","80% of total billed charges ",535.14,70,,428.11,,,0,"percent of total billed charges ","70% of total billed charges ",688.04,90,,550.43,,,0,"percent of total billed charges ","90% of total billed charges ",710.98,93,,568.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",649.82,85,,519.86,,,0,"percent of total billed charges ","85% of total billed charges ",649.82,85,,519.86,,,0,"percent of total billed charges ","85% of total billed charges ",688.04,90,,550.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",665.11,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",535.14,70,,428.11,,,0,"percent of total billed charges ","70% of total billed charges ",535.14,710.98,
"PLT 3.5 X 137MM 10H",6108789,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,788.73,630.984,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",630.98,80,,504.78,,,0,"percent of total billed charges ","80% of total billed charges ",552.11,70,,441.69,,,0,"percent of total billed charges ","70% of total billed charges ",709.86,90,,567.89,,,0,"percent of total billed charges ","90% of total billed charges ",733.52,93,,586.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",670.42,85,,536.34,,,0,"percent of total billed charges ","85% of total billed charges ",670.42,85,,536.34,,,0,"percent of total billed charges ","85% of total billed charges ",709.86,90,,567.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",686.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",552.11,70,,441.69,,,0,"percent of total billed charges ","70% of total billed charges ",552.11,733.52,
"PLT 3.5 X 163MM 12H",6108790,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,869.54,695.632,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",695.63,80,,556.50,,,0,"percent of total billed charges ","80% of total billed charges ",608.68,70,,486.94,,,0,"percent of total billed charges ","70% of total billed charges ",782.59,90,,626.07,,,0,"percent of total billed charges ","90% of total billed charges ",808.67,93,,646.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",739.11,85,,591.29,,,0,"percent of total billed charges ","85% of total billed charges ",739.11,85,,591.29,,,0,"percent of total billed charges ","85% of total billed charges ",782.59,90,,626.07,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",756.5,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",608.68,70,,486.94,,,0,"percent of total billed charges ","70% of total billed charges ",608.68,808.67,
"PLT 3.5 X 189MM 14H",6108791,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1098.53,878.824,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",878.82,80,,703.06,,,0,"percent of total billed charges ","80% of total billed charges ",768.97,70,,615.18,,,0,"percent of total billed charges ","70% of total billed charges ",988.68,90,,790.94,,,0,"percent of total billed charges ","90% of total billed charges ",1021.63,93,,817.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",933.75,85,,747.00,,,0,"percent of total billed charges ","85% of total billed charges ",933.75,85,,747.00,,,0,"percent of total billed charges ","85% of total billed charges ",988.68,90,,790.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",955.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",768.97,70,,615.18,,,0,"percent of total billed charges ","70% of total billed charges ",768.97,1021.63,
"PLT T RT ANG 3.5 X 50MM 3H",6108793,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,680.44,544.352,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",544.35,80,,435.48,,,0,"percent of total billed charges ","80% of total billed charges ",476.31,70,,381.05,,,0,"percent of total billed charges ","70% of total billed charges ",612.4,90,,489.92,,,0,"percent of total billed charges ","90% of total billed charges ",632.81,93,,506.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",578.37,85,,462.70,,,0,"percent of total billed charges ","85% of total billed charges ",578.37,85,,462.70,,,0,"percent of total billed charges ","85% of total billed charges ",612.4,90,,489.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",591.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",476.31,70,,381.05,,,0,"percent of total billed charges ","70% of total billed charges ",476.31,632.81,
"PLT T RT ANG 3.5 X 67MM 5H",6108794,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,772.57,618.056,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",618.06,80,,494.45,,,0,"percent of total billed charges ","80% of total billed charges ",540.8,70,,432.64,,,0,"percent of total billed charges ","70% of total billed charges ",695.31,90,,556.25,,,0,"percent of total billed charges ","90% of total billed charges ",718.49,93,,574.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",656.68,85,,525.34,,,0,"percent of total billed charges ","85% of total billed charges ",656.68,85,,525.34,,,0,"percent of total billed charges ","85% of total billed charges ",695.31,90,,556.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",672.14,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",540.8,70,,432.64,,,0,"percent of total billed charges ","70% of total billed charges ",540.8,718.49,
"PLT T RT ANG 3.5 X 87MM 7H",6108795,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,950.15,760.12,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",760.12,80,,608.10,,,0,"percent of total billed charges ","80% of total billed charges ",665.11,70,,532.09,,,0,"percent of total billed charges ","70% of total billed charges ",855.14,90,,684.11,,,0,"percent of total billed charges ","90% of total billed charges ",883.64,93,,706.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",807.63,85,,646.10,,,0,"percent of total billed charges ","85% of total billed charges ",807.63,85,,646.10,,,0,"percent of total billed charges ","85% of total billed charges ",855.14,90,,684.11,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",826.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",665.11,70,,532.09,,,0,"percent of total billed charges ","70% of total billed charges ",665.11,883.64,
"PLT T RT ANG 3.5 X 56MM 4H",6108796,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,701.45,561.16,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",561.16,80,,448.93,,,0,"percent of total billed charges ","80% of total billed charges ",491.02,70,,392.82,,,0,"percent of total billed charges ","70% of total billed charges ",631.31,90,,505.05,,,0,"percent of total billed charges ","90% of total billed charges ",652.35,93,,521.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",596.23,85,,476.98,,,0,"percent of total billed charges ","85% of total billed charges ",596.23,85,,476.98,,,0,"percent of total billed charges ","85% of total billed charges ",631.31,90,,505.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",610.26,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",491.02,70,,392.82,,,0,"percent of total billed charges ","70% of total billed charges ",491.02,652.35,
"PLT T RT ANG 3.5 X 78MM 6H",6108797,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,900.25,720.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",720.2,80,,576.16,,,0,"percent of total billed charges ","80% of total billed charges ",630.18,70,,504.14,,,0,"percent of total billed charges ","70% of total billed charges ",810.23,90,,648.18,,,0,"percent of total billed charges ","90% of total billed charges ",837.23,93,,669.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",765.21,85,,612.17,,,0,"percent of total billed charges ","85% of total billed charges ",765.21,85,,612.17,,,0,"percent of total billed charges ","85% of total billed charges ",810.23,90,,648.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",783.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",630.18,70,,504.14,,,0,"percent of total billed charges ","70% of total billed charges ",630.18,837.23,
"PLT T OBLQ RT 3.5 X 52MM 3H",6108798,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,761.25,609,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",609,80,,487.20,,,0,"percent of total billed charges ","80% of total billed charges ",532.88,70,,426.30,,,0,"percent of total billed charges ","70% of total billed charges ",685.13,90,,548.10,,,0,"percent of total billed charges ","90% of total billed charges ",707.96,93,,566.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",647.06,85,,517.65,,,0,"percent of total billed charges ","85% of total billed charges ",647.06,85,,517.65,,,0,"percent of total billed charges ","85% of total billed charges ",685.13,90,,548.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",662.29,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",532.88,70,,426.30,,,0,"percent of total billed charges ","70% of total billed charges ",532.88,707.96,
"PLT T OBLQ RT 3.5 X 63MM 4H",6108799,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,796.81,637.448,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",637.45,80,,509.96,,,0,"percent of total billed charges ","80% of total billed charges ",557.77,70,,446.22,,,0,"percent of total billed charges ","70% of total billed charges ",717.13,90,,573.70,,,0,"percent of total billed charges ","90% of total billed charges ",741.03,93,,592.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",677.29,85,,541.83,,,0,"percent of total billed charges ","85% of total billed charges ",677.29,85,,541.83,,,0,"percent of total billed charges ","85% of total billed charges ",717.13,90,,573.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",693.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",557.77,70,,446.22,,,0,"percent of total billed charges ","70% of total billed charges ",557.77,741.03,
"PLT T OBLQ RT 3.5 X 74MM 5H",6108800,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,832.37,665.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",665.9,80,,532.72,,,0,"percent of total billed charges ","80% of total billed charges ",582.66,70,,466.13,,,0,"percent of total billed charges ","70% of total billed charges ",749.13,90,,599.30,,,0,"percent of total billed charges ","90% of total billed charges ",774.1,93,,619.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",707.51,85,,566.01,,,0,"percent of total billed charges ","85% of total billed charges ",707.51,85,,566.01,,,0,"percent of total billed charges ","85% of total billed charges ",749.13,90,,599.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",724.16,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",582.66,70,,466.13,,,0,"percent of total billed charges ","70% of total billed charges ",582.66,774.1,
"PLT T OBLQ RT 3.5 X 96MM 7H",6108801,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,903.48,722.784,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",722.78,80,,578.22,,,0,"percent of total billed charges ","80% of total billed charges ",632.44,70,,505.95,,,0,"percent of total billed charges ","70% of total billed charges ",813.13,90,,650.50,,,0,"percent of total billed charges ","90% of total billed charges ",840.24,93,,672.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",767.96,85,,614.37,,,0,"percent of total billed charges ","85% of total billed charges ",767.96,85,,614.37,,,0,"percent of total billed charges ","85% of total billed charges ",813.13,90,,650.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",786.03,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",632.44,70,,505.95,,,0,"percent of total billed charges ","70% of total billed charges ",632.44,840.24,
"PLT T OBLQ RT 3.5 X 52MM 3H",6108802,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,762.87,610.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",610.3,80,,488.24,,,0,"percent of total billed charges ","80% of total billed charges ",534.01,70,,427.21,,,0,"percent of total billed charges ","70% of total billed charges ",686.58,90,,549.26,,,0,"percent of total billed charges ","90% of total billed charges ",709.47,93,,567.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",648.44,85,,518.75,,,0,"percent of total billed charges ","85% of total billed charges ",648.44,85,,518.75,,,0,"percent of total billed charges ","85% of total billed charges ",686.58,90,,549.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",663.7,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",534.01,70,,427.21,,,0,"percent of total billed charges ","70% of total billed charges ",534.01,709.47,
"PLT T OBLQ RT 3.5 X 63MM 4H",6108803,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,800.04,640.032,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",640.03,80,,512.02,,,0,"percent of total billed charges ","80% of total billed charges ",560.03,70,,448.02,,,0,"percent of total billed charges ","70% of total billed charges ",720.04,90,,576.03,,,0,"percent of total billed charges ","90% of total billed charges ",744.04,93,,595.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",680.03,85,,544.02,,,0,"percent of total billed charges ","85% of total billed charges ",680.03,85,,544.02,,,0,"percent of total billed charges ","85% of total billed charges ",720.04,90,,576.03,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",696.03,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",560.03,70,,448.02,,,0,"percent of total billed charges ","70% of total billed charges ",560.03,744.04,
"PLT T OBLQ RT 3.5 X 74MM 5H",6108804,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,835.6,668.48,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",668.48,80,,534.78,,,0,"percent of total billed charges ","80% of total billed charges ",584.92,70,,467.94,,,0,"percent of total billed charges ","70% of total billed charges ",752.04,90,,601.63,,,0,"percent of total billed charges ","90% of total billed charges ",777.11,93,,621.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",710.26,85,,568.21,,,0,"percent of total billed charges ","85% of total billed charges ",710.26,85,,568.21,,,0,"percent of total billed charges ","85% of total billed charges ",752.04,90,,601.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",726.97,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",584.92,70,,467.94,,,0,"percent of total billed charges ","70% of total billed charges ",584.92,777.11,
"PLT T OBLQ RT 3.5 X 96MM 7H",6108805,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,905.1,724.08,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",724.08,80,,579.26,,,0,"percent of total billed charges ","80% of total billed charges ",633.57,70,,506.86,,,0,"percent of total billed charges ","70% of total billed charges ",814.59,90,,651.67,,,0,"percent of total billed charges ","90% of total billed charges ",841.74,93,,673.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",769.34,85,,615.47,,,0,"percent of total billed charges ","85% of total billed charges ",769.34,85,,615.47,,,0,"percent of total billed charges ","85% of total billed charges ",814.59,90,,651.67,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",787.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",633.57,70,,506.86,,,0,"percent of total billed charges ","70% of total billed charges ",633.57,841.74,
"PLT 1/3 TBLR 3.5 X 57MM 5H",6108806,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,363.66,290.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",290.93,80,,232.74,,,0,"percent of total billed charges ","80% of total billed charges ",254.56,70,,203.65,,,0,"percent of total billed charges ","70% of total billed charges ",327.29,90,,261.83,,,0,"percent of total billed charges ","90% of total billed charges ",338.2,93,,270.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",309.11,85,,247.29,,,0,"percent of total billed charges ","85% of total billed charges ",309.11,85,,247.29,,,0,"percent of total billed charges ","85% of total billed charges ",327.29,90,,261.83,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",316.38,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",254.56,70,,203.65,,,0,"percent of total billed charges ","70% of total billed charges ",254.56,338.2,
"PLT 1/3 TBLR 3.5 X 69MM 6H",6108807,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,363.66,290.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",290.93,80,,232.74,,,0,"percent of total billed charges ","80% of total billed charges ",254.56,70,,203.65,,,0,"percent of total billed charges ","70% of total billed charges ",327.29,90,,261.83,,,0,"percent of total billed charges ","90% of total billed charges ",338.2,93,,270.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",309.11,85,,247.29,,,0,"percent of total billed charges ","85% of total billed charges ",309.11,85,,247.29,,,0,"percent of total billed charges ","85% of total billed charges ",327.29,90,,261.83,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",316.38,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",254.56,70,,203.65,,,0,"percent of total billed charges ","70% of total billed charges ",254.56,338.2,
"PLT 1/3 TBLR 3.5 X 81MM 7H",6108808,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,371.74,297.392,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",297.39,80,,237.91,,,0,"percent of total billed charges ","80% of total billed charges ",260.22,70,,208.18,,,0,"percent of total billed charges ","70% of total billed charges ",334.57,90,,267.66,,,0,"percent of total billed charges ","90% of total billed charges ",345.72,93,,276.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",315.98,85,,252.78,,,0,"percent of total billed charges ","85% of total billed charges ",315.98,85,,252.78,,,0,"percent of total billed charges ","85% of total billed charges ",334.57,90,,267.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",323.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",260.22,70,,208.18,,,0,"percent of total billed charges ","70% of total billed charges ",260.22,345.72,
"PLT 1/3 TBLR 3.5 X 93MM 8H",6108809,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,391.13,312.904,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",312.9,80,,250.32,,,0,"percent of total billed charges ","80% of total billed charges ",273.79,70,,219.03,,,0,"percent of total billed charges ","70% of total billed charges ",352.02,90,,281.62,,,0,"percent of total billed charges ","90% of total billed charges ",363.75,93,,291.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",332.46,85,,265.97,,,0,"percent of total billed charges ","85% of total billed charges ",332.46,85,,265.97,,,0,"percent of total billed charges ","85% of total billed charges ",352.02,90,,281.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",340.28,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.79,70,,219.03,,,0,"percent of total billed charges ","70% of total billed charges ",273.79,363.75,
"PLT 1/3 TBLR 3.5 X 117MM 10H",6108810,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,391.13,312.904,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",312.9,80,,250.32,,,0,"percent of total billed charges ","80% of total billed charges ",273.79,70,,219.03,,,0,"percent of total billed charges ","70% of total billed charges ",352.02,90,,281.62,,,0,"percent of total billed charges ","90% of total billed charges ",363.75,93,,291.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",332.46,85,,265.97,,,0,"percent of total billed charges ","85% of total billed charges ",332.46,85,,265.97,,,0,"percent of total billed charges ","85% of total billed charges ",352.02,90,,281.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",340.28,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.79,70,,219.03,,,0,"percent of total billed charges ","70% of total billed charges ",273.79,363.75,
"PLT 1/3 TBLR 3.5 X 141MM 12H",6108811,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,404.06,323.248,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",323.25,80,,258.60,,,0,"percent of total billed charges ","80% of total billed charges ",282.84,70,,226.27,,,0,"percent of total billed charges ","70% of total billed charges ",363.65,90,,290.92,,,0,"percent of total billed charges ","90% of total billed charges ",375.78,93,,300.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",343.45,85,,274.76,,,0,"percent of total billed charges ","85% of total billed charges ",343.45,85,,274.76,,,0,"percent of total billed charges ","85% of total billed charges ",363.65,90,,290.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",351.53,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",282.84,70,,226.27,,,0,"percent of total billed charges ","70% of total billed charges ",282.84,375.78,
"PLT PRX HUM STD 3.5 X 90MM 3H",6108812,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2767.42,2213.936,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2213.94,80,,1771.15,,,0,"percent of total billed charges ","80% of total billed charges ",1937.19,70,,1549.75,,,0,"percent of total billed charges ","70% of total billed charges ",2490.68,90,,1992.54,,,0,"percent of total billed charges ","90% of total billed charges ",2573.7,93,,2058.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2352.31,85,,1881.85,,,0,"percent of total billed charges ","85% of total billed charges ",2352.31,85,,1881.85,,,0,"percent of total billed charges ","85% of total billed charges ",2490.68,90,,1992.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2407.66,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1937.19,70,,1549.75,,,0,"percent of total billed charges ","70% of total billed charges ",1937.19,2573.7,
"PLT PRX HUM STD 3.5 X 114MM 5H",6108813,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2854.54,2283.632,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2283.63,80,,1826.90,,,0,"percent of total billed charges ","80% of total billed charges ",1998.18,70,,1598.54,,,0,"percent of total billed charges ","70% of total billed charges ",2569.09,90,,2055.27,,,0,"percent of total billed charges ","90% of total billed charges ",2654.72,93,,2123.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2426.36,85,,1941.09,,,0,"percent of total billed charges ","85% of total billed charges ",2426.36,85,,1941.09,,,0,"percent of total billed charges ","85% of total billed charges ",2569.09,90,,2055.27,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2483.45,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1998.18,70,,1598.54,,,0,"percent of total billed charges ","70% of total billed charges ",1998.18,2654.72,
"PLT RECON 3.5 X 70MM 5H",6108814,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,930.96,744.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",744.77,80,,595.82,,,0,"percent of total billed charges ","80% of total billed charges ",651.67,70,,521.34,,,0,"percent of total billed charges ","70% of total billed charges ",837.86,90,,670.29,,,0,"percent of total billed charges ","90% of total billed charges ",865.79,93,,692.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",791.32,85,,633.06,,,0,"percent of total billed charges ","85% of total billed charges ",791.32,85,,633.06,,,0,"percent of total billed charges ","85% of total billed charges ",837.86,90,,670.29,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",809.94,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",651.67,70,,521.34,,,0,"percent of total billed charges ","70% of total billed charges ",651.67,865.79,
"PLT RECON 3.5 X 84MM 6H",6108815,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1076.42,861.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",861.14,80,,688.91,,,0,"percent of total billed charges ","80% of total billed charges ",753.49,70,,602.79,,,0,"percent of total billed charges ","70% of total billed charges ",968.78,90,,775.02,,,0,"percent of total billed charges ","90% of total billed charges ",1001.07,93,,800.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",914.96,85,,731.97,,,0,"percent of total billed charges ","85% of total billed charges ",914.96,85,,731.97,,,0,"percent of total billed charges ","85% of total billed charges ",968.78,90,,775.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",936.49,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",753.49,70,,602.79,,,0,"percent of total billed charges ","70% of total billed charges ",753.49,1001.07,
"PLT RECON 3.5 X 98MM 7H",6108816,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,951.51,761.208,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",761.21,80,,608.97,,,0,"percent of total billed charges ","80% of total billed charges ",666.06,70,,532.85,,,0,"percent of total billed charges ","70% of total billed charges ",856.36,90,,685.09,,,0,"percent of total billed charges ","90% of total billed charges ",884.9,93,,707.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",808.78,85,,647.02,,,0,"percent of total billed charges ","85% of total billed charges ",808.78,85,,647.02,,,0,"percent of total billed charges ","85% of total billed charges ",856.36,90,,685.09,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",827.81,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",666.06,70,,532.85,,,0,"percent of total billed charges ","70% of total billed charges ",666.06,884.9,
"PLT RECON 3.5 X 112MM 8H",6108817,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,992.35,793.88,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",793.88,80,,635.10,,,0,"percent of total billed charges ","80% of total billed charges ",694.65,70,,555.72,,,0,"percent of total billed charges ","70% of total billed charges ",893.12,90,,714.50,,,0,"percent of total billed charges ","90% of total billed charges ",922.89,93,,738.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",843.5,85,,674.80,,,0,"percent of total billed charges ","85% of total billed charges ",843.5,85,,674.80,,,0,"percent of total billed charges ","85% of total billed charges ",893.12,90,,714.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",863.34,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",694.65,70,,555.72,,,0,"percent of total billed charges ","70% of total billed charges ",694.65,922.89,
"PLT RECON 3.5 X 140MM 10H",6108818,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1029.11,823.288,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",823.29,80,,658.63,,,0,"percent of total billed charges ","80% of total billed charges ",720.38,70,,576.30,,,0,"percent of total billed charges ","70% of total billed charges ",926.2,90,,740.96,,,0,"percent of total billed charges ","90% of total billed charges ",957.07,93,,765.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",874.74,85,,699.79,,,0,"percent of total billed charges ","85% of total billed charges ",874.74,85,,699.79,,,0,"percent of total billed charges ","85% of total billed charges ",926.2,90,,740.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",895.33,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",720.38,70,,576.30,,,0,"percent of total billed charges ","70% of total billed charges ",720.38,957.07,
"PLT RECON 3.5 X 168MM 12H",6108819,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1139.37,911.496,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",911.5,80,,729.20,,,0,"percent of total billed charges ","80% of total billed charges ",797.56,70,,638.05,,,0,"percent of total billed charges ","70% of total billed charges ",1025.43,90,,820.34,,,0,"percent of total billed charges ","90% of total billed charges ",1059.61,93,,847.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",968.46,85,,774.77,,,0,"percent of total billed charges ","85% of total billed charges ",968.46,85,,774.77,,,0,"percent of total billed charges ","85% of total billed charges ",1025.43,90,,820.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",991.25,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",797.56,70,,638.05,,,0,"percent of total billed charges ","70% of total billed charges ",797.56,1059.61,
"SCR CANC 6.5 X 25MM FT",6108822,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"SCR CANC 6.5 X 30MM FT",6108823,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"SCR CANC 6.5 X 35MM FT",6108824,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"SCR CANC 6.5 X 40MM FT",6108825,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"SCR CANC 6.5 X 45MM FT",6108826,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"SCR CANC 6.5 X 50MM FT",6108827,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"SCR CANC 6.5 X 55MM FT",6108828,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"SCR CANC 6.5 X 60MM FT",6108829,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"SCR VA LCKG 3.5X38MM ST",6108831,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5X70MM ST",6108832,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5X75MM ST",6108833,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"WASHER 7.0MM",6108834,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,112.5,90,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",90,80,,72.00,,,0,"percent of total billed charges ","80% of total billed charges ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",104.63,93,,83.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",95.63,85,,76.50,,,0,"percent of total billed charges ","85% of total billed charges ",95.63,85,,76.50,,,0,"percent of total billed charges ","85% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",97.88,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",78.75,104.63,
"SCR CRTX 4.5 X 14MM ST",6108836,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"SCR CRTX 4.5 X 16MM ST",6108837,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"SCR CRTX 4.5 X 18MM ST",6108838,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"SCR CRTX 4.5 X 20MM ST",6108839,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"SCR CRTX 4.5 X 22MM ST",6108840,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"SCR CRTX 4.5 X 24MM ST",6108841,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"SCR CRTX 4.5 X 26MM ST",6108842,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"SCR CRTX 4.5 X 28MM ST",6108843,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"SCR CRTX 4.5 X 30MM ST",6108844,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"SCR CRTX 4.5 X 32MM ST",6108845,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"SCR CRTX 4.5 X 34MM ST",6108846,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"SCR CRTX 4.5 X 36MM ST",6108847,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"SCR CRTX 4.5 X 38MM ST",6108848,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"SCR CRTX 4.5 X 40MM ST",6108849,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"SCR CRTX 4.5 X 42MM ST",6108850,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"SCR CRTX 4.5 X 44MM ST",6108851,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"SCR CRTX 4.5 X 46MM ST",6108852,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"SCR CRTX 4.5 X 48MM ST",6108853,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"SCR CRTX 4.5 X 50MM ST",6108854,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"SCR CRTX 4.5 X 52MM ST",6108855,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"SCR CRTX 4.5 X 54MM ST",6108856,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"SCR CRTX 4.5 X 58MM ST",6108858,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"SCR CRTX 4.5 X 60MM ST",6108859,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"SCR CRTX 4.5 X 62MM ST",6108860,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"SCR CRTX 4.5 X 64MM ST",6108861,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"SCR CRTX 4.5 X 66MM ST",6108862,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"SCR CRTX 4.5 X 68MM ST",6108863,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"SCR CANC 6.5 X 30MM PT 16MM",6108864,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"SCR CANC 6.5 X 35MM PT 16MM",6108866,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"SCR CANC 6.5 X 40MM PT 16MM",6108867,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"SCR CANC 6.5 X 45MM PT 16MM",6108868,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"SCR CANC 6.5 X 50MM PT 16MM",6108869,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"SCR CANC 6.5 X 55MM PT 16MM",6108870,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"SCR CANC 6.5 X 60MM PT 16MM",6108871,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"SCR CANC 6.5 X 65MM PT 16MM",6108872,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"SCR CANC 6.5 X 70MM PT 16MM",6108873,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"SCR CANC 6.5 X 75MM PT 16MM",6108874,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"SCR CANC 6.5 X 80MM PT 16MM",6108875,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"SCR CANC 6.5 X 85MM PT 16MM",6108876,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,156.69,125.352,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.35,80,,100.28,,,0,"percent of total billed charges ","80% of total billed charges ",109.68,70,,87.74,,,0,"percent of total billed charges ","70% of total billed charges ",141.02,90,,112.82,,,0,"percent of total billed charges ","90% of total billed charges ",145.72,93,,116.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.19,85,,106.55,,,0,"percent of total billed charges ","85% of total billed charges ",133.19,85,,106.55,,,0,"percent of total billed charges ","85% of total billed charges ",141.02,90,,112.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",136.32,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.68,70,,87.74,,,0,"percent of total billed charges ","70% of total billed charges ",109.68,145.72,
"SCR CANC 6.5 X 90MM PT 16MM",6108877,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,156.69,125.352,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.35,80,,100.28,,,0,"percent of total billed charges ","80% of total billed charges ",109.68,70,,87.74,,,0,"percent of total billed charges ","70% of total billed charges ",141.02,90,,112.82,,,0,"percent of total billed charges ","90% of total billed charges ",145.72,93,,116.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.19,85,,106.55,,,0,"percent of total billed charges ","85% of total billed charges ",133.19,85,,106.55,,,0,"percent of total billed charges ","85% of total billed charges ",141.02,90,,112.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",136.32,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.68,70,,87.74,,,0,"percent of total billed charges ","70% of total billed charges ",109.68,145.72,
"SCR CANC 6.5 X 95MM PT 16MM",6108878,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,156.69,125.352,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.35,80,,100.28,,,0,"percent of total billed charges ","80% of total billed charges ",109.68,70,,87.74,,,0,"percent of total billed charges ","70% of total billed charges ",141.02,90,,112.82,,,0,"percent of total billed charges ","90% of total billed charges ",145.72,93,,116.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.19,85,,106.55,,,0,"percent of total billed charges ","85% of total billed charges ",133.19,85,,106.55,,,0,"percent of total billed charges ","85% of total billed charges ",141.02,90,,112.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",136.32,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.68,70,,87.74,,,0,"percent of total billed charges ","70% of total billed charges ",109.68,145.72,
"SCR CANC 6.5 X 100MM PT 16MM",6108879,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,156.69,125.352,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.35,80,,100.28,,,0,"percent of total billed charges ","80% of total billed charges ",109.68,70,,87.74,,,0,"percent of total billed charges ","70% of total billed charges ",141.02,90,,112.82,,,0,"percent of total billed charges ","90% of total billed charges ",145.72,93,,116.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.19,85,,106.55,,,0,"percent of total billed charges ","85% of total billed charges ",133.19,85,,106.55,,,0,"percent of total billed charges ","85% of total billed charges ",141.02,90,,112.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",136.32,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.68,70,,87.74,,,0,"percent of total billed charges ","70% of total billed charges ",109.68,145.72,
"SCR CANC 6.5 X 105MM PT 16MM",6108880,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,156.69,125.352,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.35,80,,100.28,,,0,"percent of total billed charges ","80% of total billed charges ",109.68,70,,87.74,,,0,"percent of total billed charges ","70% of total billed charges ",141.02,90,,112.82,,,0,"percent of total billed charges ","90% of total billed charges ",145.72,93,,116.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.19,85,,106.55,,,0,"percent of total billed charges ","85% of total billed charges ",133.19,85,,106.55,,,0,"percent of total billed charges ","85% of total billed charges ",141.02,90,,112.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",136.32,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.68,70,,87.74,,,0,"percent of total billed charges ","70% of total billed charges ",109.68,145.72,
"SCR CANC 6.5 X 110MM PT 16MM",6108881,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,156.69,125.352,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.35,80,,100.28,,,0,"percent of total billed charges ","80% of total billed charges ",109.68,70,,87.74,,,0,"percent of total billed charges ","70% of total billed charges ",141.02,90,,112.82,,,0,"percent of total billed charges ","90% of total billed charges ",145.72,93,,116.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.19,85,,106.55,,,0,"percent of total billed charges ","85% of total billed charges ",133.19,85,,106.55,,,0,"percent of total billed charges ","85% of total billed charges ",141.02,90,,112.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",136.32,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.68,70,,87.74,,,0,"percent of total billed charges ","70% of total billed charges ",109.68,145.72,
"SCR CANC 6.5 X 45MM PT 32MM",6108882,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"SCR CANC 6.5 X 50MM PT 32MM",6108883,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"SCR CANC 6.5 X 55MM PT 32MM",6108884,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"SCR CANC 6.5 X 60MM PT 32MM",6108885,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"SCR CANC 6.5 X 65MM PT 32MM",6108886,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"SCR CANC 6.5 X 70MM PT 32MM",6108887,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"SCR CANC 6.5 X 75MM PT 32MM",6108888,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"SCR CANC 6.5 X 80MM PT 32MM",6108889,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"SCR CANC 6.5 X 85MM PT 32MM",6108890,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,156.69,125.352,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.35,80,,100.28,,,0,"percent of total billed charges ","80% of total billed charges ",109.68,70,,87.74,,,0,"percent of total billed charges ","70% of total billed charges ",141.02,90,,112.82,,,0,"percent of total billed charges ","90% of total billed charges ",145.72,93,,116.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.19,85,,106.55,,,0,"percent of total billed charges ","85% of total billed charges ",133.19,85,,106.55,,,0,"percent of total billed charges ","85% of total billed charges ",141.02,90,,112.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",136.32,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.68,70,,87.74,,,0,"percent of total billed charges ","70% of total billed charges ",109.68,145.72,
"SCR CANC 6.5 X 90MM PT 32MM",6108891,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,156.69,125.352,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.35,80,,100.28,,,0,"percent of total billed charges ","80% of total billed charges ",109.68,70,,87.74,,,0,"percent of total billed charges ","70% of total billed charges ",141.02,90,,112.82,,,0,"percent of total billed charges ","90% of total billed charges ",145.72,93,,116.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.19,85,,106.55,,,0,"percent of total billed charges ","85% of total billed charges ",133.19,85,,106.55,,,0,"percent of total billed charges ","85% of total billed charges ",141.02,90,,112.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",136.32,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.68,70,,87.74,,,0,"percent of total billed charges ","70% of total billed charges ",109.68,145.72,
"SCR CANC 6.5 X 95MM PT 32MM",6108892,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,156.69,125.352,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.35,80,,100.28,,,0,"percent of total billed charges ","80% of total billed charges ",109.68,70,,87.74,,,0,"percent of total billed charges ","70% of total billed charges ",141.02,90,,112.82,,,0,"percent of total billed charges ","90% of total billed charges ",145.72,93,,116.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.19,85,,106.55,,,0,"percent of total billed charges ","85% of total billed charges ",133.19,85,,106.55,,,0,"percent of total billed charges ","85% of total billed charges ",141.02,90,,112.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",136.32,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.68,70,,87.74,,,0,"percent of total billed charges ","70% of total billed charges ",109.68,145.72,
"SCR CANC 6.5 X 100MM PT 32MM",6108893,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,156.69,125.352,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.35,80,,100.28,,,0,"percent of total billed charges ","80% of total billed charges ",109.68,70,,87.74,,,0,"percent of total billed charges ","70% of total billed charges ",141.02,90,,112.82,,,0,"percent of total billed charges ","90% of total billed charges ",145.72,93,,116.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.19,85,,106.55,,,0,"percent of total billed charges ","85% of total billed charges ",133.19,85,,106.55,,,0,"percent of total billed charges ","85% of total billed charges ",141.02,90,,112.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",136.32,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.68,70,,87.74,,,0,"percent of total billed charges ","70% of total billed charges ",109.68,145.72,
"SCR CANC 6.5 X 105MM PT 32MM",6108894,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,156.69,125.352,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.35,80,,100.28,,,0,"percent of total billed charges ","80% of total billed charges ",109.68,70,,87.74,,,0,"percent of total billed charges ","70% of total billed charges ",141.02,90,,112.82,,,0,"percent of total billed charges ","90% of total billed charges ",145.72,93,,116.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.19,85,,106.55,,,0,"percent of total billed charges ","85% of total billed charges ",133.19,85,,106.55,,,0,"percent of total billed charges ","85% of total billed charges ",141.02,90,,112.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",136.32,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.68,70,,87.74,,,0,"percent of total billed charges ","70% of total billed charges ",109.68,145.72,
"SCR CANC 6.5 X 110MM PT 32MM",6108895,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,156.69,125.352,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.35,80,,100.28,,,0,"percent of total billed charges ","80% of total billed charges ",109.68,70,,87.74,,,0,"percent of total billed charges ","70% of total billed charges ",141.02,90,,112.82,,,0,"percent of total billed charges ","90% of total billed charges ",145.72,93,,116.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.19,85,,106.55,,,0,"percent of total billed charges ","85% of total billed charges ",133.19,85,,106.55,,,0,"percent of total billed charges ","85% of total billed charges ",141.02,90,,112.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",136.32,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.68,70,,87.74,,,0,"percent of total billed charges ","70% of total billed charges ",109.68,145.72,
"SCR LCKG 4.0 X 14MM ST",6108896,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,310.32,248.256,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",248.26,80,,198.61,,,0,"percent of total billed charges ","80% of total billed charges ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",288.6,93,,230.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",217.22,288.6,
"SCR LCKG 4.0 X 16MM ST",6108897,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,310.32,248.256,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",248.26,80,,198.61,,,0,"percent of total billed charges ","80% of total billed charges ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",288.6,93,,230.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",217.22,288.6,
"SCR LCKG 4.0 X 18MM ST",6108898,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,310.32,248.256,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",248.26,80,,198.61,,,0,"percent of total billed charges ","80% of total billed charges ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",288.6,93,,230.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",217.22,288.6,
"SCR LCKG 4.0 X 20MM ST",6108899,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,310.32,248.256,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",248.26,80,,198.61,,,0,"percent of total billed charges ","80% of total billed charges ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",288.6,93,,230.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",217.22,288.6,
"SCR LCKG 4.0 X 22MM ST",6108900,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,310.32,248.256,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",248.26,80,,198.61,,,0,"percent of total billed charges ","80% of total billed charges ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",288.6,93,,230.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",217.22,288.6,
"SCR LCKG 4.0 X 24MM ST",6108901,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,310.32,248.256,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",248.26,80,,198.61,,,0,"percent of total billed charges ","80% of total billed charges ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",288.6,93,,230.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",217.22,288.6,
"SCR LCKG 4.0 X 26MM ST",6108902,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,310.32,248.256,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",248.26,80,,198.61,,,0,"percent of total billed charges ","80% of total billed charges ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",288.6,93,,230.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",217.22,288.6,
"SCR LCKG 4.0 X 28MM ST",6108903,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,310.32,248.256,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",248.26,80,,198.61,,,0,"percent of total billed charges ","80% of total billed charges ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",288.6,93,,230.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",217.22,288.6,
"SCR LCKG 4.0 X 30MM ST",6108904,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,310.32,248.256,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",248.26,80,,198.61,,,0,"percent of total billed charges ","80% of total billed charges ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",288.6,93,,230.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",217.22,288.6,
"SCR LCKG 4.0 X 32MM ST",6108905,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,310.32,248.256,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",248.26,80,,198.61,,,0,"percent of total billed charges ","80% of total billed charges ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",288.6,93,,230.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",217.22,288.6,
"SCR LCKG 4.0 X 34MM ST",6108906,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,310.32,248.256,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",248.26,80,,198.61,,,0,"percent of total billed charges ","80% of total billed charges ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",288.6,93,,230.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",217.22,288.6,
"SCR LCKG 4.0 X 36MM ST",6108907,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,310.32,248.256,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",248.26,80,,198.61,,,0,"percent of total billed charges ","80% of total billed charges ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",288.6,93,,230.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",217.22,288.6,
"SCR LCKG 4.0 X 38MM ST",6108908,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,310.32,248.256,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",248.26,80,,198.61,,,0,"percent of total billed charges ","80% of total billed charges ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",288.6,93,,230.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",217.22,288.6,
"SCR LCKG 4.0 X 40MM ST",6108909,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,310.32,248.256,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",248.26,80,,198.61,,,0,"percent of total billed charges ","80% of total billed charges ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",288.6,93,,230.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",217.22,288.6,
"SCR LCKG 4.0 X 42MM ST",6108910,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,310.32,248.256,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",248.26,80,,198.61,,,0,"percent of total billed charges ","80% of total billed charges ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",288.6,93,,230.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",217.22,288.6,
"SCR LCKG 4.0 X 44MM ST",6108911,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,310.32,248.256,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",248.26,80,,198.61,,,0,"percent of total billed charges ","80% of total billed charges ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",288.6,93,,230.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",217.22,288.6,
"SCR LCKG 4.0 X 46MM ST",6108912,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,310.32,248.256,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",248.26,80,,198.61,,,0,"percent of total billed charges ","80% of total billed charges ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",288.6,93,,230.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",217.22,288.6,
"SCR LCKG 4.0 X 48MM ST",6108913,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,310.32,248.256,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",248.26,80,,198.61,,,0,"percent of total billed charges ","80% of total billed charges ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",288.6,93,,230.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",217.22,288.6,
"SCR LCKG 4.0 X 50MM ST",6108914,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,310.32,248.256,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",248.26,80,,198.61,,,0,"percent of total billed charges ","80% of total billed charges ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",288.6,93,,230.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",217.22,288.6,
"SCR LCKG 4.0 X 52MM ST",6108915,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,310.32,248.256,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",248.26,80,,198.61,,,0,"percent of total billed charges ","80% of total billed charges ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",288.6,93,,230.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",217.22,288.6,
"SCR LCKG 4.0 X 54MM ST",6108916,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,310.32,248.256,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",248.26,80,,198.61,,,0,"percent of total billed charges ","80% of total billed charges ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",288.6,93,,230.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",217.22,288.6,
"SCR LCKG 4.0 X 56MM ST",6108917,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,310.32,248.256,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",248.26,80,,198.61,,,0,"percent of total billed charges ","80% of total billed charges ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",288.6,93,,230.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",217.22,288.6,
"SCR LCKG 4.0 X 58MM ST",6108918,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,310.32,248.256,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",248.26,80,,198.61,,,0,"percent of total billed charges ","80% of total billed charges ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",288.6,93,,230.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",217.22,288.6,
"SCR LCKG 4.0 X 60MM ST",6108919,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,310.32,248.256,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",248.26,80,,198.61,,,0,"percent of total billed charges ","80% of total billed charges ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",288.6,93,,230.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",217.22,288.6,
"SCR LCKG 4.0 X 62MM ST",6108920,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,310.32,248.256,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",248.26,80,,198.61,,,0,"percent of total billed charges ","80% of total billed charges ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",288.6,93,,230.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",263.77,85,,211.02,,,0,"percent of total billed charges ","85% of total billed charges ",279.29,90,,223.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",269.98,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.22,70,,173.78,,,0,"percent of total billed charges ","70% of total billed charges ",217.22,288.6,
"SCR LCKG 5.0 X 14MM ST",6108921,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,315.17,252.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",252.14,80,,201.71,,,0,"percent of total billed charges ","80% of total billed charges ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",293.11,93,,234.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",220.62,293.11,
"SCR LCKG 5.0 X 16MM ST",6108922,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,315.17,252.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",252.14,80,,201.71,,,0,"percent of total billed charges ","80% of total billed charges ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",293.11,93,,234.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",220.62,293.11,
"SCR LCKG 5.0 X 18MM ST",6108923,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,315.17,252.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",252.14,80,,201.71,,,0,"percent of total billed charges ","80% of total billed charges ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",293.11,93,,234.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",220.62,293.11,
"SCR LCKG 5.0 X 20MM ST",6108924,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,315.17,252.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",252.14,80,,201.71,,,0,"percent of total billed charges ","80% of total billed charges ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",293.11,93,,234.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",220.62,293.11,
"SCR LCKG 5.0 X 22MM ST",6108925,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,315.17,252.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",252.14,80,,201.71,,,0,"percent of total billed charges ","80% of total billed charges ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",293.11,93,,234.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",220.62,293.11,
"SCR LCKG 5.0 X 24MM ST",6108926,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,315.17,252.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",252.14,80,,201.71,,,0,"percent of total billed charges ","80% of total billed charges ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",293.11,93,,234.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",220.62,293.11,
"SCR LCKG 5.0 X 26MM ST",6108927,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,315.17,252.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",252.14,80,,201.71,,,0,"percent of total billed charges ","80% of total billed charges ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",293.11,93,,234.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",220.62,293.11,
"SCR LCKG 5.0 X 28MM ST",6108928,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,315.17,252.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",252.14,80,,201.71,,,0,"percent of total billed charges ","80% of total billed charges ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",293.11,93,,234.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",220.62,293.11,
"SCR LCKG 5.0 X 30MM ST",6108929,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,315.17,252.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",252.14,80,,201.71,,,0,"percent of total billed charges ","80% of total billed charges ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",293.11,93,,234.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",220.62,293.11,
"SCR LCKG 5.0 X 32MM ST",6108930,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,315.17,252.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",252.14,80,,201.71,,,0,"percent of total billed charges ","80% of total billed charges ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",293.11,93,,234.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",220.62,293.11,
"SCR LCKG 5.0 X 34MM ST",6108931,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,315.17,252.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",252.14,80,,201.71,,,0,"percent of total billed charges ","80% of total billed charges ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",293.11,93,,234.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",220.62,293.11,
"SCR LCKG 5.0 X 36MM ST",6108932,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,315.17,252.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",252.14,80,,201.71,,,0,"percent of total billed charges ","80% of total billed charges ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",293.11,93,,234.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",220.62,293.11,
"SCR LCKG 5.0 X 38MM ST",6108933,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,315.17,252.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",252.14,80,,201.71,,,0,"percent of total billed charges ","80% of total billed charges ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",293.11,93,,234.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",220.62,293.11,
"SCR LCKG 5.0 X 40MM ST",6108934,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,315.17,252.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",252.14,80,,201.71,,,0,"percent of total billed charges ","80% of total billed charges ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",293.11,93,,234.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",220.62,293.11,
"SCR LCKG 5.0 X 42MM ST",6108935,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,315.17,252.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",252.14,80,,201.71,,,0,"percent of total billed charges ","80% of total billed charges ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",293.11,93,,234.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",220.62,293.11,
"SCR LCKG 5.0 X 44MM ST",6108936,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,315.17,252.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",252.14,80,,201.71,,,0,"percent of total billed charges ","80% of total billed charges ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",293.11,93,,234.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",220.62,293.11,
"SCR LCKG 5.0 X 46MM ST",6108937,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,315.17,252.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",252.14,80,,201.71,,,0,"percent of total billed charges ","80% of total billed charges ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",293.11,93,,234.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",220.62,293.11,
"SCR LCKG 5.0 X 48MM ST",6108938,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,315.17,252.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",252.14,80,,201.71,,,0,"percent of total billed charges ","80% of total billed charges ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",293.11,93,,234.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",220.62,293.11,
"SCR LCKG 5.0 X 50MM ST",6108939,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,315.17,252.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",252.14,80,,201.71,,,0,"percent of total billed charges ","80% of total billed charges ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",293.11,93,,234.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",220.62,293.11,
"SCR LCKG 5.0 X 55MM ST",6108940,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,315.17,252.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",252.14,80,,201.71,,,0,"percent of total billed charges ","80% of total billed charges ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",293.11,93,,234.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",220.62,293.11,
"SCR LCKG 5.0 X 60MM ST",6108941,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,315.17,252.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",252.14,80,,201.71,,,0,"percent of total billed charges ","80% of total billed charges ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",293.11,93,,234.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",220.62,293.11,
"SCR LCKG 5.0 X 65MM ST",6108942,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,315.17,252.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",252.14,80,,201.71,,,0,"percent of total billed charges ","80% of total billed charges ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",293.11,93,,234.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",220.62,293.11,
"SCR LCKG 5.0 X 70MM ST",6108943,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,315.17,252.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",252.14,80,,201.71,,,0,"percent of total billed charges ","80% of total billed charges ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",293.11,93,,234.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",220.62,293.11,
"SCR LCKG 5.0 X 75MM ST",6108944,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,315.17,252.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",252.14,80,,201.71,,,0,"percent of total billed charges ","80% of total billed charges ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",293.11,93,,234.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",220.62,293.11,
"SCR LCKG 5.0 X 80MM ST",6108945,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,315.17,252.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",252.14,80,,201.71,,,0,"percent of total billed charges ","80% of total billed charges ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",293.11,93,,234.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",220.62,293.11,
"SCR LCKG 5.0 X 85MM ST",6108946,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,315.17,252.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",252.14,80,,201.71,,,0,"percent of total billed charges ","80% of total billed charges ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",293.11,93,,234.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",220.62,293.11,
"SCR LCKG 5.0 X 90MM ST",6108947,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,315.17,252.136,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",252.14,80,,201.71,,,0,"percent of total billed charges ","80% of total billed charges ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",293.11,93,,234.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",267.89,85,,214.31,,,0,"percent of total billed charges ","85% of total billed charges ",283.65,90,,226.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.62,70,,176.50,,,0,"percent of total billed charges ","70% of total billed charges ",220.62,293.11,
"PLT NRRW 4.5 X 80MM 4H",6108948,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,746.71,597.368,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",597.37,80,,477.90,,,0,"percent of total billed charges ","80% of total billed charges ",522.7,70,,418.16,,,0,"percent of total billed charges ","70% of total billed charges ",672.04,90,,537.63,,,0,"percent of total billed charges ","90% of total billed charges ",694.44,93,,555.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",634.7,85,,507.76,,,0,"percent of total billed charges ","85% of total billed charges ",634.7,85,,507.76,,,0,"percent of total billed charges ","85% of total billed charges ",672.04,90,,537.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",649.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",522.7,70,,418.16,,,0,"percent of total billed charges ","70% of total billed charges ",522.7,694.44,
"PLT NRRW 4.5 X 98MM 5H",6108949,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,798.43,638.744,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",638.74,80,,510.99,,,0,"percent of total billed charges ","80% of total billed charges ",558.9,70,,447.12,,,0,"percent of total billed charges ","70% of total billed charges ",718.59,90,,574.87,,,0,"percent of total billed charges ","90% of total billed charges ",742.54,93,,594.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",678.67,85,,542.94,,,0,"percent of total billed charges ","85% of total billed charges ",678.67,85,,542.94,,,0,"percent of total billed charges ","85% of total billed charges ",718.59,90,,574.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",694.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",558.9,70,,447.12,,,0,"percent of total billed charges ","70% of total billed charges ",558.9,742.54,
"PLT NRRW 4.5 X 116MM 6H",6108950,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,845.3,676.24,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",676.24,80,,540.99,,,0,"percent of total billed charges ","80% of total billed charges ",591.71,70,,473.37,,,0,"percent of total billed charges ","70% of total billed charges ",760.77,90,,608.62,,,0,"percent of total billed charges ","90% of total billed charges ",786.13,93,,628.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",718.51,85,,574.81,,,0,"percent of total billed charges ","85% of total billed charges ",718.51,85,,574.81,,,0,"percent of total billed charges ","85% of total billed charges ",760.77,90,,608.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",735.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",591.71,70,,473.37,,,0,"percent of total billed charges ","70% of total billed charges ",591.71,786.13,
"PLT NRRW 4.5 X 134MM 7H",6108951,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,977.83,782.264,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",782.26,80,,625.81,,,0,"percent of total billed charges ","80% of total billed charges ",684.48,70,,547.58,,,0,"percent of total billed charges ","70% of total billed charges ",880.05,90,,704.04,,,0,"percent of total billed charges ","90% of total billed charges ",909.38,93,,727.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",831.16,85,,664.93,,,0,"percent of total billed charges ","85% of total billed charges ",831.16,85,,664.93,,,0,"percent of total billed charges ","85% of total billed charges ",880.05,90,,704.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",850.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",684.48,70,,547.58,,,0,"percent of total billed charges ","70% of total billed charges ",684.48,909.38,
"PLT NRRW 4.5 X 152MM 8H",6108952,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1034.4,827.52,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",827.52,80,,662.02,,,0,"percent of total billed charges ","80% of total billed charges ",724.08,70,,579.26,,,0,"percent of total billed charges ","70% of total billed charges ",930.96,90,,744.77,,,0,"percent of total billed charges ","90% of total billed charges ",961.99,93,,769.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",879.24,85,,703.39,,,0,"percent of total billed charges ","85% of total billed charges ",879.24,85,,703.39,,,0,"percent of total billed charges ","85% of total billed charges ",930.96,90,,744.77,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",899.93,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",724.08,70,,579.26,,,0,"percent of total billed charges ","70% of total billed charges ",724.08,961.99,
"PLT NRRW 4.5 X 170MM 9H",6108953,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,912.04,729.632,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",729.63,80,,583.70,,,0,"percent of total billed charges ","80% of total billed charges ",638.43,70,,510.74,,,0,"percent of total billed charges ","70% of total billed charges ",820.84,90,,656.67,,,0,"percent of total billed charges ","90% of total billed charges ",848.2,93,,678.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",775.23,85,,620.18,,,0,"percent of total billed charges ","85% of total billed charges ",775.23,85,,620.18,,,0,"percent of total billed charges ","85% of total billed charges ",820.84,90,,656.67,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",793.47,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",638.43,70,,510.74,,,0,"percent of total billed charges ","70% of total billed charges ",638.43,848.2,
"PLT NRRW 4.5 X 188MM 10H",6108954,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,990.99,792.792,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",792.79,80,,634.23,,,0,"percent of total billed charges ","80% of total billed charges ",693.69,70,,554.95,,,0,"percent of total billed charges ","70% of total billed charges ",891.89,90,,713.51,,,0,"percent of total billed charges ","90% of total billed charges ",921.62,93,,737.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",842.34,85,,673.87,,,0,"percent of total billed charges ","85% of total billed charges ",842.34,85,,673.87,,,0,"percent of total billed charges ","85% of total billed charges ",891.89,90,,713.51,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",862.16,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",693.69,70,,554.95,,,0,"percent of total billed charges ","70% of total billed charges ",693.69,921.62,
"PLT NRRW 4.5 X 206MM 11H",6108955,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1067.22,853.776,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",853.78,80,,683.02,,,0,"percent of total billed charges ","80% of total billed charges ",747.05,70,,597.64,,,0,"percent of total billed charges ","70% of total billed charges ",960.5,90,,768.40,,,0,"percent of total billed charges ","90% of total billed charges ",992.51,93,,794.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",907.14,85,,725.71,,,0,"percent of total billed charges ","85% of total billed charges ",907.14,85,,725.71,,,0,"percent of total billed charges ","85% of total billed charges ",960.5,90,,768.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",928.48,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",747.05,70,,597.64,,,0,"percent of total billed charges ","70% of total billed charges ",747.05,992.51,
"PLT NRRW 4.5 X 224MM 12H",6108956,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1147.53,918.024,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",918.02,80,,734.42,,,0,"percent of total billed charges ","80% of total billed charges ",803.27,70,,642.62,,,0,"percent of total billed charges ","70% of total billed charges ",1032.78,90,,826.22,,,0,"percent of total billed charges ","90% of total billed charges ",1067.2,93,,853.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",975.4,85,,780.32,,,0,"percent of total billed charges ","85% of total billed charges ",975.4,85,,780.32,,,0,"percent of total billed charges ","85% of total billed charges ",1032.78,90,,826.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",998.35,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",803.27,70,,642.62,,,0,"percent of total billed charges ","70% of total billed charges ",803.27,1067.2,
"PLT NRRW 4.5 X 260MM 14H",6108957,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1286.38,1029.104,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1029.1,80,,823.28,,,0,"percent of total billed charges ","80% of total billed charges ",900.47,70,,720.38,,,0,"percent of total billed charges ","70% of total billed charges ",1157.74,90,,926.19,,,0,"percent of total billed charges ","90% of total billed charges ",1196.33,93,,957.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1093.42,85,,874.74,,,0,"percent of total billed charges ","85% of total billed charges ",1093.42,85,,874.74,,,0,"percent of total billed charges ","85% of total billed charges ",1157.74,90,,926.19,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1119.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",900.47,70,,720.38,,,0,"percent of total billed charges ","70% of total billed charges ",900.47,1196.33,
"PLT NRRW 4.5 X 296MM 16H",6108958,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1504.18,1203.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1203.34,80,,962.67,,,0,"percent of total billed charges ","80% of total billed charges ",1052.93,70,,842.34,,,0,"percent of total billed charges ","70% of total billed charges ",1353.76,90,,1083.01,,,0,"percent of total billed charges ","90% of total billed charges ",1398.89,93,,1119.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1278.55,85,,1022.84,,,0,"percent of total billed charges ","85% of total billed charges ",1278.55,85,,1022.84,,,0,"percent of total billed charges ","85% of total billed charges ",1353.76,90,,1083.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1308.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1052.93,70,,842.34,,,0,"percent of total billed charges ","70% of total billed charges ",1052.93,1398.89,
"PLT BROAD 4.5 X 116MM 6H",6108959,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,901.87,721.496,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",721.5,80,,577.20,,,0,"percent of total billed charges ","80% of total billed charges ",631.31,70,,505.05,,,0,"percent of total billed charges ","70% of total billed charges ",811.68,90,,649.34,,,0,"percent of total billed charges ","90% of total billed charges ",838.74,93,,670.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",766.59,85,,613.27,,,0,"percent of total billed charges ","85% of total billed charges ",766.59,85,,613.27,,,0,"percent of total billed charges ","85% of total billed charges ",811.68,90,,649.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",784.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",631.31,70,,505.05,,,0,"percent of total billed charges ","70% of total billed charges ",631.31,838.74,
"PLT BROAD 4.5 X 134MM 7H",6108960,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,958.44,766.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",766.75,80,,613.40,,,0,"percent of total billed charges ","80% of total billed charges ",670.91,70,,536.73,,,0,"percent of total billed charges ","70% of total billed charges ",862.6,90,,690.08,,,0,"percent of total billed charges ","90% of total billed charges ",891.35,93,,713.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",814.67,85,,651.74,,,0,"percent of total billed charges ","85% of total billed charges ",814.67,85,,651.74,,,0,"percent of total billed charges ","85% of total billed charges ",862.6,90,,690.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",833.84,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",670.91,70,,536.73,,,0,"percent of total billed charges ","70% of total billed charges ",670.91,891.35,
"PLT BROAD 4.5 X 152MM 8H",6108961,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,986.91,789.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",789.53,80,,631.62,,,0,"percent of total billed charges ","80% of total billed charges ",690.84,70,,552.67,,,0,"percent of total billed charges ","70% of total billed charges ",888.22,90,,710.58,,,0,"percent of total billed charges ","90% of total billed charges ",917.83,93,,734.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",838.87,85,,671.10,,,0,"percent of total billed charges ","85% of total billed charges ",838.87,85,,671.10,,,0,"percent of total billed charges ","85% of total billed charges ",888.22,90,,710.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",858.61,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",690.84,70,,552.67,,,0,"percent of total billed charges ","70% of total billed charges ",690.84,917.83,
"PLT BROAD 4.5 X 170MM 9H",6108962,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1067.22,853.776,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",853.78,80,,683.02,,,0,"percent of total billed charges ","80% of total billed charges ",747.05,70,,597.64,,,0,"percent of total billed charges ","70% of total billed charges ",960.5,90,,768.40,,,0,"percent of total billed charges ","90% of total billed charges ",992.51,93,,794.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",907.14,85,,725.71,,,0,"percent of total billed charges ","85% of total billed charges ",907.14,85,,725.71,,,0,"percent of total billed charges ","85% of total billed charges ",960.5,90,,768.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",928.48,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",747.05,70,,597.64,,,0,"percent of total billed charges ","70% of total billed charges ",747.05,992.51,
"PLT BROAD 4.5 X 188MM 10H",6108963,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1147.53,918.024,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",918.02,80,,734.42,,,0,"percent of total billed charges ","80% of total billed charges ",803.27,70,,642.62,,,0,"percent of total billed charges ","70% of total billed charges ",1032.78,90,,826.22,,,0,"percent of total billed charges ","90% of total billed charges ",1067.2,93,,853.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",975.4,85,,780.32,,,0,"percent of total billed charges ","85% of total billed charges ",975.4,85,,780.32,,,0,"percent of total billed charges ","85% of total billed charges ",1032.78,90,,826.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",998.35,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",803.27,70,,642.62,,,0,"percent of total billed charges ","70% of total billed charges ",803.27,1067.2,
"PLT BROAD 4.5 X 206MM 11H",6108964,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1222.4,977.92,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",977.92,80,,782.34,,,0,"percent of total billed charges ","80% of total billed charges ",855.68,70,,684.54,,,0,"percent of total billed charges ","70% of total billed charges ",1100.16,90,,880.13,,,0,"percent of total billed charges ","90% of total billed charges ",1136.83,93,,909.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1039.04,85,,831.23,,,0,"percent of total billed charges ","85% of total billed charges ",1039.04,85,,831.23,,,0,"percent of total billed charges ","85% of total billed charges ",1100.16,90,,880.13,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1063.49,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",855.68,70,,684.54,,,0,"percent of total billed charges ","70% of total billed charges ",855.68,1136.83,
"PLT BROAD 4.5 X 224MM 12H",6108965,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1297.27,1037.816,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1037.82,80,,830.26,,,0,"percent of total billed charges ","80% of total billed charges ",908.09,70,,726.47,,,0,"percent of total billed charges ","70% of total billed charges ",1167.54,90,,934.03,,,0,"percent of total billed charges ","90% of total billed charges ",1206.46,93,,965.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1102.68,85,,882.14,,,0,"percent of total billed charges ","85% of total billed charges ",1102.68,85,,882.14,,,0,"percent of total billed charges ","85% of total billed charges ",1167.54,90,,934.03,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1128.62,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",908.09,70,,726.47,,,0,"percent of total billed charges ","70% of total billed charges ",908.09,1206.46,
"PLT BROAD 4.5 X 260MM 14H",6108966,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1444.29,1155.432,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1155.43,80,,924.34,,,0,"percent of total billed charges ","80% of total billed charges ",1011,70,,808.80,,,0,"percent of total billed charges ","70% of total billed charges ",1299.86,90,,1039.89,,,0,"percent of total billed charges ","90% of total billed charges ",1343.19,93,,1074.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1227.65,85,,982.12,,,0,"percent of total billed charges ","85% of total billed charges ",1227.65,85,,982.12,,,0,"percent of total billed charges ","85% of total billed charges ",1299.86,90,,1039.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1256.53,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1011,70,,808.80,,,0,"percent of total billed charges ","70% of total billed charges ",1011,1343.19,
"PLT BROAD 4.5 X 296MM 16H",6108967,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1754.65,1403.72,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1403.72,80,,1122.98,,,0,"percent of total billed charges ","80% of total billed charges ",1228.26,70,,982.61,,,0,"percent of total billed charges ","70% of total billed charges ",1579.19,90,,1263.35,,,0,"percent of total billed charges ","90% of total billed charges ",1631.82,93,,1305.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1491.45,85,,1193.16,,,0,"percent of total billed charges ","85% of total billed charges ",1491.45,85,,1193.16,,,0,"percent of total billed charges ","85% of total billed charges ",1579.19,90,,1263.35,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1526.55,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1228.26,70,,982.61,,,0,"percent of total billed charges ","70% of total billed charges ",1228.26,1631.82,
"PLT T NRRW 4.5 X 83MM 4H",6108968,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1101.25,881,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",881,80,,704.80,,,0,"percent of total billed charges ","80% of total billed charges ",770.88,70,,616.70,,,0,"percent of total billed charges ","70% of total billed charges ",991.13,90,,792.90,,,0,"percent of total billed charges ","90% of total billed charges ",1024.16,93,,819.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",936.06,85,,748.85,,,0,"percent of total billed charges ","85% of total billed charges ",936.06,85,,748.85,,,0,"percent of total billed charges ","85% of total billed charges ",991.13,90,,792.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",958.09,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",770.88,70,,616.70,,,0,"percent of total billed charges ","70% of total billed charges ",770.88,1024.16,
"PLT T NRRW 4.5 X 115MM 6H",6108969,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1263.24,1010.592,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1010.59,80,,808.47,,,0,"percent of total billed charges ","80% of total billed charges ",884.27,70,,707.42,,,0,"percent of total billed charges ","70% of total billed charges ",1136.92,90,,909.54,,,0,"percent of total billed charges ","90% of total billed charges ",1174.81,93,,939.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1073.75,85,,859.00,,,0,"percent of total billed charges ","85% of total billed charges ",1073.75,85,,859.00,,,0,"percent of total billed charges ","85% of total billed charges ",1136.92,90,,909.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1099.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",884.27,70,,707.42,,,0,"percent of total billed charges ","70% of total billed charges ",884.27,1174.81,
"PLT T NRRW 4.5 X 147MM 8H",6108970,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1457.9,1166.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1166.32,80,,933.06,,,0,"percent of total billed charges ","80% of total billed charges ",1020.53,70,,816.42,,,0,"percent of total billed charges ","70% of total billed charges ",1312.11,90,,1049.69,,,0,"percent of total billed charges ","90% of total billed charges ",1355.85,93,,1084.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1239.22,85,,991.38,,,0,"percent of total billed charges ","85% of total billed charges ",1239.22,85,,991.38,,,0,"percent of total billed charges ","85% of total billed charges ",1312.11,90,,1049.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1268.37,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1020.53,70,,816.42,,,0,"percent of total billed charges ","70% of total billed charges ",1020.53,1355.85,
"PLT PRX TIB 4.5 X 82MM 4H RT",6108971,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2582.29,2065.832,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2065.83,80,,1652.66,,,0,"percent of total billed charges ","80% of total billed charges ",1807.6,70,,1446.08,,,0,"percent of total billed charges ","70% of total billed charges ",2324.06,90,,1859.25,,,0,"percent of total billed charges ","90% of total billed charges ",2401.53,93,,1921.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2194.95,85,,1755.96,,,0,"percent of total billed charges ","85% of total billed charges ",2194.95,85,,1755.96,,,0,"percent of total billed charges ","85% of total billed charges ",2324.06,90,,1859.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2246.59,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1807.6,70,,1446.08,,,0,"percent of total billed charges ","70% of total billed charges ",1807.6,2401.53,
"PLT PRX TIB 4.5 X 82MM 4H LT",6108972,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2582.29,2065.832,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2065.83,80,,1652.66,,,0,"percent of total billed charges ","80% of total billed charges ",1807.6,70,,1446.08,,,0,"percent of total billed charges ","70% of total billed charges ",2324.06,90,,1859.25,,,0,"percent of total billed charges ","90% of total billed charges ",2401.53,93,,1921.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2194.95,85,,1755.96,,,0,"percent of total billed charges ","85% of total billed charges ",2194.95,85,,1755.96,,,0,"percent of total billed charges ","85% of total billed charges ",2324.06,90,,1859.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2246.59,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1807.6,70,,1446.08,,,0,"percent of total billed charges ","70% of total billed charges ",1807.6,2401.53,
"PLT PRX TIB 4.5 X 118MM 4H RT",6108973,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2613.6,2090.88,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2090.88,80,,1672.70,,,0,"percent of total billed charges ","80% of total billed charges ",1829.52,70,,1463.62,,,0,"percent of total billed charges ","70% of total billed charges ",2352.24,90,,1881.79,,,0,"percent of total billed charges ","90% of total billed charges ",2430.65,93,,1944.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2221.56,85,,1777.25,,,0,"percent of total billed charges ","85% of total billed charges ",2221.56,85,,1777.25,,,0,"percent of total billed charges ","85% of total billed charges ",2352.24,90,,1881.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2273.83,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1829.52,70,,1463.62,,,0,"percent of total billed charges ","70% of total billed charges ",1829.52,2430.65,
"PLT PRX TIB 4.5 X 118MM 4H LT",6108974,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2613.6,2090.88,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2090.88,80,,1672.70,,,0,"percent of total billed charges ","80% of total billed charges ",1829.52,70,,1463.62,,,0,"percent of total billed charges ","70% of total billed charges ",2352.24,90,,1881.79,,,0,"percent of total billed charges ","90% of total billed charges ",2430.65,93,,1944.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2221.56,85,,1777.25,,,0,"percent of total billed charges ","85% of total billed charges ",2221.56,85,,1777.25,,,0,"percent of total billed charges ","85% of total billed charges ",2352.24,90,,1881.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2273.83,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1829.52,70,,1463.62,,,0,"percent of total billed charges ","70% of total billed charges ",1829.52,2430.65,
"PLT MED PRX TIB 4.5 X 106MM RT",6108975,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2580.93,2064.744,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2064.74,80,,1651.79,,,0,"percent of total billed charges ","80% of total billed charges ",1806.65,70,,1445.32,,,0,"percent of total billed charges ","70% of total billed charges ",2322.84,90,,1858.27,,,0,"percent of total billed charges ","90% of total billed charges ",2400.26,93,,1920.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2193.79,85,,1755.03,,,0,"percent of total billed charges ","85% of total billed charges ",2193.79,85,,1755.03,,,0,"percent of total billed charges ","85% of total billed charges ",2322.84,90,,1858.27,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2245.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1806.65,70,,1445.32,,,0,"percent of total billed charges ","70% of total billed charges ",1806.65,2400.26,
"PLT MED PRX TIB 4.5 X 106MM LT",6108976,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2580.93,2064.744,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2064.74,80,,1651.79,,,0,"percent of total billed charges ","80% of total billed charges ",1806.65,70,,1445.32,,,0,"percent of total billed charges ","70% of total billed charges ",2322.84,90,,1858.27,,,0,"percent of total billed charges ","90% of total billed charges ",2400.26,93,,1920.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2193.79,85,,1755.03,,,0,"percent of total billed charges ","85% of total billed charges ",2193.79,85,,1755.03,,,0,"percent of total billed charges ","85% of total billed charges ",2322.84,90,,1858.27,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2245.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1806.65,70,,1445.32,,,0,"percent of total billed charges ","70% of total billed charges ",1806.65,2400.26,
"PLT MED PRX TIB 4.5 X 142MM RT",6108977,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2612.24,2089.792,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2089.79,80,,1671.83,,,0,"percent of total billed charges ","80% of total billed charges ",1828.57,70,,1462.86,,,0,"percent of total billed charges ","70% of total billed charges ",2351.02,90,,1880.82,,,0,"percent of total billed charges ","90% of total billed charges ",2429.38,93,,1943.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2220.4,85,,1776.32,,,0,"percent of total billed charges ","85% of total billed charges ",2220.4,85,,1776.32,,,0,"percent of total billed charges ","85% of total billed charges ",2351.02,90,,1880.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2272.65,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1828.57,70,,1462.86,,,0,"percent of total billed charges ","70% of total billed charges ",1828.57,2429.38,
"PLT MED PRX TIB 4.5 X 142MM LT",6108978,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2612.24,2089.792,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2089.79,80,,1671.83,,,0,"percent of total billed charges ","80% of total billed charges ",1828.57,70,,1462.86,,,0,"percent of total billed charges ","70% of total billed charges ",2351.02,90,,1880.82,,,0,"percent of total billed charges ","90% of total billed charges ",2429.38,93,,1943.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2220.4,85,,1776.32,,,0,"percent of total billed charges ","85% of total billed charges ",2220.4,85,,1776.32,,,0,"percent of total billed charges ","85% of total billed charges ",2351.02,90,,1880.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2272.65,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1828.57,70,,1462.86,,,0,"percent of total billed charges ","70% of total billed charges ",1828.57,2429.38,
"WASHER 13.0MM",6108979,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,124.99,99.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",99.99,80,,79.99,,,0,"percent of total billed charges ","80% of total billed charges ",87.49,70,,69.99,,,0,"percent of total billed charges ","70% of total billed charges ",112.49,90,,89.99,,,0,"percent of total billed charges ","90% of total billed charges ",116.24,93,,92.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",106.24,85,,84.99,,,0,"percent of total billed charges ","85% of total billed charges ",106.24,85,,84.99,,,0,"percent of total billed charges ","85% of total billed charges ",112.49,90,,89.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",108.74,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.49,70,,69.99,,,0,"percent of total billed charges ","70% of total billed charges ",87.49,116.24,
"GUIDE WIRE 2.0 X 230MM NT",6108980,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,168.33,134.664,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",134.66,80,,107.73,,,0,"percent of total billed charges ","80% of total billed charges ",117.83,70,,94.26,,,0,"percent of total billed charges ","70% of total billed charges ",151.5,90,,121.20,,,0,"percent of total billed charges ","90% of total billed charges ",156.55,93,,125.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",143.08,85,,114.46,,,0,"percent of total billed charges ","85% of total billed charges ",143.08,85,,114.46,,,0,"percent of total billed charges ","85% of total billed charges ",151.5,90,,121.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",146.45,87,,117.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.83,70,,94.26,,,0,"percent of total billed charges ","70% of total billed charges ",117.83,156.55,
"SCR CRTX 2.0 X 26MM ST",6108990,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,157.49,125.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.99,80,,100.79,,,0,"percent of total billed charges ","80% of total billed charges ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",146.47,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",110.24,146.47,
"SCR CRTX 2.0 X 28MM ST",6108991,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,157.49,125.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.99,80,,100.79,,,0,"percent of total billed charges ","80% of total billed charges ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",146.47,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",110.24,146.47,
"SCR CRTX 2.0 X 30MM ST",6108992,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,157.49,125.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.99,80,,100.79,,,0,"percent of total billed charges ","80% of total billed charges ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",146.47,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",110.24,146.47,
"SCR CRTX 2.0 X 32MM ST",6108993,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,157.49,125.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.99,80,,100.79,,,0,"percent of total billed charges ","80% of total billed charges ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",146.47,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",110.24,146.47,
"SCR CRTX 2.0 X 34MM ST",6108994,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,157.49,125.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.99,80,,100.79,,,0,"percent of total billed charges ","80% of total billed charges ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",146.47,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",110.24,146.47,
"SCR CRTX 2.0 X 36MM ST",6108995,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,157.49,125.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.99,80,,100.79,,,0,"percent of total billed charges ","80% of total billed charges ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",146.47,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",110.24,146.47,
"SCR CRTX 2.0 X 38MM ST",6108996,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,157.49,125.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.99,80,,100.79,,,0,"percent of total billed charges ","80% of total billed charges ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",146.47,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",110.24,146.47,
"SCR CRTX 2.0 X 40MM ST",6108997,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,157.49,125.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.99,80,,100.79,,,0,"percent of total billed charges ","80% of total billed charges ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",146.47,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",110.24,146.47,
"SCR CRTX 2.4 X 7MM ST",6108998,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,217.97,174.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",174.38,80,,139.50,,,0,"percent of total billed charges ","80% of total billed charges ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",202.71,93,,162.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",189.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",152.58,202.71,
"SCR CRTX 2.4 X 9MM ST",6108999,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,217.97,174.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",174.38,80,,139.50,,,0,"percent of total billed charges ","80% of total billed charges ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",202.71,93,,162.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",189.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",152.58,202.71,
"SCR CRTX 2.4 X 11MM ST",6109000,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,217.97,174.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",174.38,80,,139.50,,,0,"percent of total billed charges ","80% of total billed charges ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",202.71,93,,162.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",189.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",152.58,202.71,
"SCR CRTX 2.4 X 13MM ST",6109001,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,217.97,174.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",174.38,80,,139.50,,,0,"percent of total billed charges ","80% of total billed charges ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",202.71,93,,162.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",189.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",152.58,202.71,
"SCR LCKG 2.0 X 6MM ST",6109002,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,247.29,197.832,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",197.83,80,,158.26,,,0,"percent of total billed charges ","80% of total billed charges ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",229.98,93,,183.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",215.14,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",173.1,229.98,
"SCR LCKG 2.0 X 7MM ST",6109003,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,247.29,197.832,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",197.83,80,,158.26,,,0,"percent of total billed charges ","80% of total billed charges ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",229.98,93,,183.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",215.14,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",173.1,229.98,
"SCR LCKG 2.0 X 8MM ST",6109004,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,247.29,197.832,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",197.83,80,,158.26,,,0,"percent of total billed charges ","80% of total billed charges ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",229.98,93,,183.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",215.14,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",173.1,229.98,
"SCR LCKG 2.0 X 9MM ST",6109005,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,247.29,197.832,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",197.83,80,,158.26,,,0,"percent of total billed charges ","80% of total billed charges ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",229.98,93,,183.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",215.14,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",173.1,229.98,
"SCR LCKG 2.0 X 10MM ST",6109006,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,247.29,197.832,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",197.83,80,,158.26,,,0,"percent of total billed charges ","80% of total billed charges ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",229.98,93,,183.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",215.14,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",173.1,229.98,
"SCR LCKG 2.0 X 11MM ST",6109007,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,247.29,197.832,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",197.83,80,,158.26,,,0,"percent of total billed charges ","80% of total billed charges ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",229.98,93,,183.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",215.14,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",173.1,229.98,
"SCR LCKG 2.0 X 12MM ST",6109008,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,247.29,197.832,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",197.83,80,,158.26,,,0,"percent of total billed charges ","80% of total billed charges ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",229.98,93,,183.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",215.14,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",173.1,229.98,
"SCR LCKG 2.0 X 13MM ST",6109009,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,247.29,197.832,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",197.83,80,,158.26,,,0,"percent of total billed charges ","80% of total billed charges ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",229.98,93,,183.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",215.14,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",173.1,229.98,
"SCR LCKG 2.0 X 14MM ST",6109010,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,247.29,197.832,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",197.83,80,,158.26,,,0,"percent of total billed charges ","80% of total billed charges ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",229.98,93,,183.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",215.14,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",173.1,229.98,
"SCR LCKG 2.0 X 16MM ST",6109011,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,247.29,197.832,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",197.83,80,,158.26,,,0,"percent of total billed charges ","80% of total billed charges ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",229.98,93,,183.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",215.14,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",173.1,229.98,
"SCR LCKG 2.0 X 18MM ST",6109012,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,247.29,197.832,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",197.83,80,,158.26,,,0,"percent of total billed charges ","80% of total billed charges ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",229.98,93,,183.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",215.14,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",173.1,229.98,
"SCR LCKG 2.0 X 20MM ST",6109013,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,247.29,197.832,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",197.83,80,,158.26,,,0,"percent of total billed charges ","80% of total billed charges ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",229.98,93,,183.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",215.14,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",173.1,229.98,
"SCR LCKG 2.0 X 22MM ST",6109014,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,247.29,197.832,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",197.83,80,,158.26,,,0,"percent of total billed charges ","80% of total billed charges ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",229.98,93,,183.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",215.14,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",173.1,229.98,
"SCR LCKG 2.0 X 24MM ST",6109015,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,247.29,197.832,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",197.83,80,,158.26,,,0,"percent of total billed charges ","80% of total billed charges ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",229.98,93,,183.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",215.14,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",173.1,229.98,
"SCR LCKG 2.0 X 26MM ST",6109016,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,247.29,197.832,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",197.83,80,,158.26,,,0,"percent of total billed charges ","80% of total billed charges ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",229.98,93,,183.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",215.14,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",173.1,229.98,
"SCR LCKG 2.0 X 28MM ST",6109017,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,247.29,197.832,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",197.83,80,,158.26,,,0,"percent of total billed charges ","80% of total billed charges ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",229.98,93,,183.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",215.14,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",173.1,229.98,
"SCR LCKG 2.0 X 30MM ST",6109018,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,247.29,197.832,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",197.83,80,,158.26,,,0,"percent of total billed charges ","80% of total billed charges ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",229.98,93,,183.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",215.14,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",173.1,229.98,
"SCR LCKG 2.4 X 7MM ST",6109019,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,252.14,201.712,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",201.71,80,,161.37,,,0,"percent of total billed charges ","80% of total billed charges ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",234.49,93,,187.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",219.36,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",176.5,234.49,
"SCR LCKG 2.4 X 8MM ST",6109020,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,252.14,201.712,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",201.71,80,,161.37,,,0,"percent of total billed charges ","80% of total billed charges ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",234.49,93,,187.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",219.36,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",176.5,234.49,
"SCR LCKG 2.4 X 9MM ST",6109021,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,252.14,201.712,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",201.71,80,,161.37,,,0,"percent of total billed charges ","80% of total billed charges ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",234.49,93,,187.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",219.36,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",176.5,234.49,
"SCR LCKG 2.4 X 10MM ST",6109022,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,252.14,201.712,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",201.71,80,,161.37,,,0,"percent of total billed charges ","80% of total billed charges ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",234.49,93,,187.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",219.36,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",176.5,234.49,
"SCR LCKG 2.4 X 11MM ST",6109023,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,252.14,201.712,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",201.71,80,,161.37,,,0,"percent of total billed charges ","80% of total billed charges ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",234.49,93,,187.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",219.36,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",176.5,234.49,
"SCR LCKG 2.4 X 12MM ST",6109024,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,252.14,201.712,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",201.71,80,,161.37,,,0,"percent of total billed charges ","80% of total billed charges ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",234.49,93,,187.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",219.36,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",176.5,234.49,
"SCR LCKG 2.4 X 13MM ST",6109025,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,252.14,201.712,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",201.71,80,,161.37,,,0,"percent of total billed charges ","80% of total billed charges ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",234.49,93,,187.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",219.36,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",176.5,234.49,
"SCR LCKG 2.4 X 14MM ST",6109026,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,252.14,201.712,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",201.71,80,,161.37,,,0,"percent of total billed charges ","80% of total billed charges ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",234.49,93,,187.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",219.36,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",176.5,234.49,
"SCR LCKG 2.4 X 16MM ST",6109027,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,252.14,201.712,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",201.71,80,,161.37,,,0,"percent of total billed charges ","80% of total billed charges ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",234.49,93,,187.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",219.36,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",176.5,234.49,
"SCR LCKG 2.4 X 18MM ST",6109028,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,252.14,201.712,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",201.71,80,,161.37,,,0,"percent of total billed charges ","80% of total billed charges ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",234.49,93,,187.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",219.36,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",176.5,234.49,
"SCR LCKG 2.4 X 20MM ST",6109029,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,252.14,201.712,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",201.71,80,,161.37,,,0,"percent of total billed charges ","80% of total billed charges ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",234.49,93,,187.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",219.36,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",176.5,234.49,
"SCR LCKG 2.4 X 22MM ST",6109030,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,252.14,201.712,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",201.71,80,,161.37,,,0,"percent of total billed charges ","80% of total billed charges ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",234.49,93,,187.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",219.36,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",176.5,234.49,
"SCR LCKG 2.4 X 24MM ST",6109031,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,252.14,201.712,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",201.71,80,,161.37,,,0,"percent of total billed charges ","80% of total billed charges ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",234.49,93,,187.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",219.36,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",176.5,234.49,
"SCR LCKG 2.4 X 26MM ST",6109032,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,252.14,201.712,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",201.71,80,,161.37,,,0,"percent of total billed charges ","80% of total billed charges ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",234.49,93,,187.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",219.36,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",176.5,234.49,
"SCR LCKG 2.4 X 28MM ST",6109033,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,252.14,201.712,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",201.71,80,,161.37,,,0,"percent of total billed charges ","80% of total billed charges ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",234.49,93,,187.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",219.36,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",176.5,234.49,
"SCR LCKG 2.4 X 30MM ST",6109034,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,252.14,201.712,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",201.71,80,,161.37,,,0,"percent of total billed charges ","80% of total billed charges ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",234.49,93,,187.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",214.32,85,,171.46,,,0,"percent of total billed charges ","85% of total billed charges ",226.93,90,,181.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",219.36,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.5,70,,141.20,,,0,"percent of total billed charges ","70% of total billed charges ",176.5,234.49,
"SCR LCKG 2.4 X 32MM ST",6109035,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,217.97,174.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",174.38,80,,139.50,,,0,"percent of total billed charges ","80% of total billed charges ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",202.71,93,,162.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",189.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",152.58,202.71,
"SCR LCKG 2.4 X 34MM ST",6109036,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,217.97,174.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",174.38,80,,139.50,,,0,"percent of total billed charges ","80% of total billed charges ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",202.71,93,,162.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",189.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",152.58,202.71,
"SCR LCKG 2.4 X 36MM ST",6109037,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,217.97,174.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",174.38,80,,139.50,,,0,"percent of total billed charges ","80% of total billed charges ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",202.71,93,,162.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",189.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",152.58,202.71,
"SCR LCKG 2.4 X 38MM ST",6109038,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,217.97,174.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",174.38,80,,139.50,,,0,"percent of total billed charges ","80% of total billed charges ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",202.71,93,,162.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",189.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",152.58,202.71,
"SCR LCKG 2.4 X 40MM ST",6109039,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,217.97,174.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",174.38,80,,139.50,,,0,"percent of total billed charges ","80% of total billed charges ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",202.71,93,,162.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",185.27,85,,148.22,,,0,"percent of total billed charges ","85% of total billed charges ",196.17,90,,156.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",189.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.58,70,,122.06,,,0,"percent of total billed charges ","70% of total billed charges ",152.58,202.71,
"SCR CRTX T8 2.7 X 32MM ST",6109040,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,170.02,136.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",136.02,80,,108.82,,,0,"percent of total billed charges ","80% of total billed charges ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",158.12,93,,126.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",147.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",119.01,158.12,
"SCR CRTX T8 2.7 X 34MM ST",6109041,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,170.02,136.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",136.02,80,,108.82,,,0,"percent of total billed charges ","80% of total billed charges ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",158.12,93,,126.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",147.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",119.01,158.12,
"SCR CRTX T8 2.7 X 36MM ST",6109042,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,170.02,136.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",136.02,80,,108.82,,,0,"percent of total billed charges ","80% of total billed charges ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",158.12,93,,126.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",147.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",119.01,158.12,
"SCR CRTX T8 2.7 X 38MM ST",6109043,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,170.02,136.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",136.02,80,,108.82,,,0,"percent of total billed charges ","80% of total billed charges ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",158.12,93,,126.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",147.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",119.01,158.12,
"SCR CRTX T8 2.7 X 40MM ST",6109044,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,170.02,136.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",136.02,80,,108.82,,,0,"percent of total billed charges ","80% of total billed charges ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",158.12,93,,126.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",147.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",119.01,158.12,
"SCR CRTX T8 2.7 X 42MM ST",6109045,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,170.02,136.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",136.02,80,,108.82,,,0,"percent of total billed charges ","80% of total billed charges ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",158.12,93,,126.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",147.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",119.01,158.12,
"SCR CRTX T8 2.7 X 44MM ST",6109046,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,170.02,136.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",136.02,80,,108.82,,,0,"percent of total billed charges ","80% of total billed charges ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",158.12,93,,126.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",147.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",119.01,158.12,
"SCR CRTX T8 2.7 X 46MM ST",6109047,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,170.02,136.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",136.02,80,,108.82,,,0,"percent of total billed charges ","80% of total billed charges ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",158.12,93,,126.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",147.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",119.01,158.12,
"SCR CRTX T8 2.7 X 48MM ST",6109048,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,170.02,136.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",136.02,80,,108.82,,,0,"percent of total billed charges ","80% of total billed charges ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",158.12,93,,126.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",147.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",119.01,158.12,
"SCR CRTX T8 2.7 X 50MM ST",6109049,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,170.02,136.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",136.02,80,,108.82,,,0,"percent of total billed charges ","80% of total billed charges ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",158.12,93,,126.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",147.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",119.01,158.12,
"SCR CRTX T8 2.7 X 55MM ST",6109050,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,170.02,136.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",136.02,80,,108.82,,,0,"percent of total billed charges ","80% of total billed charges ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",158.12,93,,126.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",147.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",119.01,158.12,
"SCR CRTX T8 2.7 X 60MM ST",6109051,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,170.02,136.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",136.02,80,,108.82,,,0,"percent of total billed charges ","80% of total billed charges ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",158.12,93,,126.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",144.52,85,,115.62,,,0,"percent of total billed charges ","85% of total billed charges ",153.02,90,,122.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",147.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.01,70,,95.21,,,0,"percent of total billed charges ","70% of total billed charges ",119.01,158.12,
"SCR LCKG 2.7 X 10MM ST",6109052,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,255.37,204.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",204.3,80,,163.44,,,0,"percent of total billed charges ","80% of total billed charges ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",237.49,93,,189.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",222.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",178.76,237.49,
"SCR LCKG 2.7 X 12MM ST",6109053,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,255.37,204.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",204.3,80,,163.44,,,0,"percent of total billed charges ","80% of total billed charges ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",237.49,93,,189.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",222.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",178.76,237.49,
"SCR LCKG 2.7 X 14MM ST",6109054,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,255.37,204.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",204.3,80,,163.44,,,0,"percent of total billed charges ","80% of total billed charges ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",237.49,93,,189.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",222.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",178.76,237.49,
"SCR LCKG 2.7 X 16MM ST",6109055,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,255.37,204.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",204.3,80,,163.44,,,0,"percent of total billed charges ","80% of total billed charges ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",237.49,93,,189.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",222.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",178.76,237.49,
"SCR LCKG 2.7 X 18MM ST",6109056,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,255.37,204.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",204.3,80,,163.44,,,0,"percent of total billed charges ","80% of total billed charges ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",237.49,93,,189.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",222.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",178.76,237.49,
"SCR LCKG 2.7 X 20MM ST",6109057,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,255.37,204.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",204.3,80,,163.44,,,0,"percent of total billed charges ","80% of total billed charges ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",237.49,93,,189.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",222.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",178.76,237.49,
"SCR LCKG 2.7 X 22MM ST",6109058,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,255.37,204.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",204.3,80,,163.44,,,0,"percent of total billed charges ","80% of total billed charges ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",237.49,93,,189.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",222.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",178.76,237.49,
"SCR LCKG 2.7 X 24MM ST",6109059,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,255.37,204.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",204.3,80,,163.44,,,0,"percent of total billed charges ","80% of total billed charges ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",237.49,93,,189.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",222.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",178.76,237.49,
"SCR LCKG 2.7 X 26MM ST",6109060,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,255.37,204.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",204.3,80,,163.44,,,0,"percent of total billed charges ","80% of total billed charges ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",237.49,93,,189.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",222.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",178.76,237.49,
"SCR LCKG 2.7 X 28MM ST",6109061,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,255.37,204.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",204.3,80,,163.44,,,0,"percent of total billed charges ","80% of total billed charges ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",237.49,93,,189.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",222.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",178.76,237.49,
"SCR LCKG 2.7 X 30MM ST",6109062,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,255.37,204.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",204.3,80,,163.44,,,0,"percent of total billed charges ","80% of total billed charges ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",237.49,93,,189.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",222.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",178.76,237.49,
"SCR LCKG 2.7 X 32MM ST",6109063,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,255.37,204.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",204.3,80,,163.44,,,0,"percent of total billed charges ","80% of total billed charges ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",237.49,93,,189.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",222.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",178.76,237.49,
"SCR LCKG 2.7 X 34MM ST",6109064,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,255.37,204.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",204.3,80,,163.44,,,0,"percent of total billed charges ","80% of total billed charges ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",237.49,93,,189.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",222.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",178.76,237.49,
"SCR LCKG 2.7 X 36MM ST",6109065,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,255.37,204.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",204.3,80,,163.44,,,0,"percent of total billed charges ","80% of total billed charges ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",237.49,93,,189.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",222.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",178.76,237.49,
"SCR LCKG 2.7 X 38MM ST",6109066,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,255.37,204.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",204.3,80,,163.44,,,0,"percent of total billed charges ","80% of total billed charges ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",237.49,93,,189.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",222.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",178.76,237.49,
"SCR LCKG 2.7 X 40MM ST",6109067,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,255.37,204.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",204.3,80,,163.44,,,0,"percent of total billed charges ","80% of total billed charges ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",237.49,93,,189.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",222.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",178.76,237.49,
"SCR LCKG 2.7 X 42MM ST",6109068,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,255.37,204.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",204.3,80,,163.44,,,0,"percent of total billed charges ","80% of total billed charges ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",237.49,93,,189.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",222.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",178.76,237.49,
"SCR LCKG 2.7 X 44MM ST",6109069,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,255.37,204.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",204.3,80,,163.44,,,0,"percent of total billed charges ","80% of total billed charges ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",237.49,93,,189.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",222.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",178.76,237.49,
"SCR LCKG 2.7 X 46MM ST",6109070,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,255.37,204.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",204.3,80,,163.44,,,0,"percent of total billed charges ","80% of total billed charges ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",237.49,93,,189.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",222.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",178.76,237.49,
"SCR LCKG 2.7 X 48MM ST",6109071,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,255.37,204.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",204.3,80,,163.44,,,0,"percent of total billed charges ","80% of total billed charges ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",237.49,93,,189.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",222.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",178.76,237.49,
"SCR LCKG 2.7 X 50MM ST",6109072,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,255.37,204.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",204.3,80,,163.44,,,0,"percent of total billed charges ","80% of total billed charges ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",237.49,93,,189.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",222.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",178.76,237.49,
"SCR LCKG 2.7 X 55MM ST",6109073,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,255.37,204.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",204.3,80,,163.44,,,0,"percent of total billed charges ","80% of total billed charges ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",237.49,93,,189.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",222.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",178.76,237.49,
"SCR LCKG 2.7 X 60MM ST",6109074,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,255.37,204.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",204.3,80,,163.44,,,0,"percent of total billed charges ","80% of total billed charges ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",237.49,93,,189.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",217.06,85,,173.65,,,0,"percent of total billed charges ","85% of total billed charges ",229.83,90,,183.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",222.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.76,70,,143.01,,,0,"percent of total billed charges ","70% of total billed charges ",178.76,237.49,
"PLT 2.0 X 31MM 4H",6109075,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,528.51,422.808,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",422.81,80,,338.25,,,0,"percent of total billed charges ","80% of total billed charges ",369.96,70,,295.97,,,0,"percent of total billed charges ","70% of total billed charges ",475.66,90,,380.53,,,0,"percent of total billed charges ","90% of total billed charges ",491.51,93,,393.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",449.23,85,,359.38,,,0,"percent of total billed charges ","85% of total billed charges ",449.23,85,,359.38,,,0,"percent of total billed charges ","85% of total billed charges ",475.66,90,,380.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",459.8,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",369.96,70,,295.97,,,0,"percent of total billed charges ","70% of total billed charges ",369.96,491.51,
"PLT 2.0 X 38MM 5H",6109076,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,528.51,422.808,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",422.81,80,,338.25,,,0,"percent of total billed charges ","80% of total billed charges ",369.96,70,,295.97,,,0,"percent of total billed charges ","70% of total billed charges ",475.66,90,,380.53,,,0,"percent of total billed charges ","90% of total billed charges ",491.51,93,,393.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",449.23,85,,359.38,,,0,"percent of total billed charges ","85% of total billed charges ",449.23,85,,359.38,,,0,"percent of total billed charges ","85% of total billed charges ",475.66,90,,380.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",459.8,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",369.96,70,,295.97,,,0,"percent of total billed charges ","70% of total billed charges ",369.96,491.51,
"PLT 2.0 X 45MM 6H",6109077,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,528.51,422.808,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",422.81,80,,338.25,,,0,"percent of total billed charges ","80% of total billed charges ",369.96,70,,295.97,,,0,"percent of total billed charges ","70% of total billed charges ",475.66,90,,380.53,,,0,"percent of total billed charges ","90% of total billed charges ",491.51,93,,393.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",449.23,85,,359.38,,,0,"percent of total billed charges ","85% of total billed charges ",449.23,85,,359.38,,,0,"percent of total billed charges ","85% of total billed charges ",475.66,90,,380.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",459.8,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",369.96,70,,295.97,,,0,"percent of total billed charges ","70% of total billed charges ",369.96,491.51,
"PLT 2.0 X 52MM 7H",6109078,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,528.51,422.808,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",422.81,80,,338.25,,,0,"percent of total billed charges ","80% of total billed charges ",369.96,70,,295.97,,,0,"percent of total billed charges ","70% of total billed charges ",475.66,90,,380.53,,,0,"percent of total billed charges ","90% of total billed charges ",491.51,93,,393.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",449.23,85,,359.38,,,0,"percent of total billed charges ","85% of total billed charges ",449.23,85,,359.38,,,0,"percent of total billed charges ","85% of total billed charges ",475.66,90,,380.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",459.8,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",369.96,70,,295.97,,,0,"percent of total billed charges ","70% of total billed charges ",369.96,491.51,
"PLT 2.0 X 59MM 8H",6109079,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,528.51,422.808,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",422.81,80,,338.25,,,0,"percent of total billed charges ","80% of total billed charges ",369.96,70,,295.97,,,0,"percent of total billed charges ","70% of total billed charges ",475.66,90,,380.53,,,0,"percent of total billed charges ","90% of total billed charges ",491.51,93,,393.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",449.23,85,,359.38,,,0,"percent of total billed charges ","85% of total billed charges ",449.23,85,,359.38,,,0,"percent of total billed charges ","85% of total billed charges ",475.66,90,,380.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",459.8,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",369.96,70,,295.97,,,0,"percent of total billed charges ","70% of total billed charges ",369.96,491.51,
"PLT 2.0 X 73MM 10H",6109080,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,528.51,422.808,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",422.81,80,,338.25,,,0,"percent of total billed charges ","80% of total billed charges ",369.96,70,,295.97,,,0,"percent of total billed charges ","70% of total billed charges ",475.66,90,,380.53,,,0,"percent of total billed charges ","90% of total billed charges ",491.51,93,,393.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",449.23,85,,359.38,,,0,"percent of total billed charges ","85% of total billed charges ",449.23,85,,359.38,,,0,"percent of total billed charges ","85% of total billed charges ",475.66,90,,380.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",459.8,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",369.96,70,,295.97,,,0,"percent of total billed charges ","70% of total billed charges ",369.96,491.51,
"PLT CONDYLAR 2.0 X 54MM 7H",6109081,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1400.73,1120.584,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1120.58,80,,896.46,,,0,"percent of total billed charges ","80% of total billed charges ",980.51,70,,784.41,,,0,"percent of total billed charges ","70% of total billed charges ",1260.66,90,,1008.53,,,0,"percent of total billed charges ","90% of total billed charges ",1302.68,93,,1042.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1190.62,85,,952.50,,,0,"percent of total billed charges ","85% of total billed charges ",1190.62,85,,952.50,,,0,"percent of total billed charges ","85% of total billed charges ",1260.66,90,,1008.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1218.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",980.51,70,,784.41,,,0,"percent of total billed charges ","70% of total billed charges ",980.51,1302.68,
"PLT ADAPTION 2.0 X 81MM 12H",6109082,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,893.79,715.032,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",715.03,80,,572.02,,,0,"percent of total billed charges ","80% of total billed charges ",625.65,70,,500.52,,,0,"percent of total billed charges ","70% of total billed charges ",804.41,90,,643.53,,,0,"percent of total billed charges ","90% of total billed charges ",831.22,93,,664.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",759.72,85,,607.78,,,0,"percent of total billed charges ","85% of total billed charges ",759.72,85,,607.78,,,0,"percent of total billed charges ","85% of total billed charges ",804.41,90,,643.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",777.6,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",625.65,70,,500.52,,,0,"percent of total billed charges ","70% of total billed charges ",625.65,831.22,
"PLT T 2.0 X 53MM 3H/7H",6109083,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,934.19,747.352,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",747.35,80,,597.88,,,0,"percent of total billed charges ","80% of total billed charges ",653.93,70,,523.14,,,0,"percent of total billed charges ","70% of total billed charges ",840.77,90,,672.62,,,0,"percent of total billed charges ","90% of total billed charges ",868.8,93,,695.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",794.06,85,,635.25,,,0,"percent of total billed charges ","85% of total billed charges ",794.06,85,,635.25,,,0,"percent of total billed charges ","85% of total billed charges ",840.77,90,,672.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",812.75,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",653.93,70,,523.14,,,0,"percent of total billed charges ","70% of total billed charges ",653.93,868.8,
"PLT 2.4 X 36MM 4H",6109084,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,845.3,676.24,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",676.24,80,,540.99,,,0,"percent of total billed charges ","80% of total billed charges ",591.71,70,,473.37,,,0,"percent of total billed charges ","70% of total billed charges ",760.77,90,,608.62,,,0,"percent of total billed charges ","90% of total billed charges ",786.13,93,,628.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",718.51,85,,574.81,,,0,"percent of total billed charges ","85% of total billed charges ",718.51,85,,574.81,,,0,"percent of total billed charges ","85% of total billed charges ",760.77,90,,608.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",735.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",591.71,70,,473.37,,,0,"percent of total billed charges ","70% of total billed charges ",591.71,786.13,
"PLT 2.4 X 44MM 5H",6109085,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,845.3,676.24,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",676.24,80,,540.99,,,0,"percent of total billed charges ","80% of total billed charges ",591.71,70,,473.37,,,0,"percent of total billed charges ","70% of total billed charges ",760.77,90,,608.62,,,0,"percent of total billed charges ","90% of total billed charges ",786.13,93,,628.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",718.51,85,,574.81,,,0,"percent of total billed charges ","85% of total billed charges ",718.51,85,,574.81,,,0,"percent of total billed charges ","85% of total billed charges ",760.77,90,,608.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",735.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",591.71,70,,473.37,,,0,"percent of total billed charges ","70% of total billed charges ",591.71,786.13,
"PLT 2.4 X 52MM 6H",6109086,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,845.3,676.24,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",676.24,80,,540.99,,,0,"percent of total billed charges ","80% of total billed charges ",591.71,70,,473.37,,,0,"percent of total billed charges ","70% of total billed charges ",760.77,90,,608.62,,,0,"percent of total billed charges ","90% of total billed charges ",786.13,93,,628.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",718.51,85,,574.81,,,0,"percent of total billed charges ","85% of total billed charges ",718.51,85,,574.81,,,0,"percent of total billed charges ","85% of total billed charges ",760.77,90,,608.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",735.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",591.71,70,,473.37,,,0,"percent of total billed charges ","70% of total billed charges ",591.71,786.13,
"PLT 2.4 X 60MM 7H",6109087,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,845.3,676.24,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",676.24,80,,540.99,,,0,"percent of total billed charges ","80% of total billed charges ",591.71,70,,473.37,,,0,"percent of total billed charges ","70% of total billed charges ",760.77,90,,608.62,,,0,"percent of total billed charges ","90% of total billed charges ",786.13,93,,628.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",718.51,85,,574.81,,,0,"percent of total billed charges ","85% of total billed charges ",718.51,85,,574.81,,,0,"percent of total billed charges ","85% of total billed charges ",760.77,90,,608.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",735.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",591.71,70,,473.37,,,0,"percent of total billed charges ","70% of total billed charges ",591.71,786.13,
"PLT 2.4 X 68MM 8H",6109088,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,845.3,676.24,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",676.24,80,,540.99,,,0,"percent of total billed charges ","80% of total billed charges ",591.71,70,,473.37,,,0,"percent of total billed charges ","70% of total billed charges ",760.77,90,,608.62,,,0,"percent of total billed charges ","90% of total billed charges ",786.13,93,,628.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",718.51,85,,574.81,,,0,"percent of total billed charges ","85% of total billed charges ",718.51,85,,574.81,,,0,"percent of total billed charges ","85% of total billed charges ",760.77,90,,608.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",735.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",591.71,70,,473.37,,,0,"percent of total billed charges ","70% of total billed charges ",591.71,786.13,
"PLT 2.4 X 84MM 10H",6109089,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,845.3,676.24,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",676.24,80,,540.99,,,0,"percent of total billed charges ","80% of total billed charges ",591.71,70,,473.37,,,0,"percent of total billed charges ","70% of total billed charges ",760.77,90,,608.62,,,0,"percent of total billed charges ","90% of total billed charges ",786.13,93,,628.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",718.51,85,,574.81,,,0,"percent of total billed charges ","85% of total billed charges ",718.51,85,,574.81,,,0,"percent of total billed charges ","85% of total billed charges ",760.77,90,,608.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",735.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",591.71,70,,473.37,,,0,"percent of total billed charges ","70% of total billed charges ",591.71,786.13,
"PLT ADAPTION 2.4 X 88MM 12H",6109090,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,984.3,787.44,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",787.44,80,,629.95,,,0,"percent of total billed charges ","80% of total billed charges ",689.01,70,,551.21,,,0,"percent of total billed charges ","70% of total billed charges ",885.87,90,,708.70,,,0,"percent of total billed charges ","90% of total billed charges ",915.4,93,,732.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",836.66,85,,669.33,,,0,"percent of total billed charges ","85% of total billed charges ",836.66,85,,669.33,,,0,"percent of total billed charges ","85% of total billed charges ",885.87,90,,708.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",856.34,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",689.01,70,,551.21,,,0,"percent of total billed charges ","70% of total billed charges ",689.01,915.4,
"PLT T 2.4 X 58MM 3H/7H",6109091,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1308.16,1046.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1046.53,80,,837.22,,,0,"percent of total billed charges ","80% of total billed charges ",915.71,70,,732.57,,,0,"percent of total billed charges ","70% of total billed charges ",1177.34,90,,941.87,,,0,"percent of total billed charges ","90% of total billed charges ",1216.59,93,,973.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1111.94,85,,889.55,,,0,"percent of total billed charges ","85% of total billed charges ",1111.94,85,,889.55,,,0,"percent of total billed charges ","85% of total billed charges ",1177.34,90,,941.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1138.1,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",915.71,70,,732.57,,,0,"percent of total billed charges ","70% of total billed charges ",915.71,1216.59,
"PLT T 2.4 X 58MM 2H/7H",6109092,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1308.16,1046.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1046.53,80,,837.22,,,0,"percent of total billed charges ","80% of total billed charges ",915.71,70,,732.57,,,0,"percent of total billed charges ","70% of total billed charges ",1177.34,90,,941.87,,,0,"percent of total billed charges ","90% of total billed charges ",1216.59,93,,973.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1111.94,85,,889.55,,,0,"percent of total billed charges ","85% of total billed charges ",1111.94,85,,889.55,,,0,"percent of total billed charges ","85% of total billed charges ",1177.34,90,,941.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1138.1,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",915.71,70,,732.57,,,0,"percent of total billed charges ","70% of total billed charges ",915.71,1216.59,
"PLT 2.7 X 40MM 4H",6109093,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,892.17,713.736,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",713.74,80,,570.99,,,0,"percent of total billed charges ","80% of total billed charges ",624.52,70,,499.62,,,0,"percent of total billed charges ","70% of total billed charges ",802.95,90,,642.36,,,0,"percent of total billed charges ","90% of total billed charges ",829.72,93,,663.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",758.34,85,,606.67,,,0,"percent of total billed charges ","85% of total billed charges ",758.34,85,,606.67,,,0,"percent of total billed charges ","85% of total billed charges ",802.95,90,,642.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",776.19,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",624.52,70,,499.62,,,0,"percent of total billed charges ","70% of total billed charges ",624.52,829.72,
"PLT 2.7 X 49MM 5H",6109094,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,892.17,713.736,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",713.74,80,,570.99,,,0,"percent of total billed charges ","80% of total billed charges ",624.52,70,,499.62,,,0,"percent of total billed charges ","70% of total billed charges ",802.95,90,,642.36,,,0,"percent of total billed charges ","90% of total billed charges ",829.72,93,,663.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",758.34,85,,606.67,,,0,"percent of total billed charges ","85% of total billed charges ",758.34,85,,606.67,,,0,"percent of total billed charges ","85% of total billed charges ",802.95,90,,642.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",776.19,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",624.52,70,,499.62,,,0,"percent of total billed charges ","70% of total billed charges ",624.52,829.72,
"PLT 2.7 X 58MM 6H",6109095,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,892.17,713.736,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",713.74,80,,570.99,,,0,"percent of total billed charges ","80% of total billed charges ",624.52,70,,499.62,,,0,"percent of total billed charges ","70% of total billed charges ",802.95,90,,642.36,,,0,"percent of total billed charges ","90% of total billed charges ",829.72,93,,663.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",758.34,85,,606.67,,,0,"percent of total billed charges ","85% of total billed charges ",758.34,85,,606.67,,,0,"percent of total billed charges ","85% of total billed charges ",802.95,90,,642.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",776.19,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",624.52,70,,499.62,,,0,"percent of total billed charges ","70% of total billed charges ",624.52,829.72,
"PLT 2.7 X 67MM 7H",6109096,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,892.17,713.736,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",713.74,80,,570.99,,,0,"percent of total billed charges ","80% of total billed charges ",624.52,70,,499.62,,,0,"percent of total billed charges ","70% of total billed charges ",802.95,90,,642.36,,,0,"percent of total billed charges ","90% of total billed charges ",829.72,93,,663.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",758.34,85,,606.67,,,0,"percent of total billed charges ","85% of total billed charges ",758.34,85,,606.67,,,0,"percent of total billed charges ","85% of total billed charges ",802.95,90,,642.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",776.19,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",624.52,70,,499.62,,,0,"percent of total billed charges ","70% of total billed charges ",624.52,829.72,
"PLT 2.7 X 76MM 8H",6109097,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,892.17,713.736,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",713.74,80,,570.99,,,0,"percent of total billed charges ","80% of total billed charges ",624.52,70,,499.62,,,0,"percent of total billed charges ","70% of total billed charges ",802.95,90,,642.36,,,0,"percent of total billed charges ","90% of total billed charges ",829.72,93,,663.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",758.34,85,,606.67,,,0,"percent of total billed charges ","85% of total billed charges ",758.34,85,,606.67,,,0,"percent of total billed charges ","85% of total billed charges ",802.95,90,,642.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",776.19,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",624.52,70,,499.62,,,0,"percent of total billed charges ","70% of total billed charges ",624.52,829.72,
"PLT 2.7 X 94MM 10H",6109098,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,892.17,713.736,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",713.74,80,,570.99,,,0,"percent of total billed charges ","80% of total billed charges ",624.52,70,,499.62,,,0,"percent of total billed charges ","70% of total billed charges ",802.95,90,,642.36,,,0,"percent of total billed charges ","90% of total billed charges ",829.72,93,,663.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",758.34,85,,606.67,,,0,"percent of total billed charges ","85% of total billed charges ",758.34,85,,606.67,,,0,"percent of total billed charges ","85% of total billed charges ",802.95,90,,642.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",776.19,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",624.52,70,,499.62,,,0,"percent of total billed charges ","70% of total billed charges ",624.52,829.72,
"PLT L 2.7 X 32MM 2H/3H RT",6109099,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,846.92,677.536,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",677.54,80,,542.03,,,0,"percent of total billed charges ","80% of total billed charges ",592.84,70,,474.27,,,0,"percent of total billed charges ","70% of total billed charges ",762.23,90,,609.78,,,0,"percent of total billed charges ","90% of total billed charges ",787.64,93,,630.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",719.88,85,,575.90,,,0,"percent of total billed charges ","85% of total billed charges ",719.88,85,,575.90,,,0,"percent of total billed charges ","85% of total billed charges ",762.23,90,,609.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",736.82,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",592.84,70,,474.27,,,0,"percent of total billed charges ","70% of total billed charges ",592.84,787.64,
"PLT L 2.7 X 32MM 2H/3H LT",6109100,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,846.92,677.536,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",677.54,80,,542.03,,,0,"percent of total billed charges ","80% of total billed charges ",592.84,70,,474.27,,,0,"percent of total billed charges ","70% of total billed charges ",762.23,90,,609.78,,,0,"percent of total billed charges ","90% of total billed charges ",787.64,93,,630.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",719.88,85,,575.90,,,0,"percent of total billed charges ","85% of total billed charges ",719.88,85,,575.90,,,0,"percent of total billed charges ","85% of total billed charges ",762.23,90,,609.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",736.82,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",592.84,70,,474.27,,,0,"percent of total billed charges ","70% of total billed charges ",592.84,787.64,
"PLT L OBLQ RT 2.7 X 42 4H",6109101,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,856.61,685.288,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",685.29,80,,548.23,,,0,"percent of total billed charges ","80% of total billed charges ",599.63,70,,479.70,,,0,"percent of total billed charges ","70% of total billed charges ",770.95,90,,616.76,,,0,"percent of total billed charges ","90% of total billed charges ",796.65,93,,637.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",728.12,85,,582.50,,,0,"percent of total billed charges ","85% of total billed charges ",728.12,85,,582.50,,,0,"percent of total billed charges ","85% of total billed charges ",770.95,90,,616.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",745.25,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",599.63,70,,479.70,,,0,"percent of total billed charges ","70% of total billed charges ",599.63,796.65,
"PLT L OBLQ LT 2.7 X 35MM 3H",6109102,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,856.61,685.288,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",685.29,80,,548.23,,,0,"percent of total billed charges ","80% of total billed charges ",599.63,70,,479.70,,,0,"percent of total billed charges ","70% of total billed charges ",770.95,90,,616.76,,,0,"percent of total billed charges ","90% of total billed charges ",796.65,93,,637.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",728.12,85,,582.50,,,0,"percent of total billed charges ","85% of total billed charges ",728.12,85,,582.50,,,0,"percent of total billed charges ","85% of total billed charges ",770.95,90,,616.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",745.25,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",599.63,70,,479.70,,,0,"percent of total billed charges ","70% of total billed charges ",599.63,796.65,
"PLT CONDYLAR 2.7 X 66MM 7H",6109103,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1165.23,932.184,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",932.18,80,,745.74,,,0,"percent of total billed charges ","80% of total billed charges ",815.66,70,,652.53,,,0,"percent of total billed charges ","70% of total billed charges ",1048.71,90,,838.97,,,0,"percent of total billed charges ","90% of total billed charges ",1083.66,93,,866.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",990.45,85,,792.36,,,0,"percent of total billed charges ","85% of total billed charges ",990.45,85,,792.36,,,0,"percent of total billed charges ","85% of total billed charges ",1048.71,90,,838.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1013.75,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",815.66,70,,652.53,,,0,"percent of total billed charges ","70% of total billed charges ",815.66,1083.66,
"PLT ADAPTION 2.7 97MM 12H",6109104,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,984.3,787.44,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",787.44,80,,629.95,,,0,"percent of total billed charges ","80% of total billed charges ",689.01,70,,551.21,,,0,"percent of total billed charges ","70% of total billed charges ",885.87,90,,708.70,,,0,"percent of total billed charges ","90% of total billed charges ",915.4,93,,732.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",836.66,85,,669.33,,,0,"percent of total billed charges ","85% of total billed charges ",836.66,85,,669.33,,,0,"percent of total billed charges ","85% of total billed charges ",885.87,90,,708.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",856.34,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",689.01,70,,551.21,,,0,"percent of total billed charges ","70% of total billed charges ",689.01,915.4,
"PLT T 2.7 X 32MM 2H/3H",6109105,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1308.16,1046.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1046.53,80,,837.22,,,0,"percent of total billed charges ","80% of total billed charges ",915.71,70,,732.57,,,0,"percent of total billed charges ","70% of total billed charges ",1177.34,90,,941.87,,,0,"percent of total billed charges ","90% of total billed charges ",1216.59,93,,973.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1111.94,85,,889.55,,,0,"percent of total billed charges ","85% of total billed charges ",1111.94,85,,889.55,,,0,"percent of total billed charges ","85% of total billed charges ",1177.34,90,,941.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1138.1,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",915.71,70,,732.57,,,0,"percent of total billed charges ","70% of total billed charges ",915.71,1216.59,
"K-WIRE TROCAR TIP 0.8 X 70MM",6109106,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,296.44,237.152,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",237.15,80,,189.72,,,0,"percent of total billed charges ","80% of total billed charges ",207.51,70,,166.01,,,0,"percent of total billed charges ","70% of total billed charges ",266.8,90,,213.44,,,0,"percent of total billed charges ","90% of total billed charges ",275.69,93,,220.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",251.97,85,,201.58,,,0,"percent of total billed charges ","85% of total billed charges ",251.97,85,,201.58,,,0,"percent of total billed charges ","85% of total billed charges ",266.8,90,,213.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",257.9,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",207.51,70,,166.01,,,0,"percent of total billed charges ","70% of total billed charges ",207.51,275.69,
"K-WIRE TROCAR TIP 1.0 X 150MM",6109107,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,44.38,35.504,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",35.5,80,,28.40,,,0,"percent of total billed charges ","80% of total billed charges ",31.07,70,,24.86,,,0,"percent of total billed charges ","70% of total billed charges ",39.94,90,,31.95,,,0,"percent of total billed charges ","90% of total billed charges ",41.27,93,,33.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",37.72,85,,30.18,,,0,"percent of total billed charges ","85% of total billed charges ",37.72,85,,30.18,,,0,"percent of total billed charges ","85% of total billed charges ",39.94,90,,31.95,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",38.61,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.07,70,,24.86,,,0,"percent of total billed charges ","70% of total billed charges ",31.07,41.27,
"SCR TFNA FENESTRATED 75MM",6109110,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1381.67,1105.336,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1105.34,80,,884.27,,,0,"percent of total billed charges ","80% of total billed charges ",967.17,70,,773.74,,,0,"percent of total billed charges ","70% of total billed charges ",1243.5,90,,994.80,,,0,"percent of total billed charges ","90% of total billed charges ",1284.95,93,,1027.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1174.42,85,,939.54,,,0,"percent of total billed charges ","85% of total billed charges ",1174.42,85,,939.54,,,0,"percent of total billed charges ","85% of total billed charges ",1243.5,90,,994.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1202.05,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",967.17,70,,773.74,,,0,"percent of total billed charges ","70% of total billed charges ",967.17,1284.95,
"SCR TFNA FENESTRATED 80MM",6109111,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1381.67,1105.336,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1105.34,80,,884.27,,,0,"percent of total billed charges ","80% of total billed charges ",967.17,70,,773.74,,,0,"percent of total billed charges ","70% of total billed charges ",1243.5,90,,994.80,,,0,"percent of total billed charges ","90% of total billed charges ",1284.95,93,,1027.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1174.42,85,,939.54,,,0,"percent of total billed charges ","85% of total billed charges ",1174.42,85,,939.54,,,0,"percent of total billed charges ","85% of total billed charges ",1243.5,90,,994.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1202.05,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",967.17,70,,773.74,,,0,"percent of total billed charges ","70% of total billed charges ",967.17,1284.95,
"SCR TFNA FENESTRATED 85MM",6109112,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1381.67,1105.336,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1105.34,80,,884.27,,,0,"percent of total billed charges ","80% of total billed charges ",967.17,70,,773.74,,,0,"percent of total billed charges ","70% of total billed charges ",1243.5,90,,994.80,,,0,"percent of total billed charges ","90% of total billed charges ",1284.95,93,,1027.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1174.42,85,,939.54,,,0,"percent of total billed charges ","85% of total billed charges ",1174.42,85,,939.54,,,0,"percent of total billed charges ","85% of total billed charges ",1243.5,90,,994.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1202.05,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",967.17,70,,773.74,,,0,"percent of total billed charges ","70% of total billed charges ",967.17,1284.95,
"SCR TFNA FENESTRATED 90MM",6109113,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1381.67,1105.336,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1105.34,80,,884.27,,,0,"percent of total billed charges ","80% of total billed charges ",967.17,70,,773.74,,,0,"percent of total billed charges ","70% of total billed charges ",1243.5,90,,994.80,,,0,"percent of total billed charges ","90% of total billed charges ",1284.95,93,,1027.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1174.42,85,,939.54,,,0,"percent of total billed charges ","85% of total billed charges ",1174.42,85,,939.54,,,0,"percent of total billed charges ","85% of total billed charges ",1243.5,90,,994.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1202.05,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",967.17,70,,773.74,,,0,"percent of total billed charges ","70% of total billed charges ",967.17,1284.95,
"SCR TFNA FENESTRATED 95MM",6109114,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1381.67,1105.336,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1105.34,80,,884.27,,,0,"percent of total billed charges ","80% of total billed charges ",967.17,70,,773.74,,,0,"percent of total billed charges ","70% of total billed charges ",1243.5,90,,994.80,,,0,"percent of total billed charges ","90% of total billed charges ",1284.95,93,,1027.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1174.42,85,,939.54,,,0,"percent of total billed charges ","85% of total billed charges ",1174.42,85,,939.54,,,0,"percent of total billed charges ","85% of total billed charges ",1243.5,90,,994.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1202.05,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",967.17,70,,773.74,,,0,"percent of total billed charges ","70% of total billed charges ",967.17,1284.95,
"SCR TFNA FENESTRATED 100MM",6109115,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1381.67,1105.336,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1105.34,80,,884.27,,,0,"percent of total billed charges ","80% of total billed charges ",967.17,70,,773.74,,,0,"percent of total billed charges ","70% of total billed charges ",1243.5,90,,994.80,,,0,"percent of total billed charges ","90% of total billed charges ",1284.95,93,,1027.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1174.42,85,,939.54,,,0,"percent of total billed charges ","85% of total billed charges ",1174.42,85,,939.54,,,0,"percent of total billed charges ","85% of total billed charges ",1243.5,90,,994.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1202.05,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",967.17,70,,773.74,,,0,"percent of total billed charges ","70% of total billed charges ",967.17,1284.95,
"SCR TFNA FENESTRATED 105MM",6109116,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1381.67,1105.336,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1105.34,80,,884.27,,,0,"percent of total billed charges ","80% of total billed charges ",967.17,70,,773.74,,,0,"percent of total billed charges ","70% of total billed charges ",1243.5,90,,994.80,,,0,"percent of total billed charges ","90% of total billed charges ",1284.95,93,,1027.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1174.42,85,,939.54,,,0,"percent of total billed charges ","85% of total billed charges ",1174.42,85,,939.54,,,0,"percent of total billed charges ","85% of total billed charges ",1243.5,90,,994.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1202.05,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",967.17,70,,773.74,,,0,"percent of total billed charges ","70% of total billed charges ",967.17,1284.95,
"SCR TFNA FENESTRATED 110MM",6109117,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1381.67,1105.336,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1105.34,80,,884.27,,,0,"percent of total billed charges ","80% of total billed charges ",967.17,70,,773.74,,,0,"percent of total billed charges ","70% of total billed charges ",1243.5,90,,994.80,,,0,"percent of total billed charges ","90% of total billed charges ",1284.95,93,,1027.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1174.42,85,,939.54,,,0,"percent of total billed charges ","85% of total billed charges ",1174.42,85,,939.54,,,0,"percent of total billed charges ","85% of total billed charges ",1243.5,90,,994.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1202.05,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",967.17,70,,773.74,,,0,"percent of total billed charges ","70% of total billed charges ",967.17,1284.95,
"SCR TFNA FENESTRATED 115MM",6109118,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1381.67,1105.336,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1105.34,80,,884.27,,,0,"percent of total billed charges ","80% of total billed charges ",967.17,70,,773.74,,,0,"percent of total billed charges ","70% of total billed charges ",1243.5,90,,994.80,,,0,"percent of total billed charges ","90% of total billed charges ",1284.95,93,,1027.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1174.42,85,,939.54,,,0,"percent of total billed charges ","85% of total billed charges ",1174.42,85,,939.54,,,0,"percent of total billed charges ","85% of total billed charges ",1243.5,90,,994.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1202.05,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",967.17,70,,773.74,,,0,"percent of total billed charges ","70% of total billed charges ",967.17,1284.95,
"SCR TFNA FENESTRATED 120MM",6109119,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1381.67,1105.336,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1105.34,80,,884.27,,,0,"percent of total billed charges ","80% of total billed charges ",967.17,70,,773.74,,,0,"percent of total billed charges ","70% of total billed charges ",1243.5,90,,994.80,,,0,"percent of total billed charges ","90% of total billed charges ",1284.95,93,,1027.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1174.42,85,,939.54,,,0,"percent of total billed charges ","85% of total billed charges ",1174.42,85,,939.54,,,0,"percent of total billed charges ","85% of total billed charges ",1243.5,90,,994.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1202.05,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",967.17,70,,773.74,,,0,"percent of total billed charges ","70% of total billed charges ",967.17,1284.95,
"SCR CANN 3.0 X 8MM PT SHRT",6109120,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 10MM PT SHRT",6109121,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 12MM PT SHRT",6109122,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 14MM PT SHRT",6109123,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 16MM PT SHRT",6109124,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 18MM PT SHRT",6109125,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 20MM PT SHRT",6109126,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 22MM PT SHRT",6109127,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 24MM PT SHRT",6109128,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 26MM PT SHRT",6109129,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 28MM PT SHRT",6109130,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 30MM PT SHRT",6109131,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 32MM PT SHRT",6109132,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 34MM PT SHRT",6109133,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 36MM PT SHRT",6109134,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 38MM PT SHRT",6109135,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 40MM PT SHRT",6109136,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 14MM PT LONG",6109137,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 16MM PT LONG",6109138,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 18MM PT LONG",6109139,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 20MM PT LONG",6109140,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 22MM PT LONG",6109141,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 24MM PT LONG",6109142,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 26MM PT LONG",6109143,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 28MM PT LONG",6109144,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 30MM PT LONG",6109145,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 32MM PT LONG",6109146,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 34MM PT LONG",6109147,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 36MM PT LONG",6109148,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 38MM PT LONG",6109149,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"SCR CANN 3.0 X 40MM PT LONG",6109150,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,428.31,342.648,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",342.65,80,,274.12,,,0,"percent of total billed charges ","80% of total billed charges ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",398.33,93,,318.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",364.06,85,,291.25,,,0,"percent of total billed charges ","85% of total billed charges ",385.48,90,,308.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",372.63,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.82,70,,239.86,,,0,"percent of total billed charges ","70% of total billed charges ",299.82,398.33,
"WASHER THREAD 3.0 CANN",6109151,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,297.39,237.912,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",237.91,80,,190.33,,,0,"percent of total billed charges ","80% of total billed charges ",208.17,70,,166.54,,,0,"percent of total billed charges ","70% of total billed charges ",267.65,90,,214.12,,,0,"percent of total billed charges ","90% of total billed charges ",276.57,93,,221.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",252.78,85,,202.22,,,0,"percent of total billed charges ","85% of total billed charges ",252.78,85,,202.22,,,0,"percent of total billed charges ","85% of total billed charges ",267.65,90,,214.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",258.73,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",208.17,70,,166.54,,,0,"percent of total billed charges ","70% of total billed charges ",208.17,276.57,
"WASHER 6.5MM",6109152,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,132.51,106.008,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",106.01,80,,84.81,,,0,"percent of total billed charges ","80% of total billed charges ",92.76,70,,74.21,,,0,"percent of total billed charges ","70% of total billed charges ",119.26,90,,95.41,,,0,"percent of total billed charges ","90% of total billed charges ",123.23,93,,98.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",112.63,85,,90.10,,,0,"percent of total billed charges ","85% of total billed charges ",112.63,85,,90.10,,,0,"percent of total billed charges ","85% of total billed charges ",119.26,90,,95.41,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",115.28,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.76,70,,74.21,,,0,"percent of total billed charges ","70% of total billed charges ",92.76,123.23,
"SCR CANN 4.0 X 10MM PT SHRT",6109153,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",338.77,80,,271.02,,,0,"percent of total billed charges ","80% of total billed charges ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"SCR CANN 4.0 X 12MM PT SHRT",6109154,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",338.77,80,,271.02,,,0,"percent of total billed charges ","80% of total billed charges ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"SCR CANN 4.0 X 14MM PT SHRT",6109155,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",338.77,80,,271.02,,,0,"percent of total billed charges ","80% of total billed charges ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"SCR CANN 4.0 X 16MM PT SHRT",6109156,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",338.77,80,,271.02,,,0,"percent of total billed charges ","80% of total billed charges ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"SCR CANN 4.0 X 18MM PT SHRT",6109157,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",338.77,80,,271.02,,,0,"percent of total billed charges ","80% of total billed charges ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"SCR CANN 4.0 X 20MM PT SHRT",6109158,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",338.77,80,,271.02,,,0,"percent of total billed charges ","80% of total billed charges ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"SCR CANN 4.0 X 22MM PT SHRT",6109159,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",338.77,80,,271.02,,,0,"percent of total billed charges ","80% of total billed charges ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"SCR CANN 4.0 X 24MM PT SHRT",6109160,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",338.77,80,,271.02,,,0,"percent of total billed charges ","80% of total billed charges ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"SCR CANN 4.0 X 26MM PT SHRT",6109161,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",338.77,80,,271.02,,,0,"percent of total billed charges ","80% of total billed charges ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"SCR CANN 4.0 X 28MM PT SHRT",6109162,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",338.77,80,,271.02,,,0,"percent of total billed charges ","80% of total billed charges ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"SCR CANN 4.0 X 30MM PT SHRT",6109163,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",338.77,80,,271.02,,,0,"percent of total billed charges ","80% of total billed charges ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"SCR CANN 4.0 X 32MM PT SHRT",6109164,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",338.77,80,,271.02,,,0,"percent of total billed charges ","80% of total billed charges ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"SCR CANN 4.0 X 34MM PT SHRT",6109165,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",338.77,80,,271.02,,,0,"percent of total billed charges ","80% of total billed charges ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"SCR CANN 4.0 X 36MM PT SHRT",6109166,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",338.77,80,,271.02,,,0,"percent of total billed charges ","80% of total billed charges ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"SCR CANN 4.0 X 38MM PT SHRT",6109167,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",338.77,80,,271.02,,,0,"percent of total billed charges ","80% of total billed charges ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"SCR CANN 4.0 X 40MM PT SHRT",6109168,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",338.77,80,,271.02,,,0,"percent of total billed charges ","80% of total billed charges ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"SCR CANN 4.0 X 42MM PT SHRT",6109169,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",338.77,80,,271.02,,,0,"percent of total billed charges ","80% of total billed charges ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"SCR CANN 4.0 X 44MM PT SHRT",6109170,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",338.77,80,,271.02,,,0,"percent of total billed charges ","80% of total billed charges ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"SCR CANN 4.0 X 46MM PT SHRT",6109171,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",338.77,80,,271.02,,,0,"percent of total billed charges ","80% of total billed charges ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"SCR CANN 4.0 X 48MM PT SHRT",6109172,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",338.77,80,,271.02,,,0,"percent of total billed charges ","80% of total billed charges ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"SCR CANN 4.0 X 50MM PT SHRT",6109173,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",338.77,80,,271.02,,,0,"percent of total billed charges ","80% of total billed charges ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"SCR CANN 4.0 X 50MM PT LONG",6109174,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,423.46,338.768,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",338.77,80,,271.02,,,0,"percent of total billed charges ","80% of total billed charges ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",393.82,93,,315.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",359.94,85,,287.95,,,0,"percent of total billed charges ","85% of total billed charges ",381.11,90,,304.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.42,70,,237.14,,,0,"percent of total billed charges ","70% of total billed charges ",296.42,393.82,
"GUIDE WIRE 1.25 X 150MM THRD",6109175,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,131.66,105.328,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",105.33,80,,84.26,,,0,"percent of total billed charges ","80% of total billed charges ",92.16,70,,73.73,,,0,"percent of total billed charges ","70% of total billed charges ",118.49,90,,94.79,,,0,"percent of total billed charges ","90% of total billed charges ",122.44,93,,97.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",111.91,85,,89.53,,,0,"percent of total billed charges ","85% of total billed charges ",111.91,85,,89.53,,,0,"percent of total billed charges ","85% of total billed charges ",118.49,90,,94.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",114.54,87,,91.63,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.16,70,,73.73,,,0,"percent of total billed charges ","70% of total billed charges ",92.16,122.44,
"GUIDE WIRE 1.25X150MM NON-THRD",6109176,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,124.15,99.32,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",99.32,80,,79.46,,,0,"percent of total billed charges ","80% of total billed charges ",86.91,70,,69.53,,,0,"percent of total billed charges ","70% of total billed charges ",111.74,90,,89.39,,,0,"percent of total billed charges ","90% of total billed charges ",115.46,93,,92.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",105.53,85,,84.42,,,0,"percent of total billed charges ","85% of total billed charges ",105.53,85,,84.42,,,0,"percent of total billed charges ","85% of total billed charges ",111.74,90,,89.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",108.01,87,,86.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.91,70,,69.53,,,0,"percent of total billed charges ","70% of total billed charges ",86.91,115.46,
"SCR CANN 4.5 X 20MM PT",6109177,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,433.16,346.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",346.53,80,,277.22,,,0,"percent of total billed charges ","80% of total billed charges ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",402.84,93,,322.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",376.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",303.21,402.84,
"SCR CANN 4.5 X 22MM PT",6109178,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,433.16,346.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",346.53,80,,277.22,,,0,"percent of total billed charges ","80% of total billed charges ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",402.84,93,,322.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",376.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",303.21,402.84,
"SCR CANN 4.5 X 24MM PT",6109179,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,433.16,346.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",346.53,80,,277.22,,,0,"percent of total billed charges ","80% of total billed charges ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",402.84,93,,322.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",376.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",303.21,402.84,
"SCR CANN 4.5 X 26MM PT",6109180,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,433.16,346.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",346.53,80,,277.22,,,0,"percent of total billed charges ","80% of total billed charges ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",402.84,93,,322.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",376.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",303.21,402.84,
"SCR CANN 4.5 X 28MM PT",6109181,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,433.16,346.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",346.53,80,,277.22,,,0,"percent of total billed charges ","80% of total billed charges ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",402.84,93,,322.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",376.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",303.21,402.84,
"SCR CANN 4.5 X 30MM PT",6109182,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,433.16,346.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",346.53,80,,277.22,,,0,"percent of total billed charges ","80% of total billed charges ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",402.84,93,,322.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",376.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",303.21,402.84,
"SCR CANN 4.5 X 32MM PT",6109183,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,433.16,346.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",346.53,80,,277.22,,,0,"percent of total billed charges ","80% of total billed charges ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",402.84,93,,322.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",376.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",303.21,402.84,
"SCR CANN 4.5 X 34MM PT",6109184,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,433.16,346.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",346.53,80,,277.22,,,0,"percent of total billed charges ","80% of total billed charges ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",402.84,93,,322.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",376.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",303.21,402.84,
"SCR CANN 4.5 X 36MM PT",6109185,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,433.16,346.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",346.53,80,,277.22,,,0,"percent of total billed charges ","80% of total billed charges ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",402.84,93,,322.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",376.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",303.21,402.84,
"SCR CANN 4.5 X 38MM PT",6109186,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,433.16,346.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",346.53,80,,277.22,,,0,"percent of total billed charges ","80% of total billed charges ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",402.84,93,,322.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",376.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",303.21,402.84,
"SCR CANN 4.5 X 40MM PT",6109187,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,433.16,346.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",346.53,80,,277.22,,,0,"percent of total billed charges ","80% of total billed charges ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",402.84,93,,322.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",376.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",303.21,402.84,
"SCR CANN 4.5 X 42MM PT",6109188,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,433.16,346.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",346.53,80,,277.22,,,0,"percent of total billed charges ","80% of total billed charges ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",402.84,93,,322.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",376.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",303.21,402.84,
"SCR CANN 4.5 X 44MM PT",6109189,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,433.16,346.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",346.53,80,,277.22,,,0,"percent of total billed charges ","80% of total billed charges ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",402.84,93,,322.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",376.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",303.21,402.84,
"SCR CANN 4.5 X 46MM PT",6109190,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,433.16,346.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",346.53,80,,277.22,,,0,"percent of total billed charges ","80% of total billed charges ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",402.84,93,,322.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",376.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",303.21,402.84,
"SCR CANN 4.5 X 48MM PT",6109191,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,433.16,346.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",346.53,80,,277.22,,,0,"percent of total billed charges ","80% of total billed charges ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",402.84,93,,322.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",376.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",303.21,402.84,
"SCR CANN 4.5 X 50MM PT",6109192,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,433.16,346.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",346.53,80,,277.22,,,0,"percent of total billed charges ","80% of total billed charges ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",402.84,93,,322.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",376.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",303.21,402.84,
"SCR CANN 4.5 X 52MM PT",6109193,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,433.16,346.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",346.53,80,,277.22,,,0,"percent of total billed charges ","80% of total billed charges ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",402.84,93,,322.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",376.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",303.21,402.84,
"SCR CANN 4.5 X 54MM PT",6109194,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,433.16,346.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",346.53,80,,277.22,,,0,"percent of total billed charges ","80% of total billed charges ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",402.84,93,,322.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",376.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",303.21,402.84,
"SCR CANN 4.5 X 56MM PT",6109195,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,433.16,346.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",346.53,80,,277.22,,,0,"percent of total billed charges ","80% of total billed charges ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",402.84,93,,322.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",376.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",303.21,402.84,
"SCR CANN 4.5 X 60MM PT",6109196,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,433.16,346.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",346.53,80,,277.22,,,0,"percent of total billed charges ","80% of total billed charges ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",402.84,93,,322.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",376.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",303.21,402.84,
"SCR CANN 4.5 X 64MM PT",6109197,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,433.16,346.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",346.53,80,,277.22,,,0,"percent of total billed charges ","80% of total billed charges ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",402.84,93,,322.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",376.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",303.21,402.84,
"SCR CANN 4.5 X 68MM PT",6109198,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,433.16,346.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",346.53,80,,277.22,,,0,"percent of total billed charges ","80% of total billed charges ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",402.84,93,,322.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",376.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",303.21,402.84,
"SCR CANN 4.5 X 72MM PT",6109199,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,433.16,346.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",346.53,80,,277.22,,,0,"percent of total billed charges ","80% of total billed charges ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",402.84,93,,322.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",368.19,85,,294.55,,,0,"percent of total billed charges ","85% of total billed charges ",389.84,90,,311.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",376.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.21,70,,242.57,,,0,"percent of total billed charges ","70% of total billed charges ",303.21,402.84,
"WASHER 10.0MM",6109200,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,118.33,94.664,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",94.66,80,,75.73,,,0,"percent of total billed charges ","80% of total billed charges ",82.83,70,,66.26,,,0,"percent of total billed charges ","70% of total billed charges ",106.5,90,,85.20,,,0,"percent of total billed charges ","90% of total billed charges ",110.05,93,,88.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",100.58,85,,80.46,,,0,"percent of total billed charges ","85% of total billed charges ",100.58,85,,80.46,,,0,"percent of total billed charges ","85% of total billed charges ",106.5,90,,85.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",102.95,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.83,70,,66.26,,,0,"percent of total billed charges ","70% of total billed charges ",82.83,110.05,
"SCR CANN 6.5 X 30MM PT 16MM",6109201,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 35MM PT 16MM",6109202,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 40MM PT 16MM",6109203,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 45MM PT 16MM",6109204,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 50MM PT 16MM",6109205,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 55MM PT 16MM",6109206,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 60MM PT 16MM",6109207,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 65MM PT 16MM",6109208,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 70MM PT 16MM",6109209,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 75MM PT 16MM",6109210,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 80MM PT 16MM",6109211,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 85MM PT 16MM",6109212,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 90MM PT 16MM",6109213,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 95MM PT 16MM",6109214,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 100MM PT 16MM",6109215,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 105MM PT 16MM",6109216,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 110MM PT 16MM",6109217,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 115MM PT 16MM",6109218,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 120MM PT 16MM",6109219,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 125MM PT 16MM",6109220,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 130MM PT 16MM",6109221,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 135MM PT 16MM",6109222,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 140MM PT 16MM",6109223,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 145MM PT 16MM",6109224,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 150MM PT 16MM",6109225,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 45MM PT 32MM",6109226,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 50MM PT 32MM",6109227,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 55MM PT 32MM",6109228,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 60MM PT 32MM",6109229,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 65MM PT 32MM",6109230,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 70MM PT 32MM",6109231,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 75MM PT 32MM",6109232,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 80MM PT 32MM",6109233,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 85MM PT 32MM",6109234,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 90MM PT 32MM",6109235,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 95MM PT 32MM",6109236,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 100MM PT 32MM",6109237,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 105MM PT 32MM",6109238,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 110MM PT 32MM",6109239,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 115MM PT 32MM",6109240,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 120MM PT 32MM",6109241,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 125MM PT 32MM",6109242,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 130MM PT 32MM",6109243,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 135MM PT 32MM",6109244,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 140MM PT 32MM",6109245,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 145MM PT 32MM",6109246,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR CANN 6.5 X 150MM PT 32MM",6109247,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"GUIDE WIRE 2.8 X 300MM THRD",6109248,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,141.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"GUIDE WIRE 2.8 X 300MM W/FLUTE",6109249,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,218.19,174.552,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",174.55,80,,139.64,,,0,"percent of total billed charges ","80% of total billed charges ",152.73,70,,122.18,,,0,"percent of total billed charges ","70% of total billed charges ",196.37,90,,157.10,,,0,"percent of total billed charges ","90% of total billed charges ",202.92,93,,162.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",185.46,85,,148.37,,,0,"percent of total billed charges ","85% of total billed charges ",185.46,85,,148.37,,,0,"percent of total billed charges ","85% of total billed charges ",196.37,90,,157.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",189.83,87,,151.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.73,70,,122.18,,,0,"percent of total billed charges ","70% of total billed charges ",152.73,202.92,
"GUIDE WIRE 2.8 X 450MM THRD",6109250,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,305.16,244.128,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",244.13,80,,195.30,,,0,"percent of total billed charges ","80% of total billed charges ",213.61,70,,170.89,,,0,"percent of total billed charges ","70% of total billed charges ",274.64,90,,219.71,,,0,"percent of total billed charges ","90% of total billed charges ",283.8,93,,227.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",259.39,85,,207.51,,,0,"percent of total billed charges ","85% of total billed charges ",259.39,85,,207.51,,,0,"percent of total billed charges ","85% of total billed charges ",274.64,90,,219.71,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",265.49,87,,212.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",213.61,70,,170.89,,,0,"percent of total billed charges ","70% of total billed charges ",213.61,283.8,
"PLT CLAVICLE SUP ANT 3H RT",6109259,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1572.24,1257.792,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1257.79,80,,1006.23,,,0,"percent of total billed charges ","80% of total billed charges ",1100.57,70,,880.46,,,0,"percent of total billed charges ","70% of total billed charges ",1415.02,90,,1132.02,,,0,"percent of total billed charges ","90% of total billed charges ",1462.18,93,,1169.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1336.4,85,,1069.12,,,0,"percent of total billed charges ","85% of total billed charges ",1336.4,85,,1069.12,,,0,"percent of total billed charges ","85% of total billed charges ",1415.02,90,,1132.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1367.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1100.57,70,,880.46,,,0,"percent of total billed charges ","70% of total billed charges ",1100.57,1462.18,
"PLT CLAVICLE SUP ANT 3H LT",6109260,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1572.24,1257.792,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1257.79,80,,1006.23,,,0,"percent of total billed charges ","80% of total billed charges ",1100.57,70,,880.46,,,0,"percent of total billed charges ","70% of total billed charges ",1415.02,90,,1132.02,,,0,"percent of total billed charges ","90% of total billed charges ",1462.18,93,,1169.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1336.4,85,,1069.12,,,0,"percent of total billed charges ","85% of total billed charges ",1336.4,85,,1069.12,,,0,"percent of total billed charges ","85% of total billed charges ",1415.02,90,,1132.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1367.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1100.57,70,,880.46,,,0,"percent of total billed charges ","70% of total billed charges ",1100.57,1462.18,
"PLT CLAVICLE SUP ANT 4H RT",6109261,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1596.75,1277.4,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1277.4,80,,1021.92,,,0,"percent of total billed charges ","80% of total billed charges ",1117.73,70,,894.18,,,0,"percent of total billed charges ","70% of total billed charges ",1437.08,90,,1149.66,,,0,"percent of total billed charges ","90% of total billed charges ",1484.98,93,,1187.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1357.24,85,,1085.79,,,0,"percent of total billed charges ","85% of total billed charges ",1357.24,85,,1085.79,,,0,"percent of total billed charges ","85% of total billed charges ",1437.08,90,,1149.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1389.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1117.73,70,,894.18,,,0,"percent of total billed charges ","70% of total billed charges ",1117.73,1484.98,
"PLT CLAVICLE SUP ANT 4H LT",6109262,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1596.75,1277.4,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1277.4,80,,1021.92,,,0,"percent of total billed charges ","80% of total billed charges ",1117.73,70,,894.18,,,0,"percent of total billed charges ","70% of total billed charges ",1437.08,90,,1149.66,,,0,"percent of total billed charges ","90% of total billed charges ",1484.98,93,,1187.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1357.24,85,,1085.79,,,0,"percent of total billed charges ","85% of total billed charges ",1357.24,85,,1085.79,,,0,"percent of total billed charges ","85% of total billed charges ",1437.08,90,,1149.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1389.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1117.73,70,,894.18,,,0,"percent of total billed charges ","70% of total billed charges ",1117.73,1484.98,
"PLT CLAVICLE SUP ANT 5H RT",6109263,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1623.97,1299.176,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1299.18,80,,1039.34,,,0,"percent of total billed charges ","80% of total billed charges ",1136.78,70,,909.42,,,0,"percent of total billed charges ","70% of total billed charges ",1461.57,90,,1169.26,,,0,"percent of total billed charges ","90% of total billed charges ",1510.29,93,,1208.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1380.37,85,,1104.30,,,0,"percent of total billed charges ","85% of total billed charges ",1380.37,85,,1104.30,,,0,"percent of total billed charges ","85% of total billed charges ",1461.57,90,,1169.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1412.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1136.78,70,,909.42,,,0,"percent of total billed charges ","70% of total billed charges ",1136.78,1510.29,
"PLT CLAVICLE SUP ANT 5H LT",6109264,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1623.97,1299.176,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1299.18,80,,1039.34,,,0,"percent of total billed charges ","80% of total billed charges ",1136.78,70,,909.42,,,0,"percent of total billed charges ","70% of total billed charges ",1461.57,90,,1169.26,,,0,"percent of total billed charges ","90% of total billed charges ",1510.29,93,,1208.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1380.37,85,,1104.30,,,0,"percent of total billed charges ","85% of total billed charges ",1380.37,85,,1104.30,,,0,"percent of total billed charges ","85% of total billed charges ",1461.57,90,,1169.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1412.85,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1136.78,70,,909.42,,,0,"percent of total billed charges ","70% of total billed charges ",1136.78,1510.29,
"PLT CLAVICLE SUP ANT 6H RT",6109265,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1641.67,1313.336,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1313.34,80,,1050.67,,,0,"percent of total billed charges ","80% of total billed charges ",1149.17,70,,919.34,,,0,"percent of total billed charges ","70% of total billed charges ",1477.5,90,,1182.00,,,0,"percent of total billed charges ","90% of total billed charges ",1526.75,93,,1221.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1395.42,85,,1116.34,,,0,"percent of total billed charges ","85% of total billed charges ",1395.42,85,,1116.34,,,0,"percent of total billed charges ","85% of total billed charges ",1477.5,90,,1182.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1428.25,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1149.17,70,,919.34,,,0,"percent of total billed charges ","70% of total billed charges ",1149.17,1526.75,
"PLT CLAVICLE SUP ANT 6H LT",6109266,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1641.67,1313.336,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1313.34,80,,1050.67,,,0,"percent of total billed charges ","80% of total billed charges ",1149.17,70,,919.34,,,0,"percent of total billed charges ","70% of total billed charges ",1477.5,90,,1182.00,,,0,"percent of total billed charges ","90% of total billed charges ",1526.75,93,,1221.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1395.42,85,,1116.34,,,0,"percent of total billed charges ","85% of total billed charges ",1395.42,85,,1116.34,,,0,"percent of total billed charges ","85% of total billed charges ",1477.5,90,,1182.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1428.25,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1149.17,70,,919.34,,,0,"percent of total billed charges ","70% of total billed charges ",1149.17,1526.75,
"PLT CLAVICLE SUP ANT 7H RT",6109267,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1685.23,1348.184,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1348.18,80,,1078.54,,,0,"percent of total billed charges ","80% of total billed charges ",1179.66,70,,943.73,,,0,"percent of total billed charges ","70% of total billed charges ",1516.71,90,,1213.37,,,0,"percent of total billed charges ","90% of total billed charges ",1567.26,93,,1253.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1432.45,85,,1145.96,,,0,"percent of total billed charges ","85% of total billed charges ",1432.45,85,,1145.96,,,0,"percent of total billed charges ","85% of total billed charges ",1516.71,90,,1213.37,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1466.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1179.66,70,,943.73,,,0,"percent of total billed charges ","70% of total billed charges ",1179.66,1567.26,
"PLT CLAVICLE SUP ANT 7H LT",6109268,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1685.23,1348.184,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1348.18,80,,1078.54,,,0,"percent of total billed charges ","80% of total billed charges ",1179.66,70,,943.73,,,0,"percent of total billed charges ","70% of total billed charges ",1516.71,90,,1213.37,,,0,"percent of total billed charges ","90% of total billed charges ",1567.26,93,,1253.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1432.45,85,,1145.96,,,0,"percent of total billed charges ","85% of total billed charges ",1432.45,85,,1145.96,,,0,"percent of total billed charges ","85% of total billed charges ",1516.71,90,,1213.37,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1466.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1179.66,70,,943.73,,,0,"percent of total billed charges ","70% of total billed charges ",1179.66,1567.26,
"PLT CLAVICLE SUP ANT 8H RT",6109269,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1728.79,1383.032,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1383.03,80,,1106.42,,,0,"percent of total billed charges ","80% of total billed charges ",1210.15,70,,968.12,,,0,"percent of total billed charges ","70% of total billed charges ",1555.91,90,,1244.73,,,0,"percent of total billed charges ","90% of total billed charges ",1607.77,93,,1286.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1469.47,85,,1175.58,,,0,"percent of total billed charges ","85% of total billed charges ",1469.47,85,,1175.58,,,0,"percent of total billed charges ","85% of total billed charges ",1555.91,90,,1244.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1504.05,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1210.15,70,,968.12,,,0,"percent of total billed charges ","70% of total billed charges ",1210.15,1607.77,
"PLT CLAVICLE SUP ANT 8H LT",6109270,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1728.79,1383.032,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1383.03,80,,1106.42,,,0,"percent of total billed charges ","80% of total billed charges ",1210.15,70,,968.12,,,0,"percent of total billed charges ","70% of total billed charges ",1555.91,90,,1244.73,,,0,"percent of total billed charges ","90% of total billed charges ",1607.77,93,,1286.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1469.47,85,,1175.58,,,0,"percent of total billed charges ","85% of total billed charges ",1469.47,85,,1175.58,,,0,"percent of total billed charges ","85% of total billed charges ",1555.91,90,,1244.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1504.05,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1210.15,70,,968.12,,,0,"percent of total billed charges ","70% of total billed charges ",1210.15,1607.77,
"PLT CLAVICLE SUP LAT EXT 6H RT",6109271,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1641.67,1313.336,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1313.34,80,,1050.67,,,0,"percent of total billed charges ","80% of total billed charges ",1149.17,70,,919.34,,,0,"percent of total billed charges ","70% of total billed charges ",1477.5,90,,1182.00,,,0,"percent of total billed charges ","90% of total billed charges ",1526.75,93,,1221.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1395.42,85,,1116.34,,,0,"percent of total billed charges ","85% of total billed charges ",1395.42,85,,1116.34,,,0,"percent of total billed charges ","85% of total billed charges ",1477.5,90,,1182.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1428.25,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1149.17,70,,919.34,,,0,"percent of total billed charges ","70% of total billed charges ",1149.17,1526.75,
"PLT CLAVICLE SUP LAT EXT 6H LT",6109272,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1641.67,1313.336,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1313.34,80,,1050.67,,,0,"percent of total billed charges ","80% of total billed charges ",1149.17,70,,919.34,,,0,"percent of total billed charges ","70% of total billed charges ",1477.5,90,,1182.00,,,0,"percent of total billed charges ","90% of total billed charges ",1526.75,93,,1221.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1395.42,85,,1116.34,,,0,"percent of total billed charges ","85% of total billed charges ",1395.42,85,,1116.34,,,0,"percent of total billed charges ","85% of total billed charges ",1477.5,90,,1182.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1428.25,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1149.17,70,,919.34,,,0,"percent of total billed charges ","70% of total billed charges ",1149.17,1526.75,
"PLT CLAVICLE SUP LAT EXT 7H RT",6109273,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1685.23,1348.184,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1348.18,80,,1078.54,,,0,"percent of total billed charges ","80% of total billed charges ",1179.66,70,,943.73,,,0,"percent of total billed charges ","70% of total billed charges ",1516.71,90,,1213.37,,,0,"percent of total billed charges ","90% of total billed charges ",1567.26,93,,1253.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1432.45,85,,1145.96,,,0,"percent of total billed charges ","85% of total billed charges ",1432.45,85,,1145.96,,,0,"percent of total billed charges ","85% of total billed charges ",1516.71,90,,1213.37,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1466.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1179.66,70,,943.73,,,0,"percent of total billed charges ","70% of total billed charges ",1179.66,1567.26,
"PLT CLAVICLE SUP LAT EXT 7H LT",6109274,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1685.23,1348.184,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1348.18,80,,1078.54,,,0,"percent of total billed charges ","80% of total billed charges ",1179.66,70,,943.73,,,0,"percent of total billed charges ","70% of total billed charges ",1516.71,90,,1213.37,,,0,"percent of total billed charges ","90% of total billed charges ",1567.26,93,,1253.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1432.45,85,,1145.96,,,0,"percent of total billed charges ","85% of total billed charges ",1432.45,85,,1145.96,,,0,"percent of total billed charges ","85% of total billed charges ",1516.71,90,,1213.37,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1466.15,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1179.66,70,,943.73,,,0,"percent of total billed charges ","70% of total billed charges ",1179.66,1567.26,
"PLT CLAVICLE SUP LAT EXT 8H RT",6109275,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1728.79,1383.032,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1383.03,80,,1106.42,,,0,"percent of total billed charges ","80% of total billed charges ",1210.15,70,,968.12,,,0,"percent of total billed charges ","70% of total billed charges ",1555.91,90,,1244.73,,,0,"percent of total billed charges ","90% of total billed charges ",1607.77,93,,1286.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1469.47,85,,1175.58,,,0,"percent of total billed charges ","85% of total billed charges ",1469.47,85,,1175.58,,,0,"percent of total billed charges ","85% of total billed charges ",1555.91,90,,1244.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1504.05,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1210.15,70,,968.12,,,0,"percent of total billed charges ","70% of total billed charges ",1210.15,1607.77,
"PLT CLAVICLE SUP LAT EXT 8H LT",6109276,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1728.79,1383.032,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1383.03,80,,1106.42,,,0,"percent of total billed charges ","80% of total billed charges ",1210.15,70,,968.12,,,0,"percent of total billed charges ","70% of total billed charges ",1555.91,90,,1244.73,,,0,"percent of total billed charges ","90% of total billed charges ",1607.77,93,,1286.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1469.47,85,,1175.58,,,0,"percent of total billed charges ","85% of total billed charges ",1469.47,85,,1175.58,,,0,"percent of total billed charges ","85% of total billed charges ",1555.91,90,,1244.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1504.05,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1210.15,70,,968.12,,,0,"percent of total billed charges ","70% of total billed charges ",1210.15,1607.77,
"PLT CLAVICLE MED ANT 6H",6109277,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1728.79,1383.032,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1383.03,80,,1106.42,,,0,"percent of total billed charges ","80% of total billed charges ",1210.15,70,,968.12,,,0,"percent of total billed charges ","70% of total billed charges ",1555.91,90,,1244.73,,,0,"percent of total billed charges ","90% of total billed charges ",1607.77,93,,1286.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1469.47,85,,1175.58,,,0,"percent of total billed charges ","85% of total billed charges ",1469.47,85,,1175.58,,,0,"percent of total billed charges ","85% of total billed charges ",1555.91,90,,1244.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1504.05,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1210.15,70,,968.12,,,0,"percent of total billed charges ","70% of total billed charges ",1210.15,1607.77,
"PLT CLAVICLE MED ANT 7H",6109278,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1728.79,1383.032,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1383.03,80,,1106.42,,,0,"percent of total billed charges ","80% of total billed charges ",1210.15,70,,968.12,,,0,"percent of total billed charges ","70% of total billed charges ",1555.91,90,,1244.73,,,0,"percent of total billed charges ","90% of total billed charges ",1607.77,93,,1286.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1469.47,85,,1175.58,,,0,"percent of total billed charges ","85% of total billed charges ",1469.47,85,,1175.58,,,0,"percent of total billed charges ","85% of total billed charges ",1555.91,90,,1244.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1504.05,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1210.15,70,,968.12,,,0,"percent of total billed charges ","70% of total billed charges ",1210.15,1607.77,
"PLT CLAVICLE MED ANT 8H",6109279,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1728.79,1383.032,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1383.03,80,,1106.42,,,0,"percent of total billed charges ","80% of total billed charges ",1210.15,70,,968.12,,,0,"percent of total billed charges ","70% of total billed charges ",1555.91,90,,1244.73,,,0,"percent of total billed charges ","90% of total billed charges ",1607.77,93,,1286.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1469.47,85,,1175.58,,,0,"percent of total billed charges ","85% of total billed charges ",1469.47,85,,1175.58,,,0,"percent of total billed charges ","85% of total billed charges ",1555.91,90,,1244.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1504.05,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1210.15,70,,968.12,,,0,"percent of total billed charges ","70% of total billed charges ",1210.15,1607.77,
"PLT CLAVICLE LAT ANT 7H",6109280,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1728.79,1383.032,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1383.03,80,,1106.42,,,0,"percent of total billed charges ","80% of total billed charges ",1210.15,70,,968.12,,,0,"percent of total billed charges ","70% of total billed charges ",1555.91,90,,1244.73,,,0,"percent of total billed charges ","90% of total billed charges ",1607.77,93,,1286.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1469.47,85,,1175.58,,,0,"percent of total billed charges ","85% of total billed charges ",1469.47,85,,1175.58,,,0,"percent of total billed charges ","85% of total billed charges ",1555.91,90,,1244.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1504.05,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1210.15,70,,968.12,,,0,"percent of total billed charges ","70% of total billed charges ",1210.15,1607.77,
"PLT CLAVICLE LAT ANT 9H",6109281,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1728.79,1383.032,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1383.03,80,,1106.42,,,0,"percent of total billed charges ","80% of total billed charges ",1210.15,70,,968.12,,,0,"percent of total billed charges ","70% of total billed charges ",1555.91,90,,1244.73,,,0,"percent of total billed charges ","90% of total billed charges ",1607.77,93,,1286.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1469.47,85,,1175.58,,,0,"percent of total billed charges ","85% of total billed charges ",1469.47,85,,1175.58,,,0,"percent of total billed charges ","85% of total billed charges ",1555.91,90,,1244.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1504.05,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1210.15,70,,968.12,,,0,"percent of total billed charges ","70% of total billed charges ",1210.15,1607.77,
"PLT CLAVICLE LAT ANT 10H",6109282,"CDM ",278,RC,C1743,HCPCS,OUTPATIENT,,,1728.79,1383.032,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1383.03,80,,1106.42,,,0,"percent of total billed charges ","80% of total billed charges ",1210.15,70,,968.12,,,0,"percent of total billed charges ","70% of total billed charges ",1555.91,90,,1244.73,,,0,"percent of total billed charges ","90% of total billed charges ",1607.77,93,,1286.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1469.47,85,,1175.58,,,0,"percent of total billed charges ","85% of total billed charges ",1469.47,85,,1175.58,,,0,"percent of total billed charges ","85% of total billed charges ",1555.91,90,,1244.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1504.05,87,,1203.24,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1210.15,70,,968.12,,,0,"percent of total billed charges ","70% of total billed charges ",1210.15,1607.77,
"PLT CLAVICLE LAT ANT 11H",6109283,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1728.79,1383.032,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1383.03,80,,1106.42,,,0,"percent of total billed charges ","80% of total billed charges ",1210.15,70,,968.12,,,0,"percent of total billed charges ","70% of total billed charges ",1555.91,90,,1244.73,,,0,"percent of total billed charges ","90% of total billed charges ",1607.77,93,,1286.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1469.47,85,,1175.58,,,0,"percent of total billed charges ","85% of total billed charges ",1469.47,85,,1175.58,,,0,"percent of total billed charges ","85% of total billed charges ",1555.91,90,,1244.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1504.05,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1210.15,70,,968.12,,,0,"percent of total billed charges ","70% of total billed charges ",1210.15,1607.77,
"PLT CLAVICLE LAT ANT 12H",6109284,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1728.79,1383.032,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1383.03,80,,1106.42,,,0,"percent of total billed charges ","80% of total billed charges ",1210.15,70,,968.12,,,0,"percent of total billed charges ","70% of total billed charges ",1555.91,90,,1244.73,,,0,"percent of total billed charges ","90% of total billed charges ",1607.77,93,,1286.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1469.47,85,,1175.58,,,0,"percent of total billed charges ","85% of total billed charges ",1469.47,85,,1175.58,,,0,"percent of total billed charges ","85% of total billed charges ",1555.91,90,,1244.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1504.05,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1210.15,70,,968.12,,,0,"percent of total billed charges ","70% of total billed charges ",1210.15,1607.77,
"CAP END MULTILOC NAIL 0MM EXT",6109285,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,462.25,369.8,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",369.8,80,,295.84,,,0,"percent of total billed charges ","80% of total billed charges ",323.58,70,,258.86,,,0,"percent of total billed charges ","70% of total billed charges ",416.03,90,,332.82,,,0,"percent of total billed charges ","90% of total billed charges ",429.89,93,,343.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",392.91,85,,314.33,,,0,"percent of total billed charges ","85% of total billed charges ",392.91,85,,314.33,,,0,"percent of total billed charges ","85% of total billed charges ",416.03,90,,332.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",402.16,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",323.58,70,,258.86,,,0,"percent of total billed charges ","70% of total billed charges ",323.58,429.89,
"CAP END MULTILOC NAIL 2MM EXT",6109286,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,462.25,369.8,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",369.8,80,,295.84,,,0,"percent of total billed charges ","80% of total billed charges ",323.58,70,,258.86,,,0,"percent of total billed charges ","70% of total billed charges ",416.03,90,,332.82,,,0,"percent of total billed charges ","90% of total billed charges ",429.89,93,,343.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",392.91,85,,314.33,,,0,"percent of total billed charges ","85% of total billed charges ",392.91,85,,314.33,,,0,"percent of total billed charges ","85% of total billed charges ",416.03,90,,332.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",402.16,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",323.58,70,,258.86,,,0,"percent of total billed charges ","70% of total billed charges ",323.58,429.89,
"CAP END MULTILOC NAIL 5MM EXT",6109287,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,462.25,369.8,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",369.8,80,,295.84,,,0,"percent of total billed charges ","80% of total billed charges ",323.58,70,,258.86,,,0,"percent of total billed charges ","70% of total billed charges ",416.03,90,,332.82,,,0,"percent of total billed charges ","90% of total billed charges ",429.89,93,,343.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",392.91,85,,314.33,,,0,"percent of total billed charges ","85% of total billed charges ",392.91,85,,314.33,,,0,"percent of total billed charges ","85% of total billed charges ",416.03,90,,332.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",402.16,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",323.58,70,,258.86,,,0,"percent of total billed charges ","70% of total billed charges ",323.58,429.89,
"CAP END MULTILOC NAIL 10MM EXT",6109288,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,462.25,369.8,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",369.8,80,,295.84,,,0,"percent of total billed charges ","80% of total billed charges ",323.58,70,,258.86,,,0,"percent of total billed charges ","70% of total billed charges ",416.03,90,,332.82,,,0,"percent of total billed charges ","90% of total billed charges ",429.89,93,,343.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",392.91,85,,314.33,,,0,"percent of total billed charges ","85% of total billed charges ",392.91,85,,314.33,,,0,"percent of total billed charges ","85% of total billed charges ",416.03,90,,332.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",402.16,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",323.58,70,,258.86,,,0,"percent of total billed charges ","70% of total billed charges ",323.58,429.89,
"CAP END MULTILOC NAIL 15MM EXT",6109289,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,462.25,369.8,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",369.8,80,,295.84,,,0,"percent of total billed charges ","80% of total billed charges ",323.58,70,,258.86,,,0,"percent of total billed charges ","70% of total billed charges ",416.03,90,,332.82,,,0,"percent of total billed charges ","90% of total billed charges ",429.89,93,,343.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",392.91,85,,314.33,,,0,"percent of total billed charges ","85% of total billed charges ",392.91,85,,314.33,,,0,"percent of total billed charges ","85% of total billed charges ",416.03,90,,332.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",402.16,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",323.58,70,,258.86,,,0,"percent of total billed charges ","70% of total billed charges ",323.58,429.89,
"SCR MULTILOC 4.5 X 20MM",6109290,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,641.65,513.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",513.32,80,,410.66,,,0,"percent of total billed charges ","80% of total billed charges ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",596.73,93,,477.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",558.24,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",449.16,596.73,
"SCR MULTILOC 4.5 X 22MM",6109291,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,641.65,513.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",513.32,80,,410.66,,,0,"percent of total billed charges ","80% of total billed charges ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",596.73,93,,477.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",558.24,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",449.16,596.73,
"SCR MULTILOC 4.5 X 24MM",6109292,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,641.65,513.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",513.32,80,,410.66,,,0,"percent of total billed charges ","80% of total billed charges ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",596.73,93,,477.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",558.24,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",449.16,596.73,
"SCR MULTILOC 4.5 X 26MM",6109293,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,641.65,513.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",513.32,80,,410.66,,,0,"percent of total billed charges ","80% of total billed charges ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",596.73,93,,477.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",558.24,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",449.16,596.73,
"SCR MULTILOC 4.5 X 28MM",6109294,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,641.65,513.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",513.32,80,,410.66,,,0,"percent of total billed charges ","80% of total billed charges ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",596.73,93,,477.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",558.24,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",449.16,596.73,
"SCR MULTILOC 4.5 X 30MM",6109295,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,641.65,513.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",513.32,80,,410.66,,,0,"percent of total billed charges ","80% of total billed charges ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",596.73,93,,477.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",558.24,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",449.16,596.73,
"SCR MULTILOC 4.5 X 32MM",6109296,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,641.65,513.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",513.32,80,,410.66,,,0,"percent of total billed charges ","80% of total billed charges ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",596.73,93,,477.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",558.24,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",449.16,596.73,
"SCR MULTILOC 4.5 X 34MM",6109297,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,641.65,513.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",513.32,80,,410.66,,,0,"percent of total billed charges ","80% of total billed charges ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",596.73,93,,477.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",558.24,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",449.16,596.73,
"SCR MULTILOC 4.5 X 36MM",6109298,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,641.65,513.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",513.32,80,,410.66,,,0,"percent of total billed charges ","80% of total billed charges ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",596.73,93,,477.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",558.24,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",449.16,596.73,
"SCR MULTILOC 4.5 X 38MM",6109299,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,641.65,513.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",513.32,80,,410.66,,,0,"percent of total billed charges ","80% of total billed charges ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",596.73,93,,477.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",558.24,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",449.16,596.73,
"SCR MULTILOC 4.5 X 40MM",6109300,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,641.65,513.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",513.32,80,,410.66,,,0,"percent of total billed charges ","80% of total billed charges ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",596.73,93,,477.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",558.24,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",449.16,596.73,
"SCR MULTILOC 4.5 X 42MM",6109301,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,641.65,513.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",513.32,80,,410.66,,,0,"percent of total billed charges ","80% of total billed charges ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",596.73,93,,477.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",558.24,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",449.16,596.73,
"SCR MULTILOC 4.5 X 44MM",6109302,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,641.65,513.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",513.32,80,,410.66,,,0,"percent of total billed charges ","80% of total billed charges ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",596.73,93,,477.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",558.24,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",449.16,596.73,
"SCR MULTILOC 4.5 X 46MM",6109303,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,641.65,513.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",513.32,80,,410.66,,,0,"percent of total billed charges ","80% of total billed charges ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",596.73,93,,477.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",558.24,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",449.16,596.73,
"SCR MULTILOC 4.5 X 48MM",6109304,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,641.65,513.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",513.32,80,,410.66,,,0,"percent of total billed charges ","80% of total billed charges ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",596.73,93,,477.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",558.24,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",449.16,596.73,
"SCR MULTILOC 4.5 X 50MM",6109305,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,641.65,513.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",513.32,80,,410.66,,,0,"percent of total billed charges ","80% of total billed charges ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",596.73,93,,477.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",558.24,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",449.16,596.73,
"SCR MULTILOC 4.5 X 52MM",6109306,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,641.65,513.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",513.32,80,,410.66,,,0,"percent of total billed charges ","80% of total billed charges ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",596.73,93,,477.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",558.24,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",449.16,596.73,
"SCR MULTILOC 4.5 X 54MM",6109307,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,641.65,513.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",513.32,80,,410.66,,,0,"percent of total billed charges ","80% of total billed charges ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",596.73,93,,477.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",558.24,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",449.16,596.73,
"SCR MULTILOC 4.5 X 56MM",6109308,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,641.65,513.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",513.32,80,,410.66,,,0,"percent of total billed charges ","80% of total billed charges ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",596.73,93,,477.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",558.24,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",449.16,596.73,
"SCR MULTILOC 4.5 X 58MM",6109309,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,641.65,513.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",513.32,80,,410.66,,,0,"percent of total billed charges ","80% of total billed charges ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",596.73,93,,477.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",558.24,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",449.16,596.73,
"SCR MULTILOC 4.5 X 60MM",6109310,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,641.65,513.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",513.32,80,,410.66,,,0,"percent of total billed charges ","80% of total billed charges ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",596.73,93,,477.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",558.24,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",449.16,596.73,
"SCR TI LCKG 3.5 X 26MM ST",6109311,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,374.97,299.976,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",299.98,80,,239.98,,,0,"percent of total billed charges ","80% of total billed charges ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",348.72,93,,278.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",326.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",262.48,348.72,
"SCR TI LCKG 3.5 X 28MM ST",6109312,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,374.97,299.976,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",299.98,80,,239.98,,,0,"percent of total billed charges ","80% of total billed charges ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",348.72,93,,278.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",326.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",262.48,348.72,
"SCR TI LCKG 3.5 X 30MM ST",6109313,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,374.97,299.976,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",299.98,80,,239.98,,,0,"percent of total billed charges ","80% of total billed charges ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",348.72,93,,278.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",326.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",262.48,348.72,
"SCR TI LCKG 3.5 X 32MM ST",6109314,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,374.97,299.976,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",299.98,80,,239.98,,,0,"percent of total billed charges ","80% of total billed charges ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",348.72,93,,278.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",326.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",262.48,348.72,
"SCR TI LCKG 3.5 X 34MM ST",6109315,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,374.97,299.976,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",299.98,80,,239.98,,,0,"percent of total billed charges ","80% of total billed charges ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",348.72,93,,278.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",326.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",262.48,348.72,
"SCR TI LCKG 3.5 X 36MM ST",6109316,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,374.97,299.976,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",299.98,80,,239.98,,,0,"percent of total billed charges ","80% of total billed charges ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",348.72,93,,278.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",326.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",262.48,348.72,
"SCR TI LCKG 3.5 X 38MM ST",6109317,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,374.97,299.976,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",299.98,80,,239.98,,,0,"percent of total billed charges ","80% of total billed charges ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",348.72,93,,278.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",326.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",262.48,348.72,
"SCR TI LCKG 3.5 X 40MM ST",6109318,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,374.97,299.976,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",299.98,80,,239.98,,,0,"percent of total billed charges ","80% of total billed charges ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",348.72,93,,278.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",326.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",262.48,348.72,
"SCR TI LCKG 3.5 X 42MM ST",6109319,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,374.97,299.976,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",299.98,80,,239.98,,,0,"percent of total billed charges ","80% of total billed charges ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",348.72,93,,278.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",326.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",262.48,348.72,
"SCR TI LCKG 3.5 X 44MM ST",6109320,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,374.97,299.976,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",299.98,80,,239.98,,,0,"percent of total billed charges ","80% of total billed charges ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",348.72,93,,278.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",326.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",262.48,348.72,
"SCR TI LCKG 3.5 X 46MM ST",6109321,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,374.97,299.976,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",299.98,80,,239.98,,,0,"percent of total billed charges ","80% of total billed charges ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",348.72,93,,278.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",326.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",262.48,348.72,
"SCR TI LCKG 3.5 X 48MM ST",6109322,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,374.97,299.976,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",299.98,80,,239.98,,,0,"percent of total billed charges ","80% of total billed charges ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",348.72,93,,278.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",326.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",262.48,348.72,
"SCR TI LCKG 3.5 X 50MM ST",6109323,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,374.97,299.976,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",299.98,80,,239.98,,,0,"percent of total billed charges ","80% of total billed charges ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",348.72,93,,278.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",326.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",262.48,348.72,
"SCR TI LCKG 3.5 X 52MM ST",6109324,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,374.97,299.976,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",299.98,80,,239.98,,,0,"percent of total billed charges ","80% of total billed charges ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",348.72,93,,278.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",326.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",262.48,348.72,
"SCR TI LCKG 4.0 X 18MM",6109325,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 4.0 X 20MM",6109326,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 4.0 X 22MM",6109327,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 4.0 X 24MM",6109328,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 4.0 X 26MM",6109329,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 4.0 X 28MM",6109330,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 4.0 X 30MM",6109331,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 4.0 X 32MM",6109332,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 4.0 X 34MM",6109333,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 4.0 X 36MM",6109334,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 4.0 X 38MM",6109335,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 4.0 X 40MM",6109336,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 4.0 X 42MM",6109337,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 4.0 X 44MM",6109338,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 4.0 X 46MM",6109339,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 4.0 X 48MM",6109340,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 4.0 X 50MM",6109341,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 4.0 X 52MM",6109342,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 4.0 X 54MM",6109343,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 4.0 X 56MM",6109344,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 4.0 X 58MM",6109345,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 4.0 X 60MM",6109346,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 4.0 X 62MM",6109347,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 4.0 X 64MM",6109348,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 4.0 X 66MM",6109349,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 4.0 X 68MM",6109350,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 4.0 X 70MM",6109351,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"CAP END TIBIAL NAIL 0MM EXT",6109352,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,459.02,367.216,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",367.22,80,,293.78,,,0,"percent of total billed charges ","80% of total billed charges ",321.31,70,,257.05,,,0,"percent of total billed charges ","70% of total billed charges ",413.12,90,,330.50,,,0,"percent of total billed charges ","90% of total billed charges ",426.89,93,,341.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",390.17,85,,312.14,,,0,"percent of total billed charges ","85% of total billed charges ",390.17,85,,312.14,,,0,"percent of total billed charges ","85% of total billed charges ",413.12,90,,330.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",399.35,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",321.31,70,,257.05,,,0,"percent of total billed charges ","70% of total billed charges ",321.31,426.89,
"CAP END TIBIAL NAIL 5MM EXT",6109353,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"CAP END TIBIAL NAIL 10MM EXT",6109354,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"CAP END TIBIAL NAIL 15MM EXT",6109355,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"SCR TI LCKG 5.0 X 26MM",6109356,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 28MM",6109357,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 30MM",6109358,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 32MM",6109359,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 34MM",6109360,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 36MM",6109361,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 38MM",6109362,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 40MM",6109363,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 42MM",6109364,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 44MM",6109365,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 46MM",6109366,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 48MM",6109367,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 50MM",6109368,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 52MM",6109369,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 54MM",6109370,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 56MM",6109371,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 58MM",6109372,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 60MM",6109373,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 62MM",6109374,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 64MM",6109375,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 66MM",6109376,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 68MM",6109377,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 70MM",6109378,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 72MM",6109379,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 74MM",6109380,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 76MM",6109381,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 78MM",6109382,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 80MM",6109383,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 85MM",6109384,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 90MM",6109385,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"SCR TI LCKG 5.0 X 95MM",6109386,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,483.26,386.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",386.61,80,,309.29,,,0,"percent of total billed charges ","80% of total billed charges ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",449.43,93,,359.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",410.77,85,,328.62,,,0,"percent of total billed charges ","85% of total billed charges ",434.93,90,,347.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",420.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.28,70,,270.62,,,0,"percent of total billed charges ","70% of total billed charges ",338.28,449.43,
"NAIL TIB TI CANN 8 X 300MM",6109387,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 8 X 315MM",6109388,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 8 X 330MM",6109389,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 8 X 345MM",6109390,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 8 X 360MM",6109391,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 8 X 375MM",6109392,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 8 X 390MM",6109393,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 8 X 405MM",6109394,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 9 X 315MM",6109395,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 9 X 330MM",6109396,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 9 X 345MM",6109397,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 9 X 360MM",6109398,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 9 X 375MM",6109399,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 9 X 390MM",6109400,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 9 X 405MM",6109401,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 10 X 315MM",6109402,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 10 X 330MM",6109403,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 10 X 345MM",6109404,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 10 X 360MM",6109405,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 10 X 375MM",6109406,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 10 X 390MM",6109407,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 10 X 405MM",6109408,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 11 X 300MM",6109409,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 11 X 315MM",6109410,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 11 X 330MM",6109411,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 11 X 345MM",6109412,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 11 X 360MM",6109413,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 11 X 375MM",6109414,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 11 X 390MM",6109415,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TIB TI CANN 11 X 405MM",6109416,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2642.19,2113.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2113.75,80,,1691.00,,,0,"percent of total billed charges ","80% of total billed charges ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",2457.24,93,,1965.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2245.86,85,,1796.69,,,0,"percent of total billed charges ","85% of total billed charges ",2377.97,90,,1902.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2298.71,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1849.53,70,,1479.62,,,0,"percent of total billed charges ","70% of total billed charges ",1849.53,2457.24,
"NAIL TFNA TI CANN 10 X 170MM",6109417,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3034.23,2427.384,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2427.38,80,,1941.90,,,0,"percent of total billed charges ","80% of total billed charges ",2123.96,70,,1699.17,,,0,"percent of total billed charges ","70% of total billed charges ",2730.81,90,,2184.65,,,0,"percent of total billed charges ","90% of total billed charges ",2821.83,93,,2257.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2579.1,85,,2063.28,,,0,"percent of total billed charges ","85% of total billed charges ",2579.1,85,,2063.28,,,0,"percent of total billed charges ","85% of total billed charges ",2730.81,90,,2184.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2639.78,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2123.96,70,,1699.17,,,0,"percent of total billed charges ","70% of total billed charges ",2123.96,2821.83,
"NAIL TFNA TI CANN 10 X 320MM R",6109418,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,4252.55,3402.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3402.04,80,,2721.63,,,0,"percent of total billed charges ","80% of total billed charges ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",3954.87,93,,3163.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3699.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",2976.79,3954.87,
"NAIL TFNA TI CANN 10 X 340MM R",6109419,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,4252.55,3402.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3402.04,80,,2721.63,,,0,"percent of total billed charges ","80% of total billed charges ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",3954.87,93,,3163.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3699.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",2976.79,3954.87,
"NAIL TFNA TI CANN 10 X 360MM R",6109420,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,4252.55,3402.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3402.04,80,,2721.63,,,0,"percent of total billed charges ","80% of total billed charges ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",3954.87,93,,3163.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3699.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",2976.79,3954.87,
"NAIL TFNA TI CANN 10 X 380MM R",6109421,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,4252.55,3402.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3402.04,80,,2721.63,,,0,"percent of total billed charges ","80% of total billed charges ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",3954.87,93,,3163.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3699.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",2976.79,3954.87,
"NAIL TFNA TI CANN 10 X 400MM R",6109422,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,4252.55,3402.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3402.04,80,,2721.63,,,0,"percent of total billed charges ","80% of total billed charges ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",3954.87,93,,3163.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3699.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",2976.79,3954.87,
"NAIL TFNA TI CANN 11 X 170MM",6109423,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3034.23,2427.384,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2427.38,80,,1941.90,,,0,"percent of total billed charges ","80% of total billed charges ",2123.96,70,,1699.17,,,0,"percent of total billed charges ","70% of total billed charges ",2730.81,90,,2184.65,,,0,"percent of total billed charges ","90% of total billed charges ",2821.83,93,,2257.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2579.1,85,,2063.28,,,0,"percent of total billed charges ","85% of total billed charges ",2579.1,85,,2063.28,,,0,"percent of total billed charges ","85% of total billed charges ",2730.81,90,,2184.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2639.78,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2123.96,70,,1699.17,,,0,"percent of total billed charges ","70% of total billed charges ",2123.96,2821.83,
"NAIL TFNA TI CANN 11 X 320MM R",6109424,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,4252.55,3402.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3402.04,80,,2721.63,,,0,"percent of total billed charges ","80% of total billed charges ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",3954.87,93,,3163.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3699.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",2976.79,3954.87,
"NAIL TFNA TI CANN 12 X 320MM R",6109425,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,4252.55,3402.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3402.04,80,,2721.63,,,0,"percent of total billed charges ","80% of total billed charges ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",3954.87,93,,3163.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3699.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",2976.79,3954.87,
"NAIL TFNA TI CANN 12 X 340MM R",6109426,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,4252.55,3402.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3402.04,80,,2721.63,,,0,"percent of total billed charges ","80% of total billed charges ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",3954.87,93,,3163.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3699.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",2976.79,3954.87,
"NAIL TFNA TI CANN 12 X 360MM R",6109427,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,4252.55,3402.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3402.04,80,,2721.63,,,0,"percent of total billed charges ","80% of total billed charges ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",3954.87,93,,3163.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3699.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",2976.79,3954.87,
"NAIL TFNA TI CANN 12 X 380MM R",6109428,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,4252.55,3402.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3402.04,80,,2721.63,,,0,"percent of total billed charges ","80% of total billed charges ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",3954.87,93,,3163.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3699.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",2976.79,3954.87,
"NAIL TFNA TI CANN 12 X 400MM R",6109429,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,4252.55,3402.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3402.04,80,,2721.63,,,0,"percent of total billed charges ","80% of total billed charges ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",3954.87,93,,3163.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3699.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",2976.79,3954.87,
"NAIL TFNA TI CANN 12 X 420MM R",6109430,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,4252.55,3402.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3402.04,80,,2721.63,,,0,"percent of total billed charges ","80% of total billed charges ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",3954.87,93,,3163.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3699.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",2976.79,3954.87,
"NAIL TFNA TI CANN 12 X 440MM R",6109431,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,4252.55,3402.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3402.04,80,,2721.63,,,0,"percent of total billed charges ","80% of total billed charges ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",3954.87,93,,3163.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3699.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",2976.79,3954.87,
"NAIL TFNA TI CANN 10 X 320MM L",6109432,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,4252.55,3402.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3402.04,80,,2721.63,,,0,"percent of total billed charges ","80% of total billed charges ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",3954.87,93,,3163.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3699.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",2976.79,3954.87,
"NAIL TFNA TI CANN 10 X 340MM L",6109433,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,4252.55,3402.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3402.04,80,,2721.63,,,0,"percent of total billed charges ","80% of total billed charges ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",3954.87,93,,3163.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3699.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",2976.79,3954.87,
"NAIL TFNA TI CANN 10 X 360MM L",6109434,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,4252.55,3402.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3402.04,80,,2721.63,,,0,"percent of total billed charges ","80% of total billed charges ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",3954.87,93,,3163.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3699.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",2976.79,3954.87,
"NAIL TFNA TI CANN 10 X 380MM L",6109435,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,4252.55,3402.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3402.04,80,,2721.63,,,0,"percent of total billed charges ","80% of total billed charges ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",3954.87,93,,3163.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3699.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",2976.79,3954.87,
"NAIL TFNA TI CANN 10 X 400MM L",6109436,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,4252.55,3402.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3402.04,80,,2721.63,,,0,"percent of total billed charges ","80% of total billed charges ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",3954.87,93,,3163.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3699.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",2976.79,3954.87,
"NAIL TFNA TI CANN 11 X 320MM L",6109437,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,4252.55,3402.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3402.04,80,,2721.63,,,0,"percent of total billed charges ","80% of total billed charges ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",3954.87,93,,3163.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3699.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",2976.79,3954.87,
"NAIL TFNA TI CANN 12 X 170MM",6109438,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3033.32,2426.656,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2426.66,80,,1941.33,,,0,"percent of total billed charges ","80% of total billed charges ",2123.32,70,,1698.66,,,0,"percent of total billed charges ","70% of total billed charges ",2729.99,90,,2183.99,,,0,"percent of total billed charges ","90% of total billed charges ",2820.99,93,,2256.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2578.32,85,,2062.66,,,0,"percent of total billed charges ","85% of total billed charges ",2578.32,85,,2062.66,,,0,"percent of total billed charges ","85% of total billed charges ",2729.99,90,,2183.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2638.99,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2123.32,70,,1698.66,,,0,"percent of total billed charges ","70% of total billed charges ",2123.32,2820.99,
"NAIL TFNA TI CANN 12 X 320MM L",6109439,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,4252.55,3402.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3402.04,80,,2721.63,,,0,"percent of total billed charges ","80% of total billed charges ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",3954.87,93,,3163.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3699.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",2976.79,3954.87,
"NAIL TFNA TI CANN 12 X 340MM L",6109440,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,4252.55,3402.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3402.04,80,,2721.63,,,0,"percent of total billed charges ","80% of total billed charges ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",3954.87,93,,3163.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3699.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",2976.79,3954.87,
"NAIL TFNA TI CANN 12 X 360MM L",6109441,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,4252.55,3402.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3402.04,80,,2721.63,,,0,"percent of total billed charges ","80% of total billed charges ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",3954.87,93,,3163.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3699.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",2976.79,3954.87,
"NAIL TFNA TI CANN 12 X 380MM L",6109442,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,4252.55,3402.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3402.04,80,,2721.63,,,0,"percent of total billed charges ","80% of total billed charges ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",3954.87,93,,3163.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3699.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",2976.79,3954.87,
"NAIL TFNA TI CANN 12 X 400MM L",6109443,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,4252.55,3402.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3402.04,80,,2721.63,,,0,"percent of total billed charges ","80% of total billed charges ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",3954.87,93,,3163.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3699.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",2976.79,3954.87,
"NAIL TFNA TI CANN 12 X 420MM L",6109444,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,4252.55,3402.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3402.04,80,,2721.63,,,0,"percent of total billed charges ","80% of total billed charges ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",3954.87,93,,3163.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3699.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",2976.79,3954.87,
"NAIL TFNA TI CANN 12 X 440MM L",6109445,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,4252.55,3402.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3402.04,80,,2721.63,,,0,"percent of total billed charges ","80% of total billed charges ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",3954.87,93,,3163.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3614.67,85,,2891.74,,,0,"percent of total billed charges ","85% of total billed charges ",3827.3,90,,3061.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3699.72,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2976.79,70,,2381.43,,,0,"percent of total billed charges ","70% of total billed charges ",2976.79,3954.87,
"ROD REAMING 2.5 X 950MM",6109446,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,247.29,197.832,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",197.83,80,,158.26,,,0,"percent of total billed charges ","80% of total billed charges ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",229.98,93,,183.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",210.2,85,,168.16,,,0,"percent of total billed charges ","85% of total billed charges ",222.56,90,,178.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",215.14,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.1,70,,138.48,,,0,"percent of total billed charges ","70% of total billed charges ",173.1,229.98,
"ROD REAMING 2.5 X 650MM",6109447,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,263.45,210.76,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",210.76,80,,168.61,,,0,"percent of total billed charges ","80% of total billed charges ",184.42,70,,147.54,,,0,"percent of total billed charges ","70% of total billed charges ",237.11,90,,189.69,,,0,"percent of total billed charges ","90% of total billed charges ",245.01,93,,196.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",223.93,85,,179.14,,,0,"percent of total billed charges ","85% of total billed charges ",223.93,85,,179.14,,,0,"percent of total billed charges ","85% of total billed charges ",237.11,90,,189.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",229.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",184.42,70,,147.54,,,0,"percent of total billed charges ","70% of total billed charges ",184.42,245.01,
"GUIDE WIRE 3.2 X 400MM",6109448,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,372,297.6,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",297.6,80,,238.08,,,0,"percent of total billed charges ","80% of total billed charges ",260.4,70,,208.32,,,0,"percent of total billed charges ","70% of total billed charges ",334.8,90,,267.84,,,0,"percent of total billed charges ","90% of total billed charges ",345.96,93,,276.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",316.2,85,,252.96,,,0,"percent of total billed charges ","85% of total billed charges ",316.2,85,,252.96,,,0,"percent of total billed charges ","85% of total billed charges ",334.8,90,,267.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",323.64,87,,258.91,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",260.4,70,,208.32,,,0,"percent of total billed charges ","70% of total billed charges ",260.4,345.96,
"PLT CONDYLAR CRVD 4.5MM 6H RT",6109449,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3031.5,2425.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2425.2,80,,1940.16,,,0,"percent of total billed charges ","80% of total billed charges ",2122.05,70,,1697.64,,,0,"percent of total billed charges ","70% of total billed charges ",2728.35,90,,2182.68,,,0,"percent of total billed charges ","90% of total billed charges ",2819.3,93,,2255.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2576.78,85,,2061.42,,,0,"percent of total billed charges ","85% of total billed charges ",2576.78,85,,2061.42,,,0,"percent of total billed charges ","85% of total billed charges ",2728.35,90,,2182.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2637.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2122.05,70,,1697.64,,,0,"percent of total billed charges ","70% of total billed charges ",2122.05,2819.3,
"PLT CONDYLAR CRVD 4.5MM 6H LT",6109450,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3031.5,2425.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2425.2,80,,1940.16,,,0,"percent of total billed charges ","80% of total billed charges ",2122.05,70,,1697.64,,,0,"percent of total billed charges ","70% of total billed charges ",2728.35,90,,2182.68,,,0,"percent of total billed charges ","90% of total billed charges ",2819.3,93,,2255.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2576.78,85,,2061.42,,,0,"percent of total billed charges ","85% of total billed charges ",2576.78,85,,2061.42,,,0,"percent of total billed charges ","85% of total billed charges ",2728.35,90,,2182.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2637.41,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2122.05,70,,1697.64,,,0,"percent of total billed charges ","70% of total billed charges ",2122.05,2819.3,
"PLT CONDYLAR CRVD 4.5MM 8H RT",6109451,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3090.04,2472.032,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2472.03,80,,1977.62,,,0,"percent of total billed charges ","80% of total billed charges ",2163.03,70,,1730.42,,,0,"percent of total billed charges ","70% of total billed charges ",2781.04,90,,2224.83,,,0,"percent of total billed charges ","90% of total billed charges ",2873.74,93,,2298.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2626.53,85,,2101.22,,,0,"percent of total billed charges ","85% of total billed charges ",2626.53,85,,2101.22,,,0,"percent of total billed charges ","85% of total billed charges ",2781.04,90,,2224.83,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2688.33,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2163.03,70,,1730.42,,,0,"percent of total billed charges ","70% of total billed charges ",2163.03,2873.74,
"PLT CONDYLAR CRVD 4.5MM 8H LT",6109452,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3090.04,2472.032,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2472.03,80,,1977.62,,,0,"percent of total billed charges ","80% of total billed charges ",2163.03,70,,1730.42,,,0,"percent of total billed charges ","70% of total billed charges ",2781.04,90,,2224.83,,,0,"percent of total billed charges ","90% of total billed charges ",2873.74,93,,2298.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2626.53,85,,2101.22,,,0,"percent of total billed charges ","85% of total billed charges ",2626.53,85,,2101.22,,,0,"percent of total billed charges ","85% of total billed charges ",2781.04,90,,2224.83,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2688.33,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2163.03,70,,1730.42,,,0,"percent of total billed charges ","70% of total billed charges ",2163.03,2873.74,
"PLT CONDYLAR CRVD 4.5MM 10H RT",6109453,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3234.33,2587.464,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2587.46,80,,2069.97,,,0,"percent of total billed charges ","80% of total billed charges ",2264.03,70,,1811.22,,,0,"percent of total billed charges ","70% of total billed charges ",2910.9,90,,2328.72,,,0,"percent of total billed charges ","90% of total billed charges ",3007.93,93,,2406.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2749.18,85,,2199.34,,,0,"percent of total billed charges ","85% of total billed charges ",2749.18,85,,2199.34,,,0,"percent of total billed charges ","85% of total billed charges ",2910.9,90,,2328.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2813.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2264.03,70,,1811.22,,,0,"percent of total billed charges ","70% of total billed charges ",2264.03,3007.93,
"PLT CONDYLAR CRVD 4.5MM 10H LT",6109454,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3234.33,2587.464,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2587.46,80,,2069.97,,,0,"percent of total billed charges ","80% of total billed charges ",2264.03,70,,1811.22,,,0,"percent of total billed charges ","70% of total billed charges ",2910.9,90,,2328.72,,,0,"percent of total billed charges ","90% of total billed charges ",3007.93,93,,2406.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2749.18,85,,2199.34,,,0,"percent of total billed charges ","85% of total billed charges ",2749.18,85,,2199.34,,,0,"percent of total billed charges ","85% of total billed charges ",2910.9,90,,2328.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2813.87,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2264.03,70,,1811.22,,,0,"percent of total billed charges ","70% of total billed charges ",2264.03,3007.93,
"PLT CONDYLAR CRVD 4.5MM 12H RT",6109455,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3302.39,2641.912,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2641.91,80,,2113.53,,,0,"percent of total billed charges ","80% of total billed charges ",2311.67,70,,1849.34,,,0,"percent of total billed charges ","70% of total billed charges ",2972.15,90,,2377.72,,,0,"percent of total billed charges ","90% of total billed charges ",3071.22,93,,2456.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2807.03,85,,2245.62,,,0,"percent of total billed charges ","85% of total billed charges ",2807.03,85,,2245.62,,,0,"percent of total billed charges ","85% of total billed charges ",2972.15,90,,2377.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2873.08,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2311.67,70,,1849.34,,,0,"percent of total billed charges ","70% of total billed charges ",2311.67,3071.22,
"PLT CONDYLAR CRVD 4.5MM 12H LT",6109456,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3302.39,2641.912,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2641.91,80,,2113.53,,,0,"percent of total billed charges ","80% of total billed charges ",2311.67,70,,1849.34,,,0,"percent of total billed charges ","70% of total billed charges ",2972.15,90,,2377.72,,,0,"percent of total billed charges ","90% of total billed charges ",3071.22,93,,2456.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2807.03,85,,2245.62,,,0,"percent of total billed charges ","85% of total billed charges ",2807.03,85,,2245.62,,,0,"percent of total billed charges ","85% of total billed charges ",2972.15,90,,2377.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2873.08,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2311.67,70,,1849.34,,,0,"percent of total billed charges ","70% of total billed charges ",2311.67,3071.22,
"PLT CONDYLAR CRVD 4.5MM 14H RT",6109457,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3524.28,2819.424,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2819.42,80,,2255.54,,,0,"percent of total billed charges ","80% of total billed charges ",2467,70,,1973.60,,,0,"percent of total billed charges ","70% of total billed charges ",3171.85,90,,2537.48,,,0,"percent of total billed charges ","90% of total billed charges ",3277.58,93,,2622.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2995.64,85,,2396.51,,,0,"percent of total billed charges ","85% of total billed charges ",2995.64,85,,2396.51,,,0,"percent of total billed charges ","85% of total billed charges ",3171.85,90,,2537.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3066.12,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2467,70,,1973.60,,,0,"percent of total billed charges ","70% of total billed charges ",2467,3277.58,
"PLT CONDYLAR CRVD 4.5MM 14H LT",6109458,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3524.28,2819.424,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2819.42,80,,2255.54,,,0,"percent of total billed charges ","80% of total billed charges ",2467,70,,1973.60,,,0,"percent of total billed charges ","70% of total billed charges ",3171.85,90,,2537.48,,,0,"percent of total billed charges ","90% of total billed charges ",3277.58,93,,2622.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2995.64,85,,2396.51,,,0,"percent of total billed charges ","85% of total billed charges ",2995.64,85,,2396.51,,,0,"percent of total billed charges ","85% of total billed charges ",3171.85,90,,2537.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3066.12,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2467,70,,1973.60,,,0,"percent of total billed charges ","70% of total billed charges ",2467,3277.58,
"PLT CONDYLAR CRVD 4.5MM 16H RT",6109459,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3592.34,2873.872,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2873.87,80,,2299.10,,,0,"percent of total billed charges ","80% of total billed charges ",2514.64,70,,2011.71,,,0,"percent of total billed charges ","70% of total billed charges ",3233.11,90,,2586.49,,,0,"percent of total billed charges ","90% of total billed charges ",3340.88,93,,2672.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3053.49,85,,2442.79,,,0,"percent of total billed charges ","85% of total billed charges ",3053.49,85,,2442.79,,,0,"percent of total billed charges ","85% of total billed charges ",3233.11,90,,2586.49,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3125.34,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2514.64,70,,2011.71,,,0,"percent of total billed charges ","70% of total billed charges ",2514.64,3340.88,
"PLT CONDYLAR CRVD 4.5MM 16H LT",6109460,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3592.34,2873.872,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2873.87,80,,2299.10,,,0,"percent of total billed charges ","80% of total billed charges ",2514.64,70,,2011.71,,,0,"percent of total billed charges ","70% of total billed charges ",3233.11,90,,2586.49,,,0,"percent of total billed charges ","90% of total billed charges ",3340.88,93,,2672.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3053.49,85,,2442.79,,,0,"percent of total billed charges ","85% of total billed charges ",3053.49,85,,2442.79,,,0,"percent of total billed charges ","85% of total billed charges ",3233.11,90,,2586.49,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3125.34,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2514.64,70,,2011.71,,,0,"percent of total billed charges ","70% of total billed charges ",2514.64,3340.88,
"PLT CONDYLAR CRVD 4.5MM 18H RT",6109461,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3826.47,3061.176,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3061.18,80,,2448.94,,,0,"percent of total billed charges ","80% of total billed charges ",2678.53,70,,2142.82,,,0,"percent of total billed charges ","70% of total billed charges ",3443.82,90,,2755.06,,,0,"percent of total billed charges ","90% of total billed charges ",3558.62,93,,2846.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3252.5,85,,2602.00,,,0,"percent of total billed charges ","85% of total billed charges ",3252.5,85,,2602.00,,,0,"percent of total billed charges ","85% of total billed charges ",3443.82,90,,2755.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3329.03,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2678.53,70,,2142.82,,,0,"percent of total billed charges ","70% of total billed charges ",2678.53,3558.62,
"PLT CONDYLAR CRVD 4.5MM 18H LT",6109462,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3826.47,3061.176,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",3061.18,80,,2448.94,,,0,"percent of total billed charges ","80% of total billed charges ",2678.53,70,,2142.82,,,0,"percent of total billed charges ","70% of total billed charges ",3443.82,90,,2755.06,,,0,"percent of total billed charges ","90% of total billed charges ",3558.62,93,,2846.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3252.5,85,,2602.00,,,0,"percent of total billed charges ","85% of total billed charges ",3252.5,85,,2602.00,,,0,"percent of total billed charges ","85% of total billed charges ",3443.82,90,,2755.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3329.03,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2678.53,70,,2142.82,,,0,"percent of total billed charges ","70% of total billed charges ",2678.53,3558.62,
"STEM FEM STD SZ 5 130MM",6109463,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5626.5,4501.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4501.2,80,,3600.96,,,0,"percent of total billed charges ","80% of total billed charges ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",5232.65,93,,4186.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4895.06,87,,3916.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",3938.55,5232.65,
"STEM FEM STD SZ 6 132MM",6109464,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5626.5,4501.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4501.2,80,,3600.96,,,0,"percent of total billed charges ","80% of total billed charges ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",5232.65,93,,4186.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4895.06,87,,3916.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",3938.55,5232.65,
"STEM FEM STD SZ 7.5 135MM",6109465,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5626.5,4501.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4501.2,80,,3600.96,,,0,"percent of total billed charges ","80% of total billed charges ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",5232.65,93,,4186.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4895.06,87,,3916.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",3938.55,5232.65,
"STEM FEM STD SZ 9 137MM",6109466,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5626.5,4501.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4501.2,80,,3600.96,,,0,"percent of total billed charges ","80% of total billed charges ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",5232.65,93,,4186.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4895.06,87,,3916.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",3938.55,5232.65,
"STEM FEM STD SZ 10 140MM",6109467,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5626.5,4501.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4501.2,80,,3600.96,,,0,"percent of total billed charges ","80% of total billed charges ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",5232.65,93,,4186.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4895.06,87,,3916.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",3938.55,5232.65,
"STEM FEM STD SZ 11 142MM",6109468,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5626.5,4501.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4501.2,80,,3600.96,,,0,"percent of total billed charges ","80% of total billed charges ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",5232.65,93,,4186.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4895.06,87,,3916.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",3938.55,5232.65,
"STEM FEM STD SZ 12.5 145MM",6109469,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5626.5,4501.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4501.2,80,,3600.96,,,0,"percent of total billed charges ","80% of total billed charges ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",5232.65,93,,4186.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4895.06,87,,3916.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",3938.55,5232.65,
"STEM FEM STD SZ 13.5 147MM",6109470,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5626.5,4501.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4501.2,80,,3600.96,,,0,"percent of total billed charges ","80% of total billed charges ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",5232.65,93,,4186.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4895.06,87,,3916.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",3938.55,5232.65,
"STEM FEM STD SZ 15 150MM",6109471,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5626.5,4501.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4501.2,80,,3600.96,,,0,"percent of total billed charges ","80% of total billed charges ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",5232.65,93,,4186.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4895.06,87,,3916.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",3938.55,5232.65,
"STEM FEM STD SZ 17.5 155MM",6109472,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5626.5,4501.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4501.2,80,,3600.96,,,0,"percent of total billed charges ","80% of total billed charges ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",5232.65,93,,4186.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4895.06,87,,3916.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",3938.55,5232.65,
"STEM FEM STD SZ 20 160MM",6109473,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5626.5,4501.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4501.2,80,,3600.96,,,0,"percent of total billed charges ","80% of total billed charges ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",5232.65,93,,4186.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4895.06,87,,3916.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",3938.55,5232.65,
"STEM FEM STD SZ 22.5 165MM",6109474,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5626.5,4501.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4501.2,80,,3600.96,,,0,"percent of total billed charges ","80% of total billed charges ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",5232.65,93,,4186.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4895.06,87,,3916.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",3938.55,5232.65,
"STEM FEM LAT SZ 5 130MM",6109475,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5626.5,4501.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4501.2,80,,3600.96,,,0,"percent of total billed charges ","80% of total billed charges ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",5232.65,93,,4186.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4895.06,87,,3916.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",3938.55,5232.65,
"STEM FEM LAT SZ 6 132MM",6109476,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5626.5,4501.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4501.2,80,,3600.96,,,0,"percent of total billed charges ","80% of total billed charges ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",5232.65,93,,4186.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4895.06,87,,3916.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",3938.55,5232.65,
"STEM FEM LAT SZ 7.5 135MM",6109477,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5626.5,4501.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4501.2,80,,3600.96,,,0,"percent of total billed charges ","80% of total billed charges ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",5232.65,93,,4186.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4895.06,87,,3916.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",3938.55,5232.65,
"STEM FEM LAT SZ 9 137MM",6109478,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5626.5,4501.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4501.2,80,,3600.96,,,0,"percent of total billed charges ","80% of total billed charges ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",5232.65,93,,4186.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4895.06,87,,3916.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",3938.55,5232.65,
"STEM FEM LAT SZ 10 140MM",6109479,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5626.5,4501.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4501.2,80,,3600.96,,,0,"percent of total billed charges ","80% of total billed charges ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",5232.65,93,,4186.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4895.06,87,,3916.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",3938.55,5232.65,
"STEM FEM LAT SZ 11 142MM",6109480,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5626.5,4501.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4501.2,80,,3600.96,,,0,"percent of total billed charges ","80% of total billed charges ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",5232.65,93,,4186.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4895.06,87,,3916.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",3938.55,5232.65,
"STEM FEM LAT SZ 12.5 145MM",6109481,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5626.5,4501.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4501.2,80,,3600.96,,,0,"percent of total billed charges ","80% of total billed charges ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",5232.65,93,,4186.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4895.06,87,,3916.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",3938.55,5232.65,
"STEM FEM LAT SZ 13.5 147MM",6109482,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5626.5,4501.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4501.2,80,,3600.96,,,0,"percent of total billed charges ","80% of total billed charges ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",5232.65,93,,4186.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4895.06,87,,3916.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",3938.55,5232.65,
"STEM FEM LAT SZ 15 150MM",6109483,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5626.5,4501.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4501.2,80,,3600.96,,,0,"percent of total billed charges ","80% of total billed charges ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",5232.65,93,,4186.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4895.06,87,,3916.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",3938.55,5232.65,
"STEM FEM LAT SZ 17.5 155MM",6109484,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5626.5,4501.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4501.2,80,,3600.96,,,0,"percent of total billed charges ","80% of total billed charges ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",5232.65,93,,4186.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4895.06,87,,3916.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",3938.55,5232.65,
"STEM FEM LAT SZ 20 160MM",6109485,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5626.5,4501.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4501.2,80,,3600.96,,,0,"percent of total billed charges ","80% of total billed charges ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",5232.65,93,,4186.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4895.06,87,,3916.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",3938.55,5232.65,
"STEM FEM LAT SZ 22.5 165MM",6109486,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5626.5,4501.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4501.2,80,,3600.96,,,0,"percent of total billed charges ","80% of total billed charges ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",5232.65,93,,4186.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4895.06,87,,3916.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",3938.55,5232.65,
"STEM FEM LAT SZ 25 170MM",6109487,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,5626.5,4501.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4501.2,80,,3600.96,,,0,"percent of total billed charges ","80% of total billed charges ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",5232.65,93,,4186.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",4782.53,85,,3826.02,,,0,"percent of total billed charges ","85% of total billed charges ",5063.85,90,,4051.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4895.06,87,,3916.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3938.55,70,,3150.84,,,0,"percent of total billed charges ","70% of total billed charges ",3938.55,5232.65,
"COMP MDLR HEAD 22MM 0MM NK",6109488,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1089,871.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",871.2,80,,696.96,,,0,"percent of total billed charges ","80% of total billed charges ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",1012.77,93,,810.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",947.43,87,,757.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",762.3,1012.77,
"COMP MDLR HEAD 22MM -5MM NK",6109489,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1089,871.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",871.2,80,,696.96,,,0,"percent of total billed charges ","80% of total billed charges ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",1012.77,93,,810.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",947.43,87,,757.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",762.3,1012.77,
"COMP MDLR HEAD 22MM -3MM NK",6109490,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,1089,871.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",871.2,80,,696.96,,,0,"percent of total billed charges ","80% of total billed charges ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",1012.77,93,,810.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",925.65,85,,740.52,,,0,"percent of total billed charges ","85% of total billed charges ",980.1,90,,784.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",947.43,87,,757.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",762.3,70,,609.84,,,0,"percent of total billed charges ","70% of total billed charges ",762.3,1012.77,
"SCR VA LCKG 5.0 X 10MM ST",6109491,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,551.14,440.912,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",440.91,80,,352.73,,,0,"percent of total billed charges ","80% of total billed charges ",385.8,70,,308.64,,,0,"percent of total billed charges ","70% of total billed charges ",496.03,90,,396.82,,,0,"percent of total billed charges ","90% of total billed charges ",512.56,93,,410.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",468.47,85,,374.78,,,0,"percent of total billed charges ","85% of total billed charges ",468.47,85,,374.78,,,0,"percent of total billed charges ","85% of total billed charges ",496.03,90,,396.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",479.49,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",385.8,70,,308.64,,,0,"percent of total billed charges ","70% of total billed charges ",385.8,512.56,
"SCR VA LCKG 5.0 X 12MM ST",6109492,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,551.14,440.912,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",440.91,80,,352.73,,,0,"percent of total billed charges ","80% of total billed charges ",385.8,70,,308.64,,,0,"percent of total billed charges ","70% of total billed charges ",496.03,90,,396.82,,,0,"percent of total billed charges ","90% of total billed charges ",512.56,93,,410.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",468.47,85,,374.78,,,0,"percent of total billed charges ","85% of total billed charges ",468.47,85,,374.78,,,0,"percent of total billed charges ","85% of total billed charges ",496.03,90,,396.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",479.49,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",385.8,70,,308.64,,,0,"percent of total billed charges ","70% of total billed charges ",385.8,512.56,
"SCR VA LCKG 5.0 X 14MM ST",6109493,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,551.14,440.912,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",440.91,80,,352.73,,,0,"percent of total billed charges ","80% of total billed charges ",385.8,70,,308.64,,,0,"percent of total billed charges ","70% of total billed charges ",496.03,90,,396.82,,,0,"percent of total billed charges ","90% of total billed charges ",512.56,93,,410.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",468.47,85,,374.78,,,0,"percent of total billed charges ","85% of total billed charges ",468.47,85,,374.78,,,0,"percent of total billed charges ","85% of total billed charges ",496.03,90,,396.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",479.49,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",385.8,70,,308.64,,,0,"percent of total billed charges ","70% of total billed charges ",385.8,512.56,
"SCR VA LCKG 5.0 X 16MM ST",6109494,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,551.14,440.912,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",440.91,80,,352.73,,,0,"percent of total billed charges ","80% of total billed charges ",385.8,70,,308.64,,,0,"percent of total billed charges ","70% of total billed charges ",496.03,90,,396.82,,,0,"percent of total billed charges ","90% of total billed charges ",512.56,93,,410.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",468.47,85,,374.78,,,0,"percent of total billed charges ","85% of total billed charges ",468.47,85,,374.78,,,0,"percent of total billed charges ","85% of total billed charges ",496.03,90,,396.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",479.49,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",385.8,70,,308.64,,,0,"percent of total billed charges ","70% of total billed charges ",385.8,512.56,
"SCR VA LCKG 5.0 X 18MM ST",6109495,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,551.14,440.912,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",440.91,80,,352.73,,,0,"percent of total billed charges ","80% of total billed charges ",385.8,70,,308.64,,,0,"percent of total billed charges ","70% of total billed charges ",496.03,90,,396.82,,,0,"percent of total billed charges ","90% of total billed charges ",512.56,93,,410.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",468.47,85,,374.78,,,0,"percent of total billed charges ","85% of total billed charges ",468.47,85,,374.78,,,0,"percent of total billed charges ","85% of total billed charges ",496.03,90,,396.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",479.49,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",385.8,70,,308.64,,,0,"percent of total billed charges ","70% of total billed charges ",385.8,512.56,
"SCR VA LCKG 5.0 X 20MM ST",6109496,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,392.75,314.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",314.2,80,,251.36,,,0,"percent of total billed charges ","80% of total billed charges ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",365.26,93,,292.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",341.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",274.93,365.26,
"SCR VA LCKG 5.0 X 22MM ST",6109497,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,392.75,314.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",314.2,80,,251.36,,,0,"percent of total billed charges ","80% of total billed charges ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",365.26,93,,292.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",341.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",274.93,365.26,
"SCR VA LCKG 5.0 X 24MM ST",6109498,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,392.75,314.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",314.2,80,,251.36,,,0,"percent of total billed charges ","80% of total billed charges ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",365.26,93,,292.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",341.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",274.93,365.26,
"SCR VA LCKG 5.0 X 26MM ST",6109499,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,392.75,314.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",314.2,80,,251.36,,,0,"percent of total billed charges ","80% of total billed charges ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",365.26,93,,292.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",341.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",274.93,365.26,
"SCR VA LCKG 5.0 X 28MM ST",6109500,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,392.75,314.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",314.2,80,,251.36,,,0,"percent of total billed charges ","80% of total billed charges ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",365.26,93,,292.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",341.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",274.93,365.26,
"SCR VA LCKG 5.0 X 30MM ST",6109501,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,392.75,314.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",314.2,80,,251.36,,,0,"percent of total billed charges ","80% of total billed charges ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",365.26,93,,292.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",341.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",274.93,365.26,
"SCR VA LCKG 5.0 X 32MM ST",6109502,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,392.75,314.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",314.2,80,,251.36,,,0,"percent of total billed charges ","80% of total billed charges ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",365.26,93,,292.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",341.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",274.93,365.26,
"SCR VA LCKG 5.0 X 34MM ST",6109503,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,392.75,314.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",314.2,80,,251.36,,,0,"percent of total billed charges ","80% of total billed charges ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",365.26,93,,292.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",341.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",274.93,365.26,
"SCR VA LCKG 5.0 X 36MM ST",6109504,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,392.75,314.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",314.2,80,,251.36,,,0,"percent of total billed charges ","80% of total billed charges ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",365.26,93,,292.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",341.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",274.93,365.26,
"SCR VA LCKG 5.0 X 38MM ST",6109505,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,392.75,314.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",314.2,80,,251.36,,,0,"percent of total billed charges ","80% of total billed charges ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",365.26,93,,292.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",341.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",274.93,365.26,
"SCR VA LCKG 5.0 X 40MM ST",6109506,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,392.75,314.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",314.2,80,,251.36,,,0,"percent of total billed charges ","80% of total billed charges ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",365.26,93,,292.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",341.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",274.93,365.26,
"SCR VA LCKG 5.0 X 42MM ST",6109507,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,392.75,314.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",314.2,80,,251.36,,,0,"percent of total billed charges ","80% of total billed charges ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",365.26,93,,292.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",341.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",274.93,365.26,
"SCR VA LCKG 5.0 X 44MM ST",6109508,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,392.75,314.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",314.2,80,,251.36,,,0,"percent of total billed charges ","80% of total billed charges ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",365.26,93,,292.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",341.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",274.93,365.26,
"SCR VA LCKG 5.0 X 46MM ST",6109509,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,392.75,314.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",314.2,80,,251.36,,,0,"percent of total billed charges ","80% of total billed charges ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",365.26,93,,292.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",341.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",274.93,365.26,
"SCR VA LCKG 5.0 X 48MM ST",6109510,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,392.75,314.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",314.2,80,,251.36,,,0,"percent of total billed charges ","80% of total billed charges ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",365.26,93,,292.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",341.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",274.93,365.26,
"SCR VA LCKG 5.0 X 50MM ST",6109511,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,392.75,314.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",314.2,80,,251.36,,,0,"percent of total billed charges ","80% of total billed charges ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",365.26,93,,292.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",341.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",274.93,365.26,
"SCR VA LCKG 5.0 X 55MM ST",6109512,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,392.75,314.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",314.2,80,,251.36,,,0,"percent of total billed charges ","80% of total billed charges ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",365.26,93,,292.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",341.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",274.93,365.26,
"SCR VA LCKG 5.0 X 60MM ST",6109513,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,392.75,314.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",314.2,80,,251.36,,,0,"percent of total billed charges ","80% of total billed charges ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",365.26,93,,292.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",341.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",274.93,365.26,
"SCR VA LCKG 5.0 X 65MM ST",6109514,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,392.75,314.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",314.2,80,,251.36,,,0,"percent of total billed charges ","80% of total billed charges ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",365.26,93,,292.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",341.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",274.93,365.26,
"SCR VA LCKG 5.0 X 70MM ST",6109515,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,392.75,314.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",314.2,80,,251.36,,,0,"percent of total billed charges ","80% of total billed charges ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",365.26,93,,292.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",341.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",274.93,365.26,
"SCR VA LCKG 5.0 X 75MM ST",6109516,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,392.75,314.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",314.2,80,,251.36,,,0,"percent of total billed charges ","80% of total billed charges ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",365.26,93,,292.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",341.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",274.93,365.26,
"SCR VA LCKG 5.0 X 80MM ST",6109517,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,392.75,314.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",314.2,80,,251.36,,,0,"percent of total billed charges ","80% of total billed charges ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",365.26,93,,292.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",341.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",274.93,365.26,
"SCR VA LCKG 5.0 X 85MM ST",6109518,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,392.75,314.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",314.2,80,,251.36,,,0,"percent of total billed charges ","80% of total billed charges ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",365.26,93,,292.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",341.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",274.93,365.26,
"SCR VA LCKG 5.0 X90MM ST",6109519,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,392.75,314.2,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",314.2,80,,251.36,,,0,"percent of total billed charges ","80% of total billed charges ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",365.26,93,,292.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",333.84,85,,267.07,,,0,"percent of total billed charges ","85% of total billed charges ",353.48,90,,282.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",341.69,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.93,70,,219.94,,,0,"percent of total billed charges ","70% of total billed charges ",274.93,365.26,
"SCR CANN VA LCKG 5.0 X 20MM",6109520,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,533.36,426.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",426.69,80,,341.35,,,0,"percent of total billed charges ","80% of total billed charges ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",496.02,93,,396.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",464.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",373.35,496.02,
"SCR CANN VA LCKG 5.0 X 25MM",6109521,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,533.36,426.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",426.69,80,,341.35,,,0,"percent of total billed charges ","80% of total billed charges ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",496.02,93,,396.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",464.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",373.35,496.02,
"SCR CANN VA LCKG 5.0 X 30MM",6109522,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,533.36,426.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",426.69,80,,341.35,,,0,"percent of total billed charges ","80% of total billed charges ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",496.02,93,,396.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",464.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",373.35,496.02,
"SCR CANN VA LCKG 5.0 X 35MM",6109523,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,533.36,426.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",426.69,80,,341.35,,,0,"percent of total billed charges ","80% of total billed charges ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",496.02,93,,396.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",464.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",373.35,496.02,
"SCR CANN VA LCKG 5.0 X 40MM",6109524,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,533.36,426.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",426.69,80,,341.35,,,0,"percent of total billed charges ","80% of total billed charges ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",496.02,93,,396.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",464.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",373.35,496.02,
"SCR CANN VA LCKG 5.0 X 45MM",6109525,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,533.36,426.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",426.69,80,,341.35,,,0,"percent of total billed charges ","80% of total billed charges ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",496.02,93,,396.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",464.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",373.35,496.02,
"SCR CANN VA LCKG 5.0 X 50MM",6109526,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,533.36,426.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",426.69,80,,341.35,,,0,"percent of total billed charges ","80% of total billed charges ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",496.02,93,,396.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",464.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",373.35,496.02,
"SCR CANN VA LCKG 5.0 X 55MM",6109527,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,533.36,426.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",426.69,80,,341.35,,,0,"percent of total billed charges ","80% of total billed charges ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",496.02,93,,396.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",464.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",373.35,496.02,
"SCR CANN VA LCKG 5.0 X 60MM",6109528,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,533.36,426.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",426.69,80,,341.35,,,0,"percent of total billed charges ","80% of total billed charges ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",496.02,93,,396.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",464.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",373.35,496.02,
"SCR CANN VA LCKG 5.0 X 65MM",6109529,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,533.36,426.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",426.69,80,,341.35,,,0,"percent of total billed charges ","80% of total billed charges ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",496.02,93,,396.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",464.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",373.35,496.02,
"SCR CANN VA LCKG 5.0 X 70MM",6109530,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,533.36,426.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",426.69,80,,341.35,,,0,"percent of total billed charges ","80% of total billed charges ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",496.02,93,,396.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",464.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",373.35,496.02,
"SCR CANN VA LCKG 5.0 X 75MM",6109531,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,533.36,426.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",426.69,80,,341.35,,,0,"percent of total billed charges ","80% of total billed charges ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",496.02,93,,396.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",464.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",373.35,496.02,
"SCR CANN VA LCKG 5.0 X 80MM",6109532,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,533.36,426.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",426.69,80,,341.35,,,0,"percent of total billed charges ","80% of total billed charges ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",496.02,93,,396.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",464.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",373.35,496.02,
"SCR CANN VA LCKG 5.0 X 85MM",6109533,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,533.36,426.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",426.69,80,,341.35,,,0,"percent of total billed charges ","80% of total billed charges ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",496.02,93,,396.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",464.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",373.35,496.02,
"SCR CANN VA LCKG 5.0 X 90MM",6109534,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,533.36,426.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",426.69,80,,341.35,,,0,"percent of total billed charges ","80% of total billed charges ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",496.02,93,,396.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",453.36,85,,362.69,,,0,"percent of total billed charges ","85% of total billed charges ",480.02,90,,384.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",464.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",373.35,70,,298.68,,,0,"percent of total billed charges ","70% of total billed charges ",373.35,496.02,
"SCR CRTX 4.5 X 70MM ST",6109535,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"GUIDE WIRE 2.0 X 230MM THRD",6109536,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,175,140,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",140,80,,112.00,,,0,"percent of total billed charges ","80% of total billed charges ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",162.75,93,,130.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",148.75,85,,119.00,,,0,"percent of total billed charges ","85% of total billed charges ",148.75,85,,119.00,,,0,"percent of total billed charges ","85% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",152.25,87,,121.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",122.5,162.75,
"PLT STRT VA LCKG 1.5MM 12 H",6109537,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1016.62,813.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",813.3,80,,650.64,,,0,"percent of total billed charges ","80% of total billed charges ",711.63,70,,569.30,,,0,"percent of total billed charges ","70% of total billed charges ",914.96,90,,731.97,,,0,"percent of total billed charges ","90% of total billed charges ",945.46,93,,756.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",864.13,85,,691.30,,,0,"percent of total billed charges ","85% of total billed charges ",864.13,85,,691.30,,,0,"percent of total billed charges ","85% of total billed charges ",914.96,90,,731.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",884.46,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",711.63,70,,569.30,,,0,"percent of total billed charges ","70% of total billed charges ",711.63,945.46,
"PLT T VA LCKG 1.5MM 3H/7H",6109538,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1016.62,813.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",813.3,80,,650.64,,,0,"percent of total billed charges ","80% of total billed charges ",711.63,70,,569.30,,,0,"percent of total billed charges ","70% of total billed charges ",914.96,90,,731.97,,,0,"percent of total billed charges ","90% of total billed charges ",945.46,93,,756.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",864.13,85,,691.30,,,0,"percent of total billed charges ","85% of total billed charges ",864.13,85,,691.30,,,0,"percent of total billed charges ","85% of total billed charges ",914.96,90,,731.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",884.46,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",711.63,70,,569.30,,,0,"percent of total billed charges ","70% of total billed charges ",711.63,945.46,
"PLT Y VA LCKG 1.5MM 3H/7H",6109539,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1016.62,813.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",813.3,80,,650.64,,,0,"percent of total billed charges ","80% of total billed charges ",711.63,70,,569.30,,,0,"percent of total billed charges ","70% of total billed charges ",914.96,90,,731.97,,,0,"percent of total billed charges ","90% of total billed charges ",945.46,93,,756.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",864.13,85,,691.30,,,0,"percent of total billed charges ","85% of total billed charges ",864.13,85,,691.30,,,0,"percent of total billed charges ","85% of total billed charges ",914.96,90,,731.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",884.46,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",711.63,70,,569.30,,,0,"percent of total billed charges ","70% of total billed charges ",711.63,945.46,
"PLT PHALAN VA LCKG 1.5MM 2H/6H",6109540,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,939.26,751.408,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",751.41,80,,601.13,,,0,"percent of total billed charges ","80% of total billed charges ",657.48,70,,525.98,,,0,"percent of total billed charges ","70% of total billed charges ",845.33,90,,676.26,,,0,"percent of total billed charges ","90% of total billed charges ",873.51,93,,698.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",798.37,85,,638.70,,,0,"percent of total billed charges ","85% of total billed charges ",798.37,85,,638.70,,,0,"percent of total billed charges ","85% of total billed charges ",845.33,90,,676.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",817.16,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",657.48,70,,525.98,,,0,"percent of total billed charges ","70% of total billed charges ",657.48,873.51,
"PLT CONDY VA LCKG 1.5MM 2H/6H",6109541,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1066.73,853.384,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",853.38,80,,682.70,,,0,"percent of total billed charges ","80% of total billed charges ",746.71,70,,597.37,,,0,"percent of total billed charges ","70% of total billed charges ",960.06,90,,768.05,,,0,"percent of total billed charges ","90% of total billed charges ",992.06,93,,793.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",906.72,85,,725.38,,,0,"percent of total billed charges ","85% of total billed charges ",906.72,85,,725.38,,,0,"percent of total billed charges ","85% of total billed charges ",960.06,90,,768.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",928.06,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",746.71,70,,597.37,,,0,"percent of total billed charges ","70% of total billed charges ",746.71,992.06,
"PLT PHALAN VA LCKG 1.5MM RT",6109542,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,939.26,751.408,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",751.41,80,,601.13,,,0,"percent of total billed charges ","80% of total billed charges ",657.48,70,,525.98,,,0,"percent of total billed charges ","70% of total billed charges ",845.33,90,,676.26,,,0,"percent of total billed charges ","90% of total billed charges ",873.51,93,,698.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",798.37,85,,638.70,,,0,"percent of total billed charges ","85% of total billed charges ",798.37,85,,638.70,,,0,"percent of total billed charges ","85% of total billed charges ",845.33,90,,676.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",817.16,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",657.48,70,,525.98,,,0,"percent of total billed charges ","70% of total billed charges ",657.48,873.51,
"PLT PHALAN VA LCKG 1.5MM LT",6109543,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,939.26,751.408,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",751.41,80,,601.13,,,0,"percent of total billed charges ","80% of total billed charges ",657.48,70,,525.98,,,0,"percent of total billed charges ","70% of total billed charges ",845.33,90,,676.26,,,0,"percent of total billed charges ","90% of total billed charges ",873.51,93,,698.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",798.37,85,,638.70,,,0,"percent of total billed charges ","85% of total billed charges ",798.37,85,,638.70,,,0,"percent of total billed charges ","85% of total billed charges ",845.33,90,,676.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",817.16,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",657.48,70,,525.98,,,0,"percent of total billed charges ","70% of total billed charges ",657.48,873.51,
"PLT STRUT OBLQ RT 1.5MM 8H",6109544,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1016.62,813.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",813.3,80,,650.64,,,0,"percent of total billed charges ","80% of total billed charges ",711.63,70,,569.30,,,0,"percent of total billed charges ","70% of total billed charges ",914.96,90,,731.97,,,0,"percent of total billed charges ","90% of total billed charges ",945.46,93,,756.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",864.13,85,,691.30,,,0,"percent of total billed charges ","85% of total billed charges ",864.13,85,,691.30,,,0,"percent of total billed charges ","85% of total billed charges ",914.96,90,,731.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",884.46,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",711.63,70,,569.30,,,0,"percent of total billed charges ","70% of total billed charges ",711.63,945.46,
"PLT STRUT OBLQ LT 1.5MM 8H",6109545,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1016.62,813.296,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",813.3,80,,650.64,,,0,"percent of total billed charges ","80% of total billed charges ",711.63,70,,569.30,,,0,"percent of total billed charges ","70% of total billed charges ",914.96,90,,731.97,,,0,"percent of total billed charges ","90% of total billed charges ",945.46,93,,756.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",864.13,85,,691.30,,,0,"percent of total billed charges ","85% of total billed charges ",864.13,85,,691.30,,,0,"percent of total billed charges ","85% of total billed charges ",914.96,90,,731.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",884.46,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",711.63,70,,569.30,,,0,"percent of total billed charges ","70% of total billed charges ",711.63,945.46,
"PLT STRUT VA LCKG 1.5MM 12H",6109546,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,939.26,751.408,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",751.41,80,,601.13,,,0,"percent of total billed charges ","80% of total billed charges ",657.48,70,,525.98,,,0,"percent of total billed charges ","70% of total billed charges ",845.33,90,,676.26,,,0,"percent of total billed charges ","90% of total billed charges ",873.51,93,,698.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",798.37,85,,638.70,,,0,"percent of total billed charges ","85% of total billed charges ",798.37,85,,638.70,,,0,"percent of total billed charges ","85% of total billed charges ",845.33,90,,676.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",817.16,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",657.48,70,,525.98,,,0,"percent of total billed charges ","70% of total billed charges ",657.48,873.51,
"PLT 1ST METACARPAL DORSL 1.5MM",6109547,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,912.04,729.632,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",729.63,80,,583.70,,,0,"percent of total billed charges ","80% of total billed charges ",638.43,70,,510.74,,,0,"percent of total billed charges ","70% of total billed charges ",820.84,90,,656.67,,,0,"percent of total billed charges ","90% of total billed charges ",848.2,93,,678.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",775.23,85,,620.18,,,0,"percent of total billed charges ","85% of total billed charges ",775.23,85,,620.18,,,0,"percent of total billed charges ","85% of total billed charges ",820.84,90,,656.67,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",793.47,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",638.43,70,,510.74,,,0,"percent of total billed charges ","70% of total billed charges ",638.43,848.2,
"PLT METACARPAL NECK 1.5MM",6109548,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1197.9,958.32,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",958.32,80,,766.66,,,0,"percent of total billed charges ","80% of total billed charges ",838.53,70,,670.82,,,0,"percent of total billed charges ","70% of total billed charges ",1078.11,90,,862.49,,,0,"percent of total billed charges ","90% of total billed charges ",1114.05,93,,891.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1018.22,85,,814.58,,,0,"percent of total billed charges ","85% of total billed charges ",1018.22,85,,814.58,,,0,"percent of total billed charges ","85% of total billed charges ",1078.11,90,,862.49,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1042.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",838.53,70,,670.82,,,0,"percent of total billed charges ","70% of total billed charges ",838.53,1114.05,
"PLT STRT VA LCKG 2.0MM 12H",6109549,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,986.91,789.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",789.53,80,,631.62,,,0,"percent of total billed charges ","80% of total billed charges ",690.84,70,,552.67,,,0,"percent of total billed charges ","70% of total billed charges ",888.22,90,,710.58,,,0,"percent of total billed charges ","90% of total billed charges ",917.83,93,,734.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",838.87,85,,671.10,,,0,"percent of total billed charges ","85% of total billed charges ",838.87,85,,671.10,,,0,"percent of total billed charges ","85% of total billed charges ",888.22,90,,710.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",858.61,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",690.84,70,,552.67,,,0,"percent of total billed charges ","70% of total billed charges ",690.84,917.83,
"PLT T VA LCKG 2.0MM 3H/7H",6109550,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,986.91,789.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",789.53,80,,631.62,,,0,"percent of total billed charges ","80% of total billed charges ",690.84,70,,552.67,,,0,"percent of total billed charges ","70% of total billed charges ",888.22,90,,710.58,,,0,"percent of total billed charges ","90% of total billed charges ",917.83,93,,734.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",838.87,85,,671.10,,,0,"percent of total billed charges ","85% of total billed charges ",838.87,85,,671.10,,,0,"percent of total billed charges ","85% of total billed charges ",888.22,90,,710.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",858.61,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",690.84,70,,552.67,,,0,"percent of total billed charges ","70% of total billed charges ",690.84,917.83,
"PLT Y VA LCKG 2.0MM 3H/7H",6109551,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,986.91,789.528,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",789.53,80,,631.62,,,0,"percent of total billed charges ","80% of total billed charges ",690.84,70,,552.67,,,0,"percent of total billed charges ","70% of total billed charges ",888.22,90,,710.58,,,0,"percent of total billed charges ","90% of total billed charges ",917.83,93,,734.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",838.87,85,,671.10,,,0,"percent of total billed charges ","85% of total billed charges ",838.87,85,,671.10,,,0,"percent of total billed charges ","85% of total billed charges ",888.22,90,,710.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",858.61,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",690.84,70,,552.67,,,0,"percent of total billed charges ","70% of total billed charges ",690.84,917.83,
"PLT PHALAN VA LCKG 2.0MM 2H/6H",6109552,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1082.19,865.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",865.75,80,,692.60,,,0,"percent of total billed charges ","80% of total billed charges ",757.53,70,,606.02,,,0,"percent of total billed charges ","70% of total billed charges ",973.97,90,,779.18,,,0,"percent of total billed charges ","90% of total billed charges ",1006.44,93,,805.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",919.86,85,,735.89,,,0,"percent of total billed charges ","85% of total billed charges ",919.86,85,,735.89,,,0,"percent of total billed charges ","85% of total billed charges ",973.97,90,,779.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",941.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",757.53,70,,606.02,,,0,"percent of total billed charges ","70% of total billed charges ",757.53,1006.44,
"PLT CONDY VA LCKG 2.0MM 2H/6H",6109553,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1054.97,843.976,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",843.98,80,,675.18,,,0,"percent of total billed charges ","80% of total billed charges ",738.48,70,,590.78,,,0,"percent of total billed charges ","70% of total billed charges ",949.47,90,,759.58,,,0,"percent of total billed charges ","90% of total billed charges ",981.12,93,,784.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",896.72,85,,717.38,,,0,"percent of total billed charges ","85% of total billed charges ",896.72,85,,717.38,,,0,"percent of total billed charges ","85% of total billed charges ",949.47,90,,759.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",917.82,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",738.48,70,,590.78,,,0,"percent of total billed charges ","70% of total billed charges ",738.48,981.12,
"PLT STRUT VA LCKG 2.0MM 12H",6109554,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1082.19,865.752,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",865.75,80,,692.60,,,0,"percent of total billed charges ","80% of total billed charges ",757.53,70,,606.02,,,0,"percent of total billed charges ","70% of total billed charges ",973.97,90,,779.18,,,0,"percent of total billed charges ","90% of total billed charges ",1006.44,93,,805.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",919.86,85,,735.89,,,0,"percent of total billed charges ","85% of total billed charges ",919.86,85,,735.89,,,0,"percent of total billed charges ","85% of total billed charges ",973.97,90,,779.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",941.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",757.53,70,,606.02,,,0,"percent of total billed charges ","70% of total billed charges ",757.53,1006.44,
"PLT 1ST METACARPAL DORSL 2.0MM",6109555,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1354.44,1083.552,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1083.55,80,,866.84,,,0,"percent of total billed charges ","80% of total billed charges ",948.11,70,,758.49,,,0,"percent of total billed charges ","70% of total billed charges ",1219,90,,975.20,,,0,"percent of total billed charges ","90% of total billed charges ",1259.63,93,,1007.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1151.27,85,,921.02,,,0,"percent of total billed charges ","85% of total billed charges ",1151.27,85,,921.02,,,0,"percent of total billed charges ","85% of total billed charges ",1219,90,,975.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1178.36,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",948.11,70,,758.49,,,0,"percent of total billed charges ","70% of total billed charges ",948.11,1259.63,
"SCR CRTX 1.5 X 4MM ST",6109556,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,200.03,160.024,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",160.02,80,,128.02,,,0,"percent of total billed charges ","80% of total billed charges ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",186.03,93,,148.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",174.03,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",140.02,186.03,
"SCR CRTX 1.5 X 5MM ST",6109557,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,200.03,160.024,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",160.02,80,,128.02,,,0,"percent of total billed charges ","80% of total billed charges ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",186.03,93,,148.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",174.03,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",140.02,186.03,
"SCR CRTX 1.5 X 6MM ST",6109558,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,200.03,160.024,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",160.02,80,,128.02,,,0,"percent of total billed charges ","80% of total billed charges ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",186.03,93,,148.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",174.03,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",140.02,186.03,
"SCR CRTX 1.5 X 7MM ST",6109559,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,200.03,160.024,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",160.02,80,,128.02,,,0,"percent of total billed charges ","80% of total billed charges ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",186.03,93,,148.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",174.03,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",140.02,186.03,
"SCR CRTX 1.5 X 8MM ST",6109560,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,200.03,160.024,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",160.02,80,,128.02,,,0,"percent of total billed charges ","80% of total billed charges ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",186.03,93,,148.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",174.03,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",140.02,186.03,
"SCR CRTX 1.5 X 9MM ST",6109561,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,200.03,160.024,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",160.02,80,,128.02,,,0,"percent of total billed charges ","80% of total billed charges ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",186.03,93,,148.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",174.03,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",140.02,186.03,
"SCR CRTX 1.5 X 10MM ST",6109562,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,200.03,160.024,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",160.02,80,,128.02,,,0,"percent of total billed charges ","80% of total billed charges ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",186.03,93,,148.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",174.03,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",140.02,186.03,
"SCR CRTX 1.5 X 11MM ST",6109563,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,200.03,160.024,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",160.02,80,,128.02,,,0,"percent of total billed charges ","80% of total billed charges ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",186.03,93,,148.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",174.03,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",140.02,186.03,
"SCR CRTX 1.5 X 12MM ST",6109564,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,200.03,160.024,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",160.02,80,,128.02,,,0,"percent of total billed charges ","80% of total billed charges ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",186.03,93,,148.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",174.03,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",140.02,186.03,
"SCR CRTX 1.5 X 13MM ST",6109565,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,200.03,160.024,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",160.02,80,,128.02,,,0,"percent of total billed charges ","80% of total billed charges ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",186.03,93,,148.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",174.03,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",140.02,186.03,
"SCR CRTX 1.5 X 14MM ST",6109566,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,200.03,160.024,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",160.02,80,,128.02,,,0,"percent of total billed charges ","80% of total billed charges ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",186.03,93,,148.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",174.03,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",140.02,186.03,
"SCR CRTX 1.5 X 15MM ST",6109567,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,200.03,160.024,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",160.02,80,,128.02,,,0,"percent of total billed charges ","80% of total billed charges ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",186.03,93,,148.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",174.03,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",140.02,186.03,
"SCR CRTX 1.5 X 16MM ST",6109568,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,200.03,160.024,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",160.02,80,,128.02,,,0,"percent of total billed charges ","80% of total billed charges ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",186.03,93,,148.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",174.03,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",140.02,186.03,
"SCR CRTX 1.5 X 18MM ST",6109569,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,200.03,160.024,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",160.02,80,,128.02,,,0,"percent of total billed charges ","80% of total billed charges ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",186.03,93,,148.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",174.03,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",140.02,186.03,
"SCR CRTX 1.5 X 20MM ST",6109570,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,200.03,160.024,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",160.02,80,,128.02,,,0,"percent of total billed charges ","80% of total billed charges ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",186.03,93,,148.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",174.03,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",140.02,186.03,
"SCR CRTX 1.5 X 22MM ST",6109571,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,200.03,160.024,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",160.02,80,,128.02,,,0,"percent of total billed charges ","80% of total billed charges ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",186.03,93,,148.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",174.03,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",140.02,186.03,
"SCR CRTX 1.5 X 24MM ST",6109572,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,200.03,160.024,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",160.02,80,,128.02,,,0,"percent of total billed charges ","80% of total billed charges ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",186.03,93,,148.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",174.03,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",140.02,186.03,
"SCR VA LCKG 1.5 X 4MM ST",6109573,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,274.76,219.808,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",219.81,80,,175.85,,,0,"percent of total billed charges ","80% of total billed charges ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",255.53,93,,204.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",239.04,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",192.33,255.53,
"SCR VA LCKG 1.5 X 5MM ST",6109574,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,274.76,219.808,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",219.81,80,,175.85,,,0,"percent of total billed charges ","80% of total billed charges ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",255.53,93,,204.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",239.04,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",192.33,255.53,
"SCR VA LCKG 1.5 X 6MM ST",6109575,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,274.76,219.808,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",219.81,80,,175.85,,,0,"percent of total billed charges ","80% of total billed charges ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",255.53,93,,204.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",239.04,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",192.33,255.53,
"SCR VA LCKG 1.5 X 7MM ST",6109576,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,274.76,219.808,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",219.81,80,,175.85,,,0,"percent of total billed charges ","80% of total billed charges ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",255.53,93,,204.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",239.04,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",192.33,255.53,
"SCR VA LCKG 1.5 X 8MM ST",6109577,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,274.76,219.808,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",219.81,80,,175.85,,,0,"percent of total billed charges ","80% of total billed charges ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",255.53,93,,204.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",239.04,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",192.33,255.53,
"SCR VA LCKG 1.5 X 9MM ST",6109578,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,274.76,219.808,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",219.81,80,,175.85,,,0,"percent of total billed charges ","80% of total billed charges ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",255.53,93,,204.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",239.04,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",192.33,255.53,
"SCR VA LCKG 1.5 X 10MM ST",6109579,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,274.76,219.808,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",219.81,80,,175.85,,,0,"percent of total billed charges ","80% of total billed charges ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",255.53,93,,204.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",239.04,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",192.33,255.53,
"SCR VA LCKG 1.5 X 11MM ST",6109580,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,274.76,219.808,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",219.81,80,,175.85,,,0,"percent of total billed charges ","80% of total billed charges ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",255.53,93,,204.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",239.04,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",192.33,255.53,
"SCR VA LCKG 1.5 X 12MM ST",6109581,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,274.76,219.808,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",219.81,80,,175.85,,,0,"percent of total billed charges ","80% of total billed charges ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",255.53,93,,204.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",239.04,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",192.33,255.53,
"SCR VA LCKG 1.5 X 13MM ST",6109582,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,274.76,219.808,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",219.81,80,,175.85,,,0,"percent of total billed charges ","80% of total billed charges ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",255.53,93,,204.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",239.04,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",192.33,255.53,
"SCR VA LCKG 1.5 X 14MM ST",6109583,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,274.76,219.808,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",219.81,80,,175.85,,,0,"percent of total billed charges ","80% of total billed charges ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",255.53,93,,204.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",239.04,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",192.33,255.53,
"SCR VA LCKG 1.5 X 15MM ST",6109584,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,274.76,219.808,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",219.81,80,,175.85,,,0,"percent of total billed charges ","80% of total billed charges ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",255.53,93,,204.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",239.04,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",192.33,255.53,
"SCR VA LCKG 1.5 X 16MM ST",6109585,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,274.76,219.808,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",219.81,80,,175.85,,,0,"percent of total billed charges ","80% of total billed charges ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",255.53,93,,204.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",239.04,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",192.33,255.53,
"SCR VA LCKG 1.5 X 18MM ST",6109586,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,274.76,219.808,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",219.81,80,,175.85,,,0,"percent of total billed charges ","80% of total billed charges ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",255.53,93,,204.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",239.04,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",192.33,255.53,
"SCR VA LCKG 1.5 X 20MM ST",6109587,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,274.76,219.808,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",219.81,80,,175.85,,,0,"percent of total billed charges ","80% of total billed charges ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",255.53,93,,204.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",239.04,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",192.33,255.53,
"SCR VA LCKG 1.5 X 22MM ST",6109588,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,274.76,219.808,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",219.81,80,,175.85,,,0,"percent of total billed charges ","80% of total billed charges ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",255.53,93,,204.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",239.04,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",192.33,255.53,
"SCR VA LCKG 1.5 X 24MM ST",6109589,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,274.76,219.808,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",219.81,80,,175.85,,,0,"percent of total billed charges ","80% of total billed charges ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",255.53,93,,204.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",233.55,85,,186.84,,,0,"percent of total billed charges ","85% of total billed charges ",247.28,90,,197.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",239.04,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.33,70,,153.86,,,0,"percent of total billed charges ","70% of total billed charges ",192.33,255.53,
"SCR CRTX 2.0 X 15MM ST",6109590,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,157.49,125.992,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",125.99,80,,100.79,,,0,"percent of total billed charges ","80% of total billed charges ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",146.47,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",133.87,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.74,90,,113.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.02,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.24,70,,88.19,,,0,"percent of total billed charges ","70% of total billed charges ",110.24,146.47,
"SCR VA LCKG 2.0 X 6MM ST",6109591,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,284.46,227.568,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",227.57,80,,182.06,,,0,"percent of total billed charges ","80% of total billed charges ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",264.55,93,,211.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",247.48,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",199.12,264.55,
"SCR VA LCKG 2.0 X 7MM ST",6109592,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,284.46,227.568,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",227.57,80,,182.06,,,0,"percent of total billed charges ","80% of total billed charges ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",264.55,93,,211.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",247.48,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",199.12,264.55,
"SCR VA LCKG 2.0 X 8MM ST",6109593,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,284.46,227.568,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",227.57,80,,182.06,,,0,"percent of total billed charges ","80% of total billed charges ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",264.55,93,,211.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",247.48,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",199.12,264.55,
"SCR VA LCKG 2.0 X 9MM ST",6109594,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,284.46,227.568,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",227.57,80,,182.06,,,0,"percent of total billed charges ","80% of total billed charges ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",264.55,93,,211.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",247.48,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",199.12,264.55,
"SCR VA LCKG 2.0 X 10MM ST",6109595,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,284.46,227.568,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",227.57,80,,182.06,,,0,"percent of total billed charges ","80% of total billed charges ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",264.55,93,,211.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",247.48,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",199.12,264.55,
"SCR VA LCKG 2.0 X 11MM ST",6109596,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,284.46,227.568,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",227.57,80,,182.06,,,0,"percent of total billed charges ","80% of total billed charges ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",264.55,93,,211.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",247.48,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",199.12,264.55,
"SCR VA LCKG 2.0 X 12MM ST",6109597,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,284.46,227.568,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",227.57,80,,182.06,,,0,"percent of total billed charges ","80% of total billed charges ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",264.55,93,,211.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",247.48,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",199.12,264.55,
"SCR VA LCKG 2.0 X 13MM ST",6109598,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,284.46,227.568,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",227.57,80,,182.06,,,0,"percent of total billed charges ","80% of total billed charges ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",264.55,93,,211.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",247.48,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",199.12,264.55,
"SCR VA LCKG 2.0 X 14MM ST",6109599,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,284.46,227.568,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",227.57,80,,182.06,,,0,"percent of total billed charges ","80% of total billed charges ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",264.55,93,,211.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",247.48,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",199.12,264.55,
"SCR VA LCKG 2.0 X 15MM ST",6109600,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,284.46,227.568,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",227.57,80,,182.06,,,0,"percent of total billed charges ","80% of total billed charges ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",264.55,93,,211.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",247.48,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",199.12,264.55,
"SCR VA LCKG 2.0 X 16MM ST",6109601,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,284.46,227.568,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",227.57,80,,182.06,,,0,"percent of total billed charges ","80% of total billed charges ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",264.55,93,,211.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",247.48,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",199.12,264.55,
"SCR VA LCKG 2.0 X 18MM ST",6109602,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,284.46,227.568,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",227.57,80,,182.06,,,0,"percent of total billed charges ","80% of total billed charges ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",264.55,93,,211.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",247.48,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",199.12,264.55,
"SCR VA LCKG 2.0 X 20MM ST",6109603,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,284.46,227.568,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",227.57,80,,182.06,,,0,"percent of total billed charges ","80% of total billed charges ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",264.55,93,,211.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",247.48,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",199.12,264.55,
"SCR VA LCKG 2.0 X 22MM ST",6109604,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,284.46,227.568,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",227.57,80,,182.06,,,0,"percent of total billed charges ","80% of total billed charges ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",264.55,93,,211.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",247.48,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",199.12,264.55,
"SCR VA LCKG 2.0 X 24MM ST",6109605,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,284.46,227.568,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",227.57,80,,182.06,,,0,"percent of total billed charges ","80% of total billed charges ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",264.55,93,,211.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",241.79,85,,193.43,,,0,"percent of total billed charges ","85% of total billed charges ",256.01,90,,204.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",247.48,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",199.12,70,,159.30,,,0,"percent of total billed charges ","70% of total billed charges ",199.12,264.55,
"ANCHOR SUTURE BIOCOMP 5.5MM",6109619,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,765.02,612.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",612.02,80,,489.62,,,0,"percent of total billed charges ","80% of total billed charges ",535.51,70,,428.41,,,0,"percent of total billed charges ","70% of total billed charges ",688.52,90,,550.82,,,0,"percent of total billed charges ","90% of total billed charges ",711.47,93,,569.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",650.27,85,,520.22,,,0,"percent of total billed charges ","85% of total billed charges ",650.27,85,,520.22,,,0,"percent of total billed charges ","85% of total billed charges ",688.52,90,,550.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",665.57,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",535.51,70,,428.41,,,0,"percent of total billed charges ","70% of total billed charges ",535.51,711.47,
"ANCHOR SUTURE BIOCOMP 4.75MM",6109620,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,765.03,612.024,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",612.02,80,,489.62,,,0,"percent of total billed charges ","80% of total billed charges ",535.52,70,,428.42,,,0,"percent of total billed charges ","70% of total billed charges ",688.53,90,,550.82,,,0,"percent of total billed charges ","90% of total billed charges ",711.48,93,,569.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",650.28,85,,520.22,,,0,"percent of total billed charges ","85% of total billed charges ",650.28,85,,520.22,,,0,"percent of total billed charges ","85% of total billed charges ",688.53,90,,550.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",665.58,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",535.52,70,,428.42,,,0,"percent of total billed charges ","70% of total billed charges ",535.52,711.48,
"SWIVELOCK SP 4.75 X 24.5MM",6109623,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,905.1,724.08,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",724.08,80,,579.26,,,0,"percent of total billed charges ","80% of total billed charges ",633.57,70,,506.86,,,0,"percent of total billed charges ","70% of total billed charges ",814.59,90,,651.67,,,0,"percent of total billed charges ","90% of total billed charges ",841.74,93,,673.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",769.34,85,,615.47,,,0,"percent of total billed charges ","85% of total billed charges ",769.34,85,,615.47,,,0,"percent of total billed charges ","85% of total billed charges ",814.59,90,,651.67,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",787.44,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",633.57,70,,506.86,,,0,"percent of total billed charges ","70% of total billed charges ",633.57,841.74,
"SCR COMP 2.4X10MM PT SHRT",6109624,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,737.01,589.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",589.61,80,,471.69,,,0,"percent of total billed charges ","80% of total billed charges ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",685.42,93,,548.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",641.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",515.91,685.42,
"SCR COMP 2.4 X 12MM PT SHRT",6109626,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,737.01,589.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",589.61,80,,471.69,,,0,"percent of total billed charges ","80% of total billed charges ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",685.42,93,,548.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",641.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",515.91,685.42,
"SCR COMP 2.4 X 20MM PT SHRT",6109634,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,737.01,589.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",589.61,80,,471.69,,,0,"percent of total billed charges ","80% of total billed charges ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",685.42,93,,548.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",641.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",515.91,685.42,
"SCR COMP 2.4 X 24MM PT SHRT",6109636,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,737.01,589.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",589.61,80,,471.69,,,0,"percent of total billed charges ","80% of total billed charges ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",685.42,93,,548.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",641.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",515.91,685.42,
"SCR COMP 2.4 X 24MM PT SHRT",6109638,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,737.01,589.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",589.61,80,,471.69,,,0,"percent of total billed charges ","80% of total billed charges ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",685.42,93,,548.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",641.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",515.91,685.42,
"SCR COMP 2.4X32MM PT SHRT",6109643,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,737.01,589.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",589.61,80,,471.69,,,0,"percent of total billed charges ","80% of total billed charges ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",685.42,93,,548.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",641.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",515.91,685.42,
"SCR COMP 2.4X34MM PT SHRT",6109644,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,737.01,589.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",589.61,80,,471.69,,,0,"percent of total billed charges ","80% of total billed charges ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",685.42,93,,548.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",641.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",515.91,685.42,
"SCR COMP 2.4 X 36MM PT SHRT",6109645,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,737.01,589.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",589.61,80,,471.69,,,0,"percent of total billed charges ","80% of total billed charges ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",685.42,93,,548.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",641.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",515.91,685.42,
"CATH CHOLANGIOGRAM 4.5FR",6109665,"CDM ",270,RC,C1729,HCPCS,OUTPATIENT,,,126.9,101.52,,,,,,,,0,"other ","not separately reimbursment ",,,,93.87,93.87,93.87,"1 through 10","other ","not separately reimbursment ",101.52,80,,81.22,,,0,"percent of total billed charges ","80% of total billed charges ",88.83,70,,71.06,,,0,"percent of total billed charges ","70% of total billed charges ",114.21,90,,91.37,,,0,"percent of total billed charges ","90% of total billed charges ",118.02,93,,94.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",107.87,85,,86.30,,,0,"percent of total billed charges ","85% of total billed charges ",114.21,90,,91.37,,,0,"percent of total billed charges ","90% of total billed charges ",114.21,90,,91.37,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",110.4,87,,88.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.83,70,,71.06,,,0,"percent of total billed charges ","70% of total billed charges ",88.83,118.02,
"PLT PRX TIB SM-B 3.5X117MM RT",6109667,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2812.34,2249.872,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2249.87,80,,1799.90,,,0,"percent of total billed charges ","80% of total billed charges ",1968.64,70,,1574.91,,,0,"percent of total billed charges ","70% of total billed charges ",2531.11,90,,2024.89,,,0,"percent of total billed charges ","90% of total billed charges ",2615.48,93,,2092.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2390.49,85,,1912.39,,,0,"percent of total billed charges ","85% of total billed charges ",2390.49,85,,1912.39,,,0,"percent of total billed charges ","85% of total billed charges ",2531.11,90,,2024.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2446.74,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1968.64,70,,1574.91,,,0,"percent of total billed charges ","70% of total billed charges ",1968.64,2615.48,
"SCR VA LCKG 3.5X80MM ST",6109668,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR COMP 2.4X22MM PT LONG",6109674,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,737.01,589.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",589.61,80,,471.69,,,0,"percent of total billed charges ","80% of total billed charges ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",685.42,93,,548.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",641.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",515.91,685.42,
"SCR COMP 2.4 X 24MM PT LONG",6109676,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,737.01,589.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",589.61,80,,471.69,,,0,"percent of total billed charges ","80% of total billed charges ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",685.42,93,,548.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",641.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",515.91,685.42,
"SCR COMP 2.4X28MM PT LONG",6109680,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,737.01,589.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",589.61,80,,471.69,,,0,"percent of total billed charges ","80% of total billed charges ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",685.42,93,,548.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",641.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",515.91,685.42,
"SCR COMP 3.0 X 20MM PT SHRT",6109698,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,737.01,589.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",589.61,80,,471.69,,,0,"percent of total billed charges ","80% of total billed charges ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",685.42,93,,548.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",641.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",515.91,685.42,
"SCR COMP 3.0 X 22MM PT SHORT",6109700,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,737.01,589.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",589.61,80,,471.69,,,0,"percent of total billed charges ","80% of total billed charges ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",685.42,93,,548.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",641.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",515.91,685.42,
"SCR COMP 3.0 X 30MM PT SHRT",6109708,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,737.01,589.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",589.61,80,,471.69,,,0,"percent of total billed charges ","80% of total billed charges ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",685.42,93,,548.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",641.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",515.91,685.42,
"SCR COMP 3.0 X 32MM PT SHRT",6109709,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,737.01,589.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",589.61,80,,471.69,,,0,"percent of total billed charges ","80% of total billed charges ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",685.42,93,,548.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",641.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",515.91,685.42,
"SCR COMP 3.0 X 22MM PT LONG",6109720,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,737.01,589.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",589.61,80,,471.69,,,0,"percent of total billed charges ","80% of total billed charges ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",685.42,93,,548.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",641.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",515.91,685.42,
"SCR COMP 3.0 X 26MM PT LONG",6109724,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,737.01,589.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",589.61,80,,471.69,,,0,"percent of total billed charges ","80% of total billed charges ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",685.42,93,,548.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",641.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",515.91,685.42,
"SCR COMP 3.0 X 30MM PT LONG",6109728,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,737.01,589.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",589.61,80,,471.69,,,0,"percent of total billed charges ","80% of total billed charges ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",685.42,93,,548.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",641.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",515.91,685.42,
"GUIDE WIRE 1.1 X 150MM THRD",6109734,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,131.66,105.328,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",105.33,80,,84.26,,,0,"percent of total billed charges ","80% of total billed charges ",92.16,70,,73.73,,,0,"percent of total billed charges ","70% of total billed charges ",118.49,90,,94.79,,,0,"percent of total billed charges ","90% of total billed charges ",122.44,93,,97.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",111.91,85,,89.53,,,0,"percent of total billed charges ","85% of total billed charges ",111.91,85,,89.53,,,0,"percent of total billed charges ","85% of total billed charges ",118.49,90,,94.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",114.54,87,,91.63,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.16,70,,73.73,,,0,"percent of total billed charges ","70% of total billed charges ",92.16,122.44,
"GUIDE WIRE 1.1 X 150MM NT",6109735,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,124.99,99.992,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",99.99,80,,79.99,,,0,"percent of total billed charges ","80% of total billed charges ",87.49,70,,69.99,,,0,"percent of total billed charges ","70% of total billed charges ",112.49,90,,89.99,,,0,"percent of total billed charges ","90% of total billed charges ",116.24,93,,92.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",106.24,85,,84.99,,,0,"percent of total billed charges ","85% of total billed charges ",106.24,85,,84.99,,,0,"percent of total billed charges ","85% of total billed charges ",112.49,90,,89.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",108.74,87,,86.99,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.49,70,,69.99,,,0,"percent of total billed charges ","70% of total billed charges ",87.49,116.24,
"PLT PRX TIBIA 3.5X87MM SMB RT",6109736,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2781.03,2224.824,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2224.82,80,,1779.86,,,0,"percent of total billed charges ","80% of total billed charges ",1946.72,70,,1557.38,,,0,"percent of total billed charges ","70% of total billed charges ",2502.93,90,,2002.34,,,0,"percent of total billed charges ","90% of total billed charges ",2586.36,93,,2069.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2363.88,85,,1891.10,,,0,"percent of total billed charges ","85% of total billed charges ",2363.88,85,,1891.10,,,0,"percent of total billed charges ","85% of total billed charges ",2502.93,90,,2002.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2419.5,87,,1935.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1946.72,70,,1557.38,,,0,"percent of total billed charges ","70% of total billed charges ",1946.72,2586.36,
"PLT PRX TIB 3.5 X 87MM SM B LT",6109737,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2871.03,2296.824,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2296.82,80,,1837.46,,,0,"percent of total billed charges ","80% of total billed charges ",2009.72,70,,1607.78,,,0,"percent of total billed charges ","70% of total billed charges ",2583.93,90,,2067.14,,,0,"percent of total billed charges ","90% of total billed charges ",2670.06,93,,2136.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2440.38,85,,1952.30,,,0,"percent of total billed charges ","85% of total billed charges ",2440.38,85,,1952.30,,,0,"percent of total billed charges ","85% of total billed charges ",2583.93,90,,2067.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2497.8,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2009.72,70,,1607.78,,,0,"percent of total billed charges ","70% of total billed charges ",2009.72,2670.06,
"PLT PRX TIB 3.5 X145MM SM-LT",6109740,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3198.94,2559.152,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2559.15,80,,2047.32,,,0,"percent of total billed charges ","80% of total billed charges ",2239.26,70,,1791.41,,,0,"percent of total billed charges ","70% of total billed charges ",2879.05,90,,2303.24,,,0,"percent of total billed charges ","90% of total billed charges ",2975.01,93,,2380.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2719.1,85,,2175.28,,,0,"percent of total billed charges ","85% of total billed charges ",2719.1,85,,2175.28,,,0,"percent of total billed charges ","85% of total billed charges ",2879.05,90,,2303.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2783.08,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2239.26,70,,1791.41,,,0,"percent of total billed charges ","70% of total billed charges ",2239.26,2975.01,
"PLT PRX TIB 3.5 X177MM SM-RT",6109741,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3235.69,2588.552,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2588.55,80,,2070.84,,,0,"percent of total billed charges ","80% of total billed charges ",2264.98,70,,1811.98,,,0,"percent of total billed charges ","70% of total billed charges ",2912.12,90,,2329.70,,,0,"percent of total billed charges ","90% of total billed charges ",3009.19,93,,2407.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2750.34,85,,2200.27,,,0,"percent of total billed charges ","85% of total billed charges ",2750.34,85,,2200.27,,,0,"percent of total billed charges ","85% of total billed charges ",2912.12,90,,2329.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2815.05,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2264.98,70,,1811.98,,,0,"percent of total billed charges ","70% of total billed charges ",2264.98,3009.19,
"PLT PRX TIB 3.5 X177MM SM-LT",6109742,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3235.69,2588.552,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2588.55,80,,2070.84,,,0,"percent of total billed charges ","80% of total billed charges ",2264.98,70,,1811.98,,,0,"percent of total billed charges ","70% of total billed charges ",2912.12,90,,2329.70,,,0,"percent of total billed charges ","90% of total billed charges ",3009.19,93,,2407.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2750.34,85,,2200.27,,,0,"percent of total billed charges ","85% of total billed charges ",2750.34,85,,2200.27,,,0,"percent of total billed charges ","85% of total billed charges ",2912.12,90,,2329.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2815.05,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2264.98,70,,1811.98,,,0,"percent of total billed charges ","70% of total billed charges ",2264.98,3009.19,
"SCR VA LCKG 3.5 X 10MM ST",6109743,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 12MM ST",6109744,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 14MM ST",6109745,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 16MM ST",6109746,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 18MM ST",6109747,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 20MM ST",6109748,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 22MM ST",6109749,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 24MM ST",6109750,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 26MM ST",6109751,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 28MM ST",6109752,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 30MM ST",6109753,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 32MM ST",6109754,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 34MM ST",6109755,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 36MM ST",6109756,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 40MM ST",6109757,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 42MM ST",6109758,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 44MM ST",6109759,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 46MM ST",6109760,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 48MM ST",6109761,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 50MM ST",6109762,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 52MM ST",6109763,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 54MM ST",6109764,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 56MM ST",6109765,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 58MM ST",6109766,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 60MM ST",6109767,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 65MM ST",6109768,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 85MM ST",6109769,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 90MM ST",6109770,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 3.5 X 95MM ST",6109771,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,324.87,259.896,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",259.9,80,,207.92,,,0,"percent of total billed charges ","80% of total billed charges ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",302.13,93,,241.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",276.14,85,,220.91,,,0,"percent of total billed charges ","85% of total billed charges ",292.38,90,,233.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",282.64,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.41,70,,181.93,,,0,"percent of total billed charges ","70% of total billed charges ",227.41,302.13,
"SCR VA LCKG 2.7 X 12MM ST",6109772,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,307.09,245.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",245.67,80,,196.54,,,0,"percent of total billed charges ","80% of total billed charges ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",285.59,93,,228.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",214.96,285.59,
"SCR VA LCKG 2.7 X 14MM ST",6109773,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,307.09,245.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",245.67,80,,196.54,,,0,"percent of total billed charges ","80% of total billed charges ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",285.59,93,,228.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",214.96,285.59,
"SCR VA LCKG 2.7 X 16MM ST",6109774,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,307.09,245.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",245.67,80,,196.54,,,0,"percent of total billed charges ","80% of total billed charges ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",285.59,93,,228.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",214.96,285.59,
"SCR VA LCKG 2.7 X 18MM ST",6109775,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,307.09,245.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",245.67,80,,196.54,,,0,"percent of total billed charges ","80% of total billed charges ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",285.59,93,,228.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",214.96,285.59,
"SCR VA LCKG 2.7 X 20MM ST",6109776,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,307.09,245.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",245.67,80,,196.54,,,0,"percent of total billed charges ","80% of total billed charges ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",285.59,93,,228.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",214.96,285.59,
"SCR VA LCKG 2.7 X 22MM ST",6109777,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,307.09,245.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",245.67,80,,196.54,,,0,"percent of total billed charges ","80% of total billed charges ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",285.59,93,,228.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",214.96,285.59,
"SCR VA LCKG 2.7 X 24MM ST",6109778,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,307.09,245.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",245.67,80,,196.54,,,0,"percent of total billed charges ","80% of total billed charges ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",285.59,93,,228.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",214.96,285.59,
"SCR VA LCKG 2.7 X 26MM ST",6109779,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,307.09,245.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",245.67,80,,196.54,,,0,"percent of total billed charges ","80% of total billed charges ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",285.59,93,,228.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",214.96,285.59,
"SCR VA LCKG 2.7 X 28MM ST",6109780,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,307.09,245.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",245.67,80,,196.54,,,0,"percent of total billed charges ","80% of total billed charges ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",285.59,93,,228.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",214.96,285.59,
"SCR VA LCKG 2.7 X 30MM ST",6109781,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,307.09,245.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",245.67,80,,196.54,,,0,"percent of total billed charges ","80% of total billed charges ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",285.59,93,,228.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",214.96,285.59,
"SCR VA LCKG 2.7 X 32MM ST",6109782,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,307.09,245.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",245.67,80,,196.54,,,0,"percent of total billed charges ","80% of total billed charges ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",285.59,93,,228.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",214.96,285.59,
"SCR VA LCKG 2.7 X 34MM ST",6109783,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,307.09,245.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",245.67,80,,196.54,,,0,"percent of total billed charges ","80% of total billed charges ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",285.59,93,,228.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",214.96,285.59,
"SCR VA LCKG 2.7 X 36MM ST",6109784,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,307.09,245.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",245.67,80,,196.54,,,0,"percent of total billed charges ","80% of total billed charges ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",285.59,93,,228.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",214.96,285.59,
"SCR VA LCKG 2.7 X 38MM ST",6109785,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,307.09,245.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",245.67,80,,196.54,,,0,"percent of total billed charges ","80% of total billed charges ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",285.59,93,,228.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",214.96,285.59,
"SCR VA LCKG 2.7 X 40MM ST",6109786,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,307.09,245.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",245.67,80,,196.54,,,0,"percent of total billed charges ","80% of total billed charges ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",285.59,93,,228.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",214.96,285.59,
"SCR VA LCKG 2.7 X 42MM ST",6109787,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,307.09,245.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",245.67,80,,196.54,,,0,"percent of total billed charges ","80% of total billed charges ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",285.59,93,,228.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",214.96,285.59,
"SCR VA LCKG 2.7 X 44MM ST",6109788,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,307.09,245.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",245.67,80,,196.54,,,0,"percent of total billed charges ","80% of total billed charges ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",285.59,93,,228.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",214.96,285.59,
"SCR VA LCKG 2.7 X 46MM ST",6109789,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,307.09,245.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",245.67,80,,196.54,,,0,"percent of total billed charges ","80% of total billed charges ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",285.59,93,,228.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",214.96,285.59,
"SCR VA LCKG 2.7 X 48MM ST",6109790,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,307.09,245.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",245.67,80,,196.54,,,0,"percent of total billed charges ","80% of total billed charges ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",285.59,93,,228.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",214.96,285.59,
"SCR VA LCKG 2.7 X 50MM ST",6109791,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,307.09,245.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",245.67,80,,196.54,,,0,"percent of total billed charges ","80% of total billed charges ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",285.59,93,,228.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",214.96,285.59,
"SCR VA LCKG 2.7 X 52MM ST",6109792,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,307.09,245.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",245.67,80,,196.54,,,0,"percent of total billed charges ","80% of total billed charges ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",285.59,93,,228.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",214.96,285.59,
"SCR VA LCKG 2.7 X 54MM ST",6109793,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,307.09,245.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",245.67,80,,196.54,,,0,"percent of total billed charges ","80% of total billed charges ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",285.59,93,,228.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",214.96,285.59,
"SCR VA LCKG 2.7 X 56MM ST",6109794,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,307.09,245.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",245.67,80,,196.54,,,0,"percent of total billed charges ","80% of total billed charges ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",285.59,93,,228.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",214.96,285.59,
"SCR VA LCKG 2.7 X 58MM ST",6109795,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,307.09,245.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",245.67,80,,196.54,,,0,"percent of total billed charges ","80% of total billed charges ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",285.59,93,,228.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",214.96,285.59,
"SCR VA LCKG 2.7 X 60MM ST",6109796,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,307.09,245.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",245.67,80,,196.54,,,0,"percent of total billed charges ","80% of total billed charges ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",285.59,93,,228.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",214.96,285.59,
"SCR VA LCKG 2.7 X 10MM ST",6109797,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,307.09,245.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",245.67,80,,196.54,,,0,"percent of total billed charges ","80% of total billed charges ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",285.59,93,,228.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",261.03,85,,208.82,,,0,"percent of total billed charges ","85% of total billed charges ",276.38,90,,221.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.17,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.96,70,,171.97,,,0,"percent of total billed charges ","70% of total billed charges ",214.96,285.59,
"SCR CRTX LP 3.5 X 10MM ST",6109798,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",128.02,80,,102.42,,,0,"percent of total billed charges ","80% of total billed charges ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"SCR CRTX LP 3.5 X 12MM ST",6109799,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",128.02,80,,102.42,,,0,"percent of total billed charges ","80% of total billed charges ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"SCR CRTX LP 3.5 X 14MM ST",6109800,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",128.02,80,,102.42,,,0,"percent of total billed charges ","80% of total billed charges ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"SCR CRTX LP 3.5 X 16MM ST",6109801,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",128.02,80,,102.42,,,0,"percent of total billed charges ","80% of total billed charges ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"SCR CRTX LP 3.5 X 18MM ST",6109802,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",128.02,80,,102.42,,,0,"percent of total billed charges ","80% of total billed charges ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"SCR CRTX LP 3.5 X 20MM ST",6109803,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",128.02,80,,102.42,,,0,"percent of total billed charges ","80% of total billed charges ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"SCR CRTX LP 3.5 X 22MM ST",6109804,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",128.02,80,,102.42,,,0,"percent of total billed charges ","80% of total billed charges ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"SCR CRTX LP 3.5 X 24MM ST",6109805,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",128.02,80,,102.42,,,0,"percent of total billed charges ","80% of total billed charges ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"SCR CRTX LP 3.5 X 26MM ST",6109806,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",128.02,80,,102.42,,,0,"percent of total billed charges ","80% of total billed charges ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"SCR CRTX LP 3.5 X 28MM ST",6109807,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",128.02,80,,102.42,,,0,"percent of total billed charges ","80% of total billed charges ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"SCR CRTX LP 3.5 X 30MM ST",6109808,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",128.02,80,,102.42,,,0,"percent of total billed charges ","80% of total billed charges ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"SCR CRTX LP 3.5 X 32MM ST",6109809,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",128.02,80,,102.42,,,0,"percent of total billed charges ","80% of total billed charges ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"SCR CRTX LP 3.5 X 34MM ST",6109810,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",128.02,80,,102.42,,,0,"percent of total billed charges ","80% of total billed charges ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"SCR CRTX LP 3.5 X 36MM ST",6109811,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",128.02,80,,102.42,,,0,"percent of total billed charges ","80% of total billed charges ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"SCR CRTX LP 3.5 X 38MM ST",6109812,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",128.02,80,,102.42,,,0,"percent of total billed charges ","80% of total billed charges ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"SCR CRTX LP 3.5 X 40MM ST",6109813,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",128.02,80,,102.42,,,0,"percent of total billed charges ","80% of total billed charges ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"SCR CRTX LP 3.5 X 42MM ST",6109814,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",128.02,80,,102.42,,,0,"percent of total billed charges ","80% of total billed charges ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"SCR CRTX LP 3.5 X 44MM ST",6109815,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",128.02,80,,102.42,,,0,"percent of total billed charges ","80% of total billed charges ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"SCR CRTX LP 3.5 X 46MM ST",6109816,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",128.02,80,,102.42,,,0,"percent of total billed charges ","80% of total billed charges ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"SCR CRTX LP 3.5 X 48MM ST",6109817,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",128.02,80,,102.42,,,0,"percent of total billed charges ","80% of total billed charges ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"SCR CRTX LP 3.5 X 50MM ST",6109818,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",128.02,80,,102.42,,,0,"percent of total billed charges ","80% of total billed charges ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"SCR CRTX LP 3.5 X 52MM ST",6109819,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",128.02,80,,102.42,,,0,"percent of total billed charges ","80% of total billed charges ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"SCR CRTX LP 3.5 X 54MM ST",6109820,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",128.02,80,,102.42,,,0,"percent of total billed charges ","80% of total billed charges ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"SCR CRTX LP 3.5 X 56MM ST",6109821,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",128.02,80,,102.42,,,0,"percent of total billed charges ","80% of total billed charges ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"SCR CRTX LP 3.5 X 58MM ST",6109822,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",128.02,80,,102.42,,,0,"percent of total billed charges ","80% of total billed charges ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"SCR CRTX LP 3.5 X 60MM ST",6109823,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",128.02,80,,102.42,,,0,"percent of total billed charges ","80% of total billed charges ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"SCR CRTX 4.0 X 14MM ST",6109824,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,116.68,93.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",93.34,80,,74.67,,,0,"percent of total billed charges ","80% of total billed charges ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",108.51,93,,86.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",81.68,108.51,
"SCR CRTX 4.0 X 16MM ST",6109825,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,116.68,93.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",93.34,80,,74.67,,,0,"percent of total billed charges ","80% of total billed charges ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",108.51,93,,86.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",81.68,108.51,
"SCR CRTX 4.0 X 18MM ST",6109826,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,116.68,93.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",93.34,80,,74.67,,,0,"percent of total billed charges ","80% of total billed charges ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",108.51,93,,86.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",81.68,108.51,
"SCR CRTX 4.0 X 20MM ST",6109827,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,116.68,93.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",93.34,80,,74.67,,,0,"percent of total billed charges ","80% of total billed charges ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",108.51,93,,86.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",81.68,108.51,
"SCR CRTX 4.0 X 22MM ST",6109828,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,116.68,93.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",93.34,80,,74.67,,,0,"percent of total billed charges ","80% of total billed charges ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",108.51,93,,86.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",81.68,108.51,
"SCR CRTX 4.0 X 24MM ST",6109829,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,116.68,93.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",93.34,80,,74.67,,,0,"percent of total billed charges ","80% of total billed charges ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",108.51,93,,86.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",81.68,108.51,
"SCR CRTX 4.0 X 26MM ST",6109830,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,116.68,93.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",93.34,80,,74.67,,,0,"percent of total billed charges ","80% of total billed charges ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",108.51,93,,86.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",81.68,108.51,
"SCR CRTX 4.0 X 28MM ST",6109831,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,116.68,93.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",93.34,80,,74.67,,,0,"percent of total billed charges ","80% of total billed charges ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",108.51,93,,86.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",81.68,108.51,
"SCR CRTX 4.0 X 30MM ST",6109832,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,116.68,93.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",93.34,80,,74.67,,,0,"percent of total billed charges ","80% of total billed charges ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",108.51,93,,86.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",81.68,108.51,
"SCR CRTX 4.0 X 32MM ST",6109833,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,116.68,93.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",93.34,80,,74.67,,,0,"percent of total billed charges ","80% of total billed charges ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",108.51,93,,86.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",81.68,108.51,
"SCR CRTX 4.0 X 34MM ST",6109834,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,116.68,93.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",93.34,80,,74.67,,,0,"percent of total billed charges ","80% of total billed charges ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",108.51,93,,86.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",81.68,108.51,
"SCR CRTX 4.0 X 36MM ST",6109835,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,116.68,93.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",93.34,80,,74.67,,,0,"percent of total billed charges ","80% of total billed charges ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",108.51,93,,86.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",81.68,108.51,
"SCR CRTX 4.0 X 38MM ST",6109836,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,116.68,93.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",93.34,80,,74.67,,,0,"percent of total billed charges ","80% of total billed charges ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",108.51,93,,86.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",81.68,108.51,
"SCR CRTX 4.0 X 40MM ST",6109837,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,116.68,93.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",93.34,80,,74.67,,,0,"percent of total billed charges ","80% of total billed charges ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",108.51,93,,86.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",81.68,108.51,
"SCR CRTX 4.0 X 42MM ST",6109838,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,116.68,93.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",93.34,80,,74.67,,,0,"percent of total billed charges ","80% of total billed charges ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",108.51,93,,86.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",81.68,108.51,
"SCR CRTX 4.0 X 44MM ST",6109839,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,116.68,93.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",93.34,80,,74.67,,,0,"percent of total billed charges ","80% of total billed charges ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",108.51,93,,86.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",81.68,108.51,
"SCR CRTX 4.0 X 46MM ST",6109840,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,116.68,93.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",93.34,80,,74.67,,,0,"percent of total billed charges ","80% of total billed charges ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",108.51,93,,86.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",81.68,108.51,
"SCR CRTX 4.0 X 48MM ST",6109841,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,116.68,93.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",93.34,80,,74.67,,,0,"percent of total billed charges ","80% of total billed charges ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",108.51,93,,86.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",81.68,108.51,
"SCR CRTX 4.0 X 50MM ST",6109842,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,116.68,93.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",93.34,80,,74.67,,,0,"percent of total billed charges ","80% of total billed charges ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",108.51,93,,86.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",81.68,108.51,
"SCR CRTX 4.0 X 52MM ST",6109843,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,116.68,93.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",93.34,80,,74.67,,,0,"percent of total billed charges ","80% of total billed charges ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",108.51,93,,86.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",81.68,108.51,
"SCR CRTX 4.0 X 54MM ST",6109844,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,116.68,93.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",93.34,80,,74.67,,,0,"percent of total billed charges ","80% of total billed charges ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",108.51,93,,86.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",81.68,108.51,
"SCR CRTX 4.0 X 56MM ST",6109845,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,116.68,93.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",93.34,80,,74.67,,,0,"percent of total billed charges ","80% of total billed charges ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",108.51,93,,86.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",81.68,108.51,
"SCR CRTX 4.0 X 58MM ST",6109846,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,116.68,93.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",93.34,80,,74.67,,,0,"percent of total billed charges ","80% of total billed charges ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",108.51,93,,86.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",81.68,108.51,
"SCR CRTX 4.0 X 60MM ST",6109847,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,116.68,93.344,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",93.34,80,,74.67,,,0,"percent of total billed charges ","80% of total billed charges ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",108.51,93,,86.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.51,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",81.68,108.51,
"SCR METAPHYSEAL 2.7 X 10MM ST",6109848,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"SCR METAPHYSEAL 2.7 X 12MM ST",6109849,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"SCR METAPHYSEAL 2.7 X 14MM ST",6109850,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"SCR METAPHYSEAL 2.7 X 16MM ST",6109851,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"SCR METAPHYSEAL 2.7 X 18MM ST",6109852,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"SCR METAPHYSEAL 2.7 X 20MM ST",6109853,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"SCR METAPHYSEAL 2.7 X 22MM ST",6109854,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"SCR METAPHYSEAL 2.7 X 24MM ST",6109855,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"SCR METAPHYSEAL 2.7 X 26MM ST",6109856,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"SCR METAPHYSEAL 2.7 X 28MM ST",6109857,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"SCR METAPHYSEAL 2.7 X 30MM ST",6109858,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"SCR METAPHYSEAL 2.7 X 32MM ST",6109859,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"SCR METAPHYSEAL 2.7 X 34MM ST",6109860,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"SCR METAPHYSEAL 2.7 X 36MM ST",6109861,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"SCR METAPHYSEAL 2.7 X 38MM ST",6109862,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"SCR METAPHYSEAL 2.7 X 40MM ST",6109863,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"SCR METAPHYSEAL 2.7 X 42MM ST",6109864,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"SCR METAPHYSEAL 2.7 X 44MM ST",6109865,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"SCR METAPHYSEAL 2.7 X 46MM ST",6109866,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"SCR METAPHYSEAL 2.7 X 48MM ST",6109867,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"SCR METAPHYSEAL 2.7 X 50MM ST",6109868,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"SCR METAPHYSEAL 2.7 X 54MM ST",6109870,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"SCR METAPHYSEAL 2.7 X 56MM ST",6109871,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"SCR METAPHYSEAL 2.7 X 58MM ST",6109872,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"SCR METAPHYSEAL 2.7 X 60MM ST",6109873,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,203.36,162.688,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",162.69,80,,130.15,,,0,"percent of total billed charges ","80% of total billed charges ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",189.12,93,,151.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",172.86,85,,138.29,,,0,"percent of total billed charges ","85% of total billed charges ",183.02,90,,146.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.92,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.35,70,,113.88,,,0,"percent of total billed charges ","70% of total billed charges ",142.35,189.12,
"WIRE COMP 2.8 X200MM 10MM THRD",6109874,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,223.78,179.024,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",179.02,80,,143.22,,,0,"percent of total billed charges ","80% of total billed charges ",156.65,70,,125.32,,,0,"percent of total billed charges ","70% of total billed charges ",201.4,90,,161.12,,,0,"percent of total billed charges ","90% of total billed charges ",208.12,93,,166.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",190.21,85,,152.17,,,0,"percent of total billed charges ","85% of total billed charges ",190.21,85,,152.17,,,0,"percent of total billed charges ","85% of total billed charges ",201.4,90,,161.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",194.69,87,,155.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.65,70,,125.32,,,0,"percent of total billed charges ","70% of total billed charges ",156.65,208.12,
"WIRE COMP 2.8 X200MM 15MM THRD",6109875,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,223.78,179.024,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",179.02,80,,143.22,,,0,"percent of total billed charges ","80% of total billed charges ",156.65,70,,125.32,,,0,"percent of total billed charges ","70% of total billed charges ",201.4,90,,161.12,,,0,"percent of total billed charges ","90% of total billed charges ",208.12,93,,166.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",190.21,85,,152.17,,,0,"percent of total billed charges ","85% of total billed charges ",190.21,85,,152.17,,,0,"percent of total billed charges ","85% of total billed charges ",201.4,90,,161.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",194.69,87,,155.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.65,70,,125.32,,,0,"percent of total billed charges ","70% of total billed charges ",156.65,208.12,
"WIRE COMP 2.8 X200MM 20MM THRD",6109876,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,223.78,179.024,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",179.02,80,,143.22,,,0,"percent of total billed charges ","80% of total billed charges ",156.65,70,,125.32,,,0,"percent of total billed charges ","70% of total billed charges ",201.4,90,,161.12,,,0,"percent of total billed charges ","90% of total billed charges ",208.12,93,,166.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",190.21,85,,152.17,,,0,"percent of total billed charges ","85% of total billed charges ",190.21,85,,152.17,,,0,"percent of total billed charges ","85% of total billed charges ",201.4,90,,161.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",194.69,87,,155.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.65,70,,125.32,,,0,"percent of total billed charges ","70% of total billed charges ",156.65,208.12,
"WIRE COMP 2.8 X200MM 25MM THR",6109877,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,223.78,179.024,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",179.02,80,,143.22,,,0,"percent of total billed charges ","80% of total billed charges ",156.65,70,,125.32,,,0,"percent of total billed charges ","70% of total billed charges ",201.4,90,,161.12,,,0,"percent of total billed charges ","90% of total billed charges ",208.12,93,,166.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",190.21,85,,152.17,,,0,"percent of total billed charges ","85% of total billed charges ",190.21,85,,152.17,,,0,"percent of total billed charges ","85% of total billed charges ",201.4,90,,161.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",194.69,87,,155.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.65,70,,125.32,,,0,"percent of total billed charges ","70% of total billed charges ",156.65,208.12,
"WIRE COMP 2.8 X200MM 30MM THRD",6109878,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,223.78,179.024,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",179.02,80,,143.22,,,0,"percent of total billed charges ","80% of total billed charges ",156.65,70,,125.32,,,0,"percent of total billed charges ","70% of total billed charges ",201.4,90,,161.12,,,0,"percent of total billed charges ","90% of total billed charges ",208.12,93,,166.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",190.21,85,,152.17,,,0,"percent of total billed charges ","85% of total billed charges ",190.21,85,,152.17,,,0,"percent of total billed charges ","85% of total billed charges ",201.4,90,,161.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",194.69,87,,155.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.65,70,,125.32,,,0,"percent of total billed charges ","70% of total billed charges ",156.65,208.12,
"WIRE COMP 2.8 X200MM 35MM THRD",6109879,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,223.78,179.024,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",179.02,80,,143.22,,,0,"percent of total billed charges ","80% of total billed charges ",156.65,70,,125.32,,,0,"percent of total billed charges ","70% of total billed charges ",201.4,90,,161.12,,,0,"percent of total billed charges ","90% of total billed charges ",208.12,93,,166.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",190.21,85,,152.17,,,0,"percent of total billed charges ","85% of total billed charges ",190.21,85,,152.17,,,0,"percent of total billed charges ","85% of total billed charges ",201.4,90,,161.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",194.69,87,,155.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.65,70,,125.32,,,0,"percent of total billed charges ","70% of total billed charges ",156.65,208.12,
"WIRE COMP 2.8 X200MM 40MM THRD",6109880,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,223.78,179.024,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",179.02,80,,143.22,,,0,"percent of total billed charges ","80% of total billed charges ",156.65,70,,125.32,,,0,"percent of total billed charges ","70% of total billed charges ",201.4,90,,161.12,,,0,"percent of total billed charges ","90% of total billed charges ",208.12,93,,166.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",190.21,85,,152.17,,,0,"percent of total billed charges ","85% of total billed charges ",190.21,85,,152.17,,,0,"percent of total billed charges ","85% of total billed charges ",201.4,90,,161.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",194.69,87,,155.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.65,70,,125.32,,,0,"percent of total billed charges ","70% of total billed charges ",156.65,208.12,
"WIRE COMP 2.8 X200MM 45MM THRD",6109881,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,223.78,179.024,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",179.02,80,,143.22,,,0,"percent of total billed charges ","80% of total billed charges ",156.65,70,,125.32,,,0,"percent of total billed charges ","70% of total billed charges ",201.4,90,,161.12,,,0,"percent of total billed charges ","90% of total billed charges ",208.12,93,,166.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",190.21,85,,152.17,,,0,"percent of total billed charges ","85% of total billed charges ",190.21,85,,152.17,,,0,"percent of total billed charges ","85% of total billed charges ",201.4,90,,161.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",194.69,87,,155.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.65,70,,125.32,,,0,"percent of total billed charges ","70% of total billed charges ",156.65,208.12,
"WIRE COMP 2.8 X200MM 50MM THRD",6109882,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,223.78,179.024,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",179.02,80,,143.22,,,0,"percent of total billed charges ","80% of total billed charges ",156.65,70,,125.32,,,0,"percent of total billed charges ","70% of total billed charges ",201.4,90,,161.12,,,0,"percent of total billed charges ","90% of total billed charges ",208.12,93,,166.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",190.21,85,,152.17,,,0,"percent of total billed charges ","85% of total billed charges ",190.21,85,,152.17,,,0,"percent of total billed charges ","85% of total billed charges ",201.4,90,,161.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",194.69,87,,155.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.65,70,,125.32,,,0,"percent of total billed charges ","70% of total billed charges ",156.65,208.12,
"WIRE COMP 2.8 X200MM 55MM THRD",6109883,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,223.78,179.024,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",179.02,80,,143.22,,,0,"percent of total billed charges ","80% of total billed charges ",156.65,70,,125.32,,,0,"percent of total billed charges ","70% of total billed charges ",201.4,90,,161.12,,,0,"percent of total billed charges ","90% of total billed charges ",208.12,93,,166.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",190.21,85,,152.17,,,0,"percent of total billed charges ","85% of total billed charges ",190.21,85,,152.17,,,0,"percent of total billed charges ","85% of total billed charges ",201.4,90,,161.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",194.69,87,,155.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.65,70,,125.32,,,0,"percent of total billed charges ","70% of total billed charges ",156.65,208.12,
"WIRE COMP 2.8 X200MM 60MM THRD",6109884,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,223.78,179.024,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",179.02,80,,143.22,,,0,"percent of total billed charges ","80% of total billed charges ",156.65,70,,125.32,,,0,"percent of total billed charges ","70% of total billed charges ",201.4,90,,161.12,,,0,"percent of total billed charges ","90% of total billed charges ",208.12,93,,166.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",190.21,85,,152.17,,,0,"percent of total billed charges ","85% of total billed charges ",190.21,85,,152.17,,,0,"percent of total billed charges ","85% of total billed charges ",201.4,90,,161.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",194.69,87,,155.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.65,70,,125.32,,,0,"percent of total billed charges ","70% of total billed charges ",156.65,208.12,
"PLT MED DIST TIB 4H RT",6109885,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2678.94,2143.152,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2143.15,80,,1714.52,,,0,"percent of total billed charges ","80% of total billed charges ",1875.26,70,,1500.21,,,0,"percent of total billed charges ","70% of total billed charges ",2411.05,90,,1928.84,,,0,"percent of total billed charges ","90% of total billed charges ",2491.41,93,,1993.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2277.1,85,,1821.68,,,0,"percent of total billed charges ","85% of total billed charges ",2277.1,85,,1821.68,,,0,"percent of total billed charges ","85% of total billed charges ",2411.05,90,,1928.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2330.68,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1875.26,70,,1500.21,,,0,"percent of total billed charges ","70% of total billed charges ",1875.26,2491.41,
"PLT MED DIST TIB 4H LT",6109886,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2678.94,2143.152,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2143.15,80,,1714.52,,,0,"percent of total billed charges ","80% of total billed charges ",1875.26,70,,1500.21,,,0,"percent of total billed charges ","70% of total billed charges ",2411.05,90,,1928.84,,,0,"percent of total billed charges ","90% of total billed charges ",2491.41,93,,1993.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2277.1,85,,1821.68,,,0,"percent of total billed charges ","85% of total billed charges ",2277.1,85,,1821.68,,,0,"percent of total billed charges ","85% of total billed charges ",2411.05,90,,1928.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2330.68,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1875.26,70,,1500.21,,,0,"percent of total billed charges ","70% of total billed charges ",1875.26,2491.41,
"PLT MED DIST TIB 6H LT",6109888,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2708.89,2167.112,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2167.11,80,,1733.69,,,0,"percent of total billed charges ","80% of total billed charges ",1896.22,70,,1516.98,,,0,"percent of total billed charges ","70% of total billed charges ",2438,90,,1950.40,,,0,"percent of total billed charges ","90% of total billed charges ",2519.27,93,,2015.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2302.56,85,,1842.05,,,0,"percent of total billed charges ","85% of total billed charges ",2302.56,85,,1842.05,,,0,"percent of total billed charges ","85% of total billed charges ",2438,90,,1950.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2356.73,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1896.22,70,,1516.98,,,0,"percent of total billed charges ","70% of total billed charges ",1896.22,2519.27,
"PLT MED DIST TIB 8H RT",6109889,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2736.11,2188.888,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2188.89,80,,1751.11,,,0,"percent of total billed charges ","80% of total billed charges ",1915.28,70,,1532.22,,,0,"percent of total billed charges ","70% of total billed charges ",2462.5,90,,1970.00,,,0,"percent of total billed charges ","90% of total billed charges ",2544.58,93,,2035.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2325.69,85,,1860.55,,,0,"percent of total billed charges ","85% of total billed charges ",2325.69,85,,1860.55,,,0,"percent of total billed charges ","85% of total billed charges ",2462.5,90,,1970.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2380.42,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1915.28,70,,1532.22,,,0,"percent of total billed charges ","70% of total billed charges ",1915.28,2544.58,
"PLT MED DIST TIB 8H LT",6109890,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2736.11,2188.888,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2188.89,80,,1751.11,,,0,"percent of total billed charges ","80% of total billed charges ",1915.28,70,,1532.22,,,0,"percent of total billed charges ","70% of total billed charges ",2462.5,90,,1970.00,,,0,"percent of total billed charges ","90% of total billed charges ",2544.58,93,,2035.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2325.69,85,,1860.55,,,0,"percent of total billed charges ","85% of total billed charges ",2325.69,85,,1860.55,,,0,"percent of total billed charges ","85% of total billed charges ",2462.5,90,,1970.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2380.42,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1915.28,70,,1532.22,,,0,"percent of total billed charges ","70% of total billed charges ",1915.28,2544.58,
"PLT MED DIST TIB 10H RT",6109891,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2764.7,2211.76,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2211.76,80,,1769.41,,,0,"percent of total billed charges ","80% of total billed charges ",1935.29,70,,1548.23,,,0,"percent of total billed charges ","70% of total billed charges ",2488.23,90,,1990.58,,,0,"percent of total billed charges ","90% of total billed charges ",2571.17,93,,2056.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2350,85,,1880.00,,,0,"percent of total billed charges ","85% of total billed charges ",2350,85,,1880.00,,,0,"percent of total billed charges ","85% of total billed charges ",2488.23,90,,1990.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2405.29,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1935.29,70,,1548.23,,,0,"percent of total billed charges ","70% of total billed charges ",1935.29,2571.17,
"PLT MED DIST TIB 10H LT",6109892,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2764.7,2211.76,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2211.76,80,,1769.41,,,0,"percent of total billed charges ","80% of total billed charges ",1935.29,70,,1548.23,,,0,"percent of total billed charges ","70% of total billed charges ",2488.23,90,,1990.58,,,0,"percent of total billed charges ","90% of total billed charges ",2571.17,93,,2056.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2350,85,,1880.00,,,0,"percent of total billed charges ","85% of total billed charges ",2350,85,,1880.00,,,0,"percent of total billed charges ","85% of total billed charges ",2488.23,90,,1990.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2405.29,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1935.29,70,,1548.23,,,0,"percent of total billed charges ","70% of total billed charges ",1935.29,2571.17,
"PLT MED DIST TIB 12H RT",6109893,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3226.16,2580.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2580.93,80,,2064.74,,,0,"percent of total billed charges ","80% of total billed charges ",2258.31,70,,1806.65,,,0,"percent of total billed charges ","70% of total billed charges ",2903.54,90,,2322.83,,,0,"percent of total billed charges ","90% of total billed charges ",3000.33,93,,2400.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2742.24,85,,2193.79,,,0,"percent of total billed charges ","85% of total billed charges ",2742.24,85,,2193.79,,,0,"percent of total billed charges ","85% of total billed charges ",2903.54,90,,2322.83,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2806.76,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2258.31,70,,1806.65,,,0,"percent of total billed charges ","70% of total billed charges ",2258.31,3000.33,
"PLT MED DIST TIB 12H LT",6109894,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3226.16,2580.928,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2580.93,80,,2064.74,,,0,"percent of total billed charges ","80% of total billed charges ",2258.31,70,,1806.65,,,0,"percent of total billed charges ","70% of total billed charges ",2903.54,90,,2322.83,,,0,"percent of total billed charges ","90% of total billed charges ",3000.33,93,,2400.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2742.24,85,,2193.79,,,0,"percent of total billed charges ","85% of total billed charges ",2742.24,85,,2193.79,,,0,"percent of total billed charges ","85% of total billed charges ",2903.54,90,,2322.83,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2806.76,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2258.31,70,,1806.65,,,0,"percent of total billed charges ","70% of total billed charges ",2258.31,3000.33,
"PLT MED DIST TIB 14H RT",6109895,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3597.78,2878.224,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2878.22,80,,2302.58,,,0,"percent of total billed charges ","80% of total billed charges ",2518.45,70,,2014.76,,,0,"percent of total billed charges ","70% of total billed charges ",3238,90,,2590.40,,,0,"percent of total billed charges ","90% of total billed charges ",3345.94,93,,2676.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3058.11,85,,2446.49,,,0,"percent of total billed charges ","85% of total billed charges ",3058.11,85,,2446.49,,,0,"percent of total billed charges ","85% of total billed charges ",3238,90,,2590.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3130.07,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2518.45,70,,2014.76,,,0,"percent of total billed charges ","70% of total billed charges ",2518.45,3345.94,
"PLT MED DIST TIB 14H LT",6109896,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3597.78,2878.224,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2878.22,80,,2302.58,,,0,"percent of total billed charges ","80% of total billed charges ",2518.45,70,,2014.76,,,0,"percent of total billed charges ","70% of total billed charges ",3238,90,,2590.40,,,0,"percent of total billed charges ","90% of total billed charges ",3345.94,93,,2676.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3058.11,85,,2446.49,,,0,"percent of total billed charges ","85% of total billed charges ",3058.11,85,,2446.49,,,0,"percent of total billed charges ","85% of total billed charges ",3238,90,,2590.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3130.07,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2518.45,70,,2014.76,,,0,"percent of total billed charges ","70% of total billed charges ",2518.45,3345.94,
"PLT ANEROLAT DIST TIB 4H RT",6109897,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2850.46,2280.368,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2280.37,80,,1824.30,,,0,"percent of total billed charges ","80% of total billed charges ",1995.32,70,,1596.26,,,0,"percent of total billed charges ","70% of total billed charges ",2565.41,90,,2052.33,,,0,"percent of total billed charges ","90% of total billed charges ",2650.93,93,,2120.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2422.89,85,,1938.31,,,0,"percent of total billed charges ","85% of total billed charges ",2422.89,85,,1938.31,,,0,"percent of total billed charges ","85% of total billed charges ",2565.41,90,,2052.33,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2479.9,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1995.32,70,,1596.26,,,0,"percent of total billed charges ","70% of total billed charges ",1995.32,2650.93,
"PLT ANEROLAT DIST TIB 4H LT",6109898,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2850.46,2280.368,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2280.37,80,,1824.30,,,0,"percent of total billed charges ","80% of total billed charges ",1995.32,70,,1596.26,,,0,"percent of total billed charges ","70% of total billed charges ",2565.41,90,,2052.33,,,0,"percent of total billed charges ","90% of total billed charges ",2650.93,93,,2120.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2422.89,85,,1938.31,,,0,"percent of total billed charges ","85% of total billed charges ",2422.89,85,,1938.31,,,0,"percent of total billed charges ","85% of total billed charges ",2565.41,90,,2052.33,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2479.9,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1995.32,70,,1596.26,,,0,"percent of total billed charges ","70% of total billed charges ",1995.32,2650.93,
"PLT ANEROLAT DIST TIB 6H RT",6109899,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2883.13,2306.504,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2306.5,80,,1845.20,,,0,"percent of total billed charges ","80% of total billed charges ",2018.19,70,,1614.55,,,0,"percent of total billed charges ","70% of total billed charges ",2594.82,90,,2075.86,,,0,"percent of total billed charges ","90% of total billed charges ",2681.31,93,,2145.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2450.66,85,,1960.53,,,0,"percent of total billed charges ","85% of total billed charges ",2450.66,85,,1960.53,,,0,"percent of total billed charges ","85% of total billed charges ",2594.82,90,,2075.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2508.32,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2018.19,70,,1614.55,,,0,"percent of total billed charges ","70% of total billed charges ",2018.19,2681.31,
"PLT ANEROLAT DIST TIB 6H LT",6109900,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2883.13,2306.504,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2306.5,80,,1845.20,,,0,"percent of total billed charges ","80% of total billed charges ",2018.19,70,,1614.55,,,0,"percent of total billed charges ","70% of total billed charges ",2594.82,90,,2075.86,,,0,"percent of total billed charges ","90% of total billed charges ",2681.31,93,,2145.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2450.66,85,,1960.53,,,0,"percent of total billed charges ","85% of total billed charges ",2450.66,85,,1960.53,,,0,"percent of total billed charges ","85% of total billed charges ",2594.82,90,,2075.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2508.32,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2018.19,70,,1614.55,,,0,"percent of total billed charges ","70% of total billed charges ",2018.19,2681.31,
"PLT ANEROLAT DIST TIB 8H RT",6109901,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2913.08,2330.464,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2330.46,80,,1864.37,,,0,"percent of total billed charges ","80% of total billed charges ",2039.16,70,,1631.33,,,0,"percent of total billed charges ","70% of total billed charges ",2621.77,90,,2097.42,,,0,"percent of total billed charges ","90% of total billed charges ",2709.16,93,,2167.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2476.12,85,,1980.90,,,0,"percent of total billed charges ","85% of total billed charges ",2476.12,85,,1980.90,,,0,"percent of total billed charges ","85% of total billed charges ",2621.77,90,,2097.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2534.38,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2039.16,70,,1631.33,,,0,"percent of total billed charges ","70% of total billed charges ",2039.16,2709.16,
"PLT ANEROLAT DIST TIB 8H LT",6109902,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2913.08,2330.464,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2330.46,80,,1864.37,,,0,"percent of total billed charges ","80% of total billed charges ",2039.16,70,,1631.33,,,0,"percent of total billed charges ","70% of total billed charges ",2621.77,90,,2097.42,,,0,"percent of total billed charges ","90% of total billed charges ",2709.16,93,,2167.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2476.12,85,,1980.90,,,0,"percent of total billed charges ","85% of total billed charges ",2476.12,85,,1980.90,,,0,"percent of total billed charges ","85% of total billed charges ",2621.77,90,,2097.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2534.38,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2039.16,70,,1631.33,,,0,"percent of total billed charges ","70% of total billed charges ",2039.16,2709.16,
"PLT ANEROLAT DIST TIB 10H RT",6109903,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2941.66,2353.328,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2353.33,80,,1882.66,,,0,"percent of total billed charges ","80% of total billed charges ",2059.16,70,,1647.33,,,0,"percent of total billed charges ","70% of total billed charges ",2647.49,90,,2117.99,,,0,"percent of total billed charges ","90% of total billed charges ",2735.74,93,,2188.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2500.41,85,,2000.33,,,0,"percent of total billed charges ","85% of total billed charges ",2500.41,85,,2000.33,,,0,"percent of total billed charges ","85% of total billed charges ",2647.49,90,,2117.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2559.24,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2059.16,70,,1647.33,,,0,"percent of total billed charges ","70% of total billed charges ",2059.16,2735.74,
"PLT ANEROLAT DIST TIB 10H LT",6109904,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2941.66,2353.328,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2353.33,80,,1882.66,,,0,"percent of total billed charges ","80% of total billed charges ",2059.16,70,,1647.33,,,0,"percent of total billed charges ","70% of total billed charges ",2647.49,90,,2117.99,,,0,"percent of total billed charges ","90% of total billed charges ",2735.74,93,,2188.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2500.41,85,,2000.33,,,0,"percent of total billed charges ","85% of total billed charges ",2500.41,85,,2000.33,,,0,"percent of total billed charges ","85% of total billed charges ",2647.49,90,,2117.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2559.24,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2059.16,70,,1647.33,,,0,"percent of total billed charges ","70% of total billed charges ",2059.16,2735.74,
"PLT ANEROLAT DIST TIB 12H RT",6109905,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3337.79,2670.232,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2670.23,80,,2136.18,,,0,"percent of total billed charges ","80% of total billed charges ",2336.45,70,,1869.16,,,0,"percent of total billed charges ","70% of total billed charges ",3004.01,90,,2403.21,,,0,"percent of total billed charges ","90% of total billed charges ",3104.14,93,,2483.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2837.12,85,,2269.70,,,0,"percent of total billed charges ","85% of total billed charges ",2837.12,85,,2269.70,,,0,"percent of total billed charges ","85% of total billed charges ",3004.01,90,,2403.21,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2903.88,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2336.45,70,,1869.16,,,0,"percent of total billed charges ","70% of total billed charges ",2336.45,3104.14,
"PLT ANEROLAT DIST TIB 12H LT",6109906,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3337.79,2670.232,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2670.23,80,,2136.18,,,0,"percent of total billed charges ","80% of total billed charges ",2336.45,70,,1869.16,,,0,"percent of total billed charges ","70% of total billed charges ",3004.01,90,,2403.21,,,0,"percent of total billed charges ","90% of total billed charges ",3104.14,93,,2483.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2837.12,85,,2269.70,,,0,"percent of total billed charges ","85% of total billed charges ",2837.12,85,,2269.70,,,0,"percent of total billed charges ","85% of total billed charges ",3004.01,90,,2403.21,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2903.88,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2336.45,70,,1869.16,,,0,"percent of total billed charges ","70% of total billed charges ",2336.45,3104.14,
"PLT ANEROLAT DIST TIB 14H RT",6109907,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3724.38,2979.504,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2979.5,80,,2383.60,,,0,"percent of total billed charges ","80% of total billed charges ",2607.07,70,,2085.66,,,0,"percent of total billed charges ","70% of total billed charges ",3351.94,90,,2681.55,,,0,"percent of total billed charges ","90% of total billed charges ",3463.67,93,,2770.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3165.72,85,,2532.58,,,0,"percent of total billed charges ","85% of total billed charges ",3165.72,85,,2532.58,,,0,"percent of total billed charges ","85% of total billed charges ",3351.94,90,,2681.55,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3240.21,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2607.07,70,,2085.66,,,0,"percent of total billed charges ","70% of total billed charges ",2607.07,3463.67,
"PLT ANEROLAT DIST TIB 14H LT",6109908,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3724.38,2979.504,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2979.5,80,,2383.60,,,0,"percent of total billed charges ","80% of total billed charges ",2607.07,70,,2085.66,,,0,"percent of total billed charges ","70% of total billed charges ",3351.94,90,,2681.55,,,0,"percent of total billed charges ","90% of total billed charges ",3463.67,93,,2770.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3165.72,85,,2532.58,,,0,"percent of total billed charges ","85% of total billed charges ",3165.72,85,,2532.58,,,0,"percent of total billed charges ","85% of total billed charges ",3351.94,90,,2681.55,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3240.21,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2607.07,70,,2085.66,,,0,"percent of total billed charges ","70% of total billed charges ",2607.07,3463.67,
"PLT L DIST TIB 4H RT",6109909,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1547.74,1238.192,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1238.19,80,,990.55,,,0,"percent of total billed charges ","80% of total billed charges ",1083.42,70,,866.74,,,0,"percent of total billed charges ","70% of total billed charges ",1392.97,90,,1114.38,,,0,"percent of total billed charges ","90% of total billed charges ",1439.4,93,,1151.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1315.58,85,,1052.46,,,0,"percent of total billed charges ","85% of total billed charges ",1315.58,85,,1052.46,,,0,"percent of total billed charges ","85% of total billed charges ",1392.97,90,,1114.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1346.53,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1083.42,70,,866.74,,,0,"percent of total billed charges ","70% of total billed charges ",1083.42,1439.4,
"PLT L DIST TIB 4H LT",6109910,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1547.74,1238.192,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1238.19,80,,990.55,,,0,"percent of total billed charges ","80% of total billed charges ",1083.42,70,,866.74,,,0,"percent of total billed charges ","70% of total billed charges ",1392.97,90,,1114.38,,,0,"percent of total billed charges ","90% of total billed charges ",1439.4,93,,1151.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1315.58,85,,1052.46,,,0,"percent of total billed charges ","85% of total billed charges ",1315.58,85,,1052.46,,,0,"percent of total billed charges ","85% of total billed charges ",1392.97,90,,1114.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1346.53,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1083.42,70,,866.74,,,0,"percent of total billed charges ","70% of total billed charges ",1083.42,1439.4,
"PLT L DIST TIB 6H RT",6109911,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1610.36,1288.288,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1288.29,80,,1030.63,,,0,"percent of total billed charges ","80% of total billed charges ",1127.25,70,,901.80,,,0,"percent of total billed charges ","70% of total billed charges ",1449.32,90,,1159.46,,,0,"percent of total billed charges ","90% of total billed charges ",1497.63,93,,1198.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1368.81,85,,1095.05,,,0,"percent of total billed charges ","85% of total billed charges ",1368.81,85,,1095.05,,,0,"percent of total billed charges ","85% of total billed charges ",1449.32,90,,1159.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1401.01,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1127.25,70,,901.80,,,0,"percent of total billed charges ","70% of total billed charges ",1127.25,1497.63,
"PLT T DIST TIB 4H",6109913,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1547.74,1238.192,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1238.19,80,,990.55,,,0,"percent of total billed charges ","80% of total billed charges ",1083.42,70,,866.74,,,0,"percent of total billed charges ","70% of total billed charges ",1392.97,90,,1114.38,,,0,"percent of total billed charges ","90% of total billed charges ",1439.4,93,,1151.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1315.58,85,,1052.46,,,0,"percent of total billed charges ","85% of total billed charges ",1315.58,85,,1052.46,,,0,"percent of total billed charges ","85% of total billed charges ",1392.97,90,,1114.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1346.53,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1083.42,70,,866.74,,,0,"percent of total billed charges ","70% of total billed charges ",1083.42,1439.4,
"PLT T DIST TIB 6H",6109914,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1610.36,1288.288,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1288.29,80,,1030.63,,,0,"percent of total billed charges ","80% of total billed charges ",1127.25,70,,901.80,,,0,"percent of total billed charges ","70% of total billed charges ",1449.32,90,,1159.46,,,0,"percent of total billed charges ","90% of total billed charges ",1497.63,93,,1198.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1368.81,85,,1095.05,,,0,"percent of total billed charges ","85% of total billed charges ",1368.81,85,,1095.05,,,0,"percent of total billed charges ","85% of total billed charges ",1449.32,90,,1159.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1401.01,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1127.25,70,,901.80,,,0,"percent of total billed charges ","70% of total billed charges ",1127.25,1497.63,
"PLT LAT DIST FIB 3H RT",6109915,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1463.34,1170.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1170.67,80,,936.54,,,0,"percent of total billed charges ","80% of total billed charges ",1024.34,70,,819.47,,,0,"percent of total billed charges ","70% of total billed charges ",1317.01,90,,1053.61,,,0,"percent of total billed charges ","90% of total billed charges ",1360.91,93,,1088.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1243.84,85,,995.07,,,0,"percent of total billed charges ","85% of total billed charges ",1243.84,85,,995.07,,,0,"percent of total billed charges ","85% of total billed charges ",1317.01,90,,1053.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1273.11,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1024.34,70,,819.47,,,0,"percent of total billed charges ","70% of total billed charges ",1024.34,1360.91,
"PLT LAT DIST FIB 3H LT",6109916,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1463.34,1170.672,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1170.67,80,,936.54,,,0,"percent of total billed charges ","80% of total billed charges ",1024.34,70,,819.47,,,0,"percent of total billed charges ","70% of total billed charges ",1317.01,90,,1053.61,,,0,"percent of total billed charges ","90% of total billed charges ",1360.91,93,,1088.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1243.84,85,,995.07,,,0,"percent of total billed charges ","85% of total billed charges ",1243.84,85,,995.07,,,0,"percent of total billed charges ","85% of total billed charges ",1317.01,90,,1053.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1273.11,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1024.34,70,,819.47,,,0,"percent of total billed charges ","70% of total billed charges ",1024.34,1360.91,
"PLT LAT DIST FIB 4H RT",6109917,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1530.05,1224.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1224.04,80,,979.23,,,0,"percent of total billed charges ","80% of total billed charges ",1071.04,70,,856.83,,,0,"percent of total billed charges ","70% of total billed charges ",1377.05,90,,1101.64,,,0,"percent of total billed charges ","90% of total billed charges ",1422.95,93,,1138.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1300.54,85,,1040.43,,,0,"percent of total billed charges ","85% of total billed charges ",1300.54,85,,1040.43,,,0,"percent of total billed charges ","85% of total billed charges ",1377.05,90,,1101.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1331.14,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1071.04,70,,856.83,,,0,"percent of total billed charges ","70% of total billed charges ",1071.04,1422.95,
"PLT LAT DIST FIB 4H LT",6109918,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1530.05,1224.04,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1224.04,80,,979.23,,,0,"percent of total billed charges ","80% of total billed charges ",1071.04,70,,856.83,,,0,"percent of total billed charges ","70% of total billed charges ",1377.05,90,,1101.64,,,0,"percent of total billed charges ","90% of total billed charges ",1422.95,93,,1138.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1300.54,85,,1040.43,,,0,"percent of total billed charges ","85% of total billed charges ",1300.54,85,,1040.43,,,0,"percent of total billed charges ","85% of total billed charges ",1377.05,90,,1101.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1331.14,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1071.04,70,,856.83,,,0,"percent of total billed charges ","70% of total billed charges ",1071.04,1422.95,
"PLT LAT DIST FIB 5H RT",6109919,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1606.28,1285.024,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1285.02,80,,1028.02,,,0,"percent of total billed charges ","80% of total billed charges ",1124.4,70,,899.52,,,0,"percent of total billed charges ","70% of total billed charges ",1445.65,90,,1156.52,,,0,"percent of total billed charges ","90% of total billed charges ",1493.84,93,,1195.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1365.34,85,,1092.27,,,0,"percent of total billed charges ","85% of total billed charges ",1365.34,85,,1092.27,,,0,"percent of total billed charges ","85% of total billed charges ",1445.65,90,,1156.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1397.46,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1124.4,70,,899.52,,,0,"percent of total billed charges ","70% of total billed charges ",1124.4,1493.84,
"PLT LAT DIST FIB 5H LT",6109920,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1606.28,1285.024,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1285.02,80,,1028.02,,,0,"percent of total billed charges ","80% of total billed charges ",1124.4,70,,899.52,,,0,"percent of total billed charges ","70% of total billed charges ",1445.65,90,,1156.52,,,0,"percent of total billed charges ","90% of total billed charges ",1493.84,93,,1195.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1365.34,85,,1092.27,,,0,"percent of total billed charges ","85% of total billed charges ",1365.34,85,,1092.27,,,0,"percent of total billed charges ","85% of total billed charges ",1445.65,90,,1156.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1397.46,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1124.4,70,,899.52,,,0,"percent of total billed charges ","70% of total billed charges ",1124.4,1493.84,
"PLT LAT DIST FIB 6H RT",6109921,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1687.95,1350.36,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1350.36,80,,1080.29,,,0,"percent of total billed charges ","80% of total billed charges ",1181.57,70,,945.26,,,0,"percent of total billed charges ","70% of total billed charges ",1519.16,90,,1215.33,,,0,"percent of total billed charges ","90% of total billed charges ",1569.79,93,,1255.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1434.76,85,,1147.81,,,0,"percent of total billed charges ","85% of total billed charges ",1434.76,85,,1147.81,,,0,"percent of total billed charges ","85% of total billed charges ",1519.16,90,,1215.33,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1468.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1181.57,70,,945.26,,,0,"percent of total billed charges ","70% of total billed charges ",1181.57,1569.79,
"PLT LAT DIST FIB 6H LT",6109922,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1687.95,1350.36,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1350.36,80,,1080.29,,,0,"percent of total billed charges ","80% of total billed charges ",1181.57,70,,945.26,,,0,"percent of total billed charges ","70% of total billed charges ",1519.16,90,,1215.33,,,0,"percent of total billed charges ","90% of total billed charges ",1569.79,93,,1255.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1434.76,85,,1147.81,,,0,"percent of total billed charges ","85% of total billed charges ",1434.76,85,,1147.81,,,0,"percent of total billed charges ","85% of total billed charges ",1519.16,90,,1215.33,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1468.52,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1181.57,70,,945.26,,,0,"percent of total billed charges ","70% of total billed charges ",1181.57,1569.79,
"PLT LAT DIST FIB 7H RT",6109923,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1768.26,1414.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1414.61,80,,1131.69,,,0,"percent of total billed charges ","80% of total billed charges ",1237.78,70,,990.22,,,0,"percent of total billed charges ","70% of total billed charges ",1591.43,90,,1273.14,,,0,"percent of total billed charges ","90% of total billed charges ",1644.48,93,,1315.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1503.02,85,,1202.42,,,0,"percent of total billed charges ","85% of total billed charges ",1503.02,85,,1202.42,,,0,"percent of total billed charges ","85% of total billed charges ",1591.43,90,,1273.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1538.39,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1237.78,70,,990.22,,,0,"percent of total billed charges ","70% of total billed charges ",1237.78,1644.48,
"PLT LAT DIST FIB 7H LT",6109924,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1768.26,1414.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1414.61,80,,1131.69,,,0,"percent of total billed charges ","80% of total billed charges ",1237.78,70,,990.22,,,0,"percent of total billed charges ","70% of total billed charges ",1591.43,90,,1273.14,,,0,"percent of total billed charges ","90% of total billed charges ",1644.48,93,,1315.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1503.02,85,,1202.42,,,0,"percent of total billed charges ","85% of total billed charges ",1503.02,85,,1202.42,,,0,"percent of total billed charges ","85% of total billed charges ",1591.43,90,,1273.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1538.39,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1237.78,70,,990.22,,,0,"percent of total billed charges ","70% of total billed charges ",1237.78,1644.48,
"PLT LAT DIST FIB 9H RT",6109925,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1849.94,1479.952,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1479.95,80,,1183.96,,,0,"percent of total billed charges ","80% of total billed charges ",1294.96,70,,1035.97,,,0,"percent of total billed charges ","70% of total billed charges ",1664.95,90,,1331.96,,,0,"percent of total billed charges ","90% of total billed charges ",1720.44,93,,1376.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1572.45,85,,1257.96,,,0,"percent of total billed charges ","85% of total billed charges ",1572.45,85,,1257.96,,,0,"percent of total billed charges ","85% of total billed charges ",1664.95,90,,1331.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1609.45,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1294.96,70,,1035.97,,,0,"percent of total billed charges ","70% of total billed charges ",1294.96,1720.44,
"PLT LAT DIST FIB 9H LT",6109926,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1849.94,1479.952,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1479.95,80,,1183.96,,,0,"percent of total billed charges ","80% of total billed charges ",1294.96,70,,1035.97,,,0,"percent of total billed charges ","70% of total billed charges ",1664.95,90,,1331.96,,,0,"percent of total billed charges ","90% of total billed charges ",1720.44,93,,1376.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1572.45,85,,1257.96,,,0,"percent of total billed charges ","85% of total billed charges ",1572.45,85,,1257.96,,,0,"percent of total billed charges ","85% of total billed charges ",1664.95,90,,1331.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1609.45,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1294.96,70,,1035.97,,,0,"percent of total billed charges ","70% of total billed charges ",1294.96,1720.44,
"PLT LAT DIST FIB 11H RT",6109927,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1938.42,1550.736,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1550.74,80,,1240.59,,,0,"percent of total billed charges ","80% of total billed charges ",1356.89,70,,1085.51,,,0,"percent of total billed charges ","70% of total billed charges ",1744.58,90,,1395.66,,,0,"percent of total billed charges ","90% of total billed charges ",1802.73,93,,1442.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1647.66,85,,1318.13,,,0,"percent of total billed charges ","85% of total billed charges ",1647.66,85,,1318.13,,,0,"percent of total billed charges ","85% of total billed charges ",1744.58,90,,1395.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1686.43,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1356.89,70,,1085.51,,,0,"percent of total billed charges ","70% of total billed charges ",1356.89,1802.73,
"PLT LAT DIST FIB 11H LT",6109928,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1938.42,1550.736,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1550.74,80,,1240.59,,,0,"percent of total billed charges ","80% of total billed charges ",1356.89,70,,1085.51,,,0,"percent of total billed charges ","70% of total billed charges ",1744.58,90,,1395.66,,,0,"percent of total billed charges ","90% of total billed charges ",1802.73,93,,1442.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1647.66,85,,1318.13,,,0,"percent of total billed charges ","85% of total billed charges ",1647.66,85,,1318.13,,,0,"percent of total billed charges ","85% of total billed charges ",1744.58,90,,1395.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1686.43,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1356.89,70,,1085.51,,,0,"percent of total billed charges ","70% of total billed charges ",1356.89,1802.73,
"PLT LAT DIST FIB 13H RT",6109929,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2085.44,1668.352,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1668.35,80,,1334.68,,,0,"percent of total billed charges ","80% of total billed charges ",1459.81,70,,1167.85,,,0,"percent of total billed charges ","70% of total billed charges ",1876.9,90,,1501.52,,,0,"percent of total billed charges ","90% of total billed charges ",1939.46,93,,1551.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1772.62,85,,1418.10,,,0,"percent of total billed charges ","85% of total billed charges ",1772.62,85,,1418.10,,,0,"percent of total billed charges ","85% of total billed charges ",1876.9,90,,1501.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1814.33,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1459.81,70,,1167.85,,,0,"percent of total billed charges ","70% of total billed charges ",1459.81,1939.46,
"PLT LAT DIST FIB 13H LT",6109930,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,2085.44,1668.352,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1668.35,80,,1334.68,,,0,"percent of total billed charges ","80% of total billed charges ",1459.81,70,,1167.85,,,0,"percent of total billed charges ","70% of total billed charges ",1876.9,90,,1501.52,,,0,"percent of total billed charges ","90% of total billed charges ",1939.46,93,,1551.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1772.62,85,,1418.10,,,0,"percent of total billed charges ","85% of total billed charges ",1772.62,85,,1418.10,,,0,"percent of total billed charges ","85% of total billed charges ",1876.9,90,,1501.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1814.33,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1459.81,70,,1167.85,,,0,"percent of total billed charges ","70% of total billed charges ",1459.81,1939.46,
"NAIL PRX HUM 8 X 160MM R",6109931,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3422.18,2737.744,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2737.74,80,,2190.19,,,0,"percent of total billed charges ","80% of total billed charges ",2395.53,70,,1916.42,,,0,"percent of total billed charges ","70% of total billed charges ",3079.96,90,,2463.97,,,0,"percent of total billed charges ","90% of total billed charges ",3182.63,93,,2546.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2908.85,85,,2327.08,,,0,"percent of total billed charges ","85% of total billed charges ",2908.85,85,,2327.08,,,0,"percent of total billed charges ","85% of total billed charges ",3079.96,90,,2463.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2977.3,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2395.53,70,,1916.42,,,0,"percent of total billed charges ","70% of total billed charges ",2395.53,3182.63,
"NAIL PRX HUM 8 X 160MM L",6109932,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3422.18,2737.744,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2737.74,80,,2190.19,,,0,"percent of total billed charges ","80% of total billed charges ",2395.53,70,,1916.42,,,0,"percent of total billed charges ","70% of total billed charges ",3079.96,90,,2463.97,,,0,"percent of total billed charges ","90% of total billed charges ",3182.63,93,,2546.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2908.85,85,,2327.08,,,0,"percent of total billed charges ","85% of total billed charges ",2908.85,85,,2327.08,,,0,"percent of total billed charges ","85% of total billed charges ",3079.96,90,,2463.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2977.3,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2395.53,70,,1916.42,,,0,"percent of total billed charges ","70% of total billed charges ",2395.53,3182.63,
"NAIL PRX HUM 9.5 X 160MM R",6109933,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3422.18,2737.744,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2737.74,80,,2190.19,,,0,"percent of total billed charges ","80% of total billed charges ",2395.53,70,,1916.42,,,0,"percent of total billed charges ","70% of total billed charges ",3079.96,90,,2463.97,,,0,"percent of total billed charges ","90% of total billed charges ",3182.63,93,,2546.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2908.85,85,,2327.08,,,0,"percent of total billed charges ","85% of total billed charges ",2908.85,85,,2327.08,,,0,"percent of total billed charges ","85% of total billed charges ",3079.96,90,,2463.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2977.3,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2395.53,70,,1916.42,,,0,"percent of total billed charges ","70% of total billed charges ",2395.53,3182.63,
"NAIL PRX HUM 9.5 X 160MM L",6109934,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,3422.18,2737.744,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",2737.74,80,,2190.19,,,0,"percent of total billed charges ","80% of total billed charges ",2395.53,70,,1916.42,,,0,"percent of total billed charges ","70% of total billed charges ",3079.96,90,,2463.97,,,0,"percent of total billed charges ","90% of total billed charges ",3182.63,93,,2546.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2908.85,85,,2327.08,,,0,"percent of total billed charges ","85% of total billed charges ",2908.85,85,,2327.08,,,0,"percent of total billed charges ","85% of total billed charges ",3079.96,90,,2463.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2977.3,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2395.53,70,,1916.42,,,0,"percent of total billed charges ","70% of total billed charges ",2395.53,3182.63,
"NAIL ELASTIC 1.5 X 300MM",6109937,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,552.76,442.208,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",442.21,80,,353.77,,,0,"percent of total billed charges ","80% of total billed charges ",386.93,70,,309.54,,,0,"percent of total billed charges ","70% of total billed charges ",497.48,90,,397.98,,,0,"percent of total billed charges ","90% of total billed charges ",514.07,93,,411.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",469.85,85,,375.88,,,0,"percent of total billed charges ","85% of total billed charges ",469.85,85,,375.88,,,0,"percent of total billed charges ","85% of total billed charges ",497.48,90,,397.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",480.9,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",386.93,70,,309.54,,,0,"percent of total billed charges ","70% of total billed charges ",386.93,514.07,
"NAIL ELASTIC 2.0 X 300MM",6109938,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,589.93,471.944,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",471.94,80,,377.55,,,0,"percent of total billed charges ","80% of total billed charges ",412.95,70,,330.36,,,0,"percent of total billed charges ","70% of total billed charges ",530.94,90,,424.75,,,0,"percent of total billed charges ","90% of total billed charges ",548.63,93,,438.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",501.44,85,,401.15,,,0,"percent of total billed charges ","85% of total billed charges ",501.44,85,,401.15,,,0,"percent of total billed charges ","85% of total billed charges ",530.94,90,,424.75,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",513.24,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",412.95,70,,330.36,,,0,"percent of total billed charges ","70% of total billed charges ",412.95,548.63,
"NAIL ELASTIC 2.5 X 300MM",6109939,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,633.57,506.856,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",506.86,80,,405.49,,,0,"percent of total billed charges ","80% of total billed charges ",443.5,70,,354.80,,,0,"percent of total billed charges ","70% of total billed charges ",570.21,90,,456.17,,,0,"percent of total billed charges ","90% of total billed charges ",589.22,93,,471.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",538.53,85,,430.82,,,0,"percent of total billed charges ","85% of total billed charges ",538.53,85,,430.82,,,0,"percent of total billed charges ","85% of total billed charges ",570.21,90,,456.17,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",551.21,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",443.5,70,,354.80,,,0,"percent of total billed charges ","70% of total billed charges ",443.5,589.22,
"NAIL ELASTIC 3.0 X 300MM",6109940,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,670.74,536.592,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",536.59,80,,429.27,,,0,"percent of total billed charges ","80% of total billed charges ",469.52,70,,375.62,,,0,"percent of total billed charges ","70% of total billed charges ",603.67,90,,482.94,,,0,"percent of total billed charges ","90% of total billed charges ",623.79,93,,499.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",570.13,85,,456.10,,,0,"percent of total billed charges ","85% of total billed charges ",570.13,85,,456.10,,,0,"percent of total billed charges ","85% of total billed charges ",603.67,90,,482.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",583.54,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",469.52,70,,375.62,,,0,"percent of total billed charges ","70% of total billed charges ",469.52,623.79,
"NAIL ELASTIC 3.5 X 300MM",6109941,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,707.92,566.336,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",566.34,80,,453.07,,,0,"percent of total billed charges ","80% of total billed charges ",495.54,70,,396.43,,,0,"percent of total billed charges ","70% of total billed charges ",637.13,90,,509.70,,,0,"percent of total billed charges ","90% of total billed charges ",658.37,93,,526.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",601.73,85,,481.38,,,0,"percent of total billed charges ","85% of total billed charges ",601.73,85,,481.38,,,0,"percent of total billed charges ","85% of total billed charges ",637.13,90,,509.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",615.89,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",495.54,70,,396.43,,,0,"percent of total billed charges ","70% of total billed charges ",495.54,658.37,
"NAIL ELASTIC 4.0 X 300MM",6109942,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,759.64,607.712,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",607.71,80,,486.17,,,0,"percent of total billed charges ","80% of total billed charges ",531.75,70,,425.40,,,0,"percent of total billed charges ","70% of total billed charges ",683.68,90,,546.94,,,0,"percent of total billed charges ","90% of total billed charges ",706.47,93,,565.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",645.69,85,,516.55,,,0,"percent of total billed charges ","85% of total billed charges ",645.69,85,,516.55,,,0,"percent of total billed charges ","85% of total billed charges ",683.68,90,,546.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",660.89,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",531.75,70,,425.40,,,0,"percent of total billed charges ","70% of total billed charges ",531.75,706.47,
"BLD FENESTRATED HELICAL 95MM",6109947,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,1449.73,1159.784,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",1159.78,80,,927.82,,,0,"percent of total billed charges ","80% of total billed charges ",1014.81,70,,811.85,,,0,"percent of total billed charges ","70% of total billed charges ",1304.76,90,,1043.81,,,0,"percent of total billed charges ","90% of total billed charges ",1348.25,93,,1078.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1232.27,85,,985.82,,,0,"percent of total billed charges ","85% of total billed charges ",1232.27,85,,985.82,,,0,"percent of total billed charges ","85% of total billed charges ",1304.76,90,,1043.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1261.27,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1014.81,70,,811.85,,,0,"percent of total billed charges ","70% of total billed charges ",1014.81,1348.25,
"GRAFT ARTHROFLEX 4.0 X 7.0CM",6109957,"CDM ",278,RC,Q4125,HCPCS,OUTPATIENT,,,7196.48,5757.184,,,,,,,,0,"other ","not separately reimbursment ",33.33,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",5037.54,70,,4030.03,,,0,"percent of total billed charges ","70% of total billed charges ",6476.83,90,,5181.46,,,0,"percent of total billed charges ","90% of total billed charges ",6692.73,93,,5354.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6117.01,85,,4893.61,,,0,"percent of total billed charges ","85% of total billed charges ",6117.01,85,,4893.61,,,0,"percent of total billed charges ","85% of total billed charges ",6476.83,90,,5181.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6260.94,87,,5008.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",5037.54,70,,4030.03,,,0,"percent of total billed charges ","70% of total billed charges ",33.33,6692.73,
"GUIDE WIRE 1.6MM X 150MM THRD",6109958,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,150.02,120.016,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",105.01,70,,84.01,,,0,"percent of total billed charges ","70% of total billed charges ",135.02,90,,108.02,,,0,"percent of total billed charges ","90% of total billed charges ",139.52,93,,111.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",127.52,85,,102.02,,,0,"percent of total billed charges ","85% of total billed charges ",127.52,85,,102.02,,,0,"percent of total billed charges ","85% of total billed charges ",135.02,90,,108.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",130.52,87,,104.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",105.01,70,,84.01,,,0,"percent of total billed charges ","70% of total billed charges ",105.01,139.52,
"GUIDE WIRE 2.5 X 300MM",6109989,"CDM ",278,RC,C1769,HCPCS,OUTPATIENT,,,264.47,211.576,,,,,,,,0,"other ","not separately reimbursment ",,,,72.20,72.20,72.20,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",185.13,70,,148.10,,,0,"percent of total billed charges ","70% of total billed charges ",238.02,90,,190.42,,,0,"percent of total billed charges ","90% of total billed charges ",245.96,93,,196.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",224.8,85,,179.84,,,0,"percent of total billed charges ","85% of total billed charges ",224.8,85,,179.84,,,0,"percent of total billed charges ","85% of total billed charges ",238.02,90,,190.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",230.09,87,,184.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",185.13,70,,148.10,,,0,"percent of total billed charges ","70% of total billed charges ",185.13,245.96,
"SCREW CORTEX SELF-TAP 26MM",6112959,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,225.5,180.4,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.85,70,,126.28,,,0,"percent of total billed charges ","70% of total billed charges ",202.95,90,,162.36,,,0,"percent of total billed charges ","90% of total billed charges ",209.72,93,,167.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",191.68,85,,153.34,,,0,"percent of total billed charges ","85% of total billed charges ",191.68,85,,153.34,,,0,"percent of total billed charges ","85% of total billed charges ",202.95,90,,162.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",196.19,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.85,70,,126.28,,,0,"percent of total billed charges ","70% of total billed charges ",157.85,209.72,
"CONT MEDIA OMNIPAQUE 300/100ML",6201754,"CDM ",255,RC,Q9967,HCPCS,OUTPATIENT,,,543.5,434.8,,,,,,,,0,"other ","not separately reimbursment ",5.05,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",380.45,70,,304.36,,,0,"percent of total billed charges ","70% of total billed charges ",489.15,90,,391.32,,,0,"percent of total billed charges ","90% of total billed charges ",505.46,93,,404.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",461.98,85,,369.58,,,0,"percent of total billed charges ","85% of total billed charges ",489.15,90,,391.32,,,0,"percent of total billed charges ","90% of total billed charges ",489.15,90,,391.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",472.85,87,,358.59,260.46,448.24,15,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",380.45,70,,304.36,,,0,"percent of total billed charges ","70% of total billed charges ",5.05,505.46,
"CONT MEDIA OMNIPAQUE 300/50ML",6201965,"CDM ",255,RC,Q9967,HCPCS,OUTPATIENT,,,272,217.6,,,,,,,,0,"other ","not separately reimbursment ",5.05,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",190.4,70,,152.32,,,0,"percent of total billed charges ","70% of total billed charges ",244.8,90,,195.84,,,0,"percent of total billed charges ","90% of total billed charges ",252.96,93,,202.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",231.2,85,,184.96,,,0,"percent of total billed charges ","85% of total billed charges ",244.8,90,,195.84,,,0,"percent of total billed charges ","90% of total billed charges ",244.8,90,,195.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",236.64,87,,358.59,260.46,448.24,15,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",190.4,70,,152.32,,,0,"percent of total billed charges ","70% of total billed charges ",5.05,252.96,
"CONT MEDIA OMNIPAQUE 300/10ML",6201967,"CDM ",255,RC,Q9967,HCPCS,OUTPATIENT,,,76,60.8,,,,,,,,0,"other ","not separately reimbursment ",5.05,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",53.2,70,,42.56,,,0,"percent of total billed charges ","70% of total billed charges ",68.4,90,,54.72,,,0,"percent of total billed charges ","90% of total billed charges ",70.68,93,,56.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",64.6,85,,51.68,,,0,"percent of total billed charges ","85% of total billed charges ",68.4,90,,54.72,,,0,"percent of total billed charges ","90% of total billed charges ",68.4,90,,54.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",66.12,87,,358.59,260.46,448.24,15,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.2,70,,42.56,,,0,"percent of total billed charges ","70% of total billed charges ",5.05,70.68,
"ADRENALIN MDV 1:1000INJ",7000474,"CDM ",636,RC,J0169,HCPCS,OUTPATIENT,,,81.5,65.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",75.8,93,,60.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",69.28,85,,55.42,,,0,"percent of total billed charges ","85% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",70.91,87,,56.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",57.05,75.8,
"AMINOCAPROIC ACID 5GM VIAL",7001027,"CDM ",636,RC,S0017,HCPCS,OUTPATIENT,,,121.5,97.2,,,,,,,,0,"other ","not separately reimbursment ",10.92,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.05,70,,68.04,,,0,"percent of total billed charges ","70% of total billed charges ",109.35,90,,87.48,,,0,"percent of total billed charges ","90% of total billed charges ",113,93,,90.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",6.51,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",103.28,85,,82.62,,,0,"percent of total billed charges ","85% of total billed charges ",109.35,90,,87.48,,,0,"percent of total billed charges ","90% of total billed charges ",109.35,90,,87.48,,,0,"percent of total billed charges ","90% of total billed charges ",6.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",105.71,87,,84.57,,,0,"percent of total billed charges ","87% of total billed charges ",6.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.05,70,,68.04,,,0,"percent of total billed charges ","70% of total billed charges ",6.45,113,
"AMINOPHY IV 250MG",7001100,"CDM ",636,RC,J0280,HCPCS,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",11.36,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",8.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",8.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",8.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",8.57,44.64,
"AMINOPHY IV 500MG",7001126,"CDM ",636,RC,J0280,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",11.36,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",8.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",8.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",8.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",8.57,45.57,
"SUCCINYLCHOLINE 20 MG/ML CHG P",7001399,"CDM ",636,RC,J0330,HCPCS,OUTPATIENT,,,59.5,47.6,,,,,,,,0,"other ","not separately reimbursment ",1.02,100,,0.09,0.09,0.09,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",41.65,70,,33.32,,,0,"percent of total billed charges ","70% of total billed charges ",53.55,90,,42.84,,,0,"percent of total billed charges ","90% of total billed charges ",55.34,93,,44.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",50.58,85,,40.46,,,0,"percent of total billed charges ","85% of total billed charges ",53.55,90,,42.84,,,0,"percent of total billed charges ","90% of total billed charges ",53.55,90,,42.84,,,0,"percent of total billed charges ","90% of total billed charges ",1.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",51.77,87,,41.42,,,0,"percent of total billed charges ","87% of total billed charges ",1.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",41.65,70,,33.32,,,0,"percent of total billed charges ","70% of total billed charges ",1.02,55.34,
"CROFAB INJ 1ML/ML 10ML",7001464,"CDM ",636,RC,J0840,HCPCS,OUTPATIENT,,,4738,3790.4,,,,,,,,0,"other ","not separately reimbursment ",2436.16,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3316.6,70,,2653.28,,,0,"percent of total billed charges ","70% of total billed charges ",4264.2,90,,3411.36,,,0,"percent of total billed charges ","90% of total billed charges ",4406.34,93,,3525.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2770.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4027.3,85,,3221.84,,,0,"percent of total billed charges ","85% of total billed charges ",4264.2,90,,3411.36,,,0,"percent of total billed charges ","90% of total billed charges ",4264.2,90,,3411.36,,,0,"percent of total billed charges ","90% of total billed charges ",2743.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4122.06,87,,3297.65,,,0,"percent of total billed charges ","87% of total billed charges ",2743.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1826.52,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3316.6,70,,2653.28,,,0,"percent of total billed charges ","70% of total billed charges ",1826.52,4406.34,
"ATROPINE AMP 0.5CC-I",7002306,"CDM ",636,RC,J0461,HCPCS,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",0.1,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",0.1,44.64,
"BENADRYL 50MG 1ML VIAL",7002777,"CDM ",636,RC,J1200,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",1.04,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",0.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.98,45.57,
"BICILLIN LA 1.2MU TX",7003098,"CDM ",636,RC,J0561,HCPCS,OUTPATIENT,,,209.5,167.6,,,,,,,,0,"other ","not separately reimbursment ",32.82,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",146.65,70,,117.32,,,0,"percent of total billed charges ","70% of total billed charges ",188.55,90,,150.84,,,0,"percent of total billed charges ","90% of total billed charges ",194.84,93,,155.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",15.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",178.08,85,,142.46,,,0,"percent of total billed charges ","85% of total billed charges ",188.55,90,,150.84,,,0,"percent of total billed charges ","90% of total billed charges ",188.55,90,,150.84,,,0,"percent of total billed charges ","90% of total billed charges ",14.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",182.27,87,,145.82,,,0,"percent of total billed charges ","87% of total billed charges ",14.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.97,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",146.65,70,,117.32,,,0,"percent of total billed charges ","70% of total billed charges ",14.95,194.84,
"BRETHINE 1MG AMP-INJ",7003254,"CDM ",636,RC,J3105,HCPCS,OUTPATIENT,,,49.5,39.6,,,,,,,,0,"other ","not separately reimbursment ",7.83,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",46.04,93,,36.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",42.08,85,,33.66,,,0,"percent of total billed charges ","85% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",2.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.07,87,,34.46,,,0,"percent of total billed charges ","87% of total billed charges ",2.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",2.53,46.04,
"CALC CL 10% 10ML VIAL/INJ",7003544,"CDM ",636,RC,J0620,HCPCS,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",17.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",17.28,44.64,
"CAL GLUC 10%10CC/INJ",7003551,"CDM ",636,RC,J0620,HCPCS,OUTPATIENT,,,52.5,42,,,,,,,,0,"other ","not separately reimbursment ",17.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",48.83,93,,39.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",44.63,85,,35.70,,,0,"percent of total billed charges ","85% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",45.68,87,,36.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",17.28,48.83,
"CELESTONE SOLUSPAN 5ML INJ",7003841,"CDM ",636,RC,J0702,HCPCS,OUTPATIENT,,,90,72,,,,,,,,0,"other ","not separately reimbursment ",8.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",8.04,83.7,
"CLEOCIN 150MG/ML 2ML VIAL",7004294,"CDM ",250,RC,J0736,HCPCS,OUTPATIENT,,,46.5,37.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",43.25,93,,34.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.53,85,,31.62,,,0,"percent of total billed charges ","85% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.46,87,,32.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",32.55,43.25,
"COGENTIN 2MG/2CC-INJ",7004518,"CDM ",636,RC,J0515,HCPCS,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",21.15,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",19.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",19.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",19.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",19.51,44.64,
"COMPAZINE TAB 5MG",7004716,"CDM ",637,RC,Q0164,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",0.61,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",0.61,11.63,
"COMPAZINE TAB 10MG",7004724,"CDM ",637,RC,Q0165,HCPCS,OUTPATIENT,,,10.5,8.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.35,70,,5.88,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,90,,7.56,,,0,"percent of total billed charges ","90% of total billed charges ",9.77,93,,7.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.93,85,,7.14,,,0,"percent of total billed charges ","85% of total billed charges ",9.45,90,,7.56,,,0,"percent of total billed charges ","90% of total billed charges ",9.45,90,,7.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.14,87,,7.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.35,70,,5.88,,,0,"percent of total billed charges ","70% of total billed charges ",7.35,9.77,
"COMPAZ 5MG/ML 2ML INJ",7004799,"CDM ",636,RC,J0780,HCPCS,OUTPATIENT,,,50.5,40.4,,,,,,,,0,"other ","not separately reimbursment ",5.07,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",35.35,70,,28.28,,,0,"percent of total billed charges ","70% of total billed charges ",45.45,90,,36.36,,,0,"percent of total billed charges ","90% of total billed charges ",46.97,93,,37.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",4.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",42.93,85,,34.34,,,0,"percent of total billed charges ","85% of total billed charges ",45.45,90,,36.36,,,0,"percent of total billed charges ","90% of total billed charges ",45.45,90,,36.36,,,0,"percent of total billed charges ","90% of total billed charges ",4.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.94,87,,48.27,48.27,48.27,"1 through 10","percent of total billed charges ","87% of total billed charges ",4.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",35.35,70,,28.28,,,0,"percent of total billed charges ","70% of total billed charges ",4.74,46.97,
"CYANOCOBAL1000MG/MCG/ML VIAL",7005192,"CDM ",636,RC,J3420,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",1.86,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",2.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,0.85,0.75,0.99,"1 through 10","percent of total billed charges ","87% of total billed charges ",2.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",1.86,45.57,
"DELESTROGEN 20MG/ML 5ML",7005846,"CDM ",636,RC,J1380,HCPCS,OUTPATIENT,,,244.5,195.6,,,,,,,,0,"other ","not separately reimbursment ",11.14,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",171.15,70,,136.92,,,0,"percent of total billed charges ","70% of total billed charges ",220.05,90,,176.04,,,0,"percent of total billed charges ","90% of total billed charges ",227.39,93,,181.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",11.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",207.83,85,,166.26,,,0,"percent of total billed charges ","85% of total billed charges ",220.05,90,,176.04,,,0,"percent of total billed charges ","90% of total billed charges ",220.05,90,,176.04,,,0,"percent of total billed charges ","90% of total billed charges ",11.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",212.72,87,,170.18,,,0,"percent of total billed charges ","87% of total billed charges ",11.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",171.15,70,,136.92,,,0,"percent of total billed charges ","70% of total billed charges ",11.14,227.39,
"DELESTROGEN 50MG 5ML VIAL",7005847,"CDM ",636,RC,J1380,HCPCS,OUTPATIENT,,,72,57.6,,,,,,,,0,"other ","not separately reimbursment ",11.14,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",50.4,70,,40.32,,,0,"percent of total billed charges ","70% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",66.96,93,,53.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",11.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",61.2,85,,48.96,,,0,"percent of total billed charges ","85% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",11.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.64,87,,50.11,,,0,"percent of total billed charges ","87% of total billed charges ",11.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",50.4,70,,40.32,,,0,"percent of total billed charges ","70% of total billed charges ",11.14,66.96,
"DEMEROL SYRINGE 25MG 1ML INJ",7005887,"CDM ",636,RC,J2175,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",8.88,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",6.54,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",6.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,71.55,43.55,99.54,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",6.48,45.57,
"DEMEROL 50MG INJ 1ML",7005895,"CDM ",636,RC,J2175,HCPCS,OUTPATIENT,,,55.5,44.4,,,,,,,,0,"other ","not separately reimbursment ",8.88,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",38.85,70,,31.08,,,0,"percent of total billed charges ","70% of total billed charges ",49.95,90,,39.96,,,0,"percent of total billed charges ","90% of total billed charges ",51.62,93,,41.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",6.54,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",47.18,85,,37.74,,,0,"percent of total billed charges ","85% of total billed charges ",49.95,90,,39.96,,,0,"percent of total billed charges ","90% of total billed charges ",49.95,90,,39.96,,,0,"percent of total billed charges ","90% of total billed charges ",6.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",48.29,87,,71.55,43.55,99.54,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",38.85,70,,31.08,,,0,"percent of total billed charges ","70% of total billed charges ",6.48,51.62,
"DEMEROL SYRINGE 75MG 1ML INJ",7005929,"CDM ",636,RC,J2175,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",8.88,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",6.54,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",6.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,71.55,43.55,99.54,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",6.48,45.57,
"DEPO-MEDROL 40MG/ML 1ML VIAL",7005978,"CDM ",636,RC,J1010,HCPCS,OUTPATIENT,,,49.5,39.6,,,,,,,,0,"other ","not separately reimbursment ",,,,1.90,1.90,1.90,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",46.04,93,,36.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.08,85,,33.66,,,0,"percent of total billed charges ","85% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.07,87,,9.41,0.22,39.57,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,46.04,
"DEPO-MEDROL 80MG/ML 1ML VIAL",7005986,"CDM ",636,RC,J1010,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,1.90,1.90,1.90,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,9.41,0.22,39.57,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"DHE 45 AMPULE -INJ",7006182,"CDM ",636,RC,J1110,HCPCS,OUTPATIENT,,,292,233.6,,,,,,,,0,"other ","not separately reimbursment ",47.74,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",204.4,70,,163.52,,,0,"percent of total billed charges ","70% of total billed charges ",262.8,90,,210.24,,,0,"percent of total billed charges ","90% of total billed charges ",271.56,93,,217.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",47.89,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",248.2,85,,198.56,,,0,"percent of total billed charges ","85% of total billed charges ",262.8,90,,210.24,,,0,"percent of total billed charges ","90% of total billed charges ",262.8,90,,210.24,,,0,"percent of total billed charges ","90% of total billed charges ",47.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",254.04,87,,203.23,,,0,"percent of total billed charges ","87% of total billed charges ",47.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",204.4,70,,163.52,,,0,"percent of total billed charges ","70% of total billed charges ",47.42,271.56,
"DIAMOX VIAL 500MG",7006273,"CDM ",636,RC,J1120,HCPCS,OUTPATIENT,,,104,83.2,,,,,,,,0,"other ","not separately reimbursment ",33.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",72.8,70,,58.24,,,0,"percent of total billed charges ","70% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",96.72,93,,77.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",20.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",88.4,85,,70.72,,,0,"percent of total billed charges ","85% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",20.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",90.48,87,,72.38,,,0,"percent of total billed charges ","87% of total billed charges ",20.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",72.8,70,,58.24,,,0,"percent of total billed charges ","70% of total billed charges ",20.13,96.72,
"DILANTIN 200MG VIAL",7006489,"CDM ",636,RC,J1165,HCPCS,OUTPATIENT,,,32,25.6,,,,,,,,0,"other ","not separately reimbursment ",0.81,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.4,70,,17.92,,,0,"percent of total billed charges ","70% of total billed charges ",28.8,90,,23.04,,,0,"percent of total billed charges ","90% of total billed charges ",29.76,93,,23.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",27.2,85,,21.76,,,0,"percent of total billed charges ","85% of total billed charges ",28.8,90,,23.04,,,0,"percent of total billed charges ","90% of total billed charges ",28.8,90,,23.04,,,0,"percent of total billed charges ","90% of total billed charges ",0.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.84,87,,22.27,,,0,"percent of total billed charges ","87% of total billed charges ",0.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.4,70,,17.92,,,0,"percent of total billed charges ","70% of total billed charges ",0.45,29.76,
"DILANTIN 100MG VIAL",7006505,"CDM ",636,RC,J1165,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",0.81,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",0.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.45,45.57,
"DILAUDID 2MG/ML 1ML",7006547,"CDM ",636,RC,J1171,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,0.10,0.10,0.10,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.14,13.25,118.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"EPINEPHRIN 1:10K 0.1MG/ML 10ML",7007560,"CDM ",636,RC,J0169,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"EPINEPHRINE 1:1000 1MG/ML",7007578,"CDM ",636,RC,J0169,HCPCS,OUTPATIENT,,,50.5,40.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.35,70,,28.28,,,0,"percent of total billed charges ","70% of total billed charges ",45.45,90,,36.36,,,0,"percent of total billed charges ","90% of total billed charges ",46.97,93,,37.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.93,85,,34.34,,,0,"percent of total billed charges ","85% of total billed charges ",45.45,90,,36.36,,,0,"percent of total billed charges ","90% of total billed charges ",45.45,90,,36.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.94,87,,35.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.35,70,,28.28,,,0,"percent of total billed charges ","70% of total billed charges ",35.35,46.97,
"GLUCAGON FOR INJ-1MG/ML",7008964,"CDM ",636,RC,J1610,HCPCS,OUTPATIENT,,,358,286.4,,,,,,,,0,"other ","not separately reimbursment ",244.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",250.6,70,,200.48,,,0,"percent of total billed charges ","70% of total billed charges ",322.2,90,,257.76,,,0,"percent of total billed charges ","90% of total billed charges ",332.94,93,,266.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",173.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",304.3,85,,243.44,,,0,"percent of total billed charges ","85% of total billed charges ",322.2,90,,257.76,,,0,"percent of total billed charges ","90% of total billed charges ",322.2,90,,257.76,,,0,"percent of total billed charges ","90% of total billed charges ",171.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",311.46,87,,249.17,,,0,"percent of total billed charges ","87% of total billed charges ",171.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",164.86,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",250.6,70,,200.48,,,0,"percent of total billed charges ","70% of total billed charges ",164.86,332.94,
"HEPARIN 1000U/ML CHG PER ML",7009244,"CDM ",636,RC,J1644,HCPCS,OUTPATIENT,,,52.5,42,,,,,,,,0,"other ","not separately reimbursment ",0.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",48.83,93,,39.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",44.63,85,,35.70,,,0,"percent of total billed charges ","85% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",0.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.68,87,,36.54,,,0,"percent of total billed charges ","87% of total billed charges ",0.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",0.25,48.83,
"DROPERIDOL 5MG-2ML VIAL",7009715,"CDM ",636,RC,J1790,HCPCS,OUTPATIENT,,,54,43.2,,,,,,,,0,"other ","not separately reimbursment ",11.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.8,70,,30.24,,,0,"percent of total billed charges ","70% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",50.22,93,,40.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",45.9,85,,36.72,,,0,"percent of total billed charges ","85% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",46.98,87,,37.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.8,70,,30.24,,,0,"percent of total billed charges ","70% of total billed charges ",11.29,50.22,
"DROPERIDOL 2.5MG VIAL",7009716,"CDM ",636,RC,J1790,HCPCS,OUTPATIENT,,,50.5,40.4,,,,,,,,0,"other ","not separately reimbursment ",11.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",35.35,70,,28.28,,,0,"percent of total billed charges ","70% of total billed charges ",45.45,90,,36.36,,,0,"percent of total billed charges ","90% of total billed charges ",46.97,93,,37.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.93,85,,34.34,,,0,"percent of total billed charges ","85% of total billed charges ",45.45,90,,36.36,,,0,"percent of total billed charges ","90% of total billed charges ",45.45,90,,36.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.94,87,,35.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.35,70,,28.28,,,0,"percent of total billed charges ","70% of total billed charges ",11.29,46.97,
"INDERAL AMP 1MG/1ML",7009756,"CDM ",636,RC,J1800,HCPCS,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",9.71,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",3.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",3.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",3.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",3.32,44.64,
"Fluarix 26-27 0.5ML PFS",7009798,"CDM ",636,RC,Q2038,HCPCS,OUTPATIENT,,,65.5,52.4,,,,,,,,0,"other ","not separately reimbursment ",22.85,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",45.85,70,,36.68,,,0,"percent of total billed charges ","70% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",60.92,93,,48.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",20.36,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",55.68,85,,44.54,,,0,"percent of total billed charges ","85% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",20.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.99,87,,45.59,,,0,"percent of total billed charges ","87% of total billed charges ",20.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",45.85,70,,36.68,,,0,"percent of total billed charges ","70% of total billed charges ",20.16,60.92,
"KEFZOL 1GM INJ",7010572,"CDM ",636,RC,J0690,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",1.23,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,40.51,32.13,122.92,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.75,45.57,
"CEFAZOLIN 1GM VIAL",7010573,"CDM ",636,RC,J0690,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",1.23,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,40.51,32.13,122.92,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",0.75,106.95,
"CEFAZOLIN 2MG VIAL",7010574,"CDM ",636,RC,J0687,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",80.5,106.95,
"CEFAZOLIN 2MG VIAL",7010574,"CDM ",636,RC,J0687,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",80.5,106.95,
"CEFAZOLIN 3MG VIAL",7010575,"CDM ",636,RC,J0687,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",80.5,106.95,
"KENALOG-40 IML",7010606,"CDM ",636,RC,J3301,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",1.39,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,0.81,0.46,3.07,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",1.39,45.57,
"LANOXIN AMP 0.5MG/2ML",7010986,"CDM ",636,RC,J1160,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",11.66,100,,9.42,9.42,9.42,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",14.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",14.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",14.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",11.66,45.57,
"LASIX 20MG/2ML INJ",7011083,"CDM ",636,RC,J1938,HCPCS,OUTPATIENT,,,42.5,34,,,,,,,,0,"other ","not separately reimbursment ",,,,2.22,2.22,2.22,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.75,70,,23.80,,,0,"percent of total billed charges ","70% of total billed charges ",38.25,90,,30.60,,,0,"percent of total billed charges ","90% of total billed charges ",39.53,93,,31.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",36.13,85,,28.90,,,0,"percent of total billed charges ","85% of total billed charges ",38.25,90,,30.60,,,0,"percent of total billed charges ","90% of total billed charges ",38.25,90,,30.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",36.98,87,,29.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.75,70,,23.80,,,0,"percent of total billed charges ","70% of total billed charges ",29.75,39.53,
"FUROSEMIDE 40MG/5ML 50LN",7011092,"CDM ",259,RC,J1938,HCPCS,OUTPATIENT,,,13,10.4,,,,,,,,0,"other ","not separately reimbursment ",,,,2.22,2.22,2.22,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.1,70,,7.28,,,0,"percent of total billed charges ","70% of total billed charges ",11.7,90,,9.36,,,0,"percent of total billed charges ","90% of total billed charges ",12.09,93,,9.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.05,85,,8.84,,,0,"percent of total billed charges ","85% of total billed charges ",11.7,90,,9.36,,,0,"percent of total billed charges ","90% of total billed charges ",11.7,90,,9.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.31,87,,9.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.1,70,,7.28,,,0,"percent of total billed charges ","70% of total billed charges ",9.1,12.09,
"LIDOCAINE 1% 5ML SYR",7011299,"CDM ",250,RC,J2003,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,2.07,2.07,2.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"MANNITOL 25%50 ML",7011836,"CDM ",636,RC,J2150,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",5.82,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2.55,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",2.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",2.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",2.52,45.57,
"MEFOXIN 1GM INJ",7012065,"CDM ",636,RC,J0694,HCPCS,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",7.39,100,,5.97,5.97,5.97,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",4.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",4.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",4.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",4.61,44.64,
"CEFOXITIN 2GM IV",7012073,"CDM ",636,RC,J0694,HCPCS,OUTPATIENT,,,135,108,,,,,,,,0,"other ","not separately reimbursment ",7.39,100,,5.97,5.97,5.97,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",125.55,93,,100.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",4.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",114.75,85,,91.80,,,0,"percent of total billed charges ","85% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",4.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.45,87,,93.96,,,0,"percent of total billed charges ","87% of total billed charges ",4.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",4.61,125.55,
"METHERGINE 0.2MG/ML 1ML",7012305,"CDM ",636,RC,J2210,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",26.85,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",19.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",19.62,45.57,
"METHOTREXAT IV 25MG/ML 2ML",7012313,"CDM ",636,RC,J9260,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",2.23,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",2.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",2.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",2.16,45.57,
"MORPHINE SULF 4MG/ML",7012628,"CDM ",636,RC,J2274,HCPCS,OUTPATIENT,,,48.5,38.8,,,,,,,,0,"other ","not separately reimbursment ",18.56,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.95,70,,27.16,,,0,"percent of total billed charges ","70% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",45.11,93,,36.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",11.19,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.23,85,,32.98,,,0,"percent of total billed charges ","85% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.2,87,,36.85,33.58,40.13,"1 through 10","percent of total billed charges ","87% of total billed charges ",11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.95,70,,27.16,,,0,"percent of total billed charges ","70% of total billed charges ",11.08,45.11,
"MORPHINE GR1/6 AMP-I",7012636,"CDM ",636,RC,J2270,HCPCS,OUTPATIENT,,,50,40,,,,,,,,0,"other ","not separately reimbursment ",5.74,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",46.5,93,,37.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",3.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",42.5,85,,34.00,,,0,"percent of total billed charges ","85% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",3.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.5,87,,37.24,33.93,40.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",3.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",3.39,46.5,
"NARCAN 0.4MG/ML 1ML INJ",7013139,"CDM ",636,RC,J2312,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"NEO-SYNEP 10MG/ML 1ML",7013642,"CDM ",636,RC,J2371,HCPCS,OUTPATIENT,,,50,40,,,,,,,,0,"other ","not separately reimbursment ",,,,7.90,7.90,7.90,"1 through 10","other ","not separately reimbursment ",40,80,,32.00,,,0,"percent of total billed charges ","80% of total billed charges ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",46.5,93,,37.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.5,85,,34.00,,,0,"percent of total billed charges ","85% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.5,87,,41.81,35.12,41.81,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",35,46.5,
"NORFLEX AMP 30MG/ML 2ML",7014004,"CDM ",636,RC,J2360,HCPCS,OUTPATIENT,,,51,40.8,,,,,,,,0,"other ","not separately reimbursment ",11.73,100,,11.14,11.14,11.14,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",47.43,93,,37.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.35,85,,34.68,,,0,"percent of total billed charges ","85% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.37,87,,45.68,40.15,51.20,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",11.73,47.43,
"PENICILLIN G (K) 5MU/VIAL",7014855,"CDM ",636,RC,J2540,HCPCS,OUTPATIENT,,,49.5,39.6,,,,,,,,0,"other ","not separately reimbursment ",1.25,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",46.04,93,,36.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.93,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",42.08,85,,33.66,,,0,"percent of total billed charges ","85% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",0.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.07,87,,34.46,,,0,"percent of total billed charges ","87% of total billed charges ",0.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",0.92,46.04,
"PENICILLIN G 20 MU VIAL",7014856,"CDM ",636,RC,J2540,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",1.25,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.93,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",0.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",0.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",0.92,106.95,
"PITOCIN 10U/ML 1ML VIAL",7015530,"CDM ",636,RC,J2590,HCPCS,OUTPATIENT,,,49.5,39.6,,,,,,,,0,"other ","not separately reimbursment ",1.05,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",46.04,93,,36.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",42.08,85,,33.66,,,0,"percent of total billed charges ","85% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",0.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.07,87,,34.46,,,0,"percent of total billed charges ","87% of total billed charges ",0.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",0.87,46.04,
"POTASS CHLO 40MEQ INJ 20ML",7015944,"CDM ",636,RC,J3480,HCPCS,OUTPATIENT,,,44,35.2,,,,,,,,0,"other ","not separately reimbursment ",0.15,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30.8,70,,24.64,,,0,"percent of total billed charges ","70% of total billed charges ",39.6,90,,31.68,,,0,"percent of total billed charges ","90% of total billed charges ",40.92,93,,32.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",37.4,85,,29.92,,,0,"percent of total billed charges ","85% of total billed charges ",39.6,90,,31.68,,,0,"percent of total billed charges ","90% of total billed charges ",39.6,90,,31.68,,,0,"percent of total billed charges ","90% of total billed charges ",0.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.28,87,,30.62,,,0,"percent of total billed charges ","87% of total billed charges ",0.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30.8,70,,24.64,,,0,"percent of total billed charges ","70% of total billed charges ",0.14,40.92,
"POTASS CHLO 20MEQ-INJ 10ML",7015951,"CDM ",636,RC,J3480,HCPCS,OUTPATIENT,,,38,30.4,,,,,,,,0,"other ","not separately reimbursment ",0.15,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",26.6,70,,21.28,,,0,"percent of total billed charges ","70% of total billed charges ",34.2,90,,27.36,,,0,"percent of total billed charges ","90% of total billed charges ",35.34,93,,28.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",32.3,85,,25.84,,,0,"percent of total billed charges ","85% of total billed charges ",34.2,90,,27.36,,,0,"percent of total billed charges ","90% of total billed charges ",34.2,90,,27.36,,,0,"percent of total billed charges ","90% of total billed charges ",0.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.06,87,,26.45,,,0,"percent of total billed charges ","87% of total billed charges ",0.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",26.6,70,,21.28,,,0,"percent of total billed charges ","70% of total billed charges ",0.14,35.34,
"PREMARIN INJ 25MG/5ML",7016124,"CDM ",636,RC,J1410,HCPCS,OUTPATIENT,,,477,381.6,,,,,,,,0,"other ","not separately reimbursment ",478.73,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",333.9,70,,267.12,,,0,"percent of total billed charges ","70% of total billed charges ",429.3,90,,343.44,,,0,"percent of total billed charges ","90% of total billed charges ",443.61,93,,354.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",344.87,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",405.45,85,,324.36,,,0,"percent of total billed charges ","85% of total billed charges ",429.3,90,,343.44,,,0,"percent of total billed charges ","90% of total billed charges ",429.3,90,,343.44,,,0,"percent of total billed charges ","90% of total billed charges ",341.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",414.99,87,,331.99,,,0,"percent of total billed charges ","87% of total billed charges ",341.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",391.76,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",333.9,70,,267.12,,,0,"percent of total billed charges ","70% of total billed charges ",333.9,478.73,
"PROGESTERO 50MG/ML",7016306,"CDM ",636,RC,J2675,HCPCS,OUTPATIENT,,,92.5,74,,,,,,,,0,"other ","not separately reimbursment ",0.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",86.03,93,,68.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",78.63,85,,62.90,,,0,"percent of total billed charges ","85% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",1.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.48,87,,64.38,,,0,"percent of total billed charges ","87% of total billed charges ",1.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",0.9,86.03,
"PROCAINAMIDE 100MG/ML 10ML VIA",7016371,"CDM ",636,RC,J2690,HCPCS,OUTPATIENT,,,61,48.8,,,,,,,,0,"other ","not separately reimbursment ",240.82,100,,459.20,459.20,459.20,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",56.73,93,,45.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",91.06,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",51.85,85,,41.48,,,0,"percent of total billed charges ","85% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",90.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.07,87,,42.46,,,0,"percent of total billed charges ","87% of total billed charges ",90.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",344.53,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",42.7,344.53,
"PROTAMINE 10MG/ML 5ML",7016538,"CDM ",636,RC,J2720,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",2.74,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.4,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",1.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",1.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",1.39,45.57,
"SOL-CORTEF 50MG/ML 2ML INJ",7017924,"CDM ",636,RC,J1720,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",23.74,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",14.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",14.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",14.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",14.81,45.57,
"SOL-CORTEF 125 MG/ML 2ML",7017932,"CDM ",636,RC,J1720,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",23.74,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",14.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",14.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",14.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",14.81,45.57,
"SOL-CORTEF 125 MG/ML 4ML",7017940,"CDM ",636,RC,J1720,HCPCS,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",23.74,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",14.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",14.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",14.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",14.81,44.64,
"SOLU-MEDROL 40MG/ML VIAL",7017965,"CDM ",636,RC,J2919,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,5.40,0.58,57.18,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"SOLU-MEDRO 125MGVIAL 2ML",7017973,"CDM ",636,RC,J2919,HCPCS,OUTPATIENT,,,48.5,38.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.95,70,,27.16,,,0,"percent of total billed charges ","70% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",45.11,93,,36.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.23,85,,32.98,,,0,"percent of total billed charges ","85% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.2,87,,5.40,0.58,57.18,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.95,70,,27.16,,,0,"percent of total billed charges ","70% of total billed charges ",33.95,45.11,
"SOLU-MEDRO 500MGVIAL",7017981,"CDM ",636,RC,J2919,HCPCS,OUTPATIENT,,,51,40.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",47.43,93,,37.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.35,85,,34.68,,,0,"percent of total billed charges ","85% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.37,87,,5.40,0.58,57.18,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",35.7,47.43,
"SOLU-MEDROL 1GM VIAL",7017999,"CDM ",636,RC,J2919,HCPCS,OUTPATIENT,,,66.5,53.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.55,70,,37.24,,,0,"percent of total billed charges ","70% of total billed charges ",59.85,90,,47.88,,,0,"percent of total billed charges ","90% of total billed charges ",61.85,93,,49.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",56.53,85,,45.22,,,0,"percent of total billed charges ","85% of total billed charges ",59.85,90,,47.88,,,0,"percent of total billed charges ","90% of total billed charges ",59.85,90,,47.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",57.86,87,,5.40,0.58,57.18,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.55,70,,37.24,,,0,"percent of total billed charges ","70% of total billed charges ",46.55,61.85,
"THIAMINE 100MG/ML 1ML",7019375,"CDM ",636,RC,J3411,HCPCS,OUTPATIENT,,,47.5,38,,,,,,,,0,"other ","not separately reimbursment ",2.9,100,,2.76,2.76,2.76,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.25,70,,26.60,,,0,"percent of total billed charges ","70% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",44.18,93,,35.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.38,85,,32.30,,,0,"percent of total billed charges ","85% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.33,87,,33.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.25,70,,26.60,,,0,"percent of total billed charges ","70% of total billed charges ",2.9,44.18,
"DIAZEPAM 10MG (5MG/ML) 2ML",7020738,"CDM ",636,RC,J3360,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",8.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",8.41,45.57,
"XYLO 1% 30ML AMP 10MG/ML",7021520,"CDM ",250,RC,J2003,HCPCS,OUTPATIENT,,,51,40.8,,,,,,,,0,"other ","not separately reimbursment ",,,,2.07,2.07,2.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",47.43,93,,37.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.35,85,,34.68,,,0,"percent of total billed charges ","85% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.37,87,,35.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",35.7,47.43,
"XYLO 1% 50ML VIAL 10MG/ML",7021538,"CDM ",250,RC,J2003,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,2.07,2.07,2.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"XYLO-EPI 20 ML 10MG/ML 1%",7021546,"CDM ",250,RC,J2004,HCPCS,OUTPATIENT,,,51.5,41.2,,,,,,,,0,"other ","not separately reimbursment ",,,,1.44,1.44,1.44,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.05,70,,28.84,,,0,"percent of total billed charges ","70% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",47.9,93,,38.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.78,85,,35.02,,,0,"percent of total billed charges ","85% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.81,87,,35.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.05,70,,28.84,,,0,"percent of total billed charges ","70% of total billed charges ",36.05,47.9,
"LIDOCAINE 1% EPI 10ML VIAL",7021547,"CDM ",636,RC,J2004,HCPCS,OUTPATIENT,,,52.5,42,,,,,,,,0,"other ","not separately reimbursment ",,,,1.44,1.44,1.44,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",48.83,93,,39.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",44.63,85,,35.70,,,0,"percent of total billed charges ","85% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",45.68,87,,36.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",36.75,48.83,
"XYLO 2% 20ML VIAL 20MG/ML",7021587,"CDM ",250,RC,J2003,HCPCS,OUTPATIENT,,,49.5,39.6,,,,,,,,0,"other ","not separately reimbursment ",,,,2.07,2.07,2.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",46.04,93,,36.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.08,85,,33.66,,,0,"percent of total billed charges ","85% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.07,87,,34.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,46.04,
"XYLO-EPI 20ML 20MG/ML 2%",7021611,"CDM ",250,RC,J2004,HCPCS,OUTPATIENT,,,50.5,40.4,,,,,,,,0,"other ","not separately reimbursment ",,,,1.44,1.44,1.44,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.35,70,,28.28,,,0,"percent of total billed charges ","70% of total billed charges ",45.45,90,,36.36,,,0,"percent of total billed charges ","90% of total billed charges ",46.97,93,,37.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.93,85,,34.34,,,0,"percent of total billed charges ","85% of total billed charges ",45.45,90,,36.36,,,0,"percent of total billed charges ","90% of total billed charges ",45.45,90,,36.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.94,87,,35.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.35,70,,28.28,,,0,"percent of total billed charges ","70% of total billed charges ",35.35,46.97,
"LIDOCAINE 4% CRM 5GM",7021688,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"MUCO-MYST 20% 30ML",7023773,"CDM ",637,RC,J7608,HCPCS,OUTPATIENT,,,51,40.8,,,,,,,,0,"other ","not separately reimbursment ",12.04,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",47.43,93,,37.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",6.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",43.35,85,,34.68,,,0,"percent of total billed charges ","85% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",6.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",44.37,87,,35.50,,,0,"percent of total billed charges ","87% of total billed charges ",6.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",6.08,47.43,
"PP MEDROL DOSEPAK 4MG 21 TABS",7024987,"CDM ",253,RC,J7509,HCPCS,OUTPATIENT,,,30,24,,,,,,,,0,"other ","not separately reimbursment ",0.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",21,70,,16.80,,,0,"percent of total billed charges ","70% of total billed charges ",27,90,,21.60,,,0,"percent of total billed charges ","90% of total billed charges ",27.9,93,,22.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.5,85,,20.40,,,0,"percent of total billed charges ","85% of total billed charges ",27,90,,21.60,,,0,"percent of total billed charges ","90% of total billed charges ",27,90,,21.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.1,87,,20.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21,70,,16.80,,,0,"percent of total billed charges ","70% of total billed charges ",0.35,27.9,
"XYLO 1% 20ML 10MG/ML",7025158,"CDM ",250,RC,J2003,HCPCS,OUTPATIENT,,,49.5,39.6,,,,,,,,0,"other ","not separately reimbursment ",,,,2.07,2.07,2.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",46.04,93,,36.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.08,85,,33.66,,,0,"percent of total billed charges ","85% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.07,87,,34.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,46.04,
"XYLO 1% AMP 5ML 10MG/ML",7025182,"CDM ",250,RC,J2003,HCPCS,OUTPATIENT,,,50,40,,,,,,,,0,"other ","not separately reimbursment ",,,,2.07,2.07,2.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",46.5,93,,37.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.5,85,,34.00,,,0,"percent of total billed charges ","85% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.5,87,,34.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",35,46.5,
"DOBUTREX VIA 250MG 20ML VIAL",7025349,"CDM ",250,RC,J1250,HCPCS,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",11.91,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",8.29,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",8.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",8.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",8.21,44.64,
"REGLAN 10MG/2ML INJ",7025380,"CDM ",636,RC,J2765,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",1.33,100,,1.26,1.26,1.26,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",1.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,40.95,25.14,40.95,"1 through 10","percent of total billed charges ","87% of total billed charges ",1.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",1.13,45.57,
"VASOPRESSIN 20UN 100ML BAG IV",7025394,"CDM ",636,RC,J2601,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,100.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2.22,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",2.22,134.85,
"PHENOBARB AMP 60MG-I",7026420,"CDM ",636,RC,J2560,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",42.2,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",40.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",40.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",40.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"SUBLIMAZE AMP 2ML/100MCG",7026453,"CDM ",636,RC,J3010,HCPCS,OUTPATIENT,,,52.5,42,,,,,,,,0,"other ","not separately reimbursment ",1.25,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",48.83,93,,39.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",44.63,85,,35.70,,,0,"percent of total billed charges ","85% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",0.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.68,87,,40.95,30.39,42.84,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",0.63,48.83,
"LIDOCAINE 2% 5ML SYR",7026735,"CDM ",250,RC,J2003,HCPCS,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",,,,2.07,2.07,2.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",33.6,44.64,
"HEP B VAC 10MCG/ML ADULT 1ML",7027097,"CDM ",636,RC,C9105,HCPCS,OUTPATIENT,,,159,127.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.3,70,,89.04,,,0,"percent of total billed charges ","70% of total billed charges ",143.1,90,,114.48,,,0,"percent of total billed charges ","90% of total billed charges ",147.87,93,,118.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",135.15,85,,108.12,,,0,"percent of total billed charges ","85% of total billed charges ",143.1,90,,114.48,,,0,"percent of total billed charges ","90% of total billed charges ",143.1,90,,114.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",138.33,87,,110.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.3,70,,89.04,,,0,"percent of total billed charges ","70% of total billed charges ",111.3,147.87,
"ZANTAC INJ 50MG/2ML",7028004,"CDM ",636,RC,J2780,HCPCS,OUTPATIENT,,,49.5,39.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",46.04,93,,36.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",6.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",42.08,85,,33.66,,,0,"percent of total billed charges ","85% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",6.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.07,87,,34.46,,,0,"percent of total billed charges ","87% of total billed charges ",6.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",6.12,46.04,
"ROCEPHIN 1GM VIAL",7028152,"CDM ",636,RC,J0696,HCPCS,OUTPATIENT,,,47,37.6,,,,,,,,0,"other ","not separately reimbursment ",0.69,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",43.71,93,,34.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.51,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.95,85,,31.96,,,0,"percent of total billed charges ","85% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.89,87,,1.83,0.39,41.08,12,"percent of total billed charges ","87% of total billed charges ",0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",0.5,43.71,
"CEFTIAXONE 1GM VIAL",7028153,"CDM ",636,RC,J0696,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",0.69,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.51,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,1.83,0.39,41.08,12,"percent of total billed charges ","87% of total billed charges ",0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",0.5,106.95,
"CEFTRIAXONE 2GM VIAL",7028154,"CDM ",636,RC,J0696,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",0.69,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.51,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,1.83,0.39,41.08,12,"percent of total billed charges ","87% of total billed charges ",0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",0.5,106.95,
"KINEVAC 5MCG PERVI-I",7028517,"CDM ",636,RC,J2805,HCPCS,OUTPATIENT,,,156.5,125.2,,,,,,,,0,"other ","not separately reimbursment ",171.22,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",109.55,70,,87.64,,,0,"percent of total billed charges ","70% of total billed charges ",140.85,90,,112.68,,,0,"percent of total billed charges ","90% of total billed charges ",145.55,93,,116.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.03,85,,106.42,,,0,"percent of total billed charges ","85% of total billed charges ",140.85,90,,112.68,,,0,"percent of total billed charges ","90% of total billed charges ",140.85,90,,112.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",136.16,87,,108.93,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.55,70,,87.64,,,0,"percent of total billed charges ","70% of total billed charges ",109.55,171.22,
"MORPHINE PCA 1MG/ML 30ML",7028533,"CDM ",636,RC,J2270,HCPCS,OUTPATIENT,,,70,56,,,,,,,,0,"other ","not separately reimbursment ",5.74,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",49,70,,39.20,,,0,"percent of total billed charges ","70% of total billed charges ",63,90,,50.40,,,0,"percent of total billed charges ","90% of total billed charges ",65.1,93,,52.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",3.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",59.5,85,,47.60,,,0,"percent of total billed charges ","85% of total billed charges ",63,90,,50.40,,,0,"percent of total billed charges ","90% of total billed charges ",63,90,,50.40,,,0,"percent of total billed charges ","90% of total billed charges ",3.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60.9,87,,37.24,33.93,40.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",3.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",49,70,,39.20,,,0,"percent of total billed charges ","70% of total billed charges ",3.39,65.1,
"MEPERIDINE PCA 10MG/ML 30ML",7028541,"CDM ",636,RC,J2175,HCPCS,OUTPATIENT,,,112.5,90,,,,,,,,0,"other ","not separately reimbursment ",8.88,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",104.63,93,,83.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",6.54,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",95.63,85,,76.50,,,0,"percent of total billed charges ","85% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",6.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",97.88,87,,71.55,43.55,99.54,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",6.48,104.63,
"ROCEPHIN 500MG -INJ",7028897,"CDM ",636,RC,J0696,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",0.69,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.51,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,1.83,0.39,41.08,12,"percent of total billed charges ","87% of total billed charges ",0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.5,45.57,
"MORPHINE HIGH STR 5MG/ML 30ML",7028947,"CDM ",636,RC,J2270,HCPCS,OUTPATIENT,,,69.5,55.6,,,,,,,,0,"other ","not separately reimbursment ",5.74,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",48.65,70,,38.92,,,0,"percent of total billed charges ","70% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",64.64,93,,51.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",3.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",59.08,85,,47.26,,,0,"percent of total billed charges ","85% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",3.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60.47,87,,37.24,33.93,40.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",3.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",48.65,70,,38.92,,,0,"percent of total billed charges ","70% of total billed charges ",3.39,64.64,
"ROCEPHIN 250MG -INJ",7029242,"CDM ",636,RC,J0696,HCPCS,OUTPATIENT,,,51,40.8,,,,,,,,0,"other ","not separately reimbursment ",0.69,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",47.43,93,,37.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.51,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",43.35,85,,34.68,,,0,"percent of total billed charges ","85% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",44.37,87,,1.83,0.39,41.08,12,"percent of total billed charges ","87% of total billed charges ",0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",0.5,47.43,
"XYLO 0.5% 50ML 5MG/ML",7029283,"CDM ",250,RC,J2003,HCPCS,OUTPATIENT,,,64,51.2,,,,,,,,0,"other ","not separately reimbursment ",,,,2.07,2.07,2.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.8,70,,35.84,,,0,"percent of total billed charges ","70% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",59.52,93,,47.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",54.4,85,,43.52,,,0,"percent of total billed charges ","85% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",55.68,87,,44.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.8,70,,35.84,,,0,"percent of total billed charges ","70% of total billed charges ",44.8,59.52,
"NEOSTIGMINE 1MG/ML CHG PER ML",7029671,"CDM ",636,RC,J2710,HCPCS,OUTPATIENT,,,8,6.4,,,,,,,,0,"other ","not separately reimbursment ",1.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",5.6,70,,4.48,,,0,"percent of total billed charges ","70% of total billed charges ",7.2,90,,5.76,,,0,"percent of total billed charges ","90% of total billed charges ",7.44,93,,5.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",6.8,85,,5.44,,,0,"percent of total billed charges ","85% of total billed charges ",7.2,90,,5.76,,,0,"percent of total billed charges ","90% of total billed charges ",7.2,90,,5.76,,,0,"percent of total billed charges ","90% of total billed charges ",0.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.96,87,,5.57,,,0,"percent of total billed charges ","87% of total billed charges ",0.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",5.6,70,,4.48,,,0,"percent of total billed charges ","70% of total billed charges ",0.35,7.44,
"FORTAZ GM ADD/VAN",7029853,"CDM ",636,RC,J0713,HCPCS,OUTPATIENT,,,46.5,37.2,,,,,,,,0,"other ","not separately reimbursment ",2.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",43.25,93,,34.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.53,85,,31.62,,,0,"percent of total billed charges ","85% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",1.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.46,87,,32.37,,,0,"percent of total billed charges ","87% of total billed charges ",1.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",1.97,43.25,
"DIGIBIND 38MG VIAL",7029960,"CDM ",636,RC,J1162,HCPCS,OUTPATIENT,,,4977,3981.6,,,,,,,,0,"other ","not separately reimbursment ",6145.65,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3483.9,70,,2787.12,,,0,"percent of total billed charges ","70% of total billed charges ",4479.3,90,,3583.44,,,0,"percent of total billed charges ","90% of total billed charges ",4628.61,93,,3702.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4230.45,85,,3384.36,,,0,"percent of total billed charges ","85% of total billed charges ",4479.3,90,,3583.44,,,0,"percent of total billed charges ","90% of total billed charges ",4479.3,90,,3583.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4329.99,87,,3463.99,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",5166.99,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3483.9,70,,2787.12,,,0,"percent of total billed charges ","70% of total billed charges ",3483.9,6145.65,
"CEFAZOLIN 500MG INJ VIAL",7030034,"CDM ",636,RC,J0690,HCPCS,OUTPATIENT,,,47.5,38,,,,,,,,0,"other ","not separately reimbursment ",1.23,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.25,70,,26.60,,,0,"percent of total billed charges ","70% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",44.18,93,,35.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",40.38,85,,32.30,,,0,"percent of total billed charges ","85% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.33,87,,40.51,32.13,122.92,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.25,70,,26.60,,,0,"percent of total billed charges ","70% of total billed charges ",0.75,44.18,
"PEPCID IV 20MG/2ML-I",7030117,"CDM ",250,RC,S0028,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",1.12,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",0.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.9,45.57,
"UNASYN 3GM ADD/VAN",7030679,"CDM ",636,RC,J0295,HCPCS,OUTPATIENT,,,46.5,37.2,,,,,,,,0,"other ","not separately reimbursment ",2.33,100,,1.77,1.77,1.77,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",43.25,93,,34.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.53,85,,31.62,,,0,"percent of total billed charges ","85% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",2.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.46,87,,32.37,,,0,"percent of total billed charges ","87% of total billed charges ",2.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",2.21,43.25,
"UNASYN 1.5GM ADD/VAN",7030687,"CDM ",636,RC,J0295,HCPCS,OUTPATIENT,,,46.5,37.2,,,,,,,,0,"other ","not separately reimbursment ",2.33,100,,1.77,1.77,1.77,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",43.25,93,,34.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.53,85,,31.62,,,0,"percent of total billed charges ","85% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",2.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.46,87,,32.37,,,0,"percent of total billed charges ","87% of total billed charges ",2.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",2.21,43.25,
"ERYTHR 500MG ADD-VAN",7030950,"CDM ",636,RC,J1364,HCPCS,OUTPATIENT,,,111,88.8,,,,,,,,0,"other ","not separately reimbursment ",117.56,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",77.7,70,,62.16,,,0,"percent of total billed charges ","70% of total billed charges ",99.9,90,,79.92,,,0,"percent of total billed charges ","90% of total billed charges ",103.23,93,,82.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",78.53,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",94.35,85,,75.48,,,0,"percent of total billed charges ","85% of total billed charges ",99.9,90,,79.92,,,0,"percent of total billed charges ","90% of total billed charges ",99.9,90,,79.92,,,0,"percent of total billed charges ","90% of total billed charges ",77.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.57,87,,77.26,,,0,"percent of total billed charges ","87% of total billed charges ",77.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",77.7,70,,62.16,,,0,"percent of total billed charges ","70% of total billed charges ",77.7,117.56,
"HALDOL 5MG/ML 1ML",7031321,"CDM ",636,RC,J1630,HCPCS,OUTPATIENT,,,51,40.8,,,,,,,,0,"other ","not separately reimbursment ",1.62,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",47.43,93,,37.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.35,85,,34.68,,,0,"percent of total billed charges ","85% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.37,87,,35.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",1.62,47.43,
"FORTAZ 2GM ADD/VAN",7031693,"CDM ",636,RC,J0713,HCPCS,OUTPATIENT,,,66,52.8,,,,,,,,0,"other ","not separately reimbursment ",2.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",46.2,70,,36.96,,,0,"percent of total billed charges ","70% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",61.38,93,,49.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",56.1,85,,44.88,,,0,"percent of total billed charges ","85% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",1.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.42,87,,45.94,,,0,"percent of total billed charges ","87% of total billed charges ",1.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",46.2,70,,36.96,,,0,"percent of total billed charges ","70% of total billed charges ",1.97,61.38,
"TORADOL 30MG INJ",7031875,"CDM ",636,RC,J1885,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",0.9,100,,0.98,0.98,0.98,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,35.86,1.27,44.82,17,"percent of total billed charges ","87% of total billed charges ",0.48,100,,0.49,0.49,0.49,"1 through 10","fee schedule ","100% of KS medicaid fee schedule ",0.28,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.28,45.57,
"TORADOL 60MG INJ 2ML",7031958,"CDM ",636,RC,J1885,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",0.9,100,,0.98,0.98,0.98,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,35.86,1.27,44.82,17,"percent of total billed charges ","87% of total billed charges ",0.48,100,,0.49,0.49,0.49,"1 through 10","fee schedule ","100% of KS medicaid fee schedule ",0.28,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.28,45.57,
"XYLO 2% MPF 10ML 20MG/ML",7031974,"CDM ",250,RC,J2003,HCPCS,OUTPATIENT,,,35.5,28.4,,,,,,,,0,"other ","not separately reimbursment ",,,,2.07,2.07,2.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.85,70,,19.88,,,0,"percent of total billed charges ","70% of total billed charges ",31.95,90,,25.56,,,0,"percent of total billed charges ","90% of total billed charges ",33.02,93,,26.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",30.18,85,,24.14,,,0,"percent of total billed charges ","85% of total billed charges ",31.95,90,,25.56,,,0,"percent of total billed charges ","90% of total billed charges ",31.95,90,,25.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.89,87,,24.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.85,70,,19.88,,,0,"percent of total billed charges ","70% of total billed charges ",24.85,33.02,
"BUPIVACAINE MELOXICAM 400/12MG",7031981,"CDM ",636,RC,C9088,HCPCS,OUTPATIENT,,,312.5,250,,,,,,,,0,"other ","not separately reimbursment ",0.86,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",218.75,70,,175.00,,,0,"percent of total billed charges ","70% of total billed charges ",281.25,90,,225.00,,,0,"percent of total billed charges ","90% of total billed charges ",290.63,93,,232.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",265.63,85,,212.50,,,0,"percent of total billed charges ","85% of total billed charges ",281.25,90,,225.00,,,0,"percent of total billed charges ","90% of total billed charges ",281.25,90,,225.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",271.88,87,,217.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",218.75,70,,175.00,,,0,"percent of total billed charges ","70% of total billed charges ",0.86,290.63,
"MARCAINE SPINAL 2ML",7031982,"CDM ",250,RC,J0665,HCPCS,OUTPATIENT,,,51.5,41.2,,,,,,,,0,"other ","not separately reimbursment ",,,,1.69,1.69,1.69,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.05,70,,28.84,,,0,"percent of total billed charges ","70% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",47.9,93,,38.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.78,85,,35.02,,,0,"percent of total billed charges ","85% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.81,87,,33.79,33.79,33.79,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.05,70,,28.84,,,0,"percent of total billed charges ","70% of total billed charges ",36.05,47.9,
"DIPRIVAN 20ML VIAL",7032014,"CDM ",636,RC,J2704,HCPCS,OUTPATIENT,,,85,68,,,,,,,,0,"other ","not separately reimbursment ",0.18,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",59.5,70,,47.60,,,0,"percent of total billed charges ","70% of total billed charges ",76.5,90,,61.20,,,0,"percent of total billed charges ","90% of total billed charges ",79.05,93,,63.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",72.25,85,,57.80,,,0,"percent of total billed charges ","85% of total billed charges ",76.5,90,,61.20,,,0,"percent of total billed charges ","90% of total billed charges ",76.5,90,,61.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",73.95,87,,0.01,0.01,47.06,15,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.5,70,,47.60,,,0,"percent of total billed charges ","70% of total billed charges ",0.18,79.05,
"NEBCIN 1.2 GM VIAL",7032220,"CDM ",636,RC,J3260,HCPCS,OUTPATIENT,,,728.5,582.8,,,,,,,,0,"other ","not separately reimbursment ",3.86,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",509.95,70,,407.96,,,0,"percent of total billed charges ","70% of total billed charges ",655.65,90,,524.52,,,0,"percent of total billed charges ","90% of total billed charges ",677.51,93,,542.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",3.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",619.23,85,,495.38,,,0,"percent of total billed charges ","85% of total billed charges ",655.65,90,,524.52,,,0,"percent of total billed charges ","90% of total billed charges ",655.65,90,,524.52,,,0,"percent of total billed charges ","90% of total billed charges ",3.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",633.8,87,,507.04,,,0,"percent of total billed charges ","87% of total billed charges ",3.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",509.95,70,,407.96,,,0,"percent of total billed charges ","70% of total billed charges ",3.84,677.51,
"DIFLUCAN 200MG INJ",7032253,"CDM ",636,RC,J1450,HCPCS,OUTPATIENT,,,85,68,,,,,,,,0,"other ","not separately reimbursment ",3.59,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",59.5,70,,47.60,,,0,"percent of total billed charges ","70% of total billed charges ",76.5,90,,61.20,,,0,"percent of total billed charges ","90% of total billed charges ",79.05,93,,63.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",5.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",72.25,85,,57.80,,,0,"percent of total billed charges ","85% of total billed charges ",76.5,90,,61.20,,,0,"percent of total billed charges ","90% of total billed charges ",76.5,90,,61.20,,,0,"percent of total billed charges ","90% of total billed charges ",5.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",73.95,87,,59.16,,,0,"percent of total billed charges ","87% of total billed charges ",5.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",59.5,70,,47.60,,,0,"percent of total billed charges ","70% of total billed charges ",3.59,79.05,
"DDAVP 1ML AMP INJ 4MCG/ML",7032378,"CDM ",636,RC,J2597,HCPCS,OUTPATIENT,,,52.5,42,,,,,,,,0,"other ","not separately reimbursment ",8.14,100,,27.84,27.84,27.84,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",48.83,93,,39.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",9.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",44.63,85,,35.70,,,0,"percent of total billed charges ","85% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",9.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.68,87,,36.54,,,0,"percent of total billed charges ","87% of total billed charges ",9.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",8.14,48.83,
"PRIVIGEN 10% 5GM/50ML",7032915,"CDM ",636,RC,J1459,HCPCS,OUTPATIENT,,,1512,1209.6,,,,,,,,0,"other ","not separately reimbursment ",61.96,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1058.4,70,,846.72,,,0,"percent of total billed charges ","70% of total billed charges ",1360.8,90,,1088.64,,,0,"percent of total billed charges ","90% of total billed charges ",1406.16,93,,1124.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1285.2,85,,1028.16,,,0,"percent of total billed charges ","85% of total billed charges ",1360.8,90,,1088.64,,,0,"percent of total billed charges ","90% of total billed charges ",1360.8,90,,1088.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1315.44,87,,1052.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",50.28,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1058.4,70,,846.72,,,0,"percent of total billed charges ","70% of total billed charges ",50.28,1406.16,
"MARCAINE 0.5% 30ML",7032964,"CDM ",636,RC,J0665,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,1.69,1.69,1.69,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,33.79,33.79,33.79,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"NEUPOGEN 300MCG 1ML",7033202,"CDM ",636,RC,J1442,HCPCS,OUTPATIENT,,,712.5,570,,,,,,,,0,"other ","not separately reimbursment ",1.21,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",498.75,70,,399.00,,,0,"percent of total billed charges ","70% of total billed charges ",641.25,90,,513.00,,,0,"percent of total billed charges ","90% of total billed charges ",662.63,93,,530.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",605.63,85,,484.50,,,0,"percent of total billed charges ","85% of total billed charges ",641.25,90,,513.00,,,0,"percent of total billed charges ","90% of total billed charges ",641.25,90,,513.00,,,0,"percent of total billed charges ","90% of total billed charges ",0.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",619.88,87,,495.90,,,0,"percent of total billed charges ","87% of total billed charges ",0.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",498.75,70,,399.00,,,0,"percent of total billed charges ","70% of total billed charges ",0.97,662.63,
"FULPHILA 6MG SYR",7033204,"CDM ",636,RC,Q5108,HCPCS,OUTPATIENT,,,4220,3376,,,,,,,,0,"other ","not separately reimbursment ",220.19,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2954,70,,2363.20,,,0,"percent of total billed charges ","70% of total billed charges ",3798,90,,3038.40,,,0,"percent of total billed charges ","90% of total billed charges ",3924.6,93,,3139.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",213.3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3587,85,,2869.60,,,0,"percent of total billed charges ","85% of total billed charges ",3798,90,,3038.40,,,0,"percent of total billed charges ","90% of total billed charges ",3798,90,,3038.40,,,0,"percent of total billed charges ","90% of total billed charges ",211.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3671.4,87,,2937.12,,,0,"percent of total billed charges ","87% of total billed charges ",211.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",98.87,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2954,70,,2363.20,,,0,"percent of total billed charges ","70% of total billed charges ",98.87,3924.6,
"TBO-FILGRASTIM 300MG",7033206,"CDM ",636,RC,J1447,HCPCS,OUTPATIENT,,,345,276,,,,,,,,0,"other ","not separately reimbursment ",0.56,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",241.5,70,,193.20,,,0,"percent of total billed charges ","70% of total billed charges ",310.5,90,,248.40,,,0,"percent of total billed charges ","90% of total billed charges ",320.85,93,,256.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",293.25,85,,234.60,,,0,"percent of total billed charges ","85% of total billed charges ",310.5,90,,248.40,,,0,"percent of total billed charges ","90% of total billed charges ",310.5,90,,248.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",300.15,87,,240.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",241.5,70,,193.20,,,0,"percent of total billed charges ","70% of total billed charges ",0.25,320.85,
"TBO-FILGRASTIM 480 MG",7033208,"CDM ",636,RC,J1447,HCPCS,OUTPATIENT,,,525,420,,,,,,,,0,"other ","not separately reimbursment ",0.56,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",367.5,70,,294.00,,,0,"percent of total billed charges ","70% of total billed charges ",472.5,90,,378.00,,,0,"percent of total billed charges ","90% of total billed charges ",488.25,93,,390.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",446.25,85,,357.00,,,0,"percent of total billed charges ","85% of total billed charges ",472.5,90,,378.00,,,0,"percent of total billed charges ","90% of total billed charges ",472.5,90,,378.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",456.75,87,,365.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",367.5,70,,294.00,,,0,"percent of total billed charges ","70% of total billed charges ",0.25,488.25,
"SANDOSTATIN 0.05MG AMP",7033236,"CDM ",636,RC,J2354,HCPCS,OUTPATIENT,,,167.5,134,,,,,,,,0,"other ","not separately reimbursment ",1.44,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",117.25,70,,93.80,,,0,"percent of total billed charges ","70% of total billed charges ",150.75,90,,120.60,,,0,"percent of total billed charges ","90% of total billed charges ",155.78,93,,124.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",142.38,85,,113.90,,,0,"percent of total billed charges ","85% of total billed charges ",150.75,90,,120.60,,,0,"percent of total billed charges ","90% of total billed charges ",150.75,90,,120.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",145.73,87,,116.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.25,70,,93.80,,,0,"percent of total billed charges ","70% of total billed charges ",1.44,155.78,
"HEP B 5MCG/0.5ML PED",7033335,"CDM ",636,RC,90744,HCPCS,OUTPATIENT,,,63,50.4,,,,,,,,0,"other ","not separately reimbursment ",38.54,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.1,70,,35.28,,,0,"percent of total billed charges ","70% of total billed charges ",56.7,90,,45.36,,,0,"percent of total billed charges ","90% of total billed charges ",58.59,93,,46.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",53.55,85,,42.84,,,0,"percent of total billed charges ","85% of total billed charges ",56.7,90,,45.36,,,0,"percent of total billed charges ","90% of total billed charges ",56.7,90,,45.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",54.81,87,,43.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.1,70,,35.28,,,0,"percent of total billed charges ","70% of total billed charges ",38.54,58.59,
"ENGERIX-B 10MCG/PFS VFC",7033336,"CDM ",636,RC,90744,HCPCS,OUTPATIENT,,,45,36,,,,,,,,0,"other ","not separately reimbursment ",38.54,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.15,87,,31.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",31.5,41.85,
"ROCEPHIN GM2 VIAL",7033392,"CDM ",636,RC,J0696,HCPCS,OUTPATIENT,,,111.5,89.2,,,,,,,,0,"other ","not separately reimbursment ",0.69,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",78.05,70,,62.44,,,0,"percent of total billed charges ","70% of total billed charges ",100.35,90,,80.28,,,0,"percent of total billed charges ","90% of total billed charges ",103.7,93,,82.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.51,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",94.78,85,,75.82,,,0,"percent of total billed charges ","85% of total billed charges ",100.35,90,,80.28,,,0,"percent of total billed charges ","90% of total billed charges ",100.35,90,,80.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",97.01,87,,1.83,0.39,41.08,12,"percent of total billed charges ","87% of total billed charges ",0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",78.05,70,,62.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.5,103.7,
"INFED 50MG/ML 2ML",7033566,"CDM ",636,RC,J1750,HCPCS,OUTPATIENT,,,62.5,50,,,,,,,,0,"other ","not separately reimbursment ",22.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,3.45,3.45,3.45,"1 through 10","other ","not separately reimbursment ",43.75,70,,35.00,,,0,"percent of total billed charges ","70% of total billed charges ",56.25,90,,45.00,,,0,"percent of total billed charges ","90% of total billed charges ",58.13,93,,46.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",53.13,85,,42.50,,,0,"percent of total billed charges ","85% of total billed charges ",56.25,90,,45.00,,,0,"percent of total billed charges ","90% of total billed charges ",56.25,90,,45.00,,,0,"percent of total billed charges ","90% of total billed charges ",15.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.38,87,,10.14,10.14,10.14,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.07,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",43.75,70,,35.00,,,0,"percent of total billed charges ","70% of total billed charges ",15.84,58.13,
"BUPIVACAINE 0.125% 20ML",7033572,"CDM ",636,RC,J0666,HCPCS,OUTPATIENT,,,49.5,39.6,,,,,,,,0,"other ","not separately reimbursment ",,,,42.93,42.93,42.93,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",46.04,93,,36.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.08,85,,33.66,,,0,"percent of total billed charges ","85% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.07,87,,38.09,33.74,42.44,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.29,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",1.29,46.04,
"MARCAINE 0.25% 10ML",7033574,"CDM ",250,RC,J0665,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,1.69,1.69,1.69,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,33.79,33.79,33.79,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"MARCAINE 0.5% W/EPI 30ML",7033582,"CDM ",250,RC,J0665,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,1.69,1.69,1.69,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,33.79,33.79,33.79,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"NESCAINE 3% INJ",7033632,"CDM ",636,RC,J2400,HCPCS,OUTPATIENT,,,75.5,60.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",70.22,93,,56.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",64.18,85,,51.34,,,0,"percent of total billed charges ","85% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",65.69,87,,52.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",52.85,70.22,
"DIPRIVAN 50ML VIAL",7033640,"CDM ",636,RC,J2704,HCPCS,OUTPATIENT,,,104,83.2,,,,,,,,0,"other ","not separately reimbursment ",0.18,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",72.8,70,,58.24,,,0,"percent of total billed charges ","70% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",96.72,93,,77.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",88.4,85,,70.72,,,0,"percent of total billed charges ","85% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",90.48,87,,0.01,0.01,47.06,15,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.8,70,,58.24,,,0,"percent of total billed charges ","70% of total billed charges ",0.18,96.72,
"ACTIVASE 100MG/VIAL",7033848,"CDM ",636,RC,J2997,HCPCS,OUTPATIENT,,,15255,12204,,,,,,,,0,"other ","not separately reimbursment ",112.88,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",10678.5,70,,8542.80,,,0,"percent of total billed charges ","70% of total billed charges ",13729.5,90,,10983.60,,,0,"percent of total billed charges ","90% of total billed charges ",14187.15,93,,11349.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",88.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",12966.75,85,,10373.40,,,0,"percent of total billed charges ","85% of total billed charges ",13729.5,90,,10983.60,,,0,"percent of total billed charges ","90% of total billed charges ",13729.5,90,,10983.60,,,0,"percent of total billed charges ","90% of total billed charges ",87.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13271.85,87,,10617.48,,,0,"percent of total billed charges ","87% of total billed charges ",87.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",10678.5,70,,8542.80,,,0,"percent of total billed charges ","70% of total billed charges ",87.75,14187.15,
"VANCOMYCIN 1GM INJ",7033905,"CDM ",636,RC,J3373,HCPCS,OUTPATIENT,,,51,40.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",47.43,93,,37.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.35,85,,34.68,,,0,"percent of total billed charges ","85% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.37,87,,35.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",35.7,47.43,
"DALBAVANCIN 500 MG VIAL",7033906,"CDM ",636,RC,J0875,HCPCS,OUTPATIENT,,,7330,5864,,,,,,,,0,"other ","not separately reimbursment ",19.65,100,,5600.25,5600.25,5600.25,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",5131,70,,4104.80,,,0,"percent of total billed charges ","70% of total billed charges ",6597,90,,5277.60,,,0,"percent of total billed charges ","90% of total billed charges ",6816.9,93,,5453.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",16.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",6230.5,85,,4984.40,,,0,"percent of total billed charges ","85% of total billed charges ",6597,90,,5277.60,,,0,"percent of total billed charges ","90% of total billed charges ",6597,90,,5277.60,,,0,"percent of total billed charges ","90% of total billed charges ",15.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6377.1,87,,5101.68,,,0,"percent of total billed charges ","87% of total billed charges ",15.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.59,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",5131,70,,4104.80,,,0,"percent of total billed charges ","70% of total billed charges ",15.59,6816.9,
"VANCOMYCIN 1750MG VIAL",7033907,"CDM ",636,RC,J3371,HCPCS,OUTPATIENT,,,147,117.6,,,,,,,,0,"other ","not separately reimbursment ",8.85,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",102.9,70,,82.32,,,0,"percent of total billed charges ","70% of total billed charges ",132.3,90,,105.84,,,0,"percent of total billed charges ","90% of total billed charges ",136.71,93,,109.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",124.95,85,,99.96,,,0,"percent of total billed charges ","85% of total billed charges ",132.3,90,,105.84,,,0,"percent of total billed charges ","90% of total billed charges ",132.3,90,,105.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",127.89,87,,102.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.9,70,,82.32,,,0,"percent of total billed charges ","70% of total billed charges ",8.85,136.71,
"ADENOCARD 6MG INJ",7034333,"CDM ",636,RC,J0153,HCPCS,OUTPATIENT,,,64,51.2,,,,,,,,0,"other ","not separately reimbursment ",0.71,100,,6.88,6.88,6.88,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.8,70,,35.84,,,0,"percent of total billed charges ","70% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",59.52,93,,47.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.54,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",54.4,85,,43.52,,,0,"percent of total billed charges ","85% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",0.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",55.68,87,,44.54,,,0,"percent of total billed charges ","87% of total billed charges ",0.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.8,70,,35.84,,,0,"percent of total billed charges ","70% of total billed charges ",0.53,59.52,
"PRELONE SYRUP 15MG/5ML 30ML",7034721,"CDM ",637,RC,J7510,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",0.37,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",0.37,11.63,
"LOVENOX 30MG/0.3ML SYR",7034762,"CDM ",636,RC,J1650,HCPCS,OUTPATIENT,,,54.5,43.6,,,,,,,,0,"other ","not separately reimbursment ",0.8,100,,2.74,2.74,2.74,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",38.15,70,,30.52,,,0,"percent of total billed charges ","70% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",50.69,93,,40.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",46.33,85,,37.06,,,0,"percent of total billed charges ","85% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.42,87,,37.24,33.93,40.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",38.15,70,,30.52,,,0,"percent of total billed charges ","70% of total billed charges ",0.76,50.69,
"PRIVIGEN 10% 20GM",7035025,"CDM ",636,RC,J1459,HCPCS,OUTPATIENT,,,5400,4320,,,,,,,,0,"other ","not separately reimbursment ",61.96,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3780,70,,3024.00,,,0,"percent of total billed charges ","70% of total billed charges ",4860,90,,3888.00,,,0,"percent of total billed charges ","90% of total billed charges ",5022,93,,4017.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4590,85,,3672.00,,,0,"percent of total billed charges ","85% of total billed charges ",4860,90,,3888.00,,,0,"percent of total billed charges ","90% of total billed charges ",4860,90,,3888.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4698,87,,3758.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",50.28,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3780,70,,3024.00,,,0,"percent of total billed charges ","70% of total billed charges ",50.28,5022,
"GAMMAKED 10% 20GM 200ML VIAL",7035026,"CDM ",636,RC,J1561,HCPCS,OUTPATIENT,,,6573.5,5258.8,,,,,,,,0,"other ","not separately reimbursment ",63.59,100,,2416.42,2416.42,2416.42,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",4601.45,70,,3681.16,,,0,"percent of total billed charges ","70% of total billed charges ",5916.15,90,,4732.92,,,0,"percent of total billed charges ","90% of total billed charges ",6113.36,93,,4890.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5587.48,85,,4469.98,,,0,"percent of total billed charges ","85% of total billed charges ",5916.15,90,,4732.92,,,0,"percent of total billed charges ","90% of total billed charges ",5916.15,90,,4732.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5718.95,87,,4575.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",49.08,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4601.45,70,,3681.16,,,0,"percent of total billed charges ","70% of total billed charges ",49.08,6113.36,
"CORTROSYN 0.25MG/ML 1ML",7035124,"CDM ",636,RC,J0834,HCPCS,OUTPATIENT,,,250.5,200.4,,,,,,,,0,"other ","not separately reimbursment ",36.78,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",175.35,70,,140.28,,,0,"percent of total billed charges ","70% of total billed charges ",225.45,90,,180.36,,,0,"percent of total billed charges ","90% of total billed charges ",232.97,93,,186.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",35.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",212.93,85,,170.34,,,0,"percent of total billed charges ","85% of total billed charges ",225.45,90,,180.36,,,0,"percent of total billed charges ","90% of total billed charges ",225.45,90,,180.36,,,0,"percent of total billed charges ","90% of total billed charges ",35.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.94,87,,174.35,,,0,"percent of total billed charges ","87% of total billed charges ",35.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",175.35,70,,140.28,,,0,"percent of total billed charges ","70% of total billed charges ",35.63,232.97,
"LUPRON DEPOT 3.75 MG KIT IM",7035330,"CDM ",636,RC,J1950,HCPCS,OUTPATIENT,,,2346.5,1877.2,,,,,,,,0,"other ","not separately reimbursment ",2027.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1642.55,70,,1314.04,,,0,"percent of total billed charges ","70% of total billed charges ",2111.85,90,,1689.48,,,0,"percent of total billed charges ","90% of total billed charges ",2182.25,93,,1745.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1420.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1994.53,85,,1595.62,,,0,"percent of total billed charges ","85% of total billed charges ",2111.85,90,,1689.48,,,0,"percent of total billed charges ","90% of total billed charges ",2111.85,90,,1689.48,,,0,"percent of total billed charges ","90% of total billed charges ",1406.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2041.46,87,,1633.17,,,0,"percent of total billed charges ","87% of total billed charges ",1406.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1763.87,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1642.55,70,,1314.04,,,0,"percent of total billed charges ","70% of total billed charges ",1406.37,2182.25,
"LEQVIO INCLISIRAN 284MG PFS",7035365,"CDM ",636,RC,J1306,HCPCS,OUTPATIENT,,,3418.5,2734.8,,,,,,,,0,"other ","not separately reimbursment ",15.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2392.95,70,,1914.36,,,0,"percent of total billed charges ","70% of total billed charges ",3076.65,90,,2461.32,,,0,"percent of total billed charges ","90% of total billed charges ",3179.21,93,,2543.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2905.73,85,,2324.58,,,0,"percent of total billed charges ","85% of total billed charges ",3076.65,90,,2461.32,,,0,"percent of total billed charges ","90% of total billed charges ",3076.65,90,,2461.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2974.1,87,,2379.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",12.69,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2392.95,70,,1914.36,,,0,"percent of total billed charges ","70% of total billed charges ",12.69,3179.21,
"NARCAN 1MG/ML 2ML",7035405,"CDM ",636,RC,J2312,HCPCS,OUTPATIENT,,,52,41.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.4,70,,29.12,,,0,"percent of total billed charges ","70% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",48.36,93,,38.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",44.2,85,,35.36,,,0,"percent of total billed charges ","85% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",45.24,87,,36.19,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.4,70,,29.12,,,0,"percent of total billed charges ","70% of total billed charges ",36.4,48.36,
"ZOFRAN 2MG/ML  2ML VIAL",7035462,"CDM ",636,RC,J2405,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",0.13,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,39.65,21.78,39.65,14,"percent of total billed charges ","87% of total billed charges ",0.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.09,45.57,
"CALCIMAR 400U VIAL-I 2ML",7035983,"CDM ",636,RC,J0630,HCPCS,OUTPATIENT,,,3847,3077.6,,,,,,,,0,"other ","not separately reimbursment ",1417.27,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2692.9,70,,2154.32,,,0,"percent of total billed charges ","70% of total billed charges ",3462.3,90,,2769.84,,,0,"percent of total billed charges ","90% of total billed charges ",3577.71,93,,2862.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",3131.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3269.95,85,,2615.96,,,0,"percent of total billed charges ","85% of total billed charges ",3462.3,90,,2769.84,,,0,"percent of total billed charges ","90% of total billed charges ",3462.3,90,,2769.84,,,0,"percent of total billed charges ","90% of total billed charges ",3100.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3346.89,87,,2677.51,,,0,"percent of total billed charges ","87% of total billed charges ",3100.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2692.9,70,,2154.32,,,0,"percent of total billed charges ","70% of total billed charges ",1417.27,3577.71,
"NUBAIN 10MG/ML - INJ",7036114,"CDM ",636,RC,J2300,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",3.57,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",2.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",2.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",2.85,45.57,
"BENTYL INJ 10MG 10ML",7036346,"CDM ",636,RC,J0500,HCPCS,OUTPATIENT,,,51,40.8,,,,,,,,0,"other ","not separately reimbursment ",32.12,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",47.43,93,,37.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",33.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",43.35,85,,34.68,,,0,"percent of total billed charges ","85% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",32.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",44.37,87,,35.50,,,0,"percent of total billed charges ","87% of total billed charges ",32.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",32.12,47.43,
"AMPICILLIN 125MG INJ",7036551,"CDM ",636,RC,J0290,HCPCS,OUTPATIENT,,,47.5,38,,,,,,,,0,"other ","not separately reimbursment ",1.04,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.25,70,,26.60,,,0,"percent of total billed charges ","70% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",44.18,93,,35.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",40.38,85,,32.30,,,0,"percent of total billed charges ","85% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",0.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.33,87,,33.06,,,0,"percent of total billed charges ","87% of total billed charges ",0.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.25,70,,26.60,,,0,"percent of total billed charges ","70% of total billed charges ",0.81,44.18,
"DEXAMETHASONE 4MG/ML 1ML",7036734,"CDM ",636,RC,J1100,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",0.15,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,0.24,0.24,0.24,"1 through 10","other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,0.08,0.01,37.21,14,"percent of total billed charges ","87% of total billed charges ",0.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.12,45.57,
"DOPAMINE 200MG/5ML",7036759,"CDM ",636,RC,J1265,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",0.37,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.37,45.57,
"HEPARIN SOD 1000U/ML 30ML",7036924,"CDM ",636,RC,J1644,HCPCS,OUTPATIENT,,,46.5,37.2,,,,,,,,0,"other ","not separately reimbursment ",0.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",43.25,93,,34.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.53,85,,31.62,,,0,"percent of total billed charges ","85% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",0.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.46,87,,32.37,,,0,"percent of total billed charges ","87% of total billed charges ",0.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",0.25,43.25,
"METRONIDAZOLE 500MG PREMIX",7036957,"CDM ",250,RC,J1836,HCPCS,OUTPATIENT,,,90,72,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",63,83.7,
"PROMETHAZINE 25MG INJ",7037013,"CDM ",636,RC,J2550,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",3.99,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",2.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",2.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",2.37,45.57,
"PROMETHAZINE 50MG INJ",7037021,"CDM ",636,RC,J2550,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",3.99,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",2.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",2.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",2.37,45.57,
"PREDNISONE 20MG TAB",7037039,"CDM ",637,RC,J7512,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"GENTAMICIN SUL PED",7037286,"CDM ",636,RC,J1580,HCPCS,OUTPATIENT,,,47.5,38,,,,,,,,0,"other ","not separately reimbursment ",4.13,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.25,70,,26.60,,,0,"percent of total billed charges ","70% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",44.18,93,,35.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",40.38,85,,32.30,,,0,"percent of total billed charges ","85% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",1.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.33,87,,1.46,1.46,2.24,"1 through 10","percent of total billed charges ","87% of total billed charges ",1.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.25,70,,26.60,,,0,"percent of total billed charges ","70% of total billed charges ",1.68,44.18,
"GENTAMICIN SUL 40MG/ML",7037294,"CDM ",636,RC,J1580,HCPCS,OUTPATIENT,,,29,23.2,,,,,,,,0,"other ","not separately reimbursment ",4.13,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.3,70,,16.24,,,0,"percent of total billed charges ","70% of total billed charges ",26.1,90,,20.88,,,0,"percent of total billed charges ","90% of total billed charges ",26.97,93,,21.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",24.65,85,,19.72,,,0,"percent of total billed charges ","85% of total billed charges ",26.1,90,,20.88,,,0,"percent of total billed charges ","90% of total billed charges ",26.1,90,,20.88,,,0,"percent of total billed charges ","90% of total billed charges ",1.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.23,87,,1.46,1.46,2.24,"1 through 10","percent of total billed charges ","87% of total billed charges ",1.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.3,70,,16.24,,,0,"percent of total billed charges ","70% of total billed charges ",1.68,26.97,
"CHLORPROMAZINE 25MG TAB",7037310,"CDM ",636,RC,Q0161,HCPCS,OUTPATIENT,,,25.5,20.4,,,,,,,,0,"other ","not separately reimbursment ",2.18,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.85,70,,14.28,,,0,"percent of total billed charges ","70% of total billed charges ",22.95,90,,18.36,,,0,"percent of total billed charges ","90% of total billed charges ",23.72,93,,18.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.68,85,,17.34,,,0,"percent of total billed charges ","85% of total billed charges ",22.95,90,,18.36,,,0,"percent of total billed charges ","90% of total billed charges ",22.95,90,,18.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.19,87,,17.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.85,70,,14.28,,,0,"percent of total billed charges ","70% of total billed charges ",2.18,23.72,
"PROLIXIN 0 25MG/ML MDV 5ML",7037773,"CDM ",636,RC,J2680,HCPCS,OUTPATIENT,,,263.5,210.8,,,,,,,,0,"other ","not separately reimbursment ",12.51,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",184.45,70,,147.56,,,0,"percent of total billed charges ","70% of total billed charges ",237.15,90,,189.72,,,0,"percent of total billed charges ","90% of total billed charges ",245.06,93,,196.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",10.4,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",223.98,85,,179.18,,,0,"percent of total billed charges ","85% of total billed charges ",237.15,90,,189.72,,,0,"percent of total billed charges ","90% of total billed charges ",237.15,90,,189.72,,,0,"percent of total billed charges ","90% of total billed charges ",10.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",229.25,87,,183.40,,,0,"percent of total billed charges ","87% of total billed charges ",10.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",184.45,70,,147.56,,,0,"percent of total billed charges ","70% of total billed charges ",10.3,245.06,
"VERSED 5MG/MLVIAL 1ML",7038524,"CDM ",636,RC,J2250,HCPCS,OUTPATIENT,,,50,40,,,,,,,,0,"other ","not separately reimbursment ",0.18,100,,1.60,1.60,1.60,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",46.5,93,,37.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.5,85,,34.00,,,0,"percent of total billed charges ","85% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.5,87,,39.65,15.27,43.62,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",0.18,46.5,
"VANCOMYCIN 500MG ADV",7038714,"CDM ",636,RC,J3373,HCPCS,OUTPATIENT,,,47,37.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",43.71,93,,34.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.95,85,,31.96,,,0,"percent of total billed charges ","85% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.89,87,,32.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",32.9,43.71,
"LORAZEPAM 2MG/ML 1ML VIAL",7038847,"CDM ",636,RC,J2060,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",1.24,100,,0.94,0.94,0.94,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,20.05,4.02,36.07,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.78,45.57,
"HUMULIN R 100U/ML 10ML",7039092,"CDM ",637,RC,J1815,HCPCS,OUTPATIENT,,,34,27.2,,,,,,,,0,"other ","not separately reimbursment ",0.27,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.8,70,,19.04,,,0,"percent of total billed charges ","70% of total billed charges ",30.6,90,,24.48,,,0,"percent of total billed charges ","90% of total billed charges ",31.62,93,,25.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",28.9,85,,23.12,,,0,"percent of total billed charges ","85% of total billed charges ",30.6,90,,24.48,,,0,"percent of total billed charges ","90% of total billed charges ",30.6,90,,24.48,,,0,"percent of total billed charges ","90% of total billed charges ",0.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.58,87,,23.66,,,0,"percent of total billed charges ","87% of total billed charges ",0.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.8,70,,19.04,,,0,"percent of total billed charges ","70% of total billed charges ",0.27,31.62,
"NOVULIN 70/30 100UML",7039233,"CDM ",637,RC,J1815,HCPCS,OUTPATIENT,,,42,33.6,,,,,,,,0,"other ","not separately reimbursment ",0.27,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",29.4,70,,23.52,,,0,"percent of total billed charges ","70% of total billed charges ",37.8,90,,30.24,,,0,"percent of total billed charges ","90% of total billed charges ",39.06,93,,31.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",35.7,85,,28.56,,,0,"percent of total billed charges ","85% of total billed charges ",37.8,90,,30.24,,,0,"percent of total billed charges ","90% of total billed charges ",37.8,90,,30.24,,,0,"percent of total billed charges ","90% of total billed charges ",0.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.54,87,,29.23,,,0,"percent of total billed charges ","87% of total billed charges ",0.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",29.4,70,,23.52,,,0,"percent of total billed charges ","70% of total billed charges ",0.27,39.06,
"METHOTREXATE SODIUM 2.5MG TAB",7039340,"CDM ",636,RC,J8610,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",0.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",0.35,11.63,
"UNASYN 3GM VIAL",7039555,"CDM ",636,RC,J0295,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",2.33,100,,1.77,1.77,1.77,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",2.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",2.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",2.21,45.57,
"VERSED 2MG/2ML AMP",7039621,"CDM ",636,RC,J2250,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",0.18,100,,1.60,1.60,1.60,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,39.65,15.27,43.62,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.18,45.57,
"MARCAINE 0.75% 10ML",7039712,"CDM ",250,RC,J0665,HCPCS,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",,,,1.69,1.69,1.69,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.76,87,,33.79,33.79,33.79,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",33.6,44.64,
"SANDOSTATIN .1MG AMP",7039837,"CDM ",636,RC,J2354,HCPCS,OUTPATIENT,,,49.5,39.6,,,,,,,,0,"other ","not separately reimbursment ",1.44,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",46.04,93,,36.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.08,85,,33.66,,,0,"percent of total billed charges ","85% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.07,87,,34.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",1.44,46.04,
"AMPICILLIN 1GM ADVL",7040439,"CDM ",636,RC,J0290,HCPCS,OUTPATIENT,,,60,48,,,,,,,,0,"other ","not separately reimbursment ",1.04,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",42,70,,33.60,,,0,"percent of total billed charges ","70% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",55.8,93,,44.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",51,85,,40.80,,,0,"percent of total billed charges ","85% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",0.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",52.2,87,,41.76,,,0,"percent of total billed charges ","87% of total billed charges ",0.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",42,70,,33.60,,,0,"percent of total billed charges ","70% of total billed charges ",0.81,55.8,
"AMPICILLIN 500MG VL",7040447,"CDM ",636,RC,J0290,HCPCS,OUTPATIENT,,,47,37.6,,,,,,,,0,"other ","not separately reimbursment ",1.04,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",43.71,93,,34.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.95,85,,31.96,,,0,"percent of total billed charges ","85% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",0.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.89,87,,32.71,,,0,"percent of total billed charges ","87% of total billed charges ",0.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",0.81,43.71,
"AMOXICILLIN 400MG 5ML 100ML BT",7040474,"CDM ",259,RC,G9315,HCPCS,OUTPATIENT,,,33.5,26.8,,,,,,,,0,"other ","not separately reimbursment ",,,,28.48,28.48,28.48,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",31.16,93,,24.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.48,85,,22.78,,,0,"percent of total billed charges ","85% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.15,87,,23.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",23.45,31.16,
"ALBUMARC 25% 100ML",7040629,"CDM ",636,RC,P9046,HCPCS,OUTPATIENT,,,387.5,310,,,,,,,,0,"other ","not separately reimbursment ",27.69,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",271.25,70,,217.00,,,0,"percent of total billed charges ","70% of total billed charges ",348.75,90,,279.00,,,0,"percent of total billed charges ","90% of total billed charges ",360.38,93,,288.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",21.19,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",329.38,85,,263.50,,,0,"percent of total billed charges ","85% of total billed charges ",348.75,90,,279.00,,,0,"percent of total billed charges ","90% of total billed charges ",348.75,90,,279.00,,,0,"percent of total billed charges ","90% of total billed charges ",20.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",337.13,87,,269.70,,,0,"percent of total billed charges ","87% of total billed charges ",20.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",271.25,70,,217.00,,,0,"percent of total billed charges ","70% of total billed charges ",20.98,360.38,
"MARCAINE 0.25% 50ML",7041361,"CDM ",250,RC,J0665,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,1.69,1.69,1.69,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,33.79,33.79,33.79,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"MARCAINE 0.25% W/EPI 30ML",7041379,"CDM ",250,RC,J0665,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,1.69,1.69,1.69,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,33.79,33.79,33.79,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"AMPICILLIN 2GM ADVL",7041601,"CDM ",636,RC,J0290,HCPCS,OUTPATIENT,,,74.5,59.6,,,,,,,,0,"other ","not separately reimbursment ",1.04,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",69.29,93,,55.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",63.33,85,,50.66,,,0,"percent of total billed charges ","85% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",0.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.82,87,,51.86,,,0,"percent of total billed charges ","87% of total billed charges ",0.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",0.81,69.29,
"VENTOLIN 2.5MG/3ML NEB",7041999,"CDM ",637,RC,J7613,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",0.31,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",0.31,11.63,
"XYLO-EPI 2% 20ML MPF 20MG/ML",7042047,"CDM ",250,RC,J2004,HCPCS,OUTPATIENT,,,50.5,40.4,,,,,,,,0,"other ","not separately reimbursment ",,,,1.44,1.44,1.44,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.35,70,,28.28,,,0,"percent of total billed charges ","70% of total billed charges ",45.45,90,,36.36,,,0,"percent of total billed charges ","90% of total billed charges ",46.97,93,,37.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.93,85,,34.34,,,0,"percent of total billed charges ","85% of total billed charges ",45.45,90,,36.36,,,0,"percent of total billed charges ","90% of total billed charges ",45.45,90,,36.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.94,87,,35.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.35,70,,28.28,,,0,"percent of total billed charges ","70% of total billed charges ",35.35,46.97,
"STADOL 2MG/ML 1ML",7042096,"CDM ",636,RC,J0595,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",4.61,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",2.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",2.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",2.94,45.57,
"LIDOCAINE 4% 5ML 40MG/ML",7042138,"CDM ",250,RC,J2003,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,2.07,2.07,2.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"PREDNISONE 1MG TAB",7042252,"CDM ",637,RC,J7512,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"EPOGEN 10,000UNIT/ML",7042781,"CDM ",636,RC,J0885,HCPCS,OUTPATIENT,,,512.5,410,,,,,,,,0,"other ","not separately reimbursment ",10.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",358.75,70,,287.00,,,0,"percent of total billed charges ","70% of total billed charges ",461.25,90,,369.00,,,0,"percent of total billed charges ","90% of total billed charges ",476.63,93,,381.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",8.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",435.63,85,,348.50,,,0,"percent of total billed charges ","85% of total billed charges ",461.25,90,,369.00,,,0,"percent of total billed charges ","90% of total billed charges ",461.25,90,,369.00,,,0,"percent of total billed charges ","90% of total billed charges ",8.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",445.88,87,,356.70,,,0,"percent of total billed charges ","87% of total billed charges ",8.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.74,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",358.75,70,,287.00,,,0,"percent of total billed charges ","70% of total billed charges ",7.74,476.63,
"ARANESP 100 MCG SYR",7042782,"CDM ",636,RC,J0881,HCPCS,OUTPATIENT,,,819,655.2,,,,,,,,0,"other ","not separately reimbursment ",3.77,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",573.3,70,,458.64,,,0,"percent of total billed charges ","70% of total billed charges ",737.1,90,,589.68,,,0,"percent of total billed charges ","90% of total billed charges ",761.67,93,,609.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",3.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",696.15,85,,556.92,,,0,"percent of total billed charges ","85% of total billed charges ",737.1,90,,589.68,,,0,"percent of total billed charges ","90% of total billed charges ",737.1,90,,589.68,,,0,"percent of total billed charges ","90% of total billed charges ",3.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",712.53,87,,570.02,,,0,"percent of total billed charges ","87% of total billed charges ",3.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.02,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",573.3,70,,458.64,,,0,"percent of total billed charges ","70% of total billed charges ",3.02,761.67,
"RETACRIT EPOETINALPHAEPBX 1000",7042783,"CDM ",636,RC,Q5106,HCPCS,OUTPATIENT,,,155.5,124.4,,,,,,,,0,"other ","not separately reimbursment ",9.66,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",108.85,70,,87.08,,,0,"percent of total billed charges ","70% of total billed charges ",139.95,90,,111.96,,,0,"percent of total billed charges ","90% of total billed charges ",144.62,93,,115.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",8.75,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",132.18,85,,105.74,,,0,"percent of total billed charges ","85% of total billed charges ",139.95,90,,111.96,,,0,"percent of total billed charges ","90% of total billed charges ",139.95,90,,111.96,,,0,"percent of total billed charges ","90% of total billed charges ",8.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",135.29,87,,108.23,,,0,"percent of total billed charges ","87% of total billed charges ",8.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.57,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",108.85,70,,87.08,,,0,"percent of total billed charges ","70% of total billed charges ",7.57,144.62,
"NON ESRD EPOETIN 10,000UN 1MLV",7042784,"CDM ",636,RC,J0885,HCPCS,OUTPATIENT,,,211,168.8,,,,,,,,0,"other ","not separately reimbursment ",10.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",147.7,70,,118.16,,,0,"percent of total billed charges ","70% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",196.23,93,,156.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",8.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",179.35,85,,143.48,,,0,"percent of total billed charges ","85% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",8.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",183.57,87,,146.86,,,0,"percent of total billed charges ","87% of total billed charges ",8.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.74,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",147.7,70,,118.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.74,196.23,
"ESRD EPIETIN 100 UNINTS 1MLVL",7042785,"CDM ",636,RC,Q4081,HCPCS,OUTPATIENT,,,211,168.8,,,,,,,,0,"other ","not separately reimbursment ",1.06,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",147.7,70,,118.16,,,0,"percent of total billed charges ","70% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",196.23,93,,156.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.83,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",179.35,85,,143.48,,,0,"percent of total billed charges ","85% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",0.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",183.57,87,,146.86,,,0,"percent of total billed charges ","87% of total billed charges ",0.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",147.7,70,,118.16,,,0,"percent of total billed charges ","70% of total billed charges ",0.82,196.23,
"VITAMIN K 10MG/ML",7043292,"CDM ",636,RC,J3430,HCPCS,OUTPATIENT,,,85,68,,,,,,,,0,"other ","not separately reimbursment ",3.61,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",59.5,70,,47.60,,,0,"percent of total billed charges ","70% of total billed charges ",76.5,90,,61.20,,,0,"percent of total billed charges ","90% of total billed charges ",79.05,93,,63.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",3.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",72.25,85,,57.80,,,0,"percent of total billed charges ","85% of total billed charges ",76.5,90,,61.20,,,0,"percent of total billed charges ","90% of total billed charges ",76.5,90,,61.20,,,0,"percent of total billed charges ","90% of total billed charges ",3.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",73.95,87,,59.16,,,0,"percent of total billed charges ","87% of total billed charges ",3.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",59.5,70,,47.60,,,0,"percent of total billed charges ","70% of total billed charges ",3.56,79.05,
"VITAMIN K1 1MG/0.5ML",7043318,"CDM ",636,RC,J3430,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",3.61,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",3.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",3.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",3.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",3.56,45.57,
"DEXAMETH 4MG/ML 5ML",7043722,"CDM ",636,RC,J1100,HCPCS,OUTPATIENT,,,52.5,42,,,,,,,,0,"other ","not separately reimbursment ",0.15,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,0.24,0.24,0.24,"1 through 10","other ","not separately reimbursment ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",48.83,93,,39.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",44.63,85,,35.70,,,0,"percent of total billed charges ","85% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",0.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.68,87,,0.08,0.01,37.21,14,"percent of total billed charges ","87% of total billed charges ",0.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",0.12,48.83,
"TOBRAMYCIN 80MG VL",7043896,"CDM ",636,RC,J3260,HCPCS,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",3.86,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",3.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",3.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",3.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",3.84,44.64,
"AMPICILLIN 250MG VL",7044068,"CDM ",636,RC,J0290,HCPCS,OUTPATIENT,,,47.5,38,,,,,,,,0,"other ","not separately reimbursment ",1.04,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.25,70,,26.60,,,0,"percent of total billed charges ","70% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",44.18,93,,35.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",40.38,85,,32.30,,,0,"percent of total billed charges ","85% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",0.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.33,87,,33.06,,,0,"percent of total billed charges ","87% of total billed charges ",0.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.25,70,,26.60,,,0,"percent of total billed charges ","70% of total billed charges ",0.81,44.18,
"CHLORPROMAZINE 50 MG/2ML INJ",7044340,"CDM ",636,RC,J3230,HCPCS,OUTPATIENT,,,60,48,,,,,,,,0,"other ","not separately reimbursment ",35.94,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",42,70,,33.60,,,0,"percent of total billed charges ","70% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",55.8,93,,44.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",33.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",51,85,,40.80,,,0,"percent of total billed charges ","85% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",32.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",52.2,87,,41.76,,,0,"percent of total billed charges ","87% of total billed charges ",32.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",42,70,,33.60,,,0,"percent of total billed charges ","70% of total billed charges ",32.87,55.8,
"FENTANYL 50MCG/ML10ML",7045008,"CDM ",636,RC,J3010,HCPCS,OUTPATIENT,,,698.5,558.8,,,,,,,,0,"other ","not separately reimbursment ",1.25,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",488.95,70,,391.16,,,0,"percent of total billed charges ","70% of total billed charges ",628.65,90,,502.92,,,0,"percent of total billed charges ","90% of total billed charges ",649.61,93,,519.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",593.73,85,,474.98,,,0,"percent of total billed charges ","85% of total billed charges ",628.65,90,,502.92,,,0,"percent of total billed charges ","90% of total billed charges ",628.65,90,,502.92,,,0,"percent of total billed charges ","90% of total billed charges ",0.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",607.7,87,,40.95,30.39,42.84,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",488.95,70,,391.16,,,0,"percent of total billed charges ","70% of total billed charges ",0.63,649.61,
"TETANUS IMMUNEGLOB 250U/ML 1ML",7045123,"CDM ",636,RC,J1670,HCPCS,OUTPATIENT,,,932.5,746,,,,,,,,0,"other ","not separately reimbursment ",744.32,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",652.75,70,,522.20,,,0,"percent of total billed charges ","70% of total billed charges ",839.25,90,,671.40,,,0,"percent of total billed charges ","90% of total billed charges ",867.23,93,,693.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",446.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",792.63,85,,634.10,,,0,"percent of total billed charges ","85% of total billed charges ",839.25,90,,671.40,,,0,"percent of total billed charges ","90% of total billed charges ",839.25,90,,671.40,,,0,"percent of total billed charges ","90% of total billed charges ",441.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",811.28,87,,649.02,,,0,"percent of total billed charges ","87% of total billed charges ",441.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",588.54,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",652.75,70,,522.20,,,0,"percent of total billed charges ","70% of total billed charges ",441.7,867.23,
"ZOSYN 2.25GM VIAL",7045313,"CDM ",636,RC,J2543,HCPCS,OUTPATIENT,,,62,49.6,,,,,,,,0,"other ","not separately reimbursment ",1.58,100,,9.01,9.01,9.01,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",43.4,70,,34.72,,,0,"percent of total billed charges ","70% of total billed charges ",55.8,90,,44.64,,,0,"percent of total billed charges ","90% of total billed charges ",57.66,93,,46.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",52.7,85,,42.16,,,0,"percent of total billed charges ","85% of total billed charges ",55.8,90,,44.64,,,0,"percent of total billed charges ","90% of total billed charges ",55.8,90,,44.64,,,0,"percent of total billed charges ","90% of total billed charges ",1.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.94,87,,218.09,202.23,233.95,"1 through 10","percent of total billed charges ","87% of total billed charges ",1.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",43.4,70,,34.72,,,0,"percent of total billed charges ","70% of total billed charges ",1.48,57.66,
"PIPERACILLIN-TAZOBACT 2.25GMVL",7045314,"CDM ",636,RC,J2543,HCPCS,OUTPATIENT,,,135,108,,,,,,,,0,"other ","not separately reimbursment ",1.58,100,,9.01,9.01,9.01,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",125.55,93,,100.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",114.75,85,,91.80,,,0,"percent of total billed charges ","85% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",1.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.45,87,,218.09,202.23,233.95,"1 through 10","percent of total billed charges ","87% of total billed charges ",1.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",1.48,125.55,
"PIPERAIL TAZO 3.375GM VL",7045315,"CDM ",636,RC,J2543,HCPCS,OUTPATIENT,,,135,108,,,,,,,,0,"other ","not separately reimbursment ",1.58,100,,9.01,9.01,9.01,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",125.55,93,,100.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",114.75,85,,91.80,,,0,"percent of total billed charges ","85% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",1.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.45,87,,218.09,202.23,233.95,"1 through 10","percent of total billed charges ","87% of total billed charges ",1.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",1.48,125.55,
"FUROSEMIDE 40MG/4ML",7045388,"CDM ",636,RC,J1938,HCPCS,OUTPATIENT,,,50,40,,,,,,,,0,"other ","not separately reimbursment ",,,,2.22,2.22,2.22,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",46.5,93,,37.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.5,85,,34.00,,,0,"percent of total billed charges ","85% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.5,87,,34.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",35,46.5,
"FUROSEMIDE 20MG/2ML",7045396,"CDM ",636,RC,J1938,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,2.22,2.22,2.22,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"HYDRALAZINE 20MG/ML 1ML",7045487,"CDM ",636,RC,J0360,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",7.19,100,,5.46,5.46,5.46,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",5.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",5.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",5.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",5.2,45.57,
"RETROVIR IV 10MG/ML 20ML",7046154,"CDM ",636,RC,J3485,HCPCS,OUTPATIENT,,,62.5,50,,,,,,,,0,"other ","not separately reimbursment ",1.95,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",43.75,70,,35.00,,,0,"percent of total billed charges ","70% of total billed charges ",56.25,90,,45.00,,,0,"percent of total billed charges ","90% of total billed charges ",58.13,93,,46.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",53.13,85,,42.50,,,0,"percent of total billed charges ","85% of total billed charges ",56.25,90,,45.00,,,0,"percent of total billed charges ","90% of total billed charges ",56.25,90,,45.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",54.38,87,,43.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",43.75,70,,35.00,,,0,"percent of total billed charges ","70% of total billed charges ",1.51,58.13,
"NAROPIN 0.5% 5MG/ML 30ML",7047558,"CDM ",636,RC,J2795,HCPCS,OUTPATIENT,,,50.5,40.4,,,,,,,,0,"other ","not separately reimbursment ",0.11,100,,15.68,15.68,15.68,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",35.35,70,,28.28,,,0,"percent of total billed charges ","70% of total billed charges ",45.45,90,,36.36,,,0,"percent of total billed charges ","90% of total billed charges ",46.97,93,,37.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.93,85,,34.34,,,0,"percent of total billed charges ","85% of total billed charges ",45.45,90,,36.36,,,0,"percent of total billed charges ","90% of total billed charges ",45.45,90,,36.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.94,87,,35.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.35,70,,28.28,,,0,"percent of total billed charges ","70% of total billed charges ",0.11,46.97,
"NAROPIN 0.2% 2MG/ML 100ML",7047566,"CDM ",636,RC,J2795,HCPCS,OUTPATIENT,,,121.5,97.2,,,,,,,,0,"other ","not separately reimbursment ",0.11,100,,15.68,15.68,15.68,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.05,70,,68.04,,,0,"percent of total billed charges ","70% of total billed charges ",109.35,90,,87.48,,,0,"percent of total billed charges ","90% of total billed charges ",113,93,,90.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",103.28,85,,82.62,,,0,"percent of total billed charges ","85% of total billed charges ",109.35,90,,87.48,,,0,"percent of total billed charges ","90% of total billed charges ",109.35,90,,87.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",105.71,87,,84.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.05,70,,68.04,,,0,"percent of total billed charges ","70% of total billed charges ",0.11,113,
"ZITHROMAX 500MG INJ",7047616,"CDM ",636,RC,J0456,HCPCS,OUTPATIENT,,,48.5,38.8,,,,,,,,0,"other ","not separately reimbursment ",3.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.95,70,,27.16,,,0,"percent of total billed charges ","70% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",45.11,93,,36.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2.51,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.23,85,,32.98,,,0,"percent of total billed charges ","85% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",2.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.2,87,,33.76,,,0,"percent of total billed charges ","87% of total billed charges ",2.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.95,70,,27.16,,,0,"percent of total billed charges ","70% of total billed charges ",2.49,45.11,
"LOVENOX 40MG/0.4ML SYR",7047640,"CDM ",636,RC,J1650,HCPCS,OUTPATIENT,,,70.5,56.4,,,,,,,,0,"other ","not separately reimbursment ",0.8,100,,2.74,2.74,2.74,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",65.57,93,,52.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",59.93,85,,47.94,,,0,"percent of total billed charges ","85% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",61.34,87,,37.24,33.93,40.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",0.76,65.57,
"PHENOBARBITAL 130MG/ML VIAL",7047715,"CDM ",636,RC,J2560,HCPCS,OUTPATIENT,,,196.5,157.2,,,,,,,,0,"other ","not separately reimbursment ",42.2,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",137.55,70,,110.04,,,0,"percent of total billed charges ","70% of total billed charges ",176.85,90,,141.48,,,0,"percent of total billed charges ","90% of total billed charges ",182.75,93,,146.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",40.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",167.03,85,,133.62,,,0,"percent of total billed charges ","85% of total billed charges ",176.85,90,,141.48,,,0,"percent of total billed charges ","90% of total billed charges ",176.85,90,,141.48,,,0,"percent of total billed charges ","90% of total billed charges ",40.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",170.96,87,,136.77,,,0,"percent of total billed charges ","87% of total billed charges ",40.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",137.55,70,,110.04,,,0,"percent of total billed charges ","70% of total billed charges ",40.22,182.75,
"CEREBYX 75MG/ML 10ML",7047723,"CDM ",250,RC,Q2009,HCPCS,OUTPATIENT,,,195,156,,,,,,,,0,"other ","not separately reimbursment ",5.83,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",136.5,70,,109.20,,,0,"percent of total billed charges ","70% of total billed charges ",175.5,90,,140.40,,,0,"percent of total billed charges ","90% of total billed charges ",181.35,93,,145.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",3.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",165.75,85,,132.60,,,0,"percent of total billed charges ","85% of total billed charges ",175.5,90,,140.40,,,0,"percent of total billed charges ","90% of total billed charges ",175.5,90,,140.40,,,0,"percent of total billed charges ","90% of total billed charges ",3.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",169.65,87,,135.72,,,0,"percent of total billed charges ","87% of total billed charges ",3.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",136.5,70,,109.20,,,0,"percent of total billed charges ","70% of total billed charges ",1.34,181.35,
"CORDARONE IV 150MG/3ML",7047731,"CDM ",636,RC,J0282,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",0.57,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",0.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.31,45.57,
"LEVAQUIN IV 500MG/100ML PREMIX",7047749,"CDM ",636,RC,J1956,HCPCS,OUTPATIENT,,,87.5,70,,,,,,,,0,"other ","not separately reimbursment ",1.45,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",61.25,70,,49.00,,,0,"percent of total billed charges ","70% of total billed charges ",78.75,90,,63.00,,,0,"percent of total billed charges ","90% of total billed charges ",81.38,93,,65.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",74.38,85,,59.50,,,0,"percent of total billed charges ","85% of total billed charges ",78.75,90,,63.00,,,0,"percent of total billed charges ","90% of total billed charges ",78.75,90,,63.00,,,0,"percent of total billed charges ","90% of total billed charges ",0.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",76.13,87,,60.90,,,0,"percent of total billed charges ","87% of total billed charges ",0.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",61.25,70,,49.00,,,0,"percent of total billed charges ","70% of total billed charges ",0.91,81.38,
"HEP-LOCK 10U/ML 1ML FLUSH",7047830,"CDM ",636,RC,J1642,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",0.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.02,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,41.81,41.81,41.81,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.02,45.57,
"HUMALOG 100U/ML INSULIN",7047871,"CDM ",637,RC,J1815,HCPCS,OUTPATIENT,,,33,26.4,,,,,,,,0,"other ","not separately reimbursment ",0.27,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.1,70,,18.48,,,0,"percent of total billed charges ","70% of total billed charges ",29.7,90,,23.76,,,0,"percent of total billed charges ","90% of total billed charges ",30.69,93,,24.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",28.05,85,,22.44,,,0,"percent of total billed charges ","85% of total billed charges ",29.7,90,,23.76,,,0,"percent of total billed charges ","90% of total billed charges ",29.7,90,,23.76,,,0,"percent of total billed charges ","90% of total billed charges ",0.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.71,87,,22.97,,,0,"percent of total billed charges ","87% of total billed charges ",0.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.1,70,,18.48,,,0,"percent of total billed charges ","70% of total billed charges ",0.27,30.69,
"ANTIZOL IV 1.5ML 1GM/ML",7047897,"CDM ",636,RC,J1451,HCPCS,OUTPATIENT,,,1807.5,1446,,,,,,,,0,"other ","not separately reimbursment ",15.34,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1265.25,70,,1012.20,,,0,"percent of total billed charges ","70% of total billed charges ",1626.75,90,,1301.40,,,0,"percent of total billed charges ","90% of total billed charges ",1680.98,93,,1344.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1536.38,85,,1229.10,,,0,"percent of total billed charges ","85% of total billed charges ",1626.75,90,,1301.40,,,0,"percent of total billed charges ","90% of total billed charges ",1626.75,90,,1301.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1572.53,87,,1258.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",6.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1265.25,70,,1012.20,,,0,"percent of total billed charges ","70% of total billed charges ",6.43,1680.98,
"MARCAINE 0.25% W/EPI 10ML",7047921,"CDM ",250,RC,S0020,HCPCS,OUTPATIENT,,,42,33.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.4,70,,23.52,,,0,"percent of total billed charges ","70% of total billed charges ",37.8,90,,30.24,,,0,"percent of total billed charges ","90% of total billed charges ",39.06,93,,31.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",3.08,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",35.7,85,,28.56,,,0,"percent of total billed charges ","85% of total billed charges ",37.8,90,,30.24,,,0,"percent of total billed charges ","90% of total billed charges ",37.8,90,,30.24,,,0,"percent of total billed charges ","90% of total billed charges ",3.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.54,87,,29.23,,,0,"percent of total billed charges ","87% of total billed charges ",3.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",29.4,70,,23.52,,,0,"percent of total billed charges ","70% of total billed charges ",3.05,39.06,
"TORADOL 15MG INJ",7047939,"CDM ",636,RC,J1885,HCPCS,OUTPATIENT,,,48.5,38.8,,,,,,,,0,"other ","not separately reimbursment ",0.9,100,,0.98,0.98,0.98,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.95,70,,27.16,,,0,"percent of total billed charges ","70% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",45.11,93,,36.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.23,85,,32.98,,,0,"percent of total billed charges ","85% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",0.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.2,87,,35.86,1.27,44.82,17,"percent of total billed charges ","87% of total billed charges ",0.48,100,,0.49,0.49,0.49,"1 through 10","fee schedule ","100% of KS medicaid fee schedule ",0.28,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",33.95,70,,27.16,,,0,"percent of total billed charges ","70% of total billed charges ",0.28,45.11,
"IMITREX 6MG SQ INJ",7047954,"CDM ",636,RC,J3030,HCPCS,OUTPATIENT,,,181.5,145.2,,,,,,,,0,"other ","not separately reimbursment ",93.26,100,,88.60,88.60,88.60,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",127.05,70,,101.64,,,0,"percent of total billed charges ","70% of total billed charges ",163.35,90,,130.68,,,0,"percent of total billed charges ","90% of total billed charges ",168.8,93,,135.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",55.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",154.28,85,,123.42,,,0,"percent of total billed charges ","85% of total billed charges ",163.35,90,,130.68,,,0,"percent of total billed charges ","90% of total billed charges ",163.35,90,,130.68,,,0,"percent of total billed charges ","90% of total billed charges ",55.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",157.91,87,,126.33,,,0,"percent of total billed charges ","87% of total billed charges ",55.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",127.05,70,,101.64,,,0,"percent of total billed charges ","70% of total billed charges ",55.16,168.8,
"VANCOMYCIN 500MG VIAL",7047996,"CDM ",636,RC,J3373,HCPCS,OUTPATIENT,,,44,35.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.8,70,,24.64,,,0,"percent of total billed charges ","70% of total billed charges ",39.6,90,,31.68,,,0,"percent of total billed charges ","90% of total billed charges ",40.92,93,,32.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",37.4,85,,29.92,,,0,"percent of total billed charges ","85% of total billed charges ",39.6,90,,31.68,,,0,"percent of total billed charges ","90% of total billed charges ",39.6,90,,31.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",38.28,87,,30.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.8,70,,24.64,,,0,"percent of total billed charges ","70% of total billed charges ",30.8,40.92,
"XOPENEX 0.63MG/3ML",7049265,"CDM ",250,RC,J7614,HCPCS,OUTPATIENT,,,18,14.4,,,,,,,,0,"other ","not separately reimbursment ",0.31,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.74,93,,13.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.06,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",15.3,85,,12.24,,,0,"percent of total billed charges ","85% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",0.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.66,87,,0.18,0.18,0.18,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",0.06,16.74,
"XOPENEX 1.25MG/3ML",7049406,"CDM ",250,RC,J7614,HCPCS,OUTPATIENT,,,18,14.4,,,,,,,,0,"other ","not separately reimbursment ",0.31,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.74,93,,13.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.06,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",15.3,85,,12.24,,,0,"percent of total billed charges ","85% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",0.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.66,87,,0.18,0.18,0.18,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",0.06,16.74,
"ALBUTEROL SULFATE 2.5MG/0.5ML",7051030,"CDM ",250,RC,J7619,HCPCS,OUTPATIENT,,,15.5,12.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.85,70,,8.68,,,0,"percent of total billed charges ","70% of total billed charges ",13.95,90,,11.16,,,0,"percent of total billed charges ","90% of total billed charges ",14.42,93,,11.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.18,85,,10.54,,,0,"percent of total billed charges ","85% of total billed charges ",13.95,90,,11.16,,,0,"percent of total billed charges ","90% of total billed charges ",13.95,90,,11.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.49,87,,10.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.85,70,,8.68,,,0,"percent of total billed charges ","70% of total billed charges ",10.85,14.42,
"XOPENEX 0.31MG/3ML INH",7051691,"CDM ",637,RC,J7614,HCPCS,OUTPATIENT,,,18,14.4,,,,,,,,0,"other ","not separately reimbursment ",0.31,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.74,93,,13.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.06,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",15.3,85,,12.24,,,0,"percent of total billed charges ","85% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",0.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.66,87,,0.18,0.18,0.18,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",0.06,16.74,
"ARIMIDEX 1MG TAB",7052566,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"CYANOCOBALAMIN 100MCG TAB",7052657,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"REVATIO 20MG TAB",7053226,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,11,8.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",10.23,93,,8.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.35,85,,7.48,,,0,"percent of total billed charges ","85% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.57,87,,7.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.7,10.23,
"MYCOPHENOLATE MOFETIL 500MG",7053572,"CDM ",636,RC,J7517,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",0.27,100,,0.01,0.01,0.01,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",0.27,11.16,
"EMEND 40MG CAP",7053820,"CDM ",250,RC,J8501,HCPCS,OUTPATIENT,,,157,125.6,,,,,,,,0,"other ","not separately reimbursment ",4.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",109.9,70,,87.92,,,0,"percent of total billed charges ","70% of total billed charges ",141.3,90,,113.04,,,0,"percent of total billed charges ","90% of total billed charges ",146.01,93,,116.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.45,85,,106.76,,,0,"percent of total billed charges ","85% of total billed charges ",141.3,90,,113.04,,,0,"percent of total billed charges ","90% of total billed charges ",141.3,90,,113.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",136.59,87,,109.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.9,70,,87.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.5,146.01,
"CLEOCIN PHOSPHATE 150MG/ML 4ML",7060080,"CDM ",250,RC,J0736,HCPCS,OUTPATIENT,,,47,37.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",43.71,93,,34.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.95,85,,31.96,,,0,"percent of total billed charges ","85% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.89,87,,32.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",32.9,43.71,
"DIPRIVAN 100ML VIAL",7060205,"CDM ",250,RC,J2704,HCPCS,OUTPATIENT,,,164.5,131.6,,,,,,,,0,"other ","not separately reimbursment ",0.18,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",115.15,70,,92.12,,,0,"percent of total billed charges ","70% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",152.99,93,,122.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",139.83,85,,111.86,,,0,"percent of total billed charges ","85% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",143.12,87,,0.01,0.01,47.06,15,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.15,70,,92.12,,,0,"percent of total billed charges ","70% of total billed charges ",0.18,152.99,
"ZANTAC IV 50MG (1MG/ML) BAG",7060288,"CDM ",636,RC,J2780,HCPCS,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",6.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",6.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",6.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",6.12,44.64,
"LEVAQUIN 250MG IV 50ML PREMIX",7060379,"CDM ",636,RC,J1956,HCPCS,OUTPATIENT,,,100.5,80.4,,,,,,,,0,"other ","not separately reimbursment ",1.45,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",70.35,70,,56.28,,,0,"percent of total billed charges ","70% of total billed charges ",90.45,90,,72.36,,,0,"percent of total billed charges ","90% of total billed charges ",93.47,93,,74.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",85.43,85,,68.34,,,0,"percent of total billed charges ","85% of total billed charges ",90.45,90,,72.36,,,0,"percent of total billed charges ","90% of total billed charges ",90.45,90,,72.36,,,0,"percent of total billed charges ","90% of total billed charges ",0.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",87.44,87,,69.95,,,0,"percent of total billed charges ","87% of total billed charges ",0.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",70.35,70,,56.28,,,0,"percent of total billed charges ","70% of total billed charges ",0.91,93.47,
"MAGNESIUM SULFATE 50% (IGM/2ML",7060387,"CDM ",636,RC,J3475,HCPCS,OUTPATIENT,,,33,26.4,,,,,,,,0,"other ","not separately reimbursment ",0.83,100,,1.35,1.35,1.35,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.1,70,,18.48,,,0,"percent of total billed charges ","70% of total billed charges ",29.7,90,,23.76,,,0,"percent of total billed charges ","90% of total billed charges ",30.69,93,,24.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",28.05,85,,22.44,,,0,"percent of total billed charges ","85% of total billed charges ",29.7,90,,23.76,,,0,"percent of total billed charges ","90% of total billed charges ",29.7,90,,23.76,,,0,"percent of total billed charges ","90% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.71,87,,158.61,158.61,158.61,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.1,70,,18.48,,,0,"percent of total billed charges ","70% of total billed charges ",0.75,30.69,
"AMPICILLIN SODIUM 1GM VIAL",7060429,"CDM ",636,RC,J0290,HCPCS,OUTPATIENT,,,46.5,37.2,,,,,,,,0,"other ","not separately reimbursment ",1.04,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",43.25,93,,34.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.53,85,,31.62,,,0,"percent of total billed charges ","85% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",0.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.46,87,,32.37,,,0,"percent of total billed charges ","87% of total billed charges ",0.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",0.81,43.25,
"VERSED 50MG VIAL",7060437,"CDM ",636,RC,J2250,HCPCS,OUTPATIENT,,,51.5,41.2,,,,,,,,0,"other ","not separately reimbursment ",0.18,100,,1.60,1.60,1.60,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",36.05,70,,28.84,,,0,"percent of total billed charges ","70% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",47.9,93,,38.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.78,85,,35.02,,,0,"percent of total billed charges ","85% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.81,87,,39.65,15.27,43.62,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.05,70,,28.84,,,0,"percent of total billed charges ","70% of total billed charges ",0.18,47.9,
"FUROSEMIDE 10MG/ML 10ML INJ",7060452,"CDM ",636,RC,J1938,HCPCS,OUTPATIENT,,,47,37.6,,,,,,,,0,"other ","not separately reimbursment ",,,,2.22,2.22,2.22,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",43.71,93,,34.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.95,85,,31.96,,,0,"percent of total billed charges ","85% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.89,87,,32.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",32.9,43.71,
"HYDROXYZINE HCL 25MG/ML 1MLINJ",7060536,"CDM ",636,RC,J3410,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",17.84,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",9.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",9.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",9.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",9.03,45.57,
"FERRIC SOD GLUC 62.5MG VIAL",7060544,"CDM ",636,RC,J2916,HCPCS,OUTPATIENT,,,135,108,,,,,,,,0,"other ","not separately reimbursment ",2.81,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",125.55,93,,100.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",114.75,85,,91.80,,,0,"percent of total billed charges ","85% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",2.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.45,87,,93.96,,,0,"percent of total billed charges ","87% of total billed charges ",2.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",2.18,125.55,
"ATROPINE 0.4MG/ML 20ML",7060569,"CDM ",636,RC,J0461,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",0.1,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.1,45.57,
"VANCOMYCIN 1GM ADV",7060577,"CDM ",636,RC,J3373,HCPCS,OUTPATIENT,,,46.5,37.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",43.25,93,,34.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.53,85,,31.62,,,0,"percent of total billed charges ","85% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.46,87,,32.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",32.55,43.25,
"REMICADE 100MG/10ML IV NONBIOS",7060593,"CDM ",636,RC,J1745,HCPCS,OUTPATIENT,,,1884,1507.2,,,,,,,,0,"other ","not separately reimbursment ",39.57,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1318.8,70,,1055.04,,,0,"percent of total billed charges ","70% of total billed charges ",1695.6,90,,1356.48,,,0,"percent of total billed charges ","90% of total billed charges ",1752.12,93,,1401.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",39.93,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1601.4,85,,1281.12,,,0,"percent of total billed charges ","85% of total billed charges ",1695.6,90,,1356.48,,,0,"percent of total billed charges ","90% of total billed charges ",1695.6,90,,1356.48,,,0,"percent of total billed charges ","90% of total billed charges ",39.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1639.08,87,,1311.26,,,0,"percent of total billed charges ","87% of total billed charges ",39.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.42,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1318.8,70,,1055.04,,,0,"percent of total billed charges ","70% of total billed charges ",32.42,1752.12,
"INFLIXIMAB-AXXQ AVSOLA 100MG",7060594,"CDM ",636,RC,Q5121,HCPCS,OUTPATIENT,,,775,620,,,,,,,,0,"other ","not separately reimbursment ",44.97,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",542.5,70,,434.00,,,0,"percent of total billed charges ","70% of total billed charges ",697.5,90,,558.00,,,0,"percent of total billed charges ","90% of total billed charges ",720.75,93,,576.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",47.59,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",658.75,85,,527.00,,,0,"percent of total billed charges ","85% of total billed charges ",697.5,90,,558.00,,,0,"percent of total billed charges ","90% of total billed charges ",697.5,90,,558.00,,,0,"percent of total billed charges ","90% of total billed charges ",47.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",674.25,87,,539.40,,,0,"percent of total billed charges ","87% of total billed charges ",47.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.81,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",542.5,70,,434.00,,,0,"percent of total billed charges ","70% of total billed charges ",23.81,720.75,
"RITUXIMAB-PVVR 500MG VIAL",7060595,"CDM ",636,RC,Q5119,HCPCS,OUTPATIENT,,,6096.5,4877.2,,,,,,,,0,"other ","not separately reimbursment ",27.44,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",4267.55,70,,3414.04,,,0,"percent of total billed charges ","70% of total billed charges ",5486.85,90,,4389.48,,,0,"percent of total billed charges ","90% of total billed charges ",5669.75,93,,4535.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",59.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5182.03,85,,4145.62,,,0,"percent of total billed charges ","85% of total billed charges ",5486.85,90,,4389.48,,,0,"percent of total billed charges ","90% of total billed charges ",5486.85,90,,4389.48,,,0,"percent of total billed charges ","90% of total billed charges ",58.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5303.96,87,,4243.17,,,0,"percent of total billed charges ","87% of total billed charges ",58.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.27,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4267.55,70,,3414.04,,,0,"percent of total billed charges ","70% of total billed charges ",13.27,5669.75,
"BELATACEPT NULOJIX 250MG VIAL",7060596,"CDM ",636,RC,J0485,HCPCS,OUTPATIENT,,,1433,1146.4,,,,,,,,0,"other ","not separately reimbursment ",4.88,100,,0.01,0.01,0.01,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1003.1,70,,802.48,,,0,"percent of total billed charges ","70% of total billed charges ",1289.7,90,,1031.76,,,0,"percent of total billed charges ","90% of total billed charges ",1332.69,93,,1066.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",3.84,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1218.05,85,,974.44,,,0,"percent of total billed charges ","85% of total billed charges ",1289.7,90,,1031.76,,,0,"percent of total billed charges ","90% of total billed charges ",1289.7,90,,1031.76,,,0,"percent of total billed charges ","90% of total billed charges ",3.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1246.71,87,,997.37,,,0,"percent of total billed charges ","87% of total billed charges ",3.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.89,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1003.1,70,,802.48,,,0,"percent of total billed charges ","70% of total billed charges ",3.8,1332.69,
"INFLECTRA 100 MG VIAL",7060597,"CDM ",636,RC,Q5103,HCPCS,OUTPATIENT,,,1400,1120,,,,,,,,0,"other ","not separately reimbursment ",44.97,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",980,70,,784.00,,,0,"percent of total billed charges ","70% of total billed charges ",1260,90,,1008.00,,,0,"percent of total billed charges ","90% of total billed charges ",1302,93,,1041.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",41.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1190,85,,952.00,,,0,"percent of total billed charges ","85% of total billed charges ",1260,90,,1008.00,,,0,"percent of total billed charges ","90% of total billed charges ",1260,90,,1008.00,,,0,"percent of total billed charges ","90% of total billed charges ",41.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1218,87,,974.40,,,0,"percent of total billed charges ","87% of total billed charges ",41.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.22,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",980,70,,784.00,,,0,"percent of total billed charges ","70% of total billed charges ",24.22,1302,
"MARCAINE 0.5% W/EPI 10ML",7060676,"CDM ",250,RC,J0665,HCPCS,OUTPATIENT,,,47.5,38,,,,,,,,0,"other ","not separately reimbursment ",,,,1.69,1.69,1.69,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.25,70,,26.60,,,0,"percent of total billed charges ","70% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",44.18,93,,35.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.38,85,,32.30,,,0,"percent of total billed charges ","85% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.33,87,,33.79,33.79,33.79,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.25,70,,26.60,,,0,"percent of total billed charges ","70% of total billed charges ",33.25,44.18,
"HEPARIN 5000U/ML 1ML VIAL",7060700,"CDM ",636,RC,J1644,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",0.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",0.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.25,45.57,
"LOVENOX SYR 100MG/ML",7060783,"CDM ",636,RC,J1650,HCPCS,OUTPATIENT,,,166,132.8,,,,,,,,0,"other ","not separately reimbursment ",0.8,100,,2.74,2.74,2.74,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",116.2,70,,92.96,,,0,"percent of total billed charges ","70% of total billed charges ",149.4,90,,119.52,,,0,"percent of total billed charges ","90% of total billed charges ",154.38,93,,123.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",141.1,85,,112.88,,,0,"percent of total billed charges ","85% of total billed charges ",149.4,90,,119.52,,,0,"percent of total billed charges ","90% of total billed charges ",149.4,90,,119.52,,,0,"percent of total billed charges ","90% of total billed charges ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",144.42,87,,37.24,33.93,40.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",116.2,70,,92.96,,,0,"percent of total billed charges ","70% of total billed charges ",0.76,154.38,
"DEXAMETHASONE 10MG/ML INJ 1ML",7060809,"CDM ",636,RC,J1100,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",0.15,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,0.24,0.24,0.24,"1 through 10","other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,0.08,0.01,37.21,14,"percent of total billed charges ","87% of total billed charges ",0.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.12,45.57,
"LANTUS INSULIN 100U/ML",7060825,"CDM ",637,RC,J1815,HCPCS,OUTPATIENT,,,33,26.4,,,,,,,,0,"other ","not separately reimbursment ",0.27,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.1,70,,18.48,,,0,"percent of total billed charges ","70% of total billed charges ",29.7,90,,23.76,,,0,"percent of total billed charges ","90% of total billed charges ",30.69,93,,24.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",28.05,85,,22.44,,,0,"percent of total billed charges ","85% of total billed charges ",29.7,90,,23.76,,,0,"percent of total billed charges ","90% of total billed charges ",29.7,90,,23.76,,,0,"percent of total billed charges ","90% of total billed charges ",0.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.71,87,,22.97,,,0,"percent of total billed charges ","87% of total billed charges ",0.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.1,70,,18.48,,,0,"percent of total billed charges ","70% of total billed charges ",0.27,30.69,
"PROTONIX 40MG IV",7060833,"CDM ",636,RC,J2470,HCPCS,OUTPATIENT,,,47.5,38,,,,,,,,0,"other ","not separately reimbursment ",,,,5.85,5.85,5.85,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.25,70,,26.60,,,0,"percent of total billed charges ","70% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",44.18,93,,35.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.38,85,,32.30,,,0,"percent of total billed charges ","85% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.33,87,,34.82,34.82,41.79,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.25,70,,26.60,,,0,"percent of total billed charges ","70% of total billed charges ",33.25,44.18,
"XYLO-EPI 0.5% 50ML 5MG/ML",7060841,"CDM ",250,RC,J2004,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,1.44,1.44,1.44,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"HUMLOG 75/25 10 ML VIAL",7060890,"CDM ",636,RC,J1815,HCPCS,OUTPATIENT,,,45,36,,,,,,,,0,"other ","not separately reimbursment ",0.27,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",0.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,31.32,,,0,"percent of total billed charges ","87% of total billed charges ",0.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",0.27,41.85,
"LOVENOX 80 MG/0.8ML SYR",7060908,"CDM ",636,RC,J1650,HCPCS,OUTPATIENT,,,141,112.8,,,,,,,,0,"other ","not separately reimbursment ",0.8,100,,2.74,2.74,2.74,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",98.7,70,,78.96,,,0,"percent of total billed charges ","70% of total billed charges ",126.9,90,,101.52,,,0,"percent of total billed charges ","90% of total billed charges ",131.13,93,,104.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",119.85,85,,95.88,,,0,"percent of total billed charges ","85% of total billed charges ",126.9,90,,101.52,,,0,"percent of total billed charges ","90% of total billed charges ",126.9,90,,101.52,,,0,"percent of total billed charges ","90% of total billed charges ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.67,87,,37.24,33.93,40.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",98.7,70,,78.96,,,0,"percent of total billed charges ","70% of total billed charges ",0.76,131.13,
"LOVENOX 60MG/0.6ML SYR",7060981,"CDM ",636,RC,J1650,HCPCS,OUTPATIENT,,,107.5,86,,,,,,,,0,"other ","not separately reimbursment ",0.8,100,,2.74,2.74,2.74,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",75.25,70,,60.20,,,0,"percent of total billed charges ","70% of total billed charges ",96.75,90,,77.40,,,0,"percent of total billed charges ","90% of total billed charges ",99.98,93,,79.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.38,85,,73.10,,,0,"percent of total billed charges ","85% of total billed charges ",96.75,90,,77.40,,,0,"percent of total billed charges ","90% of total billed charges ",96.75,90,,77.40,,,0,"percent of total billed charges ","90% of total billed charges ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.53,87,,37.24,33.93,40.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",75.25,70,,60.20,,,0,"percent of total billed charges ","70% of total billed charges ",0.76,99.98,
"FENTANYL 50MCG/ML 5ML",7061005,"CDM ",636,RC,J3010,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",1.25,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,40.95,30.39,42.84,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.63,45.57,
"PRIMAXIN 500MG IM INJ",7061070,"CDM ",636,RC,J0743,HCPCS,OUTPATIENT,,,90,72,,,,,,,,0,"other ","not separately reimbursment ",9.72,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",7.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",7.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",7.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",7.61,83.7,
"MAXIPIME 1GM IV",7061096,"CDM ",636,RC,J0692,HCPCS,OUTPATIENT,,,47,37.6,,,,,,,,0,"other ","not separately reimbursment ",2.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",43.71,93,,34.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.87,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.95,85,,31.96,,,0,"percent of total billed charges ","85% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",1.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.89,87,,32.71,,,0,"percent of total billed charges ","87% of total billed charges ",1.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",1.85,43.71,
"CEFEPIME 1GM VIAL",7061097,"CDM ",636,RC,J0692,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",2.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.87,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",1.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",1.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",1.85,106.95,
"CEFEPINE 2GM VIAL",7061098,"CDM ",636,RC,J0692,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",2.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.87,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",1.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",1.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",1.85,106.95,
"LOVENOX SYR 150MG/ML 1ML",7061104,"CDM ",636,RC,J1650,HCPCS,OUTPATIENT,,,107,85.6,,,,,,,,0,"other ","not separately reimbursment ",0.8,100,,2.74,2.74,2.74,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",74.9,70,,59.92,,,0,"percent of total billed charges ","70% of total billed charges ",96.3,90,,77.04,,,0,"percent of total billed charges ","90% of total billed charges ",99.51,93,,79.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",90.95,85,,72.76,,,0,"percent of total billed charges ","85% of total billed charges ",96.3,90,,77.04,,,0,"percent of total billed charges ","90% of total billed charges ",96.3,90,,77.04,,,0,"percent of total billed charges ","90% of total billed charges ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.09,87,,37.24,33.93,40.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",74.9,70,,59.92,,,0,"percent of total billed charges ","70% of total billed charges ",0.76,99.51,
"TNKASE 50MG IV",7061112,"CDM ",636,RC,J3101,HCPCS,OUTPATIENT,,,8761,7008.8,,,,,,,,0,"other ","not separately reimbursment ",196.97,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,1562.60,1562.60,1562.60,"1 through 10","other ","not separately reimbursment ",6132.7,70,,4906.16,,,0,"percent of total billed charges ","70% of total billed charges ",7884.9,90,,6307.92,,,0,"percent of total billed charges ","90% of total billed charges ",8147.73,93,,6518.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",136.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",7446.85,85,,5957.48,,,0,"percent of total billed charges ","85% of total billed charges ",7884.9,90,,6307.92,,,0,"percent of total billed charges ","90% of total billed charges ",7884.9,90,,6307.92,,,0,"percent of total billed charges ","90% of total billed charges ",134.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7622.07,87,,6097.66,,,0,"percent of total billed charges ","87% of total billed charges ",134.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",186.97,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",6132.7,70,,4906.16,,,0,"percent of total billed charges ","70% of total billed charges ",134.74,8147.73,
"MERREM 500MG IV VIAL",7061120,"CDM ",636,RC,J2184,HCPCS,OUTPATIENT,,,46.5,37.2,,,,,,,,0,"other ","not separately reimbursment ",3.05,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",43.25,93,,34.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.53,85,,31.62,,,0,"percent of total billed charges ","85% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.46,87,,32.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",3.05,43.25,
"INVANZ 1GM INJ",7061138,"CDM ",636,RC,J1335,HCPCS,OUTPATIENT,,,193,154.4,,,,,,,,0,"other ","not separately reimbursment ",17.97,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",135.1,70,,108.08,,,0,"percent of total billed charges ","70% of total billed charges ",173.7,90,,138.96,,,0,"percent of total billed charges ","90% of total billed charges ",179.49,93,,143.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",28.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.05,85,,131.24,,,0,"percent of total billed charges ","85% of total billed charges ",173.7,90,,138.96,,,0,"percent of total billed charges ","90% of total billed charges ",173.7,90,,138.96,,,0,"percent of total billed charges ","90% of total billed charges ",28.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",167.91,87,,134.33,,,0,"percent of total billed charges ","87% of total billed charges ",28.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",135.1,70,,108.08,,,0,"percent of total billed charges ","70% of total billed charges ",17.97,179.49,
"ERTAPENEM 1GM PREMIX IV",7061140,"CDM ",636,RC,J1335,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",17.97,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",28.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",28.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",126.15,87,,100.92,,,0,"percent of total billed charges ","87% of total billed charges ",28.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",17.97,134.85,
"DILAUDID 10MG/ML INJ",7061146,"CDM ",636,RC,J1171,HCPCS,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",,,,0.10,0.10,0.10,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.76,87,,34.14,13.25,118.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",33.6,44.64,
"UNASYN 1.5GM VIAL INJ",7061153,"CDM ",636,RC,J0295,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",2.33,100,,1.77,1.77,1.77,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",2.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",2.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",2.21,45.57,
"MERREM 1GM ADV",7061179,"CDM ",636,RC,J2184,HCPCS,OUTPATIENT,,,60.5,48.4,,,,,,,,0,"other ","not separately reimbursment ",3.05,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",42.35,70,,33.88,,,0,"percent of total billed charges ","70% of total billed charges ",54.45,90,,43.56,,,0,"percent of total billed charges ","90% of total billed charges ",56.27,93,,45.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51.43,85,,41.14,,,0,"percent of total billed charges ","85% of total billed charges ",54.45,90,,43.56,,,0,"percent of total billed charges ","90% of total billed charges ",54.45,90,,43.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",52.64,87,,42.11,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.35,70,,33.88,,,0,"percent of total billed charges ","70% of total billed charges ",3.05,56.27,
"ZYVOX 600MG IV",7061203,"CDM ",636,RC,J2020,HCPCS,OUTPATIENT,,,363,290.4,,,,,,,,0,"other ","not separately reimbursment ",5.47,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",254.1,70,,203.28,,,0,"percent of total billed charges ","70% of total billed charges ",326.7,90,,261.36,,,0,"percent of total billed charges ","90% of total billed charges ",337.59,93,,270.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",6.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",308.55,85,,246.84,,,0,"percent of total billed charges ","85% of total billed charges ",326.7,90,,261.36,,,0,"percent of total billed charges ","90% of total billed charges ",326.7,90,,261.36,,,0,"percent of total billed charges ","90% of total billed charges ",6.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",315.81,87,,252.65,,,0,"percent of total billed charges ","87% of total billed charges ",6.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",254.1,70,,203.28,,,0,"percent of total billed charges ","70% of total billed charges ",5.47,337.59,
"MAGNESIUM SULFATE 20GM/500CC W",7061229,"CDM ",636,RC,J3475,HCPCS,OUTPATIENT,,,96.5,77.2,,,,,,,,0,"other ","not separately reimbursment ",0.83,100,,1.35,1.35,1.35,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",67.55,70,,54.04,,,0,"percent of total billed charges ","70% of total billed charges ",86.85,90,,69.48,,,0,"percent of total billed charges ","90% of total billed charges ",89.75,93,,71.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",82.03,85,,65.62,,,0,"percent of total billed charges ","85% of total billed charges ",86.85,90,,69.48,,,0,"percent of total billed charges ","90% of total billed charges ",86.85,90,,69.48,,,0,"percent of total billed charges ","90% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.96,87,,158.61,158.61,158.61,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",67.55,70,,54.04,,,0,"percent of total billed charges ","70% of total billed charges ",0.75,89.75,
"INTEGRILIN 2MG/ML 10 ML IV",7061260,"CDM ",636,RC,J1327,HCPCS,OUTPATIENT,,,243,194.4,,,,,,,,0,"other ","not separately reimbursment ",21.09,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",170.1,70,,136.08,,,0,"percent of total billed charges ","70% of total billed charges ",218.7,90,,174.96,,,0,"percent of total billed charges ","90% of total billed charges ",225.99,93,,180.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",206.55,85,,165.24,,,0,"percent of total billed charges ","85% of total billed charges ",218.7,90,,174.96,,,0,"percent of total billed charges ","90% of total billed charges ",218.7,90,,174.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",211.41,87,,169.13,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",3.52,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",170.1,70,,136.08,,,0,"percent of total billed charges ","70% of total billed charges ",3.52,225.99,
"INTEGRILIN 0.75MG/ML 100ML IV",7061278,"CDM ",636,RC,J1327,HCPCS,OUTPATIENT,,,755.5,604.4,,,,,,,,0,"other ","not separately reimbursment ",21.09,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",528.85,70,,423.08,,,0,"percent of total billed charges ","70% of total billed charges ",679.95,90,,543.96,,,0,"percent of total billed charges ","90% of total billed charges ",702.62,93,,562.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",642.18,85,,513.74,,,0,"percent of total billed charges ","85% of total billed charges ",679.95,90,,543.96,,,0,"percent of total billed charges ","90% of total billed charges ",679.95,90,,543.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",657.29,87,,525.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",3.52,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",528.85,70,,423.08,,,0,"percent of total billed charges ","70% of total billed charges ",3.52,702.62,
"ZOSYN 3.375 GM VIAL INJ",7061302,"CDM ",636,RC,J2543,HCPCS,OUTPATIENT,,,127,101.6,,,,,,,,0,"other ","not separately reimbursment ",1.58,100,,9.01,9.01,9.01,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",88.9,70,,71.12,,,0,"percent of total billed charges ","70% of total billed charges ",114.3,90,,91.44,,,0,"percent of total billed charges ","90% of total billed charges ",118.11,93,,94.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",107.95,85,,86.36,,,0,"percent of total billed charges ","85% of total billed charges ",114.3,90,,91.44,,,0,"percent of total billed charges ","90% of total billed charges ",114.3,90,,91.44,,,0,"percent of total billed charges ","90% of total billed charges ",1.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",110.49,87,,218.09,202.23,233.95,"1 through 10","percent of total billed charges ","87% of total billed charges ",1.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",88.9,70,,71.12,,,0,"percent of total billed charges ","70% of total billed charges ",1.48,118.11,
"LEVAQUIN 750MG/100ML IV PREMIX",7061310,"CDM ",636,RC,J1956,HCPCS,OUTPATIENT,,,94.5,75.6,,,,,,,,0,"other ","not separately reimbursment ",1.45,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",66.15,70,,52.92,,,0,"percent of total billed charges ","70% of total billed charges ",85.05,90,,68.04,,,0,"percent of total billed charges ","90% of total billed charges ",87.89,93,,70.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",80.33,85,,64.26,,,0,"percent of total billed charges ","85% of total billed charges ",85.05,90,,68.04,,,0,"percent of total billed charges ","90% of total billed charges ",85.05,90,,68.04,,,0,"percent of total billed charges ","90% of total billed charges ",0.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",82.22,87,,65.78,,,0,"percent of total billed charges ","87% of total billed charges ",0.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",66.15,70,,52.92,,,0,"percent of total billed charges ","70% of total billed charges ",0.91,87.89,
"CALCIUM GLUCONATE 10% 50 ML",7061336,"CDM ",636,RC,J0612,HCPCS,OUTPATIENT,,,60,48,,,,,,,,0,"other ","not separately reimbursment ",0.06,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",42,70,,33.60,,,0,"percent of total billed charges ","70% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",55.8,93,,44.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51,85,,40.80,,,0,"percent of total billed charges ","85% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",52.2,87,,41.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42,70,,33.60,,,0,"percent of total billed charges ","70% of total billed charges ",0.06,55.8,
"ZOMETA 4MG 100ML BAG",7061468,"CDM ",636,RC,J3489,HCPCS,OUTPATIENT,,,360,288,,,,,,,,0,"other ","not separately reimbursment ",8.93,100,,42.42,42.42,42.42,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",252,70,,201.60,,,0,"percent of total billed charges ","70% of total billed charges ",324,90,,259.20,,,0,"percent of total billed charges ","90% of total billed charges ",334.8,93,,267.84,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",8.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",306,85,,244.80,,,0,"percent of total billed charges ","85% of total billed charges ",324,90,,259.20,,,0,"percent of total billed charges ","90% of total billed charges ",324,90,,259.20,,,0,"percent of total billed charges ","90% of total billed charges ",8.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",313.2,87,,250.56,,,0,"percent of total billed charges ","87% of total billed charges ",8.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",252,70,,201.60,,,0,"percent of total billed charges ","70% of total billed charges ",8.25,334.8,
"CUBICIN 500MG VIAL",7061534,"CDM ",636,RC,J0878,HCPCS,OUTPATIENT,,,771,616.8,,,,,,,,0,"other ","not separately reimbursment ",0.25,100,,65.00,65.00,65.00,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",539.7,70,,431.76,,,0,"percent of total billed charges ","70% of total billed charges ",693.9,90,,555.12,,,0,"percent of total billed charges ","90% of total billed charges ",717.03,93,,573.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.06,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",655.35,85,,524.28,,,0,"percent of total billed charges ","85% of total billed charges ",693.9,90,,555.12,,,0,"percent of total billed charges ","90% of total billed charges ",693.9,90,,555.12,,,0,"percent of total billed charges ","90% of total billed charges ",0.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",670.77,87,,536.62,,,0,"percent of total billed charges ","87% of total billed charges ",0.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",539.7,70,,431.76,,,0,"percent of total billed charges ","70% of total billed charges ",0.06,717.03,
"LUPRON DEPOT 22.5MG KIT IM",7061583,"CDM ",636,RC,J9217,HCPCS,OUTPATIENT,,,5227,4181.6,,,,,,,,0,"other ","not separately reimbursment ",238.83,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3658.9,70,,2927.12,,,0,"percent of total billed charges ","70% of total billed charges ",4704.3,90,,3763.44,,,0,"percent of total billed charges ","90% of total billed charges ",4861.11,93,,3888.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",140.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4442.95,85,,3554.36,,,0,"percent of total billed charges ","85% of total billed charges ",4704.3,90,,3763.44,,,0,"percent of total billed charges ","90% of total billed charges ",4704.3,90,,3763.44,,,0,"percent of total billed charges ","90% of total billed charges ",139.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4547.49,87,,3637.99,,,0,"percent of total billed charges ","87% of total billed charges ",139.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",170.78,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3658.9,70,,2927.12,,,0,"percent of total billed charges ","70% of total billed charges ",139.09,4861.11,
"ZOSYN 4.5 GM ADV INJ",7061591,"CDM ",636,RC,J2543,HCPCS,OUTPATIENT,,,49.5,39.6,,,,,,,,0,"other ","not separately reimbursment ",1.58,100,,9.01,9.01,9.01,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",46.04,93,,36.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",42.08,85,,33.66,,,0,"percent of total billed charges ","85% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",1.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.07,87,,218.09,202.23,233.95,"1 through 10","percent of total billed charges ","87% of total billed charges ",1.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",1.48,46.04,
"TYGACIL 50MG IV",7061625,"CDM ",636,RC,J3243,HCPCS,OUTPATIENT,,,223.5,178.8,,,,,,,,0,"other ","not separately reimbursment ",1.01,100,,47.98,47.98,47.98,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",156.45,70,,125.16,,,0,"percent of total billed charges ","70% of total billed charges ",201.15,90,,160.92,,,0,"percent of total billed charges ","90% of total billed charges ",207.86,93,,166.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",189.98,85,,151.98,,,0,"percent of total billed charges ","85% of total billed charges ",201.15,90,,160.92,,,0,"percent of total billed charges ","90% of total billed charges ",201.15,90,,160.92,,,0,"percent of total billed charges ","90% of total billed charges ",1.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",194.45,87,,155.56,,,0,"percent of total billed charges ","87% of total billed charges ",1.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",156.45,70,,125.16,,,0,"percent of total billed charges ","70% of total billed charges ",1.01,207.86,
"PENICILLIN G (K) 5MU/100ML",7061633,"CDM ",636,RC,J2540,HCPCS,OUTPATIENT,,,125.5,100.4,,,,,,,,0,"other ","not separately reimbursment ",1.25,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",87.85,70,,70.28,,,0,"percent of total billed charges ","70% of total billed charges ",112.95,90,,90.36,,,0,"percent of total billed charges ","90% of total billed charges ",116.72,93,,93.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.93,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",106.68,85,,85.34,,,0,"percent of total billed charges ","85% of total billed charges ",112.95,90,,90.36,,,0,"percent of total billed charges ","90% of total billed charges ",112.95,90,,90.36,,,0,"percent of total billed charges ","90% of total billed charges ",0.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",109.19,87,,87.35,,,0,"percent of total billed charges ","87% of total billed charges ",0.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",87.85,70,,70.28,,,0,"percent of total billed charges ","70% of total billed charges ",0.92,116.72,
"1L D5W W/ 10 UNITS PITOCIN",7061641,"CDM ",636,RC,J2590,HCPCS,OUTPATIENT,,,123,98.4,,,,,,,,0,"other ","not separately reimbursment ",1.05,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",86.1,70,,68.88,,,0,"percent of total billed charges ","70% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",114.39,93,,91.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.55,85,,83.64,,,0,"percent of total billed charges ","85% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",0.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.01,87,,85.61,,,0,"percent of total billed charges ","87% of total billed charges ",0.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",86.1,70,,68.88,,,0,"percent of total billed charges ","70% of total billed charges ",0.87,114.39,
"OXYTOCIN 30 UNITS LR 500ML BAG",7061642,"CDM ",636,RC,J2590,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",1.05,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",0.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",0.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",0.87,106.95,
"PENICILLIN G (K) 2.5MU/100ML",7061666,"CDM ",636,RC,J2540,HCPCS,OUTPATIENT,,,125.5,100.4,,,,,,,,0,"other ","not separately reimbursment ",1.25,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",87.85,70,,70.28,,,0,"percent of total billed charges ","70% of total billed charges ",112.95,90,,90.36,,,0,"percent of total billed charges ","90% of total billed charges ",116.72,93,,93.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.93,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",106.68,85,,85.34,,,0,"percent of total billed charges ","85% of total billed charges ",112.95,90,,90.36,,,0,"percent of total billed charges ","90% of total billed charges ",112.95,90,,90.36,,,0,"percent of total billed charges ","90% of total billed charges ",0.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",109.19,87,,87.35,,,0,"percent of total billed charges ","87% of total billed charges ",0.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",87.85,70,,70.28,,,0,"percent of total billed charges ","70% of total billed charges ",0.92,116.72,
"EPTINEZUMAB JJMR 100 MG VL",7061718,"CDM ",636,RC,J3032,HCPCS,OUTPATIENT,,,3247.5,2598,,,,,,,,0,"other ","not separately reimbursment ",23.23,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2273.25,70,,1818.60,,,0,"percent of total billed charges ","70% of total billed charges ",2922.75,90,,2338.20,,,0,"percent of total billed charges ","90% of total billed charges ",3020.18,93,,2416.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",15.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2760.38,85,,2208.30,,,0,"percent of total billed charges ","85% of total billed charges ",2922.75,90,,2338.20,,,0,"percent of total billed charges ","90% of total billed charges ",2922.75,90,,2338.20,,,0,"percent of total billed charges ","90% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2825.33,87,,2260.26,,,0,"percent of total billed charges ","87% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.5,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2273.25,70,,1818.60,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,3020.18,
"MAG SULFATE/5% DEXTROSE 1GM",7061823,"CDM ",636,RC,J3475,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",0.83,100,,1.35,1.35,1.35,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,158.61,158.61,158.61,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.75,45.57,
"DILTIAZEM 100MG PREMIX BAG",7061824,"CDM ",250,RC,J1163,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",80.5,106.95,
"CEFOXITIN 1GM 50ML PRE-MIX BAG",7061849,"CDM ",636,RC,J0694,HCPCS,OUTPATIENT,,,79,63.2,,,,,,,,0,"other ","not separately reimbursment ",7.39,100,,5.97,5.97,5.97,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",55.3,70,,44.24,,,0,"percent of total billed charges ","70% of total billed charges ",71.1,90,,56.88,,,0,"percent of total billed charges ","90% of total billed charges ",73.47,93,,58.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",4.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",67.15,85,,53.72,,,0,"percent of total billed charges ","85% of total billed charges ",71.1,90,,56.88,,,0,"percent of total billed charges ","90% of total billed charges ",71.1,90,,56.88,,,0,"percent of total billed charges ","90% of total billed charges ",4.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",68.73,87,,54.98,,,0,"percent of total billed charges ","87% of total billed charges ",4.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",55.3,70,,44.24,,,0,"percent of total billed charges ","70% of total billed charges ",4.61,73.47,
"ATIVAN 2MG/ML 10ML INJ VIAL",7061872,"CDM ",636,RC,J2060,HCPCS,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",1.24,100,,0.94,0.94,0.94,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",0.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.76,87,,20.05,4.02,36.07,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",0.78,44.64,
"AMBISOME 50MG VIAL",7061880,"CDM ",636,RC,J0289,HCPCS,OUTPATIENT,,,438.5,350.8,,,,,,,,0,"other ","not separately reimbursment ",35.6,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",306.95,70,,245.56,,,0,"percent of total billed charges ","70% of total billed charges ",394.65,90,,315.72,,,0,"percent of total billed charges ","90% of total billed charges ",407.81,93,,326.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",29.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",372.73,85,,298.18,,,0,"percent of total billed charges ","85% of total billed charges ",394.65,90,,315.72,,,0,"percent of total billed charges ","90% of total billed charges ",394.65,90,,315.72,,,0,"percent of total billed charges ","90% of total billed charges ",28.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",381.5,87,,305.20,,,0,"percent of total billed charges ","87% of total billed charges ",28.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.72,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",306.95,70,,245.56,,,0,"percent of total billed charges ","70% of total billed charges ",20.72,407.81,
"FORTAZ 1GM VIAL",7061948,"CDM ",636,RC,J0713,HCPCS,OUTPATIENT,,,46.5,37.2,,,,,,,,0,"other ","not separately reimbursment ",2.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",43.25,93,,34.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.53,85,,31.62,,,0,"percent of total billed charges ","85% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",1.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.46,87,,32.37,,,0,"percent of total billed charges ","87% of total billed charges ",1.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",1.97,43.25,
"CATHFLO ACTIVASE 2MG INJ",7061971,"CDM ",636,RC,J2997,HCPCS,OUTPATIENT,,,199.5,159.6,,,,,,,,0,"other ","not separately reimbursment ",112.88,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",139.65,70,,111.72,,,0,"percent of total billed charges ","70% of total billed charges ",179.55,90,,143.64,,,0,"percent of total billed charges ","90% of total billed charges ",185.54,93,,148.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",88.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",169.58,85,,135.66,,,0,"percent of total billed charges ","85% of total billed charges ",179.55,90,,143.64,,,0,"percent of total billed charges ","90% of total billed charges ",179.55,90,,143.64,,,0,"percent of total billed charges ","90% of total billed charges ",87.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",173.57,87,,138.86,,,0,"percent of total billed charges ","87% of total billed charges ",87.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",139.65,70,,111.72,,,0,"percent of total billed charges ","70% of total billed charges ",87.75,185.54,
"ARANESP 25 MCG PFS",7061989,"CDM ",636,RC,J0881,HCPCS,OUTPATIENT,,,238.5,190.8,,,,,,,,0,"other ","not separately reimbursment ",3.77,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",166.95,70,,133.56,,,0,"percent of total billed charges ","70% of total billed charges ",214.65,90,,171.72,,,0,"percent of total billed charges ","90% of total billed charges ",221.81,93,,177.45,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",3.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",202.73,85,,162.18,,,0,"percent of total billed charges ","85% of total billed charges ",214.65,90,,171.72,,,0,"percent of total billed charges ","90% of total billed charges ",214.65,90,,171.72,,,0,"percent of total billed charges ","90% of total billed charges ",3.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",207.5,87,,166.00,,,0,"percent of total billed charges ","87% of total billed charges ",3.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.02,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",166.95,70,,133.56,,,0,"percent of total billed charges ","70% of total billed charges ",3.02,221.81,
"PHENTOLAMINE 5MG INJ",7062078,"CDM ",636,RC,J2760,HCPCS,OUTPATIENT,,,145.5,116.4,,,,,,,,0,"other ","not separately reimbursment ",579.33,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",101.85,70,,81.48,,,0,"percent of total billed charges ","70% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",135.32,93,,108.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.68,85,,98.94,,,0,"percent of total billed charges ","85% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.59,87,,101.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",420.56,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",101.85,70,,81.48,,,0,"percent of total billed charges ","70% of total billed charges ",101.85,579.33,
"BUPRENEX 0.3MG/ML 1ML INJ",7062136,"CDM ",636,RC,J0592,HCPCS,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",5.06,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",4.41,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",4.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",4.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",4.37,44.64,
"RECLAST 5MG/100ML IV",7062144,"CDM ",636,RC,J3489,HCPCS,OUTPATIENT,,,1250,1000,,,,,,,,0,"other ","not separately reimbursment ",8.93,100,,42.42,42.42,42.42,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",875,70,,700.00,,,0,"percent of total billed charges ","70% of total billed charges ",1125,90,,900.00,,,0,"percent of total billed charges ","90% of total billed charges ",1162.5,93,,930.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",8.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1062.5,85,,850.00,,,0,"percent of total billed charges ","85% of total billed charges ",1125,90,,900.00,,,0,"percent of total billed charges ","90% of total billed charges ",1125,90,,900.00,,,0,"percent of total billed charges ","90% of total billed charges ",8.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1087.5,87,,870.00,,,0,"percent of total billed charges ","87% of total billed charges ",8.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",875,70,,700.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.25,1162.5,
"CEFTRIAXONE/DEXTROSE 2GM/50ML",7062177,"CDM ",636,RC,J0696,HCPCS,OUTPATIENT,,,125.5,100.4,,,,,,,,0,"other ","not separately reimbursment ",0.69,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",87.85,70,,70.28,,,0,"percent of total billed charges ","70% of total billed charges ",112.95,90,,90.36,,,0,"percent of total billed charges ","90% of total billed charges ",116.72,93,,93.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.51,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",106.68,85,,85.34,,,0,"percent of total billed charges ","85% of total billed charges ",112.95,90,,90.36,,,0,"percent of total billed charges ","90% of total billed charges ",112.95,90,,90.36,,,0,"percent of total billed charges ","90% of total billed charges ",0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",109.19,87,,1.83,0.39,41.08,12,"percent of total billed charges ","87% of total billed charges ",0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",87.85,70,,70.28,,,0,"percent of total billed charges ","70% of total billed charges ",0.5,116.72,
"CEFTRIAXONE 1GM BAG 50ML PREMI",7062185,"CDM ",636,RC,J0696,HCPCS,OUTPATIENT,,,122.5,98,,,,,,,,0,"other ","not separately reimbursment ",0.69,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",113.93,93,,91.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.51,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.13,85,,83.30,,,0,"percent of total billed charges ","85% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.58,87,,1.83,0.39,41.08,12,"percent of total billed charges ","87% of total billed charges ",0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",0.5,113.93,
"CEFAZOLIN 1GM BAG 50ML PREMIX",7062193,"CDM ",636,RC,J0690,HCPCS,OUTPATIENT,,,89,71.2,,,,,,,,0,"other ","not separately reimbursment ",1.23,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",82.77,93,,66.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",75.65,85,,60.52,,,0,"percent of total billed charges ","85% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",77.43,87,,40.51,32.13,122.92,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",0.75,82.77,
"GENTAMICIN 80MG/50ML NS BAG",7062227,"CDM ",636,RC,J1580,HCPCS,OUTPATIENT,,,82.5,66,,,,,,,,0,"other ","not separately reimbursment ",4.13,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",57.75,70,,46.20,,,0,"percent of total billed charges ","70% of total billed charges ",74.25,90,,59.40,,,0,"percent of total billed charges ","90% of total billed charges ",76.73,93,,61.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.13,85,,56.10,,,0,"percent of total billed charges ","85% of total billed charges ",74.25,90,,59.40,,,0,"percent of total billed charges ","90% of total billed charges ",74.25,90,,59.40,,,0,"percent of total billed charges ","90% of total billed charges ",1.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",71.78,87,,1.46,1.46,2.24,"1 through 10","percent of total billed charges ","87% of total billed charges ",1.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",57.75,70,,46.20,,,0,"percent of total billed charges ","70% of total billed charges ",1.68,76.73,
"PRIVIGEN 10% 100ML BTL 10GM",7062235,"CDM ",636,RC,J1459,HCPCS,OUTPATIENT,,,2592,2073.6,,,,,,,,0,"other ","not separately reimbursment ",61.96,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1814.4,70,,1451.52,,,0,"percent of total billed charges ","70% of total billed charges ",2332.8,90,,1866.24,,,0,"percent of total billed charges ","90% of total billed charges ",2410.56,93,,1928.45,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2203.2,85,,1762.56,,,0,"percent of total billed charges ","85% of total billed charges ",2332.8,90,,1866.24,,,0,"percent of total billed charges ","90% of total billed charges ",2332.8,90,,1866.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2255.04,87,,1804.03,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",50.28,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1814.4,70,,1451.52,,,0,"percent of total billed charges ","70% of total billed charges ",50.28,2410.56,
"FAMMAKED 10% 10GM 100ML VIAL",7062236,"CDM ",636,RC,J1561,HCPCS,OUTPATIENT,,,3287,2629.6,,,,,,,,0,"other ","not separately reimbursment ",63.59,100,,2416.42,2416.42,2416.42,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2300.9,70,,1840.72,,,0,"percent of total billed charges ","70% of total billed charges ",2958.3,90,,2366.64,,,0,"percent of total billed charges ","90% of total billed charges ",3056.91,93,,2445.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2793.95,85,,2235.16,,,0,"percent of total billed charges ","85% of total billed charges ",2958.3,90,,2366.64,,,0,"percent of total billed charges ","90% of total billed charges ",2958.3,90,,2366.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2859.69,87,,2287.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",49.08,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2300.9,70,,1840.72,,,0,"percent of total billed charges ","70% of total billed charges ",49.08,3056.91,
"BROVANA 15MCG/2ML NEB",7062280,"CDM ",637,RC,J7605,HCPCS,OUTPATIENT,,,30,24,,,,,,,,0,"other ","not separately reimbursment ",2.38,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",21,70,,16.80,,,0,"percent of total billed charges ","70% of total billed charges ",27,90,,21.60,,,0,"percent of total billed charges ","90% of total billed charges ",27.9,93,,22.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.5,85,,20.40,,,0,"percent of total billed charges ","85% of total billed charges ",27,90,,21.60,,,0,"percent of total billed charges ","90% of total billed charges ",27,90,,21.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.1,87,,20.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21,70,,16.80,,,0,"percent of total billed charges ","70% of total billed charges ",2.38,27.9,
"TOBRAMYCIN 300MG NEB AMP",7062282,"CDM ",637,RC,J7682,HCPCS,OUTPATIENT,,,20.5,16.4,,,,,,,,0,"other ","not separately reimbursment ",24.97,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",14.35,70,,11.48,,,0,"percent of total billed charges ","70% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",19.07,93,,15.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.43,85,,13.94,,,0,"percent of total billed charges ","85% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.84,87,,14.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.35,70,,11.48,,,0,"percent of total billed charges ","70% of total billed charges ",14.35,24.97,
"EMEND 115MG IV 5ML",7062342,"CDM ",636,RC,J1453,HCPCS,OUTPATIENT,,,410,328,,,,,,,,0,"other ","not separately reimbursment ",0.56,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",287,70,,229.60,,,0,"percent of total billed charges ","70% of total billed charges ",369,90,,295.20,,,0,"percent of total billed charges ","90% of total billed charges ",381.3,93,,305.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",348.5,85,,278.80,,,0,"percent of total billed charges ","85% of total billed charges ",369,90,,295.20,,,0,"percent of total billed charges ","90% of total billed charges ",369,90,,295.20,,,0,"percent of total billed charges ","90% of total billed charges ",0.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",356.7,87,,285.36,,,0,"percent of total billed charges ","87% of total billed charges ",0.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",287,70,,229.60,,,0,"percent of total billed charges ","70% of total billed charges ",0.24,381.3,
"INVANZ 1GM ADV",7063040,"CDM ",636,RC,J1335,HCPCS,OUTPATIENT,,,182,145.6,,,,,,,,0,"other ","not separately reimbursment ",17.97,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",127.4,70,,101.92,,,0,"percent of total billed charges ","70% of total billed charges ",163.8,90,,131.04,,,0,"percent of total billed charges ","90% of total billed charges ",169.26,93,,135.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",28.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",154.7,85,,123.76,,,0,"percent of total billed charges ","85% of total billed charges ",163.8,90,,131.04,,,0,"percent of total billed charges ","90% of total billed charges ",163.8,90,,131.04,,,0,"percent of total billed charges ","90% of total billed charges ",28.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",158.34,87,,126.67,,,0,"percent of total billed charges ","87% of total billed charges ",28.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",127.4,70,,101.92,,,0,"percent of total billed charges ","70% of total billed charges ",17.97,169.26,
"SODIUM CHLORIDE 150ML BAG",7063100,"CDM ",636,RC,J7050,HCPCS,OUTPATIENT,,,77.5,62,,,,,,,,0,"other ","not separately reimbursment ",1.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",54.25,70,,43.40,,,0,"percent of total billed charges ","70% of total billed charges ",69.75,90,,55.80,,,0,"percent of total billed charges ","90% of total billed charges ",72.08,93,,57.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",65.88,85,,52.70,,,0,"percent of total billed charges ","85% of total billed charges ",69.75,90,,55.80,,,0,"percent of total billed charges ","90% of total billed charges ",69.75,90,,55.80,,,0,"percent of total billed charges ","90% of total billed charges ",0.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",67.43,87,,51.72,46.55,62.06,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",54.25,70,,43.40,,,0,"percent of total billed charges ","70% of total billed charges ",0.65,72.08,
"GENTAMICIN 100MG/100ML PRE-MIX",7063120,"CDM ",636,RC,J1580,HCPCS,OUTPATIENT,,,81,64.8,,,,,,,,0,"other ","not separately reimbursment ",4.13,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",56.7,70,,45.36,,,0,"percent of total billed charges ","70% of total billed charges ",72.9,90,,58.32,,,0,"percent of total billed charges ","90% of total billed charges ",75.33,93,,60.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",68.85,85,,55.08,,,0,"percent of total billed charges ","85% of total billed charges ",72.9,90,,58.32,,,0,"percent of total billed charges ","90% of total billed charges ",72.9,90,,58.32,,,0,"percent of total billed charges ","90% of total billed charges ",1.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.47,87,,1.46,1.46,2.24,"1 through 10","percent of total billed charges ","87% of total billed charges ",1.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",56.7,70,,45.36,,,0,"percent of total billed charges ","70% of total billed charges ",1.68,75.33,
"NEMBUTAL 50MG/ML 20ML MDV INJ",7063240,"CDM ",636,RC,J2515,HCPCS,OUTPATIENT,,,670.5,536.4,,,,,,,,0,"other ","not separately reimbursment ",64.12,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",469.35,70,,375.48,,,0,"percent of total billed charges ","70% of total billed charges ",603.45,90,,482.76,,,0,"percent of total billed charges ","90% of total billed charges ",623.57,93,,498.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",26.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",569.93,85,,455.94,,,0,"percent of total billed charges ","85% of total billed charges ",603.45,90,,482.76,,,0,"percent of total billed charges ","90% of total billed charges ",603.45,90,,482.76,,,0,"percent of total billed charges ","90% of total billed charges ",26.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",583.34,87,,466.67,,,0,"percent of total billed charges ","87% of total billed charges ",26.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.26,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",469.35,70,,375.48,,,0,"percent of total billed charges ","70% of total billed charges ",26.41,623.57,
"NAROPIN 2MG/ML 200ML BTL INJ",7063280,"CDM ",636,RC,J2795,HCPCS,OUTPATIENT,,,173.5,138.8,,,,,,,,0,"other ","not separately reimbursment ",0.11,100,,15.68,15.68,15.68,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",121.45,70,,97.16,,,0,"percent of total billed charges ","70% of total billed charges ",156.15,90,,124.92,,,0,"percent of total billed charges ","90% of total billed charges ",161.36,93,,129.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",147.48,85,,117.98,,,0,"percent of total billed charges ","85% of total billed charges ",156.15,90,,124.92,,,0,"percent of total billed charges ","90% of total billed charges ",156.15,90,,124.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",150.95,87,,120.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",121.45,70,,97.16,,,0,"percent of total billed charges ","70% of total billed charges ",0.11,161.36,
"CAFF CITRATE 20MG/ML 3ML IV PF",7063310,"CDM ",636,RC,J0706,HCPCS,OUTPATIENT,,,104,83.2,,,,,,,,0,"other ","not separately reimbursment ",1.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",72.8,70,,58.24,,,0,"percent of total billed charges ","70% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",96.72,93,,77.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.84,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",88.4,85,,70.72,,,0,"percent of total billed charges ","85% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",0.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",90.48,87,,72.38,,,0,"percent of total billed charges ","87% of total billed charges ",0.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",72.8,70,,58.24,,,0,"percent of total billed charges ","70% of total billed charges ",0.83,96.72,
"LEXISCAN 0.08 MG/ML 5ML IV",7063430,"CDM ",636,RC,J2785,HCPCS,OUTPATIENT,,,493.5,394.8,,,,,,,,0,"other ","not separately reimbursment ",19.79,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",345.45,70,,276.36,,,0,"percent of total billed charges ","70% of total billed charges ",444.15,90,,355.32,,,0,"percent of total billed charges ","90% of total billed charges ",458.96,93,,367.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",60.3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",419.48,85,,335.58,,,0,"percent of total billed charges ","85% of total billed charges ",444.15,90,,355.32,,,0,"percent of total billed charges ","90% of total billed charges ",444.15,90,,355.32,,,0,"percent of total billed charges ","90% of total billed charges ",59.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",429.35,87,,261.19,261.19,261.19,"1 through 10","percent of total billed charges ","87% of total billed charges ",59.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",345.45,70,,276.36,,,0,"percent of total billed charges ","70% of total billed charges ",19.79,458.96,
"KCL 10MEQ/100ML BAG",7063690,"CDM ",258,RC,J3480,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",0.15,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",0.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",0.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",0.14,106.95,
"FLUCONAZOLE 100MG/50ML BTL IV",7063730,"CDM ",636,RC,J1450,HCPCS,OUTPATIENT,,,74.5,59.6,,,,,,,,0,"other ","not separately reimbursment ",3.59,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",69.29,93,,55.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",5.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",63.33,85,,50.66,,,0,"percent of total billed charges ","85% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",5.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.82,87,,51.86,,,0,"percent of total billed charges ","87% of total billed charges ",5.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",3.59,69.29,
"HEPARIN FLUSH 100U/ML 5ML SYR",7063750,"CDM ",636,RC,J1642,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",0.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.02,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,41.81,41.81,41.81,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.02,45.57,
"HEPARIN FLUSH 50U/5ML SYR",7063751,"CDM ",636,RC,J1642,HCPCS,OUTPATIENT,,,46,36.8,,,,,,,,0,"other ","not separately reimbursment ",0.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.2,70,,25.76,,,0,"percent of total billed charges ","70% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",42.78,93,,34.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.02,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.1,85,,31.28,,,0,"percent of total billed charges ","85% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",0.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.02,87,,41.81,41.81,41.81,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.2,70,,25.76,,,0,"percent of total billed charges ","70% of total billed charges ",0.02,42.78,
"MORPHINE 2MG/ML 1 ML INJ",7063790,"CDM ",636,RC,J2270,HCPCS,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",5.74,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",3.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",3.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.76,87,,37.24,33.93,40.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",3.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",3.39,44.64,
"HUMULIN R INSULIN 100U/ML 3ML",7063840,"CDM ",636,RC,J1815,HCPCS,OUTPATIENT,,,33.5,26.8,,,,,,,,0,"other ","not separately reimbursment ",0.27,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",31.16,93,,24.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",28.48,85,,22.78,,,0,"percent of total billed charges ","85% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",0.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.15,87,,23.32,,,0,"percent of total billed charges ","87% of total billed charges ",0.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",0.27,31.16,
"INSULIN R MYXREDLIN 100U/100ML",7063842,"CDM ",637,RC,J1815,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",0.27,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",0.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",0.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",0.27,106.95,
"CALCIUM CARBON 1250MG/5ML SUSP",7063900,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,1,0.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.7,70,,0.56,,,0,"percent of total billed charges ","70% of total billed charges ",0.9,90,,0.72,,,0,"percent of total billed charges ","90% of total billed charges ",0.93,93,,0.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",0.85,85,,0.68,,,0,"percent of total billed charges ","85% of total billed charges ",0.9,90,,0.72,,,0,"percent of total billed charges ","90% of total billed charges ",0.9,90,,0.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",0.87,87,,0.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.7,70,,0.56,,,0,"percent of total billed charges ","70% of total billed charges ",0.7,0.93,
"XYLOCAINE 1% MPF 2ML VIAL 20MG",7064050,"CDM ",250,RC,J2003,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,2.07,2.07,2.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"KEPPRA 500MG/5ML INJECTION",7064180,"CDM ",636,RC,J1953,HCPCS,OUTPATIENT,,,116,92.8,,,,,,,,0,"other ","not separately reimbursment ",0.11,100,,10.45,10.45,10.45,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",81.2,70,,64.96,,,0,"percent of total billed charges ","70% of total billed charges ",104.4,90,,83.52,,,0,"percent of total billed charges ","90% of total billed charges ",107.88,93,,86.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",98.6,85,,78.88,,,0,"percent of total billed charges ","85% of total billed charges ",104.4,90,,83.52,,,0,"percent of total billed charges ","90% of total billed charges ",104.4,90,,83.52,,,0,"percent of total billed charges ","90% of total billed charges ",0.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.92,87,,0.01,0.01,0.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",81.2,70,,64.96,,,0,"percent of total billed charges ","70% of total billed charges ",0.09,107.88,
"CEFEPIME HCL 2GM VIAL",7064330,"CDM ",636,RC,J0692,HCPCS,OUTPATIENT,,,85,68,,,,,,,,0,"other ","not separately reimbursment ",2.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",59.5,70,,47.60,,,0,"percent of total billed charges ","70% of total billed charges ",76.5,90,,61.20,,,0,"percent of total billed charges ","90% of total billed charges ",79.05,93,,63.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.87,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",72.25,85,,57.80,,,0,"percent of total billed charges ","85% of total billed charges ",76.5,90,,61.20,,,0,"percent of total billed charges ","90% of total billed charges ",76.5,90,,61.20,,,0,"percent of total billed charges ","90% of total billed charges ",1.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",73.95,87,,59.16,,,0,"percent of total billed charges ","87% of total billed charges ",1.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",59.5,70,,47.60,,,0,"percent of total billed charges ","70% of total billed charges ",1.85,79.05,
"GENTAMICIN SULF 60MG/50ML BAG",7064410,"CDM ",636,RC,J1580,HCPCS,OUTPATIENT,,,79,63.2,,,,,,,,0,"other ","not separately reimbursment ",4.13,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",55.3,70,,44.24,,,0,"percent of total billed charges ","70% of total billed charges ",71.1,90,,56.88,,,0,"percent of total billed charges ","90% of total billed charges ",73.47,93,,58.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",67.15,85,,53.72,,,0,"percent of total billed charges ","85% of total billed charges ",71.1,90,,56.88,,,0,"percent of total billed charges ","90% of total billed charges ",71.1,90,,56.88,,,0,"percent of total billed charges ","90% of total billed charges ",1.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",68.73,87,,1.46,1.46,2.24,"1 through 10","percent of total billed charges ","87% of total billed charges ",1.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",55.3,70,,44.24,,,0,"percent of total billed charges ","70% of total billed charges ",1.68,73.47,
"LOVENOX 120MG SYR INJ",7064420,"CDM ",636,RC,J1650,HCPCS,OUTPATIENT,,,213.5,170.8,,,,,,,,0,"other ","not separately reimbursment ",0.8,100,,2.74,2.74,2.74,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",149.45,70,,119.56,,,0,"percent of total billed charges ","70% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",198.56,93,,158.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",181.48,85,,145.18,,,0,"percent of total billed charges ","85% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",185.75,87,,37.24,33.93,40.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",149.45,70,,119.56,,,0,"percent of total billed charges ","70% of total billed charges ",0.76,198.56,
"HYDROMORPHONE 1MG/ML 50ML BAG",7064460,"CDM ",636,RC,J1171,HCPCS,OUTPATIENT,,,90.5,72.4,,,,,,,,0,"other ","not separately reimbursment ",,,,0.10,0.10,0.10,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.35,70,,50.68,,,0,"percent of total billed charges ","70% of total billed charges ",81.45,90,,65.16,,,0,"percent of total billed charges ","90% of total billed charges ",84.17,93,,67.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",76.93,85,,61.54,,,0,"percent of total billed charges ","85% of total billed charges ",81.45,90,,65.16,,,0,"percent of total billed charges ","90% of total billed charges ",81.45,90,,65.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",78.74,87,,34.14,13.25,118.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.35,70,,50.68,,,0,"percent of total billed charges ","70% of total billed charges ",63.35,84.17,
"AMPICILLIN 2GM VIAL",7064470,"CDM ",636,RC,J0290,HCPCS,OUTPATIENT,,,66,52.8,,,,,,,,0,"other ","not separately reimbursment ",1.04,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",46.2,70,,36.96,,,0,"percent of total billed charges ","70% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",61.38,93,,49.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",56.1,85,,44.88,,,0,"percent of total billed charges ","85% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",0.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.42,87,,45.94,,,0,"percent of total billed charges ","87% of total billed charges ",0.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",46.2,70,,36.96,,,0,"percent of total billed charges ","70% of total billed charges ",0.81,61.38,
"BRINZOLAMIDE 1% SUSP 10ML",7064500,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,622.5,498,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",435.75,70,,348.60,,,0,"percent of total billed charges ","70% of total billed charges ",560.25,90,,448.20,,,0,"percent of total billed charges ","90% of total billed charges ",578.93,93,,463.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",529.13,85,,423.30,,,0,"percent of total billed charges ","85% of total billed charges ",560.25,90,,448.20,,,0,"percent of total billed charges ","90% of total billed charges ",560.25,90,,448.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",541.58,87,,433.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",435.75,70,,348.60,,,0,"percent of total billed charges ","70% of total billed charges ",435.75,578.93,
"DORZOLAMIDE HCL 2% ML OPHTH",7064530,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,178,142.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.6,70,,99.68,,,0,"percent of total billed charges ","70% of total billed charges ",160.2,90,,128.16,,,0,"percent of total billed charges ","90% of total billed charges ",165.54,93,,132.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",151.3,85,,121.04,,,0,"percent of total billed charges ","85% of total billed charges ",160.2,90,,128.16,,,0,"percent of total billed charges ","90% of total billed charges ",160.2,90,,128.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",154.86,87,,123.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.6,70,,99.68,,,0,"percent of total billed charges ","70% of total billed charges ",124.6,165.54,
"TIMOLOL MALEATE OPHTH 10ML SOL",7064580,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,93.5,74.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.45,70,,52.36,,,0,"percent of total billed charges ","70% of total billed charges ",84.15,90,,67.32,,,0,"percent of total billed charges ","90% of total billed charges ",86.96,93,,69.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",79.48,85,,63.58,,,0,"percent of total billed charges ","85% of total billed charges ",84.15,90,,67.32,,,0,"percent of total billed charges ","90% of total billed charges ",84.15,90,,67.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.35,87,,65.08,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.45,70,,52.36,,,0,"percent of total billed charges ","70% of total billed charges ",65.45,86.96,
"MOMETASONE FUROATE 220MG/INH",7064610,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,215.5,172.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",150.85,70,,120.68,,,0,"percent of total billed charges ","70% of total billed charges ",193.95,90,,155.16,,,0,"percent of total billed charges ","90% of total billed charges ",200.42,93,,160.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",183.18,85,,146.54,,,0,"percent of total billed charges ","85% of total billed charges ",193.95,90,,155.16,,,0,"percent of total billed charges ","90% of total billed charges ",193.95,90,,155.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",187.49,87,,149.99,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",150.85,70,,120.68,,,0,"percent of total billed charges ","70% of total billed charges ",150.85,200.42,
"CEFPROZIL 250MG/5ML BTL",7064700,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,140.5,112.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",130.67,93,,104.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",119.43,85,,95.54,,,0,"percent of total billed charges ","85% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",122.24,87,,97.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",98.35,130.67,
"ZINC OXIDE (TOPICAL) 2OZ JAR",7064710,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,38.5,30.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,93,,28.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.73,85,,26.18,,,0,"percent of total billed charges ","85% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.5,87,,26.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",26.95,35.81,
"LIDOCAINE 1% INJ 10ML VIAL",7064780,"CDM ",250,RC,J2003,HCPCS,OUTPATIENT,,,56,44.8,,,,,,,,0,"other ","not separately reimbursment ",,,,2.07,2.07,2.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.2,70,,31.36,,,0,"percent of total billed charges ","70% of total billed charges ",50.4,90,,40.32,,,0,"percent of total billed charges ","90% of total billed charges ",52.08,93,,41.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",47.6,85,,38.08,,,0,"percent of total billed charges ","85% of total billed charges ",50.4,90,,40.32,,,0,"percent of total billed charges ","90% of total billed charges ",50.4,90,,40.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",48.72,87,,38.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.2,70,,31.36,,,0,"percent of total billed charges ","70% of total billed charges ",39.2,52.08,
"XYLOCAINE HCL 2% 5ML INJ VIAL",7064850,"CDM ",250,RC,J2003,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,2.07,2.07,2.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"ARGATROBAN 250MG/2.5ML INJ",7064880,"CDM ",636,RC,J0883,HCPCS,OUTPATIENT,,,2495,1996,,,,,,,,0,"other ","not separately reimbursment ",3.59,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1746.5,70,,1397.20,,,0,"percent of total billed charges ","70% of total billed charges ",2245.5,90,,1796.40,,,0,"percent of total billed charges ","90% of total billed charges ",2320.35,93,,1856.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2120.75,85,,1696.60,,,0,"percent of total billed charges ","85% of total billed charges ",2245.5,90,,1796.40,,,0,"percent of total billed charges ","90% of total billed charges ",2245.5,90,,1796.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2170.65,87,,1736.52,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.61,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1746.5,70,,1397.20,,,0,"percent of total billed charges ","70% of total billed charges ",0.61,2320.35,
"DEFEROXAMINE 2GM VIAL INJ",7064890,"CDM ",636,RC,J0895,HCPCS,OUTPATIENT,,,98,78.4,,,,,,,,0,"other ","not separately reimbursment ",11.6,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.6,70,,54.88,,,0,"percent of total billed charges ","70% of total billed charges ",88.2,90,,70.56,,,0,"percent of total billed charges ","90% of total billed charges ",91.14,93,,72.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",7.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.3,85,,66.64,,,0,"percent of total billed charges ","85% of total billed charges ",88.2,90,,70.56,,,0,"percent of total billed charges ","90% of total billed charges ",88.2,90,,70.56,,,0,"percent of total billed charges ","90% of total billed charges ",7.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.26,87,,68.21,,,0,"percent of total billed charges ","87% of total billed charges ",7.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.6,70,,54.88,,,0,"percent of total billed charges ","70% of total billed charges ",7.66,91.14,
"LIDOCAINE MPF 1% 2ML 10MG/ML I",7065020,"CDM ",250,RC,J2003,HCPCS,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",,,,2.07,2.07,2.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",33.6,44.64,
"AMIODARONE HCL 900MG/18ML VIAL",7065030,"CDM ",636,RC,J0282,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",0.57,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",0.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.31,45.57,
"PHENOBARBITAL 32.4MG TAB",7065072,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,11,8.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",10.23,93,,8.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.35,85,,7.48,,,0,"percent of total billed charges ","85% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.57,87,,7.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.7,10.23,
"AZITHROMYCIN SUSP 40MG/ML 22.5",7065090,"CDM ",637,RC,Q0144,HCPCS,OUTPATIENT,,,99.5,79.6,,,,,,,,0,"other ","not separately reimbursment ",30.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",69.65,70,,55.72,,,0,"percent of total billed charges ","70% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",92.54,93,,74.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",84.58,85,,67.66,,,0,"percent of total billed charges ","85% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",86.57,87,,69.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.65,70,,55.72,,,0,"percent of total billed charges ","70% of total billed charges ",30.5,92.54,
"AMIKACIN 1GM/4ML VIAL",7065170,"CDM ",636,RC,J0278,HCPCS,OUTPATIENT,,,66,52.8,,,,,,,,0,"other ","not separately reimbursment ",1.09,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",46.2,70,,36.96,,,0,"percent of total billed charges ","70% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",61.38,93,,49.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",56.1,85,,44.88,,,0,"percent of total billed charges ","85% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",1.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.42,87,,45.94,,,0,"percent of total billed charges ","87% of total billed charges ",1.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",46.2,70,,36.96,,,0,"percent of total billed charges ","70% of total billed charges ",1.06,61.38,
"GUAIFENES COD 100MG/10ML 5ML",7065190,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7.5,6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.25,70,,4.20,,,0,"percent of total billed charges ","70% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",6.98,93,,5.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6.38,85,,5.10,,,0,"percent of total billed charges ","85% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.53,87,,5.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.25,70,,4.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,6.98,
"VANCOMYCIN 750MG INJ VIAL",7065200,"CDM ",636,RC,J3373,HCPCS,OUTPATIENT,,,46.5,37.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",43.25,93,,34.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.53,85,,31.62,,,0,"percent of total billed charges ","85% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.46,87,,32.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",32.55,43.25,
"BUPIVACAINE LIP 13.3MG/ML 20ML",7065240,"CDM ",636,RC,J0666,HCPCS,OUTPATIENT,,,728.5,582.8,,,,,,,,0,"other ","not separately reimbursment ",,,,42.93,42.93,42.93,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",509.95,70,,407.96,,,0,"percent of total billed charges ","70% of total billed charges ",655.65,90,,524.52,,,0,"percent of total billed charges ","90% of total billed charges ",677.51,93,,542.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",619.23,85,,495.38,,,0,"percent of total billed charges ","85% of total billed charges ",655.65,90,,524.52,,,0,"percent of total billed charges ","90% of total billed charges ",655.65,90,,524.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",633.8,87,,38.09,33.74,42.44,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.29,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",509.95,70,,407.96,,,0,"percent of total billed charges ","70% of total billed charges ",1.29,677.51,
"PROLASTIN-C 1000MG",7065310,"CDM ",636,RC,J0256,HCPCS,OUTPATIENT,,,1023,818.4,,,,,,,,0,"other ","not separately reimbursment ",6.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",716.1,70,,572.88,,,0,"percent of total billed charges ","70% of total billed charges ",920.7,90,,736.56,,,0,"percent of total billed charges ","90% of total billed charges ",951.39,93,,761.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",869.55,85,,695.64,,,0,"percent of total billed charges ","85% of total billed charges ",920.7,90,,736.56,,,0,"percent of total billed charges ","90% of total billed charges ",920.7,90,,736.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",890.01,87,,712.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",5.37,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",716.1,70,,572.88,,,0,"percent of total billed charges ","70% of total billed charges ",5.37,951.39,
"ZEMAIRA 1000MG VIAL",7065312,"CDM ",636,RC,J0256,HCPCS,OUTPATIENT,,,980,784,,,,,,,,0,"other ","not separately reimbursment ",6.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",686,70,,548.80,,,0,"percent of total billed charges ","70% of total billed charges ",882,90,,705.60,,,0,"percent of total billed charges ","90% of total billed charges ",911.4,93,,729.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",833,85,,666.40,,,0,"percent of total billed charges ","85% of total billed charges ",882,90,,705.60,,,0,"percent of total billed charges ","90% of total billed charges ",882,90,,705.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",852.6,87,,682.08,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",5.37,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",686,70,,548.80,,,0,"percent of total billed charges ","70% of total billed charges ",5.37,911.4,
"PREDNISONE 5MG/5ML UDC ORAL",7065320,"CDM ",637,RC,J7512,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"LANSOPRAZOLE 3MG/ML 90ML BTL",7065420,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,134,107.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.8,70,,75.04,,,0,"percent of total billed charges ","70% of total billed charges ",120.6,90,,96.48,,,0,"percent of total billed charges ","90% of total billed charges ",124.62,93,,99.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",113.9,85,,91.12,,,0,"percent of total billed charges ","85% of total billed charges ",120.6,90,,96.48,,,0,"percent of total billed charges ","90% of total billed charges ",120.6,90,,96.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",116.58,87,,93.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.8,70,,75.04,,,0,"percent of total billed charges ","70% of total billed charges ",93.8,124.62,
"VANCOMYCIN HCL 750MG ADDVIAL",7065520,"CDM ",636,RC,J3373,HCPCS,OUTPATIENT,,,52.5,42,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42,80,,33.60,,,0,"percent of total billed charges ","80% of total billed charges ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",48.83,93,,39.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",44.63,85,,35.70,,,0,"percent of total billed charges ","85% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",45.68,87,,36.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",36.75,48.83,
"IMIPENEM-CILASTATIN 250MG VIAL",7065550,"CDM ",636,RC,J0743,HCPCS,OUTPATIENT,,,135,108,,,,,,,,0,"other ","not separately reimbursment ",9.72,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",125.55,93,,100.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",7.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",114.75,85,,91.80,,,0,"percent of total billed charges ","85% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",7.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.45,87,,93.96,,,0,"percent of total billed charges ","87% of total billed charges ",7.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",7.61,125.55,
"TRIAMCINOLONE ACET 40MG/ML 5ML",7065560,"CDM ",636,RC,J3301,HCPCS,OUTPATIENT,,,111.5,89.2,,,,,,,,0,"other ","not separately reimbursment ",1.39,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",78.05,70,,62.44,,,0,"percent of total billed charges ","70% of total billed charges ",100.35,90,,80.28,,,0,"percent of total billed charges ","90% of total billed charges ",103.7,93,,82.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",94.78,85,,75.82,,,0,"percent of total billed charges ","85% of total billed charges ",100.35,90,,80.28,,,0,"percent of total billed charges ","90% of total billed charges ",100.35,90,,80.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",97.01,87,,0.81,0.46,3.07,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.05,70,,62.44,,,0,"percent of total billed charges ","70% of total billed charges ",1.39,103.7,
"RHO(D) IMMUNEGLOBULIN 1500 IU",7065580,"CDM ",636,RC,J2790,HCPCS,OUTPATIENT,,,213.5,170.8,,,,,,,,0,"other ","not separately reimbursment ",320.11,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",149.45,70,,119.56,,,0,"percent of total billed charges ","70% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",198.56,93,,158.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",76.3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",181.48,85,,145.18,,,0,"percent of total billed charges ","85% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",75.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",185.75,87,,61.73,61.73,61.73,"1 through 10","percent of total billed charges ","87% of total billed charges ",75.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",149.45,70,,119.56,,,0,"percent of total billed charges ","70% of total billed charges ",75.54,320.11,
"BOTOX 100 UNIT VIAL",7065610,"CDM ",636,RC,J0585,HCPCS,OUTPATIENT,,,1157.5,926,,,,,,,,0,"other ","not separately reimbursment ",8.13,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",810.25,70,,648.20,,,0,"percent of total billed charges ","70% of total billed charges ",1041.75,90,,833.40,,,0,"percent of total billed charges ","90% of total billed charges ",1076.48,93,,861.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",6.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",983.88,85,,787.10,,,0,"percent of total billed charges ","85% of total billed charges ",1041.75,90,,833.40,,,0,"percent of total billed charges ","90% of total billed charges ",1041.75,90,,833.40,,,0,"percent of total billed charges ","90% of total billed charges ",6.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1007.03,87,,805.62,,,0,"percent of total billed charges ","87% of total billed charges ",6.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",810.25,70,,648.20,,,0,"percent of total billed charges ","70% of total billed charges ",6.09,1076.48,
"BUPIVACAINE 0.5% 5MG/ML 10ML",7065620,"CDM ",636,RC,J0666,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,42.93,42.93,42.93,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,38.09,33.74,42.44,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.29,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",1.29,45.57,
"BENLYSTA 120MG VIAL",7065660,"CDM ",636,RC,J0490,HCPCS,OUTPATIENT,,,1817.5,1454,,,,,,,,0,"other ","not separately reimbursment ",69.59,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1272.25,70,,1017.80,,,0,"percent of total billed charges ","70% of total billed charges ",1635.75,90,,1308.60,,,0,"percent of total billed charges ","90% of total billed charges ",1690.28,93,,1352.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",48.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1544.88,85,,1235.90,,,0,"percent of total billed charges ","85% of total billed charges ",1635.75,90,,1308.60,,,0,"percent of total billed charges ","90% of total billed charges ",1635.75,90,,1308.60,,,0,"percent of total billed charges ","90% of total billed charges ",47.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1581.23,87,,1264.98,,,0,"percent of total billed charges ","87% of total billed charges ",47.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.16,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1272.25,70,,1017.80,,,0,"percent of total billed charges ","70% of total billed charges ",47.57,1690.28,
"GUSELKUMAB TREMFYA 200MG VL",7065665,"CDM ",636,RC,J1628,HCPCS,OUTPATIENT,,,20468.5,16374.8,,,,,,,,0,"other ","not separately reimbursment ",168.39,100,,1640.53,1640.53,1640.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",14327.95,70,,11462.36,,,0,"percent of total billed charges ","70% of total billed charges ",18421.65,90,,14737.32,,,0,"percent of total billed charges ","90% of total billed charges ",19035.71,93,,15228.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",120.57,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",17398.23,85,,13918.58,,,0,"percent of total billed charges ","85% of total billed charges ",18421.65,90,,14737.32,,,0,"percent of total billed charges ","90% of total billed charges ",18421.65,90,,14737.32,,,0,"percent of total billed charges ","90% of total billed charges ",119.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17807.6,87,,14246.08,,,0,"percent of total billed charges ","87% of total billed charges ",119.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",72.94,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",14327.95,70,,11462.36,,,0,"percent of total billed charges ","70% of total billed charges ",72.94,19035.71,
"BENLYSTA BELIMUMAB 400MG VIAL",7065670,"CDM ",636,RC,J0490,HCPCS,OUTPATIENT,,,2979,2383.2,,,,,,,,0,"other ","not separately reimbursment ",69.59,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2085.3,70,,1668.24,,,0,"percent of total billed charges ","70% of total billed charges ",2681.1,90,,2144.88,,,0,"percent of total billed charges ","90% of total billed charges ",2770.47,93,,2216.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",48.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2532.15,85,,2025.72,,,0,"percent of total billed charges ","85% of total billed charges ",2681.1,90,,2144.88,,,0,"percent of total billed charges ","90% of total billed charges ",2681.1,90,,2144.88,,,0,"percent of total billed charges ","90% of total billed charges ",47.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2591.73,87,,2073.38,,,0,"percent of total billed charges ","87% of total billed charges ",47.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.16,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2085.3,70,,1668.24,,,0,"percent of total billed charges ","70% of total billed charges ",47.57,2770.47,
"DOBUTAMINE/DEX 5% 1000MG/250ML",7065680,"CDM ",636,RC,J1250,HCPCS,OUTPATIENT,,,101.5,81.2,,,,,,,,0,"other ","not separately reimbursment ",11.91,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",71.05,70,,56.84,,,0,"percent of total billed charges ","70% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",94.4,93,,75.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",8.29,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",86.28,85,,69.02,,,0,"percent of total billed charges ","85% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",8.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",88.31,87,,70.65,,,0,"percent of total billed charges ","87% of total billed charges ",8.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",71.05,70,,56.84,,,0,"percent of total billed charges ","70% of total billed charges ",8.21,94.4,
"MILRINONE 20MG 100ML BAG",7065682,"CDM ",250,RC,J2260,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",2.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",1.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",1.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",1.89,106.95,
"IRON SUCROSE INJ 100MG/5ML VIA",7065700,"CDM ",636,RC,J1756,HCPCS,OUTPATIENT,,,111,88.8,,,,,,,,0,"other ","not separately reimbursment ",0.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",77.7,70,,62.16,,,0,"percent of total billed charges ","70% of total billed charges ",99.9,90,,79.92,,,0,"percent of total billed charges ","90% of total billed charges ",103.23,93,,82.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",94.35,85,,75.48,,,0,"percent of total billed charges ","85% of total billed charges ",99.9,90,,79.92,,,0,"percent of total billed charges ","90% of total billed charges ",99.9,90,,79.92,,,0,"percent of total billed charges ","90% of total billed charges ",0.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.57,87,,228.43,228.43,228.43,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",77.7,70,,62.16,,,0,"percent of total billed charges ","70% of total billed charges ",0.23,103.23,
"ORENCIA ABATACEPT 250MG VIAL",7065800,"CDM ",636,RC,J0129,HCPCS,OUTPATIENT,,,2139,1711.2,,,,,,,,0,"other ","not separately reimbursment ",53.11,100,,829.43,829.43,829.43,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1497.3,70,,1197.84,,,0,"percent of total billed charges ","70% of total billed charges ",1925.1,90,,1540.08,,,0,"percent of total billed charges ","90% of total billed charges ",1989.27,93,,1591.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",45.72,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1818.15,85,,1454.52,,,0,"percent of total billed charges ","85% of total billed charges ",1925.1,90,,1540.08,,,0,"percent of total billed charges ","90% of total billed charges ",1925.1,90,,1540.08,,,0,"percent of total billed charges ","90% of total billed charges ",45.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1860.93,87,,1488.74,,,0,"percent of total billed charges ","87% of total billed charges ",45.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",44.77,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1497.3,70,,1197.84,,,0,"percent of total billed charges ","70% of total billed charges ",44.77,1989.27,
"HYDROMORPHONE HCL 1MG/ML 0.5MG",7065840,"CDM ",636,RC,J1171,HCPCS,OUTPATIENT,,,48.5,38.8,,,,,,,,0,"other ","not separately reimbursment ",,,,0.10,0.10,0.10,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.95,70,,27.16,,,0,"percent of total billed charges ","70% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",45.11,93,,36.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.23,85,,32.98,,,0,"percent of total billed charges ","85% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.2,87,,34.14,13.25,118.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.95,70,,27.16,,,0,"percent of total billed charges ","70% of total billed charges ",33.95,45.11,
"HYDROMORPHONE HCL 1MG/ML 1ML",7065850,"CDM ",636,RC,J1171,HCPCS,OUTPATIENT,,,48.5,38.8,,,,,,,,0,"other ","not separately reimbursment ",,,,0.10,0.10,0.10,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.95,70,,27.16,,,0,"percent of total billed charges ","70% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",45.11,93,,36.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.23,85,,32.98,,,0,"percent of total billed charges ","85% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.2,87,,34.14,13.25,118.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.95,70,,27.16,,,0,"percent of total billed charges ","70% of total billed charges ",33.95,45.11,
"CEFTRIAXONE SODIUM 2GM ADV",7066000,"CDM ",636,RC,J0696,HCPCS,OUTPATIENT,,,47,37.6,,,,,,,,0,"other ","not separately reimbursment ",0.69,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",43.71,93,,34.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.51,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.95,85,,31.96,,,0,"percent of total billed charges ","85% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.89,87,,1.83,0.39,41.08,12,"percent of total billed charges ","87% of total billed charges ",0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",0.5,43.71,
"ACETAMINOPHEN IV 1000MG/100ML",7066020,"CDM ",636,RC,J0131,HCPCS,OUTPATIENT,,,123,98.4,,,,,,,,0,"other ","not separately reimbursment ",0.06,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",86.1,70,,68.88,,,0,"percent of total billed charges ","70% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",114.39,93,,91.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.55,85,,83.64,,,0,"percent of total billed charges ","85% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",0.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.01,87,,79.30,0.01,99.13,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",86.1,70,,68.88,,,0,"percent of total billed charges ","70% of total billed charges ",0.06,114.39,
"PROTONIX 40MG ORAL SUSP",7066040,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,25,20,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.5,70,,14.00,,,0,"percent of total billed charges ","70% of total billed charges ",22.5,90,,18.00,,,0,"percent of total billed charges ","90% of total billed charges ",23.25,93,,18.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.25,85,,17.00,,,0,"percent of total billed charges ","85% of total billed charges ",22.5,90,,18.00,,,0,"percent of total billed charges ","90% of total billed charges ",22.5,90,,18.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.75,87,,17.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.5,70,,14.00,,,0,"percent of total billed charges ","70% of total billed charges ",17.5,23.25,
"MICAFUNGIN SODIUM 100MG VIAL",7066070,"CDM ",636,RC,J2248,HCPCS,OUTPATIENT,,,182,145.6,,,,,,,,0,"other ","not separately reimbursment ",2.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",127.4,70,,101.92,,,0,"percent of total billed charges ","70% of total billed charges ",163.8,90,,131.04,,,0,"percent of total billed charges ","90% of total billed charges ",169.26,93,,135.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",154.7,85,,123.76,,,0,"percent of total billed charges ","85% of total billed charges ",163.8,90,,131.04,,,0,"percent of total billed charges ","90% of total billed charges ",163.8,90,,131.04,,,0,"percent of total billed charges ","90% of total billed charges ",0.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",158.34,87,,126.67,,,0,"percent of total billed charges ","87% of total billed charges ",0.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",127.4,70,,101.92,,,0,"percent of total billed charges ","70% of total billed charges ",0.97,169.26,
"TEFLARO 600MG VIAL",7066110,"CDM ",636,RC,J0712,HCPCS,OUTPATIENT,,,245,196,,,,,,,,0,"other ","not separately reimbursment ",5.87,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",171.5,70,,137.20,,,0,"percent of total billed charges ","70% of total billed charges ",220.5,90,,176.40,,,0,"percent of total billed charges ","90% of total billed charges ",227.85,93,,182.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",3.55,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",208.25,85,,166.60,,,0,"percent of total billed charges ","85% of total billed charges ",220.5,90,,176.40,,,0,"percent of total billed charges ","90% of total billed charges ",220.5,90,,176.40,,,0,"percent of total billed charges ","90% of total billed charges ",3.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",213.15,87,,170.52,,,0,"percent of total billed charges ","87% of total billed charges ",3.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.24,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",171.5,70,,137.20,,,0,"percent of total billed charges ","70% of total billed charges ",3.51,227.85,
"PRAXBIND 2.5GM INJ",7066190,"CDM ",636,RC,C9399,HCPCS,OUTPATIENT,,,3478,2782.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2434.6,70,,1947.68,,,0,"percent of total billed charges ","70% of total billed charges ",3130.2,90,,2504.16,,,0,"percent of total billed charges ","90% of total billed charges ",3234.54,93,,2587.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2956.3,85,,2365.04,,,0,"percent of total billed charges ","85% of total billed charges ",3130.2,90,,2504.16,,,0,"percent of total billed charges ","90% of total billed charges ",3130.2,90,,2504.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3025.86,87,,2420.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2434.6,70,,1947.68,,,0,"percent of total billed charges ","70% of total billed charges ",2434.6,3234.54,
"ENTYVIO 300MG VIAL",7066230,"CDM ",636,RC,J3380,HCPCS,OUTPATIENT,,,6519.5,5215.6,,,,,,,,0,"other ","not separately reimbursment ",35.07,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",4563.65,70,,3650.92,,,0,"percent of total billed charges ","70% of total billed charges ",5867.55,90,,4694.04,,,0,"percent of total billed charges ","90% of total billed charges ",6063.14,93,,4850.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",21.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5541.58,85,,4433.26,,,0,"percent of total billed charges ","85% of total billed charges ",5867.55,90,,4694.04,,,0,"percent of total billed charges ","90% of total billed charges ",5867.55,90,,4694.04,,,0,"percent of total billed charges ","90% of total billed charges ",21.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5671.97,87,,4537.58,,,0,"percent of total billed charges ","87% of total billed charges ",21.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.37,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4563.65,70,,3650.92,,,0,"percent of total billed charges ","70% of total billed charges ",21.28,6063.14,
"OCREVUS 300MG/10ML VIAL",7066235,"CDM ",636,RC,J2350,HCPCS,OUTPATIENT,,,26361,21088.8,,,,,,,,0,"other ","not separately reimbursment ",72.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",18452.7,70,,14762.16,,,0,"percent of total billed charges ","70% of total billed charges ",23724.9,90,,18979.92,,,0,"percent of total billed charges ","90% of total billed charges ",24515.73,93,,19612.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",58.87,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",22406.85,85,,17925.48,,,0,"percent of total billed charges ","85% of total billed charges ",23724.9,90,,18979.92,,,0,"percent of total billed charges ","90% of total billed charges ",23724.9,90,,18979.92,,,0,"percent of total billed charges ","90% of total billed charges ",58.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22934.07,87,,18347.26,,,0,"percent of total billed charges ","87% of total billed charges ",58.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2959.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",18452.7,70,,14762.16,,,0,"percent of total billed charges ","70% of total billed charges ",58.29,24515.73,
"JUBBONTI DENOSUMAB BBDZ 60MG",7066258,"CDM ",636,RC,Q5136,HCPCS,OUTPATIENT,,,1649.5,1319.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1154.65,70,,923.72,,,0,"percent of total billed charges ","70% of total billed charges ",1484.55,90,,1187.64,,,0,"percent of total billed charges ","90% of total billed charges ",1534.04,93,,1227.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1402.08,85,,1121.66,,,0,"percent of total billed charges ","85% of total billed charges ",1484.55,90,,1187.64,,,0,"percent of total billed charges ","90% of total billed charges ",1484.55,90,,1187.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1435.07,87,,1148.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",28.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1154.65,70,,923.72,,,0,"percent of total billed charges ","70% of total billed charges ",28.23,1534.04,
"PROLIA 60MG INJECTION",7066260,"CDM ",636,RC,J0897,HCPCS,OUTPATIENT,,,1823,1458.4,,,,,,,,0,"other ","not separately reimbursment ",32.42,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,303.69,303.69,303.69,"1 through 10","other ","not separately reimbursment ",1276.1,70,,1020.88,,,0,"percent of total billed charges ","70% of total billed charges ",1640.7,90,,1312.56,,,0,"percent of total billed charges ","90% of total billed charges ",1695.39,93,,1356.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",21.4,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1549.55,85,,1239.64,,,0,"percent of total billed charges ","85% of total billed charges ",1640.7,90,,1312.56,,,0,"percent of total billed charges ","90% of total billed charges ",1640.7,90,,1312.56,,,0,"percent of total billed charges ","90% of total billed charges ",21.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1586.01,87,,1324.87,1324.87,1324.87,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.46,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1276.1,70,,1020.88,,,0,"percent of total billed charges ","70% of total billed charges ",21.19,1695.39,
"SKYRIZI 600MG VIAL",7066262,"CDM ",636,RC,J2327,HCPCS,OUTPATIENT,,,12866,10292.8,,,,,,,,0,"other ","not separately reimbursment ",19.77,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",9006.2,70,,7204.96,,,0,"percent of total billed charges ","70% of total billed charges ",11579.4,90,,9263.52,,,0,"percent of total billed charges ","90% of total billed charges ",11965.38,93,,9572.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10936.1,85,,8748.88,,,0,"percent of total billed charges ","85% of total billed charges ",11579.4,90,,9263.52,,,0,"percent of total billed charges ","90% of total billed charges ",11579.4,90,,9263.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11193.42,87,,8954.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",14.93,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",9006.2,70,,7204.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.93,11965.38,
"IBANDRONATE SOD 3MG/3ML INJ",7066265,"CDM ",636,RC,J1740,HCPCS,OUTPATIENT,,,550.5,440.4,,,,,,,,0,"other ","not separately reimbursment ",30.54,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",385.35,70,,308.28,,,0,"percent of total billed charges ","70% of total billed charges ",495.45,90,,396.36,,,0,"percent of total billed charges ","90% of total billed charges ",511.97,93,,409.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",37.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",467.93,85,,374.34,,,0,"percent of total billed charges ","85% of total billed charges ",495.45,90,,396.36,,,0,"percent of total billed charges ","90% of total billed charges ",495.45,90,,396.36,,,0,"percent of total billed charges ","90% of total billed charges ",37.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",478.94,87,,383.15,,,0,"percent of total billed charges ","87% of total billed charges ",37.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",385.35,70,,308.28,,,0,"percent of total billed charges ","70% of total billed charges ",30.54,511.97,
"EVENITY ROMOSOZUMAB AQQG 105MG",7066266,"CDM ",636,RC,J3111,HCPCS,OUTPATIENT,,,1359.5,1087.6,,,,,,,,0,"other ","not separately reimbursment ",13.8,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",951.65,70,,761.32,,,0,"percent of total billed charges ","70% of total billed charges ",1223.55,90,,978.84,,,0,"percent of total billed charges ","90% of total billed charges ",1264.34,93,,1011.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",9.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1155.58,85,,924.46,,,0,"percent of total billed charges ","85% of total billed charges ",1223.55,90,,978.84,,,0,"percent of total billed charges ","90% of total billed charges ",1223.55,90,,978.84,,,0,"percent of total billed charges ","90% of total billed charges ",9.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1182.77,87,,946.22,,,0,"percent of total billed charges ","87% of total billed charges ",9.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",951.65,70,,761.32,,,0,"percent of total billed charges ","70% of total billed charges ",9.34,1264.34,
"XOLAIR 300 MG PFS 2ML",7066268,"CDM ",636,RC,J2357,HCPCS,OUTPATIENT,,,3153,2522.4,,,,,,,,0,"other ","not separately reimbursment ",47.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2207.1,70,,1765.68,,,0,"percent of total billed charges ","70% of total billed charges ",2837.7,90,,2270.16,,,0,"percent of total billed charges ","90% of total billed charges ",2932.29,93,,2345.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",38.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2680.05,85,,2144.04,,,0,"percent of total billed charges ","85% of total billed charges ",2837.7,90,,2270.16,,,0,"percent of total billed charges ","90% of total billed charges ",2837.7,90,,2270.16,,,0,"percent of total billed charges ","90% of total billed charges ",37.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2743.11,87,,2194.49,,,0,"percent of total billed charges ","87% of total billed charges ",37.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.5,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2207.1,70,,1765.68,,,0,"percent of total billed charges ","70% of total billed charges ",37.67,2932.29,
"MEROPENEM 1 GM VIAL",7066300,"CDM ",636,RC,J2185,HCPCS,OUTPATIENT,,,51.5,41.2,,,,,,,,0,"other ","not separately reimbursment ",0.58,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",36.05,70,,28.84,,,0,"percent of total billed charges ","70% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",47.9,93,,38.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",43.78,85,,35.02,,,0,"percent of total billed charges ","85% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",0.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",44.81,87,,35.85,,,0,"percent of total billed charges ","87% of total billed charges ",0.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",36.05,70,,28.84,,,0,"percent of total billed charges ","70% of total billed charges ",0.58,47.9,
"MEROPENEM 500 MG VIAL",7066301,"CDM ",636,RC,J2185,HCPCS,OUTPATIENT,,,135,108,,,,,,,,0,"other ","not separately reimbursment ",0.58,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",125.55,93,,100.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",114.75,85,,91.80,,,0,"percent of total billed charges ","85% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",0.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.45,87,,93.96,,,0,"percent of total billed charges ","87% of total billed charges ",0.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",0.58,125.55,
"MEROPENEM 1 GM VIAL",7066302,"CDM ",636,RC,J2185,HCPCS,OUTPATIENT,,,137,109.6,,,,,,,,0,"other ","not separately reimbursment ",0.58,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",95.9,70,,76.72,,,0,"percent of total billed charges ","70% of total billed charges ",123.3,90,,98.64,,,0,"percent of total billed charges ","90% of total billed charges ",127.41,93,,101.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",116.45,85,,93.16,,,0,"percent of total billed charges ","85% of total billed charges ",123.3,90,,98.64,,,0,"percent of total billed charges ","90% of total billed charges ",123.3,90,,98.64,,,0,"percent of total billed charges ","90% of total billed charges ",0.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",119.19,87,,95.35,,,0,"percent of total billed charges ","87% of total billed charges ",0.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",95.9,70,,76.72,,,0,"percent of total billed charges ","70% of total billed charges ",0.58,127.41,
"MEROPENEM 2GM VIALS",7066303,"CDM ",636,RC,J2183,HCPCS,OUTPATIENT,,,135,108,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",125.55,93,,100.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",114.75,85,,91.80,,,0,"percent of total billed charges ","85% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",117.45,87,,93.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",94.5,125.55,
"CEFAZOLIN 2 GM IV BAG",7066310,"CDM ",636,RC,J0690,HCPCS,OUTPATIENT,,,125.5,100.4,,,,,,,,0,"other ","not separately reimbursment ",1.23,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",87.85,70,,70.28,,,0,"percent of total billed charges ","70% of total billed charges ",112.95,90,,90.36,,,0,"percent of total billed charges ","90% of total billed charges ",116.72,93,,93.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",106.68,85,,85.34,,,0,"percent of total billed charges ","85% of total billed charges ",112.95,90,,90.36,,,0,"percent of total billed charges ","90% of total billed charges ",112.95,90,,90.36,,,0,"percent of total billed charges ","90% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",109.19,87,,40.51,32.13,122.92,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",87.85,70,,70.28,,,0,"percent of total billed charges ","70% of total billed charges ",0.75,116.72,
"FENTANYL PCA 300MCG - 30ML",7066400,"CDM ",636,RC,J3010,HCPCS,OUTPATIENT,,,53.5,42.8,,,,,,,,0,"other ","not separately reimbursment ",1.25,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",49.76,93,,39.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.48,85,,36.38,,,0,"percent of total billed charges ","85% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",0.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.55,87,,40.95,30.39,42.84,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",0.63,49.76,
"VORICONAZOLE 200 MG INJ",7066420,"CDM ",636,RC,J3465,HCPCS,OUTPATIENT,,,314.5,251.6,,,,,,,,0,"other ","not separately reimbursment ",1.42,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",220.15,70,,176.12,,,0,"percent of total billed charges ","70% of total billed charges ",283.05,90,,226.44,,,0,"percent of total billed charges ","90% of total billed charges ",292.49,93,,233.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.33,85,,213.86,,,0,"percent of total billed charges ","85% of total billed charges ",283.05,90,,226.44,,,0,"percent of total billed charges ","90% of total billed charges ",283.05,90,,226.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",273.62,87,,218.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.15,70,,176.12,,,0,"percent of total billed charges ","70% of total billed charges ",1.42,292.49,
"NUCALA MEPOLIZUMAB  100MG INJ",7066440,"CDM ",636,RC,J2182,HCPCS,OUTPATIENT,,,3918,3134.4,,,,,,,,0,"other ","not separately reimbursment ",38.95,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2742.6,70,,2194.08,,,0,"percent of total billed charges ","70% of total billed charges ",3526.2,90,,2820.96,,,0,"percent of total billed charges ","90% of total billed charges ",3643.74,93,,2914.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",28.57,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3330.3,85,,2664.24,,,0,"percent of total billed charges ","85% of total billed charges ",3526.2,90,,2820.96,,,0,"percent of total billed charges ","90% of total billed charges ",3526.2,90,,2820.96,,,0,"percent of total billed charges ","90% of total billed charges ",28.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3408.66,87,,2726.93,,,0,"percent of total billed charges ","87% of total billed charges ",28.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.89,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2742.6,70,,2194.08,,,0,"percent of total billed charges ","70% of total billed charges ",28.29,3643.74,
"STELARA USTERKINUMAB 130MGVIAL",7066500,"CDM ",636,RC,J3358,HCPCS,OUTPATIENT,,,2538,2030.4,,,,,,,,0,"other ","not separately reimbursment ",15.59,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1776.6,70,,1421.28,,,0,"percent of total billed charges ","70% of total billed charges ",2284.2,90,,1827.36,,,0,"percent of total billed charges ","90% of total billed charges ",2360.34,93,,1888.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",11.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2157.3,85,,1725.84,,,0,"percent of total billed charges ","85% of total billed charges ",2284.2,90,,1827.36,,,0,"percent of total billed charges ","90% of total billed charges ",2284.2,90,,1827.36,,,0,"percent of total billed charges ","90% of total billed charges ",11.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2208.06,87,,1766.45,,,0,"percent of total billed charges ","87% of total billed charges ",11.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.49,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1776.6,70,,1421.28,,,0,"percent of total billed charges ","70% of total billed charges ",11.68,2360.34,
"FONDAPARINUX INJ 2.5MG",7066570,"CDM ",636,RC,J1652,HCPCS,OUTPATIENT,,,88.5,70.8,,,,,,,,0,"other ","not separately reimbursment ",1.32,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",61.95,70,,49.56,,,0,"percent of total billed charges ","70% of total billed charges ",79.65,90,,63.72,,,0,"percent of total billed charges ","90% of total billed charges ",82.31,93,,65.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.44,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",75.23,85,,60.18,,,0,"percent of total billed charges ","85% of total billed charges ",79.65,90,,63.72,,,0,"percent of total billed charges ","90% of total billed charges ",79.65,90,,63.72,,,0,"percent of total billed charges ","90% of total billed charges ",1.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",77,87,,61.60,,,0,"percent of total billed charges ","87% of total billed charges ",1.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",61.95,70,,49.56,,,0,"percent of total billed charges ","70% of total billed charges ",1.32,82.31,
"DAPTOMYCIN 500 MG",7066590,"CDM ",636,RC,J0878,HCPCS,OUTPATIENT,,,186,148.8,,,,,,,,0,"other ","not separately reimbursment ",0.25,100,,65.00,65.00,65.00,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",130.2,70,,104.16,,,0,"percent of total billed charges ","70% of total billed charges ",167.4,90,,133.92,,,0,"percent of total billed charges ","90% of total billed charges ",172.98,93,,138.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.06,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",158.1,85,,126.48,,,0,"percent of total billed charges ","85% of total billed charges ",167.4,90,,133.92,,,0,"percent of total billed charges ","90% of total billed charges ",167.4,90,,133.92,,,0,"percent of total billed charges ","90% of total billed charges ",0.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.82,87,,129.46,,,0,"percent of total billed charges ","87% of total billed charges ",0.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",130.2,70,,104.16,,,0,"percent of total billed charges ","70% of total billed charges ",0.06,172.98,
"PP AZITHROMYCIN 250MG 6 TABS",7066670,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,18.5,14.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.95,70,,10.36,,,0,"percent of total billed charges ","70% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",17.21,93,,13.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.73,85,,12.58,,,0,"percent of total billed charges ","85% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.1,87,,12.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.95,70,,10.36,,,0,"percent of total billed charges ","70% of total billed charges ",12.95,17.21,
"PP CEPHALEXIN 500MG 3 TABS",7066680,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,16,12.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.88,93,,11.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.6,85,,10.88,,,0,"percent of total billed charges ","85% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.92,87,,11.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,14.88,
"INJECTAFER 750MG VIAL",7067100,"CDM ",636,RC,J1439,HCPCS,OUTPATIENT,,,2462,1969.6,,,,,,,,0,"other ","not separately reimbursment ",1.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1723.4,70,,1378.72,,,0,"percent of total billed charges ","70% of total billed charges ",2215.8,90,,1772.64,,,0,"percent of total billed charges ","90% of total billed charges ",2289.66,93,,1831.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2092.7,85,,1674.16,,,0,"percent of total billed charges ","85% of total billed charges ",2215.8,90,,1772.64,,,0,"percent of total billed charges ","90% of total billed charges ",2215.8,90,,1772.64,,,0,"percent of total billed charges ","90% of total billed charges ",1.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2141.94,87,,1713.55,,,0,"percent of total billed charges ","87% of total billed charges ",1.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1.12,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1723.4,70,,1378.72,,,0,"percent of total billed charges ","70% of total billed charges ",1.12,2289.66,
"PERAMIVIR 200MG VIAL",7067110,"CDM ",636,RC,J2547,HCPCS,OUTPATIENT,,,560,448,,,,,,,,0,"other ","not separately reimbursment ",1.96,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",392,70,,313.60,,,0,"percent of total billed charges ","70% of total billed charges ",504,90,,403.20,,,0,"percent of total billed charges ","90% of total billed charges ",520.8,93,,416.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",476,85,,380.80,,,0,"percent of total billed charges ","85% of total billed charges ",504,90,,403.20,,,0,"percent of total billed charges ","90% of total billed charges ",504,90,,403.20,,,0,"percent of total billed charges ","90% of total billed charges ",1.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",487.2,87,,389.76,,,0,"percent of total billed charges ","87% of total billed charges ",1.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",392,70,,313.60,,,0,"percent of total billed charges ","70% of total billed charges ",1.58,520.8,
"GAMUNEX-C 10% 20GM 200ML 340B",7067120,"CDM ",636,RC,J1561,HCPCS,OUTPATIENT,,,2459.5,1967.6,,,,,,,,0,"other ","not separately reimbursment ",63.59,100,,2416.42,2416.42,2416.42,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1721.65,70,,1377.32,,,0,"percent of total billed charges ","70% of total billed charges ",2213.55,90,,1770.84,,,0,"percent of total billed charges ","90% of total billed charges ",2287.34,93,,1829.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2090.58,85,,1672.46,,,0,"percent of total billed charges ","85% of total billed charges ",2213.55,90,,1770.84,,,0,"percent of total billed charges ","90% of total billed charges ",2213.55,90,,1770.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2139.77,87,,1711.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",49.08,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1721.65,70,,1377.32,,,0,"percent of total billed charges ","70% of total billed charges ",49.08,2287.34,
"GAMUNEX-C 10% 40GM 400ML 340B",7067130,"CDM ",636,RC,J1561,HCPCS,OUTPATIENT,,,4919,3935.2,,,,,,,,0,"other ","not separately reimbursment ",63.59,100,,2416.42,2416.42,2416.42,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3443.3,70,,2754.64,,,0,"percent of total billed charges ","70% of total billed charges ",4427.1,90,,3541.68,,,0,"percent of total billed charges ","90% of total billed charges ",4574.67,93,,3659.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4181.15,85,,3344.92,,,0,"percent of total billed charges ","85% of total billed charges ",4427.1,90,,3541.68,,,0,"percent of total billed charges ","90% of total billed charges ",4427.1,90,,3541.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4279.53,87,,3423.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",49.08,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3443.3,70,,2754.64,,,0,"percent of total billed charges ","70% of total billed charges ",49.08,4574.67,
"GAMUNE 10% 20GM 200ML",7067140,"CDM ",636,RC,J1561,HCPCS,OUTPATIENT,,,5110,4088,,,,,,,,0,"other ","not separately reimbursment ",63.59,100,,2416.42,2416.42,2416.42,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3577,70,,2861.60,,,0,"percent of total billed charges ","70% of total billed charges ",4599,90,,3679.20,,,0,"percent of total billed charges ","90% of total billed charges ",4752.3,93,,3801.84,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4343.5,85,,3474.80,,,0,"percent of total billed charges ","85% of total billed charges ",4599,90,,3679.20,,,0,"percent of total billed charges ","90% of total billed charges ",4599,90,,3679.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4445.7,87,,3556.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",49.08,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3577,70,,2861.60,,,0,"percent of total billed charges ","70% of total billed charges ",49.08,4752.3,
"GAMUNEX-C 10% 40GM 400ML",7067150,"CDM ",636,RC,J1561,HCPCS,OUTPATIENT,,,10200,8160,,,,,,,,0,"other ","not separately reimbursment ",63.59,100,,2416.42,2416.42,2416.42,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",7140,70,,5712.00,,,0,"percent of total billed charges ","70% of total billed charges ",9180,90,,7344.00,,,0,"percent of total billed charges ","90% of total billed charges ",9486,93,,7588.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8670,85,,6936.00,,,0,"percent of total billed charges ","85% of total billed charges ",9180,90,,7344.00,,,0,"percent of total billed charges ","90% of total billed charges ",9180,90,,7344.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",8874,87,,7099.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",49.08,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",7140,70,,5712.00,,,0,"percent of total billed charges ","70% of total billed charges ",49.08,9486,
"VANCOMYCIN 1250MG VIAL",7067170,"CDM ",636,RC,J3373,HCPCS,OUTPATIENT,,,59,47.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.3,70,,33.04,,,0,"percent of total billed charges ","70% of total billed charges ",53.1,90,,42.48,,,0,"percent of total billed charges ","90% of total billed charges ",54.87,93,,43.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",50.15,85,,40.12,,,0,"percent of total billed charges ","85% of total billed charges ",53.1,90,,42.48,,,0,"percent of total billed charges ","90% of total billed charges ",53.1,90,,42.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",51.33,87,,41.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.3,70,,33.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.3,54.87,
"VANCOMYCIN 1500MG VIAL",7067180,"CDM ",636,RC,J3373,HCPCS,OUTPATIENT,,,59,47.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.3,70,,33.04,,,0,"percent of total billed charges ","70% of total billed charges ",53.1,90,,42.48,,,0,"percent of total billed charges ","90% of total billed charges ",54.87,93,,43.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",50.15,85,,40.12,,,0,"percent of total billed charges ","85% of total billed charges ",53.1,90,,42.48,,,0,"percent of total billed charges ","90% of total billed charges ",53.1,90,,42.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",51.33,87,,41.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.3,70,,33.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.3,54.87,
"BUMETANIDE 0.5MG TAB",7067190,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,11,8.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",10.23,93,,8.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.35,85,,7.48,,,0,"percent of total billed charges ","85% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.57,87,,7.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.7,10.23,
"VANCOMYCIN 1GM PREMIX",7067210,"CDM ",636,RC,J3375,HCPCS,OUTPATIENT,,,119.5,95.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",111.14,93,,88.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",101.58,85,,81.26,,,0,"percent of total billed charges ","85% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",103.97,87,,83.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",83.65,111.14,
"VANCOMYCIN 750MG 150ML PREMIX",7067212,"CDM ",636,RC,J3375,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",80.5,106.95,
"VANCOMYCIN 500MG 100ML PREMIX",7067214,"CDM ",636,RC,J3375,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",80.5,106.95,
"VANCOMYCIN 1.5GM PREMIX",7067220,"CDM ",636,RC,J3375,HCPCS,OUTPATIENT,,,119.5,95.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",111.14,93,,88.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",101.58,85,,81.26,,,0,"percent of total billed charges ","85% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",103.97,87,,83.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",83.65,111.14,
"GAMUNEX 10GM 100ML BTL",7067300,"CDM ",636,RC,J1561,HCPCS,OUTPATIENT,,,2555,2044,,,,,,,,0,"other ","not separately reimbursment ",63.59,100,,2416.42,2416.42,2416.42,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1788.5,70,,1430.80,,,0,"percent of total billed charges ","70% of total billed charges ",2299.5,90,,1839.60,,,0,"percent of total billed charges ","90% of total billed charges ",2376.15,93,,1900.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2171.75,85,,1737.40,,,0,"percent of total billed charges ","85% of total billed charges ",2299.5,90,,1839.60,,,0,"percent of total billed charges ","90% of total billed charges ",2299.5,90,,1839.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2222.85,87,,1778.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",49.08,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1788.5,70,,1430.80,,,0,"percent of total billed charges ","70% of total billed charges ",49.08,2376.15,
"GAMUNEX 5MG 50ML BTL",7067305,"CDM ",636,RC,J1561,HCPCS,OUTPATIENT,,,1227.5,982,,,,,,,,0,"other ","not separately reimbursment ",63.59,100,,2416.42,2416.42,2416.42,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",859.25,70,,687.40,,,0,"percent of total billed charges ","70% of total billed charges ",1104.75,90,,883.80,,,0,"percent of total billed charges ","90% of total billed charges ",1141.58,93,,913.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1043.38,85,,834.70,,,0,"percent of total billed charges ","85% of total billed charges ",1104.75,90,,883.80,,,0,"percent of total billed charges ","90% of total billed charges ",1104.75,90,,883.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1067.93,87,,854.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",49.08,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",859.25,70,,687.40,,,0,"percent of total billed charges ","70% of total billed charges ",49.08,1141.58,
"PRIVIGEN 10% 40GM VIAL",7067310,"CDM ",636,RC,J1459,HCPCS,OUTPATIENT,,,5165.5,4132.4,,,,,,,,0,"other ","not separately reimbursment ",61.96,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3615.85,70,,2892.68,,,0,"percent of total billed charges ","70% of total billed charges ",4648.95,90,,3719.16,,,0,"percent of total billed charges ","90% of total billed charges ",4803.92,93,,3843.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4390.68,85,,3512.54,,,0,"percent of total billed charges ","85% of total billed charges ",4648.95,90,,3719.16,,,0,"percent of total billed charges ","90% of total billed charges ",4648.95,90,,3719.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4493.99,87,,3595.19,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",50.28,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3615.85,70,,2892.68,,,0,"percent of total billed charges ","70% of total billed charges ",50.28,4803.92,
"GAMMAGARD 30GM PT OWN MED DISP",7067311,"CDM ",250,RC,S9430,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",80.5,106.95,
"GAMMAGARD 10GM PT OWN MED DISP",7067312,"CDM ",250,RC,S9430,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",80.5,106.95,
"VANCOMYCIN 2GM IV BAG",7067370,"CDM ",636,RC,J3375,HCPCS,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,100.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"XOLAIR 150MG (OMALIZUMAB) 340B",7067380,"CDM ",636,RC,J2357,HCPCS,OUTPATIENT,,,680,544,,,,,,,,0,"other ","not separately reimbursment ",47.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",476,70,,380.80,,,0,"percent of total billed charges ","70% of total billed charges ",612,90,,489.60,,,0,"percent of total billed charges ","90% of total billed charges ",632.4,93,,505.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",38.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",578,85,,462.40,,,0,"percent of total billed charges ","85% of total billed charges ",612,90,,489.60,,,0,"percent of total billed charges ","90% of total billed charges ",612,90,,489.60,,,0,"percent of total billed charges ","90% of total billed charges ",37.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",591.6,87,,473.28,,,0,"percent of total billed charges ","87% of total billed charges ",37.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.5,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",476,70,,380.80,,,0,"percent of total billed charges ","70% of total billed charges ",37.67,632.4,
"XOLAIR 150MG PFS (OMALIZUMAB)",7067390,"CDM ",636,RC,J2357,HCPCS,OUTPATIENT,,,1549,1239.2,,,,,,,,0,"other ","not separately reimbursment ",47.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1084.3,70,,867.44,,,0,"percent of total billed charges ","70% of total billed charges ",1394.1,90,,1115.28,,,0,"percent of total billed charges ","90% of total billed charges ",1440.57,93,,1152.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",38.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1316.65,85,,1053.32,,,0,"percent of total billed charges ","85% of total billed charges ",1394.1,90,,1115.28,,,0,"percent of total billed charges ","90% of total billed charges ",1394.1,90,,1115.28,,,0,"percent of total billed charges ","90% of total billed charges ",37.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1347.63,87,,1078.10,,,0,"percent of total billed charges ","87% of total billed charges ",37.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.5,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1084.3,70,,867.44,,,0,"percent of total billed charges ","70% of total billed charges ",37.67,1440.57,
"ANDEXXA 200MG VIAL",7067400,"CDM ",636,RC,C9041,HCPCS,OUTPATIENT,,,7700,6160,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5390,70,,4312.00,,,0,"percent of total billed charges ","70% of total billed charges ",6930,90,,5544.00,,,0,"percent of total billed charges ","90% of total billed charges ",7161,93,,5728.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6545,85,,5236.00,,,0,"percent of total billed charges ","85% of total billed charges ",6930,90,,5544.00,,,0,"percent of total billed charges ","90% of total billed charges ",6930,90,,5544.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6699,87,,5359.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5390,70,,4312.00,,,0,"percent of total billed charges ","70% of total billed charges ",5390,7161,
"CEFEPIME 1GM IV PREMIX BAG",7067410,"CDM ",636,RC,J0703,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",7.47,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",7.47,106.95,
"CEFEPIME 2GM IV PREMIX BAG",7067420,"CDM ",636,RC,J0703,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",7.47,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",7.47,106.95,
"KCENTRA 1000MG VIAL",7067422,"CDM ",636,RC,J7168,HCPCS,OUTPATIENT,,,5215,4172,,,,,,,,0,"other ","not separately reimbursment ",3.62,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3650.5,70,,2920.40,,,0,"percent of total billed charges ","70% of total billed charges ",4693.5,90,,3754.80,,,0,"percent of total billed charges ","90% of total billed charges ",4849.95,93,,3879.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2.65,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4432.75,85,,3546.20,,,0,"percent of total billed charges ","85% of total billed charges ",4693.5,90,,3754.80,,,0,"percent of total billed charges ","90% of total billed charges ",4693.5,90,,3754.80,,,0,"percent of total billed charges ","90% of total billed charges ",2.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4537.05,87,,3629.64,,,0,"percent of total billed charges ","87% of total billed charges ",2.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2.09,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3650.5,70,,2920.40,,,0,"percent of total billed charges ","70% of total billed charges ",2.09,4849.95,
"KCENTRA 500MG VIAL",7067424,"CDM ",636,RC,J7168,HCPCS,OUTPATIENT,,,2607.5,2086,,,,,,,,0,"other ","not separately reimbursment ",3.62,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1825.25,70,,1460.20,,,0,"percent of total billed charges ","70% of total billed charges ",2346.75,90,,1877.40,,,0,"percent of total billed charges ","90% of total billed charges ",2424.98,93,,1939.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2.65,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2216.38,85,,1773.10,,,0,"percent of total billed charges ","85% of total billed charges ",2346.75,90,,1877.40,,,0,"percent of total billed charges ","90% of total billed charges ",2346.75,90,,1877.40,,,0,"percent of total billed charges ","90% of total billed charges ",2.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2268.53,87,,1814.82,,,0,"percent of total billed charges ","87% of total billed charges ",2.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2.09,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1825.25,70,,1460.20,,,0,"percent of total billed charges ","70% of total billed charges ",2.09,2424.98,
"MEROPENEM 500MG VIAL",7067450,"CDM ",636,RC,J2185,HCPCS,OUTPATIENT,,,42,33.6,,,,,,,,0,"other ","not separately reimbursment ",0.58,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",29.4,70,,23.52,,,0,"percent of total billed charges ","70% of total billed charges ",37.8,90,,30.24,,,0,"percent of total billed charges ","90% of total billed charges ",39.06,93,,31.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",35.7,85,,28.56,,,0,"percent of total billed charges ","85% of total billed charges ",37.8,90,,30.24,,,0,"percent of total billed charges ","90% of total billed charges ",37.8,90,,30.24,,,0,"percent of total billed charges ","90% of total billed charges ",0.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.54,87,,29.23,,,0,"percent of total billed charges ","87% of total billed charges ",0.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",29.4,70,,23.52,,,0,"percent of total billed charges ","70% of total billed charges ",0.58,39.06,
"LUPRON 11.25MG 3 MO KIT",7067470,"CDM ",636,RC,J1950,HCPCS,OUTPATIENT,,,5866,4692.8,,,,,,,,0,"other ","not separately reimbursment ",2027.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",4106.2,70,,3284.96,,,0,"percent of total billed charges ","70% of total billed charges ",5279.4,90,,4223.52,,,0,"percent of total billed charges ","90% of total billed charges ",5455.38,93,,4364.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1420.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4986.1,85,,3988.88,,,0,"percent of total billed charges ","85% of total billed charges ",5279.4,90,,4223.52,,,0,"percent of total billed charges ","90% of total billed charges ",5279.4,90,,4223.52,,,0,"percent of total billed charges ","90% of total billed charges ",1406.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5103.42,87,,4082.74,,,0,"percent of total billed charges ","87% of total billed charges ",1406.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1763.87,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4106.2,70,,3284.96,,,0,"percent of total billed charges ","70% of total billed charges ",1406.37,5455.38,
"PRIVIGEN IVIG 10% 20GM 340B",7067480,"CDM ",636,RC,J1459,HCPCS,OUTPATIENT,,,4260,3408,,,,,,,,0,"other ","not separately reimbursment ",61.96,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2982,70,,2385.60,,,0,"percent of total billed charges ","70% of total billed charges ",3834,90,,3067.20,,,0,"percent of total billed charges ","90% of total billed charges ",3961.8,93,,3169.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3621,85,,2896.80,,,0,"percent of total billed charges ","85% of total billed charges ",3834,90,,3067.20,,,0,"percent of total billed charges ","90% of total billed charges ",3834,90,,3067.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3706.2,87,,2964.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",50.28,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2982,70,,2385.60,,,0,"percent of total billed charges ","70% of total billed charges ",50.28,3961.8,
"PRIVIGEN IVIG 10% 40GM 340B",7067490,"CDM ",636,RC,J1459,HCPCS,OUTPATIENT,,,8520,6816,,,,,,,,0,"other ","not separately reimbursment ",61.96,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",5964,70,,4771.20,,,0,"percent of total billed charges ","70% of total billed charges ",7668,90,,6134.40,,,0,"percent of total billed charges ","90% of total billed charges ",7923.6,93,,6338.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7242,85,,5793.60,,,0,"percent of total billed charges ","85% of total billed charges ",7668,90,,6134.40,,,0,"percent of total billed charges ","90% of total billed charges ",7668,90,,6134.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7412.4,87,,5929.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",50.28,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",5964,70,,4771.20,,,0,"percent of total billed charges ","70% of total billed charges ",50.28,7923.6,
"KINERET 100MG SYRINGE",7067500,"CDM ",636,RC,J3490,HCPCS,OUTPATIENT,,,264,211.2,,,,,,,,0,"other ","not separately reimbursment ",,,,0.01,0.01,0.01,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",184.8,70,,147.84,,,0,"percent of total billed charges ","70% of total billed charges ",237.6,90,,190.08,,,0,"percent of total billed charges ","90% of total billed charges ",245.52,93,,196.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",224.4,85,,179.52,,,0,"percent of total billed charges ","85% of total billed charges ",237.6,90,,190.08,,,0,"percent of total billed charges ","90% of total billed charges ",237.6,90,,190.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",229.68,87,,156.45,62.59,213.94,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",184.8,70,,147.84,,,0,"percent of total billed charges ","70% of total billed charges ",184.8,245.52,
"ACTEMRA TOCILIZUMAB 400MG VIAL",7067510,"CDM ",636,RC,J3262,HCPCS,OUTPATIENT,,,3303.5,2642.8,,,,,,,,0,"other ","not separately reimbursment ",7.44,100,,0.12,0.12,0.12,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2312.45,70,,1849.96,,,0,"percent of total billed charges ","70% of total billed charges ",2973.15,90,,2378.52,,,0,"percent of total billed charges ","90% of total billed charges ",3072.26,93,,2457.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",5.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2807.98,85,,2246.38,,,0,"percent of total billed charges ","85% of total billed charges ",2973.15,90,,2378.52,,,0,"percent of total billed charges ","90% of total billed charges ",2973.15,90,,2378.52,,,0,"percent of total billed charges ","90% of total billed charges ",5.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2874.05,87,,2299.24,,,0,"percent of total billed charges ","87% of total billed charges ",5.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.61,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2312.45,70,,1849.96,,,0,"percent of total billed charges ","70% of total billed charges ",5.55,3072.26,
"TOCILIZUMAB-AAZQ 80MG",7067512,"CDM ",636,RC,Q5135,HCPCS,OUTPATIENT,,,623.5,498.8,,,,,,,,0,"other ","not separately reimbursment ",,,,0.03,0.03,0.03,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",436.45,70,,349.16,,,0,"percent of total billed charges ","70% of total billed charges ",561.15,90,,448.92,,,0,"percent of total billed charges ","90% of total billed charges ",579.86,93,,463.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",529.98,85,,423.98,,,0,"percent of total billed charges ","85% of total billed charges ",561.15,90,,448.92,,,0,"percent of total billed charges ","90% of total billed charges ",561.15,90,,448.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",542.45,87,,433.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",4.19,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",436.45,70,,349.16,,,0,"percent of total billed charges ","70% of total billed charges ",4.19,579.86,
"TOCILIZUMAB-AAZQ 200MG",7067514,"CDM ",636,RC,Q5135,HCPCS,OUTPATIENT,,,1446,1156.8,,,,,,,,0,"other ","not separately reimbursment ",,,,0.03,0.03,0.03,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1012.2,70,,809.76,,,0,"percent of total billed charges ","70% of total billed charges ",1301.4,90,,1041.12,,,0,"percent of total billed charges ","90% of total billed charges ",1344.78,93,,1075.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1229.1,85,,983.28,,,0,"percent of total billed charges ","85% of total billed charges ",1301.4,90,,1041.12,,,0,"percent of total billed charges ","90% of total billed charges ",1301.4,90,,1041.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1258.02,87,,1006.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",4.19,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1012.2,70,,809.76,,,0,"percent of total billed charges ","70% of total billed charges ",4.19,1344.78,
"TOCILIZUMAB-AAZQ 400MG",7067516,"CDM ",636,RC,Q5135,HCPCS,OUTPATIENT,,,2817,2253.6,,,,,,,,0,"other ","not separately reimbursment ",,,,0.03,0.03,0.03,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1971.9,70,,1577.52,,,0,"percent of total billed charges ","70% of total billed charges ",2535.3,90,,2028.24,,,0,"percent of total billed charges ","90% of total billed charges ",2619.81,93,,2095.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2394.45,85,,1915.56,,,0,"percent of total billed charges ","85% of total billed charges ",2535.3,90,,2028.24,,,0,"percent of total billed charges ","90% of total billed charges ",2535.3,90,,2028.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2450.79,87,,1960.63,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",4.19,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1971.9,70,,1577.52,,,0,"percent of total billed charges ","70% of total billed charges ",4.19,2619.81,
"ACTEMRA TOCILIZUMAB 200MG VIAL",7067520,"CDM ",636,RC,J3262,HCPCS,OUTPATIENT,,,1689.5,1351.6,,,,,,,,0,"other ","not separately reimbursment ",7.44,100,,0.12,0.12,0.12,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1182.65,70,,946.12,,,0,"percent of total billed charges ","70% of total billed charges ",1520.55,90,,1216.44,,,0,"percent of total billed charges ","90% of total billed charges ",1571.24,93,,1256.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",5.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1436.08,85,,1148.86,,,0,"percent of total billed charges ","85% of total billed charges ",1520.55,90,,1216.44,,,0,"percent of total billed charges ","90% of total billed charges ",1520.55,90,,1216.44,,,0,"percent of total billed charges ","90% of total billed charges ",5.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1469.87,87,,1175.90,,,0,"percent of total billed charges ","87% of total billed charges ",5.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.61,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1182.65,70,,946.12,,,0,"percent of total billed charges ","70% of total billed charges ",5.55,1571.24,
"REMDESIVIR 100MG VIAL",7067550,"CDM ",250,RC,J0248,HCPCS,OUTPATIENT,,,874,699.2,,,,,,,,0,"other ","not separately reimbursment ",7.79,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,254.16,254.16,254.16,"1 through 10","other ","not separately reimbursment ",611.8,70,,489.44,,,0,"percent of total billed charges ","70% of total billed charges ",786.6,90,,629.28,,,0,"percent of total billed charges ","90% of total billed charges ",812.82,93,,650.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",742.9,85,,594.32,,,0,"percent of total billed charges ","85% of total billed charges ",786.6,90,,629.28,,,0,"percent of total billed charges ","90% of total billed charges ",786.6,90,,629.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",760.38,87,,608.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",6.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",611.8,70,,489.44,,,0,"percent of total billed charges ","70% of total billed charges ",6.9,812.82,
"FOSPHENYTOIN 100MG VIAL",7067780,"CDM ",636,RC,Q2009,HCPCS,OUTPATIENT,,,42,33.6,,,,,,,,0,"other ","not separately reimbursment ",5.83,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",29.4,70,,23.52,,,0,"percent of total billed charges ","70% of total billed charges ",37.8,90,,30.24,,,0,"percent of total billed charges ","90% of total billed charges ",39.06,93,,31.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",3.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",35.7,85,,28.56,,,0,"percent of total billed charges ","85% of total billed charges ",37.8,90,,30.24,,,0,"percent of total billed charges ","90% of total billed charges ",37.8,90,,30.24,,,0,"percent of total billed charges ","90% of total billed charges ",3.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.54,87,,29.23,,,0,"percent of total billed charges ","87% of total billed charges ",3.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",29.4,70,,23.52,,,0,"percent of total billed charges ","70% of total billed charges ",1.34,39.06,
"BARICITINIB 2MG TAB",7067900,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,86,68.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.2,70,,48.16,,,0,"percent of total billed charges ","70% of total billed charges ",77.4,90,,61.92,,,0,"percent of total billed charges ","90% of total billed charges ",79.98,93,,63.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",73.1,85,,58.48,,,0,"percent of total billed charges ","85% of total billed charges ",77.4,90,,61.92,,,0,"percent of total billed charges ","90% of total billed charges ",77.4,90,,61.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",74.82,87,,59.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.2,70,,48.16,,,0,"percent of total billed charges ","70% of total billed charges ",60.2,79.98,
"VANCOMYCIN 1.25GM PREMIX BAG",7067910,"CDM ",636,RC,J3375,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",80.5,106.95,
"FERAHEME FERUMOYYTOL 510MG",7067920,"CDM ",636,RC,Q0138,HCPCS,OUTPATIENT,,,1635,1308,,,,,,,,0,"other ","not separately reimbursment ",0.51,100,,210.04,210.04,210.04,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1144.5,70,,915.60,,,0,"percent of total billed charges ","70% of total billed charges ",1471.5,90,,1177.20,,,0,"percent of total billed charges ","90% of total billed charges ",1520.55,93,,1216.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.01,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1389.75,85,,1111.80,,,0,"percent of total billed charges ","85% of total billed charges ",1471.5,90,,1177.20,,,0,"percent of total billed charges ","90% of total billed charges ",1471.5,90,,1177.20,,,0,"percent of total billed charges ","90% of total billed charges ",1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1422.45,87,,131.15,131.15,131.15,"1 through 10","percent of total billed charges ","87% of total billed charges ",1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",0.36,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1144.5,70,,915.60,,,0,"percent of total billed charges ","70% of total billed charges ",0.36,1520.55,
"ARANESP DARBEPOETIN ALFA 40MCG",7067930,"CDM ",636,RC,J0881,HCPCS,OUTPATIENT,,,355,284,,,,,,,,0,"other ","not separately reimbursment ",3.77,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",248.5,70,,198.80,,,0,"percent of total billed charges ","70% of total billed charges ",319.5,90,,255.60,,,0,"percent of total billed charges ","90% of total billed charges ",330.15,93,,264.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",3.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",301.75,85,,241.40,,,0,"percent of total billed charges ","85% of total billed charges ",319.5,90,,255.60,,,0,"percent of total billed charges ","90% of total billed charges ",319.5,90,,255.60,,,0,"percent of total billed charges ","90% of total billed charges ",3.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",308.85,87,,247.08,,,0,"percent of total billed charges ","87% of total billed charges ",3.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.02,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",248.5,70,,198.80,,,0,"percent of total billed charges ","70% of total billed charges ",3.02,330.15,
"PAMIDRONATE 60MG VIAL",7067960,"CDM ",636,RC,J2430,HCPCS,OUTPATIENT,,,135,108,,,,,,,,0,"other ","not separately reimbursment ",18.14,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",125.55,93,,100.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",9.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",114.75,85,,91.80,,,0,"percent of total billed charges ","85% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",9.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.45,87,,93.96,,,0,"percent of total billed charges ","87% of total billed charges ",9.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",9.16,125.55,
"CALCIUM GLUCONATE 1GM BAG",7067970,"CDM ",636,RC,J0612,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",0.06,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",0.06,106.95,
"LEVETIRACETAM 500MG/100ML BAG",7067980,"CDM ",636,RC,J1953,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",0.11,100,,10.45,10.45,10.45,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",0.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,0.01,0.01,0.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",0.09,106.95,
"LEVETIRACETAM 1000MG/100ML BAG",7067990,"CDM ",636,RC,J1953,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",0.11,100,,10.45,10.45,10.45,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",0.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,0.01,0.01,0.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",0.09,106.95,
"LEVETIRACETAM 1500MG/100ML BAG",7068000,"CDM ",636,RC,J1953,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",0.11,100,,10.45,10.45,10.45,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",0.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,0.01,0.01,0.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",0.09,106.95,
"SUGAMMADEX 500MG VIAL",7068010,"CDM ",250,RC,J3490,HCPCS,OUTPATIENT,,,246.5,197.2,,,,,,,,0,"other ","not separately reimbursment ",,,,0.01,0.01,0.01,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.55,70,,138.04,,,0,"percent of total billed charges ","70% of total billed charges ",221.85,90,,177.48,,,0,"percent of total billed charges ","90% of total billed charges ",229.25,93,,183.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",209.53,85,,167.62,,,0,"percent of total billed charges ","85% of total billed charges ",221.85,90,,177.48,,,0,"percent of total billed charges ","90% of total billed charges ",221.85,90,,177.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",214.46,87,,156.45,62.59,213.94,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.55,70,,138.04,,,0,"percent of total billed charges ","70% of total billed charges ",172.55,229.25,
"LEVETIRACETAM 500MG/5ML",7068020,"CDM ",636,RC,J1953,HCPCS,OUTPATIENT,,,18,14.4,,,,,,,,0,"other ","not separately reimbursment ",0.11,100,,10.45,10.45,10.45,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.74,93,,13.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",15.3,85,,12.24,,,0,"percent of total billed charges ","85% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",0.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.66,87,,0.01,0.01,0.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",0.09,16.74,
"STELARA USTEKINUMAB 90MG SYRG",7068040,"CDM ",636,RC,J3357,HCPCS,OUTPATIENT,,,24236,19388.8,,,,,,,,0,"other ","not separately reimbursment ",189.44,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",16965.2,70,,13572.16,,,0,"percent of total billed charges ","70% of total billed charges ",21812.4,90,,17449.92,,,0,"percent of total billed charges ","90% of total billed charges ",22539.48,93,,18031.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",178.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",20600.6,85,,16480.48,,,0,"percent of total billed charges ","85% of total billed charges ",21812.4,90,,17449.92,,,0,"percent of total billed charges ","90% of total billed charges ",21812.4,90,,17449.92,,,0,"percent of total billed charges ","90% of total billed charges ",176.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21085.32,87,,16868.26,,,0,"percent of total billed charges ","87% of total billed charges ",176.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",16965.2,70,,13572.16,,,0,"percent of total billed charges ","70% of total billed charges ",176.65,22539.48,
"GENTAMICN 120MG IV BAG",7068100,"CDM ",636,RC,J1580,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",4.13,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",1.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,1.46,1.46,2.24,"1 through 10","percent of total billed charges ","87% of total billed charges ",1.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",1.68,106.95,
"HEPARIN 1000U/1ML VIAL",7068200,"CDM ",636,RC,J1644,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",0.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",0.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.25,45.57,
"FENTANYL 50MCG/ML 20ML VIAL",7068230,"CDM ",636,RC,J3010,HCPCS,OUTPATIENT,,,40,32,,,,,,,,0,"other ","not separately reimbursment ",1.25,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",28,70,,22.40,,,0,"percent of total billed charges ","70% of total billed charges ",36,90,,28.80,,,0,"percent of total billed charges ","90% of total billed charges ",37.2,93,,29.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",34,85,,27.20,,,0,"percent of total billed charges ","85% of total billed charges ",36,90,,28.80,,,0,"percent of total billed charges ","90% of total billed charges ",36,90,,28.80,,,0,"percent of total billed charges ","90% of total billed charges ",0.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.8,87,,40.95,30.39,42.84,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",28,70,,22.40,,,0,"percent of total billed charges ","70% of total billed charges ",0.63,37.2,
"MIDAZOLAM 100MG PREMIX BAG",7068250,"CDM ",636,RC,J2251,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",0.33,100,,31.35,31.35,31.35,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",0.33,106.95,
"VANCOMYCIN 1.75GM PREMIX BAG",7068270,"CDM ",636,RC,J3375,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",80.5,106.95,
"MOLNUPIRAVIR 200MG CAP DSPK 40",7068330,"CDM ",636,RC,J3490,HCPCS,OUTPATIENT,,,33.5,26.8,,,,,,,,0,"other ","not separately reimbursment ",,,,0.01,0.01,0.01,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",31.16,93,,24.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.48,85,,22.78,,,0,"percent of total billed charges ","85% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.15,87,,156.45,62.59,213.94,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",23.45,31.16,
"POT CHLORIDE 40MEQ/100ML BAG",7068360,"CDM ",636,RC,J3480,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",0.15,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",0.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",0.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",0.14,106.95,
"SUGAMMADEX 200MG/2ML VIAL",7068405,"CDM ",636,RC,J3490,HCPCS,OUTPATIENT,,,160.5,128.4,,,,,,,,0,"other ","not separately reimbursment ",,,,0.01,0.01,0.01,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",149.27,93,,119.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.43,85,,109.14,,,0,"percent of total billed charges ","85% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.64,87,,156.45,62.59,213.94,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",112.35,149.27,
"ANAVIP CROTALIDAE FAB2 VIAL",7068410,"CDM ",636,RC,J0841,HCPCS,OUTPATIENT,,,1783,1426.4,,,,,,,,0,"other ","not separately reimbursment ",1288.65,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1248.1,70,,998.48,,,0,"percent of total billed charges ","70% of total billed charges ",1604.7,90,,1283.76,,,0,"percent of total billed charges ","90% of total billed charges ",1658.19,93,,1326.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1201.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1515.55,85,,1212.44,,,0,"percent of total billed charges ","85% of total billed charges ",1604.7,90,,1283.76,,,0,"percent of total billed charges ","90% of total billed charges ",1604.7,90,,1283.76,,,0,"percent of total billed charges ","90% of total billed charges ",1189.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1551.21,87,,1240.97,,,0,"percent of total billed charges ","87% of total billed charges ",1189.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4925.16,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1248.1,70,,998.48,,,0,"percent of total billed charges ","70% of total billed charges ",1189.81,4925.16,
"SOLUTION D5-LR 1000ML BAG",7400054,"CDM ",636,RC,J7120,HCPCS,OUTPATIENT,,,83.5,66.8,,,,,,,,0,"other ","not separately reimbursment ",3.12,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",77.66,93,,62.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2.54,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.98,85,,56.78,,,0,"percent of total billed charges ","85% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",2.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",72.65,87,,64.65,51.72,64.65,15,"percent of total billed charges ","87% of total billed charges ",2.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",2.51,77.66,
"SOLUTION D5-LR 500ML BAG",7400062,"CDM ",636,RC,J7120,HCPCS,OUTPATIENT,,,82,65.6,,,,,,,,0,"other ","not separately reimbursment ",3.12,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",57.4,70,,45.92,,,0,"percent of total billed charges ","70% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",76.26,93,,61.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2.54,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",69.7,85,,55.76,,,0,"percent of total billed charges ","85% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",2.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",71.34,87,,64.65,51.72,64.65,15,"percent of total billed charges ","87% of total billed charges ",2.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",57.4,70,,45.92,,,0,"percent of total billed charges ","70% of total billed charges ",2.51,76.26,
"SOLUTION D5-NS 500ML BAG",7400096,"CDM ",258,RC,J7042,HCPCS,OUTPATIENT,,,85.5,68.4,,,,,,,,0,"other ","not separately reimbursment ",1.45,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",59.85,70,,47.88,,,0,"percent of total billed charges ","70% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",79.52,93,,63.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",72.68,85,,58.14,,,0,"percent of total billed charges ","85% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",1.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",74.39,87,,59.51,,,0,"percent of total billed charges ","87% of total billed charges ",1.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",59.85,70,,47.88,,,0,"percent of total billed charges ","70% of total billed charges ",1.08,79.52,
"SOLUTION D5W 1000ML BAG",7400104,"CDM ",258,RC,J7070,HCPCS,OUTPATIENT,,,83.5,66.8,,,,,,,,0,"other ","not separately reimbursment ",4.63,100,,4.40,4.40,4.40,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",77.66,93,,62.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",3.51,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.98,85,,56.78,,,0,"percent of total billed charges ","85% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",3.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",72.65,87,,58.12,,,0,"percent of total billed charges ","87% of total billed charges ",3.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",3.48,77.66,
"SOL-D5W PARTIAL 50CC",7400153,"CDM ",258,RC,J7060,HCPCS,OUTPATIENT,,,82,65.6,,,,,,,,0,"other ","not separately reimbursment ",2.32,100,,1.76,1.76,1.76,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",57.4,70,,45.92,,,0,"percent of total billed charges ","70% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",76.26,93,,61.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",69.7,85,,55.76,,,0,"percent of total billed charges ","85% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",1.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",71.34,87,,57.07,,,0,"percent of total billed charges ","87% of total billed charges ",1.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",57.4,70,,45.92,,,0,"percent of total billed charges ","70% of total billed charges ",1.74,76.26,
"SOLUTION D5W 250ML BAG",7400161,"CDM ",258,RC,J7060,HCPCS,OUTPATIENT,,,83.5,66.8,,,,,,,,0,"other ","not separately reimbursment ",2.32,100,,1.76,1.76,1.76,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",77.66,93,,62.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.98,85,,56.78,,,0,"percent of total billed charges ","85% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",1.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",72.65,87,,58.12,,,0,"percent of total billed charges ","87% of total billed charges ",1.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",1.74,77.66,
"SOLUTION D5W 500ML BAG",7400179,"CDM ",258,RC,J7060,HCPCS,OUTPATIENT,,,83,66.4,,,,,,,,0,"other ","not separately reimbursment ",2.32,100,,1.76,1.76,1.76,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",1.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",72.21,87,,57.77,,,0,"percent of total billed charges ","87% of total billed charges ",1.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",1.74,77.19,
"SOLUTION D5W ADVANTAGE 100ML",7400203,"CDM ",258,RC,J7060,HCPCS,OUTPATIENT,,,86,68.8,,,,,,,,0,"other ","not separately reimbursment ",2.32,100,,1.76,1.76,1.76,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",60.2,70,,48.16,,,0,"percent of total billed charges ","70% of total billed charges ",77.4,90,,61.92,,,0,"percent of total billed charges ","90% of total billed charges ",79.98,93,,63.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",73.1,85,,58.48,,,0,"percent of total billed charges ","85% of total billed charges ",77.4,90,,61.92,,,0,"percent of total billed charges ","90% of total billed charges ",77.4,90,,61.92,,,0,"percent of total billed charges ","90% of total billed charges ",1.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",74.82,87,,59.86,,,0,"percent of total billed charges ","87% of total billed charges ",1.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",60.2,70,,48.16,,,0,"percent of total billed charges ","70% of total billed charges ",1.74,79.98,
"SOLUTION LACT RINGERS 500ML",7400237,"CDM ",636,RC,J7120,HCPCS,OUTPATIENT,,,83,66.4,,,,,,,,0,"other ","not separately reimbursment ",3.12,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2.54,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",2.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",72.21,87,,64.65,51.72,64.65,15,"percent of total billed charges ","87% of total billed charges ",2.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",2.51,77.19,
"SOLUTION LACT RINGERS 1000ML",7400245,"CDM ",636,RC,J7120,HCPCS,OUTPATIENT,,,83,66.4,,,,,,,,0,"other ","not separately reimbursment ",3.12,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2.54,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",2.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",72.21,87,,64.65,51.72,64.65,15,"percent of total billed charges ","87% of total billed charges ",2.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",2.51,77.19,
"SOLUTION NS ADDVANT 250ML",7400286,"CDM ",258,RC,J7050,HCPCS,OUTPATIENT,,,83,66.4,,,,,,,,0,"other ","not separately reimbursment ",1.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",0.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",72.21,87,,51.72,46.55,62.06,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",0.65,77.19,
"SOLUTION NS 0.9% 100ML BAG",7400294,"CDM ",258,RC,J7050,HCPCS,OUTPATIENT,,,83,66.4,,,,,,,,0,"other ","not separately reimbursment ",1.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",0.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",72.21,87,,51.72,46.55,62.06,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",0.65,77.19,
"SOLUTION NS 0.9% 250ML BAG",7400310,"CDM ",258,RC,J7050,HCPCS,OUTPATIENT,,,83.5,66.8,,,,,,,,0,"other ","not separately reimbursment ",1.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",77.66,93,,62.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.98,85,,56.78,,,0,"percent of total billed charges ","85% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",0.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",72.65,87,,51.72,46.55,62.06,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",0.65,77.66,
"SOLUTION NS 0.9% 500ML BAG",7400328,"CDM ",258,RC,J7040,HCPCS,OUTPATIENT,,,83,66.4,,,,,,,,0,"other ","not separately reimbursment ",1.68,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",1.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",72.21,87,,64.65,64.65,70.17,"1 through 10","percent of total billed charges ","87% of total billed charges ",1.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",1.3,77.19,
"SOLUTION NS 0.9% 1000ML BAG",7400336,"CDM ",258,RC,J7030,HCPCS,OUTPATIENT,,,83,66.4,,,,,,,,0,"other ","not separately reimbursment ",3.39,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",2.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",72.21,87,,51.72,32.28,64.65,"1 through 10","percent of total billed charges ","87% of total billed charges ",2.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",2.6,77.19,
"SOLUTION D5-LR W/20MEQ KCL",7400443,"CDM ",636,RC,J7120,HCPCS,OUTPATIENT,,,87,69.6,,,,,,,,0,"other ","not separately reimbursment ",3.12,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",60.9,70,,48.72,,,0,"percent of total billed charges ","70% of total billed charges ",78.3,90,,62.64,,,0,"percent of total billed charges ","90% of total billed charges ",80.91,93,,64.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2.54,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",73.95,85,,59.16,,,0,"percent of total billed charges ","85% of total billed charges ",78.3,90,,62.64,,,0,"percent of total billed charges ","90% of total billed charges ",78.3,90,,62.64,,,0,"percent of total billed charges ","90% of total billed charges ",2.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",75.69,87,,64.65,51.72,64.65,15,"percent of total billed charges ","87% of total billed charges ",2.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",60.9,70,,48.72,,,0,"percent of total billed charges ","70% of total billed charges ",2.51,80.91,
"SOLUTION D5 HEPARIN",7400484,"CDM ",636,RC,J1644,HCPCS,OUTPATIENT,,,95,76,,,,,,,,0,"other ","not separately reimbursment ",0.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",66.5,70,,53.20,,,0,"percent of total billed charges ","70% of total billed charges ",85.5,90,,68.40,,,0,"percent of total billed charges ","90% of total billed charges ",88.35,93,,70.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",80.75,85,,64.60,,,0,"percent of total billed charges ","85% of total billed charges ",85.5,90,,68.40,,,0,"percent of total billed charges ","90% of total billed charges ",85.5,90,,68.40,,,0,"percent of total billed charges ","90% of total billed charges ",0.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",82.65,87,,66.12,,,0,"percent of total billed charges ","87% of total billed charges ",0.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",66.5,70,,53.20,,,0,"percent of total billed charges ","70% of total billed charges ",0.25,88.35,
"SOLUTION D5-NS 1000 ML BAG",7400526,"CDM ",258,RC,J7042,HCPCS,OUTPATIENT,,,84,67.2,,,,,,,,0,"other ","not separately reimbursment ",1.45,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.8,70,,47.04,,,0,"percent of total billed charges ","70% of total billed charges ",75.6,90,,60.48,,,0,"percent of total billed charges ","90% of total billed charges ",78.12,93,,62.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",71.4,85,,57.12,,,0,"percent of total billed charges ","85% of total billed charges ",75.6,90,,60.48,,,0,"percent of total billed charges ","90% of total billed charges ",75.6,90,,60.48,,,0,"percent of total billed charges ","90% of total billed charges ",1.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",73.08,87,,58.46,,,0,"percent of total billed charges ","87% of total billed charges ",1.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.8,70,,47.04,,,0,"percent of total billed charges ","70% of total billed charges ",1.08,78.12,
"SOLUTION D5W W/MAG SULFATE 1GM",7400641,"CDM ",636,RC,J3475,HCPCS,OUTPATIENT,,,81.5,65.2,,,,,,,,0,"other ","not separately reimbursment ",0.83,100,,1.35,1.35,1.35,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",75.8,93,,60.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",69.28,85,,55.42,,,0,"percent of total billed charges ","85% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.91,87,,158.61,158.61,158.61,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",0.75,75.8,
"SOLUTION H20 W/MAG SULFATE 4GM",7400674,"CDM ",636,RC,J3475,HCPCS,OUTPATIENT,,,84,67.2,,,,,,,,0,"other ","not separately reimbursment ",0.83,100,,1.35,1.35,1.35,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.8,70,,47.04,,,0,"percent of total billed charges ","70% of total billed charges ",75.6,90,,60.48,,,0,"percent of total billed charges ","90% of total billed charges ",78.12,93,,62.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",71.4,85,,57.12,,,0,"percent of total billed charges ","85% of total billed charges ",75.6,90,,60.48,,,0,"percent of total billed charges ","90% of total billed charges ",75.6,90,,60.48,,,0,"percent of total billed charges ","90% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",73.08,87,,158.61,158.61,158.61,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.8,70,,47.04,,,0,"percent of total billed charges ","70% of total billed charges ",0.75,78.12,
"MAGNESIUM 2G/50ML BAG",7400675,"CDM ",258,RC,J3475,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",0.83,100,,1.35,1.35,1.35,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,158.61,158.61,158.61,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",0.75,106.95,
"SOLUTION D5W 100ML BAG",7400682,"CDM ",258,RC,J7060,HCPCS,OUTPATIENT,,,36.5,29.2,,,,,,,,0,"other ","not separately reimbursment ",2.32,100,,1.76,1.76,1.76,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",25.55,70,,20.44,,,0,"percent of total billed charges ","70% of total billed charges ",32.85,90,,26.28,,,0,"percent of total billed charges ","90% of total billed charges ",33.95,93,,27.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",31.03,85,,24.82,,,0,"percent of total billed charges ","85% of total billed charges ",32.85,90,,26.28,,,0,"percent of total billed charges ","90% of total billed charges ",32.85,90,,26.28,,,0,"percent of total billed charges ","90% of total billed charges ",1.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.76,87,,25.41,,,0,"percent of total billed charges ","87% of total billed charges ",1.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",25.55,70,,20.44,,,0,"percent of total billed charges ","70% of total billed charges ",1.74,33.95,
"HYPERBARIC TX EACH 30 MINUTES",7500010,"CDM ",413,RC,G0277,HCPCS,OUTPATIENT,,,576.5,461.2,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1406.33,1406.33,1406.33,"1 through 10","other ","not separately reimbursment ",360.16,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",403.55,70,,322.84,,,0,"percent of total billed charges ","70% of total billed charges ",518.85,90,,415.08,,,0,"percent of total billed charges ","90% of total billed charges ",536.15,93,,428.92,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.83,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",490.03,85,,392.02,,,0,"percent of total billed charges ","85% of total billed charges ",518.85,90,,415.08,,,0,"percent of total billed charges ","90% of total billed charges ",518.85,90,,415.08,,,0,"percent of total billed charges ","90% of total billed charges ",92.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",501.56,87,,401.25,,,0,"percent of total billed charges ","87% of total billed charges ",92.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",126.55,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",403.55,70,,322.84,,,0,"percent of total billed charges ","70% of total billed charges ",73.85,536.15,
"HYPERBARIC TX FACILITY",7500020,"CDM ",413,RC,G0277,HCPCS,OUTPATIENT,,,1144.5,915.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1406.33,1406.33,1406.33,"1 through 10","other ","not separately reimbursment ",360.16,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",801.15,70,,640.92,,,0,"percent of total billed charges ","70% of total billed charges ",1030.05,90,,824.04,,,0,"percent of total billed charges ","90% of total billed charges ",1064.39,93,,851.51,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.83,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",972.83,85,,778.26,,,0,"percent of total billed charges ","85% of total billed charges ",1030.05,90,,824.04,,,0,"percent of total billed charges ","90% of total billed charges ",1030.05,90,,824.04,,,0,"percent of total billed charges ","90% of total billed charges ",92.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",995.72,87,,796.58,,,0,"percent of total billed charges ","87% of total billed charges ",92.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",126.55,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",801.15,70,,640.92,,,0,"percent of total billed charges ","70% of total billed charges ",73.85,1064.39,
"REMOVE SUTURE BY DIFF PROVIDER",7501610,"CDM ",761,RC,S0630,HCPCS,OUTPATIENT,,,113,90.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.1,70,,63.28,,,0,"percent of total billed charges ","70% of total billed charges ",101.7,90,,81.36,,,0,"percent of total billed charges ","90% of total billed charges ",105.09,93,,84.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",96.05,85,,76.84,,,0,"percent of total billed charges ","85% of total billed charges ",101.7,90,,81.36,,,0,"percent of total billed charges ","90% of total billed charges ",101.7,90,,81.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",98.31,87,,78.65,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.1,70,,63.28,,,0,"percent of total billed charges ","70% of total billed charges ",79.1,105.09,
"MEDICAL RECORD ADMIN FEE",9200010,"CDM ",220,RC,S9981,HCPCS,OUTPATIENT,,,28.5,22.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,70,,15.96,,,0,"percent of total billed charges ","70% of total billed charges ",25.65,90,,20.52,,,0,"percent of total billed charges ","90% of total billed charges ",26.51,93,,21.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",24.23,85,,19.38,,,0,"percent of total billed charges ","85% of total billed charges ",25.65,90,,20.52,,,0,"percent of total billed charges ","90% of total billed charges ",25.65,90,,20.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",24.8,87,,19.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,70,,15.96,,,0,"percent of total billed charges ","70% of total billed charges ",19.95,26.51,
"US OR ANES GUIDED VASC ACCESS",1003650,"CDM ",402,RC,76937,HCPCS,OUTPATIENT,,,313.5,250.8,,23.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",82.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",219.45,70,,175.56,,,0,"percent of total billed charges ","70% of total billed charges ",282.15,90,,225.72,,,0,"percent of total billed charges ","90% of total billed charges ",291.56,93,,233.25,,,0,"percent of total billed charges ","93% of total billed charges ",23.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",266.48,85,,213.18,,,0,"percent of total billed charges ","85% of total billed charges ",282.15,90,,225.72,,,0,"percent of total billed charges ","90% of total billed charges ",282.15,90,,225.72,,,0,"percent of total billed charges ","90% of total billed charges ",15.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",272.75,87,,438.33,438.33,438.33,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",219.45,70,,175.56,,,0,"percent of total billed charges ","70% of total billed charges ",15.47,291.56,
"PACU OP ANTIBIOTIC IM",1400159,"CDM ",710,RC,96372,HCPCS,OUTPATIENT,,,240.5,192.4,,16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",29.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",223.67,93,,178.94,,,0,"percent of total billed charges ","93% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",204.43,85,,163.54,,,0,"percent of total billed charges ","85% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",209.24,87,,30.52,12.55,82.65,16,"percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,223.67,
"PACU OP NON-CHEMO INJ SUBQ/IM",1400167,"CDM ",710,RC,96372,HCPCS,OUTPATIENT,,,240.5,192.4,,16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",29.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",223.67,93,,178.94,,,0,"percent of total billed charges ","93% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",204.43,85,,163.54,,,0,"percent of total billed charges ","85% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",209.24,87,,30.52,12.55,82.65,16,"percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,223.67,
"IV PUSH SINGLE OR INITIAL",1400170,"CDM ",710,RC,96374,HCPCS,OUTPATIENT,,,308,246.4,,24.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",255.27,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",80.76,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",215.6,70,,172.48,,,0,"percent of total billed charges ","70% of total billed charges ",277.2,90,,221.76,,,0,"percent of total billed charges ","90% of total billed charges ",286.44,93,,229.15,,,0,"percent of total billed charges ","93% of total billed charges ",24.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.03,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",261.8,85,,209.44,,,0,"percent of total billed charges ","85% of total billed charges ",277.2,90,,221.76,,,0,"percent of total billed charges ","90% of total billed charges ",277.2,90,,221.76,,,0,"percent of total billed charges ","90% of total billed charges ",30.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",267.96,87,,168.95,93.31,211.19,17,"percent of total billed charges ","87% of total billed charges ",30.72,100,,141.50,141.50,141.50,"1 through 10","fee schedule ","100% of KS medicaid fee schedule ",195.61,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",215.6,70,,172.48,,,0,"percent of total billed charges ","70% of total billed charges ",24.42,286.44,
"IV PUSH ADD'L NEW DRUG GIVEN",1400180,"CDM ",710,RC,90775,HCPCS,OUTPATIENT,,,172.5,138,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.75,70,,96.60,,,0,"percent of total billed charges ","70% of total billed charges ",155.25,90,,124.20,,,0,"percent of total billed charges ","90% of total billed charges ",160.43,93,,128.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",146.63,85,,117.30,,,0,"percent of total billed charges ","85% of total billed charges ",155.25,90,,124.20,,,0,"percent of total billed charges ","90% of total billed charges ",155.25,90,,124.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",150.08,87,,120.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.75,70,,96.60,,,0,"percent of total billed charges ","70% of total billed charges ",120.75,160.43,
"PH ESOPHAGEAL REFLUX MONITORIN",1600071,"CDM ",750,RC,91037,HCPCS,OUTPATIENT,,,1885,1508,,130,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",360.4,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1319.5,70,,1055.60,,,0,"percent of total billed charges ","70% of total billed charges ",1696.5,90,,1357.20,,,0,"percent of total billed charges ","90% of total billed charges ",1753.05,93,,1402.44,,,0,"percent of total billed charges ","93% of total billed charges ",130,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",82.59,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1602.25,85,,1281.80,,,0,"percent of total billed charges ","85% of total billed charges ",1696.5,90,,1357.20,,,0,"percent of total billed charges ","90% of total billed charges ",1696.5,90,,1357.20,,,0,"percent of total billed charges ","90% of total billed charges ",81.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1639.95,87,,1311.96,,,0,"percent of total billed charges ","87% of total billed charges ",81.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.57,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1319.5,70,,1055.60,,,0,"percent of total billed charges ","70% of total billed charges ",81.77,1753.05,
"US OR ANES GUIDE NEEDLE PLACE",1600500,"CDM ",402,RC,76942,HCPCS,OUTPATIENT,,,313.5,250.8,,44.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",120.19,100,,143.86,143.86,143.86,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",121.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",219.45,70,,175.56,,,0,"percent of total billed charges ","70% of total billed charges ",282.15,90,,225.72,,,0,"percent of total billed charges ","90% of total billed charges ",291.56,93,,233.25,,,0,"percent of total billed charges ","93% of total billed charges ",44.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",266.48,85,,213.18,,,0,"percent of total billed charges ","85% of total billed charges ",282.15,90,,225.72,,,0,"percent of total billed charges ","90% of total billed charges ",282.15,90,,225.72,,,0,"percent of total billed charges ","90% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",272.75,87,,219.38,219.38,219.38,"1 through 10","percent of total billed charges ","87% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",219.45,70,,175.56,,,0,"percent of total billed charges ","70% of total billed charges ",39.25,291.56,
CARDIOVERSION,1700012,"CDM ",761,RC,92960,HCPCS,OUTPATIENT,,,1217,973.6,,210.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",481.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",227.66,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",851.9,70,,681.52,,,0,"percent of total billed charges ","70% of total billed charges ",1095.3,90,,876.24,,,0,"percent of total billed charges ","90% of total billed charges ",1131.81,93,,905.45,,,0,"percent of total billed charges ","93% of total billed charges ",210.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1034.45,85,,827.56,,,0,"percent of total billed charges ","85% of total billed charges ",1095.3,90,,876.24,,,0,"percent of total billed charges ","90% of total billed charges ",1095.3,90,,876.24,,,0,"percent of total billed charges ","90% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1058.79,87,,847.03,,,0,"percent of total billed charges ","87% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",607.84,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",851.9,70,,681.52,,,0,"percent of total billed charges ","70% of total billed charges ",196.25,1131.81,
"WOUND CARE MGMT NEW PATIENT",1700020,"CDM ",761,RC,99201,HCPCS,OUTPATIENT,,,457.5,366,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",320.25,70,,256.20,,,0,"percent of total billed charges ","70% of total billed charges ",411.75,90,,329.40,,,0,"percent of total billed charges ","90% of total billed charges ",425.48,93,,340.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",388.88,85,,311.10,,,0,"percent of total billed charges ","85% of total billed charges ",411.75,90,,329.40,,,0,"percent of total billed charges ","90% of total billed charges ",411.75,90,,329.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",398.03,87,,318.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",320.25,70,,256.20,,,0,"percent of total billed charges ","70% of total billed charges ",320.25,425.48,
"IMMUNIZATION INJECTION",1700038,"CDM ",771,RC,90471,HCPCS,OUTPATIENT,,,215,172,,14.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",34.72,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",199.95,93,,159.96,,,0,"percent of total billed charges ","93% of total billed charges ",14.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",182.75,85,,146.20,,,0,"percent of total billed charges ","85% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",187.05,87,,14.10,11.24,56.88,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",8.08,199.95,
"TREATMENT ROOM LESI ASSESSMENT",1700046,"CDM ",761,RC,99211,HCPCS,OUTPATIENT,,,217.5,174,,,,,,,,0,"other ","not separately reimbursment ",42.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",18.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",152.25,70,,121.80,,,0,"percent of total billed charges ","70% of total billed charges ",195.75,90,,156.60,,,0,"percent of total billed charges ","90% of total billed charges ",202.28,93,,161.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.72,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",184.88,85,,147.90,,,0,"percent of total billed charges ","85% of total billed charges ",195.75,90,,156.60,,,0,"percent of total billed charges ","90% of total billed charges ",195.75,90,,156.60,,,0,"percent of total billed charges ","90% of total billed charges ",17.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",189.23,87,,18.91,17.74,20.08,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",152.25,70,,121.80,,,0,"percent of total billed charges ","70% of total billed charges ",17.54,202.28,
"TREATMENT ROOM LEVEL 3",1700061,"CDM ",761,RC,99213,HCPCS,OUTPATIENT,,,292,233.6,,,,,,,,0,"other ","not separately reimbursment ",133.49,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",140.47,220,,74.27,70.21,78.33,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",204.4,70,,163.52,,,0,"percent of total billed charges ","70% of total billed charges ",262.8,90,,210.24,,,0,"percent of total billed charges ","90% of total billed charges ",271.56,93,,217.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",248.2,85,,198.56,,,0,"percent of total billed charges ","85% of total billed charges ",262.8,90,,210.24,,,0,"percent of total billed charges ","90% of total billed charges ",262.8,90,,210.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",254.04,87,,63.68,29.60,79.60,44,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",204.4,70,,163.52,,,0,"percent of total billed charges ","70% of total billed charges ",133.49,271.56,
"WOUND DEHIS W/PACKING",1700095,"CDM ",761,RC,12021,HCPCS,OUTPATIENT,,,516.5,413.2,,232.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",216.14,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",289.5,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",361.55,70,,289.24,,,0,"percent of total billed charges ","70% of total billed charges ",464.85,90,,371.88,,,0,"percent of total billed charges ","90% of total billed charges ",480.35,93,,384.28,,,0,"percent of total billed charges ","93% of total billed charges ",232.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",268.78,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",439.03,85,,351.22,,,0,"percent of total billed charges ","85% of total billed charges ",387.38,90,,309.90,,,0,"percent of total billed charges ","90% of total billed charges ",464.85,90,,371.88,,,0,"percent of total billed charges ","90% of total billed charges ",266.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",449.36,87,,359.49,,,0,"percent of total billed charges ","87% of total billed charges ",266.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",361.55,70,,289.24,,,0,"percent of total billed charges ","70% of total billed charges ",216.14,480.35,
"CATH FOR URINE SPECIMEN",1700160,"CDM ",761,RC,51701,HCPCS,OUTPATIENT,,,134.5,107.6,,41.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",144.89,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",53.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",94.15,70,,75.32,,,0,"percent of total billed charges ","70% of total billed charges ",121.05,90,,96.84,,,0,"percent of total billed charges ","90% of total billed charges ",125.09,93,,100.07,,,0,"percent of total billed charges ","93% of total billed charges ",41.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",114.33,85,,91.46,,,0,"percent of total billed charges ","85% of total billed charges ",100.88,90,,80.70,,,0,"percent of total billed charges ","90% of total billed charges ",121.05,90,,96.84,,,0,"percent of total billed charges ","90% of total billed charges ",31.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.02,87,,93.62,,,0,"percent of total billed charges ","87% of total billed charges ",31.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",94.15,70,,75.32,,,0,"percent of total billed charges ","70% of total billed charges ",31.19,144.89,
"BONE MARROW ASPIRATION",1700178,"CDM ",761,RC,38220,HCPCS,OUTPATIENT,,,1342,1073.6,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",142.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",939.4,70,,751.52,,,0,"percent of total billed charges ","70% of total billed charges ",1207.8,90,,966.24,,,0,"percent of total billed charges ","90% of total billed charges ",1248.06,93,,998.45,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.29,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1140.7,85,,912.56,,,0,"percent of total billed charges ","85% of total billed charges ",1006.5,90,,805.20,,,0,"percent of total billed charges ","90% of total billed charges ",1207.8,90,,966.24,,,0,"percent of total billed charges ","90% of total billed charges ",44.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1167.54,87,,934.03,,,0,"percent of total billed charges ","87% of total billed charges ",44.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",939.4,70,,751.52,,,0,"percent of total billed charges ","70% of total billed charges ",44.84,1518.9,
"BLOOD ADM >8 HRS",1700186,"CDM ",761,RC,36430,HCPCS,OUTPATIENT,,,1517.5,1214,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",515.69,100,,1227.22,1227.22,1227.22,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.42,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1062.25,70,,849.80,,,0,"percent of total billed charges ","70% of total billed charges ",1365.75,90,,1092.60,,,0,"percent of total billed charges ","90% of total billed charges ",1411.28,93,,1129.02,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1289.88,85,,1031.90,,,0,"percent of total billed charges ","85% of total billed charges ",1138.13,90,,910.50,,,0,"percent of total billed charges ","90% of total billed charges ",1365.75,90,,1092.60,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1320.23,87,,1056.18,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",405.73,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1062.25,70,,849.80,,,0,"percent of total billed charges ","70% of total billed charges ",77.42,1411.28,
"BLOOD ADM >6-8HRS",1700194,"CDM ",761,RC,36430,HCPCS,OUTPATIENT,,,1217,973.6,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",515.69,100,,1227.22,1227.22,1227.22,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.42,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",851.9,70,,681.52,,,0,"percent of total billed charges ","70% of total billed charges ",1095.3,90,,876.24,,,0,"percent of total billed charges ","90% of total billed charges ",1131.81,93,,905.45,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1034.45,85,,827.56,,,0,"percent of total billed charges ","85% of total billed charges ",912.75,90,,730.20,,,0,"percent of total billed charges ","90% of total billed charges ",1095.3,90,,876.24,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1058.79,87,,847.03,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",405.73,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",851.9,70,,681.52,,,0,"percent of total billed charges ","70% of total billed charges ",77.42,1131.81,
"BLOOD ADM >4-6 HRS",1700202,"CDM ",761,RC,36430,HCPCS,OUTPATIENT,,,914,731.2,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",515.69,100,,1227.22,1227.22,1227.22,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.42,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",639.8,70,,511.84,,,0,"percent of total billed charges ","70% of total billed charges ",822.6,90,,658.08,,,0,"percent of total billed charges ","90% of total billed charges ",850.02,93,,680.02,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",776.9,85,,621.52,,,0,"percent of total billed charges ","85% of total billed charges ",685.5,90,,548.40,,,0,"percent of total billed charges ","90% of total billed charges ",822.6,90,,658.08,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",795.18,87,,636.14,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",405.73,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",639.8,70,,511.84,,,0,"percent of total billed charges ","70% of total billed charges ",77.42,850.02,
"BLOOD ADM >2-4 HRS",1700210,"CDM ",761,RC,36430,HCPCS,OUTPATIENT,,,611.5,489.2,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",515.69,100,,1227.22,1227.22,1227.22,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.42,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",428.05,70,,342.44,,,0,"percent of total billed charges ","70% of total billed charges ",550.35,90,,440.28,,,0,"percent of total billed charges ","90% of total billed charges ",568.7,93,,454.96,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",519.78,85,,415.82,,,0,"percent of total billed charges ","85% of total billed charges ",458.63,90,,366.90,,,0,"percent of total billed charges ","90% of total billed charges ",550.35,90,,440.28,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",532.01,87,,425.61,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",405.73,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",428.05,70,,342.44,,,0,"percent of total billed charges ","70% of total billed charges ",77.42,568.7,
"BLOOD ADM <2 HRS",1700228,"CDM ",761,RC,36430,HCPCS,OUTPATIENT,,,355,284,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",515.69,100,,1227.22,1227.22,1227.22,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.42,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",248.5,70,,198.80,,,0,"percent of total billed charges ","70% of total billed charges ",319.5,90,,255.60,,,0,"percent of total billed charges ","90% of total billed charges ",330.15,93,,264.12,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",301.75,85,,241.40,,,0,"percent of total billed charges ","85% of total billed charges ",266.25,90,,213.00,,,0,"percent of total billed charges ","90% of total billed charges ",319.5,90,,255.60,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",308.85,87,,247.08,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",405.73,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",248.5,70,,198.80,,,0,"percent of total billed charges ","70% of total billed charges ",77.42,515.69,
"ANTIBIOTIC IM",1700236,"CDM ",761,RC,96372,HCPCS,OUTPATIENT,,,240.5,192.4,,16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",29.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",223.67,93,,178.94,,,0,"percent of total billed charges ","93% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",204.43,85,,163.54,,,0,"percent of total billed charges ","85% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",209.24,87,,30.52,12.55,82.65,16,"percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,223.67,
"NONCHEMO INJ/SUBQ/IM",1700251,"CDM ",761,RC,96372,HCPCS,OUTPATIENT,,,240.5,192.4,,16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",29.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",223.67,93,,178.94,,,0,"percent of total billed charges ","93% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",204.43,85,,163.54,,,0,"percent of total billed charges ","85% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",209.24,87,,30.52,12.55,82.65,16,"percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,223.67,
"COMP RPR SCALP/ARM/LEG 2.6-7.5",1700270,"CDM ",761,RC,13121,HCPCS,OUTPATIENT,,,1301,1040.8,,400.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",539.34,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",532.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",910.7,70,,728.56,,,0,"percent of total billed charges ","70% of total billed charges ",1170.9,90,,936.72,,,0,"percent of total billed charges ","90% of total billed charges ",1209.93,93,,967.94,,,0,"percent of total billed charges ","93% of total billed charges ",400.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1105.85,85,,884.68,,,0,"percent of total billed charges ","85% of total billed charges ",975.75,90,,780.60,,,0,"percent of total billed charges ","90% of total billed charges ",1170.9,90,,936.72,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1131.87,87,,1172.38,1172.38,1172.38,"1 through 10","percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",910.7,70,,728.56,,,0,"percent of total billed charges ","70% of total billed charges ",373.85,1209.93,
"NON-STRESS TEST OUTPATIENT",1700426,"CDM ",732,RC,59025,HCPCS,OUTPATIENT,,,520,416,,64.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",359.77,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",97.75,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",364,70,,291.20,,,0,"percent of total billed charges ","70% of total billed charges ",468,90,,374.40,,,0,"percent of total billed charges ","90% of total billed charges ",483.6,93,,386.88,,,0,"percent of total billed charges ","93% of total billed charges ",64.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",442,85,,353.60,,,0,"percent of total billed charges ","85% of total billed charges ",390,90,,312.00,,,0,"percent of total billed charges ","90% of total billed charges ",468,90,,374.40,,,0,"percent of total billed charges ","90% of total billed charges ",20.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",452.4,87,,361.01,233.36,451.26,"1 through 10","percent of total billed charges ","87% of total billed charges ",20.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",185.92,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",364,70,,291.20,,,0,"percent of total billed charges ","70% of total billed charges ",20.93,483.6,
"SCREENING AABR OUTPATIENT",1700434,"CDM ",470,RC,92651,HCPCS,OUTPATIENT,,,470.5,376.4,,101.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",185.7,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",329.35,70,,263.48,,,0,"percent of total billed charges ","70% of total billed charges ",423.45,90,,338.76,,,0,"percent of total billed charges ","90% of total billed charges ",437.57,93,,350.06,,,0,"percent of total billed charges ","93% of total billed charges ",101.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",115.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",399.93,85,,319.94,,,0,"percent of total billed charges ","85% of total billed charges ",423.45,90,,338.76,,,0,"percent of total billed charges ","90% of total billed charges ",423.45,90,,338.76,,,0,"percent of total billed charges ","90% of total billed charges ",114.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",409.34,87,,327.47,,,0,"percent of total billed charges ","87% of total billed charges ",114.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.57,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",329.35,70,,263.48,,,0,"percent of total billed charges ","70% of total billed charges ",101.68,437.57,
"BILI CHECK W/PROBE OUTPATIENT",1700459,"CDM ",300,RC,88720,HCPCS,OUTPATIENT,,,150,120,,5.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",105,70,,84.00,,,0,"percent of total billed charges ","70% of total billed charges ",135,90,,108.00,,,0,"percent of total billed charges ","90% of total billed charges ",139.5,93,,111.60,,,0,"percent of total billed charges ","93% of total billed charges ",5.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",127.5,85,,102.00,,,0,"percent of total billed charges ","85% of total billed charges ",135,90,,108.00,,,0,"percent of total billed charges ","90% of total billed charges ",135,90,,108.00,,,0,"percent of total billed charges ","90% of total billed charges ",8.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.5,87,,104.40,,,0,"percent of total billed charges ","87% of total billed charges ",8.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",105,70,,84.00,,,0,"percent of total billed charges ","70% of total billed charges ",5.01,139.5,
"CIRCUMCISION NEWBORN",1700475,"CDM ",761,RC,54150,HCPCS,OUTPATIENT,,,2157,1725.6,,659.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",600,100,,124.77,124.77,124.77,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",201.06,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1509.9,70,,1207.92,,,0,"percent of total billed charges ","70% of total billed charges ",1941.3,90,,1553.04,,,0,"percent of total billed charges ","90% of total billed charges ",2006.01,93,,1604.81,,,0,"percent of total billed charges ","93% of total billed charges ",659.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1833.45,85,,1466.76,,,0,"percent of total billed charges ","85% of total billed charges ",1617.75,90,,1294.20,,,0,"percent of total billed charges ","90% of total billed charges ",1941.3,90,,1553.04,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1876.59,87,,1501.27,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1922.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1509.9,70,,1207.92,,,0,"percent of total billed charges ","70% of total billed charges ",201.06,2006.01,
"CIRCUMCISION CLAMP/OTHR DEVICE",1700483,"CDM ",761,RC,54150,HCPCS,OUTPATIENT,,,2157,1725.6,,659.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",600,100,,124.77,124.77,124.77,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",201.06,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1509.9,70,,1207.92,,,0,"percent of total billed charges ","70% of total billed charges ",1941.3,90,,1553.04,,,0,"percent of total billed charges ","90% of total billed charges ",2006.01,93,,1604.81,,,0,"percent of total billed charges ","93% of total billed charges ",659.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1833.45,85,,1466.76,,,0,"percent of total billed charges ","85% of total billed charges ",1617.75,90,,1294.20,,,0,"percent of total billed charges ","90% of total billed charges ",1941.3,90,,1553.04,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1876.59,87,,1501.27,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1922.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1509.9,70,,1207.92,,,0,"percent of total billed charges ","70% of total billed charges ",201.06,2006.01,
"ASPIRATE PLEURA W/IMAGING",1700490,"CDM ",761,RC,32555,HCPCS,OUTPATIENT,,,1257.5,1006,,278.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",862.54,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",230.93,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",880.25,70,,704.20,,,0,"percent of total billed charges ","70% of total billed charges ",1131.75,90,,905.40,,,0,"percent of total billed charges ","90% of total billed charges ",1169.48,93,,935.58,,,0,"percent of total billed charges ","93% of total billed charges ",278.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",354.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1068.88,85,,855.10,,,0,"percent of total billed charges ","85% of total billed charges ",943.13,90,,754.50,,,0,"percent of total billed charges ","90% of total billed charges ",1131.75,90,,905.40,,,0,"percent of total billed charges ","90% of total billed charges ",350.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1094.03,87,,875.22,,,0,"percent of total billed charges ","87% of total billed charges ",350.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",576.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",880.25,70,,704.20,,,0,"percent of total billed charges ","70% of total billed charges ",230.93,1169.48,
"TX ROOM EST PATIENT LEVEL 1",1700533,"CDM ",761,RC,99211,HCPCS,OUTPATIENT,,,64.5,51.6,,,,,,,,0,"other ","not separately reimbursment ",42.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",18.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",45.15,70,,36.12,,,0,"percent of total billed charges ","70% of total billed charges ",58.05,90,,46.44,,,0,"percent of total billed charges ","90% of total billed charges ",59.99,93,,47.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.72,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",54.83,85,,43.86,,,0,"percent of total billed charges ","85% of total billed charges ",58.05,90,,46.44,,,0,"percent of total billed charges ","90% of total billed charges ",58.05,90,,46.44,,,0,"percent of total billed charges ","90% of total billed charges ",17.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.12,87,,18.91,17.74,20.08,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",45.15,70,,36.12,,,0,"percent of total billed charges ","70% of total billed charges ",17.54,59.99,
"SUPRAPUBIC CATHETER CHANGE",1700550,"CDM ",761,RC,51705,HCPCS,OUTPATIENT,,,441,352.8,,171.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",67.67,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",106.22,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",308.7,70,,246.96,,,0,"percent of total billed charges ","70% of total billed charges ",396.9,90,,317.52,,,0,"percent of total billed charges ","90% of total billed charges ",410.13,93,,328.10,,,0,"percent of total billed charges ","93% of total billed charges ",171.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",374.85,85,,299.88,,,0,"percent of total billed charges ","85% of total billed charges ",330.75,90,,264.60,,,0,"percent of total billed charges ","90% of total billed charges ",396.9,90,,317.52,,,0,"percent of total billed charges ","90% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",383.67,87,,306.94,,,0,"percent of total billed charges ","87% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",229.77,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",308.7,70,,246.96,,,0,"percent of total billed charges ","70% of total billed charges ",67.67,410.13,
"APPLY FINGER SPLINT",1700580,"CDM ",761,RC,29130,HCPCS,OUTPATIENT,,,334,267.2,,41.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",230.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",59.86,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",233.8,70,,187.04,,,0,"percent of total billed charges ","70% of total billed charges ",300.6,90,,240.48,,,0,"percent of total billed charges ","90% of total billed charges ",310.62,93,,248.50,,,0,"percent of total billed charges ","93% of total billed charges ",41.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.75,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",283.9,85,,227.12,,,0,"percent of total billed charges ","85% of total billed charges ",250.5,90,,200.40,,,0,"percent of total billed charges ","90% of total billed charges ",300.6,90,,240.48,,,0,"percent of total billed charges ","90% of total billed charges ",17.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",290.58,87,,232.46,,,0,"percent of total billed charges ","87% of total billed charges ",17.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",233.8,70,,187.04,,,0,"percent of total billed charges ","70% of total billed charges ",17.57,310.62,
"BLADDER IRRIGATION",1700590,"CDM ",761,RC,51700,HCPCS,OUTPATIENT,,,415.5,332.4,,171.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",312.17,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",63.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",290.85,70,,232.68,,,0,"percent of total billed charges ","70% of total billed charges ",373.95,90,,299.16,,,0,"percent of total billed charges ","90% of total billed charges ",386.42,93,,309.14,,,0,"percent of total billed charges ","93% of total billed charges ",171.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",353.18,85,,282.54,,,0,"percent of total billed charges ","85% of total billed charges ",311.63,90,,249.30,,,0,"percent of total billed charges ","90% of total billed charges ",373.95,90,,299.16,,,0,"percent of total billed charges ","90% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",361.49,87,,289.19,,,0,"percent of total billed charges ","87% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",229.77,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",290.85,70,,232.68,,,0,"percent of total billed charges ","70% of total billed charges ",63.32,386.42,
"INSERT BLADDER CATH-SIMPLE",1700600,"CDM ",761,RC,51702,HCPCS,OUTPATIENT,,,339.5,271.6,,41.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",144.89,100,,11.03,11.03,11.03,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",52.93,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",237.65,70,,190.12,,,0,"percent of total billed charges ","70% of total billed charges ",305.55,90,,244.44,,,0,"percent of total billed charges ","90% of total billed charges ",315.74,93,,252.59,,,0,"percent of total billed charges ","93% of total billed charges ",41.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",288.58,85,,230.86,,,0,"percent of total billed charges ","85% of total billed charges ",254.63,90,,203.70,,,0,"percent of total billed charges ","90% of total billed charges ",305.55,90,,244.44,,,0,"percent of total billed charges ","90% of total billed charges ",31.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",295.37,87,,236.30,,,0,"percent of total billed charges ","87% of total billed charges ",31.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",237.65,70,,190.12,,,0,"percent of total billed charges ","70% of total billed charges ",31.19,315.74,
"WOUND CARE ADV DRESSING CHANGE",1700620,"CDM ",761,RC,97602,HCPCS,OUTPATIENT,,,613,490.4,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.2,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,39.36,39.36,39.36,"1 through 10","other ","not separately reimbursment ",429.1,70,,343.28,,,0,"percent of total billed charges ","70% of total billed charges ",551.7,90,,441.36,,,0,"percent of total billed charges ","90% of total billed charges ",570.09,93,,456.07,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",521.05,85,,416.84,,,0,"percent of total billed charges ","85% of total billed charges ",551.7,90,,441.36,,,0,"percent of total billed charges ","90% of total billed charges ",551.7,90,,441.36,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",533.31,87,,426.65,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",429.1,70,,343.28,,,0,"percent of total billed charges ","70% of total billed charges ",184.51,570.09,
"INJ SYMPATHETIC NERVE",1700660,"CDM ",761,RC,64520,HCPCS,OUTPATIENT,,,1238,990.4,,295.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",473.69,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",176.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",866.6,70,,693.28,,,0,"percent of total billed charges ","70% of total billed charges ",1114.2,90,,891.36,,,0,"percent of total billed charges ","90% of total billed charges ",1151.34,93,,921.07,,,0,"percent of total billed charges ","93% of total billed charges ",295.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",76.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1052.3,85,,841.84,,,0,"percent of total billed charges ","85% of total billed charges ",928.5,90,,742.80,,,0,"percent of total billed charges ","90% of total billed charges ",1114.2,90,,891.36,,,0,"percent of total billed charges ","90% of total billed charges ",75.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1077.06,87,,861.65,,,0,"percent of total billed charges ","87% of total billed charges ",75.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",813.41,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",866.6,70,,693.28,,,0,"percent of total billed charges ","70% of total billed charges ",75.56,1151.34,
"INCISION OF LIP FOLD",1700670,"CDM ",761,RC,40806,HCPCS,OUTPATIENT,,,417,333.6,,305.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.17,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",291.9,70,,233.52,,,0,"percent of total billed charges ","70% of total billed charges ",375.3,90,,300.24,,,0,"percent of total billed charges ","90% of total billed charges ",387.81,93,,310.25,,,0,"percent of total billed charges ","93% of total billed charges ",305.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",352.81,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",354.45,85,,283.56,,,0,"percent of total billed charges ","85% of total billed charges ",312.75,90,,250.20,,,0,"percent of total billed charges ","90% of total billed charges ",375.3,90,,300.24,,,0,"percent of total billed charges ","90% of total billed charges ",349.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",362.79,87,,486.94,486.94,486.94,"1 through 10","percent of total billed charges ","87% of total billed charges ",349.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",495.99,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",291.9,70,,233.52,,,0,"percent of total billed charges ","70% of total billed charges ",58.17,495.99,
"APPLY SHORT LEG SPLINT",1700680,"CDM ",761,RC,29515,HCPCS,OUTPATIENT,,,370,296,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",230.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",100.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",344.1,93,,275.28,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",314.5,85,,251.60,,,0,"percent of total billed charges ","85% of total billed charges ",277.5,90,,222.00,,,0,"percent of total billed charges ","90% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",321.9,87,,41.35,41.35,41.35,"1 through 10","percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",100.87,344.1,
"EPIDURAL BLOOD PATCH",1700710,"CDM ",761,RC,62273,HCPCS,OUTPATIENT,,,1238,990.4,,224.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",448.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",236.68,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",866.6,70,,693.28,,,0,"percent of total billed charges ","70% of total billed charges ",1114.2,90,,891.36,,,0,"percent of total billed charges ","90% of total billed charges ",1151.34,93,,921.07,,,0,"percent of total billed charges ","93% of total billed charges ",224.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1052.3,85,,841.84,,,0,"percent of total billed charges ","85% of total billed charges ",928.5,90,,742.80,,,0,"percent of total billed charges ","90% of total billed charges ",1114.2,90,,891.36,,,0,"percent of total billed charges ","90% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1077.06,87,,861.65,,,0,"percent of total billed charges ","87% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",649.16,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",866.6,70,,693.28,,,0,"percent of total billed charges ","70% of total billed charges ",130.83,1151.34,
"MODERATE SEDATION < 5 YEARS",1700740,"CDM ",761,RC,99148,HCPCS,OUTPATIENT,,,1280,1024,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",896,70,,716.80,,,0,"percent of total billed charges ","70% of total billed charges ",1152,90,,921.60,,,0,"percent of total billed charges ","90% of total billed charges ",1190.4,93,,952.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1088,85,,870.40,,,0,"percent of total billed charges ","85% of total billed charges ",1152,90,,921.60,,,0,"percent of total billed charges ","90% of total billed charges ",1152,90,,921.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1113.6,87,,890.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",896,70,,716.80,,,0,"percent of total billed charges ","70% of total billed charges ",896,1190.4,
"TX KNEECAP DISLOCATION",1700760,"CDM ",761,RC,27560,HCPCS,OUTPATIENT,,,366.5,293.2,,364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",700.46,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",256.55,70,,205.24,,,0,"percent of total billed charges ","70% of total billed charges ",329.85,90,,263.88,,,0,"percent of total billed charges ","90% of total billed charges ",340.85,93,,272.68,,,0,"percent of total billed charges ","93% of total billed charges ",364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",311.53,85,,249.22,,,0,"percent of total billed charges ","85% of total billed charges ",274.88,90,,219.90,,,0,"percent of total billed charges ","90% of total billed charges ",329.85,90,,263.88,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",318.86,87,,255.09,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",256.55,70,,205.24,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,809.01,
"WOUND CARE MGMT ESTABLISHED PT",1700780,"CDM ",761,RC,99211,HCPCS,OUTPATIENT,,,217.5,174,,,,,,,,0,"other ","not separately reimbursment ",42.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",18.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",152.25,70,,121.80,,,0,"percent of total billed charges ","70% of total billed charges ",195.75,90,,156.60,,,0,"percent of total billed charges ","90% of total billed charges ",202.28,93,,161.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.72,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",184.88,85,,147.90,,,0,"percent of total billed charges ","85% of total billed charges ",195.75,90,,156.60,,,0,"percent of total billed charges ","90% of total billed charges ",195.75,90,,156.60,,,0,"percent of total billed charges ","90% of total billed charges ",17.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",189.23,87,,18.91,17.74,20.08,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",152.25,70,,121.80,,,0,"percent of total billed charges ","70% of total billed charges ",17.54,202.28,
"IV PUSH SINGLE OR INITIAL",1700800,"CDM ",761,RC,96374,HCPCS,OUTPATIENT,,,308,246.4,,24.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",255.27,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",80.76,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",215.6,70,,172.48,,,0,"percent of total billed charges ","70% of total billed charges ",277.2,90,,221.76,,,0,"percent of total billed charges ","90% of total billed charges ",286.44,93,,229.15,,,0,"percent of total billed charges ","93% of total billed charges ",24.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.03,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",261.8,85,,209.44,,,0,"percent of total billed charges ","85% of total billed charges ",277.2,90,,221.76,,,0,"percent of total billed charges ","90% of total billed charges ",277.2,90,,221.76,,,0,"percent of total billed charges ","90% of total billed charges ",30.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",267.96,87,,168.95,93.31,211.19,17,"percent of total billed charges ","87% of total billed charges ",30.72,100,,141.50,141.50,141.50,"1 through 10","fee schedule ","100% of KS medicaid fee schedule ",195.61,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",215.6,70,,172.48,,,0,"percent of total billed charges ","70% of total billed charges ",24.42,286.44,
"IV PUSH ADD'L NEW DRUG GIVEN",1700810,"CDM ",761,RC,96375,HCPCS,OUTPATIENT,,,218,174.4,,24.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.57,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",32.85,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",152.6,70,,122.08,,,0,"percent of total billed charges ","70% of total billed charges ",196.2,90,,156.96,,,0,"percent of total billed charges ","90% of total billed charges ",202.74,93,,162.19,,,0,"percent of total billed charges ","93% of total billed charges ",24.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.03,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",185.3,85,,148.24,,,0,"percent of total billed charges ","85% of total billed charges ",196.2,90,,156.96,,,0,"percent of total billed charges ","90% of total billed charges ",196.2,90,,156.96,,,0,"percent of total billed charges ","90% of total billed charges ",30.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",189.66,87,,142.80,44.18,287.15,13,"percent of total billed charges ","87% of total billed charges ",30.72,100,,44.79,44.79,44.79,"1 through 10","fee schedule ","100% of KS medicaid fee schedule ",43.06,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",152.6,70,,122.08,,,0,"percent of total billed charges ","70% of total billed charges ",24.42,202.74,
"IV DRIP 1ST HR HYDRATION",1700820,"CDM ",761,RC,96360,HCPCS,OUTPATIENT,,,578,462.4,,49.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",255.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",70.31,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",404.6,70,,323.68,,,0,"percent of total billed charges ","70% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",537.54,93,,430.03,,,0,"percent of total billed charges ","93% of total billed charges ",49.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.29,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",491.3,85,,393.04,,,0,"percent of total billed charges ","85% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",62.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",502.86,87,,159.55,60.51,406.64,"1 through 10","percent of total billed charges ","87% of total billed charges ",62.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.61,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",404.6,70,,323.68,,,0,"percent of total billed charges ","70% of total billed charges ",49.81,537.54,
"IV DRIP EA ADD'L HR HYDRATION",1700830,"CDM ",761,RC,96361,HCPCS,OUTPATIENT,,,232,185.6,,16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",133.32,100,,9.14,9.14,9.14,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",26.55,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",215.76,93,,172.61,,,0,"percent of total billed charges ","93% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",197.2,85,,157.76,,,0,"percent of total billed charges ","85% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.84,87,,131.39,93.88,240.22,16,"percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.06,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,215.76,
"IV DRIP 1ST HR THERAPY",1700840,"CDM ",761,RC,96365,HCPCS,OUTPATIENT,,,578,462.4,,86.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",255.28,100,,41.74,41.74,41.74,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",138.36,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",404.6,70,,323.68,,,0,"percent of total billed charges ","70% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",537.54,93,,430.03,,,0,"percent of total billed charges ","93% of total billed charges ",86.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",110.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",491.3,85,,393.04,,,0,"percent of total billed charges ","85% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",109.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",502.86,87,,309.11,152.46,396.95,"1 through 10","percent of total billed charges ","87% of total billed charges ",109.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.61,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",404.6,70,,323.68,,,0,"percent of total billed charges ","70% of total billed charges ",86.94,537.54,
"IV DRIP EA ADD'L HR THERAPY",1700850,"CDM ",761,RC,96366,HCPCS,OUTPATIENT,,,232,185.6,,23.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",133.32,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",43.76,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",215.76,93,,172.61,,,0,"percent of total billed charges ","93% of total billed charges ",23.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",197.2,85,,157.76,,,0,"percent of total billed charges ","85% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.84,87,,159.47,159.47,159.47,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.06,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",21.17,215.76,
"BLADDER IRRIG AND/OR INSTILLAT",1700860,"CDM ",761,RC,51700,HCPCS,OUTPATIENT,,,415.5,332.4,,171.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",312.17,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",63.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",290.85,70,,232.68,,,0,"percent of total billed charges ","70% of total billed charges ",373.95,90,,299.16,,,0,"percent of total billed charges ","90% of total billed charges ",386.42,93,,309.14,,,0,"percent of total billed charges ","93% of total billed charges ",171.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",353.18,85,,282.54,,,0,"percent of total billed charges ","85% of total billed charges ",311.63,90,,249.30,,,0,"percent of total billed charges ","90% of total billed charges ",373.95,90,,299.16,,,0,"percent of total billed charges ","90% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",361.49,87,,289.19,,,0,"percent of total billed charges ","87% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",229.77,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",290.85,70,,232.68,,,0,"percent of total billed charges ","70% of total billed charges ",63.32,386.42,
"DRAIN/INJECT JT/BURSA",1700870,"CDM ",761,RC,20610,HCPCS,OUTPATIENT,,,479,383.2,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.53,100,,11.66,11.66,11.66,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",93.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",335.3,70,,268.24,,,0,"percent of total billed charges ","70% of total billed charges ",431.1,90,,344.88,,,0,"percent of total billed charges ","90% of total billed charges ",445.47,93,,356.38,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",407.15,85,,325.72,,,0,"percent of total billed charges ","85% of total billed charges ",359.25,90,,287.40,,,0,"percent of total billed charges ","90% of total billed charges ",431.1,90,,344.88,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",416.73,87,,35.16,16.84,51.43,"1 through 10","percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",282.29,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",335.3,70,,268.24,,,0,"percent of total billed charges ","70% of total billed charges ",93.35,445.47,
"SHAVING OF LESION",1700880,"CDM ",761,RC,11310,HCPCS,OUTPATIENT,,,532.5,426,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.71,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",94.45,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",372.75,70,,298.20,,,0,"percent of total billed charges ","70% of total billed charges ",479.25,90,,383.40,,,0,"percent of total billed charges ","90% of total billed charges ",495.23,93,,396.18,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",452.63,85,,362.10,,,0,"percent of total billed charges ","85% of total billed charges ",399.38,90,,319.50,,,0,"percent of total billed charges ","90% of total billed charges ",479.25,90,,383.40,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",463.28,87,,370.62,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",372.75,70,,298.20,,,0,"percent of total billed charges ","70% of total billed charges ",94.45,495.23,
"LAYER CLOSURE OF WOUNDS",1700890,"CDM ",761,RC,12042,HCPCS,OUTPATIENT,,,435,348,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",707,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",403.3,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",304.5,70,,243.60,,,0,"percent of total billed charges ","70% of total billed charges ",391.5,90,,313.20,,,0,"percent of total billed charges ","90% of total billed charges ",404.55,93,,323.64,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",369.75,85,,295.80,,,0,"percent of total billed charges ","85% of total billed charges ",326.25,90,,261.00,,,0,"percent of total billed charges ","90% of total billed charges ",391.5,90,,313.20,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",378.45,87,,302.76,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",304.5,70,,243.60,,,0,"percent of total billed charges ","70% of total billed charges ",286,707,
"CIRCUMCISION >28 DAYS",1700900,"CDM ",761,RC,54161,HCPCS,OUTPATIENT,,,3303.5,2642.8,,659.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2751.24,100,,1725.50,1725.50,1725.50,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",409.11,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2312.45,70,,1849.96,,,0,"percent of total billed charges ","70% of total billed charges ",2973.15,90,,2378.52,,,0,"percent of total billed charges ","90% of total billed charges ",3072.26,93,,2457.81,,,0,"percent of total billed charges ","93% of total billed charges ",659.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2807.98,85,,2246.38,,,0,"percent of total billed charges ","85% of total billed charges ",2477.63,90,,1982.10,,,0,"percent of total billed charges ","90% of total billed charges ",2973.15,90,,2378.52,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2874.05,87,,2299.24,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1922.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2312.45,70,,1849.96,,,0,"percent of total billed charges ","70% of total billed charges ",327.08,3072.26,
"CIRCUMCISION <28 DAY W/O CLAMP",1700910,"CDM ",761,RC,54160,HCPCS,OUTPATIENT,,,3003,2402.4,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",310.07,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",301.58,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2102.1,70,,1681.68,,,0,"percent of total billed charges ","70% of total billed charges ",2702.7,90,,2162.16,,,0,"percent of total billed charges ","90% of total billed charges ",2792.79,93,,2234.23,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2552.55,85,,2042.04,,,0,"percent of total billed charges ","85% of total billed charges ",2252.25,90,,1801.80,,,0,"percent of total billed charges ","90% of total billed charges ",2702.7,90,,2162.16,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2612.61,87,,2090.09,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",641.27,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2102.1,70,,1681.68,,,0,"percent of total billed charges ","70% of total billed charges ",286,2792.79,
"CLOSURE OF WOUND 2.6-5.0 CM",1700920,"CDM ",761,RC,12052,HCPCS,OUTPATIENT,,,435,348,,343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",451.17,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",410.08,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",304.5,70,,243.60,,,0,"percent of total billed charges ","70% of total billed charges ",391.5,90,,313.20,,,0,"percent of total billed charges ","90% of total billed charges ",404.55,93,,323.64,,,0,"percent of total billed charges ","93% of total billed charges ",343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",369.75,85,,295.80,,,0,"percent of total billed charges ","85% of total billed charges ",326.25,90,,261.00,,,0,"percent of total billed charges ","90% of total billed charges ",391.5,90,,313.20,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",378.45,87,,302.76,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",304.5,70,,243.60,,,0,"percent of total billed charges ","70% of total billed charges ",304.5,451.17,
"NEG PRESS WOUND THERAPY <50CM",1700930,"CDM ",761,RC,97607,HCPCS,OUTPATIENT,,,533.5,426.8,,129.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",45.74,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",373.45,70,,298.76,,,0,"percent of total billed charges ","70% of total billed charges ",480.15,90,,384.12,,,0,"percent of total billed charges ","90% of total billed charges ",496.16,93,,396.93,,,0,"percent of total billed charges ","93% of total billed charges ",129.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",44.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",453.48,85,,362.78,,,0,"percent of total billed charges ","85% of total billed charges ",480.15,90,,384.12,,,0,"percent of total billed charges ","90% of total billed charges ",480.15,90,,384.12,,,0,"percent of total billed charges ","90% of total billed charges ",44.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",464.15,87,,371.32,,,0,"percent of total billed charges ","87% of total billed charges ",44.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",373.45,70,,298.76,,,0,"percent of total billed charges ","70% of total billed charges ",44.08,496.16,
"NEG PRESS WOUND THERAPY >50CM",1700940,"CDM ",761,RC,97608,HCPCS,OUTPATIENT,,,566,452.8,,45.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",396.2,70,,316.96,,,0,"percent of total billed charges ","70% of total billed charges ",509.4,90,,407.52,,,0,"percent of total billed charges ","90% of total billed charges ",526.38,93,,421.10,,,0,"percent of total billed charges ","93% of total billed charges ",45.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",481.1,85,,384.88,,,0,"percent of total billed charges ","85% of total billed charges ",509.4,90,,407.52,,,0,"percent of total billed charges ","90% of total billed charges ",509.4,90,,407.52,,,0,"percent of total billed charges ","90% of total billed charges ",57.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",492.42,87,,393.94,,,0,"percent of total billed charges ","87% of total billed charges ",57.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",396.2,70,,316.96,,,0,"percent of total billed charges ","70% of total billed charges ",45.36,526.38,
"IV PUSH SAME DRUG >30 MIN",1700950,"CDM ",761,RC,96376,HCPCS,OUTPATIENT,,,236.5,189.2,,,,,,,,0,"other ","not separately reimbursment ",43.43,100,,44.21,44.21,44.21,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",165.55,70,,132.44,,,0,"percent of total billed charges ","70% of total billed charges ",212.85,90,,170.28,,,0,"percent of total billed charges ","90% of total billed charges ",219.95,93,,175.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",15.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",201.03,85,,160.82,,,0,"percent of total billed charges ","85% of total billed charges ",212.85,90,,170.28,,,0,"percent of total billed charges ","90% of total billed charges ",212.85,90,,170.28,,,0,"percent of total billed charges ","90% of total billed charges ",15.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",205.76,87,,487.46,487.46,487.46,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",165.55,70,,132.44,,,0,"percent of total billed charges ","70% of total billed charges ",15.6,219.95,
"CHEMO ADMIN INITIAL 1ST HOUR",1700960,"CDM ",761,RC,96413,HCPCS,OUTPATIENT,,,401,320.8,,113.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",358.2,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",278.85,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",280.7,70,,224.56,,,0,"percent of total billed charges ","70% of total billed charges ",360.9,90,,288.72,,,0,"percent of total billed charges ","90% of total billed charges ",372.93,93,,298.34,,,0,"percent of total billed charges ","93% of total billed charges ",113.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",144.55,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",340.85,85,,272.68,,,0,"percent of total billed charges ","85% of total billed charges ",360.9,90,,288.72,,,0,"percent of total billed charges ","90% of total billed charges ",360.9,90,,288.72,,,0,"percent of total billed charges ","90% of total billed charges ",143.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",348.87,87,,279.10,,,0,"percent of total billed charges ","87% of total billed charges ",143.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",303.76,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",280.7,70,,224.56,,,0,"percent of total billed charges ","70% of total billed charges ",113.77,372.93,
"DEBRIDE SUBQ TISSUE",1700970,"CDM ",761,RC,11042,HCPCS,OUTPATIENT,,,658,526.4,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",451.17,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",124.63,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",460.6,70,,368.48,,,0,"percent of total billed charges ","70% of total billed charges ",592.2,90,,473.76,,,0,"percent of total billed charges ","90% of total billed charges ",611.94,93,,489.55,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",559.3,85,,447.44,,,0,"percent of total billed charges ","85% of total billed charges ",493.5,90,,394.80,,,0,"percent of total billed charges ","90% of total billed charges ",592.2,90,,473.76,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",572.46,87,,838.17,838.17,838.17,"1 through 10","percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",460.6,70,,368.48,,,0,"percent of total billed charges ","70% of total billed charges ",124.63,611.94,
"IV THERAPY-SEQUENTIAL DRUGS",1700980,"CDM ",761,RC,96367,HCPCS,OUTPATIENT,,,232,185.6,,24.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",133.32,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",62.15,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",215.76,93,,172.61,,,0,"percent of total billed charges ","93% of total billed charges ",24.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.03,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",197.2,85,,157.76,,,0,"percent of total billed charges ","85% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",30.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.84,87,,161.47,,,0,"percent of total billed charges ","87% of total billed charges ",30.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.2,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",24.42,215.76,
"IRRIGATE IMPLANT VENOUS DEVICE",1700990,"CDM ",761,RC,96523,HCPCS,OUTPATIENT,,,102,81.6,,,,,,,,0,"other ","not separately reimbursment ",54.54,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",54.19,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",71.4,70,,57.12,,,0,"percent of total billed charges ","70% of total billed charges ",91.8,90,,73.44,,,0,"percent of total billed charges ","90% of total billed charges ",94.86,93,,75.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",86.7,85,,69.36,,,0,"percent of total billed charges ","85% of total billed charges ",91.8,90,,73.44,,,0,"percent of total billed charges ","90% of total billed charges ",91.8,90,,73.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",88.74,87,,70.99,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",71.4,70,,57.12,,,0,"percent of total billed charges ","70% of total billed charges ",54.19,94.86,
"REMOVAL OF DEEP IMPLANT",1701000,"CDM ",761,RC,20680,HCPCS,OUTPATIENT,,,3639,2911.2,,920.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2815.88,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",862.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2547.3,70,,2037.84,,,0,"percent of total billed charges ","70% of total billed charges ",3275.1,90,,2620.08,,,0,"percent of total billed charges ","90% of total billed charges ",3384.27,93,,2707.42,,,0,"percent of total billed charges ","93% of total billed charges ",920.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3093.15,85,,2474.52,,,0,"percent of total billed charges ","85% of total billed charges ",2729.25,90,,2183.40,,,0,"percent of total billed charges ","90% of total billed charges ",3275.1,90,,2620.08,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3165.93,87,,2532.74,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2671.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2547.3,70,,2037.84,,,0,"percent of total billed charges ","70% of total billed charges ",327.08,3384.27,
"APPLY LONG LEG SPLINT",1701010,"CDM ",761,RC,29505,HCPCS,OUTPATIENT,,,370,296,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",230.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",104.74,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",344.1,93,,275.28,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",314.5,85,,251.60,,,0,"percent of total billed charges ","85% of total billed charges ",277.5,90,,222.00,,,0,"percent of total billed charges ","90% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",321.9,87,,257.52,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",104.74,344.1,
"PICC LINE PLACEMENT 5 YRS & >",1701020,"CDM ",761,RC,36569,HCPCS,OUTPATIENT,,,2084,1667.2,,3211,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",773.97,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",194.48,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1458.8,70,,1167.04,,,0,"percent of total billed charges ","70% of total billed charges ",1875.6,90,,1500.48,,,0,"percent of total billed charges ","90% of total billed charges ",1938.12,93,,1550.50,,,0,"percent of total billed charges ","93% of total billed charges ",3211,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4079.83,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1771.4,85,,1417.12,,,0,"percent of total billed charges ","85% of total billed charges ",1563,90,,1250.40,,,0,"percent of total billed charges ","90% of total billed charges ",1875.6,90,,1500.48,,,0,"percent of total billed charges ","90% of total billed charges ",4039.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1813.08,87,,1450.46,,,0,"percent of total billed charges ","87% of total billed charges ",4039.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1447.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1458.8,70,,1167.04,,,0,"percent of total billed charges ","70% of total billed charges ",194.48,4079.83,
"FINE NEEDLE ASP WO IMA 1ST LES",1701030,"CDM ",761,RC,10021,HCPCS,OUTPATIENT,,,532.5,426,,129.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",113.7,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",372.75,70,,298.20,,,0,"percent of total billed charges ","70% of total billed charges ",479.25,90,,383.40,,,0,"percent of total billed charges ","90% of total billed charges ",495.23,93,,396.18,,,0,"percent of total billed charges ","93% of total billed charges ",129.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",452.63,85,,362.10,,,0,"percent of total billed charges ","85% of total billed charges ",399.38,90,,319.50,,,0,"percent of total billed charges ","90% of total billed charges ",479.25,90,,383.40,,,0,"percent of total billed charges ","90% of total billed charges ",99.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",463.28,87,,370.62,,,0,"percent of total billed charges ","87% of total billed charges ",99.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",372.75,70,,298.20,,,0,"percent of total billed charges ","70% of total billed charges ",99.94,495.23,
"VACCINE PNEUMO ADMINISTRATION",1701050,"CDM ",771,RC,90471,HCPCS,OUTPATIENT,,,215,172,,14.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",34.72,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",199.95,93,,159.96,,,0,"percent of total billed charges ","93% of total billed charges ",14.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",182.75,85,,146.20,,,0,"percent of total billed charges ","85% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",187.05,87,,14.10,11.24,56.88,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",8.08,199.95,
"VACCINE INFLUENZA ADMIN",1701060,"CDM ",771,RC,90471,HCPCS,OUTPATIENT,,,215,172,,14.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",34.72,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",199.95,93,,159.96,,,0,"percent of total billed charges ","93% of total billed charges ",14.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",182.75,85,,146.20,,,0,"percent of total billed charges ","85% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",187.05,87,,14.10,11.24,56.88,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",8.08,199.95,
"IV THERAPY - SIMULTANEOUS",1701070,"CDM ",761,RC,96368,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",1.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",42.31,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",1.01,106.95,
"REMOVAL CAST",1701080,"CDM ",761,RC,29700,HCPCS,OUTPATIENT,,,385,308,,228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",278.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",67.61,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",269.5,70,,215.60,,,0,"percent of total billed charges ","70% of total billed charges ",346.5,90,,277.20,,,0,"percent of total billed charges ","90% of total billed charges ",358.05,93,,286.44,,,0,"percent of total billed charges ","93% of total billed charges ",228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",327.25,85,,261.80,,,0,"percent of total billed charges ","85% of total billed charges ",288.75,90,,231.00,,,0,"percent of total billed charges ","90% of total billed charges ",346.5,90,,277.20,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",334.95,87,,267.96,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.22,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",269.5,70,,215.60,,,0,"percent of total billed charges ","70% of total billed charges ",67.61,358.05,
"INJ INTRL CERV LUMBAR WO IMAGE",1701090,"CDM ",761,RC,62322,HCPCS,OUTPATIENT,,,1035,828,,377.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",588.83,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",168.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",724.5,70,,579.60,,,0,"percent of total billed charges ","70% of total billed charges ",931.5,90,,745.20,,,0,"percent of total billed charges ","90% of total billed charges ",962.55,93,,770.04,,,0,"percent of total billed charges ","93% of total billed charges ",377.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",435.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",879.75,85,,703.80,,,0,"percent of total billed charges ","85% of total billed charges ",776.25,90,,621.00,,,0,"percent of total billed charges ","90% of total billed charges ",931.5,90,,745.20,,,0,"percent of total billed charges ","90% of total billed charges ",431.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",900.45,87,,69.97,69.97,69.97,"1 through 10","percent of total billed charges ","87% of total billed charges ",431.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",813.41,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",724.5,70,,579.60,,,0,"percent of total billed charges ","70% of total billed charges ",168.87,962.55,
"I&D HEMATOMA",1701100,"CDM ",761,RC,10140,HCPCS,OUTPATIENT,,,2443,1954.4,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1186.75,100,,217.85,217.85,217.85,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",243.74,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1710.1,70,,1368.08,,,0,"percent of total billed charges ","70% of total billed charges ",2198.7,90,,1758.96,,,0,"percent of total billed charges ","90% of total billed charges ",2271.99,93,,1817.59,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2076.55,85,,1661.24,,,0,"percent of total billed charges ","85% of total billed charges ",1832.25,90,,1465.80,,,0,"percent of total billed charges ","90% of total billed charges ",2198.7,90,,1758.96,,,0,"percent of total billed charges ","90% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2125.41,87,,1700.33,,,0,"percent of total billed charges ","87% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1710.1,70,,1368.08,,,0,"percent of total billed charges ","70% of total billed charges ",243.74,2271.99,
"APPLY LONG ARM SPLINT",1701110,"CDM ",761,RC,29105,HCPCS,OUTPATIENT,,,406.5,325.2,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",230.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",85.14,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",284.55,70,,227.64,,,0,"percent of total billed charges ","70% of total billed charges ",365.85,90,,292.68,,,0,"percent of total billed charges ","90% of total billed charges ",378.05,93,,302.44,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",345.53,85,,276.42,,,0,"percent of total billed charges ","85% of total billed charges ",304.88,90,,243.90,,,0,"percent of total billed charges ","90% of total billed charges ",365.85,90,,292.68,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",353.66,87,,282.93,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",284.55,70,,227.64,,,0,"percent of total billed charges ","70% of total billed charges ",85.14,378.05,
"PICC LINE REMOVAL",1701120,"CDM ",761,RC,36589,HCPCS,OUTPATIENT,,,1268.5,1014.8,,163.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",958.49,100,,224.38,224.38,224.38,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",283.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",887.95,70,,710.36,,,0,"percent of total billed charges ","70% of total billed charges ",1141.65,90,,913.32,,,0,"percent of total billed charges ","90% of total billed charges ",1179.71,93,,943.77,,,0,"percent of total billed charges ","93% of total billed charges ",163.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",208.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1078.23,85,,862.58,,,0,"percent of total billed charges ","85% of total billed charges ",951.38,90,,761.10,,,0,"percent of total billed charges ","90% of total billed charges ",1141.65,90,,913.32,,,0,"percent of total billed charges ","90% of total billed charges ",206.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1103.6,87,,882.88,,,0,"percent of total billed charges ","87% of total billed charges ",206.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",576.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",887.95,70,,710.36,,,0,"percent of total billed charges ","70% of total billed charges ",163.98,1179.71,
"CONTROL NASAL HEMORRHAGE",1701130,"CDM ",761,RC,31238,HCPCS,OUTPATIENT,,,3480.5,2784.4,,549.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4632.87,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",344.56,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2436.35,70,,1949.08,,,0,"percent of total billed charges ","70% of total billed charges ",3132.45,90,,2505.96,,,0,"percent of total billed charges ","90% of total billed charges ",3236.87,93,,2589.50,,,0,"percent of total billed charges ","93% of total billed charges ",549.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2958.43,85,,2366.74,,,0,"percent of total billed charges ","85% of total billed charges ",2610.38,90,,2088.30,,,0,"percent of total billed charges ","90% of total billed charges ",3132.45,90,,2505.96,,,0,"percent of total billed charges ","90% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3028.04,87,,2422.43,,,0,"percent of total billed charges ","87% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1636.89,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2436.35,70,,1949.08,,,0,"percent of total billed charges ","70% of total billed charges ",130.83,4632.87,
"VACCINE ADMIN EACH ADD'L",1701160,"CDM ",771,RC,90472,HCPCS,OUTPATIENT,,,215,172,,14.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",26.27,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",199.95,93,,159.96,,,0,"percent of total billed charges ","93% of total billed charges ",14.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",182.75,85,,146.20,,,0,"percent of total billed charges ","85% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",187.05,87,,149.64,,,0,"percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",8.08,199.95,
"APPLY SHORT ARM SPLINT",1701180,"CDM ",761,RC,29125,HCPCS,OUTPATIENT,,,370,296,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",230.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",81.29,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",344.1,93,,275.28,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",314.5,85,,251.60,,,0,"percent of total billed charges ","85% of total billed charges ",277.5,90,,222.00,,,0,"percent of total billed charges ","90% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",321.9,87,,257.52,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",81.29,344.1,
"DRESS AND/OR DEBRIDE MED BURNS",1701200,"CDM ",761,RC,16025,HCPCS,OUTPATIENT,,,783,626.4,,189.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",371.68,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",228.98,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",548.1,70,,438.48,,,0,"percent of total billed charges ","70% of total billed charges ",704.7,90,,563.76,,,0,"percent of total billed charges ","90% of total billed charges ",728.19,93,,582.55,,,0,"percent of total billed charges ","93% of total billed charges ",189.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",665.55,85,,532.44,,,0,"percent of total billed charges ","85% of total billed charges ",587.25,90,,469.80,,,0,"percent of total billed charges ","90% of total billed charges ",704.7,90,,563.76,,,0,"percent of total billed charges ","90% of total billed charges ",217.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",681.21,87,,544.97,,,0,"percent of total billed charges ","87% of total billed charges ",217.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",548.1,70,,438.48,,,0,"percent of total billed charges ","70% of total billed charges ",184.51,728.19,
"APPLY CAST SHORT ARM",1701210,"CDM ",761,RC,29075,HCPCS,OUTPATIENT,,,703.5,562.8,,228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",432.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",125.71,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",492.45,70,,393.96,,,0,"percent of total billed charges ","70% of total billed charges ",633.15,90,,506.52,,,0,"percent of total billed charges ","90% of total billed charges ",654.26,93,,523.41,,,0,"percent of total billed charges ","93% of total billed charges ",228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",597.98,85,,478.38,,,0,"percent of total billed charges ","85% of total billed charges ",527.63,90,,422.10,,,0,"percent of total billed charges ","90% of total billed charges ",633.15,90,,506.52,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",612.05,87,,39.71,39.71,39.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.22,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",492.45,70,,393.96,,,0,"percent of total billed charges ","70% of total billed charges ",125.71,654.26,
"DRESSING CHANGE",1701230,"CDM ",761,RC,15852,HCPCS,OUTPATIENT,,,123,98.4,,314.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",95.59,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",86.1,70,,68.88,,,0,"percent of total billed charges ","70% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",114.39,93,,91.51,,,0,"percent of total billed charges ","93% of total billed charges ",314.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",363.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.55,85,,83.64,,,0,"percent of total billed charges ","85% of total billed charges ",92.25,90,,73.80,,,0,"percent of total billed charges ","90% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",359.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.01,87,,85.61,,,0,"percent of total billed charges ","87% of total billed charges ",359.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",679.69,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",86.1,70,,68.88,,,0,"percent of total billed charges ","70% of total billed charges ",86.1,679.69,
"REPAIR FINGER TENDON",1701240,"CDM ",761,RC,26418,HCPCS,OUTPATIENT,,,3201,2560.8,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3017.88,100,,2487.97,2487.97,2487.97,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1313.55,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2240.7,70,,1792.56,,,0,"percent of total billed charges ","70% of total billed charges ",2880.9,90,,2304.72,,,0,"percent of total billed charges ","90% of total billed charges ",2976.93,93,,2381.54,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2720.85,85,,2176.68,,,0,"percent of total billed charges ","85% of total billed charges ",2400.75,90,,1920.60,,,0,"percent of total billed charges ","90% of total billed charges ",2880.9,90,,2304.72,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2784.87,87,,2227.90,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2240.7,70,,1792.56,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,3017.88,
"DRAIN CEREBRAL SPINAL FLUID",1701260,"CDM ",761,RC,62272,HCPCS,OUTPATIENT,,,855,684,,224.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",433.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",179.5,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",598.5,70,,478.80,,,0,"percent of total billed charges ","70% of total billed charges ",769.5,90,,615.60,,,0,"percent of total billed charges ","90% of total billed charges ",795.15,93,,636.12,,,0,"percent of total billed charges ","93% of total billed charges ",224.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",165.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",726.75,85,,581.40,,,0,"percent of total billed charges ","85% of total billed charges ",641.25,90,,513.00,,,0,"percent of total billed charges ","90% of total billed charges ",769.5,90,,615.60,,,0,"percent of total billed charges ","90% of total billed charges ",163.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",743.85,87,,595.08,,,0,"percent of total billed charges ","87% of total billed charges ",163.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",649.16,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",598.5,70,,478.80,,,0,"percent of total billed charges ","70% of total billed charges ",163.54,795.15,
"LAP BAND ADJUSTMENT",1701270,"CDM ",761,RC,43999,HCPCS,OUTPATIENT,,,1550.5,1240.4,,554.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1085.35,70,,868.28,,,0,"percent of total billed charges ","70% of total billed charges ",1395.45,90,,1116.36,,,0,"percent of total billed charges ","90% of total billed charges ",1441.97,93,,1153.58,,,0,"percent of total billed charges ","93% of total billed charges ",554.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",640.41,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1317.93,85,,1054.34,,,0,"percent of total billed charges ","85% of total billed charges ",1162.88,90,,930.30,,,0,"percent of total billed charges ","90% of total billed charges ",1395.45,90,,1116.36,,,0,"percent of total billed charges ","90% of total billed charges ",634.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1348.94,87,,1079.15,,,0,"percent of total billed charges ","87% of total billed charges ",634.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",834.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1085.35,70,,868.28,,,0,"percent of total billed charges ","70% of total billed charges ",554.43,1441.97,
"FINE NEEDLE ASPIRATION",1701280,"CDM ",761,RC,10022,HCPCS,OUTPATIENT,,,956,764.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",669.2,70,,535.36,,,0,"percent of total billed charges ","70% of total billed charges ",860.4,90,,688.32,,,0,"percent of total billed charges ","90% of total billed charges ",889.08,93,,711.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",812.6,85,,650.08,,,0,"percent of total billed charges ","85% of total billed charges ",717,90,,573.60,,,0,"percent of total billed charges ","90% of total billed charges ",860.4,90,,688.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",831.72,87,,665.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",669.2,70,,535.36,,,0,"percent of total billed charges ","70% of total billed charges ",669.2,889.08,
"OUTPATIENT MISCELLANEOUS",1701290,"CDM ",761,RC,99211,HCPCS,OUTPATIENT,,,217.5,174,,,,,,,,0,"other ","not separately reimbursment ",42.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",18.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",152.25,70,,121.80,,,0,"percent of total billed charges ","70% of total billed charges ",195.75,90,,156.60,,,0,"percent of total billed charges ","90% of total billed charges ",202.28,93,,161.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.72,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",184.88,85,,147.90,,,0,"percent of total billed charges ","85% of total billed charges ",195.75,90,,156.60,,,0,"percent of total billed charges ","90% of total billed charges ",195.75,90,,156.60,,,0,"percent of total billed charges ","90% of total billed charges ",17.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",189.23,87,,18.91,17.74,20.08,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",152.25,70,,121.80,,,0,"percent of total billed charges ","70% of total billed charges ",17.54,202.28,
"INJ TRIGGER POINT; 1-2 MUSCLES",1701300,"CDM ",761,RC,20552,HCPCS,OUTPATIENT,,,969.5,775.6,,192.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",78.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",678.65,70,,542.92,,,0,"percent of total billed charges ","70% of total billed charges ",872.55,90,,698.04,,,0,"percent of total billed charges ","90% of total billed charges ",901.64,93,,721.31,,,0,"percent of total billed charges ","93% of total billed charges ",192.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",222,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",824.08,85,,659.26,,,0,"percent of total billed charges ","85% of total billed charges ",727.13,90,,581.70,,,0,"percent of total billed charges ","90% of total billed charges ",872.55,90,,698.04,,,0,"percent of total billed charges ","90% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",843.47,87,,47.19,47.19,47.19,"1 through 10","percent of total billed charges ","87% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",282.29,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",678.65,70,,542.92,,,0,"percent of total billed charges ","70% of total billed charges ",78.25,901.64,
"APPLY SHORT LEG CAST",1701310,"CDM ",761,RC,29405,HCPCS,OUTPATIENT,,,384.5,307.6,,228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",119,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",357.59,93,,286.07,,,0,"percent of total billed charges ","93% of total billed charges ",228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",326.83,85,,261.46,,,0,"percent of total billed charges ","85% of total billed charges ",288.38,90,,230.70,,,0,"percent of total billed charges ","90% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",334.52,87,,267.62,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.22,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",119,357.59,
"WEDGING OF CAST",1701320,"CDM ",761,RC,29740,HCPCS,OUTPATIENT,,,241,192.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.98,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",168.7,70,,134.96,,,0,"percent of total billed charges ","70% of total billed charges ",216.9,90,,173.52,,,0,"percent of total billed charges ","90% of total billed charges ",224.13,93,,179.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",204.85,85,,163.88,,,0,"percent of total billed charges ","85% of total billed charges ",180.75,90,,144.60,,,0,"percent of total billed charges ","90% of total billed charges ",216.9,90,,173.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",209.67,87,,167.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",257.22,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",168.7,70,,134.96,,,0,"percent of total billed charges ","70% of total billed charges ",140.98,257.22,
"TREAT SHOULDER DISLOCATION",1701330,"CDM ",761,RC,23650,HCPCS,OUTPATIENT,,,1287,1029.6,,260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",897.89,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",614.26,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",900.9,70,,720.72,,,0,"percent of total billed charges ","70% of total billed charges ",1158.3,90,,926.64,,,0,"percent of total billed charges ","90% of total billed charges ",1196.91,93,,957.53,,,0,"percent of total billed charges ","93% of total billed charges ",260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1093.95,85,,875.16,,,0,"percent of total billed charges ","85% of total billed charges ",965.25,90,,772.20,,,0,"percent of total billed charges ","90% of total billed charges ",1158.3,90,,926.64,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1119.69,87,,895.75,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",900.9,70,,720.72,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1196.91,
"TREAT FRACTURE RADIUS/ULNA",1701340,"CDM ",761,RC,25600,HCPCS,OUTPATIENT,,,1050.5,840.4,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",249.78,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",674.63,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",735.35,70,,588.28,,,0,"percent of total billed charges ","70% of total billed charges ",945.45,90,,756.36,,,0,"percent of total billed charges ","90% of total billed charges ",976.97,93,,781.58,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",892.93,85,,714.34,,,0,"percent of total billed charges ","85% of total billed charges ",787.88,90,,630.30,,,0,"percent of total billed charges ","90% of total billed charges ",945.45,90,,756.36,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",913.94,87,,731.15,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",735.35,70,,588.28,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,976.97,
"CHEMO ADMIN EA ADD'L HOUR",1701350,"CDM ",761,RC,96415,HCPCS,OUTPATIENT,,,236,188.8,,30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.94,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",60.08,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",165.2,70,,132.16,,,0,"percent of total billed charges ","70% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",219.48,93,,175.58,,,0,"percent of total billed charges ","93% of total billed charges ",30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",200.6,85,,160.48,,,0,"percent of total billed charges ","85% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",37.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",205.32,87,,164.26,,,0,"percent of total billed charges ","87% of total billed charges ",37.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.2,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",165.2,70,,132.16,,,0,"percent of total billed charges ","70% of total billed charges ",30,219.48,
"SPINAL FLUID TAP, DIAGNOSTIC",1701360,"CDM ",761,RC,62270,HCPCS,OUTPATIENT,,,823,658.4,,224.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",433.29,100,,109.05,109.05,109.05,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",127.49,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",576.1,70,,460.88,,,0,"percent of total billed charges ","70% of total billed charges ",740.7,90,,592.56,,,0,"percent of total billed charges ","90% of total billed charges ",765.39,93,,612.31,,,0,"percent of total billed charges ","93% of total billed charges ",224.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",165.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",699.55,85,,559.64,,,0,"percent of total billed charges ","85% of total billed charges ",617.25,90,,493.80,,,0,"percent of total billed charges ","90% of total billed charges ",740.7,90,,592.56,,,0,"percent of total billed charges ","90% of total billed charges ",163.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",716.01,87,,572.81,,,0,"percent of total billed charges ","87% of total billed charges ",163.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",649.16,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",576.1,70,,460.88,,,0,"percent of total billed charges ","70% of total billed charges ",127.49,765.39,
"DRESS/DEBRID P-THICK BURN SM",1701370,"CDM ",761,RC,16020,HCPCS,OUTPATIENT,,,783,626.4,,189.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",371.68,100,,98.42,98.42,98.42,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",111.8,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",548.1,70,,438.48,,,0,"percent of total billed charges ","70% of total billed charges ",704.7,90,,563.76,,,0,"percent of total billed charges ","90% of total billed charges ",728.19,93,,582.55,,,0,"percent of total billed charges ","93% of total billed charges ",189.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",665.55,85,,532.44,,,0,"percent of total billed charges ","85% of total billed charges ",587.25,90,,469.80,,,0,"percent of total billed charges ","90% of total billed charges ",704.7,90,,563.76,,,0,"percent of total billed charges ","90% of total billed charges ",217.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",681.21,87,,544.97,,,0,"percent of total billed charges ","87% of total billed charges ",217.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",548.1,70,,438.48,,,0,"percent of total billed charges ","70% of total billed charges ",111.8,728.19,
"ABDOMINAL PARACENTESIS",1701380,"CDM ",761,RC,49082,HCPCS,OUTPATIENT,,,1108,886.4,,260.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1079.61,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",151.49,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",775.6,70,,620.48,,,0,"percent of total billed charges ","70% of total billed charges ",997.2,90,,797.76,,,0,"percent of total billed charges ","90% of total billed charges ",1030.44,93,,824.35,,,0,"percent of total billed charges ","93% of total billed charges ",260.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.95,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",941.8,85,,753.44,,,0,"percent of total billed charges ","85% of total billed charges ",831,90,,664.80,,,0,"percent of total billed charges ","90% of total billed charges ",997.2,90,,797.76,,,0,"percent of total billed charges ","90% of total billed charges ",327.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",963.96,87,,771.17,,,0,"percent of total billed charges ","87% of total billed charges ",327.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",834.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",775.6,70,,620.48,,,0,"percent of total billed charges ","70% of total billed charges ",151.49,1079.61,
"ABD PARACENTESIS W/IMAGING",1701390,"CDM ",761,RC,49083,HCPCS,OUTPATIENT,,,1108,886.4,,260.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1079.61,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",221.78,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",775.6,70,,620.48,,,0,"percent of total billed charges ","70% of total billed charges ",997.2,90,,797.76,,,0,"percent of total billed charges ","90% of total billed charges ",1030.44,93,,824.35,,,0,"percent of total billed charges ","93% of total billed charges ",260.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.95,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",941.8,85,,753.44,,,0,"percent of total billed charges ","85% of total billed charges ",831,90,,664.80,,,0,"percent of total billed charges ","90% of total billed charges ",997.2,90,,797.76,,,0,"percent of total billed charges ","90% of total billed charges ",327.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",963.96,87,,771.17,,,0,"percent of total billed charges ","87% of total billed charges ",327.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",834.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",775.6,70,,620.48,,,0,"percent of total billed charges ","70% of total billed charges ",221.78,1079.61,
"BIOPSY THYROID",1701400,"CDM ",761,RC,60100,HCPCS,OUTPATIENT,,,956,764.8,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",443.39,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",160.97,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",669.2,70,,535.36,,,0,"percent of total billed charges ","70% of total billed charges ",860.4,90,,688.32,,,0,"percent of total billed charges ","90% of total billed charges ",889.08,93,,711.26,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",812.6,85,,650.08,,,0,"percent of total billed charges ","85% of total billed charges ",717,90,,573.60,,,0,"percent of total billed charges ","90% of total billed charges ",860.4,90,,688.32,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",831.72,87,,665.38,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",669.2,70,,535.36,,,0,"percent of total billed charges ","70% of total billed charges ",160.97,889.08,
"DRESS/DEBRIDE P-THICK; LARGE",1701410,"CDM ",761,RC,16030,HCPCS,OUTPATIENT,,,821,656.8,,314.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",371.68,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",268.73,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",574.7,70,,459.76,,,0,"percent of total billed charges ","70% of total billed charges ",738.9,90,,591.12,,,0,"percent of total billed charges ","90% of total billed charges ",763.53,93,,610.82,,,0,"percent of total billed charges ","93% of total billed charges ",314.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",363.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",697.85,85,,558.28,,,0,"percent of total billed charges ","85% of total billed charges ",615.75,90,,492.60,,,0,"percent of total billed charges ","90% of total billed charges ",738.9,90,,591.12,,,0,"percent of total billed charges ","90% of total billed charges ",359.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",714.27,87,,571.42,,,0,"percent of total billed charges ","87% of total billed charges ",359.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",574.7,70,,459.76,,,0,"percent of total billed charges ","70% of total billed charges ",268.73,763.53,
"DRAIN/INJECT JOINT/BURSA",1701420,"CDM ",761,RC,20605,HCPCS,OUTPATIENT,,,470.5,376.4,,192.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.02,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",329.35,70,,263.48,,,0,"percent of total billed charges ","70% of total billed charges ",423.45,90,,338.76,,,0,"percent of total billed charges ","90% of total billed charges ",437.57,93,,350.06,,,0,"percent of total billed charges ","93% of total billed charges ",192.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",222,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",399.93,85,,319.94,,,0,"percent of total billed charges ","85% of total billed charges ",352.88,90,,282.30,,,0,"percent of total billed charges ","90% of total billed charges ",423.45,90,,338.76,,,0,"percent of total billed charges ","90% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",409.34,87,,327.47,,,0,"percent of total billed charges ","87% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",282.29,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",329.35,70,,263.48,,,0,"percent of total billed charges ","70% of total billed charges ",77.02,437.57,
"DEBRIDE WOUND <20 CM",1701440,"CDM ",761,RC,97597,HCPCS,OUTPATIENT,,,344,275.2,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",278.76,100,,266.92,266.92,266.92,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",76.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",240.8,70,,192.64,,,0,"percent of total billed charges ","70% of total billed charges ",309.6,90,,247.68,,,0,"percent of total billed charges ","90% of total billed charges ",319.92,93,,255.94,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",292.4,85,,233.92,,,0,"percent of total billed charges ","85% of total billed charges ",309.6,90,,247.68,,,0,"percent of total billed charges ","90% of total billed charges ",309.6,90,,247.68,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",299.28,87,,239.42,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",240.8,70,,192.64,,,0,"percent of total billed charges ","70% of total billed charges ",76.25,319.92,
"TX FRACTURE HUMERUS",1701470,"CDM ",761,RC,24530,HCPCS,OUTPATIENT,,,1338.5,1070.8,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,30.21,30.21,30.21,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",730.84,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",936.95,70,,749.56,,,0,"percent of total billed charges ","70% of total billed charges ",1204.65,90,,963.72,,,0,"percent of total billed charges ","90% of total billed charges ",1244.81,93,,995.85,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1137.73,85,,910.18,,,0,"percent of total billed charges ","85% of total billed charges ",1003.88,90,,803.10,,,0,"percent of total billed charges ","90% of total billed charges ",1204.65,90,,963.72,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1164.5,87,,931.60,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",936.95,70,,749.56,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1454.4,
"SIMP RPR WOUNDS 2.6CM - 7.5CM",1701480,"CDM ",761,RC,12002,HCPCS,OUTPATIENT,,,803,642.4,,260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",457.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",120.71,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",562.1,70,,449.68,,,0,"percent of total billed charges ","70% of total billed charges ",722.7,90,,578.16,,,0,"percent of total billed charges ","90% of total billed charges ",746.79,93,,597.43,,,0,"percent of total billed charges ","93% of total billed charges ",260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",682.55,85,,546.04,,,0,"percent of total billed charges ","85% of total billed charges ",602.25,90,,481.80,,,0,"percent of total billed charges ","90% of total billed charges ",722.7,90,,578.16,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",698.61,87,,558.89,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",562.1,70,,449.68,,,0,"percent of total billed charges ","70% of total billed charges ",120.71,746.79,
"PERCUTANEOUS BX LIVER",1701490,"CDM ",761,RC,47000,HCPCS,OUTPATIENT,,,2451,1960.8,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",988.79,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",183.04,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1715.7,70,,1372.56,,,0,"percent of total billed charges ","70% of total billed charges ",2205.9,90,,1764.72,,,0,"percent of total billed charges ","90% of total billed charges ",2279.43,93,,1823.54,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",284.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2083.35,85,,1666.68,,,0,"percent of total billed charges ","85% of total billed charges ",1838.25,90,,1470.60,,,0,"percent of total billed charges ","90% of total billed charges ",2205.9,90,,1764.72,,,0,"percent of total billed charges ","90% of total billed charges ",281.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2132.37,87,,1705.90,,,0,"percent of total billed charges ","87% of total billed charges ",281.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1715.7,70,,1372.56,,,0,"percent of total billed charges ","70% of total billed charges ",183.04,2279.43,
"RADIAL/ULNA SHAFT FX W/MANIP",1701500,"CDM ",761,RC,25565,HCPCS,OUTPATIENT,,,1715.5,1372.4,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",966.97,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1200.85,70,,960.68,,,0,"percent of total billed charges ","70% of total billed charges ",1543.95,90,,1235.16,,,0,"percent of total billed charges ","90% of total billed charges ",1595.42,93,,1276.34,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1458.18,85,,1166.54,,,0,"percent of total billed charges ","85% of total billed charges ",1286.63,90,,1029.30,,,0,"percent of total billed charges ","90% of total billed charges ",1543.95,90,,1235.16,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1492.49,87,,1193.99,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1200.85,70,,960.68,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,1595.42,
"TX ANKLE FRACTURE W/MANIP",1701510,"CDM ",761,RC,27818,HCPCS,OUTPATIENT,,,2512,2009.6,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1915.97,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",907.76,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1758.4,70,,1406.72,,,0,"percent of total billed charges ","70% of total billed charges ",2260.8,90,,1808.64,,,0,"percent of total billed charges ","90% of total billed charges ",2336.16,93,,1868.93,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2135.2,85,,1708.16,,,0,"percent of total billed charges ","85% of total billed charges ",1884,90,,1507.20,,,0,"percent of total billed charges ","90% of total billed charges ",2260.8,90,,1808.64,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2185.44,87,,1748.35,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1758.4,70,,1406.72,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,2336.16,
"CHANGE BLADDER TUBE",1701520,"CDM ",761,RC,51705,HCPCS,OUTPATIENT,,,441,352.8,,171.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",67.67,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",106.22,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",308.7,70,,246.96,,,0,"percent of total billed charges ","70% of total billed charges ",396.9,90,,317.52,,,0,"percent of total billed charges ","90% of total billed charges ",410.13,93,,328.10,,,0,"percent of total billed charges ","93% of total billed charges ",171.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",374.85,85,,299.88,,,0,"percent of total billed charges ","85% of total billed charges ",330.75,90,,264.60,,,0,"percent of total billed charges ","90% of total billed charges ",396.9,90,,317.52,,,0,"percent of total billed charges ","90% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",383.67,87,,306.94,,,0,"percent of total billed charges ","87% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",229.77,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",308.7,70,,246.96,,,0,"percent of total billed charges ","70% of total billed charges ",67.67,410.13,
"INSERT NON-TUNNEL CV CATH",1701530,"CDM ",761,RC,36556,HCPCS,OUTPATIENT,,,2067,1653.6,,382.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2666.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",175.45,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1446.9,70,,1157.52,,,0,"percent of total billed charges ","70% of total billed charges ",1860.3,90,,1488.24,,,0,"percent of total billed charges ","90% of total billed charges ",1922.31,93,,1537.85,,,0,"percent of total billed charges ","93% of total billed charges ",382.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",485.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1756.95,85,,1405.56,,,0,"percent of total billed charges ","85% of total billed charges ",1550.25,90,,1240.20,,,0,"percent of total billed charges ","90% of total billed charges ",1860.3,90,,1488.24,,,0,"percent of total billed charges ","90% of total billed charges ",480.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1798.29,87,,1438.63,,,0,"percent of total billed charges ","87% of total billed charges ",480.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2903.79,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1446.9,70,,1157.52,,,0,"percent of total billed charges ","70% of total billed charges ",175.45,2903.79,
"DRAIN BREAST LEGION",1701540,"CDM ",761,RC,19000,HCPCS,OUTPATIENT,,,1194,955.2,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",412.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",88.86,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",835.8,70,,668.64,,,0,"percent of total billed charges ","70% of total billed charges ",1074.6,90,,859.68,,,0,"percent of total billed charges ","90% of total billed charges ",1110.42,93,,888.34,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1014.9,85,,811.92,,,0,"percent of total billed charges ","85% of total billed charges ",895.5,90,,716.40,,,0,"percent of total billed charges ","90% of total billed charges ",1074.6,90,,859.68,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1038.78,87,,831.02,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",835.8,70,,668.64,,,0,"percent of total billed charges ","70% of total billed charges ",88.86,1110.42,
"IMAGE CATH FLD COLL VISCERAL",1701550,"CDM ",761,RC,49405,HCPCS,OUTPATIENT,,,2531,2024.8,,826.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",407.29,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1771.7,70,,1417.36,,,0,"percent of total billed charges ","70% of total billed charges ",2277.9,90,,1822.32,,,0,"percent of total billed charges ","90% of total billed charges ",2353.83,93,,1883.06,,,0,"percent of total billed charges ","93% of total billed charges ",826.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1050.65,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2151.35,85,,1721.08,,,0,"percent of total billed charges ","85% of total billed charges ",1898.25,90,,1518.60,,,0,"percent of total billed charges ","90% of total billed charges ",2277.9,90,,1822.32,,,0,"percent of total billed charges ","90% of total billed charges ",1040.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2201.97,87,,1761.58,,,0,"percent of total billed charges ","87% of total billed charges ",1040.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1771.7,70,,1417.36,,,0,"percent of total billed charges ","70% of total billed charges ",407.29,2353.83,
"DRAINAGE KIDNEY LESION",1701560,"CDM ",761,RC,50390,HCPCS,OUTPATIENT,,,2580.5,2064.4,,343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",781.74,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",198.7,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1806.35,70,,1445.08,,,0,"percent of total billed charges ","70% of total billed charges ",2322.45,90,,1857.96,,,0,"percent of total billed charges ","90% of total billed charges ",2399.87,93,,1919.90,,,0,"percent of total billed charges ","93% of total billed charges ",343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2193.43,85,,1754.74,,,0,"percent of total billed charges ","85% of total billed charges ",1935.38,90,,1548.30,,,0,"percent of total billed charges ","90% of total billed charges ",2322.45,90,,1857.96,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2245.04,87,,1796.03,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1806.35,70,,1445.08,,,0,"percent of total billed charges ","70% of total billed charges ",198.7,2399.87,
"DRAIN/INJ JOINT/BURSA W/ US",1701570,"CDM ",761,RC,20611,HCPCS,OUTPATIENT,,,495.5,396.4,,142.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",123.18,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",346.85,70,,277.48,,,0,"percent of total billed charges ","70% of total billed charges ",445.95,90,,356.76,,,0,"percent of total billed charges ","90% of total billed charges ",460.82,93,,368.66,,,0,"percent of total billed charges ","93% of total billed charges ",142.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",181.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",421.18,85,,336.94,,,0,"percent of total billed charges ","85% of total billed charges ",371.63,90,,297.30,,,0,"percent of total billed charges ","90% of total billed charges ",445.95,90,,356.76,,,0,"percent of total billed charges ","90% of total billed charges ",179.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",431.09,87,,344.87,,,0,"percent of total billed charges ","87% of total billed charges ",179.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",282.29,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",346.85,70,,277.48,,,0,"percent of total billed charges ","70% of total billed charges ",123.18,460.82,
"RPR COMPLEX FACE 2.6-7.5 CM",1701580,"CDM ",761,RC,13152,HCPCS,OUTPATIENT,,,1114,891.2,,,,,,,,0,"other ","not separately reimbursment ",1618.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",693.26,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",779.8,70,,623.84,,,0,"percent of total billed charges ","70% of total billed charges ",1002.6,90,,802.08,,,0,"percent of total billed charges ","90% of total billed charges ",1036.02,93,,828.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",946.9,85,,757.52,,,0,"percent of total billed charges ","85% of total billed charges ",835.5,90,,668.40,,,0,"percent of total billed charges ","90% of total billed charges ",1002.6,90,,802.08,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",969.18,87,,775.34,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",679.69,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",779.8,70,,623.84,,,0,"percent of total billed charges ","70% of total billed charges ",327.08,1618.02,
"BIOPSY NECK/CHEST",1701590,"CDM ",761,RC,21550,HCPCS,OUTPATIENT,,,3146,2516.8,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",710.03,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",322.83,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2202.2,70,,1761.76,,,0,"percent of total billed charges ","70% of total billed charges ",2831.4,90,,2265.12,,,0,"percent of total billed charges ","90% of total billed charges ",2925.78,93,,2340.62,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2674.1,85,,2139.28,,,0,"percent of total billed charges ","85% of total billed charges ",2359.5,90,,1887.60,,,0,"percent of total billed charges ","90% of total billed charges ",2831.4,90,,2265.12,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2737.02,87,,2189.62,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2202.2,70,,1761.76,,,0,"percent of total billed charges ","70% of total billed charges ",294.37,2925.78,
"TX FRACTURE RADIAL SHFT W/MANI",1701600,"CDM ",761,RC,25505,HCPCS,OUTPATIENT,,,3376.5,2701.2,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",952.73,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2363.55,70,,1890.84,,,0,"percent of total billed charges ","70% of total billed charges ",3038.85,90,,2431.08,,,0,"percent of total billed charges ","90% of total billed charges ",3140.15,93,,2512.12,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2870.03,85,,2296.02,,,0,"percent of total billed charges ","85% of total billed charges ",2532.38,90,,2025.90,,,0,"percent of total billed charges ","90% of total billed charges ",3038.85,90,,2431.08,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2937.56,87,,2350.05,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2363.55,70,,1890.84,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,3140.15,
"TX FRACTURE TIBIA SHAFT CLOSED",1701610,"CDM ",761,RC,27750,HCPCS,OUTPATIENT,,,2512,2009.6,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",671.53,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1758.4,70,,1406.72,,,0,"percent of total billed charges ","70% of total billed charges ",2260.8,90,,1808.64,,,0,"percent of total billed charges ","90% of total billed charges ",2336.16,93,,1868.93,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2135.2,85,,1708.16,,,0,"percent of total billed charges ","85% of total billed charges ",1884,90,,1507.20,,,0,"percent of total billed charges ","90% of total billed charges ",2260.8,90,,1808.64,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2185.44,87,,1748.35,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1758.4,70,,1406.72,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,2336.16,
"IV THERAPY 1ST HR REPEAT VISIT",1701620,"CDM ",761,RC,96365,HCPCS,OUTPATIENT,,,578,462.4,,86.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",255.28,100,,41.74,41.74,41.74,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",138.36,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",404.6,70,,323.68,,,0,"percent of total billed charges ","70% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",537.54,93,,430.03,,,0,"percent of total billed charges ","93% of total billed charges ",86.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",110.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",491.3,85,,393.04,,,0,"percent of total billed charges ","85% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",109.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",502.86,87,,309.11,152.46,396.95,"1 through 10","percent of total billed charges ","87% of total billed charges ",109.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.61,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",404.6,70,,323.68,,,0,"percent of total billed charges ","70% of total billed charges ",86.94,537.54,
"IV THERAPY ADD HR REPEAT VISIT",1701630,"CDM ",761,RC,96366,HCPCS,OUTPATIENT,,,158,126.4,,23.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",133.32,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",43.76,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",110.6,70,,88.48,,,0,"percent of total billed charges ","70% of total billed charges ",142.2,90,,113.76,,,0,"percent of total billed charges ","90% of total billed charges ",146.94,93,,117.55,,,0,"percent of total billed charges ","93% of total billed charges ",23.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",134.3,85,,107.44,,,0,"percent of total billed charges ","85% of total billed charges ",142.2,90,,113.76,,,0,"percent of total billed charges ","90% of total billed charges ",142.2,90,,113.76,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",137.46,87,,159.47,159.47,159.47,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.06,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",110.6,70,,88.48,,,0,"percent of total billed charges ","70% of total billed charges ",21.17,146.94,
"ANTIBIOTIC IM W/IV",1701640,"CDM ",761,RC,96372,HCPCS,OUTPATIENT,,,240.5,192.4,,16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",29.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",223.67,93,,178.94,,,0,"percent of total billed charges ","93% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",204.43,85,,163.54,,,0,"percent of total billed charges ","85% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",209.24,87,,30.52,12.55,82.65,16,"percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,223.67,
"INJECTION IM/SQ W/IV",1701650,"CDM ",761,RC,96372,HCPCS,OUTPATIENT,,,240.5,192.4,,16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",29.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",223.67,93,,178.94,,,0,"percent of total billed charges ","93% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",204.43,85,,163.54,,,0,"percent of total billed charges ","85% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",209.24,87,,30.52,12.55,82.65,16,"percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,223.67,
"CLSD TX DISTAL RADIAL FX W/MAN",1701660,"CDM ",761,RC,25605,HCPCS,OUTPATIENT,,,3376.5,2701.2,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1434.2,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1060.71,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2363.55,70,,1890.84,,,0,"percent of total billed charges ","70% of total billed charges ",3038.85,90,,2431.08,,,0,"percent of total billed charges ","90% of total billed charges ",3140.15,93,,2512.12,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2870.03,85,,2296.02,,,0,"percent of total billed charges ","85% of total billed charges ",2532.38,90,,2025.90,,,0,"percent of total billed charges ","90% of total billed charges ",3038.85,90,,2431.08,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2937.56,87,,2350.05,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2363.55,70,,1890.84,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,3140.15,
"CLOSED TX METACARPAL FX",1701670,"CDM ",761,RC,26600,HCPCS,OUTPATIENT,,,938,750.4,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",432.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",596.97,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",656.6,70,,525.28,,,0,"percent of total billed charges ","70% of total billed charges ",844.2,90,,675.36,,,0,"percent of total billed charges ","90% of total billed charges ",872.34,93,,697.87,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",797.3,85,,637.84,,,0,"percent of total billed charges ","85% of total billed charges ",703.5,90,,562.80,,,0,"percent of total billed charges ","90% of total billed charges ",844.2,90,,675.36,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",816.06,87,,652.85,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",656.6,70,,525.28,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,872.34,
"SEXUAL ASSAULT NURSING EXAM",1701680,"CDM ",761,RC,99499,HCPCS,OUTPATIENT,,,689,551.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",482.3,70,,385.84,,,0,"percent of total billed charges ","70% of total billed charges ",620.1,90,,496.08,,,0,"percent of total billed charges ","90% of total billed charges ",640.77,93,,512.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",585.65,85,,468.52,,,0,"percent of total billed charges ","85% of total billed charges ",620.1,90,,496.08,,,0,"percent of total billed charges ","90% of total billed charges ",620.1,90,,496.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",599.43,87,,479.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",482.3,70,,385.84,,,0,"percent of total billed charges ","70% of total billed charges ",482.3,640.77,
"SEXUAL ASSAULT EXAM-LONG TERM",1701690,"CDM ",761,RC,99499,HCPCS,OUTPATIENT,,,475,380,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",332.5,70,,266.00,,,0,"percent of total billed charges ","70% of total billed charges ",427.5,90,,342.00,,,0,"percent of total billed charges ","90% of total billed charges ",441.75,93,,353.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",403.75,85,,323.00,,,0,"percent of total billed charges ","85% of total billed charges ",427.5,90,,342.00,,,0,"percent of total billed charges ","90% of total billed charges ",427.5,90,,342.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",413.25,87,,330.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",332.5,70,,266.00,,,0,"percent of total billed charges ","70% of total billed charges ",332.5,441.75,
"SEXUAL ASSAULT EXAM-SUSPECT",1701710,"CDM ",761,RC,99499,HCPCS,OUTPATIENT,,,475,380,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",332.5,70,,266.00,,,0,"percent of total billed charges ","70% of total billed charges ",427.5,90,,342.00,,,0,"percent of total billed charges ","90% of total billed charges ",441.75,93,,353.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",403.75,85,,323.00,,,0,"percent of total billed charges ","85% of total billed charges ",427.5,90,,342.00,,,0,"percent of total billed charges ","90% of total billed charges ",427.5,90,,342.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",413.25,87,,330.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",332.5,70,,266.00,,,0,"percent of total billed charges ","70% of total billed charges ",332.5,441.75,
"DRAIN FINGER ABSCESS-COMPLICAT",1701720,"CDM ",761,RC,26011,HCPCS,OUTPATIENT,,,2206,1764.8,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1062.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",382.89,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1544.2,70,,1235.36,,,0,"percent of total billed charges ","70% of total billed charges ",1985.4,90,,1588.32,,,0,"percent of total billed charges ","90% of total billed charges ",2051.58,93,,1641.26,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1875.1,85,,1500.08,,,0,"percent of total billed charges ","85% of total billed charges ",1654.5,90,,1323.60,,,0,"percent of total billed charges ","90% of total billed charges ",1985.4,90,,1588.32,,,0,"percent of total billed charges ","90% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1919.22,87,,1535.38,,,0,"percent of total billed charges ","87% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1544.2,70,,1235.36,,,0,"percent of total billed charges ","70% of total billed charges ",255.12,2051.58,
"DEBRIDE MUSCLE/FASCIA <20 SQCM",1701730,"CDM ",761,RC,11043,HCPCS,OUTPATIENT,,,941,752.8,,228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",700.21,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",316.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",658.7,70,,526.96,,,0,"percent of total billed charges ","70% of total billed charges ",846.9,90,,677.52,,,0,"percent of total billed charges ","90% of total billed charges ",875.13,93,,700.10,,,0,"percent of total billed charges ","93% of total billed charges ",228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",799.85,85,,639.88,,,0,"percent of total billed charges ","85% of total billed charges ",705.75,90,,564.60,,,0,"percent of total billed charges ","90% of total billed charges ",846.9,90,,677.52,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",818.67,87,,654.94,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",679.69,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",658.7,70,,526.96,,,0,"percent of total billed charges ","70% of total billed charges ",228.8,875.13,
"INJ SACROILIAC JOINT",1701740,"CDM ",761,RC,27096,HCPCS,OUTPATIENT,,,991,792.8,,104,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",675.69,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",172.85,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",693.7,70,,554.96,,,0,"percent of total billed charges ","70% of total billed charges ",891.9,90,,713.52,,,0,"percent of total billed charges ","90% of total billed charges ",921.63,93,,737.30,,,0,"percent of total billed charges ","93% of total billed charges ",104,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",842.35,85,,673.88,,,0,"percent of total billed charges ","85% of total billed charges ",743.25,90,,594.60,,,0,"percent of total billed charges ","90% of total billed charges ",891.9,90,,713.52,,,0,"percent of total billed charges ","90% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",862.17,87,,689.74,,,0,"percent of total billed charges ","87% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",693.7,70,,554.96,,,0,"percent of total billed charges ","70% of total billed charges ",104,921.63,
"REMOVE NONBIO DRUG IMPLANT",1701770,"CDM ",761,RC,11982,HCPCS,OUTPATIENT,,,237.5,190,,129.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,182.75,182.75,182.75,"1 through 10","other ","not separately reimbursment ",152.2,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",166.25,70,,133.00,,,0,"percent of total billed charges ","70% of total billed charges ",213.75,90,,171.00,,,0,"percent of total billed charges ","90% of total billed charges ",220.88,93,,176.70,,,0,"percent of total billed charges ","93% of total billed charges ",129.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",201.88,85,,161.50,,,0,"percent of total billed charges ","85% of total billed charges ",178.13,90,,142.50,,,0,"percent of total billed charges ","90% of total billed charges ",213.75,90,,171.00,,,0,"percent of total billed charges ","90% of total billed charges ",42.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",206.63,87,,120.02,120.02,120.02,"1 through 10","percent of total billed charges ","87% of total billed charges ",42.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",410.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",166.25,70,,133.00,,,0,"percent of total billed charges ","70% of total billed charges ",42.22,410.83,
"I&D SKIN ABCESS COMPLICATED",1701780,"CDM ",761,RC,10061,HCPCS,OUTPATIENT,,,1484.5,1187.6,,222.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1484.7,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",379.48,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1039.15,70,,831.32,,,0,"percent of total billed charges ","70% of total billed charges ",1336.05,90,,1068.84,,,0,"percent of total billed charges ","90% of total billed charges ",1380.59,93,,1104.47,,,0,"percent of total billed charges ","93% of total billed charges ",222.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1261.83,85,,1009.46,,,0,"percent of total billed charges ","85% of total billed charges ",1113.38,90,,890.70,,,0,"percent of total billed charges ","90% of total billed charges ",1336.05,90,,1068.84,,,0,"percent of total billed charges ","90% of total billed charges ",254.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1291.52,87,,1033.22,,,0,"percent of total billed charges ","87% of total billed charges ",254.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1039.15,70,,831.32,,,0,"percent of total billed charges ","70% of total billed charges ",222.22,1484.7,
"CHEST TUBE INSERTION",1701790,"CDM ",761,RC,32551,HCPCS,OUTPATIENT,,,3037.5,2430,,,,,,,,0,"other ","not separately reimbursment ",,,,60.24,60.24,60.24,"1 through 10","other ","not separately reimbursment ",321.13,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2126.25,70,,1701.00,,,0,"percent of total billed charges ","70% of total billed charges ",2733.75,90,,2187.00,,,0,"percent of total billed charges ","90% of total billed charges ",2824.88,93,,2259.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",226.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2581.88,85,,2065.50,,,0,"percent of total billed charges ","85% of total billed charges ",2278.13,90,,1822.50,,,0,"percent of total billed charges ","90% of total billed charges ",2733.75,90,,2187.00,,,0,"percent of total billed charges ","90% of total billed charges ",224,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2642.63,87,,2114.10,,,0,"percent of total billed charges ","87% of total billed charges ",224,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1447.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2126.25,70,,1701.00,,,0,"percent of total billed charges ","70% of total billed charges ",224,2824.88,
"I&D ABSCESS SIMPLE",1701800,"CDM ",761,RC,10060,HCPCS,OUTPATIENT,,,789.5,631.6,,202.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.72,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",217.34,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",552.65,70,,442.12,,,0,"percent of total billed charges ","70% of total billed charges ",710.55,90,,568.44,,,0,"percent of total billed charges ","90% of total billed charges ",734.24,93,,587.39,,,0,"percent of total billed charges ","93% of total billed charges ",202.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",671.08,85,,536.86,,,0,"percent of total billed charges ","85% of total billed charges ",592.13,90,,473.70,,,0,"percent of total billed charges ","90% of total billed charges ",710.55,90,,568.44,,,0,"percent of total billed charges ","90% of total billed charges ",254.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",686.87,87,,112.42,112.42,112.42,"1 through 10","percent of total billed charges ","87% of total billed charges ",254.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",552.65,70,,442.12,,,0,"percent of total billed charges ","70% of total billed charges ",184.51,734.24,
"BRONCHOSCOPY W/AVEOLAR LAVAGE",1701810,"CDM ",761,RC,31624,HCPCS,OUTPATIENT,,,2336.5,1869.2,,549.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1334.21,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",280.83,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1635.55,70,,1308.44,,,0,"percent of total billed charges ","70% of total billed charges ",2102.85,90,,1682.28,,,0,"percent of total billed charges ","90% of total billed charges ",2172.95,93,,1738.36,,,0,"percent of total billed charges ","93% of total billed charges ",549.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1986.03,85,,1588.82,,,0,"percent of total billed charges ","85% of total billed charges ",1752.38,90,,1401.90,,,0,"percent of total billed charges ","90% of total billed charges ",2102.85,90,,1682.28,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2032.76,87,,118.21,118.21,118.21,"1 through 10","percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1636.89,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1635.55,70,,1308.44,,,0,"percent of total billed charges ","70% of total billed charges ",280.83,2172.95,
"RPR EYELID NOSE EAR LIPS COMP",1701820,"CDM ",761,RC,13151,HCPCS,OUTPATIENT,,,1019.5,815.6,,,,,,,,0,"other ","not separately reimbursment ",1315.02,100,,1640.80,1640.80,1640.80,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",574.6,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",713.65,70,,570.92,,,0,"percent of total billed charges ","70% of total billed charges ",917.55,90,,734.04,,,0,"percent of total billed charges ","90% of total billed charges ",948.14,93,,758.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",866.58,85,,693.26,,,0,"percent of total billed charges ","85% of total billed charges ",764.63,90,,611.70,,,0,"percent of total billed charges ","90% of total billed charges ",917.55,90,,734.04,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",886.97,87,,709.58,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",679.69,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",713.65,70,,570.92,,,0,"percent of total billed charges ","70% of total billed charges ",327.08,1315.02,
"BIOPSY BREAST OPEN INCISIONAL",1701830,"CDM ",761,RC,19101,HCPCS,OUTPATIENT,,,4537,3629.6,,1234.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1509.95,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",458.02,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3175.9,70,,2540.72,,,0,"percent of total billed charges ","70% of total billed charges ",4083.3,90,,3266.64,,,0,"percent of total billed charges ","90% of total billed charges ",4219.41,93,,3375.53,,,0,"percent of total billed charges ","93% of total billed charges ",1234.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",594.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3856.45,85,,3085.16,,,0,"percent of total billed charges ","85% of total billed charges ",3402.75,90,,2722.20,,,0,"percent of total billed charges ","90% of total billed charges ",4083.3,90,,3266.64,,,0,"percent of total billed charges ","90% of total billed charges ",588.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3947.19,87,,3157.75,,,0,"percent of total billed charges ","87% of total billed charges ",588.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3600.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3175.9,70,,2540.72,,,0,"percent of total billed charges ","70% of total billed charges ",458.02,4219.41,
"ASPIRATE PLEURA W/O IMAGING",1701840,"CDM ",761,RC,32554,HCPCS,OUTPATIENT,,,1362,1089.6,,278.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",742.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",187,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",953.4,70,,762.72,,,0,"percent of total billed charges ","70% of total billed charges ",1225.8,90,,980.64,,,0,"percent of total billed charges ","90% of total billed charges ",1266.66,93,,1013.33,,,0,"percent of total billed charges ","93% of total billed charges ",278.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",354.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1157.7,85,,926.16,,,0,"percent of total billed charges ","85% of total billed charges ",1021.5,90,,817.20,,,0,"percent of total billed charges ","90% of total billed charges ",1225.8,90,,980.64,,,0,"percent of total billed charges ","90% of total billed charges ",350.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1184.94,87,,947.95,,,0,"percent of total billed charges ","87% of total billed charges ",350.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",576.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",953.4,70,,762.72,,,0,"percent of total billed charges ","70% of total billed charges ",187,1266.66,
"CLSD TX FINGER FX W/O MANIP",1701850,"CDM ",761,RC,26720,HCPCS,OUTPATIENT,,,1538.5,1230.8,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",391.93,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1076.95,70,,861.56,,,0,"percent of total billed charges ","70% of total billed charges ",1384.65,90,,1107.72,,,0,"percent of total billed charges ","90% of total billed charges ",1430.81,93,,1144.65,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1307.73,85,,1046.18,,,0,"percent of total billed charges ","85% of total billed charges ",1153.88,90,,923.10,,,0,"percent of total billed charges ","90% of total billed charges ",1384.65,90,,1107.72,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1338.5,87,,1070.80,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1076.95,70,,861.56,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1430.81,
"TX CLSD DIST FIB FX W/O MANIP",1701860,"CDM ",761,RC,27786,HCPCS,OUTPATIENT,,,2093.5,1674.8,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",602.01,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1465.45,70,,1172.36,,,0,"percent of total billed charges ","70% of total billed charges ",1884.15,90,,1507.32,,,0,"percent of total billed charges ","90% of total billed charges ",1946.96,93,,1557.57,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1779.48,85,,1423.58,,,0,"percent of total billed charges ","85% of total billed charges ",1570.13,90,,1256.10,,,0,"percent of total billed charges ","90% of total billed charges ",1884.15,90,,1507.32,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1821.35,87,,1457.08,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1465.45,70,,1172.36,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1946.96,
"MOD SED <5 YRS SAME PROV INIT",1701870,"CDM ",761,RC,99151,HCPCS,OUTPATIENT,,,334.5,267.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.58,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",234.15,70,,187.32,,,0,"percent of total billed charges ","70% of total billed charges ",301.05,90,,240.84,,,0,"percent of total billed charges ","90% of total billed charges ",311.09,93,,248.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",284.33,85,,227.46,,,0,"percent of total billed charges ","85% of total billed charges ",301.05,90,,240.84,,,0,"percent of total billed charges ","90% of total billed charges ",301.05,90,,240.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",291.02,87,,232.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",234.15,70,,187.32,,,0,"percent of total billed charges ","70% of total billed charges ",52.58,311.09,
"MOD SED >5 YRS SAME PROV INIT",1701880,"CDM ",761,RC,99152,HCPCS,OUTPATIENT,,,334.5,267.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.94,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",234.15,70,,187.32,,,0,"percent of total billed charges ","70% of total billed charges ",301.05,90,,240.84,,,0,"percent of total billed charges ","90% of total billed charges ",311.09,93,,248.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",284.33,85,,227.46,,,0,"percent of total billed charges ","85% of total billed charges ",301.05,90,,240.84,,,0,"percent of total billed charges ","90% of total billed charges ",301.05,90,,240.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",291.02,87,,232.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",234.15,70,,187.32,,,0,"percent of total billed charges ","70% of total billed charges ",25.94,311.09,
"MOD SED SAME PROV ADD 15 MIN",1701890,"CDM ",761,RC,99153,HCPCS,OUTPATIENT,,,66,52.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.43,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",46.2,70,,36.96,,,0,"percent of total billed charges ","70% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",61.38,93,,49.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",56.1,85,,44.88,,,0,"percent of total billed charges ","85% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",57.42,87,,45.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.2,70,,36.96,,,0,"percent of total billed charges ","70% of total billed charges ",21.43,61.38,
"MOD SED <5 YRS OTHER PROV INIT",1701900,"CDM ",761,RC,99155,HCPCS,OUTPATIENT,,,334.5,267.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",234.15,70,,187.32,,,0,"percent of total billed charges ","70% of total billed charges ",301.05,90,,240.84,,,0,"percent of total billed charges ","90% of total billed charges ",311.09,93,,248.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",284.33,85,,227.46,,,0,"percent of total billed charges ","85% of total billed charges ",301.05,90,,240.84,,,0,"percent of total billed charges ","90% of total billed charges ",301.05,90,,240.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",291.02,87,,232.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",234.15,70,,187.32,,,0,"percent of total billed charges ","70% of total billed charges ",174.09,311.09,
"MOD SED >5 YRS OTHER PROV INIT",1701910,"CDM ",761,RC,99156,HCPCS,OUTPATIENT,,,334.5,267.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",159.54,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",234.15,70,,187.32,,,0,"percent of total billed charges ","70% of total billed charges ",301.05,90,,240.84,,,0,"percent of total billed charges ","90% of total billed charges ",311.09,93,,248.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",284.33,85,,227.46,,,0,"percent of total billed charges ","85% of total billed charges ",301.05,90,,240.84,,,0,"percent of total billed charges ","90% of total billed charges ",301.05,90,,240.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",291.02,87,,232.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",234.15,70,,187.32,,,0,"percent of total billed charges ","70% of total billed charges ",159.54,311.09,
"MOD SED OTHER PROV ADD 15 MIN",1701920,"CDM ",761,RC,99157,HCPCS,OUTPATIENT,,,66,52.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",46.2,70,,36.96,,,0,"percent of total billed charges ","70% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",61.38,93,,49.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",56.1,85,,44.88,,,0,"percent of total billed charges ","85% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",57.42,87,,45.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.2,70,,36.96,,,0,"percent of total billed charges ","70% of total billed charges ",46.2,130.79,
"BX BREAST 1ST LES W/DEV & US",1701930,"CDM ",761,RC,19083,HCPCS,OUTPATIENT,,,3154,2523.2,,474.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1640.24,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",324.59,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2207.8,70,,1766.24,,,0,"percent of total billed charges ","70% of total billed charges ",2838.6,90,,2270.88,,,0,"percent of total billed charges ","90% of total billed charges ",2933.22,93,,2346.58,,,0,"percent of total billed charges ","93% of total billed charges ",474.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",603.02,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2680.9,85,,2144.72,,,0,"percent of total billed charges ","85% of total billed charges ",2365.5,90,,1892.40,,,0,"percent of total billed charges ","90% of total billed charges ",2838.6,90,,2270.88,,,0,"percent of total billed charges ","90% of total billed charges ",597.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2743.98,87,,2195.18,,,0,"percent of total billed charges ","87% of total billed charges ",597.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2207.8,70,,1766.24,,,0,"percent of total billed charges ","70% of total billed charges ",324.59,2933.22,
"TX CLOSED FX RADIUS W/O MANIP",1701940,"CDM ",761,RC,25500,HCPCS,OUTPATIENT,,,361.5,289.2,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",536.14,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",253.05,70,,202.44,,,0,"percent of total billed charges ","70% of total billed charges ",325.35,90,,260.28,,,0,"percent of total billed charges ","90% of total billed charges ",336.2,93,,268.96,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",307.28,85,,245.82,,,0,"percent of total billed charges ","85% of total billed charges ",271.13,90,,216.90,,,0,"percent of total billed charges ","90% of total billed charges ",325.35,90,,260.28,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",314.51,87,,251.61,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",253.05,70,,202.44,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1454.4,
"ELBOW DISLOCATION W/MANIP",1701950,"CDM ",761,RC,24600,HCPCS,OUTPATIENT,,,1610,1288,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",704.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1127,70,,901.60,,,0,"percent of total billed charges ","70% of total billed charges ",1449,90,,1159.20,,,0,"percent of total billed charges ","90% of total billed charges ",1497.3,93,,1197.84,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1368.5,85,,1094.80,,,0,"percent of total billed charges ","85% of total billed charges ",1207.5,90,,966.00,,,0,"percent of total billed charges ","90% of total billed charges ",1449,90,,1159.20,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1400.7,87,,1120.56,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1127,70,,901.60,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1497.3,
"REMOVE/BIVALVING ARM/LEG CAST",1701960,"CDM ",761,RC,29705,HCPCS,OUTPATIENT,,,385,308,,228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",278.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",92.11,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",269.5,70,,215.60,,,0,"percent of total billed charges ","70% of total billed charges ",346.5,90,,277.20,,,0,"percent of total billed charges ","90% of total billed charges ",358.05,93,,286.44,,,0,"percent of total billed charges ","93% of total billed charges ",228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",327.25,85,,261.80,,,0,"percent of total billed charges ","85% of total billed charges ",288.75,90,,231.00,,,0,"percent of total billed charges ","90% of total billed charges ",346.5,90,,277.20,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",334.95,87,,267.96,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.22,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",269.5,70,,215.60,,,0,"percent of total billed charges ","70% of total billed charges ",92.11,358.05,
"SHAVE LESION SINGLE < 0.5CM",1701970,"CDM ",761,RC,11306,HCPCS,OUTPATIENT,,,300.5,240.4,,171.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",74.74,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",103.18,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",210.35,70,,168.28,,,0,"percent of total billed charges ","70% of total billed charges ",270.45,90,,216.36,,,0,"percent of total billed charges ","90% of total billed charges ",279.47,93,,223.58,,,0,"percent of total billed charges ","93% of total billed charges ",171.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",255.43,85,,204.34,,,0,"percent of total billed charges ","85% of total billed charges ",225.38,90,,180.30,,,0,"percent of total billed charges ","90% of total billed charges ",270.45,90,,216.36,,,0,"percent of total billed charges ","90% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",261.44,87,,209.15,,,0,"percent of total billed charges ","87% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",210.35,70,,168.28,,,0,"percent of total billed charges ","70% of total billed charges ",74.74,279.47,
"RPR TRUNK/EXT <2.6CM SIMPLE",1701980,"CDM ",761,RC,12001,HCPCS,OUTPATIENT,,,549.5,439.6,,207.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",382.79,100,,420.48,420.48,420.48,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",91.98,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",384.65,70,,307.72,,,0,"percent of total billed charges ","70% of total billed charges ",494.55,90,,395.64,,,0,"percent of total billed charges ","90% of total billed charges ",511.04,93,,408.83,,,0,"percent of total billed charges ","93% of total billed charges ",207.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",263.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",467.08,85,,373.66,,,0,"percent of total billed charges ","85% of total billed charges ",412.13,90,,329.70,,,0,"percent of total billed charges ","90% of total billed charges ",494.55,90,,395.64,,,0,"percent of total billed charges ","90% of total billed charges ",261.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",478.07,87,,382.46,,,0,"percent of total billed charges ","87% of total billed charges ",261.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",384.65,70,,307.72,,,0,"percent of total billed charges ","70% of total billed charges ",91.98,511.04,
"TREAT ULNAR FRACTURE",1701990,"CDM ",761,RC,24675,HCPCS,OUTPATIENT,,,2070,1656,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",874.61,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1449,70,,1159.20,,,0,"percent of total billed charges ","70% of total billed charges ",1863,90,,1490.40,,,0,"percent of total billed charges ","90% of total billed charges ",1925.1,93,,1540.08,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1759.5,85,,1407.60,,,0,"percent of total billed charges ","85% of total billed charges ",1552.5,90,,1242.00,,,0,"percent of total billed charges ","90% of total billed charges ",1863,90,,1490.40,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1800.9,87,,1440.72,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1449,70,,1159.20,,,0,"percent of total billed charges ","70% of total billed charges ",457.91,1925.1,
"CLSD TX CALCANEAL FX W/O MANIP",1702000,"CDM ",761,RC,28400,HCPCS,OUTPATIENT,,,399.5,319.6,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",477.03,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",279.65,70,,223.72,,,0,"percent of total billed charges ","70% of total billed charges ",359.55,90,,287.64,,,0,"percent of total billed charges ","90% of total billed charges ",371.54,93,,297.23,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",339.58,85,,271.66,,,0,"percent of total billed charges ","85% of total billed charges ",299.63,90,,239.70,,,0,"percent of total billed charges ","90% of total billed charges ",359.55,90,,287.64,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",347.57,87,,278.06,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",279.65,70,,223.72,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,477.03,
"ENDOTRACEAL INTUBATION",1702010,"CDM ",761,RC,31500,HCPCS,OUTPATIENT,,,603.5,482.8,,234,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",293.5,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",422.45,70,,337.96,,,0,"percent of total billed charges ","70% of total billed charges ",543.15,90,,434.52,,,0,"percent of total billed charges ","90% of total billed charges ",561.26,93,,449.01,,,0,"percent of total billed charges ","93% of total billed charges ",234,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",512.98,85,,410.38,,,0,"percent of total billed charges ","85% of total billed charges ",452.63,90,,362.10,,,0,"percent of total billed charges ","90% of total billed charges ",543.15,90,,434.52,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",525.05,87,,420.04,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.82,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",422.45,70,,337.96,,,0,"percent of total billed charges ","70% of total billed charges ",217.82,561.26,
"I&D PILONIDAL CYST SIMPLE",1702020,"CDM ",761,RC,10080,HCPCS,OUTPATIENT,,,1302.5,1042,,227.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",982.73,100,,893.25,893.25,893.25,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",215.29,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",911.75,70,,729.40,,,0,"percent of total billed charges ","70% of total billed charges ",1172.25,90,,937.80,,,0,"percent of total billed charges ","90% of total billed charges ",1211.33,93,,969.06,,,0,"percent of total billed charges ","93% of total billed charges ",227.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1107.13,85,,885.70,,,0,"percent of total billed charges ","85% of total billed charges ",976.88,90,,781.50,,,0,"percent of total billed charges ","90% of total billed charges ",1172.25,90,,937.80,,,0,"percent of total billed charges ","90% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1133.18,87,,906.54,,,0,"percent of total billed charges ","87% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",911.75,70,,729.40,,,0,"percent of total billed charges ","70% of total billed charges ",215.29,1211.33,
"BRONCHOSCOPY W/FLUORO",1702030,"CDM ",761,RC,31622,HCPCS,OUTPATIENT,,,2003.5,1602.8,,549.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1461.47,100,,23.71,23.71,23.71,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",274.27,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1402.45,70,,1121.96,,,0,"percent of total billed charges ","70% of total billed charges ",1803.15,90,,1442.52,,,0,"percent of total billed charges ","90% of total billed charges ",1863.26,93,,1490.61,,,0,"percent of total billed charges ","93% of total billed charges ",549.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1702.98,85,,1362.38,,,0,"percent of total billed charges ","85% of total billed charges ",1502.63,90,,1202.10,,,0,"percent of total billed charges ","90% of total billed charges ",1803.15,90,,1442.52,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1743.05,87,,1394.44,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1636.89,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1402.45,70,,1121.96,,,0,"percent of total billed charges ","70% of total billed charges ",274.27,1863.26,
"BRONCHOSCOPY W/THER ASPIR 1ST",1702040,"CDM ",761,RC,31645,HCPCS,OUTPATIENT,,,2613,2090.4,,549.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1617.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",307.47,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1829.1,70,,1463.28,,,0,"percent of total billed charges ","70% of total billed charges ",2351.7,90,,1881.36,,,0,"percent of total billed charges ","90% of total billed charges ",2430.09,93,,1944.07,,,0,"percent of total billed charges ","93% of total billed charges ",549.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2221.05,85,,1776.84,,,0,"percent of total billed charges ","85% of total billed charges ",1959.75,90,,1567.80,,,0,"percent of total billed charges ","90% of total billed charges ",2351.7,90,,1881.36,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2273.31,87,,1818.65,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1636.89,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1829.1,70,,1463.28,,,0,"percent of total billed charges ","70% of total billed charges ",294.37,2430.09,
"INSERT TUNNELED CV CATH > 5YRS",1702050,"CDM ",761,RC,36558,HCPCS,OUTPATIENT,,,4674.5,3739.6,,382.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3067.37,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",535.94,220,,46.31,46.31,46.31,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",3272.15,70,,2617.72,,,0,"percent of total billed charges ","70% of total billed charges ",4207.05,90,,3365.64,,,0,"percent of total billed charges ","90% of total billed charges ",4347.29,93,,3477.83,,,0,"percent of total billed charges ","93% of total billed charges ",382.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",485.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3973.33,85,,3178.66,,,0,"percent of total billed charges ","85% of total billed charges ",3505.88,90,,2804.70,,,0,"percent of total billed charges ","90% of total billed charges ",4207.05,90,,3365.64,,,0,"percent of total billed charges ","90% of total billed charges ",480.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4066.82,87,,3253.46,,,0,"percent of total billed charges ","87% of total billed charges ",480.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2903.79,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3272.15,70,,2617.72,,,0,"percent of total billed charges ","70% of total billed charges ",382.2,4347.29,
"INSERT CATH PLEURA WO IMAGE",1702060,"CDM ",761,RC,32556,HCPCS,OUTPATIENT,,,2270.5,1816.4,,278.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",742.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",257.47,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1589.35,70,,1271.48,,,0,"percent of total billed charges ","70% of total billed charges ",2043.45,90,,1634.76,,,0,"percent of total billed charges ","90% of total billed charges ",2111.57,93,,1689.26,,,0,"percent of total billed charges ","93% of total billed charges ",278.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",354.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1929.93,85,,1543.94,,,0,"percent of total billed charges ","85% of total billed charges ",1702.88,90,,1362.30,,,0,"percent of total billed charges ","90% of total billed charges ",2043.45,90,,1634.76,,,0,"percent of total billed charges ","90% of total billed charges ",350.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1975.34,87,,1580.27,,,0,"percent of total billed charges ","87% of total billed charges ",350.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1764.73,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1589.35,70,,1271.48,,,0,"percent of total billed charges ","70% of total billed charges ",257.47,2111.57,
"AVULSION NAIL PLATE SIMPLE",1702070,"CDM ",761,RC,11750,HCPCS,OUTPATIENT,,,1019.5,815.6,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",451.17,100,,238.35,238.35,238.35,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",212.26,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",713.65,70,,570.92,,,0,"percent of total billed charges ","70% of total billed charges ",917.55,90,,734.04,,,0,"percent of total billed charges ","90% of total billed charges ",948.14,93,,758.51,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",866.58,85,,693.26,,,0,"percent of total billed charges ","85% of total billed charges ",764.63,90,,611.70,,,0,"percent of total billed charges ","90% of total billed charges ",917.55,90,,734.04,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",886.97,87,,106.41,106.41,106.41,"1 through 10","percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",713.65,70,,570.92,,,0,"percent of total billed charges ","70% of total billed charges ",212.26,948.14,
"EVACUATE SUBUNGAL HEMATOMA",1702080,"CDM ",761,RC,11740,HCPCS,OUTPATIENT,,,200.5,160.4,,260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,86.51,86.51,86.51,"1 through 10","other ","not separately reimbursment ",64.81,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",140.35,70,,112.28,,,0,"percent of total billed charges ","70% of total billed charges ",180.45,90,,144.36,,,0,"percent of total billed charges ","90% of total billed charges ",186.47,93,,149.18,,,0,"percent of total billed charges ","93% of total billed charges ",260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",170.43,85,,136.34,,,0,"percent of total billed charges ","85% of total billed charges ",150.38,90,,120.30,,,0,"percent of total billed charges ","90% of total billed charges ",180.45,90,,144.36,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",174.44,87,,139.55,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",140.35,70,,112.28,,,0,"percent of total billed charges ","70% of total billed charges ",64.81,330.35,
"CLSD TX SUPRACONDYLAR FEMORAL",1702090,"CDM ",761,RC,27501,HCPCS,OUTPATIENT,,,438,350.4,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",963.6,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",306.6,70,,245.28,,,0,"percent of total billed charges ","70% of total billed charges ",394.2,90,,315.36,,,0,"percent of total billed charges ","90% of total billed charges ",407.34,93,,325.87,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",372.3,85,,297.84,,,0,"percent of total billed charges ","85% of total billed charges ",328.5,90,,262.80,,,0,"percent of total billed charges ","90% of total billed charges ",394.2,90,,315.36,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",381.06,87,,304.85,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",306.6,70,,245.28,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,963.6,
"DEBRIDE TISSUE/MUSCLE/BONE",1702100,"CDM ",761,RC,11044,HCPCS,OUTPATIENT,,,1627.5,1302,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1805.43,100,,40.42,40.42,40.42,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",462.68,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1139.25,70,,911.40,,,0,"percent of total billed charges ","70% of total billed charges ",1464.75,90,,1171.80,,,0,"percent of total billed charges ","90% of total billed charges ",1513.58,93,,1210.86,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1383.38,85,,1106.70,,,0,"percent of total billed charges ","85% of total billed charges ",1220.63,90,,976.50,,,0,"percent of total billed charges ","90% of total billed charges ",1464.75,90,,1171.80,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1415.93,87,,1132.74,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1139.25,70,,911.40,,,0,"percent of total billed charges ","70% of total billed charges ",261.66,1805.43,
"BX BREAST EA ADD LESION W/US",1702120,"CDM ",761,RC,19084,HCPCS,OUTPATIENT,,,2751,2200.8,,,,,,,,0,"other ","not separately reimbursment ",1886.68,100,,608.28,608.28,608.28,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",161.59,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1925.7,70,,1540.56,,,0,"percent of total billed charges ","70% of total billed charges ",2475.9,90,,1980.72,,,0,"percent of total billed charges ","90% of total billed charges ",2558.43,93,,2046.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2338.35,85,,1870.68,,,0,"percent of total billed charges ","85% of total billed charges ",2063.25,90,,1650.60,,,0,"percent of total billed charges ","90% of total billed charges ",2475.9,90,,1980.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2393.37,87,,1914.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1925.7,70,,1540.56,,,0,"percent of total billed charges ","70% of total billed charges ",161.59,2558.43,
"BX/EXC LYMPH NODE SUPERFICIAL",1702130,"CDM ",761,RC,38505,HCPCS,OUTPATIENT,,,2565,2052,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",668.62,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",179.15,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1795.5,70,,1436.40,,,0,"percent of total billed charges ","70% of total billed charges ",2308.5,90,,1846.80,,,0,"percent of total billed charges ","90% of total billed charges ",2385.45,93,,1908.36,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2180.25,85,,1744.20,,,0,"percent of total billed charges ","85% of total billed charges ",1923.75,90,,1539.00,,,0,"percent of total billed charges ","90% of total billed charges ",2308.5,90,,1846.80,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2231.55,87,,1785.24,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1795.5,70,,1436.40,,,0,"percent of total billed charges ","70% of total billed charges ",179.15,2385.45,
"INJ ANESTHETIC OTHR PERI NERVE",1702140,"CDM ",761,RC,64450,HCPCS,OUTPATIENT,,,1137.5,910,,224.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",859.51,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",87.89,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",796.25,70,,637.00,,,0,"percent of total billed charges ","70% of total billed charges ",1023.75,90,,819.00,,,0,"percent of total billed charges ","90% of total billed charges ",1057.88,93,,846.30,,,0,"percent of total billed charges ","93% of total billed charges ",224.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",222,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",966.88,85,,773.50,,,0,"percent of total billed charges ","85% of total billed charges ",853.13,90,,682.50,,,0,"percent of total billed charges ","90% of total billed charges ",1023.75,90,,819.00,,,0,"percent of total billed charges ","90% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",989.63,87,,791.70,,,0,"percent of total billed charges ","87% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",649.16,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",796.25,70,,637.00,,,0,"percent of total billed charges ","70% of total billed charges ",87.89,1057.88,
"INSERT BLADDER CATH COMPLEX",1702150,"CDM ",761,RC,51703,HCPCS,OUTPATIENT,,,480,384,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",183.86,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",158.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",336,70,,268.80,,,0,"percent of total billed charges ","70% of total billed charges ",432,90,,345.60,,,0,"percent of total billed charges ","90% of total billed charges ",446.4,93,,357.12,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",408,85,,326.40,,,0,"percent of total billed charges ","85% of total billed charges ",360,90,,288.00,,,0,"percent of total billed charges ","90% of total billed charges ",432,90,,345.60,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",417.6,87,,334.08,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",118.33,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",336,70,,268.80,,,0,"percent of total billed charges ","70% of total billed charges ",118.33,446.4,
"EXC PENILE POST CIRC ADHESIONS",1702160,"CDM ",761,RC,54162,HCPCS,OUTPATIENT,,,3232,2585.6,,659.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1102.31,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",415.34,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2262.4,70,,1809.92,,,0,"percent of total billed charges ","70% of total billed charges ",2908.8,90,,2327.04,,,0,"percent of total billed charges ","90% of total billed charges ",3005.76,93,,2404.61,,,0,"percent of total billed charges ","93% of total billed charges ",659.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2747.2,85,,2197.76,,,0,"percent of total billed charges ","85% of total billed charges ",2424,90,,1939.20,,,0,"percent of total billed charges ","90% of total billed charges ",2908.8,90,,2327.04,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2811.84,87,,2249.47,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1922.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2262.4,70,,1809.92,,,0,"percent of total billed charges ","70% of total billed charges ",327.08,3005.76,
"INJ ANESTHETIC FEMORAL NERVE",1702170,"CDM ",761,RC,64447,HCPCS,OUTPATIENT,,,1035,828,,224.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",368.2,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",111.08,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",724.5,70,,579.60,,,0,"percent of total billed charges ","70% of total billed charges ",931.5,90,,745.20,,,0,"percent of total billed charges ","90% of total billed charges ",962.55,93,,770.04,,,0,"percent of total billed charges ","93% of total billed charges ",224.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",222,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",879.75,85,,703.80,,,0,"percent of total billed charges ","85% of total billed charges ",776.25,90,,621.00,,,0,"percent of total billed charges ","90% of total billed charges ",931.5,90,,745.20,,,0,"percent of total billed charges ","90% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",900.45,87,,720.36,,,0,"percent of total billed charges ","87% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",649.16,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",724.5,70,,579.60,,,0,"percent of total billed charges ","70% of total billed charges ",111.08,962.55,
"REMOVE IMPLANT SUPERFICIAL",1702190,"CDM ",761,RC,20670,HCPCS,OUTPATIENT,,,2057,1645.6,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1038.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",297.07,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1439.9,70,,1151.92,,,0,"percent of total billed charges ","70% of total billed charges ",1851.3,90,,1481.04,,,0,"percent of total billed charges ","90% of total billed charges ",1913.01,93,,1530.41,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1748.45,85,,1398.76,,,0,"percent of total billed charges ","85% of total billed charges ",1542.75,90,,1234.20,,,0,"percent of total billed charges ","90% of total billed charges ",1851.3,90,,1481.04,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1789.59,87,,1431.67,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1439.9,70,,1151.92,,,0,"percent of total billed charges ","70% of total billed charges ",297.07,1913.01,
"TX CLOSED ANKLE FX WO MANIP",1702200,"CDM ",761,RC,28430,HCPCS,OUTPATIENT,,,2009.5,1607.6,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",439.05,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1406.65,70,,1125.32,,,0,"percent of total billed charges ","70% of total billed charges ",1808.55,90,,1446.84,,,0,"percent of total billed charges ","90% of total billed charges ",1868.84,93,,1495.07,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1708.08,85,,1366.46,,,0,"percent of total billed charges ","85% of total billed charges ",1507.13,90,,1205.70,,,0,"percent of total billed charges ","90% of total billed charges ",1808.55,90,,1446.84,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1748.27,87,,1398.62,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1406.65,70,,1125.32,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1868.84,
"NASOGASTRIC TUBE PLACEMENT",1702210,"CDM ",761,RC,43752,HCPCS,OUTPATIENT,,,629.5,503.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.15,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",440.65,70,,352.52,,,0,"percent of total billed charges ","70% of total billed charges ",566.55,90,,453.24,,,0,"percent of total billed charges ","90% of total billed charges ",585.44,93,,468.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",535.08,85,,428.06,,,0,"percent of total billed charges ","85% of total billed charges ",472.13,90,,377.70,,,0,"percent of total billed charges ","90% of total billed charges ",566.55,90,,453.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",547.67,87,,438.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",410.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",440.65,70,,352.52,,,0,"percent of total billed charges ","70% of total billed charges ",84.15,585.44,
"TOE FX W/O MANIP-METATARSAL",1702220,"CDM ",761,RC,28470,HCPCS,OUTPATIENT,,,1924,1539.2,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",427.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1346.8,70,,1077.44,,,0,"percent of total billed charges ","70% of total billed charges ",1731.6,90,,1385.28,,,0,"percent of total billed charges ","90% of total billed charges ",1789.32,93,,1431.46,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1635.4,85,,1308.32,,,0,"percent of total billed charges ","85% of total billed charges ",1443,90,,1154.40,,,0,"percent of total billed charges ","90% of total billed charges ",1731.6,90,,1385.28,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1673.88,87,,1339.10,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1346.8,70,,1077.44,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1789.32,
"REMOVE TUNNELED CV CATH",1702230,"CDM ",761,RC,36590,HCPCS,OUTPATIENT,,,2785,2228,,275.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1906.88,100,,1531.82,1531.82,1531.82,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",390.68,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1949.5,70,,1559.60,,,0,"percent of total billed charges ","70% of total billed charges ",2506.5,90,,2005.20,,,0,"percent of total billed charges ","90% of total billed charges ",2590.05,93,,2072.04,,,0,"percent of total billed charges ","93% of total billed charges ",275.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",350.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2367.25,85,,1893.80,,,0,"percent of total billed charges ","85% of total billed charges ",2088.75,90,,1671.00,,,0,"percent of total billed charges ","90% of total billed charges ",2506.5,90,,2005.20,,,0,"percent of total billed charges ","90% of total billed charges ",346.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2422.95,87,,1938.36,,,0,"percent of total billed charges ","87% of total billed charges ",346.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1447.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1949.5,70,,1559.60,,,0,"percent of total billed charges ","70% of total billed charges ",275.54,2590.05,
"CRANIO/MAXIOFACIAL UNLSTD PROC",1702240,"CDM ",761,RC,21299,HCPCS,OUTPATIENT,,,807.5,646,,96.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",565.25,70,,452.20,,,0,"percent of total billed charges ","70% of total billed charges ",726.75,90,,581.40,,,0,"percent of total billed charges ","90% of total billed charges ",750.98,93,,600.78,,,0,"percent of total billed charges ","93% of total billed charges ",96.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",111.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",686.38,85,,549.10,,,0,"percent of total billed charges ","85% of total billed charges ",605.63,90,,484.50,,,0,"percent of total billed charges ","90% of total billed charges ",726.75,90,,581.40,,,0,"percent of total billed charges ","90% of total billed charges ",109.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",702.53,87,,562.02,,,0,"percent of total billed charges ","87% of total billed charges ",109.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.82,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",565.25,70,,452.20,,,0,"percent of total billed charges ","70% of total billed charges ",96.14,750.98,
"EXPLR REMOVE FB FOREARM WRIST",1702250,"CDM ",761,RC,25248,HCPCS,OUTPATIENT,,,1736,1388.8,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",541.36,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",867.42,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1215.2,70,,972.16,,,0,"percent of total billed charges ","70% of total billed charges ",1562.4,90,,1249.92,,,0,"percent of total billed charges ","90% of total billed charges ",1614.48,93,,1291.58,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1475.6,85,,1180.48,,,0,"percent of total billed charges ","85% of total billed charges ",1302,90,,1041.60,,,0,"percent of total billed charges ","90% of total billed charges ",1562.4,90,,1249.92,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1510.32,87,,1208.26,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1215.2,70,,972.16,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,1614.48,
"REPAIR FOREARM TENDON/MUSCLE",1702260,"CDM ",761,RC,25270,HCPCS,OUTPATIENT,,,4674.5,3739.6,,1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1402.45,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1022.43,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3272.15,70,,2617.72,,,0,"percent of total billed charges ","70% of total billed charges ",4207.05,90,,3365.64,,,0,"percent of total billed charges ","90% of total billed charges ",4347.29,93,,3477.83,,,0,"percent of total billed charges ","93% of total billed charges ",1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3973.33,85,,3178.66,,,0,"percent of total billed charges ","85% of total billed charges ",3505.88,90,,2804.70,,,0,"percent of total billed charges ","90% of total billed charges ",4207.05,90,,3365.64,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4066.82,87,,3253.46,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3009.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3272.15,70,,2617.72,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,4347.29,
"AVULSION NAIL PLATE SIMPLE",1702270,"CDM ",761,RC,11730,HCPCS,OUTPATIENT,,,286.5,229.2,,260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.71,100,,157.01,157.01,157.01,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",112.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",200.55,70,,160.44,,,0,"percent of total billed charges ","70% of total billed charges ",257.85,90,,206.28,,,0,"percent of total billed charges ","90% of total billed charges ",266.45,93,,213.16,,,0,"percent of total billed charges ","93% of total billed charges ",260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",243.53,85,,194.82,,,0,"percent of total billed charges ","85% of total billed charges ",214.88,90,,171.90,,,0,"percent of total billed charges ","90% of total billed charges ",257.85,90,,206.28,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",249.26,87,,199.41,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",200.55,70,,160.44,,,0,"percent of total billed charges ","70% of total billed charges ",112.79,330.35,
"REPAIR WOUND LESION 1.1-2.5CM",1702280,"CDM ",761,RC,13131,HCPCS,OUTPATIENT,,,1041.5,833.2,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",787.8,100,,909.19,909.19,909.19,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",499.77,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",729.05,70,,583.24,,,0,"percent of total billed charges ","70% of total billed charges ",937.35,90,,749.88,,,0,"percent of total billed charges ","90% of total billed charges ",968.6,93,,774.88,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",885.28,85,,708.22,,,0,"percent of total billed charges ","85% of total billed charges ",781.13,90,,624.90,,,0,"percent of total billed charges ","90% of total billed charges ",937.35,90,,749.88,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",906.11,87,,724.89,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",729.05,70,,583.24,,,0,"percent of total billed charges ","70% of total billed charges ",286,968.6,
"INTER RPR NECK/HAND/FEET <2.6C",1702290,"CDM ",761,RC,12041,HCPCS,OUTPATIENT,,,692,553.6,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",532.27,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",297.18,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",484.4,70,,387.52,,,0,"percent of total billed charges ","70% of total billed charges ",622.8,90,,498.24,,,0,"percent of total billed charges ","90% of total billed charges ",643.56,93,,514.85,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",588.2,85,,470.56,,,0,"percent of total billed charges ","85% of total billed charges ",519,90,,415.20,,,0,"percent of total billed charges ","90% of total billed charges ",622.8,90,,498.24,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",602.04,87,,481.63,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",484.4,70,,387.52,,,0,"percent of total billed charges ","70% of total billed charges ",257.4,643.56,
"APPL MULT LAY COMPRES LOW LEG",1702300,"CDM ",761,RC,29581,HCPCS,OUTPATIENT,,,625.5,500.4,,38.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",58.81,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",437.85,70,,350.28,,,0,"percent of total billed charges ","70% of total billed charges ",562.95,90,,450.36,,,0,"percent of total billed charges ","90% of total billed charges ",581.72,93,,465.38,,,0,"percent of total billed charges ","93% of total billed charges ",38.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",48.5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",531.68,85,,425.34,,,0,"percent of total billed charges ","85% of total billed charges ",469.13,90,,375.30,,,0,"percent of total billed charges ","90% of total billed charges ",562.95,90,,450.36,,,0,"percent of total billed charges ","90% of total billed charges ",48.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",544.19,87,,435.35,,,0,"percent of total billed charges ","87% of total billed charges ",48.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",437.85,70,,350.28,,,0,"percent of total billed charges ","70% of total billed charges ",38.17,581.72,
"REPLACE GASTRONOMY TUBE PERCUT",1702310,"CDM ",761,RC,43762,HCPCS,OUTPATIENT,,,441,352.8,,150.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.58,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",76.47,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",308.7,70,,246.96,,,0,"percent of total billed charges ","70% of total billed charges ",396.9,90,,317.52,,,0,"percent of total billed charges ","90% of total billed charges ",410.13,93,,328.10,,,0,"percent of total billed charges ","93% of total billed charges ",150.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",191.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",374.85,85,,299.88,,,0,"percent of total billed charges ","85% of total billed charges ",330.75,90,,264.60,,,0,"percent of total billed charges ","90% of total billed charges ",396.9,90,,317.52,,,0,"percent of total billed charges ","90% of total billed charges ",189.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",383.67,87,,306.94,,,0,"percent of total billed charges ","87% of total billed charges ",189.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",229.77,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",308.7,70,,246.96,,,0,"percent of total billed charges ","70% of total billed charges ",76.47,462.58,
"CHEMICAL CAUTERIZATION TISSUE",1702330,"CDM ",761,RC,17250,HCPCS,OUTPATIENT,,,625.5,500.4,,85.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",388.85,100,,88.32,88.32,88.32,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",76.45,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",437.85,70,,350.28,,,0,"percent of total billed charges ","70% of total billed charges ",562.95,90,,450.36,,,0,"percent of total billed charges ","90% of total billed charges ",581.72,93,,465.38,,,0,"percent of total billed charges ","93% of total billed charges ",85.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",99.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",531.68,85,,425.34,,,0,"percent of total billed charges ","85% of total billed charges ",469.13,90,,375.30,,,0,"percent of total billed charges ","90% of total billed charges ",562.95,90,,450.36,,,0,"percent of total billed charges ","90% of total billed charges ",98.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",544.19,87,,435.35,,,0,"percent of total billed charges ","87% of total billed charges ",98.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",437.85,70,,350.28,,,0,"percent of total billed charges ","70% of total billed charges ",76.45,581.72,
"INJ INTRL LUMB/SAC W/IMAGE",1702340,"CDM ",761,RC,62323,HCPCS,OUTPATIENT,,,1182.5,946,,377.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1141.8,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",207.26,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",827.75,70,,662.20,,,0,"percent of total billed charges ","70% of total billed charges ",1064.25,90,,851.40,,,0,"percent of total billed charges ","90% of total billed charges ",1099.73,93,,879.78,,,0,"percent of total billed charges ","93% of total billed charges ",377.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",435.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1005.13,85,,804.10,,,0,"percent of total billed charges ","85% of total billed charges ",886.88,90,,709.50,,,0,"percent of total billed charges ","90% of total billed charges ",1064.25,90,,851.40,,,0,"percent of total billed charges ","90% of total billed charges ",431.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1028.78,87,,823.02,,,0,"percent of total billed charges ","87% of total billed charges ",431.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",649.16,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",827.75,70,,662.20,,,0,"percent of total billed charges ","70% of total billed charges ",207.26,1141.8,
"BRONCHOSCOPY W/BIOPSY",1702350,"CDM ",761,RC,31625,HCPCS,OUTPATIENT,,,2985,2388,,549.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1729.12,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",328.11,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2089.5,70,,1671.60,,,0,"percent of total billed charges ","70% of total billed charges ",2686.5,90,,2149.20,,,0,"percent of total billed charges ","90% of total billed charges ",2776.05,93,,2220.84,,,0,"percent of total billed charges ","93% of total billed charges ",549.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2537.25,85,,2029.80,,,0,"percent of total billed charges ","85% of total billed charges ",2238.75,90,,1791.00,,,0,"percent of total billed charges ","90% of total billed charges ",2686.5,90,,2149.20,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2596.95,87,,2077.56,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1636.89,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2089.5,70,,1671.60,,,0,"percent of total billed charges ","70% of total billed charges ",294.37,2776.05,
"REPAIR COMP FCCMKHF 2.6-7.5CM",1702360,"CDM ",761,RC,13132,HCPCS,OUTPATIENT,,,1502.5,1202,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1008.99,100,,2661.01,2661.01,2661.01,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",626.08,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1051.75,70,,841.40,,,0,"percent of total billed charges ","70% of total billed charges ",1352.25,90,,1081.80,,,0,"percent of total billed charges ","90% of total billed charges ",1397.33,93,,1117.86,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1277.13,85,,1021.70,,,0,"percent of total billed charges ","85% of total billed charges ",1126.88,90,,901.50,,,0,"percent of total billed charges ","90% of total billed charges ",1352.25,90,,1081.80,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1307.18,87,,1045.74,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1051.75,70,,841.40,,,0,"percent of total billed charges ","70% of total billed charges ",286,1397.33,
"TX CLOSED ANKLE FX W/MANIP",1702370,"CDM ",761,RC,27760,HCPCS,OUTPATIENT,,,1924,1539.2,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",641.7,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1346.8,70,,1077.44,,,0,"percent of total billed charges ","70% of total billed charges ",1731.6,90,,1385.28,,,0,"percent of total billed charges ","90% of total billed charges ",1789.32,93,,1431.46,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1635.4,85,,1308.32,,,0,"percent of total billed charges ","85% of total billed charges ",1443,90,,1154.40,,,0,"percent of total billed charges ","90% of total billed charges ",1731.6,90,,1385.28,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1673.88,87,,1339.10,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1346.8,70,,1077.44,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1789.32,
"REMOVE IMPACTED CERUMEN UNI",1702380,"CDM ",761,RC,69209,HCPCS,OUTPATIENT,,,654.5,523.6,,37.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",586.49,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",30.76,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",458.15,70,,366.52,,,0,"percent of total billed charges ","70% of total billed charges ",589.05,90,,471.24,,,0,"percent of total billed charges ","90% of total billed charges ",608.69,93,,486.95,,,0,"percent of total billed charges ","93% of total billed charges ",37.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",48.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",556.33,85,,445.06,,,0,"percent of total billed charges ","85% of total billed charges ",490.88,90,,392.70,,,0,"percent of total billed charges ","90% of total billed charges ",589.05,90,,471.24,,,0,"percent of total billed charges ","90% of total billed charges ",47.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",569.42,87,,13.40,8.04,18.75,"1 through 10","percent of total billed charges ","87% of total billed charges ",47.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",458.15,70,,366.52,,,0,"percent of total billed charges ","70% of total billed charges ",30.76,608.69,
"IMAGE GD FLD COL CATH SFT TISS",1702390,"CDM ",761,RC,10030,HCPCS,OUTPATIENT,,,1605.5,1284.4,,107.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",283.05,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1123.85,70,,899.08,,,0,"percent of total billed charges ","70% of total billed charges ",1444.95,90,,1155.96,,,0,"percent of total billed charges ","90% of total billed charges ",1493.12,93,,1194.50,,,0,"percent of total billed charges ","93% of total billed charges ",107.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",137.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1364.68,85,,1091.74,,,0,"percent of total billed charges ","85% of total billed charges ",1204.13,90,,963.30,,,0,"percent of total billed charges ","90% of total billed charges ",1444.95,90,,1155.96,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1396.79,87,,1117.43,,,0,"percent of total billed charges ","87% of total billed charges ",135.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1123.85,70,,899.08,,,0,"percent of total billed charges ","70% of total billed charges ",107.93,1493.12,
"BX BREAST PERCUT NEEDLE",1702400,"CDM ",761,RC,19100,HCPCS,OUTPATIENT,,,1750,1400,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",451.47,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",140.67,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1225,70,,980.00,,,0,"percent of total billed charges ","70% of total billed charges ",1575,90,,1260.00,,,0,"percent of total billed charges ","90% of total billed charges ",1627.5,93,,1302.00,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",594.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1487.5,85,,1190.00,,,0,"percent of total billed charges ","85% of total billed charges ",1312.5,90,,1050.00,,,0,"percent of total billed charges ","90% of total billed charges ",1575,90,,1260.00,,,0,"percent of total billed charges ","90% of total billed charges ",588.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1522.5,87,,1218.00,,,0,"percent of total billed charges ","87% of total billed charges ",588.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1225,70,,980.00,,,0,"percent of total billed charges ","70% of total billed charges ",140.67,1627.5,
"INJ HIP ARTHROGRAPHY WO ANESTH",1702410,"CDM ",761,RC,27093,HCPCS,OUTPATIENT,,,601,480.8,,83.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",310.07,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",141.86,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",420.7,70,,336.56,,,0,"percent of total billed charges ","70% of total billed charges ",540.9,90,,432.72,,,0,"percent of total billed charges ","90% of total billed charges ",558.93,93,,447.14,,,0,"percent of total billed charges ","93% of total billed charges ",83.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",510.85,85,,408.68,,,0,"percent of total billed charges ","85% of total billed charges ",450.75,90,,360.60,,,0,"percent of total billed charges ","90% of total billed charges ",540.9,90,,432.72,,,0,"percent of total billed charges ","90% of total billed charges ",105.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",522.87,87,,418.30,,,0,"percent of total billed charges ","87% of total billed charges ",105.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",420.7,70,,336.56,,,0,"percent of total billed charges ","70% of total billed charges ",83.82,558.93,
"FINGER FX W/MANIPULATION",1702430,"CDM ",761,RC,26725,HCPCS,OUTPATIENT,,,1509.5,1207.6,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1137.26,100,,4161.21,4161.21,4161.21,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",634.63,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1056.65,70,,845.32,,,0,"percent of total billed charges ","70% of total billed charges ",1358.55,90,,1086.84,,,0,"percent of total billed charges ","90% of total billed charges ",1403.84,93,,1123.07,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1283.08,85,,1026.46,,,0,"percent of total billed charges ","85% of total billed charges ",1132.13,90,,905.70,,,0,"percent of total billed charges ","90% of total billed charges ",1358.55,90,,1086.84,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1313.27,87,,1050.62,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1056.65,70,,845.32,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1403.84,
"BX MUSCLE PERCUTANEOUS NEEDLE",1702440,"CDM ",761,RC,20206,HCPCS,OUTPATIENT,,,1750,1400,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",638.32,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",119.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1225,70,,980.00,,,0,"percent of total billed charges ","70% of total billed charges ",1575,90,,1260.00,,,0,"percent of total billed charges ","90% of total billed charges ",1627.5,93,,1302.00,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1487.5,85,,1190.00,,,0,"percent of total billed charges ","85% of total billed charges ",1312.5,90,,1050.00,,,0,"percent of total billed charges ","90% of total billed charges ",1575,90,,1260.00,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1522.5,87,,1218.00,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1225,70,,980.00,,,0,"percent of total billed charges ","70% of total billed charges ",119.28,1627.5,
"TX PROXIMAL TIBIA FRACTURE",1702450,"CDM ",761,RC,27530,HCPCS,OUTPATIENT,,,1924,1539.2,,364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",602.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1346.8,70,,1077.44,,,0,"percent of total billed charges ","70% of total billed charges ",1731.6,90,,1385.28,,,0,"percent of total billed charges ","90% of total billed charges ",1789.32,93,,1431.46,,,0,"percent of total billed charges ","93% of total billed charges ",364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1635.4,85,,1308.32,,,0,"percent of total billed charges ","85% of total billed charges ",1443,90,,1154.40,,,0,"percent of total billed charges ","90% of total billed charges ",1731.6,90,,1385.28,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1673.88,87,,1339.10,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1346.8,70,,1077.44,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1789.32,
"INJ LUMB/SAC 1ST LEV W/IMAGE",1702460,"CDM ",761,RC,64483,HCPCS,OUTPATIENT,,,1288.5,1030.8,,295.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",688.43,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",232.14,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",901.95,70,,721.56,,,0,"percent of total billed charges ","70% of total billed charges ",1159.65,90,,927.72,,,0,"percent of total billed charges ","90% of total billed charges ",1198.31,93,,958.65,,,0,"percent of total billed charges ","93% of total billed charges ",295.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",222,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1095.23,85,,876.18,,,0,"percent of total billed charges ","85% of total billed charges ",966.38,90,,773.10,,,0,"percent of total billed charges ","90% of total billed charges ",1159.65,90,,927.72,,,0,"percent of total billed charges ","90% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1121,87,,896.80,,,0,"percent of total billed charges ","87% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",813.41,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",901.95,70,,721.56,,,0,"percent of total billed charges ","70% of total billed charges ",219.8,1198.31,
"INJ LUMB/SAC EA ADD LEV W/IMAG",1702470,"CDM ",761,RC,64484,HCPCS,OUTPATIENT,,,1255.5,1004.4,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",941.32,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",107.95,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",878.85,70,,703.08,,,0,"percent of total billed charges ","70% of total billed charges ",1129.95,90,,903.96,,,0,"percent of total billed charges ","90% of total billed charges ",1167.62,93,,934.10,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1067.18,85,,853.74,,,0,"percent of total billed charges ","85% of total billed charges ",941.63,90,,753.30,,,0,"percent of total billed charges ","90% of total billed charges ",1129.95,90,,903.96,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1092.29,87,,873.83,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",878.85,70,,703.08,,,0,"percent of total billed charges ","70% of total billed charges ",107.95,1167.62,
"INJ ANESTH ILIO/GROIN NERVE",1702480,"CDM ",761,RC,64425,HCPCS,OUTPATIENT,,,1035,828,,224.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",310.07,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",114.86,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",724.5,70,,579.60,,,0,"percent of total billed charges ","70% of total billed charges ",931.5,90,,745.20,,,0,"percent of total billed charges ","90% of total billed charges ",962.55,93,,770.04,,,0,"percent of total billed charges ","93% of total billed charges ",224.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",222,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",879.75,85,,703.80,,,0,"percent of total billed charges ","85% of total billed charges ",776.25,90,,621.00,,,0,"percent of total billed charges ","90% of total billed charges ",931.5,90,,745.20,,,0,"percent of total billed charges ","90% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",900.45,87,,720.36,,,0,"percent of total billed charges ","87% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",649.16,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",724.5,70,,579.60,,,0,"percent of total billed charges ","70% of total billed charges ",114.86,962.55,
"RPR LESION COMP EA ADD 5CM/<",1702490,"CDM ",761,RC,13133,HCPCS,OUTPATIENT,,,318.5,254.8,,,,,,,,0,"other ","not separately reimbursment ",,,,2661.01,2661.01,2661.01,"1 through 10","other ","not separately reimbursment ",259.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",222.95,70,,178.36,,,0,"percent of total billed charges ","70% of total billed charges ",286.65,90,,229.32,,,0,"percent of total billed charges ","90% of total billed charges ",296.21,93,,236.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",107.9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",270.73,85,,216.58,,,0,"percent of total billed charges ","85% of total billed charges ",238.88,90,,191.10,,,0,"percent of total billed charges ","90% of total billed charges ",286.65,90,,229.32,,,0,"percent of total billed charges ","90% of total billed charges ",106.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.1,87,,221.68,,,0,"percent of total billed charges ","87% of total billed charges ",106.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",222.95,70,,178.36,,,0,"percent of total billed charges ","70% of total billed charges ",106.83,296.21,
"RPR INTERMEDIATE WOUND < 2.6CM",1702500,"CDM ",761,RC,12031,HCPCS,OUTPATIENT,,,1943.5,1554.8,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",451.17,100,,112.22,112.22,112.22,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",310.99,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1360.45,70,,1088.36,,,0,"percent of total billed charges ","70% of total billed charges ",1749.15,90,,1399.32,,,0,"percent of total billed charges ","90% of total billed charges ",1807.46,93,,1445.97,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1651.98,85,,1321.58,,,0,"percent of total billed charges ","85% of total billed charges ",1457.63,90,,1166.10,,,0,"percent of total billed charges ","90% of total billed charges ",1749.15,90,,1399.32,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1690.85,87,,1352.68,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1360.45,70,,1088.36,,,0,"percent of total billed charges ","70% of total billed charges ",286,1807.46,
"BIOPSY PLEURA PERQ NEEDLE",1702510,"CDM ",761,RC,32400,HCPCS,OUTPATIENT,,,2861,2288.8,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",626.88,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",177.94,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2002.7,70,,1602.16,,,0,"percent of total billed charges ","70% of total billed charges ",2574.9,90,,2059.92,,,0,"percent of total billed charges ","90% of total billed charges ",2660.73,93,,2128.58,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2431.85,85,,1945.48,,,0,"percent of total billed charges ","85% of total billed charges ",2145.75,90,,1716.60,,,0,"percent of total billed charges ","90% of total billed charges ",2574.9,90,,2059.92,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2489.07,87,,1991.26,,,0,"percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2002.7,70,,1602.16,,,0,"percent of total billed charges ","70% of total billed charges ",65.42,2660.73,
"INSERT SUBQ CARDIAC RHY MNTR",1702520,"CDM ",761,RC,33285,HCPCS,OUTPATIENT,,,15310,12248,,4812.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",177.41,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",10717,70,,8573.60,,,0,"percent of total billed charges ","70% of total billed charges ",13779,90,,11023.20,,,0,"percent of total billed charges ","90% of total billed charges ",14238.3,93,,11390.64,,,0,"percent of total billed charges ","93% of total billed charges ",4812.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6114.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",13013.5,85,,10410.80,,,0,"percent of total billed charges ","85% of total billed charges ",11482.5,90,,9186.00,,,0,"percent of total billed charges ","90% of total billed charges ",13779,90,,11023.20,,,0,"percent of total billed charges ","90% of total billed charges ",6054.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13319.7,87,,10655.76,,,0,"percent of total billed charges ","87% of total billed charges ",6054.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7610.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",10717,70,,8573.60,,,0,"percent of total billed charges ","70% of total billed charges ",177.41,14238.3,
"REVISE AMPUTATION FINGER",1702530,"CDM ",761,RC,26952,HCPCS,OUTPATIENT,,,4154.5,3323.6,,1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2094.74,100,,2461.60,2461.60,2461.60,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1436.29,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2908.15,70,,2326.52,,,0,"percent of total billed charges ","70% of total billed charges ",3739.05,90,,2991.24,,,0,"percent of total billed charges ","90% of total billed charges ",3863.69,93,,3090.95,,,0,"percent of total billed charges ","93% of total billed charges ",1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",528.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3531.33,85,,2825.06,,,0,"percent of total billed charges ","85% of total billed charges ",3115.88,90,,2492.70,,,0,"percent of total billed charges ","90% of total billed charges ",3739.05,90,,2991.24,,,0,"percent of total billed charges ","90% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3614.42,87,,2891.54,,,0,"percent of total billed charges ","87% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3009.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2908.15,70,,2326.52,,,0,"percent of total billed charges ","70% of total billed charges ",523.33,3863.69,
"ARTERIAL/VENOUS FOREARM TRANSP",1702540,"CDM ",761,RC,36820,HCPCS,OUTPATIENT,,,10544,8435.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1443.29,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",7380.8,70,,5904.64,,,0,"percent of total billed charges ","70% of total billed charges ",9489.6,90,,7591.68,,,0,"percent of total billed charges ","90% of total billed charges ",9805.92,93,,7844.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8962.4,85,,7169.92,,,0,"percent of total billed charges ","85% of total billed charges ",7908,90,,6326.40,,,0,"percent of total billed charges ","90% of total billed charges ",9489.6,90,,7591.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9173.28,87,,7338.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",5117.41,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",7380.8,70,,5904.64,,,0,"percent of total billed charges ","70% of total billed charges ",1443.29,9805.92,
"FINE NEEDLE ASPIR W/US 1ST LES",1702550,"CDM ",761,RC,10005,HCPCS,OUTPATIENT,,,1175,940,,376.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",643.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",154.4,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",822.5,70,,658.00,,,0,"percent of total billed charges ","70% of total billed charges ",1057.5,90,,846.00,,,0,"percent of total billed charges ","90% of total billed charges ",1092.75,93,,874.20,,,0,"percent of total billed charges ","93% of total billed charges ",376.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",478.47,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",998.75,85,,799.00,,,0,"percent of total billed charges ","85% of total billed charges ",881.25,90,,705.00,,,0,"percent of total billed charges ","90% of total billed charges ",1057.5,90,,846.00,,,0,"percent of total billed charges ","90% of total billed charges ",473.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1022.25,87,,379.16,379.16,379.16,"1 through 10","percent of total billed charges ","87% of total billed charges ",473.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",822.5,70,,658.00,,,0,"percent of total billed charges ","70% of total billed charges ",154.4,1092.75,
"INJ TRIGGER POINT 3 OR MORE",1702560,"CDM ",761,RC,20553,HCPCS,OUTPATIENT,,,440,352,,192.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",88.92,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",308,70,,246.40,,,0,"percent of total billed charges ","70% of total billed charges ",396,90,,316.80,,,0,"percent of total billed charges ","90% of total billed charges ",409.2,93,,327.36,,,0,"percent of total billed charges ","93% of total billed charges ",192.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",222,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",374,85,,299.20,,,0,"percent of total billed charges ","85% of total billed charges ",330,90,,264.00,,,0,"percent of total billed charges ","90% of total billed charges ",396,90,,316.80,,,0,"percent of total billed charges ","90% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",382.8,87,,306.24,,,0,"percent of total billed charges ","87% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",282.29,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",308,70,,246.40,,,0,"percent of total billed charges ","70% of total billed charges ",88.92,409.2,
"EPISIOTOMY OR VAGINAL REPAIR",1702570,"CDM ",761,RC,59300,HCPCS,OUTPATIENT,,,3200,2560,,1012.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",292.91,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2240,70,,1792.00,,,0,"percent of total billed charges ","70% of total billed charges ",2880,90,,2304.00,,,0,"percent of total billed charges ","90% of total billed charges ",2976,93,,2380.80,,,0,"percent of total billed charges ","93% of total billed charges ",1012.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2720,85,,2176.00,,,0,"percent of total billed charges ","85% of total billed charges ",2400,90,,1920.00,,,0,"percent of total billed charges ","90% of total billed charges ",2880,90,,2304.00,,,0,"percent of total billed charges ","90% of total billed charges ",254.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2784,87,,2227.20,,,0,"percent of total billed charges ","87% of total billed charges ",254.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2977.04,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2240,70,,1792.00,,,0,"percent of total billed charges ","70% of total billed charges ",254.14,2977.04,
"BIOPSY BONE SUPERFICIAL",1702580,"CDM ",761,RC,20220,HCPCS,OUTPATIENT,,,1750,1400,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",451.47,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",182.34,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1225,70,,980.00,,,0,"percent of total billed charges ","70% of total billed charges ",1575,90,,1260.00,,,0,"percent of total billed charges ","90% of total billed charges ",1627.5,93,,1302.00,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",284.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1487.5,85,,1190.00,,,0,"percent of total billed charges ","85% of total billed charges ",1312.5,90,,1050.00,,,0,"percent of total billed charges ","90% of total billed charges ",1575,90,,1260.00,,,0,"percent of total billed charges ","90% of total billed charges ",281.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1522.5,87,,1218.00,,,0,"percent of total billed charges ","87% of total billed charges ",281.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1225,70,,980.00,,,0,"percent of total billed charges ","70% of total billed charges ",182.34,1627.5,
"REMOVE/RPR CAST SHOULDER/HIP",1702590,"CDM ",761,RC,29710,HCPCS,OUTPATIENT,,,534.5,427.6,,228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",278.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",168.1,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",374.15,70,,299.32,,,0,"percent of total billed charges ","70% of total billed charges ",481.05,90,,384.84,,,0,"percent of total billed charges ","90% of total billed charges ",497.09,93,,397.67,,,0,"percent of total billed charges ","93% of total billed charges ",228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",454.33,85,,363.46,,,0,"percent of total billed charges ","85% of total billed charges ",400.88,90,,320.70,,,0,"percent of total billed charges ","90% of total billed charges ",481.05,90,,384.84,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",465.02,87,,372.02,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.22,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",374.15,70,,299.32,,,0,"percent of total billed charges ","70% of total billed charges ",168.1,497.09,
"FINE NEEDLE ASP W/US EA ADD",1702600,"CDM ",761,RC,10006,HCPCS,OUTPATIENT,,,555,444,,,,,,,,0,"other ","not separately reimbursment ",643.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",105.89,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",388.5,70,,310.80,,,0,"percent of total billed charges ","70% of total billed charges ",499.5,90,,399.60,,,0,"percent of total billed charges ","90% of total billed charges ",516.15,93,,412.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",471.75,85,,377.40,,,0,"percent of total billed charges ","85% of total billed charges ",416.25,90,,333.00,,,0,"percent of total billed charges ","90% of total billed charges ",499.5,90,,399.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",482.85,87,,386.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",388.5,70,,310.80,,,0,"percent of total billed charges ","70% of total billed charges ",105.89,643.64,
"EXTERNAL CEPHALIC VERSION",1702610,"CDM ",761,RC,59412,HCPCS,OUTPATIENT,,,4944,3955.2,,1012.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",204.29,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3460.8,70,,2768.64,,,0,"percent of total billed charges ","70% of total billed charges ",4449.6,90,,3559.68,,,0,"percent of total billed charges ","90% of total billed charges ",4597.92,93,,3678.34,,,0,"percent of total billed charges ","93% of total billed charges ",1012.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4202.4,85,,3361.92,,,0,"percent of total billed charges ","85% of total billed charges ",3708,90,,2966.40,,,0,"percent of total billed charges ","90% of total billed charges ",4449.6,90,,3559.68,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4301.28,87,,3441.02,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2977.04,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3460.8,70,,2768.64,,,0,"percent of total billed charges ","70% of total billed charges ",204.29,4597.92,
"NYSTAGMUS POS TEST 4 OR MORE",1702620,"CDM ",761,RC,92542,HCPCS,OUTPATIENT,,,185.5,148.4,,41.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",62.13,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",129.85,70,,103.88,,,0,"percent of total billed charges ","70% of total billed charges ",166.95,90,,133.56,,,0,"percent of total billed charges ","90% of total billed charges ",172.52,93,,138.02,,,0,"percent of total billed charges ","93% of total billed charges ",41.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.75,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",157.68,85,,126.14,,,0,"percent of total billed charges ","85% of total billed charges ",166.95,90,,133.56,,,0,"percent of total billed charges ","90% of total billed charges ",166.95,90,,133.56,,,0,"percent of total billed charges ","90% of total billed charges ",18.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.39,87,,129.11,,,0,"percent of total billed charges ","87% of total billed charges ",18.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",129.85,70,,103.88,,,0,"percent of total billed charges ","70% of total billed charges ",18.56,172.52,
"EXPLORE WOUND EXTREMITY",1702630,"CDM ",761,RC,20103,HCPCS,OUTPATIENT,,,862.5,690,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",310.07,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",708.6,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",603.75,70,,483.00,,,0,"percent of total billed charges ","70% of total billed charges ",776.25,90,,621.00,,,0,"percent of total billed charges ","90% of total billed charges ",802.13,93,,641.70,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",594.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",733.13,85,,586.50,,,0,"percent of total billed charges ","85% of total billed charges ",646.88,90,,517.50,,,0,"percent of total billed charges ","90% of total billed charges ",776.25,90,,621.00,,,0,"percent of total billed charges ","90% of total billed charges ",588.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",750.38,87,,600.30,,,0,"percent of total billed charges ","87% of total billed charges ",588.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",603.75,70,,483.00,,,0,"percent of total billed charges ","70% of total billed charges ",310.07,1518.9,
"TX OPEN SHAFT FX FINGER",1702640,"CDM ",761,RC,26735,HCPCS,OUTPATIENT,,,5008.5,4006.8,,1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3638.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1228.96,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3505.95,70,,2804.76,,,0,"percent of total billed charges ","70% of total billed charges ",4507.65,90,,3606.12,,,0,"percent of total billed charges ","90% of total billed charges ",4657.91,93,,3726.33,,,0,"percent of total billed charges ","93% of total billed charges ",1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4257.23,85,,3405.78,,,0,"percent of total billed charges ","85% of total billed charges ",3756.38,90,,3005.10,,,0,"percent of total billed charges ","90% of total billed charges ",4507.65,90,,3606.12,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4357.4,87,,3485.92,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3009.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3505.95,70,,2804.76,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,4657.91,
"CLOSED FX METACARPAL W/MANIP",1702650,"CDM ",761,RC,26605,HCPCS,OUTPATIENT,,,1315,1052,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",621.43,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",920.5,70,,736.40,,,0,"percent of total billed charges ","70% of total billed charges ",1183.5,90,,946.80,,,0,"percent of total billed charges ","90% of total billed charges ",1222.95,93,,978.36,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1117.75,85,,894.20,,,0,"percent of total billed charges ","85% of total billed charges ",986.25,90,,789.00,,,0,"percent of total billed charges ","90% of total billed charges ",1183.5,90,,946.80,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1144.05,87,,915.24,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",920.5,70,,736.40,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1222.95,
"DEBRIDE SKIN/MUSCLE FX SITE",1702660,"CDM ",761,RC,11011,HCPCS,OUTPATIENT,,,964.5,771.6,,,,,,,,0,"other ","not separately reimbursment ",783.58,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",605.55,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",675.15,70,,540.12,,,0,"percent of total billed charges ","70% of total billed charges ",868.05,90,,694.44,,,0,"percent of total billed charges ","90% of total billed charges ",896.99,93,,717.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",819.83,85,,655.86,,,0,"percent of total billed charges ","85% of total billed charges ",723.38,90,,578.70,,,0,"percent of total billed charges ","90% of total billed charges ",868.05,90,,694.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",839.12,87,,671.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",675.15,70,,540.12,,,0,"percent of total billed charges ","70% of total billed charges ",605.55,896.99,
"BX BREAST 1ST LES W/DEV & IMAG",1702670,"CDM ",761,RC,19081,HCPCS,OUTPATIENT,,,3521.5,2817.2,,474.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1890.72,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",344.23,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2465.05,70,,1972.04,,,0,"percent of total billed charges ","70% of total billed charges ",3169.35,90,,2535.48,,,0,"percent of total billed charges ","90% of total billed charges ",3275,93,,2620.00,,,0,"percent of total billed charges ","93% of total billed charges ",474.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",603.02,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2993.28,85,,2394.62,,,0,"percent of total billed charges ","85% of total billed charges ",2641.13,90,,2112.90,,,0,"percent of total billed charges ","90% of total billed charges ",3169.35,90,,2535.48,,,0,"percent of total billed charges ","90% of total billed charges ",597.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3063.71,87,,2450.97,,,0,"percent of total billed charges ","87% of total billed charges ",597.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2465.05,70,,1972.04,,,0,"percent of total billed charges ","70% of total billed charges ",344.23,3275,
"BX BREAST ADD LES W/DEV & IMAG",1702680,"CDM ",761,RC,19082,HCPCS,OUTPATIENT,,,3227.5,2582,,,,,,,,0,"other ","not separately reimbursment ",2166.45,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",173.01,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2259.25,70,,1807.40,,,0,"percent of total billed charges ","70% of total billed charges ",2904.75,90,,2323.80,,,0,"percent of total billed charges ","90% of total billed charges ",3001.58,93,,2401.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2743.38,85,,2194.70,,,0,"percent of total billed charges ","85% of total billed charges ",2420.63,90,,1936.50,,,0,"percent of total billed charges ","90% of total billed charges ",2904.75,90,,2323.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2807.93,87,,2246.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2259.25,70,,1807.40,,,0,"percent of total billed charges ","70% of total billed charges ",173.01,3001.58,
"CLSD TX PROX FIBULA WO MANIP",1702690,"CDM ",761,RC,27780,HCPCS,OUTPATIENT,,,1936.5,1549.2,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",594.44,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1355.55,70,,1084.44,,,0,"percent of total billed charges ","70% of total billed charges ",1742.85,90,,1394.28,,,0,"percent of total billed charges ","90% of total billed charges ",1800.95,93,,1440.76,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1646.03,85,,1316.82,,,0,"percent of total billed charges ","85% of total billed charges ",1452.38,90,,1161.90,,,0,"percent of total billed charges ","90% of total billed charges ",1742.85,90,,1394.28,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1684.76,87,,1347.81,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1355.55,70,,1084.44,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1800.95,
"CLSD TX FX GREAT TOE",1702700,"CDM ",761,RC,28495,HCPCS,OUTPATIENT,,,2143.5,1714.8,,76.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1617.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",309.76,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1500.45,70,,1200.36,,,0,"percent of total billed charges ","70% of total billed charges ",1929.15,90,,1543.32,,,0,"percent of total billed charges ","90% of total billed charges ",1993.46,93,,1594.77,,,0,"percent of total billed charges ","93% of total billed charges ",76.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",86.59,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1821.98,85,,1457.58,,,0,"percent of total billed charges ","85% of total billed charges ",1607.63,90,,1286.10,,,0,"percent of total billed charges ","90% of total billed charges ",1929.15,90,,1543.32,,,0,"percent of total billed charges ","90% of total billed charges ",85.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1864.85,87,,1491.88,,,0,"percent of total billed charges ","87% of total billed charges ",85.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1500.45,70,,1200.36,,,0,"percent of total billed charges ","70% of total billed charges ",76.39,1993.46,
"FINE NEEDLE ASPIR W/CT GUIDE",1702710,"CDM ",761,RC,10009,HCPCS,OUTPATIENT,,,1066,852.8,,376.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",643.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",232.96,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",746.2,70,,596.96,,,0,"percent of total billed charges ","70% of total billed charges ",959.4,90,,767.52,,,0,"percent of total billed charges ","90% of total billed charges ",991.38,93,,793.10,,,0,"percent of total billed charges ","93% of total billed charges ",376.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",478.47,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",906.1,85,,724.88,,,0,"percent of total billed charges ","85% of total billed charges ",799.5,90,,639.60,,,0,"percent of total billed charges ","90% of total billed charges ",959.4,90,,767.52,,,0,"percent of total billed charges ","90% of total billed charges ",473.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",927.42,87,,741.94,,,0,"percent of total billed charges ","87% of total billed charges ",473.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",746.2,70,,596.96,,,0,"percent of total billed charges ","70% of total billed charges ",232.96,991.38,
"CLSD TX FINGER DISLOCATE W/MAN",1702720,"CDM ",761,RC,26770,HCPCS,OUTPATIENT,,,1129.5,903.6,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,696.03,696.03,696.03,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",541.75,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",790.65,70,,632.52,,,0,"percent of total billed charges ","70% of total billed charges ",1016.55,90,,813.24,,,0,"percent of total billed charges ","90% of total billed charges ",1050.44,93,,840.35,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",960.08,85,,768.06,,,0,"percent of total billed charges ","85% of total billed charges ",847.13,90,,677.70,,,0,"percent of total billed charges ","90% of total billed charges ",1016.55,90,,813.24,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",982.67,87,,786.14,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",790.65,70,,632.52,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1050.44,
"CLSD TX RADIAL FX WO MANIP",1702730,"CDM ",761,RC,24650,HCPCS,OUTPATIENT,,,1034,827.2,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",510.93,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",723.8,70,,579.04,,,0,"percent of total billed charges ","70% of total billed charges ",930.6,90,,744.48,,,0,"percent of total billed charges ","90% of total billed charges ",961.62,93,,769.30,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",878.9,85,,703.12,,,0,"percent of total billed charges ","85% of total billed charges ",775.5,90,,620.40,,,0,"percent of total billed charges ","90% of total billed charges ",930.6,90,,744.48,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",899.58,87,,719.66,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",723.8,70,,579.04,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,961.62,
"CLSD TX SHLDR W/MANIP & ANESTH",1702740,"CDM ",761,RC,23655,HCPCS,OUTPATIENT,,,2653.5,2122.8,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,2343.45,2343.45,2343.45,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",849,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1857.45,70,,1485.96,,,0,"percent of total billed charges ","70% of total billed charges ",2388.15,90,,1910.52,,,0,"percent of total billed charges ","90% of total billed charges ",2467.76,93,,1974.21,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2255.48,85,,1804.38,,,0,"percent of total billed charges ","85% of total billed charges ",1990.13,90,,1592.10,,,0,"percent of total billed charges ","90% of total billed charges ",2388.15,90,,1910.52,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2308.55,87,,1846.84,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1857.45,70,,1485.96,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,2467.76,
"BX ABDOMINAL MASS PERQ NEEDLE",1702750,"CDM ",761,RC,49180,HCPCS,OUTPATIENT,,,2556,2044.8,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1930.94,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",173.91,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1789.2,70,,1431.36,,,0,"percent of total billed charges ","70% of total billed charges ",2300.4,90,,1840.32,,,0,"percent of total billed charges ","90% of total billed charges ",2377.08,93,,1901.66,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2172.6,85,,1738.08,,,0,"percent of total billed charges ","85% of total billed charges ",1917,90,,1533.60,,,0,"percent of total billed charges ","90% of total billed charges ",2300.4,90,,1840.32,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2223.72,87,,1778.98,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1789.2,70,,1431.36,,,0,"percent of total billed charges ","70% of total billed charges ",173.91,2377.08,
"URINE VOLUME MEASURE US",1702760,"CDM ",761,RC,51798,HCPCS,OUTPATIENT,,,161,128.8,,156,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",67.67,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",21.08,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",112.7,70,,90.16,,,0,"percent of total billed charges ","70% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",149.73,93,,119.78,,,0,"percent of total billed charges ","93% of total billed charges ",156,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",136.85,85,,109.48,,,0,"percent of total billed charges ","85% of total billed charges ",120.75,90,,96.60,,,0,"percent of total billed charges ","90% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",140.07,87,,112.06,,,0,"percent of total billed charges ","87% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",112.7,70,,90.16,,,0,"percent of total billed charges ","70% of total billed charges ",21.08,198.21,
"TX CLSD INTERPHALANG W/ANESTH",1702770,"CDM ",761,RC,26775,HCPCS,OUTPATIENT,,,1075,860,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",735.06,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",752.5,70,,602.00,,,0,"percent of total billed charges ","70% of total billed charges ",967.5,90,,774.00,,,0,"percent of total billed charges ","90% of total billed charges ",999.75,93,,799.80,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",913.75,85,,731.00,,,0,"percent of total billed charges ","85% of total billed charges ",806.25,90,,645.00,,,0,"percent of total billed charges ","90% of total billed charges ",967.5,90,,774.00,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",935.25,87,,748.20,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.22,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",752.5,70,,602.00,,,0,"percent of total billed charges ","70% of total billed charges ",257.22,999.75,
"INSTILLATION CHEM PLEURODESIS",1702780,"CDM ",761,RC,32560,HCPCS,OUTPATIENT,,,1175,940,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",158.8,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",822.5,70,,658.00,,,0,"percent of total billed charges ","70% of total billed charges ",1057.5,90,,846.00,,,0,"percent of total billed charges ","90% of total billed charges ",1092.75,93,,874.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",226.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",998.75,85,,799.00,,,0,"percent of total billed charges ","85% of total billed charges ",881.25,90,,705.00,,,0,"percent of total billed charges ","90% of total billed charges ",1057.5,90,,846.00,,,0,"percent of total billed charges ","90% of total billed charges ",224,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1022.25,87,,817.80,,,0,"percent of total billed charges ","87% of total billed charges ",224,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",576.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",822.5,70,,658.00,,,0,"percent of total billed charges ","70% of total billed charges ",158.8,1092.75,
"EXC BENIGN LESION 2.1-3.0CM",1702790,"CDM ",761,RC,11403,HCPCS,OUTPATIENT,,,1682.5,1346,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",783.57,100,,468.70,468.70,468.70,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",305.03,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1177.75,70,,942.20,,,0,"percent of total billed charges ","70% of total billed charges ",1514.25,90,,1211.40,,,0,"percent of total billed charges ","90% of total billed charges ",1564.73,93,,1251.78,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1430.13,85,,1144.10,,,0,"percent of total billed charges ","85% of total billed charges ",1261.88,90,,1009.50,,,0,"percent of total billed charges ","90% of total billed charges ",1514.25,90,,1211.40,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1463.78,87,,1171.02,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1177.75,70,,942.20,,,0,"percent of total billed charges ","70% of total billed charges ",257.4,1564.73,
"EXC HEMORROID CLOT",1702800,"CDM ",761,RC,46320,HCPCS,OUTPATIENT,,,3893,3114.4,,382.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1691.75,100,,131.20,131.20,131.20,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",234.17,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2725.1,70,,2180.08,,,0,"percent of total billed charges ","70% of total billed charges ",3503.7,90,,2802.96,,,0,"percent of total billed charges ","90% of total billed charges ",3620.49,93,,2896.39,,,0,"percent of total billed charges ","93% of total billed charges ",382.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3309.05,85,,2647.24,,,0,"percent of total billed charges ","85% of total billed charges ",2919.75,90,,2335.80,,,0,"percent of total billed charges ","90% of total billed charges ",3503.7,90,,2802.96,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3386.91,87,,2709.53,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1100.5,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2725.1,70,,2180.08,,,0,"percent of total billed charges ","70% of total billed charges ",234.17,3620.49,
TRACHEOSTOMY,1702810,"CDM ",761,RC,31600,HCPCS,OUTPATIENT,,,5360.5,4288.4,,1042.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",626.52,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3752.35,70,,3001.88,,,0,"percent of total billed charges ","70% of total billed charges ",4824.45,90,,3859.56,,,0,"percent of total billed charges ","90% of total billed charges ",4985.27,93,,3988.22,,,0,"percent of total billed charges ","93% of total billed charges ",1042.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",495.53,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4556.43,85,,3645.14,,,0,"percent of total billed charges ","85% of total billed charges ",4020.38,90,,3216.30,,,0,"percent of total billed charges ","90% of total billed charges ",4824.45,90,,3859.56,,,0,"percent of total billed charges ","90% of total billed charges ",490.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4663.64,87,,3730.91,,,0,"percent of total billed charges ","87% of total billed charges ",490.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3049.08,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3752.35,70,,3001.88,,,0,"percent of total billed charges ","70% of total billed charges ",490.62,4985.27,
"ADJC TISS TRANS FMNHF <10SQCM",1702830,"CDM ",761,RC,14040,HCPCS,OUTPATIENT,,,3322,2657.6,,590.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1778.61,100,,983.60,983.60,983.60,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1281.37,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2325.4,70,,1860.32,,,0,"percent of total billed charges ","70% of total billed charges ",2989.8,90,,2391.84,,,0,"percent of total billed charges ","90% of total billed charges ",3089.46,93,,2471.57,,,0,"percent of total billed charges ","93% of total billed charges ",590.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2823.7,85,,2258.96,,,0,"percent of total billed charges ","85% of total billed charges ",2491.5,90,,1993.20,,,0,"percent of total billed charges ","90% of total billed charges ",2989.8,90,,2391.84,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2890.14,87,,1432.59,1432.59,1432.59,"1 through 10","percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1897.5,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2325.4,70,,1860.32,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,3089.46,
"I&D PERIRECTAL ABSCESS",1702840,"CDM ",761,RC,46040,HCPCS,OUTPATIENT,,,3379,2703.2,,382.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2329.06,100,,603.09,603.09,603.09,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",877.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2365.3,70,,1892.24,,,0,"percent of total billed charges ","70% of total billed charges ",3041.1,90,,2432.88,,,0,"percent of total billed charges ","90% of total billed charges ",3142.47,93,,2513.98,,,0,"percent of total billed charges ","93% of total billed charges ",382.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",429.45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2872.15,85,,2297.72,,,0,"percent of total billed charges ","85% of total billed charges ",2534.25,90,,2027.40,,,0,"percent of total billed charges ","90% of total billed charges ",3041.1,90,,2432.88,,,0,"percent of total billed charges ","90% of total billed charges ",425.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2939.73,87,,2351.78,,,0,"percent of total billed charges ","87% of total billed charges ",425.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1100.5,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2365.3,70,,1892.24,,,0,"percent of total billed charges ","70% of total billed charges ",382.28,3142.47,
"INSERT NEEDLE BONE CAVITY",1702850,"CDM ",761,RC,36680,HCPCS,OUTPATIENT,,,674.5,539.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",121.13,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",472.15,70,,377.72,,,0,"percent of total billed charges ","70% of total billed charges ",607.05,90,,485.64,,,0,"percent of total billed charges ","90% of total billed charges ",627.29,93,,501.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",573.33,85,,458.66,,,0,"percent of total billed charges ","85% of total billed charges ",505.88,90,,404.70,,,0,"percent of total billed charges ","90% of total billed charges ",607.05,90,,485.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",586.82,87,,469.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",410.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",472.15,70,,377.72,,,0,"percent of total billed charges ","70% of total billed charges ",121.13,627.29,
"LARYNGOSCOPY W/FB REMOVAL",1702860,"CDM ",761,RC,31530,HCPCS,OUTPATIENT,,,4602,3681.6,,549.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4157.16,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",409.9,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3221.4,70,,2577.12,,,0,"percent of total billed charges ","70% of total billed charges ",4141.8,90,,3313.44,,,0,"percent of total billed charges ","90% of total billed charges ",4279.86,93,,3423.89,,,0,"percent of total billed charges ","93% of total billed charges ",549.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",249.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3911.7,85,,3129.36,,,0,"percent of total billed charges ","85% of total billed charges ",3451.5,90,,2761.20,,,0,"percent of total billed charges ","90% of total billed charges ",4141.8,90,,3313.44,,,0,"percent of total billed charges ","90% of total billed charges ",247.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4003.74,87,,3202.99,,,0,"percent of total billed charges ","87% of total billed charges ",247.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1636.89,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3221.4,70,,2577.12,,,0,"percent of total billed charges ","70% of total billed charges ",247.27,4279.86,
"TX ULNA SHAFT FX",1702870,"CDM ",761,RC,25530,HCPCS,OUTPATIENT,,,1849.5,1479.6,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",504.55,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1294.65,70,,1035.72,,,0,"percent of total billed charges ","70% of total billed charges ",1664.55,90,,1331.64,,,0,"percent of total billed charges ","90% of total billed charges ",1720.04,93,,1376.03,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1572.08,85,,1257.66,,,0,"percent of total billed charges ","85% of total billed charges ",1387.13,90,,1109.70,,,0,"percent of total billed charges ","90% of total billed charges ",1664.55,90,,1331.64,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1609.07,87,,1287.26,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1294.65,70,,1035.72,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1720.04,
"I&D ABSCESS DEEP THIGH/KNEE",1702880,"CDM ",761,RC,27301,HCPCS,OUTPATIENT,,,4688,3750.4,,920.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3669.33,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1042.34,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3281.6,70,,2625.28,,,0,"percent of total billed charges ","70% of total billed charges ",4219.2,90,,3375.36,,,0,"percent of total billed charges ","90% of total billed charges ",4359.84,93,,3487.87,,,0,"percent of total billed charges ","93% of total billed charges ",920.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",594.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3984.8,85,,3187.84,,,0,"percent of total billed charges ","85% of total billed charges ",3516,90,,2812.80,,,0,"percent of total billed charges ","90% of total billed charges ",4219.2,90,,3375.36,,,0,"percent of total billed charges ","90% of total billed charges ",588.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4078.56,87,,3262.85,,,0,"percent of total billed charges ","87% of total billed charges ",588.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2671.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3281.6,70,,2625.28,,,0,"percent of total billed charges ","70% of total billed charges ",588.74,4359.84,
"INJECTION CHEMO IM/SUBQ",1702890,"CDM ",761,RC,96402,HCPCS,OUTPATIENT,,,95,76,,42.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",68.38,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",66.5,70,,53.20,,,0,"percent of total billed charges ","70% of total billed charges ",85.5,90,,68.40,,,0,"percent of total billed charges ","90% of total billed charges ",88.35,93,,70.68,,,0,"percent of total billed charges ","93% of total billed charges ",42.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",80.75,85,,64.60,,,0,"percent of total billed charges ","85% of total billed charges ",85.5,90,,68.40,,,0,"percent of total billed charges ","90% of total billed charges ",85.5,90,,68.40,,,0,"percent of total billed charges ","90% of total billed charges ",53.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",82.65,87,,66.12,,,0,"percent of total billed charges ","87% of total billed charges ",53.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",66.5,70,,53.20,,,0,"percent of total billed charges ","70% of total billed charges ",35.35,88.35,
"INTERMED RPR TRUNK 2.6-7.5CM",1702900,"CDM ",761,RC,12032,HCPCS,OUTPATIENT,,,1548.5,1238.8,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",451.17,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",389.99,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1083.95,70,,867.16,,,0,"percent of total billed charges ","70% of total billed charges ",1393.65,90,,1114.92,,,0,"percent of total billed charges ","90% of total billed charges ",1440.11,93,,1152.09,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1316.23,85,,1052.98,,,0,"percent of total billed charges ","85% of total billed charges ",1161.38,90,,929.10,,,0,"percent of total billed charges ","90% of total billed charges ",1393.65,90,,1114.92,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1347.2,87,,1077.76,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1083.95,70,,867.16,,,0,"percent of total billed charges ","70% of total billed charges ",286,1440.11,
"INTERMED RPR FACE <2.6CM",1702910,"CDM ",761,RC,12051,HCPCS,OUTPATIENT,,,912,729.6,,343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",715.08,100,,86.48,86.48,86.48,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",347.86,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",638.4,70,,510.72,,,0,"percent of total billed charges ","70% of total billed charges ",820.8,90,,656.64,,,0,"percent of total billed charges ","90% of total billed charges ",848.16,93,,678.53,,,0,"percent of total billed charges ","93% of total billed charges ",343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",775.2,85,,620.16,,,0,"percent of total billed charges ","85% of total billed charges ",684,90,,547.20,,,0,"percent of total billed charges ","90% of total billed charges ",820.8,90,,656.64,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",793.44,87,,634.75,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",638.4,70,,510.72,,,0,"percent of total billed charges ","70% of total billed charges ",343.2,848.16,
"CLSD TX DIST PHALANGE WO MANIP",1702920,"CDM ",761,RC,26750,HCPCS,OUTPATIENT,,,775,620,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",432.28,100,,86.51,86.51,86.51,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",392.92,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",542.5,70,,434.00,,,0,"percent of total billed charges ","70% of total billed charges ",697.5,90,,558.00,,,0,"percent of total billed charges ","90% of total billed charges ",720.75,93,,576.60,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",658.75,85,,527.00,,,0,"percent of total billed charges ","85% of total billed charges ",581.25,90,,465.00,,,0,"percent of total billed charges ","90% of total billed charges ",697.5,90,,558.00,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",674.25,87,,539.40,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",542.5,70,,434.00,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,720.75,
"CHEMO ADMIN PUSH SINGLE OR INT",1702930,"CDM ",761,RC,96409,HCPCS,OUTPATIENT,,,296,236.8,,42.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",133.32,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",214.61,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",207.2,70,,165.76,,,0,"percent of total billed charges ","70% of total billed charges ",266.4,90,,213.12,,,0,"percent of total billed charges ","90% of total billed charges ",275.28,93,,220.22,,,0,"percent of total billed charges ","93% of total billed charges ",42.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",251.6,85,,201.28,,,0,"percent of total billed charges ","85% of total billed charges ",266.4,90,,213.12,,,0,"percent of total billed charges ","90% of total billed charges ",266.4,90,,213.12,,,0,"percent of total billed charges ","90% of total billed charges ",53.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.52,87,,206.02,,,0,"percent of total billed charges ","87% of total billed charges ",53.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",303.76,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",207.2,70,,165.76,,,0,"percent of total billed charges ","70% of total billed charges ",42.83,303.76,
"CHEMO ADMIN IM/SUBQ",1702940,"CDM ",761,RC,96401,HCPCS,OUTPATIENT,,,165.5,132.4,,42.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",155.3,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",115.85,70,,92.68,,,0,"percent of total billed charges ","70% of total billed charges ",148.95,90,,119.16,,,0,"percent of total billed charges ","90% of total billed charges ",153.92,93,,123.14,,,0,"percent of total billed charges ","93% of total billed charges ",42.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.68,85,,112.54,,,0,"percent of total billed charges ","85% of total billed charges ",148.95,90,,119.16,,,0,"percent of total billed charges ","90% of total billed charges ",148.95,90,,119.16,,,0,"percent of total billed charges ","90% of total billed charges ",53.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.99,87,,115.19,,,0,"percent of total billed charges ","87% of total billed charges ",53.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",115.85,70,,92.68,,,0,"percent of total billed charges ","70% of total billed charges ",42.83,155.3,
"I&D VULVA/PERINEUM",1702950,"CDM ",761,RC,56405,HCPCS,OUTPATIENT,,,507.5,406,,228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",264.55,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",355.25,70,,284.20,,,0,"percent of total billed charges ","70% of total billed charges ",456.75,90,,365.40,,,0,"percent of total billed charges ","90% of total billed charges ",471.98,93,,377.58,,,0,"percent of total billed charges ","93% of total billed charges ",228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",431.38,85,,345.10,,,0,"percent of total billed charges ","85% of total billed charges ",380.63,90,,304.50,,,0,"percent of total billed charges ","90% of total billed charges ",456.75,90,,365.40,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",441.53,87,,353.22,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",280.24,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",355.25,70,,284.20,,,0,"percent of total billed charges ","70% of total billed charges ",228.8,471.98,
"IV SEQUENT DRUG REPEAT VISIT",1702960,"CDM ",761,RC,96367,HCPCS,OUTPATIENT,,,232,185.6,,24.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",133.32,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",62.15,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",215.76,93,,172.61,,,0,"percent of total billed charges ","93% of total billed charges ",24.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.03,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",197.2,85,,157.76,,,0,"percent of total billed charges ","85% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",30.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.84,87,,161.47,,,0,"percent of total billed charges ","87% of total billed charges ",30.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.2,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",24.42,215.76,
"CLSD HUMERAL FX PROX W/O MANIP",1702965,"CDM ",761,RC,23600,HCPCS,OUTPATIENT,,,1875,1500,,364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",657.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1312.5,70,,1050.00,,,0,"percent of total billed charges ","70% of total billed charges ",1687.5,90,,1350.00,,,0,"percent of total billed charges ","90% of total billed charges ",1743.75,93,,1395.00,,,0,"percent of total billed charges ","93% of total billed charges ",364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1593.75,85,,1275.00,,,0,"percent of total billed charges ","85% of total billed charges ",1406.25,90,,1125.00,,,0,"percent of total billed charges ","90% of total billed charges ",1687.5,90,,1350.00,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1631.25,87,,1305.00,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1312.5,70,,1050.00,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1743.75,
"CLSD HUMERAL FX PROX W/O MANIP",1702965,"CDM ",761,RC,23600,HCPCS,OUTPATIENT,,,1781.5,1425.2,,364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",657.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1247.05,70,,997.64,,,0,"percent of total billed charges ","70% of total billed charges ",1603.35,90,,1282.68,,,0,"percent of total billed charges ","90% of total billed charges ",1656.8,93,,1325.44,,,0,"percent of total billed charges ","93% of total billed charges ",364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1514.28,85,,1211.42,,,0,"percent of total billed charges ","85% of total billed charges ",1336.13,90,,1068.90,,,0,"percent of total billed charges ","90% of total billed charges ",1603.35,90,,1282.68,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1549.91,87,,1239.93,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1247.05,70,,997.64,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1656.8,
"BX ENDOMETRIAL W/WO EDOCERV BX",1702970,"CDM ",761,RC,58100,HCPCS,OUTPATIENT,,,1959,1567.2,,418.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",214.32,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",131.58,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1371.3,70,,1097.04,,,0,"percent of total billed charges ","70% of total billed charges ",1763.1,90,,1410.48,,,0,"percent of total billed charges ","90% of total billed charges ",1821.87,93,,1457.50,,,0,"percent of total billed charges ","93% of total billed charges ",418.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",531.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1665.15,85,,1332.12,,,0,"percent of total billed charges ","85% of total billed charges ",1469.25,90,,1175.40,,,0,"percent of total billed charges ","90% of total billed charges ",1763.1,90,,1410.48,,,0,"percent of total billed charges ","90% of total billed charges ",525.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1704.33,87,,1363.46,,,0,"percent of total billed charges ","87% of total billed charges ",525.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",185.92,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1371.3,70,,1097.04,,,0,"percent of total billed charges ","70% of total billed charges ",131.58,1821.87,
"SPINAL PUNCT DRAIN CEREB FLUID",1702980,"CDM ",761,RC,62329,HCPCS,OUTPATIENT,,,1169,935.2,,406.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",668.38,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",225.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",818.3,70,,654.64,,,0,"percent of total billed charges ","70% of total billed charges ",1052.1,90,,841.68,,,0,"percent of total billed charges ","90% of total billed charges ",1087.17,93,,869.74,,,0,"percent of total billed charges ","93% of total billed charges ",406.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",516.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",993.65,85,,794.92,,,0,"percent of total billed charges ","85% of total billed charges ",876.75,90,,701.40,,,0,"percent of total billed charges ","90% of total billed charges ",1052.1,90,,841.68,,,0,"percent of total billed charges ","90% of total billed charges ",511.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1017.03,87,,813.62,,,0,"percent of total billed charges ","87% of total billed charges ",511.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",649.16,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",818.3,70,,654.64,,,0,"percent of total billed charges ","70% of total billed charges ",225.87,1087.17,
"BX PUNCH SKIN SINGLE LESION",1702990,"CDM ",761,RC,11104,HCPCS,OUTPATIENT,,,803,642.4,,129.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",451.17,100,,21.90,21.90,21.90,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",97.42,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",562.1,70,,449.68,,,0,"percent of total billed charges ","70% of total billed charges ",722.7,90,,578.16,,,0,"percent of total billed charges ","90% of total billed charges ",746.79,93,,597.43,,,0,"percent of total billed charges ","93% of total billed charges ",129.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",145.72,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",682.55,85,,546.04,,,0,"percent of total billed charges ","85% of total billed charges ",602.25,90,,481.80,,,0,"percent of total billed charges ","90% of total billed charges ",722.7,90,,578.16,,,0,"percent of total billed charges ","90% of total billed charges ",144.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",698.61,87,,90.82,90.82,90.82,"1 through 10","percent of total billed charges ","87% of total billed charges ",144.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",562.1,70,,449.68,,,0,"percent of total billed charges ","70% of total billed charges ",97.42,746.79,
"BX PUNCH SKIN EA ADD LESION",1703000,"CDM ",761,RC,11105,HCPCS,OUTPATIENT,,,227.5,182,,,,,,,,0,"other ","not separately reimbursment ",451.17,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",53.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",159.25,70,,127.40,,,0,"percent of total billed charges ","70% of total billed charges ",204.75,90,,163.80,,,0,"percent of total billed charges ","90% of total billed charges ",211.58,93,,169.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",193.38,85,,154.70,,,0,"percent of total billed charges ","85% of total billed charges ",170.63,90,,136.50,,,0,"percent of total billed charges ","90% of total billed charges ",204.75,90,,163.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",197.93,87,,158.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",159.25,70,,127.40,,,0,"percent of total billed charges ","70% of total billed charges ",53.28,451.17,
"ARTHROTOMY W/BX SAC JOINT",1703010,"CDM ",761,RC,27050,HCPCS,OUTPATIENT,,,2771.5,2217.2,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",836.77,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1940.05,70,,1552.04,,,0,"percent of total billed charges ","70% of total billed charges ",2494.35,90,,1995.48,,,0,"percent of total billed charges ","90% of total billed charges ",2577.5,93,,2062.00,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",386.93,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2355.78,85,,1884.62,,,0,"percent of total billed charges ","85% of total billed charges ",2078.63,90,,1662.90,,,0,"percent of total billed charges ","90% of total billed charges ",2494.35,90,,1995.48,,,0,"percent of total billed charges ","90% of total billed charges ",383.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2411.21,87,,1928.97,,,0,"percent of total billed charges ","87% of total billed charges ",383.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1940.05,70,,1552.04,,,0,"percent of total billed charges ","70% of total billed charges ",383.1,2577.5,
"BX/EXC LYMPH NODE OPEN SPRFCL",1703020,"CDM ",761,RC,38500,HCPCS,OUTPATIENT,,,5644.5,4515.6,,1234.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2227.05,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",522.13,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3951.15,70,,3160.92,,,0,"percent of total billed charges ","70% of total billed charges ",5080.05,90,,4064.04,,,0,"percent of total billed charges ","90% of total billed charges ",5249.39,93,,4199.51,,,0,"percent of total billed charges ","93% of total billed charges ",1234.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",284.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4797.83,85,,3838.26,,,0,"percent of total billed charges ","85% of total billed charges ",4233.38,90,,3386.70,,,0,"percent of total billed charges ","90% of total billed charges ",5080.05,90,,4064.04,,,0,"percent of total billed charges ","90% of total billed charges ",281.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4910.72,87,,3928.58,,,0,"percent of total billed charges ","87% of total billed charges ",281.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3600.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3951.15,70,,3160.92,,,0,"percent of total billed charges ","70% of total billed charges ",281.29,5249.39,
"PLACE BREAST DEVICE 1ST LES US",1703030,"CDM ",761,RC,19285,HCPCS,OUTPATIENT,,,1249,999.2,,66.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",398.95,100,,379.79,379.79,379.79,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",177.52,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",874.3,70,,699.44,,,0,"percent of total billed charges ","70% of total billed charges ",1124.1,90,,899.28,,,0,"percent of total billed charges ","90% of total billed charges ",1161.57,93,,929.26,,,0,"percent of total billed charges ","93% of total billed charges ",66.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1061.65,85,,849.32,,,0,"percent of total billed charges ","85% of total billed charges ",936.75,90,,749.40,,,0,"percent of total billed charges ","90% of total billed charges ",1124.1,90,,899.28,,,0,"percent of total billed charges ","90% of total billed charges ",83.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1086.63,87,,869.30,,,0,"percent of total billed charges ","87% of total billed charges ",83.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",874.3,70,,699.44,,,0,"percent of total billed charges ","70% of total billed charges ",66.41,1161.57,
"TX SCAPULA FX W/MANIP",1703040,"CDM ",761,RC,23575,HCPCS,OUTPATIENT,,,2233.5,1786.8,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1077.67,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",788.59,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1563.45,70,,1250.76,,,0,"percent of total billed charges ","70% of total billed charges ",2010.15,90,,1608.12,,,0,"percent of total billed charges ","90% of total billed charges ",2077.16,93,,1661.73,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1898.48,85,,1518.78,,,0,"percent of total billed charges ","85% of total billed charges ",1675.13,90,,1340.10,,,0,"percent of total billed charges ","90% of total billed charges ",2010.15,90,,1608.12,,,0,"percent of total billed charges ","90% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1943.15,87,,1554.52,,,0,"percent of total billed charges ","87% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1563.45,70,,1250.76,,,0,"percent of total billed charges ","70% of total billed charges ",130.83,2077.16,
"CLSD TX SUPRACONDULAR W/MANIP",1703050,"CDM ",761,RC,24535,HCPCS,OUTPATIENT,,,2523,2018.4,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1178.08,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1766.1,70,,1412.88,,,0,"percent of total billed charges ","70% of total billed charges ",2270.7,90,,1816.56,,,0,"percent of total billed charges ","90% of total billed charges ",2346.39,93,,1877.11,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2144.55,85,,1715.64,,,0,"percent of total billed charges ","85% of total billed charges ",1892.25,90,,1513.80,,,0,"percent of total billed charges ","90% of total billed charges ",2270.7,90,,1816.56,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2195.01,87,,1756.01,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1766.1,70,,1412.88,,,0,"percent of total billed charges ","70% of total billed charges ",457.91,2346.39,
"CLSD TX BIMALLEOLAR ANKLE W/MA",1703060,"CDM ",761,RC,27810,HCPCS,OUTPATIENT,,,2523,2018.4,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",883.72,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1766.1,70,,1412.88,,,0,"percent of total billed charges ","70% of total billed charges ",2270.7,90,,1816.56,,,0,"percent of total billed charges ","90% of total billed charges ",2346.39,93,,1877.11,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2144.55,85,,1715.64,,,0,"percent of total billed charges ","85% of total billed charges ",1892.25,90,,1513.80,,,0,"percent of total billed charges ","90% of total billed charges ",2270.7,90,,1816.56,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2195.01,87,,1756.01,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1766.1,70,,1412.88,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,2346.39,
"TX ANKLE FX WO MANIPULATION",1703065,"CDM ",761,RC,27816,HCPCS,OUTPATIENT,,,1849.5,1479.6,,210.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",612.72,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1294.65,70,,1035.72,,,0,"percent of total billed charges ","70% of total billed charges ",1664.55,90,,1331.64,,,0,"percent of total billed charges ","90% of total billed charges ",1720.04,93,,1376.03,,,0,"percent of total billed charges ","93% of total billed charges ",210.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",243.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1572.08,85,,1257.66,,,0,"percent of total billed charges ","85% of total billed charges ",1387.13,90,,1109.70,,,0,"percent of total billed charges ","90% of total billed charges ",1664.55,90,,1331.64,,,0,"percent of total billed charges ","90% of total billed charges ",241.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1609.07,87,,1287.26,,,0,"percent of total billed charges ","87% of total billed charges ",241.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1294.65,70,,1035.72,,,0,"percent of total billed charges ","70% of total billed charges ",210.99,1720.04,
"BX NEEDLE LUNG/MEDIAST W/IMAGE",1703075,"CDM ",761,RC,32408,HCPCS,OUTPATIENT,,,2495,1996,,1006.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",348.45,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",320.63,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1746.5,70,,1397.20,,,0,"percent of total billed charges ","70% of total billed charges ",2245.5,90,,1796.40,,,0,"percent of total billed charges ","90% of total billed charges ",2320.35,93,,1856.28,,,0,"percent of total billed charges ","93% of total billed charges ",1006.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1162.01,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2120.75,85,,1696.60,,,0,"percent of total billed charges ","85% of total billed charges ",1871.25,90,,1497.00,,,0,"percent of total billed charges ","90% of total billed charges ",2245.5,90,,1796.40,,,0,"percent of total billed charges ","90% of total billed charges ",1150.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2170.65,87,,1736.52,,,0,"percent of total billed charges ","87% of total billed charges ",1150.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1746.5,70,,1397.20,,,0,"percent of total billed charges ","70% of total billed charges ",320.63,2320.35,
"TX HUMERUS FX WO MANIPULATION",1703085,"CDM ",761,RC,24560,HCPCS,OUTPATIENT,,,1784.5,1427.6,,416,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",614.17,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1249.15,70,,999.32,,,0,"percent of total billed charges ","70% of total billed charges ",1606.05,90,,1284.84,,,0,"percent of total billed charges ","90% of total billed charges ",1659.59,93,,1327.67,,,0,"percent of total billed charges ","93% of total billed charges ",416,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",528.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1516.83,85,,1213.46,,,0,"percent of total billed charges ","85% of total billed charges ",1338.38,90,,1070.70,,,0,"percent of total billed charges ","90% of total billed charges ",1606.05,90,,1284.84,,,0,"percent of total billed charges ","90% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1552.52,87,,1242.02,,,0,"percent of total billed charges ","87% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1249.15,70,,999.32,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1659.59,
"INSERT CATH PLEURA W/IMAGE",1703090,"CDM ",761,RC,32557,HCPCS,OUTPATIENT,,,2050,1640,,278.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",862.54,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",314.01,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1435,70,,1148.00,,,0,"percent of total billed charges ","70% of total billed charges ",1845,90,,1476.00,,,0,"percent of total billed charges ","90% of total billed charges ",1906.5,93,,1525.20,,,0,"percent of total billed charges ","93% of total billed charges ",278.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",354.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1742.5,85,,1394.00,,,0,"percent of total billed charges ","85% of total billed charges ",1537.5,90,,1230.00,,,0,"percent of total billed charges ","90% of total billed charges ",1845,90,,1476.00,,,0,"percent of total billed charges ","90% of total billed charges ",350.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1783.5,87,,1426.80,,,0,"percent of total billed charges ","87% of total billed charges ",350.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1447.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1435,70,,1148.00,,,0,"percent of total billed charges ","70% of total billed charges ",278.77,1906.5,
"VACC ADM UPTO 18Y 1ST/ONLY CMP",1703095,"CDM ",761,RC,90460,HCPCS,OUTPATIENT,,,215,172,,,,,,,,0,"other ","not separately reimbursment ",,,,89.51,89.51,89.51,"1 through 10","other ","not separately reimbursment ",34.72,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",199.95,93,,159.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",182.75,85,,146.20,,,0,"percent of total billed charges ","85% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",187.05,87,,28.20,14.10,42.30,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",34.72,199.95,
"INC/REMOVAL FB SUBQ TISSUE-SIM",1703100,"CDM ",761,RC,10120,HCPCS,OUTPATIENT,,,1286,1028.8,,223.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1075.65,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",214.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",900.2,70,,720.16,,,0,"percent of total billed charges ","70% of total billed charges ",1157.4,90,,925.92,,,0,"percent of total billed charges ","90% of total billed charges ",1195.98,93,,956.78,,,0,"percent of total billed charges ","93% of total billed charges ",223.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1093.1,85,,874.48,,,0,"percent of total billed charges ","85% of total billed charges ",964.5,90,,771.60,,,0,"percent of total billed charges ","90% of total billed charges ",1157.4,90,,925.92,,,0,"percent of total billed charges ","90% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1118.82,87,,895.06,,,0,"percent of total billed charges ","87% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",900.2,70,,720.16,,,0,"percent of total billed charges ","70% of total billed charges ",214.57,1195.98,
CKMB,2000024,"CDM ",301,RC,82553,HCPCS,OUTPATIENT,,,259.5,207.6,,11.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",181.65,70,,145.32,,,0,"percent of total billed charges ","70% of total billed charges ",233.55,90,,186.84,,,0,"percent of total billed charges ","90% of total billed charges ",241.34,93,,193.07,,,0,"percent of total billed charges ","93% of total billed charges ",11.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",220.58,85,,176.46,,,0,"percent of total billed charges ","85% of total billed charges ",233.55,90,,186.84,,,0,"percent of total billed charges ","90% of total billed charges ",233.55,90,,186.84,,,0,"percent of total billed charges ","90% of total billed charges ",20.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",225.77,87,,201.28,169.07,201.28,"1 through 10","percent of total billed charges ","87% of total billed charges ",20.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.55,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",181.65,70,,145.32,,,0,"percent of total billed charges ","70% of total billed charges ",11.55,241.34,
"ACETONE SERUM QL",2000057,"CDM ",301,RC,82009,HCPCS,OUTPATIENT,,,71,56.8,,3.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,43.52,43.52,43.52,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.7,70,,39.76,,,0,"percent of total billed charges ","70% of total billed charges ",63.9,90,,51.12,,,0,"percent of total billed charges ","90% of total billed charges ",66.03,93,,52.82,,,0,"percent of total billed charges ","93% of total billed charges ",3.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2.08,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",60.35,85,,48.28,,,0,"percent of total billed charges ","85% of total billed charges ",63.9,90,,51.12,,,0,"percent of total billed charges ","90% of total billed charges ",63.9,90,,51.12,,,0,"percent of total billed charges ","90% of total billed charges ",2.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",61.77,87,,49.42,,,0,"percent of total billed charges ","87% of total billed charges ",2.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.51,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",49.7,70,,39.76,,,0,"percent of total billed charges ","70% of total billed charges ",2.06,66.03,
"ALBUMIN SERUM",2000073,"CDM ",301,RC,82040,HCPCS,OUTPATIENT,,,97,77.6,,4.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,12.74,12.74,12.74,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",90.21,93,,72.17,,,0,"percent of total billed charges ","93% of total billed charges ",4.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",82.45,85,,65.96,,,0,"percent of total billed charges ","85% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.39,87,,4.86,4.86,49.24,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.95,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",4.95,90.21,
"BLOOD ALCOHOL",2000081,"CDM ",301,RC,80321,HCPCS,OUTPATIENT,,,210.5,168.4,,15.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,165.33,165.33,165.33,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",195.77,93,,156.62,,,0,"percent of total billed charges ","93% of total billed charges ",15.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",178.93,85,,143.14,,,0,"percent of total billed charges ","85% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",183.14,87,,113.79,97.52,130.06,"1 through 10","percent of total billed charges ","87% of total billed charges ",19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",15.5,195.77,
"AMMONIA BLOOD",2000099,"CDM ",301,RC,82140,HCPCS,OUTPATIENT,,,251,200.8,,12.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,192.10,192.10,192.10,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",175.7,70,,140.56,,,0,"percent of total billed charges ","70% of total billed charges ",225.9,90,,180.72,,,0,"percent of total billed charges ","90% of total billed charges ",233.43,93,,186.74,,,0,"percent of total billed charges ","93% of total billed charges ",12.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",213.35,85,,170.68,,,0,"percent of total billed charges ","85% of total billed charges ",225.9,90,,180.72,,,0,"percent of total billed charges ","90% of total billed charges ",225.9,90,,180.72,,,0,"percent of total billed charges ","90% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",218.37,87,,174.70,,,0,"percent of total billed charges ","87% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.57,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",175.7,70,,140.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.38,233.43,
"BILIRUBIN DIRECT",2000107,"CDM ",301,RC,82248,HCPCS,OUTPATIENT,,,103,82.4,,4.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.1,70,,57.68,,,0,"percent of total billed charges ","70% of total billed charges ",92.7,90,,74.16,,,0,"percent of total billed charges ","90% of total billed charges ",95.79,93,,76.63,,,0,"percent of total billed charges ","93% of total billed charges ",4.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",87.55,85,,70.04,,,0,"percent of total billed charges ","85% of total billed charges ",92.7,90,,74.16,,,0,"percent of total billed charges ","90% of total billed charges ",92.7,90,,74.16,,,0,"percent of total billed charges ","90% of total billed charges ",4.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",89.61,87,,71.69,,,0,"percent of total billed charges ","87% of total billed charges ",4.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",72.1,70,,57.68,,,0,"percent of total billed charges ","70% of total billed charges ",4.13,95.79,
"BILIRUBIN TOTAL",2000123,"CDM ",301,RC,82247,HCPCS,OUTPATIENT,,,103,82.4,,5.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.1,70,,57.68,,,0,"percent of total billed charges ","70% of total billed charges ",92.7,90,,74.16,,,0,"percent of total billed charges ","90% of total billed charges ",95.79,93,,76.63,,,0,"percent of total billed charges ","93% of total billed charges ",5.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",87.55,85,,70.04,,,0,"percent of total billed charges ","85% of total billed charges ",92.7,90,,74.16,,,0,"percent of total billed charges ","90% of total billed charges ",92.7,90,,74.16,,,0,"percent of total billed charges ","90% of total billed charges ",7.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",89.61,87,,71.69,,,0,"percent of total billed charges ","87% of total billed charges ",7.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",72.1,70,,57.68,,,0,"percent of total billed charges ","70% of total billed charges ",5.01,95.79,
"CALCIUM SERUM",2000149,"CDM ",301,RC,82310,HCPCS,OUTPATIENT,,,103,82.4,,5.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.1,70,,57.68,,,0,"percent of total billed charges ","70% of total billed charges ",92.7,90,,74.16,,,0,"percent of total billed charges ","90% of total billed charges ",95.79,93,,76.63,,,0,"percent of total billed charges ","93% of total billed charges ",5.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",87.55,85,,70.04,,,0,"percent of total billed charges ","85% of total billed charges ",92.7,90,,74.16,,,0,"percent of total billed charges ","90% of total billed charges ",92.7,90,,74.16,,,0,"percent of total billed charges ","90% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",89.61,87,,71.69,,,0,"percent of total billed charges ","87% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.16,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",72.1,70,,57.68,,,0,"percent of total billed charges ","70% of total billed charges ",5.16,95.79,
BICARBONATE,2000156,"CDM ",301,RC,82374,HCPCS,OUTPATIENT,,,97,77.6,,4.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",90.21,93,,72.17,,,0,"percent of total billed charges ","93% of total billed charges ",4.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",82.45,85,,65.96,,,0,"percent of total billed charges ","85% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",8.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.39,87,,67.51,,,0,"percent of total billed charges ","87% of total billed charges ",8.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",4.88,90.21,
"CHLORIDE SERUM",2000172,"CDM ",301,RC,82435,HCPCS,OUTPATIENT,,,91.5,73.2,,4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.05,70,,51.24,,,0,"percent of total billed charges ","70% of total billed charges ",82.35,90,,65.88,,,0,"percent of total billed charges ","90% of total billed charges ",85.1,93,,68.08,,,0,"percent of total billed charges ","93% of total billed charges ",4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",77.78,85,,62.22,,,0,"percent of total billed charges ","85% of total billed charges ",82.35,90,,65.88,,,0,"percent of total billed charges ","90% of total billed charges ",82.35,90,,65.88,,,0,"percent of total billed charges ","90% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",79.61,87,,63.69,,,0,"percent of total billed charges ","87% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.59,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",64.05,70,,51.24,,,0,"percent of total billed charges ","70% of total billed charges ",4.2,85.1,
"CHOLESTEROL SERUM",2000198,"CDM ",301,RC,82465,HCPCS,OUTPATIENT,,,90.5,72.4,,4.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.35,70,,50.68,,,0,"percent of total billed charges ","70% of total billed charges ",81.45,90,,65.16,,,0,"percent of total billed charges ","90% of total billed charges ",84.17,93,,67.34,,,0,"percent of total billed charges ","93% of total billed charges ",4.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",76.93,85,,61.54,,,0,"percent of total billed charges ","85% of total billed charges ",81.45,90,,65.16,,,0,"percent of total billed charges ","90% of total billed charges ",81.45,90,,65.16,,,0,"percent of total billed charges ","90% of total billed charges ",7.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",78.74,87,,62.99,,,0,"percent of total billed charges ","87% of total billed charges ",7.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.34,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63.35,70,,50.68,,,0,"percent of total billed charges ","70% of total billed charges ",4.34,84.17,
CPK,2000222,"CDM ",301,RC,82550,HCPCS,OUTPATIENT,,,134,107.2,,6.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.8,70,,75.04,,,0,"percent of total billed charges ","70% of total billed charges ",120.6,90,,96.48,,,0,"percent of total billed charges ","90% of total billed charges ",124.62,93,,99.70,,,0,"percent of total billed charges ","93% of total billed charges ",6.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",113.9,85,,91.12,,,0,"percent of total billed charges ","85% of total billed charges ",120.6,90,,96.48,,,0,"percent of total billed charges ","90% of total billed charges ",120.6,90,,96.48,,,0,"percent of total billed charges ","90% of total billed charges ",11.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",116.58,87,,93.87,29.50,104.30,"1 through 10","percent of total billed charges ","87% of total billed charges ",11.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.51,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",93.8,70,,75.04,,,0,"percent of total billed charges ","70% of total billed charges ",6.51,124.62,
CREATININE,2000248,"CDM ",301,RC,82565,HCPCS,OUTPATIENT,,,24.5,19.6,,5.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.15,70,,13.72,,,0,"percent of total billed charges ","70% of total billed charges ",22.05,90,,17.64,,,0,"percent of total billed charges ","90% of total billed charges ",22.79,93,,18.23,,,0,"percent of total billed charges ","93% of total billed charges ",5.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",20.83,85,,16.66,,,0,"percent of total billed charges ","85% of total billed charges ",22.05,90,,17.64,,,0,"percent of total billed charges ","90% of total billed charges ",22.05,90,,17.64,,,0,"percent of total billed charges ","90% of total billed charges ",9.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.32,87,,5.02,5.02,5.02,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",17.15,70,,13.72,,,0,"percent of total billed charges ","70% of total billed charges ",5.12,22.79,
ELECTROLYTES,2000289,"CDM ",301,RC,80051,HCPCS,OUTPATIENT,,,48,38.4,,6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.93,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",7.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",7.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",6,44.64,
GLUCOSE,2000305,"CDM ",301,RC,82947,HCPCS,OUTPATIENT,,,83,66.4,,3.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",3.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",6.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",72.21,87,,64.65,40.33,64.65,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",3.93,77.19,
HAPTOGLOBIN,2000354,"CDM ",301,RC,83010,HCPCS,OUTPATIENT,,,115,92,,12.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",12.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.58,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",12.58,106.95,
"CREATININE URINE",2000362,"CDM ",301,RC,82570,HCPCS,OUTPATIENT,,,108,86.4,,5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,5.08,4.98,50.30,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",5.18,100.44,
"IMMUNOGLOBULIN IGG",2000370,"CDM ",301,RC,82784,HCPCS,OUTPATIENT,,,108,86.4,,9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,75.17,,,0,"percent of total billed charges ","87% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",9.3,100.44,
"IMMUNOGLOBULIN IGA",2000388,"CDM ",301,RC,82784,HCPCS,OUTPATIENT,,,108,86.4,,9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,75.17,,,0,"percent of total billed charges ","87% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",9.3,100.44,
"IMMUNOGLOBULIN IGM",2000396,"CDM ",301,RC,82784,HCPCS,OUTPATIENT,,,108,86.4,,9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,75.17,,,0,"percent of total billed charges ","87% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",9.3,100.44,
"IMMUNOGLOBULIN IGE",2000404,"CDM ",301,RC,82785,HCPCS,OUTPATIENT,,,108,86.4,,13.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,75.73,75.73,75.73,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",13.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.57,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",17.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,87.28,71.25,103.31,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.46,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",13.99,100.44,
"INSULIN TOTAL",2000412,"CDM ",301,RC,83525,HCPCS,OUTPATIENT,,,112.5,90,,11.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.69,60.69,60.69,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",104.63,93,,83.70,,,0,"percent of total billed charges ","93% of total billed charges ",11.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",95.63,85,,76.50,,,0,"percent of total billed charges ","85% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",97.88,87,,69.65,66.61,81.84,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.43,104.63,
"IRON SERUM",2000446,"CDM ",301,RC,83540,HCPCS,OUTPATIENT,,,127,101.6,,5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,6.34,6.34,6.34,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.9,70,,71.12,,,0,"percent of total billed charges ","70% of total billed charges ",114.3,90,,91.44,,,0,"percent of total billed charges ","90% of total billed charges ",118.11,93,,94.49,,,0,"percent of total billed charges ","93% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",107.95,85,,86.36,,,0,"percent of total billed charges ","85% of total billed charges ",114.3,90,,91.44,,,0,"percent of total billed charges ","90% of total billed charges ",114.3,90,,91.44,,,0,"percent of total billed charges ","90% of total billed charges ",6.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",110.49,87,,16.81,6.35,98.70,16,"percent of total billed charges ","87% of total billed charges ",6.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.47,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",88.9,70,,71.12,,,0,"percent of total billed charges ","70% of total billed charges ",5.5,118.11,
"IRON BINDING CAPACITY",2000453,"CDM ",301,RC,83550,HCPCS,OUTPATIENT,,,177.5,142,,8.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.25,70,,99.40,,,0,"percent of total billed charges ","70% of total billed charges ",159.75,90,,127.80,,,0,"percent of total billed charges ","90% of total billed charges ",165.08,93,,132.06,,,0,"percent of total billed charges ","93% of total billed charges ",8.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",150.88,85,,120.70,,,0,"percent of total billed charges ","85% of total billed charges ",159.75,90,,127.80,,,0,"percent of total billed charges ","90% of total billed charges ",159.75,90,,127.80,,,0,"percent of total billed charges ","90% of total billed charges ",15.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",154.43,87,,123.54,,,0,"percent of total billed charges ","87% of total billed charges ",15.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",124.25,70,,99.40,,,0,"percent of total billed charges ","70% of total billed charges ",8.74,165.08,
LDH,2000479,"CDM ",301,RC,83615,HCPCS,OUTPATIENT,,,123,98.4,,6.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.1,70,,68.88,,,0,"percent of total billed charges ","70% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",114.39,93,,91.51,,,0,"percent of total billed charges ","93% of total billed charges ",6.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.55,85,,83.64,,,0,"percent of total billed charges ","85% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.01,87,,81.33,26.88,95.68,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.04,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",86.1,70,,68.88,,,0,"percent of total billed charges ","70% of total billed charges ",6.04,114.39,
"LEAD BLOOD ADULT",2000487,"CDM ",301,RC,83655,HCPCS,OUTPATIENT,,,54,43.2,,11.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.8,70,,30.24,,,0,"percent of total billed charges ","70% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",50.22,93,,40.18,,,0,"percent of total billed charges ","93% of total billed charges ",11.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.9,85,,36.72,,,0,"percent of total billed charges ","85% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",15.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.98,87,,33.45,33.45,33.45,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.11,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",37.8,70,,30.24,,,0,"percent of total billed charges ","70% of total billed charges ",11.7,50.22,
"LIPASE SERUM",2000511,"CDM ",301,RC,83690,HCPCS,OUTPATIENT,,,61.5,49.2,,6.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.05,70,,34.44,,,0,"percent of total billed charges ","70% of total billed charges ",55.35,90,,44.28,,,0,"percent of total billed charges ","90% of total billed charges ",57.2,93,,45.76,,,0,"percent of total billed charges ","93% of total billed charges ",6.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",52.28,85,,41.82,,,0,"percent of total billed charges ","85% of total billed charges ",55.35,90,,44.28,,,0,"percent of total billed charges ","90% of total billed charges ",55.35,90,,44.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.51,87,,38.27,27.51,47.84,14,"percent of total billed charges ","87% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.89,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",43.05,70,,34.44,,,0,"percent of total billed charges ","70% of total billed charges ",6.89,57.2,
"LITHIUM LEVEL",2000552,"CDM ",301,RC,80178,HCPCS,OUTPATIENT,,,218.5,174.8,,6.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",203.21,93,,162.57,,,0,"percent of total billed charges ","93% of total billed charges ",6.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",185.73,85,,148.58,,,0,"percent of total billed charges ","85% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",190.1,87,,152.08,,,0,"percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",6.61,203.21,
"MAGNESIUM LEVEL",2000560,"CDM ",301,RC,83735,HCPCS,OUTPATIENT,,,75.5,60.4,,6.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",70.22,93,,56.18,,,0,"percent of total billed charges ","93% of total billed charges ",6.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",64.18,85,,51.34,,,0,"percent of total billed charges ","85% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.69,87,,46.55,6.57,58.19,15,"percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.7,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",6.7,70.22,
"PHOSPHATASE ACID TOTAL",2000636,"CDM ",301,RC,84060,HCPCS,OUTPATIENT,,,79,63.2,,8.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.3,70,,44.24,,,0,"percent of total billed charges ","70% of total billed charges ",71.1,90,,56.88,,,0,"percent of total billed charges ","90% of total billed charges ",73.47,93,,58.78,,,0,"percent of total billed charges ","93% of total billed charges ",8.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",67.15,85,,53.72,,,0,"percent of total billed charges ","85% of total billed charges ",71.1,90,,56.88,,,0,"percent of total billed charges ","90% of total billed charges ",71.1,90,,56.88,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",68.73,87,,54.98,,,0,"percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",55.3,70,,44.24,,,0,"percent of total billed charges ","70% of total billed charges ",7.64,73.47,
"ALKALINE PHOSPHATASE",2000644,"CDM ",301,RC,84075,HCPCS,OUTPATIENT,,,36,28.8,,5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,27.63,27.63,27.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.2,70,,20.16,,,0,"percent of total billed charges ","70% of total billed charges ",32.4,90,,25.92,,,0,"percent of total billed charges ","90% of total billed charges ",33.48,93,,26.78,,,0,"percent of total billed charges ","93% of total billed charges ",5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",30.6,85,,24.48,,,0,"percent of total billed charges ","85% of total billed charges ",32.4,90,,25.92,,,0,"percent of total billed charges ","90% of total billed charges ",32.4,90,,25.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.32,87,,25.06,,,0,"percent of total billed charges ","87% of total billed charges ",9.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",25.2,70,,20.16,,,0,"percent of total billed charges ","70% of total billed charges ",5.18,33.48,
"PHOSPHOROUS INORGANIC",2000669,"CDM ",301,RC,84100,HCPCS,OUTPATIENT,,,109.5,87.6,,4.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,12.18,12.18,12.18,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.65,70,,61.32,,,0,"percent of total billed charges ","70% of total billed charges ",98.55,90,,78.84,,,0,"percent of total billed charges ","90% of total billed charges ",101.84,93,,81.47,,,0,"percent of total billed charges ","93% of total billed charges ",4.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",93.08,85,,74.46,,,0,"percent of total billed charges ","85% of total billed charges ",98.55,90,,78.84,,,0,"percent of total billed charges ","90% of total billed charges ",98.55,90,,78.84,,,0,"percent of total billed charges ","90% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",95.27,87,,68.27,4.65,85.34,11,"percent of total billed charges ","87% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",76.65,70,,61.32,,,0,"percent of total billed charges ","70% of total billed charges ",4.74,101.84,
"POTASSIUM SERUM",2000677,"CDM ",301,RC,84132,HCPCS,OUTPATIENT,,,92.5,74,,4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",86.03,93,,68.82,,,0,"percent of total billed charges ","93% of total billed charges ",4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",78.63,85,,62.90,,,0,"percent of total billed charges ","85% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.48,87,,64.38,,,0,"percent of total billed charges ","87% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.76,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",4.2,86.03,
"PROTEIN TOTAL",2000693,"CDM ",301,RC,84156,HCPCS,OUTPATIENT,,,108,86.4,,3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,43.83,11.65,76.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",3.67,100.44,
HOMOCYSTINE,2000701,"CDM ",301,RC,83090,HCPCS,OUTPATIENT,,,336,268.8,,17.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",235.2,70,,188.16,,,0,"percent of total billed charges ","70% of total billed charges ",302.4,90,,241.92,,,0,"percent of total billed charges ","90% of total billed charges ",312.48,93,,249.98,,,0,"percent of total billed charges ","93% of total billed charges ",17.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",285.6,85,,228.48,,,0,"percent of total billed charges ","85% of total billed charges ",302.4,90,,241.92,,,0,"percent of total billed charges ","90% of total billed charges ",302.4,90,,241.92,,,0,"percent of total billed charges ","90% of total billed charges ",25.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",292.32,87,,261.19,261.19,261.19,"1 through 10","percent of total billed charges ","87% of total billed charges ",25.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.92,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",235.2,70,,188.16,,,0,"percent of total billed charges ","70% of total billed charges ",17.92,312.48,
"ORGANISM ID",2000743,"CDM ",306,RC,87077,HCPCS,OUTPATIENT,,,229,183.2,,8.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",160.3,70,,128.24,,,0,"percent of total billed charges ","70% of total billed charges ",206.1,90,,164.88,,,0,"percent of total billed charges ","90% of total billed charges ",212.97,93,,170.38,,,0,"percent of total billed charges ","93% of total billed charges ",8.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.54,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",194.65,85,,155.72,,,0,"percent of total billed charges ","85% of total billed charges ",206.1,90,,164.88,,,0,"percent of total billed charges ","90% of total billed charges ",206.1,90,,164.88,,,0,"percent of total billed charges ","90% of total billed charges ",12.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",199.23,87,,159.38,,,0,"percent of total billed charges ","87% of total billed charges ",12.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.08,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",160.3,70,,128.24,,,0,"percent of total billed charges ","70% of total billed charges ",8.08,212.97,
SALICYLATES,2000750,"CDM ",301,RC,80329,HCPCS,OUTPATIENT,,,137.5,110,,22.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.25,70,,77.00,,,0,"percent of total billed charges ","70% of total billed charges ",123.75,90,,99.00,,,0,"percent of total billed charges ","90% of total billed charges ",127.88,93,,102.30,,,0,"percent of total billed charges ","93% of total billed charges ",22.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.95,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",116.88,85,,93.50,,,0,"percent of total billed charges ","85% of total billed charges ",123.75,90,,99.00,,,0,"percent of total billed charges ","90% of total billed charges ",123.75,90,,99.00,,,0,"percent of total billed charges ","90% of total billed charges ",28.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",119.63,87,,95.70,,,0,"percent of total billed charges ","87% of total billed charges ",28.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",96.25,70,,77.00,,,0,"percent of total billed charges ","70% of total billed charges ",22.78,127.88,
"STREP SCREEN",2000768,"CDM ",306,RC,87081,HCPCS,OUTPATIENT,,,187,149.6,,6.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",173.91,93,,139.13,,,0,"percent of total billed charges ","93% of total billed charges ",6.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",158.95,85,,127.16,,,0,"percent of total billed charges ","85% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",162.69,87,,156.45,156.45,156.45,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.63,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",6.63,173.91,
"SODIUM SERUM",2000776,"CDM ",301,RC,84295,HCPCS,OUTPATIENT,,,97,77.6,,4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,9.27,9.27,9.27,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",90.21,93,,72.17,,,0,"percent of total billed charges ","93% of total billed charges ",4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",82.45,85,,65.96,,,0,"percent of total billed charges ","85% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.39,87,,67.51,,,0,"percent of total billed charges ","87% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.8,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",4.2,90.21,
"TESTOSTERONE TOTAL",2000792,"CDM ",301,RC,84403,HCPCS,OUTPATIENT,,,225,180,,25.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.5,70,,126.00,,,0,"percent of total billed charges ","70% of total billed charges ",202.5,90,,162.00,,,0,"percent of total billed charges ","90% of total billed charges ",209.25,93,,167.40,,,0,"percent of total billed charges ","93% of total billed charges ",25.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.58,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",191.25,85,,153.00,,,0,"percent of total billed charges ","85% of total billed charges ",202.5,90,,162.00,,,0,"percent of total billed charges ","90% of total billed charges ",202.5,90,,162.00,,,0,"percent of total billed charges ","90% of total billed charges ",40.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.75,87,,117.78,25.30,174.56,11,"percent of total billed charges ","87% of total billed charges ",40.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.81,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.5,70,,126.00,,,0,"percent of total billed charges ","70% of total billed charges ",25.81,209.25,
SGOT,2000834,"CDM ",301,RC,84450,HCPCS,OUTPATIENT,,,108,86.4,,5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,82.88,82.88,82.88,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",9.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,75.17,,,0,"percent of total billed charges ","87% of total billed charges ",9.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",5.18,100.44,
SGPT,2000842,"CDM ",301,RC,84460,HCPCS,OUTPATIENT,,,108,86.4,,5.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,82.88,82.88,82.88,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",5.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",9.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,75.17,,,0,"percent of total billed charges ","87% of total billed charges ",9.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",5.3,100.44,
TRIGLYCERIDES,2000859,"CDM ",301,RC,84478,HCPCS,OUTPATIENT,,,124.5,99.6,,5.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,11.77,11.77,11.77,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.15,70,,69.72,,,0,"percent of total billed charges ","70% of total billed charges ",112.05,90,,89.64,,,0,"percent of total billed charges ","90% of total billed charges ",115.79,93,,92.63,,,0,"percent of total billed charges ","93% of total billed charges ",5.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",105.83,85,,84.66,,,0,"percent of total billed charges ","85% of total billed charges ",112.05,90,,89.64,,,0,"percent of total billed charges ","90% of total billed charges ",112.05,90,,89.64,,,0,"percent of total billed charges ","90% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",108.32,87,,86.66,,,0,"percent of total billed charges ","87% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",87.15,70,,69.72,,,0,"percent of total billed charges ","70% of total billed charges ",5.74,115.79,
BUN,2000867,"CDM ",301,RC,84520,HCPCS,OUTPATIENT,,,92.5,74,,3.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",86.03,93,,68.82,,,0,"percent of total billed charges ","93% of total billed charges ",3.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",78.63,85,,62.90,,,0,"percent of total billed charges ","85% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",7.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.48,87,,64.38,,,0,"percent of total billed charges ","87% of total billed charges ",7.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.95,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",3.95,86.03,
"URIC ACID BLOOD",2000875,"CDM ",301,RC,84550,HCPCS,OUTPATIENT,,,90.5,72.4,,4.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,4.43,4.43,4.43,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.35,70,,50.68,,,0,"percent of total billed charges ","70% of total billed charges ",81.45,90,,65.16,,,0,"percent of total billed charges ","90% of total billed charges ",84.17,93,,67.34,,,0,"percent of total billed charges ","93% of total billed charges ",4.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.26,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",76.93,85,,61.54,,,0,"percent of total billed charges ","85% of total billed charges ",81.45,90,,65.16,,,0,"percent of total billed charges ","90% of total billed charges ",81.45,90,,65.16,,,0,"percent of total billed charges ","90% of total billed charges ",8.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",78.74,87,,4.43,4.43,70.25,13,"percent of total billed charges ","87% of total billed charges ",8.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.51,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63.35,70,,50.68,,,0,"percent of total billed charges ","70% of total billed charges ",4.51,84.17,
"*RHEUM IMMUNOASSAY",2000883,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,99.5,79.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.65,70,,55.72,,,0,"percent of total billed charges ","70% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",92.54,93,,74.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",84.58,85,,67.66,,,0,"percent of total billed charges ","85% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",86.57,87,,69.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",69.65,70,,55.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,92.54,
"VITAMIN A",2000891,"CDM ",301,RC,84590,HCPCS,OUTPATIENT,,,102.5,82,,11.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.75,70,,57.40,,,0,"percent of total billed charges ","70% of total billed charges ",92.25,90,,73.80,,,0,"percent of total billed charges ","90% of total billed charges ",95.33,93,,76.26,,,0,"percent of total billed charges ","93% of total billed charges ",11.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",87.13,85,,69.70,,,0,"percent of total billed charges ","85% of total billed charges ",92.25,90,,73.80,,,0,"percent of total billed charges ","90% of total billed charges ",92.25,90,,73.80,,,0,"percent of total billed charges ","90% of total billed charges ",17.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",89.18,87,,71.34,,,0,"percent of total billed charges ","87% of total billed charges ",17.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",71.75,70,,57.40,,,0,"percent of total billed charges ","70% of total billed charges ",11.61,95.33,
"ALDOSTERONE SERUM",2000933,"CDM ",301,RC,82088,HCPCS,OUTPATIENT,,,271.5,217.2,,34.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",190.05,70,,152.04,,,0,"percent of total billed charges ","70% of total billed charges ",244.35,90,,195.48,,,0,"percent of total billed charges ","90% of total billed charges ",252.5,93,,202.00,,,0,"percent of total billed charges ","93% of total billed charges ",34.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.58,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",230.78,85,,184.62,,,0,"percent of total billed charges ","85% of total billed charges ",244.35,90,,195.48,,,0,"percent of total billed charges ","90% of total billed charges ",244.35,90,,195.48,,,0,"percent of total billed charges ","90% of total billed charges ",40.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",236.21,87,,188.97,,,0,"percent of total billed charges ","87% of total billed charges ",40.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.75,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",190.05,70,,152.04,,,0,"percent of total billed charges ","70% of total billed charges ",34.64,252.5,
"AMYLASE SERUM",2000941,"CDM ",301,RC,82150,HCPCS,OUTPATIENT,,,134,107.2,,6.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.8,70,,75.04,,,0,"percent of total billed charges ","70% of total billed charges ",120.6,90,,96.48,,,0,"percent of total billed charges ","90% of total billed charges ",124.62,93,,99.70,,,0,"percent of total billed charges ","93% of total billed charges ",6.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",113.9,85,,91.12,,,0,"percent of total billed charges ","85% of total billed charges ",120.6,90,,96.48,,,0,"percent of total billed charges ","90% of total billed charges ",120.6,90,,96.48,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",116.58,87,,86.05,56.66,104.30,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.48,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",93.8,70,,75.04,,,0,"percent of total billed charges ","70% of total billed charges ",6.48,124.62,
"ANTI RBC ELUTION",2001006,"CDM ",300,RC,86860,HCPCS,OUTPATIENT,,,183,146.4,,129.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.1,70,,102.48,,,0,"percent of total billed charges ","70% of total billed charges ",164.7,90,,131.76,,,0,"percent of total billed charges ","90% of total billed charges ",170.19,93,,136.15,,,0,"percent of total billed charges ","93% of total billed charges ",129.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",155.55,85,,124.44,,,0,"percent of total billed charges ","85% of total billed charges ",164.7,90,,131.76,,,0,"percent of total billed charges ","90% of total billed charges ",164.7,90,,131.76,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",159.21,87,,127.37,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",128.1,70,,102.48,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,170.19,
ESTRADIOL,2001030,"CDM ",301,RC,82670,HCPCS,OUTPATIENT,,,269,215.2,,27.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.3,70,,150.64,,,0,"percent of total billed charges ","70% of total billed charges ",242.1,90,,193.68,,,0,"percent of total billed charges ","90% of total billed charges ",250.17,93,,200.14,,,0,"percent of total billed charges ","93% of total billed charges ",27.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",51.03,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",228.65,85,,182.92,,,0,"percent of total billed charges ","85% of total billed charges ",242.1,90,,193.68,,,0,"percent of total billed charges ","90% of total billed charges ",242.1,90,,193.68,,,0,"percent of total billed charges ","90% of total billed charges ",50.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",234.03,87,,141.05,45.60,167.23,"1 through 10","percent of total billed charges ","87% of total billed charges ",50.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.94,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",188.3,70,,150.64,,,0,"percent of total billed charges ","70% of total billed charges ",27.94,250.17,
"ESTRIOL SERUM",2001048,"CDM ",301,RC,82677,HCPCS,OUTPATIENT,,,149,119.2,,21.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.3,70,,83.44,,,0,"percent of total billed charges ","70% of total billed charges ",134.1,90,,107.28,,,0,"percent of total billed charges ","90% of total billed charges ",138.57,93,,110.86,,,0,"percent of total billed charges ","93% of total billed charges ",21.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",126.65,85,,101.32,,,0,"percent of total billed charges ","85% of total billed charges ",134.1,90,,107.28,,,0,"percent of total billed charges ","90% of total billed charges ",134.1,90,,107.28,,,0,"percent of total billed charges ","90% of total billed charges ",28.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",129.63,87,,103.70,,,0,"percent of total billed charges ","87% of total billed charges ",28.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.3,70,,83.44,,,0,"percent of total billed charges ","70% of total billed charges ",21.42,138.57,
"*FSH (FOLLICLE STIM HORMONE",2001055,"CDM ",301,RC,83001,HCPCS,OUTPATIENT,,,157.5,126,,18.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.25,70,,88.20,,,0,"percent of total billed charges ","70% of total billed charges ",141.75,90,,113.40,,,0,"percent of total billed charges ","90% of total billed charges ",146.48,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",18.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",133.88,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.75,90,,113.40,,,0,"percent of total billed charges ","90% of total billed charges ",141.75,90,,113.40,,,0,"percent of total billed charges ","90% of total billed charges ",32.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",137.03,87,,65.74,26.01,110.16,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.57,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",110.25,70,,88.20,,,0,"percent of total billed charges ","70% of total billed charges ",18.57,146.48,
"DHEA SULFATE",2001071,"CDM ",301,RC,82627,HCPCS,OUTPATIENT,,,172,137.6,,22.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,96.22,96.22,96.22,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.4,70,,96.32,,,0,"percent of total billed charges ","70% of total billed charges ",154.8,90,,123.84,,,0,"percent of total billed charges ","90% of total billed charges ",159.96,93,,127.97,,,0,"percent of total billed charges ","93% of total billed charges ",22.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",146.2,85,,116.96,,,0,"percent of total billed charges ","85% of total billed charges ",154.8,90,,123.84,,,0,"percent of total billed charges ","90% of total billed charges ",154.8,90,,123.84,,,0,"percent of total billed charges ","90% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.64,87,,119.71,,,0,"percent of total billed charges ","87% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.23,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",120.4,70,,96.32,,,0,"percent of total billed charges ","70% of total billed charges ",22.23,159.96,
"RBC AG OTHER THAN ABO OR RHD",2001121,"CDM ",300,RC,86905,HCPCS,OUTPATIENT,,,221,176.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154.7,70,,123.76,,,0,"percent of total billed charges ","70% of total billed charges ",198.9,90,,159.12,,,0,"percent of total billed charges ","90% of total billed charges ",205.53,93,,164.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",6.27,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",187.85,85,,150.28,,,0,"percent of total billed charges ","85% of total billed charges ",198.9,90,,159.12,,,0,"percent of total billed charges ","90% of total billed charges ",198.9,90,,159.12,,,0,"percent of total billed charges ","90% of total billed charges ",6.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",192.27,87,,153.82,,,0,"percent of total billed charges ","87% of total billed charges ",6.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",154.7,70,,123.76,,,0,"percent of total billed charges ","70% of total billed charges ",6.21,329.64,
"PREG TEST URINE QL",2001162,"CDM ",307,RC,81025,HCPCS,OUTPATIENT,,,188,150.4,,7.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,6.20,6.20,6.20,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.6,70,,105.28,,,0,"percent of total billed charges ","70% of total billed charges ",169.2,90,,135.36,,,0,"percent of total billed charges ","90% of total billed charges ",174.84,93,,139.87,,,0,"percent of total billed charges ","93% of total billed charges ",7.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",159.8,85,,127.84,,,0,"percent of total billed charges ","85% of total billed charges ",169.2,90,,135.36,,,0,"percent of total billed charges ","90% of total billed charges ",169.2,90,,135.36,,,0,"percent of total billed charges ","90% of total billed charges ",9.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",163.56,87,,130.34,86.68,162.92,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",131.6,70,,105.28,,,0,"percent of total billed charges ","70% of total billed charges ",7.43,174.84,
"PREG TEST SERUM QL",2001170,"CDM ",301,RC,84703,HCPCS,OUTPATIENT,,,120.5,96.4,,7.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.56,64.56,64.56,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.35,70,,67.48,,,0,"percent of total billed charges ","70% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",112.07,93,,89.66,,,0,"percent of total billed charges ","93% of total billed charges ",7.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.89,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",102.43,85,,81.94,,,0,"percent of total billed charges ","85% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",11.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",104.84,87,,84.18,70.15,93.53,"1 through 10","percent of total billed charges ","87% of total billed charges ",11.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.52,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",84.35,70,,67.48,,,0,"percent of total billed charges ","70% of total billed charges ",7.52,112.07,
"AFB SENSITIVITY",2001204,"CDM ",306,RC,87190,HCPCS,OUTPATIENT,,,312.5,250,,6.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",218.75,70,,175.00,,,0,"percent of total billed charges ","70% of total billed charges ",281.25,90,,225.00,,,0,"percent of total billed charges ","90% of total billed charges ",290.63,93,,232.50,,,0,"percent of total billed charges ","93% of total billed charges ",6.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.93,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",265.63,85,,212.50,,,0,"percent of total billed charges ","85% of total billed charges ",281.25,90,,225.00,,,0,"percent of total billed charges ","90% of total billed charges ",281.25,90,,225.00,,,0,"percent of total billed charges ","90% of total billed charges ",7.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",271.88,87,,217.50,,,0,"percent of total billed charges ","87% of total billed charges ",7.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.31,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",218.75,70,,175.00,,,0,"percent of total billed charges ","70% of total billed charges ",6.24,290.63,
"SPECIFIC GRAVITY",2001220,"CDM ",307,RC,81000,HCPCS,OUTPATIENT,,,60.5,48.4,,4.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.35,70,,33.88,,,0,"percent of total billed charges ","70% of total billed charges ",54.45,90,,43.56,,,0,"percent of total billed charges ","90% of total billed charges ",56.27,93,,45.02,,,0,"percent of total billed charges ","93% of total billed charges ",4.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",51.43,85,,41.14,,,0,"percent of total billed charges ","85% of total billed charges ",54.45,90,,43.56,,,0,"percent of total billed charges ","90% of total billed charges ",54.45,90,,43.56,,,0,"percent of total billed charges ","90% of total billed charges ",5.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",52.64,87,,42.11,,,0,"percent of total billed charges ","87% of total billed charges ",5.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",42.35,70,,33.88,,,0,"percent of total billed charges ","70% of total billed charges ",4.01,56.27,
"URINALYSIS ROUTINE",2001246,"CDM ",307,RC,81000,HCPCS,OUTPATIENT,,,86,68.8,,4.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.2,70,,48.16,,,0,"percent of total billed charges ","70% of total billed charges ",77.4,90,,61.92,,,0,"percent of total billed charges ","90% of total billed charges ",79.98,93,,63.98,,,0,"percent of total billed charges ","93% of total billed charges ",4.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",73.1,85,,58.48,,,0,"percent of total billed charges ","85% of total billed charges ",77.4,90,,61.92,,,0,"percent of total billed charges ","90% of total billed charges ",77.4,90,,61.92,,,0,"percent of total billed charges ","90% of total billed charges ",5.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",74.82,87,,59.86,,,0,"percent of total billed charges ","87% of total billed charges ",5.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",60.2,70,,48.16,,,0,"percent of total billed charges ","70% of total billed charges ",4.01,79.98,
"CBC W/AUTO DIFF",2001287,"CDM ",305,RC,85025,HCPCS,OUTPATIENT,,,190,152,,6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,7.61,7.61,7.61,"1 through 10","other ","not separately reimbursment ",,,,14.65,14.65,14.65,"1 through 10","other ","not separately reimbursment ",133,70,,106.40,,,0,"percent of total billed charges ","70% of total billed charges ",171,90,,136.80,,,0,"percent of total billed charges ","90% of total billed charges ",176.7,93,,141.36,,,0,"percent of total billed charges ","93% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",161.5,85,,129.20,,,0,"percent of total billed charges ","85% of total billed charges ",171,90,,136.80,,,0,"percent of total billed charges ","90% of total billed charges ",171,90,,136.80,,,0,"percent of total billed charges ","90% of total billed charges ",6.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",165.3,87,,131.71,7.62,164.64,48,"percent of total billed charges ","87% of total billed charges ",6.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.77,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",133,70,,106.40,,,0,"percent of total billed charges ","70% of total billed charges ",6.54,176.7,
HEMATOCRIT,2001295,"CDM ",305,RC,85014,HCPCS,OUTPATIENT,,,45,36,,2.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",2.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1.73,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",1.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,32.39,27.27,37.51,"1 through 10","percent of total billed charges ","87% of total billed charges ",1.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2.37,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",1.71,41.85,
HEMOGLOBIN,2001303,"CDM ",305,RC,85018,HCPCS,OUTPATIENT,,,19,15.2,,2.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.3,70,,10.64,,,0,"percent of total billed charges ","70% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.67,93,,14.14,,,0,"percent of total billed charges ","93% of total billed charges ",2.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1.73,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",16.15,85,,12.92,,,0,"percent of total billed charges ","85% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",1.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.53,87,,2.37,1.90,14.74,11,"percent of total billed charges ","87% of total billed charges ",1.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2.37,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",13.3,70,,10.64,,,0,"percent of total billed charges ","70% of total billed charges ",1.71,17.67,
"WHITE CELL COUNT",2001329,"CDM ",305,RC,85048,HCPCS,OUTPATIENT,,,19,15.2,,2.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.3,70,,10.64,,,0,"percent of total billed charges ","70% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.67,93,,14.14,,,0,"percent of total billed charges ","93% of total billed charges ",2.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1.73,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",16.15,85,,12.92,,,0,"percent of total billed charges ","85% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",1.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.53,87,,13.22,,,0,"percent of total billed charges ","87% of total billed charges ",1.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2.54,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",13.3,70,,10.64,,,0,"percent of total billed charges ","70% of total billed charges ",1.71,17.67,
"PLATELET COUNT",2001337,"CDM ",305,RC,85049,HCPCS,OUTPATIENT,,,30.5,24.4,,4.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.35,70,,17.08,,,0,"percent of total billed charges ","70% of total billed charges ",27.45,90,,21.96,,,0,"percent of total billed charges ","90% of total billed charges ",28.37,93,,22.70,,,0,"percent of total billed charges ","93% of total billed charges ",4.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.83,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",25.93,85,,20.74,,,0,"percent of total billed charges ","85% of total billed charges ",27.45,90,,21.96,,,0,"percent of total billed charges ","90% of total billed charges ",27.45,90,,21.96,,,0,"percent of total billed charges ","90% of total billed charges ",11.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.54,87,,21.23,,,0,"percent of total billed charges ","87% of total billed charges ",11.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.48,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",21.35,70,,17.08,,,0,"percent of total billed charges ","70% of total billed charges ",4.48,28.37,
"RETICULOCYTE COUNT",2001345,"CDM ",305,RC,85045,HCPCS,OUTPATIENT,,,154,123.2,,3.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",107.8,70,,86.24,,,0,"percent of total billed charges ","70% of total billed charges ",138.6,90,,110.88,,,0,"percent of total billed charges ","90% of total billed charges ",143.22,93,,114.58,,,0,"percent of total billed charges ","93% of total billed charges ",3.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",130.9,85,,104.72,,,0,"percent of total billed charges ","85% of total billed charges ",138.6,90,,110.88,,,0,"percent of total billed charges ","90% of total billed charges ",138.6,90,,110.88,,,0,"percent of total billed charges ","90% of total billed charges ",7.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",133.98,87,,3.92,3.92,3.92,"1 through 10","percent of total billed charges ","87% of total billed charges ",7.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.99,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",107.8,70,,86.24,,,0,"percent of total billed charges ","70% of total billed charges ",3.99,143.22,
"SEDIMENTATION RATE-W",2001352,"CDM ",305,RC,85651,HCPCS,OUTPATIENT,,,75.5,60.4,,4.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,4.18,4.18,4.18,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",70.22,93,,56.18,,,0,"percent of total billed charges ","93% of total billed charges ",4.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",64.18,85,,51.34,,,0,"percent of total billed charges ","85% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",6.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.69,87,,42.59,4.19,65.51,16,"percent of total billed charges ","87% of total billed charges ",6.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.26,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",4.26,70.22,
"SICKLE CELL MONITOR",2001360,"CDM ",305,RC,85660,HCPCS,OUTPATIENT,,,98,78.4,,4.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.6,70,,54.88,,,0,"percent of total billed charges ","70% of total billed charges ",88.2,90,,70.56,,,0,"percent of total billed charges ","90% of total billed charges ",91.14,93,,72.91,,,0,"percent of total billed charges ","93% of total billed charges ",4.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.3,85,,66.64,,,0,"percent of total billed charges ","85% of total billed charges ",88.2,90,,70.56,,,0,"percent of total billed charges ","90% of total billed charges ",88.2,90,,70.56,,,0,"percent of total billed charges ","90% of total billed charges ",6.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.26,87,,68.21,,,0,"percent of total billed charges ","87% of total billed charges ",6.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.51,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.6,70,,54.88,,,0,"percent of total billed charges ","70% of total billed charges ",4.68,91.14,
"BLEEDING TIME SIMPLATE",2001386,"CDM ",305,RC,85002,HCPCS,OUTPATIENT,,,90.5,72.4,,4.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.35,70,,50.68,,,0,"percent of total billed charges ","70% of total billed charges ",81.45,90,,65.16,,,0,"percent of total billed charges ","90% of total billed charges ",84.17,93,,67.34,,,0,"percent of total billed charges ","93% of total billed charges ",4.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",76.93,85,,61.54,,,0,"percent of total billed charges ","85% of total billed charges ",81.45,90,,65.16,,,0,"percent of total billed charges ","90% of total billed charges ",81.45,90,,65.16,,,0,"percent of total billed charges ","90% of total billed charges ",4.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",78.74,87,,62.99,,,0,"percent of total billed charges ","87% of total billed charges ",4.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63.35,70,,50.68,,,0,"percent of total billed charges ","70% of total billed charges ",4.1,84.17,
"CLOT RETRACTION",2001394,"CDM ",305,RC,85170,HCPCS,OUTPATIENT,,,54.5,43.6,,5.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.15,70,,30.52,,,0,"percent of total billed charges ","70% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",50.69,93,,40.55,,,0,"percent of total billed charges ","93% of total billed charges ",5.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",46.33,85,,37.06,,,0,"percent of total billed charges ","85% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",6.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.42,87,,37.94,,,0,"percent of total billed charges ","87% of total billed charges ",6.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",38.15,70,,30.52,,,0,"percent of total billed charges ","70% of total billed charges ",5.2,50.69,
PTT,2001402,"CDM ",305,RC,85730,HCPCS,OUTPATIENT,,,57,45.6,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.9,70,,31.92,,,0,"percent of total billed charges ","70% of total billed charges ",51.3,90,,41.04,,,0,"percent of total billed charges ","90% of total billed charges ",53.01,93,,42.41,,,0,"percent of total billed charges ","93% of total billed charges ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",48.45,85,,38.76,,,0,"percent of total billed charges ","85% of total billed charges ",51.3,90,,41.04,,,0,"percent of total billed charges ","90% of total billed charges ",51.3,90,,41.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",49.59,87,,49.13,5.89,151.44,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",39.9,70,,31.92,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,53.01,
"PROTHROMBIN TIME",2001410,"CDM ",305,RC,85610,HCPCS,OUTPATIENT,,,72.5,58,,4.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.75,70,,40.60,,,0,"percent of total billed charges ","70% of total billed charges ",65.25,90,,52.20,,,0,"percent of total billed charges ","90% of total billed charges ",67.43,93,,53.94,,,0,"percent of total billed charges ","93% of total billed charges ",4.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",61.63,85,,49.30,,,0,"percent of total billed charges ","85% of total billed charges ",65.25,90,,52.20,,,0,"percent of total billed charges ","90% of total billed charges ",65.25,90,,52.20,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.08,87,,50.34,4.21,62.93,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.29,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",50.75,70,,40.60,,,0,"percent of total billed charges ","70% of total billed charges ",4.29,67.43,
"COMPLEMENT 5 SERUM",2001444,"CDM ",302,RC,86329,HCPCS,OUTPATIENT,,,188.5,150.8,,13.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.95,70,,105.56,,,0,"percent of total billed charges ","70% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",175.31,93,,140.25,,,0,"percent of total billed charges ","93% of total billed charges ",13.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",160.23,85,,128.18,,,0,"percent of total billed charges ","85% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",164,87,,131.20,,,0,"percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",131.95,70,,105.56,,,0,"percent of total billed charges ","70% of total billed charges ",13.65,175.31,
"BILE URINE",2001451,"CDM ",307,RC,81000,HCPCS,OUTPATIENT,,,65,52,,4.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.5,70,,36.40,,,0,"percent of total billed charges ","70% of total billed charges ",58.5,90,,46.80,,,0,"percent of total billed charges ","90% of total billed charges ",60.45,93,,48.36,,,0,"percent of total billed charges ","93% of total billed charges ",4.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",55.25,85,,44.20,,,0,"percent of total billed charges ","85% of total billed charges ",58.5,90,,46.80,,,0,"percent of total billed charges ","90% of total billed charges ",58.5,90,,46.80,,,0,"percent of total billed charges ","90% of total billed charges ",5.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.55,87,,45.24,,,0,"percent of total billed charges ","87% of total billed charges ",5.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",45.5,70,,36.40,,,0,"percent of total billed charges ","70% of total billed charges ",4.01,60.45,
"SPERM COUNT(FERTILITY)",2001469,"CDM ",309,RC,89320,HCPCS,OUTPATIENT,,,299.5,239.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",209.65,70,,167.72,,,0,"percent of total billed charges ","70% of total billed charges ",269.55,90,,215.64,,,0,"percent of total billed charges ","90% of total billed charges ",278.54,93,,222.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",254.58,85,,203.66,,,0,"percent of total billed charges ","85% of total billed charges ",269.55,90,,215.64,,,0,"percent of total billed charges ","90% of total billed charges ",269.55,90,,215.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",260.57,87,,208.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",12.31,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",209.65,70,,167.72,,,0,"percent of total billed charges ","70% of total billed charges ",12.31,278.54,
"SPERM COUNT POST VAS",2001477,"CDM ",300,RC,89321,HCPCS,OUTPATIENT,,,149,119.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.3,70,,83.44,,,0,"percent of total billed charges ","70% of total billed charges ",134.1,90,,107.28,,,0,"percent of total billed charges ","90% of total billed charges ",138.57,93,,110.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",126.65,85,,101.32,,,0,"percent of total billed charges ","85% of total billed charges ",134.1,90,,107.28,,,0,"percent of total billed charges ","90% of total billed charges ",134.1,90,,107.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",129.63,87,,103.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.3,70,,83.44,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,138.57,
"COLD AGGLUTININS TITER",2001485,"CDM ",302,RC,86157,HCPCS,OUTPATIENT,,,120,96,,7.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84,70,,67.20,,,0,"percent of total billed charges ","70% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",111.6,93,,89.28,,,0,"percent of total billed charges ","93% of total billed charges ",7.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",102,85,,81.60,,,0,"percent of total billed charges ","85% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",104.4,87,,83.52,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.06,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",84,70,,67.20,,,0,"percent of total billed charges ","70% of total billed charges ",7.5,111.6,
"C-REACTIVE PROTEIN",2001493,"CDM ",302,RC,86140,HCPCS,OUTPATIENT,,,75.5,60.4,,5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,5.08,5.08,5.08,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",70.22,93,,56.18,,,0,"percent of total billed charges ","93% of total billed charges ",5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",64.18,85,,51.34,,,0,"percent of total billed charges ","85% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.69,87,,20.30,5.08,51.72,12,"percent of total billed charges ","87% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",5.18,70.22,
"ANTI SMOOTH MUSCLE ABS",2001501,"CDM ",302,RC,86255,HCPCS,OUTPATIENT,,,372,297.6,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",260.4,70,,208.32,,,0,"percent of total billed charges ","70% of total billed charges ",334.8,90,,267.84,,,0,"percent of total billed charges ","90% of total billed charges ",345.96,93,,276.77,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",316.2,85,,252.96,,,0,"percent of total billed charges ","85% of total billed charges ",334.8,90,,267.84,,,0,"percent of total billed charges ","90% of total billed charges ",334.8,90,,267.84,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",323.64,87,,258.91,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",260.4,70,,208.32,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,345.96,
"MONO TEST",2001535,"CDM ",302,RC,86308,HCPCS,OUTPATIENT,,,202,161.6,,5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,109.48,109.48,109.48,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.4,70,,113.12,,,0,"percent of total billed charges ","70% of total billed charges ",181.8,90,,145.44,,,0,"percent of total billed charges ","90% of total billed charges ",187.86,93,,150.29,,,0,"percent of total billed charges ","93% of total billed charges ",5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",171.7,85,,137.36,,,0,"percent of total billed charges ","85% of total billed charges ",181.8,90,,145.44,,,0,"percent of total billed charges ","90% of total billed charges ",181.8,90,,145.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",175.74,87,,138.78,31.07,138.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",141.4,70,,113.12,,,0,"percent of total billed charges ","70% of total billed charges ",5.18,187.86,
"*SLB ANA",2001543,"CDM ",302,RC,86038,HCPCS,OUTPATIENT,,,129,103.2,,12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",119.97,93,,95.98,,,0,"percent of total billed charges ","93% of total billed charges ",12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",109.65,85,,87.72,,,0,"percent of total billed charges ","85% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.23,87,,88.36,11.85,147.83,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",12.09,119.97,
"PROTEIN TOTAL CSF",2001584,"CDM ",301,RC,84157,HCPCS,OUTPATIENT,,,96,76.8,,4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.2,70,,53.76,,,0,"percent of total billed charges ","70% of total billed charges ",86.4,90,,69.12,,,0,"percent of total billed charges ","90% of total billed charges ",89.28,93,,71.42,,,0,"percent of total billed charges ","93% of total billed charges ",4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",81.6,85,,65.28,,,0,"percent of total billed charges ","85% of total billed charges ",86.4,90,,69.12,,,0,"percent of total billed charges ","90% of total billed charges ",86.4,90,,69.12,,,0,"percent of total billed charges ","90% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.52,87,,66.82,,,0,"percent of total billed charges ","87% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",67.2,70,,53.76,,,0,"percent of total billed charges ","70% of total billed charges ",4,89.28,
"C1 BINDING CELL",2001600,"CDM ",302,RC,86160,HCPCS,OUTPATIENT,,,185,148,,12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,133.30,133.30,133.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",172.05,93,,137.64,,,0,"percent of total billed charges ","93% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",157.25,85,,125.80,,,0,"percent of total billed charges ","85% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",160.95,87,,226.71,226.71,226.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",12,172.05,
"CBC (HEMOGRAM)",2001618,"CDM ",305,RC,85027,HCPCS,OUTPATIENT,,,142.5,114,,6.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,16.67,16.67,16.67,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.75,70,,79.80,,,0,"percent of total billed charges ","70% of total billed charges ",128.25,90,,102.60,,,0,"percent of total billed charges ","90% of total billed charges ",132.53,93,,106.02,,,0,"percent of total billed charges ","93% of total billed charges ",6.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.83,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",121.13,85,,96.90,,,0,"percent of total billed charges ","85% of total billed charges ",128.25,90,,102.60,,,0,"percent of total billed charges ","90% of total billed charges ",128.25,90,,102.60,,,0,"percent of total billed charges ","90% of total billed charges ",11.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",123.98,87,,98.96,6.35,123.70,18,"percent of total billed charges ","87% of total billed charges ",11.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.47,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",99.75,70,,79.80,,,0,"percent of total billed charges ","70% of total billed charges ",6.47,132.53,
"GLUCOSE 2 HR PP",2001634,"CDM ",301,RC,82947,HCPCS,OUTPATIENT,,,83,66.4,,3.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",3.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",6.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",72.21,87,,64.65,40.33,64.65,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",3.93,77.19,
"ELECTROPHORESIS CSF",2001659,"CDM ",301,RC,84166,HCPCS,OUTPATIENT,,,56,44.8,,17.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.2,70,,31.36,,,0,"percent of total billed charges ","70% of total billed charges ",50.4,90,,40.32,,,0,"percent of total billed charges ","90% of total billed charges ",52.08,93,,41.66,,,0,"percent of total billed charges ","93% of total billed charges ",17.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",47.6,85,,38.08,,,0,"percent of total billed charges ","85% of total billed charges ",50.4,90,,40.32,,,0,"percent of total billed charges ","90% of total billed charges ",50.4,90,,40.32,,,0,"percent of total billed charges ","90% of total billed charges ",27.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",48.72,87,,38.98,,,0,"percent of total billed charges ","87% of total billed charges ",27.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",39.2,70,,31.36,,,0,"percent of total billed charges ","70% of total billed charges ",17.82,52.08,
"INDIA INK PREP(CSF)",2001683,"CDM ",306,RC,87210,HCPCS,OUTPATIENT,,,146,116.8,,5.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,73.95,73.95,73.95,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",5.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",6.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,101.62,,,0,"percent of total billed charges ","87% of total billed charges ",6.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",5.02,135.78,
"CULTURE AFB",2001691,"CDM ",306,RC,87116,HCPCS,OUTPATIENT,,,93.5,74.8,,10.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.45,70,,52.36,,,0,"percent of total billed charges ","70% of total billed charges ",84.15,90,,67.32,,,0,"percent of total billed charges ","90% of total billed charges ",86.96,93,,69.57,,,0,"percent of total billed charges ","93% of total billed charges ",10.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",79.48,85,,63.58,,,0,"percent of total billed charges ","85% of total billed charges ",84.15,90,,67.32,,,0,"percent of total billed charges ","90% of total billed charges ",84.15,90,,67.32,,,0,"percent of total billed charges ","90% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",81.35,87,,65.08,,,0,"percent of total billed charges ","87% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.8,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",65.45,70,,52.36,,,0,"percent of total billed charges ","70% of total billed charges ",10.5,86.96,
"AFB SMEAR",2001709,"CDM ",306,RC,87206,HCPCS,OUTPATIENT,,,89,71.2,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",82.77,93,,66.22,,,0,"percent of total billed charges ","93% of total billed charges ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",75.65,85,,60.52,,,0,"percent of total billed charges ","85% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",77.43,87,,121.54,121.54,121.54,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,82.77,
"SERTRALINE (ZOLOFT)",2001717,"CDM ",301,RC,82542,HCPCS,OUTPATIENT,,,187,149.6,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",173.91,93,,139.13,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",158.95,85,,127.16,,,0,"percent of total billed charges ","85% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",162.69,87,,130.15,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,173.91,
"FETAL BLEED SCRN TST",2001725,"CDM ",305,RC,85461,HCPCS,OUTPATIENT,,,72,57.6,,8.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.4,70,,40.32,,,0,"percent of total billed charges ","70% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",66.96,93,,53.57,,,0,"percent of total billed charges ","93% of total billed charges ",8.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",61.2,85,,48.96,,,0,"percent of total billed charges ","85% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.64,87,,50.11,,,0,"percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.36,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",50.4,70,,40.32,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,66.96,
"CULTURE GC",2001741,"CDM ",306,RC,87081,HCPCS,OUTPATIENT,,,82,65.6,,6.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.4,70,,45.92,,,0,"percent of total billed charges ","70% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",76.26,93,,61.01,,,0,"percent of total billed charges ","93% of total billed charges ",6.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",69.7,85,,55.76,,,0,"percent of total billed charges ","85% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",71.34,87,,156.45,156.45,156.45,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.63,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",57.4,70,,45.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.63,76.26,
"ADRENOCORT HORM ACTH",2001758,"CDM ",301,RC,82024,HCPCS,OUTPATIENT,,,225,180,,32.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,112.66,112.66,112.66,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.5,70,,126.00,,,0,"percent of total billed charges ","70% of total billed charges ",202.5,90,,162.00,,,0,"percent of total billed charges ","90% of total billed charges ",209.25,93,,167.40,,,0,"percent of total billed charges ","93% of total billed charges ",32.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",191.25,85,,153.00,,,0,"percent of total billed charges ","85% of total billed charges ",202.5,90,,162.00,,,0,"percent of total billed charges ","90% of total billed charges ",202.5,90,,162.00,,,0,"percent of total billed charges ","90% of total billed charges ",34.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.75,87,,156.60,,,0,"percent of total billed charges ","87% of total billed charges ",34.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.5,70,,126.00,,,0,"percent of total billed charges ","70% of total billed charges ",32.83,209.25,
"KOH PREP",2001766,"CDM ",306,RC,87210,HCPCS,OUTPATIENT,,,146,116.8,,5.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,73.95,73.95,73.95,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",5.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",6.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,101.62,,,0,"percent of total billed charges ","87% of total billed charges ",6.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",5.02,135.78,
SEROTONIN,2001808,"CDM ",301,RC,84260,HCPCS,OUTPATIENT,,,261.5,209.2,,26.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",243.2,93,,194.56,,,0,"percent of total billed charges ","93% of total billed charges ",26.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",222.28,85,,177.82,,,0,"percent of total billed charges ","85% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",30.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",227.51,87,,182.01,,,0,"percent of total billed charges ","87% of total billed charges ",30.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",26.33,243.2,
"*CULTURE STOOL E COLI",2001816,"CDM ",306,RC,87046,HCPCS,OUTPATIENT,,,249.5,199.6,,8.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174.65,70,,139.72,,,0,"percent of total billed charges ","70% of total billed charges ",224.55,90,,179.64,,,0,"percent of total billed charges ","90% of total billed charges ",232.04,93,,185.63,,,0,"percent of total billed charges ","93% of total billed charges ",8.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",212.08,85,,169.66,,,0,"percent of total billed charges ","85% of total billed charges ",224.55,90,,179.64,,,0,"percent of total billed charges ","90% of total billed charges ",224.55,90,,179.64,,,0,"percent of total billed charges ","90% of total billed charges ",3.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.07,87,,173.66,,,0,"percent of total billed charges ","87% of total billed charges ",3.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.44,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",174.65,70,,139.72,,,0,"percent of total billed charges ","70% of total billed charges ",3.62,232.04,
"BETA STREP CULTURE",2001832,"CDM ",306,RC,87081,HCPCS,OUTPATIENT,,,213.5,170.8,,6.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.45,70,,119.56,,,0,"percent of total billed charges ","70% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",198.56,93,,158.85,,,0,"percent of total billed charges ","93% of total billed charges ",6.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",181.48,85,,145.18,,,0,"percent of total billed charges ","85% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",185.75,87,,156.45,156.45,156.45,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.63,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",149.45,70,,119.56,,,0,"percent of total billed charges ","70% of total billed charges ",6.63,198.56,
VENIPUNCTURE,2001840,"CDM ",300,RC,36415,HCPCS,OUTPATIENT,,,36.5,29.2,,,,,,,,0,"other ","not separately reimbursment ",,,,8.91,8.91,8.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.55,70,,20.44,,,0,"percent of total billed charges ","70% of total billed charges ",32.85,90,,26.28,,,0,"percent of total billed charges ","90% of total billed charges ",33.95,93,,27.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",31.03,85,,24.82,,,0,"percent of total billed charges ","85% of total billed charges ",27.38,90,,21.90,,,0,"percent of total billed charges ","90% of total billed charges ",32.85,90,,26.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",31.76,87,,23.79,6.55,29.74,47,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",9.34,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",25.55,70,,20.44,,,0,"percent of total billed charges ","70% of total billed charges ",9.34,33.95,
"BILIRUBIN NEONATAL TOTAL",2001857,"CDM ",301,RC,82247,HCPCS,OUTPATIENT,,,103,82.4,,5.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.1,70,,57.68,,,0,"percent of total billed charges ","70% of total billed charges ",92.7,90,,74.16,,,0,"percent of total billed charges ","90% of total billed charges ",95.79,93,,76.63,,,0,"percent of total billed charges ","93% of total billed charges ",5.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",87.55,85,,70.04,,,0,"percent of total billed charges ","85% of total billed charges ",92.7,90,,74.16,,,0,"percent of total billed charges ","90% of total billed charges ",92.7,90,,74.16,,,0,"percent of total billed charges ","90% of total billed charges ",7.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",89.61,87,,71.69,,,0,"percent of total billed charges ","87% of total billed charges ",7.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",72.1,70,,57.68,,,0,"percent of total billed charges ","70% of total billed charges ",5.01,95.79,
"CULTURE URINE QT",2001915,"CDM ",306,RC,87086,HCPCS,OUTPATIENT,,,251,200.8,,8.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,19.40,10.21,28.59,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",175.7,70,,140.56,,,0,"percent of total billed charges ","70% of total billed charges ",225.9,90,,180.72,,,0,"percent of total billed charges ","90% of total billed charges ",233.43,93,,186.74,,,0,"percent of total billed charges ","93% of total billed charges ",8.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",213.35,85,,170.68,,,0,"percent of total billed charges ","85% of total billed charges ",225.9,90,,180.72,,,0,"percent of total billed charges ","90% of total billed charges ",225.9,90,,180.72,,,0,"percent of total billed charges ","90% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",218.37,87,,163.79,7.91,172.40,26,"percent of total billed charges ","87% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",175.7,70,,140.56,,,0,"percent of total billed charges ","70% of total billed charges ",8.07,233.43,
"VDRL SPINAL FLUID",2001923,"CDM ",302,RC,86593,HCPCS,OUTPATIENT,,,62.5,50,,4.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.75,70,,35.00,,,0,"percent of total billed charges ","70% of total billed charges ",56.25,90,,45.00,,,0,"percent of total billed charges ","90% of total billed charges ",58.13,93,,46.50,,,0,"percent of total billed charges ","93% of total billed charges ",4.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",53.13,85,,42.50,,,0,"percent of total billed charges ","85% of total billed charges ",56.25,90,,45.00,,,0,"percent of total billed charges ","90% of total billed charges ",56.25,90,,45.00,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.38,87,,43.50,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.4,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",43.75,70,,35.00,,,0,"percent of total billed charges ","70% of total billed charges ",4.4,58.13,
"COMPLEMENT 50",2001949,"CDM ",302,RC,86162,HCPCS,OUTPATIENT,,,224.5,179.6,,20.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,66.14,66.14,66.14,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",208.79,93,,167.03,,,0,"percent of total billed charges ","93% of total billed charges ",20.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",190.83,85,,152.66,,,0,"percent of total billed charges ","85% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",31.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.32,87,,156.26,,,0,"percent of total billed charges ","87% of total billed charges ",31.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.32,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",20.32,208.79,
"DIRECT COOMBS BROAD",2001956,"CDM ",300,RC,86880,HCPCS,OUTPATIENT,,,211,168.8,,5.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.7,70,,118.16,,,0,"percent of total billed charges ","70% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",196.23,93,,156.98,,,0,"percent of total billed charges ","93% of total billed charges ",5.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",179.35,85,,143.48,,,0,"percent of total billed charges ","85% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",183.57,87,,146.86,,,0,"percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",147.7,70,,118.16,,,0,"percent of total billed charges ","70% of total billed charges ",5.39,196.23,
"COOMBS ANTIBODY SCREEN",2001964,"CDM ",302,RC,86850,HCPCS,OUTPATIENT,,,119.5,95.6,,8.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",111.14,93,,88.91,,,0,"percent of total billed charges ","93% of total billed charges ",8.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",101.58,85,,81.26,,,0,"percent of total billed charges ","85% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",103.97,87,,81.89,81.89,81.89,12,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.92,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",8.3,111.14,
"PHLEBOTOMY THERAPEUTIC",2002004,"CDM ",940,RC,99195,HCPCS,OUTPATIENT,,,260.5,208.4,,102.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",69.01,100,,22.57,22.57,22.57,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",205.68,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",182.35,70,,145.88,,,0,"percent of total billed charges ","70% of total billed charges ",234.45,90,,187.56,,,0,"percent of total billed charges ","90% of total billed charges ",242.27,93,,193.82,,,0,"percent of total billed charges ","93% of total billed charges ",102.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",221.43,85,,177.14,,,0,"percent of total billed charges ","85% of total billed charges ",234.45,90,,187.56,,,0,"percent of total billed charges ","90% of total billed charges ",234.45,90,,187.56,,,0,"percent of total billed charges ","90% of total billed charges ",116.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.64,87,,91.49,65.99,116.99,"1 through 10","percent of total billed charges ","87% of total billed charges ",116.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",182.35,70,,145.88,,,0,"percent of total billed charges ","70% of total billed charges ",69.01,242.27,
"*CORTISOL 24HR URINE",2002030,"CDM ",301,RC,82530,HCPCS,OUTPATIENT,,,142,113.6,,15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,79.16,79.16,79.16,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.4,70,,79.52,,,0,"percent of total billed charges ","70% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",132.06,93,,105.65,,,0,"percent of total billed charges ","93% of total billed charges ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",120.7,85,,96.56,,,0,"percent of total billed charges ","85% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",123.54,87,,88.27,88.27,88.27,"1 through 10","percent of total billed charges ","87% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.71,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",99.4,70,,79.52,,,0,"percent of total billed charges ","70% of total billed charges ",15,132.06,
TOBRAMYCIN,2002046,"CDM ",301,RC,80200,HCPCS,OUTPATIENT,,,437,349.6,,16.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",305.9,70,,244.72,,,0,"percent of total billed charges ","70% of total billed charges ",393.3,90,,314.64,,,0,"percent of total billed charges ","90% of total billed charges ",406.41,93,,325.13,,,0,"percent of total billed charges ","93% of total billed charges ",16.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.44,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",371.45,85,,297.16,,,0,"percent of total billed charges ","85% of total billed charges ",393.3,90,,314.64,,,0,"percent of total billed charges ","90% of total billed charges ",393.3,90,,314.64,,,0,"percent of total billed charges ","90% of total billed charges ",29.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",380.19,87,,304.15,,,0,"percent of total billed charges ","87% of total billed charges ",29.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.13,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",305.9,70,,244.72,,,0,"percent of total billed charges ","70% of total billed charges ",16.13,406.41,
"RHO-IMUN GLOBULIN (RHO GAM)",2002053,"CDM ",636,RC,90384,HCPCS,OUTPATIENT,,,410.5,328.4,,,,,,,,0,"other ","not separately reimbursment ",115.24,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",287.35,70,,229.88,,,0,"percent of total billed charges ","70% of total billed charges ",369.45,90,,295.56,,,0,"percent of total billed charges ","90% of total billed charges ",381.77,93,,305.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",76.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",348.93,85,,279.14,,,0,"percent of total billed charges ","85% of total billed charges ",369.45,90,,295.56,,,0,"percent of total billed charges ","90% of total billed charges ",369.45,90,,295.56,,,0,"percent of total billed charges ","90% of total billed charges ",75.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",357.14,87,,285.71,,,0,"percent of total billed charges ","87% of total billed charges ",75.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",287.35,70,,229.88,,,0,"percent of total billed charges ","70% of total billed charges ",75.52,381.77,
"DIRECT COOMBS IGG",2002087,"CDM ",300,RC,86880,HCPCS,OUTPATIENT,,,138.5,110.8,,5.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.95,70,,77.56,,,0,"percent of total billed charges ","70% of total billed charges ",124.65,90,,99.72,,,0,"percent of total billed charges ","90% of total billed charges ",128.81,93,,103.05,,,0,"percent of total billed charges ","93% of total billed charges ",5.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",117.73,85,,94.18,,,0,"percent of total billed charges ","85% of total billed charges ",124.65,90,,99.72,,,0,"percent of total billed charges ","90% of total billed charges ",124.65,90,,99.72,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",120.5,87,,96.40,,,0,"percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",96.95,70,,77.56,,,0,"percent of total billed charges ","70% of total billed charges ",5.39,128.81,
"SUSCEPTIBILITY TEST STPNE",2002095,"CDM ",306,RC,87186,HCPCS,OUTPATIENT,,,284,227.2,,8.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",198.8,70,,159.04,,,0,"percent of total billed charges ","70% of total billed charges ",255.6,90,,204.48,,,0,"percent of total billed charges ","90% of total billed charges ",264.12,93,,211.30,,,0,"percent of total billed charges ","93% of total billed charges ",8.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",241.4,85,,193.12,,,0,"percent of total billed charges ","85% of total billed charges ",255.6,90,,204.48,,,0,"percent of total billed charges ","90% of total billed charges ",255.6,90,,204.48,,,0,"percent of total billed charges ","90% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",247.08,87,,8.48,8.48,105.80,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.65,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",198.8,70,,159.04,,,0,"percent of total billed charges ","70% of total billed charges ",8.65,264.12,
"MYOGLOBIN URINE",2002103,"CDM ",301,RC,83874,HCPCS,OUTPATIENT,,,105,84,,12.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,45.66,45.66,45.66,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.5,70,,58.80,,,0,"percent of total billed charges ","70% of total billed charges ",94.5,90,,75.60,,,0,"percent of total billed charges ","90% of total billed charges ",97.65,93,,78.12,,,0,"percent of total billed charges ","93% of total billed charges ",12.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",89.25,85,,71.40,,,0,"percent of total billed charges ","85% of total billed charges ",94.5,90,,75.60,,,0,"percent of total billed charges ","90% of total billed charges ",94.5,90,,75.60,,,0,"percent of total billed charges ","90% of total billed charges ",22.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",91.35,87,,73.08,,,0,"percent of total billed charges ","87% of total billed charges ",22.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.92,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",73.5,70,,58.80,,,0,"percent of total billed charges ","70% of total billed charges ",12.92,97.65,
"DIRECT COOMBS NON IGG",2002145,"CDM ",300,RC,86880,HCPCS,OUTPATIENT,,,138.5,110.8,,5.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.95,70,,77.56,,,0,"percent of total billed charges ","70% of total billed charges ",124.65,90,,99.72,,,0,"percent of total billed charges ","90% of total billed charges ",128.81,93,,103.05,,,0,"percent of total billed charges ","93% of total billed charges ",5.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",117.73,85,,94.18,,,0,"percent of total billed charges ","85% of total billed charges ",124.65,90,,99.72,,,0,"percent of total billed charges ","90% of total billed charges ",124.65,90,,99.72,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",120.5,87,,96.40,,,0,"percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",96.95,70,,77.56,,,0,"percent of total billed charges ","70% of total billed charges ",5.39,128.81,
"OCCULT BLOOD (STOOL)",2002160,"CDM ",301,RC,82270,HCPCS,OUTPATIENT,,,28.5,22.8,,3.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,70,,15.96,,,0,"percent of total billed charges ","70% of total billed charges ",25.65,90,,20.52,,,0,"percent of total billed charges ","90% of total billed charges ",26.51,93,,21.21,,,0,"percent of total billed charges ","93% of total billed charges ",3.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",24.23,85,,19.38,,,0,"percent of total billed charges ","85% of total billed charges ",25.65,90,,20.52,,,0,"percent of total billed charges ","90% of total billed charges ",25.65,90,,20.52,,,0,"percent of total billed charges ","90% of total billed charges ",4.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.8,87,,10.94,4.30,51.43,"1 through 10","percent of total billed charges ","87% of total billed charges ",4.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.38,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",19.95,70,,15.96,,,0,"percent of total billed charges ","70% of total billed charges ",3.82,26.51,
"FECAL FAT 72 HR",2002194,"CDM ",301,RC,82710,HCPCS,OUTPATIENT,,,203,162.4,,14.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.1,70,,113.68,,,0,"percent of total billed charges ","70% of total billed charges ",182.7,90,,146.16,,,0,"percent of total billed charges ","90% of total billed charges ",188.79,93,,151.03,,,0,"percent of total billed charges ","93% of total billed charges ",14.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.86,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",172.55,85,,138.04,,,0,"percent of total billed charges ","85% of total billed charges ",182.7,90,,146.16,,,0,"percent of total billed charges ","90% of total billed charges ",182.7,90,,146.16,,,0,"percent of total billed charges ","90% of total billed charges ",14.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",176.61,87,,141.29,,,0,"percent of total billed charges ","87% of total billed charges ",14.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.8,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.1,70,,113.68,,,0,"percent of total billed charges ","70% of total billed charges ",14.28,188.79,
"COCCIDOIDES TOT ANTIBODIES",2002228,"CDM ",302,RC,86635,HCPCS,OUTPATIENT,,,146,116.8,,9.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",9.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,101.62,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.47,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,135.78,
"CYSTINE URINE QT",2002236,"CDM ",301,RC,82128,HCPCS,OUTPATIENT,,,161,128.8,,18.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.7,70,,90.16,,,0,"percent of total billed charges ","70% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",149.73,93,,119.78,,,0,"percent of total billed charges ","93% of total billed charges ",18.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",136.85,85,,109.48,,,0,"percent of total billed charges ","85% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",23.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",140.07,87,,112.06,,,0,"percent of total billed charges ","87% of total billed charges ",23.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.87,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",112.7,70,,90.16,,,0,"percent of total billed charges ","70% of total billed charges ",13.87,149.73,
"CRYOGLOBULIN QL",2002244,"CDM ",300,RC,82595,HCPCS,OUTPATIENT,,,41.5,33.2,,6.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,0.24,0.24,0.24,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.05,70,,23.24,,,0,"percent of total billed charges ","70% of total billed charges ",37.35,90,,29.88,,,0,"percent of total billed charges ","90% of total billed charges ",38.6,93,,30.88,,,0,"percent of total billed charges ","93% of total billed charges ",6.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",35.28,85,,28.22,,,0,"percent of total billed charges ","85% of total billed charges ",37.35,90,,29.88,,,0,"percent of total billed charges ","90% of total billed charges ",37.35,90,,29.88,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.11,87,,28.89,,,0,"percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.47,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",29.05,70,,23.24,,,0,"percent of total billed charges ","70% of total billed charges ",6.47,38.6,
GGTP,2002269,"CDM ",301,RC,82977,HCPCS,OUTPATIENT,,,141.5,113.2,,7.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.05,70,,79.24,,,0,"percent of total billed charges ","70% of total billed charges ",127.35,90,,101.88,,,0,"percent of total billed charges ","90% of total billed charges ",131.6,93,,105.28,,,0,"percent of total billed charges ","93% of total billed charges ",7.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",120.28,85,,96.22,,,0,"percent of total billed charges ","85% of total billed charges ",127.35,90,,101.88,,,0,"percent of total billed charges ","90% of total billed charges ",127.35,90,,101.88,,,0,"percent of total billed charges ","90% of total billed charges ",11.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",123.11,87,,93.42,24.33,106.60,"1 through 10","percent of total billed charges ","87% of total billed charges ",11.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.2,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",99.05,70,,79.24,,,0,"percent of total billed charges ","70% of total billed charges ",7.2,131.6,
"HISTOPLASMA TITER MYCELIAL",2002277,"CDM ",302,RC,86698,HCPCS,OUTPATIENT,,,210.5,168.4,,11.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",195.77,93,,156.62,,,0,"percent of total billed charges ","93% of total billed charges ",11.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",178.93,85,,143.14,,,0,"percent of total billed charges ","85% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",183.14,87,,146.51,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.79,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,195.77,
"HISTOPLASMA ABS IMMUNODIFF",2002281,"CDM ",302,RC,86698,HCPCS,OUTPATIENT,,,210.5,168.4,,11.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",195.77,93,,156.62,,,0,"percent of total billed charges ","93% of total billed charges ",11.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",178.93,85,,143.14,,,0,"percent of total billed charges ","85% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",183.14,87,,146.51,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.79,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,195.77,
"KETONES URINE",2002285,"CDM ",307,RC,81000,HCPCS,OUTPATIENT,,,60.5,48.4,,4.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.35,70,,33.88,,,0,"percent of total billed charges ","70% of total billed charges ",54.45,90,,43.56,,,0,"percent of total billed charges ","90% of total billed charges ",56.27,93,,45.02,,,0,"percent of total billed charges ","93% of total billed charges ",4.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",51.43,85,,41.14,,,0,"percent of total billed charges ","85% of total billed charges ",54.45,90,,43.56,,,0,"percent of total billed charges ","90% of total billed charges ",54.45,90,,43.56,,,0,"percent of total billed charges ","90% of total billed charges ",5.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",52.64,87,,42.11,,,0,"percent of total billed charges ","87% of total billed charges ",5.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",42.35,70,,33.88,,,0,"percent of total billed charges ","70% of total billed charges ",4.01,56.27,
"PH URINE",2002319,"CDM ",307,RC,81001,HCPCS,OUTPATIENT,,,51,40.8,,3.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",47.43,93,,37.94,,,0,"percent of total billed charges ","93% of total billed charges ",3.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",43.35,85,,34.68,,,0,"percent of total billed charges ","85% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",5.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",44.37,87,,73.31,3.00,104.73,29,"percent of total billed charges ","87% of total billed charges ",5.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.17,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",3.17,47.43,
"PHOSPHOROUS URINE",2002327,"CDM ",301,RC,84105,HCPCS,OUTPATIENT,,,54.5,43.6,,5.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.15,70,,30.52,,,0,"percent of total billed charges ","70% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",50.69,93,,40.55,,,0,"percent of total billed charges ","93% of total billed charges ",5.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",46.33,85,,37.06,,,0,"percent of total billed charges ","85% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.42,87,,37.94,,,0,"percent of total billed charges ","87% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.78,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",38.15,70,,30.52,,,0,"percent of total billed charges ","70% of total billed charges ",5.78,50.69,
"URIC ACID URINE",2002350,"CDM ",301,RC,84560,HCPCS,OUTPATIENT,,,97,77.6,,5.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",90.21,93,,72.17,,,0,"percent of total billed charges ","93% of total billed charges ",5.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",82.45,85,,65.96,,,0,"percent of total billed charges ","85% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.39,87,,67.51,,,0,"percent of total billed charges ","87% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.08,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",5.08,90.21,
"URINE PROTEIN,QUANT",2002368,"CDM ",301,RC,84156,HCPCS,OUTPATIENT,,,69,55.2,,3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.3,70,,38.64,,,0,"percent of total billed charges ","70% of total billed charges ",62.1,90,,49.68,,,0,"percent of total billed charges ","90% of total billed charges ",64.17,93,,51.34,,,0,"percent of total billed charges ","93% of total billed charges ",3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",58.65,85,,46.92,,,0,"percent of total billed charges ","85% of total billed charges ",62.1,90,,49.68,,,0,"percent of total billed charges ","90% of total billed charges ",62.1,90,,49.68,,,0,"percent of total billed charges ","90% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60.03,87,,43.83,11.65,76.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",48.3,70,,38.64,,,0,"percent of total billed charges ","70% of total billed charges ",3.67,64.17,
"CULTURE VIRAL GENERAL 8573",2002376,"CDM ",301,RC,84252,HCPCS,OUTPATIENT,,,246,196.8,,20.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.2,70,,137.76,,,0,"percent of total billed charges ","70% of total billed charges ",221.4,90,,177.12,,,0,"percent of total billed charges ","90% of total billed charges ",228.78,93,,183.02,,,0,"percent of total billed charges ","93% of total billed charges ",20.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",209.1,85,,167.28,,,0,"percent of total billed charges ","85% of total billed charges ",221.4,90,,177.12,,,0,"percent of total billed charges ","90% of total billed charges ",221.4,90,,177.12,,,0,"percent of total billed charges ","90% of total billed charges ",36.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",214.02,87,,171.22,,,0,"percent of total billed charges ","87% of total billed charges ",36.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.23,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",172.2,70,,137.76,,,0,"percent of total billed charges ","70% of total billed charges ",20.23,228.78,
"ANTIBODY IDENTIFY",2002400,"CDM ",300,RC,86870,HCPCS,OUTPATIENT,,,442,353.6,,252.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",309.4,70,,247.52,,,0,"percent of total billed charges ","70% of total billed charges ",397.8,90,,318.24,,,0,"percent of total billed charges ","90% of total billed charges ",411.06,93,,328.85,,,0,"percent of total billed charges ","93% of total billed charges ",252.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",375.7,85,,300.56,,,0,"percent of total billed charges ","85% of total billed charges ",397.8,90,,318.24,,,0,"percent of total billed charges ","90% of total billed charges ",397.8,90,,318.24,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",384.54,87,,307.63,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",309.4,70,,247.52,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,411.06,
"T3 TRIIODOTHYRONINE ANTIOBODY",2002405,"CDM ",301,RC,83519,HCPCS,OUTPATIENT,,,142,113.6,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.4,70,,79.52,,,0,"percent of total billed charges ","70% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",132.06,93,,105.65,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",120.7,85,,96.56,,,0,"percent of total billed charges ","85% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",123.54,87,,98.83,,,0,"percent of total billed charges ","87% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",99.4,70,,79.52,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,132.06,
"ANTIBODY TITER INDIRECT",2002418,"CDM ",300,RC,86886,HCPCS,OUTPATIENT,,,221,176.8,,5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154.7,70,,123.76,,,0,"percent of total billed charges ","70% of total billed charges ",198.9,90,,159.12,,,0,"percent of total billed charges ","90% of total billed charges ",205.53,93,,164.42,,,0,"percent of total billed charges ","93% of total billed charges ",5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",187.85,85,,150.28,,,0,"percent of total billed charges ","85% of total billed charges ",198.9,90,,159.12,,,0,"percent of total billed charges ","90% of total billed charges ",198.9,90,,159.12,,,0,"percent of total billed charges ","90% of total billed charges ",9.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",192.27,87,,153.82,,,0,"percent of total billed charges ","87% of total billed charges ",9.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",154.7,70,,123.76,,,0,"percent of total billed charges ","70% of total billed charges ",5.18,205.53,
"HLA 27",2002426,"CDM ",302,RC,86812,HCPCS,OUTPATIENT,,,165,132,,25.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",25.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",41.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,114.84,,,0,"percent of total billed charges ","87% of total billed charges ",41.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.81,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",25.81,153.45,
"GENTAMYCIN TROUGH",2002459,"CDM ",300,RC,80170,HCPCS,OUTPATIENT,,,212,169.6,,16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.4,70,,118.72,,,0,"percent of total billed charges ","70% of total billed charges ",190.8,90,,152.64,,,0,"percent of total billed charges ","90% of total billed charges ",197.16,93,,157.73,,,0,"percent of total billed charges ","93% of total billed charges ",16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.95,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",180.2,85,,144.16,,,0,"percent of total billed charges ","85% of total billed charges ",190.8,90,,152.64,,,0,"percent of total billed charges ","90% of total billed charges ",190.8,90,,152.64,,,0,"percent of total billed charges ","90% of total billed charges ",29.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.44,87,,147.55,,,0,"percent of total billed charges ","87% of total billed charges ",29.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.38,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",148.4,70,,118.72,,,0,"percent of total billed charges ","70% of total billed charges ",16.38,197.16,
"LIPOPROTEIN (A)",2002467,"CDM ",301,RC,83695,HCPCS,OUTPATIENT,,,90,72,,14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",20.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",20.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.32,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",14.32,83.7,
"VALPROIC ACID",2002509,"CDM ",300,RC,80164,HCPCS,OUTPATIENT,,,367,293.6,,13.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",256.9,70,,205.52,,,0,"percent of total billed charges ","70% of total billed charges ",330.3,90,,264.24,,,0,"percent of total billed charges ","90% of total billed charges ",341.31,93,,273.05,,,0,"percent of total billed charges ","93% of total billed charges ",13.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.73,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",311.95,85,,249.56,,,0,"percent of total billed charges ","85% of total billed charges ",330.3,90,,264.24,,,0,"percent of total billed charges ","90% of total billed charges ",330.3,90,,264.24,,,0,"percent of total billed charges ","90% of total billed charges ",24.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",319.29,87,,252.14,252.14,252.14,"1 through 10","percent of total billed charges ","87% of total billed charges ",24.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.54,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",256.9,70,,205.52,,,0,"percent of total billed charges ","70% of total billed charges ",13.54,341.31,
"ALPHAFETOPROTEIN AMNIO FLUID",2002517,"CDM ",301,RC,82106,HCPCS,OUTPATIENT,,,131,104.8,,14.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.7,70,,73.36,,,0,"percent of total billed charges ","70% of total billed charges ",117.9,90,,94.32,,,0,"percent of total billed charges ","90% of total billed charges ",121.83,93,,97.46,,,0,"percent of total billed charges ","93% of total billed charges ",14.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",111.35,85,,89.08,,,0,"percent of total billed charges ","85% of total billed charges ",117.9,90,,94.32,,,0,"percent of total billed charges ","90% of total billed charges ",117.9,90,,94.32,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",113.97,87,,91.18,,,0,"percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",91.7,70,,73.36,,,0,"percent of total billed charges ","70% of total billed charges ",14.45,121.83,
"TEGRETOL (CARBAMAZEPINE)",2002541,"CDM ",300,RC,80156,HCPCS,OUTPATIENT,,,399,319.2,,14.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",279.3,70,,223.44,,,0,"percent of total billed charges ","70% of total billed charges ",359.1,90,,287.28,,,0,"percent of total billed charges ","90% of total billed charges ",371.07,93,,296.86,,,0,"percent of total billed charges ","93% of total billed charges ",14.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.59,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",339.15,85,,271.32,,,0,"percent of total billed charges ","85% of total billed charges ",359.1,90,,287.28,,,0,"percent of total billed charges ","90% of total billed charges ",359.1,90,,287.28,,,0,"percent of total billed charges ","90% of total billed charges ",22.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",347.13,87,,277.70,,,0,"percent of total billed charges ","87% of total billed charges ",22.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.57,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",279.3,70,,223.44,,,0,"percent of total billed charges ","70% of total billed charges ",14.57,371.07,
"CHLAM TRACH ABS",2002566,"CDM ",302,RC,86631,HCPCS,OUTPATIENT,,,230.5,184.4,,10.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",161.35,70,,129.08,,,0,"percent of total billed charges ","70% of total billed charges ",207.45,90,,165.96,,,0,"percent of total billed charges ","90% of total billed charges ",214.37,93,,171.50,,,0,"percent of total billed charges ","93% of total billed charges ",10.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",195.93,85,,156.74,,,0,"percent of total billed charges ","85% of total billed charges ",207.45,90,,165.96,,,0,"percent of total billed charges ","90% of total billed charges ",207.45,90,,165.96,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.54,87,,160.43,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",161.35,70,,129.08,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,214.37,
"FLUOXETINE (PROZAC)",2002616,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,168.5,134.8,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",156.71,93,,125.37,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.23,85,,114.58,,,0,"percent of total billed charges ","85% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",146.6,87,,117.28,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,156.71,
ETHOSUXIMID,2002624,"CDM ",301,RC,80168,HCPCS,OUTPATIENT,,,260,208,,16.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",182,70,,145.60,,,0,"percent of total billed charges ","70% of total billed charges ",234,90,,187.20,,,0,"percent of total billed charges ","90% of total billed charges ",241.8,93,,193.44,,,0,"percent of total billed charges ","93% of total billed charges ",16.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.57,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",221,85,,176.80,,,0,"percent of total billed charges ","85% of total billed charges ",234,90,,187.20,,,0,"percent of total billed charges ","90% of total billed charges ",234,90,,187.20,,,0,"percent of total billed charges ","90% of total billed charges ",24.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.2,87,,180.96,,,0,"percent of total billed charges ","87% of total billed charges ",24.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.34,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",182,70,,145.60,,,0,"percent of total billed charges ","70% of total billed charges ",16.34,241.8,
"LIPID PROFILE B",2002632,"CDM ",301,RC,80061,HCPCS,OUTPATIENT,,,342.5,274,,13.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,13.12,13.12,13.12,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",239.75,70,,191.80,,,0,"percent of total billed charges ","70% of total billed charges ",308.25,90,,246.60,,,0,"percent of total billed charges ","90% of total billed charges ",318.53,93,,254.82,,,0,"percent of total billed charges ","93% of total billed charges ",13.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",291.13,85,,232.90,,,0,"percent of total billed charges ","85% of total billed charges ",308.25,90,,246.60,,,0,"percent of total billed charges ","90% of total billed charges ",308.25,90,,246.60,,,0,"percent of total billed charges ","90% of total billed charges ",19.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.98,87,,225.85,13.13,282.31,32,"percent of total billed charges ","87% of total billed charges ",19.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",239.75,70,,191.80,,,0,"percent of total billed charges ","70% of total billed charges ",13.39,318.53,
"FTA ABS (FLUORESCENT TREPONEMA",2002640,"CDM ",302,RC,86780,HCPCS,OUTPATIENT,,,408,326.4,,13.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",285.6,70,,228.48,,,0,"percent of total billed charges ","70% of total billed charges ",367.2,90,,293.76,,,0,"percent of total billed charges ","90% of total billed charges ",379.44,93,,303.55,,,0,"percent of total billed charges ","93% of total billed charges ",13.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.29,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",346.8,85,,277.44,,,0,"percent of total billed charges ","85% of total billed charges ",367.2,90,,293.76,,,0,"percent of total billed charges ","90% of total billed charges ",367.2,90,,293.76,,,0,"percent of total billed charges ","90% of total billed charges ",21.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",354.96,87,,92.67,92.66,92.67,11,"percent of total billed charges ","87% of total billed charges ",21.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.24,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",285.6,70,,228.48,,,0,"percent of total billed charges ","70% of total billed charges ",13.24,379.44,
"MERCURY BLOOD",2002657,"CDM ",301,RC,83825,HCPCS,OUTPATIENT,,,53,42.4,,13.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,42.75,42.75,42.75,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",49.29,93,,39.43,,,0,"percent of total billed charges ","93% of total billed charges ",13.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.05,85,,36.04,,,0,"percent of total billed charges ","85% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.11,87,,36.89,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.26,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",13.18,49.29,
"ANTI MUSCLE ABS",2002673,"CDM ",302,RC,86256,HCPCS,OUTPATIENT,,,327.5,262,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",229.25,70,,183.40,,,0,"percent of total billed charges ","70% of total billed charges ",294.75,90,,235.80,,,0,"percent of total billed charges ","90% of total billed charges ",304.58,93,,243.66,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",278.38,85,,222.70,,,0,"percent of total billed charges ","85% of total billed charges ",294.75,90,,235.80,,,0,"percent of total billed charges ","90% of total billed charges ",294.75,90,,235.80,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",284.93,87,,17.72,12.99,22.44,"1 through 10","percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",229.25,70,,183.40,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,304.58,
"COMPLEMENT C3",2002699,"CDM ",302,RC,86160,HCPCS,OUTPATIENT,,,165,132,,12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,133.30,133.30,133.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,226.71,226.71,226.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",12,153.45,
"MITOCHONDRIAL ABS W/ TITER",2002715,"CDM ",302,RC,86255,HCPCS,OUTPATIENT,,,146,116.8,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,101.62,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,135.78,
"COMPLEMENT C4",2002723,"CDM ",302,RC,86160,HCPCS,OUTPATIENT,,,165,132,,12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,133.30,133.30,133.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,226.71,226.71,226.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",12,153.45,
"ROTAVIRUS IA",2002764,"CDM ",306,RC,87425,HCPCS,OUTPATIENT,,,156,124.8,,10.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",145.08,93,,116.06,,,0,"percent of total billed charges ","93% of total billed charges ",10.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",132.6,85,,106.08,,,0,"percent of total billed charges ","85% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",135.72,87,,108.58,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",10.18,145.08,
"ESTROGENS TOTAL",2002772,"CDM ",301,RC,82672,HCPCS,OUTPATIENT,,,178.5,142.8,,21.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,50.27,50.27,50.27,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.95,70,,99.96,,,0,"percent of total billed charges ","70% of total billed charges ",160.65,90,,128.52,,,0,"percent of total billed charges ","90% of total billed charges ",166.01,93,,132.81,,,0,"percent of total billed charges ","93% of total billed charges ",21.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",151.73,85,,121.38,,,0,"percent of total billed charges ","85% of total billed charges ",160.65,90,,128.52,,,0,"percent of total billed charges ","90% of total billed charges ",160.65,90,,128.52,,,0,"percent of total billed charges ","90% of total billed charges ",39.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",155.3,87,,138.78,138.78,138.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",39.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.7,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",124.95,70,,99.96,,,0,"percent of total billed charges ","70% of total billed charges ",21.7,166.01,
"LUPUS ANTICOAGULANT HEXAGONAL",2002863,"CDM ",305,RC,85597,HCPCS,OUTPATIENT,,,267.5,214,,17.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,134.09,134.09,134.09,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",248.78,93,,199.02,,,0,"percent of total billed charges ","93% of total billed charges ",17.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",227.38,85,,181.90,,,0,"percent of total billed charges ","85% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",25.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",232.73,87,,231.88,231.88,231.88,"1 through 10","percent of total billed charges ","87% of total billed charges ",25.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",17.98,248.78,
"CRYPTOCOCCUS AG",2002905,"CDM ",306,RC,87899,HCPCS,OUTPATIENT,,,165,132,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",14.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",14.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,114.84,,,0,"percent of total billed charges ","87% of total billed charges ",14.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",14.82,153.45,
"BETA HCG QT",2002913,"CDM ",301,RC,84702,HCPCS,OUTPATIENT,,,152.5,122,,12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.75,70,,85.40,,,0,"percent of total billed charges ","70% of total billed charges ",137.25,90,,109.80,,,0,"percent of total billed charges ","90% of total billed charges ",141.83,93,,113.46,,,0,"percent of total billed charges ","93% of total billed charges ",12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.89,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",129.63,85,,103.70,,,0,"percent of total billed charges ","85% of total billed charges ",137.25,90,,109.80,,,0,"percent of total billed charges ","90% of total billed charges ",137.25,90,,109.80,,,0,"percent of total billed charges ","90% of total billed charges ",11.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.68,87,,94.83,84.28,118.53,"1 through 10","percent of total billed charges ","87% of total billed charges ",11.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",106.75,70,,85.40,,,0,"percent of total billed charges ","70% of total billed charges ",11.77,141.83,
"VITAMIN B6 PLASMA",2002921,"CDM ",301,RC,84207,HCPCS,OUTPATIENT,,,269,215.2,,,,,,,,0,"other ","not separately reimbursment ",,,,71.46,71.46,71.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.3,70,,150.64,,,0,"percent of total billed charges ","70% of total billed charges ",242.1,90,,193.68,,,0,"percent of total billed charges ","90% of total billed charges ",250.17,93,,200.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",228.65,85,,182.92,,,0,"percent of total billed charges ","85% of total billed charges ",242.1,90,,193.68,,,0,"percent of total billed charges ","90% of total billed charges ",242.1,90,,193.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.03,87,,187.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",28.1,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",188.3,70,,150.64,,,0,"percent of total billed charges ","70% of total billed charges ",28.1,250.17,
"CULTURE ANAEROBIC ID",2002996,"CDM ",306,RC,87076,HCPCS,OUTPATIENT,,,157,125.6,,8.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.9,70,,87.92,,,0,"percent of total billed charges ","70% of total billed charges ",141.3,90,,113.04,,,0,"percent of total billed charges ","90% of total billed charges ",146.01,93,,116.81,,,0,"percent of total billed charges ","93% of total billed charges ",8.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.44,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",133.45,85,,106.76,,,0,"percent of total billed charges ","85% of total billed charges ",141.3,90,,113.04,,,0,"percent of total billed charges ","90% of total billed charges ",141.3,90,,113.04,,,0,"percent of total billed charges ","90% of total billed charges ",17.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",136.59,87,,109.27,,,0,"percent of total billed charges ","87% of total billed charges ",17.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.08,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",109.9,70,,87.92,,,0,"percent of total billed charges ","70% of total billed charges ",8.08,146.01,
"HEPATITIS B SURFACE",2003002,"CDM ",302,RC,86706,HCPCS,OUTPATIENT,,,133,106.4,,10.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.1,70,,74.48,,,0,"percent of total billed charges ","70% of total billed charges ",119.7,90,,95.76,,,0,"percent of total billed charges ","90% of total billed charges ",123.69,93,,98.95,,,0,"percent of total billed charges ","93% of total billed charges ",10.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",113.05,85,,90.44,,,0,"percent of total billed charges ","85% of total billed charges ",119.7,90,,95.76,,,0,"percent of total billed charges ","90% of total billed charges ",119.7,90,,95.76,,,0,"percent of total billed charges ","90% of total billed charges ",19.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",115.71,87,,92.57,,,0,"percent of total billed charges ","87% of total billed charges ",19.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",93.1,70,,74.48,,,0,"percent of total billed charges ","70% of total billed charges ",10.74,123.69,
"FETAL-MATERNAL RATIO",2003010,"CDM ",305,RC,85460,HCPCS,OUTPATIENT,,,108,86.4,,7.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",7.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,75.17,,,0,"percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.73,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",7.73,100.44,
"ALPHA-1 ANTITRYPSIN",2003036,"CDM ",301,RC,82103,HCPCS,OUTPATIENT,,,108,86.4,,13.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",13.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,75.17,,,0,"percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.44,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",13.44,100.44,
"CULTURE BODY FLUID",2003051,"CDM ",306,RC,87070,HCPCS,OUTPATIENT,,,284,227.2,,7.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,28.62,28.62,28.62,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",198.8,70,,159.04,,,0,"percent of total billed charges ","70% of total billed charges ",255.6,90,,204.48,,,0,"percent of total billed charges ","90% of total billed charges ",264.12,93,,211.30,,,0,"percent of total billed charges ","93% of total billed charges ",7.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",241.4,85,,193.12,,,0,"percent of total billed charges ","85% of total billed charges ",255.6,90,,204.48,,,0,"percent of total billed charges ","90% of total billed charges ",255.6,90,,204.48,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",247.08,87,,40.73,8.45,128.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",198.8,70,,159.04,,,0,"percent of total billed charges ","70% of total billed charges ",7.35,264.12,
"BETA STREP B AG",2003077,"CDM ",306,RC,87899,HCPCS,OUTPATIENT,,,213.5,170.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.45,70,,119.56,,,0,"percent of total billed charges ","70% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",198.56,93,,158.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",14.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",181.48,85,,145.18,,,0,"percent of total billed charges ","85% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",14.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",185.75,87,,148.60,,,0,"percent of total billed charges ","87% of total billed charges ",14.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",149.45,70,,119.56,,,0,"percent of total billed charges ","70% of total billed charges ",14.82,198.56,
"BETA STREP A AG",2003085,"CDM ",306,RC,87899,HCPCS,OUTPATIENT,,,213.5,170.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.45,70,,119.56,,,0,"percent of total billed charges ","70% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",198.56,93,,158.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",14.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",181.48,85,,145.18,,,0,"percent of total billed charges ","85% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",14.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",185.75,87,,148.60,,,0,"percent of total billed charges ","87% of total billed charges ",14.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",149.45,70,,119.56,,,0,"percent of total billed charges ","70% of total billed charges ",14.82,198.56,
"C ALBICANS ABS QL",2003101,"CDM ",302,RC,86628,HCPCS,OUTPATIENT,,,177,141.6,,10.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.9,70,,99.12,,,0,"percent of total billed charges ","70% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",164.61,93,,131.69,,,0,"percent of total billed charges ","93% of total billed charges ",10.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",150.45,85,,120.36,,,0,"percent of total billed charges ","85% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",153.99,87,,123.19,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",123.9,70,,99.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,164.61,
"CULTURE ANAEROBIC",2003143,"CDM ",306,RC,87075,HCPCS,OUTPATIENT,,,156,124.8,,9.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,58.27,58.27,58.27,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",145.08,93,,116.06,,,0,"percent of total billed charges ","93% of total billed charges ",9.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",132.6,85,,106.08,,,0,"percent of total billed charges ","85% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",17.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",135.72,87,,108.58,,,0,"percent of total billed charges ","87% of total billed charges ",17.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.47,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",9.47,145.08,
"BACTERIAL ISOL & ID BLOOD",2003150,"CDM ",306,RC,87040,HCPCS,OUTPATIENT,,,333,266.4,,9.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,361.08,361.08,361.08,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",233.1,70,,186.48,,,0,"percent of total billed charges ","70% of total billed charges ",299.7,90,,239.76,,,0,"percent of total billed charges ","90% of total billed charges ",309.69,93,,247.75,,,0,"percent of total billed charges ","93% of total billed charges ",9.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",283.05,85,,226.44,,,0,"percent of total billed charges ","85% of total billed charges ",299.7,90,,239.76,,,0,"percent of total billed charges ","90% of total billed charges ",299.7,90,,239.76,,,0,"percent of total billed charges ","90% of total billed charges ",12.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",289.71,87,,228.86,192.24,228.86,"1 through 10","percent of total billed charges ","87% of total billed charges ",12.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.32,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",233.1,70,,186.48,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,309.69,
"ENVIRONMENTAL CULTURE",2003184,"CDM ",306,RC,87070,HCPCS,OUTPATIENT,,,248.5,198.8,,7.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,28.62,28.62,28.62,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.95,70,,139.16,,,0,"percent of total billed charges ","70% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",231.11,93,,184.89,,,0,"percent of total billed charges ","93% of total billed charges ",7.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",211.23,85,,168.98,,,0,"percent of total billed charges ","85% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",216.2,87,,40.73,8.45,128.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",173.95,70,,139.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.35,231.11,
"FUNGUS ID, YEAST",2003192,"CDM ",306,RC,87106,HCPCS,OUTPATIENT,,,111,88.8,,10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.7,70,,62.16,,,0,"percent of total billed charges ","70% of total billed charges ",99.9,90,,79.92,,,0,"percent of total billed charges ","90% of total billed charges ",103.23,93,,82.58,,,0,"percent of total billed charges ","93% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",94.35,85,,75.48,,,0,"percent of total billed charges ","85% of total billed charges ",99.9,90,,79.92,,,0,"percent of total billed charges ","90% of total billed charges ",99.9,90,,79.92,,,0,"percent of total billed charges ","90% of total billed charges ",15.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.57,87,,77.26,,,0,"percent of total billed charges ","87% of total billed charges ",15.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.32,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",77.7,70,,62.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.32,103.23,
"CULTURE GENITAL",2003218,"CDM ",306,RC,87070,HCPCS,OUTPATIENT,,,94,75.2,,7.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,28.62,28.62,28.62,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.8,70,,52.64,,,0,"percent of total billed charges ","70% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",87.42,93,,69.94,,,0,"percent of total billed charges ","93% of total billed charges ",7.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",79.9,85,,63.92,,,0,"percent of total billed charges ","85% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",81.78,87,,40.73,8.45,128.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",65.8,70,,52.64,,,0,"percent of total billed charges ","70% of total billed charges ",7.35,87.42,
"CULTURE INFLUENZA VIRUS",2003234,"CDM ",306,RC,87252,HCPCS,OUTPATIENT,,,534,427.2,,26.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",373.8,70,,299.04,,,0,"percent of total billed charges ","70% of total billed charges ",480.6,90,,384.48,,,0,"percent of total billed charges ","90% of total billed charges ",496.62,93,,397.30,,,0,"percent of total billed charges ","93% of total billed charges ",26.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.59,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",453.9,85,,363.12,,,0,"percent of total billed charges ","85% of total billed charges ",480.6,90,,384.48,,,0,"percent of total billed charges ","90% of total billed charges ",480.6,90,,384.48,,,0,"percent of total billed charges ","90% of total billed charges ",35.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",464.58,87,,371.66,,,0,"percent of total billed charges ","87% of total billed charges ",35.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",373.8,70,,299.04,,,0,"percent of total billed charges ","70% of total billed charges ",26.07,496.62,
"CULTURE LOWER RESPIRATORY",2003267,"CDM ",306,RC,87070,HCPCS,OUTPATIENT,,,284,227.2,,7.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,28.62,28.62,28.62,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",198.8,70,,159.04,,,0,"percent of total billed charges ","70% of total billed charges ",255.6,90,,204.48,,,0,"percent of total billed charges ","90% of total billed charges ",264.12,93,,211.30,,,0,"percent of total billed charges ","93% of total billed charges ",7.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",241.4,85,,193.12,,,0,"percent of total billed charges ","85% of total billed charges ",255.6,90,,204.48,,,0,"percent of total billed charges ","90% of total billed charges ",255.6,90,,204.48,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",247.08,87,,40.73,8.45,128.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",198.8,70,,159.04,,,0,"percent of total billed charges ","70% of total billed charges ",7.35,264.12,
"*CULTURE STOOL SALMONELLA/SHIG",2003275,"CDM ",306,RC,87045,HCPCS,OUTPATIENT,,,249.5,199.6,,9.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174.65,70,,139.72,,,0,"percent of total billed charges ","70% of total billed charges ",224.55,90,,179.64,,,0,"percent of total billed charges ","90% of total billed charges ",232.04,93,,185.63,,,0,"percent of total billed charges ","93% of total billed charges ",9.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",212.08,85,,169.66,,,0,"percent of total billed charges ","85% of total billed charges ",224.55,90,,179.64,,,0,"percent of total billed charges ","90% of total billed charges ",224.55,90,,179.64,,,0,"percent of total billed charges ","90% of total billed charges ",14.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.07,87,,173.66,,,0,"percent of total billed charges ","87% of total billed charges ",14.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.44,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",174.65,70,,139.72,,,0,"percent of total billed charges ","70% of total billed charges ",9.44,232.04,
"VARICELLA VIRUS IGG ABS",2003309,"CDM ",302,RC,86787,HCPCS,OUTPATIENT,,,185,148,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,67.33,67.33,67.33,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",172.05,93,,137.64,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",157.25,85,,125.80,,,0,"percent of total billed charges ","85% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",160.95,87,,17.79,17.79,17.79,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,172.05,
"O&P PIN PREP",2003317,"CDM ",306,RC,87172,HCPCS,OUTPATIENT,,,204,163.2,,4.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",4.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",6.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,141.98,,,0,"percent of total billed charges ","87% of total billed charges ",6.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.26,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",4.26,189.72,
"*FUNGAL ABS QT ASPERG",2003325,"CDM ",302,RC,86606,HCPCS,OUTPATIENT,,,156,124.8,,12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,55.22,55.22,55.22,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",145.08,93,,116.06,,,0,"percent of total billed charges ","93% of total billed charges ",12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",132.6,85,,106.08,,,0,"percent of total billed charges ","85% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",135.72,87,,108.58,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,145.08,
"CULTURE UPPER RESPIRATORY",2003366,"CDM ",306,RC,87070,HCPCS,OUTPATIENT,,,251,200.8,,7.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,28.62,28.62,28.62,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",175.7,70,,140.56,,,0,"percent of total billed charges ","70% of total billed charges ",225.9,90,,180.72,,,0,"percent of total billed charges ","90% of total billed charges ",233.43,93,,186.74,,,0,"percent of total billed charges ","93% of total billed charges ",7.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",213.35,85,,170.68,,,0,"percent of total billed charges ","85% of total billed charges ",225.9,90,,180.72,,,0,"percent of total billed charges ","90% of total billed charges ",225.9,90,,180.72,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",218.37,87,,40.73,8.45,128.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",175.7,70,,140.56,,,0,"percent of total billed charges ","70% of total billed charges ",7.35,233.43,
ACETAMINOPHEN,2003382,"CDM ",301,RC,80329,HCPCS,OUTPATIENT,,,167,133.6,,22.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.9,70,,93.52,,,0,"percent of total billed charges ","70% of total billed charges ",150.3,90,,120.24,,,0,"percent of total billed charges ","90% of total billed charges ",155.31,93,,124.25,,,0,"percent of total billed charges ","93% of total billed charges ",22.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.95,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",141.95,85,,113.56,,,0,"percent of total billed charges ","85% of total billed charges ",150.3,90,,120.24,,,0,"percent of total billed charges ","90% of total billed charges ",150.3,90,,120.24,,,0,"percent of total billed charges ","90% of total billed charges ",28.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",145.29,87,,116.23,,,0,"percent of total billed charges ","87% of total billed charges ",28.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",116.9,70,,93.52,,,0,"percent of total billed charges ","70% of total billed charges ",22.78,155.31,
ALUMINUM,2003424,"CDM ",301,RC,82108,HCPCS,OUTPATIENT,,,78.5,62.8,,21.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.95,70,,43.96,,,0,"percent of total billed charges ","70% of total billed charges ",70.65,90,,56.52,,,0,"percent of total billed charges ","90% of total billed charges ",73.01,93,,58.41,,,0,"percent of total billed charges ","93% of total billed charges ",21.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",66.73,85,,53.38,,,0,"percent of total billed charges ","85% of total billed charges ",70.65,90,,56.52,,,0,"percent of total billed charges ","90% of total billed charges ",70.65,90,,56.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",68.3,87,,54.64,,,0,"percent of total billed charges ","87% of total billed charges ",14.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.48,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",54.95,70,,43.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.92,73.01,
"AMPHETAMINES QL URINE",2003432,"CDM ",300,RC,80307,HCPCS,OUTPATIENT,,,160.5,128.4,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",149.27,93,,119.42,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",136.43,85,,109.14,,,0,"percent of total billed charges ","85% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",139.64,87,,111.71,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",62.14,149.27,
"ARSENIC WHOLE BLOOD",2003457,"CDM ",301,RC,82175,HCPCS,OUTPATIENT,,,65.5,52.4,,16.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,53.10,53.10,53.10,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.85,70,,36.68,,,0,"percent of total billed charges ","70% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",60.92,93,,48.74,,,0,"percent of total billed charges ","93% of total billed charges ",16.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.81,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",55.68,85,,44.54,,,0,"percent of total billed charges ","85% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",11.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.99,87,,45.59,,,0,"percent of total billed charges ","87% of total billed charges ",11.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.97,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",45.85,70,,36.68,,,0,"percent of total billed charges ","70% of total billed charges ",11.69,60.92,
"BARBITURATES SERUM QT",2003465,"CDM ",301,RC,80345,HCPCS,OUTPATIENT,,,98.5,78.8,,16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",16.38,91.61,
BENZODIAZEPINE,2003473,"CDM ",300,RC,80346,HCPCS,OUTPATIENT,,,98.5,78.8,,23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",23.71,91.61,
CALCITONIN,2003481,"CDM ",301,RC,82308,HCPCS,OUTPATIENT,,,225,180,,22.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.5,70,,126.00,,,0,"percent of total billed charges ","70% of total billed charges ",202.5,90,,162.00,,,0,"percent of total billed charges ","90% of total billed charges ",209.25,93,,167.40,,,0,"percent of total billed charges ","93% of total billed charges ",22.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",191.25,85,,153.00,,,0,"percent of total billed charges ","85% of total billed charges ",202.5,90,,162.00,,,0,"percent of total billed charges ","90% of total billed charges ",202.5,90,,162.00,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.75,87,,156.60,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.79,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.5,70,,126.00,,,0,"percent of total billed charges ","70% of total billed charges ",13.18,209.25,
"CALCIUM IONIZED #4831",2003499,"CDM ",301,RC,82330,HCPCS,OUTPATIENT,,,102.5,82,,11.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,33.35,33.35,33.35,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.75,70,,57.40,,,0,"percent of total billed charges ","70% of total billed charges ",92.25,90,,73.80,,,0,"percent of total billed charges ","90% of total billed charges ",95.33,93,,76.26,,,0,"percent of total billed charges ","93% of total billed charges ",11.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",87.13,85,,69.70,,,0,"percent of total billed charges ","85% of total billed charges ",92.25,90,,73.80,,,0,"percent of total billed charges ","90% of total billed charges ",92.25,90,,73.80,,,0,"percent of total billed charges ","90% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",89.18,87,,71.34,,,0,"percent of total billed charges ","87% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.68,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",71.75,70,,57.40,,,0,"percent of total billed charges ","70% of total billed charges ",8.24,95.33,
"*CHOLINESTERASE PLASMA",2003523,"CDM ",301,RC,82480,HCPCS,OUTPATIENT,,,111,88.8,,7.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.7,70,,62.16,,,0,"percent of total billed charges ","70% of total billed charges ",99.9,90,,79.92,,,0,"percent of total billed charges ","90% of total billed charges ",103.23,93,,82.58,,,0,"percent of total billed charges ","93% of total billed charges ",7.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",94.35,85,,75.48,,,0,"percent of total billed charges ","85% of total billed charges ",99.9,90,,79.92,,,0,"percent of total billed charges ","90% of total billed charges ",99.9,90,,79.92,,,0,"percent of total billed charges ","90% of total billed charges ",14.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.57,87,,77.26,,,0,"percent of total billed charges ","87% of total billed charges ",14.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.87,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",77.7,70,,62.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.87,103.23,
"COCAINE BLOOD QT",2003531,"CDM ",301,RC,80353,HCPCS,OUTPATIENT,,,98.5,78.8,,9.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",9.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",12.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",12.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",9.98,91.61,
"CODEINE BLOOD QT",2003549,"CDM ",301,RC,80361,HCPCS,OUTPATIENT,,,249,199.2,,10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,38.30,38.30,38.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174.3,70,,139.44,,,0,"percent of total billed charges ","70% of total billed charges ",224.1,90,,179.28,,,0,"percent of total billed charges ","90% of total billed charges ",231.57,93,,185.26,,,0,"percent of total billed charges ","93% of total billed charges ",10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",211.65,85,,169.32,,,0,"percent of total billed charges ","85% of total billed charges ",224.1,90,,179.28,,,0,"percent of total billed charges ","90% of total billed charges ",224.1,90,,179.28,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",216.63,87,,173.30,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",174.3,70,,139.44,,,0,"percent of total billed charges ","70% of total billed charges ",10.4,231.57,
"DNA DS ABS (CRITHIDIA)",2003606,"CDM ",302,RC,86225,HCPCS,OUTPATIENT,,,169,135.2,,13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,72.72,72.72,72.72,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",157.17,93,,125.74,,,0,"percent of total billed charges ","93% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.65,85,,114.92,,,0,"percent of total billed charges ","85% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",24.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.03,87,,115.94,115.94,115.94,"1 through 10","percent of total billed charges ","87% of total billed charges ",24.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",13.74,157.17,
"ERYTHROPOIETIN SERUM",2003622,"CDM ",301,RC,82668,HCPCS,OUTPATIENT,,,153,122.4,,18.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",107.1,70,,85.68,,,0,"percent of total billed charges ","70% of total billed charges ",137.7,90,,110.16,,,0,"percent of total billed charges ","90% of total billed charges ",142.29,93,,113.83,,,0,"percent of total billed charges ","93% of total billed charges ",18.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",130.05,85,,104.04,,,0,"percent of total billed charges ","85% of total billed charges ",137.7,90,,110.16,,,0,"percent of total billed charges ","90% of total billed charges ",137.7,90,,110.16,,,0,"percent of total billed charges ","90% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",133.11,87,,107.06,107.06,107.06,"1 through 10","percent of total billed charges ","87% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.79,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",107.1,70,,85.68,,,0,"percent of total billed charges ","70% of total billed charges ",18.79,142.29,
"FLUORIDE SERUM",2003630,"CDM ",301,RC,82735,HCPCS,OUTPATIENT,,,338,270.4,,10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",236.6,70,,189.28,,,0,"percent of total billed charges ","70% of total billed charges ",304.2,90,,243.36,,,0,"percent of total billed charges ","90% of total billed charges ",314.34,93,,251.47,,,0,"percent of total billed charges ","93% of total billed charges ",10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",287.3,85,,229.84,,,0,"percent of total billed charges ","85% of total billed charges ",304.2,90,,243.36,,,0,"percent of total billed charges ","90% of total billed charges ",304.2,90,,243.36,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",294.06,87,,235.25,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.54,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",236.6,70,,189.28,,,0,"percent of total billed charges ","70% of total billed charges ",10.48,314.34,
FRUCTOSAMINE,2003655,"CDM ",301,RC,82985,HCPCS,OUTPATIENT,,,91.5,73.2,,14.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,39.54,39.54,39.54,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.05,70,,51.24,,,0,"percent of total billed charges ","70% of total billed charges ",82.35,90,,65.88,,,0,"percent of total billed charges ","90% of total billed charges ",85.1,93,,68.08,,,0,"percent of total billed charges ","93% of total billed charges ",14.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.03,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",77.78,85,,62.22,,,0,"percent of total billed charges ","85% of total billed charges ",82.35,90,,65.88,,,0,"percent of total billed charges ","90% of total billed charges ",82.35,90,,65.88,,,0,"percent of total billed charges ","90% of total billed charges ",18.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",79.61,87,,63.69,,,0,"percent of total billed charges ","87% of total billed charges ",18.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.76,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",64.05,70,,51.24,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,85.1,
"FRUCTOSE SEMEN",2003663,"CDM ",301,RC,82757,HCPCS,OUTPATIENT,,,359,287.2,,11.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",251.3,70,,201.04,,,0,"percent of total billed charges ","70% of total billed charges ",323.1,90,,258.48,,,0,"percent of total billed charges ","90% of total billed charges ",333.87,93,,267.10,,,0,"percent of total billed charges ","93% of total billed charges ",11.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",305.15,85,,244.12,,,0,"percent of total billed charges ","85% of total billed charges ",323.1,90,,258.48,,,0,"percent of total billed charges ","90% of total billed charges ",323.1,90,,258.48,,,0,"percent of total billed charges ","90% of total billed charges ",14.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",312.33,87,,249.86,,,0,"percent of total billed charges ","87% of total billed charges ",14.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.34,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",251.3,70,,201.04,,,0,"percent of total billed charges ","70% of total billed charges ",11.86,333.87,
"1,5 ANHYDROGLUCITOL -GLYCOMARK",2003689,"CDM ",301,RC,84378,HCPCS,OUTPATIENT,,,367.5,294,,11.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,281.78,281.78,281.78,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",257.25,70,,205.80,,,0,"percent of total billed charges ","70% of total billed charges ",330.75,90,,264.60,,,0,"percent of total billed charges ","90% of total billed charges ",341.78,93,,273.42,,,0,"percent of total billed charges ","93% of total billed charges ",11.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",312.38,85,,249.90,,,0,"percent of total billed charges ","85% of total billed charges ",330.75,90,,264.60,,,0,"percent of total billed charges ","90% of total billed charges ",330.75,90,,264.60,,,0,"percent of total billed charges ","90% of total billed charges ",35.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",319.73,87,,255.78,,,0,"percent of total billed charges ","87% of total billed charges ",35.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",257.25,70,,205.80,,,0,"percent of total billed charges ","70% of total billed charges ",11.53,341.78,
"IMMUNOGLOBULIN IGD",2003739,"CDM ",301,RC,82784,HCPCS,OUTPATIENT,,,108,86.4,,9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,75.17,,,0,"percent of total billed charges ","87% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",9.3,100.44,
"IMMUNOGLOBULIN G SUBCLASS I",2003747,"CDM ",301,RC,82787,HCPCS,OUTPATIENT,,,73,58.4,,8.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.1,70,,40.88,,,0,"percent of total billed charges ","70% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",67.89,93,,54.31,,,0,"percent of total billed charges ","93% of total billed charges ",8.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.05,85,,49.64,,,0,"percent of total billed charges ","85% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",17.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.51,87,,50.81,,,0,"percent of total billed charges ","87% of total billed charges ",17.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.02,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",51.1,70,,40.88,,,0,"percent of total billed charges ","70% of total billed charges ",8.02,67.89,
"IMMUNOGLOBULIN G SUBCLASS II",2003754,"CDM ",301,RC,82787,HCPCS,OUTPATIENT,,,73,58.4,,8.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.1,70,,40.88,,,0,"percent of total billed charges ","70% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",67.89,93,,54.31,,,0,"percent of total billed charges ","93% of total billed charges ",8.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.05,85,,49.64,,,0,"percent of total billed charges ","85% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",17.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.51,87,,50.81,,,0,"percent of total billed charges ","87% of total billed charges ",17.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.02,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",51.1,70,,40.88,,,0,"percent of total billed charges ","70% of total billed charges ",8.02,67.89,
"IMMUNOGLOBULIN G SUBCLASS 3)",2003762,"CDM ",301,RC,82787,HCPCS,OUTPATIENT,,,73,58.4,,8.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.1,70,,40.88,,,0,"percent of total billed charges ","70% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",67.89,93,,54.31,,,0,"percent of total billed charges ","93% of total billed charges ",8.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.05,85,,49.64,,,0,"percent of total billed charges ","85% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",17.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.51,87,,50.81,,,0,"percent of total billed charges ","87% of total billed charges ",17.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.02,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",51.1,70,,40.88,,,0,"percent of total billed charges ","70% of total billed charges ",8.02,67.89,
"IMMUNOGLOBULIN G SUBCLASS 4",2003770,"CDM ",301,RC,82787,HCPCS,OUTPATIENT,,,85.5,68.4,,8.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.85,70,,47.88,,,0,"percent of total billed charges ","70% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",79.52,93,,63.62,,,0,"percent of total billed charges ","93% of total billed charges ",8.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",72.68,85,,58.14,,,0,"percent of total billed charges ","85% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",17.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",74.39,87,,59.51,,,0,"percent of total billed charges ","87% of total billed charges ",17.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.02,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",59.85,70,,47.88,,,0,"percent of total billed charges ","70% of total billed charges ",8.02,79.52,
"LACTIC ACID, SERUM",2003812,"CDM ",301,RC,83605,HCPCS,OUTPATIENT,,,210.5,168.4,,10.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",195.77,93,,156.62,,,0,"percent of total billed charges ","93% of total billed charges ",10.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",178.93,85,,143.14,,,0,"percent of total billed charges ","85% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",183.14,87,,130.68,127.41,202.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.57,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",10.08,195.77,
"*LH (LUTEINIZING HORM)",2003861,"CDM ",301,RC,83002,HCPCS,OUTPATIENT,,,153,122.4,,18.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",107.1,70,,85.68,,,0,"percent of total billed charges ","70% of total billed charges ",137.7,90,,110.16,,,0,"percent of total billed charges ","90% of total billed charges ",142.29,93,,113.83,,,0,"percent of total billed charges ","93% of total billed charges ",18.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",130.05,85,,104.04,,,0,"percent of total billed charges ","85% of total billed charges ",137.7,90,,110.16,,,0,"percent of total billed charges ","90% of total billed charges ",137.7,90,,110.16,,,0,"percent of total billed charges ","90% of total billed charges ",32.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",133.11,87,,87.72,47.08,111.82,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.52,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",107.1,70,,85.68,,,0,"percent of total billed charges ","70% of total billed charges ",18.52,142.29,
MORPHINE,2003879,"CDM ",301,RC,80361,HCPCS,OUTPATIENT,,,431,344.8,,10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,38.30,38.30,38.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",301.7,70,,241.36,,,0,"percent of total billed charges ","70% of total billed charges ",387.9,90,,310.32,,,0,"percent of total billed charges ","90% of total billed charges ",400.83,93,,320.66,,,0,"percent of total billed charges ","93% of total billed charges ",10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",366.35,85,,293.08,,,0,"percent of total billed charges ","85% of total billed charges ",387.9,90,,310.32,,,0,"percent of total billed charges ","90% of total billed charges ",387.9,90,,310.32,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",374.97,87,,299.98,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",301.7,70,,241.36,,,0,"percent of total billed charges ","70% of total billed charges ",10.4,400.83,
"MUCIN CLOT",2003887,"CDM ",301,RC,83872,HCPCS,OUTPATIENT,,,96,76.8,,5.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.2,70,,53.76,,,0,"percent of total billed charges ","70% of total billed charges ",86.4,90,,69.12,,,0,"percent of total billed charges ","90% of total billed charges ",89.28,93,,71.42,,,0,"percent of total billed charges ","93% of total billed charges ",5.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",81.6,85,,65.28,,,0,"percent of total billed charges ","85% of total billed charges ",86.4,90,,69.12,,,0,"percent of total billed charges ","90% of total billed charges ",86.4,90,,69.12,,,0,"percent of total billed charges ","90% of total billed charges ",9.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.52,87,,66.82,,,0,"percent of total billed charges ","87% of total billed charges ",9.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.86,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",67.2,70,,53.76,,,0,"percent of total billed charges ","70% of total billed charges ",5.86,89.28,
PHENYTOIN,2003937,"CDM ",301,RC,80185,HCPCS,OUTPATIENT,,,140.5,112.4,,13.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,65.12,65.12,65.12,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",130.67,93,,104.54,,,0,"percent of total billed charges ","93% of total billed charges ",13.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.57,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",119.43,85,,95.54,,,0,"percent of total billed charges ","85% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",20.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.24,87,,97.79,,,0,"percent of total billed charges ","87% of total billed charges ",20.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.25,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",13.25,130.67,
PROGESTERONE,2003945,"CDM ",301,RC,84144,HCPCS,OUTPATIENT,,,155.5,124.4,,20.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,85.83,85.83,85.83,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.85,70,,87.08,,,0,"percent of total billed charges ","70% of total billed charges ",139.95,90,,111.96,,,0,"percent of total billed charges ","90% of total billed charges ",144.62,93,,115.70,,,0,"percent of total billed charges ","93% of total billed charges ",20.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",132.18,85,,105.74,,,0,"percent of total billed charges ","85% of total billed charges ",139.95,90,,111.96,,,0,"percent of total billed charges ","90% of total billed charges ",139.95,90,,111.96,,,0,"percent of total billed charges ","90% of total billed charges ",37.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",135.29,87,,57.38,24.31,82.77,"1 through 10","percent of total billed charges ","87% of total billed charges ",37.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.86,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",108.85,70,,87.08,,,0,"percent of total billed charges ","70% of total billed charges ",20.86,144.62,
"PSA TOTAL",2003952,"CDM ",301,RC,84153,HCPCS,OUTPATIENT,,,210.5,168.4,,18.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,81.31,81.31,81.31,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",195.77,93,,156.62,,,0,"percent of total billed charges ","93% of total billed charges ",18.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.55,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",178.93,85,,143.14,,,0,"percent of total billed charges ","85% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",28.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",183.14,87,,18.03,18.03,18.03,"1 through 10","percent of total billed charges ","87% of total billed charges ",28.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",18.39,195.77,
QUINIDINE,2003960,"CDM ",300,RC,80194,HCPCS,OUTPATIENT,,,158,126.4,,20.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.6,70,,88.48,,,0,"percent of total billed charges ","70% of total billed charges ",142.2,90,,113.76,,,0,"percent of total billed charges ","90% of total billed charges ",146.94,93,,117.55,,,0,"percent of total billed charges ","93% of total billed charges ",20.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.65,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",134.3,85,,107.44,,,0,"percent of total billed charges ","85% of total billed charges ",142.2,90,,113.76,,,0,"percent of total billed charges ","90% of total billed charges ",142.2,90,,113.76,,,0,"percent of total billed charges ","90% of total billed charges ",26.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",137.46,87,,109.97,,,0,"percent of total billed charges ","87% of total billed charges ",26.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.6,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",110.6,70,,88.48,,,0,"percent of total billed charges ","70% of total billed charges ",14.6,146.94,
TRANSFERRIN,2003994,"CDM ",301,RC,84466,HCPCS,OUTPATIENT,,,126,100.8,,12.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,12.50,12.50,12.50,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.2,70,,70.56,,,0,"percent of total billed charges ","70% of total billed charges ",113.4,90,,90.72,,,0,"percent of total billed charges ","90% of total billed charges ",117.18,93,,93.74,,,0,"percent of total billed charges ","93% of total billed charges ",12.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",107.1,85,,85.68,,,0,"percent of total billed charges ","85% of total billed charges ",113.4,90,,90.72,,,0,"percent of total billed charges ","90% of total billed charges ",113.4,90,,90.72,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",109.62,87,,19.77,12.51,97.84,14,"percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.76,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",88.2,70,,70.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.76,117.18,
"VITAMIN D,25-HYDROX",2004034,"CDM ",301,RC,82306,HCPCS,OUTPATIENT,,,410.5,328.4,,25.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,29.01,29.01,29.01,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",287.35,70,,229.88,,,0,"percent of total billed charges ","70% of total billed charges ",369.45,90,,295.56,,,0,"percent of total billed charges ","90% of total billed charges ",381.77,93,,305.42,,,0,"percent of total billed charges ","93% of total billed charges ",25.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",348.93,85,,279.14,,,0,"percent of total billed charges ","85% of total billed charges ",369.45,90,,295.56,,,0,"percent of total billed charges ","90% of total billed charges ",369.45,90,,295.56,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",357.14,87,,41.52,29.01,318.94,20,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.6,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",287.35,70,,229.88,,,0,"percent of total billed charges ","70% of total billed charges ",13.18,381.77,
"D-XYLOSE TOLERANCE",2004075,"CDM ",301,RC,84620,HCPCS,OUTPATIENT,,,324.5,259.6,,17.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.15,70,,181.72,,,0,"percent of total billed charges ","70% of total billed charges ",292.05,90,,233.64,,,0,"percent of total billed charges ","90% of total billed charges ",301.79,93,,241.43,,,0,"percent of total billed charges ","93% of total billed charges ",17.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",275.83,85,,220.66,,,0,"percent of total billed charges ","85% of total billed charges ",292.05,90,,233.64,,,0,"percent of total billed charges ","90% of total billed charges ",292.05,90,,233.64,,,0,"percent of total billed charges ","90% of total billed charges ",21.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",282.32,87,,225.86,,,0,"percent of total billed charges ","87% of total billed charges ",21.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.91,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",227.15,70,,181.72,,,0,"percent of total billed charges ","70% of total billed charges ",12.91,301.79,
"ZINC SERUM",2004083,"CDM ",301,RC,84630,HCPCS,OUTPATIENT,,,85,68,,11.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.5,70,,47.60,,,0,"percent of total billed charges ","70% of total billed charges ",76.5,90,,61.20,,,0,"percent of total billed charges ","90% of total billed charges ",79.05,93,,63.24,,,0,"percent of total billed charges ","93% of total billed charges ",11.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",72.25,85,,57.80,,,0,"percent of total billed charges ","85% of total billed charges ",76.5,90,,61.20,,,0,"percent of total billed charges ","90% of total billed charges ",76.5,90,,61.20,,,0,"percent of total billed charges ","90% of total billed charges ",20.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",73.95,87,,59.16,,,0,"percent of total billed charges ","87% of total billed charges ",20.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",59.5,70,,47.60,,,0,"percent of total billed charges ","70% of total billed charges ",11.39,79.05,
"EOSINOPHILE COUNT NASAL",2004117,"CDM ",300,RC,89190,HCPCS,OUTPATIENT,,,123,98.4,,4.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.1,70,,68.88,,,0,"percent of total billed charges ","70% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",114.39,93,,91.51,,,0,"percent of total billed charges ","93% of total billed charges ",4.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.55,85,,83.64,,,0,"percent of total billed charges ","85% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.01,87,,85.61,,,0,"percent of total billed charges ","87% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.79,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",86.1,70,,68.88,,,0,"percent of total billed charges ","70% of total billed charges ",4.92,114.39,
"FIBRINOGEN QT",2004133,"CDM ",305,RC,85384,HCPCS,OUTPATIENT,,,52.5,42,,9.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",48.83,93,,39.06,,,0,"percent of total billed charges ","93% of total billed charges ",9.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",44.63,85,,35.70,,,0,"percent of total billed charges ","85% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.68,87,,36.54,,,0,"percent of total billed charges ","87% of total billed charges ",13.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.72,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",9.72,48.83,
"MALARIA SMEAR",2004141,"CDM ",306,RC,87207,HCPCS,OUTPATIENT,,,133,106.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.1,70,,74.48,,,0,"percent of total billed charges ","70% of total billed charges ",119.7,90,,95.76,,,0,"percent of total billed charges ","90% of total billed charges ",123.69,93,,98.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",113.05,85,,90.44,,,0,"percent of total billed charges ","85% of total billed charges ",119.7,90,,95.76,,,0,"percent of total billed charges ","90% of total billed charges ",119.7,90,,95.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",115.71,87,,92.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",5.99,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",93.1,70,,74.48,,,0,"percent of total billed charges ","70% of total billed charges ",5.99,123.69,
ANTISTREPTOLYSIN,2004174,"CDM ",302,RC,86060,HCPCS,OUTPATIENT,,,94,75.2,,7.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.8,70,,52.64,,,0,"percent of total billed charges ","70% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",87.42,93,,69.94,,,0,"percent of total billed charges ","93% of total billed charges ",7.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.81,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",79.9,85,,63.92,,,0,"percent of total billed charges ","85% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",11.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",81.78,87,,65.42,,,0,"percent of total billed charges ","87% of total billed charges ",11.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",65.8,70,,52.64,,,0,"percent of total billed charges ","70% of total billed charges ",7.3,87.42,
"CMV ABS IG G",2004182,"CDM ",302,RC,86644,HCPCS,OUTPATIENT,,,204,163.2,,12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,141.98,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,189.72,
"RICKETTSIA IGG",2004257,"CDM ",302,RC,86757,HCPCS,OUTPATIENT,,,351,280.8,,19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",245.7,70,,196.56,,,0,"percent of total billed charges ","70% of total billed charges ",315.9,90,,252.72,,,0,"percent of total billed charges ","90% of total billed charges ",326.43,93,,261.14,,,0,"percent of total billed charges ","93% of total billed charges ",19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",298.35,85,,238.68,,,0,"percent of total billed charges ","85% of total billed charges ",315.9,90,,252.72,,,0,"percent of total billed charges ","90% of total billed charges ",315.9,90,,252.72,,,0,"percent of total billed charges ","90% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",305.37,87,,244.30,,,0,"percent of total billed charges ","87% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.35,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",245.7,70,,196.56,,,0,"percent of total billed charges ","70% of total billed charges ",19.35,326.43,
"HLA TYPING A,B,C",2004265,"CDM ",302,RC,86813,HCPCS,OUTPATIENT,,,1947.5,1558,,83.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1363.25,70,,1090.60,,,0,"percent of total billed charges ","70% of total billed charges ",1752.75,90,,1402.20,,,0,"percent of total billed charges ","90% of total billed charges ",1811.18,93,,1448.94,,,0,"percent of total billed charges ","93% of total billed charges ",83.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",105.89,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1655.38,85,,1324.30,,,0,"percent of total billed charges ","85% of total billed charges ",1752.75,90,,1402.20,,,0,"percent of total billed charges ","90% of total billed charges ",1752.75,90,,1402.20,,,0,"percent of total billed charges ","90% of total billed charges ",104.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1694.33,87,,1355.46,,,0,"percent of total billed charges ","87% of total billed charges ",104.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",58,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1363.25,70,,1090.60,,,0,"percent of total billed charges ","70% of total billed charges ",58,1811.18,
"*RUBELLA ANTIBODIES",2004273,"CDM ",302,RC,86762,HCPCS,OUTPATIENT,,,89,71.2,,12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",82.77,93,,66.22,,,0,"percent of total billed charges ","93% of total billed charges ",12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",75.65,85,,60.52,,,0,"percent of total billed charges ","85% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",77.43,87,,48.62,10.18,58.34,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,82.77,
"C1 ESTERASE INHIBITOR",2004323,"CDM ",302,RC,86160,HCPCS,OUTPATIENT,,,185,148,,12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,133.30,133.30,133.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",172.05,93,,137.64,,,0,"percent of total billed charges ","93% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",157.25,85,,125.80,,,0,"percent of total billed charges ","85% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",160.95,87,,226.71,226.71,226.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",12,172.05,
"HEPATITIS C ANTIBODY IGG",2004331,"CDM ",302,RC,86803,HCPCS,OUTPATIENT,,,126.5,101.2,,14.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.55,70,,70.84,,,0,"percent of total billed charges ","70% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",117.65,93,,94.12,,,0,"percent of total billed charges ","93% of total billed charges ",14.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",107.53,85,,86.02,,,0,"percent of total billed charges ","85% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",19.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",110.06,87,,86.63,86.63,86.63,12,"percent of total billed charges ","87% of total billed charges ",19.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",88.55,70,,70.84,,,0,"percent of total billed charges ","70% of total billed charges ",14.27,117.65,
"HEPATITIS DELTA VIRUS",2004364,"CDM ",302,RC,86692,HCPCS,OUTPATIENT,,,210.5,168.4,,14.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",195.77,93,,156.62,,,0,"percent of total billed charges ","93% of total billed charges ",14.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",178.93,85,,143.14,,,0,"percent of total billed charges ","85% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",183.14,87,,146.51,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.16,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,195.77,
"HEPATITIS A TOTAL",2004380,"CDM ",302,RC,86708,HCPCS,OUTPATIENT,,,126.5,101.2,,12.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.55,70,,70.84,,,0,"percent of total billed charges ","70% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",117.65,93,,94.12,,,0,"percent of total billed charges ","93% of total billed charges ",12.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",107.53,85,,86.02,,,0,"percent of total billed charges ","85% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",19.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",110.06,87,,88.05,,,0,"percent of total billed charges ","87% of total billed charges ",19.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",88.55,70,,70.84,,,0,"percent of total billed charges ","70% of total billed charges ",12.39,117.65,
"ANGIOTENSIN CONV ENZ",2004406,"CDM ",301,RC,82164,HCPCS,OUTPATIENT,,,108,86.4,,14.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",14.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",21.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,75.17,,,0,"percent of total billed charges ","87% of total billed charges ",21.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.6,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",14.6,100.44,
"HEPATITIS A ANTIBODY IGM",2004414,"CDM ",302,RC,86709,HCPCS,OUTPATIENT,,,140.5,112.4,,11.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,18.23,18.23,18.23,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",130.67,93,,104.54,,,0,"percent of total billed charges ","93% of total billed charges ",11.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",119.43,85,,95.54,,,0,"percent of total billed charges ","85% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",19.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.24,87,,97.79,,,0,"percent of total billed charges ","87% of total billed charges ",19.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.26,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",11.26,130.67,
"HEPATITIS B SURFACE AG",2004430,"CDM ",306,RC,87340,HCPCS,OUTPATIENT,,,68,54.4,,10.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.6,70,,38.08,,,0,"percent of total billed charges ","70% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",63.24,93,,50.59,,,0,"percent of total billed charges ","93% of total billed charges ",10.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",57.8,85,,46.24,,,0,"percent of total billed charges ","85% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",15.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.16,87,,46.55,46.55,46.55,11,"percent of total billed charges ","87% of total billed charges ",15.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.33,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",47.6,70,,38.08,,,0,"percent of total billed charges ","70% of total billed charges ",10.33,63.24,
"HEPATITIS B CORE TOTAL",2004463,"CDM ",302,RC,86704,HCPCS,OUTPATIENT,,,123,98.4,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.1,70,,68.88,,,0,"percent of total billed charges ","70% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",114.39,93,,91.51,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.29,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.55,85,,83.64,,,0,"percent of total billed charges ","85% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",19.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.01,87,,85.61,,,0,"percent of total billed charges ","87% of total billed charges ",19.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",86.1,70,,68.88,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,114.39,
"COMPLEMENT C3 BF",2004471,"CDM ",302,RC,86160,HCPCS,OUTPATIENT,,,165,132,,12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,133.30,133.30,133.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,226.71,226.71,226.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",12,153.45,
"HEPATITIS BE AG",2004505,"CDM ",306,RC,87350,HCPCS,OUTPATIENT,,,120.5,96.4,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.35,70,,67.48,,,0,"percent of total billed charges ","70% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",112.07,93,,89.66,,,0,"percent of total billed charges ","93% of total billed charges ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",102.43,85,,81.94,,,0,"percent of total billed charges ","85% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",104.84,87,,83.87,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",84.35,70,,67.48,,,0,"percent of total billed charges ","70% of total billed charges ",10,112.07,
"HEPATITIS BE ANTIBODY",2004521,"CDM ",302,RC,86707,HCPCS,OUTPATIENT,,,217,173.6,,11.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,41.56,41.56,41.56,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.9,70,,121.52,,,0,"percent of total billed charges ","70% of total billed charges ",195.3,90,,156.24,,,0,"percent of total billed charges ","90% of total billed charges ",201.81,93,,161.45,,,0,"percent of total billed charges ","93% of total billed charges ",11.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",184.45,85,,147.56,,,0,"percent of total billed charges ","85% of total billed charges ",195.3,90,,156.24,,,0,"percent of total billed charges ","90% of total billed charges ",195.3,90,,156.24,,,0,"percent of total billed charges ","90% of total billed charges ",19.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",188.79,87,,151.03,,,0,"percent of total billed charges ","87% of total billed charges ",19.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.57,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",151.9,70,,121.52,,,0,"percent of total billed charges ","70% of total billed charges ",11.57,201.81,
"*NORTRIPTYLINE (AVENTYL)",2004554,"CDM ",300,RC,80335,HCPCS,OUTPATIENT,,,122.5,98,,23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",113.93,93,,91.14,,,0,"percent of total billed charges ","93% of total billed charges ",23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.13,85,,83.30,,,0,"percent of total billed charges ","85% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.58,87,,85.26,,,0,"percent of total billed charges ","87% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",23.71,113.93,
"PLATELET GLYCOPROTEIN TOT ANTI",2004562,"CDM ",302,RC,86022,HCPCS,OUTPATIENT,,,185,148,,15.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,30.11,30.11,30.11,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",172.05,93,,137.64,,,0,"percent of total billed charges ","93% of total billed charges ",15.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",157.25,85,,125.80,,,0,"percent of total billed charges ","85% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",160.95,87,,89.65,89.65,89.65,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.37,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,172.05,
"*AMITRIPTYLINE (ELAVIL)",2004588,"CDM ",300,RC,80335,HCPCS,OUTPATIENT,,,122.5,98,,23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",113.93,93,,91.14,,,0,"percent of total billed charges ","93% of total billed charges ",23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.13,85,,83.30,,,0,"percent of total billed charges ","85% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.58,87,,85.26,,,0,"percent of total billed charges ","87% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",23.71,113.93,
"DESIPRAMINE (NORPRAMIN)",2004620,"CDM ",300,RC,80335,HCPCS,OUTPATIENT,,,122.5,98,,23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",113.93,93,,91.14,,,0,"percent of total billed charges ","93% of total billed charges ",23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.13,85,,83.30,,,0,"percent of total billed charges ","85% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.58,87,,85.26,,,0,"percent of total billed charges ","87% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",23.71,113.93,
"*HEAVY METAL URINE MERCURY",2004638,"CDM ",301,RC,83825,HCPCS,OUTPATIENT,,,53,42.4,,13.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,42.75,42.75,42.75,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",49.29,93,,39.43,,,0,"percent of total billed charges ","93% of total billed charges ",13.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.05,85,,36.04,,,0,"percent of total billed charges ","85% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.11,87,,36.89,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.26,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",13.18,49.29,
"CLONAZEPAM  (KLONOPIN)",2004653,"CDM ",300,RC,80346,HCPCS,OUTPATIENT,,,98.5,78.8,,23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",23.71,91.61,
"*EBV NUCLEAR AG",2004661,"CDM ",302,RC,86664,HCPCS,OUTPATIENT,,,175,140,,13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",162.75,93,,130.20,,,0,"percent of total billed charges ","93% of total billed charges ",13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",148.75,85,,119.00,,,0,"percent of total billed charges ","85% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",152.25,87,,121.80,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.29,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,162.75,
"*HEAVY METAL URINE LEAD",2004679,"CDM ",301,RC,83655,HCPCS,OUTPATIENT,,,54,43.2,,11.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.8,70,,30.24,,,0,"percent of total billed charges ","70% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",50.22,93,,40.18,,,0,"percent of total billed charges ","93% of total billed charges ",11.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.9,85,,36.72,,,0,"percent of total billed charges ","85% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",15.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.98,87,,33.45,33.45,33.45,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.11,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",37.8,70,,30.24,,,0,"percent of total billed charges ","70% of total billed charges ",11.7,50.22,
"*HEAVY METAL BLD LEAD",2004729,"CDM ",301,RC,83655,HCPCS,OUTPATIENT,,,105.5,84.4,,11.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.85,70,,59.08,,,0,"percent of total billed charges ","70% of total billed charges ",94.95,90,,75.96,,,0,"percent of total billed charges ","90% of total billed charges ",98.12,93,,78.50,,,0,"percent of total billed charges ","93% of total billed charges ",11.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",89.68,85,,71.74,,,0,"percent of total billed charges ","85% of total billed charges ",94.95,90,,75.96,,,0,"percent of total billed charges ","90% of total billed charges ",94.95,90,,75.96,,,0,"percent of total billed charges ","90% of total billed charges ",15.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",91.79,87,,33.45,33.45,33.45,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.11,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",73.85,70,,59.08,,,0,"percent of total billed charges ","70% of total billed charges ",11.7,98.12,
"*HEAVY METAL BLD MERCURY",2004752,"CDM ",301,RC,83825,HCPCS,OUTPATIENT,,,105.5,84.4,,13.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,42.75,42.75,42.75,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.85,70,,59.08,,,0,"percent of total billed charges ","70% of total billed charges ",94.95,90,,75.96,,,0,"percent of total billed charges ","90% of total billed charges ",98.12,93,,78.50,,,0,"percent of total billed charges ","93% of total billed charges ",13.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",89.68,85,,71.74,,,0,"percent of total billed charges ","85% of total billed charges ",94.95,90,,75.96,,,0,"percent of total billed charges ","90% of total billed charges ",94.95,90,,75.96,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",91.79,87,,73.43,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.26,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",73.85,70,,59.08,,,0,"percent of total billed charges ","70% of total billed charges ",13.18,98.12,
"FACTOR IX",2004760,"CDM ",305,RC,85250,HCPCS,OUTPATIENT,,,145.5,116.4,,16.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.85,70,,81.48,,,0,"percent of total billed charges ","70% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",135.32,93,,108.26,,,0,"percent of total billed charges ","93% of total billed charges ",16.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",123.68,85,,98.94,,,0,"percent of total billed charges ","85% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",126.59,87,,101.27,,,0,"percent of total billed charges ","87% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.04,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",101.85,70,,81.48,,,0,"percent of total billed charges ","70% of total billed charges ",15.45,135.32,
"CANCER AG 125",2004786,"CDM ",302,RC,86304,HCPCS,OUTPATIENT,,,155,124,,20.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.5,70,,86.80,,,0,"percent of total billed charges ","70% of total billed charges ",139.5,90,,111.60,,,0,"percent of total billed charges ","90% of total billed charges ",144.15,93,,115.32,,,0,"percent of total billed charges ","93% of total billed charges ",20.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",131.75,85,,105.40,,,0,"percent of total billed charges ","85% of total billed charges ",139.5,90,,111.60,,,0,"percent of total billed charges ","90% of total billed charges ",139.5,90,,111.60,,,0,"percent of total billed charges ","90% of total billed charges ",31.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",134.85,87,,107.88,,,0,"percent of total billed charges ","87% of total billed charges ",31.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.81,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",108.5,70,,86.80,,,0,"percent of total billed charges ","70% of total billed charges ",20.81,144.15,
"PROCAINAMIDE (PRONESTYL)",2004828,"CDM ",301,RC,80192,HCPCS,OUTPATIENT,,,150,120,,22.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",105,70,,84.00,,,0,"percent of total billed charges ","70% of total billed charges ",135,90,,108.00,,,0,"percent of total billed charges ","90% of total billed charges ",139.5,93,,111.60,,,0,"percent of total billed charges ","93% of total billed charges ",22.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.4,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",127.5,85,,102.00,,,0,"percent of total billed charges ","85% of total billed charges ",135,90,,108.00,,,0,"percent of total billed charges ","90% of total billed charges ",135,90,,108.00,,,0,"percent of total billed charges ","90% of total billed charges ",28.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.5,87,,104.40,,,0,"percent of total billed charges ","87% of total billed charges ",28.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.75,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",105,70,,84.00,,,0,"percent of total billed charges ","70% of total billed charges ",16.75,139.5,
"FACTOR VIII",2004836,"CDM ",305,RC,85240,HCPCS,OUTPATIENT,,,173.5,138.8,,17.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",121.45,70,,97.16,,,0,"percent of total billed charges ","70% of total billed charges ",156.15,90,,124.92,,,0,"percent of total billed charges ","90% of total billed charges ",161.36,93,,129.09,,,0,"percent of total billed charges ","93% of total billed charges ",17.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",147.48,85,,117.98,,,0,"percent of total billed charges ","85% of total billed charges ",156.15,90,,124.92,,,0,"percent of total billed charges ","90% of total billed charges ",156.15,90,,124.92,,,0,"percent of total billed charges ","90% of total billed charges ",24.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",150.95,87,,150.42,150.42,150.42,"1 through 10","percent of total billed charges ","87% of total billed charges ",24.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.89,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",121.45,70,,97.16,,,0,"percent of total billed charges ","70% of total billed charges ",17.89,161.36,
"HALOPERIDOL (HALDOL)",2004950,"CDM ",301,RC,80173,HCPCS,OUTPATIENT,,,186.5,149.2,,15.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.55,70,,104.44,,,0,"percent of total billed charges ","70% of total billed charges ",167.85,90,,134.28,,,0,"percent of total billed charges ","90% of total billed charges ",173.45,93,,138.76,,,0,"percent of total billed charges ","93% of total billed charges ",15.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.59,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",158.53,85,,126.82,,,0,"percent of total billed charges ","85% of total billed charges ",167.85,90,,134.28,,,0,"percent of total billed charges ","90% of total billed charges ",167.85,90,,134.28,,,0,"percent of total billed charges ","90% of total billed charges ",22.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",162.26,87,,129.81,,,0,"percent of total billed charges ","87% of total billed charges ",22.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.78,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",130.55,70,,104.44,,,0,"percent of total billed charges ","70% of total billed charges ",15.78,173.45,
"DIAZEPAM (VALIUM)",2004968,"CDM ",300,RC,80346,HCPCS,OUTPATIENT,,,98.5,78.8,,23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",23.71,91.61,
"CITRIC ACID URINE",2004976,"CDM ",301,RC,82507,HCPCS,OUTPATIENT,,,159.5,127.6,,23.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.65,70,,89.32,,,0,"percent of total billed charges ","70% of total billed charges ",143.55,90,,114.84,,,0,"percent of total billed charges ","90% of total billed charges ",148.34,93,,118.67,,,0,"percent of total billed charges ","93% of total billed charges ",23.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",135.58,85,,108.46,,,0,"percent of total billed charges ","85% of total billed charges ",143.55,90,,114.84,,,0,"percent of total billed charges ","90% of total billed charges ",143.55,90,,114.84,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",138.77,87,,111.02,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.8,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",111.65,70,,89.32,,,0,"percent of total billed charges ","70% of total billed charges ",13.18,148.34,
ALDOLASE,2004992,"CDM ",301,RC,82085,HCPCS,OUTPATIENT,,,69,55.2,,9.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,0.40,0.40,0.40,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.3,70,,38.64,,,0,"percent of total billed charges ","70% of total billed charges ",62.1,90,,49.68,,,0,"percent of total billed charges ","90% of total billed charges ",64.17,93,,51.34,,,0,"percent of total billed charges ","93% of total billed charges ",9.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.27,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",58.65,85,,46.92,,,0,"percent of total billed charges ","85% of total billed charges ",62.1,90,,49.68,,,0,"percent of total billed charges ","90% of total billed charges ",62.1,90,,49.68,,,0,"percent of total billed charges ","90% of total billed charges ",14.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60.03,87,,48.02,,,0,"percent of total billed charges ","87% of total billed charges ",14.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",48.3,70,,38.64,,,0,"percent of total billed charges ","70% of total billed charges ",9.71,64.17,
VANCOMYCIN,2005007,"CDM ",301,RC,80202,HCPCS,OUTPATIENT,,,311.5,249.2,,13.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",218.05,70,,174.44,,,0,"percent of total billed charges ","70% of total billed charges ",280.35,90,,224.28,,,0,"percent of total billed charges ","90% of total billed charges ",289.7,93,,231.76,,,0,"percent of total billed charges ","93% of total billed charges ",13.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.73,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",264.78,85,,211.82,,,0,"percent of total billed charges ","85% of total billed charges ",280.35,90,,224.28,,,0,"percent of total billed charges ","90% of total billed charges ",280.35,90,,224.28,,,0,"percent of total billed charges ","90% of total billed charges ",24.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",271.01,87,,216.81,,,0,"percent of total billed charges ","87% of total billed charges ",24.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.54,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",218.05,70,,174.44,,,0,"percent of total billed charges ","70% of total billed charges ",13.54,289.7,
"CLO TEST",2005015,"CDM ",306,RC,87081,HCPCS,OUTPATIENT,,,228,182.4,,6.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",159.6,70,,127.68,,,0,"percent of total billed charges ","70% of total billed charges ",205.2,90,,164.16,,,0,"percent of total billed charges ","90% of total billed charges ",212.04,93,,169.63,,,0,"percent of total billed charges ","93% of total billed charges ",6.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",193.8,85,,155.04,,,0,"percent of total billed charges ","85% of total billed charges ",205.2,90,,164.16,,,0,"percent of total billed charges ","90% of total billed charges ",205.2,90,,164.16,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.36,87,,156.45,156.45,156.45,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.63,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",159.6,70,,127.68,,,0,"percent of total billed charges ","70% of total billed charges ",6.63,212.04,
"HEMOGLOBIN FRACTIONIZATION",2005031,"CDM ",301,RC,83021,HCPCS,OUTPATIENT,,,125,100,,17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.5,70,,70.00,,,0,"percent of total billed charges ","70% of total billed charges ",112.5,90,,90.00,,,0,"percent of total billed charges ","90% of total billed charges ",116.25,93,,93.00,,,0,"percent of total billed charges ","93% of total billed charges ",17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",106.25,85,,85.00,,,0,"percent of total billed charges ","85% of total billed charges ",112.5,90,,90.00,,,0,"percent of total billed charges ","90% of total billed charges ",112.5,90,,90.00,,,0,"percent of total billed charges ","90% of total billed charges ",23.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",108.75,87,,77.19,77.19,77.19,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",87.5,70,,70.00,,,0,"percent of total billed charges ","70% of total billed charges ",17.8,116.25,
"*MUMPS ANTIBODIES",2005098,"CDM ",302,RC,86735,HCPCS,OUTPATIENT,,,183.5,146.8,,11.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",170.66,93,,136.53,,,0,"percent of total billed charges ","93% of total billed charges ",11.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",155.98,85,,124.78,,,0,"percent of total billed charges ","85% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",159.65,87,,127.72,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,170.66,
"HEMOGLOBIN A2 QT",2005114,"CDM ",301,RC,83020,HCPCS,OUTPATIENT,,,114,91.2,,12.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.8,70,,63.84,,,0,"percent of total billed charges ","70% of total billed charges ",102.6,90,,82.08,,,0,"percent of total billed charges ","90% of total billed charges ",106.02,93,,84.82,,,0,"percent of total billed charges ","93% of total billed charges ",12.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",96.9,85,,77.52,,,0,"percent of total billed charges ","85% of total billed charges ",102.6,90,,82.08,,,0,"percent of total billed charges ","90% of total billed charges ",102.6,90,,82.08,,,0,"percent of total billed charges ","90% of total billed charges ",23.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",99.18,87,,79.34,,,0,"percent of total billed charges ","87% of total billed charges ",23.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.87,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",79.8,70,,63.84,,,0,"percent of total billed charges ","70% of total billed charges ",12.87,106.02,
"CANCER AG 15-3",2005130,"CDM ",302,RC,86300,HCPCS,OUTPATIENT,,,169,135.2,,20.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",157.17,93,,125.74,,,0,"percent of total billed charges ","93% of total billed charges ",20.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.65,85,,114.92,,,0,"percent of total billed charges ","85% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",31.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.03,87,,117.62,,,0,"percent of total billed charges ","87% of total billed charges ",31.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.81,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",20.81,157.17,
"T3 UPTAKE",2005189,"CDM ",301,RC,84479,HCPCS,OUTPATIENT,,,41.5,33.2,,6.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.05,70,,23.24,,,0,"percent of total billed charges ","70% of total billed charges ",37.35,90,,29.88,,,0,"percent of total billed charges ","90% of total billed charges ",38.6,93,,30.88,,,0,"percent of total billed charges ","93% of total billed charges ",6.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",35.28,85,,28.22,,,0,"percent of total billed charges ","85% of total billed charges ",37.35,90,,29.88,,,0,"percent of total billed charges ","90% of total billed charges ",37.35,90,,29.88,,,0,"percent of total billed charges ","90% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.11,87,,6.35,6.35,21.68,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.47,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",29.05,70,,23.24,,,0,"percent of total billed charges ","70% of total billed charges ",6.47,38.6,
T4,2005197,"CDM ",301,RC,84436,HCPCS,OUTPATIENT,,,85.5,68.4,,6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.85,70,,47.88,,,0,"percent of total billed charges ","70% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",79.52,93,,63.62,,,0,"percent of total billed charges ","93% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",72.68,85,,58.14,,,0,"percent of total billed charges ","85% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",74.39,87,,59.51,,,0,"percent of total billed charges ","87% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.87,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",59.85,70,,47.88,,,0,"percent of total billed charges ","70% of total billed charges ",6.87,79.52,
DIGOXIN,2005205,"CDM ",301,RC,80162,HCPCS,OUTPATIENT,,,303,242.4,,13.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,65.12,65.12,65.12,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",212.1,70,,169.68,,,0,"percent of total billed charges ","70% of total billed charges ",272.7,90,,218.16,,,0,"percent of total billed charges ","90% of total billed charges ",281.79,93,,225.43,,,0,"percent of total billed charges ","93% of total billed charges ",13.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",257.55,85,,206.04,,,0,"percent of total billed charges ","85% of total billed charges ",272.7,90,,218.16,,,0,"percent of total billed charges ","90% of total billed charges ",272.7,90,,218.16,,,0,"percent of total billed charges ","90% of total billed charges ",24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",263.61,87,,210.89,,,0,"percent of total billed charges ","87% of total billed charges ",24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.28,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",212.1,70,,169.68,,,0,"percent of total billed charges ","70% of total billed charges ",13.28,281.79,
TSH,2005213,"CDM ",301,RC,84443,HCPCS,OUTPATIENT,,,137.5,110,,15.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,16.46,16.46,16.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.25,70,,77.00,,,0,"percent of total billed charges ","70% of total billed charges ",123.75,90,,99.00,,,0,"percent of total billed charges ","90% of total billed charges ",127.88,93,,102.30,,,0,"percent of total billed charges ","93% of total billed charges ",15.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",116.88,85,,93.50,,,0,"percent of total billed charges ","85% of total billed charges ",123.75,90,,99.00,,,0,"percent of total billed charges ","90% of total billed charges ",123.75,90,,99.00,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",119.63,87,,85.17,16.47,106.46,40,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.8,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",96.25,70,,77.00,,,0,"percent of total billed charges ","70% of total billed charges ",15.75,127.88,
"CHOLESTEROL HDL",2005262,"CDM ",301,RC,83718,HCPCS,OUTPATIENT,,,165,132,,8.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",8.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.87,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",14.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,114.84,,,0,"percent of total billed charges ","87% of total billed charges ",14.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",8.19,153.45,
"GENTAMYCIN PEAK",2005304,"CDM ",300,RC,80170,HCPCS,OUTPATIENT,,,221,176.8,,16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154.7,70,,123.76,,,0,"percent of total billed charges ","70% of total billed charges ",198.9,90,,159.12,,,0,"percent of total billed charges ","90% of total billed charges ",205.53,93,,164.42,,,0,"percent of total billed charges ","93% of total billed charges ",16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.95,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",187.85,85,,150.28,,,0,"percent of total billed charges ","85% of total billed charges ",198.9,90,,159.12,,,0,"percent of total billed charges ","90% of total billed charges ",198.9,90,,159.12,,,0,"percent of total billed charges ","90% of total billed charges ",29.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",192.27,87,,153.82,,,0,"percent of total billed charges ","87% of total billed charges ",29.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.38,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",154.7,70,,123.76,,,0,"percent of total billed charges ","70% of total billed charges ",16.38,205.53,
"HEPATITIS B CORE AB IGM",2005320,"CDM ",302,RC,86705,HCPCS,OUTPATIENT,,,94,75.2,,11.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,40.78,40.78,40.78,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.8,70,,52.64,,,0,"percent of total billed charges ","70% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",87.42,93,,69.94,,,0,"percent of total billed charges ","93% of total billed charges ",11.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",79.9,85,,63.92,,,0,"percent of total billed charges ","85% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",19.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",81.78,87,,65.42,,,0,"percent of total billed charges ","87% of total billed charges ",19.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.77,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",65.8,70,,52.64,,,0,"percent of total billed charges ","70% of total billed charges ",11.77,87.42,
"WET MOUNT",2005338,"CDM ",306,RC,87210,HCPCS,OUTPATIENT,,,146,116.8,,5.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,73.95,73.95,73.95,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",5.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",6.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,101.62,,,0,"percent of total billed charges ","87% of total billed charges ",6.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",5.02,135.78,
"PARATHYROID HORMONE",2005395,"CDM ",301,RC,83970,HCPCS,OUTPATIENT,,,804.5,643.6,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,185.57,185.57,185.57,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",563.15,70,,450.52,,,0,"percent of total billed charges ","70% of total billed charges ",724.05,90,,579.24,,,0,"percent of total billed charges ","90% of total billed charges ",748.19,93,,598.55,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",683.83,85,,547.06,,,0,"percent of total billed charges ","85% of total billed charges ",724.05,90,,579.24,,,0,"percent of total billed charges ","90% of total billed charges ",724.05,90,,579.24,,,0,"percent of total billed charges ","90% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",699.92,87,,176.24,40.46,261.19,"1 through 10","percent of total billed charges ","87% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.28,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",563.15,70,,450.52,,,0,"percent of total billed charges ","70% of total billed charges ",30.22,748.19,
"PKU COLLECTION",2005403,"CDM ",301,RC,84030,HCPCS,OUTPATIENT,,,96,76.8,,4.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.2,70,,53.76,,,0,"percent of total billed charges ","70% of total billed charges ",86.4,90,,69.12,,,0,"percent of total billed charges ","90% of total billed charges ",89.28,93,,71.42,,,0,"percent of total billed charges ","93% of total billed charges ",4.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",81.6,85,,65.28,,,0,"percent of total billed charges ","85% of total billed charges ",86.4,90,,69.12,,,0,"percent of total billed charges ","90% of total billed charges ",86.4,90,,69.12,,,0,"percent of total billed charges ","90% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.52,87,,66.82,,,0,"percent of total billed charges ","87% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.5,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",67.2,70,,53.76,,,0,"percent of total billed charges ","70% of total billed charges ",4.68,89.28,
"PHENOBARBITAL LEVEL",2005411,"CDM ",301,RC,80184,HCPCS,OUTPATIENT,,,294,235.2,,15.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",205.8,70,,164.64,,,0,"percent of total billed charges ","70% of total billed charges ",264.6,90,,211.68,,,0,"percent of total billed charges ","90% of total billed charges ",273.42,93,,218.74,,,0,"percent of total billed charges ","93% of total billed charges ",15.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",249.9,85,,199.92,,,0,"percent of total billed charges ","85% of total billed charges ",264.6,90,,211.68,,,0,"percent of total billed charges ","90% of total billed charges ",264.6,90,,211.68,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",255.78,87,,204.62,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",205.8,70,,164.64,,,0,"percent of total billed charges ","70% of total billed charges ",15.3,273.42,
"RENIN PLASMA",2005429,"CDM ",301,RC,84244,HCPCS,OUTPATIENT,,,432,345.6,,21.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",302.4,70,,241.92,,,0,"percent of total billed charges ","70% of total billed charges ",388.8,90,,311.04,,,0,"percent of total billed charges ","90% of total billed charges ",401.76,93,,321.41,,,0,"percent of total billed charges ","93% of total billed charges ",21.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",367.2,85,,293.76,,,0,"percent of total billed charges ","85% of total billed charges ",388.8,90,,311.04,,,0,"percent of total billed charges ","90% of total billed charges ",388.8,90,,311.04,,,0,"percent of total billed charges ","90% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",375.84,87,,300.67,,,0,"percent of total billed charges ","87% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.99,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",302.4,70,,241.92,,,0,"percent of total billed charges ","70% of total billed charges ",21.99,401.76,
"PROLACTIN SERUM",2005445,"CDM ",301,RC,84146,HCPCS,OUTPATIENT,,,172,137.6,,19.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.4,70,,96.32,,,0,"percent of total billed charges ","70% of total billed charges ",154.8,90,,123.84,,,0,"percent of total billed charges ","90% of total billed charges ",159.96,93,,127.97,,,0,"percent of total billed charges ","93% of total billed charges ",19.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.37,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",146.2,85,,116.96,,,0,"percent of total billed charges ","85% of total billed charges ",154.8,90,,123.84,,,0,"percent of total billed charges ","90% of total billed charges ",154.8,90,,123.84,,,0,"percent of total billed charges ","90% of total billed charges ",35.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.64,87,,98.52,91.82,105.22,"1 through 10","percent of total billed charges ","87% of total billed charges ",35.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.38,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",120.4,70,,96.32,,,0,"percent of total billed charges ","70% of total billed charges ",19.38,159.96,
THEOPHYLLINE,2005452,"CDM ",301,RC,80198,HCPCS,OUTPATIENT,,,387.5,310,,14.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",271.25,70,,217.00,,,0,"percent of total billed charges ","70% of total billed charges ",348.75,90,,279.00,,,0,"percent of total billed charges ","90% of total billed charges ",360.38,93,,288.30,,,0,"percent of total billed charges ","93% of total billed charges ",14.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.85,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",329.38,85,,263.50,,,0,"percent of total billed charges ","85% of total billed charges ",348.75,90,,279.00,,,0,"percent of total billed charges ","90% of total billed charges ",348.75,90,,279.00,,,0,"percent of total billed charges ","90% of total billed charges ",25.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",337.13,87,,269.70,,,0,"percent of total billed charges ","87% of total billed charges ",25.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",271.25,70,,217.00,,,0,"percent of total billed charges ","70% of total billed charges ",14.14,360.38,
"TOXOPLASMA TITER IG M",2005494,"CDM ",302,RC,86778,HCPCS,OUTPATIENT,,,155,124,,12.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.5,70,,86.80,,,0,"percent of total billed charges ","70% of total billed charges ",139.5,90,,111.60,,,0,"percent of total billed charges ","90% of total billed charges ",144.15,93,,115.32,,,0,"percent of total billed charges ","93% of total billed charges ",12.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",131.75,85,,105.40,,,0,"percent of total billed charges ","85% of total billed charges ",139.5,90,,111.60,,,0,"percent of total billed charges ","90% of total billed charges ",139.5,90,,111.60,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",134.85,87,,107.88,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.41,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",108.5,70,,86.80,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,144.15,
"*EBV VIRAL CAPSID AG",2005502,"CDM ",302,RC,86665,HCPCS,OUTPATIENT,,,185,148,,15.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",172.05,93,,137.64,,,0,"percent of total billed charges ","93% of total billed charges ",15.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",157.25,85,,125.80,,,0,"percent of total billed charges ","85% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",160.95,87,,128.76,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,172.05,
"ANA PATTERN TITER",2005510,"CDM ",302,RC,86038,HCPCS,OUTPATIENT,,,129,103.2,,12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",119.97,93,,95.98,,,0,"percent of total billed charges ","93% of total billed charges ",12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",109.65,85,,87.72,,,0,"percent of total billed charges ","85% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.23,87,,88.36,11.85,147.83,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",12.09,119.97,
"REDUCE SUBSTANCE STOOL",2005528,"CDM ",301,RC,84376,HCPCS,OUTPATIENT,,,146.5,117.2,,5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.55,70,,82.04,,,0,"percent of total billed charges ","70% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",136.25,93,,109.00,,,0,"percent of total billed charges ","93% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.53,85,,99.62,,,0,"percent of total billed charges ","85% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",35.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.46,87,,101.97,,,0,"percent of total billed charges ","87% of total billed charges ",35.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.5,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.55,70,,82.04,,,0,"percent of total billed charges ","70% of total billed charges ",5.5,136.25,
"*HEM FRAC HGB CHROMATOGRAPHY",2005544,"CDM ",301,RC,83021,HCPCS,OUTPATIENT,,,158.5,126.8,,17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.95,70,,88.76,,,0,"percent of total billed charges ","70% of total billed charges ",142.65,90,,114.12,,,0,"percent of total billed charges ","90% of total billed charges ",147.41,93,,117.93,,,0,"percent of total billed charges ","93% of total billed charges ",17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",134.73,85,,107.78,,,0,"percent of total billed charges ","85% of total billed charges ",142.65,90,,114.12,,,0,"percent of total billed charges ","90% of total billed charges ",142.65,90,,114.12,,,0,"percent of total billed charges ","90% of total billed charges ",23.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",137.9,87,,77.19,77.19,77.19,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",110.95,70,,88.76,,,0,"percent of total billed charges ","70% of total billed charges ",17.8,147.41,
"FUNGUS ID YEAST, CULTURE",2005601,"CDM ",306,RC,87106,HCPCS,OUTPATIENT,,,111,88.8,,10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.7,70,,62.16,,,0,"percent of total billed charges ","70% of total billed charges ",99.9,90,,79.92,,,0,"percent of total billed charges ","90% of total billed charges ",103.23,93,,82.58,,,0,"percent of total billed charges ","93% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",94.35,85,,75.48,,,0,"percent of total billed charges ","85% of total billed charges ",99.9,90,,79.92,,,0,"percent of total billed charges ","90% of total billed charges ",99.9,90,,79.92,,,0,"percent of total billed charges ","90% of total billed charges ",15.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.57,87,,77.26,,,0,"percent of total billed charges ","87% of total billed charges ",15.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.32,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",77.7,70,,62.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.32,103.23,
"HSV CULTURE",2005619,"CDM ",306,RC,87255,HCPCS,OUTPATIENT,,,339.5,271.6,,28.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",237.65,70,,190.12,,,0,"percent of total billed charges ","70% of total billed charges ",305.55,90,,244.44,,,0,"percent of total billed charges ","90% of total billed charges ",315.74,93,,252.59,,,0,"percent of total billed charges ","93% of total billed charges ",28.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",288.58,85,,230.86,,,0,"percent of total billed charges ","85% of total billed charges ",305.55,90,,244.44,,,0,"percent of total billed charges ","90% of total billed charges ",305.55,90,,244.44,,,0,"percent of total billed charges ","90% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",295.37,87,,236.30,,,0,"percent of total billed charges ","87% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.86,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",237.65,70,,190.12,,,0,"percent of total billed charges ","70% of total billed charges ",19.62,315.74,
"TORCH ABS HERPES II",2005643,"CDM ",302,RC,86694,HCPCS,OUTPATIENT,,,219.5,175.6,,12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.65,70,,122.92,,,0,"percent of total billed charges ","70% of total billed charges ",197.55,90,,158.04,,,0,"percent of total billed charges ","90% of total billed charges ",204.14,93,,163.31,,,0,"percent of total billed charges ","93% of total billed charges ",12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",186.58,85,,149.26,,,0,"percent of total billed charges ","85% of total billed charges ",197.55,90,,158.04,,,0,"percent of total billed charges ","90% of total billed charges ",197.55,90,,158.04,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",190.97,87,,152.78,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",153.65,70,,122.92,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,204.14,
"TORCH ABS HERPES I",2005650,"CDM ",302,RC,86695,HCPCS,OUTPATIENT,,,175,140,,11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,76.02,76.02,76.02,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",162.75,93,,130.20,,,0,"percent of total billed charges ","93% of total billed charges ",11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",148.75,85,,119.00,,,0,"percent of total billed charges ","85% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",152.25,87,,121.80,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,162.75,
"TORCH ABS CMV",2005668,"CDM ",302,RC,86644,HCPCS,OUTPATIENT,,,204,163.2,,12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,141.98,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,189.72,
"*FUNGAL ABS QT BLASTO",2005718,"CDM ",302,RC,86612,HCPCS,OUTPATIENT,,,82,65.6,,10.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.4,70,,45.92,,,0,"percent of total billed charges ","70% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",76.26,93,,61.01,,,0,"percent of total billed charges ","93% of total billed charges ",10.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",69.7,85,,55.76,,,0,"percent of total billed charges ","85% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",71.34,87,,57.07,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.9,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",57.4,70,,45.92,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,76.26,
"*FUNGAL ABS QT COCCIDIO",2005726,"CDM ",302,RC,86635,HCPCS,OUTPATIENT,,,146,116.8,,9.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",9.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,101.62,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.47,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,135.78,
"*FUNGAL ABS QT HISTO MYCELIAL",2005734,"CDM ",302,RC,86698,HCPCS,OUTPATIENT,,,169,135.2,,11.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",157.17,93,,125.74,,,0,"percent of total billed charges ","93% of total billed charges ",11.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.65,85,,114.92,,,0,"percent of total billed charges ","85% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.03,87,,117.62,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.79,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,157.17,
"*FUNGAL ABS QT HISTO YEAST",2005742,"CDM ",302,RC,86698,HCPCS,OUTPATIENT,,,169,135.2,,11.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",157.17,93,,125.74,,,0,"percent of total billed charges ","93% of total billed charges ",11.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.65,85,,114.92,,,0,"percent of total billed charges ","85% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.03,87,,117.62,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.79,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,157.17,
"*RHEUM PRO B CRP",2005767,"CDM ",302,RC,86140,HCPCS,OUTPATIENT,,,134,107.2,,5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,5.08,5.08,5.08,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.8,70,,75.04,,,0,"percent of total billed charges ","70% of total billed charges ",120.6,90,,96.48,,,0,"percent of total billed charges ","90% of total billed charges ",124.62,93,,99.70,,,0,"percent of total billed charges ","93% of total billed charges ",5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",113.9,85,,91.12,,,0,"percent of total billed charges ","85% of total billed charges ",120.6,90,,96.48,,,0,"percent of total billed charges ","90% of total billed charges ",120.6,90,,96.48,,,0,"percent of total billed charges ","90% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",116.58,87,,20.30,5.08,51.72,12,"percent of total billed charges ","87% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",93.8,70,,75.04,,,0,"percent of total billed charges ","70% of total billed charges ",5.18,124.62,
"*RHEUM PRO B RF",2005775,"CDM ",302,RC,86431,HCPCS,OUTPATIENT,,,134,107.2,,5.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,5.56,5.56,5.56,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.8,70,,75.04,,,0,"percent of total billed charges ","70% of total billed charges ",120.6,90,,96.48,,,0,"percent of total billed charges ","90% of total billed charges ",124.62,93,,99.70,,,0,"percent of total billed charges ","93% of total billed charges ",5.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",113.9,85,,91.12,,,0,"percent of total billed charges ","85% of total billed charges ",120.6,90,,96.48,,,0,"percent of total billed charges ","90% of total billed charges ",120.6,90,,96.48,,,0,"percent of total billed charges ","90% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",116.58,87,,5.56,5.56,56.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",93.8,70,,75.04,,,0,"percent of total billed charges ","70% of total billed charges ",5.67,124.62,
"GLUCOSE CSF",2005858,"CDM ",301,RC,82945,HCPCS,OUTPATIENT,,,97,77.6,,3.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",90.21,93,,72.17,,,0,"percent of total billed charges ","93% of total billed charges ",3.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",82.45,85,,65.96,,,0,"percent of total billed charges ","85% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",6.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.39,87,,67.51,,,0,"percent of total billed charges ","87% of total billed charges ",6.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",3.93,90.21,
"CANNABINOID URINE",2005882,"CDM ",300,RC,80307,HCPCS,OUTPATIENT,,,404.5,323.6,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",283.15,70,,226.52,,,0,"percent of total billed charges ","70% of total billed charges ",364.05,90,,291.24,,,0,"percent of total billed charges ","90% of total billed charges ",376.19,93,,300.95,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",343.83,85,,275.06,,,0,"percent of total billed charges ","85% of total billed charges ",364.05,90,,291.24,,,0,"percent of total billed charges ","90% of total billed charges ",364.05,90,,291.24,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",351.92,87,,281.54,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",283.15,70,,226.52,,,0,"percent of total billed charges ","70% of total billed charges ",62.14,376.19,
"THYROGLOBULIN ANTIBODY",2005890,"CDM ",302,RC,86800,HCPCS,OUTPATIENT,,,194,155.2,,15.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,82.69,82.69,82.69,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",180.42,93,,144.34,,,0,"percent of total billed charges ","93% of total billed charges ",15.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.9,85,,131.92,,,0,"percent of total billed charges ","85% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",28.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",168.78,87,,15.60,15.60,63.84,"1 through 10","percent of total billed charges ","87% of total billed charges ",28.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.91,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",15.91,180.42,
"*ANALYZER MICROSOMAL ABS",2005908,"CDM ",302,RC,86376,HCPCS,OUTPATIENT,,,143,114.4,,14.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.97,60.97,60.97,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",100.1,70,,80.08,,,0,"percent of total billed charges ","70% of total billed charges ",128.7,90,,102.96,,,0,"percent of total billed charges ","90% of total billed charges ",132.99,93,,106.39,,,0,"percent of total billed charges ","93% of total billed charges ",14.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",121.55,85,,97.24,,,0,"percent of total billed charges ","85% of total billed charges ",128.7,90,,102.96,,,0,"percent of total billed charges ","90% of total billed charges ",128.7,90,,102.96,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",124.41,87,,55.52,12.39,96.11,"1 through 10","percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.55,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",100.1,70,,80.08,,,0,"percent of total billed charges ","70% of total billed charges ",14.55,132.99,
"BUSPAR LEVEL",2005924,"CDM ",300,RC,80299,HCPCS,OUTPATIENT,,,399,319.2,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",279.3,70,,223.44,,,0,"percent of total billed charges ","70% of total billed charges ",359.1,90,,287.28,,,0,"percent of total billed charges ","90% of total billed charges ",371.07,93,,296.86,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",339.15,85,,271.32,,,0,"percent of total billed charges ","85% of total billed charges ",359.1,90,,287.28,,,0,"percent of total billed charges ","90% of total billed charges ",359.1,90,,287.28,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",347.13,87,,277.70,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",279.3,70,,223.44,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,371.07,
"CANCER AG 19-9",2005940,"CDM ",302,RC,86301,HCPCS,OUTPATIENT,,,101.5,81.2,,20.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.87,64.87,64.87,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.05,70,,56.84,,,0,"percent of total billed charges ","70% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",94.4,93,,75.52,,,0,"percent of total billed charges ","93% of total billed charges ",20.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",86.28,85,,69.02,,,0,"percent of total billed charges ","85% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",31.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",88.31,87,,70.65,,,0,"percent of total billed charges ","87% of total billed charges ",31.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.81,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",71.05,70,,56.84,,,0,"percent of total billed charges ","70% of total billed charges ",20.81,94.4,
CLONIDINE,2006054,"CDM ",301,RC,82542,HCPCS,OUTPATIENT,,,638.5,510.8,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",446.95,70,,357.56,,,0,"percent of total billed charges ","70% of total billed charges ",574.65,90,,459.72,,,0,"percent of total billed charges ","90% of total billed charges ",593.81,93,,475.05,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",542.73,85,,434.18,,,0,"percent of total billed charges ","85% of total billed charges ",574.65,90,,459.72,,,0,"percent of total billed charges ","90% of total billed charges ",574.65,90,,459.72,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",555.5,87,,444.40,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",446.95,70,,357.56,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,593.81,
"CATECHOLAMINES FRAC, URINE",2006070,"CDM ",301,RC,82384,HCPCS,OUTPATIENT,,,246,196.8,,25.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.2,70,,137.76,,,0,"percent of total billed charges ","70% of total billed charges ",221.4,90,,177.12,,,0,"percent of total billed charges ","90% of total billed charges ",228.78,93,,183.02,,,0,"percent of total billed charges ","93% of total billed charges ",25.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",209.1,85,,167.28,,,0,"percent of total billed charges ","85% of total billed charges ",221.4,90,,177.12,,,0,"percent of total billed charges ","90% of total billed charges ",221.4,90,,177.12,,,0,"percent of total billed charges ","90% of total billed charges ",35.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",214.02,87,,171.22,,,0,"percent of total billed charges ","87% of total billed charges ",35.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.25,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",172.2,70,,137.76,,,0,"percent of total billed charges ","70% of total billed charges ",25.25,228.78,
"CATECHOLAMINES FRAC, BLOOD",2006088,"CDM ",301,RC,82384,HCPCS,OUTPATIENT,,,246,196.8,,25.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.2,70,,137.76,,,0,"percent of total billed charges ","70% of total billed charges ",221.4,90,,177.12,,,0,"percent of total billed charges ","90% of total billed charges ",228.78,93,,183.02,,,0,"percent of total billed charges ","93% of total billed charges ",25.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",209.1,85,,167.28,,,0,"percent of total billed charges ","85% of total billed charges ",221.4,90,,177.12,,,0,"percent of total billed charges ","90% of total billed charges ",221.4,90,,177.12,,,0,"percent of total billed charges ","90% of total billed charges ",35.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",214.02,87,,171.22,,,0,"percent of total billed charges ","87% of total billed charges ",35.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.25,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",172.2,70,,137.76,,,0,"percent of total billed charges ","70% of total billed charges ",25.25,228.78,
"REDUCING SUGAR URINE",2006104,"CDM ",307,RC,81000,HCPCS,OUTPATIENT,,,32,25.6,,4.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.4,70,,17.92,,,0,"percent of total billed charges ","70% of total billed charges ",28.8,90,,23.04,,,0,"percent of total billed charges ","90% of total billed charges ",29.76,93,,23.81,,,0,"percent of total billed charges ","93% of total billed charges ",4.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",27.2,85,,21.76,,,0,"percent of total billed charges ","85% of total billed charges ",28.8,90,,23.04,,,0,"percent of total billed charges ","90% of total billed charges ",28.8,90,,23.04,,,0,"percent of total billed charges ","90% of total billed charges ",5.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.84,87,,22.27,,,0,"percent of total billed charges ","87% of total billed charges ",5.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",22.4,70,,17.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.01,29.76,
"TREPONEMA PALLIDUM TPPA BLOOD",2006203,"CDM ",302,RC,86780,HCPCS,OUTPATIENT,,,156,124.8,,13.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",145.08,93,,116.06,,,0,"percent of total billed charges ","93% of total billed charges ",13.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.29,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",132.6,85,,106.08,,,0,"percent of total billed charges ","85% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",21.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",135.72,87,,92.67,92.66,92.67,11,"percent of total billed charges ","87% of total billed charges ",21.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.24,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",13.24,145.08,
FELBAMATE,2006211,"CDM ",301,RC,82542,HCPCS,OUTPATIENT,,,187,149.6,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",173.91,93,,139.13,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",158.95,85,,127.16,,,0,"percent of total billed charges ","85% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",162.69,87,,130.15,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,173.91,
"HEMOGLOBIN FREE PLASMA",2006229,"CDM ",301,RC,83051,HCPCS,OUTPATIENT,,,202,161.6,,6.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.4,70,,113.12,,,0,"percent of total billed charges ","70% of total billed charges ",181.8,90,,145.44,,,0,"percent of total billed charges ","90% of total billed charges ",187.86,93,,150.29,,,0,"percent of total billed charges ","93% of total billed charges ",6.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1.73,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",171.7,85,,137.36,,,0,"percent of total billed charges ","85% of total billed charges ",181.8,90,,145.44,,,0,"percent of total billed charges ","90% of total billed charges ",181.8,90,,145.44,,,0,"percent of total billed charges ","90% of total billed charges ",1.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",175.74,87,,140.59,,,0,"percent of total billed charges ","87% of total billed charges ",1.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.31,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",141.4,70,,113.12,,,0,"percent of total billed charges ","70% of total billed charges ",1.71,187.86,
"DNA DS ABS (FARR)",2006237,"CDM ",302,RC,86225,HCPCS,OUTPATIENT,,,169,135.2,,13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,72.72,72.72,72.72,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",157.17,93,,125.74,,,0,"percent of total billed charges ","93% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.65,85,,114.92,,,0,"percent of total billed charges ","85% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",24.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.03,87,,115.94,115.94,115.94,"1 through 10","percent of total billed charges ","87% of total billed charges ",24.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",13.74,157.17,
"RA FACTOR",2006245,"CDM ",302,RC,86431,HCPCS,OUTPATIENT,,,75.5,60.4,,5.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,5.56,5.56,5.56,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",70.22,93,,56.18,,,0,"percent of total billed charges ","93% of total billed charges ",5.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",64.18,85,,51.34,,,0,"percent of total billed charges ","85% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.69,87,,5.56,5.56,56.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",5.67,70.22,
"SCLERODERMA ABS 70",2006302,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,149.5,119.6,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",139.04,93,,111.23,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",127.08,85,,101.66,,,0,"percent of total billed charges ","85% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.07,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,139.04,
"ANTI-MITOCHONDRIAL ANTIBODY",2006310,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,149,119.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.3,70,,83.44,,,0,"percent of total billed charges ","70% of total billed charges ",134.1,90,,107.28,,,0,"percent of total billed charges ","90% of total billed charges ",138.57,93,,110.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",126.65,85,,101.32,,,0,"percent of total billed charges ","85% of total billed charges ",134.1,90,,107.28,,,0,"percent of total billed charges ","90% of total billed charges ",134.1,90,,107.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",129.63,87,,103.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.3,70,,83.44,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,138.57,
"ANTI PARIETAL CELL ABS",2006328,"CDM ",302,RC,86256,HCPCS,OUTPATIENT,,,165,132,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,17.72,12.99,22.44,"1 through 10","percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,153.45,
"CHLAMYDIA RAPID",2006369,"CDM ",306,RC,87320,HCPCS,OUTPATIENT,,,236,188.8,,10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",165.2,70,,132.16,,,0,"percent of total billed charges ","70% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",219.48,93,,175.58,,,0,"percent of total billed charges ","93% of total billed charges ",10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",200.6,85,,160.48,,,0,"percent of total billed charges ","85% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",205.32,87,,164.26,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",165.2,70,,132.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.4,219.48,
"CMV ABS IG M",2006401,"CDM ",302,RC,86645,HCPCS,OUTPATIENT,,,204,163.2,,14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,141.98,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.85,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,189.72,
"HERPES SIMPLEX (HSV) I&II IGM",2006419,"CDM ",302,RC,86694,HCPCS,OUTPATIENT,,,243.5,194.8,,12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.45,70,,136.36,,,0,"percent of total billed charges ","70% of total billed charges ",219.15,90,,175.32,,,0,"percent of total billed charges ","90% of total billed charges ",226.46,93,,181.17,,,0,"percent of total billed charges ","93% of total billed charges ",12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",206.98,85,,165.58,,,0,"percent of total billed charges ","85% of total billed charges ",219.15,90,,175.32,,,0,"percent of total billed charges ","90% of total billed charges ",219.15,90,,175.32,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",211.85,87,,169.48,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",170.45,70,,136.36,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,226.46,
"*SLA DBLSTRND DNA ABS",2006427,"CDM ",302,RC,86225,HCPCS,OUTPATIENT,,,169,135.2,,13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,72.72,72.72,72.72,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",157.17,93,,125.74,,,0,"percent of total billed charges ","93% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.65,85,,114.92,,,0,"percent of total billed charges ","85% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",24.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.03,87,,115.94,115.94,115.94,"1 through 10","percent of total billed charges ","87% of total billed charges ",24.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",13.74,157.17,
"MYOGLOBIN SERUM",2006476,"CDM ",301,RC,83874,HCPCS,OUTPATIENT,,,105,84,,12.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,45.66,45.66,45.66,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.5,70,,58.80,,,0,"percent of total billed charges ","70% of total billed charges ",94.5,90,,75.60,,,0,"percent of total billed charges ","90% of total billed charges ",97.65,93,,78.12,,,0,"percent of total billed charges ","93% of total billed charges ",12.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",89.25,85,,71.40,,,0,"percent of total billed charges ","85% of total billed charges ",94.5,90,,75.60,,,0,"percent of total billed charges ","90% of total billed charges ",94.5,90,,75.60,,,0,"percent of total billed charges ","90% of total billed charges ",22.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",91.35,87,,73.08,,,0,"percent of total billed charges ","87% of total billed charges ",22.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.92,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",73.5,70,,58.80,,,0,"percent of total billed charges ","70% of total billed charges ",12.92,97.65,
"PROTEIN, BODY FLUID+",2006484,"CDM ",301,RC,84155,HCPCS,OUTPATIENT,,,108,86.4,,3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,75.17,,,0,"percent of total billed charges ","87% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",3.67,100.44,
"AMYLASE PERITONEAL FLUID",2006492,"CDM ",301,RC,82150,HCPCS,OUTPATIENT,,,65.5,52.4,,6.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.85,70,,36.68,,,0,"percent of total billed charges ","70% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",60.92,93,,48.74,,,0,"percent of total billed charges ","93% of total billed charges ",6.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",55.68,85,,44.54,,,0,"percent of total billed charges ","85% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.99,87,,86.05,56.66,104.30,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.48,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",45.85,70,,36.68,,,0,"percent of total billed charges ","70% of total billed charges ",6.48,60.92,
"C-PEPTIDE SERUM",2006500,"CDM ",301,RC,84681,HCPCS,OUTPATIENT,,,144.5,115.6,,17.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,71.80,71.80,71.80,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.15,70,,80.92,,,0,"percent of total billed charges ","70% of total billed charges ",130.05,90,,104.04,,,0,"percent of total billed charges ","90% of total billed charges ",134.39,93,,107.51,,,0,"percent of total billed charges ","93% of total billed charges ",17.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.08,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",122.83,85,,98.26,,,0,"percent of total billed charges ","85% of total billed charges ",130.05,90,,104.04,,,0,"percent of total billed charges ","90% of total billed charges ",130.05,90,,104.04,,,0,"percent of total billed charges ","90% of total billed charges ",21.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",125.72,87,,112.49,94.49,112.49,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.81,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",101.15,70,,80.92,,,0,"percent of total billed charges ","70% of total billed charges ",17.69,134.39,
"THYROGLOBULIN ABS",2006542,"CDM ",302,RC,86800,HCPCS,OUTPATIENT,,,194,155.2,,15.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,82.69,82.69,82.69,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",180.42,93,,144.34,,,0,"percent of total billed charges ","93% of total billed charges ",15.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.9,85,,131.92,,,0,"percent of total billed charges ","85% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",28.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",168.78,87,,15.60,15.60,63.84,"1 through 10","percent of total billed charges ","87% of total billed charges ",28.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.91,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",15.91,180.42,
"STS (RPR) QL",2006559,"CDM ",302,RC,86592,HCPCS,OUTPATIENT,,,114,91.2,,4.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,19.37,19.37,19.37,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.8,70,,63.84,,,0,"percent of total billed charges ","70% of total billed charges ",102.6,90,,82.08,,,0,"percent of total billed charges ","90% of total billed charges ",106.02,93,,84.82,,,0,"percent of total billed charges ","93% of total billed charges ",4.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",96.9,85,,77.52,,,0,"percent of total billed charges ","85% of total billed charges ",102.6,90,,82.08,,,0,"percent of total billed charges ","90% of total billed charges ",102.6,90,,82.08,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",99.18,87,,23.71,23.71,23.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.26,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",79.8,70,,63.84,,,0,"percent of total billed charges ","70% of total billed charges ",4.26,106.02,
"CAFFEINE SERUM",2006591,"CDM ",301,RC,80155,HCPCS,OUTPATIENT,,,199,159.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.3,70,,111.44,,,0,"percent of total billed charges ","70% of total billed charges ",179.1,90,,143.28,,,0,"percent of total billed charges ","90% of total billed charges ",185.07,93,,148.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",169.15,85,,135.32,,,0,"percent of total billed charges ","85% of total billed charges ",179.1,90,,143.28,,,0,"percent of total billed charges ","90% of total billed charges ",179.1,90,,143.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",173.13,87,,138.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",38.57,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",139.3,70,,111.44,,,0,"percent of total billed charges ","70% of total billed charges ",38.57,185.07,
"ANTITHROMBIN III FUNCTIONAL",2006633,"CDM ",305,RC,85300,HCPCS,OUTPATIENT,,,126,100.8,,11.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.2,70,,70.56,,,0,"percent of total billed charges ","70% of total billed charges ",113.4,90,,90.72,,,0,"percent of total billed charges ","90% of total billed charges ",117.18,93,,93.74,,,0,"percent of total billed charges ","93% of total billed charges ",11.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.11,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",107.1,85,,85.68,,,0,"percent of total billed charges ","85% of total billed charges ",113.4,90,,90.72,,,0,"percent of total billed charges ","90% of total billed charges ",113.4,90,,90.72,,,0,"percent of total billed charges ","90% of total billed charges ",20.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",109.62,87,,87.70,,,0,"percent of total billed charges ","87% of total billed charges ",20.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.85,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",88.2,70,,70.56,,,0,"percent of total billed charges ","70% of total billed charges ",11.85,117.18,
"CARDIOLIPIN IGA ABS",2006666,"CDM ",302,RC,86147,HCPCS,OUTPATIENT,,,224.5,179.6,,25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",208.79,93,,167.03,,,0,"percent of total billed charges ","93% of total billed charges ",25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",190.83,85,,152.66,,,0,"percent of total billed charges ","85% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.32,87,,156.26,,,0,"percent of total billed charges ","87% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",25.45,208.79,
"VZV ABS, IGG",2006674,"CDM ",302,RC,86787,HCPCS,OUTPATIENT,,,185,148,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,67.33,67.33,67.33,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",172.05,93,,137.64,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",157.25,85,,125.80,,,0,"percent of total billed charges ","85% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",160.95,87,,17.79,17.79,17.79,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,172.05,
"H PYLORI ABS IG G",2006682,"CDM ",302,RC,86677,HCPCS,OUTPATIENT,,,114,91.2,,14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,47.59,47.59,47.59,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.8,70,,63.84,,,0,"percent of total billed charges ","70% of total billed charges ",102.6,90,,82.08,,,0,"percent of total billed charges ","90% of total billed charges ",106.02,93,,84.82,,,0,"percent of total billed charges ","93% of total billed charges ",14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",96.9,85,,77.52,,,0,"percent of total billed charges ","85% of total billed charges ",102.6,90,,82.08,,,0,"percent of total billed charges ","90% of total billed charges ",102.6,90,,82.08,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",99.18,87,,78.01,78.01,78.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.85,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",79.8,70,,63.84,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,106.02,
"*EBV ABS EARLY AG IGG",2006708,"CDM ",302,RC,86663,HCPCS,OUTPATIENT,,,188.5,150.8,,11.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.95,70,,105.56,,,0,"percent of total billed charges ","70% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",175.31,93,,140.25,,,0,"percent of total billed charges ","93% of total billed charges ",11.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",160.23,85,,128.18,,,0,"percent of total billed charges ","85% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",164,87,,131.20,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",131.95,70,,105.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,175.31,
"IMMUNOGLOB G INDEX CSF",2006740,"CDM ",301,RC,82784,HCPCS,OUTPATIENT,,,108,86.4,,9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,75.17,,,0,"percent of total billed charges ","87% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",9.3,100.44,
"C1 ESTERASE INH FUNC",2006799,"CDM ",302,RC,86161,HCPCS,OUTPATIENT,,,158,126.4,,12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.6,70,,88.48,,,0,"percent of total billed charges ","70% of total billed charges ",142.2,90,,113.76,,,0,"percent of total billed charges ","90% of total billed charges ",146.94,93,,117.55,,,0,"percent of total billed charges ","93% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",134.3,85,,107.44,,,0,"percent of total billed charges ","85% of total billed charges ",142.2,90,,113.76,,,0,"percent of total billed charges ","90% of total billed charges ",142.2,90,,113.76,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",137.46,87,,109.97,,,0,"percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",110.6,70,,88.48,,,0,"percent of total billed charges ","70% of total billed charges ",12,146.94,
"T4 FREE DIRECT SERUM",2006815,"CDM ",301,RC,84439,HCPCS,OUTPATIENT,,,137.5,110,,9.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,8.84,8.84,8.84,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.25,70,,77.00,,,0,"percent of total billed charges ","70% of total billed charges ",123.75,90,,99.00,,,0,"percent of total billed charges ","90% of total billed charges ",127.88,93,,102.30,,,0,"percent of total billed charges ","93% of total billed charges ",9.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",116.88,85,,93.50,,,0,"percent of total billed charges ","85% of total billed charges ",123.75,90,,99.00,,,0,"percent of total billed charges ","90% of total billed charges ",123.75,90,,99.00,,,0,"percent of total billed charges ","90% of total billed charges ",15.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",119.63,87,,53.23,8.84,106.46,25,"percent of total billed charges ","87% of total billed charges ",15.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.02,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",96.25,70,,77.00,,,0,"percent of total billed charges ","70% of total billed charges ",9.02,127.88,
"*PROTEIN S FREE",2006849,"CDM ",305,RC,85306,HCPCS,OUTPATIENT,,,201,160.8,,15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.7,70,,112.56,,,0,"percent of total billed charges ","70% of total billed charges ",180.9,90,,144.72,,,0,"percent of total billed charges ","90% of total billed charges ",186.93,93,,149.54,,,0,"percent of total billed charges ","93% of total billed charges ",15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",170.85,85,,136.68,,,0,"percent of total billed charges ","85% of total billed charges ",180.9,90,,144.72,,,0,"percent of total billed charges ","90% of total billed charges ",180.9,90,,144.72,,,0,"percent of total billed charges ","90% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",174.87,87,,174.12,174.12,174.12,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.32,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",140.7,70,,112.56,,,0,"percent of total billed charges ","70% of total billed charges ",15.32,186.93,
"PROTEIN S ANTIGEN TOTAL",2006856,"CDM ",305,RC,85305,HCPCS,OUTPATIENT,,,111.5,89.2,,11.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.05,70,,62.44,,,0,"percent of total billed charges ","70% of total billed charges ",100.35,90,,80.28,,,0,"percent of total billed charges ","90% of total billed charges ",103.7,93,,82.96,,,0,"percent of total billed charges ","93% of total billed charges ",11.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.86,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",94.78,85,,75.82,,,0,"percent of total billed charges ","85% of total billed charges ",100.35,90,,80.28,,,0,"percent of total billed charges ","90% of total billed charges ",100.35,90,,80.28,,,0,"percent of total billed charges ","90% of total billed charges ",15.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",97.01,87,,77.61,,,0,"percent of total billed charges ","87% of total billed charges ",15.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",78.05,70,,62.44,,,0,"percent of total billed charges ","70% of total billed charges ",11.61,103.7,
"PROTEIN C AG",2006872,"CDM ",305,RC,85302,HCPCS,OUTPATIENT,,,120.5,96.4,,11.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.35,70,,67.48,,,0,"percent of total billed charges ","70% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",112.07,93,,89.66,,,0,"percent of total billed charges ","93% of total billed charges ",11.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",102.43,85,,81.94,,,0,"percent of total billed charges ","85% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",104.84,87,,83.87,,,0,"percent of total billed charges ","87% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",84.35,70,,67.48,,,0,"percent of total billed charges ","70% of total billed charges ",11.81,112.07,
"COPPER SERUM",2006880,"CDM ",301,RC,82525,HCPCS,OUTPATIENT,,,85,68,,12.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.5,70,,47.60,,,0,"percent of total billed charges ","70% of total billed charges ",76.5,90,,61.20,,,0,"percent of total billed charges ","90% of total billed charges ",79.05,93,,63.24,,,0,"percent of total billed charges ","93% of total billed charges ",12.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",72.25,85,,57.80,,,0,"percent of total billed charges ","85% of total billed charges ",76.5,90,,61.20,,,0,"percent of total billed charges ","90% of total billed charges ",76.5,90,,61.20,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",73.95,87,,59.16,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.41,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",59.5,70,,47.60,,,0,"percent of total billed charges ","70% of total billed charges ",12.41,79.05,
"HEXOSAMINIDASE A TOT",2006948,"CDM ",301,RC,83080,HCPCS,OUTPATIENT,,,1042.5,834,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",729.75,70,,583.80,,,0,"percent of total billed charges ","70% of total billed charges ",938.25,90,,750.60,,,0,"percent of total billed charges ","90% of total billed charges ",969.53,93,,775.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",886.13,85,,708.90,,,0,"percent of total billed charges ","85% of total billed charges ",938.25,90,,750.60,,,0,"percent of total billed charges ","90% of total billed charges ",938.25,90,,750.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",906.98,87,,725.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",16.87,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",729.75,70,,583.80,,,0,"percent of total billed charges ","70% of total billed charges ",16.87,969.53,
"MYCOPLASMA CULTURE PNEUMONIAE",2006955,"CDM ",306,RC,87109,HCPCS,OUTPATIENT,,,204,163.2,,13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,141.98,,,0,"percent of total billed charges ","87% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,189.72,
"AMIODARONE QT",2007003,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,590.5,472.4,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",413.35,70,,330.68,,,0,"percent of total billed charges ","70% of total billed charges ",531.45,90,,425.16,,,0,"percent of total billed charges ","90% of total billed charges ",549.17,93,,439.34,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",501.93,85,,401.54,,,0,"percent of total billed charges ","85% of total billed charges ",531.45,90,,425.16,,,0,"percent of total billed charges ","90% of total billed charges ",531.45,90,,425.16,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",513.74,87,,410.99,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",413.35,70,,330.68,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,549.17,
"*EXT NUCLEAR ANT,ABS,ANY METH",2007037,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,149.5,119.6,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",139.04,93,,111.23,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",127.08,85,,101.66,,,0,"percent of total billed charges ","85% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.07,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,139.04,
*INTERCELLULAR/DERMAL-EPIDERMA,2007086,"CDM ",302,RC,86256,HCPCS,OUTPATIENT,,,165,132,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,17.72,12.99,22.44,"1 through 10","percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,153.45,
"VARICELLA ZOSTER ABS IGM",2007144,"CDM ",302,RC,86787,HCPCS,OUTPATIENT,,,185,148,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,67.33,67.33,67.33,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",172.05,93,,137.64,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",157.25,85,,125.80,,,0,"percent of total billed charges ","85% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",160.95,87,,17.79,17.79,17.79,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,172.05,
"BETA 2 MICROGLOBULIN SERUM",2007169,"CDM ",301,RC,82232,HCPCS,OUTPATIENT,,,90,72,,16.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",16.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.55,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",29.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",29.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",16.18,83.7,
"*BETA AMYLOID 1-40",2007172,"CDM ",301,RC,82233,HCPCS,OUTPATIENT,,,246,196.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.2,70,,137.76,,,0,"percent of total billed charges ","70% of total billed charges ",221.4,90,,177.12,,,0,"percent of total billed charges ","90% of total billed charges ",228.78,93,,183.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",209.1,85,,167.28,,,0,"percent of total billed charges ","85% of total billed charges ",221.4,90,,177.12,,,0,"percent of total billed charges ","90% of total billed charges ",221.4,90,,177.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",214.02,87,,171.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",128.91,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",172.2,70,,137.76,,,0,"percent of total billed charges ","70% of total billed charges ",128.91,228.78,
"*BETA AMYLOID 1-42",2007175,"CDM ",301,RC,82234,HCPCS,OUTPATIENT,,,246,196.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.2,70,,137.76,,,0,"percent of total billed charges ","70% of total billed charges ",221.4,90,,177.12,,,0,"percent of total billed charges ","90% of total billed charges ",228.78,93,,183.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",209.1,85,,167.28,,,0,"percent of total billed charges ","85% of total billed charges ",221.4,90,,177.12,,,0,"percent of total billed charges ","90% of total billed charges ",221.4,90,,177.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",214.02,87,,171.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",128.91,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",172.2,70,,137.76,,,0,"percent of total billed charges ","70% of total billed charges ",128.91,228.78,
"ACETONE URINE QL",2007193,"CDM ",301,RC,82009,HCPCS,OUTPATIENT,,,71,56.8,,3.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,43.52,43.52,43.52,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.7,70,,39.76,,,0,"percent of total billed charges ","70% of total billed charges ",63.9,90,,51.12,,,0,"percent of total billed charges ","90% of total billed charges ",66.03,93,,52.82,,,0,"percent of total billed charges ","93% of total billed charges ",3.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2.08,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",60.35,85,,48.28,,,0,"percent of total billed charges ","85% of total billed charges ",63.9,90,,51.12,,,0,"percent of total billed charges ","90% of total billed charges ",63.9,90,,51.12,,,0,"percent of total billed charges ","90% of total billed charges ",2.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",61.77,87,,49.42,,,0,"percent of total billed charges ","87% of total billed charges ",2.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.51,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",49.7,70,,39.76,,,0,"percent of total billed charges ","70% of total billed charges ",2.06,66.03,
"*MEASLES (RUBEOLA)",2007243,"CDM ",302,RC,86765,HCPCS,OUTPATIENT,,,191,152.8,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.7,70,,106.96,,,0,"percent of total billed charges ","70% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",177.63,93,,142.10,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",162.35,85,,129.88,,,0,"percent of total billed charges ","85% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",166.17,87,,132.94,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",133.7,70,,106.96,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,177.63,
"*EASTERN EQ ENC ABS IG G",2007300,"CDM ",302,RC,86652,HCPCS,OUTPATIENT,,,164.5,131.6,,11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.15,70,,92.12,,,0,"percent of total billed charges ","70% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",152.99,93,,122.39,,,0,"percent of total billed charges ","93% of total billed charges ",11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",139.83,85,,111.86,,,0,"percent of total billed charges ","85% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.12,87,,114.50,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.15,70,,92.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,152.99,
"*EASTERN EQ ENC ABS IGM",2007318,"CDM ",302,RC,86652,HCPCS,OUTPATIENT,,,239.5,191.6,,11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.65,70,,134.12,,,0,"percent of total billed charges ","70% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",222.74,93,,178.19,,,0,"percent of total billed charges ","93% of total billed charges ",11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",203.58,85,,162.86,,,0,"percent of total billed charges ","85% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",208.37,87,,166.70,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",167.65,70,,134.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,222.74,
"*WESTERN EQ ENC ABS IGG",2007326,"CDM ",302,RC,86654,HCPCS,OUTPATIENT,,,164.5,131.6,,11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.15,70,,92.12,,,0,"percent of total billed charges ","70% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",152.99,93,,122.39,,,0,"percent of total billed charges ","93% of total billed charges ",11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",139.83,85,,111.86,,,0,"percent of total billed charges ","85% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.12,87,,114.50,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.15,70,,92.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,152.99,
"*WESTERN EQ ENC ABS IGM SERUM",2007334,"CDM ",302,RC,86654,HCPCS,OUTPATIENT,,,239.5,191.6,,11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.65,70,,134.12,,,0,"percent of total billed charges ","70% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",222.74,93,,178.19,,,0,"percent of total billed charges ","93% of total billed charges ",11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",203.58,85,,162.86,,,0,"percent of total billed charges ","85% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",208.37,87,,166.70,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",167.65,70,,134.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,222.74,
"*ST LOUIS ENC ABS IGM SERUM",2007342,"CDM ",302,RC,86653,HCPCS,OUTPATIENT,,,239.5,191.6,,11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.65,70,,134.12,,,0,"percent of total billed charges ","70% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",222.74,93,,178.19,,,0,"percent of total billed charges ","93% of total billed charges ",11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",203.58,85,,162.86,,,0,"percent of total billed charges ","85% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",208.37,87,,166.70,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",167.65,70,,134.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,222.74,
"*ST LOUIS ENC ABS IGG",2007359,"CDM ",302,RC,86653,HCPCS,OUTPATIENT,,,164.5,131.6,,11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.15,70,,92.12,,,0,"percent of total billed charges ","70% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",152.99,93,,122.39,,,0,"percent of total billed charges ","93% of total billed charges ",11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",139.83,85,,111.86,,,0,"percent of total billed charges ","85% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.12,87,,114.50,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.15,70,,92.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,152.99,
"*CALIF ENC ABS IGM SERUM",2007367,"CDM ",302,RC,86651,HCPCS,OUTPATIENT,,,239.5,191.6,,11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.65,70,,134.12,,,0,"percent of total billed charges ","70% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",222.74,93,,178.19,,,0,"percent of total billed charges ","93% of total billed charges ",11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",203.58,85,,162.86,,,0,"percent of total billed charges ","85% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",208.37,87,,166.70,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",167.65,70,,134.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,222.74,
"*CALIF ENC ABS IGG",2007375,"CDM ",302,RC,86651,HCPCS,OUTPATIENT,,,164.5,131.6,,11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.15,70,,92.12,,,0,"percent of total billed charges ","70% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",152.99,93,,122.39,,,0,"percent of total billed charges ","93% of total billed charges ",11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",139.83,85,,111.86,,,0,"percent of total billed charges ","85% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.12,87,,114.50,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.15,70,,92.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,152.99,
"NEURONTIN (GABAPENTIN)",2007383,"CDM ",301,RC,80171,HCPCS,OUTPATIENT,,,97.5,78,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.25,70,,54.60,,,0,"percent of total billed charges ","70% of total billed charges ",87.75,90,,70.20,,,0,"percent of total billed charges ","90% of total billed charges ",90.68,93,,72.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",82.88,85,,66.30,,,0,"percent of total billed charges ","85% of total billed charges ",87.75,90,,70.20,,,0,"percent of total billed charges ","90% of total billed charges ",87.75,90,,70.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",84.83,87,,67.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",21.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.25,70,,54.60,,,0,"percent of total billed charges ","70% of total billed charges ",21.67,90.68,
"FECAL FAT QUAL",2007409,"CDM ",301,RC,82705,HCPCS,OUTPATIENT,,,77.5,62,,5.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.25,70,,43.40,,,0,"percent of total billed charges ","70% of total billed charges ",69.75,90,,55.80,,,0,"percent of total billed charges ","90% of total billed charges ",72.08,93,,57.66,,,0,"percent of total billed charges ","93% of total billed charges ",5.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",65.88,85,,52.70,,,0,"percent of total billed charges ","85% of total billed charges ",69.75,90,,55.80,,,0,"percent of total billed charges ","90% of total billed charges ",69.75,90,,55.80,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",67.43,87,,53.94,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",54.25,70,,43.40,,,0,"percent of total billed charges ","70% of total billed charges ",5.09,72.08,
"CMV CULTURE",2007433,"CDM ",306,RC,87252,HCPCS,OUTPATIENT,,,271,216.8,,26.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",189.7,70,,151.76,,,0,"percent of total billed charges ","70% of total billed charges ",243.9,90,,195.12,,,0,"percent of total billed charges ","90% of total billed charges ",252.03,93,,201.62,,,0,"percent of total billed charges ","93% of total billed charges ",26.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.59,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",230.35,85,,184.28,,,0,"percent of total billed charges ","85% of total billed charges ",243.9,90,,195.12,,,0,"percent of total billed charges ","90% of total billed charges ",243.9,90,,195.12,,,0,"percent of total billed charges ","90% of total billed charges ",35.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",235.77,87,,188.62,,,0,"percent of total billed charges ","87% of total billed charges ",35.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",189.7,70,,151.76,,,0,"percent of total billed charges ","70% of total billed charges ",26.07,252.03,
"GLOMERULAR BASEMENT MEMBRANE",2007607,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,142.5,114,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.75,70,,79.80,,,0,"percent of total billed charges ","70% of total billed charges ",128.25,90,,102.60,,,0,"percent of total billed charges ","90% of total billed charges ",132.53,93,,106.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",121.13,85,,96.90,,,0,"percent of total billed charges ","85% of total billed charges ",128.25,90,,102.60,,,0,"percent of total billed charges ","90% of total billed charges ",128.25,90,,102.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",123.98,87,,99.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",99.75,70,,79.80,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,132.53,
"CRYPTOSPORIDIUM STOOL",2007615,"CDM ",306,RC,87328,HCPCS,OUTPATIENT,,,308,246.4,,11.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",215.6,70,,172.48,,,0,"percent of total billed charges ","70% of total billed charges ",277.2,90,,221.76,,,0,"percent of total billed charges ","90% of total billed charges ",286.44,93,,229.15,,,0,"percent of total billed charges ","93% of total billed charges ",11.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",261.8,85,,209.44,,,0,"percent of total billed charges ","85% of total billed charges ",277.2,90,,221.76,,,0,"percent of total billed charges ","90% of total billed charges ",277.2,90,,221.76,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",267.96,87,,214.37,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",215.6,70,,172.48,,,0,"percent of total billed charges ","70% of total billed charges ",11.75,286.44,
"PHENYTOIN FREE SERUM",2007623,"CDM ",300,RC,80186,HCPCS,OUTPATIENT,,,143,114.4,,13.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",100.1,70,,80.08,,,0,"percent of total billed charges ","70% of total billed charges ",128.7,90,,102.96,,,0,"percent of total billed charges ","90% of total billed charges ",132.99,93,,106.39,,,0,"percent of total billed charges ","93% of total billed charges ",13.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.59,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",121.55,85,,97.24,,,0,"percent of total billed charges ","85% of total billed charges ",128.7,90,,102.96,,,0,"percent of total billed charges ","90% of total billed charges ",128.7,90,,102.96,,,0,"percent of total billed charges ","90% of total billed charges ",25.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",124.41,87,,99.53,,,0,"percent of total billed charges ","87% of total billed charges ",25.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.76,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",100.1,70,,80.08,,,0,"percent of total billed charges ","70% of total billed charges ",13.76,132.99,
"EBV ABS VIR CAP AG IGA",2007698,"CDM ",302,RC,86665,HCPCS,OUTPATIENT,,,185,148,,15.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",172.05,93,,137.64,,,0,"percent of total billed charges ","93% of total billed charges ",15.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",157.25,85,,125.80,,,0,"percent of total billed charges ","85% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",160.95,87,,128.76,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,172.05,
"*PROTEIN ELEC INTERP",2007714,"CDM ",301,RC,84156,HCPCS,OUTPATIENT,,,42.5,34,,3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.75,70,,23.80,,,0,"percent of total billed charges ","70% of total billed charges ",38.25,90,,30.60,,,0,"percent of total billed charges ","90% of total billed charges ",39.53,93,,31.62,,,0,"percent of total billed charges ","93% of total billed charges ",3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",36.13,85,,28.90,,,0,"percent of total billed charges ","85% of total billed charges ",38.25,90,,30.60,,,0,"percent of total billed charges ","90% of total billed charges ",38.25,90,,30.60,,,0,"percent of total billed charges ","90% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.98,87,,43.83,11.65,76.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",29.75,70,,23.80,,,0,"percent of total billed charges ","70% of total billed charges ",3.67,39.53,
"UREA NITROGEN URINE",2007896,"CDM ",301,RC,84540,HCPCS,OUTPATIENT,,,111,88.8,,5.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,17.21,17.21,17.21,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.7,70,,62.16,,,0,"percent of total billed charges ","70% of total billed charges ",99.9,90,,79.92,,,0,"percent of total billed charges ","90% of total billed charges ",103.23,93,,82.58,,,0,"percent of total billed charges ","93% of total billed charges ",5.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",94.35,85,,75.48,,,0,"percent of total billed charges ","85% of total billed charges ",99.9,90,,79.92,,,0,"percent of total billed charges ","90% of total billed charges ",99.9,90,,79.92,,,0,"percent of total billed charges ","90% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.57,87,,77.26,,,0,"percent of total billed charges ","87% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.56,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",77.7,70,,62.16,,,0,"percent of total billed charges ","70% of total billed charges ",5.56,103.23,
"COMPLEMENT C2",2007912,"CDM ",302,RC,86160,HCPCS,OUTPATIENT,,,210.5,168.4,,12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,133.30,133.30,133.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",195.77,93,,156.62,,,0,"percent of total billed charges ","93% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",178.93,85,,143.14,,,0,"percent of total billed charges ","85% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",183.14,87,,226.71,226.71,226.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",12,195.77,
"GLUCOSE URINE",2007920,"CDM ",307,RC,81000,HCPCS,OUTPATIENT,,,36,28.8,,4.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.2,70,,20.16,,,0,"percent of total billed charges ","70% of total billed charges ",32.4,90,,25.92,,,0,"percent of total billed charges ","90% of total billed charges ",33.48,93,,26.78,,,0,"percent of total billed charges ","93% of total billed charges ",4.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",30.6,85,,24.48,,,0,"percent of total billed charges ","85% of total billed charges ",32.4,90,,25.92,,,0,"percent of total billed charges ","90% of total billed charges ",32.4,90,,25.92,,,0,"percent of total billed charges ","90% of total billed charges ",5.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.32,87,,25.06,,,0,"percent of total billed charges ","87% of total billed charges ",5.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",25.2,70,,20.16,,,0,"percent of total billed charges ","70% of total billed charges ",4.01,33.48,
"GLUCOSE BSM",2007938,"CDM ",301,RC,82948,HCPCS,OUTPATIENT,,,83,66.4,,4.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,51.00,51.00,51.00,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",4.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2.08,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",2.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",72.21,87,,64.65,29.81,93.10,"1 through 10","percent of total billed charges ","87% of total billed charges ",2.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.04,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",2.06,77.19,
"CD 3",2007953,"CDM ",300,RC,88182,HCPCS,OUTPATIENT,,,384.5,307.6,,113.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",301.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",357.59,93,,286.07,,,0,"percent of total billed charges ","93% of total billed charges ",113.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",48.57,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",326.83,85,,261.46,,,0,"percent of total billed charges ","85% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",48.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",334.52,87,,267.62,,,0,"percent of total billed charges ","87% of total billed charges ",48.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.92,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",47.92,357.59,
"CD 4",2007961,"CDM ",300,RC,88182,HCPCS,OUTPATIENT,,,384.5,307.6,,113.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",301.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",357.59,93,,286.07,,,0,"percent of total billed charges ","93% of total billed charges ",113.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",48.57,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",326.83,85,,261.46,,,0,"percent of total billed charges ","85% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",48.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",334.52,87,,267.62,,,0,"percent of total billed charges ","87% of total billed charges ",48.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.92,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",47.92,357.59,
"CD 8",2007979,"CDM ",300,RC,88182,HCPCS,OUTPATIENT,,,384.5,307.6,,113.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",301.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",357.59,93,,286.07,,,0,"percent of total billed charges ","93% of total billed charges ",113.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",48.57,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",326.83,85,,261.46,,,0,"percent of total billed charges ","85% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",48.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",334.52,87,,267.62,,,0,"percent of total billed charges ","87% of total billed charges ",48.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.92,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",47.92,357.59,
"CD 19",2007987,"CDM ",300,RC,88182,HCPCS,OUTPATIENT,,,384.5,307.6,,113.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",301.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",357.59,93,,286.07,,,0,"percent of total billed charges ","93% of total billed charges ",113.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",48.57,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",326.83,85,,261.46,,,0,"percent of total billed charges ","85% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",48.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",334.52,87,,267.62,,,0,"percent of total billed charges ","87% of total billed charges ",48.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.92,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",47.92,357.59,
"COMPLEMENT AG",2008084,"CDM ",300,RC,86160,HCPCS,OUTPATIENT,,,165,132,,12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,133.30,133.30,133.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,226.71,226.71,226.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",12,153.45,
"HEP C VIRUS RNA BY PCR QL",2008126,"CDM ",306,RC,87522,HCPCS,OUTPATIENT,,,721,576.8,,36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,109.38,109.38,109.38,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",504.7,70,,403.76,,,0,"percent of total billed charges ","70% of total billed charges ",648.9,90,,519.12,,,0,"percent of total billed charges ","90% of total billed charges ",670.53,93,,536.42,,,0,"percent of total billed charges ","93% of total billed charges ",36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",612.85,85,,490.28,,,0,"percent of total billed charges ","85% of total billed charges ",648.9,90,,519.12,,,0,"percent of total billed charges ","90% of total billed charges ",648.9,90,,519.12,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",627.27,87,,501.82,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.84,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",504.7,70,,403.76,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,670.53,
"H INFLUENZA B",2008142,"CDM ",301,RC,83518,HCPCS,OUTPATIENT,,,122.5,98,,9.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",113.93,93,,91.14,,,0,"percent of total billed charges ","93% of total billed charges ",9.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.13,85,,83.30,,,0,"percent of total billed charges ","85% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.58,87,,85.26,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",9.64,113.93,
"TOXOPLASMA GONDI IG G",2008167,"CDM ",302,RC,86777,HCPCS,OUTPATIENT,,,191,152.8,,12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.7,70,,106.96,,,0,"percent of total billed charges ","70% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",177.63,93,,142.10,,,0,"percent of total billed charges ","93% of total billed charges ",12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",162.35,85,,129.88,,,0,"percent of total billed charges ","85% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",166.17,87,,132.94,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",133.7,70,,106.96,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,177.63,
"*FLOWCYTOMETRY/TC ADD-ON",2008241,"CDM ",300,RC,88185,HCPCS,OUTPATIENT,,,218.5,174.8,,19.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.24,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",203.21,93,,162.57,,,0,"percent of total billed charges ","93% of total billed charges ",19.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",185.73,85,,148.58,,,0,"percent of total billed charges ","85% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",21.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",190.1,87,,152.08,,,0,"percent of total billed charges ","87% of total billed charges ",21.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",19.52,203.21,
"GLUCOSE 6-PHOSPHATE DEHYDROG Q",2008316,"CDM ",301,RC,82955,HCPCS,OUTPATIENT,,,164.5,131.6,,9.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.15,70,,92.12,,,0,"percent of total billed charges ","70% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",152.99,93,,122.39,,,0,"percent of total billed charges ","93% of total billed charges ",9.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.72,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",139.83,85,,111.86,,,0,"percent of total billed charges ","85% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",17.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.12,87,,114.50,,,0,"percent of total billed charges ","87% of total billed charges ",17.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.69,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.15,70,,92.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.69,152.99,
DHEA,2008340,"CDM ",301,RC,82626,HCPCS,OUTPATIENT,,,194,155.2,,23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",180.42,93,,144.34,,,0,"percent of total billed charges ","93% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.9,85,,131.92,,,0,"percent of total billed charges ","85% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",168.78,87,,101.79,101.79,101.79,"1 through 10","percent of total billed charges ","87% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",23.1,180.42,
"BLASTOMYCES TOTAL ANTIBODIES",2008357,"CDM ",302,RC,86612,HCPCS,OUTPATIENT,,,114,91.2,,10.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.8,70,,63.84,,,0,"percent of total billed charges ","70% of total billed charges ",102.6,90,,82.08,,,0,"percent of total billed charges ","90% of total billed charges ",106.02,93,,84.82,,,0,"percent of total billed charges ","93% of total billed charges ",10.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",96.9,85,,77.52,,,0,"percent of total billed charges ","85% of total billed charges ",102.6,90,,82.08,,,0,"percent of total billed charges ","90% of total billed charges ",102.6,90,,82.08,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",99.18,87,,79.34,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.9,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",79.8,70,,63.84,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,106.02,
"BLASTOMYCES ABS IMMUNODIFF",2008359,"CDM ",302,RC,86612,HCPCS,OUTPATIENT,,,36,28.8,,10.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.2,70,,20.16,,,0,"percent of total billed charges ","70% of total billed charges ",32.4,90,,25.92,,,0,"percent of total billed charges ","90% of total billed charges ",33.48,93,,26.78,,,0,"percent of total billed charges ","93% of total billed charges ",10.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",30.6,85,,24.48,,,0,"percent of total billed charges ","85% of total billed charges ",32.4,90,,25.92,,,0,"percent of total billed charges ","90% of total billed charges ",32.4,90,,25.92,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.32,87,,25.06,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.9,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",25.2,70,,20.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,33.48,
"T3 FREE SERUM",2008381,"CDM ",301,RC,84481,HCPCS,OUTPATIENT,,,422.5,338,,16.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",295.75,70,,236.60,,,0,"percent of total billed charges ","70% of total billed charges ",380.25,90,,304.20,,,0,"percent of total billed charges ","90% of total billed charges ",392.93,93,,314.34,,,0,"percent of total billed charges ","93% of total billed charges ",16.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.95,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",359.13,85,,287.30,,,0,"percent of total billed charges ","85% of total billed charges ",380.25,90,,304.20,,,0,"percent of total billed charges ","90% of total billed charges ",380.25,90,,304.20,,,0,"percent of total billed charges ","90% of total billed charges ",30.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",367.58,87,,55.64,16.61,328.42,"1 through 10","percent of total billed charges ","87% of total billed charges ",30.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.94,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",295.75,70,,236.60,,,0,"percent of total billed charges ","70% of total billed charges ",16.94,392.93,
"*T CELLS T4 & T8",2008464,"CDM ",302,RC,86360,HCPCS,OUTPATIENT,,,370,296,,39.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,162.94,162.94,162.94,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",344.1,93,,275.28,,,0,"percent of total billed charges ","93% of total billed charges ",39.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",314.5,85,,251.60,,,0,"percent of total billed charges ","85% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",37.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",321.9,87,,257.52,,,0,"percent of total billed charges ","87% of total billed charges ",37.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",37.61,344.1,
"GIARDIA LAMBLIA, EIA",2008480,"CDM ",306,RC,87329,HCPCS,OUTPATIENT,,,156,124.8,,10.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,71.83,71.83,71.83,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",145.08,93,,116.06,,,0,"percent of total billed charges ","93% of total billed charges ",10.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",132.6,85,,106.08,,,0,"percent of total billed charges ","85% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",135.72,87,,108.58,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",10.18,145.08,
"ADENOSINE DEAMINASE",2008522,"CDM ",301,RC,84311,HCPCS,OUTPATIENT,,,146.5,117.2,,,,,,,,0,"other ","not separately reimbursment ",,,,89.76,89.76,89.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.55,70,,82.04,,,0,"percent of total billed charges ","70% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",136.25,93,,109.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",124.53,85,,99.62,,,0,"percent of total billed charges ","85% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",127.46,87,,101.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",8.1,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.55,70,,82.04,,,0,"percent of total billed charges ","70% of total billed charges ",8.1,136.25,
"CHLORDIAZEPOXIDE #7682",2008548,"CDM ",300,RC,80346,HCPCS,OUTPATIENT,,,104.5,83.6,,23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.15,70,,58.52,,,0,"percent of total billed charges ","70% of total billed charges ",94.05,90,,75.24,,,0,"percent of total billed charges ","90% of total billed charges ",97.19,93,,77.75,,,0,"percent of total billed charges ","93% of total billed charges ",23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",88.83,85,,71.06,,,0,"percent of total billed charges ","85% of total billed charges ",94.05,90,,75.24,,,0,"percent of total billed charges ","90% of total billed charges ",94.05,90,,75.24,,,0,"percent of total billed charges ","90% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",90.92,87,,72.74,,,0,"percent of total billed charges ","87% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",73.15,70,,58.52,,,0,"percent of total billed charges ","70% of total billed charges ",23.71,97.19,
"FRAGILE X FETAL STUDY",2008555,"CDM ",301,RC,81243,HCPCS,OUTPATIENT,,,578,462.4,,112.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",404.6,70,,323.68,,,0,"percent of total billed charges ","70% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",537.54,93,,430.03,,,0,"percent of total billed charges ","93% of total billed charges ",112.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",491.3,85,,393.04,,,0,"percent of total billed charges ","85% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",141.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",502.86,87,,402.29,,,0,"percent of total billed charges ","87% of total billed charges ",141.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.04,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",404.6,70,,323.68,,,0,"percent of total billed charges ","70% of total billed charges ",57.04,537.54,
"FOLATE RBC & SERUM W/HCT",2008589,"CDM ",300,RC,82747,HCPCS,OUTPATIENT,,,138.5,110.8,,17.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.88,60.88,60.88,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.95,70,,77.56,,,0,"percent of total billed charges ","70% of total billed charges ",124.65,90,,99.72,,,0,"percent of total billed charges ","90% of total billed charges ",128.81,93,,103.05,,,0,"percent of total billed charges ","93% of total billed charges ",17.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",117.73,85,,94.18,,,0,"percent of total billed charges ","85% of total billed charges ",124.65,90,,99.72,,,0,"percent of total billed charges ","90% of total billed charges ",124.65,90,,99.72,,,0,"percent of total billed charges ","90% of total billed charges ",28.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",120.5,87,,96.40,,,0,"percent of total billed charges ","87% of total billed charges ",28.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",96.95,70,,77.56,,,0,"percent of total billed charges ","70% of total billed charges ",17.64,128.81,
"LEAD BLOOD PEDIATRIC",2008597,"CDM ",301,RC,83655,HCPCS,OUTPATIENT,,,54,43.2,,11.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.8,70,,30.24,,,0,"percent of total billed charges ","70% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",50.22,93,,40.18,,,0,"percent of total billed charges ","93% of total billed charges ",11.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.9,85,,36.72,,,0,"percent of total billed charges ","85% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",15.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.98,87,,33.45,33.45,33.45,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.11,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",37.8,70,,30.24,,,0,"percent of total billed charges ","70% of total billed charges ",11.7,50.22,
"ANTITHROMBIN III AG",2008605,"CDM ",305,RC,85301,HCPCS,OUTPATIENT,,,55,44,,10.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,26.87,26.87,26.87,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.5,70,,30.80,,,0,"percent of total billed charges ","70% of total billed charges ",49.5,90,,39.60,,,0,"percent of total billed charges ","90% of total billed charges ",51.15,93,,40.92,,,0,"percent of total billed charges ","93% of total billed charges ",10.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",46.75,85,,37.40,,,0,"percent of total billed charges ","85% of total billed charges ",49.5,90,,39.60,,,0,"percent of total billed charges ","90% of total billed charges ",49.5,90,,39.60,,,0,"percent of total billed charges ","90% of total billed charges ",19.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.85,87,,38.28,,,0,"percent of total billed charges ","87% of total billed charges ",19.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.81,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",38.5,70,,30.80,,,0,"percent of total billed charges ","70% of total billed charges ",10.81,51.15,
"*DIBUCAINE NO",2008704,"CDM ",301,RC,82638,HCPCS,OUTPATIENT,,,97,77.6,,12.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",90.21,93,,72.17,,,0,"percent of total billed charges ","93% of total billed charges ",12.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",82.45,85,,65.96,,,0,"percent of total billed charges ","85% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",17.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.39,87,,67.51,,,0,"percent of total billed charges ","87% of total billed charges ",17.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.25,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",12.25,90.21,
"HPV DETEC",2008811,"CDM ",306,RC,87625,HCPCS,OUTPATIENT,,,465.5,372.4,,40.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",325.85,70,,260.68,,,0,"percent of total billed charges ","70% of total billed charges ",418.95,90,,335.16,,,0,"percent of total billed charges ","90% of total billed charges ",432.92,93,,346.34,,,0,"percent of total billed charges ","93% of total billed charges ",40.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",395.68,85,,316.54,,,0,"percent of total billed charges ","85% of total billed charges ",418.95,90,,335.16,,,0,"percent of total billed charges ","90% of total billed charges ",418.95,90,,335.16,,,0,"percent of total billed charges ","90% of total billed charges ",53.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",404.99,87,,323.99,,,0,"percent of total billed charges ","87% of total billed charges ",53.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.54,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",325.85,70,,260.68,,,0,"percent of total billed charges ","70% of total billed charges ",40.54,432.92,
"HPV HIGH RISK PAP SMEAR",2008829,"CDM ",306,RC,87623,HCPCS,OUTPATIENT,,,225.5,180.4,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.85,70,,126.28,,,0,"percent of total billed charges ","70% of total billed charges ",202.95,90,,162.36,,,0,"percent of total billed charges ","90% of total billed charges ",209.72,93,,167.78,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",191.68,85,,153.34,,,0,"percent of total billed charges ","85% of total billed charges ",202.95,90,,162.36,,,0,"percent of total billed charges ","90% of total billed charges ",202.95,90,,162.36,,,0,"percent of total billed charges ","90% of total billed charges ",53.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",196.19,87,,156.95,,,0,"percent of total billed charges ","87% of total billed charges ",53.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.85,70,,126.28,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,209.72,
"PAROXETINE (PAXIL)",2008860,"CDM ",301,RC,82542,HCPCS,OUTPATIENT,,,187,149.6,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",173.91,93,,139.13,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",158.95,85,,127.16,,,0,"percent of total billed charges ","85% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",162.69,87,,130.15,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,173.91,
"SODIUM URINE RANDOM",2008886,"CDM ",301,RC,84300,HCPCS,OUTPATIENT,,,102.5,82,,4.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.75,70,,57.40,,,0,"percent of total billed charges ","70% of total billed charges ",92.25,90,,73.80,,,0,"percent of total billed charges ","90% of total billed charges ",95.33,93,,76.26,,,0,"percent of total billed charges ","93% of total billed charges ",4.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",87.13,85,,69.70,,,0,"percent of total billed charges ","85% of total billed charges ",92.25,90,,73.80,,,0,"percent of total billed charges ","90% of total billed charges ",92.25,90,,73.80,,,0,"percent of total billed charges ","90% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",89.18,87,,4.96,4.96,4.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",71.75,70,,57.40,,,0,"percent of total billed charges ","70% of total billed charges ",4.3,95.33,
"CYCLOSPORINE WHOLE BLOOD W/REP",2008894,"CDM ",301,RC,80158,HCPCS,OUTPATIENT,,,174.5,139.6,,15.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,76.70,76.70,76.70,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.15,70,,97.72,,,0,"percent of total billed charges ","70% of total billed charges ",157.05,90,,125.64,,,0,"percent of total billed charges ","90% of total billed charges ",162.29,93,,129.83,,,0,"percent of total billed charges ","93% of total billed charges ",15.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",148.33,85,,118.66,,,0,"percent of total billed charges ","85% of total billed charges ",157.05,90,,125.64,,,0,"percent of total billed charges ","90% of total billed charges ",157.05,90,,125.64,,,0,"percent of total billed charges ","90% of total billed charges ",14.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",151.82,87,,121.46,,,0,"percent of total billed charges ","87% of total billed charges ",14.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",122.15,70,,97.72,,,0,"percent of total billed charges ","70% of total billed charges ",14.49,162.29,
LAMOTRIGINE,2008902,"CDM ",301,RC,82542,HCPCS,OUTPATIENT,,,187,149.6,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",173.91,93,,139.13,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",158.95,85,,127.16,,,0,"percent of total billed charges ","85% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",162.69,87,,130.15,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,173.91,
"FLUVOXAMINE (LUVOX)",2008910,"CDM ",301,RC,82542,HCPCS,OUTPATIENT,,,187,149.6,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",173.91,93,,139.13,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",158.95,85,,127.16,,,0,"percent of total billed charges ","85% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",162.69,87,,130.15,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,173.91,
"GLUCAGON PLASMA",2008928,"CDM ",301,RC,82943,HCPCS,OUTPATIENT,,,164.5,131.6,,14.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.15,70,,92.12,,,0,"percent of total billed charges ","70% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",152.99,93,,122.39,,,0,"percent of total billed charges ","93% of total billed charges ",14.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",139.83,85,,111.86,,,0,"percent of total billed charges ","85% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",25.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.12,87,,114.50,,,0,"percent of total billed charges ","87% of total billed charges ",25.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.29,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.15,70,,92.12,,,0,"percent of total billed charges ","70% of total billed charges ",14.29,152.99,
"GLUCOSE BODY FLUID",2008936,"CDM ",301,RC,82945,HCPCS,OUTPATIENT,,,97,77.6,,3.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",90.21,93,,72.17,,,0,"percent of total billed charges ","93% of total billed charges ",3.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",82.45,85,,65.96,,,0,"percent of total billed charges ","85% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",6.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.39,87,,67.51,,,0,"percent of total billed charges ","87% of total billed charges ",6.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",3.93,90.21,
"CRYSTALS MISC FLUID",2008944,"CDM ",309,RC,89060,HCPCS,OUTPATIENT,,,186.5,149.2,,7.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.55,70,,104.44,,,0,"percent of total billed charges ","70% of total billed charges ",167.85,90,,134.28,,,0,"percent of total billed charges ","90% of total billed charges ",173.45,93,,138.76,,,0,"percent of total billed charges ","93% of total billed charges ",7.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",158.53,85,,126.82,,,0,"percent of total billed charges ","85% of total billed charges ",167.85,90,,134.28,,,0,"percent of total billed charges ","90% of total billed charges ",167.85,90,,134.28,,,0,"percent of total billed charges ","90% of total billed charges ",12.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",162.26,87,,129.81,,,0,"percent of total billed charges ","87% of total billed charges ",12.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.33,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",130.55,70,,104.44,,,0,"percent of total billed charges ","70% of total billed charges ",7.33,173.45,
"CLORAZEPATE (TRANXENE)",2008993,"CDM ",300,RC,80346,HCPCS,OUTPATIENT,,,98.5,78.8,,23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",23.71,91.61,
ANDROSTENEDIONE,2009082,"CDM ",301,RC,82157,HCPCS,OUTPATIENT,,,254,203.2,,24.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.8,70,,142.24,,,0,"percent of total billed charges ","70% of total billed charges ",228.6,90,,182.88,,,0,"percent of total billed charges ","90% of total billed charges ",236.22,93,,188.98,,,0,"percent of total billed charges ","93% of total billed charges ",24.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",215.9,85,,172.72,,,0,"percent of total billed charges ","85% of total billed charges ",228.6,90,,182.88,,,0,"percent of total billed charges ","90% of total billed charges ",228.6,90,,182.88,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",220.98,87,,176.78,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.28,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",177.8,70,,142.24,,,0,"percent of total billed charges ","70% of total billed charges ",13.18,236.22,
"SERZONE (NEFAZODONE)",2009116,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,319,255.2,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",223.3,70,,178.64,,,0,"percent of total billed charges ","70% of total billed charges ",287.1,90,,229.68,,,0,"percent of total billed charges ","90% of total billed charges ",296.67,93,,237.34,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",271.15,85,,216.92,,,0,"percent of total billed charges ","85% of total billed charges ",287.1,90,,229.68,,,0,"percent of total billed charges ","90% of total billed charges ",287.1,90,,229.68,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.53,87,,222.02,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",223.3,70,,178.64,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,296.67,
"CARNITINE TOTAL & FREE",2009124,"CDM ",301,RC,82379,HCPCS,OUTPATIENT,,,403,322.4,,16.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",282.1,70,,225.68,,,0,"percent of total billed charges ","70% of total billed charges ",362.7,90,,290.16,,,0,"percent of total billed charges ","90% of total billed charges ",374.79,93,,299.83,,,0,"percent of total billed charges ","93% of total billed charges ",16.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",342.55,85,,274.04,,,0,"percent of total billed charges ","85% of total billed charges ",362.7,90,,290.16,,,0,"percent of total billed charges ","90% of total billed charges ",362.7,90,,290.16,,,0,"percent of total billed charges ","90% of total billed charges ",25.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",350.61,87,,280.49,,,0,"percent of total billed charges ","87% of total billed charges ",25.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.87,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",282.1,70,,225.68,,,0,"percent of total billed charges ","70% of total billed charges ",16.87,374.79,
"DNA ANTIBODY DOUBLE STRANDED",2009165,"CDM ",302,RC,86225,HCPCS,OUTPATIENT,,,169,135.2,,13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,72.72,72.72,72.72,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",157.17,93,,125.74,,,0,"percent of total billed charges ","93% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.65,85,,114.92,,,0,"percent of total billed charges ","85% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",24.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.03,87,,115.94,115.94,115.94,"1 through 10","percent of total billed charges ","87% of total billed charges ",24.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",13.74,157.17,
"*LEAD & PROTO RBC PROTO",2009223,"CDM ",301,RC,84202,HCPCS,OUTPATIENT,,,79.5,63.6,,12.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.65,70,,44.52,,,0,"percent of total billed charges ","70% of total billed charges ",71.55,90,,57.24,,,0,"percent of total billed charges ","90% of total billed charges ",73.94,93,,59.15,,,0,"percent of total billed charges ","93% of total billed charges ",12.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",67.58,85,,54.06,,,0,"percent of total billed charges ","85% of total billed charges ",71.55,90,,57.24,,,0,"percent of total billed charges ","90% of total billed charges ",71.55,90,,57.24,,,0,"percent of total billed charges ","90% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",69.17,87,,55.34,,,0,"percent of total billed charges ","87% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.35,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",55.65,70,,44.52,,,0,"percent of total billed charges ","70% of total billed charges ",12.2,73.94,
"FACTOR X",2009249,"CDM ",305,RC,85260,HCPCS,OUTPATIENT,,,145.5,116.4,,15.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.85,70,,81.48,,,0,"percent of total billed charges ","70% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",135.32,93,,108.26,,,0,"percent of total billed charges ","93% of total billed charges ",15.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",123.68,85,,98.94,,,0,"percent of total billed charges ","85% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",126.59,87,,101.27,,,0,"percent of total billed charges ","87% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.89,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",101.85,70,,81.48,,,0,"percent of total billed charges ","70% of total billed charges ",15.22,135.32,
"PROTEIN S ACTIVITY",2009306,"CDM ",305,RC,85306,HCPCS,OUTPATIENT,,,201,160.8,,15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.7,70,,112.56,,,0,"percent of total billed charges ","70% of total billed charges ",180.9,90,,144.72,,,0,"percent of total billed charges ","90% of total billed charges ",186.93,93,,149.54,,,0,"percent of total billed charges ","93% of total billed charges ",15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",170.85,85,,136.68,,,0,"percent of total billed charges ","85% of total billed charges ",180.9,90,,144.72,,,0,"percent of total billed charges ","90% of total billed charges ",180.9,90,,144.72,,,0,"percent of total billed charges ","90% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",174.87,87,,174.12,174.12,174.12,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.32,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",140.7,70,,112.56,,,0,"percent of total billed charges ","70% of total billed charges ",15.32,186.93,
"PROTEIN C ACTIVITY",2009314,"CDM ",305,RC,85303,HCPCS,OUTPATIENT,,,167.5,134,,13.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.25,70,,93.80,,,0,"percent of total billed charges ","70% of total billed charges ",150.75,90,,120.60,,,0,"percent of total billed charges ","90% of total billed charges ",155.78,93,,124.62,,,0,"percent of total billed charges ","93% of total billed charges ",13.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",142.38,85,,113.90,,,0,"percent of total billed charges ","85% of total billed charges ",150.75,90,,120.60,,,0,"percent of total billed charges ","90% of total billed charges ",150.75,90,,120.60,,,0,"percent of total billed charges ","90% of total billed charges ",21.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",145.73,87,,145.25,145.25,145.25,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.84,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.25,70,,93.80,,,0,"percent of total billed charges ","70% of total billed charges ",13.84,155.78,
"DIGITOXIN  SERUM",2009348,"CDM ",300,RC,80299,HCPCS,OUTPATIENT,,,489.5,391.6,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",342.65,70,,274.12,,,0,"percent of total billed charges ","70% of total billed charges ",440.55,90,,352.44,,,0,"percent of total billed charges ","90% of total billed charges ",455.24,93,,364.19,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",416.08,85,,332.86,,,0,"percent of total billed charges ","85% of total billed charges ",440.55,90,,352.44,,,0,"percent of total billed charges ","90% of total billed charges ",440.55,90,,352.44,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",425.87,87,,340.70,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",342.65,70,,274.12,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,455.24,
"*SLA ANTI-HISTONE ABS",2009355,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,90,72,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,83.7,
"FACTOR XIII FIBREN SCREEN",2009389,"CDM ",305,RC,85291,HCPCS,OUTPATIENT,,,145.5,116.4,,9.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.85,70,,81.48,,,0,"percent of total billed charges ","70% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",135.32,93,,108.26,,,0,"percent of total billed charges ","93% of total billed charges ",9.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",123.68,85,,98.94,,,0,"percent of total billed charges ","85% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",126.59,87,,101.27,,,0,"percent of total billed charges ","87% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.11,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",101.85,70,,81.48,,,0,"percent of total billed charges ","70% of total billed charges ",9.11,135.32,
"FACTOR XII",2009397,"CDM ",305,RC,85280,HCPCS,OUTPATIENT,,,145.5,116.4,,16.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.85,70,,81.48,,,0,"percent of total billed charges ","70% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",135.32,93,,108.26,,,0,"percent of total billed charges ","93% of total billed charges ",16.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",123.68,85,,98.94,,,0,"percent of total billed charges ","85% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",126.59,87,,101.27,,,0,"percent of total billed charges ","87% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.35,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",101.85,70,,81.48,,,0,"percent of total billed charges ","70% of total billed charges ",15.45,135.32,
"FACTOR XI",2009405,"CDM ",305,RC,85270,HCPCS,OUTPATIENT,,,145.5,116.4,,15.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.85,70,,81.48,,,0,"percent of total billed charges ","70% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",135.32,93,,108.26,,,0,"percent of total billed charges ","93% of total billed charges ",15.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",123.68,85,,98.94,,,0,"percent of total billed charges ","85% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",126.59,87,,101.27,,,0,"percent of total billed charges ","87% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.89,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",101.85,70,,81.48,,,0,"percent of total billed charges ","70% of total billed charges ",15.22,135.32,
"FACTOR VII",2009413,"CDM ",305,RC,85230,HCPCS,OUTPATIENT,,,145.5,116.4,,15.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.21,78.21,78.21,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.85,70,,81.48,,,0,"percent of total billed charges ","70% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",135.32,93,,108.26,,,0,"percent of total billed charges ","93% of total billed charges ",15.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",123.68,85,,98.94,,,0,"percent of total billed charges ","85% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",126.59,87,,101.27,,,0,"percent of total billed charges ","87% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.89,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",101.85,70,,81.48,,,0,"percent of total billed charges ","70% of total billed charges ",15.22,135.32,
"FACTOR V",2009421,"CDM ",305,RC,85220,HCPCS,OUTPATIENT,,,145.5,116.4,,15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.85,70,,81.48,,,0,"percent of total billed charges ","70% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",135.32,93,,108.26,,,0,"percent of total billed charges ","93% of total billed charges ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",123.68,85,,98.94,,,0,"percent of total billed charges ","85% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",126.59,87,,101.27,,,0,"percent of total billed charges ","87% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",101.85,70,,81.48,,,0,"percent of total billed charges ","70% of total billed charges ",15,135.32,
"FACTOR II ACTIVITY",2009439,"CDM ",305,RC,85210,HCPCS,OUTPATIENT,,,145.5,116.4,,11.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.85,70,,81.48,,,0,"percent of total billed charges ","70% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",135.32,93,,108.26,,,0,"percent of total billed charges ","93% of total billed charges ",11.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",123.68,85,,98.94,,,0,"percent of total billed charges ","85% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",126.59,87,,101.27,,,0,"percent of total billed charges ","87% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",101.85,70,,81.48,,,0,"percent of total billed charges ","70% of total billed charges ",11.81,135.32,
"CRYPTOCOCCUS ABS QT",2009470,"CDM ",302,RC,86641,HCPCS,OUTPATIENT,,,372,297.6,,12.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",260.4,70,,208.32,,,0,"percent of total billed charges ","70% of total billed charges ",334.8,90,,267.84,,,0,"percent of total billed charges ","90% of total billed charges ",345.96,93,,276.77,,,0,"percent of total billed charges ","93% of total billed charges ",12.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",316.2,85,,252.96,,,0,"percent of total billed charges ","85% of total billed charges ",334.8,90,,267.84,,,0,"percent of total billed charges ","90% of total billed charges ",334.8,90,,267.84,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",323.64,87,,258.91,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.41,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",260.4,70,,208.32,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,345.96,
"ETHYLENE GLYCOL SERUM",2009546,"CDM ",301,RC,82693,HCPCS,OUTPATIENT,,,338,270.4,,14.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,207.40,207.40,207.40,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",236.6,70,,189.28,,,0,"percent of total billed charges ","70% of total billed charges ",304.2,90,,243.36,,,0,"percent of total billed charges ","90% of total billed charges ",314.34,93,,251.47,,,0,"percent of total billed charges ","93% of total billed charges ",14.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",287.3,85,,229.84,,,0,"percent of total billed charges ","85% of total billed charges ",304.2,90,,243.36,,,0,"percent of total billed charges ","90% of total billed charges ",304.2,90,,243.36,,,0,"percent of total billed charges ","90% of total billed charges ",21.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",294.06,87,,235.25,,,0,"percent of total billed charges ","87% of total billed charges ",21.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.9,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",236.6,70,,189.28,,,0,"percent of total billed charges ","70% of total billed charges ",14.9,314.34,
"ESTRONE SERUM",2009553,"CDM ",301,RC,82679,HCPCS,OUTPATIENT,,,135,108,,21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",125.55,93,,100.44,,,0,"percent of total billed charges ","93% of total billed charges ",21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",114.75,85,,91.80,,,0,"percent of total billed charges ","85% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",27.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.45,87,,93.96,,,0,"percent of total billed charges ","87% of total billed charges ",27.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.95,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",21,125.55,
"HERPES SIMPLEX VIR I ABS IGG",2009595,"CDM ",302,RC,86695,HCPCS,OUTPATIENT,,,175,140,,11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,76.02,76.02,76.02,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",162.75,93,,130.20,,,0,"percent of total billed charges ","93% of total billed charges ",11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",148.75,85,,119.00,,,0,"percent of total billed charges ","85% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",152.25,87,,121.80,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,162.75,
"THYROGLOBULIN SERUM",2009603,"CDM ",301,RC,84432,HCPCS,OUTPATIENT,,,178.5,142.8,,16.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,106.38,106.38,106.38,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.95,70,,99.96,,,0,"percent of total billed charges ","70% of total billed charges ",160.65,90,,128.52,,,0,"percent of total billed charges ","90% of total billed charges ",166.01,93,,132.81,,,0,"percent of total billed charges ","93% of total billed charges ",16.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",151.73,85,,121.38,,,0,"percent of total billed charges ","85% of total billed charges ",160.65,90,,128.52,,,0,"percent of total billed charges ","90% of total billed charges ",160.65,90,,128.52,,,0,"percent of total billed charges ","90% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",155.3,87,,47.42,22.08,72.76,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",124.95,70,,99.96,,,0,"percent of total billed charges ","70% of total billed charges ",16.05,166.01,
"AMPHETAMINES SERUM",2009611,"CDM ",300,RC,80307,HCPCS,OUTPATIENT,,,160.5,128.4,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",149.27,93,,119.42,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",136.43,85,,109.14,,,0,"percent of total billed charges ","85% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",139.64,87,,111.71,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",62.14,149.27,
"ALBUMIN BODY FLUID",2009645,"CDM ",301,RC,82042,HCPCS,OUTPATIENT,,,53,42.4,,6.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",49.29,93,,39.43,,,0,"percent of total billed charges ","93% of total billed charges ",6.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.05,85,,36.04,,,0,"percent of total billed charges ","85% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.11,87,,36.89,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.78,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",6.61,49.29,
"H PYLORI ABS IG A",2009678,"CDM ",302,RC,86677,HCPCS,OUTPATIENT,,,217,173.6,,14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,47.59,47.59,47.59,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.9,70,,121.52,,,0,"percent of total billed charges ","70% of total billed charges ",195.3,90,,156.24,,,0,"percent of total billed charges ","90% of total billed charges ",201.81,93,,161.45,,,0,"percent of total billed charges ","93% of total billed charges ",14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",184.45,85,,147.56,,,0,"percent of total billed charges ","85% of total billed charges ",195.3,90,,156.24,,,0,"percent of total billed charges ","90% of total billed charges ",195.3,90,,156.24,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",188.79,87,,78.01,78.01,78.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.85,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",151.9,70,,121.52,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,201.81,
"LYME DISEASE ABS IGG",2009736,"CDM ",302,RC,86618,HCPCS,OUTPATIENT,,,204,163.2,,14.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",14.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,141.98,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,189.72,
"DNA ANTIBODY SINGLE STRANDED",2009744,"CDM ",302,RC,86226,HCPCS,OUTPATIENT,,,200.5,160.4,,12.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.35,70,,112.28,,,0,"percent of total billed charges ","70% of total billed charges ",180.45,90,,144.36,,,0,"percent of total billed charges ","90% of total billed charges ",186.47,93,,149.18,,,0,"percent of total billed charges ","93% of total billed charges ",12.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",170.43,85,,136.34,,,0,"percent of total billed charges ","85% of total billed charges ",180.45,90,,144.36,,,0,"percent of total billed charges ","90% of total billed charges ",180.45,90,,144.36,,,0,"percent of total billed charges ","90% of total billed charges ",21.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",174.44,87,,139.55,,,0,"percent of total billed charges ","87% of total billed charges ",21.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.11,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",140.35,70,,112.28,,,0,"percent of total billed charges ","70% of total billed charges ",12.11,186.47,
"ANTIDIURETIC HORM (ADH) PROFIL",2009769,"CDM ",301,RC,84588,HCPCS,OUTPATIENT,,,261.5,209.2,,28.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",243.2,93,,194.56,,,0,"percent of total billed charges ","93% of total billed charges ",28.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",222.28,85,,177.82,,,0,"percent of total billed charges ","85% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",227.51,87,,182.01,,,0,"percent of total billed charges ","87% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.94,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",28.85,243.2,
"HEPATITIS C VIRUS ABS (RIBA)",2009793,"CDM ",302,RC,86804,HCPCS,OUTPATIENT,,,434.5,347.6,,15.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",304.15,70,,243.32,,,0,"percent of total billed charges ","70% of total billed charges ",391.05,90,,312.84,,,0,"percent of total billed charges ","90% of total billed charges ",404.09,93,,323.27,,,0,"percent of total billed charges ","93% of total billed charges ",15.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",369.33,85,,295.46,,,0,"percent of total billed charges ","85% of total billed charges ",391.05,90,,312.84,,,0,"percent of total billed charges ","90% of total billed charges ",391.05,90,,312.84,,,0,"percent of total billed charges ","90% of total billed charges ",19.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",378.02,87,,302.42,,,0,"percent of total billed charges ","87% of total billed charges ",19.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.49,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",304.15,70,,243.32,,,0,"percent of total billed charges ","70% of total billed charges ",15.2,404.09,
"ISLET CELL ANTIBODY",2009850,"CDM ",302,RC,86341,HCPCS,OUTPATIENT,,,213.5,170.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.45,70,,119.56,,,0,"percent of total billed charges ","70% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",198.56,93,,158.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",181.48,85,,145.18,,,0,"percent of total billed charges ","85% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",185.75,87,,148.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",23.57,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",149.45,70,,119.56,,,0,"percent of total billed charges ","70% of total billed charges ",23.57,198.56,
"HIV 1 - DNA",2009900,"CDM ",306,RC,87535,HCPCS,OUTPATIENT,,,649,519.2,,29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",454.3,70,,363.44,,,0,"percent of total billed charges ","70% of total billed charges ",584.1,90,,467.28,,,0,"percent of total billed charges ","90% of total billed charges ",603.57,93,,482.86,,,0,"percent of total billed charges ","93% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",551.65,85,,441.32,,,0,"percent of total billed charges ","85% of total billed charges ",584.1,90,,467.28,,,0,"percent of total billed charges ","90% of total billed charges ",584.1,90,,467.28,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",564.63,87,,451.70,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",454.3,70,,363.44,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,603.57,
GASTRIN,2009991,"CDM ",301,RC,82941,HCPCS,OUTPATIENT,,,146.5,117.2,,17.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.55,70,,82.04,,,0,"percent of total billed charges ","70% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",136.25,93,,109.00,,,0,"percent of total billed charges ","93% of total billed charges ",17.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.57,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.53,85,,99.62,,,0,"percent of total billed charges ","85% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",31.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.46,87,,101.97,,,0,"percent of total billed charges ","87% of total billed charges ",31.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.63,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.55,70,,82.04,,,0,"percent of total billed charges ","70% of total billed charges ",17.63,136.25,
"PROSTATIC ACID PHOS EIA",2010007,"CDM ",301,RC,84066,HCPCS,OUTPATIENT,,,78.5,62.8,,13.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.95,70,,43.96,,,0,"percent of total billed charges ","70% of total billed charges ",70.65,90,,56.52,,,0,"percent of total billed charges ","90% of total billed charges ",73.01,93,,58.41,,,0,"percent of total billed charges ","93% of total billed charges ",13.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",66.73,85,,53.38,,,0,"percent of total billed charges ","85% of total billed charges ",70.65,90,,56.52,,,0,"percent of total billed charges ","90% of total billed charges ",70.65,90,,56.52,,,0,"percent of total billed charges ","90% of total billed charges ",17.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",68.3,87,,54.64,,,0,"percent of total billed charges ","87% of total billed charges ",17.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.66,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",54.95,70,,43.96,,,0,"percent of total billed charges ","70% of total billed charges ",9.66,73.01,
"STONE ANALYSIS KIDNEY",2010015,"CDM ",301,RC,82365,HCPCS,OUTPATIENT,,,108,86.4,,12.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,47.95,47.95,47.95,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",12.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,75.17,,,0,"percent of total billed charges ","87% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.9,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,100.44,
"DRUG ABUSE QUAL URINE",2010049,"CDM ",300,RC,80306,HCPCS,OUTPATIENT,,,338,270.4,,15.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",236.6,70,,189.28,,,0,"percent of total billed charges ","70% of total billed charges ",304.2,90,,243.36,,,0,"percent of total billed charges ","90% of total billed charges ",314.34,93,,251.47,,,0,"percent of total billed charges ","93% of total billed charges ",15.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",287.3,85,,229.84,,,0,"percent of total billed charges ","85% of total billed charges ",304.2,90,,243.36,,,0,"percent of total billed charges ","90% of total billed charges ",304.2,90,,243.36,,,0,"percent of total billed charges ","90% of total billed charges ",20.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",294.06,87,,242.05,112.41,268.94,"1 through 10","percent of total billed charges ","87% of total billed charges ",20.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",236.6,70,,189.28,,,0,"percent of total billed charges ","70% of total billed charges ",15.94,314.34,
"VANCOMYCIN TROUGH",2010056,"CDM ",301,RC,80202,HCPCS,OUTPATIENT,,,260,208,,13.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",182,70,,145.60,,,0,"percent of total billed charges ","70% of total billed charges ",234,90,,187.20,,,0,"percent of total billed charges ","90% of total billed charges ",241.8,93,,193.44,,,0,"percent of total billed charges ","93% of total billed charges ",13.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.73,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",221,85,,176.80,,,0,"percent of total billed charges ","85% of total billed charges ",234,90,,187.20,,,0,"percent of total billed charges ","90% of total billed charges ",234,90,,187.20,,,0,"percent of total billed charges ","90% of total billed charges ",24.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.2,87,,180.96,,,0,"percent of total billed charges ","87% of total billed charges ",24.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.54,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",182,70,,145.60,,,0,"percent of total billed charges ","70% of total billed charges ",13.54,241.8,
"TOBRAMYCIN RANDOM",2010064,"CDM ",301,RC,80200,HCPCS,OUTPATIENT,,,110,88,,16.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77,70,,61.60,,,0,"percent of total billed charges ","70% of total billed charges ",99,90,,79.20,,,0,"percent of total billed charges ","90% of total billed charges ",102.3,93,,81.84,,,0,"percent of total billed charges ","93% of total billed charges ",16.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.44,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",93.5,85,,74.80,,,0,"percent of total billed charges ","85% of total billed charges ",99,90,,79.20,,,0,"percent of total billed charges ","90% of total billed charges ",99,90,,79.20,,,0,"percent of total billed charges ","90% of total billed charges ",29.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",95.7,87,,76.56,,,0,"percent of total billed charges ","87% of total billed charges ",29.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.13,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",77,70,,61.60,,,0,"percent of total billed charges ","70% of total billed charges ",16.13,102.3,
"HIV I RNA",2010114,"CDM ",306,RC,87536,HCPCS,OUTPATIENT,,,633.5,506.8,,85.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,217.26,217.26,217.26,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",443.45,70,,354.76,,,0,"percent of total billed charges ","70% of total billed charges ",570.15,90,,456.12,,,0,"percent of total billed charges ","90% of total billed charges ",589.16,93,,471.33,,,0,"percent of total billed charges ","93% of total billed charges ",85.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",142.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",538.48,85,,430.78,,,0,"percent of total billed charges ","85% of total billed charges ",570.15,90,,456.12,,,0,"percent of total billed charges ","90% of total billed charges ",570.15,90,,456.12,,,0,"percent of total billed charges ","90% of total billed charges ",141.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",551.15,87,,440.92,,,0,"percent of total billed charges ","87% of total billed charges ",141.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.1,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",443.45,70,,354.76,,,0,"percent of total billed charges ","70% of total billed charges ",85.1,589.16,
"PRE ALBUMIN",2010379,"CDM ",301,RC,84134,HCPCS,OUTPATIENT,,,105,84,,12.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.5,70,,58.80,,,0,"percent of total billed charges ","70% of total billed charges ",94.5,90,,75.60,,,0,"percent of total billed charges ","90% of total billed charges ",97.65,93,,78.12,,,0,"percent of total billed charges ","93% of total billed charges ",12.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",89.25,85,,71.40,,,0,"percent of total billed charges ","85% of total billed charges ",94.5,90,,75.60,,,0,"percent of total billed charges ","90% of total billed charges ",94.5,90,,75.60,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",91.35,87,,73.08,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.59,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",73.5,70,,58.80,,,0,"percent of total billed charges ","70% of total billed charges ",6.87,97.65,
"COMPLEMENT C7",2010387,"CDM ",302,RC,86160,HCPCS,OUTPATIENT,,,165,132,,12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,133.30,133.30,133.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,226.71,226.71,226.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",12,153.45,
"COMPLEMENT C6",2010395,"CDM ",302,RC,86160,HCPCS,OUTPATIENT,,,165,132,,12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,133.30,133.30,133.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,226.71,226.71,226.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",12,153.45,
"HIV P24 AG",2010486,"CDM ",306,RC,87390,HCPCS,OUTPATIENT,,,308,246.4,,20.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",215.6,70,,172.48,,,0,"percent of total billed charges ","70% of total billed charges ",277.2,90,,221.76,,,0,"percent of total billed charges ","90% of total billed charges ",286.44,93,,229.15,,,0,"percent of total billed charges ","93% of total billed charges ",20.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",261.8,85,,209.44,,,0,"percent of total billed charges ","85% of total billed charges ",277.2,90,,221.76,,,0,"percent of total billed charges ","90% of total billed charges ",277.2,90,,221.76,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",267.96,87,,214.37,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.06,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",215.6,70,,172.48,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,286.44,
"GENTAMYCIN RANDOM",2010536,"CDM ",300,RC,80170,HCPCS,OUTPATIENT,,,150,120,,16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",105,70,,84.00,,,0,"percent of total billed charges ","70% of total billed charges ",135,90,,108.00,,,0,"percent of total billed charges ","90% of total billed charges ",139.5,93,,111.60,,,0,"percent of total billed charges ","93% of total billed charges ",16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.95,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",127.5,85,,102.00,,,0,"percent of total billed charges ","85% of total billed charges ",135,90,,108.00,,,0,"percent of total billed charges ","90% of total billed charges ",135,90,,108.00,,,0,"percent of total billed charges ","90% of total billed charges ",29.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.5,87,,104.40,,,0,"percent of total billed charges ","87% of total billed charges ",29.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.38,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",105,70,,84.00,,,0,"percent of total billed charges ","70% of total billed charges ",16.38,139.5,
"DRUG SCREEN NON DOT-URINE",2010551,"CDM ",300,RC,80100,HCPCS,OUTPATIENT,,,61.5,49.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.05,70,,34.44,,,0,"percent of total billed charges ","70% of total billed charges ",55.35,90,,44.28,,,0,"percent of total billed charges ","90% of total billed charges ",57.2,93,,45.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",52.28,85,,41.82,,,0,"percent of total billed charges ","85% of total billed charges ",55.35,90,,44.28,,,0,"percent of total billed charges ","90% of total billed charges ",55.35,90,,44.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",53.51,87,,42.81,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.05,70,,34.44,,,0,"percent of total billed charges ","70% of total billed charges ",43.05,57.2,
"DRUG SCREEN DOT-URINE",2010569,"CDM ",300,RC,80100,HCPCS,OUTPATIENT,,,94,75.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.8,70,,52.64,,,0,"percent of total billed charges ","70% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",87.42,93,,69.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",79.9,85,,63.92,,,0,"percent of total billed charges ","85% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.78,87,,65.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.8,70,,52.64,,,0,"percent of total billed charges ","70% of total billed charges ",65.8,87.42,
"BREATH ALCOHOL TEST",2010577,"CDM ",301,RC,80100,HCPCS,OUTPATIENT,,,68,54.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.6,70,,38.08,,,0,"percent of total billed charges ","70% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",63.24,93,,50.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",57.8,85,,46.24,,,0,"percent of total billed charges ","85% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",59.16,87,,47.33,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.6,70,,38.08,,,0,"percent of total billed charges ","70% of total billed charges ",47.6,63.24,
"DRUG SCREEN COLLECTION NONE",2010593,"CDM ",301,RC,80307,HCPCS,OUTPATIENT,,,34,27.2,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.8,70,,19.04,,,0,"percent of total billed charges ","70% of total billed charges ",30.6,90,,24.48,,,0,"percent of total billed charges ","90% of total billed charges ",31.62,93,,25.30,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",28.9,85,,23.12,,,0,"percent of total billed charges ","85% of total billed charges ",30.6,90,,24.48,,,0,"percent of total billed charges ","90% of total billed charges ",30.6,90,,24.48,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.58,87,,23.66,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",23.8,70,,19.04,,,0,"percent of total billed charges ","70% of total billed charges ",23.8,80.98,
"TROPONIN I QUAL",2010718,"CDM ",301,RC,84512,HCPCS,OUTPATIENT,,,327,261.6,,10.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",228.9,70,,183.12,,,0,"percent of total billed charges ","70% of total billed charges ",294.3,90,,235.44,,,0,"percent of total billed charges ","90% of total billed charges ",304.11,93,,243.29,,,0,"percent of total billed charges ","93% of total billed charges ",10.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.86,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",277.95,85,,222.36,,,0,"percent of total billed charges ","85% of total billed charges ",294.3,90,,235.44,,,0,"percent of total billed charges ","90% of total billed charges ",294.3,90,,235.44,,,0,"percent of total billed charges ","90% of total billed charges ",15.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",284.49,87,,203.43,143.98,508.58,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",228.9,70,,183.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.09,304.11,
"MICROALBUMIN RANDOM UA",2010734,"CDM ",301,RC,82043,HCPCS,OUTPATIENT,,,53,42.4,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",49.29,93,,39.43,,,0,"percent of total billed charges ","93% of total billed charges ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.05,85,,36.04,,,0,"percent of total billed charges ","85% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.11,87,,5.67,5.33,35.21,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.78,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,49.29,
"*HEM FRAC RBC SICKLE",2010874,"CDM ",305,RC,85660,HCPCS,OUTPATIENT,,,139,111.2,,4.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.3,70,,77.84,,,0,"percent of total billed charges ","70% of total billed charges ",125.1,90,,100.08,,,0,"percent of total billed charges ","90% of total billed charges ",129.27,93,,103.42,,,0,"percent of total billed charges ","93% of total billed charges ",4.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",118.15,85,,94.52,,,0,"percent of total billed charges ","85% of total billed charges ",125.1,90,,100.08,,,0,"percent of total billed charges ","90% of total billed charges ",125.1,90,,100.08,,,0,"percent of total billed charges ","90% of total billed charges ",6.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",120.93,87,,96.74,,,0,"percent of total billed charges ","87% of total billed charges ",6.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.51,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",97.3,70,,77.84,,,0,"percent of total billed charges ","70% of total billed charges ",4.68,129.27,
"ALPHAFETOPROTEIN SERUM TM  #22",2010882,"CDM ",301,RC,82105,HCPCS,OUTPATIENT,,,120.5,96.4,,14.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.35,70,,67.48,,,0,"percent of total billed charges ","70% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",112.07,93,,89.66,,,0,"percent of total billed charges ","93% of total billed charges ",14.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",102.43,85,,81.94,,,0,"percent of total billed charges ","85% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",104.84,87,,74.83,74.82,74.83,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.77,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",84.35,70,,67.48,,,0,"percent of total billed charges ","70% of total billed charges ",14.25,112.07,
"VASO INTESTINAL PEPTIDE VIP",2010932,"CDM ",301,RC,84586,HCPCS,OUTPATIENT,,,220.5,176.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154.35,70,,123.48,,,0,"percent of total billed charges ","70% of total billed charges ",198.45,90,,158.76,,,0,"percent of total billed charges ","90% of total billed charges ",205.07,93,,164.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",187.43,85,,149.94,,,0,"percent of total billed charges ","85% of total billed charges ",198.45,90,,158.76,,,0,"percent of total billed charges ","90% of total billed charges ",198.45,90,,158.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",191.84,87,,153.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",35.33,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",154.35,70,,123.48,,,0,"percent of total billed charges ","70% of total billed charges ",35.33,205.07,
CRYOFIBRINOGEN,2010957,"CDM ",301,RC,82585,HCPCS,OUTPATIENT,,,172.5,138,,12.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1.02,1.02,1.02,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.75,70,,96.60,,,0,"percent of total billed charges ","70% of total billed charges ",155.25,90,,124.20,,,0,"percent of total billed charges ","90% of total billed charges ",160.43,93,,128.34,,,0,"percent of total billed charges ","93% of total billed charges ",12.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",146.63,85,,117.30,,,0,"percent of total billed charges ","85% of total billed charges ",155.25,90,,124.20,,,0,"percent of total billed charges ","90% of total billed charges ",155.25,90,,124.20,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",150.08,87,,120.06,,,0,"percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",120.75,70,,96.60,,,0,"percent of total billed charges ","70% of total billed charges ",9.61,160.43,
"*MYASTHENIA ACETYLCHOL RECEPT",2011021,"CDM ",301,RC,84238,HCPCS,OUTPATIENT,,,108,86.4,,36.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,286.80,286.80,286.80,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",36.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",66.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,71.68,71.68,71.68,"1 through 10","percent of total billed charges ","87% of total billed charges ",66.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.57,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",36.57,100.44,
"SCLERODERMA DIAGNOSTIC",2011039,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,149.5,119.6,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",139.04,93,,111.23,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",127.08,85,,101.66,,,0,"percent of total billed charges ","85% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.07,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,139.04,
"CULTURE SKIN-SOFT TISSUE",2011070,"CDM ",306,RC,87070,HCPCS,OUTPATIENT,,,248.5,198.8,,7.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,28.62,28.62,28.62,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.95,70,,139.16,,,0,"percent of total billed charges ","70% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",231.11,93,,184.89,,,0,"percent of total billed charges ","93% of total billed charges ",7.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",211.23,85,,168.98,,,0,"percent of total billed charges ","85% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",216.2,87,,40.73,8.45,128.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",173.95,70,,139.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.35,231.11,
"CULTURE PLACENTA",2011088,"CDM ",306,RC,87070,HCPCS,OUTPATIENT,,,248.5,198.8,,7.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,28.62,28.62,28.62,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.95,70,,139.16,,,0,"percent of total billed charges ","70% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",231.11,93,,184.89,,,0,"percent of total billed charges ","93% of total billed charges ",7.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",211.23,85,,168.98,,,0,"percent of total billed charges ","85% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",216.2,87,,40.73,8.45,128.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",173.95,70,,139.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.35,231.11,
"CULTURE OPERATIVE SITE",2011096,"CDM ",306,RC,87070,HCPCS,OUTPATIENT,,,248.5,198.8,,7.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,28.62,28.62,28.62,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.95,70,,139.16,,,0,"percent of total billed charges ","70% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",231.11,93,,184.89,,,0,"percent of total billed charges ","93% of total billed charges ",7.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",211.23,85,,168.98,,,0,"percent of total billed charges ","85% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",216.2,87,,40.73,8.45,128.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",173.95,70,,139.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.35,231.11,
"CULTURE IV DEVICE",2011104,"CDM ",306,RC,87070,HCPCS,OUTPATIENT,,,248.5,198.8,,7.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,28.62,28.62,28.62,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.95,70,,139.16,,,0,"percent of total billed charges ","70% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",231.11,93,,184.89,,,0,"percent of total billed charges ","93% of total billed charges ",7.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",211.23,85,,168.98,,,0,"percent of total billed charges ","85% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",216.2,87,,40.73,8.45,128.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",173.95,70,,139.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.35,231.11,
"FUNGUS ID, MOLD",2011112,"CDM ",306,RC,87107,HCPCS,OUTPATIENT,,,107,85.6,,10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.9,70,,59.92,,,0,"percent of total billed charges ","70% of total billed charges ",96.3,90,,77.04,,,0,"percent of total billed charges ","90% of total billed charges ",99.51,93,,79.61,,,0,"percent of total billed charges ","93% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",90.95,85,,72.76,,,0,"percent of total billed charges ","85% of total billed charges ",96.3,90,,77.04,,,0,"percent of total billed charges ","90% of total billed charges ",96.3,90,,77.04,,,0,"percent of total billed charges ","90% of total billed charges ",15.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.09,87,,74.47,,,0,"percent of total billed charges ","87% of total billed charges ",15.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.32,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",74.9,70,,59.92,,,0,"percent of total billed charges ","70% of total billed charges ",10.32,99.51,
"SUSCEPTIBILITY TEST N/U",2011120,"CDM ",306,RC,87186,HCPCS,OUTPATIENT,,,248.5,198.8,,8.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.95,70,,139.16,,,0,"percent of total billed charges ","70% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",231.11,93,,184.89,,,0,"percent of total billed charges ","93% of total billed charges ",8.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",211.23,85,,168.98,,,0,"percent of total billed charges ","85% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",216.2,87,,8.48,8.48,105.80,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.65,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",173.95,70,,139.16,,,0,"percent of total billed charges ","70% of total billed charges ",8.65,231.11,
"SUSCEPTIBILITY TEST RPC",2011138,"CDM ",306,RC,87186,HCPCS,OUTPATIENT,,,248.5,198.8,,8.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.95,70,,139.16,,,0,"percent of total billed charges ","70% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",231.11,93,,184.89,,,0,"percent of total billed charges ","93% of total billed charges ",8.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",211.23,85,,168.98,,,0,"percent of total billed charges ","85% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",216.2,87,,8.48,8.48,105.80,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.65,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",173.95,70,,139.16,,,0,"percent of total billed charges ","70% of total billed charges ",8.65,231.11,
"SUSCEPTIBILITY TEST CPC",2011146,"CDM ",306,RC,87186,HCPCS,OUTPATIENT,,,248.5,198.8,,8.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.95,70,,139.16,,,0,"percent of total billed charges ","70% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",231.11,93,,184.89,,,0,"percent of total billed charges ","93% of total billed charges ",8.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",211.23,85,,168.98,,,0,"percent of total billed charges ","85% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",216.2,87,,8.48,8.48,105.80,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.65,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",173.95,70,,139.16,,,0,"percent of total billed charges ","70% of total billed charges ",8.65,231.11,
"SUSCEPTIBILITY TEST RUC",2011153,"CDM ",306,RC,87186,HCPCS,OUTPATIENT,,,248.5,198.8,,8.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.95,70,,139.16,,,0,"percent of total billed charges ","70% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",231.11,93,,184.89,,,0,"percent of total billed charges ","93% of total billed charges ",8.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",211.23,85,,168.98,,,0,"percent of total billed charges ","85% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",216.2,87,,8.48,8.48,105.80,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.65,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",173.95,70,,139.16,,,0,"percent of total billed charges ","70% of total billed charges ",8.65,231.11,
"SUSCEPTIBILITY TEST RNC",2011161,"CDM ",306,RC,87186,HCPCS,OUTPATIENT,,,248.5,198.8,,8.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.95,70,,139.16,,,0,"percent of total billed charges ","70% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",231.11,93,,184.89,,,0,"percent of total billed charges ","93% of total billed charges ",8.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",211.23,85,,168.98,,,0,"percent of total billed charges ","85% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",216.2,87,,8.48,8.48,105.80,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.65,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",173.95,70,,139.16,,,0,"percent of total billed charges ","70% of total billed charges ",8.65,231.11,
"ACID PHOS PROSTATIC",2011195,"CDM ",301,RC,84066,HCPCS,OUTPATIENT,,,78.5,62.8,,13.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.95,70,,43.96,,,0,"percent of total billed charges ","70% of total billed charges ",70.65,90,,56.52,,,0,"percent of total billed charges ","90% of total billed charges ",73.01,93,,58.41,,,0,"percent of total billed charges ","93% of total billed charges ",13.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",66.73,85,,53.38,,,0,"percent of total billed charges ","85% of total billed charges ",70.65,90,,56.52,,,0,"percent of total billed charges ","90% of total billed charges ",70.65,90,,56.52,,,0,"percent of total billed charges ","90% of total billed charges ",17.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",68.3,87,,54.64,,,0,"percent of total billed charges ","87% of total billed charges ",17.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.66,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",54.95,70,,43.96,,,0,"percent of total billed charges ","70% of total billed charges ",9.66,73.01,
"*ANTI EXTRACT NUC AG RNP",2011245,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,149.5,119.6,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",139.04,93,,111.23,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",127.08,85,,101.66,,,0,"percent of total billed charges ","85% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.07,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,139.04,
"*ANTI EXTRACT NUC AG SMITH",2011252,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,149.5,119.6,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",139.04,93,,111.23,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",127.08,85,,101.66,,,0,"percent of total billed charges ","85% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.07,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,139.04,
"*CARDIOLIPIN IGA",2011260,"CDM ",302,RC,86147,HCPCS,OUTPATIENT,,,224.5,179.6,,25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",208.79,93,,167.03,,,0,"percent of total billed charges ","93% of total billed charges ",25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",190.83,85,,152.66,,,0,"percent of total billed charges ","85% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.32,87,,156.26,,,0,"percent of total billed charges ","87% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",25.45,208.79,
"*CARDIOLIPIN ABS IGG",2011278,"CDM ",302,RC,86147,HCPCS,OUTPATIENT,,,224.5,179.6,,25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",208.79,93,,167.03,,,0,"percent of total billed charges ","93% of total billed charges ",25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",190.83,85,,152.66,,,0,"percent of total billed charges ","85% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.32,87,,156.26,,,0,"percent of total billed charges ","87% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",25.45,208.79,
"*CARDIOLIPIN IGM",2011294,"CDM ",302,RC,86147,HCPCS,OUTPATIENT,,,224.5,179.6,,25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",208.79,93,,167.03,,,0,"percent of total billed charges ","93% of total billed charges ",25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",190.83,85,,152.66,,,0,"percent of total billed charges ","85% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.32,87,,156.26,,,0,"percent of total billed charges ","87% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",25.45,208.79,
"TESTOSTERONE TOTAL",2011310,"CDM ",301,RC,84403,HCPCS,OUTPATIENT,,,225,180,,25.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.5,70,,126.00,,,0,"percent of total billed charges ","70% of total billed charges ",202.5,90,,162.00,,,0,"percent of total billed charges ","90% of total billed charges ",209.25,93,,167.40,,,0,"percent of total billed charges ","93% of total billed charges ",25.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.58,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",191.25,85,,153.00,,,0,"percent of total billed charges ","85% of total billed charges ",202.5,90,,162.00,,,0,"percent of total billed charges ","90% of total billed charges ",202.5,90,,162.00,,,0,"percent of total billed charges ","90% of total billed charges ",40.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.75,87,,117.78,25.30,174.56,11,"percent of total billed charges ","87% of total billed charges ",40.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.81,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.5,70,,126.00,,,0,"percent of total billed charges ","70% of total billed charges ",25.81,209.25,
"*CHLAMYDIA & GC CHLAMYDIA PROB",2011344,"CDM ",306,RC,87490,HCPCS,OUTPATIENT,,,165,132,,19.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",19.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,114.84,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.75,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,153.45,
"TESTOSTERONE FREE",2011351,"CDM ",301,RC,84402,HCPCS,OUTPATIENT,,,225,180,,25.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.5,70,,126.00,,,0,"percent of total billed charges ","70% of total billed charges ",202.5,90,,162.00,,,0,"percent of total billed charges ","90% of total billed charges ",209.25,93,,167.40,,,0,"percent of total billed charges ","93% of total billed charges ",25.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.57,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",191.25,85,,153.00,,,0,"percent of total billed charges ","85% of total billed charges ",202.5,90,,162.00,,,0,"percent of total billed charges ","90% of total billed charges ",202.5,90,,162.00,,,0,"percent of total billed charges ","90% of total billed charges ",40.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.75,87,,139.65,24.97,174.56,"1 through 10","percent of total billed charges ","87% of total billed charges ",40.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.47,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.5,70,,126.00,,,0,"percent of total billed charges ","70% of total billed charges ",25.47,209.25,
"ACID PHOS TOTAL",2011393,"CDM ",301,RC,84060,HCPCS,OUTPATIENT,,,151.5,121.2,,8.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.05,70,,84.84,,,0,"percent of total billed charges ","70% of total billed charges ",136.35,90,,109.08,,,0,"percent of total billed charges ","90% of total billed charges ",140.9,93,,112.72,,,0,"percent of total billed charges ","93% of total billed charges ",8.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",128.78,85,,103.02,,,0,"percent of total billed charges ","85% of total billed charges ",136.35,90,,109.08,,,0,"percent of total billed charges ","90% of total billed charges ",136.35,90,,109.08,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",131.81,87,,105.45,,,0,"percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",106.05,70,,84.84,,,0,"percent of total billed charges ","70% of total billed charges ",7.64,140.9,
"*HEAVY METAL URINE ARSENIC",2011419,"CDM ",301,RC,82175,HCPCS,OUTPATIENT,,,65.5,52.4,,16.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,53.10,53.10,53.10,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.85,70,,36.68,,,0,"percent of total billed charges ","70% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",60.92,93,,48.74,,,0,"percent of total billed charges ","93% of total billed charges ",16.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.81,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",55.68,85,,44.54,,,0,"percent of total billed charges ","85% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",11.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.99,87,,45.59,,,0,"percent of total billed charges ","87% of total billed charges ",11.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.97,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",45.85,70,,36.68,,,0,"percent of total billed charges ","70% of total billed charges ",11.69,60.92,
"*HEAVY METAL URINE CREATININE",2011427,"CDM ",301,RC,82570,HCPCS,OUTPATIENT,,,47,37.6,,5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",43.71,93,,34.97,,,0,"percent of total billed charges ","93% of total billed charges ",5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.95,85,,31.96,,,0,"percent of total billed charges ","85% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.89,87,,5.08,4.98,50.30,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",5.18,43.71,
"HERPES SIMPLEX I IMMUNASY IGG)",2011468,"CDM ",302,RC,86695,HCPCS,OUTPATIENT,,,175,140,,11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,76.02,76.02,76.02,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",162.75,93,,130.20,,,0,"percent of total billed charges ","93% of total billed charges ",11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",148.75,85,,119.00,,,0,"percent of total billed charges ","85% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",152.25,87,,121.80,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,162.75,
"HERPES SIMPLEX II IMMUNASY IGG",2011476,"CDM ",302,RC,86696,HCPCS,OUTPATIENT,,,188.5,150.8,,19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.29,80.29,80.29,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.95,70,,105.56,,,0,"percent of total billed charges ","70% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",175.31,93,,140.25,,,0,"percent of total billed charges ","93% of total billed charges ",19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",160.23,85,,128.18,,,0,"percent of total billed charges ","85% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",164,87,,131.20,,,0,"percent of total billed charges ","87% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.35,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",131.95,70,,105.56,,,0,"percent of total billed charges ","70% of total billed charges ",19.35,175.31,
"*HEAVY METAL BLD ARSENIC",2011484,"CDM ",301,RC,82175,HCPCS,OUTPATIENT,,,105.5,84.4,,16.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,53.10,53.10,53.10,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.85,70,,59.08,,,0,"percent of total billed charges ","70% of total billed charges ",94.95,90,,75.96,,,0,"percent of total billed charges ","90% of total billed charges ",98.12,93,,78.50,,,0,"percent of total billed charges ","93% of total billed charges ",16.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.81,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",89.68,85,,71.74,,,0,"percent of total billed charges ","85% of total billed charges ",94.95,90,,75.96,,,0,"percent of total billed charges ","90% of total billed charges ",94.95,90,,75.96,,,0,"percent of total billed charges ","90% of total billed charges ",11.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",91.79,87,,73.43,,,0,"percent of total billed charges ","87% of total billed charges ",11.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.97,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",73.85,70,,59.08,,,0,"percent of total billed charges ","70% of total billed charges ",11.69,98.12,
"*FUNGAL ABS QL ASPERG",2011575,"CDM ",302,RC,86606,HCPCS,OUTPATIENT,,,156,124.8,,12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,55.22,55.22,55.22,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",145.08,93,,116.06,,,0,"percent of total billed charges ","93% of total billed charges ",12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",132.6,85,,106.08,,,0,"percent of total billed charges ","85% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",135.72,87,,108.58,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,145.08,
"*FUNGAL ABS QL BLASTO",2011583,"CDM ",302,RC,86612,HCPCS,OUTPATIENT,,,59,47.2,,10.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.3,70,,33.04,,,0,"percent of total billed charges ","70% of total billed charges ",53.1,90,,42.48,,,0,"percent of total billed charges ","90% of total billed charges ",54.87,93,,43.90,,,0,"percent of total billed charges ","93% of total billed charges ",10.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",50.15,85,,40.12,,,0,"percent of total billed charges ","85% of total billed charges ",53.1,90,,42.48,,,0,"percent of total billed charges ","90% of total billed charges ",53.1,90,,42.48,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",51.33,87,,41.06,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.9,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",41.3,70,,33.04,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,54.87,
"*FUNGAL ABS QL COCCIDIOIDES",2011591,"CDM ",302,RC,86635,HCPCS,OUTPATIENT,,,146,116.8,,9.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",9.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,101.62,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.47,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,135.78,
"*FUNGAL ABS QL HISTO",2011609,"CDM ",302,RC,86698,HCPCS,OUTPATIENT,,,169,135.2,,11.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",157.17,93,,125.74,,,0,"percent of total billed charges ","93% of total billed charges ",11.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.65,85,,114.92,,,0,"percent of total billed charges ","85% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.03,87,,117.62,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.79,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,157.17,
"O&P WET/DRY MOUNT",2011633,"CDM ",306,RC,87177,HCPCS,OUTPATIENT,,,86,68.8,,8.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.2,70,,48.16,,,0,"percent of total billed charges ","70% of total billed charges ",77.4,90,,61.92,,,0,"percent of total billed charges ","90% of total billed charges ",79.98,93,,63.98,,,0,"percent of total billed charges ","93% of total billed charges ",8.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",73.1,85,,58.48,,,0,"percent of total billed charges ","85% of total billed charges ",77.4,90,,61.92,,,0,"percent of total billed charges ","90% of total billed charges ",77.4,90,,61.92,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",74.82,87,,59.86,,,0,"percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.9,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",60.2,70,,48.16,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,79.98,
"*H PYLORI ABS IGG",2011641,"CDM ",302,RC,86677,HCPCS,OUTPATIENT,,,183.5,146.8,,14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,47.59,47.59,47.59,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",170.66,93,,136.53,,,0,"percent of total billed charges ","93% of total billed charges ",14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",155.98,85,,124.78,,,0,"percent of total billed charges ","85% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",159.65,87,,78.01,78.01,78.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.85,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,170.66,
"H PYLORI IGM ABS #7736",2011658,"CDM ",302,RC,86677,HCPCS,OUTPATIENT,,,211,168.8,,14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,47.59,47.59,47.59,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.7,70,,118.16,,,0,"percent of total billed charges ","70% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",196.23,93,,156.98,,,0,"percent of total billed charges ","93% of total billed charges ",14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",179.35,85,,143.48,,,0,"percent of total billed charges ","85% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",183.57,87,,78.01,78.01,78.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.85,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",147.7,70,,118.16,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,196.23,
"*LEUKOCYTE AUTOMATED",2011666,"CDM ",305,RC,85048,HCPCS,OUTPATIENT,,,45,36,,2.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",2.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1.73,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",1.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,31.32,,,0,"percent of total billed charges ","87% of total billed charges ",1.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2.54,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",1.71,41.85,
"*CD4 & CD8 COUNT",2011674,"CDM ",302,RC,86360,HCPCS,OUTPATIENT,,,370,296,,39.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,162.94,162.94,162.94,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",344.1,93,,275.28,,,0,"percent of total billed charges ","93% of total billed charges ",39.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",314.5,85,,251.60,,,0,"percent of total billed charges ","85% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",37.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",321.9,87,,257.52,,,0,"percent of total billed charges ","87% of total billed charges ",37.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",37.61,344.1,
"*IG G SUBCLASS IGG",2011682,"CDM ",301,RC,82784,HCPCS,OUTPATIENT,,,108,86.4,,9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,75.17,,,0,"percent of total billed charges ","87% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",9.3,100.44,
"*IG A",2011690,"CDM ",301,RC,82784,HCPCS,OUTPATIENT,,,73.5,58.8,,9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",9.3,68.36,
"*IG M",2011708,"CDM ",301,RC,82784,HCPCS,OUTPATIENT,,,73.5,58.8,,9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",9.3,68.36,
"*LDH ISOENZYMES FRACT",2011906,"CDM ",301,RC,83625,HCPCS,OUTPATIENT,,,102.5,82,,12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.75,70,,57.40,,,0,"percent of total billed charges ","70% of total billed charges ",92.25,90,,73.80,,,0,"percent of total billed charges ","90% of total billed charges ",95.33,93,,76.26,,,0,"percent of total billed charges ","93% of total billed charges ",12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",87.13,85,,69.70,,,0,"percent of total billed charges ","85% of total billed charges ",92.25,90,,73.80,,,0,"percent of total billed charges ","90% of total billed charges ",92.25,90,,73.80,,,0,"percent of total billed charges ","90% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",89.18,87,,71.34,,,0,"percent of total billed charges ","87% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.79,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",71.75,70,,57.40,,,0,"percent of total billed charges ","70% of total billed charges ",12.79,95.33,
"*LEGIONELLA PNEUMO 1-14",2011914,"CDM ",302,RC,86713,HCPCS,OUTPATIENT,,,175,140,,13.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",162.75,93,,130.20,,,0,"percent of total billed charges ","93% of total billed charges ",13.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",148.75,85,,119.00,,,0,"percent of total billed charges ","85% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",152.25,87,,121.80,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,162.75,
"*PROTEIN S TOTAL",2011963,"CDM ",305,RC,85305,HCPCS,OUTPATIENT,,,129,103.2,,11.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",119.97,93,,95.98,,,0,"percent of total billed charges ","93% of total billed charges ",11.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.86,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",109.65,85,,87.72,,,0,"percent of total billed charges ","85% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",15.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.23,87,,89.78,,,0,"percent of total billed charges ","87% of total billed charges ",15.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",11.61,119.97,
"*CULTURE STOOL CAMPYLOBACTER",2012003,"CDM ",306,RC,87046,HCPCS,OUTPATIENT,,,249.5,199.6,,8.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174.65,70,,139.72,,,0,"percent of total billed charges ","70% of total billed charges ",224.55,90,,179.64,,,0,"percent of total billed charges ","90% of total billed charges ",232.04,93,,185.63,,,0,"percent of total billed charges ","93% of total billed charges ",8.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",212.08,85,,169.66,,,0,"percent of total billed charges ","85% of total billed charges ",224.55,90,,179.64,,,0,"percent of total billed charges ","90% of total billed charges ",224.55,90,,179.64,,,0,"percent of total billed charges ","90% of total billed charges ",3.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.07,87,,173.66,,,0,"percent of total billed charges ","87% of total billed charges ",3.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.44,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",174.65,70,,139.72,,,0,"percent of total billed charges ","70% of total billed charges ",3.62,232.04,
"CPK FRACTIONATION)",2012011,"CDM ",301,RC,82552,HCPCS,OUTPATIENT,,,104,83.2,,13.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.8,70,,58.24,,,0,"percent of total billed charges ","70% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",96.72,93,,77.38,,,0,"percent of total billed charges ","93% of total billed charges ",13.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",88.4,85,,70.72,,,0,"percent of total billed charges ","85% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",90.48,87,,72.38,,,0,"percent of total billed charges ","87% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",72.8,70,,58.24,,,0,"percent of total billed charges ","70% of total billed charges ",13.39,96.72,
"*COXSACKIE B ABS",2012029,"CDM ",302,RC,86658,HCPCS,OUTPATIENT,,,194,155.2,,11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",180.42,93,,144.34,,,0,"percent of total billed charges ","93% of total billed charges ",11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.9,85,,131.92,,,0,"percent of total billed charges ","85% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",168.78,87,,135.02,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,180.42,
"*COXSACKIE A7 ABS",2012086,"CDM ",302,RC,86658,HCPCS,OUTPATIENT,,,194,155.2,,11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",180.42,93,,144.34,,,0,"percent of total billed charges ","93% of total billed charges ",11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.9,85,,131.92,,,0,"percent of total billed charges ","85% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",168.78,87,,135.02,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,180.42,
"*COXSACKIE A9 ABS",2012094,"CDM ",302,RC,86658,HCPCS,OUTPATIENT,,,194,155.2,,11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",180.42,93,,144.34,,,0,"percent of total billed charges ","93% of total billed charges ",11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.9,85,,131.92,,,0,"percent of total billed charges ","85% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",168.78,87,,135.02,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,180.42,
"*COXSACKIE A10 ABS",2012102,"CDM ",302,RC,86658,HCPCS,OUTPATIENT,,,194,155.2,,11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",180.42,93,,144.34,,,0,"percent of total billed charges ","93% of total billed charges ",11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.9,85,,131.92,,,0,"percent of total billed charges ","85% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",168.78,87,,135.02,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,180.42,
"*COXSACKIE A16 ABS",2012110,"CDM ",302,RC,86658,HCPCS,OUTPATIENT,,,194,155.2,,11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",180.42,93,,144.34,,,0,"percent of total billed charges ","93% of total billed charges ",11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.9,85,,131.92,,,0,"percent of total billed charges ","85% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",168.78,87,,135.02,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,180.42,
"*CHROM ANAL TISSUE CUL",2012128,"CDM ",300,RC,88235,HCPCS,OUTPATIENT,,,1410.5,1128.4,,127.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",987.35,70,,789.88,,,0,"percent of total billed charges ","70% of total billed charges ",1269.45,90,,1015.56,,,0,"percent of total billed charges ","90% of total billed charges ",1311.77,93,,1049.42,,,0,"percent of total billed charges ","93% of total billed charges ",127.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",44.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1198.93,85,,959.14,,,0,"percent of total billed charges ","85% of total billed charges ",1269.45,90,,1015.56,,,0,"percent of total billed charges ","90% of total billed charges ",1269.45,90,,1015.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1227.14,87,,981.71,,,0,"percent of total billed charges ","87% of total billed charges ",43.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",150.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",987.35,70,,789.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.6,1311.77,
"*CHROM ANAL AMN FL CELL",2012136,"CDM ",300,RC,88267,HCPCS,OUTPATIENT,,,1410.5,1128.4,,188.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",987.35,70,,789.88,,,0,"percent of total billed charges ","70% of total billed charges ",1269.45,90,,1015.56,,,0,"percent of total billed charges ","90% of total billed charges ",1311.77,93,,1049.42,,,0,"percent of total billed charges ","93% of total billed charges ",188.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",328.29,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1198.93,85,,959.14,,,0,"percent of total billed charges ","85% of total billed charges ",1269.45,90,,1015.56,,,0,"percent of total billed charges ","90% of total billed charges ",1269.45,90,,1015.56,,,0,"percent of total billed charges ","90% of total billed charges ",325.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1227.14,87,,981.71,,,0,"percent of total billed charges ","87% of total billed charges ",325.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",188.57,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",987.35,70,,789.88,,,0,"percent of total billed charges ","70% of total billed charges ",188.57,1311.77,
"*CHROM ANAL KARYO TYPES",2012144,"CDM ",300,RC,88280,HCPCS,OUTPATIENT,,,1144,915.2,,33.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",800.8,70,,640.64,,,0,"percent of total billed charges ","70% of total billed charges ",1029.6,90,,823.68,,,0,"percent of total billed charges ","90% of total billed charges ",1063.92,93,,851.14,,,0,"percent of total billed charges ","93% of total billed charges ",33.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.84,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",972.4,85,,777.92,,,0,"percent of total billed charges ","85% of total billed charges ",1029.6,90,,823.68,,,0,"percent of total billed charges ","90% of total billed charges ",1029.6,90,,823.68,,,0,"percent of total billed charges ","90% of total billed charges ",45.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",995.28,87,,796.22,,,0,"percent of total billed charges ","87% of total billed charges ",45.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.47,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",800.8,70,,640.64,,,0,"percent of total billed charges ","70% of total billed charges ",33.47,1063.92,
"*CHROM ANAL INTERP",2012151,"CDM ",300,RC,88291,HCPCS,OUTPATIENT,,,1144,915.2,,26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",69.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",800.8,70,,640.64,,,0,"percent of total billed charges ","70% of total billed charges ",1029.6,90,,823.68,,,0,"percent of total billed charges ","90% of total billed charges ",1063.92,93,,851.14,,,0,"percent of total billed charges ","93% of total billed charges ",26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",972.4,85,,777.92,,,0,"percent of total billed charges ","85% of total billed charges ",1029.6,90,,823.68,,,0,"percent of total billed charges ","90% of total billed charges ",1029.6,90,,823.68,,,0,"percent of total billed charges ","90% of total billed charges ",32.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",995.28,87,,796.22,,,0,"percent of total billed charges ","87% of total billed charges ",32.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",800.8,70,,640.64,,,0,"percent of total billed charges ","70% of total billed charges ",26,1063.92,
"*CHROM ANAL TISSUE 15-20 CELLS",2012193,"CDM ",310,RC,88262,HCPCS,OUTPATIENT,,,1235,988,,125.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",864.5,70,,691.60,,,0,"percent of total billed charges ","70% of total billed charges ",1111.5,90,,889.20,,,0,"percent of total billed charges ","90% of total billed charges ",1148.55,93,,918.84,,,0,"percent of total billed charges ","93% of total billed charges ",125.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",227.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1049.75,85,,839.80,,,0,"percent of total billed charges ","85% of total billed charges ",1111.5,90,,889.20,,,0,"percent of total billed charges ","90% of total billed charges ",1111.5,90,,889.20,,,0,"percent of total billed charges ","90% of total billed charges ",225.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1074.45,87,,859.56,,,0,"percent of total billed charges ","87% of total billed charges ",225.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",125.49,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",864.5,70,,691.60,,,0,"percent of total billed charges ","70% of total billed charges ",125.49,1148.55,
"*CHROM ANAL TISSUE LYM CULT",2012201,"CDM ",310,RC,88233,HCPCS,OUTPATIENT,,,1051,840.8,,119.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",735.7,70,,588.56,,,0,"percent of total billed charges ","70% of total billed charges ",945.9,90,,756.72,,,0,"percent of total billed charges ","90% of total billed charges ",977.43,93,,781.94,,,0,"percent of total billed charges ","93% of total billed charges ",119.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",52.84,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",893.35,85,,714.68,,,0,"percent of total billed charges ","85% of total billed charges ",945.9,90,,756.72,,,0,"percent of total billed charges ","90% of total billed charges ",945.9,90,,756.72,,,0,"percent of total billed charges ","90% of total billed charges ",52.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",914.37,87,,731.50,,,0,"percent of total billed charges ","87% of total billed charges ",52.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",140.72,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",735.7,70,,588.56,,,0,"percent of total billed charges ","70% of total billed charges ",52.32,977.43,
"*N.MENNINGITIS GROUP A/Y",2012284,"CDM ",302,RC,86403,HCPCS,OUTPATIENT,,,211,168.8,,11.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.7,70,,118.16,,,0,"percent of total billed charges ","70% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",196.23,93,,156.98,,,0,"percent of total billed charges ","93% of total billed charges ",11.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",179.35,85,,143.48,,,0,"percent of total billed charges ","85% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",18.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",183.57,87,,146.86,,,0,"percent of total billed charges ","87% of total billed charges ",18.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.54,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",147.7,70,,118.16,,,0,"percent of total billed charges ","70% of total billed charges ",11.54,196.23,
"*S.PNEUMONIA AG DET",2012292,"CDM ",302,RC,86403,HCPCS,OUTPATIENT,,,211,168.8,,11.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.7,70,,118.16,,,0,"percent of total billed charges ","70% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",196.23,93,,156.98,,,0,"percent of total billed charges ","93% of total billed charges ",11.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",179.35,85,,143.48,,,0,"percent of total billed charges ","85% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",18.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",183.57,87,,146.86,,,0,"percent of total billed charges ","87% of total billed charges ",18.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.54,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",147.7,70,,118.16,,,0,"percent of total billed charges ","70% of total billed charges ",11.54,196.23,
"*H.INFLUENZA TYPE B AG DET",2012300,"CDM ",302,RC,86403,HCPCS,OUTPATIENT,,,211,168.8,,11.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.7,70,,118.16,,,0,"percent of total billed charges ","70% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",196.23,93,,156.98,,,0,"percent of total billed charges ","93% of total billed charges ",11.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",179.35,85,,143.48,,,0,"percent of total billed charges ","85% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",18.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",183.57,87,,146.86,,,0,"percent of total billed charges ","87% of total billed charges ",18.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.54,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",147.7,70,,118.16,,,0,"percent of total billed charges ","70% of total billed charges ",11.54,196.23,
"*FMR1 GENE ANALYSIS ALLELES",2012318,"CDM ",301,RC,81243,HCPCS,OUTPATIENT,,,426,340.8,,112.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",298.2,70,,238.56,,,0,"percent of total billed charges ","70% of total billed charges ",383.4,90,,306.72,,,0,"percent of total billed charges ","90% of total billed charges ",396.18,93,,316.94,,,0,"percent of total billed charges ","93% of total billed charges ",112.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",362.1,85,,289.68,,,0,"percent of total billed charges ","85% of total billed charges ",383.4,90,,306.72,,,0,"percent of total billed charges ","90% of total billed charges ",383.4,90,,306.72,,,0,"percent of total billed charges ","90% of total billed charges ",141.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",370.62,87,,296.50,,,0,"percent of total billed charges ","87% of total billed charges ",141.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.04,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",298.2,70,,238.56,,,0,"percent of total billed charges ","70% of total billed charges ",57.04,396.18,
"*FMR1 CHARACTERIZATION ALLELES",2012326,"CDM ",301,RC,81244,HCPCS,OUTPATIENT,,,426,340.8,,50.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",298.2,70,,238.56,,,0,"percent of total billed charges ","70% of total billed charges ",383.4,90,,306.72,,,0,"percent of total billed charges ","90% of total billed charges ",396.18,93,,316.94,,,0,"percent of total billed charges ","93% of total billed charges ",50.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",362.1,85,,289.68,,,0,"percent of total billed charges ","85% of total billed charges ",383.4,90,,306.72,,,0,"percent of total billed charges ","90% of total billed charges ",383.4,90,,306.72,,,0,"percent of total billed charges ","90% of total billed charges ",63.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",370.62,87,,296.50,,,0,"percent of total billed charges ","87% of total billed charges ",63.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",44.89,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",298.2,70,,238.56,,,0,"percent of total billed charges ","70% of total billed charges ",44.89,396.18,
"EBV EARLY ANTIGEN IGG ANTIBODI",2012383,"CDM ",302,RC,86663,HCPCS,OUTPATIENT,,,168.5,134.8,,11.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",156.71,93,,125.37,,,0,"percent of total billed charges ","93% of total billed charges ",11.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.23,85,,114.58,,,0,"percent of total billed charges ","85% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",146.6,87,,117.28,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,156.71,
"*ECHOVIRUS ABS 4",2012417,"CDM ",302,RC,86658,HCPCS,OUTPATIENT,,,194,155.2,,11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",180.42,93,,144.34,,,0,"percent of total billed charges ","93% of total billed charges ",11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.9,85,,131.92,,,0,"percent of total billed charges ","85% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",168.78,87,,135.02,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,180.42,
"*ECHOVIRUS ABS 9",2012425,"CDM ",302,RC,86658,HCPCS,OUTPATIENT,,,194,155.2,,11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",180.42,93,,144.34,,,0,"percent of total billed charges ","93% of total billed charges ",11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.9,85,,131.92,,,0,"percent of total billed charges ","85% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",168.78,87,,135.02,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,180.42,
"*ECHOVIRUS ABS 11",2012433,"CDM ",302,RC,86658,HCPCS,OUTPATIENT,,,194,155.2,,11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",180.42,93,,144.34,,,0,"percent of total billed charges ","93% of total billed charges ",11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.9,85,,131.92,,,0,"percent of total billed charges ","85% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",168.78,87,,135.02,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,180.42,
"*ECHOVIRUS ABS 7",2012441,"CDM ",302,RC,86658,HCPCS,OUTPATIENT,,,194,155.2,,11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",180.42,93,,144.34,,,0,"percent of total billed charges ","93% of total billed charges ",11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.9,85,,131.92,,,0,"percent of total billed charges ","85% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",168.78,87,,135.02,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,180.42,
"*CHOLINESTERASE RBC",2012458,"CDM ",301,RC,82482,HCPCS,OUTPATIENT,,,137,109.6,,10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.9,70,,76.72,,,0,"percent of total billed charges ","70% of total billed charges ",123.3,90,,98.64,,,0,"percent of total billed charges ","90% of total billed charges ",127.41,93,,101.93,,,0,"percent of total billed charges ","93% of total billed charges ",10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",116.45,85,,93.16,,,0,"percent of total billed charges ","85% of total billed charges ",123.3,90,,98.64,,,0,"percent of total billed charges ","90% of total billed charges ",123.3,90,,98.64,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",119.19,87,,95.35,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.81,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",95.9,70,,76.72,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,127.41,
"PARATH INTACT ONLY",2012466,"CDM ",301,RC,83970,HCPCS,OUTPATIENT,,,336,268.8,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,185.57,185.57,185.57,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",235.2,70,,188.16,,,0,"percent of total billed charges ","70% of total billed charges ",302.4,90,,241.92,,,0,"percent of total billed charges ","90% of total billed charges ",312.48,93,,249.98,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",285.6,85,,228.48,,,0,"percent of total billed charges ","85% of total billed charges ",302.4,90,,241.92,,,0,"percent of total billed charges ","90% of total billed charges ",302.4,90,,241.92,,,0,"percent of total billed charges ","90% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",292.32,87,,176.24,40.46,261.19,"1 through 10","percent of total billed charges ","87% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.28,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",235.2,70,,188.16,,,0,"percent of total billed charges ","70% of total billed charges ",30.22,312.48,
"*CHLAMYDIA & GC GC PROBE",2012615,"CDM ",306,RC,87590,HCPCS,OUTPATIENT,,,165,132,,22.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",22.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,114.84,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,153.45,
"*MYASTHENIA ANTIMUSCLE ABS",2012623,"CDM ",302,RC,86256,HCPCS,OUTPATIENT,,,165,132,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,17.72,12.99,22.44,"1 through 10","percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,153.45,
"*INSULIN F&T BOUND",2012664,"CDM ",301,RC,83525,HCPCS,OUTPATIENT,,,112.5,90,,11.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.69,60.69,60.69,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",104.63,93,,83.70,,,0,"percent of total billed charges ","93% of total billed charges ",11.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",95.63,85,,76.50,,,0,"percent of total billed charges ","85% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",97.88,87,,69.65,66.61,81.84,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.43,104.63,
"*INSULIN F&T FREE",2012672,"CDM ",301,RC,83527,HCPCS,OUTPATIENT,,,225,180,,11.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.5,70,,126.00,,,0,"percent of total billed charges ","70% of total billed charges ",202.5,90,,162.00,,,0,"percent of total billed charges ","90% of total billed charges ",209.25,93,,167.40,,,0,"percent of total billed charges ","93% of total billed charges ",11.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",191.25,85,,153.00,,,0,"percent of total billed charges ","85% of total billed charges ",202.5,90,,162.00,,,0,"percent of total billed charges ","90% of total billed charges ",202.5,90,,162.00,,,0,"percent of total billed charges ","90% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.75,87,,156.60,,,0,"percent of total billed charges ","87% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.95,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.5,70,,126.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.81,209.25,
"*MICROACBUMIN UA CREATININE",2012854,"CDM ",301,RC,82570,HCPCS,OUTPATIENT,,,60,48,,5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42,70,,33.60,,,0,"percent of total billed charges ","70% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",55.8,93,,44.64,,,0,"percent of total billed charges ","93% of total billed charges ",5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",51,85,,40.80,,,0,"percent of total billed charges ","85% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",52.2,87,,5.08,4.98,50.30,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",42,70,,33.60,,,0,"percent of total billed charges ","70% of total billed charges ",5.18,55.8,
"*LEAD & PROTO LEAD",2012961,"CDM ",301,RC,83655,HCPCS,OUTPATIENT,,,54,43.2,,11.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.8,70,,30.24,,,0,"percent of total billed charges ","70% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",50.22,93,,40.18,,,0,"percent of total billed charges ","93% of total billed charges ",11.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.9,85,,36.72,,,0,"percent of total billed charges ","85% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",15.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.98,87,,33.45,33.45,33.45,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.11,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",37.8,70,,30.24,,,0,"percent of total billed charges ","70% of total billed charges ",11.7,50.22,
"GM ONE TRIAD AUTO ABS",2013019,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,90,72,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,83.7,
"LYME DISEASE ABS IGM",2013043,"CDM ",302,RC,86618,HCPCS,OUTPATIENT,,,204,163.2,,14.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",14.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,141.98,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,189.72,
"NEISSERIA GONORRH BY DNA PROBE",2013100,"CDM ",306,RC,87591,HCPCS,OUTPATIENT,,,239.5,191.6,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.65,70,,134.12,,,0,"percent of total billed charges ","70% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",222.74,93,,178.19,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.47,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",203.58,85,,162.86,,,0,"percent of total billed charges ","85% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",208.37,87,,140.08,140.08,140.08,20,"percent of total billed charges ","87% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",167.65,70,,134.12,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,222.74,
OSTEOCALCIN,2013118,"CDM ",301,RC,83519,HCPCS,OUTPATIENT,,,147.5,118,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.25,70,,82.60,,,0,"percent of total billed charges ","70% of total billed charges ",132.75,90,,106.20,,,0,"percent of total billed charges ","90% of total billed charges ",137.18,93,,109.74,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",125.38,85,,100.30,,,0,"percent of total billed charges ","85% of total billed charges ",132.75,90,,106.20,,,0,"percent of total billed charges ","90% of total billed charges ",132.75,90,,106.20,,,0,"percent of total billed charges ","90% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",128.33,87,,102.66,,,0,"percent of total billed charges ","87% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",103.25,70,,82.60,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,137.18,
GABITRIL,2013126,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,435,348,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",304.5,70,,243.60,,,0,"percent of total billed charges ","70% of total billed charges ",391.5,90,,313.20,,,0,"percent of total billed charges ","90% of total billed charges ",404.55,93,,323.64,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",369.75,85,,295.80,,,0,"percent of total billed charges ","85% of total billed charges ",391.5,90,,313.20,,,0,"percent of total billed charges ","90% of total billed charges ",391.5,90,,313.20,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",378.45,87,,302.76,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",304.5,70,,243.60,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,404.55,
"TOBRAMICIN TROUGH",2013159,"CDM ",301,RC,80200,HCPCS,OUTPATIENT,,,110,88,,16.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77,70,,61.60,,,0,"percent of total billed charges ","70% of total billed charges ",99,90,,79.20,,,0,"percent of total billed charges ","90% of total billed charges ",102.3,93,,81.84,,,0,"percent of total billed charges ","93% of total billed charges ",16.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.44,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",93.5,85,,74.80,,,0,"percent of total billed charges ","85% of total billed charges ",99,90,,79.20,,,0,"percent of total billed charges ","90% of total billed charges ",99,90,,79.20,,,0,"percent of total billed charges ","90% of total billed charges ",29.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",95.7,87,,76.56,,,0,"percent of total billed charges ","87% of total billed charges ",29.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.13,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",77,70,,61.60,,,0,"percent of total billed charges ","70% of total billed charges ",16.13,102.3,
"HEPATITIS B SURFACE AG",2013167,"CDM ",306,RC,87340,HCPCS,OUTPATIENT,,,68,54.4,,10.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.6,70,,38.08,,,0,"percent of total billed charges ","70% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",63.24,93,,50.59,,,0,"percent of total billed charges ","93% of total billed charges ",10.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",57.8,85,,46.24,,,0,"percent of total billed charges ","85% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",15.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.16,87,,46.55,46.55,46.55,11,"percent of total billed charges ","87% of total billed charges ",15.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.33,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",47.6,70,,38.08,,,0,"percent of total billed charges ","70% of total billed charges ",10.33,63.24,
"URINALYSIS, AUTOMATED",2013183,"CDM ",307,RC,81003,HCPCS,OUTPATIENT,,,79.5,63.6,,1.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,7.08,7.08,7.08,"1 through 10","other ","not separately reimbursment ",55.65,70,,44.52,,,0,"percent of total billed charges ","70% of total billed charges ",71.55,90,,57.24,,,0,"percent of total billed charges ","90% of total billed charges ",73.94,93,,59.15,,,0,"percent of total billed charges ","93% of total billed charges ",1.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",67.58,85,,54.06,,,0,"percent of total billed charges ","85% of total billed charges ",71.55,90,,57.24,,,0,"percent of total billed charges ","90% of total billed charges ",71.55,90,,57.24,,,0,"percent of total billed charges ","90% of total billed charges ",1.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",69.17,87,,43.45,2.21,54.31,33,"percent of total billed charges ","87% of total billed charges ",1.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2.25,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",55.65,70,,44.52,,,0,"percent of total billed charges ","70% of total billed charges ",1.91,73.94,
"HEPATITIS C ABS IGG",2013233,"CDM ",302,RC,86803,HCPCS,OUTPATIENT,,,126.5,101.2,,14.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.55,70,,70.84,,,0,"percent of total billed charges ","70% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",117.65,93,,94.12,,,0,"percent of total billed charges ","93% of total billed charges ",14.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",107.53,85,,86.02,,,0,"percent of total billed charges ","85% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",19.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",110.06,87,,86.63,86.63,86.63,12,"percent of total billed charges ","87% of total billed charges ",19.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",88.55,70,,70.84,,,0,"percent of total billed charges ","70% of total billed charges ",14.27,117.65,
"HEPATITIS BE ABS",2013241,"CDM ",302,RC,86707,HCPCS,OUTPATIENT,,,120.5,96.4,,11.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,41.56,41.56,41.56,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.35,70,,67.48,,,0,"percent of total billed charges ","70% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",112.07,93,,89.66,,,0,"percent of total billed charges ","93% of total billed charges ",11.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",102.43,85,,81.94,,,0,"percent of total billed charges ","85% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",19.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",104.84,87,,83.87,,,0,"percent of total billed charges ","87% of total billed charges ",19.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.57,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",84.35,70,,67.48,,,0,"percent of total billed charges ","70% of total billed charges ",11.57,112.07,
"PORPHOBILINOGEN QT RDM URINE",2013266,"CDM ",301,RC,84110,HCPCS,OUTPATIENT,,,82,65.6,,7.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.4,70,,45.92,,,0,"percent of total billed charges ","70% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",76.26,93,,61.01,,,0,"percent of total billed charges ","93% of total billed charges ",7.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",69.7,85,,55.76,,,0,"percent of total billed charges ","85% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",71.34,87,,57.07,,,0,"percent of total billed charges ","87% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.44,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",57.4,70,,45.92,,,0,"percent of total billed charges ","70% of total billed charges ",7.88,76.26,
"EBV EARLY ANTIGEN IGA ANTIBODI",2013274,"CDM ",302,RC,86663,HCPCS,OUTPATIENT,,,278,222.4,,11.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",194.6,70,,155.68,,,0,"percent of total billed charges ","70% of total billed charges ",250.2,90,,200.16,,,0,"percent of total billed charges ","90% of total billed charges ",258.54,93,,206.83,,,0,"percent of total billed charges ","93% of total billed charges ",11.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",236.3,85,,189.04,,,0,"percent of total billed charges ","85% of total billed charges ",250.2,90,,200.16,,,0,"percent of total billed charges ","90% of total billed charges ",250.2,90,,200.16,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",241.86,87,,193.49,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",194.6,70,,155.68,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,258.54,
"IBUPROFEN SERUM",2013316,"CDM ",301,RC,82542,HCPCS,OUTPATIENT,,,187,149.6,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",173.91,93,,139.13,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",158.95,85,,127.16,,,0,"percent of total billed charges ","85% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",162.69,87,,130.15,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,173.91,
"ABO GROUP",2013324,"CDM ",300,RC,86900,HCPCS,OUTPATIENT,,,276,220.8,,2.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",193.2,70,,154.56,,,0,"percent of total billed charges ","70% of total billed charges ",248.4,90,,198.72,,,0,"percent of total billed charges ","90% of total billed charges ",256.68,93,,205.34,,,0,"percent of total billed charges ","93% of total billed charges ",2.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",234.6,85,,187.68,,,0,"percent of total billed charges ","85% of total billed charges ",248.4,90,,198.72,,,0,"percent of total billed charges ","90% of total billed charges ",248.4,90,,198.72,,,0,"percent of total billed charges ","90% of total billed charges ",5.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",240.12,87,,151.71,76.74,189.64,"1 through 10","percent of total billed charges ","87% of total billed charges ",5.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",193.2,70,,154.56,,,0,"percent of total billed charges ","70% of total billed charges ",2.99,256.68,
"RH TYPE",2013332,"CDM ",300,RC,86901,HCPCS,OUTPATIENT,,,88,70.4,,2.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.6,70,,49.28,,,0,"percent of total billed charges ","70% of total billed charges ",79.2,90,,63.36,,,0,"percent of total billed charges ","90% of total billed charges ",81.84,93,,65.47,,,0,"percent of total billed charges ","93% of total billed charges ",2.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",74.8,85,,59.84,,,0,"percent of total billed charges ","85% of total billed charges ",79.2,90,,63.36,,,0,"percent of total billed charges ","90% of total billed charges ",79.2,90,,63.36,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",76.56,87,,60.34,60.34,60.34,12,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",61.6,70,,49.28,,,0,"percent of total billed charges ","70% of total billed charges ",2.99,81.84,
"*FEBRILE AGG TYPHOID O",2013340,"CDM ",302,RC,86000,HCPCS,OUTPATIENT,,,45,36,,5.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,31.32,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.93,41.85,
"*FEBRILE AGG TYPHOID H",2013365,"CDM ",302,RC,86000,HCPCS,OUTPATIENT,,,45,36,,5.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,31.32,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.93,41.85,
"*FEBRILE AGG PARATY B",2013373,"CDM ",302,RC,86000,HCPCS,OUTPATIENT,,,45,36,,5.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,31.32,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.93,41.85,
"*FEBRILE AGG PARATY A",2013381,"CDM ",302,RC,86000,HCPCS,OUTPATIENT,,,45,36,,5.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,31.32,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.93,41.85,
"*FEBRILE AGG BRUCELLA",2013399,"CDM ",302,RC,86000,HCPCS,OUTPATIENT,,,45,36,,5.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,31.32,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.93,41.85,
"*FEBRILE AGG RMSF",2013407,"CDM ",302,RC,86000,HCPCS,OUTPATIENT,,,389.5,311.6,,5.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",272.65,70,,218.12,,,0,"percent of total billed charges ","70% of total billed charges ",350.55,90,,280.44,,,0,"percent of total billed charges ","90% of total billed charges ",362.24,93,,289.79,,,0,"percent of total billed charges ","93% of total billed charges ",5.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",331.08,85,,264.86,,,0,"percent of total billed charges ","85% of total billed charges ",350.55,90,,280.44,,,0,"percent of total billed charges ","90% of total billed charges ",350.55,90,,280.44,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",338.87,87,,271.10,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",272.65,70,,218.12,,,0,"percent of total billed charges ","70% of total billed charges ",5.93,362.24,
"CROSSMATCH 1 UNIT",2013449,"CDM ",300,RC,86922,HCPCS,OUTPATIENT,,,331,264.8,,,,,,,,0,"other ","not separately reimbursment ",,,,50.02,50.02,50.02,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",231.7,70,,185.36,,,0,"percent of total billed charges ","70% of total billed charges ",297.9,90,,238.32,,,0,"percent of total billed charges ","90% of total billed charges ",307.83,93,,246.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",24.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",281.35,85,,225.08,,,0,"percent of total billed charges ","85% of total billed charges ",297.9,90,,238.32,,,0,"percent of total billed charges ","90% of total billed charges ",297.9,90,,238.32,,,0,"percent of total billed charges ","90% of total billed charges ",24.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",287.97,87,,166.34,166.34,166.34,"1 through 10","percent of total billed charges ","87% of total billed charges ",24.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",231.7,70,,185.36,,,0,"percent of total billed charges ","70% of total billed charges ",24.08,307.83,
"GRAM STAIN",2013761,"CDM ",306,RC,87205,HCPCS,OUTPATIENT,,,58,46.4,,4.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,13.05,13.05,13.05,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.6,70,,32.48,,,0,"percent of total billed charges ","70% of total billed charges ",52.2,90,,41.76,,,0,"percent of total billed charges ","90% of total billed charges ",53.94,93,,43.15,,,0,"percent of total billed charges ","93% of total billed charges ",4.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",49.3,85,,39.44,,,0,"percent of total billed charges ","85% of total billed charges ",52.2,90,,41.76,,,0,"percent of total billed charges ","90% of total billed charges ",52.2,90,,41.76,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",50.46,87,,16.96,4.19,32.43,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.26,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",40.6,70,,32.48,,,0,"percent of total billed charges ","70% of total billed charges ",4.26,53.94,
"LDH BODY FLUID",2013779,"CDM ",301,RC,83615,HCPCS,OUTPATIENT,,,123,98.4,,6.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.1,70,,68.88,,,0,"percent of total billed charges ","70% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",114.39,93,,91.51,,,0,"percent of total billed charges ","93% of total billed charges ",6.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.55,85,,83.64,,,0,"percent of total billed charges ","85% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.01,87,,81.33,26.88,95.68,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.04,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",86.1,70,,68.88,,,0,"percent of total billed charges ","70% of total billed charges ",6.04,114.39,
"ANTI CHROMATIN ABS IG G",2013795,"CDM ",301,RC,83516,HCPCS,OUTPATIENT,,,201.5,161.2,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.05,70,,112.84,,,0,"percent of total billed charges ","70% of total billed charges ",181.35,90,,145.08,,,0,"percent of total billed charges ","90% of total billed charges ",187.4,93,,149.92,,,0,"percent of total billed charges ","93% of total billed charges ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",171.28,85,,137.02,,,0,"percent of total billed charges ","85% of total billed charges ",181.35,90,,145.08,,,0,"percent of total billed charges ","90% of total billed charges ",181.35,90,,145.08,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",175.31,87,,53.32,28.74,77.90,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",141.05,70,,112.84,,,0,"percent of total billed charges ","70% of total billed charges ",10,187.4,
"GLIADIN ABS IGG",2013803,"CDM ",301,RC,83516,HCPCS,OUTPATIENT,,,108,86.4,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,53.32,28.74,77.90,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",10,100.44,
"ENDOMYSIAL ABS IGA #161786",2013811,"CDM ",301,RC,83516,HCPCS,OUTPATIENT,,,118,94.4,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.6,70,,66.08,,,0,"percent of total billed charges ","70% of total billed charges ",106.2,90,,84.96,,,0,"percent of total billed charges ","90% of total billed charges ",109.74,93,,87.79,,,0,"percent of total billed charges ","93% of total billed charges ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",100.3,85,,80.24,,,0,"percent of total billed charges ","85% of total billed charges ",106.2,90,,84.96,,,0,"percent of total billed charges ","90% of total billed charges ",106.2,90,,84.96,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",102.66,87,,53.32,28.74,77.90,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",82.6,70,,66.08,,,0,"percent of total billed charges ","70% of total billed charges ",10,109.74,
"VON WILLEBRAND FACTOR ANTIGEN",2013829,"CDM ",305,RC,85246,HCPCS,OUTPATIENT,,,131.5,105.2,,19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.05,70,,73.64,,,0,"percent of total billed charges ","70% of total billed charges ",118.35,90,,94.68,,,0,"percent of total billed charges ","90% of total billed charges ",122.3,93,,97.84,,,0,"percent of total billed charges ","93% of total billed charges ",19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",111.78,85,,89.42,,,0,"percent of total billed charges ","85% of total billed charges ",118.35,90,,94.68,,,0,"percent of total billed charges ","90% of total billed charges ",118.35,90,,94.68,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",114.41,87,,149.99,149.99,149.99,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.94,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",92.05,70,,73.64,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,122.3,
"VON WILLEBRAND ANTIGEN",2013852,"CDM ",305,RC,85246,HCPCS,OUTPATIENT,,,131.5,105.2,,19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.05,70,,73.64,,,0,"percent of total billed charges ","70% of total billed charges ",118.35,90,,94.68,,,0,"percent of total billed charges ","90% of total billed charges ",122.3,93,,97.84,,,0,"percent of total billed charges ","93% of total billed charges ",19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",111.78,85,,89.42,,,0,"percent of total billed charges ","85% of total billed charges ",118.35,90,,94.68,,,0,"percent of total billed charges ","90% of total billed charges ",118.35,90,,94.68,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",114.41,87,,149.99,149.99,149.99,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.94,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",92.05,70,,73.64,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,122.3,
"FACTOR BL FRAGMENT",2013878,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,276.5,221.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",193.55,70,,154.84,,,0,"percent of total billed charges ","70% of total billed charges ",248.85,90,,199.08,,,0,"percent of total billed charges ","90% of total billed charges ",257.15,93,,205.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",235.03,85,,188.02,,,0,"percent of total billed charges ","85% of total billed charges ",248.85,90,,199.08,,,0,"percent of total billed charges ","90% of total billed charges ",248.85,90,,199.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",240.56,87,,192.45,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",193.55,70,,154.84,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,257.15,
"MANNOSE BINDING PROTEIN",2013928,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,129.5,103.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.65,70,,72.52,,,0,"percent of total billed charges ","70% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",120.44,93,,96.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",110.08,85,,88.06,,,0,"percent of total billed charges ","85% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",112.67,87,,90.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",90.65,70,,72.52,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,120.44,
"H INFLUENZA ABS",2013944,"CDM ",302,RC,86684,HCPCS,OUTPATIENT,,,1367,1093.6,,13.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",956.9,70,,765.52,,,0,"percent of total billed charges ","70% of total billed charges ",1230.3,90,,984.24,,,0,"percent of total billed charges ","90% of total billed charges ",1271.31,93,,1017.05,,,0,"percent of total billed charges ","93% of total billed charges ",13.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1161.95,85,,929.56,,,0,"percent of total billed charges ","85% of total billed charges ",1230.3,90,,984.24,,,0,"percent of total billed charges ","90% of total billed charges ",1230.3,90,,984.24,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1189.29,87,,951.43,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.84,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",956.9,70,,765.52,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,1271.31,
"NATURAL KILLER CELL FUNCTION",2013985,"CDM ",302,RC,86849,HCPCS,OUTPATIENT,,,564.5,451.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",395.15,70,,316.12,,,0,"percent of total billed charges ","70% of total billed charges ",508.05,90,,406.44,,,0,"percent of total billed charges ","90% of total billed charges ",524.99,93,,419.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",479.83,85,,383.86,,,0,"percent of total billed charges ","85% of total billed charges ",508.05,90,,406.44,,,0,"percent of total billed charges ","90% of total billed charges ",508.05,90,,406.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",491.12,87,,392.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",395.15,70,,316.12,,,0,"percent of total billed charges ","70% of total billed charges ",395.15,524.99,
"BETA 2 MICROGLOBULIN URINE",2014025,"CDM ",301,RC,82232,HCPCS,OUTPATIENT,,,90,72,,16.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",16.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.55,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",29.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",29.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",16.18,83.7,
"ANA BF",2014074,"CDM ",302,RC,86038,HCPCS,OUTPATIENT,,,397,317.6,,12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",277.9,70,,222.32,,,0,"percent of total billed charges ","70% of total billed charges ",357.3,90,,285.84,,,0,"percent of total billed charges ","90% of total billed charges ",369.21,93,,295.37,,,0,"percent of total billed charges ","93% of total billed charges ",12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",337.45,85,,269.96,,,0,"percent of total billed charges ","85% of total billed charges ",357.3,90,,285.84,,,0,"percent of total billed charges ","90% of total billed charges ",357.3,90,,285.84,,,0,"percent of total billed charges ","90% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",345.39,87,,88.36,11.85,147.83,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",277.9,70,,222.32,,,0,"percent of total billed charges ","70% of total billed charges ",12.09,369.21,
"RHEUMATOID FACTOR FLUID #1540F",2014082,"CDM ",302,RC,86431,HCPCS,OUTPATIENT,,,75.5,60.4,,5.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,5.56,5.56,5.56,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",70.22,93,,56.18,,,0,"percent of total billed charges ","93% of total billed charges ",5.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",64.18,85,,51.34,,,0,"percent of total billed charges ","85% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.69,87,,5.56,5.56,56.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",5.67,70.22,
"LDH BODY FLUID",2014090,"CDM ",301,RC,83615,HCPCS,OUTPATIENT,,,123,98.4,,6.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.1,70,,68.88,,,0,"percent of total billed charges ","70% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",114.39,93,,91.51,,,0,"percent of total billed charges ","93% of total billed charges ",6.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.55,85,,83.64,,,0,"percent of total billed charges ","85% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.01,87,,81.33,26.88,95.68,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.04,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",86.1,70,,68.88,,,0,"percent of total billed charges ","70% of total billed charges ",6.04,114.39,
"*SLA RA FACTOR",2014157,"CDM ",302,RC,86431,HCPCS,OUTPATIENT,,,124,99.2,,5.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,5.56,5.56,5.56,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.8,70,,69.44,,,0,"percent of total billed charges ","70% of total billed charges ",111.6,90,,89.28,,,0,"percent of total billed charges ","90% of total billed charges ",115.32,93,,92.26,,,0,"percent of total billed charges ","93% of total billed charges ",5.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",105.4,85,,84.32,,,0,"percent of total billed charges ","85% of total billed charges ",111.6,90,,89.28,,,0,"percent of total billed charges ","90% of total billed charges ",111.6,90,,89.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.88,87,,5.56,5.56,56.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",86.8,70,,69.44,,,0,"percent of total billed charges ","70% of total billed charges ",5.67,115.32,
"RUBELLA ABS IGM",2014165,"CDM ",302,RC,86762,HCPCS,OUTPATIENT,,,89,71.2,,12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",82.77,93,,66.22,,,0,"percent of total billed charges ","93% of total billed charges ",12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",75.65,85,,60.52,,,0,"percent of total billed charges ","85% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",77.43,87,,48.62,10.18,58.34,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,82.77,
"VDRL BLOOD",2014173,"CDM ",302,RC,86592,HCPCS,OUTPATIENT,,,82,65.6,,4.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,19.37,19.37,19.37,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.4,70,,45.92,,,0,"percent of total billed charges ","70% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",76.26,93,,61.01,,,0,"percent of total billed charges ","93% of total billed charges ",4.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",69.7,85,,55.76,,,0,"percent of total billed charges ","85% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",71.34,87,,23.71,23.71,23.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.26,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",57.4,70,,45.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.26,76.26,
"VDRL CSF",2014181,"CDM ",302,RC,86592,HCPCS,OUTPATIENT,,,75.5,60.4,,4.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,19.37,19.37,19.37,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",70.22,93,,56.18,,,0,"percent of total billed charges ","93% of total billed charges ",4.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",64.18,85,,51.34,,,0,"percent of total billed charges ","85% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.69,87,,23.71,23.71,23.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.26,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",4.26,70.22,
"HEMOGLOBIN A1C",2014207,"CDM ",301,RC,83036,HCPCS,OUTPATIENT,,,78.5,62.8,,9.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,9.52,9.52,9.52,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.95,70,,43.96,,,0,"percent of total billed charges ","70% of total billed charges ",70.65,90,,56.52,,,0,"percent of total billed charges ","90% of total billed charges ",73.01,93,,58.41,,,0,"percent of total billed charges ","93% of total billed charges ",9.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.73,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",66.73,85,,53.38,,,0,"percent of total billed charges ","85% of total billed charges ",70.65,90,,56.52,,,0,"percent of total billed charges ","90% of total billed charges ",70.65,90,,56.52,,,0,"percent of total billed charges ","90% of total billed charges ",17.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",68.3,87,,48.62,9.52,60.77,36,"percent of total billed charges ","87% of total billed charges ",17.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",54.95,70,,43.96,,,0,"percent of total billed charges ","70% of total billed charges ",9.71,73.01,
"HEPATITIS B SURFACE AG",2014223,"CDM ",306,RC,87340,HCPCS,OUTPATIENT,,,68,54.4,,10.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.6,70,,38.08,,,0,"percent of total billed charges ","70% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",63.24,93,,50.59,,,0,"percent of total billed charges ","93% of total billed charges ",10.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",57.8,85,,46.24,,,0,"percent of total billed charges ","85% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",15.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.16,87,,46.55,46.55,46.55,11,"percent of total billed charges ","87% of total billed charges ",15.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.33,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",47.6,70,,38.08,,,0,"percent of total billed charges ","70% of total billed charges ",10.33,63.24,
"HEPATITIS A ABS IGM",2014231,"CDM ",302,RC,86709,HCPCS,OUTPATIENT,,,140.5,112.4,,11.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,18.23,18.23,18.23,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",130.67,93,,104.54,,,0,"percent of total billed charges ","93% of total billed charges ",11.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",119.43,85,,95.54,,,0,"percent of total billed charges ","85% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",19.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.24,87,,97.79,,,0,"percent of total billed charges ","87% of total billed charges ",19.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.26,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",11.26,130.67,
"ANA W/REFLEX",2014256,"CDM ",302,RC,86038,HCPCS,OUTPATIENT,,,129,103.2,,12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",119.97,93,,95.98,,,0,"percent of total billed charges ","93% of total billed charges ",12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",109.65,85,,87.72,,,0,"percent of total billed charges ","85% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.23,87,,88.36,11.85,147.83,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",12.09,119.97,
"UA W/MICRO MANUAL",2014264,"CDM ",307,RC,81000,HCPCS,OUTPATIENT,,,86,68.8,,4.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.2,70,,48.16,,,0,"percent of total billed charges ","70% of total billed charges ",77.4,90,,61.92,,,0,"percent of total billed charges ","90% of total billed charges ",79.98,93,,63.98,,,0,"percent of total billed charges ","93% of total billed charges ",4.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",73.1,85,,58.48,,,0,"percent of total billed charges ","85% of total billed charges ",77.4,90,,61.92,,,0,"percent of total billed charges ","90% of total billed charges ",77.4,90,,61.92,,,0,"percent of total billed charges ","90% of total billed charges ",5.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",74.82,87,,59.86,,,0,"percent of total billed charges ","87% of total billed charges ",5.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",60.2,70,,48.16,,,0,"percent of total billed charges ","70% of total billed charges ",4.01,79.98,
"POTASSIUM BF",2014298,"CDM ",301,RC,84999,HCPCS,OUTPATIENT,,,103,82.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.1,70,,57.68,,,0,"percent of total billed charges ","70% of total billed charges ",92.7,90,,74.16,,,0,"percent of total billed charges ","90% of total billed charges ",95.79,93,,76.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",87.55,85,,70.04,,,0,"percent of total billed charges ","85% of total billed charges ",92.7,90,,74.16,,,0,"percent of total billed charges ","90% of total billed charges ",92.7,90,,74.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",89.61,87,,71.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.1,70,,57.68,,,0,"percent of total billed charges ","70% of total billed charges ",72.1,95.79,
"SODIUM BF",2014306,"CDM ",301,RC,84999,HCPCS,OUTPATIENT,,,102.5,82,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.75,70,,57.40,,,0,"percent of total billed charges ","70% of total billed charges ",92.25,90,,73.80,,,0,"percent of total billed charges ","90% of total billed charges ",95.33,93,,76.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",87.13,85,,69.70,,,0,"percent of total billed charges ","85% of total billed charges ",92.25,90,,73.80,,,0,"percent of total billed charges ","90% of total billed charges ",92.25,90,,73.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",89.18,87,,71.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.75,70,,57.40,,,0,"percent of total billed charges ","70% of total billed charges ",71.75,95.33,
"HISTOPLASMA AG QUANTITATIVE",2014314,"CDM ",306,RC,87385,HCPCS,OUTPATIENT,,,410.5,328.4,,11.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,52.51,52.51,52.51,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",287.35,70,,229.88,,,0,"percent of total billed charges ","70% of total billed charges ",369.45,90,,295.56,,,0,"percent of total billed charges ","90% of total billed charges ",381.77,93,,305.42,,,0,"percent of total billed charges ","93% of total billed charges ",11.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",348.93,85,,279.14,,,0,"percent of total billed charges ","85% of total billed charges ",369.45,90,,295.56,,,0,"percent of total billed charges ","90% of total billed charges ",369.45,90,,295.56,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",357.14,87,,68.96,68.96,68.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.25,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",287.35,70,,229.88,,,0,"percent of total billed charges ","70% of total billed charges ",11.26,381.77,
"INSULIN AUTO ABS IAA",2014348,"CDM ",302,RC,86337,HCPCS,OUTPATIENT,,,232,185.6,,21.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",215.76,93,,172.61,,,0,"percent of total billed charges ","93% of total billed charges ",21.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",197.2,85,,157.76,,,0,"percent of total billed charges ","85% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",30.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.84,87,,161.47,,,0,"percent of total billed charges ","87% of total billed charges ",30.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.41,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",21.41,215.76,
"CYSTIC FIBROSIS PROFILE",2014355,"CDM ",301,RC,81220,HCPCS,OUTPATIENT,,,1053.5,842.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",737.45,70,,589.96,,,0,"percent of total billed charges ","70% of total billed charges ",948.15,90,,758.52,,,0,"percent of total billed charges ","90% of total billed charges ",979.76,93,,783.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",895.48,85,,716.38,,,0,"percent of total billed charges ","85% of total billed charges ",948.15,90,,758.52,,,0,"percent of total billed charges ","90% of total billed charges ",948.15,90,,758.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",916.55,87,,733.24,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",556.6,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",737.45,70,,589.96,,,0,"percent of total billed charges ","70% of total billed charges ",556.6,979.76,
"CFVANTAGE CYSTIC FIBROSIS EXP",2014357,"CDM ",300,RC,81220,HCPCS,OUTPATIENT,,,1053.5,842.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",737.45,70,,589.96,,,0,"percent of total billed charges ","70% of total billed charges ",948.15,90,,758.52,,,0,"percent of total billed charges ","90% of total billed charges ",979.76,93,,783.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",895.48,85,,716.38,,,0,"percent of total billed charges ","85% of total billed charges ",948.15,90,,758.52,,,0,"percent of total billed charges ","90% of total billed charges ",948.15,90,,758.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",916.55,87,,733.24,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",556.6,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",737.45,70,,589.96,,,0,"percent of total billed charges ","70% of total billed charges ",556.6,979.76,
"UA W/O MICRO MANUAL",2014363,"CDM ",307,RC,81002,HCPCS,OUTPATIENT,,,47.5,38,,3.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.25,70,,26.60,,,0,"percent of total billed charges ","70% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",44.18,93,,35.34,,,0,"percent of total billed charges ","93% of total billed charges ",3.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",40.38,85,,32.30,,,0,"percent of total billed charges ","85% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",3.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.33,87,,3.42,3.42,3.47,13,"percent of total billed charges ","87% of total billed charges ",3.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.48,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",33.25,70,,26.60,,,0,"percent of total billed charges ","70% of total billed charges ",3.01,44.18,
"UA W/O MICRO AUTO",2014371,"CDM ",307,RC,81003,HCPCS,OUTPATIENT,,,62.5,50,,1.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,7.08,7.08,7.08,"1 through 10","other ","not separately reimbursment ",43.75,70,,35.00,,,0,"percent of total billed charges ","70% of total billed charges ",56.25,90,,45.00,,,0,"percent of total billed charges ","90% of total billed charges ",58.13,93,,46.50,,,0,"percent of total billed charges ","93% of total billed charges ",1.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",53.13,85,,42.50,,,0,"percent of total billed charges ","85% of total billed charges ",56.25,90,,45.00,,,0,"percent of total billed charges ","90% of total billed charges ",56.25,90,,45.00,,,0,"percent of total billed charges ","90% of total billed charges ",1.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.38,87,,43.45,2.21,54.31,33,"percent of total billed charges ","87% of total billed charges ",1.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2.25,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",43.75,70,,35.00,,,0,"percent of total billed charges ","70% of total billed charges ",1.91,58.13,
"PH URINE NOVAS",2014378,"CDM ",301,RC,81003,HCPCS,OUTPATIENT,,,51,40.8,,1.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,7.08,7.08,7.08,"1 through 10","other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",47.43,93,,37.94,,,0,"percent of total billed charges ","93% of total billed charges ",1.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",43.35,85,,34.68,,,0,"percent of total billed charges ","85% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",1.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",44.37,87,,43.45,2.21,54.31,33,"percent of total billed charges ","87% of total billed charges ",1.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2.25,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",1.91,47.43,
"URINE MICROSCOPIC",2014389,"CDM ",307,RC,81015,HCPCS,OUTPATIENT,,,26.5,21.2,,2.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.55,70,,14.84,,,0,"percent of total billed charges ","70% of total billed charges ",23.85,90,,19.08,,,0,"percent of total billed charges ","90% of total billed charges ",24.65,93,,19.72,,,0,"percent of total billed charges ","93% of total billed charges ",2.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",22.53,85,,18.02,,,0,"percent of total billed charges ","85% of total billed charges ",23.85,90,,19.08,,,0,"percent of total billed charges ","90% of total billed charges ",23.85,90,,19.08,,,0,"percent of total billed charges ","90% of total billed charges ",2.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.06,87,,2.99,2.99,2.99,"1 through 10","percent of total billed charges ","87% of total billed charges ",2.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",18.55,70,,14.84,,,0,"percent of total billed charges ","70% of total billed charges ",2.59,24.65,
"NEUROFILAMENT LIGHT CHAIN NFL",2014390,"CDM ",301,RC,83884,HCPCS,OUTPATIENT,,,499,399.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",349.3,70,,279.44,,,0,"percent of total billed charges ","70% of total billed charges ",449.1,90,,359.28,,,0,"percent of total billed charges ","90% of total billed charges ",464.07,93,,371.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",424.15,85,,339.32,,,0,"percent of total billed charges ","85% of total billed charges ",449.1,90,,359.28,,,0,"percent of total billed charges ","90% of total billed charges ",449.1,90,,359.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",434.13,87,,347.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",116.23,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",349.3,70,,279.44,,,0,"percent of total billed charges ","70% of total billed charges ",116.23,464.07,
"NEUROFILAMENT LIGHT CHAIN NFL",2014390,"CDM ",301,RC,83884,HCPCS,OUTPATIENT,,,450,360,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",315,70,,252.00,,,0,"percent of total billed charges ","70% of total billed charges ",405,90,,324.00,,,0,"percent of total billed charges ","90% of total billed charges ",418.5,93,,334.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",382.5,85,,306.00,,,0,"percent of total billed charges ","85% of total billed charges ",405,90,,324.00,,,0,"percent of total billed charges ","90% of total billed charges ",405,90,,324.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",391.5,87,,313.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",116.23,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",315,70,,252.00,,,0,"percent of total billed charges ","70% of total billed charges ",116.23,418.5,
"UA W/CULTURE IF INDICATED",2014421,"CDM ",307,RC,81002,HCPCS,OUTPATIENT,,,47.5,38,,3.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.25,70,,26.60,,,0,"percent of total billed charges ","70% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",44.18,93,,35.34,,,0,"percent of total billed charges ","93% of total billed charges ",3.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",40.38,85,,32.30,,,0,"percent of total billed charges ","85% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",3.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.33,87,,3.42,3.42,3.47,13,"percent of total billed charges ","87% of total billed charges ",3.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.48,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",33.25,70,,26.60,,,0,"percent of total billed charges ","70% of total billed charges ",3.01,44.18,
"HAEMOPHILUS SUSCEPTIBILITY",2014447,"CDM ",306,RC,87186,HCPCS,OUTPATIENT,,,284,227.2,,8.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",198.8,70,,159.04,,,0,"percent of total billed charges ","70% of total billed charges ",255.6,90,,204.48,,,0,"percent of total billed charges ","90% of total billed charges ",264.12,93,,211.30,,,0,"percent of total billed charges ","93% of total billed charges ",8.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",241.4,85,,193.12,,,0,"percent of total billed charges ","85% of total billed charges ",255.6,90,,204.48,,,0,"percent of total billed charges ","90% of total billed charges ",255.6,90,,204.48,,,0,"percent of total billed charges ","90% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",247.08,87,,8.48,8.48,105.80,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.65,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",198.8,70,,159.04,,,0,"percent of total billed charges ","70% of total billed charges ",8.65,264.12,
"OLIGOCLONAL BANDING CSF",2014462,"CDM ",301,RC,83916,HCPCS,OUTPATIENT,,,264.5,211.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",185.15,70,,148.12,,,0,"percent of total billed charges ","70% of total billed charges ",238.05,90,,190.44,,,0,"percent of total billed charges ","90% of total billed charges ",245.99,93,,196.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",224.83,85,,179.86,,,0,"percent of total billed charges ","85% of total billed charges ",238.05,90,,190.44,,,0,"percent of total billed charges ","90% of total billed charges ",238.05,90,,190.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",230.12,87,,184.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",27.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",185.15,70,,148.12,,,0,"percent of total billed charges ","70% of total billed charges ",27.39,245.99,
"*ALBUMIN OTHER SOURCE",2014470,"CDM ",301,RC,82042,HCPCS,OUTPATIENT,,,53,42.4,,6.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",49.29,93,,39.43,,,0,"percent of total billed charges ","93% of total billed charges ",6.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.05,85,,36.04,,,0,"percent of total billed charges ","85% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.11,87,,36.89,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.78,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",6.61,49.29,
"LEGIONELLA PNEUMOPHILA URINE A",2014538,"CDM ",306,RC,87449,HCPCS,OUTPATIENT,,,156,124.8,,11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",145.08,93,,116.06,,,0,"percent of total billed charges ","93% of total billed charges ",11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",132.6,85,,106.08,,,0,"percent of total billed charges ","85% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",135.72,87,,108.58,,,0,"percent of total billed charges ","87% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",11.98,145.08,
"MYELIN BASIC PROTEIN CSF",2014546,"CDM ",301,RC,83873,HCPCS,OUTPATIENT,,,158.5,126.8,,17.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.95,70,,88.76,,,0,"percent of total billed charges ","70% of total billed charges ",142.65,90,,114.12,,,0,"percent of total billed charges ","90% of total billed charges ",147.41,93,,117.93,,,0,"percent of total billed charges ","93% of total billed charges ",17.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",134.73,85,,107.78,,,0,"percent of total billed charges ","85% of total billed charges ",142.65,90,,114.12,,,0,"percent of total billed charges ","90% of total billed charges ",142.65,90,,114.12,,,0,"percent of total billed charges ","90% of total billed charges ",31.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",137.9,87,,110.32,,,0,"percent of total billed charges ","87% of total billed charges ",31.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.2,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",110.95,70,,88.76,,,0,"percent of total billed charges ","70% of total billed charges ",17.2,147.41,
"SULFONYL UREA SERUM",2014561,"CDM ",300,RC,80307,HCPCS,OUTPATIENT,,,686,548.8,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",480.2,70,,384.16,,,0,"percent of total billed charges ","70% of total billed charges ",617.4,90,,493.92,,,0,"percent of total billed charges ","90% of total billed charges ",637.98,93,,510.38,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",583.1,85,,466.48,,,0,"percent of total billed charges ","85% of total billed charges ",617.4,90,,493.92,,,0,"percent of total billed charges ","90% of total billed charges ",617.4,90,,493.92,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",596.82,87,,477.46,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",480.2,70,,384.16,,,0,"percent of total billed charges ","70% of total billed charges ",62.14,637.98,
"*GROUP B/E. COLI K1 AG DET",2014587,"CDM ",302,RC,86403,HCPCS,OUTPATIENT,,,211,168.8,,11.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.7,70,,118.16,,,0,"percent of total billed charges ","70% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",196.23,93,,156.98,,,0,"percent of total billed charges ","93% of total billed charges ",11.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",179.35,85,,143.48,,,0,"percent of total billed charges ","85% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",18.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",183.57,87,,146.86,,,0,"percent of total billed charges ","87% of total billed charges ",18.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.54,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",147.7,70,,118.16,,,0,"percent of total billed charges ","70% of total billed charges ",11.54,196.23,
"*ANTI-PHOSPHATIDYLSERINE ANTI",2014595,"CDM ",302,RC,86148,HCPCS,OUTPATIENT,,,138.5,110.8,,16.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.95,70,,77.56,,,0,"percent of total billed charges ","70% of total billed charges ",124.65,90,,99.72,,,0,"percent of total billed charges ","90% of total billed charges ",128.81,93,,103.05,,,0,"percent of total billed charges ","93% of total billed charges ",16.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",117.73,85,,94.18,,,0,"percent of total billed charges ","85% of total billed charges ",124.65,90,,99.72,,,0,"percent of total billed charges ","90% of total billed charges ",124.65,90,,99.72,,,0,"percent of total billed charges ","90% of total billed charges ",22.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",120.5,87,,96.40,,,0,"percent of total billed charges ","87% of total billed charges ",22.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",96.95,70,,77.56,,,0,"percent of total billed charges ","70% of total billed charges ",16.07,128.81,
"HEPATIC PANEL",2014603,"CDM ",301,RC,80076,HCPCS,OUTPATIENT,,,305.5,244.4,,8.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",213.85,70,,171.08,,,0,"percent of total billed charges ","70% of total billed charges ",274.95,90,,219.96,,,0,"percent of total billed charges ","90% of total billed charges ",284.12,93,,227.30,,,0,"percent of total billed charges ","93% of total billed charges ",8.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",259.68,85,,207.74,,,0,"percent of total billed charges ","85% of total billed charges ",274.95,90,,219.96,,,0,"percent of total billed charges ","90% of total billed charges ",274.95,90,,219.96,,,0,"percent of total billed charges ","90% of total billed charges ",14.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",265.79,87,,226.53,85.35,251.70,"1 through 10","percent of total billed charges ","87% of total billed charges ",14.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.17,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",213.85,70,,171.08,,,0,"percent of total billed charges ","70% of total billed charges ",8.17,284.12,
"BASIC METABOLIC PROFILE",2014611,"CDM ",301,RC,80048,HCPCS,OUTPATIENT,,,167,133.6,,8.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,23.50,23.50,23.50,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.9,70,,93.52,,,0,"percent of total billed charges ","70% of total billed charges ",150.3,90,,120.24,,,0,"percent of total billed charges ","90% of total billed charges ",155.31,93,,124.25,,,0,"percent of total billed charges ","93% of total billed charges ",8.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",141.95,85,,113.56,,,0,"percent of total billed charges ","85% of total billed charges ",150.3,90,,120.24,,,0,"percent of total billed charges ","90% of total billed charges ",150.3,90,,120.24,,,0,"percent of total billed charges ","90% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",145.29,87,,133.20,8.30,137.49,15,"percent of total billed charges ","87% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.46,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",116.9,70,,93.52,,,0,"percent of total billed charges ","70% of total billed charges ",8.46,155.31,
"COMPREHENSIVE METABOLIC PANEL",2014629,"CDM ",301,RC,80053,HCPCS,OUTPATIENT,,,236.5,189.2,,10.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,10.35,10.35,10.35,"1 through 10","other ","not separately reimbursment ",,,,33.31,33.31,33.31,"1 through 10","other ","not separately reimbursment ",165.55,70,,132.44,,,0,"percent of total billed charges ","70% of total billed charges ",212.85,90,,170.28,,,0,"percent of total billed charges ","90% of total billed charges ",219.95,93,,175.96,,,0,"percent of total billed charges ","93% of total billed charges ",10.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",201.03,85,,160.82,,,0,"percent of total billed charges ","85% of total billed charges ",212.85,90,,170.28,,,0,"percent of total billed charges ","90% of total billed charges ",212.85,90,,170.28,,,0,"percent of total billed charges ","90% of total billed charges ",16.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",205.76,87,,155.85,10.35,194.81,43,"percent of total billed charges ","87% of total billed charges ",16.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.56,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",165.55,70,,132.44,,,0,"percent of total billed charges ","70% of total billed charges ",10.56,219.95,
"HEPATITIS PANEL",2014645,"CDM ",301,RC,80074,HCPCS,OUTPATIENT,,,253.5,202.8,,40.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.45,70,,141.96,,,0,"percent of total billed charges ","70% of total billed charges ",228.15,90,,182.52,,,0,"percent of total billed charges ","90% of total billed charges ",235.76,93,,188.61,,,0,"percent of total billed charges ","93% of total billed charges ",40.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",215.48,85,,172.38,,,0,"percent of total billed charges ","85% of total billed charges ",228.15,90,,182.52,,,0,"percent of total billed charges ","90% of total billed charges ",228.15,90,,182.52,,,0,"percent of total billed charges ","90% of total billed charges ",40.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",220.55,87,,176.44,,,0,"percent of total billed charges ","87% of total billed charges ",40.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.63,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",177.45,70,,141.96,,,0,"percent of total billed charges ","70% of total billed charges ",40.49,235.76,
"*IG G SUBCLASSES 1-4",2014652,"CDM ",301,RC,82787,HCPCS,OUTPATIENT,,,73,58.4,,8.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.1,70,,40.88,,,0,"percent of total billed charges ","70% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",67.89,93,,54.31,,,0,"percent of total billed charges ","93% of total billed charges ",8.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.05,85,,49.64,,,0,"percent of total billed charges ","85% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",17.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.51,87,,50.81,,,0,"percent of total billed charges ","87% of total billed charges ",17.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.02,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",51.1,70,,40.88,,,0,"percent of total billed charges ","70% of total billed charges ",8.02,67.89,
"*APLSP RVV TIME, DILUTED",2014678,"CDM ",305,RC,85613,HCPCS,OUTPATIENT,,,64,51.2,,8.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.8,70,,35.84,,,0,"percent of total billed charges ","70% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",59.52,93,,47.62,,,0,"percent of total billed charges ","93% of total billed charges ",8.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",54.4,85,,43.52,,,0,"percent of total billed charges ","85% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",55.68,87,,55.59,55.59,55.59,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.58,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",44.8,70,,35.84,,,0,"percent of total billed charges ","70% of total billed charges ",6.87,59.52,
"*SLB C3 C4",2014702,"CDM ",302,RC,86160,HCPCS,OUTPATIENT,,,165,132,,12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,133.30,133.30,133.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,226.71,226.71,226.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",12,153.45,
"CHOLESTEROL FLUID",2014728,"CDM ",301,RC,84311,HCPCS,OUTPATIENT,,,146.5,117.2,,,,,,,,0,"other ","not separately reimbursment ",,,,89.76,89.76,89.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.55,70,,82.04,,,0,"percent of total billed charges ","70% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",136.25,93,,109.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",124.53,85,,99.62,,,0,"percent of total billed charges ","85% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",127.46,87,,101.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",8.1,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.55,70,,82.04,,,0,"percent of total billed charges ","70% of total billed charges ",8.1,136.25,
"TSH RECEPTOR BINDING ABS NOS",2014736,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,325.5,260.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.85,70,,182.28,,,0,"percent of total billed charges ","70% of total billed charges ",292.95,90,,234.36,,,0,"percent of total billed charges ","90% of total billed charges ",302.72,93,,242.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",276.68,85,,221.34,,,0,"percent of total billed charges ","85% of total billed charges ",292.95,90,,234.36,,,0,"percent of total billed charges ","90% of total billed charges ",292.95,90,,234.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",283.19,87,,226.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",227.85,70,,182.28,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,302.72,
"HEPATITIS B SURFACE ABS",2014777,"CDM ",302,RC,86706,HCPCS,OUTPATIENT,,,133,106.4,,10.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.1,70,,74.48,,,0,"percent of total billed charges ","70% of total billed charges ",119.7,90,,95.76,,,0,"percent of total billed charges ","90% of total billed charges ",123.69,93,,98.95,,,0,"percent of total billed charges ","93% of total billed charges ",10.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",113.05,85,,90.44,,,0,"percent of total billed charges ","85% of total billed charges ",119.7,90,,95.76,,,0,"percent of total billed charges ","90% of total billed charges ",119.7,90,,95.76,,,0,"percent of total billed charges ","90% of total billed charges ",19.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",115.71,87,,92.57,,,0,"percent of total billed charges ","87% of total billed charges ",19.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",93.1,70,,74.48,,,0,"percent of total billed charges ","70% of total billed charges ",10.74,123.69,
"*HANTAVIRUS ABS",2014785,"CDM ",302,RC,86790,HCPCS,OUTPATIENT,,,975,780,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.58,80.58,80.58,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",682.5,70,,546.00,,,0,"percent of total billed charges ","70% of total billed charges ",877.5,90,,702.00,,,0,"percent of total billed charges ","90% of total billed charges ",906.75,93,,725.40,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",828.75,85,,663.00,,,0,"percent of total billed charges ","85% of total billed charges ",877.5,90,,702.00,,,0,"percent of total billed charges ","90% of total billed charges ",877.5,90,,702.00,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",848.25,87,,199.98,199.98,199.98,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",682.5,70,,546.00,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,906.75,
"*ALBUMIN SERUM",2014793,"CDM ",301,RC,82040,HCPCS,OUTPATIENT,,,29.5,23.6,,4.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,12.74,12.74,12.74,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.65,70,,16.52,,,0,"percent of total billed charges ","70% of total billed charges ",26.55,90,,21.24,,,0,"percent of total billed charges ","90% of total billed charges ",27.44,93,,21.95,,,0,"percent of total billed charges ","93% of total billed charges ",4.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",25.08,85,,20.06,,,0,"percent of total billed charges ","85% of total billed charges ",26.55,90,,21.24,,,0,"percent of total billed charges ","90% of total billed charges ",26.55,90,,21.24,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.67,87,,4.86,4.86,49.24,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.95,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",20.65,70,,16.52,,,0,"percent of total billed charges ","70% of total billed charges ",4.95,27.44,
"*LYME DISEASE ABS RESPONSE",2014819,"CDM ",300,RC,86618,HCPCS,OUTPATIENT,,,204,163.2,,14.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",14.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,141.98,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,189.72,
"*ANTI EXTRACTABLE NUC AG",2014835,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,185,148,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",172.05,93,,137.64,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",157.25,85,,125.80,,,0,"percent of total billed charges ","85% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",160.95,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,172.05,
"*BORDETELLA PERTUSSIS DFA",2014843,"CDM ",306,RC,87265,HCPCS,OUTPATIENT,,,155,124,,11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.5,70,,86.80,,,0,"percent of total billed charges ","70% of total billed charges ",139.5,90,,111.60,,,0,"percent of total billed charges ","90% of total billed charges ",144.15,93,,115.32,,,0,"percent of total billed charges ","93% of total billed charges ",11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",131.75,85,,105.40,,,0,"percent of total billed charges ","85% of total billed charges ",139.5,90,,111.60,,,0,"percent of total billed charges ","90% of total billed charges ",139.5,90,,111.60,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",134.85,87,,107.88,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",108.5,70,,86.80,,,0,"percent of total billed charges ","70% of total billed charges ",11.98,144.15,
"PLATELET ASSOCIATED IGG ABS",2014868,"CDM ",302,RC,86022,HCPCS,OUTPATIENT,,,174,139.2,,15.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,30.11,30.11,30.11,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",121.8,70,,97.44,,,0,"percent of total billed charges ","70% of total billed charges ",156.6,90,,125.28,,,0,"percent of total billed charges ","90% of total billed charges ",161.82,93,,129.46,,,0,"percent of total billed charges ","93% of total billed charges ",15.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",147.9,85,,118.32,,,0,"percent of total billed charges ","85% of total billed charges ",156.6,90,,125.28,,,0,"percent of total billed charges ","90% of total billed charges ",156.6,90,,125.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",151.38,87,,89.65,89.65,89.65,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.37,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",121.8,70,,97.44,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,161.82,
FERRITIN,2014876,"CDM ",301,RC,82728,HCPCS,OUTPATIENT,,,115,92,,13.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,13.36,13.36,13.36,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",13.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",24.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,24.64,13.36,89.22,21,"percent of total billed charges ","87% of total billed charges ",24.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.63,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",13.63,106.95,
"PRIMIDONE (MYSOLINE)",2014884,"CDM ",301,RC,80188,HCPCS,OUTPATIENT,,,135.5,108.4,,16.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.85,70,,75.88,,,0,"percent of total billed charges ","70% of total billed charges ",121.95,90,,97.56,,,0,"percent of total billed charges ","90% of total billed charges ",126.02,93,,100.82,,,0,"percent of total billed charges ","93% of total billed charges ",16.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",115.18,85,,92.14,,,0,"percent of total billed charges ","85% of total billed charges ",121.95,90,,97.56,,,0,"percent of total billed charges ","90% of total billed charges ",121.95,90,,97.56,,,0,"percent of total billed charges ","90% of total billed charges ",29.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.89,87,,94.31,,,0,"percent of total billed charges ","87% of total billed charges ",29.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.59,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",94.85,70,,75.88,,,0,"percent of total billed charges ","70% of total billed charges ",16.59,126.02,
"CORTISOL PLASMA, TOTAL",2014892,"CDM ",301,RC,82533,HCPCS,OUTPATIENT,,,130,104,,16.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91,70,,72.80,,,0,"percent of total billed charges ","70% of total billed charges ",117,90,,93.60,,,0,"percent of total billed charges ","90% of total billed charges ",120.9,93,,96.72,,,0,"percent of total billed charges ","93% of total billed charges ",16.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",110.5,85,,88.40,,,0,"percent of total billed charges ","85% of total billed charges ",117,90,,93.60,,,0,"percent of total billed charges ","90% of total billed charges ",117,90,,93.60,,,0,"percent of total billed charges ","90% of total billed charges ",29.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",113.1,87,,68.05,68.05,68.05,"1 through 10","percent of total billed charges ","87% of total billed charges ",29.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",91,70,,72.80,,,0,"percent of total billed charges ","70% of total billed charges ",16.3,120.9,
"*FECAL CHLORIDE",2014926,"CDM ",301,RC,82438,HCPCS,OUTPATIENT,,,179,143.2,,4.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.3,70,,100.24,,,0,"percent of total billed charges ","70% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",166.47,93,,133.18,,,0,"percent of total billed charges ","93% of total billed charges ",4.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",152.15,85,,121.72,,,0,"percent of total billed charges ","85% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",5.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",155.73,87,,124.58,,,0,"percent of total billed charges ","87% of total billed charges ",5.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",125.3,70,,100.24,,,0,"percent of total billed charges ","70% of total billed charges ",4.25,166.47,
"HEPATITIS B ABS IGM",2014934,"CDM ",302,RC,86705,HCPCS,OUTPATIENT,,,94,75.2,,11.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,40.78,40.78,40.78,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.8,70,,52.64,,,0,"percent of total billed charges ","70% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",87.42,93,,69.94,,,0,"percent of total billed charges ","93% of total billed charges ",11.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",79.9,85,,63.92,,,0,"percent of total billed charges ","85% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",19.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",81.78,87,,65.42,,,0,"percent of total billed charges ","87% of total billed charges ",19.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.77,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",65.8,70,,52.64,,,0,"percent of total billed charges ","70% of total billed charges ",11.77,87.42,
"HEPATITIS BC ABS IGG",2014959,"CDM ",302,RC,86704,HCPCS,OUTPATIENT,,,123,98.4,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.1,70,,68.88,,,0,"percent of total billed charges ","70% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",114.39,93,,91.51,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.29,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.55,85,,83.64,,,0,"percent of total billed charges ","85% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",19.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.01,87,,85.61,,,0,"percent of total billed charges ","87% of total billed charges ",19.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",86.1,70,,68.88,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,114.39,
"TOPIRAMATE (TOPAMAX) SERUM",2014967,"CDM ",301,RC,80201,HCPCS,OUTPATIENT,,,171.5,137.2,,10.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,92.82,92.82,92.82,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.05,70,,96.04,,,0,"percent of total billed charges ","70% of total billed charges ",154.35,90,,123.48,,,0,"percent of total billed charges ","90% of total billed charges ",159.5,93,,127.60,,,0,"percent of total billed charges ","93% of total billed charges ",10.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",145.78,85,,116.62,,,0,"percent of total billed charges ","85% of total billed charges ",154.35,90,,123.48,,,0,"percent of total billed charges ","90% of total billed charges ",154.35,90,,123.48,,,0,"percent of total billed charges ","90% of total billed charges ",14.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.21,87,,82.36,82.36,82.36,"1 through 10","percent of total billed charges ","87% of total billed charges ",14.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.92,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",120.05,70,,96.04,,,0,"percent of total billed charges ","70% of total billed charges ",10.71,159.5,
"CA 27-29",2014975,"CDM ",302,RC,86300,HCPCS,OUTPATIENT,,,155,124,,20.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.5,70,,86.80,,,0,"percent of total billed charges ","70% of total billed charges ",139.5,90,,111.60,,,0,"percent of total billed charges ","90% of total billed charges ",144.15,93,,115.32,,,0,"percent of total billed charges ","93% of total billed charges ",20.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",131.75,85,,105.40,,,0,"percent of total billed charges ","85% of total billed charges ",139.5,90,,111.60,,,0,"percent of total billed charges ","90% of total billed charges ",139.5,90,,111.60,,,0,"percent of total billed charges ","90% of total billed charges ",31.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",134.85,87,,107.88,,,0,"percent of total billed charges ","87% of total billed charges ",31.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.81,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",108.5,70,,86.80,,,0,"percent of total billed charges ","70% of total billed charges ",20.81,144.15,
"TREPONEMA PALLIDUM TPPA CSF",2014983,"CDM ",302,RC,86780,HCPCS,OUTPATIENT,,,156,124.8,,13.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",145.08,93,,116.06,,,0,"percent of total billed charges ","93% of total billed charges ",13.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.29,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",132.6,85,,106.08,,,0,"percent of total billed charges ","85% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",21.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",135.72,87,,92.67,92.66,92.67,11,"percent of total billed charges ","87% of total billed charges ",21.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.24,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",13.24,145.08,
"CREATININE CLEARANCE",2015014,"CDM ",301,RC,82575,HCPCS,OUTPATIENT,,,189.5,151.6,,9.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.65,70,,106.12,,,0,"percent of total billed charges ","70% of total billed charges ",170.55,90,,136.44,,,0,"percent of total billed charges ","90% of total billed charges ",176.24,93,,140.99,,,0,"percent of total billed charges ","93% of total billed charges ",9.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",161.08,85,,128.86,,,0,"percent of total billed charges ","85% of total billed charges ",170.55,90,,136.44,,,0,"percent of total billed charges ","90% of total billed charges ",170.55,90,,136.44,,,0,"percent of total billed charges ","90% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",164.87,87,,131.90,,,0,"percent of total billed charges ","87% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.46,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",132.65,70,,106.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.46,176.24,
"*IMMUNE COMPLEX ASSAY",2015022,"CDM ",302,RC,86332,HCPCS,OUTPATIENT,,,261.5,209.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",243.2,93,,194.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",222.28,85,,177.82,,,0,"percent of total billed charges ","85% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",227.51,87,,182.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",24.37,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",24.37,243.2,
PLASMINOGEN,2015048,"CDM ",300,RC,85420,HCPCS,OUTPATIENT,,,337,269.6,,6.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",235.9,70,,188.72,,,0,"percent of total billed charges ","70% of total billed charges ",303.3,90,,242.64,,,0,"percent of total billed charges ","90% of total billed charges ",313.41,93,,250.73,,,0,"percent of total billed charges ","93% of total billed charges ",6.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.72,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",286.45,85,,229.16,,,0,"percent of total billed charges ","85% of total billed charges ",303.3,90,,242.64,,,0,"percent of total billed charges ","90% of total billed charges ",303.3,90,,242.64,,,0,"percent of total billed charges ","90% of total billed charges ",8.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",293.19,87,,234.55,,,0,"percent of total billed charges ","87% of total billed charges ",8.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",235.9,70,,188.72,,,0,"percent of total billed charges ","70% of total billed charges ",6.53,313.41,
"*LEGIONELLA PNEUMOPHILA BY DFA",2015071,"CDM ",306,RC,87278,HCPCS,OUTPATIENT,,,165,132,,14.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",14.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,114.84,,,0,"percent of total billed charges ","87% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.6,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",14.09,153.45,
"*CHLAMYDIA PSITTACI BY DFA",2015089,"CDM ",306,RC,87299,HCPCS,OUTPATIENT,,,198.5,158.8,,15.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",138.95,70,,111.16,,,0,"percent of total billed charges ","70% of total billed charges ",178.65,90,,142.92,,,0,"percent of total billed charges ","90% of total billed charges ",184.61,93,,147.69,,,0,"percent of total billed charges ","93% of total billed charges ",15.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",168.73,85,,134.98,,,0,"percent of total billed charges ","85% of total billed charges ",178.65,90,,142.92,,,0,"percent of total billed charges ","90% of total billed charges ",178.65,90,,142.92,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",172.7,87,,138.16,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.1,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",138.95,70,,111.16,,,0,"percent of total billed charges ","70% of total billed charges ",15.75,184.61,
"HEMOSIDERIN URINE (80473)",2015105,"CDM ",301,RC,83070,HCPCS,OUTPATIENT,,,176,140.8,,4.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.2,70,,98.56,,,0,"percent of total billed charges ","70% of total billed charges ",158.4,90,,126.72,,,0,"percent of total billed charges ","90% of total billed charges ",163.68,93,,130.94,,,0,"percent of total billed charges ","93% of total billed charges ",4.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2.36,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",149.6,85,,119.68,,,0,"percent of total billed charges ","85% of total billed charges ",158.4,90,,126.72,,,0,"percent of total billed charges ","90% of total billed charges ",158.4,90,,126.72,,,0,"percent of total billed charges ","90% of total billed charges ",2.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",153.12,87,,122.50,,,0,"percent of total billed charges ","87% of total billed charges ",2.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.75,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",123.2,70,,98.56,,,0,"percent of total billed charges ","70% of total billed charges ",2.34,163.68,
"DRUG SCREEN CONFIRMATION",2015147,"CDM ",300,RC,80307,HCPCS,OUTPATIENT,,,642,513.6,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",449.4,70,,359.52,,,0,"percent of total billed charges ","70% of total billed charges ",577.8,90,,462.24,,,0,"percent of total billed charges ","90% of total billed charges ",597.06,93,,477.65,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",545.7,85,,436.56,,,0,"percent of total billed charges ","85% of total billed charges ",577.8,90,,462.24,,,0,"percent of total billed charges ","90% of total billed charges ",577.8,90,,462.24,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",558.54,87,,446.83,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",449.4,70,,359.52,,,0,"percent of total billed charges ","70% of total billed charges ",62.14,597.06,
"*ALLERGEN SPECIFIC IGE QT",2015188,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"*C ALBICANS ANTIGEN",2015246,"CDM ",306,RC,87899,HCPCS,OUTPATIENT,,,165,132,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",14.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",14.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,114.84,,,0,"percent of total billed charges ","87% of total billed charges ",14.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",14.82,153.45,
"PREWARM TECHNIQUE",2015253,"CDM ",300,RC,86850,HCPCS,OUTPATIENT,,,119.5,95.6,,8.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",111.14,93,,88.91,,,0,"percent of total billed charges ","93% of total billed charges ",8.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",101.58,85,,81.26,,,0,"percent of total billed charges ","85% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",103.97,87,,81.89,81.89,81.89,12,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.92,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",8.3,111.14,
"INSULIN-LIKE GROWTH FACTOR I",2015295,"CDM ",301,RC,84305,HCPCS,OUTPATIENT,,,254,203.2,,21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.8,70,,142.24,,,0,"percent of total billed charges ","70% of total billed charges ",228.6,90,,182.88,,,0,"percent of total billed charges ","90% of total billed charges ",236.22,93,,188.98,,,0,"percent of total billed charges ","93% of total billed charges ",21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",215.9,85,,172.72,,,0,"percent of total billed charges ","85% of total billed charges ",228.6,90,,182.88,,,0,"percent of total billed charges ","90% of total billed charges ",228.6,90,,182.88,,,0,"percent of total billed charges ","90% of total billed charges ",27.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",220.98,87,,176.78,,,0,"percent of total billed charges ","87% of total billed charges ",27.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.26,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",177.8,70,,142.24,,,0,"percent of total billed charges ","70% of total billed charges ",21,236.22,
"INFLUENZA A & B RAPID",2015303,"CDM ",306,RC,87400,HCPCS,OUTPATIENT,,,164,131.2,,12.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.8,70,,91.84,,,0,"percent of total billed charges ","70% of total billed charges ",147.6,90,,118.08,,,0,"percent of total billed charges ","90% of total billed charges ",152.52,93,,122.02,,,0,"percent of total billed charges ","93% of total billed charges ",12.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.01,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",139.4,85,,111.52,,,0,"percent of total billed charges ","85% of total billed charges ",147.6,90,,118.08,,,0,"percent of total billed charges ","90% of total billed charges ",147.6,90,,118.08,,,0,"percent of total billed charges ","90% of total billed charges ",9.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",142.68,87,,114.14,,,0,"percent of total billed charges ","87% of total billed charges ",9.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.13,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",114.8,70,,91.84,,,0,"percent of total billed charges ","70% of total billed charges ",9.91,152.52,
"HEPATITIS PROFILE V #28928",2015311,"CDM ",302,RC,86709,HCPCS,OUTPATIENT,,,215.5,172.4,,11.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,18.23,18.23,18.23,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",150.85,70,,120.68,,,0,"percent of total billed charges ","70% of total billed charges ",193.95,90,,155.16,,,0,"percent of total billed charges ","90% of total billed charges ",200.42,93,,160.34,,,0,"percent of total billed charges ","93% of total billed charges ",11.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",183.18,85,,146.54,,,0,"percent of total billed charges ","85% of total billed charges ",193.95,90,,155.16,,,0,"percent of total billed charges ","90% of total billed charges ",193.95,90,,155.16,,,0,"percent of total billed charges ","90% of total billed charges ",19.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",187.49,87,,149.99,,,0,"percent of total billed charges ","87% of total billed charges ",19.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.26,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",150.85,70,,120.68,,,0,"percent of total billed charges ","70% of total billed charges ",11.26,200.42,
"HANTAVIRUS ABS IGG BY ELISA",2015337,"CDM ",302,RC,86790,HCPCS,OUTPATIENT,,,550,440,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.58,80.58,80.58,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",385,70,,308.00,,,0,"percent of total billed charges ","70% of total billed charges ",495,90,,396.00,,,0,"percent of total billed charges ","90% of total billed charges ",511.5,93,,409.20,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",467.5,85,,374.00,,,0,"percent of total billed charges ","85% of total billed charges ",495,90,,396.00,,,0,"percent of total billed charges ","90% of total billed charges ",495,90,,396.00,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",478.5,87,,199.98,199.98,199.98,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",385,70,,308.00,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,511.5,
"AMYLASE PERICARDIAL/PLEURAL FL",2015360,"CDM ",301,RC,82150,HCPCS,OUTPATIENT,,,55,44,,6.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.5,70,,30.80,,,0,"percent of total billed charges ","70% of total billed charges ",49.5,90,,39.60,,,0,"percent of total billed charges ","90% of total billed charges ",51.15,93,,40.92,,,0,"percent of total billed charges ","93% of total billed charges ",6.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",46.75,85,,37.40,,,0,"percent of total billed charges ","85% of total billed charges ",49.5,90,,39.60,,,0,"percent of total billed charges ","90% of total billed charges ",49.5,90,,39.60,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.85,87,,86.05,56.66,104.30,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.48,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",38.5,70,,30.80,,,0,"percent of total billed charges ","70% of total billed charges ",6.48,51.15,
"*GANLIOSIDE PNL NOS RIA",2015428,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,90,72,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,83.7,
"ASIALO GM 1 AB",2015436,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,90,72,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,83.7,
"*MYCOPLASMA AB",2015451,"CDM ",302,RC,86738,HCPCS,OUTPATIENT,,,201.5,161.2,,11.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.05,70,,112.84,,,0,"percent of total billed charges ","70% of total billed charges ",181.35,90,,145.08,,,0,"percent of total billed charges ","90% of total billed charges ",187.4,93,,149.92,,,0,"percent of total billed charges ","93% of total billed charges ",11.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",171.28,85,,137.02,,,0,"percent of total billed charges ","85% of total billed charges ",181.35,90,,145.08,,,0,"percent of total billed charges ","90% of total billed charges ",181.35,90,,145.08,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",175.31,87,,140.25,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.24,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",141.05,70,,112.84,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,187.4,
"C DIFFICILE TOXIN",2015493,"CDM ",306,RC,87324,HCPCS,OUTPATIENT,,,424,339.2,,10.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.8,70,,237.44,,,0,"percent of total billed charges ","70% of total billed charges ",381.6,90,,305.28,,,0,"percent of total billed charges ","90% of total billed charges ",394.32,93,,315.46,,,0,"percent of total billed charges ","93% of total billed charges ",10.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",360.4,85,,288.32,,,0,"percent of total billed charges ","85% of total billed charges ",381.6,90,,305.28,,,0,"percent of total billed charges ","90% of total billed charges ",381.6,90,,305.28,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",368.88,87,,295.10,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",296.8,70,,237.44,,,0,"percent of total billed charges ","70% of total billed charges ",10.18,394.32,
"ARC ABO DESCREPANCY RESOLUTION",2015519,"CDM ",300,RC,86999,HCPCS,OUTPATIENT,,,270,216,,51.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",189,70,,151.20,,,0,"percent of total billed charges ","70% of total billed charges ",243,90,,194.40,,,0,"percent of total billed charges ","90% of total billed charges ",251.1,93,,200.88,,,0,"percent of total billed charges ","93% of total billed charges ",51.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",229.5,85,,183.60,,,0,"percent of total billed charges ","85% of total billed charges ",243,90,,194.40,,,0,"percent of total billed charges ","90% of total billed charges ",243,90,,194.40,,,0,"percent of total billed charges ","90% of total billed charges ",64.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",234.9,87,,187.92,,,0,"percent of total billed charges ","87% of total billed charges ",64.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.59,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",189,70,,151.20,,,0,"percent of total billed charges ","70% of total billed charges ",26.59,251.1,
"ARC RA PHENOTYPE COMPLETE",2015527,"CDM ",300,RC,86906,HCPCS,OUTPATIENT,,,124,99.2,,7.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.8,70,,69.44,,,0,"percent of total billed charges ","70% of total billed charges ",111.6,90,,89.28,,,0,"percent of total billed charges ","90% of total billed charges ",115.32,93,,92.26,,,0,"percent of total billed charges ","93% of total billed charges ",7.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",105.4,85,,84.32,,,0,"percent of total billed charges ","85% of total billed charges ",111.6,90,,89.28,,,0,"percent of total billed charges ","90% of total billed charges ",111.6,90,,89.28,,,0,"percent of total billed charges ","90% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.88,87,,86.30,,,0,"percent of total billed charges ","87% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",86.8,70,,69.44,,,0,"percent of total billed charges ","70% of total billed charges ",7.75,115.32,
"ARC ANTIGEN TYPE OF RECIP PER",2015535,"CDM ",300,RC,86905,HCPCS,OUTPATIENT,,,567.5,454,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",397.25,70,,317.80,,,0,"percent of total billed charges ","70% of total billed charges ",510.75,90,,408.60,,,0,"percent of total billed charges ","90% of total billed charges ",527.78,93,,422.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",6.27,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",482.38,85,,385.90,,,0,"percent of total billed charges ","85% of total billed charges ",510.75,90,,408.60,,,0,"percent of total billed charges ","90% of total billed charges ",510.75,90,,408.60,,,0,"percent of total billed charges ","90% of total billed charges ",6.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",493.73,87,,394.98,,,0,"percent of total billed charges ","87% of total billed charges ",6.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",397.25,70,,317.80,,,0,"percent of total billed charges ","70% of total billed charges ",6.21,527.78,
"ARC DIRECT ANTIGLOBULIN",2015543,"CDM ",300,RC,86880,HCPCS,OUTPATIENT,,,138.5,110.8,,5.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.95,70,,77.56,,,0,"percent of total billed charges ","70% of total billed charges ",124.65,90,,99.72,,,0,"percent of total billed charges ","90% of total billed charges ",128.81,93,,103.05,,,0,"percent of total billed charges ","93% of total billed charges ",5.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",117.73,85,,94.18,,,0,"percent of total billed charges ","85% of total billed charges ",124.65,90,,99.72,,,0,"percent of total billed charges ","90% of total billed charges ",124.65,90,,99.72,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",120.5,87,,96.40,,,0,"percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",96.95,70,,77.56,,,0,"percent of total billed charges ","70% of total billed charges ",5.39,128.81,
"ARC ANTIBODY ELUTION",2015550,"CDM ",300,RC,86860,HCPCS,OUTPATIENT,,,183,146.4,,129.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.1,70,,102.48,,,0,"percent of total billed charges ","70% of total billed charges ",164.7,90,,131.76,,,0,"percent of total billed charges ","90% of total billed charges ",170.19,93,,136.15,,,0,"percent of total billed charges ","93% of total billed charges ",129.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",155.55,85,,124.44,,,0,"percent of total billed charges ","85% of total billed charges ",164.7,90,,131.76,,,0,"percent of total billed charges ","90% of total billed charges ",164.7,90,,131.76,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",159.21,87,,127.37,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",128.1,70,,102.48,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,170.19,
"ARC ANTIBODY SCREEN EA SERUM",2015568,"CDM ",300,RC,86850,HCPCS,OUTPATIENT,,,119.5,95.6,,8.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",111.14,93,,88.91,,,0,"percent of total billed charges ","93% of total billed charges ",8.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",101.58,85,,81.26,,,0,"percent of total billed charges ","85% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",103.97,87,,81.89,81.89,81.89,12,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.92,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",8.3,111.14,
"ARC ANTIBODY PANEL EA SERUM",2015576,"CDM ",300,RC,86870,HCPCS,OUTPATIENT,,,442,353.6,,252.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",309.4,70,,247.52,,,0,"percent of total billed charges ","70% of total billed charges ",397.8,90,,318.24,,,0,"percent of total billed charges ","90% of total billed charges ",411.06,93,,328.85,,,0,"percent of total billed charges ","93% of total billed charges ",252.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",375.7,85,,300.56,,,0,"percent of total billed charges ","85% of total billed charges ",397.8,90,,318.24,,,0,"percent of total billed charges ","90% of total billed charges ",397.8,90,,318.24,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",384.54,87,,307.63,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",309.4,70,,247.52,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,411.06,
"ARC ANTIBODY TITER PER TITER",2015584,"CDM ",300,RC,86886,HCPCS,OUTPATIENT,,,270,216,,5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",189,70,,151.20,,,0,"percent of total billed charges ","70% of total billed charges ",243,90,,194.40,,,0,"percent of total billed charges ","90% of total billed charges ",251.1,93,,200.88,,,0,"percent of total billed charges ","93% of total billed charges ",5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",229.5,85,,183.60,,,0,"percent of total billed charges ","85% of total billed charges ",243,90,,194.40,,,0,"percent of total billed charges ","90% of total billed charges ",243,90,,194.40,,,0,"percent of total billed charges ","90% of total billed charges ",9.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",234.9,87,,187.92,,,0,"percent of total billed charges ","87% of total billed charges ",9.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",189,70,,151.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.18,251.1,
"ARC INHIBITION 08 SERUM PER PR",2015592,"CDM ",300,RC,86977,HCPCS,OUTPATIENT,,,230,184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",161,70,,128.80,,,0,"percent of total billed charges ","70% of total billed charges ",207,90,,165.60,,,0,"percent of total billed charges ","90% of total billed charges ",213.9,93,,171.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",195.5,85,,156.40,,,0,"percent of total billed charges ","85% of total billed charges ",207,90,,165.60,,,0,"percent of total billed charges ","90% of total billed charges ",207,90,,165.60,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.1,87,,160.08,,,0,"percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",161,70,,128.80,,,0,"percent of total billed charges ","70% of total billed charges ",9.61,213.9,
"ARC ADSORPTION 08 SERUM PER AD",2015600,"CDM ",300,RC,86978,HCPCS,OUTPATIENT,,,336.5,269.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",235.55,70,,188.44,,,0,"percent of total billed charges ","70% of total billed charges ",302.85,90,,242.28,,,0,"percent of total billed charges ","90% of total billed charges ",312.95,93,,250.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",286.03,85,,228.82,,,0,"percent of total billed charges ","85% of total billed charges ",302.85,90,,242.28,,,0,"percent of total billed charges ","90% of total billed charges ",302.85,90,,242.28,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",292.76,87,,234.21,,,0,"percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",235.55,70,,188.44,,,0,"percent of total billed charges ","70% of total billed charges ",9.61,312.95,
"ARC CHEM PRETREAT RBC PER CELL",2015618,"CDM ",300,RC,86970,HCPCS,OUTPATIENT,,,102,81.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.4,70,,57.12,,,0,"percent of total billed charges ","70% of total billed charges ",91.8,90,,73.44,,,0,"percent of total billed charges ","90% of total billed charges ",94.86,93,,75.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",86.7,85,,69.36,,,0,"percent of total billed charges ","85% of total billed charges ",91.8,90,,73.44,,,0,"percent of total billed charges ","90% of total billed charges ",91.8,90,,73.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",88.74,87,,70.99,,,0,"percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",71.4,70,,57.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.61,94.86,
"ARC ENZ PRETREAT PER CELL",2015626,"CDM ",300,RC,86971,HCPCS,OUTPATIENT,,,230,184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",161,70,,128.80,,,0,"percent of total billed charges ","70% of total billed charges ",207,90,,165.60,,,0,"percent of total billed charges ","90% of total billed charges ",213.9,93,,171.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",195.5,85,,156.40,,,0,"percent of total billed charges ","85% of total billed charges ",207,90,,165.60,,,0,"percent of total billed charges ","90% of total billed charges ",207,90,,165.60,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.1,87,,160.08,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",161,70,,128.80,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,213.9,
"ARC DONOR AG TYPING PER TEST",2015634,"CDM ",300,RC,86902,HCPCS,OUTPATIENT,,,170,136,,5.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119,70,,95.20,,,0,"percent of total billed charges ","70% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",158.1,93,,126.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",144.5,85,,115.60,,,0,"percent of total billed charges ","85% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",5.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.9,87,,118.32,,,0,"percent of total billed charges ","87% of total billed charges ",5.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",119,70,,95.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.4,329.64,
"ARC DONOR NEG FOR SINGLE AG AV",2015642,"CDM ",300,RC,86902,HCPCS,OUTPATIENT,,,59,47.2,,5.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.3,70,,33.04,,,0,"percent of total billed charges ","70% of total billed charges ",53.1,90,,42.48,,,0,"percent of total billed charges ","90% of total billed charges ",54.87,93,,43.90,,,0,"percent of total billed charges ","93% of total billed charges ",5.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",50.15,85,,40.12,,,0,"percent of total billed charges ","85% of total billed charges ",53.1,90,,42.48,,,0,"percent of total billed charges ","90% of total billed charges ",53.1,90,,42.48,,,0,"percent of total billed charges ","90% of total billed charges ",5.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",51.33,87,,41.06,,,0,"percent of total billed charges ","87% of total billed charges ",5.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",41.3,70,,33.04,,,0,"percent of total billed charges ","70% of total billed charges ",5.4,329.64,
"ARC DONOR NEG FOR MUL AG AVG 1",2015659,"CDM ",300,RC,86902,HCPCS,OUTPATIENT,,,59,47.2,,5.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.3,70,,33.04,,,0,"percent of total billed charges ","70% of total billed charges ",53.1,90,,42.48,,,0,"percent of total billed charges ","90% of total billed charges ",54.87,93,,43.90,,,0,"percent of total billed charges ","93% of total billed charges ",5.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",50.15,85,,40.12,,,0,"percent of total billed charges ","85% of total billed charges ",53.1,90,,42.48,,,0,"percent of total billed charges ","90% of total billed charges ",53.1,90,,42.48,,,0,"percent of total billed charges ","90% of total billed charges ",5.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",51.33,87,,41.06,,,0,"percent of total billed charges ","87% of total billed charges ",5.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",41.3,70,,33.04,,,0,"percent of total billed charges ","70% of total billed charges ",5.4,329.64,
"ARC DONOR UNIT RARE PHENO AVG2",2015667,"CDM ",300,RC,86902,HCPCS,OUTPATIENT,,,60,48,,5.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42,70,,33.60,,,0,"percent of total billed charges ","70% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",55.8,93,,44.64,,,0,"percent of total billed charges ","93% of total billed charges ",5.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",51,85,,40.80,,,0,"percent of total billed charges ","85% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",5.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",52.2,87,,41.76,,,0,"percent of total billed charges ","87% of total billed charges ",5.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",42,70,,33.60,,,0,"percent of total billed charges ","70% of total billed charges ",5.4,329.64,
"ARC DONOR HIGH INCIDENCE AG NE",2015675,"CDM ",300,RC,86902,HCPCS,OUTPATIENT,,,59,47.2,,5.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.3,70,,33.04,,,0,"percent of total billed charges ","70% of total billed charges ",53.1,90,,42.48,,,0,"percent of total billed charges ","90% of total billed charges ",54.87,93,,43.90,,,0,"percent of total billed charges ","93% of total billed charges ",5.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",50.15,85,,40.12,,,0,"percent of total billed charges ","85% of total billed charges ",53.1,90,,42.48,,,0,"percent of total billed charges ","90% of total billed charges ",53.1,90,,42.48,,,0,"percent of total billed charges ","90% of total billed charges ",5.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",51.33,87,,41.06,,,0,"percent of total billed charges ","87% of total billed charges ",5.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",41.3,70,,33.04,,,0,"percent of total billed charges ","70% of total billed charges ",5.4,329.64,
"ARC SCREENING CROSSMATCH",2015683,"CDM ",300,RC,86904,HCPCS,OUTPATIENT,,,156,124.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",145.08,93,,116.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",7.93,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",132.6,85,,106.08,,,0,"percent of total billed charges ","85% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",7.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",135.72,87,,108.58,,,0,"percent of total billed charges ","87% of total billed charges ",7.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",7.85,145.08,
"ARC COMPAT TEST PER UNIT IMMED",2015691,"CDM ",300,RC,86920,HCPCS,OUTPATIENT,,,230,184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",161,70,,128.80,,,0,"percent of total billed charges ","70% of total billed charges ",207,90,,165.60,,,0,"percent of total billed charges ","90% of total billed charges ",213.9,93,,171.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",62.3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",195.5,85,,156.40,,,0,"percent of total billed charges ","85% of total billed charges ",207,90,,165.60,,,0,"percent of total billed charges ","90% of total billed charges ",207,90,,165.60,,,0,"percent of total billed charges ","90% of total billed charges ",61.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.1,87,,160.08,,,0,"percent of total billed charges ","87% of total billed charges ",61.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",161,70,,128.80,,,0,"percent of total billed charges ","70% of total billed charges ",61.68,213.9,
"ARC COMPAT TEST PER UNIT INCUB",2015709,"CDM ",300,RC,86921,HCPCS,OUTPATIENT,,,230,184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",161,70,,128.80,,,0,"percent of total billed charges ","70% of total billed charges ",207,90,,165.60,,,0,"percent of total billed charges ","90% of total billed charges ",213.9,93,,171.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",24.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",195.5,85,,156.40,,,0,"percent of total billed charges ","85% of total billed charges ",207,90,,165.60,,,0,"percent of total billed charges ","90% of total billed charges ",207,90,,165.60,,,0,"percent of total billed charges ","90% of total billed charges ",24.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.1,87,,160.08,,,0,"percent of total billed charges ","87% of total billed charges ",24.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",161,70,,128.80,,,0,"percent of total billed charges ","70% of total billed charges ",24.08,213.9,
"ARC COMPAT TEST ANTIGLOB",2015717,"CDM ",300,RC,86922,HCPCS,OUTPATIENT,,,266,212.8,,,,,,,,0,"other ","not separately reimbursment ",,,,50.02,50.02,50.02,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",186.2,70,,148.96,,,0,"percent of total billed charges ","70% of total billed charges ",239.4,90,,191.52,,,0,"percent of total billed charges ","90% of total billed charges ",247.38,93,,197.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",24.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",226.1,85,,180.88,,,0,"percent of total billed charges ","85% of total billed charges ",239.4,90,,191.52,,,0,"percent of total billed charges ","90% of total billed charges ",239.4,90,,191.52,,,0,"percent of total billed charges ","90% of total billed charges ",24.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",231.42,87,,166.34,166.34,166.34,"1 through 10","percent of total billed charges ","87% of total billed charges ",24.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",186.2,70,,148.96,,,0,"percent of total billed charges ","70% of total billed charges ",24.08,247.38,
"ARC RECIPIENT HLA A&B",2015733,"CDM ",302,RC,86813,HCPCS,OUTPATIENT,,,1167.5,934,,83.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",817.25,70,,653.80,,,0,"percent of total billed charges ","70% of total billed charges ",1050.75,90,,840.60,,,0,"percent of total billed charges ","90% of total billed charges ",1085.78,93,,868.62,,,0,"percent of total billed charges ","93% of total billed charges ",83.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",105.89,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",992.38,85,,793.90,,,0,"percent of total billed charges ","85% of total billed charges ",1050.75,90,,840.60,,,0,"percent of total billed charges ","90% of total billed charges ",1050.75,90,,840.60,,,0,"percent of total billed charges ","90% of total billed charges ",104.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1015.73,87,,812.58,,,0,"percent of total billed charges ","87% of total billed charges ",104.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",58,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",817.25,70,,653.80,,,0,"percent of total billed charges ","70% of total billed charges ",58,1085.78,
"ARC PLATELET ALLOIMMUNIZATION",2015741,"CDM ",302,RC,86022,HCPCS,OUTPATIENT,,,797,637.6,,15.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,30.11,30.11,30.11,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",557.9,70,,446.32,,,0,"percent of total billed charges ","70% of total billed charges ",717.3,90,,573.84,,,0,"percent of total billed charges ","90% of total billed charges ",741.21,93,,592.97,,,0,"percent of total billed charges ","93% of total billed charges ",15.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",677.45,85,,541.96,,,0,"percent of total billed charges ","85% of total billed charges ",717.3,90,,573.84,,,0,"percent of total billed charges ","90% of total billed charges ",717.3,90,,573.84,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",693.39,87,,89.65,89.65,89.65,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.37,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",557.9,70,,446.32,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,741.21,
"ARC PLATELET CROSSMATCH PER CO",2015758,"CDM ",302,RC,86022,HCPCS,OUTPATIENT,,,797,637.6,,15.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,30.11,30.11,30.11,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",557.9,70,,446.32,,,0,"percent of total billed charges ","70% of total billed charges ",717.3,90,,573.84,,,0,"percent of total billed charges ","90% of total billed charges ",741.21,93,,592.97,,,0,"percent of total billed charges ","93% of total billed charges ",15.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",677.45,85,,541.96,,,0,"percent of total billed charges ","85% of total billed charges ",717.3,90,,573.84,,,0,"percent of total billed charges ","90% of total billed charges ",717.3,90,,573.84,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",693.39,87,,89.65,89.65,89.65,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.37,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",557.9,70,,446.32,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,741.21,
"BREATH ALCOHOL TEST (AFTER HOU",2015766,"CDM ",300,RC,80100,HCPCS,OUTPATIENT,,,120,96,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84,70,,67.20,,,0,"percent of total billed charges ","70% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",111.6,93,,89.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",102,85,,81.60,,,0,"percent of total billed charges ","85% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",104.4,87,,83.52,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84,70,,67.20,,,0,"percent of total billed charges ","70% of total billed charges ",84,111.6,
"DRUG COLLECTION (AFTER HOURS)",2015774,"CDM ",300,RC,80307,HCPCS,OUTPATIENT,,,74.5,59.6,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",69.29,93,,55.43,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",63.33,85,,50.66,,,0,"percent of total billed charges ","85% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.82,87,,51.86,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",52.15,80.98,
"CREATININE URINE RANDOM",2015816,"CDM ",301,RC,82570,HCPCS,OUTPATIENT,,,108,86.4,,5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,5.08,4.98,50.30,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",5.18,100.44,
"CHLORIDE URINE RANDOM",2015824,"CDM ",301,RC,82436,HCPCS,OUTPATIENT,,,59.5,47.6,,4.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,19.83,19.83,19.83,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.65,70,,33.32,,,0,"percent of total billed charges ","70% of total billed charges ",53.55,90,,42.84,,,0,"percent of total billed charges ","90% of total billed charges ",55.34,93,,44.27,,,0,"percent of total billed charges ","93% of total billed charges ",4.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",50.58,85,,40.46,,,0,"percent of total billed charges ","85% of total billed charges ",53.55,90,,42.84,,,0,"percent of total billed charges ","90% of total billed charges ",53.55,90,,42.84,,,0,"percent of total billed charges ","90% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",51.77,87,,41.42,,,0,"percent of total billed charges ","87% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.75,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",41.65,70,,33.32,,,0,"percent of total billed charges ","70% of total billed charges ",4.89,55.34,
"POTASSIUM URINE RANDOM",2015832,"CDM ",301,RC,84133,HCPCS,OUTPATIENT,,,92.5,74,,4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",86.03,93,,68.82,,,0,"percent of total billed charges ","93% of total billed charges ",4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",78.63,85,,62.90,,,0,"percent of total billed charges ","85% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.48,87,,64.38,,,0,"percent of total billed charges ","87% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.73,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",4.2,86.03,
"MYELOPEROXIDASE ABS",2015899,"CDM ",302,RC,86021,HCPCS,OUTPATIENT,,,217,173.6,,12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.9,70,,121.52,,,0,"percent of total billed charges ","70% of total billed charges ",195.3,90,,156.24,,,0,"percent of total billed charges ","90% of total billed charges ",201.81,93,,161.45,,,0,"percent of total billed charges ","93% of total billed charges ",12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",184.45,85,,147.56,,,0,"percent of total billed charges ","85% of total billed charges ",195.3,90,,156.24,,,0,"percent of total billed charges ","90% of total billed charges ",195.3,90,,156.24,,,0,"percent of total billed charges ","90% of total billed charges ",9.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",188.79,87,,151.03,,,0,"percent of total billed charges ","87% of total billed charges ",9.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",151.9,70,,121.52,,,0,"percent of total billed charges ","70% of total billed charges ",9.82,201.81,
"ANGIOTENSIN-CONV ENZ CSF",2015907,"CDM ",301,RC,82164,HCPCS,OUTPATIENT,,,108,86.4,,14.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",14.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",21.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,75.17,,,0,"percent of total billed charges ","87% of total billed charges ",21.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.6,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",14.6,100.44,
"CHLORIDE BODY FLUID",2015972,"CDM ",301,RC,82438,HCPCS,OUTPATIENT,,,91.5,73.2,,4.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.05,70,,51.24,,,0,"percent of total billed charges ","70% of total billed charges ",82.35,90,,65.88,,,0,"percent of total billed charges ","90% of total billed charges ",85.1,93,,68.08,,,0,"percent of total billed charges ","93% of total billed charges ",4.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",77.78,85,,62.22,,,0,"percent of total billed charges ","85% of total billed charges ",82.35,90,,65.88,,,0,"percent of total billed charges ","90% of total billed charges ",82.35,90,,65.88,,,0,"percent of total billed charges ","90% of total billed charges ",5.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",79.61,87,,63.69,,,0,"percent of total billed charges ","87% of total billed charges ",5.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",64.05,70,,51.24,,,0,"percent of total billed charges ","70% of total billed charges ",4.25,85.1,
"PROTEIN BODY FLUID",2015980,"CDM ",301,RC,84155,HCPCS,OUTPATIENT,,,108,86.4,,3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,75.17,,,0,"percent of total billed charges ","87% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",3.67,100.44,
"URIC ACID BODY FLUID",2015998,"CDM ",301,RC,84560,HCPCS,OUTPATIENT,,,92.5,74,,5.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",86.03,93,,68.82,,,0,"percent of total billed charges ","93% of total billed charges ",5.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",78.63,85,,62.90,,,0,"percent of total billed charges ","85% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.48,87,,64.38,,,0,"percent of total billed charges ","87% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.08,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",5.08,86.03,
"AUTOIMMUNE INNER EAR AG",2016046,"CDM ",301,RC,84182,HCPCS,OUTPATIENT,,,867,693.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",606.9,70,,485.52,,,0,"percent of total billed charges ","70% of total billed charges ",780.3,90,,624.24,,,0,"percent of total billed charges ","90% of total billed charges ",806.31,93,,645.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",736.95,85,,589.56,,,0,"percent of total billed charges ","85% of total billed charges ",780.3,90,,624.24,,,0,"percent of total billed charges ","90% of total billed charges ",780.3,90,,624.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",754.29,87,,603.43,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",29.21,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",606.9,70,,485.52,,,0,"percent of total billed charges ","70% of total billed charges ",29.21,806.31,
"LDL DIRECT",2016053,"CDM ",301,RC,83721,HCPCS,OUTPATIENT,,,97,77.6,,10.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",90.21,93,,72.17,,,0,"percent of total billed charges ","93% of total billed charges ",10.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.87,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",82.45,85,,65.96,,,0,"percent of total billed charges ","85% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",14.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.39,87,,67.51,,,0,"percent of total billed charges ","87% of total billed charges ",14.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.5,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",10.5,90.21,
"*HSV AMPLIFIED PROBE TECHNIQUE",2016061,"CDM ",306,RC,87529,HCPCS,OUTPATIENT,,,708.5,566.8,,29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,180.36,180.36,180.36,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",495.95,70,,396.76,,,0,"percent of total billed charges ","70% of total billed charges ",637.65,90,,510.12,,,0,"percent of total billed charges ","90% of total billed charges ",658.91,93,,527.13,,,0,"percent of total billed charges ","93% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",602.23,85,,481.78,,,0,"percent of total billed charges ","85% of total billed charges ",637.65,90,,510.12,,,0,"percent of total billed charges ","90% of total billed charges ",637.65,90,,510.12,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",616.4,87,,493.12,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",495.95,70,,396.76,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,658.91,
"PH BODY FLUID",2016095,"CDM ",301,RC,83986,HCPCS,OUTPATIENT,,,137,109.6,,3.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.9,70,,76.72,,,0,"percent of total billed charges ","70% of total billed charges ",123.3,90,,98.64,,,0,"percent of total billed charges ","90% of total billed charges ",127.41,93,,101.93,,,0,"percent of total billed charges ","93% of total billed charges ",3.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",116.45,85,,93.16,,,0,"percent of total billed charges ","85% of total billed charges ",123.3,90,,98.64,,,0,"percent of total billed charges ","90% of total billed charges ",123.3,90,,98.64,,,0,"percent of total billed charges ","90% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",119.19,87,,95.35,,,0,"percent of total billed charges ","87% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.58,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",95.9,70,,76.72,,,0,"percent of total billed charges ","70% of total billed charges ",3.58,127.41,
"*PH BODY FLUID NS",2016097,"CDM ",301,RC,83986,HCPCS,OUTPATIENT,,,35,28,,3.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.5,70,,19.60,,,0,"percent of total billed charges ","70% of total billed charges ",31.5,90,,25.20,,,0,"percent of total billed charges ","90% of total billed charges ",32.55,93,,26.04,,,0,"percent of total billed charges ","93% of total billed charges ",3.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",29.75,85,,23.80,,,0,"percent of total billed charges ","85% of total billed charges ",31.5,90,,25.20,,,0,"percent of total billed charges ","90% of total billed charges ",31.5,90,,25.20,,,0,"percent of total billed charges ","90% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.45,87,,24.36,,,0,"percent of total billed charges ","87% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.58,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",24.5,70,,19.60,,,0,"percent of total billed charges ","70% of total billed charges ",3.58,32.55,
"FK 506 (TACROLIMUS)",2016103,"CDM ",301,RC,80197,HCPCS,OUTPATIENT,,,187,149.6,,12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.62,80.62,80.62,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",173.91,93,,139.13,,,0,"percent of total billed charges ","93% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.86,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",158.95,85,,127.16,,,0,"percent of total billed charges ","85% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",15.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",162.69,87,,130.15,,,0,"percent of total billed charges ","87% of total billed charges ",15.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.73,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",12,173.91,
OXCARBAZEPINE,2016137,"CDM ",301,RC,82542,HCPCS,OUTPATIENT,,,187,149.6,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",173.91,93,,139.13,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",158.95,85,,127.16,,,0,"percent of total billed charges ","85% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",162.69,87,,130.15,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,173.91,
PREKALLIKREIN,2016145,"CDM ",305,RC,85292,HCPCS,OUTPATIENT,,,458,366.4,,16.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",320.6,70,,256.48,,,0,"percent of total billed charges ","70% of total billed charges ",412.2,90,,329.76,,,0,"percent of total billed charges ","90% of total billed charges ",425.94,93,,340.75,,,0,"percent of total billed charges ","93% of total billed charges ",16.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",389.3,85,,311.44,,,0,"percent of total billed charges ","85% of total billed charges ",412.2,90,,329.76,,,0,"percent of total billed charges ","90% of total billed charges ",412.2,90,,329.76,,,0,"percent of total billed charges ","90% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",398.46,87,,318.77,,,0,"percent of total billed charges ","87% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",320.6,70,,256.48,,,0,"percent of total billed charges ","70% of total billed charges ",15.45,425.94,
"ANTI-68 KD (HSP-70) ABS",2016178,"CDM ",301,RC,84182,HCPCS,OUTPATIENT,,,684.5,547.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",479.15,70,,383.32,,,0,"percent of total billed charges ","70% of total billed charges ",616.05,90,,492.84,,,0,"percent of total billed charges ","90% of total billed charges ",636.59,93,,509.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",581.83,85,,465.46,,,0,"percent of total billed charges ","85% of total billed charges ",616.05,90,,492.84,,,0,"percent of total billed charges ","90% of total billed charges ",616.05,90,,492.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",595.52,87,,476.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",29.21,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",479.15,70,,383.32,,,0,"percent of total billed charges ","70% of total billed charges ",29.21,636.59,
"BODY FLUID COUNT & DIFF BF",2016194,"CDM ",300,RC,89051,HCPCS,OUTPATIENT,,,148,118.4,,4.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.6,70,,82.88,,,0,"percent of total billed charges ","70% of total billed charges ",133.2,90,,106.56,,,0,"percent of total billed charges ","90% of total billed charges ",137.64,93,,110.11,,,0,"percent of total billed charges ","93% of total billed charges ",4.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.87,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",125.8,85,,100.64,,,0,"percent of total billed charges ","85% of total billed charges ",133.2,90,,106.56,,,0,"percent of total billed charges ","90% of total billed charges ",133.2,90,,106.56,,,0,"percent of total billed charges ","90% of total billed charges ",4.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",128.76,87,,103.01,,,0,"percent of total billed charges ","87% of total billed charges ",4.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.6,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",103.6,70,,82.88,,,0,"percent of total billed charges ","70% of total billed charges ",4.76,137.64,
"APOLIPOPROTEIN A-1",2016251,"CDM ",301,RC,82172,HCPCS,OUTPATIENT,,,72,57.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.4,70,,40.32,,,0,"percent of total billed charges ","70% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",66.96,93,,53.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",61.2,85,,48.96,,,0,"percent of total billed charges ","85% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",62.64,87,,50.11,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",21.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",50.4,70,,40.32,,,0,"percent of total billed charges ","70% of total billed charges ",21.09,66.96,
"TRILIPTAL (OXCARBAZEPINE)",2016277,"CDM ",301,RC,80183,HCPCS,OUTPATIENT,,,115.5,92.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.85,70,,64.68,,,0,"percent of total billed charges ","70% of total billed charges ",103.95,90,,83.16,,,0,"percent of total billed charges ","90% of total billed charges ",107.42,93,,85.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",98.18,85,,78.54,,,0,"percent of total billed charges ","85% of total billed charges ",103.95,90,,83.16,,,0,"percent of total billed charges ","90% of total billed charges ",103.95,90,,83.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.49,87,,80.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",13.25,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",80.85,70,,64.68,,,0,"percent of total billed charges ","70% of total billed charges ",13.25,107.42,
"*LCM VIRUS AB CSF",2016293,"CDM ",302,RC,86727,HCPCS,OUTPATIENT,,,451,360.8,,10.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",315.7,70,,252.56,,,0,"percent of total billed charges ","70% of total billed charges ",405.9,90,,324.72,,,0,"percent of total billed charges ","90% of total billed charges ",419.43,93,,335.54,,,0,"percent of total billed charges ","93% of total billed charges ",10.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",383.35,85,,306.68,,,0,"percent of total billed charges ","85% of total billed charges ",405.9,90,,324.72,,,0,"percent of total billed charges ","90% of total billed charges ",405.9,90,,324.72,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",392.37,87,,313.90,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.87,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",315.7,70,,252.56,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,419.43,
"POOLING BLOOD PRODUCT",2016301,"CDM ",300,RC,86965,HCPCS,OUTPATIENT,,,230,184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",161,70,,128.80,,,0,"percent of total billed charges ","70% of total billed charges ",207,90,,165.60,,,0,"percent of total billed charges ","90% of total billed charges ",213.9,93,,171.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",195.5,85,,156.40,,,0,"percent of total billed charges ","85% of total billed charges ",207,90,,165.60,,,0,"percent of total billed charges ","90% of total billed charges ",207,90,,165.60,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.1,87,,160.08,,,0,"percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",161,70,,128.80,,,0,"percent of total billed charges ","70% of total billed charges ",9.61,213.9,
KALLIKREIN,2016319,"CDM ",305,RC,85292,HCPCS,OUTPATIENT,,,416,332.8,,16.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",291.2,70,,232.96,,,0,"percent of total billed charges ","70% of total billed charges ",374.4,90,,299.52,,,0,"percent of total billed charges ","90% of total billed charges ",386.88,93,,309.50,,,0,"percent of total billed charges ","93% of total billed charges ",16.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",353.6,85,,282.88,,,0,"percent of total billed charges ","85% of total billed charges ",374.4,90,,299.52,,,0,"percent of total billed charges ","90% of total billed charges ",374.4,90,,299.52,,,0,"percent of total billed charges ","90% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",361.92,87,,289.54,,,0,"percent of total billed charges ","87% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",291.2,70,,232.96,,,0,"percent of total billed charges ","70% of total billed charges ",15.45,386.88,
"HEMOCHROMATOSIS DNA MUTATE ANA",2016327,"CDM ",301,RC,81256,HCPCS,OUTPATIENT,,,1500.5,1200.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1050.35,70,,840.28,,,0,"percent of total billed charges ","70% of total billed charges ",1350.45,90,,1080.36,,,0,"percent of total billed charges ","90% of total billed charges ",1395.47,93,,1116.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1275.43,85,,1020.34,,,0,"percent of total billed charges ","85% of total billed charges ",1350.45,90,,1080.36,,,0,"percent of total billed charges ","90% of total billed charges ",1350.45,90,,1080.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1305.44,87,,1031.38,1031.38,1031.38,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",65.36,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1050.35,70,,840.28,,,0,"percent of total billed charges ","70% of total billed charges ",65.36,1395.47,
"THAW PRODUCTS OTHER THAN FFP",2016350,"CDM ",300,RC,86999,HCPCS,OUTPATIENT,,,36.5,29.2,,51.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.55,70,,20.44,,,0,"percent of total billed charges ","70% of total billed charges ",32.85,90,,26.28,,,0,"percent of total billed charges ","90% of total billed charges ",33.95,93,,27.16,,,0,"percent of total billed charges ","93% of total billed charges ",51.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",31.03,85,,24.82,,,0,"percent of total billed charges ","85% of total billed charges ",32.85,90,,26.28,,,0,"percent of total billed charges ","90% of total billed charges ",32.85,90,,26.28,,,0,"percent of total billed charges ","90% of total billed charges ",64.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.76,87,,25.41,,,0,"percent of total billed charges ","87% of total billed charges ",64.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.59,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",25.55,70,,20.44,,,0,"percent of total billed charges ","70% of total billed charges ",25.55,65.35,
"INTRINSIC FACTOR BLOCKING AB",2016392,"CDM ",302,RC,86340,HCPCS,OUTPATIENT,,,221,176.8,,15.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,62.69,62.69,62.69,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154.7,70,,123.76,,,0,"percent of total billed charges ","70% of total billed charges ",198.9,90,,159.12,,,0,"percent of total billed charges ","90% of total billed charges ",205.53,93,,164.42,,,0,"percent of total billed charges ","93% of total billed charges ",15.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",187.85,85,,150.28,,,0,"percent of total billed charges ","85% of total billed charges ",198.9,90,,159.12,,,0,"percent of total billed charges ","90% of total billed charges ",198.9,90,,159.12,,,0,"percent of total billed charges ","90% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",192.27,87,,153.82,,,0,"percent of total billed charges ","87% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.08,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",154.7,70,,123.76,,,0,"percent of total billed charges ","70% of total billed charges ",15.08,205.53,
"PYRUVATE KINASE RBC",2016400,"CDM ",301,RC,84220,HCPCS,OUTPATIENT,,,511.5,409.2,,8.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",358.05,70,,286.44,,,0,"percent of total billed charges ","70% of total billed charges ",460.35,90,,368.28,,,0,"percent of total billed charges ","90% of total billed charges ",475.7,93,,380.56,,,0,"percent of total billed charges ","93% of total billed charges ",8.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",434.78,85,,347.82,,,0,"percent of total billed charges ","85% of total billed charges ",460.35,90,,368.28,,,0,"percent of total billed charges ","90% of total billed charges ",460.35,90,,368.28,,,0,"percent of total billed charges ","90% of total billed charges ",6.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",445.01,87,,356.01,,,0,"percent of total billed charges ","87% of total billed charges ",6.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.44,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",358.05,70,,286.44,,,0,"percent of total billed charges ","70% of total billed charges ",6.67,475.7,
"*PTT PLASMA SUBSTITUION",2016467,"CDM ",305,RC,85611,HCPCS,OUTPATIENT,,,57,45.6,,3.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.9,70,,31.92,,,0,"percent of total billed charges ","70% of total billed charges ",51.3,90,,41.04,,,0,"percent of total billed charges ","90% of total billed charges ",53.01,93,,42.41,,,0,"percent of total billed charges ","93% of total billed charges ",3.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",48.45,85,,38.76,,,0,"percent of total billed charges ","85% of total billed charges ",51.3,90,,41.04,,,0,"percent of total billed charges ","90% of total billed charges ",51.3,90,,41.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",49.59,87,,39.67,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.94,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",39.9,70,,31.92,,,0,"percent of total billed charges ","70% of total billed charges ",3.94,53.01,
"RUSSEL VIPER VENOM(LUPUS ANTI)",2016475,"CDM ",305,RC,85613,HCPCS,OUTPATIENT,,,64,51.2,,8.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.8,70,,35.84,,,0,"percent of total billed charges ","70% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",59.52,93,,47.62,,,0,"percent of total billed charges ","93% of total billed charges ",8.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",54.4,85,,43.52,,,0,"percent of total billed charges ","85% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",55.68,87,,55.59,55.59,55.59,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.58,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",44.8,70,,35.84,,,0,"percent of total billed charges ","70% of total billed charges ",6.87,59.52,
"MYCOPLASMA PNEUMONIAE IGM AB",2016483,"CDM ",302,RC,86738,HCPCS,OUTPATIENT,,,201.5,161.2,,11.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.05,70,,112.84,,,0,"percent of total billed charges ","70% of total billed charges ",181.35,90,,145.08,,,0,"percent of total billed charges ","90% of total billed charges ",187.4,93,,149.92,,,0,"percent of total billed charges ","93% of total billed charges ",11.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",171.28,85,,137.02,,,0,"percent of total billed charges ","85% of total billed charges ",181.35,90,,145.08,,,0,"percent of total billed charges ","90% of total billed charges ",181.35,90,,145.08,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",175.31,87,,140.25,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.24,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",141.05,70,,112.84,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,187.4,
"HEPATITIS B CORE AB IGM",2016491,"CDM ",302,RC,86705,HCPCS,OUTPATIENT,,,94,75.2,,11.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,40.78,40.78,40.78,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.8,70,,52.64,,,0,"percent of total billed charges ","70% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",87.42,93,,69.94,,,0,"percent of total billed charges ","93% of total billed charges ",11.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",79.9,85,,63.92,,,0,"percent of total billed charges ","85% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",19.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",81.78,87,,65.42,,,0,"percent of total billed charges ","87% of total billed charges ",19.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.77,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",65.8,70,,52.64,,,0,"percent of total billed charges ","70% of total billed charges ",11.77,87.42,
"ZYPREXA (OLANZAPINE)",2016509,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,289,231.2,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",202.3,70,,161.84,,,0,"percent of total billed charges ","70% of total billed charges ",260.1,90,,208.08,,,0,"percent of total billed charges ","90% of total billed charges ",268.77,93,,215.02,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",245.65,85,,196.52,,,0,"percent of total billed charges ","85% of total billed charges ",260.1,90,,208.08,,,0,"percent of total billed charges ","90% of total billed charges ",260.1,90,,208.08,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",251.43,87,,201.14,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",202.3,70,,161.84,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,268.77,
"MICROALBUMIN SEMI QUANT",2016517,"CDM ",301,RC,82044,HCPCS,OUTPATIENT,,,69,55.2,,5.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.3,70,,38.64,,,0,"percent of total billed charges ","70% of total billed charges ",62.1,90,,49.68,,,0,"percent of total billed charges ","90% of total billed charges ",64.17,93,,51.34,,,0,"percent of total billed charges ","93% of total billed charges ",5.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",58.65,85,,46.92,,,0,"percent of total billed charges ","85% of total billed charges ",62.1,90,,49.68,,,0,"percent of total billed charges ","90% of total billed charges ",62.1,90,,49.68,,,0,"percent of total billed charges ","90% of total billed charges ",1.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60.03,87,,48.02,,,0,"percent of total billed charges ","87% of total billed charges ",1.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.23,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",48.3,70,,38.64,,,0,"percent of total billed charges ","70% of total billed charges ",1.96,64.17,
"FOLATE, SERUM",2016525,"CDM ",301,RC,82746,HCPCS,OUTPATIENT,,,133,106.4,,14.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,14.41,14.41,56.10,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.1,70,,74.48,,,0,"percent of total billed charges ","70% of total billed charges ",119.7,90,,95.76,,,0,"percent of total billed charges ","90% of total billed charges ",123.69,93,,98.95,,,0,"percent of total billed charges ","93% of total billed charges ",14.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.85,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",113.05,85,,90.44,,,0,"percent of total billed charges ","85% of total billed charges ",119.7,90,,95.76,,,0,"percent of total billed charges ","90% of total billed charges ",119.7,90,,95.76,,,0,"percent of total billed charges ","90% of total billed charges ",26.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",115.71,87,,14.41,14.41,100.08,12,"percent of total billed charges ","87% of total billed charges ",26.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.7,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",93.1,70,,74.48,,,0,"percent of total billed charges ","70% of total billed charges ",14.7,123.69,
"VITAMIN B12",2016533,"CDM ",301,RC,82607,HCPCS,OUTPATIENT,,,189.5,151.6,,15.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,14.78,14.78,14.78,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.65,70,,106.12,,,0,"percent of total billed charges ","70% of total billed charges ",170.55,90,,136.44,,,0,"percent of total billed charges ","90% of total billed charges ",176.24,93,,140.99,,,0,"percent of total billed charges ","93% of total billed charges ",15.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",161.08,85,,128.86,,,0,"percent of total billed charges ","85% of total billed charges ",170.55,90,,136.44,,,0,"percent of total billed charges ","90% of total billed charges ",170.55,90,,136.44,,,0,"percent of total billed charges ","90% of total billed charges ",27.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",164.87,87,,19.84,14.78,146.97,16,"percent of total billed charges ","87% of total billed charges ",27.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.08,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",132.65,70,,106.12,,,0,"percent of total billed charges ","70% of total billed charges ",15.08,176.24,
"*GLIADIN IGA ANTIBODIES",2016582,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,90,72,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,83.7,
"*GLIADIN IGG ANTIBODIES",2016590,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,90,72,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,83.7,
"*ENDOMYSIAL IGA AUTOANTIBODIES",2016608,"CDM ",302,RC,86256,HCPCS,OUTPATIENT,,,165,132,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,17.72,12.99,22.44,"1 through 10","percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,153.45,
"*RETICULINE IGA AUTOANTIBODIES",2016616,"CDM ",302,RC,86256,HCPCS,OUTPATIENT,,,165,132,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,17.72,12.99,22.44,"1 through 10","percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,153.45,
RAPAMINE(SIROLIMUS),2016632,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,304,243.2,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",212.8,70,,170.24,,,0,"percent of total billed charges ","70% of total billed charges ",273.6,90,,218.88,,,0,"percent of total billed charges ","90% of total billed charges ",282.72,93,,226.18,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",258.4,85,,206.72,,,0,"percent of total billed charges ","85% of total billed charges ",273.6,90,,218.88,,,0,"percent of total billed charges ","90% of total billed charges ",273.6,90,,218.88,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.48,87,,211.58,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",212.8,70,,170.24,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,282.72,
CERULOPLASMIN,2016673,"CDM ",301,RC,82390,HCPCS,OUTPATIENT,,,81,64.8,,9.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.7,70,,45.36,,,0,"percent of total billed charges ","70% of total billed charges ",72.9,90,,58.32,,,0,"percent of total billed charges ","90% of total billed charges ",75.33,93,,60.26,,,0,"percent of total billed charges ","93% of total billed charges ",9.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",68.85,85,,55.08,,,0,"percent of total billed charges ","85% of total billed charges ",72.9,90,,58.32,,,0,"percent of total billed charges ","90% of total billed charges ",72.9,90,,58.32,,,0,"percent of total billed charges ","90% of total billed charges ",12.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.47,87,,56.38,,,0,"percent of total billed charges ","87% of total billed charges ",12.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",56.7,70,,45.36,,,0,"percent of total billed charges ","70% of total billed charges ",9.6,75.33,
"TRANSGLUTAMINASE IGG",2016723,"CDM ",301,RC,83516,HCPCS,OUTPATIENT,,,127,101.6,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.9,70,,71.12,,,0,"percent of total billed charges ","70% of total billed charges ",114.3,90,,91.44,,,0,"percent of total billed charges ","90% of total billed charges ",118.11,93,,94.49,,,0,"percent of total billed charges ","93% of total billed charges ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",107.95,85,,86.36,,,0,"percent of total billed charges ","85% of total billed charges ",114.3,90,,91.44,,,0,"percent of total billed charges ","90% of total billed charges ",114.3,90,,91.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",110.49,87,,53.32,28.74,77.90,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",88.9,70,,71.12,,,0,"percent of total billed charges ","70% of total billed charges ",10,118.11,
"HISTOPLASMA URINE",2016749,"CDM ",306,RC,87799,HCPCS,OUTPATIENT,,,2388,1910.4,,36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,301.18,301.18,301.18,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1671.6,70,,1337.28,,,0,"percent of total billed charges ","70% of total billed charges ",2149.2,90,,1719.36,,,0,"percent of total billed charges ","90% of total billed charges ",2220.84,93,,1776.67,,,0,"percent of total billed charges ","93% of total billed charges ",36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2029.8,85,,1623.84,,,0,"percent of total billed charges ","85% of total billed charges ",2149.2,90,,1719.36,,,0,"percent of total billed charges ","90% of total billed charges ",2149.2,90,,1719.36,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2077.56,87,,765.89,765.89,765.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.84,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1671.6,70,,1337.28,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,2220.84,
"THYROID PEROXIDASE ABS",2016756,"CDM ",302,RC,86376,HCPCS,OUTPATIENT,,,140.5,112.4,,14.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.97,60.97,60.97,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",130.67,93,,104.54,,,0,"percent of total billed charges ","93% of total billed charges ",14.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",119.43,85,,95.54,,,0,"percent of total billed charges ","85% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.24,87,,55.52,12.39,96.11,"1 through 10","percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.55,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",14.55,130.67,
"*HAV PANELV ANTIHAV TOTAL",2016806,"CDM ",302,RC,86708,HCPCS,OUTPATIENT,,,126.5,101.2,,12.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.55,70,,70.84,,,0,"percent of total billed charges ","70% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",117.65,93,,94.12,,,0,"percent of total billed charges ","93% of total billed charges ",12.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",107.53,85,,86.02,,,0,"percent of total billed charges ","85% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",19.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",110.06,87,,88.05,,,0,"percent of total billed charges ","87% of total billed charges ",19.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",88.55,70,,70.84,,,0,"percent of total billed charges ","70% of total billed charges ",12.39,117.65,
"*HAV PANELV ANTIHAV IGM",2016814,"CDM ",302,RC,86709,HCPCS,OUTPATIENT,,,140.5,112.4,,11.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,18.23,18.23,18.23,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",130.67,93,,104.54,,,0,"percent of total billed charges ","93% of total billed charges ",11.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",119.43,85,,95.54,,,0,"percent of total billed charges ","85% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",19.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.24,87,,97.79,,,0,"percent of total billed charges ","87% of total billed charges ",19.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.26,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",11.26,130.67,
"ANTI NEURONAL NUCLEAR AB",2016822,"CDM ",301,RC,84181,HCPCS,OUTPATIENT,,,181,144.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",126.7,70,,101.36,,,0,"percent of total billed charges ","70% of total billed charges ",162.9,90,,130.32,,,0,"percent of total billed charges ","90% of total billed charges ",168.33,93,,134.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",153.85,85,,123.08,,,0,"percent of total billed charges ","85% of total billed charges ",162.9,90,,130.32,,,0,"percent of total billed charges ","90% of total billed charges ",162.9,90,,130.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",157.47,87,,125.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",126.7,70,,101.36,,,0,"percent of total billed charges ","70% of total billed charges ",17.03,168.33,
"LATEX IGE",2016848,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,101,80.8,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.7,70,,56.56,,,0,"percent of total billed charges ","70% of total billed charges ",90.9,90,,72.72,,,0,"percent of total billed charges ","90% of total billed charges ",93.93,93,,75.14,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",85.85,85,,68.68,,,0,"percent of total billed charges ","85% of total billed charges ",90.9,90,,72.72,,,0,"percent of total billed charges ","90% of total billed charges ",90.9,90,,72.72,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",87.87,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",70.7,70,,56.56,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,93.93,
"*RICKETTSIA ABS IGM",2016855,"CDM ",302,RC,86757,HCPCS,OUTPATIENT,,,351,280.8,,19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",245.7,70,,196.56,,,0,"percent of total billed charges ","70% of total billed charges ",315.9,90,,252.72,,,0,"percent of total billed charges ","90% of total billed charges ",326.43,93,,261.14,,,0,"percent of total billed charges ","93% of total billed charges ",19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",298.35,85,,238.68,,,0,"percent of total billed charges ","85% of total billed charges ",315.9,90,,252.72,,,0,"percent of total billed charges ","90% of total billed charges ",315.9,90,,252.72,,,0,"percent of total billed charges ","90% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",305.37,87,,244.30,,,0,"percent of total billed charges ","87% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.35,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",245.7,70,,196.56,,,0,"percent of total billed charges ","70% of total billed charges ",19.35,326.43,
"*RICKETTSIA ABS IGG",2016863,"CDM ",302,RC,86757,HCPCS,OUTPATIENT,,,351,280.8,,19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",245.7,70,,196.56,,,0,"percent of total billed charges ","70% of total billed charges ",315.9,90,,252.72,,,0,"percent of total billed charges ","90% of total billed charges ",326.43,93,,261.14,,,0,"percent of total billed charges ","93% of total billed charges ",19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",298.35,85,,238.68,,,0,"percent of total billed charges ","85% of total billed charges ",315.9,90,,252.72,,,0,"percent of total billed charges ","90% of total billed charges ",315.9,90,,252.72,,,0,"percent of total billed charges ","90% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",305.37,87,,244.30,,,0,"percent of total billed charges ","87% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.35,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",245.7,70,,196.56,,,0,"percent of total billed charges ","70% of total billed charges ",19.35,326.43,
"*WEST NILE VIRUS IGG",2016871,"CDM ",302,RC,86790,HCPCS,OUTPATIENT,,,146,116.8,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.58,80.58,80.58,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,199.98,199.98,199.98,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,135.78,
"*WEST NILE VIRUS 1GM",2016889,"CDM ",302,RC,86790,HCPCS,OUTPATIENT,,,146,116.8,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.58,80.58,80.58,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,199.98,199.98,199.98,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,135.78,
BNP,2016905,"CDM ",301,RC,83880,HCPCS,OUTPATIENT,,,298,238.4,,33.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",208.6,70,,166.88,,,0,"percent of total billed charges ","70% of total billed charges ",268.2,90,,214.56,,,0,"percent of total billed charges ","90% of total billed charges ",277.14,93,,221.71,,,0,"percent of total billed charges ","93% of total billed charges ",33.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",253.3,85,,202.64,,,0,"percent of total billed charges ","85% of total billed charges ",268.2,90,,214.56,,,0,"percent of total billed charges ","90% of total billed charges ",268.2,90,,214.56,,,0,"percent of total billed charges ","90% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",259.26,87,,179.38,34.64,231.45,"1 through 10","percent of total billed charges ","87% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.26,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",208.6,70,,166.88,,,0,"percent of total billed charges ","70% of total billed charges ",30.22,277.14,
"*HEP PRO VII,HBCAR,TOT",2016939,"CDM ",302,RC,86704,HCPCS,OUTPATIENT,,,261.5,209.2,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",243.2,93,,194.56,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.29,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",222.28,85,,177.82,,,0,"percent of total billed charges ","85% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",19.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",227.51,87,,182.01,,,0,"percent of total billed charges ","87% of total billed charges ",19.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,243.2,
"HEP B VIRUS DNA",2016947,"CDM ",306,RC,87516,HCPCS,OUTPATIENT,,,340,272,,29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",238,70,,190.40,,,0,"percent of total billed charges ","70% of total billed charges ",306,90,,244.80,,,0,"percent of total billed charges ","90% of total billed charges ",316.2,93,,252.96,,,0,"percent of total billed charges ","93% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",289,85,,231.20,,,0,"percent of total billed charges ","85% of total billed charges ",306,90,,244.80,,,0,"percent of total billed charges ","90% of total billed charges ",306,90,,244.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",295.8,87,,236.64,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",238,70,,190.40,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,316.2,
"*HEP PRO VII,HBCAB,IGM",2016954,"CDM ",302,RC,86705,HCPCS,OUTPATIENT,,,278,222.4,,11.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,40.78,40.78,40.78,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",194.6,70,,155.68,,,0,"percent of total billed charges ","70% of total billed charges ",250.2,90,,200.16,,,0,"percent of total billed charges ","90% of total billed charges ",258.54,93,,206.83,,,0,"percent of total billed charges ","93% of total billed charges ",11.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",236.3,85,,189.04,,,0,"percent of total billed charges ","85% of total billed charges ",250.2,90,,200.16,,,0,"percent of total billed charges ","90% of total billed charges ",250.2,90,,200.16,,,0,"percent of total billed charges ","90% of total billed charges ",19.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",241.86,87,,193.49,,,0,"percent of total billed charges ","87% of total billed charges ",19.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.77,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",194.6,70,,155.68,,,0,"percent of total billed charges ","70% of total billed charges ",11.77,258.54,
"*HEP PRO VII,HBSAB",2016962,"CDM ",302,RC,86706,HCPCS,OUTPATIENT,,,261.5,209.2,,10.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",243.2,93,,194.56,,,0,"percent of total billed charges ","93% of total billed charges ",10.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",222.28,85,,177.82,,,0,"percent of total billed charges ","85% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",19.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",227.51,87,,182.01,,,0,"percent of total billed charges ","87% of total billed charges ",19.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",10.74,243.2,
"*HEP PRO VII,HBEAB",2016970,"CDM ",302,RC,86707,HCPCS,OUTPATIENT,,,183.5,146.8,,11.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,41.56,41.56,41.56,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",170.66,93,,136.53,,,0,"percent of total billed charges ","93% of total billed charges ",11.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",155.98,85,,124.78,,,0,"percent of total billed charges ","85% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",19.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",159.65,87,,127.72,,,0,"percent of total billed charges ","87% of total billed charges ",19.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.57,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",11.57,170.66,
"*HEP PRO VII,HAAB,TOT",2016988,"CDM ",302,RC,86708,HCPCS,OUTPATIENT,,,240,192,,12.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",168,70,,134.40,,,0,"percent of total billed charges ","70% of total billed charges ",216,90,,172.80,,,0,"percent of total billed charges ","90% of total billed charges ",223.2,93,,178.56,,,0,"percent of total billed charges ","93% of total billed charges ",12.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",204,85,,163.20,,,0,"percent of total billed charges ","85% of total billed charges ",216,90,,172.80,,,0,"percent of total billed charges ","90% of total billed charges ",216,90,,172.80,,,0,"percent of total billed charges ","90% of total billed charges ",19.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",208.8,87,,167.04,,,0,"percent of total billed charges ","87% of total billed charges ",19.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",168,70,,134.40,,,0,"percent of total billed charges ","70% of total billed charges ",12.39,223.2,
"*HEP PRO VII,HAAB,IGM",2016996,"CDM ",302,RC,86709,HCPCS,OUTPATIENT,,,337,269.6,,11.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,18.23,18.23,18.23,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",235.9,70,,188.72,,,0,"percent of total billed charges ","70% of total billed charges ",303.3,90,,242.64,,,0,"percent of total billed charges ","90% of total billed charges ",313.41,93,,250.73,,,0,"percent of total billed charges ","93% of total billed charges ",11.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",286.45,85,,229.16,,,0,"percent of total billed charges ","85% of total billed charges ",303.3,90,,242.64,,,0,"percent of total billed charges ","90% of total billed charges ",303.3,90,,242.64,,,0,"percent of total billed charges ","90% of total billed charges ",19.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",293.19,87,,234.55,,,0,"percent of total billed charges ","87% of total billed charges ",19.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.26,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",235.9,70,,188.72,,,0,"percent of total billed charges ","70% of total billed charges ",11.26,313.41,
"*HEP PRO VII,HBSAG",2017002,"CDM ",306,RC,87340,HCPCS,OUTPATIENT,,,237.5,190,,10.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",166.25,70,,133.00,,,0,"percent of total billed charges ","70% of total billed charges ",213.75,90,,171.00,,,0,"percent of total billed charges ","90% of total billed charges ",220.88,93,,176.70,,,0,"percent of total billed charges ","93% of total billed charges ",10.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",201.88,85,,161.50,,,0,"percent of total billed charges ","85% of total billed charges ",213.75,90,,171.00,,,0,"percent of total billed charges ","90% of total billed charges ",213.75,90,,171.00,,,0,"percent of total billed charges ","90% of total billed charges ",15.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",206.63,87,,46.55,46.55,46.55,11,"percent of total billed charges ","87% of total billed charges ",15.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.33,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",166.25,70,,133.00,,,0,"percent of total billed charges ","70% of total billed charges ",10.33,220.88,
"*HEP PRO VII,HBEAG",2017010,"CDM ",306,RC,87350,HCPCS,OUTPATIENT,,,168.5,134.8,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",156.71,93,,125.37,,,0,"percent of total billed charges ","93% of total billed charges ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.23,85,,114.58,,,0,"percent of total billed charges ","85% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",146.6,87,,117.28,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",10,156.71,
"*PROTEIN C",2017044,"CDM ",305,RC,85303,HCPCS,OUTPATIENT,,,167.5,134,,13.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.25,70,,93.80,,,0,"percent of total billed charges ","70% of total billed charges ",150.75,90,,120.60,,,0,"percent of total billed charges ","90% of total billed charges ",155.78,93,,124.62,,,0,"percent of total billed charges ","93% of total billed charges ",13.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",142.38,85,,113.90,,,0,"percent of total billed charges ","85% of total billed charges ",150.75,90,,120.60,,,0,"percent of total billed charges ","90% of total billed charges ",150.75,90,,120.60,,,0,"percent of total billed charges ","90% of total billed charges ",21.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",145.73,87,,145.25,145.25,145.25,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.84,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.25,70,,93.80,,,0,"percent of total billed charges ","70% of total billed charges ",13.84,155.78,
"*PROTEIN S",2017051,"CDM ",305,RC,85306,HCPCS,OUTPATIENT,,,201,160.8,,15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.7,70,,112.56,,,0,"percent of total billed charges ","70% of total billed charges ",180.9,90,,144.72,,,0,"percent of total billed charges ","90% of total billed charges ",186.93,93,,149.54,,,0,"percent of total billed charges ","93% of total billed charges ",15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",170.85,85,,136.68,,,0,"percent of total billed charges ","85% of total billed charges ",180.9,90,,144.72,,,0,"percent of total billed charges ","90% of total billed charges ",180.9,90,,144.72,,,0,"percent of total billed charges ","90% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",174.87,87,,174.12,174.12,174.12,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.32,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",140.7,70,,112.56,,,0,"percent of total billed charges ","70% of total billed charges ",15.32,186.93,
"*VONWILLEBRAND FACTOR AG #0862",2017077,"CDM ",305,RC,85246,HCPCS,OUTPATIENT,,,173,138.4,,19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",121.1,70,,96.88,,,0,"percent of total billed charges ","70% of total billed charges ",155.7,90,,124.56,,,0,"percent of total billed charges ","90% of total billed charges ",160.89,93,,128.71,,,0,"percent of total billed charges ","93% of total billed charges ",19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",147.05,85,,117.64,,,0,"percent of total billed charges ","85% of total billed charges ",155.7,90,,124.56,,,0,"percent of total billed charges ","90% of total billed charges ",155.7,90,,124.56,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",150.51,87,,149.99,149.99,149.99,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.94,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",121.1,70,,96.88,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,160.89,
"SUSCEPTIBILITY TEST NUC51",2017127,"CDM ",306,RC,87186,HCPCS,OUTPATIENT,,,270.5,216.4,,8.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",189.35,70,,151.48,,,0,"percent of total billed charges ","70% of total billed charges ",243.45,90,,194.76,,,0,"percent of total billed charges ","90% of total billed charges ",251.57,93,,201.26,,,0,"percent of total billed charges ","93% of total billed charges ",8.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",229.93,85,,183.94,,,0,"percent of total billed charges ","85% of total billed charges ",243.45,90,,194.76,,,0,"percent of total billed charges ","90% of total billed charges ",243.45,90,,194.76,,,0,"percent of total billed charges ","90% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",235.34,87,,8.48,8.48,105.80,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.65,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",189.35,70,,151.48,,,0,"percent of total billed charges ","70% of total billed charges ",8.65,251.57,
"17 A HYDROXYPROGRESERONE",2017135,"CDM ",301,RC,83498,HCPCS,OUTPATIENT,,,187,149.6,,27.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",173.91,93,,139.13,,,0,"percent of total billed charges ","93% of total billed charges ",27.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",158.95,85,,127.16,,,0,"percent of total billed charges ","85% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",36.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",162.69,87,,130.15,,,0,"percent of total billed charges ","87% of total billed charges ",36.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.17,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",27.17,173.91,
"CRYPTOCOCCUS AG CSF",2017150,"CDM ",306,RC,87449,HCPCS,OUTPATIENT,,,156,124.8,,11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",145.08,93,,116.06,,,0,"percent of total billed charges ","93% of total billed charges ",11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",132.6,85,,106.08,,,0,"percent of total billed charges ","85% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",135.72,87,,108.58,,,0,"percent of total billed charges ","87% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",11.98,145.08,
"*VON WILLIBRAND VIII RISTO",2017168,"CDM ",305,RC,85245,HCPCS,OUTPATIENT,,,173,138.4,,19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",121.1,70,,96.88,,,0,"percent of total billed charges ","70% of total billed charges ",155.7,90,,124.56,,,0,"percent of total billed charges ","90% of total billed charges ",160.89,93,,128.71,,,0,"percent of total billed charges ","93% of total billed charges ",19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",147.05,85,,117.64,,,0,"percent of total billed charges ","85% of total billed charges ",155.7,90,,124.56,,,0,"percent of total billed charges ","90% of total billed charges ",155.7,90,,124.56,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",150.51,87,,149.99,149.99,149.99,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.94,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",121.1,70,,96.88,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,160.89,
"SUSCEPTIBILITY TEST PC20",2017184,"CDM ",306,RC,87186,HCPCS,OUTPATIENT,,,248.5,198.8,,8.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.95,70,,139.16,,,0,"percent of total billed charges ","70% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",231.11,93,,184.89,,,0,"percent of total billed charges ","93% of total billed charges ",8.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",211.23,85,,168.98,,,0,"percent of total billed charges ","85% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",216.2,87,,8.48,8.48,105.80,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.65,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",173.95,70,,139.16,,,0,"percent of total billed charges ","70% of total billed charges ",8.65,231.11,
CEA,2017192,"CDM ",301,RC,82378,HCPCS,OUTPATIENT,,,374,299.2,,18.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",261.8,70,,209.44,,,0,"percent of total billed charges ","70% of total billed charges ",336.6,90,,269.28,,,0,"percent of total billed charges ","90% of total billed charges ",347.82,93,,278.26,,,0,"percent of total billed charges ","93% of total billed charges ",18.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.58,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",317.9,85,,254.32,,,0,"percent of total billed charges ","85% of total billed charges ",336.6,90,,269.28,,,0,"percent of total billed charges ","90% of total billed charges ",336.6,90,,269.28,,,0,"percent of total billed charges ","90% of total billed charges ",34.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",325.38,87,,94.14,33.70,251.22,"1 through 10","percent of total billed charges ","87% of total billed charges ",34.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.96,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",261.8,70,,209.44,,,0,"percent of total billed charges ","70% of total billed charges ",18.96,347.82,
PNEUMOSLIDE,2017226,"CDM ",300,RC,87077,HCPCS,OUTPATIENT,,,143,114.4,,8.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",100.1,70,,80.08,,,0,"percent of total billed charges ","70% of total billed charges ",128.7,90,,102.96,,,0,"percent of total billed charges ","90% of total billed charges ",132.99,93,,106.39,,,0,"percent of total billed charges ","93% of total billed charges ",8.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.54,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",121.55,85,,97.24,,,0,"percent of total billed charges ","85% of total billed charges ",128.7,90,,102.96,,,0,"percent of total billed charges ","90% of total billed charges ",128.7,90,,102.96,,,0,"percent of total billed charges ","90% of total billed charges ",12.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",124.41,87,,99.53,,,0,"percent of total billed charges ","87% of total billed charges ",12.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.08,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",100.1,70,,80.08,,,0,"percent of total billed charges ","70% of total billed charges ",8.08,132.99,
"PNEUMOCYSTIS CARINIL PNEUMONIA",2017309,"CDM ",306,RC,87281,HCPCS,OUTPATIENT,,,155.5,124.4,,11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.85,70,,87.08,,,0,"percent of total billed charges ","70% of total billed charges ",139.95,90,,111.96,,,0,"percent of total billed charges ","90% of total billed charges ",144.62,93,,115.70,,,0,"percent of total billed charges ","93% of total billed charges ",11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",132.18,85,,105.74,,,0,"percent of total billed charges ","85% of total billed charges ",139.95,90,,111.96,,,0,"percent of total billed charges ","90% of total billed charges ",139.95,90,,111.96,,,0,"percent of total billed charges ","90% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",135.29,87,,108.23,,,0,"percent of total billed charges ","87% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",108.85,70,,87.08,,,0,"percent of total billed charges ","70% of total billed charges ",11.98,144.62,
"LEGIONELLA SPECIES CULTURE #86",2017317,"CDM ",306,RC,87081,HCPCS,OUTPATIENT,,,133,106.4,,6.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.1,70,,74.48,,,0,"percent of total billed charges ","70% of total billed charges ",119.7,90,,95.76,,,0,"percent of total billed charges ","90% of total billed charges ",123.69,93,,98.95,,,0,"percent of total billed charges ","93% of total billed charges ",6.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",113.05,85,,90.44,,,0,"percent of total billed charges ","85% of total billed charges ",119.7,90,,95.76,,,0,"percent of total billed charges ","90% of total billed charges ",119.7,90,,95.76,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",115.71,87,,156.45,156.45,156.45,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.63,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",93.1,70,,74.48,,,0,"percent of total billed charges ","70% of total billed charges ",6.63,123.69,
"METHOTREXATE SERUM",2017325,"CDM ",300,RC,80299,HCPCS,OUTPATIENT,,,168.5,134.8,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",156.71,93,,125.37,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.23,85,,114.58,,,0,"percent of total billed charges ","85% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",146.6,87,,117.28,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,156.71,
"MYCOPLASMA IGG ABS",2017341,"CDM ",302,RC,86738,HCPCS,OUTPATIENT,,,201.5,161.2,,11.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.05,70,,112.84,,,0,"percent of total billed charges ","70% of total billed charges ",181.35,90,,145.08,,,0,"percent of total billed charges ","90% of total billed charges ",187.4,93,,149.92,,,0,"percent of total billed charges ","93% of total billed charges ",11.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",171.28,85,,137.02,,,0,"percent of total billed charges ","85% of total billed charges ",181.35,90,,145.08,,,0,"percent of total billed charges ","90% of total billed charges ",181.35,90,,145.08,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",175.31,87,,140.25,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.24,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",141.05,70,,112.84,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,187.4,
"*BLOOD SMEAR W/ MANUAL DIFF",2017440,"CDM ",305,RC,85007,HCPCS,OUTPATIENT,,,49,39.2,,3.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",3.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",2.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,33.79,3.73,42.24,"1 through 10","percent of total billed charges ","87% of total billed charges ",2.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.8,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",2.74,45.57,
"AMINO ACID PROF,QUANT URINE",2017531,"CDM ",301,RC,82139,HCPCS,OUTPATIENT,,,2160,1728,,16.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1512,70,,1209.60,,,0,"percent of total billed charges ","70% of total billed charges ",1944,90,,1555.20,,,0,"percent of total billed charges ","90% of total billed charges ",2008.8,93,,1607.04,,,0,"percent of total billed charges ","93% of total billed charges ",16.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1836,85,,1468.80,,,0,"percent of total billed charges ","85% of total billed charges ",1944,90,,1555.20,,,0,"percent of total billed charges ","90% of total billed charges ",1944,90,,1555.20,,,0,"percent of total billed charges ","90% of total billed charges ",23.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1879.2,87,,1503.36,,,0,"percent of total billed charges ","87% of total billed charges ",23.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.87,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1512,70,,1209.60,,,0,"percent of total billed charges ","70% of total billed charges ",16.87,2008.8,
"EBV QUANT BY VIRAL LOAD PCR",2017572,"CDM ",306,RC,87799,HCPCS,OUTPATIENT,,,1114,891.2,,36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,301.18,301.18,301.18,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",779.8,70,,623.84,,,0,"percent of total billed charges ","70% of total billed charges ",1002.6,90,,802.08,,,0,"percent of total billed charges ","90% of total billed charges ",1036.02,93,,828.82,,,0,"percent of total billed charges ","93% of total billed charges ",36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",946.9,85,,757.52,,,0,"percent of total billed charges ","85% of total billed charges ",1002.6,90,,802.08,,,0,"percent of total billed charges ","90% of total billed charges ",1002.6,90,,802.08,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",969.18,87,,765.89,765.89,765.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.84,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",779.8,70,,623.84,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,1036.02,
"KEPPRA (LEVETIRACETAM)",2017598,"CDM ",301,RC,80177,HCPCS,OUTPATIENT,,,588,470.4,,13.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,32.72,32.72,32.72,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",411.6,70,,329.28,,,0,"percent of total billed charges ","70% of total billed charges ",529.2,90,,423.36,,,0,"percent of total billed charges ","90% of total billed charges ",546.84,93,,437.47,,,0,"percent of total billed charges ","93% of total billed charges ",13.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",499.8,85,,399.84,,,0,"percent of total billed charges ","85% of total billed charges ",529.2,90,,423.36,,,0,"percent of total billed charges ","90% of total billed charges ",529.2,90,,423.36,,,0,"percent of total billed charges ","90% of total billed charges ",20.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",511.56,87,,409.25,,,0,"percent of total billed charges ","87% of total billed charges ",20.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.25,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",411.6,70,,329.28,,,0,"percent of total billed charges ","70% of total billed charges ",13.25,546.84,
"FACTOR V LEIDEN MUTATION",2017606,"CDM ",301,RC,81241,HCPCS,OUTPATIENT,,,307,245.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.9,70,,171.92,,,0,"percent of total billed charges ","70% of total billed charges ",276.3,90,,221.04,,,0,"percent of total billed charges ","90% of total billed charges ",285.51,93,,228.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",260.95,85,,208.76,,,0,"percent of total billed charges ","85% of total billed charges ",276.3,90,,221.04,,,0,"percent of total billed charges ","90% of total billed charges ",276.3,90,,221.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.09,87,,213.67,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",73.37,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",214.9,70,,171.92,,,0,"percent of total billed charges ","70% of total billed charges ",73.37,285.51,
"*MERCURY, URINE CREATININE",2017648,"CDM ",301,RC,82570,HCPCS,OUTPATIENT,,,47,37.6,,5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",43.71,93,,34.97,,,0,"percent of total billed charges ","93% of total billed charges ",5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.95,85,,31.96,,,0,"percent of total billed charges ","85% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.89,87,,5.08,4.98,50.30,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",5.18,43.71,
"*MERCURY, URINE ASSAY",2017655,"CDM ",301,RC,83825,HCPCS,OUTPATIENT,,,53,42.4,,13.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,42.75,42.75,42.75,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",49.29,93,,39.43,,,0,"percent of total billed charges ","93% of total billed charges ",13.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.05,85,,36.04,,,0,"percent of total billed charges ","85% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.11,87,,36.89,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.26,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",13.18,49.29,
TRYPTASE,2017663,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,99.5,79.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.65,70,,55.72,,,0,"percent of total billed charges ","70% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",92.54,93,,74.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",84.58,85,,67.66,,,0,"percent of total billed charges ","85% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",86.57,87,,69.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",69.65,70,,55.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,92.54,
"METANEPHRINES FRAC FREE PLASMA",2017671,"CDM ",301,RC,83835,HCPCS,OUTPATIENT,,,263.5,210.8,,16.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",184.45,70,,147.56,,,0,"percent of total billed charges ","70% of total billed charges ",237.15,90,,189.72,,,0,"percent of total billed charges ","90% of total billed charges ",245.06,93,,196.05,,,0,"percent of total billed charges ","93% of total billed charges ",16.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.06,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",223.98,85,,179.18,,,0,"percent of total billed charges ","85% of total billed charges ",237.15,90,,189.72,,,0,"percent of total billed charges ","90% of total billed charges ",237.15,90,,189.72,,,0,"percent of total billed charges ","90% of total billed charges ",29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",229.25,87,,183.40,,,0,"percent of total billed charges ","87% of total billed charges ",29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.94,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",184.45,70,,147.56,,,0,"percent of total billed charges ","70% of total billed charges ",16.94,245.06,
"HERPES SIM VIRUS CULT W/O TYPI",2017689,"CDM ",306,RC,87255,HCPCS,OUTPATIENT,,,224.5,179.6,,28.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",208.79,93,,167.03,,,0,"percent of total billed charges ","93% of total billed charges ",28.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",190.83,85,,152.66,,,0,"percent of total billed charges ","85% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.32,87,,156.26,,,0,"percent of total billed charges ","87% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.86,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",19.62,208.79,
"HERPES SIM VIRUS CULT RFLX TYP",2017692,"CDM ",306,RC,87255,HCPCS,OUTPATIENT,,,224.5,179.6,,28.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",208.79,93,,167.03,,,0,"percent of total billed charges ","93% of total billed charges ",28.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",190.83,85,,152.66,,,0,"percent of total billed charges ","85% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.32,87,,156.26,,,0,"percent of total billed charges ","87% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.86,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",19.62,208.79,
"*WEST NILE VIRUS CSF IGM",2017705,"CDM ",302,RC,86790,HCPCS,OUTPATIENT,,,146,116.8,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.58,80.58,80.58,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,199.98,199.98,199.98,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,135.78,
"*WEST NILE VIRUS CSF IGG",2017713,"CDM ",302,RC,86790,HCPCS,OUTPATIENT,,,146,116.8,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.58,80.58,80.58,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,199.98,199.98,199.98,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,135.78,
"ST LOUIS ENCEPHALITIS SER IGM",2017721,"CDM ",302,RC,86653,HCPCS,OUTPATIENT,,,239.5,191.6,,11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.65,70,,134.12,,,0,"percent of total billed charges ","70% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",222.74,93,,178.19,,,0,"percent of total billed charges ","93% of total billed charges ",11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",203.58,85,,162.86,,,0,"percent of total billed charges ","85% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",208.37,87,,166.70,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",167.65,70,,134.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,222.74,
"ST LOUIS ENCEPHALITIS SER IGG",2017739,"CDM ",302,RC,86653,HCPCS,OUTPATIENT,,,164.5,131.6,,11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.15,70,,92.12,,,0,"percent of total billed charges ","70% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",152.99,93,,122.39,,,0,"percent of total billed charges ","93% of total billed charges ",11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",139.83,85,,111.86,,,0,"percent of total billed charges ","85% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.12,87,,114.50,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.15,70,,92.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,152.99,
"STRIATIONAL ABS",2017747,"CDM ",302,RC,86256,HCPCS,OUTPATIENT,,,198,158.4,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",138.6,70,,110.88,,,0,"percent of total billed charges ","70% of total billed charges ",178.2,90,,142.56,,,0,"percent of total billed charges ","90% of total billed charges ",184.14,93,,147.31,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",168.3,85,,134.64,,,0,"percent of total billed charges ","85% of total billed charges ",178.2,90,,142.56,,,0,"percent of total billed charges ","90% of total billed charges ",178.2,90,,142.56,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",172.26,87,,17.72,12.99,22.44,"1 through 10","percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",138.6,70,,110.88,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,184.14,
"*HANTAVIRUS AB IGG",2017762,"CDM ",302,RC,86790,HCPCS,OUTPATIENT,,,609,487.2,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.58,80.58,80.58,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",426.3,70,,341.04,,,0,"percent of total billed charges ","70% of total billed charges ",548.1,90,,438.48,,,0,"percent of total billed charges ","90% of total billed charges ",566.37,93,,453.10,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",517.65,85,,414.12,,,0,"percent of total billed charges ","85% of total billed charges ",548.1,90,,438.48,,,0,"percent of total billed charges ","90% of total billed charges ",548.1,90,,438.48,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",529.83,87,,199.98,199.98,199.98,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",426.3,70,,341.04,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,566.37,
"*HANTAVIRUS AB IGM",2017770,"CDM ",302,RC,86790,HCPCS,OUTPATIENT,,,609,487.2,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.58,80.58,80.58,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",426.3,70,,341.04,,,0,"percent of total billed charges ","70% of total billed charges ",548.1,90,,438.48,,,0,"percent of total billed charges ","90% of total billed charges ",566.37,93,,453.10,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",517.65,85,,414.12,,,0,"percent of total billed charges ","85% of total billed charges ",548.1,90,,438.48,,,0,"percent of total billed charges ","90% of total billed charges ",548.1,90,,438.48,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",529.83,87,,199.98,199.98,199.98,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",426.3,70,,341.04,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,566.37,
"WEST NILE VIRUS PCR SERUM",2017788,"CDM ",306,RC,87798,HCPCS,OUTPATIENT,,,1582,1265.6,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1107.4,70,,885.92,,,0,"percent of total billed charges ","70% of total billed charges ",1423.8,90,,1139.04,,,0,"percent of total billed charges ","90% of total billed charges ",1471.26,93,,1177.01,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1344.7,85,,1075.76,,,0,"percent of total billed charges ","85% of total billed charges ",1423.8,90,,1139.04,,,0,"percent of total billed charges ","90% of total billed charges ",1423.8,90,,1139.04,,,0,"percent of total billed charges ","90% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1376.34,87,,1101.07,,,0,"percent of total billed charges ","87% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1107.4,70,,885.92,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,1471.26,
"MONOCLONAL GAMMOPATHIES URINE",2017820,"CDM ",302,RC,86335,HCPCS,OUTPATIENT,,,213.5,170.8,,29.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.45,70,,119.56,,,0,"percent of total billed charges ","70% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",198.56,93,,158.85,,,0,"percent of total billed charges ","93% of total billed charges ",29.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",181.48,85,,145.18,,,0,"percent of total billed charges ","85% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",45.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",185.75,87,,148.60,,,0,"percent of total billed charges ","87% of total billed charges ",45.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.35,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",149.45,70,,119.56,,,0,"percent of total billed charges ","70% of total billed charges ",29.35,198.56,
"ASPERGILLUS FUMIGATUS IGE",2017838,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"ASPERGILLUS FUMIGATUS IGG",2017846,"CDM ",302,RC,86001,HCPCS,OUTPATIENT,,,81.5,65.2,,6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",75.8,93,,60.64,,,0,"percent of total billed charges ","93% of total billed charges ",6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",69.28,85,,55.42,,,0,"percent of total billed charges ","85% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.91,87,,56.73,,,0,"percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",6.65,75.8,
"*LUPUS PLATELET NEUTRALIZATION",2017861,"CDM ",305,RC,85597,HCPCS,OUTPATIENT,,,267.5,214,,17.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,134.09,134.09,134.09,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",248.78,93,,199.02,,,0,"percent of total billed charges ","93% of total billed charges ",17.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",227.38,85,,181.90,,,0,"percent of total billed charges ","85% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",25.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",232.73,87,,231.88,231.88,231.88,"1 through 10","percent of total billed charges ","87% of total billed charges ",25.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",17.98,248.78,
"*LUPUS ANTICOAG RVVDIL",2017879,"CDM ",305,RC,85613,HCPCS,OUTPATIENT,,,72.5,58,,8.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.75,70,,40.60,,,0,"percent of total billed charges ","70% of total billed charges ",65.25,90,,52.20,,,0,"percent of total billed charges ","90% of total billed charges ",67.43,93,,53.94,,,0,"percent of total billed charges ","93% of total billed charges ",8.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",61.63,85,,49.30,,,0,"percent of total billed charges ","85% of total billed charges ",65.25,90,,52.20,,,0,"percent of total billed charges ","90% of total billed charges ",65.25,90,,52.20,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.08,87,,55.59,55.59,55.59,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.58,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",50.75,70,,40.60,,,0,"percent of total billed charges ","70% of total billed charges ",6.87,67.43,
"*LUPUS ANTICOAG PTT",2017895,"CDM ",305,RC,85730,HCPCS,OUTPATIENT,,,72.5,58,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.75,70,,40.60,,,0,"percent of total billed charges ","70% of total billed charges ",65.25,90,,52.20,,,0,"percent of total billed charges ","90% of total billed charges ",67.43,93,,53.94,,,0,"percent of total billed charges ","93% of total billed charges ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",61.63,85,,49.30,,,0,"percent of total billed charges ","85% of total billed charges ",65.25,90,,52.20,,,0,"percent of total billed charges ","90% of total billed charges ",65.25,90,,52.20,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.08,87,,49.13,5.89,151.44,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",50.75,70,,40.60,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,67.43,
"*LUPUS ANTICOAG PTT SUB1",2017903,"CDM ",305,RC,85732,HCPCS,OUTPATIENT,,,72.5,58,,5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.75,70,,40.60,,,0,"percent of total billed charges ","70% of total billed charges ",65.25,90,,52.20,,,0,"percent of total billed charges ","90% of total billed charges ",67.43,93,,53.94,,,0,"percent of total billed charges ","93% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",61.63,85,,49.30,,,0,"percent of total billed charges ","85% of total billed charges ",65.25,90,,52.20,,,0,"percent of total billed charges ","90% of total billed charges ",65.25,90,,52.20,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.08,87,,50.46,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.47,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",50.75,70,,40.60,,,0,"percent of total billed charges ","70% of total billed charges ",5.5,67.43,
"*ASPERGILLUS PREC A",2017937,"CDM ",302,RC,86606,HCPCS,OUTPATIENT,,,156,124.8,,12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,55.22,55.22,55.22,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",145.08,93,,116.06,,,0,"percent of total billed charges ","93% of total billed charges ",12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",132.6,85,,106.08,,,0,"percent of total billed charges ","85% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",135.72,87,,108.58,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,145.08,
"*ASPERGILLUS PREC B",2017945,"CDM ",302,RC,86606,HCPCS,OUTPATIENT,,,156,124.8,,12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,55.22,55.22,55.22,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",145.08,93,,116.06,,,0,"percent of total billed charges ","93% of total billed charges ",12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",132.6,85,,106.08,,,0,"percent of total billed charges ","85% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",135.72,87,,108.58,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,145.08,
"*ASPERGILLUS PREC C",2017952,"CDM ",302,RC,86606,HCPCS,OUTPATIENT,,,156,124.8,,12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,55.22,55.22,55.22,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",145.08,93,,116.06,,,0,"percent of total billed charges ","93% of total billed charges ",12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",132.6,85,,106.08,,,0,"percent of total billed charges ","85% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",135.72,87,,108.58,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,145.08,
"*ASPERGILLUS ANTIBODY SERUM",2017955,"CDM ",302,RC,86603,HCPCS,OUTPATIENT,,,30,24,,10.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21,70,,16.80,,,0,"percent of total billed charges ","70% of total billed charges ",27,90,,21.60,,,0,"percent of total billed charges ","90% of total billed charges ",27.9,93,,22.32,,,0,"percent of total billed charges ","93% of total billed charges ",10.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",25.5,85,,20.40,,,0,"percent of total billed charges ","85% of total billed charges ",27,90,,21.60,,,0,"percent of total billed charges ","90% of total billed charges ",27,90,,21.60,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.1,87,,20.88,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.87,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",21,70,,16.80,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,27.9,
"THYROID-STIMULATING IMMUNOGLOB",2017978,"CDM ",301,RC,84445,HCPCS,OUTPATIENT,,,894,715.2,,50.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,393.69,393.69,393.69,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",625.8,70,,500.64,,,0,"percent of total billed charges ","70% of total billed charges ",804.6,90,,643.68,,,0,"percent of total billed charges ","90% of total billed charges ",831.42,93,,665.14,,,0,"percent of total billed charges ","93% of total billed charges ",50.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",88.47,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",759.9,85,,607.92,,,0,"percent of total billed charges ","85% of total billed charges ",804.6,90,,643.68,,,0,"percent of total billed charges ","90% of total billed charges ",804.6,90,,643.68,,,0,"percent of total billed charges ","90% of total billed charges ",87.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",777.78,87,,438.97,145.39,629.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",87.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",50.86,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",625.8,70,,500.64,,,0,"percent of total billed charges ","70% of total billed charges ",50.86,831.42,
"C-REACTIVE PROT,HIGH SENSITIVI",2017986,"CDM ",302,RC,86141,HCPCS,OUTPATIENT,,,226,180.8,,11.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,162.00,162.00,162.00,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",158.2,70,,126.56,,,0,"percent of total billed charges ","70% of total billed charges ",203.4,90,,162.72,,,0,"percent of total billed charges ","90% of total billed charges ",210.18,93,,168.14,,,0,"percent of total billed charges ","93% of total billed charges ",11.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",192.1,85,,153.68,,,0,"percent of total billed charges ","85% of total billed charges ",203.4,90,,162.72,,,0,"percent of total billed charges ","90% of total billed charges ",203.4,90,,162.72,,,0,"percent of total billed charges ","90% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",196.62,87,,124.13,124.13,124.13,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.95,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",158.2,70,,126.56,,,0,"percent of total billed charges ","70% of total billed charges ",8.24,210.18,
"GLUTAMIC ACID DECARBOXYLASE",2017994,"CDM ",301,RC,86341,HCPCS,OUTPATIENT,,,222.5,178,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.75,70,,124.60,,,0,"percent of total billed charges ","70% of total billed charges ",200.25,90,,160.20,,,0,"percent of total billed charges ","90% of total billed charges ",206.93,93,,165.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",189.13,85,,151.30,,,0,"percent of total billed charges ","85% of total billed charges ",200.25,90,,160.20,,,0,"percent of total billed charges ","90% of total billed charges ",200.25,90,,160.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",193.58,87,,154.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",23.57,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",155.75,70,,124.60,,,0,"percent of total billed charges ","70% of total billed charges ",23.57,206.93,
"CD4 COUNT ABSOLUTE",2018000,"CDM ",302,RC,86361,HCPCS,OUTPATIENT,,,250,200,,26.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",175,70,,140.00,,,0,"percent of total billed charges ","70% of total billed charges ",225,90,,180.00,,,0,"percent of total billed charges ","90% of total billed charges ",232.5,93,,186.00,,,0,"percent of total billed charges ","93% of total billed charges ",26.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",212.5,85,,170.00,,,0,"percent of total billed charges ","85% of total billed charges ",225,90,,180.00,,,0,"percent of total billed charges ","90% of total billed charges ",225,90,,180.00,,,0,"percent of total billed charges ","90% of total billed charges ",37.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.5,87,,174.00,,,0,"percent of total billed charges ","87% of total billed charges ",37.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.78,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",175,70,,140.00,,,0,"percent of total billed charges ","70% of total billed charges ",26.78,232.5,
"MYELIN ASSOC GLYCOPROTEIN IGM",2018018,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,90,72,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,83.7,
"BORDETELLA PERTUSSUS IGG ABS",2018042,"CDM ",302,RC,86615,HCPCS,OUTPATIENT,,,180.5,144.4,,11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",126.35,70,,101.08,,,0,"percent of total billed charges ","70% of total billed charges ",162.45,90,,129.96,,,0,"percent of total billed charges ","90% of total billed charges ",167.87,93,,134.30,,,0,"percent of total billed charges ","93% of total billed charges ",11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",153.43,85,,122.74,,,0,"percent of total billed charges ","85% of total billed charges ",162.45,90,,129.96,,,0,"percent of total billed charges ","90% of total billed charges ",162.45,90,,129.96,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",157.04,87,,125.63,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",126.35,70,,101.08,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,167.87,
"LEPTIN SERUM",2018059,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,168.5,134.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",156.71,93,,125.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",143.23,85,,114.58,,,0,"percent of total billed charges ","85% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",146.6,87,,117.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,156.71,
"BORDETELLS PERTUSSIS IGM/ABS",2018091,"CDM ",302,RC,86615,HCPCS,OUTPATIENT,,,180.5,144.4,,11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",126.35,70,,101.08,,,0,"percent of total billed charges ","70% of total billed charges ",162.45,90,,129.96,,,0,"percent of total billed charges ","90% of total billed charges ",167.87,93,,134.30,,,0,"percent of total billed charges ","93% of total billed charges ",11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",153.43,85,,122.74,,,0,"percent of total billed charges ","85% of total billed charges ",162.45,90,,129.96,,,0,"percent of total billed charges ","90% of total billed charges ",162.45,90,,129.96,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",157.04,87,,125.63,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",126.35,70,,101.08,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,167.87,
"HEP B VIRUS DNA QUANT PCR RFLX",2018109,"CDM ",306,RC,87517,HCPCS,OUTPATIENT,,,704,563.2,,36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",492.8,70,,394.24,,,0,"percent of total billed charges ","70% of total billed charges ",633.6,90,,506.88,,,0,"percent of total billed charges ","90% of total billed charges ",654.72,93,,523.78,,,0,"percent of total billed charges ","93% of total billed charges ",36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",598.4,85,,478.72,,,0,"percent of total billed charges ","85% of total billed charges ",633.6,90,,506.88,,,0,"percent of total billed charges ","90% of total billed charges ",633.6,90,,506.88,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",612.48,87,,489.98,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.84,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",492.8,70,,394.24,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,654.72,
"HEPATITIS C VIRUS RNA",2018117,"CDM ",306,RC,87522,HCPCS,OUTPATIENT,,,633.5,506.8,,36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,109.38,109.38,109.38,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",443.45,70,,354.76,,,0,"percent of total billed charges ","70% of total billed charges ",570.15,90,,456.12,,,0,"percent of total billed charges ","90% of total billed charges ",589.16,93,,471.33,,,0,"percent of total billed charges ","93% of total billed charges ",36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",538.48,85,,430.78,,,0,"percent of total billed charges ","85% of total billed charges ",570.15,90,,456.12,,,0,"percent of total billed charges ","90% of total billed charges ",570.15,90,,456.12,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",551.15,87,,440.92,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.84,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",443.45,70,,354.76,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,589.16,
"MAGNESIUM,RBC",2018125,"CDM ",301,RC,83735,HCPCS,OUTPATIENT,,,56.5,45.2,,6.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.55,70,,31.64,,,0,"percent of total billed charges ","70% of total billed charges ",50.85,90,,40.68,,,0,"percent of total billed charges ","90% of total billed charges ",52.55,93,,42.04,,,0,"percent of total billed charges ","93% of total billed charges ",6.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",48.03,85,,38.42,,,0,"percent of total billed charges ","85% of total billed charges ",50.85,90,,40.68,,,0,"percent of total billed charges ","90% of total billed charges ",50.85,90,,40.68,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",49.16,87,,46.55,6.57,58.19,15,"percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.7,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",39.55,70,,31.64,,,0,"percent of total billed charges ","70% of total billed charges ",6.7,52.55,
"KETAMINE URINE",2018133,"CDM ",301,RC,82542,HCPCS,OUTPATIENT,,,236.5,189.2,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",165.55,70,,132.44,,,0,"percent of total billed charges ","70% of total billed charges ",212.85,90,,170.28,,,0,"percent of total billed charges ","90% of total billed charges ",219.95,93,,175.96,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",201.03,85,,160.82,,,0,"percent of total billed charges ","85% of total billed charges ",212.85,90,,170.28,,,0,"percent of total billed charges ","90% of total billed charges ",212.85,90,,170.28,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",205.76,87,,164.61,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",165.55,70,,132.44,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,219.95,
"*ALLERGENS 10,EA ALLERGEN",2018174,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,163,130.4,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.1,70,,91.28,,,0,"percent of total billed charges ","70% of total billed charges ",146.7,90,,117.36,,,0,"percent of total billed charges ","90% of total billed charges ",151.59,93,,121.27,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",138.55,85,,110.84,,,0,"percent of total billed charges ","85% of total billed charges ",146.7,90,,117.36,,,0,"percent of total billed charges ","90% of total billed charges ",146.7,90,,117.36,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",141.81,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",114.1,70,,91.28,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,151.59,
"CHLAMDIA TRACHOMATIS CULTURE",2018182,"CDM ",306,RC,87110,HCPCS,OUTPATIENT,,,210.5,168.4,,19.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",195.77,93,,156.62,,,0,"percent of total billed charges ","93% of total billed charges ",19.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",178.93,85,,143.14,,,0,"percent of total billed charges ","85% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",183.14,87,,146.51,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.6,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",19.6,195.77,
"*FOOD ALLERGEN PROF I COMPONEN",2018216,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"*FOOD ALLERGEN PROI IGE",2018224,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,163,130.4,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.1,70,,91.28,,,0,"percent of total billed charges ","70% of total billed charges ",146.7,90,,117.36,,,0,"percent of total billed charges ","90% of total billed charges ",151.59,93,,121.27,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",138.55,85,,110.84,,,0,"percent of total billed charges ","85% of total billed charges ",146.7,90,,117.36,,,0,"percent of total billed charges ","90% of total billed charges ",146.7,90,,117.36,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",141.81,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",114.1,70,,91.28,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,151.59,
"*ENVIRO ALLERG PROFIE IGE",2018240,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"SUSCEPTIBILITY TEST H FLU",2018257,"CDM ",306,RC,87186,HCPCS,OUTPATIENT,,,284,227.2,,8.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",198.8,70,,159.04,,,0,"percent of total billed charges ","70% of total billed charges ",255.6,90,,204.48,,,0,"percent of total billed charges ","90% of total billed charges ",264.12,93,,211.30,,,0,"percent of total billed charges ","93% of total billed charges ",8.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",241.4,85,,193.12,,,0,"percent of total billed charges ","85% of total billed charges ",255.6,90,,204.48,,,0,"percent of total billed charges ","90% of total billed charges ",255.6,90,,204.48,,,0,"percent of total billed charges ","90% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",247.08,87,,8.48,8.48,105.80,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.65,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",198.8,70,,159.04,,,0,"percent of total billed charges ","70% of total billed charges ",8.65,264.12,
"*L/S RATIO-CREATININE",2018273,"CDM ",301,RC,82570,HCPCS,OUTPATIENT,,,220.5,176.4,,5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154.35,70,,123.48,,,0,"percent of total billed charges ","70% of total billed charges ",198.45,90,,158.76,,,0,"percent of total billed charges ","90% of total billed charges ",205.07,93,,164.06,,,0,"percent of total billed charges ","93% of total billed charges ",5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",187.43,85,,149.94,,,0,"percent of total billed charges ","85% of total billed charges ",198.45,90,,158.76,,,0,"percent of total billed charges ","90% of total billed charges ",198.45,90,,158.76,,,0,"percent of total billed charges ","90% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",191.84,87,,5.08,4.98,50.30,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",154.35,70,,123.48,,,0,"percent of total billed charges ","70% of total billed charges ",5.18,205.07,
"*L/S RATIO-(L/S)",2018281,"CDM ",301,RC,83661,HCPCS,OUTPATIENT,,,220.5,176.4,,31.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154.35,70,,123.48,,,0,"percent of total billed charges ","70% of total billed charges ",198.45,90,,158.76,,,0,"percent of total billed charges ","90% of total billed charges ",205.07,93,,164.06,,,0,"percent of total billed charges ","93% of total billed charges ",31.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",187.43,85,,149.94,,,0,"percent of total billed charges ","85% of total billed charges ",198.45,90,,158.76,,,0,"percent of total billed charges ","90% of total billed charges ",198.45,90,,158.76,,,0,"percent of total billed charges ","90% of total billed charges ",39.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",191.84,87,,153.47,,,0,"percent of total billed charges ","87% of total billed charges ",39.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.99,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",154.35,70,,123.48,,,0,"percent of total billed charges ","70% of total billed charges ",21.99,205.07,
"*L/S RATIO-PHOSPHATIDY LG",2018299,"CDM ",301,RC,84081,HCPCS,OUTPATIENT,,,220.5,176.4,,8.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154.35,70,,123.48,,,0,"percent of total billed charges ","70% of total billed charges ",198.45,90,,158.76,,,0,"percent of total billed charges ","90% of total billed charges ",205.07,93,,164.06,,,0,"percent of total billed charges ","93% of total billed charges ",8.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",187.43,85,,149.94,,,0,"percent of total billed charges ","85% of total billed charges ",198.45,90,,158.76,,,0,"percent of total billed charges ","90% of total billed charges ",198.45,90,,158.76,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",191.84,87,,153.47,,,0,"percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.52,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",154.35,70,,123.48,,,0,"percent of total billed charges ","70% of total billed charges ",8.74,205.07,
"CARBAMAZEPINE, FREE",2018315,"CDM ",300,RC,80157,HCPCS,OUTPATIENT,,,193,154.4,,11.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.1,70,,108.08,,,0,"percent of total billed charges ","70% of total billed charges ",173.7,90,,138.96,,,0,"percent of total billed charges ","90% of total billed charges ",179.49,93,,143.59,,,0,"percent of total billed charges ","93% of total billed charges ",11.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.05,85,,131.24,,,0,"percent of total billed charges ","85% of total billed charges ",173.7,90,,138.96,,,0,"percent of total billed charges ","90% of total billed charges ",173.7,90,,138.96,,,0,"percent of total billed charges ","90% of total billed charges ",15.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",167.91,87,,134.33,,,0,"percent of total billed charges ","87% of total billed charges ",15.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.25,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",135.1,70,,108.08,,,0,"percent of total billed charges ","70% of total billed charges ",11.68,179.49,
"*CRYPTOSPORIDIUM CONCENTRATION",2018349,"CDM ",306,RC,87015,HCPCS,OUTPATIENT,,,59.5,47.6,,6.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.65,70,,33.32,,,0,"percent of total billed charges ","70% of total billed charges ",53.55,90,,42.84,,,0,"percent of total billed charges ","90% of total billed charges ",55.34,93,,44.27,,,0,"percent of total billed charges ","93% of total billed charges ",6.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",50.58,85,,40.46,,,0,"percent of total billed charges ","85% of total billed charges ",53.55,90,,42.84,,,0,"percent of total billed charges ","90% of total billed charges ",53.55,90,,42.84,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",51.77,87,,41.42,,,0,"percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.68,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",41.65,70,,33.32,,,0,"percent of total billed charges ","70% of total billed charges ",6.68,55.34,
"*TORCH ABS CMV IGM",2018364,"CDM ",302,RC,86645,HCPCS,OUTPATIENT,,,204,163.2,,14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,141.98,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.85,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,189.72,
"*TORCH ABS HSVNST",2018372,"CDM ",302,RC,86694,HCPCS,OUTPATIENT,,,219.5,175.6,,12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.65,70,,122.92,,,0,"percent of total billed charges ","70% of total billed charges ",197.55,90,,158.04,,,0,"percent of total billed charges ","90% of total billed charges ",204.14,93,,163.31,,,0,"percent of total billed charges ","93% of total billed charges ",12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",186.58,85,,149.26,,,0,"percent of total billed charges ","85% of total billed charges ",197.55,90,,158.04,,,0,"percent of total billed charges ","90% of total billed charges ",197.55,90,,158.04,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",190.97,87,,152.78,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",153.65,70,,122.92,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,204.14,
"*TORCH ABS TOXO IGM",2018380,"CDM ",302,RC,86778,HCPCS,OUTPATIENT,,,152,121.6,,12.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",141.36,93,,113.09,,,0,"percent of total billed charges ","93% of total billed charges ",12.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",129.2,85,,103.36,,,0,"percent of total billed charges ","85% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.24,87,,105.79,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.41,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,141.36,
"*TORCH ABS RUBELLA",2018398,"CDM ",302,RC,86762,HCPCS,OUTPATIENT,,,145,116,,12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",126.15,87,,48.62,10.18,58.34,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,134.85,
"*TORCH ABS CMV",2018406,"CDM ",302,RC,86644,HCPCS,OUTPATIENT,,,204,163.2,,12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,141.98,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,189.72,
"*TORCH ABS TOXOPLASMA",2018414,"CDM ",302,RC,86777,HCPCS,OUTPATIENT,,,191,152.8,,12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.7,70,,106.96,,,0,"percent of total billed charges ","70% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",177.63,93,,142.10,,,0,"percent of total billed charges ","93% of total billed charges ",12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",162.35,85,,129.88,,,0,"percent of total billed charges ","85% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",166.17,87,,132.94,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",133.7,70,,106.96,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,177.63,
"HERPES VIRUS-6 IGG ABS",2018463,"CDM ",302,RC,86790,HCPCS,OUTPATIENT,,,146,116.8,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.58,80.58,80.58,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,199.98,199.98,199.98,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,135.78,
"5-HYDROXYINDOLACETIC ACID",2018510,"CDM ",301,RC,83497,HCPCS,OUTPATIENT,,,104,83.2,,12.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.8,70,,58.24,,,0,"percent of total billed charges ","70% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",96.72,93,,77.38,,,0,"percent of total billed charges ","93% of total billed charges ",12.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",88.4,85,,70.72,,,0,"percent of total billed charges ","85% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",18.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",90.48,87,,72.38,,,0,"percent of total billed charges ","87% of total billed charges ",18.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.9,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",72.8,70,,58.24,,,0,"percent of total billed charges ","70% of total billed charges ",12.9,96.72,
"T3 REVERSE",2018521,"CDM ",301,RC,84482,HCPCS,OUTPATIENT,,,178.5,142.8,,13.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,88.78,88.78,88.78,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.95,70,,99.96,,,0,"percent of total billed charges ","70% of total billed charges ",160.65,90,,128.52,,,0,"percent of total billed charges ","90% of total billed charges ",166.01,93,,132.81,,,0,"percent of total billed charges ","93% of total billed charges ",13.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.44,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",151.73,85,,121.38,,,0,"percent of total billed charges ","85% of total billed charges ",160.65,90,,128.52,,,0,"percent of total billed charges ","90% of total billed charges ",160.65,90,,128.52,,,0,"percent of total billed charges ","90% of total billed charges ",10.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",155.3,87,,124.24,,,0,"percent of total billed charges ","87% of total billed charges ",10.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.76,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",124.95,70,,99.96,,,0,"percent of total billed charges ","70% of total billed charges ",10.34,166.01,
"TRIGLYCERIDE, BODY FLUID",2018530,"CDM ",301,RC,84478,HCPCS,OUTPATIENT,,,146.5,117.2,,5.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,11.77,11.77,11.77,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.55,70,,82.04,,,0,"percent of total billed charges ","70% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",136.25,93,,109.00,,,0,"percent of total billed charges ","93% of total billed charges ",5.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.53,85,,99.62,,,0,"percent of total billed charges ","85% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.46,87,,101.97,,,0,"percent of total billed charges ","87% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.55,70,,82.04,,,0,"percent of total billed charges ","70% of total billed charges ",5.74,136.25,
"D-DIMER (DIC)",2018540,"CDM ",305,RC,85380,HCPCS,OUTPATIENT,,,146,116.8,,10.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",10.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",13.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,101.62,,,0,"percent of total billed charges ","87% of total billed charges ",13.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",10.18,135.78,
"ORGANISM ID, MOLD",2018550,"CDM ",306,RC,87107,HCPCS,OUTPATIENT,,,107,85.6,,10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.9,70,,59.92,,,0,"percent of total billed charges ","70% of total billed charges ",96.3,90,,77.04,,,0,"percent of total billed charges ","90% of total billed charges ",99.51,93,,79.61,,,0,"percent of total billed charges ","93% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",90.95,85,,72.76,,,0,"percent of total billed charges ","85% of total billed charges ",96.3,90,,77.04,,,0,"percent of total billed charges ","90% of total billed charges ",96.3,90,,77.04,,,0,"percent of total billed charges ","90% of total billed charges ",15.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.09,87,,74.47,,,0,"percent of total billed charges ","87% of total billed charges ",15.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.32,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",74.9,70,,59.92,,,0,"percent of total billed charges ","70% of total billed charges ",10.32,99.51,
"ORGANISM ID, ANAEROBE",2018560,"CDM ",306,RC,87076,HCPCS,OUTPATIENT,,,121,96.8,,8.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.7,70,,67.76,,,0,"percent of total billed charges ","70% of total billed charges ",108.9,90,,87.12,,,0,"percent of total billed charges ","90% of total billed charges ",112.53,93,,90.02,,,0,"percent of total billed charges ","93% of total billed charges ",8.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.44,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",102.85,85,,82.28,,,0,"percent of total billed charges ","85% of total billed charges ",108.9,90,,87.12,,,0,"percent of total billed charges ","90% of total billed charges ",108.9,90,,87.12,,,0,"percent of total billed charges ","90% of total billed charges ",17.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",105.27,87,,84.22,,,0,"percent of total billed charges ","87% of total billed charges ",17.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.08,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",84.7,70,,67.76,,,0,"percent of total billed charges ","70% of total billed charges ",8.08,112.53,
"ORGANISM ID, YEAST",2018570,"CDM ",306,RC,87106,HCPCS,OUTPATIENT,,,111,88.8,,10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.7,70,,62.16,,,0,"percent of total billed charges ","70% of total billed charges ",99.9,90,,79.92,,,0,"percent of total billed charges ","90% of total billed charges ",103.23,93,,82.58,,,0,"percent of total billed charges ","93% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",94.35,85,,75.48,,,0,"percent of total billed charges ","85% of total billed charges ",99.9,90,,79.92,,,0,"percent of total billed charges ","90% of total billed charges ",99.9,90,,79.92,,,0,"percent of total billed charges ","90% of total billed charges ",15.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.57,87,,77.26,,,0,"percent of total billed charges ","87% of total billed charges ",15.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.32,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",77.7,70,,62.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.32,103.23,
KLEIHAUER-BEHKE,2018620,"CDM ",305,RC,85460,HCPCS,OUTPATIENT,,,231.5,185.2,,7.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.05,70,,129.64,,,0,"percent of total billed charges ","70% of total billed charges ",208.35,90,,166.68,,,0,"percent of total billed charges ","90% of total billed charges ",215.3,93,,172.24,,,0,"percent of total billed charges ","93% of total billed charges ",7.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",196.78,85,,157.42,,,0,"percent of total billed charges ","85% of total billed charges ",208.35,90,,166.68,,,0,"percent of total billed charges ","90% of total billed charges ",208.35,90,,166.68,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.41,87,,161.13,,,0,"percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.73,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",162.05,70,,129.64,,,0,"percent of total billed charges ","70% of total billed charges ",7.73,215.3,
"D-DIMER (DVT)",2018630,"CDM ",305,RC,85379,HCPCS,OUTPATIENT,,,146,116.8,,10.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",10.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",13.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,101.02,9.98,126.28,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",10.18,135.78,
"*TORCH M, CYTOMEGALOVIRUS, M",2018640,"CDM ",302,RC,86645,HCPCS,OUTPATIENT,,,204,163.2,,14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,141.98,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.85,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,189.72,
"*TORCH M, HERPES SIMPLEX I,M",2018650,"CDM ",302,RC,86695,HCPCS,OUTPATIENT,,,175,140,,11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,76.02,76.02,76.02,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",162.75,93,,130.20,,,0,"percent of total billed charges ","93% of total billed charges ",11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",148.75,85,,119.00,,,0,"percent of total billed charges ","85% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",152.25,87,,121.80,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,162.75,
"*TORCH M, HERPES SIMPLEX II,M",2018660,"CDM ",302,RC,86696,HCPCS,OUTPATIENT,,,188.5,150.8,,19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.29,80.29,80.29,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.95,70,,105.56,,,0,"percent of total billed charges ","70% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",175.31,93,,140.25,,,0,"percent of total billed charges ","93% of total billed charges ",19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",160.23,85,,128.18,,,0,"percent of total billed charges ","85% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",164,87,,131.20,,,0,"percent of total billed charges ","87% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.35,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",131.95,70,,105.56,,,0,"percent of total billed charges ","70% of total billed charges ",19.35,175.31,
"*TORCH M, RUBELLA",2018670,"CDM ",302,RC,86762,HCPCS,OUTPATIENT,,,131,104.8,,12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.7,70,,73.36,,,0,"percent of total billed charges ","70% of total billed charges ",117.9,90,,94.32,,,0,"percent of total billed charges ","90% of total billed charges ",121.83,93,,97.46,,,0,"percent of total billed charges ","93% of total billed charges ",12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",111.35,85,,89.08,,,0,"percent of total billed charges ","85% of total billed charges ",117.9,90,,94.32,,,0,"percent of total billed charges ","90% of total billed charges ",117.9,90,,94.32,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",113.97,87,,48.62,10.18,58.34,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",91.7,70,,73.36,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,121.83,
"*TORCH M, TOXOPLASMOSIS M",2018680,"CDM ",302,RC,86778,HCPCS,OUTPATIENT,,,152,121.6,,12.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",141.36,93,,113.09,,,0,"percent of total billed charges ","93% of total billed charges ",12.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",129.2,85,,103.36,,,0,"percent of total billed charges ","85% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.24,87,,105.79,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.41,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,141.36,
"*TORCH G, CYTOMEGALOVIRUS G",2018690,"CDM ",302,RC,86644,HCPCS,OUTPATIENT,,,62.5,50,,12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.75,70,,35.00,,,0,"percent of total billed charges ","70% of total billed charges ",56.25,90,,45.00,,,0,"percent of total billed charges ","90% of total billed charges ",58.13,93,,46.50,,,0,"percent of total billed charges ","93% of total billed charges ",12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",53.13,85,,42.50,,,0,"percent of total billed charges ","85% of total billed charges ",56.25,90,,45.00,,,0,"percent of total billed charges ","90% of total billed charges ",56.25,90,,45.00,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.38,87,,43.50,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",43.75,70,,35.00,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,58.13,
"*TORCH G, HERPES SIMPLEX G",2018700,"CDM ",302,RC,86694,HCPCS,OUTPATIENT,,,219.5,175.6,,12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.65,70,,122.92,,,0,"percent of total billed charges ","70% of total billed charges ",197.55,90,,158.04,,,0,"percent of total billed charges ","90% of total billed charges ",204.14,93,,163.31,,,0,"percent of total billed charges ","93% of total billed charges ",12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",186.58,85,,149.26,,,0,"percent of total billed charges ","85% of total billed charges ",197.55,90,,158.04,,,0,"percent of total billed charges ","90% of total billed charges ",197.55,90,,158.04,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",190.97,87,,152.78,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",153.65,70,,122.92,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,204.14,
"*TORCH G, RUBELLA G",2018710,"CDM ",302,RC,86762,HCPCS,OUTPATIENT,,,89,71.2,,12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",82.77,93,,66.22,,,0,"percent of total billed charges ","93% of total billed charges ",12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",75.65,85,,60.52,,,0,"percent of total billed charges ","85% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",77.43,87,,48.62,10.18,58.34,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,82.77,
"*TORCH G, TOXOPLASMOSIS G",2018720,"CDM ",302,RC,86777,HCPCS,OUTPATIENT,,,191,152.8,,12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.7,70,,106.96,,,0,"percent of total billed charges ","70% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",177.63,93,,142.10,,,0,"percent of total billed charges ","93% of total billed charges ",12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",162.35,85,,129.88,,,0,"percent of total billed charges ","85% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",166.17,87,,132.94,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",133.7,70,,106.96,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,177.63,
"OSMOLALITY FECAL",2018730,"CDM ",301,RC,84999,HCPCS,OUTPATIENT,,,347.5,278,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",243.25,70,,194.60,,,0,"percent of total billed charges ","70% of total billed charges ",312.75,90,,250.20,,,0,"percent of total billed charges ","90% of total billed charges ",323.18,93,,258.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",295.38,85,,236.30,,,0,"percent of total billed charges ","85% of total billed charges ",312.75,90,,250.20,,,0,"percent of total billed charges ","90% of total billed charges ",312.75,90,,250.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",302.33,87,,241.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",243.25,70,,194.60,,,0,"percent of total billed charges ","70% of total billed charges ",243.25,323.18,
"SEX HORMONE BINDING GLOBULIN",2018740,"CDM ",301,RC,84270,HCPCS,OUTPATIENT,,,261.5,209.2,,18.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.82,64.82,64.82,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",243.2,93,,194.56,,,0,"percent of total billed charges ","93% of total billed charges ",18.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",222.28,85,,177.82,,,0,"percent of total billed charges ","85% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",23.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",227.51,87,,162.40,97.34,162.40,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.73,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",18.47,243.2,
"*ALLERGENS SPECIFIC IGE",2018760,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"*TRPI ANTITHROMBIN III ACT",2018780,"CDM ",305,RC,85300,HCPCS,OUTPATIENT,,,126.5,101.2,,11.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.55,70,,70.84,,,0,"percent of total billed charges ","70% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",117.65,93,,94.12,,,0,"percent of total billed charges ","93% of total billed charges ",11.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.11,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",107.53,85,,86.02,,,0,"percent of total billed charges ","85% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",20.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",110.06,87,,88.05,,,0,"percent of total billed charges ","87% of total billed charges ",20.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.85,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",88.55,70,,70.84,,,0,"percent of total billed charges ","70% of total billed charges ",11.85,117.65,
"*TRPI PROTEIN C ACTIVITY",2018810,"CDM ",305,RC,85303,HCPCS,OUTPATIENT,,,167.5,134,,13.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.25,70,,93.80,,,0,"percent of total billed charges ","70% of total billed charges ",150.75,90,,120.60,,,0,"percent of total billed charges ","90% of total billed charges ",155.78,93,,124.62,,,0,"percent of total billed charges ","93% of total billed charges ",13.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",142.38,85,,113.90,,,0,"percent of total billed charges ","85% of total billed charges ",150.75,90,,120.60,,,0,"percent of total billed charges ","90% of total billed charges ",150.75,90,,120.60,,,0,"percent of total billed charges ","90% of total billed charges ",21.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",145.73,87,,145.25,145.25,145.25,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.84,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.25,70,,93.80,,,0,"percent of total billed charges ","70% of total billed charges ",13.84,155.78,
"*TRPI PROTEIN S FREE",2018830,"CDM ",305,RC,85306,HCPCS,OUTPATIENT,,,201,160.8,,15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.7,70,,112.56,,,0,"percent of total billed charges ","70% of total billed charges ",180.9,90,,144.72,,,0,"percent of total billed charges ","90% of total billed charges ",186.93,93,,149.54,,,0,"percent of total billed charges ","93% of total billed charges ",15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",170.85,85,,136.68,,,0,"percent of total billed charges ","85% of total billed charges ",180.9,90,,144.72,,,0,"percent of total billed charges ","90% of total billed charges ",180.9,90,,144.72,,,0,"percent of total billed charges ","90% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",174.87,87,,174.12,174.12,174.12,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.32,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",140.7,70,,112.56,,,0,"percent of total billed charges ","70% of total billed charges ",15.32,186.93,
"*TRPI APC RESISTANCE ASSAY",2018840,"CDM ",305,RC,85307,HCPCS,OUTPATIENT,,,467.5,374,,15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",327.25,70,,261.80,,,0,"percent of total billed charges ","70% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",434.78,93,,347.82,,,0,"percent of total billed charges ","93% of total billed charges ",15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",397.38,85,,317.90,,,0,"percent of total billed charges ","85% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",406.73,87,,325.38,,,0,"percent of total billed charges ","87% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.32,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",327.25,70,,261.80,,,0,"percent of total billed charges ","70% of total billed charges ",15.32,434.78,
"ARC CMV TESTING",2018890,"CDM ",302,RC,86644,HCPCS,OUTPATIENT,,,374,299.2,,12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",261.8,70,,209.44,,,0,"percent of total billed charges ","70% of total billed charges ",336.6,90,,269.28,,,0,"percent of total billed charges ","90% of total billed charges ",347.82,93,,278.26,,,0,"percent of total billed charges ","93% of total billed charges ",12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",317.9,85,,254.32,,,0,"percent of total billed charges ","85% of total billed charges ",336.6,90,,269.28,,,0,"percent of total billed charges ","90% of total billed charges ",336.6,90,,269.28,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",325.38,87,,260.30,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",261.8,70,,209.44,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,347.82,
"JO-1 ANTIBODY",2018950,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,225.5,180.4,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.85,70,,126.28,,,0,"percent of total billed charges ","70% of total billed charges ",202.95,90,,162.36,,,0,"percent of total billed charges ","90% of total billed charges ",209.72,93,,167.78,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",191.68,85,,153.34,,,0,"percent of total billed charges ","85% of total billed charges ",202.95,90,,162.36,,,0,"percent of total billed charges ","90% of total billed charges ",202.95,90,,162.36,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",196.19,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.85,70,,126.28,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,209.72,
"DUP CHARCOT-MARIE-TOOTH DIS",2018960,"CDM ",300,RC,88275,HCPCS,OUTPATIENT,,,2654,2123.2,,47.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1857.8,70,,1486.24,,,0,"percent of total billed charges ","70% of total billed charges ",2388.6,90,,1910.88,,,0,"percent of total billed charges ","90% of total billed charges ",2468.22,93,,1974.58,,,0,"percent of total billed charges ","93% of total billed charges ",47.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.02,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2255.9,85,,1804.72,,,0,"percent of total billed charges ","85% of total billed charges ",2388.6,90,,1910.88,,,0,"percent of total billed charges ","90% of total billed charges ",2388.6,90,,1910.88,,,0,"percent of total billed charges ","90% of total billed charges ",62.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2308.98,87,,1847.18,,,0,"percent of total billed charges ","87% of total billed charges ",62.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",51.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1857.8,70,,1486.24,,,0,"percent of total billed charges ","70% of total billed charges ",47.69,2468.22,
"LEUKOCYTE ALKALINE PHOS (LAP)",2018970,"CDM ",305,RC,85540,HCPCS,OUTPATIENT,,,57.5,46,,8.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.25,70,,32.20,,,0,"percent of total billed charges ","70% of total billed charges ",51.75,90,,41.40,,,0,"percent of total billed charges ","90% of total billed charges ",53.48,93,,42.78,,,0,"percent of total billed charges ","93% of total billed charges ",8.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",48.88,85,,39.10,,,0,"percent of total billed charges ","85% of total billed charges ",51.75,90,,41.40,,,0,"percent of total billed charges ","90% of total billed charges ",51.75,90,,41.40,,,0,"percent of total billed charges ","90% of total billed charges ",12.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",50.03,87,,40.02,,,0,"percent of total billed charges ","87% of total billed charges ",12.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.6,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",40.25,70,,32.20,,,0,"percent of total billed charges ","70% of total billed charges ",8.6,53.48,
"HEP C VIRUS,NGI QUANT BY PCR",2018980,"CDM ",306,RC,87522,HCPCS,OUTPATIENT,,,683.5,546.8,,36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,109.38,109.38,109.38,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",478.45,70,,382.76,,,0,"percent of total billed charges ","70% of total billed charges ",615.15,90,,492.12,,,0,"percent of total billed charges ","90% of total billed charges ",635.66,93,,508.53,,,0,"percent of total billed charges ","93% of total billed charges ",36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",580.98,85,,464.78,,,0,"percent of total billed charges ","85% of total billed charges ",615.15,90,,492.12,,,0,"percent of total billed charges ","90% of total billed charges ",615.15,90,,492.12,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",594.65,87,,475.72,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.84,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",478.45,70,,382.76,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,635.66,
"HIV 1 RNA QUANT CSF",2018990,"CDM ",306,RC,87536,HCPCS,OUTPATIENT,,,633.5,506.8,,85.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,217.26,217.26,217.26,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",443.45,70,,354.76,,,0,"percent of total billed charges ","70% of total billed charges ",570.15,90,,456.12,,,0,"percent of total billed charges ","90% of total billed charges ",589.16,93,,471.33,,,0,"percent of total billed charges ","93% of total billed charges ",85.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",142.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",538.48,85,,430.78,,,0,"percent of total billed charges ","85% of total billed charges ",570.15,90,,456.12,,,0,"percent of total billed charges ","90% of total billed charges ",570.15,90,,456.12,,,0,"percent of total billed charges ","90% of total billed charges ",141.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",551.15,87,,440.92,,,0,"percent of total billed charges ","87% of total billed charges ",141.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.1,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",443.45,70,,354.76,,,0,"percent of total billed charges ","70% of total billed charges ",85.1,589.16,
"RICKETTSIA IGM",2019000,"CDM ",302,RC,86757,HCPCS,OUTPATIENT,,,351,280.8,,19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",245.7,70,,196.56,,,0,"percent of total billed charges ","70% of total billed charges ",315.9,90,,252.72,,,0,"percent of total billed charges ","90% of total billed charges ",326.43,93,,261.14,,,0,"percent of total billed charges ","93% of total billed charges ",19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",298.35,85,,238.68,,,0,"percent of total billed charges ","85% of total billed charges ",315.9,90,,252.72,,,0,"percent of total billed charges ","90% of total billed charges ",315.9,90,,252.72,,,0,"percent of total billed charges ","90% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",305.37,87,,244.30,,,0,"percent of total billed charges ","87% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.35,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",245.7,70,,196.56,,,0,"percent of total billed charges ","70% of total billed charges ",19.35,326.43,
"*ALLERGEN IGE #4",2019020,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"*SLB ANTI DNA DBLSTRND",2019030,"CDM ",302,RC,86225,HCPCS,OUTPATIENT,,,169,135.2,,13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,72.72,72.72,72.72,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",157.17,93,,125.74,,,0,"percent of total billed charges ","93% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.65,85,,114.92,,,0,"percent of total billed charges ","85% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",24.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.03,87,,115.94,115.94,115.94,"1 through 10","percent of total billed charges ","87% of total billed charges ",24.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",13.74,157.17,
"METHADONE #007781",2019060,"CDM ",301,RC,80358,HCPCS,OUTPATIENT,,,109,87.2,,19.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.3,70,,61.04,,,0,"percent of total billed charges ","70% of total billed charges ",98.1,90,,78.48,,,0,"percent of total billed charges ","90% of total billed charges ",101.37,93,,81.10,,,0,"percent of total billed charges ","93% of total billed charges ",19.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.37,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",92.65,85,,74.12,,,0,"percent of total billed charges ","85% of total billed charges ",98.1,90,,78.48,,,0,"percent of total billed charges ","90% of total billed charges ",98.1,90,,78.48,,,0,"percent of total billed charges ","90% of total billed charges ",25.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",94.83,87,,75.86,,,0,"percent of total billed charges ","87% of total billed charges ",25.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",76.3,70,,61.04,,,0,"percent of total billed charges ","70% of total billed charges ",19.97,101.37,
"KETONE BODIES",2019070,"CDM ",301,RC,82009,HCPCS,OUTPATIENT,,,79,63.2,,3.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,43.52,43.52,43.52,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.3,70,,44.24,,,0,"percent of total billed charges ","70% of total billed charges ",71.1,90,,56.88,,,0,"percent of total billed charges ","90% of total billed charges ",73.47,93,,58.78,,,0,"percent of total billed charges ","93% of total billed charges ",3.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2.08,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",67.15,85,,53.72,,,0,"percent of total billed charges ","85% of total billed charges ",71.1,90,,56.88,,,0,"percent of total billed charges ","90% of total billed charges ",71.1,90,,56.88,,,0,"percent of total billed charges ","90% of total billed charges ",2.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",68.73,87,,54.98,,,0,"percent of total billed charges ","87% of total billed charges ",2.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.51,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",55.3,70,,44.24,,,0,"percent of total billed charges ","70% of total billed charges ",2.06,73.47,
"*CBC W/DIFF",2019090,"CDM ",305,RC,85027,HCPCS,OUTPATIENT,,,142.5,114,,6.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,16.67,16.67,16.67,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.75,70,,79.80,,,0,"percent of total billed charges ","70% of total billed charges ",128.25,90,,102.60,,,0,"percent of total billed charges ","90% of total billed charges ",132.53,93,,106.02,,,0,"percent of total billed charges ","93% of total billed charges ",6.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.83,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",121.13,85,,96.90,,,0,"percent of total billed charges ","85% of total billed charges ",128.25,90,,102.60,,,0,"percent of total billed charges ","90% of total billed charges ",128.25,90,,102.60,,,0,"percent of total billed charges ","90% of total billed charges ",11.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",123.98,87,,98.96,6.35,123.70,18,"percent of total billed charges ","87% of total billed charges ",11.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.47,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",99.75,70,,79.80,,,0,"percent of total billed charges ","70% of total billed charges ",6.47,132.53,
"VITAMIN B1 PLASMA",2019110,"CDM ",301,RC,84425,HCPCS,OUTPATIENT,,,157.5,126,,21.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,69.47,69.47,69.47,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.25,70,,88.20,,,0,"percent of total billed charges ","70% of total billed charges ",141.75,90,,113.40,,,0,"percent of total billed charges ","90% of total billed charges ",146.48,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",21.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",133.88,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.75,90,,113.40,,,0,"percent of total billed charges ","90% of total billed charges ",141.75,90,,113.40,,,0,"percent of total billed charges ","90% of total billed charges ",38.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",137.03,87,,109.62,,,0,"percent of total billed charges ","87% of total billed charges ",38.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.23,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",110.25,70,,88.20,,,0,"percent of total billed charges ","70% of total billed charges ",21.23,146.48,
"TISSUE TRANSGLUTAM,IGA ABS",2019120,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,136.5,109.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.55,70,,76.44,,,0,"percent of total billed charges ","70% of total billed charges ",122.85,90,,98.28,,,0,"percent of total billed charges ","90% of total billed charges ",126.95,93,,101.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",116.03,85,,92.82,,,0,"percent of total billed charges ","85% of total billed charges ",122.85,90,,98.28,,,0,"percent of total billed charges ","90% of total billed charges ",122.85,90,,98.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",118.76,87,,95.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",95.55,70,,76.44,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,126.95,
"PENICILLIUM BREVICOMP IGE",2019130,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"PENICILLIUM NOTATUM",2019140,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"SUSCEP,AEROBIC & FACUL ANAEROB",2019160,"CDM ",306,RC,87184,HCPCS,OUTPATIENT,,,294,235.2,,7.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",205.8,70,,164.64,,,0,"percent of total billed charges ","70% of total billed charges ",264.6,90,,211.68,,,0,"percent of total billed charges ","90% of total billed charges ",273.42,93,,218.74,,,0,"percent of total billed charges ","93% of total billed charges ",7.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.57,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",249.9,85,,199.92,,,0,"percent of total billed charges ","85% of total billed charges ",264.6,90,,211.68,,,0,"percent of total billed charges ","90% of total billed charges ",264.6,90,,211.68,,,0,"percent of total billed charges ","90% of total billed charges ",12.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",255.78,87,,204.62,,,0,"percent of total billed charges ","87% of total billed charges ",12.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.48,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",205.8,70,,164.64,,,0,"percent of total billed charges ","70% of total billed charges ",7.48,273.42,
"MYCOPHENALIC ACID",2019180,"CDM ",301,RC,82485,HCPCS,OUTPATIENT,,,126.5,101.2,,17.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.55,70,,70.84,,,0,"percent of total billed charges ","70% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",117.65,93,,94.12,,,0,"percent of total billed charges ","93% of total billed charges ",17.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",107.53,85,,86.02,,,0,"percent of total billed charges ","85% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",22.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",110.06,87,,88.05,,,0,"percent of total billed charges ","87% of total billed charges ",22.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.65,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",88.55,70,,70.84,,,0,"percent of total billed charges ","70% of total billed charges ",17.68,117.65,
"BREATH ALCOHOL CONF(AFTER HRS)",2019290,"CDM ",301,RC,82075,HCPCS,OUTPATIENT,,,76.5,61.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.55,70,,42.84,,,0,"percent of total billed charges ","70% of total billed charges ",68.85,90,,55.08,,,0,"percent of total billed charges ","90% of total billed charges ",71.15,93,,56.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",65.03,85,,52.02,,,0,"percent of total billed charges ","85% of total billed charges ",68.85,90,,55.08,,,0,"percent of total billed charges ","90% of total billed charges ",68.85,90,,55.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",66.56,87,,53.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",53.55,70,,42.84,,,0,"percent of total billed charges ","70% of total billed charges ",30,71.15,
"AMINO ACID PROF QUAL URINE",2019300,"CDM ",301,RC,82128,HCPCS,OUTPATIENT,,,354.5,283.6,,18.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",248.15,70,,198.52,,,0,"percent of total billed charges ","70% of total billed charges ",319.05,90,,255.24,,,0,"percent of total billed charges ","90% of total billed charges ",329.69,93,,263.75,,,0,"percent of total billed charges ","93% of total billed charges ",18.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",301.33,85,,241.06,,,0,"percent of total billed charges ","85% of total billed charges ",319.05,90,,255.24,,,0,"percent of total billed charges ","90% of total billed charges ",319.05,90,,255.24,,,0,"percent of total billed charges ","90% of total billed charges ",23.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",308.42,87,,246.74,,,0,"percent of total billed charges ","87% of total billed charges ",23.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.87,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",248.15,70,,198.52,,,0,"percent of total billed charges ","70% of total billed charges ",13.87,329.69,
"CYCLIC AMP, URINE",2019320,"CDM ",301,RC,82030,HCPCS,OUTPATIENT,,,675,540,,37.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",472.5,70,,378.00,,,0,"percent of total billed charges ","70% of total billed charges ",607.5,90,,486.00,,,0,"percent of total billed charges ","90% of total billed charges ",627.75,93,,502.20,,,0,"percent of total billed charges ","93% of total billed charges ",37.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",573.75,85,,459.00,,,0,"percent of total billed charges ","85% of total billed charges ",607.5,90,,486.00,,,0,"percent of total billed charges ","90% of total billed charges ",607.5,90,,486.00,,,0,"percent of total billed charges ","90% of total billed charges ",46.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",587.25,87,,469.80,,,0,"percent of total billed charges ","87% of total billed charges ",46.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.8,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",472.5,70,,378.00,,,0,"percent of total billed charges ","70% of total billed charges ",25.8,627.75,
"*LACTOSE FASTING,30 MIN,60 MIN",2019380,"CDM ",301,RC,82951,HCPCS,OUTPATIENT,,,161.5,129.2,,12.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.05,70,,90.44,,,0,"percent of total billed charges ","70% of total billed charges ",145.35,90,,116.28,,,0,"percent of total billed charges ","90% of total billed charges ",150.2,93,,120.16,,,0,"percent of total billed charges ","93% of total billed charges ",12.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",137.28,85,,109.82,,,0,"percent of total billed charges ","85% of total billed charges ",145.35,90,,116.28,,,0,"percent of total billed charges ","90% of total billed charges ",145.35,90,,116.28,,,0,"percent of total billed charges ","90% of total billed charges ",23.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",140.51,87,,125.42,125.42,125.42,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.87,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",113.05,70,,90.44,,,0,"percent of total billed charges ","70% of total billed charges ",12.87,150.2,
"*LACTOSE TOLERANCE EA ADD SPC",2019430,"CDM ",301,RC,82952,HCPCS,OUTPATIENT,,,55,44,,3.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.5,70,,30.80,,,0,"percent of total billed charges ","70% of total billed charges ",49.5,90,,39.60,,,0,"percent of total billed charges ","90% of total billed charges ",51.15,93,,40.92,,,0,"percent of total billed charges ","93% of total billed charges ",3.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",46.75,85,,37.40,,,0,"percent of total billed charges ","85% of total billed charges ",49.5,90,,39.60,,,0,"percent of total billed charges ","90% of total billed charges ",49.5,90,,39.60,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.85,87,,38.28,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.92,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",38.5,70,,30.80,,,0,"percent of total billed charges ","70% of total billed charges ",3.92,51.15,
HLA-B27,2019440,"CDM ",302,RC,86812,HCPCS,OUTPATIENT,,,532,425.6,,25.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",372.4,70,,297.92,,,0,"percent of total billed charges ","70% of total billed charges ",478.8,90,,383.04,,,0,"percent of total billed charges ","90% of total billed charges ",494.76,93,,395.81,,,0,"percent of total billed charges ","93% of total billed charges ",25.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",452.2,85,,361.76,,,0,"percent of total billed charges ","85% of total billed charges ",478.8,90,,383.04,,,0,"percent of total billed charges ","90% of total billed charges ",478.8,90,,383.04,,,0,"percent of total billed charges ","90% of total billed charges ",41.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.84,87,,370.27,,,0,"percent of total billed charges ","87% of total billed charges ",41.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.81,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",372.4,70,,297.92,,,0,"percent of total billed charges ","70% of total billed charges ",25.81,494.76,
"HIV VIRAL LOAD",2019550,"CDM ",306,RC,87536,HCPCS,OUTPATIENT,,,667,533.6,,85.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,217.26,217.26,217.26,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",466.9,70,,373.52,,,0,"percent of total billed charges ","70% of total billed charges ",600.3,90,,480.24,,,0,"percent of total billed charges ","90% of total billed charges ",620.31,93,,496.25,,,0,"percent of total billed charges ","93% of total billed charges ",85.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",142.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",566.95,85,,453.56,,,0,"percent of total billed charges ","85% of total billed charges ",600.3,90,,480.24,,,0,"percent of total billed charges ","90% of total billed charges ",600.3,90,,480.24,,,0,"percent of total billed charges ","90% of total billed charges ",141.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",580.29,87,,464.23,,,0,"percent of total billed charges ","87% of total billed charges ",141.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.1,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",466.9,70,,373.52,,,0,"percent of total billed charges ","70% of total billed charges ",85.1,620.31,
"CMV DNA (PCR) DETECTR #7575",2019580,"CDM ",306,RC,87496,HCPCS,OUTPATIENT,,,566,452.8,,29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",396.2,70,,316.96,,,0,"percent of total billed charges ","70% of total billed charges ",509.4,90,,407.52,,,0,"percent of total billed charges ","90% of total billed charges ",526.38,93,,421.10,,,0,"percent of total billed charges ","93% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",481.1,85,,384.88,,,0,"percent of total billed charges ","85% of total billed charges ",509.4,90,,407.52,,,0,"percent of total billed charges ","90% of total billed charges ",509.4,90,,407.52,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",492.42,87,,393.94,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",396.2,70,,316.96,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,526.38,
"ECHINOCOCCUS AB",2019600,"CDM ",302,RC,86682,HCPCS,OUTPATIENT,,,226,180.8,,11.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",158.2,70,,126.56,,,0,"percent of total billed charges ","70% of total billed charges ",203.4,90,,162.72,,,0,"percent of total billed charges ","90% of total billed charges ",210.18,93,,168.14,,,0,"percent of total billed charges ","93% of total billed charges ",11.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",192.1,85,,153.68,,,0,"percent of total billed charges ","85% of total billed charges ",203.4,90,,162.72,,,0,"percent of total billed charges ","90% of total billed charges ",203.4,90,,162.72,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",196.62,87,,155.16,155.16,155.16,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",158.2,70,,126.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,210.18,
"ALUBUMIN GLYCATED #216836",2019610,"CDM ",301,RC,82985,HCPCS,OUTPATIENT,,,586.5,469.2,,14.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,39.54,39.54,39.54,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",410.55,70,,328.44,,,0,"percent of total billed charges ","70% of total billed charges ",527.85,90,,422.28,,,0,"percent of total billed charges ","90% of total billed charges ",545.45,93,,436.36,,,0,"percent of total billed charges ","93% of total billed charges ",14.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.03,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",498.53,85,,398.82,,,0,"percent of total billed charges ","85% of total billed charges ",527.85,90,,422.28,,,0,"percent of total billed charges ","90% of total billed charges ",527.85,90,,422.28,,,0,"percent of total billed charges ","90% of total billed charges ",18.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",510.26,87,,408.21,,,0,"percent of total billed charges ","87% of total billed charges ",18.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.76,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",410.55,70,,328.44,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,545.45,
ELUTION,2019630,"CDM ",309,RC,86860,HCPCS,OUTPATIENT,,,229,183.2,,129.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",160.3,70,,128.24,,,0,"percent of total billed charges ","70% of total billed charges ",206.1,90,,164.88,,,0,"percent of total billed charges ","90% of total billed charges ",212.97,93,,170.38,,,0,"percent of total billed charges ","93% of total billed charges ",129.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",194.65,85,,155.72,,,0,"percent of total billed charges ","85% of total billed charges ",206.1,90,,164.88,,,0,"percent of total billed charges ","90% of total billed charges ",206.1,90,,164.88,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",199.23,87,,159.38,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",160.3,70,,128.24,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,212.97,
"STYPVEN TIME #117093",2019640,"CDM ",305,RC,85612,HCPCS,OUTPATIENT,,,403,322.4,,5.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",282.1,70,,225.68,,,0,"percent of total billed charges ","70% of total billed charges ",362.7,90,,290.16,,,0,"percent of total billed charges ","90% of total billed charges ",374.79,93,,299.83,,,0,"percent of total billed charges ","93% of total billed charges ",5.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",342.55,85,,274.04,,,0,"percent of total billed charges ","85% of total billed charges ",362.7,90,,290.16,,,0,"percent of total billed charges ","90% of total billed charges ",362.7,90,,290.16,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",350.61,87,,280.49,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.48,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",282.1,70,,225.68,,,0,"percent of total billed charges ","70% of total billed charges ",5.46,374.79,
"VITAMIN K",2019650,"CDM ",301,RC,84597,HCPCS,OUTPATIENT,,,117,93.6,,13.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,51.74,51.74,51.74,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.9,70,,65.52,,,0,"percent of total billed charges ","70% of total billed charges ",105.3,90,,84.24,,,0,"percent of total billed charges ","90% of total billed charges ",108.81,93,,87.05,,,0,"percent of total billed charges ","93% of total billed charges ",13.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",99.45,85,,79.56,,,0,"percent of total billed charges ","85% of total billed charges ",105.3,90,,84.24,,,0,"percent of total billed charges ","90% of total billed charges ",105.3,90,,84.24,,,0,"percent of total billed charges ","90% of total billed charges ",24.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",101.79,87,,81.43,,,0,"percent of total billed charges ","87% of total billed charges ",24.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.72,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",81.9,70,,65.52,,,0,"percent of total billed charges ","70% of total billed charges ",13.72,108.81,
"OCCULT BLOOD,GASTRIC FL",2019660,"CDM ",301,RC,82271,HCPCS,OUTPATIENT,,,73,58.4,,4.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.1,70,,40.88,,,0,"percent of total billed charges ","70% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",67.89,93,,54.31,,,0,"percent of total billed charges ","93% of total billed charges ",4.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.05,85,,49.64,,,0,"percent of total billed charges ","85% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",5.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.51,87,,50.81,,,0,"percent of total billed charges ","87% of total billed charges ",5.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.32,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",51.1,70,,40.88,,,0,"percent of total billed charges ","70% of total billed charges ",4.52,67.89,
"ERYTHROCYTOSIS EVALUATION",2019670,"CDM ",301,RC,84160,HCPCS,OUTPATIENT,,,2109.5,1687.6,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1476.65,70,,1181.32,,,0,"percent of total billed charges ","70% of total billed charges ",1898.55,90,,1518.84,,,0,"percent of total billed charges ","90% of total billed charges ",1961.84,93,,1569.47,,,0,"percent of total billed charges ","93% of total billed charges ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1793.08,85,,1434.46,,,0,"percent of total billed charges ","85% of total billed charges ",1898.55,90,,1518.84,,,0,"percent of total billed charges ","90% of total billed charges ",1898.55,90,,1518.84,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1835.27,87,,1468.22,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1476.65,70,,1181.32,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,1961.84,
"CYCLOSPORINE WHOLE BLOOD",2019680,"CDM ",300,RC,80158,HCPCS,OUTPATIENT,,,139.5,111.6,,15.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,76.70,76.70,76.70,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.65,70,,78.12,,,0,"percent of total billed charges ","70% of total billed charges ",125.55,90,,100.44,,,0,"percent of total billed charges ","90% of total billed charges ",129.74,93,,103.79,,,0,"percent of total billed charges ","93% of total billed charges ",15.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",118.58,85,,94.86,,,0,"percent of total billed charges ","85% of total billed charges ",125.55,90,,100.44,,,0,"percent of total billed charges ","90% of total billed charges ",125.55,90,,100.44,,,0,"percent of total billed charges ","90% of total billed charges ",14.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",121.37,87,,97.10,,,0,"percent of total billed charges ","87% of total billed charges ",14.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",97.65,70,,78.12,,,0,"percent of total billed charges ","70% of total billed charges ",14.49,129.74,
"CYSTIC ECHNIOCOCCUS",2019690,"CDM ",302,RC,86682,HCPCS,OUTPATIENT,,,228,182.4,,11.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",159.6,70,,127.68,,,0,"percent of total billed charges ","70% of total billed charges ",205.2,90,,164.16,,,0,"percent of total billed charges ","90% of total billed charges ",212.04,93,,169.63,,,0,"percent of total billed charges ","93% of total billed charges ",11.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",193.8,85,,155.04,,,0,"percent of total billed charges ","85% of total billed charges ",205.2,90,,164.16,,,0,"percent of total billed charges ","90% of total billed charges ",205.2,90,,164.16,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.36,87,,155.16,155.16,155.16,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",159.6,70,,127.68,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,212.04,
"TRICHINELLA SPIRALIS IGG",2019700,"CDM ",302,RC,86784,HCPCS,OUTPATIENT,,,465,372,,10.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",325.5,70,,260.40,,,0,"percent of total billed charges ","70% of total billed charges ",418.5,90,,334.80,,,0,"percent of total billed charges ","90% of total billed charges ",432.45,93,,345.96,,,0,"percent of total billed charges ","93% of total billed charges ",10.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",395.25,85,,316.20,,,0,"percent of total billed charges ","85% of total billed charges ",418.5,90,,334.80,,,0,"percent of total billed charges ","90% of total billed charges ",418.5,90,,334.80,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",404.55,87,,323.64,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.56,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",325.5,70,,260.40,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,432.45,
"*METANEPHRINES URINE",2019840,"CDM ",301,RC,83835,HCPCS,OUTPATIENT,,,146.5,117.2,,16.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.55,70,,82.04,,,0,"percent of total billed charges ","70% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",136.25,93,,109.00,,,0,"percent of total billed charges ","93% of total billed charges ",16.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.06,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.53,85,,99.62,,,0,"percent of total billed charges ","85% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.46,87,,101.97,,,0,"percent of total billed charges ","87% of total billed charges ",29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.94,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.55,70,,82.04,,,0,"percent of total billed charges ","70% of total billed charges ",16.94,136.25,
"*PHEOCHROMOCYTOMA EVALUATION",2019850,"CDM ",301,RC,82570,HCPCS,OUTPATIENT,,,66.5,53.2,,5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.55,70,,37.24,,,0,"percent of total billed charges ","70% of total billed charges ",59.85,90,,47.88,,,0,"percent of total billed charges ","90% of total billed charges ",61.85,93,,49.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",56.53,85,,45.22,,,0,"percent of total billed charges ","85% of total billed charges ",59.85,90,,47.88,,,0,"percent of total billed charges ","90% of total billed charges ",59.85,90,,47.88,,,0,"percent of total billed charges ","90% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.86,87,,5.08,4.98,50.30,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",46.55,70,,37.24,,,0,"percent of total billed charges ","70% of total billed charges ",5.18,61.85,
"INSULIN-LIKE GROWTH FAC BIND",2019860,"CDM ",301,RC,83519,HCPCS,OUTPATIENT,,,97,77.6,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",90.21,93,,72.17,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",82.45,85,,65.96,,,0,"percent of total billed charges ","85% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.39,87,,67.51,,,0,"percent of total billed charges ","87% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,90.21,
"ACETYCHOLINE REC BINDING ABS",2019880,"CDM ",301,RC,84238,HCPCS,OUTPATIENT,,,289.5,231.6,,36.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,286.80,286.80,286.80,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",202.65,70,,162.12,,,0,"percent of total billed charges ","70% of total billed charges ",260.55,90,,208.44,,,0,"percent of total billed charges ","90% of total billed charges ",269.24,93,,215.39,,,0,"percent of total billed charges ","93% of total billed charges ",36.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",246.08,85,,196.86,,,0,"percent of total billed charges ","85% of total billed charges ",260.55,90,,208.44,,,0,"percent of total billed charges ","90% of total billed charges ",260.55,90,,208.44,,,0,"percent of total billed charges ","90% of total billed charges ",66.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",251.87,87,,71.68,71.68,71.68,"1 through 10","percent of total billed charges ","87% of total billed charges ",66.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.57,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",202.65,70,,162.12,,,0,"percent of total billed charges ","70% of total billed charges ",36.57,269.24,
"ACETYCHOLINE REC BLOCKING ABS",2019890,"CDM ",301,RC,84238,HCPCS,OUTPATIENT,,,108,86.4,,36.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,286.80,286.80,286.80,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",36.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",66.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,71.68,71.68,71.68,"1 through 10","percent of total billed charges ","87% of total billed charges ",66.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.57,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",36.57,100.44,
"MUSK ANTIBODY TITER",2019910,"CDM ",301,RC,83519,HCPCS,OUTPATIENT,,,1857.5,1486,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1300.25,70,,1040.20,,,0,"percent of total billed charges ","70% of total billed charges ",1671.75,90,,1337.40,,,0,"percent of total billed charges ","90% of total billed charges ",1727.48,93,,1381.98,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1578.88,85,,1263.10,,,0,"percent of total billed charges ","85% of total billed charges ",1671.75,90,,1337.40,,,0,"percent of total billed charges ","90% of total billed charges ",1671.75,90,,1337.40,,,0,"percent of total billed charges ","90% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1616.03,87,,1292.82,,,0,"percent of total billed charges ","87% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1300.25,70,,1040.20,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,1727.48,
"TRANSGLUTAMINASE IGA",2019940,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,127,101.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.9,70,,71.12,,,0,"percent of total billed charges ","70% of total billed charges ",114.3,90,,91.44,,,0,"percent of total billed charges ","90% of total billed charges ",118.11,93,,94.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",107.95,85,,86.36,,,0,"percent of total billed charges ","85% of total billed charges ",114.3,90,,91.44,,,0,"percent of total billed charges ","90% of total billed charges ",114.3,90,,91.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",110.49,87,,88.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",88.9,70,,71.12,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,118.11,
"MATHYLMALONIC ACID SERUM",2019960,"CDM ",301,RC,83921,HCPCS,OUTPATIENT,,,147.5,118,,19.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.25,70,,82.60,,,0,"percent of total billed charges ","70% of total billed charges ",132.75,90,,106.20,,,0,"percent of total billed charges ","90% of total billed charges ",137.18,93,,109.74,,,0,"percent of total billed charges ","93% of total billed charges ",19.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.55,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",125.38,85,,100.30,,,0,"percent of total billed charges ","85% of total billed charges ",132.75,90,,106.20,,,0,"percent of total billed charges ","90% of total billed charges ",132.75,90,,106.20,,,0,"percent of total billed charges ","90% of total billed charges ",25.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",128.33,87,,102.66,,,0,"percent of total billed charges ","87% of total billed charges ",25.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.21,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",103.25,70,,82.60,,,0,"percent of total billed charges ","70% of total billed charges ",19.34,137.18,
"SULFATE 24 HR URINE",2019970,"CDM ",301,RC,84392,HCPCS,OUTPATIENT,,,238.5,190.8,,5.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",166.95,70,,133.56,,,0,"percent of total billed charges ","70% of total billed charges ",214.65,90,,171.72,,,0,"percent of total billed charges ","90% of total billed charges ",221.81,93,,177.45,,,0,"percent of total billed charges ","93% of total billed charges ",5.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",202.73,85,,162.18,,,0,"percent of total billed charges ","85% of total billed charges ",214.65,90,,171.72,,,0,"percent of total billed charges ","90% of total billed charges ",214.65,90,,171.72,,,0,"percent of total billed charges ","90% of total billed charges ",8.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",207.5,87,,166.00,,,0,"percent of total billed charges ","87% of total billed charges ",8.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.49,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",166.95,70,,133.56,,,0,"percent of total billed charges ","70% of total billed charges ",5.49,221.81,
"*TAU PHOSPHORYLATED EA",2019973,"CDM ",301,RC,84393,HCPCS,OUTPATIENT,,,246,196.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.2,70,,137.76,,,0,"percent of total billed charges ","70% of total billed charges ",221.4,90,,177.12,,,0,"percent of total billed charges ","90% of total billed charges ",228.78,93,,183.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",209.1,85,,167.28,,,0,"percent of total billed charges ","85% of total billed charges ",221.4,90,,177.12,,,0,"percent of total billed charges ","90% of total billed charges ",221.4,90,,177.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",214.02,87,,171.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",128.91,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",172.2,70,,137.76,,,0,"percent of total billed charges ","70% of total billed charges ",128.91,228.78,
"*VOL MEASURE TIMED COLLECTION",2019990,"CDM ",307,RC,81050,HCPCS,OUTPATIENT,,,44.5,35.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.15,70,,24.92,,,0,"percent of total billed charges ","70% of total billed charges ",40.05,90,,32.04,,,0,"percent of total billed charges ","90% of total billed charges ",41.39,93,,33.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",37.83,85,,30.26,,,0,"percent of total billed charges ","85% of total billed charges ",40.05,90,,32.04,,,0,"percent of total billed charges ","90% of total billed charges ",40.05,90,,32.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",38.72,87,,3.57,3.57,3.57,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",3.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.15,70,,24.92,,,0,"percent of total billed charges ","70% of total billed charges ",3.64,41.39,
"*MICROALBUMIN 24HR URINE",2020000,"CDM ",301,RC,82043,HCPCS,OUTPATIENT,,,53,42.4,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",49.29,93,,39.43,,,0,"percent of total billed charges ","93% of total billed charges ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.05,85,,36.04,,,0,"percent of total billed charges ","85% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.11,87,,5.67,5.33,35.21,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.78,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,49.29,
"*CALCIUM URINE 24HR",2020010,"CDM ",301,RC,82340,HCPCS,OUTPATIENT,,,51.5,41.2,,6.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.05,70,,28.84,,,0,"percent of total billed charges ","70% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",47.9,93,,38.32,,,0,"percent of total billed charges ","93% of total billed charges ",6.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",43.78,85,,35.02,,,0,"percent of total billed charges ","85% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",10.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",44.81,87,,35.85,,,0,"percent of total billed charges ","87% of total billed charges ",10.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",36.05,70,,28.84,,,0,"percent of total billed charges ","70% of total billed charges ",6.03,47.9,
"*CHLORIDE URINE 24HR",2020020,"CDM ",301,RC,82436,HCPCS,OUTPATIENT,,,87,69.6,,4.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,19.83,19.83,19.83,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.9,70,,48.72,,,0,"percent of total billed charges ","70% of total billed charges ",78.3,90,,62.64,,,0,"percent of total billed charges ","90% of total billed charges ",80.91,93,,64.73,,,0,"percent of total billed charges ","93% of total billed charges ",4.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",73.95,85,,59.16,,,0,"percent of total billed charges ","85% of total billed charges ",78.3,90,,62.64,,,0,"percent of total billed charges ","90% of total billed charges ",78.3,90,,62.64,,,0,"percent of total billed charges ","90% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",75.69,87,,60.55,,,0,"percent of total billed charges ","87% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.75,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",60.9,70,,48.72,,,0,"percent of total billed charges ","70% of total billed charges ",4.89,80.91,
"RISTOCETIN COFACTOR FUNC #1871",2020030,"CDM ",305,RC,85245,HCPCS,OUTPATIENT,,,132,105.6,,19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.4,70,,73.92,,,0,"percent of total billed charges ","70% of total billed charges ",118.8,90,,95.04,,,0,"percent of total billed charges ","90% of total billed charges ",122.76,93,,98.21,,,0,"percent of total billed charges ","93% of total billed charges ",19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",112.2,85,,89.76,,,0,"percent of total billed charges ","85% of total billed charges ",118.8,90,,95.04,,,0,"percent of total billed charges ","90% of total billed charges ",118.8,90,,95.04,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",114.84,87,,149.99,149.99,149.99,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.94,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",92.4,70,,73.92,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,122.76,
"LIVER-KIDNEY MICROSOMAL AUTOAB",2020040,"CDM ",302,RC,86376,HCPCS,OUTPATIENT,,,140.5,112.4,,14.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.97,60.97,60.97,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",130.67,93,,104.54,,,0,"percent of total billed charges ","93% of total billed charges ",14.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",119.43,85,,95.54,,,0,"percent of total billed charges ","85% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.24,87,,55.52,12.39,96.11,"1 through 10","percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.55,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",14.55,130.67,
"CYCLIC CITRUL PEPTIDE IGG ABS",2020070,"CDM ",300,RC,86200,HCPCS,OUTPATIENT,,,395,316,,12.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,33.25,33.25,33.25,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",276.5,70,,221.20,,,0,"percent of total billed charges ","70% of total billed charges ",355.5,90,,284.40,,,0,"percent of total billed charges ","90% of total billed charges ",367.35,93,,293.88,,,0,"percent of total billed charges ","93% of total billed charges ",12.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",335.75,85,,268.60,,,0,"percent of total billed charges ","85% of total billed charges ",355.5,90,,284.40,,,0,"percent of total billed charges ","90% of total billed charges ",355.5,90,,284.40,,,0,"percent of total billed charges ","90% of total billed charges ",20.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",343.65,87,,274.92,,,0,"percent of total billed charges ","87% of total billed charges ",20.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.95,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",276.5,70,,221.20,,,0,"percent of total billed charges ","70% of total billed charges ",12.95,367.35,
"BRUCELLA ABORTUS IGG",2020080,"CDM ",302,RC,86622,HCPCS,OUTPATIENT,,,168,134.4,,7.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.6,70,,94.08,,,0,"percent of total billed charges ","70% of total billed charges ",151.2,90,,120.96,,,0,"percent of total billed charges ","90% of total billed charges ",156.24,93,,124.99,,,0,"percent of total billed charges ","93% of total billed charges ",7.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",142.8,85,,114.24,,,0,"percent of total billed charges ","85% of total billed charges ",151.2,90,,120.96,,,0,"percent of total billed charges ","90% of total billed charges ",151.2,90,,120.96,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",146.16,87,,116.93,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.6,70,,94.08,,,0,"percent of total billed charges ","70% of total billed charges ",7.59,156.24,
"*SULFATE QT 24HR URINE",2020090,"CDM ",301,RC,84392,HCPCS,OUTPATIENT,,,362,289.6,,5.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",253.4,70,,202.72,,,0,"percent of total billed charges ","70% of total billed charges ",325.8,90,,260.64,,,0,"percent of total billed charges ","90% of total billed charges ",336.66,93,,269.33,,,0,"percent of total billed charges ","93% of total billed charges ",5.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",307.7,85,,246.16,,,0,"percent of total billed charges ","85% of total billed charges ",325.8,90,,260.64,,,0,"percent of total billed charges ","90% of total billed charges ",325.8,90,,260.64,,,0,"percent of total billed charges ","90% of total billed charges ",8.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",314.94,87,,251.95,,,0,"percent of total billed charges ","87% of total billed charges ",8.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.49,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",253.4,70,,202.72,,,0,"percent of total billed charges ","70% of total billed charges ",5.49,336.66,
"*GLUCOSE TOLERANCE 3 SPECS",2020100,"CDM ",301,RC,82951,HCPCS,OUTPATIENT,,,161.5,129.2,,12.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.05,70,,90.44,,,0,"percent of total billed charges ","70% of total billed charges ",145.35,90,,116.28,,,0,"percent of total billed charges ","90% of total billed charges ",150.2,93,,120.16,,,0,"percent of total billed charges ","93% of total billed charges ",12.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",137.28,85,,109.82,,,0,"percent of total billed charges ","85% of total billed charges ",145.35,90,,116.28,,,0,"percent of total billed charges ","90% of total billed charges ",145.35,90,,116.28,,,0,"percent of total billed charges ","90% of total billed charges ",23.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",140.51,87,,125.42,125.42,125.42,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.87,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",113.05,70,,90.44,,,0,"percent of total billed charges ","70% of total billed charges ",12.87,150.2,
"*GLUCOSE TOLERANCE ADD'L SPECI",2020110,"CDM ",301,RC,82952,HCPCS,OUTPATIENT,,,55,44,,3.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.5,70,,30.80,,,0,"percent of total billed charges ","70% of total billed charges ",49.5,90,,39.60,,,0,"percent of total billed charges ","90% of total billed charges ",51.15,93,,40.92,,,0,"percent of total billed charges ","93% of total billed charges ",3.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",46.75,85,,37.40,,,0,"percent of total billed charges ","85% of total billed charges ",49.5,90,,39.60,,,0,"percent of total billed charges ","90% of total billed charges ",49.5,90,,39.60,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.85,87,,38.28,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.92,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",38.5,70,,30.80,,,0,"percent of total billed charges ","70% of total billed charges ",3.92,51.15,
"*HYDROXYPROLIME 24HR",2020120,"CDM ",301,RC,83500,HCPCS,OUTPATIENT,,,564.5,451.6,,23.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",395.15,70,,316.12,,,0,"percent of total billed charges ","70% of total billed charges ",508.05,90,,406.44,,,0,"percent of total billed charges ","90% of total billed charges ",524.99,93,,419.99,,,0,"percent of total billed charges ","93% of total billed charges ",23.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",479.83,85,,383.86,,,0,"percent of total billed charges ","85% of total billed charges ",508.05,90,,406.44,,,0,"percent of total billed charges ","90% of total billed charges ",508.05,90,,406.44,,,0,"percent of total billed charges ","90% of total billed charges ",30.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",491.12,87,,392.90,,,0,"percent of total billed charges ","87% of total billed charges ",30.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.65,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",395.15,70,,316.12,,,0,"percent of total billed charges ","70% of total billed charges ",22.65,524.99,
"*LEAD URINE 24HR",2020130,"CDM ",301,RC,83655,HCPCS,OUTPATIENT,,,54,43.2,,11.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.8,70,,30.24,,,0,"percent of total billed charges ","70% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",50.22,93,,40.18,,,0,"percent of total billed charges ","93% of total billed charges ",11.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.9,85,,36.72,,,0,"percent of total billed charges ","85% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",15.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.98,87,,33.45,33.45,33.45,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.11,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",37.8,70,,30.24,,,0,"percent of total billed charges ","70% of total billed charges ",11.7,50.22,
"*METANEPHRINES QT FRAC 24H URI",2020140,"CDM ",301,RC,83835,HCPCS,OUTPATIENT,,,146.5,117.2,,16.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.55,70,,82.04,,,0,"percent of total billed charges ","70% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",136.25,93,,109.00,,,0,"percent of total billed charges ","93% of total billed charges ",16.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.06,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.53,85,,99.62,,,0,"percent of total billed charges ","85% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.46,87,,101.97,,,0,"percent of total billed charges ","87% of total billed charges ",29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.94,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.55,70,,82.04,,,0,"percent of total billed charges ","70% of total billed charges ",16.94,136.25,
"*POTASSIUM URINE 24HR",2020150,"CDM ",301,RC,84133,HCPCS,OUTPATIENT,,,96.5,77.2,,4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.55,70,,54.04,,,0,"percent of total billed charges ","70% of total billed charges ",86.85,90,,69.48,,,0,"percent of total billed charges ","90% of total billed charges ",89.75,93,,71.80,,,0,"percent of total billed charges ","93% of total billed charges ",4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",82.03,85,,65.62,,,0,"percent of total billed charges ","85% of total billed charges ",86.85,90,,69.48,,,0,"percent of total billed charges ","90% of total billed charges ",86.85,90,,69.48,,,0,"percent of total billed charges ","90% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.96,87,,67.17,,,0,"percent of total billed charges ","87% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.73,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",67.55,70,,54.04,,,0,"percent of total billed charges ","70% of total billed charges ",4.2,89.75,
"*PROTEIN 24HR URINE",2020160,"CDM ",301,RC,84156,HCPCS,OUTPATIENT,,,92.5,74,,3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",86.03,93,,68.82,,,0,"percent of total billed charges ","93% of total billed charges ",3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",78.63,85,,62.90,,,0,"percent of total billed charges ","85% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.48,87,,43.83,11.65,76.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",3.67,86.03,
"*PROTEIN ELECT 24HR URINE",2020170,"CDM ",301,RC,84166,HCPCS,OUTPATIENT,,,56,44.8,,17.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.2,70,,31.36,,,0,"percent of total billed charges ","70% of total billed charges ",50.4,90,,40.32,,,0,"percent of total billed charges ","90% of total billed charges ",52.08,93,,41.66,,,0,"percent of total billed charges ","93% of total billed charges ",17.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",47.6,85,,38.08,,,0,"percent of total billed charges ","85% of total billed charges ",50.4,90,,40.32,,,0,"percent of total billed charges ","90% of total billed charges ",50.4,90,,40.32,,,0,"percent of total billed charges ","90% of total billed charges ",27.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",48.72,87,,38.98,,,0,"percent of total billed charges ","87% of total billed charges ",27.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",39.2,70,,31.36,,,0,"percent of total billed charges ","70% of total billed charges ",17.82,52.08,
"*SODIUM URINE 24HR",2020180,"CDM ",301,RC,84300,HCPCS,OUTPATIENT,,,65.5,52.4,,4.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.85,70,,36.68,,,0,"percent of total billed charges ","70% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",60.92,93,,48.74,,,0,"percent of total billed charges ","93% of total billed charges ",4.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",55.68,85,,44.54,,,0,"percent of total billed charges ","85% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.99,87,,4.96,4.96,4.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",45.85,70,,36.68,,,0,"percent of total billed charges ","70% of total billed charges ",4.3,60.92,
"*ELECTROPHORETIC TECHNIQUE",2020190,"CDM ",301,RC,82664,HCPCS,OUTPATIENT,,,181,144.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",126.7,70,,101.36,,,0,"percent of total billed charges ","70% of total billed charges ",162.9,90,,130.32,,,0,"percent of total billed charges ","90% of total billed charges ",168.33,93,,134.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",153.85,85,,123.08,,,0,"percent of total billed charges ","85% of total billed charges ",162.9,90,,130.32,,,0,"percent of total billed charges ","90% of total billed charges ",162.9,90,,130.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",157.47,87,,125.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",61.5,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",126.7,70,,101.36,,,0,"percent of total billed charges ","70% of total billed charges ",61.5,168.33,
"*GAMMAGLOBULIN IGG,IGA,IGM,IGD",2020200,"CDM ",301,RC,82784,HCPCS,OUTPATIENT,,,108,86.4,,9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,75.17,,,0,"percent of total billed charges ","87% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",9.3,100.44,
"PROSTAGLANDIN PG-D2 SER",2020230,"CDM ",301,RC,84150,HCPCS,OUTPATIENT,,,1136,908.8,,35.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",795.2,70,,636.16,,,0,"percent of total billed charges ","70% of total billed charges ",1022.4,90,,817.92,,,0,"percent of total billed charges ","90% of total billed charges ",1056.48,93,,845.18,,,0,"percent of total billed charges ","93% of total billed charges ",35.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",965.6,85,,772.48,,,0,"percent of total billed charges ","85% of total billed charges ",1022.4,90,,817.92,,,0,"percent of total billed charges ","90% of total billed charges ",1022.4,90,,817.92,,,0,"percent of total billed charges ","90% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",988.32,87,,790.66,,,0,"percent of total billed charges ","87% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.77,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",795.2,70,,636.16,,,0,"percent of total billed charges ","70% of total billed charges ",30.22,1056.48,
"*HISTAMINE 24HR URINE",2020250,"CDM ",301,RC,83088,HCPCS,OUTPATIENT,,,217.5,174,,25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.25,70,,121.80,,,0,"percent of total billed charges ","70% of total billed charges ",195.75,90,,156.60,,,0,"percent of total billed charges ","90% of total billed charges ",202.28,93,,161.82,,,0,"percent of total billed charges ","93% of total billed charges ",25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",184.88,85,,147.90,,,0,"percent of total billed charges ","85% of total billed charges ",195.75,90,,156.60,,,0,"percent of total billed charges ","90% of total billed charges ",195.75,90,,156.60,,,0,"percent of total billed charges ","90% of total billed charges ",32.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",189.23,87,,151.38,,,0,"percent of total billed charges ","87% of total billed charges ",32.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",152.25,70,,121.80,,,0,"percent of total billed charges ","70% of total billed charges ",25,202.28,
"LEPTOSPIRA AB IHA,CSF",2020260,"CDM ",302,RC,86720,HCPCS,OUTPATIENT,,,359.5,287.6,,13.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",251.65,70,,201.32,,,0,"percent of total billed charges ","70% of total billed charges ",323.55,90,,258.84,,,0,"percent of total billed charges ","90% of total billed charges ",334.34,93,,267.47,,,0,"percent of total billed charges ","93% of total billed charges ",13.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",305.58,85,,244.46,,,0,"percent of total billed charges ","85% of total billed charges ",323.55,90,,258.84,,,0,"percent of total billed charges ","90% of total billed charges ",323.55,90,,258.84,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",312.77,87,,250.22,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.2,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",251.65,70,,201.32,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,334.34,
DEXAMETHASONE,2020270,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,196,156.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",137.2,70,,109.76,,,0,"percent of total billed charges ","70% of total billed charges ",176.4,90,,141.12,,,0,"percent of total billed charges ","90% of total billed charges ",182.28,93,,145.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",166.6,85,,133.28,,,0,"percent of total billed charges ","85% of total billed charges ",176.4,90,,141.12,,,0,"percent of total billed charges ","90% of total billed charges ",176.4,90,,141.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",170.52,87,,136.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",137.2,70,,109.76,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,182.28,
"ANABOLIC STEROID SCREEN 548977",2020280,"CDM ",301,RC,82542,HCPCS,OUTPATIENT,,,396,316.8,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",277.2,70,,221.76,,,0,"percent of total billed charges ","70% of total billed charges ",356.4,90,,285.12,,,0,"percent of total billed charges ","90% of total billed charges ",368.28,93,,294.62,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",336.6,85,,269.28,,,0,"percent of total billed charges ","85% of total billed charges ",356.4,90,,285.12,,,0,"percent of total billed charges ","90% of total billed charges ",356.4,90,,285.12,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",344.52,87,,275.62,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",277.2,70,,221.76,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,368.28,
"LEPTOSPIRA AB",2020290,"CDM ",302,RC,86720,HCPCS,OUTPATIENT,,,609,487.2,,13.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",426.3,70,,341.04,,,0,"percent of total billed charges ","70% of total billed charges ",548.1,90,,438.48,,,0,"percent of total billed charges ","90% of total billed charges ",566.37,93,,453.10,,,0,"percent of total billed charges ","93% of total billed charges ",13.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",517.65,85,,414.12,,,0,"percent of total billed charges ","85% of total billed charges ",548.1,90,,438.48,,,0,"percent of total billed charges ","90% of total billed charges ",548.1,90,,438.48,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",529.83,87,,423.86,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.2,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",426.3,70,,341.04,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,566.37,
"LECITHIN/SPHINGOMYELIN RATIO",2020300,"CDM ",301,RC,83661,HCPCS,OUTPATIENT,,,422,337.6,,31.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",295.4,70,,236.32,,,0,"percent of total billed charges ","70% of total billed charges ",379.8,90,,303.84,,,0,"percent of total billed charges ","90% of total billed charges ",392.46,93,,313.97,,,0,"percent of total billed charges ","93% of total billed charges ",31.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",358.7,85,,286.96,,,0,"percent of total billed charges ","85% of total billed charges ",379.8,90,,303.84,,,0,"percent of total billed charges ","90% of total billed charges ",379.8,90,,303.84,,,0,"percent of total billed charges ","90% of total billed charges ",39.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",367.14,87,,293.71,,,0,"percent of total billed charges ","87% of total billed charges ",39.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.99,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",295.4,70,,236.32,,,0,"percent of total billed charges ","70% of total billed charges ",21.99,392.46,
"*THAW CRYOPRECIPITATE",2020320,"CDM ",390,RC,86931,HCPCS,OUTPATIENT,,,36.5,29.2,,20.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.55,70,,20.44,,,0,"percent of total billed charges ","70% of total billed charges ",32.85,90,,26.28,,,0,"percent of total billed charges ","90% of total billed charges ",33.95,93,,27.16,,,0,"percent of total billed charges ","93% of total billed charges ",20.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",31.03,85,,24.82,,,0,"percent of total billed charges ","85% of total billed charges ",32.85,90,,26.28,,,0,"percent of total billed charges ","90% of total billed charges ",32.85,90,,26.28,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.76,87,,25.41,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",25.55,70,,20.44,,,0,"percent of total billed charges ","70% of total billed charges ",20.8,156.68,
"BK VIRUS DNA QUANT PLASMA",2020340,"CDM ",306,RC,87798,HCPCS,OUTPATIENT,,,1671.5,1337.2,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1170.05,70,,936.04,,,0,"percent of total billed charges ","70% of total billed charges ",1504.35,90,,1203.48,,,0,"percent of total billed charges ","90% of total billed charges ",1554.5,93,,1243.60,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1420.78,85,,1136.62,,,0,"percent of total billed charges ","85% of total billed charges ",1504.35,90,,1203.48,,,0,"percent of total billed charges ","90% of total billed charges ",1504.35,90,,1203.48,,,0,"percent of total billed charges ","90% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.21,87,,1163.37,,,0,"percent of total billed charges ","87% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1170.05,70,,936.04,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,1554.5,
"GROWTH HORMONE #3182",2020350,"CDM ",301,RC,83003,HCPCS,OUTPATIENT,,,127,101.6,,16.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,56.11,56.11,56.11,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.9,70,,71.12,,,0,"percent of total billed charges ","70% of total billed charges ",114.3,90,,91.44,,,0,"percent of total billed charges ","90% of total billed charges ",118.11,93,,94.49,,,0,"percent of total billed charges ","93% of total billed charges ",16.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",107.95,85,,86.36,,,0,"percent of total billed charges ","85% of total billed charges ",114.3,90,,91.44,,,0,"percent of total billed charges ","90% of total billed charges ",114.3,90,,91.44,,,0,"percent of total billed charges ","90% of total billed charges ",27.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",110.49,87,,88.39,,,0,"percent of total billed charges ","87% of total billed charges ",27.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",88.9,70,,71.12,,,0,"percent of total billed charges ","70% of total billed charges ",16.67,118.11,
"IGF-I LC/MS",2020360,"CDM ",301,RC,84305,HCPCS,OUTPATIENT,,,254,203.2,,21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.8,70,,142.24,,,0,"percent of total billed charges ","70% of total billed charges ",228.6,90,,182.88,,,0,"percent of total billed charges ","90% of total billed charges ",236.22,93,,188.98,,,0,"percent of total billed charges ","93% of total billed charges ",21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",215.9,85,,172.72,,,0,"percent of total billed charges ","85% of total billed charges ",228.6,90,,182.88,,,0,"percent of total billed charges ","90% of total billed charges ",228.6,90,,182.88,,,0,"percent of total billed charges ","90% of total billed charges ",27.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",220.98,87,,176.78,,,0,"percent of total billed charges ","87% of total billed charges ",27.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.26,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",177.8,70,,142.24,,,0,"percent of total billed charges ","70% of total billed charges ",21,236.22,
"RBC FOLATE  #3522R",2020380,"CDM ",301,RC,82747,HCPCS,OUTPATIENT,,,138.5,110.8,,17.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.88,60.88,60.88,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.95,70,,77.56,,,0,"percent of total billed charges ","70% of total billed charges ",124.65,90,,99.72,,,0,"percent of total billed charges ","90% of total billed charges ",128.81,93,,103.05,,,0,"percent of total billed charges ","93% of total billed charges ",17.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",117.73,85,,94.18,,,0,"percent of total billed charges ","85% of total billed charges ",124.65,90,,99.72,,,0,"percent of total billed charges ","90% of total billed charges ",124.65,90,,99.72,,,0,"percent of total billed charges ","90% of total billed charges ",28.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",120.5,87,,96.40,,,0,"percent of total billed charges ","87% of total billed charges ",28.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",96.95,70,,77.56,,,0,"percent of total billed charges ","70% of total billed charges ",17.64,128.81,
"*PERTUSSIS IGA/IGG/IGM ABS",2020600,"CDM ",302,RC,86615,HCPCS,OUTPATIENT,,,180.5,144.4,,11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",126.35,70,,101.08,,,0,"percent of total billed charges ","70% of total billed charges ",162.45,90,,129.96,,,0,"percent of total billed charges ","90% of total billed charges ",167.87,93,,134.30,,,0,"percent of total billed charges ","93% of total billed charges ",11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",153.43,85,,122.74,,,0,"percent of total billed charges ","85% of total billed charges ",162.45,90,,129.96,,,0,"percent of total billed charges ","90% of total billed charges ",162.45,90,,129.96,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",157.04,87,,125.63,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",126.35,70,,101.08,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,167.87,
"LDH CSF",2020620,"CDM ",301,RC,83615,HCPCS,OUTPATIENT,,,123,98.4,,6.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.1,70,,68.88,,,0,"percent of total billed charges ","70% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",114.39,93,,91.51,,,0,"percent of total billed charges ","93% of total billed charges ",6.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.55,85,,83.64,,,0,"percent of total billed charges ","85% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.01,87,,81.33,26.88,95.68,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.04,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",86.1,70,,68.88,,,0,"percent of total billed charges ","70% of total billed charges ",6.04,114.39,
"*BORRELIA BURGDORFERI IGG ANTI",2020640,"CDM ",302,RC,86618,HCPCS,OUTPATIENT,,,204,163.2,,14.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",14.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,141.98,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,189.72,
"*BORRELIA BURGDORFERI IGM ANTI",2020650,"CDM ",302,RC,86618,HCPCS,OUTPATIENT,,,204,163.2,,14.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",14.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,141.98,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,189.72,
"*SS-A IGG AUTOANTIBODY",2020670,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,149.5,119.6,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",139.04,93,,111.23,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",127.08,85,,101.66,,,0,"percent of total billed charges ","85% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.07,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,139.04,
"*SS-B IGG AUTOANTIBODY",2020680,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,149.5,119.6,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",139.04,93,,111.23,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",127.08,85,,101.66,,,0,"percent of total billed charges ","85% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.07,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,139.04,
"*CHLAMIDIA TRACH RRNA URINE",2020700,"CDM ",306,RC,87591,HCPCS,OUTPATIENT,,,204,163.2,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.47,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,140.08,140.08,140.08,20,"percent of total billed charges ","87% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,189.72,
"*NEISSERIA GONORRHE RRNA URINE",2020710,"CDM ",306,RC,87491,HCPCS,OUTPATIENT,,,204,163.2,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.47,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,140.08,140.08,140.08,20,"percent of total billed charges ","87% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,189.72,
"*CULT NON-NEOPLASTIC DISORDER",2020730,"CDM ",300,RC,88230,HCPCS,OUTPATIENT,,,1410.5,1128.4,,99.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",987.35,70,,789.88,,,0,"percent of total billed charges ","70% of total billed charges ",1269.45,90,,1015.56,,,0,"percent of total billed charges ","90% of total billed charges ",1311.77,93,,1049.42,,,0,"percent of total billed charges ","93% of total billed charges ",99.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1198.93,85,,959.14,,,0,"percent of total billed charges ","85% of total billed charges ",1269.45,90,,1015.56,,,0,"percent of total billed charges ","90% of total billed charges ",1269.45,90,,1015.56,,,0,"percent of total billed charges ","90% of total billed charges ",34.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1227.14,87,,981.71,,,0,"percent of total billed charges ","87% of total billed charges ",34.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",116.49,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",987.35,70,,789.88,,,0,"percent of total billed charges ","70% of total billed charges ",34.88,1311.77,
"*CHROM ANALYS 2 KAROTYPES W/BA",2020740,"CDM ",300,RC,88262,HCPCS,OUTPATIENT,,,1235,988,,125.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",864.5,70,,691.60,,,0,"percent of total billed charges ","70% of total billed charges ",1111.5,90,,889.20,,,0,"percent of total billed charges ","90% of total billed charges ",1148.55,93,,918.84,,,0,"percent of total billed charges ","93% of total billed charges ",125.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",227.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1049.75,85,,839.80,,,0,"percent of total billed charges ","85% of total billed charges ",1111.5,90,,889.20,,,0,"percent of total billed charges ","90% of total billed charges ",1111.5,90,,889.20,,,0,"percent of total billed charges ","90% of total billed charges ",225.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1074.45,87,,859.56,,,0,"percent of total billed charges ","87% of total billed charges ",225.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",125.49,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",864.5,70,,691.60,,,0,"percent of total billed charges ","70% of total billed charges ",125.49,1148.55,
"*CYTOGENIC/MOLECULAR INTER/REP",2020750,"CDM ",300,RC,88291,HCPCS,OUTPATIENT,,,939,751.2,,26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",69.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",657.3,70,,525.84,,,0,"percent of total billed charges ","70% of total billed charges ",845.1,90,,676.08,,,0,"percent of total billed charges ","90% of total billed charges ",873.27,93,,698.62,,,0,"percent of total billed charges ","93% of total billed charges ",26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",798.15,85,,638.52,,,0,"percent of total billed charges ","85% of total billed charges ",845.1,90,,676.08,,,0,"percent of total billed charges ","90% of total billed charges ",845.1,90,,676.08,,,0,"percent of total billed charges ","90% of total billed charges ",32.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",816.93,87,,653.54,,,0,"percent of total billed charges ","87% of total billed charges ",32.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",657.3,70,,525.84,,,0,"percent of total billed charges ","70% of total billed charges ",26,873.27,
"*MICROPOLYSPORA FAENI",2020770,"CDM ",302,RC,86001,HCPCS,OUTPATIENT,,,92.5,74,,6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",86.03,93,,68.82,,,0,"percent of total billed charges ","93% of total billed charges ",6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",78.63,85,,62.90,,,0,"percent of total billed charges ","85% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.48,87,,64.38,,,0,"percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",6.65,86.03,
"*SACCHAROMONOSPORA VIRIDIS",2020780,"CDM ",302,RC,86001,HCPCS,OUTPATIENT,,,92.5,74,,6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",86.03,93,,68.82,,,0,"percent of total billed charges ","93% of total billed charges ",6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",78.63,85,,62.90,,,0,"percent of total billed charges ","85% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.48,87,,64.38,,,0,"percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",6.65,86.03,
"*THERMOACTINOMYCES CANDIDUS",2020790,"CDM ",302,RC,86001,HCPCS,OUTPATIENT,,,92.5,74,,6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",86.03,93,,68.82,,,0,"percent of total billed charges ","93% of total billed charges ",6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",78.63,85,,62.90,,,0,"percent of total billed charges ","85% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.48,87,,64.38,,,0,"percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",6.65,86.03,
"*THERMOATINOMYCES SACCHARI",2020800,"CDM ",302,RC,86001,HCPCS,OUTPATIENT,,,92.5,74,,6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",86.03,93,,68.82,,,0,"percent of total billed charges ","93% of total billed charges ",6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",78.63,85,,62.90,,,0,"percent of total billed charges ","85% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.48,87,,64.38,,,0,"percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",6.65,86.03,
"*THERMOACTINOMYCES VULGARIS",2020810,"CDM ",302,RC,86001,HCPCS,OUTPATIENT,,,92.5,74,,6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",86.03,93,,68.82,,,0,"percent of total billed charges ","93% of total billed charges ",6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",78.63,85,,62.90,,,0,"percent of total billed charges ","85% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.48,87,,64.38,,,0,"percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",6.65,86.03,
"*AUREOBASIDIUM PULLULANS IGG",2020820,"CDM ",302,RC,86001,HCPCS,OUTPATIENT,,,92.5,74,,6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",86.03,93,,68.82,,,0,"percent of total billed charges ","93% of total billed charges ",6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",78.63,85,,62.90,,,0,"percent of total billed charges ","85% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.48,87,,64.38,,,0,"percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",6.65,86.03,
"*ALTERNARIA TENUIS IGG",2020830,"CDM ",302,RC,86001,HCPCS,OUTPATIENT,,,92.5,74,,6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",86.03,93,,68.82,,,0,"percent of total billed charges ","93% of total billed charges ",6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",78.63,85,,62.90,,,0,"percent of total billed charges ","85% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.48,87,,64.38,,,0,"percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",6.65,86.03,
"*ASPERGILLUS FUMIGATUS",2020840,"CDM ",302,RC,86001,HCPCS,OUTPATIENT,,,92.5,74,,6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",86.03,93,,68.82,,,0,"percent of total billed charges ","93% of total billed charges ",6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",78.63,85,,62.90,,,0,"percent of total billed charges ","85% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",83.25,90,,66.60,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.48,87,,64.38,,,0,"percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",64.75,70,,51.80,,,0,"percent of total billed charges ","70% of total billed charges ",6.65,86.03,
"*CLADOSPORIUM HERBARUM IGG",2020850,"CDM ",302,RC,86331,HCPCS,OUTPATIENT,,,243.5,194.8,,11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,429.15,429.15,429.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.45,70,,136.36,,,0,"percent of total billed charges ","70% of total billed charges ",219.15,90,,175.32,,,0,"percent of total billed charges ","90% of total billed charges ",226.46,93,,181.17,,,0,"percent of total billed charges ","93% of total billed charges ",11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",206.98,85,,165.58,,,0,"percent of total billed charges ","85% of total billed charges ",219.15,90,,175.32,,,0,"percent of total billed charges ","90% of total billed charges ",219.15,90,,175.32,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",211.85,87,,169.48,,,0,"percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",170.45,70,,136.36,,,0,"percent of total billed charges ","70% of total billed charges ",11.98,226.46,
"*PENICILLIUM NOTATUM IGG",2020860,"CDM ",302,RC,86331,HCPCS,OUTPATIENT,,,243.5,194.8,,11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,429.15,429.15,429.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.45,70,,136.36,,,0,"percent of total billed charges ","70% of total billed charges ",219.15,90,,175.32,,,0,"percent of total billed charges ","90% of total billed charges ",226.46,93,,181.17,,,0,"percent of total billed charges ","93% of total billed charges ",11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",206.98,85,,165.58,,,0,"percent of total billed charges ","85% of total billed charges ",219.15,90,,175.32,,,0,"percent of total billed charges ","90% of total billed charges ",219.15,90,,175.32,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",211.85,87,,169.48,,,0,"percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",170.45,70,,136.36,,,0,"percent of total billed charges ","70% of total billed charges ",11.98,226.46,
"*PHOMA SPP IGG",2020870,"CDM ",302,RC,86331,HCPCS,OUTPATIENT,,,243.5,194.8,,11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,429.15,429.15,429.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.45,70,,136.36,,,0,"percent of total billed charges ","70% of total billed charges ",219.15,90,,175.32,,,0,"percent of total billed charges ","90% of total billed charges ",226.46,93,,181.17,,,0,"percent of total billed charges ","93% of total billed charges ",11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",206.98,85,,165.58,,,0,"percent of total billed charges ","85% of total billed charges ",219.15,90,,175.32,,,0,"percent of total billed charges ","90% of total billed charges ",219.15,90,,175.32,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",211.85,87,,169.48,,,0,"percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",170.45,70,,136.36,,,0,"percent of total billed charges ","70% of total billed charges ",11.98,226.46,
"*TRICHODERMA VIRIDE IGG",2020880,"CDM ",302,RC,86331,HCPCS,OUTPATIENT,,,243.5,194.8,,11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,429.15,429.15,429.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.45,70,,136.36,,,0,"percent of total billed charges ","70% of total billed charges ",219.15,90,,175.32,,,0,"percent of total billed charges ","90% of total billed charges ",226.46,93,,181.17,,,0,"percent of total billed charges ","93% of total billed charges ",11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",206.98,85,,165.58,,,0,"percent of total billed charges ","85% of total billed charges ",219.15,90,,175.32,,,0,"percent of total billed charges ","90% of total billed charges ",219.15,90,,175.32,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",211.85,87,,169.48,,,0,"percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",170.45,70,,136.36,,,0,"percent of total billed charges ","70% of total billed charges ",11.98,226.46,
"*MIXED FEATHERS IGG",2020890,"CDM ",302,RC,86331,HCPCS,OUTPATIENT,,,243.5,194.8,,11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,429.15,429.15,429.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.45,70,,136.36,,,0,"percent of total billed charges ","70% of total billed charges ",219.15,90,,175.32,,,0,"percent of total billed charges ","90% of total billed charges ",226.46,93,,181.17,,,0,"percent of total billed charges ","93% of total billed charges ",11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",206.98,85,,165.58,,,0,"percent of total billed charges ","85% of total billed charges ",219.15,90,,175.32,,,0,"percent of total billed charges ","90% of total billed charges ",219.15,90,,175.32,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",211.85,87,,169.48,,,0,"percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",170.45,70,,136.36,,,0,"percent of total billed charges ","70% of total billed charges ",11.98,226.46,
"*PIGEON DROPPINGS IGG",2020900,"CDM ",302,RC,86606,HCPCS,OUTPATIENT,,,156,124.8,,12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,55.22,55.22,55.22,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",145.08,93,,116.06,,,0,"percent of total billed charges ","93% of total billed charges ",12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",132.6,85,,106.08,,,0,"percent of total billed charges ","85% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",135.72,87,,108.58,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,145.08,
"*HIGH-RESOLUTION LIPOPROTEINS",2020930,"CDM ",301,RC,83701,HCPCS,OUTPATIENT,,,82,65.6,,20.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.4,70,,45.92,,,0,"percent of total billed charges ","70% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",76.26,93,,61.01,,,0,"percent of total billed charges ","93% of total billed charges ",20.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",69.7,85,,55.76,,,0,"percent of total billed charges ","85% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",71.34,87,,57.07,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.86,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",57.4,70,,45.92,,,0,"percent of total billed charges ","70% of total billed charges ",20.8,76.26,
"*TRIGLYCERIDE LIPOPROTEINS",2020940,"CDM ",301,RC,84478,HCPCS,OUTPATIENT,,,79,63.2,,5.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,11.77,11.77,11.77,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.3,70,,44.24,,,0,"percent of total billed charges ","70% of total billed charges ",71.1,90,,56.88,,,0,"percent of total billed charges ","90% of total billed charges ",73.47,93,,58.78,,,0,"percent of total billed charges ","93% of total billed charges ",5.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",67.15,85,,53.72,,,0,"percent of total billed charges ","85% of total billed charges ",71.1,90,,56.88,,,0,"percent of total billed charges ","90% of total billed charges ",71.1,90,,56.88,,,0,"percent of total billed charges ","90% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",68.73,87,,54.98,,,0,"percent of total billed charges ","87% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",55.3,70,,44.24,,,0,"percent of total billed charges ","70% of total billed charges ",5.74,73.47,
"CSF VIRAL STUDY",2020950,"CDM ",306,RC,87252,HCPCS,OUTPATIENT,,,271,216.8,,26.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",189.7,70,,151.76,,,0,"percent of total billed charges ","70% of total billed charges ",243.9,90,,195.12,,,0,"percent of total billed charges ","90% of total billed charges ",252.03,93,,201.62,,,0,"percent of total billed charges ","93% of total billed charges ",26.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.59,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",230.35,85,,184.28,,,0,"percent of total billed charges ","85% of total billed charges ",243.9,90,,195.12,,,0,"percent of total billed charges ","90% of total billed charges ",243.9,90,,195.12,,,0,"percent of total billed charges ","90% of total billed charges ",35.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",235.77,87,,188.62,,,0,"percent of total billed charges ","87% of total billed charges ",35.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",189.7,70,,151.76,,,0,"percent of total billed charges ","70% of total billed charges ",26.07,252.03,
"*ACT PART THROMBOPLASTIN TIME",2020960,"CDM ",305,RC,85730,HCPCS,OUTPATIENT,,,173,138.4,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",121.1,70,,96.88,,,0,"percent of total billed charges ","70% of total billed charges ",155.7,90,,124.56,,,0,"percent of total billed charges ","90% of total billed charges ",160.89,93,,128.71,,,0,"percent of total billed charges ","93% of total billed charges ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",147.05,85,,117.64,,,0,"percent of total billed charges ","85% of total billed charges ",155.7,90,,124.56,,,0,"percent of total billed charges ","90% of total billed charges ",155.7,90,,124.56,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",150.51,87,,49.13,5.89,151.44,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",121.1,70,,96.88,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,160.89,
"*ALKALINE PHOS ISO BY IEF",2020970,"CDM ",301,RC,84080,HCPCS,OUTPATIENT,,,112.5,90,,14.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",104.63,93,,83.70,,,0,"percent of total billed charges ","93% of total billed charges ",14.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.02,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",95.63,85,,76.50,,,0,"percent of total billed charges ","85% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",26.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",97.88,87,,78.30,,,0,"percent of total billed charges ","87% of total billed charges ",26.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.78,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",14.78,104.63,
"*FECAL POTASSIUM",2020980,"CDM ",301,RC,84311,HCPCS,OUTPATIENT,,,179,143.2,,,,,,,,0,"other ","not separately reimbursment ",,,,89.76,89.76,89.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.3,70,,100.24,,,0,"percent of total billed charges ","70% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",166.47,93,,133.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",152.15,85,,121.72,,,0,"percent of total billed charges ","85% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",155.73,87,,124.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",8.1,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",125.3,70,,100.24,,,0,"percent of total billed charges ","70% of total billed charges ",8.1,166.47,
"*FECAL SODIUM",2020990,"CDM ",301,RC,84302,HCPCS,OUTPATIENT,,,179,143.2,,4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.3,70,,100.24,,,0,"percent of total billed charges ","70% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",166.47,93,,133.18,,,0,"percent of total billed charges ","93% of total billed charges ",4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",152.15,85,,121.72,,,0,"percent of total billed charges ","85% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",155.73,87,,124.58,,,0,"percent of total billed charges ","87% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.86,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",125.3,70,,100.24,,,0,"percent of total billed charges ","70% of total billed charges ",4.2,166.47,
"*WHITE CELLS",2021000,"CDM ",300,RC,87209,HCPCS,OUTPATIENT,,,68,54.4,,17.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.6,70,,38.08,,,0,"percent of total billed charges ","70% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",63.24,93,,50.59,,,0,"percent of total billed charges ","93% of total billed charges ",17.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",57.8,85,,46.24,,,0,"percent of total billed charges ","85% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",27.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.16,87,,47.33,,,0,"percent of total billed charges ","87% of total billed charges ",27.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",47.6,70,,38.08,,,0,"percent of total billed charges ","70% of total billed charges ",17.98,63.24,
"*URINE CREATININE",2021010,"CDM ",301,RC,82570,HCPCS,OUTPATIENT,,,178,142.4,,5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.6,70,,99.68,,,0,"percent of total billed charges ","70% of total billed charges ",160.2,90,,128.16,,,0,"percent of total billed charges ","90% of total billed charges ",165.54,93,,132.43,,,0,"percent of total billed charges ","93% of total billed charges ",5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",151.3,85,,121.04,,,0,"percent of total billed charges ","85% of total billed charges ",160.2,90,,128.16,,,0,"percent of total billed charges ","90% of total billed charges ",160.2,90,,128.16,,,0,"percent of total billed charges ","90% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",154.86,87,,5.08,4.98,50.30,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",124.6,70,,99.68,,,0,"percent of total billed charges ","70% of total billed charges ",5.18,165.54,
"*BRUCELLA ABORTUS IGM ANTIBODI",2021030,"CDM ",302,RC,86622,HCPCS,OUTPATIENT,,,416.5,333.2,,7.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",291.55,70,,233.24,,,0,"percent of total billed charges ","70% of total billed charges ",374.85,90,,299.88,,,0,"percent of total billed charges ","90% of total billed charges ",387.35,93,,309.88,,,0,"percent of total billed charges ","93% of total billed charges ",7.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",354.03,85,,283.22,,,0,"percent of total billed charges ","85% of total billed charges ",374.85,90,,299.88,,,0,"percent of total billed charges ","90% of total billed charges ",374.85,90,,299.88,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",362.36,87,,289.89,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",291.55,70,,233.24,,,0,"percent of total billed charges ","70% of total billed charges ",7.59,387.35,
"*BRUCELLA ABORTUS IGG ANTIBODI",2021040,"CDM ",302,RC,86622,HCPCS,OUTPATIENT,,,416.5,333.2,,7.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",291.55,70,,233.24,,,0,"percent of total billed charges ","70% of total billed charges ",374.85,90,,299.88,,,0,"percent of total billed charges ","90% of total billed charges ",387.35,93,,309.88,,,0,"percent of total billed charges ","93% of total billed charges ",7.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",354.03,85,,283.22,,,0,"percent of total billed charges ","85% of total billed charges ",374.85,90,,299.88,,,0,"percent of total billed charges ","90% of total billed charges ",374.85,90,,299.88,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",362.36,87,,289.89,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",291.55,70,,233.24,,,0,"percent of total billed charges ","70% of total billed charges ",7.59,387.35,
"*VMA URINE",2021050,"CDM ",301,RC,84585,HCPCS,OUTPATIENT,,,135,108,,15.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",125.55,93,,100.44,,,0,"percent of total billed charges ","93% of total billed charges ",15.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",114.75,85,,91.80,,,0,"percent of total billed charges ","85% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",26.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.45,87,,93.96,,,0,"percent of total billed charges ","87% of total billed charges ",26.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.5,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",15.5,125.55,
"*CALCIUM 24HR URINE",2021060,"CDM ",301,RC,82340,HCPCS,OUTPATIENT,,,51.5,41.2,,6.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.05,70,,28.84,,,0,"percent of total billed charges ","70% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",47.9,93,,38.32,,,0,"percent of total billed charges ","93% of total billed charges ",6.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",43.78,85,,35.02,,,0,"percent of total billed charges ","85% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",10.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",44.81,87,,35.85,,,0,"percent of total billed charges ","87% of total billed charges ",10.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",36.05,70,,28.84,,,0,"percent of total billed charges ","70% of total billed charges ",6.03,47.9,
"*OXALATE URINE",2021070,"CDM ",301,RC,83945,HCPCS,OUTPATIENT,,,106,84.8,,12.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.2,70,,59.36,,,0,"percent of total billed charges ","70% of total billed charges ",95.4,90,,76.32,,,0,"percent of total billed charges ","90% of total billed charges ",98.58,93,,78.86,,,0,"percent of total billed charges ","93% of total billed charges ",12.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",90.1,85,,72.08,,,0,"percent of total billed charges ","85% of total billed charges ",95.4,90,,76.32,,,0,"percent of total billed charges ","90% of total billed charges ",95.4,90,,76.32,,,0,"percent of total billed charges ","90% of total billed charges ",10.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",92.22,87,,73.78,,,0,"percent of total billed charges ","87% of total billed charges ",10.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",74.2,70,,59.36,,,0,"percent of total billed charges ","70% of total billed charges ",10.08,98.58,
"*5-HIAA URINE",2021080,"CDM ",301,RC,83497,HCPCS,OUTPATIENT,,,104,83.2,,12.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.8,70,,58.24,,,0,"percent of total billed charges ","70% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",96.72,93,,77.38,,,0,"percent of total billed charges ","93% of total billed charges ",12.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",88.4,85,,70.72,,,0,"percent of total billed charges ","85% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",18.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",90.48,87,,72.38,,,0,"percent of total billed charges ","87% of total billed charges ",18.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.9,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",72.8,70,,58.24,,,0,"percent of total billed charges ","70% of total billed charges ",12.9,96.72,
"*17-KETOSTEROIDS 24 HR URINE",2021090,"CDM ",301,RC,83586,HCPCS,OUTPATIENT,,,126.5,101.2,,12.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.55,70,,70.84,,,0,"percent of total billed charges ","70% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",117.65,93,,94.12,,,0,"percent of total billed charges ","93% of total billed charges ",12.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",107.53,85,,86.02,,,0,"percent of total billed charges ","85% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",110.06,87,,88.05,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.8,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",88.55,70,,70.84,,,0,"percent of total billed charges ","70% of total billed charges ",12.8,117.65,
"*AMYLASE URINE",2021110,"CDM ",301,RC,82150,HCPCS,OUTPATIENT,,,134,107.2,,6.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.8,70,,75.04,,,0,"percent of total billed charges ","70% of total billed charges ",120.6,90,,96.48,,,0,"percent of total billed charges ","90% of total billed charges ",124.62,93,,99.70,,,0,"percent of total billed charges ","93% of total billed charges ",6.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",113.9,85,,91.12,,,0,"percent of total billed charges ","85% of total billed charges ",120.6,90,,96.48,,,0,"percent of total billed charges ","90% of total billed charges ",120.6,90,,96.48,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",116.58,87,,86.05,56.66,104.30,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.48,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",93.8,70,,75.04,,,0,"percent of total billed charges ","70% of total billed charges ",6.48,124.62,
"*BETA 2 GLYCOPROTEIN I ANTIBOD",2021120,"CDM ",302,RC,86146,HCPCS,OUTPATIENT,,,160,128,,25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112,70,,89.60,,,0,"percent of total billed charges ","70% of total billed charges ",144,90,,115.20,,,0,"percent of total billed charges ","90% of total billed charges ",148.8,93,,119.04,,,0,"percent of total billed charges ","93% of total billed charges ",25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",136,85,,108.80,,,0,"percent of total billed charges ","85% of total billed charges ",144,90,,115.20,,,0,"percent of total billed charges ","90% of total billed charges ",144,90,,115.20,,,0,"percent of total billed charges ","90% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",139.2,87,,111.36,,,0,"percent of total billed charges ","87% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",112,70,,89.60,,,0,"percent of total billed charges ","70% of total billed charges ",25.45,148.8,
"*ECHOVIRUS ABS 30",2021130,"CDM ",302,RC,86658,HCPCS,OUTPATIENT,,,194,155.2,,11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",180.42,93,,144.34,,,0,"percent of total billed charges ","93% of total billed charges ",11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.9,85,,131.92,,,0,"percent of total billed charges ","85% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",168.78,87,,135.02,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,180.42,
"*PROTEIN TOTAL SERUM",2021140,"CDM ",301,RC,84155,HCPCS,OUTPATIENT,,,19.5,15.6,,3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.65,70,,10.92,,,0,"percent of total billed charges ","70% of total billed charges ",17.55,90,,14.04,,,0,"percent of total billed charges ","90% of total billed charges ",18.14,93,,14.51,,,0,"percent of total billed charges ","93% of total billed charges ",3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",16.58,85,,13.26,,,0,"percent of total billed charges ","85% of total billed charges ",17.55,90,,14.04,,,0,"percent of total billed charges ","90% of total billed charges ",17.55,90,,14.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.97,87,,13.58,,,0,"percent of total billed charges ","87% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",13.65,70,,10.92,,,0,"percent of total billed charges ","70% of total billed charges ",3.67,18.14,
"*PROTEIN ELECTRO FRAC & QUAN",2021150,"CDM ",301,RC,84165,HCPCS,OUTPATIENT,,,90,72,,10.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",10.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",10.74,83.7,
"GLANGLIOSIDE MONOSAILIC ACID",2021160,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,90,72,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,83.7,
"HTLV - I/II #9898",2021170,"CDM ",302,RC,86790,HCPCS,OUTPATIENT,,,213.5,170.8,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.58,80.58,80.58,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.45,70,,119.56,,,0,"percent of total billed charges ","70% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",198.56,93,,158.85,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",181.48,85,,145.18,,,0,"percent of total billed charges ","85% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",185.75,87,,199.98,199.98,199.98,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",149.45,70,,119.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,198.56,
"*BORDETELLA PERTUSSIS CULTURE",2021180,"CDM ",306,RC,87081,HCPCS,OUTPATIENT,,,78,62.4,,6.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.6,70,,43.68,,,0,"percent of total billed charges ","70% of total billed charges ",70.2,90,,56.16,,,0,"percent of total billed charges ","90% of total billed charges ",72.54,93,,58.03,,,0,"percent of total billed charges ","93% of total billed charges ",6.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",66.3,85,,53.04,,,0,"percent of total billed charges ","85% of total billed charges ",70.2,90,,56.16,,,0,"percent of total billed charges ","90% of total billed charges ",70.2,90,,56.16,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",67.86,87,,156.45,156.45,156.45,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.63,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",54.6,70,,43.68,,,0,"percent of total billed charges ","70% of total billed charges ",6.63,72.54,
"ABSORPTION ANTIBODY",2021190,"CDM ",300,RC,86970,HCPCS,OUTPATIENT,,,282,225.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",197.4,70,,157.92,,,0,"percent of total billed charges ","70% of total billed charges ",253.8,90,,203.04,,,0,"percent of total billed charges ","90% of total billed charges ",262.26,93,,209.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",239.7,85,,191.76,,,0,"percent of total billed charges ","85% of total billed charges ",253.8,90,,203.04,,,0,"percent of total billed charges ","90% of total billed charges ",253.8,90,,203.04,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",245.34,87,,196.27,,,0,"percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",197.4,70,,157.92,,,0,"percent of total billed charges ","70% of total billed charges ",9.61,262.26,
"*N. MENNINGITIS GROUP C/W135",2021200,"CDM ",302,RC,86403,HCPCS,OUTPATIENT,,,211,168.8,,11.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.7,70,,118.16,,,0,"percent of total billed charges ","70% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",196.23,93,,156.98,,,0,"percent of total billed charges ","93% of total billed charges ",11.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",179.35,85,,143.48,,,0,"percent of total billed charges ","85% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",18.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",183.57,87,,146.86,,,0,"percent of total billed charges ","87% of total billed charges ",18.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.54,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",147.7,70,,118.16,,,0,"percent of total billed charges ","70% of total billed charges ",11.54,196.23,
"*STREPTOCOCCUS GP B AG DET",2021210,"CDM ",302,RC,86403,HCPCS,OUTPATIENT,,,211,168.8,,11.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.7,70,,118.16,,,0,"percent of total billed charges ","70% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",196.23,93,,156.98,,,0,"percent of total billed charges ","93% of total billed charges ",11.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",179.35,85,,143.48,,,0,"percent of total billed charges ","85% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",18.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",183.57,87,,146.86,,,0,"percent of total billed charges ","87% of total billed charges ",18.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.54,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",147.7,70,,118.16,,,0,"percent of total billed charges ","70% of total billed charges ",11.54,196.23,
"*BARTONELLA HENSELAE IGM ABS",2021220,"CDM ",302,RC,86611,HCPCS,OUTPATIENT,,,155.5,124.4,,9.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.85,70,,87.08,,,0,"percent of total billed charges ","70% of total billed charges ",139.95,90,,111.96,,,0,"percent of total billed charges ","90% of total billed charges ",144.62,93,,115.70,,,0,"percent of total billed charges ","93% of total billed charges ",9.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",132.18,85,,105.74,,,0,"percent of total billed charges ","85% of total billed charges ",139.95,90,,111.96,,,0,"percent of total billed charges ","90% of total billed charges ",139.95,90,,111.96,,,0,"percent of total billed charges ","90% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",135.29,87,,108.23,,,0,"percent of total billed charges ","87% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",108.85,70,,87.08,,,0,"percent of total billed charges ","70% of total billed charges ",9.17,144.62,
"*BARTONELLA HENSELAE IGG ABS",2021230,"CDM ",302,RC,86611,HCPCS,OUTPATIENT,,,155.5,124.4,,9.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.85,70,,87.08,,,0,"percent of total billed charges ","70% of total billed charges ",139.95,90,,111.96,,,0,"percent of total billed charges ","90% of total billed charges ",144.62,93,,115.70,,,0,"percent of total billed charges ","93% of total billed charges ",9.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",132.18,85,,105.74,,,0,"percent of total billed charges ","85% of total billed charges ",139.95,90,,111.96,,,0,"percent of total billed charges ","90% of total billed charges ",139.95,90,,111.96,,,0,"percent of total billed charges ","90% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",135.29,87,,108.23,,,0,"percent of total billed charges ","87% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",108.85,70,,87.08,,,0,"percent of total billed charges ","70% of total billed charges ",9.17,144.62,
"*CANDIDA IGG ABS",2021240,"CDM ",302,RC,86628,HCPCS,OUTPATIENT,,,177,141.6,,10.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.9,70,,99.12,,,0,"percent of total billed charges ","70% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",164.61,93,,131.69,,,0,"percent of total billed charges ","93% of total billed charges ",10.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",150.45,85,,120.36,,,0,"percent of total billed charges ","85% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",153.99,87,,123.19,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",123.9,70,,99.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,164.61,
"*CANDIDA IGM ABS",2021250,"CDM ",302,RC,86628,HCPCS,OUTPATIENT,,,177,141.6,,10.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.9,70,,99.12,,,0,"percent of total billed charges ","70% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",164.61,93,,131.69,,,0,"percent of total billed charges ","93% of total billed charges ",10.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",150.45,85,,120.36,,,0,"percent of total billed charges ","85% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",153.99,87,,123.19,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",123.9,70,,99.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,164.61,
"*CANDIDA IGA ABS",2021260,"CDM ",302,RC,86628,HCPCS,OUTPATIENT,,,177,141.6,,10.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.9,70,,99.12,,,0,"percent of total billed charges ","70% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",164.61,93,,131.69,,,0,"percent of total billed charges ","93% of total billed charges ",10.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",150.45,85,,120.36,,,0,"percent of total billed charges ","85% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",153.99,87,,123.19,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",123.9,70,,99.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,164.61,
"*ALPHA CAROTENE",2021270,"CDM ",301,RC,82380,HCPCS,OUTPATIENT,,,85.5,68.4,,9.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.85,70,,47.88,,,0,"percent of total billed charges ","70% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",79.52,93,,63.62,,,0,"percent of total billed charges ","93% of total billed charges ",9.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",72.68,85,,58.14,,,0,"percent of total billed charges ","85% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",74.39,87,,59.51,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",59.85,70,,47.88,,,0,"percent of total billed charges ","70% of total billed charges ",9.22,79.52,
"*BETA CAROTENE",2021280,"CDM ",301,RC,82380,HCPCS,OUTPATIENT,,,85.5,68.4,,9.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.85,70,,47.88,,,0,"percent of total billed charges ","70% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",79.52,93,,63.62,,,0,"percent of total billed charges ","93% of total billed charges ",9.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",72.68,85,,58.14,,,0,"percent of total billed charges ","85% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",74.39,87,,59.51,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",59.85,70,,47.88,,,0,"percent of total billed charges ","70% of total billed charges ",9.22,79.52,
"*CYTOGENICS INTERP",2021290,"CDM ",310,RC,88291,HCPCS,OUTPATIENT,,,995,796,,26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",69.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",696.5,70,,557.20,,,0,"percent of total billed charges ","70% of total billed charges ",895.5,90,,716.40,,,0,"percent of total billed charges ","90% of total billed charges ",925.35,93,,740.28,,,0,"percent of total billed charges ","93% of total billed charges ",26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",845.75,85,,676.60,,,0,"percent of total billed charges ","85% of total billed charges ",895.5,90,,716.40,,,0,"percent of total billed charges ","90% of total billed charges ",895.5,90,,716.40,,,0,"percent of total billed charges ","90% of total billed charges ",32.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",865.65,87,,692.52,,,0,"percent of total billed charges ","87% of total billed charges ",32.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",696.5,70,,557.20,,,0,"percent of total billed charges ","70% of total billed charges ",26,925.35,
*CLOMIPRAMINE,2021300,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,168.5,134.8,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",156.71,93,,125.37,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.23,85,,114.58,,,0,"percent of total billed charges ","85% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",146.6,87,,117.28,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,156.71,
"*FACTOR VIII ACTIVITY",2021310,"CDM ",305,RC,85240,HCPCS,OUTPATIENT,,,173.5,138.8,,17.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",121.45,70,,97.16,,,0,"percent of total billed charges ","70% of total billed charges ",156.15,90,,124.92,,,0,"percent of total billed charges ","90% of total billed charges ",161.36,93,,129.09,,,0,"percent of total billed charges ","93% of total billed charges ",17.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",147.48,85,,117.98,,,0,"percent of total billed charges ","85% of total billed charges ",156.15,90,,124.92,,,0,"percent of total billed charges ","90% of total billed charges ",156.15,90,,124.92,,,0,"percent of total billed charges ","90% of total billed charges ",24.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",150.95,87,,150.42,150.42,150.42,"1 through 10","percent of total billed charges ","87% of total billed charges ",24.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.89,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",121.45,70,,97.16,,,0,"percent of total billed charges ","70% of total billed charges ",17.89,161.36,
"*RISTOCETIN COFACTOR",2021320,"CDM ",305,RC,85245,HCPCS,OUTPATIENT,,,142,113.6,,19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.4,70,,79.52,,,0,"percent of total billed charges ","70% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",132.06,93,,105.65,,,0,"percent of total billed charges ","93% of total billed charges ",19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",120.7,85,,96.56,,,0,"percent of total billed charges ","85% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",123.54,87,,149.99,149.99,149.99,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.94,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",99.4,70,,79.52,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,132.06,
"*VON WILLEBRAND MULTIMERS",2021330,"CDM ",305,RC,85247,HCPCS,OUTPATIENT,,,142,113.6,,19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.4,70,,79.52,,,0,"percent of total billed charges ","70% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",132.06,93,,105.65,,,0,"percent of total billed charges ","93% of total billed charges ",19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",120.7,85,,96.56,,,0,"percent of total billed charges ","85% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",123.54,87,,98.83,,,0,"percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.94,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",99.4,70,,79.52,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,132.06,
*CLOZAPINE,2021340,"CDM ",300,RC,80159,HCPCS,OUTPATIENT,,,45.5,36.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.85,70,,25.48,,,0,"percent of total billed charges ","70% of total billed charges ",40.95,90,,32.76,,,0,"percent of total billed charges ","90% of total billed charges ",42.32,93,,33.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.68,85,,30.94,,,0,"percent of total billed charges ","85% of total billed charges ",40.95,90,,32.76,,,0,"percent of total billed charges ","90% of total billed charges ",40.95,90,,32.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.59,87,,31.67,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",20.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.85,70,,25.48,,,0,"percent of total billed charges ","70% of total billed charges ",20.14,42.32,
*NORCLOZAPINE,2021350,"CDM ",300,RC,80299,HCPCS,OUTPATIENT,,,168.5,134.8,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",156.71,93,,125.37,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.23,85,,114.58,,,0,"percent of total billed charges ","85% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",146.6,87,,117.28,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,156.71,
"*COXSACKIE A2 ABS",2021360,"CDM ",302,RC,86658,HCPCS,OUTPATIENT,,,194,155.2,,11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",180.42,93,,144.34,,,0,"percent of total billed charges ","93% of total billed charges ",11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.9,85,,131.92,,,0,"percent of total billed charges ","85% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",168.78,87,,135.02,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,180.42,
"*COXSACKIE A4 ABS",2021370,"CDM ",302,RC,86658,HCPCS,OUTPATIENT,,,194,155.2,,11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",180.42,93,,144.34,,,0,"percent of total billed charges ","93% of total billed charges ",11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.9,85,,131.92,,,0,"percent of total billed charges ","85% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",168.78,87,,135.02,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,180.42,
"*CULTURE STOOL STAPH AUREUS",2021380,"CDM ",306,RC,87046,HCPCS,OUTPATIENT,,,249.5,199.6,,8.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174.65,70,,139.72,,,0,"percent of total billed charges ","70% of total billed charges ",224.55,90,,179.64,,,0,"percent of total billed charges ","90% of total billed charges ",232.04,93,,185.63,,,0,"percent of total billed charges ","93% of total billed charges ",8.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",212.08,85,,169.66,,,0,"percent of total billed charges ","85% of total billed charges ",224.55,90,,179.64,,,0,"percent of total billed charges ","90% of total billed charges ",224.55,90,,179.64,,,0,"percent of total billed charges ","90% of total billed charges ",3.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.07,87,,173.66,,,0,"percent of total billed charges ","87% of total billed charges ",3.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.44,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",174.65,70,,139.72,,,0,"percent of total billed charges ","70% of total billed charges ",3.62,232.04,
*DOXEPIN,2021390,"CDM ",300,RC,80335,HCPCS,OUTPATIENT,,,122.5,98,,23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",113.93,93,,91.14,,,0,"percent of total billed charges ","93% of total billed charges ",23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.13,85,,83.30,,,0,"percent of total billed charges ","85% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.58,87,,85.26,,,0,"percent of total billed charges ","87% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",23.71,113.93,
*NORDOXEPIN,2021400,"CDM ",300,RC,80299,HCPCS,OUTPATIENT,,,168.5,134.8,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",156.71,93,,125.37,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.23,85,,114.58,,,0,"percent of total billed charges ","85% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",146.6,87,,117.28,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,156.71,
"*MECONIUM STOOL",2021410,"CDM ",300,RC,80307,HCPCS,OUTPATIENT,,,185,148,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",172.05,93,,137.64,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",157.25,85,,125.80,,,0,"percent of total billed charges ","85% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",160.95,87,,128.76,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",62.14,172.05,
"*PARAINFLUENZA TYPES 1-3",2021430,"CDM ",306,RC,87279,HCPCS,OUTPATIENT,,,152,121.6,,14.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",141.36,93,,113.09,,,0,"percent of total billed charges ","93% of total billed charges ",14.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",129.2,85,,103.36,,,0,"percent of total billed charges ","85% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.24,87,,105.79,,,0,"percent of total billed charges ","87% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",14.09,141.36,
"*THROMBOPLASTIN TIME",2021450,"CDM ",305,RC,85730,HCPCS,OUTPATIENT,,,98,78.4,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.6,70,,54.88,,,0,"percent of total billed charges ","70% of total billed charges ",88.2,90,,70.56,,,0,"percent of total billed charges ","90% of total billed charges ",91.14,93,,72.91,,,0,"percent of total billed charges ","93% of total billed charges ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.3,85,,66.64,,,0,"percent of total billed charges ","85% of total billed charges ",88.2,90,,70.56,,,0,"percent of total billed charges ","90% of total billed charges ",88.2,90,,70.56,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.26,87,,49.13,5.89,151.44,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.6,70,,54.88,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,91.14,
"*PTT SUB PLASMA FRACTIONS",2021460,"CDM ",305,RC,85732,HCPCS,OUTPATIENT,,,98,78.4,,5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.6,70,,54.88,,,0,"percent of total billed charges ","70% of total billed charges ",88.2,90,,70.56,,,0,"percent of total billed charges ","90% of total billed charges ",91.14,93,,72.91,,,0,"percent of total billed charges ","93% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.3,85,,66.64,,,0,"percent of total billed charges ","85% of total billed charges ",88.2,90,,70.56,,,0,"percent of total billed charges ","90% of total billed charges ",88.2,90,,70.56,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.26,87,,68.21,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.47,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.6,70,,54.88,,,0,"percent of total billed charges ","70% of total billed charges ",5.5,91.14,
"*CLOTTING FACTOR VIII 1 STAGE",2021470,"CDM ",305,RC,85240,HCPCS,OUTPATIENT,,,173.5,138.8,,17.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",121.45,70,,97.16,,,0,"percent of total billed charges ","70% of total billed charges ",156.15,90,,124.92,,,0,"percent of total billed charges ","90% of total billed charges ",161.36,93,,129.09,,,0,"percent of total billed charges ","93% of total billed charges ",17.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",147.48,85,,117.98,,,0,"percent of total billed charges ","85% of total billed charges ",156.15,90,,124.92,,,0,"percent of total billed charges ","90% of total billed charges ",156.15,90,,124.92,,,0,"percent of total billed charges ","90% of total billed charges ",24.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",150.95,87,,150.42,150.42,150.42,"1 through 10","percent of total billed charges ","87% of total billed charges ",24.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.89,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",121.45,70,,97.16,,,0,"percent of total billed charges ","70% of total billed charges ",17.89,161.36,
"*FACTOR INHIBITOR TEST",2021480,"CDM ",305,RC,85335,HCPCS,OUTPATIENT,,,120.5,96.4,,11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.35,70,,67.48,,,0,"percent of total billed charges ","70% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",112.07,93,,89.66,,,0,"percent of total billed charges ","93% of total billed charges ",11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",102.43,85,,81.94,,,0,"percent of total billed charges ","85% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",14.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",104.84,87,,83.87,,,0,"percent of total billed charges ","87% of total billed charges ",14.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.87,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",84.35,70,,67.48,,,0,"percent of total billed charges ","70% of total billed charges ",11.08,112.07,
"*GLIADIN ABS IGA",2021490,"CDM ",301,RC,83516,HCPCS,OUTPATIENT,,,108,86.4,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,53.32,28.74,77.90,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",10,100.44,
"*H PYLORI ABS IGM",2021500,"CDM ",302,RC,86677,HCPCS,OUTPATIENT,,,183.5,146.8,,14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,47.59,47.59,47.59,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",170.66,93,,136.53,,,0,"percent of total billed charges ","93% of total billed charges ",14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",155.98,85,,124.78,,,0,"percent of total billed charges ","85% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",159.65,87,,78.01,78.01,78.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.85,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,170.66,
"*HERPES SIMPLEX TYPE I",2021520,"CDM ",302,RC,86695,HCPCS,OUTPATIENT,,,175,140,,11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,76.02,76.02,76.02,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",162.75,93,,130.20,,,0,"percent of total billed charges ","93% of total billed charges ",11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",148.75,85,,119.00,,,0,"percent of total billed charges ","85% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",152.25,87,,121.80,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,162.75,
"*HERPES SIMPLEX TYPE 2",2021530,"CDM ",302,RC,86695,HCPCS,OUTPATIENT,,,175,140,,11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,76.02,76.02,76.02,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",162.75,93,,130.20,,,0,"percent of total billed charges ","93% of total billed charges ",11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",148.75,85,,119.00,,,0,"percent of total billed charges ","85% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",152.25,87,,121.80,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,162.75,
"*CREATININE, 24HR URINE",2021550,"CDM ",301,RC,82570,HCPCS,OUTPATIENT,,,106.5,85.2,,5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.55,70,,59.64,,,0,"percent of total billed charges ","70% of total billed charges ",95.85,90,,76.68,,,0,"percent of total billed charges ","90% of total billed charges ",99.05,93,,79.24,,,0,"percent of total billed charges ","93% of total billed charges ",5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",90.53,85,,72.42,,,0,"percent of total billed charges ","85% of total billed charges ",95.85,90,,76.68,,,0,"percent of total billed charges ","90% of total billed charges ",95.85,90,,76.68,,,0,"percent of total billed charges ","90% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",92.66,87,,5.08,4.98,50.30,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",74.55,70,,59.64,,,0,"percent of total billed charges ","70% of total billed charges ",5.18,99.05,
"*HOMOVANILLAC ACID",2021560,"CDM ",301,RC,83150,HCPCS,OUTPATIENT,,,130,104,,21.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91,70,,72.80,,,0,"percent of total billed charges ","70% of total billed charges ",117,90,,93.60,,,0,"percent of total billed charges ","90% of total billed charges ",120.9,93,,96.72,,,0,"percent of total billed charges ","93% of total billed charges ",21.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",110.5,85,,88.40,,,0,"percent of total billed charges ","85% of total billed charges ",117,90,,93.60,,,0,"percent of total billed charges ","90% of total billed charges ",117,90,,93.60,,,0,"percent of total billed charges ","90% of total billed charges ",28.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",113.1,87,,90.48,,,0,"percent of total billed charges ","87% of total billed charges ",28.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.41,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",91,70,,72.80,,,0,"percent of total billed charges ","70% of total billed charges ",21.53,120.9,
"*HYDROXINDOLACETIC ACID",2021570,"CDM ",301,RC,83497,HCPCS,OUTPATIENT,,,104,83.2,,12.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.8,70,,58.24,,,0,"percent of total billed charges ","70% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",96.72,93,,77.38,,,0,"percent of total billed charges ","93% of total billed charges ",12.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",88.4,85,,70.72,,,0,"percent of total billed charges ","85% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",18.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",90.48,87,,72.38,,,0,"percent of total billed charges ","87% of total billed charges ",18.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.9,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",72.8,70,,58.24,,,0,"percent of total billed charges ","70% of total billed charges ",12.9,96.72,
*IMIPRAMINE,2021580,"CDM ",301,RC,80335,HCPCS,OUTPATIENT,,,122.5,98,,23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",113.93,93,,91.14,,,0,"percent of total billed charges ","93% of total billed charges ",23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.13,85,,83.30,,,0,"percent of total billed charges ","85% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.58,87,,85.26,,,0,"percent of total billed charges ","87% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",23.71,113.93,
*DESIPRAMINE,2021590,"CDM ",301,RC,80335,HCPCS,OUTPATIENT,,,122.5,98,,23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",113.93,93,,91.14,,,0,"percent of total billed charges ","93% of total billed charges ",23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.13,85,,83.30,,,0,"percent of total billed charges ","85% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.58,87,,85.26,,,0,"percent of total billed charges ","87% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",23.71,113.93,
"*IGG,IGA,IGM TOTAL",2021600,"CDM ",301,RC,82784,HCPCS,OUTPATIENT,,,108,86.4,,9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,75.17,,,0,"percent of total billed charges ","87% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",9.3,100.44,
"*MONOCLONAL GAMMOPATHIES SERUM",2021610,"CDM ",302,RC,86334,HCPCS,OUTPATIENT,,,299.5,239.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",209.65,70,,167.72,,,0,"percent of total billed charges ","70% of total billed charges ",269.55,90,,215.64,,,0,"percent of total billed charges ","90% of total billed charges ",278.54,93,,222.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",254.58,85,,203.66,,,0,"percent of total billed charges ","85% of total billed charges ",269.55,90,,215.64,,,0,"percent of total billed charges ","90% of total billed charges ",269.55,90,,215.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",260.57,87,,208.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",22.34,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",209.65,70,,167.72,,,0,"percent of total billed charges ","70% of total billed charges ",22.34,278.54,
"*PROTEIN TOTAL, SERUM",2021620,"CDM ",301,RC,84155,HCPCS,OUTPATIENT,,,26,20.8,,3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.2,70,,14.56,,,0,"percent of total billed charges ","70% of total billed charges ",23.4,90,,18.72,,,0,"percent of total billed charges ","90% of total billed charges ",24.18,93,,19.34,,,0,"percent of total billed charges ","93% of total billed charges ",3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",22.1,85,,17.68,,,0,"percent of total billed charges ","85% of total billed charges ",23.4,90,,18.72,,,0,"percent of total billed charges ","90% of total billed charges ",23.4,90,,18.72,,,0,"percent of total billed charges ","90% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.62,87,,18.10,,,0,"percent of total billed charges ","87% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",18.2,70,,14.56,,,0,"percent of total billed charges ","70% of total billed charges ",3.67,24.18,
"*PROTEIN ELECTRO FRAC SERUM",2021630,"CDM ",301,RC,84165,HCPCS,OUTPATIENT,,,90,72,,10.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",10.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",10.74,83.7,
"*GAMMAGLOBULIN IGA,IGD,IGM,IGG",2021640,"CDM ",301,RC,82784,HCPCS,OUTPATIENT,,,108,86.4,,9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,75.17,,,0,"percent of total billed charges ","87% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",9.3,100.44,
"*CULTURE LEGIONELLA",2021670,"CDM ",306,RC,87081,HCPCS,OUTPATIENT,,,135,108,,6.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",125.55,93,,100.44,,,0,"percent of total billed charges ","93% of total billed charges ",6.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",114.75,85,,91.80,,,0,"percent of total billed charges ","85% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.45,87,,156.45,156.45,156.45,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.63,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",6.63,125.55,
"*HISTONE DNA COMPLEX",2021680,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,141,112.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.7,70,,78.96,,,0,"percent of total billed charges ","70% of total billed charges ",126.9,90,,101.52,,,0,"percent of total billed charges ","90% of total billed charges ",131.13,93,,104.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",119.85,85,,95.88,,,0,"percent of total billed charges ","85% of total billed charges ",126.9,90,,101.52,,,0,"percent of total billed charges ","90% of total billed charges ",126.9,90,,101.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",122.67,87,,98.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",98.7,70,,78.96,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,131.13,
"*U1 RNP/SNRNP IGG ABS",2021690,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,149.5,119.6,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",139.04,93,,111.23,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",127.08,85,,101.66,,,0,"percent of total billed charges ","85% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.07,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,139.04,
"*SMITH IGG AUTO ABS",2021700,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,149.5,119.6,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",139.04,93,,111.23,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",127.08,85,,101.66,,,0,"percent of total billed charges ","85% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.07,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,139.04,
"*SSA & SSB IGG AUTO ABS",2021710,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,149.5,119.6,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",139.04,93,,111.23,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",127.08,85,,101.66,,,0,"percent of total billed charges ","85% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.07,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,139.04,
"*RHEUMATOID FACTOR",2021720,"CDM ",302,RC,86431,HCPCS,OUTPATIENT,,,75.5,60.4,,5.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,5.56,5.56,5.56,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",70.22,93,,56.18,,,0,"percent of total billed charges ","93% of total billed charges ",5.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",64.18,85,,51.34,,,0,"percent of total billed charges ","85% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.69,87,,5.56,5.56,56.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",5.67,70.22,
"*BORRELIA BURGDORFERI AB",2021730,"CDM ",302,RC,86617,HCPCS,OUTPATIENT,,,252,201.6,,13.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,243.52,243.52,243.52,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.4,70,,141.12,,,0,"percent of total billed charges ","70% of total billed charges ",226.8,90,,181.44,,,0,"percent of total billed charges ","90% of total billed charges ",234.36,93,,187.49,,,0,"percent of total billed charges ","93% of total billed charges ",13.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",214.2,85,,171.36,,,0,"percent of total billed charges ","85% of total billed charges ",226.8,90,,181.44,,,0,"percent of total billed charges ","90% of total billed charges ",226.8,90,,181.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.24,87,,345.66,93.43,345.66,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.49,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",176.4,70,,141.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,234.36,
"*MAG 24 HR URINE",2021740,"CDM ",301,RC,83735,HCPCS,OUTPATIENT,,,56.5,45.2,,6.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.55,70,,31.64,,,0,"percent of total billed charges ","70% of total billed charges ",50.85,90,,40.68,,,0,"percent of total billed charges ","90% of total billed charges ",52.55,93,,42.04,,,0,"percent of total billed charges ","93% of total billed charges ",6.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",48.03,85,,38.42,,,0,"percent of total billed charges ","85% of total billed charges ",50.85,90,,40.68,,,0,"percent of total billed charges ","90% of total billed charges ",50.85,90,,40.68,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",49.16,87,,46.55,6.57,58.19,15,"percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.7,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",39.55,70,,31.64,,,0,"percent of total billed charges ","70% of total billed charges ",6.7,52.55,
"*CREATININE URINE MET",2021750,"CDM ",301,RC,82570,HCPCS,OUTPATIENT,,,73,58.4,,5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.1,70,,40.88,,,0,"percent of total billed charges ","70% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",67.89,93,,54.31,,,0,"percent of total billed charges ","93% of total billed charges ",5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.05,85,,49.64,,,0,"percent of total billed charges ","85% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.51,87,,5.08,4.98,50.30,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",51.1,70,,40.88,,,0,"percent of total billed charges ","70% of total billed charges ",5.18,67.89,
"*CATECHOLAMINES TOTAL URINE",2021760,"CDM ",301,RC,82382,HCPCS,OUTPATIENT,,,172,137.6,,23.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.4,70,,96.32,,,0,"percent of total billed charges ","70% of total billed charges ",154.8,90,,123.84,,,0,"percent of total billed charges ","90% of total billed charges ",159.96,93,,127.97,,,0,"percent of total billed charges ","93% of total billed charges ",23.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",146.2,85,,116.96,,,0,"percent of total billed charges ","85% of total billed charges ",154.8,90,,123.84,,,0,"percent of total billed charges ","90% of total billed charges ",154.8,90,,123.84,,,0,"percent of total billed charges ","90% of total billed charges ",28.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.64,87,,119.71,,,0,"percent of total billed charges ","87% of total billed charges ",28.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",120.4,70,,96.32,,,0,"percent of total billed charges ","70% of total billed charges ",23.21,159.96,
"*PARAINFLUENZA VIR TYPE 1,2,3",2021770,"CDM ",302,RC,86790,HCPCS,OUTPATIENT,,,200.5,160.4,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.58,80.58,80.58,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.35,70,,112.28,,,0,"percent of total billed charges ","70% of total billed charges ",180.45,90,,144.36,,,0,"percent of total billed charges ","90% of total billed charges ",186.47,93,,149.18,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",170.43,85,,136.34,,,0,"percent of total billed charges ","85% of total billed charges ",180.45,90,,144.36,,,0,"percent of total billed charges ","90% of total billed charges ",180.45,90,,144.36,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",174.44,87,,199.98,199.98,199.98,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",140.35,70,,112.28,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,186.47,
"*PARAINFLUENZA VIR RNA 1,2,3",2021780,"CDM ",306,RC,87798,HCPCS,OUTPATIENT,,,285.5,228.4,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",199.85,70,,159.88,,,0,"percent of total billed charges ","70% of total billed charges ",256.95,90,,205.56,,,0,"percent of total billed charges ","90% of total billed charges ",265.52,93,,212.42,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",242.68,85,,194.14,,,0,"percent of total billed charges ","85% of total billed charges ",256.95,90,,205.56,,,0,"percent of total billed charges ","90% of total billed charges ",256.95,90,,205.56,,,0,"percent of total billed charges ","90% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",248.39,87,,198.71,,,0,"percent of total billed charges ","87% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",199.85,70,,159.88,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,265.52,
"*CALCIUM TOTAL",2021790,"CDM ",301,RC,82310,HCPCS,OUTPATIENT,,,43,34.4,,5.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.1,70,,24.08,,,0,"percent of total billed charges ","70% of total billed charges ",38.7,90,,30.96,,,0,"percent of total billed charges ","90% of total billed charges ",39.99,93,,31.99,,,0,"percent of total billed charges ","93% of total billed charges ",5.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",36.55,85,,29.24,,,0,"percent of total billed charges ","85% of total billed charges ",38.7,90,,30.96,,,0,"percent of total billed charges ","90% of total billed charges ",38.7,90,,30.96,,,0,"percent of total billed charges ","90% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.41,87,,29.93,,,0,"percent of total billed charges ","87% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.16,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",30.1,70,,24.08,,,0,"percent of total billed charges ","70% of total billed charges ",5.16,39.99,
*PARATHORMONE,2021800,"CDM ",301,RC,83970,HCPCS,OUTPATIENT,,,336,268.8,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,185.57,185.57,185.57,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",235.2,70,,188.16,,,0,"percent of total billed charges ","70% of total billed charges ",302.4,90,,241.92,,,0,"percent of total billed charges ","90% of total billed charges ",312.48,93,,249.98,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",285.6,85,,228.48,,,0,"percent of total billed charges ","85% of total billed charges ",302.4,90,,241.92,,,0,"percent of total billed charges ","90% of total billed charges ",302.4,90,,241.92,,,0,"percent of total billed charges ","90% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",292.32,87,,176.24,40.46,261.19,"1 through 10","percent of total billed charges ","87% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.28,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",235.2,70,,188.16,,,0,"percent of total billed charges ","70% of total billed charges ",30.22,312.48,
"*CALCIUM IONIZED",2021810,"CDM ",301,RC,82330,HCPCS,OUTPATIENT,,,109.5,87.6,,11.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,33.35,33.35,33.35,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.65,70,,61.32,,,0,"percent of total billed charges ","70% of total billed charges ",98.55,90,,78.84,,,0,"percent of total billed charges ","90% of total billed charges ",101.84,93,,81.47,,,0,"percent of total billed charges ","93% of total billed charges ",11.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",93.08,85,,74.46,,,0,"percent of total billed charges ","85% of total billed charges ",98.55,90,,78.84,,,0,"percent of total billed charges ","90% of total billed charges ",98.55,90,,78.84,,,0,"percent of total billed charges ","90% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",95.27,87,,76.22,,,0,"percent of total billed charges ","87% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.68,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",76.65,70,,61.32,,,0,"percent of total billed charges ","70% of total billed charges ",8.24,101.84,
"*PARVOVIRUS B19 IGG & IGM",2021820,"CDM ",302,RC,86747,HCPCS,OUTPATIENT,,,213.5,170.8,,12.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.45,70,,119.56,,,0,"percent of total billed charges ","70% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",198.56,93,,158.85,,,0,"percent of total billed charges ","93% of total billed charges ",12.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",181.48,85,,145.18,,,0,"percent of total billed charges ","85% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",185.75,87,,148.60,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",149.45,70,,119.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,198.56,
*PHOSPHATIDYLGLYCEROL,2021830,"CDM ",301,RC,84081,HCPCS,OUTPATIENT,,,108,86.4,,8.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",8.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,75.17,,,0,"percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.52,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",8.74,100.44,
"*PORPHYRINS 24 HR URINE",2021840,"CDM ",301,RC,84120,HCPCS,OUTPATIENT,,,207.5,166,,12.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",145.25,70,,116.20,,,0,"percent of total billed charges ","70% of total billed charges ",186.75,90,,149.40,,,0,"percent of total billed charges ","90% of total billed charges ",192.98,93,,154.38,,,0,"percent of total billed charges ","93% of total billed charges ",12.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",176.38,85,,141.10,,,0,"percent of total billed charges ","85% of total billed charges ",186.75,90,,149.40,,,0,"percent of total billed charges ","90% of total billed charges ",186.75,90,,149.40,,,0,"percent of total billed charges ","90% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",180.53,87,,144.42,,,0,"percent of total billed charges ","87% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.71,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",145.25,70,,116.20,,,0,"percent of total billed charges ","70% of total billed charges ",12.5,192.98,
"*PSA TOTAL",2021850,"CDM ",301,RC,84153,HCPCS,OUTPATIENT,,,149,119.2,,18.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,81.31,81.31,81.31,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.3,70,,83.44,,,0,"percent of total billed charges ","70% of total billed charges ",134.1,90,,107.28,,,0,"percent of total billed charges ","90% of total billed charges ",138.57,93,,110.86,,,0,"percent of total billed charges ","93% of total billed charges ",18.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.55,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",126.65,85,,101.32,,,0,"percent of total billed charges ","85% of total billed charges ",134.1,90,,107.28,,,0,"percent of total billed charges ","90% of total billed charges ",134.1,90,,107.28,,,0,"percent of total billed charges ","90% of total billed charges ",28.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",129.63,87,,18.03,18.03,18.03,"1 through 10","percent of total billed charges ","87% of total billed charges ",28.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.3,70,,83.44,,,0,"percent of total billed charges ","70% of total billed charges ",18.39,138.57,
"*PSA FREE",2021860,"CDM ",301,RC,84154,HCPCS,OUTPATIENT,,,112.5,90,,18.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,56.65,56.65,56.65,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",104.63,93,,83.70,,,0,"percent of total billed charges ","93% of total billed charges ",18.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.59,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",95.63,85,,76.50,,,0,"percent of total billed charges ","85% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",33.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",97.88,87,,18.03,18.03,18.03,"1 through 10","percent of total billed charges ","87% of total billed charges ",33.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",18.39,104.63,
"*PROTEIN TOTAL URINE",2021870,"CDM ",301,RC,84156,HCPCS,OUTPATIENT,,,42.5,34,,3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.75,70,,23.80,,,0,"percent of total billed charges ","70% of total billed charges ",38.25,90,,30.60,,,0,"percent of total billed charges ","90% of total billed charges ",39.53,93,,31.62,,,0,"percent of total billed charges ","93% of total billed charges ",3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",36.13,85,,28.90,,,0,"percent of total billed charges ","85% of total billed charges ",38.25,90,,30.60,,,0,"percent of total billed charges ","90% of total billed charges ",38.25,90,,30.60,,,0,"percent of total billed charges ","90% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.98,87,,43.83,11.65,76.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",29.75,70,,23.80,,,0,"percent of total billed charges ","70% of total billed charges ",3.67,39.53,
"*PROT ELECTRO FRAC/QUAN OTHER",2021880,"CDM ",301,RC,84166,HCPCS,OUTPATIENT,,,56,44.8,,17.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.2,70,,31.36,,,0,"percent of total billed charges ","70% of total billed charges ",50.4,90,,40.32,,,0,"percent of total billed charges ","90% of total billed charges ",52.08,93,,41.66,,,0,"percent of total billed charges ","93% of total billed charges ",17.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",47.6,85,,38.08,,,0,"percent of total billed charges ","85% of total billed charges ",50.4,90,,40.32,,,0,"percent of total billed charges ","90% of total billed charges ",50.4,90,,40.32,,,0,"percent of total billed charges ","90% of total billed charges ",27.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",48.72,87,,38.98,,,0,"percent of total billed charges ","87% of total billed charges ",27.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",39.2,70,,31.36,,,0,"percent of total billed charges ","70% of total billed charges ",17.82,52.08,
"*PROTEIN TOTAL CSF",2021890,"CDM ",301,RC,84157,HCPCS,OUTPATIENT,,,42.5,34,,4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.75,70,,23.80,,,0,"percent of total billed charges ","70% of total billed charges ",38.25,90,,30.60,,,0,"percent of total billed charges ","90% of total billed charges ",39.53,93,,31.62,,,0,"percent of total billed charges ","93% of total billed charges ",4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",36.13,85,,28.90,,,0,"percent of total billed charges ","85% of total billed charges ",38.25,90,,30.60,,,0,"percent of total billed charges ","90% of total billed charges ",38.25,90,,30.60,,,0,"percent of total billed charges ","90% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.98,87,,29.58,,,0,"percent of total billed charges ","87% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",29.75,70,,23.80,,,0,"percent of total billed charges ","70% of total billed charges ",4,39.53,
"*PROTHROMBIN TIME",2021900,"CDM ",305,RC,85610,HCPCS,OUTPATIENT,,,57,45.6,,4.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.9,70,,31.92,,,0,"percent of total billed charges ","70% of total billed charges ",51.3,90,,41.04,,,0,"percent of total billed charges ","90% of total billed charges ",53.01,93,,42.41,,,0,"percent of total billed charges ","93% of total billed charges ",4.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",48.45,85,,38.76,,,0,"percent of total billed charges ","85% of total billed charges ",51.3,90,,41.04,,,0,"percent of total billed charges ","90% of total billed charges ",51.3,90,,41.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",49.59,87,,50.34,4.21,62.93,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.29,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",39.9,70,,31.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.29,53.01,
*PARATHORMONE,2021910,"CDM ",301,RC,83970,HCPCS,OUTPATIENT,,,336,268.8,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,185.57,185.57,185.57,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",235.2,70,,188.16,,,0,"percent of total billed charges ","70% of total billed charges ",302.4,90,,241.92,,,0,"percent of total billed charges ","90% of total billed charges ",312.48,93,,249.98,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",285.6,85,,228.48,,,0,"percent of total billed charges ","85% of total billed charges ",302.4,90,,241.92,,,0,"percent of total billed charges ","90% of total billed charges ",302.4,90,,241.92,,,0,"percent of total billed charges ","90% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",292.32,87,,176.24,40.46,261.19,"1 through 10","percent of total billed charges ","87% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.28,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",235.2,70,,188.16,,,0,"percent of total billed charges ","70% of total billed charges ",30.22,312.48,
"*BLOOD COUNT LEUKOCYTE",2021920,"CDM ",305,RC,85048,HCPCS,OUTPATIENT,,,19,15.2,,2.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.3,70,,10.64,,,0,"percent of total billed charges ","70% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.67,93,,14.14,,,0,"percent of total billed charges ","93% of total billed charges ",2.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1.73,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",16.15,85,,12.92,,,0,"percent of total billed charges ","85% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",1.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.53,87,,13.22,,,0,"percent of total billed charges ","87% of total billed charges ",1.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2.54,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",13.3,70,,10.64,,,0,"percent of total billed charges ","70% of total billed charges ",1.71,17.67,
"*B-CELLS TOTAL COUNT",2021930,"CDM ",302,RC,86355,HCPCS,OUTPATIENT,,,152,121.6,,37.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,96.83,96.83,96.83,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",141.36,93,,113.09,,,0,"percent of total billed charges ","93% of total billed charges ",37.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",129.2,85,,103.36,,,0,"percent of total billed charges ","85% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",58.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.24,87,,105.79,,,0,"percent of total billed charges ","87% of total billed charges ",58.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.72,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",37.72,141.36,
"*T-CELLS TOTAL COUNT",2021940,"CDM ",302,RC,86359,HCPCS,OUTPATIENT,,,152,121.6,,32.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,98.84,98.84,98.84,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",141.36,93,,113.09,,,0,"percent of total billed charges ","93% of total billed charges ",32.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",129.2,85,,103.36,,,0,"percent of total billed charges ","85% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",37.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.24,87,,105.79,,,0,"percent of total billed charges ","87% of total billed charges ",37.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.72,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",32.07,141.36,
"*VITAMIN E ALPHA",2021950,"CDM ",301,RC,82542,HCPCS,OUTPATIENT,,,187,149.6,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",173.91,93,,139.13,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",158.95,85,,127.16,,,0,"percent of total billed charges ","85% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",162.69,87,,130.15,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,173.91,
"*VITAMIN E GAMMA",2021960,"CDM ",301,RC,84446,HCPCS,OUTPATIENT,,,121.5,97.2,,14.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,53.53,53.53,53.53,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.05,70,,68.04,,,0,"percent of total billed charges ","70% of total billed charges ",109.35,90,,87.48,,,0,"percent of total billed charges ","90% of total billed charges ",113,93,,90.40,,,0,"percent of total billed charges ","93% of total billed charges ",14.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",103.28,85,,82.62,,,0,"percent of total billed charges ","85% of total billed charges ",109.35,90,,87.48,,,0,"percent of total billed charges ","90% of total billed charges ",109.35,90,,87.48,,,0,"percent of total billed charges ","90% of total billed charges ",24.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",105.71,87,,84.57,,,0,"percent of total billed charges ","87% of total billed charges ",24.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",85.05,70,,68.04,,,0,"percent of total billed charges ","70% of total billed charges ",14.18,113,
*VOLATILES,2021970,"CDM ",301,RC,84600,HCPCS,OUTPATIENT,,,131,104.8,,16.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.7,70,,73.36,,,0,"percent of total billed charges ","70% of total billed charges ",117.9,90,,94.32,,,0,"percent of total billed charges ","90% of total billed charges ",121.83,93,,97.46,,,0,"percent of total billed charges ","93% of total billed charges ",16.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",111.35,85,,89.08,,,0,"percent of total billed charges ","85% of total billed charges ",117.9,90,,94.32,,,0,"percent of total billed charges ","90% of total billed charges ",117.9,90,,94.32,,,0,"percent of total billed charges ","90% of total billed charges ",21.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",113.97,87,,91.18,,,0,"percent of total billed charges ","87% of total billed charges ",21.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.11,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",91.7,70,,73.36,,,0,"percent of total billed charges ","70% of total billed charges ",16.8,121.83,
"*H PYLORI ABS IGA",2022510,"CDM ",302,RC,86677,HCPCS,OUTPATIENT,,,183.5,146.8,,14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,47.59,47.59,47.59,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",170.66,93,,136.53,,,0,"percent of total billed charges ","93% of total billed charges ",14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",155.98,85,,124.78,,,0,"percent of total billed charges ","85% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",159.65,87,,78.01,78.01,78.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.85,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,170.66,
"*CONC FOR INFECTIOUS AGENTS",2022530,"CDM ",306,RC,87015,HCPCS,OUTPATIENT,,,105.5,84.4,,6.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.85,70,,59.08,,,0,"percent of total billed charges ","70% of total billed charges ",94.95,90,,75.96,,,0,"percent of total billed charges ","90% of total billed charges ",98.12,93,,78.50,,,0,"percent of total billed charges ","93% of total billed charges ",6.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",89.68,85,,71.74,,,0,"percent of total billed charges ","85% of total billed charges ",94.95,90,,75.96,,,0,"percent of total billed charges ","90% of total billed charges ",94.95,90,,75.96,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",91.79,87,,73.43,,,0,"percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.68,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",73.85,70,,59.08,,,0,"percent of total billed charges ","70% of total billed charges ",6.68,98.12,
"*CRYPTOSPORIDIUM PARVUM",2022540,"CDM ",306,RC,87206,HCPCS,OUTPATIENT,,,89,71.2,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",82.77,93,,66.22,,,0,"percent of total billed charges ","93% of total billed charges ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",75.65,85,,60.52,,,0,"percent of total billed charges ","85% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",77.43,87,,121.54,121.54,121.54,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,82.77,
*CYCLOSPORA,2022550,"CDM ",306,RC,87206,HCPCS,OUTPATIENT,,,89,71.2,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",82.77,93,,66.22,,,0,"percent of total billed charges ","93% of total billed charges ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",75.65,85,,60.52,,,0,"percent of total billed charges ","85% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",77.43,87,,121.54,121.54,121.54,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,82.77,
"*ISOSPORA BELLI",2022560,"CDM ",306,RC,87206,HCPCS,OUTPATIENT,,,89,71.2,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",82.77,93,,66.22,,,0,"percent of total billed charges ","93% of total billed charges ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",75.65,85,,60.52,,,0,"percent of total billed charges ","85% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",77.43,87,,121.54,121.54,121.54,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,82.77,
*MICROSPORIDIUM,2022570,"CDM ",300,RC,88313,HCPCS,OUTPATIENT,,,132,105.6,,62.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",165.51,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",92.4,70,,73.92,,,0,"percent of total billed charges ","70% of total billed charges ",118.8,90,,95.04,,,0,"percent of total billed charges ","90% of total billed charges ",122.76,93,,98.21,,,0,"percent of total billed charges ","93% of total billed charges ",62.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",112.2,85,,89.76,,,0,"percent of total billed charges ","85% of total billed charges ",118.8,90,,95.04,,,0,"percent of total billed charges ","90% of total billed charges ",118.8,90,,95.04,,,0,"percent of total billed charges ","90% of total billed charges ",3.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",114.84,87,,91.87,,,0,"percent of total billed charges ","87% of total billed charges ",3.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",92.4,70,,73.92,,,0,"percent of total billed charges ","70% of total billed charges ",3.95,165.51,
METHANOL,2022580,"CDM ",301,RC,84600,HCPCS,OUTPATIENT,,,131,104.8,,16.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.7,70,,73.36,,,0,"percent of total billed charges ","70% of total billed charges ",117.9,90,,94.32,,,0,"percent of total billed charges ","90% of total billed charges ",121.83,93,,97.46,,,0,"percent of total billed charges ","93% of total billed charges ",16.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",111.35,85,,89.08,,,0,"percent of total billed charges ","85% of total billed charges ",117.9,90,,94.32,,,0,"percent of total billed charges ","90% of total billed charges ",117.9,90,,94.32,,,0,"percent of total billed charges ","90% of total billed charges ",21.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",113.97,87,,91.18,,,0,"percent of total billed charges ","87% of total billed charges ",21.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.11,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",91.7,70,,73.36,,,0,"percent of total billed charges ","70% of total billed charges ",16.8,121.83,
"ENTAMOEBA HISTOLYTICA AG DETEC",2022590,"CDM ",306,RC,87337,HCPCS,OUTPATIENT,,,169,135.2,,11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",157.17,93,,125.74,,,0,"percent of total billed charges ","93% of total billed charges ",11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.65,85,,114.92,,,0,"percent of total billed charges ","85% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.03,87,,117.62,,,0,"percent of total billed charges ","87% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",11.98,157.17,
"HEPATITIS C RNA QUAN BY PCR",2022610,"CDM ",306,RC,87522,HCPCS,OUTPATIENT,,,650.5,520.4,,36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,109.38,109.38,109.38,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",455.35,70,,364.28,,,0,"percent of total billed charges ","70% of total billed charges ",585.45,90,,468.36,,,0,"percent of total billed charges ","90% of total billed charges ",604.97,93,,483.98,,,0,"percent of total billed charges ","93% of total billed charges ",36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",552.93,85,,442.34,,,0,"percent of total billed charges ","85% of total billed charges ",585.45,90,,468.36,,,0,"percent of total billed charges ","90% of total billed charges ",585.45,90,,468.36,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",565.94,87,,452.75,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.84,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",455.35,70,,364.28,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,604.97,
"MONOCLONAL GAMMOPATHIES  3125",2022620,"CDM ",302,RC,86334,HCPCS,OUTPATIENT,,,269,215.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.3,70,,150.64,,,0,"percent of total billed charges ","70% of total billed charges ",242.1,90,,193.68,,,0,"percent of total billed charges ","90% of total billed charges ",250.17,93,,200.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",228.65,85,,182.92,,,0,"percent of total billed charges ","85% of total billed charges ",242.1,90,,193.68,,,0,"percent of total billed charges ","90% of total billed charges ",242.1,90,,193.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.03,87,,187.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",22.34,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",188.3,70,,150.64,,,0,"percent of total billed charges ","70% of total billed charges ",22.34,250.17,
"LEGIONELLA PNEUMO AG DETECTION",2022640,"CDM ",306,RC,87278,HCPCS,OUTPATIENT,,,165,132,,14.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",14.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,114.84,,,0,"percent of total billed charges ","87% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.6,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",14.09,153.45,
"CAT DANDER",2022650,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"DOG DANDER",2022660,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"CARBON MONO-CARBOXYHEMOGLOBIN",2022670,"CDM ",301,RC,82375,HCPCS,OUTPATIENT,,,100.5,80.4,,12.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,61.55,61.55,61.55,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.35,70,,56.28,,,0,"percent of total billed charges ","70% of total billed charges ",90.45,90,,72.36,,,0,"percent of total billed charges ","90% of total billed charges ",93.47,93,,74.78,,,0,"percent of total billed charges ","93% of total billed charges ",12.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",85.43,85,,68.34,,,0,"percent of total billed charges ","85% of total billed charges ",90.45,90,,72.36,,,0,"percent of total billed charges ","90% of total billed charges ",90.45,90,,72.36,,,0,"percent of total billed charges ","90% of total billed charges ",20.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",87.44,87,,69.95,,,0,"percent of total billed charges ","87% of total billed charges ",20.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.32,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",70.35,70,,56.28,,,0,"percent of total billed charges ","70% of total billed charges ",12.32,93.47,
"RH PHENOTYPE, COMPLETE",2022690,"CDM ",300,RC,86906,HCPCS,OUTPATIENT,,,249.5,199.6,,7.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174.65,70,,139.72,,,0,"percent of total billed charges ","70% of total billed charges ",224.55,90,,179.64,,,0,"percent of total billed charges ","90% of total billed charges ",232.04,93,,185.63,,,0,"percent of total billed charges ","93% of total billed charges ",7.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",212.08,85,,169.66,,,0,"percent of total billed charges ","85% of total billed charges ",224.55,90,,179.64,,,0,"percent of total billed charges ","90% of total billed charges ",224.55,90,,179.64,,,0,"percent of total billed charges ","90% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.07,87,,173.66,,,0,"percent of total billed charges ","87% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",174.65,70,,139.72,,,0,"percent of total billed charges ","70% of total billed charges ",7.75,232.04,
"RETICULOCYTE SEPARATION",2022700,"CDM ",300,RC,86972,HCPCS,OUTPATIENT,,,713,570.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",499.1,70,,399.28,,,0,"percent of total billed charges ","70% of total billed charges ",641.7,90,,513.36,,,0,"percent of total billed charges ","90% of total billed charges ",663.09,93,,530.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",606.05,85,,484.84,,,0,"percent of total billed charges ","85% of total billed charges ",641.7,90,,513.36,,,0,"percent of total billed charges ","90% of total billed charges ",641.7,90,,513.36,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",620.31,87,,496.25,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",499.1,70,,399.28,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,663.09,
"*PLATELET GLYCOPROT IIG/IIIA",2022720,"CDM ",302,RC,86022,HCPCS,OUTPATIENT,,,191.5,153.2,,15.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,30.11,30.11,30.11,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",134.05,70,,107.24,,,0,"percent of total billed charges ","70% of total billed charges ",172.35,90,,137.88,,,0,"percent of total billed charges ","90% of total billed charges ",178.1,93,,142.48,,,0,"percent of total billed charges ","93% of total billed charges ",15.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",162.78,85,,130.22,,,0,"percent of total billed charges ","85% of total billed charges ",172.35,90,,137.88,,,0,"percent of total billed charges ","90% of total billed charges ",172.35,90,,137.88,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",166.61,87,,89.65,89.65,89.65,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.37,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",134.05,70,,107.24,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,178.1,
"*PLATELET GLYCOPROT I6/IX ABS",2022730,"CDM ",302,RC,86022,HCPCS,OUTPATIENT,,,191.5,153.2,,15.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,30.11,30.11,30.11,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",134.05,70,,107.24,,,0,"percent of total billed charges ","70% of total billed charges ",172.35,90,,137.88,,,0,"percent of total billed charges ","90% of total billed charges ",178.1,93,,142.48,,,0,"percent of total billed charges ","93% of total billed charges ",15.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",162.78,85,,130.22,,,0,"percent of total billed charges ","85% of total billed charges ",172.35,90,,137.88,,,0,"percent of total billed charges ","90% of total billed charges ",172.35,90,,137.88,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",166.61,87,,89.65,89.65,89.65,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.37,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",134.05,70,,107.24,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,178.1,
"*PLATELET GP IA/IIA TOTAL ABS",2022740,"CDM ",302,RC,86022,HCPCS,OUTPATIENT,,,191.5,153.2,,15.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,30.11,30.11,30.11,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",134.05,70,,107.24,,,0,"percent of total billed charges ","70% of total billed charges ",172.35,90,,137.88,,,0,"percent of total billed charges ","90% of total billed charges ",178.1,93,,142.48,,,0,"percent of total billed charges ","93% of total billed charges ",15.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",162.78,85,,130.22,,,0,"percent of total billed charges ","85% of total billed charges ",172.35,90,,137.88,,,0,"percent of total billed charges ","90% of total billed charges ",172.35,90,,137.88,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",166.61,87,,89.65,89.65,89.65,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.37,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",134.05,70,,107.24,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,178.1,
"*MYELIN ASSAY GLYCOPROTEIN IGM",2022760,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,90,72,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,83.7,
"*SULFOGLUCORONYL PARA IGM ABS",2022770,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,90,72,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,83.7,
"*FUNGAL STAIN",2022790,"CDM ",306,RC,87206,HCPCS,OUTPATIENT,,,89,71.2,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",82.77,93,,66.22,,,0,"percent of total billed charges ","93% of total billed charges ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",75.65,85,,60.52,,,0,"percent of total billed charges ","85% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",77.43,87,,121.54,121.54,121.54,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,82.77,
"*FUNGUS CULTURE",2022800,"CDM ",306,RC,87206,HCPCS,OUTPATIENT,,,89,71.2,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",82.77,93,,66.22,,,0,"percent of total billed charges ","93% of total billed charges ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",75.65,85,,60.52,,,0,"percent of total billed charges ","85% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",77.43,87,,121.54,121.54,121.54,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,82.77,
"TOXOPLASMA DNA PCR #7521",2022810,"CDM ",306,RC,87798,HCPCS,OUTPATIENT,,,600.5,480.4,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",420.35,70,,336.28,,,0,"percent of total billed charges ","70% of total billed charges ",540.45,90,,432.36,,,0,"percent of total billed charges ","90% of total billed charges ",558.47,93,,446.78,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",510.43,85,,408.34,,,0,"percent of total billed charges ","85% of total billed charges ",540.45,90,,432.36,,,0,"percent of total billed charges ","90% of total billed charges ",540.45,90,,432.36,,,0,"percent of total billed charges ","90% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",522.44,87,,417.95,,,0,"percent of total billed charges ","87% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",420.35,70,,336.28,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,558.47,
"*CANDIDA ALBICANS IGG ABS",2022840,"CDM ",302,RC,86628,HCPCS,OUTPATIENT,,,177,141.6,,10.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.9,70,,99.12,,,0,"percent of total billed charges ","70% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",164.61,93,,131.69,,,0,"percent of total billed charges ","93% of total billed charges ",10.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",150.45,85,,120.36,,,0,"percent of total billed charges ","85% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",153.99,87,,123.19,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",123.9,70,,99.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,164.61,
"*CANDIDA ALBICANS IGM ABS",2022850,"CDM ",302,RC,86628,HCPCS,OUTPATIENT,,,177,141.6,,10.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.9,70,,99.12,,,0,"percent of total billed charges ","70% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",164.61,93,,131.69,,,0,"percent of total billed charges ","93% of total billed charges ",10.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",150.45,85,,120.36,,,0,"percent of total billed charges ","85% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",153.99,87,,123.19,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",123.9,70,,99.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,164.61,
"*CANDIDA ALBICANS IGA ABS",2022860,"CDM ",302,RC,86628,HCPCS,OUTPATIENT,,,177,141.6,,10.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.9,70,,99.12,,,0,"percent of total billed charges ","70% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",164.61,93,,131.69,,,0,"percent of total billed charges ","93% of total billed charges ",10.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",150.45,85,,120.36,,,0,"percent of total billed charges ","85% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",153.99,87,,123.19,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",123.9,70,,99.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,164.61,
"AEROBIC ISOLATE DEFINITE ID",2022870,"CDM ",306,RC,87077,HCPCS,OUTPATIENT,,,236,188.8,,8.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",165.2,70,,132.16,,,0,"percent of total billed charges ","70% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",219.48,93,,175.58,,,0,"percent of total billed charges ","93% of total billed charges ",8.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.54,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",200.6,85,,160.48,,,0,"percent of total billed charges ","85% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",12.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",205.32,87,,164.26,,,0,"percent of total billed charges ","87% of total billed charges ",12.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.08,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",165.2,70,,132.16,,,0,"percent of total billed charges ","70% of total billed charges ",8.08,219.48,
"*CYTOGENETIC KARYOTYPE",2022890,"CDM ",300,RC,88262,HCPCS,OUTPATIENT,,,1235,988,,125.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",864.5,70,,691.60,,,0,"percent of total billed charges ","70% of total billed charges ",1111.5,90,,889.20,,,0,"percent of total billed charges ","90% of total billed charges ",1148.55,93,,918.84,,,0,"percent of total billed charges ","93% of total billed charges ",125.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",227.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1049.75,85,,839.80,,,0,"percent of total billed charges ","85% of total billed charges ",1111.5,90,,889.20,,,0,"percent of total billed charges ","90% of total billed charges ",1111.5,90,,889.20,,,0,"percent of total billed charges ","90% of total billed charges ",225.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1074.45,87,,859.56,,,0,"percent of total billed charges ","87% of total billed charges ",225.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",125.49,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",864.5,70,,691.60,,,0,"percent of total billed charges ","70% of total billed charges ",125.49,1148.55,
"*CYTOGENETIC STUDY",2022900,"CDM ",300,RC,88230,HCPCS,OUTPATIENT,,,1410.5,1128.4,,99.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",987.35,70,,789.88,,,0,"percent of total billed charges ","70% of total billed charges ",1269.45,90,,1015.56,,,0,"percent of total billed charges ","90% of total billed charges ",1311.77,93,,1049.42,,,0,"percent of total billed charges ","93% of total billed charges ",99.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1198.93,85,,959.14,,,0,"percent of total billed charges ","85% of total billed charges ",1269.45,90,,1015.56,,,0,"percent of total billed charges ","90% of total billed charges ",1269.45,90,,1015.56,,,0,"percent of total billed charges ","90% of total billed charges ",34.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1227.14,87,,981.71,,,0,"percent of total billed charges ","87% of total billed charges ",34.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",116.49,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",987.35,70,,789.88,,,0,"percent of total billed charges ","70% of total billed charges ",34.88,1311.77,
"*INTERPRETATION (KARYOTYPE)",2022910,"CDM ",300,RC,88291,HCPCS,OUTPATIENT,,,846,676.8,,26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",69.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",592.2,70,,473.76,,,0,"percent of total billed charges ","70% of total billed charges ",761.4,90,,609.12,,,0,"percent of total billed charges ","90% of total billed charges ",786.78,93,,629.42,,,0,"percent of total billed charges ","93% of total billed charges ",26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",719.1,85,,575.28,,,0,"percent of total billed charges ","85% of total billed charges ",761.4,90,,609.12,,,0,"percent of total billed charges ","90% of total billed charges ",761.4,90,,609.12,,,0,"percent of total billed charges ","90% of total billed charges ",32.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",736.02,87,,588.82,,,0,"percent of total billed charges ","87% of total billed charges ",32.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",592.2,70,,473.76,,,0,"percent of total billed charges ","70% of total billed charges ",26,786.78,
"*EBV CASPID AG IGG",2022930,"CDM ",302,RC,86665,HCPCS,OUTPATIENT,,,185,148,,15.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",172.05,93,,137.64,,,0,"percent of total billed charges ","93% of total billed charges ",15.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",157.25,85,,125.80,,,0,"percent of total billed charges ","85% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",160.95,87,,128.76,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,172.05,
"*EBV CASPID AG IGM",2022940,"CDM ",302,RC,86665,HCPCS,OUTPATIENT,,,185,148,,15.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",172.05,93,,137.64,,,0,"percent of total billed charges ","93% of total billed charges ",15.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",157.25,85,,125.80,,,0,"percent of total billed charges ","85% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",160.95,87,,128.76,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,172.05,
"AMINOACID PROF >5 QUANT #4993",2022950,"CDM ",301,RC,82139,HCPCS,OUTPATIENT,,,1170.5,936.4,,16.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",819.35,70,,655.48,,,0,"percent of total billed charges ","70% of total billed charges ",1053.45,90,,842.76,,,0,"percent of total billed charges ","90% of total billed charges ",1088.57,93,,870.86,,,0,"percent of total billed charges ","93% of total billed charges ",16.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",994.93,85,,795.94,,,0,"percent of total billed charges ","85% of total billed charges ",1053.45,90,,842.76,,,0,"percent of total billed charges ","90% of total billed charges ",1053.45,90,,842.76,,,0,"percent of total billed charges ","90% of total billed charges ",23.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1018.34,87,,814.67,,,0,"percent of total billed charges ","87% of total billed charges ",23.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.87,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",819.35,70,,655.48,,,0,"percent of total billed charges ","70% of total billed charges ",16.87,1088.57,
"*CHLAMYDIA PNEUMONIAE IGG ABS",2022970,"CDM ",302,RC,86631,HCPCS,OUTPATIENT,,,206.5,165.2,,10.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",192.05,93,,153.64,,,0,"percent of total billed charges ","93% of total billed charges ",10.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",175.53,85,,140.42,,,0,"percent of total billed charges ","85% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",179.66,87,,143.73,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,192.05,
"*CHLAMYDIA PNEUMONIAE IGM ABS",2022980,"CDM ",302,RC,86631,HCPCS,OUTPATIENT,,,206.5,165.2,,10.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",192.05,93,,153.64,,,0,"percent of total billed charges ","93% of total billed charges ",10.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",175.53,85,,140.42,,,0,"percent of total billed charges ","85% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",179.66,87,,143.73,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,192.05,
"*CHLAMYDIA PNEUMONIAE IGA ABS",2022990,"CDM ",302,RC,86631,HCPCS,OUTPATIENT,,,206.5,165.2,,10.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",192.05,93,,153.64,,,0,"percent of total billed charges ","93% of total billed charges ",10.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",175.53,85,,140.42,,,0,"percent of total billed charges ","85% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",179.66,87,,143.73,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,192.05,
"*CHLAMYDIA TRACHOMATIS IGG ABS",2023000,"CDM ",302,RC,86631,HCPCS,OUTPATIENT,,,206.5,165.2,,10.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",192.05,93,,153.64,,,0,"percent of total billed charges ","93% of total billed charges ",10.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",175.53,85,,140.42,,,0,"percent of total billed charges ","85% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",179.66,87,,143.73,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,192.05,
"*CHLAMYDIA TRACHOMATIS IGM ABS",2023010,"CDM ",302,RC,86631,HCPCS,OUTPATIENT,,,206.5,165.2,,10.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",192.05,93,,153.64,,,0,"percent of total billed charges ","93% of total billed charges ",10.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",175.53,85,,140.42,,,0,"percent of total billed charges ","85% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",179.66,87,,143.73,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,192.05,
"*CHLAMYDIA TRACHOMATIS IGA ABS",2023020,"CDM ",302,RC,86631,HCPCS,OUTPATIENT,,,206.5,165.2,,10.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",192.05,93,,153.64,,,0,"percent of total billed charges ","93% of total billed charges ",10.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",175.53,85,,140.42,,,0,"percent of total billed charges ","85% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",179.66,87,,143.73,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,192.05,
"*CHLAMYDIA PSITTACI IGG ABS",2023030,"CDM ",302,RC,86632,HCPCS,OUTPATIENT,,,185,148,,10.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",172.05,93,,137.64,,,0,"percent of total billed charges ","93% of total billed charges ",10.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",157.25,85,,125.80,,,0,"percent of total billed charges ","85% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",160.95,87,,128.76,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.68,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,172.05,
"*CHLAMYDIA PSITTACI IGM ABS",2023040,"CDM ",302,RC,86632,HCPCS,OUTPATIENT,,,185,148,,10.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",172.05,93,,137.64,,,0,"percent of total billed charges ","93% of total billed charges ",10.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",157.25,85,,125.80,,,0,"percent of total billed charges ","85% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",160.95,87,,128.76,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.68,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,172.05,
"*CHLAMYDIA PSITTACI IGA ABS",2023050,"CDM ",302,RC,86632,HCPCS,OUTPATIENT,,,185,148,,10.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",172.05,93,,137.64,,,0,"percent of total billed charges ","93% of total billed charges ",10.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",157.25,85,,125.80,,,0,"percent of total billed charges ","85% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",160.95,87,,128.76,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.68,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,172.05,
"*CHLORPROPAMIDE (DIABINESE)",2023170,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,168.5,134.8,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",156.71,93,,125.37,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.23,85,,114.58,,,0,"percent of total billed charges ","85% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",146.6,87,,117.28,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,156.71,
"*TOLAZIMIDE (TOLINASE)",2023180,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,168.5,134.8,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",156.71,93,,125.37,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.23,85,,114.58,,,0,"percent of total billed charges ","85% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",146.6,87,,117.28,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,156.71,
"*TOLBUTAMIDE (ORINASE)",2023190,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,168.5,134.8,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",156.71,93,,125.37,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.23,85,,114.58,,,0,"percent of total billed charges ","85% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",146.6,87,,117.28,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,156.71,
"*GLYBURIDE (MICRONASE)",2023200,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,168.5,134.8,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",156.71,93,,125.37,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.23,85,,114.58,,,0,"percent of total billed charges ","85% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",146.6,87,,117.28,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,156.71,
"*ACETOHEXAMIDE (DYMELOR)",2023220,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,168.5,134.8,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",156.71,93,,125.37,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.23,85,,114.58,,,0,"percent of total billed charges ","85% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",146.6,87,,117.28,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,156.71,
"*AIAT PHENOTYPE",2023250,"CDM ",301,RC,82103,HCPCS,OUTPATIENT,,,486,388.8,,13.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",340.2,70,,272.16,,,0,"percent of total billed charges ","70% of total billed charges ",437.4,90,,349.92,,,0,"percent of total billed charges ","90% of total billed charges ",451.98,93,,361.58,,,0,"percent of total billed charges ","93% of total billed charges ",13.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",413.1,85,,330.48,,,0,"percent of total billed charges ","85% of total billed charges ",437.4,90,,349.92,,,0,"percent of total billed charges ","90% of total billed charges ",437.4,90,,349.92,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",422.82,87,,338.26,,,0,"percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.44,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",340.2,70,,272.16,,,0,"percent of total billed charges ","70% of total billed charges ",13.44,451.98,
*ALPHA-1-ANTITRYPSIN,2023260,"CDM ",301,RC,82104,HCPCS,OUTPATIENT,,,486,388.8,,13.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",340.2,70,,272.16,,,0,"percent of total billed charges ","70% of total billed charges ",437.4,90,,349.92,,,0,"percent of total billed charges ","90% of total billed charges ",451.98,93,,361.58,,,0,"percent of total billed charges ","93% of total billed charges ",13.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",413.1,85,,330.48,,,0,"percent of total billed charges ","85% of total billed charges ",437.4,90,,349.92,,,0,"percent of total billed charges ","90% of total billed charges ",437.4,90,,349.92,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",422.82,87,,338.26,,,0,"percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.46,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",340.2,70,,272.16,,,0,"percent of total billed charges ","70% of total billed charges ",13.65,451.98,
"*TRANSGLUTAMINASE IGA AUTO ABS",2023270,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,90,72,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,83.7,
SELENIUM,2023280,"CDM ",301,RC,84255,HCPCS,OUTPATIENT,,,172,137.6,,21.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.4,70,,96.32,,,0,"percent of total billed charges ","70% of total billed charges ",154.8,90,,123.84,,,0,"percent of total billed charges ","90% of total billed charges ",159.96,93,,127.97,,,0,"percent of total billed charges ","93% of total billed charges ",21.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",146.2,85,,116.96,,,0,"percent of total billed charges ","85% of total billed charges ",154.8,90,,123.84,,,0,"percent of total billed charges ","90% of total billed charges ",154.8,90,,123.84,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.64,87,,119.71,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",120.4,70,,96.32,,,0,"percent of total billed charges ","70% of total billed charges ",13.18,159.96,
"REVERSE T3",2023290,"CDM ",301,RC,84482,HCPCS,OUTPATIENT,,,178.5,142.8,,13.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,88.78,88.78,88.78,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.95,70,,99.96,,,0,"percent of total billed charges ","70% of total billed charges ",160.65,90,,128.52,,,0,"percent of total billed charges ","90% of total billed charges ",166.01,93,,132.81,,,0,"percent of total billed charges ","93% of total billed charges ",13.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.44,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",151.73,85,,121.38,,,0,"percent of total billed charges ","85% of total billed charges ",160.65,90,,128.52,,,0,"percent of total billed charges ","90% of total billed charges ",160.65,90,,128.52,,,0,"percent of total billed charges ","90% of total billed charges ",10.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",155.3,87,,124.24,,,0,"percent of total billed charges ","87% of total billed charges ",10.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.76,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",124.95,70,,99.96,,,0,"percent of total billed charges ","70% of total billed charges ",10.34,166.01,
ISONIAZID,2023300,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,426.5,341.2,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",298.55,70,,238.84,,,0,"percent of total billed charges ","70% of total billed charges ",383.85,90,,307.08,,,0,"percent of total billed charges ","90% of total billed charges ",396.65,93,,317.32,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",362.53,85,,290.02,,,0,"percent of total billed charges ","85% of total billed charges ",383.85,90,,307.08,,,0,"percent of total billed charges ","90% of total billed charges ",383.85,90,,307.08,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",371.06,87,,296.85,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",298.55,70,,238.84,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,396.65,
"*HEPATITIS A VIRUS ABS",2023320,"CDM ",302,RC,86708,HCPCS,OUTPATIENT,,,126.5,101.2,,12.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.55,70,,70.84,,,0,"percent of total billed charges ","70% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",117.65,93,,94.12,,,0,"percent of total billed charges ","93% of total billed charges ",12.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",107.53,85,,86.02,,,0,"percent of total billed charges ","85% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",19.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",110.06,87,,88.05,,,0,"percent of total billed charges ","87% of total billed charges ",19.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",88.55,70,,70.84,,,0,"percent of total billed charges ","70% of total billed charges ",12.39,117.65,
"*HEPATITIS B VIR CORE TOT ABS",2023330,"CDM ",302,RC,86704,HCPCS,OUTPATIENT,,,123,98.4,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.1,70,,68.88,,,0,"percent of total billed charges ","70% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",114.39,93,,91.51,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.29,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.55,85,,83.64,,,0,"percent of total billed charges ","85% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",19.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.01,87,,85.61,,,0,"percent of total billed charges ","87% of total billed charges ",19.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",86.1,70,,68.88,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,114.39,
"*HEPATITIS ACUTE PROFILE",2023340,"CDM ",301,RC,80074,HCPCS,OUTPATIENT,,,253.5,202.8,,40.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.45,70,,141.96,,,0,"percent of total billed charges ","70% of total billed charges ",228.15,90,,182.52,,,0,"percent of total billed charges ","90% of total billed charges ",235.76,93,,188.61,,,0,"percent of total billed charges ","93% of total billed charges ",40.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",215.48,85,,172.38,,,0,"percent of total billed charges ","85% of total billed charges ",228.15,90,,182.52,,,0,"percent of total billed charges ","90% of total billed charges ",228.15,90,,182.52,,,0,"percent of total billed charges ","90% of total billed charges ",40.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",220.55,87,,176.44,,,0,"percent of total billed charges ","87% of total billed charges ",40.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.63,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",177.45,70,,141.96,,,0,"percent of total billed charges ","70% of total billed charges ",40.49,235.76,
"*HEPATITIS B VIR SVR FACE ABS",2023350,"CDM ",302,RC,86706,HCPCS,OUTPATIENT,,,133,106.4,,10.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.1,70,,74.48,,,0,"percent of total billed charges ","70% of total billed charges ",119.7,90,,95.76,,,0,"percent of total billed charges ","90% of total billed charges ",123.69,93,,98.95,,,0,"percent of total billed charges ","93% of total billed charges ",10.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",113.05,85,,90.44,,,0,"percent of total billed charges ","85% of total billed charges ",119.7,90,,95.76,,,0,"percent of total billed charges ","90% of total billed charges ",119.7,90,,95.76,,,0,"percent of total billed charges ","90% of total billed charges ",19.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",115.71,87,,92.57,,,0,"percent of total billed charges ","87% of total billed charges ",19.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",93.1,70,,74.48,,,0,"percent of total billed charges ","70% of total billed charges ",10.74,123.69,
"*HERPES VIRUS-6 HUMAN IGG ABS",2023390,"CDM ",302,RC,86790,HCPCS,OUTPATIENT,,,146,116.8,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.58,80.58,80.58,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,199.98,199.98,199.98,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,135.78,
"*HERPES VIRUS-6 HUMAN IGM ABS",2023400,"CDM ",302,RC,86790,HCPCS,OUTPATIENT,,,146,116.8,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.58,80.58,80.58,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,199.98,199.98,199.98,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,135.78,
"*CYSTINE 24 HR URINE",2023410,"CDM ",301,RC,82131,HCPCS,OUTPATIENT,,,596.5,477.2,,19.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",417.55,70,,334.04,,,0,"percent of total billed charges ","70% of total billed charges ",536.85,90,,429.48,,,0,"percent of total billed charges ","90% of total billed charges ",554.75,93,,443.80,,,0,"percent of total billed charges ","93% of total billed charges ",19.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",507.03,85,,405.62,,,0,"percent of total billed charges ","85% of total billed charges ",536.85,90,,429.48,,,0,"percent of total billed charges ","90% of total billed charges ",536.85,90,,429.48,,,0,"percent of total billed charges ","90% of total billed charges ",25.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",518.96,87,,415.17,,,0,"percent of total billed charges ","87% of total billed charges ",25.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",417.55,70,,334.04,,,0,"percent of total billed charges ","70% of total billed charges ",19.81,554.75,
"*MOL CYTOGENETICS DNA PROBE",2023480,"CDM ",300,RC,88271,HCPCS,OUTPATIENT,,,362,289.6,,21.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",253.4,70,,202.72,,,0,"percent of total billed charges ","70% of total billed charges ",325.8,90,,260.64,,,0,"percent of total billed charges ","90% of total billed charges ",336.66,93,,269.33,,,0,"percent of total billed charges ","93% of total billed charges ",21.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",307.7,85,,246.16,,,0,"percent of total billed charges ","85% of total billed charges ",325.8,90,,260.64,,,0,"percent of total billed charges ","90% of total billed charges ",325.8,90,,260.64,,,0,"percent of total billed charges ","90% of total billed charges ",33.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",314.94,87,,251.95,,,0,"percent of total billed charges ","87% of total billed charges ",33.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.42,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",253.4,70,,202.72,,,0,"percent of total billed charges ","70% of total billed charges ",21.42,336.66,
"*MOL CYTOGENETICS CHROMOSOMAL",2023490,"CDM ",300,RC,88273,HCPCS,OUTPATIENT,,,362,289.6,,34.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",253.4,70,,202.72,,,0,"percent of total billed charges ","70% of total billed charges ",325.8,90,,260.64,,,0,"percent of total billed charges ","90% of total billed charges ",336.66,93,,269.33,,,0,"percent of total billed charges ","93% of total billed charges ",34.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",50.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",307.7,85,,246.16,,,0,"percent of total billed charges ","85% of total billed charges ",325.8,90,,260.64,,,0,"percent of total billed charges ","90% of total billed charges ",325.8,90,,260.64,,,0,"percent of total billed charges ","90% of total billed charges ",49.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",314.94,87,,251.95,,,0,"percent of total billed charges ","87% of total billed charges ",49.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.81,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",253.4,70,,202.72,,,0,"percent of total billed charges ","70% of total billed charges ",34.81,336.66,
"*CYTOGENIC/MOLECULAR INTER/REP",2023500,"CDM ",300,RC,88291,HCPCS,OUTPATIENT,,,291.5,233.2,,26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",69.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",204.05,70,,163.24,,,0,"percent of total billed charges ","70% of total billed charges ",262.35,90,,209.88,,,0,"percent of total billed charges ","90% of total billed charges ",271.1,93,,216.88,,,0,"percent of total billed charges ","93% of total billed charges ",26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",247.78,85,,198.22,,,0,"percent of total billed charges ","85% of total billed charges ",262.35,90,,209.88,,,0,"percent of total billed charges ","90% of total billed charges ",262.35,90,,209.88,,,0,"percent of total billed charges ","90% of total billed charges ",32.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",253.61,87,,202.89,,,0,"percent of total billed charges ","87% of total billed charges ",32.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",204.05,70,,163.24,,,0,"percent of total billed charges ","70% of total billed charges ",26,271.1,
"*AMPHETAMINES URINE",2023520,"CDM ",301,RC,80324,HCPCS,OUTPATIENT,,,73.5,58.8,,10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.48,68.36,
"*METHAMPHETAMINE URINE",2023530,"CDM ",301,RC,80324,HCPCS,OUTPATIENT,,,73.5,58.8,,10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.48,68.36,
"KAPPA LIGHT CHAIN UR #1731UR",2023550,"CDM ",301,RC,83883,HCPCS,OUTPATIENT,,,112.5,90,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",104.63,93,,83.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",95.63,85,,76.50,,,0,"percent of total billed charges ","85% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",97.88,87,,78.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",13.6,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",13.6,104.63,
"DEHYDROCHOLESTER C7/C8 #S43330",2023560,"CDM ",301,RC,82542,HCPCS,OUTPATIENT,,,880,704,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",616,70,,492.80,,,0,"percent of total billed charges ","70% of total billed charges ",792,90,,633.60,,,0,"percent of total billed charges ","90% of total billed charges ",818.4,93,,654.72,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",748,85,,598.40,,,0,"percent of total billed charges ","85% of total billed charges ",792,90,,633.60,,,0,"percent of total billed charges ","90% of total billed charges ",792,90,,633.60,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",765.6,87,,612.48,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",616,70,,492.80,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,818.4,
"SODIUM, FECAL #S50508",2023570,"CDM ",301,RC,84302,HCPCS,OUTPATIENT,,,179,143.2,,4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.3,70,,100.24,,,0,"percent of total billed charges ","70% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",166.47,93,,133.18,,,0,"percent of total billed charges ","93% of total billed charges ",4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",152.15,85,,121.72,,,0,"percent of total billed charges ","85% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",155.73,87,,124.58,,,0,"percent of total billed charges ","87% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.86,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",125.3,70,,100.24,,,0,"percent of total billed charges ","70% of total billed charges ",4.2,166.47,
"POTASSIUM, FECAL #S50509",2023580,"CDM ",301,RC,84133,HCPCS,OUTPATIENT,,,179,143.2,,4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.3,70,,100.24,,,0,"percent of total billed charges ","70% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",166.47,93,,133.18,,,0,"percent of total billed charges ","93% of total billed charges ",4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",152.15,85,,121.72,,,0,"percent of total billed charges ","85% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",155.73,87,,124.58,,,0,"percent of total billed charges ","87% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.73,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",125.3,70,,100.24,,,0,"percent of total billed charges ","70% of total billed charges ",4.2,166.47,
"MAGNESIUM RANDOM FECES #S49974",2023590,"CDM ",301,RC,83735,HCPCS,OUTPATIENT,,,573,458.4,,6.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",401.1,70,,320.88,,,0,"percent of total billed charges ","70% of total billed charges ",515.7,90,,412.56,,,0,"percent of total billed charges ","90% of total billed charges ",532.89,93,,426.31,,,0,"percent of total billed charges ","93% of total billed charges ",6.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",487.05,85,,389.64,,,0,"percent of total billed charges ","85% of total billed charges ",515.7,90,,412.56,,,0,"percent of total billed charges ","90% of total billed charges ",515.7,90,,412.56,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",498.51,87,,46.55,6.57,58.19,15,"percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.7,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",401.1,70,,320.88,,,0,"percent of total billed charges ","70% of total billed charges ",6.7,532.89,
"INSULIN LIKE FACTOR II #S49270",2023600,"CDM ",301,RC,83519,HCPCS,OUTPATIENT,,,251.5,201.2,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.05,70,,140.84,,,0,"percent of total billed charges ","70% of total billed charges ",226.35,90,,181.08,,,0,"percent of total billed charges ","90% of total billed charges ",233.9,93,,187.12,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",213.78,85,,171.02,,,0,"percent of total billed charges ","85% of total billed charges ",226.35,90,,181.08,,,0,"percent of total billed charges ","90% of total billed charges ",226.35,90,,181.08,,,0,"percent of total billed charges ","90% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",218.81,87,,175.05,,,0,"percent of total billed charges ","87% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",176.05,70,,140.84,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,233.9,
"IMM COMP ASSAY,RAJI CELL #1230",2023610,"CDM ",302,RC,86332,HCPCS,OUTPATIENT,,,252,201.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.4,70,,141.12,,,0,"percent of total billed charges ","70% of total billed charges ",226.8,90,,181.44,,,0,"percent of total billed charges ","90% of total billed charges ",234.36,93,,187.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",214.2,85,,171.36,,,0,"percent of total billed charges ","85% of total billed charges ",226.8,90,,181.44,,,0,"percent of total billed charges ","90% of total billed charges ",226.8,90,,181.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",219.24,87,,175.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",24.37,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",176.4,70,,141.12,,,0,"percent of total billed charges ","70% of total billed charges ",24.37,234.36,
ZONISAMIDE,2023620,"CDM ",301,RC,80203,HCPCS,OUTPATIENT,,,122.5,98,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",113.93,93,,91.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",104.13,85,,83.30,,,0,"percent of total billed charges ","85% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",106.58,87,,85.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",13.25,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",13.25,113.93,
"CARDIOLIPIN IGG AUTO ABS #3372",2023630,"CDM ",302,RC,86147,HCPCS,OUTPATIENT,,,224.5,179.6,,25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",208.79,93,,167.03,,,0,"percent of total billed charges ","93% of total billed charges ",25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",190.83,85,,152.66,,,0,"percent of total billed charges ","85% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.32,87,,156.26,,,0,"percent of total billed charges ","87% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",25.45,208.79,
"CARDIOLIPIN IGM AUTO ABS #3373",2023640,"CDM ",302,RC,86147,HCPCS,OUTPATIENT,,,224.5,179.6,,25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",208.79,93,,167.03,,,0,"percent of total billed charges ","93% of total billed charges ",25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",190.83,85,,152.66,,,0,"percent of total billed charges ","85% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.32,87,,156.26,,,0,"percent of total billed charges ","87% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",25.45,208.79,
"*ANTIPHOSPHATIDYLSERINE ABS",2023660,"CDM ",302,RC,86148,HCPCS,OUTPATIENT,,,170,136,,16.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119,70,,95.20,,,0,"percent of total billed charges ","70% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",158.1,93,,126.48,,,0,"percent of total billed charges ","93% of total billed charges ",16.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",144.5,85,,115.60,,,0,"percent of total billed charges ","85% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",22.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.9,87,,118.32,,,0,"percent of total billed charges ","87% of total billed charges ",22.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",119,70,,95.20,,,0,"percent of total billed charges ","70% of total billed charges ",16.07,158.1,
"*CEA(CARCINOEMBRYOGENIC ANTIG)",2023670,"CDM ",301,RC,82378,HCPCS,OUTPATIENT,,,157.5,126,,18.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.25,70,,88.20,,,0,"percent of total billed charges ","70% of total billed charges ",141.75,90,,113.40,,,0,"percent of total billed charges ","90% of total billed charges ",146.48,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",18.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.58,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",133.88,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.75,90,,113.40,,,0,"percent of total billed charges ","90% of total billed charges ",141.75,90,,113.40,,,0,"percent of total billed charges ","90% of total billed charges ",34.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",137.03,87,,94.14,33.70,251.22,"1 through 10","percent of total billed charges ","87% of total billed charges ",34.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.96,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",110.25,70,,88.20,,,0,"percent of total billed charges ","70% of total billed charges ",18.96,146.48,
"*CA 19-9",2023680,"CDM ",302,RC,86301,HCPCS,OUTPATIENT,,,117.5,94,,20.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.87,64.87,64.87,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.25,70,,65.80,,,0,"percent of total billed charges ","70% of total billed charges ",105.75,90,,84.60,,,0,"percent of total billed charges ","90% of total billed charges ",109.28,93,,87.42,,,0,"percent of total billed charges ","93% of total billed charges ",20.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",99.88,85,,79.90,,,0,"percent of total billed charges ","85% of total billed charges ",105.75,90,,84.60,,,0,"percent of total billed charges ","90% of total billed charges ",105.75,90,,84.60,,,0,"percent of total billed charges ","90% of total billed charges ",31.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",102.23,87,,81.78,,,0,"percent of total billed charges ","87% of total billed charges ",31.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.81,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",82.25,70,,65.80,,,0,"percent of total billed charges ","70% of total billed charges ",20.81,109.28,
"*MUMPS IGG ABS",2023700,"CDM ",302,RC,86735,HCPCS,OUTPATIENT,,,183.5,146.8,,11.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",170.66,93,,136.53,,,0,"percent of total billed charges ","93% of total billed charges ",11.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",155.98,85,,124.78,,,0,"percent of total billed charges ","85% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",159.65,87,,127.72,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,170.66,
"*MUMPS IGM ABS",2023710,"CDM ",302,RC,86735,HCPCS,OUTPATIENT,,,183.5,146.8,,11.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",170.66,93,,136.53,,,0,"percent of total billed charges ","93% of total billed charges ",11.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",155.98,85,,124.78,,,0,"percent of total billed charges ","85% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",159.65,87,,127.72,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,170.66,
"*ANALYZE 100-300 CELLS INTERPH",2023740,"CDM ",300,RC,88275,HCPCS,OUTPATIENT,,,1184,947.2,,47.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",828.8,70,,663.04,,,0,"percent of total billed charges ","70% of total billed charges ",1065.6,90,,852.48,,,0,"percent of total billed charges ","90% of total billed charges ",1101.12,93,,880.90,,,0,"percent of total billed charges ","93% of total billed charges ",47.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.02,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1006.4,85,,805.12,,,0,"percent of total billed charges ","85% of total billed charges ",1065.6,90,,852.48,,,0,"percent of total billed charges ","90% of total billed charges ",1065.6,90,,852.48,,,0,"percent of total billed charges ","90% of total billed charges ",62.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1030.08,87,,824.06,,,0,"percent of total billed charges ","87% of total billed charges ",62.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",51.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",828.8,70,,663.04,,,0,"percent of total billed charges ","70% of total billed charges ",47.69,1101.12,
"HEP B SUR AG W/O NEUTRALIZATIO",2023750,"CDM ",306,RC,87340,HCPCS,OUTPATIENT,,,68,54.4,,10.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.6,70,,38.08,,,0,"percent of total billed charges ","70% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",63.24,93,,50.59,,,0,"percent of total billed charges ","93% of total billed charges ",10.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",57.8,85,,46.24,,,0,"percent of total billed charges ","85% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",15.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.16,87,,46.55,46.55,46.55,11,"percent of total billed charges ","87% of total billed charges ",15.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.33,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",47.6,70,,38.08,,,0,"percent of total billed charges ","70% of total billed charges ",10.33,63.24,
"PROTEIN S AG FREE #5935",2023760,"CDM ",305,RC,85306,HCPCS,OUTPATIENT,,,201,160.8,,15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.7,70,,112.56,,,0,"percent of total billed charges ","70% of total billed charges ",180.9,90,,144.72,,,0,"percent of total billed charges ","90% of total billed charges ",186.93,93,,149.54,,,0,"percent of total billed charges ","93% of total billed charges ",15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",170.85,85,,136.68,,,0,"percent of total billed charges ","85% of total billed charges ",180.9,90,,144.72,,,0,"percent of total billed charges ","90% of total billed charges ",180.9,90,,144.72,,,0,"percent of total billed charges ","90% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",174.87,87,,174.12,174.12,174.12,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.32,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",140.7,70,,112.56,,,0,"percent of total billed charges ","70% of total billed charges ",15.32,186.93,
"*FLOW CYTOMETRY FIRST MARKER",2023770,"CDM ",300,RC,88184,HCPCS,OUTPATIENT,,,218.5,174.8,,53.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",137.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",203.21,93,,162.57,,,0,"percent of total billed charges ","93% of total billed charges ",53.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",185.73,85,,148.58,,,0,"percent of total billed charges ","85% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",43.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",190.1,87,,152.08,,,0,"percent of total billed charges ","87% of total billed charges ",43.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",43.19,329.64,
"*FLOW CYTOMETRY EA ADD MARKER",2023790,"CDM ",300,RC,88185,HCPCS,OUTPATIENT,,,218.5,174.8,,19.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.24,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",203.21,93,,162.57,,,0,"percent of total billed charges ","93% of total billed charges ",19.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",185.73,85,,148.58,,,0,"percent of total billed charges ","85% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",21.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",190.1,87,,152.08,,,0,"percent of total billed charges ","87% of total billed charges ",21.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",19.52,203.21,
"*CITRATE 24HR URINE",2023810,"CDM ",301,RC,82507,HCPCS,OUTPATIENT,,,85.5,68.4,,23.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.85,70,,47.88,,,0,"percent of total billed charges ","70% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",79.52,93,,63.62,,,0,"percent of total billed charges ","93% of total billed charges ",23.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",72.68,85,,58.14,,,0,"percent of total billed charges ","85% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",74.39,87,,59.51,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.8,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",59.85,70,,47.88,,,0,"percent of total billed charges ","70% of total billed charges ",13.18,79.52,
"*OSMOLARITY 24HR URINE",2023820,"CDM ",301,RC,83935,HCPCS,OUTPATIENT,,,69,55.2,,6.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2.32,2.32,2.32,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.3,70,,38.64,,,0,"percent of total billed charges ","70% of total billed charges ",62.1,90,,49.68,,,0,"percent of total billed charges ","90% of total billed charges ",64.17,93,,51.34,,,0,"percent of total billed charges ","93% of total billed charges ",6.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.53,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",58.65,85,,46.92,,,0,"percent of total billed charges ","85% of total billed charges ",62.1,90,,49.68,,,0,"percent of total billed charges ","90% of total billed charges ",62.1,90,,49.68,,,0,"percent of total billed charges ","90% of total billed charges ",8.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60.03,87,,6.69,6.69,6.69,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",48.3,70,,38.64,,,0,"percent of total billed charges ","70% of total billed charges ",6.46,64.17,
"*PH URINE",2023830,"CDM ",301,RC,83986,HCPCS,OUTPATIENT,,,35,28,,3.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.5,70,,19.60,,,0,"percent of total billed charges ","70% of total billed charges ",31.5,90,,25.20,,,0,"percent of total billed charges ","90% of total billed charges ",32.55,93,,26.04,,,0,"percent of total billed charges ","93% of total billed charges ",3.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",29.75,85,,23.80,,,0,"percent of total billed charges ","85% of total billed charges ",31.5,90,,25.20,,,0,"percent of total billed charges ","90% of total billed charges ",31.5,90,,25.20,,,0,"percent of total billed charges ","90% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.45,87,,24.36,,,0,"percent of total billed charges ","87% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.58,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",24.5,70,,19.60,,,0,"percent of total billed charges ","70% of total billed charges ",3.58,32.55,
"*PHOSPHORUS 24HR URINE",2023840,"CDM ",301,RC,84105,HCPCS,OUTPATIENT,,,41,32.8,,5.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.7,70,,22.96,,,0,"percent of total billed charges ","70% of total billed charges ",36.9,90,,29.52,,,0,"percent of total billed charges ","90% of total billed charges ",38.13,93,,30.50,,,0,"percent of total billed charges ","93% of total billed charges ",5.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",34.85,85,,27.88,,,0,"percent of total billed charges ","85% of total billed charges ",36.9,90,,29.52,,,0,"percent of total billed charges ","90% of total billed charges ",36.9,90,,29.52,,,0,"percent of total billed charges ","90% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.67,87,,28.54,,,0,"percent of total billed charges ","87% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.78,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",28.7,70,,22.96,,,0,"percent of total billed charges ","70% of total billed charges ",5.78,38.13,
"*POTASSIUM 24HR URINE",2023850,"CDM ",301,RC,84133,HCPCS,OUTPATIENT,,,44.5,35.6,,4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.15,70,,24.92,,,0,"percent of total billed charges ","70% of total billed charges ",40.05,90,,32.04,,,0,"percent of total billed charges ","90% of total billed charges ",41.39,93,,33.11,,,0,"percent of total billed charges ","93% of total billed charges ",4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",37.83,85,,30.26,,,0,"percent of total billed charges ","85% of total billed charges ",40.05,90,,32.04,,,0,"percent of total billed charges ","90% of total billed charges ",40.05,90,,32.04,,,0,"percent of total billed charges ","90% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.72,87,,30.98,,,0,"percent of total billed charges ","87% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.73,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.15,70,,24.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.2,41.39,
"*URIC ACID 24HR URINE",2023860,"CDM ",301,RC,84560,HCPCS,OUTPATIENT,,,47,37.6,,5.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",43.71,93,,34.97,,,0,"percent of total billed charges ","93% of total billed charges ",5.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.95,85,,31.96,,,0,"percent of total billed charges ","85% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.89,87,,32.71,,,0,"percent of total billed charges ","87% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.08,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",5.08,43.71,
"*ASSAY URINE/URIC ACID OTH SRC",2023864,"CDM ",301,RC,84560,HCPCS,OUTPATIENT,,,47,37.6,,5.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",43.71,93,,34.97,,,0,"percent of total billed charges ","93% of total billed charges ",5.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.95,85,,31.96,,,0,"percent of total billed charges ","85% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.89,87,,32.71,,,0,"percent of total billed charges ","87% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.08,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",5.08,43.71,
"C DIFF TITER #S44785",2023880,"CDM ",306,RC,87253,HCPCS,OUTPATIENT,,,702.5,562,,17.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",491.75,70,,393.40,,,0,"percent of total billed charges ","70% of total billed charges ",632.25,90,,505.80,,,0,"percent of total billed charges ","90% of total billed charges ",653.33,93,,522.66,,,0,"percent of total billed charges ","93% of total billed charges ",17.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",597.13,85,,477.70,,,0,"percent of total billed charges ","85% of total billed charges ",632.25,90,,505.80,,,0,"percent of total billed charges ","90% of total billed charges ",632.25,90,,505.80,,,0,"percent of total billed charges ","90% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",611.18,87,,488.94,,,0,"percent of total billed charges ","87% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.2,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",491.75,70,,393.40,,,0,"percent of total billed charges ","70% of total billed charges ",17.17,653.33,
"QUETIAPINE (SEROQUEL) LEVEL",2023890,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,303,242.4,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",212.1,70,,169.68,,,0,"percent of total billed charges ","70% of total billed charges ",272.7,90,,218.16,,,0,"percent of total billed charges ","90% of total billed charges ",281.79,93,,225.43,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",257.55,85,,206.04,,,0,"percent of total billed charges ","85% of total billed charges ",272.7,90,,218.16,,,0,"percent of total billed charges ","90% of total billed charges ",272.7,90,,218.16,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",263.61,87,,210.89,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",212.1,70,,169.68,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,281.79,
"TRAZADONE LEVEL (DESYREL)#4960",2023900,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,168.5,134.8,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",156.71,93,,125.37,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.23,85,,114.58,,,0,"percent of total billed charges ","85% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",146.6,87,,117.28,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,156.71,
"FIBRINOLYTIC DEGRADATION PROD",2023910,"CDM ",305,RC,85362,HCPCS,OUTPATIENT,,,158,126.4,,6.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,50.59,50.59,50.59,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.6,70,,88.48,,,0,"percent of total billed charges ","70% of total billed charges ",142.2,90,,113.76,,,0,"percent of total billed charges ","90% of total billed charges ",146.94,93,,117.55,,,0,"percent of total billed charges ","93% of total billed charges ",6.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.57,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",134.3,85,,107.44,,,0,"percent of total billed charges ","85% of total billed charges ",142.2,90,,113.76,,,0,"percent of total billed charges ","90% of total billed charges ",142.2,90,,113.76,,,0,"percent of total billed charges ","90% of total billed charges ",12.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",137.46,87,,109.97,,,0,"percent of total billed charges ","87% of total billed charges ",12.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.89,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",110.6,70,,88.48,,,0,"percent of total billed charges ","70% of total billed charges ",6.89,146.94,
"*SPLIT OF BLD/BLD PROD EA UNIT",2023920,"CDM ",300,RC,86985,HCPCS,OUTPATIENT,,,63,50.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.1,70,,35.28,,,0,"percent of total billed charges ","70% of total billed charges ",56.7,90,,45.36,,,0,"percent of total billed charges ","90% of total billed charges ",58.59,93,,46.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",53.55,85,,42.84,,,0,"percent of total billed charges ","85% of total billed charges ",56.7,90,,45.36,,,0,"percent of total billed charges ","90% of total billed charges ",56.7,90,,45.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",54.81,87,,43.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",44.1,70,,35.28,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,156.68,
BETAHYDROXBUTYRITE,2023950,"CDM ",301,RC,84311,HCPCS,OUTPATIENT,,,146.5,117.2,,,,,,,,0,"other ","not separately reimbursment ",,,,89.76,89.76,89.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.55,70,,82.04,,,0,"percent of total billed charges ","70% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",136.25,93,,109.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",124.53,85,,99.62,,,0,"percent of total billed charges ","85% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",127.46,87,,101.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",8.1,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.55,70,,82.04,,,0,"percent of total billed charges ","70% of total billed charges ",8.1,136.25,
BUTABARBITAL,2023960,"CDM ",301,RC,80345,HCPCS,OUTPATIENT,,,239.5,191.6,,16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.65,70,,134.12,,,0,"percent of total billed charges ","70% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",222.74,93,,178.19,,,0,"percent of total billed charges ","93% of total billed charges ",16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",203.58,85,,162.86,,,0,"percent of total billed charges ","85% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",208.37,87,,166.70,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",167.65,70,,134.12,,,0,"percent of total billed charges ","70% of total billed charges ",16.38,222.74,
"BORDATELLA PERTUSSIS PCR CULT",2023970,"CDM ",306,RC,87801,HCPCS,OUTPATIENT,,,785,628,,59.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,531.68,531.68,531.68,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",549.5,70,,439.60,,,0,"percent of total billed charges ","70% of total billed charges ",706.5,90,,565.20,,,0,"percent of total billed charges ","90% of total billed charges ",730.05,93,,584.04,,,0,"percent of total billed charges ","93% of total billed charges ",59.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",667.25,85,,533.80,,,0,"percent of total billed charges ","85% of total billed charges ",706.5,90,,565.20,,,0,"percent of total billed charges ","90% of total billed charges ",706.5,90,,565.20,,,0,"percent of total billed charges ","90% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",682.95,87,,546.36,,,0,"percent of total billed charges ","87% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.2,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",549.5,70,,439.60,,,0,"percent of total billed charges ","70% of total billed charges ",53.94,730.05,
"CRYPTOCOCCUS ANTIGEN CSF #9189",2023980,"CDM ",306,RC,87327,HCPCS,OUTPATIENT,,,152,121.6,,13.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",141.36,93,,113.09,,,0,"percent of total billed charges ","93% of total billed charges ",13.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",129.2,85,,103.36,,,0,"percent of total billed charges ","85% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.24,87,,105.79,,,0,"percent of total billed charges ","87% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.42,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.42,141.36,
"FLECAINIDE #4921",2023990,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,168.5,134.8,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",156.71,93,,125.37,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.23,85,,114.58,,,0,"percent of total billed charges ","85% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",146.6,87,,117.28,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,156.71,
"MELATONIN #40725",2024000,"CDM ",301,RC,83519,HCPCS,OUTPATIENT,,,690.5,552.4,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",483.35,70,,386.68,,,0,"percent of total billed charges ","70% of total billed charges ",621.45,90,,497.16,,,0,"percent of total billed charges ","90% of total billed charges ",642.17,93,,513.74,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",586.93,85,,469.54,,,0,"percent of total billed charges ","85% of total billed charges ",621.45,90,,497.16,,,0,"percent of total billed charges ","90% of total billed charges ",621.45,90,,497.16,,,0,"percent of total billed charges ","90% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",600.74,87,,480.59,,,0,"percent of total billed charges ","87% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",483.35,70,,386.68,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,642.17,
"IGA FIBRONECTIN #S49839",2024010,"CDM ",301,RC,83516,HCPCS,OUTPATIENT,,,665,532,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",465.5,70,,372.40,,,0,"percent of total billed charges ","70% of total billed charges ",598.5,90,,478.80,,,0,"percent of total billed charges ","90% of total billed charges ",618.45,93,,494.76,,,0,"percent of total billed charges ","93% of total billed charges ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",565.25,85,,452.20,,,0,"percent of total billed charges ","85% of total billed charges ",598.5,90,,478.80,,,0,"percent of total billed charges ","90% of total billed charges ",598.5,90,,478.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",578.55,87,,53.32,28.74,77.90,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",465.5,70,,372.40,,,0,"percent of total billed charges ","70% of total billed charges ",10,618.45,
"COCAINE, URINE",2024020,"CDM ",301,RC,80353,HCPCS,OUTPATIENT,,,98.5,78.8,,9.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",9.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",12.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",12.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",9.98,91.61,
"CHLAM TRACHOMATIS URINE #7437U",2024030,"CDM ",306,RC,87491,HCPCS,OUTPATIENT,,,204,163.2,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.47,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,140.08,140.08,140.08,20,"percent of total billed charges ","87% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,189.72,
"BARBITURATES CONF-URINE S50811",2024040,"CDM ",301,RC,80345,HCPCS,OUTPATIENT,,,208.5,166.8,,16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",145.95,70,,116.76,,,0,"percent of total billed charges ","70% of total billed charges ",187.65,90,,150.12,,,0,"percent of total billed charges ","90% of total billed charges ",193.91,93,,155.13,,,0,"percent of total billed charges ","93% of total billed charges ",16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",177.23,85,,141.78,,,0,"percent of total billed charges ","85% of total billed charges ",187.65,90,,150.12,,,0,"percent of total billed charges ","90% of total billed charges ",187.65,90,,150.12,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",181.4,87,,145.12,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",145.95,70,,116.76,,,0,"percent of total billed charges ","70% of total billed charges ",16.38,193.91,
"CORTISONE  #540845",2024050,"CDM ",301,RC,83789,HCPCS,OUTPATIENT,,,581.5,465.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",407.05,70,,325.64,,,0,"percent of total billed charges ","70% of total billed charges ",523.35,90,,418.68,,,0,"percent of total billed charges ","90% of total billed charges ",540.8,93,,432.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",494.28,85,,395.42,,,0,"percent of total billed charges ","85% of total billed charges ",523.35,90,,418.68,,,0,"percent of total billed charges ","90% of total billed charges ",523.35,90,,418.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",505.91,87,,404.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",24.11,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",407.05,70,,325.64,,,0,"percent of total billed charges ","70% of total billed charges ",24.11,540.8,
"ZIPRASIDONE (GEODAN) LEVEL",2024060,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,448,358.4,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",313.6,70,,250.88,,,0,"percent of total billed charges ","70% of total billed charges ",403.2,90,,322.56,,,0,"percent of total billed charges ","90% of total billed charges ",416.64,93,,333.31,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",380.8,85,,304.64,,,0,"percent of total billed charges ","85% of total billed charges ",403.2,90,,322.56,,,0,"percent of total billed charges ","90% of total billed charges ",403.2,90,,322.56,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",389.76,87,,311.81,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",313.6,70,,250.88,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,416.64,
"DRUG SCR NON-DOT URINE-AFT HRS",2024080,"CDM ",300,RC,80307,HCPCS,OUTPATIENT,,,74.5,59.6,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",69.29,93,,55.43,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",63.33,85,,50.66,,,0,"percent of total billed charges ","85% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.82,87,,51.86,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",52.15,80.98,
"CYCLIC CITRUL PEPTIDE AB (CCP)",2024100,"CDM ",300,RC,86200,HCPCS,OUTPATIENT,,,395,316,,12.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,33.25,33.25,33.25,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",276.5,70,,221.20,,,0,"percent of total billed charges ","70% of total billed charges ",355.5,90,,284.40,,,0,"percent of total billed charges ","90% of total billed charges ",367.35,93,,293.88,,,0,"percent of total billed charges ","93% of total billed charges ",12.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",335.75,85,,268.60,,,0,"percent of total billed charges ","85% of total billed charges ",355.5,90,,284.40,,,0,"percent of total billed charges ","90% of total billed charges ",355.5,90,,284.40,,,0,"percent of total billed charges ","90% of total billed charges ",20.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",343.65,87,,274.92,,,0,"percent of total billed charges ","87% of total billed charges ",20.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.95,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",276.5,70,,221.20,,,0,"percent of total billed charges ","70% of total billed charges ",12.95,367.35,
"TRICYCLICS CONF, SERUM #S46565",2024200,"CDM ",301,RC,80307,HCPCS,OUTPATIENT,,,438.5,350.8,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",306.95,70,,245.56,,,0,"percent of total billed charges ","70% of total billed charges ",394.65,90,,315.72,,,0,"percent of total billed charges ","90% of total billed charges ",407.81,93,,326.25,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",372.73,85,,298.18,,,0,"percent of total billed charges ","85% of total billed charges ",394.65,90,,315.72,,,0,"percent of total billed charges ","90% of total billed charges ",394.65,90,,315.72,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",381.5,87,,305.20,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",306.95,70,,245.56,,,0,"percent of total billed charges ","70% of total billed charges ",62.14,407.81,
"ALDOSTERONE, URINE  #3104UR",2024210,"CDM ",301,RC,82088,HCPCS,OUTPATIENT,,,273,218.4,,34.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",191.1,70,,152.88,,,0,"percent of total billed charges ","70% of total billed charges ",245.7,90,,196.56,,,0,"percent of total billed charges ","90% of total billed charges ",253.89,93,,203.11,,,0,"percent of total billed charges ","93% of total billed charges ",34.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.58,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",232.05,85,,185.64,,,0,"percent of total billed charges ","85% of total billed charges ",245.7,90,,196.56,,,0,"percent of total billed charges ","90% of total billed charges ",245.7,90,,196.56,,,0,"percent of total billed charges ","90% of total billed charges ",40.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",237.51,87,,190.01,,,0,"percent of total billed charges ","87% of total billed charges ",40.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.75,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",191.1,70,,152.88,,,0,"percent of total billed charges ","70% of total billed charges ",34.64,253.89,
"ORGANIC ACID, URINE #S49589",2024230,"CDM ",301,RC,83918,HCPCS,OUTPATIENT,,,787,629.6,,20.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",550.9,70,,440.72,,,0,"percent of total billed charges ","70% of total billed charges ",708.3,90,,566.64,,,0,"percent of total billed charges ","90% of total billed charges ",731.91,93,,585.53,,,0,"percent of total billed charges ","93% of total billed charges ",20.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.55,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",668.95,85,,535.16,,,0,"percent of total billed charges ","85% of total billed charges ",708.3,90,,566.64,,,0,"percent of total billed charges ","90% of total billed charges ",708.3,90,,566.64,,,0,"percent of total billed charges ","90% of total billed charges ",25.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",684.69,87,,547.75,,,0,"percent of total billed charges ","87% of total billed charges ",25.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.6,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",550.9,70,,440.72,,,0,"percent of total billed charges ","70% of total billed charges ",20.06,731.91,
"IGA FIBRONECTIN #S49839",2024240,"CDM ",301,RC,83516,HCPCS,OUTPATIENT,,,632.5,506,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",442.75,70,,354.20,,,0,"percent of total billed charges ","70% of total billed charges ",569.25,90,,455.40,,,0,"percent of total billed charges ","90% of total billed charges ",588.23,93,,470.58,,,0,"percent of total billed charges ","93% of total billed charges ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",537.63,85,,430.10,,,0,"percent of total billed charges ","85% of total billed charges ",569.25,90,,455.40,,,0,"percent of total billed charges ","90% of total billed charges ",569.25,90,,455.40,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",550.28,87,,53.32,28.74,77.90,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",442.75,70,,354.20,,,0,"percent of total billed charges ","70% of total billed charges ",10,588.23,
"ANTIGEN SCREENING DONOR",2024250,"CDM ",300,RC,86902,HCPCS,OUTPATIENT,,,183,146.4,,5.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.1,70,,102.48,,,0,"percent of total billed charges ","70% of total billed charges ",164.7,90,,131.76,,,0,"percent of total billed charges ","90% of total billed charges ",170.19,93,,136.15,,,0,"percent of total billed charges ","93% of total billed charges ",5.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",155.55,85,,124.44,,,0,"percent of total billed charges ","85% of total billed charges ",164.7,90,,131.76,,,0,"percent of total billed charges ","90% of total billed charges ",164.7,90,,131.76,,,0,"percent of total billed charges ","90% of total billed charges ",5.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",159.21,87,,127.37,,,0,"percent of total billed charges ","87% of total billed charges ",5.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",128.1,70,,102.48,,,0,"percent of total billed charges ","70% of total billed charges ",5.4,329.64,
"FRESH FROZEN PLASMA THAWING",2024260,"CDM ",300,RC,86927,HCPCS,OUTPATIENT,,,38,30.4,,129.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.6,70,,21.28,,,0,"percent of total billed charges ","70% of total billed charges ",34.2,90,,27.36,,,0,"percent of total billed charges ","90% of total billed charges ",35.34,93,,28.27,,,0,"percent of total billed charges ","93% of total billed charges ",129.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",32.3,85,,25.84,,,0,"percent of total billed charges ","85% of total billed charges ",34.2,90,,27.36,,,0,"percent of total billed charges ","90% of total billed charges ",34.2,90,,27.36,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.06,87,,26.45,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",26.6,70,,21.28,,,0,"percent of total billed charges ","70% of total billed charges ",26.17,156.68,
"DSUI CONFIRMATION FOR THC",2024280,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,367,293.6,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",256.9,70,,205.52,,,0,"percent of total billed charges ","70% of total billed charges ",330.3,90,,264.24,,,0,"percent of total billed charges ","90% of total billed charges ",341.31,93,,273.05,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",311.95,85,,249.56,,,0,"percent of total billed charges ","85% of total billed charges ",330.3,90,,264.24,,,0,"percent of total billed charges ","90% of total billed charges ",330.3,90,,264.24,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",319.29,87,,255.43,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",256.9,70,,205.52,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,341.31,
"JAK 2 V617F MUTATION QUANT",2024290,"CDM ",300,RC,81270,HCPCS,OUTPATIENT,,,1337,1069.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",935.9,70,,748.72,,,0,"percent of total billed charges ","70% of total billed charges ",1203.3,90,,962.64,,,0,"percent of total billed charges ","90% of total billed charges ",1243.41,93,,994.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1136.45,85,,909.16,,,0,"percent of total billed charges ","85% of total billed charges ",1203.3,90,,962.64,,,0,"percent of total billed charges ","90% of total billed charges ",1203.3,90,,962.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1163.19,87,,930.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",91.66,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",935.9,70,,748.72,,,0,"percent of total billed charges ","70% of total billed charges ",91.66,1243.41,
"*BLOOD CELLS NEOPLASTIC DISORD",2024360,"CDM ",300,RC,88237,HCPCS,OUTPATIENT,,,477,381.6,,122.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",333.9,70,,267.12,,,0,"percent of total billed charges ","70% of total billed charges ",429.3,90,,343.44,,,0,"percent of total billed charges ","90% of total billed charges ",443.61,93,,354.89,,,0,"percent of total billed charges ","93% of total billed charges ",122.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",405.45,85,,324.36,,,0,"percent of total billed charges ","85% of total billed charges ",429.3,90,,343.44,,,0,"percent of total billed charges ","90% of total billed charges ",429.3,90,,343.44,,,0,"percent of total billed charges ","90% of total billed charges ",34.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",414.99,87,,331.99,,,0,"percent of total billed charges ","87% of total billed charges ",34.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.75,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",333.9,70,,267.12,,,0,"percent of total billed charges ","70% of total billed charges ",34.88,443.61,
"*MOLECULAR CYTOGENETICS",2024370,"CDM ",300,RC,88271,HCPCS,OUTPATIENT,,,348,278.4,,21.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",243.6,70,,194.88,,,0,"percent of total billed charges ","70% of total billed charges ",313.2,90,,250.56,,,0,"percent of total billed charges ","90% of total billed charges ",323.64,93,,258.91,,,0,"percent of total billed charges ","93% of total billed charges ",21.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",295.8,85,,236.64,,,0,"percent of total billed charges ","85% of total billed charges ",313.2,90,,250.56,,,0,"percent of total billed charges ","90% of total billed charges ",313.2,90,,250.56,,,0,"percent of total billed charges ","90% of total billed charges ",33.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",302.76,87,,242.21,,,0,"percent of total billed charges ","87% of total billed charges ",33.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.42,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",243.6,70,,194.88,,,0,"percent of total billed charges ","70% of total billed charges ",21.42,323.64,
"*MOLECULAR CYTOGENETIC FISH",2024380,"CDM ",300,RC,88271,HCPCS,OUTPATIENT,,,362,289.6,,21.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",253.4,70,,202.72,,,0,"percent of total billed charges ","70% of total billed charges ",325.8,90,,260.64,,,0,"percent of total billed charges ","90% of total billed charges ",336.66,93,,269.33,,,0,"percent of total billed charges ","93% of total billed charges ",21.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",307.7,85,,246.16,,,0,"percent of total billed charges ","85% of total billed charges ",325.8,90,,260.64,,,0,"percent of total billed charges ","90% of total billed charges ",325.8,90,,260.64,,,0,"percent of total billed charges ","90% of total billed charges ",33.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",314.94,87,,251.95,,,0,"percent of total billed charges ","87% of total billed charges ",33.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.42,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",253.4,70,,202.72,,,0,"percent of total billed charges ","70% of total billed charges ",21.42,336.66,
"*IN SITU HYBRIDIZATION",2024390,"CDM ",300,RC,88275,HCPCS,OUTPATIENT,,,371.5,297.2,,47.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",260.05,70,,208.04,,,0,"percent of total billed charges ","70% of total billed charges ",334.35,90,,267.48,,,0,"percent of total billed charges ","90% of total billed charges ",345.5,93,,276.40,,,0,"percent of total billed charges ","93% of total billed charges ",47.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.02,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",315.78,85,,252.62,,,0,"percent of total billed charges ","85% of total billed charges ",334.35,90,,267.48,,,0,"percent of total billed charges ","90% of total billed charges ",334.35,90,,267.48,,,0,"percent of total billed charges ","90% of total billed charges ",62.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",323.21,87,,258.57,,,0,"percent of total billed charges ","87% of total billed charges ",62.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",51.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",260.05,70,,208.04,,,0,"percent of total billed charges ","70% of total billed charges ",47.69,345.5,
"ZIPRASIDONE (GEODON) #S49651",2024410,"CDM ",300,RC,80299,HCPCS,OUTPATIENT,,,428.5,342.8,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.95,70,,239.96,,,0,"percent of total billed charges ","70% of total billed charges ",385.65,90,,308.52,,,0,"percent of total billed charges ","90% of total billed charges ",398.51,93,,318.81,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",364.23,85,,291.38,,,0,"percent of total billed charges ","85% of total billed charges ",385.65,90,,308.52,,,0,"percent of total billed charges ","90% of total billed charges ",385.65,90,,308.52,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",372.8,87,,298.24,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",299.95,70,,239.96,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,398.51,
"BENZTROPINE (COGENTIN) #S49693",2024420,"CDM ",300,RC,80299,HCPCS,OUTPATIENT,,,315.5,252.4,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.85,70,,176.68,,,0,"percent of total billed charges ","70% of total billed charges ",283.95,90,,227.16,,,0,"percent of total billed charges ","90% of total billed charges ",293.42,93,,234.74,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",268.18,85,,214.54,,,0,"percent of total billed charges ","85% of total billed charges ",283.95,90,,227.16,,,0,"percent of total billed charges ","90% of total billed charges ",283.95,90,,227.16,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",274.49,87,,219.59,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",220.85,70,,176.68,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,293.42,
"OLANZAPINE (ZYPREXA) #4933",2024430,"CDM ",300,RC,80299,HCPCS,OUTPATIENT,,,264.5,211.6,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",185.15,70,,148.12,,,0,"percent of total billed charges ","70% of total billed charges ",238.05,90,,190.44,,,0,"percent of total billed charges ","90% of total billed charges ",245.99,93,,196.79,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",224.83,85,,179.86,,,0,"percent of total billed charges ","85% of total billed charges ",238.05,90,,190.44,,,0,"percent of total billed charges ","90% of total billed charges ",238.05,90,,190.44,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",230.12,87,,184.10,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",185.15,70,,148.12,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,245.99,
*CODEINE,2024490,"CDM ",301,RC,80361,HCPCS,OUTPATIENT,,,98.5,78.8,,10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,38.30,38.30,38.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.4,91.61,
*ETHYLMORPHINE,2024500,"CDM ",301,RC,80361,HCPCS,OUTPATIENT,,,98.5,78.8,,10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,38.30,38.30,38.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.4,91.61,
*HYDROMORPHOME,2024510,"CDM ",301,RC,80361,HCPCS,OUTPATIENT,,,98.5,78.8,,10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,38.30,38.30,38.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.4,91.61,
*MORPHINE,2024520,"CDM ",301,RC,80361,HCPCS,OUTPATIENT,,,98.5,78.8,,10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,38.30,38.30,38.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.4,91.61,
*NORCODEINE,2024530,"CDM ",301,RC,80361,HCPCS,OUTPATIENT,,,98.5,78.8,,10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,38.30,38.30,38.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.4,91.61,
*NORMORPHINE,2024540,"CDM ",301,RC,80361,HCPCS,OUTPATIENT,,,98.5,78.8,,10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,38.30,38.30,38.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.4,91.61,
*DIHYDROCODEINE,2024550,"CDM ",301,RC,80361,HCPCS,OUTPATIENT,,,98.5,78.8,,10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,38.30,38.30,38.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.4,91.61,
*HYDROCODONE,2024560,"CDM ",301,RC,80361,HCPCS,OUTPATIENT,,,98.5,78.8,,10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,38.30,38.30,38.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.4,91.61,
*OXYCODONE,2024570,"CDM ",301,RC,80361,HCPCS,OUTPATIENT,,,98.5,78.8,,10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,38.30,38.30,38.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.4,91.61,
"*THYROGLOBULIN ACUTE ANTIBODY",2024590,"CDM ",302,RC,86376,HCPCS,OUTPATIENT,,,140.5,112.4,,14.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.97,60.97,60.97,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",130.67,93,,104.54,,,0,"percent of total billed charges ","93% of total billed charges ",14.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",119.43,85,,95.54,,,0,"percent of total billed charges ","85% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.24,87,,55.52,12.39,96.11,"1 through 10","percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.55,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",14.55,130.67,
"*THYROID PEROXIDE AUTOANTIBODY",2024600,"CDM ",302,RC,86800,HCPCS,OUTPATIENT,,,194,155.2,,15.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,82.69,82.69,82.69,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",180.42,93,,144.34,,,0,"percent of total billed charges ","93% of total billed charges ",15.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.9,85,,131.92,,,0,"percent of total billed charges ","85% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",28.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",168.78,87,,15.60,15.60,63.84,"1 through 10","percent of total billed charges ","87% of total billed charges ",28.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.91,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",15.91,180.42,
*AMOBARBITAL,2024620,"CDM ",301,RC,80345,HCPCS,OUTPATIENT,,,98.5,78.8,,16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",16.38,91.61,
*BUTALBITAL,2024630,"CDM ",301,RC,80345,HCPCS,OUTPATIENT,,,98.5,78.8,,16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",16.38,91.61,
*BUTABARBITAL,2024640,"CDM ",301,RC,80345,HCPCS,OUTPATIENT,,,98.5,78.8,,16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",16.38,91.61,
*PHENOBARBITAL,2024650,"CDM ",301,RC,80345,HCPCS,OUTPATIENT,,,98.5,78.8,,16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",16.38,91.61,
*SEROBARBITAL,2024660,"CDM ",301,RC,80345,HCPCS,OUTPATIENT,,,98.5,78.8,,16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",16.38,91.61,
*PENTOBARBITAL,2024670,"CDM ",301,RC,80345,HCPCS,OUTPATIENT,,,98.5,78.8,,16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",16.38,91.61,
*MEPHOBARBITAL,2024680,"CDM ",301,RC,80345,HCPCS,OUTPATIENT,,,98.5,78.8,,16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",16.38,91.61,
*AMPHETAMINE,2024700,"CDM ",301,RC,80324,HCPCS,OUTPATIENT,,,73.5,58.8,,10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.48,68.36,
*METHAMPHETAMINE,2024710,"CDM ",301,RC,80324,HCPCS,OUTPATIENT,,,73.5,58.8,,10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.48,68.36,
*EPHEDRINE/PSEUDOEPHEDRINE,2024720,"CDM ",301,RC,80324,HCPCS,OUTPATIENT,,,73.5,58.8,,10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.48,68.36,
*PPA,2024730,"CDM ",301,RC,80324,HCPCS,OUTPATIENT,,,73.5,58.8,,10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.48,68.36,
*PHENTERMINE,2024740,"CDM ",301,RC,80324,HCPCS,OUTPATIENT,,,73.5,58.8,,10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.48,68.36,
*CHLOROAMPHETAMINE,2024750,"CDM ",301,RC,80324,HCPCS,OUTPATIENT,,,73.5,58.8,,10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.48,68.36,
*PHENMETRAZINE,2024760,"CDM ",301,RC,80324,HCPCS,OUTPATIENT,,,73.5,58.8,,10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.48,68.36,
*PHENDIMETRAZINE,2024770,"CDM ",301,RC,80324,HCPCS,OUTPATIENT,,,73.5,58.8,,10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.48,68.36,
*BENZPHETAMINE,2024780,"CDM ",301,RC,80324,HCPCS,OUTPATIENT,,,73.5,58.8,,10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.48,68.36,
*METHAMPHENTAMINE,2024790,"CDM ",301,RC,80324,HCPCS,OUTPATIENT,,,73.5,58.8,,10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.48,68.36,
*MDA,2024800,"CDM ",301,RC,80324,HCPCS,OUTPATIENT,,,73.5,58.8,,10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.48,68.36,
*MDMA,2024810,"CDM ",301,RC,80324,HCPCS,OUTPATIENT,,,73.5,58.8,,10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.48,68.36,
*MDEA,2024820,"CDM ",301,RC,80324,HCPCS,OUTPATIENT,,,73.5,58.8,,10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.48,68.36,
IGF-BP3,2024830,"CDM ",301,RC,83519,HCPCS,OUTPATIENT,,,105.5,84.4,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.85,70,,59.08,,,0,"percent of total billed charges ","70% of total billed charges ",94.95,90,,75.96,,,0,"percent of total billed charges ","90% of total billed charges ",98.12,93,,78.50,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",89.68,85,,71.74,,,0,"percent of total billed charges ","85% of total billed charges ",94.95,90,,75.96,,,0,"percent of total billed charges ","90% of total billed charges ",94.95,90,,75.96,,,0,"percent of total billed charges ","90% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",91.79,87,,73.43,,,0,"percent of total billed charges ","87% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",73.85,70,,59.08,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,98.12,
"ARIPIPRAZOLE (ABILIFY) #S50550",2024840,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,576.5,461.2,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",403.55,70,,322.84,,,0,"percent of total billed charges ","70% of total billed charges ",518.85,90,,415.08,,,0,"percent of total billed charges ","90% of total billed charges ",536.15,93,,428.92,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",490.03,85,,392.02,,,0,"percent of total billed charges ","85% of total billed charges ",518.85,90,,415.08,,,0,"percent of total billed charges ","90% of total billed charges ",518.85,90,,415.08,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",501.56,87,,401.25,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",403.55,70,,322.84,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,536.15,
"THROMBIN TIME #4210",2024850,"CDM ",305,RC,85670,HCPCS,OUTPATIENT,,,97.5,78,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.25,70,,54.60,,,0,"percent of total billed charges ","70% of total billed charges ",87.75,90,,70.20,,,0,"percent of total billed charges ","90% of total billed charges ",90.68,93,,72.54,,,0,"percent of total billed charges ","93% of total billed charges ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",82.88,85,,66.30,,,0,"percent of total billed charges ","85% of total billed charges ",87.75,90,,70.20,,,0,"percent of total billed charges ","90% of total billed charges ",87.75,90,,70.20,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.83,87,,67.86,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.77,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.25,70,,54.60,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,90.68,
"NIACIN LEVEL #S41930",2024860,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,139,111.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.3,70,,77.84,,,0,"percent of total billed charges ","70% of total billed charges ",125.1,90,,100.08,,,0,"percent of total billed charges ","90% of total billed charges ",129.27,93,,103.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",118.15,85,,94.52,,,0,"percent of total billed charges ","85% of total billed charges ",125.1,90,,100.08,,,0,"percent of total billed charges ","90% of total billed charges ",125.1,90,,100.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",120.93,87,,96.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",97.3,70,,77.84,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,129.27,
"NIACIN #S51032",2024870,"CDM ",301,RC,84591,HCPCS,OUTPATIENT,,,228,182.4,,14.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",159.6,70,,127.68,,,0,"percent of total billed charges ","70% of total billed charges ",205.2,90,,164.16,,,0,"percent of total billed charges ","90% of total billed charges ",212.04,93,,169.63,,,0,"percent of total billed charges ","93% of total billed charges ",14.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",193.8,85,,155.04,,,0,"percent of total billed charges ","85% of total billed charges ",205.2,90,,164.16,,,0,"percent of total billed charges ","90% of total billed charges ",205.2,90,,164.16,,,0,"percent of total billed charges ","90% of total billed charges ",17.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.36,87,,158.69,,,0,"percent of total billed charges ","87% of total billed charges ",17.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",159.6,70,,127.68,,,0,"percent of total billed charges ","70% of total billed charges ",14.5,212.04,
"OVA & PARASITE: WORM ID  #2368",2024880,"CDM ",306,RC,87169,HCPCS,OUTPATIENT,,,184,147.2,,4.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.8,70,,103.04,,,0,"percent of total billed charges ","70% of total billed charges ",165.6,90,,132.48,,,0,"percent of total billed charges ","90% of total billed charges ",171.12,93,,136.90,,,0,"percent of total billed charges ","93% of total billed charges ",4.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",156.4,85,,125.12,,,0,"percent of total billed charges ","85% of total billed charges ",165.6,90,,132.48,,,0,"percent of total billed charges ","90% of total billed charges ",165.6,90,,132.48,,,0,"percent of total billed charges ","90% of total billed charges ",6.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",160.08,87,,128.06,,,0,"percent of total billed charges ","87% of total billed charges ",6.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",128.8,70,,103.04,,,0,"percent of total billed charges ","70% of total billed charges ",4.3,171.12,
"BK(POLYOMAVIRUS) DNA UQ #8149",2024890,"CDM ",306,RC,87799,HCPCS,OUTPATIENT,,,1817,1453.6,,36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,301.18,301.18,301.18,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1271.9,70,,1017.52,,,0,"percent of total billed charges ","70% of total billed charges ",1635.3,90,,1308.24,,,0,"percent of total billed charges ","90% of total billed charges ",1689.81,93,,1351.85,,,0,"percent of total billed charges ","93% of total billed charges ",36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1544.45,85,,1235.56,,,0,"percent of total billed charges ","85% of total billed charges ",1635.3,90,,1308.24,,,0,"percent of total billed charges ","90% of total billed charges ",1635.3,90,,1308.24,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1580.79,87,,765.89,765.89,765.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.84,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1271.9,70,,1017.52,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,1689.81,
"CMV DNA QUANT PCR-BLOOD",2024900,"CDM ",306,RC,87497,HCPCS,OUTPATIENT,,,261.5,209.2,,36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",243.2,93,,194.56,,,0,"percent of total billed charges ","93% of total billed charges ",36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",222.28,85,,177.82,,,0,"percent of total billed charges ","85% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",227.51,87,,182.01,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.84,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,243.2,
"CENTROMERE #1109",2024910,"CDM ",302,RC,86255,HCPCS,OUTPATIENT,,,146,116.8,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,101.62,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,135.78,
"RISPERIDONE #4141",2024920,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,294,235.2,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",205.8,70,,164.64,,,0,"percent of total billed charges ","70% of total billed charges ",264.6,90,,211.68,,,0,"percent of total billed charges ","90% of total billed charges ",273.42,93,,218.74,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",249.9,85,,199.92,,,0,"percent of total billed charges ","85% of total billed charges ",264.6,90,,211.68,,,0,"percent of total billed charges ","90% of total billed charges ",264.6,90,,211.68,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",255.78,87,,204.62,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",205.8,70,,164.64,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,273.42,
"YERSINIA CULTURE #5702",2024930,"CDM ",306,RC,87081,HCPCS,OUTPATIENT,,,119.5,95.6,,6.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",111.14,93,,88.91,,,0,"percent of total billed charges ","93% of total billed charges ",6.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",101.58,85,,81.26,,,0,"percent of total billed charges ","85% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",103.97,87,,156.45,156.45,156.45,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.63,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.63,111.14,
"D5 DNA AUTOANTIBODIED",2024960,"CDM ",302,RC,86160,HCPCS,OUTPATIENT,,,165,132,,12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,133.30,133.30,133.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,226.71,226.71,226.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",12,153.45,
"C3 COMPLEMENT",2024970,"CDM ",302,RC,86160,HCPCS,OUTPATIENT,,,165,132,,12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,133.30,133.30,133.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,226.71,226.71,226.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",12,153.45,
"C4 COMPLEMENT",2024980,"CDM ",302,RC,86225,HCPCS,OUTPATIENT,,,169,135.2,,13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,72.72,72.72,72.72,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",157.17,93,,125.74,,,0,"percent of total billed charges ","93% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.65,85,,114.92,,,0,"percent of total billed charges ","85% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",24.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.03,87,,115.94,115.94,115.94,"1 through 10","percent of total billed charges ","87% of total billed charges ",24.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",13.74,157.17,
"VIT D 1,25-DIHYDROXY #3523",2024990,"CDM ",301,RC,82652,HCPCS,OUTPATIENT,,,191.5,153.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",134.05,70,,107.24,,,0,"percent of total billed charges ","70% of total billed charges ",172.35,90,,137.88,,,0,"percent of total billed charges ","90% of total billed charges ",178.1,93,,142.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",162.78,85,,130.22,,,0,"percent of total billed charges ","85% of total billed charges ",172.35,90,,137.88,,,0,"percent of total billed charges ","90% of total billed charges ",172.35,90,,137.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",166.61,87,,133.29,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",38.5,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",134.05,70,,107.24,,,0,"percent of total billed charges ","70% of total billed charges ",38.5,178.1,
"QUANTIFERON TB GOLD",2025000,"CDM ",302,RC,86480,HCPCS,OUTPATIENT,,,243.5,194.8,,61.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,159.20,159.20,159.20,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.45,70,,136.36,,,0,"percent of total billed charges ","70% of total billed charges ",219.15,90,,175.32,,,0,"percent of total billed charges ","90% of total billed charges ",226.46,93,,181.17,,,0,"percent of total billed charges ","93% of total billed charges ",61.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",97.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",206.98,85,,165.58,,,0,"percent of total billed charges ","85% of total billed charges ",219.15,90,,175.32,,,0,"percent of total billed charges ","90% of total billed charges ",219.15,90,,175.32,,,0,"percent of total billed charges ","90% of total billed charges ",96.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",211.85,87,,205.98,103.19,308.76,"1 through 10","percent of total billed charges ","87% of total billed charges ",96.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",61.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",170.45,70,,136.36,,,0,"percent of total billed charges ","70% of total billed charges ",61.98,226.46,
"THALLIUM SERUM",2025010,"CDM ",301,RC,83018,HCPCS,OUTPATIENT,,,193,154.4,,19.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.1,70,,108.08,,,0,"percent of total billed charges ","70% of total billed charges ",173.7,90,,138.96,,,0,"percent of total billed charges ","90% of total billed charges ",179.49,93,,143.59,,,0,"percent of total billed charges ","93% of total billed charges ",19.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.37,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.05,85,,131.24,,,0,"percent of total billed charges ","85% of total billed charges ",173.7,90,,138.96,,,0,"percent of total billed charges ","90% of total billed charges ",173.7,90,,138.96,,,0,"percent of total billed charges ","90% of total billed charges ",25.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",167.91,87,,134.33,,,0,"percent of total billed charges ","87% of total billed charges ",25.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.96,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",135.1,70,,108.08,,,0,"percent of total billed charges ","70% of total billed charges ",19.2,179.49,
"MAGNESIUM URINE RANDOM #4866UR",2025020,"CDM ",301,RC,83735,HCPCS,OUTPATIENT,,,56.5,45.2,,6.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.55,70,,31.64,,,0,"percent of total billed charges ","70% of total billed charges ",50.85,90,,40.68,,,0,"percent of total billed charges ","90% of total billed charges ",52.55,93,,42.04,,,0,"percent of total billed charges ","93% of total billed charges ",6.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",48.03,85,,38.42,,,0,"percent of total billed charges ","85% of total billed charges ",50.85,90,,40.68,,,0,"percent of total billed charges ","90% of total billed charges ",50.85,90,,40.68,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",49.16,87,,46.55,6.57,58.19,15,"percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.7,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",39.55,70,,31.64,,,0,"percent of total billed charges ","70% of total billed charges ",6.7,52.55,
"*NEPHELOMETRY, EA ANALYTE",2025050,"CDM ",301,RC,83883,HCPCS,OUTPATIENT,,,446.5,357.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",312.55,70,,250.04,,,0,"percent of total billed charges ","70% of total billed charges ",401.85,90,,321.48,,,0,"percent of total billed charges ","90% of total billed charges ",415.25,93,,332.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",379.53,85,,303.62,,,0,"percent of total billed charges ","85% of total billed charges ",401.85,90,,321.48,,,0,"percent of total billed charges ","90% of total billed charges ",401.85,90,,321.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",388.46,87,,310.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",13.6,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",312.55,70,,250.04,,,0,"percent of total billed charges ","70% of total billed charges ",13.6,415.25,
"*ACHR BINDING AUTOANTIBODIES",2025070,"CDM ",301,RC,83519,HCPCS,OUTPATIENT,,,251,200.8,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",175.7,70,,140.56,,,0,"percent of total billed charges ","70% of total billed charges ",225.9,90,,180.72,,,0,"percent of total billed charges ","90% of total billed charges ",233.43,93,,186.74,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",213.35,85,,170.68,,,0,"percent of total billed charges ","85% of total billed charges ",225.9,90,,180.72,,,0,"percent of total billed charges ","90% of total billed charges ",225.9,90,,180.72,,,0,"percent of total billed charges ","90% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",218.37,87,,174.70,,,0,"percent of total billed charges ","87% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",175.7,70,,140.56,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,233.43,
"*ACHR BLOCKING AUTOANTIBODIES",2025080,"CDM ",301,RC,83519,HCPCS,OUTPATIENT,,,251,200.8,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",175.7,70,,140.56,,,0,"percent of total billed charges ","70% of total billed charges ",225.9,90,,180.72,,,0,"percent of total billed charges ","90% of total billed charges ",233.43,93,,186.74,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",213.35,85,,170.68,,,0,"percent of total billed charges ","85% of total billed charges ",225.9,90,,180.72,,,0,"percent of total billed charges ","90% of total billed charges ",225.9,90,,180.72,,,0,"percent of total billed charges ","90% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",218.37,87,,174.70,,,0,"percent of total billed charges ","87% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",175.7,70,,140.56,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,233.43,
"*ACHR MODULATING AUTOANTIBODIE",2025090,"CDM ",301,RC,83519,HCPCS,OUTPATIENT,,,251,200.8,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",175.7,70,,140.56,,,0,"percent of total billed charges ","70% of total billed charges ",225.9,90,,180.72,,,0,"percent of total billed charges ","90% of total billed charges ",233.43,93,,186.74,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",213.35,85,,170.68,,,0,"percent of total billed charges ","85% of total billed charges ",225.9,90,,180.72,,,0,"percent of total billed charges ","90% of total billed charges ",225.9,90,,180.72,,,0,"percent of total billed charges ","90% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",218.37,87,,174.70,,,0,"percent of total billed charges ","87% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",175.7,70,,140.56,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,233.43,
"ACETYLOCHOLINE RECPTOR ALPHA3",2025105,"CDM ",301,RC,83519,HCPCS,OUTPATIENT,,,155.5,124.4,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.85,70,,87.08,,,0,"percent of total billed charges ","70% of total billed charges ",139.95,90,,111.96,,,0,"percent of total billed charges ","90% of total billed charges ",144.62,93,,115.70,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",132.18,85,,105.74,,,0,"percent of total billed charges ","85% of total billed charges ",139.95,90,,111.96,,,0,"percent of total billed charges ","90% of total billed charges ",139.95,90,,111.96,,,0,"percent of total billed charges ","90% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",135.29,87,,108.23,,,0,"percent of total billed charges ","87% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",108.85,70,,87.08,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,144.62,
"CHROMATIN IGG ABS #1140",2025110,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,126.5,101.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.55,70,,70.84,,,0,"percent of total billed charges ","70% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",117.65,93,,94.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",107.53,85,,86.02,,,0,"percent of total billed charges ","85% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",110.06,87,,88.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",88.55,70,,70.84,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,117.65,
"SM (SMITH) IGG ABS #1220",2025120,"CDM ",300,RC,86235,HCPCS,OUTPATIENT,,,149.5,119.6,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",139.04,93,,111.23,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",127.08,85,,101.66,,,0,"percent of total billed charges ","85% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.07,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,139.04,
"NRNP/SM IGG ABS #1215",2025130,"CDM ",300,RC,86235,HCPCS,OUTPATIENT,,,149.5,119.6,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",139.04,93,,111.23,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",127.08,85,,101.66,,,0,"percent of total billed charges ","85% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.07,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,139.04,
"*C3 OR C4 COMPLEMENT",2025190,"CDM ",302,RC,86160,HCPCS,OUTPATIENT,,,165,132,,12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,133.30,133.30,133.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,226.71,226.71,226.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",12,153.45,
"*DSDNA AUTOABS",2025200,"CDM ",302,RC,86225,HCPCS,OUTPATIENT,,,169,135.2,,13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,72.72,72.72,72.72,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",157.17,93,,125.74,,,0,"percent of total billed charges ","93% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.65,85,,114.92,,,0,"percent of total billed charges ","85% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",24.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.03,87,,115.94,115.94,115.94,"1 through 10","percent of total billed charges ","87% of total billed charges ",24.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",13.74,157.17,
"PROTHROMBIN FACTOR II MUTATION",2025210,"CDM ",300,RC,81240,HCPCS,OUTPATIENT,,,747,597.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",522.9,70,,418.32,,,0,"percent of total billed charges ","70% of total billed charges ",672.3,90,,537.84,,,0,"percent of total billed charges ","90% of total billed charges ",694.71,93,,555.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",634.95,85,,507.96,,,0,"percent of total billed charges ","85% of total billed charges ",672.3,90,,537.84,,,0,"percent of total billed charges ","90% of total billed charges ",672.3,90,,537.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",649.89,87,,519.91,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",65.69,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",522.9,70,,418.32,,,0,"percent of total billed charges ","70% of total billed charges ",65.69,694.71,
"*ANA PATTERN",2025280,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,90,72,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,83.7,
"*ANA ABS",2025290,"CDM ",302,RC,86038,HCPCS,OUTPATIENT,,,129,103.2,,12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",119.97,93,,95.98,,,0,"percent of total billed charges ","93% of total billed charges ",12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",109.65,85,,87.72,,,0,"percent of total billed charges ","85% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.23,87,,88.36,11.85,147.83,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",12.09,119.97,
"*COMPLEMENT AG 1 AND 2",2025300,"CDM ",302,RC,86160,HCPCS,OUTPATIENT,,,165,132,,12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,133.30,133.30,133.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,226.71,226.71,226.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",12,153.45,
"*EXTRACTABLE NUCLEAR ANTIGEN",2025310,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,149.5,119.6,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",139.04,93,,111.23,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",127.08,85,,101.66,,,0,"percent of total billed charges ","85% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.07,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,139.04,
"*DNA ABS",2025320,"CDM ",302,RC,86225,HCPCS,OUTPATIENT,,,169,135.2,,13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,72.72,72.72,72.72,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",157.17,93,,125.74,,,0,"percent of total billed charges ","93% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.65,85,,114.92,,,0,"percent of total billed charges ","85% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",24.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.03,87,,115.94,115.94,115.94,"1 through 10","percent of total billed charges ","87% of total billed charges ",24.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",13.74,157.17,
"*THYROID PEROXIDASE AUTOABS",2025330,"CDM ",302,RC,86376,HCPCS,OUTPATIENT,,,140.5,112.4,,14.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.97,60.97,60.97,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",130.67,93,,104.54,,,0,"percent of total billed charges ","93% of total billed charges ",14.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",119.43,85,,95.54,,,0,"percent of total billed charges ","85% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.24,87,,55.52,12.39,96.11,"1 through 10","percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.55,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",14.55,130.67,
"*C3/C4 COMPLEMENT",2025340,"CDM ",302,RC,86431,HCPCS,OUTPATIENT,,,93,74.4,,5.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,5.56,5.56,5.56,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.1,70,,52.08,,,0,"percent of total billed charges ","70% of total billed charges ",83.7,90,,66.96,,,0,"percent of total billed charges ","90% of total billed charges ",86.49,93,,69.19,,,0,"percent of total billed charges ","93% of total billed charges ",5.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",79.05,85,,63.24,,,0,"percent of total billed charges ","85% of total billed charges ",83.7,90,,66.96,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,90,,66.96,,,0,"percent of total billed charges ","90% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.91,87,,5.56,5.56,56.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",65.1,70,,52.08,,,0,"percent of total billed charges ","70% of total billed charges ",5.67,86.49,
"*CMV IGG ABS",2025360,"CDM ",302,RC,86644,HCPCS,OUTPATIENT,,,204,163.2,,12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,141.98,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,189.72,
"*CMV IGM ABS",2025370,"CDM ",302,RC,86645,HCPCS,OUTPATIENT,,,204,163.2,,14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,141.98,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.85,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,189.72,
"*TOXOPLASMA GANDII IGG ABS",2025390,"CDM ",302,RC,86777,HCPCS,OUTPATIENT,,,191,152.8,,12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.7,70,,106.96,,,0,"percent of total billed charges ","70% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",177.63,93,,142.10,,,0,"percent of total billed charges ","93% of total billed charges ",12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",162.35,85,,129.88,,,0,"percent of total billed charges ","85% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",166.17,87,,132.94,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",133.7,70,,106.96,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,177.63,
"*TOXOPLASMA GANDII IGM ABS",2025400,"CDM ",302,RC,86778,HCPCS,OUTPATIENT,,,152,121.6,,12.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",141.36,93,,113.09,,,0,"percent of total billed charges ","93% of total billed charges ",12.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",129.2,85,,103.36,,,0,"percent of total billed charges ","85% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.24,87,,105.79,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.41,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,141.36,
*ALPHA-FETOPROTEIN,2025420,"CDM ",301,RC,82105,HCPCS,OUTPATIENT,,,120.5,96.4,,14.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.35,70,,67.48,,,0,"percent of total billed charges ","70% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",112.07,93,,89.66,,,0,"percent of total billed charges ","93% of total billed charges ",14.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",102.43,85,,81.94,,,0,"percent of total billed charges ","85% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",104.84,87,,74.83,74.82,74.83,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.77,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",84.35,70,,67.48,,,0,"percent of total billed charges ","70% of total billed charges ",14.25,112.07,
"*BETA-HUMAN CHORIONIC GONADOTR",2025430,"CDM ",301,RC,84702,HCPCS,OUTPATIENT,,,120.5,96.4,,12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.35,70,,67.48,,,0,"percent of total billed charges ","70% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",112.07,93,,89.66,,,0,"percent of total billed charges ","93% of total billed charges ",12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.89,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",102.43,85,,81.94,,,0,"percent of total billed charges ","85% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",11.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",104.84,87,,94.83,84.28,118.53,"1 through 10","percent of total billed charges ","87% of total billed charges ",11.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",84.35,70,,67.48,,,0,"percent of total billed charges ","70% of total billed charges ",11.77,112.07,
"*LAMBDA LIGHT CHAIN URINE",2025450,"CDM ",301,RC,83883,HCPCS,OUTPATIENT,,,112.5,90,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",104.63,93,,83.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",95.63,85,,76.50,,,0,"percent of total billed charges ","85% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",97.88,87,,78.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",13.6,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",13.6,104.63,
"*AMIKACIN PEAK OR TROUGH",2025470,"CDM ",301,RC,80150,HCPCS,OUTPATIENT,,,89,71.2,,12.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",82.77,93,,66.22,,,0,"percent of total billed charges ","93% of total billed charges ",12.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",75.65,85,,60.52,,,0,"percent of total billed charges ","85% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",77.43,87,,61.94,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.08,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",12.82,82.77,
"*TOTAL CK",2025490,"CDM ",301,RC,82550,HCPCS,OUTPATIENT,,,56,44.8,,6.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.2,70,,31.36,,,0,"percent of total billed charges ","70% of total billed charges ",50.4,90,,40.32,,,0,"percent of total billed charges ","90% of total billed charges ",52.08,93,,41.66,,,0,"percent of total billed charges ","93% of total billed charges ",6.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",47.6,85,,38.08,,,0,"percent of total billed charges ","85% of total billed charges ",50.4,90,,40.32,,,0,"percent of total billed charges ","90% of total billed charges ",50.4,90,,40.32,,,0,"percent of total billed charges ","90% of total billed charges ",11.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",48.72,87,,93.87,29.50,104.30,"1 through 10","percent of total billed charges ","87% of total billed charges ",11.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.51,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",39.2,70,,31.36,,,0,"percent of total billed charges ","70% of total billed charges ",6.51,52.08,
"*CK ISOENZYMES",2025500,"CDM ",301,RC,82552,HCPCS,OUTPATIENT,,,104,83.2,,13.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.8,70,,58.24,,,0,"percent of total billed charges ","70% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",96.72,93,,77.38,,,0,"percent of total billed charges ","93% of total billed charges ",13.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",88.4,85,,70.72,,,0,"percent of total billed charges ","85% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",90.48,87,,72.38,,,0,"percent of total billed charges ","87% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",72.8,70,,58.24,,,0,"percent of total billed charges ","70% of total billed charges ",13.39,96.72,
"THYROXINE FREE, DIR DIAL #3954",2025570,"CDM ",301,RC,84439,HCPCS,OUTPATIENT,,,69.5,55.6,,9.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,8.84,8.84,8.84,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.65,70,,38.92,,,0,"percent of total billed charges ","70% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",64.64,93,,51.71,,,0,"percent of total billed charges ","93% of total billed charges ",9.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",59.08,85,,47.26,,,0,"percent of total billed charges ","85% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",15.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60.47,87,,53.23,8.84,106.46,25,"percent of total billed charges ","87% of total billed charges ",15.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.02,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",48.65,70,,38.92,,,0,"percent of total billed charges ","70% of total billed charges ",9.02,64.64,
*DESIPRAMINE,2025590,"CDM ",301,RC,80335,HCPCS,OUTPATIENT,,,122.5,98,,23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",113.93,93,,91.14,,,0,"percent of total billed charges ","93% of total billed charges ",23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.13,85,,83.30,,,0,"percent of total billed charges ","85% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.58,87,,85.26,,,0,"percent of total billed charges ","87% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",23.71,113.93,
*IMIPRAMINE,2025600,"CDM ",301,RC,80335,HCPCS,OUTPATIENT,,,122.5,98,,23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",113.93,93,,91.14,,,0,"percent of total billed charges ","93% of total billed charges ",23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.13,85,,83.30,,,0,"percent of total billed charges ","85% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.58,87,,85.26,,,0,"percent of total billed charges ","87% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",23.71,113.93,
*AMITRIPTYLINE,2025610,"CDM ",301,RC,80335,HCPCS,OUTPATIENT,,,122.5,98,,23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",113.93,93,,91.14,,,0,"percent of total billed charges ","93% of total billed charges ",23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.13,85,,83.30,,,0,"percent of total billed charges ","85% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.58,87,,85.26,,,0,"percent of total billed charges ","87% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",23.71,113.93,
*NORTRIPTYLINE,2025620,"CDM ",301,RC,80335,HCPCS,OUTPATIENT,,,122.5,98,,23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",113.93,93,,91.14,,,0,"percent of total billed charges ","93% of total billed charges ",23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.13,85,,83.30,,,0,"percent of total billed charges ","85% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.58,87,,85.26,,,0,"percent of total billed charges ","87% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",23.71,113.93,
"*DESMETHYLELAMI/CLAMI PRAMINE",2025630,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,168.5,134.8,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",156.71,93,,125.37,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.23,85,,114.58,,,0,"percent of total billed charges ","85% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",146.6,87,,117.28,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,156.71,
"VARICELLA-ZOSTER DNA",2025720,"CDM ",306,RC,87798,HCPCS,OUTPATIENT,,,586,468.8,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",410.2,70,,328.16,,,0,"percent of total billed charges ","70% of total billed charges ",527.4,90,,421.92,,,0,"percent of total billed charges ","90% of total billed charges ",544.98,93,,435.98,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",498.1,85,,398.48,,,0,"percent of total billed charges ","85% of total billed charges ",527.4,90,,421.92,,,0,"percent of total billed charges ","90% of total billed charges ",527.4,90,,421.92,,,0,"percent of total billed charges ","90% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",509.82,87,,407.86,,,0,"percent of total billed charges ","87% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",410.2,70,,328.16,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,544.98,
"CORTISOL FREE 24HR UR #3129U",2025730,"CDM ",301,RC,82530,HCPCS,OUTPATIENT,,,142,113.6,,15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,79.16,79.16,79.16,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.4,70,,79.52,,,0,"percent of total billed charges ","70% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",132.06,93,,105.65,,,0,"percent of total billed charges ","93% of total billed charges ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",120.7,85,,96.56,,,0,"percent of total billed charges ","85% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",123.54,87,,88.27,88.27,88.27,"1 through 10","percent of total billed charges ","87% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.71,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",99.4,70,,79.52,,,0,"percent of total billed charges ","70% of total billed charges ",15,132.06,
"PHENCYCLIDINE CONF #4101U",2025740,"CDM ",301,RC,80307,HCPCS,OUTPATIENT,,,160.5,128.4,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",149.27,93,,119.42,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",136.43,85,,109.14,,,0,"percent of total billed charges ","85% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",139.64,87,,111.71,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",62.14,149.27,
"ACT PROTEIN C RESISTANCE #5900",2025750,"CDM ",305,RC,85307,HCPCS,OUTPATIENT,,,467.5,374,,15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",327.25,70,,261.80,,,0,"percent of total billed charges ","70% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",434.78,93,,347.82,,,0,"percent of total billed charges ","93% of total billed charges ",15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",397.38,85,,317.90,,,0,"percent of total billed charges ","85% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",406.73,87,,325.38,,,0,"percent of total billed charges ","87% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.32,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",327.25,70,,261.80,,,0,"percent of total billed charges ","70% of total billed charges ",15.32,434.78,
"*FACTOR VII AG RATIOS",2025760,"CDM ",305,RC,85230,HCPCS,OUTPATIENT,,,631.5,505.2,,15.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.21,78.21,78.21,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",442.05,70,,353.64,,,0,"percent of total billed charges ","70% of total billed charges ",568.35,90,,454.68,,,0,"percent of total billed charges ","90% of total billed charges ",587.3,93,,469.84,,,0,"percent of total billed charges ","93% of total billed charges ",15.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",536.78,85,,429.42,,,0,"percent of total billed charges ","85% of total billed charges ",568.35,90,,454.68,,,0,"percent of total billed charges ","90% of total billed charges ",568.35,90,,454.68,,,0,"percent of total billed charges ","90% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",549.41,87,,439.53,,,0,"percent of total billed charges ","87% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.89,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",442.05,70,,353.64,,,0,"percent of total billed charges ","70% of total billed charges ",15.22,587.3,
"LUPUS ANTICOAG: DRVVT #1911",2025780,"CDM ",305,RC,85613,HCPCS,OUTPATIENT,,,64,51.2,,8.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.8,70,,35.84,,,0,"percent of total billed charges ","70% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",59.52,93,,47.62,,,0,"percent of total billed charges ","93% of total billed charges ",8.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",54.4,85,,43.52,,,0,"percent of total billed charges ","85% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",55.68,87,,55.59,55.59,55.59,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.58,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",44.8,70,,35.84,,,0,"percent of total billed charges ","70% of total billed charges ",6.87,59.52,
"ACTIVATED PROT C RESIST #5900",2025790,"CDM ",305,RC,85307,HCPCS,OUTPATIENT,,,467.5,374,,15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",327.25,70,,261.80,,,0,"percent of total billed charges ","70% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",434.78,93,,347.82,,,0,"percent of total billed charges ","93% of total billed charges ",15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",397.38,85,,317.90,,,0,"percent of total billed charges ","85% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",406.73,87,,325.38,,,0,"percent of total billed charges ","87% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.32,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",327.25,70,,261.80,,,0,"percent of total billed charges ","70% of total billed charges ",15.32,434.78,
"*PHOSPHATIDYLINOSITOL IGG",2025800,"CDM ",302,RC,86148,HCPCS,OUTPATIENT,,,182.5,146,,16.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.75,70,,102.20,,,0,"percent of total billed charges ","70% of total billed charges ",164.25,90,,131.40,,,0,"percent of total billed charges ","90% of total billed charges ",169.73,93,,135.78,,,0,"percent of total billed charges ","93% of total billed charges ",16.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",155.13,85,,124.10,,,0,"percent of total billed charges ","85% of total billed charges ",164.25,90,,131.40,,,0,"percent of total billed charges ","90% of total billed charges ",164.25,90,,131.40,,,0,"percent of total billed charges ","90% of total billed charges ",22.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",158.78,87,,127.02,,,0,"percent of total billed charges ","87% of total billed charges ",22.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",127.75,70,,102.20,,,0,"percent of total billed charges ","70% of total billed charges ",16.07,169.73,
"*PHOSPHATIDYLINOSITOL IGM",2025810,"CDM ",302,RC,86148,HCPCS,OUTPATIENT,,,182.5,146,,16.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.75,70,,102.20,,,0,"percent of total billed charges ","70% of total billed charges ",164.25,90,,131.40,,,0,"percent of total billed charges ","90% of total billed charges ",169.73,93,,135.78,,,0,"percent of total billed charges ","93% of total billed charges ",16.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",155.13,85,,124.10,,,0,"percent of total billed charges ","85% of total billed charges ",164.25,90,,131.40,,,0,"percent of total billed charges ","90% of total billed charges ",164.25,90,,131.40,,,0,"percent of total billed charges ","90% of total billed charges ",22.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",158.78,87,,127.02,,,0,"percent of total billed charges ","87% of total billed charges ",22.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",127.75,70,,102.20,,,0,"percent of total billed charges ","70% of total billed charges ",16.07,169.73,
"*PHOSPHATIDYLINOSITOL IGA",2025820,"CDM ",302,RC,86148,HCPCS,OUTPATIENT,,,182.5,146,,16.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.75,70,,102.20,,,0,"percent of total billed charges ","70% of total billed charges ",164.25,90,,131.40,,,0,"percent of total billed charges ","90% of total billed charges ",169.73,93,,135.78,,,0,"percent of total billed charges ","93% of total billed charges ",16.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",155.13,85,,124.10,,,0,"percent of total billed charges ","85% of total billed charges ",164.25,90,,131.40,,,0,"percent of total billed charges ","90% of total billed charges ",164.25,90,,131.40,,,0,"percent of total billed charges ","90% of total billed charges ",22.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",158.78,87,,127.02,,,0,"percent of total billed charges ","87% of total billed charges ",22.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",127.75,70,,102.20,,,0,"percent of total billed charges ","70% of total billed charges ",16.07,169.73,
"PNH-CD #59 EXPRESSION S42830",2025840,"CDM ",302,RC,86356,HCPCS,OUTPATIENT,,,785.5,628.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",549.85,70,,439.88,,,0,"percent of total billed charges ","70% of total billed charges ",706.95,90,,565.56,,,0,"percent of total billed charges ","90% of total billed charges ",730.52,93,,584.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",21.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",667.68,85,,534.14,,,0,"percent of total billed charges ","85% of total billed charges ",706.95,90,,565.56,,,0,"percent of total billed charges ","90% of total billed charges ",706.95,90,,565.56,,,0,"percent of total billed charges ","90% of total billed charges ",21.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",683.39,87,,546.71,,,0,"percent of total billed charges ","87% of total billed charges ",21.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.78,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",549.85,70,,439.88,,,0,"percent of total billed charges ","70% of total billed charges ",21.14,730.52,
"*CRYPTOSPORIDIUM ANTIGEN",2025860,"CDM ",306,RC,87269,HCPCS,OUTPATIENT,,,170.5,136.4,,13.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.35,70,,95.48,,,0,"percent of total billed charges ","70% of total billed charges ",153.45,90,,122.76,,,0,"percent of total billed charges ","90% of total billed charges ",158.57,93,,126.86,,,0,"percent of total billed charges ","93% of total billed charges ",13.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",144.93,85,,115.94,,,0,"percent of total billed charges ","85% of total billed charges ",153.45,90,,122.76,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,90,,122.76,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",148.34,87,,118.67,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",119.35,70,,95.48,,,0,"percent of total billed charges ","70% of total billed charges ",13.61,158.57,
"*GIARDIA LAMBLIA ANTIGEN",2025870,"CDM ",306,RC,87272,HCPCS,OUTPATIENT,,,152,121.6,,11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",141.36,93,,113.09,,,0,"percent of total billed charges ","93% of total billed charges ",11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",129.2,85,,103.36,,,0,"percent of total billed charges ","85% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.24,87,,105.79,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",11.98,141.36,
"HEP C PCR",2025880,"CDM ",306,RC,87522,HCPCS,OUTPATIENT,,,269,215.2,,36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,109.38,109.38,109.38,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.3,70,,150.64,,,0,"percent of total billed charges ","70% of total billed charges ",242.1,90,,193.68,,,0,"percent of total billed charges ","90% of total billed charges ",250.17,93,,200.14,,,0,"percent of total billed charges ","93% of total billed charges ",36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",228.65,85,,182.92,,,0,"percent of total billed charges ","85% of total billed charges ",242.1,90,,193.68,,,0,"percent of total billed charges ","90% of total billed charges ",242.1,90,,193.68,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",234.03,87,,187.22,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.84,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",188.3,70,,150.64,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,250.17,
"T3 TOTAL",2025890,"CDM ",301,RC,84480,HCPCS,OUTPATIENT,,,102.5,82,,14.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,39.29,39.29,39.29,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.75,70,,57.40,,,0,"percent of total billed charges ","70% of total billed charges ",92.25,90,,73.80,,,0,"percent of total billed charges ","90% of total billed charges ",95.33,93,,76.26,,,0,"percent of total billed charges ","93% of total billed charges ",14.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",87.13,85,,69.70,,,0,"percent of total billed charges ","85% of total billed charges ",92.25,90,,73.80,,,0,"percent of total billed charges ","90% of total billed charges ",92.25,90,,73.80,,,0,"percent of total billed charges ","90% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",89.18,87,,62.25,48.61,75.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",71.75,70,,57.40,,,0,"percent of total billed charges ","70% of total billed charges ",14.18,95.33,
"HELIBACTER PYLORI AG STL #2443",2025900,"CDM ",306,RC,87338,HCPCS,OUTPATIENT,,,226,180.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",158.2,70,,126.56,,,0,"percent of total billed charges ","70% of total billed charges ",203.4,90,,162.72,,,0,"percent of total billed charges ","90% of total billed charges ",210.18,93,,168.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",192.1,85,,153.68,,,0,"percent of total billed charges ","85% of total billed charges ",203.4,90,,162.72,,,0,"percent of total billed charges ","90% of total billed charges ",203.4,90,,162.72,,,0,"percent of total billed charges ","90% of total billed charges ",17.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",196.62,87,,67.70,22.56,112.84,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.38,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",158.2,70,,126.56,,,0,"percent of total billed charges ","70% of total billed charges ",14.38,210.18,
"H PYLORI IGA ANTIBODIES",2025910,"CDM ",302,RC,86677,HCPCS,OUTPATIENT,,,188.5,150.8,,14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,47.59,47.59,47.59,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.95,70,,105.56,,,0,"percent of total billed charges ","70% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",175.31,93,,140.25,,,0,"percent of total billed charges ","93% of total billed charges ",14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",160.23,85,,128.18,,,0,"percent of total billed charges ","85% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",164,87,,78.01,78.01,78.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.85,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",131.95,70,,105.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,175.31,
"FENTANYL&/ORFENTANYL UR #4302U",2025920,"CDM ",301,RC,80361,HCPCS,OUTPATIENT,,,128,102.4,,10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,38.30,38.30,38.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",89.6,70,,71.68,,,0,"percent of total billed charges ","70% of total billed charges ",115.2,90,,92.16,,,0,"percent of total billed charges ","90% of total billed charges ",119.04,93,,95.23,,,0,"percent of total billed charges ","93% of total billed charges ",10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",108.8,85,,87.04,,,0,"percent of total billed charges ","85% of total billed charges ",115.2,90,,92.16,,,0,"percent of total billed charges ","90% of total billed charges ",115.2,90,,92.16,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",111.36,87,,89.09,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",89.6,70,,71.68,,,0,"percent of total billed charges ","70% of total billed charges ",10.4,119.04,
"RETT SYNDROME 2 GENE S51295",2025930,"CDM ",301,RC,81302,HCPCS,OUTPATIENT,,,2047,1637.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1432.9,70,,1146.32,,,0,"percent of total billed charges ","70% of total billed charges ",1842.3,90,,1473.84,,,0,"percent of total billed charges ","90% of total billed charges ",1903.71,93,,1522.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1739.95,85,,1391.96,,,0,"percent of total billed charges ","85% of total billed charges ",1842.3,90,,1473.84,,,0,"percent of total billed charges ","90% of total billed charges ",1842.3,90,,1473.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1780.89,87,,1424.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",527.87,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1432.9,70,,1146.32,,,0,"percent of total billed charges ","70% of total billed charges ",527.87,1903.71,
"IGM, URINE RANDOM 1508UR",2026020,"CDM ",301,RC,82784,HCPCS,OUTPATIENT,,,108,86.4,,9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,75.17,,,0,"percent of total billed charges ","87% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",9.3,100.44,
"*FLOW CYTOMETRY INTERP",2026040,"CDM ",300,RC,88187,HCPCS,OUTPATIENT,,,197,157.6,,33.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",75.7,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",137.9,70,,110.32,,,0,"percent of total billed charges ","70% of total billed charges ",177.3,90,,141.84,,,0,"percent of total billed charges ","90% of total billed charges ",183.21,93,,146.57,,,0,"percent of total billed charges ","93% of total billed charges ",33.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",167.45,85,,133.96,,,0,"percent of total billed charges ","85% of total billed charges ",177.3,90,,141.84,,,0,"percent of total billed charges ","90% of total billed charges ",177.3,90,,141.84,,,0,"percent of total billed charges ","90% of total billed charges ",58.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",171.39,87,,137.11,,,0,"percent of total billed charges ","87% of total billed charges ",58.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",137.9,70,,110.32,,,0,"percent of total billed charges ","70% of total billed charges ",33.41,183.21,
"*FLOW CYTOMETRY MARKER",2026050,"CDM ",300,RC,88185,HCPCS,OUTPATIENT,,,245,196,,19.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.24,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",171.5,70,,137.20,,,0,"percent of total billed charges ","70% of total billed charges ",220.5,90,,176.40,,,0,"percent of total billed charges ","90% of total billed charges ",227.85,93,,182.28,,,0,"percent of total billed charges ","93% of total billed charges ",19.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",208.25,85,,166.60,,,0,"percent of total billed charges ","85% of total billed charges ",220.5,90,,176.40,,,0,"percent of total billed charges ","90% of total billed charges ",220.5,90,,176.40,,,0,"percent of total billed charges ","90% of total billed charges ",21.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",213.15,87,,170.52,,,0,"percent of total billed charges ","87% of total billed charges ",21.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",171.5,70,,137.20,,,0,"percent of total billed charges ","70% of total billed charges ",19.52,227.85,
"*FLOW CYTOMETRY CELL SURFACE",2026060,"CDM ",300,RC,88184,HCPCS,OUTPATIENT,,,245,196,,53.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",137.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",171.5,70,,137.20,,,0,"percent of total billed charges ","70% of total billed charges ",220.5,90,,176.40,,,0,"percent of total billed charges ","90% of total billed charges ",227.85,93,,182.28,,,0,"percent of total billed charges ","93% of total billed charges ",53.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",208.25,85,,166.60,,,0,"percent of total billed charges ","85% of total billed charges ",220.5,90,,176.40,,,0,"percent of total billed charges ","90% of total billed charges ",220.5,90,,176.40,,,0,"percent of total billed charges ","90% of total billed charges ",43.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",213.15,87,,170.52,,,0,"percent of total billed charges ","87% of total billed charges ",43.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",171.5,70,,137.20,,,0,"percent of total billed charges ","70% of total billed charges ",43.19,329.64,
"HEPATITIS C VIR SUBTYPR #7473",2026070,"CDM ",306,RC,87902,HCPCS,OUTPATIENT,,,1611.5,1289.2,,,,,,,,0,"other ","not separately reimbursment ",,,,306.82,306.82,306.82,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1128.05,70,,902.44,,,0,"percent of total billed charges ","70% of total billed charges ",1450.35,90,,1160.28,,,0,"percent of total billed charges ","90% of total billed charges ",1498.7,93,,1198.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",321.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1369.78,85,,1095.82,,,0,"percent of total billed charges ","85% of total billed charges ",1450.35,90,,1160.28,,,0,"percent of total billed charges ","90% of total billed charges ",1450.35,90,,1160.28,,,0,"percent of total billed charges ","90% of total billed charges ",317.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1402.01,87,,1121.61,,,0,"percent of total billed charges ","87% of total billed charges ",317.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1128.05,70,,902.44,,,0,"percent of total billed charges ","70% of total billed charges ",257.45,1498.7,
"CHROMOGRANIN A ELECT SERUM",2026080,"CDM ",302,RC,86316,HCPCS,OUTPATIENT,,,317,253.6,,20.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,65.25,65.25,65.25,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",221.9,70,,177.52,,,0,"percent of total billed charges ","70% of total billed charges ",285.3,90,,228.24,,,0,"percent of total billed charges ","90% of total billed charges ",294.81,93,,235.85,,,0,"percent of total billed charges ","93% of total billed charges ",20.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",269.45,85,,215.56,,,0,"percent of total billed charges ","85% of total billed charges ",285.3,90,,228.24,,,0,"percent of total billed charges ","90% of total billed charges ",285.3,90,,228.24,,,0,"percent of total billed charges ","90% of total billed charges ",31.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",275.79,87,,220.63,,,0,"percent of total billed charges ","87% of total billed charges ",31.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.81,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",221.9,70,,177.52,,,0,"percent of total billed charges ","70% of total billed charges ",20.81,294.81,
"OATS IGG #F7G",2026090,"CDM ",302,RC,86001,HCPCS,OUTPATIENT,,,81.5,65.2,,6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",75.8,93,,60.64,,,0,"percent of total billed charges ","93% of total billed charges ",6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",69.28,85,,55.42,,,0,"percent of total billed charges ","85% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.91,87,,56.73,,,0,"percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",6.65,75.8,
"WHEAT IGG #F4G",2026100,"CDM ",302,RC,86001,HCPCS,OUTPATIENT,,,81.5,65.2,,6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",75.8,93,,60.64,,,0,"percent of total billed charges ","93% of total billed charges ",6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",69.28,85,,55.42,,,0,"percent of total billed charges ","85% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.91,87,,56.73,,,0,"percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",6.65,75.8,
"CORN IGG #F8G",2026110,"CDM ",302,RC,86001,HCPCS,OUTPATIENT,,,81.5,65.2,,6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",75.8,93,,60.64,,,0,"percent of total billed charges ","93% of total billed charges ",6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",69.28,85,,55.42,,,0,"percent of total billed charges ","85% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.91,87,,56.73,,,0,"percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",6.65,75.8,
"MILK COWS IGG",2026120,"CDM ",302,RC,86001,HCPCS,OUTPATIENT,,,198,158.4,,6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",138.6,70,,110.88,,,0,"percent of total billed charges ","70% of total billed charges ",178.2,90,,142.56,,,0,"percent of total billed charges ","90% of total billed charges ",184.14,93,,147.31,,,0,"percent of total billed charges ","93% of total billed charges ",6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",168.3,85,,134.64,,,0,"percent of total billed charges ","85% of total billed charges ",178.2,90,,142.56,,,0,"percent of total billed charges ","90% of total billed charges ",178.2,90,,142.56,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",172.26,87,,137.81,,,0,"percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",138.6,70,,110.88,,,0,"percent of total billed charges ","70% of total billed charges ",6.65,184.14,
"PEANUT IGG #F13G",2026130,"CDM ",302,RC,86001,HCPCS,OUTPATIENT,,,81.5,65.2,,6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",75.8,93,,60.64,,,0,"percent of total billed charges ","93% of total billed charges ",6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",69.28,85,,55.42,,,0,"percent of total billed charges ","85% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.91,87,,56.73,,,0,"percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",6.65,75.8,
"SOYBEAN IGG #F14G",2026140,"CDM ",302,RC,86001,HCPCS,OUTPATIENT,,,81.5,65.2,,6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",75.8,93,,60.64,,,0,"percent of total billed charges ","93% of total billed charges ",6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",69.28,85,,55.42,,,0,"percent of total billed charges ","85% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.91,87,,56.73,,,0,"percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",6.65,75.8,
"EGG WHITE IGG #F1G",2026150,"CDM ",302,RC,86001,HCPCS,OUTPATIENT,,,81.5,65.2,,6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",75.8,93,,60.64,,,0,"percent of total billed charges ","93% of total billed charges ",6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",69.28,85,,55.42,,,0,"percent of total billed charges ","85% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.91,87,,56.73,,,0,"percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",6.65,75.8,
"EGG YOLK IGG #F75",2026155,"CDM ",302,RC,86001,HCPCS,OUTPATIENT,,,81.5,65.2,,6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",75.8,93,,60.64,,,0,"percent of total billed charges ","93% of total billed charges ",6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",69.28,85,,55.42,,,0,"percent of total billed charges ","85% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.91,87,,56.73,,,0,"percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",6.65,75.8,
"*AMA-M2 EP (M1P3) IGG",2026180,"CDM ",301,RC,83516,HCPCS,OUTPATIENT,,,208,166.4,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",145.6,70,,116.48,,,0,"percent of total billed charges ","70% of total billed charges ",187.2,90,,149.76,,,0,"percent of total billed charges ","90% of total billed charges ",193.44,93,,154.75,,,0,"percent of total billed charges ","93% of total billed charges ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",176.8,85,,141.44,,,0,"percent of total billed charges ","85% of total billed charges ",187.2,90,,149.76,,,0,"percent of total billed charges ","90% of total billed charges ",187.2,90,,149.76,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",180.96,87,,53.32,28.74,77.90,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",145.6,70,,116.48,,,0,"percent of total billed charges ","70% of total billed charges ",10,193.44,
"*ANA ANTIBODIES",2026190,"CDM ",302,RC,86038,HCPCS,OUTPATIENT,,,391,312.8,,12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.7,70,,218.96,,,0,"percent of total billed charges ","70% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",363.63,93,,290.90,,,0,"percent of total billed charges ","93% of total billed charges ",12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",332.35,85,,265.88,,,0,"percent of total billed charges ","85% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",340.17,87,,88.36,11.85,147.83,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",273.7,70,,218.96,,,0,"percent of total billed charges ","70% of total billed charges ",12.09,363.63,
"*COMPLEMENT C3",2026200,"CDM ",302,RC,86160,HCPCS,OUTPATIENT,,,391,312.8,,12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,133.30,133.30,133.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.7,70,,218.96,,,0,"percent of total billed charges ","70% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",363.63,93,,290.90,,,0,"percent of total billed charges ","93% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",332.35,85,,265.88,,,0,"percent of total billed charges ","85% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",340.17,87,,226.71,226.71,226.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",273.7,70,,218.96,,,0,"percent of total billed charges ","70% of total billed charges ",12,363.63,
"*COMPLEMENT C4",2026210,"CDM ",302,RC,86160,HCPCS,OUTPATIENT,,,391,312.8,,12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,133.30,133.30,133.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.7,70,,218.96,,,0,"percent of total billed charges ","70% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",363.63,93,,290.90,,,0,"percent of total billed charges ","93% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",332.35,85,,265.88,,,0,"percent of total billed charges ","85% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",340.17,87,,226.71,226.71,226.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",273.7,70,,218.96,,,0,"percent of total billed charges ","70% of total billed charges ",12,363.63,
"*DNA DS (ABS)",2026220,"CDM ",302,RC,86225,HCPCS,OUTPATIENT,,,391,312.8,,13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,72.72,72.72,72.72,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.7,70,,218.96,,,0,"percent of total billed charges ","70% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",363.63,93,,290.90,,,0,"percent of total billed charges ","93% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",332.35,85,,265.88,,,0,"percent of total billed charges ","85% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",24.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",340.17,87,,115.94,115.94,115.94,"1 through 10","percent of total billed charges ","87% of total billed charges ",24.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",273.7,70,,218.96,,,0,"percent of total billed charges ","70% of total billed charges ",13.74,363.63,
"*NRNP/SM IGG AUTOABS",2026230,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,391,312.8,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.7,70,,218.96,,,0,"percent of total billed charges ","70% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",363.63,93,,290.90,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",332.35,85,,265.88,,,0,"percent of total billed charges ","85% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",340.17,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",273.7,70,,218.96,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,363.63,
"*SM (SMITH) IGG AUTOABS",2026240,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,391,312.8,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.7,70,,218.96,,,0,"percent of total billed charges ","70% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",363.63,93,,290.90,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",332.35,85,,265.88,,,0,"percent of total billed charges ","85% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",340.17,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",273.7,70,,218.96,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,363.63,
"*SS-A IGG AUTOABS",2026250,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,391,312.8,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.7,70,,218.96,,,0,"percent of total billed charges ","70% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",363.63,93,,290.90,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",332.35,85,,265.88,,,0,"percent of total billed charges ","85% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",340.17,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",273.7,70,,218.96,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,363.63,
"*SS-B IGG AUTOABS",2026260,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,391,312.8,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.7,70,,218.96,,,0,"percent of total billed charges ","70% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",363.63,93,,290.90,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",332.35,85,,265.88,,,0,"percent of total billed charges ","85% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",340.17,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",273.7,70,,218.96,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,363.63,
"*SCL70 IGG AUTOABS",2026270,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,391,312.8,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.7,70,,218.96,,,0,"percent of total billed charges ","70% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",363.63,93,,290.90,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",332.35,85,,265.88,,,0,"percent of total billed charges ","85% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",340.17,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",273.7,70,,218.96,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,363.63,
"*PARIETAL AUTOABS",2026280,"CDM ",302,RC,86255,HCPCS,OUTPATIENT,,,391,312.8,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.7,70,,218.96,,,0,"percent of total billed charges ","70% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",363.63,93,,290.90,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",332.35,85,,265.88,,,0,"percent of total billed charges ","85% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",340.17,87,,272.14,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",273.7,70,,218.96,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,363.63,
"*STRIATIONAL AUTOABS",2026290,"CDM ",302,RC,86255,HCPCS,OUTPATIENT,,,391,312.8,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.7,70,,218.96,,,0,"percent of total billed charges ","70% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",363.63,93,,290.90,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",332.35,85,,265.88,,,0,"percent of total billed charges ","85% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",340.17,87,,272.14,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",273.7,70,,218.96,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,363.63,
"*SMOOTH MUSCLE AUTOABS",2026300,"CDM ",302,RC,86255,HCPCS,OUTPATIENT,,,146,116.8,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,101.62,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,135.78,
"*THYROID PEROXIDOSE AUTOABS",2026310,"CDM ",302,RC,86376,HCPCS,OUTPATIENT,,,391,312.8,,14.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.97,60.97,60.97,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.7,70,,218.96,,,0,"percent of total billed charges ","70% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",363.63,93,,290.90,,,0,"percent of total billed charges ","93% of total billed charges ",14.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",332.35,85,,265.88,,,0,"percent of total billed charges ","85% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",340.17,87,,55.52,12.39,96.11,"1 through 10","percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.55,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",273.7,70,,218.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.55,363.63,
"*RHEUMATOID FACTOR QUANTITATIV",2026320,"CDM ",302,RC,86431,HCPCS,OUTPATIENT,,,391,312.8,,5.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,5.56,5.56,5.56,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.7,70,,218.96,,,0,"percent of total billed charges ","70% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",363.63,93,,290.90,,,0,"percent of total billed charges ","93% of total billed charges ",5.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",332.35,85,,265.88,,,0,"percent of total billed charges ","85% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",351.9,90,,281.52,,,0,"percent of total billed charges ","90% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",340.17,87,,5.56,5.56,56.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",273.7,70,,218.96,,,0,"percent of total billed charges ","70% of total billed charges ",5.67,363.63,
"*ACHR BINDING AUTOANTIBODIES",2026330,"CDM ",301,RC,83519,HCPCS,OUTPATIENT,,,215,172,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",199.95,93,,159.96,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",182.75,85,,146.20,,,0,"percent of total billed charges ","85% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",187.05,87,,149.64,,,0,"percent of total billed charges ","87% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,199.95,
"*ACHR BLOCKING AUTOANTIBODIES",2026340,"CDM ",301,RC,83519,HCPCS,OUTPATIENT,,,215,172,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",199.95,93,,159.96,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",182.75,85,,146.20,,,0,"percent of total billed charges ","85% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",187.05,87,,149.64,,,0,"percent of total billed charges ","87% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,199.95,
"*ACHR MODULATING AUTOANTIBODIE",2026350,"CDM ",301,RC,83519,HCPCS,OUTPATIENT,,,215,172,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",199.95,93,,159.96,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",182.75,85,,146.20,,,0,"percent of total billed charges ","85% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",187.05,87,,149.64,,,0,"percent of total billed charges ","87% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,199.95,
"*STRIATIONAL AUTOANTIBODIES",2026360,"CDM ",302,RC,86255,HCPCS,OUTPATIENT,,,405,324,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",283.5,70,,226.80,,,0,"percent of total billed charges ","70% of total billed charges ",364.5,90,,291.60,,,0,"percent of total billed charges ","90% of total billed charges ",376.65,93,,301.32,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",344.25,85,,275.40,,,0,"percent of total billed charges ","85% of total billed charges ",364.5,90,,291.60,,,0,"percent of total billed charges ","90% of total billed charges ",364.5,90,,291.60,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",352.35,87,,281.88,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",283.5,70,,226.80,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,376.65,
"CANNABINOIDS #S51482",2026380,"CDM ",301,RC,80307,HCPCS,OUTPATIENT,,,202,161.6,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.4,70,,113.12,,,0,"percent of total billed charges ","70% of total billed charges ",181.8,90,,145.44,,,0,"percent of total billed charges ","90% of total billed charges ",187.86,93,,150.29,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",171.7,85,,137.36,,,0,"percent of total billed charges ","85% of total billed charges ",181.8,90,,145.44,,,0,"percent of total billed charges ","90% of total billed charges ",181.8,90,,145.44,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",175.74,87,,140.59,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",141.4,70,,113.12,,,0,"percent of total billed charges ","70% of total billed charges ",62.14,187.86,
"UGT1A1 GENOTYPING",2026480,"CDM ",309,RC,81350,HCPCS,OUTPATIENT,,,2501.5,2001.2,,90.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1751.05,70,,1400.84,,,0,"percent of total billed charges ","70% of total billed charges ",2251.35,90,,1801.08,,,0,"percent of total billed charges ","90% of total billed charges ",2326.4,93,,1861.12,,,0,"percent of total billed charges ","93% of total billed charges ",90.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",115.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2126.28,85,,1701.02,,,0,"percent of total billed charges ","85% of total billed charges ",2251.35,90,,1801.08,,,0,"percent of total billed charges ","90% of total billed charges ",2251.35,90,,1801.08,,,0,"percent of total billed charges ","90% of total billed charges ",114.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2176.31,87,,1741.05,,,0,"percent of total billed charges ","87% of total billed charges ",114.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",234,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1751.05,70,,1400.84,,,0,"percent of total billed charges ","70% of total billed charges ",90.63,2326.4,
"*PLATELET ANTIBODIES",2026490,"CDM ",302,RC,86022,HCPCS,OUTPATIENT,,,149,119.2,,15.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,30.11,30.11,30.11,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.3,70,,83.44,,,0,"percent of total billed charges ","70% of total billed charges ",134.1,90,,107.28,,,0,"percent of total billed charges ","90% of total billed charges ",138.57,93,,110.86,,,0,"percent of total billed charges ","93% of total billed charges ",15.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",126.65,85,,101.32,,,0,"percent of total billed charges ","85% of total billed charges ",134.1,90,,107.28,,,0,"percent of total billed charges ","90% of total billed charges ",134.1,90,,107.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",129.63,87,,89.65,89.65,89.65,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.37,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.3,70,,83.44,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,138.57,
"*PLATELET ASSOC IMMUNOGLOBULIN",2026500,"CDM ",302,RC,86023,HCPCS,OUTPATIENT,,,287,229.6,,10.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",200.9,70,,160.72,,,0,"percent of total billed charges ","70% of total billed charges ",258.3,90,,206.64,,,0,"percent of total billed charges ","90% of total billed charges ",266.91,93,,213.53,,,0,"percent of total billed charges ","93% of total billed charges ",10.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",243.95,85,,195.16,,,0,"percent of total billed charges ","85% of total billed charges ",258.3,90,,206.64,,,0,"percent of total billed charges ","90% of total billed charges ",258.3,90,,206.64,,,0,"percent of total billed charges ","90% of total billed charges ",9.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",249.69,87,,199.75,,,0,"percent of total billed charges ","87% of total billed charges ",9.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.46,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",200.9,70,,160.72,,,0,"percent of total billed charges ","70% of total billed charges ",9.82,266.91,
"*ANTIBODY ID",2026520,"CDM ",302,RC,86021,HCPCS,OUTPATIENT,,,198,158.4,,12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",138.6,70,,110.88,,,0,"percent of total billed charges ","70% of total billed charges ",178.2,90,,142.56,,,0,"percent of total billed charges ","90% of total billed charges ",184.14,93,,147.31,,,0,"percent of total billed charges ","93% of total billed charges ",12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",168.3,85,,134.64,,,0,"percent of total billed charges ","85% of total billed charges ",178.2,90,,142.56,,,0,"percent of total billed charges ","90% of total billed charges ",178.2,90,,142.56,,,0,"percent of total billed charges ","90% of total billed charges ",9.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",172.26,87,,137.81,,,0,"percent of total billed charges ","87% of total billed charges ",9.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",138.6,70,,110.88,,,0,"percent of total billed charges ","70% of total billed charges ",9.82,184.14,
"*ANTINUCLEAR ANTIBODIES",2026530,"CDM ",302,RC,86038,HCPCS,OUTPATIENT,,,198,158.4,,12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",138.6,70,,110.88,,,0,"percent of total billed charges ","70% of total billed charges ",178.2,90,,142.56,,,0,"percent of total billed charges ","90% of total billed charges ",184.14,93,,147.31,,,0,"percent of total billed charges ","93% of total billed charges ",12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",168.3,85,,134.64,,,0,"percent of total billed charges ","85% of total billed charges ",178.2,90,,142.56,,,0,"percent of total billed charges ","90% of total billed charges ",178.2,90,,142.56,,,0,"percent of total billed charges ","90% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",172.26,87,,88.36,11.85,147.83,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",138.6,70,,110.88,,,0,"percent of total billed charges ","70% of total billed charges ",12.09,184.14,
"*PLATELET ANTIBODIES",2026550,"CDM ",302,RC,86022,HCPCS,OUTPATIENT,,,149,119.2,,15.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,30.11,30.11,30.11,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.3,70,,83.44,,,0,"percent of total billed charges ","70% of total billed charges ",134.1,90,,107.28,,,0,"percent of total billed charges ","90% of total billed charges ",138.57,93,,110.86,,,0,"percent of total billed charges ","93% of total billed charges ",15.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",126.65,85,,101.32,,,0,"percent of total billed charges ","85% of total billed charges ",134.1,90,,107.28,,,0,"percent of total billed charges ","90% of total billed charges ",134.1,90,,107.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",129.63,87,,89.65,89.65,89.65,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.37,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.3,70,,83.44,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,138.57,
"*PLATELET ASSOC IMMUNOGL ASSAY",2026560,"CDM ",302,RC,86023,HCPCS,OUTPATIENT,,,287,229.6,,10.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",200.9,70,,160.72,,,0,"percent of total billed charges ","70% of total billed charges ",258.3,90,,206.64,,,0,"percent of total billed charges ","90% of total billed charges ",266.91,93,,213.53,,,0,"percent of total billed charges ","93% of total billed charges ",10.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",243.95,85,,195.16,,,0,"percent of total billed charges ","85% of total billed charges ",258.3,90,,206.64,,,0,"percent of total billed charges ","90% of total billed charges ",258.3,90,,206.64,,,0,"percent of total billed charges ","90% of total billed charges ",9.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",249.69,87,,199.75,,,0,"percent of total billed charges ","87% of total billed charges ",9.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.46,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",200.9,70,,160.72,,,0,"percent of total billed charges ","70% of total billed charges ",9.82,266.91,
"ACT PROTEIN C RESIST #5901",2026580,"CDM ",305,RC,85307,HCPCS,OUTPATIENT,,,467.5,374,,15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",327.25,70,,261.80,,,0,"percent of total billed charges ","70% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",434.78,93,,347.82,,,0,"percent of total billed charges ","93% of total billed charges ",15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",397.38,85,,317.90,,,0,"percent of total billed charges ","85% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",406.73,87,,325.38,,,0,"percent of total billed charges ","87% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.32,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",327.25,70,,261.80,,,0,"percent of total billed charges ","70% of total billed charges ",15.32,434.78,
"IODINE 24HR URINE",2026600,"CDM ",301,RC,82542,HCPCS,OUTPATIENT,,,457,365.6,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",319.9,70,,255.92,,,0,"percent of total billed charges ","70% of total billed charges ",411.3,90,,329.04,,,0,"percent of total billed charges ","90% of total billed charges ",425.01,93,,340.01,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",388.45,85,,310.76,,,0,"percent of total billed charges ","85% of total billed charges ",411.3,90,,329.04,,,0,"percent of total billed charges ","90% of total billed charges ",411.3,90,,329.04,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",397.59,87,,318.07,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",319.9,70,,255.92,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,425.01,
"*CARDIOLIPIN AB EA IG CLASS",2026680,"CDM ",302,RC,86147,HCPCS,OUTPATIENT,,,224.5,179.6,,25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",208.79,93,,167.03,,,0,"percent of total billed charges ","93% of total billed charges ",25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",190.83,85,,152.66,,,0,"percent of total billed charges ","85% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.32,87,,156.26,,,0,"percent of total billed charges ","87% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",25.45,208.79,
"*ANTIPHOSPHATIDYLSERINE AB",2026690,"CDM ",302,RC,86148,HCPCS,OUTPATIENT,,,140.5,112.4,,16.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",130.67,93,,104.54,,,0,"percent of total billed charges ","93% of total billed charges ",16.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",119.43,85,,95.54,,,0,"percent of total billed charges ","85% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",22.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.24,87,,97.79,,,0,"percent of total billed charges ","87% of total billed charges ",22.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",16.07,130.67,
"RHEUMATOID ARTH FACTOR #1013",2026710,"CDM ",302,RC,86038,HCPCS,OUTPATIENT,,,638,510.4,,12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",446.6,70,,357.28,,,0,"percent of total billed charges ","70% of total billed charges ",574.2,90,,459.36,,,0,"percent of total billed charges ","90% of total billed charges ",593.34,93,,474.67,,,0,"percent of total billed charges ","93% of total billed charges ",12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",542.3,85,,433.84,,,0,"percent of total billed charges ","85% of total billed charges ",574.2,90,,459.36,,,0,"percent of total billed charges ","90% of total billed charges ",574.2,90,,459.36,,,0,"percent of total billed charges ","90% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",555.06,87,,88.36,11.85,147.83,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",446.6,70,,357.28,,,0,"percent of total billed charges ","70% of total billed charges ",12.09,593.34,
"*CYCLIC CITRULLINATED PEP AB",2026720,"CDM ",302,RC,86200,HCPCS,OUTPATIENT,,,87,69.6,,12.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,33.25,33.25,33.25,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.9,70,,48.72,,,0,"percent of total billed charges ","70% of total billed charges ",78.3,90,,62.64,,,0,"percent of total billed charges ","90% of total billed charges ",80.91,93,,64.73,,,0,"percent of total billed charges ","93% of total billed charges ",12.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",73.95,85,,59.16,,,0,"percent of total billed charges ","85% of total billed charges ",78.3,90,,62.64,,,0,"percent of total billed charges ","90% of total billed charges ",78.3,90,,62.64,,,0,"percent of total billed charges ","90% of total billed charges ",20.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",75.69,87,,60.55,,,0,"percent of total billed charges ","87% of total billed charges ",20.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.95,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",60.9,70,,48.72,,,0,"percent of total billed charges ","70% of total billed charges ",12.95,80.91,
"*QUANTITATIVE TEST RHEUMATOID",2026730,"CDM ",302,RC,86431,HCPCS,OUTPATIENT,,,75.5,60.4,,5.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,5.56,5.56,5.56,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",70.22,93,,56.18,,,0,"percent of total billed charges ","93% of total billed charges ",5.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",64.18,85,,51.34,,,0,"percent of total billed charges ","85% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.69,87,,5.56,5.56,56.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",5.67,70.22,
"PROINSULIN PLASMA #S51596",2026750,"CDM ",301,RC,84206,HCPCS,OUTPATIENT,,,815.5,652.4,,22.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",570.85,70,,456.68,,,0,"percent of total billed charges ","70% of total billed charges ",733.95,90,,587.16,,,0,"percent of total billed charges ","90% of total billed charges ",758.42,93,,606.74,,,0,"percent of total billed charges ","93% of total billed charges ",22.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",693.18,85,,554.54,,,0,"percent of total billed charges ","85% of total billed charges ",733.95,90,,587.16,,,0,"percent of total billed charges ","90% of total billed charges ",733.95,90,,587.16,,,0,"percent of total billed charges ","90% of total billed charges ",22.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",709.49,87,,567.59,,,0,"percent of total billed charges ","87% of total billed charges ",22.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.69,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",570.85,70,,456.68,,,0,"percent of total billed charges ","70% of total billed charges ",22.24,758.42,
"LOPERAMIDE #S48305",2026830,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,859,687.2,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",601.3,70,,481.04,,,0,"percent of total billed charges ","70% of total billed charges ",773.1,90,,618.48,,,0,"percent of total billed charges ","90% of total billed charges ",798.87,93,,639.10,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",730.15,85,,584.12,,,0,"percent of total billed charges ","85% of total billed charges ",773.1,90,,618.48,,,0,"percent of total billed charges ","90% of total billed charges ",773.1,90,,618.48,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",747.33,87,,597.86,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",601.3,70,,481.04,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,798.87,
"DIPHENOXYLATE #S48465",2026840,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,268,214.4,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.6,70,,150.08,,,0,"percent of total billed charges ","70% of total billed charges ",241.2,90,,192.96,,,0,"percent of total billed charges ","90% of total billed charges ",249.24,93,,199.39,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",227.8,85,,182.24,,,0,"percent of total billed charges ","85% of total billed charges ",241.2,90,,192.96,,,0,"percent of total billed charges ","90% of total billed charges ",241.2,90,,192.96,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",233.16,87,,186.53,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",187.6,70,,150.08,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,249.24,
"HTLV HBS W/REFLEX 1B & BANDS",2026850,"CDM ",302,RC,86790,HCPCS,OUTPATIENT,,,183.5,146.8,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.58,80.58,80.58,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",170.66,93,,136.53,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",155.98,85,,124.78,,,0,"percent of total billed charges ","85% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",159.65,87,,199.98,199.98,199.98,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,170.66,
"ENDOMYSIAL IGG #S51072",2026860,"CDM ",302,RC,86255,HCPCS,OUTPATIENT,,,284.5,227.6,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",199.15,70,,159.32,,,0,"percent of total billed charges ","70% of total billed charges ",256.05,90,,204.84,,,0,"percent of total billed charges ","90% of total billed charges ",264.59,93,,211.67,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",241.83,85,,193.46,,,0,"percent of total billed charges ","85% of total billed charges ",256.05,90,,204.84,,,0,"percent of total billed charges ","90% of total billed charges ",256.05,90,,204.84,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",247.52,87,,198.02,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",199.15,70,,159.32,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,264.59,
"PRADER-WILLI/ANGLEMAN DNA",2026920,"CDM ",309,RC,81331,HCPCS,OUTPATIENT,,,1152.5,922,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",806.75,70,,645.40,,,0,"percent of total billed charges ","70% of total billed charges ",1037.25,90,,829.80,,,0,"percent of total billed charges ","90% of total billed charges ",1071.83,93,,857.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",979.63,85,,783.70,,,0,"percent of total billed charges ","85% of total billed charges ",1037.25,90,,829.80,,,0,"percent of total billed charges ","90% of total billed charges ",1037.25,90,,829.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1002.68,87,,802.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",51.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",806.75,70,,645.40,,,0,"percent of total billed charges ","70% of total billed charges ",51.07,1071.83,
"CYTOLOGY, URINE #S41795",2026930,"CDM ",300,RC,88112,HCPCS,OUTPATIENT,,,492,393.6,,60.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",138.03,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",344.4,70,,275.52,,,0,"percent of total billed charges ","70% of total billed charges ",442.8,90,,354.24,,,0,"percent of total billed charges ","90% of total billed charges ",457.56,93,,366.05,,,0,"percent of total billed charges ","93% of total billed charges ",60.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",418.2,85,,334.56,,,0,"percent of total billed charges ","85% of total billed charges ",442.8,90,,354.24,,,0,"percent of total billed charges ","90% of total billed charges ",442.8,90,,354.24,,,0,"percent of total billed charges ","90% of total billed charges ",40.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",428.04,87,,342.43,,,0,"percent of total billed charges ","87% of total billed charges ",40.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.92,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",344.4,70,,275.52,,,0,"percent of total billed charges ","70% of total billed charges ",40.28,457.56,
"FUNGAL ID BY DNA PROBE #5633",2026940,"CDM ",306,RC,87149,HCPCS,OUTPATIENT,,,119.5,95.6,,20.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",111.14,93,,88.91,,,0,"percent of total billed charges ","93% of total billed charges ",20.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",101.58,85,,81.26,,,0,"percent of total billed charges ","85% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",30.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",103.97,87,,83.18,,,0,"percent of total billed charges ","87% of total billed charges ",30.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",20.05,111.14,
"CIPROFLOXIN #S48777",2026950,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,347.5,278,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",243.25,70,,194.60,,,0,"percent of total billed charges ","70% of total billed charges ",312.75,90,,250.20,,,0,"percent of total billed charges ","90% of total billed charges ",323.18,93,,258.54,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",295.38,85,,236.30,,,0,"percent of total billed charges ","85% of total billed charges ",312.75,90,,250.20,,,0,"percent of total billed charges ","90% of total billed charges ",312.75,90,,250.20,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",302.33,87,,241.86,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",243.25,70,,194.60,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,323.18,
"E2G DOG EPITHELIUM",2026960,"CDM ",302,RC,86001,HCPCS,OUTPATIENT,,,81.5,65.2,,6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",75.8,93,,60.64,,,0,"percent of total billed charges ","93% of total billed charges ",6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",69.28,85,,55.42,,,0,"percent of total billed charges ","85% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.91,87,,56.73,,,0,"percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",6.65,75.8,
"F45G YEAST",2026970,"CDM ",302,RC,86001,HCPCS,OUTPATIENT,,,81.5,65.2,,6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",75.8,93,,60.64,,,0,"percent of total billed charges ","93% of total billed charges ",6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",69.28,85,,55.42,,,0,"percent of total billed charges ","85% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.91,87,,56.73,,,0,"percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",6.65,75.8,
"F245G EGG",2026980,"CDM ",302,RC,86001,HCPCS,OUTPATIENT,,,81.5,65.2,,6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",75.8,93,,60.64,,,0,"percent of total billed charges ","93% of total billed charges ",6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",69.28,85,,55.42,,,0,"percent of total billed charges ","85% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.91,87,,56.73,,,0,"percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",6.65,75.8,
"FUNGAL ID DNA SPUTUM #5633",2027050,"CDM ",306,RC,87149,HCPCS,OUTPATIENT,,,119.5,95.6,,20.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",111.14,93,,88.91,,,0,"percent of total billed charges ","93% of total billed charges ",20.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",101.58,85,,81.26,,,0,"percent of total billed charges ","85% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",30.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",103.97,87,,83.18,,,0,"percent of total billed charges ","87% of total billed charges ",30.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",20.05,111.14,
"TOXOCARA ABS #S50345",2027120,"CDM ",302,RC,86682,HCPCS,OUTPATIENT,,,305,244,,11.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",213.5,70,,170.80,,,0,"percent of total billed charges ","70% of total billed charges ",274.5,90,,219.60,,,0,"percent of total billed charges ","90% of total billed charges ",283.65,93,,226.92,,,0,"percent of total billed charges ","93% of total billed charges ",11.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",259.25,85,,207.40,,,0,"percent of total billed charges ","85% of total billed charges ",274.5,90,,219.60,,,0,"percent of total billed charges ","90% of total billed charges ",274.5,90,,219.60,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",265.35,87,,155.16,155.16,155.16,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",213.5,70,,170.80,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,283.65,
"NOROVIRUS RNA, RT-PCR #S51232",2027130,"CDM ",306,RC,87798,HCPCS,OUTPATIENT,,,1321,1056.8,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",924.7,70,,739.76,,,0,"percent of total billed charges ","70% of total billed charges ",1188.9,90,,951.12,,,0,"percent of total billed charges ","90% of total billed charges ",1228.53,93,,982.82,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1122.85,85,,898.28,,,0,"percent of total billed charges ","85% of total billed charges ",1188.9,90,,951.12,,,0,"percent of total billed charges ","90% of total billed charges ",1188.9,90,,951.12,,,0,"percent of total billed charges ","90% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1149.27,87,,919.42,,,0,"percent of total billed charges ","87% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",924.7,70,,739.76,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,1228.53,
"H. PYLORI TITER #7761",2027140,"CDM ",302,RC,86677,HCPCS,OUTPATIENT,,,114,91.2,,14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,47.59,47.59,47.59,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.8,70,,63.84,,,0,"percent of total billed charges ","70% of total billed charges ",102.6,90,,82.08,,,0,"percent of total billed charges ","90% of total billed charges ",106.02,93,,84.82,,,0,"percent of total billed charges ","93% of total billed charges ",14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",96.9,85,,77.52,,,0,"percent of total billed charges ","85% of total billed charges ",102.6,90,,82.08,,,0,"percent of total billed charges ","90% of total billed charges ",102.6,90,,82.08,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",99.18,87,,78.01,78.01,78.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.85,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",79.8,70,,63.84,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,106.02,
"CLOSTRID DIFF CYTO AB #S44785",2027150,"CDM ",306,RC,87230,HCPCS,OUTPATIENT,,,269,215.2,,19.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.3,70,,150.64,,,0,"percent of total billed charges ","70% of total billed charges ",242.1,90,,193.68,,,0,"percent of total billed charges ","90% of total billed charges ",250.17,93,,200.14,,,0,"percent of total billed charges ","93% of total billed charges ",19.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",228.65,85,,182.92,,,0,"percent of total billed charges ","85% of total billed charges ",242.1,90,,193.68,,,0,"percent of total billed charges ","90% of total billed charges ",242.1,90,,193.68,,,0,"percent of total billed charges ","90% of total billed charges ",32.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",234.03,87,,187.22,,,0,"percent of total billed charges ","87% of total billed charges ",32.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.73,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",188.3,70,,150.64,,,0,"percent of total billed charges ","70% of total billed charges ",19.73,250.17,
"FACTOR V HR2 ALLELE #S51402",2027190,"CDM ",309,RC,81400,HCPCS,OUTPATIENT,,,1203.5,962.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",842.45,70,,673.96,,,0,"percent of total billed charges ","70% of total billed charges ",1083.15,90,,866.52,,,0,"percent of total billed charges ","90% of total billed charges ",1119.26,93,,895.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1022.98,85,,818.38,,,0,"percent of total billed charges ","85% of total billed charges ",1083.15,90,,866.52,,,0,"percent of total billed charges ","90% of total billed charges ",1083.15,90,,866.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1047.05,87,,837.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",63.96,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",842.45,70,,673.96,,,0,"percent of total billed charges ","70% of total billed charges ",63.96,1119.26,
"HEPATITIS C VIRUS RNA #7516",2027200,"CDM ",306,RC,87521,HCPCS,OUTPATIENT,,,344.5,275.6,,29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.15,70,,192.92,,,0,"percent of total billed charges ","70% of total billed charges ",310.05,90,,248.04,,,0,"percent of total billed charges ","90% of total billed charges ",320.39,93,,256.31,,,0,"percent of total billed charges ","93% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",292.83,85,,234.26,,,0,"percent of total billed charges ","85% of total billed charges ",310.05,90,,248.04,,,0,"percent of total billed charges ","90% of total billed charges ",310.05,90,,248.04,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",299.72,87,,239.78,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",241.15,70,,192.92,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,320.39,
"GASTRIC ANALYSIS #S51438",2027210,"CDM ",301,RC,82930,HCPCS,OUTPATIENT,,,117.5,94,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.25,70,,65.80,,,0,"percent of total billed charges ","70% of total billed charges ",105.75,90,,84.60,,,0,"percent of total billed charges ","90% of total billed charges ",109.28,93,,87.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.88,85,,79.90,,,0,"percent of total billed charges ","85% of total billed charges ",105.75,90,,84.60,,,0,"percent of total billed charges ","90% of total billed charges ",105.75,90,,84.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",102.23,87,,81.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",6.71,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",82.25,70,,65.80,,,0,"percent of total billed charges ","70% of total billed charges ",6.71,109.28,
"*IGE, GAMMAGLOBULIN",2027220,"CDM ",301,RC,82785,HCPCS,OUTPATIENT,,,138.5,110.8,,13.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,75.73,75.73,75.73,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.95,70,,77.56,,,0,"percent of total billed charges ","70% of total billed charges ",124.65,90,,99.72,,,0,"percent of total billed charges ","90% of total billed charges ",128.81,93,,103.05,,,0,"percent of total billed charges ","93% of total billed charges ",13.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.57,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",117.73,85,,94.18,,,0,"percent of total billed charges ","85% of total billed charges ",124.65,90,,99.72,,,0,"percent of total billed charges ","90% of total billed charges ",124.65,90,,99.72,,,0,"percent of total billed charges ","90% of total billed charges ",17.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",120.5,87,,87.28,71.25,103.31,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.46,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",96.95,70,,77.56,,,0,"percent of total billed charges ","70% of total billed charges ",13.99,128.81,
"ALLERGEN SPEC IGE EA ALLERGEN",2027230,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"*SINGLE DRUG CLASS METHOD,EACH",2027250,"CDM ",301,RC,80307,HCPCS,OUTPATIENT,,,160.5,128.4,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",149.27,93,,119.42,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",136.43,85,,109.14,,,0,"percent of total billed charges ","85% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",139.64,87,,111.71,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",62.14,149.27,
"TRYPSINOGEN LEVEL #S51306",2027270,"CDM ",301,RC,83519,HCPCS,OUTPATIENT,,,248.5,198.8,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.95,70,,139.16,,,0,"percent of total billed charges ","70% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",231.11,93,,184.89,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",211.23,85,,168.98,,,0,"percent of total billed charges ","85% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",216.2,87,,172.96,,,0,"percent of total billed charges ","87% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",173.95,70,,139.16,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,231.11,
"PYRUVATE #S41620",2027280,"CDM ",301,RC,84210,HCPCS,OUTPATIENT,,,229.5,183.6,,12.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",160.65,70,,128.52,,,0,"percent of total billed charges ","70% of total billed charges ",206.55,90,,165.24,,,0,"percent of total billed charges ","90% of total billed charges ",213.44,93,,170.75,,,0,"percent of total billed charges ","93% of total billed charges ",12.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",195.08,85,,156.06,,,0,"percent of total billed charges ","85% of total billed charges ",206.55,90,,165.24,,,0,"percent of total billed charges ","90% of total billed charges ",206.55,90,,165.24,,,0,"percent of total billed charges ","90% of total billed charges ",14.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",199.67,87,,159.74,,,0,"percent of total billed charges ","87% of total billed charges ",14.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.48,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",160.65,70,,128.52,,,0,"percent of total billed charges ","70% of total billed charges ",12.31,213.44,
"*THYROGLOBULIN ANTIBODY",2027300,"CDM ",302,RC,86800,HCPCS,OUTPATIENT,,,194,155.2,,15.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,82.69,82.69,82.69,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",180.42,93,,144.34,,,0,"percent of total billed charges ","93% of total billed charges ",15.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.9,85,,131.92,,,0,"percent of total billed charges ","85% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",28.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",168.78,87,,15.60,15.60,63.84,"1 through 10","percent of total billed charges ","87% of total billed charges ",28.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.91,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",15.91,180.42,
*THYROGLOBULIN,2027310,"CDM ",301,RC,84432,HCPCS,OUTPATIENT,,,178.5,142.8,,16.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,106.38,106.38,106.38,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.95,70,,99.96,,,0,"percent of total billed charges ","70% of total billed charges ",160.65,90,,128.52,,,0,"percent of total billed charges ","90% of total billed charges ",166.01,93,,132.81,,,0,"percent of total billed charges ","93% of total billed charges ",16.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",151.73,85,,121.38,,,0,"percent of total billed charges ","85% of total billed charges ",160.65,90,,128.52,,,0,"percent of total billed charges ","90% of total billed charges ",160.65,90,,128.52,,,0,"percent of total billed charges ","90% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",155.3,87,,47.42,22.08,72.76,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",124.95,70,,99.96,,,0,"percent of total billed charges ","70% of total billed charges ",16.05,166.01,
"DEOXYCORTICOSTERONE #S51354",2027320,"CDM ",301,RC,82633,HCPCS,OUTPATIENT,,,383,306.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",268.1,70,,214.48,,,0,"percent of total billed charges ","70% of total billed charges ",344.7,90,,275.76,,,0,"percent of total billed charges ","90% of total billed charges ",356.19,93,,284.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",325.55,85,,260.44,,,0,"percent of total billed charges ","85% of total billed charges ",344.7,90,,275.76,,,0,"percent of total billed charges ","90% of total billed charges ",344.7,90,,275.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",333.21,87,,266.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",30.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",268.1,70,,214.48,,,0,"percent of total billed charges ","70% of total billed charges ",30.98,356.19,
"11-DEOXYCORTISOL LC,MS #S51410",2027330,"CDM ",301,RC,82634,HCPCS,OUTPATIENT,,,196,156.8,,24.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",137.2,70,,109.76,,,0,"percent of total billed charges ","70% of total billed charges ",176.4,90,,141.12,,,0,"percent of total billed charges ","90% of total billed charges ",182.28,93,,145.82,,,0,"percent of total billed charges ","93% of total billed charges ",24.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",166.6,85,,133.28,,,0,"percent of total billed charges ","85% of total billed charges ",176.4,90,,141.12,,,0,"percent of total billed charges ","90% of total billed charges ",176.4,90,,141.12,,,0,"percent of total billed charges ","90% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",170.52,87,,136.42,,,0,"percent of total billed charges ","87% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.28,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",137.2,70,,109.76,,,0,"percent of total billed charges ","70% of total billed charges ",24.89,182.28,
"VITAMIN C #VITC",2027340,"CDM ",301,RC,82180,HCPCS,OUTPATIENT,,,97,77.6,,9.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",90.21,93,,72.17,,,0,"percent of total billed charges ","93% of total billed charges ",9.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.06,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",82.45,85,,65.96,,,0,"percent of total billed charges ","85% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",17.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.39,87,,67.51,,,0,"percent of total billed charges ","87% of total billed charges ",17.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.89,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",9.89,90.21,
"MILK COWS IGE",2027350,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"EGG YOLK ALLERGEN #EEGGYO",2027360,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,93,74.4,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.1,70,,52.08,,,0,"percent of total billed charges ","70% of total billed charges ",83.7,90,,66.96,,,0,"percent of total billed charges ","90% of total billed charges ",86.49,93,,69.19,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",79.05,85,,63.24,,,0,"percent of total billed charges ","85% of total billed charges ",83.7,90,,66.96,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,90,,66.96,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.91,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",65.1,70,,52.08,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,86.49,
"HIV WESTERN BLOT #HIVWB",2027370,"CDM ",302,RC,86689,HCPCS,OUTPATIENT,,,414.5,331.6,,19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",290.15,70,,232.12,,,0,"percent of total billed charges ","70% of total billed charges ",373.05,90,,298.44,,,0,"percent of total billed charges ","90% of total billed charges ",385.49,93,,308.39,,,0,"percent of total billed charges ","93% of total billed charges ",19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",352.33,85,,281.86,,,0,"percent of total billed charges ","85% of total billed charges ",373.05,90,,298.44,,,0,"percent of total billed charges ","90% of total billed charges ",373.05,90,,298.44,,,0,"percent of total billed charges ","90% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",360.62,87,,288.50,,,0,"percent of total billed charges ","87% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.35,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",290.15,70,,232.12,,,0,"percent of total billed charges ","70% of total billed charges ",19.35,385.49,
"FUNGUS CULTURE #CFUN",2027440,"CDM ",306,RC,87102,HCPCS,OUTPATIENT,,,187,149.6,,8.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",173.91,93,,139.13,,,0,"percent of total billed charges ","93% of total billed charges ",8.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",158.95,85,,127.16,,,0,"percent of total billed charges ","85% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",162.69,87,,130.15,,,0,"percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.41,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,173.91,
"HAEMOPHILUS FLU B,ABS #HINBG",2027450,"CDM ",302,RC,86317,HCPCS,OUTPATIENT,,,170.5,136.4,,12.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.35,70,,95.48,,,0,"percent of total billed charges ","70% of total billed charges ",153.45,90,,122.76,,,0,"percent of total billed charges ","90% of total billed charges ",158.57,93,,126.86,,,0,"percent of total billed charges ","93% of total billed charges ",12.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",144.93,85,,115.94,,,0,"percent of total billed charges ","85% of total billed charges ",153.45,90,,122.76,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,90,,122.76,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",148.34,87,,118.67,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.99,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",119.35,70,,95.48,,,0,"percent of total billed charges ","70% of total billed charges ",12.74,158.57,
"SMITH-LEMIL OPITZ SCREEN",2027460,"CDM ",301,RC,82542,HCPCS,OUTPATIENT,,,379.5,303.6,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",265.65,70,,212.52,,,0,"percent of total billed charges ","70% of total billed charges ",341.55,90,,273.24,,,0,"percent of total billed charges ","90% of total billed charges ",352.94,93,,282.35,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",322.58,85,,258.06,,,0,"percent of total billed charges ","85% of total billed charges ",341.55,90,,273.24,,,0,"percent of total billed charges ","90% of total billed charges ",341.55,90,,273.24,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.17,87,,264.14,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",265.65,70,,212.52,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,352.94,
"*CYTOGENETICS,INTERP & REPORT",2027470,"CDM ",300,RC,88291,HCPCS,OUTPATIENT,,,446,356.8,,26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",69.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",312.2,70,,249.76,,,0,"percent of total billed charges ","70% of total billed charges ",401.4,90,,321.12,,,0,"percent of total billed charges ","90% of total billed charges ",414.78,93,,331.82,,,0,"percent of total billed charges ","93% of total billed charges ",26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",379.1,85,,303.28,,,0,"percent of total billed charges ","85% of total billed charges ",401.4,90,,321.12,,,0,"percent of total billed charges ","90% of total billed charges ",401.4,90,,321.12,,,0,"percent of total billed charges ","90% of total billed charges ",32.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",388.02,87,,310.42,,,0,"percent of total billed charges ","87% of total billed charges ",32.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",312.2,70,,249.76,,,0,"percent of total billed charges ","70% of total billed charges ",26,414.78,
"*CHROMOSOMAL SITU ANAL 10-30",2027480,"CDM ",300,RC,88273,HCPCS,OUTPATIENT,,,446,356.8,,34.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",312.2,70,,249.76,,,0,"percent of total billed charges ","70% of total billed charges ",401.4,90,,321.12,,,0,"percent of total billed charges ","90% of total billed charges ",414.78,93,,331.82,,,0,"percent of total billed charges ","93% of total billed charges ",34.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",50.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",379.1,85,,303.28,,,0,"percent of total billed charges ","85% of total billed charges ",401.4,90,,321.12,,,0,"percent of total billed charges ","90% of total billed charges ",401.4,90,,321.12,,,0,"percent of total billed charges ","90% of total billed charges ",49.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",388.02,87,,310.42,,,0,"percent of total billed charges ","87% of total billed charges ",49.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.81,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",312.2,70,,249.76,,,0,"percent of total billed charges ","70% of total billed charges ",34.81,414.78,
"*MOLECULAR CYTO DNA PROBE EACH",2027490,"CDM ",300,RC,88271,HCPCS,OUTPATIENT,,,446,356.8,,21.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",312.2,70,,249.76,,,0,"percent of total billed charges ","70% of total billed charges ",401.4,90,,321.12,,,0,"percent of total billed charges ","90% of total billed charges ",414.78,93,,331.82,,,0,"percent of total billed charges ","93% of total billed charges ",21.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",379.1,85,,303.28,,,0,"percent of total billed charges ","85% of total billed charges ",401.4,90,,321.12,,,0,"percent of total billed charges ","90% of total billed charges ",401.4,90,,321.12,,,0,"percent of total billed charges ","90% of total billed charges ",33.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",388.02,87,,310.42,,,0,"percent of total billed charges ","87% of total billed charges ",33.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.42,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",312.2,70,,249.76,,,0,"percent of total billed charges ","70% of total billed charges ",21.42,414.78,
"RNP (RIBONUCLEIC PROT ANTIBOD)",2027510,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,149.5,119.6,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",139.04,93,,111.23,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",127.08,85,,101.66,,,0,"percent of total billed charges ","85% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.07,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,139.04,
"VITB2 -VITAMIN B2 (RIBOFLAVIN)",2027520,"CDM ",301,RC,84252,HCPCS,OUTPATIENT,,,761,608.8,,20.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",532.7,70,,426.16,,,0,"percent of total billed charges ","70% of total billed charges ",684.9,90,,547.92,,,0,"percent of total billed charges ","90% of total billed charges ",707.73,93,,566.18,,,0,"percent of total billed charges ","93% of total billed charges ",20.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",646.85,85,,517.48,,,0,"percent of total billed charges ","85% of total billed charges ",684.9,90,,547.92,,,0,"percent of total billed charges ","90% of total billed charges ",684.9,90,,547.92,,,0,"percent of total billed charges ","90% of total billed charges ",36.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",662.07,87,,529.66,,,0,"percent of total billed charges ","87% of total billed charges ",36.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.23,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",532.7,70,,426.16,,,0,"percent of total billed charges ","70% of total billed charges ",20.23,707.73,
"OCCULT BLOOD OTHER NON-SCREEN",2027580,"CDM ",301,RC,82272,HCPCS,OUTPATIENT,,,73,58.4,,3.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.1,70,,40.88,,,0,"percent of total billed charges ","70% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",67.89,93,,54.31,,,0,"percent of total billed charges ","93% of total billed charges ",3.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.05,85,,49.64,,,0,"percent of total billed charges ","85% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",5.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.51,87,,50.81,,,0,"percent of total billed charges ","87% of total billed charges ",5.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.23,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",51.1,70,,40.88,,,0,"percent of total billed charges ","70% of total billed charges ",3.86,67.89,
"*HEP B CORE ANTIBODY",2027590,"CDM ",302,RC,86704,HCPCS,OUTPATIENT,,,145,116,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.29,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",19.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",126.15,87,,100.92,,,0,"percent of total billed charges ","87% of total billed charges ",19.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,134.85,
"*HEP B SURFACE ANTIBODY",2027600,"CDM ",302,RC,86706,HCPCS,OUTPATIENT,,,133,106.4,,10.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.1,70,,74.48,,,0,"percent of total billed charges ","70% of total billed charges ",119.7,90,,95.76,,,0,"percent of total billed charges ","90% of total billed charges ",123.69,93,,98.95,,,0,"percent of total billed charges ","93% of total billed charges ",10.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",113.05,85,,90.44,,,0,"percent of total billed charges ","85% of total billed charges ",119.7,90,,95.76,,,0,"percent of total billed charges ","90% of total billed charges ",119.7,90,,95.76,,,0,"percent of total billed charges ","90% of total billed charges ",19.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",115.71,87,,92.57,,,0,"percent of total billed charges ","87% of total billed charges ",19.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",93.1,70,,74.48,,,0,"percent of total billed charges ","70% of total billed charges ",10.74,123.69,
"*HEP B SURFACE ANTIGEN",2027610,"CDM ",306,RC,87340,HCPCS,OUTPATIENT,,,68,54.4,,10.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.6,70,,38.08,,,0,"percent of total billed charges ","70% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",63.24,93,,50.59,,,0,"percent of total billed charges ","93% of total billed charges ",10.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",57.8,85,,46.24,,,0,"percent of total billed charges ","85% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",15.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.16,87,,46.55,46.55,46.55,11,"percent of total billed charges ","87% of total billed charges ",15.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.33,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",47.6,70,,38.08,,,0,"percent of total billed charges ","70% of total billed charges ",10.33,63.24,
"MCOMO-OPIATES CONFIRM, URINE",2027630,"CDM ",301,RC,80307,HCPCS,OUTPATIENT,,,216,172.8,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.2,70,,120.96,,,0,"percent of total billed charges ","70% of total billed charges ",194.4,90,,155.52,,,0,"percent of total billed charges ","90% of total billed charges ",200.88,93,,160.70,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",183.6,85,,146.88,,,0,"percent of total billed charges ","85% of total billed charges ",194.4,90,,155.52,,,0,"percent of total billed charges ","90% of total billed charges ",194.4,90,,155.52,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",187.92,87,,150.34,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",151.2,70,,120.96,,,0,"percent of total billed charges ","70% of total billed charges ",62.14,200.88,
"MBENZ-BENZODIAZAPINE CONF URIN",2027640,"CDM ",301,RC,80307,HCPCS,OUTPATIENT,,,216,172.8,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.2,70,,120.96,,,0,"percent of total billed charges ","70% of total billed charges ",194.4,90,,155.52,,,0,"percent of total billed charges ","90% of total billed charges ",200.88,93,,160.70,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",183.6,85,,146.88,,,0,"percent of total billed charges ","85% of total billed charges ",194.4,90,,155.52,,,0,"percent of total billed charges ","90% of total billed charges ",194.4,90,,155.52,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",187.92,87,,150.34,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",151.2,70,,120.96,,,0,"percent of total billed charges ","70% of total billed charges ",62.14,200.88,
"MTHCC-THC-CANNABINOIDS-CONF UR",2027650,"CDM ",301,RC,80307,HCPCS,OUTPATIENT,,,216,172.8,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.2,70,,120.96,,,0,"percent of total billed charges ","70% of total billed charges ",194.4,90,,155.52,,,0,"percent of total billed charges ","90% of total billed charges ",200.88,93,,160.70,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",183.6,85,,146.88,,,0,"percent of total billed charges ","85% of total billed charges ",194.4,90,,155.52,,,0,"percent of total billed charges ","90% of total billed charges ",194.4,90,,155.52,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",187.92,87,,150.34,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",151.2,70,,120.96,,,0,"percent of total billed charges ","70% of total billed charges ",62.14,200.88,
"*INFECTIOUS AGENT DETECTION",2027660,"CDM ",306,RC,87260,HCPCS,OUTPATIENT,,,169,135.2,,14.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",157.17,93,,125.74,,,0,"percent of total billed charges ","93% of total billed charges ",14.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.65,85,,114.92,,,0,"percent of total billed charges ","85% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.03,87,,117.62,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",14.43,157.17,
"*INFLUENZA A VIRUS",2027670,"CDM ",306,RC,87276,HCPCS,OUTPATIENT,,,152,121.6,,14.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",141.36,93,,113.09,,,0,"percent of total billed charges ","93% of total billed charges ",14.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",129.2,85,,103.36,,,0,"percent of total billed charges ","85% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.24,87,,105.79,,,0,"percent of total billed charges ","87% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",14.09,141.36,
"*INFLUENZA B VIRUS",2027680,"CDM ",306,RC,87275,HCPCS,OUTPATIENT,,,152,121.6,,12.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",141.36,93,,113.09,,,0,"percent of total billed charges ","93% of total billed charges ",12.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",129.2,85,,103.36,,,0,"percent of total billed charges ","85% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.24,87,,105.79,,,0,"percent of total billed charges ","87% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.25,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",12.25,141.36,
"AMINOLEVULINIC ACID, URINE",2027700,"CDM ",301,RC,82135,HCPCS,OUTPATIENT,,,325.5,260.4,,16.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.85,70,,182.28,,,0,"percent of total billed charges ","70% of total billed charges ",292.95,90,,234.36,,,0,"percent of total billed charges ","90% of total billed charges ",302.72,93,,242.18,,,0,"percent of total billed charges ","93% of total billed charges ",16.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",276.68,85,,221.34,,,0,"percent of total billed charges ","85% of total billed charges ",292.95,90,,234.36,,,0,"percent of total billed charges ","90% of total billed charges ",292.95,90,,234.36,,,0,"percent of total billed charges ","90% of total billed charges ",21.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",283.19,87,,226.55,,,0,"percent of total billed charges ","87% of total billed charges ",21.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",227.85,70,,182.28,,,0,"percent of total billed charges ","70% of total billed charges ",16.45,302.72,
"PORPHOBILINOGEN (PBGD)",2027710,"CDM ",301,RC,82657,HCPCS,OUTPATIENT,,,218,174.4,,22.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.6,70,,122.08,,,0,"percent of total billed charges ","70% of total billed charges ",196.2,90,,156.96,,,0,"percent of total billed charges ","90% of total billed charges ",202.74,93,,162.19,,,0,"percent of total billed charges ","93% of total billed charges ",22.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",185.3,85,,148.24,,,0,"percent of total billed charges ","85% of total billed charges ",196.2,90,,156.96,,,0,"percent of total billed charges ","90% of total billed charges ",196.2,90,,156.96,,,0,"percent of total billed charges ","90% of total billed charges ",38.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",189.66,87,,151.73,,,0,"percent of total billed charges ","87% of total billed charges ",38.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.17,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",152.6,70,,122.08,,,0,"percent of total billed charges ","70% of total billed charges ",22.17,202.74,
*MANUAL,2027730,"CDM ",300,RC,88368,HCPCS,OUTPATIENT,,,801.5,641.2,,123.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",280.96,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",561.05,70,,448.84,,,0,"percent of total billed charges ","70% of total billed charges ",721.35,90,,577.08,,,0,"percent of total billed charges ","90% of total billed charges ",745.4,93,,596.32,,,0,"percent of total billed charges ","93% of total billed charges ",123.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",681.28,85,,545.02,,,0,"percent of total billed charges ","85% of total billed charges ",721.35,90,,577.08,,,0,"percent of total billed charges ","90% of total billed charges ",721.35,90,,577.08,,,0,"percent of total billed charges ","90% of total billed charges ",59.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",697.31,87,,557.85,,,0,"percent of total billed charges ","87% of total billed charges ",59.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",561.05,70,,448.84,,,0,"percent of total billed charges ","70% of total billed charges ",59.62,745.4,
"*ALLERGY SPECIFIC IGE QT EACH",2027750,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"HEPARIN LEVEL FACTOR XA(HEPXA)",2027760,"CDM ",305,RC,85520,HCPCS,OUTPATIENT,,,170,136,,13.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119,70,,95.20,,,0,"percent of total billed charges ","70% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",158.1,93,,126.48,,,0,"percent of total billed charges ","93% of total billed charges ",13.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",144.5,85,,115.60,,,0,"percent of total billed charges ","85% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",23.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.9,87,,118.32,,,0,"percent of total billed charges ","87% of total billed charges ",23.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",119,70,,95.20,,,0,"percent of total billed charges ","70% of total billed charges ",13.09,158.1,
"*MORPHOMETRIC ANALYSIS",2027770,"CDM ",310,RC,88368,HCPCS,OUTPATIENT,,,746.5,597.2,,123.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",280.96,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",522.55,70,,418.04,,,0,"percent of total billed charges ","70% of total billed charges ",671.85,90,,537.48,,,0,"percent of total billed charges ","90% of total billed charges ",694.25,93,,555.40,,,0,"percent of total billed charges ","93% of total billed charges ",123.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",634.53,85,,507.62,,,0,"percent of total billed charges ","85% of total billed charges ",671.85,90,,537.48,,,0,"percent of total billed charges ","90% of total billed charges ",671.85,90,,537.48,,,0,"percent of total billed charges ","90% of total billed charges ",59.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",649.46,87,,519.57,,,0,"percent of total billed charges ","87% of total billed charges ",59.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",522.55,70,,418.04,,,0,"percent of total billed charges ","70% of total billed charges ",59.62,694.25,
"*TISSUE CULT NON NEOPL LYMPHOS",2027790,"CDM ",300,RC,88230,HCPCS,OUTPATIENT,,,1410.5,1128.4,,99.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",987.35,70,,789.88,,,0,"percent of total billed charges ","70% of total billed charges ",1269.45,90,,1015.56,,,0,"percent of total billed charges ","90% of total billed charges ",1311.77,93,,1049.42,,,0,"percent of total billed charges ","93% of total billed charges ",99.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1198.93,85,,959.14,,,0,"percent of total billed charges ","85% of total billed charges ",1269.45,90,,1015.56,,,0,"percent of total billed charges ","90% of total billed charges ",1269.45,90,,1015.56,,,0,"percent of total billed charges ","90% of total billed charges ",34.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1227.14,87,,981.71,,,0,"percent of total billed charges ","87% of total billed charges ",34.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",116.49,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",987.35,70,,789.88,,,0,"percent of total billed charges ","70% of total billed charges ",34.88,1311.77,
"*CHROMO ANALYSIS; 15-20 CELLS",2027800,"CDM ",300,RC,88262,HCPCS,OUTPATIENT,,,1235,988,,125.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",864.5,70,,691.60,,,0,"percent of total billed charges ","70% of total billed charges ",1111.5,90,,889.20,,,0,"percent of total billed charges ","90% of total billed charges ",1148.55,93,,918.84,,,0,"percent of total billed charges ","93% of total billed charges ",125.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",227.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1049.75,85,,839.80,,,0,"percent of total billed charges ","85% of total billed charges ",1111.5,90,,889.20,,,0,"percent of total billed charges ","90% of total billed charges ",1111.5,90,,889.20,,,0,"percent of total billed charges ","90% of total billed charges ",225.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1074.45,87,,859.56,,,0,"percent of total billed charges ","87% of total billed charges ",225.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",125.49,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",864.5,70,,691.60,,,0,"percent of total billed charges ","70% of total billed charges ",125.49,1148.55,
"*CHROMO ANAL; ADDL KARYOTYPES",2027810,"CDM ",300,RC,88280,HCPCS,OUTPATIENT,,,548.5,438.8,,33.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",383.95,70,,307.16,,,0,"percent of total billed charges ","70% of total billed charges ",493.65,90,,394.92,,,0,"percent of total billed charges ","90% of total billed charges ",510.11,93,,408.09,,,0,"percent of total billed charges ","93% of total billed charges ",33.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.84,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",466.23,85,,372.98,,,0,"percent of total billed charges ","85% of total billed charges ",493.65,90,,394.92,,,0,"percent of total billed charges ","90% of total billed charges ",493.65,90,,394.92,,,0,"percent of total billed charges ","90% of total billed charges ",45.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",477.2,87,,381.76,,,0,"percent of total billed charges ","87% of total billed charges ",45.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.47,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",383.95,70,,307.16,,,0,"percent of total billed charges ","70% of total billed charges ",33.47,510.11,
"*CYTOGENICS AND MOLECULAR CYTO",2027820,"CDM ",310,RC,88291,HCPCS,OUTPATIENT,,,398,318.4,,26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",69.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",278.6,70,,222.88,,,0,"percent of total billed charges ","70% of total billed charges ",358.2,90,,286.56,,,0,"percent of total billed charges ","90% of total billed charges ",370.14,93,,296.11,,,0,"percent of total billed charges ","93% of total billed charges ",26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",338.3,85,,270.64,,,0,"percent of total billed charges ","85% of total billed charges ",358.2,90,,286.56,,,0,"percent of total billed charges ","90% of total billed charges ",358.2,90,,286.56,,,0,"percent of total billed charges ","90% of total billed charges ",32.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",346.26,87,,277.01,,,0,"percent of total billed charges ","87% of total billed charges ",32.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",278.6,70,,222.88,,,0,"percent of total billed charges ","70% of total billed charges ",26,370.14,
"*MORPHOMETRIC ANALY, EA PROBE",2027840,"CDM ",310,RC,88368,HCPCS,OUTPATIENT,,,665.5,532.4,,123.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",280.96,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",465.85,70,,372.68,,,0,"percent of total billed charges ","70% of total billed charges ",598.95,90,,479.16,,,0,"percent of total billed charges ","90% of total billed charges ",618.92,93,,495.14,,,0,"percent of total billed charges ","93% of total billed charges ",123.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",565.68,85,,452.54,,,0,"percent of total billed charges ","85% of total billed charges ",598.95,90,,479.16,,,0,"percent of total billed charges ","90% of total billed charges ",598.95,90,,479.16,,,0,"percent of total billed charges ","90% of total billed charges ",59.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",578.99,87,,463.19,,,0,"percent of total billed charges ","87% of total billed charges ",59.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",465.85,70,,372.68,,,0,"percent of total billed charges ","70% of total billed charges ",59.62,618.92,
"*MORPHOMETRIC ANAL, EA PROBE",2027860,"CDM ",310,RC,88368,HCPCS,OUTPATIENT,,,705.5,564.4,,123.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",280.96,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",493.85,70,,395.08,,,0,"percent of total billed charges ","70% of total billed charges ",634.95,90,,507.96,,,0,"percent of total billed charges ","90% of total billed charges ",656.12,93,,524.90,,,0,"percent of total billed charges ","93% of total billed charges ",123.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",599.68,85,,479.74,,,0,"percent of total billed charges ","85% of total billed charges ",634.95,90,,507.96,,,0,"percent of total billed charges ","90% of total billed charges ",634.95,90,,507.96,,,0,"percent of total billed charges ","90% of total billed charges ",59.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",613.79,87,,491.03,,,0,"percent of total billed charges ","87% of total billed charges ",59.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",493.85,70,,395.08,,,0,"percent of total billed charges ","70% of total billed charges ",59.62,656.12,
"*ADD'L HIGH REP STUDY",2027880,"CDM ",300,RC,88289,HCPCS,OUTPATIENT,,,1057,845.6,,34.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",739.9,70,,591.92,,,0,"percent of total billed charges ","70% of total billed charges ",951.3,90,,761.04,,,0,"percent of total billed charges ","90% of total billed charges ",983.01,93,,786.41,,,0,"percent of total billed charges ","93% of total billed charges ",34.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.87,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",898.45,85,,718.76,,,0,"percent of total billed charges ","85% of total billed charges ",951.3,90,,761.04,,,0,"percent of total billed charges ","90% of total billed charges ",951.3,90,,761.04,,,0,"percent of total billed charges ","90% of total billed charges ",62.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",919.59,87,,735.67,,,0,"percent of total billed charges ","87% of total billed charges ",62.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",739.9,70,,591.92,,,0,"percent of total billed charges ","70% of total billed charges ",34.43,983.01,
"*TISSUE CULT NON-NEO DISORDERS",2027890,"CDM ",300,RC,88230,HCPCS,OUTPATIENT,,,1410.5,1128.4,,99.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",987.35,70,,789.88,,,0,"percent of total billed charges ","70% of total billed charges ",1269.45,90,,1015.56,,,0,"percent of total billed charges ","90% of total billed charges ",1311.77,93,,1049.42,,,0,"percent of total billed charges ","93% of total billed charges ",99.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1198.93,85,,959.14,,,0,"percent of total billed charges ","85% of total billed charges ",1269.45,90,,1015.56,,,0,"percent of total billed charges ","90% of total billed charges ",1269.45,90,,1015.56,,,0,"percent of total billed charges ","90% of total billed charges ",34.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1227.14,87,,981.71,,,0,"percent of total billed charges ","87% of total billed charges ",34.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",116.49,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",987.35,70,,789.88,,,0,"percent of total billed charges ","70% of total billed charges ",34.88,1311.77,
"*COUNT 15-20 CELLS W/BANDING",2027900,"CDM ",300,RC,88262,HCPCS,OUTPATIENT,,,1235,988,,125.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",864.5,70,,691.60,,,0,"percent of total billed charges ","70% of total billed charges ",1111.5,90,,889.20,,,0,"percent of total billed charges ","90% of total billed charges ",1148.55,93,,918.84,,,0,"percent of total billed charges ","93% of total billed charges ",125.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",227.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1049.75,85,,839.80,,,0,"percent of total billed charges ","85% of total billed charges ",1111.5,90,,889.20,,,0,"percent of total billed charges ","90% of total billed charges ",1111.5,90,,889.20,,,0,"percent of total billed charges ","90% of total billed charges ",225.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1074.45,87,,859.56,,,0,"percent of total billed charges ","87% of total billed charges ",225.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",125.49,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",864.5,70,,691.60,,,0,"percent of total billed charges ","70% of total billed charges ",125.49,1148.55,
"*CYTOGENICS, INTERP & REPORT",2027910,"CDM ",300,RC,88291,HCPCS,OUTPATIENT,,,404,323.2,,26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",69.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",282.8,70,,226.24,,,0,"percent of total billed charges ","70% of total billed charges ",363.6,90,,290.88,,,0,"percent of total billed charges ","90% of total billed charges ",375.72,93,,300.58,,,0,"percent of total billed charges ","93% of total billed charges ",26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",343.4,85,,274.72,,,0,"percent of total billed charges ","85% of total billed charges ",363.6,90,,290.88,,,0,"percent of total billed charges ","90% of total billed charges ",363.6,90,,290.88,,,0,"percent of total billed charges ","90% of total billed charges ",32.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",351.48,87,,281.18,,,0,"percent of total billed charges ","87% of total billed charges ",32.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",282.8,70,,226.24,,,0,"percent of total billed charges ","70% of total billed charges ",26,375.72,
"*MORPHOMETRIC ANAL; MANUAL",2027930,"CDM ",310,RC,88368,HCPCS,OUTPATIENT,,,665.5,532.4,,123.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",280.96,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",465.85,70,,372.68,,,0,"percent of total billed charges ","70% of total billed charges ",598.95,90,,479.16,,,0,"percent of total billed charges ","90% of total billed charges ",618.92,93,,495.14,,,0,"percent of total billed charges ","93% of total billed charges ",123.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",565.68,85,,452.54,,,0,"percent of total billed charges ","85% of total billed charges ",598.95,90,,479.16,,,0,"percent of total billed charges ","90% of total billed charges ",598.95,90,,479.16,,,0,"percent of total billed charges ","90% of total billed charges ",59.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",578.99,87,,463.19,,,0,"percent of total billed charges ","87% of total billed charges ",59.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",465.85,70,,372.68,,,0,"percent of total billed charges ","70% of total billed charges ",59.62,618.92,
17-HYDROXYPROGESTERONE,2027950,"CDM ",301,RC,83498,HCPCS,OUTPATIENT,,,187,149.6,,27.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",173.91,93,,139.13,,,0,"percent of total billed charges ","93% of total billed charges ",27.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",158.95,85,,127.16,,,0,"percent of total billed charges ","85% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",36.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",162.69,87,,130.15,,,0,"percent of total billed charges ","87% of total billed charges ",36.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.17,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",27.17,173.91,
"*TISSUE CULT NON-NEOPLASTIC",2027960,"CDM ",300,RC,88230,HCPCS,OUTPATIENT,,,1410.5,1128.4,,99.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",987.35,70,,789.88,,,0,"percent of total billed charges ","70% of total billed charges ",1269.45,90,,1015.56,,,0,"percent of total billed charges ","90% of total billed charges ",1311.77,93,,1049.42,,,0,"percent of total billed charges ","93% of total billed charges ",99.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1198.93,85,,959.14,,,0,"percent of total billed charges ","85% of total billed charges ",1269.45,90,,1015.56,,,0,"percent of total billed charges ","90% of total billed charges ",1269.45,90,,1015.56,,,0,"percent of total billed charges ","90% of total billed charges ",34.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1227.14,87,,981.71,,,0,"percent of total billed charges ","87% of total billed charges ",34.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",116.49,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",987.35,70,,789.88,,,0,"percent of total billed charges ","70% of total billed charges ",34.88,1311.77,
"*COUNT 15-20 CELLS W/BANDING",2027970,"CDM ",300,RC,88262,HCPCS,OUTPATIENT,,,1235,988,,125.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",864.5,70,,691.60,,,0,"percent of total billed charges ","70% of total billed charges ",1111.5,90,,889.20,,,0,"percent of total billed charges ","90% of total billed charges ",1148.55,93,,918.84,,,0,"percent of total billed charges ","93% of total billed charges ",125.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",227.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1049.75,85,,839.80,,,0,"percent of total billed charges ","85% of total billed charges ",1111.5,90,,889.20,,,0,"percent of total billed charges ","90% of total billed charges ",1111.5,90,,889.20,,,0,"percent of total billed charges ","90% of total billed charges ",225.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1074.45,87,,859.56,,,0,"percent of total billed charges ","87% of total billed charges ",225.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",125.49,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",864.5,70,,691.60,,,0,"percent of total billed charges ","70% of total billed charges ",125.49,1148.55,
"*CHROMOSOME ANALYSIS, EACH",2027980,"CDM ",300,RC,88280,HCPCS,OUTPATIENT,,,548.5,438.8,,33.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",383.95,70,,307.16,,,0,"percent of total billed charges ","70% of total billed charges ",493.65,90,,394.92,,,0,"percent of total billed charges ","90% of total billed charges ",510.11,93,,408.09,,,0,"percent of total billed charges ","93% of total billed charges ",33.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.84,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",466.23,85,,372.98,,,0,"percent of total billed charges ","85% of total billed charges ",493.65,90,,394.92,,,0,"percent of total billed charges ","90% of total billed charges ",493.65,90,,394.92,,,0,"percent of total billed charges ","90% of total billed charges ",45.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",477.2,87,,381.76,,,0,"percent of total billed charges ","87% of total billed charges ",45.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.47,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",383.95,70,,307.16,,,0,"percent of total billed charges ","70% of total billed charges ",33.47,510.11,
"*CYTOGENICS INTERP & REPORT",2027990,"CDM ",300,RC,88291,HCPCS,OUTPATIENT,,,291.5,233.2,,26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",69.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",204.05,70,,163.24,,,0,"percent of total billed charges ","70% of total billed charges ",262.35,90,,209.88,,,0,"percent of total billed charges ","90% of total billed charges ",271.1,93,,216.88,,,0,"percent of total billed charges ","93% of total billed charges ",26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",247.78,85,,198.22,,,0,"percent of total billed charges ","85% of total billed charges ",262.35,90,,209.88,,,0,"percent of total billed charges ","90% of total billed charges ",262.35,90,,209.88,,,0,"percent of total billed charges ","90% of total billed charges ",32.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",253.61,87,,202.89,,,0,"percent of total billed charges ","87% of total billed charges ",32.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",204.05,70,,163.24,,,0,"percent of total billed charges ","70% of total billed charges ",26,271.1,
"EOSINOPHIL COUNT, BODY FLUID",2028010,"CDM ",301,RC,89050,HCPCS,OUTPATIENT,,,123.5,98.8,,4.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.45,70,,69.16,,,0,"percent of total billed charges ","70% of total billed charges ",111.15,90,,88.92,,,0,"percent of total billed charges ","90% of total billed charges ",114.86,93,,91.89,,,0,"percent of total billed charges ","93% of total billed charges ",4.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.87,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.98,85,,83.98,,,0,"percent of total billed charges ","85% of total billed charges ",111.15,90,,88.92,,,0,"percent of total billed charges ","90% of total billed charges ",111.15,90,,88.92,,,0,"percent of total billed charges ","90% of total billed charges ",4.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.45,87,,85.96,,,0,"percent of total billed charges ","87% of total billed charges ",4.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.72,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",86.45,70,,69.16,,,0,"percent of total billed charges ","70% of total billed charges ",4.01,114.86,
*URINE,2028020,"CDM ",301,RC,84156,HCPCS,OUTPATIENT,,,127,101.6,,3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.9,70,,71.12,,,0,"percent of total billed charges ","70% of total billed charges ",114.3,90,,91.44,,,0,"percent of total billed charges ","90% of total billed charges ",118.11,93,,94.49,,,0,"percent of total billed charges ","93% of total billed charges ",3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",107.95,85,,86.36,,,0,"percent of total billed charges ","85% of total billed charges ",114.3,90,,91.44,,,0,"percent of total billed charges ","90% of total billed charges ",114.3,90,,91.44,,,0,"percent of total billed charges ","90% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",110.49,87,,43.83,11.65,76.01,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",88.9,70,,71.12,,,0,"percent of total billed charges ","70% of total billed charges ",3.67,118.11,
"*OTHER FLUIDS - URINE",2028030,"CDM ",302,RC,86335,HCPCS,OUTPATIENT,,,218,174.4,,29.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.6,70,,122.08,,,0,"percent of total billed charges ","70% of total billed charges ",196.2,90,,156.96,,,0,"percent of total billed charges ","90% of total billed charges ",202.74,93,,162.19,,,0,"percent of total billed charges ","93% of total billed charges ",29.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",185.3,85,,148.24,,,0,"percent of total billed charges ","85% of total billed charges ",196.2,90,,156.96,,,0,"percent of total billed charges ","90% of total billed charges ",196.2,90,,156.96,,,0,"percent of total billed charges ","90% of total billed charges ",45.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",189.66,87,,151.73,,,0,"percent of total billed charges ","87% of total billed charges ",45.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.35,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",152.6,70,,122.08,,,0,"percent of total billed charges ","70% of total billed charges ",29.35,202.74,
"ARRAY GENOMIC HYBRID (ACGH)",2028160,"CDM ",309,RC,81229,HCPCS,OUTPATIENT,,,4773.5,3818.8,,986,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3341.45,70,,2673.16,,,0,"percent of total billed charges ","70% of total billed charges ",4296.15,90,,3436.92,,,0,"percent of total billed charges ","90% of total billed charges ",4439.36,93,,3551.49,,,0,"percent of total billed charges ","93% of total billed charges ",986,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1252.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4057.48,85,,3245.98,,,0,"percent of total billed charges ","85% of total billed charges ",4296.15,90,,3436.92,,,0,"percent of total billed charges ","90% of total billed charges ",4296.15,90,,3436.92,,,0,"percent of total billed charges ","90% of total billed charges ",1240.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4152.95,87,,3322.36,,,0,"percent of total billed charges ","87% of total billed charges ",1240.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1160,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",3341.45,70,,2673.16,,,0,"percent of total billed charges ","70% of total billed charges ",986,4439.36,
"B CELL MARKER (CD20)",2028170,"CDM ",300,RC,88184,HCPCS,OUTPATIENT,,,333,266.4,,53.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",137.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",233.1,70,,186.48,,,0,"percent of total billed charges ","70% of total billed charges ",299.7,90,,239.76,,,0,"percent of total billed charges ","90% of total billed charges ",309.69,93,,247.75,,,0,"percent of total billed charges ","93% of total billed charges ",53.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",283.05,85,,226.44,,,0,"percent of total billed charges ","85% of total billed charges ",299.7,90,,239.76,,,0,"percent of total billed charges ","90% of total billed charges ",299.7,90,,239.76,,,0,"percent of total billed charges ","90% of total billed charges ",43.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",289.71,87,,231.77,,,0,"percent of total billed charges ","87% of total billed charges ",43.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",233.1,70,,186.48,,,0,"percent of total billed charges ","70% of total billed charges ",43.19,329.64,
"CYTOPATHY,THIN LAYER PAP SMEAR",2028180,"CDM ",300,RC,88175,HCPCS,OUTPATIENT,,,74.5,59.6,,25.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",69.29,93,,55.43,,,0,"percent of total billed charges ","93% of total billed charges ",25.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",63.33,85,,50.66,,,0,"percent of total billed charges ","85% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",33.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.82,87,,51.86,,,0,"percent of total billed charges ","87% of total billed charges ",33.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",25.7,69.29,
"CYTOLOGY INTERP PAP SMEAR",2028190,"CDM ",300,RC,88141,HCPCS,OUTPATIENT,,,63.5,50.8,,19.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",46.4,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",44.45,70,,35.56,,,0,"percent of total billed charges ","70% of total billed charges ",57.15,90,,45.72,,,0,"percent of total billed charges ","90% of total billed charges ",59.06,93,,47.25,,,0,"percent of total billed charges ","93% of total billed charges ",19.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",53.98,85,,43.18,,,0,"percent of total billed charges ","85% of total billed charges ",57.15,90,,45.72,,,0,"percent of total billed charges ","90% of total billed charges ",57.15,90,,45.72,,,0,"percent of total billed charges ","90% of total billed charges ",16.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",55.25,87,,44.20,,,0,"percent of total billed charges ","87% of total billed charges ",16.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.45,70,,35.56,,,0,"percent of total billed charges ","70% of total billed charges ",16.08,59.06,
"RUBEOLA IGM",2028200,"CDM ",302,RC,86765,HCPCS,OUTPATIENT,,,191,152.8,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.7,70,,106.96,,,0,"percent of total billed charges ","70% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",177.63,93,,142.10,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",162.35,85,,129.88,,,0,"percent of total billed charges ","85% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",166.17,87,,132.94,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",133.7,70,,106.96,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,177.63,
*MANUAL,2028220,"CDM ",300,RC,88368,HCPCS,OUTPATIENT,,,746,596.8,,123.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",280.96,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",522.2,70,,417.76,,,0,"percent of total billed charges ","70% of total billed charges ",671.4,90,,537.12,,,0,"percent of total billed charges ","90% of total billed charges ",693.78,93,,555.02,,,0,"percent of total billed charges ","93% of total billed charges ",123.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",634.1,85,,507.28,,,0,"percent of total billed charges ","85% of total billed charges ",671.4,90,,537.12,,,0,"percent of total billed charges ","90% of total billed charges ",671.4,90,,537.12,,,0,"percent of total billed charges ","90% of total billed charges ",59.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",649.02,87,,519.22,,,0,"percent of total billed charges ","87% of total billed charges ",59.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",522.2,70,,417.76,,,0,"percent of total billed charges ","70% of total billed charges ",59.62,693.78,
"*FUNGUS NES",2028240,"CDM ",302,RC,86671,HCPCS,OUTPATIENT,,,258,206.4,,10.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.6,70,,144.48,,,0,"percent of total billed charges ","70% of total billed charges ",232.2,90,,185.76,,,0,"percent of total billed charges ","90% of total billed charges ",239.94,93,,191.95,,,0,"percent of total billed charges ","93% of total billed charges ",10.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",219.3,85,,175.44,,,0,"percent of total billed charges ","85% of total billed charges ",232.2,90,,185.76,,,0,"percent of total billed charges ","90% of total billed charges ",232.2,90,,185.76,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",224.46,87,,179.57,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.25,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",180.6,70,,144.48,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,239.94,
"NEUTROPHIL OXIDATIVE BURST",2028260,"CDM ",300,RC,82657,HCPCS,OUTPATIENT,,,323.5,258.8,,22.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",226.45,70,,181.16,,,0,"percent of total billed charges ","70% of total billed charges ",291.15,90,,232.92,,,0,"percent of total billed charges ","90% of total billed charges ",300.86,93,,240.69,,,0,"percent of total billed charges ","93% of total billed charges ",22.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",274.98,85,,219.98,,,0,"percent of total billed charges ","85% of total billed charges ",291.15,90,,232.92,,,0,"percent of total billed charges ","90% of total billed charges ",291.15,90,,232.92,,,0,"percent of total billed charges ","90% of total billed charges ",38.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",281.45,87,,225.16,,,0,"percent of total billed charges ","87% of total billed charges ",38.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.17,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",226.45,70,,181.16,,,0,"percent of total billed charges ","70% of total billed charges ",22.17,300.86,
"PNEUMOCOCCAL ANTIGEN (PNEUMG)",2028270,"CDM ",302,RC,86317,HCPCS,OUTPATIENT,,,2125,1700,,12.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1487.5,70,,1190.00,,,0,"percent of total billed charges ","70% of total billed charges ",1912.5,90,,1530.00,,,0,"percent of total billed charges ","90% of total billed charges ",1976.25,93,,1581.00,,,0,"percent of total billed charges ","93% of total billed charges ",12.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1806.25,85,,1445.00,,,0,"percent of total billed charges ","85% of total billed charges ",1912.5,90,,1530.00,,,0,"percent of total billed charges ","90% of total billed charges ",1912.5,90,,1530.00,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1848.75,87,,1479.00,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.99,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1487.5,70,,1190.00,,,0,"percent of total billed charges ","70% of total billed charges ",12.74,1976.25,
*IMMUNODIFFUSION,2028290,"CDM ",302,RC,86329,HCPCS,OUTPATIENT,,,571,456.8,,13.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",399.7,70,,319.76,,,0,"percent of total billed charges ","70% of total billed charges ",513.9,90,,411.12,,,0,"percent of total billed charges ","90% of total billed charges ",531.03,93,,424.82,,,0,"percent of total billed charges ","93% of total billed charges ",13.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",485.35,85,,388.28,,,0,"percent of total billed charges ","85% of total billed charges ",513.9,90,,411.12,,,0,"percent of total billed charges ","90% of total billed charges ",513.9,90,,411.12,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",496.77,87,,397.42,,,0,"percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",399.7,70,,319.76,,,0,"percent of total billed charges ","70% of total billed charges ",13.65,531.03,
"*COMPLEMENT ANTIGEN",2028300,"CDM ",302,RC,86160,HCPCS,OUTPATIENT,,,571,456.8,,12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,133.30,133.30,133.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",399.7,70,,319.76,,,0,"percent of total billed charges ","70% of total billed charges ",513.9,90,,411.12,,,0,"percent of total billed charges ","90% of total billed charges ",531.03,93,,424.82,,,0,"percent of total billed charges ","93% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",485.35,85,,388.28,,,0,"percent of total billed charges ","85% of total billed charges ",513.9,90,,411.12,,,0,"percent of total billed charges ","90% of total billed charges ",513.9,90,,411.12,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",496.77,87,,226.71,226.71,226.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",399.7,70,,319.76,,,0,"percent of total billed charges ","70% of total billed charges ",12,531.03,
"NICOTINE/COTININE METABO NICOT",2028320,"CDM ",301,RC,80323,HCPCS,OUTPATIENT,,,152.5,122,,11.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,42.90,42.90,42.90,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.75,70,,85.40,,,0,"percent of total billed charges ","70% of total billed charges ",137.25,90,,109.80,,,0,"percent of total billed charges ","90% of total billed charges ",141.83,93,,113.46,,,0,"percent of total billed charges ","93% of total billed charges ",11.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",129.63,85,,103.70,,,0,"percent of total billed charges ","85% of total billed charges ",137.25,90,,109.80,,,0,"percent of total billed charges ","90% of total billed charges ",137.25,90,,109.80,,,0,"percent of total billed charges ","90% of total billed charges ",14.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.68,87,,106.14,,,0,"percent of total billed charges ","87% of total billed charges ",14.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",106.75,70,,85.40,,,0,"percent of total billed charges ","70% of total billed charges ",11.86,141.83,
"ANA TITER REFLEX",2028380,"CDM ",302,RC,86039,HCPCS,OUTPATIENT,,,115,92,,11.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",11.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.37,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",20.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,78.87,10.94,78.87,"1 through 10","percent of total billed charges ","87% of total billed charges ",20.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.16,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",11.16,106.95,
"*IMMUNOASSAY INFECTIOUS AGENT",2028390,"CDM ",302,RC,86317,HCPCS,OUTPATIENT,,,183.5,146.8,,12.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",170.66,93,,136.53,,,0,"percent of total billed charges ","93% of total billed charges ",12.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",155.98,85,,124.78,,,0,"percent of total billed charges ","85% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",159.65,87,,127.72,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.99,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",12.74,170.66,
"INTERFERON/BETA IGG, MAID",2028410,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,586,468.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",410.2,70,,328.16,,,0,"percent of total billed charges ","70% of total billed charges ",527.4,90,,421.92,,,0,"percent of total billed charges ","90% of total billed charges ",544.98,93,,435.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",498.1,85,,398.48,,,0,"percent of total billed charges ","85% of total billed charges ",527.4,90,,421.92,,,0,"percent of total billed charges ","90% of total billed charges ",527.4,90,,421.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",509.82,87,,407.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",410.2,70,,328.16,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,544.98,
"*DRUG SCREEN; SINGLE; QUAL",2028420,"CDM ",301,RC,80307,HCPCS,OUTPATIENT,,,160.5,128.4,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",149.27,93,,119.42,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",136.43,85,,109.14,,,0,"percent of total billed charges ","85% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",139.64,87,,111.71,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",62.14,149.27,
"*DRUG ANALYSIS; TISSUE PREP",2028430,"CDM ",301,RC,80302,HCPCS,OUTPATIENT,,,80,64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56,70,,44.80,,,0,"percent of total billed charges ","70% of total billed charges ",72,90,,57.60,,,0,"percent of total billed charges ","90% of total billed charges ",74.4,93,,59.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",68,85,,54.40,,,0,"percent of total billed charges ","85% of total billed charges ",72,90,,57.60,,,0,"percent of total billed charges ","90% of total billed charges ",72,90,,57.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",69.6,87,,55.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56,70,,44.80,,,0,"percent of total billed charges ","70% of total billed charges ",56,74.4,
"PREGNENOLONE (PRGNLN)",2028450,"CDM ",301,RC,84140,HCPCS,OUTPATIENT,,,203.5,162.8,,20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.45,70,,113.96,,,0,"percent of total billed charges ","70% of total billed charges ",183.15,90,,146.52,,,0,"percent of total billed charges ","90% of total billed charges ",189.26,93,,151.41,,,0,"percent of total billed charges ","93% of total billed charges ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",172.98,85,,138.38,,,0,"percent of total billed charges ","85% of total billed charges ",183.15,90,,146.52,,,0,"percent of total billed charges ","90% of total billed charges ",183.15,90,,146.52,,,0,"percent of total billed charges ","90% of total billed charges ",34.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.05,87,,141.64,,,0,"percent of total billed charges ","87% of total billed charges ",34.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.45,70,,113.96,,,0,"percent of total billed charges ","70% of total billed charges ",20.67,189.26,
"*EBV IGG AND IGM",2028530,"CDM ",302,RC,86664,HCPCS,OUTPATIENT,,,175,140,,13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",162.75,93,,130.20,,,0,"percent of total billed charges ","93% of total billed charges ",13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",148.75,85,,119.00,,,0,"percent of total billed charges ","85% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",152.25,87,,121.80,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.29,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,162.75,
"*IFE SERUM",2028560,"CDM ",302,RC,86334,HCPCS,OUTPATIENT,,,269,215.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.3,70,,150.64,,,0,"percent of total billed charges ","70% of total billed charges ",242.1,90,,193.68,,,0,"percent of total billed charges ","90% of total billed charges ",250.17,93,,200.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",228.65,85,,182.92,,,0,"percent of total billed charges ","85% of total billed charges ",242.1,90,,193.68,,,0,"percent of total billed charges ","90% of total billed charges ",242.1,90,,193.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.03,87,,187.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",22.34,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",188.3,70,,150.64,,,0,"percent of total billed charges ","70% of total billed charges ",22.34,250.17,
"*PROTEIN TOTAL, SERUM",2028570,"CDM ",301,RC,84155,HCPCS,OUTPATIENT,,,65.5,52.4,,3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.85,70,,36.68,,,0,"percent of total billed charges ","70% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",60.92,93,,48.74,,,0,"percent of total billed charges ","93% of total billed charges ",3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",55.68,85,,44.54,,,0,"percent of total billed charges ","85% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.99,87,,45.59,,,0,"percent of total billed charges ","87% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",45.85,70,,36.68,,,0,"percent of total billed charges ","70% of total billed charges ",3.67,60.92,
"ESTROGEN, FRACTIONATED",2028590,"CDM ",301,RC,82671,HCPCS,OUTPATIENT,,,261.5,209.2,,32.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",243.2,93,,194.56,,,0,"percent of total billed charges ","93% of total billed charges ",32.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",48.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",222.28,85,,177.82,,,0,"percent of total billed charges ","85% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",48.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",227.51,87,,182.01,,,0,"percent of total billed charges ","87% of total billed charges ",48.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.29,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",32.29,243.2,
"*TISSUE CULT; LYMPHOCYTE",2028600,"CDM ",300,RC,88230,HCPCS,OUTPATIENT,,,1100.5,880.4,,99.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",770.35,70,,616.28,,,0,"percent of total billed charges ","70% of total billed charges ",990.45,90,,792.36,,,0,"percent of total billed charges ","90% of total billed charges ",1023.47,93,,818.78,,,0,"percent of total billed charges ","93% of total billed charges ",99.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",935.43,85,,748.34,,,0,"percent of total billed charges ","85% of total billed charges ",990.45,90,,792.36,,,0,"percent of total billed charges ","90% of total billed charges ",990.45,90,,792.36,,,0,"percent of total billed charges ","90% of total billed charges ",34.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",957.44,87,,765.95,,,0,"percent of total billed charges ","87% of total billed charges ",34.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",116.49,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",770.35,70,,616.28,,,0,"percent of total billed charges ","70% of total billed charges ",34.88,1023.47,
"*MOLECULAR CYTO; DNA PROBE",2028610,"CDM ",300,RC,88271,HCPCS,OUTPATIENT,,,282.5,226,,21.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",197.75,70,,158.20,,,0,"percent of total billed charges ","70% of total billed charges ",254.25,90,,203.40,,,0,"percent of total billed charges ","90% of total billed charges ",262.73,93,,210.18,,,0,"percent of total billed charges ","93% of total billed charges ",21.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",240.13,85,,192.10,,,0,"percent of total billed charges ","85% of total billed charges ",254.25,90,,203.40,,,0,"percent of total billed charges ","90% of total billed charges ",254.25,90,,203.40,,,0,"percent of total billed charges ","90% of total billed charges ",33.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",245.78,87,,196.62,,,0,"percent of total billed charges ","87% of total billed charges ",33.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.42,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",197.75,70,,158.20,,,0,"percent of total billed charges ","70% of total billed charges ",21.42,262.73,
"*MOLE CYTO; INTERPHASE",2028620,"CDM ",300,RC,88274,HCPCS,OUTPATIENT,,,674.5,539.6,,41.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",472.15,70,,377.72,,,0,"percent of total billed charges ","70% of total billed charges ",607.05,90,,485.64,,,0,"percent of total billed charges ","90% of total billed charges ",627.29,93,,501.83,,,0,"percent of total billed charges ","93% of total billed charges ",41.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",573.33,85,,458.66,,,0,"percent of total billed charges ","85% of total billed charges ",607.05,90,,485.64,,,0,"percent of total billed charges ","90% of total billed charges ",607.05,90,,485.64,,,0,"percent of total billed charges ","90% of total billed charges ",54.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",586.82,87,,469.46,,,0,"percent of total billed charges ","87% of total billed charges ",54.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.38,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",472.15,70,,377.72,,,0,"percent of total billed charges ","70% of total billed charges ",41.34,627.29,
"*INTERP & REPORT",2028630,"CDM ",300,RC,88291,HCPCS,OUTPATIENT,,,674.5,539.6,,26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",69.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",472.15,70,,377.72,,,0,"percent of total billed charges ","70% of total billed charges ",607.05,90,,485.64,,,0,"percent of total billed charges ","90% of total billed charges ",627.29,93,,501.83,,,0,"percent of total billed charges ","93% of total billed charges ",26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",573.33,85,,458.66,,,0,"percent of total billed charges ","85% of total billed charges ",607.05,90,,485.64,,,0,"percent of total billed charges ","90% of total billed charges ",607.05,90,,485.64,,,0,"percent of total billed charges ","90% of total billed charges ",32.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",586.82,87,,469.46,,,0,"percent of total billed charges ","87% of total billed charges ",32.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",472.15,70,,377.72,,,0,"percent of total billed charges ","70% of total billed charges ",26,627.29,
"*CHLAMYDIA ANTIBODY",2028650,"CDM ",302,RC,86631,HCPCS,OUTPATIENT,,,206.5,165.2,,10.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",192.05,93,,153.64,,,0,"percent of total billed charges ","93% of total billed charges ",10.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",175.53,85,,140.42,,,0,"percent of total billed charges ","85% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",179.66,87,,143.73,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,192.05,
"CANDIDA ALBICANS IGE",2028670,"CDM ",302,RC,86628,HCPCS,OUTPATIENT,,,177,141.6,,10.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.9,70,,99.12,,,0,"percent of total billed charges ","70% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",164.61,93,,131.69,,,0,"percent of total billed charges ","93% of total billed charges ",10.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",150.45,85,,120.36,,,0,"percent of total billed charges ","85% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",153.99,87,,123.19,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",123.9,70,,99.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,164.61,
"*ASSAY, NEPHELOMETRY",2028690,"CDM ",301,RC,83883,HCPCS,OUTPATIENT,,,112.5,90,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",104.63,93,,83.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",95.63,85,,76.50,,,0,"percent of total billed charges ","85% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",97.88,87,,78.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",13.6,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",13.6,104.63,
"MANUAL DIFFERENTIAL",2028700,"CDM ",305,RC,85007,HCPCS,OUTPATIENT,,,49,39.2,,3.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",3.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",2.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,33.79,3.73,42.24,"1 through 10","percent of total billed charges ","87% of total billed charges ",2.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.8,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",2.74,45.57,
"*FLOW CYTO INTERP 9-15 MARKERS",2028710,"CDM ",300,RC,88188,HCPCS,OUTPATIENT,,,343,274.4,,58.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",131.47,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",240.1,70,,192.08,,,0,"percent of total billed charges ","70% of total billed charges ",308.7,90,,246.96,,,0,"percent of total billed charges ","90% of total billed charges ",318.99,93,,255.19,,,0,"percent of total billed charges ","93% of total billed charges ",58.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",73.9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",291.55,85,,233.24,,,0,"percent of total billed charges ","85% of total billed charges ",308.7,90,,246.96,,,0,"percent of total billed charges ","90% of total billed charges ",308.7,90,,246.96,,,0,"percent of total billed charges ","90% of total billed charges ",73.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",298.41,87,,238.73,,,0,"percent of total billed charges ","87% of total billed charges ",73.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",240.1,70,,192.08,,,0,"percent of total billed charges ","70% of total billed charges ",58.02,318.99,
"*FLOW CYTOMETRY; FIRST MARKER",2028720,"CDM ",300,RC,88184,HCPCS,OUTPATIENT,,,218.5,174.8,,53.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",137.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",203.21,93,,162.57,,,0,"percent of total billed charges ","93% of total billed charges ",53.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",185.73,85,,148.58,,,0,"percent of total billed charges ","85% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",43.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",190.1,87,,152.08,,,0,"percent of total billed charges ","87% of total billed charges ",43.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",43.19,329.64,
"*FLOW CYTO; EA ADD'L MARKER 12",2028730,"CDM ",300,RC,88185,HCPCS,OUTPATIENT,,,1436.5,1149.2,,19.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.24,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1005.55,70,,804.44,,,0,"percent of total billed charges ","70% of total billed charges ",1292.85,90,,1034.28,,,0,"percent of total billed charges ","90% of total billed charges ",1335.95,93,,1068.76,,,0,"percent of total billed charges ","93% of total billed charges ",19.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1221.03,85,,976.82,,,0,"percent of total billed charges ","85% of total billed charges ",1292.85,90,,1034.28,,,0,"percent of total billed charges ","90% of total billed charges ",1292.85,90,,1034.28,,,0,"percent of total billed charges ","90% of total billed charges ",21.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1249.76,87,,999.81,,,0,"percent of total billed charges ","87% of total billed charges ",21.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1005.55,70,,804.44,,,0,"percent of total billed charges ","70% of total billed charges ",19.52,1335.95,
"*CYTOSPIN AND INTERP",2028740,"CDM ",300,RC,88108,HCPCS,OUTPATIENT,,,341,272.8,,53.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",133.03,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",238.7,70,,190.96,,,0,"percent of total billed charges ","70% of total billed charges ",306.9,90,,245.52,,,0,"percent of total billed charges ","90% of total billed charges ",317.13,93,,253.70,,,0,"percent of total billed charges ","93% of total billed charges ",53.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",289.85,85,,231.88,,,0,"percent of total billed charges ","85% of total billed charges ",306.9,90,,245.52,,,0,"percent of total billed charges ","90% of total billed charges ",306.9,90,,245.52,,,0,"percent of total billed charges ","90% of total billed charges ",10.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",296.67,87,,237.34,,,0,"percent of total billed charges ","87% of total billed charges ",10.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",238.7,70,,190.96,,,0,"percent of total billed charges ","70% of total billed charges ",10.13,317.13,
"STREPTOZYME SCREEN/RFLX",2028760,"CDM ",302,RC,86403,HCPCS,OUTPATIENT,,,420.5,336.4,,11.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",294.35,70,,235.48,,,0,"percent of total billed charges ","70% of total billed charges ",378.45,90,,302.76,,,0,"percent of total billed charges ","90% of total billed charges ",391.07,93,,312.86,,,0,"percent of total billed charges ","93% of total billed charges ",11.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",357.43,85,,285.94,,,0,"percent of total billed charges ","85% of total billed charges ",378.45,90,,302.76,,,0,"percent of total billed charges ","90% of total billed charges ",378.45,90,,302.76,,,0,"percent of total billed charges ","90% of total billed charges ",18.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",365.84,87,,292.67,,,0,"percent of total billed charges ","87% of total billed charges ",18.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.54,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",294.35,70,,235.48,,,0,"percent of total billed charges ","70% of total billed charges ",11.54,391.07,
"*CARDIOLIPID AB EA IGG CLASS",2028770,"CDM ",302,RC,86147,HCPCS,OUTPATIENT,,,224.5,179.6,,25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",208.79,93,,167.03,,,0,"percent of total billed charges ","93% of total billed charges ",25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",190.83,85,,152.66,,,0,"percent of total billed charges ","85% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.32,87,,156.26,,,0,"percent of total billed charges ","87% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",25.45,208.79,
"*ANTI-PHOSPHATIDYLSERINE AB",2028780,"CDM ",302,RC,86148,HCPCS,OUTPATIENT,,,140.5,112.4,,16.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",130.67,93,,104.54,,,0,"percent of total billed charges ","93% of total billed charges ",16.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",119.43,85,,95.54,,,0,"percent of total billed charges ","85% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",22.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.24,87,,97.79,,,0,"percent of total billed charges ","87% of total billed charges ",22.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",16.07,130.67,
"*IMMUNOASSAY QUANT NOS",2028790,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,90,72,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,83.7,
"HUMAN METAPNEUMOVIRUS RT - PCR",2028810,"CDM ",306,RC,87798,HCPCS,OUTPATIENT,,,1751,1400.8,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1225.7,70,,980.56,,,0,"percent of total billed charges ","70% of total billed charges ",1575.9,90,,1260.72,,,0,"percent of total billed charges ","90% of total billed charges ",1628.43,93,,1302.74,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1488.35,85,,1190.68,,,0,"percent of total billed charges ","85% of total billed charges ",1575.9,90,,1260.72,,,0,"percent of total billed charges ","90% of total billed charges ",1575.9,90,,1260.72,,,0,"percent of total billed charges ","90% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1523.37,87,,1218.70,,,0,"percent of total billed charges ","87% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1225.7,70,,980.56,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,1628.43,
"*N. GONORRHOEAE, DNA",2028820,"CDM ",306,RC,87591,HCPCS,OUTPATIENT,,,204,163.2,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.47,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,140.08,140.08,140.08,20,"percent of total billed charges ","87% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,189.72,
"*INF AGENT DETECT NA CHLAMYDIA",2028830,"CDM ",306,RC,87491,HCPCS,OUTPATIENT,,,204,163.2,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.47,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,140.08,140.08,140.08,20,"percent of total billed charges ","87% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,189.72,
"*ASSAY URINE, VMA",2028840,"CDM ",301,RC,84585,HCPCS,OUTPATIENT,,,135,108,,15.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",125.55,93,,100.44,,,0,"percent of total billed charges ","93% of total billed charges ",15.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",114.75,85,,91.80,,,0,"percent of total billed charges ","85% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",26.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.45,87,,93.96,,,0,"percent of total billed charges ","87% of total billed charges ",26.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.5,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",15.5,125.55,
"*ASSAY FOR HVA",2028850,"CDM ",301,RC,83150,HCPCS,OUTPATIENT,,,130,104,,21.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91,70,,72.80,,,0,"percent of total billed charges ","70% of total billed charges ",117,90,,93.60,,,0,"percent of total billed charges ","90% of total billed charges ",120.9,93,,96.72,,,0,"percent of total billed charges ","93% of total billed charges ",21.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",110.5,85,,88.40,,,0,"percent of total billed charges ","85% of total billed charges ",117,90,,93.60,,,0,"percent of total billed charges ","90% of total billed charges ",117,90,,93.60,,,0,"percent of total billed charges ","90% of total billed charges ",28.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",113.1,87,,90.48,,,0,"percent of total billed charges ","87% of total billed charges ",28.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.41,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",91,70,,72.80,,,0,"percent of total billed charges ","70% of total billed charges ",21.53,120.9,
"*AB; HERPES SIMPLEX, TYPE I",2028880,"CDM ",302,RC,86695,HCPCS,OUTPATIENT,,,175,140,,11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,76.02,76.02,76.02,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",162.75,93,,130.20,,,0,"percent of total billed charges ","93% of total billed charges ",11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",148.75,85,,119.00,,,0,"percent of total billed charges ","85% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",152.25,87,,121.80,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,162.75,
"*HERPES SIMPLEX, TYPE 2",2028890,"CDM ",302,RC,86696,HCPCS,OUTPATIENT,,,188.5,150.8,,19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.29,80.29,80.29,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.95,70,,105.56,,,0,"percent of total billed charges ","70% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",175.31,93,,140.25,,,0,"percent of total billed charges ","93% of total billed charges ",19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",160.23,85,,128.18,,,0,"percent of total billed charges ","85% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",164,87,,131.20,,,0,"percent of total billed charges ","87% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.35,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",131.95,70,,105.56,,,0,"percent of total billed charges ","70% of total billed charges ",19.35,175.31,
"MEASLES (RUBEOLA) AB, IGM",2028900,"CDM ",302,RC,86765,HCPCS,OUTPATIENT,,,191,152.8,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.7,70,,106.96,,,0,"percent of total billed charges ","70% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",177.63,93,,142.10,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",162.35,85,,129.88,,,0,"percent of total billed charges ","85% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",166.17,87,,132.94,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",133.7,70,,106.96,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,177.63,
"*BETA 2 GLYCOPROTEIN AB EACH",2028920,"CDM ",302,RC,86146,HCPCS,OUTPATIENT,,,160,128,,25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112,70,,89.60,,,0,"percent of total billed charges ","70% of total billed charges ",144,90,,115.20,,,0,"percent of total billed charges ","90% of total billed charges ",148.8,93,,119.04,,,0,"percent of total billed charges ","93% of total billed charges ",25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",136,85,,108.80,,,0,"percent of total billed charges ","85% of total billed charges ",144,90,,115.20,,,0,"percent of total billed charges ","90% of total billed charges ",144,90,,115.20,,,0,"percent of total billed charges ","90% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",139.2,87,,111.36,,,0,"percent of total billed charges ","87% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",112,70,,89.60,,,0,"percent of total billed charges ","70% of total billed charges ",25.45,148.8,
"*SALMONELLA TYPHI",2028930,"CDM ",302,RC,86768,HCPCS,OUTPATIENT,,,143,114.4,,11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",100.1,70,,80.08,,,0,"percent of total billed charges ","70% of total billed charges ",128.7,90,,102.96,,,0,"percent of total billed charges ","90% of total billed charges ",132.99,93,,106.39,,,0,"percent of total billed charges ","93% of total billed charges ",11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",121.55,85,,97.24,,,0,"percent of total billed charges ","85% of total billed charges ",128.7,90,,102.96,,,0,"percent of total billed charges ","90% of total billed charges ",128.7,90,,102.96,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",124.41,87,,99.53,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",100.1,70,,80.08,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,132.99,
"*ANTIBODY; MUMPS",2028960,"CDM ",302,RC,86735,HCPCS,OUTPATIENT,,,183.5,146.8,,11.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",170.66,93,,136.53,,,0,"percent of total billed charges ","93% of total billed charges ",11.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",155.98,85,,124.78,,,0,"percent of total billed charges ","85% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",159.65,87,,127.72,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,170.66,
"*ANTIBODY; RUBEOLA",2028970,"CDM ",302,RC,86765,HCPCS,OUTPATIENT,,,191,152.8,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.7,70,,106.96,,,0,"percent of total billed charges ","70% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",177.63,93,,142.10,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",162.35,85,,129.88,,,0,"percent of total billed charges ","85% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",166.17,87,,132.94,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",133.7,70,,106.96,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,177.63,
"*ANTIBODY; RUBELLA",2028980,"CDM ",302,RC,86762,HCPCS,OUTPATIENT,,,89,71.2,,12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",82.77,93,,66.22,,,0,"percent of total billed charges ","93% of total billed charges ",12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",75.65,85,,60.52,,,0,"percent of total billed charges ","85% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",77.43,87,,48.62,10.18,58.34,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,82.77,
"RETICULIN AB; IGG",2028990,"CDM ",302,RC,86255,HCPCS,OUTPATIENT,,,512.5,410,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",358.75,70,,287.00,,,0,"percent of total billed charges ","70% of total billed charges ",461.25,90,,369.00,,,0,"percent of total billed charges ","90% of total billed charges ",476.63,93,,381.30,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",435.63,85,,348.50,,,0,"percent of total billed charges ","85% of total billed charges ",461.25,90,,369.00,,,0,"percent of total billed charges ","90% of total billed charges ",461.25,90,,369.00,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",445.88,87,,356.70,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",358.75,70,,287.00,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,476.63,
"RETICULIN AB, IGA",2029000,"CDM ",302,RC,86255,HCPCS,OUTPATIENT,,,232,185.6,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",215.76,93,,172.61,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",197.2,85,,157.76,,,0,"percent of total billed charges ","85% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.84,87,,161.47,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,215.76,
"METHYLENETETRAHYDROFOLATE MRMD",2029050,"CDM ",309,RC,81291,HCPCS,OUTPATIENT,,,519,415.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",363.3,70,,290.64,,,0,"percent of total billed charges ","70% of total billed charges ",467.1,90,,373.68,,,0,"percent of total billed charges ","90% of total billed charges ",482.67,93,,386.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",441.15,85,,352.92,,,0,"percent of total billed charges ","85% of total billed charges ",467.1,90,,373.68,,,0,"percent of total billed charges ","90% of total billed charges ",467.1,90,,373.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",451.53,87,,361.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",65.34,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",363.3,70,,290.64,,,0,"percent of total billed charges ","70% of total billed charges ",65.34,482.67,
"*PROTEIN S, FREE",2029150,"CDM ",305,RC,85306,HCPCS,OUTPATIENT,,,69.5,55.6,,15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.65,70,,38.92,,,0,"percent of total billed charges ","70% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",64.64,93,,51.71,,,0,"percent of total billed charges ","93% of total billed charges ",15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",59.08,85,,47.26,,,0,"percent of total billed charges ","85% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60.47,87,,174.12,174.12,174.12,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.32,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",48.65,70,,38.92,,,0,"percent of total billed charges ","70% of total billed charges ",15.32,64.64,
"PHOSPHOLIPID NEUTRAL, HEXAGON",2029170,"CDM ",305,RC,85597,HCPCS,OUTPATIENT,,,267.5,214,,17.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,134.09,134.09,134.09,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",248.78,93,,199.02,,,0,"percent of total billed charges ","93% of total billed charges ",17.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",227.38,85,,181.90,,,0,"percent of total billed charges ","85% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",25.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",232.73,87,,231.88,231.88,231.88,"1 through 10","percent of total billed charges ","87% of total billed charges ",25.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",17.98,248.78,
"*SINGLE DRUG CLASS; EACH",2029180,"CDM ",301,RC,80307,HCPCS,OUTPATIENT,,,160.5,128.4,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",149.27,93,,119.42,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",136.43,85,,109.14,,,0,"percent of total billed charges ","85% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",139.64,87,,111.71,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",62.14,149.27,
"*TISSUE PREP DRUG ANALYSIS",2029190,"CDM ",301,RC,80302,HCPCS,OUTPATIENT,,,42.5,34,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.75,70,,23.80,,,0,"percent of total billed charges ","70% of total billed charges ",38.25,90,,30.60,,,0,"percent of total billed charges ","90% of total billed charges ",39.53,93,,31.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",36.13,85,,28.90,,,0,"percent of total billed charges ","85% of total billed charges ",38.25,90,,30.60,,,0,"percent of total billed charges ","90% of total billed charges ",38.25,90,,30.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",36.98,87,,29.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.75,70,,23.80,,,0,"percent of total billed charges ","70% of total billed charges ",29.75,39.53,
"*DILUTED RBC COUNT",2029210,"CDM ",305,RC,85613,HCPCS,OUTPATIENT,,,121,96.8,,8.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.7,70,,67.76,,,0,"percent of total billed charges ","70% of total billed charges ",108.9,90,,87.12,,,0,"percent of total billed charges ","90% of total billed charges ",112.53,93,,90.02,,,0,"percent of total billed charges ","93% of total billed charges ",8.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",102.85,85,,82.28,,,0,"percent of total billed charges ","85% of total billed charges ",108.9,90,,87.12,,,0,"percent of total billed charges ","90% of total billed charges ",108.9,90,,87.12,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",105.27,87,,55.59,55.59,55.59,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.58,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",84.7,70,,67.76,,,0,"percent of total billed charges ","70% of total billed charges ",6.87,112.53,
"*THROMBOPLASTIN TIME, PARTIAL",2029220,"CDM ",305,RC,85730,HCPCS,OUTPATIENT,,,57,45.6,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.9,70,,31.92,,,0,"percent of total billed charges ","70% of total billed charges ",51.3,90,,41.04,,,0,"percent of total billed charges ","90% of total billed charges ",53.01,93,,42.41,,,0,"percent of total billed charges ","93% of total billed charges ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",48.45,85,,38.76,,,0,"percent of total billed charges ","85% of total billed charges ",51.3,90,,41.04,,,0,"percent of total billed charges ","90% of total billed charges ",51.3,90,,41.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",49.59,87,,49.13,5.89,151.44,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",39.9,70,,31.92,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,53.01,
"*CARDIOLIPID AB",2029230,"CDM ",302,RC,86147,HCPCS,OUTPATIENT,,,224.5,179.6,,25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",208.79,93,,167.03,,,0,"percent of total billed charges ","93% of total billed charges ",25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",190.83,85,,152.66,,,0,"percent of total billed charges ","85% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.32,87,,156.26,,,0,"percent of total billed charges ","87% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",25.45,208.79,
"*BETA2 GLYCOPROTEIN 1AB",2029240,"CDM ",305,RC,86146,HCPCS,OUTPATIENT,,,236,188.8,,25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",165.2,70,,132.16,,,0,"percent of total billed charges ","70% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",219.48,93,,175.58,,,0,"percent of total billed charges ","93% of total billed charges ",25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",200.6,85,,160.48,,,0,"percent of total billed charges ","85% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",205.32,87,,164.26,,,0,"percent of total billed charges ","87% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",165.2,70,,132.16,,,0,"percent of total billed charges ","70% of total billed charges ",25.45,219.48,
"*PLATELET NEUTRALIZATION",2029250,"CDM ",305,RC,85597,HCPCS,OUTPATIENT,,,267.5,214,,17.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,134.09,134.09,134.09,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",248.78,93,,199.02,,,0,"percent of total billed charges ","93% of total billed charges ",17.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",227.38,85,,181.90,,,0,"percent of total billed charges ","85% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",25.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",232.73,87,,231.88,231.88,231.88,"1 through 10","percent of total billed charges ","87% of total billed charges ",25.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",17.98,248.78,
"FECAL LEUKOCYTES (STOOL WBC)",2029270,"CDM ",301,RC,89055,HCPCS,OUTPATIENT,,,31,24.8,,4.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.7,70,,17.36,,,0,"percent of total billed charges ","70% of total billed charges ",27.9,90,,22.32,,,0,"percent of total billed charges ","90% of total billed charges ",28.83,93,,23.06,,,0,"percent of total billed charges ","93% of total billed charges ",4.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",26.35,85,,21.08,,,0,"percent of total billed charges ","85% of total billed charges ",27.9,90,,22.32,,,0,"percent of total billed charges ","90% of total billed charges ",27.9,90,,22.32,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.97,87,,21.58,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.26,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",21.7,70,,17.36,,,0,"percent of total billed charges ","70% of total billed charges ",4.26,28.83,
"*FIBRIN DEGRADATION, QUANT",2029280,"CDM ",305,RC,85379,HCPCS,OUTPATIENT,,,346,276.8,,10.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",242.2,70,,193.76,,,0,"percent of total billed charges ","70% of total billed charges ",311.4,90,,249.12,,,0,"percent of total billed charges ","90% of total billed charges ",321.78,93,,257.42,,,0,"percent of total billed charges ","93% of total billed charges ",10.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",294.1,85,,235.28,,,0,"percent of total billed charges ","85% of total billed charges ",311.4,90,,249.12,,,0,"percent of total billed charges ","90% of total billed charges ",311.4,90,,249.12,,,0,"percent of total billed charges ","90% of total billed charges ",13.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",301.02,87,,101.02,9.98,126.28,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",242.2,70,,193.76,,,0,"percent of total billed charges ","70% of total billed charges ",10.18,321.78,
"*FIBRIN DEGRADATION PRODUCTS",2029290,"CDM ",305,RC,85362,HCPCS,OUTPATIENT,,,346,276.8,,6.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,50.59,50.59,50.59,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",242.2,70,,193.76,,,0,"percent of total billed charges ","70% of total billed charges ",311.4,90,,249.12,,,0,"percent of total billed charges ","90% of total billed charges ",321.78,93,,257.42,,,0,"percent of total billed charges ","93% of total billed charges ",6.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.57,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",294.1,85,,235.28,,,0,"percent of total billed charges ","85% of total billed charges ",311.4,90,,249.12,,,0,"percent of total billed charges ","90% of total billed charges ",311.4,90,,249.12,,,0,"percent of total billed charges ","90% of total billed charges ",12.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",301.02,87,,240.82,,,0,"percent of total billed charges ","87% of total billed charges ",12.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.89,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",242.2,70,,193.76,,,0,"percent of total billed charges ","70% of total billed charges ",6.89,321.78,
"*IMMUNOASSAY NOS",2029300,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,390.5,312.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.35,70,,218.68,,,0,"percent of total billed charges ","70% of total billed charges ",351.45,90,,281.16,,,0,"percent of total billed charges ","90% of total billed charges ",363.17,93,,290.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",331.93,85,,265.54,,,0,"percent of total billed charges ","85% of total billed charges ",351.45,90,,281.16,,,0,"percent of total billed charges ","90% of total billed charges ",351.45,90,,281.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",339.74,87,,271.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",273.35,70,,218.68,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,363.17,
"ALPHA 1 ANTITRYPSIN, FECES",2029320,"CDM ",301,RC,82103,HCPCS,OUTPATIENT,,,376,300.8,,13.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.2,70,,210.56,,,0,"percent of total billed charges ","70% of total billed charges ",338.4,90,,270.72,,,0,"percent of total billed charges ","90% of total billed charges ",349.68,93,,279.74,,,0,"percent of total billed charges ","93% of total billed charges ",13.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",319.6,85,,255.68,,,0,"percent of total billed charges ","85% of total billed charges ",338.4,90,,270.72,,,0,"percent of total billed charges ","90% of total billed charges ",338.4,90,,270.72,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",327.12,87,,261.70,,,0,"percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.44,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",263.2,70,,210.56,,,0,"percent of total billed charges ","70% of total billed charges ",13.44,349.68,
"PANCREATIC ELASTASE,FECAL",2029330,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,639.5,511.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",447.65,70,,358.12,,,0,"percent of total billed charges ","70% of total billed charges ",575.55,90,,460.44,,,0,"percent of total billed charges ","90% of total billed charges ",594.74,93,,475.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",543.58,85,,434.86,,,0,"percent of total billed charges ","85% of total billed charges ",575.55,90,,460.44,,,0,"percent of total billed charges ","90% of total billed charges ",575.55,90,,460.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",556.37,87,,445.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",447.65,70,,358.12,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,594.74,
"*FLOW CYTOMETRY, ONE MARKER",2029340,"CDM ",300,RC,88184,HCPCS,OUTPATIENT,,,218.5,174.8,,53.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",137.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",203.21,93,,162.57,,,0,"percent of total billed charges ","93% of total billed charges ",53.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",185.73,85,,148.58,,,0,"percent of total billed charges ","85% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",43.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",190.1,87,,152.08,,,0,"percent of total billed charges ","87% of total billed charges ",43.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",43.19,329.64,
"*FLOW CYTO EA ADD'L MARKER",2029350,"CDM ",300,RC,88185,HCPCS,OUTPATIENT,,,218.5,174.8,,19.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.24,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",203.21,93,,162.57,,,0,"percent of total billed charges ","93% of total billed charges ",19.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",185.73,85,,148.58,,,0,"percent of total billed charges ","85% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",21.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",190.1,87,,152.08,,,0,"percent of total billed charges ","87% of total billed charges ",21.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",19.52,203.21,
"IMMUNOASSAY BY RIA; QUANT",2029380,"CDM ",301,RC,83519,HCPCS,OUTPATIENT,,,781.5,625.2,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",547.05,70,,437.64,,,0,"percent of total billed charges ","70% of total billed charges ",703.35,90,,562.68,,,0,"percent of total billed charges ","90% of total billed charges ",726.8,93,,581.44,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",664.28,85,,531.42,,,0,"percent of total billed charges ","85% of total billed charges ",703.35,90,,562.68,,,0,"percent of total billed charges ","90% of total billed charges ",703.35,90,,562.68,,,0,"percent of total billed charges ","90% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",679.91,87,,543.93,,,0,"percent of total billed charges ","87% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",547.05,70,,437.64,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,726.8,
"*CYTOPATHOLOGY THIN LAYER",2029390,"CDM ",300,RC,88175,HCPCS,OUTPATIENT,,,74.5,59.6,,25.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",69.29,93,,55.43,,,0,"percent of total billed charges ","93% of total billed charges ",25.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",63.33,85,,50.66,,,0,"percent of total billed charges ","85% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",33.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.82,87,,51.86,,,0,"percent of total billed charges ","87% of total billed charges ",33.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",25.7,69.29,
"*CYTOPATHOLOGY INTERP",2029400,"CDM ",300,RC,88141,HCPCS,OUTPATIENT,,,99.5,79.6,,19.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",46.4,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",69.65,70,,55.72,,,0,"percent of total billed charges ","70% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",92.54,93,,74.03,,,0,"percent of total billed charges ","93% of total billed charges ",19.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",84.58,85,,67.66,,,0,"percent of total billed charges ","85% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",16.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",86.57,87,,69.26,,,0,"percent of total billed charges ","87% of total billed charges ",16.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",69.65,70,,55.72,,,0,"percent of total billed charges ","70% of total billed charges ",16.08,92.54,
"*OLIGOCLONAL BANDS",2029420,"CDM ",301,RC,83916,HCPCS,OUTPATIENT,,,161,128.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.7,70,,90.16,,,0,"percent of total billed charges ","70% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",149.73,93,,119.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.85,85,,109.48,,,0,"percent of total billed charges ","85% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",140.07,87,,112.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",27.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",112.7,70,,90.16,,,0,"percent of total billed charges ","70% of total billed charges ",27.39,149.73,
"*MYELIN BASIC PROTEIN, CSF",2029430,"CDM ",301,RC,83873,HCPCS,OUTPATIENT,,,52,41.6,,17.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.4,70,,29.12,,,0,"percent of total billed charges ","70% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",48.36,93,,38.69,,,0,"percent of total billed charges ","93% of total billed charges ",17.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",44.2,85,,35.36,,,0,"percent of total billed charges ","85% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",31.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.24,87,,36.19,,,0,"percent of total billed charges ","87% of total billed charges ",31.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.2,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",36.4,70,,29.12,,,0,"percent of total billed charges ","70% of total billed charges ",17.2,48.36,
"*ALBUMIN, SERUM",2029440,"CDM ",301,RC,82040,HCPCS,OUTPATIENT,,,52,41.6,,4.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,12.74,12.74,12.74,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.4,70,,29.12,,,0,"percent of total billed charges ","70% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",48.36,93,,38.69,,,0,"percent of total billed charges ","93% of total billed charges ",4.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",44.2,85,,35.36,,,0,"percent of total billed charges ","85% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.24,87,,4.86,4.86,49.24,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.95,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",36.4,70,,29.12,,,0,"percent of total billed charges ","70% of total billed charges ",4.95,48.36,
"*ALBUMIN QUANTITATIVE EACH",2029450,"CDM ",301,RC,82042,HCPCS,OUTPATIENT,,,53,42.4,,6.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",49.29,93,,39.43,,,0,"percent of total billed charges ","93% of total billed charges ",6.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.05,85,,36.04,,,0,"percent of total billed charges ","85% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.11,87,,36.89,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.78,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",6.61,49.29,
"*GAMMAGLOBULIN IG,A,D,G,M EACH",2029460,"CDM ",301,RC,82784,HCPCS,OUTPATIENT,,,108,86.4,,9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,75.17,,,0,"percent of total billed charges ","87% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",9.3,100.44,
*ALPHA-FETOPROTEIN,2029480,"CDM ",301,RC,82105,HCPCS,OUTPATIENT,,,120.5,96.4,,14.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.35,70,,67.48,,,0,"percent of total billed charges ","70% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",112.07,93,,89.66,,,0,"percent of total billed charges ","93% of total billed charges ",14.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",102.43,85,,81.94,,,0,"percent of total billed charges ","85% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",104.84,87,,74.83,74.82,74.83,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.77,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",84.35,70,,67.48,,,0,"percent of total billed charges ","70% of total billed charges ",14.25,112.07,
"*GONADOTROPIN, CHORIONIC",2029490,"CDM ",301,RC,84702,HCPCS,OUTPATIENT,,,120.5,96.4,,12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.35,70,,67.48,,,0,"percent of total billed charges ","70% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",112.07,93,,89.66,,,0,"percent of total billed charges ","93% of total billed charges ",12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.89,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",102.43,85,,81.94,,,0,"percent of total billed charges ","85% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",11.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",104.84,87,,94.83,84.28,118.53,"1 through 10","percent of total billed charges ","87% of total billed charges ",11.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",84.35,70,,67.48,,,0,"percent of total billed charges ","70% of total billed charges ",11.77,112.07,
*ESTRIOL,2029500,"CDM ",301,RC,82677,HCPCS,OUTPATIENT,,,149,119.2,,21.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.3,70,,83.44,,,0,"percent of total billed charges ","70% of total billed charges ",134.1,90,,107.28,,,0,"percent of total billed charges ","90% of total billed charges ",138.57,93,,110.86,,,0,"percent of total billed charges ","93% of total billed charges ",21.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",126.65,85,,101.32,,,0,"percent of total billed charges ","85% of total billed charges ",134.1,90,,107.28,,,0,"percent of total billed charges ","90% of total billed charges ",134.1,90,,107.28,,,0,"percent of total billed charges ","90% of total billed charges ",28.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",129.63,87,,103.70,,,0,"percent of total billed charges ","87% of total billed charges ",28.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.3,70,,83.44,,,0,"percent of total billed charges ","70% of total billed charges ",21.42,138.57,
"*INHIBIN A",2029510,"CDM ",302,RC,86336,HCPCS,OUTPATIENT,,,282,225.6,,15.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",197.4,70,,157.92,,,0,"percent of total billed charges ","70% of total billed charges ",253.8,90,,203.04,,,0,"percent of total billed charges ","90% of total billed charges ",262.26,93,,209.81,,,0,"percent of total billed charges ","93% of total billed charges ",15.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.44,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",239.7,85,,191.76,,,0,"percent of total billed charges ","85% of total billed charges ",253.8,90,,203.04,,,0,"percent of total billed charges ","90% of total billed charges ",253.8,90,,203.04,,,0,"percent of total billed charges ","90% of total billed charges ",24.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",245.34,87,,196.27,,,0,"percent of total billed charges ","87% of total billed charges ",24.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.59,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",197.4,70,,157.92,,,0,"percent of total billed charges ","70% of total billed charges ",15.59,262.26,
"RIBOSOME P ABS, IGG",2029530,"CDM ",300,RC,88184,HCPCS,OUTPATIENT,,,271,216.8,,53.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",137.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",189.7,70,,151.76,,,0,"percent of total billed charges ","70% of total billed charges ",243.9,90,,195.12,,,0,"percent of total billed charges ","90% of total billed charges ",252.03,93,,201.62,,,0,"percent of total billed charges ","93% of total billed charges ",53.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",230.35,85,,184.28,,,0,"percent of total billed charges ","85% of total billed charges ",243.9,90,,195.12,,,0,"percent of total billed charges ","90% of total billed charges ",243.9,90,,195.12,,,0,"percent of total billed charges ","90% of total billed charges ",43.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",235.77,87,,188.62,,,0,"percent of total billed charges ","87% of total billed charges ",43.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",189.7,70,,151.76,,,0,"percent of total billed charges ","70% of total billed charges ",43.19,329.64,
"NEURONAL NUCLEAR ABS, IGG W/",2029540,"CDM ",302,RC,86255,HCPCS,OUTPATIENT,,,504.5,403.6,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",353.15,70,,282.52,,,0,"percent of total billed charges ","70% of total billed charges ",454.05,90,,363.24,,,0,"percent of total billed charges ","90% of total billed charges ",469.19,93,,375.35,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",428.83,85,,343.06,,,0,"percent of total billed charges ","85% of total billed charges ",454.05,90,,363.24,,,0,"percent of total billed charges ","90% of total billed charges ",454.05,90,,363.24,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",438.92,87,,351.14,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",353.15,70,,282.52,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,469.19,
"CENTROMERE B ABS",2029550,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,232,185.6,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",215.76,93,,172.61,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",197.2,85,,157.76,,,0,"percent of total billed charges ","85% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.84,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,215.76,
"*MICROALBUMIN URINE QUANT",2029560,"CDM ",301,RC,82043,HCPCS,OUTPATIENT,,,53,42.4,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",49.29,93,,39.43,,,0,"percent of total billed charges ","93% of total billed charges ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.05,85,,36.04,,,0,"percent of total billed charges ","85% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.11,87,,5.67,5.33,35.21,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.78,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,49.29,
"*ASSAY URINE CREATININE",2029570,"CDM ",301,RC,82570,HCPCS,OUTPATIENT,,,47,37.6,,5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",43.71,93,,34.97,,,0,"percent of total billed charges ","93% of total billed charges ",5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.95,85,,31.96,,,0,"percent of total billed charges ","85% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.89,87,,5.08,4.98,50.30,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",5.18,43.71,
"*OLIGOCLONAL BANDS",2029590,"CDM ",301,RC,83916,HCPCS,OUTPATIENT,,,161,128.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.7,70,,90.16,,,0,"percent of total billed charges ","70% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",149.73,93,,119.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.85,85,,109.48,,,0,"percent of total billed charges ","85% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",140.07,87,,112.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",27.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",112.7,70,,90.16,,,0,"percent of total billed charges ","70% of total billed charges ",27.39,149.73,
"*MYELIN BASIC PROTEIN",2029600,"CDM ",301,RC,83873,HCPCS,OUTPATIENT,,,135,108,,17.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",125.55,93,,100.44,,,0,"percent of total billed charges ","93% of total billed charges ",17.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",114.75,85,,91.80,,,0,"percent of total billed charges ","85% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",31.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.45,87,,93.96,,,0,"percent of total billed charges ","87% of total billed charges ",31.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.2,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",17.2,125.55,
"*ALBUMIN, SERUM",2029610,"CDM ",301,RC,82040,HCPCS,OUTPATIENT,,,52,41.6,,4.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,12.74,12.74,12.74,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.4,70,,29.12,,,0,"percent of total billed charges ","70% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",48.36,93,,38.69,,,0,"percent of total billed charges ","93% of total billed charges ",4.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",44.2,85,,35.36,,,0,"percent of total billed charges ","85% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.24,87,,4.86,4.86,49.24,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.95,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",36.4,70,,29.12,,,0,"percent of total billed charges ","70% of total billed charges ",4.95,48.36,
"*ALBUMIN, URINE",2029620,"CDM ",301,RC,82042,HCPCS,OUTPATIENT,,,53,42.4,,6.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",49.29,93,,39.43,,,0,"percent of total billed charges ","93% of total billed charges ",6.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.05,85,,36.04,,,0,"percent of total billed charges ","85% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.11,87,,36.89,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.78,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",6.61,49.29,
"*GAMMAGLOBULIN,IGA,IGD,IGG,IGM",2029630,"CDM ",301,RC,82784,HCPCS,OUTPATIENT,,,108,86.4,,9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,75.17,,,0,"percent of total billed charges ","87% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",9.3,100.44,
"SPOROTHRIX ANTIBODY",2029650,"CDM ",302,RC,86671,HCPCS,OUTPATIENT,,,1049,839.2,,10.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",734.3,70,,587.44,,,0,"percent of total billed charges ","70% of total billed charges ",944.1,90,,755.28,,,0,"percent of total billed charges ","90% of total billed charges ",975.57,93,,780.46,,,0,"percent of total billed charges ","93% of total billed charges ",10.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",891.65,85,,713.32,,,0,"percent of total billed charges ","85% of total billed charges ",944.1,90,,755.28,,,0,"percent of total billed charges ","90% of total billed charges ",944.1,90,,755.28,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",912.63,87,,730.10,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.25,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",734.3,70,,587.44,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,975.57,
"*PROTHROMBIN TIME",2029660,"CDM ",305,RC,85610,HCPCS,OUTPATIENT,,,33.5,26.8,,4.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",31.16,93,,24.93,,,0,"percent of total billed charges ","93% of total billed charges ",4.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",28.48,85,,22.78,,,0,"percent of total billed charges ","85% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.15,87,,50.34,4.21,62.93,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.29,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",4.29,31.16,
"*THROMBOPLASTIN TIME; PARTIAL",2029670,"CDM ",305,RC,85730,HCPCS,OUTPATIENT,,,57,45.6,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.9,70,,31.92,,,0,"percent of total billed charges ","70% of total billed charges ",51.3,90,,41.04,,,0,"percent of total billed charges ","90% of total billed charges ",53.01,93,,42.41,,,0,"percent of total billed charges ","93% of total billed charges ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",48.45,85,,38.76,,,0,"percent of total billed charges ","85% of total billed charges ",51.3,90,,41.04,,,0,"percent of total billed charges ","90% of total billed charges ",51.3,90,,41.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",49.59,87,,49.13,5.89,151.44,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",39.9,70,,31.92,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,53.01,
"INFLUENZA B VIRUS ABS, IGG",2029690,"CDM ",302,RC,86710,HCPCS,OUTPATIENT,,,175,140,,11.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",162.75,93,,130.20,,,0,"percent of total billed charges ","93% of total billed charges ",11.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",148.75,85,,119.00,,,0,"percent of total billed charges ","85% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",152.25,87,,121.80,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.55,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,162.75,
*ENTEROVIRUS,2029710,"CDM ",302,RC,86658,HCPCS,OUTPATIENT,,,323,258.4,,11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",226.1,70,,180.88,,,0,"percent of total billed charges ","70% of total billed charges ",290.7,90,,232.56,,,0,"percent of total billed charges ","90% of total billed charges ",300.39,93,,240.31,,,0,"percent of total billed charges ","93% of total billed charges ",11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",274.55,85,,219.64,,,0,"percent of total billed charges ","85% of total billed charges ",290.7,90,,232.56,,,0,"percent of total billed charges ","90% of total billed charges ",290.7,90,,232.56,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",281.01,87,,224.81,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",226.1,70,,180.88,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,300.39,
"NEISSERIA MENINGITIDES",2029740,"CDM ",302,RC,86741,HCPCS,OUTPATIENT,,,383.5,306.8,,7.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",268.45,70,,214.76,,,0,"percent of total billed charges ","70% of total billed charges ",345.15,90,,276.12,,,0,"percent of total billed charges ","90% of total billed charges ",356.66,93,,285.33,,,0,"percent of total billed charges ","93% of total billed charges ",7.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",325.98,85,,260.78,,,0,"percent of total billed charges ","85% of total billed charges ",345.15,90,,276.12,,,0,"percent of total billed charges ","90% of total billed charges ",345.15,90,,276.12,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",333.65,87,,266.92,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",268.45,70,,214.76,,,0,"percent of total billed charges ","70% of total billed charges ",7.8,356.66,
"ORGANIC ACIDS, PLASMA",2029760,"CDM ",301,RC,83918,HCPCS,OUTPATIENT,,,553,442.4,,20.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",387.1,70,,309.68,,,0,"percent of total billed charges ","70% of total billed charges ",497.7,90,,398.16,,,0,"percent of total billed charges ","90% of total billed charges ",514.29,93,,411.43,,,0,"percent of total billed charges ","93% of total billed charges ",20.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.55,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",470.05,85,,376.04,,,0,"percent of total billed charges ","85% of total billed charges ",497.7,90,,398.16,,,0,"percent of total billed charges ","90% of total billed charges ",497.7,90,,398.16,,,0,"percent of total billed charges ","90% of total billed charges ",25.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",481.11,87,,384.89,,,0,"percent of total billed charges ","87% of total billed charges ",25.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.6,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",387.1,70,,309.68,,,0,"percent of total billed charges ","70% of total billed charges ",20.06,514.29,
"C-TELOPEPTIDE, BETA-CROSS LINK",2029770,"CDM ",301,RC,82523,HCPCS,OUTPATIENT,,,394,315.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",275.8,70,,220.64,,,0,"percent of total billed charges ","70% of total billed charges ",354.6,90,,283.68,,,0,"percent of total billed charges ","90% of total billed charges ",366.42,93,,293.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",334.9,85,,267.92,,,0,"percent of total billed charges ","85% of total billed charges ",354.6,90,,283.68,,,0,"percent of total billed charges ","90% of total billed charges ",354.6,90,,283.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",342.78,87,,274.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",18.68,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",275.8,70,,220.64,,,0,"percent of total billed charges ","70% of total billed charges ",18.68,366.42,
"RABIES ANTIBODY IGG",2029780,"CDM ",302,RC,86790,HCPCS,OUTPATIENT,,,504.5,403.6,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.58,80.58,80.58,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",353.15,70,,282.52,,,0,"percent of total billed charges ","70% of total billed charges ",454.05,90,,363.24,,,0,"percent of total billed charges ","90% of total billed charges ",469.19,93,,375.35,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",428.83,85,,343.06,,,0,"percent of total billed charges ","85% of total billed charges ",454.05,90,,363.24,,,0,"percent of total billed charges ","90% of total billed charges ",454.05,90,,363.24,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",438.92,87,,199.98,199.98,199.98,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",353.15,70,,282.52,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,469.19,
"COMPLEMENT C5A",2029790,"CDM ",302,RC,86160,HCPCS,OUTPATIENT,,,672,537.6,,12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,133.30,133.30,133.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",470.4,70,,376.32,,,0,"percent of total billed charges ","70% of total billed charges ",604.8,90,,483.84,,,0,"percent of total billed charges ","90% of total billed charges ",624.96,93,,499.97,,,0,"percent of total billed charges ","93% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",571.2,85,,456.96,,,0,"percent of total billed charges ","85% of total billed charges ",604.8,90,,483.84,,,0,"percent of total billed charges ","90% of total billed charges ",604.8,90,,483.84,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",584.64,87,,226.71,226.71,226.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",470.4,70,,376.32,,,0,"percent of total billed charges ","70% of total billed charges ",12,624.96,
"OXYCODONE URINE SCREEN",2029870,"CDM ",301,RC,80361,HCPCS,OUTPATIENT,,,98.5,78.8,,10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,38.30,38.30,38.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.4,91.61,
"*DNA FISH PROBE 9P21",2029880,"CDM ",300,RC,88368,HCPCS,OUTPATIENT,,,525.5,420.4,,123.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",280.96,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",367.85,70,,294.28,,,0,"percent of total billed charges ","70% of total billed charges ",472.95,90,,378.36,,,0,"percent of total billed charges ","90% of total billed charges ",488.72,93,,390.98,,,0,"percent of total billed charges ","93% of total billed charges ",123.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",446.68,85,,357.34,,,0,"percent of total billed charges ","85% of total billed charges ",472.95,90,,378.36,,,0,"percent of total billed charges ","90% of total billed charges ",472.95,90,,378.36,,,0,"percent of total billed charges ","90% of total billed charges ",59.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",457.19,87,,365.75,,,0,"percent of total billed charges ","87% of total billed charges ",59.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",367.85,70,,294.28,,,0,"percent of total billed charges ","70% of total billed charges ",59.62,488.72,
"*DNA FISH PROBE CEP 3,7,17",2029890,"CDM ",300,RC,88368,HCPCS,OUTPATIENT,,,525.5,420.4,,123.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",280.96,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",367.85,70,,294.28,,,0,"percent of total billed charges ","70% of total billed charges ",472.95,90,,378.36,,,0,"percent of total billed charges ","90% of total billed charges ",488.72,93,,390.98,,,0,"percent of total billed charges ","93% of total billed charges ",123.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",446.68,85,,357.34,,,0,"percent of total billed charges ","85% of total billed charges ",472.95,90,,378.36,,,0,"percent of total billed charges ","90% of total billed charges ",472.95,90,,378.36,,,0,"percent of total billed charges ","90% of total billed charges ",59.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",457.19,87,,365.75,,,0,"percent of total billed charges ","87% of total billed charges ",59.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",367.85,70,,294.28,,,0,"percent of total billed charges ","70% of total billed charges ",59.62,488.72,
"TRAMADOL LEVEL",2029910,"CDM ",301,RC,80307,HCPCS,OUTPATIENT,,,160.5,128.4,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",149.27,93,,119.42,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",136.43,85,,109.14,,,0,"percent of total billed charges ","85% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",139.64,87,,111.71,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",62.14,149.27,
"*CHLAMYDIA ANTIBODY",2029920,"CDM ",302,RC,86631,HCPCS,OUTPATIENT,,,503.5,402.8,,10.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",352.45,70,,281.96,,,0,"percent of total billed charges ","70% of total billed charges ",453.15,90,,362.52,,,0,"percent of total billed charges ","90% of total billed charges ",468.26,93,,374.61,,,0,"percent of total billed charges ","93% of total billed charges ",10.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",427.98,85,,342.38,,,0,"percent of total billed charges ","85% of total billed charges ",453.15,90,,362.52,,,0,"percent of total billed charges ","90% of total billed charges ",453.15,90,,362.52,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",438.05,87,,350.44,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",352.45,70,,281.96,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,468.26,
"*CHLAMYDIA IGM ANTIBODY",2029930,"CDM ",302,RC,86632,HCPCS,OUTPATIENT,,,503.5,402.8,,10.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",352.45,70,,281.96,,,0,"percent of total billed charges ","70% of total billed charges ",453.15,90,,362.52,,,0,"percent of total billed charges ","90% of total billed charges ",468.26,93,,374.61,,,0,"percent of total billed charges ","93% of total billed charges ",10.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",427.98,85,,342.38,,,0,"percent of total billed charges ","85% of total billed charges ",453.15,90,,362.52,,,0,"percent of total billed charges ","90% of total billed charges ",453.15,90,,362.52,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",438.05,87,,350.44,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.68,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",352.45,70,,281.96,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,468.26,
"BILE ACIDS, FRACTIONATED/TOTAL",2029950,"CDM ",301,RC,82542,HCPCS,OUTPATIENT,,,474.5,379.6,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",332.15,70,,265.72,,,0,"percent of total billed charges ","70% of total billed charges ",427.05,90,,341.64,,,0,"percent of total billed charges ","90% of total billed charges ",441.29,93,,353.03,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",403.33,85,,322.66,,,0,"percent of total billed charges ","85% of total billed charges ",427.05,90,,341.64,,,0,"percent of total billed charges ","90% of total billed charges ",427.05,90,,341.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",412.82,87,,330.26,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",332.15,70,,265.72,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,441.29,
"*FLOWCYTOMETRY; 1 MARKER",2029960,"CDM ",300,RC,88184,HCPCS,OUTPATIENT,,,218.5,174.8,,53.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",137.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",203.21,93,,162.57,,,0,"percent of total billed charges ","93% of total billed charges ",53.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",185.73,85,,148.58,,,0,"percent of total billed charges ","85% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",43.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",190.1,87,,152.08,,,0,"percent of total billed charges ","87% of total billed charges ",43.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",43.19,329.64,
"*FLOWCYTOMETRY EA ADD'L MARKER",2029970,"CDM ",300,RC,88185,HCPCS,OUTPATIENT,,,218.5,174.8,,19.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.24,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",203.21,93,,162.57,,,0,"percent of total billed charges ","93% of total billed charges ",19.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",185.73,85,,148.58,,,0,"percent of total billed charges ","85% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",21.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",190.1,87,,152.08,,,0,"percent of total billed charges ","87% of total billed charges ",21.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",19.52,203.21,
"*EHRLICHIA IGG",2029990,"CDM ",302,RC,86666,HCPCS,OUTPATIENT,,,312,249.6,,9.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",218.4,70,,174.72,,,0,"percent of total billed charges ","70% of total billed charges ",280.8,90,,224.64,,,0,"percent of total billed charges ","90% of total billed charges ",290.16,93,,232.13,,,0,"percent of total billed charges ","93% of total billed charges ",9.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",265.2,85,,212.16,,,0,"percent of total billed charges ","85% of total billed charges ",280.8,90,,224.64,,,0,"percent of total billed charges ","90% of total billed charges ",280.8,90,,224.64,,,0,"percent of total billed charges ","90% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",271.44,87,,217.15,,,0,"percent of total billed charges ","87% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",218.4,70,,174.72,,,0,"percent of total billed charges ","70% of total billed charges ",9.17,290.16,
"*EHRLICHIA IGM",2030000,"CDM ",302,RC,86666,HCPCS,OUTPATIENT,,,312,249.6,,9.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",218.4,70,,174.72,,,0,"percent of total billed charges ","70% of total billed charges ",280.8,90,,224.64,,,0,"percent of total billed charges ","90% of total billed charges ",290.16,93,,232.13,,,0,"percent of total billed charges ","93% of total billed charges ",9.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",265.2,85,,212.16,,,0,"percent of total billed charges ","85% of total billed charges ",280.8,90,,224.64,,,0,"percent of total billed charges ","90% of total billed charges ",280.8,90,,224.64,,,0,"percent of total billed charges ","90% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",271.44,87,,217.15,,,0,"percent of total billed charges ","87% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",218.4,70,,174.72,,,0,"percent of total billed charges ","70% of total billed charges ",9.17,290.16,
"*COXIELLA BURNETII IGG",2030020,"CDM ",302,RC,86638,HCPCS,OUTPATIENT,,,336.5,269.2,,10.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",235.55,70,,188.44,,,0,"percent of total billed charges ","70% of total billed charges ",302.85,90,,242.28,,,0,"percent of total billed charges ","90% of total billed charges ",312.95,93,,250.36,,,0,"percent of total billed charges ","93% of total billed charges ",10.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",286.03,85,,228.82,,,0,"percent of total billed charges ","85% of total billed charges ",302.85,90,,242.28,,,0,"percent of total billed charges ","90% of total billed charges ",302.85,90,,242.28,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",292.76,87,,234.21,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",235.55,70,,188.44,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,312.95,
"*COXIELLA BURNETII IGM",2030030,"CDM ",302,RC,86638,HCPCS,OUTPATIENT,,,336.5,269.2,,10.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",235.55,70,,188.44,,,0,"percent of total billed charges ","70% of total billed charges ",302.85,90,,242.28,,,0,"percent of total billed charges ","90% of total billed charges ",312.95,93,,250.36,,,0,"percent of total billed charges ","93% of total billed charges ",10.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",286.03,85,,228.82,,,0,"percent of total billed charges ","85% of total billed charges ",302.85,90,,242.28,,,0,"percent of total billed charges ","90% of total billed charges ",302.85,90,,242.28,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",292.76,87,,234.21,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",235.55,70,,188.44,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,312.95,
NORTRIPTYLINE,2030050,"CDM ",301,RC,80335,HCPCS,OUTPATIENT,,,122.5,98,,23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",113.93,93,,91.14,,,0,"percent of total billed charges ","93% of total billed charges ",23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.13,85,,83.30,,,0,"percent of total billed charges ","85% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.58,87,,85.26,,,0,"percent of total billed charges ","87% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",23.71,113.93,
"ANTI-MULLERIAN HORMONE (AMH)",2030060,"CDM ",301,RC,83516,HCPCS,OUTPATIENT,,,480,384,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",336,70,,268.80,,,0,"percent of total billed charges ","70% of total billed charges ",432,90,,345.60,,,0,"percent of total billed charges ","90% of total billed charges ",446.4,93,,357.12,,,0,"percent of total billed charges ","93% of total billed charges ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",408,85,,326.40,,,0,"percent of total billed charges ","85% of total billed charges ",432,90,,345.60,,,0,"percent of total billed charges ","90% of total billed charges ",432,90,,345.60,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",417.6,87,,53.32,28.74,77.90,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",336,70,,268.80,,,0,"percent of total billed charges ","70% of total billed charges ",10,446.4,
"METHYLMALONIC ACID URINE QUAN",2030070,"CDM ",301,RC,83921,HCPCS,OUTPATIENT,,,178,142.4,,19.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.6,70,,99.68,,,0,"percent of total billed charges ","70% of total billed charges ",160.2,90,,128.16,,,0,"percent of total billed charges ","90% of total billed charges ",165.54,93,,132.43,,,0,"percent of total billed charges ","93% of total billed charges ",19.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.55,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",151.3,85,,121.04,,,0,"percent of total billed charges ","85% of total billed charges ",160.2,90,,128.16,,,0,"percent of total billed charges ","90% of total billed charges ",160.2,90,,128.16,,,0,"percent of total billed charges ","90% of total billed charges ",25.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",154.86,87,,123.89,,,0,"percent of total billed charges ","87% of total billed charges ",25.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.21,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",124.6,70,,99.68,,,0,"percent of total billed charges ","70% of total billed charges ",19.34,165.54,
"PARATHYROID HORMONE (PTH-RP)",2030080,"CDM ",301,RC,83519,HCPCS,OUTPATIENT,,,781.5,625.2,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",547.05,70,,437.64,,,0,"percent of total billed charges ","70% of total billed charges ",703.35,90,,562.68,,,0,"percent of total billed charges ","90% of total billed charges ",726.8,93,,581.44,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",664.28,85,,531.42,,,0,"percent of total billed charges ","85% of total billed charges ",703.35,90,,562.68,,,0,"percent of total billed charges ","90% of total billed charges ",703.35,90,,562.68,,,0,"percent of total billed charges ","90% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",679.91,87,,543.93,,,0,"percent of total billed charges ","87% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",547.05,70,,437.64,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,726.8,
"*SEX HORMONE BINDING GLOBULIN",2030100,"CDM ",301,RC,84270,HCPCS,OUTPATIENT,,,261.5,209.2,,18.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.82,64.82,64.82,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",243.2,93,,194.56,,,0,"percent of total billed charges ","93% of total billed charges ",18.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",222.28,85,,177.82,,,0,"percent of total billed charges ","85% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",23.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",227.51,87,,162.40,97.34,162.40,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.73,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",18.47,243.2,
"*TOTAL TESTOSTERONE",2030110,"CDM ",301,RC,84403,HCPCS,OUTPATIENT,,,225,180,,25.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.5,70,,126.00,,,0,"percent of total billed charges ","70% of total billed charges ",202.5,90,,162.00,,,0,"percent of total billed charges ","90% of total billed charges ",209.25,93,,167.40,,,0,"percent of total billed charges ","93% of total billed charges ",25.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.58,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",191.25,85,,153.00,,,0,"percent of total billed charges ","85% of total billed charges ",202.5,90,,162.00,,,0,"percent of total billed charges ","90% of total billed charges ",202.5,90,,162.00,,,0,"percent of total billed charges ","90% of total billed charges ",40.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.75,87,,117.78,25.30,174.56,11,"percent of total billed charges ","87% of total billed charges ",40.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.81,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.5,70,,126.00,,,0,"percent of total billed charges ","70% of total billed charges ",25.81,209.25,
"PORK ALLERGY TEST",2030120,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
EVEROLIMUS,2030130,"CDM ",301,RC,80169,HCPCS,OUTPATIENT,,,357.5,286,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",250.25,70,,200.20,,,0,"percent of total billed charges ","70% of total billed charges ",321.75,90,,257.40,,,0,"percent of total billed charges ","90% of total billed charges ",332.48,93,,265.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",303.88,85,,243.10,,,0,"percent of total billed charges ","85% of total billed charges ",321.75,90,,257.40,,,0,"percent of total billed charges ","90% of total billed charges ",321.75,90,,257.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",311.03,87,,248.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",13.73,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",250.25,70,,200.20,,,0,"percent of total billed charges ","70% of total billed charges ",13.73,332.48,
"FT4 BY DIRECT DIALYSIS",2030140,"CDM ",301,RC,84439,HCPCS,OUTPATIENT,,,115,92,,9.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,8.84,8.84,8.84,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",9.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",15.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,53.23,8.84,106.46,25,"percent of total billed charges ","87% of total billed charges ",15.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.02,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",9.02,106.95,
"*CHLAMYDIA IGG",2030150,"CDM ",302,RC,86631,HCPCS,OUTPATIENT,,,278,222.4,,10.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",194.6,70,,155.68,,,0,"percent of total billed charges ","70% of total billed charges ",250.2,90,,200.16,,,0,"percent of total billed charges ","90% of total billed charges ",258.54,93,,206.83,,,0,"percent of total billed charges ","93% of total billed charges ",10.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",236.3,85,,189.04,,,0,"percent of total billed charges ","85% of total billed charges ",250.2,90,,200.16,,,0,"percent of total billed charges ","90% of total billed charges ",250.2,90,,200.16,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",241.86,87,,193.49,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",194.6,70,,155.68,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,258.54,
"*CHLAMYDIA IGM",2030160,"CDM ",302,RC,86632,HCPCS,OUTPATIENT,,,278,222.4,,10.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",194.6,70,,155.68,,,0,"percent of total billed charges ","70% of total billed charges ",250.2,90,,200.16,,,0,"percent of total billed charges ","90% of total billed charges ",258.54,93,,206.83,,,0,"percent of total billed charges ","93% of total billed charges ",10.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",236.3,85,,189.04,,,0,"percent of total billed charges ","85% of total billed charges ",250.2,90,,200.16,,,0,"percent of total billed charges ","90% of total billed charges ",250.2,90,,200.16,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",241.86,87,,193.49,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.68,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",194.6,70,,155.68,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,258.54,
"*TESTOSTERONE, TOTAL",2030180,"CDM ",301,RC,84403,HCPCS,OUTPATIENT,,,225,180,,25.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.5,70,,126.00,,,0,"percent of total billed charges ","70% of total billed charges ",202.5,90,,162.00,,,0,"percent of total billed charges ","90% of total billed charges ",209.25,93,,167.40,,,0,"percent of total billed charges ","93% of total billed charges ",25.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.58,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",191.25,85,,153.00,,,0,"percent of total billed charges ","85% of total billed charges ",202.5,90,,162.00,,,0,"percent of total billed charges ","90% of total billed charges ",202.5,90,,162.00,,,0,"percent of total billed charges ","90% of total billed charges ",40.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.75,87,,117.78,25.30,174.56,11,"percent of total billed charges ","87% of total billed charges ",40.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.81,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.5,70,,126.00,,,0,"percent of total billed charges ","70% of total billed charges ",25.81,209.25,
"*SEX HORMONE BINDING GLOBULIN",2030190,"CDM ",301,RC,84270,HCPCS,OUTPATIENT,,,261.5,209.2,,18.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.82,64.82,64.82,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",243.2,93,,194.56,,,0,"percent of total billed charges ","93% of total billed charges ",18.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",222.28,85,,177.82,,,0,"percent of total billed charges ","85% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",23.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",227.51,87,,162.40,97.34,162.40,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.73,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",18.47,243.2,
"THIOPURINE,METHYLTRANSFERASE",2030250,"CDM ",309,RC,81401,HCPCS,OUTPATIENT,,,1808.5,1446.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1265.95,70,,1012.76,,,0,"percent of total billed charges ","70% of total billed charges ",1627.65,90,,1302.12,,,0,"percent of total billed charges ","90% of total billed charges ",1681.91,93,,1345.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1537.23,85,,1229.78,,,0,"percent of total billed charges ","85% of total billed charges ",1627.65,90,,1302.12,,,0,"percent of total billed charges ","90% of total billed charges ",1627.65,90,,1302.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1573.4,87,,1258.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",137,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1265.95,70,,1012.76,,,0,"percent of total billed charges ","70% of total billed charges ",137,1681.91,
"IODINE, SERUM",2030260,"CDM ",301,RC,83789,HCPCS,OUTPATIENT,,,457,365.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",319.9,70,,255.92,,,0,"percent of total billed charges ","70% of total billed charges ",411.3,90,,329.04,,,0,"percent of total billed charges ","90% of total billed charges ",425.01,93,,340.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",388.45,85,,310.76,,,0,"percent of total billed charges ","85% of total billed charges ",411.3,90,,329.04,,,0,"percent of total billed charges ","90% of total billed charges ",411.3,90,,329.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",397.59,87,,318.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",24.11,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",319.9,70,,255.92,,,0,"percent of total billed charges ","70% of total billed charges ",24.11,425.01,
"*CYCLIC CITRULINATED PEPTITE",2030270,"CDM ",302,RC,86200,HCPCS,OUTPATIENT,,,465,372,,12.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,33.25,33.25,33.25,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",325.5,70,,260.40,,,0,"percent of total billed charges ","70% of total billed charges ",418.5,90,,334.80,,,0,"percent of total billed charges ","90% of total billed charges ",432.45,93,,345.96,,,0,"percent of total billed charges ","93% of total billed charges ",12.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",395.25,85,,316.20,,,0,"percent of total billed charges ","85% of total billed charges ",418.5,90,,334.80,,,0,"percent of total billed charges ","90% of total billed charges ",418.5,90,,334.80,,,0,"percent of total billed charges ","90% of total billed charges ",20.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",404.55,87,,323.64,,,0,"percent of total billed charges ","87% of total billed charges ",20.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.95,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",325.5,70,,260.40,,,0,"percent of total billed charges ","70% of total billed charges ",12.95,432.45,
"*RHEUMATOID FACTOR, IGM",2030280,"CDM ",302,RC,86431,HCPCS,OUTPATIENT,,,206.5,165.2,,5.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,5.56,5.56,5.56,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",192.05,93,,153.64,,,0,"percent of total billed charges ","93% of total billed charges ",5.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",175.53,85,,140.42,,,0,"percent of total billed charges ","85% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",179.66,87,,5.56,5.56,56.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",5.67,192.05,
"*RHEUMATOID FACTOR IGG & IGA",2030290,"CDM ",302,RC,86430,HCPCS,OUTPATIENT,,,206.5,165.2,,6.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",192.05,93,,153.64,,,0,"percent of total billed charges ","93% of total billed charges ",6.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",175.53,85,,140.42,,,0,"percent of total billed charges ","85% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",179.66,87,,143.73,,,0,"percent of total billed charges ","87% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",6.14,192.05,
"THYROID BINDING GLOBULIN (TGB)",2030320,"CDM ",301,RC,84442,HCPCS,OUTPATIENT,,,175.5,140.4,,14.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,55.94,55.94,55.94,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.85,70,,98.28,,,0,"percent of total billed charges ","70% of total billed charges ",157.95,90,,126.36,,,0,"percent of total billed charges ","90% of total billed charges ",163.22,93,,130.58,,,0,"percent of total billed charges ","93% of total billed charges ",14.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",149.18,85,,119.34,,,0,"percent of total billed charges ","85% of total billed charges ",157.95,90,,126.36,,,0,"percent of total billed charges ","90% of total billed charges ",157.95,90,,126.36,,,0,"percent of total billed charges ","90% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",152.69,87,,122.15,,,0,"percent of total billed charges ","87% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.78,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",122.85,70,,98.28,,,0,"percent of total billed charges ","70% of total billed charges ",14.78,163.22,
LACOSAMIDE,2030330,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,350,280,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",245,70,,196.00,,,0,"percent of total billed charges ","70% of total billed charges ",315,90,,252.00,,,0,"percent of total billed charges ","90% of total billed charges ",325.5,93,,260.40,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",297.5,85,,238.00,,,0,"percent of total billed charges ","85% of total billed charges ",315,90,,252.00,,,0,"percent of total billed charges ","90% of total billed charges ",315,90,,252.00,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",304.5,87,,243.60,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",245,70,,196.00,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,325.5,
"CORTISOL FREE, SERUM",2030340,"CDM ",301,RC,82530,HCPCS,OUTPATIENT,,,212.5,170,,15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,79.16,79.16,79.16,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.75,70,,119.00,,,0,"percent of total billed charges ","70% of total billed charges ",191.25,90,,153.00,,,0,"percent of total billed charges ","90% of total billed charges ",197.63,93,,158.10,,,0,"percent of total billed charges ","93% of total billed charges ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",180.63,85,,144.50,,,0,"percent of total billed charges ","85% of total billed charges ",191.25,90,,153.00,,,0,"percent of total billed charges ","90% of total billed charges ",191.25,90,,153.00,,,0,"percent of total billed charges ","90% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.88,87,,88.27,88.27,88.27,"1 through 10","percent of total billed charges ","87% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.71,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",148.75,70,,119.00,,,0,"percent of total billed charges ","70% of total billed charges ",15,197.63,
*IMMUNOASSAY,2030350,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,158,126.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.6,70,,88.48,,,0,"percent of total billed charges ","70% of total billed charges ",142.2,90,,113.76,,,0,"percent of total billed charges ","90% of total billed charges ",146.94,93,,117.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",134.3,85,,107.44,,,0,"percent of total billed charges ","85% of total billed charges ",142.2,90,,113.76,,,0,"percent of total billed charges ","90% of total billed charges ",142.2,90,,113.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.46,87,,109.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",110.6,70,,88.48,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,146.94,
"*FLUORESCENT AB SCREEN",2030360,"CDM ",302,RC,86255,HCPCS,OUTPATIENT,,,170,136,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119,70,,95.20,,,0,"percent of total billed charges ","70% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",158.1,93,,126.48,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",144.5,85,,115.60,,,0,"percent of total billed charges ","85% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.9,87,,118.32,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",119,70,,95.20,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,158.1,
"*MAG WESTERN BLOT",2030370,"CDM ",301,RC,84181,HCPCS,OUTPATIENT,,,164.5,131.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.15,70,,92.12,,,0,"percent of total billed charges ","70% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",152.99,93,,122.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",139.83,85,,111.86,,,0,"percent of total billed charges ","85% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",143.12,87,,114.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.15,70,,92.12,,,0,"percent of total billed charges ","70% of total billed charges ",17.03,152.99,
"*ANNA TITER",2030380,"CDM ",302,RC,86256,HCPCS,OUTPATIENT,,,245.5,196.4,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",171.85,70,,137.48,,,0,"percent of total billed charges ","70% of total billed charges ",220.95,90,,176.76,,,0,"percent of total billed charges ","90% of total billed charges ",228.32,93,,182.66,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",208.68,85,,166.94,,,0,"percent of total billed charges ","85% of total billed charges ",220.95,90,,176.76,,,0,"percent of total billed charges ","90% of total billed charges ",220.95,90,,176.76,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",213.59,87,,17.72,12.99,22.44,"1 through 10","percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",171.85,70,,137.48,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,228.32,
"*ANNA WESTERN BLOT",2030390,"CDM ",301,RC,84181,HCPCS,OUTPATIENT,,,164.5,131.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.15,70,,92.12,,,0,"percent of total billed charges ","70% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",152.99,93,,122.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",139.83,85,,111.86,,,0,"percent of total billed charges ","85% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",143.12,87,,114.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.15,70,,92.12,,,0,"percent of total billed charges ","70% of total billed charges ",17.03,152.99,
"TISSUE TRANSGLUAMINASE,ABS IGG",2030440,"CDM ",301,RC,83516,HCPCS,OUTPATIENT,,,108,86.4,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,53.32,28.74,77.90,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",10,100.44,
"TZANCK SMEAR, CYTOLOGY",2030450,"CDM ",300,RC,88160,HCPCS,OUTPATIENT,,,184,147.2,,55.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",147.97,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",128.8,70,,103.04,,,0,"percent of total billed charges ","70% of total billed charges ",165.6,90,,132.48,,,0,"percent of total billed charges ","90% of total billed charges ",171.12,93,,136.90,,,0,"percent of total billed charges ","93% of total billed charges ",55.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",156.4,85,,125.12,,,0,"percent of total billed charges ","85% of total billed charges ",165.6,90,,132.48,,,0,"percent of total billed charges ","90% of total billed charges ",165.6,90,,132.48,,,0,"percent of total billed charges ","90% of total billed charges ",7.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",160.08,87,,128.06,,,0,"percent of total billed charges ","87% of total billed charges ",7.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.59,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",128.8,70,,103.04,,,0,"percent of total billed charges ","70% of total billed charges ",7.13,171.12,
"HIV GENOTYPE",2030460,"CDM ",306,RC,87901,HCPCS,OUTPATIENT,,,2025,1620,,257.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1417.5,70,,1134.00,,,0,"percent of total billed charges ","70% of total billed charges ",1822.5,90,,1458.00,,,0,"percent of total billed charges ","90% of total billed charges ",1883.25,93,,1506.60,,,0,"percent of total billed charges ","93% of total billed charges ",257.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",376.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1721.25,85,,1377.00,,,0,"percent of total billed charges ","85% of total billed charges ",1822.5,90,,1458.00,,,0,"percent of total billed charges ","90% of total billed charges ",1822.5,90,,1458.00,,,0,"percent of total billed charges ","90% of total billed charges ",372.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1761.75,87,,1409.40,,,0,"percent of total billed charges ","87% of total billed charges ",372.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1417.5,70,,1134.00,,,0,"percent of total billed charges ","70% of total billed charges ",257.45,1883.25,
"GALCL SEQUENCE ANALYSIS",2030540,"CDM ",309,RC,81401,HCPCS,OUTPATIENT,,,6610,5288,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4627,70,,3701.60,,,0,"percent of total billed charges ","70% of total billed charges ",5949,90,,4759.20,,,0,"percent of total billed charges ","90% of total billed charges ",6147.3,93,,4917.84,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5618.5,85,,4494.80,,,0,"percent of total billed charges ","85% of total billed charges ",5949,90,,4759.20,,,0,"percent of total billed charges ","90% of total billed charges ",5949,90,,4759.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5750.7,87,,4600.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",137,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",4627,70,,3701.60,,,0,"percent of total billed charges ","70% of total billed charges ",137,6147.3,
"*ALCOHOL; EXCEPT BREATH",2030560,"CDM ",301,RC,80321,HCPCS,OUTPATIENT,,,259.5,207.6,,15.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,165.33,165.33,165.33,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",181.65,70,,145.32,,,0,"percent of total billed charges ","70% of total billed charges ",233.55,90,,186.84,,,0,"percent of total billed charges ","90% of total billed charges ",241.34,93,,193.07,,,0,"percent of total billed charges ","93% of total billed charges ",15.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",220.58,85,,176.46,,,0,"percent of total billed charges ","85% of total billed charges ",233.55,90,,186.84,,,0,"percent of total billed charges ","90% of total billed charges ",233.55,90,,186.84,,,0,"percent of total billed charges ","90% of total billed charges ",19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",225.77,87,,113.79,97.52,130.06,"1 through 10","percent of total billed charges ","87% of total billed charges ",19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",181.65,70,,145.32,,,0,"percent of total billed charges ","70% of total billed charges ",15.5,241.34,
"DENGUE FEVER VIRUS ABS, IGM",2030570,"CDM ",302,RC,86790,HCPCS,OUTPATIENT,,,189,151.2,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.58,80.58,80.58,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.3,70,,105.84,,,0,"percent of total billed charges ","70% of total billed charges ",170.1,90,,136.08,,,0,"percent of total billed charges ","90% of total billed charges ",175.77,93,,140.62,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",160.65,85,,128.52,,,0,"percent of total billed charges ","85% of total billed charges ",170.1,90,,136.08,,,0,"percent of total billed charges ","90% of total billed charges ",170.1,90,,136.08,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",164.43,87,,199.98,199.98,199.98,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",132.3,70,,105.84,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,175.77,
"*CONC INFECTIOUS AGENTS",2030580,"CDM ",306,RC,87015,HCPCS,OUTPATIENT,,,119.5,95.6,,6.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",111.14,93,,88.91,,,0,"percent of total billed charges ","93% of total billed charges ",6.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",101.58,85,,81.26,,,0,"percent of total billed charges ","85% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",103.97,87,,83.18,,,0,"percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.68,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.68,111.14,
"*SMEAR SPECIAL STAIN",2030590,"CDM ",306,RC,87207,HCPCS,OUTPATIENT,,,119.5,95.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",111.14,93,,88.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",101.58,85,,81.26,,,0,"percent of total billed charges ","85% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",103.97,87,,83.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",5.99,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",5.99,111.14,
"*VIRUS NOT ELSEWHERE SPECIFIED",2030610,"CDM ",302,RC,86790,HCPCS,OUTPATIENT,,,146,116.8,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.58,80.58,80.58,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,199.98,199.98,199.98,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,135.78,
"*VIRUS NOT ELSEWHERE SPECIFIED",2030630,"CDM ",302,RC,86790,HCPCS,OUTPATIENT,,,976,780.8,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.58,80.58,80.58,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",683.2,70,,546.56,,,0,"percent of total billed charges ","70% of total billed charges ",878.4,90,,702.72,,,0,"percent of total billed charges ","90% of total billed charges ",907.68,93,,726.14,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",829.6,85,,663.68,,,0,"percent of total billed charges ","85% of total billed charges ",878.4,90,,702.72,,,0,"percent of total billed charges ","90% of total billed charges ",878.4,90,,702.72,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",849.12,87,,199.98,199.98,199.98,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",683.2,70,,546.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,907.68,
"BANANA ALLERGEN, IGE",2030650,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,83,66.4,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",72.21,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,77.19,
"ANTIPLATELET ANTIBODY DIRECT",2030660,"CDM ",302,RC,86023,HCPCS,OUTPATIENT,,,327.5,262,,10.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",229.25,70,,183.40,,,0,"percent of total billed charges ","70% of total billed charges ",294.75,90,,235.80,,,0,"percent of total billed charges ","90% of total billed charges ",304.58,93,,243.66,,,0,"percent of total billed charges ","93% of total billed charges ",10.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",278.38,85,,222.70,,,0,"percent of total billed charges ","85% of total billed charges ",294.75,90,,235.80,,,0,"percent of total billed charges ","90% of total billed charges ",294.75,90,,235.80,,,0,"percent of total billed charges ","90% of total billed charges ",9.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",284.93,87,,227.94,,,0,"percent of total billed charges ","87% of total billed charges ",9.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.46,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",229.25,70,,183.40,,,0,"percent of total billed charges ","70% of total billed charges ",9.82,304.58,
"TPMT LEVEL",2030670,"CDM ",301,RC,83789,HCPCS,OUTPATIENT,,,921.5,737.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",645.05,70,,516.04,,,0,"percent of total billed charges ","70% of total billed charges ",829.35,90,,663.48,,,0,"percent of total billed charges ","90% of total billed charges ",857,93,,685.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",783.28,85,,626.62,,,0,"percent of total billed charges ","85% of total billed charges ",829.35,90,,663.48,,,0,"percent of total billed charges ","90% of total billed charges ",829.35,90,,663.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",801.71,87,,641.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",24.11,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",645.05,70,,516.04,,,0,"percent of total billed charges ","70% of total billed charges ",24.11,857,
"VON WILLEBRAND MULTIMERIC ANAL",2030680,"CDM ",305,RC,85247,HCPCS,OUTPATIENT,,,330.5,264.4,,19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",231.35,70,,185.08,,,0,"percent of total billed charges ","70% of total billed charges ",297.45,90,,237.96,,,0,"percent of total billed charges ","90% of total billed charges ",307.37,93,,245.90,,,0,"percent of total billed charges ","93% of total billed charges ",19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",280.93,85,,224.74,,,0,"percent of total billed charges ","85% of total billed charges ",297.45,90,,237.96,,,0,"percent of total billed charges ","90% of total billed charges ",297.45,90,,237.96,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",287.54,87,,230.03,,,0,"percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.94,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",231.35,70,,185.08,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,307.37,
"*B CELLS, TOTAL COUNT",2030690,"CDM ",302,RC,86355,HCPCS,OUTPATIENT,,,152,121.6,,37.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,96.83,96.83,96.83,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",141.36,93,,113.09,,,0,"percent of total billed charges ","93% of total billed charges ",37.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",129.2,85,,103.36,,,0,"percent of total billed charges ","85% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",58.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.24,87,,105.79,,,0,"percent of total billed charges ","87% of total billed charges ",58.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.72,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",37.72,141.36,
"*T CELLS, TOTAL COUNT",2030700,"CDM ",302,RC,86359,HCPCS,OUTPATIENT,,,152,121.6,,32.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,98.84,98.84,98.84,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",141.36,93,,113.09,,,0,"percent of total billed charges ","93% of total billed charges ",32.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",129.2,85,,103.36,,,0,"percent of total billed charges ","85% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",37.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.24,87,,105.79,,,0,"percent of total billed charges ","87% of total billed charges ",37.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.72,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",32.07,141.36,
"*NATURAL KILLER CELLS,TOTAL",2030710,"CDM ",302,RC,86357,HCPCS,OUTPATIENT,,,152,121.6,,37.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,96.83,96.83,96.83,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",141.36,93,,113.09,,,0,"percent of total billed charges ","93% of total billed charges ",37.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",129.2,85,,103.36,,,0,"percent of total billed charges ","85% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",58.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.24,87,,105.79,,,0,"percent of total billed charges ","87% of total billed charges ",58.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.72,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",37.72,141.36,
"*ABSOLUTE CD4/CD 8,RATIO INCL",2030720,"CDM ",302,RC,86360,HCPCS,OUTPATIENT,,,370,296,,39.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,162.94,162.94,162.94,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",344.1,93,,275.28,,,0,"percent of total billed charges ","93% of total billed charges ",39.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",314.5,85,,251.60,,,0,"percent of total billed charges ","85% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",37.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",321.9,87,,257.52,,,0,"percent of total billed charges ","87% of total billed charges ",37.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",37.61,344.1,
"LISTERIA ANTIBOY, SERUM",2030740,"CDM ",302,RC,86609,HCPCS,OUTPATIENT,,,239.5,191.6,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.65,70,,134.12,,,0,"percent of total billed charges ","70% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",222.74,93,,178.19,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",203.58,85,,162.86,,,0,"percent of total billed charges ","85% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",208.37,87,,166.70,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",167.65,70,,134.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,222.74,
"DIPHTHERIA ANTITOXOID",2030745,"CDM ",301,RC,86648,HCPCS,OUTPATIENT,,,141,112.8,,12.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.7,70,,78.96,,,0,"percent of total billed charges ","70% of total billed charges ",126.9,90,,101.52,,,0,"percent of total billed charges ","90% of total billed charges ",131.13,93,,104.90,,,0,"percent of total billed charges ","93% of total billed charges ",12.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",119.85,85,,95.88,,,0,"percent of total billed charges ","85% of total billed charges ",126.9,90,,101.52,,,0,"percent of total billed charges ","90% of total billed charges ",126.9,90,,101.52,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.67,87,,98.14,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.21,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",98.7,70,,78.96,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,131.13,
*C-PEPTIDE,2030750,"CDM ",301,RC,84681,HCPCS,OUTPATIENT,,,144.5,115.6,,17.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,71.80,71.80,71.80,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.15,70,,80.92,,,0,"percent of total billed charges ","70% of total billed charges ",130.05,90,,104.04,,,0,"percent of total billed charges ","90% of total billed charges ",134.39,93,,107.51,,,0,"percent of total billed charges ","93% of total billed charges ",17.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.08,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",122.83,85,,98.26,,,0,"percent of total billed charges ","85% of total billed charges ",130.05,90,,104.04,,,0,"percent of total billed charges ","90% of total billed charges ",130.05,90,,104.04,,,0,"percent of total billed charges ","90% of total billed charges ",21.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",125.72,87,,112.49,94.49,112.49,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.81,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",101.15,70,,80.92,,,0,"percent of total billed charges ","70% of total billed charges ",17.69,134.39,
"EPSTEIN-BARR VIRUS EA ABS, IGG",2030770,"CDM ",302,RC,86663,HCPCS,OUTPATIENT,,,168.5,134.8,,11.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",156.71,93,,125.37,,,0,"percent of total billed charges ","93% of total billed charges ",11.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.23,85,,114.58,,,0,"percent of total billed charges ","85% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",146.6,87,,117.28,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,156.71,
"VARICELLA-ZOSTER RAPID CULT",2030780,"CDM ",306,RC,87254,HCPCS,OUTPATIENT,,,534,427.2,,16.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",373.8,70,,299.04,,,0,"percent of total billed charges ","70% of total billed charges ",480.6,90,,384.48,,,0,"percent of total billed charges ","90% of total billed charges ",496.62,93,,397.30,,,0,"percent of total billed charges ","93% of total billed charges ",16.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",453.9,85,,363.12,,,0,"percent of total billed charges ","85% of total billed charges ",480.6,90,,384.48,,,0,"percent of total billed charges ","90% of total billed charges ",480.6,90,,384.48,,,0,"percent of total billed charges ","90% of total billed charges ",7.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",464.58,87,,371.66,,,0,"percent of total billed charges ","87% of total billed charges ",7.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.55,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",373.8,70,,299.04,,,0,"percent of total billed charges ","70% of total billed charges ",7.52,496.62,
"IL-6 (INTERLEUKIN-6)",2030790,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,557.5,446,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",390.25,70,,312.20,,,0,"percent of total billed charges ","70% of total billed charges ",501.75,90,,401.40,,,0,"percent of total billed charges ","90% of total billed charges ",518.48,93,,414.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",473.88,85,,379.10,,,0,"percent of total billed charges ","85% of total billed charges ",501.75,90,,401.40,,,0,"percent of total billed charges ","90% of total billed charges ",501.75,90,,401.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",485.03,87,,388.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",390.25,70,,312.20,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,518.48,
"*CARDIOLIPIN AB EA IG CLASS",2030800,"CDM ",302,RC,86147,HCPCS,OUTPATIENT,,,224.5,179.6,,25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",208.79,93,,167.03,,,0,"percent of total billed charges ","93% of total billed charges ",25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",190.83,85,,152.66,,,0,"percent of total billed charges ","85% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.32,87,,156.26,,,0,"percent of total billed charges ","87% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",25.45,208.79,
DIHYDROTESTOSTERONE,2030880,"CDM ",301,RC,80327,HCPCS,OUTPATIENT,,,237.5,190,,15.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",166.25,70,,133.00,,,0,"percent of total billed charges ","70% of total billed charges ",213.75,90,,171.00,,,0,"percent of total billed charges ","90% of total billed charges ",220.88,93,,176.70,,,0,"percent of total billed charges ","93% of total billed charges ",15.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",201.88,85,,161.50,,,0,"percent of total billed charges ","85% of total billed charges ",213.75,90,,171.00,,,0,"percent of total billed charges ","90% of total billed charges ",213.75,90,,171.00,,,0,"percent of total billed charges ","90% of total billed charges ",19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",206.63,87,,165.30,,,0,"percent of total billed charges ","87% of total billed charges ",19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",166.25,70,,133.00,,,0,"percent of total billed charges ","70% of total billed charges ",15.5,220.88,
"NEISSERIA GONORRHOEAE AB,CF",2030890,"CDM ",302,RC,86609,HCPCS,OUTPATIENT,,,202,161.6,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.4,70,,113.12,,,0,"percent of total billed charges ","70% of total billed charges ",181.8,90,,145.44,,,0,"percent of total billed charges ","90% of total billed charges ",187.86,93,,150.29,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",171.7,85,,137.36,,,0,"percent of total billed charges ","85% of total billed charges ",181.8,90,,145.44,,,0,"percent of total billed charges ","90% of total billed charges ",181.8,90,,145.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",175.74,87,,140.59,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",141.4,70,,113.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,187.86,
"*CREATINE 24 HOUR URINE",2030910,"CDM ",301,RC,82540,HCPCS,OUTPATIENT,,,99.5,79.6,,4.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.65,70,,55.72,,,0,"percent of total billed charges ","70% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",92.54,93,,74.03,,,0,"percent of total billed charges ","93% of total billed charges ",4.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",84.58,85,,67.66,,,0,"percent of total billed charges ","85% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",8.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",86.57,87,,69.26,,,0,"percent of total billed charges ","87% of total billed charges ",8.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.63,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",69.65,70,,55.72,,,0,"percent of total billed charges ","70% of total billed charges ",4.63,92.54,
"ENTEROVIRUS, RNA, RT-PCR",2030920,"CDM ",306,RC,87498,HCPCS,OUTPATIENT,,,1619,1295.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1133.3,70,,906.64,,,0,"percent of total billed charges ","70% of total billed charges ",1457.1,90,,1165.68,,,0,"percent of total billed charges ","90% of total billed charges ",1505.67,93,,1204.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",43.78,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1376.15,85,,1100.92,,,0,"percent of total billed charges ","85% of total billed charges ",1457.1,90,,1165.68,,,0,"percent of total billed charges ","90% of total billed charges ",1457.1,90,,1165.68,,,0,"percent of total billed charges ","90% of total billed charges ",43.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1408.53,87,,1126.82,,,0,"percent of total billed charges ","87% of total billed charges ",43.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1133.3,70,,906.64,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,1505.67,
"S. PNEUMONAIE ANTIGEN",2030930,"CDM ",302,RC,86403,HCPCS,OUTPATIENT,,,601,480.8,,11.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",420.7,70,,336.56,,,0,"percent of total billed charges ","70% of total billed charges ",540.9,90,,432.72,,,0,"percent of total billed charges ","90% of total billed charges ",558.93,93,,447.14,,,0,"percent of total billed charges ","93% of total billed charges ",11.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",510.85,85,,408.68,,,0,"percent of total billed charges ","85% of total billed charges ",540.9,90,,432.72,,,0,"percent of total billed charges ","90% of total billed charges ",540.9,90,,432.72,,,0,"percent of total billed charges ","90% of total billed charges ",18.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",522.87,87,,418.30,,,0,"percent of total billed charges ","87% of total billed charges ",18.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.54,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",420.7,70,,336.56,,,0,"percent of total billed charges ","70% of total billed charges ",11.54,558.93,
"*IMMUNOASSAY ANALYTE MULT STEP",2030940,"CDM ",301,RC,83516,HCPCS,OUTPATIENT,,,108,86.4,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,53.32,28.74,77.90,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",10,100.44,
"*GAMMAGLOBULIN IGA,D,G,M EACH",2030950,"CDM ",301,RC,82784,HCPCS,OUTPATIENT,,,108,86.4,,9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,75.17,,,0,"percent of total billed charges ","87% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",9.3,100.44,
"PFA-100 (PLATE FUNCTION ASSAY)",2030970,"CDM ",305,RC,85397,HCPCS,OUTPATIENT,,,242.5,194,,26.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",169.75,70,,135.80,,,0,"percent of total billed charges ","70% of total billed charges ",218.25,90,,174.60,,,0,"percent of total billed charges ","90% of total billed charges ",225.53,93,,180.42,,,0,"percent of total billed charges ","93% of total billed charges ",26.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",206.13,85,,164.90,,,0,"percent of total billed charges ","85% of total billed charges ",218.25,90,,174.60,,,0,"percent of total billed charges ","90% of total billed charges ",218.25,90,,174.60,,,0,"percent of total billed charges ","90% of total billed charges ",10.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",210.98,87,,168.78,,,0,"percent of total billed charges ","87% of total billed charges ",10.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.86,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",169.75,70,,135.80,,,0,"percent of total billed charges ","70% of total billed charges ",10.42,225.53,
ACYLCARNITINE,2030980,"CDM ",301,RC,82017,HCPCS,OUTPATIENT,,,666,532.8,,16.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",466.2,70,,372.96,,,0,"percent of total billed charges ","70% of total billed charges ",599.4,90,,479.52,,,0,"percent of total billed charges ","90% of total billed charges ",619.38,93,,495.50,,,0,"percent of total billed charges ","93% of total billed charges ",16.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",566.1,85,,452.88,,,0,"percent of total billed charges ","85% of total billed charges ",599.4,90,,479.52,,,0,"percent of total billed charges ","90% of total billed charges ",599.4,90,,479.52,,,0,"percent of total billed charges ","90% of total billed charges ",25.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",579.42,87,,463.54,,,0,"percent of total billed charges ","87% of total billed charges ",25.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.87,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",466.2,70,,372.96,,,0,"percent of total billed charges ","70% of total billed charges ",16.87,619.38,
"COTININE URINE",2030990,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,274.5,219.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.15,70,,153.72,,,0,"percent of total billed charges ","70% of total billed charges ",247.05,90,,197.64,,,0,"percent of total billed charges ","90% of total billed charges ",255.29,93,,204.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",233.33,85,,186.66,,,0,"percent of total billed charges ","85% of total billed charges ",247.05,90,,197.64,,,0,"percent of total billed charges ","90% of total billed charges ",247.05,90,,197.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",238.82,87,,191.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",192.15,70,,153.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,255.29,
"MYCOPLASMA PNEU DNA, QUAL",2031000,"CDM ",306,RC,87581,HCPCS,OUTPATIENT,,,1534,1227.2,,29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1073.8,70,,859.04,,,0,"percent of total billed charges ","70% of total billed charges ",1380.6,90,,1104.48,,,0,"percent of total billed charges ","90% of total billed charges ",1426.62,93,,1141.30,,,0,"percent of total billed charges ","93% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1303.9,85,,1043.12,,,0,"percent of total billed charges ","85% of total billed charges ",1380.6,90,,1104.48,,,0,"percent of total billed charges ","90% of total billed charges ",1380.6,90,,1104.48,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1334.58,87,,1067.66,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1073.8,70,,859.04,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,1426.62,
"RHEUMATOID FACTOR,LA,FLUID QUA",2031010,"CDM ",302,RC,86430,HCPCS,OUTPATIENT,,,325,260,,6.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.5,70,,182.00,,,0,"percent of total billed charges ","70% of total billed charges ",292.5,90,,234.00,,,0,"percent of total billed charges ","90% of total billed charges ",302.25,93,,241.80,,,0,"percent of total billed charges ","93% of total billed charges ",6.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",276.25,85,,221.00,,,0,"percent of total billed charges ","85% of total billed charges ",292.5,90,,234.00,,,0,"percent of total billed charges ","90% of total billed charges ",292.5,90,,234.00,,,0,"percent of total billed charges ","90% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",282.75,87,,226.20,,,0,"percent of total billed charges ","87% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",227.5,70,,182.00,,,0,"percent of total billed charges ","70% of total billed charges ",6.14,302.25,
"COLLECTION CENTRAL/PERIPH CATH",2031090,"CDM ",300,RC,36592,HCPCS,OUTPATIENT,,,117.5,94,,,,,,,,0,"other ","not separately reimbursment ",144.89,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",60.48,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",82.25,70,,65.80,,,0,"percent of total billed charges ","70% of total billed charges ",105.75,90,,84.60,,,0,"percent of total billed charges ","90% of total billed charges ",109.28,93,,87.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.88,85,,79.90,,,0,"percent of total billed charges ","85% of total billed charges ",88.13,90,,70.50,,,0,"percent of total billed charges ","90% of total billed charges ",105.75,90,,84.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",102.23,87,,81.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",82.25,70,,65.80,,,0,"percent of total billed charges ","70% of total billed charges ",60.48,144.89,
"*IMMUNOASSAY ANALYTE MULT STEP",2031100,"CDM ",300,RC,86364,HCPCS,OUTPATIENT,,,249.5,199.6,,7.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,135.32,135.32,135.32,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174.65,70,,139.72,,,0,"percent of total billed charges ","70% of total billed charges ",224.55,90,,179.64,,,0,"percent of total billed charges ","90% of total billed charges ",232.04,93,,185.63,,,0,"percent of total billed charges ","93% of total billed charges ",7.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",212.08,85,,169.66,,,0,"percent of total billed charges ","85% of total billed charges ",224.55,90,,179.64,,,0,"percent of total billed charges ","90% of total billed charges ",224.55,90,,179.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",217.07,87,,173.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",11.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",174.65,70,,139.72,,,0,"percent of total billed charges ","70% of total billed charges ",7.49,232.04,
"MUSK ANTIBODY TEST",2031103,"CDM ",300,RC,86366,HCPCS,OUTPATIENT,,,540,432,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",378,70,,302.40,,,0,"percent of total billed charges ","70% of total billed charges ",486,90,,388.80,,,0,"percent of total billed charges ","90% of total billed charges ",502.2,93,,401.76,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",459,85,,367.20,,,0,"percent of total billed charges ","85% of total billed charges ",486,90,,388.80,,,0,"percent of total billed charges ","90% of total billed charges ",486,90,,388.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",469.8,87,,375.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",378,70,,302.40,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,502.2,
"ALPHA SUBUNIT GLYCOPROTEIN HOR",2031120,"CDM ",301,RC,83519,HCPCS,OUTPATIENT,,,280.5,224.4,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",196.35,70,,157.08,,,0,"percent of total billed charges ","70% of total billed charges ",252.45,90,,201.96,,,0,"percent of total billed charges ","90% of total billed charges ",260.87,93,,208.70,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",238.43,85,,190.74,,,0,"percent of total billed charges ","85% of total billed charges ",252.45,90,,201.96,,,0,"percent of total billed charges ","90% of total billed charges ",252.45,90,,201.96,,,0,"percent of total billed charges ","90% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",244.04,87,,195.23,,,0,"percent of total billed charges ","87% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",196.35,70,,157.08,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,260.87,
"*FACTOR VIII (AHG) 1-STAGE",2031130,"CDM ",305,RC,85240,HCPCS,OUTPATIENT,,,612,489.6,,17.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",428.4,70,,342.72,,,0,"percent of total billed charges ","70% of total billed charges ",550.8,90,,440.64,,,0,"percent of total billed charges ","90% of total billed charges ",569.16,93,,455.33,,,0,"percent of total billed charges ","93% of total billed charges ",17.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",520.2,85,,416.16,,,0,"percent of total billed charges ","85% of total billed charges ",550.8,90,,440.64,,,0,"percent of total billed charges ","90% of total billed charges ",550.8,90,,440.64,,,0,"percent of total billed charges ","90% of total billed charges ",24.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",532.44,87,,150.42,150.42,150.42,"1 through 10","percent of total billed charges ","87% of total billed charges ",24.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.89,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",428.4,70,,342.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.89,569.16,
"*FACTOR INHIBITOR TEST",2031140,"CDM ",305,RC,85335,HCPCS,OUTPATIENT,,,612,489.6,,11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",428.4,70,,342.72,,,0,"percent of total billed charges ","70% of total billed charges ",550.8,90,,440.64,,,0,"percent of total billed charges ","90% of total billed charges ",569.16,93,,455.33,,,0,"percent of total billed charges ","93% of total billed charges ",11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",520.2,85,,416.16,,,0,"percent of total billed charges ","85% of total billed charges ",550.8,90,,440.64,,,0,"percent of total billed charges ","90% of total billed charges ",550.8,90,,440.64,,,0,"percent of total billed charges ","90% of total billed charges ",14.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",532.44,87,,425.95,,,0,"percent of total billed charges ","87% of total billed charges ",14.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.87,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",428.4,70,,342.72,,,0,"percent of total billed charges ","70% of total billed charges ",11.08,569.16,
"*GAMMAGLOBULIN IG-A,D,G,M EACH",2031250,"CDM ",301,RC,82784,HCPCS,OUTPATIENT,,,108,86.4,,9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,75.17,,,0,"percent of total billed charges ","87% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",9.3,100.44,
"*NEPHELOMETRY EACH ANALYTE",2031260,"CDM ",301,RC,83883,HCPCS,OUTPATIENT,,,112.5,90,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",104.63,93,,83.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",95.63,85,,76.50,,,0,"percent of total billed charges ","85% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",97.88,87,,78.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",13.6,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",13.6,104.63,
"*PROTEIN TOTAL",2031270,"CDM ",301,RC,84155,HCPCS,OUTPATIENT,,,43,34.4,,3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.1,70,,24.08,,,0,"percent of total billed charges ","70% of total billed charges ",38.7,90,,30.96,,,0,"percent of total billed charges ","90% of total billed charges ",39.99,93,,31.99,,,0,"percent of total billed charges ","93% of total billed charges ",3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",36.55,85,,29.24,,,0,"percent of total billed charges ","85% of total billed charges ",38.7,90,,30.96,,,0,"percent of total billed charges ","90% of total billed charges ",38.7,90,,30.96,,,0,"percent of total billed charges ","90% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.41,87,,29.93,,,0,"percent of total billed charges ","87% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",30.1,70,,24.08,,,0,"percent of total billed charges ","70% of total billed charges ",3.67,39.99,
"*PROTEIN SERUM",2031280,"CDM ",301,RC,84165,HCPCS,OUTPATIENT,,,90,72,,10.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",10.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",10.74,83.7,
"*IMMUNOFIXATION SERUM",2031290,"CDM ",302,RC,86334,HCPCS,OUTPATIENT,,,269,215.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.3,70,,150.64,,,0,"percent of total billed charges ","70% of total billed charges ",242.1,90,,193.68,,,0,"percent of total billed charges ","90% of total billed charges ",250.17,93,,200.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",228.65,85,,182.92,,,0,"percent of total billed charges ","85% of total billed charges ",242.1,90,,193.68,,,0,"percent of total billed charges ","90% of total billed charges ",242.1,90,,193.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.03,87,,187.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",22.34,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",188.3,70,,150.64,,,0,"percent of total billed charges ","70% of total billed charges ",22.34,250.17,
"TAY-SACHS DISEASE MUT ANALYSIS",2031370,"CDM ",309,RC,81255,HCPCS,OUTPATIENT,,,792,633.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",554.4,70,,443.52,,,0,"percent of total billed charges ","70% of total billed charges ",712.8,90,,570.24,,,0,"percent of total billed charges ","90% of total billed charges ",736.56,93,,589.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",673.2,85,,538.56,,,0,"percent of total billed charges ","85% of total billed charges ",712.8,90,,570.24,,,0,"percent of total billed charges ","90% of total billed charges ",712.8,90,,570.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",689.04,87,,551.23,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",51.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",554.4,70,,443.52,,,0,"percent of total billed charges ","70% of total billed charges ",51.45,736.56,
"ECSTACY RANDOM URINE",2031380,"CDM ",301,RC,80324,HCPCS,OUTPATIENT,,,179.5,143.6,,10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.65,70,,100.52,,,0,"percent of total billed charges ","70% of total billed charges ",161.55,90,,129.24,,,0,"percent of total billed charges ","90% of total billed charges ",166.94,93,,133.55,,,0,"percent of total billed charges ","93% of total billed charges ",10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",152.58,85,,122.06,,,0,"percent of total billed charges ","85% of total billed charges ",161.55,90,,129.24,,,0,"percent of total billed charges ","90% of total billed charges ",161.55,90,,129.24,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",156.17,87,,124.94,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",125.65,70,,100.52,,,0,"percent of total billed charges ","70% of total billed charges ",10.48,166.94,
"ROHYNOL, QUANT URINE",2031390,"CDM ",301,RC,80346,HCPCS,OUTPATIENT,,,304,243.2,,23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",212.8,70,,170.24,,,0,"percent of total billed charges ","70% of total billed charges ",273.6,90,,218.88,,,0,"percent of total billed charges ","90% of total billed charges ",282.72,93,,226.18,,,0,"percent of total billed charges ","93% of total billed charges ",23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",258.4,85,,206.72,,,0,"percent of total billed charges ","85% of total billed charges ",273.6,90,,218.88,,,0,"percent of total billed charges ","90% of total billed charges ",273.6,90,,218.88,,,0,"percent of total billed charges ","90% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.48,87,,211.58,,,0,"percent of total billed charges ","87% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",212.8,70,,170.24,,,0,"percent of total billed charges ","70% of total billed charges ",23.71,282.72,
"GHB(GAMMA-HYDROXY ACID) URINE",2031400,"CDM ",301,RC,82542,HCPCS,OUTPATIENT,,,362,289.6,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",253.4,70,,202.72,,,0,"percent of total billed charges ","70% of total billed charges ",325.8,90,,260.64,,,0,"percent of total billed charges ","90% of total billed charges ",336.66,93,,269.33,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",307.7,85,,246.16,,,0,"percent of total billed charges ","85% of total billed charges ",325.8,90,,260.64,,,0,"percent of total billed charges ","90% of total billed charges ",325.8,90,,260.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",314.94,87,,251.95,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",253.4,70,,202.72,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,336.66,
"*CHLAMYDIA CULTURE",2031410,"CDM ",306,RC,87110,HCPCS,OUTPATIENT,,,210.5,168.4,,19.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",195.77,93,,156.62,,,0,"percent of total billed charges ","93% of total billed charges ",19.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",178.93,85,,143.14,,,0,"percent of total billed charges ","85% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",183.14,87,,146.51,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.6,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",19.6,195.77,
"*CULTURE TYPING EA ANTISERUM",2031420,"CDM ",306,RC,87140,HCPCS,OUTPATIENT,,,102.5,82,,5.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.75,70,,57.40,,,0,"percent of total billed charges ","70% of total billed charges ",92.25,90,,73.80,,,0,"percent of total billed charges ","90% of total billed charges ",95.33,93,,76.26,,,0,"percent of total billed charges ","93% of total billed charges ",5.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.19,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",87.13,85,,69.70,,,0,"percent of total billed charges ","85% of total billed charges ",92.25,90,,73.80,,,0,"percent of total billed charges ","90% of total billed charges ",92.25,90,,73.80,,,0,"percent of total billed charges ","90% of total billed charges ",10.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",89.18,87,,71.34,,,0,"percent of total billed charges ","87% of total billed charges ",10.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.57,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",71.75,70,,57.40,,,0,"percent of total billed charges ","70% of total billed charges ",5.57,95.33,
"C1Q (COMPLEMENT COMPONENT)",2031440,"CDM ",302,RC,86160,HCPCS,OUTPATIENT,,,232,185.6,,12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,133.30,133.30,133.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",215.76,93,,172.61,,,0,"percent of total billed charges ","93% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",197.2,85,,157.76,,,0,"percent of total billed charges ","85% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.84,87,,226.71,226.71,226.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",12,215.76,
"HLA-DRB1 CLASS II DNA TYPING",2031450,"CDM ",302,RC,86817,HCPCS,OUTPATIENT,,,717.5,574,,90.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",502.25,70,,401.80,,,0,"percent of total billed charges ","70% of total billed charges ",645.75,90,,516.60,,,0,"percent of total billed charges ","90% of total billed charges ",667.28,93,,533.82,,,0,"percent of total billed charges ","93% of total billed charges ",90.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.58,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",609.88,85,,487.90,,,0,"percent of total billed charges ","85% of total billed charges ",645.75,90,,516.60,,,0,"percent of total billed charges ","90% of total billed charges ",645.75,90,,516.60,,,0,"percent of total billed charges ","90% of total billed charges ",116.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",624.23,87,,499.38,,,0,"percent of total billed charges ","87% of total billed charges ",116.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",502.25,70,,401.80,,,0,"percent of total billed charges ","70% of total billed charges ",90.22,667.28,
"HLA-DQ CLASS II DNA TYPING",2031500,"CDM ",309,RC,81383,HCPCS,OUTPATIENT,,,635,508,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",444.5,70,,355.60,,,0,"percent of total billed charges ","70% of total billed charges ",571.5,90,,457.20,,,0,"percent of total billed charges ","90% of total billed charges ",590.55,93,,472.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",539.75,85,,431.80,,,0,"percent of total billed charges ","85% of total billed charges ",571.5,90,,457.20,,,0,"percent of total billed charges ","90% of total billed charges ",571.5,90,,457.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",552.45,87,,441.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",109.13,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",444.5,70,,355.60,,,0,"percent of total billed charges ","70% of total billed charges ",109.13,590.55,
"*FLOW CYTOMETRY, FIRST MARKER",2031510,"CDM ",300,RC,88184,HCPCS,OUTPATIENT,,,218.5,174.8,,53.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",137.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",203.21,93,,162.57,,,0,"percent of total billed charges ","93% of total billed charges ",53.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",185.73,85,,148.58,,,0,"percent of total billed charges ","85% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",43.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",190.1,87,,152.08,,,0,"percent of total billed charges ","87% of total billed charges ",43.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",43.19,329.64,
"*FLOW CYTO EA ADD'L MARKER",2031520,"CDM ",300,RC,88185,HCPCS,OUTPATIENT,,,218.5,174.8,,19.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.24,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",203.21,93,,162.57,,,0,"percent of total billed charges ","93% of total billed charges ",19.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",185.73,85,,148.58,,,0,"percent of total billed charges ","85% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",21.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",190.1,87,,152.08,,,0,"percent of total billed charges ","87% of total billed charges ",21.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",19.52,203.21,
"*IMMUNOASSAY ANALYTE",2031550,"CDM ",302,RC,83516,HCPCS,OUTPATIENT,,,108,86.4,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,53.32,28.74,77.90,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",10,100.44,
"*ANTINUCLEAR ANTIBODIES",2031560,"CDM ",302,RC,86038,HCPCS,OUTPATIENT,,,144.5,115.6,,12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.15,70,,80.92,,,0,"percent of total billed charges ","70% of total billed charges ",130.05,90,,104.04,,,0,"percent of total billed charges ","90% of total billed charges ",134.39,93,,107.51,,,0,"percent of total billed charges ","93% of total billed charges ",12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",122.83,85,,98.26,,,0,"percent of total billed charges ","85% of total billed charges ",130.05,90,,104.04,,,0,"percent of total billed charges ","90% of total billed charges ",130.05,90,,104.04,,,0,"percent of total billed charges ","90% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",125.72,87,,88.36,11.85,147.83,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",101.15,70,,80.92,,,0,"percent of total billed charges ","70% of total billed charges ",12.09,134.39,
"*COMPLEMENT ANTIGEN EACH",2031570,"CDM ",302,RC,86160,HCPCS,OUTPATIENT,,,165,132,,12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,133.30,133.30,133.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,226.71,226.71,226.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",12,153.45,
"*DNA ANTIBODY",2031580,"CDM ",302,RC,86225,HCPCS,OUTPATIENT,,,169,135.2,,13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,72.72,72.72,72.72,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",157.17,93,,125.74,,,0,"percent of total billed charges ","93% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.65,85,,114.92,,,0,"percent of total billed charges ","85% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",24.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.03,87,,115.94,115.94,115.94,"1 through 10","percent of total billed charges ","87% of total billed charges ",24.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",13.74,157.17,
"*EXTRACTABLE NA, ANTIBODY",2031590,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,149.5,119.6,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",139.04,93,,111.23,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",127.08,85,,101.66,,,0,"percent of total billed charges ","85% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.07,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,139.04,
"*MICROSOMAL ANTIBODIES EACH",2031600,"CDM ",302,RC,86376,HCPCS,OUTPATIENT,,,140.5,112.4,,14.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.97,60.97,60.97,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",130.67,93,,104.54,,,0,"percent of total billed charges ","93% of total billed charges ",14.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",119.43,85,,95.54,,,0,"percent of total billed charges ","85% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.24,87,,55.52,12.39,96.11,"1 through 10","percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.55,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",14.55,130.67,
"*RA FACTOR, QUANTITATIVE",2031610,"CDM ",302,RC,86431,HCPCS,OUTPATIENT,,,110.5,88.4,,5.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,5.56,5.56,5.56,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.35,70,,61.88,,,0,"percent of total billed charges ","70% of total billed charges ",99.45,90,,79.56,,,0,"percent of total billed charges ","90% of total billed charges ",102.77,93,,82.22,,,0,"percent of total billed charges ","93% of total billed charges ",5.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",93.93,85,,75.14,,,0,"percent of total billed charges ","85% of total billed charges ",99.45,90,,79.56,,,0,"percent of total billed charges ","90% of total billed charges ",99.45,90,,79.56,,,0,"percent of total billed charges ","90% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,87,,5.56,5.56,56.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",77.35,70,,61.88,,,0,"percent of total billed charges ","70% of total billed charges ",5.67,102.77,
"AUTO UA W/MICROSCOPIC",2031630,"CDM ",307,RC,81001,HCPCS,OUTPATIENT,,,120.5,96.4,,3.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.35,70,,67.48,,,0,"percent of total billed charges ","70% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",112.07,93,,89.66,,,0,"percent of total billed charges ","93% of total billed charges ",3.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",102.43,85,,81.94,,,0,"percent of total billed charges ","85% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",108.45,90,,86.76,,,0,"percent of total billed charges ","90% of total billed charges ",5.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",104.84,87,,73.31,3.00,104.73,29,"percent of total billed charges ","87% of total billed charges ",5.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.17,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",84.35,70,,67.48,,,0,"percent of total billed charges ","70% of total billed charges ",3.17,112.07,
"*HERPES SIMPLEX VIRUS, QUANT",2031700,"CDM ",306,RC,87530,HCPCS,OUTPATIENT,,,531,424.8,,36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",371.7,70,,297.36,,,0,"percent of total billed charges ","70% of total billed charges ",477.9,90,,382.32,,,0,"percent of total billed charges ","90% of total billed charges ",493.83,93,,395.06,,,0,"percent of total billed charges ","93% of total billed charges ",36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",451.35,85,,361.08,,,0,"percent of total billed charges ","85% of total billed charges ",477.9,90,,382.32,,,0,"percent of total billed charges ","90% of total billed charges ",477.9,90,,382.32,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",461.97,87,,612.88,612.88,612.88,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.84,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",371.7,70,,297.36,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,493.83,
"GM-CSF PLASMA",2031720,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,1249,999.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",874.3,70,,699.44,,,0,"percent of total billed charges ","70% of total billed charges ",1124.1,90,,899.28,,,0,"percent of total billed charges ","90% of total billed charges ",1161.57,93,,929.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1061.65,85,,849.32,,,0,"percent of total billed charges ","85% of total billed charges ",1124.1,90,,899.28,,,0,"percent of total billed charges ","90% of total billed charges ",1124.1,90,,899.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1086.63,87,,869.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",874.3,70,,699.44,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,1161.57,
"OVA 1",2031730,"CDM ",301,RC,84999,HCPCS,OUTPATIENT,,,2098,1678.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1468.6,70,,1174.88,,,0,"percent of total billed charges ","70% of total billed charges ",1888.2,90,,1510.56,,,0,"percent of total billed charges ","90% of total billed charges ",1951.14,93,,1560.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1783.3,85,,1426.64,,,0,"percent of total billed charges ","85% of total billed charges ",1888.2,90,,1510.56,,,0,"percent of total billed charges ","90% of total billed charges ",1888.2,90,,1510.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1825.26,87,,1460.21,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1468.6,70,,1174.88,,,0,"percent of total billed charges ","70% of total billed charges ",1468.6,1951.14,
"THYROTROPIN-BIND INHIBIT IMMU",2031740,"CDM ",301,RC,84235,HCPCS,OUTPATIENT,,,335.5,268.4,,75.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",234.85,70,,187.88,,,0,"percent of total billed charges ","70% of total billed charges ",301.95,90,,241.56,,,0,"percent of total billed charges ","90% of total billed charges ",312.02,93,,249.62,,,0,"percent of total billed charges ","93% of total billed charges ",75.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",95.55,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",285.18,85,,228.14,,,0,"percent of total billed charges ","85% of total billed charges ",301.95,90,,241.56,,,0,"percent of total billed charges ","90% of total billed charges ",301.95,90,,241.56,,,0,"percent of total billed charges ","90% of total billed charges ",94.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",291.89,87,,233.51,,,0,"percent of total billed charges ","87% of total billed charges ",94.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",71.23,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",234.85,70,,187.88,,,0,"percent of total billed charges ","70% of total billed charges ",71.23,312.02,
"*NEPHELOMETRY, EACH ANALYTE",2031750,"CDM ",301,RC,83883,HCPCS,OUTPATIENT,,,389.5,311.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",272.65,70,,218.12,,,0,"percent of total billed charges ","70% of total billed charges ",350.55,90,,280.44,,,0,"percent of total billed charges ","90% of total billed charges ",362.24,93,,289.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",331.08,85,,264.86,,,0,"percent of total billed charges ","85% of total billed charges ",350.55,90,,280.44,,,0,"percent of total billed charges ","90% of total billed charges ",350.55,90,,280.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",338.87,87,,271.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",13.6,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",272.65,70,,218.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.6,362.24,
"*AMP PROBE TECHNIQUE EACH",2031770,"CDM ",306,RC,87798,HCPCS,OUTPATIENT,,,1037,829.6,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",725.9,70,,580.72,,,0,"percent of total billed charges ","70% of total billed charges ",933.3,90,,746.64,,,0,"percent of total billed charges ","90% of total billed charges ",964.41,93,,771.53,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",881.45,85,,705.16,,,0,"percent of total billed charges ","85% of total billed charges ",933.3,90,,746.64,,,0,"percent of total billed charges ","90% of total billed charges ",933.3,90,,746.64,,,0,"percent of total billed charges ","90% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",902.19,87,,721.75,,,0,"percent of total billed charges ","87% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",725.9,70,,580.72,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,964.41,
"*INFLUENZA VIRUS EACH",2031780,"CDM ",306,RC,87502,HCPCS,OUTPATIENT,,,1037,829.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",725.9,70,,580.72,,,0,"percent of total billed charges ","70% of total billed charges ",933.3,90,,746.64,,,0,"percent of total billed charges ","90% of total billed charges ",964.41,93,,771.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",106.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",881.45,85,,705.16,,,0,"percent of total billed charges ","85% of total billed charges ",933.3,90,,746.64,,,0,"percent of total billed charges ","90% of total billed charges ",933.3,90,,746.64,,,0,"percent of total billed charges ","90% of total billed charges ",105.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",902.19,87,,57.48,45.67,106.34,"1 through 10","percent of total billed charges ","87% of total billed charges ",105.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",95.8,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",725.9,70,,580.72,,,0,"percent of total billed charges ","70% of total billed charges ",95.8,964.41,
"PANCREATIC POLYPEPTIDE",2031800,"CDM ",301,RC,83519,HCPCS,OUTPATIENT,,,301.5,241.2,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",211.05,70,,168.84,,,0,"percent of total billed charges ","70% of total billed charges ",271.35,90,,217.08,,,0,"percent of total billed charges ","90% of total billed charges ",280.4,93,,224.32,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",256.28,85,,205.02,,,0,"percent of total billed charges ","85% of total billed charges ",271.35,90,,217.08,,,0,"percent of total billed charges ","90% of total billed charges ",271.35,90,,217.08,,,0,"percent of total billed charges ","90% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.31,87,,209.85,,,0,"percent of total billed charges ","87% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",211.05,70,,168.84,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,280.4,
*METANEPHRINES,2031810,"CDM ",301,RC,83835,HCPCS,OUTPATIENT,,,146.5,117.2,,16.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.55,70,,82.04,,,0,"percent of total billed charges ","70% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",136.25,93,,109.00,,,0,"percent of total billed charges ","93% of total billed charges ",16.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.06,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.53,85,,99.62,,,0,"percent of total billed charges ","85% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.46,87,,101.97,,,0,"percent of total billed charges ","87% of total billed charges ",29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.94,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.55,70,,82.04,,,0,"percent of total billed charges ","70% of total billed charges ",16.94,136.25,
"*CREATININE, RANDOM URINE",2031820,"CDM ",301,RC,82570,HCPCS,OUTPATIENT,,,139,111.2,,5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.3,70,,77.84,,,0,"percent of total billed charges ","70% of total billed charges ",125.1,90,,100.08,,,0,"percent of total billed charges ","90% of total billed charges ",129.27,93,,103.42,,,0,"percent of total billed charges ","93% of total billed charges ",5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",118.15,85,,94.52,,,0,"percent of total billed charges ","85% of total billed charges ",125.1,90,,100.08,,,0,"percent of total billed charges ","90% of total billed charges ",125.1,90,,100.08,,,0,"percent of total billed charges ","90% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",120.93,87,,5.08,4.98,50.30,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",97.3,70,,77.84,,,0,"percent of total billed charges ","70% of total billed charges ",5.18,129.27,
"*SINGLE DRUG CLASS EACH",2031840,"CDM ",301,RC,80307,HCPCS,OUTPATIENT,,,160.5,128.4,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",149.27,93,,119.42,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",136.43,85,,109.14,,,0,"percent of total billed charges ","85% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",139.64,87,,111.71,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",62.14,149.27,
"SULFASALAZINE,FREE/TOTAL,SERUM",2031860,"CDM ",301,RC,84311,HCPCS,OUTPATIENT,,,405,324,,,,,,,,0,"other ","not separately reimbursment ",,,,89.76,89.76,89.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",283.5,70,,226.80,,,0,"percent of total billed charges ","70% of total billed charges ",364.5,90,,291.60,,,0,"percent of total billed charges ","90% of total billed charges ",376.65,93,,301.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",344.25,85,,275.40,,,0,"percent of total billed charges ","85% of total billed charges ",364.5,90,,291.60,,,0,"percent of total billed charges ","90% of total billed charges ",364.5,90,,291.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",352.35,87,,281.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",8.1,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",283.5,70,,226.80,,,0,"percent of total billed charges ","70% of total billed charges ",8.1,376.65,
"*MOLECULAR CYTO,DNA PROBE EA",2031870,"CDM ",300,RC,88271,HCPCS,OUTPATIENT,,,475,380,,21.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",332.5,70,,266.00,,,0,"percent of total billed charges ","70% of total billed charges ",427.5,90,,342.00,,,0,"percent of total billed charges ","90% of total billed charges ",441.75,93,,353.40,,,0,"percent of total billed charges ","93% of total billed charges ",21.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",403.75,85,,323.00,,,0,"percent of total billed charges ","85% of total billed charges ",427.5,90,,342.00,,,0,"percent of total billed charges ","90% of total billed charges ",427.5,90,,342.00,,,0,"percent of total billed charges ","90% of total billed charges ",33.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",413.25,87,,330.60,,,0,"percent of total billed charges ","87% of total billed charges ",33.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.42,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",332.5,70,,266.00,,,0,"percent of total billed charges ","70% of total billed charges ",21.42,441.75,
"*CHROMOSOMAL INSITU 10-30 CELL",2031880,"CDM ",300,RC,88273,HCPCS,OUTPATIENT,,,475,380,,34.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",332.5,70,,266.00,,,0,"percent of total billed charges ","70% of total billed charges ",427.5,90,,342.00,,,0,"percent of total billed charges ","90% of total billed charges ",441.75,93,,353.40,,,0,"percent of total billed charges ","93% of total billed charges ",34.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",50.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",403.75,85,,323.00,,,0,"percent of total billed charges ","85% of total billed charges ",427.5,90,,342.00,,,0,"percent of total billed charges ","90% of total billed charges ",427.5,90,,342.00,,,0,"percent of total billed charges ","90% of total billed charges ",49.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",413.25,87,,330.60,,,0,"percent of total billed charges ","87% of total billed charges ",49.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.81,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",332.5,70,,266.00,,,0,"percent of total billed charges ","70% of total billed charges ",34.81,441.75,
"*INTERP AND REPORT",2031890,"CDM ",300,RC,88291,HCPCS,OUTPATIENT,,,475,380,,26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",69.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",332.5,70,,266.00,,,0,"percent of total billed charges ","70% of total billed charges ",427.5,90,,342.00,,,0,"percent of total billed charges ","90% of total billed charges ",441.75,93,,353.40,,,0,"percent of total billed charges ","93% of total billed charges ",26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",403.75,85,,323.00,,,0,"percent of total billed charges ","85% of total billed charges ",427.5,90,,342.00,,,0,"percent of total billed charges ","90% of total billed charges ",427.5,90,,342.00,,,0,"percent of total billed charges ","90% of total billed charges ",32.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",413.25,87,,330.60,,,0,"percent of total billed charges ","87% of total billed charges ",32.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",332.5,70,,266.00,,,0,"percent of total billed charges ","70% of total billed charges ",26,441.75,
"ERYTHROCYTE PROTOPORPHYRIN",2031920,"CDM ",301,RC,84202,HCPCS,OUTPATIENT,,,193.5,154.8,,12.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.45,70,,108.36,,,0,"percent of total billed charges ","70% of total billed charges ",174.15,90,,139.32,,,0,"percent of total billed charges ","90% of total billed charges ",179.96,93,,143.97,,,0,"percent of total billed charges ","93% of total billed charges ",12.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.48,85,,131.58,,,0,"percent of total billed charges ","85% of total billed charges ",174.15,90,,139.32,,,0,"percent of total billed charges ","90% of total billed charges ",174.15,90,,139.32,,,0,"percent of total billed charges ","90% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",168.35,87,,134.68,,,0,"percent of total billed charges ","87% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.35,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",135.45,70,,108.36,,,0,"percent of total billed charges ","70% of total billed charges ",12.2,179.96,
"HIV-2 DNA/RNA, QUAL, REAL-TIME",2031930,"CDM ",302,RC,87538,HCPCS,OUTPATIENT,,,977.5,782,,29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",684.25,70,,547.40,,,0,"percent of total billed charges ","70% of total billed charges ",879.75,90,,703.80,,,0,"percent of total billed charges ","90% of total billed charges ",909.08,93,,727.26,,,0,"percent of total billed charges ","93% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",830.88,85,,664.70,,,0,"percent of total billed charges ","85% of total billed charges ",879.75,90,,703.80,,,0,"percent of total billed charges ","90% of total billed charges ",879.75,90,,703.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",850.43,87,,680.34,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",684.25,70,,547.40,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,909.08,
"HIV-1 RNA, QUAL, TMA",2031940,"CDM ",306,RC,87535,HCPCS,OUTPATIENT,,,1187.5,950,,29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",831.25,70,,665.00,,,0,"percent of total billed charges ","70% of total billed charges ",1068.75,90,,855.00,,,0,"percent of total billed charges ","90% of total billed charges ",1104.38,93,,883.50,,,0,"percent of total billed charges ","93% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1009.38,85,,807.50,,,0,"percent of total billed charges ","85% of total billed charges ",1068.75,90,,855.00,,,0,"percent of total billed charges ","90% of total billed charges ",1068.75,90,,855.00,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1033.13,87,,826.50,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",831.25,70,,665.00,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,1104.38,
"HISTAMINE LEVEL",2031950,"CDM ",301,RC,83088,HCPCS,OUTPATIENT,,,254.5,203.6,,25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.15,70,,142.52,,,0,"percent of total billed charges ","70% of total billed charges ",229.05,90,,183.24,,,0,"percent of total billed charges ","90% of total billed charges ",236.69,93,,189.35,,,0,"percent of total billed charges ","93% of total billed charges ",25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",216.33,85,,173.06,,,0,"percent of total billed charges ","85% of total billed charges ",229.05,90,,183.24,,,0,"percent of total billed charges ","90% of total billed charges ",229.05,90,,183.24,,,0,"percent of total billed charges ","90% of total billed charges ",32.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",221.42,87,,177.14,,,0,"percent of total billed charges ","87% of total billed charges ",32.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",178.15,70,,142.52,,,0,"percent of total billed charges ","70% of total billed charges ",25,236.69,
"C DIFF TOXIN B, QUAL, PCR",2031960,"CDM ",306,RC,87493,HCPCS,OUTPATIENT,,,452,361.6,,34.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,63.13,63.13,63.13,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",316.4,70,,253.12,,,0,"percent of total billed charges ","70% of total billed charges ",406.8,90,,325.44,,,0,"percent of total billed charges ","90% of total billed charges ",420.36,93,,336.29,,,0,"percent of total billed charges ","93% of total billed charges ",34.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.27,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",384.2,85,,307.36,,,0,"percent of total billed charges ","85% of total billed charges ",406.8,90,,325.44,,,0,"percent of total billed charges ","90% of total billed charges ",406.8,90,,325.44,,,0,"percent of total billed charges ","90% of total billed charges ",44.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",393.24,87,,314.59,,,0,"percent of total billed charges ","87% of total billed charges ",44.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",316.4,70,,253.12,,,0,"percent of total billed charges ","70% of total billed charges ",34.26,420.36,
"VISCOSITY, SERUM",2031970,"CDM ",301,RC,85810,HCPCS,OUTPATIENT,,,104.5,83.6,,11.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.15,70,,58.52,,,0,"percent of total billed charges ","70% of total billed charges ",94.05,90,,75.24,,,0,"percent of total billed charges ","90% of total billed charges ",97.19,93,,77.75,,,0,"percent of total billed charges ","93% of total billed charges ",11.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",88.83,85,,71.06,,,0,"percent of total billed charges ","85% of total billed charges ",94.05,90,,75.24,,,0,"percent of total billed charges ","90% of total billed charges ",94.05,90,,75.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",90.92,87,,72.74,,,0,"percent of total billed charges ","87% of total billed charges ",15.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",73.15,70,,58.52,,,0,"percent of total billed charges ","70% of total billed charges ",11.6,97.19,
"21-HYDROXYLASE ANTIBODY",2031980,"CDM ",301,RC,83519,HCPCS,OUTPATIENT,,,346,276.8,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",242.2,70,,193.76,,,0,"percent of total billed charges ","70% of total billed charges ",311.4,90,,249.12,,,0,"percent of total billed charges ","90% of total billed charges ",321.78,93,,257.42,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",294.1,85,,235.28,,,0,"percent of total billed charges ","85% of total billed charges ",311.4,90,,249.12,,,0,"percent of total billed charges ","90% of total billed charges ",311.4,90,,249.12,,,0,"percent of total billed charges ","90% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",301.02,87,,240.82,,,0,"percent of total billed charges ","87% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",242.2,70,,193.76,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,321.78,
"GONADOTROPIN RELEASING HORMONE",2031990,"CDM ",301,RC,83727,HCPCS,OUTPATIENT,,,807.5,646,,17.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",565.25,70,,452.20,,,0,"percent of total billed charges ","70% of total billed charges ",726.75,90,,581.40,,,0,"percent of total billed charges ","90% of total billed charges ",750.98,93,,600.78,,,0,"percent of total billed charges ","93% of total billed charges ",17.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",686.38,85,,549.10,,,0,"percent of total billed charges ","85% of total billed charges ",726.75,90,,581.40,,,0,"percent of total billed charges ","90% of total billed charges ",726.75,90,,581.40,,,0,"percent of total billed charges ","90% of total billed charges ",30.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",702.53,87,,562.02,,,0,"percent of total billed charges ","87% of total billed charges ",30.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",565.25,70,,452.20,,,0,"percent of total billed charges ","70% of total billed charges ",17.19,750.98,
*17-HYDROXYPREGNENOLONE,2032000,"CDM ",301,RC,84143,HCPCS,OUTPATIENT,,,194,155.2,,22.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",180.42,93,,144.34,,,0,"percent of total billed charges ","93% of total billed charges ",22.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.9,85,,131.92,,,0,"percent of total billed charges ","85% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",34.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",168.78,87,,135.02,,,0,"percent of total billed charges ","87% of total billed charges ",34.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.81,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",22.81,180.42,
"*HYDROXYPROGESTERONE, 17-D",2032010,"CDM ",301,RC,83498,HCPCS,OUTPATIENT,,,187,149.6,,27.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",173.91,93,,139.13,,,0,"percent of total billed charges ","93% of total billed charges ",27.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",158.95,85,,127.16,,,0,"percent of total billed charges ","85% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",36.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",162.69,87,,130.15,,,0,"percent of total billed charges ","87% of total billed charges ",36.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.17,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",27.17,173.91,
*DEHYDROEPIANDROSTONE,2032020,"CDM ",301,RC,82626,HCPCS,OUTPATIENT,,,194,155.2,,23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",180.42,93,,144.34,,,0,"percent of total billed charges ","93% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.9,85,,131.92,,,0,"percent of total billed charges ","85% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",168.78,87,,101.79,101.79,101.79,"1 through 10","percent of total billed charges ","87% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",23.1,180.42,
*ANDROSTENDIONE,2032030,"CDM ",301,RC,82157,HCPCS,OUTPATIENT,,,254,203.2,,24.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.8,70,,142.24,,,0,"percent of total billed charges ","70% of total billed charges ",228.6,90,,182.88,,,0,"percent of total billed charges ","90% of total billed charges ",236.22,93,,188.98,,,0,"percent of total billed charges ","93% of total billed charges ",24.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",215.9,85,,172.72,,,0,"percent of total billed charges ","85% of total billed charges ",228.6,90,,182.88,,,0,"percent of total billed charges ","90% of total billed charges ",228.6,90,,182.88,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",220.98,87,,176.78,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.28,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",177.8,70,,142.24,,,0,"percent of total billed charges ","70% of total billed charges ",13.18,236.22,
"*CORTISOL, TOTAL",2032040,"CDM ",301,RC,82533,HCPCS,OUTPATIENT,,,144,115.2,,16.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",100.8,70,,80.64,,,0,"percent of total billed charges ","70% of total billed charges ",129.6,90,,103.68,,,0,"percent of total billed charges ","90% of total billed charges ",133.92,93,,107.14,,,0,"percent of total billed charges ","93% of total billed charges ",16.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",122.4,85,,97.92,,,0,"percent of total billed charges ","85% of total billed charges ",129.6,90,,103.68,,,0,"percent of total billed charges ","90% of total billed charges ",129.6,90,,103.68,,,0,"percent of total billed charges ","90% of total billed charges ",29.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",125.28,87,,68.05,68.05,68.05,"1 through 10","percent of total billed charges ","87% of total billed charges ",29.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",100.8,70,,80.64,,,0,"percent of total billed charges ","70% of total billed charges ",16.3,133.92,
"*VIRUS ISOL W/ID EA VIRUS",2032120,"CDM ",306,RC,87254,HCPCS,OUTPATIENT,,,376,300.8,,16.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.2,70,,210.56,,,0,"percent of total billed charges ","70% of total billed charges ",338.4,90,,270.72,,,0,"percent of total billed charges ","90% of total billed charges ",349.68,93,,279.74,,,0,"percent of total billed charges ","93% of total billed charges ",16.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",319.6,85,,255.68,,,0,"percent of total billed charges ","85% of total billed charges ",338.4,90,,270.72,,,0,"percent of total billed charges ","90% of total billed charges ",338.4,90,,270.72,,,0,"percent of total billed charges ","90% of total billed charges ",7.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",327.12,87,,261.70,,,0,"percent of total billed charges ","87% of total billed charges ",7.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.55,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",263.2,70,,210.56,,,0,"percent of total billed charges ","70% of total billed charges ",7.52,349.68,
"*ALLERGEN SPECIFIC IGE EACH",2032140,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"C-ANCA(PROTEINESE-3 ABS) 34151",2032160,"CDM ",302,RC,86021,HCPCS,OUTPATIENT,,,365,292,,12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",255.5,70,,204.40,,,0,"percent of total billed charges ","70% of total billed charges ",328.5,90,,262.80,,,0,"percent of total billed charges ","90% of total billed charges ",339.45,93,,271.56,,,0,"percent of total billed charges ","93% of total billed charges ",12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",310.25,85,,248.20,,,0,"percent of total billed charges ","85% of total billed charges ",328.5,90,,262.80,,,0,"percent of total billed charges ","90% of total billed charges ",328.5,90,,262.80,,,0,"percent of total billed charges ","90% of total billed charges ",9.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",317.55,87,,254.04,,,0,"percent of total billed charges ","87% of total billed charges ",9.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",255.5,70,,204.40,,,0,"percent of total billed charges ","70% of total billed charges ",9.82,339.45,
"HEPATITIS B PCR, QUANT #8369",2032170,"CDM ",306,RC,87517,HCPCS,OUTPATIENT,,,1251.5,1001.2,,36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",876.05,70,,700.84,,,0,"percent of total billed charges ","70% of total billed charges ",1126.35,90,,901.08,,,0,"percent of total billed charges ","90% of total billed charges ",1163.9,93,,931.12,,,0,"percent of total billed charges ","93% of total billed charges ",36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1063.78,85,,851.02,,,0,"percent of total billed charges ","85% of total billed charges ",1126.35,90,,901.08,,,0,"percent of total billed charges ","90% of total billed charges ",1126.35,90,,901.08,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1088.81,87,,871.05,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.84,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",876.05,70,,700.84,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,1163.9,
"ANCA SCREEN W/REFLEX TO TITER",2032180,"CDM ",302,RC,86021,HCPCS,OUTPATIENT,,,185,148,,12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",172.05,93,,137.64,,,0,"percent of total billed charges ","93% of total billed charges ",12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",157.25,85,,125.80,,,0,"percent of total billed charges ","85% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",9.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",160.95,87,,128.76,,,0,"percent of total billed charges ","87% of total billed charges ",9.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",9.82,172.05,
"ENTAMOEBA HISTOLYTICA IGG ABS",2032190,"CDM ",302,RC,86753,HCPCS,OUTPATIENT,,,273,218.4,,10.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",191.1,70,,152.88,,,0,"percent of total billed charges ","70% of total billed charges ",245.7,90,,196.56,,,0,"percent of total billed charges ","90% of total billed charges ",253.89,93,,203.11,,,0,"percent of total billed charges ","93% of total billed charges ",10.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",232.05,85,,185.64,,,0,"percent of total billed charges ","85% of total billed charges ",245.7,90,,196.56,,,0,"percent of total billed charges ","90% of total billed charges ",245.7,90,,196.56,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",237.51,87,,190.01,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",191.1,70,,152.88,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,253.89,
"HU ANTIBODY",2032200,"CDM ",302,RC,86255,HCPCS,OUTPATIENT,,,446,356.8,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",312.2,70,,249.76,,,0,"percent of total billed charges ","70% of total billed charges ",401.4,90,,321.12,,,0,"percent of total billed charges ","90% of total billed charges ",414.78,93,,331.82,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",379.1,85,,303.28,,,0,"percent of total billed charges ","85% of total billed charges ",401.4,90,,321.12,,,0,"percent of total billed charges ","90% of total billed charges ",401.4,90,,321.12,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",388.02,87,,310.42,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",312.2,70,,249.76,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,414.78,
"*IMMUNOASSAY FOR ANALYTE, QUAN",2032210,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,108,86.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",93.96,87,,75.17,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,100.44,
"SULFADIAZINE, SERUM/PLASMA",2032320,"CDM ",301,RC,84311,HCPCS,OUTPATIENT,,,805.5,644.4,,,,,,,,0,"other ","not separately reimbursment ",,,,89.76,89.76,89.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",563.85,70,,451.08,,,0,"percent of total billed charges ","70% of total billed charges ",724.95,90,,579.96,,,0,"percent of total billed charges ","90% of total billed charges ",749.12,93,,599.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",684.68,85,,547.74,,,0,"percent of total billed charges ","85% of total billed charges ",724.95,90,,579.96,,,0,"percent of total billed charges ","90% of total billed charges ",724.95,90,,579.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",700.79,87,,560.63,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",8.1,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",563.85,70,,451.08,,,0,"percent of total billed charges ","70% of total billed charges ",8.1,749.12,
"VMA, RANDOM URINE",2032330,"CDM ",301,RC,84585,HCPCS,OUTPATIENT,,,135,108,,15.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",125.55,93,,100.44,,,0,"percent of total billed charges ","93% of total billed charges ",15.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",114.75,85,,91.80,,,0,"percent of total billed charges ","85% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",26.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.45,87,,93.96,,,0,"percent of total billed charges ","87% of total billed charges ",26.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.5,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",15.5,125.55,
"*FREE KAPPA W/K-L RATIO, SERUM",2032340,"CDM ",301,RC,83883,HCPCS,OUTPATIENT,,,211.5,169.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.05,70,,118.44,,,0,"percent of total billed charges ","70% of total billed charges ",190.35,90,,152.28,,,0,"percent of total billed charges ","90% of total billed charges ",196.7,93,,157.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",179.78,85,,143.82,,,0,"percent of total billed charges ","85% of total billed charges ",190.35,90,,152.28,,,0,"percent of total billed charges ","90% of total billed charges ",190.35,90,,152.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",184.01,87,,147.21,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",13.6,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",148.05,70,,118.44,,,0,"percent of total billed charges ","70% of total billed charges ",13.6,196.7,
"*FREE LAMBDA W/K-L RATIO,SERUM",2032350,"CDM ",301,RC,83883,HCPCS,OUTPATIENT,,,211.5,169.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.05,70,,118.44,,,0,"percent of total billed charges ","70% of total billed charges ",190.35,90,,152.28,,,0,"percent of total billed charges ","90% of total billed charges ",196.7,93,,157.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",179.78,85,,143.82,,,0,"percent of total billed charges ","85% of total billed charges ",190.35,90,,152.28,,,0,"percent of total billed charges ","90% of total billed charges ",190.35,90,,152.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",184.01,87,,147.21,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",13.6,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",148.05,70,,118.44,,,0,"percent of total billed charges ","70% of total billed charges ",13.6,196.7,
"IFE, URINE",2032370,"CDM ",302,RC,86335,HCPCS,OUTPATIENT,,,203.5,162.8,,29.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.45,70,,113.96,,,0,"percent of total billed charges ","70% of total billed charges ",183.15,90,,146.52,,,0,"percent of total billed charges ","90% of total billed charges ",189.26,93,,151.41,,,0,"percent of total billed charges ","93% of total billed charges ",29.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",172.98,85,,138.38,,,0,"percent of total billed charges ","85% of total billed charges ",183.15,90,,146.52,,,0,"percent of total billed charges ","90% of total billed charges ",183.15,90,,146.52,,,0,"percent of total billed charges ","90% of total billed charges ",45.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.05,87,,141.64,,,0,"percent of total billed charges ","87% of total billed charges ",45.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.35,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.45,70,,113.96,,,0,"percent of total billed charges ","70% of total billed charges ",29.35,189.26,
"*COMPLEMENT, ANTIGEN, EACH",2032380,"CDM ",302,RC,86160,HCPCS,OUTPATIENT,,,165,132,,12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,133.30,133.30,133.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,226.71,226.71,226.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",12,153.45,
"*DNA ANTIBODY",2032390,"CDM ",302,RC,86225,HCPCS,OUTPATIENT,,,169,135.2,,13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,72.72,72.72,72.72,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",157.17,93,,125.74,,,0,"percent of total billed charges ","93% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.65,85,,114.92,,,0,"percent of total billed charges ","85% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",24.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.03,87,,115.94,115.94,115.94,"1 through 10","percent of total billed charges ","87% of total billed charges ",24.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",13.74,157.17,
"HEPTIMAX HCV, RNA",2032410,"CDM ",306,RC,87522,HCPCS,OUTPATIENT,,,2003.5,1602.8,,36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,109.38,109.38,109.38,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1402.45,70,,1121.96,,,0,"percent of total billed charges ","70% of total billed charges ",1803.15,90,,1442.52,,,0,"percent of total billed charges ","90% of total billed charges ",1863.26,93,,1490.61,,,0,"percent of total billed charges ","93% of total billed charges ",36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1702.98,85,,1362.38,,,0,"percent of total billed charges ","85% of total billed charges ",1803.15,90,,1442.52,,,0,"percent of total billed charges ","90% of total billed charges ",1803.15,90,,1442.52,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1743.05,87,,1394.44,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.84,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1402.45,70,,1121.96,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,1863.26,
"HEPTIMAX HCV, RNA REFLEX/GENO",2032420,"CDM ",306,RC,87522,HCPCS,OUTPATIENT,,,1946,1556.8,,36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,109.38,109.38,109.38,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1362.2,70,,1089.76,,,0,"percent of total billed charges ","70% of total billed charges ",1751.4,90,,1401.12,,,0,"percent of total billed charges ","90% of total billed charges ",1809.78,93,,1447.82,,,0,"percent of total billed charges ","93% of total billed charges ",36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1654.1,85,,1323.28,,,0,"percent of total billed charges ","85% of total billed charges ",1751.4,90,,1401.12,,,0,"percent of total billed charges ","90% of total billed charges ",1751.4,90,,1401.12,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1693.02,87,,1354.42,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.84,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1362.2,70,,1089.76,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,1809.78,
"DRUG SCREEN - HAIR COLLECTION",2032430,"CDM ",302,RC,80100,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"*ANTIBODY; RICKETTSIA",2032440,"CDM ",302,RC,86757,HCPCS,OUTPATIENT,,,351,280.8,,19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",245.7,70,,196.56,,,0,"percent of total billed charges ","70% of total billed charges ",315.9,90,,252.72,,,0,"percent of total billed charges ","90% of total billed charges ",326.43,93,,261.14,,,0,"percent of total billed charges ","93% of total billed charges ",19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",298.35,85,,238.68,,,0,"percent of total billed charges ","85% of total billed charges ",315.9,90,,252.72,,,0,"percent of total billed charges ","90% of total billed charges ",315.9,90,,252.72,,,0,"percent of total billed charges ","90% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",305.37,87,,244.30,,,0,"percent of total billed charges ","87% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.35,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",245.7,70,,196.56,,,0,"percent of total billed charges ","70% of total billed charges ",19.35,326.43,
"*NUCLEAR ANTIGEN AB",2032470,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,453.5,362.8,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",317.45,70,,253.96,,,0,"percent of total billed charges ","70% of total billed charges ",408.15,90,,326.52,,,0,"percent of total billed charges ","90% of total billed charges ",421.76,93,,337.41,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",385.48,85,,308.38,,,0,"percent of total billed charges ","85% of total billed charges ",408.15,90,,326.52,,,0,"percent of total billed charges ","90% of total billed charges ",408.15,90,,326.52,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",394.55,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",317.45,70,,253.96,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,421.76,
"*IMMUNOASSAY ANALYTE",2032480,"CDM ",302,RC,83516,HCPCS,OUTPATIENT,,,291.5,233.2,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",204.05,70,,163.24,,,0,"percent of total billed charges ","70% of total billed charges ",262.35,90,,209.88,,,0,"percent of total billed charges ","90% of total billed charges ",271.1,93,,216.88,,,0,"percent of total billed charges ","93% of total billed charges ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",247.78,85,,198.22,,,0,"percent of total billed charges ","85% of total billed charges ",262.35,90,,209.88,,,0,"percent of total billed charges ","90% of total billed charges ",262.35,90,,209.88,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",253.61,87,,53.32,28.74,77.90,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",204.05,70,,163.24,,,0,"percent of total billed charges ","70% of total billed charges ",10,271.1,
"CYTOPATHOLOGY BODY FLUID",2032490,"CDM ",311,RC,88104,HCPCS,OUTPATIENT,,,142,113.6,,52.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",139.41,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",99.4,70,,79.52,,,0,"percent of total billed charges ","70% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",132.06,93,,105.65,,,0,"percent of total billed charges ","93% of total billed charges ",52.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",120.7,85,,96.56,,,0,"percent of total billed charges ","85% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",5.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",123.54,87,,98.83,,,0,"percent of total billed charges ","87% of total billed charges ",5.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",99.4,70,,79.52,,,0,"percent of total billed charges ","70% of total billed charges ",5.02,139.41,
"CYTO NON-GYN CELL ENHANCEMENT",2032500,"CDM ",311,RC,88112,HCPCS,OUTPATIENT,,,140.5,112.4,,60.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",138.03,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",130.67,93,,104.54,,,0,"percent of total billed charges ","93% of total billed charges ",60.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",119.43,85,,95.54,,,0,"percent of total billed charges ","85% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",40.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.24,87,,97.79,,,0,"percent of total billed charges ","87% of total billed charges ",40.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.92,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",40.28,138.03,
"CYTOPATH NEEDLE ASPIRATION",2032510,"CDM ",311,RC,88173,HCPCS,OUTPATIENT,,,383,306.4,,122.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",325.67,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",268.1,70,,214.48,,,0,"percent of total billed charges ","70% of total billed charges ",344.7,90,,275.76,,,0,"percent of total billed charges ","90% of total billed charges ",356.19,93,,284.95,,,0,"percent of total billed charges ","93% of total billed charges ",122.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",325.55,85,,260.44,,,0,"percent of total billed charges ","85% of total billed charges ",344.7,90,,275.76,,,0,"percent of total billed charges ","90% of total billed charges ",344.7,90,,275.76,,,0,"percent of total billed charges ","90% of total billed charges ",17.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",333.21,87,,266.57,,,0,"percent of total billed charges ","87% of total billed charges ",17.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.92,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",268.1,70,,214.48,,,0,"percent of total billed charges ","70% of total billed charges ",17.62,356.19,
"CYTO EXAM 1",2032520,"CDM ",310,RC,88300,HCPCS,OUTPATIENT,,,54.5,43.6,,13.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30.98,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",38.15,70,,30.52,,,0,"percent of total billed charges ","70% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",50.69,93,,40.55,,,0,"percent of total billed charges ","93% of total billed charges ",13.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.89,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",46.33,85,,37.06,,,0,"percent of total billed charges ","85% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",3.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.42,87,,37.94,,,0,"percent of total billed charges ","87% of total billed charges ",3.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.59,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",38.15,70,,30.52,,,0,"percent of total billed charges ","70% of total billed charges ",3.85,50.69,
"CYTO EXAM 2",2032530,"CDM ",310,RC,88302,HCPCS,OUTPATIENT,,,137,109.6,,28.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",64.5,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",95.9,70,,76.72,,,0,"percent of total billed charges ","70% of total billed charges ",123.3,90,,98.64,,,0,"percent of total billed charges ","90% of total billed charges ",127.41,93,,101.93,,,0,"percent of total billed charges ","93% of total billed charges ",28.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",116.45,85,,93.16,,,0,"percent of total billed charges ","85% of total billed charges ",123.3,90,,98.64,,,0,"percent of total billed charges ","90% of total billed charges ",123.3,90,,98.64,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",119.19,87,,95.35,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",95.9,70,,76.72,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,127.41,
"CYTO EXAM 3",2032540,"CDM ",310,RC,88304,HCPCS,OUTPATIENT,,,191,152.8,,37.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.18,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",133.7,70,,106.96,,,0,"percent of total billed charges ","70% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",177.63,93,,142.10,,,0,"percent of total billed charges ","93% of total billed charges ",37.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.01,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",162.35,85,,129.88,,,0,"percent of total billed charges ","85% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",12.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",166.17,87,,132.94,,,0,"percent of total billed charges ","87% of total billed charges ",12.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.92,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",133.7,70,,106.96,,,0,"percent of total billed charges ","70% of total billed charges ",12.88,177.63,
"CYTO EXAM 4",2032550,"CDM ",310,RC,88305,HCPCS,OUTPATIENT,,,332,265.6,,65.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",148.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",232.4,70,,185.92,,,0,"percent of total billed charges ","70% of total billed charges ",298.8,90,,239.04,,,0,"percent of total billed charges ","90% of total billed charges ",308.76,93,,247.01,,,0,"percent of total billed charges ","93% of total billed charges ",65.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.65,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",282.2,85,,225.76,,,0,"percent of total billed charges ","85% of total billed charges ",298.8,90,,239.04,,,0,"percent of total billed charges ","90% of total billed charges ",298.8,90,,239.04,,,0,"percent of total billed charges ","90% of total billed charges ",22.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",288.84,87,,231.07,,,0,"percent of total billed charges ","87% of total billed charges ",22.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.92,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",232.4,70,,185.92,,,0,"percent of total billed charges ","70% of total billed charges ",22.43,308.76,
"CYTO EXAM 5",2032560,"CDM ",310,RC,88307,HCPCS,OUTPATIENT,,,461.5,369.2,,220.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",589.07,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",323.05,70,,258.44,,,0,"percent of total billed charges ","70% of total billed charges ",415.35,90,,332.28,,,0,"percent of total billed charges ","90% of total billed charges ",429.2,93,,343.36,,,0,"percent of total billed charges ","93% of total billed charges ",220.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.73,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",392.28,85,,313.82,,,0,"percent of total billed charges ","85% of total billed charges ",415.35,90,,332.28,,,0,"percent of total billed charges ","90% of total billed charges ",415.35,90,,332.28,,,0,"percent of total billed charges ","90% of total billed charges ",33.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",401.51,87,,321.21,,,0,"percent of total billed charges ","87% of total billed charges ",33.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",323.05,70,,258.44,,,0,"percent of total billed charges ","70% of total billed charges ",33.4,589.07,
"CYTO EXAM 6",2032570,"CDM ",310,RC,88309,HCPCS,OUTPATIENT,,,621.5,497.2,,337.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",898.61,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",435.05,70,,348.04,,,0,"percent of total billed charges ","70% of total billed charges ",559.35,90,,447.48,,,0,"percent of total billed charges ","90% of total billed charges ",578,93,,462.40,,,0,"percent of total billed charges ","93% of total billed charges ",337.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",528.28,85,,422.62,,,0,"percent of total billed charges ","85% of total billed charges ",559.35,90,,447.48,,,0,"percent of total billed charges ","90% of total billed charges ",559.35,90,,447.48,,,0,"percent of total billed charges ","90% of total billed charges ",39.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",540.71,87,,432.57,,,0,"percent of total billed charges ","87% of total billed charges ",39.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",740.94,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",435.05,70,,348.04,,,0,"percent of total billed charges ","70% of total billed charges ",39.06,898.61,
DECALCIFICATION,2032580,"CDM ",310,RC,88311,HCPCS,OUTPATIENT,,,83.5,66.8,,16.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",43.16,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",77.66,93,,62.13,,,0,"percent of total billed charges ","93% of total billed charges ",16.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.98,85,,56.78,,,0,"percent of total billed charges ","85% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",3.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",72.65,87,,58.12,,,0,"percent of total billed charges ","87% of total billed charges ",3.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",3.95,77.66,
"SPECIAL STAIN GPI",2032590,"CDM ",310,RC,88312,HCPCS,OUTPATIENT,,,131.5,105.2,,87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",231.9,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",92.05,70,,73.64,,,0,"percent of total billed charges ","70% of total billed charges ",118.35,90,,94.68,,,0,"percent of total billed charges ","90% of total billed charges ",122.3,93,,97.84,,,0,"percent of total billed charges ","93% of total billed charges ",87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.95,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",111.78,85,,89.42,,,0,"percent of total billed charges ","85% of total billed charges ",118.35,90,,94.68,,,0,"percent of total billed charges ","90% of total billed charges ",118.35,90,,94.68,,,0,"percent of total billed charges ","90% of total billed charges ",12.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",114.41,87,,91.53,,,0,"percent of total billed charges ","87% of total billed charges ",12.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.92,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",92.05,70,,73.64,,,0,"percent of total billed charges ","70% of total billed charges ",12.82,231.9,
"SPECIAL STAIN GPP 2",2032600,"CDM ",310,RC,88313,HCPCS,OUTPATIENT,,,104,83.2,,62.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",165.51,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",72.8,70,,58.24,,,0,"percent of total billed charges ","70% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",96.72,93,,77.38,,,0,"percent of total billed charges ","93% of total billed charges ",62.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",88.4,85,,70.72,,,0,"percent of total billed charges ","85% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",3.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",90.48,87,,72.38,,,0,"percent of total billed charges ","87% of total billed charges ",3.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",72.8,70,,58.24,,,0,"percent of total billed charges ","70% of total billed charges ",3.95,165.51,
"SPECIAL STAIN HIS",2032610,"CDM ",310,RC,88314,HCPCS,OUTPATIENT,,,310,248,,76.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",202.93,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",217,70,,173.60,,,0,"percent of total billed charges ","70% of total billed charges ",279,90,,223.20,,,0,"percent of total billed charges ","90% of total billed charges ",288.3,93,,230.64,,,0,"percent of total billed charges ","93% of total billed charges ",76.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",263.5,85,,210.80,,,0,"percent of total billed charges ","85% of total billed charges ",279,90,,223.20,,,0,"percent of total billed charges ","90% of total billed charges ",279,90,,223.20,,,0,"percent of total billed charges ","90% of total billed charges ",6.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",269.7,87,,215.76,,,0,"percent of total billed charges ","87% of total billed charges ",6.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",217,70,,173.60,,,0,"percent of total billed charges ","70% of total billed charges ",6.54,288.3,
"TISSUE BLOCK, INITIAL",2032620,"CDM ",310,RC,88331,HCPCS,OUTPATIENT,,,319,255.2,,80.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",213.99,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",223.3,70,,178.64,,,0,"percent of total billed charges ","70% of total billed charges ",287.1,90,,229.68,,,0,"percent of total billed charges ","90% of total billed charges ",296.67,93,,237.34,,,0,"percent of total billed charges ","93% of total billed charges ",80.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.65,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",271.15,85,,216.92,,,0,"percent of total billed charges ","85% of total billed charges ",287.1,90,,229.68,,,0,"percent of total billed charges ","90% of total billed charges ",287.1,90,,229.68,,,0,"percent of total billed charges ","90% of total billed charges ",23.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.53,87,,222.02,,,0,"percent of total billed charges ","87% of total billed charges ",23.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",223.3,70,,178.64,,,0,"percent of total billed charges ","70% of total billed charges ",23.42,296.67,
"TISSUE BLOCK ADD",2032630,"CDM ",310,RC,88332,HCPCS,OUTPATIENT,,,219,175.2,,42.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",113.34,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",153.3,70,,122.64,,,0,"percent of total billed charges ","70% of total billed charges ",197.1,90,,157.68,,,0,"percent of total billed charges ","90% of total billed charges ",203.67,93,,162.94,,,0,"percent of total billed charges ","93% of total billed charges ",42.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",186.15,85,,148.92,,,0,"percent of total billed charges ","85% of total billed charges ",197.1,90,,157.68,,,0,"percent of total billed charges ","90% of total billed charges ",197.1,90,,157.68,,,0,"percent of total billed charges ","90% of total billed charges ",9.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",190.53,87,,152.42,,,0,"percent of total billed charges ","87% of total billed charges ",9.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",153.3,70,,122.64,,,0,"percent of total billed charges ","70% of total billed charges ",9.51,203.67,
"TOUCH SQUASH",2032640,"CDM ",310,RC,88333,HCPCS,OUTPATIENT,,,64,51.2,,73.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",140.8,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",44.8,70,,35.84,,,0,"percent of total billed charges ","70% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",59.52,93,,47.62,,,0,"percent of total billed charges ","93% of total billed charges ",73.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",54.4,85,,43.52,,,0,"percent of total billed charges ","85% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",18.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",55.68,87,,44.54,,,0,"percent of total billed charges ","87% of total billed charges ",18.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",740.94,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",44.8,70,,35.84,,,0,"percent of total billed charges ","70% of total billed charges ",18.14,740.94,
"TOUCH SQUASH ADD",2032650,"CDM ",310,RC,88334,HCPCS,OUTPATIENT,,,39.5,31.6,,44.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",86.9,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",27.65,70,,22.12,,,0,"percent of total billed charges ","70% of total billed charges ",35.55,90,,28.44,,,0,"percent of total billed charges ","90% of total billed charges ",36.74,93,,29.39,,,0,"percent of total billed charges ","93% of total billed charges ",44.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",33.58,85,,26.86,,,0,"percent of total billed charges ","85% of total billed charges ",35.55,90,,28.44,,,0,"percent of total billed charges ","90% of total billed charges ",35.55,90,,28.44,,,0,"percent of total billed charges ","90% of total billed charges ",11.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.37,87,,27.50,,,0,"percent of total billed charges ","87% of total billed charges ",11.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",27.65,70,,22.12,,,0,"percent of total billed charges ","70% of total billed charges ",11.07,86.9,
"NEUROMYELITIS OPTICA IGG AB",2032660,"CDM ",302,RC,83516,HCPCS,OUTPATIENT,,,1315.5,1052.4,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",920.85,70,,736.68,,,0,"percent of total billed charges ","70% of total billed charges ",1183.95,90,,947.16,,,0,"percent of total billed charges ","90% of total billed charges ",1223.42,93,,978.74,,,0,"percent of total billed charges ","93% of total billed charges ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1118.18,85,,894.54,,,0,"percent of total billed charges ","85% of total billed charges ",1183.95,90,,947.16,,,0,"percent of total billed charges ","90% of total billed charges ",1183.95,90,,947.16,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1144.49,87,,53.32,28.74,77.90,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",920.85,70,,736.68,,,0,"percent of total billed charges ","70% of total billed charges ",10,1223.42,
*RENIN,2032670,"CDM ",301,RC,84244,HCPCS,OUTPATIENT,,,177.5,142,,21.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.25,70,,99.40,,,0,"percent of total billed charges ","70% of total billed charges ",159.75,90,,127.80,,,0,"percent of total billed charges ","90% of total billed charges ",165.08,93,,132.06,,,0,"percent of total billed charges ","93% of total billed charges ",21.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",150.88,85,,120.70,,,0,"percent of total billed charges ","85% of total billed charges ",159.75,90,,127.80,,,0,"percent of total billed charges ","90% of total billed charges ",159.75,90,,127.80,,,0,"percent of total billed charges ","90% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",154.43,87,,123.54,,,0,"percent of total billed charges ","87% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.99,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",124.25,70,,99.40,,,0,"percent of total billed charges ","70% of total billed charges ",21.99,165.08,
*ALDOSTERONE,2032680,"CDM ",301,RC,82088,HCPCS,OUTPATIENT,,,271.5,217.2,,34.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",190.05,70,,152.04,,,0,"percent of total billed charges ","70% of total billed charges ",244.35,90,,195.48,,,0,"percent of total billed charges ","90% of total billed charges ",252.5,93,,202.00,,,0,"percent of total billed charges ","93% of total billed charges ",34.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.58,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",230.78,85,,184.62,,,0,"percent of total billed charges ","85% of total billed charges ",244.35,90,,195.48,,,0,"percent of total billed charges ","90% of total billed charges ",244.35,90,,195.48,,,0,"percent of total billed charges ","90% of total billed charges ",40.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",236.21,87,,188.97,,,0,"percent of total billed charges ","87% of total billed charges ",40.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.75,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",190.05,70,,152.04,,,0,"percent of total billed charges ","70% of total billed charges ",34.64,252.5,
"CHROMIUM LEVEL, SERUM",2032700,"CDM ",301,RC,82495,HCPCS,OUTPATIENT,,,176.5,141.2,,17.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.55,70,,98.84,,,0,"percent of total billed charges ","70% of total billed charges ",158.85,90,,127.08,,,0,"percent of total billed charges ","90% of total billed charges ",164.15,93,,131.32,,,0,"percent of total billed charges ","93% of total billed charges ",17.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",150.03,85,,120.02,,,0,"percent of total billed charges ","85% of total billed charges ",158.85,90,,127.08,,,0,"percent of total billed charges ","90% of total billed charges ",158.85,90,,127.08,,,0,"percent of total billed charges ","90% of total billed charges ",10.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",153.56,87,,122.85,,,0,"percent of total billed charges ","87% of total billed charges ",10.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.28,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",123.55,70,,98.84,,,0,"percent of total billed charges ","70% of total billed charges ",10.08,164.15,
"FIBRIN MONOMER",2032710,"CDM ",302,RC,85362,HCPCS,OUTPATIENT,,,229,183.2,,6.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,50.59,50.59,50.59,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",160.3,70,,128.24,,,0,"percent of total billed charges ","70% of total billed charges ",206.1,90,,164.88,,,0,"percent of total billed charges ","90% of total billed charges ",212.97,93,,170.38,,,0,"percent of total billed charges ","93% of total billed charges ",6.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.57,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",194.65,85,,155.72,,,0,"percent of total billed charges ","85% of total billed charges ",206.1,90,,164.88,,,0,"percent of total billed charges ","90% of total billed charges ",206.1,90,,164.88,,,0,"percent of total billed charges ","90% of total billed charges ",12.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",199.23,87,,159.38,,,0,"percent of total billed charges ","87% of total billed charges ",12.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.89,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",160.3,70,,128.24,,,0,"percent of total billed charges ","70% of total billed charges ",6.89,212.97,
"*HERPES SIMPLEX UNSPEC, AB",2032720,"CDM ",302,RC,86694,HCPCS,OUTPATIENT,,,219.5,175.6,,12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.65,70,,122.92,,,0,"percent of total billed charges ","70% of total billed charges ",197.55,90,,158.04,,,0,"percent of total billed charges ","90% of total billed charges ",204.14,93,,163.31,,,0,"percent of total billed charges ","93% of total billed charges ",12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",186.58,85,,149.26,,,0,"percent of total billed charges ","85% of total billed charges ",197.55,90,,158.04,,,0,"percent of total billed charges ","90% of total billed charges ",197.55,90,,158.04,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",190.97,87,,152.78,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",153.65,70,,122.92,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,204.14,
"HSV I/II, WESTERN BLOT",2032750,"CDM ",301,RC,84181,HCPCS,OUTPATIENT,,,353.5,282.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",247.45,70,,197.96,,,0,"percent of total billed charges ","70% of total billed charges ",318.15,90,,254.52,,,0,"percent of total billed charges ","90% of total billed charges ",328.76,93,,263.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",300.48,85,,240.38,,,0,"percent of total billed charges ","85% of total billed charges ",318.15,90,,254.52,,,0,"percent of total billed charges ","90% of total billed charges ",318.15,90,,254.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",307.55,87,,246.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",247.45,70,,197.96,,,0,"percent of total billed charges ","70% of total billed charges ",17.03,328.76,
"LIPASE, PERITONEAL FLUID",2032760,"CDM ",301,RC,83690,HCPCS,OUTPATIENT,,,88.5,70.8,,6.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.95,70,,49.56,,,0,"percent of total billed charges ","70% of total billed charges ",79.65,90,,63.72,,,0,"percent of total billed charges ","90% of total billed charges ",82.31,93,,65.85,,,0,"percent of total billed charges ","93% of total billed charges ",6.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",75.23,85,,60.18,,,0,"percent of total billed charges ","85% of total billed charges ",79.65,90,,63.72,,,0,"percent of total billed charges ","90% of total billed charges ",79.65,90,,63.72,,,0,"percent of total billed charges ","90% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",77,87,,38.27,27.51,47.84,14,"percent of total billed charges ","87% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.89,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",61.95,70,,49.56,,,0,"percent of total billed charges ","70% of total billed charges ",6.89,82.31,
"*ANTIBODY ID; PLATELETS",2032770,"CDM ",302,RC,86022,HCPCS,OUTPATIENT,,,860,688,,15.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,30.11,30.11,30.11,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",602,70,,481.60,,,0,"percent of total billed charges ","70% of total billed charges ",774,90,,619.20,,,0,"percent of total billed charges ","90% of total billed charges ",799.8,93,,639.84,,,0,"percent of total billed charges ","93% of total billed charges ",15.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",731,85,,584.80,,,0,"percent of total billed charges ","85% of total billed charges ",774,90,,619.20,,,0,"percent of total billed charges ","90% of total billed charges ",774,90,,619.20,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",748.2,87,,89.65,89.65,89.65,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.37,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",602,70,,481.60,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,799.8,
"LONG CHAIN ACY-COA (LCHAD)",2032850,"CDM ",301,RC,81479,HCPCS,OUTPATIENT,,,1280.5,1024.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",896.35,70,,717.08,,,0,"percent of total billed charges ","70% of total billed charges ",1152.45,90,,921.96,,,0,"percent of total billed charges ","90% of total billed charges ",1190.87,93,,952.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1088.43,85,,870.74,,,0,"percent of total billed charges ","85% of total billed charges ",1152.45,90,,921.96,,,0,"percent of total billed charges ","90% of total billed charges ",1152.45,90,,921.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1114.04,87,,891.23,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",896.35,70,,717.08,,,0,"percent of total billed charges ","70% of total billed charges ",896.35,1190.87,
"VARICELLA, CSF",2032860,"CDM ",302,RC,86787,HCPCS,OUTPATIENT,,,363,290.4,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,67.33,67.33,67.33,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",254.1,70,,203.28,,,0,"percent of total billed charges ","70% of total billed charges ",326.7,90,,261.36,,,0,"percent of total billed charges ","90% of total billed charges ",337.59,93,,270.07,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",308.55,85,,246.84,,,0,"percent of total billed charges ","85% of total billed charges ",326.7,90,,261.36,,,0,"percent of total billed charges ","90% of total billed charges ",326.7,90,,261.36,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",315.81,87,,17.79,17.79,17.79,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",254.1,70,,203.28,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,337.59,
"NEUTROPHIL ABS, FLOW CYTOMETRY",2032870,"CDM ",302,RC,86021,HCPCS,OUTPATIENT,,,873.5,698.8,,12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",611.45,70,,489.16,,,0,"percent of total billed charges ","70% of total billed charges ",786.15,90,,628.92,,,0,"percent of total billed charges ","90% of total billed charges ",812.36,93,,649.89,,,0,"percent of total billed charges ","93% of total billed charges ",12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",742.48,85,,593.98,,,0,"percent of total billed charges ","85% of total billed charges ",786.15,90,,628.92,,,0,"percent of total billed charges ","90% of total billed charges ",786.15,90,,628.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",759.95,87,,607.96,,,0,"percent of total billed charges ","87% of total billed charges ",9.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",611.45,70,,489.16,,,0,"percent of total billed charges ","70% of total billed charges ",9.82,812.36,
"COTTONWOOD ALLERGY TEST",2032880,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,80,64,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56,70,,44.80,,,0,"percent of total billed charges ","70% of total billed charges ",72,90,,57.60,,,0,"percent of total billed charges ","90% of total billed charges ",74.4,93,,59.52,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",68,85,,54.40,,,0,"percent of total billed charges ","85% of total billed charges ",72,90,,57.60,,,0,"percent of total billed charges ","90% of total billed charges ",72,90,,57.60,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",69.6,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",56,70,,44.80,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,74.4,
"INSECT VENOM PANEL",2032885,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,69,55.2,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.3,70,,38.64,,,0,"percent of total billed charges ","70% of total billed charges ",62.1,90,,49.68,,,0,"percent of total billed charges ","90% of total billed charges ",64.17,93,,51.34,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",58.65,85,,46.92,,,0,"percent of total billed charges ","85% of total billed charges ",62.1,90,,49.68,,,0,"percent of total billed charges ","90% of total billed charges ",62.1,90,,49.68,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60.03,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",48.3,70,,38.64,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,64.17,
"*DRUG SCREEN QUAL EACH CLASS",2032890,"CDM ",301,RC,80307,HCPCS,OUTPATIENT,,,160.5,128.4,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",149.27,93,,119.42,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",136.43,85,,109.14,,,0,"percent of total billed charges ","85% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",139.64,87,,111.71,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",62.14,149.27,
"*ANTIBODY LEUKOCYTE ID",2032920,"CDM ",302,RC,86021,HCPCS,OUTPATIENT,,,424,339.2,,12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.8,70,,237.44,,,0,"percent of total billed charges ","70% of total billed charges ",381.6,90,,305.28,,,0,"percent of total billed charges ","90% of total billed charges ",394.32,93,,315.46,,,0,"percent of total billed charges ","93% of total billed charges ",12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",360.4,85,,288.32,,,0,"percent of total billed charges ","85% of total billed charges ",381.6,90,,305.28,,,0,"percent of total billed charges ","90% of total billed charges ",381.6,90,,305.28,,,0,"percent of total billed charges ","90% of total billed charges ",9.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",368.88,87,,295.10,,,0,"percent of total billed charges ","87% of total billed charges ",9.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",296.8,70,,237.44,,,0,"percent of total billed charges ","70% of total billed charges ",9.82,394.32,
"*ALLERGEN SPECIFIC IGE",2032950,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"*ALLERGEN SPECIFIC IGE",2032970,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"METHEMOGLOBIN RECUDTASE B",2032980,"CDM ",301,RC,84311,HCPCS,OUTPATIENT,,,893,714.4,,,,,,,,0,"other ","not separately reimbursment ",,,,89.76,89.76,89.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",625.1,70,,500.08,,,0,"percent of total billed charges ","70% of total billed charges ",803.7,90,,642.96,,,0,"percent of total billed charges ","90% of total billed charges ",830.49,93,,664.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",759.05,85,,607.24,,,0,"percent of total billed charges ","85% of total billed charges ",803.7,90,,642.96,,,0,"percent of total billed charges ","90% of total billed charges ",803.7,90,,642.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",776.91,87,,621.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",8.1,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",625.1,70,,500.08,,,0,"percent of total billed charges ","70% of total billed charges ",8.1,830.49,
"*ASSAY OF PROTEIN SERUM",2032990,"CDM ",301,RC,84155,HCPCS,OUTPATIENT,,,19.5,15.6,,3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.65,70,,10.92,,,0,"percent of total billed charges ","70% of total billed charges ",17.55,90,,14.04,,,0,"percent of total billed charges ","90% of total billed charges ",18.14,93,,14.51,,,0,"percent of total billed charges ","93% of total billed charges ",3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",16.58,85,,13.26,,,0,"percent of total billed charges ","85% of total billed charges ",17.55,90,,14.04,,,0,"percent of total billed charges ","90% of total billed charges ",17.55,90,,14.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.97,87,,13.58,,,0,"percent of total billed charges ","87% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",13.65,70,,10.92,,,0,"percent of total billed charges ","70% of total billed charges ",3.67,18.14,
"*INFLUENZA DNA AMP PROBE",2033010,"CDM ",306,RC,87502,HCPCS,OUTPATIENT,,,729.5,583.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",510.65,70,,408.52,,,0,"percent of total billed charges ","70% of total billed charges ",656.55,90,,525.24,,,0,"percent of total billed charges ","90% of total billed charges ",678.44,93,,542.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",106.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",620.08,85,,496.06,,,0,"percent of total billed charges ","85% of total billed charges ",656.55,90,,525.24,,,0,"percent of total billed charges ","90% of total billed charges ",656.55,90,,525.24,,,0,"percent of total billed charges ","90% of total billed charges ",105.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",634.67,87,,57.48,45.67,106.34,"1 through 10","percent of total billed charges ","87% of total billed charges ",105.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",95.8,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",510.65,70,,408.52,,,0,"percent of total billed charges ","70% of total billed charges ",95.8,678.44,
"*INFEC AGENT DETECT BY NA EACH",2033020,"CDM ",306,RC,87798,HCPCS,OUTPATIENT,,,1169.5,935.6,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",818.65,70,,654.92,,,0,"percent of total billed charges ","70% of total billed charges ",1052.55,90,,842.04,,,0,"percent of total billed charges ","90% of total billed charges ",1087.64,93,,870.11,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",994.08,85,,795.26,,,0,"percent of total billed charges ","85% of total billed charges ",1052.55,90,,842.04,,,0,"percent of total billed charges ","90% of total billed charges ",1052.55,90,,842.04,,,0,"percent of total billed charges ","90% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1017.47,87,,813.98,,,0,"percent of total billed charges ","87% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",818.65,70,,654.92,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,1087.64,
"*ANTINUCLEAR ABS (ANA)",2033040,"CDM ",302,RC,86038,HCPCS,OUTPATIENT,,,170,136,,12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119,70,,95.20,,,0,"percent of total billed charges ","70% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",158.1,93,,126.48,,,0,"percent of total billed charges ","93% of total billed charges ",12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",144.5,85,,115.60,,,0,"percent of total billed charges ","85% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.9,87,,88.36,11.85,147.83,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",119,70,,95.20,,,0,"percent of total billed charges ","70% of total billed charges ",12.09,158.1,
"*NUCLEAR ANTIGEN ABS EACH",2033050,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,170,136,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119,70,,95.20,,,0,"percent of total billed charges ","70% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",158.1,93,,126.48,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",144.5,85,,115.60,,,0,"percent of total billed charges ","85% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.9,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",119,70,,95.20,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,158.1,
"*FLUORESCENT NONINFECT AB EACH",2033060,"CDM ",302,RC,86255,HCPCS,OUTPATIENT,,,170,136,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119,70,,95.20,,,0,"percent of total billed charges ","70% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",158.1,93,,126.48,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",144.5,85,,115.60,,,0,"percent of total billed charges ","85% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.9,87,,118.32,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",119,70,,95.20,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,158.1,
"*RHEUMATOID FACTOR, QUAN",2033070,"CDM ",302,RC,86431,HCPCS,OUTPATIENT,,,170,136,,5.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,5.56,5.56,5.56,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119,70,,95.20,,,0,"percent of total billed charges ","70% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",158.1,93,,126.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",144.5,85,,115.60,,,0,"percent of total billed charges ","85% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.9,87,,5.56,5.56,56.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",119,70,,95.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.67,158.1,
"*ANTINUCLEAR ABS (ANA) TITER",2033080,"CDM ",302,RC,86039,HCPCS,OUTPATIENT,,,170,136,,11.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119,70,,95.20,,,0,"percent of total billed charges ","70% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",158.1,93,,126.48,,,0,"percent of total billed charges ","93% of total billed charges ",11.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.37,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",144.5,85,,115.60,,,0,"percent of total billed charges ","85% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",20.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.9,87,,78.87,10.94,78.87,"1 through 10","percent of total billed charges ","87% of total billed charges ",20.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.16,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",119,70,,95.20,,,0,"percent of total billed charges ","70% of total billed charges ",11.16,158.1,
"*FLUORESCENT NONINFECT  TITER",2033090,"CDM ",302,RC,86256,HCPCS,OUTPATIENT,,,165,132,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,17.72,12.99,22.44,"1 through 10","percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,153.45,
"*HSV AMPLIFIED PROBE TECHNIQUE",2033110,"CDM ",310,RC,87529,HCPCS,OUTPATIENT,,,779.5,623.6,,29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,180.36,180.36,180.36,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",545.65,70,,436.52,,,0,"percent of total billed charges ","70% of total billed charges ",701.55,90,,561.24,,,0,"percent of total billed charges ","90% of total billed charges ",724.94,93,,579.95,,,0,"percent of total billed charges ","93% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",662.58,85,,530.06,,,0,"percent of total billed charges ","85% of total billed charges ",701.55,90,,561.24,,,0,"percent of total billed charges ","90% of total billed charges ",701.55,90,,561.24,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",678.17,87,,542.54,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",545.65,70,,436.52,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,724.94,
"*RIA NONANTIBODY",2033120,"CDM ",302,RC,83519,HCPCS,OUTPATIENT,,,229.5,183.6,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",160.65,70,,128.52,,,0,"percent of total billed charges ","70% of total billed charges ",206.55,90,,165.24,,,0,"percent of total billed charges ","90% of total billed charges ",213.44,93,,170.75,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",195.08,85,,156.06,,,0,"percent of total billed charges ","85% of total billed charges ",206.55,90,,165.24,,,0,"percent of total billed charges ","90% of total billed charges ",206.55,90,,165.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",199.67,87,,159.74,,,0,"percent of total billed charges ","87% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",160.65,70,,128.52,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,213.44,
"*ISLET CELL ANTIBODY",2033130,"CDM ",302,RC,86341,HCPCS,OUTPATIENT,,,357.5,286,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",250.25,70,,200.20,,,0,"percent of total billed charges ","70% of total billed charges ",321.75,90,,257.40,,,0,"percent of total billed charges ","90% of total billed charges ",332.48,93,,265.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",303.88,85,,243.10,,,0,"percent of total billed charges ","85% of total billed charges ",321.75,90,,257.40,,,0,"percent of total billed charges ","90% of total billed charges ",321.75,90,,257.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",311.03,87,,248.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",23.57,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",250.25,70,,200.20,,,0,"percent of total billed charges ","70% of total billed charges ",23.57,332.48,
"*INSULIN ANTIBODIES",2033140,"CDM ",302,RC,86337,HCPCS,OUTPATIENT,,,357.5,286,,21.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",250.25,70,,200.20,,,0,"percent of total billed charges ","70% of total billed charges ",321.75,90,,257.40,,,0,"percent of total billed charges ","90% of total billed charges ",332.48,93,,265.98,,,0,"percent of total billed charges ","93% of total billed charges ",21.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",303.88,85,,243.10,,,0,"percent of total billed charges ","85% of total billed charges ",321.75,90,,257.40,,,0,"percent of total billed charges ","90% of total billed charges ",321.75,90,,257.40,,,0,"percent of total billed charges ","90% of total billed charges ",30.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",311.03,87,,248.82,,,0,"percent of total billed charges ","87% of total billed charges ",30.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.41,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",250.25,70,,200.20,,,0,"percent of total billed charges ","70% of total billed charges ",21.41,332.48,
"GAD65 NEURO SYNDROME AB TEST",2033155,"CDM ",302,RC,86341,HCPCS,OUTPATIENT,,,362.5,290,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",253.75,70,,203.00,,,0,"percent of total billed charges ","70% of total billed charges ",326.25,90,,261.00,,,0,"percent of total billed charges ","90% of total billed charges ",337.13,93,,269.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",308.13,85,,246.50,,,0,"percent of total billed charges ","85% of total billed charges ",326.25,90,,261.00,,,0,"percent of total billed charges ","90% of total billed charges ",326.25,90,,261.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",315.38,87,,252.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",23.57,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",253.75,70,,203.00,,,0,"percent of total billed charges ","70% of total billed charges ",23.57,337.13,
"MYCOBACTERIUM TUBERCULOSIS,PCR",2033160,"CDM ",306,RC,87556,HCPCS,OUTPATIENT,,,827,661.6,,35.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",578.9,70,,463.12,,,0,"percent of total billed charges ","70% of total billed charges ",744.3,90,,595.44,,,0,"percent of total billed charges ","90% of total billed charges ",769.11,93,,615.29,,,0,"percent of total billed charges ","93% of total billed charges ",35.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",702.95,85,,562.36,,,0,"percent of total billed charges ","85% of total billed charges ",744.3,90,,595.44,,,0,"percent of total billed charges ","90% of total billed charges ",744.3,90,,595.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",719.49,87,,575.59,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.68,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",578.9,70,,463.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,769.11,
*HOMOCYSTEINE,2033170,"CDM ",301,RC,83090,HCPCS,OUTPATIENT,,,336,268.8,,17.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",235.2,70,,188.16,,,0,"percent of total billed charges ","70% of total billed charges ",302.4,90,,241.92,,,0,"percent of total billed charges ","90% of total billed charges ",312.48,93,,249.98,,,0,"percent of total billed charges ","93% of total billed charges ",17.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",285.6,85,,228.48,,,0,"percent of total billed charges ","85% of total billed charges ",302.4,90,,241.92,,,0,"percent of total billed charges ","90% of total billed charges ",302.4,90,,241.92,,,0,"percent of total billed charges ","90% of total billed charges ",25.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",292.32,87,,261.19,261.19,261.19,"1 through 10","percent of total billed charges ","87% of total billed charges ",25.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.92,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",235.2,70,,188.16,,,0,"percent of total billed charges ","70% of total billed charges ",17.92,312.48,
"*ORGANIC ACID,SINGLE,QUAN",2033180,"CDM ",301,RC,83921,HCPCS,OUTPATIENT,,,96,76.8,,19.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.2,70,,53.76,,,0,"percent of total billed charges ","70% of total billed charges ",86.4,90,,69.12,,,0,"percent of total billed charges ","90% of total billed charges ",89.28,93,,71.42,,,0,"percent of total billed charges ","93% of total billed charges ",19.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.55,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",81.6,85,,65.28,,,0,"percent of total billed charges ","85% of total billed charges ",86.4,90,,69.12,,,0,"percent of total billed charges ","90% of total billed charges ",86.4,90,,69.12,,,0,"percent of total billed charges ","90% of total billed charges ",25.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.52,87,,66.82,,,0,"percent of total billed charges ","87% of total billed charges ",25.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.21,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",67.2,70,,53.76,,,0,"percent of total billed charges ","70% of total billed charges ",19.34,89.28,
"TRYPANOSOMA CRUZI ABS, TOTAL",2033200,"CDM ",302,RC,86753,HCPCS,OUTPATIENT,,,461.5,369.2,,10.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",323.05,70,,258.44,,,0,"percent of total billed charges ","70% of total billed charges ",415.35,90,,332.28,,,0,"percent of total billed charges ","90% of total billed charges ",429.2,93,,343.36,,,0,"percent of total billed charges ","93% of total billed charges ",10.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",392.28,85,,313.82,,,0,"percent of total billed charges ","85% of total billed charges ",415.35,90,,332.28,,,0,"percent of total billed charges ","90% of total billed charges ",415.35,90,,332.28,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",401.51,87,,321.21,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",323.05,70,,258.44,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,429.2,
"CLOBAZAM LEVEL",2033210,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,165.5,132.4,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.85,70,,92.68,,,0,"percent of total billed charges ","70% of total billed charges ",148.95,90,,119.16,,,0,"percent of total billed charges ","90% of total billed charges ",153.92,93,,123.14,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.68,85,,112.54,,,0,"percent of total billed charges ","85% of total billed charges ",148.95,90,,119.16,,,0,"percent of total billed charges ","90% of total billed charges ",148.95,90,,119.16,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.99,87,,115.19,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.85,70,,92.68,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,153.92,
"SRP (SIGNAL RECOG PROT)AUTO AB",2033220,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,402,321.6,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",281.4,70,,225.12,,,0,"percent of total billed charges ","70% of total billed charges ",361.8,90,,289.44,,,0,"percent of total billed charges ","90% of total billed charges ",373.86,93,,299.09,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",341.7,85,,273.36,,,0,"percent of total billed charges ","85% of total billed charges ",361.8,90,,289.44,,,0,"percent of total billed charges ","90% of total billed charges ",361.8,90,,289.44,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",349.74,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",281.4,70,,225.12,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,373.86,
"*MOPATH PROC LEVEL 5",2033230,"CDM ",300,RC,81404,HCPCS,OUTPATIENT,,,1458.5,1166.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1020.95,70,,816.76,,,0,"percent of total billed charges ","70% of total billed charges ",1312.65,90,,1050.12,,,0,"percent of total billed charges ","90% of total billed charges ",1356.41,93,,1085.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1239.73,85,,991.78,,,0,"percent of total billed charges ","85% of total billed charges ",1312.65,90,,1050.12,,,0,"percent of total billed charges ","90% of total billed charges ",1312.65,90,,1050.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1268.9,87,,1015.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",274.83,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1020.95,70,,816.76,,,0,"percent of total billed charges ","70% of total billed charges ",274.83,1356.41,
"*MOPATH PROC LEVEL 6",2033240,"CDM ",300,RC,81405,HCPCS,OUTPATIENT,,,1160,928,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",812,70,,649.60,,,0,"percent of total billed charges ","70% of total billed charges ",1044,90,,835.20,,,0,"percent of total billed charges ","90% of total billed charges ",1078.8,93,,863.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",986,85,,788.80,,,0,"percent of total billed charges ","85% of total billed charges ",1044,90,,835.20,,,0,"percent of total billed charges ","90% of total billed charges ",1044,90,,835.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1009.2,87,,807.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",301.35,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",812,70,,649.60,,,0,"percent of total billed charges ","70% of total billed charges ",301.35,1078.8,
"*SERPINA1 GENE",2033250,"CDM ",309,RC,81332,HCPCS,OUTPATIENT,,,545,436,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",381.5,70,,305.20,,,0,"percent of total billed charges ","70% of total billed charges ",490.5,90,,392.40,,,0,"percent of total billed charges ","90% of total billed charges ",506.85,93,,405.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",463.25,85,,370.60,,,0,"percent of total billed charges ","85% of total billed charges ",490.5,90,,392.40,,,0,"percent of total billed charges ","90% of total billed charges ",490.5,90,,392.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",474.15,87,,379.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",43.65,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",381.5,70,,305.20,,,0,"percent of total billed charges ","70% of total billed charges ",43.65,506.85,
"*ALPHA-1-ANTITRYPSIN TOTAL",2033260,"CDM ",301,RC,82103,HCPCS,OUTPATIENT,,,446,356.8,,13.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",312.2,70,,249.76,,,0,"percent of total billed charges ","70% of total billed charges ",401.4,90,,321.12,,,0,"percent of total billed charges ","90% of total billed charges ",414.78,93,,331.82,,,0,"percent of total billed charges ","93% of total billed charges ",13.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",379.1,85,,303.28,,,0,"percent of total billed charges ","85% of total billed charges ",401.4,90,,321.12,,,0,"percent of total billed charges ","90% of total billed charges ",401.4,90,,321.12,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",388.02,87,,310.42,,,0,"percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.44,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",312.2,70,,249.76,,,0,"percent of total billed charges ","70% of total billed charges ",13.44,414.78,
"*COPPER ASSAY",2033280,"CDM ",301,RC,82525,HCPCS,OUTPATIENT,,,126,100.8,,12.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.2,70,,70.56,,,0,"percent of total billed charges ","70% of total billed charges ",113.4,90,,90.72,,,0,"percent of total billed charges ","90% of total billed charges ",117.18,93,,93.74,,,0,"percent of total billed charges ","93% of total billed charges ",12.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",107.1,85,,85.68,,,0,"percent of total billed charges ","85% of total billed charges ",113.4,90,,90.72,,,0,"percent of total billed charges ","90% of total billed charges ",113.4,90,,90.72,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",109.62,87,,87.70,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.41,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",88.2,70,,70.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.41,117.18,
"*ALLERGEN SPECIFIC IGE",2033300,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"*CLOT INHIBIT PROTEIN S TOTAL",2033310,"CDM ",305,RC,85305,HCPCS,OUTPATIENT,,,261.5,209.2,,11.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",243.2,93,,194.56,,,0,"percent of total billed charges ","93% of total billed charges ",11.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.86,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",222.28,85,,177.82,,,0,"percent of total billed charges ","85% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",15.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",227.51,87,,182.01,,,0,"percent of total billed charges ","87% of total billed charges ",15.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",11.61,243.2,
"*CLOT INHIBIT PROTEIN S FREE",2033320,"CDM ",305,RC,85306,HCPCS,OUTPATIENT,,,261.5,209.2,,15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",243.2,93,,194.56,,,0,"percent of total billed charges ","93% of total billed charges ",15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",222.28,85,,177.82,,,0,"percent of total billed charges ","85% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",227.51,87,,174.12,174.12,174.12,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.32,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",15.32,243.2,
"*CLOT INHIBIT PROTEIN C ANTIGE",2033340,"CDM ",305,RC,85302,HCPCS,OUTPATIENT,,,348.5,278.8,,11.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",243.95,70,,195.16,,,0,"percent of total billed charges ","70% of total billed charges ",313.65,90,,250.92,,,0,"percent of total billed charges ","90% of total billed charges ",324.11,93,,259.29,,,0,"percent of total billed charges ","93% of total billed charges ",11.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",296.23,85,,236.98,,,0,"percent of total billed charges ","85% of total billed charges ",313.65,90,,250.92,,,0,"percent of total billed charges ","90% of total billed charges ",313.65,90,,250.92,,,0,"percent of total billed charges ","90% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",303.2,87,,242.56,,,0,"percent of total billed charges ","87% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",243.95,70,,195.16,,,0,"percent of total billed charges ","70% of total billed charges ",11.81,324.11,
"*CLOT INHIBIT PROTEIN C ACTIVI",2033350,"CDM ",305,RC,85303,HCPCS,OUTPATIENT,,,348.5,278.8,,13.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",243.95,70,,195.16,,,0,"percent of total billed charges ","70% of total billed charges ",313.65,90,,250.92,,,0,"percent of total billed charges ","90% of total billed charges ",324.11,93,,259.29,,,0,"percent of total billed charges ","93% of total billed charges ",13.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",296.23,85,,236.98,,,0,"percent of total billed charges ","85% of total billed charges ",313.65,90,,250.92,,,0,"percent of total billed charges ","90% of total billed charges ",313.65,90,,250.92,,,0,"percent of total billed charges ","90% of total billed charges ",21.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",303.2,87,,145.25,145.25,145.25,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.84,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",243.95,70,,195.16,,,0,"percent of total billed charges ","70% of total billed charges ",13.84,324.11,
"DNASE-B ANTIBODY",2033370,"CDM ",302,RC,86215,HCPCS,OUTPATIENT,,,177,141.6,,11.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.9,70,,99.12,,,0,"percent of total billed charges ","70% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",164.61,93,,131.69,,,0,"percent of total billed charges ","93% of total billed charges ",11.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.81,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",150.45,85,,120.36,,,0,"percent of total billed charges ","85% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",11.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",153.99,87,,123.19,,,0,"percent of total billed charges ","87% of total billed charges ",11.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.25,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",123.9,70,,99.12,,,0,"percent of total billed charges ","70% of total billed charges ",11.26,164.61,
"*NEPHELOMETRY, EACH",2033400,"CDM ",301,RC,83883,HCPCS,OUTPATIENT,,,112.5,90,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",104.63,93,,83.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",95.63,85,,76.50,,,0,"percent of total billed charges ","85% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",97.88,87,,78.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",13.6,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",13.6,104.63,
"*PROTEIN, TOTAL",2033410,"CDM ",301,RC,84155,HCPCS,OUTPATIENT,,,82,65.6,,3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.4,70,,45.92,,,0,"percent of total billed charges ","70% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",76.26,93,,61.01,,,0,"percent of total billed charges ","93% of total billed charges ",3.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",69.7,85,,55.76,,,0,"percent of total billed charges ","85% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",71.34,87,,57.07,,,0,"percent of total billed charges ","87% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",57.4,70,,45.92,,,0,"percent of total billed charges ","70% of total billed charges ",3.67,76.26,
"*PROTEIN, E-PHORESIS SERUM",2033420,"CDM ",301,RC,84165,HCPCS,OUTPATIENT,,,90,72,,10.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",10.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",10.74,83.7,
"THYROGLOBULIN (REFLEXIVE) PAML",2033440,"CDM ",302,RC,86800,HCPCS,OUTPATIENT,,,194,155.2,,15.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,82.69,82.69,82.69,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",180.42,93,,144.34,,,0,"percent of total billed charges ","93% of total billed charges ",15.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.9,85,,131.92,,,0,"percent of total billed charges ","85% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",28.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",168.78,87,,15.60,15.60,63.84,"1 through 10","percent of total billed charges ","87% of total billed charges ",28.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.91,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",15.91,180.42,
"THYROGLOBULIN ABS PAML",2033450,"CDM ",302,RC,86800,HCPCS,OUTPATIENT,,,194,155.2,,15.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,82.69,82.69,82.69,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",180.42,93,,144.34,,,0,"percent of total billed charges ","93% of total billed charges ",15.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.9,85,,131.92,,,0,"percent of total billed charges ","85% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",28.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",168.78,87,,15.60,15.60,63.84,"1 through 10","percent of total billed charges ","87% of total billed charges ",28.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.91,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",15.91,180.42,
"*PHENOTYPE INFECT AGENT DRUG",2033460,"CDM ",306,RC,87900,HCPCS,OUTPATIENT,,,485.5,388.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",339.85,70,,271.88,,,0,"percent of total billed charges ","70% of total billed charges ",436.95,90,,349.56,,,0,"percent of total billed charges ","90% of total billed charges ",451.52,93,,361.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",412.68,85,,330.14,,,0,"percent of total billed charges ","85% of total billed charges ",436.95,90,,349.56,,,0,"percent of total billed charges ","90% of total billed charges ",436.95,90,,349.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",422.39,87,,337.91,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",130.35,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",339.85,70,,271.88,,,0,"percent of total billed charges ","70% of total billed charges ",130.35,451.52,
"*HIV REVERSE T GENO DNA",2033470,"CDM ",306,RC,87901,HCPCS,OUTPATIENT,,,1019,815.2,,257.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",713.3,70,,570.64,,,0,"percent of total billed charges ","70% of total billed charges ",917.1,90,,733.68,,,0,"percent of total billed charges ","90% of total billed charges ",947.67,93,,758.14,,,0,"percent of total billed charges ","93% of total billed charges ",257.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",376.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",866.15,85,,692.92,,,0,"percent of total billed charges ","85% of total billed charges ",917.1,90,,733.68,,,0,"percent of total billed charges ","90% of total billed charges ",917.1,90,,733.68,,,0,"percent of total billed charges ","90% of total billed charges ",372.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",886.53,87,,709.22,,,0,"percent of total billed charges ","87% of total billed charges ",372.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",713.3,70,,570.64,,,0,"percent of total billed charges ","70% of total billed charges ",257.45,947.67,
"*COMPLEMENT ANTIGEN",2033490,"CDM ",302,RC,86160,HCPCS,OUTPATIENT,,,246.5,197.2,,12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,133.30,133.30,133.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.55,70,,138.04,,,0,"percent of total billed charges ","70% of total billed charges ",221.85,90,,177.48,,,0,"percent of total billed charges ","90% of total billed charges ",229.25,93,,183.40,,,0,"percent of total billed charges ","93% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",209.53,85,,167.62,,,0,"percent of total billed charges ","85% of total billed charges ",221.85,90,,177.48,,,0,"percent of total billed charges ","90% of total billed charges ",221.85,90,,177.48,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",214.46,87,,226.71,226.71,226.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",172.55,70,,138.04,,,0,"percent of total billed charges ","70% of total billed charges ",12,229.25,
"*IMMUNE COMPLEX ASSAY",2033500,"CDM ",302,RC,86332,HCPCS,OUTPATIENT,,,252,201.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.4,70,,141.12,,,0,"percent of total billed charges ","70% of total billed charges ",226.8,90,,181.44,,,0,"percent of total billed charges ","90% of total billed charges ",234.36,93,,187.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",214.2,85,,171.36,,,0,"percent of total billed charges ","85% of total billed charges ",226.8,90,,181.44,,,0,"percent of total billed charges ","90% of total billed charges ",226.8,90,,181.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",219.24,87,,175.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",24.37,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",176.4,70,,141.12,,,0,"percent of total billed charges ","70% of total billed charges ",24.37,234.36,
"NOROVIRUS, STOOL #15544",2033520,"CDM ",302,RC,87449,HCPCS,OUTPATIENT,,,447.5,358,,11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",313.25,70,,250.60,,,0,"percent of total billed charges ","70% of total billed charges ",402.75,90,,322.20,,,0,"percent of total billed charges ","90% of total billed charges ",416.18,93,,332.94,,,0,"percent of total billed charges ","93% of total billed charges ",11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",380.38,85,,304.30,,,0,"percent of total billed charges ","85% of total billed charges ",402.75,90,,322.20,,,0,"percent of total billed charges ","90% of total billed charges ",402.75,90,,322.20,,,0,"percent of total billed charges ","90% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",389.33,87,,311.46,,,0,"percent of total billed charges ","87% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",313.25,70,,250.60,,,0,"percent of total billed charges ","70% of total billed charges ",11.98,416.18,
"TOMATO ALLERGEN IGE",2033540,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"RYE ALLERGEN IGE",2033550,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"RICE ALLERGEN IGE",2033560,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"CHEESE, CHEDDAR ALLERGEN IGG",2033570,"CDM ",302,RC,86001,HCPCS,OUTPATIENT,,,81.5,65.2,,6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",75.8,93,,60.64,,,0,"percent of total billed charges ","93% of total billed charges ",6.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",69.28,85,,55.42,,,0,"percent of total billed charges ","85% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.91,87,,56.73,,,0,"percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",6.65,75.8,
"CRYPTOCOCCAL ANTIGEN, LA",2033620,"CDM ",302,RC,86403,HCPCS,OUTPATIENT,,,230.5,184.4,,11.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",161.35,70,,129.08,,,0,"percent of total billed charges ","70% of total billed charges ",207.45,90,,165.96,,,0,"percent of total billed charges ","90% of total billed charges ",214.37,93,,171.50,,,0,"percent of total billed charges ","93% of total billed charges ",11.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",195.93,85,,156.74,,,0,"percent of total billed charges ","85% of total billed charges ",207.45,90,,165.96,,,0,"percent of total billed charges ","90% of total billed charges ",207.45,90,,165.96,,,0,"percent of total billed charges ","90% of total billed charges ",18.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.54,87,,160.43,,,0,"percent of total billed charges ","87% of total billed charges ",18.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.54,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",161.35,70,,129.08,,,0,"percent of total billed charges ","70% of total billed charges ",11.54,214.37,
"*RICKETTSIA ANTIBODY",2033630,"CDM ",302,RC,86757,HCPCS,OUTPATIENT,,,351,280.8,,19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",245.7,70,,196.56,,,0,"percent of total billed charges ","70% of total billed charges ",315.9,90,,252.72,,,0,"percent of total billed charges ","90% of total billed charges ",326.43,93,,261.14,,,0,"percent of total billed charges ","93% of total billed charges ",19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",298.35,85,,238.68,,,0,"percent of total billed charges ","85% of total billed charges ",315.9,90,,252.72,,,0,"percent of total billed charges ","90% of total billed charges ",315.9,90,,252.72,,,0,"percent of total billed charges ","90% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",305.37,87,,244.30,,,0,"percent of total billed charges ","87% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.35,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",245.7,70,,196.56,,,0,"percent of total billed charges ","70% of total billed charges ",19.35,326.43,
"*BRUCELLA ANTIBODY",2033640,"CDM ",302,RC,86622,HCPCS,OUTPATIENT,,,149.5,119.6,,7.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",139.04,93,,111.23,,,0,"percent of total billed charges ","93% of total billed charges ",7.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",127.08,85,,101.66,,,0,"percent of total billed charges ","85% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.07,87,,104.06,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",7.59,139.04,
"*SALMONELLA ANTIBODY",2033650,"CDM ",302,RC,86768,HCPCS,OUTPATIENT,,,143,114.4,,11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",100.1,70,,80.08,,,0,"percent of total billed charges ","70% of total billed charges ",128.7,90,,102.96,,,0,"percent of total billed charges ","90% of total billed charges ",132.99,93,,106.39,,,0,"percent of total billed charges ","93% of total billed charges ",11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",121.55,85,,97.24,,,0,"percent of total billed charges ","85% of total billed charges ",128.7,90,,102.96,,,0,"percent of total billed charges ","90% of total billed charges ",128.7,90,,102.96,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",124.41,87,,99.53,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",100.1,70,,80.08,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,132.99,
"*PLATELET ANTIBODIES",2033670,"CDM ",302,RC,86022,HCPCS,OUTPATIENT,,,788,630.4,,15.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,30.11,30.11,30.11,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",551.6,70,,441.28,,,0,"percent of total billed charges ","70% of total billed charges ",709.2,90,,567.36,,,0,"percent of total billed charges ","90% of total billed charges ",732.84,93,,586.27,,,0,"percent of total billed charges ","93% of total billed charges ",15.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",669.8,85,,535.84,,,0,"percent of total billed charges ","85% of total billed charges ",709.2,90,,567.36,,,0,"percent of total billed charges ","90% of total billed charges ",709.2,90,,567.36,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",685.56,87,,89.65,89.65,89.65,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.37,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",551.6,70,,441.28,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,732.84,
"BILE ACIDS, TOTAL",2033690,"CDM ",301,RC,82239,HCPCS,OUTPATIENT,,,238.5,190.8,,17.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",166.95,70,,133.56,,,0,"percent of total billed charges ","70% of total billed charges ",214.65,90,,171.72,,,0,"percent of total billed charges ","90% of total billed charges ",221.81,93,,177.45,,,0,"percent of total billed charges ","93% of total billed charges ",17.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",202.73,85,,162.18,,,0,"percent of total billed charges ","85% of total billed charges ",214.65,90,,171.72,,,0,"percent of total billed charges ","90% of total billed charges ",214.65,90,,171.72,,,0,"percent of total billed charges ","90% of total billed charges ",31.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",207.5,87,,166.00,,,0,"percent of total billed charges ","87% of total billed charges ",31.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",166.95,70,,133.56,,,0,"percent of total billed charges ","70% of total billed charges ",17.12,221.81,
"AMINO ACID ANALYSIS FOR MSUD",2033700,"CDM ",301,RC,82136,HCPCS,OUTPATIENT,,,567.5,454,,18.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",397.25,70,,317.80,,,0,"percent of total billed charges ","70% of total billed charges ",510.75,90,,408.60,,,0,"percent of total billed charges ","90% of total billed charges ",527.78,93,,422.22,,,0,"percent of total billed charges ","93% of total billed charges ",18.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",482.38,85,,385.90,,,0,"percent of total billed charges ","85% of total billed charges ",510.75,90,,408.60,,,0,"percent of total billed charges ","90% of total billed charges ",510.75,90,,408.60,,,0,"percent of total billed charges ","90% of total billed charges ",23.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",493.73,87,,394.98,,,0,"percent of total billed charges ","87% of total billed charges ",23.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",397.25,70,,317.80,,,0,"percent of total billed charges ","70% of total billed charges ",18.13,527.78,
"SOLUBLE LIVER ANTIGEN AUTOAB",2033710,"CDM ",302,RC,83520,HCPCS,OUTPATIENT,,,250,200,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",175,70,,140.00,,,0,"percent of total billed charges ","70% of total billed charges ",225,90,,180.00,,,0,"percent of total billed charges ","90% of total billed charges ",232.5,93,,186.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",212.5,85,,170.00,,,0,"percent of total billed charges ","85% of total billed charges ",225,90,,180.00,,,0,"percent of total billed charges ","90% of total billed charges ",225,90,,180.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",217.5,87,,174.00,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",175,70,,140.00,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,232.5,
"PROCOLLAGEN 1N TERM PROPEPTIDE",2033720,"CDM ",302,RC,83519,HCPCS,OUTPATIENT,,,422,337.6,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",295.4,70,,236.32,,,0,"percent of total billed charges ","70% of total billed charges ",379.8,90,,303.84,,,0,"percent of total billed charges ","90% of total billed charges ",392.46,93,,313.97,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",358.7,85,,286.96,,,0,"percent of total billed charges ","85% of total billed charges ",379.8,90,,303.84,,,0,"percent of total billed charges ","90% of total billed charges ",379.8,90,,303.84,,,0,"percent of total billed charges ","90% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",367.14,87,,293.71,,,0,"percent of total billed charges ","87% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",295.4,70,,236.32,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,392.46,
"ALKALINE PHOSPHATASE BONE SPEC",2033730,"CDM ",301,RC,84075,HCPCS,OUTPATIENT,,,191,152.8,,5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,27.63,27.63,27.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.7,70,,106.96,,,0,"percent of total billed charges ","70% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",177.63,93,,142.10,,,0,"percent of total billed charges ","93% of total billed charges ",5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",162.35,85,,129.88,,,0,"percent of total billed charges ","85% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",9.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",166.17,87,,132.94,,,0,"percent of total billed charges ","87% of total billed charges ",9.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",133.7,70,,106.96,,,0,"percent of total billed charges ","70% of total billed charges ",5.18,177.63,
"*ALLERGEN SPECIFIC IGE",2033740,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"IODINE, RANDOM URINE",2033760,"CDM ",301,RC,83789,HCPCS,OUTPATIENT,,,457,365.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",319.9,70,,255.92,,,0,"percent of total billed charges ","70% of total billed charges ",411.3,90,,329.04,,,0,"percent of total billed charges ","90% of total billed charges ",425.01,93,,340.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",388.45,85,,310.76,,,0,"percent of total billed charges ","85% of total billed charges ",411.3,90,,329.04,,,0,"percent of total billed charges ","90% of total billed charges ",411.3,90,,329.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",397.59,87,,318.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",24.11,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",319.9,70,,255.92,,,0,"percent of total billed charges ","70% of total billed charges ",24.11,425.01,
"ANTI-HISTONE ABS",2033770,"CDM ",302,RC,83516,HCPCS,OUTPATIENT,,,154.5,123.6,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.15,70,,86.52,,,0,"percent of total billed charges ","70% of total billed charges ",139.05,90,,111.24,,,0,"percent of total billed charges ","90% of total billed charges ",143.69,93,,114.95,,,0,"percent of total billed charges ","93% of total billed charges ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",131.33,85,,105.06,,,0,"percent of total billed charges ","85% of total billed charges ",139.05,90,,111.24,,,0,"percent of total billed charges ","90% of total billed charges ",139.05,90,,111.24,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",134.42,87,,53.32,28.74,77.90,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",108.15,70,,86.52,,,0,"percent of total billed charges ","70% of total billed charges ",10,143.69,
"*WBC ANTIBODY ID",2033780,"CDM ",302,RC,86021,HCPCS,OUTPATIENT,,,341,272.8,,12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",238.7,70,,190.96,,,0,"percent of total billed charges ","70% of total billed charges ",306.9,90,,245.52,,,0,"percent of total billed charges ","90% of total billed charges ",317.13,93,,253.70,,,0,"percent of total billed charges ","93% of total billed charges ",12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",289.85,85,,231.88,,,0,"percent of total billed charges ","85% of total billed charges ",306.9,90,,245.52,,,0,"percent of total billed charges ","90% of total billed charges ",306.9,90,,245.52,,,0,"percent of total billed charges ","90% of total billed charges ",9.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",296.67,87,,237.34,,,0,"percent of total billed charges ","87% of total billed charges ",9.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",238.7,70,,190.96,,,0,"percent of total billed charges ","70% of total billed charges ",9.82,317.13,
"*FUNGUS NES ANTIBODY",2033790,"CDM ",302,RC,86671,HCPCS,OUTPATIENT,,,341,272.8,,10.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",238.7,70,,190.96,,,0,"percent of total billed charges ","70% of total billed charges ",306.9,90,,245.52,,,0,"percent of total billed charges ","90% of total billed charges ",317.13,93,,253.70,,,0,"percent of total billed charges ","93% of total billed charges ",10.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",289.85,85,,231.88,,,0,"percent of total billed charges ","85% of total billed charges ",306.9,90,,245.52,,,0,"percent of total billed charges ","90% of total billed charges ",306.9,90,,245.52,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",296.67,87,,237.34,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.25,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",238.7,70,,190.96,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,317.13,
"FIBRINOGEN ACTIVITY",2033810,"CDM ",305,RC,85384,HCPCS,OUTPATIENT,,,70,56,,9.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49,70,,39.20,,,0,"percent of total billed charges ","70% of total billed charges ",63,90,,50.40,,,0,"percent of total billed charges ","90% of total billed charges ",65.1,93,,52.08,,,0,"percent of total billed charges ","93% of total billed charges ",9.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",59.5,85,,47.60,,,0,"percent of total billed charges ","85% of total billed charges ",63,90,,50.40,,,0,"percent of total billed charges ","90% of total billed charges ",63,90,,50.40,,,0,"percent of total billed charges ","90% of total billed charges ",13.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60.9,87,,48.72,,,0,"percent of total billed charges ","87% of total billed charges ",13.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.72,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",49,70,,39.20,,,0,"percent of total billed charges ","70% of total billed charges ",9.72,65.1,
"PLASMINOGEN ACT INHIBITOR-1",2033820,"CDM ",305,RC,85415,HCPCS,OUTPATIENT,,,284.5,227.6,,14.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",199.15,70,,159.32,,,0,"percent of total billed charges ","70% of total billed charges ",256.05,90,,204.84,,,0,"percent of total billed charges ","90% of total billed charges ",264.59,93,,211.67,,,0,"percent of total billed charges ","93% of total billed charges ",14.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",241.83,85,,193.46,,,0,"percent of total billed charges ","85% of total billed charges ",256.05,90,,204.84,,,0,"percent of total billed charges ","90% of total billed charges ",256.05,90,,204.84,,,0,"percent of total billed charges ","90% of total billed charges ",13.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",247.52,87,,198.02,,,0,"percent of total billed charges ","87% of total billed charges ",13.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",199.15,70,,159.32,,,0,"percent of total billed charges ","70% of total billed charges ",13.35,264.59,
ALPHA-2-ANTIPLASMIN,2033830,"CDM ",305,RC,85410,HCPCS,OUTPATIENT,,,271,216.8,,6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",189.7,70,,151.76,,,0,"percent of total billed charges ","70% of total billed charges ",243.9,90,,195.12,,,0,"percent of total billed charges ","90% of total billed charges ",252.03,93,,201.62,,,0,"percent of total billed charges ","93% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.72,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",230.35,85,,184.28,,,0,"percent of total billed charges ","85% of total billed charges ",243.9,90,,195.12,,,0,"percent of total billed charges ","90% of total billed charges ",243.9,90,,195.12,,,0,"percent of total billed charges ","90% of total billed charges ",8.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",235.77,87,,188.62,,,0,"percent of total billed charges ","87% of total billed charges ",8.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.71,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",189.7,70,,151.76,,,0,"percent of total billed charges ","70% of total billed charges ",6.6,252.03,
"EUGLOBULIN CLOT LYSIS TIME",2033840,"CDM ",305,RC,85360,HCPCS,OUTPATIENT,,,223,178.4,,8.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.1,70,,124.88,,,0,"percent of total billed charges ","70% of total billed charges ",200.7,90,,160.56,,,0,"percent of total billed charges ","90% of total billed charges ",207.39,93,,165.91,,,0,"percent of total billed charges ","93% of total billed charges ",8.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",189.55,85,,151.64,,,0,"percent of total billed charges ","85% of total billed charges ",200.7,90,,160.56,,,0,"percent of total billed charges ","90% of total billed charges ",200.7,90,,160.56,,,0,"percent of total billed charges ","90% of total billed charges ",15.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",194.01,87,,155.21,,,0,"percent of total billed charges ","87% of total billed charges ",15.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.41,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",156.1,70,,124.88,,,0,"percent of total billed charges ","70% of total billed charges ",8.41,207.39,
"BERYLLIUM LYMPHOCYTE PROLIFERA",2033850,"CDM ",302,RC,86353,HCPCS,OUTPATIENT,,,1064,851.2,,49.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",744.8,70,,595.84,,,0,"percent of total billed charges ","70% of total billed charges ",957.6,90,,766.08,,,0,"percent of total billed charges ","90% of total billed charges ",989.52,93,,791.62,,,0,"percent of total billed charges ","93% of total billed charges ",49.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",89.53,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",904.4,85,,723.52,,,0,"percent of total billed charges ","85% of total billed charges ",957.6,90,,766.08,,,0,"percent of total billed charges ","90% of total billed charges ",957.6,90,,766.08,,,0,"percent of total billed charges ","90% of total billed charges ",88.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",925.68,87,,740.54,,,0,"percent of total billed charges ","87% of total billed charges ",88.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",49.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",744.8,70,,595.84,,,0,"percent of total billed charges ","70% of total billed charges ",49.03,989.52,
"*COCCIDIOIDES ANTIBODIES",2033860,"CDM ",302,RC,86635,HCPCS,OUTPATIENT,,,197,157.6,,9.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",137.9,70,,110.32,,,0,"percent of total billed charges ","70% of total billed charges ",177.3,90,,141.84,,,0,"percent of total billed charges ","90% of total billed charges ",183.21,93,,146.57,,,0,"percent of total billed charges ","93% of total billed charges ",9.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",167.45,85,,133.96,,,0,"percent of total billed charges ","85% of total billed charges ",177.3,90,,141.84,,,0,"percent of total billed charges ","90% of total billed charges ",177.3,90,,141.84,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",171.39,87,,137.11,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.47,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",137.9,70,,110.32,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,183.21,
"*ALLERGEN SPECIFIC IGE",2033880,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"*ALLERGEN SPECIFIC IGE, EACH",2033890,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"*BCR/ABL MINOR BREAKPOINT",2033910,"CDM ",300,RC,81207,HCPCS,OUTPATIENT,,,528.5,422.8,,,,,,,,0,"other ","not separately reimbursment ",,,,236.67,236.67,236.67,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",369.95,70,,295.96,,,0,"percent of total billed charges ","70% of total billed charges ",475.65,90,,380.52,,,0,"percent of total billed charges ","90% of total billed charges ",491.51,93,,393.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",449.23,85,,359.38,,,0,"percent of total billed charges ","85% of total billed charges ",475.65,90,,380.52,,,0,"percent of total billed charges ","90% of total billed charges ",475.65,90,,380.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",459.8,87,,367.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",144.84,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",369.95,70,,295.96,,,0,"percent of total billed charges ","70% of total billed charges ",144.84,491.51,
"*BCR/ABL MAJOR BREAKPOINT",2033920,"CDM ",300,RC,81206,HCPCS,OUTPATIENT,,,573.5,458.8,,,,,,,,0,"other ","not separately reimbursment ",,,,232.08,232.08,232.08,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",401.45,70,,321.16,,,0,"percent of total billed charges ","70% of total billed charges ",516.15,90,,412.92,,,0,"percent of total billed charges ","90% of total billed charges ",533.36,93,,426.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",487.48,85,,389.98,,,0,"percent of total billed charges ","85% of total billed charges ",516.15,90,,412.92,,,0,"percent of total billed charges ","90% of total billed charges ",516.15,90,,412.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",498.95,87,,399.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",163.96,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",401.45,70,,321.16,,,0,"percent of total billed charges ","70% of total billed charges ",163.96,533.36,
"VITAMIN B1 - WHOLE BLOOD",2033940,"CDM ",301,RC,84425,HCPCS,OUTPATIENT,,,211.5,169.2,,21.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,69.47,69.47,69.47,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.05,70,,118.44,,,0,"percent of total billed charges ","70% of total billed charges ",190.35,90,,152.28,,,0,"percent of total billed charges ","90% of total billed charges ",196.7,93,,157.36,,,0,"percent of total billed charges ","93% of total billed charges ",21.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",179.78,85,,143.82,,,0,"percent of total billed charges ","85% of total billed charges ",190.35,90,,152.28,,,0,"percent of total billed charges ","90% of total billed charges ",190.35,90,,152.28,,,0,"percent of total billed charges ","90% of total billed charges ",38.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.01,87,,147.21,,,0,"percent of total billed charges ","87% of total billed charges ",38.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.23,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",148.05,70,,118.44,,,0,"percent of total billed charges ","70% of total billed charges ",21.23,196.7,
"CYSTATIN C",2033950,"CDM ",301,RC,82610,HCPCS,OUTPATIENT,,,336.5,269.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",235.55,70,,188.44,,,0,"percent of total billed charges ","70% of total billed charges ",302.85,90,,242.28,,,0,"percent of total billed charges ","90% of total billed charges ",312.95,93,,250.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",286.03,85,,228.82,,,0,"percent of total billed charges ","85% of total billed charges ",302.85,90,,242.28,,,0,"percent of total billed charges ","90% of total billed charges ",302.85,90,,242.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",292.76,87,,234.21,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",18.52,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",235.55,70,,188.44,,,0,"percent of total billed charges ","70% of total billed charges ",18.52,312.95,
"COPPER FREE LEVEL",2033960,"CDM ",301,RC,82525,HCPCS,OUTPATIENT,,,297,237.6,,12.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",207.9,70,,166.32,,,0,"percent of total billed charges ","70% of total billed charges ",267.3,90,,213.84,,,0,"percent of total billed charges ","90% of total billed charges ",276.21,93,,220.97,,,0,"percent of total billed charges ","93% of total billed charges ",12.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",252.45,85,,201.96,,,0,"percent of total billed charges ","85% of total billed charges ",267.3,90,,213.84,,,0,"percent of total billed charges ","90% of total billed charges ",267.3,90,,213.84,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",258.39,87,,206.71,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.41,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",207.9,70,,166.32,,,0,"percent of total billed charges ","70% of total billed charges ",12.41,276.21,
"C-DIFF CULTURE",2033970,"CDM ",306,RC,87158,HCPCS,OUTPATIENT,,,539.5,431.6,,6.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",377.65,70,,302.12,,,0,"percent of total billed charges ","70% of total billed charges ",485.55,90,,388.44,,,0,"percent of total billed charges ","90% of total billed charges ",501.74,93,,401.39,,,0,"percent of total billed charges ","93% of total billed charges ",6.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",458.58,85,,366.86,,,0,"percent of total billed charges ","85% of total billed charges ",485.55,90,,388.44,,,0,"percent of total billed charges ","90% of total billed charges ",485.55,90,,388.44,,,0,"percent of total billed charges ","90% of total billed charges ",8.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",469.37,87,,375.50,,,0,"percent of total billed charges ","87% of total billed charges ",8.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",377.65,70,,302.12,,,0,"percent of total billed charges ","70% of total billed charges ",6.58,501.74,
*CH50,2034000,"CDM ",302,RC,86162,HCPCS,OUTPATIENT,,,224.5,179.6,,20.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,66.14,66.14,66.14,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",208.79,93,,167.03,,,0,"percent of total billed charges ","93% of total billed charges ",20.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",190.83,85,,152.66,,,0,"percent of total billed charges ","85% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",31.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.32,87,,156.26,,,0,"percent of total billed charges ","87% of total billed charges ",31.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.32,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",20.32,208.79,
*ANA,2034010,"CDM ",302,RC,86038,HCPCS,OUTPATIENT,,,129,103.2,,12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",119.97,93,,95.98,,,0,"percent of total billed charges ","93% of total billed charges ",12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",109.65,85,,87.72,,,0,"percent of total billed charges ","85% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.23,87,,88.36,11.85,147.83,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",12.09,119.97,
*DSDNA,2034020,"CDM ",302,RC,86225,HCPCS,OUTPATIENT,,,169,135.2,,13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,72.72,72.72,72.72,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",157.17,93,,125.74,,,0,"percent of total billed charges ","93% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.65,85,,114.92,,,0,"percent of total billed charges ","85% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",24.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.03,87,,115.94,115.94,115.94,"1 through 10","percent of total billed charges ","87% of total billed charges ",24.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.74,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",13.74,157.17,
*SSA,2034030,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,149.5,119.6,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",139.04,93,,111.23,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",127.08,85,,101.66,,,0,"percent of total billed charges ","85% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.07,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,139.04,
*SSB,2034040,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,149.5,119.6,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",139.04,93,,111.23,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",127.08,85,,101.66,,,0,"percent of total billed charges ","85% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.07,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,139.04,
"*SMITH ABS",2034050,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,149.5,119.6,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",139.04,93,,111.23,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",127.08,85,,101.66,,,0,"percent of total billed charges ","85% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.07,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,139.04,
*RNP,2034060,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,168,134.4,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.6,70,,94.08,,,0,"percent of total billed charges ","70% of total billed charges ",151.2,90,,120.96,,,0,"percent of total billed charges ","90% of total billed charges ",156.24,93,,124.99,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",142.8,85,,114.24,,,0,"percent of total billed charges ","85% of total billed charges ",151.2,90,,120.96,,,0,"percent of total billed charges ","90% of total billed charges ",151.2,90,,120.96,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",146.16,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.6,70,,94.08,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,156.24,
*CHROMATIN,2034070,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,149.5,119.6,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",139.04,93,,111.23,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",127.08,85,,101.66,,,0,"percent of total billed charges ","85% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.07,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,139.04,
*C3,2034080,"CDM ",302,RC,86160,HCPCS,OUTPATIENT,,,165,132,,12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,133.30,133.30,133.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,226.71,226.71,226.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",12,153.45,
*C4,2034090,"CDM ",302,RC,86160,HCPCS,OUTPATIENT,,,165,132,,12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,133.30,133.30,133.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,226.71,226.71,226.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",12,153.45,
"*ALMOND IGE",2034110,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"*WALNUT BLACK FOOD, IGE",2034120,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,75.5,60.4,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",70.22,93,,56.18,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",64.18,85,,51.34,,,0,"percent of total billed charges ","85% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.69,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,70.22,
"*WALNUT ENGLISH FOOD, IGE",2034130,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,165,132,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,153.45,
"*BRAZIL NUT, IGE",2034140,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,75.5,60.4,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",70.22,93,,56.18,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",64.18,85,,51.34,,,0,"percent of total billed charges ","85% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.69,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,70.22,
"*CASHEW, IGE",2034150,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,75.5,60.4,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",70.22,93,,56.18,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",64.18,85,,51.34,,,0,"percent of total billed charges ","85% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.69,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,70.22,
"*COCONUT, IGE",2034160,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,75.5,60.4,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",70.22,93,,56.18,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",64.18,85,,51.34,,,0,"percent of total billed charges ","85% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.69,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,70.22,
"*HAZELNUT/FILBERT IGE",2034170,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,75.5,60.4,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",70.22,93,,56.18,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",64.18,85,,51.34,,,0,"percent of total billed charges ","85% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.69,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,70.22,
"*PECAN FOOD, IGE",2034180,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,75.5,60.4,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",70.22,93,,56.18,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",64.18,85,,51.34,,,0,"percent of total billed charges ","85% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.69,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,70.22,
"*PISTACHIO NUT, IGE",2034190,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,75.5,60.4,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",70.22,93,,56.18,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",64.18,85,,51.34,,,0,"percent of total billed charges ","85% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.69,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,70.22,
"*COTTON SEED, IGE",2034200,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,75.5,60.4,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",70.22,93,,56.18,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",64.18,85,,51.34,,,0,"percent of total billed charges ","85% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.69,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,70.22,
"*SESAME SEED, IGE",2034210,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,75.5,60.4,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",70.22,93,,56.18,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",64.18,85,,51.34,,,0,"percent of total billed charges ","85% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.69,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,70.22,
"*SUNFLOWER SEED, IGE",2034220,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,75.5,60.4,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",70.22,93,,56.18,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",64.18,85,,51.34,,,0,"percent of total billed charges ","85% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.69,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,70.22,
"*FLAXSEED/LINSEED IGE",2034230,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,155,124,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.5,70,,86.80,,,0,"percent of total billed charges ","70% of total billed charges ",139.5,90,,111.60,,,0,"percent of total billed charges ","90% of total billed charges ",144.15,93,,115.32,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",131.75,85,,105.40,,,0,"percent of total billed charges ","85% of total billed charges ",139.5,90,,111.60,,,0,"percent of total billed charges ","90% of total billed charges ",139.5,90,,111.60,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",134.85,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",108.5,70,,86.80,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,144.15,
"*PEANUT, IGE",2034240,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"MDMA/METABOLITES, SERUM",2034250,"CDM ",301,RC,80324,HCPCS,OUTPATIENT,,,172.5,138,,10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.75,70,,96.60,,,0,"percent of total billed charges ","70% of total billed charges ",155.25,90,,124.20,,,0,"percent of total billed charges ","90% of total billed charges ",160.43,93,,128.34,,,0,"percent of total billed charges ","93% of total billed charges ",10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",146.63,85,,117.30,,,0,"percent of total billed charges ","85% of total billed charges ",155.25,90,,124.20,,,0,"percent of total billed charges ","90% of total billed charges ",155.25,90,,124.20,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",150.08,87,,120.06,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",120.75,70,,96.60,,,0,"percent of total billed charges ","70% of total billed charges ",10.48,160.43,
"PROTEINASE-3 ABS",2034260,"CDM ",302,RC,86021,HCPCS,OUTPATIENT,,,352,281.6,,12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",246.4,70,,197.12,,,0,"percent of total billed charges ","70% of total billed charges ",316.8,90,,253.44,,,0,"percent of total billed charges ","90% of total billed charges ",327.36,93,,261.89,,,0,"percent of total billed charges ","93% of total billed charges ",12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",299.2,85,,239.36,,,0,"percent of total billed charges ","85% of total billed charges ",316.8,90,,253.44,,,0,"percent of total billed charges ","90% of total billed charges ",316.8,90,,253.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",306.24,87,,244.99,,,0,"percent of total billed charges ","87% of total billed charges ",9.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",246.4,70,,197.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.82,327.36,
"*CHLAMYDIA ANTIBODY",2034270,"CDM ",302,RC,86631,HCPCS,OUTPATIENT,,,206.5,165.2,,10.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",192.05,93,,153.64,,,0,"percent of total billed charges ","93% of total billed charges ",10.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",175.53,85,,140.42,,,0,"percent of total billed charges ","85% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",179.66,87,,143.73,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,192.05,
"*CHLAMYDIA IGM ANTIBODY",2034280,"CDM ",302,RC,86632,HCPCS,OUTPATIENT,,,185,148,,10.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",172.05,93,,137.64,,,0,"percent of total billed charges ","93% of total billed charges ",10.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",157.25,85,,125.80,,,0,"percent of total billed charges ","85% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",160.95,87,,128.76,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.68,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,172.05,
"HIV-1 RNA W/RELEX GENOTYPE",2034300,"CDM ",306,RC,87536,HCPCS,OUTPATIENT,,,1346.5,1077.2,,85.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,217.26,217.26,217.26,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",942.55,70,,754.04,,,0,"percent of total billed charges ","70% of total billed charges ",1211.85,90,,969.48,,,0,"percent of total billed charges ","90% of total billed charges ",1252.25,93,,1001.80,,,0,"percent of total billed charges ","93% of total billed charges ",85.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",142.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1144.53,85,,915.62,,,0,"percent of total billed charges ","85% of total billed charges ",1211.85,90,,969.48,,,0,"percent of total billed charges ","90% of total billed charges ",1211.85,90,,969.48,,,0,"percent of total billed charges ","90% of total billed charges ",141.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1171.46,87,,937.17,,,0,"percent of total billed charges ","87% of total billed charges ",141.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.1,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",942.55,70,,754.04,,,0,"percent of total billed charges ","70% of total billed charges ",85.1,1252.25,
"*TISSUE CULT LYMPHOCYTE",2034310,"CDM ",310,RC,88230,HCPCS,OUTPATIENT,,,1100.5,880.4,,99.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",770.35,70,,616.28,,,0,"percent of total billed charges ","70% of total billed charges ",990.45,90,,792.36,,,0,"percent of total billed charges ","90% of total billed charges ",1023.47,93,,818.78,,,0,"percent of total billed charges ","93% of total billed charges ",99.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",935.43,85,,748.34,,,0,"percent of total billed charges ","85% of total billed charges ",990.45,90,,792.36,,,0,"percent of total billed charges ","90% of total billed charges ",990.45,90,,792.36,,,0,"percent of total billed charges ","90% of total billed charges ",34.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",957.44,87,,765.95,,,0,"percent of total billed charges ","87% of total billed charges ",34.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",116.49,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",770.35,70,,616.28,,,0,"percent of total billed charges ","70% of total billed charges ",34.88,1023.47,
"*CHROMOSOME ANAL 15-20 CELLS",2034320,"CDM ",310,RC,88262,HCPCS,OUTPATIENT,,,1235,988,,125.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",864.5,70,,691.60,,,0,"percent of total billed charges ","70% of total billed charges ",1111.5,90,,889.20,,,0,"percent of total billed charges ","90% of total billed charges ",1148.55,93,,918.84,,,0,"percent of total billed charges ","93% of total billed charges ",125.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",227.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1049.75,85,,839.80,,,0,"percent of total billed charges ","85% of total billed charges ",1111.5,90,,889.20,,,0,"percent of total billed charges ","90% of total billed charges ",1111.5,90,,889.20,,,0,"percent of total billed charges ","90% of total billed charges ",225.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1074.45,87,,859.56,,,0,"percent of total billed charges ","87% of total billed charges ",225.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",125.49,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",864.5,70,,691.60,,,0,"percent of total billed charges ","70% of total billed charges ",125.49,1148.55,
"*FMR1 GENE DETECTION",2034330,"CDM ",310,RC,81243,HCPCS,OUTPATIENT,,,145,116,,112.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",112.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",141.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",126.15,87,,100.92,,,0,"percent of total billed charges ","87% of total billed charges ",141.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.04,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",57.04,143.16,
"*FMR1 GENE CHARACTER",2034340,"CDM ",310,RC,81244,HCPCS,OUTPATIENT,,,145,116,,50.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",50.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",63.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",126.15,87,,100.92,,,0,"percent of total billed charges ","87% of total billed charges ",63.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",44.89,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",44.89,134.85,
"*CORTISOL FREE",2034360,"CDM ",301,RC,82530,HCPCS,OUTPATIENT,,,142,113.6,,15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,79.16,79.16,79.16,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.4,70,,79.52,,,0,"percent of total billed charges ","70% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",132.06,93,,105.65,,,0,"percent of total billed charges ","93% of total billed charges ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",120.7,85,,96.56,,,0,"percent of total billed charges ","85% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",123.54,87,,88.27,88.27,88.27,"1 through 10","percent of total billed charges ","87% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.71,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",99.4,70,,79.52,,,0,"percent of total billed charges ","70% of total billed charges ",15,132.06,
"*ASSAY URINE CREATININE",2034370,"CDM ",301,RC,82570,HCPCS,OUTPATIENT,,,65,52,,5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.5,70,,36.40,,,0,"percent of total billed charges ","70% of total billed charges ",58.5,90,,46.80,,,0,"percent of total billed charges ","90% of total billed charges ",60.45,93,,48.36,,,0,"percent of total billed charges ","93% of total billed charges ",5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",55.25,85,,44.20,,,0,"percent of total billed charges ","85% of total billed charges ",58.5,90,,46.80,,,0,"percent of total billed charges ","90% of total billed charges ",58.5,90,,46.80,,,0,"percent of total billed charges ","90% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.55,87,,5.08,4.98,50.30,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",45.5,70,,36.40,,,0,"percent of total billed charges ","70% of total billed charges ",5.18,60.45,
"PROSTAGLANDIN E2, SERUM",2034390,"CDM ",301,RC,84150,HCPCS,OUTPATIENT,,,931,744.8,,35.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",651.7,70,,521.36,,,0,"percent of total billed charges ","70% of total billed charges ",837.9,90,,670.32,,,0,"percent of total billed charges ","90% of total billed charges ",865.83,93,,692.66,,,0,"percent of total billed charges ","93% of total billed charges ",35.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",791.35,85,,633.08,,,0,"percent of total billed charges ","85% of total billed charges ",837.9,90,,670.32,,,0,"percent of total billed charges ","90% of total billed charges ",837.9,90,,670.32,,,0,"percent of total billed charges ","90% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.97,87,,647.98,,,0,"percent of total billed charges ","87% of total billed charges ",30.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.77,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",651.7,70,,521.36,,,0,"percent of total billed charges ","70% of total billed charges ",30.22,865.83,
"FSH, PEDIATRIC",2034400,"CDM ",301,RC,83001,HCPCS,OUTPATIENT,,,157.5,126,,18.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.25,70,,88.20,,,0,"percent of total billed charges ","70% of total billed charges ",141.75,90,,113.40,,,0,"percent of total billed charges ","90% of total billed charges ",146.48,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",18.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",133.88,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.75,90,,113.40,,,0,"percent of total billed charges ","90% of total billed charges ",141.75,90,,113.40,,,0,"percent of total billed charges ","90% of total billed charges ",32.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",137.03,87,,65.74,26.01,110.16,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.57,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",110.25,70,,88.20,,,0,"percent of total billed charges ","70% of total billed charges ",18.57,146.48,
"LACTOFERRIN, QUAL STOOL",2034410,"CDM ",301,RC,83630,HCPCS,OUTPATIENT,,,213.5,170.8,,16.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.45,70,,119.56,,,0,"percent of total billed charges ","70% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",198.56,93,,158.85,,,0,"percent of total billed charges ","93% of total billed charges ",16.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.11,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",181.48,85,,145.18,,,0,"percent of total billed charges ","85% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",185.75,87,,148.60,,,0,"percent of total billed charges ","87% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.7,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",149.45,70,,119.56,,,0,"percent of total billed charges ","70% of total billed charges ",16.75,198.56,
"SHIGA TOXINS, FECAL",2034420,"CDM ",302,RC,87427,HCPCS,OUTPATIENT,,,312.5,250,,11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",218.75,70,,175.00,,,0,"percent of total billed charges ","70% of total billed charges ",281.25,90,,225.00,,,0,"percent of total billed charges ","90% of total billed charges ",290.63,93,,232.50,,,0,"percent of total billed charges ","93% of total billed charges ",11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",265.63,85,,212.50,,,0,"percent of total billed charges ","85% of total billed charges ",281.25,90,,225.00,,,0,"percent of total billed charges ","90% of total billed charges ",281.25,90,,225.00,,,0,"percent of total billed charges ","90% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",271.88,87,,217.50,,,0,"percent of total billed charges ","87% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",218.75,70,,175.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.98,290.63,
SOMATOSTATIN,2034430,"CDM ",301,RC,84307,HCPCS,OUTPATIENT,,,276.5,221.2,,18.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",193.55,70,,154.84,,,0,"percent of total billed charges ","70% of total billed charges ",248.85,90,,199.08,,,0,"percent of total billed charges ","90% of total billed charges ",257.15,93,,205.72,,,0,"percent of total billed charges ","93% of total billed charges ",18.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",235.03,85,,188.02,,,0,"percent of total billed charges ","85% of total billed charges ",248.85,90,,199.08,,,0,"percent of total billed charges ","90% of total billed charges ",248.85,90,,199.08,,,0,"percent of total billed charges ","90% of total billed charges ",27.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",240.56,87,,192.45,,,0,"percent of total billed charges ","87% of total billed charges ",27.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.28,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",193.55,70,,154.84,,,0,"percent of total billed charges ","70% of total billed charges ",18.28,257.15,
"PORPHYRINS, FRAC, RANDOM URINE",2034440,"CDM ",301,RC,84120,HCPCS,OUTPATIENT,,,136.5,109.2,,12.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.55,70,,76.44,,,0,"percent of total billed charges ","70% of total billed charges ",122.85,90,,98.28,,,0,"percent of total billed charges ","90% of total billed charges ",126.95,93,,101.56,,,0,"percent of total billed charges ","93% of total billed charges ",12.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",116.03,85,,92.82,,,0,"percent of total billed charges ","85% of total billed charges ",122.85,90,,98.28,,,0,"percent of total billed charges ","90% of total billed charges ",122.85,90,,98.28,,,0,"percent of total billed charges ","90% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",118.76,87,,95.01,,,0,"percent of total billed charges ","87% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.71,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",95.55,70,,76.44,,,0,"percent of total billed charges ","70% of total billed charges ",12.5,126.95,
"NUCLEOTIDASE 5",2034450,"CDM ",301,RC,83915,HCPCS,OUTPATIENT,,,170.5,136.4,,11.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,51.15,51.15,51.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.35,70,,95.48,,,0,"percent of total billed charges ","70% of total billed charges ",153.45,90,,122.76,,,0,"percent of total billed charges ","90% of total billed charges ",158.57,93,,126.86,,,0,"percent of total billed charges ","93% of total billed charges ",11.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",144.93,85,,115.94,,,0,"percent of total billed charges ","85% of total billed charges ",153.45,90,,122.76,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,90,,122.76,,,0,"percent of total billed charges ","90% of total billed charges ",14.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",148.34,87,,118.67,,,0,"percent of total billed charges ","87% of total billed charges ",14.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.15,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",119.35,70,,95.48,,,0,"percent of total billed charges ","70% of total billed charges ",11.15,158.57,
"*TISSUE CULT BONE MARROW",2034460,"CDM ",300,RC,88237,HCPCS,OUTPATIENT,,,539.5,431.6,,122.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",377.65,70,,302.12,,,0,"percent of total billed charges ","70% of total billed charges ",485.55,90,,388.44,,,0,"percent of total billed charges ","90% of total billed charges ",501.74,93,,401.39,,,0,"percent of total billed charges ","93% of total billed charges ",122.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",458.58,85,,366.86,,,0,"percent of total billed charges ","85% of total billed charges ",485.55,90,,388.44,,,0,"percent of total billed charges ","90% of total billed charges ",485.55,90,,388.44,,,0,"percent of total billed charges ","90% of total billed charges ",34.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",469.37,87,,375.50,,,0,"percent of total billed charges ","87% of total billed charges ",34.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.75,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",377.65,70,,302.12,,,0,"percent of total billed charges ","70% of total billed charges ",34.88,501.74,
"*ANALYZE 20-25 CELLS",2034470,"CDM ",300,RC,88264,HCPCS,OUTPATIENT,,,1675,1340,,144.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1172.5,70,,938.00,,,0,"percent of total billed charges ","70% of total billed charges ",1507.5,90,,1206.00,,,0,"percent of total billed charges ","90% of total billed charges ",1557.75,93,,1246.20,,,0,"percent of total billed charges ","93% of total billed charges ",144.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",227.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1423.75,85,,1139.00,,,0,"percent of total billed charges ","85% of total billed charges ",1507.5,90,,1206.00,,,0,"percent of total billed charges ","90% of total billed charges ",1507.5,90,,1206.00,,,0,"percent of total billed charges ","90% of total billed charges ",225.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1457.25,87,,1165.80,,,0,"percent of total billed charges ","87% of total billed charges ",225.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",144.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1172.5,70,,938.00,,,0,"percent of total billed charges ","70% of total billed charges ",144.61,1557.75,
"*CYTO/MOLECULAR REPORT",2034480,"CDM ",300,RC,88291,HCPCS,OUTPATIENT,,,539.5,431.6,,26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",69.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",377.65,70,,302.12,,,0,"percent of total billed charges ","70% of total billed charges ",485.55,90,,388.44,,,0,"percent of total billed charges ","90% of total billed charges ",501.74,93,,401.39,,,0,"percent of total billed charges ","93% of total billed charges ",26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",458.58,85,,366.86,,,0,"percent of total billed charges ","85% of total billed charges ",485.55,90,,388.44,,,0,"percent of total billed charges ","90% of total billed charges ",485.55,90,,388.44,,,0,"percent of total billed charges ","90% of total billed charges ",32.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",469.37,87,,375.50,,,0,"percent of total billed charges ","87% of total billed charges ",32.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",377.65,70,,302.12,,,0,"percent of total billed charges ","70% of total billed charges ",26,501.74,
"*IMMUNOASSAY ANALYTE",2034500,"CDM ",301,RC,83516,HCPCS,OUTPATIENT,,,141,112.8,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.7,70,,78.96,,,0,"percent of total billed charges ","70% of total billed charges ",126.9,90,,101.52,,,0,"percent of total billed charges ","90% of total billed charges ",131.13,93,,104.90,,,0,"percent of total billed charges ","93% of total billed charges ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",119.85,85,,95.88,,,0,"percent of total billed charges ","85% of total billed charges ",126.9,90,,101.52,,,0,"percent of total billed charges ","90% of total billed charges ",126.9,90,,101.52,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.67,87,,53.32,28.74,77.90,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",98.7,70,,78.96,,,0,"percent of total billed charges ","70% of total billed charges ",10,131.13,
"*ASSAY IGA,IGD,IGG,IGM",2034510,"CDM ",301,RC,82784,HCPCS,OUTPATIENT,,,141,112.8,,9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.7,70,,78.96,,,0,"percent of total billed charges ","70% of total billed charges ",126.9,90,,101.52,,,0,"percent of total billed charges ","90% of total billed charges ",131.13,93,,104.90,,,0,"percent of total billed charges ","93% of total billed charges ",9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",119.85,85,,95.88,,,0,"percent of total billed charges ","85% of total billed charges ",126.9,90,,101.52,,,0,"percent of total billed charges ","90% of total billed charges ",126.9,90,,101.52,,,0,"percent of total billed charges ","90% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.67,87,,98.14,,,0,"percent of total billed charges ","87% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",98.7,70,,78.96,,,0,"percent of total billed charges ","70% of total billed charges ",9.3,131.13,
"ANTIPHOPHOLIPID IGG ABS",2034530,"CDM ",302,RC,83516,HCPCS,OUTPATIENT,,,247,197.6,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.9,70,,138.32,,,0,"percent of total billed charges ","70% of total billed charges ",222.3,90,,177.84,,,0,"percent of total billed charges ","90% of total billed charges ",229.71,93,,183.77,,,0,"percent of total billed charges ","93% of total billed charges ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",209.95,85,,167.96,,,0,"percent of total billed charges ","85% of total billed charges ",222.3,90,,177.84,,,0,"percent of total billed charges ","90% of total billed charges ",222.3,90,,177.84,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",214.89,87,,53.32,28.74,77.90,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",172.9,70,,138.32,,,0,"percent of total billed charges ","70% of total billed charges ",10,229.71,
"CALCIUM, RANDOM URINE",2034540,"CDM ",301,RC,82310,HCPCS,OUTPATIENT,,,63.5,50.8,,5.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.45,70,,35.56,,,0,"percent of total billed charges ","70% of total billed charges ",57.15,90,,45.72,,,0,"percent of total billed charges ","90% of total billed charges ",59.06,93,,47.25,,,0,"percent of total billed charges ","93% of total billed charges ",5.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",53.98,85,,43.18,,,0,"percent of total billed charges ","85% of total billed charges ",57.15,90,,45.72,,,0,"percent of total billed charges ","90% of total billed charges ",57.15,90,,45.72,,,0,"percent of total billed charges ","90% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",55.25,87,,44.20,,,0,"percent of total billed charges ","87% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.16,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",44.45,70,,35.56,,,0,"percent of total billed charges ","70% of total billed charges ",5.16,59.06,
"CHICKEN MEAT IGE (F83)",2034550,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"BACTERIAL QUAN COLONY URINE",2034560,"CDM ",306,RC,87086,HCPCS,OUTPATIENT,,,168.5,134.8,,8.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,19.40,10.21,28.59,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",156.71,93,,125.37,,,0,"percent of total billed charges ","93% of total billed charges ",8.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.23,85,,114.58,,,0,"percent of total billed charges ","85% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",146.6,87,,163.79,7.91,172.40,26,"percent of total billed charges ","87% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",8.07,156.71,
"BACTERIAL ISOL & ID URINE",2034570,"CDM ",306,RC,87088,HCPCS,OUTPATIENT,,,236,188.8,,8.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,26.63,26.63,26.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",165.2,70,,132.16,,,0,"percent of total billed charges ","70% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",219.48,93,,175.58,,,0,"percent of total billed charges ","93% of total billed charges ",8.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",200.6,85,,160.48,,,0,"percent of total billed charges ","85% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",205.32,87,,80.77,7.93,162.06,12,"percent of total billed charges ","87% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",165.2,70,,132.16,,,0,"percent of total billed charges ","70% of total billed charges ",8.09,219.48,
"COBALT, SERUM",2034580,"CDM ",301,RC,83018,HCPCS,OUTPATIENT,,,252,201.6,,19.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.4,70,,141.12,,,0,"percent of total billed charges ","70% of total billed charges ",226.8,90,,181.44,,,0,"percent of total billed charges ","90% of total billed charges ",234.36,93,,187.49,,,0,"percent of total billed charges ","93% of total billed charges ",19.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.37,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",214.2,85,,171.36,,,0,"percent of total billed charges ","85% of total billed charges ",226.8,90,,181.44,,,0,"percent of total billed charges ","90% of total billed charges ",226.8,90,,181.44,,,0,"percent of total billed charges ","90% of total billed charges ",25.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.24,87,,175.39,,,0,"percent of total billed charges ","87% of total billed charges ",25.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.96,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",176.4,70,,141.12,,,0,"percent of total billed charges ","70% of total billed charges ",19.2,234.36,
"LACTIC ACID, BODY FLUID",2034590,"CDM ",301,RC,83605,HCPCS,OUTPATIENT,,,142.5,114,,10.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.75,70,,79.80,,,0,"percent of total billed charges ","70% of total billed charges ",128.25,90,,102.60,,,0,"percent of total billed charges ","90% of total billed charges ",132.53,93,,106.02,,,0,"percent of total billed charges ","93% of total billed charges ",10.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",121.13,85,,96.90,,,0,"percent of total billed charges ","85% of total billed charges ",128.25,90,,102.60,,,0,"percent of total billed charges ","90% of total billed charges ",128.25,90,,102.60,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",123.98,87,,130.68,127.41,202.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.57,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",99.75,70,,79.80,,,0,"percent of total billed charges ","70% of total billed charges ",10.08,132.53,
"*ASSAY OF INSULIN",2034610,"CDM ",301,RC,83525,HCPCS,OUTPATIENT,,,112.5,90,,11.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.69,60.69,60.69,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",104.63,93,,83.70,,,0,"percent of total billed charges ","93% of total billed charges ",11.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",95.63,85,,76.50,,,0,"percent of total billed charges ","85% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",97.88,87,,69.65,66.61,81.84,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.43,104.63,
"*DRUG SCREEN, SINGLE",2034630,"CDM ",301,RC,80307,HCPCS,OUTPATIENT,,,160.5,128.4,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",149.27,93,,119.42,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",136.43,85,,109.14,,,0,"percent of total billed charges ","85% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",139.64,87,,111.71,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",62.14,149.27,
"*MONONUCLEAR CELL ANTIGEN, EA",2034650,"CDM ",302,RC,86356,HCPCS,OUTPATIENT,,,660,528,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",462,70,,369.60,,,0,"percent of total billed charges ","70% of total billed charges ",594,90,,475.20,,,0,"percent of total billed charges ","90% of total billed charges ",613.8,93,,491.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",21.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",561,85,,448.80,,,0,"percent of total billed charges ","85% of total billed charges ",594,90,,475.20,,,0,"percent of total billed charges ","90% of total billed charges ",594,90,,475.20,,,0,"percent of total billed charges ","90% of total billed charges ",21.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",574.2,87,,459.36,,,0,"percent of total billed charges ","87% of total billed charges ",21.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.78,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",462,70,,369.60,,,0,"percent of total billed charges ","70% of total billed charges ",21.14,613.8,
"*FACTOR VIII ACTIVITY CLOTTING",2034670,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,291.5,233.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",204.05,70,,163.24,,,0,"percent of total billed charges ","70% of total billed charges ",262.35,90,,209.88,,,0,"percent of total billed charges ","90% of total billed charges ",271.1,93,,216.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",247.78,85,,198.22,,,0,"percent of total billed charges ","85% of total billed charges ",262.35,90,,209.88,,,0,"percent of total billed charges ","90% of total billed charges ",262.35,90,,209.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",253.61,87,,202.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",204.05,70,,163.24,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,271.1,
"*PARTIAL THROMBOPLASTIN TIME",2034680,"CDM ",305,RC,85240,HCPCS,OUTPATIENT,,,261.5,209.2,,17.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",243.2,93,,194.56,,,0,"percent of total billed charges ","93% of total billed charges ",17.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",222.28,85,,177.82,,,0,"percent of total billed charges ","85% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",24.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",227.51,87,,150.42,150.42,150.42,"1 through 10","percent of total billed charges ","87% of total billed charges ",24.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.89,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",17.89,243.2,
"*RISTOCETIN COFACTOR",2034690,"CDM ",305,RC,85245,HCPCS,OUTPATIENT,,,261.5,209.2,,19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",243.2,93,,194.56,,,0,"percent of total billed charges ","93% of total billed charges ",19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",222.28,85,,177.82,,,0,"percent of total billed charges ","85% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",227.51,87,,149.99,149.99,149.99,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.94,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,243.2,
"*VON WILLEBRAND FACTOR ANTIGEN",2034700,"CDM ",305,RC,85246,HCPCS,OUTPATIENT,,,261.5,209.2,,19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",243.2,93,,194.56,,,0,"percent of total billed charges ","93% of total billed charges ",19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",222.28,85,,177.82,,,0,"percent of total billed charges ","85% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",227.51,87,,149.99,149.99,149.99,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.94,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,243.2,
"*VON WILLEBRAND ANTIGEN, MULTI",2034710,"CDM ",305,RC,85247,HCPCS,OUTPATIENT,,,261.5,209.2,,19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",243.2,93,,194.56,,,0,"percent of total billed charges ","93% of total billed charges ",19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",222.28,85,,177.82,,,0,"percent of total billed charges ","85% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",227.51,87,,182.01,,,0,"percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.94,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,243.2,
"*VON WILLEBRAND FAC COLLAGEN",2034720,"CDM ",305,RC,85730,HCPCS,OUTPATIENT,,,261.5,209.2,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",243.2,93,,194.56,,,0,"percent of total billed charges ","93% of total billed charges ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",222.28,85,,177.82,,,0,"percent of total billed charges ","85% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",227.51,87,,49.13,5.89,151.44,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,243.2,
"*VW PTT PLASMA OR WHOLE BLOOD",2034725,"CDM ",305,RC,85730,HCPCS,OUTPATIENT,,,106,84.8,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.2,70,,59.36,,,0,"percent of total billed charges ","70% of total billed charges ",95.4,90,,76.32,,,0,"percent of total billed charges ","90% of total billed charges ",98.58,93,,78.86,,,0,"percent of total billed charges ","93% of total billed charges ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",90.1,85,,72.08,,,0,"percent of total billed charges ","85% of total billed charges ",95.4,90,,76.32,,,0,"percent of total billed charges ","90% of total billed charges ",95.4,90,,76.32,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",92.22,87,,49.13,5.89,151.44,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",74.2,70,,59.36,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,98.58,
"*RUBEOLA ANTIBODY",2034740,"CDM ",302,RC,86765,HCPCS,OUTPATIENT,,,191,152.8,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.7,70,,106.96,,,0,"percent of total billed charges ","70% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",177.63,93,,142.10,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",162.35,85,,129.88,,,0,"percent of total billed charges ","85% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",166.17,87,,132.94,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",133.7,70,,106.96,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,177.63,
"*HERPES SIMPLEX TYPE 1",2034760,"CDM ",302,RC,86695,HCPCS,OUTPATIENT,,,175,140,,11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,76.02,76.02,76.02,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",162.75,93,,130.20,,,0,"percent of total billed charges ","93% of total billed charges ",11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",148.75,85,,119.00,,,0,"percent of total billed charges ","85% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",152.25,87,,121.80,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,162.75,
"*HERPES SIMPLEX TYPE 2",2034770,"CDM ",302,RC,86696,HCPCS,OUTPATIENT,,,188.5,150.8,,19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.29,80.29,80.29,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.95,70,,105.56,,,0,"percent of total billed charges ","70% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",175.31,93,,140.25,,,0,"percent of total billed charges ","93% of total billed charges ",19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",160.23,85,,128.18,,,0,"percent of total billed charges ","85% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",164,87,,131.20,,,0,"percent of total billed charges ","87% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.35,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",131.95,70,,105.56,,,0,"percent of total billed charges ","70% of total billed charges ",19.35,175.31,
"BETA-GLOBIN GENE ANALYSIS",2034790,"CDM ",300,RC,81403,HCPCS,OUTPATIENT,,,2665,2132,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1865.5,70,,1492.40,,,0,"percent of total billed charges ","70% of total billed charges ",2398.5,90,,1918.80,,,0,"percent of total billed charges ","90% of total billed charges ",2478.45,93,,1982.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2265.25,85,,1812.20,,,0,"percent of total billed charges ","85% of total billed charges ",2398.5,90,,1918.80,,,0,"percent of total billed charges ","90% of total billed charges ",2398.5,90,,1918.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2318.55,87,,1854.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",185.2,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1865.5,70,,1492.40,,,0,"percent of total billed charges ","70% of total billed charges ",185.2,2478.45,
"CEPHALOSPORIN IGE",2034800,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,167,133.6,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.9,70,,93.52,,,0,"percent of total billed charges ","70% of total billed charges ",150.3,90,,120.24,,,0,"percent of total billed charges ","90% of total billed charges ",155.31,93,,124.25,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",141.95,85,,113.56,,,0,"percent of total billed charges ","85% of total billed charges ",150.3,90,,120.24,,,0,"percent of total billed charges ","90% of total billed charges ",150.3,90,,120.24,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",145.29,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",116.9,70,,93.52,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,155.31,
"ERYTHROMYCIN IGE",2034810,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,167,133.6,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.9,70,,93.52,,,0,"percent of total billed charges ","70% of total billed charges ",150.3,90,,120.24,,,0,"percent of total billed charges ","90% of total billed charges ",155.31,93,,124.25,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",141.95,85,,113.56,,,0,"percent of total billed charges ","85% of total billed charges ",150.3,90,,120.24,,,0,"percent of total billed charges ","90% of total billed charges ",150.3,90,,120.24,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",145.29,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",116.9,70,,93.52,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,155.31,
"AMOXICILLIN IGE",2034820,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"SULFAMETHOXAZOLE IGE",2034830,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,167,133.6,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.9,70,,93.52,,,0,"percent of total billed charges ","70% of total billed charges ",150.3,90,,120.24,,,0,"percent of total billed charges ","90% of total billed charges ",155.31,93,,124.25,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",141.95,85,,113.56,,,0,"percent of total billed charges ","85% of total billed charges ",150.3,90,,120.24,,,0,"percent of total billed charges ","90% of total billed charges ",150.3,90,,120.24,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",145.29,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",116.9,70,,93.52,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,155.31,
"TETRACYCLINE IGE",2034840,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,206.5,165.2,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",192.05,93,,153.64,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",175.53,85,,140.42,,,0,"percent of total billed charges ","85% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",179.66,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,192.05,
"*HSV DNA AMP PROBE",2034850,"CDM ",306,RC,87529,HCPCS,OUTPATIENT,,,253,202.4,,29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,180.36,180.36,180.36,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.1,70,,141.68,,,0,"percent of total billed charges ","70% of total billed charges ",227.7,90,,182.16,,,0,"percent of total billed charges ","90% of total billed charges ",235.29,93,,188.23,,,0,"percent of total billed charges ","93% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",215.05,85,,172.04,,,0,"percent of total billed charges ","85% of total billed charges ",227.7,90,,182.16,,,0,"percent of total billed charges ","90% of total billed charges ",227.7,90,,182.16,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",220.11,87,,176.09,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",177.1,70,,141.68,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,235.29,
"*ASSAY SERUM ALBUMIN",2034870,"CDM ",301,RC,82040,HCPCS,OUTPATIENT,,,73.5,58.8,,4.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,12.74,12.74,12.74,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",4.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.95,87,,4.86,4.86,49.24,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.95,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",4.95,68.36,
"*ASSAY URINE ALBUMIN",2034880,"CDM ",301,RC,82042,HCPCS,OUTPATIENT,,,73.5,58.8,,6.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",6.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.78,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",6.61,68.36,
"*ASSAY IGA/IGD/IGG/IGM EACH",2034890,"CDM ",301,RC,82784,HCPCS,OUTPATIENT,,,108,86.4,,9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,75.17,,,0,"percent of total billed charges ","87% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",9.3,100.44,
"*ASSAY CSF PROTEIN",2034900,"CDM ",301,RC,83873,HCPCS,OUTPATIENT,,,135,108,,17.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",125.55,93,,100.44,,,0,"percent of total billed charges ","93% of total billed charges ",17.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",114.75,85,,91.80,,,0,"percent of total billed charges ","85% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",31.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.45,87,,93.96,,,0,"percent of total billed charges ","87% of total billed charges ",31.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.2,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",17.2,125.55,
"*OLIGOCLONAL BANDS",2034910,"CDM ",301,RC,83916,HCPCS,OUTPATIENT,,,161,128.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.7,70,,90.16,,,0,"percent of total billed charges ","70% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",149.73,93,,119.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.85,85,,109.48,,,0,"percent of total billed charges ","85% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",140.07,87,,112.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",27.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",112.7,70,,90.16,,,0,"percent of total billed charges ","70% of total billed charges ",27.39,149.73,
"*ASSAY CREATININE URINE",2034930,"CDM ",301,RC,82570,HCPCS,OUTPATIENT,,,47,37.6,,5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",43.71,93,,34.97,,,0,"percent of total billed charges ","93% of total billed charges ",5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.95,85,,31.96,,,0,"percent of total billed charges ","85% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.89,87,,5.08,4.98,50.30,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",5.18,43.71,
"*ASSAY URINE VMA",2034940,"CDM ",301,RC,84585,HCPCS,OUTPATIENT,,,135,108,,15.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",125.55,93,,100.44,,,0,"percent of total billed charges ","93% of total billed charges ",15.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",114.75,85,,91.80,,,0,"percent of total billed charges ","85% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",26.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.45,87,,93.96,,,0,"percent of total billed charges ","87% of total billed charges ",26.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.5,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",15.5,125.55,
"*ANTI-NUCLEAR ANTIBODY",2034960,"CDM ",302,RC,86038,HCPCS,OUTPATIENT,,,129,103.2,,12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",119.97,93,,95.98,,,0,"percent of total billed charges ","93% of total billed charges ",12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",109.65,85,,87.72,,,0,"percent of total billed charges ","85% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.23,87,,88.36,11.85,147.83,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",12.09,119.97,
"*ANTI-NUC AB TITER & PATTERN",2034980,"CDM ",302,RC,86039,HCPCS,OUTPATIENT,,,115,92,,11.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",11.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.37,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",20.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,78.87,10.94,78.87,"1 through 10","percent of total billed charges ","87% of total billed charges ",20.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.16,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",11.16,106.95,
"VITAMIN B3",2034990,"CDM ",301,RC,84591,HCPCS,OUTPATIENT,,,446.5,357.2,,14.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",312.55,70,,250.04,,,0,"percent of total billed charges ","70% of total billed charges ",401.85,90,,321.48,,,0,"percent of total billed charges ","90% of total billed charges ",415.25,93,,332.20,,,0,"percent of total billed charges ","93% of total billed charges ",14.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",379.53,85,,303.62,,,0,"percent of total billed charges ","85% of total billed charges ",401.85,90,,321.48,,,0,"percent of total billed charges ","90% of total billed charges ",401.85,90,,321.48,,,0,"percent of total billed charges ","90% of total billed charges ",17.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",388.46,87,,310.77,,,0,"percent of total billed charges ","87% of total billed charges ",17.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",312.55,70,,250.04,,,0,"percent of total billed charges ","70% of total billed charges ",14.5,415.25,
"ZINC TRANSPORTER 8 AB",2035000,"CDM ",302,RC,86341,HCPCS,OUTPATIENT,,,2519,2015.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1763.3,70,,1410.64,,,0,"percent of total billed charges ","70% of total billed charges ",2267.1,90,,1813.68,,,0,"percent of total billed charges ","90% of total billed charges ",2342.67,93,,1874.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2141.15,85,,1712.92,,,0,"percent of total billed charges ","85% of total billed charges ",2267.1,90,,1813.68,,,0,"percent of total billed charges ","90% of total billed charges ",2267.1,90,,1813.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2191.53,87,,1753.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",23.57,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1763.3,70,,1410.64,,,0,"percent of total billed charges ","70% of total billed charges ",23.57,2342.67,
"IA-2 ANTIBODY",2035010,"CDM ",302,RC,86341,HCPCS,OUTPATIENT,,,606,484.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",424.2,70,,339.36,,,0,"percent of total billed charges ","70% of total billed charges ",545.4,90,,436.32,,,0,"percent of total billed charges ","90% of total billed charges ",563.58,93,,450.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",515.1,85,,412.08,,,0,"percent of total billed charges ","85% of total billed charges ",545.4,90,,436.32,,,0,"percent of total billed charges ","90% of total billed charges ",545.4,90,,436.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",527.22,87,,421.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",23.57,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",424.2,70,,339.36,,,0,"percent of total billed charges ","70% of total billed charges ",23.57,563.58,
"BETA-GLOBIN COMPLETE",2035020,"CDM ",309,RC,81404,HCPCS,OUTPATIENT,,,2665,2132,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1865.5,70,,1492.40,,,0,"percent of total billed charges ","70% of total billed charges ",2398.5,90,,1918.80,,,0,"percent of total billed charges ","90% of total billed charges ",2478.45,93,,1982.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2265.25,85,,1812.20,,,0,"percent of total billed charges ","85% of total billed charges ",2398.5,90,,1918.80,,,0,"percent of total billed charges ","90% of total billed charges ",2398.5,90,,1918.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2318.55,87,,1854.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",274.83,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1865.5,70,,1492.40,,,0,"percent of total billed charges ","70% of total billed charges ",274.83,2478.45,
"*VIRUS AB NOS",2035030,"CDM ",302,RC,86790,HCPCS,OUTPATIENT,,,525,420,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.58,80.58,80.58,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",367.5,70,,294.00,,,0,"percent of total billed charges ","70% of total billed charges ",472.5,90,,378.00,,,0,"percent of total billed charges ","90% of total billed charges ",488.25,93,,390.60,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",446.25,85,,357.00,,,0,"percent of total billed charges ","85% of total billed charges ",472.5,90,,378.00,,,0,"percent of total billed charges ","90% of total billed charges ",472.5,90,,378.00,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",456.75,87,,199.98,199.98,199.98,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",367.5,70,,294.00,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,488.25,
"PINE NUT IGE",2035050,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"PISTACHIO IGE",2035060,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"SUNFLOWER SEED IGE",2035070,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"WALNUT IGE",2035080,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"*SESAME IGE",2035090,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"BRAZIL NUT IGE",2035100,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"CASHEW NUT IGE",2035110,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"MACADAMIA NUT IGE",2035120,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"*PEANUT IGE",2035140,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"*ALMOND IGE",2035150,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"*COCONUT IGE",2035160,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"*PECAN IGE",2035170,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"*BABESIA MICROTI AB",2035180,"CDM ",302,RC,86753,HCPCS,OUTPATIENT,,,98.5,78.8,,10.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",10.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,91.61,
"*COLORADO TICK VIRUS AB",2035200,"CDM ",302,RC,86790,HCPCS,OUTPATIENT,,,231.5,185.2,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.58,80.58,80.58,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.05,70,,129.64,,,0,"percent of total billed charges ","70% of total billed charges ",208.35,90,,166.68,,,0,"percent of total billed charges ","90% of total billed charges ",215.3,93,,172.24,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",196.78,85,,157.42,,,0,"percent of total billed charges ","85% of total billed charges ",208.35,90,,166.68,,,0,"percent of total billed charges ","90% of total billed charges ",208.35,90,,166.68,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.41,87,,199.98,199.98,199.98,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",162.05,70,,129.64,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,215.3,
"FRANCISELLA TULARENSIS AB (DA)",2035220,"CDM ",302,RC,86000,HCPCS,OUTPATIENT,,,224.5,179.6,,5.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",208.79,93,,167.03,,,0,"percent of total billed charges ","93% of total billed charges ",5.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",190.83,85,,152.66,,,0,"percent of total billed charges ","85% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.32,87,,156.26,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",5.93,208.79,
"SALMONELLA/SHIGELLA STOOL CULT",2035230,"CDM ",306,RC,87045,HCPCS,OUTPATIENT,,,131.5,105.2,,9.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.05,70,,73.64,,,0,"percent of total billed charges ","70% of total billed charges ",118.35,90,,94.68,,,0,"percent of total billed charges ","90% of total billed charges ",122.3,93,,97.84,,,0,"percent of total billed charges ","93% of total billed charges ",9.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",111.78,85,,89.42,,,0,"percent of total billed charges ","85% of total billed charges ",118.35,90,,94.68,,,0,"percent of total billed charges ","90% of total billed charges ",118.35,90,,94.68,,,0,"percent of total billed charges ","90% of total billed charges ",14.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",114.41,87,,91.53,,,0,"percent of total billed charges ","87% of total billed charges ",14.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.44,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",92.05,70,,73.64,,,0,"percent of total billed charges ","70% of total billed charges ",9.44,122.3,
"ELUTION RBC'S",2035240,"CDM ",302,RC,86860,HCPCS,OUTPATIENT,,,183,146.4,,129.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.1,70,,102.48,,,0,"percent of total billed charges ","70% of total billed charges ",164.7,90,,131.76,,,0,"percent of total billed charges ","90% of total billed charges ",170.19,93,,136.15,,,0,"percent of total billed charges ","93% of total billed charges ",129.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",155.55,85,,124.44,,,0,"percent of total billed charges ","85% of total billed charges ",164.7,90,,131.76,,,0,"percent of total billed charges ","90% of total billed charges ",164.7,90,,131.76,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",159.21,87,,127.37,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",128.1,70,,102.48,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,170.19,
"PRETREATMENT RBC'S W/CHEMICAL",2035250,"CDM ",302,RC,86970,HCPCS,OUTPATIENT,,,102,81.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.4,70,,57.12,,,0,"percent of total billed charges ","70% of total billed charges ",91.8,90,,73.44,,,0,"percent of total billed charges ","90% of total billed charges ",94.86,93,,75.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",86.7,85,,69.36,,,0,"percent of total billed charges ","85% of total billed charges ",91.8,90,,73.44,,,0,"percent of total billed charges ","90% of total billed charges ",91.8,90,,73.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",88.74,87,,70.99,,,0,"percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",71.4,70,,57.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.61,94.86,
"CORTISOL TOTAL",2035260,"CDM ",301,RC,82533,HCPCS,OUTPATIENT,,,130,104,,16.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91,70,,72.80,,,0,"percent of total billed charges ","70% of total billed charges ",117,90,,93.60,,,0,"percent of total billed charges ","90% of total billed charges ",120.9,93,,96.72,,,0,"percent of total billed charges ","93% of total billed charges ",16.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",110.5,85,,88.40,,,0,"percent of total billed charges ","85% of total billed charges ",117,90,,93.60,,,0,"percent of total billed charges ","90% of total billed charges ",117,90,,93.60,,,0,"percent of total billed charges ","90% of total billed charges ",29.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",113.1,87,,68.05,68.05,68.05,"1 through 10","percent of total billed charges ","87% of total billed charges ",29.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",91,70,,72.80,,,0,"percent of total billed charges ","70% of total billed charges ",16.3,120.9,
"EOSINOPHILS, URINE",2035270,"CDM ",305,RC,85999,HCPCS,OUTPATIENT,,,96.5,77.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.55,70,,54.04,,,0,"percent of total billed charges ","70% of total billed charges ",86.85,90,,69.48,,,0,"percent of total billed charges ","90% of total billed charges ",89.75,93,,71.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",82.03,85,,65.62,,,0,"percent of total billed charges ","85% of total billed charges ",86.85,90,,69.48,,,0,"percent of total billed charges ","90% of total billed charges ",86.85,90,,69.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",83.96,87,,67.17,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.55,70,,54.04,,,0,"percent of total billed charges ","70% of total billed charges ",67.55,89.75,
"*PROTHROMBIN TIME",2035280,"CDM ",305,RC,85610,HCPCS,OUTPATIENT,,,106,84.8,,4.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.2,70,,59.36,,,0,"percent of total billed charges ","70% of total billed charges ",95.4,90,,76.32,,,0,"percent of total billed charges ","90% of total billed charges ",98.58,93,,78.86,,,0,"percent of total billed charges ","93% of total billed charges ",4.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",90.1,85,,72.08,,,0,"percent of total billed charges ","85% of total billed charges ",95.4,90,,76.32,,,0,"percent of total billed charges ","90% of total billed charges ",95.4,90,,76.32,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",92.22,87,,50.34,4.21,62.93,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.29,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",74.2,70,,59.36,,,0,"percent of total billed charges ","70% of total billed charges ",4.29,98.58,
"*THROMBOPLASTIN TIME PARTIAL",2035290,"CDM ",305,RC,85730,HCPCS,OUTPATIENT,,,57,45.6,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.9,70,,31.92,,,0,"percent of total billed charges ","70% of total billed charges ",51.3,90,,41.04,,,0,"percent of total billed charges ","90% of total billed charges ",53.01,93,,42.41,,,0,"percent of total billed charges ","93% of total billed charges ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",48.45,85,,38.76,,,0,"percent of total billed charges ","85% of total billed charges ",51.3,90,,41.04,,,0,"percent of total billed charges ","90% of total billed charges ",51.3,90,,41.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",49.59,87,,49.13,5.89,151.44,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",39.9,70,,31.92,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,53.01,
"*ASSAY SWEAT SODIUM",2035310,"CDM ",301,RC,84302,HCPCS,OUTPATIENT,,,114,91.2,,4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.8,70,,63.84,,,0,"percent of total billed charges ","70% of total billed charges ",102.6,90,,82.08,,,0,"percent of total billed charges ","90% of total billed charges ",106.02,93,,84.82,,,0,"percent of total billed charges ","93% of total billed charges ",4.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",96.9,85,,77.52,,,0,"percent of total billed charges ","85% of total billed charges ",102.6,90,,82.08,,,0,"percent of total billed charges ","90% of total billed charges ",102.6,90,,82.08,,,0,"percent of total billed charges ","90% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",99.18,87,,79.34,,,0,"percent of total billed charges ","87% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.86,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",79.8,70,,63.84,,,0,"percent of total billed charges ","70% of total billed charges ",4.2,106.02,
*SPECTROPHOTOMETRY,2035320,"CDM ",301,RC,84311,HCPCS,OUTPATIENT,,,146.5,117.2,,,,,,,,0,"other ","not separately reimbursment ",,,,89.76,89.76,89.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.55,70,,82.04,,,0,"percent of total billed charges ","70% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",136.25,93,,109.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",124.53,85,,99.62,,,0,"percent of total billed charges ","85% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",131.85,90,,105.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",127.46,87,,101.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",8.1,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.55,70,,82.04,,,0,"percent of total billed charges ","70% of total billed charges ",8.1,136.25,
"*ANTITHROMBIN III ACTIVITY",2035340,"CDM ",305,RC,85300,HCPCS,OUTPATIENT,,,454.5,363.6,,11.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",318.15,70,,254.52,,,0,"percent of total billed charges ","70% of total billed charges ",409.05,90,,327.24,,,0,"percent of total billed charges ","90% of total billed charges ",422.69,93,,338.15,,,0,"percent of total billed charges ","93% of total billed charges ",11.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.11,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",386.33,85,,309.06,,,0,"percent of total billed charges ","85% of total billed charges ",409.05,90,,327.24,,,0,"percent of total billed charges ","90% of total billed charges ",409.05,90,,327.24,,,0,"percent of total billed charges ","90% of total billed charges ",20.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",395.42,87,,316.34,,,0,"percent of total billed charges ","87% of total billed charges ",20.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.85,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",318.15,70,,254.52,,,0,"percent of total billed charges ","70% of total billed charges ",11.85,422.69,
"*CLOT INHIBIT PROT C",2035350,"CDM ",305,RC,85303,HCPCS,OUTPATIENT,,,454.5,363.6,,13.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",318.15,70,,254.52,,,0,"percent of total billed charges ","70% of total billed charges ",409.05,90,,327.24,,,0,"percent of total billed charges ","90% of total billed charges ",422.69,93,,338.15,,,0,"percent of total billed charges ","93% of total billed charges ",13.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",386.33,85,,309.06,,,0,"percent of total billed charges ","85% of total billed charges ",409.05,90,,327.24,,,0,"percent of total billed charges ","90% of total billed charges ",409.05,90,,327.24,,,0,"percent of total billed charges ","90% of total billed charges ",21.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",395.42,87,,145.25,145.25,145.25,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.84,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",318.15,70,,254.52,,,0,"percent of total billed charges ","70% of total billed charges ",13.84,422.69,
"*CLOT INHIBIT PROT S FREE",2035360,"CDM ",305,RC,85306,HCPCS,OUTPATIENT,,,454.5,363.6,,15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",318.15,70,,254.52,,,0,"percent of total billed charges ","70% of total billed charges ",409.05,90,,327.24,,,0,"percent of total billed charges ","90% of total billed charges ",422.69,93,,338.15,,,0,"percent of total billed charges ","93% of total billed charges ",15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",386.33,85,,309.06,,,0,"percent of total billed charges ","85% of total billed charges ",409.05,90,,327.24,,,0,"percent of total billed charges ","90% of total billed charges ",409.05,90,,327.24,,,0,"percent of total billed charges ","90% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",395.42,87,,174.12,174.12,174.12,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.32,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",318.15,70,,254.52,,,0,"percent of total billed charges ","70% of total billed charges ",15.32,422.69,
"*F2 GENE",2035370,"CDM ",300,RC,81240,HCPCS,OUTPATIENT,,,672.5,538,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",470.75,70,,376.60,,,0,"percent of total billed charges ","70% of total billed charges ",605.25,90,,484.20,,,0,"percent of total billed charges ","90% of total billed charges ",625.43,93,,500.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",571.63,85,,457.30,,,0,"percent of total billed charges ","85% of total billed charges ",605.25,90,,484.20,,,0,"percent of total billed charges ","90% of total billed charges ",605.25,90,,484.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",585.08,87,,468.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",65.69,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",470.75,70,,376.60,,,0,"percent of total billed charges ","70% of total billed charges ",65.69,625.43,
"*F5 GENE",2035380,"CDM ",300,RC,81241,HCPCS,OUTPATIENT,,,672.5,538,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",470.75,70,,376.60,,,0,"percent of total billed charges ","70% of total billed charges ",605.25,90,,484.20,,,0,"percent of total billed charges ","90% of total billed charges ",625.43,93,,500.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",571.63,85,,457.30,,,0,"percent of total billed charges ","85% of total billed charges ",605.25,90,,484.20,,,0,"percent of total billed charges ","90% of total billed charges ",605.25,90,,484.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",585.08,87,,468.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",73.37,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",470.75,70,,376.60,,,0,"percent of total billed charges ","70% of total billed charges ",73.37,625.43,
"*MOPATH PROCEDURE LEVEL 1",2035390,"CDM ",300,RC,81400,HCPCS,OUTPATIENT,,,672.5,538,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",470.75,70,,376.60,,,0,"percent of total billed charges ","70% of total billed charges ",605.25,90,,484.20,,,0,"percent of total billed charges ","90% of total billed charges ",625.43,93,,500.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",571.63,85,,457.30,,,0,"percent of total billed charges ","85% of total billed charges ",605.25,90,,484.20,,,0,"percent of total billed charges ","90% of total billed charges ",605.25,90,,484.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",585.08,87,,468.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",63.96,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",470.75,70,,376.60,,,0,"percent of total billed charges ","70% of total billed charges ",63.96,625.43,
"DONATH LANDSTEINER",2035420,"CDM ",302,RC,86941,HCPCS,OUTPATIENT,,,547,437.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",382.9,70,,306.32,,,0,"percent of total billed charges ","70% of total billed charges ",492.3,90,,393.84,,,0,"percent of total billed charges ","90% of total billed charges ",508.71,93,,406.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",14.53,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",464.95,85,,371.96,,,0,"percent of total billed charges ","85% of total billed charges ",492.3,90,,393.84,,,0,"percent of total billed charges ","90% of total billed charges ",492.3,90,,393.84,,,0,"percent of total billed charges ","90% of total billed charges ",14.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",475.89,87,,380.71,,,0,"percent of total billed charges ","87% of total billed charges ",14.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.11,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",382.9,70,,306.32,,,0,"percent of total billed charges ","70% of total billed charges ",12.11,508.71,
"FISH MYELO NEOPLA EOSINOPHILIA",2035430,"CDM ",300,RC,88271,HCPCS,OUTPATIENT,,,3415,2732,,21.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2390.5,70,,1912.40,,,0,"percent of total billed charges ","70% of total billed charges ",3073.5,90,,2458.80,,,0,"percent of total billed charges ","90% of total billed charges ",3175.95,93,,2540.76,,,0,"percent of total billed charges ","93% of total billed charges ",21.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2902.75,85,,2322.20,,,0,"percent of total billed charges ","85% of total billed charges ",3073.5,90,,2458.80,,,0,"percent of total billed charges ","90% of total billed charges ",3073.5,90,,2458.80,,,0,"percent of total billed charges ","90% of total billed charges ",33.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2971.05,87,,2376.84,,,0,"percent of total billed charges ","87% of total billed charges ",33.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.42,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",2390.5,70,,1912.40,,,0,"percent of total billed charges ","70% of total billed charges ",21.42,3175.95,
"PORPHYRINS TOTAL PLASMA",2035440,"CDM ",301,RC,82542,HCPCS,OUTPATIENT,,,226,180.8,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",158.2,70,,126.56,,,0,"percent of total billed charges ","70% of total billed charges ",203.4,90,,162.72,,,0,"percent of total billed charges ","90% of total billed charges ",210.18,93,,168.14,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",192.1,85,,153.68,,,0,"percent of total billed charges ","85% of total billed charges ",203.4,90,,162.72,,,0,"percent of total billed charges ","90% of total billed charges ",203.4,90,,162.72,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",196.62,87,,157.30,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",158.2,70,,126.56,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,210.18,
"MARIJUANA METABOLITES URINE",2035450,"CDM ",301,RC,82542,HCPCS,OUTPATIENT,,,295.5,236.4,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",206.85,70,,165.48,,,0,"percent of total billed charges ","70% of total billed charges ",265.95,90,,212.76,,,0,"percent of total billed charges ","90% of total billed charges ",274.82,93,,219.86,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",251.18,85,,200.94,,,0,"percent of total billed charges ","85% of total billed charges ",265.95,90,,212.76,,,0,"percent of total billed charges ","90% of total billed charges ",265.95,90,,212.76,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.09,87,,205.67,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",206.85,70,,165.48,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,274.82,
"VWF COLLAGEN BINDING ASSAL",2035460,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,635,508,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",444.5,70,,355.60,,,0,"percent of total billed charges ","70% of total billed charges ",571.5,90,,457.20,,,0,"percent of total billed charges ","90% of total billed charges ",590.55,93,,472.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",539.75,85,,431.80,,,0,"percent of total billed charges ","85% of total billed charges ",571.5,90,,457.20,,,0,"percent of total billed charges ","90% of total billed charges ",571.5,90,,457.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",552.45,87,,441.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",444.5,70,,355.60,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,590.55,
"INTERLEUKIN 6 HIGH SENSTIVITY",2035470,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,496,396.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",347.2,70,,277.76,,,0,"percent of total billed charges ","70% of total billed charges ",446.4,90,,357.12,,,0,"percent of total billed charges ","90% of total billed charges ",461.28,93,,369.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",421.6,85,,337.28,,,0,"percent of total billed charges ","85% of total billed charges ",446.4,90,,357.12,,,0,"percent of total billed charges ","90% of total billed charges ",446.4,90,,357.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",431.52,87,,345.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",347.2,70,,277.76,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,461.28,
"INTERLEUKIN 2RECET ALPHA CHAIN",2035475,"CDM ",302,RC,83520,HCPCS,OUTPATIENT,,,139,111.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.3,70,,77.84,,,0,"percent of total billed charges ","70% of total billed charges ",125.1,90,,100.08,,,0,"percent of total billed charges ","90% of total billed charges ",129.27,93,,103.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",118.15,85,,94.52,,,0,"percent of total billed charges ","85% of total billed charges ",125.1,90,,100.08,,,0,"percent of total billed charges ","90% of total billed charges ",125.1,90,,100.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",120.93,87,,96.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",97.3,70,,77.84,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,129.27,
"*ENZYME CELL ACTIVITY",2035480,"CDM ",301,RC,82657,HCPCS,OUTPATIENT,,,452,361.6,,22.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",316.4,70,,253.12,,,0,"percent of total billed charges ","70% of total billed charges ",406.8,90,,325.44,,,0,"percent of total billed charges ","90% of total billed charges ",420.36,93,,336.29,,,0,"percent of total billed charges ","93% of total billed charges ",22.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",384.2,85,,307.36,,,0,"percent of total billed charges ","85% of total billed charges ",406.8,90,,325.44,,,0,"percent of total billed charges ","90% of total billed charges ",406.8,90,,325.44,,,0,"percent of total billed charges ","90% of total billed charges ",38.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",393.24,87,,314.59,,,0,"percent of total billed charges ","87% of total billed charges ",38.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.17,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",316.4,70,,253.12,,,0,"percent of total billed charges ","70% of total billed charges ",22.17,420.36,
"HYALURONIC ACID SERUM",2035485,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,232.5,186,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.75,70,,130.20,,,0,"percent of total billed charges ","70% of total billed charges ",209.25,90,,167.40,,,0,"percent of total billed charges ","90% of total billed charges ",216.23,93,,172.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",197.63,85,,158.10,,,0,"percent of total billed charges ","85% of total billed charges ",209.25,90,,167.40,,,0,"percent of total billed charges ","90% of total billed charges ",209.25,90,,167.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",202.28,87,,161.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",162.75,70,,130.20,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,216.23,
"*ASSAY G6PD ENZYME",2035490,"CDM ",301,RC,82955,HCPCS,OUTPATIENT,,,452,361.6,,9.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",316.4,70,,253.12,,,0,"percent of total billed charges ","70% of total billed charges ",406.8,90,,325.44,,,0,"percent of total billed charges ","90% of total billed charges ",420.36,93,,336.29,,,0,"percent of total billed charges ","93% of total billed charges ",9.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.72,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",384.2,85,,307.36,,,0,"percent of total billed charges ","85% of total billed charges ",406.8,90,,325.44,,,0,"percent of total billed charges ","90% of total billed charges ",406.8,90,,325.44,,,0,"percent of total billed charges ","90% of total billed charges ",17.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",393.24,87,,314.59,,,0,"percent of total billed charges ","87% of total billed charges ",17.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.69,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",316.4,70,,253.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.69,420.36,
"*ASSAY PHOSPHOHEXOSE ENZYMES",2035500,"CDM ",301,RC,84087,HCPCS,OUTPATIENT,,,452,361.6,,10.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",316.4,70,,253.12,,,0,"percent of total billed charges ","70% of total billed charges ",406.8,90,,325.44,,,0,"percent of total billed charges ","90% of total billed charges ",420.36,93,,336.29,,,0,"percent of total billed charges ","93% of total billed charges ",10.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.86,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",384.2,85,,307.36,,,0,"percent of total billed charges ","85% of total billed charges ",406.8,90,,325.44,,,0,"percent of total billed charges ","90% of total billed charges ",406.8,90,,325.44,,,0,"percent of total billed charges ","90% of total billed charges ",18.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",393.24,87,,314.59,,,0,"percent of total billed charges ","87% of total billed charges ",18.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.73,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",316.4,70,,253.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.73,420.36,
"*ASSAY PYRUVATE KINASE",2035510,"CDM ",301,RC,84220,HCPCS,OUTPATIENT,,,452,361.6,,8.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",316.4,70,,253.12,,,0,"percent of total billed charges ","70% of total billed charges ",406.8,90,,325.44,,,0,"percent of total billed charges ","90% of total billed charges ",420.36,93,,336.29,,,0,"percent of total billed charges ","93% of total billed charges ",8.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",384.2,85,,307.36,,,0,"percent of total billed charges ","85% of total billed charges ",406.8,90,,325.44,,,0,"percent of total billed charges ","90% of total billed charges ",406.8,90,,325.44,,,0,"percent of total billed charges ","90% of total billed charges ",6.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",393.24,87,,314.59,,,0,"percent of total billed charges ","87% of total billed charges ",6.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.44,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",316.4,70,,253.12,,,0,"percent of total billed charges ","70% of total billed charges ",6.67,420.36,
"*ASSAY GLUTATHIONE",2035520,"CDM ",301,RC,82978,HCPCS,OUTPATIENT,,,452,361.6,,13.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",316.4,70,,253.12,,,0,"percent of total billed charges ","70% of total billed charges ",406.8,90,,325.44,,,0,"percent of total billed charges ","90% of total billed charges ",420.36,93,,336.29,,,0,"percent of total billed charges ","93% of total billed charges ",13.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.89,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",384.2,85,,307.36,,,0,"percent of total billed charges ","85% of total billed charges ",406.8,90,,325.44,,,0,"percent of total billed charges ","90% of total billed charges ",406.8,90,,325.44,,,0,"percent of total billed charges ","90% of total billed charges ",11.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",393.24,87,,314.59,,,0,"percent of total billed charges ","87% of total billed charges ",11.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",316.4,70,,253.12,,,0,"percent of total billed charges ","70% of total billed charges ",11.77,420.36,
"*NUCLEAR ANTIGEN ANTIBODY",2035540,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,149.5,119.6,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",139.04,93,,111.23,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",127.08,85,,101.66,,,0,"percent of total billed charges ","85% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.07,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,139.04,
"*ENTEROVIRUS ANTIBODY",2035560,"CDM ",302,RC,86658,HCPCS,OUTPATIENT,,,194,155.2,,11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",180.42,93,,144.34,,,0,"percent of total billed charges ","93% of total billed charges ",11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.9,85,,131.92,,,0,"percent of total billed charges ","85% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",168.78,87,,135.02,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,180.42,
"LYME DNA QUAL PCR CSF",2035580,"CDM ",302,RC,87801,HCPCS,OUTPATIENT,,,934,747.2,,59.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,531.68,531.68,531.68,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",653.8,70,,523.04,,,0,"percent of total billed charges ","70% of total billed charges ",840.6,90,,672.48,,,0,"percent of total billed charges ","90% of total billed charges ",868.62,93,,694.90,,,0,"percent of total billed charges ","93% of total billed charges ",59.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",793.9,85,,635.12,,,0,"percent of total billed charges ","85% of total billed charges ",840.6,90,,672.48,,,0,"percent of total billed charges ","90% of total billed charges ",840.6,90,,672.48,,,0,"percent of total billed charges ","90% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",812.58,87,,650.06,,,0,"percent of total billed charges ","87% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.2,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",653.8,70,,523.04,,,0,"percent of total billed charges ","70% of total billed charges ",53.94,868.62,
"N-TELEPEPTIDE COLLAGEN URINE",2035590,"CDM ",301,RC,82523,HCPCS,OUTPATIENT,,,179,143.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.3,70,,100.24,,,0,"percent of total billed charges ","70% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",166.47,93,,133.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",152.15,85,,121.72,,,0,"percent of total billed charges ","85% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",155.73,87,,124.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",18.68,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",125.3,70,,100.24,,,0,"percent of total billed charges ","70% of total billed charges ",18.68,166.47,
"CALPROTECTIN, STOOL",2035600,"CDM ",301,RC,83993,HCPCS,OUTPATIENT,,,405,324,,,,,,,,0,"other ","not separately reimbursment ",,,,25.01,25.01,25.01,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",283.5,70,,226.80,,,0,"percent of total billed charges ","70% of total billed charges ",364.5,90,,291.60,,,0,"percent of total billed charges ","90% of total billed charges ",376.65,93,,301.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",24.47,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",344.25,85,,275.40,,,0,"percent of total billed charges ","85% of total billed charges ",364.5,90,,291.60,,,0,"percent of total billed charges ","90% of total billed charges ",364.5,90,,291.60,,,0,"percent of total billed charges ","90% of total billed charges ",24.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",352.35,87,,315.06,315.06,315.06,"1 through 10","percent of total billed charges ","87% of total billed charges ",24.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.63,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",283.5,70,,226.80,,,0,"percent of total billed charges ","70% of total billed charges ",19.63,376.65,
"*CATECHOLAMINE URINE W/O CREAT",2035610,"CDM ",301,RC,82384,HCPCS,OUTPATIENT,,,246,196.8,,25.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.2,70,,137.76,,,0,"percent of total billed charges ","70% of total billed charges ",221.4,90,,177.12,,,0,"percent of total billed charges ","90% of total billed charges ",228.78,93,,183.02,,,0,"percent of total billed charges ","93% of total billed charges ",25.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",209.1,85,,167.28,,,0,"percent of total billed charges ","85% of total billed charges ",221.4,90,,177.12,,,0,"percent of total billed charges ","90% of total billed charges ",221.4,90,,177.12,,,0,"percent of total billed charges ","90% of total billed charges ",35.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",214.02,87,,171.22,,,0,"percent of total billed charges ","87% of total billed charges ",35.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.25,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",172.2,70,,137.76,,,0,"percent of total billed charges ","70% of total billed charges ",25.25,228.78,
"*HSV DNA QUANT",2035640,"CDM ",306,RC,87530,HCPCS,OUTPATIENT,,,446,356.8,,36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",312.2,70,,249.76,,,0,"percent of total billed charges ","70% of total billed charges ",401.4,90,,321.12,,,0,"percent of total billed charges ","90% of total billed charges ",414.78,93,,331.82,,,0,"percent of total billed charges ","93% of total billed charges ",36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",379.1,85,,303.28,,,0,"percent of total billed charges ","85% of total billed charges ",401.4,90,,321.12,,,0,"percent of total billed charges ","90% of total billed charges ",401.4,90,,321.12,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",388.02,87,,612.88,612.88,612.88,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.84,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",312.2,70,,249.76,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,414.78,
"CHROMOSOME MICROARRAY POSTNATA",2035650,"CDM ",300,RC,81229,HCPCS,OUTPATIENT,,,5336,4268.8,,986,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3735.2,70,,2988.16,,,0,"percent of total billed charges ","70% of total billed charges ",4802.4,90,,3841.92,,,0,"percent of total billed charges ","90% of total billed charges ",4962.48,93,,3969.98,,,0,"percent of total billed charges ","93% of total billed charges ",986,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1252.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4535.6,85,,3628.48,,,0,"percent of total billed charges ","85% of total billed charges ",4802.4,90,,3841.92,,,0,"percent of total billed charges ","90% of total billed charges ",4802.4,90,,3841.92,,,0,"percent of total billed charges ","90% of total billed charges ",1240.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4642.32,87,,3713.86,,,0,"percent of total billed charges ","87% of total billed charges ",1240.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1160,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",3735.2,70,,2988.16,,,0,"percent of total billed charges ","70% of total billed charges ",986,4962.48,
"MITOCHONDRIA MS AB IGG",2035660,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,226,180.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",158.2,70,,126.56,,,0,"percent of total billed charges ","70% of total billed charges ",203.4,90,,162.72,,,0,"percent of total billed charges ","90% of total billed charges ",210.18,93,,168.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",192.1,85,,153.68,,,0,"percent of total billed charges ","85% of total billed charges ",203.4,90,,162.72,,,0,"percent of total billed charges ","90% of total billed charges ",203.4,90,,162.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",196.62,87,,157.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",158.2,70,,126.56,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,210.18,
"*BRCA 1&2 SEG&COM/DUP",2035670,"CDM ",300,RC,81162,HCPCS,OUTPATIENT,,,2868.5,2294.8,,,,,,,,0,"other ","not separately reimbursment ",,,,2287.50,2287.50,2287.50,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2007.95,70,,1606.36,,,0,"percent of total billed charges ","70% of total billed charges ",2581.65,90,,2065.32,,,0,"percent of total billed charges ","90% of total billed charges ",2667.71,93,,2134.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2438.23,85,,1950.58,,,0,"percent of total billed charges ","85% of total billed charges ",2581.65,90,,2065.32,,,0,"percent of total billed charges ","90% of total billed charges ",2581.65,90,,2065.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2495.6,87,,1996.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1824.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",2007.95,70,,1606.36,,,0,"percent of total billed charges ","70% of total billed charges ",1824.88,2667.71,
"*BRCA 1&2 UNCOM/DUP",2035680,"CDM ",300,RC,81479,HCPCS,OUTPATIENT,,,2868.5,2294.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2007.95,70,,1606.36,,,0,"percent of total billed charges ","70% of total billed charges ",2581.65,90,,2065.32,,,0,"percent of total billed charges ","90% of total billed charges ",2667.71,93,,2134.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2438.23,85,,1950.58,,,0,"percent of total billed charges ","85% of total billed charges ",2581.65,90,,2065.32,,,0,"percent of total billed charges ","90% of total billed charges ",2581.65,90,,2065.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2495.6,87,,1996.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2007.95,70,,1606.36,,,0,"percent of total billed charges ","70% of total billed charges ",2007.95,2667.71,
"FLUNITRAZEPAM QUANT URINE",2035700,"CDM ",301,RC,80346,HCPCS,OUTPATIENT,,,424.5,339.6,,23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",297.15,70,,237.72,,,0,"percent of total billed charges ","70% of total billed charges ",382.05,90,,305.64,,,0,"percent of total billed charges ","90% of total billed charges ",394.79,93,,315.83,,,0,"percent of total billed charges ","93% of total billed charges ",23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",360.83,85,,288.66,,,0,"percent of total billed charges ","85% of total billed charges ",382.05,90,,305.64,,,0,"percent of total billed charges ","90% of total billed charges ",382.05,90,,305.64,,,0,"percent of total billed charges ","90% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",369.32,87,,295.46,,,0,"percent of total billed charges ","87% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",297.15,70,,237.72,,,0,"percent of total billed charges ","70% of total billed charges ",23.71,394.79,
"*DRUG SCREEN QUAL/MULTI",2035710,"CDM ",301,RC,80304,HCPCS,OUTPATIENT,,,414,331.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",289.8,70,,231.84,,,0,"percent of total billed charges ","70% of total billed charges ",372.6,90,,298.08,,,0,"percent of total billed charges ","90% of total billed charges ",385.02,93,,308.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",351.9,85,,281.52,,,0,"percent of total billed charges ","85% of total billed charges ",372.6,90,,298.08,,,0,"percent of total billed charges ","90% of total billed charges ",372.6,90,,298.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",360.18,87,,288.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",289.8,70,,231.84,,,0,"percent of total billed charges ","70% of total billed charges ",289.8,385.02,
"*ASSAY OF VOLATILES",2035720,"CDM ",301,RC,84600,HCPCS,OUTPATIENT,,,290.5,232.4,,16.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",203.35,70,,162.68,,,0,"percent of total billed charges ","70% of total billed charges ",261.45,90,,209.16,,,0,"percent of total billed charges ","90% of total billed charges ",270.17,93,,216.14,,,0,"percent of total billed charges ","93% of total billed charges ",16.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",246.93,85,,197.54,,,0,"percent of total billed charges ","85% of total billed charges ",261.45,90,,209.16,,,0,"percent of total billed charges ","90% of total billed charges ",261.45,90,,209.16,,,0,"percent of total billed charges ","90% of total billed charges ",21.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",252.74,87,,202.19,,,0,"percent of total billed charges ","87% of total billed charges ",21.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.11,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",203.35,70,,162.68,,,0,"percent of total billed charges ","70% of total billed charges ",16.8,270.17,
"CALRECTICULIN MUTATION ANLYSIS",2035740,"CDM ",300,RC,81219,HCPCS,OUTPATIENT,,,1899.5,1519.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1329.65,70,,1063.72,,,0,"percent of total billed charges ","70% of total billed charges ",1709.55,90,,1367.64,,,0,"percent of total billed charges ","90% of total billed charges ",1766.54,93,,1413.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1614.58,85,,1291.66,,,0,"percent of total billed charges ","85% of total billed charges ",1709.55,90,,1367.64,,,0,"percent of total billed charges ","90% of total billed charges ",1709.55,90,,1367.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1652.57,87,,1322.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",121.63,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1329.65,70,,1063.72,,,0,"percent of total billed charges ","70% of total billed charges ",121.63,1766.54,
"*CALR GENE VAR ALYS EX09",2035743,"CDM ",300,RC,81219,HCPCS,OUTPATIENT,,,438,350.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",306.6,70,,245.28,,,0,"percent of total billed charges ","70% of total billed charges ",394.2,90,,315.36,,,0,"percent of total billed charges ","90% of total billed charges ",407.34,93,,325.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",372.3,85,,297.84,,,0,"percent of total billed charges ","85% of total billed charges ",394.2,90,,315.36,,,0,"percent of total billed charges ","90% of total billed charges ",394.2,90,,315.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",381.06,87,,304.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",121.63,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",306.6,70,,245.28,,,0,"percent of total billed charges ","70% of total billed charges ",121.63,407.34,
"MOPATH PROC GENE ANALYSIS",2035750,"CDM ",300,RC,81402,HCPCS,OUTPATIENT,,,1765,1412,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1235.5,70,,988.40,,,0,"percent of total billed charges ","70% of total billed charges ",1588.5,90,,1270.80,,,0,"percent of total billed charges ","90% of total billed charges ",1641.45,93,,1313.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1500.25,85,,1200.20,,,0,"percent of total billed charges ","85% of total billed charges ",1588.5,90,,1270.80,,,0,"percent of total billed charges ","90% of total billed charges ",1588.5,90,,1270.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1535.55,87,,1228.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",150.33,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1235.5,70,,988.40,,,0,"percent of total billed charges ","70% of total billed charges ",150.33,1641.45,
"JAK 2 MUTATION EXONS 12 & 13",2035760,"CDM ",300,RC,81403,HCPCS,OUTPATIENT,,,125,100,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.5,70,,70.00,,,0,"percent of total billed charges ","70% of total billed charges ",112.5,90,,90.00,,,0,"percent of total billed charges ","90% of total billed charges ",116.25,93,,93.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",106.25,85,,85.00,,,0,"percent of total billed charges ","85% of total billed charges ",112.5,90,,90.00,,,0,"percent of total billed charges ","90% of total billed charges ",112.5,90,,90.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",108.75,87,,87.00,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",185.2,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",87.5,70,,70.00,,,0,"percent of total billed charges ","70% of total billed charges ",87.5,185.2,
"QUADSCREEN #30294",2035820,"CDM ",300,RC,81511,HCPCS,OUTPATIENT,,,417.5,334,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",292.25,70,,233.80,,,0,"percent of total billed charges ","70% of total billed charges ",375.75,90,,300.60,,,0,"percent of total billed charges ","90% of total billed charges ",388.28,93,,310.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",354.88,85,,283.90,,,0,"percent of total billed charges ","85% of total billed charges ",375.75,90,,300.60,,,0,"percent of total billed charges ","90% of total billed charges ",375.75,90,,300.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",363.23,87,,290.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",153.5,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",292.25,70,,233.80,,,0,"percent of total billed charges ","70% of total billed charges ",153.5,388.28,
"*URINALYSIS NONAUTO W/SCOPE",2035840,"CDM ",307,RC,81000,HCPCS,OUTPATIENT,,,32,25.6,,4.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.4,70,,17.92,,,0,"percent of total billed charges ","70% of total billed charges ",28.8,90,,23.04,,,0,"percent of total billed charges ","90% of total billed charges ",29.76,93,,23.81,,,0,"percent of total billed charges ","93% of total billed charges ",4.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",27.2,85,,21.76,,,0,"percent of total billed charges ","85% of total billed charges ",28.8,90,,23.04,,,0,"percent of total billed charges ","90% of total billed charges ",28.8,90,,23.04,,,0,"percent of total billed charges ","90% of total billed charges ",5.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.84,87,,22.27,,,0,"percent of total billed charges ","87% of total billed charges ",5.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",22.4,70,,17.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.01,29.76,
"*HERPES SIMPLEX TYPE I",2035850,"CDM ",302,RC,86695,HCPCS,OUTPATIENT,,,175,140,,11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,76.02,76.02,76.02,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",162.75,93,,130.20,,,0,"percent of total billed charges ","93% of total billed charges ",11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",148.75,85,,119.00,,,0,"percent of total billed charges ","85% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",152.25,87,,121.80,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,162.75,
"*HERPES SIMPLEX TYPE 2",2035860,"CDM ",302,RC,86696,HCPCS,OUTPATIENT,,,188.5,150.8,,19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.29,80.29,80.29,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.95,70,,105.56,,,0,"percent of total billed charges ","70% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",175.31,93,,140.25,,,0,"percent of total billed charges ","93% of total billed charges ",19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",160.23,85,,128.18,,,0,"percent of total billed charges ","85% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",164,87,,131.20,,,0,"percent of total billed charges ","87% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.35,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",131.95,70,,105.56,,,0,"percent of total billed charges ","70% of total billed charges ",19.35,175.31,
"HPV RNA E6/E7 REFLEX GNO 90942",2035880,"CDM ",306,RC,87624,HCPCS,OUTPATIENT,,,332.5,266,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",232.75,70,,186.20,,,0,"percent of total billed charges ","70% of total billed charges ",299.25,90,,239.40,,,0,"percent of total billed charges ","90% of total billed charges ",309.23,93,,247.38,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",282.63,85,,226.10,,,0,"percent of total billed charges ","85% of total billed charges ",299.25,90,,239.40,,,0,"percent of total billed charges ","90% of total billed charges ",299.25,90,,239.40,,,0,"percent of total billed charges ","90% of total billed charges ",53.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",289.28,87,,231.42,,,0,"percent of total billed charges ","87% of total billed charges ",53.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",232.75,70,,186.20,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,309.23,
"CK ISOENZYMES W/O TOTAL #377",2035890,"CDM ",301,RC,82552,HCPCS,OUTPATIENT,,,104,83.2,,13.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.8,70,,58.24,,,0,"percent of total billed charges ","70% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",96.72,93,,77.38,,,0,"percent of total billed charges ","93% of total billed charges ",13.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",88.4,85,,70.72,,,0,"percent of total billed charges ","85% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",90.48,87,,72.38,,,0,"percent of total billed charges ","87% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",72.8,70,,58.24,,,0,"percent of total billed charges ","70% of total billed charges ",13.39,96.72,
"*ANTINUCLEAR AB",2035900,"CDM ",302,RC,86038,HCPCS,OUTPATIENT,,,129,103.2,,12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",119.97,93,,95.98,,,0,"percent of total billed charges ","93% of total billed charges ",12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",109.65,85,,87.72,,,0,"percent of total billed charges ","85% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.23,87,,88.36,11.85,147.83,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",12.09,119.97,
"*NUCLEAR ANTIGEN AB",2035910,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,149.5,119.6,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",139.04,93,,111.23,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",127.08,85,,101.66,,,0,"percent of total billed charges ","85% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.07,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,139.04,
"*FLUORESCENT AB SCREEN",2035920,"CDM ",302,RC,86255,HCPCS,OUTPATIENT,,,146,116.8,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,101.62,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,135.78,
"*MICROSOMAL AB EA",2035930,"CDM ",302,RC,86376,HCPCS,OUTPATIENT,,,140.5,112.4,,14.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.97,60.97,60.97,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",130.67,93,,104.54,,,0,"percent of total billed charges ","93% of total billed charges ",14.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",119.43,85,,95.54,,,0,"percent of total billed charges ","85% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.24,87,,55.52,12.39,96.11,"1 through 10","percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.55,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",14.55,130.67,
"TOT PROT PERITONEAL FLD #17428",2035940,"CDM ",301,RC,84157,HCPCS,OUTPATIENT,,,61.5,49.2,,4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.05,70,,34.44,,,0,"percent of total billed charges ","70% of total billed charges ",55.35,90,,44.28,,,0,"percent of total billed charges ","90% of total billed charges ",57.2,93,,45.76,,,0,"percent of total billed charges ","93% of total billed charges ",4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",52.28,85,,41.82,,,0,"percent of total billed charges ","85% of total billed charges ",55.35,90,,44.28,,,0,"percent of total billed charges ","90% of total billed charges ",55.35,90,,44.28,,,0,"percent of total billed charges ","90% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.51,87,,42.81,,,0,"percent of total billed charges ","87% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",43.05,70,,34.44,,,0,"percent of total billed charges ","70% of total billed charges ",4,57.2,
"*COMPLEMENT ANTIGEN",2035950,"CDM ",302,RC,86160,HCPCS,OUTPATIENT,,,165,132,,12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,133.30,133.30,133.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,226.71,226.71,226.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",12,153.45,
"*RHEUMATOID FACTOR QUAN",2035960,"CDM ",302,RC,86431,HCPCS,OUTPATIENT,,,129,103.2,,5.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,5.56,5.56,5.56,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",119.97,93,,95.98,,,0,"percent of total billed charges ","93% of total billed charges ",5.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",109.65,85,,87.72,,,0,"percent of total billed charges ","85% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.23,87,,5.56,5.56,56.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.67,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",5.67,119.97,
"*IMMUNOASSAY AB",2035970,"CDM ",302,RC,83516,HCPCS,OUTPATIENT,,,108,86.4,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,53.32,28.74,77.90,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",10,100.44,
"ANA IFA RFLX SCLERO AB 90073",2035990,"CDM ",302,RC,86038,HCPCS,OUTPATIENT,,,129,103.2,,12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",119.97,93,,95.98,,,0,"percent of total billed charges ","93% of total billed charges ",12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",109.65,85,,87.72,,,0,"percent of total billed charges ","85% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.23,87,,88.36,11.85,147.83,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",12.09,119.97,
"*ANTINUCLEAR AB",2036000,"CDM ",302,RC,86038,HCPCS,OUTPATIENT,,,129,103.2,,12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",119.97,93,,95.98,,,0,"percent of total billed charges ","93% of total billed charges ",12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",109.65,85,,87.72,,,0,"percent of total billed charges ","85% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.23,87,,88.36,11.85,147.83,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",12.09,119.97,
"*CCP AB",2036010,"CDM ",302,RC,86200,HCPCS,OUTPATIENT,,,98.5,78.8,,12.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,33.25,33.25,33.25,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",12.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",20.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",20.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.95,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",12.95,91.61,
"*PAP THIN PREP",2036030,"CDM ",300,RC,88175,HCPCS,OUTPATIENT,,,139,111.2,,25.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.3,70,,77.84,,,0,"percent of total billed charges ","70% of total billed charges ",125.1,90,,100.08,,,0,"percent of total billed charges ","90% of total billed charges ",129.27,93,,103.42,,,0,"percent of total billed charges ","93% of total billed charges ",25.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",118.15,85,,94.52,,,0,"percent of total billed charges ","85% of total billed charges ",125.1,90,,100.08,,,0,"percent of total billed charges ","90% of total billed charges ",125.1,90,,100.08,,,0,"percent of total billed charges ","90% of total billed charges ",33.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",120.93,87,,96.74,,,0,"percent of total billed charges ","87% of total billed charges ",33.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",97.3,70,,77.84,,,0,"percent of total billed charges ","70% of total billed charges ",25.7,129.27,
"*CYTOPATHOLOGY INTERP",2036040,"CDM ",300,RC,88141,HCPCS,OUTPATIENT,,,99.5,79.6,,19.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",46.4,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",69.65,70,,55.72,,,0,"percent of total billed charges ","70% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",92.54,93,,74.03,,,0,"percent of total billed charges ","93% of total billed charges ",19.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",84.58,85,,67.66,,,0,"percent of total billed charges ","85% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",16.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",86.57,87,,69.26,,,0,"percent of total billed charges ","87% of total billed charges ",16.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",69.65,70,,55.72,,,0,"percent of total billed charges ","70% of total billed charges ",16.08,92.54,
"*CYTOPATH TBS C/V MANUAL",2036060,"CDM ",300,RC,88164,HCPCS,OUTPATIENT,,,119,95.2,,13.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.3,70,,66.64,,,0,"percent of total billed charges ","70% of total billed charges ",107.1,90,,85.68,,,0,"percent of total billed charges ","90% of total billed charges ",110.67,93,,88.54,,,0,"percent of total billed charges ","93% of total billed charges ",13.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.4,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",101.15,85,,80.92,,,0,"percent of total billed charges ","85% of total billed charges ",107.1,90,,85.68,,,0,"percent of total billed charges ","90% of total billed charges ",107.1,90,,85.68,,,0,"percent of total billed charges ","90% of total billed charges ",16.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",103.53,87,,82.82,,,0,"percent of total billed charges ","87% of total billed charges ",16.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.54,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",83.3,70,,66.64,,,0,"percent of total billed charges ","70% of total billed charges ",13.53,110.67,
"*CYTOPATH W/ INTERP",2036070,"CDM ",300,RC,88141,HCPCS,OUTPATIENT,,,119,95.2,,19.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",46.4,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",83.3,70,,66.64,,,0,"percent of total billed charges ","70% of total billed charges ",107.1,90,,85.68,,,0,"percent of total billed charges ","90% of total billed charges ",110.67,93,,88.54,,,0,"percent of total billed charges ","93% of total billed charges ",19.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",101.15,85,,80.92,,,0,"percent of total billed charges ","85% of total billed charges ",107.1,90,,85.68,,,0,"percent of total billed charges ","90% of total billed charges ",107.1,90,,85.68,,,0,"percent of total billed charges ","90% of total billed charges ",16.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",103.53,87,,82.82,,,0,"percent of total billed charges ","87% of total billed charges ",16.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",83.3,70,,66.64,,,0,"percent of total billed charges ","70% of total billed charges ",16.08,110.67,
"ZINC TRANS 8 (ARUP 2006196)",2036090,"CDM ",302,RC,86341,HCPCS,OUTPATIENT,,,1419.5,1135.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",993.65,70,,794.92,,,0,"percent of total billed charges ","70% of total billed charges ",1277.55,90,,1022.04,,,0,"percent of total billed charges ","90% of total billed charges ",1320.14,93,,1056.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1206.58,85,,965.26,,,0,"percent of total billed charges ","85% of total billed charges ",1277.55,90,,1022.04,,,0,"percent of total billed charges ","90% of total billed charges ",1277.55,90,,1022.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1234.97,87,,987.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",23.57,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",993.65,70,,794.92,,,0,"percent of total billed charges ","70% of total billed charges ",23.57,1320.14,
"ALBUMIN, PLEURAL",2036100,"CDM ",301,RC,82042,HCPCS,OUTPATIENT,,,61.5,49.2,,6.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.05,70,,34.44,,,0,"percent of total billed charges ","70% of total billed charges ",55.35,90,,44.28,,,0,"percent of total billed charges ","90% of total billed charges ",57.2,93,,45.76,,,0,"percent of total billed charges ","93% of total billed charges ",6.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",52.28,85,,41.82,,,0,"percent of total billed charges ","85% of total billed charges ",55.35,90,,44.28,,,0,"percent of total billed charges ","90% of total billed charges ",55.35,90,,44.28,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.51,87,,42.81,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.78,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",43.05,70,,34.44,,,0,"percent of total billed charges ","70% of total billed charges ",6.61,57.2,
"TOTAL PROTEIN, SYNOVIAL",2036110,"CDM ",301,RC,84157,HCPCS,OUTPATIENT,,,64,51.2,,4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.8,70,,35.84,,,0,"percent of total billed charges ","70% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",59.52,93,,47.62,,,0,"percent of total billed charges ","93% of total billed charges ",4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",54.4,85,,43.52,,,0,"percent of total billed charges ","85% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",55.68,87,,44.54,,,0,"percent of total billed charges ","87% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",44.8,70,,35.84,,,0,"percent of total billed charges ","70% of total billed charges ",4,59.52,
"TOTAL PROTEIN, PLEURAL",2036120,"CDM ",301,RC,84157,HCPCS,OUTPATIENT,,,54,43.2,,4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.8,70,,30.24,,,0,"percent of total billed charges ","70% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",50.22,93,,40.18,,,0,"percent of total billed charges ","93% of total billed charges ",4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.9,85,,36.72,,,0,"percent of total billed charges ","85% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.98,87,,37.58,,,0,"percent of total billed charges ","87% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",37.8,70,,30.24,,,0,"percent of total billed charges ","70% of total billed charges ",4,50.22,
"TOTAL PROTEIN, PERICARDIAL FLD",2036130,"CDM ",301,RC,84157,HCPCS,OUTPATIENT,,,65,52,,4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.5,70,,36.40,,,0,"percent of total billed charges ","70% of total billed charges ",58.5,90,,46.80,,,0,"percent of total billed charges ","90% of total billed charges ",60.45,93,,48.36,,,0,"percent of total billed charges ","93% of total billed charges ",4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",55.25,85,,44.20,,,0,"percent of total billed charges ","85% of total billed charges ",58.5,90,,46.80,,,0,"percent of total billed charges ","90% of total billed charges ",58.5,90,,46.80,,,0,"percent of total billed charges ","90% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.55,87,,45.24,,,0,"percent of total billed charges ","87% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",45.5,70,,36.40,,,0,"percent of total billed charges ","70% of total billed charges ",4,60.45,
"ALBUMIN, PERITONEAL",2036140,"CDM ",301,RC,82042,HCPCS,OUTPATIENT,,,61.5,49.2,,6.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.05,70,,34.44,,,0,"percent of total billed charges ","70% of total billed charges ",55.35,90,,44.28,,,0,"percent of total billed charges ","90% of total billed charges ",57.2,93,,45.76,,,0,"percent of total billed charges ","93% of total billed charges ",6.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",52.28,85,,41.82,,,0,"percent of total billed charges ","85% of total billed charges ",55.35,90,,44.28,,,0,"percent of total billed charges ","90% of total billed charges ",55.35,90,,44.28,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.51,87,,42.81,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.78,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",43.05,70,,34.44,,,0,"percent of total billed charges ","70% of total billed charges ",6.61,57.2,
"ALBUMIN, PERICARDIAL FLUID",2036150,"CDM ",301,RC,82042,HCPCS,OUTPATIENT,,,61.5,49.2,,6.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.05,70,,34.44,,,0,"percent of total billed charges ","70% of total billed charges ",55.35,90,,44.28,,,0,"percent of total billed charges ","90% of total billed charges ",57.2,93,,45.76,,,0,"percent of total billed charges ","93% of total billed charges ",6.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",52.28,85,,41.82,,,0,"percent of total billed charges ","85% of total billed charges ",55.35,90,,44.28,,,0,"percent of total billed charges ","90% of total billed charges ",55.35,90,,44.28,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.51,87,,42.81,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.78,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",43.05,70,,34.44,,,0,"percent of total billed charges ","70% of total billed charges ",6.61,57.2,
"ALBUMIN, SYNOVIAL",2036160,"CDM ",301,RC,82042,HCPCS,OUTPATIENT,,,65,52,,6.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.5,70,,36.40,,,0,"percent of total billed charges ","70% of total billed charges ",58.5,90,,46.80,,,0,"percent of total billed charges ","90% of total billed charges ",60.45,93,,48.36,,,0,"percent of total billed charges ","93% of total billed charges ",6.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",55.25,85,,44.20,,,0,"percent of total billed charges ","85% of total billed charges ",58.5,90,,46.80,,,0,"percent of total billed charges ","90% of total billed charges ",58.5,90,,46.80,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.55,87,,45.24,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.78,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",45.5,70,,36.40,,,0,"percent of total billed charges ","70% of total billed charges ",6.61,60.45,
"*FLUORESCENT AB SCREEN",2036170,"CDM ",302,RC,86255,HCPCS,OUTPATIENT,,,146,116.8,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,101.62,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,135.78,
"*FLUORESCENT AB TITER",2036180,"CDM ",302,RC,86256,HCPCS,OUTPATIENT,,,165,132,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,17.72,12.99,22.44,"1 through 10","percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,153.45,
"SURE PATH PAP  #14471",2036200,"CDM ",300,RC,88142,HCPCS,OUTPATIENT,,,145,116,,17.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",17.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.58,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",23.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",126.15,87,,100.92,,,0,"percent of total billed charges ","87% of total billed charges ",23.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.26,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",17.85,134.85,
"BULLOUS PEMPH 180 AB #16034",2036210,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,148.5,118.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.95,70,,83.16,,,0,"percent of total billed charges ","70% of total billed charges ",133.65,90,,106.92,,,0,"percent of total billed charges ","90% of total billed charges ",138.11,93,,110.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",126.23,85,,100.98,,,0,"percent of total billed charges ","85% of total billed charges ",133.65,90,,106.92,,,0,"percent of total billed charges ","90% of total billed charges ",133.65,90,,106.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",129.2,87,,103.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",103.95,70,,83.16,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,138.11,
"BULLOUS PEMPH 230 AB #161316",2036213,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,148.5,118.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.95,70,,83.16,,,0,"percent of total billed charges ","70% of total billed charges ",133.65,90,,106.92,,,0,"percent of total billed charges ","90% of total billed charges ",138.11,93,,110.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",126.23,85,,100.98,,,0,"percent of total billed charges ","85% of total billed charges ",133.65,90,,106.92,,,0,"percent of total billed charges ","90% of total billed charges ",133.65,90,,106.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",129.2,87,,103.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",103.95,70,,83.16,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,138.11,
"*CYTO C/V AUTO FLUID REDO",2036220,"CDM ",300,RC,88175,HCPCS,OUTPATIENT,,,89,71.2,,25.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",82.77,93,,66.22,,,0,"percent of total billed charges ","93% of total billed charges ",25.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",75.65,85,,60.52,,,0,"percent of total billed charges ","85% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",33.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",77.43,87,,61.94,,,0,"percent of total billed charges ","87% of total billed charges ",33.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",25.7,82.77,
"*HPV DNA AMP PROBE",2036230,"CDM ",306,RC,87623,HCPCS,OUTPATIENT,,,175,140,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",162.75,93,,130.20,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",148.75,85,,119.00,,,0,"percent of total billed charges ","85% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",53.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",152.25,87,,121.80,,,0,"percent of total billed charges ","87% of total billed charges ",53.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,162.75,
"*CHYLMA TRACH DNA AMP PROBE",2036240,"CDM ",306,RC,87491,HCPCS,OUTPATIENT,,,204,163.2,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.47,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,140.08,140.08,140.08,20,"percent of total billed charges ","87% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,189.72,
"*N. GONORRHOEAE DNA AMP PROBE",2036250,"CDM ",306,RC,87591,HCPCS,OUTPATIENT,,,204,163.2,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.47,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,140.08,140.08,140.08,20,"percent of total billed charges ","87% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,189.72,
"*IMMUNOASSAY QUANT NOS NONAB",2036270,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,90,72,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,83.7,
"*CLINICAL CHEMISTRY TEST",2036280,"CDM ",301,RC,84999,HCPCS,OUTPATIENT,,,83,66.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",72.21,87,,57.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",58.1,77.19,
"CRYPTOSPORIDUM AG EIA 90389",2036300,"CDM ",302,RC,87328,HCPCS,OUTPATIENT,,,255,204,,11.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.5,70,,142.80,,,0,"percent of total billed charges ","70% of total billed charges ",229.5,90,,183.60,,,0,"percent of total billed charges ","90% of total billed charges ",237.15,93,,189.72,,,0,"percent of total billed charges ","93% of total billed charges ",11.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",216.75,85,,173.40,,,0,"percent of total billed charges ","85% of total billed charges ",229.5,90,,183.60,,,0,"percent of total billed charges ","90% of total billed charges ",229.5,90,,183.60,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",221.85,87,,177.48,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",178.5,70,,142.80,,,0,"percent of total billed charges ","70% of total billed charges ",11.75,237.15,
"THIOPURINE METABOLITES 91745",2036310,"CDM ",301,RC,83789,HCPCS,OUTPATIENT,,,410.5,328.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",287.35,70,,229.88,,,0,"percent of total billed charges ","70% of total billed charges ",369.45,90,,295.56,,,0,"percent of total billed charges ","90% of total billed charges ",381.77,93,,305.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",348.93,85,,279.14,,,0,"percent of total billed charges ","85% of total billed charges ",369.45,90,,295.56,,,0,"percent of total billed charges ","90% of total billed charges ",369.45,90,,295.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",357.14,87,,285.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",24.11,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",287.35,70,,229.88,,,0,"percent of total billed charges ","70% of total billed charges ",24.11,381.77,
"OSMOTIC FRAG SCREEN 17364",2036320,"CDM ",305,RC,85557,HCPCS,OUTPATIENT,,,70.5,56.4,,11.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",65.57,93,,52.46,,,0,"percent of total billed charges ","93% of total billed charges ",11.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.81,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",59.93,85,,47.94,,,0,"percent of total billed charges ","85% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",11.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",61.34,87,,49.07,,,0,"percent of total billed charges ","87% of total billed charges ",11.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.36,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",11.36,65.57,
"*SPECIFIC INFECT AGENT CONC",2036330,"CDM ",306,RC,87015,HCPCS,OUTPATIENT,,,113,90.4,,6.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.1,70,,63.28,,,0,"percent of total billed charges ","70% of total billed charges ",101.7,90,,81.36,,,0,"percent of total billed charges ","90% of total billed charges ",105.09,93,,84.07,,,0,"percent of total billed charges ","93% of total billed charges ",6.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",96.05,85,,76.84,,,0,"percent of total billed charges ","85% of total billed charges ",101.7,90,,81.36,,,0,"percent of total billed charges ","90% of total billed charges ",101.7,90,,81.36,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",98.31,87,,78.65,,,0,"percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.68,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",79.1,70,,63.28,,,0,"percent of total billed charges ","70% of total billed charges ",6.68,105.09,
"*SMEAR SPECIAL STAIN",2036340,"CDM ",306,RC,87207,HCPCS,OUTPATIENT,,,113,90.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.1,70,,63.28,,,0,"percent of total billed charges ","70% of total billed charges ",101.7,90,,81.36,,,0,"percent of total billed charges ","90% of total billed charges ",105.09,93,,84.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",96.05,85,,76.84,,,0,"percent of total billed charges ","85% of total billed charges ",101.7,90,,81.36,,,0,"percent of total billed charges ","90% of total billed charges ",101.7,90,,81.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",98.31,87,,78.65,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",5.99,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",79.1,70,,63.28,,,0,"percent of total billed charges ","70% of total billed charges ",5.99,105.09,
"HEP B SURFACE AG EIA",2036360,"CDM ",302,RC,87341,HCPCS,OUTPATIENT,,,156,124.8,,10.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",145.08,93,,116.06,,,0,"percent of total billed charges ","93% of total billed charges ",10.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",132.6,85,,106.08,,,0,"percent of total billed charges ","85% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",140.4,90,,112.32,,,0,"percent of total billed charges ","90% of total billed charges ",15.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",135.72,87,,108.58,,,0,"percent of total billed charges ","87% of total billed charges ",15.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.33,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",109.2,70,,87.36,,,0,"percent of total billed charges ","70% of total billed charges ",10.33,145.08,
"TETANUS ANTITOXOID",2036390,"CDM ",302,RC,86774,HCPCS,OUTPATIENT,,,194,155.2,,12.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",180.42,93,,144.34,,,0,"percent of total billed charges ","93% of total billed charges ",12.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.9,85,,131.92,,,0,"percent of total billed charges ","85% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",174.6,90,,139.68,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",168.78,87,,135.02,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.8,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",135.8,70,,108.64,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,180.42,
"BURPOPION METABOLITE",2036400,"CDM ",301,RC,83789,HCPCS,OUTPATIENT,,,410.5,328.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",287.35,70,,229.88,,,0,"percent of total billed charges ","70% of total billed charges ",369.45,90,,295.56,,,0,"percent of total billed charges ","90% of total billed charges ",381.77,93,,305.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",348.93,85,,279.14,,,0,"percent of total billed charges ","85% of total billed charges ",369.45,90,,295.56,,,0,"percent of total billed charges ","90% of total billed charges ",369.45,90,,295.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",357.14,87,,285.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",24.11,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",287.35,70,,229.88,,,0,"percent of total billed charges ","70% of total billed charges ",24.11,381.77,
"*ASSAY 17 KETOSTEROIDS",2036410,"CDM ",301,RC,83586,HCPCS,OUTPATIENT,,,152.5,122,,12.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.75,70,,85.40,,,0,"percent of total billed charges ","70% of total billed charges ",137.25,90,,109.80,,,0,"percent of total billed charges ","90% of total billed charges ",141.83,93,,113.46,,,0,"percent of total billed charges ","93% of total billed charges ",12.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",129.63,85,,103.70,,,0,"percent of total billed charges ","85% of total billed charges ",137.25,90,,109.80,,,0,"percent of total billed charges ","90% of total billed charges ",137.25,90,,109.80,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.68,87,,106.14,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.8,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",106.75,70,,85.40,,,0,"percent of total billed charges ","70% of total billed charges ",12.8,141.83,
"*ASSAY URINE CREATININE",2036430,"CDM ",301,RC,82570,HCPCS,OUTPATIENT,,,152.5,122,,5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.75,70,,85.40,,,0,"percent of total billed charges ","70% of total billed charges ",137.25,90,,109.80,,,0,"percent of total billed charges ","90% of total billed charges ",141.83,93,,113.46,,,0,"percent of total billed charges ","93% of total billed charges ",5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",129.63,85,,103.70,,,0,"percent of total billed charges ","85% of total billed charges ",137.25,90,,109.80,,,0,"percent of total billed charges ","90% of total billed charges ",137.25,90,,109.80,,,0,"percent of total billed charges ","90% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.68,87,,5.08,4.98,50.30,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",106.75,70,,85.40,,,0,"percent of total billed charges ","70% of total billed charges ",5.18,141.83,
"*B-CELLS TOTAL COUNT",2036440,"CDM ",302,RC,86355,HCPCS,OUTPATIENT,,,252,201.6,,37.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,96.83,96.83,96.83,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.4,70,,141.12,,,0,"percent of total billed charges ","70% of total billed charges ",226.8,90,,181.44,,,0,"percent of total billed charges ","90% of total billed charges ",234.36,93,,187.49,,,0,"percent of total billed charges ","93% of total billed charges ",37.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",214.2,85,,171.36,,,0,"percent of total billed charges ","85% of total billed charges ",226.8,90,,181.44,,,0,"percent of total billed charges ","90% of total billed charges ",226.8,90,,181.44,,,0,"percent of total billed charges ","90% of total billed charges ",58.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.24,87,,175.39,,,0,"percent of total billed charges ","87% of total billed charges ",58.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.72,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",176.4,70,,141.12,,,0,"percent of total billed charges ","70% of total billed charges ",37.72,234.36,
"*T-CELLS TOTAL COUNT",2036450,"CDM ",302,RC,86359,HCPCS,OUTPATIENT,,,252,201.6,,32.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,98.84,98.84,98.84,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.4,70,,141.12,,,0,"percent of total billed charges ","70% of total billed charges ",226.8,90,,181.44,,,0,"percent of total billed charges ","90% of total billed charges ",234.36,93,,187.49,,,0,"percent of total billed charges ","93% of total billed charges ",32.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",214.2,85,,171.36,,,0,"percent of total billed charges ","85% of total billed charges ",226.8,90,,181.44,,,0,"percent of total billed charges ","90% of total billed charges ",226.8,90,,181.44,,,0,"percent of total billed charges ","90% of total billed charges ",37.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.24,87,,175.39,,,0,"percent of total billed charges ","87% of total billed charges ",37.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.72,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",176.4,70,,141.12,,,0,"percent of total billed charges ","70% of total billed charges ",32.07,234.36,
"*T-CELL ABSOLUTE COUNT/RATIO",2036460,"CDM ",302,RC,86360,HCPCS,OUTPATIENT,,,370,296,,39.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,162.94,162.94,162.94,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",344.1,93,,275.28,,,0,"percent of total billed charges ","93% of total billed charges ",39.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",314.5,85,,251.60,,,0,"percent of total billed charges ","85% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",37.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",321.9,87,,257.52,,,0,"percent of total billed charges ","87% of total billed charges ",37.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",37.61,344.1,
"LIPASE, URINE RANDOM",2036480,"CDM ",301,RC,83690,HCPCS,OUTPATIENT,,,80,64,,6.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56,70,,44.80,,,0,"percent of total billed charges ","70% of total billed charges ",72,90,,57.60,,,0,"percent of total billed charges ","90% of total billed charges ",74.4,93,,59.52,,,0,"percent of total billed charges ","93% of total billed charges ",6.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",68,85,,54.40,,,0,"percent of total billed charges ","85% of total billed charges ",72,90,,57.60,,,0,"percent of total billed charges ","90% of total billed charges ",72,90,,57.60,,,0,"percent of total billed charges ","90% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",69.6,87,,38.27,27.51,47.84,14,"percent of total billed charges ","87% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.89,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",56,70,,44.80,,,0,"percent of total billed charges ","70% of total billed charges ",6.89,74.4,
"*COCCIDIOIDES AB",2036490,"CDM ",302,RC,86635,HCPCS,OUTPATIENT,,,197,157.6,,9.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",137.9,70,,110.32,,,0,"percent of total billed charges ","70% of total billed charges ",177.3,90,,141.84,,,0,"percent of total billed charges ","90% of total billed charges ",183.21,93,,146.57,,,0,"percent of total billed charges ","93% of total billed charges ",9.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",167.45,85,,133.96,,,0,"percent of total billed charges ","85% of total billed charges ",177.3,90,,141.84,,,0,"percent of total billed charges ","90% of total billed charges ",177.3,90,,141.84,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",171.39,87,,137.11,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.47,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",137.9,70,,110.32,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,183.21,
"*RUSSELL VIPER VENOM DILUTED",2036510,"CDM ",305,RC,85613,HCPCS,OUTPATIENT,,,64,51.2,,8.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.8,70,,35.84,,,0,"percent of total billed charges ","70% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",59.52,93,,47.62,,,0,"percent of total billed charges ","93% of total billed charges ",8.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",54.4,85,,43.52,,,0,"percent of total billed charges ","85% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",55.68,87,,55.59,55.59,55.59,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.58,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",44.8,70,,35.84,,,0,"percent of total billed charges ","70% of total billed charges ",6.87,59.52,
"*THROMBOPLASTIN TIME PARTIAL",2036520,"CDM ",305,RC,85730,HCPCS,OUTPATIENT,,,57,45.6,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.9,70,,31.92,,,0,"percent of total billed charges ","70% of total billed charges ",51.3,90,,41.04,,,0,"percent of total billed charges ","90% of total billed charges ",53.01,93,,42.41,,,0,"percent of total billed charges ","93% of total billed charges ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",48.45,85,,38.76,,,0,"percent of total billed charges ","85% of total billed charges ",51.3,90,,41.04,,,0,"percent of total billed charges ","90% of total billed charges ",51.3,90,,41.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",49.59,87,,49.13,5.89,151.44,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",39.9,70,,31.92,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,53.01,
"*ANTITHROMBIN III ACTIVITY",2036540,"CDM ",305,RC,85300,HCPCS,OUTPATIENT,,,117.5,94,,11.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.25,70,,65.80,,,0,"percent of total billed charges ","70% of total billed charges ",105.75,90,,84.60,,,0,"percent of total billed charges ","90% of total billed charges ",109.28,93,,87.42,,,0,"percent of total billed charges ","93% of total billed charges ",11.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.11,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",99.88,85,,79.90,,,0,"percent of total billed charges ","85% of total billed charges ",105.75,90,,84.60,,,0,"percent of total billed charges ","90% of total billed charges ",105.75,90,,84.60,,,0,"percent of total billed charges ","90% of total billed charges ",20.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",102.23,87,,81.78,,,0,"percent of total billed charges ","87% of total billed charges ",20.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.85,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",82.25,70,,65.80,,,0,"percent of total billed charges ","70% of total billed charges ",11.85,109.28,
"*CLOT INHIBIT PROT C, ACTIVITY",2036550,"CDM ",305,RC,85303,HCPCS,OUTPATIENT,,,167.5,134,,13.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.25,70,,93.80,,,0,"percent of total billed charges ","70% of total billed charges ",150.75,90,,120.60,,,0,"percent of total billed charges ","90% of total billed charges ",155.78,93,,124.62,,,0,"percent of total billed charges ","93% of total billed charges ",13.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",142.38,85,,113.90,,,0,"percent of total billed charges ","85% of total billed charges ",150.75,90,,120.60,,,0,"percent of total billed charges ","90% of total billed charges ",150.75,90,,120.60,,,0,"percent of total billed charges ","90% of total billed charges ",21.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",145.73,87,,145.25,145.25,145.25,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.84,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.25,70,,93.80,,,0,"percent of total billed charges ","70% of total billed charges ",13.84,155.78,
"*CLOT INHIBIT PROT S FREE",2036560,"CDM ",305,RC,85306,HCPCS,OUTPATIENT,,,201,160.8,,15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.7,70,,112.56,,,0,"percent of total billed charges ","70% of total billed charges ",180.9,90,,144.72,,,0,"percent of total billed charges ","90% of total billed charges ",186.93,93,,149.54,,,0,"percent of total billed charges ","93% of total billed charges ",15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",170.85,85,,136.68,,,0,"percent of total billed charges ","85% of total billed charges ",180.9,90,,144.72,,,0,"percent of total billed charges ","90% of total billed charges ",180.9,90,,144.72,,,0,"percent of total billed charges ","90% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",174.87,87,,174.12,174.12,174.12,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.32,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",140.7,70,,112.56,,,0,"percent of total billed charges ","70% of total billed charges ",15.32,186.93,
"*ASSAY ACTIVITY PROTEIN C",2036570,"CDM ",305,RC,85307,HCPCS,OUTPATIENT,,,467.5,374,,15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",327.25,70,,261.80,,,0,"percent of total billed charges ","70% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",434.78,93,,347.82,,,0,"percent of total billed charges ","93% of total billed charges ",15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",397.38,85,,317.90,,,0,"percent of total billed charges ","85% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",406.73,87,,325.38,,,0,"percent of total billed charges ","87% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.32,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",327.25,70,,261.80,,,0,"percent of total billed charges ","70% of total billed charges ",15.32,434.78,
"*CORTISOL TOTAL",2036590,"CDM ",301,RC,82533,HCPCS,OUTPATIENT,,,130,104,,16.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91,70,,72.80,,,0,"percent of total billed charges ","70% of total billed charges ",117,90,,93.60,,,0,"percent of total billed charges ","90% of total billed charges ",120.9,93,,96.72,,,0,"percent of total billed charges ","93% of total billed charges ",16.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",110.5,85,,88.40,,,0,"percent of total billed charges ","85% of total billed charges ",117,90,,93.60,,,0,"percent of total billed charges ","90% of total billed charges ",117,90,,93.60,,,0,"percent of total billed charges ","90% of total billed charges ",29.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",113.1,87,,68.05,68.05,68.05,"1 through 10","percent of total billed charges ","87% of total billed charges ",29.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",91,70,,72.80,,,0,"percent of total billed charges ","70% of total billed charges ",16.3,120.9,
"HPV MRNA E6/E7 RECTAL",2036610,"CDM ",302,RC,87624,HCPCS,OUTPATIENT,,,175,140,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",162.75,93,,130.20,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",148.75,85,,119.00,,,0,"percent of total billed charges ","85% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",53.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",152.25,87,,121.80,,,0,"percent of total billed charges ","87% of total billed charges ",53.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,162.75,
"*TOTAL CORTISOL",2036620,"CDM ",301,RC,82533,HCPCS,OUTPATIENT,,,130,104,,16.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91,70,,72.80,,,0,"percent of total billed charges ","70% of total billed charges ",117,90,,93.60,,,0,"percent of total billed charges ","90% of total billed charges ",120.9,93,,96.72,,,0,"percent of total billed charges ","93% of total billed charges ",16.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",110.5,85,,88.40,,,0,"percent of total billed charges ","85% of total billed charges ",117,90,,93.60,,,0,"percent of total billed charges ","90% of total billed charges ",117,90,,93.60,,,0,"percent of total billed charges ","90% of total billed charges ",29.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",113.1,87,,68.05,68.05,68.05,"1 through 10","percent of total billed charges ","87% of total billed charges ",29.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",91,70,,72.80,,,0,"percent of total billed charges ","70% of total billed charges ",16.3,120.9,
"*FECES CULT AEROBIC BACT",2036640,"CDM ",306,RC,87045,HCPCS,OUTPATIENT,,,183.5,146.8,,9.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",170.66,93,,136.53,,,0,"percent of total billed charges ","93% of total billed charges ",9.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",155.98,85,,124.78,,,0,"percent of total billed charges ","85% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",14.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",159.65,87,,127.72,,,0,"percent of total billed charges ","87% of total billed charges ",14.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.44,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",9.44,170.66,
"*STOOL CULT AEROBIC BACT EA",2036650,"CDM ",306,RC,87046,HCPCS,OUTPATIENT,,,183.5,146.8,,8.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",170.66,93,,136.53,,,0,"percent of total billed charges ","93% of total billed charges ",8.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",155.98,85,,124.78,,,0,"percent of total billed charges ","85% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",3.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",159.65,87,,127.72,,,0,"percent of total billed charges ","87% of total billed charges ",3.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.44,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",3.62,170.66,
"*SHIGA-LIKE TOXIN AG EIA",2036660,"CDM ",306,RC,87427,HCPCS,OUTPATIENT,,,183.5,146.8,,11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",170.66,93,,136.53,,,0,"percent of total billed charges ","93% of total billed charges ",11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",155.98,85,,124.78,,,0,"percent of total billed charges ","85% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",159.65,87,,127.72,,,0,"percent of total billed charges ","87% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",11.98,170.66,
"PARIETAL CELL AB W/REFLEX",2036680,"CDM ",302,RC,86255,HCPCS,OUTPATIENT,,,146,116.8,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,101.62,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,135.78,
"*BILIRUBIN TOTAL",2036690,"CDM ",301,RC,82247,HCPCS,OUTPATIENT,,,97,77.6,,5.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",90.21,93,,72.17,,,0,"percent of total billed charges ","93% of total billed charges ",5.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",82.45,85,,65.96,,,0,"percent of total billed charges ","85% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",7.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.39,87,,67.51,,,0,"percent of total billed charges ","87% of total billed charges ",7.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",5.01,90.21,
"*BILIRUBIN DIRECT",2036700,"CDM ",301,RC,82248,HCPCS,OUTPATIENT,,,103,82.4,,4.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.1,70,,57.68,,,0,"percent of total billed charges ","70% of total billed charges ",92.7,90,,74.16,,,0,"percent of total billed charges ","90% of total billed charges ",95.79,93,,76.63,,,0,"percent of total billed charges ","93% of total billed charges ",4.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",87.55,85,,70.04,,,0,"percent of total billed charges ","85% of total billed charges ",92.7,90,,74.16,,,0,"percent of total billed charges ","90% of total billed charges ",92.7,90,,74.16,,,0,"percent of total billed charges ","90% of total billed charges ",4.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",89.61,87,,71.69,,,0,"percent of total billed charges ","87% of total billed charges ",4.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",72.1,70,,57.68,,,0,"percent of total billed charges ","70% of total billed charges ",4.13,95.79,
"SESAME SEED IGE",2036720,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"COCONUT IGE",2036730,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"FLAXSEED IGE",2036740,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"HAZELNUT IGE",2036750,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"PECAN NUT IGE",2036760,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"DPD GENE MUTATION",2036770,"CDM ",300,RC,81400,HCPCS,OUTPATIENT,,,1337,1069.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",935.9,70,,748.72,,,0,"percent of total billed charges ","70% of total billed charges ",1203.3,90,,962.64,,,0,"percent of total billed charges ","90% of total billed charges ",1243.41,93,,994.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1136.45,85,,909.16,,,0,"percent of total billed charges ","85% of total billed charges ",1203.3,90,,962.64,,,0,"percent of total billed charges ","90% of total billed charges ",1203.3,90,,962.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1163.19,87,,930.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",63.96,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",935.9,70,,748.72,,,0,"percent of total billed charges ","70% of total billed charges ",63.96,1243.41,
"ALMOND AGE",2036780,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"*LYME DISEASE AB",2036790,"CDM ",302,RC,86618,HCPCS,OUTPATIENT,,,297,237.6,,14.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",207.9,70,,166.32,,,0,"percent of total billed charges ","70% of total billed charges ",267.3,90,,213.84,,,0,"percent of total billed charges ","90% of total billed charges ",276.21,93,,220.97,,,0,"percent of total billed charges ","93% of total billed charges ",14.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",252.45,85,,201.96,,,0,"percent of total billed charges ","85% of total billed charges ",267.3,90,,213.84,,,0,"percent of total billed charges ","90% of total billed charges ",267.3,90,,213.84,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",258.39,87,,206.71,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.03,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",207.9,70,,166.32,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,276.21,
"ARSENIC, RANDOM URINE",2036810,"CDM ",301,RC,82175,HCPCS,OUTPATIENT,,,179,143.2,,16.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,53.10,53.10,53.10,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.3,70,,100.24,,,0,"percent of total billed charges ","70% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",166.47,93,,133.18,,,0,"percent of total billed charges ","93% of total billed charges ",16.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.81,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",152.15,85,,121.72,,,0,"percent of total billed charges ","85% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",11.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",155.73,87,,124.58,,,0,"percent of total billed charges ","87% of total billed charges ",11.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.97,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",125.3,70,,100.24,,,0,"percent of total billed charges ","70% of total billed charges ",11.69,166.47,
"OXYGEN DISSOCIATION P50RBC",2036820,"CDM ",301,RC,82820,HCPCS,OUTPATIENT,,,1583,1266.4,,11.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1108.1,70,,886.48,,,0,"percent of total billed charges ","70% of total billed charges ",1424.7,90,,1139.76,,,0,"percent of total billed charges ","90% of total billed charges ",1472.19,93,,1177.75,,,0,"percent of total billed charges ","93% of total billed charges ",11.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1345.55,85,,1076.44,,,0,"percent of total billed charges ","85% of total billed charges ",1424.7,90,,1139.76,,,0,"percent of total billed charges ","90% of total billed charges ",1424.7,90,,1139.76,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1377.21,87,,1101.77,,,0,"percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.34,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1108.1,70,,886.48,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,1472.19,
"HEMOGLOBIN, FREE URINE",2036830,"CDM ",301,RC,83069,HCPCS,OUTPATIENT,,,164.5,131.6,,3.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.15,70,,92.12,,,0,"percent of total billed charges ","70% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",152.99,93,,122.39,,,0,"percent of total billed charges ","93% of total billed charges ",3.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",139.83,85,,111.86,,,0,"percent of total billed charges ","85% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",2.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.12,87,,114.50,,,0,"percent of total billed charges ","87% of total billed charges ",2.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.95,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.15,70,,92.12,,,0,"percent of total billed charges ","70% of total billed charges ",2.74,152.99,
"DEXAMETHASONE SUPP(DST) 1 SPEC",2036840,"CDM ",301,RC,82533,HCPCS,OUTPATIENT,,,130,104,,16.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91,70,,72.80,,,0,"percent of total billed charges ","70% of total billed charges ",117,90,,93.60,,,0,"percent of total billed charges ","90% of total billed charges ",120.9,93,,96.72,,,0,"percent of total billed charges ","93% of total billed charges ",16.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",110.5,85,,88.40,,,0,"percent of total billed charges ","85% of total billed charges ",117,90,,93.60,,,0,"percent of total billed charges ","90% of total billed charges ",117,90,,93.60,,,0,"percent of total billed charges ","90% of total billed charges ",29.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",113.1,87,,68.05,68.05,68.05,"1 through 10","percent of total billed charges ","87% of total billed charges ",29.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",91,70,,72.80,,,0,"percent of total billed charges ","70% of total billed charges ",16.3,120.9,
"*ID PLATELETS ABS",2036850,"CDM ",302,RC,86022,HCPCS,OUTPATIENT,,,163,130.4,,15.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,30.11,30.11,30.11,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.1,70,,91.28,,,0,"percent of total billed charges ","70% of total billed charges ",146.7,90,,117.36,,,0,"percent of total billed charges ","90% of total billed charges ",151.59,93,,121.27,,,0,"percent of total billed charges ","93% of total billed charges ",15.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",138.55,85,,110.84,,,0,"percent of total billed charges ","85% of total billed charges ",146.7,90,,117.36,,,0,"percent of total billed charges ","90% of total billed charges ",146.7,90,,117.36,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",141.81,87,,89.65,89.65,89.65,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.37,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",114.1,70,,91.28,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,151.59,
"25-HYDROXYVITAMIN D (D2, D3)",2036860,"CDM ",301,RC,82306,HCPCS,OUTPATIENT,,,410.5,328.4,,25.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,29.01,29.01,29.01,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",287.35,70,,229.88,,,0,"percent of total billed charges ","70% of total billed charges ",369.45,90,,295.56,,,0,"percent of total billed charges ","90% of total billed charges ",381.77,93,,305.42,,,0,"percent of total billed charges ","93% of total billed charges ",25.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",348.93,85,,279.14,,,0,"percent of total billed charges ","85% of total billed charges ",369.45,90,,295.56,,,0,"percent of total billed charges ","90% of total billed charges ",369.45,90,,295.56,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",357.14,87,,41.52,29.01,318.94,20,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.6,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",287.35,70,,229.88,,,0,"percent of total billed charges ","70% of total billed charges ",13.18,381.77,
"*ID PLATELET ABS",2036870,"CDM ",302,RC,86022,HCPCS,OUTPATIENT,,,299.5,239.6,,15.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,30.11,30.11,30.11,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",209.65,70,,167.72,,,0,"percent of total billed charges ","70% of total billed charges ",269.55,90,,215.64,,,0,"percent of total billed charges ","90% of total billed charges ",278.54,93,,222.83,,,0,"percent of total billed charges ","93% of total billed charges ",15.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",254.58,85,,203.66,,,0,"percent of total billed charges ","85% of total billed charges ",269.55,90,,215.64,,,0,"percent of total billed charges ","90% of total billed charges ",269.55,90,,215.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",260.57,87,,89.65,89.65,89.65,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.37,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",209.65,70,,167.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,278.54,
"PARVO B19 DNA, QUANT PCR",2036890,"CDM ",306,RC,87799,HCPCS,OUTPATIENT,,,710.5,568.4,,36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,301.18,301.18,301.18,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",497.35,70,,397.88,,,0,"percent of total billed charges ","70% of total billed charges ",639.45,90,,511.56,,,0,"percent of total billed charges ","90% of total billed charges ",660.77,93,,528.62,,,0,"percent of total billed charges ","93% of total billed charges ",36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",603.93,85,,483.14,,,0,"percent of total billed charges ","85% of total billed charges ",639.45,90,,511.56,,,0,"percent of total billed charges ","90% of total billed charges ",639.45,90,,511.56,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",618.14,87,,765.89,765.89,765.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.84,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",497.35,70,,397.88,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,660.77,
"TRANSFUSION PROCEDURE",2036900,"CDM ",302,RC,86999,HCPCS,OUTPATIENT,,,278,222.4,,51.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",194.6,70,,155.68,,,0,"percent of total billed charges ","70% of total billed charges ",250.2,90,,200.16,,,0,"percent of total billed charges ","90% of total billed charges ",258.54,93,,206.83,,,0,"percent of total billed charges ","93% of total billed charges ",51.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",236.3,85,,189.04,,,0,"percent of total billed charges ","85% of total billed charges ",250.2,90,,200.16,,,0,"percent of total billed charges ","90% of total billed charges ",250.2,90,,200.16,,,0,"percent of total billed charges ","90% of total billed charges ",64.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",241.86,87,,193.49,,,0,"percent of total billed charges ","87% of total billed charges ",64.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.59,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",194.6,70,,155.68,,,0,"percent of total billed charges ","70% of total billed charges ",26.59,258.54,
"*HEMOGLOBIN CHROMOTOGRAPHY",2036910,"CDM ",301,RC,83021,HCPCS,OUTPATIENT,,,110.5,88.4,,17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.35,70,,61.88,,,0,"percent of total billed charges ","70% of total billed charges ",99.45,90,,79.56,,,0,"percent of total billed charges ","90% of total billed charges ",102.77,93,,82.22,,,0,"percent of total billed charges ","93% of total billed charges ",17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",93.93,85,,75.14,,,0,"percent of total billed charges ","85% of total billed charges ",99.45,90,,79.56,,,0,"percent of total billed charges ","90% of total billed charges ",99.45,90,,79.56,,,0,"percent of total billed charges ","90% of total billed charges ",23.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,87,,77.19,77.19,77.19,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",77.35,70,,61.88,,,0,"percent of total billed charges ","70% of total billed charges ",17.8,102.77,
"*HEMATOCRIT RBC",2036920,"CDM ",305,RC,85014,HCPCS,OUTPATIENT,,,33.5,26.8,,2.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",31.16,93,,24.93,,,0,"percent of total billed charges ","93% of total billed charges ",2.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1.73,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",28.48,85,,22.78,,,0,"percent of total billed charges ","85% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",1.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.15,87,,32.39,27.27,37.51,"1 through 10","percent of total billed charges ","87% of total billed charges ",1.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2.37,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",1.71,31.16,
"*MOPATH PROC LEVEL 5",2036940,"CDM ",300,RC,81404,HCPCS,OUTPATIENT,,,1634,1307.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.8,70,,915.04,,,0,"percent of total billed charges ","70% of total billed charges ",1470.6,90,,1176.48,,,0,"percent of total billed charges ","90% of total billed charges ",1519.62,93,,1215.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1388.9,85,,1111.12,,,0,"percent of total billed charges ","85% of total billed charges ",1470.6,90,,1176.48,,,0,"percent of total billed charges ","90% of total billed charges ",1470.6,90,,1176.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1421.58,87,,1137.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",274.83,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1143.8,70,,915.04,,,0,"percent of total billed charges ","70% of total billed charges ",274.83,1519.62,
"*KRAS GENE",2036950,"CDM ",300,RC,81275,HCPCS,OUTPATIENT,,,1634,1307.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.8,70,,915.04,,,0,"percent of total billed charges ","70% of total billed charges ",1470.6,90,,1176.48,,,0,"percent of total billed charges ","90% of total billed charges ",1519.62,93,,1215.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1388.9,85,,1111.12,,,0,"percent of total billed charges ","85% of total billed charges ",1470.6,90,,1176.48,,,0,"percent of total billed charges ","90% of total billed charges ",1470.6,90,,1176.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1421.58,87,,1137.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",193.25,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1143.8,70,,915.04,,,0,"percent of total billed charges ","70% of total billed charges ",193.25,1519.62,
"JOHN CUNNINGHAM AB W/REFLEX",2036970,"CDM ",302,RC,86711,HCPCS,OUTPATIENT,,,5195,4156,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3636.5,70,,2909.20,,,0,"percent of total billed charges ","70% of total billed charges ",4675.5,90,,3740.40,,,0,"percent of total billed charges ","90% of total billed charges ",4831.35,93,,3865.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4415.75,85,,3532.60,,,0,"percent of total billed charges ","85% of total billed charges ",4675.5,90,,3740.40,,,0,"percent of total billed charges ","90% of total billed charges ",4675.5,90,,3740.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4519.65,87,,3615.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",16.89,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",3636.5,70,,2909.20,,,0,"percent of total billed charges ","70% of total billed charges ",16.89,4831.35,
*PAP,2036990,"CDM ",300,RC,88175,HCPCS,OUTPATIENT,,,122,97.6,,25.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.4,70,,68.32,,,0,"percent of total billed charges ","70% of total billed charges ",109.8,90,,87.84,,,0,"percent of total billed charges ","90% of total billed charges ",113.46,93,,90.77,,,0,"percent of total billed charges ","93% of total billed charges ",25.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",103.7,85,,82.96,,,0,"percent of total billed charges ","85% of total billed charges ",109.8,90,,87.84,,,0,"percent of total billed charges ","90% of total billed charges ",109.8,90,,87.84,,,0,"percent of total billed charges ","90% of total billed charges ",33.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.14,87,,84.91,,,0,"percent of total billed charges ","87% of total billed charges ",33.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",85.4,70,,68.32,,,0,"percent of total billed charges ","70% of total billed charges ",25.7,113.46,
*HPV,2037000,"CDM ",300,RC,87624,HCPCS,OUTPATIENT,,,307,245.6,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.9,70,,171.92,,,0,"percent of total billed charges ","70% of total billed charges ",276.3,90,,221.04,,,0,"percent of total billed charges ","90% of total billed charges ",285.51,93,,228.41,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",260.95,85,,208.76,,,0,"percent of total billed charges ","85% of total billed charges ",276.3,90,,221.04,,,0,"percent of total billed charges ","90% of total billed charges ",276.3,90,,221.04,,,0,"percent of total billed charges ","90% of total billed charges ",53.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",267.09,87,,213.67,,,0,"percent of total billed charges ","87% of total billed charges ",53.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",214.9,70,,171.92,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,285.51,
*HPV,2037020,"CDM ",300,RC,87624,HCPCS,OUTPATIENT,,,377.5,302,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",264.25,70,,211.40,,,0,"percent of total billed charges ","70% of total billed charges ",339.75,90,,271.80,,,0,"percent of total billed charges ","90% of total billed charges ",351.08,93,,280.86,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",320.88,85,,256.70,,,0,"percent of total billed charges ","85% of total billed charges ",339.75,90,,271.80,,,0,"percent of total billed charges ","90% of total billed charges ",339.75,90,,271.80,,,0,"percent of total billed charges ","90% of total billed charges ",53.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",328.43,87,,262.74,,,0,"percent of total billed charges ","87% of total billed charges ",53.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",264.25,70,,211.40,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,351.08,
*PAP,2037030,"CDM ",300,RC,88175,HCPCS,OUTPATIENT,,,315.5,252.4,,25.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.85,70,,176.68,,,0,"percent of total billed charges ","70% of total billed charges ",283.95,90,,227.16,,,0,"percent of total billed charges ","90% of total billed charges ",293.42,93,,234.74,,,0,"percent of total billed charges ","93% of total billed charges ",25.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",268.18,85,,214.54,,,0,"percent of total billed charges ","85% of total billed charges ",283.95,90,,227.16,,,0,"percent of total billed charges ","90% of total billed charges ",283.95,90,,227.16,,,0,"percent of total billed charges ","90% of total billed charges ",33.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",274.49,87,,219.59,,,0,"percent of total billed charges ","87% of total billed charges ",33.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",220.85,70,,176.68,,,0,"percent of total billed charges ","70% of total billed charges ",25.7,293.42,
"*CYTOPATH C/V AUTO FLUID REDO",2037040,"CDM ",300,RC,88175,HCPCS,OUTPATIENT,,,74.5,59.6,,25.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",69.29,93,,55.43,,,0,"percent of total billed charges ","93% of total billed charges ",25.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",63.33,85,,50.66,,,0,"percent of total billed charges ","85% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",33.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.82,87,,51.86,,,0,"percent of total billed charges ","87% of total billed charges ",33.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",25.7,69.29,
"*CHYLAM TRACH DNA AMP PROBE",2037050,"CDM ",306,RC,87491,HCPCS,OUTPATIENT,,,204,163.2,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.47,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,140.08,140.08,140.08,20,"percent of total billed charges ","87% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,189.72,
"*N GONORRHOEAE DNA AMP PROBE",2037060,"CDM ",306,RC,87591,HCPCS,OUTPATIENT,,,204,163.2,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.47,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,140.08,140.08,140.08,20,"percent of total billed charges ","87% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,189.72,
"*FLUORESCENT AB SCREEN",2037080,"CDM ",302,RC,86255,HCPCS,OUTPATIENT,,,146,116.8,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,101.62,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,135.78,
"*FLUORESCENT AB TITER",2037090,"CDM ",302,RC,86256,HCPCS,OUTPATIENT,,,165,132,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.55,87,,17.72,12.99,22.44,"1 through 10","percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,153.45,
"*TOXOPLASMA AB",2037110,"CDM ",302,RC,86777,HCPCS,OUTPATIENT,,,341,272.8,,12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",238.7,70,,190.96,,,0,"percent of total billed charges ","70% of total billed charges ",306.9,90,,245.52,,,0,"percent of total billed charges ","90% of total billed charges ",317.13,93,,253.70,,,0,"percent of total billed charges ","93% of total billed charges ",12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",289.85,85,,231.88,,,0,"percent of total billed charges ","85% of total billed charges ",306.9,90,,245.52,,,0,"percent of total billed charges ","90% of total billed charges ",306.9,90,,245.52,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",296.67,87,,237.34,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",238.7,70,,190.96,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,317.13,
"*TOXOPLASMA AB IGM",2037120,"CDM ",302,RC,86778,HCPCS,OUTPATIENT,,,341,272.8,,12.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",238.7,70,,190.96,,,0,"percent of total billed charges ","70% of total billed charges ",306.9,90,,245.52,,,0,"percent of total billed charges ","90% of total billed charges ",317.13,93,,253.70,,,0,"percent of total billed charges ","93% of total billed charges ",12.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",289.85,85,,231.88,,,0,"percent of total billed charges ","85% of total billed charges ",306.9,90,,245.52,,,0,"percent of total billed charges ","90% of total billed charges ",306.9,90,,245.52,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",296.67,87,,237.34,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.41,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",238.7,70,,190.96,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,317.13,
"*CMV AB",2037140,"CDM ",302,RC,86644,HCPCS,OUTPATIENT,,,246.5,197.2,,12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.55,70,,138.04,,,0,"percent of total billed charges ","70% of total billed charges ",221.85,90,,177.48,,,0,"percent of total billed charges ","90% of total billed charges ",229.25,93,,183.40,,,0,"percent of total billed charges ","93% of total billed charges ",12.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",209.53,85,,167.62,,,0,"percent of total billed charges ","85% of total billed charges ",221.85,90,,177.48,,,0,"percent of total billed charges ","90% of total billed charges ",221.85,90,,177.48,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",214.46,87,,171.57,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",172.55,70,,138.04,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,229.25,
"*CMV AB IGM",2037150,"CDM ",302,RC,86645,HCPCS,OUTPATIENT,,,246.5,197.2,,14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.55,70,,138.04,,,0,"percent of total billed charges ","70% of total billed charges ",221.85,90,,177.48,,,0,"percent of total billed charges ","90% of total billed charges ",229.25,93,,183.40,,,0,"percent of total billed charges ","93% of total billed charges ",14.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",209.53,85,,167.62,,,0,"percent of total billed charges ","85% of total billed charges ",221.85,90,,177.48,,,0,"percent of total billed charges ","90% of total billed charges ",221.85,90,,177.48,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",214.46,87,,171.57,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.85,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",172.55,70,,138.04,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,229.25,
"*HERPES SIMPLEX TYPE 1",2037170,"CDM ",302,RC,86695,HCPCS,OUTPATIENT,,,175,140,,11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,76.02,76.02,76.02,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",162.75,93,,130.20,,,0,"percent of total billed charges ","93% of total billed charges ",11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",148.75,85,,119.00,,,0,"percent of total billed charges ","85% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",152.25,87,,121.80,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,162.75,
"*HERPES SIMPLEX TYPE 2",2037180,"CDM ",302,RC,86696,HCPCS,OUTPATIENT,,,188.5,150.8,,19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.29,80.29,80.29,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.95,70,,105.56,,,0,"percent of total billed charges ","70% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",175.31,93,,140.25,,,0,"percent of total billed charges ","93% of total billed charges ",19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",160.23,85,,128.18,,,0,"percent of total billed charges ","85% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",164,87,,131.20,,,0,"percent of total billed charges ","87% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.35,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",131.95,70,,105.56,,,0,"percent of total billed charges ","70% of total billed charges ",19.35,175.31,
"TROPONIN T QUANT",2037200,"CDM ",301,RC,84484,HCPCS,OUTPATIENT,,,156.5,125.2,,12.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.55,70,,87.64,,,0,"percent of total billed charges ","70% of total billed charges ",140.85,90,,112.68,,,0,"percent of total billed charges ","90% of total billed charges ",145.55,93,,116.44,,,0,"percent of total billed charges ","93% of total billed charges ",12.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",133.03,85,,106.42,,,0,"percent of total billed charges ","85% of total billed charges ",140.85,90,,112.68,,,0,"percent of total billed charges ","90% of total billed charges ",140.85,90,,112.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",136.16,87,,108.93,,,0,"percent of total billed charges ","87% of total billed charges ",17.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.47,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",109.55,70,,87.64,,,0,"percent of total billed charges ","70% of total billed charges ",12.47,145.55,
"*HIV-1 AG EIA",2037210,"CDM ",306,RC,87390,HCPCS,OUTPATIENT,,,175,140,,20.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",162.75,93,,130.20,,,0,"percent of total billed charges ","93% of total billed charges ",20.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",148.75,85,,119.00,,,0,"percent of total billed charges ","85% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",152.25,87,,121.80,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.06,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,162.75,
"*HIV-1/HIV-2 1 RESULT AB",2037220,"CDM ",302,RC,86703,HCPCS,OUTPATIENT,,,123,98.4,,11.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.1,70,,68.88,,,0,"percent of total billed charges ","70% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",114.39,93,,91.51,,,0,"percent of total billed charges ","93% of total billed charges ",11.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.55,85,,83.64,,,0,"percent of total billed charges ","85% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",6.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.01,87,,99.99,99.99,99.99,11,"percent of total billed charges ","87% of total billed charges ",6.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.71,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",86.1,70,,68.88,,,0,"percent of total billed charges ","70% of total billed charges ",6.54,114.39,
"*CLOT INHIBIT PROTEIN S TOTAL",2037230,"CDM ",305,RC,85305,HCPCS,OUTPATIENT,,,88,70.4,,11.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.6,70,,49.28,,,0,"percent of total billed charges ","70% of total billed charges ",79.2,90,,63.36,,,0,"percent of total billed charges ","90% of total billed charges ",81.84,93,,65.47,,,0,"percent of total billed charges ","93% of total billed charges ",11.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.86,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",74.8,85,,59.84,,,0,"percent of total billed charges ","85% of total billed charges ",79.2,90,,63.36,,,0,"percent of total billed charges ","90% of total billed charges ",79.2,90,,63.36,,,0,"percent of total billed charges ","90% of total billed charges ",15.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",76.56,87,,61.25,,,0,"percent of total billed charges ","87% of total billed charges ",15.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",61.6,70,,49.28,,,0,"percent of total billed charges ","70% of total billed charges ",11.61,81.84,
"*CLOT INHIBIT PROTEIN S FREE",2037240,"CDM ",305,RC,85360,HCPCS,OUTPATIENT,,,123.5,98.8,,8.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.45,70,,69.16,,,0,"percent of total billed charges ","70% of total billed charges ",111.15,90,,88.92,,,0,"percent of total billed charges ","90% of total billed charges ",114.86,93,,91.89,,,0,"percent of total billed charges ","93% of total billed charges ",8.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.98,85,,83.98,,,0,"percent of total billed charges ","85% of total billed charges ",111.15,90,,88.92,,,0,"percent of total billed charges ","90% of total billed charges ",111.15,90,,88.92,,,0,"percent of total billed charges ","90% of total billed charges ",15.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.45,87,,85.96,,,0,"percent of total billed charges ","87% of total billed charges ",15.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.41,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",86.45,70,,69.16,,,0,"percent of total billed charges ","70% of total billed charges ",8.41,114.86,
"*FLOWCYTOMETRY/TC 1 MARKER",2037260,"CDM ",300,RC,88184,HCPCS,OUTPATIENT,,,218.5,174.8,,53.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",137.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",203.21,93,,162.57,,,0,"percent of total billed charges ","93% of total billed charges ",53.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",185.73,85,,148.58,,,0,"percent of total billed charges ","85% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",43.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",190.1,87,,152.08,,,0,"percent of total billed charges ","87% of total billed charges ",43.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",43.19,329.64,
"*FLOWCYTOMETRY/TC ADD ON",2037270,"CDM ",300,RC,88185,HCPCS,OUTPATIENT,,,218.5,174.8,,19.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.24,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",203.21,93,,162.57,,,0,"percent of total billed charges ","93% of total billed charges ",19.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",185.73,85,,148.58,,,0,"percent of total billed charges ","85% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",21.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",190.1,87,,152.08,,,0,"percent of total billed charges ","87% of total billed charges ",21.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",19.52,203.21,
"KAPPA FREE LIGHT CHAINS CSF",2037290,"CDM ",301,RC,83883,HCPCS,OUTPATIENT,,,556.5,445.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",389.55,70,,311.64,,,0,"percent of total billed charges ","70% of total billed charges ",500.85,90,,400.68,,,0,"percent of total billed charges ","90% of total billed charges ",517.55,93,,414.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",473.03,85,,378.42,,,0,"percent of total billed charges ","85% of total billed charges ",500.85,90,,400.68,,,0,"percent of total billed charges ","90% of total billed charges ",500.85,90,,400.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",484.16,87,,387.33,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",13.6,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",389.55,70,,311.64,,,0,"percent of total billed charges ","70% of total billed charges ",13.6,517.55,
"CYANIDE, BLOOD",2037300,"CDM ",301,RC,82600,HCPCS,OUTPATIENT,,,192,153.6,,16.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",134.4,70,,107.52,,,0,"percent of total billed charges ","70% of total billed charges ",172.8,90,,138.24,,,0,"percent of total billed charges ","90% of total billed charges ",178.56,93,,142.85,,,0,"percent of total billed charges ","93% of total billed charges ",16.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",163.2,85,,130.56,,,0,"percent of total billed charges ","85% of total billed charges ",172.8,90,,138.24,,,0,"percent of total billed charges ","90% of total billed charges ",172.8,90,,138.24,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",167.04,87,,133.63,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",134.4,70,,107.52,,,0,"percent of total billed charges ","70% of total billed charges ",13.18,178.56,
"*CYTOPATH C/V AUTO FLUID REDO",2037310,"CDM ",300,RC,88175,HCPCS,OUTPATIENT,,,117.5,94,,25.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.25,70,,65.80,,,0,"percent of total billed charges ","70% of total billed charges ",105.75,90,,84.60,,,0,"percent of total billed charges ","90% of total billed charges ",109.28,93,,87.42,,,0,"percent of total billed charges ","93% of total billed charges ",25.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",99.88,85,,79.90,,,0,"percent of total billed charges ","85% of total billed charges ",105.75,90,,84.60,,,0,"percent of total billed charges ","90% of total billed charges ",105.75,90,,84.60,,,0,"percent of total billed charges ","90% of total billed charges ",33.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",102.23,87,,81.78,,,0,"percent of total billed charges ","87% of total billed charges ",33.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",82.25,70,,65.80,,,0,"percent of total billed charges ","70% of total billed charges ",25.7,109.28,
"*CHYLMD TRACH DNA AMP PROBE",2037320,"CDM ",306,RC,87491,HCPCS,OUTPATIENT,,,204,163.2,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.47,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,140.08,140.08,140.08,20,"percent of total billed charges ","87% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,189.72,
"*N GONNORRHOEAE DNA AMP PROBE",2037330,"CDM ",306,RC,87591,HCPCS,OUTPATIENT,,,204,163.2,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.47,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,140.08,140.08,140.08,20,"percent of total billed charges ","87% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,189.72,
"*FLOWCYTOMETRY/TC 1 MARKER",2037350,"CDM ",300,RC,88184,HCPCS,OUTPATIENT,,,218.5,174.8,,53.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",137.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",203.21,93,,162.57,,,0,"percent of total billed charges ","93% of total billed charges ",53.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",185.73,85,,148.58,,,0,"percent of total billed charges ","85% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",43.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",190.1,87,,152.08,,,0,"percent of total billed charges ","87% of total billed charges ",43.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",43.19,329.64,
"BETA 2 GLYCOPROTEIN 1 AB IGM",2037390,"CDM ",302,RC,86146,HCPCS,OUTPATIENT,,,160,128,,25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112,70,,89.60,,,0,"percent of total billed charges ","70% of total billed charges ",144,90,,115.20,,,0,"percent of total billed charges ","90% of total billed charges ",148.8,93,,119.04,,,0,"percent of total billed charges ","93% of total billed charges ",25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",136,85,,108.80,,,0,"percent of total billed charges ","85% of total billed charges ",144,90,,115.20,,,0,"percent of total billed charges ","90% of total billed charges ",144,90,,115.20,,,0,"percent of total billed charges ","90% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",139.2,87,,111.36,,,0,"percent of total billed charges ","87% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",112,70,,89.60,,,0,"percent of total billed charges ","70% of total billed charges ",25.45,148.8,
"JAK2 V617F MUT PLASMA LEUMETA",2037400,"CDM ",309,RC,81270,HCPCS,OUTPATIENT,,,1715.5,1372.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1200.85,70,,960.68,,,0,"percent of total billed charges ","70% of total billed charges ",1543.95,90,,1235.16,,,0,"percent of total billed charges ","90% of total billed charges ",1595.42,93,,1276.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1458.18,85,,1166.54,,,0,"percent of total billed charges ","85% of total billed charges ",1543.95,90,,1235.16,,,0,"percent of total billed charges ","90% of total billed charges ",1543.95,90,,1235.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1492.49,87,,1193.99,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",91.66,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1200.85,70,,960.68,,,0,"percent of total billed charges ","70% of total billed charges ",91.66,1595.42,
"*JAK2 GENE ALYS V617F",2037403,"CDM ",300,RC,81270,HCPCS,OUTPATIENT,,,1337,1069.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",935.9,70,,748.72,,,0,"percent of total billed charges ","70% of total billed charges ",1203.3,90,,962.64,,,0,"percent of total billed charges ","90% of total billed charges ",1243.41,93,,994.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1136.45,85,,909.16,,,0,"percent of total billed charges ","85% of total billed charges ",1203.3,90,,962.64,,,0,"percent of total billed charges ","90% of total billed charges ",1203.3,90,,962.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1163.19,87,,930.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",91.66,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",935.9,70,,748.72,,,0,"percent of total billed charges ","70% of total billed charges ",91.66,1243.41,
"*JAK2 GENE TRGT ALYS EX12/13",2037405,"CDM ",300,RC,81279,HCPCS,OUTPATIENT,,,1337,1069.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",935.9,70,,748.72,,,0,"percent of total billed charges ","70% of total billed charges ",1203.3,90,,962.64,,,0,"percent of total billed charges ","90% of total billed charges ",1243.41,93,,994.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",158.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1136.45,85,,909.16,,,0,"percent of total billed charges ","85% of total billed charges ",1203.3,90,,962.64,,,0,"percent of total billed charges ","90% of total billed charges ",1203.3,90,,962.64,,,0,"percent of total billed charges ","90% of total billed charges ",157.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1163.19,87,,930.55,,,0,"percent of total billed charges ","87% of total billed charges ",157.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",185.2,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",935.9,70,,748.72,,,0,"percent of total billed charges ","70% of total billed charges ",157.42,1243.41,
"HYPOGLYCEMIA PANEL SERUM PLASM",2037410,"CDM ",301,RC,83789,HCPCS,OUTPATIENT,,,410.5,328.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",287.35,70,,229.88,,,0,"percent of total billed charges ","70% of total billed charges ",369.45,90,,295.56,,,0,"percent of total billed charges ","90% of total billed charges ",381.77,93,,305.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",348.93,85,,279.14,,,0,"percent of total billed charges ","85% of total billed charges ",369.45,90,,295.56,,,0,"percent of total billed charges ","90% of total billed charges ",369.45,90,,295.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",357.14,87,,285.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",24.11,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",287.35,70,,229.88,,,0,"percent of total billed charges ","70% of total billed charges ",24.11,381.77,
"*HEXAGNAL PHOS PLTLT NEUT",2037420,"CDM ",301,RC,85598,HCPCS,OUTPATIENT,,,267.5,214,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",248.78,93,,199.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",227.38,85,,181.90,,,0,"percent of total billed charges ","85% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",232.73,87,,186.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",17.98,248.78,
"*PHOSPHOLIPID PLTLT NEUT",2037430,"CDM ",305,RC,85597,HCPCS,OUTPATIENT,,,267.5,214,,17.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,134.09,134.09,134.09,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",248.78,93,,199.02,,,0,"percent of total billed charges ","93% of total billed charges ",17.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",227.38,85,,181.90,,,0,"percent of total billed charges ","85% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",25.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",232.73,87,,231.88,231.88,231.88,"1 through 10","percent of total billed charges ","87% of total billed charges ",25.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",17.98,248.78,
"*RUSSEL VIPER VENOM DILUTED",2037440,"CDM ",305,RC,85613,HCPCS,OUTPATIENT,,,64,51.2,,8.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.8,70,,35.84,,,0,"percent of total billed charges ","70% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",59.52,93,,47.62,,,0,"percent of total billed charges ","93% of total billed charges ",8.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",54.4,85,,43.52,,,0,"percent of total billed charges ","85% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",55.68,87,,55.59,55.59,55.59,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.58,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",44.8,70,,35.84,,,0,"percent of total billed charges ","70% of total billed charges ",6.87,59.52,
"*THROMBIN TIME PLASMA",2037450,"CDM ",305,RC,85670,HCPCS,OUTPATIENT,,,61.5,49.2,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.05,70,,34.44,,,0,"percent of total billed charges ","70% of total billed charges ",55.35,90,,44.28,,,0,"percent of total billed charges ","90% of total billed charges ",57.2,93,,45.76,,,0,"percent of total billed charges ","93% of total billed charges ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",52.28,85,,41.82,,,0,"percent of total billed charges ","85% of total billed charges ",55.35,90,,44.28,,,0,"percent of total billed charges ","90% of total billed charges ",55.35,90,,44.28,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.51,87,,42.81,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.77,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",43.05,70,,34.44,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,57.2,
EPINEPHRINE,2037480,"CDM ",301,RC,82542,HCPCS,OUTPATIENT,,,842.5,674,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",589.75,70,,471.80,,,0,"percent of total billed charges ","70% of total billed charges ",758.25,90,,606.60,,,0,"percent of total billed charges ","90% of total billed charges ",783.53,93,,626.82,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",716.13,85,,572.90,,,0,"percent of total billed charges ","85% of total billed charges ",758.25,90,,606.60,,,0,"percent of total billed charges ","90% of total billed charges ",758.25,90,,606.60,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",732.98,87,,586.38,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",589.75,70,,471.80,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,783.53,
"EPINEPHRINE PLASMA",2037490,"CDM ",301,RC,82542,HCPCS,OUTPATIENT,,,187,149.6,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",173.91,93,,139.13,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",158.95,85,,127.16,,,0,"percent of total billed charges ","85% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",162.69,87,,130.15,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,173.91,
"NOREPINEPHRINE PLASMA",2037500,"CDM ",301,RC,82542,HCPCS,OUTPATIENT,,,187,149.6,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",173.91,93,,139.13,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",158.95,85,,127.16,,,0,"percent of total billed charges ","85% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",162.69,87,,130.15,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,173.91,
"MYCOPLASMA PNEUMON AB IGG IGM",2037510,"CDM ",302,RC,86389,HCPCS,OUTPATIENT,,,110,88,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88,80,,70.40,,,0,"percent of total billed charges ","80% of total billed charges ",77,70,,61.60,,,0,"percent of total billed charges ","70% of total billed charges ",99,90,,79.20,,,0,"percent of total billed charges ","90% of total billed charges ",102.3,93,,81.84,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",93.5,85,,74.80,,,0,"percent of total billed charges ","85% of total billed charges ",99,90,,79.20,,,0,"percent of total billed charges ","90% of total billed charges ",99,90,,79.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",95.7,87,,76.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77,70,,61.60,,,0,"percent of total billed charges ","70% of total billed charges ",77,102.3,
"SMOOTH MUSCLE AB W/ REF TITER",2037520,"CDM ",302,RC,86255,HCPCS,OUTPATIENT,,,202,161.6,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.4,70,,113.12,,,0,"percent of total billed charges ","70% of total billed charges ",181.8,90,,145.44,,,0,"percent of total billed charges ","90% of total billed charges ",187.86,93,,150.29,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",171.7,85,,137.36,,,0,"percent of total billed charges ","85% of total billed charges ",181.8,90,,145.44,,,0,"percent of total billed charges ","90% of total billed charges ",181.8,90,,145.44,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",175.74,87,,140.59,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",141.4,70,,113.12,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,187.86,
"CENTROMERE B ABS",2037530,"CDM ",302,RC,86038,HCPCS,OUTPATIENT,,,129,103.2,,12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",119.97,93,,95.98,,,0,"percent of total billed charges ","93% of total billed charges ",12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",109.65,85,,87.72,,,0,"percent of total billed charges ","85% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.23,87,,88.36,11.85,147.83,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",12.09,119.97,
"*EXTRACT NUC ANTIGEN AB, EACH",2037540,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,149.5,119.6,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",139.04,93,,111.23,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",127.08,85,,101.66,,,0,"percent of total billed charges ","85% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",134.55,90,,107.64,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.07,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.65,70,,83.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,139.04,
"*HERPES SIMPLEX TYPE 1 TEST",2037560,"CDM ",302,RC,86695,HCPCS,OUTPATIENT,,,175,140,,11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,76.02,76.02,76.02,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",162.75,93,,130.20,,,0,"percent of total billed charges ","93% of total billed charges ",11.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",148.75,85,,119.00,,,0,"percent of total billed charges ","85% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",152.25,87,,121.80,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,162.75,
"*HERPES SIMPLEX TYPE 2 TEST",2037570,"CDM ",302,RC,86696,HCPCS,OUTPATIENT,,,188.5,150.8,,19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.29,80.29,80.29,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.95,70,,105.56,,,0,"percent of total billed charges ","70% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",175.31,93,,140.25,,,0,"percent of total billed charges ","93% of total billed charges ",19.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",160.23,85,,128.18,,,0,"percent of total billed charges ","85% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",164,87,,131.20,,,0,"percent of total billed charges ","87% of total billed charges ",29.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.35,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",131.95,70,,105.56,,,0,"percent of total billed charges ","70% of total billed charges ",19.35,175.31,
"EPSTEIN BARR VIR (EBNA) AB IGG",2037590,"CDM ",302,RC,86664,HCPCS,OUTPATIENT,,,175,140,,13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",162.75,93,,130.20,,,0,"percent of total billed charges ","93% of total billed charges ",13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",148.75,85,,119.00,,,0,"percent of total billed charges ","85% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",152.25,87,,121.80,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.29,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,162.75,
"BLACK WALNUT IGE",2037600,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,61,48.8,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",56.73,93,,45.38,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",51.85,85,,41.48,,,0,"percent of total billed charges ","85% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.07,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,56.73,
"DERMATOPHAGOIDES PTERONYSSINUS",2037610,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"DERMATOPHAGOIDES FARINAE IGE",2037620,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"CHESTNUT IGE",2037630,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"ENGLISH WALNUT FOOD",2037640,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,61,48.8,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",56.73,93,,45.38,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",51.85,85,,41.48,,,0,"percent of total billed charges ","85% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.07,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,56.73,
"MESQUITE TREE IGE",2037650,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"BERMUDA GRASS IGE",2037660,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"RUSSIAN THISTLE IGE",2037670,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"FIREBUSH IGE",2037680,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"MEADOW FESCUE IGE",2037690,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"COMMON RAGWEED IGE",2037700,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"BAHIA GRASS IGE",2037710,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"JOHNSON GRASS IGE",2037720,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"TIMOTHY GRASS",2037730,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"BIRCH IGE",2037740,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"MOUNTAIN CEDAR IGE",2037750,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"MAPLE IGE",2037760,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"SYCAMORE IGE",2037770,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"ELM IGE",2037780,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"WHITE MULBERRY IGE",2037790,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"OAK IGE",2037800,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"HICKORY/PECAN TREE IGE",2037810,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"PINE IGE",2037820,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"EPICOCCUM PURPURASCENS IGE",2037830,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"STEMPHYLIUM BOTRYOSUM IGE",2037840,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"RHIZOPUS NIGRICANS IGE",2037850,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"CURVULARIA LUNATA IGE",2037860,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"CLADOSPORIUM HERBARUM IGE",2037870,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"ALTERNARIA ALTERNATA IGE",2037880,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"MUCOR RACEMOSUS IGE",2037890,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"*FLOWCYTOMETRY TC 1 MARKER",2037900,"CDM ",300,RC,88184,HCPCS,OUTPATIENT,,,218.5,174.8,,53.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",137.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",203.21,93,,162.57,,,0,"percent of total billed charges ","93% of total billed charges ",53.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",185.73,85,,148.58,,,0,"percent of total billed charges ","85% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",43.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",190.1,87,,152.08,,,0,"percent of total billed charges ","87% of total billed charges ",43.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",43.19,329.64,
"*FLOWCYTOMETRY/TC ADD ON",2037910,"CDM ",300,RC,88185,HCPCS,OUTPATIENT,,,218.5,174.8,,19.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.24,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",203.21,93,,162.57,,,0,"percent of total billed charges ","93% of total billed charges ",19.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",185.73,85,,148.58,,,0,"percent of total billed charges ","85% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",21.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",190.1,87,,152.08,,,0,"percent of total billed charges ","87% of total billed charges ",21.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",19.52,203.21,
"*FLOW CYTO >16 MARKERS INTERP",2037920,"CDM ",300,RC,88189,HCPCS,OUTPATIENT,,,537,429.6,,78.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",177.5,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",375.9,70,,300.72,,,0,"percent of total billed charges ","70% of total billed charges ",483.3,90,,386.64,,,0,"percent of total billed charges ","90% of total billed charges ",499.41,93,,399.53,,,0,"percent of total billed charges ","93% of total billed charges ",78.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",97.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",456.45,85,,365.16,,,0,"percent of total billed charges ","85% of total billed charges ",483.3,90,,386.64,,,0,"percent of total billed charges ","90% of total billed charges ",483.3,90,,386.64,,,0,"percent of total billed charges ","90% of total billed charges ",96.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",467.19,87,,373.75,,,0,"percent of total billed charges ","87% of total billed charges ",96.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",375.9,70,,300.72,,,0,"percent of total billed charges ","70% of total billed charges ",78.33,499.41,
"BRAF MUTATION ANALYSIS",2037940,"CDM ",300,RC,81210,HCPCS,OUTPATIENT,,,1407,1125.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",984.9,70,,787.92,,,0,"percent of total billed charges ","70% of total billed charges ",1266.3,90,,1013.04,,,0,"percent of total billed charges ","90% of total billed charges ",1308.51,93,,1046.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1195.95,85,,956.76,,,0,"percent of total billed charges ","85% of total billed charges ",1266.3,90,,1013.04,,,0,"percent of total billed charges ","90% of total billed charges ",1266.3,90,,1013.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1224.09,87,,979.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",175.4,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",984.9,70,,787.92,,,0,"percent of total billed charges ","70% of total billed charges ",175.4,1308.51,
"*VIRUS INOCULATION TISSUE",2037950,"CDM ",306,RC,87252,HCPCS,OUTPATIENT,,,271,216.8,,26.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",189.7,70,,151.76,,,0,"percent of total billed charges ","70% of total billed charges ",243.9,90,,195.12,,,0,"percent of total billed charges ","90% of total billed charges ",252.03,93,,201.62,,,0,"percent of total billed charges ","93% of total billed charges ",26.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.59,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",230.35,85,,184.28,,,0,"percent of total billed charges ","85% of total billed charges ",243.9,90,,195.12,,,0,"percent of total billed charges ","90% of total billed charges ",243.9,90,,195.12,,,0,"percent of total billed charges ","90% of total billed charges ",35.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",235.77,87,,188.62,,,0,"percent of total billed charges ","87% of total billed charges ",35.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",189.7,70,,151.76,,,0,"percent of total billed charges ","70% of total billed charges ",26.07,252.03,
"*VIRUS INOCULATION SHELL VIA",2037960,"CDM ",306,RC,87254,HCPCS,OUTPATIENT,,,210.5,168.4,,16.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",195.77,93,,156.62,,,0,"percent of total billed charges ","93% of total billed charges ",16.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",178.93,85,,143.14,,,0,"percent of total billed charges ","85% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",7.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",183.14,87,,146.51,,,0,"percent of total billed charges ","87% of total billed charges ",7.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.55,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",7.52,195.77,
"*VIRUS INOCULATION TISS-URINE",2037980,"CDM ",306,RC,87252,HCPCS,OUTPATIENT,,,271,216.8,,26.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",189.7,70,,151.76,,,0,"percent of total billed charges ","70% of total billed charges ",243.9,90,,195.12,,,0,"percent of total billed charges ","90% of total billed charges ",252.03,93,,201.62,,,0,"percent of total billed charges ","93% of total billed charges ",26.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.59,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",230.35,85,,184.28,,,0,"percent of total billed charges ","85% of total billed charges ",243.9,90,,195.12,,,0,"percent of total billed charges ","90% of total billed charges ",243.9,90,,195.12,,,0,"percent of total billed charges ","90% of total billed charges ",35.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",235.77,87,,188.62,,,0,"percent of total billed charges ","87% of total billed charges ",35.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",189.7,70,,151.76,,,0,"percent of total billed charges ","70% of total billed charges ",26.07,252.03,
"*VIRUS INOCUL SHELL VIA-URINE",2037990,"CDM ",306,RC,87254,HCPCS,OUTPATIENT,,,204,163.2,,16.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",16.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",7.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,141.98,,,0,"percent of total billed charges ","87% of total billed charges ",7.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.55,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",7.52,189.72,
"LIVER CYTOSOL LC",2038000,"CDM ",302,RC,86376,HCPCS,OUTPATIENT,,,270.5,216.4,,14.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.97,60.97,60.97,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",189.35,70,,151.48,,,0,"percent of total billed charges ","70% of total billed charges ",243.45,90,,194.76,,,0,"percent of total billed charges ","90% of total billed charges ",251.57,93,,201.26,,,0,"percent of total billed charges ","93% of total billed charges ",14.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",229.93,85,,183.94,,,0,"percent of total billed charges ","85% of total billed charges ",243.45,90,,194.76,,,0,"percent of total billed charges ","90% of total billed charges ",243.45,90,,194.76,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",235.34,87,,55.52,12.39,96.11,"1 through 10","percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.55,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",189.35,70,,151.48,,,0,"percent of total billed charges ","70% of total billed charges ",14.55,251.57,
"ALPRAZOLAM (XANAX)",2038010,"CDM ",301,RC,80346,HCPCS,OUTPATIENT,,,98.5,78.8,,23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",23.71,91.61,
"TPMT ACTIVITY",2038020,"CDM ",301,RC,83789,HCPCS,OUTPATIENT,,,758.5,606.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",530.95,70,,424.76,,,0,"percent of total billed charges ","70% of total billed charges ",682.65,90,,546.12,,,0,"percent of total billed charges ","90% of total billed charges ",705.41,93,,564.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",644.73,85,,515.78,,,0,"percent of total billed charges ","85% of total billed charges ",682.65,90,,546.12,,,0,"percent of total billed charges ","90% of total billed charges ",682.65,90,,546.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",659.9,87,,527.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",24.11,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",530.95,70,,424.76,,,0,"percent of total billed charges ","70% of total billed charges ",24.11,705.41,
"HEMOGLOBIN FETAL",2038030,"CDM ",301,RC,83021,HCPCS,OUTPATIENT,,,110.5,88.4,,17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.35,70,,61.88,,,0,"percent of total billed charges ","70% of total billed charges ",99.45,90,,79.56,,,0,"percent of total billed charges ","90% of total billed charges ",102.77,93,,82.22,,,0,"percent of total billed charges ","93% of total billed charges ",17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",93.93,85,,75.14,,,0,"percent of total billed charges ","85% of total billed charges ",99.45,90,,79.56,,,0,"percent of total billed charges ","90% of total billed charges ",99.45,90,,79.56,,,0,"percent of total billed charges ","90% of total billed charges ",23.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,87,,77.19,77.19,77.19,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",77.35,70,,61.88,,,0,"percent of total billed charges ","70% of total billed charges ",17.8,102.77,
"BACTERIAL ISOL & ID OTHER",2038040,"CDM ",306,RC,87071,HCPCS,OUTPATIENT,,,236,188.8,,8.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",165.2,70,,132.16,,,0,"percent of total billed charges ","70% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",219.48,93,,175.58,,,0,"percent of total billed charges ","93% of total billed charges ",8.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",200.6,85,,160.48,,,0,"percent of total billed charges ","85% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",7.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",205.32,87,,164.26,,,0,"percent of total billed charges ","87% of total billed charges ",7.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.89,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",165.2,70,,132.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.25,219.48,
"URIC ACID URINE W/O CREATININE",2038050,"CDM ",301,RC,84560,HCPCS,OUTPATIENT,,,47,37.6,,5.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",43.71,93,,34.97,,,0,"percent of total billed charges ","93% of total billed charges ",5.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.95,85,,31.96,,,0,"percent of total billed charges ","85% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.89,87,,32.71,,,0,"percent of total billed charges ","87% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.08,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",5.08,43.71,
"ALLERGY SHELL FISH PANEL",2038065,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,39,31.2,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.93,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,36.27,
"ANTI-MULLERIAN HORMONE ASSESS",2038080,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,90,72,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,83.7,
"ADAMTS 13 ACTIVITY W/REFLEX",2038090,"CDM ",301,RC,85397,HCPCS,OUTPATIENT,,,308.5,246.8,,26.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",215.95,70,,172.76,,,0,"percent of total billed charges ","70% of total billed charges ",277.65,90,,222.12,,,0,"percent of total billed charges ","90% of total billed charges ",286.91,93,,229.53,,,0,"percent of total billed charges ","93% of total billed charges ",26.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",262.23,85,,209.78,,,0,"percent of total billed charges ","85% of total billed charges ",277.65,90,,222.12,,,0,"percent of total billed charges ","90% of total billed charges ",277.65,90,,222.12,,,0,"percent of total billed charges ","90% of total billed charges ",10.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",268.4,87,,214.72,,,0,"percent of total billed charges ","87% of total billed charges ",10.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.86,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",215.95,70,,172.76,,,0,"percent of total billed charges ","70% of total billed charges ",10.42,286.91,
"*CONCENTRATION ANY TYPE",2038110,"CDM ",306,RC,87015,HCPCS,OUTPATIENT,,,105,84,,6.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.5,70,,58.80,,,0,"percent of total billed charges ","70% of total billed charges ",94.5,90,,75.60,,,0,"percent of total billed charges ","90% of total billed charges ",97.65,93,,78.12,,,0,"percent of total billed charges ","93% of total billed charges ",6.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",89.25,85,,71.40,,,0,"percent of total billed charges ","85% of total billed charges ",94.5,90,,75.60,,,0,"percent of total billed charges ","90% of total billed charges ",94.5,90,,75.60,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",91.35,87,,73.08,,,0,"percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.68,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",73.5,70,,58.80,,,0,"percent of total billed charges ","70% of total billed charges ",6.68,97.65,
*CRYPTOSPORIDIUM,2038120,"CDM ",306,RC,87272,HCPCS,OUTPATIENT,,,167,133.6,,11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.9,70,,93.52,,,0,"percent of total billed charges ","70% of total billed charges ",150.3,90,,120.24,,,0,"percent of total billed charges ","90% of total billed charges ",155.31,93,,124.25,,,0,"percent of total billed charges ","93% of total billed charges ",11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",141.95,85,,113.56,,,0,"percent of total billed charges ","85% of total billed charges ",150.3,90,,120.24,,,0,"percent of total billed charges ","90% of total billed charges ",150.3,90,,120.24,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",145.29,87,,116.23,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",116.9,70,,93.52,,,0,"percent of total billed charges ","70% of total billed charges ",11.98,155.31,
"PTH RELATED PROTEIN",2038130,"CDM ",301,RC,83519,HCPCS,OUTPATIENT,,,81,64.8,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.7,70,,45.36,,,0,"percent of total billed charges ","70% of total billed charges ",72.9,90,,58.32,,,0,"percent of total billed charges ","90% of total billed charges ",75.33,93,,60.26,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",68.85,85,,55.08,,,0,"percent of total billed charges ","85% of total billed charges ",72.9,90,,58.32,,,0,"percent of total billed charges ","90% of total billed charges ",72.9,90,,58.32,,,0,"percent of total billed charges ","90% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.47,87,,56.38,,,0,"percent of total billed charges ","87% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",56.7,70,,45.36,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,75.33,
"TRICHOMONAS QUALITATIVE TMA",2038140,"CDM ",306,RC,87661,HCPCS,OUTPATIENT,,,511,408.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",357.7,70,,286.16,,,0,"percent of total billed charges ","70% of total billed charges ",459.9,90,,367.92,,,0,"percent of total billed charges ","90% of total billed charges ",475.23,93,,380.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",434.35,85,,347.48,,,0,"percent of total billed charges ","85% of total billed charges ",459.9,90,,367.92,,,0,"percent of total billed charges ","90% of total billed charges ",459.9,90,,367.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",444.57,87,,130.13,56.69,140.08,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",357.7,70,,286.16,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,475.23,
TMPT,2038150,"CDM ",309,RC,81401,HCPCS,OUTPATIENT,,,790,632,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",553,70,,442.40,,,0,"percent of total billed charges ","70% of total billed charges ",711,90,,568.80,,,0,"percent of total billed charges ","90% of total billed charges ",734.7,93,,587.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",671.5,85,,537.20,,,0,"percent of total billed charges ","85% of total billed charges ",711,90,,568.80,,,0,"percent of total billed charges ","90% of total billed charges ",711,90,,568.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",687.3,87,,549.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",137,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",553,70,,442.40,,,0,"percent of total billed charges ","70% of total billed charges ",137,734.7,
"*C DIFF TOXIN",2038170,"CDM ",302,RC,87449,HCPCS,OUTPATIENT,,,164.5,131.6,,11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.15,70,,92.12,,,0,"percent of total billed charges ","70% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",152.99,93,,122.39,,,0,"percent of total billed charges ","93% of total billed charges ",11.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",139.83,85,,111.86,,,0,"percent of total billed charges ","85% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.12,87,,114.50,,,0,"percent of total billed charges ","87% of total billed charges ",18.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.15,70,,92.12,,,0,"percent of total billed charges ","70% of total billed charges ",11.98,152.99,
*GHD,2038180,"CDM ",302,RC,87324,HCPCS,OUTPATIENT,,,164.5,131.6,,10.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.15,70,,92.12,,,0,"percent of total billed charges ","70% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",152.99,93,,122.39,,,0,"percent of total billed charges ","93% of total billed charges ",10.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",139.83,85,,111.86,,,0,"percent of total billed charges ","85% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",148.05,90,,118.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.12,87,,114.50,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.15,70,,92.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.18,152.99,
"MYCOPLASMA HOMINIS PCR",2038190,"CDM ",306,RC,87798,HCPCS,OUTPATIENT,,,253,202.4,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.1,70,,141.68,,,0,"percent of total billed charges ","70% of total billed charges ",227.7,90,,182.16,,,0,"percent of total billed charges ","90% of total billed charges ",235.29,93,,188.23,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",215.05,85,,172.04,,,0,"percent of total billed charges ","85% of total billed charges ",227.7,90,,182.16,,,0,"percent of total billed charges ","90% of total billed charges ",227.7,90,,182.16,,,0,"percent of total billed charges ","90% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",220.11,87,,176.09,,,0,"percent of total billed charges ","87% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",177.1,70,,141.68,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,235.29,
"SUSCEPTIBILITY AEROBIC SENDOUT",2038200,"CDM ",306,RC,87186,HCPCS,OUTPATIENT,,,101.5,81.2,,8.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.05,70,,56.84,,,0,"percent of total billed charges ","70% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",94.4,93,,75.52,,,0,"percent of total billed charges ","93% of total billed charges ",8.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",86.28,85,,69.02,,,0,"percent of total billed charges ","85% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",88.31,87,,8.48,8.48,105.80,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.65,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",71.05,70,,56.84,,,0,"percent of total billed charges ","70% of total billed charges ",8.65,94.4,
"*APOLIPOPROTEIN A1",2038220,"CDM ",301,RC,82172,HCPCS,OUTPATIENT,,,72,57.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.4,70,,40.32,,,0,"percent of total billed charges ","70% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",66.96,93,,53.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",61.2,85,,48.96,,,0,"percent of total billed charges ","85% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",62.64,87,,50.11,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",21.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",50.4,70,,40.32,,,0,"percent of total billed charges ","70% of total billed charges ",21.09,66.96,
"*ALPHA 2 MACROGLOBULIN",2038230,"CDM ",301,RC,83883,HCPCS,OUTPATIENT,,,112.5,90,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",104.63,93,,83.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",95.63,85,,76.50,,,0,"percent of total billed charges ","85% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",97.88,87,,78.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",13.6,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",13.6,104.63,
"*ALANINE AMINOTRANSFERASE ALT",2038240,"CDM ",301,RC,84460,HCPCS,OUTPATIENT,,,27,21.6,,5.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,82.88,82.88,82.88,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.9,70,,15.12,,,0,"percent of total billed charges ","70% of total billed charges ",24.3,90,,19.44,,,0,"percent of total billed charges ","90% of total billed charges ",25.11,93,,20.09,,,0,"percent of total billed charges ","93% of total billed charges ",5.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",22.95,85,,18.36,,,0,"percent of total billed charges ","85% of total billed charges ",24.3,90,,19.44,,,0,"percent of total billed charges ","90% of total billed charges ",24.3,90,,19.44,,,0,"percent of total billed charges ","90% of total billed charges ",9.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.49,87,,18.79,,,0,"percent of total billed charges ","87% of total billed charges ",9.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",18.9,70,,15.12,,,0,"percent of total billed charges ","70% of total billed charges ",5.3,25.11,
"*GAMMA GLUTAMYL",2038250,"CDM ",301,RC,82977,HCPCS,OUTPATIENT,,,35,28,,7.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.5,70,,19.60,,,0,"percent of total billed charges ","70% of total billed charges ",31.5,90,,25.20,,,0,"percent of total billed charges ","90% of total billed charges ",32.55,93,,26.04,,,0,"percent of total billed charges ","93% of total billed charges ",7.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",29.75,85,,23.80,,,0,"percent of total billed charges ","85% of total billed charges ",31.5,90,,25.20,,,0,"percent of total billed charges ","90% of total billed charges ",31.5,90,,25.20,,,0,"percent of total billed charges ","90% of total billed charges ",11.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.45,87,,93.42,24.33,106.60,"1 through 10","percent of total billed charges ","87% of total billed charges ",11.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.2,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",24.5,70,,19.60,,,0,"percent of total billed charges ","70% of total billed charges ",7.2,32.55,
*HAPTOGLOBIN,2038260,"CDM ",301,RC,83010,HCPCS,OUTPATIENT,,,115,92,,12.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",12.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.58,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",12.58,106.95,
"PTT LA W/RFLX HEXGNAL PHASE",2038270,"CDM ",305,RC,85730,HCPCS,OUTPATIENT,,,43.5,34.8,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.45,70,,24.36,,,0,"percent of total billed charges ","70% of total billed charges ",39.15,90,,31.32,,,0,"percent of total billed charges ","90% of total billed charges ",40.46,93,,32.37,,,0,"percent of total billed charges ","93% of total billed charges ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",36.98,85,,29.58,,,0,"percent of total billed charges ","85% of total billed charges ",39.15,90,,31.32,,,0,"percent of total billed charges ","90% of total billed charges ",39.15,90,,31.32,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.85,87,,49.13,5.89,151.44,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",30.45,70,,24.36,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,40.46,
"DRVVT SCRN W/RFLX CONFIRM MIX",2038280,"CDM ",305,RC,85613,HCPCS,OUTPATIENT,,,53.5,42.8,,8.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",49.76,93,,39.81,,,0,"percent of total billed charges ","93% of total billed charges ",8.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.48,85,,36.38,,,0,"percent of total billed charges ","85% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.55,87,,55.59,55.59,55.59,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.58,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",6.87,49.76,
"COOMBS INDIRECT QUAL AB ID",2038290,"CDM ",302,RC,86885,HCPCS,OUTPATIENT,,,50,40,,5.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",46.5,93,,37.20,,,0,"percent of total billed charges ","93% of total billed charges ",5.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",42.5,85,,34.00,,,0,"percent of total billed charges ","85% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.5,87,,34.80,,,0,"percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",5.72,156.68,
"*AMMONIA URINE",2038320,"CDM ",301,RC,82140,HCPCS,OUTPATIENT,,,97,77.6,,12.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,192.10,192.10,192.10,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",90.21,93,,72.17,,,0,"percent of total billed charges ","93% of total billed charges ",12.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",82.45,85,,65.96,,,0,"percent of total billed charges ","85% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.39,87,,67.51,,,0,"percent of total billed charges ","87% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.57,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",12.38,90.21,
"CREATININE PERITONEAL FLUID",2038330,"CDM ",301,RC,82570,HCPCS,OUTPATIENT,,,45.5,36.4,,5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.85,70,,25.48,,,0,"percent of total billed charges ","70% of total billed charges ",40.95,90,,32.76,,,0,"percent of total billed charges ","90% of total billed charges ",42.32,93,,33.86,,,0,"percent of total billed charges ","93% of total billed charges ",5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.68,85,,30.94,,,0,"percent of total billed charges ","85% of total billed charges ",40.95,90,,32.76,,,0,"percent of total billed charges ","90% of total billed charges ",40.95,90,,32.76,,,0,"percent of total billed charges ","90% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.59,87,,5.08,4.98,50.30,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.85,70,,25.48,,,0,"percent of total billed charges ","70% of total billed charges ",5.18,42.32,
*HEMOGLOBIN,2038350,"CDM ",305,RC,85018,HCPCS,OUTPATIENT,,,19,15.2,,2.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.3,70,,10.64,,,0,"percent of total billed charges ","70% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.67,93,,14.14,,,0,"percent of total billed charges ","93% of total billed charges ",2.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1.73,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",16.15,85,,12.92,,,0,"percent of total billed charges ","85% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",1.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.53,87,,2.37,1.90,14.74,11,"percent of total billed charges ","87% of total billed charges ",1.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2.37,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",13.3,70,,10.64,,,0,"percent of total billed charges ","70% of total billed charges ",1.71,17.67,
"*RED BLOOD CELLS AUTOMATED",2038360,"CDM ",305,RC,85041,HCPCS,OUTPATIENT,,,20,16,,2.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14,70,,11.20,,,0,"percent of total billed charges ","70% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",18.6,93,,14.88,,,0,"percent of total billed charges ","93% of total billed charges ",2.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1.73,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",17,85,,13.60,,,0,"percent of total billed charges ","85% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",1.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.4,87,,15.52,15.52,15.52,"1 through 10","percent of total billed charges ","87% of total billed charges ",1.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.02,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",14,70,,11.20,,,0,"percent of total billed charges ","70% of total billed charges ",1.71,18.6,
"*CANDIDA SPECIES",2038380,"CDM ",306,RC,87480,HCPCS,OUTPATIENT,,,146,116.8,,17.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",17.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,101.62,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,135.78,
"*GARDNER VAGINALIS",2038390,"CDM ",306,RC,87510,HCPCS,OUTPATIENT,,,146,116.8,,17.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",17.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,101.62,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,135.78,
"*TRICHOMONAS VAGINALIS",2038400,"CDM ",306,RC,87660,HCPCS,OUTPATIENT,,,146,116.8,,20.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",20.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",30.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,101.62,,,0,"percent of total billed charges ","87% of total billed charges ",30.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",20.05,135.78,
"MYCOPLASMA GENITALIUM PCR",2038410,"CDM ",306,RC,87798,HCPCS,OUTPATIENT,,,269.5,215.6,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.65,70,,150.92,,,0,"percent of total billed charges ","70% of total billed charges ",242.55,90,,194.04,,,0,"percent of total billed charges ","90% of total billed charges ",250.64,93,,200.51,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",229.08,85,,183.26,,,0,"percent of total billed charges ","85% of total billed charges ",242.55,90,,194.04,,,0,"percent of total billed charges ","90% of total billed charges ",242.55,90,,194.04,,,0,"percent of total billed charges ","90% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",234.47,87,,187.58,,,0,"percent of total billed charges ","87% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",188.65,70,,150.92,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,250.64,
"BK VIRUS DNA QUAL PCR CSF",2038430,"CDM ",306,RC,87798,HCPCS,OUTPATIENT,,,443.5,354.8,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",310.45,70,,248.36,,,0,"percent of total billed charges ","70% of total billed charges ",399.15,90,,319.32,,,0,"percent of total billed charges ","90% of total billed charges ",412.46,93,,329.97,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",376.98,85,,301.58,,,0,"percent of total billed charges ","85% of total billed charges ",399.15,90,,319.32,,,0,"percent of total billed charges ","90% of total billed charges ",399.15,90,,319.32,,,0,"percent of total billed charges ","90% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",385.85,87,,308.68,,,0,"percent of total billed charges ","87% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",310.45,70,,248.36,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,412.46,
"WEST NILE VIRUS RNA QUAL CSF",2038440,"CDM ",306,RC,87798,HCPCS,OUTPATIENT,,,851,680.8,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",595.7,70,,476.56,,,0,"percent of total billed charges ","70% of total billed charges ",765.9,90,,612.72,,,0,"percent of total billed charges ","90% of total billed charges ",791.43,93,,633.14,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",723.35,85,,578.68,,,0,"percent of total billed charges ","85% of total billed charges ",765.9,90,,612.72,,,0,"percent of total billed charges ","90% of total billed charges ",765.9,90,,612.72,,,0,"percent of total billed charges ","90% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",740.37,87,,592.30,,,0,"percent of total billed charges ","87% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",595.7,70,,476.56,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,791.43,
"*MALARIA IFA SCREEN",2038460,"CDM ",302,RC,86750,HCPCS,OUTPATIENT,,,89,71.2,,7.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",82.77,93,,66.22,,,0,"percent of total billed charges ","93% of total billed charges ",7.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",75.65,85,,60.52,,,0,"percent of total billed charges ","85% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",77.43,87,,61.94,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",7.8,82.77,
PROCALCITONIN,2038470,"CDM ",301,RC,84145,HCPCS,OUTPATIENT,,,187,149.6,,23.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",173.91,93,,139.13,,,0,"percent of total billed charges ","93% of total billed charges ",23.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",158.95,85,,127.16,,,0,"percent of total billed charges ","85% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",30.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",162.69,87,,130.73,119.11,142.35,"1 through 10","percent of total billed charges ","87% of total billed charges ",30.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",23.6,173.91,
"RHEUMATOID FCT W/RFLX SYNOV FL",2038480,"CDM ",302,RC,86430,HCPCS,OUTPATIENT,,,206.5,165.2,,6.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",192.05,93,,153.64,,,0,"percent of total billed charges ","93% of total billed charges ",6.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",175.53,85,,140.42,,,0,"percent of total billed charges ","85% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",179.66,87,,143.73,,,0,"percent of total billed charges ","87% of total billed charges ",10.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",6.14,192.05,
"LYMPHOCYTE SUBSET PANEL 5 BLD",2038490,"CDM ",302,RC,86361,HCPCS,OUTPATIENT,,,206.5,165.2,,26.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",192.05,93,,153.64,,,0,"percent of total billed charges ","93% of total billed charges ",26.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",175.53,85,,140.42,,,0,"percent of total billed charges ","85% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",37.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",179.66,87,,143.73,,,0,"percent of total billed charges ","87% of total billed charges ",37.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.78,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",26.78,192.05,
"*APOLIPOPROTEIN B",2038500,"CDM ",301,RC,82172,HCPCS,OUTPATIENT,,,72,57.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.4,70,,40.32,,,0,"percent of total billed charges ","70% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",66.96,93,,53.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",61.2,85,,48.96,,,0,"percent of total billed charges ","85% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",62.64,87,,50.11,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",21.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",50.4,70,,40.32,,,0,"percent of total billed charges ","70% of total billed charges ",21.09,66.96,
"IMMUKNOW CELL FUNCTION ASSAY",2038520,"CDM ",302,RC,86352,HCPCS,OUTPATIENT,,,533.5,426.8,,115.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",373.45,70,,298.76,,,0,"percent of total billed charges ","70% of total billed charges ",480.15,90,,384.12,,,0,"percent of total billed charges ","90% of total billed charges ",496.16,93,,396.93,,,0,"percent of total billed charges ","93% of total billed charges ",115.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",109.29,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",453.48,85,,362.78,,,0,"percent of total billed charges ","85% of total billed charges ",480.15,90,,384.12,,,0,"percent of total billed charges ","90% of total billed charges ",480.15,90,,384.12,,,0,"percent of total billed charges ","90% of total billed charges ",108.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",464.15,87,,371.32,,,0,"percent of total billed charges ","87% of total billed charges ",108.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",135.86,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",373.45,70,,298.76,,,0,"percent of total billed charges ","70% of total billed charges ",108.21,496.16,
"INHIBIN A",2038530,"CDM ",302,RC,86336,HCPCS,OUTPATIENT,,,243.5,194.8,,15.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.45,70,,136.36,,,0,"percent of total billed charges ","70% of total billed charges ",219.15,90,,175.32,,,0,"percent of total billed charges ","90% of total billed charges ",226.46,93,,181.17,,,0,"percent of total billed charges ","93% of total billed charges ",15.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.44,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",206.98,85,,165.58,,,0,"percent of total billed charges ","85% of total billed charges ",219.15,90,,175.32,,,0,"percent of total billed charges ","90% of total billed charges ",219.15,90,,175.32,,,0,"percent of total billed charges ","90% of total billed charges ",24.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",211.85,87,,169.48,,,0,"percent of total billed charges ","87% of total billed charges ",24.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.59,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",170.45,70,,136.36,,,0,"percent of total billed charges ","70% of total billed charges ",15.59,226.46,
"INHIBIN B",2038540,"CDM ",301,RC,82397,HCPCS,OUTPATIENT,,,143,114.4,,13.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,39.17,39.17,39.17,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",100.1,70,,80.08,,,0,"percent of total billed charges ","70% of total billed charges ",128.7,90,,102.96,,,0,"percent of total billed charges ","90% of total billed charges ",132.99,93,,106.39,,,0,"percent of total billed charges ","93% of total billed charges ",13.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",121.55,85,,97.24,,,0,"percent of total billed charges ","85% of total billed charges ",128.7,90,,102.96,,,0,"percent of total billed charges ","90% of total billed charges ",128.7,90,,102.96,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",124.41,87,,99.53,,,0,"percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",100.1,70,,80.08,,,0,"percent of total billed charges ","70% of total billed charges ",13.65,132.99,
"TISSUE THROMBOPLSTIN INHIN TTI",2038545,"CDM ",302,RC,85705,HCPCS,OUTPATIENT,,,109.5,87.6,,9.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.65,70,,61.32,,,0,"percent of total billed charges ","70% of total billed charges ",98.55,90,,78.84,,,0,"percent of total billed charges ","90% of total billed charges ",101.84,93,,81.47,,,0,"percent of total billed charges ","93% of total billed charges ",9.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",93.08,85,,74.46,,,0,"percent of total billed charges ","85% of total billed charges ",98.55,90,,78.84,,,0,"percent of total billed charges ","90% of total billed charges ",98.55,90,,78.84,,,0,"percent of total billed charges ","90% of total billed charges ",13.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",95.27,87,,76.22,,,0,"percent of total billed charges ","87% of total billed charges ",13.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.63,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",76.65,70,,61.32,,,0,"percent of total billed charges ","70% of total billed charges ",9.63,101.84,
"MUMPS IGM ANTIBODIES",2038550,"CDM ",302,RC,86735,HCPCS,OUTPATIENT,,,183.5,146.8,,11.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",170.66,93,,136.53,,,0,"percent of total billed charges ","93% of total billed charges ",11.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",155.98,85,,124.78,,,0,"percent of total billed charges ","85% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",165.15,90,,132.12,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",159.65,87,,127.72,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",128.45,70,,102.76,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,170.66,
"HEP C RNA QT PCR W/REFLEX",2038560,"CDM ",306,RC,87522,HCPCS,OUTPATIENT,,,650.5,520.4,,36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,109.38,109.38,109.38,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",455.35,70,,364.28,,,0,"percent of total billed charges ","70% of total billed charges ",585.45,90,,468.36,,,0,"percent of total billed charges ","90% of total billed charges ",604.97,93,,483.98,,,0,"percent of total billed charges ","93% of total billed charges ",36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",552.93,85,,442.34,,,0,"percent of total billed charges ","85% of total billed charges ",585.45,90,,468.36,,,0,"percent of total billed charges ","90% of total billed charges ",585.45,90,,468.36,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",565.94,87,,452.75,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.84,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",455.35,70,,364.28,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,604.97,
"HEP C RNA QT PCR LIPA",2038570,"CDM ",306,RC,87902,HCPCS,OUTPATIENT,,,1057,845.6,,,,,,,,0,"other ","not separately reimbursment ",,,,306.82,306.82,306.82,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",739.9,70,,591.92,,,0,"percent of total billed charges ","70% of total billed charges ",951.3,90,,761.04,,,0,"percent of total billed charges ","90% of total billed charges ",983.01,93,,786.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",321.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",898.45,85,,718.76,,,0,"percent of total billed charges ","85% of total billed charges ",951.3,90,,761.04,,,0,"percent of total billed charges ","90% of total billed charges ",951.3,90,,761.04,,,0,"percent of total billed charges ","90% of total billed charges ",317.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",919.59,87,,735.67,,,0,"percent of total billed charges ","87% of total billed charges ",317.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",739.9,70,,591.92,,,0,"percent of total billed charges ","70% of total billed charges ",257.45,983.01,
"HEP C RNA QT PCR DRUG RESIST",2038580,"CDM ",306,RC,87902,HCPCS,OUTPATIENT,,,1057,845.6,,,,,,,,0,"other ","not separately reimbursment ",,,,306.82,306.82,306.82,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",739.9,70,,591.92,,,0,"percent of total billed charges ","70% of total billed charges ",951.3,90,,761.04,,,0,"percent of total billed charges ","90% of total billed charges ",983.01,93,,786.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",321.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",898.45,85,,718.76,,,0,"percent of total billed charges ","85% of total billed charges ",951.3,90,,761.04,,,0,"percent of total billed charges ","90% of total billed charges ",951.3,90,,761.04,,,0,"percent of total billed charges ","90% of total billed charges ",317.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",919.59,87,,735.67,,,0,"percent of total billed charges ","87% of total billed charges ",317.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",739.9,70,,591.92,,,0,"percent of total billed charges ","70% of total billed charges ",257.45,983.01,
"HEP C RNA NS5A DRUG RESIST",2038590,"CDM ",306,RC,87902,HCPCS,OUTPATIENT,,,1057,845.6,,,,,,,,0,"other ","not separately reimbursment ",,,,306.82,306.82,306.82,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",739.9,70,,591.92,,,0,"percent of total billed charges ","70% of total billed charges ",951.3,90,,761.04,,,0,"percent of total billed charges ","90% of total billed charges ",983.01,93,,786.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",321.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",898.45,85,,718.76,,,0,"percent of total billed charges ","85% of total billed charges ",951.3,90,,761.04,,,0,"percent of total billed charges ","90% of total billed charges ",951.3,90,,761.04,,,0,"percent of total billed charges ","90% of total billed charges ",317.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",919.59,87,,735.67,,,0,"percent of total billed charges ","87% of total billed charges ",317.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",739.9,70,,591.92,,,0,"percent of total billed charges ","70% of total billed charges ",257.45,983.01,
"IMMUNOHISTO ANTB SINGLE STAIN",2038610,"CDM ",310,RC,88342,HCPCS,OUTPATIENT,,,797.5,638,,78.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",208.82,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",558.25,70,,446.60,,,0,"percent of total billed charges ","70% of total billed charges ",717.75,90,,574.20,,,0,"percent of total billed charges ","90% of total billed charges ",741.68,93,,593.34,,,0,"percent of total billed charges ","93% of total billed charges ",78.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.41,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",677.88,85,,542.30,,,0,"percent of total billed charges ","85% of total billed charges ",717.75,90,,574.20,,,0,"percent of total billed charges ","90% of total billed charges ",717.75,90,,574.20,,,0,"percent of total billed charges ","90% of total billed charges ",13.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",693.83,87,,555.06,,,0,"percent of total billed charges ","87% of total billed charges ",13.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",558.25,70,,446.60,,,0,"percent of total billed charges ","70% of total billed charges ",13.28,741.68,
"MORPHOMETRIC ANALYSIS ANTB MAN",2038620,"CDM ",310,RC,88360,HCPCS,OUTPATIENT,,,384.5,307.6,,93.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",249.99,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",357.59,93,,286.07,,,0,"percent of total billed charges ","93% of total billed charges ",93.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",326.83,85,,261.46,,,0,"percent of total billed charges ","85% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",41.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",334.52,87,,267.62,,,0,"percent of total billed charges ","87% of total billed charges ",41.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",41.25,357.59,
"CONSULT & REPORT MICROSLIDE",2038630,"CDM ",310,RC,88321,HCPCS,OUTPATIENT,,,153,122.4,,76.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",176.31,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",107.1,70,,85.68,,,0,"percent of total billed charges ","70% of total billed charges ",137.7,90,,110.16,,,0,"percent of total billed charges ","90% of total billed charges ",142.29,93,,113.83,,,0,"percent of total billed charges ","93% of total billed charges ",76.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.84,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",130.05,85,,104.04,,,0,"percent of total billed charges ","85% of total billed charges ",137.7,90,,110.16,,,0,"percent of total billed charges ","90% of total billed charges ",137.7,90,,110.16,,,0,"percent of total billed charges ","90% of total billed charges ",53.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",133.11,87,,106.49,,,0,"percent of total billed charges ","87% of total billed charges ",53.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",107.1,70,,85.68,,,0,"percent of total billed charges ","70% of total billed charges ",34.35,176.31,
"IMMUNOCHEM EA ADD ANTB",2038640,"CDM ",310,RC,88341,HCPCS,OUTPATIENT,,,231,184.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",182.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",161.7,70,,129.36,,,0,"percent of total billed charges ","70% of total billed charges ",207.9,90,,166.32,,,0,"percent of total billed charges ","90% of total billed charges ",214.83,93,,171.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",196.35,85,,157.08,,,0,"percent of total billed charges ","85% of total billed charges ",207.9,90,,166.32,,,0,"percent of total billed charges ","90% of total billed charges ",207.9,90,,166.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",200.97,87,,160.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",161.7,70,,129.36,,,0,"percent of total billed charges ","70% of total billed charges ",161.7,214.83,
"DRUG SCREEN THOPURINE METAB",2038650,"CDM ",301,RC,80375,HCPCS,OUTPATIENT,,,153,122.4,,17.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",107.1,70,,85.68,,,0,"percent of total billed charges ","70% of total billed charges ",137.7,90,,110.16,,,0,"percent of total billed charges ","90% of total billed charges ",142.29,93,,113.83,,,0,"percent of total billed charges ","93% of total billed charges ",17.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",130.05,85,,104.04,,,0,"percent of total billed charges ","85% of total billed charges ",137.7,90,,110.16,,,0,"percent of total billed charges ","90% of total billed charges ",137.7,90,,110.16,,,0,"percent of total billed charges ","90% of total billed charges ",22.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",133.11,87,,106.49,,,0,"percent of total billed charges ","87% of total billed charges ",22.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",107.1,70,,85.68,,,0,"percent of total billed charges ","70% of total billed charges ",17.88,142.29,
"MICROSATELLITE INSTABILITY",2038660,"CDM ",310,RC,81301,HCPCS,OUTPATIENT,,,485.5,388.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",339.85,70,,271.88,,,0,"percent of total billed charges ","70% of total billed charges ",436.95,90,,349.56,,,0,"percent of total billed charges ","90% of total billed charges ",451.52,93,,361.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",412.68,85,,330.14,,,0,"percent of total billed charges ","85% of total billed charges ",436.95,90,,349.56,,,0,"percent of total billed charges ","90% of total billed charges ",436.95,90,,349.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",422.39,87,,337.91,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",348.56,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",339.85,70,,271.88,,,0,"percent of total billed charges ","70% of total billed charges ",339.85,451.52,
"FACTOR VIII ANTEGEN",2038680,"CDM ",305,RC,85244,HCPCS,OUTPATIENT,,,201,160.8,,18.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.7,70,,112.56,,,0,"percent of total billed charges ","70% of total billed charges ",180.9,90,,144.72,,,0,"percent of total billed charges ","90% of total billed charges ",186.93,93,,149.54,,,0,"percent of total billed charges ","93% of total billed charges ",18.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",170.85,85,,136.68,,,0,"percent of total billed charges ","85% of total billed charges ",180.9,90,,144.72,,,0,"percent of total billed charges ","90% of total billed charges ",180.9,90,,144.72,,,0,"percent of total billed charges ","90% of total billed charges ",24.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",174.87,87,,139.90,,,0,"percent of total billed charges ","87% of total billed charges ",24.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.42,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",140.7,70,,112.56,,,0,"percent of total billed charges ","70% of total billed charges ",18.9,186.93,
"ESLICARBAZEPINE SERUM",2038690,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,168.5,134.8,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",156.71,93,,125.37,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.23,85,,114.58,,,0,"percent of total billed charges ","85% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",146.6,87,,117.28,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,156.71,
"HIV 1/2 ABS SCREEN W/REFLEX",2038700,"CDM ",302,RC,86703,HCPCS,OUTPATIENT,,,146,116.8,,11.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",11.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",6.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,99.99,99.99,99.99,11,"percent of total billed charges ","87% of total billed charges ",6.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.71,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",6.54,135.78,
"MUMPS RNA QUAL REAL TIME PCR",2038710,"CDM ",306,RC,87798,HCPCS,OUTPATIENT,,,494,395.2,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",345.8,70,,276.64,,,0,"percent of total billed charges ","70% of total billed charges ",444.6,90,,355.68,,,0,"percent of total billed charges ","90% of total billed charges ",459.42,93,,367.54,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",419.9,85,,335.92,,,0,"percent of total billed charges ","85% of total billed charges ",444.6,90,,355.68,,,0,"percent of total billed charges ","90% of total billed charges ",444.6,90,,355.68,,,0,"percent of total billed charges ","90% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",429.78,87,,343.82,,,0,"percent of total billed charges ","87% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",345.8,70,,276.64,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,459.42,
"MOLECULAR PATH KRAS EA ADD",2038720,"CDM ",310,RC,81276,HCPCS,OUTPATIENT,,,750,600,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",525,70,,420.00,,,0,"percent of total billed charges ","70% of total billed charges ",675,90,,540.00,,,0,"percent of total billed charges ","90% of total billed charges ",697.5,93,,558.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",637.5,85,,510.00,,,0,"percent of total billed charges ","85% of total billed charges ",675,90,,540.00,,,0,"percent of total billed charges ","90% of total billed charges ",675,90,,540.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",652.5,87,,522.00,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",193.25,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",525,70,,420.00,,,0,"percent of total billed charges ","70% of total billed charges ",193.25,697.5,
"MOLECULAR PATH NRAS COLORECTAL",2038730,"CDM ",310,RC,81311,HCPCS,OUTPATIENT,,,1103,882.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",772.1,70,,617.68,,,0,"percent of total billed charges ","70% of total billed charges ",992.7,90,,794.16,,,0,"percent of total billed charges ","90% of total billed charges ",1025.79,93,,820.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",937.55,85,,750.04,,,0,"percent of total billed charges ","85% of total billed charges ",992.7,90,,794.16,,,0,"percent of total billed charges ","90% of total billed charges ",992.7,90,,794.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",959.61,87,,767.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",295.79,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",772.1,70,,617.68,,,0,"percent of total billed charges ","70% of total billed charges ",295.79,1025.79,
"MOLECULAR PATH EA ADD STAIN",2038740,"CDM ",310,RC,88364,HCPCS,OUTPATIENT,,,384.5,307.6,,106.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",284.17,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",357.59,93,,286.07,,,0,"percent of total billed charges ","93% of total billed charges ",106.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",270.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",326.83,85,,261.46,,,0,"percent of total billed charges ","85% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",267.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",334.52,87,,267.62,,,0,"percent of total billed charges ","87% of total billed charges ",267.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",106.61,357.59,
"MOLECULAR PATH CONSULT REPORT",2038750,"CDM ",310,RC,88323,HCPCS,OUTPATIENT,,,330,264,,105.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",239.91,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",231,70,,184.80,,,0,"percent of total billed charges ","70% of total billed charges ",297,90,,237.60,,,0,"percent of total billed charges ","90% of total billed charges ",306.9,93,,245.52,,,0,"percent of total billed charges ","93% of total billed charges ",105.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",280.5,85,,224.40,,,0,"percent of total billed charges ","85% of total billed charges ",297,90,,237.60,,,0,"percent of total billed charges ","90% of total billed charges ",297,90,,237.60,,,0,"percent of total billed charges ","90% of total billed charges ",14.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",287.1,87,,229.68,,,0,"percent of total billed charges ","87% of total billed charges ",14.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.92,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",231,70,,184.80,,,0,"percent of total billed charges ","70% of total billed charges ",14.08,306.9,
"MOLECULAR PATH INITIAL STAIN",2038760,"CDM ",310,RC,88365,HCPCS,OUTPATIENT,,,330,264,,138.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",369.78,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",231,70,,184.80,,,0,"percent of total billed charges ","70% of total billed charges ",297,90,,237.60,,,0,"percent of total billed charges ","90% of total billed charges ",306.9,93,,245.52,,,0,"percent of total billed charges ","93% of total billed charges ",138.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",280.5,85,,224.40,,,0,"percent of total billed charges ","85% of total billed charges ",297,90,,237.60,,,0,"percent of total billed charges ","90% of total billed charges ",297,90,,237.60,,,0,"percent of total billed charges ","90% of total billed charges ",46.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",287.1,87,,229.68,,,0,"percent of total billed charges ","87% of total billed charges ",46.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",231,70,,184.80,,,0,"percent of total billed charges ","70% of total billed charges ",46.77,369.78,
"*AMPHETAMINES 5 OR MORE",2038780,"CDM ",301,RC,80326,HCPCS,OUTPATIENT,,,219,175.2,,10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.3,70,,122.64,,,0,"percent of total billed charges ","70% of total billed charges ",197.1,90,,157.68,,,0,"percent of total billed charges ","90% of total billed charges ",203.67,93,,162.94,,,0,"percent of total billed charges ","93% of total billed charges ",10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",186.15,85,,148.92,,,0,"percent of total billed charges ","85% of total billed charges ",197.1,90,,157.68,,,0,"percent of total billed charges ","90% of total billed charges ",197.1,90,,157.68,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",190.53,87,,152.42,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",153.3,70,,122.64,,,0,"percent of total billed charges ","70% of total billed charges ",10.48,203.67,
METHYLENEDIOXYAMPHETAMINES/MDA,2038790,"CDM ",301,RC,80359,HCPCS,OUTPATIENT,,,182.5,146,,19.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.75,70,,102.20,,,0,"percent of total billed charges ","70% of total billed charges ",164.25,90,,131.40,,,0,"percent of total billed charges ","90% of total billed charges ",169.73,93,,135.78,,,0,"percent of total billed charges ","93% of total billed charges ",19.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.37,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",155.13,85,,124.10,,,0,"percent of total billed charges ","85% of total billed charges ",164.25,90,,131.40,,,0,"percent of total billed charges ","90% of total billed charges ",164.25,90,,131.40,,,0,"percent of total billed charges ","90% of total billed charges ",25.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",158.78,87,,127.02,,,0,"percent of total billed charges ","87% of total billed charges ",25.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",127.75,70,,102.20,,,0,"percent of total billed charges ","70% of total billed charges ",19.97,169.73,
"BARBITURATES PANEL BLOOD",2038800,"CDM ",301,RC,80345,HCPCS,OUTPATIENT,,,378.5,302.8,,16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",264.95,70,,211.96,,,0,"percent of total billed charges ","70% of total billed charges ",340.65,90,,272.52,,,0,"percent of total billed charges ","90% of total billed charges ",352.01,93,,281.61,,,0,"percent of total billed charges ","93% of total billed charges ",16.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",321.73,85,,257.38,,,0,"percent of total billed charges ","85% of total billed charges ",340.65,90,,272.52,,,0,"percent of total billed charges ","90% of total billed charges ",340.65,90,,272.52,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.3,87,,263.44,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",264.95,70,,211.96,,,0,"percent of total billed charges ","70% of total billed charges ",16.38,352.01,
"MYCOPLASMA PNEUMONIAE IGA",2038810,"CDM ",302,RC,86738,HCPCS,OUTPATIENT,,,243.5,194.8,,11.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.45,70,,136.36,,,0,"percent of total billed charges ","70% of total billed charges ",219.15,90,,175.32,,,0,"percent of total billed charges ","90% of total billed charges ",226.46,93,,181.17,,,0,"percent of total billed charges ","93% of total billed charges ",11.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",206.98,85,,165.58,,,0,"percent of total billed charges ","85% of total billed charges ",219.15,90,,175.32,,,0,"percent of total billed charges ","90% of total billed charges ",219.15,90,,175.32,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",211.85,87,,169.48,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.24,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",170.45,70,,136.36,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,226.46,
"AMPHET/METHAMPHET QUANT URINE",2038820,"CDM ",301,RC,80249,HCPCS,OUTPATIENT,,,90.5,72.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.35,70,,50.68,,,0,"percent of total billed charges ","70% of total billed charges ",81.45,90,,65.16,,,0,"percent of total billed charges ","90% of total billed charges ",84.17,93,,67.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",76.93,85,,61.54,,,0,"percent of total billed charges ","85% of total billed charges ",81.45,90,,65.16,,,0,"percent of total billed charges ","90% of total billed charges ",81.45,90,,65.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",78.74,87,,62.99,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.35,70,,50.68,,,0,"percent of total billed charges ","70% of total billed charges ",63.35,84.17,
"MOSQUITO i71 IGE",2038830,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
GLYCOSAMINOGYCANS,2038840,"CDM ",301,RC,83864,HCPCS,OUTPATIENT,,,261.5,209.2,,24.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",243.2,93,,194.56,,,0,"percent of total billed charges ","93% of total billed charges ",24.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",222.28,85,,177.82,,,0,"percent of total billed charges ","85% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",227.51,87,,182.01,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.5,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",13.18,243.2,
"FATTY ACIDS LONG CHAIN",2038850,"CDM ",301,RC,82726,HCPCS,OUTPATIENT,,,321.5,257.2,,16.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",225.05,70,,180.04,,,0,"percent of total billed charges ","70% of total billed charges ",289.35,90,,231.48,,,0,"percent of total billed charges ","90% of total billed charges ",299,93,,239.20,,,0,"percent of total billed charges ","93% of total billed charges ",16.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",273.28,85,,218.62,,,0,"percent of total billed charges ","85% of total billed charges ",289.35,90,,231.48,,,0,"percent of total billed charges ","90% of total billed charges ",289.35,90,,231.48,,,0,"percent of total billed charges ","90% of total billed charges ",12.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",279.71,87,,223.77,,,0,"percent of total billed charges ","87% of total billed charges ",12.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.75,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",225.05,70,,180.04,,,0,"percent of total billed charges ","70% of total billed charges ",12.55,299,
"LYSOSOMAL & PEROXISOMAL DISORD",2038860,"CDM ",301,RC,82542,HCPCS,OUTPATIENT,,,269,215.2,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.3,70,,150.64,,,0,"percent of total billed charges ","70% of total billed charges ",242.1,90,,193.68,,,0,"percent of total billed charges ","90% of total billed charges ",250.17,93,,200.14,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",228.65,85,,182.92,,,0,"percent of total billed charges ","85% of total billed charges ",242.1,90,,193.68,,,0,"percent of total billed charges ","90% of total billed charges ",242.1,90,,193.68,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",234.03,87,,187.22,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",188.3,70,,150.64,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,250.17,
"IGF - BP1 (RAI)",2038870,"CDM ",301,RC,83519,HCPCS,OUTPATIENT,,,72,57.6,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.4,70,,40.32,,,0,"percent of total billed charges ","70% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",66.96,93,,53.57,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",61.2,85,,48.96,,,0,"percent of total billed charges ","85% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.64,87,,50.11,,,0,"percent of total billed charges ","87% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",50.4,70,,40.32,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,66.96,
"*CASHEW IGE",2038900,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"*HAZELNUT IGE",2038910,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"GLUTEN ALLERGEN IGE",2038920,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"MELONS ALLERGEN IGE",2038930,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"LEFLUNOMIDE METABOLITE",2038940,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,219.5,175.6,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.65,70,,122.92,,,0,"percent of total billed charges ","70% of total billed charges ",197.55,90,,158.04,,,0,"percent of total billed charges ","90% of total billed charges ",204.14,93,,163.31,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",186.58,85,,149.26,,,0,"percent of total billed charges ","85% of total billed charges ",197.55,90,,158.04,,,0,"percent of total billed charges ","90% of total billed charges ",197.55,90,,158.04,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",190.97,87,,152.78,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",153.65,70,,122.92,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,204.14,
"TSH RECEPTOR BINDING ABS RIH",2038950,"CDM ",301,RC,83519,HCPCS,OUTPATIENT,,,68.5,54.8,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.95,70,,38.36,,,0,"percent of total billed charges ","70% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",63.71,93,,50.97,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",58.23,85,,46.58,,,0,"percent of total billed charges ","85% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.6,87,,47.68,,,0,"percent of total billed charges ","87% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",47.95,70,,38.36,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,63.71,
"SOYBEAN F14 IGE",2038960,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,75.5,60.4,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",70.22,93,,56.18,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",64.18,85,,51.34,,,0,"percent of total billed charges ","85% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.69,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,70.22,
"TRANSFERRIN BETA2",2038970,"CDM ",302,RC,86335,HCPCS,OUTPATIENT,,,489,391.2,,29.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",342.3,70,,273.84,,,0,"percent of total billed charges ","70% of total billed charges ",440.1,90,,352.08,,,0,"percent of total billed charges ","90% of total billed charges ",454.77,93,,363.82,,,0,"percent of total billed charges ","93% of total billed charges ",29.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",415.65,85,,332.52,,,0,"percent of total billed charges ","85% of total billed charges ",440.1,90,,352.08,,,0,"percent of total billed charges ","90% of total billed charges ",440.1,90,,352.08,,,0,"percent of total billed charges ","90% of total billed charges ",45.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",425.43,87,,340.34,,,0,"percent of total billed charges ","87% of total billed charges ",45.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.35,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",342.3,70,,273.84,,,0,"percent of total billed charges ","70% of total billed charges ",29.35,454.77,
"*PHOSPHATIDYLSERINE AB IGA",2038990,"CDM ",302,RC,86148,HCPCS,OUTPATIENT,,,182.5,146,,16.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.75,70,,102.20,,,0,"percent of total billed charges ","70% of total billed charges ",164.25,90,,131.40,,,0,"percent of total billed charges ","90% of total billed charges ",169.73,93,,135.78,,,0,"percent of total billed charges ","93% of total billed charges ",16.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",155.13,85,,124.10,,,0,"percent of total billed charges ","85% of total billed charges ",164.25,90,,131.40,,,0,"percent of total billed charges ","90% of total billed charges ",164.25,90,,131.40,,,0,"percent of total billed charges ","90% of total billed charges ",22.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",158.78,87,,127.02,,,0,"percent of total billed charges ","87% of total billed charges ",22.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",127.75,70,,102.20,,,0,"percent of total billed charges ","70% of total billed charges ",16.07,169.73,
"*PHOSPHATIDYLSERINE AB IGG",2039000,"CDM ",302,RC,86148,HCPCS,OUTPATIENT,,,182.5,146,,16.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.75,70,,102.20,,,0,"percent of total billed charges ","70% of total billed charges ",164.25,90,,131.40,,,0,"percent of total billed charges ","90% of total billed charges ",169.73,93,,135.78,,,0,"percent of total billed charges ","93% of total billed charges ",16.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",155.13,85,,124.10,,,0,"percent of total billed charges ","85% of total billed charges ",164.25,90,,131.40,,,0,"percent of total billed charges ","90% of total billed charges ",164.25,90,,131.40,,,0,"percent of total billed charges ","90% of total billed charges ",22.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",158.78,87,,127.02,,,0,"percent of total billed charges ","87% of total billed charges ",22.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",127.75,70,,102.20,,,0,"percent of total billed charges ","70% of total billed charges ",16.07,169.73,
"*PHOSPHATIDYLSERINE AB IGM",2039010,"CDM ",302,RC,86148,HCPCS,OUTPATIENT,,,182.5,146,,16.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.75,70,,102.20,,,0,"percent of total billed charges ","70% of total billed charges ",164.25,90,,131.40,,,0,"percent of total billed charges ","90% of total billed charges ",169.73,93,,135.78,,,0,"percent of total billed charges ","93% of total billed charges ",16.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",155.13,85,,124.10,,,0,"percent of total billed charges ","85% of total billed charges ",164.25,90,,131.40,,,0,"percent of total billed charges ","90% of total billed charges ",164.25,90,,131.40,,,0,"percent of total billed charges ","90% of total billed charges ",22.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",158.78,87,,127.02,,,0,"percent of total billed charges ","87% of total billed charges ",22.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",127.75,70,,102.20,,,0,"percent of total billed charges ","70% of total billed charges ",16.07,169.73,
"*AFB STAIN",2039020,"CDM ",306,RC,87206,HCPCS,OUTPATIENT,,,19,15.2,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.3,70,,10.64,,,0,"percent of total billed charges ","70% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.67,93,,14.14,,,0,"percent of total billed charges ","93% of total billed charges ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",16.15,85,,12.92,,,0,"percent of total billed charges ","85% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.53,87,,121.54,121.54,121.54,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",13.3,70,,10.64,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,17.67,
"HEP C RNA GENOTYPE LIPA",2039040,"CDM ",306,RC,87902,HCPCS,OUTPATIENT,,,1057,845.6,,,,,,,,0,"other ","not separately reimbursment ",,,,306.82,306.82,306.82,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",739.9,70,,591.92,,,0,"percent of total billed charges ","70% of total billed charges ",951.3,90,,761.04,,,0,"percent of total billed charges ","90% of total billed charges ",983.01,93,,786.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",321.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",898.45,85,,718.76,,,0,"percent of total billed charges ","85% of total billed charges ",951.3,90,,761.04,,,0,"percent of total billed charges ","90% of total billed charges ",951.3,90,,761.04,,,0,"percent of total billed charges ","90% of total billed charges ",317.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",919.59,87,,735.67,,,0,"percent of total billed charges ","87% of total billed charges ",317.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",739.9,70,,591.92,,,0,"percent of total billed charges ","70% of total billed charges ",257.45,983.01,
"HEP C RNA GENOTYPE DRUG RESIST",2039050,"CDM ",306,RC,87902,HCPCS,OUTPATIENT,,,1095,876,,,,,,,,0,"other ","not separately reimbursment ",,,,306.82,306.82,306.82,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",766.5,70,,613.20,,,0,"percent of total billed charges ","70% of total billed charges ",985.5,90,,788.40,,,0,"percent of total billed charges ","90% of total billed charges ",1018.35,93,,814.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",321.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",930.75,85,,744.60,,,0,"percent of total billed charges ","85% of total billed charges ",985.5,90,,788.40,,,0,"percent of total billed charges ","90% of total billed charges ",985.5,90,,788.40,,,0,"percent of total billed charges ","90% of total billed charges ",317.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",952.65,87,,762.12,,,0,"percent of total billed charges ","87% of total billed charges ",317.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",766.5,70,,613.20,,,0,"percent of total billed charges ","70% of total billed charges ",257.45,1018.35,
"BRAF GENE ANALYSIS",2039060,"CDM ",310,RC,81210,HCPCS,OUTPATIENT,,,675,540,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",472.5,70,,378.00,,,0,"percent of total billed charges ","70% of total billed charges ",607.5,90,,486.00,,,0,"percent of total billed charges ","90% of total billed charges ",627.75,93,,502.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",573.75,85,,459.00,,,0,"percent of total billed charges ","85% of total billed charges ",607.5,90,,486.00,,,0,"percent of total billed charges ","90% of total billed charges ",607.5,90,,486.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",587.25,87,,469.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",175.4,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",472.5,70,,378.00,,,0,"percent of total billed charges ","70% of total billed charges ",175.4,627.75,
"EGFR GENE ANALYSIS",2039070,"CDM ",310,RC,81235,HCPCS,OUTPATIENT,,,820,656,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",574,70,,459.20,,,0,"percent of total billed charges ","70% of total billed charges ",738,90,,590.40,,,0,"percent of total billed charges ","90% of total billed charges ",762.6,93,,610.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",697,85,,557.60,,,0,"percent of total billed charges ","85% of total billed charges ",738,90,,590.40,,,0,"percent of total billed charges ","90% of total billed charges ",738,90,,590.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",713.4,87,,570.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",324.58,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",574,70,,459.20,,,0,"percent of total billed charges ","70% of total billed charges ",324.58,762.6,
"KRAS GENE ANALYSIS VAR EXON2",2039080,"CDM ",310,RC,81275,HCPCS,OUTPATIENT,,,650,520,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",455,70,,364.00,,,0,"percent of total billed charges ","70% of total billed charges ",585,90,,468.00,,,0,"percent of total billed charges ","90% of total billed charges ",604.5,93,,483.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",552.5,85,,442.00,,,0,"percent of total billed charges ","85% of total billed charges ",585,90,,468.00,,,0,"percent of total billed charges ","90% of total billed charges ",585,90,,468.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",565.5,87,,452.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",193.25,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",455,70,,364.00,,,0,"percent of total billed charges ","70% of total billed charges ",193.25,604.5,
"TUMOR IMMUNOHISTOCHEM COMP GEN",2039090,"CDM ",310,RC,88361,HCPCS,OUTPATIENT,,,447,357.6,,110.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",249.99,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",312.9,70,,250.32,,,0,"percent of total billed charges ","70% of total billed charges ",402.3,90,,321.84,,,0,"percent of total billed charges ","90% of total billed charges ",415.71,93,,332.57,,,0,"percent of total billed charges ","93% of total billed charges ",110.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",379.95,85,,303.96,,,0,"percent of total billed charges ","85% of total billed charges ",402.3,90,,321.84,,,0,"percent of total billed charges ","90% of total billed charges ",402.3,90,,321.84,,,0,"percent of total billed charges ","90% of total billed charges ",60.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",388.89,87,,311.11,,,0,"percent of total billed charges ","87% of total billed charges ",60.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",312.9,70,,250.32,,,0,"percent of total billed charges ","70% of total billed charges ",60.37,415.71,
"MORPHMTRC ANLYS COMP ASSIST EA",2039100,"CDM ",310,RC,88374,HCPCS,OUTPATIENT,,,294,235.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",646.8,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",205.8,70,,164.64,,,0,"percent of total billed charges ","70% of total billed charges ",264.6,90,,211.68,,,0,"percent of total billed charges ","90% of total billed charges ",273.42,93,,218.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",249.9,85,,199.92,,,0,"percent of total billed charges ","85% of total billed charges ",264.6,90,,211.68,,,0,"percent of total billed charges ","90% of total billed charges ",264.6,90,,211.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",255.78,87,,204.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",205.8,70,,164.64,,,0,"percent of total billed charges ","70% of total billed charges ",156.68,646.8,
"MORPHMTRC ANLYS MANUAL EA ADD",2039110,"CDM ",310,RC,88377,HCPCS,OUTPATIENT,,,294,235.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",646.8,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",205.8,70,,164.64,,,0,"percent of total billed charges ","70% of total billed charges ",264.6,90,,211.68,,,0,"percent of total billed charges ","90% of total billed charges ",273.42,93,,218.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",249.9,85,,199.92,,,0,"percent of total billed charges ","85% of total billed charges ",264.6,90,,211.68,,,0,"percent of total billed charges ","90% of total billed charges ",264.6,90,,211.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",255.78,87,,204.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",205.8,70,,164.64,,,0,"percent of total billed charges ","70% of total billed charges ",156.68,646.8,
"MICRODISSECTION MANUAL",2039120,"CDM ",310,RC,88381,HCPCS,OUTPATIENT,,,206,164.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",429.2,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",144.2,70,,115.36,,,0,"percent of total billed charges ","70% of total billed charges ",185.4,90,,148.32,,,0,"percent of total billed charges ","90% of total billed charges ",191.58,93,,153.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",175.1,85,,140.08,,,0,"percent of total billed charges ","85% of total billed charges ",185.4,90,,148.32,,,0,"percent of total billed charges ","90% of total billed charges ",185.4,90,,148.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",179.22,87,,143.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.2,70,,115.36,,,0,"percent of total billed charges ","70% of total billed charges ",144.2,429.2,
"ADIPONECTIN IMMUNOASSAY QUANT",2039130,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,213.5,170.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.45,70,,119.56,,,0,"percent of total billed charges ","70% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",198.56,93,,158.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",181.48,85,,145.18,,,0,"percent of total billed charges ","85% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",185.75,87,,148.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",149.45,70,,119.56,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,198.56,
"CANDIDA ALBICANS IGE",2039140,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"CARDIOLIPIN AB IGM",2039150,"CDM ",302,RC,86147,HCPCS,OUTPATIENT,,,224.5,179.6,,25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",208.79,93,,167.03,,,0,"percent of total billed charges ","93% of total billed charges ",25.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",190.83,85,,152.66,,,0,"percent of total billed charges ","85% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.32,87,,156.26,,,0,"percent of total billed charges ","87% of total billed charges ",33.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",25.45,208.79,
"CORTISONE SERUM",2039160,"CDM ",301,RC,82542,HCPCS,OUTPATIENT,,,187,149.6,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",173.91,93,,139.13,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",158.95,85,,127.16,,,0,"percent of total billed charges ","85% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",162.69,87,,130.15,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,173.91,
LEPTIN,2039170,"CDM ",301,RC,82397,HCPCS,OUTPATIENT,,,79,63.2,,13.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,39.17,39.17,39.17,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.3,70,,44.24,,,0,"percent of total billed charges ","70% of total billed charges ",71.1,90,,56.88,,,0,"percent of total billed charges ","90% of total billed charges ",73.47,93,,58.78,,,0,"percent of total billed charges ","93% of total billed charges ",13.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",67.15,85,,53.72,,,0,"percent of total billed charges ","85% of total billed charges ",71.1,90,,56.88,,,0,"percent of total billed charges ","90% of total billed charges ",71.1,90,,56.88,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",68.73,87,,54.98,,,0,"percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",55.3,70,,44.24,,,0,"percent of total billed charges ","70% of total billed charges ",13.65,73.47,
"*CHEMILUMINESCENT ASSAY",2039173,"CDM ",301,RC,82397,HCPCS,OUTPATIENT,,,191,152.8,,13.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,39.17,39.17,39.17,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.7,70,,106.96,,,0,"percent of total billed charges ","70% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",177.63,93,,142.10,,,0,"percent of total billed charges ","93% of total billed charges ",13.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",162.35,85,,129.88,,,0,"percent of total billed charges ","85% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",166.17,87,,132.94,,,0,"percent of total billed charges ","87% of total billed charges ",17.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",133.7,70,,106.96,,,0,"percent of total billed charges ","70% of total billed charges ",13.65,177.63,
"METHYLENETETRAHYDROFOLATE REDU",2039180,"CDM ",300,RC,81291,HCPCS,OUTPATIENT,,,165,132,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,93,,122.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",140.25,85,,112.20,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",143.55,87,,114.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",65.34,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.5,70,,92.40,,,0,"percent of total billed charges ","70% of total billed charges ",65.34,153.45,
"*OPIATE URINE",2039200,"CDM ",301,RC,80361,HCPCS,OUTPATIENT,,,88.5,70.8,,10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,38.30,38.30,38.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.95,70,,49.56,,,0,"percent of total billed charges ","70% of total billed charges ",79.65,90,,63.72,,,0,"percent of total billed charges ","90% of total billed charges ",82.31,93,,65.85,,,0,"percent of total billed charges ","93% of total billed charges ",10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",75.23,85,,60.18,,,0,"percent of total billed charges ","85% of total billed charges ",79.65,90,,63.72,,,0,"percent of total billed charges ","90% of total billed charges ",79.65,90,,63.72,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",77,87,,61.60,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",61.95,70,,49.56,,,0,"percent of total billed charges ","70% of total billed charges ",10.4,82.31,
"*OXYCODONE SCREEN URINE",2039210,"CDM ",301,RC,80365,HCPCS,OUTPATIENT,,,48.5,38.8,,10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,21.43,21.43,21.43,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.95,70,,27.16,,,0,"percent of total billed charges ","70% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",45.11,93,,36.09,,,0,"percent of total billed charges ","93% of total billed charges ",10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.23,85,,32.98,,,0,"percent of total billed charges ","85% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.2,87,,33.76,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.95,70,,27.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.4,45.11,
"*N GONORRHEAE URINE/SWAB",2039230,"CDM ",306,RC,87591,HCPCS,OUTPATIENT,,,204,163.2,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.47,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,140.08,140.08,140.08,20,"percent of total billed charges ","87% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,189.72,
"*CHLAMYDIA TRACH URINE/SWAB",2039240,"CDM ",306,RC,87491,HCPCS,OUTPATIENT,,,204,163.2,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.47,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,140.08,140.08,140.08,20,"percent of total billed charges ","87% of total billed charges ",53.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,189.72,
"*TRICHOMONAS URINE/SWAB",2039250,"CDM ",306,RC,87661,HCPCS,OUTPATIENT,,,204,163.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",177.48,87,,130.13,56.69,140.08,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,189.72,
"STREP B ASSAY",2039260,"CDM ",306,RC,87802,HCPCS,OUTPATIENT,,,168,134.4,,10.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.6,70,,94.08,,,0,"percent of total billed charges ","70% of total billed charges ",151.2,90,,120.96,,,0,"percent of total billed charges ","90% of total billed charges ",156.24,93,,124.99,,,0,"percent of total billed charges ","93% of total billed charges ",10.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",142.8,85,,114.24,,,0,"percent of total billed charges ","85% of total billed charges ",151.2,90,,120.96,,,0,"percent of total billed charges ","90% of total billed charges ",151.2,90,,120.96,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",146.16,87,,92.06,90.91,115.08,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.73,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.6,70,,94.08,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,156.24,
"*INFECT AG MULTI ORGANISMS",2039270,"CDM ",306,RC,87801,HCPCS,OUTPATIENT,,,333.5,266.8,,59.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,531.68,531.68,531.68,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",233.45,70,,186.76,,,0,"percent of total billed charges ","70% of total billed charges ",300.15,90,,240.12,,,0,"percent of total billed charges ","90% of total billed charges ",310.16,93,,248.13,,,0,"percent of total billed charges ","93% of total billed charges ",59.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",283.48,85,,226.78,,,0,"percent of total billed charges ","85% of total billed charges ",300.15,90,,240.12,,,0,"percent of total billed charges ","90% of total billed charges ",300.15,90,,240.12,,,0,"percent of total billed charges ","90% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",290.15,87,,232.12,,,0,"percent of total billed charges ","87% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.2,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",233.45,70,,186.76,,,0,"percent of total billed charges ","70% of total billed charges ",53.94,310.16,
"*CANDIDA SPECIES",2039280,"CDM ",306,RC,87481,HCPCS,OUTPATIENT,,,168,134.4,,29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.6,70,,94.08,,,0,"percent of total billed charges ","70% of total billed charges ",151.2,90,,120.96,,,0,"percent of total billed charges ","90% of total billed charges ",156.24,93,,124.99,,,0,"percent of total billed charges ","93% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",142.8,85,,114.24,,,0,"percent of total billed charges ","85% of total billed charges ",151.2,90,,120.96,,,0,"percent of total billed charges ","90% of total billed charges ",151.2,90,,120.96,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",146.16,87,,230.15,230.15,230.15,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.6,70,,94.08,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,156.24,
"*CANDIDA SPECIES",2039290,"CDM ",306,RC,87481,HCPCS,OUTPATIENT,,,168,134.4,,29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.6,70,,94.08,,,0,"percent of total billed charges ","70% of total billed charges ",151.2,90,,120.96,,,0,"percent of total billed charges ","90% of total billed charges ",156.24,93,,124.99,,,0,"percent of total billed charges ","93% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",142.8,85,,114.24,,,0,"percent of total billed charges ","85% of total billed charges ",151.2,90,,120.96,,,0,"percent of total billed charges ","90% of total billed charges ",151.2,90,,120.96,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",146.16,87,,230.15,230.15,230.15,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",117.6,70,,94.08,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,156.24,
"MRSA PCR",2039310,"CDM ",306,RC,87641,HCPCS,OUTPATIENT,,,204,163.2,,,,,,,,0,"other ","not separately reimbursment ",,,,124.32,124.32,124.32,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",43.78,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",43.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,140.08,140.08,140.08,"1 through 10","percent of total billed charges ","87% of total billed charges ",43.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,189.72,
"C DIFF PCR",2039320,"CDM ",306,RC,87493,HCPCS,OUTPATIENT,,,206.5,165.2,,34.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,63.13,63.13,63.13,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",192.05,93,,153.64,,,0,"percent of total billed charges ","93% of total billed charges ",34.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.27,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",175.53,85,,140.42,,,0,"percent of total billed charges ","85% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",44.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",179.66,87,,143.73,,,0,"percent of total billed charges ","87% of total billed charges ",44.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",34.26,192.05,
"ENTERIC BACTERIAL PANEL",2039330,"CDM ",306,RC,87505,HCPCS,OUTPATIENT,,,2413,1930.4,,128.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1689.1,70,,1351.28,,,0,"percent of total billed charges ","70% of total billed charges ",2171.7,90,,1737.36,,,0,"percent of total billed charges ","90% of total billed charges ",2244.09,93,,1795.27,,,0,"percent of total billed charges ","93% of total billed charges ",128.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",196.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2051.05,85,,1640.84,,,0,"percent of total billed charges ","85% of total billed charges ",2171.7,90,,1737.36,,,0,"percent of total billed charges ","90% of total billed charges ",2171.7,90,,1737.36,,,0,"percent of total billed charges ","90% of total billed charges ",194.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2099.31,87,,1679.45,,,0,"percent of total billed charges ","87% of total billed charges ",194.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",128.29,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1689.1,70,,1351.28,,,0,"percent of total billed charges ","70% of total billed charges ",128.29,2244.09,
"*SHIGELLA SPC DNA",2039340,"CDM ",306,RC,87505,HCPCS,OUTPATIENT,,,604,483.2,,128.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",422.8,70,,338.24,,,0,"percent of total billed charges ","70% of total billed charges ",543.6,90,,434.88,,,0,"percent of total billed charges ","90% of total billed charges ",561.72,93,,449.38,,,0,"percent of total billed charges ","93% of total billed charges ",128.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",196.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",513.4,85,,410.72,,,0,"percent of total billed charges ","85% of total billed charges ",543.6,90,,434.88,,,0,"percent of total billed charges ","90% of total billed charges ",543.6,90,,434.88,,,0,"percent of total billed charges ","90% of total billed charges ",194.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",525.48,87,,420.38,,,0,"percent of total billed charges ","87% of total billed charges ",194.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",128.29,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",422.8,70,,338.24,,,0,"percent of total billed charges ","70% of total billed charges ",128.29,561.72,
"*SHIGELLA TOXIN",2039350,"CDM ",306,RC,87505,HCPCS,OUTPATIENT,,,604,483.2,,128.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",422.8,70,,338.24,,,0,"percent of total billed charges ","70% of total billed charges ",543.6,90,,434.88,,,0,"percent of total billed charges ","90% of total billed charges ",561.72,93,,449.38,,,0,"percent of total billed charges ","93% of total billed charges ",128.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",196.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",513.4,85,,410.72,,,0,"percent of total billed charges ","85% of total billed charges ",543.6,90,,434.88,,,0,"percent of total billed charges ","90% of total billed charges ",543.6,90,,434.88,,,0,"percent of total billed charges ","90% of total billed charges ",194.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",525.48,87,,420.38,,,0,"percent of total billed charges ","87% of total billed charges ",194.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",128.29,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",422.8,70,,338.24,,,0,"percent of total billed charges ","70% of total billed charges ",128.29,561.72,
"*CAMPYLOBACTER SPC",2039360,"CDM ",306,RC,87505,HCPCS,OUTPATIENT,,,604,483.2,,128.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",422.8,70,,338.24,,,0,"percent of total billed charges ","70% of total billed charges ",543.6,90,,434.88,,,0,"percent of total billed charges ","90% of total billed charges ",561.72,93,,449.38,,,0,"percent of total billed charges ","93% of total billed charges ",128.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",196.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",513.4,85,,410.72,,,0,"percent of total billed charges ","85% of total billed charges ",543.6,90,,434.88,,,0,"percent of total billed charges ","90% of total billed charges ",543.6,90,,434.88,,,0,"percent of total billed charges ","90% of total billed charges ",194.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",525.48,87,,420.38,,,0,"percent of total billed charges ","87% of total billed charges ",194.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",128.29,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",422.8,70,,338.24,,,0,"percent of total billed charges ","70% of total billed charges ",128.29,561.72,
"*SALMONELLA SPECIES DNA",2039370,"CDM ",306,RC,87505,HCPCS,OUTPATIENT,,,604,483.2,,128.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",422.8,70,,338.24,,,0,"percent of total billed charges ","70% of total billed charges ",543.6,90,,434.88,,,0,"percent of total billed charges ","90% of total billed charges ",561.72,93,,449.38,,,0,"percent of total billed charges ","93% of total billed charges ",128.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",196.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",513.4,85,,410.72,,,0,"percent of total billed charges ","85% of total billed charges ",543.6,90,,434.88,,,0,"percent of total billed charges ","90% of total billed charges ",543.6,90,,434.88,,,0,"percent of total billed charges ","90% of total billed charges ",194.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",525.48,87,,420.38,,,0,"percent of total billed charges ","87% of total billed charges ",194.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",128.29,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",422.8,70,,338.24,,,0,"percent of total billed charges ","70% of total billed charges ",128.29,561.72,
"ENTERIC PARASITE PANEL",2039380,"CDM ",306,RC,87505,HCPCS,OUTPATIENT,,,1399,1119.2,,128.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",979.3,70,,783.44,,,0,"percent of total billed charges ","70% of total billed charges ",1259.1,90,,1007.28,,,0,"percent of total billed charges ","90% of total billed charges ",1301.07,93,,1040.86,,,0,"percent of total billed charges ","93% of total billed charges ",128.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",196.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1189.15,85,,951.32,,,0,"percent of total billed charges ","85% of total billed charges ",1259.1,90,,1007.28,,,0,"percent of total billed charges ","90% of total billed charges ",1259.1,90,,1007.28,,,0,"percent of total billed charges ","90% of total billed charges ",194.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1217.13,87,,973.70,,,0,"percent of total billed charges ","87% of total billed charges ",194.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",128.29,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",979.3,70,,783.44,,,0,"percent of total billed charges ","70% of total billed charges ",128.29,1301.07,
"*GIARDIA LAMBLIA",2039390,"CDM ",306,RC,87505,HCPCS,OUTPATIENT,,,604,483.2,,128.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",422.8,70,,338.24,,,0,"percent of total billed charges ","70% of total billed charges ",543.6,90,,434.88,,,0,"percent of total billed charges ","90% of total billed charges ",561.72,93,,449.38,,,0,"percent of total billed charges ","93% of total billed charges ",128.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",196.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",513.4,85,,410.72,,,0,"percent of total billed charges ","85% of total billed charges ",543.6,90,,434.88,,,0,"percent of total billed charges ","90% of total billed charges ",543.6,90,,434.88,,,0,"percent of total billed charges ","90% of total billed charges ",194.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",525.48,87,,420.38,,,0,"percent of total billed charges ","87% of total billed charges ",194.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",128.29,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",422.8,70,,338.24,,,0,"percent of total billed charges ","70% of total billed charges ",128.29,561.72,
"*CRYPTOSPOR PARVUM",2039400,"CDM ",306,RC,87505,HCPCS,OUTPATIENT,,,604,483.2,,128.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",422.8,70,,338.24,,,0,"percent of total billed charges ","70% of total billed charges ",543.6,90,,434.88,,,0,"percent of total billed charges ","90% of total billed charges ",561.72,93,,449.38,,,0,"percent of total billed charges ","93% of total billed charges ",128.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",196.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",513.4,85,,410.72,,,0,"percent of total billed charges ","85% of total billed charges ",543.6,90,,434.88,,,0,"percent of total billed charges ","90% of total billed charges ",543.6,90,,434.88,,,0,"percent of total billed charges ","90% of total billed charges ",194.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",525.48,87,,420.38,,,0,"percent of total billed charges ","87% of total billed charges ",194.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",128.29,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",422.8,70,,338.24,,,0,"percent of total billed charges ","70% of total billed charges ",128.29,561.72,
"*ENTAMOEBA HISTOLYTICA",2039410,"CDM ",306,RC,87505,HCPCS,OUTPATIENT,,,604,483.2,,128.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",422.8,70,,338.24,,,0,"percent of total billed charges ","70% of total billed charges ",543.6,90,,434.88,,,0,"percent of total billed charges ","90% of total billed charges ",561.72,93,,449.38,,,0,"percent of total billed charges ","93% of total billed charges ",128.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",196.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",513.4,85,,410.72,,,0,"percent of total billed charges ","85% of total billed charges ",543.6,90,,434.88,,,0,"percent of total billed charges ","90% of total billed charges ",543.6,90,,434.88,,,0,"percent of total billed charges ","90% of total billed charges ",194.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",525.48,87,,420.38,,,0,"percent of total billed charges ","87% of total billed charges ",194.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",128.29,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",422.8,70,,338.24,,,0,"percent of total billed charges ","70% of total billed charges ",128.29,561.72,
"CULTURE VIRAL BODY FLUID",2039420,"CDM ",306,RC,87252,HCPCS,OUTPATIENT,,,90,72,,26.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",26.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.59,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",35.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",35.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",26.07,83.7,
"SYPHILIS IGG/IGM RPR",2039440,"CDM ",302,RC,86780,HCPCS,OUTPATIENT,,,135,108,,13.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",125.55,93,,100.44,,,0,"percent of total billed charges ","93% of total billed charges ",13.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.29,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",114.75,85,,91.80,,,0,"percent of total billed charges ","85% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",21.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.45,87,,92.67,92.66,92.67,11,"percent of total billed charges ","87% of total billed charges ",21.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.24,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",13.24,125.55,
"TRICYCLIC ANTIDEPRESENTS URINE",2039450,"CDM ",301,RC,80335,HCPCS,OUTPATIENT,,,122.5,98,,23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",113.93,93,,91.14,,,0,"percent of total billed charges ","93% of total billed charges ",23.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.13,85,,83.30,,,0,"percent of total billed charges ","85% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.58,87,,85.26,,,0,"percent of total billed charges ","87% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",23.71,113.93,
"PROPOXYPHENE DRUG SCREEN URINE",2039460,"CDM ",301,RC,80367,HCPCS,OUTPATIENT,,,215,172,,10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",199.95,93,,159.96,,,0,"percent of total billed charges ","93% of total billed charges ",10.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",182.75,85,,146.20,,,0,"percent of total billed charges ","85% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",187.05,87,,149.64,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",10.4,199.95,
"QNATAL ADVANCE",2039470,"CDM ",300,RC,81420,HCPCS,OUTPATIENT,,,1941.5,1553.2,,671,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1359.05,70,,1087.24,,,0,"percent of total billed charges ","70% of total billed charges ",1747.35,90,,1397.88,,,0,"percent of total billed charges ","90% of total billed charges ",1805.6,93,,1444.48,,,0,"percent of total billed charges ","93% of total billed charges ",671,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",852.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1650.28,85,,1320.22,,,0,"percent of total billed charges ","85% of total billed charges ",1747.35,90,,1397.88,,,0,"percent of total billed charges ","90% of total billed charges ",1747.35,90,,1397.88,,,0,"percent of total billed charges ","90% of total billed charges ",844.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1689.11,87,,1351.29,,,0,"percent of total billed charges ","87% of total billed charges ",844.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",759.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1359.05,70,,1087.24,,,0,"percent of total billed charges ","70% of total billed charges ",671,1805.6,
"BETA HYDROXYBUTYRATE",2039480,"CDM ",301,RC,82010,HCPCS,OUTPATIENT,,,71,56.8,,6.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.7,70,,39.76,,,0,"percent of total billed charges ","70% of total billed charges ",63.9,90,,51.12,,,0,"percent of total billed charges ","90% of total billed charges ",66.03,93,,52.82,,,0,"percent of total billed charges ","93% of total billed charges ",6.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2.08,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",60.35,85,,48.28,,,0,"percent of total billed charges ","85% of total billed charges ",63.9,90,,51.12,,,0,"percent of total billed charges ","90% of total billed charges ",63.9,90,,51.12,,,0,"percent of total billed charges ","90% of total billed charges ",2.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",61.77,87,,49.42,,,0,"percent of total billed charges ","87% of total billed charges ",2.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.17,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",49.7,70,,39.76,,,0,"percent of total billed charges ","70% of total billed charges ",2.06,66.03,
"CLOSTRIDIUM DIFF RFLX TOXB PCR",2039490,"CDM ",306,RC,87081,HCPCS,OUTPATIENT,,,119.5,95.6,,6.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",111.14,93,,88.91,,,0,"percent of total billed charges ","93% of total billed charges ",6.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",101.58,85,,81.26,,,0,"percent of total billed charges ","85% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",103.97,87,,156.45,156.45,156.45,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.63,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.63,111.14,
"SWEET POTATO F54 IGE",2039500,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"VIRAL RESP RAPID CULTURE RFLX",2039510,"CDM ",306,RC,87254,HCPCS,OUTPATIENT,,,210.5,168.4,,16.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",195.77,93,,156.62,,,0,"percent of total billed charges ","93% of total billed charges ",16.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",178.93,85,,143.14,,,0,"percent of total billed charges ","85% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",7.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",183.14,87,,146.51,,,0,"percent of total billed charges ","87% of total billed charges ",7.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.55,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",7.52,195.77,
"ORGANIC ACIDS RAND URINE QL",2039525,"CDM ",301,RC,83919,HCPCS,OUTPATIENT,,,541,432.8,,13.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",378.7,70,,302.96,,,0,"percent of total billed charges ","70% of total billed charges ",486.9,90,,389.52,,,0,"percent of total billed charges ","90% of total billed charges ",503.13,93,,402.50,,,0,"percent of total billed charges ","93% of total billed charges ",13.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",459.85,85,,367.88,,,0,"percent of total billed charges ","85% of total billed charges ",486.9,90,,389.52,,,0,"percent of total billed charges ","90% of total billed charges ",486.9,90,,389.52,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",470.67,87,,376.54,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",378.7,70,,302.96,,,0,"percent of total billed charges ","70% of total billed charges ",13.18,503.13,
"*ORGANIC ACIDS QUALITATIVE",2039530,"CDM ",301,RC,83919,HCPCS,OUTPATIENT,,,336,268.8,,13.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",235.2,70,,188.16,,,0,"percent of total billed charges ","70% of total billed charges ",302.4,90,,241.92,,,0,"percent of total billed charges ","90% of total billed charges ",312.48,93,,249.98,,,0,"percent of total billed charges ","93% of total billed charges ",13.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",285.6,85,,228.48,,,0,"percent of total billed charges ","85% of total billed charges ",302.4,90,,241.92,,,0,"percent of total billed charges ","90% of total billed charges ",302.4,90,,241.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",292.32,87,,233.86,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",235.2,70,,188.16,,,0,"percent of total billed charges ","70% of total billed charges ",13.18,312.48,
"*HEP E VIRUS ANTIBODIES IGM",2039550,"CDM ",302,RC,86790,HCPCS,OUTPATIENT,,,93,74.4,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.58,80.58,80.58,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.1,70,,52.08,,,0,"percent of total billed charges ","70% of total billed charges ",83.7,90,,66.96,,,0,"percent of total billed charges ","90% of total billed charges ",86.49,93,,69.19,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",79.05,85,,63.24,,,0,"percent of total billed charges ","85% of total billed charges ",83.7,90,,66.96,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,90,,66.96,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.91,87,,199.98,199.98,199.98,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",65.1,70,,52.08,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,86.49,
"*HEP E VIRUS ANTIBODIES IGG",2039560,"CDM ",302,RC,86790,HCPCS,OUTPATIENT,,,93,74.4,,10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,80.58,80.58,80.58,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.1,70,,52.08,,,0,"percent of total billed charges ","70% of total billed charges ",83.7,90,,66.96,,,0,"percent of total billed charges ","90% of total billed charges ",86.49,93,,69.19,,,0,"percent of total billed charges ","93% of total billed charges ",10.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",79.05,85,,63.24,,,0,"percent of total billed charges ","85% of total billed charges ",83.7,90,,66.96,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,90,,66.96,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.91,87,,199.98,199.98,199.98,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",65.1,70,,52.08,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,86.49,
"EGG MIX (YOLK & WHITE) IGE",2039570,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"EGG WHITE IGE",2039580,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"QHERIT EXPANDED CARRIER SCREEN",2039610,"CDM ",300,RC,81443,HCPCS,OUTPATIENT,,,1898.5,1518.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1328.95,70,,1063.16,,,0,"percent of total billed charges ","70% of total billed charges ",1708.65,90,,1366.92,,,0,"percent of total billed charges ","90% of total billed charges ",1765.61,93,,1412.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1613.73,85,,1290.98,,,0,"percent of total billed charges ","85% of total billed charges ",1708.65,90,,1366.92,,,0,"percent of total billed charges ","90% of total billed charges ",1708.65,90,,1366.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1651.7,87,,1321.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2448.56,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1328.95,70,,1063.16,,,0,"percent of total billed charges ","70% of total billed charges ",1328.95,2448.56,
"VALPROIC ACID FREE",2039620,"CDM ",301,RC,80165,HCPCS,OUTPATIENT,,,59.5,47.6,,13.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.65,70,,33.32,,,0,"percent of total billed charges ","70% of total billed charges ",53.55,90,,42.84,,,0,"percent of total billed charges ","90% of total billed charges ",55.34,93,,44.27,,,0,"percent of total billed charges ","93% of total billed charges ",13.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.72,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",50.58,85,,40.46,,,0,"percent of total billed charges ","85% of total billed charges ",53.55,90,,42.84,,,0,"percent of total billed charges ","90% of total billed charges ",53.55,90,,42.84,,,0,"percent of total billed charges ","90% of total billed charges ",20.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",51.77,87,,41.42,,,0,"percent of total billed charges ","87% of total billed charges ",20.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.54,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",41.65,70,,33.32,,,0,"percent of total billed charges ","70% of total billed charges ",13.54,55.34,
*ISOENZYMES,2039630,"CDM ",301,RC,84080,HCPCS,OUTPATIENT,,,115.5,92.4,,14.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.85,70,,64.68,,,0,"percent of total billed charges ","70% of total billed charges ",103.95,90,,83.16,,,0,"percent of total billed charges ","90% of total billed charges ",107.42,93,,85.94,,,0,"percent of total billed charges ","93% of total billed charges ",14.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.02,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",98.18,85,,78.54,,,0,"percent of total billed charges ","85% of total billed charges ",103.95,90,,83.16,,,0,"percent of total billed charges ","90% of total billed charges ",103.95,90,,83.16,,,0,"percent of total billed charges ","90% of total billed charges ",26.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.49,87,,80.39,,,0,"percent of total billed charges ","87% of total billed charges ",26.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.78,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",80.85,70,,64.68,,,0,"percent of total billed charges ","70% of total billed charges ",14.78,107.42,
"*ALKALINE PHOSPHATE",2039650,"CDM ",301,RC,84075,HCPCS,OUTPATIENT,,,23,18.4,,5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,27.63,27.63,27.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.1,70,,12.88,,,0,"percent of total billed charges ","70% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",21.39,93,,17.11,,,0,"percent of total billed charges ","93% of total billed charges ",5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",19.55,85,,15.64,,,0,"percent of total billed charges ","85% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",9.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.01,87,,16.01,,,0,"percent of total billed charges ","87% of total billed charges ",9.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",16.1,70,,12.88,,,0,"percent of total billed charges ","70% of total billed charges ",5.18,21.39,
"LIVER FIBROSIS FIBRO/ACTI TEST",2039660,"CDM ",300,RC,81596,HCPCS,OUTPATIENT,,,449,359.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",314.3,70,,251.44,,,0,"percent of total billed charges ","70% of total billed charges ",404.1,90,,323.28,,,0,"percent of total billed charges ","90% of total billed charges ",417.57,93,,334.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",381.65,85,,305.32,,,0,"percent of total billed charges ","85% of total billed charges ",404.1,90,,323.28,,,0,"percent of total billed charges ","90% of total billed charges ",404.1,90,,323.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",390.63,87,,312.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",72.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",314.3,70,,251.44,,,0,"percent of total billed charges ","70% of total billed charges ",72.19,417.57,
"LYME DIS DNA QUAL PCR BLOOD",2039670,"CDM ",302,RC,87801,HCPCS,OUTPATIENT,,,506.5,405.2,,59.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,531.68,531.68,531.68,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",354.55,70,,283.64,,,0,"percent of total billed charges ","70% of total billed charges ",455.85,90,,364.68,,,0,"percent of total billed charges ","90% of total billed charges ",471.05,93,,376.84,,,0,"percent of total billed charges ","93% of total billed charges ",59.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",430.53,85,,344.42,,,0,"percent of total billed charges ","85% of total billed charges ",455.85,90,,364.68,,,0,"percent of total billed charges ","90% of total billed charges ",455.85,90,,364.68,,,0,"percent of total billed charges ","90% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",440.66,87,,352.53,,,0,"percent of total billed charges ","87% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.2,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",354.55,70,,283.64,,,0,"percent of total billed charges ","70% of total billed charges ",53.94,471.05,
"RPR W/REFLEX TITER FTA CONFIRM",2039680,"CDM ",302,RC,86592,HCPCS,OUTPATIENT,,,35,28,,4.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,19.37,19.37,19.37,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.5,70,,19.60,,,0,"percent of total billed charges ","70% of total billed charges ",31.5,90,,25.20,,,0,"percent of total billed charges ","90% of total billed charges ",32.55,93,,26.04,,,0,"percent of total billed charges ","93% of total billed charges ",4.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",29.75,85,,23.80,,,0,"percent of total billed charges ","85% of total billed charges ",31.5,90,,25.20,,,0,"percent of total billed charges ","90% of total billed charges ",31.5,90,,25.20,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.45,87,,23.71,23.71,23.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.26,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",24.5,70,,19.60,,,0,"percent of total billed charges ","70% of total billed charges ",4.26,32.55,
"*IMMUNOASSAY QUANT NONAB",2039700,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,71,56.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.7,70,,39.76,,,0,"percent of total billed charges ","70% of total billed charges ",63.9,90,,51.12,,,0,"percent of total billed charges ","90% of total billed charges ",66.03,93,,52.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",60.35,85,,48.28,,,0,"percent of total billed charges ","85% of total billed charges ",63.9,90,,51.12,,,0,"percent of total billed charges ","90% of total billed charges ",63.9,90,,51.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",61.77,87,,49.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",49.7,70,,39.76,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,66.03,
"*QUANT THERAPEUTIC DRUG",2039710,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,210,168,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147,70,,117.60,,,0,"percent of total billed charges ","70% of total billed charges ",189,90,,151.20,,,0,"percent of total billed charges ","90% of total billed charges ",195.3,93,,156.24,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",178.5,85,,142.80,,,0,"percent of total billed charges ","85% of total billed charges ",189,90,,151.20,,,0,"percent of total billed charges ","90% of total billed charges ",189,90,,151.20,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",182.7,87,,146.16,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",147,70,,117.60,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,195.3,
"SYNTH CANNABINOIDS QUAL BLD >7",2039720,"CDM ",301,RC,80352,HCPCS,OUTPATIENT,,,82.5,66,,17.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.75,70,,46.20,,,0,"percent of total billed charges ","70% of total billed charges ",74.25,90,,59.40,,,0,"percent of total billed charges ","90% of total billed charges ",76.73,93,,61.38,,,0,"percent of total billed charges ","93% of total billed charges ",17.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.13,85,,56.10,,,0,"percent of total billed charges ","85% of total billed charges ",74.25,90,,59.40,,,0,"percent of total billed charges ","90% of total billed charges ",74.25,90,,59.40,,,0,"percent of total billed charges ","90% of total billed charges ",22.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",71.78,87,,57.42,,,0,"percent of total billed charges ","87% of total billed charges ",22.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",57.75,70,,46.20,,,0,"percent of total billed charges ","70% of total billed charges ",17.88,76.73,
"DRUG MONITOR PANEL 8 W/CONF UR",2039730,"CDM ",301,RC,80307,HCPCS,OUTPATIENT,,,189.5,151.6,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.65,70,,106.12,,,0,"percent of total billed charges ","70% of total billed charges ",170.55,90,,136.44,,,0,"percent of total billed charges ","90% of total billed charges ",176.24,93,,140.99,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",161.08,85,,128.86,,,0,"percent of total billed charges ","85% of total billed charges ",170.55,90,,136.44,,,0,"percent of total billed charges ","90% of total billed charges ",170.55,90,,136.44,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",164.87,87,,131.90,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",132.65,70,,106.12,,,0,"percent of total billed charges ","70% of total billed charges ",62.14,176.24,
"DRUG MONITOR METHYLPHENIDATE",2039740,"CDM ",301,RC,80360,HCPCS,OUTPATIENT,,,44.5,35.6,,19.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.15,70,,24.92,,,0,"percent of total billed charges ","70% of total billed charges ",40.05,90,,32.04,,,0,"percent of total billed charges ","90% of total billed charges ",41.39,93,,33.11,,,0,"percent of total billed charges ","93% of total billed charges ",19.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.37,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",37.83,85,,30.26,,,0,"percent of total billed charges ","85% of total billed charges ",40.05,90,,32.04,,,0,"percent of total billed charges ","90% of total billed charges ",40.05,90,,32.04,,,0,"percent of total billed charges ","90% of total billed charges ",25.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.72,87,,30.98,,,0,"percent of total billed charges ","87% of total billed charges ",25.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",31.15,70,,24.92,,,0,"percent of total billed charges ","70% of total billed charges ",19.97,41.39,
"RITUXAN SENSITIVITY CD20",2039750,"CDM ",300,RC,86356,HCPCS,OUTPATIENT,,,152,121.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",141.36,93,,113.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",21.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",129.2,85,,103.36,,,0,"percent of total billed charges ","85% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",21.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.24,87,,105.79,,,0,"percent of total billed charges ","87% of total billed charges ",21.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.78,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",21.14,141.36,
"DRUG SCRN METHAMPH QUANT URINE",2039770,"CDM ",300,RC,80374,HCPCS,OUTPATIENT,,,55.5,44.4,,9.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.85,70,,31.08,,,0,"percent of total billed charges ","70% of total billed charges ",49.95,90,,39.96,,,0,"percent of total billed charges ","90% of total billed charges ",51.62,93,,41.30,,,0,"percent of total billed charges ","93% of total billed charges ",9.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",47.18,85,,37.74,,,0,"percent of total billed charges ","85% of total billed charges ",49.95,90,,39.96,,,0,"percent of total billed charges ","90% of total billed charges ",49.95,90,,39.96,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",48.29,87,,38.63,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",38.85,70,,31.08,,,0,"percent of total billed charges ","70% of total billed charges ",9.1,51.62,
"DRUG SCRN BUPRENOPHINE QT URIN",2039780,"CDM ",300,RC,80348,HCPCS,OUTPATIENT,,,55.5,44.4,,19.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,21.30,21.30,21.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.85,70,,31.08,,,0,"percent of total billed charges ","70% of total billed charges ",49.95,90,,39.96,,,0,"percent of total billed charges ","90% of total billed charges ",51.62,93,,41.30,,,0,"percent of total billed charges ","93% of total billed charges ",19.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.37,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",47.18,85,,37.74,,,0,"percent of total billed charges ","85% of total billed charges ",49.95,90,,39.96,,,0,"percent of total billed charges ","90% of total billed charges ",49.95,90,,39.96,,,0,"percent of total billed charges ","90% of total billed charges ",25.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",48.29,87,,38.63,,,0,"percent of total billed charges ","87% of total billed charges ",25.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",38.85,70,,31.08,,,0,"percent of total billed charges ","70% of total billed charges ",19.97,51.62,
"CANNABINOIDS PANEL SERUM/PLASM",2039785,"CDM ",302,RC,80349,HCPCS,OUTPATIENT,,,69.5,55.6,,17.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.65,70,,38.92,,,0,"percent of total billed charges ","70% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",64.64,93,,51.71,,,0,"percent of total billed charges ","93% of total billed charges ",17.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",59.08,85,,47.26,,,0,"percent of total billed charges ","85% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",22.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60.47,87,,48.38,,,0,"percent of total billed charges ","87% of total billed charges ",22.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",48.65,70,,38.92,,,0,"percent of total billed charges ","70% of total billed charges ",17.88,64.64,
"AMMONIUM 24HR URINE",2039790,"CDM ",301,RC,82140,HCPCS,OUTPATIENT,,,269,215.2,,12.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,192.10,192.10,192.10,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.3,70,,150.64,,,0,"percent of total billed charges ","70% of total billed charges ",242.1,90,,193.68,,,0,"percent of total billed charges ","90% of total billed charges ",250.17,93,,200.14,,,0,"percent of total billed charges ","93% of total billed charges ",12.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",228.65,85,,182.92,,,0,"percent of total billed charges ","85% of total billed charges ",242.1,90,,193.68,,,0,"percent of total billed charges ","90% of total billed charges ",242.1,90,,193.68,,,0,"percent of total billed charges ","90% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",234.03,87,,187.22,,,0,"percent of total billed charges ","87% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.57,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",188.3,70,,150.64,,,0,"percent of total billed charges ","70% of total billed charges ",12.38,250.17,
"BRCA ADVANTAGE COMPREHENSIVE",2039800,"CDM ",300,RC,81162,HCPCS,OUTPATIENT,,,3945,3156,,,,,,,,0,"other ","not separately reimbursment ",,,,2287.50,2287.50,2287.50,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2761.5,70,,2209.20,,,0,"percent of total billed charges ","70% of total billed charges ",3550.5,90,,2840.40,,,0,"percent of total billed charges ","90% of total billed charges ",3668.85,93,,2935.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3353.25,85,,2682.60,,,0,"percent of total billed charges ","85% of total billed charges ",3550.5,90,,2840.40,,,0,"percent of total billed charges ","90% of total billed charges ",3550.5,90,,2840.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3432.15,87,,2745.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1824.88,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",2761.5,70,,2209.20,,,0,"percent of total billed charges ","70% of total billed charges ",1824.88,3668.85,
"CLOPIDOGREL CYPZCIA GENOTYPE",2039810,"CDM ",300,RC,81225,HCPCS,OUTPATIENT,,,706,564.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",494.2,70,,395.36,,,0,"percent of total billed charges ","70% of total billed charges ",635.4,90,,508.32,,,0,"percent of total billed charges ","90% of total billed charges ",656.58,93,,525.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",600.1,85,,480.08,,,0,"percent of total billed charges ","85% of total billed charges ",635.4,90,,508.32,,,0,"percent of total billed charges ","90% of total billed charges ",635.4,90,,508.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",614.22,87,,491.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",291.36,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",494.2,70,,395.36,,,0,"percent of total billed charges ","70% of total billed charges ",291.36,656.58,
"HISTAMINE RELEASE",2039820,"CDM ",302,RC,86343,HCPCS,OUTPATIENT,,,162.5,130,,10.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.75,70,,91.00,,,0,"percent of total billed charges ","70% of total billed charges ",146.25,90,,117.00,,,0,"percent of total billed charges ","90% of total billed charges ",151.13,93,,120.90,,,0,"percent of total billed charges ","93% of total billed charges ",10.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",138.13,85,,110.50,,,0,"percent of total billed charges ","85% of total billed charges ",146.25,90,,117.00,,,0,"percent of total billed charges ","90% of total billed charges ",146.25,90,,117.00,,,0,"percent of total billed charges ","90% of total billed charges ",7.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",141.38,87,,113.10,,,0,"percent of total billed charges ","87% of total billed charges ",7.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.46,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",113.75,70,,91.00,,,0,"percent of total billed charges ","70% of total billed charges ",7.52,151.13,
"SM/RNP ANTIBODY",2039830,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,83.5,66.8,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",77.66,93,,62.13,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.98,85,,56.78,,,0,"percent of total billed charges ","85% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",72.65,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,77.66,
"COENZYME Q10",2039840,"CDM ",301,RC,82542,HCPCS,OUTPATIENT,,,267.5,214,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",248.78,93,,199.02,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",227.38,85,,181.90,,,0,"percent of total billed charges ","85% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",232.73,87,,186.18,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,248.78,
"RESPIRATORY VIRAL PANEL PCR",2039850,"CDM ",306,RC,87633,HCPCS,OUTPATIENT,,,2247,1797.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1572.9,70,,1258.32,,,0,"percent of total billed charges ","70% of total billed charges ",2022.3,90,,1617.84,,,0,"percent of total billed charges ","90% of total billed charges ",2089.71,93,,1671.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",391.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1909.95,85,,1527.96,,,0,"percent of total billed charges ","85% of total billed charges ",2022.3,90,,1617.84,,,0,"percent of total billed charges ","90% of total billed charges ",2022.3,90,,1617.84,,,0,"percent of total billed charges ","90% of total billed charges ",387.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1954.89,87,,1563.91,,,0,"percent of total billed charges ","87% of total billed charges ",387.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",416.78,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",1572.9,70,,1258.32,,,0,"percent of total billed charges ","70% of total billed charges ",387.29,2089.71,
"HEP B SAG W/REFLEX CONF",2039870,"CDM ",306,RC,87340,HCPCS,OUTPATIENT,,,68,54.4,,10.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.6,70,,38.08,,,0,"percent of total billed charges ","70% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",63.24,93,,50.59,,,0,"percent of total billed charges ","93% of total billed charges ",10.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",57.8,85,,46.24,,,0,"percent of total billed charges ","85% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",15.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.16,87,,46.55,46.55,46.55,11,"percent of total billed charges ","87% of total billed charges ",15.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.33,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",47.6,70,,38.08,,,0,"percent of total billed charges ","70% of total billed charges ",10.33,63.24,
"NICKEL BLOOD",2039880,"CDM ",301,RC,83885,HCPCS,OUTPATIENT,,,62.5,50,,8.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.75,70,,35.00,,,0,"percent of total billed charges ","70% of total billed charges ",56.25,90,,45.00,,,0,"percent of total billed charges ","90% of total billed charges ",58.13,93,,46.50,,,0,"percent of total billed charges ","93% of total billed charges ",8.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",53.13,85,,42.50,,,0,"percent of total billed charges ","85% of total billed charges ",56.25,90,,45.00,,,0,"percent of total billed charges ","90% of total billed charges ",56.25,90,,45.00,,,0,"percent of total billed charges ","90% of total billed charges ",10.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.38,87,,43.50,,,0,"percent of total billed charges ","87% of total billed charges ",10.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.51,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",43.75,70,,35.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.01,58.13,
"LYSOZYME (MURAMIDASE)",2039890,"CDM ",305,RC,85549,HCPCS,OUTPATIENT,,,56,44.8,,15.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.2,70,,31.36,,,0,"percent of total billed charges ","70% of total billed charges ",50.4,90,,40.32,,,0,"percent of total billed charges ","90% of total billed charges ",52.08,93,,41.66,,,0,"percent of total billed charges ","93% of total billed charges ",15.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",47.6,85,,38.08,,,0,"percent of total billed charges ","85% of total billed charges ",50.4,90,,40.32,,,0,"percent of total billed charges ","90% of total billed charges ",50.4,90,,40.32,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",48.72,87,,32.22,32.22,32.22,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.75,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",39.2,70,,31.36,,,0,"percent of total billed charges ","70% of total billed charges ",13.18,52.08,
PALIPERIDONE,2039900,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,162.5,130,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.75,70,,91.00,,,0,"percent of total billed charges ","70% of total billed charges ",146.25,90,,117.00,,,0,"percent of total billed charges ","90% of total billed charges ",151.13,93,,120.90,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",138.13,85,,110.50,,,0,"percent of total billed charges ","85% of total billed charges ",146.25,90,,117.00,,,0,"percent of total billed charges ","90% of total billed charges ",146.25,90,,117.00,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",141.38,87,,113.10,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",113.75,70,,91.00,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,151.13,
"*ACT PROTEIN C RESIST ASSAY",2039930,"CDM ",305,RC,85307,HCPCS,OUTPATIENT,,,280,224,,15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",196,70,,156.80,,,0,"percent of total billed charges ","70% of total billed charges ",252,90,,201.60,,,0,"percent of total billed charges ","90% of total billed charges ",260.4,93,,208.32,,,0,"percent of total billed charges ","93% of total billed charges ",15.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",238,85,,190.40,,,0,"percent of total billed charges ","85% of total billed charges ",252,90,,201.60,,,0,"percent of total billed charges ","90% of total billed charges ",252,90,,201.60,,,0,"percent of total billed charges ","90% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",243.6,87,,194.88,,,0,"percent of total billed charges ","87% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.32,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",196,70,,156.80,,,0,"percent of total billed charges ","70% of total billed charges ",15.32,260.4,
"*PTT 20210G A MUTATION ANALYS",2039940,"CDM ",305,RC,85730,HCPCS,OUTPATIENT,,,47,37.6,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",43.71,93,,34.97,,,0,"percent of total billed charges ","93% of total billed charges ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.95,85,,31.96,,,0,"percent of total billed charges ","85% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.89,87,,49.13,5.89,151.44,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,43.71,
"SARS COV2 RNA QLT RT PCR",2039960,"CDM ",306,RC,87635,HCPCS,OUTPATIENT,,,203,162.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.1,70,,113.68,,,0,"percent of total billed charges ","70% of total billed charges ",182.7,90,,146.16,,,0,"percent of total billed charges ","90% of total billed charges ",188.79,93,,151.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",44.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",172.55,85,,138.04,,,0,"percent of total billed charges ","85% of total billed charges ",182.7,90,,146.16,,,0,"percent of total billed charges ","90% of total billed charges ",182.7,90,,146.16,,,0,"percent of total billed charges ","90% of total billed charges ",43.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",176.61,87,,50.29,48.84,128.07,"1 through 10","percent of total billed charges ","87% of total billed charges ",43.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",51.31,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.1,70,,113.68,,,0,"percent of total billed charges ","70% of total billed charges ",43.61,188.79,
"ALBUMIN CSF",2039970,"CDM ",301,RC,82042,HCPCS,OUTPATIENT,,,53,42.4,,6.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",49.29,93,,39.43,,,0,"percent of total billed charges ","93% of total billed charges ",6.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.05,85,,36.04,,,0,"percent of total billed charges ","85% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.11,87,,36.89,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.78,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",6.61,49.29,
PHENYLALANINE,2039980,"CDM ",301,RC,84030,HCPCS,OUTPATIENT,,,34.5,27.6,,4.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.15,70,,19.32,,,0,"percent of total billed charges ","70% of total billed charges ",31.05,90,,24.84,,,0,"percent of total billed charges ","90% of total billed charges ",32.09,93,,25.67,,,0,"percent of total billed charges ","93% of total billed charges ",4.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",29.33,85,,23.46,,,0,"percent of total billed charges ","85% of total billed charges ",31.05,90,,24.84,,,0,"percent of total billed charges ","90% of total billed charges ",31.05,90,,24.84,,,0,"percent of total billed charges ","90% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.02,87,,24.02,,,0,"percent of total billed charges ","87% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.5,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",24.15,70,,19.32,,,0,"percent of total billed charges ","70% of total billed charges ",4.68,32.09,
RUFINAMIDE,2039990,"CDM ",301,RC,80339,HCPCS,OUTPATIENT,,,103.5,82.8,,15.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.45,70,,57.96,,,0,"percent of total billed charges ","70% of total billed charges ",93.15,90,,74.52,,,0,"percent of total billed charges ","90% of total billed charges ",96.26,93,,77.01,,,0,"percent of total billed charges ","93% of total billed charges ",15.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",87.98,85,,70.38,,,0,"percent of total billed charges ","85% of total billed charges ",93.15,90,,74.52,,,0,"percent of total billed charges ","90% of total billed charges ",93.15,90,,74.52,,,0,"percent of total billed charges ","90% of total billed charges ",19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",90.05,87,,72.04,,,0,"percent of total billed charges ","87% of total billed charges ",19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",72.45,70,,57.96,,,0,"percent of total billed charges ","70% of total billed charges ",15.5,96.26,
"MYCOPLASMA HOMINIS UREAPLS CUL",2040000,"CDM ",306,RC,87109,HCPCS,OUTPATIENT,,,170.5,136.4,,13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.35,70,,95.48,,,0,"percent of total billed charges ","70% of total billed charges ",153.45,90,,122.76,,,0,"percent of total billed charges ","90% of total billed charges ",158.57,93,,126.86,,,0,"percent of total billed charges ","93% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",144.93,85,,115.94,,,0,"percent of total billed charges ","85% of total billed charges ",153.45,90,,122.76,,,0,"percent of total billed charges ","90% of total billed charges ",153.45,90,,122.76,,,0,"percent of total billed charges ","90% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",148.34,87,,118.67,,,0,"percent of total billed charges ","87% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",119.35,70,,95.48,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,158.57,
"STAPH PCR",2040010,"CDM ",306,RC,87150,HCPCS,OUTPATIENT,,,204,163.2,,34.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",34.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.27,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",44.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.48,87,,141.98,,,0,"percent of total billed charges ","87% of total billed charges ",44.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",34.26,189.72,
"BRIVARACETAM BLOOD LIQ CHROMAT",2040020,"CDM ",301,RC,80375,HCPCS,OUTPATIENT,,,177,141.6,,17.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.9,70,,99.12,,,0,"percent of total billed charges ","70% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",164.61,93,,131.69,,,0,"percent of total billed charges ","93% of total billed charges ",17.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",150.45,85,,120.36,,,0,"percent of total billed charges ","85% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",22.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",153.99,87,,123.19,,,0,"percent of total billed charges ","87% of total billed charges ",22.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",123.9,70,,99.12,,,0,"percent of total billed charges ","70% of total billed charges ",17.88,164.61,
"*NF1 SEQUENCING",2040040,"CDM ",300,RC,81408,HCPCS,OUTPATIENT,,,649,519.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",454.3,70,,363.44,,,0,"percent of total billed charges ","70% of total billed charges ",584.1,90,,467.28,,,0,"percent of total billed charges ","90% of total billed charges ",603.57,93,,482.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",551.65,85,,441.32,,,0,"percent of total billed charges ","85% of total billed charges ",584.1,90,,467.28,,,0,"percent of total billed charges ","90% of total billed charges ",584.1,90,,467.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",564.63,87,,451.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2000,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",454.3,70,,363.44,,,0,"percent of total billed charges ","70% of total billed charges ",454.3,2000,
"*NF1 DELETION / DUPLICATION",2040050,"CDM ",300,RC,81479,HCPCS,OUTPATIENT,,,219.5,175.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.65,70,,122.92,,,0,"percent of total billed charges ","70% of total billed charges ",197.55,90,,158.04,,,0,"percent of total billed charges ","90% of total billed charges ",204.14,93,,163.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",186.58,85,,149.26,,,0,"percent of total billed charges ","85% of total billed charges ",197.55,90,,158.04,,,0,"percent of total billed charges ","90% of total billed charges ",197.55,90,,158.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",190.97,87,,152.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.65,70,,122.92,,,0,"percent of total billed charges ","70% of total billed charges ",153.65,204.14,
"FRESH FROZEN PLASMA THAWING",2040060,"CDM ",390,RC,86927,HCPCS,OUTPATIENT,,,341,272.8,,129.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",238.7,70,,190.96,,,0,"percent of total billed charges ","70% of total billed charges ",306.9,90,,245.52,,,0,"percent of total billed charges ","90% of total billed charges ",317.13,93,,253.70,,,0,"percent of total billed charges ","93% of total billed charges ",129.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",289.85,85,,231.88,,,0,"percent of total billed charges ","85% of total billed charges ",306.9,90,,245.52,,,0,"percent of total billed charges ","90% of total billed charges ",306.9,90,,245.52,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",296.67,87,,237.34,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",238.7,70,,190.96,,,0,"percent of total billed charges ","70% of total billed charges ",26.17,317.13,
"FROZEN CRYOPRECIP THAWING",2040070,"CDM ",390,RC,86931,HCPCS,OUTPATIENT,,,665,532,,20.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",465.5,70,,372.40,,,0,"percent of total billed charges ","70% of total billed charges ",598.5,90,,478.80,,,0,"percent of total billed charges ","90% of total billed charges ",618.45,93,,494.76,,,0,"percent of total billed charges ","93% of total billed charges ",20.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",565.25,85,,452.20,,,0,"percent of total billed charges ","85% of total billed charges ",598.5,90,,478.80,,,0,"percent of total billed charges ","90% of total billed charges ",598.5,90,,478.80,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",578.55,87,,462.84,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",465.5,70,,372.40,,,0,"percent of total billed charges ","70% of total billed charges ",20.8,618.45,
"SARS COV2 RNA QLT RT PCR INHS",2040080,"CDM ",306,RC,87635,HCPCS,OUTPATIENT,,,203,162.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.1,70,,113.68,,,0,"percent of total billed charges ","70% of total billed charges ",182.7,90,,146.16,,,0,"percent of total billed charges ","90% of total billed charges ",188.79,93,,151.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",44.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",172.55,85,,138.04,,,0,"percent of total billed charges ","85% of total billed charges ",182.7,90,,146.16,,,0,"percent of total billed charges ","90% of total billed charges ",182.7,90,,146.16,,,0,"percent of total billed charges ","90% of total billed charges ",43.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",176.61,87,,50.29,48.84,128.07,"1 through 10","percent of total billed charges ","87% of total billed charges ",43.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",51.31,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.1,70,,113.68,,,0,"percent of total billed charges ","70% of total billed charges ",43.61,188.79,
"HIV 1/2 ATG ATB 4TH GEN W/RFLX",2040090,"CDM ",306,RC,87389,HCPCS,OUTPATIENT,,,97,77.6,,24.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,35.73,35.73,35.73,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",90.21,93,,72.17,,,0,"percent of total billed charges ","93% of total billed charges ",24.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",82.45,85,,65.96,,,0,"percent of total billed charges ","85% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",87.3,90,,69.84,,,0,"percent of total billed charges ","90% of total billed charges ",36.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.39,87,,67.51,,,0,"percent of total billed charges ","87% of total billed charges ",36.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.08,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",67.9,70,,54.32,,,0,"percent of total billed charges ","70% of total billed charges ",24.08,90.21,
"COLLAGEN TYPE I C-TELOPEPTIDE",2040100,"CDM ",301,RC,82523,HCPCS,OUTPATIENT,,,89.5,71.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.65,70,,50.12,,,0,"percent of total billed charges ","70% of total billed charges ",80.55,90,,64.44,,,0,"percent of total billed charges ","90% of total billed charges ",83.24,93,,66.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",76.08,85,,60.86,,,0,"percent of total billed charges ","85% of total billed charges ",80.55,90,,64.44,,,0,"percent of total billed charges ","90% of total billed charges ",80.55,90,,64.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",77.87,87,,62.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",18.68,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",62.65,70,,50.12,,,0,"percent of total billed charges ","70% of total billed charges ",18.68,83.24,
"*IMMUNOGLOBULIN IGG CSF",2040120,"CDM ",301,RC,82784,HCPCS,OUTPATIENT,,,68.5,54.8,,9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.95,70,,38.36,,,0,"percent of total billed charges ","70% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",63.71,93,,50.97,,,0,"percent of total billed charges ","93% of total billed charges ",9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",58.23,85,,46.58,,,0,"percent of total billed charges ","85% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.6,87,,47.68,,,0,"percent of total billed charges ","87% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",47.95,70,,38.36,,,0,"percent of total billed charges ","70% of total billed charges ",9.3,63.71,
"*IMMUNOGLOBULIN IGA CSF",2040130,"CDM ",301,RC,82784,HCPCS,OUTPATIENT,,,68.5,54.8,,9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.95,70,,38.36,,,0,"percent of total billed charges ","70% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",63.71,93,,50.97,,,0,"percent of total billed charges ","93% of total billed charges ",9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",58.23,85,,46.58,,,0,"percent of total billed charges ","85% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.6,87,,47.68,,,0,"percent of total billed charges ","87% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",47.95,70,,38.36,,,0,"percent of total billed charges ","70% of total billed charges ",9.3,63.71,
"*IMMUNOGLOBULIN IGM CSF",2040140,"CDM ",301,RC,82784,HCPCS,OUTPATIENT,,,68.5,54.8,,9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.95,70,,38.36,,,0,"percent of total billed charges ","70% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",63.71,93,,50.97,,,0,"percent of total billed charges ","93% of total billed charges ",9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",58.23,85,,46.58,,,0,"percent of total billed charges ","85% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.6,87,,47.68,,,0,"percent of total billed charges ","87% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",47.95,70,,38.36,,,0,"percent of total billed charges ","70% of total billed charges ",9.3,63.71,
"STREP PNEUMONIAE ANTIGEN URINE",2040150,"CDM ",306,RC,87899,HCPCS,OUTPATIENT,,,213.5,170.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.45,70,,119.56,,,0,"percent of total billed charges ","70% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",198.56,93,,158.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",14.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",181.48,85,,145.18,,,0,"percent of total billed charges ","85% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",14.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",185.75,87,,148.60,,,0,"percent of total billed charges ","87% of total billed charges ",14.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",149.45,70,,119.56,,,0,"percent of total billed charges ","70% of total billed charges ",14.82,198.56,
"MANGO FRUIT F91 IGE",2040160,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"SARS COV2 SEROLOGY ANTIBODY",2040170,"CDM ",302,RC,86769,HCPCS,OUTPATIENT,,,146,116.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",36.17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,101.62,,,0,"percent of total billed charges ","87% of total billed charges ",35.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.13,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",35.81,135.78,
"*MYELOPEROXIDASE ABS",2040190,"CDM ",302,RC,86021,HCPCS,OUTPATIENT,,,90,72,,12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",9.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",9.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",9.82,83.7,
"*PROTEINASE 3 ABS",2040200,"CDM ",302,RC,86021,HCPCS,OUTPATIENT,,,90,72,,12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",12.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",9.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",9.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",9.82,83.7,
"NICOTINE COTININE URINE",2040210,"CDM ",301,RC,80323,HCPCS,OUTPATIENT,,,152.5,122,,11.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,42.90,42.90,42.90,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.75,70,,85.40,,,0,"percent of total billed charges ","70% of total billed charges ",137.25,90,,109.80,,,0,"percent of total billed charges ","90% of total billed charges ",141.83,93,,113.46,,,0,"percent of total billed charges ","93% of total billed charges ",11.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",129.63,85,,103.70,,,0,"percent of total billed charges ","85% of total billed charges ",137.25,90,,109.80,,,0,"percent of total billed charges ","90% of total billed charges ",137.25,90,,109.80,,,0,"percent of total billed charges ","90% of total billed charges ",14.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.68,87,,106.14,,,0,"percent of total billed charges ","87% of total billed charges ",14.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",106.75,70,,85.40,,,0,"percent of total billed charges ","70% of total billed charges ",11.86,141.83,
"VITAMIN B2 RIBOFLAVIN PLASMA",2040220,"CDM ",301,RC,84252,HCPCS,OUTPATIENT,,,240,192,,20.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",168,70,,134.40,,,0,"percent of total billed charges ","70% of total billed charges ",216,90,,172.80,,,0,"percent of total billed charges ","90% of total billed charges ",223.2,93,,178.56,,,0,"percent of total billed charges ","93% of total billed charges ",20.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",204,85,,163.20,,,0,"percent of total billed charges ","85% of total billed charges ",216,90,,172.80,,,0,"percent of total billed charges ","90% of total billed charges ",216,90,,172.80,,,0,"percent of total billed charges ","90% of total billed charges ",36.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",208.8,87,,167.04,,,0,"percent of total billed charges ","87% of total billed charges ",36.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.23,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",168,70,,134.40,,,0,"percent of total billed charges ","70% of total billed charges ",20.23,223.2,
"TISSUE TRANSGLUTAMINASEAB IGA",2040230,"CDM ",301,RC,83516,HCPCS,OUTPATIENT,,,127,101.6,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.9,70,,71.12,,,0,"percent of total billed charges ","70% of total billed charges ",114.3,90,,91.44,,,0,"percent of total billed charges ","90% of total billed charges ",118.11,93,,94.49,,,0,"percent of total billed charges ","93% of total billed charges ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",107.95,85,,86.36,,,0,"percent of total billed charges ","85% of total billed charges ",114.3,90,,91.44,,,0,"percent of total billed charges ","90% of total billed charges ",114.3,90,,91.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",110.49,87,,53.32,28.74,77.90,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",88.9,70,,71.12,,,0,"percent of total billed charges ","70% of total billed charges ",10,118.11,
"AMINO ACID ANALYSIS LC/MS PLSM",2040240,"CDM ",301,RC,82139,HCPCS,OUTPATIENT,,,720,576,,16.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",504,70,,403.20,,,0,"percent of total billed charges ","70% of total billed charges ",648,90,,518.40,,,0,"percent of total billed charges ","90% of total billed charges ",669.6,93,,535.68,,,0,"percent of total billed charges ","93% of total billed charges ",16.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",612,85,,489.60,,,0,"percent of total billed charges ","85% of total billed charges ",648,90,,518.40,,,0,"percent of total billed charges ","90% of total billed charges ",648,90,,518.40,,,0,"percent of total billed charges ","90% of total billed charges ",23.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",626.4,87,,501.12,,,0,"percent of total billed charges ","87% of total billed charges ",23.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.87,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",504,70,,403.20,,,0,"percent of total billed charges ","70% of total billed charges ",16.87,669.6,
"IMMUNOGLOBULIN IGM CSF",2040250,"CDM ",301,RC,82784,HCPCS,OUTPATIENT,,,68.5,54.8,,9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.95,70,,38.36,,,0,"percent of total billed charges ","70% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",63.71,93,,50.97,,,0,"percent of total billed charges ","93% of total billed charges ",9.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",58.23,85,,46.58,,,0,"percent of total billed charges ","85% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.6,87,,47.68,,,0,"percent of total billed charges ","87% of total billed charges ",16.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.3,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",47.95,70,,38.36,,,0,"percent of total billed charges ","70% of total billed charges ",9.3,63.71,
"VANILLA F234 IGE",2040260,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,45,36,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.15,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,41.85,
"TOTAL GLYCOHEMOGLOBIN",2040270,"CDM ",301,RC,83036,HCPCS,OUTPATIENT,,,54.5,43.6,,9.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,9.52,9.52,9.52,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.15,70,,30.52,,,0,"percent of total billed charges ","70% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",50.69,93,,40.55,,,0,"percent of total billed charges ","93% of total billed charges ",9.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.73,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",46.33,85,,37.06,,,0,"percent of total billed charges ","85% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",17.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.42,87,,48.62,9.52,60.77,36,"percent of total billed charges ","87% of total billed charges ",17.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",38.15,70,,30.52,,,0,"percent of total billed charges ","70% of total billed charges ",9.71,50.69,
BIOTINIDASE,2040280,"CDM ",301,RC,82261,HCPCS,OUTPATIENT,,,116.5,93.2,,14.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.55,70,,65.24,,,0,"percent of total billed charges ","70% of total billed charges ",104.85,90,,83.88,,,0,"percent of total billed charges ","90% of total billed charges ",108.35,93,,86.68,,,0,"percent of total billed charges ","93% of total billed charges ",14.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",99.03,85,,79.22,,,0,"percent of total billed charges ","85% of total billed charges ",104.85,90,,83.88,,,0,"percent of total billed charges ","90% of total billed charges ",104.85,90,,83.88,,,0,"percent of total billed charges ","90% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",101.36,87,,81.09,,,0,"percent of total billed charges ","87% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.87,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",81.55,70,,65.24,,,0,"percent of total billed charges ","70% of total billed charges ",13.74,108.35,
"RBC ANTIBODY SCREEN W/RFLX ID",2040300,"CDM ",302,RC,86850,HCPCS,OUTPATIENT,,,119.5,95.6,,8.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",111.14,93,,88.91,,,0,"percent of total billed charges ","93% of total billed charges ",8.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",101.58,85,,81.26,,,0,"percent of total billed charges ","85% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",103.97,87,,81.89,81.89,81.89,12,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.92,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",8.3,111.14,
"HEP C RNA GENO NS5B DRG RESIST",2040305,"CDM ",306,RC,87902,HCPCS,OUTPATIENT,,,1145,916,,,,,,,,0,"other ","not separately reimbursment ",,,,306.82,306.82,306.82,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",801.5,70,,641.20,,,0,"percent of total billed charges ","70% of total billed charges ",1030.5,90,,824.40,,,0,"percent of total billed charges ","90% of total billed charges ",1064.85,93,,851.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",321.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",973.25,85,,778.60,,,0,"percent of total billed charges ","85% of total billed charges ",1030.5,90,,824.40,,,0,"percent of total billed charges ","90% of total billed charges ",1030.5,90,,824.40,,,0,"percent of total billed charges ","90% of total billed charges ",317.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",996.15,87,,796.92,,,0,"percent of total billed charges ","87% of total billed charges ",317.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",801.5,70,,641.20,,,0,"percent of total billed charges ","70% of total billed charges ",257.45,1064.85,
"STRONGYLOIDES AB IGG",2040310,"CDM ",302,RC,86682,HCPCS,OUTPATIENT,,,149,119.2,,11.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.3,70,,83.44,,,0,"percent of total billed charges ","70% of total billed charges ",134.1,90,,107.28,,,0,"percent of total billed charges ","90% of total billed charges ",138.57,93,,110.86,,,0,"percent of total billed charges ","93% of total billed charges ",11.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",126.65,85,,101.32,,,0,"percent of total billed charges ","85% of total billed charges ",134.1,90,,107.28,,,0,"percent of total billed charges ","90% of total billed charges ",134.1,90,,107.28,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",129.63,87,,155.16,155.16,155.16,"1 through 10","percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",104.3,70,,83.44,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,138.57,
"ITRACONAZOLE / OHITRACONAZOLE",2040315,"CDM ",301,RC,80189,HCPCS,OUTPATIENT,,,100,80,,23.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70,70,,56.00,,,0,"percent of total billed charges ","70% of total billed charges ",90,90,,72.00,,,0,"percent of total billed charges ","90% of total billed charges ",93,93,,74.40,,,0,"percent of total billed charges ","93% of total billed charges ",23.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.27,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",85,85,,68.00,,,0,"percent of total billed charges ","85% of total billed charges ",90,90,,72.00,,,0,"percent of total billed charges ","90% of total billed charges ",90,90,,72.00,,,0,"percent of total billed charges ","90% of total billed charges ",28.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",87,87,,69.60,,,0,"percent of total billed charges ","87% of total billed charges ",28.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.11,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",70,70,,56.00,,,0,"percent of total billed charges ","70% of total billed charges ",23.04,93,
"RIBOSOMAL P ANTIBODY",2040320,"CDM ",301,RC,83516,HCPCS,OUTPATIENT,,,108,86.4,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,53.32,28.74,77.90,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",10,100.44,
"OMEGA 3 AND 6 FATTY ACIDS",2040325,"CDM ",301,RC,82542,HCPCS,OUTPATIENT,,,267.5,214,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",248.78,93,,199.02,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",227.38,85,,181.90,,,0,"percent of total billed charges ","85% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",232.73,87,,186.18,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,248.78,
"PYRUVIC ACID PYRUVATE BLD",2040330,"CDM ",301,RC,84210,HCPCS,OUTPATIENT,,,60,48,,12.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42,70,,33.60,,,0,"percent of total billed charges ","70% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",55.8,93,,44.64,,,0,"percent of total billed charges ","93% of total billed charges ",12.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",51,85,,40.80,,,0,"percent of total billed charges ","85% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",14.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",52.2,87,,41.76,,,0,"percent of total billed charges ","87% of total billed charges ",14.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.48,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",42,70,,33.60,,,0,"percent of total billed charges ","70% of total billed charges ",12.31,55.8,
"DAT W/RFLX ANTI C3 & ANTI IGG",2040335,"CDM ",302,RC,86880,HCPCS,OUTPATIENT,,,138.5,110.8,,5.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.95,70,,77.56,,,0,"percent of total billed charges ","70% of total billed charges ",124.65,90,,99.72,,,0,"percent of total billed charges ","90% of total billed charges ",128.81,93,,103.05,,,0,"percent of total billed charges ","93% of total billed charges ",5.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",117.73,85,,94.18,,,0,"percent of total billed charges ","85% of total billed charges ",124.65,90,,99.72,,,0,"percent of total billed charges ","90% of total billed charges ",124.65,90,,99.72,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",120.5,87,,96.40,,,0,"percent of total billed charges ","87% of total billed charges ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",96.95,70,,77.56,,,0,"percent of total billed charges ","70% of total billed charges ",5.39,128.81,
"DRUG MONITOR PANEL1 URINE CON",2040340,"CDM ",301,RC,80307,HCPCS,OUTPATIENT,,,189.5,151.6,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.65,70,,106.12,,,0,"percent of total billed charges ","70% of total billed charges ",170.55,90,,136.44,,,0,"percent of total billed charges ","90% of total billed charges ",176.24,93,,140.99,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",161.08,85,,128.86,,,0,"percent of total billed charges ","85% of total billed charges ",170.55,90,,136.44,,,0,"percent of total billed charges ","90% of total billed charges ",170.55,90,,136.44,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",164.87,87,,131.90,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",132.65,70,,106.12,,,0,"percent of total billed charges ","70% of total billed charges ",62.14,176.24,
"ALCOHOL ETHYL QL URINE CONF",2040345,"CDM ",301,RC,80307,HCPCS,OUTPATIENT,,,189.5,151.6,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.65,70,,106.12,,,0,"percent of total billed charges ","70% of total billed charges ",170.55,90,,136.44,,,0,"percent of total billed charges ","90% of total billed charges ",176.24,93,,140.99,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",161.08,85,,128.86,,,0,"percent of total billed charges ","85% of total billed charges ",170.55,90,,136.44,,,0,"percent of total billed charges ","90% of total billed charges ",170.55,90,,136.44,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",164.87,87,,131.90,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",132.65,70,,106.12,,,0,"percent of total billed charges ","70% of total billed charges ",62.14,176.24,
"*QTY RADIOIMMUNOASSAY",2040355,"CDM ",302,RC,83519,HCPCS,OUTPATIENT,,,112.5,90,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",104.63,93,,83.70,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",95.63,85,,76.50,,,0,"percent of total billed charges ","85% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",97.88,87,,78.30,,,0,"percent of total billed charges ","87% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,104.63,
"SJOGRENS ANTIBODY SS-A",2040360,"CDM ",302,RC,86235,HCPCS,OUTPATIENT,,,117,93.6,,17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,312.76,312.76,312.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.9,70,,65.52,,,0,"percent of total billed charges ","70% of total billed charges ",105.3,90,,84.24,,,0,"percent of total billed charges ","90% of total billed charges ",108.81,93,,87.05,,,0,"percent of total billed charges ","93% of total billed charges ",17.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",99.45,85,,79.56,,,0,"percent of total billed charges ","85% of total billed charges ",105.3,90,,84.24,,,0,"percent of total billed charges ","90% of total billed charges ",105.3,90,,84.24,,,0,"percent of total billed charges ","90% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",101.79,87,,512.89,512.89,512.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",32.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",81.9,70,,65.52,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,108.81,
"DRUG ABUSE PANEL 9 W/CONF",2040370,"CDM ",301,RC,80307,HCPCS,OUTPATIENT,,,224.5,179.6,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",208.79,93,,167.03,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",190.83,85,,152.66,,,0,"percent of total billed charges ","85% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.32,87,,156.26,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",62.14,208.79,
"APOLIPOPROTEIN B",2040375,"CDM ",301,RC,82172,HCPCS,OUTPATIENT,,,72,57.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.4,70,,40.32,,,0,"percent of total billed charges ","70% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",66.96,93,,53.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",61.2,85,,48.96,,,0,"percent of total billed charges ","85% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",62.64,87,,50.11,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",21.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",50.4,70,,40.32,,,0,"percent of total billed charges ","70% of total billed charges ",21.09,66.96,
"ACETYLCHOLINE RECEPTOR MOD ATB",2040380,"CDM ",301,RC,83519,HCPCS,OUTPATIENT,,,215,172,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",199.95,93,,159.96,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",182.75,85,,146.20,,,0,"percent of total billed charges ","85% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",187.05,87,,149.64,,,0,"percent of total billed charges ","87% of total billed charges ",15.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,199.95,
"NICOTINE & EXP METAB LC/MS URI",2040385,"CDM ",301,RC,80323,HCPCS,OUTPATIENT,,,152.5,122,,11.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,42.90,42.90,42.90,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.75,70,,85.40,,,0,"percent of total billed charges ","70% of total billed charges ",137.25,90,,109.80,,,0,"percent of total billed charges ","90% of total billed charges ",141.83,93,,113.46,,,0,"percent of total billed charges ","93% of total billed charges ",11.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",129.63,85,,103.70,,,0,"percent of total billed charges ","85% of total billed charges ",137.25,90,,109.80,,,0,"percent of total billed charges ","90% of total billed charges ",137.25,90,,109.80,,,0,"percent of total billed charges ","90% of total billed charges ",14.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.68,87,,106.14,,,0,"percent of total billed charges ","87% of total billed charges ",14.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",106.75,70,,85.40,,,0,"percent of total billed charges ","70% of total billed charges ",11.86,141.83,
"LEPTOSPIRA DNA QLT PCR",2040390,"CDM ",306,RC,87798,HCPCS,OUTPATIENT,,,443.5,354.8,,35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",310.45,70,,248.36,,,0,"percent of total billed charges ","70% of total billed charges ",399.15,90,,319.32,,,0,"percent of total billed charges ","90% of total billed charges ",412.46,93,,329.97,,,0,"percent of total billed charges ","93% of total billed charges ",35.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",376.98,85,,301.58,,,0,"percent of total billed charges ","85% of total billed charges ",399.15,90,,319.32,,,0,"percent of total billed charges ","90% of total billed charges ",399.15,90,,319.32,,,0,"percent of total billed charges ","90% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",385.85,87,,308.68,,,0,"percent of total billed charges ","87% of total billed charges ",53.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",310.45,70,,248.36,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,412.46,
"DRUG TOXMONITOR 9SCREEN URINE",2040395,"CDM ",301,RC,80307,HCPCS,OUTPATIENT,,,224.5,179.6,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",208.79,93,,167.03,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",190.83,85,,152.66,,,0,"percent of total billed charges ","85% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",202.05,90,,161.64,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.32,87,,156.26,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",157.15,70,,125.72,,,0,"percent of total billed charges ","70% of total billed charges ",62.14,208.79,
"DRUG TOX MONITOR ALCHOL METAB",2040400,"CDM ",301,RC,80307,HCPCS,OUTPATIENT,,,160.5,128.4,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",149.27,93,,119.42,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",136.43,85,,109.14,,,0,"percent of total billed charges ","85% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",139.64,87,,111.71,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",62.14,149.27,
"FACTOR XIII",2040405,"CDM ",305,RC,85290,HCPCS,OUTPATIENT,,,113,90.4,,13.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.1,70,,63.28,,,0,"percent of total billed charges ","70% of total billed charges ",101.7,90,,81.36,,,0,"percent of total billed charges ","90% of total billed charges ",105.09,93,,84.07,,,0,"percent of total billed charges ","93% of total billed charges ",13.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",96.05,85,,76.84,,,0,"percent of total billed charges ","85% of total billed charges ",101.7,90,,81.36,,,0,"percent of total billed charges ","90% of total billed charges ",101.7,90,,81.36,,,0,"percent of total billed charges ","90% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",98.31,87,,78.65,,,0,"percent of total billed charges ","87% of total billed charges ",15.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.34,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",79.1,70,,63.28,,,0,"percent of total billed charges ","70% of total billed charges ",13.89,105.09,
"TPMT ACTIVITY",2040410,"CDM ",301,RC,82657,HCPCS,OUTPATIENT,,,364,291.2,,22.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",254.8,70,,203.84,,,0,"percent of total billed charges ","70% of total billed charges ",327.6,90,,262.08,,,0,"percent of total billed charges ","90% of total billed charges ",338.52,93,,270.82,,,0,"percent of total billed charges ","93% of total billed charges ",22.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",309.4,85,,247.52,,,0,"percent of total billed charges ","85% of total billed charges ",327.6,90,,262.08,,,0,"percent of total billed charges ","90% of total billed charges ",327.6,90,,262.08,,,0,"percent of total billed charges ","90% of total billed charges ",38.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",316.68,87,,253.34,,,0,"percent of total billed charges ","87% of total billed charges ",38.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.17,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",254.8,70,,203.84,,,0,"percent of total billed charges ","70% of total billed charges ",22.17,338.52,
"INFLIXIMAB LEVEL IBD",2040415,"CDM ",301,RC,80230,HCPCS,OUTPATIENT,,,216,172.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.2,70,,120.96,,,0,"percent of total billed charges ","70% of total billed charges ",194.4,90,,155.52,,,0,"percent of total billed charges ","90% of total billed charges ",200.88,93,,160.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",183.6,85,,146.88,,,0,"percent of total billed charges ","85% of total billed charges ",194.4,90,,155.52,,,0,"percent of total billed charges ","90% of total billed charges ",194.4,90,,155.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",187.92,87,,150.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",38.57,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",151.2,70,,120.96,,,0,"percent of total billed charges ","70% of total billed charges ",38.57,200.88,
"*ORGANIC ACID TOTAL QUANT",2040425,"CDM ",301,RC,83918,HCPCS,OUTPATIENT,,,336,268.8,,20.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",235.2,70,,188.16,,,0,"percent of total billed charges ","70% of total billed charges ",302.4,90,,241.92,,,0,"percent of total billed charges ","90% of total billed charges ",312.48,93,,249.98,,,0,"percent of total billed charges ","93% of total billed charges ",20.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.55,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",285.6,85,,228.48,,,0,"percent of total billed charges ","85% of total billed charges ",302.4,90,,241.92,,,0,"percent of total billed charges ","90% of total billed charges ",302.4,90,,241.92,,,0,"percent of total billed charges ","90% of total billed charges ",25.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",292.32,87,,233.86,,,0,"percent of total billed charges ","87% of total billed charges ",25.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.6,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",235.2,70,,188.16,,,0,"percent of total billed charges ","70% of total billed charges ",20.06,312.48,
"*COLUMN CHOMATOGRAPHY",2040435,"CDM ",301,RC,82542,HCPCS,OUTPATIENT,,,257,205.6,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",179.9,70,,143.92,,,0,"percent of total billed charges ","70% of total billed charges ",231.3,90,,185.04,,,0,"percent of total billed charges ","90% of total billed charges ",239.01,93,,191.21,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",218.45,85,,174.76,,,0,"percent of total billed charges ","85% of total billed charges ",231.3,90,,185.04,,,0,"percent of total billed charges ","90% of total billed charges ",231.3,90,,185.04,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",223.59,87,,178.87,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",179.9,70,,143.92,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,239.01,
"DPD CROSSLINKS",2040455,"CDM ",301,RC,82523,HCPCS,OUTPATIENT,,,179,143.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.3,70,,100.24,,,0,"percent of total billed charges ","70% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",166.47,93,,133.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",152.15,85,,121.72,,,0,"percent of total billed charges ","85% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",155.73,87,,124.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",18.68,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",125.3,70,,100.24,,,0,"percent of total billed charges ","70% of total billed charges ",18.68,166.47,
"SACCHAROMYCES ASCA IGG",2040460,"CDM ",302,RC,86671,HCPCS,OUTPATIENT,,,258,206.4,,10.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.6,70,,144.48,,,0,"percent of total billed charges ","70% of total billed charges ",232.2,90,,185.76,,,0,"percent of total billed charges ","90% of total billed charges ",239.94,93,,191.95,,,0,"percent of total billed charges ","93% of total billed charges ",10.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",219.3,85,,175.44,,,0,"percent of total billed charges ","85% of total billed charges ",232.2,90,,185.76,,,0,"percent of total billed charges ","90% of total billed charges ",232.2,90,,185.76,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",224.46,87,,179.57,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.25,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",180.6,70,,144.48,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,239.94,
"SACCHAROMYCESCEREVISIAE ACSA",2040463,"CDM ",302,RC,86671,HCPCS,OUTPATIENT,,,63,50.4,,10.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.1,70,,35.28,,,0,"percent of total billed charges ","70% of total billed charges ",56.7,90,,45.36,,,0,"percent of total billed charges ","90% of total billed charges ",58.59,93,,46.87,,,0,"percent of total billed charges ","93% of total billed charges ",10.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",53.55,85,,42.84,,,0,"percent of total billed charges ","85% of total billed charges ",56.7,90,,45.36,,,0,"percent of total billed charges ","90% of total billed charges ",56.7,90,,45.36,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.81,87,,43.85,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.25,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",44.1,70,,35.28,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,58.59,
"UREA NITROGEN 24HR WO CREATINE",2040465,"CDM ",301,RC,84540,HCPCS,OUTPATIENT,,,111,88.8,,5.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,17.21,17.21,17.21,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.7,70,,62.16,,,0,"percent of total billed charges ","70% of total billed charges ",99.9,90,,79.92,,,0,"percent of total billed charges ","90% of total billed charges ",103.23,93,,82.58,,,0,"percent of total billed charges ","93% of total billed charges ",5.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",94.35,85,,75.48,,,0,"percent of total billed charges ","85% of total billed charges ",99.9,90,,79.92,,,0,"percent of total billed charges ","90% of total billed charges ",99.9,90,,79.92,,,0,"percent of total billed charges ","90% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.57,87,,77.26,,,0,"percent of total billed charges ","87% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.56,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",77.7,70,,62.16,,,0,"percent of total billed charges ","70% of total billed charges ",5.56,103.23,
"PHOSPHATE 24HR URINE WO CREAT",2040470,"CDM ",301,RC,84105,HCPCS,OUTPATIENT,,,54.5,43.6,,5.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.15,70,,30.52,,,0,"percent of total billed charges ","70% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",50.69,93,,40.55,,,0,"percent of total billed charges ","93% of total billed charges ",5.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",46.33,85,,37.06,,,0,"percent of total billed charges ","85% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.42,87,,37.94,,,0,"percent of total billed charges ","87% of total billed charges ",8.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.78,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",38.15,70,,30.52,,,0,"percent of total billed charges ","70% of total billed charges ",5.78,50.69,
"ANA IFA RFLX TIT/PATTERN MULTI",2040475,"CDM ",302,RC,86038,HCPCS,OUTPATIENT,,,129,103.2,,12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",119.97,93,,95.98,,,0,"percent of total billed charges ","93% of total billed charges ",12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",109.65,85,,87.72,,,0,"percent of total billed charges ","85% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.23,87,,88.36,11.85,147.83,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",12.09,119.97,
"HLA DRB1 LOW RESOLUTION",2040480,"CDM ",302,RC,81376,HCPCS,OUTPATIENT,,,532,425.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",372.4,70,,297.92,,,0,"percent of total billed charges ","70% of total billed charges ",478.8,90,,383.04,,,0,"percent of total billed charges ","90% of total billed charges ",494.76,93,,395.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",452.2,85,,361.76,,,0,"percent of total billed charges ","85% of total billed charges ",478.8,90,,383.04,,,0,"percent of total billed charges ","90% of total billed charges ",478.8,90,,383.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",462.84,87,,370.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",122.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",372.4,70,,297.92,,,0,"percent of total billed charges ","70% of total billed charges ",122.22,494.76,
"PHOSPHATIDYLETHANOL BLOOD",2040485,"CDM ",301,RC,80321,HCPCS,OUTPATIENT,,,210.5,168.4,,15.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,165.33,165.33,165.33,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",195.77,93,,156.62,,,0,"percent of total billed charges ","93% of total billed charges ",15.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",178.93,85,,143.14,,,0,"percent of total billed charges ","85% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",183.14,87,,113.79,97.52,130.06,"1 through 10","percent of total billed charges ","87% of total billed charges ",19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",15.5,195.77,
"HIV 1 RNA QUANT REALTIME PCR",2040490,"CDM ",306,RC,87536,HCPCS,OUTPATIENT,,,633.5,506.8,,85.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,217.26,217.26,217.26,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",443.45,70,,354.76,,,0,"percent of total billed charges ","70% of total billed charges ",570.15,90,,456.12,,,0,"percent of total billed charges ","90% of total billed charges ",589.16,93,,471.33,,,0,"percent of total billed charges ","93% of total billed charges ",85.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",142.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",538.48,85,,430.78,,,0,"percent of total billed charges ","85% of total billed charges ",570.15,90,,456.12,,,0,"percent of total billed charges ","90% of total billed charges ",570.15,90,,456.12,,,0,"percent of total billed charges ","90% of total billed charges ",141.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",551.15,87,,440.92,,,0,"percent of total billed charges ","87% of total billed charges ",141.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.1,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",443.45,70,,354.76,,,0,"percent of total billed charges ","70% of total billed charges ",85.1,589.16,
"LDH PLEURAL FLUID",2040495,"CDM ",301,RC,83615,HCPCS,OUTPATIENT,,,123,98.4,,6.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.1,70,,68.88,,,0,"percent of total billed charges ","70% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",114.39,93,,91.51,,,0,"percent of total billed charges ","93% of total billed charges ",6.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",104.55,85,,83.64,,,0,"percent of total billed charges ","85% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",110.7,90,,88.56,,,0,"percent of total billed charges ","90% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.01,87,,81.33,26.88,95.68,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.04,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",86.1,70,,68.88,,,0,"percent of total billed charges ","70% of total billed charges ",6.04,114.39,
"SED RATE ERYTHROCYTE AUTOMATED",2040510,"CDM ",305,RC,85652,HCPCS,OUTPATIENT,,,62,49.6,,2.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.4,70,,34.72,,,0,"percent of total billed charges ","70% of total billed charges ",55.8,90,,44.64,,,0,"percent of total billed charges ","90% of total billed charges ",57.66,93,,46.13,,,0,"percent of total billed charges ","93% of total billed charges ",2.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",52.7,85,,42.16,,,0,"percent of total billed charges ","85% of total billed charges ",55.8,90,,44.64,,,0,"percent of total billed charges ","90% of total billed charges ",55.8,90,,44.64,,,0,"percent of total billed charges ","90% of total billed charges ",6.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.94,87,,43.15,,,0,"percent of total billed charges ","87% of total billed charges ",6.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2.7,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",43.4,70,,34.72,,,0,"percent of total billed charges ","70% of total billed charges ",2.7,57.66,
"INFLUENZA A&B RAPID ID NOW",2040515,"CDM ",306,RC,87502,HCPCS,OUTPATIENT,,,210,168,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147,70,,117.60,,,0,"percent of total billed charges ","70% of total billed charges ",189,90,,151.20,,,0,"percent of total billed charges ","90% of total billed charges ",195.3,93,,156.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",106.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",178.5,85,,142.80,,,0,"percent of total billed charges ","85% of total billed charges ",189,90,,151.20,,,0,"percent of total billed charges ","90% of total billed charges ",189,90,,151.20,,,0,"percent of total billed charges ","90% of total billed charges ",105.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",182.7,87,,57.48,45.67,106.34,"1 through 10","percent of total billed charges ","87% of total billed charges ",105.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",95.8,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",147,70,,117.60,,,0,"percent of total billed charges ","70% of total billed charges ",95.8,195.3,
"STREP A RAPID ID NOW",2040520,"CDM ",306,RC,87651,HCPCS,OUTPATIENT,,,152,121.6,,29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",141.36,93,,113.09,,,0,"percent of total billed charges ","93% of total billed charges ",29.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",129.2,85,,103.36,,,0,"percent of total billed charges ","85% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.24,87,,35.09,30.36,96.48,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,141.36,
"RSV RAPID ID NOW",2040525,"CDM ",306,RC,87634,HCPCS,OUTPATIENT,,,253,202.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.1,70,,141.68,,,0,"percent of total billed charges ","70% of total billed charges ",227.7,90,,182.16,,,0,"percent of total billed charges ","90% of total billed charges ",235.29,93,,188.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",77.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",215.05,85,,172.04,,,0,"percent of total billed charges ","85% of total billed charges ",227.7,90,,182.16,,,0,"percent of total billed charges ","90% of total billed charges ",227.7,90,,182.16,,,0,"percent of total billed charges ","90% of total billed charges ",76.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",220.11,87,,99.95,59.27,173.69,"1 through 10","percent of total billed charges ","87% of total billed charges ",76.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.2,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",177.1,70,,141.68,,,0,"percent of total billed charges ","70% of total billed charges ",70.2,235.29,
"BLADDER CANCER FISH",2040530,"CDM ",300,RC,88120,HCPCS,OUTPATIENT,,,376,300.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",827.2,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",263.2,70,,210.56,,,0,"percent of total billed charges ","70% of total billed charges ",338.4,90,,270.72,,,0,"percent of total billed charges ","90% of total billed charges ",349.68,93,,279.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",38.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",319.6,85,,255.68,,,0,"percent of total billed charges ","85% of total billed charges ",338.4,90,,270.72,,,0,"percent of total billed charges ","90% of total billed charges ",338.4,90,,270.72,,,0,"percent of total billed charges ","90% of total billed charges ",38.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",327.12,87,,261.70,,,0,"percent of total billed charges ","87% of total billed charges ",38.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",263.2,70,,210.56,,,0,"percent of total billed charges ","70% of total billed charges ",38.14,827.2,
"PANCREATIC ELASTASE 1",2040540,"CDM ",301,RC,82653,HCPCS,OUTPATIENT,,,73,58.4,,14.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,51.21,51.21,51.21,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.1,70,,40.88,,,0,"percent of total billed charges ","70% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",67.89,93,,54.31,,,0,"percent of total billed charges ","93% of total billed charges ",14.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",62.05,85,,49.64,,,0,"percent of total billed charges ","85% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.51,87,,50.81,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",22.97,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",51.1,70,,40.88,,,0,"percent of total billed charges ","70% of total billed charges ",14.93,67.89,
"HLA AB SCREEN CLASS I",2040545,"CDM ",302,RC,86830,HCPCS,OUTPATIENT,,,354,283.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",247.8,70,,198.24,,,0,"percent of total billed charges ","70% of total billed charges ",318.6,90,,254.88,,,0,"percent of total billed charges ","90% of total billed charges ",329.22,93,,263.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",300.9,85,,240.72,,,0,"percent of total billed charges ","85% of total billed charges ",318.6,90,,254.88,,,0,"percent of total billed charges ","90% of total billed charges ",318.6,90,,254.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",307.98,87,,246.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",95.52,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",247.8,70,,198.24,,,0,"percent of total billed charges ","70% of total billed charges ",95.52,329.22,
"GASTROINTESTIN PAN PATH RT PCR",2040550,"CDM ",300,RC,87506,HCPCS,OUTPATIENT,,,692.5,554,,246.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",484.75,70,,387.80,,,0,"percent of total billed charges ","70% of total billed charges ",623.25,90,,498.60,,,0,"percent of total billed charges ","90% of total billed charges ",644.03,93,,515.22,,,0,"percent of total billed charges ","93% of total billed charges ",246.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",326.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",588.63,85,,470.90,,,0,"percent of total billed charges ","85% of total billed charges ",623.25,90,,498.60,,,0,"percent of total billed charges ","90% of total billed charges ",623.25,90,,498.60,,,0,"percent of total billed charges ","90% of total billed charges ",323,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",602.48,87,,481.98,,,0,"percent of total billed charges ","87% of total billed charges ",323,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.99,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",484.75,70,,387.80,,,0,"percent of total billed charges ","70% of total billed charges ",246.88,644.03,
"AQUAPORIN 4 AB IGG CBA",2040555,"CDM ",302,RC,86052,HCPCS,OUTPATIENT,,,729,583.2,,7.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",510.3,70,,408.24,,,0,"percent of total billed charges ","70% of total billed charges ",656.1,90,,524.88,,,0,"percent of total billed charges ","90% of total billed charges ",677.97,93,,542.38,,,0,"percent of total billed charges ","93% of total billed charges ",7.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",619.65,85,,495.72,,,0,"percent of total billed charges ","85% of total billed charges ",656.1,90,,524.88,,,0,"percent of total billed charges ","90% of total billed charges ",656.1,90,,524.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",634.23,87,,507.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",510.3,70,,408.24,,,0,"percent of total billed charges ","70% of total billed charges ",7.83,677.97,
"INFLIXMAB ANTIDRUG AB IBD",2040560,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,244,195.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.8,70,,136.64,,,0,"percent of total billed charges ","70% of total billed charges ",219.6,90,,175.68,,,0,"percent of total billed charges ","90% of total billed charges ",226.92,93,,181.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",207.4,85,,165.92,,,0,"percent of total billed charges ","85% of total billed charges ",219.6,90,,175.68,,,0,"percent of total billed charges ","90% of total billed charges ",219.6,90,,175.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",212.28,87,,169.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",170.8,70,,136.64,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,226.92,
"CORTISOL FREE 24HR UA W/CREAT",2040565,"CDM ",301,RC,82530,HCPCS,OUTPATIENT,,,142,113.6,,15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,79.16,79.16,79.16,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.4,70,,79.52,,,0,"percent of total billed charges ","70% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",132.06,93,,105.65,,,0,"percent of total billed charges ","93% of total billed charges ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",120.7,85,,96.56,,,0,"percent of total billed charges ","85% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",123.54,87,,88.27,88.27,88.27,"1 through 10","percent of total billed charges ","87% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.71,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",99.4,70,,79.52,,,0,"percent of total billed charges ","70% of total billed charges ",15,132.06,
"*GLUCOSE QUANT BLOOD",2040570,"CDM ",301,RC,82947,HCPCS,OUTPATIENT,,,83,66.4,,3.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",3.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",6.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",72.21,87,,64.65,40.33,64.65,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",3.93,77.19,
"*TRANSFERASE AST SGOT",2040575,"CDM ",301,RC,84450,HCPCS,OUTPATIENT,,,108,86.4,,5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,82.88,82.88,82.88,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",100.44,93,,80.35,,,0,"percent of total billed charges ","93% of total billed charges ",5.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.8,85,,73.44,,,0,"percent of total billed charges ","85% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",97.2,90,,77.76,,,0,"percent of total billed charges ","90% of total billed charges ",9.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.96,87,,75.17,,,0,"percent of total billed charges ","87% of total billed charges ",9.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.18,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.6,70,,60.48,,,0,"percent of total billed charges ","70% of total billed charges ",5.18,100.44,
"*PLATELET COUNT AUTOMATED",2040580,"CDM ",305,RC,85049,HCPCS,OUTPATIENT,,,30.5,24.4,,4.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.35,70,,17.08,,,0,"percent of total billed charges ","70% of total billed charges ",27.45,90,,21.96,,,0,"percent of total billed charges ","90% of total billed charges ",28.37,93,,22.70,,,0,"percent of total billed charges ","93% of total billed charges ",4.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.83,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",25.93,85,,20.74,,,0,"percent of total billed charges ","85% of total billed charges ",27.45,90,,21.96,,,0,"percent of total billed charges ","90% of total billed charges ",27.45,90,,21.96,,,0,"percent of total billed charges ","90% of total billed charges ",11.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.54,87,,21.23,,,0,"percent of total billed charges ","87% of total billed charges ",11.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.48,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",21.35,70,,17.08,,,0,"percent of total billed charges ","70% of total billed charges ",4.48,28.37,
"*ALBUMIN FLUID",2040585,"CDM ",301,RC,82040,HCPCS,OUTPATIENT,,,53,42.4,,4.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,12.74,12.74,12.74,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",49.29,93,,39.43,,,0,"percent of total billed charges ","93% of total billed charges ",4.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.05,85,,36.04,,,0,"percent of total billed charges ","85% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.11,87,,4.86,4.86,49.24,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.95,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",4.95,49.29,
"NPM EXON 12 MUTA CELL BSD",2040600,"CDM ",300,RC,81310,HCPCS,OUTPATIENT,,,534,427.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",373.8,70,,299.04,,,0,"percent of total billed charges ","70% of total billed charges ",480.6,90,,384.48,,,0,"percent of total billed charges ","90% of total billed charges ",496.62,93,,397.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",453.9,85,,363.12,,,0,"percent of total billed charges ","85% of total billed charges ",480.6,90,,384.48,,,0,"percent of total billed charges ","90% of total billed charges ",480.6,90,,384.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",464.58,87,,371.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",246.52,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",373.8,70,,299.04,,,0,"percent of total billed charges ","70% of total billed charges ",246.52,496.62,
"ADENOVIRUS DNA QT RT PCR",2040635,"CDM ",306,RC,87799,HCPCS,OUTPATIENT,,,541,432.8,,36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,301.18,301.18,301.18,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",378.7,70,,302.96,,,0,"percent of total billed charges ","70% of total billed charges ",486.9,90,,389.52,,,0,"percent of total billed charges ","90% of total billed charges ",503.13,93,,402.50,,,0,"percent of total billed charges ","93% of total billed charges ",36.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",459.85,85,,367.88,,,0,"percent of total billed charges ","85% of total billed charges ",486.9,90,,389.52,,,0,"percent of total billed charges ","90% of total billed charges ",486.9,90,,389.52,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",470.67,87,,765.89,765.89,765.89,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.84,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",378.7,70,,302.96,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,503.13,
"ADALIMUMAB AD/AB RHEUMATIC DIS",2040640,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,274.5,219.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.15,70,,153.72,,,0,"percent of total billed charges ","70% of total billed charges ",247.05,90,,197.64,,,0,"percent of total billed charges ","90% of total billed charges ",255.29,93,,204.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",233.33,85,,186.66,,,0,"percent of total billed charges ","85% of total billed charges ",247.05,90,,197.64,,,0,"percent of total billed charges ","90% of total billed charges ",247.05,90,,197.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",238.82,87,,191.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",192.15,70,,153.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,255.29,
"14.3.3 ETA PROTEIN",2040645,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,105.5,84.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.85,70,,59.08,,,0,"percent of total billed charges ","70% of total billed charges ",94.95,90,,75.96,,,0,"percent of total billed charges ","90% of total billed charges ",98.12,93,,78.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",89.68,85,,71.74,,,0,"percent of total billed charges ","85% of total billed charges ",94.95,90,,75.96,,,0,"percent of total billed charges ","90% of total billed charges ",94.95,90,,75.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",91.79,87,,73.43,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",73.85,70,,59.08,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,98.12,
"*T CELL GENE ANAL ABN POP",2040655,"CDM ",300,RC,81342,HCPCS,OUTPATIENT,,,376,300.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.2,70,,210.56,,,0,"percent of total billed charges ","70% of total billed charges ",338.4,90,,270.72,,,0,"percent of total billed charges ","90% of total billed charges ",349.68,93,,279.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",319.6,85,,255.68,,,0,"percent of total billed charges ","85% of total billed charges ",338.4,90,,270.72,,,0,"percent of total billed charges ","90% of total billed charges ",338.4,90,,270.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",327.12,87,,261.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",201.5,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",263.2,70,,210.56,,,0,"percent of total billed charges ","70% of total billed charges ",201.5,349.68,
"PHOSPHATIDYLSERINE PROTH ABIGM",2040660,"CDM ",302,RC,83516,HCPCS,OUTPATIENT,,,98,78.4,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.6,70,,54.88,,,0,"percent of total billed charges ","70% of total billed charges ",88.2,90,,70.56,,,0,"percent of total billed charges ","90% of total billed charges ",91.14,93,,72.91,,,0,"percent of total billed charges ","93% of total billed charges ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",83.3,85,,66.64,,,0,"percent of total billed charges ","85% of total billed charges ",88.2,90,,70.56,,,0,"percent of total billed charges ","90% of total billed charges ",88.2,90,,70.56,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.26,87,,53.32,28.74,77.90,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.6,70,,54.88,,,0,"percent of total billed charges ","70% of total billed charges ",10,91.14,
"ASPERGILLUS AG EIA SERUM",2040665,"CDM ",302,RC,87305,HCPCS,OUTPATIENT,,,107,85.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.9,70,,59.92,,,0,"percent of total billed charges ","70% of total billed charges ",96.3,90,,77.04,,,0,"percent of total billed charges ","90% of total billed charges ",99.51,93,,79.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",14.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",90.95,85,,72.76,,,0,"percent of total billed charges ","85% of total billed charges ",96.3,90,,77.04,,,0,"percent of total billed charges ","90% of total billed charges ",96.3,90,,77.04,,,0,"percent of total billed charges ","90% of total billed charges ",14.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.09,87,,74.47,,,0,"percent of total billed charges ","87% of total billed charges ",14.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",74.9,70,,59.92,,,0,"percent of total billed charges ","70% of total billed charges ",11.98,99.51,
"*MPL GENE ALYS EX10",2040668,"CDM ",300,RC,81339,HCPCS,OUTPATIENT,,,438,350.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",306.6,70,,245.28,,,0,"percent of total billed charges ","70% of total billed charges ",394.2,90,,315.36,,,0,"percent of total billed charges ","90% of total billed charges ",407.34,93,,325.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",158.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",372.3,85,,297.84,,,0,"percent of total billed charges ","85% of total billed charges ",394.2,90,,315.36,,,0,"percent of total billed charges ","90% of total billed charges ",394.2,90,,315.36,,,0,"percent of total billed charges ","90% of total billed charges ",157.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",381.06,87,,304.85,,,0,"percent of total billed charges ","87% of total billed charges ",157.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",185.2,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",306.6,70,,245.28,,,0,"percent of total billed charges ","70% of total billed charges ",157.42,407.34,
"TPMT GENOTYPE",2040670,"CDM ",300,RC,81335,HCPCS,OUTPATIENT,,,251,200.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",175.7,70,,140.56,,,0,"percent of total billed charges ","70% of total billed charges ",225.9,90,,180.72,,,0,"percent of total billed charges ","90% of total billed charges ",233.43,93,,186.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",213.35,85,,170.68,,,0,"percent of total billed charges ","85% of total billed charges ",225.9,90,,180.72,,,0,"percent of total billed charges ","90% of total billed charges ",225.9,90,,180.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",218.37,87,,174.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",174.81,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",175.7,70,,140.56,,,0,"percent of total billed charges ","70% of total billed charges ",174.81,233.43,
"BETA LACTOGLOBULIN F77 IGE",2040675,"CDM ",302,RC,86008,HCPCS,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",19.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",19.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",19.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.93,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",17.93,36.27,
"AMIODARONE LEVEL",2040680,"CDM ",301,RC,80151,HCPCS,OUTPATIENT,,,59.5,47.6,,15.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.65,70,,33.32,,,0,"percent of total billed charges ","70% of total billed charges ",53.55,90,,42.84,,,0,"percent of total billed charges ","90% of total billed charges ",55.34,93,,44.27,,,0,"percent of total billed charges ","93% of total billed charges ",15.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",50.58,85,,40.46,,,0,"percent of total billed charges ","85% of total billed charges ",53.55,90,,42.84,,,0,"percent of total billed charges ","90% of total billed charges ",53.55,90,,42.84,,,0,"percent of total billed charges ","90% of total billed charges ",19.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",51.77,87,,41.42,,,0,"percent of total billed charges ","87% of total billed charges ",19.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",41.65,70,,33.32,,,0,"percent of total billed charges ","70% of total billed charges ",15.84,55.34,
"ADALIMUMAB DRUG ASSAY LEVEL",2040690,"CDM ",301,RC,80145,HCPCS,OUTPATIENT,,,124.5,99.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.15,70,,69.72,,,0,"percent of total billed charges ","70% of total billed charges ",112.05,90,,89.64,,,0,"percent of total billed charges ","90% of total billed charges ",115.79,93,,92.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",105.83,85,,84.66,,,0,"percent of total billed charges ","85% of total billed charges ",112.05,90,,89.64,,,0,"percent of total billed charges ","90% of total billed charges ",112.05,90,,89.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",108.32,87,,86.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",38.57,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",87.15,70,,69.72,,,0,"percent of total billed charges ","70% of total billed charges ",38.57,115.79,
"IMMUNOASSAY ANALYTE MULTI STEP",2040695,"CDM ",302,RC,83516,HCPCS,OUTPATIENT,,,78,62.4,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.6,70,,43.68,,,0,"percent of total billed charges ","70% of total billed charges ",70.2,90,,56.16,,,0,"percent of total billed charges ","90% of total billed charges ",72.54,93,,58.03,,,0,"percent of total billed charges ","93% of total billed charges ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",66.3,85,,53.04,,,0,"percent of total billed charges ","85% of total billed charges ",70.2,90,,56.16,,,0,"percent of total billed charges ","90% of total billed charges ",70.2,90,,56.16,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",67.86,87,,53.32,28.74,77.90,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",54.6,70,,43.68,,,0,"percent of total billed charges ","70% of total billed charges ",10,72.54,
"*PROTHROMBIN COAG FACTOR II",2040705,"CDM ",300,RC,81240,HCPCS,OUTPATIENT,,,295,236,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",206.5,70,,165.20,,,0,"percent of total billed charges ","70% of total billed charges ",265.5,90,,212.40,,,0,"percent of total billed charges ","90% of total billed charges ",274.35,93,,219.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",250.75,85,,200.60,,,0,"percent of total billed charges ","85% of total billed charges ",265.5,90,,212.40,,,0,"percent of total billed charges ","90% of total billed charges ",265.5,90,,212.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",256.65,87,,205.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",65.69,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",206.5,70,,165.20,,,0,"percent of total billed charges ","70% of total billed charges ",65.69,274.35,
"*LIPOPROTEIN PARTICLE QUANT",2040715,"CDM ",301,RC,83704,HCPCS,OUTPATIENT,,,67,53.6,,31.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.9,70,,37.52,,,0,"percent of total billed charges ","70% of total billed charges ",60.3,90,,48.24,,,0,"percent of total billed charges ","90% of total billed charges ",62.31,93,,49.85,,,0,"percent of total billed charges ","93% of total billed charges ",31.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",56.95,85,,45.56,,,0,"percent of total billed charges ","85% of total billed charges ",60.3,90,,48.24,,,0,"percent of total billed charges ","90% of total billed charges ",60.3,90,,48.24,,,0,"percent of total billed charges ","90% of total billed charges ",41.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",58.29,87,,46.63,,,0,"percent of total billed charges ","87% of total billed charges ",41.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",46.9,70,,37.52,,,0,"percent of total billed charges ","70% of total billed charges ",31.49,62.31,
"*LIPID PANEL",2040720,"CDM ",301,RC,80061,HCPCS,OUTPATIENT,,,131,104.8,,13.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,13.12,13.12,13.12,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.7,70,,73.36,,,0,"percent of total billed charges ","70% of total billed charges ",117.9,90,,94.32,,,0,"percent of total billed charges ","90% of total billed charges ",121.83,93,,97.46,,,0,"percent of total billed charges ","93% of total billed charges ",13.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",111.35,85,,89.08,,,0,"percent of total billed charges ","85% of total billed charges ",117.9,90,,94.32,,,0,"percent of total billed charges ","90% of total billed charges ",117.9,90,,94.32,,,0,"percent of total billed charges ","90% of total billed charges ",19.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",113.97,87,,225.85,13.13,282.31,32,"percent of total billed charges ","87% of total billed charges ",19.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",91.7,70,,73.36,,,0,"percent of total billed charges ","70% of total billed charges ",13.39,121.83,
OXLDL,2040725,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,81.5,65.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",75.8,93,,60.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",69.28,85,,55.42,,,0,"percent of total billed charges ","85% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",70.91,87,,56.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,75.8,
"OXALATE SERUM/PLASMA",2040735,"CDM ",301,RC,83945,HCPCS,OUTPATIENT,,,96.5,77.2,,12.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.55,70,,54.04,,,0,"percent of total billed charges ","70% of total billed charges ",86.85,90,,69.48,,,0,"percent of total billed charges ","90% of total billed charges ",89.75,93,,71.80,,,0,"percent of total billed charges ","93% of total billed charges ",12.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",82.03,85,,65.62,,,0,"percent of total billed charges ","85% of total billed charges ",86.85,90,,69.48,,,0,"percent of total billed charges ","90% of total billed charges ",86.85,90,,69.48,,,0,"percent of total billed charges ","90% of total billed charges ",10.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.96,87,,67.17,,,0,"percent of total billed charges ","87% of total billed charges ",10.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.45,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",67.55,70,,54.04,,,0,"percent of total billed charges ","70% of total billed charges ",10.08,89.75,
"MOG ABS W/RFLX TITER CSF",2040740,"CDM ",302,RC,86362,HCPCS,OUTPATIENT,,,815.5,652.4,,7.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",570.85,70,,456.68,,,0,"percent of total billed charges ","70% of total billed charges ",733.95,90,,587.16,,,0,"percent of total billed charges ","90% of total billed charges ",758.42,93,,606.74,,,0,"percent of total billed charges ","93% of total billed charges ",7.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",693.18,85,,554.54,,,0,"percent of total billed charges ","85% of total billed charges ",733.95,90,,587.16,,,0,"percent of total billed charges ","90% of total billed charges ",733.95,90,,587.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",709.49,87,,567.59,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",570.85,70,,456.68,,,0,"percent of total billed charges ","70% of total billed charges ",7.83,758.42,
"MOG ABS W/RFLX TITER SERUM",2040742,"CDM ",302,RC,86362,HCPCS,OUTPATIENT,,,815.5,652.4,,7.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",570.85,70,,456.68,,,0,"percent of total billed charges ","70% of total billed charges ",733.95,90,,587.16,,,0,"percent of total billed charges ","90% of total billed charges ",758.42,93,,606.74,,,0,"percent of total billed charges ","93% of total billed charges ",7.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",693.18,85,,554.54,,,0,"percent of total billed charges ","85% of total billed charges ",733.95,90,,587.16,,,0,"percent of total billed charges ","90% of total billed charges ",733.95,90,,587.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",709.49,87,,567.59,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",570.85,70,,456.68,,,0,"percent of total billed charges ","70% of total billed charges ",7.83,758.42,
"*T-CELL RECEPTOR BGR PCR",2040750,"CDM ",300,RC,81340,HCPCS,OUTPATIENT,,,395.5,316.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",276.85,70,,221.48,,,0,"percent of total billed charges ","70% of total billed charges ",355.95,90,,284.76,,,0,"percent of total billed charges ","90% of total billed charges ",367.82,93,,294.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",336.18,85,,268.94,,,0,"percent of total billed charges ","85% of total billed charges ",355.95,90,,284.76,,,0,"percent of total billed charges ","90% of total billed charges ",355.95,90,,284.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",344.09,87,,275.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",208.92,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",276.85,70,,221.48,,,0,"percent of total billed charges ","70% of total billed charges ",208.92,367.82,
"*CULTURE TUBERCLE BACILLI",2040755,"CDM ",306,RC,87116,HCPCS,OUTPATIENT,,,93.5,74.8,,10.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.45,70,,52.36,,,0,"percent of total billed charges ","70% of total billed charges ",84.15,90,,67.32,,,0,"percent of total billed charges ","90% of total billed charges ",86.96,93,,69.57,,,0,"percent of total billed charges ","93% of total billed charges ",10.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",79.48,85,,63.58,,,0,"percent of total billed charges ","85% of total billed charges ",84.15,90,,67.32,,,0,"percent of total billed charges ","90% of total billed charges ",84.15,90,,67.32,,,0,"percent of total billed charges ","90% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",81.35,87,,65.08,,,0,"percent of total billed charges ","87% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.8,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",65.45,70,,52.36,,,0,"percent of total billed charges ","70% of total billed charges ",10.5,86.96,
"COPEPTIN SERUM",2040765,"CDM ",300,RC,86255,HCPCS,OUTPATIENT,,,146,116.8,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,101.62,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,135.78,
"*HEMOGLOBIN FRACTION QT ELECTR",2040770,"CDM ",301,RC,83020,HCPCS,OUTPATIENT,,,124.5,99.6,,12.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.15,70,,69.72,,,0,"percent of total billed charges ","70% of total billed charges ",112.05,90,,89.64,,,0,"percent of total billed charges ","90% of total billed charges ",115.79,93,,92.63,,,0,"percent of total billed charges ","93% of total billed charges ",12.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",105.83,85,,84.66,,,0,"percent of total billed charges ","85% of total billed charges ",112.05,90,,89.64,,,0,"percent of total billed charges ","90% of total billed charges ",112.05,90,,89.64,,,0,"percent of total billed charges ","90% of total billed charges ",23.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",108.32,87,,86.66,,,0,"percent of total billed charges ","87% of total billed charges ",23.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.87,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",87.15,70,,69.72,,,0,"percent of total billed charges ","70% of total billed charges ",12.87,115.79,
"COTISOL LC/MS SALIVA",2040780,"CDM ",300,RC,82530,HCPCS,OUTPATIENT,,,142,113.6,,15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,79.16,79.16,79.16,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.4,70,,79.52,,,0,"percent of total billed charges ","70% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",132.06,93,,105.65,,,0,"percent of total billed charges ","93% of total billed charges ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",120.7,85,,96.56,,,0,"percent of total billed charges ","85% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",123.54,87,,88.27,88.27,88.27,"1 through 10","percent of total billed charges ","87% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.71,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",99.4,70,,79.52,,,0,"percent of total billed charges ","70% of total billed charges ",15,132.06,
"PERFLUORO SUBST PFAS SERUM/PLA",2040785,"CDM ",300,RC,82542,HCPCS,OUTPATIENT,,,245,196,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",171.5,70,,137.20,,,0,"percent of total billed charges ","70% of total billed charges ",220.5,90,,176.40,,,0,"percent of total billed charges ","90% of total billed charges ",227.85,93,,182.28,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",208.25,85,,166.60,,,0,"percent of total billed charges ","85% of total billed charges ",220.5,90,,176.40,,,0,"percent of total billed charges ","90% of total billed charges ",220.5,90,,176.40,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",213.15,87,,170.52,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",171.5,70,,137.20,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,227.85,
"OSMOLARITY SERUM",2040790,"CDM ",301,RC,83930,HCPCS,OUTPATIENT,,,50.5,40.4,,6.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,30.60,30.60,30.60,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.35,70,,28.28,,,0,"percent of total billed charges ","70% of total billed charges ",45.45,90,,36.36,,,0,"percent of total billed charges ","90% of total billed charges ",46.97,93,,37.58,,,0,"percent of total billed charges ","93% of total billed charges ",6.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.53,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",42.93,85,,34.34,,,0,"percent of total billed charges ","85% of total billed charges ",45.45,90,,36.36,,,0,"percent of total billed charges ","90% of total billed charges ",45.45,90,,36.36,,,0,"percent of total billed charges ","90% of total billed charges ",8.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.94,87,,35.15,,,0,"percent of total billed charges ","87% of total billed charges ",8.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.61,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",35.35,70,,28.28,,,0,"percent of total billed charges ","70% of total billed charges ",6.46,46.97,
"OSMOLARITY URINE",2040795,"CDM ",301,RC,83935,HCPCS,OUTPATIENT,,,54.5,43.6,,6.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2.32,2.32,2.32,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.15,70,,30.52,,,0,"percent of total billed charges ","70% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",50.69,93,,40.55,,,0,"percent of total billed charges ","93% of total billed charges ",6.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.53,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",46.33,85,,37.06,,,0,"percent of total billed charges ","85% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",8.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.42,87,,6.69,6.69,6.69,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.82,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",38.15,70,,30.52,,,0,"percent of total billed charges ","70% of total billed charges ",6.46,50.69,
"SUSCEPTIBILITY TEST YEAST",2040800,"CDM ",306,RC,87186,HCPCS,OUTPATIENT,,,170,136,,8.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119,70,,95.20,,,0,"percent of total billed charges ","70% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",158.1,93,,126.48,,,0,"percent of total billed charges ","93% of total billed charges ",8.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",144.5,85,,115.60,,,0,"percent of total billed charges ","85% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",153,90,,122.40,,,0,"percent of total billed charges ","90% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.9,87,,8.48,8.48,105.80,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.65,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",119,70,,95.20,,,0,"percent of total billed charges ","70% of total billed charges ",8.65,158.1,
"BABESIM MICROTI DNA PCR",2040805,"CDM ",302,RC,87469,HCPCS,OUTPATIENT,,,207,165.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.9,70,,115.92,,,0,"percent of total billed charges ","70% of total billed charges ",186.3,90,,149.04,,,0,"percent of total billed charges ","90% of total billed charges ",192.51,93,,154.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",175.95,85,,140.76,,,0,"percent of total billed charges ","85% of total billed charges ",186.3,90,,149.04,,,0,"percent of total billed charges ","90% of total billed charges ",186.3,90,,149.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",180.09,87,,144.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",144.9,70,,115.92,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,192.51,
AMNIOSURE,2040810,"CDM ",301,RC,83986,HCPCS,OUTPATIENT,,,161,128.8,,3.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.7,70,,90.16,,,0,"percent of total billed charges ","70% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",149.73,93,,119.78,,,0,"percent of total billed charges ","93% of total billed charges ",3.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",136.85,85,,109.48,,,0,"percent of total billed charges ","85% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",140.07,87,,112.06,,,0,"percent of total billed charges ","87% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.58,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",112.7,70,,90.16,,,0,"percent of total billed charges ","70% of total billed charges ",3.58,149.73,
"AMNIOTIC PH",2040815,"CDM ",301,RC,83986,HCPCS,OUTPATIENT,,,137,109.6,,3.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.9,70,,76.72,,,0,"percent of total billed charges ","70% of total billed charges ",123.3,90,,98.64,,,0,"percent of total billed charges ","90% of total billed charges ",127.41,93,,101.93,,,0,"percent of total billed charges ","93% of total billed charges ",3.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",116.45,85,,93.16,,,0,"percent of total billed charges ","85% of total billed charges ",123.3,90,,98.64,,,0,"percent of total billed charges ","90% of total billed charges ",123.3,90,,98.64,,,0,"percent of total billed charges ","90% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",119.19,87,,95.35,,,0,"percent of total billed charges ","87% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3.58,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",95.9,70,,76.72,,,0,"percent of total billed charges ","70% of total billed charges ",3.58,127.41,
"LIVER FIBROSIS (ELF) SCORE",2040820,"CDM ",300,RC,81517,HCPCS,OUTPATIENT,,,552,441.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",386.4,70,,309.12,,,0,"percent of total billed charges ","70% of total billed charges ",496.8,90,,397.44,,,0,"percent of total billed charges ","90% of total billed charges ",513.36,93,,410.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",469.2,85,,375.36,,,0,"percent of total billed charges ","85% of total billed charges ",496.8,90,,397.44,,,0,"percent of total billed charges ","90% of total billed charges ",496.8,90,,397.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",480.24,87,,138.14,138.14,138.14,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",176.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",386.4,70,,309.12,,,0,"percent of total billed charges ","70% of total billed charges ",176.19,513.36,
"DRUG SCREEN MNTR FENTANYL URIN",2040825,"CDM ",300,RC,80307,HCPCS,OUTPATIENT,,,160.5,128.4,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",149.27,93,,119.42,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",136.43,85,,109.14,,,0,"percent of total billed charges ","85% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",139.64,87,,111.71,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",62.14,149.27,
"MYCOPLASMA GENITALIUM RRNA TMA",2040835,"CDM ",306,RC,87563,HCPCS,OUTPATIENT,,,94,75.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.8,70,,52.64,,,0,"percent of total billed charges ","70% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",87.42,93,,69.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",79.9,85,,63.92,,,0,"percent of total billed charges ","85% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.78,87,,65.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",35.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",65.8,70,,52.64,,,0,"percent of total billed charges ","70% of total billed charges ",35.09,87.42,
"*ADALIMUMAB LEVEL",2040845,"CDM ",301,RC,80145,HCPCS,OUTPATIENT,,,124.5,99.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.15,70,,69.72,,,0,"percent of total billed charges ","70% of total billed charges ",112.05,90,,89.64,,,0,"percent of total billed charges ","90% of total billed charges ",115.79,93,,92.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",105.83,85,,84.66,,,0,"percent of total billed charges ","85% of total billed charges ",112.05,90,,89.64,,,0,"percent of total billed charges ","90% of total billed charges ",112.05,90,,89.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",108.32,87,,86.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",38.57,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",87.15,70,,69.72,,,0,"percent of total billed charges ","70% of total billed charges ",38.57,115.79,
"*ADALIMUMAB ANTIDRUG ABS QNT",2040850,"CDM ",301,RC,83520,HCPCS,OUTPATIENT,,,90,72,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,83.7,
"*WESTERN BLOT TEST",2040855,"CDM ",301,RC,84182,HCPCS,OUTPATIENT,,,107.5,86,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.25,70,,60.20,,,0,"percent of total billed charges ","70% of total billed charges ",96.75,90,,77.40,,,0,"percent of total billed charges ","90% of total billed charges ",99.98,93,,79.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",91.38,85,,73.10,,,0,"percent of total billed charges ","85% of total billed charges ",96.75,90,,77.40,,,0,"percent of total billed charges ","90% of total billed charges ",96.75,90,,77.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",93.53,87,,74.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",29.21,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",75.25,70,,60.20,,,0,"percent of total billed charges ","70% of total billed charges ",29.21,99.98,
"*ANCA ABS EACH",2040865,"CDM ",302,RC,86036,HCPCS,OUTPATIENT,,,81.5,65.2,,7.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",75.8,93,,60.64,,,0,"percent of total billed charges ","93% of total billed charges ",7.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",69.28,85,,55.42,,,0,"percent of total billed charges ","85% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",70.91,87,,56.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",7.83,75.8,
"*VITAMIN B12",2040880,"CDM ",301,RC,82607,HCPCS,OUTPATIENT,,,189.5,151.6,,15.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,14.78,14.78,14.78,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.65,70,,106.12,,,0,"percent of total billed charges ","70% of total billed charges ",170.55,90,,136.44,,,0,"percent of total billed charges ","90% of total billed charges ",176.24,93,,140.99,,,0,"percent of total billed charges ","93% of total billed charges ",15.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",161.08,85,,128.86,,,0,"percent of total billed charges ","85% of total billed charges ",170.55,90,,136.44,,,0,"percent of total billed charges ","90% of total billed charges ",170.55,90,,136.44,,,0,"percent of total billed charges ","90% of total billed charges ",27.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",164.87,87,,19.84,14.78,146.97,16,"percent of total billed charges ","87% of total billed charges ",27.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.08,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",132.65,70,,106.12,,,0,"percent of total billed charges ","70% of total billed charges ",15.08,176.24,
"*INTRINSIC FACTOR AB",2040885,"CDM ",302,RC,86340,HCPCS,OUTPATIENT,,,221,176.8,,15.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,62.69,62.69,62.69,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154.7,70,,123.76,,,0,"percent of total billed charges ","70% of total billed charges ",198.9,90,,159.12,,,0,"percent of total billed charges ","90% of total billed charges ",205.53,93,,164.42,,,0,"percent of total billed charges ","93% of total billed charges ",15.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",187.85,85,,150.28,,,0,"percent of total billed charges ","85% of total billed charges ",198.9,90,,159.12,,,0,"percent of total billed charges ","90% of total billed charges ",198.9,90,,159.12,,,0,"percent of total billed charges ","90% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",192.27,87,,153.82,,,0,"percent of total billed charges ","87% of total billed charges ",23.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.08,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",154.7,70,,123.76,,,0,"percent of total billed charges ","70% of total billed charges ",15.08,205.53,
"*ACETYLCHOL RCPTR BINDING AB",2040895,"CDM ",302,RC,86041,HCPCS,OUTPATIENT,,,94,75.2,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.8,70,,52.64,,,0,"percent of total billed charges ","70% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",87.42,93,,69.94,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",79.9,85,,63.92,,,0,"percent of total billed charges ","85% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.78,87,,65.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",65.8,70,,52.64,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,87.42,
"*ACETYLCHOLN BLOCKING AB",2040900,"CDM ",302,RC,86042,HCPCS,OUTPATIENT,,,94,75.2,,15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.8,70,,52.64,,,0,"percent of total billed charges ","70% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",87.42,93,,69.94,,,0,"percent of total billed charges ","93% of total billed charges ",15.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",79.9,85,,63.92,,,0,"percent of total billed charges ","85% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.78,87,,65.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",18.39,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",65.8,70,,52.64,,,0,"percent of total billed charges ","70% of total billed charges ",15.64,87.42,
"*ACETYLCHOLN RCPTR MODLTG AB",2040905,"CDM ",302,RC,86043,HCPCS,OUTPATIENT,,,63,50.4,,10.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.1,70,,35.28,,,0,"percent of total billed charges ","70% of total billed charges ",56.7,90,,45.36,,,0,"percent of total billed charges ","90% of total billed charges ",58.59,93,,46.87,,,0,"percent of total billed charges ","93% of total billed charges ",10.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",53.55,85,,42.84,,,0,"percent of total billed charges ","85% of total billed charges ",56.7,90,,45.36,,,0,"percent of total billed charges ","90% of total billed charges ",56.7,90,,45.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",54.81,87,,43.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",44.1,70,,35.28,,,0,"percent of total billed charges ","70% of total billed charges ",10.24,58.59,
"*ZIKA VIRUS DNA/RNA AMP PROBE",2040915,"CDM ",300,RC,87662,HCPCS,OUTPATIENT,,,615,492,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",430.5,70,,344.40,,,0,"percent of total billed charges ","70% of total billed charges ",553.5,90,,442.80,,,0,"percent of total billed charges ","90% of total billed charges ",571.95,93,,457.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",522.75,85,,418.20,,,0,"percent of total billed charges ","85% of total billed charges ",553.5,90,,442.80,,,0,"percent of total billed charges ","90% of total billed charges ",553.5,90,,442.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",535.05,87,,428.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",51.31,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",430.5,70,,344.40,,,0,"percent of total billed charges ","70% of total billed charges ",51.31,571.95,
"*ZIKA VIRUS AB IGM",2040920,"CDM ",300,RC,86794,HCPCS,OUTPATIENT,,,94,75.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.8,70,,52.64,,,0,"percent of total billed charges ","70% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",87.42,93,,69.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",79.9,85,,63.92,,,0,"percent of total billed charges ","85% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",84.6,90,,67.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.78,87,,65.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",16.85,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",65.8,70,,52.64,,,0,"percent of total billed charges ","70% of total billed charges ",16.85,87.42,
"HISTOPLASMA GALACTOM AG URINE",2040940,"CDM ",306,RC,87385,HCPCS,OUTPATIENT,,,101,80.8,,11.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,52.51,52.51,52.51,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.7,70,,56.56,,,0,"percent of total billed charges ","70% of total billed charges ",90.9,90,,72.72,,,0,"percent of total billed charges ","90% of total billed charges ",93.93,93,,75.14,,,0,"percent of total billed charges ","93% of total billed charges ",11.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",85.85,85,,68.68,,,0,"percent of total billed charges ","85% of total billed charges ",90.9,90,,72.72,,,0,"percent of total billed charges ","90% of total billed charges ",90.9,90,,72.72,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",87.87,87,,68.96,68.96,68.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.25,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",70.7,70,,56.56,,,0,"percent of total billed charges ","70% of total billed charges ",11.26,93.93,
"*Q FEVER AB W/REFLEX TO TITERS",2040945,"CDM ",302,RC,86638,HCPCS,OUTPATIENT,,,57,45.6,,10.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.9,70,,31.92,,,0,"percent of total billed charges ","70% of total billed charges ",51.3,90,,41.04,,,0,"percent of total billed charges ","90% of total billed charges ",53.01,93,,42.41,,,0,"percent of total billed charges ","93% of total billed charges ",10.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",48.45,85,,38.76,,,0,"percent of total billed charges ","85% of total billed charges ",51.3,90,,41.04,,,0,"percent of total billed charges ","90% of total billed charges ",51.3,90,,41.04,,,0,"percent of total billed charges ","90% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",49.59,87,,39.67,,,0,"percent of total billed charges ","87% of total billed charges ",7.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.12,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",39.9,70,,31.92,,,0,"percent of total billed charges ","70% of total billed charges ",7.96,53.01,
"*FUNGAL ABS HISTOPLASM IMMUNOD",2040955,"CDM ",302,RC,86698,HCPCS,OUTPATIENT,,,107,85.6,,11.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.9,70,,59.92,,,0,"percent of total billed charges ","70% of total billed charges ",96.3,90,,77.04,,,0,"percent of total billed charges ","90% of total billed charges ",99.51,93,,79.61,,,0,"percent of total billed charges ","93% of total billed charges ",11.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",90.95,85,,72.76,,,0,"percent of total billed charges ","85% of total billed charges ",96.3,90,,77.04,,,0,"percent of total billed charges ","90% of total billed charges ",96.3,90,,77.04,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.09,87,,74.47,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.79,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",74.9,70,,59.92,,,0,"percent of total billed charges ","70% of total billed charges ",9.81,99.51,
"LACTOFERRIN QT STOOL",2040970,"CDM ",300,RC,83631,HCPCS,OUTPATIENT,,,139,111.2,,19.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.3,70,,77.84,,,0,"percent of total billed charges ","70% of total billed charges ",125.1,90,,100.08,,,0,"percent of total billed charges ","90% of total billed charges ",129.27,93,,103.42,,,0,"percent of total billed charges ","93% of total billed charges ",19.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",118.15,85,,94.52,,,0,"percent of total billed charges ","85% of total billed charges ",125.1,90,,100.08,,,0,"percent of total billed charges ","90% of total billed charges ",125.1,90,,100.08,,,0,"percent of total billed charges ","90% of total billed charges ",30.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",120.93,87,,96.74,,,0,"percent of total billed charges ","87% of total billed charges ",30.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.63,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",97.3,70,,77.84,,,0,"percent of total billed charges ","70% of total billed charges ",19.63,129.27,
"FAM MEDITERANEAN FEV MUTA ANYL",2040975,"CDM ",300,RC,81402,HCPCS,OUTPATIENT,,,784,627.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",548.8,70,,439.04,,,0,"percent of total billed charges ","70% of total billed charges ",705.6,90,,564.48,,,0,"percent of total billed charges ","90% of total billed charges ",729.12,93,,583.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",666.4,85,,533.12,,,0,"percent of total billed charges ","85% of total billed charges ",705.6,90,,564.48,,,0,"percent of total billed charges ","90% of total billed charges ",705.6,90,,564.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",682.08,87,,545.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",150.33,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",548.8,70,,439.04,,,0,"percent of total billed charges ","70% of total billed charges ",150.33,729.12,
"AMPHETAMINE CONFIRM MECONIUM",2040985,"CDM ",301,RC,80324,HCPCS,OUTPATIENT,,,73.5,58.8,,10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",10.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",13.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",10.48,68.36,
"ACTIN SMOOTH MUSCLE AB EA",2040990,"CDM ",302,RC,86015,HCPCS,OUTPATIENT,,,57,45.6,,7.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.9,70,,31.92,,,0,"percent of total billed charges ","70% of total billed charges ",51.3,90,,41.04,,,0,"percent of total billed charges ","90% of total billed charges ",53.01,93,,42.41,,,0,"percent of total billed charges ","93% of total billed charges ",7.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",48.45,85,,38.76,,,0,"percent of total billed charges ","85% of total billed charges ",51.3,90,,41.04,,,0,"percent of total billed charges ","90% of total billed charges ",51.3,90,,41.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",49.59,87,,39.67,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",39.9,70,,31.92,,,0,"percent of total billed charges ","70% of total billed charges ",7.49,53.01,
"DNA DS AB CRITHIDIA IFM W/RFLX",2041000,"CDM ",302,RC,86255,HCPCS,OUTPATIENT,,,169,135.2,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",157.17,93,,125.74,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.65,85,,114.92,,,0,"percent of total billed charges ","85% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.03,87,,117.62,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,157.17,
"ANA MULTIPLEX W/RFLX II AB CAS",2041010,"CDM ",302,RC,86038,HCPCS,OUTPATIENT,,,129,103.2,,12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",119.97,93,,95.98,,,0,"percent of total billed charges ","93% of total billed charges ",12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",109.65,85,,87.72,,,0,"percent of total billed charges ","85% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.23,87,,88.36,11.85,147.83,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",12.09,119.97,
"OXYCODDONE W CON URINE DRUGTES",2041020,"CDM ",301,RC,80307,HCPCS,OUTPATIENT,,,324.5,259.6,,63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.15,70,,181.72,,,0,"percent of total billed charges ","70% of total billed charges ",292.05,90,,233.64,,,0,"percent of total billed charges ","90% of total billed charges ",301.79,93,,241.43,,,0,"percent of total billed charges ","93% of total billed charges ",63.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",275.83,85,,220.66,,,0,"percent of total billed charges ","85% of total billed charges ",292.05,90,,233.64,,,0,"percent of total billed charges ","90% of total billed charges ",292.05,90,,233.64,,,0,"percent of total billed charges ","90% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",282.32,87,,225.86,,,0,"percent of total billed charges ","87% of total billed charges ",80.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",227.15,70,,181.72,,,0,"percent of total billed charges ","70% of total billed charges ",62.14,301.79,
"ANA MULTIPLEX W/RFLX TO DSDNA",2041030,"CDM ",301,RC,86038,HCPCS,OUTPATIENT,,,129,103.2,,12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",119.97,93,,95.98,,,0,"percent of total billed charges ","93% of total billed charges ",12.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",109.65,85,,87.72,,,0,"percent of total billed charges ","85% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",116.1,90,,92.88,,,0,"percent of total billed charges ","90% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.23,87,,88.36,11.85,147.83,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",90.3,70,,72.24,,,0,"percent of total billed charges ","70% of total billed charges ",12.09,119.97,
"PENCILLOYL G & V PROFILE",2041035,"CDM ",301,RC,86003,HCPCS,OUTPATIENT,,,32,25.6,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.4,70,,17.92,,,0,"percent of total billed charges ","70% of total billed charges ",28.8,90,,23.04,,,0,"percent of total billed charges ","90% of total billed charges ",29.76,93,,23.81,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",27.2,85,,21.76,,,0,"percent of total billed charges ","85% of total billed charges ",28.8,90,,23.04,,,0,"percent of total billed charges ","90% of total billed charges ",28.8,90,,23.04,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.84,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",22.4,70,,17.92,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,29.76,
"KAPPA LIGHT CHAIN FREE URINE",2041040,"CDM ",301,RC,83521,HCPCS,OUTPATIENT,,,83,66.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",72.21,87,,57.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.27,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,77.19,
"RNA POLYMERASE III AB",2041045,"CDM ",301,RC,83516,HCPCS,OUTPATIENT,,,78,62.4,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.6,70,,43.68,,,0,"percent of total billed charges ","70% of total billed charges ",70.2,90,,56.16,,,0,"percent of total billed charges ","90% of total billed charges ",72.54,93,,58.03,,,0,"percent of total billed charges ","93% of total billed charges ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",66.3,85,,53.04,,,0,"percent of total billed charges ","85% of total billed charges ",70.2,90,,56.16,,,0,"percent of total billed charges ","90% of total billed charges ",70.2,90,,56.16,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",67.86,87,,53.32,28.74,77.90,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.53,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",54.6,70,,43.68,,,0,"percent of total billed charges ","70% of total billed charges ",10,72.54,
"DRUG SCREEN QUANTALCOHOLS",2041050,"CDM ",301,RC,80320,HCPCS,OUTPATIENT,,,81,64.8,,15.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.7,70,,45.36,,,0,"percent of total billed charges ","70% of total billed charges ",72.9,90,,58.32,,,0,"percent of total billed charges ","90% of total billed charges ",75.33,93,,60.26,,,0,"percent of total billed charges ","93% of total billed charges ",15.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",68.85,85,,55.08,,,0,"percent of total billed charges ","85% of total billed charges ",72.9,90,,58.32,,,0,"percent of total billed charges ","90% of total billed charges ",72.9,90,,58.32,,,0,"percent of total billed charges ","90% of total billed charges ",19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.47,87,,56.38,,,0,"percent of total billed charges ","87% of total billed charges ",19.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",56.7,70,,45.36,,,0,"percent of total billed charges ","70% of total billed charges ",15.5,75.33,
"QUANTITATIVE ASSAY DRUG",2041055,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,90.5,72.4,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.35,70,,50.68,,,0,"percent of total billed charges ","70% of total billed charges ",81.45,90,,65.16,,,0,"percent of total billed charges ","90% of total billed charges ",84.17,93,,67.34,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",76.93,85,,61.54,,,0,"percent of total billed charges ","85% of total billed charges ",81.45,90,,65.16,,,0,"percent of total billed charges ","90% of total billed charges ",81.45,90,,65.16,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",78.74,87,,62.99,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63.35,70,,50.68,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,84.17,
"*45 CELLS MOSAICISM 2KARYOTYPE",2041065,"CDM ",310,RC,88263,HCPCS,OUTPATIENT,,,470.5,376.4,,150.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",329.35,70,,263.48,,,0,"percent of total billed charges ","70% of total billed charges ",423.45,90,,338.76,,,0,"percent of total billed charges ","90% of total billed charges ",437.57,93,,350.06,,,0,"percent of total billed charges ","93% of total billed charges ",150.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",274.44,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",399.93,85,,319.94,,,0,"percent of total billed charges ","85% of total billed charges ",423.45,90,,338.76,,,0,"percent of total billed charges ","90% of total billed charges ",423.45,90,,338.76,,,0,"percent of total billed charges ","90% of total billed charges ",271.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",409.34,87,,327.47,,,0,"percent of total billed charges ","87% of total billed charges ",271.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",150.29,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",329.35,70,,263.48,,,0,"percent of total billed charges ","70% of total billed charges ",150.29,437.57,
"*COMPREHENSIVE METOLIC PANEL",2041075,"CDM ",301,RC,80053,HCPCS,OUTPATIENT,,,57.5,46,,10.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,10.35,10.35,10.35,"1 through 10","other ","not separately reimbursment ",,,,33.31,33.31,33.31,"1 through 10","other ","not separately reimbursment ",40.25,70,,32.20,,,0,"percent of total billed charges ","70% of total billed charges ",51.75,90,,41.40,,,0,"percent of total billed charges ","90% of total billed charges ",53.48,93,,42.78,,,0,"percent of total billed charges ","93% of total billed charges ",10.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",48.88,85,,39.10,,,0,"percent of total billed charges ","85% of total billed charges ",51.75,90,,41.40,,,0,"percent of total billed charges ","90% of total billed charges ",51.75,90,,41.40,,,0,"percent of total billed charges ","90% of total billed charges ",16.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",50.03,87,,155.85,10.35,194.81,43,"percent of total billed charges ","87% of total billed charges ",16.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.56,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",40.25,70,,32.20,,,0,"percent of total billed charges ","70% of total billed charges ",10.56,53.48,
"LYMPHOCYTE SUBSET PANEL 4",2041090,"CDM ",301,RC,86360,HCPCS,OUTPATIENT,,,426.5,341.2,,39.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,162.94,162.94,162.94,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",298.55,70,,238.84,,,0,"percent of total billed charges ","70% of total billed charges ",383.85,90,,307.08,,,0,"percent of total billed charges ","90% of total billed charges ",396.65,93,,317.32,,,0,"percent of total billed charges ","93% of total billed charges ",39.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",362.53,85,,290.02,,,0,"percent of total billed charges ","85% of total billed charges ",383.85,90,,307.08,,,0,"percent of total billed charges ","90% of total billed charges ",383.85,90,,307.08,,,0,"percent of total billed charges ","90% of total billed charges ",37.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",371.06,87,,296.85,,,0,"percent of total billed charges ","87% of total billed charges ",37.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.98,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",298.55,70,,238.84,,,0,"percent of total billed charges ","70% of total billed charges ",37.61,396.65,
"EPIDERMAL ABS W/REFLEX TITER",2041095,"CDM ",301,RC,86255,HCPCS,OUTPATIENT,,,157,125.6,,12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.9,70,,87.92,,,0,"percent of total billed charges ","70% of total billed charges ",141.3,90,,113.04,,,0,"percent of total billed charges ","90% of total billed charges ",146.01,93,,116.81,,,0,"percent of total billed charges ","93% of total billed charges ",12.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",133.45,85,,106.76,,,0,"percent of total billed charges ","85% of total billed charges ",141.3,90,,113.04,,,0,"percent of total billed charges ","90% of total billed charges ",141.3,90,,113.04,,,0,"percent of total billed charges ","90% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",136.59,87,,109.27,,,0,"percent of total billed charges ","87% of total billed charges ",20.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.05,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",109.9,70,,87.92,,,0,"percent of total billed charges ","70% of total billed charges ",12.05,146.01,
"DIURETICS PANEL SERUM/PLASMA",2041100,"CDM ",302,RC,80375,HCPCS,OUTPATIENT,,,107.5,86,,17.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.25,70,,60.20,,,0,"percent of total billed charges ","70% of total billed charges ",96.75,90,,77.40,,,0,"percent of total billed charges ","90% of total billed charges ",99.98,93,,79.98,,,0,"percent of total billed charges ","93% of total billed charges ",17.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.38,85,,73.10,,,0,"percent of total billed charges ","85% of total billed charges ",96.75,90,,77.40,,,0,"percent of total billed charges ","90% of total billed charges ",96.75,90,,77.40,,,0,"percent of total billed charges ","90% of total billed charges ",22.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.53,87,,74.82,,,0,"percent of total billed charges ","87% of total billed charges ",22.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",75.25,70,,60.20,,,0,"percent of total billed charges ","70% of total billed charges ",17.88,99.98,
CBC,2089993,"CDM ",305,RC,85025,HCPCS,OUTPATIENT,,,141.5,113.2,,6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,7.61,7.61,7.61,"1 through 10","other ","not separately reimbursment ",,,,14.65,14.65,14.65,"1 through 10","other ","not separately reimbursment ",99.05,70,,79.24,,,0,"percent of total billed charges ","70% of total billed charges ",127.35,90,,101.88,,,0,"percent of total billed charges ","90% of total billed charges ",131.6,93,,105.28,,,0,"percent of total billed charges ","93% of total billed charges ",6.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",120.28,85,,96.22,,,0,"percent of total billed charges ","85% of total billed charges ",127.35,90,,101.88,,,0,"percent of total billed charges ","90% of total billed charges ",127.35,90,,101.88,,,0,"percent of total billed charges ","90% of total billed charges ",6.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",123.11,87,,131.71,7.62,164.64,48,"percent of total billed charges ","87% of total billed charges ",6.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.77,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",99.05,70,,79.24,,,0,"percent of total billed charges ","70% of total billed charges ",6.54,131.6,
"MEXITIL (MEXILETINE)",2099034,"CDM ",301,RC,82542,HCPCS,OUTPATIENT,,,375,300,,20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.5,70,,210.00,,,0,"percent of total billed charges ","70% of total billed charges ",337.5,90,,270.00,,,0,"percent of total billed charges ","90% of total billed charges ",348.75,93,,279.00,,,0,"percent of total billed charges ","93% of total billed charges ",20.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",318.75,85,,255.00,,,0,"percent of total billed charges ","85% of total billed charges ",337.5,90,,270.00,,,0,"percent of total billed charges ","90% of total billed charges ",337.5,90,,270.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",326.25,87,,261.00,,,0,"percent of total billed charges ","87% of total billed charges ",11.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.09,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",262.5,70,,210.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.45,348.75,
"SARS COV2 TOT AB SPIKE SEMI QT",2401020,"CDM ",301,RC,86769,HCPCS,OUTPATIENT,,,146,116.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",36.17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,101.62,,,0,"percent of total billed charges ","87% of total billed charges ",35.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.13,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",35.81,135.78,
"SARS COV2 AB IGG NUCLE QL",2401025,"CDM ",306,RC,86769,HCPCS,OUTPATIENT,,,146,116.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,93,,108.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",36.17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",124.1,85,,99.28,,,0,"percent of total billed charges ","85% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",131.4,90,,105.12,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.02,87,,101.62,,,0,"percent of total billed charges ","87% of total billed charges ",35.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.13,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",102.2,70,,81.76,,,0,"percent of total billed charges ","70% of total billed charges ",35.81,135.78,
"MANDIBLE LESS THAN 4 VIEWS",3000015,"CDM ",320,RC,70100,HCPCS,OUTPATIENT,,,494.5,395.6,,26.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,280.28,280.28,280.28,"1 through 10","other ","not separately reimbursment ",80.06,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",346.15,70,,276.92,,,0,"percent of total billed charges ","70% of total billed charges ",445.05,90,,356.04,,,0,"percent of total billed charges ","90% of total billed charges ",459.89,93,,367.91,,,0,"percent of total billed charges ","93% of total billed charges ",26.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",420.33,85,,336.26,,,0,"percent of total billed charges ","85% of total billed charges ",445.05,90,,356.04,,,0,"percent of total billed charges ","90% of total billed charges ",445.05,90,,356.04,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",430.22,87,,344.18,,,0,"percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",346.15,70,,276.92,,,0,"percent of total billed charges ","70% of total billed charges ",21.07,459.89,
"ENEMA SINGLE BARIUM",3000023,"CDM ",320,RC,74270,HCPCS,OUTPATIENT,,,1933,1546.4,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1006.97,100,,673.77,673.77,673.77,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",332.2,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1353.1,70,,1082.48,,,0,"percent of total billed charges ","70% of total billed charges ",1739.7,90,,1391.76,,,0,"percent of total billed charges ","90% of total billed charges ",1797.69,93,,1438.15,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",69.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1643.05,85,,1314.44,,,0,"percent of total billed charges ","85% of total billed charges ",1739.7,90,,1391.76,,,0,"percent of total billed charges ","90% of total billed charges ",1739.7,90,,1391.76,,,0,"percent of total billed charges ","90% of total billed charges ",68.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1681.71,87,,1345.37,,,0,"percent of total billed charges ","87% of total billed charges ",68.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1353.1,70,,1082.48,,,0,"percent of total billed charges ","70% of total billed charges ",68.41,1797.69,
"MANDIBLE 4 OR MORE VIEWS",3000031,"CDM ",320,RC,70110,HCPCS,OUTPATIENT,,,725.5,580.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",210.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",91.61,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",507.85,70,,406.28,,,0,"percent of total billed charges ","70% of total billed charges ",652.95,90,,522.36,,,0,"percent of total billed charges ","90% of total billed charges ",674.72,93,,539.78,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.26,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",616.68,85,,493.34,,,0,"percent of total billed charges ","85% of total billed charges ",652.95,90,,522.36,,,0,"percent of total billed charges ","90% of total billed charges ",652.95,90,,522.36,,,0,"percent of total billed charges ","90% of total billed charges ",25.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",631.19,87,,504.95,,,0,"percent of total billed charges ","87% of total billed charges ",25.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",507.85,70,,406.28,,,0,"percent of total billed charges ","70% of total billed charges ",25.01,674.72,
"MASTOID 3 OR MORE VIEWS",3000056,"CDM ",320,RC,70130,HCPCS,OUTPATIENT,,,804,643.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",131.3,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",562.8,70,,450.24,,,0,"percent of total billed charges ","70% of total billed charges ",723.6,90,,578.88,,,0,"percent of total billed charges ","90% of total billed charges ",747.72,93,,598.18,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",683.4,85,,546.72,,,0,"percent of total billed charges ","85% of total billed charges ",723.6,90,,578.88,,,0,"percent of total billed charges ","90% of total billed charges ",723.6,90,,578.88,,,0,"percent of total billed charges ","90% of total billed charges ",31.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",699.48,87,,559.58,,,0,"percent of total billed charges ","87% of total billed charges ",31.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",562.8,70,,450.24,,,0,"percent of total billed charges ","70% of total billed charges ",31.66,747.72,
"SINUS 2-VIEWS",3000064,"CDM ",320,RC,70210,HCPCS,OUTPATIENT,,,544,435.2,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.86,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",67.54,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",380.8,70,,304.64,,,0,"percent of total billed charges ","70% of total billed charges ",489.6,90,,391.68,,,0,"percent of total billed charges ","90% of total billed charges ",505.92,93,,404.74,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",462.4,85,,369.92,,,0,"percent of total billed charges ","85% of total billed charges ",489.6,90,,391.68,,,0,"percent of total billed charges ","90% of total billed charges ",489.6,90,,391.68,,,0,"percent of total billed charges ","90% of total billed charges ",22.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",473.28,87,,378.62,,,0,"percent of total billed charges ","87% of total billed charges ",22.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",380.8,70,,304.64,,,0,"percent of total billed charges ","70% of total billed charges ",22.9,505.92,
"MASTOID LESS THAN 3 VIEWS",3000072,"CDM ",320,RC,70120,HCPCS,OUTPATIENT,,,561,448.8,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.76,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",392.7,70,,314.16,,,0,"percent of total billed charges ","70% of total billed charges ",504.9,90,,403.92,,,0,"percent of total billed charges ","90% of total billed charges ",521.73,93,,417.38,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.26,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",476.85,85,,381.48,,,0,"percent of total billed charges ","85% of total billed charges ",504.9,90,,403.92,,,0,"percent of total billed charges ","90% of total billed charges ",504.9,90,,403.92,,,0,"percent of total billed charges ","90% of total billed charges ",25.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",488.07,87,,390.46,,,0,"percent of total billed charges ","87% of total billed charges ",25.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",392.7,70,,314.16,,,0,"percent of total billed charges ","70% of total billed charges ",25.01,521.73,
"FACIAL BONES 3 OR MORE VIEWS",3000106,"CDM ",320,RC,70150,HCPCS,OUTPATIENT,,,756.5,605.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",189.56,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",99.29,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",529.55,70,,423.64,,,0,"percent of total billed charges ","70% of total billed charges ",680.85,90,,544.68,,,0,"percent of total billed charges ","90% of total billed charges ",703.55,93,,562.84,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",643.03,85,,514.42,,,0,"percent of total billed charges ","85% of total billed charges ",680.85,90,,544.68,,,0,"percent of total billed charges ","90% of total billed charges ",680.85,90,,544.68,,,0,"percent of total billed charges ","90% of total billed charges ",31.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",658.16,87,,526.53,,,0,"percent of total billed charges ","87% of total billed charges ",31.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",529.55,70,,423.64,,,0,"percent of total billed charges ","70% of total billed charges ",31.66,703.55,
"FACIAL BONES 2-VIEWS",3000122,"CDM ",320,RC,70140,HCPCS,OUTPATIENT,,,561,448.8,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",179.34,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",66.99,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",392.7,70,,314.16,,,0,"percent of total billed charges ","70% of total billed charges ",504.9,90,,403.92,,,0,"percent of total billed charges ","90% of total billed charges ",521.73,93,,417.38,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.26,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",476.85,85,,381.48,,,0,"percent of total billed charges ","85% of total billed charges ",504.9,90,,403.92,,,0,"percent of total billed charges ","90% of total billed charges ",504.9,90,,403.92,,,0,"percent of total billed charges ","90% of total billed charges ",25.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",488.07,87,,3.86,3.86,3.86,"1 through 10","percent of total billed charges ","87% of total billed charges ",25.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",392.7,70,,314.16,,,0,"percent of total billed charges ","70% of total billed charges ",25.01,521.73,
"NASAL BONES",3000130,"CDM ",320,RC,70160,HCPCS,OUTPATIENT,,,523,418.4,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.74,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",79.31,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",366.1,70,,292.88,,,0,"percent of total billed charges ","70% of total billed charges ",470.7,90,,376.56,,,0,"percent of total billed charges ","90% of total billed charges ",486.39,93,,389.11,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",444.55,85,,355.64,,,0,"percent of total billed charges ","85% of total billed charges ",470.7,90,,376.56,,,0,"percent of total billed charges ","90% of total billed charges ",470.7,90,,376.56,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",455.01,87,,364.01,,,0,"percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",366.1,70,,292.88,,,0,"percent of total billed charges ","70% of total billed charges ",21.07,486.39,
"SINUS 3 OR MORE VIEWS",3000205,"CDM ",320,RC,70220,HCPCS,OUTPATIENT,,,794,635.2,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",194.2,100,,70.92,70.92,70.92,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",78.96,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",555.8,70,,444.64,,,0,"percent of total billed charges ","70% of total billed charges ",714.6,90,,571.68,,,0,"percent of total billed charges ","90% of total billed charges ",738.42,93,,590.74,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",674.9,85,,539.92,,,0,"percent of total billed charges ","85% of total billed charges ",714.6,90,,571.68,,,0,"percent of total billed charges ","90% of total billed charges ",714.6,90,,571.68,,,0,"percent of total billed charges ","90% of total billed charges ",31.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",690.78,87,,552.62,,,0,"percent of total billed charges ","87% of total billed charges ",31.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",555.8,70,,444.64,,,0,"percent of total billed charges ","70% of total billed charges ",31.66,738.42,
"SKULL 4 OR MORE VIEWS",3000221,"CDM ",320,RC,70260,HCPCS,OUTPATIENT,,,936,748.8,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",210.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",93.9,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",655.2,70,,524.16,,,0,"percent of total billed charges ","70% of total billed charges ",842.4,90,,673.92,,,0,"percent of total billed charges ","90% of total billed charges ",870.48,93,,696.38,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",795.6,85,,636.48,,,0,"percent of total billed charges ","85% of total billed charges ",842.4,90,,673.92,,,0,"percent of total billed charges ","90% of total billed charges ",842.4,90,,673.92,,,0,"percent of total billed charges ","90% of total billed charges ",35.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",814.32,87,,651.46,,,0,"percent of total billed charges ","87% of total billed charges ",35.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",655.2,70,,524.16,,,0,"percent of total billed charges ","70% of total billed charges ",35.99,870.48,
"TMJ BILATERAL",3000247,"CDM ",320,RC,70330,HCPCS,OUTPATIENT,,,730,584,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,371.03,371.03,371.03,"1 through 10","other ","not separately reimbursment ",111.58,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",511,70,,408.80,,,0,"percent of total billed charges ","70% of total billed charges ",657,90,,525.60,,,0,"percent of total billed charges ","90% of total billed charges ",678.9,93,,543.12,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.93,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",620.5,85,,496.40,,,0,"percent of total billed charges ","85% of total billed charges ",657,90,,525.60,,,0,"percent of total billed charges ","90% of total billed charges ",657,90,,525.60,,,0,"percent of total billed charges ","90% of total billed charges ",33.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",635.1,87,,508.08,,,0,"percent of total billed charges ","87% of total billed charges ",33.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",511,70,,408.80,,,0,"percent of total billed charges ","70% of total billed charges ",33.59,678.9,
"SKULL LESS THAN 4 VIEWS",3000288,"CDM ",320,RC,70250,HCPCS,OUTPATIENT,,,571,456.8,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.1,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",74.54,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",399.7,70,,319.76,,,0,"percent of total billed charges ","70% of total billed charges ",513.9,90,,411.12,,,0,"percent of total billed charges ","90% of total billed charges ",531.03,93,,424.82,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.26,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",485.35,85,,388.28,,,0,"percent of total billed charges ","85% of total billed charges ",513.9,90,,411.12,,,0,"percent of total billed charges ","90% of total billed charges ",513.9,90,,411.12,,,0,"percent of total billed charges ","90% of total billed charges ",25.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",496.77,87,,397.42,,,0,"percent of total billed charges ","87% of total billed charges ",25.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",399.7,70,,319.76,,,0,"percent of total billed charges ","70% of total billed charges ",25.01,531.03,
SIALOGRAM,3000296,"CDM ",320,RC,70390,HCPCS,OUTPATIENT,,,1290,1032,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",251.17,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",903,70,,722.40,,,0,"percent of total billed charges ","70% of total billed charges ",1161,90,,928.80,,,0,"percent of total billed charges ","90% of total billed charges ",1199.7,93,,959.76,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.02,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1096.5,85,,877.20,,,0,"percent of total billed charges ","85% of total billed charges ",1161,90,,928.80,,,0,"percent of total billed charges ","90% of total billed charges ",1161,90,,928.80,,,0,"percent of total billed charges ","90% of total billed charges ",34.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1122.3,87,,897.84,,,0,"percent of total billed charges ","87% of total billed charges ",34.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",903,70,,722.40,,,0,"percent of total billed charges ","70% of total billed charges ",34.67,1199.7,
"ANGIO EXT BILAT",3000304,"CDM ",323,RC,75716,HCPCS,OUTPATIENT,,,4132.5,3306,,2532.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3219.68,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",343.27,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2892.75,70,,2314.20,,,0,"percent of total billed charges ","70% of total billed charges ",3719.25,90,,2975.40,,,0,"percent of total billed charges ","90% of total billed charges ",3843.23,93,,3074.58,,,0,"percent of total billed charges ","93% of total billed charges ",2532.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",173.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3512.63,85,,2810.10,,,0,"percent of total billed charges ","85% of total billed charges ",3719.25,90,,2975.40,,,0,"percent of total billed charges ","90% of total billed charges ",3719.25,90,,2975.40,,,0,"percent of total billed charges ","90% of total billed charges ",171.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3595.28,87,,2876.22,,,0,"percent of total billed charges ","87% of total billed charges ",171.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2903.79,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2892.75,70,,2314.20,,,0,"percent of total billed charges ","70% of total billed charges ",171.39,3843.23,
"CHEST SINGLE VIEW",3000346,"CDM ",324,RC,71045,HCPCS,OUTPATIENT,,,566.5,453.2,,,,,,,,0,"other ","not separately reimbursment ",123.58,100,,17.44,17.44,17.44,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",53.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",396.55,70,,317.24,,,0,"percent of total billed charges ","70% of total billed charges ",509.85,90,,407.88,,,0,"percent of total billed charges ","90% of total billed charges ",526.85,93,,421.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",6.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",481.53,85,,385.22,,,0,"percent of total billed charges ","85% of total billed charges ",509.85,90,,407.88,,,0,"percent of total billed charges ","90% of total billed charges ",509.85,90,,407.88,,,0,"percent of total billed charges ","90% of total billed charges ",6.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",492.86,87,,311.35,85.32,389.19,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",396.55,70,,317.24,,,0,"percent of total billed charges ","70% of total billed charges ",6.57,526.85,
"CHEST PA/LAT",3000353,"CDM ",320,RC,71046,HCPCS,OUTPATIENT,,,724,579.2,,,,,,,,0,"other ","not separately reimbursment ",150.77,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",69.98,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",506.8,70,,405.44,,,0,"percent of total billed charges ","70% of total billed charges ",651.6,90,,521.28,,,0,"percent of total billed charges ","90% of total billed charges ",673.32,93,,538.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",12.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",615.4,85,,492.32,,,0,"percent of total billed charges ","85% of total billed charges ",651.6,90,,521.28,,,0,"percent of total billed charges ","90% of total billed charges ",651.6,90,,521.28,,,0,"percent of total billed charges ","90% of total billed charges ",12.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",629.88,87,,170.90,60.28,497.81,12,"percent of total billed charges ","87% of total billed charges ",12.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",506.8,70,,405.44,,,0,"percent of total billed charges ","70% of total billed charges ",12.12,673.32,
"INF VENACAVAGRAM",3000361,"CDM ",329,RC,75825,HCPCS,OUTPATIENT,,,3262.5,2610,,2532.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",238.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2283.75,70,,1827.00,,,0,"percent of total billed charges ","70% of total billed charges ",2936.25,90,,2349.00,,,0,"percent of total billed charges ","90% of total billed charges ",3034.13,93,,2427.30,,,0,"percent of total billed charges ","93% of total billed charges ",2532.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",137.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2773.13,85,,2218.50,,,0,"percent of total billed charges ","85% of total billed charges ",2936.25,90,,2349.00,,,0,"percent of total billed charges ","90% of total billed charges ",2936.25,90,,2349.00,,,0,"percent of total billed charges ","90% of total billed charges ",135.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2838.38,87,,2270.70,,,0,"percent of total billed charges ","87% of total billed charges ",135.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2903.79,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2283.75,70,,1827.00,,,0,"percent of total billed charges ","70% of total billed charges ",135.74,3034.13,
"FLUORO PACEMAKER INSERT",3000395,"CDM ",320,RC,76000,HCPCS,OUTPATIENT,,,972,777.6,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",234.16,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",88.86,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",680.4,70,,544.32,,,0,"percent of total billed charges ","70% of total billed charges ",874.8,90,,699.84,,,0,"percent of total billed charges ","90% of total billed charges ",903.96,93,,723.17,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.59,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",826.2,85,,660.96,,,0,"percent of total billed charges ","85% of total billed charges ",874.8,90,,699.84,,,0,"percent of total billed charges ","90% of total billed charges ",874.8,90,,699.84,,,0,"percent of total billed charges ","90% of total billed charges ",37.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",845.64,87,,446.52,307.90,585.13,"1 through 10","percent of total billed charges ","87% of total billed charges ",37.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",680.4,70,,544.32,,,0,"percent of total billed charges ","70% of total billed charges ",37.22,903.96,
"RIBS BIL+ PA CHEST MIN 4 VIEWS",3000411,"CDM ",320,RC,71111,HCPCS,OUTPATIENT,,,837,669.6,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",245.31,100,,220.25,220.25,220.25,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",110.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",585.9,70,,468.72,,,0,"percent of total billed charges ","70% of total billed charges ",753.3,90,,602.64,,,0,"percent of total billed charges ","90% of total billed charges ",778.41,93,,622.73,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",711.45,85,,569.16,,,0,"percent of total billed charges ","85% of total billed charges ",753.3,90,,602.64,,,0,"percent of total billed charges ","90% of total billed charges ",753.3,90,,602.64,,,0,"percent of total billed charges ","90% of total billed charges ",35.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",728.19,87,,582.55,,,0,"percent of total billed charges ","87% of total billed charges ",35.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",585.9,70,,468.72,,,0,"percent of total billed charges ","70% of total billed charges ",35.99,778.41,
"RIBS BILATERAL 3 VIEWS",3000437,"CDM ",320,RC,71110,HCPCS,OUTPATIENT,,,730,584,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",134.73,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",91.89,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",511,70,,408.80,,,0,"percent of total billed charges ","70% of total billed charges ",657,90,,525.60,,,0,"percent of total billed charges ","90% of total billed charges ",678.9,93,,543.12,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",620.5,85,,496.40,,,0,"percent of total billed charges ","85% of total billed charges ",657,90,,525.60,,,0,"percent of total billed charges ","90% of total billed charges ",657,90,,525.60,,,0,"percent of total billed charges ","90% of total billed charges ",31.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",635.1,87,,508.08,,,0,"percent of total billed charges ","87% of total billed charges ",31.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",511,70,,408.80,,,0,"percent of total billed charges ","70% of total billed charges ",31.66,678.9,
STERNUM,3000445,"CDM ",320,RC,71120,HCPCS,OUTPATIENT,,,594.5,475.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",144.96,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",70.53,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",416.15,70,,332.92,,,0,"percent of total billed charges ","70% of total billed charges ",535.05,90,,428.04,,,0,"percent of total billed charges ","90% of total billed charges ",552.89,93,,442.31,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",505.33,85,,404.26,,,0,"percent of total billed charges ","85% of total billed charges ",535.05,90,,428.04,,,0,"percent of total billed charges ","90% of total billed charges ",535.05,90,,428.04,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",517.22,87,,413.78,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",416.15,70,,332.92,,,0,"percent of total billed charges ","70% of total billed charges ",26.17,552.89,
"STERNOCLAVICULAR JOI",3000452,"CDM ",320,RC,71130,HCPCS,OUTPATIENT,,,567,453.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,288.15,288.15,288.15,"1 through 10","other ","not separately reimbursment ",86.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",396.9,70,,317.52,,,0,"percent of total billed charges ","70% of total billed charges ",510.3,90,,408.24,,,0,"percent of total billed charges ","90% of total billed charges ",527.31,93,,421.85,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.37,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",481.95,85,,385.56,,,0,"percent of total billed charges ","85% of total billed charges ",510.3,90,,408.24,,,0,"percent of total billed charges ","90% of total billed charges ",510.3,90,,408.24,,,0,"percent of total billed charges ","90% of total billed charges ",28.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",493.29,87,,394.63,,,0,"percent of total billed charges ","87% of total billed charges ",28.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",396.9,70,,317.52,,,0,"percent of total billed charges ","70% of total billed charges ",28.09,527.31,
IVP-IV-BOLUS,3000478,"CDM ",320,RC,74400,HCPCS,OUTPATIENT,,,1751,1400.8,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",481.33,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",287.89,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1225.7,70,,980.56,,,0,"percent of total billed charges ","70% of total billed charges ",1575.9,90,,1260.72,,,0,"percent of total billed charges ","90% of total billed charges ",1628.43,93,,1302.74,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",68.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1488.35,85,,1190.68,,,0,"percent of total billed charges ","85% of total billed charges ",1575.9,90,,1260.72,,,0,"percent of total billed charges ","90% of total billed charges ",1575.9,90,,1260.72,,,0,"percent of total billed charges ","90% of total billed charges ",67.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1523.37,87,,1218.70,,,0,"percent of total billed charges ","87% of total billed charges ",67.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1225.7,70,,980.56,,,0,"percent of total billed charges ","70% of total billed charges ",67.66,1628.43,
"HYPERTENSIVE IVP",3000486,"CDM ",320,RC,74400,HCPCS,OUTPATIENT,,,1744,1395.2,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",481.33,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",287.89,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1220.8,70,,976.64,,,0,"percent of total billed charges ","70% of total billed charges ",1569.6,90,,1255.68,,,0,"percent of total billed charges ","90% of total billed charges ",1621.92,93,,1297.54,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",68.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1482.4,85,,1185.92,,,0,"percent of total billed charges ","85% of total billed charges ",1569.6,90,,1255.68,,,0,"percent of total billed charges ","90% of total billed charges ",1569.6,90,,1255.68,,,0,"percent of total billed charges ","90% of total billed charges ",67.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1517.28,87,,1213.82,,,0,"percent of total billed charges ","87% of total billed charges ",67.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1220.8,70,,976.64,,,0,"percent of total billed charges ","70% of total billed charges ",67.66,1621.92,
"NECK SOFT TISSUE",3000494,"CDM ",320,RC,70360,HCPCS,OUTPATIENT,,,455.5,364.4,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",129.16,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",65.54,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",318.85,70,,255.08,,,0,"percent of total billed charges ","70% of total billed charges ",409.95,90,,327.96,,,0,"percent of total billed charges ","90% of total billed charges ",423.62,93,,338.90,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",387.18,85,,309.74,,,0,"percent of total billed charges ","85% of total billed charges ",409.95,90,,327.96,,,0,"percent of total billed charges ","90% of total billed charges ",409.95,90,,327.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.29,87,,317.03,,,0,"percent of total billed charges ","87% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",318.85,70,,255.08,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,423.62,
"RETROGRADE PYLEOGRAM",3000510,"CDM ",320,RC,74420,HCPCS,OUTPATIENT,,,1751,1400.8,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",160.91,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1225.7,70,,980.56,,,0,"percent of total billed charges ","70% of total billed charges ",1575.9,90,,1260.72,,,0,"percent of total billed charges ","90% of total billed charges ",1628.43,93,,1302.74,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",44.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1488.35,85,,1190.68,,,0,"percent of total billed charges ","85% of total billed charges ",1575.9,90,,1260.72,,,0,"percent of total billed charges ","90% of total billed charges ",1575.9,90,,1260.72,,,0,"percent of total billed charges ","90% of total billed charges ",44.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1523.37,87,,1218.70,,,0,"percent of total billed charges ","87% of total billed charges ",44.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1225.7,70,,980.56,,,0,"percent of total billed charges ","70% of total billed charges ",44.48,1628.43,
CYSTOGRAM,3000528,"CDM ",320,RC,74430,HCPCS,OUTPATIENT,,,1607,1285.6,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",348.45,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",85.18,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1124.9,70,,899.92,,,0,"percent of total billed charges ","70% of total billed charges ",1446.3,90,,1157.04,,,0,"percent of total billed charges ","90% of total billed charges ",1494.51,93,,1195.61,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1365.95,85,,1092.76,,,0,"percent of total billed charges ","85% of total billed charges ",1446.3,90,,1157.04,,,0,"percent of total billed charges ","90% of total billed charges ",1446.3,90,,1157.04,,,0,"percent of total billed charges ","90% of total billed charges ",42.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1398.09,87,,1118.47,,,0,"percent of total billed charges ","87% of total billed charges ",42.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.84,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1124.9,70,,899.92,,,0,"percent of total billed charges ","70% of total billed charges ",42.24,1494.51,
"VOIDING CYSTO URETHO",3000544,"CDM ",320,RC,74455,HCPCS,OUTPATIENT,,,1543,1234.4,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",406.06,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",221.45,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1080.1,70,,864.08,,,0,"percent of total billed charges ","70% of total billed charges ",1388.7,90,,1110.96,,,0,"percent of total billed charges ","90% of total billed charges ",1434.99,93,,1147.99,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1311.55,85,,1049.24,,,0,"percent of total billed charges ","85% of total billed charges ",1388.7,90,,1110.96,,,0,"percent of total billed charges ","90% of total billed charges ",1388.7,90,,1110.96,,,0,"percent of total billed charges ","90% of total billed charges ",63.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1342.41,87,,1073.93,,,0,"percent of total billed charges ","87% of total billed charges ",63.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1080.1,70,,864.08,,,0,"percent of total billed charges ","70% of total billed charges ",63.33,1434.99,
"RETRO URETHROCYSTOGR",3000551,"CDM ",320,RC,74450,HCPCS,OUTPATIENT,,,1236.5,989.2,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",865.55,70,,692.44,,,0,"percent of total billed charges ","70% of total billed charges ",1112.85,90,,890.28,,,0,"percent of total billed charges ","90% of total billed charges ",1149.95,93,,919.96,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1051.03,85,,840.82,,,0,"percent of total billed charges ","85% of total billed charges ",1112.85,90,,890.28,,,0,"percent of total billed charges ","90% of total billed charges ",1112.85,90,,890.28,,,0,"percent of total billed charges ","90% of total billed charges ",37.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1075.76,87,,860.61,,,0,"percent of total billed charges ","87% of total billed charges ",37.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",865.55,70,,692.44,,,0,"percent of total billed charges ","70% of total billed charges ",37.94,1149.95,
URETHROGRAM,3000569,"CDM ",320,RC,74450,HCPCS,OUTPATIENT,,,1710,1368,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1197,70,,957.60,,,0,"percent of total billed charges ","70% of total billed charges ",1539,90,,1231.20,,,0,"percent of total billed charges ","90% of total billed charges ",1590.3,93,,1272.24,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1453.5,85,,1162.80,,,0,"percent of total billed charges ","85% of total billed charges ",1539,90,,1231.20,,,0,"percent of total billed charges ","90% of total billed charges ",1539,90,,1231.20,,,0,"percent of total billed charges ","90% of total billed charges ",37.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1487.7,87,,1190.16,,,0,"percent of total billed charges ","87% of total billed charges ",37.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1197,70,,957.60,,,0,"percent of total billed charges ","70% of total billed charges ",37.94,1590.3,
HYSTEROSALPINGOGRAM,3000593,"CDM ",320,RC,74740,HCPCS,OUTPATIENT,,,932,745.6,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",359.6,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",204.86,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",652.4,70,,521.92,,,0,"percent of total billed charges ","70% of total billed charges ",838.8,90,,671.04,,,0,"percent of total billed charges ","90% of total billed charges ",866.76,93,,693.41,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",52.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",792.2,85,,633.76,,,0,"percent of total billed charges ","85% of total billed charges ",838.8,90,,671.04,,,0,"percent of total billed charges ","90% of total billed charges ",838.8,90,,671.04,,,0,"percent of total billed charges ","90% of total billed charges ",51.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",810.84,87,,648.67,,,0,"percent of total billed charges ","87% of total billed charges ",51.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",652.4,70,,521.92,,,0,"percent of total billed charges ","70% of total billed charges ",51.97,866.76,
"C-SPINE 2 OR 3 VIEWS AP&LAT",3000619,"CDM ",320,RC,72040,HCPCS,OUTPATIENT,,,574,459.2,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",159.82,100,,153.06,153.06,153.06,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",82.41,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",401.8,70,,321.44,,,0,"percent of total billed charges ","70% of total billed charges ",516.6,90,,413.28,,,0,"percent of total billed charges ","90% of total billed charges ",533.82,93,,427.06,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",487.9,85,,390.32,,,0,"percent of total billed charges ","85% of total billed charges ",516.6,90,,413.28,,,0,"percent of total billed charges ","90% of total billed charges ",516.6,90,,413.28,,,0,"percent of total billed charges ","90% of total billed charges ",24.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.38,87,,230.12,98.72,361.52,"1 through 10","percent of total billed charges ","87% of total billed charges ",24.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",401.8,70,,321.44,,,0,"percent of total billed charges ","70% of total billed charges ",24.25,533.82,
"T-SPINE 3-VIEWS",3000627,"CDM ",320,RC,72072,HCPCS,OUTPATIENT,,,701.5,561.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",81.8,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",491.05,70,,392.84,,,0,"percent of total billed charges ","70% of total billed charges ",631.35,90,,505.08,,,0,"percent of total billed charges ","90% of total billed charges ",652.4,93,,521.92,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",596.28,85,,477.02,,,0,"percent of total billed charges ","85% of total billed charges ",631.35,90,,505.08,,,0,"percent of total billed charges ","90% of total billed charges ",631.35,90,,505.08,,,0,"percent of total billed charges ","90% of total billed charges ",29.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",610.31,87,,48.59,48.59,48.59,"1 through 10","percent of total billed charges ","87% of total billed charges ",29.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",491.05,70,,392.84,,,0,"percent of total billed charges ","70% of total billed charges ",29.74,652.4,
"L-SPINE 2-VIEWS AP&LAT",3000643,"CDM ",320,RC,72100,HCPCS,OUTPATIENT,,,708.5,566.8,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",174.69,100,,11.60,11.60,11.60,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",83.12,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",495.95,70,,396.76,,,0,"percent of total billed charges ","70% of total billed charges ",637.65,90,,510.12,,,0,"percent of total billed charges ","90% of total billed charges ",658.91,93,,527.13,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",602.23,85,,481.78,,,0,"percent of total billed charges ","85% of total billed charges ",637.65,90,,510.12,,,0,"percent of total billed charges ","90% of total billed charges ",637.65,90,,510.12,,,0,"percent of total billed charges ","90% of total billed charges ",26.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",616.4,87,,246.43,52.74,487.03,"1 through 10","percent of total billed charges ","87% of total billed charges ",26.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",495.95,70,,396.76,,,0,"percent of total billed charges ","70% of total billed charges ",26.93,658.91,
"L-SPINE COMPLETE",3000650,"CDM ",320,RC,72110,HCPCS,OUTPATIENT,,,1089.5,871.6,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",248.1,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",106.9,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",762.65,70,,610.12,,,0,"percent of total billed charges ","70% of total billed charges ",980.55,90,,784.44,,,0,"percent of total billed charges ","90% of total billed charges ",1013.24,93,,810.59,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",926.08,85,,740.86,,,0,"percent of total billed charges ","85% of total billed charges ",980.55,90,,784.44,,,0,"percent of total billed charges ","90% of total billed charges ",980.55,90,,784.44,,,0,"percent of total billed charges ","90% of total billed charges ",36.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",947.87,87,,76.96,76.96,76.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",36.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",762.65,70,,610.12,,,0,"percent of total billed charges ","70% of total billed charges ",36.76,1013.24,
PELVIS,3000668,"CDM ",320,RC,72170,HCPCS,OUTPATIENT,,,588,470.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",126.37,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",57.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",411.6,70,,329.28,,,0,"percent of total billed charges ","70% of total billed charges ",529.2,90,,423.36,,,0,"percent of total billed charges ","90% of total billed charges ",546.84,93,,437.47,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",499.8,85,,399.84,,,0,"percent of total billed charges ","85% of total billed charges ",529.2,90,,423.36,,,0,"percent of total billed charges ","90% of total billed charges ",529.2,90,,423.36,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",511.56,87,,403.85,403.85,403.85,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",411.6,70,,329.28,,,0,"percent of total billed charges ","70% of total billed charges ",21.07,546.84,
"SACROILIAC JOINTS",3000684,"CDM ",320,RC,72202,HCPCS,OUTPATIENT,,,701.5,561.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",144.96,100,,138.82,138.82,138.82,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",81.8,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",491.05,70,,392.84,,,0,"percent of total billed charges ","70% of total billed charges ",631.35,90,,505.08,,,0,"percent of total billed charges ","90% of total billed charges ",652.4,93,,521.92,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.26,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",596.28,85,,477.02,,,0,"percent of total billed charges ","85% of total billed charges ",631.35,90,,505.08,,,0,"percent of total billed charges ","90% of total billed charges ",631.35,90,,505.08,,,0,"percent of total billed charges ","90% of total billed charges ",25.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",610.31,87,,488.25,,,0,"percent of total billed charges ","87% of total billed charges ",25.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",491.05,70,,392.84,,,0,"percent of total billed charges ","70% of total billed charges ",25.01,652.4,
"L-SPINE W/BENDING/FLEX/EXTION",3000692,"CDM ",320,RC,72114,HCPCS,OUTPATIENT,,,1540,1232,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",299.2,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",129.29,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1078,70,,862.40,,,0,"percent of total billed charges ","70% of total billed charges ",1386,90,,1108.80,,,0,"percent of total billed charges ","90% of total billed charges ",1432.2,93,,1145.76,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1309,85,,1047.20,,,0,"percent of total billed charges ","85% of total billed charges ",1386,90,,1108.80,,,0,"percent of total billed charges ","90% of total billed charges ",1386,90,,1108.80,,,0,"percent of total billed charges ","90% of total billed charges ",47.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1339.8,87,,1071.84,,,0,"percent of total billed charges ","87% of total billed charges ",47.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1078,70,,862.40,,,0,"percent of total billed charges ","70% of total billed charges ",47.24,1432.2,
"SACRUM & COCCYX TWO VIEWS",3000700,"CDM ",320,RC,72220,HCPCS,OUTPATIENT,,,569,455.2,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.1,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",67.54,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",398.3,70,,318.64,,,0,"percent of total billed charges ","70% of total billed charges ",512.1,90,,409.68,,,0,"percent of total billed charges ","90% of total billed charges ",529.17,93,,423.34,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",483.65,85,,386.92,,,0,"percent of total billed charges ","85% of total billed charges ",512.1,90,,409.68,,,0,"percent of total billed charges ","90% of total billed charges ",512.1,90,,409.68,,,0,"percent of total billed charges ","90% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",495.03,87,,396.02,,,0,"percent of total billed charges ","87% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",398.3,70,,318.64,,,0,"percent of total billed charges ","70% of total billed charges ",23.1,529.17,
"ERCP (FLUORO < 1 HR)",3000783,"CDM ",320,RC,74330,HCPCS,OUTPATIENT,,,2230,1784,,105.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1561,70,,1248.80,,,0,"percent of total billed charges ","70% of total billed charges ",2007,90,,1605.60,,,0,"percent of total billed charges ","90% of total billed charges ",2073.9,93,,1659.12,,,0,"percent of total billed charges ","93% of total billed charges ",105.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",94.93,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1895.5,85,,1516.40,,,0,"percent of total billed charges ","85% of total billed charges ",2007,90,,1605.60,,,0,"percent of total billed charges ","90% of total billed charges ",2007,90,,1605.60,,,0,"percent of total billed charges ","90% of total billed charges ",93.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1940.1,87,,1552.08,,,0,"percent of total billed charges ","87% of total billed charges ",93.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1561,70,,1248.80,,,0,"percent of total billed charges ","70% of total billed charges ",93.99,2073.9,
"ABD ANGIO W/ RUNOFF",3000817,"CDM ",323,RC,75630,HCPCS,OUTPATIENT,,,2738,2190.4,,2532.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",333.43,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1916.6,70,,1533.28,,,0,"percent of total billed charges ","70% of total billed charges ",2464.2,90,,1971.36,,,0,"percent of total billed charges ","90% of total billed charges ",2546.34,93,,2037.07,,,0,"percent of total billed charges ","93% of total billed charges ",2532.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",283.95,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2327.3,85,,1861.84,,,0,"percent of total billed charges ","85% of total billed charges ",2464.2,90,,1971.36,,,0,"percent of total billed charges ","90% of total billed charges ",2464.2,90,,1971.36,,,0,"percent of total billed charges ","90% of total billed charges ",281.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2382.06,87,,1905.65,,,0,"percent of total billed charges ","87% of total billed charges ",281.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2903.79,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1916.6,70,,1533.28,,,0,"percent of total billed charges ","70% of total billed charges ",281.14,2903.79,
"A-C JOINTS",3000841,"CDM ",320,RC,73050,HCPCS,OUTPATIENT,,,601,480.8,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",146.81,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",59.33,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",420.7,70,,336.56,,,0,"percent of total billed charges ","70% of total billed charges ",540.9,90,,432.72,,,0,"percent of total billed charges ","90% of total billed charges ",558.93,93,,447.14,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",510.85,85,,408.68,,,0,"percent of total billed charges ","85% of total billed charges ",540.9,90,,432.72,,,0,"percent of total billed charges ","90% of total billed charges ",540.9,90,,432.72,,,0,"percent of total billed charges ","90% of total billed charges ",20.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",522.87,87,,418.30,,,0,"percent of total billed charges ","87% of total billed charges ",20.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",420.7,70,,336.56,,,0,"percent of total billed charges ","70% of total billed charges ",20.19,558.93,
"CORPORA CAVERNOSOGRA",3001005,"CDM ",329,RC,74445,HCPCS,OUTPATIENT,,,1499.5,1199.6,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1049.65,70,,839.72,,,0,"percent of total billed charges ","70% of total billed charges ",1349.55,90,,1079.64,,,0,"percent of total billed charges ","90% of total billed charges ",1394.54,93,,1115.63,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.73,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1274.58,85,,1019.66,,,0,"percent of total billed charges ","85% of total billed charges ",1349.55,90,,1079.64,,,0,"percent of total billed charges ","90% of total billed charges ",1349.55,90,,1079.64,,,0,"percent of total billed charges ","90% of total billed charges ",29.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1304.57,87,,1043.66,,,0,"percent of total billed charges ","87% of total billed charges ",29.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1049.65,70,,839.72,,,0,"percent of total billed charges ","70% of total billed charges ",29.44,1394.54,
ADBOMEN/KUB,3001229,"CDM ",320,RC,74018,HCPCS,OUTPATIENT,,,568,454.4,,,,,,,,0,"other ","not separately reimbursment ",134.73,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",62.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",397.6,70,,318.08,,,0,"percent of total billed charges ","70% of total billed charges ",511.2,90,,408.96,,,0,"percent of total billed charges ","90% of total billed charges ",528.24,93,,422.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",11.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",482.8,85,,386.24,,,0,"percent of total billed charges ","85% of total billed charges ",511.2,90,,408.96,,,0,"percent of total billed charges ","90% of total billed charges ",511.2,90,,408.96,,,0,"percent of total billed charges ","90% of total billed charges ",11.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",494.16,87,,195.25,195.25,195.25,"1 through 10","percent of total billed charges ","87% of total billed charges ",11.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",397.6,70,,318.08,,,0,"percent of total billed charges ","70% of total billed charges ",11.23,528.24,
"ABD FLAT & UPRIGHT",3001237,"CDM ",320,RC,74019,HCPCS,OUTPATIENT,,,765.5,612.4,,,,,,,,0,"other ","not separately reimbursment ",100.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",76.96,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",535.85,70,,428.68,,,0,"percent of total billed charges ","70% of total billed charges ",688.95,90,,551.16,,,0,"percent of total billed charges ","90% of total billed charges ",711.92,93,,569.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",13.59,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",650.68,85,,520.54,,,0,"percent of total billed charges ","85% of total billed charges ",688.95,90,,551.16,,,0,"percent of total billed charges ","90% of total billed charges ",688.95,90,,551.16,,,0,"percent of total billed charges ","90% of total billed charges ",13.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",665.99,87,,532.79,,,0,"percent of total billed charges ","87% of total billed charges ",13.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",535.85,70,,428.68,,,0,"percent of total billed charges ","70% of total billed charges ",13.46,711.92,
"SWALLOW ESOPHAGRAM BARIUM",3001245,"CDM ",320,RC,74220,HCPCS,OUTPATIENT,,,657.5,526,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",270.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",210.56,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",460.25,70,,368.20,,,0,"percent of total billed charges ","70% of total billed charges ",591.75,90,,473.40,,,0,"percent of total billed charges ","90% of total billed charges ",611.48,93,,489.18,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",558.88,85,,447.10,,,0,"percent of total billed charges ","85% of total billed charges ",591.75,90,,473.40,,,0,"percent of total billed charges ","90% of total billed charges ",591.75,90,,473.40,,,0,"percent of total billed charges ","90% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",572.03,87,,457.62,,,0,"percent of total billed charges ","87% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",460.25,70,,368.20,,,0,"percent of total billed charges ","70% of total billed charges ",39.25,611.48,
"UGI AIR CONTRAST BARIUM",3001252,"CDM ",320,RC,74246,HCPCS,OUTPATIENT,,,860,688,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",355.88,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",301.84,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",602,70,,481.60,,,0,"percent of total billed charges ","70% of total billed charges ",774,90,,619.20,,,0,"percent of total billed charges ","90% of total billed charges ",799.8,93,,639.84,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.41,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",731,85,,584.80,,,0,"percent of total billed charges ","85% of total billed charges ",774,90,,619.20,,,0,"percent of total billed charges ","90% of total billed charges ",774,90,,619.20,,,0,"percent of total billed charges ","90% of total billed charges ",56.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",748.2,87,,598.56,,,0,"percent of total billed charges ","87% of total billed charges ",56.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",602,70,,481.60,,,0,"percent of total billed charges ","70% of total billed charges ",56.84,799.8,
"SMALL BOWEL SERIES BARIUM",3001286,"CDM ",320,RC,74250,HCPCS,OUTPATIENT,,,746.5,597.2,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",311.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",263.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",522.55,70,,418.04,,,0,"percent of total billed charges ","70% of total billed charges ",671.85,90,,537.48,,,0,"percent of total billed charges ","90% of total billed charges ",694.25,93,,555.40,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",634.53,85,,507.62,,,0,"percent of total billed charges ","85% of total billed charges ",671.85,90,,537.48,,,0,"percent of total billed charges ","90% of total billed charges ",671.85,90,,537.48,,,0,"percent of total billed charges ","90% of total billed charges ",42.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",649.46,87,,519.57,,,0,"percent of total billed charges ","87% of total billed charges ",42.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",522.55,70,,418.04,,,0,"percent of total billed charges ","70% of total billed charges ",42.22,694.25,
"ENEMA AC BARIUM",3001294,"CDM ",320,RC,74280,HCPCS,OUTPATIENT,,,1933,1546.4,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1006.97,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",477.53,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1353.1,70,,1082.48,,,0,"percent of total billed charges ","70% of total billed charges ",1739.7,90,,1391.76,,,0,"percent of total billed charges ","90% of total billed charges ",1797.69,93,,1438.15,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",79.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1643.05,85,,1314.44,,,0,"percent of total billed charges ","85% of total billed charges ",1739.7,90,,1391.76,,,0,"percent of total billed charges ","90% of total billed charges ",1739.7,90,,1391.76,,,0,"percent of total billed charges ","90% of total billed charges ",78.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1681.71,87,,1345.37,,,0,"percent of total billed charges ","87% of total billed charges ",78.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1353.1,70,,1082.48,,,0,"percent of total billed charges ","70% of total billed charges ",78.64,1797.69,
"UGI SINGLE W/SBS BARIUM",3001302,"CDM ",320,RC,74240,HCPCS,OUTPATIENT,,,1030,824,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",426.5,100,,507.50,507.50,507.50,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",264.51,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",721,70,,576.80,,,0,"percent of total billed charges ","70% of total billed charges ",927,90,,741.60,,,0,"percent of total billed charges ","90% of total billed charges ",957.9,93,,766.32,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",52.85,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",875.5,85,,700.40,,,0,"percent of total billed charges ","85% of total billed charges ",927,90,,741.60,,,0,"percent of total billed charges ","90% of total billed charges ",927,90,,741.60,,,0,"percent of total billed charges ","90% of total billed charges ",52.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",896.1,87,,716.88,,,0,"percent of total billed charges ","87% of total billed charges ",52.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",721,70,,576.80,,,0,"percent of total billed charges ","70% of total billed charges ",52.33,957.9,
"ORAL CHOLE NON-VIS",3001310,"CDM ",320,RC,74290,HCPCS,OUTPATIENT,,,612,489.6,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",184.73,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",428.4,70,,342.72,,,0,"percent of total billed charges ","70% of total billed charges ",550.8,90,,440.64,,,0,"percent of total billed charges ","90% of total billed charges ",569.16,93,,455.33,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",520.2,85,,416.16,,,0,"percent of total billed charges ","85% of total billed charges ",550.8,90,,440.64,,,0,"percent of total billed charges ","90% of total billed charges ",550.8,90,,440.64,,,0,"percent of total billed charges ","90% of total billed charges ",29.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",532.44,87,,425.95,,,0,"percent of total billed charges ","87% of total billed charges ",29.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",428.4,70,,342.72,,,0,"percent of total billed charges ","70% of total billed charges ",29.74,569.16,
"ORAL CHOLECYSTOGRAM",3001328,"CDM ",320,RC,74290,HCPCS,OUTPATIENT,,,944,755.2,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",184.73,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",660.8,70,,528.64,,,0,"percent of total billed charges ","70% of total billed charges ",849.6,90,,679.68,,,0,"percent of total billed charges ","90% of total billed charges ",877.92,93,,702.34,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",802.4,85,,641.92,,,0,"percent of total billed charges ","85% of total billed charges ",849.6,90,,679.68,,,0,"percent of total billed charges ","90% of total billed charges ",849.6,90,,679.68,,,0,"percent of total billed charges ","90% of total billed charges ",29.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",821.28,87,,657.02,,,0,"percent of total billed charges ","87% of total billed charges ",29.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",660.8,70,,528.64,,,0,"percent of total billed charges ","70% of total billed charges ",29.74,877.92,
"T-TUBE CHOLANGIOGRAM",3001344,"CDM ",320,RC,47531,HCPCS,OUTPATIENT,,,897,717.6,,237.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",603.98,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",145.66,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",627.9,70,,502.32,,,0,"percent of total billed charges ","70% of total billed charges ",807.3,90,,645.84,,,0,"percent of total billed charges ","90% of total billed charges ",834.21,93,,667.37,,,0,"percent of total billed charges ","93% of total billed charges ",237.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",302.08,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",762.45,85,,609.96,,,0,"percent of total billed charges ","85% of total billed charges ",672.75,90,,538.20,,,0,"percent of total billed charges ","90% of total billed charges ",807.3,90,,645.84,,,0,"percent of total billed charges ","90% of total billed charges ",299.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",780.39,87,,624.31,,,0,"percent of total billed charges ","87% of total billed charges ",299.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3292.74,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",627.9,70,,502.32,,,0,"percent of total billed charges ","70% of total billed charges ",145.66,3292.74,
"OR CHOLANG",3001443,"CDM ",320,RC,74300,HCPCS,OUTPATIENT,,,1188,950.4,,88.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,269.86,269.86,269.86,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",831.6,70,,665.28,,,0,"percent of total billed charges ","70% of total billed charges ",1069.2,90,,855.36,,,0,"percent of total billed charges ","90% of total billed charges ",1104.84,93,,883.87,,,0,"percent of total billed charges ","93% of total billed charges ",88.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1009.8,85,,807.84,,,0,"percent of total billed charges ","85% of total billed charges ",1069.2,90,,855.36,,,0,"percent of total billed charges ","90% of total billed charges ",1069.2,90,,855.36,,,0,"percent of total billed charges ","90% of total billed charges ",55.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1033.56,87,,826.85,,,0,"percent of total billed charges ","87% of total billed charges ",55.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",831.6,70,,665.28,,,0,"percent of total billed charges ","70% of total billed charges ",55.6,1104.84,
"C-SPINE 1-VIEW",3001468,"CDM ",320,RC,72020,HCPCS,OUTPATIENT,,,548.5,438.8,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",170.97,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",50.89,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",383.95,70,,307.16,,,0,"percent of total billed charges ","70% of total billed charges ",493.65,90,,394.92,,,0,"percent of total billed charges ","90% of total billed charges ",510.11,93,,408.09,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",466.23,85,,372.98,,,0,"percent of total billed charges ","85% of total billed charges ",493.65,90,,394.92,,,0,"percent of total billed charges ","90% of total billed charges ",493.65,90,,394.92,,,0,"percent of total billed charges ","90% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",477.2,87,,381.76,,,0,"percent of total billed charges ","87% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",383.95,70,,307.16,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,510.11,
"C-SPINE 6 OR MORE VIEWS",3001476,"CDM ",320,RC,72052,HCPCS,OUTPATIENT,,,1013,810.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",271.33,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",129.29,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",709.1,70,,567.28,,,0,"percent of total billed charges ","70% of total billed charges ",911.7,90,,729.36,,,0,"percent of total billed charges ","90% of total billed charges ",942.09,93,,753.67,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.78,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",861.05,85,,688.84,,,0,"percent of total billed charges ","85% of total billed charges ",911.7,90,,729.36,,,0,"percent of total billed charges ","90% of total billed charges ",911.7,90,,729.36,,,0,"percent of total billed charges ","90% of total billed charges ",45.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",881.31,87,,705.05,,,0,"percent of total billed charges ","87% of total billed charges ",45.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",709.1,70,,567.28,,,0,"percent of total billed charges ","70% of total billed charges ",45.33,942.09,
"C-SPINE 4 OR 5 VIEWS",3001484,"CDM ",320,RC,72050,HCPCS,OUTPATIENT,,,839,671.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",230.44,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",111.1,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",587.3,70,,469.84,,,0,"percent of total billed charges ","70% of total billed charges ",755.1,90,,604.08,,,0,"percent of total billed charges ","90% of total billed charges ",780.27,93,,624.22,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",713.15,85,,570.52,,,0,"percent of total billed charges ","85% of total billed charges ",755.1,90,,604.08,,,0,"percent of total billed charges ","90% of total billed charges ",755.1,90,,604.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",729.93,87,,583.94,,,0,"percent of total billed charges ","87% of total billed charges ",35.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",587.3,70,,469.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.99,780.27,
"ORBITS 4-VIEWS",3001526,"CDM ",320,RC,70200,HCPCS,OUTPATIENT,,,751,600.8,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",182.12,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",101.51,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",525.7,70,,420.56,,,0,"percent of total billed charges ","70% of total billed charges ",675.9,90,,540.72,,,0,"percent of total billed charges ","90% of total billed charges ",698.43,93,,558.74,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",638.35,85,,510.68,,,0,"percent of total billed charges ","85% of total billed charges ",675.9,90,,540.72,,,0,"percent of total billed charges ","90% of total billed charges ",675.9,90,,540.72,,,0,"percent of total billed charges ","90% of total billed charges ",31.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",653.37,87,,522.70,,,0,"percent of total billed charges ","87% of total billed charges ",31.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",525.7,70,,420.56,,,0,"percent of total billed charges ","70% of total billed charges ",31.66,698.43,
"ORBITS 2-VIEWS",3001534,"CDM ",320,RC,70200,HCPCS,OUTPATIENT,,,447.5,358,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",182.12,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",101.51,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",313.25,70,,250.60,,,0,"percent of total billed charges ","70% of total billed charges ",402.75,90,,322.20,,,0,"percent of total billed charges ","90% of total billed charges ",416.18,93,,332.94,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",380.38,85,,304.30,,,0,"percent of total billed charges ","85% of total billed charges ",402.75,90,,322.20,,,0,"percent of total billed charges ","90% of total billed charges ",402.75,90,,322.20,,,0,"percent of total billed charges ","90% of total billed charges ",31.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",389.33,87,,311.46,,,0,"percent of total billed charges ","87% of total billed charges ",31.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",313.25,70,,250.60,,,0,"percent of total billed charges ","70% of total billed charges ",31.66,416.18,
"NEEDLE PLACEMENT/ASP/BX/LOC FL",3001542,"CDM ",320,RC,77002,HCPCS,OUTPATIENT,,,1040,832,,,,,,,,0,"other ","not separately reimbursment ",372.61,100,,24.51,24.51,24.51,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",243.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",728,70,,582.40,,,0,"percent of total billed charges ","70% of total billed charges ",936,90,,748.80,,,0,"percent of total billed charges ","90% of total billed charges ",967.2,93,,773.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",36.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",884,85,,707.20,,,0,"percent of total billed charges ","85% of total billed charges ",936,90,,748.80,,,0,"percent of total billed charges ","90% of total billed charges ",936,90,,748.80,,,0,"percent of total billed charges ","90% of total billed charges ",35.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",904.8,87,,723.84,,,0,"percent of total billed charges ","87% of total billed charges ",35.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",728,70,,582.40,,,0,"percent of total billed charges ","70% of total billed charges ",35.92,967.2,
"METASTATIC BONE SURV",3001559,"CDM ",320,RC,77075,HCPCS,OUTPATIENT,,,1626.5,1301.2,,,,,,,,0,"other ","not separately reimbursment ",506.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",208.14,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1138.55,70,,910.84,,,0,"percent of total billed charges ","70% of total billed charges ",1463.85,90,,1171.08,,,0,"percent of total billed charges ","90% of total billed charges ",1512.65,93,,1210.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",53.47,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1382.53,85,,1106.02,,,0,"percent of total billed charges ","85% of total billed charges ",1463.85,90,,1171.08,,,0,"percent of total billed charges ","90% of total billed charges ",1463.85,90,,1171.08,,,0,"percent of total billed charges ","90% of total billed charges ",52.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1415.06,87,,1132.05,,,0,"percent of total billed charges ","87% of total billed charges ",52.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1138.55,70,,910.84,,,0,"percent of total billed charges ","70% of total billed charges ",52.94,1512.65,
"BONE SURVEY CHILD",3001567,"CDM ",320,RC,77076,HCPCS,OUTPATIENT,,,1626.5,1301.2,,,,,,,,0,"other ","not separately reimbursment ",,,,881.96,881.96,881.96,"1 through 10","other ","not separately reimbursment ",224.4,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1138.55,70,,910.84,,,0,"percent of total billed charges ","70% of total billed charges ",1463.85,90,,1171.08,,,0,"percent of total billed charges ","90% of total billed charges ",1512.65,93,,1210.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",33.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1382.53,85,,1106.02,,,0,"percent of total billed charges ","85% of total billed charges ",1463.85,90,,1171.08,,,0,"percent of total billed charges ","90% of total billed charges ",1463.85,90,,1171.08,,,0,"percent of total billed charges ","90% of total billed charges ",33.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1415.06,87,,1132.05,,,0,"percent of total billed charges ","87% of total billed charges ",33.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1138.55,70,,910.84,,,0,"percent of total billed charges ","70% of total billed charges ",33.27,1512.65,
"FISTULA/SINUS TRACT",3001575,"CDM ",320,RC,76080,HCPCS,OUTPATIENT,,,847,677.6,,427.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",127.18,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",592.9,70,,474.32,,,0,"percent of total billed charges ","70% of total billed charges ",762.3,90,,609.84,,,0,"percent of total billed charges ","90% of total billed charges ",787.71,93,,630.17,,,0,"percent of total billed charges ","93% of total billed charges ",427.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.41,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",719.95,85,,575.96,,,0,"percent of total billed charges ","85% of total billed charges ",762.3,90,,609.84,,,0,"percent of total billed charges ","90% of total billed charges ",762.3,90,,609.84,,,0,"percent of total billed charges ","90% of total billed charges ",28.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",736.89,87,,589.51,,,0,"percent of total billed charges ","87% of total billed charges ",28.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",502.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",592.9,70,,474.32,,,0,"percent of total billed charges ","70% of total billed charges ",28.13,787.71,
"MAMMO DIAG BILATERAL W/CAD",3001609,"CDM ",401,RC,77066,HCPCS,OUTPATIENT,,,1070.5,856.4,,125.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",123.22,100,,118.02,118.02,118.02,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",333.3,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",749.35,70,,599.48,,,0,"percent of total billed charges ","70% of total billed charges ",963.45,90,,770.76,,,0,"percent of total billed charges ","90% of total billed charges ",995.57,93,,796.46,,,0,"percent of total billed charges ","93% of total billed charges ",125.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",76.08,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",909.93,85,,727.94,,,0,"percent of total billed charges ","85% of total billed charges ",963.45,90,,770.76,,,0,"percent of total billed charges ","90% of total billed charges ",963.45,90,,770.76,,,0,"percent of total billed charges ","90% of total billed charges ",75.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",931.34,87,,95.99,82.27,543.80,"1 through 10","percent of total billed charges ","87% of total billed charges ",75.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",749.35,70,,599.48,,,0,"percent of total billed charges ","70% of total billed charges ",75.33,995.57,
"SURGERY SPECIMEN",3001617,"CDM ",320,RC,76098,HCPCS,OUTPATIENT,,,959.5,767.6,,427.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,27.64,27.64,27.64,"1 through 10","other ","not separately reimbursment ",84.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",671.65,70,,537.32,,,0,"percent of total billed charges ","70% of total billed charges ",863.55,90,,690.84,,,0,"percent of total billed charges ","90% of total billed charges ",892.34,93,,713.87,,,0,"percent of total billed charges ","93% of total billed charges ",427.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",815.58,85,,652.46,,,0,"percent of total billed charges ","85% of total billed charges ",863.55,90,,690.84,,,0,"percent of total billed charges ","90% of total billed charges ",863.55,90,,690.84,,,0,"percent of total billed charges ","90% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",834.77,87,,667.82,,,0,"percent of total billed charges ","87% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",502.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",671.65,70,,537.32,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,892.34,
"VENOGRAM EXT BIL",3001641,"CDM ",320,RC,75822,HCPCS,OUTPATIENT,,,1627.5,1302,,1264.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",282.06,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1139.25,70,,911.40,,,0,"percent of total billed charges ","70% of total billed charges ",1464.75,90,,1171.80,,,0,"percent of total billed charges ","90% of total billed charges ",1513.58,93,,1210.86,,,0,"percent of total billed charges ","93% of total billed charges ",1264.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1383.38,85,,1106.70,,,0,"percent of total billed charges ","85% of total billed charges ",1464.75,90,,1171.80,,,0,"percent of total billed charges ","90% of total billed charges ",1464.75,90,,1171.80,,,0,"percent of total billed charges ","90% of total billed charges ",59.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1415.93,87,,1132.74,,,0,"percent of total billed charges ","87% of total billed charges ",59.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1447.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1139.25,70,,911.40,,,0,"percent of total billed charges ","70% of total billed charges ",59.38,1513.58,
"MYELOGRAM,LUMBAR",3001666,"CDM ",320,RC,72265,HCPCS,OUTPATIENT,,,3584,2867.2,,629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2818.91,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",230.82,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2508.8,70,,2007.04,,,0,"percent of total billed charges ","70% of total billed charges ",3225.6,90,,2580.48,,,0,"percent of total billed charges ","90% of total billed charges ",3333.12,93,,2666.50,,,0,"percent of total billed charges ","93% of total billed charges ",629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",142.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3046.4,85,,2437.12,,,0,"percent of total billed charges ","85% of total billed charges ",3225.6,90,,2580.48,,,0,"percent of total billed charges ","90% of total billed charges ",3225.6,90,,2580.48,,,0,"percent of total billed charges ","90% of total billed charges ",140.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3118.08,87,,2494.46,,,0,"percent of total billed charges ","87% of total billed charges ",140.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",720.93,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2508.8,70,,2007.04,,,0,"percent of total billed charges ","70% of total billed charges ",140.64,3333.12,
FLUOROSCOPY,3001682,"CDM ",320,RC,76000,HCPCS,OUTPATIENT,,,903.5,722.8,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",234.16,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",88.86,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",632.45,70,,505.96,,,0,"percent of total billed charges ","70% of total billed charges ",813.15,90,,650.52,,,0,"percent of total billed charges ","90% of total billed charges ",840.26,93,,672.21,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.59,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",767.98,85,,614.38,,,0,"percent of total billed charges ","85% of total billed charges ",813.15,90,,650.52,,,0,"percent of total billed charges ","90% of total billed charges ",813.15,90,,650.52,,,0,"percent of total billed charges ","90% of total billed charges ",37.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",786.05,87,,446.52,307.90,585.13,"1 through 10","percent of total billed charges ","87% of total billed charges ",37.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",632.45,70,,505.96,,,0,"percent of total billed charges ","70% of total billed charges ",37.22,840.26,
"CHEST BILATERAL DECUBS",3001716,"CDM ",324,RC,71046,HCPCS,OUTPATIENT,,,900,720,,,,,,,,0,"other ","not separately reimbursment ",150.77,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",69.98,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",630,70,,504.00,,,0,"percent of total billed charges ","70% of total billed charges ",810,90,,648.00,,,0,"percent of total billed charges ","90% of total billed charges ",837,93,,669.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",12.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",765,85,,612.00,,,0,"percent of total billed charges ","85% of total billed charges ",810,90,,648.00,,,0,"percent of total billed charges ","90% of total billed charges ",810,90,,648.00,,,0,"percent of total billed charges ","90% of total billed charges ",12.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",783,87,,170.90,60.28,497.81,12,"percent of total billed charges ","87% of total billed charges ",12.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",630,70,,504.00,,,0,"percent of total billed charges ","70% of total billed charges ",12.12,837,
"BONE LENGTH STUDY",3001740,"CDM ",320,RC,77073,HCPCS,OUTPATIENT,,,636,508.8,,,,,,,,0,"other ","not separately reimbursment ",239.73,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",94.12,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",445.2,70,,356.16,,,0,"percent of total billed charges ","70% of total billed charges ",572.4,90,,457.92,,,0,"percent of total billed charges ","90% of total billed charges ",591.48,93,,473.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",20.95,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",540.6,85,,432.48,,,0,"percent of total billed charges ","85% of total billed charges ",572.4,90,,457.92,,,0,"percent of total billed charges ","90% of total billed charges ",572.4,90,,457.92,,,0,"percent of total billed charges ","90% of total billed charges ",20.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",553.32,87,,442.66,,,0,"percent of total billed charges ","87% of total billed charges ",20.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",445.2,70,,356.16,,,0,"percent of total billed charges ","70% of total billed charges ",20.74,591.48,
"BONE DENSITY STUDY",3001757,"CDM ",320,RC,77080,HCPCS,OUTPATIENT,,,759,607.2,,,,,,,,0,"other ","not separately reimbursment ",197.96,100,,103.22,103.22,103.22,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",76.74,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",531.3,70,,425.04,,,0,"percent of total billed charges ","70% of total billed charges ",683.1,90,,546.48,,,0,"percent of total billed charges ","90% of total billed charges ",705.87,93,,564.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",54.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",645.15,85,,516.12,,,0,"percent of total billed charges ","85% of total billed charges ",683.1,90,,546.48,,,0,"percent of total billed charges ","90% of total billed charges ",683.1,90,,546.48,,,0,"percent of total billed charges ","90% of total billed charges ",53.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",660.33,87,,103.23,102.35,521.51,"1 through 10","percent of total billed charges ","87% of total billed charges ",53.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",531.3,70,,425.04,,,0,"percent of total billed charges ","70% of total billed charges ",53.89,705.87,
"MAMMO SCREENING BIL W/CAD",3001765,"CDM ",403,RC,77067,HCPCS,OUTPATIENT,,,471,376.8,,102.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",268.36,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",329.7,70,,263.76,,,0,"percent of total billed charges ","70% of total billed charges ",423.9,90,,339.12,,,0,"percent of total billed charges ","90% of total billed charges ",438.03,93,,350.42,,,0,"percent of total billed charges ","93% of total billed charges ",102.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",73.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",400.35,85,,320.28,,,0,"percent of total billed charges ","85% of total billed charges ",423.9,90,,339.12,,,0,"percent of total billed charges ","90% of total billed charges ",423.9,90,,339.12,,,0,"percent of total billed charges ","90% of total billed charges ",73.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",409.77,87,,323.68,79.44,323.68,21,"percent of total billed charges ","87% of total billed charges ",73.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",329.7,70,,263.76,,,0,"percent of total billed charges ","70% of total billed charges ",73.06,438.03,
"SCOLIOSIS STUDY S&U-ONE VIEW",3001799,"CDM ",320,RC,72081,HCPCS,OUTPATIENT,,,832,665.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",88.92,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",582.4,70,,465.92,,,0,"percent of total billed charges ","70% of total billed charges ",748.8,90,,599.04,,,0,"percent of total billed charges ","90% of total billed charges ",773.76,93,,619.01,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",52.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",707.2,85,,565.76,,,0,"percent of total billed charges ","85% of total billed charges ",748.8,90,,599.04,,,0,"percent of total billed charges ","90% of total billed charges ",748.8,90,,599.04,,,0,"percent of total billed charges ","90% of total billed charges ",51.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",723.84,87,,579.07,,,0,"percent of total billed charges ","87% of total billed charges ",51.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",582.4,70,,465.92,,,0,"percent of total billed charges ","70% of total billed charges ",51.7,773.76,
"ABDOMEN AORTAGRAM",3001856,"CDM ",323,RC,75625,HCPCS,OUTPATIENT,,,2464,1971.2,,2532.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2137.16,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",266.95,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1724.8,70,,1379.84,,,0,"percent of total billed charges ","70% of total billed charges ",2217.6,90,,1774.08,,,0,"percent of total billed charges ","90% of total billed charges ",2291.52,93,,1833.22,,,0,"percent of total billed charges ","93% of total billed charges ",2532.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",181.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2094.4,85,,1675.52,,,0,"percent of total billed charges ","85% of total billed charges ",2217.6,90,,1774.08,,,0,"percent of total billed charges ","90% of total billed charges ",2217.6,90,,1774.08,,,0,"percent of total billed charges ","90% of total billed charges ",179.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2143.68,87,,1714.94,,,0,"percent of total billed charges ","87% of total billed charges ",179.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2903.79,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1724.8,70,,1379.84,,,0,"percent of total billed charges ","70% of total billed charges ",179.89,2903.79,
"CATHETER PATENCY",3001872,"CDM ",329,RC,75898,HCPCS,OUTPATIENT,,,765.5,612.4,,2532.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",535.85,70,,428.68,,,0,"percent of total billed charges ","70% of total billed charges ",688.95,90,,551.16,,,0,"percent of total billed charges ","90% of total billed charges ",711.92,93,,569.54,,,0,"percent of total billed charges ","93% of total billed charges ",2532.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",650.68,85,,520.54,,,0,"percent of total billed charges ","85% of total billed charges ",688.95,90,,551.16,,,0,"percent of total billed charges ","90% of total billed charges ",688.95,90,,551.16,,,0,"percent of total billed charges ","90% of total billed charges ",42.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",665.99,87,,532.79,,,0,"percent of total billed charges ","87% of total billed charges ",42.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2903.79,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",535.85,70,,428.68,,,0,"percent of total billed charges ","70% of total billed charges ",42.24,2903.79,
"RIBS UNILATERAL RIGHT",3001898,"CDM ",320,RC,71100,HCPCS,OUTPATIENT,,,574,459.2,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",133.8,100,,9.47,9.47,9.47,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",76.89,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",401.8,70,,321.44,,,0,"percent of total billed charges ","70% of total billed charges ",516.6,90,,413.28,,,0,"percent of total billed charges ","90% of total billed charges ",533.82,93,,427.06,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",487.9,85,,390.32,,,0,"percent of total billed charges ","85% of total billed charges ",516.6,90,,413.28,,,0,"percent of total billed charges ","90% of total billed charges ",516.6,90,,413.28,,,0,"percent of total billed charges ","90% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.38,87,,225.57,97.81,360.61,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",401.8,70,,321.44,,,0,"percent of total billed charges ","70% of total billed charges ",23.1,533.82,
"RIBS UNI RIGHT + PA",3001906,"CDM ",320,RC,71101,HCPCS,OUTPATIENT,,,720.5,576.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",199.78,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",88.31,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",504.35,70,,403.48,,,0,"percent of total billed charges ","70% of total billed charges ",648.45,90,,518.76,,,0,"percent of total billed charges ","90% of total billed charges ",670.07,93,,536.06,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.81,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",612.43,85,,489.94,,,0,"percent of total billed charges ","85% of total billed charges ",648.45,90,,518.76,,,0,"percent of total billed charges ","90% of total billed charges ",648.45,90,,518.76,,,0,"percent of total billed charges ","90% of total billed charges ",21.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",626.84,87,,93.43,93.43,93.43,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",504.35,70,,403.48,,,0,"percent of total billed charges ","70% of total billed charges ",21.59,670.07,
"CLAVICLE 2 VIEW RIGHT",3001922,"CDM ",320,RC,73000,HCPCS,OUTPATIENT,,,462.5,370,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",114.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",66.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",323.75,70,,259.00,,,0,"percent of total billed charges ","70% of total billed charges ",416.25,90,,333.00,,,0,"percent of total billed charges ","90% of total billed charges ",430.13,93,,344.10,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",393.13,85,,314.50,,,0,"percent of total billed charges ","85% of total billed charges ",416.25,90,,333.00,,,0,"percent of total billed charges ","90% of total billed charges ",416.25,90,,333.00,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",402.38,87,,321.90,,,0,"percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",323.75,70,,259.00,,,0,"percent of total billed charges ","70% of total billed charges ",21.07,430.13,
"SCAPULA 2 VIEW RIGHT",3001948,"CDM ",320,RC,73010,HCPCS,OUTPATIENT,,,401,320.8,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",49.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",280.7,70,,224.56,,,0,"percent of total billed charges ","70% of total billed charges ",360.9,90,,288.72,,,0,"percent of total billed charges ","90% of total billed charges ",372.93,93,,298.34,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",340.85,85,,272.68,,,0,"percent of total billed charges ","85% of total billed charges ",360.9,90,,288.72,,,0,"percent of total billed charges ","90% of total billed charges ",360.9,90,,288.72,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",348.87,87,,279.10,,,0,"percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",280.7,70,,224.56,,,0,"percent of total billed charges ","70% of total billed charges ",21.07,372.93,
"SHOULDER MIN 2 VIEWS RIGHT",3001955,"CDM ",320,RC,73030,HCPCS,OUTPATIENT,,,588,470.4,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",140.31,100,,52.33,24.42,80.23,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",71.76,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",411.6,70,,329.28,,,0,"percent of total billed charges ","70% of total billed charges ",529.2,90,,423.36,,,0,"percent of total billed charges ","90% of total billed charges ",546.84,93,,437.47,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",499.8,85,,399.84,,,0,"percent of total billed charges ","85% of total billed charges ",529.2,90,,423.36,,,0,"percent of total billed charges ","90% of total billed charges ",529.2,90,,423.36,,,0,"percent of total billed charges ","90% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",511.56,87,,323.08,125.15,387.70,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",411.6,70,,329.28,,,0,"percent of total billed charges ","70% of total billed charges ",23.1,546.84,
"HUMERUS 2 OR MORE VIEWS RIGHT",3001963,"CDM ",320,RC,73060,HCPCS,OUTPATIENT,,,509.5,407.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",137.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",66.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",356.65,70,,285.32,,,0,"percent of total billed charges ","70% of total billed charges ",458.55,90,,366.84,,,0,"percent of total billed charges ","90% of total billed charges ",473.84,93,,379.07,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",433.08,85,,346.46,,,0,"percent of total billed charges ","85% of total billed charges ",458.55,90,,366.84,,,0,"percent of total billed charges ","90% of total billed charges ",458.55,90,,366.84,,,0,"percent of total billed charges ","90% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",443.27,87,,65.87,61.95,81.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",356.65,70,,285.32,,,0,"percent of total billed charges ","70% of total billed charges ",23.1,473.84,
"HUMERUS 1 VIEW RIGHT",3001971,"CDM ",320,RC,73060,HCPCS,OUTPATIENT,,,401,320.8,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",137.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",66.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",280.7,70,,224.56,,,0,"percent of total billed charges ","70% of total billed charges ",360.9,90,,288.72,,,0,"percent of total billed charges ","90% of total billed charges ",372.93,93,,298.34,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",340.85,85,,272.68,,,0,"percent of total billed charges ","85% of total billed charges ",360.9,90,,288.72,,,0,"percent of total billed charges ","90% of total billed charges ",360.9,90,,288.72,,,0,"percent of total billed charges ","90% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",348.87,87,,65.87,61.95,81.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",280.7,70,,224.56,,,0,"percent of total billed charges ","70% of total billed charges ",23.1,372.93,
"ELBOW 3 OR MORE VIEWS RIGHT",3001989,"CDM ",320,RC,73080,HCPCS,OUTPATIENT,,,525,420,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",151.46,100,,154.12,154.12,154.12,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",67.54,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",367.5,70,,294.00,,,0,"percent of total billed charges ","70% of total billed charges ",472.5,90,,378.00,,,0,"percent of total billed charges ","90% of total billed charges ",488.25,93,,390.60,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",446.25,85,,357.00,,,0,"percent of total billed charges ","85% of total billed charges ",472.5,90,,378.00,,,0,"percent of total billed charges ","90% of total billed charges ",472.5,90,,378.00,,,0,"percent of total billed charges ","90% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",456.75,87,,141.07,141.07,141.07,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",367.5,70,,294.00,,,0,"percent of total billed charges ","70% of total billed charges ",23.1,488.25,
"ELBOW 2 VIEW RIGHT",3001997,"CDM ",320,RC,73070,HCPCS,OUTPATIENT,,,462.5,370,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",113.36,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",60.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",323.75,70,,259.00,,,0,"percent of total billed charges ","70% of total billed charges ",416.25,90,,333.00,,,0,"percent of total billed charges ","90% of total billed charges ",430.13,93,,344.10,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",393.13,85,,314.50,,,0,"percent of total billed charges ","85% of total billed charges ",416.25,90,,333.00,,,0,"percent of total billed charges ","90% of total billed charges ",416.25,90,,333.00,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",402.38,87,,46.65,15.59,77.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",323.75,70,,259.00,,,0,"percent of total billed charges ","70% of total billed charges ",21.07,430.13,
"FOREARM 2 VIEW RIGHT",3002011,"CDM ",320,RC,73090,HCPCS,OUTPATIENT,,,547,437.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",124.51,100,,126.68,126.68,126.68,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",60.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",382.9,70,,306.32,,,0,"percent of total billed charges ","70% of total billed charges ",492.3,90,,393.84,,,0,"percent of total billed charges ","90% of total billed charges ",508.71,93,,406.97,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",464.95,85,,371.96,,,0,"percent of total billed charges ","85% of total billed charges ",492.3,90,,393.84,,,0,"percent of total billed charges ","90% of total billed charges ",492.3,90,,393.84,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",475.89,87,,146.97,36.80,330.06,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",382.9,70,,306.32,,,0,"percent of total billed charges ","70% of total billed charges ",21.07,508.71,
"WRIST 3 OR MORE VIEWS RIGHT",3002037,"CDM ",320,RC,73110,HCPCS,OUTPATIENT,,,626.5,501.2,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.1,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",84.83,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",438.55,70,,350.84,,,0,"percent of total billed charges ","70% of total billed charges ",563.85,90,,451.08,,,0,"percent of total billed charges ","90% of total billed charges ",582.65,93,,466.12,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",532.53,85,,426.02,,,0,"percent of total billed charges ","85% of total billed charges ",563.85,90,,451.08,,,0,"percent of total billed charges ","90% of total billed charges ",563.85,90,,451.08,,,0,"percent of total billed charges ","90% of total billed charges ",21.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",545.06,87,,122.02,33.24,351.91,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",438.55,70,,350.84,,,0,"percent of total billed charges ","70% of total billed charges ",21.46,582.65,
"WRIST 2 VIEW RIGHT",3002045,"CDM ",320,RC,73100,HCPCS,OUTPATIENT,,,547,437.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",70.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",382.9,70,,306.32,,,0,"percent of total billed charges ","70% of total billed charges ",492.3,90,,393.84,,,0,"percent of total billed charges ","90% of total billed charges ",508.71,93,,406.97,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.11,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",464.95,85,,371.96,,,0,"percent of total billed charges ","85% of total billed charges ",492.3,90,,393.84,,,0,"percent of total billed charges ","90% of total billed charges ",492.3,90,,393.84,,,0,"percent of total billed charges ","90% of total billed charges ",19.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",475.89,87,,380.71,,,0,"percent of total billed charges ","87% of total billed charges ",19.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",382.9,70,,306.32,,,0,"percent of total billed charges ","70% of total billed charges ",19.91,508.71,
"HAND 3 OR MORE VIEWS RIGHT",3002052,"CDM ",320,RC,73130,HCPCS,OUTPATIENT,,,588,470.4,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",136.59,100,,85.47,85.47,85.47,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",75.86,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",411.6,70,,329.28,,,0,"percent of total billed charges ","70% of total billed charges ",529.2,90,,423.36,,,0,"percent of total billed charges ","90% of total billed charges ",546.84,93,,437.47,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",499.8,85,,399.84,,,0,"percent of total billed charges ","85% of total billed charges ",529.2,90,,423.36,,,0,"percent of total billed charges ","90% of total billed charges ",529.2,90,,423.36,,,0,"percent of total billed charges ","90% of total billed charges ",21.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",511.56,87,,75.67,46.84,355.39,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",411.6,70,,329.28,,,0,"percent of total billed charges ","70% of total billed charges ",21.46,546.84,
"HAND 2 VIEW RIGHT",3002060,"CDM ",320,RC,73120,HCPCS,OUTPATIENT,,,509.5,407.6,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",104.07,100,,99.64,99.64,99.64,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",64.72,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",356.65,70,,285.32,,,0,"percent of total billed charges ","70% of total billed charges ",458.55,90,,366.84,,,0,"percent of total billed charges ","90% of total billed charges ",473.84,93,,379.07,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.53,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",433.08,85,,346.46,,,0,"percent of total billed charges ","85% of total billed charges ",458.55,90,,366.84,,,0,"percent of total billed charges ","90% of total billed charges ",458.55,90,,366.84,,,0,"percent of total billed charges ","90% of total billed charges ",14.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",443.27,87,,354.62,,,0,"percent of total billed charges ","87% of total billed charges ",14.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",356.65,70,,285.32,,,0,"percent of total billed charges ","70% of total billed charges ",14.39,473.84,
"FINGERS LEFT 5TH DIGIT",3002078,"CDM ",320,RC,73140,HCPCS,OUTPATIENT,,,374.5,299.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",105.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.64,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",348.29,93,,278.63,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",318.33,85,,254.66,,,0,"percent of total billed charges ","85% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",325.82,87,,260.66,,,0,"percent of total billed charges ","87% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,348.29,
"FINGERS LEFT 4TH DIGIT",3002086,"CDM ",320,RC,73140,HCPCS,OUTPATIENT,,,374.5,299.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",105.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.64,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",348.29,93,,278.63,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",318.33,85,,254.66,,,0,"percent of total billed charges ","85% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",325.82,87,,260.66,,,0,"percent of total billed charges ","87% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,348.29,
"FINGERS LEFT 3RD DIGIT",3002094,"CDM ",320,RC,73140,HCPCS,OUTPATIENT,,,374.5,299.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",105.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.64,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",348.29,93,,278.63,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",318.33,85,,254.66,,,0,"percent of total billed charges ","85% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",325.82,87,,260.66,,,0,"percent of total billed charges ","87% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,348.29,
"FINGERS RIGHT 5TH DIGIT",3002102,"CDM ",320,RC,73140,HCPCS,OUTPATIENT,,,374.5,299.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",105.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.64,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",348.29,93,,278.63,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",318.33,85,,254.66,,,0,"percent of total billed charges ","85% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",325.82,87,,260.66,,,0,"percent of total billed charges ","87% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,348.29,
"FINGERS RIGHT 4TH DIGIT",3002110,"CDM ",320,RC,73140,HCPCS,OUTPATIENT,,,374.5,299.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",105.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.64,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",348.29,93,,278.63,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",318.33,85,,254.66,,,0,"percent of total billed charges ","85% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",325.82,87,,260.66,,,0,"percent of total billed charges ","87% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,348.29,
"FINGERS RIGHT 3RD DIGIT",3002128,"CDM ",320,RC,73140,HCPCS,OUTPATIENT,,,374.5,299.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",105.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.64,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",348.29,93,,278.63,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",318.33,85,,254.66,,,0,"percent of total billed charges ","85% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",325.82,87,,260.66,,,0,"percent of total billed charges ","87% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,348.29,
"FINGERS RIGHT 2ND DIGIT",3002136,"CDM ",320,RC,73140,HCPCS,OUTPATIENT,,,374.5,299.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",105.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.64,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",348.29,93,,278.63,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",318.33,85,,254.66,,,0,"percent of total billed charges ","85% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",325.82,87,,260.66,,,0,"percent of total billed charges ","87% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,348.29,
"THUMB 2-3 VIEW RIGHT",3002144,"CDM ",320,RC,73140,HCPCS,OUTPATIENT,,,374.5,299.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",105.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.64,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",348.29,93,,278.63,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",318.33,85,,254.66,,,0,"percent of total billed charges ","85% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",325.82,87,,260.66,,,0,"percent of total billed charges ","87% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,348.29,
"HIP W/PELVIS 2-3 VIEWS RIGHT",3002151,"CDM ",320,RC,73502,HCPCS,OUTPATIENT,,,588,470.4,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",173.25,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",97.64,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",411.6,70,,329.28,,,0,"percent of total billed charges ","70% of total billed charges ",529.2,90,,423.36,,,0,"percent of total billed charges ","90% of total billed charges ",546.84,93,,437.47,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",52.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",499.8,85,,399.84,,,0,"percent of total billed charges ","85% of total billed charges ",529.2,90,,423.36,,,0,"percent of total billed charges ","90% of total billed charges ",529.2,90,,423.36,,,0,"percent of total billed charges ","90% of total billed charges ",51.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",511.56,87,,60.97,60.97,60.97,"1 through 10","percent of total billed charges ","87% of total billed charges ",51.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",411.6,70,,329.28,,,0,"percent of total billed charges ","70% of total billed charges ",51.7,546.84,
"HIP W/PELVIS 1 VIEW RIGHT",3002177,"CDM ",320,RC,73501,HCPCS,OUTPATIENT,,,429.5,343.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",142.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",67.63,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",300.65,70,,240.52,,,0,"percent of total billed charges ","70% of total billed charges ",386.55,90,,309.24,,,0,"percent of total billed charges ","90% of total billed charges ",399.44,93,,319.55,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",52.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",365.08,85,,292.06,,,0,"percent of total billed charges ","85% of total billed charges ",386.55,90,,309.24,,,0,"percent of total billed charges ","90% of total billed charges ",386.55,90,,309.24,,,0,"percent of total billed charges ","90% of total billed charges ",51.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.67,87,,298.94,,,0,"percent of total billed charges ","87% of total billed charges ",51.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",300.65,70,,240.52,,,0,"percent of total billed charges ","70% of total billed charges ",51.7,399.44,
"CHEST 4 OR MORE VIEWS",3002193,"CDM ",324,RC,71048,HCPCS,OUTPATIENT,,,1052,841.6,,,,,,,,0,"other ","not separately reimbursment ",161.89,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",96.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",736.4,70,,589.12,,,0,"percent of total billed charges ","70% of total billed charges ",946.8,90,,757.44,,,0,"percent of total billed charges ","90% of total billed charges ",978.36,93,,782.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",46.84,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",894.2,85,,715.36,,,0,"percent of total billed charges ","85% of total billed charges ",946.8,90,,757.44,,,0,"percent of total billed charges ","90% of total billed charges ",946.8,90,,757.44,,,0,"percent of total billed charges ","90% of total billed charges ",46.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",915.24,87,,732.19,,,0,"percent of total billed charges ","87% of total billed charges ",46.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",736.4,70,,589.12,,,0,"percent of total billed charges ","70% of total billed charges ",46.38,978.36,
"FEMUR 1 VIEW RIGHT",3002201,"CDM ",320,RC,73551,HCPCS,OUTPATIENT,,,401,320.8,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",60.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",280.7,70,,224.56,,,0,"percent of total billed charges ","70% of total billed charges ",360.9,90,,288.72,,,0,"percent of total billed charges ","90% of total billed charges ",372.93,93,,298.34,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",52.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",340.85,85,,272.68,,,0,"percent of total billed charges ","85% of total billed charges ",360.9,90,,288.72,,,0,"percent of total billed charges ","90% of total billed charges ",360.9,90,,288.72,,,0,"percent of total billed charges ","90% of total billed charges ",51.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",348.87,87,,279.10,,,0,"percent of total billed charges ","87% of total billed charges ",51.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",280.7,70,,224.56,,,0,"percent of total billed charges ","70% of total billed charges ",51.7,372.93,
"FEMUR MIN 2 VIEW RIGHT",3002219,"CDM ",320,RC,73552,HCPCS,OUTPATIENT,,,626.5,501.2,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",73.15,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",438.55,70,,350.84,,,0,"percent of total billed charges ","70% of total billed charges ",563.85,90,,451.08,,,0,"percent of total billed charges ","90% of total billed charges ",582.65,93,,466.12,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",52.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",532.53,85,,426.02,,,0,"percent of total billed charges ","85% of total billed charges ",563.85,90,,451.08,,,0,"percent of total billed charges ","90% of total billed charges ",563.85,90,,451.08,,,0,"percent of total billed charges ","90% of total billed charges ",51.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",545.06,87,,59.51,59.51,59.51,"1 through 10","percent of total billed charges ","87% of total billed charges ",51.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",438.55,70,,350.84,,,0,"percent of total billed charges ","70% of total billed charges ",51.7,582.65,
"KNEE 4 OR MORE VIEW RIGHT",3002227,"CDM ",320,RC,73564,HCPCS,OUTPATIENT,,,660.5,528.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",216.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",96.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",462.35,70,,369.88,,,0,"percent of total billed charges ","70% of total billed charges ",594.45,90,,475.56,,,0,"percent of total billed charges ","90% of total billed charges ",614.27,93,,491.42,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.26,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",561.43,85,,449.14,,,0,"percent of total billed charges ","85% of total billed charges ",594.45,90,,475.56,,,0,"percent of total billed charges ","90% of total billed charges ",594.45,90,,475.56,,,0,"percent of total billed charges ","90% of total billed charges ",25.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",574.64,87,,88.53,41.62,278.54,"1 through 10","percent of total billed charges ","87% of total billed charges ",25.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",462.35,70,,369.88,,,0,"percent of total billed charges ","70% of total billed charges ",25.01,614.27,
"KNEE 1 OR 2 VIEW RIGHT",3002235,"CDM ",320,RC,73560,HCPCS,OUTPATIENT,,,467.5,374,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.79,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",70.93,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",327.25,70,,261.80,,,0,"percent of total billed charges ","70% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",434.78,93,,347.82,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",397.38,85,,317.90,,,0,"percent of total billed charges ","85% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",406.73,87,,158.93,80.56,237.29,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",327.25,70,,261.80,,,0,"percent of total billed charges ","70% of total billed charges ",21.07,434.78,
"TIB/FIB 2 VIEW RIGHT",3002250,"CDM ",320,RC,73590,HCPCS,OUTPATIENT,,,547,437.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",142.17,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",65.41,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",382.9,70,,306.32,,,0,"percent of total billed charges ","70% of total billed charges ",492.3,90,,393.84,,,0,"percent of total billed charges ","90% of total billed charges ",508.71,93,,406.97,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",464.95,85,,371.96,,,0,"percent of total billed charges ","85% of total billed charges ",492.3,90,,393.84,,,0,"percent of total billed charges ","90% of total billed charges ",492.3,90,,393.84,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",475.89,87,,380.71,,,0,"percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",382.9,70,,306.32,,,0,"percent of total billed charges ","70% of total billed charges ",21.07,508.71,
"LOWER EXT INFANT RIGHT",3002276,"CDM ",320,RC,73592,HCPCS,OUTPATIENT,,,389.5,311.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",138.45,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",66.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",272.65,70,,218.12,,,0,"percent of total billed charges ","70% of total billed charges ",350.55,90,,280.44,,,0,"percent of total billed charges ","90% of total billed charges ",362.24,93,,289.79,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",331.08,85,,264.86,,,0,"percent of total billed charges ","85% of total billed charges ",350.55,90,,280.44,,,0,"percent of total billed charges ","90% of total billed charges ",350.55,90,,280.44,,,0,"percent of total billed charges ","90% of total billed charges ",15.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",338.87,87,,271.10,,,0,"percent of total billed charges ","87% of total billed charges ",15.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",272.65,70,,218.12,,,0,"percent of total billed charges ","70% of total billed charges ",15.13,362.24,
"ANKLE 2 VIEW RIGHT",3002284,"CDM ",320,RC,73600,HCPCS,OUTPATIENT,,,450.5,360.4,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",104.07,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",66.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",315.35,70,,252.28,,,0,"percent of total billed charges ","70% of total billed charges ",405.45,90,,324.36,,,0,"percent of total billed charges ","90% of total billed charges ",418.97,93,,335.18,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.11,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",382.93,85,,306.34,,,0,"percent of total billed charges ","85% of total billed charges ",405.45,90,,324.36,,,0,"percent of total billed charges ","90% of total billed charges ",405.45,90,,324.36,,,0,"percent of total billed charges ","90% of total billed charges ",19.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",391.94,87,,313.55,,,0,"percent of total billed charges ","87% of total billed charges ",19.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",315.35,70,,252.28,,,0,"percent of total billed charges ","70% of total billed charges ",19.91,418.97,
"ANKLE 3 VIEW RIGHT",3002292,"CDM ",320,RC,73610,HCPCS,OUTPATIENT,,,547,437.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",139.38,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",76.54,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",382.9,70,,306.32,,,0,"percent of total billed charges ","70% of total billed charges ",492.3,90,,393.84,,,0,"percent of total billed charges ","90% of total billed charges ",508.71,93,,406.97,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",464.95,85,,371.96,,,0,"percent of total billed charges ","85% of total billed charges ",492.3,90,,393.84,,,0,"percent of total billed charges ","90% of total billed charges ",492.3,90,,393.84,,,0,"percent of total billed charges ","90% of total billed charges ",21.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",475.89,87,,380.71,,,0,"percent of total billed charges ","87% of total billed charges ",21.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",382.9,70,,306.32,,,0,"percent of total billed charges ","70% of total billed charges ",21.46,508.71,
"FOOT 3 OR MORE VIEWS RIGHT",3002300,"CDM ",320,RC,73630,HCPCS,OUTPATIENT,,,550,440,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",134.73,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",71.7,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",385,70,,308.00,,,0,"percent of total billed charges ","70% of total billed charges ",495,90,,396.00,,,0,"percent of total billed charges ","90% of total billed charges ",511.5,93,,409.20,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",467.5,85,,374.00,,,0,"percent of total billed charges ","85% of total billed charges ",495,90,,396.00,,,0,"percent of total billed charges ","90% of total billed charges ",495,90,,396.00,,,0,"percent of total billed charges ","90% of total billed charges ",21.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",478.5,87,,377.99,128.29,377.99,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",385,70,,308.00,,,0,"percent of total billed charges ","70% of total billed charges ",21.46,511.5,
"FOOT 2 VIEW RIGHT",3002318,"CDM ",320,RC,73620,HCPCS,OUTPATIENT,,,447.5,358,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",94.78,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",58.5,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",313.25,70,,250.60,,,0,"percent of total billed charges ","70% of total billed charges ",402.75,90,,322.20,,,0,"percent of total billed charges ","90% of total billed charges ",416.18,93,,332.94,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.11,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",380.38,85,,304.30,,,0,"percent of total billed charges ","85% of total billed charges ",402.75,90,,322.20,,,0,"percent of total billed charges ","90% of total billed charges ",402.75,90,,322.20,,,0,"percent of total billed charges ","90% of total billed charges ",19.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",389.33,87,,311.46,,,0,"percent of total billed charges ","87% of total billed charges ",19.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",313.25,70,,250.60,,,0,"percent of total billed charges ","70% of total billed charges ",19.91,416.18,
"HEEL (OSCALSIS) RIGHT",3002326,"CDM ",320,RC,73650,HCPCS,OUTPATIENT,,,509.5,407.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",114.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",59.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",356.65,70,,285.32,,,0,"percent of total billed charges ","70% of total billed charges ",458.55,90,,366.84,,,0,"percent of total billed charges ","90% of total billed charges ",473.84,93,,379.07,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",433.08,85,,346.46,,,0,"percent of total billed charges ","85% of total billed charges ",458.55,90,,366.84,,,0,"percent of total billed charges ","90% of total billed charges ",458.55,90,,366.84,,,0,"percent of total billed charges ","90% of total billed charges ",19.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",443.27,87,,354.62,,,0,"percent of total billed charges ","87% of total billed charges ",19.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",356.65,70,,285.32,,,0,"percent of total billed charges ","70% of total billed charges ",19.16,473.84,
"TOE LEFT 2ND DIGIT",3002334,"CDM ",320,RC,73660,HCPCS,OUTPATIENT,,,374.5,299.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.79,100,,64.51,64.51,64.51,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",60.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",348.29,93,,278.63,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",318.33,85,,254.66,,,0,"percent of total billed charges ","85% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",325.82,87,,260.66,,,0,"percent of total billed charges ","87% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,348.29,
"WRIST ARTHROGRAM RIGHT",3002342,"CDM ",322,RC,73115,HCPCS,OUTPATIENT,,,1752.5,1402,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",287.56,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1226.75,70,,981.40,,,0,"percent of total billed charges ","70% of total billed charges ",1577.25,90,,1261.80,,,0,"percent of total billed charges ","90% of total billed charges ",1629.83,93,,1303.86,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1489.63,85,,1191.70,,,0,"percent of total billed charges ","85% of total billed charges ",1577.25,90,,1261.80,,,0,"percent of total billed charges ","90% of total billed charges ",1577.25,90,,1261.80,,,0,"percent of total billed charges ","90% of total billed charges ",63.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1524.68,87,,1219.74,,,0,"percent of total billed charges ","87% of total billed charges ",63.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.84,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1226.75,70,,981.40,,,0,"percent of total billed charges ","70% of total billed charges ",63.33,1629.83,
"TOE LEFT 3RD DIGIT",3002359,"CDM ",320,RC,73660,HCPCS,OUTPATIENT,,,374.5,299.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.79,100,,64.51,64.51,64.51,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",60.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",348.29,93,,278.63,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",318.33,85,,254.66,,,0,"percent of total billed charges ","85% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",325.82,87,,260.66,,,0,"percent of total billed charges ","87% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,348.29,
"TOE LEFT 4TH DIGIT",3002367,"CDM ",320,RC,73660,HCPCS,OUTPATIENT,,,374.5,299.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.79,100,,64.51,64.51,64.51,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",60.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",348.29,93,,278.63,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",318.33,85,,254.66,,,0,"percent of total billed charges ","85% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",325.82,87,,260.66,,,0,"percent of total billed charges ","87% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,348.29,
"TOE LEFT 5TH DIGIT",3002375,"CDM ",320,RC,73660,HCPCS,OUTPATIENT,,,374.5,299.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.79,100,,64.51,64.51,64.51,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",60.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",348.29,93,,278.63,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",318.33,85,,254.66,,,0,"percent of total billed charges ","85% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",325.82,87,,260.66,,,0,"percent of total billed charges ","87% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,348.29,
"TOE RIGHT GREAT",3002383,"CDM ",320,RC,73660,HCPCS,OUTPATIENT,,,374.5,299.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.79,100,,64.51,64.51,64.51,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",60.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",348.29,93,,278.63,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",318.33,85,,254.66,,,0,"percent of total billed charges ","85% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",325.82,87,,260.66,,,0,"percent of total billed charges ","87% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,348.29,
"TOE RIGHT 2ND DIGIT",3002391,"CDM ",320,RC,73660,HCPCS,OUTPATIENT,,,374.5,299.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.79,100,,64.51,64.51,64.51,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",60.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",348.29,93,,278.63,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",318.33,85,,254.66,,,0,"percent of total billed charges ","85% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",325.82,87,,260.66,,,0,"percent of total billed charges ","87% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,348.29,
"TOE RIGHT 3RD DIGIT",3002409,"CDM ",320,RC,73660,HCPCS,OUTPATIENT,,,374.5,299.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.79,100,,64.51,64.51,64.51,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",60.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",348.29,93,,278.63,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",318.33,85,,254.66,,,0,"percent of total billed charges ","85% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",325.82,87,,260.66,,,0,"percent of total billed charges ","87% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,348.29,
"TOE RIGHT 4TH DIGIT",3002417,"CDM ",320,RC,73660,HCPCS,OUTPATIENT,,,374.5,299.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.79,100,,64.51,64.51,64.51,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",60.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",348.29,93,,278.63,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",318.33,85,,254.66,,,0,"percent of total billed charges ","85% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",325.82,87,,260.66,,,0,"percent of total billed charges ","87% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,348.29,
"TOE RIGHT 5TH DIGIT",3002425,"CDM ",320,RC,73660,HCPCS,OUTPATIENT,,,374.5,299.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.79,100,,64.51,64.51,64.51,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",60.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",348.29,93,,278.63,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",318.33,85,,254.66,,,0,"percent of total billed charges ","85% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",325.82,87,,260.66,,,0,"percent of total billed charges ","87% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,348.29,
"KNEE ARTHROGRAM RIGHT",3002433,"CDM ",322,RC,73580,HCPCS,OUTPATIENT,,,1991.5,1593.2,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,949.56,949.56,949.56,"1 through 10","other ","not separately reimbursment ",310.05,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1394.05,70,,1115.24,,,0,"percent of total billed charges ","70% of total billed charges ",1792.35,90,,1433.88,,,0,"percent of total billed charges ","90% of total billed charges ",1852.1,93,,1481.68,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1692.78,85,,1354.22,,,0,"percent of total billed charges ","85% of total billed charges ",1792.35,90,,1433.88,,,0,"percent of total billed charges ","90% of total billed charges ",1792.35,90,,1433.88,,,0,"percent of total billed charges ","90% of total billed charges ",105.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1732.61,87,,1386.09,,,0,"percent of total billed charges ","87% of total billed charges ",105.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.84,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1394.05,70,,1115.24,,,0,"percent of total billed charges ","70% of total billed charges ",105.57,1852.1,
"SHOULDER ARTHROGRAM RIGHT",3002441,"CDM ",322,RC,73040,HCPCS,OUTPATIENT,,,1576.5,1261.2,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",347.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",277.2,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1103.55,70,,882.84,,,0,"percent of total billed charges ","70% of total billed charges ",1418.85,90,,1135.08,,,0,"percent of total billed charges ","90% of total billed charges ",1466.15,93,,1172.92,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.85,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1340.03,85,,1072.02,,,0,"percent of total billed charges ","85% of total billed charges ",1418.85,90,,1135.08,,,0,"percent of total billed charges ","90% of total billed charges ",1418.85,90,,1135.08,,,0,"percent of total billed charges ","90% of total billed charges ",84.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1371.56,87,,1097.25,,,0,"percent of total billed charges ","87% of total billed charges ",84.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.84,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1103.55,70,,882.84,,,0,"percent of total billed charges ","70% of total billed charges ",84.01,1466.15,
"MAMMO DIAG UNI RIGHT W/CAD",3002458,"CDM ",401,RC,77065,HCPCS,OUTPATIENT,,,614,491.2,,99.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",123.22,100,,75.30,75.30,75.30,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",263.87,220,,15.37,15.37,15.37,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",429.8,70,,343.84,,,0,"percent of total billed charges ","70% of total billed charges ",552.6,90,,442.08,,,0,"percent of total billed charges ","90% of total billed charges ",571.02,93,,456.82,,,0,"percent of total billed charges ","93% of total billed charges ",99.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",61.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",521.9,85,,417.52,,,0,"percent of total billed charges ","85% of total billed charges ",552.6,90,,442.08,,,0,"percent of total billed charges ","90% of total billed charges ",552.6,90,,442.08,,,0,"percent of total billed charges ","90% of total billed charges ",60.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",534.18,87,,427.34,,,0,"percent of total billed charges ","87% of total billed charges ",60.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",429.8,70,,343.84,,,0,"percent of total billed charges ","70% of total billed charges ",60.64,571.02,
"HIP ARTHROGRAM RIGHT",3002482,"CDM ",322,RC,73525,HCPCS,OUTPATIENT,,,1576.5,1261.2,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,29.01,29.01,29.01,"1 through 10","other ","not separately reimbursment ",281.69,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1103.55,70,,882.84,,,0,"percent of total billed charges ","70% of total billed charges ",1418.85,90,,1135.08,,,0,"percent of total billed charges ","90% of total billed charges ",1466.15,93,,1172.92,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.85,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1340.03,85,,1072.02,,,0,"percent of total billed charges ","85% of total billed charges ",1418.85,90,,1135.08,,,0,"percent of total billed charges ","90% of total billed charges ",1418.85,90,,1135.08,,,0,"percent of total billed charges ","90% of total billed charges ",84.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1371.56,87,,1097.25,,,0,"percent of total billed charges ","87% of total billed charges ",84.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.84,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1103.55,70,,882.84,,,0,"percent of total billed charges ","70% of total billed charges ",84.01,1466.15,
"VENOGRAM UNI EXT RIGHT",3002490,"CDM ",340,RC,78457,HCPCS,OUTPATIENT,,,1238,990.4,,428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",357.96,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",866.6,70,,693.28,,,0,"percent of total billed charges ","70% of total billed charges ",1114.2,90,,891.36,,,0,"percent of total billed charges ","90% of total billed charges ",1151.34,93,,921.07,,,0,"percent of total billed charges ","93% of total billed charges ",428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1052.3,85,,841.84,,,0,"percent of total billed charges ","85% of total billed charges ",1114.2,90,,891.36,,,0,"percent of total billed charges ","90% of total billed charges ",1114.2,90,,891.36,,,0,"percent of total billed charges ","90% of total billed charges ",17.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1077.06,87,,861.65,,,0,"percent of total billed charges ","87% of total billed charges ",17.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",866.6,70,,693.28,,,0,"percent of total billed charges ","70% of total billed charges ",17.79,1151.34,
"BONE AGE",3002508,"CDM ",320,RC,77072,HCPCS,OUTPATIENT,,,389.5,311.6,,,,,,,,0,"other ","not separately reimbursment ",139.38,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",54.56,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",272.65,70,,218.12,,,0,"percent of total billed charges ","70% of total billed charges ",350.55,90,,280.44,,,0,"percent of total billed charges ","90% of total billed charges ",362.24,93,,289.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",10.95,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",331.08,85,,264.86,,,0,"percent of total billed charges ","85% of total billed charges ",350.55,90,,280.44,,,0,"percent of total billed charges ","90% of total billed charges ",350.55,90,,280.44,,,0,"percent of total billed charges ","90% of total billed charges ",10.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",338.87,87,,267.65,267.65,267.65,"1 through 10","percent of total billed charges ","87% of total billed charges ",10.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",272.65,70,,218.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.84,362.24,
"LOWER EXT INFANT LEFT",3002532,"CDM ",320,RC,73592,HCPCS,OUTPATIENT,,,389.5,311.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",138.45,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",66.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",272.65,70,,218.12,,,0,"percent of total billed charges ","70% of total billed charges ",350.55,90,,280.44,,,0,"percent of total billed charges ","90% of total billed charges ",362.24,93,,289.79,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",331.08,85,,264.86,,,0,"percent of total billed charges ","85% of total billed charges ",350.55,90,,280.44,,,0,"percent of total billed charges ","90% of total billed charges ",350.55,90,,280.44,,,0,"percent of total billed charges ","90% of total billed charges ",15.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",338.87,87,,271.10,,,0,"percent of total billed charges ","87% of total billed charges ",15.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",272.65,70,,218.12,,,0,"percent of total billed charges ","70% of total billed charges ",15.13,362.24,
"MAMMO DIAG UNI LEFT W/CAD",3002540,"CDM ",401,RC,77065,HCPCS,OUTPATIENT,,,614,491.2,,99.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",123.22,100,,75.30,75.30,75.30,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",263.87,220,,15.37,15.37,15.37,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",429.8,70,,343.84,,,0,"percent of total billed charges ","70% of total billed charges ",552.6,90,,442.08,,,0,"percent of total billed charges ","90% of total billed charges ",571.02,93,,456.82,,,0,"percent of total billed charges ","93% of total billed charges ",99.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",61.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",521.9,85,,417.52,,,0,"percent of total billed charges ","85% of total billed charges ",552.6,90,,442.08,,,0,"percent of total billed charges ","90% of total billed charges ",552.6,90,,442.08,,,0,"percent of total billed charges ","90% of total billed charges ",60.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",534.18,87,,427.34,,,0,"percent of total billed charges ","87% of total billed charges ",60.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",429.8,70,,343.84,,,0,"percent of total billed charges ","70% of total billed charges ",60.64,571.02,
"VENOGRAM UNI EXT LEFT",3002557,"CDM ",340,RC,78457,HCPCS,OUTPATIENT,,,1238,990.4,,428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",357.96,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",866.6,70,,693.28,,,0,"percent of total billed charges ","70% of total billed charges ",1114.2,90,,891.36,,,0,"percent of total billed charges ","90% of total billed charges ",1151.34,93,,921.07,,,0,"percent of total billed charges ","93% of total billed charges ",428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1052.3,85,,841.84,,,0,"percent of total billed charges ","85% of total billed charges ",1114.2,90,,891.36,,,0,"percent of total billed charges ","90% of total billed charges ",1114.2,90,,891.36,,,0,"percent of total billed charges ","90% of total billed charges ",17.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1077.06,87,,861.65,,,0,"percent of total billed charges ","87% of total billed charges ",17.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",866.6,70,,693.28,,,0,"percent of total billed charges ","70% of total billed charges ",17.79,1151.34,
"RIBS UNI LEFT + PA CHEST",3002565,"CDM ",320,RC,71101,HCPCS,OUTPATIENT,,,720.5,576.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",199.78,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",88.31,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",504.35,70,,403.48,,,0,"percent of total billed charges ","70% of total billed charges ",648.45,90,,518.76,,,0,"percent of total billed charges ","90% of total billed charges ",670.07,93,,536.06,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.81,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",612.43,85,,489.94,,,0,"percent of total billed charges ","85% of total billed charges ",648.45,90,,518.76,,,0,"percent of total billed charges ","90% of total billed charges ",648.45,90,,518.76,,,0,"percent of total billed charges ","90% of total billed charges ",21.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",626.84,87,,93.43,93.43,93.43,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",504.35,70,,403.48,,,0,"percent of total billed charges ","70% of total billed charges ",21.59,670.07,
"RIBS UNILATERAL LEFT",3002573,"CDM ",320,RC,71100,HCPCS,OUTPATIENT,,,574,459.2,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",133.8,100,,9.47,9.47,9.47,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",76.89,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",401.8,70,,321.44,,,0,"percent of total billed charges ","70% of total billed charges ",516.6,90,,413.28,,,0,"percent of total billed charges ","90% of total billed charges ",533.82,93,,427.06,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",487.9,85,,390.32,,,0,"percent of total billed charges ","85% of total billed charges ",516.6,90,,413.28,,,0,"percent of total billed charges ","90% of total billed charges ",516.6,90,,413.28,,,0,"percent of total billed charges ","90% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.38,87,,225.57,97.81,360.61,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",401.8,70,,321.44,,,0,"percent of total billed charges ","70% of total billed charges ",23.1,533.82,
"SHOULDER MIN 2 VIEWS LEFT",3002581,"CDM ",320,RC,73030,HCPCS,OUTPATIENT,,,588,470.4,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",140.31,100,,52.33,24.42,80.23,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",71.76,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",411.6,70,,329.28,,,0,"percent of total billed charges ","70% of total billed charges ",529.2,90,,423.36,,,0,"percent of total billed charges ","90% of total billed charges ",546.84,93,,437.47,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",499.8,85,,399.84,,,0,"percent of total billed charges ","85% of total billed charges ",529.2,90,,423.36,,,0,"percent of total billed charges ","90% of total billed charges ",529.2,90,,423.36,,,0,"percent of total billed charges ","90% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",511.56,87,,323.08,125.15,387.70,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",411.6,70,,329.28,,,0,"percent of total billed charges ","70% of total billed charges ",23.1,546.84,
"WRIST 3 OR MORE VIEW LEFT",3002599,"CDM ",320,RC,73110,HCPCS,OUTPATIENT,,,626.5,501.2,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.1,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",84.83,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",438.55,70,,350.84,,,0,"percent of total billed charges ","70% of total billed charges ",563.85,90,,451.08,,,0,"percent of total billed charges ","90% of total billed charges ",582.65,93,,466.12,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",532.53,85,,426.02,,,0,"percent of total billed charges ","85% of total billed charges ",563.85,90,,451.08,,,0,"percent of total billed charges ","90% of total billed charges ",563.85,90,,451.08,,,0,"percent of total billed charges ","90% of total billed charges ",21.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",545.06,87,,122.02,33.24,351.91,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",438.55,70,,350.84,,,0,"percent of total billed charges ","70% of total billed charges ",21.46,582.65,
"THUMB 2-3 VIEW LEFT",3002607,"CDM ",320,RC,73140,HCPCS,OUTPATIENT,,,374.5,299.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",105.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.64,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",348.29,93,,278.63,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",318.33,85,,254.66,,,0,"percent of total billed charges ","85% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",325.82,87,,260.66,,,0,"percent of total billed charges ","87% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,348.29,
"TIB/FIB 2 VIEW LEFT",3002615,"CDM ",320,RC,73590,HCPCS,OUTPATIENT,,,547,437.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",142.17,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",65.41,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",382.9,70,,306.32,,,0,"percent of total billed charges ","70% of total billed charges ",492.3,90,,393.84,,,0,"percent of total billed charges ","90% of total billed charges ",508.71,93,,406.97,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",464.95,85,,371.96,,,0,"percent of total billed charges ","85% of total billed charges ",492.3,90,,393.84,,,0,"percent of total billed charges ","90% of total billed charges ",492.3,90,,393.84,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",475.89,87,,380.71,,,0,"percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",382.9,70,,306.32,,,0,"percent of total billed charges ","70% of total billed charges ",21.07,508.71,
"WRIST ARTHROGRAM LEFT",3002623,"CDM ",322,RC,73115,HCPCS,OUTPATIENT,,,1752.5,1402,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",287.56,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1226.75,70,,981.40,,,0,"percent of total billed charges ","70% of total billed charges ",1577.25,90,,1261.80,,,0,"percent of total billed charges ","90% of total billed charges ",1629.83,93,,1303.86,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1489.63,85,,1191.70,,,0,"percent of total billed charges ","85% of total billed charges ",1577.25,90,,1261.80,,,0,"percent of total billed charges ","90% of total billed charges ",1577.25,90,,1261.80,,,0,"percent of total billed charges ","90% of total billed charges ",63.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1524.68,87,,1219.74,,,0,"percent of total billed charges ","87% of total billed charges ",63.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.84,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1226.75,70,,981.40,,,0,"percent of total billed charges ","70% of total billed charges ",63.33,1629.83,
"TOE LEFT GREAT",3002631,"CDM ",320,RC,73660,HCPCS,OUTPATIENT,,,374.5,299.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.79,100,,64.51,64.51,64.51,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",60.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",348.29,93,,278.63,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",318.33,85,,254.66,,,0,"percent of total billed charges ","85% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",325.82,87,,260.66,,,0,"percent of total billed charges ","87% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,348.29,
"SHOULDER ARTHROGRAM LEFT",3002649,"CDM ",322,RC,73040,HCPCS,OUTPATIENT,,,1576.5,1261.2,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",347.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",277.2,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1103.55,70,,882.84,,,0,"percent of total billed charges ","70% of total billed charges ",1418.85,90,,1135.08,,,0,"percent of total billed charges ","90% of total billed charges ",1466.15,93,,1172.92,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.85,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1340.03,85,,1072.02,,,0,"percent of total billed charges ","85% of total billed charges ",1418.85,90,,1135.08,,,0,"percent of total billed charges ","90% of total billed charges ",1418.85,90,,1135.08,,,0,"percent of total billed charges ","90% of total billed charges ",84.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1371.56,87,,1097.25,,,0,"percent of total billed charges ","87% of total billed charges ",84.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.84,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1103.55,70,,882.84,,,0,"percent of total billed charges ","70% of total billed charges ",84.01,1466.15,
"WRIST 2 VIEW LEFT",3002656,"CDM ",320,RC,73100,HCPCS,OUTPATIENT,,,547,437.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",70.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",382.9,70,,306.32,,,0,"percent of total billed charges ","70% of total billed charges ",492.3,90,,393.84,,,0,"percent of total billed charges ","90% of total billed charges ",508.71,93,,406.97,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.11,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",464.95,85,,371.96,,,0,"percent of total billed charges ","85% of total billed charges ",492.3,90,,393.84,,,0,"percent of total billed charges ","90% of total billed charges ",492.3,90,,393.84,,,0,"percent of total billed charges ","90% of total billed charges ",19.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",475.89,87,,380.71,,,0,"percent of total billed charges ","87% of total billed charges ",19.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",382.9,70,,306.32,,,0,"percent of total billed charges ","70% of total billed charges ",19.91,508.71,
"KNEE ARTHROGRAM LEFT",3002664,"CDM ",322,RC,73580,HCPCS,OUTPATIENT,,,1991.5,1593.2,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,949.56,949.56,949.56,"1 through 10","other ","not separately reimbursment ",310.05,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1394.05,70,,1115.24,,,0,"percent of total billed charges ","70% of total billed charges ",1792.35,90,,1433.88,,,0,"percent of total billed charges ","90% of total billed charges ",1852.1,93,,1481.68,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1692.78,85,,1354.22,,,0,"percent of total billed charges ","85% of total billed charges ",1792.35,90,,1433.88,,,0,"percent of total billed charges ","90% of total billed charges ",1792.35,90,,1433.88,,,0,"percent of total billed charges ","90% of total billed charges ",105.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1732.61,87,,1386.09,,,0,"percent of total billed charges ","87% of total billed charges ",105.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.84,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1394.05,70,,1115.24,,,0,"percent of total billed charges ","70% of total billed charges ",105.57,1852.1,
"HIP ARTHROGRAM LEFT",3002680,"CDM ",322,RC,73525,HCPCS,OUTPATIENT,,,1576.5,1261.2,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,29.01,29.01,29.01,"1 through 10","other ","not separately reimbursment ",281.69,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1103.55,70,,882.84,,,0,"percent of total billed charges ","70% of total billed charges ",1418.85,90,,1135.08,,,0,"percent of total billed charges ","90% of total billed charges ",1466.15,93,,1172.92,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.85,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1340.03,85,,1072.02,,,0,"percent of total billed charges ","85% of total billed charges ",1418.85,90,,1135.08,,,0,"percent of total billed charges ","90% of total billed charges ",1418.85,90,,1135.08,,,0,"percent of total billed charges ","90% of total billed charges ",84.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1371.56,87,,1097.25,,,0,"percent of total billed charges ","87% of total billed charges ",84.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.84,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1103.55,70,,882.84,,,0,"percent of total billed charges ","70% of total billed charges ",84.01,1466.15,
"FOOT 2 VIEW LEFT",3002698,"CDM ",320,RC,73620,HCPCS,OUTPATIENT,,,447.5,358,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",94.78,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",58.5,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",313.25,70,,250.60,,,0,"percent of total billed charges ","70% of total billed charges ",402.75,90,,322.20,,,0,"percent of total billed charges ","90% of total billed charges ",416.18,93,,332.94,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.11,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",380.38,85,,304.30,,,0,"percent of total billed charges ","85% of total billed charges ",402.75,90,,322.20,,,0,"percent of total billed charges ","90% of total billed charges ",402.75,90,,322.20,,,0,"percent of total billed charges ","90% of total billed charges ",19.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",389.33,87,,311.46,,,0,"percent of total billed charges ","87% of total billed charges ",19.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",313.25,70,,250.60,,,0,"percent of total billed charges ","70% of total billed charges ",19.91,416.18,
"HEEL (OSCALSIS) LEFT",3002706,"CDM ",320,RC,73650,HCPCS,OUTPATIENT,,,509.5,407.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",114.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",59.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",356.65,70,,285.32,,,0,"percent of total billed charges ","70% of total billed charges ",458.55,90,,366.84,,,0,"percent of total billed charges ","90% of total billed charges ",473.84,93,,379.07,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",433.08,85,,346.46,,,0,"percent of total billed charges ","85% of total billed charges ",458.55,90,,366.84,,,0,"percent of total billed charges ","90% of total billed charges ",458.55,90,,366.84,,,0,"percent of total billed charges ","90% of total billed charges ",19.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",443.27,87,,354.62,,,0,"percent of total billed charges ","87% of total billed charges ",19.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",356.65,70,,285.32,,,0,"percent of total billed charges ","70% of total billed charges ",19.16,473.84,
"HIP W/PELVIS 1 VIEW LEFT",3002714,"CDM ",320,RC,73501,HCPCS,OUTPATIENT,,,429.5,343.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",142.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",67.63,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",300.65,70,,240.52,,,0,"percent of total billed charges ","70% of total billed charges ",386.55,90,,309.24,,,0,"percent of total billed charges ","90% of total billed charges ",399.44,93,,319.55,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",52.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",365.08,85,,292.06,,,0,"percent of total billed charges ","85% of total billed charges ",386.55,90,,309.24,,,0,"percent of total billed charges ","90% of total billed charges ",386.55,90,,309.24,,,0,"percent of total billed charges ","90% of total billed charges ",51.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.67,87,,298.94,,,0,"percent of total billed charges ","87% of total billed charges ",51.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",300.65,70,,240.52,,,0,"percent of total billed charges ","70% of total billed charges ",51.7,399.44,
"KNEE 1 OR 2 VIEW LEFT",3002722,"CDM ",320,RC,73560,HCPCS,OUTPATIENT,,,467.5,374,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.79,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",70.93,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",327.25,70,,261.80,,,0,"percent of total billed charges ","70% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",434.78,93,,347.82,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",397.38,85,,317.90,,,0,"percent of total billed charges ","85% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",406.73,87,,158.93,80.56,237.29,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",327.25,70,,261.80,,,0,"percent of total billed charges ","70% of total billed charges ",21.07,434.78,
"FOOT 3 OR MORE VIEWS LEFT",3002730,"CDM ",320,RC,73630,HCPCS,OUTPATIENT,,,550,440,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",134.73,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",71.7,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",385,70,,308.00,,,0,"percent of total billed charges ","70% of total billed charges ",495,90,,396.00,,,0,"percent of total billed charges ","90% of total billed charges ",511.5,93,,409.20,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",467.5,85,,374.00,,,0,"percent of total billed charges ","85% of total billed charges ",495,90,,396.00,,,0,"percent of total billed charges ","90% of total billed charges ",495,90,,396.00,,,0,"percent of total billed charges ","90% of total billed charges ",21.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",478.5,87,,377.99,128.29,377.99,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",385,70,,308.00,,,0,"percent of total billed charges ","70% of total billed charges ",21.46,511.5,
"KNEE 4 OR MORE VIEW LEFT",3002748,"CDM ",320,RC,73564,HCPCS,OUTPATIENT,,,660.5,528.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",216.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",96.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",462.35,70,,369.88,,,0,"percent of total billed charges ","70% of total billed charges ",594.45,90,,475.56,,,0,"percent of total billed charges ","90% of total billed charges ",614.27,93,,491.42,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.26,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",561.43,85,,449.14,,,0,"percent of total billed charges ","85% of total billed charges ",594.45,90,,475.56,,,0,"percent of total billed charges ","90% of total billed charges ",594.45,90,,475.56,,,0,"percent of total billed charges ","90% of total billed charges ",25.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",574.64,87,,88.53,41.62,278.54,"1 through 10","percent of total billed charges ","87% of total billed charges ",25.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",462.35,70,,369.88,,,0,"percent of total billed charges ","70% of total billed charges ",25.01,614.27,
"HIP W/PELVIS 2-3 VIEWS LEFT",3002763,"CDM ",320,RC,73502,HCPCS,OUTPATIENT,,,588,470.4,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",173.25,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",97.64,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",411.6,70,,329.28,,,0,"percent of total billed charges ","70% of total billed charges ",529.2,90,,423.36,,,0,"percent of total billed charges ","90% of total billed charges ",546.84,93,,437.47,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",52.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",499.8,85,,399.84,,,0,"percent of total billed charges ","85% of total billed charges ",529.2,90,,423.36,,,0,"percent of total billed charges ","90% of total billed charges ",529.2,90,,423.36,,,0,"percent of total billed charges ","90% of total billed charges ",51.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",511.56,87,,60.97,60.97,60.97,"1 through 10","percent of total billed charges ","87% of total billed charges ",51.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",411.6,70,,329.28,,,0,"percent of total billed charges ","70% of total billed charges ",51.7,546.84,
"HAND 2 VIEW LEFT",3002771,"CDM ",320,RC,73120,HCPCS,OUTPATIENT,,,509.5,407.6,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",104.07,100,,99.64,99.64,99.64,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",64.72,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",356.65,70,,285.32,,,0,"percent of total billed charges ","70% of total billed charges ",458.55,90,,366.84,,,0,"percent of total billed charges ","90% of total billed charges ",473.84,93,,379.07,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.53,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",433.08,85,,346.46,,,0,"percent of total billed charges ","85% of total billed charges ",458.55,90,,366.84,,,0,"percent of total billed charges ","90% of total billed charges ",458.55,90,,366.84,,,0,"percent of total billed charges ","90% of total billed charges ",14.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",443.27,87,,354.62,,,0,"percent of total billed charges ","87% of total billed charges ",14.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",356.65,70,,285.32,,,0,"percent of total billed charges ","70% of total billed charges ",14.39,473.84,
"HAND 3 OR MORE VIEWS LEFT",3002789,"CDM ",320,RC,73130,HCPCS,OUTPATIENT,,,588,470.4,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",136.59,100,,85.47,85.47,85.47,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",75.86,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",411.6,70,,329.28,,,0,"percent of total billed charges ","70% of total billed charges ",529.2,90,,423.36,,,0,"percent of total billed charges ","90% of total billed charges ",546.84,93,,437.47,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",499.8,85,,399.84,,,0,"percent of total billed charges ","85% of total billed charges ",529.2,90,,423.36,,,0,"percent of total billed charges ","90% of total billed charges ",529.2,90,,423.36,,,0,"percent of total billed charges ","90% of total billed charges ",21.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",511.56,87,,75.67,46.84,355.39,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",411.6,70,,329.28,,,0,"percent of total billed charges ","70% of total billed charges ",21.46,546.84,
"FOREARM 2 VIEW LEFT",3002797,"CDM ",320,RC,73090,HCPCS,OUTPATIENT,,,547,437.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",124.51,100,,126.68,126.68,126.68,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",60.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",382.9,70,,306.32,,,0,"percent of total billed charges ","70% of total billed charges ",492.3,90,,393.84,,,0,"percent of total billed charges ","90% of total billed charges ",508.71,93,,406.97,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",464.95,85,,371.96,,,0,"percent of total billed charges ","85% of total billed charges ",492.3,90,,393.84,,,0,"percent of total billed charges ","90% of total billed charges ",492.3,90,,393.84,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",475.89,87,,146.97,36.80,330.06,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",382.9,70,,306.32,,,0,"percent of total billed charges ","70% of total billed charges ",21.07,508.71,
"HUMERUS 2 OR MORE VIEWS LEFT",3002805,"CDM ",320,RC,73060,HCPCS,OUTPATIENT,,,509.5,407.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",137.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",66.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",356.65,70,,285.32,,,0,"percent of total billed charges ","70% of total billed charges ",458.55,90,,366.84,,,0,"percent of total billed charges ","90% of total billed charges ",473.84,93,,379.07,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",433.08,85,,346.46,,,0,"percent of total billed charges ","85% of total billed charges ",458.55,90,,366.84,,,0,"percent of total billed charges ","90% of total billed charges ",458.55,90,,366.84,,,0,"percent of total billed charges ","90% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",443.27,87,,65.87,61.95,81.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",356.65,70,,285.32,,,0,"percent of total billed charges ","70% of total billed charges ",23.1,473.84,
"FINGERS LEFT 2ND DIGIT",3002813,"CDM ",320,RC,73140,HCPCS,OUTPATIENT,,,374.5,299.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",105.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.64,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",348.29,93,,278.63,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",318.33,85,,254.66,,,0,"percent of total billed charges ","85% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",337.05,90,,269.64,,,0,"percent of total billed charges ","90% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",325.82,87,,260.66,,,0,"percent of total billed charges ","87% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",262.15,70,,209.72,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,348.29,
"FEMUR MIN 2 VIEW LEFT",3002821,"CDM ",320,RC,73552,HCPCS,OUTPATIENT,,,626.5,501.2,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",73.15,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",438.55,70,,350.84,,,0,"percent of total billed charges ","70% of total billed charges ",563.85,90,,451.08,,,0,"percent of total billed charges ","90% of total billed charges ",582.65,93,,466.12,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",52.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",532.53,85,,426.02,,,0,"percent of total billed charges ","85% of total billed charges ",563.85,90,,451.08,,,0,"percent of total billed charges ","90% of total billed charges ",563.85,90,,451.08,,,0,"percent of total billed charges ","90% of total billed charges ",51.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",545.06,87,,59.51,59.51,59.51,"1 through 10","percent of total billed charges ","87% of total billed charges ",51.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",438.55,70,,350.84,,,0,"percent of total billed charges ","70% of total billed charges ",51.7,582.65,
"ELBOW 3 OR MORE VIEWS LEFT",3002839,"CDM ",320,RC,73080,HCPCS,OUTPATIENT,,,525,420,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",151.46,100,,154.12,154.12,154.12,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",67.54,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",367.5,70,,294.00,,,0,"percent of total billed charges ","70% of total billed charges ",472.5,90,,378.00,,,0,"percent of total billed charges ","90% of total billed charges ",488.25,93,,390.60,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",446.25,85,,357.00,,,0,"percent of total billed charges ","85% of total billed charges ",472.5,90,,378.00,,,0,"percent of total billed charges ","90% of total billed charges ",472.5,90,,378.00,,,0,"percent of total billed charges ","90% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",456.75,87,,141.07,141.07,141.07,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",367.5,70,,294.00,,,0,"percent of total billed charges ","70% of total billed charges ",23.1,488.25,
"ELBOW 2 VIEW LEFT",3002847,"CDM ",320,RC,73070,HCPCS,OUTPATIENT,,,462.5,370,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",113.36,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",60.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",323.75,70,,259.00,,,0,"percent of total billed charges ","70% of total billed charges ",416.25,90,,333.00,,,0,"percent of total billed charges ","90% of total billed charges ",430.13,93,,344.10,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",393.13,85,,314.50,,,0,"percent of total billed charges ","85% of total billed charges ",416.25,90,,333.00,,,0,"percent of total billed charges ","90% of total billed charges ",416.25,90,,333.00,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",402.38,87,,46.65,15.59,77.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",323.75,70,,259.00,,,0,"percent of total billed charges ","70% of total billed charges ",21.07,430.13,
"CLAVICLE 2 VIEW LEFT",3002854,"CDM ",320,RC,73000,HCPCS,OUTPATIENT,,,462.5,370,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",114.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",66.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",323.75,70,,259.00,,,0,"percent of total billed charges ","70% of total billed charges ",416.25,90,,333.00,,,0,"percent of total billed charges ","90% of total billed charges ",430.13,93,,344.10,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",393.13,85,,314.50,,,0,"percent of total billed charges ","85% of total billed charges ",416.25,90,,333.00,,,0,"percent of total billed charges ","90% of total billed charges ",416.25,90,,333.00,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",402.38,87,,321.90,,,0,"percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",323.75,70,,259.00,,,0,"percent of total billed charges ","70% of total billed charges ",21.07,430.13,
"ANKLE 2 VIEW LEFT",3002862,"CDM ",320,RC,73600,HCPCS,OUTPATIENT,,,450.5,360.4,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",104.07,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",66.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",315.35,70,,252.28,,,0,"percent of total billed charges ","70% of total billed charges ",405.45,90,,324.36,,,0,"percent of total billed charges ","90% of total billed charges ",418.97,93,,335.18,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.11,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",382.93,85,,306.34,,,0,"percent of total billed charges ","85% of total billed charges ",405.45,90,,324.36,,,0,"percent of total billed charges ","90% of total billed charges ",405.45,90,,324.36,,,0,"percent of total billed charges ","90% of total billed charges ",19.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",391.94,87,,313.55,,,0,"percent of total billed charges ","87% of total billed charges ",19.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",315.35,70,,252.28,,,0,"percent of total billed charges ","70% of total billed charges ",19.91,418.97,
"ANKLE 3 VIEW LEFT",3002870,"CDM ",320,RC,73610,HCPCS,OUTPATIENT,,,547,437.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",139.38,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",76.54,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",382.9,70,,306.32,,,0,"percent of total billed charges ","70% of total billed charges ",492.3,90,,393.84,,,0,"percent of total billed charges ","90% of total billed charges ",508.71,93,,406.97,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",464.95,85,,371.96,,,0,"percent of total billed charges ","85% of total billed charges ",492.3,90,,393.84,,,0,"percent of total billed charges ","90% of total billed charges ",492.3,90,,393.84,,,0,"percent of total billed charges ","90% of total billed charges ",21.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",475.89,87,,380.71,,,0,"percent of total billed charges ","87% of total billed charges ",21.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",382.9,70,,306.32,,,0,"percent of total billed charges ","70% of total billed charges ",21.46,508.71,
"HUMERUS 1 VIEW LEFT",3002896,"CDM ",320,RC,73060,HCPCS,OUTPATIENT,,,401,320.8,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",137.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",66.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",280.7,70,,224.56,,,0,"percent of total billed charges ","70% of total billed charges ",360.9,90,,288.72,,,0,"percent of total billed charges ","90% of total billed charges ",372.93,93,,298.34,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",340.85,85,,272.68,,,0,"percent of total billed charges ","85% of total billed charges ",360.9,90,,288.72,,,0,"percent of total billed charges ","90% of total billed charges ",360.9,90,,288.72,,,0,"percent of total billed charges ","90% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",348.87,87,,65.87,61.95,81.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",280.7,70,,224.56,,,0,"percent of total billed charges ","70% of total billed charges ",23.1,372.93,
"FEMUR 1 VIEW LEFT",3002920,"CDM ",320,RC,73551,HCPCS,OUTPATIENT,,,177.5,142,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",60.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",124.25,70,,99.40,,,0,"percent of total billed charges ","70% of total billed charges ",159.75,90,,127.80,,,0,"percent of total billed charges ","90% of total billed charges ",165.08,93,,132.06,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",52.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",150.88,85,,120.70,,,0,"percent of total billed charges ","85% of total billed charges ",159.75,90,,127.80,,,0,"percent of total billed charges ","90% of total billed charges ",159.75,90,,127.80,,,0,"percent of total billed charges ","90% of total billed charges ",51.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",154.43,87,,123.54,,,0,"percent of total billed charges ","87% of total billed charges ",51.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",124.25,70,,99.40,,,0,"percent of total billed charges ","70% of total billed charges ",51.7,165.08,
"SCAPULA 2 VIEW LEFT",3002961,"CDM ",320,RC,73010,HCPCS,OUTPATIENT,,,401,320.8,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",49.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",280.7,70,,224.56,,,0,"percent of total billed charges ","70% of total billed charges ",360.9,90,,288.72,,,0,"percent of total billed charges ","90% of total billed charges ",372.93,93,,298.34,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",340.85,85,,272.68,,,0,"percent of total billed charges ","85% of total billed charges ",360.9,90,,288.72,,,0,"percent of total billed charges ","90% of total billed charges ",360.9,90,,288.72,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",348.87,87,,279.10,,,0,"percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",280.7,70,,224.56,,,0,"percent of total billed charges ","70% of total billed charges ",21.07,372.93,
"PERCUTANEOUS SMALL BOWEL",3002987,"CDM ",320,RC,74250,HCPCS,OUTPATIENT,,,1320.5,1056.4,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",311.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",263.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",924.35,70,,739.48,,,0,"percent of total billed charges ","70% of total billed charges ",1188.45,90,,950.76,,,0,"percent of total billed charges ","90% of total billed charges ",1228.07,93,,982.46,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1122.43,85,,897.94,,,0,"percent of total billed charges ","85% of total billed charges ",1188.45,90,,950.76,,,0,"percent of total billed charges ","90% of total billed charges ",1188.45,90,,950.76,,,0,"percent of total billed charges ","90% of total billed charges ",42.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1148.84,87,,919.07,,,0,"percent of total billed charges ","87% of total billed charges ",42.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",924.35,70,,739.48,,,0,"percent of total billed charges ","70% of total billed charges ",42.22,1228.07,
"ELBOW ARTHROGRAM RIGHT",3003019,"CDM ",322,RC,73085,HCPCS,OUTPATIENT,,,1367,1093.6,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",237.45,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",956.9,70,,765.52,,,0,"percent of total billed charges ","70% of total billed charges ",1230.3,90,,984.24,,,0,"percent of total billed charges ","90% of total billed charges ",1271.31,93,,1017.05,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",87.87,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1161.95,85,,929.56,,,0,"percent of total billed charges ","85% of total billed charges ",1230.3,90,,984.24,,,0,"percent of total billed charges ","90% of total billed charges ",1230.3,90,,984.24,,,0,"percent of total billed charges ","90% of total billed charges ",87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1189.29,87,,951.43,,,0,"percent of total billed charges ","87% of total billed charges ",87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.84,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",956.9,70,,765.52,,,0,"percent of total billed charges ","70% of total billed charges ",87,1271.31,
"ELBOW ARTHROGRAM LEFT",3003027,"CDM ",322,RC,73085,HCPCS,OUTPATIENT,,,1367,1093.6,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",237.45,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",956.9,70,,765.52,,,0,"percent of total billed charges ","70% of total billed charges ",1230.3,90,,984.24,,,0,"percent of total billed charges ","90% of total billed charges ",1271.31,93,,1017.05,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",87.87,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1161.95,85,,929.56,,,0,"percent of total billed charges ","85% of total billed charges ",1230.3,90,,984.24,,,0,"percent of total billed charges ","90% of total billed charges ",1230.3,90,,984.24,,,0,"percent of total billed charges ","90% of total billed charges ",87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1189.29,87,,951.43,,,0,"percent of total billed charges ","87% of total billed charges ",87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.84,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",956.9,70,,765.52,,,0,"percent of total billed charges ","70% of total billed charges ",87,1271.31,
"L-SPINE BENDING ONLY",3003035,"CDM ",320,RC,72120,HCPCS,OUTPATIENT,,,741.5,593.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",233.23,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",85.18,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",519.05,70,,415.24,,,0,"percent of total billed charges ","70% of total billed charges ",667.35,90,,533.88,,,0,"percent of total billed charges ","90% of total billed charges ",689.6,93,,551.68,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",630.28,85,,504.22,,,0,"percent of total billed charges ","85% of total billed charges ",667.35,90,,533.88,,,0,"percent of total billed charges ","90% of total billed charges ",667.35,90,,533.88,,,0,"percent of total billed charges ","90% of total billed charges ",25.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",645.11,87,,516.09,,,0,"percent of total billed charges ","87% of total billed charges ",25.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",519.05,70,,415.24,,,0,"percent of total billed charges ","70% of total billed charges ",25.25,689.6,
"KNEE 3 VIEWS LEFT",3003043,"CDM ",320,RC,73562,HCPCS,OUTPATIENT,,,602.5,482,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.6,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",84.9,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",421.75,70,,337.40,,,0,"percent of total billed charges ","70% of total billed charges ",542.25,90,,433.80,,,0,"percent of total billed charges ","90% of total billed charges ",560.33,93,,448.26,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",512.13,85,,409.70,,,0,"percent of total billed charges ","85% of total billed charges ",542.25,90,,433.80,,,0,"percent of total billed charges ","90% of total billed charges ",542.25,90,,433.80,,,0,"percent of total billed charges ","90% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",524.18,87,,413.76,413.76,413.76,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",421.75,70,,337.40,,,0,"percent of total billed charges ","70% of total billed charges ",23.1,560.33,
"KNEE 3 VIEWS RIGHT",3003050,"CDM ",320,RC,73562,HCPCS,OUTPATIENT,,,602.5,482,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.6,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",84.9,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",421.75,70,,337.40,,,0,"percent of total billed charges ","70% of total billed charges ",542.25,90,,433.80,,,0,"percent of total billed charges ","90% of total billed charges ",560.33,93,,448.26,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",512.13,85,,409.70,,,0,"percent of total billed charges ","85% of total billed charges ",542.25,90,,433.80,,,0,"percent of total billed charges ","90% of total billed charges ",542.25,90,,433.80,,,0,"percent of total billed charges ","90% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",524.18,87,,413.76,413.76,413.76,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",421.75,70,,337.40,,,0,"percent of total billed charges ","70% of total billed charges ",23.1,560.33,
"PELVIS 3 OR MORE VIEWS",3003068,"CDM ",320,RC,72190,HCPCS,OUTPATIENT,,,741.5,593.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",135.66,100,,3.12,3.12,3.12,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",88.15,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",519.05,70,,415.24,,,0,"percent of total billed charges ","70% of total billed charges ",667.35,90,,533.88,,,0,"percent of total billed charges ","90% of total billed charges ",689.6,93,,551.68,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",630.28,85,,504.22,,,0,"percent of total billed charges ","85% of total billed charges ",667.35,90,,533.88,,,0,"percent of total billed charges ","90% of total billed charges ",667.35,90,,533.88,,,0,"percent of total billed charges ","90% of total billed charges ",26.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",645.11,87,,516.09,,,0,"percent of total billed charges ","87% of total billed charges ",26.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",519.05,70,,415.24,,,0,"percent of total billed charges ","70% of total billed charges ",26.93,689.6,
"HICKMAN/PORT CATH INSERT",3003076,"CDM ",320,RC,77001,HCPCS,OUTPATIENT,,,901,720.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",213.86,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",630.7,70,,504.56,,,0,"percent of total billed charges ","70% of total billed charges ",810.9,90,,648.72,,,0,"percent of total billed charges ","90% of total billed charges ",837.93,93,,670.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",59.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",765.85,85,,612.68,,,0,"percent of total billed charges ","85% of total billed charges ",810.9,90,,648.72,,,0,"percent of total billed charges ","90% of total billed charges ",810.9,90,,648.72,,,0,"percent of total billed charges ","90% of total billed charges ",58.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",783.87,87,,782.27,782.27,782.27,"1 through 10","percent of total billed charges ","87% of total billed charges ",58.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",630.7,70,,504.56,,,0,"percent of total billed charges ","70% of total billed charges ",58.56,837.93,
"EXPIRATION CHEST",3003084,"CDM ",324,RC,71045,HCPCS,OUTPATIENT,,,566.5,453.2,,,,,,,,0,"other ","not separately reimbursment ",123.58,100,,17.44,17.44,17.44,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",53.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",396.55,70,,317.24,,,0,"percent of total billed charges ","70% of total billed charges ",509.85,90,,407.88,,,0,"percent of total billed charges ","90% of total billed charges ",526.85,93,,421.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",6.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",481.53,85,,385.22,,,0,"percent of total billed charges ","85% of total billed charges ",509.85,90,,407.88,,,0,"percent of total billed charges ","90% of total billed charges ",509.85,90,,407.88,,,0,"percent of total billed charges ","90% of total billed charges ",6.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",492.86,87,,311.35,85.32,389.19,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",396.55,70,,317.24,,,0,"percent of total billed charges ","70% of total billed charges ",6.57,526.85,
"CHEST LAT DECUB RIGHT",3003092,"CDM ",324,RC,71045,HCPCS,OUTPATIENT,,,450.5,360.4,,,,,,,,0,"other ","not separately reimbursment ",123.58,100,,17.44,17.44,17.44,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",53.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",315.35,70,,252.28,,,0,"percent of total billed charges ","70% of total billed charges ",405.45,90,,324.36,,,0,"percent of total billed charges ","90% of total billed charges ",418.97,93,,335.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",6.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",382.93,85,,306.34,,,0,"percent of total billed charges ","85% of total billed charges ",405.45,90,,324.36,,,0,"percent of total billed charges ","90% of total billed charges ",405.45,90,,324.36,,,0,"percent of total billed charges ","90% of total billed charges ",6.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",391.94,87,,311.35,85.32,389.19,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",315.35,70,,252.28,,,0,"percent of total billed charges ","70% of total billed charges ",6.57,418.97,
"CHEST LAT DECUB LEFT",3003100,"CDM ",324,RC,71045,HCPCS,OUTPATIENT,,,450.5,360.4,,,,,,,,0,"other ","not separately reimbursment ",123.58,100,,17.44,17.44,17.44,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",53.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",315.35,70,,252.28,,,0,"percent of total billed charges ","70% of total billed charges ",405.45,90,,324.36,,,0,"percent of total billed charges ","90% of total billed charges ",418.97,93,,335.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",6.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",382.93,85,,306.34,,,0,"percent of total billed charges ","85% of total billed charges ",405.45,90,,324.36,,,0,"percent of total billed charges ","90% of total billed charges ",405.45,90,,324.36,,,0,"percent of total billed charges ","90% of total billed charges ",6.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",391.94,87,,311.35,85.32,389.19,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",315.35,70,,252.28,,,0,"percent of total billed charges ","70% of total billed charges ",6.57,418.97,
"UPPER EXT INFANT LEFT",3003118,"CDM ",320,RC,73092,HCPCS,OUTPATIENT,,,389.5,311.6,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",103.14,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",66.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",272.65,70,,218.12,,,0,"percent of total billed charges ","70% of total billed charges ",350.55,90,,280.44,,,0,"percent of total billed charges ","90% of total billed charges ",362.24,93,,289.79,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",331.08,85,,264.86,,,0,"percent of total billed charges ","85% of total billed charges ",350.55,90,,280.44,,,0,"percent of total billed charges ","90% of total billed charges ",350.55,90,,280.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",338.87,87,,271.10,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",272.65,70,,218.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,362.24,
"UPPER EXT INFANT RIGHT",3003126,"CDM ",320,RC,73092,HCPCS,OUTPATIENT,,,389.5,311.6,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",103.14,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",66.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",272.65,70,,218.12,,,0,"percent of total billed charges ","70% of total billed charges ",350.55,90,,280.44,,,0,"percent of total billed charges ","90% of total billed charges ",362.24,93,,289.79,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",331.08,85,,264.86,,,0,"percent of total billed charges ","85% of total billed charges ",350.55,90,,280.44,,,0,"percent of total billed charges ","90% of total billed charges ",350.55,90,,280.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",338.87,87,,271.10,,,0,"percent of total billed charges ","87% of total billed charges ",13.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",272.65,70,,218.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.08,362.24,
"SWALLOW GASTROVIEW",3003134,"CDM ",320,RC,74220,HCPCS,OUTPATIENT,,,657.5,526,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",270.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",210.56,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",460.25,70,,368.20,,,0,"percent of total billed charges ","70% of total billed charges ",591.75,90,,473.40,,,0,"percent of total billed charges ","90% of total billed charges ",611.48,93,,489.18,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",558.88,85,,447.10,,,0,"percent of total billed charges ","85% of total billed charges ",591.75,90,,473.40,,,0,"percent of total billed charges ","90% of total billed charges ",591.75,90,,473.40,,,0,"percent of total billed charges ","90% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",572.03,87,,457.62,,,0,"percent of total billed charges ","87% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",460.25,70,,368.20,,,0,"percent of total billed charges ","70% of total billed charges ",39.25,611.48,
"SMALL BOWEL SERIES GASTROVIEW",3003142,"CDM ",320,RC,74250,HCPCS,OUTPATIENT,,,746.5,597.2,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",311.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",263.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",522.55,70,,418.04,,,0,"percent of total billed charges ","70% of total billed charges ",671.85,90,,537.48,,,0,"percent of total billed charges ","90% of total billed charges ",694.25,93,,555.40,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",634.53,85,,507.62,,,0,"percent of total billed charges ","85% of total billed charges ",671.85,90,,537.48,,,0,"percent of total billed charges ","90% of total billed charges ",671.85,90,,537.48,,,0,"percent of total billed charges ","90% of total billed charges ",42.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",649.46,87,,519.57,,,0,"percent of total billed charges ","87% of total billed charges ",42.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",522.55,70,,418.04,,,0,"percent of total billed charges ","70% of total billed charges ",42.22,694.25,
"SMALL BOWEL GASTRO CHALLENGE",3003145,"CDM ",320,RC,74250,HCPCS,OUTPATIENT,,,746.5,597.2,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",311.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",263.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",522.55,70,,418.04,,,0,"percent of total billed charges ","70% of total billed charges ",671.85,90,,537.48,,,0,"percent of total billed charges ","90% of total billed charges ",694.25,93,,555.40,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",634.53,85,,507.62,,,0,"percent of total billed charges ","85% of total billed charges ",671.85,90,,537.48,,,0,"percent of total billed charges ","90% of total billed charges ",671.85,90,,537.48,,,0,"percent of total billed charges ","90% of total billed charges ",42.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",649.46,87,,519.57,,,0,"percent of total billed charges ","87% of total billed charges ",42.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",522.55,70,,418.04,,,0,"percent of total billed charges ","70% of total billed charges ",42.22,694.25,
"UGI AND SBS GASTROVIEW",3003159,"CDM ",320,RC,74240,HCPCS,OUTPATIENT,,,1777,1421.6,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",426.5,100,,507.50,507.50,507.50,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",264.51,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1243.9,70,,995.12,,,0,"percent of total billed charges ","70% of total billed charges ",1599.3,90,,1279.44,,,0,"percent of total billed charges ","90% of total billed charges ",1652.61,93,,1322.09,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",52.85,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1510.45,85,,1208.36,,,0,"percent of total billed charges ","85% of total billed charges ",1599.3,90,,1279.44,,,0,"percent of total billed charges ","90% of total billed charges ",1599.3,90,,1279.44,,,0,"percent of total billed charges ","90% of total billed charges ",52.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1545.99,87,,1236.79,,,0,"percent of total billed charges ","87% of total billed charges ",52.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1243.9,70,,995.12,,,0,"percent of total billed charges ","70% of total billed charges ",52.33,1652.61,
"UGI SINGLE GASTROVIEW",3003167,"CDM ",320,RC,74240,HCPCS,OUTPATIENT,,,1030,824,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",426.5,100,,507.50,507.50,507.50,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",264.51,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",721,70,,576.80,,,0,"percent of total billed charges ","70% of total billed charges ",927,90,,741.60,,,0,"percent of total billed charges ","90% of total billed charges ",957.9,93,,766.32,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",52.85,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",875.5,85,,700.40,,,0,"percent of total billed charges ","85% of total billed charges ",927,90,,741.60,,,0,"percent of total billed charges ","90% of total billed charges ",927,90,,741.60,,,0,"percent of total billed charges ","90% of total billed charges ",52.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",896.1,87,,716.88,,,0,"percent of total billed charges ","87% of total billed charges ",52.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",721,70,,576.80,,,0,"percent of total billed charges ","70% of total billed charges ",52.33,957.9,
"ENEMA SINGLE GASTROVIEW",3003175,"CDM ",320,RC,74270,HCPCS,OUTPATIENT,,,1933,1546.4,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1006.97,100,,673.77,673.77,673.77,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",332.2,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1353.1,70,,1082.48,,,0,"percent of total billed charges ","70% of total billed charges ",1739.7,90,,1391.76,,,0,"percent of total billed charges ","90% of total billed charges ",1797.69,93,,1438.15,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",69.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1643.05,85,,1314.44,,,0,"percent of total billed charges ","85% of total billed charges ",1739.7,90,,1391.76,,,0,"percent of total billed charges ","90% of total billed charges ",1739.7,90,,1391.76,,,0,"percent of total billed charges ","90% of total billed charges ",68.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1681.71,87,,1345.37,,,0,"percent of total billed charges ","87% of total billed charges ",68.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1353.1,70,,1082.48,,,0,"percent of total billed charges ","70% of total billed charges ",68.41,1797.69,
"ACUTE ABDOMEN SERIES",3003183,"CDM ",320,RC,74022,HCPCS,OUTPATIENT,,,1158,926.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",263.89,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",104.54,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",810.6,70,,648.48,,,0,"percent of total billed charges ","70% of total billed charges ",1042.2,90,,833.76,,,0,"percent of total billed charges ","90% of total billed charges ",1076.94,93,,861.55,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",984.3,85,,787.44,,,0,"percent of total billed charges ","85% of total billed charges ",1042.2,90,,833.76,,,0,"percent of total billed charges ","90% of total billed charges ",1042.2,90,,833.76,,,0,"percent of total billed charges ","90% of total billed charges ",29.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1007.46,87,,805.97,,,0,"percent of total billed charges ","87% of total billed charges ",29.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",810.6,70,,648.48,,,0,"percent of total billed charges ","70% of total billed charges ",29.74,1076.94,
"BABYGRAM-FOREIGN BODY CHILD",3003217,"CDM ",320,RC,76010,HCPCS,OUTPATIENT,,,568,454.4,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.43,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",62.08,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",397.6,70,,318.08,,,0,"percent of total billed charges ","70% of total billed charges ",511.2,90,,408.96,,,0,"percent of total billed charges ","90% of total billed charges ",528.24,93,,422.59,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",482.8,85,,386.24,,,0,"percent of total billed charges ","85% of total billed charges ",511.2,90,,408.96,,,0,"percent of total billed charges ","90% of total billed charges ",511.2,90,,408.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",494.16,87,,395.33,,,0,"percent of total billed charges ","87% of total billed charges ",16.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",397.6,70,,318.08,,,0,"percent of total billed charges ","70% of total billed charges ",16.59,528.24,
"SHOULDER 1 VIEW EACH BILATERAL",3003225,"CDM ",320,RC,73020,HCPCS,OUTPATIENT,,,756.5,605.2,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",105.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",44.59,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",529.55,70,,423.64,,,0,"percent of total billed charges ","70% of total billed charges ",680.85,90,,544.68,,,0,"percent of total billed charges ","90% of total billed charges ",703.55,93,,562.84,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",643.03,85,,514.42,,,0,"percent of total billed charges ","85% of total billed charges ",680.85,90,,544.68,,,0,"percent of total billed charges ","90% of total billed charges ",680.85,90,,544.68,,,0,"percent of total billed charges ","90% of total billed charges ",19.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",658.16,87,,526.53,,,0,"percent of total billed charges ","87% of total billed charges ",19.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",529.55,70,,423.64,,,0,"percent of total billed charges ","70% of total billed charges ",19.16,703.55,
"SHOULDER 1 VIEW LEFT",3003233,"CDM ",320,RC,73020,HCPCS,OUTPATIENT,,,381,304.8,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",105.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",44.59,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",266.7,70,,213.36,,,0,"percent of total billed charges ","70% of total billed charges ",342.9,90,,274.32,,,0,"percent of total billed charges ","90% of total billed charges ",354.33,93,,283.46,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",323.85,85,,259.08,,,0,"percent of total billed charges ","85% of total billed charges ",342.9,90,,274.32,,,0,"percent of total billed charges ","90% of total billed charges ",342.9,90,,274.32,,,0,"percent of total billed charges ","90% of total billed charges ",19.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",331.47,87,,265.18,,,0,"percent of total billed charges ","87% of total billed charges ",19.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",266.7,70,,213.36,,,0,"percent of total billed charges ","70% of total billed charges ",19.16,354.33,
"SHOULDER 1 VIEW RIGHT",3003241,"CDM ",320,RC,73020,HCPCS,OUTPATIENT,,,381,304.8,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",105.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",44.59,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",266.7,70,,213.36,,,0,"percent of total billed charges ","70% of total billed charges ",342.9,90,,274.32,,,0,"percent of total billed charges ","90% of total billed charges ",354.33,93,,283.46,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",323.85,85,,259.08,,,0,"percent of total billed charges ","85% of total billed charges ",342.9,90,,274.32,,,0,"percent of total billed charges ","90% of total billed charges ",342.9,90,,274.32,,,0,"percent of total billed charges ","90% of total billed charges ",19.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",331.47,87,,265.18,,,0,"percent of total billed charges ","87% of total billed charges ",19.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",266.7,70,,213.36,,,0,"percent of total billed charges ","70% of total billed charges ",19.16,354.33,
"THORACOLMBAR MINIMUM 2 VIEWS",3003258,"CDM ",320,RC,72080,HCPCS,OUTPATIENT,,,435,348,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",192.34,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",72.67,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",304.5,70,,243.60,,,0,"percent of total billed charges ","70% of total billed charges ",391.5,90,,313.20,,,0,"percent of total billed charges ","90% of total billed charges ",404.55,93,,323.64,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",369.75,85,,295.80,,,0,"percent of total billed charges ","85% of total billed charges ",391.5,90,,313.20,,,0,"percent of total billed charges ","90% of total billed charges ",391.5,90,,313.20,,,0,"percent of total billed charges ","90% of total billed charges ",26.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",378.45,87,,302.76,,,0,"percent of total billed charges ","87% of total billed charges ",26.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",304.5,70,,243.60,,,0,"percent of total billed charges ","70% of total billed charges ",26.93,404.55,
"NG OR FEEDING TUBE FLUORO",3003274,"CDM ",320,RC,74340,HCPCS,OUTPATIENT,,,1343.5,1074.8,,59.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",940.45,70,,752.36,,,0,"percent of total billed charges ","70% of total billed charges ",1209.15,90,,967.32,,,0,"percent of total billed charges ","90% of total billed charges ",1249.46,93,,999.57,,,0,"percent of total billed charges ","93% of total billed charges ",59.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.08,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1141.98,85,,913.58,,,0,"percent of total billed charges ","85% of total billed charges ",1209.15,90,,967.32,,,0,"percent of total billed charges ","90% of total billed charges ",1209.15,90,,967.32,,,0,"percent of total billed charges ","90% of total billed charges ",27.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1168.85,87,,935.08,,,0,"percent of total billed charges ","87% of total billed charges ",27.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",940.45,70,,752.36,,,0,"percent of total billed charges ","70% of total billed charges ",27.8,1249.46,
"GASTRIC TUBE PLACEMENT",3003282,"CDM ",761,RC,49465,HCPCS,OUTPATIENT,,,1028.5,822.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.45,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",719.95,70,,575.96,,,0,"percent of total billed charges ","70% of total billed charges ",925.65,90,,740.52,,,0,"percent of total billed charges ","90% of total billed charges ",956.51,93,,765.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",60.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",874.23,85,,699.38,,,0,"percent of total billed charges ","85% of total billed charges ",771.38,90,,617.10,,,0,"percent of total billed charges ","90% of total billed charges ",925.65,90,,740.52,,,0,"percent of total billed charges ","90% of total billed charges ",59.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",894.8,87,,715.84,,,0,"percent of total billed charges ","87% of total billed charges ",59.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",719.95,70,,575.96,,,0,"percent of total billed charges ","70% of total billed charges ",59.56,956.51,
"STRESS VIEW ANY EXTREMITY",3003290,"CDM ",320,RC,77071,HCPCS,OUTPATIENT,,,741.5,593.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.18,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",519.05,70,,415.24,,,0,"percent of total billed charges ","70% of total billed charges ",667.35,90,,533.88,,,0,"percent of total billed charges ","90% of total billed charges ",689.6,93,,551.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",27.26,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",630.28,85,,504.22,,,0,"percent of total billed charges ","85% of total billed charges ",667.35,90,,533.88,,,0,"percent of total billed charges ","90% of total billed charges ",667.35,90,,533.88,,,0,"percent of total billed charges ","90% of total billed charges ",26.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",645.11,87,,516.09,,,0,"percent of total billed charges ","87% of total billed charges ",26.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",519.05,70,,415.24,,,0,"percent of total billed charges ","70% of total billed charges ",26.99,689.6,
"ABDOMEN LAT DECUB LEFT",3003332,"CDM ",320,RC,74018,HCPCS,OUTPATIENT,,,568,454.4,,,,,,,,0,"other ","not separately reimbursment ",134.73,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",62.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",397.6,70,,318.08,,,0,"percent of total billed charges ","70% of total billed charges ",511.2,90,,408.96,,,0,"percent of total billed charges ","90% of total billed charges ",528.24,93,,422.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",11.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",482.8,85,,386.24,,,0,"percent of total billed charges ","85% of total billed charges ",511.2,90,,408.96,,,0,"percent of total billed charges ","90% of total billed charges ",511.2,90,,408.96,,,0,"percent of total billed charges ","90% of total billed charges ",11.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",494.16,87,,195.25,195.25,195.25,"1 through 10","percent of total billed charges ","87% of total billed charges ",11.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",397.6,70,,318.08,,,0,"percent of total billed charges ","70% of total billed charges ",11.23,528.24,
"ABDOMEN LATERAL VIEW ONLY",3003340,"CDM ",320,RC,74018,HCPCS,OUTPATIENT,,,568,454.4,,,,,,,,0,"other ","not separately reimbursment ",134.73,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",62.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",397.6,70,,318.08,,,0,"percent of total billed charges ","70% of total billed charges ",511.2,90,,408.96,,,0,"percent of total billed charges ","90% of total billed charges ",528.24,93,,422.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",11.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",482.8,85,,386.24,,,0,"percent of total billed charges ","85% of total billed charges ",511.2,90,,408.96,,,0,"percent of total billed charges ","90% of total billed charges ",511.2,90,,408.96,,,0,"percent of total billed charges ","90% of total billed charges ",11.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",494.16,87,,195.25,195.25,195.25,"1 through 10","percent of total billed charges ","87% of total billed charges ",11.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",397.6,70,,318.08,,,0,"percent of total billed charges ","70% of total billed charges ",11.23,528.24,
"ABDOMEN LAT DECUB BILATERAL",3003357,"CDM ",320,RC,74018,HCPCS,OUTPATIENT,,,1124,899.2,,,,,,,,0,"other ","not separately reimbursment ",134.73,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",62.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",786.8,70,,629.44,,,0,"percent of total billed charges ","70% of total billed charges ",1011.6,90,,809.28,,,0,"percent of total billed charges ","90% of total billed charges ",1045.32,93,,836.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",11.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",955.4,85,,764.32,,,0,"percent of total billed charges ","85% of total billed charges ",1011.6,90,,809.28,,,0,"percent of total billed charges ","90% of total billed charges ",1011.6,90,,809.28,,,0,"percent of total billed charges ","90% of total billed charges ",11.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",977.88,87,,195.25,195.25,195.25,"1 through 10","percent of total billed charges ","87% of total billed charges ",11.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",786.8,70,,629.44,,,0,"percent of total billed charges ","70% of total billed charges ",11.23,1045.32,
"ABDOMEN LAT DECUB RIGHT",3003365,"CDM ",320,RC,74018,HCPCS,OUTPATIENT,,,568,454.4,,,,,,,,0,"other ","not separately reimbursment ",134.73,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",62.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",397.6,70,,318.08,,,0,"percent of total billed charges ","70% of total billed charges ",511.2,90,,408.96,,,0,"percent of total billed charges ","90% of total billed charges ",528.24,93,,422.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",11.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",482.8,85,,386.24,,,0,"percent of total billed charges ","85% of total billed charges ",511.2,90,,408.96,,,0,"percent of total billed charges ","90% of total billed charges ",511.2,90,,408.96,,,0,"percent of total billed charges ","90% of total billed charges ",11.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",494.16,87,,195.25,195.25,195.25,"1 through 10","percent of total billed charges ","87% of total billed charges ",11.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",397.6,70,,318.08,,,0,"percent of total billed charges ","70% of total billed charges ",11.23,528.24,
"ABDOMEN UPRIGHT ONLY",3003373,"CDM ",320,RC,74018,HCPCS,OUTPATIENT,,,568,454.4,,,,,,,,0,"other ","not separately reimbursment ",134.73,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",62.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",397.6,70,,318.08,,,0,"percent of total billed charges ","70% of total billed charges ",511.2,90,,408.96,,,0,"percent of total billed charges ","90% of total billed charges ",528.24,93,,422.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",11.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",482.8,85,,386.24,,,0,"percent of total billed charges ","85% of total billed charges ",511.2,90,,408.96,,,0,"percent of total billed charges ","90% of total billed charges ",511.2,90,,408.96,,,0,"percent of total billed charges ","90% of total billed charges ",11.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",494.16,87,,195.25,195.25,195.25,"1 through 10","percent of total billed charges ","87% of total billed charges ",11.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",397.6,70,,318.08,,,0,"percent of total billed charges ","70% of total billed charges ",11.23,528.24,
"BREAST NEEDLE LOCALIZATION RT",3003381,"CDM ",320,RC,19281,HCPCS,OUTPATIENT,,,1122.5,898,,66.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",278.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",208.3,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",785.75,70,,628.60,,,0,"percent of total billed charges ","70% of total billed charges ",1010.25,90,,808.20,,,0,"percent of total billed charges ","90% of total billed charges ",1043.93,93,,835.14,,,0,"percent of total billed charges ","93% of total billed charges ",66.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",954.13,85,,763.30,,,0,"percent of total billed charges ","85% of total billed charges ",841.88,90,,673.50,,,0,"percent of total billed charges ","90% of total billed charges ",1010.25,90,,808.20,,,0,"percent of total billed charges ","90% of total billed charges ",83.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",976.58,87,,781.26,,,0,"percent of total billed charges ","87% of total billed charges ",83.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",785.75,70,,628.60,,,0,"percent of total billed charges ","70% of total billed charges ",66.41,1518.9,
"BREAST NEEDLE LOCALIZATION LT",3003399,"CDM ",320,RC,19281,HCPCS,OUTPATIENT,,,1122.5,898,,66.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",278.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",208.3,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",785.75,70,,628.60,,,0,"percent of total billed charges ","70% of total billed charges ",1010.25,90,,808.20,,,0,"percent of total billed charges ","90% of total billed charges ",1043.93,93,,835.14,,,0,"percent of total billed charges ","93% of total billed charges ",66.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",954.13,85,,763.30,,,0,"percent of total billed charges ","85% of total billed charges ",841.88,90,,673.50,,,0,"percent of total billed charges ","90% of total billed charges ",1010.25,90,,808.20,,,0,"percent of total billed charges ","90% of total billed charges ",83.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",976.58,87,,781.26,,,0,"percent of total billed charges ","87% of total billed charges ",83.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",785.75,70,,628.60,,,0,"percent of total billed charges ","70% of total billed charges ",66.41,1518.9,
"CERVICAL SPINE FLEX & EXT",3003407,"CDM ",320,RC,72040,HCPCS,OUTPATIENT,,,574,459.2,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",159.82,100,,153.06,153.06,153.06,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",82.41,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",401.8,70,,321.44,,,0,"percent of total billed charges ","70% of total billed charges ",516.6,90,,413.28,,,0,"percent of total billed charges ","90% of total billed charges ",533.82,93,,427.06,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",487.9,85,,390.32,,,0,"percent of total billed charges ","85% of total billed charges ",516.6,90,,413.28,,,0,"percent of total billed charges ","90% of total billed charges ",516.6,90,,413.28,,,0,"percent of total billed charges ","90% of total billed charges ",24.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.38,87,,230.12,98.72,361.52,"1 through 10","percent of total billed charges ","87% of total billed charges ",24.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",401.8,70,,321.44,,,0,"percent of total billed charges ","70% of total billed charges ",24.25,533.82,
"KNEE BILATERAL 4 VIEWS OR MORE",3003415,"CDM ",320,RC,73564,HCPCS,OUTPATIENT,,,1193.5,954.8,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",216.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",96.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",835.45,70,,668.36,,,0,"percent of total billed charges ","70% of total billed charges ",1074.15,90,,859.32,,,0,"percent of total billed charges ","90% of total billed charges ",1109.96,93,,887.97,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.26,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1014.48,85,,811.58,,,0,"percent of total billed charges ","85% of total billed charges ",1074.15,90,,859.32,,,0,"percent of total billed charges ","90% of total billed charges ",1074.15,90,,859.32,,,0,"percent of total billed charges ","90% of total billed charges ",25.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1038.35,87,,88.53,41.62,278.54,"1 through 10","percent of total billed charges ","87% of total billed charges ",25.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",835.45,70,,668.36,,,0,"percent of total billed charges ","70% of total billed charges ",25.01,1109.96,
"KNEE BILATERAL 3 VIEWS",3003423,"CDM ",320,RC,73562,HCPCS,OUTPATIENT,,,1050,840,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.6,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",84.9,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",735,70,,588.00,,,0,"percent of total billed charges ","70% of total billed charges ",945,90,,756.00,,,0,"percent of total billed charges ","90% of total billed charges ",976.5,93,,781.20,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",892.5,85,,714.00,,,0,"percent of total billed charges ","85% of total billed charges ",945,90,,756.00,,,0,"percent of total billed charges ","90% of total billed charges ",945,90,,756.00,,,0,"percent of total billed charges ","90% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",913.5,87,,413.76,413.76,413.76,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",735,70,,588.00,,,0,"percent of total billed charges ","70% of total billed charges ",23.1,976.5,
"SIALAGRAM LEFT",3003431,"CDM ",320,RC,70390,HCPCS,OUTPATIENT,,,974,779.2,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",251.17,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",681.8,70,,545.44,,,0,"percent of total billed charges ","70% of total billed charges ",876.6,90,,701.28,,,0,"percent of total billed charges ","90% of total billed charges ",905.82,93,,724.66,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.02,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",827.9,85,,662.32,,,0,"percent of total billed charges ","85% of total billed charges ",876.6,90,,701.28,,,0,"percent of total billed charges ","90% of total billed charges ",876.6,90,,701.28,,,0,"percent of total billed charges ","90% of total billed charges ",34.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",847.38,87,,677.90,,,0,"percent of total billed charges ","87% of total billed charges ",34.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",681.8,70,,545.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.67,905.82,
"SIALAGRAM RIGHT",3003449,"CDM ",320,RC,70390,HCPCS,OUTPATIENT,,,974,779.2,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",251.17,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",681.8,70,,545.44,,,0,"percent of total billed charges ","70% of total billed charges ",876.6,90,,701.28,,,0,"percent of total billed charges ","90% of total billed charges ",905.82,93,,724.66,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.02,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",827.9,85,,662.32,,,0,"percent of total billed charges ","85% of total billed charges ",876.6,90,,701.28,,,0,"percent of total billed charges ","90% of total billed charges ",876.6,90,,701.28,,,0,"percent of total billed charges ","90% of total billed charges ",34.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",847.38,87,,677.90,,,0,"percent of total billed charges ","87% of total billed charges ",34.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",681.8,70,,545.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.67,905.82,
"SCAPULA BILATERAL",3003456,"CDM ",320,RC,73010,HCPCS,OUTPATIENT,,,797,637.6,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",49.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",557.9,70,,446.32,,,0,"percent of total billed charges ","70% of total billed charges ",717.3,90,,573.84,,,0,"percent of total billed charges ","90% of total billed charges ",741.21,93,,592.97,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",677.45,85,,541.96,,,0,"percent of total billed charges ","85% of total billed charges ",717.3,90,,573.84,,,0,"percent of total billed charges ","90% of total billed charges ",717.3,90,,573.84,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",693.39,87,,554.71,,,0,"percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",557.9,70,,446.32,,,0,"percent of total billed charges ","70% of total billed charges ",21.07,741.21,
"T-SPINE W/OBLIQUES",3003464,"CDM ",320,RC,72074,HCPCS,OUTPATIENT,,,825.5,660.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",169.11,100,,141.67,141.67,141.67,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",92.99,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",577.85,70,,462.28,,,0,"percent of total billed charges ","70% of total billed charges ",742.95,90,,594.36,,,0,"percent of total billed charges ","90% of total billed charges ",767.72,93,,614.18,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",701.68,85,,561.34,,,0,"percent of total billed charges ","85% of total billed charges ",742.95,90,,594.36,,,0,"percent of total billed charges ","90% of total billed charges ",742.95,90,,594.36,,,0,"percent of total billed charges ","90% of total billed charges ",25.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",718.19,87,,574.55,,,0,"percent of total billed charges ","87% of total billed charges ",25.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",577.85,70,,462.28,,,0,"percent of total billed charges ","70% of total billed charges ",25.73,767.72,
"UGI AC W/SWALLOW BARIUM",3003498,"CDM ",320,RC,74246,HCPCS,OUTPATIENT,,,2778,2222.4,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",355.88,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",301.84,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1944.6,70,,1555.68,,,0,"percent of total billed charges ","70% of total billed charges ",2500.2,90,,2000.16,,,0,"percent of total billed charges ","90% of total billed charges ",2583.54,93,,2066.83,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.41,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2361.3,85,,1889.04,,,0,"percent of total billed charges ","85% of total billed charges ",2500.2,90,,2000.16,,,0,"percent of total billed charges ","90% of total billed charges ",2500.2,90,,2000.16,,,0,"percent of total billed charges ","90% of total billed charges ",56.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2416.86,87,,1933.49,,,0,"percent of total billed charges ","87% of total billed charges ",56.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1944.6,70,,1555.68,,,0,"percent of total billed charges ","70% of total billed charges ",56.84,2583.54,
"HEEL BILATERAL",3003514,"CDM ",320,RC,73650,HCPCS,OUTPATIENT,,,1011.5,809.2,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",114.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",59.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",708.05,70,,566.44,,,0,"percent of total billed charges ","70% of total billed charges ",910.35,90,,728.28,,,0,"percent of total billed charges ","90% of total billed charges ",940.7,93,,752.56,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",859.78,85,,687.82,,,0,"percent of total billed charges ","85% of total billed charges ",910.35,90,,728.28,,,0,"percent of total billed charges ","90% of total billed charges ",910.35,90,,728.28,,,0,"percent of total billed charges ","90% of total billed charges ",19.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",880.01,87,,704.01,,,0,"percent of total billed charges ","87% of total billed charges ",19.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",708.05,70,,566.44,,,0,"percent of total billed charges ","70% of total billed charges ",19.16,940.7,
CLAVICLE-BILATERAL,3009867,"CDM ",320,RC,73000,HCPCS,OUTPATIENT,,,919,735.2,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",114.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",66.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",643.3,70,,514.64,,,0,"percent of total billed charges ","70% of total billed charges ",827.1,90,,661.68,,,0,"percent of total billed charges ","90% of total billed charges ",854.67,93,,683.74,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",781.15,85,,624.92,,,0,"percent of total billed charges ","85% of total billed charges ",827.1,90,,661.68,,,0,"percent of total billed charges ","90% of total billed charges ",827.1,90,,661.68,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",799.53,87,,639.62,,,0,"percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",643.3,70,,514.64,,,0,"percent of total billed charges ","70% of total billed charges ",21.07,854.67,
HUMERUS-BILATERAL,3009875,"CDM ",320,RC,73060,HCPCS,OUTPATIENT,,,1011.5,809.2,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",137.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",66.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",708.05,70,,566.44,,,0,"percent of total billed charges ","70% of total billed charges ",910.35,90,,728.28,,,0,"percent of total billed charges ","90% of total billed charges ",940.7,93,,752.56,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",859.78,85,,687.82,,,0,"percent of total billed charges ","85% of total billed charges ",910.35,90,,728.28,,,0,"percent of total billed charges ","90% of total billed charges ",910.35,90,,728.28,,,0,"percent of total billed charges ","90% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",880.01,87,,65.87,61.95,81.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",23.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",708.05,70,,566.44,,,0,"percent of total billed charges ","70% of total billed charges ",23.1,940.7,
TIB/FIB-BILATERAL,3009891,"CDM ",320,RC,73590,HCPCS,OUTPATIENT,,,1089.5,871.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",142.17,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",65.41,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",762.65,70,,610.12,,,0,"percent of total billed charges ","70% of total billed charges ",980.55,90,,784.44,,,0,"percent of total billed charges ","90% of total billed charges ",1013.24,93,,810.59,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",926.08,85,,740.86,,,0,"percent of total billed charges ","85% of total billed charges ",980.55,90,,784.44,,,0,"percent of total billed charges ","90% of total billed charges ",980.55,90,,784.44,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",947.87,87,,758.30,,,0,"percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",762.65,70,,610.12,,,0,"percent of total billed charges ","70% of total billed charges ",21.07,1013.24,
FOREARMS-BILATERAL,3009917,"CDM ",320,RC,73090,HCPCS,OUTPATIENT,,,1094.5,875.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",124.51,100,,126.68,126.68,126.68,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",60.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",766.15,70,,612.92,,,0,"percent of total billed charges ","70% of total billed charges ",985.05,90,,788.04,,,0,"percent of total billed charges ","90% of total billed charges ",1017.89,93,,814.31,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",930.33,85,,744.26,,,0,"percent of total billed charges ","85% of total billed charges ",985.05,90,,788.04,,,0,"percent of total billed charges ","90% of total billed charges ",985.05,90,,788.04,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",952.22,87,,146.97,36.80,330.06,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",766.15,70,,612.92,,,0,"percent of total billed charges ","70% of total billed charges ",21.07,1017.89,
ELBOW-BILATERAL,3009925,"CDM ",320,RC,73070,HCPCS,OUTPATIENT,,,919,735.2,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",113.36,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",60.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",643.3,70,,514.64,,,0,"percent of total billed charges ","70% of total billed charges ",827.1,90,,661.68,,,0,"percent of total billed charges ","90% of total billed charges ",854.67,93,,683.74,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",781.15,85,,624.92,,,0,"percent of total billed charges ","85% of total billed charges ",827.1,90,,661.68,,,0,"percent of total billed charges ","90% of total billed charges ",827.1,90,,661.68,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",799.53,87,,46.65,15.59,77.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",643.3,70,,514.64,,,0,"percent of total billed charges ","70% of total billed charges ",21.07,854.67,
WRISTS-BILATERAL,3009933,"CDM ",320,RC,73100,HCPCS,OUTPATIENT,,,1242,993.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",70.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",869.4,70,,695.52,,,0,"percent of total billed charges ","70% of total billed charges ",1117.8,90,,894.24,,,0,"percent of total billed charges ","90% of total billed charges ",1155.06,93,,924.05,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.11,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1055.7,85,,844.56,,,0,"percent of total billed charges ","85% of total billed charges ",1117.8,90,,894.24,,,0,"percent of total billed charges ","90% of total billed charges ",1117.8,90,,894.24,,,0,"percent of total billed charges ","90% of total billed charges ",19.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1080.54,87,,864.43,,,0,"percent of total billed charges ","87% of total billed charges ",19.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",869.4,70,,695.52,,,0,"percent of total billed charges ","70% of total billed charges ",19.91,1155.06,
HAND-BILATERAL,3009941,"CDM ",320,RC,73120,HCPCS,OUTPATIENT,,,1162,929.6,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",104.07,100,,99.64,99.64,99.64,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",64.72,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",813.4,70,,650.72,,,0,"percent of total billed charges ","70% of total billed charges ",1045.8,90,,836.64,,,0,"percent of total billed charges ","90% of total billed charges ",1080.66,93,,864.53,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.53,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",987.7,85,,790.16,,,0,"percent of total billed charges ","85% of total billed charges ",1045.8,90,,836.64,,,0,"percent of total billed charges ","90% of total billed charges ",1045.8,90,,836.64,,,0,"percent of total billed charges ","90% of total billed charges ",14.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1010.94,87,,808.75,,,0,"percent of total billed charges ","87% of total billed charges ",14.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",813.4,70,,650.72,,,0,"percent of total billed charges ","70% of total billed charges ",14.39,1080.66,
"KNEE-BILATERAL 2 VIEWS EACH",3009958,"CDM ",320,RC,73560,HCPCS,OUTPATIENT,,,945,756,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.79,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",70.93,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",661.5,70,,529.20,,,0,"percent of total billed charges ","70% of total billed charges ",850.5,90,,680.40,,,0,"percent of total billed charges ","90% of total billed charges ",878.85,93,,703.08,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",803.25,85,,642.60,,,0,"percent of total billed charges ","85% of total billed charges ",850.5,90,,680.40,,,0,"percent of total billed charges ","90% of total billed charges ",850.5,90,,680.40,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",822.15,87,,158.93,80.56,237.29,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",661.5,70,,529.20,,,0,"percent of total billed charges ","70% of total billed charges ",21.07,878.85,
FEET-BILATERAL,3009966,"CDM ",320,RC,73620,HCPCS,OUTPATIENT,,,1096,876.8,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",94.78,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",58.5,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",767.2,70,,613.76,,,0,"percent of total billed charges ","70% of total billed charges ",986.4,90,,789.12,,,0,"percent of total billed charges ","90% of total billed charges ",1019.28,93,,815.42,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.11,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",931.6,85,,745.28,,,0,"percent of total billed charges ","85% of total billed charges ",986.4,90,,789.12,,,0,"percent of total billed charges ","90% of total billed charges ",986.4,90,,789.12,,,0,"percent of total billed charges ","90% of total billed charges ",19.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",953.52,87,,762.82,,,0,"percent of total billed charges ","87% of total billed charges ",19.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",767.2,70,,613.76,,,0,"percent of total billed charges ","70% of total billed charges ",19.91,1019.28,
ANKLES-BILATERAL,3009974,"CDM ",320,RC,73610,HCPCS,OUTPATIENT,,,1089.5,871.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",139.38,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",76.54,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",762.65,70,,610.12,,,0,"percent of total billed charges ","70% of total billed charges ",980.55,90,,784.44,,,0,"percent of total billed charges ","90% of total billed charges ",1013.24,93,,810.59,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",926.08,85,,740.86,,,0,"percent of total billed charges ","85% of total billed charges ",980.55,90,,784.44,,,0,"percent of total billed charges ","90% of total billed charges ",980.55,90,,784.44,,,0,"percent of total billed charges ","90% of total billed charges ",21.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",947.87,87,,758.30,,,0,"percent of total billed charges ","87% of total billed charges ",21.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",762.65,70,,610.12,,,0,"percent of total billed charges ","70% of total billed charges ",21.46,1013.24,
"AP SINGLE VIEW CXR",3009990,"CDM ",324,RC,71045,HCPCS,OUTPATIENT,,,566.5,453.2,,,,,,,,0,"other ","not separately reimbursment ",123.58,100,,17.44,17.44,17.44,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",53.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",396.55,70,,317.24,,,0,"percent of total billed charges ","70% of total billed charges ",509.85,90,,407.88,,,0,"percent of total billed charges ","90% of total billed charges ",526.85,93,,421.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",6.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",481.53,85,,385.22,,,0,"percent of total billed charges ","85% of total billed charges ",509.85,90,,407.88,,,0,"percent of total billed charges ","90% of total billed charges ",509.85,90,,407.88,,,0,"percent of total billed charges ","90% of total billed charges ",6.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",492.86,87,,311.35,85.32,389.19,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",396.55,70,,317.24,,,0,"percent of total billed charges ","70% of total billed charges ",6.57,526.85,
"*SHOULDER INJECT ARTHRO LT",3010013,"CDM ",761,RC,20610,HCPCS,OUTPATIENT,,,479,383.2,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.53,100,,11.66,11.66,11.66,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",93.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",335.3,70,,268.24,,,0,"percent of total billed charges ","70% of total billed charges ",431.1,90,,344.88,,,0,"percent of total billed charges ","90% of total billed charges ",445.47,93,,356.38,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",407.15,85,,325.72,,,0,"percent of total billed charges ","85% of total billed charges ",359.25,90,,287.40,,,0,"percent of total billed charges ","90% of total billed charges ",431.1,90,,344.88,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",416.73,87,,35.16,16.84,51.43,"1 through 10","percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",282.29,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",335.3,70,,268.24,,,0,"percent of total billed charges ","70% of total billed charges ",93.35,445.47,
"*SHOULDER INJECT ARTHRO RT",3010017,"CDM ",761,RC,20610,HCPCS,OUTPATIENT,,,479,383.2,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.53,100,,11.66,11.66,11.66,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",93.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",335.3,70,,268.24,,,0,"percent of total billed charges ","70% of total billed charges ",431.1,90,,344.88,,,0,"percent of total billed charges ","90% of total billed charges ",445.47,93,,356.38,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",407.15,85,,325.72,,,0,"percent of total billed charges ","85% of total billed charges ",359.25,90,,287.40,,,0,"percent of total billed charges ","90% of total billed charges ",431.1,90,,344.88,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",416.73,87,,35.16,16.84,51.43,"1 through 10","percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",282.29,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",335.3,70,,268.24,,,0,"percent of total billed charges ","70% of total billed charges ",93.35,445.47,
"*LUMBAR FACET INJ 1ST LEVEL",3010110,"CDM ",320,RC,64493,HCPCS,OUTPATIENT,,,1360,1088,,260.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",692.03,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",187.66,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",952,70,,761.60,,,0,"percent of total billed charges ","70% of total billed charges ",1224,90,,979.20,,,0,"percent of total billed charges ","90% of total billed charges ",1264.8,93,,1011.84,,,0,"percent of total billed charges ","93% of total billed charges ",260.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",331.37,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1156,85,,924.80,,,0,"percent of total billed charges ","85% of total billed charges ",1020,90,,816.00,,,0,"percent of total billed charges ","90% of total billed charges ",1224,90,,979.20,,,0,"percent of total billed charges ","90% of total billed charges ",328.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1183.2,87,,946.56,,,0,"percent of total billed charges ","87% of total billed charges ",328.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",813.41,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",952,70,,761.60,,,0,"percent of total billed charges ","70% of total billed charges ",187.66,1264.8,
"*LUMBAR FACET INJ FLUORO CHG",3010120,"CDM ",320,RC,76000,HCPCS,OUTPATIENT,,,714,571.2,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",234.16,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",88.86,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",499.8,70,,399.84,,,0,"percent of total billed charges ","70% of total billed charges ",642.6,90,,514.08,,,0,"percent of total billed charges ","90% of total billed charges ",664.02,93,,531.22,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.59,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",606.9,85,,485.52,,,0,"percent of total billed charges ","85% of total billed charges ",642.6,90,,514.08,,,0,"percent of total billed charges ","90% of total billed charges ",642.6,90,,514.08,,,0,"percent of total billed charges ","90% of total billed charges ",37.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",621.18,87,,446.52,307.90,585.13,"1 through 10","percent of total billed charges ","87% of total billed charges ",37.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",499.8,70,,399.84,,,0,"percent of total billed charges ","70% of total billed charges ",37.22,664.02,
"*LUMBAR FACET INJ 2ND LEVEL",3010130,"CDM ",320,RC,64494,HCPCS,OUTPATIENT,,,475,380,,92.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",984.68,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",107.27,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",332.5,70,,266.00,,,0,"percent of total billed charges ","70% of total billed charges ",427.5,90,,342.00,,,0,"percent of total billed charges ","90% of total billed charges ",441.75,93,,353.40,,,0,"percent of total billed charges ","93% of total billed charges ",92.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",403.75,85,,323.00,,,0,"percent of total billed charges ","85% of total billed charges ",356.25,90,,285.00,,,0,"percent of total billed charges ","90% of total billed charges ",427.5,90,,342.00,,,0,"percent of total billed charges ","90% of total billed charges ",116.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",413.25,87,,330.60,,,0,"percent of total billed charges ","87% of total billed charges ",116.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",332.5,70,,266.00,,,0,"percent of total billed charges ","70% of total billed charges ",92.58,984.68,
"*INJECTION HIP RT",3010140,"CDM ",761,RC,20610,HCPCS,OUTPATIENT,,,479,383.2,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.53,100,,11.66,11.66,11.66,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",93.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",335.3,70,,268.24,,,0,"percent of total billed charges ","70% of total billed charges ",431.1,90,,344.88,,,0,"percent of total billed charges ","90% of total billed charges ",445.47,93,,356.38,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",407.15,85,,325.72,,,0,"percent of total billed charges ","85% of total billed charges ",359.25,90,,287.40,,,0,"percent of total billed charges ","90% of total billed charges ",431.1,90,,344.88,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",416.73,87,,35.16,16.84,51.43,"1 through 10","percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",282.29,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",335.3,70,,268.24,,,0,"percent of total billed charges ","70% of total billed charges ",93.35,445.47,
"*FLUORO NEEDLE PLACEMENT",3010150,"CDM ",320,RC,77002,HCPCS,OUTPATIENT,,,1332,1065.6,,,,,,,,0,"other ","not separately reimbursment ",372.61,100,,24.51,24.51,24.51,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",243.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",932.4,70,,745.92,,,0,"percent of total billed charges ","70% of total billed charges ",1198.8,90,,959.04,,,0,"percent of total billed charges ","90% of total billed charges ",1238.76,93,,991.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",36.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1132.2,85,,905.76,,,0,"percent of total billed charges ","85% of total billed charges ",1198.8,90,,959.04,,,0,"percent of total billed charges ","90% of total billed charges ",1198.8,90,,959.04,,,0,"percent of total billed charges ","90% of total billed charges ",35.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1158.84,87,,927.07,,,0,"percent of total billed charges ","87% of total billed charges ",35.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",932.4,70,,745.92,,,0,"percent of total billed charges ","70% of total billed charges ",35.92,1238.76,
"*INJECTION HIP LT",3010160,"CDM ",761,RC,20610,HCPCS,OUTPATIENT,,,479,383.2,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.53,100,,11.66,11.66,11.66,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",93.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",335.3,70,,268.24,,,0,"percent of total billed charges ","70% of total billed charges ",431.1,90,,344.88,,,0,"percent of total billed charges ","90% of total billed charges ",445.47,93,,356.38,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",407.15,85,,325.72,,,0,"percent of total billed charges ","85% of total billed charges ",359.25,90,,287.40,,,0,"percent of total billed charges ","90% of total billed charges ",431.1,90,,344.88,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",416.73,87,,35.16,16.84,51.43,"1 through 10","percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",282.29,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",335.3,70,,268.24,,,0,"percent of total billed charges ","70% of total billed charges ",93.35,445.47,
"SNIFF TEST",3010170,"CDM ",320,RC,76000,HCPCS,OUTPATIENT,,,353,282.4,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",234.16,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",88.86,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",247.1,70,,197.68,,,0,"percent of total billed charges ","70% of total billed charges ",317.7,90,,254.16,,,0,"percent of total billed charges ","90% of total billed charges ",328.29,93,,262.63,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.59,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",300.05,85,,240.04,,,0,"percent of total billed charges ","85% of total billed charges ",317.7,90,,254.16,,,0,"percent of total billed charges ","90% of total billed charges ",317.7,90,,254.16,,,0,"percent of total billed charges ","90% of total billed charges ",37.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",307.11,87,,446.52,307.90,585.13,"1 through 10","percent of total billed charges ","87% of total billed charges ",37.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",247.1,70,,197.68,,,0,"percent of total billed charges ","70% of total billed charges ",37.22,328.29,
"FLUOROSCOPY MINI C-ARM",3010260,"CDM ",320,RC,76000,HCPCS,OUTPATIENT,,,315,252,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",234.16,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",88.86,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",220.5,70,,176.40,,,0,"percent of total billed charges ","70% of total billed charges ",283.5,90,,226.80,,,0,"percent of total billed charges ","90% of total billed charges ",292.95,93,,234.36,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.59,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",267.75,85,,214.20,,,0,"percent of total billed charges ","85% of total billed charges ",283.5,90,,226.80,,,0,"percent of total billed charges ","90% of total billed charges ",283.5,90,,226.80,,,0,"percent of total billed charges ","90% of total billed charges ",37.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",274.05,87,,446.52,307.90,585.13,"1 through 10","percent of total billed charges ","87% of total billed charges ",37.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",220.5,70,,176.40,,,0,"percent of total billed charges ","70% of total billed charges ",37.22,292.95,
"THORACIC SPINE 1 VIEW ONLY",3010280,"CDM ",320,RC,72020,HCPCS,OUTPATIENT,,,548.5,438.8,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",170.97,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",50.89,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",383.95,70,,307.16,,,0,"percent of total billed charges ","70% of total billed charges ",493.65,90,,394.92,,,0,"percent of total billed charges ","90% of total billed charges ",510.11,93,,408.09,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",466.23,85,,372.98,,,0,"percent of total billed charges ","85% of total billed charges ",493.65,90,,394.92,,,0,"percent of total billed charges ","90% of total billed charges ",493.65,90,,394.92,,,0,"percent of total billed charges ","90% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",477.2,87,,381.76,,,0,"percent of total billed charges ","87% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",383.95,70,,307.16,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,510.11,
"LUMBAR SPINE 1 VIEW ONLY",3010290,"CDM ",320,RC,72020,HCPCS,OUTPATIENT,,,548.5,438.8,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",170.97,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",50.89,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",383.95,70,,307.16,,,0,"percent of total billed charges ","70% of total billed charges ",493.65,90,,394.92,,,0,"percent of total billed charges ","90% of total billed charges ",510.11,93,,408.09,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",466.23,85,,372.98,,,0,"percent of total billed charges ","85% of total billed charges ",493.65,90,,394.92,,,0,"percent of total billed charges ","90% of total billed charges ",493.65,90,,394.92,,,0,"percent of total billed charges ","90% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",477.2,87,,381.76,,,0,"percent of total billed charges ","87% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",383.95,70,,307.16,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,510.11,
"ABD KUB & OBLIQUE/CONE VIEW",3010310,"CDM ",320,RC,74019,HCPCS,OUTPATIENT,,,765.5,612.4,,,,,,,,0,"other ","not separately reimbursment ",100.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",76.96,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",535.85,70,,428.68,,,0,"percent of total billed charges ","70% of total billed charges ",688.95,90,,551.16,,,0,"percent of total billed charges ","90% of total billed charges ",711.92,93,,569.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",13.59,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",650.68,85,,520.54,,,0,"percent of total billed charges ","85% of total billed charges ",688.95,90,,551.16,,,0,"percent of total billed charges ","90% of total billed charges ",688.95,90,,551.16,,,0,"percent of total billed charges ","90% of total billed charges ",13.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",665.99,87,,532.79,,,0,"percent of total billed charges ","87% of total billed charges ",13.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",535.85,70,,428.68,,,0,"percent of total billed charges ","70% of total billed charges ",13.46,711.92,
"SACROILIAC JOINT INJECTION RT",3010320,"CDM ",320,RC,27096,HCPCS,OUTPATIENT,,,991,792.8,,104,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",675.69,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",172.85,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",693.7,70,,554.96,,,0,"percent of total billed charges ","70% of total billed charges ",891.9,90,,713.52,,,0,"percent of total billed charges ","90% of total billed charges ",921.63,93,,737.30,,,0,"percent of total billed charges ","93% of total billed charges ",104,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",842.35,85,,673.88,,,0,"percent of total billed charges ","85% of total billed charges ",743.25,90,,594.60,,,0,"percent of total billed charges ","90% of total billed charges ",891.9,90,,713.52,,,0,"percent of total billed charges ","90% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",862.17,87,,689.74,,,0,"percent of total billed charges ","87% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",693.7,70,,554.96,,,0,"percent of total billed charges ","70% of total billed charges ",104,921.63,
"SACROILIAC JOINT INJECTION LT",3010330,"CDM ",320,RC,27096,HCPCS,OUTPATIENT,,,991,792.8,,104,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",675.69,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",172.85,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",693.7,70,,554.96,,,0,"percent of total billed charges ","70% of total billed charges ",891.9,90,,713.52,,,0,"percent of total billed charges ","90% of total billed charges ",921.63,93,,737.30,,,0,"percent of total billed charges ","93% of total billed charges ",104,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",842.35,85,,673.88,,,0,"percent of total billed charges ","85% of total billed charges ",743.25,90,,594.60,,,0,"percent of total billed charges ","90% of total billed charges ",891.9,90,,713.52,,,0,"percent of total billed charges ","90% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",862.17,87,,689.74,,,0,"percent of total billed charges ","87% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",693.7,70,,554.96,,,0,"percent of total billed charges ","70% of total billed charges ",104,921.63,
"*LUMBAR FACET 3RD LEV OR MORE",3010370,"CDM ",320,RC,64495,HCPCS,OUTPATIENT,,,475,380,,92.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1403.26,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",108.64,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",332.5,70,,266.00,,,0,"percent of total billed charges ","70% of total billed charges ",427.5,90,,342.00,,,0,"percent of total billed charges ","90% of total billed charges ",441.75,93,,353.40,,,0,"percent of total billed charges ","93% of total billed charges ",92.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",403.75,85,,323.00,,,0,"percent of total billed charges ","85% of total billed charges ",356.25,90,,285.00,,,0,"percent of total billed charges ","90% of total billed charges ",427.5,90,,342.00,,,0,"percent of total billed charges ","90% of total billed charges ",116.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",413.25,87,,330.60,,,0,"percent of total billed charges ","87% of total billed charges ",116.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",332.5,70,,266.00,,,0,"percent of total billed charges ","70% of total billed charges ",92.58,1403.26,
"ORBITS FOR FOREIGN BODY",3010400,"CDM ",320,RC,70030,HCPCS,OUTPATIENT,,,476,380.8,,17.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.63,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",67.63,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",333.2,70,,266.56,,,0,"percent of total billed charges ","70% of total billed charges ",428.4,90,,342.72,,,0,"percent of total billed charges ","90% of total billed charges ",442.68,93,,354.14,,,0,"percent of total billed charges ","93% of total billed charges ",17.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",404.6,85,,323.68,,,0,"percent of total billed charges ","85% of total billed charges ",428.4,90,,342.72,,,0,"percent of total billed charges ","90% of total billed charges ",428.4,90,,342.72,,,0,"percent of total billed charges ","90% of total billed charges ",11.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",414.12,87,,331.30,,,0,"percent of total billed charges ","87% of total billed charges ",11.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",333.2,70,,266.56,,,0,"percent of total billed charges ","70% of total billed charges ",11.12,442.68,
"KNEE BILATERAL AP WT BEARING",3010410,"CDM ",320,RC,73565,HCPCS,OUTPATIENT,,,492.5,394,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",109.65,100,,131.24,131.24,131.24,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",84.06,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",344.75,70,,275.80,,,0,"percent of total billed charges ","70% of total billed charges ",443.25,90,,354.60,,,0,"percent of total billed charges ","90% of total billed charges ",458.03,93,,366.42,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.11,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",418.63,85,,334.90,,,0,"percent of total billed charges ","85% of total billed charges ",443.25,90,,354.60,,,0,"percent of total billed charges ","90% of total billed charges ",443.25,90,,354.60,,,0,"percent of total billed charges ","90% of total billed charges ",19.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",428.48,87,,270.67,270.67,270.67,"1 through 10","percent of total billed charges ","87% of total billed charges ",19.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",344.75,70,,275.80,,,0,"percent of total billed charges ","70% of total billed charges ",19.91,458.03,
"*SWALLOWING FUNCTION",3010470,"CDM ",320,RC,74230,HCPCS,OUTPATIENT,,,1524.5,1219.6,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",312.21,100,,32.32,32.32,32.32,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",271.59,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1067.15,70,,853.72,,,0,"percent of total billed charges ","70% of total billed charges ",1372.05,90,,1097.64,,,0,"percent of total billed charges ","90% of total billed charges ",1417.79,93,,1134.23,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1295.83,85,,1036.66,,,0,"percent of total billed charges ","85% of total billed charges ",1372.05,90,,1097.64,,,0,"percent of total billed charges ","90% of total billed charges ",1372.05,90,,1097.64,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1326.32,87,,1061.06,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1067.15,70,,853.72,,,0,"percent of total billed charges ","70% of total billed charges ",26.17,1417.79,
"SCOLIOSIS STUDY - 2-3 VIEWS",3010480,"CDM ",320,RC,72082,HCPCS,OUTPATIENT,,,1249,999.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,408.16,408.16,408.16,"1 through 10","other ","not separately reimbursment ",146.3,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",874.3,70,,699.44,,,0,"percent of total billed charges ","70% of total billed charges ",1124.1,90,,899.28,,,0,"percent of total billed charges ","90% of total billed charges ",1161.57,93,,929.26,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",86.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1061.65,85,,849.32,,,0,"percent of total billed charges ","85% of total billed charges ",1124.1,90,,899.28,,,0,"percent of total billed charges ","90% of total billed charges ",1124.1,90,,899.28,,,0,"percent of total billed charges ","90% of total billed charges ",85.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1086.63,87,,869.30,,,0,"percent of total billed charges ","87% of total billed charges ",85.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",874.3,70,,699.44,,,0,"percent of total billed charges ","70% of total billed charges ",85.63,1161.57,
"HIP W/PELVIS MIN 4 VIEW LEFT",3010490,"CDM ",320,RC,73503,HCPCS,OUTPATIENT,,,776,620.8,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",213.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",122.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",543.2,70,,434.56,,,0,"percent of total billed charges ","70% of total billed charges ",698.4,90,,558.72,,,0,"percent of total billed charges ","90% of total billed charges ",721.68,93,,577.34,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",86.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",659.6,85,,527.68,,,0,"percent of total billed charges ","85% of total billed charges ",698.4,90,,558.72,,,0,"percent of total billed charges ","90% of total billed charges ",698.4,90,,558.72,,,0,"percent of total billed charges ","90% of total billed charges ",85.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",675.12,87,,78.73,77.31,82.65,"1 through 10","percent of total billed charges ","87% of total billed charges ",85.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",543.2,70,,434.56,,,0,"percent of total billed charges ","70% of total billed charges ",85.63,721.68,
"HIP W/PELVIS MIN 4 VIEW RIGHT",3010500,"CDM ",320,RC,73503,HCPCS,OUTPATIENT,,,776,620.8,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",213.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",122.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",543.2,70,,434.56,,,0,"percent of total billed charges ","70% of total billed charges ",698.4,90,,558.72,,,0,"percent of total billed charges ","90% of total billed charges ",721.68,93,,577.34,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",86.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",659.6,85,,527.68,,,0,"percent of total billed charges ","85% of total billed charges ",698.4,90,,558.72,,,0,"percent of total billed charges ","90% of total billed charges ",698.4,90,,558.72,,,0,"percent of total billed charges ","90% of total billed charges ",85.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",675.12,87,,78.73,77.31,82.65,"1 through 10","percent of total billed charges ","87% of total billed charges ",85.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",543.2,70,,434.56,,,0,"percent of total billed charges ","70% of total billed charges ",85.63,721.68,
"FLUORO LINE PLACE - REPOSITION",3010510,"CDM ",320,RC,36597,HCPCS,OUTPATIENT,,,819,655.2,,382.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",575.11,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",124.63,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",573.3,70,,458.64,,,0,"percent of total billed charges ","70% of total billed charges ",737.1,90,,589.68,,,0,"percent of total billed charges ","90% of total billed charges ",761.67,93,,609.34,,,0,"percent of total billed charges ","93% of total billed charges ",382.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",485.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",696.15,85,,556.92,,,0,"percent of total billed charges ","85% of total billed charges ",614.25,90,,491.40,,,0,"percent of total billed charges ","90% of total billed charges ",737.1,90,,589.68,,,0,"percent of total billed charges ","90% of total billed charges ",480.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",712.53,87,,570.02,,,0,"percent of total billed charges ","87% of total billed charges ",480.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1447.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",573.3,70,,458.64,,,0,"percent of total billed charges ","70% of total billed charges ",124.63,1447.68,
"HIP BILATERAL W/PELVIS 3-4 VWS",3010520,"CDM ",320,RC,73522,HCPCS,OUTPATIENT,,,1407,1125.6,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",111.94,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",984.9,70,,787.92,,,0,"percent of total billed charges ","70% of total billed charges ",1266.3,90,,1013.04,,,0,"percent of total billed charges ","90% of total billed charges ",1308.51,93,,1046.81,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",86.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1195.95,85,,956.76,,,0,"percent of total billed charges ","85% of total billed charges ",1266.3,90,,1013.04,,,0,"percent of total billed charges ","90% of total billed charges ",1266.3,90,,1013.04,,,0,"percent of total billed charges ","90% of total billed charges ",85.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1224.09,87,,979.27,,,0,"percent of total billed charges ","87% of total billed charges ",85.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",984.9,70,,787.92,,,0,"percent of total billed charges ","70% of total billed charges ",85.63,1308.51,
"HIP BILATERAL W/PELV MIN 5 VWS",3010530,"CDM ",320,RC,73523,HCPCS,OUTPATIENT,,,1717,1373.6,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",127.97,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1201.9,70,,961.52,,,0,"percent of total billed charges ","70% of total billed charges ",1545.3,90,,1236.24,,,0,"percent of total billed charges ","90% of total billed charges ",1596.81,93,,1277.45,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",164.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1459.45,85,,1167.56,,,0,"percent of total billed charges ","85% of total billed charges ",1545.3,90,,1236.24,,,0,"percent of total billed charges ","90% of total billed charges ",1545.3,90,,1236.24,,,0,"percent of total billed charges ","90% of total billed charges ",163.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1493.79,87,,1195.03,,,0,"percent of total billed charges ","87% of total billed charges ",163.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1201.9,70,,961.52,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,1596.81,
"HIP BILATERAL W/PELVIS 2 VIEWS",3010540,"CDM ",320,RC,73521,HCPCS,OUTPATIENT,,,1162,929.6,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",813.4,70,,650.72,,,0,"percent of total billed charges ","70% of total billed charges ",1045.8,90,,836.64,,,0,"percent of total billed charges ","90% of total billed charges ",1080.66,93,,864.53,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",86.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",987.7,85,,790.16,,,0,"percent of total billed charges ","85% of total billed charges ",1045.8,90,,836.64,,,0,"percent of total billed charges ","90% of total billed charges ",1045.8,90,,836.64,,,0,"percent of total billed charges ","90% of total billed charges ",85.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1010.94,87,,808.75,,,0,"percent of total billed charges ","87% of total billed charges ",85.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",813.4,70,,650.72,,,0,"percent of total billed charges ","70% of total billed charges ",85.63,1080.66,
"NEPHROSTOGRAM ANTEGRADE",3010550,"CDM ",320,RC,74425,HCPCS,OUTPATIENT,,,873.5,698.8,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",290.11,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",611.45,70,,489.16,,,0,"percent of total billed charges ","70% of total billed charges ",786.15,90,,628.92,,,0,"percent of total billed charges ","90% of total billed charges ",812.36,93,,649.89,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",52.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",742.48,85,,593.98,,,0,"percent of total billed charges ","85% of total billed charges ",786.15,90,,628.92,,,0,"percent of total billed charges ","90% of total billed charges ",786.15,90,,628.92,,,0,"percent of total billed charges ","90% of total billed charges ",51.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",759.95,87,,607.96,,,0,"percent of total billed charges ","87% of total billed charges ",51.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.84,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",611.45,70,,489.16,,,0,"percent of total billed charges ","70% of total billed charges ",51.97,812.36,
"CHEST 2 VIEWS",3010570,"CDM ",324,RC,71046,HCPCS,OUTPATIENT,,,730,584,,,,,,,,0,"other ","not separately reimbursment ",150.77,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",69.98,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",511,70,,408.80,,,0,"percent of total billed charges ","70% of total billed charges ",657,90,,525.60,,,0,"percent of total billed charges ","90% of total billed charges ",678.9,93,,543.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",12.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",620.5,85,,496.40,,,0,"percent of total billed charges ","85% of total billed charges ",657,90,,525.60,,,0,"percent of total billed charges ","90% of total billed charges ",657,90,,525.60,,,0,"percent of total billed charges ","90% of total billed charges ",12.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",635.1,87,,170.90,60.28,497.81,12,"percent of total billed charges ","87% of total billed charges ",12.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",511,70,,408.80,,,0,"percent of total billed charges ","70% of total billed charges ",12.12,678.9,
"CHEST 3 VIEWS",3010580,"CDM ",324,RC,71047,HCPCS,OUTPATIENT,,,893.5,714.8,,,,,,,,0,"other ","not separately reimbursment ",156.95,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",88.31,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",625.45,70,,500.36,,,0,"percent of total billed charges ","70% of total billed charges ",804.15,90,,643.32,,,0,"percent of total billed charges ","90% of total billed charges ",830.96,93,,664.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",42.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",759.48,85,,607.58,,,0,"percent of total billed charges ","85% of total billed charges ",804.15,90,,643.32,,,0,"percent of total billed charges ","90% of total billed charges ",804.15,90,,643.32,,,0,"percent of total billed charges ","90% of total billed charges ",42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",777.35,87,,621.88,,,0,"percent of total billed charges ","87% of total billed charges ",42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",625.45,70,,500.36,,,0,"percent of total billed charges ","70% of total billed charges ",42,830.96,
"ABDOMEN 3 OR MORE VIEWS",3010590,"CDM ",320,RC,74021,HCPCS,OUTPATIENT,,,962.5,770,,,,,,,,0,"other ","not separately reimbursment ",149.6,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",90.38,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",673.75,70,,539.00,,,0,"percent of total billed charges ","70% of total billed charges ",866.25,90,,693.00,,,0,"percent of total billed charges ","90% of total billed charges ",895.13,93,,716.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",42.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",818.13,85,,654.50,,,0,"percent of total billed charges ","85% of total billed charges ",866.25,90,,693.00,,,0,"percent of total billed charges ","90% of total billed charges ",866.25,90,,693.00,,,0,"percent of total billed charges ","90% of total billed charges ",42.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",837.38,87,,669.90,,,0,"percent of total billed charges ","87% of total billed charges ",42.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",673.75,70,,539.00,,,0,"percent of total billed charges ","70% of total billed charges ",42.06,895.13,
"INJ INTRL LUMB/SAC W/IMAGE",3010600,"CDM ",761,RC,62323,HCPCS,OUTPATIENT,,,1182.5,946,,377.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1141.8,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",207.26,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",827.75,70,,662.20,,,0,"percent of total billed charges ","70% of total billed charges ",1064.25,90,,851.40,,,0,"percent of total billed charges ","90% of total billed charges ",1099.73,93,,879.78,,,0,"percent of total billed charges ","93% of total billed charges ",377.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",435.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1005.13,85,,804.10,,,0,"percent of total billed charges ","85% of total billed charges ",886.88,90,,709.50,,,0,"percent of total billed charges ","90% of total billed charges ",1064.25,90,,851.40,,,0,"percent of total billed charges ","90% of total billed charges ",431.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1028.78,87,,823.02,,,0,"percent of total billed charges ","87% of total billed charges ",431.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",649.16,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",827.75,70,,662.20,,,0,"percent of total billed charges ","70% of total billed charges ",207.26,1141.8,
"INJ FLUORO GUIDANCE",3010610,"CDM ",320,RC,77003,HCPCS,OUTPATIENT,,,467.5,374,,,,,,,,0,"other ","not separately reimbursment ",235.09,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",220.92,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",327.25,70,,261.80,,,0,"percent of total billed charges ","70% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",434.78,93,,347.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",29.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",397.38,85,,317.90,,,0,"percent of total billed charges ","85% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",29.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",406.73,87,,325.38,,,0,"percent of total billed charges ","87% of total billed charges ",29.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",327.25,70,,261.80,,,0,"percent of total billed charges ","70% of total billed charges ",29.27,434.78,
"LUMBAR PUNCTURE THERAPEUTIC",3010640,"CDM ",761,RC,62272,HCPCS,OUTPATIENT,,,855,684,,224.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",433.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",179.5,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",598.5,70,,478.80,,,0,"percent of total billed charges ","70% of total billed charges ",769.5,90,,615.60,,,0,"percent of total billed charges ","90% of total billed charges ",795.15,93,,636.12,,,0,"percent of total billed charges ","93% of total billed charges ",224.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",165.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",726.75,85,,581.40,,,0,"percent of total billed charges ","85% of total billed charges ",641.25,90,,513.00,,,0,"percent of total billed charges ","90% of total billed charges ",769.5,90,,615.60,,,0,"percent of total billed charges ","90% of total billed charges ",163.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",743.85,87,,595.08,,,0,"percent of total billed charges ","87% of total billed charges ",163.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",649.16,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",598.5,70,,478.80,,,0,"percent of total billed charges ","70% of total billed charges ",163.54,795.15,
"LUMBAR PUNCTURE DIAGNOSTIC",3010660,"CDM ",761,RC,62270,HCPCS,OUTPATIENT,,,855,684,,224.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",433.29,100,,109.05,109.05,109.05,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",127.49,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",598.5,70,,478.80,,,0,"percent of total billed charges ","70% of total billed charges ",769.5,90,,615.60,,,0,"percent of total billed charges ","90% of total billed charges ",795.15,93,,636.12,,,0,"percent of total billed charges ","93% of total billed charges ",224.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",165.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",726.75,85,,581.40,,,0,"percent of total billed charges ","85% of total billed charges ",641.25,90,,513.00,,,0,"percent of total billed charges ","90% of total billed charges ",769.5,90,,615.60,,,0,"percent of total billed charges ","90% of total billed charges ",163.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",743.85,87,,595.08,,,0,"percent of total billed charges ","87% of total billed charges ",163.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",649.16,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",598.5,70,,478.80,,,0,"percent of total billed charges ","70% of total billed charges ",127.49,795.15,
"INJECTION CYSTOGRAM",3010670,"CDM ",761,RC,51600,HCPCS,OUTPATIENT,,,514.5,411.6,,156,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",310.07,100,,313.61,313.61,313.61,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",91.56,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",360.15,70,,288.12,,,0,"percent of total billed charges ","70% of total billed charges ",463.05,90,,370.44,,,0,"percent of total billed charges ","90% of total billed charges ",478.49,93,,382.79,,,0,"percent of total billed charges ","93% of total billed charges ",156,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",437.33,85,,349.86,,,0,"percent of total billed charges ","85% of total billed charges ",385.88,90,,308.70,,,0,"percent of total billed charges ","90% of total billed charges ",463.05,90,,370.44,,,0,"percent of total billed charges ","90% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",447.62,87,,358.10,,,0,"percent of total billed charges ","87% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",360.15,70,,288.12,,,0,"percent of total billed charges ","70% of total billed charges ",91.56,478.49,
"FLUOROSCOPY MINI C-ARM",3010680,"CDM ",320,RC,76000,HCPCS,OUTPATIENT,,,315,252,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",234.16,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",88.86,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",220.5,70,,176.40,,,0,"percent of total billed charges ","70% of total billed charges ",283.5,90,,226.80,,,0,"percent of total billed charges ","90% of total billed charges ",292.95,93,,234.36,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.59,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",267.75,85,,214.20,,,0,"percent of total billed charges ","85% of total billed charges ",283.5,90,,226.80,,,0,"percent of total billed charges ","90% of total billed charges ",283.5,90,,226.80,,,0,"percent of total billed charges ","90% of total billed charges ",37.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",274.05,87,,446.52,307.90,585.13,"1 through 10","percent of total billed charges ","87% of total billed charges ",37.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",220.5,70,,176.40,,,0,"percent of total billed charges ","70% of total billed charges ",37.22,292.95,
"MAMMO DIAG DIGITAL TOMO UNI RT",3010690,"CDM ",401,RC,77061,HCPCS,OUTPATIENT,,,101.5,81.2,,35.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16,100,,15.34,15.34,15.34,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",71.05,70,,56.84,,,0,"percent of total billed charges ","70% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",94.4,93,,75.52,,,0,"percent of total billed charges ","93% of total billed charges ",35.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",86.28,85,,69.02,,,0,"percent of total billed charges ","85% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",19.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",88.31,87,,70.65,,,0,"percent of total billed charges ","87% of total billed charges ",19.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",71.05,70,,56.84,,,0,"percent of total billed charges ","70% of total billed charges ",16,94.4,
"MAMMO DIAG DIGITAL TOMO UNI LT",3010700,"CDM ",401,RC,77061,HCPCS,OUTPATIENT,,,101.5,81.2,,35.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16,100,,15.34,15.34,15.34,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",71.05,70,,56.84,,,0,"percent of total billed charges ","70% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",94.4,93,,75.52,,,0,"percent of total billed charges ","93% of total billed charges ",35.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",86.28,85,,69.02,,,0,"percent of total billed charges ","85% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",19.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",88.31,87,,70.65,,,0,"percent of total billed charges ","87% of total billed charges ",19.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",71.05,70,,56.84,,,0,"percent of total billed charges ","70% of total billed charges ",16,94.4,
"MAMMO DIAG DIGITAL TOMO BILAT",3010710,"CDM ",401,RC,77062,HCPCS,OUTPATIENT,,,126.5,101.2,,35.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.66,100,,25.56,25.56,25.56,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",88.55,70,,70.84,,,0,"percent of total billed charges ","70% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",117.65,93,,94.12,,,0,"percent of total billed charges ","93% of total billed charges ",35.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",107.53,85,,86.02,,,0,"percent of total billed charges ","85% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",19.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",110.06,87,,86.63,86.63,86.63,"1 through 10","percent of total billed charges ","87% of total billed charges ",19.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",88.55,70,,70.84,,,0,"percent of total billed charges ","70% of total billed charges ",19.71,117.65,
"MAMMO SCREEN TOMO BILAT",3010720,"CDM ",403,RC,77063,HCPCS,OUTPATIENT,,,253,202.4,,33.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.1,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",110.66,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",177.1,70,,141.68,,,0,"percent of total billed charges ","70% of total billed charges ",227.7,90,,182.16,,,0,"percent of total billed charges ","90% of total billed charges ",235.29,93,,188.23,,,0,"percent of total billed charges ","93% of total billed charges ",33.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",215.05,85,,172.04,,,0,"percent of total billed charges ","85% of total billed charges ",227.7,90,,182.16,,,0,"percent of total billed charges ","90% of total billed charges ",227.7,90,,182.16,,,0,"percent of total billed charges ","90% of total billed charges ",19.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",220.11,87,,173.69,20.68,173.69,21,"percent of total billed charges ","87% of total billed charges ",19.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",177.1,70,,141.68,,,0,"percent of total billed charges ","70% of total billed charges ",19.71,235.29,
"MAMMO SCREEN LEFT W/CAD",3010730,"CDM ",403,RC,77067,HCPCS,OUTPATIENT,,,345.5,276.4,,102.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",268.36,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",241.85,70,,193.48,,,0,"percent of total billed charges ","70% of total billed charges ",310.95,90,,248.76,,,0,"percent of total billed charges ","90% of total billed charges ",321.32,93,,257.06,,,0,"percent of total billed charges ","93% of total billed charges ",102.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",73.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",293.68,85,,234.94,,,0,"percent of total billed charges ","85% of total billed charges ",310.95,90,,248.76,,,0,"percent of total billed charges ","90% of total billed charges ",310.95,90,,248.76,,,0,"percent of total billed charges ","90% of total billed charges ",73.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",300.59,87,,323.68,79.44,323.68,21,"percent of total billed charges ","87% of total billed charges ",73.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",241.85,70,,193.48,,,0,"percent of total billed charges ","70% of total billed charges ",73.06,321.32,
"MAMMO SCREEN RIGHT W/CAD",3010740,"CDM ",403,RC,77067,HCPCS,OUTPATIENT,,,345.5,276.4,,102.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",268.36,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",241.85,70,,193.48,,,0,"percent of total billed charges ","70% of total billed charges ",310.95,90,,248.76,,,0,"percent of total billed charges ","90% of total billed charges ",321.32,93,,257.06,,,0,"percent of total billed charges ","93% of total billed charges ",102.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",73.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",293.68,85,,234.94,,,0,"percent of total billed charges ","85% of total billed charges ",310.95,90,,248.76,,,0,"percent of total billed charges ","90% of total billed charges ",310.95,90,,248.76,,,0,"percent of total billed charges ","90% of total billed charges ",73.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",300.59,87,,323.68,79.44,323.68,21,"percent of total billed charges ","87% of total billed charges ",73.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",241.85,70,,193.48,,,0,"percent of total billed charges ","70% of total billed charges ",73.06,321.32,
"BIOPSY BONE DEEP",3010750,"CDM ",761,RC,20225,HCPCS,OUTPATIENT,,,1843,1474.4,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",895.87,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",271.26,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1290.1,70,,1032.08,,,0,"percent of total billed charges ","70% of total billed charges ",1658.7,90,,1326.96,,,0,"percent of total billed charges ","90% of total billed charges ",1713.99,93,,1371.19,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1566.55,85,,1253.24,,,0,"percent of total billed charges ","85% of total billed charges ",1382.25,90,,1105.80,,,0,"percent of total billed charges ","90% of total billed charges ",1658.7,90,,1326.96,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1603.41,87,,1282.73,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1290.1,70,,1032.08,,,0,"percent of total billed charges ","70% of total billed charges ",271.26,1713.99,
"BIOPSY BONE SUPERFICIAL",3010760,"CDM ",761,RC,20220,HCPCS,OUTPATIENT,,,1750,1400,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",451.47,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",182.34,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1225,70,,980.00,,,0,"percent of total billed charges ","70% of total billed charges ",1575,90,,1260.00,,,0,"percent of total billed charges ","90% of total billed charges ",1627.5,93,,1302.00,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",284.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1487.5,85,,1190.00,,,0,"percent of total billed charges ","85% of total billed charges ",1312.5,90,,1050.00,,,0,"percent of total billed charges ","90% of total billed charges ",1575,90,,1260.00,,,0,"percent of total billed charges ","90% of total billed charges ",281.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1522.5,87,,1218.00,,,0,"percent of total billed charges ","87% of total billed charges ",281.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1225,70,,980.00,,,0,"percent of total billed charges ","70% of total billed charges ",182.34,1627.5,
"MAMMO SCREEN TOMO UNI LEFT",3010770,"CDM ",403,RC,77063,HCPCS,OUTPATIENT,,,101.5,81.2,,33.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.1,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",110.66,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",71.05,70,,56.84,,,0,"percent of total billed charges ","70% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",94.4,93,,75.52,,,0,"percent of total billed charges ","93% of total billed charges ",33.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",86.28,85,,69.02,,,0,"percent of total billed charges ","85% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",19.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",88.31,87,,173.69,20.68,173.69,21,"percent of total billed charges ","87% of total billed charges ",19.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",71.05,70,,56.84,,,0,"percent of total billed charges ","70% of total billed charges ",19.71,110.66,
"MAMMO SCREEN TOMO UNI RIGHT",3010780,"CDM ",403,RC,77063,HCPCS,OUTPATIENT,,,101.5,81.2,,33.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.1,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",110.66,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",71.05,70,,56.84,,,0,"percent of total billed charges ","70% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",94.4,93,,75.52,,,0,"percent of total billed charges ","93% of total billed charges ",33.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",86.28,85,,69.02,,,0,"percent of total billed charges ","85% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",19.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",88.31,87,,173.69,20.68,173.69,21,"percent of total billed charges ","87% of total billed charges ",19.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",71.05,70,,56.84,,,0,"percent of total billed charges ","70% of total billed charges ",19.71,110.66,
"MYELOGRAM CERVICAL",3010830,"CDM ",320,RC,72240,HCPCS,OUTPATIENT,,,3584,2867.2,,629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2818.91,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",243.5,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2508.8,70,,2007.04,,,0,"percent of total billed charges ","70% of total billed charges ",3225.6,90,,2580.48,,,0,"percent of total billed charges ","90% of total billed charges ",3333.12,93,,2666.50,,,0,"percent of total billed charges ","93% of total billed charges ",629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",142.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3046.4,85,,2437.12,,,0,"percent of total billed charges ","85% of total billed charges ",3225.6,90,,2580.48,,,0,"percent of total billed charges ","90% of total billed charges ",3225.6,90,,2580.48,,,0,"percent of total billed charges ","90% of total billed charges ",140.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3118.08,87,,2494.46,,,0,"percent of total billed charges ","87% of total billed charges ",140.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",720.93,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2508.8,70,,2007.04,,,0,"percent of total billed charges ","70% of total billed charges ",140.97,3333.12,
"MYELOGRAM THORACIC",3010840,"CDM ",320,RC,72255,HCPCS,OUTPATIENT,,,3584,2867.2,,629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2818.91,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",248.34,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2508.8,70,,2007.04,,,0,"percent of total billed charges ","70% of total billed charges ",3225.6,90,,2580.48,,,0,"percent of total billed charges ","90% of total billed charges ",3333.12,93,,2666.50,,,0,"percent of total billed charges ","93% of total billed charges ",629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",142.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3046.4,85,,2437.12,,,0,"percent of total billed charges ","85% of total billed charges ",3225.6,90,,2580.48,,,0,"percent of total billed charges ","90% of total billed charges ",3225.6,90,,2580.48,,,0,"percent of total billed charges ","90% of total billed charges ",140.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3118.08,87,,2494.46,,,0,"percent of total billed charges ","87% of total billed charges ",140.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",720.93,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2508.8,70,,2007.04,,,0,"percent of total billed charges ","70% of total billed charges ",140.64,3333.12,
"MYELOGRAM 2 OR MORE REGIONS",3010850,"CDM ",320,RC,72270,HCPCS,OUTPATIENT,,,3590,2872,,629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2818.91,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",352.22,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2513,70,,2010.40,,,0,"percent of total billed charges ","70% of total billed charges ",3231,90,,2584.80,,,0,"percent of total billed charges ","90% of total billed charges ",3338.7,93,,2670.96,,,0,"percent of total billed charges ","93% of total billed charges ",629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3051.5,85,,2441.20,,,0,"percent of total billed charges ","85% of total billed charges ",3231,90,,2584.80,,,0,"percent of total billed charges ","90% of total billed charges ",3231,90,,2584.80,,,0,"percent of total billed charges ","90% of total billed charges ",183.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3123.3,87,,2498.64,,,0,"percent of total billed charges ","87% of total billed charges ",183.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",720.93,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2513,70,,2010.40,,,0,"percent of total billed charges ","70% of total billed charges ",183.16,3338.7,
"*SKULL LESS THAN 4 VIEWS",3010870,"CDM ",320,RC,70250,HCPCS,OUTPATIENT,,,571,456.8,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.1,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",74.54,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",399.7,70,,319.76,,,0,"percent of total billed charges ","70% of total billed charges ",513.9,90,,411.12,,,0,"percent of total billed charges ","90% of total billed charges ",531.03,93,,424.82,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.26,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",485.35,85,,388.28,,,0,"percent of total billed charges ","85% of total billed charges ",513.9,90,,411.12,,,0,"percent of total billed charges ","90% of total billed charges ",513.9,90,,411.12,,,0,"percent of total billed charges ","90% of total billed charges ",25.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",496.77,87,,397.42,,,0,"percent of total billed charges ","87% of total billed charges ",25.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",399.7,70,,319.76,,,0,"percent of total billed charges ","70% of total billed charges ",25.01,531.03,
"*NECK SOFT TISSUE",3010880,"CDM ",320,RC,70360,HCPCS,OUTPATIENT,,,455.5,364.4,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",129.16,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",65.54,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",318.85,70,,255.08,,,0,"percent of total billed charges ","70% of total billed charges ",409.95,90,,327.96,,,0,"percent of total billed charges ","90% of total billed charges ",423.62,93,,338.90,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",387.18,85,,309.74,,,0,"percent of total billed charges ","85% of total billed charges ",409.95,90,,327.96,,,0,"percent of total billed charges ","90% of total billed charges ",409.95,90,,327.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.29,87,,317.03,,,0,"percent of total billed charges ","87% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",318.85,70,,255.08,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,423.62,
"*CHEST SINGLE VIEW",3010890,"CDM ",324,RC,71045,HCPCS,OUTPATIENT,,,566.5,453.2,,,,,,,,0,"other ","not separately reimbursment ",123.58,100,,17.44,17.44,17.44,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",53.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",396.55,70,,317.24,,,0,"percent of total billed charges ","70% of total billed charges ",509.85,90,,407.88,,,0,"percent of total billed charges ","90% of total billed charges ",526.85,93,,421.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",6.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",481.53,85,,385.22,,,0,"percent of total billed charges ","85% of total billed charges ",509.85,90,,407.88,,,0,"percent of total billed charges ","90% of total billed charges ",509.85,90,,407.88,,,0,"percent of total billed charges ","90% of total billed charges ",6.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",492.86,87,,311.35,85.32,389.19,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",396.55,70,,317.24,,,0,"percent of total billed charges ","70% of total billed charges ",6.57,526.85,
*ADBOMEN/KUB,3010990,"CDM ",320,RC,74018,HCPCS,OUTPATIENT,,,568,454.4,,,,,,,,0,"other ","not separately reimbursment ",134.73,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",62.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",397.6,70,,318.08,,,0,"percent of total billed charges ","70% of total billed charges ",511.2,90,,408.96,,,0,"percent of total billed charges ","90% of total billed charges ",528.24,93,,422.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",11.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",482.8,85,,386.24,,,0,"percent of total billed charges ","85% of total billed charges ",511.2,90,,408.96,,,0,"percent of total billed charges ","90% of total billed charges ",511.2,90,,408.96,,,0,"percent of total billed charges ","90% of total billed charges ",11.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",494.16,87,,195.25,195.25,195.25,"1 through 10","percent of total billed charges ","87% of total billed charges ",11.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",397.6,70,,318.08,,,0,"percent of total billed charges ","70% of total billed charges ",11.23,528.24,
"*KNEE INJECT ARTHRO LEFT",3011050,"CDM ",761,RC,20610,HCPCS,OUTPATIENT,,,479,383.2,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.53,100,,11.66,11.66,11.66,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",93.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",335.3,70,,268.24,,,0,"percent of total billed charges ","70% of total billed charges ",431.1,90,,344.88,,,0,"percent of total billed charges ","90% of total billed charges ",445.47,93,,356.38,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",407.15,85,,325.72,,,0,"percent of total billed charges ","85% of total billed charges ",359.25,90,,287.40,,,0,"percent of total billed charges ","90% of total billed charges ",431.1,90,,344.88,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",416.73,87,,35.16,16.84,51.43,"1 through 10","percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",282.29,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",335.3,70,,268.24,,,0,"percent of total billed charges ","70% of total billed charges ",93.35,445.47,
"*KNEE INJECT ARTHRO RIGHT",3011055,"CDM ",761,RC,20610,HCPCS,OUTPATIENT,,,479,383.2,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.53,100,,11.66,11.66,11.66,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",93.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",335.3,70,,268.24,,,0,"percent of total billed charges ","70% of total billed charges ",431.1,90,,344.88,,,0,"percent of total billed charges ","90% of total billed charges ",445.47,93,,356.38,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",407.15,85,,325.72,,,0,"percent of total billed charges ","85% of total billed charges ",359.25,90,,287.40,,,0,"percent of total billed charges ","90% of total billed charges ",431.1,90,,344.88,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",416.73,87,,35.16,16.84,51.43,"1 through 10","percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",282.29,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",335.3,70,,268.24,,,0,"percent of total billed charges ","70% of total billed charges ",93.35,445.47,
"*ELBOW INJECT ARTHRO LEFT",3011060,"CDM ",761,RC,20605,HCPCS,OUTPATIENT,,,470.5,376.4,,192.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.02,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",329.35,70,,263.48,,,0,"percent of total billed charges ","70% of total billed charges ",423.45,90,,338.76,,,0,"percent of total billed charges ","90% of total billed charges ",437.57,93,,350.06,,,0,"percent of total billed charges ","93% of total billed charges ",192.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",222,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",399.93,85,,319.94,,,0,"percent of total billed charges ","85% of total billed charges ",352.88,90,,282.30,,,0,"percent of total billed charges ","90% of total billed charges ",423.45,90,,338.76,,,0,"percent of total billed charges ","90% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",409.34,87,,327.47,,,0,"percent of total billed charges ","87% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",282.29,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",329.35,70,,263.48,,,0,"percent of total billed charges ","70% of total billed charges ",77.02,437.57,
"*ELBOW INJECT ARTHRO RIGHT",3011065,"CDM ",761,RC,20605,HCPCS,OUTPATIENT,,,470.5,376.4,,192.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.02,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",329.35,70,,263.48,,,0,"percent of total billed charges ","70% of total billed charges ",423.45,90,,338.76,,,0,"percent of total billed charges ","90% of total billed charges ",437.57,93,,350.06,,,0,"percent of total billed charges ","93% of total billed charges ",192.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",222,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",399.93,85,,319.94,,,0,"percent of total billed charges ","85% of total billed charges ",352.88,90,,282.30,,,0,"percent of total billed charges ","90% of total billed charges ",423.45,90,,338.76,,,0,"percent of total billed charges ","90% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",409.34,87,,327.47,,,0,"percent of total billed charges ","87% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",282.29,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",329.35,70,,263.48,,,0,"percent of total billed charges ","70% of total billed charges ",77.02,437.57,
"*WRIST INJECT ARTHRO LEFT",3011070,"CDM ",761,RC,20605,HCPCS,OUTPATIENT,,,470.5,376.4,,192.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.02,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",329.35,70,,263.48,,,0,"percent of total billed charges ","70% of total billed charges ",423.45,90,,338.76,,,0,"percent of total billed charges ","90% of total billed charges ",437.57,93,,350.06,,,0,"percent of total billed charges ","93% of total billed charges ",192.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",222,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",399.93,85,,319.94,,,0,"percent of total billed charges ","85% of total billed charges ",352.88,90,,282.30,,,0,"percent of total billed charges ","90% of total billed charges ",423.45,90,,338.76,,,0,"percent of total billed charges ","90% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",409.34,87,,327.47,,,0,"percent of total billed charges ","87% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",282.29,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",329.35,70,,263.48,,,0,"percent of total billed charges ","70% of total billed charges ",77.02,437.57,
"*WRIST INJECT ARTHRO RIGHT",3011075,"CDM ",761,RC,20605,HCPCS,OUTPATIENT,,,470.5,376.4,,192.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.02,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",329.35,70,,263.48,,,0,"percent of total billed charges ","70% of total billed charges ",423.45,90,,338.76,,,0,"percent of total billed charges ","90% of total billed charges ",437.57,93,,350.06,,,0,"percent of total billed charges ","93% of total billed charges ",192.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",222,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",399.93,85,,319.94,,,0,"percent of total billed charges ","85% of total billed charges ",352.88,90,,282.30,,,0,"percent of total billed charges ","90% of total billed charges ",423.45,90,,338.76,,,0,"percent of total billed charges ","90% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",409.34,87,,327.47,,,0,"percent of total billed charges ","87% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",282.29,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",329.35,70,,263.48,,,0,"percent of total billed charges ","70% of total billed charges ",77.02,437.57,
"CT ORBITS W/CONT",3200011,"CDM ",351,RC,70481,HCPCS,OUTPATIENT,,,2636.5,2109.2,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",394.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1845.55,70,,1476.44,,,0,"percent of total billed charges ","70% of total billed charges ",2372.85,90,,1898.28,,,0,"percent of total billed charges ","90% of total billed charges ",2451.95,93,,1961.56,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2241.03,85,,1792.82,,,0,"percent of total billed charges ","85% of total billed charges ",2372.85,90,,1898.28,,,0,"percent of total billed charges ","90% of total billed charges ",2372.85,90,,1898.28,,,0,"percent of total billed charges ","90% of total billed charges ",160.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2293.76,87,,1835.01,,,0,"percent of total billed charges ","87% of total billed charges ",160.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1845.55,70,,1476.44,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,2451.95,
"CT SINUS W/CONT",3200037,"CDM ",351,RC,70487,HCPCS,OUTPATIENT,,,1959,1567.2,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,575.02,575.02,575.02,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",332.13,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1371.3,70,,1097.04,,,0,"percent of total billed charges ","70% of total billed charges ",1763.1,90,,1410.48,,,0,"percent of total billed charges ","90% of total billed charges ",1821.87,93,,1457.50,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",158.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1665.15,85,,1332.12,,,0,"percent of total billed charges ","85% of total billed charges ",1763.1,90,,1410.48,,,0,"percent of total billed charges ","90% of total billed charges ",1763.1,90,,1410.48,,,0,"percent of total billed charges ","90% of total billed charges ",157.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1704.33,87,,1363.46,,,0,"percent of total billed charges ","87% of total billed charges ",157.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1371.3,70,,1097.04,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,1821.87,
"CT HEAD W/O CONTRAST",3200045,"CDM ",351,RC,70450,HCPCS,OUTPATIENT,,,2392,1913.6,,106.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,44.48,44.48,44.48,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",230.27,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1674.4,70,,1339.52,,,0,"percent of total billed charges ","70% of total billed charges ",2152.8,90,,1722.24,,,0,"percent of total billed charges ","90% of total billed charges ",2224.56,93,,1779.65,,,0,"percent of total billed charges ","93% of total billed charges ",106.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",124.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2033.2,85,,1626.56,,,0,"percent of total billed charges ","85% of total billed charges ",2152.8,90,,1722.24,,,0,"percent of total billed charges ","90% of total billed charges ",2152.8,90,,1722.24,,,0,"percent of total billed charges ","90% of total billed charges ",123.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2081.04,87,,1906.05,629.57,2076.99,"1 through 10","percent of total billed charges ","87% of total billed charges ",123.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1674.4,70,,1339.52,,,0,"percent of total billed charges ","70% of total billed charges ",96.14,2224.56,
"CT HEAD W/CONT",3200052,"CDM ",351,RC,70460,HCPCS,OUTPATIENT,,,2636.5,2109.2,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",323.84,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1845.55,70,,1476.44,,,0,"percent of total billed charges ","70% of total billed charges ",2372.85,90,,1898.28,,,0,"percent of total billed charges ","90% of total billed charges ",2451.95,93,,1961.56,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",152.81,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2241.03,85,,1792.82,,,0,"percent of total billed charges ","85% of total billed charges ",2372.85,90,,1898.28,,,0,"percent of total billed charges ","90% of total billed charges ",2372.85,90,,1898.28,,,0,"percent of total billed charges ","90% of total billed charges ",151.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2293.76,87,,1835.01,,,0,"percent of total billed charges ","87% of total billed charges ",151.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1845.55,70,,1476.44,,,0,"percent of total billed charges ","70% of total billed charges ",151.3,2451.95,
"CT HEAD W&W/O CONT",3200060,"CDM ",351,RC,70470,HCPCS,OUTPATIENT,,,2990,2392,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",380.14,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2093,70,,1674.40,,,0,"percent of total billed charges ","70% of total billed charges ",2691,90,,2152.80,,,0,"percent of total billed charges ","90% of total billed charges ",2780.7,93,,2224.56,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",186.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2541.5,85,,2033.20,,,0,"percent of total billed charges ","85% of total billed charges ",2691,90,,2152.80,,,0,"percent of total billed charges ","90% of total billed charges ",2691,90,,2152.80,,,0,"percent of total billed charges ","90% of total billed charges ",184.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2601.3,87,,2081.04,,,0,"percent of total billed charges ","87% of total billed charges ",184.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2093,70,,1674.40,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,2780.7,
"CT CHEST DIAGNOSTIC WO CONT",3200078,"CDM ",352,RC,71250,HCPCS,OUTPATIENT,,,2963.5,2370.8,,106.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",289.63,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2074.45,70,,1659.56,,,0,"percent of total billed charges ","70% of total billed charges ",2667.15,90,,2133.72,,,0,"percent of total billed charges ","90% of total billed charges ",2756.06,93,,2204.85,,,0,"percent of total billed charges ","93% of total billed charges ",106.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",238.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2518.98,85,,2015.18,,,0,"percent of total billed charges ","85% of total billed charges ",2667.15,90,,2133.72,,,0,"percent of total billed charges ","90% of total billed charges ",2667.15,90,,2133.72,,,0,"percent of total billed charges ","90% of total billed charges ",236.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2578.25,87,,2062.60,,,0,"percent of total billed charges ","87% of total billed charges ",236.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2074.45,70,,1659.56,,,0,"percent of total billed charges ","70% of total billed charges ",96.14,2756.06,
"CT CHEST W/ CONT",3200086,"CDM ",352,RC,71260,HCPCS,OUTPATIENT,,,3265.5,2612.4,,180.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",363.46,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2285.85,70,,1828.68,,,0,"percent of total billed charges ","70% of total billed charges ",2938.95,90,,2351.16,,,0,"percent of total billed charges ","90% of total billed charges ",3036.92,93,,2429.54,,,0,"percent of total billed charges ","93% of total billed charges ",180.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",302.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2775.68,85,,2220.54,,,0,"percent of total billed charges ","85% of total billed charges ",2938.95,90,,2351.16,,,0,"percent of total billed charges ","90% of total billed charges ",2938.95,90,,2351.16,,,0,"percent of total billed charges ","90% of total billed charges ",299.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2840.99,87,,2014.66,541.18,2417.60,"1 through 10","percent of total billed charges ","87% of total billed charges ",299.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2285.85,70,,1828.68,,,0,"percent of total billed charges ","70% of total billed charges ",161.3,3036.92,
"CT CHEST W&/WO CONT",3200094,"CDM ",352,RC,71270,HCPCS,OUTPATIENT,,,3703.5,2962.8,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,29.59,29.59,29.59,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",430.8,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2592.45,70,,2073.96,,,0,"percent of total billed charges ","70% of total billed charges ",3333.15,90,,2666.52,,,0,"percent of total billed charges ","90% of total billed charges ",3444.26,93,,2755.41,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",225.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3147.98,85,,2518.38,,,0,"percent of total billed charges ","85% of total billed charges ",3333.15,90,,2666.52,,,0,"percent of total billed charges ","90% of total billed charges ",3333.15,90,,2666.52,,,0,"percent of total billed charges ","90% of total billed charges ",223.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3222.05,87,,2577.64,,,0,"percent of total billed charges ","87% of total billed charges ",223.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2592.45,70,,2073.96,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,3444.26,
"CT C-SPINE W/O CONT",3200102,"CDM ",352,RC,72125,HCPCS,OUTPATIENT,,,2392,1913.6,,106.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",283.54,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1674.4,70,,1339.52,,,0,"percent of total billed charges ","70% of total billed charges ",2152.8,90,,1722.24,,,0,"percent of total billed charges ","90% of total billed charges ",2224.56,93,,1779.65,,,0,"percent of total billed charges ","93% of total billed charges ",106.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",158.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2033.2,85,,1626.56,,,0,"percent of total billed charges ","85% of total billed charges ",2152.8,90,,1722.24,,,0,"percent of total billed charges ","90% of total billed charges ",2152.8,90,,1722.24,,,0,"percent of total billed charges ","90% of total billed charges ",157.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2081.04,87,,1869.29,1703.13,2035.45,"1 through 10","percent of total billed charges ","87% of total billed charges ",157.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1674.4,70,,1339.52,,,0,"percent of total billed charges ","70% of total billed charges ",96.14,2224.56,
"CT C-SPINE W&W/O CONT",3200110,"CDM ",352,RC,72127,HCPCS,OUTPATIENT,,,2990,2392,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",432.67,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2093,70,,1674.40,,,0,"percent of total billed charges ","70% of total billed charges ",2691,90,,2152.80,,,0,"percent of total billed charges ","90% of total billed charges ",2780.7,93,,2224.56,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",214.73,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2541.5,85,,2033.20,,,0,"percent of total billed charges ","85% of total billed charges ",2691,90,,2152.80,,,0,"percent of total billed charges ","90% of total billed charges ",2691,90,,2152.80,,,0,"percent of total billed charges ","90% of total billed charges ",212.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2601.3,87,,2081.04,,,0,"percent of total billed charges ","87% of total billed charges ",212.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2093,70,,1674.40,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,2780.7,
"CT T-SPINE W/O CONT",3200128,"CDM ",352,RC,72128,HCPCS,OUTPATIENT,,,3145.5,2516.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",282.83,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2201.85,70,,1761.48,,,0,"percent of total billed charges ","70% of total billed charges ",2830.95,90,,2264.76,,,0,"percent of total billed charges ","90% of total billed charges ",2925.32,93,,2340.26,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",158.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2673.68,85,,2138.94,,,0,"percent of total billed charges ","85% of total billed charges ",2830.95,90,,2264.76,,,0,"percent of total billed charges ","90% of total billed charges ",2830.95,90,,2264.76,,,0,"percent of total billed charges ","90% of total billed charges ",157.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2736.59,87,,103.23,103.23,103.23,"1 through 10","percent of total billed charges ","87% of total billed charges ",157.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2201.85,70,,1761.48,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,2925.32,
"CT L-SPINE W/CONT",3200136,"CDM ",352,RC,72132,HCPCS,OUTPATIENT,,,3265.5,2612.4,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",368.72,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2285.85,70,,1828.68,,,0,"percent of total billed charges ","70% of total billed charges ",2938.95,90,,2351.16,,,0,"percent of total billed charges ","90% of total billed charges ",3036.92,93,,2429.54,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.08,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2775.68,85,,2220.54,,,0,"percent of total billed charges ","85% of total billed charges ",2938.95,90,,2351.16,,,0,"percent of total billed charges ","90% of total billed charges ",2938.95,90,,2351.16,,,0,"percent of total billed charges ","90% of total billed charges ",182.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2840.99,87,,2272.79,,,0,"percent of total billed charges ","87% of total billed charges ",182.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2285.85,70,,1828.68,,,0,"percent of total billed charges ","70% of total billed charges ",182.26,3036.92,
"CT L-SPINE W/O CONT",3200144,"CDM ",352,RC,72131,HCPCS,OUTPATIENT,,,2963.5,2370.8,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",282.15,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2074.45,70,,1659.56,,,0,"percent of total billed charges ","70% of total billed charges ",2667.15,90,,2133.72,,,0,"percent of total billed charges ","90% of total billed charges ",2756.06,93,,2204.85,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",158.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2518.98,85,,2015.18,,,0,"percent of total billed charges ","85% of total billed charges ",2667.15,90,,2133.72,,,0,"percent of total billed charges ","90% of total billed charges ",2667.15,90,,2133.72,,,0,"percent of total billed charges ","90% of total billed charges ",157.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2578.25,87,,1644.18,522.38,1785.21,"1 through 10","percent of total billed charges ","87% of total billed charges ",157.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2074.45,70,,1659.56,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,2756.06,
"CT PELVIS W/O CONT",3200151,"CDM ",352,RC,72192,HCPCS,OUTPATIENT,,,3099,2479.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,460.02,460.02,460.02,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",290.38,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2169.3,70,,1735.44,,,0,"percent of total billed charges ","70% of total billed charges ",2789.1,90,,2231.28,,,0,"percent of total billed charges ","90% of total billed charges ",2882.07,93,,2305.66,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",155.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2634.15,85,,2107.32,,,0,"percent of total billed charges ","85% of total billed charges ",2789.1,90,,2231.28,,,0,"percent of total billed charges ","90% of total billed charges ",2789.1,90,,2231.28,,,0,"percent of total billed charges ","90% of total billed charges ",154.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2696.13,87,,2156.90,,,0,"percent of total billed charges ","87% of total billed charges ",154.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2169.3,70,,1735.44,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,2882.07,
"CT PELVIS W/CONT",3200169,"CDM ",352,RC,72193,HCPCS,OUTPATIENT,,,3401,2720.8,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",508.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2380.7,70,,1904.56,,,0,"percent of total billed charges ","70% of total billed charges ",3060.9,90,,2448.72,,,0,"percent of total billed charges ","90% of total billed charges ",3162.93,93,,2530.34,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",292.87,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2890.85,85,,2312.68,,,0,"percent of total billed charges ","85% of total billed charges ",3060.9,90,,2448.72,,,0,"percent of total billed charges ","90% of total billed charges ",3060.9,90,,2448.72,,,0,"percent of total billed charges ","90% of total billed charges ",289.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2958.87,87,,2367.10,,,0,"percent of total billed charges ","87% of total billed charges ",289.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2380.7,70,,1904.56,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,3162.93,
"CT PELVIS W&W/O CONT",3200177,"CDM ",352,RC,72194,HCPCS,OUTPATIENT,,,3837.5,3070,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",559.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2686.25,70,,2149.00,,,0,"percent of total billed charges ","70% of total billed charges ",3453.75,90,,2763.00,,,0,"percent of total billed charges ","90% of total billed charges ",3568.88,93,,2855.10,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",212.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3261.88,85,,2609.50,,,0,"percent of total billed charges ","85% of total billed charges ",3453.75,90,,2763.00,,,0,"percent of total billed charges ","90% of total billed charges ",3453.75,90,,2763.00,,,0,"percent of total billed charges ","90% of total billed charges ",210.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3338.63,87,,2670.90,,,0,"percent of total billed charges ","87% of total billed charges ",210.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2686.25,70,,2149.00,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,3568.88,
"CT UPPER EXT W/O CONT LT",3200185,"CDM ",350,RC,73200,HCPCS,OUTPATIENT,,,2420.5,1936.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,488.77,488.77,488.77,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",356.11,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2251.07,93,,1800.86,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2057.43,85,,1645.94,,,0,"percent of total billed charges ","85% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2105.84,87,,1493.33,1493.33,1493.33,"1 through 10","percent of total billed charges ","87% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,2251.07,
"CT ABDOMEN W/O CONT",3200219,"CDM ",352,RC,74150,HCPCS,OUTPATIENT,,,3099,2479.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",299.38,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2169.3,70,,1735.44,,,0,"percent of total billed charges ","70% of total billed charges ",2789.1,90,,2231.28,,,0,"percent of total billed charges ","90% of total billed charges ",2882.07,93,,2305.66,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",154.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2634.15,85,,2107.32,,,0,"percent of total billed charges ","85% of total billed charges ",2789.1,90,,2231.28,,,0,"percent of total billed charges ","90% of total billed charges ",2789.1,90,,2231.28,,,0,"percent of total billed charges ","90% of total billed charges ",153.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2696.13,87,,2156.90,,,0,"percent of total billed charges ","87% of total billed charges ",153.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2169.3,70,,1735.44,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,2882.07,
"CT ABDOMEN W/CONT",3200227,"CDM ",352,RC,74160,HCPCS,OUTPATIENT,,,3401,2720.8,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",519.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2380.7,70,,1904.56,,,0,"percent of total billed charges ","70% of total billed charges ",3060.9,90,,2448.72,,,0,"percent of total billed charges ","90% of total billed charges ",3162.93,93,,2530.34,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",276.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2890.85,85,,2312.68,,,0,"percent of total billed charges ","85% of total billed charges ",3060.9,90,,2448.72,,,0,"percent of total billed charges ","90% of total billed charges ",3060.9,90,,2448.72,,,0,"percent of total billed charges ","90% of total billed charges ",273.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2958.87,87,,505.82,505.82,505.82,"1 through 10","percent of total billed charges ","87% of total billed charges ",273.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2380.7,70,,1904.56,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,3162.93,
"CT ABDOMEN W&W/O CONT",3200235,"CDM ",352,RC,74170,HCPCS,OUTPATIENT,,,3837.5,3070,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,457.28,457.28,457.28,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",580.84,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2686.25,70,,2149.00,,,0,"percent of total billed charges ","70% of total billed charges ",3453.75,90,,2763.00,,,0,"percent of total billed charges ","90% of total billed charges ",3568.88,93,,2855.10,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",362.86,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3261.88,85,,2609.50,,,0,"percent of total billed charges ","85% of total billed charges ",3453.75,90,,2763.00,,,0,"percent of total billed charges ","90% of total billed charges ",3453.75,90,,2763.00,,,0,"percent of total billed charges ","90% of total billed charges ",359.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3338.63,87,,2670.90,,,0,"percent of total billed charges ","87% of total billed charges ",359.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2686.25,70,,2149.00,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,3568.88,
"CT 3D IMAGING",3200292,"CDM ",350,RC,76376,HCPCS,OUTPATIENT,,,1369,1095.2,,109.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",318.72,100,,6.53,6.53,6.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",47.72,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",958.3,70,,766.64,,,0,"percent of total billed charges ","70% of total billed charges ",1232.1,90,,985.68,,,0,"percent of total billed charges ","90% of total billed charges ",1273.17,93,,1018.54,,,0,"percent of total billed charges ","93% of total billed charges ",109.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.65,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1163.65,85,,930.92,,,0,"percent of total billed charges ","85% of total billed charges ",1232.1,90,,985.68,,,0,"percent of total billed charges ","90% of total billed charges ",1232.1,90,,985.68,,,0,"percent of total billed charges ","90% of total billed charges ",126.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1191.03,87,,950.62,950.62,950.62,"1 through 10","percent of total billed charges ","87% of total billed charges ",126.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",958.3,70,,766.64,,,0,"percent of total billed charges ","70% of total billed charges ",47.72,1273.17,
"CT SCANOGRAM ONLY",3200326,"CDM ",350,RC,77073,HCPCS,OUTPATIENT,,,461.5,369.2,,,,,,,,0,"other ","not separately reimbursment ",239.73,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",94.12,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",323.05,70,,258.44,,,0,"percent of total billed charges ","70% of total billed charges ",415.35,90,,332.28,,,0,"percent of total billed charges ","90% of total billed charges ",429.2,93,,343.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",20.95,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",392.28,85,,313.82,,,0,"percent of total billed charges ","85% of total billed charges ",415.35,90,,332.28,,,0,"percent of total billed charges ","90% of total billed charges ",415.35,90,,332.28,,,0,"percent of total billed charges ","90% of total billed charges ",20.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",401.51,87,,321.21,,,0,"percent of total billed charges ","87% of total billed charges ",20.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",323.05,70,,258.44,,,0,"percent of total billed charges ","70% of total billed charges ",20.74,429.2,
"CT SINUS W/O CONT",3200342,"CDM ",351,RC,70486,HCPCS,OUTPATIENT,,,1744,1395.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,460.02,460.02,460.02,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",277.99,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1220.8,70,,976.64,,,0,"percent of total billed charges ","70% of total billed charges ",1569.6,90,,1255.68,,,0,"percent of total billed charges ","90% of total billed charges ",1621.92,93,,1297.54,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",134.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1482.4,85,,1185.92,,,0,"percent of total billed charges ","85% of total billed charges ",1569.6,90,,1255.68,,,0,"percent of total billed charges ","90% of total billed charges ",1569.6,90,,1255.68,,,0,"percent of total billed charges ","90% of total billed charges ",133.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1517.28,87,,1213.82,,,0,"percent of total billed charges ","87% of total billed charges ",133.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1220.8,70,,976.64,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,1621.92,
"CT SINUS W&W/O CONT",3200367,"CDM ",351,RC,70488,HCPCS,OUTPATIENT,,,2179.5,1743.6,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",405.02,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1525.65,70,,1220.52,,,0,"percent of total billed charges ","70% of total billed charges ",1961.55,90,,1569.24,,,0,"percent of total billed charges ","90% of total billed charges ",2026.94,93,,1621.55,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1852.58,85,,1482.06,,,0,"percent of total billed charges ","85% of total billed charges ",1961.55,90,,1569.24,,,0,"percent of total billed charges ","90% of total billed charges ",1961.55,90,,1569.24,,,0,"percent of total billed charges ","90% of total billed charges ",183.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1896.17,87,,1516.94,,,0,"percent of total billed charges ","87% of total billed charges ",183.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1525.65,70,,1220.52,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,2026.94,
"CT SOFT TISS NECK W/O CONT",3200375,"CDM ",351,RC,70490,HCPCS,OUTPATIENT,,,2198,1758.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,485.86,485.86,485.86,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",328.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1538.6,70,,1230.88,,,0,"percent of total billed charges ","70% of total billed charges ",1978.2,90,,1582.56,,,0,"percent of total billed charges ","90% of total billed charges ",2044.14,93,,1635.31,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",190.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1868.3,85,,1494.64,,,0,"percent of total billed charges ","85% of total billed charges ",1978.2,90,,1582.56,,,0,"percent of total billed charges ","90% of total billed charges ",1978.2,90,,1582.56,,,0,"percent of total billed charges ","90% of total billed charges ",189.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1912.26,87,,1529.81,,,0,"percent of total billed charges ","87% of total billed charges ",189.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1538.6,70,,1230.88,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,2044.14,
"CT MASTOIDS W&W/O CONT",3200383,"CDM ",351,RC,70482,HCPCS,OUTPATIENT,,,2990,2392,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",462.75,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2093,70,,1674.40,,,0,"percent of total billed charges ","70% of total billed charges ",2691,90,,2152.80,,,0,"percent of total billed charges ","90% of total billed charges ",2780.7,93,,2224.56,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",191.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2541.5,85,,2033.20,,,0,"percent of total billed charges ","85% of total billed charges ",2691,90,,2152.80,,,0,"percent of total billed charges ","90% of total billed charges ",2691,90,,2152.80,,,0,"percent of total billed charges ","90% of total billed charges ",189.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2601.3,87,,2081.04,,,0,"percent of total billed charges ","87% of total billed charges ",189.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2093,70,,1674.40,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,2780.7,
"CT SOFT TISS NECK W&W/O C",3200391,"CDM ",351,RC,70492,HCPCS,OUTPATIENT,,,2746.5,2197.2,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,514.44,514.44,514.44,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",485.94,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1922.55,70,,1538.04,,,0,"percent of total billed charges ","70% of total billed charges ",2471.85,90,,1977.48,,,0,"percent of total billed charges ","90% of total billed charges ",2554.25,93,,2043.40,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",192.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2334.53,85,,1867.62,,,0,"percent of total billed charges ","85% of total billed charges ",2471.85,90,,1977.48,,,0,"percent of total billed charges ","90% of total billed charges ",2471.85,90,,1977.48,,,0,"percent of total billed charges ","90% of total billed charges ",190.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2389.46,87,,1911.57,,,0,"percent of total billed charges ","87% of total billed charges ",190.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1922.55,70,,1538.04,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,2554.25,
"CT ORBITS W/O CONT",3200409,"CDM ",351,RC,70480,HCPCS,OUTPATIENT,,,2392,1913.6,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",346.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1674.4,70,,1339.52,,,0,"percent of total billed charges ","70% of total billed charges ",2152.8,90,,1722.24,,,0,"percent of total billed charges ","90% of total billed charges ",2224.56,93,,1779.65,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",139.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2033.2,85,,1626.56,,,0,"percent of total billed charges ","85% of total billed charges ",2152.8,90,,1722.24,,,0,"percent of total billed charges ","90% of total billed charges ",2152.8,90,,1722.24,,,0,"percent of total billed charges ","90% of total billed charges ",138.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2081.04,87,,1664.83,,,0,"percent of total billed charges ","87% of total billed charges ",138.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1674.4,70,,1339.52,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,2224.56,
"CT ORBITS W&W/O CONT",3200417,"CDM ",351,RC,70482,HCPCS,OUTPATIENT,,,2990,2392,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",462.75,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2093,70,,1674.40,,,0,"percent of total billed charges ","70% of total billed charges ",2691,90,,2152.80,,,0,"percent of total billed charges ","90% of total billed charges ",2780.7,93,,2224.56,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",191.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2541.5,85,,2033.20,,,0,"percent of total billed charges ","85% of total billed charges ",2691,90,,2152.80,,,0,"percent of total billed charges ","90% of total billed charges ",2691,90,,2152.80,,,0,"percent of total billed charges ","90% of total billed charges ",189.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2601.3,87,,2081.04,,,0,"percent of total billed charges ","87% of total billed charges ",189.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2093,70,,1674.40,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,2780.7,
"CT UPPER EXT W/O CONT RT",3200425,"CDM ",350,RC,73200,HCPCS,OUTPATIENT,,,2420.5,1936.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,488.77,488.77,488.77,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",356.11,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2251.07,93,,1800.86,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2057.43,85,,1645.94,,,0,"percent of total billed charges ","85% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2105.84,87,,1493.33,1493.33,1493.33,"1 through 10","percent of total billed charges ","87% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,2251.07,
"CT WRIST LEFT W/O CONTRAST",3200433,"CDM ",350,RC,73200,HCPCS,OUTPATIENT,,,2420.5,1936.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,488.77,488.77,488.77,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",356.11,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2251.07,93,,1800.86,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2057.43,85,,1645.94,,,0,"percent of total billed charges ","85% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2105.84,87,,1493.33,1493.33,1493.33,"1 through 10","percent of total billed charges ","87% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,2251.07,
"CT WRIST RIGHT W/O CONTRAST",3200441,"CDM ",350,RC,73200,HCPCS,OUTPATIENT,,,2420.5,1936.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,488.77,488.77,488.77,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",356.11,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2251.07,93,,1800.86,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2057.43,85,,1645.94,,,0,"percent of total billed charges ","85% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2105.84,87,,1493.33,1493.33,1493.33,"1 through 10","percent of total billed charges ","87% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,2251.07,
"CT SELLA TURCICA W/O CONT",3200474,"CDM ",351,RC,70480,HCPCS,OUTPATIENT,,,2392,1913.6,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",346.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1674.4,70,,1339.52,,,0,"percent of total billed charges ","70% of total billed charges ",2152.8,90,,1722.24,,,0,"percent of total billed charges ","90% of total billed charges ",2224.56,93,,1779.65,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",139.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2033.2,85,,1626.56,,,0,"percent of total billed charges ","85% of total billed charges ",2152.8,90,,1722.24,,,0,"percent of total billed charges ","90% of total billed charges ",2152.8,90,,1722.24,,,0,"percent of total billed charges ","90% of total billed charges ",138.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2081.04,87,,1664.83,,,0,"percent of total billed charges ","87% of total billed charges ",138.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1674.4,70,,1339.52,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,2224.56,
"CT SELLA TURCICA W/CONT",3200482,"CDM ",351,RC,70481,HCPCS,OUTPATIENT,,,2636.5,2109.2,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",394.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1845.55,70,,1476.44,,,0,"percent of total billed charges ","70% of total billed charges ",2372.85,90,,1898.28,,,0,"percent of total billed charges ","90% of total billed charges ",2451.95,93,,1961.56,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2241.03,85,,1792.82,,,0,"percent of total billed charges ","85% of total billed charges ",2372.85,90,,1898.28,,,0,"percent of total billed charges ","90% of total billed charges ",2372.85,90,,1898.28,,,0,"percent of total billed charges ","90% of total billed charges ",160.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2293.76,87,,1835.01,,,0,"percent of total billed charges ","87% of total billed charges ",160.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1845.55,70,,1476.44,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,2451.95,
"CT SELLA TUR W&W/O CONT",3200490,"CDM ",351,RC,70482,HCPCS,OUTPATIENT,,,2990,2392,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",462.75,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2093,70,,1674.40,,,0,"percent of total billed charges ","70% of total billed charges ",2691,90,,2152.80,,,0,"percent of total billed charges ","90% of total billed charges ",2780.7,93,,2224.56,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",191.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2541.5,85,,2033.20,,,0,"percent of total billed charges ","85% of total billed charges ",2691,90,,2152.80,,,0,"percent of total billed charges ","90% of total billed charges ",2691,90,,2152.80,,,0,"percent of total billed charges ","90% of total billed charges ",189.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2601.3,87,,2081.04,,,0,"percent of total billed charges ","87% of total billed charges ",189.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2093,70,,1674.40,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,2780.7,
"CT SHOULDER LEFT W/O CONTRAST",3200508,"CDM ",350,RC,73200,HCPCS,OUTPATIENT,,,2420.5,1936.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,488.77,488.77,488.77,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",356.11,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2251.07,93,,1800.86,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2057.43,85,,1645.94,,,0,"percent of total billed charges ","85% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2105.84,87,,1493.33,1493.33,1493.33,"1 through 10","percent of total billed charges ","87% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,2251.07,
"CT SHOULDER RIGHT W/O CONTRAST",3200516,"CDM ",350,RC,73200,HCPCS,OUTPATIENT,,,2420.5,1936.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,488.77,488.77,488.77,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",356.11,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2251.07,93,,1800.86,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2057.43,85,,1645.94,,,0,"percent of total billed charges ","85% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2105.84,87,,1493.33,1493.33,1493.33,"1 through 10","percent of total billed charges ","87% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,2251.07,
"CT SOFT TISS NECK W/CONT",3200532,"CDM ",350,RC,70491,HCPCS,OUTPATIENT,,,2418,1934.4,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,60.02,60.02,60.02,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",404.4,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1692.6,70,,1354.08,,,0,"percent of total billed charges ","70% of total billed charges ",2176.2,90,,1740.96,,,0,"percent of total billed charges ","90% of total billed charges ",2248.74,93,,1798.99,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",228.87,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2055.3,85,,1644.24,,,0,"percent of total billed charges ","85% of total billed charges ",2176.2,90,,1740.96,,,0,"percent of total billed charges ","90% of total billed charges ",2176.2,90,,1740.96,,,0,"percent of total billed charges ","90% of total billed charges ",226.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2103.66,87,,1682.93,,,0,"percent of total billed charges ","87% of total billed charges ",226.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1692.6,70,,1354.08,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,2248.74,
"CT HIP LEFT W/O CONTRAST",3200581,"CDM ",350,RC,73700,HCPCS,OUTPATIENT,,,2420.5,1936.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,11.42,11.42,11.42,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",282.15,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2251.07,93,,1800.86,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2057.43,85,,1645.94,,,0,"percent of total billed charges ","85% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2105.84,87,,1684.67,,,0,"percent of total billed charges ","87% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,2251.07,
"CT HIP RIGHT W/O CONTRAST",3200599,"CDM ",350,RC,73700,HCPCS,OUTPATIENT,,,2420.5,1936.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,11.42,11.42,11.42,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",282.15,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2251.07,93,,1800.86,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2057.43,85,,1645.94,,,0,"percent of total billed charges ","85% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2105.84,87,,1684.67,,,0,"percent of total billed charges ","87% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,2251.07,
"CT MASTOIDS W/O CONT",3200607,"CDM ",351,RC,70480,HCPCS,OUTPATIENT,,,2392,1913.6,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",346.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1674.4,70,,1339.52,,,0,"percent of total billed charges ","70% of total billed charges ",2152.8,90,,1722.24,,,0,"percent of total billed charges ","90% of total billed charges ",2224.56,93,,1779.65,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",139.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2033.2,85,,1626.56,,,0,"percent of total billed charges ","85% of total billed charges ",2152.8,90,,1722.24,,,0,"percent of total billed charges ","90% of total billed charges ",2152.8,90,,1722.24,,,0,"percent of total billed charges ","90% of total billed charges ",138.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2081.04,87,,1664.83,,,0,"percent of total billed charges ","87% of total billed charges ",138.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1674.4,70,,1339.52,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,2224.56,
"CT MASTOIDS W/CONT",3200615,"CDM ",351,RC,70481,HCPCS,OUTPATIENT,,,2636.5,2109.2,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",394.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1845.55,70,,1476.44,,,0,"percent of total billed charges ","70% of total billed charges ",2372.85,90,,1898.28,,,0,"percent of total billed charges ","90% of total billed charges ",2451.95,93,,1961.56,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2241.03,85,,1792.82,,,0,"percent of total billed charges ","85% of total billed charges ",2372.85,90,,1898.28,,,0,"percent of total billed charges ","90% of total billed charges ",2372.85,90,,1898.28,,,0,"percent of total billed charges ","90% of total billed charges ",160.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2293.76,87,,1835.01,,,0,"percent of total billed charges ","87% of total billed charges ",160.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1845.55,70,,1476.44,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,2451.95,
"CT IAC'S W/CONT",3200623,"CDM ",351,RC,70481,HCPCS,OUTPATIENT,,,2636.5,2109.2,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",394.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1845.55,70,,1476.44,,,0,"percent of total billed charges ","70% of total billed charges ",2372.85,90,,1898.28,,,0,"percent of total billed charges ","90% of total billed charges ",2451.95,93,,1961.56,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2241.03,85,,1792.82,,,0,"percent of total billed charges ","85% of total billed charges ",2372.85,90,,1898.28,,,0,"percent of total billed charges ","90% of total billed charges ",2372.85,90,,1898.28,,,0,"percent of total billed charges ","90% of total billed charges ",160.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2293.76,87,,1835.01,,,0,"percent of total billed charges ","87% of total billed charges ",160.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1845.55,70,,1476.44,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,2451.95,
"CT IAC'S W&W/O CONT",3200631,"CDM ",351,RC,70482,HCPCS,OUTPATIENT,,,2990,2392,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",462.75,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2093,70,,1674.40,,,0,"percent of total billed charges ","70% of total billed charges ",2691,90,,2152.80,,,0,"percent of total billed charges ","90% of total billed charges ",2780.7,93,,2224.56,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",191.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2541.5,85,,2033.20,,,0,"percent of total billed charges ","85% of total billed charges ",2691,90,,2152.80,,,0,"percent of total billed charges ","90% of total billed charges ",2691,90,,2152.80,,,0,"percent of total billed charges ","90% of total billed charges ",189.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2601.3,87,,2081.04,,,0,"percent of total billed charges ","87% of total billed charges ",189.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2093,70,,1674.40,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,2780.7,
"CT IAC'S W/O CONT",3200649,"CDM ",351,RC,70480,HCPCS,OUTPATIENT,,,2392,1913.6,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",346.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1674.4,70,,1339.52,,,0,"percent of total billed charges ","70% of total billed charges ",2152.8,90,,1722.24,,,0,"percent of total billed charges ","90% of total billed charges ",2224.56,93,,1779.65,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",139.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2033.2,85,,1626.56,,,0,"percent of total billed charges ","85% of total billed charges ",2152.8,90,,1722.24,,,0,"percent of total billed charges ","90% of total billed charges ",2152.8,90,,1722.24,,,0,"percent of total billed charges ","90% of total billed charges ",138.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2081.04,87,,1664.83,,,0,"percent of total billed charges ","87% of total billed charges ",138.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1674.4,70,,1339.52,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,2224.56,
"CT KIDNEYS W&W/O CONT",3200656,"CDM ",352,RC,74170,HCPCS,OUTPATIENT,,,3837.5,3070,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,457.28,457.28,457.28,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",580.84,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2686.25,70,,2149.00,,,0,"percent of total billed charges ","70% of total billed charges ",3453.75,90,,2763.00,,,0,"percent of total billed charges ","90% of total billed charges ",3568.88,93,,2855.10,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",362.86,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3261.88,85,,2609.50,,,0,"percent of total billed charges ","85% of total billed charges ",3453.75,90,,2763.00,,,0,"percent of total billed charges ","90% of total billed charges ",3453.75,90,,2763.00,,,0,"percent of total billed charges ","90% of total billed charges ",359.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3338.63,87,,2670.90,,,0,"percent of total billed charges ","87% of total billed charges ",359.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2686.25,70,,2149.00,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,3568.88,
"CT KIDNEYS W/CONT",3200664,"CDM ",352,RC,74160,HCPCS,OUTPATIENT,,,3401,2720.8,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",519.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2380.7,70,,1904.56,,,0,"percent of total billed charges ","70% of total billed charges ",3060.9,90,,2448.72,,,0,"percent of total billed charges ","90% of total billed charges ",3162.93,93,,2530.34,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",276.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2890.85,85,,2312.68,,,0,"percent of total billed charges ","85% of total billed charges ",3060.9,90,,2448.72,,,0,"percent of total billed charges ","90% of total billed charges ",3060.9,90,,2448.72,,,0,"percent of total billed charges ","90% of total billed charges ",273.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2958.87,87,,505.82,505.82,505.82,"1 through 10","percent of total billed charges ","87% of total billed charges ",273.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2380.7,70,,1904.56,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,3162.93,
"CT KIDNEYS W/O CONT",3200672,"CDM ",352,RC,74150,HCPCS,OUTPATIENT,,,3099,2479.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",299.38,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2169.3,70,,1735.44,,,0,"percent of total billed charges ","70% of total billed charges ",2789.1,90,,2231.28,,,0,"percent of total billed charges ","90% of total billed charges ",2882.07,93,,2305.66,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",154.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2634.15,85,,2107.32,,,0,"percent of total billed charges ","85% of total billed charges ",2789.1,90,,2231.28,,,0,"percent of total billed charges ","90% of total billed charges ",2789.1,90,,2231.28,,,0,"percent of total billed charges ","90% of total billed charges ",153.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2696.13,87,,2156.90,,,0,"percent of total billed charges ","87% of total billed charges ",153.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2169.3,70,,1735.44,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,2882.07,
"CT KNEE RIGHT W/O CONTRAST",3200680,"CDM ",350,RC,73700,HCPCS,OUTPATIENT,,,2420.5,1936.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,11.42,11.42,11.42,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",282.15,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2251.07,93,,1800.86,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2057.43,85,,1645.94,,,0,"percent of total billed charges ","85% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2105.84,87,,1684.67,,,0,"percent of total billed charges ","87% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,2251.07,
"CT KNEE LEFT W/O CONTRAST",3200698,"CDM ",350,RC,73700,HCPCS,OUTPATIENT,,,2420.5,1936.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,11.42,11.42,11.42,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",282.15,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2251.07,93,,1800.86,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2057.43,85,,1645.94,,,0,"percent of total billed charges ","85% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2105.84,87,,1684.67,,,0,"percent of total billed charges ","87% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,2251.07,
"CT ELBOW RIGHT W/O CONTRAST",3200706,"CDM ",350,RC,73200,HCPCS,OUTPATIENT,,,2420.5,1936.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,488.77,488.77,488.77,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",356.11,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2251.07,93,,1800.86,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2057.43,85,,1645.94,,,0,"percent of total billed charges ","85% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2105.84,87,,1493.33,1493.33,1493.33,"1 through 10","percent of total billed charges ","87% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,2251.07,
"CT ELBOW LEFT W/O CONTRAST",3200714,"CDM ",350,RC,73200,HCPCS,OUTPATIENT,,,2420.5,1936.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,488.77,488.77,488.77,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",356.11,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2251.07,93,,1800.86,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2057.43,85,,1645.94,,,0,"percent of total billed charges ","85% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2105.84,87,,1493.33,1493.33,1493.33,"1 through 10","percent of total billed charges ","87% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,2251.07,
"CT FACIAL BONES W/O CONTRAST",3200722,"CDM ",351,RC,70486,HCPCS,OUTPATIENT,,,1744,1395.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,460.02,460.02,460.02,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",277.99,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1220.8,70,,976.64,,,0,"percent of total billed charges ","70% of total billed charges ",1569.6,90,,1255.68,,,0,"percent of total billed charges ","90% of total billed charges ",1621.92,93,,1297.54,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",134.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1482.4,85,,1185.92,,,0,"percent of total billed charges ","85% of total billed charges ",1569.6,90,,1255.68,,,0,"percent of total billed charges ","90% of total billed charges ",1569.6,90,,1255.68,,,0,"percent of total billed charges ","90% of total billed charges ",133.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1517.28,87,,1213.82,,,0,"percent of total billed charges ","87% of total billed charges ",133.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1220.8,70,,976.64,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,1621.92,
"CT C-SPINE W/ CONT",3200730,"CDM ",352,RC,72126,HCPCS,OUTPATIENT,,,2636.5,2109.2,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,575.02,575.02,575.02,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",368.72,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1845.55,70,,1476.44,,,0,"percent of total billed charges ","70% of total billed charges ",2372.85,90,,1898.28,,,0,"percent of total billed charges ","90% of total billed charges ",2451.95,93,,1961.56,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.08,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2241.03,85,,1792.82,,,0,"percent of total billed charges ","85% of total billed charges ",2372.85,90,,1898.28,,,0,"percent of total billed charges ","90% of total billed charges ",2372.85,90,,1898.28,,,0,"percent of total billed charges ","90% of total billed charges ",182.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2293.76,87,,1835.01,,,0,"percent of total billed charges ","87% of total billed charges ",182.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1845.55,70,,1476.44,,,0,"percent of total billed charges ","70% of total billed charges ",182.26,2451.95,
"CT ANKLE LEFT W/O CONTRAST",3200748,"CDM ",350,RC,73700,HCPCS,OUTPATIENT,,,2420.5,1936.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,11.42,11.42,11.42,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",282.15,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2251.07,93,,1800.86,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2057.43,85,,1645.94,,,0,"percent of total billed charges ","85% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2105.84,87,,1684.67,,,0,"percent of total billed charges ","87% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,2251.07,
"CT ANKLE RIGHT W/O CONTRAST",3200755,"CDM ",350,RC,73700,HCPCS,OUTPATIENT,,,2420.5,1936.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,11.42,11.42,11.42,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",282.15,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2251.07,93,,1800.86,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2057.43,85,,1645.94,,,0,"percent of total billed charges ","85% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2105.84,87,,1684.67,,,0,"percent of total billed charges ","87% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,2251.07,
"CT T-SPINE W/CONT",3200763,"CDM ",352,RC,72129,HCPCS,OUTPATIENT,,,3563,2850.4,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",371.49,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2494.1,70,,1995.28,,,0,"percent of total billed charges ","70% of total billed charges ",3206.7,90,,2565.36,,,0,"percent of total billed charges ","90% of total billed charges ",3313.59,93,,2650.87,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.08,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3028.55,85,,2422.84,,,0,"percent of total billed charges ","85% of total billed charges ",3206.7,90,,2565.36,,,0,"percent of total billed charges ","90% of total billed charges ",3206.7,90,,2565.36,,,0,"percent of total billed charges ","90% of total billed charges ",182.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3099.81,87,,2479.85,,,0,"percent of total billed charges ","87% of total billed charges ",182.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2494.1,70,,1995.28,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,3313.59,
"CT HIGH RESOLUTION CHEST",3200805,"CDM ",350,RC,76380,HCPCS,OUTPATIENT,,,1401,1120.8,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",288.22,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",980.7,70,,784.56,,,0,"percent of total billed charges ","70% of total billed charges ",1260.9,90,,1008.72,,,0,"percent of total billed charges ","90% of total billed charges ",1302.93,93,,1042.34,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1190.85,85,,952.68,,,0,"percent of total billed charges ","85% of total billed charges ",1260.9,90,,1008.72,,,0,"percent of total billed charges ","90% of total billed charges ",1260.9,90,,1008.72,,,0,"percent of total billed charges ","90% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1218.87,87,,975.10,,,0,"percent of total billed charges ","87% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",980.7,70,,784.56,,,0,"percent of total billed charges ","70% of total billed charges ",39.25,1302.93,
"CT LOW EXT W&W/O CONT RT",3200813,"CDM ",350,RC,73702,HCPCS,OUTPATIENT,,,3024.5,2419.6,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",425.77,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2117.15,70,,1693.72,,,0,"percent of total billed charges ","70% of total billed charges ",2722.05,90,,2177.64,,,0,"percent of total billed charges ","90% of total billed charges ",2812.79,93,,2250.23,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",191.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2570.83,85,,2056.66,,,0,"percent of total billed charges ","85% of total billed charges ",2722.05,90,,2177.64,,,0,"percent of total billed charges ","90% of total billed charges ",2722.05,90,,2177.64,,,0,"percent of total billed charges ","90% of total billed charges ",189.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2631.32,87,,2105.06,,,0,"percent of total billed charges ","87% of total billed charges ",189.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2117.15,70,,1693.72,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,2812.79,
"CT UP EXT W&W/O CONT RT",3200821,"CDM ",350,RC,73202,HCPCS,OUTPATIENT,,,2872.5,2298,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,575.02,575.02,575.02,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",550.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2010.75,70,,1608.60,,,0,"percent of total billed charges ","70% of total billed charges ",2585.25,90,,2068.20,,,0,"percent of total billed charges ","90% of total billed charges ",2671.43,93,,2137.14,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",191.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2441.63,85,,1953.30,,,0,"percent of total billed charges ","85% of total billed charges ",2585.25,90,,2068.20,,,0,"percent of total billed charges ","90% of total billed charges ",2585.25,90,,2068.20,,,0,"percent of total billed charges ","90% of total billed charges ",189.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2499.08,87,,1999.26,,,0,"percent of total billed charges ","87% of total billed charges ",189.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2010.75,70,,1608.60,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,2671.43,
"CT LOW EXT W/O CONT RIGHT",3200839,"CDM ",350,RC,73700,HCPCS,OUTPATIENT,,,2420.5,1936.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,11.42,11.42,11.42,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",282.15,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2251.07,93,,1800.86,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2057.43,85,,1645.94,,,0,"percent of total billed charges ","85% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2105.84,87,,1684.67,,,0,"percent of total billed charges ","87% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,2251.07,
"CT LOW EXT W/O CONT LEFT",3200847,"CDM ",350,RC,73700,HCPCS,OUTPATIENT,,,2420.5,1936.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,11.42,11.42,11.42,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",282.15,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2251.07,93,,1800.86,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2057.43,85,,1645.94,,,0,"percent of total billed charges ","85% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",2178.45,90,,1742.76,,,0,"percent of total billed charges ","90% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2105.84,87,,1684.67,,,0,"percent of total billed charges ","87% of total billed charges ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1694.35,70,,1355.48,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,2251.07,
"CT UPPEREXT W&W/O CONT LT",3200854,"CDM ",350,RC,73202,HCPCS,OUTPATIENT,,,2872.5,2298,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,575.02,575.02,575.02,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",550.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2010.75,70,,1608.60,,,0,"percent of total billed charges ","70% of total billed charges ",2585.25,90,,2068.20,,,0,"percent of total billed charges ","90% of total billed charges ",2671.43,93,,2137.14,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",191.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2441.63,85,,1953.30,,,0,"percent of total billed charges ","85% of total billed charges ",2585.25,90,,2068.20,,,0,"percent of total billed charges ","90% of total billed charges ",2585.25,90,,2068.20,,,0,"percent of total billed charges ","90% of total billed charges ",189.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2499.08,87,,1999.26,,,0,"percent of total billed charges ","87% of total billed charges ",189.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2010.75,70,,1608.60,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,2671.43,
"CT LOW EXT W&W/O CONT LEFT",3200862,"CDM ",350,RC,73702,HCPCS,OUTPATIENT,,,3024.5,2419.6,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",425.77,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2117.15,70,,1693.72,,,0,"percent of total billed charges ","70% of total billed charges ",2722.05,90,,2177.64,,,0,"percent of total billed charges ","90% of total billed charges ",2812.79,93,,2250.23,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",191.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2570.83,85,,2056.66,,,0,"percent of total billed charges ","85% of total billed charges ",2722.05,90,,2177.64,,,0,"percent of total billed charges ","90% of total billed charges ",2722.05,90,,2177.64,,,0,"percent of total billed charges ","90% of total billed charges ",189.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2631.32,87,,2105.06,,,0,"percent of total billed charges ","87% of total billed charges ",189.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2117.15,70,,1693.72,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,2812.79,
"CT RENAL STONE W/O CONTRAST",3200870,"CDM ",350,RC,74176,HCPCS,OUTPATIENT,,,5629,4503.2,,,,,,,,0,"other ","not separately reimbursment ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",400.03,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3940.3,70,,3152.24,,,0,"percent of total billed charges ","70% of total billed charges ",5066.1,90,,4052.88,,,0,"percent of total billed charges ","90% of total billed charges ",5234.97,93,,4187.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",80.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4784.65,85,,3827.72,,,0,"percent of total billed charges ","85% of total billed charges ",5066.1,90,,4052.88,,,0,"percent of total billed charges ","90% of total billed charges ",5066.1,90,,4052.88,,,0,"percent of total billed charges ","90% of total billed charges ",79.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4897.23,87,,3472.48,844.66,3472.48,"1 through 10","percent of total billed charges ","87% of total billed charges ",79.44,100,,187.71,187.71,187.71,"1 through 10","fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3940.3,70,,3152.24,,,0,"percent of total billed charges ","70% of total billed charges ",79.44,5234.97,
"CT CHEST ANGIO PE W/WO CX",3200888,"CDM ",352,RC,71275,HCPCS,OUTPATIENT,,,4705.5,3764.4,,180.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1143.85,100,,1163.80,1163.80,1163.80,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",613.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3293.85,70,,2635.08,,,0,"percent of total billed charges ","70% of total billed charges ",4234.95,90,,3387.96,,,0,"percent of total billed charges ","90% of total billed charges ",4376.12,93,,3500.90,,,0,"percent of total billed charges ","93% of total billed charges ",180.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",225.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3999.68,85,,3199.74,,,0,"percent of total billed charges ","85% of total billed charges ",4234.95,90,,3387.96,,,0,"percent of total billed charges ","90% of total billed charges ",4234.95,90,,3387.96,,,0,"percent of total billed charges ","90% of total billed charges ",223.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4093.79,87,,171.34,111.03,2083.85,"1 through 10","percent of total billed charges ","87% of total billed charges ",223.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3293.85,70,,2635.08,,,0,"percent of total billed charges ","70% of total billed charges ",161.3,4376.12,
"CT L-SPINE W&W/O CONT",3200896,"CDM ",352,RC,72133,HCPCS,OUTPATIENT,,,3483.5,2786.8,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",431.99,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2438.45,70,,1950.76,,,0,"percent of total billed charges ","70% of total billed charges ",3135.15,90,,2508.12,,,0,"percent of total billed charges ","90% of total billed charges ",3239.66,93,,2591.73,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",214.73,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2960.98,85,,2368.78,,,0,"percent of total billed charges ","85% of total billed charges ",3135.15,90,,2508.12,,,0,"percent of total billed charges ","90% of total billed charges ",3135.15,90,,2508.12,,,0,"percent of total billed charges ","90% of total billed charges ",212.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3030.65,87,,2424.52,,,0,"percent of total billed charges ","87% of total billed charges ",212.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2438.45,70,,1950.76,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,3239.66,
"CT POSTERIOR FOSSA WITH CONTRA",3200912,"CDM ",351,RC,70481,HCPCS,OUTPATIENT,,,2636.5,2109.2,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",394.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1845.55,70,,1476.44,,,0,"percent of total billed charges ","70% of total billed charges ",2372.85,90,,1898.28,,,0,"percent of total billed charges ","90% of total billed charges ",2451.95,93,,1961.56,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2241.03,85,,1792.82,,,0,"percent of total billed charges ","85% of total billed charges ",2372.85,90,,1898.28,,,0,"percent of total billed charges ","90% of total billed charges ",2372.85,90,,1898.28,,,0,"percent of total billed charges ","90% of total billed charges ",160.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2293.76,87,,1835.01,,,0,"percent of total billed charges ","87% of total billed charges ",160.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1845.55,70,,1476.44,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,2451.95,
"CT POSTERIOR FOSSA W/WO CONTRA",3200920,"CDM ",351,RC,70482,HCPCS,OUTPATIENT,,,2990,2392,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",462.75,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2093,70,,1674.40,,,0,"percent of total billed charges ","70% of total billed charges ",2691,90,,2152.80,,,0,"percent of total billed charges ","90% of total billed charges ",2780.7,93,,2224.56,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",191.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2541.5,85,,2033.20,,,0,"percent of total billed charges ","85% of total billed charges ",2691,90,,2152.80,,,0,"percent of total billed charges ","90% of total billed charges ",2691,90,,2152.80,,,0,"percent of total billed charges ","90% of total billed charges ",189.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2601.3,87,,2081.04,,,0,"percent of total billed charges ","87% of total billed charges ",189.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2093,70,,1674.40,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,2780.7,
"CT POSTERIOR FOSSA W/OUT CONTR",3200938,"CDM ",351,RC,70480,HCPCS,OUTPATIENT,,,2392,1913.6,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",346.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1674.4,70,,1339.52,,,0,"percent of total billed charges ","70% of total billed charges ",2152.8,90,,1722.24,,,0,"percent of total billed charges ","90% of total billed charges ",2224.56,93,,1779.65,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",139.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2033.2,85,,1626.56,,,0,"percent of total billed charges ","85% of total billed charges ",2152.8,90,,1722.24,,,0,"percent of total billed charges ","90% of total billed charges ",2152.8,90,,1722.24,,,0,"percent of total billed charges ","90% of total billed charges ",138.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2081.04,87,,1664.83,,,0,"percent of total billed charges ","87% of total billed charges ",138.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1674.4,70,,1339.52,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,2224.56,
"CT T-SPINE W/WO CONTRAST",3200946,"CDM ",352,RC,72130,HCPCS,OUTPATIENT,,,3981,3184.8,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",434.41,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2786.7,70,,2229.36,,,0,"percent of total billed charges ","70% of total billed charges ",3582.9,90,,2866.32,,,0,"percent of total billed charges ","90% of total billed charges ",3702.33,93,,2961.86,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",214.73,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3383.85,85,,2707.08,,,0,"percent of total billed charges ","85% of total billed charges ",3582.9,90,,2866.32,,,0,"percent of total billed charges ","90% of total billed charges ",3582.9,90,,2866.32,,,0,"percent of total billed charges ","90% of total billed charges ",212.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3463.47,87,,2770.78,,,0,"percent of total billed charges ","87% of total billed charges ",212.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2786.7,70,,2229.36,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,3702.33,
"CT UPPER EXT W/CONT RT",3200953,"CDM ",352,RC,73201,HCPCS,OUTPATIENT,,,2511.5,2009.2,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,571.60,571.60,571.60,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",440.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1758.05,70,,1406.44,,,0,"percent of total billed charges ","70% of total billed charges ",2260.35,90,,1808.28,,,0,"percent of total billed charges ","90% of total billed charges ",2335.7,93,,1868.56,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",158.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2134.78,85,,1707.82,,,0,"percent of total billed charges ","85% of total billed charges ",2260.35,90,,1808.28,,,0,"percent of total billed charges ","90% of total billed charges ",2260.35,90,,1808.28,,,0,"percent of total billed charges ","90% of total billed charges ",157.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2185.01,87,,1549.18,1549.18,1549.18,"1 through 10","percent of total billed charges ","87% of total billed charges ",157.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1758.05,70,,1406.44,,,0,"percent of total billed charges ","70% of total billed charges ",157.12,2335.7,
"CT UPPER EXT W/CONT LEFT",3200961,"CDM ",352,RC,73201,HCPCS,OUTPATIENT,,,2511.5,2009.2,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,571.60,571.60,571.60,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",440.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1758.05,70,,1406.44,,,0,"percent of total billed charges ","70% of total billed charges ",2260.35,90,,1808.28,,,0,"percent of total billed charges ","90% of total billed charges ",2335.7,93,,1868.56,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",158.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2134.78,85,,1707.82,,,0,"percent of total billed charges ","85% of total billed charges ",2260.35,90,,1808.28,,,0,"percent of total billed charges ","90% of total billed charges ",2260.35,90,,1808.28,,,0,"percent of total billed charges ","90% of total billed charges ",157.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2185.01,87,,1549.18,1549.18,1549.18,"1 through 10","percent of total billed charges ","87% of total billed charges ",157.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1758.05,70,,1406.44,,,0,"percent of total billed charges ","70% of total billed charges ",157.12,2335.7,
"CT LOWER EXT W/CONTRAST RIGHT",3200995,"CDM ",352,RC,73701,HCPCS,OUTPATIENT,,,2511.5,2009.2,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",364.14,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1758.05,70,,1406.44,,,0,"percent of total billed charges ","70% of total billed charges ",2260.35,90,,1808.28,,,0,"percent of total billed charges ","90% of total billed charges ",2335.7,93,,1868.56,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",158.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2134.78,85,,1707.82,,,0,"percent of total billed charges ","85% of total billed charges ",2260.35,90,,1808.28,,,0,"percent of total billed charges ","90% of total billed charges ",2260.35,90,,1808.28,,,0,"percent of total billed charges ","90% of total billed charges ",157.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2185.01,87,,1748.01,,,0,"percent of total billed charges ","87% of total billed charges ",157.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1758.05,70,,1406.44,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,2335.7,
"CT LOWER EXT W/CONTRAST LEFT",3201001,"CDM ",352,RC,73701,HCPCS,OUTPATIENT,,,2511.5,2009.2,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",364.14,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1758.05,70,,1406.44,,,0,"percent of total billed charges ","70% of total billed charges ",2260.35,90,,1808.28,,,0,"percent of total billed charges ","90% of total billed charges ",2335.7,93,,1868.56,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",158.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2134.78,85,,1707.82,,,0,"percent of total billed charges ","85% of total billed charges ",2260.35,90,,1808.28,,,0,"percent of total billed charges ","90% of total billed charges ",2260.35,90,,1808.28,,,0,"percent of total billed charges ","90% of total billed charges ",157.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2185.01,87,,1748.01,,,0,"percent of total billed charges ","87% of total billed charges ",157.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1758.05,70,,1406.44,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,2335.7,
"CT CYSTOGRAM",3201010,"CDM ",352,RC,72193,HCPCS,OUTPATIENT,,,3401,2720.8,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",508.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2380.7,70,,1904.56,,,0,"percent of total billed charges ","70% of total billed charges ",3060.9,90,,2448.72,,,0,"percent of total billed charges ","90% of total billed charges ",3162.93,93,,2530.34,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",292.87,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2890.85,85,,2312.68,,,0,"percent of total billed charges ","85% of total billed charges ",3060.9,90,,2448.72,,,0,"percent of total billed charges ","90% of total billed charges ",3060.9,90,,2448.72,,,0,"percent of total billed charges ","90% of total billed charges ",289.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2958.87,87,,2367.10,,,0,"percent of total billed charges ","87% of total billed charges ",289.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2380.7,70,,1904.56,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,3162.93,
"INJECTION CYSTOGRAM",3201020,"CDM ",761,RC,51600,HCPCS,OUTPATIENT,,,514.5,411.6,,156,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",310.07,100,,313.61,313.61,313.61,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",91.56,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",360.15,70,,288.12,,,0,"percent of total billed charges ","70% of total billed charges ",463.05,90,,370.44,,,0,"percent of total billed charges ","90% of total billed charges ",478.49,93,,382.79,,,0,"percent of total billed charges ","93% of total billed charges ",156,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",437.33,85,,349.86,,,0,"percent of total billed charges ","85% of total billed charges ",385.88,90,,308.70,,,0,"percent of total billed charges ","90% of total billed charges ",463.05,90,,370.44,,,0,"percent of total billed charges ","90% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",447.62,87,,358.10,,,0,"percent of total billed charges ","87% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",360.15,70,,288.12,,,0,"percent of total billed charges ","70% of total billed charges ",91.56,478.49,
"CT ABDOMEN ANGIOGRAPHY W/WO &",3202009,"CDM ",350,RC,74175,HCPCS,OUTPATIENT,,,4612,3689.6,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1186.59,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",671.22,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3228.4,70,,2582.72,,,0,"percent of total billed charges ","70% of total billed charges ",4150.8,90,,3320.64,,,0,"percent of total billed charges ","90% of total billed charges ",4289.16,93,,3431.33,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",362.86,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3920.2,85,,3136.16,,,0,"percent of total billed charges ","85% of total billed charges ",4150.8,90,,3320.64,,,0,"percent of total billed charges ","90% of total billed charges ",4150.8,90,,3320.64,,,0,"percent of total billed charges ","90% of total billed charges ",359.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4012.44,87,,3209.95,,,0,"percent of total billed charges ","87% of total billed charges ",359.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3228.4,70,,2582.72,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,4289.16,
"CT ABD/PELVIS ANGIOGRAPHY W/WO",3202041,"CDM ",350,RC,74174,HCPCS,OUTPATIENT,,,7988,6390.4,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1704.15,100,,63.82,63.82,63.82,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",834.97,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",5591.6,70,,4473.28,,,0,"percent of total billed charges ","70% of total billed charges ",7189.2,90,,5751.36,,,0,"percent of total billed charges ","90% of total billed charges ",7428.84,93,,5943.07,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",498.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",6789.8,85,,5431.84,,,0,"percent of total billed charges ","85% of total billed charges ",7189.2,90,,5751.36,,,0,"percent of total billed charges ","90% of total billed charges ",7189.2,90,,5751.36,,,0,"percent of total billed charges ","90% of total billed charges ",493.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6949.56,87,,340.75,290.01,4996.03,"1 through 10","percent of total billed charges ","87% of total billed charges ",493.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",5591.6,70,,4473.28,,,0,"percent of total billed charges ","70% of total billed charges ",313.17,7428.84,
"CT AORTA RUNOFF ANGIOGRAPHY &",3202082,"CDM ",350,RC,75635,HCPCS,OUTPATIENT,,,8472.5,6778,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1249.77,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",893.07,220,,35.27,35.27,35.27,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",5930.75,70,,4744.60,,,0,"percent of total billed charges ","70% of total billed charges ",7625.25,90,,6100.20,,,0,"percent of total billed charges ","90% of total billed charges ",7879.43,93,,6303.54,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",281.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",7201.63,85,,5761.30,,,0,"percent of total billed charges ","85% of total billed charges ",7625.25,90,,6100.20,,,0,"percent of total billed charges ","90% of total billed charges ",7625.25,90,,6100.20,,,0,"percent of total billed charges ","90% of total billed charges ",278.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7371.08,87,,5896.86,,,0,"percent of total billed charges ","87% of total billed charges ",278.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",5930.75,70,,4744.60,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,7879.43,
"CT CHEST ANGIOGRAPHY W/WO & RE",3202124,"CDM ",350,RC,71275,HCPCS,OUTPATIENT,,,4705.5,3764.4,,180.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1143.85,100,,1163.80,1163.80,1163.80,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",613.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3293.85,70,,2635.08,,,0,"percent of total billed charges ","70% of total billed charges ",4234.95,90,,3387.96,,,0,"percent of total billed charges ","90% of total billed charges ",4376.12,93,,3500.90,,,0,"percent of total billed charges ","93% of total billed charges ",180.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",225.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3999.68,85,,3199.74,,,0,"percent of total billed charges ","85% of total billed charges ",4234.95,90,,3387.96,,,0,"percent of total billed charges ","90% of total billed charges ",4234.95,90,,3387.96,,,0,"percent of total billed charges ","90% of total billed charges ",223.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4093.79,87,,171.34,111.03,2083.85,"1 through 10","percent of total billed charges ","87% of total billed charges ",223.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3293.85,70,,2635.08,,,0,"percent of total billed charges ","70% of total billed charges ",161.3,4376.12,
"CT HEAD ANGIOGRAPHY W/WO & REC",3202207,"CDM ",350,RC,70496,HCPCS,OUTPATIENT,,,2921.5,2337.2,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1158.71,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",600.93,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2045.05,70,,1636.04,,,0,"percent of total billed charges ","70% of total billed charges ",2629.35,90,,2103.48,,,0,"percent of total billed charges ","90% of total billed charges ",2717,93,,2173.60,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",192.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2483.28,85,,1986.62,,,0,"percent of total billed charges ","85% of total billed charges ",2629.35,90,,2103.48,,,0,"percent of total billed charges ","90% of total billed charges ",2629.35,90,,2103.48,,,0,"percent of total billed charges ","90% of total billed charges ",190.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2541.71,87,,194.65,71.34,1459.58,"1 through 10","percent of total billed charges ","87% of total billed charges ",190.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2045.05,70,,1636.04,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,2717,
"CT LOWER EXTREMITY ANGIO BIL &",3202249,"CDM ",350,RC,73706,HCPCS,OUTPATIENT,,,7308.5,5846.8,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",708.42,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",5115.95,70,,4092.76,,,0,"percent of total billed charges ","70% of total billed charges ",6577.65,90,,5262.12,,,0,"percent of total billed charges ","90% of total billed charges ",6796.91,93,,5437.53,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",191.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",6212.23,85,,4969.78,,,0,"percent of total billed charges ","85% of total billed charges ",6577.65,90,,5262.12,,,0,"percent of total billed charges ","90% of total billed charges ",6577.65,90,,5262.12,,,0,"percent of total billed charges ","90% of total billed charges ",189.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6358.4,87,,5086.72,,,0,"percent of total billed charges ","87% of total billed charges ",189.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",5115.95,70,,4092.76,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,6796.91,
"CT LOWER EXTREMITY ANGIO LEFT",3202280,"CDM ",350,RC,73706,HCPCS,OUTPATIENT,,,3658,2926.4,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",708.42,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2560.6,70,,2048.48,,,0,"percent of total billed charges ","70% of total billed charges ",3292.2,90,,2633.76,,,0,"percent of total billed charges ","90% of total billed charges ",3401.94,93,,2721.55,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",191.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3109.3,85,,2487.44,,,0,"percent of total billed charges ","85% of total billed charges ",3292.2,90,,2633.76,,,0,"percent of total billed charges ","90% of total billed charges ",3292.2,90,,2633.76,,,0,"percent of total billed charges ","90% of total billed charges ",189.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3182.46,87,,2545.97,,,0,"percent of total billed charges ","87% of total billed charges ",189.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2560.6,70,,2048.48,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,3401.94,
"CT LOWER EXTREMITY ANGIO RIGHT",3202322,"CDM ",350,RC,73706,HCPCS,OUTPATIENT,,,3658,2926.4,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",708.42,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2560.6,70,,2048.48,,,0,"percent of total billed charges ","70% of total billed charges ",3292.2,90,,2633.76,,,0,"percent of total billed charges ","90% of total billed charges ",3401.94,93,,2721.55,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",191.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3109.3,85,,2487.44,,,0,"percent of total billed charges ","85% of total billed charges ",3292.2,90,,2633.76,,,0,"percent of total billed charges ","90% of total billed charges ",3292.2,90,,2633.76,,,0,"percent of total billed charges ","90% of total billed charges ",189.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3182.46,87,,2545.97,,,0,"percent of total billed charges ","87% of total billed charges ",189.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2560.6,70,,2048.48,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,3401.94,
"CT NECK ANGIOGRAPHY W/WO & REC",3202363,"CDM ",350,RC,70498,HCPCS,OUTPATIENT,,,3398,2718.4,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1159.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",600.23,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2378.6,70,,1902.88,,,0,"percent of total billed charges ","70% of total billed charges ",3058.2,90,,2446.56,,,0,"percent of total billed charges ","90% of total billed charges ",3160.14,93,,2528.11,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",192.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2888.3,85,,2310.64,,,0,"percent of total billed charges ","85% of total billed charges ",3058.2,90,,2446.56,,,0,"percent of total billed charges ","90% of total billed charges ",3058.2,90,,2446.56,,,0,"percent of total billed charges ","90% of total billed charges ",190.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2956.26,87,,2306.71,2306.71,2306.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",190.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2378.6,70,,1902.88,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,3160.14,
"CT HEAD/NECK ANGIO W/WO CONT",3202370,"CDM ",350,RC,70471,HCPCS,OUTPATIENT,,,3845,3076,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3076,80,,2460.80,,,0,"percent of total billed charges ","80% of total billed charges ",2691.5,70,,2153.20,,,0,"percent of total billed charges ","70% of total billed charges ",3460.5,90,,2768.40,,,0,"percent of total billed charges ","90% of total billed charges ",3575.85,93,,2860.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3268.25,85,,2614.60,,,0,"percent of total billed charges ","85% of total billed charges ",3460.5,90,,2768.40,,,0,"percent of total billed charges ","90% of total billed charges ",3460.5,90,,2768.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3345.15,87,,2676.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2691.5,70,,2153.20,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,3575.85,
"CT PELVIS ANGIO W/WO CONT",3202405,"CDM ",350,RC,72191,HCPCS,OUTPATIENT,,,4506.5,3605.2,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",670.47,220,,35.27,35.27,35.27,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",3154.55,70,,2523.64,,,0,"percent of total billed charges ","70% of total billed charges ",4055.85,90,,3244.68,,,0,"percent of total billed charges ","90% of total billed charges ",4191.05,93,,3352.84,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",212.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3830.53,85,,3064.42,,,0,"percent of total billed charges ","85% of total billed charges ",4055.85,90,,3244.68,,,0,"percent of total billed charges ","90% of total billed charges ",4055.85,90,,3244.68,,,0,"percent of total billed charges ","90% of total billed charges ",210.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3920.66,87,,3136.53,,,0,"percent of total billed charges ","87% of total billed charges ",210.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3154.55,70,,2523.64,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,4191.05,
"CT UP EXT ANGIO RT",3202447,"CDM ",350,RC,73206,HCPCS,OUTPATIENT,,,3530,2824,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",653.18,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2471,70,,1976.80,,,0,"percent of total billed charges ","70% of total billed charges ",3177,90,,2541.60,,,0,"percent of total billed charges ","90% of total billed charges ",3282.9,93,,2626.32,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",191.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3000.5,85,,2400.40,,,0,"percent of total billed charges ","85% of total billed charges ",3177,90,,2541.60,,,0,"percent of total billed charges ","90% of total billed charges ",3177,90,,2541.60,,,0,"percent of total billed charges ","90% of total billed charges ",189.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3071.1,87,,2456.88,,,0,"percent of total billed charges ","87% of total billed charges ",189.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2471,70,,1976.80,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,3282.9,
"CT UP EXT ANGIO BILAT",3202488,"CDM ",350,RC,73206,HCPCS,OUTPATIENT,,,7051,5640.8,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",653.18,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4935.7,70,,3948.56,,,0,"percent of total billed charges ","70% of total billed charges ",6345.9,90,,5076.72,,,0,"percent of total billed charges ","90% of total billed charges ",6557.43,93,,5245.94,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",191.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5993.35,85,,4794.68,,,0,"percent of total billed charges ","85% of total billed charges ",6345.9,90,,5076.72,,,0,"percent of total billed charges ","90% of total billed charges ",6345.9,90,,5076.72,,,0,"percent of total billed charges ","90% of total billed charges ",189.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6134.37,87,,4907.50,,,0,"percent of total billed charges ","87% of total billed charges ",189.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4935.7,70,,3948.56,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,6557.43,
"CT UP EXT ANGIO LEFT",3202520,"CDM ",350,RC,73206,HCPCS,OUTPATIENT,,,3530,2824,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",653.18,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2471,70,,1976.80,,,0,"percent of total billed charges ","70% of total billed charges ",3177,90,,2541.60,,,0,"percent of total billed charges ","90% of total billed charges ",3282.9,93,,2626.32,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",191.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3000.5,85,,2400.40,,,0,"percent of total billed charges ","85% of total billed charges ",3177,90,,2541.60,,,0,"percent of total billed charges ","90% of total billed charges ",3177,90,,2541.60,,,0,"percent of total billed charges ","90% of total billed charges ",189.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3071.1,87,,2456.88,,,0,"percent of total billed charges ","87% of total billed charges ",189.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2471,70,,1976.80,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,3282.9,
"CT ABDOMEN & PELVIS W CONTRAST",3209905,"CDM ",350,RC,74177,HCPCS,OUTPATIENT,,,6178.5,4942.8,,,,,,,,0,"other ","not separately reimbursment ",480.41,100,,49.36,49.36,49.36,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",674.67,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4324.95,70,,3459.96,,,0,"percent of total billed charges ","70% of total billed charges ",5560.65,90,,4448.52,,,0,"percent of total billed charges ","90% of total billed charges ",5746.01,93,,4596.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",152.9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5251.73,85,,4201.38,,,0,"percent of total billed charges ","85% of total billed charges ",5560.65,90,,4448.52,,,0,"percent of total billed charges ","90% of total billed charges ",5560.65,90,,4448.52,,,0,"percent of total billed charges ","90% of total billed charges ",151.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5375.3,87,,3811.42,903.50,4764.27,13,"percent of total billed charges ","87% of total billed charges ",151.39,100,,212.58,212.58,212.58,"1 through 10","fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4324.95,70,,3459.96,,,0,"percent of total billed charges ","70% of total billed charges ",151.39,5746.01,
"CT ABDOMEN & PELVIS WO CONTRAS",3209913,"CDM ",350,RC,74176,HCPCS,OUTPATIENT,,,5629,4503.2,,,,,,,,0,"other ","not separately reimbursment ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",400.03,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3940.3,70,,3152.24,,,0,"percent of total billed charges ","70% of total billed charges ",5066.1,90,,4052.88,,,0,"percent of total billed charges ","90% of total billed charges ",5234.97,93,,4187.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",80.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4784.65,85,,3827.72,,,0,"percent of total billed charges ","85% of total billed charges ",5066.1,90,,4052.88,,,0,"percent of total billed charges ","90% of total billed charges ",5066.1,90,,4052.88,,,0,"percent of total billed charges ","90% of total billed charges ",79.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4897.23,87,,3472.48,844.66,3472.48,"1 through 10","percent of total billed charges ","87% of total billed charges ",79.44,100,,187.71,187.71,187.71,"1 through 10","fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3940.3,70,,3152.24,,,0,"percent of total billed charges ","70% of total billed charges ",79.44,5234.97,
"CT ABDOMEN & PELVIS W/WO CONTR",3209921,"CDM ",350,RC,74178,HCPCS,OUTPATIENT,,,6974,5579.2,,,,,,,,0,"other ","not separately reimbursment ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",755.52,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4881.8,70,,3905.44,,,0,"percent of total billed charges ","70% of total billed charges ",6276.6,90,,5021.28,,,0,"percent of total billed charges ","90% of total billed charges ",6485.82,93,,5188.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",202.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5927.9,85,,4742.32,,,0,"percent of total billed charges ","85% of total billed charges ",6276.6,90,,5021.28,,,0,"percent of total billed charges ","90% of total billed charges ",6276.6,90,,5021.28,,,0,"percent of total billed charges ","90% of total billed charges ",200.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6067.38,87,,4213.97,1120.12,4893.19,"1 through 10","percent of total billed charges ","87% of total billed charges ",200.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4881.8,70,,3905.44,,,0,"percent of total billed charges ","70% of total billed charges ",200.25,6485.82,
"CT UPPER EXT W/ &W/O CONT BIL",3210020,"CDM ",352,RC,73202,HCPCS,OUTPATIENT,,,3158.5,2526.8,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,575.02,575.02,575.02,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",550.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2210.95,70,,1768.76,,,0,"percent of total billed charges ","70% of total billed charges ",2842.65,90,,2274.12,,,0,"percent of total billed charges ","90% of total billed charges ",2937.41,93,,2349.93,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",191.22,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2684.73,85,,2147.78,,,0,"percent of total billed charges ","85% of total billed charges ",2842.65,90,,2274.12,,,0,"percent of total billed charges ","90% of total billed charges ",2842.65,90,,2274.12,,,0,"percent of total billed charges ","90% of total billed charges ",189.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2747.9,87,,2198.32,,,0,"percent of total billed charges ","87% of total billed charges ",189.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2210.95,70,,1768.76,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,2937.41,
"CT HIGH RESOLUTE CHEST INSP/EX",3210060,"CDM ",352,RC,76380,HCPCS,OUTPATIENT,,,1968.5,1574.8,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",288.22,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1377.95,70,,1102.36,,,0,"percent of total billed charges ","70% of total billed charges ",1771.65,90,,1417.32,,,0,"percent of total billed charges ","90% of total billed charges ",1830.71,93,,1464.57,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1673.23,85,,1338.58,,,0,"percent of total billed charges ","85% of total billed charges ",1771.65,90,,1417.32,,,0,"percent of total billed charges ","90% of total billed charges ",1771.65,90,,1417.32,,,0,"percent of total billed charges ","90% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1712.6,87,,1370.08,,,0,"percent of total billed charges ","87% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1377.95,70,,1102.36,,,0,"percent of total billed charges ","70% of total billed charges ",39.25,1830.71,
"CT FACIAL W/WO IV CONTRAST",3210070,"CDM ",351,RC,70488,HCPCS,OUTPATIENT,,,2179.5,1743.6,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",405.02,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1525.65,70,,1220.52,,,0,"percent of total billed charges ","70% of total billed charges ",1961.55,90,,1569.24,,,0,"percent of total billed charges ","90% of total billed charges ",2026.94,93,,1621.55,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1852.58,85,,1482.06,,,0,"percent of total billed charges ","85% of total billed charges ",1961.55,90,,1569.24,,,0,"percent of total billed charges ","90% of total billed charges ",1961.55,90,,1569.24,,,0,"percent of total billed charges ","90% of total billed charges ",183.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1896.17,87,,1516.94,,,0,"percent of total billed charges ","87% of total billed charges ",183.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1525.65,70,,1220.52,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,2026.94,
"*CT GUIDANCE",3210100,"CDM ",359,RC,77012,HCPCS,OUTPATIENT,,,2387,1909.6,,,,,,,,0,"other ","not separately reimbursment ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",300.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1670.9,70,,1336.72,,,0,"percent of total billed charges ","70% of total billed charges ",2148.3,90,,1718.64,,,0,"percent of total billed charges ","90% of total billed charges ",2219.91,93,,1775.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",157.72,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2028.95,85,,1623.16,,,0,"percent of total billed charges ","85% of total billed charges ",2148.3,90,,1718.64,,,0,"percent of total billed charges ","90% of total billed charges ",2148.3,90,,1718.64,,,0,"percent of total billed charges ","90% of total billed charges ",156.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2076.69,87,,1661.35,,,0,"percent of total billed charges ","87% of total billed charges ",156.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1670.9,70,,1336.72,,,0,"percent of total billed charges ","70% of total billed charges ",156.16,2219.91,
"*CT GUIDANCE",3210120,"CDM ",359,RC,75989,HCPCS,OUTPATIENT,,,2951.5,2361.2,,85.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",241.67,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2066.05,70,,1652.84,,,0,"percent of total billed charges ","70% of total billed charges ",2656.35,90,,2125.08,,,0,"percent of total billed charges ","90% of total billed charges ",2744.9,93,,2195.92,,,0,"percent of total billed charges ","93% of total billed charges ",85.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",92.5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2508.78,85,,2007.02,,,0,"percent of total billed charges ","85% of total billed charges ",2656.35,90,,2125.08,,,0,"percent of total billed charges ","90% of total billed charges ",2656.35,90,,2125.08,,,0,"percent of total billed charges ","90% of total billed charges ",91.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2567.81,87,,2054.25,,,0,"percent of total billed charges ","87% of total billed charges ",91.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2066.05,70,,1652.84,,,0,"percent of total billed charges ","70% of total billed charges ",85.05,2744.9,
"CT FACIAL W/IV CONTRAST",3210130,"CDM ",351,RC,70487,HCPCS,OUTPATIENT,,,1959,1567.2,,153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,575.02,575.02,575.02,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",332.13,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1371.3,70,,1097.04,,,0,"percent of total billed charges ","70% of total billed charges ",1763.1,90,,1410.48,,,0,"percent of total billed charges ","90% of total billed charges ",1821.87,93,,1457.50,,,0,"percent of total billed charges ","93% of total billed charges ",153.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",158.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1665.15,85,,1332.12,,,0,"percent of total billed charges ","85% of total billed charges ",1763.1,90,,1410.48,,,0,"percent of total billed charges ","90% of total billed charges ",1763.1,90,,1410.48,,,0,"percent of total billed charges ","90% of total billed charges ",157.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1704.33,87,,1363.46,,,0,"percent of total billed charges ","87% of total billed charges ",157.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",161.3,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1371.3,70,,1097.04,,,0,"percent of total billed charges ","70% of total billed charges ",153.29,1821.87,
"CT UROGRAM W/ W/O IV CONTRAST",3210140,"CDM ",350,RC,74178,HCPCS,OUTPATIENT,,,6974,5579.2,,,,,,,,0,"other ","not separately reimbursment ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",755.52,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4881.8,70,,3905.44,,,0,"percent of total billed charges ","70% of total billed charges ",6276.6,90,,5021.28,,,0,"percent of total billed charges ","90% of total billed charges ",6485.82,93,,5188.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",202.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5927.9,85,,4742.32,,,0,"percent of total billed charges ","85% of total billed charges ",6276.6,90,,5021.28,,,0,"percent of total billed charges ","90% of total billed charges ",6276.6,90,,5021.28,,,0,"percent of total billed charges ","90% of total billed charges ",200.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6067.38,87,,4213.97,1120.12,4893.19,"1 through 10","percent of total billed charges ","87% of total billed charges ",200.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4881.8,70,,3905.44,,,0,"percent of total billed charges ","70% of total billed charges ",200.25,6485.82,
"CT ARTHROGRAM SHLDR LT W/CONT",3210150,"CDM ",352,RC,73201,HCPCS,OUTPATIENT,,,1195,956,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,571.60,571.60,571.60,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",440.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",836.5,70,,669.20,,,0,"percent of total billed charges ","70% of total billed charges ",1075.5,90,,860.40,,,0,"percent of total billed charges ","90% of total billed charges ",1111.35,93,,889.08,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",158.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1015.75,85,,812.60,,,0,"percent of total billed charges ","85% of total billed charges ",1075.5,90,,860.40,,,0,"percent of total billed charges ","90% of total billed charges ",1075.5,90,,860.40,,,0,"percent of total billed charges ","90% of total billed charges ",157.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1039.65,87,,1549.18,1549.18,1549.18,"1 through 10","percent of total billed charges ","87% of total billed charges ",157.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",836.5,70,,669.20,,,0,"percent of total billed charges ","70% of total billed charges ",157.12,1111.35,
"CT ARTHROGRAM SHLDR RT W/CONT",3210160,"CDM ",352,RC,73201,HCPCS,OUTPATIENT,,,1195,956,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,571.60,571.60,571.60,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",440.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",836.5,70,,669.20,,,0,"percent of total billed charges ","70% of total billed charges ",1075.5,90,,860.40,,,0,"percent of total billed charges ","90% of total billed charges ",1111.35,93,,889.08,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",158.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1015.75,85,,812.60,,,0,"percent of total billed charges ","85% of total billed charges ",1075.5,90,,860.40,,,0,"percent of total billed charges ","90% of total billed charges ",1075.5,90,,860.40,,,0,"percent of total billed charges ","90% of total billed charges ",157.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1039.65,87,,1549.18,1549.18,1549.18,"1 through 10","percent of total billed charges ","87% of total billed charges ",157.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",836.5,70,,669.20,,,0,"percent of total billed charges ","70% of total billed charges ",157.12,1111.35,
"CT CHEST SCRN LOW DOSE WO CONT",3210165,"CDM ",352,RC,71271,HCPCS,OUTPATIENT,,,2963.5,2370.8,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",299.29,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2074.45,70,,1659.56,,,0,"percent of total billed charges ","70% of total billed charges ",2667.15,90,,2133.72,,,0,"percent of total billed charges ","90% of total billed charges ",2756.06,93,,2204.85,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",73.13,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2518.98,85,,2015.18,,,0,"percent of total billed charges ","85% of total billed charges ",2667.15,90,,2133.72,,,0,"percent of total billed charges ","90% of total billed charges ",2667.15,90,,2133.72,,,0,"percent of total billed charges ","90% of total billed charges ",72.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2578.25,87,,2285.16,2285.16,2285.16,"1 through 10","percent of total billed charges ","87% of total billed charges ",72.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2074.45,70,,1659.56,,,0,"percent of total billed charges ","70% of total billed charges ",72.41,2756.06,
"US AMNIOCENTESIS",3400017,"CDM ",402,RC,76946,HCPCS,OUTPATIENT,,,2396,1916.8,,60.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",92.92,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",67.63,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1677.2,70,,1341.76,,,0,"percent of total billed charges ","70% of total billed charges ",2156.4,90,,1725.12,,,0,"percent of total billed charges ","90% of total billed charges ",2228.28,93,,1782.62,,,0,"percent of total billed charges ","93% of total billed charges ",60.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",50.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2036.6,85,,1629.28,,,0,"percent of total billed charges ","85% of total billed charges ",2156.4,90,,1725.12,,,0,"percent of total billed charges ","90% of total billed charges ",2156.4,90,,1725.12,,,0,"percent of total billed charges ","90% of total billed charges ",49.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2084.52,87,,1667.62,,,0,"percent of total billed charges ","87% of total billed charges ",49.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1677.2,70,,1341.76,,,0,"percent of total billed charges ","70% of total billed charges ",49.92,2228.28,
"US SPLEEN",3400025,"CDM ",402,RC,76705,HCPCS,OUTPATIENT,,,1453.5,1162.8,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.94,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",184.91,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1017.45,70,,813.96,,,0,"percent of total billed charges ","70% of total billed charges ",1308.15,90,,1046.52,,,0,"percent of total billed charges ","90% of total billed charges ",1351.76,93,,1081.41,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",49.3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1235.48,85,,988.38,,,0,"percent of total billed charges ","85% of total billed charges ",1308.15,90,,1046.52,,,0,"percent of total billed charges ","90% of total billed charges ",1308.15,90,,1046.52,,,0,"percent of total billed charges ","90% of total billed charges ",48.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1264.55,87,,871.19,418.96,1008.33,"1 through 10","percent of total billed charges ","87% of total billed charges ",48.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1017.45,70,,813.96,,,0,"percent of total billed charges ","70% of total billed charges ",48.81,1351.76,
"US LIVER",3400033,"CDM ",402,RC,76705,HCPCS,OUTPATIENT,,,1453.5,1162.8,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.94,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",184.91,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1017.45,70,,813.96,,,0,"percent of total billed charges ","70% of total billed charges ",1308.15,90,,1046.52,,,0,"percent of total billed charges ","90% of total billed charges ",1351.76,93,,1081.41,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",49.3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1235.48,85,,988.38,,,0,"percent of total billed charges ","85% of total billed charges ",1308.15,90,,1046.52,,,0,"percent of total billed charges ","90% of total billed charges ",1308.15,90,,1046.52,,,0,"percent of total billed charges ","90% of total billed charges ",48.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1264.55,87,,871.19,418.96,1008.33,"1 through 10","percent of total billed charges ","87% of total billed charges ",48.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1017.45,70,,813.96,,,0,"percent of total billed charges ","70% of total billed charges ",48.81,1351.76,
"US BREAST BILATERAL",3400041,"CDM ",402,RC,76641,HCPCS,OUTPATIENT,,,1530.5,1224.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",94.94,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",217.69,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1071.35,70,,857.08,,,0,"percent of total billed charges ","70% of total billed charges ",1377.45,90,,1101.96,,,0,"percent of total billed charges ","90% of total billed charges ",1423.37,93,,1138.70,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1300.93,85,,1040.74,,,0,"percent of total billed charges ","85% of total billed charges ",1377.45,90,,1101.96,,,0,"percent of total billed charges ","90% of total billed charges ",1377.45,90,,1101.96,,,0,"percent of total billed charges ","90% of total billed charges ",53.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1331.54,87,,102.35,38.75,103.23,"1 through 10","percent of total billed charges ","87% of total billed charges ",53.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1071.35,70,,857.08,,,0,"percent of total billed charges ","70% of total billed charges ",53.43,1423.37,
"US GALL BLADDER",3400058,"CDM ",402,RC,76705,HCPCS,OUTPATIENT,,,1466,1172.8,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.94,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",184.91,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1026.2,70,,820.96,,,0,"percent of total billed charges ","70% of total billed charges ",1319.4,90,,1055.52,,,0,"percent of total billed charges ","90% of total billed charges ",1363.38,93,,1090.70,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",49.3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1246.1,85,,996.88,,,0,"percent of total billed charges ","85% of total billed charges ",1319.4,90,,1055.52,,,0,"percent of total billed charges ","90% of total billed charges ",1319.4,90,,1055.52,,,0,"percent of total billed charges ","90% of total billed charges ",48.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1275.42,87,,871.19,418.96,1008.33,"1 through 10","percent of total billed charges ","87% of total billed charges ",48.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1026.2,70,,820.96,,,0,"percent of total billed charges ","70% of total billed charges ",48.81,1363.38,
"US EXT SOFT TISSUE",3400066,"CDM ",402,RC,76881,HCPCS,OUTPATIENT,,,1161.5,929.2,,,,,,,,0,"other ","not separately reimbursment ",117.16,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",123.66,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",813.05,70,,650.44,,,0,"percent of total billed charges ","70% of total billed charges ",1045.35,90,,836.28,,,0,"percent of total billed charges ","90% of total billed charges ",1080.2,93,,864.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",52.45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",987.28,85,,789.82,,,0,"percent of total billed charges ","85% of total billed charges ",1045.35,90,,836.28,,,0,"percent of total billed charges ","90% of total billed charges ",1045.35,90,,836.28,,,0,"percent of total billed charges ","90% of total billed charges ",51.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1010.51,87,,808.41,,,0,"percent of total billed charges ","87% of total billed charges ",51.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",813.05,70,,650.44,,,0,"percent of total billed charges ","70% of total billed charges ",51.93,1080.2,
"US PANCREAS",3400074,"CDM ",402,RC,76705,HCPCS,OUTPATIENT,,,1455.5,1164.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.94,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",184.91,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1018.85,70,,815.08,,,0,"percent of total billed charges ","70% of total billed charges ",1309.95,90,,1047.96,,,0,"percent of total billed charges ","90% of total billed charges ",1353.62,93,,1082.90,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",49.3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1237.18,85,,989.74,,,0,"percent of total billed charges ","85% of total billed charges ",1309.95,90,,1047.96,,,0,"percent of total billed charges ","90% of total billed charges ",1309.95,90,,1047.96,,,0,"percent of total billed charges ","90% of total billed charges ",48.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1266.29,87,,871.19,418.96,1008.33,"1 through 10","percent of total billed charges ","87% of total billed charges ",48.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1018.85,70,,815.08,,,0,"percent of total billed charges ","70% of total billed charges ",48.81,1353.62,
"US AORTA",3400082,"CDM ",402,RC,76770,HCPCS,OUTPATIENT,,,1470,1176,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",151.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",229.5,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1029,70,,823.20,,,0,"percent of total billed charges ","70% of total billed charges ",1323,90,,1058.40,,,0,"percent of total billed charges ","90% of total billed charges ",1367.1,93,,1093.68,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",79.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1249.5,85,,999.60,,,0,"percent of total billed charges ","85% of total billed charges ",1323,90,,1058.40,,,0,"percent of total billed charges ","90% of total billed charges ",1323,90,,1058.40,,,0,"percent of total billed charges ","90% of total billed charges ",78.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1278.9,87,,495.14,165.09,825.18,"1 through 10","percent of total billed charges ","87% of total billed charges ",78.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1029,70,,823.20,,,0,"percent of total billed charges ","70% of total billed charges ",78.9,1367.1,
"US PED HIP W/PHYSICIAN",3400090,"CDM ",402,RC,76885,HCPCS,OUTPATIENT,,,1021.5,817.2,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",289.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",715.05,70,,572.04,,,0,"percent of total billed charges ","70% of total billed charges ",919.35,90,,735.48,,,0,"percent of total billed charges ","90% of total billed charges ",950,93,,760.00,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",49.55,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",868.28,85,,694.62,,,0,"percent of total billed charges ","85% of total billed charges ",919.35,90,,735.48,,,0,"percent of total billed charges ","90% of total billed charges ",919.35,90,,735.48,,,0,"percent of total billed charges ","90% of total billed charges ",49.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",888.71,87,,710.97,,,0,"percent of total billed charges ","87% of total billed charges ",49.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",715.05,70,,572.04,,,0,"percent of total billed charges ","70% of total billed charges ",49.06,950,
"US RENAL",3400108,"CDM ",402,RC,76770,HCPCS,OUTPATIENT,,,1298,1038.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",151.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",229.5,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",908.6,70,,726.88,,,0,"percent of total billed charges ","70% of total billed charges ",1168.2,90,,934.56,,,0,"percent of total billed charges ","90% of total billed charges ",1207.14,93,,965.71,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",79.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1103.3,85,,882.64,,,0,"percent of total billed charges ","85% of total billed charges ",1168.2,90,,934.56,,,0,"percent of total billed charges ","90% of total billed charges ",1168.2,90,,934.56,,,0,"percent of total billed charges ","90% of total billed charges ",78.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1129.26,87,,495.14,165.09,825.18,"1 through 10","percent of total billed charges ","87% of total billed charges ",78.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",908.6,70,,726.88,,,0,"percent of total billed charges ","70% of total billed charges ",78.9,1207.14,
"US PELVIS",3400116,"CDM ",402,RC,76856,HCPCS,OUTPATIENT,,,1549,1239.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",123.22,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",223.63,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1084.3,70,,867.44,,,0,"percent of total billed charges ","70% of total billed charges ",1394.1,90,,1115.28,,,0,"percent of total billed charges ","90% of total billed charges ",1440.57,93,,1152.46,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.36,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1316.65,85,,1053.32,,,0,"percent of total billed charges ","85% of total billed charges ",1394.1,90,,1115.28,,,0,"percent of total billed charges ","90% of total billed charges ",1394.1,90,,1115.28,,,0,"percent of total billed charges ","90% of total billed charges ",64.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1347.63,87,,974.79,888.14,1061.44,"1 through 10","percent of total billed charges ","87% of total billed charges ",64.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1084.3,70,,867.44,,,0,"percent of total billed charges ","70% of total billed charges ",64.71,1440.57,
"US THYROID",3400124,"CDM ",402,RC,76536,HCPCS,OUTPATIENT,,,1111.5,889.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.76,100,,239.51,239.51,239.51,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",235.16,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",778.05,70,,622.44,,,0,"percent of total billed charges ","70% of total billed charges ",1000.35,90,,800.28,,,0,"percent of total billed charges ","90% of total billed charges ",1033.7,93,,826.96,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",944.78,85,,755.82,,,0,"percent of total billed charges ","85% of total billed charges ",1000.35,90,,800.28,,,0,"percent of total billed charges ","90% of total billed charges ",1000.35,90,,800.28,,,0,"percent of total billed charges ","90% of total billed charges ",25.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",967.01,87,,621.67,235.67,699.38,"1 through 10","percent of total billed charges ","87% of total billed charges ",25.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",778.05,70,,622.44,,,0,"percent of total billed charges ","70% of total billed charges ",25.9,1033.7,
"US OB >= 14 WKS ONE FETUS",3400132,"CDM ",402,RC,76805,HCPCS,OUTPATIENT,,,1159,927.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.31,100,,113.44,113.44,113.44,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",285.19,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",811.3,70,,649.04,,,0,"percent of total billed charges ","70% of total billed charges ",1043.1,90,,834.48,,,0,"percent of total billed charges ","90% of total billed charges ",1077.87,93,,862.30,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",76.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",985.15,85,,788.12,,,0,"percent of total billed charges ","85% of total billed charges ",1043.1,90,,834.48,,,0,"percent of total billed charges ","90% of total billed charges ",1043.1,90,,834.48,,,0,"percent of total billed charges ","90% of total billed charges ",76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1008.33,87,,93.89,93.89,537.35,"1 through 10","percent of total billed charges ","87% of total billed charges ",76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",811.3,70,,649.04,,,0,"percent of total billed charges ","70% of total billed charges ",76,1077.87,
"US OB LIMITED",3400140,"CDM ",402,RC,76815,HCPCS,OUTPATIENT,,,429.5,343.6,,,,,,,,0,"other ","not separately reimbursment ",141.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",171.51,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",300.65,70,,240.52,,,0,"percent of total billed charges ","70% of total billed charges ",386.55,90,,309.24,,,0,"percent of total billed charges ","90% of total billed charges ",399.44,93,,319.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",51.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",365.08,85,,292.06,,,0,"percent of total billed charges ","85% of total billed charges ",386.55,90,,309.24,,,0,"percent of total billed charges ","90% of total billed charges ",386.55,90,,309.24,,,0,"percent of total billed charges ","90% of total billed charges ",50.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.67,87,,42.88,42.88,42.88,"1 through 10","percent of total billed charges ","87% of total billed charges ",50.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",300.65,70,,240.52,,,0,"percent of total billed charges ","70% of total billed charges ",50.74,399.44,
"US ABDOMEN",3400157,"CDM ",402,RC,76700,HCPCS,OUTPATIENT,,,1515,1212,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",151.5,100,,36.27,36.27,36.27,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",247.98,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1060.5,70,,848.40,,,0,"percent of total billed charges ","70% of total billed charges ",1363.5,90,,1090.80,,,0,"percent of total billed charges ","90% of total billed charges ",1408.95,93,,1127.16,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",79.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1287.75,85,,1030.20,,,0,"percent of total billed charges ","85% of total billed charges ",1363.5,90,,1090.80,,,0,"percent of total billed charges ","90% of total billed charges ",1363.5,90,,1090.80,,,0,"percent of total billed charges ","90% of total billed charges ",78.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1318.05,87,,733.16,733.16,733.16,"1 through 10","percent of total billed charges ","87% of total billed charges ",78.9,100,,82.57,82.57,82.57,"1 through 10","fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1060.5,70,,848.40,,,0,"percent of total billed charges ","70% of total billed charges ",78.9,1408.95,
"US CAROTID BILATERAL",3400165,"CDM ",921,RC,93880,HCPCS,OUTPATIENT,,,1386.5,1109.2,,177.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",400.36,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",970.55,70,,776.44,,,0,"percent of total billed charges ","70% of total billed charges ",1247.85,90,,998.28,,,0,"percent of total billed charges ","90% of total billed charges ",1289.45,93,,1031.56,,,0,"percent of total billed charges ","93% of total billed charges ",177.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",164.58,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1178.53,85,,942.82,,,0,"percent of total billed charges ","85% of total billed charges ",1247.85,90,,998.28,,,0,"percent of total billed charges ","90% of total billed charges ",1247.85,90,,998.28,,,0,"percent of total billed charges ","90% of total billed charges ",162.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1206.26,87,,143.99,32.76,744.51,"1 through 10","percent of total billed charges ","87% of total billed charges ",162.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",970.55,70,,776.44,,,0,"percent of total billed charges ","70% of total billed charges ",162.95,1289.45,
"US THORACENTESIS/LOCATION",3400173,"CDM ",402,RC,76942,HCPCS,OUTPATIENT,,,1116.5,893.2,,44.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",120.19,100,,143.86,143.86,143.86,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",121.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",781.55,70,,625.24,,,0,"percent of total billed charges ","70% of total billed charges ",1004.85,90,,803.88,,,0,"percent of total billed charges ","90% of total billed charges ",1038.35,93,,830.68,,,0,"percent of total billed charges ","93% of total billed charges ",44.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",949.03,85,,759.22,,,0,"percent of total billed charges ","85% of total billed charges ",1004.85,90,,803.88,,,0,"percent of total billed charges ","90% of total billed charges ",1004.85,90,,803.88,,,0,"percent of total billed charges ","90% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",971.36,87,,219.38,219.38,219.38,"1 through 10","percent of total billed charges ","87% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",781.55,70,,625.24,,,0,"percent of total billed charges ","70% of total billed charges ",39.25,1038.35,
"US PROSTATE TRANSREC",3400181,"CDM ",402,RC,76872,HCPCS,OUTPATIENT,,,1161,928.8,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",101,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",425.83,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",812.7,70,,650.16,,,0,"percent of total billed charges ","70% of total billed charges ",1044.9,90,,835.92,,,0,"percent of total billed charges ","90% of total billed charges ",1079.73,93,,863.78,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.01,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",986.85,85,,789.48,,,0,"percent of total billed charges ","85% of total billed charges ",1044.9,90,,835.92,,,0,"percent of total billed charges ","90% of total billed charges ",1044.9,90,,835.92,,,0,"percent of total billed charges ","90% of total billed charges ",61.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1010.07,87,,808.06,,,0,"percent of total billed charges ","87% of total billed charges ",61.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",812.7,70,,650.16,,,0,"percent of total billed charges ","70% of total billed charges ",61.4,1079.73,
"US CYST ASPIRATION",3400199,"CDM ",402,RC,76942,HCPCS,OUTPATIENT,,,1116.5,893.2,,44.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",120.19,100,,143.86,143.86,143.86,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",121.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",781.55,70,,625.24,,,0,"percent of total billed charges ","70% of total billed charges ",1004.85,90,,803.88,,,0,"percent of total billed charges ","90% of total billed charges ",1038.35,93,,830.68,,,0,"percent of total billed charges ","93% of total billed charges ",44.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",949.03,85,,759.22,,,0,"percent of total billed charges ","85% of total billed charges ",1004.85,90,,803.88,,,0,"percent of total billed charges ","90% of total billed charges ",1004.85,90,,803.88,,,0,"percent of total billed charges ","90% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",971.36,87,,219.38,219.38,219.38,"1 through 10","percent of total billed charges ","87% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",781.55,70,,625.24,,,0,"percent of total billed charges ","70% of total billed charges ",39.25,1038.35,
"US NEEDLE BIOPSY",3400207,"CDM ",402,RC,76942,HCPCS,OUTPATIENT,,,1116.5,893.2,,44.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",120.19,100,,143.86,143.86,143.86,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",121.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",781.55,70,,625.24,,,0,"percent of total billed charges ","70% of total billed charges ",1004.85,90,,803.88,,,0,"percent of total billed charges ","90% of total billed charges ",1038.35,93,,830.68,,,0,"percent of total billed charges ","93% of total billed charges ",44.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",949.03,85,,759.22,,,0,"percent of total billed charges ","85% of total billed charges ",1004.85,90,,803.88,,,0,"percent of total billed charges ","90% of total billed charges ",1004.85,90,,803.88,,,0,"percent of total billed charges ","90% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",971.36,87,,219.38,219.38,219.38,"1 through 10","percent of total billed charges ","87% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",781.55,70,,625.24,,,0,"percent of total billed charges ","70% of total billed charges ",39.25,1038.35,
"US NON-OB TRANSVAGINAL",3400215,"CDM ",402,RC,76830,HCPCS,OUTPATIENT,,,1402.5,1122,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",123.22,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",252.67,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",981.75,70,,785.40,,,0,"percent of total billed charges ","70% of total billed charges ",1262.25,90,,1009.80,,,0,"percent of total billed charges ","90% of total billed charges ",1304.33,93,,1043.46,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.36,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1192.13,85,,953.70,,,0,"percent of total billed charges ","85% of total billed charges ",1262.25,90,,1009.80,,,0,"percent of total billed charges ","90% of total billed charges ",1262.25,90,,1009.80,,,0,"percent of total billed charges ","90% of total billed charges ",64.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1220.18,87,,607.70,76.05,980.53,"1 through 10","percent of total billed charges ","87% of total billed charges ",64.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",981.75,70,,785.40,,,0,"percent of total billed charges ","70% of total billed charges ",64.71,1304.33,
"RENAL WITH BLADDER RENTENTION",3400223,"CDM ",402,RC,76770,HCPCS,OUTPATIENT,,,1617,1293.6,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",151.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",229.5,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1131.9,70,,905.52,,,0,"percent of total billed charges ","70% of total billed charges ",1455.3,90,,1164.24,,,0,"percent of total billed charges ","90% of total billed charges ",1503.81,93,,1203.05,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",79.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1374.45,85,,1099.56,,,0,"percent of total billed charges ","85% of total billed charges ",1455.3,90,,1164.24,,,0,"percent of total billed charges ","90% of total billed charges ",1455.3,90,,1164.24,,,0,"percent of total billed charges ","90% of total billed charges ",78.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1406.79,87,,495.14,165.09,825.18,"1 through 10","percent of total billed charges ","87% of total billed charges ",78.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1131.9,70,,905.52,,,0,"percent of total billed charges ","70% of total billed charges ",78.9,1503.81,
"US BREAST LEFT",3400256,"CDM ",402,RC,76641,HCPCS,OUTPATIENT,,,1116.5,893.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",94.94,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",217.69,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",781.55,70,,625.24,,,0,"percent of total billed charges ","70% of total billed charges ",1004.85,90,,803.88,,,0,"percent of total billed charges ","90% of total billed charges ",1038.35,93,,830.68,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",949.03,85,,759.22,,,0,"percent of total billed charges ","85% of total billed charges ",1004.85,90,,803.88,,,0,"percent of total billed charges ","90% of total billed charges ",1004.85,90,,803.88,,,0,"percent of total billed charges ","90% of total billed charges ",53.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",971.36,87,,102.35,38.75,103.23,"1 through 10","percent of total billed charges ","87% of total billed charges ",53.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",781.55,70,,625.24,,,0,"percent of total billed charges ","70% of total billed charges ",53.43,1038.35,
"US BREAST RIGHT",3400264,"CDM ",402,RC,76641,HCPCS,OUTPATIENT,,,1116.5,893.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",94.94,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",217.69,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",781.55,70,,625.24,,,0,"percent of total billed charges ","70% of total billed charges ",1004.85,90,,803.88,,,0,"percent of total billed charges ","90% of total billed charges ",1038.35,93,,830.68,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",949.03,85,,759.22,,,0,"percent of total billed charges ","85% of total billed charges ",1004.85,90,,803.88,,,0,"percent of total billed charges ","90% of total billed charges ",1004.85,90,,803.88,,,0,"percent of total billed charges ","90% of total billed charges ",53.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",971.36,87,,102.35,38.75,103.23,"1 through 10","percent of total billed charges ","87% of total billed charges ",53.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",781.55,70,,625.24,,,0,"percent of total billed charges ","70% of total billed charges ",53.43,1038.35,
"US DUPLEX A/V COMP SM PTS",3400298,"CDM ",921,RC,93975,HCPCS,OUTPATIENT,,,3316.5,2653.2,,137.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",556.69,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2321.55,70,,1857.24,,,0,"percent of total billed charges ","70% of total billed charges ",2984.85,90,,2387.88,,,0,"percent of total billed charges ","90% of total billed charges ",3084.35,93,,2467.48,,,0,"percent of total billed charges ","93% of total billed charges ",137.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2819.03,85,,2255.22,,,0,"percent of total billed charges ","85% of total billed charges ",2984.85,90,,2387.88,,,0,"percent of total billed charges ","90% of total billed charges ",2984.85,90,,2387.88,,,0,"percent of total billed charges ","90% of total billed charges ",53.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2885.36,87,,2308.29,,,0,"percent of total billed charges ","87% of total billed charges ",53.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2321.55,70,,1857.24,,,0,"percent of total billed charges ","70% of total billed charges ",53.64,3084.35,
"US TESTICULAR",3400306,"CDM ",402,RC,76870,HCPCS,OUTPATIENT,,,1351.5,1081.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",123.22,100,,118.02,118.02,118.02,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",212.92,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",946.05,70,,756.84,,,0,"percent of total billed charges ","70% of total billed charges ",1216.35,90,,973.08,,,0,"percent of total billed charges ","90% of total billed charges ",1256.9,93,,1005.52,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.58,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1148.78,85,,919.02,,,0,"percent of total billed charges ","85% of total billed charges ",1216.35,90,,973.08,,,0,"percent of total billed charges ","90% of total billed charges ",1216.35,90,,973.08,,,0,"percent of total billed charges ","90% of total billed charges ",46.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1175.81,87,,156.14,156.14,156.14,"1 through 10","percent of total billed charges ","87% of total billed charges ",46.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",946.05,70,,756.84,,,0,"percent of total billed charges ","70% of total billed charges ",46.12,1256.9,
"US ABDOMEN SINGLE QUAD",3400330,"CDM ",402,RC,76705,HCPCS,OUTPATIENT,,,1418.5,1134.8,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.94,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",184.91,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",992.95,70,,794.36,,,0,"percent of total billed charges ","70% of total billed charges ",1276.65,90,,1021.32,,,0,"percent of total billed charges ","90% of total billed charges ",1319.21,93,,1055.37,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",49.3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1205.73,85,,964.58,,,0,"percent of total billed charges ","85% of total billed charges ",1276.65,90,,1021.32,,,0,"percent of total billed charges ","90% of total billed charges ",1276.65,90,,1021.32,,,0,"percent of total billed charges ","90% of total billed charges ",48.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1234.1,87,,871.19,418.96,1008.33,"1 through 10","percent of total billed charges ","87% of total billed charges ",48.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",992.95,70,,794.36,,,0,"percent of total billed charges ","70% of total billed charges ",48.81,1319.21,
"US PED HEAD",3400348,"CDM ",402,RC,76506,HCPCS,OUTPATIENT,,,923.5,738.8,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",242.22,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",646.45,70,,517.16,,,0,"percent of total billed charges ","70% of total billed charges ",831.15,90,,664.92,,,0,"percent of total billed charges ","90% of total billed charges ",858.86,93,,687.09,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",784.98,85,,627.98,,,0,"percent of total billed charges ","85% of total billed charges ",831.15,90,,664.92,,,0,"percent of total billed charges ","90% of total billed charges ",831.15,90,,664.92,,,0,"percent of total billed charges ","90% of total billed charges ",56.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",803.45,87,,642.76,,,0,"percent of total billed charges ","87% of total billed charges ",56.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",646.45,70,,517.16,,,0,"percent of total billed charges ","70% of total billed charges ",56.67,858.86,
"US ARTERIES LOW EXT BILAT",3400363,"CDM ",921,RC,93925,HCPCS,OUTPATIENT,,,2354.5,1883.6,,177.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.76,100,,38.05,38.05,38.05,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",505.78,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1648.15,70,,1318.52,,,0,"percent of total billed charges ","70% of total billed charges ",2119.05,90,,1695.24,,,0,"percent of total billed charges ","90% of total billed charges ",2189.69,93,,1751.75,,,0,"percent of total billed charges ","93% of total billed charges ",177.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2001.33,85,,1601.06,,,0,"percent of total billed charges ","85% of total billed charges ",2119.05,90,,1695.24,,,0,"percent of total billed charges ","90% of total billed charges ",2119.05,90,,1695.24,,,0,"percent of total billed charges ","90% of total billed charges ",53.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2048.42,87,,102.34,102.34,102.34,"1 through 10","percent of total billed charges ","87% of total billed charges ",53.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1648.15,70,,1318.52,,,0,"percent of total billed charges ","70% of total billed charges ",53.64,2189.69,
"US FETAL BIOPHYS WO NST",3400371,"CDM ",402,RC,76819,HCPCS,OUTPATIENT,,,1324,1059.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",141.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",176.48,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",926.8,70,,741.44,,,0,"percent of total billed charges ","70% of total billed charges ",1191.6,90,,953.28,,,0,"percent of total billed charges ","90% of total billed charges ",1231.32,93,,985.06,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",49.55,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1125.4,85,,900.32,,,0,"percent of total billed charges ","85% of total billed charges ",1191.6,90,,953.28,,,0,"percent of total billed charges ","90% of total billed charges ",1191.6,90,,953.28,,,0,"percent of total billed charges ","90% of total billed charges ",49.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1151.88,87,,925.79,925.79,925.79,"1 through 10","percent of total billed charges ","87% of total billed charges ",49.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",926.8,70,,741.44,,,0,"percent of total billed charges ","70% of total billed charges ",49.06,1231.32,
"US CAROTID RIGHT",3400389,"CDM ",921,RC,93882,HCPCS,OUTPATIENT,,,814,651.2,,62.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",260.68,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",569.8,70,,455.84,,,0,"percent of total billed charges ","70% of total billed charges ",732.6,90,,586.08,,,0,"percent of total billed charges ","90% of total billed charges ",757.02,93,,605.62,,,0,"percent of total billed charges ","93% of total billed charges ",62.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",691.9,85,,553.52,,,0,"percent of total billed charges ","85% of total billed charges ",732.6,90,,586.08,,,0,"percent of total billed charges ","90% of total billed charges ",732.6,90,,586.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",708.18,87,,566.54,,,0,"percent of total billed charges ","87% of total billed charges ",35.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",569.8,70,,455.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.98,757.02,
"US CAROTID LEFT",3400397,"CDM ",921,RC,93882,HCPCS,OUTPATIENT,,,814,651.2,,62.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",260.68,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",569.8,70,,455.84,,,0,"percent of total billed charges ","70% of total billed charges ",732.6,90,,586.08,,,0,"percent of total billed charges ","90% of total billed charges ",757.02,93,,605.62,,,0,"percent of total billed charges ","93% of total billed charges ",62.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",691.9,85,,553.52,,,0,"percent of total billed charges ","85% of total billed charges ",732.6,90,,586.08,,,0,"percent of total billed charges ","90% of total billed charges ",732.6,90,,586.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",708.18,87,,566.54,,,0,"percent of total billed charges ","87% of total billed charges ",35.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",569.8,70,,455.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.98,757.02,
"US ARTERY LOW EXT RIGHT",3400405,"CDM ",921,RC,93926,HCPCS,OUTPATIENT,,,1289.5,1031.6,,108,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.76,100,,460.36,460.36,460.36,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",299.05,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",902.65,70,,722.12,,,0,"percent of total billed charges ","70% of total billed charges ",1160.55,90,,928.44,,,0,"percent of total billed charges ","90% of total billed charges ",1199.24,93,,959.39,,,0,"percent of total billed charges ","93% of total billed charges ",108,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1096.08,85,,876.86,,,0,"percent of total billed charges ","85% of total billed charges ",1160.55,90,,928.44,,,0,"percent of total billed charges ","90% of total billed charges ",1160.55,90,,928.44,,,0,"percent of total billed charges ","90% of total billed charges ",40.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1121.87,87,,897.50,,,0,"percent of total billed charges ","87% of total billed charges ",40.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",902.65,70,,722.12,,,0,"percent of total billed charges ","70% of total billed charges ",40.56,1199.24,
"US ARTERY LOW EXT LEFT",3400413,"CDM ",921,RC,93926,HCPCS,OUTPATIENT,,,1289.5,1031.6,,108,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.76,100,,460.36,460.36,460.36,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",299.05,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",902.65,70,,722.12,,,0,"percent of total billed charges ","70% of total billed charges ",1160.55,90,,928.44,,,0,"percent of total billed charges ","90% of total billed charges ",1199.24,93,,959.39,,,0,"percent of total billed charges ","93% of total billed charges ",108,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1096.08,85,,876.86,,,0,"percent of total billed charges ","85% of total billed charges ",1160.55,90,,928.44,,,0,"percent of total billed charges ","90% of total billed charges ",1160.55,90,,928.44,,,0,"percent of total billed charges ","90% of total billed charges ",40.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1121.87,87,,897.50,,,0,"percent of total billed charges ","87% of total billed charges ",40.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",902.65,70,,722.12,,,0,"percent of total billed charges ","70% of total billed charges ",40.56,1199.24,
"US ARTERIES UPPER EXT BIL",3400421,"CDM ",921,RC,93930,HCPCS,OUTPATIENT,,,2139.5,1711.6,,95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",409.68,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1497.65,70,,1198.12,,,0,"percent of total billed charges ","70% of total billed charges ",1925.55,90,,1540.44,,,0,"percent of total billed charges ","90% of total billed charges ",1989.74,93,,1591.79,,,0,"percent of total billed charges ","93% of total billed charges ",95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1818.58,85,,1454.86,,,0,"percent of total billed charges ","85% of total billed charges ",1925.55,90,,1540.44,,,0,"percent of total billed charges ","90% of total billed charges ",1925.55,90,,1540.44,,,0,"percent of total billed charges ","90% of total billed charges ",53.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1861.37,87,,1489.10,,,0,"percent of total billed charges ","87% of total billed charges ",53.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1497.65,70,,1198.12,,,0,"percent of total billed charges ","70% of total billed charges ",53.64,1989.74,
"US ARTERY UPPER EXT RIGHT",3400439,"CDM ",921,RC,93931,HCPCS,OUTPATIENT,,,1289.5,1031.6,,70.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",259.64,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",902.65,70,,722.12,,,0,"percent of total billed charges ","70% of total billed charges ",1160.55,90,,928.44,,,0,"percent of total billed charges ","90% of total billed charges ",1199.24,93,,959.39,,,0,"percent of total billed charges ","93% of total billed charges ",70.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1096.08,85,,876.86,,,0,"percent of total billed charges ","85% of total billed charges ",1160.55,90,,928.44,,,0,"percent of total billed charges ","90% of total billed charges ",1160.55,90,,928.44,,,0,"percent of total billed charges ","90% of total billed charges ",40.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1121.87,87,,897.50,,,0,"percent of total billed charges ","87% of total billed charges ",40.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",902.65,70,,722.12,,,0,"percent of total billed charges ","70% of total billed charges ",40.56,1199.24,
"US ARTERY UPPER EXT LEFT",3400447,"CDM ",921,RC,93931,HCPCS,OUTPATIENT,,,1289.5,1031.6,,70.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",259.64,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",902.65,70,,722.12,,,0,"percent of total billed charges ","70% of total billed charges ",1160.55,90,,928.44,,,0,"percent of total billed charges ","90% of total billed charges ",1199.24,93,,959.39,,,0,"percent of total billed charges ","93% of total billed charges ",70.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1096.08,85,,876.86,,,0,"percent of total billed charges ","85% of total billed charges ",1160.55,90,,928.44,,,0,"percent of total billed charges ","90% of total billed charges ",1160.55,90,,928.44,,,0,"percent of total billed charges ","90% of total billed charges ",40.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1121.87,87,,897.50,,,0,"percent of total billed charges ","87% of total billed charges ",40.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",902.65,70,,722.12,,,0,"percent of total billed charges ","70% of total billed charges ",40.56,1199.24,
"US VENOUS LOW EXT BILATERAL",3400454,"CDM ",921,RC,93970,HCPCS,OUTPATIENT,,,2782.5,2226,,197.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",393.07,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1947.75,70,,1558.20,,,0,"percent of total billed charges ","70% of total billed charges ",2504.25,90,,2003.40,,,0,"percent of total billed charges ","90% of total billed charges ",2587.73,93,,2070.18,,,0,"percent of total billed charges ","93% of total billed charges ",197.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2365.13,85,,1892.10,,,0,"percent of total billed charges ","85% of total billed charges ",2504.25,90,,2003.40,,,0,"percent of total billed charges ","90% of total billed charges ",2504.25,90,,2003.40,,,0,"percent of total billed charges ","90% of total billed charges ",53.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2420.78,87,,230.63,230.63,230.63,"1 through 10","percent of total billed charges ","87% of total billed charges ",53.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1947.75,70,,1558.20,,,0,"percent of total billed charges ","70% of total billed charges ",53.64,2587.73,
"US VENOUS LOW EXT RIGHT",3400462,"CDM ",921,RC,93971,HCPCS,OUTPATIENT,,,1394.5,1115.6,,119.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",249.26,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",976.15,70,,780.92,,,0,"percent of total billed charges ","70% of total billed charges ",1255.05,90,,1004.04,,,0,"percent of total billed charges ","90% of total billed charges ",1296.89,93,,1037.51,,,0,"percent of total billed charges ","93% of total billed charges ",119.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",121.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1185.33,85,,948.26,,,0,"percent of total billed charges ","85% of total billed charges ",1255.05,90,,1004.04,,,0,"percent of total billed charges ","90% of total billed charges ",1255.05,90,,1004.04,,,0,"percent of total billed charges ","90% of total billed charges ",120.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1213.22,87,,21.07,21.07,21.07,"1 through 10","percent of total billed charges ","87% of total billed charges ",120.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",976.15,70,,780.92,,,0,"percent of total billed charges ","70% of total billed charges ",96.14,1296.89,
"US VENOUS LOW EXT LEFT",3400470,"CDM ",921,RC,93971,HCPCS,OUTPATIENT,,,1394.5,1115.6,,119.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",249.26,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",976.15,70,,780.92,,,0,"percent of total billed charges ","70% of total billed charges ",1255.05,90,,1004.04,,,0,"percent of total billed charges ","90% of total billed charges ",1296.89,93,,1037.51,,,0,"percent of total billed charges ","93% of total billed charges ",119.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",121.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1185.33,85,,948.26,,,0,"percent of total billed charges ","85% of total billed charges ",1255.05,90,,1004.04,,,0,"percent of total billed charges ","90% of total billed charges ",1255.05,90,,1004.04,,,0,"percent of total billed charges ","90% of total billed charges ",120.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1213.22,87,,21.07,21.07,21.07,"1 through 10","percent of total billed charges ","87% of total billed charges ",120.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",976.15,70,,780.92,,,0,"percent of total billed charges ","70% of total billed charges ",96.14,1296.89,
"US BREAST BX LT W/DVC 1ST LES",3400488,"CDM ",761,RC,19083,HCPCS,OUTPATIENT,,,3154,2523.2,,474.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1640.24,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",324.59,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2207.8,70,,1766.24,,,0,"percent of total billed charges ","70% of total billed charges ",2838.6,90,,2270.88,,,0,"percent of total billed charges ","90% of total billed charges ",2933.22,93,,2346.58,,,0,"percent of total billed charges ","93% of total billed charges ",474.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",603.02,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2680.9,85,,2144.72,,,0,"percent of total billed charges ","85% of total billed charges ",2365.5,90,,1892.40,,,0,"percent of total billed charges ","90% of total billed charges ",2838.6,90,,2270.88,,,0,"percent of total billed charges ","90% of total billed charges ",597.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2743.98,87,,2195.18,,,0,"percent of total billed charges ","87% of total billed charges ",597.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2207.8,70,,1766.24,,,0,"percent of total billed charges ","70% of total billed charges ",324.59,2933.22,
"US BREAST BX RT W/DVC 1ST LES",3400496,"CDM ",761,RC,19083,HCPCS,OUTPATIENT,,,3154,2523.2,,474.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1640.24,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",324.59,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2207.8,70,,1766.24,,,0,"percent of total billed charges ","70% of total billed charges ",2838.6,90,,2270.88,,,0,"percent of total billed charges ","90% of total billed charges ",2933.22,93,,2346.58,,,0,"percent of total billed charges ","93% of total billed charges ",474.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",603.02,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2680.9,85,,2144.72,,,0,"percent of total billed charges ","85% of total billed charges ",2365.5,90,,1892.40,,,0,"percent of total billed charges ","90% of total billed charges ",2838.6,90,,2270.88,,,0,"percent of total billed charges ","90% of total billed charges ",597.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2743.98,87,,2195.18,,,0,"percent of total billed charges ","87% of total billed charges ",597.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2207.8,70,,1766.24,,,0,"percent of total billed charges ","70% of total billed charges ",324.59,2933.22,
"US OB TRANSVAGINAL",3400504,"CDM ",402,RC,76817,HCPCS,OUTPATIENT,,,1317.5,1054,,,,,,,,0,"other ","not separately reimbursment ",141.5,100,,47.43,47.43,47.43,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",196.39,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",922.25,70,,737.80,,,0,"percent of total billed charges ","70% of total billed charges ",1185.75,90,,948.60,,,0,"percent of total billed charges ","90% of total billed charges ",1225.28,93,,980.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",65.36,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1119.88,85,,895.90,,,0,"percent of total billed charges ","85% of total billed charges ",1185.75,90,,948.60,,,0,"percent of total billed charges ","90% of total billed charges ",1185.75,90,,948.60,,,0,"percent of total billed charges ","90% of total billed charges ",64.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1146.23,87,,130.68,130.68,130.68,"1 through 10","percent of total billed charges ","87% of total billed charges ",64.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",922.25,70,,737.80,,,0,"percent of total billed charges ","70% of total billed charges ",64.71,1225.28,
"US OB<14 WKS SINGLE FETUS",3400512,"CDM ",402,RC,76801,HCPCS,OUTPATIENT,,,2196.5,1757.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.31,100,,89.77,89.77,89.77,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",248.56,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1537.55,70,,1230.04,,,0,"percent of total billed charges ","70% of total billed charges ",1976.85,90,,1581.48,,,0,"percent of total billed charges ","90% of total billed charges ",2042.75,93,,1634.20,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",76.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1867.03,85,,1493.62,,,0,"percent of total billed charges ","85% of total billed charges ",1976.85,90,,1581.48,,,0,"percent of total billed charges ","90% of total billed charges ",1976.85,90,,1581.48,,,0,"percent of total billed charges ","90% of total billed charges ",76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1910.96,87,,75.41,75.41,75.41,"1 through 10","percent of total billed charges ","87% of total billed charges ",76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1537.55,70,,1230.04,,,0,"percent of total billed charges ","70% of total billed charges ",76,2042.75,
"US OB <14WKS ADD FETUS",3400520,"CDM ",402,RC,76802,HCPCS,OUTPATIENT,,,1645.5,1316.4,,54.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",77.77,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",130.24,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1151.85,70,,921.48,,,0,"percent of total billed charges ","70% of total billed charges ",1480.95,90,,1184.76,,,0,"percent of total billed charges ","90% of total billed charges ",1530.32,93,,1224.26,,,0,"percent of total billed charges ","93% of total billed charges ",54.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1398.68,85,,1118.94,,,0,"percent of total billed charges ","85% of total billed charges ",1480.95,90,,1184.76,,,0,"percent of total billed charges ","90% of total billed charges ",1480.95,90,,1184.76,,,0,"percent of total billed charges ","90% of total billed charges ",38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1431.59,87,,1145.27,,,0,"percent of total billed charges ","87% of total billed charges ",38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1151.85,70,,921.48,,,0,"percent of total billed charges ","70% of total billed charges ",38,1530.32,
"US OB >=14WKS EACH ADD",3400538,"CDM ",402,RC,76810,HCPCS,OUTPATIENT,,,1645.5,1316.4,,84.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",73.73,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",186.96,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1151.85,70,,921.48,,,0,"percent of total billed charges ","70% of total billed charges ",1480.95,90,,1184.76,,,0,"percent of total billed charges ","90% of total billed charges ",1530.32,93,,1224.26,,,0,"percent of total billed charges ","93% of total billed charges ",84.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",179.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1398.68,85,,1118.94,,,0,"percent of total billed charges ","85% of total billed charges ",1480.95,90,,1184.76,,,0,"percent of total billed charges ","90% of total billed charges ",1480.95,90,,1184.76,,,0,"percent of total billed charges ","90% of total billed charges ",177.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1431.59,87,,1145.27,,,0,"percent of total billed charges ","87% of total billed charges ",177.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1151.85,70,,921.48,,,0,"percent of total billed charges ","70% of total billed charges ",73.73,1530.32,
"US BIOPSY PROSTATE",3400546,"CDM ",402,RC,76942,HCPCS,OUTPATIENT,,,1116.5,893.2,,44.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",120.19,100,,143.86,143.86,143.86,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",121.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",781.55,70,,625.24,,,0,"percent of total billed charges ","70% of total billed charges ",1004.85,90,,803.88,,,0,"percent of total billed charges ","90% of total billed charges ",1038.35,93,,830.68,,,0,"percent of total billed charges ","93% of total billed charges ",44.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",949.03,85,,759.22,,,0,"percent of total billed charges ","85% of total billed charges ",1004.85,90,,803.88,,,0,"percent of total billed charges ","90% of total billed charges ",1004.85,90,,803.88,,,0,"percent of total billed charges ","90% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",971.36,87,,219.38,219.38,219.38,"1 through 10","percent of total billed charges ","87% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",781.55,70,,625.24,,,0,"percent of total billed charges ","70% of total billed charges ",39.25,1038.35,
"US PELVIC LIMITED/FOLLOWUP",3400561,"CDM ",402,RC,76857,HCPCS,OUTPATIENT,,,991.5,793.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",103.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",100.63,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",694.05,70,,555.24,,,0,"percent of total billed charges ","70% of total billed charges ",892.35,90,,713.88,,,0,"percent of total billed charges ","90% of total billed charges ",922.1,93,,737.68,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",842.78,85,,674.22,,,0,"percent of total billed charges ","85% of total billed charges ",892.35,90,,713.88,,,0,"percent of total billed charges ","90% of total billed charges ",892.35,90,,713.88,,,0,"percent of total billed charges ","90% of total billed charges ",42.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",862.61,87,,82.58,82.58,82.58,"1 through 10","percent of total billed charges ","87% of total billed charges ",42.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",694.05,70,,555.24,,,0,"percent of total billed charges ","70% of total billed charges ",42.24,922.1,
"US PED HIP W/O PHYSICIAN",3400579,"CDM ",402,RC,76886,HCPCS,OUTPATIENT,,,589.5,471.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",90.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",212.08,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",412.65,70,,330.12,,,0,"percent of total billed charges ","70% of total billed charges ",530.55,90,,424.44,,,0,"percent of total billed charges ","90% of total billed charges ",548.24,93,,438.59,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",49.55,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",501.08,85,,400.86,,,0,"percent of total billed charges ","85% of total billed charges ",530.55,90,,424.44,,,0,"percent of total billed charges ","90% of total billed charges ",530.55,90,,424.44,,,0,"percent of total billed charges ","90% of total billed charges ",49.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",512.87,87,,410.30,,,0,"percent of total billed charges ","87% of total billed charges ",49.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",412.65,70,,330.12,,,0,"percent of total billed charges ","70% of total billed charges ",49.06,548.24,
"US TRANSVAGINAL FOLLICIES",3400587,"CDM ",402,RC,76857,HCPCS,OUTPATIENT,,,971.5,777.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",103.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",100.63,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",680.05,70,,544.04,,,0,"percent of total billed charges ","70% of total billed charges ",874.35,90,,699.48,,,0,"percent of total billed charges ","90% of total billed charges ",903.5,93,,722.80,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",825.78,85,,660.62,,,0,"percent of total billed charges ","85% of total billed charges ",874.35,90,,699.48,,,0,"percent of total billed charges ","90% of total billed charges ",874.35,90,,699.48,,,0,"percent of total billed charges ","90% of total billed charges ",42.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",845.21,87,,82.58,82.58,82.58,"1 through 10","percent of total billed charges ","87% of total billed charges ",42.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",680.05,70,,544.04,,,0,"percent of total billed charges ","70% of total billed charges ",42.24,903.5,
"US OB FOLLOW-UP SIZE EVAL",3400702,"CDM ",402,RC,76816,HCPCS,OUTPATIENT,,,354,283.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",141.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",231.66,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",247.8,70,,198.24,,,0,"percent of total billed charges ","70% of total billed charges ",318.6,90,,254.88,,,0,"percent of total billed charges ","90% of total billed charges ",329.22,93,,263.38,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",300.9,85,,240.72,,,0,"percent of total billed charges ","85% of total billed charges ",318.6,90,,254.88,,,0,"percent of total billed charges ","90% of total billed charges ",318.6,90,,254.88,,,0,"percent of total billed charges ","90% of total billed charges ",44.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",307.98,87,,58.86,55.92,58.86,"1 through 10","percent of total billed charges ","87% of total billed charges ",44.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",247.8,70,,198.24,,,0,"percent of total billed charges ","70% of total billed charges ",44.55,329.22,
"US SOFT TISSUE NECK",3400710,"CDM ",402,RC,76536,HCPCS,OUTPATIENT,,,1111.5,889.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.76,100,,239.51,239.51,239.51,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",235.16,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",778.05,70,,622.44,,,0,"percent of total billed charges ","70% of total billed charges ",1000.35,90,,800.28,,,0,"percent of total billed charges ","90% of total billed charges ",1033.7,93,,826.96,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",944.78,85,,755.82,,,0,"percent of total billed charges ","85% of total billed charges ",1000.35,90,,800.28,,,0,"percent of total billed charges ","90% of total billed charges ",1000.35,90,,800.28,,,0,"percent of total billed charges ","90% of total billed charges ",25.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",967.01,87,,621.67,235.67,699.38,"1 through 10","percent of total billed charges ","87% of total billed charges ",25.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",778.05,70,,622.44,,,0,"percent of total billed charges ","70% of total billed charges ",25.9,1033.7,
"US TV OB W/ TRANSABDOMINAL",3400720,"CDM ",402,RC,76817,HCPCS,OUTPATIENT,,,467.5,374,,,,,,,,0,"other ","not separately reimbursment ",141.5,100,,47.43,47.43,47.43,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",196.39,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",327.25,70,,261.80,,,0,"percent of total billed charges ","70% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",434.78,93,,347.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",65.36,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",397.38,85,,317.90,,,0,"percent of total billed charges ","85% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",64.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",406.73,87,,130.68,130.68,130.68,"1 through 10","percent of total billed charges ","87% of total billed charges ",64.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",327.25,70,,261.80,,,0,"percent of total billed charges ","70% of total billed charges ",64.71,434.78,
"US TV PELVIC W/ TRANSABDOMINAL",3400730,"CDM ",402,RC,76830,HCPCS,OUTPATIENT,,,467.5,374,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",123.22,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",252.67,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",327.25,70,,261.80,,,0,"percent of total billed charges ","70% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",434.78,93,,347.82,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.36,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",397.38,85,,317.90,,,0,"percent of total billed charges ","85% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",64.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",406.73,87,,607.70,76.05,980.53,"1 through 10","percent of total billed charges ","87% of total billed charges ",64.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",327.25,70,,261.80,,,0,"percent of total billed charges ","70% of total billed charges ",64.71,434.78,
"US GUIDED COMPRESSION RPR ART",3400750,"CDM ",402,RC,76936,HCPCS,OUTPATIENT,,,330.5,264.4,,,,,,,,0,"other ","not separately reimbursment ",416.12,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",546.99,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",231.35,70,,185.08,,,0,"percent of total billed charges ","70% of total billed charges ",297.45,90,,237.96,,,0,"percent of total billed charges ","90% of total billed charges ",307.37,93,,245.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",150.7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",280.93,85,,224.74,,,0,"percent of total billed charges ","85% of total billed charges ",297.45,90,,237.96,,,0,"percent of total billed charges ","90% of total billed charges ",297.45,90,,237.96,,,0,"percent of total billed charges ","90% of total billed charges ",149.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",287.54,87,,230.03,,,0,"percent of total billed charges ","87% of total billed charges ",149.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.57,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",231.35,70,,185.08,,,0,"percent of total billed charges ","70% of total billed charges ",149.21,546.99,
"US GUIDED VASCULAR ACCESS",3400760,"CDM ",402,RC,76937,HCPCS,OUTPATIENT,,,627,501.6,,23.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",82.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",438.9,70,,351.12,,,0,"percent of total billed charges ","70% of total billed charges ",564.3,90,,451.44,,,0,"percent of total billed charges ","90% of total billed charges ",583.11,93,,466.49,,,0,"percent of total billed charges ","93% of total billed charges ",23.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",532.95,85,,426.36,,,0,"percent of total billed charges ","85% of total billed charges ",564.3,90,,451.44,,,0,"percent of total billed charges ","90% of total billed charges ",564.3,90,,451.44,,,0,"percent of total billed charges ","90% of total billed charges ",15.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",545.49,87,,438.33,438.33,438.33,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",438.9,70,,351.12,,,0,"percent of total billed charges ","70% of total billed charges ",15.47,583.11,
"US ABI BILATERAL 1-2 LEVELS",3400770,"CDM ",921,RC,93922,HCPCS,OUTPATIENT,,,491.5,393.2,,93.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.76,100,,254.40,254.40,254.40,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",169.4,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",344.05,70,,275.24,,,0,"percent of total billed charges ","70% of total billed charges ",442.35,90,,353.88,,,0,"percent of total billed charges ","90% of total billed charges ",457.1,93,,365.68,,,0,"percent of total billed charges ","93% of total billed charges ",93.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",417.78,85,,334.22,,,0,"percent of total billed charges ","85% of total billed charges ",442.35,90,,353.88,,,0,"percent of total billed charges ","90% of total billed charges ",442.35,90,,353.88,,,0,"percent of total billed charges ","90% of total billed charges ",53.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",427.61,87,,342.09,,,0,"percent of total billed charges ","87% of total billed charges ",53.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",344.05,70,,275.24,,,0,"percent of total billed charges ","70% of total billed charges ",53.64,480.76,
"US ABDOMEN LIMITED, 1 QUAD",3400780,"CDM ",320,RC,76705,HCPCS,OUTPATIENT,,,1470,1176,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.94,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",184.91,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1029,70,,823.20,,,0,"percent of total billed charges ","70% of total billed charges ",1323,90,,1058.40,,,0,"percent of total billed charges ","90% of total billed charges ",1367.1,93,,1093.68,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",49.3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1249.5,85,,999.60,,,0,"percent of total billed charges ","85% of total billed charges ",1323,90,,1058.40,,,0,"percent of total billed charges ","90% of total billed charges ",1323,90,,1058.40,,,0,"percent of total billed charges ","90% of total billed charges ",48.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1278.9,87,,871.19,418.96,1008.33,"1 through 10","percent of total billed charges ","87% of total billed charges ",48.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1029,70,,823.20,,,0,"percent of total billed charges ","70% of total billed charges ",48.81,1367.1,
"US EXTREMITY SOFT TISS LIMITED",3400790,"CDM ",402,RC,76882,HCPCS,OUTPATIENT,,,584.5,467.6,,,,,,,,0,"other ","not separately reimbursment ",117.16,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",117.83,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",409.15,70,,327.32,,,0,"percent of total billed charges ","70% of total billed charges ",526.05,90,,420.84,,,0,"percent of total billed charges ","90% of total billed charges ",543.59,93,,434.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",6.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",496.83,85,,397.46,,,0,"percent of total billed charges ","85% of total billed charges ",526.05,90,,420.84,,,0,"percent of total billed charges ","90% of total billed charges ",526.05,90,,420.84,,,0,"percent of total billed charges ","90% of total billed charges ",6.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",508.52,87,,406.82,,,0,"percent of total billed charges ","87% of total billed charges ",6.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",409.15,70,,327.32,,,0,"percent of total billed charges ","70% of total billed charges ",6.08,543.59,
"US PROCEDURE OTHER",3400800,"CDM ",402,RC,76999,HCPCS,OUTPATIENT,,,584.5,467.6,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",61.61,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",409.15,70,,327.32,,,0,"percent of total billed charges ","70% of total billed charges ",526.05,90,,420.84,,,0,"percent of total billed charges ","90% of total billed charges ",543.59,93,,434.87,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",78.75,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",496.83,85,,397.46,,,0,"percent of total billed charges ","85% of total billed charges ",526.05,90,,420.84,,,0,"percent of total billed charges ","90% of total billed charges ",526.05,90,,420.84,,,0,"percent of total billed charges ","90% of total billed charges ",77.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",508.52,87,,406.82,,,0,"percent of total billed charges ","87% of total billed charges ",77.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",409.15,70,,327.32,,,0,"percent of total billed charges ","70% of total billed charges ",61.61,543.59,
"*BLADDER ULTRASOUND",3400810,"CDM ",402,RC,76857,HCPCS,OUTPATIENT,,,561,448.8,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",103.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",100.63,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",392.7,70,,314.16,,,0,"percent of total billed charges ","70% of total billed charges ",504.9,90,,403.92,,,0,"percent of total billed charges ","90% of total billed charges ",521.73,93,,417.38,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",476.85,85,,381.48,,,0,"percent of total billed charges ","85% of total billed charges ",504.9,90,,403.92,,,0,"percent of total billed charges ","90% of total billed charges ",504.9,90,,403.92,,,0,"percent of total billed charges ","90% of total billed charges ",42.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",488.07,87,,82.58,82.58,82.58,"1 through 10","percent of total billed charges ","87% of total billed charges ",42.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",392.7,70,,314.16,,,0,"percent of total billed charges ","70% of total billed charges ",42.24,521.73,
"US THORACENTESIS NEEDLE ASPIR",3400830,"CDM ",402,RC,32555,HCPCS,OUTPATIENT,,,1257.5,1006,,278.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",862.54,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",230.93,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",880.25,70,,704.20,,,0,"percent of total billed charges ","70% of total billed charges ",1131.75,90,,905.40,,,0,"percent of total billed charges ","90% of total billed charges ",1169.48,93,,935.58,,,0,"percent of total billed charges ","93% of total billed charges ",278.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",354.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1068.88,85,,855.10,,,0,"percent of total billed charges ","85% of total billed charges ",943.13,90,,754.50,,,0,"percent of total billed charges ","90% of total billed charges ",1131.75,90,,905.40,,,0,"percent of total billed charges ","90% of total billed charges ",350.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1094.03,87,,875.22,,,0,"percent of total billed charges ","87% of total billed charges ",350.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",576.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",880.25,70,,704.20,,,0,"percent of total billed charges ","70% of total billed charges ",230.93,1169.48,
"US PARACENTESIS ABD",3400840,"CDM ",402,RC,49083,HCPCS,OUTPATIENT,,,1694.5,1355.6,,260.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1079.61,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",221.78,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1186.15,70,,948.92,,,0,"percent of total billed charges ","70% of total billed charges ",1525.05,90,,1220.04,,,0,"percent of total billed charges ","90% of total billed charges ",1575.89,93,,1260.71,,,0,"percent of total billed charges ","93% of total billed charges ",260.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.95,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1440.33,85,,1152.26,,,0,"percent of total billed charges ","85% of total billed charges ",1270.88,90,,1016.70,,,0,"percent of total billed charges ","90% of total billed charges ",1525.05,90,,1220.04,,,0,"percent of total billed charges ","90% of total billed charges ",327.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1474.22,87,,1179.38,,,0,"percent of total billed charges ","87% of total billed charges ",327.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",834.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1186.15,70,,948.92,,,0,"percent of total billed charges ","70% of total billed charges ",221.78,1575.89,
"US BREAST BILATERAL LIMITED",3400860,"CDM ",402,RC,76642,HCPCS,OUTPATIENT,,,458,366.4,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",94.94,100,,87.47,84.70,90.23,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",178.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",320.6,70,,256.48,,,0,"percent of total billed charges ","70% of total billed charges ",412.2,90,,329.76,,,0,"percent of total billed charges ","90% of total billed charges ",425.94,93,,340.75,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",389.3,85,,311.44,,,0,"percent of total billed charges ","85% of total billed charges ",412.2,90,,329.76,,,0,"percent of total billed charges ","90% of total billed charges ",412.2,90,,329.76,,,0,"percent of total billed charges ","90% of total billed charges ",53.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",398.46,87,,186.19,156.40,186.19,"1 through 10","percent of total billed charges ","87% of total billed charges ",53.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",320.6,70,,256.48,,,0,"percent of total billed charges ","70% of total billed charges ",53.43,425.94,
"US BREAST RIGHT LIMITED",3400870,"CDM ",402,RC,76642,HCPCS,OUTPATIENT,,,266.5,213.2,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",94.94,100,,87.47,84.70,90.23,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",178.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",186.55,70,,149.24,,,0,"percent of total billed charges ","70% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",247.85,93,,198.28,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",226.53,85,,181.22,,,0,"percent of total billed charges ","85% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",53.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",231.86,87,,186.19,156.40,186.19,"1 through 10","percent of total billed charges ","87% of total billed charges ",53.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",186.55,70,,149.24,,,0,"percent of total billed charges ","70% of total billed charges ",53.43,247.85,
"US BREAST LEFT LIMITED",3400880,"CDM ",402,RC,76642,HCPCS,OUTPATIENT,,,266.5,213.2,,73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",94.94,100,,87.47,84.70,90.23,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",178.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",186.55,70,,149.24,,,0,"percent of total billed charges ","70% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",247.85,93,,198.28,,,0,"percent of total billed charges ","93% of total billed charges ",73.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",226.53,85,,181.22,,,0,"percent of total billed charges ","85% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",53.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",231.86,87,,186.19,156.40,186.19,"1 through 10","percent of total billed charges ","87% of total billed charges ",53.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.03,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",186.55,70,,149.24,,,0,"percent of total billed charges ","70% of total billed charges ",53.43,247.85,
"US ABD AORTA SCREEN ANEURYSM",3400890,"CDM ",402,RC,76706,HCPCS,OUTPATIENT,,,1515,1212,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",151.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",224.03,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1060.5,70,,848.40,,,0,"percent of total billed charges ","70% of total billed charges ",1363.5,90,,1090.80,,,0,"percent of total billed charges ","90% of total billed charges ",1408.95,93,,1127.16,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1287.75,85,,1030.20,,,0,"percent of total billed charges ","85% of total billed charges ",1363.5,90,,1090.80,,,0,"percent of total billed charges ","90% of total billed charges ",1363.5,90,,1090.80,,,0,"percent of total billed charges ","90% of total billed charges ",95.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1318.05,87,,1054.44,,,0,"percent of total billed charges ","87% of total billed charges ",95.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1060.5,70,,848.40,,,0,"percent of total billed charges ","70% of total billed charges ",90.85,1408.95,
"US GUIDED VASCULAR ACCESS",3400910,"CDM ",402,RC,76937,HCPCS,OUTPATIENT,,,627,501.6,,23.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",82.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",438.9,70,,351.12,,,0,"percent of total billed charges ","70% of total billed charges ",564.3,90,,451.44,,,0,"percent of total billed charges ","90% of total billed charges ",583.11,93,,466.49,,,0,"percent of total billed charges ","93% of total billed charges ",23.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",532.95,85,,426.36,,,0,"percent of total billed charges ","85% of total billed charges ",564.3,90,,451.44,,,0,"percent of total billed charges ","90% of total billed charges ",564.3,90,,451.44,,,0,"percent of total billed charges ","90% of total billed charges ",15.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",545.49,87,,438.33,438.33,438.33,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",438.9,70,,351.12,,,0,"percent of total billed charges ","70% of total billed charges ",15.47,583.11,
"US SOFT TISSUE HEAD",3400930,"CDM ",402,RC,76536,HCPCS,OUTPATIENT,,,1011,808.8,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.76,100,,239.51,239.51,239.51,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",235.16,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",707.7,70,,566.16,,,0,"percent of total billed charges ","70% of total billed charges ",909.9,90,,727.92,,,0,"percent of total billed charges ","90% of total billed charges ",940.23,93,,752.18,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",859.35,85,,687.48,,,0,"percent of total billed charges ","85% of total billed charges ",909.9,90,,727.92,,,0,"percent of total billed charges ","90% of total billed charges ",909.9,90,,727.92,,,0,"percent of total billed charges ","90% of total billed charges ",25.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",879.57,87,,621.67,235.67,699.38,"1 through 10","percent of total billed charges ","87% of total billed charges ",25.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",707.7,70,,566.16,,,0,"percent of total billed charges ","70% of total billed charges ",25.9,940.23,
"US VENOUS UPPER EXT BILATERAL",3400940,"CDM ",921,RC,93970,HCPCS,OUTPATIENT,,,2782.5,2226,,197.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",393.07,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1947.75,70,,1558.20,,,0,"percent of total billed charges ","70% of total billed charges ",2504.25,90,,2003.40,,,0,"percent of total billed charges ","90% of total billed charges ",2587.73,93,,2070.18,,,0,"percent of total billed charges ","93% of total billed charges ",197.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2365.13,85,,1892.10,,,0,"percent of total billed charges ","85% of total billed charges ",2504.25,90,,2003.40,,,0,"percent of total billed charges ","90% of total billed charges ",2504.25,90,,2003.40,,,0,"percent of total billed charges ","90% of total billed charges ",53.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2420.78,87,,230.63,230.63,230.63,"1 through 10","percent of total billed charges ","87% of total billed charges ",53.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1947.75,70,,1558.20,,,0,"percent of total billed charges ","70% of total billed charges ",53.64,2587.73,
"US VENOUS UPPER EXT RIGHT",3400950,"CDM ",921,RC,93971,HCPCS,OUTPATIENT,,,1394.5,1115.6,,119.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",249.26,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",976.15,70,,780.92,,,0,"percent of total billed charges ","70% of total billed charges ",1255.05,90,,1004.04,,,0,"percent of total billed charges ","90% of total billed charges ",1296.89,93,,1037.51,,,0,"percent of total billed charges ","93% of total billed charges ",119.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",121.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1185.33,85,,948.26,,,0,"percent of total billed charges ","85% of total billed charges ",1255.05,90,,1004.04,,,0,"percent of total billed charges ","90% of total billed charges ",1255.05,90,,1004.04,,,0,"percent of total billed charges ","90% of total billed charges ",120.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1213.22,87,,21.07,21.07,21.07,"1 through 10","percent of total billed charges ","87% of total billed charges ",120.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",976.15,70,,780.92,,,0,"percent of total billed charges ","70% of total billed charges ",96.14,1296.89,
"US VENOUS UPPER EXT LEFT",3400960,"CDM ",921,RC,93971,HCPCS,OUTPATIENT,,,1394.5,1115.6,,119.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",249.26,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",976.15,70,,780.92,,,0,"percent of total billed charges ","70% of total billed charges ",1255.05,90,,1004.04,,,0,"percent of total billed charges ","90% of total billed charges ",1296.89,93,,1037.51,,,0,"percent of total billed charges ","93% of total billed charges ",119.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",121.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1185.33,85,,948.26,,,0,"percent of total billed charges ","85% of total billed charges ",1255.05,90,,1004.04,,,0,"percent of total billed charges ","90% of total billed charges ",1255.05,90,,1004.04,,,0,"percent of total billed charges ","90% of total billed charges ",120.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1213.22,87,,21.07,21.07,21.07,"1 through 10","percent of total billed charges ","87% of total billed charges ",120.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",976.15,70,,780.92,,,0,"percent of total billed charges ","70% of total billed charges ",96.14,1296.89,
"US ABI UNILATERAL LIMITED",3400970,"CDM ",921,RC,93922,HCPCS,OUTPATIENT,,,366,292.8,,93.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.76,100,,254.40,254.40,254.40,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",169.4,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",256.2,70,,204.96,,,0,"percent of total billed charges ","70% of total billed charges ",329.4,90,,263.52,,,0,"percent of total billed charges ","90% of total billed charges ",340.38,93,,272.30,,,0,"percent of total billed charges ","93% of total billed charges ",93.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",311.1,85,,248.88,,,0,"percent of total billed charges ","85% of total billed charges ",329.4,90,,263.52,,,0,"percent of total billed charges ","90% of total billed charges ",329.4,90,,263.52,,,0,"percent of total billed charges ","90% of total billed charges ",53.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",318.42,87,,254.74,,,0,"percent of total billed charges ","87% of total billed charges ",53.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",256.2,70,,204.96,,,0,"percent of total billed charges ","70% of total billed charges ",53.64,480.76,
"US SPINAL CORD NEWBORN",3400985,"CDM ",402,RC,76800,HCPCS,OUTPATIENT,,,266.5,213.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.16,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",304.52,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",186.55,70,,149.24,,,0,"percent of total billed charges ","70% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",247.85,93,,198.28,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",226.53,85,,181.22,,,0,"percent of total billed charges ","85% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",56.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",231.86,87,,185.49,,,0,"percent of total billed charges ","87% of total billed charges ",56.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",186.55,70,,149.24,,,0,"percent of total billed charges ","70% of total billed charges ",56.67,304.52,
"US FETAL UMB ARTERY S/D RATIO",3400990,"CDM ",402,RC,76820,HCPCS,OUTPATIENT,,,926,740.8,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",95.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",648.2,70,,518.56,,,0,"percent of total billed charges ","70% of total billed charges ",833.4,90,,666.72,,,0,"percent of total billed charges ","90% of total billed charges ",861.18,93,,688.94,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",787.1,85,,629.68,,,0,"percent of total billed charges ","85% of total billed charges ",833.4,90,,666.72,,,0,"percent of total billed charges ","90% of total billed charges ",833.4,90,,666.72,,,0,"percent of total billed charges ","90% of total billed charges ",55.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",805.62,87,,803.82,803.82,803.82,"1 through 10","percent of total billed charges ","87% of total billed charges ",55.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",648.2,70,,518.56,,,0,"percent of total billed charges ","70% of total billed charges ",55.74,861.18,
"US DUPLEX HEMODIALYSIS ACCESS",3400995,"CDM ",921,RC,93990,HCPCS,OUTPATIENT,,,207,165.6,,93.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",306.66,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",144.9,70,,115.92,,,0,"percent of total billed charges ","70% of total billed charges ",186.3,90,,149.04,,,0,"percent of total billed charges ","90% of total billed charges ",192.51,93,,154.01,,,0,"percent of total billed charges ","93% of total billed charges ",93.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",175.95,85,,140.76,,,0,"percent of total billed charges ","85% of total billed charges ",186.3,90,,149.04,,,0,"percent of total billed charges ","90% of total billed charges ",186.3,90,,149.04,,,0,"percent of total billed charges ","90% of total billed charges ",53.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",180.09,87,,144.07,,,0,"percent of total billed charges ","87% of total billed charges ",53.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",144.9,70,,115.92,,,0,"percent of total billed charges ","70% of total billed charges ",53.64,480.76,
"US OB FETAL ANATOMY & MATERNAL",3401000,"CDM ",402,RC,76811,HCPCS,OUTPATIENT,,,1357.5,1086,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",235.33,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",368.3,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",950.25,70,,760.20,,,0,"percent of total billed charges ","70% of total billed charges ",1221.75,90,,977.40,,,0,"percent of total billed charges ","90% of total billed charges ",1262.48,93,,1009.98,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",76.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1153.88,85,,923.10,,,0,"percent of total billed charges ","85% of total billed charges ",1221.75,90,,977.40,,,0,"percent of total billed charges ","90% of total billed charges ",1221.75,90,,977.40,,,0,"percent of total billed charges ","90% of total billed charges ",76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1181.03,87,,944.82,,,0,"percent of total billed charges ","87% of total billed charges ",76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",950.25,70,,760.20,,,0,"percent of total billed charges ","70% of total billed charges ",76,1262.48,
"US OB FETAL & MAT EA ADD FET",3401005,"CDM ",402,RC,76812,HCPCS,OUTPATIENT,,,536.5,429.2,,54.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",108.07,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",408.94,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",375.55,70,,300.44,,,0,"percent of total billed charges ","70% of total billed charges ",482.85,90,,386.28,,,0,"percent of total billed charges ","90% of total billed charges ",498.95,93,,399.16,,,0,"percent of total billed charges ","93% of total billed charges ",54.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",456.03,85,,364.82,,,0,"percent of total billed charges ","85% of total billed charges ",482.85,90,,386.28,,,0,"percent of total billed charges ","90% of total billed charges ",482.85,90,,386.28,,,0,"percent of total billed charges ","90% of total billed charges ",38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",466.76,87,,373.41,,,0,"percent of total billed charges ","87% of total billed charges ",38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",375.55,70,,300.44,,,0,"percent of total billed charges ","70% of total billed charges ",38,498.95,
"US LIVER ARETERIAL LIMITED",3401010,"CDM ",921,RC,93976,HCPCS,OUTPATIENT,,,1775,1420,,91.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",331.89,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1242.5,70,,994.00,,,0,"percent of total billed charges ","70% of total billed charges ",1597.5,90,,1278.00,,,0,"percent of total billed charges ","90% of total billed charges ",1650.75,93,,1320.60,,,0,"percent of total billed charges ","93% of total billed charges ",91.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1508.75,85,,1207.00,,,0,"percent of total billed charges ","85% of total billed charges ",1597.5,90,,1278.00,,,0,"percent of total billed charges ","90% of total billed charges ",1597.5,90,,1278.00,,,0,"percent of total billed charges ","90% of total billed charges ",40.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1544.25,87,,1241.27,1241.27,1241.27,"1 through 10","percent of total billed charges ","87% of total billed charges ",40.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1242.5,70,,994.00,,,0,"percent of total billed charges ","70% of total billed charges ",40.56,1650.75,
"US RENAL ARTERIAL LIMITED",3401015,"CDM ",921,RC,93976,HCPCS,OUTPATIENT,,,1775,1420,,91.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",331.89,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1242.5,70,,994.00,,,0,"percent of total billed charges ","70% of total billed charges ",1597.5,90,,1278.00,,,0,"percent of total billed charges ","90% of total billed charges ",1650.75,93,,1320.60,,,0,"percent of total billed charges ","93% of total billed charges ",91.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1508.75,85,,1207.00,,,0,"percent of total billed charges ","85% of total billed charges ",1597.5,90,,1278.00,,,0,"percent of total billed charges ","90% of total billed charges ",1597.5,90,,1278.00,,,0,"percent of total billed charges ","90% of total billed charges ",40.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1544.25,87,,1241.27,1241.27,1241.27,"1 through 10","percent of total billed charges ","87% of total billed charges ",40.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1242.5,70,,994.00,,,0,"percent of total billed charges ","70% of total billed charges ",40.56,1650.75,
"US GUIDE BREAST W/DVC RT 1ST",3401020,"CDM ",761,RC,19285,HCPCS,OUTPATIENT,,,1249,999.2,,66.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",398.95,100,,379.79,379.79,379.79,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",177.52,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",874.3,70,,699.44,,,0,"percent of total billed charges ","70% of total billed charges ",1124.1,90,,899.28,,,0,"percent of total billed charges ","90% of total billed charges ",1161.57,93,,929.26,,,0,"percent of total billed charges ","93% of total billed charges ",66.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1061.65,85,,849.32,,,0,"percent of total billed charges ","85% of total billed charges ",936.75,90,,749.40,,,0,"percent of total billed charges ","90% of total billed charges ",1124.1,90,,899.28,,,0,"percent of total billed charges ","90% of total billed charges ",83.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1086.63,87,,869.30,,,0,"percent of total billed charges ","87% of total billed charges ",83.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",874.3,70,,699.44,,,0,"percent of total billed charges ","70% of total billed charges ",66.41,1161.57,
"US GUIDE BREAST W/DVC LT 1ST",3401025,"CDM ",761,RC,19285,HCPCS,OUTPATIENT,,,1249,999.2,,66.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",398.95,100,,379.79,379.79,379.79,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",177.52,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",874.3,70,,699.44,,,0,"percent of total billed charges ","70% of total billed charges ",1124.1,90,,899.28,,,0,"percent of total billed charges ","90% of total billed charges ",1161.57,93,,929.26,,,0,"percent of total billed charges ","93% of total billed charges ",66.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1061.65,85,,849.32,,,0,"percent of total billed charges ","85% of total billed charges ",936.75,90,,749.40,,,0,"percent of total billed charges ","90% of total billed charges ",1124.1,90,,899.28,,,0,"percent of total billed charges ","90% of total billed charges ",83.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1086.63,87,,869.30,,,0,"percent of total billed charges ","87% of total billed charges ",83.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",874.3,70,,699.44,,,0,"percent of total billed charges ","70% of total billed charges ",66.41,1161.57,
"US GUIDE BREAST W/DVC ADD LES",3401030,"CDM ",761,RC,19286,HCPCS,OUTPATIENT,,,746.5,597.2,,,,,,,,0,"other ","not separately reimbursment ",398.95,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",89.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",522.55,70,,418.04,,,0,"percent of total billed charges ","70% of total billed charges ",671.85,90,,537.48,,,0,"percent of total billed charges ","90% of total billed charges ",694.25,93,,555.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",634.53,85,,507.62,,,0,"percent of total billed charges ","85% of total billed charges ",559.88,90,,447.90,,,0,"percent of total billed charges ","90% of total billed charges ",671.85,90,,537.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",649.46,87,,519.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",522.55,70,,418.04,,,0,"percent of total billed charges ","70% of total billed charges ",89.28,694.25,
"US BREAST BX W/DVC ADD LES",3401035,"CDM ",761,RC,19084,HCPCS,OUTPATIENT,,,2751,2200.8,,,,,,,,0,"other ","not separately reimbursment ",1886.68,100,,608.28,608.28,608.28,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",161.59,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1925.7,70,,1540.56,,,0,"percent of total billed charges ","70% of total billed charges ",2475.9,90,,1980.72,,,0,"percent of total billed charges ","90% of total billed charges ",2558.43,93,,2046.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2338.35,85,,1870.68,,,0,"percent of total billed charges ","85% of total billed charges ",2063.25,90,,1650.60,,,0,"percent of total billed charges ","90% of total billed charges ",2475.9,90,,1980.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2393.37,87,,1914.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1925.7,70,,1540.56,,,0,"percent of total billed charges ","70% of total billed charges ",161.59,2558.43,
"*US BREAST CYST ASP RT 1ST LES",3401045,"CDM ",761,RC,19000,HCPCS,OUTPATIENT,,,1193.5,954.8,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",412.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",88.86,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",835.45,70,,668.36,,,0,"percent of total billed charges ","70% of total billed charges ",1074.15,90,,859.32,,,0,"percent of total billed charges ","90% of total billed charges ",1109.96,93,,887.97,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1014.48,85,,811.58,,,0,"percent of total billed charges ","85% of total billed charges ",895.13,90,,716.10,,,0,"percent of total billed charges ","90% of total billed charges ",1074.15,90,,859.32,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1038.35,87,,830.68,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",835.45,70,,668.36,,,0,"percent of total billed charges ","70% of total billed charges ",88.86,1109.96,
"*US BREAST CYST ASP LT 1ST LES",3401055,"CDM ",761,RC,19000,HCPCS,OUTPATIENT,,,1194,955.2,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",412.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",88.86,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",835.8,70,,668.64,,,0,"percent of total billed charges ","70% of total billed charges ",1074.6,90,,859.68,,,0,"percent of total billed charges ","90% of total billed charges ",1110.42,93,,888.34,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1014.9,85,,811.92,,,0,"percent of total billed charges ","85% of total billed charges ",895.5,90,,716.40,,,0,"percent of total billed charges ","90% of total billed charges ",1074.6,90,,859.68,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1038.78,87,,831.02,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",835.8,70,,668.64,,,0,"percent of total billed charges ","70% of total billed charges ",88.86,1110.42,
"*US BREAST CYST ASP EA ADD LES",3401065,"CDM ",761,RC,19001,HCPCS,OUTPATIENT,,,595.5,476.4,,61.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",416.85,70,,333.48,,,0,"percent of total billed charges ","70% of total billed charges ",535.95,90,,428.76,,,0,"percent of total billed charges ","90% of total billed charges ",553.82,93,,443.06,,,0,"percent of total billed charges ","93% of total billed charges ",61.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",78.11,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",506.18,85,,404.94,,,0,"percent of total billed charges ","85% of total billed charges ",446.63,90,,357.30,,,0,"percent of total billed charges ","90% of total billed charges ",535.95,90,,428.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",518.09,87,,414.47,,,0,"percent of total billed charges ","87% of total billed charges ",77.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",416.85,70,,333.48,,,0,"percent of total billed charges ","70% of total billed charges ",44.09,553.82,
"US FNA BX W/US GDN RT",3401070,"CDM ",761,RC,10005,HCPCS,OUTPATIENT,,,1596.5,1277.2,,376.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",643.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",154.4,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1117.55,70,,894.04,,,0,"percent of total billed charges ","70% of total billed charges ",1436.85,90,,1149.48,,,0,"percent of total billed charges ","90% of total billed charges ",1484.75,93,,1187.80,,,0,"percent of total billed charges ","93% of total billed charges ",376.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",478.47,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1357.03,85,,1085.62,,,0,"percent of total billed charges ","85% of total billed charges ",1197.38,90,,957.90,,,0,"percent of total billed charges ","90% of total billed charges ",1436.85,90,,1149.48,,,0,"percent of total billed charges ","90% of total billed charges ",473.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1388.96,87,,379.16,379.16,379.16,"1 through 10","percent of total billed charges ","87% of total billed charges ",473.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1117.55,70,,894.04,,,0,"percent of total billed charges ","70% of total billed charges ",154.4,1484.75,
"US FNA BX W/US GDN LT",3401075,"CDM ",761,RC,10005,HCPCS,OUTPATIENT,,,1596.5,1277.2,,376.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",643.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",154.4,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1117.55,70,,894.04,,,0,"percent of total billed charges ","70% of total billed charges ",1436.85,90,,1149.48,,,0,"percent of total billed charges ","90% of total billed charges ",1484.75,93,,1187.80,,,0,"percent of total billed charges ","93% of total billed charges ",376.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",478.47,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1357.03,85,,1085.62,,,0,"percent of total billed charges ","85% of total billed charges ",1197.38,90,,957.90,,,0,"percent of total billed charges ","90% of total billed charges ",1436.85,90,,1149.48,,,0,"percent of total billed charges ","90% of total billed charges ",473.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1388.96,87,,379.16,379.16,379.16,"1 through 10","percent of total billed charges ","87% of total billed charges ",473.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1117.55,70,,894.04,,,0,"percent of total billed charges ","70% of total billed charges ",154.4,1484.75,
"US FNA BX W/US GDN EA ADD RT",3401080,"CDM ",761,RC,10006,HCPCS,OUTPATIENT,,,1596.5,1277.2,,,,,,,,0,"other ","not separately reimbursment ",643.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",105.89,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1117.55,70,,894.04,,,0,"percent of total billed charges ","70% of total billed charges ",1436.85,90,,1149.48,,,0,"percent of total billed charges ","90% of total billed charges ",1484.75,93,,1187.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1357.03,85,,1085.62,,,0,"percent of total billed charges ","85% of total billed charges ",1197.38,90,,957.90,,,0,"percent of total billed charges ","90% of total billed charges ",1436.85,90,,1149.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1388.96,87,,1111.17,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1117.55,70,,894.04,,,0,"percent of total billed charges ","70% of total billed charges ",105.89,1484.75,
"US FNA BX W/US GDN EA ADD LT",3401085,"CDM ",761,RC,10006,HCPCS,OUTPATIENT,,,1596.5,1277.2,,,,,,,,0,"other ","not separately reimbursment ",643.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",105.89,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1117.55,70,,894.04,,,0,"percent of total billed charges ","70% of total billed charges ",1436.85,90,,1149.48,,,0,"percent of total billed charges ","90% of total billed charges ",1484.75,93,,1187.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1357.03,85,,1085.62,,,0,"percent of total billed charges ","85% of total billed charges ",1197.38,90,,957.90,,,0,"percent of total billed charges ","90% of total billed charges ",1436.85,90,,1149.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1388.96,87,,1111.17,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1117.55,70,,894.04,,,0,"percent of total billed charges ","70% of total billed charges ",105.89,1484.75,
"NM BONE SCAN THREE PHASE",3600038,"CDM ",340,RC,78315,HCPCS,OUTPATIENT,,,2645,2116,,330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",347.52,100,,413.50,413.50,413.50,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",680.83,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1851.5,70,,1481.20,,,0,"percent of total billed charges ","70% of total billed charges ",2380.5,90,,1904.40,,,0,"percent of total billed charges ","90% of total billed charges ",2459.85,93,,1967.88,,,0,"percent of total billed charges ","93% of total billed charges ",330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",118.93,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2248.25,85,,1798.60,,,0,"percent of total billed charges ","85% of total billed charges ",2380.5,90,,1904.40,,,0,"percent of total billed charges ","90% of total billed charges ",2380.5,90,,1904.40,,,0,"percent of total billed charges ","90% of total billed charges ",117.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2301.15,87,,172.69,172.69,172.69,"1 through 10","percent of total billed charges ","87% of total billed charges ",117.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",367.65,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1851.5,70,,1481.20,,,0,"percent of total billed charges ","70% of total billed charges ",117.75,2459.85,
"NM BONE SCAN TOTAL BODY",3600053,"CDM ",340,RC,78306,HCPCS,OUTPATIENT,,,2588,2070.4,,330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",400.49,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",583.26,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1811.6,70,,1449.28,,,0,"percent of total billed charges ","70% of total billed charges ",2329.2,90,,1863.36,,,0,"percent of total billed charges ","90% of total billed charges ",2406.84,93,,1925.47,,,0,"percent of total billed charges ","93% of total billed charges ",330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",118.93,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2199.8,85,,1759.84,,,0,"percent of total billed charges ","85% of total billed charges ",2329.2,90,,1863.36,,,0,"percent of total billed charges ","90% of total billed charges ",2329.2,90,,1863.36,,,0,"percent of total billed charges ","90% of total billed charges ",117.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2251.56,87,,1801.25,,,0,"percent of total billed charges ","87% of total billed charges ",117.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",367.65,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1811.6,70,,1449.28,,,0,"percent of total billed charges ","70% of total billed charges ",117.75,2406.84,
"NM BONE SCAN SINGLE AREA",3600061,"CDM ",340,RC,78300,HCPCS,OUTPATIENT,,,1815,1452,,330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",343.8,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",448.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1270.5,70,,1016.40,,,0,"percent of total billed charges ","70% of total billed charges ",1633.5,90,,1306.80,,,0,"percent of total billed charges ","90% of total billed charges ",1687.95,93,,1350.36,,,0,"percent of total billed charges ","93% of total billed charges ",330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",82.59,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1542.75,85,,1234.20,,,0,"percent of total billed charges ","85% of total billed charges ",1633.5,90,,1306.80,,,0,"percent of total billed charges ","90% of total billed charges ",1633.5,90,,1306.80,,,0,"percent of total billed charges ","90% of total billed charges ",81.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1579.05,87,,1263.24,,,0,"percent of total billed charges ","87% of total billed charges ",81.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",367.65,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1270.5,70,,1016.40,,,0,"percent of total billed charges ","70% of total billed charges ",81.77,1687.95,
"NM LIVER SCAN STATIC ONLY",3600079,"CDM ",340,RC,78201,HCPCS,OUTPATIENT,,,1420.5,1136.4,,428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",375.01,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",994.35,70,,795.48,,,0,"percent of total billed charges ","70% of total billed charges ",1278.45,90,,1022.76,,,0,"percent of total billed charges ","90% of total billed charges ",1321.07,93,,1056.86,,,0,"percent of total billed charges ","93% of total billed charges ",428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.33,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1207.43,85,,965.94,,,0,"percent of total billed charges ","85% of total billed charges ",1278.45,90,,1022.76,,,0,"percent of total billed charges ","90% of total billed charges ",1278.45,90,,1022.76,,,0,"percent of total billed charges ","90% of total billed charges ",65.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1235.84,87,,988.67,,,0,"percent of total billed charges ","87% of total billed charges ",65.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",994.35,70,,795.48,,,0,"percent of total billed charges ","70% of total billed charges ",65.67,1321.07,
"NM HEPATO-BILIARY SCAN",3600087,"CDM ",340,RC,78227,HCPCS,OUTPATIENT,,,2209.5,1767.6,,428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",529.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",859.03,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1546.65,70,,1237.32,,,0,"percent of total billed charges ","70% of total billed charges ",1988.55,90,,1590.84,,,0,"percent of total billed charges ","90% of total billed charges ",2054.84,93,,1643.87,,,0,"percent of total billed charges ","93% of total billed charges ",428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",251.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1878.08,85,,1502.46,,,0,"percent of total billed charges ","85% of total billed charges ",1988.55,90,,1590.84,,,0,"percent of total billed charges ","90% of total billed charges ",1988.55,90,,1590.84,,,0,"percent of total billed charges ","90% of total billed charges ",249.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1922.27,87,,1534.70,574.70,1841.64,"1 through 10","percent of total billed charges ","87% of total billed charges ",249.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1546.65,70,,1237.32,,,0,"percent of total billed charges ","70% of total billed charges ",249.47,2054.84,
"NM LIVER & SPLEEN SCAN",3600103,"CDM ",340,RC,78215,HCPCS,OUTPATIENT,,,2088,1670.4,,330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",386.41,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1461.6,70,,1169.28,,,0,"percent of total billed charges ","70% of total billed charges ",1879.2,90,,1503.36,,,0,"percent of total billed charges ","90% of total billed charges ",1941.84,93,,1553.47,,,0,"percent of total billed charges ","93% of total billed charges ",330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",74.51,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1774.8,85,,1419.84,,,0,"percent of total billed charges ","85% of total billed charges ",1879.2,90,,1503.36,,,0,"percent of total billed charges ","90% of total billed charges ",1879.2,90,,1503.36,,,0,"percent of total billed charges ","90% of total billed charges ",73.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1816.56,87,,1453.25,,,0,"percent of total billed charges ","87% of total billed charges ",73.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",367.65,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1461.6,70,,1169.28,,,0,"percent of total billed charges ","70% of total billed charges ",73.77,1941.84,
"NM LUNG SCAN PERFUSION",3600111,"CDM ",340,RC,78580,HCPCS,OUTPATIENT,,,2599.5,2079.6,,330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",465.61,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1819.65,70,,1455.72,,,0,"percent of total billed charges ","70% of total billed charges ",2339.55,90,,1871.64,,,0,"percent of total billed charges ","90% of total billed charges ",2417.54,93,,1934.03,,,0,"percent of total billed charges ","93% of total billed charges ",330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",89.19,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2209.58,85,,1767.66,,,0,"percent of total billed charges ","85% of total billed charges ",2339.55,90,,1871.64,,,0,"percent of total billed charges ","90% of total billed charges ",2339.55,90,,1871.64,,,0,"percent of total billed charges ","90% of total billed charges ",88.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2261.57,87,,1809.26,,,0,"percent of total billed charges ","87% of total billed charges ",88.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",367.65,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1819.65,70,,1455.72,,,0,"percent of total billed charges ","70% of total billed charges ",88.31,2417.54,
"NM LUNG SCAN VENT",3600129,"CDM ",341,RC,78579,HCPCS,OUTPATIENT,,,2356.5,1885.2,,330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",367.75,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1649.55,70,,1319.64,,,0,"percent of total billed charges ","70% of total billed charges ",2120.85,90,,1696.68,,,0,"percent of total billed charges ","90% of total billed charges ",2191.55,93,,1753.24,,,0,"percent of total billed charges ","93% of total billed charges ",330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",267.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2003.03,85,,1602.42,,,0,"percent of total billed charges ","85% of total billed charges ",2120.85,90,,1696.68,,,0,"percent of total billed charges ","90% of total billed charges ",2120.85,90,,1696.68,,,0,"percent of total billed charges ","90% of total billed charges ",264.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2050.16,87,,1640.13,,,0,"percent of total billed charges ","87% of total billed charges ",264.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",367.65,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1649.55,70,,1319.64,,,0,"percent of total billed charges ","70% of total billed charges ",264.83,2191.55,
"NM LUNG SCAN VENT/PERF QUANT",3600137,"CDM ",340,RC,78598,HCPCS,OUTPATIENT,,,3208.5,2566.8,,428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",597.72,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2245.95,70,,1796.76,,,0,"percent of total billed charges ","70% of total billed charges ",2887.65,90,,2310.12,,,0,"percent of total billed charges ","90% of total billed charges ",2983.91,93,,2387.13,,,0,"percent of total billed charges ","93% of total billed charges ",428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",271.7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2727.23,85,,2181.78,,,0,"percent of total billed charges ","85% of total billed charges ",2887.65,90,,2310.12,,,0,"percent of total billed charges ","90% of total billed charges ",2887.65,90,,2310.12,,,0,"percent of total billed charges ","90% of total billed charges ",269.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2791.4,87,,2233.12,,,0,"percent of total billed charges ","87% of total billed charges ",269.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2245.95,70,,1796.76,,,0,"percent of total billed charges ","70% of total billed charges ",269.01,2983.91,
"NM THYROID UPTAKE",3600194,"CDM ",340,RC,78012,HCPCS,OUTPATIENT,,,686,548.8,,330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",203.49,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",164.82,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",480.2,70,,384.16,,,0,"percent of total billed charges ","70% of total billed charges ",617.4,90,,493.92,,,0,"percent of total billed charges ","90% of total billed charges ",637.98,93,,510.38,,,0,"percent of total billed charges ","93% of total billed charges ",330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",97.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",583.1,85,,466.48,,,0,"percent of total billed charges ","85% of total billed charges ",617.4,90,,493.92,,,0,"percent of total billed charges ","90% of total billed charges ",617.4,90,,493.92,,,0,"percent of total billed charges ","90% of total billed charges ",96.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",596.82,87,,477.46,,,0,"percent of total billed charges ","87% of total billed charges ",96.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",367.65,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",480.2,70,,384.16,,,0,"percent of total billed charges ","70% of total billed charges ",96.97,637.98,
"NM I123 THYROID SCAN",3600210,"CDM ",340,RC,78013,HCPCS,OUTPATIENT,,,1198,958.4,,330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",334.51,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",381.08,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",838.6,70,,670.88,,,0,"percent of total billed charges ","70% of total billed charges ",1078.2,90,,862.56,,,0,"percent of total billed charges ","90% of total billed charges ",1114.14,93,,891.31,,,0,"percent of total billed charges ","93% of total billed charges ",330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",128.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1018.3,85,,814.64,,,0,"percent of total billed charges ","85% of total billed charges ",1078.2,90,,862.56,,,0,"percent of total billed charges ","90% of total billed charges ",1078.2,90,,862.56,,,0,"percent of total billed charges ","90% of total billed charges ",127.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1042.26,87,,833.81,,,0,"percent of total billed charges ","87% of total billed charges ",127.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",367.65,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",838.6,70,,670.88,,,0,"percent of total billed charges ","70% of total billed charges ",127.6,1114.14,
"NM BRAIN FLOW",3600236,"CDM ",340,RC,78610,HCPCS,OUTPATIENT,,,998,798.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",343.27,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",698.6,70,,558.88,,,0,"percent of total billed charges ","70% of total billed charges ",898.2,90,,718.56,,,0,"percent of total billed charges ","90% of total billed charges ",928.14,93,,742.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",848.3,85,,678.64,,,0,"percent of total billed charges ","85% of total billed charges ",898.2,90,,718.56,,,0,"percent of total billed charges ","90% of total billed charges ",898.2,90,,718.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",868.26,87,,694.61,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",499.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",698.6,70,,558.88,,,0,"percent of total billed charges ","70% of total billed charges ",343.27,928.14,
"NM BRAIN SCAN 4 VIEWS",3600244,"CDM ",340,RC,78605,HCPCS,OUTPATIENT,,,2076,1660.8,,428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",394.31,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1453.2,70,,1162.56,,,0,"percent of total billed charges ","70% of total billed charges ",1868.4,90,,1494.72,,,0,"percent of total billed charges ","90% of total billed charges ",1930.68,93,,1544.54,,,0,"percent of total billed charges ","93% of total billed charges ",428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1764.6,85,,1411.68,,,0,"percent of total billed charges ","85% of total billed charges ",1868.4,90,,1494.72,,,0,"percent of total billed charges ","90% of total billed charges ",1868.4,90,,1494.72,,,0,"percent of total billed charges ","90% of total billed charges ",82.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1806.12,87,,1444.90,,,0,"percent of total billed charges ","87% of total billed charges ",82.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1453.2,70,,1162.56,,,0,"percent of total billed charges ","70% of total billed charges ",82.66,1930.68,
"NM BRAIN SCAN & FLOW",3600251,"CDM ",340,RC,78606,HCPCS,OUTPATIENT,,,2266,1812.8,,428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",642.91,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1586.2,70,,1268.96,,,0,"percent of total billed charges ","70% of total billed charges ",2039.4,90,,1631.52,,,0,"percent of total billed charges ","90% of total billed charges ",2107.38,93,,1685.90,,,0,"percent of total billed charges ","93% of total billed charges ",428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",98.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1926.1,85,,1540.88,,,0,"percent of total billed charges ","85% of total billed charges ",2039.4,90,,1631.52,,,0,"percent of total billed charges ","90% of total billed charges ",2039.4,90,,1631.52,,,0,"percent of total billed charges ","90% of total billed charges ",97.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1971.42,87,,1577.14,,,0,"percent of total billed charges ","87% of total billed charges ",97.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1586.2,70,,1268.96,,,0,"percent of total billed charges ","70% of total billed charges ",97.19,2107.38,
"NM THYROID WHOLE BODY SCAN",3600269,"CDM ",340,RC,78018,HCPCS,OUTPATIENT,,,2924,2339.2,,428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",381.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",616.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2046.8,70,,1637.44,,,0,"percent of total billed charges ","70% of total billed charges ",2631.6,90,,2105.28,,,0,"percent of total billed charges ","90% of total billed charges ",2719.32,93,,2175.46,,,0,"percent of total billed charges ","93% of total billed charges ",428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",125.53,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2485.4,85,,1988.32,,,0,"percent of total billed charges ","85% of total billed charges ",2631.6,90,,2105.28,,,0,"percent of total billed charges ","90% of total billed charges ",2631.6,90,,2105.28,,,0,"percent of total billed charges ","90% of total billed charges ",124.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2543.88,87,,2035.10,,,0,"percent of total billed charges ","87% of total billed charges ",124.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2046.8,70,,1637.44,,,0,"percent of total billed charges ","70% of total billed charges ",124.29,2719.32,
"NM MUGA SCAN W/EJEC FX",3600335,"CDM ",340,RC,78472,HCPCS,OUTPATIENT,,,2645,2116,,330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",507.34,100,,607.27,607.27,607.27,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",452.08,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1851.5,70,,1481.20,,,0,"percent of total billed charges ","70% of total billed charges ",2380.5,90,,1904.40,,,0,"percent of total billed charges ","90% of total billed charges ",2459.85,93,,1967.88,,,0,"percent of total billed charges ","93% of total billed charges ",330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",227.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2248.25,85,,1798.60,,,0,"percent of total billed charges ","85% of total billed charges ",2380.5,90,,1904.40,,,0,"percent of total billed charges ","90% of total billed charges ",2380.5,90,,1904.40,,,0,"percent of total billed charges ","90% of total billed charges ",225.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2301.15,87,,1840.92,,,0,"percent of total billed charges ","87% of total billed charges ",225.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",367.65,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1851.5,70,,1481.20,,,0,"percent of total billed charges ","70% of total billed charges ",225.36,2459.85,
"NM MECKLES DIVERTICULUM",3600343,"CDM ",340,RC,78290,HCPCS,OUTPATIENT,,,2343,1874.4,,330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",646.65,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1640.1,70,,1312.08,,,0,"percent of total billed charges ","70% of total billed charges ",2108.7,90,,1686.96,,,0,"percent of total billed charges ","90% of total billed charges ",2178.99,93,,1743.19,,,0,"percent of total billed charges ","93% of total billed charges ",330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",88.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1991.55,85,,1593.24,,,0,"percent of total billed charges ","85% of total billed charges ",2108.7,90,,1686.96,,,0,"percent of total billed charges ","90% of total billed charges ",2108.7,90,,1686.96,,,0,"percent of total billed charges ","90% of total billed charges ",87.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2038.41,87,,1630.73,,,0,"percent of total billed charges ","87% of total billed charges ",87.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",367.65,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1640.1,70,,1312.08,,,0,"percent of total billed charges ","70% of total billed charges ",87.64,2178.99,
"NM GI BLEED",3600384,"CDM ",340,RC,78278,HCPCS,OUTPATIENT,,,2077.5,1662,,330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",685.45,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1454.25,70,,1163.40,,,0,"percent of total billed charges ","70% of total billed charges ",1869.75,90,,1495.80,,,0,"percent of total billed charges ","90% of total billed charges ",1932.08,93,,1545.66,,,0,"percent of total billed charges ","93% of total billed charges ",330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1765.88,85,,1412.70,,,0,"percent of total billed charges ","85% of total billed charges ",1869.75,90,,1495.80,,,0,"percent of total billed charges ","90% of total billed charges ",1869.75,90,,1495.80,,,0,"percent of total billed charges ","90% of total billed charges ",22.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1807.43,87,,1445.94,,,0,"percent of total billed charges ","87% of total billed charges ",22.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",367.65,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1454.25,70,,1163.40,,,0,"percent of total billed charges ","70% of total billed charges ",22.24,1932.08,
"NM TESTICULAR SCAN",3600418,"CDM ",340,RC,78761,HCPCS,OUTPATIENT,,,1837.5,1470,,330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",419.08,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1286.25,70,,1029.00,,,0,"percent of total billed charges ","70% of total billed charges ",1653.75,90,,1323.00,,,0,"percent of total billed charges ","90% of total billed charges ",1708.88,93,,1367.10,,,0,"percent of total billed charges ","93% of total billed charges ",330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.65,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1561.88,85,,1249.50,,,0,"percent of total billed charges ","85% of total billed charges ",1653.75,90,,1323.00,,,0,"percent of total billed charges ","90% of total billed charges ",1653.75,90,,1323.00,,,0,"percent of total billed charges ","90% of total billed charges ",28.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1598.63,87,,1278.90,,,0,"percent of total billed charges ","87% of total billed charges ",28.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",367.65,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1286.25,70,,1029.00,,,0,"percent of total billed charges ","70% of total billed charges ",28.37,1708.88,
"*NM AUTOMATED DATA",3600426,"CDM ",340,RC,78890,HCPCS,OUTPATIENT,,,448.5,358.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",358.8,80,,287.04,,,0,"percent of total billed charges ","80% of total billed charges ",313.95,70,,251.16,,,0,"percent of total billed charges ","70% of total billed charges ",403.65,90,,322.92,,,0,"percent of total billed charges ","90% of total billed charges ",417.11,93,,333.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",381.23,85,,304.98,,,0,"percent of total billed charges ","85% of total billed charges ",403.65,90,,322.92,,,0,"percent of total billed charges ","90% of total billed charges ",403.65,90,,322.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",390.2,87,,312.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",313.95,70,,251.16,,,0,"percent of total billed charges ","70% of total billed charges ",313.95,417.11,
"NM TESTICULAR W/FLOW",3600434,"CDM ",340,RC,78761,HCPCS,OUTPATIENT,,,2449.5,1959.6,,330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",419.08,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1714.65,70,,1371.72,,,0,"percent of total billed charges ","70% of total billed charges ",2204.55,90,,1763.64,,,0,"percent of total billed charges ","90% of total billed charges ",2278.04,93,,1822.43,,,0,"percent of total billed charges ","93% of total billed charges ",330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.65,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2082.08,85,,1665.66,,,0,"percent of total billed charges ","85% of total billed charges ",2204.55,90,,1763.64,,,0,"percent of total billed charges ","90% of total billed charges ",2204.55,90,,1763.64,,,0,"percent of total billed charges ","90% of total billed charges ",28.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2131.07,87,,1704.86,,,0,"percent of total billed charges ","87% of total billed charges ",28.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",367.65,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1714.65,70,,1371.72,,,0,"percent of total billed charges ","70% of total billed charges ",28.37,2278.04,
"NM ARTERIO FLOW",3600442,"CDM ",340,RC,78445,HCPCS,OUTPATIENT,,,1332,1065.6,,330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",413.05,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",932.4,70,,745.92,,,0,"percent of total billed charges ","70% of total billed charges ",1198.8,90,,959.04,,,0,"percent of total billed charges ","90% of total billed charges ",1238.76,93,,991.01,,,0,"percent of total billed charges ","93% of total billed charges ",330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1132.2,85,,905.76,,,0,"percent of total billed charges ","85% of total billed charges ",1198.8,90,,959.04,,,0,"percent of total billed charges ","90% of total billed charges ",1198.8,90,,959.04,,,0,"percent of total billed charges ","90% of total billed charges ",17.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1158.84,87,,927.07,,,0,"percent of total billed charges ","87% of total billed charges ",17.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",367.65,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",932.4,70,,745.92,,,0,"percent of total billed charges ","70% of total billed charges ",17.79,1238.76,
"NM VASCULAR FLOW BIL",3600459,"CDM ",340,RC,78445,HCPCS,OUTPATIENT,,,1301,1040.8,,330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",413.05,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",910.7,70,,728.56,,,0,"percent of total billed charges ","70% of total billed charges ",1170.9,90,,936.72,,,0,"percent of total billed charges ","90% of total billed charges ",1209.93,93,,967.94,,,0,"percent of total billed charges ","93% of total billed charges ",330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1105.85,85,,884.68,,,0,"percent of total billed charges ","85% of total billed charges ",1170.9,90,,936.72,,,0,"percent of total billed charges ","90% of total billed charges ",1170.9,90,,936.72,,,0,"percent of total billed charges ","90% of total billed charges ",17.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1131.87,87,,905.50,,,0,"percent of total billed charges ","87% of total billed charges ",17.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",367.65,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",910.7,70,,728.56,,,0,"percent of total billed charges ","70% of total billed charges ",17.79,1209.93,
"NM VENOGRAM BILATERAL",3600467,"CDM ",340,RC,78458,HCPCS,OUTPATIENT,,,2668.5,2134.8,,330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",409.33,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1867.95,70,,1494.36,,,0,"percent of total billed charges ","70% of total billed charges ",2401.65,90,,1921.32,,,0,"percent of total billed charges ","90% of total billed charges ",2481.71,93,,1985.37,,,0,"percent of total billed charges ","93% of total billed charges ",330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2268.23,85,,1814.58,,,0,"percent of total billed charges ","85% of total billed charges ",2401.65,90,,1921.32,,,0,"percent of total billed charges ","90% of total billed charges ",2401.65,90,,1921.32,,,0,"percent of total billed charges ","90% of total billed charges ",17.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2321.6,87,,1857.28,,,0,"percent of total billed charges ","87% of total billed charges ",17.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",367.65,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1867.95,70,,1494.36,,,0,"percent of total billed charges ","70% of total billed charges ",17.79,2481.71,
"NM CARDIAC MULT SPECT",3600491,"CDM ",340,RC,78452,HCPCS,OUTPATIENT,,,4331.5,3465.2,,1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1468.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",933.92,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3032.05,70,,2425.64,,,0,"percent of total billed charges ","70% of total billed charges ",3898.35,90,,3118.68,,,0,"percent of total billed charges ","90% of total billed charges ",4028.3,93,,3222.64,,,0,"percent of total billed charges ","93% of total billed charges ",1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",203.11,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3681.78,85,,2945.42,,,0,"percent of total billed charges ","85% of total billed charges ",3898.35,90,,3118.68,,,0,"percent of total billed charges ","90% of total billed charges ",3898.35,90,,3118.68,,,0,"percent of total billed charges ","90% of total billed charges ",201.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3768.41,87,,3760.91,3760.91,3760.91,"1 through 10","percent of total billed charges ","87% of total billed charges ",201.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1190.63,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3032.05,70,,2425.64,,,0,"percent of total billed charges ","70% of total billed charges ",201.1,4028.3,
"NM TUMOR LOCAL SPECT",3600509,"CDM ",340,RC,78803,HCPCS,OUTPATIENT,,,3391,2712.8,,1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2467.38,2467.38,2467.38,"1 through 10","other ","not separately reimbursment ",755.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2373.7,70,,1898.96,,,0,"percent of total billed charges ","70% of total billed charges ",3051.9,90,,2441.52,,,0,"percent of total billed charges ","90% of total billed charges ",3153.63,93,,2522.90,,,0,"percent of total billed charges ","93% of total billed charges ",1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",197.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2882.35,85,,2305.88,,,0,"percent of total billed charges ","85% of total billed charges ",3051.9,90,,2441.52,,,0,"percent of total billed charges ","90% of total billed charges ",3051.9,90,,2441.52,,,0,"percent of total billed charges ","90% of total billed charges ",195.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2950.17,87,,2360.14,,,0,"percent of total billed charges ","87% of total billed charges ",195.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2373.7,70,,1898.96,,,0,"percent of total billed charges ","70% of total billed charges ",195.37,3153.63,
"NM KIDNEY SPECT",3600517,"CDM ",340,RC,78803,HCPCS,OUTPATIENT,,,3275.5,2620.4,,1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2467.38,2467.38,2467.38,"1 through 10","other ","not separately reimbursment ",755.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2292.85,70,,1834.28,,,0,"percent of total billed charges ","70% of total billed charges ",2947.95,90,,2358.36,,,0,"percent of total billed charges ","90% of total billed charges ",3046.22,93,,2436.98,,,0,"percent of total billed charges ","93% of total billed charges ",1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",197.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2784.18,85,,2227.34,,,0,"percent of total billed charges ","85% of total billed charges ",2947.95,90,,2358.36,,,0,"percent of total billed charges ","90% of total billed charges ",2947.95,90,,2358.36,,,0,"percent of total billed charges ","90% of total billed charges ",195.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2849.69,87,,2279.75,,,0,"percent of total billed charges ","87% of total billed charges ",195.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2292.85,70,,1834.28,,,0,"percent of total billed charges ","70% of total billed charges ",195.37,3046.22,
"NM BONE SPECT",3600525,"CDM ",340,RC,78803,HCPCS,OUTPATIENT,,,3602.5,2882,,1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2467.38,2467.38,2467.38,"1 through 10","other ","not separately reimbursment ",755.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2521.75,70,,2017.40,,,0,"percent of total billed charges ","70% of total billed charges ",3242.25,90,,2593.80,,,0,"percent of total billed charges ","90% of total billed charges ",3350.33,93,,2680.26,,,0,"percent of total billed charges ","93% of total billed charges ",1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",197.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3062.13,85,,2449.70,,,0,"percent of total billed charges ","85% of total billed charges ",3242.25,90,,2593.80,,,0,"percent of total billed charges ","90% of total billed charges ",3242.25,90,,2593.80,,,0,"percent of total billed charges ","90% of total billed charges ",195.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3134.18,87,,2507.34,,,0,"percent of total billed charges ","87% of total billed charges ",195.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2521.75,70,,2017.40,,,0,"percent of total billed charges ","70% of total billed charges ",195.37,3350.33,
"NM GASTRIC EMPTYING",3600533,"CDM ",340,RC,78264,HCPCS,OUTPATIENT,,,2266.5,1813.2,,330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",269.47,100,,161.28,161.28,161.28,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",649.48,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1586.55,70,,1269.24,,,0,"percent of total billed charges ","70% of total billed charges ",2039.85,90,,1631.88,,,0,"percent of total billed charges ","90% of total billed charges ",2107.85,93,,1686.28,,,0,"percent of total billed charges ","93% of total billed charges ",330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",35.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1926.53,85,,1541.22,,,0,"percent of total billed charges ","85% of total billed charges ",2039.85,90,,1631.88,,,0,"percent of total billed charges ","90% of total billed charges ",2039.85,90,,1631.88,,,0,"percent of total billed charges ","90% of total billed charges ",34.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1971.86,87,,1577.49,,,0,"percent of total billed charges ","87% of total billed charges ",34.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",367.65,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1586.55,70,,1269.24,,,0,"percent of total billed charges ","70% of total billed charges ",34.75,2107.85,
"NM CISTERNOGRAPHY",3600558,"CDM ",340,RC,78630,HCPCS,OUTPATIENT,,,3425,2740,,428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",663.23,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2397.5,70,,1918.00,,,0,"percent of total billed charges ","70% of total billed charges ",3082.5,90,,2466.00,,,0,"percent of total billed charges ","90% of total billed charges ",3185.25,93,,2548.20,,,0,"percent of total billed charges ","93% of total billed charges ",428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",50.54,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2911.25,85,,2329.00,,,0,"percent of total billed charges ","85% of total billed charges ",3082.5,90,,2466.00,,,0,"percent of total billed charges ","90% of total billed charges ",3082.5,90,,2466.00,,,0,"percent of total billed charges ","90% of total billed charges ",50.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2979.75,87,,2383.80,,,0,"percent of total billed charges ","87% of total billed charges ",50.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2397.5,70,,1918.00,,,0,"percent of total billed charges ","70% of total billed charges ",50.04,3185.25,
"NM LIVER SPECT",3600566,"CDM ",340,RC,78803,HCPCS,OUTPATIENT,,,3292,2633.6,,1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2467.38,2467.38,2467.38,"1 through 10","other ","not separately reimbursment ",755.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2304.4,70,,1843.52,,,0,"percent of total billed charges ","70% of total billed charges ",2962.8,90,,2370.24,,,0,"percent of total billed charges ","90% of total billed charges ",3061.56,93,,2449.25,,,0,"percent of total billed charges ","93% of total billed charges ",1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",197.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2798.2,85,,2238.56,,,0,"percent of total billed charges ","85% of total billed charges ",2962.8,90,,2370.24,,,0,"percent of total billed charges ","90% of total billed charges ",2962.8,90,,2370.24,,,0,"percent of total billed charges ","90% of total billed charges ",195.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2864.04,87,,2291.23,,,0,"percent of total billed charges ","87% of total billed charges ",195.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2304.4,70,,1843.52,,,0,"percent of total billed charges ","70% of total billed charges ",195.37,3061.56,
"NM CARDIAC SINGLE SPECT",3600574,"CDM ",340,RC,78451,HCPCS,OUTPATIENT,,,3602.5,2882,,1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1010,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",671.95,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2521.75,70,,2017.40,,,0,"percent of total billed charges ","70% of total billed charges ",3242.25,90,,2593.80,,,0,"percent of total billed charges ","90% of total billed charges ",3350.33,93,,2680.26,,,0,"percent of total billed charges ","93% of total billed charges ",1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",105.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3062.13,85,,2449.70,,,0,"percent of total billed charges ","85% of total billed charges ",3242.25,90,,2593.80,,,0,"percent of total billed charges ","90% of total billed charges ",3242.25,90,,2593.80,,,0,"percent of total billed charges ","90% of total billed charges ",104.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3134.18,87,,2507.34,,,0,"percent of total billed charges ","87% of total billed charges ",104.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1190.63,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2521.75,70,,2017.40,,,0,"percent of total billed charges ","70% of total billed charges ",104.05,3350.33,
"NM CEREBRAL SPECT",3600582,"CDM ",340,RC,78803,HCPCS,OUTPATIENT,,,3452,2761.6,,1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2467.38,2467.38,2467.38,"1 through 10","other ","not separately reimbursment ",755.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2416.4,70,,1933.12,,,0,"percent of total billed charges ","70% of total billed charges ",3106.8,90,,2485.44,,,0,"percent of total billed charges ","90% of total billed charges ",3210.36,93,,2568.29,,,0,"percent of total billed charges ","93% of total billed charges ",1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",197.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2934.2,85,,2347.36,,,0,"percent of total billed charges ","85% of total billed charges ",3106.8,90,,2485.44,,,0,"percent of total billed charges ","90% of total billed charges ",3106.8,90,,2485.44,,,0,"percent of total billed charges ","90% of total billed charges ",195.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3003.24,87,,2402.59,,,0,"percent of total billed charges ","87% of total billed charges ",195.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2416.4,70,,1933.12,,,0,"percent of total billed charges ","70% of total billed charges ",195.37,3210.36,
"NM ABSCESS LOCAL SPECT",3600590,"CDM ",340,RC,78803,HCPCS,OUTPATIENT,,,3391,2712.8,,1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2467.38,2467.38,2467.38,"1 through 10","other ","not separately reimbursment ",755.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2373.7,70,,1898.96,,,0,"percent of total billed charges ","70% of total billed charges ",3051.9,90,,2441.52,,,0,"percent of total billed charges ","90% of total billed charges ",3153.63,93,,2522.90,,,0,"percent of total billed charges ","93% of total billed charges ",1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",197.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2882.35,85,,2305.88,,,0,"percent of total billed charges ","85% of total billed charges ",3051.9,90,,2441.52,,,0,"percent of total billed charges ","90% of total billed charges ",3051.9,90,,2441.52,,,0,"percent of total billed charges ","90% of total billed charges ",195.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2950.17,87,,2360.14,,,0,"percent of total billed charges ","87% of total billed charges ",195.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2373.7,70,,1898.96,,,0,"percent of total billed charges ","70% of total billed charges ",195.37,3153.63,
"NM LUNG SPECT",3600608,"CDM ",340,RC,78803,HCPCS,OUTPATIENT,,,1298,1038.4,,1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2467.38,2467.38,2467.38,"1 through 10","other ","not separately reimbursment ",755.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",908.6,70,,726.88,,,0,"percent of total billed charges ","70% of total billed charges ",1168.2,90,,934.56,,,0,"percent of total billed charges ","90% of total billed charges ",1207.14,93,,965.71,,,0,"percent of total billed charges ","93% of total billed charges ",1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",197.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1103.3,85,,882.64,,,0,"percent of total billed charges ","85% of total billed charges ",1168.2,90,,934.56,,,0,"percent of total billed charges ","90% of total billed charges ",1168.2,90,,934.56,,,0,"percent of total billed charges ","90% of total billed charges ",195.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1129.26,87,,903.41,,,0,"percent of total billed charges ","87% of total billed charges ",195.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",908.6,70,,726.88,,,0,"percent of total billed charges ","70% of total billed charges ",195.37,1207.14,
"NM PARATHYROID SESTAMIBI",3600665,"CDM ",340,RC,78070,HCPCS,OUTPATIENT,,,2417.5,1934,,330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,999.34,999.34,999.34,"1 through 10","other ","not separately reimbursment ",575.94,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1692.25,70,,1353.80,,,0,"percent of total billed charges ","70% of total billed charges ",2175.75,90,,1740.60,,,0,"percent of total billed charges ","90% of total billed charges ",2248.28,93,,1798.62,,,0,"percent of total billed charges ","93% of total billed charges ",330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",67.27,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2054.88,85,,1643.90,,,0,"percent of total billed charges ","85% of total billed charges ",2175.75,90,,1740.60,,,0,"percent of total billed charges ","90% of total billed charges ",2175.75,90,,1740.60,,,0,"percent of total billed charges ","90% of total billed charges ",66.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2103.23,87,,1682.58,,,0,"percent of total billed charges ","87% of total billed charges ",66.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",367.65,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1692.25,70,,1353.80,,,0,"percent of total billed charges ","70% of total billed charges ",66.6,2248.28,
"NM BONE SCAN MULTI AREA",3600673,"CDM ",340,RC,78305,HCPCS,OUTPATIENT,,,1988.5,1590.8,,330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",542.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1391.95,70,,1113.56,,,0,"percent of total billed charges ","70% of total billed charges ",1789.65,90,,1431.72,,,0,"percent of total billed charges ","90% of total billed charges ",1849.31,93,,1479.45,,,0,"percent of total billed charges ","93% of total billed charges ",330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1690.23,85,,1352.18,,,0,"percent of total billed charges ","85% of total billed charges ",1789.65,90,,1431.72,,,0,"percent of total billed charges ","90% of total billed charges ",1789.65,90,,1431.72,,,0,"percent of total billed charges ","90% of total billed charges ",111.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1730,87,,1384.00,,,0,"percent of total billed charges ","87% of total billed charges ",111.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",367.65,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1391.95,70,,1113.56,,,0,"percent of total billed charges ","70% of total billed charges ",111.13,1849.31,
"NM LYMPH GLAND/LYMPHATICS",3600681,"CDM ",340,RC,78195,HCPCS,OUTPATIENT,,,3178,2542.4,,428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",697.64,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2224.6,70,,1779.68,,,0,"percent of total billed charges ","70% of total billed charges ",2860.2,90,,2288.16,,,0,"percent of total billed charges ","90% of total billed charges ",2955.54,93,,2364.43,,,0,"percent of total billed charges ","93% of total billed charges ",428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.65,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2701.3,85,,2161.04,,,0,"percent of total billed charges ","85% of total billed charges ",2860.2,90,,2288.16,,,0,"percent of total billed charges ","90% of total billed charges ",2860.2,90,,2288.16,,,0,"percent of total billed charges ","90% of total billed charges ",38.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2764.86,87,,2211.89,,,0,"percent of total billed charges ","87% of total billed charges ",38.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2224.6,70,,1779.68,,,0,"percent of total billed charges ","70% of total billed charges ",38.27,2955.54,
"NM VENOGRAM RIGHT",3600699,"CDM ",340,RC,78457,HCPCS,OUTPATIENT,,,1923.5,1538.8,,428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",357.96,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1346.45,70,,1077.16,,,0,"percent of total billed charges ","70% of total billed charges ",1731.15,90,,1384.92,,,0,"percent of total billed charges ","90% of total billed charges ",1788.86,93,,1431.09,,,0,"percent of total billed charges ","93% of total billed charges ",428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1634.98,85,,1307.98,,,0,"percent of total billed charges ","85% of total billed charges ",1731.15,90,,1384.92,,,0,"percent of total billed charges ","90% of total billed charges ",1731.15,90,,1384.92,,,0,"percent of total billed charges ","90% of total billed charges ",17.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1673.45,87,,1338.76,,,0,"percent of total billed charges ","87% of total billed charges ",17.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1346.45,70,,1077.16,,,0,"percent of total billed charges ","70% of total billed charges ",17.79,1788.86,
"NM VENOGRAM LEFT",3600707,"CDM ",340,RC,78457,HCPCS,OUTPATIENT,,,1923.5,1538.8,,428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",357.96,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1346.45,70,,1077.16,,,0,"percent of total billed charges ","70% of total billed charges ",1731.15,90,,1384.92,,,0,"percent of total billed charges ","90% of total billed charges ",1788.86,93,,1431.09,,,0,"percent of total billed charges ","93% of total billed charges ",428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1634.98,85,,1307.98,,,0,"percent of total billed charges ","85% of total billed charges ",1731.15,90,,1384.92,,,0,"percent of total billed charges ","90% of total billed charges ",1731.15,90,,1384.92,,,0,"percent of total billed charges ","90% of total billed charges ",17.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1673.45,87,,1338.76,,,0,"percent of total billed charges ","87% of total billed charges ",17.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1346.45,70,,1077.16,,,0,"percent of total billed charges ","70% of total billed charges ",17.79,1788.86,
"NM CARDIAC MULT SPECT-PER",3600715,"CDM ",340,RC,78452,HCPCS,OUTPATIENT,,,4331.5,3465.2,,1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1468.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",933.92,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3032.05,70,,2425.64,,,0,"percent of total billed charges ","70% of total billed charges ",3898.35,90,,3118.68,,,0,"percent of total billed charges ","90% of total billed charges ",4028.3,93,,3222.64,,,0,"percent of total billed charges ","93% of total billed charges ",1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",203.11,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3681.78,85,,2945.42,,,0,"percent of total billed charges ","85% of total billed charges ",3898.35,90,,3118.68,,,0,"percent of total billed charges ","90% of total billed charges ",3898.35,90,,3118.68,,,0,"percent of total billed charges ","90% of total billed charges ",201.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3768.41,87,,3760.91,3760.91,3760.91,"1 through 10","percent of total billed charges ","87% of total billed charges ",201.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1190.63,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3032.05,70,,2425.64,,,0,"percent of total billed charges ","70% of total billed charges ",201.1,4028.3,
"NM CARDIAC MULT SPECT-DOB",3600723,"CDM ",340,RC,78452,HCPCS,OUTPATIENT,,,4331.5,3465.2,,1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1468.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",933.92,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3032.05,70,,2425.64,,,0,"percent of total billed charges ","70% of total billed charges ",3898.35,90,,3118.68,,,0,"percent of total billed charges ","90% of total billed charges ",4028.3,93,,3222.64,,,0,"percent of total billed charges ","93% of total billed charges ",1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",203.11,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3681.78,85,,2945.42,,,0,"percent of total billed charges ","85% of total billed charges ",3898.35,90,,3118.68,,,0,"percent of total billed charges ","90% of total billed charges ",3898.35,90,,3118.68,,,0,"percent of total billed charges ","90% of total billed charges ",201.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3768.41,87,,3760.91,3760.91,3760.91,"1 through 10","percent of total billed charges ","87% of total billed charges ",201.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1190.63,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3032.05,70,,2425.64,,,0,"percent of total billed charges ","70% of total billed charges ",201.1,4028.3,
"NM LUNG V/Q IMAGING",3600749,"CDM ",341,RC,78582,HCPCS,OUTPATIENT,,,3585,2868,,428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",693.18,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",654.92,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2509.5,70,,2007.60,,,0,"percent of total billed charges ","70% of total billed charges ",3226.5,90,,2581.20,,,0,"percent of total billed charges ","90% of total billed charges ",3334.05,93,,2667.24,,,0,"percent of total billed charges ","93% of total billed charges ",428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",271.7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3047.25,85,,2437.80,,,0,"percent of total billed charges ","85% of total billed charges ",3226.5,90,,2581.20,,,0,"percent of total billed charges ","90% of total billed charges ",3226.5,90,,2581.20,,,0,"percent of total billed charges ","90% of total billed charges ",269.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3118.95,87,,2495.16,,,0,"percent of total billed charges ","87% of total billed charges ",269.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2509.5,70,,2007.60,,,0,"percent of total billed charges ","70% of total billed charges ",269.01,3334.05,
"NM RENAL FLOW/FUNC W/O LASIX",3600764,"CDM ",341,RC,78707,HCPCS,OUTPATIENT,,,2458,1966.4,,428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",458.85,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1720.6,70,,1376.48,,,0,"percent of total billed charges ","70% of total billed charges ",2212.2,90,,1769.76,,,0,"percent of total billed charges ","90% of total billed charges ",2285.94,93,,1828.75,,,0,"percent of total billed charges ","93% of total billed charges ",428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2089.3,85,,1671.44,,,0,"percent of total billed charges ","85% of total billed charges ",2212.2,90,,1769.76,,,0,"percent of total billed charges ","90% of total billed charges ",2212.2,90,,1769.76,,,0,"percent of total billed charges ","90% of total billed charges ",58.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2138.46,87,,1710.77,,,0,"percent of total billed charges ","87% of total billed charges ",58.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1720.6,70,,1376.48,,,0,"percent of total billed charges ","70% of total billed charges ",58.87,2285.94,
"NM RENAL FLOW/FUNC W/LASIX",3600772,"CDM ",341,RC,78708,HCPCS,OUTPATIENT,,,3021.5,2417.2,,428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",840,100,,849.59,849.59,849.59,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",363.13,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2115.05,70,,1692.04,,,0,"percent of total billed charges ","70% of total billed charges ",2719.35,90,,2175.48,,,0,"percent of total billed charges ","90% of total billed charges ",2810,93,,2248.00,,,0,"percent of total billed charges ","93% of total billed charges ",428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2568.28,85,,2054.62,,,0,"percent of total billed charges ","85% of total billed charges ",2719.35,90,,2175.48,,,0,"percent of total billed charges ","90% of total billed charges ",2719.35,90,,2175.48,,,0,"percent of total billed charges ","90% of total billed charges ",58.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2628.71,87,,2102.97,,,0,"percent of total billed charges ","87% of total billed charges ",58.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2115.05,70,,1692.04,,,0,"percent of total billed charges ","70% of total billed charges ",58.87,2810,
"NM TUMOR IMAGING LIMITED",3600780,"CDM ",341,RC,78800,HCPCS,OUTPATIENT,,,1988.5,1590.8,,330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",498.43,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1391.95,70,,1113.56,,,0,"percent of total billed charges ","70% of total billed charges ",1789.65,90,,1431.72,,,0,"percent of total billed charges ","90% of total billed charges ",1849.31,93,,1479.45,,,0,"percent of total billed charges ","93% of total billed charges ",330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",68.45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1690.23,85,,1352.18,,,0,"percent of total billed charges ","85% of total billed charges ",1789.65,90,,1431.72,,,0,"percent of total billed charges ","90% of total billed charges ",1789.65,90,,1431.72,,,0,"percent of total billed charges ","90% of total billed charges ",67.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1730,87,,1384.00,,,0,"percent of total billed charges ","87% of total billed charges ",67.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",367.65,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1391.95,70,,1113.56,,,0,"percent of total billed charges ","70% of total billed charges ",67.77,1849.31,
"NM TUMOR IMAGE BODY 2 DAY",3600798,"CDM ",341,RC,78804,HCPCS,OUTPATIENT,,,3021.5,2417.2,,1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1281.5,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2115.05,70,,1692.04,,,0,"percent of total billed charges ","70% of total billed charges ",2719.35,90,,2175.48,,,0,"percent of total billed charges ","90% of total billed charges ",2810,93,,2248.00,,,0,"percent of total billed charges ","93% of total billed charges ",1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",326.37,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2568.28,85,,2054.62,,,0,"percent of total billed charges ","85% of total billed charges ",2719.35,90,,2175.48,,,0,"percent of total billed charges ","90% of total billed charges ",2719.35,90,,2175.48,,,0,"percent of total billed charges ","90% of total billed charges ",323.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2628.71,87,,2102.97,,,0,"percent of total billed charges ","87% of total billed charges ",323.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2115.05,70,,1692.04,,,0,"percent of total billed charges ","70% of total billed charges ",323.14,2810,
"NM THYROID ABLATION,CARCI",3600806,"CDM ",342,RC,79005,HCPCS,OUTPATIENT,,,2190,1752,,212.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",495.26,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",285.69,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1533,70,,1226.40,,,0,"percent of total billed charges ","70% of total billed charges ",1971,90,,1576.80,,,0,"percent of total billed charges ","90% of total billed charges ",2036.7,93,,1629.36,,,0,"percent of total billed charges ","93% of total billed charges ",212.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",89.84,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1861.5,85,,1489.20,,,0,"percent of total billed charges ","85% of total billed charges ",1971,90,,1576.80,,,0,"percent of total billed charges ","90% of total billed charges ",1971,90,,1576.80,,,0,"percent of total billed charges ","90% of total billed charges ",88.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1905.3,87,,1524.24,,,0,"percent of total billed charges ","87% of total billed charges ",88.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",214.58,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1533,70,,1226.40,,,0,"percent of total billed charges ","70% of total billed charges ",88.95,2036.7,
"NM ULTRATAG",3600970,"CDM ",343,RC,A9560,HCPCS,OUTPATIENT,,,452,361.6,,,,,,,,0,"other ","not separately reimbursment ",215.13,100,,257.48,257.48,257.48,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",316.4,70,,253.12,,,0,"percent of total billed charges ","70% of total billed charges ",406.8,90,,325.44,,,0,"percent of total billed charges ","90% of total billed charges ",420.36,93,,336.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",384.2,85,,307.36,,,0,"percent of total billed charges ","85% of total billed charges ",406.8,90,,325.44,,,0,"percent of total billed charges ","90% of total billed charges ",406.8,90,,325.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",393.24,87,,314.59,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",316.4,70,,253.12,,,0,"percent of total billed charges ","70% of total billed charges ",215.13,420.36,
"NM MYOCARDIAL LEXISCAN",3601110,"CDM ",341,RC,78452,HCPCS,OUTPATIENT,,,4331.5,3465.2,,1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1468.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",933.92,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3032.05,70,,2425.64,,,0,"percent of total billed charges ","70% of total billed charges ",3898.35,90,,3118.68,,,0,"percent of total billed charges ","90% of total billed charges ",4028.3,93,,3222.64,,,0,"percent of total billed charges ","93% of total billed charges ",1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",203.11,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3681.78,85,,2945.42,,,0,"percent of total billed charges ","85% of total billed charges ",3898.35,90,,3118.68,,,0,"percent of total billed charges ","90% of total billed charges ",3898.35,90,,3118.68,,,0,"percent of total billed charges ","90% of total billed charges ",201.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3768.41,87,,3760.91,3760.91,3760.91,"1 through 10","percent of total billed charges ","87% of total billed charges ",201.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1190.63,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3032.05,70,,2425.64,,,0,"percent of total billed charges ","70% of total billed charges ",201.1,4028.3,
"NM RENAL W/CAPTOPRIL",3601120,"CDM ",341,RC,78709,HCPCS,OUTPATIENT,,,1023.5,818.8,,428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",729.54,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",716.45,70,,573.16,,,0,"percent of total billed charges ","70% of total billed charges ",921.15,90,,736.92,,,0,"percent of total billed charges ","90% of total billed charges ",951.86,93,,761.49,,,0,"percent of total billed charges ","93% of total billed charges ",428.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",869.98,85,,695.98,,,0,"percent of total billed charges ","85% of total billed charges ",921.15,90,,736.92,,,0,"percent of total billed charges ","90% of total billed charges ",921.15,90,,736.92,,,0,"percent of total billed charges ","90% of total billed charges ",58.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",890.45,87,,712.36,,,0,"percent of total billed charges ","87% of total billed charges ",58.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",716.45,70,,573.16,,,0,"percent of total billed charges ","70% of total billed charges ",58.87,951.86,
"NM HEPATO-BILIARY SCAN- NONVIS",3601130,"CDM ",341,RC,78226,HCPCS,OUTPATIENT,,,2209.5,1767.6,,330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",529.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",638.77,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1546.65,70,,1237.32,,,0,"percent of total billed charges ","70% of total billed charges ",1988.55,90,,1590.84,,,0,"percent of total billed charges ","90% of total billed charges ",2054.84,93,,1643.87,,,0,"percent of total billed charges ","93% of total billed charges ",330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",251.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1878.08,85,,1502.46,,,0,"percent of total billed charges ","85% of total billed charges ",1988.55,90,,1590.84,,,0,"percent of total billed charges ","90% of total billed charges ",1988.55,90,,1590.84,,,0,"percent of total billed charges ","90% of total billed charges ",249.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1922.27,87,,1537.82,,,0,"percent of total billed charges ","87% of total billed charges ",249.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",367.65,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1546.65,70,,1237.32,,,0,"percent of total billed charges ","70% of total billed charges ",249.47,2054.84,
"NM SALIVARY SERIAL IMAGES",3601150,"CDM ",340,RC,78231,HCPCS,OUTPATIENT,,,1137,909.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.6,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",795.9,70,,636.72,,,0,"percent of total billed charges ","70% of total billed charges ",1023.3,90,,818.64,,,0,"percent of total billed charges ","90% of total billed charges ",1057.41,93,,845.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",966.45,85,,773.16,,,0,"percent of total billed charges ","85% of total billed charges ",1023.3,90,,818.64,,,0,"percent of total billed charges ","90% of total billed charges ",1023.3,90,,818.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",989.19,87,,791.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",367.65,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",795.9,70,,636.72,,,0,"percent of total billed charges ","70% of total billed charges ",217.6,1057.41,
"NM THYROID I123 SCAN & UPTAKE",3601170,"CDM ",340,RC,78014,HCPCS,OUTPATIENT,,,1514.5,1211.6,,330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",424.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",468.05,220,,79.60,79.60,79.60,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",1060.15,70,,848.12,,,0,"percent of total billed charges ","70% of total billed charges ",1363.05,90,,1090.44,,,0,"percent of total billed charges ","90% of total billed charges ",1408.49,93,,1126.79,,,0,"percent of total billed charges ","93% of total billed charges ",330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.08,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1287.33,85,,1029.86,,,0,"percent of total billed charges ","85% of total billed charges ",1363.05,90,,1090.44,,,0,"percent of total billed charges ","90% of total billed charges ",1363.05,90,,1090.44,,,0,"percent of total billed charges ","90% of total billed charges ",198.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1317.62,87,,1054.10,,,0,"percent of total billed charges ","87% of total billed charges ",198.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",367.65,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1060.15,70,,848.12,,,0,"percent of total billed charges ","70% of total billed charges ",198.1,1408.49,
"NM PARATHYROID SESTAMI W/SPECT",3601180,"CDM ",340,RC,78071,HCPCS,OUTPATIENT,,,1517.5,1214,,330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",690.03,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1062.25,70,,849.80,,,0,"percent of total billed charges ","70% of total billed charges ",1365.75,90,,1092.60,,,0,"percent of total billed charges ","90% of total billed charges ",1411.28,93,,1129.02,,,0,"percent of total billed charges ","93% of total billed charges ",330.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",276.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1289.88,85,,1031.90,,,0,"percent of total billed charges ","85% of total billed charges ",1365.75,90,,1092.60,,,0,"percent of total billed charges ","90% of total billed charges ",1365.75,90,,1092.60,,,0,"percent of total billed charges ","90% of total billed charges ",273.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1320.23,87,,1056.18,,,0,"percent of total billed charges ","87% of total billed charges ",273.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",367.65,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1062.25,70,,849.80,,,0,"percent of total billed charges ","70% of total billed charges ",273.87,1411.28,
"MYOCARDIAL VIABILITY STUDY",3601190,"CDM ",341,RC,78454,HCPCS,OUTPATIENT,,,1990.5,1592.4,,1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1010,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",854.17,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1393.35,70,,1114.68,,,0,"percent of total billed charges ","70% of total billed charges ",1791.45,90,,1433.16,,,0,"percent of total billed charges ","90% of total billed charges ",1851.17,93,,1480.94,,,0,"percent of total billed charges ","93% of total billed charges ",1128.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",82.41,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1691.93,85,,1353.54,,,0,"percent of total billed charges ","85% of total billed charges ",1791.45,90,,1433.16,,,0,"percent of total billed charges ","90% of total billed charges ",1791.45,90,,1433.16,,,0,"percent of total billed charges ","90% of total billed charges ",81.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1731.74,87,,1385.39,,,0,"percent of total billed charges ","87% of total billed charges ",81.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1190.63,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1393.35,70,,1114.68,,,0,"percent of total billed charges ","70% of total billed charges ",81.59,1851.17,
"MRI ABDOMEN W/O",3800018,"CDM ",610,RC,74181,HCPCS,OUTPATIENT,,,4548,3638.4,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,661.32,661.32,661.32,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",432.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3183.6,70,,2546.88,,,0,"percent of total billed charges ","70% of total billed charges ",4093.2,90,,3274.56,,,0,"percent of total billed charges ","90% of total billed charges ",4229.64,93,,3383.71,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",280.41,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3865.8,85,,3092.64,,,0,"percent of total billed charges ","85% of total billed charges ",4093.2,90,,3274.56,,,0,"percent of total billed charges ","90% of total billed charges ",4093.2,90,,3274.56,,,0,"percent of total billed charges ","90% of total billed charges ",277.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3956.76,87,,3165.41,,,0,"percent of total billed charges ","87% of total billed charges ",277.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3183.6,70,,2546.88,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,4229.64,
"MRI BONE MARROW",3800026,"CDM ",610,RC,77084,HCPCS,OUTPATIENT,,,4392.5,3514,,,,,,,,0,"other ","not separately reimbursment ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",703.91,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3074.75,70,,2459.80,,,0,"percent of total billed charges ","70% of total billed charges ",3953.25,90,,3162.60,,,0,"percent of total billed charges ","90% of total billed charges ",4085.03,93,,3268.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",235.87,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3733.63,85,,2986.90,,,0,"percent of total billed charges ","85% of total billed charges ",3953.25,90,,3162.60,,,0,"percent of total billed charges ","90% of total billed charges ",3953.25,90,,3162.60,,,0,"percent of total billed charges ","90% of total billed charges ",233.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3821.48,87,,3057.18,,,0,"percent of total billed charges ","87% of total billed charges ",233.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3074.75,70,,2459.80,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,4085.03,
"MRI HEAD WO CONT",3800034,"CDM ",611,RC,70551,HCPCS,OUTPATIENT,,,4799.5,3839.6,,233.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",430.69,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3359.65,70,,2687.72,,,0,"percent of total billed charges ","70% of total billed charges ",4319.55,90,,3455.64,,,0,"percent of total billed charges ","90% of total billed charges ",4463.54,93,,3570.83,,,0,"percent of total billed charges ","93% of total billed charges ",233.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",249.65,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4079.58,85,,3263.66,,,0,"percent of total billed charges ","85% of total billed charges ",4319.55,90,,3455.64,,,0,"percent of total billed charges ","90% of total billed charges ",4319.55,90,,3455.64,,,0,"percent of total billed charges ","90% of total billed charges ",247.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4175.57,87,,731.16,188.90,1273.41,"1 through 10","percent of total billed charges ","87% of total billed charges ",247.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3359.65,70,,2687.72,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,4463.54,
"MRI HEAD W/CONT",3800042,"CDM ",611,RC,70552,HCPCS,OUTPATIENT,,,5277.5,4222,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,525.90,525.90,525.90,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",594.9,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3694.25,70,,2955.40,,,0,"percent of total billed charges ","70% of total billed charges ",4749.75,90,,3799.80,,,0,"percent of total billed charges ","90% of total billed charges ",4908.08,93,,3926.46,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",299.57,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4485.88,85,,3588.70,,,0,"percent of total billed charges ","85% of total billed charges ",4749.75,90,,3799.80,,,0,"percent of total billed charges ","90% of total billed charges ",4749.75,90,,3799.80,,,0,"percent of total billed charges ","90% of total billed charges ",296.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4591.43,87,,3673.14,,,0,"percent of total billed charges ","87% of total billed charges ",296.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3694.25,70,,2955.40,,,0,"percent of total billed charges ","70% of total billed charges ",296.6,4908.08,
"MRI HEAD W&W/O CONT",3800059,"CDM ",611,RC,70553,HCPCS,OUTPATIENT,,,5999.5,4799.6,,368.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",702.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4199.65,70,,3359.72,,,0,"percent of total billed charges ","70% of total billed charges ",5399.55,90,,4319.64,,,0,"percent of total billed charges ","90% of total billed charges ",5579.54,93,,4463.63,,,0,"percent of total billed charges ","93% of total billed charges ",368.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1065.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5099.58,85,,4079.66,,,0,"percent of total billed charges ","85% of total billed charges ",5399.55,90,,4319.64,,,0,"percent of total billed charges ","90% of total billed charges ",5399.55,90,,4319.64,,,0,"percent of total billed charges ","90% of total billed charges ",1054.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5219.57,87,,1080.95,256.01,3917.62,"1 through 10","percent of total billed charges ","87% of total billed charges ",1054.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4199.65,70,,3359.72,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,5579.54,
"MRI C-SPINE W/O CONT",3800067,"CDM ",612,RC,72141,HCPCS,OUTPATIENT,,,4324,3459.2,,233.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,661.32,661.32,661.32,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",421.01,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3026.8,70,,2421.44,,,0,"percent of total billed charges ","70% of total billed charges ",3891.6,90,,3113.28,,,0,"percent of total billed charges ","90% of total billed charges ",4021.32,93,,3217.06,,,0,"percent of total billed charges ","93% of total billed charges ",233.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",479.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3675.4,85,,2940.32,,,0,"percent of total billed charges ","85% of total billed charges ",3891.6,90,,3113.28,,,0,"percent of total billed charges ","90% of total billed charges ",3891.6,90,,3113.28,,,0,"percent of total billed charges ","90% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3761.88,87,,168.49,53.34,1090.53,"1 through 10","percent of total billed charges ","87% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3026.8,70,,2421.44,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,4021.32,
"MRI C-SPINE W/CONT",3800075,"CDM ",612,RC,72142,HCPCS,OUTPATIENT,,,5159.5,4127.6,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",608.74,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3611.65,70,,2889.32,,,0,"percent of total billed charges ","70% of total billed charges ",4643.55,90,,3714.84,,,0,"percent of total billed charges ","90% of total billed charges ",4798.34,93,,3838.67,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",231.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4385.58,85,,3508.46,,,0,"percent of total billed charges ","85% of total billed charges ",4643.55,90,,3714.84,,,0,"percent of total billed charges ","90% of total billed charges ",4643.55,90,,3714.84,,,0,"percent of total billed charges ","90% of total billed charges ",228.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4488.77,87,,3591.02,,,0,"percent of total billed charges ","87% of total billed charges ",228.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3611.65,70,,2889.32,,,0,"percent of total billed charges ","70% of total billed charges ",228.96,4798.34,
"MRI C-SPINE W&W/O CONT",3800083,"CDM ",612,RC,72156,HCPCS,OUTPATIENT,,,5404,4323.2,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",707.72,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3782.8,70,,3026.24,,,0,"percent of total billed charges ","70% of total billed charges ",4863.6,90,,3890.88,,,0,"percent of total billed charges ","90% of total billed charges ",5025.72,93,,4020.58,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",481.03,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4593.4,85,,3674.72,,,0,"percent of total billed charges ","85% of total billed charges ",4863.6,90,,3890.88,,,0,"percent of total billed charges ","90% of total billed charges ",4863.6,90,,3890.88,,,0,"percent of total billed charges ","90% of total billed charges ",476.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4701.48,87,,3761.18,,,0,"percent of total billed charges ","87% of total billed charges ",476.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3782.8,70,,3026.24,,,0,"percent of total billed charges ","70% of total billed charges ",313.17,5025.72,
"MRI CHEST W/O CONT",3800091,"CDM ",610,RC,71550,HCPCS,OUTPATIENT,,,4392.5,3514,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",751.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3074.75,70,,2459.80,,,0,"percent of total billed charges ","70% of total billed charges ",3953.25,90,,3162.60,,,0,"percent of total billed charges ","90% of total billed charges ",4085.03,93,,3268.02,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",293.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3733.63,85,,2986.90,,,0,"percent of total billed charges ","85% of total billed charges ",3953.25,90,,3162.60,,,0,"percent of total billed charges ","90% of total billed charges ",3953.25,90,,3162.60,,,0,"percent of total billed charges ","90% of total billed charges ",291.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3821.48,87,,3057.18,,,0,"percent of total billed charges ","87% of total billed charges ",291.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3074.75,70,,2459.80,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,4085.03,
"MRI IAC WO CONTRAST",3800109,"CDM ",610,RC,70540,HCPCS,OUTPATIENT,,,3759.5,3007.6,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",499.95,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2631.65,70,,2105.32,,,0,"percent of total billed charges ","70% of total billed charges ",3383.55,90,,2706.84,,,0,"percent of total billed charges ","90% of total billed charges ",3496.34,93,,2797.07,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3195.58,85,,2556.46,,,0,"percent of total billed charges ","85% of total billed charges ",3383.55,90,,2706.84,,,0,"percent of total billed charges ","90% of total billed charges ",3383.55,90,,2706.84,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3270.77,87,,2616.62,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2631.65,70,,2105.32,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,3496.34,
"MRA HEAD WO CONTRAST",3800133,"CDM ",615,RC,70544,HCPCS,OUTPATIENT,,,4324,3459.2,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",664.93,100,,300.00,300.00,300.00,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",471.94,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3026.8,70,,2421.44,,,0,"percent of total billed charges ","70% of total billed charges ",3891.6,90,,3113.28,,,0,"percent of total billed charges ","90% of total billed charges ",4021.32,93,,3217.06,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",255.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3675.4,85,,2940.32,,,0,"percent of total billed charges ","85% of total billed charges ",3891.6,90,,3113.28,,,0,"percent of total billed charges ","90% of total billed charges ",3891.6,90,,3113.28,,,0,"percent of total billed charges ","90% of total billed charges ",252.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3761.88,87,,3009.50,,,0,"percent of total billed charges ","87% of total billed charges ",252.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3026.8,70,,2421.44,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,4021.32,
"MRI L-SPINE W/CONT",3800141,"CDM ",612,RC,72149,HCPCS,OUTPATIENT,,,5424.5,4339.6,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,208.10,208.10,208.10,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",597.67,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3797.15,70,,3037.72,,,0,"percent of total billed charges ","70% of total billed charges ",4882.05,90,,3905.64,,,0,"percent of total billed charges ","90% of total billed charges ",5044.79,93,,4035.83,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",231.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4610.83,85,,3688.66,,,0,"percent of total billed charges ","85% of total billed charges ",4882.05,90,,3905.64,,,0,"percent of total billed charges ","90% of total billed charges ",4882.05,90,,3905.64,,,0,"percent of total billed charges ","90% of total billed charges ",228.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4719.32,87,,3775.46,,,0,"percent of total billed charges ","87% of total billed charges ",228.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3797.15,70,,3037.72,,,0,"percent of total billed charges ","70% of total billed charges ",228.96,5044.79,
"MRI L-SPINE W/O CONT",3800158,"CDM ",612,RC,72148,HCPCS,OUTPATIENT,,,4324,3459.2,,233.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,47.89,47.89,47.89,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",421.7,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3026.8,70,,2421.44,,,0,"percent of total billed charges ","70% of total billed charges ",3891.6,90,,3113.28,,,0,"percent of total billed charges ","90% of total billed charges ",4021.32,93,,3217.06,,,0,"percent of total billed charges ","93% of total billed charges ",233.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",532.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3675.4,85,,2940.32,,,0,"percent of total billed charges ","85% of total billed charges ",3891.6,90,,3113.28,,,0,"percent of total billed charges ","90% of total billed charges ",3891.6,90,,3113.28,,,0,"percent of total billed charges ","90% of total billed charges ",526.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3761.88,87,,1240.04,68.04,2793.85,"1 through 10","percent of total billed charges ","87% of total billed charges ",526.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3026.8,70,,2421.44,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,4021.32,
"MRI L-SPINE W&W/O CONT",3800166,"CDM ",612,RC,72158,HCPCS,OUTPATIENT,,,5683,4546.4,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,529.06,529.06,529.06,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",705.63,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3978.1,70,,3182.48,,,0,"percent of total billed charges ","70% of total billed charges ",5114.7,90,,4091.76,,,0,"percent of total billed charges ","90% of total billed charges ",5285.19,93,,4228.15,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",481.03,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4830.55,85,,3864.44,,,0,"percent of total billed charges ","85% of total billed charges ",5114.7,90,,4091.76,,,0,"percent of total billed charges ","90% of total billed charges ",5114.7,90,,4091.76,,,0,"percent of total billed charges ","90% of total billed charges ",476.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4944.21,87,,62.51,62.51,62.51,"1 through 10","percent of total billed charges ","87% of total billed charges ",476.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3978.1,70,,3182.48,,,0,"percent of total billed charges ","70% of total billed charges ",313.17,5285.19,
"MRI ORBIT FACE NECK WO CX",3800182,"CDM ",610,RC,70540,HCPCS,OUTPATIENT,,,3759.5,3007.6,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",499.95,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2631.65,70,,2105.32,,,0,"percent of total billed charges ","70% of total billed charges ",3383.55,90,,2706.84,,,0,"percent of total billed charges ","90% of total billed charges ",3496.34,93,,2797.07,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3195.58,85,,2556.46,,,0,"percent of total billed charges ","85% of total billed charges ",3383.55,90,,2706.84,,,0,"percent of total billed charges ","90% of total billed charges ",3383.55,90,,2706.84,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3270.77,87,,2616.62,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2631.65,70,,2105.32,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,3496.34,
"MRI PELVIS W/CONT",3800190,"CDM ",612,RC,72196,HCPCS,OUTPATIENT,,,5004,4003.2,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",595.94,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3502.8,70,,2802.24,,,0,"percent of total billed charges ","70% of total billed charges ",4503.6,90,,3602.88,,,0,"percent of total billed charges ","90% of total billed charges ",4653.72,93,,3722.98,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",206.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4253.4,85,,3402.72,,,0,"percent of total billed charges ","85% of total billed charges ",4503.6,90,,3602.88,,,0,"percent of total billed charges ","90% of total billed charges ",4503.6,90,,3602.88,,,0,"percent of total billed charges ","90% of total billed charges ",204.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4353.48,87,,3482.78,,,0,"percent of total billed charges ","87% of total billed charges ",204.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3502.8,70,,2802.24,,,0,"percent of total billed charges ","70% of total billed charges ",204.69,4653.72,
"MRI T-SPINE W/CONT",3800208,"CDM ",612,RC,72147,HCPCS,OUTPATIENT,,,5424.5,4339.6,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,661.32,661.32,661.32,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",602.51,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3797.15,70,,3037.72,,,0,"percent of total billed charges ","70% of total billed charges ",4882.05,90,,3905.64,,,0,"percent of total billed charges ","90% of total billed charges ",5044.79,93,,4035.83,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",231.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4610.83,85,,3688.66,,,0,"percent of total billed charges ","85% of total billed charges ",4882.05,90,,3905.64,,,0,"percent of total billed charges ","90% of total billed charges ",4882.05,90,,3905.64,,,0,"percent of total billed charges ","90% of total billed charges ",228.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4719.32,87,,3775.46,,,0,"percent of total billed charges ","87% of total billed charges ",228.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3797.15,70,,3037.72,,,0,"percent of total billed charges ","70% of total billed charges ",228.96,5044.79,
"MRI T-SPINE W/O CONT",3800216,"CDM ",612,RC,72146,HCPCS,OUTPATIENT,,,4548,3638.4,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,661.32,661.32,661.32,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",420.33,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3183.6,70,,2546.88,,,0,"percent of total billed charges ","70% of total billed charges ",4093.2,90,,3274.56,,,0,"percent of total billed charges ","90% of total billed charges ",4229.64,93,,3383.71,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",532.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3865.8,85,,3092.64,,,0,"percent of total billed charges ","85% of total billed charges ",4093.2,90,,3274.56,,,0,"percent of total billed charges ","90% of total billed charges ",4093.2,90,,3274.56,,,0,"percent of total billed charges ","90% of total billed charges ",526.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3956.76,87,,1734.59,621.42,2847.75,"1 through 10","percent of total billed charges ","87% of total billed charges ",526.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3183.6,70,,2546.88,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,4229.64,
"MRI T-SPINE W&W/O CONT",3800224,"CDM ",612,RC,72157,HCPCS,OUTPATIENT,,,5683,4546.4,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",708.4,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3978.1,70,,3182.48,,,0,"percent of total billed charges ","70% of total billed charges ",5114.7,90,,4091.76,,,0,"percent of total billed charges ","90% of total billed charges ",5285.19,93,,4228.15,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.72,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4830.55,85,,3864.44,,,0,"percent of total billed charges ","85% of total billed charges ",5114.7,90,,4091.76,,,0,"percent of total billed charges ","90% of total billed charges ",5114.7,90,,4091.76,,,0,"percent of total billed charges ","90% of total billed charges ",475.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4944.21,87,,3955.37,,,0,"percent of total billed charges ","87% of total billed charges ",475.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3978.1,70,,3182.48,,,0,"percent of total billed charges ","70% of total billed charges ",313.17,5285.19,
"MRI TMJ",3800232,"CDM ",610,RC,70336,HCPCS,OUTPATIENT,,,3332.5,2666,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",589.01,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2332.75,70,,1866.20,,,0,"percent of total billed charges ","70% of total billed charges ",2999.25,90,,2399.40,,,0,"percent of total billed charges ","90% of total billed charges ",3099.23,93,,2479.38,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",138.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2832.63,85,,2266.10,,,0,"percent of total billed charges ","85% of total billed charges ",2999.25,90,,2399.40,,,0,"percent of total billed charges ","90% of total billed charges ",2999.25,90,,2399.40,,,0,"percent of total billed charges ","90% of total billed charges ",137.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2899.28,87,,2319.42,,,0,"percent of total billed charges ","87% of total billed charges ",137.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2332.75,70,,1866.20,,,0,"percent of total billed charges ","70% of total billed charges ",137.37,3099.23,
"MRA UPPER EXT RT W&WO CONTRAST",3800265,"CDM ",618,RC,73225,HCPCS,OUTPATIENT,,,3294,2635.2,,412.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",754.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2305.8,70,,1844.64,,,0,"percent of total billed charges ","70% of total billed charges ",2964.6,90,,2371.68,,,0,"percent of total billed charges ","90% of total billed charges ",3063.42,93,,2450.74,,,0,"percent of total billed charges ","93% of total billed charges ",412.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2799.9,85,,2239.92,,,0,"percent of total billed charges ","85% of total billed charges ",2964.6,90,,2371.68,,,0,"percent of total billed charges ","90% of total billed charges ",2964.6,90,,2371.68,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2865.78,87,,2292.62,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2305.8,70,,1844.64,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,3063.42,
"MRA UPPER EXT RT W/0 CONTRAST",3800323,"CDM ",618,RC,73225,HCPCS,OUTPATIENT,,,2427,1941.6,,412.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",754.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1698.9,70,,1359.12,,,0,"percent of total billed charges ","70% of total billed charges ",2184.3,90,,1747.44,,,0,"percent of total billed charges ","90% of total billed charges ",2257.11,93,,1805.69,,,0,"percent of total billed charges ","93% of total billed charges ",412.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2062.95,85,,1650.36,,,0,"percent of total billed charges ","85% of total billed charges ",2184.3,90,,1747.44,,,0,"percent of total billed charges ","90% of total billed charges ",2184.3,90,,1747.44,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2111.49,87,,1689.19,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1698.9,70,,1359.12,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,2257.11,
"MRA UPPER EXT RIGHT W CONTRAST",3800356,"CDM ",618,RC,73225,HCPCS,OUTPATIENT,,,2753,2202.4,,412.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",754.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1927.1,70,,1541.68,,,0,"percent of total billed charges ","70% of total billed charges ",2477.7,90,,1982.16,,,0,"percent of total billed charges ","90% of total billed charges ",2560.29,93,,2048.23,,,0,"percent of total billed charges ","93% of total billed charges ",412.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2340.05,85,,1872.04,,,0,"percent of total billed charges ","85% of total billed charges ",2477.7,90,,1982.16,,,0,"percent of total billed charges ","90% of total billed charges ",2477.7,90,,1982.16,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2395.11,87,,1916.09,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1927.1,70,,1541.68,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,2560.29,
"MRA ABDOMEN ANGIO WO CONTRAST",3800380,"CDM ",618,RC,C8901,HCPCS,OUTPATIENT,,,5048,4038.4,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",4038.4,80,,3230.72,,,0,"percent of total billed charges ","80% of total billed charges ",3533.6,70,,2826.88,,,0,"percent of total billed charges ","70% of total billed charges ",4543.2,90,,3634.56,,,0,"percent of total billed charges ","90% of total billed charges ",4694.64,93,,3755.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4290.8,85,,3432.64,,,0,"percent of total billed charges ","85% of total billed charges ",4543.2,90,,3634.56,,,0,"percent of total billed charges ","90% of total billed charges ",4543.2,90,,3634.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4391.76,87,,3513.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3533.6,70,,2826.88,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,4694.64,
"MRI BREAST-BIL W/O CONT",3800414,"CDM ",610,RC,77047,HCPCS,OUTPATIENT,,,5397.5,4318,,,,,,,,0,"other ","not separately reimbursment ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",484.07,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3778.25,70,,3022.60,,,0,"percent of total billed charges ","70% of total billed charges ",4857.75,90,,3886.20,,,0,"percent of total billed charges ","90% of total billed charges ",5019.68,93,,4015.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",151.36,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4587.88,85,,3670.30,,,0,"percent of total billed charges ","85% of total billed charges ",4857.75,90,,3886.20,,,0,"percent of total billed charges ","90% of total billed charges ",4857.75,90,,3886.20,,,0,"percent of total billed charges ","90% of total billed charges ",149.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4695.83,87,,3756.66,,,0,"percent of total billed charges ","87% of total billed charges ",149.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3778.25,70,,3022.60,,,0,"percent of total billed charges ","70% of total billed charges ",149.86,5019.68,
"MRI BREAST LEFT W/O CONT",3800422,"CDM ",610,RC,77046,HCPCS,OUTPATIENT,,,4392.5,3514,,,,,,,,0,"other ","not separately reimbursment ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",470.58,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3074.75,70,,2459.80,,,0,"percent of total billed charges ","70% of total billed charges ",3953.25,90,,3162.60,,,0,"percent of total billed charges ","90% of total billed charges ",4085.03,93,,3268.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",151.36,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3733.63,85,,2986.90,,,0,"percent of total billed charges ","85% of total billed charges ",3953.25,90,,3162.60,,,0,"percent of total billed charges ","90% of total billed charges ",3953.25,90,,3162.60,,,0,"percent of total billed charges ","90% of total billed charges ",149.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3821.48,87,,3057.18,,,0,"percent of total billed charges ","87% of total billed charges ",149.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3074.75,70,,2459.80,,,0,"percent of total billed charges ","70% of total billed charges ",149.86,4085.03,
"MRI BREAST RIGHT W/O CONT",3800430,"CDM ",610,RC,77046,HCPCS,OUTPATIENT,,,4392.5,3514,,,,,,,,0,"other ","not separately reimbursment ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",470.58,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3074.75,70,,2459.80,,,0,"percent of total billed charges ","70% of total billed charges ",3953.25,90,,3162.60,,,0,"percent of total billed charges ","90% of total billed charges ",4085.03,93,,3268.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",151.36,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3733.63,85,,2986.90,,,0,"percent of total billed charges ","85% of total billed charges ",3953.25,90,,3162.60,,,0,"percent of total billed charges ","90% of total billed charges ",3953.25,90,,3162.60,,,0,"percent of total billed charges ","90% of total billed charges ",149.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3821.48,87,,3057.18,,,0,"percent of total billed charges ","87% of total billed charges ",149.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3074.75,70,,2459.80,,,0,"percent of total billed charges ","70% of total billed charges ",149.86,4085.03,
"MRI SHOULDER-LEFT WO",3800448,"CDM ",610,RC,73221,HCPCS,OUTPATIENT,,,4709.5,3767.6,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",444.29,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3296.65,70,,2637.32,,,0,"percent of total billed charges ","70% of total billed charges ",4238.55,90,,3390.84,,,0,"percent of total billed charges ","90% of total billed charges ",4379.84,93,,3503.87,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4003.08,85,,3202.46,,,0,"percent of total billed charges ","85% of total billed charges ",4238.55,90,,3390.84,,,0,"percent of total billed charges ","90% of total billed charges ",4238.55,90,,3390.84,,,0,"percent of total billed charges ","90% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4097.27,87,,53.34,53.34,92.54,"1 through 10","percent of total billed charges ","87% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3296.65,70,,2637.32,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,4379.84,
"MRI SHOULDER-RIGHT WO",3800455,"CDM ",610,RC,73221,HCPCS,OUTPATIENT,,,4709.5,3767.6,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",444.29,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3296.65,70,,2637.32,,,0,"percent of total billed charges ","70% of total billed charges ",4238.55,90,,3390.84,,,0,"percent of total billed charges ","90% of total billed charges ",4379.84,93,,3503.87,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4003.08,85,,3202.46,,,0,"percent of total billed charges ","85% of total billed charges ",4238.55,90,,3390.84,,,0,"percent of total billed charges ","90% of total billed charges ",4238.55,90,,3390.84,,,0,"percent of total billed charges ","90% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4097.27,87,,53.34,53.34,92.54,"1 through 10","percent of total billed charges ","87% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3296.65,70,,2637.32,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,4379.84,
"MRI ELBOW-LEFT WO",3800463,"CDM ",610,RC,73221,HCPCS,OUTPATIENT,,,4709.5,3767.6,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",444.29,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3296.65,70,,2637.32,,,0,"percent of total billed charges ","70% of total billed charges ",4238.55,90,,3390.84,,,0,"percent of total billed charges ","90% of total billed charges ",4379.84,93,,3503.87,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4003.08,85,,3202.46,,,0,"percent of total billed charges ","85% of total billed charges ",4238.55,90,,3390.84,,,0,"percent of total billed charges ","90% of total billed charges ",4238.55,90,,3390.84,,,0,"percent of total billed charges ","90% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4097.27,87,,53.34,53.34,92.54,"1 through 10","percent of total billed charges ","87% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3296.65,70,,2637.32,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,4379.84,
"MRI ELBOW-RIGHT WO",3800471,"CDM ",610,RC,73221,HCPCS,OUTPATIENT,,,4709.5,3767.6,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",444.29,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3296.65,70,,2637.32,,,0,"percent of total billed charges ","70% of total billed charges ",4238.55,90,,3390.84,,,0,"percent of total billed charges ","90% of total billed charges ",4379.84,93,,3503.87,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4003.08,85,,3202.46,,,0,"percent of total billed charges ","85% of total billed charges ",4238.55,90,,3390.84,,,0,"percent of total billed charges ","90% of total billed charges ",4238.55,90,,3390.84,,,0,"percent of total billed charges ","90% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4097.27,87,,53.34,53.34,92.54,"1 through 10","percent of total billed charges ","87% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3296.65,70,,2637.32,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,4379.84,
"MRI WRIST-LEFT WO",3800489,"CDM ",610,RC,73221,HCPCS,OUTPATIENT,,,4709.5,3767.6,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",444.29,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3296.65,70,,2637.32,,,0,"percent of total billed charges ","70% of total billed charges ",4238.55,90,,3390.84,,,0,"percent of total billed charges ","90% of total billed charges ",4379.84,93,,3503.87,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4003.08,85,,3202.46,,,0,"percent of total billed charges ","85% of total billed charges ",4238.55,90,,3390.84,,,0,"percent of total billed charges ","90% of total billed charges ",4238.55,90,,3390.84,,,0,"percent of total billed charges ","90% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4097.27,87,,53.34,53.34,92.54,"1 through 10","percent of total billed charges ","87% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3296.65,70,,2637.32,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,4379.84,
"MRI WRIST-RIGHT WO",3800497,"CDM ",610,RC,73221,HCPCS,OUTPATIENT,,,4709.5,3767.6,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",444.29,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3296.65,70,,2637.32,,,0,"percent of total billed charges ","70% of total billed charges ",4238.55,90,,3390.84,,,0,"percent of total billed charges ","90% of total billed charges ",4379.84,93,,3503.87,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4003.08,85,,3202.46,,,0,"percent of total billed charges ","85% of total billed charges ",4238.55,90,,3390.84,,,0,"percent of total billed charges ","90% of total billed charges ",4238.55,90,,3390.84,,,0,"percent of total billed charges ","90% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4097.27,87,,53.34,53.34,92.54,"1 through 10","percent of total billed charges ","87% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3296.65,70,,2637.32,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,4379.84,
"MRI HUMERUS-LEFT W/WO",3800505,"CDM ",610,RC,73220,HCPCS,OUTPATIENT,,,4385,3508,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",913.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3069.5,70,,2455.60,,,0,"percent of total billed charges ","70% of total billed charges ",3946.5,90,,3157.20,,,0,"percent of total billed charges ","90% of total billed charges ",4078.05,93,,3262.44,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3727.25,85,,2981.80,,,0,"percent of total billed charges ","85% of total billed charges ",3946.5,90,,3157.20,,,0,"percent of total billed charges ","90% of total billed charges ",3946.5,90,,3157.20,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3814.95,87,,3051.96,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3069.5,70,,2455.60,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,4078.05,
"MRI HUMERUS-RIGHT W/WO",3800513,"CDM ",610,RC,73220,HCPCS,OUTPATIENT,,,4385,3508,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",913.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3069.5,70,,2455.60,,,0,"percent of total billed charges ","70% of total billed charges ",3946.5,90,,3157.20,,,0,"percent of total billed charges ","90% of total billed charges ",4078.05,93,,3262.44,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3727.25,85,,2981.80,,,0,"percent of total billed charges ","85% of total billed charges ",3946.5,90,,3157.20,,,0,"percent of total billed charges ","90% of total billed charges ",3946.5,90,,3157.20,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3814.95,87,,3051.96,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3069.5,70,,2455.60,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,4078.05,
"MRI FOREARM-LEFT W/WO",3800521,"CDM ",610,RC,73220,HCPCS,OUTPATIENT,,,4385,3508,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",913.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3069.5,70,,2455.60,,,0,"percent of total billed charges ","70% of total billed charges ",3946.5,90,,3157.20,,,0,"percent of total billed charges ","90% of total billed charges ",4078.05,93,,3262.44,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3727.25,85,,2981.80,,,0,"percent of total billed charges ","85% of total billed charges ",3946.5,90,,3157.20,,,0,"percent of total billed charges ","90% of total billed charges ",3946.5,90,,3157.20,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3814.95,87,,3051.96,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3069.5,70,,2455.60,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,4078.05,
"MRI FOREARM-RIGHT W/WO",3800539,"CDM ",610,RC,73220,HCPCS,OUTPATIENT,,,4385,3508,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",913.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3069.5,70,,2455.60,,,0,"percent of total billed charges ","70% of total billed charges ",3946.5,90,,3157.20,,,0,"percent of total billed charges ","90% of total billed charges ",4078.05,93,,3262.44,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3727.25,85,,2981.80,,,0,"percent of total billed charges ","85% of total billed charges ",3946.5,90,,3157.20,,,0,"percent of total billed charges ","90% of total billed charges ",3946.5,90,,3157.20,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3814.95,87,,3051.96,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3069.5,70,,2455.60,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,4078.05,
"MRI HAND-RIGHT W/WO",3800547,"CDM ",610,RC,73220,HCPCS,OUTPATIENT,,,4385,3508,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",913.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3069.5,70,,2455.60,,,0,"percent of total billed charges ","70% of total billed charges ",3946.5,90,,3157.20,,,0,"percent of total billed charges ","90% of total billed charges ",4078.05,93,,3262.44,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3727.25,85,,2981.80,,,0,"percent of total billed charges ","85% of total billed charges ",3946.5,90,,3157.20,,,0,"percent of total billed charges ","90% of total billed charges ",3946.5,90,,3157.20,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3814.95,87,,3051.96,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3069.5,70,,2455.60,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,4078.05,
"MRI HAND-LEFT W/WO",3800554,"CDM ",610,RC,73220,HCPCS,OUTPATIENT,,,4385,3508,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",913.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3069.5,70,,2455.60,,,0,"percent of total billed charges ","70% of total billed charges ",3946.5,90,,3157.20,,,0,"percent of total billed charges ","90% of total billed charges ",4078.05,93,,3262.44,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3727.25,85,,2981.80,,,0,"percent of total billed charges ","85% of total billed charges ",3946.5,90,,3157.20,,,0,"percent of total billed charges ","90% of total billed charges ",3946.5,90,,3157.20,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3814.95,87,,3051.96,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3069.5,70,,2455.60,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,4078.05,
"MRI HIP LEFT WO",3800562,"CDM ",610,RC,73721,HCPCS,OUTPATIENT,,,5179,4143.2,,233.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",443.61,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3625.3,70,,2900.24,,,0,"percent of total billed charges ","70% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",4816.47,93,,3853.18,,,0,"percent of total billed charges ","93% of total billed charges ",233.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",479.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4402.15,85,,3521.72,,,0,"percent of total billed charges ","85% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4505.73,87,,234.64,234.64,234.64,"1 through 10","percent of total billed charges ","87% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3625.3,70,,2900.24,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,4816.47,
"MRI HIP RIGHT WO",3800570,"CDM ",610,RC,73721,HCPCS,OUTPATIENT,,,5179,4143.2,,233.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",443.61,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3625.3,70,,2900.24,,,0,"percent of total billed charges ","70% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",4816.47,93,,3853.18,,,0,"percent of total billed charges ","93% of total billed charges ",233.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",479.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4402.15,85,,3521.72,,,0,"percent of total billed charges ","85% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4505.73,87,,234.64,234.64,234.64,"1 through 10","percent of total billed charges ","87% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3625.3,70,,2900.24,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,4816.47,
"MRI KNEE LEFT WO",3800588,"CDM ",610,RC,73721,HCPCS,OUTPATIENT,,,5179,4143.2,,233.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",443.61,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3625.3,70,,2900.24,,,0,"percent of total billed charges ","70% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",4816.47,93,,3853.18,,,0,"percent of total billed charges ","93% of total billed charges ",233.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",479.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4402.15,85,,3521.72,,,0,"percent of total billed charges ","85% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4505.73,87,,234.64,234.64,234.64,"1 through 10","percent of total billed charges ","87% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3625.3,70,,2900.24,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,4816.47,
"MRI KNEE RIGHT WO",3800596,"CDM ",610,RC,73721,HCPCS,OUTPATIENT,,,5179,4143.2,,233.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",443.61,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3625.3,70,,2900.24,,,0,"percent of total billed charges ","70% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",4816.47,93,,3853.18,,,0,"percent of total billed charges ","93% of total billed charges ",233.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",479.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4402.15,85,,3521.72,,,0,"percent of total billed charges ","85% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4505.73,87,,234.64,234.64,234.64,"1 through 10","percent of total billed charges ","87% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3625.3,70,,2900.24,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,4816.47,
"MRI ANKLE LEFT WO",3800604,"CDM ",610,RC,73721,HCPCS,OUTPATIENT,,,5179,4143.2,,233.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",443.61,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3625.3,70,,2900.24,,,0,"percent of total billed charges ","70% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",4816.47,93,,3853.18,,,0,"percent of total billed charges ","93% of total billed charges ",233.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",479.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4402.15,85,,3521.72,,,0,"percent of total billed charges ","85% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4505.73,87,,234.64,234.64,234.64,"1 through 10","percent of total billed charges ","87% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3625.3,70,,2900.24,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,4816.47,
"MRI ANKLE RIGHT WO",3800612,"CDM ",610,RC,73721,HCPCS,OUTPATIENT,,,5179,4143.2,,233.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",443.61,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3625.3,70,,2900.24,,,0,"percent of total billed charges ","70% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",4816.47,93,,3853.18,,,0,"percent of total billed charges ","93% of total billed charges ",233.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",479.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4402.15,85,,3521.72,,,0,"percent of total billed charges ","85% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4505.73,87,,234.64,234.64,234.64,"1 through 10","percent of total billed charges ","87% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3625.3,70,,2900.24,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,4816.47,
"MRI FOOT LEFT W/WO",3800620,"CDM ",610,RC,73720,HCPCS,OUTPATIENT,,,4823,3858.4,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",748.55,220,,70.75,70.75,70.75,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",3376.1,70,,2700.88,,,0,"percent of total billed charges ","70% of total billed charges ",4340.7,90,,3472.56,,,0,"percent of total billed charges ","90% of total billed charges ",4485.39,93,,3588.31,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4099.55,85,,3279.64,,,0,"percent of total billed charges ","85% of total billed charges ",4340.7,90,,3472.56,,,0,"percent of total billed charges ","90% of total billed charges ",4340.7,90,,3472.56,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4196.01,87,,3356.81,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3376.1,70,,2700.88,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,4485.39,
"MRI FOOT RIGHT W/WO",3800638,"CDM ",610,RC,73720,HCPCS,OUTPATIENT,,,4823,3858.4,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",748.55,220,,70.75,70.75,70.75,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",3376.1,70,,2700.88,,,0,"percent of total billed charges ","70% of total billed charges ",4340.7,90,,3472.56,,,0,"percent of total billed charges ","90% of total billed charges ",4485.39,93,,3588.31,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4099.55,85,,3279.64,,,0,"percent of total billed charges ","85% of total billed charges ",4340.7,90,,3472.56,,,0,"percent of total billed charges ","90% of total billed charges ",4340.7,90,,3472.56,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4196.01,87,,3356.81,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3376.1,70,,2700.88,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,4485.39,
"MRI FEMUR LEFT W/WO",3800646,"CDM ",610,RC,73720,HCPCS,OUTPATIENT,,,4823,3858.4,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",748.55,220,,70.75,70.75,70.75,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",3376.1,70,,2700.88,,,0,"percent of total billed charges ","70% of total billed charges ",4340.7,90,,3472.56,,,0,"percent of total billed charges ","90% of total billed charges ",4485.39,93,,3588.31,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4099.55,85,,3279.64,,,0,"percent of total billed charges ","85% of total billed charges ",4340.7,90,,3472.56,,,0,"percent of total billed charges ","90% of total billed charges ",4340.7,90,,3472.56,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4196.01,87,,3356.81,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3376.1,70,,2700.88,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,4485.39,
"MRI FEMUR RIGHT W/WO",3800653,"CDM ",610,RC,73720,HCPCS,OUTPATIENT,,,4823,3858.4,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",748.55,220,,70.75,70.75,70.75,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",3376.1,70,,2700.88,,,0,"percent of total billed charges ","70% of total billed charges ",4340.7,90,,3472.56,,,0,"percent of total billed charges ","90% of total billed charges ",4485.39,93,,3588.31,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4099.55,85,,3279.64,,,0,"percent of total billed charges ","85% of total billed charges ",4340.7,90,,3472.56,,,0,"percent of total billed charges ","90% of total billed charges ",4340.7,90,,3472.56,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4196.01,87,,3356.81,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3376.1,70,,2700.88,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,4485.39,
"MRI TIB/FIB LEFT W/WO",3800661,"CDM ",610,RC,73720,HCPCS,OUTPATIENT,,,4823,3858.4,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",748.55,220,,70.75,70.75,70.75,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",3376.1,70,,2700.88,,,0,"percent of total billed charges ","70% of total billed charges ",4340.7,90,,3472.56,,,0,"percent of total billed charges ","90% of total billed charges ",4485.39,93,,3588.31,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4099.55,85,,3279.64,,,0,"percent of total billed charges ","85% of total billed charges ",4340.7,90,,3472.56,,,0,"percent of total billed charges ","90% of total billed charges ",4340.7,90,,3472.56,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4196.01,87,,3356.81,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3376.1,70,,2700.88,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,4485.39,
"MRI TIB/FIB RIGHT W/WO",3800679,"CDM ",610,RC,73720,HCPCS,OUTPATIENT,,,4823,3858.4,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",748.55,220,,70.75,70.75,70.75,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",3376.1,70,,2700.88,,,0,"percent of total billed charges ","70% of total billed charges ",4340.7,90,,3472.56,,,0,"percent of total billed charges ","90% of total billed charges ",4485.39,93,,3588.31,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4099.55,85,,3279.64,,,0,"percent of total billed charges ","85% of total billed charges ",4340.7,90,,3472.56,,,0,"percent of total billed charges ","90% of total billed charges ",4340.7,90,,3472.56,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4196.01,87,,3356.81,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3376.1,70,,2700.88,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,4485.39,
"MRA NECK WO CONTRAST",3800687,"CDM ",615,RC,70547,HCPCS,OUTPATIENT,,,2213,1770.4,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",473.31,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1549.1,70,,1239.28,,,0,"percent of total billed charges ","70% of total billed charges ",1991.7,90,,1593.36,,,0,"percent of total billed charges ","90% of total billed charges ",2058.09,93,,1646.47,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",255.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1881.05,85,,1504.84,,,0,"percent of total billed charges ","85% of total billed charges ",1991.7,90,,1593.36,,,0,"percent of total billed charges ","90% of total billed charges ",1991.7,90,,1593.36,,,0,"percent of total billed charges ","90% of total billed charges ",252.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1925.31,87,,1540.25,,,0,"percent of total billed charges ","87% of total billed charges ",252.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1549.1,70,,1239.28,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,2058.09,
"MRA NECK WITH CONTRAST",3800695,"CDM ",615,RC,70548,HCPCS,OUTPATIENT,,,2366.5,1893.2,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",540.06,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1656.55,70,,1325.24,,,0,"percent of total billed charges ","70% of total billed charges ",2129.85,90,,1703.88,,,0,"percent of total billed charges ","90% of total billed charges ",2200.85,93,,1760.68,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",255.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2011.53,85,,1609.22,,,0,"percent of total billed charges ","85% of total billed charges ",2129.85,90,,1703.88,,,0,"percent of total billed charges ","90% of total billed charges ",2129.85,90,,1703.88,,,0,"percent of total billed charges ","90% of total billed charges ",252.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2058.86,87,,1647.09,,,0,"percent of total billed charges ","87% of total billed charges ",252.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1656.55,70,,1325.24,,,0,"percent of total billed charges ","70% of total billed charges ",252.51,2200.85,
"MRA NECK W&WO CONTRAST",3800703,"CDM ",615,RC,70549,HCPCS,OUTPATIENT,,,3072,2457.6,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",756.82,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2150.4,70,,1720.32,,,0,"percent of total billed charges ","70% of total billed charges ",2764.8,90,,2211.84,,,0,"percent of total billed charges ","90% of total billed charges ",2856.96,93,,2285.57,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",255.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2611.2,85,,2088.96,,,0,"percent of total billed charges ","85% of total billed charges ",2764.8,90,,2211.84,,,0,"percent of total billed charges ","90% of total billed charges ",2764.8,90,,2211.84,,,0,"percent of total billed charges ","90% of total billed charges ",252.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2672.64,87,,2138.11,,,0,"percent of total billed charges ","87% of total billed charges ",252.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2150.4,70,,1720.32,,,0,"percent of total billed charges ","70% of total billed charges ",252.51,2856.96,
"MRA HEAD W/CONTRAST",3800711,"CDM ",615,RC,70545,HCPCS,OUTPATIENT,,,5332,4265.6,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",497.51,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3732.4,70,,2985.92,,,0,"percent of total billed charges ","70% of total billed charges ",4798.8,90,,3839.04,,,0,"percent of total billed charges ","90% of total billed charges ",4958.76,93,,3967.01,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",255.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4532.2,85,,3625.76,,,0,"percent of total billed charges ","85% of total billed charges ",4798.8,90,,3839.04,,,0,"percent of total billed charges ","90% of total billed charges ",4798.8,90,,3839.04,,,0,"percent of total billed charges ","90% of total billed charges ",252.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4638.84,87,,3711.07,,,0,"percent of total billed charges ","87% of total billed charges ",252.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3732.4,70,,2985.92,,,0,"percent of total billed charges ","70% of total billed charges ",252.51,4958.76,
"MRA HEAD W&WO CONTRAST",3800729,"CDM ",615,RC,70546,HCPCS,OUTPATIENT,,,6341,5072.8,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",720.35,220,,70.75,70.75,70.75,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",4438.7,70,,3550.96,,,0,"percent of total billed charges ","70% of total billed charges ",5706.9,90,,4565.52,,,0,"percent of total billed charges ","90% of total billed charges ",5897.13,93,,4717.70,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",255.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5389.85,85,,4311.88,,,0,"percent of total billed charges ","85% of total billed charges ",5706.9,90,,4565.52,,,0,"percent of total billed charges ","90% of total billed charges ",5706.9,90,,4565.52,,,0,"percent of total billed charges ","90% of total billed charges ",252.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5516.67,87,,4413.34,,,0,"percent of total billed charges ","87% of total billed charges ",252.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4438.7,70,,3550.96,,,0,"percent of total billed charges ","70% of total billed charges ",252.51,5897.13,
"MRI BREAST LEFT W&WO CONT",3800737,"CDM ",610,RC,77048,HCPCS,OUTPATIENT,,,5030,4024,,,,,,,,0,"other ","not separately reimbursment ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",744.74,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3521,70,,2816.80,,,0,"percent of total billed charges ","70% of total billed charges ",4527,90,,3621.60,,,0,"percent of total billed charges ","90% of total billed charges ",4677.9,93,,3742.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4275.5,85,,3420.40,,,0,"percent of total billed charges ","85% of total billed charges ",4527,90,,3621.60,,,0,"percent of total billed charges ","90% of total billed charges ",4527,90,,3621.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4376.1,87,,3500.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3521,70,,2816.80,,,0,"percent of total billed charges ","70% of total billed charges ",552.52,4677.9,
"MRI BREAST RT W&W/O CONT",3800745,"CDM ",610,RC,77048,HCPCS,OUTPATIENT,,,5030,4024,,,,,,,,0,"other ","not separately reimbursment ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",744.74,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3521,70,,2816.80,,,0,"percent of total billed charges ","70% of total billed charges ",4527,90,,3621.60,,,0,"percent of total billed charges ","90% of total billed charges ",4677.9,93,,3742.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4275.5,85,,3420.40,,,0,"percent of total billed charges ","85% of total billed charges ",4527,90,,3621.60,,,0,"percent of total billed charges ","90% of total billed charges ",4527,90,,3621.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4376.1,87,,3500.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3521,70,,2816.80,,,0,"percent of total billed charges ","70% of total billed charges ",552.52,4677.9,
"MRI BREAST BIL W&W/O CONT",3800786,"CDM ",610,RC,77049,HCPCS,OUTPATIENT,,,6179.5,4943.6,,,,,,,,0,"other ","not separately reimbursment ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",761,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4325.65,70,,3460.52,,,0,"percent of total billed charges ","70% of total billed charges ",5561.55,90,,4449.24,,,0,"percent of total billed charges ","90% of total billed charges ",5746.94,93,,4597.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",175.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5252.58,85,,4202.06,,,0,"percent of total billed charges ","85% of total billed charges ",5561.55,90,,4449.24,,,0,"percent of total billed charges ","90% of total billed charges ",5561.55,90,,4449.24,,,0,"percent of total billed charges ","90% of total billed charges ",173.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5376.17,87,,4300.94,,,0,"percent of total billed charges ","87% of total billed charges ",173.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",4325.65,70,,3460.52,,,0,"percent of total billed charges ","70% of total billed charges ",173.36,5746.94,
"MRA ABDOMEN ANGIO W/CONTRAST",3800794,"CDM ",618,RC,C8900,HCPCS,OUTPATIENT,,,5403,4322.4,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",4322.4,80,,3457.92,,,0,"percent of total billed charges ","80% of total billed charges ",3782.1,70,,3025.68,,,0,"percent of total billed charges ","70% of total billed charges ",4862.7,90,,3890.16,,,0,"percent of total billed charges ","90% of total billed charges ",5024.79,93,,4019.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4592.55,85,,3674.04,,,0,"percent of total billed charges ","85% of total billed charges ",4862.7,90,,3890.16,,,0,"percent of total billed charges ","90% of total billed charges ",4862.7,90,,3890.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4700.61,87,,3760.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3782.1,70,,3025.68,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,5024.79,
"MRA ABDOMEN ANGIO W&WO CONTRAS",3800802,"CDM ",618,RC,C8902,HCPCS,OUTPATIENT,,,5779,4623.2,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",4623.2,80,,3698.56,,,0,"percent of total billed charges ","80% of total billed charges ",4045.3,70,,3236.24,,,0,"percent of total billed charges ","70% of total billed charges ",5201.1,90,,4160.88,,,0,"percent of total billed charges ","90% of total billed charges ",5374.47,93,,4299.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4912.15,85,,3929.72,,,0,"percent of total billed charges ","85% of total billed charges ",5201.1,90,,4160.88,,,0,"percent of total billed charges ","90% of total billed charges ",5201.1,90,,4160.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5027.73,87,,4022.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4045.3,70,,3236.24,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,5374.47,
"MRI SOFT TISSUE NECK W/0 CONTR",3800810,"CDM ",610,RC,70540,HCPCS,OUTPATIENT,,,3759.5,3007.6,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",499.95,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2631.65,70,,2105.32,,,0,"percent of total billed charges ","70% of total billed charges ",3383.55,90,,2706.84,,,0,"percent of total billed charges ","90% of total billed charges ",3496.34,93,,2797.07,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3195.58,85,,2556.46,,,0,"percent of total billed charges ","85% of total billed charges ",3383.55,90,,2706.84,,,0,"percent of total billed charges ","90% of total billed charges ",3383.55,90,,2706.84,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3270.77,87,,2616.62,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2631.65,70,,2105.32,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,3496.34,
"MRI SOFT TISSUE NECK W CONTRAS",3800828,"CDM ",610,RC,70542,HCPCS,OUTPATIENT,,,4883.5,3906.8,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",594.13,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3418.45,70,,2734.76,,,0,"percent of total billed charges ","70% of total billed charges ",4395.15,90,,3516.12,,,0,"percent of total billed charges ","90% of total billed charges ",4541.66,93,,3633.33,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4150.98,85,,3320.78,,,0,"percent of total billed charges ","85% of total billed charges ",4395.15,90,,3516.12,,,0,"percent of total billed charges ","90% of total billed charges ",4395.15,90,,3516.12,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4248.65,87,,3398.92,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3418.45,70,,2734.76,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,4541.66,
"MRI ORBIT FACE NECK W/WO CX",3800836,"CDM ",610,RC,70543,HCPCS,OUTPATIENT,,,6006,4804.8,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,529.06,529.06,529.06,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",749.94,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4204.2,70,,3363.36,,,0,"percent of total billed charges ","70% of total billed charges ",5405.4,90,,4324.32,,,0,"percent of total billed charges ","90% of total billed charges ",5585.58,93,,4468.46,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5105.1,85,,4084.08,,,0,"percent of total billed charges ","85% of total billed charges ",5405.4,90,,4324.32,,,0,"percent of total billed charges ","90% of total billed charges ",5405.4,90,,4324.32,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5225.22,87,,4180.18,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4204.2,70,,3363.36,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,5585.58,
"MRA UPPER EXT LEFT W/CONT",3800844,"CDM ",618,RC,73225,HCPCS,OUTPATIENT,,,2753,2202.4,,412.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",754.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1927.1,70,,1541.68,,,0,"percent of total billed charges ","70% of total billed charges ",2477.7,90,,1982.16,,,0,"percent of total billed charges ","90% of total billed charges ",2560.29,93,,2048.23,,,0,"percent of total billed charges ","93% of total billed charges ",412.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2340.05,85,,1872.04,,,0,"percent of total billed charges ","85% of total billed charges ",2477.7,90,,1982.16,,,0,"percent of total billed charges ","90% of total billed charges ",2477.7,90,,1982.16,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2395.11,87,,1916.09,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1927.1,70,,1541.68,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,2560.29,
"MRA UPPER EXT LEFT W/O CONTRAS",3800851,"CDM ",618,RC,73225,HCPCS,OUTPATIENT,,,2427,1941.6,,412.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",754.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1698.9,70,,1359.12,,,0,"percent of total billed charges ","70% of total billed charges ",2184.3,90,,1747.44,,,0,"percent of total billed charges ","90% of total billed charges ",2257.11,93,,1805.69,,,0,"percent of total billed charges ","93% of total billed charges ",412.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2062.95,85,,1650.36,,,0,"percent of total billed charges ","85% of total billed charges ",2184.3,90,,1747.44,,,0,"percent of total billed charges ","90% of total billed charges ",2184.3,90,,1747.44,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2111.49,87,,1689.19,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1698.9,70,,1359.12,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,2257.11,
"MRA UPPER EXT LEFT W&WO CONTRA",3800869,"CDM ",618,RC,73225,HCPCS,OUTPATIENT,,,3294,2635.2,,412.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",754.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2305.8,70,,1844.64,,,0,"percent of total billed charges ","70% of total billed charges ",2964.6,90,,2371.68,,,0,"percent of total billed charges ","90% of total billed charges ",3063.42,93,,2450.74,,,0,"percent of total billed charges ","93% of total billed charges ",412.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2799.9,85,,2239.92,,,0,"percent of total billed charges ","85% of total billed charges ",2964.6,90,,2371.68,,,0,"percent of total billed charges ","90% of total billed charges ",2964.6,90,,2371.68,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2865.78,87,,2292.62,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2305.8,70,,1844.64,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,3063.42,
"MRA UPPER EXT BIL W/CONT",3800877,"CDM ",618,RC,73225,HCPCS,OUTPATIENT,,,5502,4401.6,,412.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",754.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3851.4,70,,3081.12,,,0,"percent of total billed charges ","70% of total billed charges ",4951.8,90,,3961.44,,,0,"percent of total billed charges ","90% of total billed charges ",5116.86,93,,4093.49,,,0,"percent of total billed charges ","93% of total billed charges ",412.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4676.7,85,,3741.36,,,0,"percent of total billed charges ","85% of total billed charges ",4951.8,90,,3961.44,,,0,"percent of total billed charges ","90% of total billed charges ",4951.8,90,,3961.44,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4786.74,87,,3829.39,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3851.4,70,,3081.12,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,5116.86,
"MRA UPPER EXT BIL W/O CONTO CO",3800885,"CDM ",610,RC,73225,HCPCS,OUTPATIENT,,,4845.5,3876.4,,412.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",754.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3391.85,70,,2713.48,,,0,"percent of total billed charges ","70% of total billed charges ",4360.95,90,,3488.76,,,0,"percent of total billed charges ","90% of total billed charges ",4506.32,93,,3605.06,,,0,"percent of total billed charges ","93% of total billed charges ",412.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4118.68,85,,3294.94,,,0,"percent of total billed charges ","85% of total billed charges ",4360.95,90,,3488.76,,,0,"percent of total billed charges ","90% of total billed charges ",4360.95,90,,3488.76,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4215.59,87,,3372.47,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3391.85,70,,2713.48,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,4506.32,
"MRA UPPER EXT BIL W/WO CONT",3800893,"CDM ",618,RC,73225,HCPCS,OUTPATIENT,,,6580,5264,,412.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",754.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4606,70,,3684.80,,,0,"percent of total billed charges ","70% of total billed charges ",5922,90,,4737.60,,,0,"percent of total billed charges ","90% of total billed charges ",6119.4,93,,4895.52,,,0,"percent of total billed charges ","93% of total billed charges ",412.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5593,85,,4474.40,,,0,"percent of total billed charges ","85% of total billed charges ",5922,90,,4737.60,,,0,"percent of total billed charges ","90% of total billed charges ",5922,90,,4737.60,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5724.6,87,,4579.68,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",4606,70,,3684.80,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,6119.4,
"MRI PELVIS W/WO CONTRAST",3800901,"CDM ",610,RC,72197,HCPCS,OUTPATIENT,,,5683,4546.4,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,495.99,495.99,495.99,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",748.9,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3978.1,70,,3182.48,,,0,"percent of total billed charges ","70% of total billed charges ",5114.7,90,,4091.76,,,0,"percent of total billed charges ","90% of total billed charges ",5285.19,93,,4228.15,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",212.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4830.55,85,,3864.44,,,0,"percent of total billed charges ","85% of total billed charges ",5114.7,90,,4091.76,,,0,"percent of total billed charges ","90% of total billed charges ",5114.7,90,,4091.76,,,0,"percent of total billed charges ","90% of total billed charges ",210.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4944.21,87,,3955.37,,,0,"percent of total billed charges ","87% of total billed charges ",210.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3978.1,70,,3182.48,,,0,"percent of total billed charges ","70% of total billed charges ",210.29,5285.19,
"MRI PELVIS WO CONTRAST",3800919,"CDM ",610,RC,72195,HCPCS,OUTPATIENT,,,4225,3380,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",508.66,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2957.5,70,,2366.00,,,0,"percent of total billed charges ","70% of total billed charges ",3802.5,90,,3042.00,,,0,"percent of total billed charges ","90% of total billed charges ",3929.25,93,,3143.40,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",206.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3591.25,85,,2873.00,,,0,"percent of total billed charges ","85% of total billed charges ",3802.5,90,,3042.00,,,0,"percent of total billed charges ","90% of total billed charges ",3802.5,90,,3042.00,,,0,"percent of total billed charges ","90% of total billed charges ",204.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3675.75,87,,2940.60,,,0,"percent of total billed charges ","87% of total billed charges ",204.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2957.5,70,,2366.00,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,3929.25,
"MRI HUMERUS LT W CONTRAST",3800927,"CDM ",610,RC,73219,HCPCS,OUTPATIENT,,,3862,3089.6,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",734.8,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3591.66,93,,2873.33,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3282.7,85,,2626.16,,,0,"percent of total billed charges ","85% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3359.94,87,,2687.95,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,3591.66,
"MRI HUMERUS RT W CONTRAST",3800935,"CDM ",610,RC,73219,HCPCS,OUTPATIENT,,,3862,3089.6,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",734.8,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3591.66,93,,2873.33,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3282.7,85,,2626.16,,,0,"percent of total billed charges ","85% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3359.94,87,,2687.95,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,3591.66,
"MRI HUMERUS LT WO CONTRAST",3800943,"CDM ",610,RC,73218,HCPCS,OUTPATIENT,,,3510.5,2808.4,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,529.06,529.06,529.06,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",673.46,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2457.35,70,,1965.88,,,0,"percent of total billed charges ","70% of total billed charges ",3159.45,90,,2527.56,,,0,"percent of total billed charges ","90% of total billed charges ",3264.77,93,,2611.82,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2983.93,85,,2387.14,,,0,"percent of total billed charges ","85% of total billed charges ",3159.45,90,,2527.56,,,0,"percent of total billed charges ","90% of total billed charges ",3159.45,90,,2527.56,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3054.14,87,,2443.31,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2457.35,70,,1965.88,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,3264.77,
"MRI HUMERUS RT WO CONTRAST",3800950,"CDM ",610,RC,73218,HCPCS,OUTPATIENT,,,3510.5,2808.4,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,529.06,529.06,529.06,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",673.46,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2457.35,70,,1965.88,,,0,"percent of total billed charges ","70% of total billed charges ",3159.45,90,,2527.56,,,0,"percent of total billed charges ","90% of total billed charges ",3264.77,93,,2611.82,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2983.93,85,,2387.14,,,0,"percent of total billed charges ","85% of total billed charges ",3159.45,90,,2527.56,,,0,"percent of total billed charges ","90% of total billed charges ",3159.45,90,,2527.56,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3054.14,87,,2443.31,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2457.35,70,,1965.88,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,3264.77,
"MRI FOREARM LT W CONTRAST",3800968,"CDM ",610,RC,73219,HCPCS,OUTPATIENT,,,3862,3089.6,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",734.8,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3591.66,93,,2873.33,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3282.7,85,,2626.16,,,0,"percent of total billed charges ","85% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3359.94,87,,2687.95,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,3591.66,
"MRI FOREARM RT W CONTRAST",3800976,"CDM ",610,RC,73219,HCPCS,OUTPATIENT,,,3862,3089.6,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",734.8,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3591.66,93,,2873.33,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3282.7,85,,2626.16,,,0,"percent of total billed charges ","85% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3359.94,87,,2687.95,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,3591.66,
"MRI FOREARM LT WO CONTRAST",3800984,"CDM ",610,RC,73218,HCPCS,OUTPATIENT,,,3510.5,2808.4,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,529.06,529.06,529.06,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",673.46,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2457.35,70,,1965.88,,,0,"percent of total billed charges ","70% of total billed charges ",3159.45,90,,2527.56,,,0,"percent of total billed charges ","90% of total billed charges ",3264.77,93,,2611.82,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2983.93,85,,2387.14,,,0,"percent of total billed charges ","85% of total billed charges ",3159.45,90,,2527.56,,,0,"percent of total billed charges ","90% of total billed charges ",3159.45,90,,2527.56,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3054.14,87,,2443.31,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2457.35,70,,1965.88,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,3264.77,
"MRI FOREARM RT WO CONTRAST",3800992,"CDM ",610,RC,73218,HCPCS,OUTPATIENT,,,3510.5,2808.4,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,529.06,529.06,529.06,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",673.46,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2457.35,70,,1965.88,,,0,"percent of total billed charges ","70% of total billed charges ",3159.45,90,,2527.56,,,0,"percent of total billed charges ","90% of total billed charges ",3264.77,93,,2611.82,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2983.93,85,,2387.14,,,0,"percent of total billed charges ","85% of total billed charges ",3159.45,90,,2527.56,,,0,"percent of total billed charges ","90% of total billed charges ",3159.45,90,,2527.56,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3054.14,87,,2443.31,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2457.35,70,,1965.88,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,3264.77,
"MRI HAND RT W CONTRAST",3801008,"CDM ",610,RC,73219,HCPCS,OUTPATIENT,,,3862,3089.6,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",734.8,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3591.66,93,,2873.33,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3282.7,85,,2626.16,,,0,"percent of total billed charges ","85% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3359.94,87,,2687.95,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,3591.66,
"MRI HAND LT W CONTRAST",3801016,"CDM ",610,RC,73219,HCPCS,OUTPATIENT,,,3862,3089.6,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",734.8,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3591.66,93,,2873.33,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3282.7,85,,2626.16,,,0,"percent of total billed charges ","85% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3359.94,87,,2687.95,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,3591.66,
"MRI HAND LT WO CONTRAST",3801024,"CDM ",610,RC,73218,HCPCS,OUTPATIENT,,,3510.5,2808.4,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,529.06,529.06,529.06,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",673.46,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2457.35,70,,1965.88,,,0,"percent of total billed charges ","70% of total billed charges ",3159.45,90,,2527.56,,,0,"percent of total billed charges ","90% of total billed charges ",3264.77,93,,2611.82,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2983.93,85,,2387.14,,,0,"percent of total billed charges ","85% of total billed charges ",3159.45,90,,2527.56,,,0,"percent of total billed charges ","90% of total billed charges ",3159.45,90,,2527.56,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3054.14,87,,2443.31,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2457.35,70,,1965.88,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,3264.77,
"MRI HAND RT WO CONTRAST",3801032,"CDM ",610,RC,73218,HCPCS,OUTPATIENT,,,3510.5,2808.4,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,529.06,529.06,529.06,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",673.46,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2457.35,70,,1965.88,,,0,"percent of total billed charges ","70% of total billed charges ",3159.45,90,,2527.56,,,0,"percent of total billed charges ","90% of total billed charges ",3264.77,93,,2611.82,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2983.93,85,,2387.14,,,0,"percent of total billed charges ","85% of total billed charges ",3159.45,90,,2527.56,,,0,"percent of total billed charges ","90% of total billed charges ",3159.45,90,,2527.56,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3054.14,87,,2443.31,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2457.35,70,,1965.88,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,3264.77,
"MRI SHOULDER W/CONTRAST RIGHT",3801040,"CDM ",610,RC,73222,HCPCS,OUTPATIENT,,,5179,4143.2,,629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",696.78,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3625.3,70,,2900.24,,,0,"percent of total billed charges ","70% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",4816.47,93,,3853.18,,,0,"percent of total billed charges ","93% of total billed charges ",629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4402.15,85,,3521.72,,,0,"percent of total billed charges ","85% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4505.73,87,,3604.58,,,0,"percent of total billed charges ","87% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",720.93,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3625.3,70,,2900.24,,,0,"percent of total billed charges ","70% of total billed charges ",253.61,4816.47,
"MRI SHOULDER W/CONTRAST LEFT",3801057,"CDM ",610,RC,73222,HCPCS,OUTPATIENT,,,5179,4143.2,,629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",696.78,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3625.3,70,,2900.24,,,0,"percent of total billed charges ","70% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",4816.47,93,,3853.18,,,0,"percent of total billed charges ","93% of total billed charges ",629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4402.15,85,,3521.72,,,0,"percent of total billed charges ","85% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4505.73,87,,3604.58,,,0,"percent of total billed charges ","87% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",720.93,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3625.3,70,,2900.24,,,0,"percent of total billed charges ","70% of total billed charges ",253.61,4816.47,
"MRI SHOULDER W/WO CONTRAST RIG",3801065,"CDM ",610,RC,73223,HCPCS,OUTPATIENT,,,5886,4708.8,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",863.3,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4120.2,70,,3296.16,,,0,"percent of total billed charges ","70% of total billed charges ",5297.4,90,,4237.92,,,0,"percent of total billed charges ","90% of total billed charges ",5473.98,93,,4379.18,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5003.1,85,,4002.48,,,0,"percent of total billed charges ","85% of total billed charges ",5297.4,90,,4237.92,,,0,"percent of total billed charges ","90% of total billed charges ",5297.4,90,,4237.92,,,0,"percent of total billed charges ","90% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5120.82,87,,4096.66,,,0,"percent of total billed charges ","87% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4120.2,70,,3296.16,,,0,"percent of total billed charges ","70% of total billed charges ",253.61,5473.98,
"MRI SHOULDER W/WO CONTRAST LEF",3801073,"CDM ",610,RC,73223,HCPCS,OUTPATIENT,,,5886,4708.8,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",863.3,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4120.2,70,,3296.16,,,0,"percent of total billed charges ","70% of total billed charges ",5297.4,90,,4237.92,,,0,"percent of total billed charges ","90% of total billed charges ",5473.98,93,,4379.18,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5003.1,85,,4002.48,,,0,"percent of total billed charges ","85% of total billed charges ",5297.4,90,,4237.92,,,0,"percent of total billed charges ","90% of total billed charges ",5297.4,90,,4237.92,,,0,"percent of total billed charges ","90% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5120.82,87,,4096.66,,,0,"percent of total billed charges ","87% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4120.2,70,,3296.16,,,0,"percent of total billed charges ","70% of total billed charges ",253.61,5473.98,
"MRI ELBOW W/CONTRAST RIGHT",3801081,"CDM ",610,RC,73222,HCPCS,OUTPATIENT,,,5179,4143.2,,629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",696.78,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3625.3,70,,2900.24,,,0,"percent of total billed charges ","70% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",4816.47,93,,3853.18,,,0,"percent of total billed charges ","93% of total billed charges ",629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4402.15,85,,3521.72,,,0,"percent of total billed charges ","85% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4505.73,87,,3604.58,,,0,"percent of total billed charges ","87% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",720.93,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3625.3,70,,2900.24,,,0,"percent of total billed charges ","70% of total billed charges ",253.61,4816.47,
"MRI ELBOW W/CONTRAST LEFT",3801099,"CDM ",610,RC,73222,HCPCS,OUTPATIENT,,,5179,4143.2,,629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",696.78,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3625.3,70,,2900.24,,,0,"percent of total billed charges ","70% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",4816.47,93,,3853.18,,,0,"percent of total billed charges ","93% of total billed charges ",629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4402.15,85,,3521.72,,,0,"percent of total billed charges ","85% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4505.73,87,,3604.58,,,0,"percent of total billed charges ","87% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",720.93,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3625.3,70,,2900.24,,,0,"percent of total billed charges ","70% of total billed charges ",253.61,4816.47,
"MRI ELBOW W/WO CONTRAST RIGHT",3801107,"CDM ",610,RC,73223,HCPCS,OUTPATIENT,,,5886,4708.8,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",863.3,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4120.2,70,,3296.16,,,0,"percent of total billed charges ","70% of total billed charges ",5297.4,90,,4237.92,,,0,"percent of total billed charges ","90% of total billed charges ",5473.98,93,,4379.18,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5003.1,85,,4002.48,,,0,"percent of total billed charges ","85% of total billed charges ",5297.4,90,,4237.92,,,0,"percent of total billed charges ","90% of total billed charges ",5297.4,90,,4237.92,,,0,"percent of total billed charges ","90% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5120.82,87,,4096.66,,,0,"percent of total billed charges ","87% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4120.2,70,,3296.16,,,0,"percent of total billed charges ","70% of total billed charges ",253.61,5473.98,
"MRI ELBOW W/WO CONTRAST LEFT",3801115,"CDM ",610,RC,73223,HCPCS,OUTPATIENT,,,5886,4708.8,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",863.3,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4120.2,70,,3296.16,,,0,"percent of total billed charges ","70% of total billed charges ",5297.4,90,,4237.92,,,0,"percent of total billed charges ","90% of total billed charges ",5473.98,93,,4379.18,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5003.1,85,,4002.48,,,0,"percent of total billed charges ","85% of total billed charges ",5297.4,90,,4237.92,,,0,"percent of total billed charges ","90% of total billed charges ",5297.4,90,,4237.92,,,0,"percent of total billed charges ","90% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5120.82,87,,4096.66,,,0,"percent of total billed charges ","87% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4120.2,70,,3296.16,,,0,"percent of total billed charges ","70% of total billed charges ",253.61,5473.98,
"MRI WRIST W/CONTRAST RIGHT",3801123,"CDM ",610,RC,73222,HCPCS,OUTPATIENT,,,5179,4143.2,,629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",696.78,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3625.3,70,,2900.24,,,0,"percent of total billed charges ","70% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",4816.47,93,,3853.18,,,0,"percent of total billed charges ","93% of total billed charges ",629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4402.15,85,,3521.72,,,0,"percent of total billed charges ","85% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4505.73,87,,3604.58,,,0,"percent of total billed charges ","87% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",720.93,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3625.3,70,,2900.24,,,0,"percent of total billed charges ","70% of total billed charges ",253.61,4816.47,
"MRI WRIST W/CONTRAST LEFT",3801131,"CDM ",610,RC,73222,HCPCS,OUTPATIENT,,,5179,4143.2,,629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",696.78,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3625.3,70,,2900.24,,,0,"percent of total billed charges ","70% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",4816.47,93,,3853.18,,,0,"percent of total billed charges ","93% of total billed charges ",629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4402.15,85,,3521.72,,,0,"percent of total billed charges ","85% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",4661.1,90,,3728.88,,,0,"percent of total billed charges ","90% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4505.73,87,,3604.58,,,0,"percent of total billed charges ","87% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",720.93,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3625.3,70,,2900.24,,,0,"percent of total billed charges ","70% of total billed charges ",253.61,4816.47,
"MRI WRIST W/WO CONTRAST LEFT",3801149,"CDM ",610,RC,73223,HCPCS,OUTPATIENT,,,5886,4708.8,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",863.3,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4120.2,70,,3296.16,,,0,"percent of total billed charges ","70% of total billed charges ",5297.4,90,,4237.92,,,0,"percent of total billed charges ","90% of total billed charges ",5473.98,93,,4379.18,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5003.1,85,,4002.48,,,0,"percent of total billed charges ","85% of total billed charges ",5297.4,90,,4237.92,,,0,"percent of total billed charges ","90% of total billed charges ",5297.4,90,,4237.92,,,0,"percent of total billed charges ","90% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5120.82,87,,4096.66,,,0,"percent of total billed charges ","87% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4120.2,70,,3296.16,,,0,"percent of total billed charges ","70% of total billed charges ",253.61,5473.98,
"MRI WRIST W/WO CONTRAST RIGHT",3801156,"CDM ",610,RC,73223,HCPCS,OUTPATIENT,,,5886,4708.8,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",863.3,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4120.2,70,,3296.16,,,0,"percent of total billed charges ","70% of total billed charges ",5297.4,90,,4237.92,,,0,"percent of total billed charges ","90% of total billed charges ",5473.98,93,,4379.18,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5003.1,85,,4002.48,,,0,"percent of total billed charges ","85% of total billed charges ",5297.4,90,,4237.92,,,0,"percent of total billed charges ","90% of total billed charges ",5297.4,90,,4237.92,,,0,"percent of total billed charges ","90% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5120.82,87,,4096.66,,,0,"percent of total billed charges ","87% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4120.2,70,,3296.16,,,0,"percent of total billed charges ","70% of total billed charges ",253.61,5473.98,
"MRI HIP W/CONTRAST LEFT",3801164,"CDM ",610,RC,73722,HCPCS,OUTPATIENT,,,5698,4558.4,,629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,525.90,525.90,525.90,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",698.17,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3988.6,70,,3190.88,,,0,"percent of total billed charges ","70% of total billed charges ",5128.2,90,,4102.56,,,0,"percent of total billed charges ","90% of total billed charges ",5299.14,93,,4239.31,,,0,"percent of total billed charges ","93% of total billed charges ",629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",479.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4843.3,85,,3874.64,,,0,"percent of total billed charges ","85% of total billed charges ",5128.2,90,,4102.56,,,0,"percent of total billed charges ","90% of total billed charges ",5128.2,90,,4102.56,,,0,"percent of total billed charges ","90% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4957.26,87,,3965.81,,,0,"percent of total billed charges ","87% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",720.93,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3988.6,70,,3190.88,,,0,"percent of total billed charges ","70% of total billed charges ",474.59,5299.14,
"MRI HIP W/WO CONTRAST RIGHT",3801172,"CDM ",610,RC,73723,HCPCS,OUTPATIENT,,,6476,5180.8,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,407.38,407.38,407.38,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",860.55,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4533.2,70,,3626.56,,,0,"percent of total billed charges ","70% of total billed charges ",5828.4,90,,4662.72,,,0,"percent of total billed charges ","90% of total billed charges ",6022.68,93,,4818.14,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",479.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5504.6,85,,4403.68,,,0,"percent of total billed charges ","85% of total billed charges ",5828.4,90,,4662.72,,,0,"percent of total billed charges ","90% of total billed charges ",5828.4,90,,4662.72,,,0,"percent of total billed charges ","90% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5634.12,87,,4507.30,,,0,"percent of total billed charges ","87% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4533.2,70,,3626.56,,,0,"percent of total billed charges ","70% of total billed charges ",313.17,6022.68,
"MRI HIP W/WO CONTRAST LEFT",3801180,"CDM ",610,RC,73723,HCPCS,OUTPATIENT,,,6476,5180.8,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,407.38,407.38,407.38,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",860.55,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4533.2,70,,3626.56,,,0,"percent of total billed charges ","70% of total billed charges ",5828.4,90,,4662.72,,,0,"percent of total billed charges ","90% of total billed charges ",6022.68,93,,4818.14,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",479.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5504.6,85,,4403.68,,,0,"percent of total billed charges ","85% of total billed charges ",5828.4,90,,4662.72,,,0,"percent of total billed charges ","90% of total billed charges ",5828.4,90,,4662.72,,,0,"percent of total billed charges ","90% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5634.12,87,,4507.30,,,0,"percent of total billed charges ","87% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4533.2,70,,3626.56,,,0,"percent of total billed charges ","70% of total billed charges ",313.17,6022.68,
"MRI KNEE W/CONTRAST RIGHT",3801198,"CDM ",610,RC,73722,HCPCS,OUTPATIENT,,,5698,4558.4,,629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,525.90,525.90,525.90,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",698.17,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3988.6,70,,3190.88,,,0,"percent of total billed charges ","70% of total billed charges ",5128.2,90,,4102.56,,,0,"percent of total billed charges ","90% of total billed charges ",5299.14,93,,4239.31,,,0,"percent of total billed charges ","93% of total billed charges ",629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",479.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4843.3,85,,3874.64,,,0,"percent of total billed charges ","85% of total billed charges ",5128.2,90,,4102.56,,,0,"percent of total billed charges ","90% of total billed charges ",5128.2,90,,4102.56,,,0,"percent of total billed charges ","90% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4957.26,87,,3965.81,,,0,"percent of total billed charges ","87% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",720.93,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3988.6,70,,3190.88,,,0,"percent of total billed charges ","70% of total billed charges ",474.59,5299.14,
"MRI KNEE W/CONTRAST LEFT",3801206,"CDM ",610,RC,73722,HCPCS,OUTPATIENT,,,5698,4558.4,,629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,525.90,525.90,525.90,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",698.17,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3988.6,70,,3190.88,,,0,"percent of total billed charges ","70% of total billed charges ",5128.2,90,,4102.56,,,0,"percent of total billed charges ","90% of total billed charges ",5299.14,93,,4239.31,,,0,"percent of total billed charges ","93% of total billed charges ",629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",479.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4843.3,85,,3874.64,,,0,"percent of total billed charges ","85% of total billed charges ",5128.2,90,,4102.56,,,0,"percent of total billed charges ","90% of total billed charges ",5128.2,90,,4102.56,,,0,"percent of total billed charges ","90% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4957.26,87,,3965.81,,,0,"percent of total billed charges ","87% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",720.93,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3988.6,70,,3190.88,,,0,"percent of total billed charges ","70% of total billed charges ",474.59,5299.14,
"MRI KNEE W/WO CONTRAST RIGHT",3801214,"CDM ",610,RC,73723,HCPCS,OUTPATIENT,,,6476,5180.8,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,407.38,407.38,407.38,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",860.55,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4533.2,70,,3626.56,,,0,"percent of total billed charges ","70% of total billed charges ",5828.4,90,,4662.72,,,0,"percent of total billed charges ","90% of total billed charges ",6022.68,93,,4818.14,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",479.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5504.6,85,,4403.68,,,0,"percent of total billed charges ","85% of total billed charges ",5828.4,90,,4662.72,,,0,"percent of total billed charges ","90% of total billed charges ",5828.4,90,,4662.72,,,0,"percent of total billed charges ","90% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5634.12,87,,4507.30,,,0,"percent of total billed charges ","87% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4533.2,70,,3626.56,,,0,"percent of total billed charges ","70% of total billed charges ",313.17,6022.68,
"MRI KNEE W/WO CONTRAST LEFT",3801222,"CDM ",610,RC,73723,HCPCS,OUTPATIENT,,,6476,5180.8,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,407.38,407.38,407.38,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",860.55,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4533.2,70,,3626.56,,,0,"percent of total billed charges ","70% of total billed charges ",5828.4,90,,4662.72,,,0,"percent of total billed charges ","90% of total billed charges ",6022.68,93,,4818.14,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",479.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5504.6,85,,4403.68,,,0,"percent of total billed charges ","85% of total billed charges ",5828.4,90,,4662.72,,,0,"percent of total billed charges ","90% of total billed charges ",5828.4,90,,4662.72,,,0,"percent of total billed charges ","90% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5634.12,87,,4507.30,,,0,"percent of total billed charges ","87% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4533.2,70,,3626.56,,,0,"percent of total billed charges ","70% of total billed charges ",313.17,6022.68,
"MRI ANKLE W/CONTRAST RIGHT",3801230,"CDM ",610,RC,73722,HCPCS,OUTPATIENT,,,5698,4558.4,,629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,525.90,525.90,525.90,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",698.17,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3988.6,70,,3190.88,,,0,"percent of total billed charges ","70% of total billed charges ",5128.2,90,,4102.56,,,0,"percent of total billed charges ","90% of total billed charges ",5299.14,93,,4239.31,,,0,"percent of total billed charges ","93% of total billed charges ",629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",479.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4843.3,85,,3874.64,,,0,"percent of total billed charges ","85% of total billed charges ",5128.2,90,,4102.56,,,0,"percent of total billed charges ","90% of total billed charges ",5128.2,90,,4102.56,,,0,"percent of total billed charges ","90% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4957.26,87,,3965.81,,,0,"percent of total billed charges ","87% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",720.93,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3988.6,70,,3190.88,,,0,"percent of total billed charges ","70% of total billed charges ",474.59,5299.14,
"MRI ANKLE W/CONTRAST LEFT",3801248,"CDM ",610,RC,73722,HCPCS,OUTPATIENT,,,5698,4558.4,,629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,525.90,525.90,525.90,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",698.17,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3988.6,70,,3190.88,,,0,"percent of total billed charges ","70% of total billed charges ",5128.2,90,,4102.56,,,0,"percent of total billed charges ","90% of total billed charges ",5299.14,93,,4239.31,,,0,"percent of total billed charges ","93% of total billed charges ",629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",479.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4843.3,85,,3874.64,,,0,"percent of total billed charges ","85% of total billed charges ",5128.2,90,,4102.56,,,0,"percent of total billed charges ","90% of total billed charges ",5128.2,90,,4102.56,,,0,"percent of total billed charges ","90% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4957.26,87,,3965.81,,,0,"percent of total billed charges ","87% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",720.93,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3988.6,70,,3190.88,,,0,"percent of total billed charges ","70% of total billed charges ",474.59,5299.14,
"MRI ANKLE W/WO CONTRAST LEFT",3801255,"CDM ",610,RC,73723,HCPCS,OUTPATIENT,,,6476,5180.8,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,407.38,407.38,407.38,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",860.55,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4533.2,70,,3626.56,,,0,"percent of total billed charges ","70% of total billed charges ",5828.4,90,,4662.72,,,0,"percent of total billed charges ","90% of total billed charges ",6022.68,93,,4818.14,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",479.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5504.6,85,,4403.68,,,0,"percent of total billed charges ","85% of total billed charges ",5828.4,90,,4662.72,,,0,"percent of total billed charges ","90% of total billed charges ",5828.4,90,,4662.72,,,0,"percent of total billed charges ","90% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5634.12,87,,4507.30,,,0,"percent of total billed charges ","87% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4533.2,70,,3626.56,,,0,"percent of total billed charges ","70% of total billed charges ",313.17,6022.68,
"MRI ANKLE W/WO CONTRAST RIGHT",3801263,"CDM ",610,RC,73723,HCPCS,OUTPATIENT,,,6476,5180.8,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,407.38,407.38,407.38,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",860.55,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4533.2,70,,3626.56,,,0,"percent of total billed charges ","70% of total billed charges ",5828.4,90,,4662.72,,,0,"percent of total billed charges ","90% of total billed charges ",6022.68,93,,4818.14,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",479.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5504.6,85,,4403.68,,,0,"percent of total billed charges ","85% of total billed charges ",5828.4,90,,4662.72,,,0,"percent of total billed charges ","90% of total billed charges ",5828.4,90,,4662.72,,,0,"percent of total billed charges ","90% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5634.12,87,,4507.30,,,0,"percent of total billed charges ","87% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4533.2,70,,3626.56,,,0,"percent of total billed charges ","70% of total billed charges ",313.17,6022.68,
"MRI PITUITARY WO CONT",3801271,"CDM ",610,RC,70551,HCPCS,OUTPATIENT,,,4799.5,3839.6,,233.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",430.69,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3359.65,70,,2687.72,,,0,"percent of total billed charges ","70% of total billed charges ",4319.55,90,,3455.64,,,0,"percent of total billed charges ","90% of total billed charges ",4463.54,93,,3570.83,,,0,"percent of total billed charges ","93% of total billed charges ",233.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",249.65,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4079.58,85,,3263.66,,,0,"percent of total billed charges ","85% of total billed charges ",4319.55,90,,3455.64,,,0,"percent of total billed charges ","90% of total billed charges ",4319.55,90,,3455.64,,,0,"percent of total billed charges ","90% of total billed charges ",247.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4175.57,87,,731.16,188.90,1273.41,"1 through 10","percent of total billed charges ","87% of total billed charges ",247.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3359.65,70,,2687.72,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,4463.54,
"MRI PITUITARY W/CONTRAST",3801289,"CDM ",610,RC,70552,HCPCS,OUTPATIENT,,,5277.5,4222,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,525.90,525.90,525.90,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",594.9,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3694.25,70,,2955.40,,,0,"percent of total billed charges ","70% of total billed charges ",4749.75,90,,3799.80,,,0,"percent of total billed charges ","90% of total billed charges ",4908.08,93,,3926.46,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",299.57,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4485.88,85,,3588.70,,,0,"percent of total billed charges ","85% of total billed charges ",4749.75,90,,3799.80,,,0,"percent of total billed charges ","90% of total billed charges ",4749.75,90,,3799.80,,,0,"percent of total billed charges ","90% of total billed charges ",296.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4591.43,87,,3673.14,,,0,"percent of total billed charges ","87% of total billed charges ",296.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3694.25,70,,2955.40,,,0,"percent of total billed charges ","70% of total billed charges ",296.6,4908.08,
"MRI PITUITARY W/WO CONTRAST",3801297,"CDM ",610,RC,70553,HCPCS,OUTPATIENT,,,5999.5,4799.6,,368.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",702.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4199.65,70,,3359.72,,,0,"percent of total billed charges ","70% of total billed charges ",5399.55,90,,4319.64,,,0,"percent of total billed charges ","90% of total billed charges ",5579.54,93,,4463.63,,,0,"percent of total billed charges ","93% of total billed charges ",368.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1065.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5099.58,85,,4079.66,,,0,"percent of total billed charges ","85% of total billed charges ",5399.55,90,,4319.64,,,0,"percent of total billed charges ","90% of total billed charges ",5399.55,90,,4319.64,,,0,"percent of total billed charges ","90% of total billed charges ",1054.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5219.57,87,,1080.95,256.01,3917.62,"1 through 10","percent of total billed charges ","87% of total billed charges ",1054.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4199.65,70,,3359.72,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,5579.54,
"MRI ABDOMEN W/WO CONTRAST",3801305,"CDM ",610,RC,74183,HCPCS,OUTPATIENT,,,5280,4224,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",750.29,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3696,70,,2956.80,,,0,"percent of total billed charges ","70% of total billed charges ",4752,90,,3801.60,,,0,"percent of total billed charges ","90% of total billed charges ",4910.4,93,,3928.32,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",280.41,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4488,85,,3590.40,,,0,"percent of total billed charges ","85% of total billed charges ",4752,90,,3801.60,,,0,"percent of total billed charges ","90% of total billed charges ",4752,90,,3801.60,,,0,"percent of total billed charges ","90% of total billed charges ",277.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4593.6,87,,135.96,135.96,135.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",277.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3696,70,,2956.80,,,0,"percent of total billed charges ","70% of total billed charges ",277.63,4910.4,
"MRI ABDOMEN W/CONTRAST",3801313,"CDM ",610,RC,74182,HCPCS,OUTPATIENT,,,4644.5,3715.6,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",669.9,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3251.15,70,,2600.92,,,0,"percent of total billed charges ","70% of total billed charges ",4180.05,90,,3344.04,,,0,"percent of total billed charges ","90% of total billed charges ",4319.39,93,,3455.51,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",280.41,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3947.83,85,,3158.26,,,0,"percent of total billed charges ","85% of total billed charges ",4180.05,90,,3344.04,,,0,"percent of total billed charges ","90% of total billed charges ",4180.05,90,,3344.04,,,0,"percent of total billed charges ","90% of total billed charges ",277.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4040.72,87,,3232.58,,,0,"percent of total billed charges ","87% of total billed charges ",277.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3251.15,70,,2600.92,,,0,"percent of total billed charges ","70% of total billed charges ",277.63,4319.39,
"MRI FEMUR W/CONTRAST RIGHT",3801321,"CDM ",610,RC,73719,HCPCS,OUTPATIENT,,,4248,3398.4,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",581.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2973.6,70,,2378.88,,,0,"percent of total billed charges ","70% of total billed charges ",3823.2,90,,3058.56,,,0,"percent of total billed charges ","90% of total billed charges ",3950.64,93,,3160.51,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3610.8,85,,2888.64,,,0,"percent of total billed charges ","85% of total billed charges ",3823.2,90,,3058.56,,,0,"percent of total billed charges ","90% of total billed charges ",3823.2,90,,3058.56,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3695.76,87,,2956.61,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2973.6,70,,2378.88,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,3950.64,
"MRI FEMUR W/CONTRAST LEFT",3801339,"CDM ",610,RC,73719,HCPCS,OUTPATIENT,,,4248,3398.4,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",581.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2973.6,70,,2378.88,,,0,"percent of total billed charges ","70% of total billed charges ",3823.2,90,,3058.56,,,0,"percent of total billed charges ","90% of total billed charges ",3950.64,93,,3160.51,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3610.8,85,,2888.64,,,0,"percent of total billed charges ","85% of total billed charges ",3823.2,90,,3058.56,,,0,"percent of total billed charges ","90% of total billed charges ",3823.2,90,,3058.56,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3695.76,87,,2956.61,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2973.6,70,,2378.88,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,3950.64,
"MRI FEMUR WO/CONTRAST RIGHT",3801347,"CDM ",610,RC,73718,HCPCS,OUTPATIENT,,,3862,3089.6,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",493.72,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3591.66,93,,2873.33,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3282.7,85,,2626.16,,,0,"percent of total billed charges ","85% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3359.94,87,,102.34,102.34,102.34,"1 through 10","percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,3591.66,
"MRI FEMUR WO/CONTRAST LEFT",3801354,"CDM ",610,RC,73718,HCPCS,OUTPATIENT,,,3862,3089.6,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",493.72,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3591.66,93,,2873.33,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3282.7,85,,2626.16,,,0,"percent of total billed charges ","85% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3359.94,87,,102.34,102.34,102.34,"1 through 10","percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,3591.66,
"MRI TIB/FIB WO/CONTRAST LEFT",3801362,"CDM ",610,RC,73718,HCPCS,OUTPATIENT,,,3862,3089.6,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",493.72,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3591.66,93,,2873.33,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3282.7,85,,2626.16,,,0,"percent of total billed charges ","85% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3359.94,87,,102.34,102.34,102.34,"1 through 10","percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,3591.66,
"MRI TIB/FIB WO/CONTRAST RIGHT",3801370,"CDM ",610,RC,73718,HCPCS,OUTPATIENT,,,3862,3089.6,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",493.72,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3591.66,93,,2873.33,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3282.7,85,,2626.16,,,0,"percent of total billed charges ","85% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3359.94,87,,102.34,102.34,102.34,"1 through 10","percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,3591.66,
"MRI TIB/FIB W/CONTRAST RIGHT",3801388,"CDM ",610,RC,73719,HCPCS,OUTPATIENT,,,4248,3398.4,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",581.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2973.6,70,,2378.88,,,0,"percent of total billed charges ","70% of total billed charges ",3823.2,90,,3058.56,,,0,"percent of total billed charges ","90% of total billed charges ",3950.64,93,,3160.51,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3610.8,85,,2888.64,,,0,"percent of total billed charges ","85% of total billed charges ",3823.2,90,,3058.56,,,0,"percent of total billed charges ","90% of total billed charges ",3823.2,90,,3058.56,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3695.76,87,,2956.61,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2973.6,70,,2378.88,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,3950.64,
"MRI TIB/FIB W/CONTRAST LEFT",3801396,"CDM ",610,RC,73719,HCPCS,OUTPATIENT,,,4248,3398.4,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",581.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2973.6,70,,2378.88,,,0,"percent of total billed charges ","70% of total billed charges ",3823.2,90,,3058.56,,,0,"percent of total billed charges ","90% of total billed charges ",3950.64,93,,3160.51,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3610.8,85,,2888.64,,,0,"percent of total billed charges ","85% of total billed charges ",3823.2,90,,3058.56,,,0,"percent of total billed charges ","90% of total billed charges ",3823.2,90,,3058.56,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3695.76,87,,2956.61,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2973.6,70,,2378.88,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,3950.64,
"MRI FOOT WO/CONTRAST LEFT",3801404,"CDM ",610,RC,73718,HCPCS,OUTPATIENT,,,3862,3089.6,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",493.72,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3591.66,93,,2873.33,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3282.7,85,,2626.16,,,0,"percent of total billed charges ","85% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3359.94,87,,102.34,102.34,102.34,"1 through 10","percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,3591.66,
"MRI FOOT WO/CONTRAST RIGHT",3801412,"CDM ",610,RC,73718,HCPCS,OUTPATIENT,,,3862,3089.6,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",493.72,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3591.66,93,,2873.33,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3282.7,85,,2626.16,,,0,"percent of total billed charges ","85% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3359.94,87,,102.34,102.34,102.34,"1 through 10","percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,3591.66,
"MRI FOOT W/CONTRAST RIGHT",3801420,"CDM ",610,RC,73719,HCPCS,OUTPATIENT,,,4248,3398.4,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",581.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2973.6,70,,2378.88,,,0,"percent of total billed charges ","70% of total billed charges ",3823.2,90,,3058.56,,,0,"percent of total billed charges ","90% of total billed charges ",3950.64,93,,3160.51,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3610.8,85,,2888.64,,,0,"percent of total billed charges ","85% of total billed charges ",3823.2,90,,3058.56,,,0,"percent of total billed charges ","90% of total billed charges ",3823.2,90,,3058.56,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3695.76,87,,2956.61,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2973.6,70,,2378.88,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,3950.64,
"MRI FOOT W/CONTRAST LEFT",3801438,"CDM ",610,RC,73719,HCPCS,OUTPATIENT,,,4248,3398.4,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",581.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2973.6,70,,2378.88,,,0,"percent of total billed charges ","70% of total billed charges ",3823.2,90,,3058.56,,,0,"percent of total billed charges ","90% of total billed charges ",3950.64,93,,3160.51,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3610.8,85,,2888.64,,,0,"percent of total billed charges ","85% of total billed charges ",3823.2,90,,3058.56,,,0,"percent of total billed charges ","90% of total billed charges ",3823.2,90,,3058.56,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3695.76,87,,2956.61,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2973.6,70,,2378.88,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,3950.64,
"MRI HIP W/CONTRAST RIGHT",3801446,"CDM ",610,RC,73722,HCPCS,OUTPATIENT,,,5698,4558.4,,629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,525.90,525.90,525.90,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",698.17,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3988.6,70,,3190.88,,,0,"percent of total billed charges ","70% of total billed charges ",5128.2,90,,4102.56,,,0,"percent of total billed charges ","90% of total billed charges ",5299.14,93,,4239.31,,,0,"percent of total billed charges ","93% of total billed charges ",629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",479.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4843.3,85,,3874.64,,,0,"percent of total billed charges ","85% of total billed charges ",5128.2,90,,4102.56,,,0,"percent of total billed charges ","90% of total billed charges ",5128.2,90,,4102.56,,,0,"percent of total billed charges ","90% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4957.26,87,,3965.81,,,0,"percent of total billed charges ","87% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",720.93,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3988.6,70,,3190.88,,,0,"percent of total billed charges ","70% of total billed charges ",474.59,5299.14,
"MRA CHEST W CONTRAST",3801453,"CDM ",618,RC,C8909,HCPCS,OUTPATIENT,,,4617,3693.6,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",3693.6,80,,2954.88,,,0,"percent of total billed charges ","80% of total billed charges ",3231.9,70,,2585.52,,,0,"percent of total billed charges ","70% of total billed charges ",4155.3,90,,3324.24,,,0,"percent of total billed charges ","90% of total billed charges ",4293.81,93,,3435.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3924.45,85,,3139.56,,,0,"percent of total billed charges ","85% of total billed charges ",4155.3,90,,3324.24,,,0,"percent of total billed charges ","90% of total billed charges ",4155.3,90,,3324.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4016.79,87,,3213.43,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3231.9,70,,2585.52,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,4293.81,
"MRA CHEST + WO CONTRAST",3801461,"CDM ",618,RC,C8910,HCPCS,OUTPATIENT,,,3573.5,2858.8,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",2858.8,80,,2287.04,,,0,"percent of total billed charges ","80% of total billed charges ",2501.45,70,,2001.16,,,0,"percent of total billed charges ","70% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",3323.36,93,,2658.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3037.48,85,,2429.98,,,0,"percent of total billed charges ","85% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3108.95,87,,2487.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2501.45,70,,2001.16,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,3323.36,
"MRA CHEST W/WO CONTRAST",3801479,"CDM ",618,RC,C8911,HCPCS,OUTPATIENT,,,5680,4544,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",4544,80,,3635.20,,,0,"percent of total billed charges ","80% of total billed charges ",3976,70,,3180.80,,,0,"percent of total billed charges ","70% of total billed charges ",5112,90,,4089.60,,,0,"percent of total billed charges ","90% of total billed charges ",5282.4,93,,4225.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4828,85,,3862.40,,,0,"percent of total billed charges ","85% of total billed charges ",5112,90,,4089.60,,,0,"percent of total billed charges ","90% of total billed charges ",5112,90,,4089.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4941.6,87,,3953.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3976,70,,3180.80,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,5282.4,
"MRA SPINAL CANAL W/WO CONTR",3801487,"CDM ",618,RC,72159,HCPCS,OUTPATIENT,,,3573.5,2858.8,,390,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",760.96,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2501.45,70,,2001.16,,,0,"percent of total billed charges ","70% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",3323.36,93,,2658.69,,,0,"percent of total billed charges ","93% of total billed charges ",390,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",247.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3037.48,85,,2429.98,,,0,"percent of total billed charges ","85% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",245.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3108.95,87,,2487.16,,,0,"percent of total billed charges ","87% of total billed charges ",245.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2501.45,70,,2001.16,,,0,"percent of total billed charges ","70% of total billed charges ",245.31,3323.36,
"MRA LOWER EXT W/CONTRAST RIGHT",3801495,"CDM ",616,RC,C8912,HCPCS,OUTPATIENT,,,2935,2348,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",2348,80,,1878.40,,,0,"percent of total billed charges ","80% of total billed charges ",2054.5,70,,1643.60,,,0,"percent of total billed charges ","70% of total billed charges ",2641.5,90,,2113.20,,,0,"percent of total billed charges ","90% of total billed charges ",2729.55,93,,2183.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2494.75,85,,1995.80,,,0,"percent of total billed charges ","85% of total billed charges ",2641.5,90,,2113.20,,,0,"percent of total billed charges ","90% of total billed charges ",2641.5,90,,2113.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2553.45,87,,2042.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2054.5,70,,1643.60,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,2729.55,
"MRA LOWER EXT WO CONTRAST RIGH",3801503,"CDM ",616,RC,C8913,HCPCS,OUTPATIENT,,,2668,2134.4,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",2134.4,80,,1707.52,,,0,"percent of total billed charges ","80% of total billed charges ",1867.6,70,,1494.08,,,0,"percent of total billed charges ","70% of total billed charges ",2401.2,90,,1920.96,,,0,"percent of total billed charges ","90% of total billed charges ",2481.24,93,,1984.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2267.8,85,,1814.24,,,0,"percent of total billed charges ","85% of total billed charges ",2401.2,90,,1920.96,,,0,"percent of total billed charges ","90% of total billed charges ",2401.2,90,,1920.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2321.16,87,,1856.93,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1867.6,70,,1494.08,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,2481.24,
"MRA LOWER EXT W/WO CONTRAST RI",3801511,"CDM ",616,RC,C8914,HCPCS,OUTPATIENT,,,3573.5,2858.8,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",2858.8,80,,2287.04,,,0,"percent of total billed charges ","80% of total billed charges ",2501.45,70,,2001.16,,,0,"percent of total billed charges ","70% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",3323.36,93,,2658.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3037.48,85,,2429.98,,,0,"percent of total billed charges ","85% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3108.95,87,,2487.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2501.45,70,,2001.16,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,3323.36,
"MRA LOWER EXT W/CONTRAST LEFT",3801529,"CDM ",616,RC,C8912,HCPCS,OUTPATIENT,,,2935,2348,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",2348,80,,1878.40,,,0,"percent of total billed charges ","80% of total billed charges ",2054.5,70,,1643.60,,,0,"percent of total billed charges ","70% of total billed charges ",2641.5,90,,2113.20,,,0,"percent of total billed charges ","90% of total billed charges ",2729.55,93,,2183.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2494.75,85,,1995.80,,,0,"percent of total billed charges ","85% of total billed charges ",2641.5,90,,2113.20,,,0,"percent of total billed charges ","90% of total billed charges ",2641.5,90,,2113.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2553.45,87,,2042.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2054.5,70,,1643.60,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,2729.55,
"MRA LOWER EXT WO CONTRAST LEFT",3801537,"CDM ",616,RC,C8913,HCPCS,OUTPATIENT,,,2668,2134.4,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",2134.4,80,,1707.52,,,0,"percent of total billed charges ","80% of total billed charges ",1867.6,70,,1494.08,,,0,"percent of total billed charges ","70% of total billed charges ",2401.2,90,,1920.96,,,0,"percent of total billed charges ","90% of total billed charges ",2481.24,93,,1984.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2267.8,85,,1814.24,,,0,"percent of total billed charges ","85% of total billed charges ",2401.2,90,,1920.96,,,0,"percent of total billed charges ","90% of total billed charges ",2401.2,90,,1920.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2321.16,87,,1856.93,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1867.6,70,,1494.08,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,2481.24,
"MRA LOWER EXT W/WO CONTRAST LE",3801545,"CDM ",616,RC,C8914,HCPCS,OUTPATIENT,,,3573.5,2858.8,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",2858.8,80,,2287.04,,,0,"percent of total billed charges ","80% of total billed charges ",2501.45,70,,2001.16,,,0,"percent of total billed charges ","70% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",3323.36,93,,2658.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3037.48,85,,2429.98,,,0,"percent of total billed charges ","85% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3108.95,87,,2487.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2501.45,70,,2001.16,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,3323.36,
"MRI CHEST W/CONT",3801552,"CDM ",610,RC,71551,HCPCS,OUTPATIENT,,,4842,3873.6,,629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",831.67,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3389.4,70,,2711.52,,,0,"percent of total billed charges ","70% of total billed charges ",4357.8,90,,3486.24,,,0,"percent of total billed charges ","90% of total billed charges ",4503.06,93,,3602.45,,,0,"percent of total billed charges ","93% of total billed charges ",629.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",293.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4115.7,85,,3292.56,,,0,"percent of total billed charges ","85% of total billed charges ",4357.8,90,,3486.24,,,0,"percent of total billed charges ","90% of total billed charges ",4357.8,90,,3486.24,,,0,"percent of total billed charges ","90% of total billed charges ",291.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4212.54,87,,3370.03,,,0,"percent of total billed charges ","87% of total billed charges ",291.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",720.93,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3389.4,70,,2711.52,,,0,"percent of total billed charges ","70% of total billed charges ",291.03,4503.06,
"MRI CHEST W&W/O CONT",3801560,"CDM ",610,RC,71552,HCPCS,OUTPATIENT,,,5490.5,4392.4,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,125.45,125.45,125.45,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1051.42,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3843.35,70,,3074.68,,,0,"percent of total billed charges ","70% of total billed charges ",4941.45,90,,3953.16,,,0,"percent of total billed charges ","90% of total billed charges ",5106.17,93,,4084.94,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",293.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4666.93,85,,3733.54,,,0,"percent of total billed charges ","85% of total billed charges ",4941.45,90,,3953.16,,,0,"percent of total billed charges ","90% of total billed charges ",4941.45,90,,3953.16,,,0,"percent of total billed charges ","90% of total billed charges ",291.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4776.74,87,,3821.39,,,0,"percent of total billed charges ","87% of total billed charges ",291.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3843.35,70,,3074.68,,,0,"percent of total billed charges ","70% of total billed charges ",291.03,5106.17,
"MRA RENAL ARTERIES W/WO CONT",3801570,"CDM ",618,RC,74185,HCPCS,OUTPATIENT,,,6926,5540.8,,442.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",741.6,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4848.2,70,,3878.56,,,0,"percent of total billed charges ","70% of total billed charges ",6233.4,90,,4986.72,,,0,"percent of total billed charges ","90% of total billed charges ",6441.18,93,,5152.94,,,0,"percent of total billed charges ","93% of total billed charges ",442.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",281.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5887.1,85,,4709.68,,,0,"percent of total billed charges ","85% of total billed charges ",6233.4,90,,4986.72,,,0,"percent of total billed charges ","90% of total billed charges ",6233.4,90,,4986.72,,,0,"percent of total billed charges ","90% of total billed charges ",278.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6025.62,87,,4820.50,,,0,"percent of total billed charges ","87% of total billed charges ",278.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",4848.2,70,,3878.56,,,0,"percent of total billed charges ","70% of total billed charges ",278.26,6441.18,
"MRI TOE W/ & W/O",3801580,"CDM ",610,RC,73723,HCPCS,OUTPATIENT,,,2248,1798.4,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,407.38,407.38,407.38,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",860.55,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1573.6,70,,1258.88,,,0,"percent of total billed charges ","70% of total billed charges ",2023.2,90,,1618.56,,,0,"percent of total billed charges ","90% of total billed charges ",2090.64,93,,1672.51,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",479.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1910.8,85,,1528.64,,,0,"percent of total billed charges ","85% of total billed charges ",2023.2,90,,1618.56,,,0,"percent of total billed charges ","90% of total billed charges ",2023.2,90,,1618.56,,,0,"percent of total billed charges ","90% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1955.76,87,,1564.61,,,0,"percent of total billed charges ","87% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1573.6,70,,1258.88,,,0,"percent of total billed charges ","70% of total billed charges ",313.17,2090.64,
"MRI FINGER W/ & W/O CONTRAST",3801590,"CDM ",610,RC,73223,HCPCS,OUTPATIENT,,,2248,1798.4,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",863.3,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1573.6,70,,1258.88,,,0,"percent of total billed charges ","70% of total billed charges ",2023.2,90,,1618.56,,,0,"percent of total billed charges ","90% of total billed charges ",2090.64,93,,1672.51,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1910.8,85,,1528.64,,,0,"percent of total billed charges ","85% of total billed charges ",2023.2,90,,1618.56,,,0,"percent of total billed charges ","90% of total billed charges ",2023.2,90,,1618.56,,,0,"percent of total billed charges ","90% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1955.76,87,,1564.61,,,0,"percent of total billed charges ","87% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1573.6,70,,1258.88,,,0,"percent of total billed charges ","70% of total billed charges ",253.61,2090.64,
"MRI 3D RECONSTRUCTION",3801600,"CDM ",610,RC,76376,HCPCS,OUTPATIENT,,,1190,952,,109.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",318.72,100,,6.53,6.53,6.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",47.72,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",833,70,,666.40,,,0,"percent of total billed charges ","70% of total billed charges ",1071,90,,856.80,,,0,"percent of total billed charges ","90% of total billed charges ",1106.7,93,,885.36,,,0,"percent of total billed charges ","93% of total billed charges ",109.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.65,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1011.5,85,,809.20,,,0,"percent of total billed charges ","85% of total billed charges ",1071,90,,856.80,,,0,"percent of total billed charges ","90% of total billed charges ",1071,90,,856.80,,,0,"percent of total billed charges ","90% of total billed charges ",126.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1035.3,87,,950.62,950.62,950.62,"1 through 10","percent of total billed charges ","87% of total billed charges ",126.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",833,70,,666.40,,,0,"percent of total billed charges ","70% of total billed charges ",47.72,1106.7,
"MR SHOULDER ARTHROGRAM RIGHT",3801610,"CDM ",610,RC,73223,HCPCS,OUTPATIENT,,,4164,3331.2,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",863.3,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2914.8,70,,2331.84,,,0,"percent of total billed charges ","70% of total billed charges ",3747.6,90,,2998.08,,,0,"percent of total billed charges ","90% of total billed charges ",3872.52,93,,3098.02,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3539.4,85,,2831.52,,,0,"percent of total billed charges ","85% of total billed charges ",3747.6,90,,2998.08,,,0,"percent of total billed charges ","90% of total billed charges ",3747.6,90,,2998.08,,,0,"percent of total billed charges ","90% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3622.68,87,,2898.14,,,0,"percent of total billed charges ","87% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2914.8,70,,2331.84,,,0,"percent of total billed charges ","70% of total billed charges ",253.61,3872.52,
"MR SHOULDER ARTHROGRAM LEFT",3801620,"CDM ",610,RC,73223,HCPCS,OUTPATIENT,,,4164,3331.2,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",863.3,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2914.8,70,,2331.84,,,0,"percent of total billed charges ","70% of total billed charges ",3747.6,90,,2998.08,,,0,"percent of total billed charges ","90% of total billed charges ",3872.52,93,,3098.02,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3539.4,85,,2831.52,,,0,"percent of total billed charges ","85% of total billed charges ",3747.6,90,,2998.08,,,0,"percent of total billed charges ","90% of total billed charges ",3747.6,90,,2998.08,,,0,"percent of total billed charges ","90% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3622.68,87,,2898.14,,,0,"percent of total billed charges ","87% of total billed charges ",253.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2914.8,70,,2331.84,,,0,"percent of total billed charges ","70% of total billed charges ",253.61,3872.52,
"MRI IAC W/ CONTRAST",3801630,"CDM ",610,RC,70542,HCPCS,OUTPATIENT,,,4585,3668,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",594.13,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3209.5,70,,2567.60,,,0,"percent of total billed charges ","70% of total billed charges ",4126.5,90,,3301.20,,,0,"percent of total billed charges ","90% of total billed charges ",4264.05,93,,3411.24,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3897.25,85,,3117.80,,,0,"percent of total billed charges ","85% of total billed charges ",4126.5,90,,3301.20,,,0,"percent of total billed charges ","90% of total billed charges ",4126.5,90,,3301.20,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3988.95,87,,3191.16,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3209.5,70,,2567.60,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,4264.05,
"MRI IAC W/WO CONTRAST",3801640,"CDM ",610,RC,70543,HCPCS,OUTPATIENT,,,5409.5,4327.6,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,529.06,529.06,529.06,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",749.94,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3786.65,70,,3029.32,,,0,"percent of total billed charges ","70% of total billed charges ",4868.55,90,,3894.84,,,0,"percent of total billed charges ","90% of total billed charges ",5030.84,93,,4024.67,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4598.08,85,,3678.46,,,0,"percent of total billed charges ","85% of total billed charges ",4868.55,90,,3894.84,,,0,"percent of total billed charges ","90% of total billed charges ",4868.55,90,,3894.84,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4706.27,87,,3765.02,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3786.65,70,,3029.32,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,5030.84,
"MRI SCAPULA W/WO CONTRAST",3801650,"CDM ",610,RC,73220,HCPCS,OUTPATIENT,,,4385,3508,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",913.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3069.5,70,,2455.60,,,0,"percent of total billed charges ","70% of total billed charges ",3946.5,90,,3157.20,,,0,"percent of total billed charges ","90% of total billed charges ",4078.05,93,,3262.44,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3727.25,85,,2981.80,,,0,"percent of total billed charges ","85% of total billed charges ",3946.5,90,,3157.20,,,0,"percent of total billed charges ","90% of total billed charges ",3946.5,90,,3157.20,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3814.95,87,,3051.96,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3069.5,70,,2455.60,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,4078.05,
"MRI SCAPULA W/O IV CONTRAST",3801660,"CDM ",610,RC,73218,HCPCS,OUTPATIENT,,,3510.5,2808.4,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,529.06,529.06,529.06,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",673.46,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2457.35,70,,1965.88,,,0,"percent of total billed charges ","70% of total billed charges ",3159.45,90,,2527.56,,,0,"percent of total billed charges ","90% of total billed charges ",3264.77,93,,2611.82,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2983.93,85,,2387.14,,,0,"percent of total billed charges ","85% of total billed charges ",3159.45,90,,2527.56,,,0,"percent of total billed charges ","90% of total billed charges ",3159.45,90,,2527.56,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3054.14,87,,2443.31,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2457.35,70,,1965.88,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,3264.77,
"MRI MRCP ABDOMEN W/O CONTRAST",3801670,"CDM ",610,RC,74181,HCPCS,OUTPATIENT,,,4548,3638.4,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,661.32,661.32,661.32,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",432.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3183.6,70,,2546.88,,,0,"percent of total billed charges ","70% of total billed charges ",4093.2,90,,3274.56,,,0,"percent of total billed charges ","90% of total billed charges ",4229.64,93,,3383.71,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",280.41,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3865.8,85,,3092.64,,,0,"percent of total billed charges ","85% of total billed charges ",4093.2,90,,3274.56,,,0,"percent of total billed charges ","90% of total billed charges ",4093.2,90,,3274.56,,,0,"percent of total billed charges ","90% of total billed charges ",277.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3956.76,87,,3165.41,,,0,"percent of total billed charges ","87% of total billed charges ",277.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3183.6,70,,2546.88,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,4229.64,
"MRA LOWER EXT BILAT W/WO CONTR",3801680,"CDM ",616,RC,73725,HCPCS,OUTPATIENT,,,5361.5,4289.2,,412.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",737.59,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3753.05,70,,3002.44,,,0,"percent of total billed charges ","70% of total billed charges ",4825.35,90,,3860.28,,,0,"percent of total billed charges ","90% of total billed charges ",4986.2,93,,3988.96,,,0,"percent of total billed charges ","93% of total billed charges ",412.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4557.28,85,,3645.82,,,0,"percent of total billed charges ","85% of total billed charges ",4825.35,90,,3860.28,,,0,"percent of total billed charges ","90% of total billed charges ",4825.35,90,,3860.28,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4664.51,87,,3731.61,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3753.05,70,,3002.44,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,4986.2,
"MRA LOWER EXT BILAT W/O CONTRA",3801690,"CDM ",616,RC,C8913,HCPCS,OUTPATIENT,,,4004.5,3203.6,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",3203.6,80,,2562.88,,,0,"percent of total billed charges ","80% of total billed charges ",2803.15,70,,2242.52,,,0,"percent of total billed charges ","70% of total billed charges ",3604.05,90,,2883.24,,,0,"percent of total billed charges ","90% of total billed charges ",3724.19,93,,2979.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3403.83,85,,2723.06,,,0,"percent of total billed charges ","85% of total billed charges ",3604.05,90,,2883.24,,,0,"percent of total billed charges ","90% of total billed charges ",3604.05,90,,2883.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3483.92,87,,2787.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2803.15,70,,2242.52,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,3724.19,
"MRI BRACHIAL PLEXUS WO CX",3801700,"CDM ",610,RC,73218,HCPCS,OUTPATIENT,,,3993,3194.4,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,529.06,529.06,529.06,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",673.46,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2795.1,70,,2236.08,,,0,"percent of total billed charges ","70% of total billed charges ",3593.7,90,,2874.96,,,0,"percent of total billed charges ","90% of total billed charges ",3713.49,93,,2970.79,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3394.05,85,,2715.24,,,0,"percent of total billed charges ","85% of total billed charges ",3593.7,90,,2874.96,,,0,"percent of total billed charges ","90% of total billed charges ",3593.7,90,,2874.96,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3473.91,87,,2779.13,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2795.1,70,,2236.08,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,3713.49,
"MRV HEAD WO CX",3801710,"CDM ",615,RC,70544,HCPCS,OUTPATIENT,,,4324,3459.2,,198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",664.93,100,,300.00,300.00,300.00,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",471.94,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3026.8,70,,2421.44,,,0,"percent of total billed charges ","70% of total billed charges ",3891.6,90,,3113.28,,,0,"percent of total billed charges ","90% of total billed charges ",4021.32,93,,3217.06,,,0,"percent of total billed charges ","93% of total billed charges ",198.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",255.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3675.4,85,,2940.32,,,0,"percent of total billed charges ","85% of total billed charges ",3891.6,90,,3113.28,,,0,"percent of total billed charges ","90% of total billed charges ",3891.6,90,,3113.28,,,0,"percent of total billed charges ","90% of total billed charges ",252.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3761.88,87,,3009.50,,,0,"percent of total billed charges ","87% of total billed charges ",252.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3026.8,70,,2421.44,,,0,"percent of total billed charges ","70% of total billed charges ",198.49,4021.32,
"MRI LOW EXT SURG PLAN RT WO CX",3801760,"CDM ",610,RC,73721,HCPCS,OUTPATIENT,,,3862,3089.6,,233.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",443.61,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3591.66,93,,2873.33,,,0,"percent of total billed charges ","93% of total billed charges ",233.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",479.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3282.7,85,,2626.16,,,0,"percent of total billed charges ","85% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3359.94,87,,234.64,234.64,234.64,"1 through 10","percent of total billed charges ","87% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,3591.66,
"MRI LOW EXT SURG PLAN LT WO CX",3801770,"CDM ",610,RC,73721,HCPCS,OUTPATIENT,,,3862,3089.6,,233.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",443.61,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3591.66,93,,2873.33,,,0,"percent of total billed charges ","93% of total billed charges ",233.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",479.34,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3282.7,85,,2626.16,,,0,"percent of total billed charges ","85% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",3475.8,90,,2780.64,,,0,"percent of total billed charges ","90% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3359.94,87,,234.64,234.64,234.64,"1 through 10","percent of total billed charges ","87% of total billed charges ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2703.4,70,,2162.72,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,3591.66,
"MRI BRACHIAL PLEXUS W/WO CX",3801800,"CDM ",610,RC,73220,HCPCS,OUTPATIENT,,,4389,3511.2,,313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",913.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3072.3,70,,2457.84,,,0,"percent of total billed charges ","70% of total billed charges ",3950.1,90,,3160.08,,,0,"percent of total billed charges ","90% of total billed charges ",4081.77,93,,3265.42,,,0,"percent of total billed charges ","93% of total billed charges ",313.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",262.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3730.65,85,,2984.52,,,0,"percent of total billed charges ","85% of total billed charges ",3950.1,90,,3160.08,,,0,"percent of total billed charges ","90% of total billed charges ",3950.1,90,,3160.08,,,0,"percent of total billed charges ","90% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3818.43,87,,3054.74,,,0,"percent of total billed charges ","87% of total billed charges ",259.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3072.3,70,,2457.84,,,0,"percent of total billed charges ","70% of total billed charges ",259.58,4081.77,
"XR ORBITS FB",3900000,"CDM ",969,RC,70030,HCPCS,OUTPATIENT,,,22,17.6,,19.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.3,41,
"XR MANDIBLE <4V",3900010,"CDM ",969,RC,70100,HCPCS,OUTPATIENT,,,22,17.6,,22.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,280.28,280.28,280.28,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",49,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",22.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.64,49,
"XR MANDIBLE MIN 4V",3900015,"CDM ",969,RC,70110,HCPCS,OUTPATIENT,,,22,17.6,,28.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",60,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",28.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",28.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.84,60,
"XR MASTOIDS <3V",3900020,"CDM ",969,RC,70120,HCPCS,OUTPATIENT,,,22,17.6,,25.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",51,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",25.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",25.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.27,51,
"XR MASTOIDS <3V",3900025,"CDM ",969,RC,70130,HCPCS,OUTPATIENT,,,40,32,,39.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",81,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",39.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",39.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.29,81,
"XR FACIAL BONES <3V",3900030,"CDM ",969,RC,70140,HCPCS,OUTPATIENT,,,24.5,19.6,,23.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",52,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,3.86,3.86,3.86,"1 through 10",other,"not separately reimbursment ",23.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.64,52,
"XR FACIAL BONES MIN 3V",3900035,"CDM ",969,RC,70150,HCPCS,OUTPATIENT,,,30.5,24.4,,32.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",67,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",32.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.15,67,
"XR NASAL BONES MIN 3V",3900040,"CDM ",969,RC,70160,HCPCS,OUTPATIENT,,,21,16.8,,23.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.17,47,
"XR ORBITS BILATERAL 4V",3900045,"CDM ",969,RC,70200,HCPCS,OUTPATIENT,,,33.5,26.8,,33.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",68,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",33.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.33,68,
"XR SINUS <3V",3900050,"CDM ",969,RC,70210,HCPCS,OUTPATIENT,,,21,16.8,,23.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",50,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,50,
"XR SINUS MIN 3V",3900055,"CDM ",969,RC,70220,HCPCS,OUTPATIENT,,,26.5,21.2,,30.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,70.92,70.92,70.92,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",66,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",30.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.44,66,
"XR SKULL <4V",3900060,"CDM ",969,RC,70250,HCPCS,OUTPATIENT,,,22,17.6,,26.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",56,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",26.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",26.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.85,56,
"XR SKULL MIN 4V",3900065,"CDM ",969,RC,70260,HCPCS,OUTPATIENT,,,33.5,26.8,,37.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",80,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",37.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.26,80,
"SR TMJ BI",3900070,"CDM ",969,RC,70330,HCPCS,OUTPATIENT,,,28.5,22.8,,34.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,371.03,371.03,371.03,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",71,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",34.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.57,71,
"MRI TMJ WO CONT",3900075,"CDM ",969,RC,70336,HCPCS,OUTPATIENT,,,168.5,134.8,,385.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",385.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",766,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",385.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",385.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",385.43,766,
"XR SOFT TISSUE NECK",3900080,"CDM ",969,RC,70360,HCPCS,OUTPATIENT,,,22,17.6,,19.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",40,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.82,40,
"CT HEAD/BRAIN WO CONT",3900085,"CDM ",969,RC,70450,HCPCS,OUTPATIENT,,,98.5,78.8,,167.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,44.48,44.48,44.48,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",378,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",167.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1906.05,629.57,2076.99,"1 through 10",other,"not separately reimbursment ",167.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.64,378,
"CT HEAD/BRAIN W/CONT",3900090,"CDM ",969,RC,70460,HCPCS,OUTPATIENT,,,130,104,,213.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",213.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",457,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",213.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",213.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",213.51,457,
"CT HEAD/BRAIN W/WO CONT",3900095,"CDM ",969,RC,70470,HCPCS,OUTPATIENT,,,413,330.4,,258.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",258.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",543,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",258.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",258.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",258.72,543,
"CT ORBIT/EAR/FOSSA WO CONT",3900100,"CDM ",969,RC,70480,HCPCS,OUTPATIENT,,,147,117.6,,187.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",438,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",187.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",187.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.76,438,
"CT ORBIT EAR SELLA FOSSA W/CX",3900105,"CDM ",969,RC,70481,HCPCS,OUTPATIENT,,,130,104,,253.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",253.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",568,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",253.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",253.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",253.68,568,
"CT ORBIT EAR SELLA FOSSA W/WO",3900110,"CDM ",969,RC,70482,HCPCS,OUTPATIENT,,,145.5,116.4,,290.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",290.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",609,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",290.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",290.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",290.76,609,
"CT MAXILLOFACIAL WO CONT",3900115,"CDM ",969,RC,70486,HCPCS,OUTPATIENT,,,98.5,78.8,,181.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,460.02,460.02,460.02,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",181.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",388,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",181.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",181.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",181.83,388,
"CT MAXILLOFACIAL W/CONT",3900120,"CDM ",969,RC,70487,HCPCS,OUTPATIENT,,,130,104,,244.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,575.02,575.02,575.02,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",244.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",499,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",244.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",244.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",244.58,499,
"CT MAXILLOFACIAL W/WO CX",3900125,"CDM ",969,RC,70488,HCPCS,OUTPATIENT,,,145.5,116.4,,289.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",289.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",606,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",289.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",289.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",289.37,606,
"CT SOFT TISSUE NECK WO CONT",3900130,"CDM ",969,RC,70490,HCPCS,OUTPATIENT,,,147.5,118,,187.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,485.86,485.86,485.86,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",391,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",187.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",187.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.53,391,
"CT SOFT TISSUE NECK W/WO CONT",3900135,"CDM ",969,RC,70492,HCPCS,OUTPATIENT,,,185,148,,290.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,514.44,514.44,514.44,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",290.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",594,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",290.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",290.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",290.6,594,
"CT ANGIO HEAD",3900140,"CDM ",969,RC,70496,HCPCS,OUTPATIENT,,,201,160.8,,379.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",379.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",762,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",379.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,194.65,71.34,1459.58,"1 through 10",other,"not separately reimbursment ",379.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",379.56,762,
"CT ANGIO NECK",3900145,"CDM ",969,RC,70498,HCPCS,OUTPATIENT,,,201,160.8,,379.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",379.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",784,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",379.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2306.71,2306.71,2306.71,"1 through 10",other,"not separately reimbursment ",379.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",379.56,784,
"MRI ORBIT FACE NECK WO CONT",3900150,"CDM ",969,RC,70540,HCPCS,OUTPATIENT,,,154,123.2,,300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",817,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.44,817,
"MRI ORBIT FACE NECK W/CONT",3900240,"CDM ",969,RC,70542,HCPCS,OUTPATIENT,,,186.5,149.2,,450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",895,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",450.4,895,
"MRI ORBIT FACE NECK (IAC) W/WO",3900245,"CDM ",969,RC,70543,HCPCS,OUTPATIENT,,,239.5,191.6,,798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,529.06,529.06,529.06,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1586,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.09,1586,
"MRA HEAD WO CONT",3900250,"CDM ",969,RC,70544,HCPCS,OUTPATIENT,,,137,109.6,,294.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,300.00,300.00,300.00,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",294.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",742,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",294.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",294.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",294.14,742,
"MR VENO HEAD WO CONT",3900255,"CDM ",969,RC,70544,HCPCS,OUTPATIENT,,,137,109.6,,294.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,300.00,300.00,300.00,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",294.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",742,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",294.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",294.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",294.14,742,
"MRA HEAD W/CONT",3900260,"CDM ",969,RC,70545,HCPCS,OUTPATIENT,,,137,109.6,,332.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",332.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",742,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",332.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",332.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",332.66,742,
"MRA HEAD W/WO CONT",3900265,"CDM ",969,RC,70546,HCPCS,OUTPATIENT,,,169.5,135.6,,709.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,70.75,70.75,70.75,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",709.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1409,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",709.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",709.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",709.1,1409,
"MRA NECK WO CONT",3900270,"CDM ",969,RC,70547,HCPCS,OUTPATIENT,,,138,110.4,,293.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",293.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",742,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",293.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",293.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",293.87,742,
"MRA NECK W/CONT",3900275,"CDM ",969,RC,70548,HCPCS,OUTPATIENT,,,171.5,137.2,,333.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",333.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",742,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",333.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",333.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",333.02,742,
"MRA NECK W/WO CONT",3900280,"CDM ",969,RC,70549,HCPCS,OUTPATIENT,,,206,164.8,,709.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",709.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1409,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",709.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",709.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",709.1,1409,
"MRI BRAIN WO CONT",3900285,"CDM ",969,RC,70551,HCPCS,OUTPATIENT,,,169.5,135.6,,385.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",385.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",826,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",385.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,731.16,188.90,1273.41,"1 through 10",other,"not separately reimbursment ",385.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",385.43,826,
"MRI HEAD W/CONT",3900290,"CDM ",969,RC,70552,HCPCS,OUTPATIENT,,,205,164,,462.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,525.90,525.90,525.90,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",462.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",919,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",462.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",462.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",462.54,919,
"MRI BRAIN W/WO CONT",3900295,"CDM ",969,RC,70553,HCPCS,OUTPATIENT,,,262.5,210,,467.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",467.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1624,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",467.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1080.95,256.01,3917.62,"1 through 10",other,"not separately reimbursment ",467.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",467.71,1624,
"XR CHEST SINGLE VIEW",3900300,"CDM ",969,RC,71045,HCPCS,OUTPATIENT,,,22,17.6,,12.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,17.44,17.44,17.44,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,311.35,85.32,389.19,"1 through 10",other,"not separately reimbursment ",12.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,34,
"XR CHEST 2 VIEWS",3900305,"CDM ",969,RC,71046,HCPCS,OUTPATIENT,,,26.5,21.2,,18.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",43,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",18.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,170.90,60.28,497.81,12,other,"not separately reimbursment ",18.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.48,43,
"XR CHEST 3 VIEWS",3900310,"CDM ",969,RC,71047,HCPCS,OUTPATIENT,,,32.5,26,,23.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",54,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.66,54,
"XR CHEST 4 OR MORE VIEWS",3900315,"CDM ",969,RC,71048,HCPCS,OUTPATIENT,,,37,29.6,,25.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",59,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",25.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",25.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.42,59,
"XR RIBS UNI 2V RIGHT",3900320,"CDM ",969,RC,71100,HCPCS,OUTPATIENT,,,26.5,21.2,,24.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,9.47,9.47,9.47,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",51,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,225.57,97.81,360.61,"1 through 10",other,"not separately reimbursment ",24.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.55,51,
"XR RIBS UNI 2V LEFT",3900325,"CDM ",969,RC,71100,HCPCS,OUTPATIENT,,,26.5,21.2,,24.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,9.47,9.47,9.47,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",51,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,225.57,97.81,360.61,"1 through 10",other,"not separately reimbursment ",24.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.55,51,
"XR RIBS RT W/CXR 1V",3900330,"CDM ",969,RC,71101,HCPCS,OUTPATIENT,,,31.5,25.2,,29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",62,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,93.43,93.43,93.43,"1 through 10",other,"not separately reimbursment ",29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.76,62,
"XR RIBS LFT W/CXR 1V",3900335,"CDM ",969,RC,71101,HCPCS,OUTPATIENT,,,31.5,25.2,,29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",62,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,93.43,93.43,93.43,"1 through 10",other,"not separately reimbursment ",29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.76,62,
"XR RIBS BILAT 3 VIEWS",3900340,"CDM ",969,RC,71110,HCPCS,OUTPATIENT,,,38,30.4,,31.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",68,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",31.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",31.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.62,68,
"XR RIBS BILAT MIN 4V",3900345,"CDM ",969,RC,71111,HCPCS,OUTPATIENT,,,38,30.4,,38.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,220.25,220.25,220.25,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",81,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",38.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",38.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.94,81,
"XR STERNUM MIN 2V",3900350,"CDM ",969,RC,71120,HCPCS,OUTPATIENT,,,23,18.4,,25.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",54,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",25.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",25.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.63,54,
"XR STERNOCLAVICLUAR MIN 3V",3900355,"CDM ",969,RC,71130,HCPCS,OUTPATIENT,,,26.5,21.2,,28.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,288.15,288.15,288.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",59,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",28.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",28.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.17,59,
"CT CHEST WO CONT",3900360,"CDM ",969,RC,71250,HCPCS,OUTPATIENT,,,124.5,99.6,,182.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",182.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",436,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",182.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",182.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",182.5,436,
"CT CHEST W/CONT",3900365,"CDM ",969,RC,71260,HCPCS,OUTPATIENT,,,134,107.2,,247.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",247.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",541,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",247.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2014.66,541.18,2417.60,"1 through 10",other,"not separately reimbursment ",247.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",247.15,541,
"CT CHEST W/WO CONTRAST",3900370,"CDM ",969,RC,71270,HCPCS,OUTPATIENT,,,143.5,114.8,,287.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,29.59,29.59,29.59,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",287.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",622,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",287.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",287.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",287.75,622,
"CT CHEST WO CX SCREENING",3900375,"CDM ",969,RC,71271,HCPCS,OUTPATIENT,,,124.5,99.6,,90.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2285.16,2285.16,2285.16,"1 through 10",other,"not separately reimbursment ",90.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.61,90.61,
"CT ANGIO CHEST W/WO CX",3900380,"CDM ",969,RC,71275,HCPCS,OUTPATIENT,,,209,167.2,,431.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1163.80,1163.80,1163.80,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",431.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",858,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",431.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,171.34,111.03,2083.85,"1 through 10",other,"not separately reimbursment ",431.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",431.95,858,
"MRI CHEST WO CONT",3900385,"CDM ",969,RC,71550,HCPCS,OUTPATIENT,,,167.5,134,,304.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",304.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",769,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",304.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",304.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",304.55,769,
"MRI CHEST W/CONT",3900390,"CDM ",969,RC,71551,HCPCS,OUTPATIENT,,,198,158.4,,456.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",456.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",907,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",456.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",456.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",456.32,907,
"MRI CHEST W/WO CONT",3900395,"CDM ",969,RC,71552,HCPCS,OUTPATIENT,,,259.5,207.6,,798.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,125.45,125.45,125.45,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1586,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",798.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",798.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.76,1586,
"XR CERVICAL SPINE 1V",3900400,"CDM ",969,RC,72020,HCPCS,OUTPATIENT,,,19,15.2,,17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",37,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.8,37,
"XR THORACIC SPINE 1V",3900405,"CDM ",969,RC,72020,HCPCS,OUTPATIENT,,,19,15.2,,17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",37,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.8,37,
"XR LUMBAR SPINE 1V",3900410,"CDM ",969,RC,72020,HCPCS,OUTPATIENT,,,19,15.2,,17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",37,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.8,37,
"XR CERVICAL SPINE 2-3V",3900415,"CDM ",969,RC,72040,HCPCS,OUTPATIENT,,,26.5,21.2,,27.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,153.06,153.06,153.06,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",56,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",27.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,230.12,98.72,361.52,"1 through 10",other,"not separately reimbursment ",27.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,56,
"XR C SPINE 6 OR MORE VIEWS",3900420,"CDM ",969,RC,72052,HCPCS,OUTPATIENT,,,36,28.8,,48.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",99,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",48.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",48.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.48,99,
"XR THORACIC SPINE 3V",3900425,"CDM ",969,RC,72072,HCPCS,OUTPATIENT,,,66,52.8,,28.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",60,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",28.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,48.59,48.59,48.59,"1 through 10",other,"not separately reimbursment ",28.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.93,60,
"XR THORACIC SPINE MIN 4V",3900430,"CDM ",969,RC,72074,HCPCS,OUTPATIENT,,,29.5,23.6,,34.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,141.67,141.67,141.67,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",71,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",34.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.14,71,
"THORACOLMBAR MINIMUM 2 VIEWS",3900434,"CDM ",969,RC,72080,HCPCS,OUTPATIENT,,,30,24,,26.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",57,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",26.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",26.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.78,57,
"XR ENTIRE SPINE 1V",3900435,"CDM ",969,RC,72081,HCPCS,OUTPATIENT,,,30.5,24.4,,23.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",52,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.34,52,
"XR ENTIRE SPINE 2-3V",3900440,"CDM ",969,RC,72082,HCPCS,OUTPATIENT,,,37,29.6,,37.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,408.16,408.16,408.16,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",83,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",37.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.33,83,
"XR LUMBAR SAC SPINE 2-3V",3900445,"CDM ",969,RC,72100,HCPCS,OUTPATIENT,,,26.5,21.2,,28.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,11.60,11.60,11.60,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",58,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",28.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,246.43,52.74,487.03,"1 through 10",other,"not separately reimbursment ",28.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.45,58,
"XR LUMBAR SAC SPINE MIN 4V",3900450,"CDM ",969,RC,72110,HCPCS,OUTPATIENT,,,26.5,21.2,,39.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",116,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",39.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,76.96,76.96,76.96,"1 through 10",other,"not separately reimbursment ",39.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.73,116,
"XR LUMBAR SAC SPINE MIN 6V",3900455,"CDM ",969,RC,72114,HCPCS,OUTPATIENT,,,36,28.8,,51.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",105,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",51.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.54,105,
"XR LUMBAR SAC BENDING 2-3V",3900460,"CDM ",969,RC,72120,HCPCS,OUTPATIENT,,,26.5,21.2,,35.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",72,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",35.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",35.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.53,72,
"CT CERVICAL SPINE WO CONT",3900465,"CDM ",969,RC,72125,HCPCS,OUTPATIENT,,,115,92,,182.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",182.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",471,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",182.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1869.29,1703.13,2035.45,"1 through 10",other,"not separately reimbursment ",182.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",182.5,471,
"CT CERVICAL SPINE W/CONT",3900470,"CDM ",969,RC,72126,HCPCS,OUTPATIENT,,,140.5,112.4,,246.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,575.02,575.02,575.02,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",246.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",506,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",246.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",246.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",246.24,506,
"CT CERVICAL SPINE W/WO CONT",3900475,"CDM ",969,RC,72127,HCPCS,OUTPATIENT,,,145.5,116.4,,283.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",283.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",613,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",283.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",283.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",283.47,613,
"CT THORACIC SPINE WO CONT",3900480,"CDM ",969,RC,72128,HCPCS,OUTPATIENT,,,115,92,,182.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",182.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",484,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",182.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,103.23,103.23,103.23,"1 through 10",other,"not separately reimbursment ",182.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",182.5,484,
"CT THORACIC SPINE W/CONT",3900485,"CDM ",969,RC,72129,HCPCS,OUTPATIENT,,,140.5,112.4,,246.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",246.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",506,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",246.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",246.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",246.52,506,
"CT THORACIC SPINE W/WO CONT",3900490,"CDM ",969,RC,72130,HCPCS,OUTPATIENT,,,146.5,117.2,,283.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",283.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",613,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",283.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",283.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",283.47,613,
"CT LUMBAR SPINE WO CONT",3900495,"CDM ",969,RC,72131,HCPCS,OUTPATIENT,,,115,92,,182.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",182.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",436,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",182.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1644.18,522.38,1785.21,"1 through 10",other,"not separately reimbursment ",182.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",182.5,436,
"CT LUMBAR SPINE W/CONT",3900500,"CDM ",969,RC,72132,HCPCS,OUTPATIENT,,,140.5,112.4,,246.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",246.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",506,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",246.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",246.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",246.24,506,
"CT LUMBAR SPINE W/WO CONT",3900505,"CDM ",969,RC,72133,HCPCS,OUTPATIENT,,,24.5,19.6,,283.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",283.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",613,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",283.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",283.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",283.47,613,
"MRI CERVICAL SPINE WO CONT",3900510,"CDM ",969,RC,72141,HCPCS,OUTPATIENT,,,170.5,136.4,,308.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,661.32,661.32,661.32,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",308.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",830,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",308.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,168.49,53.34,1090.53,"1 through 10",other,"not separately reimbursment ",308.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",308.76,830,
"MRI CERVICAL SPINE W/CONT",3900515,"CDM ",969,RC,72142,HCPCS,OUTPATIENT,,,206,164.8,,468.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",468.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",931,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",468.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",468.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",468.56,931,
"MRI THORACIC SPINE WO CONT",3900520,"CDM ",969,RC,72146,HCPCS,OUTPATIENT,,,170.5,136.4,,308.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,661.32,661.32,661.32,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",308.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",846,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",308.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1734.59,621.42,2847.75,"1 through 10",other,"not separately reimbursment ",308.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",308.68,846,
"MRI THORACIC SPINE W/CONT",3900525,"CDM ",969,RC,72147,HCPCS,OUTPATIENT,,,205,164,,468.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,661.32,661.32,661.32,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",468.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",931,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",468.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",468.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",468.28,931,
"MRI LUMBAR SPINE WO CONT",3900530,"CDM ",969,RC,72148,HCPCS,OUTPATIENT,,,170.5,136.4,,304.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,47.89,47.89,47.89,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",304.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",897,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",304.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1240.04,68.04,2793.85,"1 through 10",other,"not separately reimbursment ",304.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",304.09,897,
"MRI LUMBAR SPINE W/CONT",3900535,"CDM ",969,RC,72149,HCPCS,OUTPATIENT,,,205,164,,462.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,208.10,208.10,208.10,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",462.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",920,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",462.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",462.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",462.81,920,
"MRI CERVICAL SPINE W/WO CONT",3900540,"CDM ",969,RC,72156,HCPCS,OUTPATIENT,,,263.5,210.8,,475.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",475.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1641,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",475.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",475.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",475.55,1641,
"MRI THORACIC SPINE W/WO CONT",3900545,"CDM ",969,RC,72157,HCPCS,OUTPATIENT,,,263.5,210.8,,475.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",475.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1641,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",475.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",475.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",475.32,1641,
"MRI LUMBAR SPINE W/WO CONT",3900550,"CDM ",969,RC,72158,HCPCS,OUTPATIENT,,,263.5,210.8,,467.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,529.06,529.06,529.06,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",467.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1624,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",467.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,62.51,62.51,62.51,"1 through 10",other,"not separately reimbursment ",467.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",467.71,1624,
"MRA SPINAL CANAL W/WO CONT",3900555,"CDM ",969,RC,72159,HCPCS,OUTPATIENT,,,206,164.8,,375,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",375,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",858,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",375,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",375,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3,858,
"XR PELVIS 1-2 VIEWS",3900560,"CDM ",969,RC,72170,HCPCS,OUTPATIENT,,,21,16.8,,20.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",49,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,403.85,403.85,403.85,"1 through 10",other,"not separately reimbursment ",20.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.38,49,
"XR PELVIS MIN 3 VIEWS",3900565,"CDM ",969,RC,72190,HCPCS,OUTPATIENT,,,29.5,23.6,,28.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,3.12,3.12,3.12,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",58,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",28.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",28.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.69,58,
"CT ANGIO PELVIS W/WO CONT",3900570,"CDM ",969,RC,72191,HCPCS,OUTPATIENT,,,206,164.8,,417.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,35.27,35.27,35.27,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",417.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",830,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",417.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",417.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",417.48,830,
"CT PELVIS WO CONT",3900575,"CDM ",969,RC,72192,HCPCS,OUTPATIENT,,,124.5,99.6,,179.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,460.02,460.02,460.02,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",179.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",469,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",179.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",179.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",179.97,469,
"CT PELVIS W/CONT",3900580,"CDM ",969,RC,72193,HCPCS,OUTPATIENT,,,133,106.4,,244.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",244.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",534,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",244.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",244.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",244.58,534,
"CT PELVIS W/WO CONT",3900585,"CDM ",969,RC,72194,HCPCS,OUTPATIENT,,,140.5,112.4,,281.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",281.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",659,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",281.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",281.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",281.3,659,
"MRI PELVIS WO CONT",3900590,"CDM ",969,RC,72195,HCPCS,OUTPATIENT,,,172.5,138,,381.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",381.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",757,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",381.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",381.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",381.12,757,
"MRI PELVIS W/CONT",3900595,"CDM ",969,RC,72196,HCPCS,OUTPATIENT,,,198,158.4,,456.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",456.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",907,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",456.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",456.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",456.32,907,
"MRI PELVIS W/WO CONT",3900600,"CDM ",969,RC,72197,HCPCS,OUTPATIENT,,,253,202.4,,804.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,495.99,495.99,495.99,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",804.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1597,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",804.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",804.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",804.2,1597,
"XR SACROILIAC 3 OR MORE VIEWS",3900605,"CDM ",969,RC,72202,HCPCS,OUTPATIENT,,,26.5,21.2,,26.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,138.82,138.82,138.82,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",54,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",26.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",26.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.15,54,
"XR SACRUM COCCYX MIN 2V",3900610,"CDM ",969,RC,72220,HCPCS,OUTPATIENT,,,21,16.8,,22.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",22.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.73,47,
"XR CLAVICLE BILATERAL",3900615,"CDM ",969,RC,73000,HCPCS,OUTPATIENT,,,40,32,,20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.62,42,
"XR CLAVICLE RIGHT",3900620,"CDM ",969,RC,73000,HCPCS,OUTPATIENT,,,20,16,,20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.62,42,
"XR CLAVICLE LEFT",3900625,"CDM ",969,RC,73000,HCPCS,OUTPATIENT,,,20,16,,20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.62,42,
"XR SCAPULA RIGHT",3900630,"CDM ",969,RC,73010,HCPCS,OUTPATIENT,,,22,17.6,,21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",44,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.5,44,
"XR SCAPULA LEFT",3900635,"CDM ",969,RC,73010,HCPCS,OUTPATIENT,,,22,17.6,,21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",44,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.5,44,
"XR SHOULDER RT 1V",3900640,"CDM ",969,RC,73020,HCPCS,OUTPATIENT,,,22,17.6,,18.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",40,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",18.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",18.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,40,
"XR SHOULDER LFT 1V",3900645,"CDM ",969,RC,73020,HCPCS,OUTPATIENT,,,22,17.6,,18.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",40,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",18.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",18.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,40,
"XR SHOULDER RT MIN 2V",3900650,"CDM ",969,RC,73030,HCPCS,OUTPATIENT,,,22,17.6,,22.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,52.33,24.42,80.23,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",52,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,323.08,125.15,387.70,"1 through 10",other,"not separately reimbursment ",22.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.77,52,
"XR SHOULDER LFT MIN 2V",3900655,"CDM ",969,RC,73030,HCPCS,OUTPATIENT,,,22,17.6,,22.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,52.33,24.42,80.23,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",52,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,323.08,125.15,387.70,"1 through 10",other,"not separately reimbursment ",22.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.77,52,
"XR AC JOINT BILATERAL",3900660,"CDM ",969,RC,73050,HCPCS,OUTPATIENT,,,22,17.6,,27.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",56,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",27.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",27.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,56,
"XR HUMERUS RT",3900665,"CDM ",969,RC,73060,HCPCS,OUTPATIENT,,,19,15.2,,22.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,65.87,61.95,81.55,"1 through 10",other,"not separately reimbursment ",22.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.45,47,
"XR HUMERUS LFT",3900670,"CDM ",969,RC,73060,HCPCS,OUTPATIENT,,,19,15.2,,22.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,65.87,61.95,81.55,"1 through 10",other,"not separately reimbursment ",22.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.45,47,
"XR ELBOW RT 2V",3900675,"CDM ",969,RC,73070,HCPCS,OUTPATIENT,,,20,16,,20.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,46.65,15.59,77.71,"1 through 10",other,"not separately reimbursment ",20.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.3,42,
"XR ELBOW LFT 2V",3900680,"CDM ",969,RC,73070,HCPCS,OUTPATIENT,,,20,16,,20.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,46.65,15.59,77.71,"1 through 10",other,"not separately reimbursment ",20.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.3,42,
"XR ELBOW RT MIN 3V",3900685,"CDM ",969,RC,73080,HCPCS,OUTPATIENT,,,21,16.8,,24.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,154.12,154.12,154.12,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",50,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,141.07,141.07,141.07,"1 through 10",other,"not separately reimbursment ",24.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.96,50,
"XR ELBOW LFT MIN 3V",3900690,"CDM ",969,RC,73080,HCPCS,OUTPATIENT,,,21,16.8,,24.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,154.12,154.12,154.12,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",50,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,141.07,141.07,141.07,"1 through 10",other,"not separately reimbursment ",24.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.96,50,
"XR FOREARM RT 2V",3900695,"CDM ",969,RC,73090,HCPCS,OUTPATIENT,,,19,15.2,,20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,126.68,126.68,126.68,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,146.97,36.80,330.06,"1 through 10",other,"not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.62,42,
"XR FOREARM LFT 2V",3900700,"CDM ",969,RC,73090,HCPCS,OUTPATIENT,,,19,15.2,,20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,126.68,126.68,126.68,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,146.97,36.80,330.06,"1 through 10",other,"not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.62,42,
"XR UP EXT INFANT LFT <12M",3900705,"CDM ",969,RC,73092,HCPCS,OUTPATIENT,,,19,15.2,,20.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.64,46,
"XR UP EXT INFANT RT <12M",3900710,"CDM ",969,RC,73092,HCPCS,OUTPATIENT,,,19,15.2,,20.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.64,46,
"XR WRIST LEFT 2V",3900715,"CDM ",969,RC,73100,HCPCS,OUTPATIENT,,,20,16,,20.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",43,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.9,43,
"XR WRIST RIGHT 2V",3900720,"CDM ",969,RC,73100,HCPCS,OUTPATIENT,,,20,16,,20.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",43,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.9,43,
"XR WRIST RIGHT MIN 3V",3900725,"CDM ",969,RC,73110,HCPCS,OUTPATIENT,,,21,16.8,,24.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",52,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,122.02,33.24,351.91,"1 through 10",other,"not separately reimbursment ",24.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.28,52,
"XR WRIST LEFT MIN 3V",3900730,"CDM ",969,RC,73110,HCPCS,OUTPATIENT,,,21,16.8,,24.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",52,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,122.02,33.24,351.91,"1 through 10",other,"not separately reimbursment ",24.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.28,52,
"XR HAND RIGHT 2V",3900735,"CDM ",969,RC,73120,HCPCS,OUTPATIENT,,,20,16,,20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,99.64,99.64,99.64,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.34,41,
"XR HAND LEFT 2V",3900740,"CDM ",969,RC,73120,HCPCS,OUTPATIENT,,,20,16,,20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,99.64,99.64,99.64,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.34,41,
"XR HAND RIGHT MIN 3V",3900745,"CDM ",969,RC,73130,HCPCS,OUTPATIENT,,,21,16.8,,22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,85.47,85.47,85.47,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,75.67,46.84,355.39,"1 through 10",other,"not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.88,46,
"XR HAND LEFT MIN 3V",3900750,"CDM ",969,RC,73130,HCPCS,OUTPATIENT,,,21,16.8,,22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,85.47,85.47,85.47,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,75.67,46.84,355.39,"1 through 10",other,"not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.88,46,
"XR FINGER LFT 4TH DIGIT",3900755,"CDM ",969,RC,73140,HCPCS,OUTPATIENT,,,17,13.6,,19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,47,
"XR FINGER LFT 3RD DIGIT",3900760,"CDM ",969,RC,73140,HCPCS,OUTPATIENT,,,17,13.6,,19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,47,
"XR FINGER RT THUMB",3900765,"CDM ",969,RC,73140,HCPCS,OUTPATIENT,,,17,13.6,,19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,47,
"XR FINGER RT 2ND DIGIT",3900770,"CDM ",969,RC,73140,HCPCS,OUTPATIENT,,,17,13.6,,19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,47,
"XR FINGER RT 3RD DIGIT",3900775,"CDM ",969,RC,73140,HCPCS,OUTPATIENT,,,17,13.6,,19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,47,
"XR FINGER RT 4TH DIGIT",3900780,"CDM ",969,RC,73140,HCPCS,OUTPATIENT,,,17,13.6,,19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,47,
"XR FINGER RT 5TH DIGIT",3900785,"CDM ",969,RC,73140,HCPCS,OUTPATIENT,,,17,13.6,,19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,47,
"XR FINGER LFT THUMB",3900790,"CDM ",969,RC,73140,HCPCS,OUTPATIENT,,,17,13.6,,19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,47,
"XR FINGER LFT 2ND DIGIT",3900795,"CDM ",969,RC,73140,HCPCS,OUTPATIENT,,,17,13.6,,19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,47,
"XR FINGER LFT 5TH DIGIT",3900800,"CDM ",969,RC,73140,HCPCS,OUTPATIENT,,,17,13.6,,19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,47,
"CT UP EXT WO CONT LFT",3900805,"CDM ",969,RC,73200,HCPCS,OUTPATIENT,,,115,92,,180.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,488.77,488.77,488.77,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",413,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",180.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1493.33,1493.33,1493.33,"1 through 10",other,"not separately reimbursment ",180.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.28,413,
"CT UP EXT WO CONT RT",3900810,"CDM ",969,RC,73200,HCPCS,OUTPATIENT,,,115,92,,180.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,488.77,488.77,488.77,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",413,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",180.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1493.33,1493.33,1493.33,"1 through 10",other,"not separately reimbursment ",180.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.28,413,
"CT UP EXT W/CONT RT",3900815,"CDM ",969,RC,73201,HCPCS,OUTPATIENT,,,133,106.4,,237.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,571.60,571.60,571.60,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",237.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",479,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",237.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1549.18,1549.18,1549.18,"1 through 10",other,"not separately reimbursment ",237.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",237.17,479,
"CT UP EXT W/CONT LFT",3900820,"CDM ",969,RC,73201,HCPCS,OUTPATIENT,,,133,106.4,,237.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,571.60,571.60,571.60,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",237.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",479,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",237.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1549.18,1549.18,1549.18,"1 through 10",other,"not separately reimbursment ",237.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",237.17,479,
"CT UP EXT W/WO CONT LFT",3900825,"CDM ",969,RC,73202,HCPCS,OUTPATIENT,,,139,111.2,,281.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,575.02,575.02,575.02,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",281.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",590,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",281.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",281.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",281.53,590,
"CT UP EXT W/WO CONT RT",3900830,"CDM ",969,RC,73202,HCPCS,OUTPATIENT,,,139,111.2,,281.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,575.02,575.02,575.02,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",281.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",590,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",281.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",281.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",281.53,590,
"CT ANGIO UP EXT RIGHT",3900835,"CDM ",969,RC,73206,HCPCS,OUTPATIENT,,,206,164.8,,387.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",387.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",770,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",387.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",387.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",387.64,770,
"CT ANGIO UP EXT LEFT",3900840,"CDM ",969,RC,73206,HCPCS,OUTPATIENT,,,206,164.8,,387.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",387.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",770,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",387.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",387.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",387.64,770,
"CT ANGIO UP EXT BILATERAL",3900845,"CDM ",969,RC,73206,HCPCS,OUTPATIENT,,,206,164.8,,387.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",387.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",770,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",387.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",387.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",387.64,770,
"MRI UP EXT OTH THAN JNT WO CON",3900850,"CDM ",969,RC,73218,HCPCS,OUTPATIENT,,,156,124.8,,300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,529.06,529.06,529.06,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",745,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.44,745,
"MRI UP EXT OTH THAN JNT WO CON",3900855,"CDM ",969,RC,73218,HCPCS,OUTPATIENT,,,156,124.8,,300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,529.06,529.06,529.06,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",745,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.44,745,
"MRI SCAPULA WO CONT",3900860,"CDM ",969,RC,73218,HCPCS,OUTPATIENT,,,156,124.8,,300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,529.06,529.06,529.06,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",745,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.44,745,
"MRI BRACHIAL PLEXUS WO CONT",3900865,"CDM ",969,RC,73218,HCPCS,OUTPATIENT,,,156,124.8,,300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,529.06,529.06,529.06,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",745,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.44,745,
"MRI UP EXT OTH THAN JNT W/CONT",3900870,"CDM ",969,RC,73219,HCPCS,OUTPATIENT,,,186.5,149.2,,450.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",450.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",895,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",450.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",450.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",450.67,895,
"MRI UP EXT OTH THAN JNT W/CONT",3900875,"CDM ",969,RC,73219,HCPCS,OUTPATIENT,,,186.5,149.2,,450.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",450.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",895,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",450.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",450.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",450.67,895,
"MRI UP EXT OTH THAN JNT W/WO C",3900880,"CDM ",969,RC,73220,HCPCS,OUTPATIENT,,,248,198.4,,798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1586,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.09,1586,
"MRI SCAPULA W/WO CONT",3900885,"CDM ",969,RC,73220,HCPCS,OUTPATIENT,,,248,198.4,,798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1586,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.09,1586,
"MRI BRACHIAL PLEXUS W/WO CONT",3900890,"CDM ",969,RC,73220,HCPCS,OUTPATIENT,,,248,198.4,,798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1586,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.09,1586,
"MRI UP EXT OTH THAN JNT W/WO C",3900895,"CDM ",969,RC,73220,HCPCS,OUTPATIENT,,,248,198.4,,798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1586,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.09,1586,
"MRI UP EXT ANY JOINT WO CONT L",3900900,"CDM ",969,RC,73221,HCPCS,OUTPATIENT,,,156,124.8,,300.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",776,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",300.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,53.34,53.34,92.54,"1 through 10",other,"not separately reimbursment ",300.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.35,776,
"MRI UP EXT ANY JOINT WO CONT R",3900905,"CDM ",969,RC,73221,HCPCS,OUTPATIENT,,,156,124.8,,300.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",776,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",300.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,53.34,53.34,92.54,"1 through 10",other,"not separately reimbursment ",300.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.35,776,
"MRI UP EXT ANY JNT W/CONT LFT",3900910,"CDM ",969,RC,73222,HCPCS,OUTPATIENT,,,187.5,150,,450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",895,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",450.4,895,
"MRI UP EXT ANY JNT W/CONT RT",3900915,"CDM ",969,RC,73222,HCPCS,OUTPATIENT,,,187.5,150,,450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",895,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",450.4,895,
"MRI UP EXT ANY JNT W/WO CONT L",3900920,"CDM ",969,RC,73223,HCPCS,OUTPATIENT,,,248,198.4,,798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1586,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.09,1586,
"MRI FINGER W/WO CONT",3900925,"CDM ",969,RC,73223,HCPCS,OUTPATIENT,,,248,198.4,,798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1586,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.09,1586,
"MRI UP EXT ANY JNT W/WO CONT R",3900930,"CDM ",969,RC,73223,HCPCS,OUTPATIENT,,,248,198.4,,798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1586,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.09,1586,
"XR HIP LFT 1V +/- PELVIS",3900935,"CDM ",969,RC,73501,HCPCS,OUTPATIENT,,,22,17.6,,17.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",40,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.96,40,
"XR HIP RT 1V +/- PELVIS",3900940,"CDM ",969,RC,73501,HCPCS,OUTPATIENT,,,22,17.6,,17.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",40,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.96,40,
"XR HIP RT 2-3V +/- PELVIS",3900945,"CDM ",969,RC,73502,HCPCS,OUTPATIENT,,,26.5,21.2,,24.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",55,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.97,60.97,60.97,"1 through 10",other,"not separately reimbursment ",24.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.78,55,
"XR HIP LT 2-3V +/- PELVIS",3900950,"CDM ",969,RC,73502,HCPCS,OUTPATIENT,,,26.5,21.2,,24.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",55,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.97,60.97,60.97,"1 through 10",other,"not separately reimbursment ",24.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.78,55,
"XR HIP RT 4V +/- PELVIS",3900955,"CDM ",969,RC,73503,HCPCS,OUTPATIENT,,,32.5,26,,30.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",69,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.73,77.31,82.65,"1 through 10",other,"not separately reimbursment ",30.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.93,69,
"XR HIP LT 4V +/- PELVIS",3900960,"CDM ",969,RC,73503,HCPCS,OUTPATIENT,,,32.5,26,,30.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",69,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.73,77.31,82.65,"1 through 10",other,"not separately reimbursment ",30.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.93,69,
"XR FEMUR 1V RIGHT",3900965,"CDM ",969,RC,73551,HCPCS,OUTPATIENT,,,20,16,,16.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",37,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",16.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",16.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.65,37,
"XR FEMUR 1V LEFT",3900970,"CDM ",969,RC,73551,HCPCS,OUTPATIENT,,,20,16,,16.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",37,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",16.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",16.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.65,37,
"XR FEMUR 2V LEFT",3900975,"CDM ",969,RC,73552,HCPCS,OUTPATIENT,,,22,17.6,,19.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",43,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,59.51,59.51,59.51,"1 through 10",other,"not separately reimbursment ",19.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.43,43,
"XR FEMUR 2V RIGHT",3900980,"CDM ",969,RC,73552,HCPCS,OUTPATIENT,,,22,17.6,,19.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",43,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,59.51,59.51,59.51,"1 through 10",other,"not separately reimbursment ",19.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.43,43,
"XR KNEE 1-2V RIGHT",3900985,"CDM ",969,RC,73560,HCPCS,OUTPATIENT,,,20,16,,21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",50,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,158.93,80.56,237.29,"1 through 10",other,"not separately reimbursment ",21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.5,50,
"XR KNEE 1-2V LEFT",3900990,"CDM ",969,RC,73560,HCPCS,OUTPATIENT,,,20,16,,21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",50,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,158.93,80.56,237.29,"1 through 10",other,"not separately reimbursment ",21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.5,50,
"XR KNEE 3V LEFT",3900995,"CDM ",969,RC,73562,HCPCS,OUTPATIENT,,,22,17.6,,24.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",57,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,413.76,413.76,413.76,"1 through 10",other,"not separately reimbursment ",24.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.99,57,
"XR KNEE 3V RIGHT",3901000,"CDM ",969,RC,73562,HCPCS,OUTPATIENT,,,22,17.6,,24.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",57,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,413.76,413.76,413.76,"1 through 10",other,"not separately reimbursment ",24.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.99,57,
"XR KNEE 4 OR MORE VIEWS RT",3901005,"CDM ",969,RC,73564,HCPCS,OUTPATIENT,,,27.5,22,,28.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",71,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",28.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,88.53,41.62,278.54,"1 through 10",other,"not separately reimbursment ",28.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.45,71,
"XR KNEE 4 OR MORE VIEWS LT",3901010,"CDM ",969,RC,73564,HCPCS,OUTPATIENT,,,27.5,22,,28.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",71,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",28.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,88.53,41.62,278.54,"1 through 10",other,"not separately reimbursment ",28.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.45,71,
"XR KNEE BILAT WT ONLY",3901015,"CDM ",969,RC,73565,HCPCS,OUTPATIENT,,,21,16.8,,22.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,131.24,131.24,131.24,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,270.67,270.67,270.67,"1 through 10",other,"not separately reimbursment ",22.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,51,
"XR TIBIA FIBULA 2V RT",3901020,"CDM ",969,RC,73590,HCPCS,OUTPATIENT,,,19,15.2,,20.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",43,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.94,43,
"XR TIBIA FIBULA 2V LFT",3901025,"CDM ",969,RC,73590,HCPCS,OUTPATIENT,,,19,15.2,,20.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",43,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.94,43,
"XR LOW EXT INFANT 2V RT",3901030,"CDM ",969,RC,73592,HCPCS,OUTPATIENT,,,19,15.2,,20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",44,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.62,44,
"XR LOW EXT INFANT 2V LFT",3901035,"CDM ",969,RC,73592,HCPCS,OUTPATIENT,,,19,15.2,,20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",44,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.62,44,
"XR ANKLE 2V RIGHT",3901040,"CDM ",969,RC,73600,HCPCS,OUTPATIENT,,,19,15.2,,20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.34,41,
"XR ANKLE 2V LEFT",3901045,"CDM ",969,RC,73600,HCPCS,OUTPATIENT,,,19,15.2,,20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.34,41,
"XR ANKLE MIN 3V RIGTH",3901050,"CDM ",969,RC,73610,HCPCS,OUTPATIENT,,,21,16.8,,22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",53,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.88,53,
"XR ANKLE MIN 3V LEFT",3901055,"CDM ",969,RC,73610,HCPCS,OUTPATIENT,,,21,16.8,,22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",53,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.88,53,
"XR FOOT 2V LEFT",3901060,"CDM ",969,RC,73620,HCPCS,OUTPATIENT,,,19,15.2,,20.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,41,
"XR FOOT 2V RIGHT",3901065,"CDM ",969,RC,73620,HCPCS,OUTPATIENT,,,19,15.2,,20.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,41,
"XR FOOT MIN 3V RIGHT",3901070,"CDM ",969,RC,73630,HCPCS,OUTPATIENT,,,20,16,,22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",52,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,377.99,128.29,377.99,"1 through 10",other,"not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.88,52,
"XR FOOT MIN 3V LEFT",3901075,"CDM ",969,RC,73630,HCPCS,OUTPATIENT,,,20,16,,22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",52,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,377.99,128.29,377.99,"1 through 10",other,"not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.88,52,
"XR CALCANEUS MIN 2V RT",3901080,"CDM ",969,RC,73650,HCPCS,OUTPATIENT,,,19,15.2,,19.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",40,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.79,40,
"XR CALCANEUS MIN 2V LFT",3901085,"CDM ",969,RC,73650,HCPCS,OUTPATIENT,,,19,15.2,,19.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",40,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.79,40,
"XR TOE LFT 2ND DIGIT",3901090,"CDM ",969,RC,73660,HCPCS,OUTPATIENT,,,16,12.8,,19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.51,64.51,64.51,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,42,
"XR TOE LFT 3RD DIGIT",3901095,"CDM ",969,RC,73660,HCPCS,OUTPATIENT,,,16,12.8,,19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.51,64.51,64.51,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,42,
"XR TOE LFT 4TH DIGIT",3901100,"CDM ",969,RC,73660,HCPCS,OUTPATIENT,,,16,12.8,,19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.51,64.51,64.51,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,42,
"XR TOE LFT 5TH DIGIT",3901105,"CDM ",969,RC,73660,HCPCS,OUTPATIENT,,,16,12.8,,19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.51,64.51,64.51,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,42,
"XR TOE RT 1ST DIGIT",3901110,"CDM ",969,RC,73660,HCPCS,OUTPATIENT,,,16,12.8,,19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.51,64.51,64.51,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,42,
"XR TOE RT 2ND DIGIT",3901115,"CDM ",969,RC,73660,HCPCS,OUTPATIENT,,,16,12.8,,19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.51,64.51,64.51,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,42,
"XR TOE RT 3RD DIGIT",3901120,"CDM ",969,RC,73660,HCPCS,OUTPATIENT,,,16,12.8,,19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.51,64.51,64.51,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,42,
"XR TOE RT 4TH DIGIT",3901125,"CDM ",969,RC,73660,HCPCS,OUTPATIENT,,,16,12.8,,19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.51,64.51,64.51,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,42,
"XR TOE RT 5TH DIGIT",3901130,"CDM ",969,RC,73660,HCPCS,OUTPATIENT,,,16,12.8,,19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.51,64.51,64.51,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,42,
"XR TOE LFT 1ST DIGIT",3901135,"CDM ",969,RC,73660,HCPCS,OUTPATIENT,,,16,12.8,,19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.51,64.51,64.51,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,42,
"CT LOW EXT RT WO CONT",3901140,"CDM ",969,RC,73700,HCPCS,OUTPATIENT,,,115,92,,180.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,11.42,11.42,11.42,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",413,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",180.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",180.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.28,413,
"CT LOW EXT LFT WO CONT",3901145,"CDM ",969,RC,73700,HCPCS,OUTPATIENT,,,115,92,,180.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,11.42,11.42,11.42,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",413,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",180.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",180.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.28,413,
"CT LOW EXT LFT W/CONT",3901150,"CDM ",969,RC,73701,HCPCS,OUTPATIENT,,,133,106.4,,238.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",238.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",529,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",238.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",238.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",238.28,529,
"CT LOW EXT RT W/CONT",3901155,"CDM ",969,RC,73701,HCPCS,OUTPATIENT,,,133,106.4,,238.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",238.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",529,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",238.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",238.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",238.28,529,
"CT LOW EXT RT W/WO CONT",3901160,"CDM ",969,RC,73702,HCPCS,OUTPATIENT,,,139,111.2,,281.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",281.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",590,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",281.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",281.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",281.81,590,
"CT LOW EXT LFT W/WO CONT",3901165,"CDM ",969,RC,73702,HCPCS,OUTPATIENT,,,139,111.2,,281.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",281.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",590,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",281.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",281.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",281.81,590,
"CT ANGIO LOW EXT RIGHT",3901170,"CDM ",969,RC,73706,HCPCS,OUTPATIENT,,,216.5,173.2,,391.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",777,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",391.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",391.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.3,777,
"CT ANGIO LOW EXT LEFT",3901175,"CDM ",969,RC,73706,HCPCS,OUTPATIENT,,,216.5,173.2,,391.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",777,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",391.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",391.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.3,777,
"CT ANGIO LOW EXT BILAT",3901180,"CDM ",969,RC,73706,HCPCS,OUTPATIENT,,,216.5,173.2,,391.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",777,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",391.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",391.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.3,777,
"MRI LOW EXT RT WO CONT",3901185,"CDM ",969,RC,73718,HCPCS,OUTPATIENT,,,155,124,,300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",745,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,102.34,102.34,102.34,"1 through 10",other,"not separately reimbursment ",300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.44,745,
"MRI LOW EXT LFT WO CONT",3901190,"CDM ",969,RC,73718,HCPCS,OUTPATIENT,,,155,124,,300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",745,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,102.34,102.34,102.34,"1 through 10",other,"not separately reimbursment ",300.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.44,745,
"MRI LOW EXT LFT W/CONT",3901195,"CDM ",969,RC,73719,HCPCS,OUTPATIENT,,,186.5,149.2,,450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",895,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",450.4,895,
"MRI LOW EXT RT W/CONT",3901200,"CDM ",969,RC,73719,HCPCS,OUTPATIENT,,,186.5,149.2,,450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",895,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",450.4,895,
"MRI LOW EXT RT W/WO CONT",3901205,"CDM ",969,RC,73720,HCPCS,OUTPATIENT,,,248,198.4,,797.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,70.75,70.75,70.75,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",797.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1591,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",797.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",797.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",797.82,1591,
"MRI LOW EXT LFT W/WO CONT",3901210,"CDM ",969,RC,73720,HCPCS,OUTPATIENT,,,248,198.4,,797.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,70.75,70.75,70.75,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",797.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1591,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",797.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",797.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",797.82,1591,
"MRI LOW EXT ANY JNT RT WO CONT",3901215,"CDM ",969,RC,73721,HCPCS,OUTPATIENT,,,156,124.8,,300.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",807,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",300.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,234.64,234.64,234.64,"1 through 10",other,"not separately reimbursment ",300.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.35,807,
"MRI LOW EXT ANY JNT LT WO CONT",3901220,"CDM ",969,RC,73721,HCPCS,OUTPATIENT,,,156,124.8,,300.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",807,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",300.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,234.64,234.64,234.64,"1 through 10",other,"not separately reimbursment ",300.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.35,807,
"MRI LOW EXT LFT ANY JNT W/CONT",3901225,"CDM ",969,RC,73722,HCPCS,OUTPATIENT,,,187.5,150,,450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,525.90,525.90,525.90,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",895,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",450.4,895,
"MRI LOW EXT RT ANY JNT W/CONT",3901230,"CDM ",969,RC,73722,HCPCS,OUTPATIENT,,,187.5,150,,450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,525.90,525.90,525.90,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",895,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",450.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",450.4,895,
"MRI LOW EXT ANY JNT RT W/WO CO",3901235,"CDM ",969,RC,73723,HCPCS,OUTPATIENT,,,248,198.4,,798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,407.38,407.38,407.38,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1586,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.09,1586,
"MRI LOW EXT ANY JNT RT W/WO CO",3901240,"CDM ",969,RC,73723,HCPCS,OUTPATIENT,,,248,198.4,,798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,407.38,407.38,407.38,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1586,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.09,1586,
"MRI LOW EXT ANY JNT LT W/WO CO",3901245,"CDM ",969,RC,73723,HCPCS,OUTPATIENT,,,248,198.4,,798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,407.38,407.38,407.38,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1586,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.09,1586,
"XR ABDOMEN 1 VIEW",3901250,"CDM ",969,RC,74018,HCPCS,OUTPATIENT,,,22,17.6,,16.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",39,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",16.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,195.25,195.25,195.25,"1 through 10",other,"not separately reimbursment ",16.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.51,39,
"XR ABDOMEN 2 VIEWS",3901255,"CDM ",969,RC,74019,HCPCS,OUTPATIENT,,,27.5,22,,20.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.2,47,
"XR ABDOMEN 3 VIEWS",3901260,"CDM ",969,RC,74021,HCPCS,OUTPATIENT,,,31.5,25.2,,23.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",55,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.59,55,
"XR ABD 2 OR MOVE V +/- CXR",3901265,"CDM ",969,RC,74022,HCPCS,OUTPATIENT,,,38,30.4,,35.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",73,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",35.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",35.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.39,73,
"CT ABDOMEN WO CONT",3901270,"CDM ",969,RC,74150,HCPCS,OUTPATIENT,,,136,108.8,,183.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",525,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",183.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",183.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.73,525,
"CT ABDOMEN W/CONT",3901275,"CDM ",969,RC,74160,HCPCS,OUTPATIENT,,,146.5,117.2,,249.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",249.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",567,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",249.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,505.82,505.82,505.82,"1 through 10",other,"not separately reimbursment ",249.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",249.29,567,
"CT ABDOMEN W/WO CONT",3901280,"CDM ",969,RC,74170,HCPCS,OUTPATIENT,,,160,128,,288.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,457.28,457.28,457.28,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",288.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",674,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",288.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",288.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",288.82,674,
"CT ANGIO ABDOMEN PELVIS",3901285,"CDM ",969,RC,74174,HCPCS,OUTPATIENT,,,251,200.8,,239.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,63.82,63.82,63.82,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",239.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",741,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",239.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,340.75,290.01,4996.03,"1 through 10",other,"not separately reimbursment ",239.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",239.25,741,
"CT ANGIO ABDOMEN",3901290,"CDM ",969,RC,74175,HCPCS,OUTPATIENT,,,208,166.4,,420.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",420.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",836,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",420.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",420.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",420.87,836,
"CT ABDOMEN PELVIS WO CONT",3901295,"CDM ",969,RC,74176,HCPCS,OUTPATIENT,,,200,160,,99.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",303,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",99.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,3472.48,844.66,3472.48,"1 through 10",other,"not separately reimbursment ",99.96,100,,187.71,187.71,187.71,"1 through 10","fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.96,303,
"CT ABDOMEN PELVIS W/CONT",3901300,"CDM ",969,RC,74177,HCPCS,OUTPATIENT,,,209,167.2,,156.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,49.36,49.36,49.36,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",476,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",156.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,3811.42,903.50,4764.27,13,other,"not separately reimbursment ",156.86,100,,212.58,212.58,212.58,"1 through 10","fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.86,476,
"CT ABDOMEN PELVIS W/WO CONT",3901305,"CDM ",969,RC,74178,HCPCS,OUTPATIENT,,,230,184,,198.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",198.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",603,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",198.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,4213.97,1120.12,4893.19,"1 through 10",other,"not separately reimbursment ",198.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",198.59,603,
"MRI ABDOMEN WO CONT",3901310,"CDM ",969,RC,74181,HCPCS,OUTPATIENT,,,167.5,134,,304.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,661.32,661.32,661.32,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",304.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",769,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",304.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",304.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",304.44,769,
"MRI ABDOMEN W/CONT",3901315,"CDM ",969,RC,74182,HCPCS,OUTPATIENT,,,198,158.4,,456.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",456.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",907,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",456.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",456.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",456.32,907,
"MRI ABDOMEN W/WO CONT",3901320,"CDM ",969,RC,74183,HCPCS,OUTPATIENT,,,253,202.4,,804.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",804.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1597,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",804.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,135.96,135.96,135.96,"1 through 10",other,"not separately reimbursment ",804.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",804.2,1597,
"MRA RENAL ARTERIES",3901325,"CDM ",969,RC,74185,HCPCS,OUTPATIENT,,,205,164,,355.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",355.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",827,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",355.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",355.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",355.7,827,
"XR CHOLANGIOGRAM OPERATIVE",3901330,"CDM ",969,RC,74300,HCPCS,OUTPATIENT,,,32.5,26,,90.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,269.86,269.86,269.86,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",76,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",90.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",90.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76,90.19,
"XR UROGRAPHY PYELO IV",3901335,"CDM ",969,RC,74400,HCPCS,OUTPATIENT,,,55.5,44.4,,78.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",160,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",78.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",78.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7,160,
"XR BLADDER & URETHRA",3901340,"CDM ",969,RC,74450,HCPCS,OUTPATIENT,,,38,30.4,,56.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",112,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",56.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",56.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5,112,
"CT ANGIO ABD AORTA RUNOFF",3901345,"CDM ",969,RC,75635,HCPCS,OUTPATIENT,,,272,217.6,,549.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,35.27,35.27,35.27,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",549.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1092,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",549.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",549.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",549.75,1092,
"XR FB SINGLE VIEW PEDIATRIC",3901350,"CDM ",969,RC,76010,HCPCS,OUTPATIENT,,,22,17.6,,21.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",44,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",21.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",21.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.26,44,
"XR SURG SPECIMEN",3901355,"CDM ",969,RC,76098,HCPCS,OUTPATIENT,,,37,29.6,,15.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,27.64,27.64,27.64,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",37,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.89,37,
"CT LIMITED OR FOLLOW-UP STUDY",3901360,"CDM ",969,RC,76380,HCPCS,OUTPATIENT,,,110,88,,110.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",282,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",110.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",110.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.03,282,
"US NEONATAL HEAD LIMITED",3901365,"CDM ",969,RC,76506,HCPCS,OUTPATIENT,,,81,64.8,,68.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",179,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",68.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.8,179,
"US SOFT TISSUE HEAD NECK",3901370,"CDM ",969,RC,76536,HCPCS,OUTPATIENT,,,209.5,167.6,,64.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,239.51,239.51,239.51,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",171,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",64.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,621.67,235.67,699.38,"1 through 10",other,"not separately reimbursment ",64.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.11,171,
"US BREAST UNILATERAL RT",3901375,"CDM ",969,RC,76641,HCPCS,OUTPATIENT,,,93.5,74.8,,64.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",147,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",64.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,102.35,38.75,103.23,"1 through 10",other,"not separately reimbursment ",64.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.95,147,
"US BREAST BILATERAL",3901380,"CDM ",969,RC,76641,HCPCS,OUTPATIENT,,,93.5,74.8,,64.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",147,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",64.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,102.35,38.75,103.23,"1 through 10",other,"not separately reimbursment ",64.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.95,147,
"US BREAST UNILATERAL LFT",3901385,"CDM ",969,RC,76641,HCPCS,OUTPATIENT,,,93.5,74.8,,64.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",147,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",64.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,102.35,38.75,103.23,"1 through 10",other,"not separately reimbursment ",64.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.95,147,
"US BREAST LIMITED LFT",3901395,"CDM ",969,RC,76642,HCPCS,OUTPATIENT,,,87.5,70,,53.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,87.47,84.70,90.23,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",121,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",53.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,186.19,156.40,186.19,"1 through 10",other,"not separately reimbursment ",53.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.48,121,
"US BREAST LIMITED RT",3901400,"CDM ",969,RC,76642,HCPCS,OUTPATIENT,,,87.5,70,,53.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,87.47,84.70,90.23,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",121,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",53.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,186.19,156.40,186.19,"1 through 10",other,"not separately reimbursment ",53.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.48,121,
"US BREAST LIMITED BILATERAL",3901405,"CDM ",969,RC,76642,HCPCS,OUTPATIENT,,,87.5,70,,53.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,87.47,84.70,90.23,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",121,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",53.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,186.19,156.40,186.19,"1 through 10",other,"not separately reimbursment ",53.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.48,121,
"US ABDOMEN COMPLETE",3901410,"CDM ",969,RC,76700,HCPCS,OUTPATIENT,,,103,82.4,,98.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,36.27,36.27,36.27,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",215,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",98.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,733.16,733.16,733.16,"1 through 10",other,"not separately reimbursment ",98.69,100,,82.57,82.57,82.57,"1 through 10","fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.69,215,
"US ABDOMEN LIMITED",3901415,"CDM ",969,RC,76705,HCPCS,OUTPATIENT,,,75,60,,73.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",168,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",73.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,871.19,418.96,1008.33,"1 through 10",other,"not separately reimbursment ",73.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.78,168,
"US ABD AORTA ANEURYSM SCREEN",3901420,"CDM ",969,RC,76706,HCPCS,OUTPATIENT,,,69.5,55.6,,57.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",154,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",57.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",57.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.23,154,
"US RETROPERITONEAL COMPLETE",3901425,"CDM ",969,RC,76770,HCPCS,OUTPATIENT,,,93.5,74.8,,94.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",211,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,495.14,165.09,825.18,"1 through 10",other,"not separately reimbursment ",94.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.92,211,
"US RETROPERITONEAL LIMITED",3901430,"CDM ",969,RC,76775,HCPCS,OUTPATIENT,,,73.5,58.8,,74.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",119.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",164,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",74.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",74.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.3,164,
"US SPINAL CANAL",3901435,"CDM ",969,RC,76800,HCPCS,OUTPATIENT,,,161,128.8,,90.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",197,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",90.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",90.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.74,197,
"US OB <=14 WEEKS SINGLE FETUS",3901440,"CDM ",969,RC,76801,HCPCS,OUTPATIENT,,,126.5,101.2,,116.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",162.34,100,,89.77,89.77,89.77,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",206,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",116.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,75.41,75.41,75.41,"1 through 10",other,"not separately reimbursment ",116.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.17,206,
"US OB <14WKS ADD FETUS",3901443,"CDM ",969,RC,76802,HCPCS,OUTPATIENT,,,87,69.6,,66.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",134,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",66.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",66.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.78,134,
"US OB >=14 WEEKS",3901445,"CDM ",969,RC,76805,HCPCS,OUTPATIENT,,,126.5,101.2,,116.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,113.44,113.44,113.44,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",220,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",116.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,93.89,93.89,537.35,"1 through 10",other,"not separately reimbursment ",116.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.17,220,
"US OB FETAL ANAT SINGLE FETUS",3901450,"CDM ",969,RC,76811,HCPCS,OUTPATIENT,,,240.5,192.4,,189.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",189.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",377,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",189.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",189.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",189.04,377,
"US OB FETAL ANATOMY & MATERNAL",3901455,"CDM ",969,RC,76811,HCPCS,OUTPATIENT,,,240.5,192.4,,189.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",189.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",377,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",189.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",189.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",189.04,377,
"US OB LIMITED 1 OR MORE FETUS",3901460,"CDM ",969,RC,76815,HCPCS,OUTPATIENT,,,83,66.4,,77.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",137,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",77.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,42.88,42.88,42.88,"1 through 10",other,"not separately reimbursment ",77.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.55,137,
"US OB FOLLOW UP EACH FETUS",3901465,"CDM ",969,RC,76816,HCPCS,OUTPATIENT,,,108.5,86.8,,68.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",176,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,58.86,55.92,58.86,"1 through 10",other,"not separately reimbursment ",68.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.54,176,
"US OB TRANSVAGINAL",3901470,"CDM ",969,RC,76817,HCPCS,OUTPATIENT,,,95.5,76.4,,83.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.67,100,,47.43,47.43,47.43,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",153,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",83.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,130.68,130.68,130.68,"1 through 10",other,"not separately reimbursment ",83.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.3,153,
"US OB BIOPHYS PROFILE WO NST",3901475,"CDM ",969,RC,76819,HCPCS,OUTPATIENT,,,98,78.4,,79.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",158,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",79.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,925.79,925.79,925.79,"1 through 10",other,"not separately reimbursment ",79.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.41,158,
"US FETAL UMB ARTERY RATIO",3901480,"CDM ",969,RC,76820,HCPCS,OUTPATIENT,,,57.5,46,,68.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",137,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,803.82,803.82,803.82,"1 through 10",other,"not separately reimbursment ",68.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.89,137,
"US TRANSVAGINAL NON OB",3901485,"CDM ",969,RC,76830,HCPCS,OUTPATIENT,,,88.5,70.8,,84.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",181,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",84.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,607.70,76.05,980.53,"1 through 10",other,"not separately reimbursment ",84.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.83,181,
"US PELVIC COMPLETE",3901490,"CDM ",969,RC,76856,HCPCS,OUTPATIENT,,,87.5,70,,85.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",191,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,974.79,888.14,1061.44,"1 through 10",other,"not separately reimbursment ",85.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.1,191,
"US PELVIC LIMITED",3901495,"CDM ",969,RC,76857,HCPCS,OUTPATIENT,,,63.5,50.8,,64.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",109.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",141,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",64.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,82.58,82.58,82.58,"1 through 10",other,"not separately reimbursment ",64.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.35,141,
"US SCROTUM/TESTICULAR",3901500,"CDM ",969,RC,76870,HCPCS,OUTPATIENT,,,81,64.8,,70.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,118.02,118.02,118.02,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",177,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",70.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,156.14,156.14,156.14,"1 through 10",other,"not separately reimbursment ",70.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.9,177,
"US TRANSRECTAL",3901505,"CDM ",969,RC,76872,HCPCS,OUTPATIENT,,,86.5,69.2,,87.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",151.19,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",198,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",87.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",87.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8,198,
"US COMPLETE JOINT",3901510,"CDM ",969,RC,76881,HCPCS,OUTPATIENT,,,142,113.6,,53.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",163,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",53.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",53.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5,163,
"US EXT SOFT TISSUE LIMITED",3901515,"CDM ",969,RC,76882,HCPCS,OUTPATIENT,,,87.5,70,,13.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",79,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",13.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",13.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.92,79,
"US HIPS INFANT",3901520,"CDM ",969,RC,76885,HCPCS,OUTPATIENT,,,94.5,75.6,,71.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",211,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",71.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",71.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.84,211,
"US HIPS INFANT LIMITED",3901525,"CDM ",969,RC,76886,HCPCS,OUTPATIENT,,,80,64,,67.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",151,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",67.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",67.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.84,151,
"US GUIDE COMP PSEUDOANEURYSM",3901530,"CDM ",969,RC,76936,HCPCS,OUTPATIENT,,,223,178.4,,247.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",247.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",542,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",247.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",247.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",247.13,542,
"US GUIDE VASCULAR ACCESS",3901535,"CDM ",969,RC,76937,HCPCS,OUTPATIENT,,,36,28.8,,25.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.68,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",55,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",25.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,438.33,438.33,438.33,"1 through 10",other,"not separately reimbursment ",25.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.68,55,
"US GUIDE NEEDLE PLACEMENT",3901540,"CDM ",969,RC,76942,HCPCS,OUTPATIENT,,,82,65.6,,108.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.07,100,,143.86,143.86,143.86,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",281,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",108.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,219.38,219.38,219.38,"1 through 10",other,"not separately reimbursment ",108.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.07,281,
"US GUIDE AMNIOCENTESIS",3901545,"CDM ",969,RC,76946,HCPCS,OUTPATIENT,,,49.5,39.6,,60.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",120,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",60.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",60.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.55,120,
"US OTHER UNLISTED",3901550,"CDM ",969,RC,76999,HCPCS,OUTPATIENT,,,71.5,57.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",60.78,85,,48.62,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.78,60.78,
"CT BIOPSY OR ASPIRATION",3901555,"CDM ",969,RC,77012,HCPCS,OUTPATIENT,,,167.5,134,,194.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",194.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",473,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",194.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",194.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",194.54,473,
"MRI BREAST UNI RT WO CONT",3901560,"CDM ",969,RC,77046,HCPCS,OUTPATIENT,,,165.5,132.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",340,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.42,340,
"MRI BREAST UNI LFT WO CONT",3901565,"CDM ",969,RC,77046,HCPCS,OUTPATIENT,,,165.5,132.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",340,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.42,340,
"MRI BREAST BILAT WO CONT",3901570,"CDM ",969,RC,77047,HCPCS,OUTPATIENT,,,183,146.4,,156.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",349,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",156.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",156.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.51,349,
"MRI BREAST UNI LFT W/WO CONT",3901575,"CDM ",969,RC,77048,HCPCS,OUTPATIENT,,,241.5,193.2,,241.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",538,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",241.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",241.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.35,538,
"MRI BREAST UNI RT W/WO CONT",3901580,"CDM ",969,RC,77048,HCPCS,OUTPATIENT,,,241.5,193.2,,241.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",538,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",241.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",241.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.35,538,
"MRI BREAST BILAT W/WO CONT",3901585,"CDM ",969,RC,77049,HCPCS,OUTPATIENT,,,264.5,211.6,,246.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",246.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",551,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",246.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",246.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",246.82,551,
"MM DIAG MAMMO UNI RT W/CAD",3901590,"CDM ",969,RC,77065,HCPCS,OUTPATIENT,,,101,80.8,,62.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,75.30,75.30,75.30,"1 through 10","other ","not separately reimbursment ",,,,15.37,15.37,15.37,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",182,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",62.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",62.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6,182,
"MM DIAG MAMMO UNI LFT W/CAD",3901595,"CDM ",969,RC,77065,HCPCS,OUTPATIENT,,,101,80.8,,62.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,75.30,75.30,75.30,"1 through 10","other ","not separately reimbursment ",,,,15.37,15.37,15.37,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",182,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",62.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",62.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6,182,
"MM DIAG MAMMO BILAT W/CAD",3901600,"CDM ",969,RC,77066,HCPCS,OUTPATIENT,,,115,92,,78.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,118.02,118.02,118.02,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",231,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",78.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,95.99,82.27,543.80,"1 through 10",other,"not separately reimbursment ",78.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.34,231,
"MM SCREEN MAMMO UNI LEFT W/CAD",3901605,"CDM ",969,RC,77067,HCPCS,OUTPATIENT,,,90,72,,62.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",186,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",62.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,323.68,79.44,323.68,21,other,"not separately reimbursment ",62.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.26,186,
"MM SCREEN MAMMO UNI RT W/CAD",3901610,"CDM ",969,RC,77067,HCPCS,OUTPATIENT,,,90,72,,62.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",186,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",62.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,323.68,79.44,323.68,21,other,"not separately reimbursment ",62.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.26,186,
"MM SCREEN MAMMO BILAT W/CAD",3901615,"CDM ",969,RC,77067,HCPCS,OUTPATIENT,,,95,76,,62.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",186,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",62.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,323.68,79.44,323.68,21,other,"not separately reimbursment ",62.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.26,186,
"XR STRESS  VIEW ANY EXTREMITY",3901620,"CDM ",969,RC,77071,HCPCS,OUTPATIENT,,,44,35.2,,25.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",68,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",25.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",25.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.95,68,
"XR BONE AGE STUDY",3901625,"CDM ",969,RC,77072,HCPCS,OUTPATIENT,,,22,17.6,,17.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",36,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,267.65,267.65,267.65,"1 through 10",other,"not separately reimbursment ",17.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.67,36,
"CT SCANOGRAM",3901630,"CDM ",969,RC,77073,HCPCS,OUTPATIENT,,,31.5,25.2,,30.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",64,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",30.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.51,64,
"XR BONE AGE STUDY",3901635,"CDM ",969,RC,77073,HCPCS,OUTPATIENT,,,31.5,25.2,,30.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",64,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",30.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.51,64,
"XR BONE SURVEY COMPLETE",3901640,"CDM ",969,RC,77075,HCPCS,OUTPATIENT,,,64,51.2,,71.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",146,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",71.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",71.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.76,146,
"XR BONE SURVEY INFANT",3901645,"CDM ",969,RC,77076,HCPCS,OUTPATIENT,,,82,65.6,,58.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,881.96,881.96,881.96,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",152,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",58.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.6,152,
"DEXA BONE DENSITY STUDY",3901650,"CDM ",969,RC,77080,HCPCS,OUTPATIENT,,,23,18.4,,59.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,103.22,103.22,103.22,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",130,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",59.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,103.23,102.35,521.51,"1 through 10",other,"not separately reimbursment ",59.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.93,130,
"MRI BONE MARROW",3901655,"CDM ",969,RC,77084,HCPCS,OUTPATIENT,,,184,147.2,,285,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",285,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",665,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",285,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",285,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,665,
"NM THYROID UPTAKE",3901660,"CDM ",969,RC,78012,HCPCS,OUTPATIENT,,,22,17.6,,48.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",109,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",48.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",48.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.55,109,
"NM THYROID SCAN",3901665,"CDM ",969,RC,78013,HCPCS,OUTPATIENT,,,42,33.6,,122.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",274,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",122.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",122.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.6,274,
"NM THYROID UPDAKE AND SCAN",3901670,"CDM ",969,RC,78014,HCPCS,OUTPATIENT,,,56.5,45.2,,141.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,79.60,79.60,79.60,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",317,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",141.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",141.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.8,317,
"NM THYROID WHOLE BODY",3901675,"CDM ",969,RC,78018,HCPCS,OUTPATIENT,,,94.5,75.6,,193.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",193.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",473,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",193.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",193.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",193.17,473,
"NM PARATHYROID",3901680,"CDM ",969,RC,78070,HCPCS,OUTPATIENT,,,91,72.8,,155.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,999.34,999.34,999.34,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",417,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",155.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",155.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.23,417,
"NM PARATHYROID SPECT",3901685,"CDM ",969,RC,78071,HCPCS,OUTPATIENT,,,135,108,,212.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",212.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",475,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",212.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",212.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",212.09,475,
"NM LYMPH SYSTEM",3901690,"CDM ",969,RC,78195,HCPCS,OUTPATIENT,,,134,107.2,,168.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",168.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",497,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",168.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",168.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",168.2,497,
"NM LIVER STATIC ONLY",3901700,"CDM ",969,RC,78201,HCPCS,OUTPATIENT,,,49.5,39.6,,114.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",254,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",114.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",114.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.47,254,
"NM LIVER AND SPLEEN",3901705,"CDM ",969,RC,78215,HCPCS,OUTPATIENT,,,55.5,44.4,,127.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",265,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",127.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",127.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.36,265,
"NM HEPATOBILIARY SYSTEM",3901710,"CDM ",969,RC,78226,HCPCS,OUTPATIENT,,,84,67.2,,139.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",509,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",139.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",139.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.22,509,
"NM HEPATO SYSTEM W/PHARM INTV",3901715,"CDM ",969,RC,78227,HCPCS,OUTPATIENT,,,102.5,82,,189.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",189.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",689,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",189.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1534.70,574.70,1841.64,"1 through 10",other,"not separately reimbursment ",189.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",189.3,689,
"NM SALIVARY GLAND W/SERIAL",3901720,"CDM ",969,RC,78231,HCPCS,OUTPATIENT,,,52.5,42,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",225,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",225,225,
"NM GASTRIC EMPTYING STUDY",3901725,"CDM ",969,RC,78264,HCPCS,OUTPATIENT,,,90,72,,151.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,161.28,161.28,161.28,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",397,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",151.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",151.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.82,397,
"NM GI BLEEDING",3901730,"CDM ",969,RC,78278,HCPCS,OUTPATIENT,,,112,89.6,,181.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",181.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",481,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",181.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",181.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",181.72,481,
"NM INTESTINE IMAGING",3901735,"CDM ",969,RC,78290,HCPCS,OUTPATIENT,,,77.5,62,,187.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",463,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",187.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",187.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.36,463,
"NM BONE SCAN LIMITED",3901740,"CDM ",969,RC,78300,HCPCS,OUTPATIENT,,,71.5,57.2,,117.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",248,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",117.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",117.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.15,248,
"NM BONE SCAN MULTI AREA",3901745,"CDM ",969,RC,78305,HCPCS,OUTPATIENT,,,95.5,76.4,,158.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",158.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",328,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",158.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",158.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",158.85,328,
"NM BONE SCAN WHOLE BODY",3901750,"CDM ",969,RC,78306,HCPCS,OUTPATIENT,,,97.5,78,,177.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",359,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",177.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",177.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.39,359,
"NM BONE SCAN 3 PHASE",3901755,"CDM ",969,RC,78315,HCPCS,OUTPATIENT,,,115,92,,180.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,413.50,413.50,413.50,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",481,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",180.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,172.69,172.69,172.69,"1 through 10",other,"not separately reimbursment ",180.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.45,481,
"NM NONCARDIAC VASCULAR FLOW",3901760,"CDM ",969,RC,78445,HCPCS,OUTPATIENT,,,57.5,46,,74.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",242,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",74.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",74.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.74,242,
"NM MYOCARDIAL SPECT",3901765,"CDM ",969,RC,78451,HCPCS,OUTPATIENT,,,155,124,,113.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",479,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",113.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",113.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.67,479,
"NM MYO SPECT MULTI STUDIES",3901770,"CDM ",969,RC,78452,HCPCS,OUTPATIENT,,,183,146.4,,194.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",194.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",667,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",194.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,3760.91,3760.91,3760.91,"1 through 10",other,"not separately reimbursment ",194.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",194.13,667,
"NM VENOGRAM UNI RIGHT",3901775,"CDM ",969,RC,78457,HCPCS,OUTPATIENT,,,85,68,,109.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",284,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",109.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",109.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.06,284,
"NM VENOGRAM BILATERAL",3901778,"CDM ",969,RC,78458,HCPCS,OUTPATIENT,,,103,82.4,,154.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",312,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",154.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",154.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154.21,312,
"NM VENOGRAM UNI LEFT",3901780,"CDM ",969,RC,78457,HCPCS,OUTPATIENT,,,85,68,,109.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",284,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",109.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",109.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.06,284,
"NM MUGA SCAN",3901785,"CDM ",969,RC,78472,HCPCS,OUTPATIENT,,,111,88.8,,199.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,607.27,607.27,607.27,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",199.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",402,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",199.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",199.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",199.41,402,
"NM LUNG SCAN PERFUSION",3901795,"CDM ",969,RC,78580,HCPCS,OUTPATIENT,,,84,67.2,,147.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",333,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",147.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",147.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.57,333,
"NM BRAIN SCAN MIN 4V",3901800,"CDM ",969,RC,78605,HCPCS,OUTPATIENT,,,62,49.6,,136.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",277,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",136.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",136.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136.39,277,
"NM BRAIN SCAN 4V W/FLOW",3901805,"CDM ",969,RC,78606,HCPCS,OUTPATIENT,,,73.5,58.8,,198.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",198.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",454,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",198.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",198.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",198.24,454,
"NM CISTERNOGRAM",3901810,"CDM ",969,RC,78630,HCPCS,OUTPATIENT,,,77.5,62,,174.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",468,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",174.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",174.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174.12,468,
"NM KIDNEY FLOW/FUNCT WO RX",3901815,"CDM ",969,RC,78707,HCPCS,OUTPATIENT,,,108,86.4,,168.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",168.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",354,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",168.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",168.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",168.99,354,
"NM KIDNEY FLOW/FUNCT W/RX",3901820,"CDM ",969,RC,78708,HCPCS,OUTPATIENT,,,136,108.8,,155.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,849.59,849.59,849.59,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",356,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",155.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",155.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.83,356,
"NM  KIDNEY FLOW/FUNCT W/WO RX",3901825,"CDM ",969,RC,78709,HCPCS,OUTPATIENT,,,157,125.6,,237.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",237.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",517,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",237.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",237.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",237.44,517,
"NM TESTICULAR W/FLOW",3901830,"CDM ",969,RC,78761,HCPCS,OUTPATIENT,,,83,66.4,,122.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",296,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",122.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",122.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.23,296,
"NM TUMOR LOCALIZATION LIMITED",3901835,"CDM ",969,RC,78800,HCPCS,OUTPATIENT,,,74.5,59.6,,126.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",126.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",271,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",126.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",126.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",126.08,271,
"NM SPECT ONE AREA 1 DAY IMG",3901840,"CDM ",969,RC,78803,HCPCS,OUTPATIENT,,,121.5,97.2,,253.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2467.38,2467.38,2467.38,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",253.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",512,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",253.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",253.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",253.9,512,
"NM PLANAR WHOLE BODY 2+ D IMG",3901845,"CDM ",969,RC,78804,HCPCS,OUTPATIENT,,,113,90.4,,402.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",402.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",811,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",402.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",402.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",402.46,811,
"US CAROTID DOPPLER BILATERAL",3901850,"CDM ",969,RC,93880,HCPCS,OUTPATIENT,,,91,72.8,,181.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",181.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",367,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",181.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,143.99,32.76,744.51,"1 through 10",other,"not separately reimbursment ",181.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",181.66,367,
"US CAROTID DOPPLER UNI RIGHT",3901855,"CDM ",969,RC,93882,HCPCS,OUTPATIENT,,,55.5,44.4,,115.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",286,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",115.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",115.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.48,286,
"US CAROTID DOPPLER UNI LEFT",3901860,"CDM ",969,RC,93882,HCPCS,OUTPATIENT,,,55.5,44.4,,115.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",286,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",115.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",115.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.48,286,
"US ABI BIL EXT 1-2 LEVEL",3901865,"CDM ",969,RC,93922,HCPCS,OUTPATIENT,,,28.5,22.8,,85.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,254.40,254.40,254.40,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",193,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.61,193,
"US ARTERIAL LOW EXT BILAT",3901870,"CDM ",969,RC,93925,HCPCS,OUTPATIENT,,,98,78.4,,215.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,38.05,38.05,38.05,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",215.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",433,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",215.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,102.34,102.34,102.34,"1 through 10",other,"not separately reimbursment ",215.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",215.02,433,
"US ARTERIAL LOW EXT LEFT",3901875,"CDM ",969,RC,93926,HCPCS,OUTPATIENT,,,60,48,,130.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,460.36,460.36,460.36,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",282,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",130.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",130.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.6,282,
"US ARTERIAL LOW EXT RIGHT",3901880,"CDM ",969,RC,93926,HCPCS,OUTPATIENT,,,60,48,,130.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,460.36,460.36,460.36,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",282,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",130.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",130.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.6,282,
"US ARTERIAL UP EXT BILATERAL",3901885,"CDM ",969,RC,93930,HCPCS,OUTPATIENT,,,100,80,,172.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",386,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",172.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",172.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.18,386,
"US ARTERIAL UP EXT UNI LEFT",3901890,"CDM ",969,RC,93931,HCPCS,OUTPATIENT,,,61,48.8,,112.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",271,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",112.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",112.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.33,271,
"US ARTERIAL UP EXT UNI RIGHT",3901895,"CDM ",969,RC,93931,HCPCS,OUTPATIENT,,,61,48.8,,112.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",271,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",112.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",112.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.33,271,
"US VENOUS EXT BILATERAL",3901900,"CDM ",969,RC,93970,HCPCS,OUTPATIENT,,,86.5,69.2,,177.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",355,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",177.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,230.63,230.63,230.63,"1 through 10",other,"not separately reimbursment ",177.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.19,355,
"US VENOUS EXT UNILAT RIGHT",3901905,"CDM ",969,RC,93971,HCPCS,OUTPATIENT,,,55.5,44.4,,120.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",243,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",120.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,21.07,21.07,21.07,"1 through 10",other,"not separately reimbursment ",120.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.45,243,
"US VENOUS EXT UNILAT LEFT",3901910,"CDM ",969,RC,93971,HCPCS,OUTPATIENT,,,55.5,44.4,,120.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",243,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",120.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,21.07,21.07,21.07,"1 through 10",other,"not separately reimbursment ",120.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.45,243,
"US VASCULAR STUDY COMPLETE",3901915,"CDM ",969,RC,93975,HCPCS,OUTPATIENT,,,145,116,,280.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",280.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",557,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",280.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",280.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",280.77,557,
"US VASCULAR STUDY LIMITED",3901920,"CDM ",969,RC,93976,HCPCS,OUTPATIENT,,,100,80,,165.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",165.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",330,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",165.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1241.27,1241.27,1241.27,"1 through 10",other,"not separately reimbursment ",165.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",165.96,330,
"US HEMODIALYSIS ACCESS",3901925,"CDM ",969,RC,93990,HCPCS,OUTPATIENT,,,54.5,43.6,,124.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",299,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",124.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",124.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.31,299,
"MRA ABDOMEN W AND/OR WO CONT",3901930,"CDM ",969,RC,74185,HCPCS,OUTPATIENT,,,205,164,,355.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",355.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",827,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",355.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",355.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",355.7,827,
"MRA CHEST W AND/OR WO CONT",3901935,"CDM ",969,RC,71555,HCPCS,OUTPATIENT,,,206,164.8,,356.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",356.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",833,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",356.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",356.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",356.27,833,
"MR SHOULDER ARTHROGRAM RT",3901940,"CDM ",969,RC,73223,HCPCS,OUTPATIENT,,,248,198.4,,798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1586,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.09,1586,
"MR SHOULDER ARTHROGRAM LFT",3901945,"CDM ",969,RC,73223,HCPCS,OUTPATIENT,,,248,198.4,,798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1586,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",798.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",798.09,1586,
"US ER THORAX/CHEST LIMITED",3901950,"CDM ",969,RC,76604,HCPCS,OUTPATIENT,,,72.5,58,,63.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",130,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",63.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",63.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.2,130,
"XR COLON SINGLE",3901955,"CDM ",969,RC,74270,HCPCS,OUTPATIENT,,,95.5,76.4,,90.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,673.77,673.77,673.77,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",220,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",90.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",90.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.4,220,
"XR URETHROGRAM W/WO KUB",3901960,"CDM ",969,RC,74420,HCPCS,OUTPATIENT,,,50,40,,122.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",181,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",122.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",122.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.08,181,
"XR ESOPHAGUS SINGLE",3901965,"CDM ",969,RC,74220,HCPCS,OUTPATIENT,,,55.5,44.4,,61.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",128,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",61.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",61.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.35,128,
"XR UPPER GI DOUBLE",3901970,"CDM ",969,RC,74246,HCPCS,OUTPATIENT,,,83.5,66.8,,87.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",187,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",87.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",87.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8,187,
"XR SMALL BOWEL SINGLE",3901975,"CDM ",969,RC,74250,HCPCS,OUTPATIENT,,,74.5,59.6,,69.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",152,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",69.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",69.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.62,152,
"XR COLON DOUBLE CONT",3901980,"CDM ",969,RC,74280,HCPCS,OUTPATIENT,,,115.5,92.4,,135.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",306,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",135.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",135.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.34,306,
"XR VENOGRAM EXT BILAT",3901985,"CDM ",969,RC,75822,HCPCS,OUTPATIENT,,,133.5,106.8,,101.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",226,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",101.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",101.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.63,226,
"XR MYELOGRAM L-S SPINE",3901990,"CDM ",969,RC,72265,HCPCS,OUTPATIENT,,,80,64,,123.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",303,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",123.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",123.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.79,303,
"FLUORO < 1HR",3901995,"CDM ",969,RC,76000,HCPCS,OUTPATIENT,,,60,48,,44.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",142,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,446.52,307.90,585.13,"1 through 10",other,"not separately reimbursment ",44.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.75,142,
"XR WRIST ARTHROGRAM RIGHT",3902000,"CDM ",969,RC,73115,HCPCS,OUTPATIENT,,,53.5,42.8,,74.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",159,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",74.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",74.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.38,159,
"XR WRIST ARTHROGRAM LEFT",3902005,"CDM ",969,RC,73115,HCPCS,OUTPATIENT,,,53.5,42.8,,74.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",159,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",74.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",74.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.38,159,
"XR KNEE ARTHROGRAM RIGHT",3902010,"CDM ",969,RC,73580,HCPCS,OUTPATIENT,,,62,49.6,,98.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,949.56,949.56,949.56,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",196,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",98.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",98.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.23,196,
"XR KNEE ARTHROGRAM LEFT",3902015,"CDM ",969,RC,73580,HCPCS,OUTPATIENT,,,62,49.6,,98.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,949.56,949.56,949.56,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",196,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",98.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",98.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.23,196,
"XR SHOULDER ARTHROGRAM RIGHT",3902020,"CDM ",969,RC,73040,HCPCS,OUTPATIENT,,,53.5,42.8,,83.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",166,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",83.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",83.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.46,166,
"XR SHOULDER ARTHROGRAM LEFT",3902025,"CDM ",969,RC,73040,HCPCS,OUTPATIENT,,,53.5,42.8,,83.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",166,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",83.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",83.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.46,166,
"XR HIP ARTHROGRAM RIGHT",3902030,"CDM ",969,RC,73525,HCPCS,OUTPATIENT,,,56,44.8,,83.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,29.01,29.01,29.01,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",166,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",83.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",83.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.69,166,
"XR HIP ARTHROGRAM LEFT",3902035,"CDM ",969,RC,73525,HCPCS,OUTPATIENT,,,56,44.8,,83.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,29.01,29.01,29.01,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",166,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",83.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",83.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.69,166,
"XR ELBOW ARTHROGRAM RIGHT",3902040,"CDM ",969,RC,73085,HCPCS,OUTPATIENT,,,50,40,,83.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",166,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",83.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",83.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.73,166,
"XR ELBOW ARTHROGRAM LEFT",3902045,"CDM ",969,RC,73085,HCPCS,OUTPATIENT,,,50,40,,83.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",166,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",83.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",83.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.73,166,
"XR UPPER GI SINGLE",3902050,"CDM ",969,RC,74240,HCPCS,OUTPATIENT,,,75.5,60.4,,77.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,507.50,507.50,507.50,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",164,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",77.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",77.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.18,164,
"XR FLUORO GI TUBE PLACEMENT",3902055,"CDM ",920,RC,74340,HCPCS,OUTPATIENT,,,55,44,,59.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.5,70,,30.80,,,0,"percent of total billed charges ","70% of total billed charges ",49.5,90,,39.60,,,0,"percent of total billed charges ","90% of total billed charges ",51.15,93,,40.92,,,0,"percent of total billed charges ","93% of total billed charges ",59.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.08,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",46.75,85,,37.40,,,0,"percent of total billed charges ","85% of total billed charges ",49.5,90,,39.60,,,0,"percent of total billed charges ","90% of total billed charges ",49.5,90,,39.60,,,0,"percent of total billed charges ","90% of total billed charges ",27.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.85,87,,38.28,,,0,"percent of total billed charges ","87% of total billed charges ",27.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",38.5,70,,30.80,,,0,"percent of total billed charges ","70% of total billed charges ",27.8,59.85,
"XR FLUORO GI TUBE PLACEMENT",3902055,"CDM ",920,RC,74340,HCPCS,OUTPATIENT,,,50,40,,59.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",46.5,93,,37.20,,,0,"percent of total billed charges ","93% of total billed charges ",59.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.08,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",42.5,85,,34.00,,,0,"percent of total billed charges ","85% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",27.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.5,87,,34.80,,,0,"percent of total billed charges ","87% of total billed charges ",27.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",27.8,59.85,
"FLUORO NEEDLE PLACEMENT ADD ON",3902060,"CDM ",969,RC,77002,HCPCS,OUTPATIENT,,,54,43.2,,54.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",61.12,100,,24.51,24.51,24.51,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",140,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",54.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",54.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.57,140,
"XR MYELOGRAM C SPINE",3902065,"CDM ",969,RC,72240,HCPCS,OUTPATIENT,,,85.5,68.4,,136.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",348,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",136.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",136.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136.92,348,
"XR MYELOGRAM TSPINE",3902070,"CDM ",969,RC,72255,HCPCS,OUTPATIENT,,,84,67.2,,161.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",161.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",323,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",161.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",161.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",161.93,323,
"XR MYELOGRAM 2 + SPINE REGIONS",3902075,"CDM ",969,RC,72270,HCPCS,OUTPATIENT,,,135.5,108.4,,231.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",231.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",460,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",231.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",231.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",231.44,460,
"US SPINAL CANAL",3902080,"CDM ",969,RC,76800,HCPCS,OUTPATIENT,,,135.5,108.4,,90.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",197,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",90.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",90.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.74,197,
"XR UROGRAPHY ANTEGRADE",3902085,"CDM ",969,RC,74425,HCPCS,OUTPATIENT,,,47.5,38,,52.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",105,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",52.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.89,105,
"XR HYSTEROSALPINGOGRAM",3902090,"CDM ",969,RC,74740,HCPCS,OUTPATIENT,,,35.5,28.4,,56.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",116,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",56.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",56.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.79,116,
"FLUORO VENOUS DEVICE PLACEMENT",3902095,"CDM ",969,RC,77001,HCPCS,OUTPATIENT,,,35,28,,70.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.27,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",161,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",70.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,782.27,782.27,782.27,"1 through 10",other,"not separately reimbursment ",70.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.27,161,
"XR FISTULA SINUS TRACT",3902100,"CDM ",969,RC,76080,HCPCS,OUTPATIENT,,,48,38.4,,52.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",105,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",52.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.8,105,
"FLUORO < 1HR ERCP",3902105,"CDM ",969,RC,74330,HCPCS,OUTPATIENT,,,55.5,44.4,,126.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",126.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",255,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",126.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",126.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",126.29,255,
"XR SWALLOW FUNCTION",3902110,"CDM ",969,RC,74230,HCPCS,OUTPATIENT,,,49.5,39.6,,59.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,32.32,32.32,32.32,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",178,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",59.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",59.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.62,178,
"XR URETHRA BLADDER",3902115,"CDM ",969,RC,74455,HCPCS,OUTPATIENT,,,31.5,25.2,,59.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",133,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",59.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",59.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.81,133,
"XR BLADDER CONT MIN 3V",3902120,"CDM ",969,RC,74430,HCPCS,OUTPATIENT,,,30,24,,43.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",115,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",43.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",43.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.67,115,
"US OB >=14WKS EACH ADD",3902190,"CDM ",969,RC,76810,HCPCS,OUTPATIENT,,,103.5,82.8,,228.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",228.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",393,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",228.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",228.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",228.15,393,
"MM SCREEN MAMMO LT TOMO",3902210,"CDM ",969,RC,77063,HCPCS,OUTPATIENT,,,55.5,44.4,,32.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",76,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,173.69,20.68,173.69,21,other,"not separately reimbursment ",32.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.28,76,
"MM SCREEN MAMMO RT TOMO",3902215,"CDM ",969,RC,77063,HCPCS,OUTPATIENT,,,55.5,44.4,,32.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",76,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,173.69,20.68,173.69,21,other,"not separately reimbursment ",32.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.28,76,
"MM SCREEN MAMMO BILAT TOMO",3902220,"CDM ",969,RC,77063,HCPCS,OUTPATIENT,,,55.5,44.4,,32.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",76,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,173.69,20.68,173.69,21,other,"not separately reimbursment ",32.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.28,76,
"OB/WITH NON STRESS TEST",4000097,"CDM ",720,RC,59025,HCPCS,OUTPATIENT,,,520,416,,64.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",359.77,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",97.75,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",364,70,,291.20,,,0,"percent of total billed charges ","70% of total billed charges ",468,90,,374.40,,,0,"percent of total billed charges ","90% of total billed charges ",483.6,93,,386.88,,,0,"percent of total billed charges ","93% of total billed charges ",64.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",442,85,,353.60,,,0,"percent of total billed charges ","85% of total billed charges ",390,90,,312.00,,,0,"percent of total billed charges ","90% of total billed charges ",468,90,,374.40,,,0,"percent of total billed charges ","90% of total billed charges ",20.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",452.4,87,,361.01,233.36,451.26,"1 through 10","percent of total billed charges ","87% of total billed charges ",20.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",185.92,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",364,70,,291.20,,,0,"percent of total billed charges ","70% of total billed charges ",20.93,483.6,
"INJECTION IM/SUBQ",4000270,"CDM ",729,RC,96372,HCPCS,OUTPATIENT,,,240.5,192.4,,16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",29.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",223.67,93,,178.94,,,0,"percent of total billed charges ","93% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",204.43,85,,163.54,,,0,"percent of total billed charges ","85% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",209.24,87,,30.52,12.55,82.65,16,"percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,223.67,
"ANTIBIOTIC IM",4000280,"CDM ",729,RC,96372,HCPCS,OUTPATIENT,,,240.5,192.4,,16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",29.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",223.67,93,,178.94,,,0,"percent of total billed charges ","93% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",204.43,85,,163.54,,,0,"percent of total billed charges ","85% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",209.24,87,,30.52,12.55,82.65,16,"percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,223.67,
"OB MONITOR NEW LEVEL 1, 1ST HR",4000340,"CDM ",729,RC,99201,HCPCS,OUTPATIENT,,,219,175.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.3,70,,122.64,,,0,"percent of total billed charges ","70% of total billed charges ",197.1,90,,157.68,,,0,"percent of total billed charges ","90% of total billed charges ",203.67,93,,162.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",186.15,85,,148.92,,,0,"percent of total billed charges ","85% of total billed charges ",197.1,90,,157.68,,,0,"percent of total billed charges ","90% of total billed charges ",197.1,90,,157.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",190.53,87,,152.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.3,70,,122.64,,,0,"percent of total billed charges ","70% of total billed charges ",153.3,203.67,
"OB MON NEW LEVEL 1 EA ADD'L HR",4000350,"CDM ",729,RC,99201,HCPCS,OUTPATIENT,,,61,48.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",56.73,93,,45.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51.85,85,,41.48,,,0,"percent of total billed charges ","85% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",53.07,87,,42.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",42.7,56.73,
"OB MONITOR NEW LEVEL 2, 1ST HR",4000360,"CDM ",729,RC,99202,HCPCS,OUTPATIENT,,,247.5,198,,,,,,,,0,"other ","not separately reimbursment ",67.67,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",102.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",173.25,70,,138.60,,,0,"percent of total billed charges ","70% of total billed charges ",222.75,90,,178.20,,,0,"percent of total billed charges ","90% of total billed charges ",230.18,93,,184.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",210.38,85,,168.30,,,0,"percent of total billed charges ","85% of total billed charges ",222.75,90,,178.20,,,0,"percent of total billed charges ","90% of total billed charges ",222.75,90,,178.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",215.33,87,,54.83,15.38,80.66,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.25,70,,138.60,,,0,"percent of total billed charges ","70% of total billed charges ",67.67,230.18,
"OB MON NEW LEVEL 2 EA ADD'L HR",4000370,"CDM ",729,RC,99202,HCPCS,OUTPATIENT,,,61,48.8,,,,,,,,0,"other ","not separately reimbursment ",67.67,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",102.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",56.73,93,,45.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51.85,85,,41.48,,,0,"percent of total billed charges ","85% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",53.07,87,,54.83,15.38,80.66,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",42.7,102.28,
"OB MONITOR NEW LEVEL 3, 1ST HR",4000380,"CDM ",729,RC,99203,HCPCS,OUTPATIENT,,,266.5,213.2,,,,,,,,0,"other ","not separately reimbursment ",101,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",174.04,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",186.55,70,,149.24,,,0,"percent of total billed charges ","70% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",247.85,93,,198.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",226.53,85,,181.22,,,0,"percent of total billed charges ","85% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",231.86,87,,69.36,34.13,104.06,20,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",186.55,70,,149.24,,,0,"percent of total billed charges ","70% of total billed charges ",101,247.85,
"OB MON NEW LEVEL 3 EA ADD'L HR",4000390,"CDM ",729,RC,99203,HCPCS,OUTPATIENT,,,61,48.8,,,,,,,,0,"other ","not separately reimbursment ",101,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",134.2,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",56.73,93,,45.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51.85,85,,41.48,,,0,"percent of total billed charges ","85% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",53.07,87,,69.36,34.13,104.06,20,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",42.7,134.2,
"OB MONITOR NEW LEVEL 4, 1ST HR",4000400,"CDM ",729,RC,99204,HCPCS,OUTPATIENT,,,339,271.2,,,,,,,,0,"other ","not separately reimbursment ",101,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",283.03,220,,154.69,154.69,154.69,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",237.3,70,,189.84,,,0,"percent of total billed charges ","70% of total billed charges ",305.1,90,,244.08,,,0,"percent of total billed charges ","90% of total billed charges ",315.27,93,,252.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",288.15,85,,230.52,,,0,"percent of total billed charges ","85% of total billed charges ",305.1,90,,244.08,,,0,"percent of total billed charges ","90% of total billed charges ",305.1,90,,244.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",294.93,87,,135.17,78.68,154.59,15,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",237.3,70,,189.84,,,0,"percent of total billed charges ","70% of total billed charges ",101,315.27,
"OB MON NEW LEVEL 4 EA ADD'L HR",4000410,"CDM ",729,RC,99204,HCPCS,OUTPATIENT,,,61,48.8,,,,,,,,0,"other ","not separately reimbursment ",101,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",134.2,220,,154.69,154.69,154.69,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",56.73,93,,45.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51.85,85,,41.48,,,0,"percent of total billed charges ","85% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",53.07,87,,135.17,78.68,154.59,15,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",42.7,134.2,
"OB MONITOR NEW LEVEL 5 1ST HR",4000420,"CDM ",729,RC,99205,HCPCS,OUTPATIENT,,,367,293.6,,,,,,,,0,"other ","not separately reimbursment ",168.67,100,,264.13,264.13,264.13,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",384.08,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",256.9,70,,205.52,,,0,"percent of total billed charges ","70% of total billed charges ",330.3,90,,264.24,,,0,"percent of total billed charges ","90% of total billed charges ",341.31,93,,273.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",311.95,85,,249.56,,,0,"percent of total billed charges ","85% of total billed charges ",330.3,90,,264.24,,,0,"percent of total billed charges ","90% of total billed charges ",330.3,90,,264.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",319.29,87,,255.43,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",256.9,70,,205.52,,,0,"percent of total billed charges ","70% of total billed charges ",168.67,384.08,
"OB MONITOR EST LEVEL 1, 1ST HR",4000423,"CDM ",729,RC,99211,HCPCS,OUTPATIENT,,,219,175.2,,,,,,,,0,"other ","not separately reimbursment ",42.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",18.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",153.3,70,,122.64,,,0,"percent of total billed charges ","70% of total billed charges ",197.1,90,,157.68,,,0,"percent of total billed charges ","90% of total billed charges ",203.67,93,,162.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.72,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",186.15,85,,148.92,,,0,"percent of total billed charges ","85% of total billed charges ",197.1,90,,157.68,,,0,"percent of total billed charges ","90% of total billed charges ",197.1,90,,157.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",190.53,87,,18.91,17.74,20.08,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",153.3,70,,122.64,,,0,"percent of total billed charges ","70% of total billed charges ",17.54,203.67,
"OB MON NEW LEVEL 1 EA ADD'L HR",4000425,"CDM ",729,RC,99211,HCPCS,OUTPATIENT,,,61,48.8,,,,,,,,0,"other ","not separately reimbursment ",42.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",18.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",56.73,93,,45.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.72,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",51.85,85,,41.48,,,0,"percent of total billed charges ","85% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",17.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.07,87,,18.91,17.74,20.08,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",17.54,56.73,
"OB MON NEW LEVEL 5 EA ADD'L HR",4000430,"CDM ",729,RC,99205,HCPCS,OUTPATIENT,,,61,48.8,,,,,,,,0,"other ","not separately reimbursment ",168.67,100,,264.13,264.13,264.13,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",134.2,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",56.73,93,,45.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51.85,85,,41.48,,,0,"percent of total billed charges ","85% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",53.07,87,,42.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",42.7,168.67,
"OB MONITOR EST LEVEL 3, 1ST HR",4000440,"CDM ",729,RC,99213,HCPCS,OUTPATIENT,,,266.5,213.2,,,,,,,,0,"other ","not separately reimbursment ",133.49,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",140.47,220,,74.27,70.21,78.33,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",186.55,70,,149.24,,,0,"percent of total billed charges ","70% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",247.85,93,,198.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",226.53,85,,181.22,,,0,"percent of total billed charges ","85% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",231.86,87,,63.68,29.60,79.60,44,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",186.55,70,,149.24,,,0,"percent of total billed charges ","70% of total billed charges ",133.49,247.85,
"OB MON EST LEVEL 3 EA ADD'L HR",4000450,"CDM ",729,RC,99213,HCPCS,OUTPATIENT,,,61,48.8,,,,,,,,0,"other ","not separately reimbursment ",133.49,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",134.2,220,,74.27,70.21,78.33,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",56.73,93,,45.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51.85,85,,41.48,,,0,"percent of total billed charges ","85% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",53.07,87,,63.68,29.60,79.60,44,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",42.7,134.2,
"OB MONITOR EST LEVEL 4 1ST HR",4000460,"CDM ",729,RC,99214,HCPCS,OUTPATIENT,,,339,271.2,,,,,,,,0,"other ","not separately reimbursment ",188.57,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",207.04,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",237.3,70,,189.84,,,0,"percent of total billed charges ","70% of total billed charges ",305.1,90,,244.08,,,0,"percent of total billed charges ","90% of total billed charges ",315.27,93,,252.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",288.15,85,,230.52,,,0,"percent of total billed charges ","85% of total billed charges ",305.1,90,,244.08,,,0,"percent of total billed charges ","90% of total billed charges ",305.1,90,,244.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",294.93,87,,92.46,47.94,115.58,37,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",237.3,70,,189.84,,,0,"percent of total billed charges ","70% of total billed charges ",188.57,315.27,
"OB MON EST LEV 4, EA ADD'L HR",4000470,"CDM ",729,RC,99214,HCPCS,OUTPATIENT,,,61,48.8,,,,,,,,0,"other ","not separately reimbursment ",188.57,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",134.2,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",56.73,93,,45.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51.85,85,,41.48,,,0,"percent of total billed charges ","85% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",53.07,87,,92.46,47.94,115.58,37,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",42.7,188.57,
"OB MONITOR EST LEVEL 5, 1ST HR",4000480,"CDM ",729,RC,99215,HCPCS,OUTPATIENT,,,367,293.6,,,,,,,,0,"other ","not separately reimbursment ",266.24,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",306.2,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",256.9,70,,205.52,,,0,"percent of total billed charges ","70% of total billed charges ",330.3,90,,264.24,,,0,"percent of total billed charges ","90% of total billed charges ",341.31,93,,273.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",311.95,85,,249.56,,,0,"percent of total billed charges ","85% of total billed charges ",330.3,90,,264.24,,,0,"percent of total billed charges ","90% of total billed charges ",330.3,90,,264.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",319.29,87,,157.63,127.56,162.13,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",256.9,70,,205.52,,,0,"percent of total billed charges ","70% of total billed charges ",256.9,341.31,
"OB MON EST LEVEL 5 EA ADD'L HR",4000490,"CDM ",729,RC,99215,HCPCS,OUTPATIENT,,,61,48.8,,,,,,,,0,"other ","not separately reimbursment ",266.24,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",134.2,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",56.73,93,,45.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51.85,85,,41.48,,,0,"percent of total billed charges ","85% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",53.07,87,,157.63,127.56,162.13,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",42.7,266.24,
"CATHETERIZATION FOLEY SIMPLE",4000500,"CDM ",729,RC,51702,HCPCS,OUTPATIENT,,,339.5,271.6,,41.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",144.89,100,,11.03,11.03,11.03,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",52.93,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",237.65,70,,190.12,,,0,"percent of total billed charges ","70% of total billed charges ",305.55,90,,244.44,,,0,"percent of total billed charges ","90% of total billed charges ",315.74,93,,252.59,,,0,"percent of total billed charges ","93% of total billed charges ",41.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",288.58,85,,230.86,,,0,"percent of total billed charges ","85% of total billed charges ",254.63,90,,203.70,,,0,"percent of total billed charges ","90% of total billed charges ",305.55,90,,244.44,,,0,"percent of total billed charges ","90% of total billed charges ",31.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",295.37,87,,236.30,,,0,"percent of total billed charges ","87% of total billed charges ",31.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",237.65,70,,190.12,,,0,"percent of total billed charges ","70% of total billed charges ",31.19,315.74,
"AMNISURE TEST",4000510,"CDM ",301,RC,84112,HCPCS,OUTPATIENT,,,161.5,129.2,,83.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.05,70,,90.44,,,0,"percent of total billed charges ","70% of total billed charges ",145.35,90,,116.28,,,0,"percent of total billed charges ","90% of total billed charges ",150.2,93,,120.16,,,0,"percent of total billed charges ","93% of total billed charges ",83.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",101.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",137.28,85,,109.82,,,0,"percent of total billed charges ","85% of total billed charges ",145.35,90,,116.28,,,0,"percent of total billed charges ","90% of total billed charges ",145.35,90,,116.28,,,0,"percent of total billed charges ","90% of total billed charges ",100.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",140.51,87,,112.41,,,0,"percent of total billed charges ","87% of total billed charges ",100.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",98.11,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",113.05,70,,90.44,,,0,"percent of total billed charges ","70% of total billed charges ",83.39,150.2,
"EXTERNAL CEPHALIC VERSION",4000520,"CDM ",729,RC,59412,HCPCS,OUTPATIENT,,,4944,3955.2,,1012.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",204.29,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3460.8,70,,2768.64,,,0,"percent of total billed charges ","70% of total billed charges ",4449.6,90,,3559.68,,,0,"percent of total billed charges ","90% of total billed charges ",4597.92,93,,3678.34,,,0,"percent of total billed charges ","93% of total billed charges ",1012.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4202.4,85,,3361.92,,,0,"percent of total billed charges ","85% of total billed charges ",3708,90,,2966.40,,,0,"percent of total billed charges ","90% of total billed charges ",4449.6,90,,3559.68,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4301.28,87,,3441.02,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2977.04,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3460.8,70,,2768.64,,,0,"percent of total billed charges ","70% of total billed charges ",204.29,4597.92,
"STRESS CONTRACTION TEST",4000530,"CDM ",920,RC,59020,HCPCS,OUTPATIENT,,,899,719.2,,68.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",359.77,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",141.9,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",629.3,70,,503.44,,,0,"percent of total billed charges ","70% of total billed charges ",809.1,90,,647.28,,,0,"percent of total billed charges ","90% of total billed charges ",836.07,93,,668.86,,,0,"percent of total billed charges ","93% of total billed charges ",68.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",764.15,85,,611.32,,,0,"percent of total billed charges ","85% of total billed charges ",674.25,90,,539.40,,,0,"percent of total billed charges ","90% of total billed charges ",809.1,90,,647.28,,,0,"percent of total billed charges ","90% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",782.13,87,,625.70,,,0,"percent of total billed charges ","87% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",185.92,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",629.3,70,,503.44,,,0,"percent of total billed charges ","70% of total billed charges ",39.25,836.07,
"I&D BARTHOLIN'S GLAND ABSCESS",4000540,"CDM ",729,RC,56420,HCPCS,OUTPATIENT,,,516.5,413.2,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",231.7,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",361.55,70,,289.24,,,0,"percent of total billed charges ","70% of total billed charges ",464.85,90,,371.88,,,0,"percent of total billed charges ","90% of total billed charges ",480.35,93,,384.28,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",439.03,85,,351.22,,,0,"percent of total billed charges ","85% of total billed charges ",387.38,90,,309.90,,,0,"percent of total billed charges ","90% of total billed charges ",464.85,90,,371.88,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",449.36,87,,359.49,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",185.92,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",361.55,70,,289.24,,,0,"percent of total billed charges ","70% of total billed charges ",185.92,480.35,
"IV PUSH SINGLE OR INITIAL",4000550,"CDM ",729,RC,96374,HCPCS,OUTPATIENT,,,308,246.4,,24.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",255.27,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",80.76,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",215.6,70,,172.48,,,0,"percent of total billed charges ","70% of total billed charges ",277.2,90,,221.76,,,0,"percent of total billed charges ","90% of total billed charges ",286.44,93,,229.15,,,0,"percent of total billed charges ","93% of total billed charges ",24.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.03,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",261.8,85,,209.44,,,0,"percent of total billed charges ","85% of total billed charges ",277.2,90,,221.76,,,0,"percent of total billed charges ","90% of total billed charges ",277.2,90,,221.76,,,0,"percent of total billed charges ","90% of total billed charges ",30.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",267.96,87,,168.95,93.31,211.19,17,"percent of total billed charges ","87% of total billed charges ",30.72,100,,141.50,141.50,141.50,"1 through 10","fee schedule ","100% of KS medicaid fee schedule ",195.61,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",215.6,70,,172.48,,,0,"percent of total billed charges ","70% of total billed charges ",24.42,286.44,
"IV PUSH ADD'L NEW DRUG GIVEN",4000560,"CDM ",729,RC,96375,HCPCS,OUTPATIENT,,,218,174.4,,24.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.57,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",32.85,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",152.6,70,,122.08,,,0,"percent of total billed charges ","70% of total billed charges ",196.2,90,,156.96,,,0,"percent of total billed charges ","90% of total billed charges ",202.74,93,,162.19,,,0,"percent of total billed charges ","93% of total billed charges ",24.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.03,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",185.3,85,,148.24,,,0,"percent of total billed charges ","85% of total billed charges ",196.2,90,,156.96,,,0,"percent of total billed charges ","90% of total billed charges ",196.2,90,,156.96,,,0,"percent of total billed charges ","90% of total billed charges ",30.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",189.66,87,,142.80,44.18,287.15,13,"percent of total billed charges ","87% of total billed charges ",30.72,100,,44.79,44.79,44.79,"1 through 10","fee schedule ","100% of KS medicaid fee schedule ",43.06,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",152.6,70,,122.08,,,0,"percent of total billed charges ","70% of total billed charges ",24.42,202.74,
"IV DRIP 1ST HR HYDRATION",4000570,"CDM ",729,RC,96360,HCPCS,OUTPATIENT,,,578,462.4,,49.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",255.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",70.31,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",404.6,70,,323.68,,,0,"percent of total billed charges ","70% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",537.54,93,,430.03,,,0,"percent of total billed charges ","93% of total billed charges ",49.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.29,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",491.3,85,,393.04,,,0,"percent of total billed charges ","85% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",62.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",502.86,87,,159.55,60.51,406.64,"1 through 10","percent of total billed charges ","87% of total billed charges ",62.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.61,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",404.6,70,,323.68,,,0,"percent of total billed charges ","70% of total billed charges ",49.81,537.54,
"IV DRIP EA ADD'L HR HYDRATION",4000580,"CDM ",729,RC,96361,HCPCS,OUTPATIENT,,,232,185.6,,16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",133.32,100,,9.14,9.14,9.14,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",26.55,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",215.76,93,,172.61,,,0,"percent of total billed charges ","93% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",197.2,85,,157.76,,,0,"percent of total billed charges ","85% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.84,87,,131.39,93.88,240.22,16,"percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.06,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,215.76,
"IV DRIP 1ST HR THERAPY",4000590,"CDM ",729,RC,96365,HCPCS,OUTPATIENT,,,578,462.4,,86.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",255.28,100,,41.74,41.74,41.74,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",138.36,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",404.6,70,,323.68,,,0,"percent of total billed charges ","70% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",537.54,93,,430.03,,,0,"percent of total billed charges ","93% of total billed charges ",86.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",110.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",491.3,85,,393.04,,,0,"percent of total billed charges ","85% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",109.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",502.86,87,,309.11,152.46,396.95,"1 through 10","percent of total billed charges ","87% of total billed charges ",109.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.61,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",404.6,70,,323.68,,,0,"percent of total billed charges ","70% of total billed charges ",86.94,537.54,
"IV DRIP EA ADD'L HR THERAPY",4000600,"CDM ",729,RC,96366,HCPCS,OUTPATIENT,,,232,185.6,,23.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",133.32,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",43.76,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",215.76,93,,172.61,,,0,"percent of total billed charges ","93% of total billed charges ",23.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",197.2,85,,157.76,,,0,"percent of total billed charges ","85% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.84,87,,159.47,159.47,159.47,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.06,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",21.17,215.76,
"IV PUSH SAME DRUG >30 MIN",4000620,"CDM ",729,RC,96376,HCPCS,OUTPATIENT,,,236.5,189.2,,,,,,,,0,"other ","not separately reimbursment ",43.43,100,,44.21,44.21,44.21,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",165.55,70,,132.44,,,0,"percent of total billed charges ","70% of total billed charges ",212.85,90,,170.28,,,0,"percent of total billed charges ","90% of total billed charges ",219.95,93,,175.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",15.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",201.03,85,,160.82,,,0,"percent of total billed charges ","85% of total billed charges ",212.85,90,,170.28,,,0,"percent of total billed charges ","90% of total billed charges ",212.85,90,,170.28,,,0,"percent of total billed charges ","90% of total billed charges ",15.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",205.76,87,,487.46,487.46,487.46,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",165.55,70,,132.44,,,0,"percent of total billed charges ","70% of total billed charges ",15.6,219.95,
"IMMUNIZATION ADMIN",4000630,"CDM ",729,RC,90471,HCPCS,OUTPATIENT,,,215,172,,14.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",34.72,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",199.95,93,,159.96,,,0,"percent of total billed charges ","93% of total billed charges ",14.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",182.75,85,,146.20,,,0,"percent of total billed charges ","85% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",187.05,87,,14.10,11.24,56.88,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",8.08,199.95,
"IV THERAPY-SEQUENTIAL DRUGS",4000640,"CDM ",729,RC,96367,HCPCS,OUTPATIENT,,,232,185.6,,24.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",133.32,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",62.15,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",215.76,93,,172.61,,,0,"percent of total billed charges ","93% of total billed charges ",24.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.03,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",197.2,85,,157.76,,,0,"percent of total billed charges ","85% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",30.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.84,87,,161.47,,,0,"percent of total billed charges ","87% of total billed charges ",30.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.2,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",24.42,215.76,
"INCISION RECTAL ABSCESS",4000650,"CDM ",729,RC,46040,HCPCS,OUTPATIENT,,,3379,2703.2,,382.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2329.06,100,,603.09,603.09,603.09,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",877.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2365.3,70,,1892.24,,,0,"percent of total billed charges ","70% of total billed charges ",3041.1,90,,2432.88,,,0,"percent of total billed charges ","90% of total billed charges ",3142.47,93,,2513.98,,,0,"percent of total billed charges ","93% of total billed charges ",382.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",429.45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2872.15,85,,2297.72,,,0,"percent of total billed charges ","85% of total billed charges ",2534.25,90,,2027.40,,,0,"percent of total billed charges ","90% of total billed charges ",3041.1,90,,2432.88,,,0,"percent of total billed charges ","90% of total billed charges ",425.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2939.73,87,,2351.78,,,0,"percent of total billed charges ","87% of total billed charges ",425.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1100.5,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2365.3,70,,1892.24,,,0,"percent of total billed charges ","70% of total billed charges ",382.28,3142.47,
"DELIVER PLACENTA",4000660,"CDM ",729,RC,59414,HCPCS,OUTPATIENT,,,4286.5,3429.2,,1012.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,135.15,135.15,135.15,"1 through 10","other ","not separately reimbursment ",180.07,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3000.55,70,,2400.44,,,0,"percent of total billed charges ","70% of total billed charges ",3857.85,90,,3086.28,,,0,"percent of total billed charges ","90% of total billed charges ",3986.45,93,,3189.16,,,0,"percent of total billed charges ","93% of total billed charges ",1012.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3643.53,85,,2914.82,,,0,"percent of total billed charges ","85% of total billed charges ",3214.88,90,,2571.90,,,0,"percent of total billed charges ","90% of total billed charges ",3857.85,90,,3086.28,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3729.26,87,,2983.41,,,0,"percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2977.04,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3000.55,70,,2400.44,,,0,"percent of total billed charges ","70% of total billed charges ",65.42,3986.45,
"IV THERAPY 1ST HR REPEAT VISIT",4000670,"CDM ",729,RC,96365,HCPCS,OUTPATIENT,,,578,462.4,,86.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",255.28,100,,41.74,41.74,41.74,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",138.36,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",404.6,70,,323.68,,,0,"percent of total billed charges ","70% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",537.54,93,,430.03,,,0,"percent of total billed charges ","93% of total billed charges ",86.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",110.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",491.3,85,,393.04,,,0,"percent of total billed charges ","85% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",109.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",502.86,87,,309.11,152.46,396.95,"1 through 10","percent of total billed charges ","87% of total billed charges ",109.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.61,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",404.6,70,,323.68,,,0,"percent of total billed charges ","70% of total billed charges ",86.94,537.54,
"IV THERAPY ADD HR REPEAT VISIT",4000680,"CDM ",729,RC,96366,HCPCS,OUTPATIENT,,,158,126.4,,23.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",133.32,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",43.76,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",110.6,70,,88.48,,,0,"percent of total billed charges ","70% of total billed charges ",142.2,90,,113.76,,,0,"percent of total billed charges ","90% of total billed charges ",146.94,93,,117.55,,,0,"percent of total billed charges ","93% of total billed charges ",23.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",134.3,85,,107.44,,,0,"percent of total billed charges ","85% of total billed charges ",142.2,90,,113.76,,,0,"percent of total billed charges ","90% of total billed charges ",142.2,90,,113.76,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",137.46,87,,159.47,159.47,159.47,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.06,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",110.6,70,,88.48,,,0,"percent of total billed charges ","70% of total billed charges ",21.17,146.94,
"ANTIBIOTIC IM W/IV",4000690,"CDM ",729,RC,96372,HCPCS,OUTPATIENT,,,240.5,192.4,,16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",29.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",223.67,93,,178.94,,,0,"percent of total billed charges ","93% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",204.43,85,,163.54,,,0,"percent of total billed charges ","85% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",209.24,87,,30.52,12.55,82.65,16,"percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,223.67,
"INJECTION IM/SQ W/IV",4000700,"CDM ",729,RC,96372,HCPCS,OUTPATIENT,,,240.5,192.4,,16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",29.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",223.67,93,,178.94,,,0,"percent of total billed charges ","93% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",204.43,85,,163.54,,,0,"percent of total billed charges ","85% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",209.24,87,,30.52,12.55,82.65,16,"percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,223.67,
"IV THERAPY SIMULTANEOUS",4000720,"CDM ",761,RC,96368,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",1.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",42.31,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",1.01,106.95,
"IV THERAPY SEQUENTIAL",4000730,"CDM ",761,RC,96367,HCPCS,OUTPATIENT,,,232,185.6,,24.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",133.32,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",62.15,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",215.76,93,,172.61,,,0,"percent of total billed charges ","93% of total billed charges ",24.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.03,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",197.2,85,,157.76,,,0,"percent of total billed charges ","85% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",30.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.84,87,,161.47,,,0,"percent of total billed charges ","87% of total billed charges ",30.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.2,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",24.42,215.76,
"BLOOD ADMIN < 2HRS",4000740,"CDM ",761,RC,36430,HCPCS,OUTPATIENT,,,307,245.6,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",515.69,100,,1227.22,1227.22,1227.22,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.42,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",214.9,70,,171.92,,,0,"percent of total billed charges ","70% of total billed charges ",276.3,90,,221.04,,,0,"percent of total billed charges ","90% of total billed charges ",285.51,93,,228.41,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",260.95,85,,208.76,,,0,"percent of total billed charges ","85% of total billed charges ",230.25,90,,184.20,,,0,"percent of total billed charges ","90% of total billed charges ",276.3,90,,221.04,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",267.09,87,,213.67,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",405.73,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",214.9,70,,171.92,,,0,"percent of total billed charges ","70% of total billed charges ",77.42,515.69,
"BLOOD ADMIN 2-4HRS",4000750,"CDM ",761,RC,36430,HCPCS,OUTPATIENT,,,611.5,489.2,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",515.69,100,,1227.22,1227.22,1227.22,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.42,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",428.05,70,,342.44,,,0,"percent of total billed charges ","70% of total billed charges ",550.35,90,,440.28,,,0,"percent of total billed charges ","90% of total billed charges ",568.7,93,,454.96,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",519.78,85,,415.82,,,0,"percent of total billed charges ","85% of total billed charges ",458.63,90,,366.90,,,0,"percent of total billed charges ","90% of total billed charges ",550.35,90,,440.28,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",532.01,87,,425.61,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",405.73,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",428.05,70,,342.44,,,0,"percent of total billed charges ","70% of total billed charges ",77.42,568.7,
"BLOOD ADMIN 4-6 HRS",4000760,"CDM ",761,RC,36430,HCPCS,OUTPATIENT,,,914,731.2,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",515.69,100,,1227.22,1227.22,1227.22,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.42,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",639.8,70,,511.84,,,0,"percent of total billed charges ","70% of total billed charges ",822.6,90,,658.08,,,0,"percent of total billed charges ","90% of total billed charges ",850.02,93,,680.02,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",776.9,85,,621.52,,,0,"percent of total billed charges ","85% of total billed charges ",685.5,90,,548.40,,,0,"percent of total billed charges ","90% of total billed charges ",822.6,90,,658.08,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",795.18,87,,636.14,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",405.73,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",639.8,70,,511.84,,,0,"percent of total billed charges ","70% of total billed charges ",77.42,850.02,
"BLOOD ADMIN 6-8 HRS",4000770,"CDM ",761,RC,36430,HCPCS,OUTPATIENT,,,1217,973.6,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",515.69,100,,1227.22,1227.22,1227.22,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.42,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",851.9,70,,681.52,,,0,"percent of total billed charges ","70% of total billed charges ",1095.3,90,,876.24,,,0,"percent of total billed charges ","90% of total billed charges ",1131.81,93,,905.45,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1034.45,85,,827.56,,,0,"percent of total billed charges ","85% of total billed charges ",912.75,90,,730.20,,,0,"percent of total billed charges ","90% of total billed charges ",1095.3,90,,876.24,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1058.79,87,,847.03,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",405.73,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",851.9,70,,681.52,,,0,"percent of total billed charges ","70% of total billed charges ",77.42,1131.81,
"BLOOD ADMIN >8 HRS",4000780,"CDM ",761,RC,36430,HCPCS,OUTPATIENT,,,1517.5,1214,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",515.69,100,,1227.22,1227.22,1227.22,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.42,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1062.25,70,,849.80,,,0,"percent of total billed charges ","70% of total billed charges ",1365.75,90,,1092.60,,,0,"percent of total billed charges ","90% of total billed charges ",1411.28,93,,1129.02,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1289.88,85,,1031.90,,,0,"percent of total billed charges ","85% of total billed charges ",1138.13,90,,910.50,,,0,"percent of total billed charges ","90% of total billed charges ",1365.75,90,,1092.60,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1320.23,87,,1056.18,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",405.73,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1062.25,70,,849.80,,,0,"percent of total billed charges ","70% of total billed charges ",77.42,1411.28,
"I&D PILONIDAL CYST SIMPLE",4000790,"CDM ",720,RC,10080,HCPCS,OUTPATIENT,,,1302.5,1042,,227.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",982.73,100,,893.25,893.25,893.25,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",215.29,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",911.75,70,,729.40,,,0,"percent of total billed charges ","70% of total billed charges ",1172.25,90,,937.80,,,0,"percent of total billed charges ","90% of total billed charges ",1211.33,93,,969.06,,,0,"percent of total billed charges ","93% of total billed charges ",227.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1107.13,85,,885.70,,,0,"percent of total billed charges ","85% of total billed charges ",976.88,90,,781.50,,,0,"percent of total billed charges ","90% of total billed charges ",1172.25,90,,937.80,,,0,"percent of total billed charges ","90% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1133.18,87,,906.54,,,0,"percent of total billed charges ","87% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",911.75,70,,729.40,,,0,"percent of total billed charges ","70% of total billed charges ",215.29,1211.33,
"LACTATION CONSULTATION",4000825,"CDM ",761,RC,99401,HCPCS,OUTPATIENT,,,99.5,79.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.06,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",69.65,70,,55.72,,,0,"percent of total billed charges ","70% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",92.54,93,,74.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",84.58,85,,67.66,,,0,"percent of total billed charges ","85% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",86.57,87,,69.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.65,70,,55.72,,,0,"percent of total billed charges ","70% of total billed charges ",51.06,92.54,
"PKU OB",4200069,"CDM ",301,RC,84030,HCPCS,OUTPATIENT,,,86,68.8,,4.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.2,70,,48.16,,,0,"percent of total billed charges ","70% of total billed charges ",77.4,90,,61.92,,,0,"percent of total billed charges ","90% of total billed charges ",79.98,93,,63.98,,,0,"percent of total billed charges ","93% of total billed charges ",4.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",73.1,85,,58.48,,,0,"percent of total billed charges ","85% of total billed charges ",77.4,90,,61.92,,,0,"percent of total billed charges ","90% of total billed charges ",77.4,90,,61.92,,,0,"percent of total billed charges ","90% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",74.82,87,,59.86,,,0,"percent of total billed charges ","87% of total billed charges ",5.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.5,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",60.2,70,,48.16,,,0,"percent of total billed charges ","70% of total billed charges ",4.68,79.98,
"SCREENING AABR NB",4200168,"CDM ",470,RC,92587,HCPCS,OUTPATIENT,,,409.5,327.6,,,,,,,,0,"other ","not separately reimbursment ",56.33,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",46.68,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",286.65,70,,229.32,,,0,"percent of total billed charges ","70% of total billed charges ",368.55,90,,294.84,,,0,"percent of total billed charges ","90% of total billed charges ",380.84,93,,304.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",41.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",348.08,85,,278.46,,,0,"percent of total billed charges ","85% of total billed charges ",368.55,90,,294.84,,,0,"percent of total billed charges ","90% of total billed charges ",368.55,90,,294.84,,,0,"percent of total billed charges ","90% of total billed charges ",40.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",356.27,87,,285.02,,,0,"percent of total billed charges ","87% of total billed charges ",40.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.57,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",286.65,70,,229.32,,,0,"percent of total billed charges ","70% of total billed charges ",40.77,380.84,
"BILI CHECK W/PROBE",4200200,"CDM ",300,RC,88720,HCPCS,OUTPATIENT,,,150,120,,5.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",105,70,,84.00,,,0,"percent of total billed charges ","70% of total billed charges ",135,90,,108.00,,,0,"percent of total billed charges ","90% of total billed charges ",139.5,93,,111.60,,,0,"percent of total billed charges ","93% of total billed charges ",5.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",127.5,85,,102.00,,,0,"percent of total billed charges ","85% of total billed charges ",135,90,,108.00,,,0,"percent of total billed charges ","90% of total billed charges ",135,90,,108.00,,,0,"percent of total billed charges ","90% of total billed charges ",8.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.5,87,,104.40,,,0,"percent of total billed charges ","87% of total billed charges ",8.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.01,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",105,70,,84.00,,,0,"percent of total billed charges ","70% of total billed charges ",5.01,139.5,
"CIRCUMCISION NEWBORN",4200210,"CDM ",723,RC,54150,HCPCS,OUTPATIENT,,,2157,1725.6,,659.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",600,100,,124.77,124.77,124.77,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",201.06,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1509.9,70,,1207.92,,,0,"percent of total billed charges ","70% of total billed charges ",1941.3,90,,1553.04,,,0,"percent of total billed charges ","90% of total billed charges ",2006.01,93,,1604.81,,,0,"percent of total billed charges ","93% of total billed charges ",659.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1833.45,85,,1466.76,,,0,"percent of total billed charges ","85% of total billed charges ",1617.75,90,,1294.20,,,0,"percent of total billed charges ","90% of total billed charges ",1941.3,90,,1553.04,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1876.59,87,,1501.27,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1922.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1509.9,70,,1207.92,,,0,"percent of total billed charges ","70% of total billed charges ",201.06,2006.01,
"SCREENING AABR NEWBORN",4200220,"CDM ",470,RC,92651,HCPCS,OUTPATIENT,,,470.5,376.4,,101.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",185.7,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",329.35,70,,263.48,,,0,"percent of total billed charges ","70% of total billed charges ",423.45,90,,338.76,,,0,"percent of total billed charges ","90% of total billed charges ",437.57,93,,350.06,,,0,"percent of total billed charges ","93% of total billed charges ",101.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",115.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",399.93,85,,319.94,,,0,"percent of total billed charges ","85% of total billed charges ",423.45,90,,338.76,,,0,"percent of total billed charges ","90% of total billed charges ",423.45,90,,338.76,,,0,"percent of total billed charges ","90% of total billed charges ",114.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",409.34,87,,327.47,,,0,"percent of total billed charges ","87% of total billed charges ",114.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.57,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",329.35,70,,263.48,,,0,"percent of total billed charges ","70% of total billed charges ",101.68,437.57,
"ER FACILITY LEVEL 1",4600011,"CDM ",450,RC,99281,HCPCS,OUTPATIENT,,,510.5,408.4,,105,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",170.31,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",45.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",357.35,70,,285.88,,,0,"percent of total billed charges ","70% of total billed charges ",459.45,90,,367.56,,,0,"percent of total billed charges ","90% of total billed charges ",474.77,93,,379.82,,,0,"percent of total billed charges ","93% of total billed charges ",105,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.75,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",433.93,85,,347.14,,,0,"percent of total billed charges ","85% of total billed charges ",459.45,90,,367.56,,,0,"percent of total billed charges ","90% of total billed charges ",459.45,90,,367.56,,,0,"percent of total billed charges ","90% of total billed charges ",57.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",444.14,87,,17.14,17.14,17.14,"1 through 10","percent of total billed charges ","87% of total billed charges ",57.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",77.54,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",357.35,70,,285.88,,,0,"percent of total billed charges ","70% of total billed charges ",45.87,474.77,
"ER FACILITY LEVEL 4",4600110,"CDM ",450,RC,99284,HCPCS,OUTPATIENT,,,1893,1514.4,,105,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",695.24,100,,413.32,413.32,413.32,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",255.68,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1325.1,70,,1060.08,,,0,"percent of total billed charges ","70% of total billed charges ",1703.7,90,,1362.96,,,0,"percent of total billed charges ","90% of total billed charges ",1760.49,93,,1408.39,,,0,"percent of total billed charges ","93% of total billed charges ",105,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.75,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1609.05,85,,1287.24,,,0,"percent of total billed charges ","85% of total billed charges ",1703.7,90,,1362.96,,,0,"percent of total billed charges ","90% of total billed charges ",1703.7,90,,1362.96,,,0,"percent of total billed charges ","90% of total billed charges ",57.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1646.91,87,,1040.95,353.74,1239.17,16,"percent of total billed charges ","87% of total billed charges ",57.18,100,,413.32,413.32,413.32,"1 through 10","fee schedule ","100% of KS medicaid fee schedule ",383.73,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1325.1,70,,1060.08,,,0,"percent of total billed charges ","70% of total billed charges ",57.18,1760.49,
"ER FACILITY LEVEL 2",4600201,"CDM ",450,RC,99282,HCPCS,OUTPATIENT,,,698.5,558.8,,105,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",265.31,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",88.79,220,,356.16,356.16,356.16,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",488.95,70,,391.16,,,0,"percent of total billed charges ","70% of total billed charges ",628.65,90,,502.92,,,0,"percent of total billed charges ","90% of total billed charges ",649.61,93,,519.69,,,0,"percent of total billed charges ","93% of total billed charges ",105,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.75,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",593.73,85,,474.98,,,0,"percent of total billed charges ","85% of total billed charges ",628.65,90,,502.92,,,0,"percent of total billed charges ","90% of total billed charges ",628.65,90,,502.92,,,0,"percent of total billed charges ","90% of total billed charges ",57.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",607.7,87,,60.23,32.69,256.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",57.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",141.19,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",488.95,70,,391.16,,,0,"percent of total billed charges ","70% of total billed charges ",57.18,649.61,
"ER FACILITY LEVEL 3",4600227,"CDM ",450,RC,99283,HCPCS,OUTPATIENT,,,1155.5,924.4,,105,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",407.79,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",150.9,220,,301.39,301.39,301.39,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",808.85,70,,647.08,,,0,"percent of total billed charges ","70% of total billed charges ",1039.95,90,,831.96,,,0,"percent of total billed charges ","90% of total billed charges ",1074.62,93,,859.70,,,0,"percent of total billed charges ","93% of total billed charges ",105,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",58.01,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",982.18,85,,785.74,,,0,"percent of total billed charges ","85% of total billed charges ",1039.95,90,,831.96,,,0,"percent of total billed charges ","90% of total billed charges ",1039.95,90,,831.96,,,0,"percent of total billed charges ","90% of total billed charges ",57.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1005.29,87,,569.33,146.28,782.15,22,"percent of total billed charges ","87% of total billed charges ",57.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",251.04,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",808.85,70,,647.08,,,0,"percent of total billed charges ","70% of total billed charges ",57.44,1074.62,
"INJECTION -IM/SUBQ",4600409,"CDM ",450,RC,96372,HCPCS,OUTPATIENT,,,240.5,192.4,,16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",29.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",223.67,93,,178.94,,,0,"percent of total billed charges ","93% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",204.43,85,,163.54,,,0,"percent of total billed charges ","85% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",209.24,87,,30.52,12.55,82.65,16,"percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,223.67,
"ANTIBIOTIC IM",4600417,"CDM ",450,RC,96372,HCPCS,OUTPATIENT,,,240.5,192.4,,16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",29.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",223.67,93,,178.94,,,0,"percent of total billed charges ","93% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",204.43,85,,163.54,,,0,"percent of total billed charges ","85% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",209.24,87,,30.52,12.55,82.65,16,"percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,223.67,
"ANOSCOPY DIAGNOSTIC W/WO SPECI",4600441,"CDM ",450,RC,46600,HCPCS,OUTPATIENT,,,164,131.2,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",140.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",83.71,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",114.8,70,,91.84,,,0,"percent of total billed charges ","70% of total billed charges ",147.6,90,,118.08,,,0,"percent of total billed charges ","90% of total billed charges ",152.52,93,,122.02,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",139.4,85,,111.52,,,0,"percent of total billed charges ","85% of total billed charges ",123,90,,98.40,,,0,"percent of total billed charges ","90% of total billed charges ",147.6,90,,118.08,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",142.68,87,,114.14,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",114.8,70,,91.84,,,0,"percent of total billed charges ","70% of total billed charges ",83.71,264.28,
"APPLY LONG LEG SPLINT",4600458,"CDM ",450,RC,29505,HCPCS,OUTPATIENT,,,370,296,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",230.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",104.74,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",344.1,93,,275.28,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",314.5,85,,251.60,,,0,"percent of total billed charges ","85% of total billed charges ",277.5,90,,222.00,,,0,"percent of total billed charges ","90% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",321.9,87,,257.52,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",104.74,344.1,
"STRAPPING SHOULDER/CLAVICLE",4600466,"CDM ",450,RC,29240,HCPCS,OUTPATIENT,,,384.5,307.6,,41.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",39.36,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",357.59,93,,286.07,,,0,"percent of total billed charges ","93% of total billed charges ",41.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",326.83,85,,261.46,,,0,"percent of total billed charges ","85% of total billed charges ",288.38,90,,230.70,,,0,"percent of total billed charges ","90% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",37.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",334.52,87,,267.62,,,0,"percent of total billed charges ","87% of total billed charges ",37.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",37.94,357.59,
"REMOVAL/BIVALVING CAST",4600474,"CDM ",450,RC,29700,HCPCS,OUTPATIENT,,,385,308,,228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",278.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",67.61,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",269.5,70,,215.60,,,0,"percent of total billed charges ","70% of total billed charges ",346.5,90,,277.20,,,0,"percent of total billed charges ","90% of total billed charges ",358.05,93,,286.44,,,0,"percent of total billed charges ","93% of total billed charges ",228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",327.25,85,,261.80,,,0,"percent of total billed charges ","85% of total billed charges ",288.75,90,,231.00,,,0,"percent of total billed charges ","90% of total billed charges ",346.5,90,,277.20,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",334.95,87,,267.96,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.22,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",269.5,70,,215.60,,,0,"percent of total billed charges ","70% of total billed charges ",67.61,358.05,
"STRAPPING TOES",4600482,"CDM ",450,RC,29550,HCPCS,OUTPATIENT,,,384.5,307.6,,57.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",23.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",357.59,93,,286.07,,,0,"percent of total billed charges ","93% of total billed charges ",57.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",326.83,85,,261.46,,,0,"percent of total billed charges ","85% of total billed charges ",288.38,90,,230.70,,,0,"percent of total billed charges ","90% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",334.52,87,,267.62,,,0,"percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",23.87,357.59,
"AVULSION NAIL PLATE SIMPLE",4600490,"CDM ",450,RC,11730,HCPCS,OUTPATIENT,,,286.5,229.2,,260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.71,100,,157.01,157.01,157.01,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",112.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",200.55,70,,160.44,,,0,"percent of total billed charges ","70% of total billed charges ",257.85,90,,206.28,,,0,"percent of total billed charges ","90% of total billed charges ",266.45,93,,213.16,,,0,"percent of total billed charges ","93% of total billed charges ",260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",243.53,85,,194.82,,,0,"percent of total billed charges ","85% of total billed charges ",214.88,90,,171.90,,,0,"percent of total billed charges ","90% of total billed charges ",257.85,90,,206.28,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",249.26,87,,199.41,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",200.55,70,,160.44,,,0,"percent of total billed charges ","70% of total billed charges ",112.79,330.35,
"EVACUATE SUBUNGAL HEMATOMA",4600508,"CDM ",450,RC,11740,HCPCS,OUTPATIENT,,,200.5,160.4,,260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,86.51,86.51,86.51,"1 through 10","other ","not separately reimbursment ",64.81,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",140.35,70,,112.28,,,0,"percent of total billed charges ","70% of total billed charges ",180.45,90,,144.36,,,0,"percent of total billed charges ","90% of total billed charges ",186.47,93,,149.18,,,0,"percent of total billed charges ","93% of total billed charges ",260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",170.43,85,,136.34,,,0,"percent of total billed charges ","85% of total billed charges ",150.38,90,,120.30,,,0,"percent of total billed charges ","90% of total billed charges ",180.45,90,,144.36,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",174.44,87,,139.55,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",140.35,70,,112.28,,,0,"percent of total billed charges ","70% of total billed charges ",64.81,330.35,
"REPAIR OF NAIL BED",4600516,"CDM ",450,RC,11760,HCPCS,OUTPATIENT,,,720,576,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",371.68,100,,1906.23,1906.23,1906.23,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",230.6,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",504,70,,403.20,,,0,"percent of total billed charges ","70% of total billed charges ",648,90,,518.40,,,0,"percent of total billed charges ","90% of total billed charges ",669.6,93,,535.68,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",612,85,,489.60,,,0,"percent of total billed charges ","85% of total billed charges ",540,90,,432.00,,,0,"percent of total billed charges ","90% of total billed charges ",648,90,,518.40,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",626.4,87,,501.12,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",679.69,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",504,70,,403.20,,,0,"percent of total billed charges ","70% of total billed charges ",230.6,679.69,
"EXCISION OF INGROWN TOENAIL",4600524,"CDM ",450,RC,11765,HCPCS,OUTPATIENT,,,261.5,209.2,,228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",692.86,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",191.07,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",243.2,93,,194.56,,,0,"percent of total billed charges ","93% of total billed charges ",228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",222.28,85,,177.82,,,0,"percent of total billed charges ","85% of total billed charges ",196.13,90,,156.90,,,0,"percent of total billed charges ","90% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",227.51,87,,182.01,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",183.05,692.86,
"I&D SKIN ABCESS-SIMPLE",4600532,"CDM ",450,RC,10060,HCPCS,OUTPATIENT,,,789.5,631.6,,202.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.72,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",217.34,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",552.65,70,,442.12,,,0,"percent of total billed charges ","70% of total billed charges ",710.55,90,,568.44,,,0,"percent of total billed charges ","90% of total billed charges ",734.24,93,,587.39,,,0,"percent of total billed charges ","93% of total billed charges ",202.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",671.08,85,,536.86,,,0,"percent of total billed charges ","85% of total billed charges ",592.13,90,,473.70,,,0,"percent of total billed charges ","90% of total billed charges ",710.55,90,,568.44,,,0,"percent of total billed charges ","90% of total billed charges ",254.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",686.87,87,,112.42,112.42,112.42,"1 through 10","percent of total billed charges ","87% of total billed charges ",254.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",552.65,70,,442.12,,,0,"percent of total billed charges ","70% of total billed charges ",184.51,734.24,
"I&D SKIN ABCESS-COMPLICATED",4600540,"CDM ",450,RC,10061,HCPCS,OUTPATIENT,,,1484.5,1187.6,,222.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1484.7,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",379.48,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1039.15,70,,831.32,,,0,"percent of total billed charges ","70% of total billed charges ",1336.05,90,,1068.84,,,0,"percent of total billed charges ","90% of total billed charges ",1380.59,93,,1104.47,,,0,"percent of total billed charges ","93% of total billed charges ",222.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1261.83,85,,1009.46,,,0,"percent of total billed charges ","85% of total billed charges ",1113.38,90,,890.70,,,0,"percent of total billed charges ","90% of total billed charges ",1336.05,90,,1068.84,,,0,"percent of total billed charges ","90% of total billed charges ",254.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1291.52,87,,1033.22,,,0,"percent of total billed charges ","87% of total billed charges ",254.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1039.15,70,,831.32,,,0,"percent of total billed charges ","70% of total billed charges ",222.22,1484.7,
"I&D PILONIDAL CYST-SIMPLE",4600557,"CDM ",450,RC,10080,HCPCS,OUTPATIENT,,,1302.5,1042,,227.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",982.73,100,,893.25,893.25,893.25,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",215.29,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",911.75,70,,729.40,,,0,"percent of total billed charges ","70% of total billed charges ",1172.25,90,,937.80,,,0,"percent of total billed charges ","90% of total billed charges ",1211.33,93,,969.06,,,0,"percent of total billed charges ","93% of total billed charges ",227.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1107.13,85,,885.70,,,0,"percent of total billed charges ","85% of total billed charges ",976.88,90,,781.50,,,0,"percent of total billed charges ","90% of total billed charges ",1172.25,90,,937.80,,,0,"percent of total billed charges ","90% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1133.18,87,,906.54,,,0,"percent of total billed charges ","87% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",911.75,70,,729.40,,,0,"percent of total billed charges ","70% of total billed charges ",215.29,1211.33,
"I&D HEMATOMA/SEROMA",4600565,"CDM ",450,RC,10140,HCPCS,OUTPATIENT,,,2443,1954.4,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1186.75,100,,217.85,217.85,217.85,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",243.74,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1710.1,70,,1368.08,,,0,"percent of total billed charges ","70% of total billed charges ",2198.7,90,,1758.96,,,0,"percent of total billed charges ","90% of total billed charges ",2271.99,93,,1817.59,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2076.55,85,,1661.24,,,0,"percent of total billed charges ","85% of total billed charges ",1832.25,90,,1465.80,,,0,"percent of total billed charges ","90% of total billed charges ",2198.7,90,,1758.96,,,0,"percent of total billed charges ","90% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2125.41,87,,1700.33,,,0,"percent of total billed charges ","87% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1710.1,70,,1368.08,,,0,"percent of total billed charges ","70% of total billed charges ",243.74,2271.99,
"DRAIN/INJECT INTERM JOINT/BURS",4600573,"CDM ",450,RC,20605,HCPCS,OUTPATIENT,,,470.5,376.4,,192.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.02,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",329.35,70,,263.48,,,0,"percent of total billed charges ","70% of total billed charges ",423.45,90,,338.76,,,0,"percent of total billed charges ","90% of total billed charges ",437.57,93,,350.06,,,0,"percent of total billed charges ","93% of total billed charges ",192.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",222,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",399.93,85,,319.94,,,0,"percent of total billed charges ","85% of total billed charges ",352.88,90,,282.30,,,0,"percent of total billed charges ","90% of total billed charges ",423.45,90,,338.76,,,0,"percent of total billed charges ","90% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",409.34,87,,327.47,,,0,"percent of total billed charges ","87% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",282.29,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",329.35,70,,263.48,,,0,"percent of total billed charges ","70% of total billed charges ",77.02,437.57,
"DRAIN/INJECT MAJOR JOINT OR BU",4600581,"CDM ",450,RC,20610,HCPCS,OUTPATIENT,,,479,383.2,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.53,100,,11.66,11.66,11.66,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",93.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",335.3,70,,268.24,,,0,"percent of total billed charges ","70% of total billed charges ",431.1,90,,344.88,,,0,"percent of total billed charges ","90% of total billed charges ",445.47,93,,356.38,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",407.15,85,,325.72,,,0,"percent of total billed charges ","85% of total billed charges ",359.25,90,,287.40,,,0,"percent of total billed charges ","90% of total billed charges ",431.1,90,,344.88,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",416.73,87,,35.16,16.84,51.43,"1 through 10","percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",282.29,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",335.3,70,,268.24,,,0,"percent of total billed charges ","70% of total billed charges ",93.35,445.47,
"DEBRIDE SKIN-SUBQ TISSUE",4600607,"CDM ",450,RC,11042,HCPCS,OUTPATIENT,,,658,526.4,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",451.17,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",124.63,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",460.6,70,,368.48,,,0,"percent of total billed charges ","70% of total billed charges ",592.2,90,,473.76,,,0,"percent of total billed charges ","90% of total billed charges ",611.94,93,,489.55,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",559.3,85,,447.44,,,0,"percent of total billed charges ","85% of total billed charges ",493.5,90,,394.80,,,0,"percent of total billed charges ","90% of total billed charges ",592.2,90,,473.76,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",572.46,87,,838.17,838.17,838.17,"1 through 10","percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",460.6,70,,368.48,,,0,"percent of total billed charges ","70% of total billed charges ",124.63,611.94,
BURNS-DRESS/DEBRIDE-SMALL,4600615,"CDM ",450,RC,16020,HCPCS,OUTPATIENT,,,783,626.4,,189.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",371.68,100,,98.42,98.42,98.42,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",111.8,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",548.1,70,,438.48,,,0,"percent of total billed charges ","70% of total billed charges ",704.7,90,,563.76,,,0,"percent of total billed charges ","90% of total billed charges ",728.19,93,,582.55,,,0,"percent of total billed charges ","93% of total billed charges ",189.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",665.55,85,,532.44,,,0,"percent of total billed charges ","85% of total billed charges ",587.25,90,,469.80,,,0,"percent of total billed charges ","90% of total billed charges ",704.7,90,,563.76,,,0,"percent of total billed charges ","90% of total billed charges ",217.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",681.21,87,,544.97,,,0,"percent of total billed charges ","87% of total billed charges ",217.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",548.1,70,,438.48,,,0,"percent of total billed charges ","70% of total billed charges ",111.8,728.19,
"BURNS-DRESS/DEBRIDE-MED-1 EXTR",4600623,"CDM ",450,RC,16025,HCPCS,OUTPATIENT,,,783,626.4,,189.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",371.68,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",228.98,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",548.1,70,,438.48,,,0,"percent of total billed charges ","70% of total billed charges ",704.7,90,,563.76,,,0,"percent of total billed charges ","90% of total billed charges ",728.19,93,,582.55,,,0,"percent of total billed charges ","93% of total billed charges ",189.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",665.55,85,,532.44,,,0,"percent of total billed charges ","85% of total billed charges ",587.25,90,,469.80,,,0,"percent of total billed charges ","90% of total billed charges ",704.7,90,,563.76,,,0,"percent of total billed charges ","90% of total billed charges ",217.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",681.21,87,,544.97,,,0,"percent of total billed charges ","87% of total billed charges ",217.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",548.1,70,,438.48,,,0,"percent of total billed charges ","70% of total billed charges ",184.51,728.19,
"TX WOUND DEHISC W/PACKING",4600631,"CDM ",450,RC,12021,HCPCS,OUTPATIENT,,,516.5,413.2,,232.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",216.14,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",289.5,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",361.55,70,,289.24,,,0,"percent of total billed charges ","70% of total billed charges ",464.85,90,,371.88,,,0,"percent of total billed charges ","90% of total billed charges ",480.35,93,,384.28,,,0,"percent of total billed charges ","93% of total billed charges ",232.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",268.78,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",439.03,85,,351.22,,,0,"percent of total billed charges ","85% of total billed charges ",387.38,90,,309.90,,,0,"percent of total billed charges ","90% of total billed charges ",464.85,90,,371.88,,,0,"percent of total billed charges ","90% of total billed charges ",266.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",449.36,87,,359.49,,,0,"percent of total billed charges ","87% of total billed charges ",266.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",361.55,70,,289.24,,,0,"percent of total billed charges ","70% of total billed charges ",216.14,480.35,
"INC/REMOVAL FB SUBQ TISSUE-SIM",4600649,"CDM ",450,RC,10120,HCPCS,OUTPATIENT,,,1077.5,862,,223.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1075.65,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",214.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",754.25,70,,603.40,,,0,"percent of total billed charges ","70% of total billed charges ",969.75,90,,775.80,,,0,"percent of total billed charges ","90% of total billed charges ",1002.08,93,,801.66,,,0,"percent of total billed charges ","93% of total billed charges ",223.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",915.88,85,,732.70,,,0,"percent of total billed charges ","85% of total billed charges ",808.13,90,,646.50,,,0,"percent of total billed charges ","90% of total billed charges ",969.75,90,,775.80,,,0,"percent of total billed charges ","90% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",937.43,87,,749.94,,,0,"percent of total billed charges ","87% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",754.25,70,,603.40,,,0,"percent of total billed charges ","70% of total billed charges ",214.57,1075.65,
"REMOVAL FB EYE-CONJUNCTIVAL",4600656,"CDM ",450,RC,65205,HCPCS,OUTPATIENT,,,184,147.2,,234,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",310.07,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",60.81,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",128.8,70,,103.04,,,0,"percent of total billed charges ","70% of total billed charges ",165.6,90,,132.48,,,0,"percent of total billed charges ","90% of total billed charges ",171.12,93,,136.90,,,0,"percent of total billed charges ","93% of total billed charges ",234,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",156.4,85,,125.12,,,0,"percent of total billed charges ","85% of total billed charges ",138,90,,110.40,,,0,"percent of total billed charges ","90% of total billed charges ",165.6,90,,132.48,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",160.08,87,,128.06,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",128.8,70,,103.04,,,0,"percent of total billed charges ","70% of total billed charges ",60.81,310.07,
"REMOVAL FB CORNEA W/SLIT LAMP",4600664,"CDM ",450,RC,65222,HCPCS,OUTPATIENT,,,236,188.8,,416,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",521.72,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",105.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",165.2,70,,132.16,,,0,"percent of total billed charges ","70% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",219.48,93,,175.58,,,0,"percent of total billed charges ","93% of total billed charges ",416,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",528.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",200.6,85,,160.48,,,0,"percent of total billed charges ","85% of total billed charges ",177,90,,141.60,,,0,"percent of total billed charges ","90% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",205.32,87,,164.26,,,0,"percent of total billed charges ","87% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",165.2,70,,132.16,,,0,"percent of total billed charges ","70% of total billed charges ",105.09,528.56,
"REMOVE FB INTRANASAL",4600672,"CDM ",450,RC,30300,HCPCS,OUTPATIENT,,,507,405.6,,140.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",938.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",258.61,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",354.9,70,,283.92,,,0,"percent of total billed charges ","70% of total billed charges ",456.3,90,,365.04,,,0,"percent of total billed charges ","90% of total billed charges ",471.51,93,,377.21,,,0,"percent of total billed charges ","93% of total billed charges ",140.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",178.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",430.95,85,,344.76,,,0,"percent of total billed charges ","85% of total billed charges ",380.25,90,,304.20,,,0,"percent of total billed charges ","90% of total billed charges ",456.3,90,,365.04,,,0,"percent of total billed charges ","90% of total billed charges ",176.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",441.09,87,,352.87,,,0,"percent of total billed charges ","87% of total billed charges ",176.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",354.9,70,,283.92,,,0,"percent of total billed charges ","70% of total billed charges ",122.35,938.29,
"REMOVAL FB EXTERNAL EAR",4600680,"CDM ",450,RC,69200,HCPCS,OUTPATIENT,,,312.5,250,,136.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",241.39,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",97.7,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",218.75,70,,175.00,,,0,"percent of total billed charges ","70% of total billed charges ",281.25,90,,225.00,,,0,"percent of total billed charges ","90% of total billed charges ",290.63,93,,232.50,,,0,"percent of total billed charges ","93% of total billed charges ",136.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",173.44,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",265.63,85,,212.50,,,0,"percent of total billed charges ","85% of total billed charges ",234.38,90,,187.50,,,0,"percent of total billed charges ","90% of total billed charges ",281.25,90,,225.00,,,0,"percent of total billed charges ","90% of total billed charges ",171.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",271.88,87,,217.50,,,0,"percent of total billed charges ","87% of total billed charges ",171.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",218.75,70,,175.00,,,0,"percent of total billed charges ","70% of total billed charges ",97.7,290.63,
"ELBOW DISLOC W/MANIP-CHILD",4600698,"CDM ",450,RC,24640,HCPCS,OUTPATIENT,,,658,526.4,,364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",170.19,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",460.6,70,,368.48,,,0,"percent of total billed charges ","70% of total billed charges ",592.2,90,,473.76,,,0,"percent of total billed charges ","90% of total billed charges ",611.94,93,,489.55,,,0,"percent of total billed charges ","93% of total billed charges ",364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",559.3,85,,447.44,,,0,"percent of total billed charges ","85% of total billed charges ",493.5,90,,394.80,,,0,"percent of total billed charges ","90% of total billed charges ",592.2,90,,473.76,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",572.46,87,,457.97,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",460.6,70,,368.48,,,0,"percent of total billed charges ","70% of total billed charges ",170.19,809.01,
"TOE DISLOCATION (NOT GREAT TOE",4600706,"CDM ",450,RC,28660,HCPCS,OUTPATIENT,,,612.5,490,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",191.18,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",428.75,70,,343.00,,,0,"percent of total billed charges ","70% of total billed charges ",551.25,90,,441.00,,,0,"percent of total billed charges ","90% of total billed charges ",569.63,93,,455.70,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",520.63,85,,416.50,,,0,"percent of total billed charges ","85% of total billed charges ",459.38,90,,367.50,,,0,"percent of total billed charges ","90% of total billed charges ",551.25,90,,441.00,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",532.88,87,,426.30,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",428.75,70,,343.00,,,0,"percent of total billed charges ","70% of total billed charges ",191.18,809.01,
"TOE FX W/O MANIP-PHALANGE",4600714,"CDM ",450,RC,28510,HCPCS,OUTPATIENT,,,575,460,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",432.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",247.41,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",402.5,70,,322.00,,,0,"percent of total billed charges ","70% of total billed charges ",517.5,90,,414.00,,,0,"percent of total billed charges ","90% of total billed charges ",534.75,93,,427.80,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",488.75,85,,391.00,,,0,"percent of total billed charges ","85% of total billed charges ",431.25,90,,345.00,,,0,"percent of total billed charges ","90% of total billed charges ",517.5,90,,414.00,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",500.25,87,,400.20,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",402.5,70,,322.00,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,534.75,
"SIMP RPR TRK/EXT <2.6 CM",4600722,"CDM ",450,RC,12001,HCPCS,OUTPATIENT,,,549.5,439.6,,207.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",382.79,100,,420.48,420.48,420.48,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",91.98,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",384.65,70,,307.72,,,0,"percent of total billed charges ","70% of total billed charges ",494.55,90,,395.64,,,0,"percent of total billed charges ","90% of total billed charges ",511.04,93,,408.83,,,0,"percent of total billed charges ","93% of total billed charges ",207.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",263.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",467.08,85,,373.66,,,0,"percent of total billed charges ","85% of total billed charges ",412.13,90,,329.70,,,0,"percent of total billed charges ","90% of total billed charges ",494.55,90,,395.64,,,0,"percent of total billed charges ","90% of total billed charges ",261.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",478.07,87,,382.46,,,0,"percent of total billed charges ","87% of total billed charges ",261.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",384.65,70,,307.72,,,0,"percent of total billed charges ","70% of total billed charges ",91.98,511.04,
"SIMP RPR TRK/EXT 2.6-7.5CM",4600730,"CDM ",450,RC,12002,HCPCS,OUTPATIENT,,,803,642.4,,260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",457.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",120.71,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",562.1,70,,449.68,,,0,"percent of total billed charges ","70% of total billed charges ",722.7,90,,578.16,,,0,"percent of total billed charges ","90% of total billed charges ",746.79,93,,597.43,,,0,"percent of total billed charges ","93% of total billed charges ",260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",682.55,85,,546.04,,,0,"percent of total billed charges ","85% of total billed charges ",602.25,90,,481.80,,,0,"percent of total billed charges ","90% of total billed charges ",722.7,90,,578.16,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",698.61,87,,558.89,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",562.1,70,,449.68,,,0,"percent of total billed charges ","70% of total billed charges ",120.71,746.79,
"CHANGE CYSTOSTOMY TUBE-SIMPLE",4600755,"CDM ",450,RC,51705,HCPCS,OUTPATIENT,,,441,352.8,,171.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",67.67,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",106.22,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",308.7,70,,246.96,,,0,"percent of total billed charges ","70% of total billed charges ",396.9,90,,317.52,,,0,"percent of total billed charges ","90% of total billed charges ",410.13,93,,328.10,,,0,"percent of total billed charges ","93% of total billed charges ",171.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",374.85,85,,299.88,,,0,"percent of total billed charges ","85% of total billed charges ",330.75,90,,264.60,,,0,"percent of total billed charges ","90% of total billed charges ",396.9,90,,317.52,,,0,"percent of total billed charges ","90% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",383.67,87,,306.94,,,0,"percent of total billed charges ","87% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",229.77,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",308.7,70,,246.96,,,0,"percent of total billed charges ","70% of total billed charges ",67.67,410.13,
"SIMPLE REPAIR FACE <2.6 CM",4600763,"CDM ",450,RC,12011,HCPCS,OUTPATIENT,,,583.5,466.8,,68.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",475.71,100,,359.50,359.50,359.50,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",112.97,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",408.45,70,,326.76,,,0,"percent of total billed charges ","70% of total billed charges ",525.15,90,,420.12,,,0,"percent of total billed charges ","90% of total billed charges ",542.66,93,,434.13,,,0,"percent of total billed charges ","93% of total billed charges ",68.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",79.29,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",495.98,85,,396.78,,,0,"percent of total billed charges ","85% of total billed charges ",437.63,90,,350.10,,,0,"percent of total billed charges ","90% of total billed charges ",525.15,90,,420.12,,,0,"percent of total billed charges ","90% of total billed charges ",78.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",507.65,87,,406.12,,,0,"percent of total billed charges ","87% of total billed charges ",78.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",408.45,70,,326.76,,,0,"percent of total billed charges ","70% of total billed charges ",68.64,542.66,
"SIMPLE REPAIR FACE 2.6-5 CM",4600771,"CDM ",450,RC,12013,HCPCS,OUTPATIENT,,,639.5,511.6,,336.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",475.71,100,,547.40,547.40,547.40,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",119.22,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",447.65,70,,358.12,,,0,"percent of total billed charges ","70% of total billed charges ",575.55,90,,460.44,,,0,"percent of total billed charges ","90% of total billed charges ",594.74,93,,475.79,,,0,"percent of total billed charges ","93% of total billed charges ",336.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",428.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",543.58,85,,434.86,,,0,"percent of total billed charges ","85% of total billed charges ",479.63,90,,383.70,,,0,"percent of total billed charges ","90% of total billed charges ",575.55,90,,460.44,,,0,"percent of total billed charges ","90% of total billed charges ",423.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",556.37,87,,445.10,,,0,"percent of total billed charges ","87% of total billed charges ",423.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",447.65,70,,358.12,,,0,"percent of total billed charges ","70% of total billed charges ",119.22,594.74,
"INTERMEDIATE REPAIR TRUNK (2.6",4600789,"CDM ",450,RC,12031,HCPCS,OUTPATIENT,,,632.5,506,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",451.17,100,,112.22,112.22,112.22,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",310.99,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",442.75,70,,354.20,,,0,"percent of total billed charges ","70% of total billed charges ",569.25,90,,455.40,,,0,"percent of total billed charges ","90% of total billed charges ",588.23,93,,470.58,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",537.63,85,,430.10,,,0,"percent of total billed charges ","85% of total billed charges ",474.38,90,,379.50,,,0,"percent of total billed charges ","90% of total billed charges ",569.25,90,,455.40,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",550.28,87,,440.22,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",442.75,70,,354.20,,,0,"percent of total billed charges ","70% of total billed charges ",286,588.23,
"GASTRIC INTUBATION AND LAVAGE",4600797,"CDM ",450,RC,43753,HCPCS,OUTPATIENT,,,677.5,542,,24.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.99,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",474.25,70,,379.40,,,0,"percent of total billed charges ","70% of total billed charges ",609.75,90,,487.80,,,0,"percent of total billed charges ","90% of total billed charges ",630.08,93,,504.06,,,0,"percent of total billed charges ","93% of total billed charges ",24.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.57,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",575.88,85,,460.70,,,0,"percent of total billed charges ","85% of total billed charges ",508.13,90,,406.50,,,0,"percent of total billed charges ","90% of total billed charges ",609.75,90,,487.80,,,0,"percent of total billed charges ","90% of total billed charges ",31.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",589.43,87,,471.54,,,0,"percent of total billed charges ","87% of total billed charges ",31.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.57,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",474.25,70,,379.40,,,0,"percent of total billed charges ","70% of total billed charges ",24.85,630.08,
"IMMUNIZATION INJECTION",4600805,"CDM ",771,RC,90471,HCPCS,OUTPATIENT,,,215,172,,14.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",34.72,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",199.95,93,,159.96,,,0,"percent of total billed charges ","93% of total billed charges ",14.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",182.75,85,,146.20,,,0,"percent of total billed charges ","85% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",187.05,87,,14.10,11.24,56.88,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",8.08,199.95,
"CATHETERIZATION URETHRA SIMPLE",4600813,"CDM ",450,RC,51702,HCPCS,OUTPATIENT,,,339.5,271.6,,41.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",144.89,100,,11.03,11.03,11.03,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",52.93,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",237.65,70,,190.12,,,0,"percent of total billed charges ","70% of total billed charges ",305.55,90,,244.44,,,0,"percent of total billed charges ","90% of total billed charges ",315.74,93,,252.59,,,0,"percent of total billed charges ","93% of total billed charges ",41.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",288.58,85,,230.86,,,0,"percent of total billed charges ","85% of total billed charges ",254.63,90,,203.70,,,0,"percent of total billed charges ","90% of total billed charges ",305.55,90,,244.44,,,0,"percent of total billed charges ","90% of total billed charges ",31.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",295.37,87,,236.30,,,0,"percent of total billed charges ","87% of total billed charges ",31.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",237.65,70,,190.12,,,0,"percent of total billed charges ","70% of total billed charges ",31.19,315.74,
"INSERT BLADDER CATH COMPLEX",4600821,"CDM ",450,RC,51703,HCPCS,OUTPATIENT,,,480,384,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",183.86,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",158.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",336,70,,268.80,,,0,"percent of total billed charges ","70% of total billed charges ",432,90,,345.60,,,0,"percent of total billed charges ","90% of total billed charges ",446.4,93,,357.12,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",408,85,,326.40,,,0,"percent of total billed charges ","85% of total billed charges ",360,90,,288.00,,,0,"percent of total billed charges ","90% of total billed charges ",432,90,,345.60,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",417.6,87,,334.08,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",118.33,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",336,70,,268.80,,,0,"percent of total billed charges ","70% of total billed charges ",118.33,446.4,
"NASAL HEMORRHAGE SIMPLE",4600847,"CDM ",450,RC,30901,HCPCS,OUTPATIENT,,,373.5,298.8,,234,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",488.84,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",116.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",261.45,70,,209.16,,,0,"percent of total billed charges ","70% of total billed charges ",336.15,90,,268.92,,,0,"percent of total billed charges ","90% of total billed charges ",347.36,93,,277.89,,,0,"percent of total billed charges ","93% of total billed charges ",234,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",317.48,85,,253.98,,,0,"percent of total billed charges ","85% of total billed charges ",280.13,90,,224.10,,,0,"percent of total billed charges ","90% of total billed charges ",336.15,90,,268.92,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",324.95,87,,259.96,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",261.45,70,,209.16,,,0,"percent of total billed charges ","70% of total billed charges ",116.62,488.84,
"NASAL HEMORRHAGE CAUTERY",4600854,"CDM ",450,RC,30903,HCPCS,OUTPATIENT,,,657,525.6,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",593.88,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",159.13,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",459.9,70,,367.92,,,0,"percent of total billed charges ","70% of total billed charges ",591.3,90,,473.04,,,0,"percent of total billed charges ","90% of total billed charges ",611.01,93,,488.81,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",558.45,85,,446.76,,,0,"percent of total billed charges ","85% of total billed charges ",492.75,90,,394.20,,,0,"percent of total billed charges ","90% of total billed charges ",591.3,90,,473.04,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",571.59,87,,457.27,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.36,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",459.9,70,,367.92,,,0,"percent of total billed charges ","70% of total billed charges ",122.36,611.01,
"REMOVAL IMPACTED CERUMEN",4600862,"CDM ",450,RC,69210,HCPCS,OUTPATIENT,,,175,140,,140.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",543.31,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",68.24,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",162.75,93,,130.20,,,0,"percent of total billed charges ","93% of total billed charges ",140.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",178.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",148.75,85,,119.00,,,0,"percent of total billed charges ","85% of total billed charges ",131.25,90,,105.00,,,0,"percent of total billed charges ","90% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",176.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",152.25,87,,42.37,42.37,42.37,"1 through 10","percent of total billed charges ","87% of total billed charges ",176.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",54.25,543.31,
"SPINAL PUNCTURE DIAGNOSTIC",4600870,"CDM ",450,RC,62270,HCPCS,OUTPATIENT,,,855,684,,224.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",433.29,100,,109.05,109.05,109.05,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",127.49,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",598.5,70,,478.80,,,0,"percent of total billed charges ","70% of total billed charges ",769.5,90,,615.60,,,0,"percent of total billed charges ","90% of total billed charges ",795.15,93,,636.12,,,0,"percent of total billed charges ","93% of total billed charges ",224.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",165.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",726.75,85,,581.40,,,0,"percent of total billed charges ","85% of total billed charges ",641.25,90,,513.00,,,0,"percent of total billed charges ","90% of total billed charges ",769.5,90,,615.60,,,0,"percent of total billed charges ","90% of total billed charges ",163.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",743.85,87,,595.08,,,0,"percent of total billed charges ","87% of total billed charges ",163.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",649.16,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",598.5,70,,478.80,,,0,"percent of total billed charges ","70% of total billed charges ",127.49,795.15,
"ENDOTRACHEAL INTUBATION",4600888,"CDM ",450,RC,31500,HCPCS,OUTPATIENT,,,603.5,482.8,,234,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",293.5,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",422.45,70,,337.96,,,0,"percent of total billed charges ","70% of total billed charges ",543.15,90,,434.52,,,0,"percent of total billed charges ","90% of total billed charges ",561.26,93,,449.01,,,0,"percent of total billed charges ","93% of total billed charges ",234,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",512.98,85,,410.38,,,0,"percent of total billed charges ","85% of total billed charges ",452.63,90,,362.10,,,0,"percent of total billed charges ","90% of total billed charges ",543.15,90,,434.52,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",525.05,87,,420.04,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.82,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",422.45,70,,337.96,,,0,"percent of total billed charges ","70% of total billed charges ",217.82,561.26,
"TRIGGER POINT INJECTION ONE/TW",4600896,"CDM ",450,RC,20552,HCPCS,OUTPATIENT,,,464,371.2,,192.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",78.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",324.8,70,,259.84,,,0,"percent of total billed charges ","70% of total billed charges ",417.6,90,,334.08,,,0,"percent of total billed charges ","90% of total billed charges ",431.52,93,,345.22,,,0,"percent of total billed charges ","93% of total billed charges ",192.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",222,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",394.4,85,,315.52,,,0,"percent of total billed charges ","85% of total billed charges ",348,90,,278.40,,,0,"percent of total billed charges ","90% of total billed charges ",417.6,90,,334.08,,,0,"percent of total billed charges ","90% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",403.68,87,,47.19,47.19,47.19,"1 through 10","percent of total billed charges ","87% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",282.29,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",324.8,70,,259.84,,,0,"percent of total billed charges ","70% of total billed charges ",78.25,431.52,
"APPLY FINGER SPLINT",4600904,"CDM ",450,RC,29130,HCPCS,OUTPATIENT,,,334,267.2,,41.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",230.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",59.86,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",233.8,70,,187.04,,,0,"percent of total billed charges ","70% of total billed charges ",300.6,90,,240.48,,,0,"percent of total billed charges ","90% of total billed charges ",310.62,93,,248.50,,,0,"percent of total billed charges ","93% of total billed charges ",41.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.75,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",283.9,85,,227.12,,,0,"percent of total billed charges ","85% of total billed charges ",250.5,90,,200.40,,,0,"percent of total billed charges ","90% of total billed charges ",300.6,90,,240.48,,,0,"percent of total billed charges ","90% of total billed charges ",17.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",290.58,87,,232.46,,,0,"percent of total billed charges ","87% of total billed charges ",17.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",233.8,70,,187.04,,,0,"percent of total billed charges ","70% of total billed charges ",17.57,310.62,
"APPLY SHORT ARM SPLINT",4600912,"CDM ",450,RC,29125,HCPCS,OUTPATIENT,,,370,296,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",230.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",81.29,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",344.1,93,,275.28,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",314.5,85,,251.60,,,0,"percent of total billed charges ","85% of total billed charges ",277.5,90,,222.00,,,0,"percent of total billed charges ","90% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",321.9,87,,257.52,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",81.29,344.1,
"APPLY LONG ARM SPLINT",4600920,"CDM ",450,RC,29105,HCPCS,OUTPATIENT,,,406.5,325.2,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",230.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",85.14,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",284.55,70,,227.64,,,0,"percent of total billed charges ","70% of total billed charges ",365.85,90,,292.68,,,0,"percent of total billed charges ","90% of total billed charges ",378.05,93,,302.44,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",345.53,85,,276.42,,,0,"percent of total billed charges ","85% of total billed charges ",304.88,90,,243.90,,,0,"percent of total billed charges ","90% of total billed charges ",365.85,90,,292.68,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",353.66,87,,282.93,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",284.55,70,,227.64,,,0,"percent of total billed charges ","70% of total billed charges ",85.14,378.05,
"APPLY SHORT LEG SPLINT",4600938,"CDM ",450,RC,29515,HCPCS,OUTPATIENT,,,370,296,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",230.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",100.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",344.1,93,,275.28,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",314.5,85,,251.60,,,0,"percent of total billed charges ","85% of total billed charges ",277.5,90,,222.00,,,0,"percent of total billed charges ","90% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",321.9,87,,41.35,41.35,41.35,"1 through 10","percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",100.87,344.1,
"PLACEMENT CENTRAL VENOUS CATHE",4600946,"CDM ",450,RC,36556,HCPCS,OUTPATIENT,,,2067,1653.6,,382.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2666.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",175.45,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1446.9,70,,1157.52,,,0,"percent of total billed charges ","70% of total billed charges ",1860.3,90,,1488.24,,,0,"percent of total billed charges ","90% of total billed charges ",1922.31,93,,1537.85,,,0,"percent of total billed charges ","93% of total billed charges ",382.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",485.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1756.95,85,,1405.56,,,0,"percent of total billed charges ","85% of total billed charges ",1550.25,90,,1240.20,,,0,"percent of total billed charges ","90% of total billed charges ",1860.3,90,,1488.24,,,0,"percent of total billed charges ","90% of total billed charges ",480.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1798.29,87,,1438.63,,,0,"percent of total billed charges ","87% of total billed charges ",480.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2903.79,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1446.9,70,,1157.52,,,0,"percent of total billed charges ","70% of total billed charges ",175.45,2903.79,
"EPIDURAL BLOOD PATCH",4600953,"CDM ",450,RC,62273,HCPCS,OUTPATIENT,,,1238,990.4,,224.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",448.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",236.68,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",866.6,70,,693.28,,,0,"percent of total billed charges ","70% of total billed charges ",1114.2,90,,891.36,,,0,"percent of total billed charges ","90% of total billed charges ",1151.34,93,,921.07,,,0,"percent of total billed charges ","93% of total billed charges ",224.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1052.3,85,,841.84,,,0,"percent of total billed charges ","85% of total billed charges ",928.5,90,,742.80,,,0,"percent of total billed charges ","90% of total billed charges ",1114.2,90,,891.36,,,0,"percent of total billed charges ","90% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1077.06,87,,861.65,,,0,"percent of total billed charges ","87% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",649.16,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",866.6,70,,693.28,,,0,"percent of total billed charges ","70% of total billed charges ",130.83,1151.34,
"INSERT CHEST TUBE THORACOSTOMY",4600961,"CDM ",450,RC,32551,HCPCS,OUTPATIENT,,,3037.5,2430,,,,,,,,0,"other ","not separately reimbursment ",,,,60.24,60.24,60.24,"1 through 10","other ","not separately reimbursment ",321.13,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2126.25,70,,1701.00,,,0,"percent of total billed charges ","70% of total billed charges ",2733.75,90,,2187.00,,,0,"percent of total billed charges ","90% of total billed charges ",2824.88,93,,2259.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",226.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2581.88,85,,2065.50,,,0,"percent of total billed charges ","85% of total billed charges ",2278.13,90,,1822.50,,,0,"percent of total billed charges ","90% of total billed charges ",2733.75,90,,2187.00,,,0,"percent of total billed charges ","90% of total billed charges ",224,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2642.63,87,,2114.10,,,0,"percent of total billed charges ","87% of total billed charges ",224,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1447.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2126.25,70,,1701.00,,,0,"percent of total billed charges ","70% of total billed charges ",224,2824.88,
"NASAL HEMORRHAGE REPACKING",4600987,"CDM ",450,RC,30906,HCPCS,OUTPATIENT,,,933.5,746.8,,,,,,,,0,"other ","not separately reimbursment ",210.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",280.3,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",653.45,70,,522.76,,,0,"percent of total billed charges ","70% of total billed charges ",840.15,90,,672.12,,,0,"percent of total billed charges ","90% of total billed charges ",868.16,93,,694.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",793.48,85,,634.78,,,0,"percent of total billed charges ","85% of total billed charges ",700.13,90,,560.10,,,0,"percent of total billed charges ","90% of total billed charges ",840.15,90,,672.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",812.15,87,,649.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",217.82,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",653.45,70,,522.76,,,0,"percent of total billed charges ","70% of total billed charges ",210.08,868.16,
"NASAL HEMORRHAGE COMPLEX",4600995,"CDM ",450,RC,30905,HCPCS,OUTPATIENT,,,807,645.6,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",354.51,100,,24.08,24.08,24.08,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",217.14,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",564.9,70,,451.92,,,0,"percent of total billed charges ","70% of total billed charges ",726.3,90,,581.04,,,0,"percent of total billed charges ","90% of total billed charges ",750.51,93,,600.41,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",363.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",685.95,85,,548.76,,,0,"percent of total billed charges ","85% of total billed charges ",605.25,90,,484.20,,,0,"percent of total billed charges ","90% of total billed charges ",726.3,90,,581.04,,,0,"percent of total billed charges ","90% of total billed charges ",359.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",702.09,87,,561.67,,,0,"percent of total billed charges ","87% of total billed charges ",359.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.36,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",564.9,70,,451.92,,,0,"percent of total billed charges ","70% of total billed charges ",122.36,750.51,
"INTERMEDIATE REPAIR FACE >30 C",4601001,"CDM ",450,RC,12057,HCPCS,OUTPATIENT,,,1904,1523.2,,,,,,,,0,"other ","not separately reimbursment ",1818,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",857.74,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1332.8,70,,1066.24,,,0,"percent of total billed charges ","70% of total billed charges ",1713.6,90,,1370.88,,,0,"percent of total billed charges ","90% of total billed charges ",1770.72,93,,1416.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1618.4,85,,1294.72,,,0,"percent of total billed charges ","85% of total billed charges ",1428,90,,1142.40,,,0,"percent of total billed charges ","90% of total billed charges ",1713.6,90,,1370.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1656.48,87,,1325.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1332.8,70,,1066.24,,,0,"percent of total billed charges ","70% of total billed charges ",373.85,1818,
"INTERMEDIATE REPAIR FACE 20.1-",4601019,"CDM ",450,RC,12056,HCPCS,OUTPATIENT,,,1851,1480.8,,,,,,,,0,"other ","not separately reimbursment ",1605.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",786.76,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1295.7,70,,1036.56,,,0,"percent of total billed charges ","70% of total billed charges ",1665.9,90,,1332.72,,,0,"percent of total billed charges ","90% of total billed charges ",1721.43,93,,1377.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1573.35,85,,1258.68,,,0,"percent of total billed charges ","85% of total billed charges ",1388.25,90,,1110.60,,,0,"percent of total billed charges ","90% of total billed charges ",1665.9,90,,1332.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1610.37,87,,1288.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1295.7,70,,1036.56,,,0,"percent of total billed charges ","70% of total billed charges ",373.85,1721.43,
"INTERMEDIATE REPAIR FACE 12. 6",4601027,"CDM ",450,RC,12055,HCPCS,OUTPATIENT,,,1287.5,1030,,343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1363.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",610.7,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",901.25,70,,721.00,,,0,"percent of total billed charges ","70% of total billed charges ",1158.75,90,,927.00,,,0,"percent of total billed charges ","90% of total billed charges ",1197.38,93,,957.90,,,0,"percent of total billed charges ","93% of total billed charges ",343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1094.38,85,,875.50,,,0,"percent of total billed charges ","85% of total billed charges ",965.63,90,,772.50,,,0,"percent of total billed charges ","90% of total billed charges ",1158.75,90,,927.00,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1120.13,87,,896.10,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",901.25,70,,721.00,,,0,"percent of total billed charges ","70% of total billed charges ",343.2,1363.5,
"INTERMEDIATE REPAIR FACE 7.6-1",4601035,"CDM ",450,RC,12054,HCPCS,OUTPATIENT,,,1007.5,806,,343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1060.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",448.45,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",705.25,70,,564.20,,,0,"percent of total billed charges ","70% of total billed charges ",906.75,90,,725.40,,,0,"percent of total billed charges ","90% of total billed charges ",936.98,93,,749.58,,,0,"percent of total billed charges ","93% of total billed charges ",343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",856.38,85,,685.10,,,0,"percent of total billed charges ","85% of total billed charges ",755.63,90,,604.50,,,0,"percent of total billed charges ","90% of total billed charges ",906.75,90,,725.40,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",876.53,87,,701.22,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",705.25,70,,564.20,,,0,"percent of total billed charges ","70% of total billed charges ",343.2,1060.5,
"INTERMEDIATE REPAIR FACE 5.1-7",4601043,"CDM ",450,RC,12053,HCPCS,OUTPATIENT,,,907,725.6,,343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",973.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",441.23,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",634.9,70,,507.92,,,0,"percent of total billed charges ","70% of total billed charges ",816.3,90,,653.04,,,0,"percent of total billed charges ","90% of total billed charges ",843.51,93,,674.81,,,0,"percent of total billed charges ","93% of total billed charges ",343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",770.95,85,,616.76,,,0,"percent of total billed charges ","85% of total billed charges ",680.25,90,,544.20,,,0,"percent of total billed charges ","90% of total billed charges ",816.3,90,,653.04,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",789.09,87,,631.27,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",634.9,70,,507.92,,,0,"percent of total billed charges ","70% of total billed charges ",343.2,973.64,
"INTERMEDIATE REPAIR FACE 2.6-5",4601050,"CDM ",450,RC,12052,HCPCS,OUTPATIENT,,,435,348,,343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",451.17,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",410.08,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",304.5,70,,243.60,,,0,"percent of total billed charges ","70% of total billed charges ",391.5,90,,313.20,,,0,"percent of total billed charges ","90% of total billed charges ",404.55,93,,323.64,,,0,"percent of total billed charges ","93% of total billed charges ",343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",369.75,85,,295.80,,,0,"percent of total billed charges ","85% of total billed charges ",326.25,90,,261.00,,,0,"percent of total billed charges ","90% of total billed charges ",391.5,90,,313.20,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",378.45,87,,302.76,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",304.5,70,,243.60,,,0,"percent of total billed charges ","70% of total billed charges ",304.5,451.17,
"INTERMED RPR FACE <2.6CM",4601068,"CDM ",450,RC,12051,HCPCS,OUTPATIENT,,,912,729.6,,343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",715.08,100,,86.48,86.48,86.48,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",347.86,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",638.4,70,,510.72,,,0,"percent of total billed charges ","70% of total billed charges ",820.8,90,,656.64,,,0,"percent of total billed charges ","90% of total billed charges ",848.16,93,,678.53,,,0,"percent of total billed charges ","93% of total billed charges ",343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",775.2,85,,620.16,,,0,"percent of total billed charges ","85% of total billed charges ",684,90,,547.20,,,0,"percent of total billed charges ","90% of total billed charges ",820.8,90,,656.64,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",793.44,87,,634.75,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",638.4,70,,510.72,,,0,"percent of total billed charges ","70% of total billed charges ",343.2,848.16,
"INTER RPR NECK/HANDS/FEET >30",4601076,"CDM ",450,RC,12047,HCPCS,OUTPATIENT,,,1686.5,1349.2,,,,,,,,0,"other ","not separately reimbursment ",1538.23,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",718.39,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1180.55,70,,944.44,,,0,"percent of total billed charges ","70% of total billed charges ",1517.85,90,,1214.28,,,0,"percent of total billed charges ","90% of total billed charges ",1568.45,93,,1254.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1433.53,85,,1146.82,,,0,"percent of total billed charges ","85% of total billed charges ",1264.88,90,,1011.90,,,0,"percent of total billed charges ","90% of total billed charges ",1517.85,90,,1214.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1467.26,87,,1173.81,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1897.5,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1180.55,70,,944.44,,,0,"percent of total billed charges ","70% of total billed charges ",718.39,1897.5,
"INTER RPR NECK/HANDS/FEET 20.1",4601084,"CDM ",450,RC,12046,HCPCS,OUTPATIENT,,,1531,1224.8,,,,,,,,0,"other ","not separately reimbursment ",1538.23,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",646.73,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1071.7,70,,857.36,,,0,"percent of total billed charges ","70% of total billed charges ",1377.9,90,,1102.32,,,0,"percent of total billed charges ","90% of total billed charges ",1423.83,93,,1139.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1301.35,85,,1041.08,,,0,"percent of total billed charges ","85% of total billed charges ",1148.25,90,,918.60,,,0,"percent of total billed charges ","90% of total billed charges ",1377.9,90,,1102.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1331.97,87,,1065.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",679.69,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1071.7,70,,857.36,,,0,"percent of total billed charges ","70% of total billed charges ",646.73,1538.23,
"INTER RPR NECK/HANDS/FEET 12.6",4601092,"CDM ",450,RC,12045,HCPCS,OUTPATIENT,,,1040.5,832.4,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1086.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",555.63,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",728.35,70,,582.68,,,0,"percent of total billed charges ","70% of total billed charges ",936.45,90,,749.16,,,0,"percent of total billed charges ","90% of total billed charges ",967.67,93,,774.14,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",884.43,85,,707.54,,,0,"percent of total billed charges ","85% of total billed charges ",780.38,90,,624.30,,,0,"percent of total billed charges ","90% of total billed charges ",936.45,90,,749.16,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",905.24,87,,724.19,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",679.69,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",728.35,70,,582.68,,,0,"percent of total billed charges ","70% of total billed charges ",286,1086.76,
"INTER RPR NECK/HANDS/FEET 7.6-",4601100,"CDM ",450,RC,12044,HCPCS,OUTPATIENT,,,917,733.6,,343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",438.97,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",641.9,70,,513.52,,,0,"percent of total billed charges ","70% of total billed charges ",825.3,90,,660.24,,,0,"percent of total billed charges ","90% of total billed charges ",852.81,93,,682.25,,,0,"percent of total billed charges ","93% of total billed charges ",343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",779.45,85,,623.56,,,0,"percent of total billed charges ","85% of total billed charges ",687.75,90,,550.20,,,0,"percent of total billed charges ","90% of total billed charges ",825.3,90,,660.24,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",797.79,87,,638.23,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",679.69,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",641.9,70,,513.52,,,0,"percent of total billed charges ","70% of total billed charges ",343.2,852.81,
"INTER RPR NECK/HANDS/FEET 2.6-",4601118,"CDM ",450,RC,12042,HCPCS,OUTPATIENT,,,435,348,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",707,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",403.3,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",304.5,70,,243.60,,,0,"percent of total billed charges ","70% of total billed charges ",391.5,90,,313.20,,,0,"percent of total billed charges ","90% of total billed charges ",404.55,93,,323.64,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",369.75,85,,295.80,,,0,"percent of total billed charges ","85% of total billed charges ",326.25,90,,261.00,,,0,"percent of total billed charges ","90% of total billed charges ",391.5,90,,313.20,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",378.45,87,,302.76,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",304.5,70,,243.60,,,0,"percent of total billed charges ","70% of total billed charges ",286,707,
"INTER RPR NECK/HANDS/FEET <2.6",4601126,"CDM ",450,RC,12041,HCPCS,OUTPATIENT,,,692,553.6,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",532.27,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",297.18,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",484.4,70,,387.52,,,0,"percent of total billed charges ","70% of total billed charges ",622.8,90,,498.24,,,0,"percent of total billed charges ","90% of total billed charges ",643.56,93,,514.85,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",588.2,85,,470.56,,,0,"percent of total billed charges ","85% of total billed charges ",519,90,,415.20,,,0,"percent of total billed charges ","90% of total billed charges ",622.8,90,,498.24,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",602.04,87,,481.63,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",484.4,70,,387.52,,,0,"percent of total billed charges ","70% of total billed charges ",257.4,643.56,
"REPAIR TONGUE LACERATION",4601134,"CDM ",450,RC,41250,HCPCS,OUTPATIENT,,,677.5,542,,171.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",313.5,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",474.25,70,,379.40,,,0,"percent of total billed charges ","70% of total billed charges ",609.75,90,,487.80,,,0,"percent of total billed charges ","90% of total billed charges ",630.08,93,,504.06,,,0,"percent of total billed charges ","93% of total billed charges ",171.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",575.88,85,,460.70,,,0,"percent of total billed charges ","85% of total billed charges ",508.13,90,,406.50,,,0,"percent of total billed charges ","90% of total billed charges ",609.75,90,,487.80,,,0,"percent of total billed charges ","90% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",589.43,87,,471.54,,,0,"percent of total billed charges ","87% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",410.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",474.25,70,,379.40,,,0,"percent of total billed charges ","70% of total billed charges ",171.6,630.08,
"INTERMEDIATE RPR TRUCK >30 CM",4601142,"CDM ",450,RC,12037,HCPCS,OUTPATIENT,,,1621,1296.8,,590.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2606.81,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",668.56,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1134.7,70,,907.76,,,0,"percent of total billed charges ","70% of total billed charges ",1458.9,90,,1167.12,,,0,"percent of total billed charges ","90% of total billed charges ",1507.53,93,,1206.02,,,0,"percent of total billed charges ","93% of total billed charges ",590.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1377.85,85,,1102.28,,,0,"percent of total billed charges ","85% of total billed charges ",1215.75,90,,972.60,,,0,"percent of total billed charges ","90% of total billed charges ",1458.9,90,,1167.12,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1410.27,87,,1128.22,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1897.5,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1134.7,70,,907.76,,,0,"percent of total billed charges ","70% of total billed charges ",327.08,2606.81,
"INTERMEDIATE RPR TRUNK 20.1-30",4601159,"CDM ",450,RC,12036,HCPCS,OUTPATIENT,,,1461.5,1169.2,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2204.83,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",577.04,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1023.05,70,,818.44,,,0,"percent of total billed charges ","70% of total billed charges ",1315.35,90,,1052.28,,,0,"percent of total billed charges ","90% of total billed charges ",1359.2,93,,1087.36,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1242.28,85,,993.82,,,0,"percent of total billed charges ","85% of total billed charges ",1096.13,90,,876.90,,,0,"percent of total billed charges ","90% of total billed charges ",1315.35,90,,1052.28,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1271.51,87,,1017.21,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",679.69,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1023.05,70,,818.44,,,0,"percent of total billed charges ","70% of total billed charges ",257.4,2204.83,
"INTERMEDIATE RPR TRUNK 12.6-20",4601167,"CDM ",450,RC,12035,HCPCS,OUTPATIENT,,,947,757.6,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1824.06,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",492.71,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",662.9,70,,530.32,,,0,"percent of total billed charges ","70% of total billed charges ",852.3,90,,681.84,,,0,"percent of total billed charges ","90% of total billed charges ",880.71,93,,704.57,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",804.95,85,,643.96,,,0,"percent of total billed charges ","85% of total billed charges ",710.25,90,,568.20,,,0,"percent of total billed charges ","90% of total billed charges ",852.3,90,,681.84,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",823.89,87,,659.11,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",662.9,70,,530.32,,,0,"percent of total billed charges ","70% of total billed charges ",286,1824.06,
"INTERMEDIATE RPR TRUNK 7.6-12.",4601175,"CDM ",450,RC,12034,HCPCS,OUTPATIENT,,,873,698.4,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1548.33,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",421.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",611.1,70,,488.88,,,0,"percent of total billed charges ","70% of total billed charges ",785.7,90,,628.56,,,0,"percent of total billed charges ","90% of total billed charges ",811.89,93,,649.51,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",742.05,85,,593.64,,,0,"percent of total billed charges ","85% of total billed charges ",654.75,90,,523.80,,,0,"percent of total billed charges ","90% of total billed charges ",785.7,90,,628.56,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",759.51,87,,607.61,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",611.1,70,,488.88,,,0,"percent of total billed charges ","70% of total billed charges ",286,1548.33,
"INTERMED RPR TRUNK 2.6-7.5CM",4601183,"CDM ",450,RC,12032,HCPCS,OUTPATIENT,,,1676,1340.8,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",451.17,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",389.99,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1173.2,70,,938.56,,,0,"percent of total billed charges ","70% of total billed charges ",1508.4,90,,1206.72,,,0,"percent of total billed charges ","90% of total billed charges ",1558.68,93,,1246.94,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1424.6,85,,1139.68,,,0,"percent of total billed charges ","85% of total billed charges ",1257,90,,1005.60,,,0,"percent of total billed charges ","90% of total billed charges ",1508.4,90,,1206.72,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1458.12,87,,1166.50,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1173.2,70,,938.56,,,0,"percent of total billed charges ","70% of total billed charges ",286,1558.68,
"SIMPLE REPAIR FACE >30CM",4601191,"CDM ",450,RC,12018,HCPCS,OUTPATIENT,,,1264,1011.2,,,,,,,,0,"other ","not separately reimbursment ",1538.23,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",352.84,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",884.8,70,,707.84,,,0,"percent of total billed charges ","70% of total billed charges ",1137.6,90,,910.08,,,0,"percent of total billed charges ","90% of total billed charges ",1175.52,93,,940.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1074.4,85,,859.52,,,0,"percent of total billed charges ","85% of total billed charges ",948,90,,758.40,,,0,"percent of total billed charges ","90% of total billed charges ",1137.6,90,,910.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1099.68,87,,879.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",884.8,70,,707.84,,,0,"percent of total billed charges ","70% of total billed charges ",184.51,1538.23,
"SIMPLE REPAIR FACE 20.1-30   C",4601209,"CDM ",450,RC,12017,HCPCS,OUTPATIENT,,,1071,856.8,,379.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1538.23,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",311.43,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",749.7,70,,599.76,,,0,"percent of total billed charges ","70% of total billed charges ",963.9,90,,771.12,,,0,"percent of total billed charges ","90% of total billed charges ",996.03,93,,796.82,,,0,"percent of total billed charges ","93% of total billed charges ",379.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",910.35,85,,728.28,,,0,"percent of total billed charges ","85% of total billed charges ",803.25,90,,642.60,,,0,"percent of total billed charges ","90% of total billed charges ",963.9,90,,771.12,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",931.77,87,,745.42,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",749.7,70,,599.76,,,0,"percent of total billed charges ","70% of total billed charges ",311.43,1538.23,
"SIMPLE REPAIR FACE 12.6-20 CM",4601217,"CDM ",450,RC,12016,HCPCS,OUTPATIENT,,,1109,887.2,,370.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",264.33,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",776.3,70,,621.04,,,0,"percent of total billed charges ","70% of total billed charges ",998.1,90,,798.48,,,0,"percent of total billed charges ","90% of total billed charges ",1031.37,93,,825.10,,,0,"percent of total billed charges ","93% of total billed charges ",370.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",428.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",942.65,85,,754.12,,,0,"percent of total billed charges ","85% of total billed charges ",831.75,90,,665.40,,,0,"percent of total billed charges ","90% of total billed charges ",998.1,90,,798.48,,,0,"percent of total billed charges ","90% of total billed charges ",423.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",964.83,87,,771.86,,,0,"percent of total billed charges ","87% of total billed charges ",423.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",776.3,70,,621.04,,,0,"percent of total billed charges ","70% of total billed charges ",264.33,1031.37,
"SIMPLE REPAIR FACE 7.6-12.5 CM",4601225,"CDM ",450,RC,12015,HCPCS,OUTPATIENT,,,937,749.6,,336.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",193.36,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",655.9,70,,524.72,,,0,"percent of total billed charges ","70% of total billed charges ",843.3,90,,674.64,,,0,"percent of total billed charges ","90% of total billed charges ",871.41,93,,697.13,,,0,"percent of total billed charges ","93% of total billed charges ",336.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",428.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",796.45,85,,637.16,,,0,"percent of total billed charges ","85% of total billed charges ",702.75,90,,562.20,,,0,"percent of total billed charges ","90% of total billed charges ",843.3,90,,674.64,,,0,"percent of total billed charges ","90% of total billed charges ",423.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",815.19,87,,652.15,,,0,"percent of total billed charges ","87% of total billed charges ",423.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",655.9,70,,524.72,,,0,"percent of total billed charges ","70% of total billed charges ",184.51,871.41,
"SIMPLE REPAIR FACE 5.1-7.5 CM",4601233,"CDM ",450,RC,12014,HCPCS,OUTPATIENT,,,744,595.2,,336.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",475.71,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",153.14,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",520.8,70,,416.64,,,0,"percent of total billed charges ","70% of total billed charges ",669.6,90,,535.68,,,0,"percent of total billed charges ","90% of total billed charges ",691.92,93,,553.54,,,0,"percent of total billed charges ","93% of total billed charges ",336.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",428.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",632.4,85,,505.92,,,0,"percent of total billed charges ","85% of total billed charges ",558,90,,446.40,,,0,"percent of total billed charges ","90% of total billed charges ",669.6,90,,535.68,,,0,"percent of total billed charges ","90% of total billed charges ",423.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",647.28,87,,517.82,,,0,"percent of total billed charges ","87% of total billed charges ",423.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",520.8,70,,416.64,,,0,"percent of total billed charges ","70% of total billed charges ",153.14,691.92,
"SIMP RPR TRK/EXT >30 CM",4601241,"CDM ",450,RC,12007,HCPCS,OUTPATIENT,,,1309,1047.2,,229.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1538.23,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",298.36,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",916.3,70,,733.04,,,0,"percent of total billed charges ","70% of total billed charges ",1178.1,90,,942.48,,,0,"percent of total billed charges ","90% of total billed charges ",1217.37,93,,973.90,,,0,"percent of total billed charges ","93% of total billed charges ",229.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",291.36,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1112.65,85,,890.12,,,0,"percent of total billed charges ","85% of total billed charges ",981.75,90,,785.40,,,0,"percent of total billed charges ","90% of total billed charges ",1178.1,90,,942.48,,,0,"percent of total billed charges ","90% of total billed charges ",288.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1138.83,87,,911.06,,,0,"percent of total billed charges ","87% of total billed charges ",288.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",916.3,70,,733.04,,,0,"percent of total billed charges ","70% of total billed charges ",184.51,1538.23,
"SIMP RPR TRK/EXT 20.1-30 CM",4601258,"CDM ",450,RC,12006,HCPCS,OUTPATIENT,,,1160,928,,252.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1538.23,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",239.12,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",812,70,,649.60,,,0,"percent of total billed charges ","70% of total billed charges ",1044,90,,835.20,,,0,"percent of total billed charges ","90% of total billed charges ",1078.8,93,,863.04,,,0,"percent of total billed charges ","93% of total billed charges ",252.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",291.36,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",986,85,,788.80,,,0,"percent of total billed charges ","85% of total billed charges ",870,90,,696.00,,,0,"percent of total billed charges ","90% of total billed charges ",1044,90,,835.20,,,0,"percent of total billed charges ","90% of total billed charges ",288.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1009.2,87,,807.36,,,0,"percent of total billed charges ","87% of total billed charges ",288.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",812,70,,649.60,,,0,"percent of total billed charges ","70% of total billed charges ",239.12,1538.23,
"SIMP RPR TRK/EXT 12.6-20 CM",4601266,"CDM ",450,RC,12005,HCPCS,OUTPATIENT,,,848,678.4,,240.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",194.68,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",593.6,70,,474.88,,,0,"percent of total billed charges ","70% of total billed charges ",763.2,90,,610.56,,,0,"percent of total billed charges ","90% of total billed charges ",788.64,93,,630.91,,,0,"percent of total billed charges ","93% of total billed charges ",240.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",720.8,85,,576.64,,,0,"percent of total billed charges ","85% of total billed charges ",636,90,,508.80,,,0,"percent of total billed charges ","90% of total billed charges ",763.2,90,,610.56,,,0,"percent of total billed charges ","90% of total billed charges ",274.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",737.76,87,,590.21,,,0,"percent of total billed charges ","87% of total billed charges ",274.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",593.6,70,,474.88,,,0,"percent of total billed charges ","70% of total billed charges ",194.68,809.01,
"SIMP RPR TRK/EXT 7.6-12.5 CM",4601274,"CDM ",450,RC,12004,HCPCS,OUTPATIENT,,,677.5,542,,207.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",577.72,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",149.45,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",474.25,70,,379.40,,,0,"percent of total billed charges ","70% of total billed charges ",609.75,90,,487.80,,,0,"percent of total billed charges ","90% of total billed charges ",630.08,93,,504.06,,,0,"percent of total billed charges ","93% of total billed charges ",207.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",263.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",575.88,85,,460.70,,,0,"percent of total billed charges ","85% of total billed charges ",508.13,90,,406.50,,,0,"percent of total billed charges ","90% of total billed charges ",609.75,90,,487.80,,,0,"percent of total billed charges ","90% of total billed charges ",261.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",589.43,87,,471.54,,,0,"percent of total billed charges ","87% of total billed charges ",261.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",474.25,70,,379.40,,,0,"percent of total billed charges ","70% of total billed charges ",149.45,630.08,
"TOE FX W/O MANIP-METATARSAL",4601282,"CDM ",450,RC,28470,HCPCS,OUTPATIENT,,,1924,1539.2,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",427.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1346.8,70,,1077.44,,,0,"percent of total billed charges ","70% of total billed charges ",1731.6,90,,1385.28,,,0,"percent of total billed charges ","90% of total billed charges ",1789.32,93,,1431.46,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1635.4,85,,1308.32,,,0,"percent of total billed charges ","85% of total billed charges ",1443,90,,1154.40,,,0,"percent of total billed charges ","90% of total billed charges ",1731.6,90,,1385.28,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1673.88,87,,1339.10,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1346.8,70,,1077.44,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1789.32,
"CLOSED TX DISTAL PHALANGEAL",4601290,"CDM ",450,RC,26750,HCPCS,OUTPATIENT,,,775,620,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",432.28,100,,86.51,86.51,86.51,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",392.92,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",542.5,70,,434.00,,,0,"percent of total billed charges ","70% of total billed charges ",697.5,90,,558.00,,,0,"percent of total billed charges ","90% of total billed charges ",720.75,93,,576.60,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",658.75,85,,527.00,,,0,"percent of total billed charges ","85% of total billed charges ",581.25,90,,465.00,,,0,"percent of total billed charges ","90% of total billed charges ",697.5,90,,558.00,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",674.25,87,,539.40,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",542.5,70,,434.00,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,720.75,
"CLOSED TX DISTAL RADIAL",4601308,"CDM ",450,RC,25600,HCPCS,OUTPATIENT,,,1050.5,840.4,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",249.78,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",674.63,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",735.35,70,,588.28,,,0,"percent of total billed charges ","70% of total billed charges ",945.45,90,,756.36,,,0,"percent of total billed charges ","90% of total billed charges ",976.97,93,,781.58,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",892.93,85,,714.34,,,0,"percent of total billed charges ","85% of total billed charges ",787.88,90,,630.30,,,0,"percent of total billed charges ","90% of total billed charges ",945.45,90,,756.36,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",913.94,87,,731.15,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",735.35,70,,588.28,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,976.97,
"HUMERAL FX PROX W/O MANIP",4601316,"CDM ",450,RC,23600,HCPCS,OUTPATIENT,,,1242,993.6,,364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",657.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",869.4,70,,695.52,,,0,"percent of total billed charges ","70% of total billed charges ",1117.8,90,,894.24,,,0,"percent of total billed charges ","90% of total billed charges ",1155.06,93,,924.05,,,0,"percent of total billed charges ","93% of total billed charges ",364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1055.7,85,,844.56,,,0,"percent of total billed charges ","85% of total billed charges ",931.5,90,,745.20,,,0,"percent of total billed charges ","90% of total billed charges ",1117.8,90,,894.24,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1080.54,87,,864.43,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",869.4,70,,695.52,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1454.4,
"CLOSED TX-CLAVICULAR",4601324,"CDM ",450,RC,23500,HCPCS,OUTPATIENT,,,874,699.2,,260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",473.24,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",611.8,70,,489.44,,,0,"percent of total billed charges ","70% of total billed charges ",786.6,90,,629.28,,,0,"percent of total billed charges ","90% of total billed charges ",812.82,93,,650.26,,,0,"percent of total billed charges ","93% of total billed charges ",260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",742.9,85,,594.32,,,0,"percent of total billed charges ","85% of total billed charges ",655.5,90,,524.40,,,0,"percent of total billed charges ","90% of total billed charges ",786.6,90,,629.28,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",760.38,87,,608.30,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",611.8,70,,489.44,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,812.82,
"CLOSED TX METACARPAL",4601332,"CDM ",450,RC,26600,HCPCS,OUTPATIENT,,,938,750.4,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",432.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",596.97,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",656.6,70,,525.28,,,0,"percent of total billed charges ","70% of total billed charges ",844.2,90,,675.36,,,0,"percent of total billed charges ","90% of total billed charges ",872.34,93,,697.87,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",797.3,85,,637.84,,,0,"percent of total billed charges ","85% of total billed charges ",703.5,90,,562.80,,,0,"percent of total billed charges ","90% of total billed charges ",844.2,90,,675.36,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",816.06,87,,652.85,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",656.6,70,,525.28,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,872.34,
"SHOULDER DISLOC W/MANIP W/O AN",4601340,"CDM ",450,RC,23650,HCPCS,OUTPATIENT,,,1287,1029.6,,260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",897.89,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",614.26,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",900.9,70,,720.72,,,0,"percent of total billed charges ","70% of total billed charges ",1158.3,90,,926.64,,,0,"percent of total billed charges ","90% of total billed charges ",1196.91,93,,957.53,,,0,"percent of total billed charges ","93% of total billed charges ",260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1093.95,85,,875.16,,,0,"percent of total billed charges ","85% of total billed charges ",965.25,90,,772.20,,,0,"percent of total billed charges ","90% of total billed charges ",1158.3,90,,926.64,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1119.69,87,,895.75,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",900.9,70,,720.72,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1196.91,
"ELBOW DISLOC W/MANIP-ADULT",4601357,"CDM ",450,RC,24600,HCPCS,OUTPATIENT,,,1610,1288,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",704.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1127,70,,901.60,,,0,"percent of total billed charges ","70% of total billed charges ",1449,90,,1159.20,,,0,"percent of total billed charges ","90% of total billed charges ",1497.3,93,,1197.84,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1368.5,85,,1094.80,,,0,"percent of total billed charges ","85% of total billed charges ",1207.5,90,,966.00,,,0,"percent of total billed charges ","90% of total billed charges ",1449,90,,1159.20,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1400.7,87,,1120.56,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1127,70,,901.60,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1497.3,
"KNUCKLE DISLOC W/MANIP METACAR",4601365,"CDM ",450,RC,26700,HCPCS,OUTPATIENT,,,1256,1004.8,,76.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",648.52,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",879.2,70,,703.36,,,0,"percent of total billed charges ","70% of total billed charges ",1130.4,90,,904.32,,,0,"percent of total billed charges ","90% of total billed charges ",1168.08,93,,934.46,,,0,"percent of total billed charges ","93% of total billed charges ",76.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1067.6,85,,854.08,,,0,"percent of total billed charges ","85% of total billed charges ",942,90,,753.60,,,0,"percent of total billed charges ","90% of total billed charges ",1130.4,90,,904.32,,,0,"percent of total billed charges ","90% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1092.72,87,,874.18,,,0,"percent of total billed charges ","87% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",879.2,70,,703.36,,,0,"percent of total billed charges ","70% of total billed charges ",39.25,1168.08,
"CLSD TX FINGER DISLOCATE W/MAN",4601373,"CDM ",450,RC,26770,HCPCS,OUTPATIENT,,,1129.5,903.6,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,696.03,696.03,696.03,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",541.75,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",790.65,70,,632.52,,,0,"percent of total billed charges ","70% of total billed charges ",1016.55,90,,813.24,,,0,"percent of total billed charges ","90% of total billed charges ",1050.44,93,,840.35,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",960.08,85,,768.06,,,0,"percent of total billed charges ","85% of total billed charges ",847.13,90,,677.70,,,0,"percent of total billed charges ","90% of total billed charges ",1016.55,90,,813.24,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",982.67,87,,786.14,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",790.65,70,,632.52,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1050.44,
"INC/REMOVE FB SUBQ TISS-COMPLI",4601381,"CDM ",450,RC,10121,HCPCS,OUTPATIENT,,,1514.5,1211.6,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1517.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",379.81,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1060.15,70,,848.12,,,0,"percent of total billed charges ","70% of total billed charges ",1363.05,90,,1090.44,,,0,"percent of total billed charges ","90% of total billed charges ",1408.49,93,,1126.79,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",355.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1287.33,85,,1029.86,,,0,"percent of total billed charges ","85% of total billed charges ",1135.88,90,,908.70,,,0,"percent of total billed charges ","90% of total billed charges ",1363.05,90,,1090.44,,,0,"percent of total billed charges ","90% of total billed charges ",352.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1317.62,87,,1054.10,,,0,"percent of total billed charges ","87% of total billed charges ",352.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1060.15,70,,848.12,,,0,"percent of total billed charges ","70% of total billed charges ",352.15,1518.9,
"REMOVAL FB-MUSCLE/SIMPLE",4601399,"CDM ",450,RC,20520,HCPCS,OUTPATIENT,,,1034,827.2,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",606,100,,519.99,519.99,519.99,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",304.77,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",723.8,70,,579.04,,,0,"percent of total billed charges ","70% of total billed charges ",930.6,90,,744.48,,,0,"percent of total billed charges ","90% of total billed charges ",961.62,93,,769.30,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",878.9,85,,703.12,,,0,"percent of total billed charges ","85% of total billed charges ",775.5,90,,620.40,,,0,"percent of total billed charges ","90% of total billed charges ",930.6,90,,744.48,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",899.58,87,,719.66,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",723.8,70,,579.04,,,0,"percent of total billed charges ","70% of total billed charges ",304.77,1518.9,
"BURNS-DRESS/DEBRIDE-LG>1 EXTRE",4601407,"CDM ",450,RC,16030,HCPCS,OUTPATIENT,,,821,656.8,,314.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",371.68,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",268.73,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",574.7,70,,459.76,,,0,"percent of total billed charges ","70% of total billed charges ",738.9,90,,591.12,,,0,"percent of total billed charges ","90% of total billed charges ",763.53,93,,610.82,,,0,"percent of total billed charges ","93% of total billed charges ",314.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",363.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",697.85,85,,558.28,,,0,"percent of total billed charges ","85% of total billed charges ",615.75,90,,492.60,,,0,"percent of total billed charges ","90% of total billed charges ",738.9,90,,591.12,,,0,"percent of total billed charges ","90% of total billed charges ",359.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",714.27,87,,571.42,,,0,"percent of total billed charges ","87% of total billed charges ",359.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",574.7,70,,459.76,,,0,"percent of total billed charges ","70% of total billed charges ",268.73,763.53,
"I&D PILONIDAL CYST-COMPLICATED",4601415,"CDM ",450,RC,10081,HCPCS,OUTPATIENT,,,1961,1568.8,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1968.49,100,,1441.29,1441.29,1441.29,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",352.55,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1372.7,70,,1098.16,,,0,"percent of total billed charges ","70% of total billed charges ",1764.9,90,,1411.92,,,0,"percent of total billed charges ","90% of total billed charges ",1823.73,93,,1458.98,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1666.85,85,,1333.48,,,0,"percent of total billed charges ","85% of total billed charges ",1470.75,90,,1176.60,,,0,"percent of total billed charges ","90% of total billed charges ",1764.9,90,,1411.92,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1706.07,87,,1364.86,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1372.7,70,,1098.16,,,0,"percent of total billed charges ","70% of total billed charges ",286,1968.49,
"DRAIN FINGER ABSCESS-COMPLICAT",4601423,"CDM ",450,RC,26011,HCPCS,OUTPATIENT,,,2206,1764.8,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1062.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",382.89,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1544.2,70,,1235.36,,,0,"percent of total billed charges ","70% of total billed charges ",1985.4,90,,1588.32,,,0,"percent of total billed charges ","90% of total billed charges ",2051.58,93,,1641.26,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1875.1,85,,1500.08,,,0,"percent of total billed charges ","85% of total billed charges ",1654.5,90,,1323.60,,,0,"percent of total billed charges ","90% of total billed charges ",1985.4,90,,1588.32,,,0,"percent of total billed charges ","90% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1919.22,87,,1535.38,,,0,"percent of total billed charges ","87% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1544.2,70,,1235.36,,,0,"percent of total billed charges ","70% of total billed charges ",255.12,2051.58,
"DRAIN FINGER ABCESS-SIMPLE",4601431,"CDM ",450,RC,26010,HCPCS,OUTPATIENT,,,1034.5,827.6,,202.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.17,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",290.84,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",724.15,70,,579.32,,,0,"percent of total billed charges ","70% of total billed charges ",931.05,90,,744.84,,,0,"percent of total billed charges ","90% of total billed charges ",962.09,93,,769.67,,,0,"percent of total billed charges ","93% of total billed charges ",202.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",879.33,85,,703.46,,,0,"percent of total billed charges ","85% of total billed charges ",775.88,90,,620.70,,,0,"percent of total billed charges ","90% of total billed charges ",931.05,90,,744.84,,,0,"percent of total billed charges ","90% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",900.02,87,,720.02,,,0,"percent of total billed charges ","87% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",724.15,70,,579.32,,,0,"percent of total billed charges ","70% of total billed charges ",184.51,962.09,
"REMOVAL FB CORNEA W/O SLIT LAM",4601449,"CDM ",450,RC,65220,HCPCS,OUTPATIENT,,,500.5,400.4,,416,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",541.36,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",84.83,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",350.35,70,,280.28,,,0,"percent of total billed charges ","70% of total billed charges ",450.45,90,,360.36,,,0,"percent of total billed charges ","90% of total billed charges ",465.47,93,,372.38,,,0,"percent of total billed charges ","93% of total billed charges ",416,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",528.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",425.43,85,,340.34,,,0,"percent of total billed charges ","85% of total billed charges ",375.38,90,,300.30,,,0,"percent of total billed charges ","90% of total billed charges ",450.45,90,,360.36,,,0,"percent of total billed charges ","90% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",435.44,87,,348.35,,,0,"percent of total billed charges ","87% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",410.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",350.35,70,,280.28,,,0,"percent of total billed charges ","70% of total billed charges ",84.83,541.36,
"NASOGASTRIC TUBE PLACEMENT",4601456,"CDM ",450,RC,43752,HCPCS,OUTPATIENT,,,629.5,503.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.15,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",440.65,70,,352.52,,,0,"percent of total billed charges ","70% of total billed charges ",566.55,90,,453.24,,,0,"percent of total billed charges ","90% of total billed charges ",585.44,93,,468.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",535.08,85,,428.06,,,0,"percent of total billed charges ","85% of total billed charges ",472.13,90,,377.70,,,0,"percent of total billed charges ","90% of total billed charges ",566.55,90,,453.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",547.67,87,,438.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",410.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",440.65,70,,352.52,,,0,"percent of total billed charges ","70% of total billed charges ",84.15,585.44,
"REMOVAL FB FOOT",4601522,"CDM ",450,RC,28190,HCPCS,OUTPATIENT,,,1155.5,924.4,,457.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1991.72,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",276.12,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",808.85,70,,647.08,,,0,"percent of total billed charges ","70% of total billed charges ",1039.95,90,,831.96,,,0,"percent of total billed charges ","90% of total billed charges ",1074.62,93,,859.70,,,0,"percent of total billed charges ","93% of total billed charges ",457.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",528.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",982.18,85,,785.74,,,0,"percent of total billed charges ","85% of total billed charges ",866.63,90,,693.30,,,0,"percent of total billed charges ","90% of total billed charges ",1039.95,90,,831.96,,,0,"percent of total billed charges ","90% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1005.29,87,,804.23,,,0,"percent of total billed charges ","87% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",808.85,70,,647.08,,,0,"percent of total billed charges ","70% of total billed charges ",276.12,1991.72,
"ER FACILITY LEVEL 6 1ST HR",4601530,"CDM ",450,RC,99291,HCPCS,OUTPATIENT,,,4134.5,3307.6,,122.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1021.79,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",455.05,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2894.15,70,,2315.32,,,0,"percent of total billed charges ","70% of total billed charges ",3721.05,90,,2976.84,,,0,"percent of total billed charges ","90% of total billed charges ",3845.09,93,,3076.07,,,0,"percent of total billed charges ","93% of total billed charges ",122.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",155.36,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3514.33,85,,2811.46,,,0,"percent of total billed charges ","85% of total billed charges ",3721.05,90,,2976.84,,,0,"percent of total billed charges ","90% of total billed charges ",3721.05,90,,2976.84,,,0,"percent of total billed charges ","90% of total billed charges ",153.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3597.02,87,,190.97,190.97,190.97,"1 through 10","percent of total billed charges ","87% of total billed charges ",153.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",759.66,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2894.15,70,,2315.32,,,0,"percent of total billed charges ","70% of total billed charges ",122.27,3845.09,
"ER FACILITY LEVEL 5",4601548,"CDM ",450,RC,99285,HCPCS,OUTPATIENT,,,2967,2373.6,,105,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1080.54,100,,569.48,569.48,569.48,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",371.01,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2076.9,70,,1661.52,,,0,"percent of total billed charges ","70% of total billed charges ",2670.3,90,,2136.24,,,0,"percent of total billed charges ","90% of total billed charges ",2759.31,93,,2207.45,,,0,"percent of total billed charges ","93% of total billed charges ",105,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",140.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2521.95,85,,2017.56,,,0,"percent of total billed charges ","85% of total billed charges ",2670.3,90,,2136.24,,,0,"percent of total billed charges ","90% of total billed charges ",2670.3,90,,2136.24,,,0,"percent of total billed charges ","90% of total billed charges ",138.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2581.29,87,,1561.47,554.84,2094.62,"1 through 10","percent of total billed charges ","87% of total billed charges ",138.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",547.66,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2076.9,70,,1661.52,,,0,"percent of total billed charges ","70% of total billed charges ",105,2759.31,
"ER FACILITY LEVEL 6 ADD 30 MIN",4601555,"CDM ",450,RC,99292,HCPCS,OUTPATIENT,,,935,748,,58.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",303.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",228.38,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",654.5,70,,523.60,,,0,"percent of total billed charges ","70% of total billed charges ",841.5,90,,673.20,,,0,"percent of total billed charges ","90% of total billed charges ",869.55,93,,695.64,,,0,"percent of total billed charges ","93% of total billed charges ",58.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",74.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",794.75,85,,635.80,,,0,"percent of total billed charges ","85% of total billed charges ",841.5,90,,673.20,,,0,"percent of total billed charges ","90% of total billed charges ",841.5,90,,673.20,,,0,"percent of total billed charges ","90% of total billed charges ",74.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",813.45,87,,95.60,95.60,95.60,"1 through 10","percent of total billed charges ","87% of total billed charges ",74.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",654.5,70,,523.60,,,0,"percent of total billed charges ","70% of total billed charges ",58.86,869.55,
"EXC BENIGN LES <.5CM F/E/N/L",4601563,"CDM ",450,RC,11440,HCPCS,OUTPATIENT,,,1437.5,1150,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",783.57,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",217.18,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1006.25,70,,805.00,,,0,"percent of total billed charges ","70% of total billed charges ",1293.75,90,,1035.00,,,0,"percent of total billed charges ","90% of total billed charges ",1336.88,93,,1069.50,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1221.88,85,,977.50,,,0,"percent of total billed charges ","85% of total billed charges ",1078.13,90,,862.50,,,0,"percent of total billed charges ","90% of total billed charges ",1293.75,90,,1035.00,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1250.63,87,,1000.50,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1006.25,70,,805.00,,,0,"percent of total billed charges ","70% of total billed charges ",217.18,1336.88,
"REVISE AMPUTATION FINGER",4601571,"CDM ",450,RC,26952,HCPCS,OUTPATIENT,,,4154.5,3323.6,,1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2094.74,100,,2461.60,2461.60,2461.60,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1436.29,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2908.15,70,,2326.52,,,0,"percent of total billed charges ","70% of total billed charges ",3739.05,90,,2991.24,,,0,"percent of total billed charges ","90% of total billed charges ",3863.69,93,,3090.95,,,0,"percent of total billed charges ","93% of total billed charges ",1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",528.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3531.33,85,,2825.06,,,0,"percent of total billed charges ","85% of total billed charges ",3115.88,90,,2492.70,,,0,"percent of total billed charges ","90% of total billed charges ",3739.05,90,,2991.24,,,0,"percent of total billed charges ","90% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3614.42,87,,2891.54,,,0,"percent of total billed charges ","87% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3009.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2908.15,70,,2326.52,,,0,"percent of total billed charges ","70% of total billed charges ",523.33,3863.69,
"INSERTION ARTERIAL CATH",4601597,"CDM ",450,RC,36620,HCPCS,OUTPATIENT,,,521.5,417.2,,234,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",93.08,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",365.05,70,,292.04,,,0,"percent of total billed charges ","70% of total billed charges ",469.35,90,,375.48,,,0,"percent of total billed charges ","90% of total billed charges ",485,93,,388.00,,,0,"percent of total billed charges ","93% of total billed charges ",234,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",443.28,85,,354.62,,,0,"percent of total billed charges ","85% of total billed charges ",391.13,90,,312.90,,,0,"percent of total billed charges ","90% of total billed charges ",469.35,90,,375.48,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",453.71,87,,362.97,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",365.05,70,,292.04,,,0,"percent of total billed charges ","70% of total billed charges ",93.08,485,
"REPAIR FLOOR MOUTH/TONGUE POST",4601662,"CDM ",450,RC,41251,HCPCS,OUTPATIENT,,,781.5,625.2,,171.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",368.94,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",547.05,70,,437.64,,,0,"percent of total billed charges ","70% of total billed charges ",703.35,90,,562.68,,,0,"percent of total billed charges ","90% of total billed charges ",726.8,93,,581.44,,,0,"percent of total billed charges ","93% of total billed charges ",171.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",664.28,85,,531.42,,,0,"percent of total billed charges ","85% of total billed charges ",586.13,90,,468.90,,,0,"percent of total billed charges ","90% of total billed charges ",703.35,90,,562.68,,,0,"percent of total billed charges ","90% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",679.91,87,,543.93,,,0,"percent of total billed charges ","87% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.82,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",547.05,70,,437.64,,,0,"percent of total billed charges ","70% of total billed charges ",171.6,726.8,
"ANKLE FX W/O MANIP",4601670,"CDM ",450,RC,27808,HCPCS,OUTPATIENT,,,1134,907.2,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",638.37,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",793.8,70,,635.04,,,0,"percent of total billed charges ","70% of total billed charges ",1020.6,90,,816.48,,,0,"percent of total billed charges ","90% of total billed charges ",1054.62,93,,843.70,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",963.9,85,,771.12,,,0,"percent of total billed charges ","85% of total billed charges ",850.5,90,,680.40,,,0,"percent of total billed charges ","90% of total billed charges ",1020.6,90,,816.48,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",986.58,87,,789.26,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",793.8,70,,635.04,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1454.4,
"TIBIA/FIBULA FX W/O MANIP",4601688,"CDM ",450,RC,27750,HCPCS,OUTPATIENT,,,2512,2009.6,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",671.53,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1758.4,70,,1406.72,,,0,"percent of total billed charges ","70% of total billed charges ",2260.8,90,,1808.64,,,0,"percent of total billed charges ","90% of total billed charges ",2336.16,93,,1868.93,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2135.2,85,,1708.16,,,0,"percent of total billed charges ","85% of total billed charges ",1884,90,,1507.20,,,0,"percent of total billed charges ","90% of total billed charges ",2260.8,90,,1808.64,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2185.44,87,,1748.35,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1758.4,70,,1406.72,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,2336.16,
"STRAPPING ANKLE AND /OR FOOT",4601696,"CDM ",450,RC,29540,HCPCS,OUTPATIENT,,,384.5,307.6,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",37.29,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",357.59,93,,286.07,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",326.83,85,,261.46,,,0,"percent of total billed charges ","85% of total billed charges ",288.38,90,,230.70,,,0,"percent of total billed charges ","90% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",334.52,87,,267.62,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",37.29,357.59,
"STRAPPING ELBOW OR WRIST",4601704,"CDM ",450,RC,29260,HCPCS,OUTPATIENT,,,384.5,307.6,,25.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",40.74,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",357.59,93,,286.07,,,0,"percent of total billed charges ","93% of total billed charges ",25.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",326.83,85,,261.46,,,0,"percent of total billed charges ","85% of total billed charges ",288.38,90,,230.70,,,0,"percent of total billed charges ","90% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",28.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",334.52,87,,5.27,5.27,5.27,"1 through 10","percent of total billed charges ","87% of total billed charges ",28.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",25.17,357.59,
"REPAIR TENDON FINGER",4601712,"CDM ",450,RC,26418,HCPCS,OUTPATIENT,,,3201,2560.8,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3017.88,100,,2487.97,2487.97,2487.97,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1313.55,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2240.7,70,,1792.56,,,0,"percent of total billed charges ","70% of total billed charges ",2880.9,90,,2304.72,,,0,"percent of total billed charges ","90% of total billed charges ",2976.93,93,,2381.54,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2720.85,85,,2176.68,,,0,"percent of total billed charges ","85% of total billed charges ",2400.75,90,,1920.60,,,0,"percent of total billed charges ","90% of total billed charges ",2880.9,90,,2304.72,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2784.87,87,,2227.90,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2240.7,70,,1792.56,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,3017.88,
"FINGER FX W/MANIPULATION",4601720,"CDM ",450,RC,26725,HCPCS,OUTPATIENT,,,1509.5,1207.6,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1137.26,100,,4161.21,4161.21,4161.21,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",634.63,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1056.65,70,,845.32,,,0,"percent of total billed charges ","70% of total billed charges ",1358.55,90,,1086.84,,,0,"percent of total billed charges ","90% of total billed charges ",1403.84,93,,1123.07,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1283.08,85,,1026.46,,,0,"percent of total billed charges ","85% of total billed charges ",1132.13,90,,905.70,,,0,"percent of total billed charges ","90% of total billed charges ",1358.55,90,,1086.84,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1313.27,87,,1050.62,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1056.65,70,,845.32,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1403.84,
"HUMERAL FX SHAFT W/O MANIP",4601738,"CDM ",450,RC,24500,HCPCS,OUTPATIENT,,,1217,973.6,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",695.66,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",851.9,70,,681.52,,,0,"percent of total billed charges ","70% of total billed charges ",1095.3,90,,876.24,,,0,"percent of total billed charges ","90% of total billed charges ",1131.81,93,,905.45,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1034.45,85,,827.56,,,0,"percent of total billed charges ","85% of total billed charges ",912.75,90,,730.20,,,0,"percent of total billed charges ","90% of total billed charges ",1095.3,90,,876.24,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1058.79,87,,847.03,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",851.9,70,,681.52,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1454.4,
"REM IMPLANT SUPERFICIAL",4601746,"CDM ",450,RC,20670,HCPCS,OUTPATIENT,,,2057,1645.6,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1038.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",297.07,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1439.9,70,,1151.92,,,0,"percent of total billed charges ","70% of total billed charges ",1851.3,90,,1481.04,,,0,"percent of total billed charges ","90% of total billed charges ",1913.01,93,,1530.41,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1748.45,85,,1398.76,,,0,"percent of total billed charges ","85% of total billed charges ",1542.75,90,,1234.20,,,0,"percent of total billed charges ","90% of total billed charges ",1851.3,90,,1481.04,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1789.59,87,,1431.67,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1439.9,70,,1151.92,,,0,"percent of total billed charges ","70% of total billed charges ",297.07,1913.01,
"COMP RPR SCALP/ARM/LEG 2.6-7.5",4601779,"CDM ",450,RC,13121,HCPCS,OUTPATIENT,,,1301,1040.8,,400.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",539.34,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",532.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",910.7,70,,728.56,,,0,"percent of total billed charges ","70% of total billed charges ",1170.9,90,,936.72,,,0,"percent of total billed charges ","90% of total billed charges ",1209.93,93,,967.94,,,0,"percent of total billed charges ","93% of total billed charges ",400.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1105.85,85,,884.68,,,0,"percent of total billed charges ","85% of total billed charges ",975.75,90,,780.60,,,0,"percent of total billed charges ","90% of total billed charges ",1170.9,90,,936.72,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1131.87,87,,1172.38,1172.38,1172.38,"1 through 10","percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",910.7,70,,728.56,,,0,"percent of total billed charges ","70% of total billed charges ",373.85,1209.93,
"COMPLEX RPR S/A/L 1.1-2.5CM",4601787,"CDM ",450,RC,13120,HCPCS,OUTPATIENT,,,983.5,786.8,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",310.07,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",480.72,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",688.45,70,,550.76,,,0,"percent of total billed charges ","70% of total billed charges ",885.15,90,,708.12,,,0,"percent of total billed charges ","90% of total billed charges ",914.66,93,,731.73,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",835.98,85,,668.78,,,0,"percent of total billed charges ","85% of total billed charges ",737.63,90,,590.10,,,0,"percent of total billed charges ","90% of total billed charges ",885.15,90,,708.12,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",855.65,87,,684.52,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",688.45,70,,550.76,,,0,"percent of total billed charges ","70% of total billed charges ",286,914.66,
"COMP RPR SCALP/ARM/LEG ADD <5C",4601795,"CDM ",450,RC,13122,HCPCS,OUTPATIENT,,,343.5,274.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",169.82,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",240.45,70,,192.36,,,0,"percent of total billed charges ","70% of total billed charges ",309.15,90,,247.32,,,0,"percent of total billed charges ","90% of total billed charges ",319.46,93,,255.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",291.98,85,,233.58,,,0,"percent of total billed charges ","85% of total billed charges ",257.63,90,,206.10,,,0,"percent of total billed charges ","90% of total billed charges ",309.15,90,,247.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",298.85,87,,1345.66,1345.66,1345.66,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",240.45,70,,192.36,,,0,"percent of total billed charges ","70% of total billed charges ",169.82,319.46,
GRAFT-DERMA/FAT/FASCIA,4601803,"CDM ",450,RC,15770,HCPCS,OUTPATIENT,,,1778,1422.4,,,,,,,,0,"other ","not separately reimbursment ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1384.22,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1244.6,70,,995.68,,,0,"percent of total billed charges ","70% of total billed charges ",1600.2,90,,1280.16,,,0,"percent of total billed charges ","90% of total billed charges ",1653.54,93,,1322.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1511.3,85,,1209.04,,,0,"percent of total billed charges ","85% of total billed charges ",1333.5,90,,1066.80,,,0,"percent of total billed charges ","90% of total billed charges ",1600.2,90,,1280.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1546.86,87,,1237.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",3259.01,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1244.6,70,,995.68,,,0,"percent of total billed charges ","70% of total billed charges ",809.01,3259.01,
"DEBRIDE FB REM OPEN FX",4601811,"CDM ",450,RC,11010,HCPCS,OUTPATIENT,,,974,779.2,,,,,,,,0,"other ","not separately reimbursment ",783.58,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",565.31,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",681.8,70,,545.44,,,0,"percent of total billed charges ","70% of total billed charges ",876.6,90,,701.28,,,0,"percent of total billed charges ","90% of total billed charges ",905.82,93,,724.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",827.9,85,,662.32,,,0,"percent of total billed charges ","85% of total billed charges ",730.5,90,,584.40,,,0,"percent of total billed charges ","90% of total billed charges ",876.6,90,,701.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",847.38,87,,677.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",681.8,70,,545.44,,,0,"percent of total billed charges ","70% of total billed charges ",565.31,905.82,
"TX DISTAL FIB FX W/O MANIP",4601829,"CDM ",450,RC,27786,HCPCS,OUTPATIENT,,,2093.5,1674.8,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",602.01,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1465.45,70,,1172.36,,,0,"percent of total billed charges ","70% of total billed charges ",1884.15,90,,1507.32,,,0,"percent of total billed charges ","90% of total billed charges ",1946.96,93,,1557.57,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1779.48,85,,1423.58,,,0,"percent of total billed charges ","85% of total billed charges ",1570.13,90,,1256.10,,,0,"percent of total billed charges ","90% of total billed charges ",1884.15,90,,1507.32,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1821.35,87,,1457.08,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1465.45,70,,1172.36,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1946.96,
"V-Y PLASTY HANDS OR FEET",4601837,"CDM ",450,RC,14040,HCPCS,OUTPATIENT,,,1914,1531.2,,590.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1778.61,100,,983.60,983.60,983.60,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1281.37,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1339.8,70,,1071.84,,,0,"percent of total billed charges ","70% of total billed charges ",1722.6,90,,1378.08,,,0,"percent of total billed charges ","90% of total billed charges ",1780.02,93,,1424.02,,,0,"percent of total billed charges ","93% of total billed charges ",590.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1626.9,85,,1301.52,,,0,"percent of total billed charges ","85% of total billed charges ",1435.5,90,,1148.40,,,0,"percent of total billed charges ","90% of total billed charges ",1722.6,90,,1378.08,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1665.18,87,,1432.59,1432.59,1432.59,"1 through 10","percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1897.5,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1339.8,70,,1071.84,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,1897.5,
"RADIAL/ULNAR SHAFT FX MANIP",4601845,"CDM ",450,RC,25565,HCPCS,OUTPATIENT,,,1715.5,1372.4,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",966.97,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1200.85,70,,960.68,,,0,"percent of total billed charges ","70% of total billed charges ",1543.95,90,,1235.16,,,0,"percent of total billed charges ","90% of total billed charges ",1595.42,93,,1276.34,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1458.18,85,,1166.54,,,0,"percent of total billed charges ","85% of total billed charges ",1286.63,90,,1029.30,,,0,"percent of total billed charges ","90% of total billed charges ",1543.95,90,,1235.16,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1492.49,87,,1193.99,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1200.85,70,,960.68,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,1595.42,
"DISTAL FX FINGER OR THUMB",4601852,"CDM ",450,RC,26765,HCPCS,OUTPATIENT,,,1674.5,1339.6,,1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2094.74,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1039.26,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1172.15,70,,937.72,,,0,"percent of total billed charges ","70% of total billed charges ",1507.05,90,,1205.64,,,0,"percent of total billed charges ","90% of total billed charges ",1557.29,93,,1245.83,,,0,"percent of total billed charges ","93% of total billed charges ",1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1423.33,85,,1138.66,,,0,"percent of total billed charges ","85% of total billed charges ",1255.88,90,,1004.70,,,0,"percent of total billed charges ","90% of total billed charges ",1507.05,90,,1205.64,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1456.82,87,,1165.46,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3009.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1172.15,70,,937.72,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,3009.11,
"DEBRIDE FB W/FX SKIN-BONE",4601860,"CDM ",450,RC,11012,HCPCS,OUTPATIENT,,,2243,1794.4,,1728.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3084.55,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",848.69,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1570.1,70,,1256.08,,,0,"percent of total billed charges ","70% of total billed charges ",2018.7,90,,1614.96,,,0,"percent of total billed charges ","90% of total billed charges ",2085.99,93,,1668.79,,,0,"percent of total billed charges ","93% of total billed charges ",1728.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1996.87,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1906.55,85,,1525.24,,,0,"percent of total billed charges ","85% of total billed charges ",1682.25,90,,1345.80,,,0,"percent of total billed charges ","90% of total billed charges ",2018.7,90,,1614.96,,,0,"percent of total billed charges ","90% of total billed charges ",1977.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1951.41,87,,1561.13,,,0,"percent of total billed charges ","87% of total billed charges ",1977.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2671.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1570.1,70,,1256.08,,,0,"percent of total billed charges ","70% of total billed charges ",848.69,3084.55,
"CLOSED FX METACARPAL W/MANIP",4601878,"CDM ",450,RC,26605,HCPCS,OUTPATIENT,,,1315,1052,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",621.43,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",920.5,70,,736.40,,,0,"percent of total billed charges ","70% of total billed charges ",1183.5,90,,946.80,,,0,"percent of total billed charges ","90% of total billed charges ",1222.95,93,,978.36,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1117.75,85,,894.20,,,0,"percent of total billed charges ","85% of total billed charges ",986.25,90,,789.00,,,0,"percent of total billed charges ","90% of total billed charges ",1183.5,90,,946.80,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1144.05,87,,915.24,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",920.5,70,,736.40,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1222.95,
"SHAFT FX FINGER OR THUMB",4601886,"CDM ",450,RC,26735,HCPCS,OUTPATIENT,,,5008.5,4006.8,,1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3638.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1228.96,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3505.95,70,,2804.76,,,0,"percent of total billed charges ","70% of total billed charges ",4507.65,90,,3606.12,,,0,"percent of total billed charges ","90% of total billed charges ",4657.91,93,,3726.33,,,0,"percent of total billed charges ","93% of total billed charges ",1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4257.23,85,,3405.78,,,0,"percent of total billed charges ","85% of total billed charges ",3756.38,90,,3005.10,,,0,"percent of total billed charges ","90% of total billed charges ",4507.65,90,,3606.12,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4357.4,87,,3485.92,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3009.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3505.95,70,,2804.76,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,4657.91,
"CLSD TX PATELLAR DISLOC W/O AN",4601894,"CDM ",450,RC,27560,HCPCS,OUTPATIENT,,,366.5,293.2,,364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",700.46,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",256.55,70,,205.24,,,0,"percent of total billed charges ","70% of total billed charges ",329.85,90,,263.88,,,0,"percent of total billed charges ","90% of total billed charges ",340.85,93,,272.68,,,0,"percent of total billed charges ","93% of total billed charges ",364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",311.53,85,,249.22,,,0,"percent of total billed charges ","85% of total billed charges ",274.88,90,,219.90,,,0,"percent of total billed charges ","90% of total billed charges ",329.85,90,,263.88,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",318.86,87,,255.09,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",256.55,70,,205.24,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,809.01,
"I&D PERIRECTAL ABSCESS",4601902,"CDM ",450,RC,46040,HCPCS,OUTPATIENT,,,3379,2703.2,,382.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2329.06,100,,603.09,603.09,603.09,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",877.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2365.3,70,,1892.24,,,0,"percent of total billed charges ","70% of total billed charges ",3041.1,90,,2432.88,,,0,"percent of total billed charges ","90% of total billed charges ",3142.47,93,,2513.98,,,0,"percent of total billed charges ","93% of total billed charges ",382.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",429.45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2872.15,85,,2297.72,,,0,"percent of total billed charges ","85% of total billed charges ",2534.25,90,,2027.40,,,0,"percent of total billed charges ","90% of total billed charges ",3041.1,90,,2432.88,,,0,"percent of total billed charges ","90% of total billed charges ",425.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2939.73,87,,2351.78,,,0,"percent of total billed charges ","87% of total billed charges ",425.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1100.5,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2365.3,70,,1892.24,,,0,"percent of total billed charges ","70% of total billed charges ",382.28,3142.47,
"PUNCTURE ASPIRATION ABSCESS",4601910,"CDM ",450,RC,10160,HCPCS,OUTPATIENT,,,948,758.4,,223.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",947.38,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",196.81,220,,79.15,79.15,79.15,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",663.6,70,,530.88,,,0,"percent of total billed charges ","70% of total billed charges ",853.2,90,,682.56,,,0,"percent of total billed charges ","90% of total billed charges ",881.64,93,,705.31,,,0,"percent of total billed charges ","93% of total billed charges ",223.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",805.8,85,,644.64,,,0,"percent of total billed charges ","85% of total billed charges ",711,90,,568.80,,,0,"percent of total billed charges ","90% of total billed charges ",853.2,90,,682.56,,,0,"percent of total billed charges ","90% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",824.76,87,,659.81,,,0,"percent of total billed charges ","87% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",663.6,70,,530.88,,,0,"percent of total billed charges ","70% of total billed charges ",196.81,947.38,
"ANKLE DISLOCATION-CLOSED TX",4601928,"CDM ",450,RC,27840,HCPCS,OUTPATIENT,,,1217,973.6,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",793.08,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",851.9,70,,681.52,,,0,"percent of total billed charges ","70% of total billed charges ",1095.3,90,,876.24,,,0,"percent of total billed charges ","90% of total billed charges ",1131.81,93,,905.45,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1034.45,85,,827.56,,,0,"percent of total billed charges ","85% of total billed charges ",912.75,90,,730.20,,,0,"percent of total billed charges ","90% of total billed charges ",1095.3,90,,876.24,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1058.79,87,,847.03,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",851.9,70,,681.52,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1131.81,
"CLSD REDUCTION-DISTAL TIBIA",4601936,"CDM ",450,RC,27825,HCPCS,OUTPATIENT,,,1749.5,1399.6,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1605.9,100,,3659.25,3659.25,3659.25,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1016.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1224.65,70,,979.72,,,0,"percent of total billed charges ","70% of total billed charges ",1574.55,90,,1259.64,,,0,"percent of total billed charges ","90% of total billed charges ",1627.04,93,,1301.63,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1487.08,85,,1189.66,,,0,"percent of total billed charges ","85% of total billed charges ",1312.13,90,,1049.70,,,0,"percent of total billed charges ","90% of total billed charges ",1574.55,90,,1259.64,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1522.07,87,,1217.66,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1224.65,70,,979.72,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,1627.04,
"COMP RPR TRUNK 2.6CM-7.5CM",4601944,"CDM ",450,RC,13101,HCPCS,OUTPATIENT,,,1203.5,962.8,,343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",539.34,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",511.98,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",842.45,70,,673.96,,,0,"percent of total billed charges ","70% of total billed charges ",1083.15,90,,866.52,,,0,"percent of total billed charges ","90% of total billed charges ",1119.26,93,,895.41,,,0,"percent of total billed charges ","93% of total billed charges ",343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1022.98,85,,818.38,,,0,"percent of total billed charges ","85% of total billed charges ",902.63,90,,722.10,,,0,"percent of total billed charges ","90% of total billed charges ",1083.15,90,,866.52,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1047.05,87,,837.64,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",679.69,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",842.45,70,,673.96,,,0,"percent of total billed charges ","70% of total billed charges ",343.2,1119.26,
"DILATION URETHRAL STRIC MALE",4601951,"CDM ",450,RC,53620,HCPCS,OUTPATIENT,,,592.5,474,,343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1980.61,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",180.07,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",414.75,70,,331.80,,,0,"percent of total billed charges ","70% of total billed charges ",533.25,90,,426.60,,,0,"percent of total billed charges ","90% of total billed charges ",551.03,93,,440.82,,,0,"percent of total billed charges ","93% of total billed charges ",343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",503.63,85,,402.90,,,0,"percent of total billed charges ","85% of total billed charges ",444.38,90,,355.50,,,0,"percent of total billed charges ","90% of total billed charges ",533.25,90,,426.60,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",515.48,87,,412.38,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",641.27,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",414.75,70,,331.80,,,0,"percent of total billed charges ","70% of total billed charges ",180.07,1980.61,
"CLSD RADIAL SHAFT FX W/MANIP",4601969,"CDM ",450,RC,25505,HCPCS,OUTPATIENT,,,3376.5,2701.2,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",952.73,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2363.55,70,,1890.84,,,0,"percent of total billed charges ","70% of total billed charges ",3038.85,90,,2431.08,,,0,"percent of total billed charges ","90% of total billed charges ",3140.15,93,,2512.12,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2870.03,85,,2296.02,,,0,"percent of total billed charges ","85% of total billed charges ",2532.38,90,,2025.90,,,0,"percent of total billed charges ","90% of total billed charges ",3038.85,90,,2431.08,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2937.56,87,,2350.05,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2363.55,70,,1890.84,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,3140.15,
"CLSD TX PHALANGE W/MANIP",4601977,"CDM ",450,RC,26755,HCPCS,OUTPATIENT,,,1172.5,938,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",541.36,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",572.4,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",820.75,70,,656.60,,,0,"percent of total billed charges ","70% of total billed charges ",1055.25,90,,844.20,,,0,"percent of total billed charges ","90% of total billed charges ",1090.43,93,,872.34,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",996.63,85,,797.30,,,0,"percent of total billed charges ","85% of total billed charges ",879.38,90,,703.50,,,0,"percent of total billed charges ","90% of total billed charges ",1055.25,90,,844.20,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1020.08,87,,816.06,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",820.75,70,,656.60,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1090.43,
"RETROBULBAR INJECTION",4601985,"CDM ",450,RC,67500,HCPCS,OUTPATIENT,,,198,158.4,,114.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",130.99,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",138.6,70,,110.88,,,0,"percent of total billed charges ","70% of total billed charges ",178.2,90,,142.56,,,0,"percent of total billed charges ","90% of total billed charges ",184.14,93,,147.31,,,0,"percent of total billed charges ","93% of total billed charges ",114.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",168.3,85,,134.64,,,0,"percent of total billed charges ","85% of total billed charges ",148.5,90,,118.80,,,0,"percent of total billed charges ","90% of total billed charges ",178.2,90,,142.56,,,0,"percent of total billed charges ","90% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",172.26,87,,137.81,,,0,"percent of total billed charges ","87% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",291.89,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",138.6,70,,110.88,,,0,"percent of total billed charges ","70% of total billed charges ",114.4,291.89,
"CLSD TX RADIAL FX W/O MANIP",4601993,"CDM ",450,RC,24650,HCPCS,OUTPATIENT,,,1034,827.2,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",510.93,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",723.8,70,,579.04,,,0,"percent of total billed charges ","70% of total billed charges ",930.6,90,,744.48,,,0,"percent of total billed charges ","90% of total billed charges ",961.62,93,,769.30,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",878.9,85,,703.12,,,0,"percent of total billed charges ","85% of total billed charges ",775.5,90,,620.40,,,0,"percent of total billed charges ","90% of total billed charges ",930.6,90,,744.48,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",899.58,87,,719.66,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",723.8,70,,579.04,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,961.62,
"DEBRIDE,SKIN,SUB-TISSUE/MUSCLE",4602009,"CDM ",450,RC,11043,HCPCS,OUTPATIENT,,,941,752.8,,228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",700.21,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",316.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",658.7,70,,526.96,,,0,"percent of total billed charges ","70% of total billed charges ",846.9,90,,677.52,,,0,"percent of total billed charges ","90% of total billed charges ",875.13,93,,700.10,,,0,"percent of total billed charges ","93% of total billed charges ",228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",799.85,85,,639.88,,,0,"percent of total billed charges ","85% of total billed charges ",705.75,90,,564.60,,,0,"percent of total billed charges ","90% of total billed charges ",846.9,90,,677.52,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",818.67,87,,654.94,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",679.69,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",658.7,70,,526.96,,,0,"percent of total billed charges ","70% of total billed charges ",228.8,875.13,
"CLSD TX PROX HUMERAL W/MANIP",4602017,"CDM ",450,RC,23605,HCPCS,OUTPATIENT,,,1548,1238.4,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2781.54,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",886.73,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1083.6,70,,866.88,,,0,"percent of total billed charges ","70% of total billed charges ",1393.2,90,,1114.56,,,0,"percent of total billed charges ","90% of total billed charges ",1439.64,93,,1151.71,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1315.8,85,,1052.64,,,0,"percent of total billed charges ","85% of total billed charges ",1161,90,,928.80,,,0,"percent of total billed charges ","90% of total billed charges ",1393.2,90,,1114.56,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1346.76,87,,1077.41,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1083.6,70,,866.88,,,0,"percent of total billed charges ","70% of total billed charges ",457.91,2781.54,
"CLSD TX NASAL FX W/O MANIP",4602025,"CDM ",450,RC,21310,HCPCS,OUTPATIENT,,,458.5,366.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",366.8,80,,293.44,,,0,"percent of total billed charges ","80% of total billed charges ",320.95,70,,256.76,,,0,"percent of total billed charges ","70% of total billed charges ",412.65,90,,330.12,,,0,"percent of total billed charges ","90% of total billed charges ",426.41,93,,341.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",389.73,85,,311.78,,,0,"percent of total billed charges ","85% of total billed charges ",343.88,90,,275.10,,,0,"percent of total billed charges ","90% of total billed charges ",412.65,90,,330.12,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",398.9,87,,319.12,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",320.95,70,,256.76,,,0,"percent of total billed charges ","70% of total billed charges ",294.37,426.41,
"REPAIR COMPLEX 2.6-7.5 CM",4602033,"CDM ",450,RC,13132,HCPCS,OUTPATIENT,,,1502.5,1202,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1008.99,100,,2661.01,2661.01,2661.01,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",626.08,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1051.75,70,,841.40,,,0,"percent of total billed charges ","70% of total billed charges ",1352.25,90,,1081.80,,,0,"percent of total billed charges ","90% of total billed charges ",1397.33,93,,1117.86,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1277.13,85,,1021.70,,,0,"percent of total billed charges ","85% of total billed charges ",1126.88,90,,901.50,,,0,"percent of total billed charges ","90% of total billed charges ",1352.25,90,,1081.80,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1307.18,87,,1045.74,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1051.75,70,,841.40,,,0,"percent of total billed charges ","70% of total billed charges ",286,1397.33,
"FULL THICK GRAFT FREE <20CM",4602041,"CDM ",450,RC,15240,HCPCS,OUTPATIENT,,,2250.5,1800.4,,590.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3312.8,100,,209.26,209.26,209.26,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1632.18,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1575.35,70,,1260.28,,,0,"percent of total billed charges ","70% of total billed charges ",2025.45,90,,1620.36,,,0,"percent of total billed charges ","90% of total billed charges ",2092.97,93,,1674.38,,,0,"percent of total billed charges ","93% of total billed charges ",590.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1912.93,85,,1530.34,,,0,"percent of total billed charges ","85% of total billed charges ",1687.88,90,,1350.30,,,0,"percent of total billed charges ","90% of total billed charges ",2025.45,90,,1620.36,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1957.94,87,,1432.59,1432.59,1432.59,"1 through 10","percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1897.5,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1575.35,70,,1260.28,,,0,"percent of total billed charges ","70% of total billed charges ",327.08,3312.8,
"CLSD TX DISTAL RADIAL FX W/MAN",4602058,"CDM ",450,RC,25605,HCPCS,OUTPATIENT,,,3376.5,2701.2,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1434.2,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1060.71,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2363.55,70,,1890.84,,,0,"percent of total billed charges ","70% of total billed charges ",3038.85,90,,2431.08,,,0,"percent of total billed charges ","90% of total billed charges ",3140.15,93,,2512.12,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2870.03,85,,2296.02,,,0,"percent of total billed charges ","85% of total billed charges ",2532.38,90,,2025.90,,,0,"percent of total billed charges ","90% of total billed charges ",3038.85,90,,2431.08,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2937.56,87,,2350.05,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2363.55,70,,1890.84,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,3140.15,
"MASTOTOMY W/DRAINAGE ABSCESS",4602066,"CDM ",450,RC,19020,HCPCS,OUTPATIENT,,,920,736,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1766.49,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",639.91,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",644,70,,515.20,,,0,"percent of total billed charges ","70% of total billed charges ",828,90,,662.40,,,0,"percent of total billed charges ","90% of total billed charges ",855.6,93,,684.48,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",594.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",782,85,,625.60,,,0,"percent of total billed charges ","85% of total billed charges ",690,90,,552.00,,,0,"percent of total billed charges ","90% of total billed charges ",828,90,,662.40,,,0,"percent of total billed charges ","90% of total billed charges ",588.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",800.4,87,,640.32,,,0,"percent of total billed charges ","87% of total billed charges ",588.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",644,70,,515.20,,,0,"percent of total billed charges ","70% of total billed charges ",525.22,1766.49,
"CLSD TX TIBIAL SHAFT FX W/MANI",4602074,"CDM ",450,RC,27752,HCPCS,OUTPATIENT,,,1720,1376,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1016.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1204,70,,963.20,,,0,"percent of total billed charges ","70% of total billed charges ",1548,90,,1238.40,,,0,"percent of total billed charges ","90% of total billed charges ",1599.6,93,,1279.68,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1462,85,,1169.60,,,0,"percent of total billed charges ","85% of total billed charges ",1290,90,,1032.00,,,0,"percent of total billed charges ","90% of total billed charges ",1548,90,,1238.40,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1496.4,87,,1197.12,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1204,70,,963.20,,,0,"percent of total billed charges ","70% of total billed charges ",457.91,1599.6,
"INC THROMBOSED HEMORRHOID, EXT",4602082,"CDM ",450,RC,46083,HCPCS,OUTPATIENT,,,568,454.4,,222.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",116.15,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",226.95,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",397.6,70,,318.08,,,0,"percent of total billed charges ","70% of total billed charges ",511.2,90,,408.96,,,0,"percent of total billed charges ","90% of total billed charges ",528.24,93,,422.59,,,0,"percent of total billed charges ","93% of total billed charges ",222.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",482.8,85,,386.24,,,0,"percent of total billed charges ","85% of total billed charges ",426,90,,340.80,,,0,"percent of total billed charges ","90% of total billed charges ",511.2,90,,408.96,,,0,"percent of total billed charges ","90% of total billed charges ",254.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",494.16,87,,395.33,,,0,"percent of total billed charges ","87% of total billed charges ",254.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",229.77,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",397.6,70,,318.08,,,0,"percent of total billed charges ","70% of total billed charges ",116.15,528.24,
"BLEPHAROTOMY,EYE,DRAIN ABSCESS",4602090,"CDM ",450,RC,67700,HCPCS,OUTPATIENT,,,869.5,695.6,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",238.3,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",608.65,70,,486.92,,,0,"percent of total billed charges ","70% of total billed charges ",782.55,90,,626.04,,,0,"percent of total billed charges ","90% of total billed charges ",808.64,93,,646.91,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",739.08,85,,591.26,,,0,"percent of total billed charges ","85% of total billed charges ",652.13,90,,521.70,,,0,"percent of total billed charges ","90% of total billed charges ",782.55,90,,626.04,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",756.47,87,,605.18,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",291.89,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",608.65,70,,486.92,,,0,"percent of total billed charges ","70% of total billed charges ",238.3,808.64,
"EXC BENIGN LESION 0.6-1.0 CM",4602100,"CDM ",450,RC,11421,HCPCS,OUTPATIENT,,,2116.5,1693.2,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",783.57,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",225.68,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1481.55,70,,1185.24,,,0,"percent of total billed charges ","70% of total billed charges ",1904.85,90,,1523.88,,,0,"percent of total billed charges ","90% of total billed charges ",1968.35,93,,1574.68,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1799.03,85,,1439.22,,,0,"percent of total billed charges ","85% of total billed charges ",1587.38,90,,1269.90,,,0,"percent of total billed charges ","90% of total billed charges ",1904.85,90,,1523.88,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1841.36,87,,1473.09,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1481.55,70,,1185.24,,,0,"percent of total billed charges ","70% of total billed charges ",225.68,1968.35,
"REMOVAL CV CATHETER W/O",4602110,"CDM ",450,RC,36589,HCPCS,OUTPATIENT,,,1268.5,1014.8,,163.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",958.49,100,,224.38,224.38,224.38,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",283.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",887.95,70,,710.36,,,0,"percent of total billed charges ","70% of total billed charges ",1141.65,90,,913.32,,,0,"percent of total billed charges ","90% of total billed charges ",1179.71,93,,943.77,,,0,"percent of total billed charges ","93% of total billed charges ",163.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",208.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1078.23,85,,862.58,,,0,"percent of total billed charges ","85% of total billed charges ",951.38,90,,761.10,,,0,"percent of total billed charges ","90% of total billed charges ",1141.65,90,,913.32,,,0,"percent of total billed charges ","90% of total billed charges ",206.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1103.6,87,,882.88,,,0,"percent of total billed charges ","87% of total billed charges ",206.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",576.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",887.95,70,,710.36,,,0,"percent of total billed charges ","70% of total billed charges ",163.98,1179.71,
"CLSD TX ULNAR W/MANIP",4602120,"CDM ",450,RC,25535,HCPCS,OUTPATIENT,,,1579,1263.2,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",951.04,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1105.3,70,,884.24,,,0,"percent of total billed charges ","70% of total billed charges ",1421.1,90,,1136.88,,,0,"percent of total billed charges ","90% of total billed charges ",1468.47,93,,1174.78,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1342.15,85,,1073.72,,,0,"percent of total billed charges ","85% of total billed charges ",1184.25,90,,947.40,,,0,"percent of total billed charges ","90% of total billed charges ",1421.1,90,,1136.88,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1373.73,87,,1098.98,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1105.3,70,,884.24,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1468.47,
"CLSD TX SUPRACONDYLAR W/O MAN",4602130,"CDM ",450,RC,24530,HCPCS,OUTPATIENT,,,1338.5,1070.8,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,30.21,30.21,30.21,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",730.84,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",936.95,70,,749.56,,,0,"percent of total billed charges ","70% of total billed charges ",1204.65,90,,963.72,,,0,"percent of total billed charges ","90% of total billed charges ",1244.81,93,,995.85,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1137.73,85,,910.18,,,0,"percent of total billed charges ","85% of total billed charges ",1003.88,90,,803.10,,,0,"percent of total billed charges ","90% of total billed charges ",1204.65,90,,963.72,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1164.5,87,,931.60,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",936.95,70,,749.56,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1454.4,
"TX PROXIMAL TIBIA FRACTURE",4602140,"CDM ",450,RC,27530,HCPCS,OUTPATIENT,,,1924,1539.2,,364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",602.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1346.8,70,,1077.44,,,0,"percent of total billed charges ","70% of total billed charges ",1731.6,90,,1385.28,,,0,"percent of total billed charges ","90% of total billed charges ",1789.32,93,,1431.46,,,0,"percent of total billed charges ","93% of total billed charges ",364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1635.4,85,,1308.32,,,0,"percent of total billed charges ","85% of total billed charges ",1443,90,,1154.40,,,0,"percent of total billed charges ","90% of total billed charges ",1731.6,90,,1385.28,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1673.88,87,,1339.10,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1346.8,70,,1077.44,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1789.32,
"DEBRIDE INFECTED SKIN",4602150,"CDM ",450,RC,11000,HCPCS,OUTPATIENT,,,385,308,,228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",278.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",58.48,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",269.5,70,,215.60,,,0,"percent of total billed charges ","70% of total billed charges ",346.5,90,,277.20,,,0,"percent of total billed charges ","90% of total billed charges ",358.05,93,,286.44,,,0,"percent of total billed charges ","93% of total billed charges ",228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",327.25,85,,261.80,,,0,"percent of total billed charges ","85% of total billed charges ",288.75,90,,231.00,,,0,"percent of total billed charges ","90% of total billed charges ",346.5,90,,277.20,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",334.95,87,,267.96,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",269.5,70,,215.60,,,0,"percent of total billed charges ","70% of total billed charges ",58.48,373.85,
"EXC BENIGN LESION NECK",4602160,"CDM ",450,RC,11423,HCPCS,OUTPATIENT,,,652.5,522,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1640.24,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",320.41,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",456.75,70,,365.40,,,0,"percent of total billed charges ","70% of total billed charges ",587.25,90,,469.80,,,0,"percent of total billed charges ","90% of total billed charges ",606.83,93,,485.46,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",554.63,85,,443.70,,,0,"percent of total billed charges ","85% of total billed charges ",489.38,90,,391.50,,,0,"percent of total billed charges ","90% of total billed charges ",587.25,90,,469.80,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",567.68,87,,454.14,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",456.75,70,,365.40,,,0,"percent of total billed charges ","70% of total billed charges ",320.41,1640.24,
"RPR EXTENSOR TENDON FOOT",4602170,"CDM ",450,RC,28208,HCPCS,OUTPATIENT,,,1445,1156,,1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1402.45,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",662.9,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1011.5,70,,809.20,,,0,"percent of total billed charges ","70% of total billed charges ",1300.5,90,,1040.40,,,0,"percent of total billed charges ","90% of total billed charges ",1343.85,93,,1075.08,,,0,"percent of total billed charges ","93% of total billed charges ",1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1228.25,85,,982.60,,,0,"percent of total billed charges ","85% of total billed charges ",1083.75,90,,867.00,,,0,"percent of total billed charges ","90% of total billed charges ",1300.5,90,,1040.40,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1257.15,87,,1005.72,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3009.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1011.5,70,,809.20,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,3009.11,
"APPLICATION SHORT ARM CAST",4602180,"CDM ",450,RC,29075,HCPCS,OUTPATIENT,,,703.5,562.8,,228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",432.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",125.71,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",492.45,70,,393.96,,,0,"percent of total billed charges ","70% of total billed charges ",633.15,90,,506.52,,,0,"percent of total billed charges ","90% of total billed charges ",654.26,93,,523.41,,,0,"percent of total billed charges ","93% of total billed charges ",228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",597.98,85,,478.38,,,0,"percent of total billed charges ","85% of total billed charges ",527.63,90,,422.10,,,0,"percent of total billed charges ","90% of total billed charges ",633.15,90,,506.52,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",612.05,87,,39.71,39.71,39.71,"1 through 10","percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.22,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",492.45,70,,393.96,,,0,"percent of total billed charges ","70% of total billed charges ",125.71,654.26,
"CLSD TX PHALANX W/MANIP",4602190,"CDM ",450,RC,28515,HCPCS,OUTPATIENT,,,561,448.8,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",432.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",296.47,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",392.7,70,,314.16,,,0,"percent of total billed charges ","70% of total billed charges ",504.9,90,,403.92,,,0,"percent of total billed charges ","90% of total billed charges ",521.73,93,,417.38,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",476.85,85,,381.48,,,0,"percent of total billed charges ","85% of total billed charges ",420.75,90,,336.60,,,0,"percent of total billed charges ","90% of total billed charges ",504.9,90,,403.92,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",488.07,87,,390.46,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",392.7,70,,314.16,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,521.73,
"SUTURE OF ARTERY",4602210,"CDM ",450,RC,35206,HCPCS,OUTPATIENT,,,2519,2015.2,,1032.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1538.23,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1579.03,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1763.3,70,,1410.64,,,0,"percent of total billed charges ","70% of total billed charges ",2267.1,90,,1813.68,,,0,"percent of total billed charges ","90% of total billed charges ",2342.67,93,,1874.14,,,0,"percent of total billed charges ","93% of total billed charges ",1032.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2141.15,85,,1712.92,,,0,"percent of total billed charges ","85% of total billed charges ",1889.25,90,,1511.40,,,0,"percent of total billed charges ","90% of total billed charges ",2267.1,90,,1813.68,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2191.53,87,,1753.22,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2903.79,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1763.3,70,,1410.64,,,0,"percent of total billed charges ","70% of total billed charges ",457.91,2903.79,
"EXTERNAL PACEMAKER",4602220,"CDM ",450,RC,92953,HCPCS,OUTPATIENT,,,578.5,462.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.78,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",404.95,70,,323.96,,,0,"percent of total billed charges ","70% of total billed charges ",520.65,90,,416.52,,,0,"percent of total billed charges ","90% of total billed charges ",538.01,93,,430.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",491.73,85,,393.38,,,0,"percent of total billed charges ","85% of total billed charges ",520.65,90,,416.52,,,0,"percent of total billed charges ","90% of total billed charges ",520.65,90,,416.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",503.3,87,,402.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",607.84,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",404.95,70,,323.96,,,0,"percent of total billed charges ","70% of total billed charges ",1.78,607.84,
"CARDIOVERSION (FACILITY)",4602230,"CDM ",450,RC,92960,HCPCS,OUTPATIENT,,,1217,973.6,,210.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",481.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",227.66,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",851.9,70,,681.52,,,0,"percent of total billed charges ","70% of total billed charges ",1095.3,90,,876.24,,,0,"percent of total billed charges ","90% of total billed charges ",1131.81,93,,905.45,,,0,"percent of total billed charges ","93% of total billed charges ",210.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1034.45,85,,827.56,,,0,"percent of total billed charges ","85% of total billed charges ",1095.3,90,,876.24,,,0,"percent of total billed charges ","90% of total billed charges ",1095.3,90,,876.24,,,0,"percent of total billed charges ","90% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1058.79,87,,847.03,,,0,"percent of total billed charges ","87% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",607.84,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",851.9,70,,681.52,,,0,"percent of total billed charges ","70% of total billed charges ",196.25,1131.81,
"HAND/FINGER STRAPPING",4602260,"CDM ",450,RC,29280,HCPCS,OUTPATIENT,,,384.5,307.6,,22.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",41.45,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",357.59,93,,286.07,,,0,"percent of total billed charges ","93% of total billed charges ",22.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",326.83,85,,261.46,,,0,"percent of total billed charges ","85% of total billed charges ",288.38,90,,230.70,,,0,"percent of total billed charges ","90% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",26.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",334.52,87,,267.62,,,0,"percent of total billed charges ","87% of total billed charges ",26.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",22.85,357.59,
"REPAIR BLD VESSEL LOWER EXT",4602270,"CDM ",450,RC,35226,HCPCS,OUTPATIENT,,,4712,3769.6,,343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1538.23,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1670.26,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3298.4,70,,2638.72,,,0,"percent of total billed charges ","70% of total billed charges ",4240.8,90,,3392.64,,,0,"percent of total billed charges ","90% of total billed charges ",4382.16,93,,3505.73,,,0,"percent of total billed charges ","93% of total billed charges ",343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4005.2,85,,3204.16,,,0,"percent of total billed charges ","85% of total billed charges ",3534,90,,2827.20,,,0,"percent of total billed charges ","90% of total billed charges ",4240.8,90,,3392.64,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4099.44,87,,3279.55,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3298.4,70,,2638.72,,,0,"percent of total billed charges ","70% of total billed charges ",343.2,4382.16,
"REPAIR LIP FULL THICKNESS",4602280,"CDM ",450,RC,40650,HCPCS,OUTPATIENT,,,1451.5,1161.2,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2008.89,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",640.9,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1016.05,70,,812.84,,,0,"percent of total billed charges ","70% of total billed charges ",1306.35,90,,1045.08,,,0,"percent of total billed charges ","90% of total billed charges ",1349.9,93,,1079.92,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1233.78,85,,987.02,,,0,"percent of total billed charges ","85% of total billed charges ",1088.63,90,,870.90,,,0,"percent of total billed charges ","90% of total billed charges ",1306.35,90,,1045.08,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1262.81,87,,1010.25,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",495.99,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1016.05,70,,812.84,,,0,"percent of total billed charges ","70% of total billed charges ",257.4,2008.89,
"BLADDER IRRIGATION",4602290,"CDM ",450,RC,51700,HCPCS,OUTPATIENT,,,415.5,332.4,,171.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",312.17,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",63.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",290.85,70,,232.68,,,0,"percent of total billed charges ","70% of total billed charges ",373.95,90,,299.16,,,0,"percent of total billed charges ","90% of total billed charges ",386.42,93,,309.14,,,0,"percent of total billed charges ","93% of total billed charges ",171.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",353.18,85,,282.54,,,0,"percent of total billed charges ","85% of total billed charges ",311.63,90,,249.30,,,0,"percent of total billed charges ","90% of total billed charges ",373.95,90,,299.16,,,0,"percent of total billed charges ","90% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",361.49,87,,289.19,,,0,"percent of total billed charges ","87% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",229.77,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",290.85,70,,232.68,,,0,"percent of total billed charges ","70% of total billed charges ",63.32,386.42,
"CLOSED TX DISTAL TIBIA W/O",4602300,"CDM ",450,RC,27824,HCPCS,OUTPATIENT,,,1791,1432.8,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",634.81,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1253.7,70,,1002.96,,,0,"percent of total billed charges ","70% of total billed charges ",1611.9,90,,1289.52,,,0,"percent of total billed charges ","90% of total billed charges ",1665.63,93,,1332.50,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1522.35,85,,1217.88,,,0,"percent of total billed charges ","85% of total billed charges ",1343.25,90,,1074.60,,,0,"percent of total billed charges ","90% of total billed charges ",1611.9,90,,1289.52,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1558.17,87,,1246.54,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1253.7,70,,1002.96,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1665.63,
"APPLY SHORT LEG CAST/WALKING",4602310,"CDM ",450,RC,29425,HCPCS,OUTPATIENT,,,469,375.2,,228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",111.39,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",328.3,70,,262.64,,,0,"percent of total billed charges ","70% of total billed charges ",422.1,90,,337.68,,,0,"percent of total billed charges ","90% of total billed charges ",436.17,93,,348.94,,,0,"percent of total billed charges ","93% of total billed charges ",228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",398.65,85,,318.92,,,0,"percent of total billed charges ","85% of total billed charges ",351.75,90,,281.40,,,0,"percent of total billed charges ","90% of total billed charges ",422.1,90,,337.68,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",408.03,87,,326.42,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.22,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",328.3,70,,262.64,,,0,"percent of total billed charges ","70% of total billed charges ",111.39,436.17,
"CLSD TX SHLDR W/MANIP & ANESTH",4602320,"CDM ",450,RC,23655,HCPCS,OUTPATIENT,,,2653.5,2122.8,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,2343.45,2343.45,2343.45,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",849,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1857.45,70,,1485.96,,,0,"percent of total billed charges ","70% of total billed charges ",2388.15,90,,1910.52,,,0,"percent of total billed charges ","90% of total billed charges ",2467.76,93,,1974.21,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2255.48,85,,1804.38,,,0,"percent of total billed charges ","85% of total billed charges ",1990.13,90,,1592.10,,,0,"percent of total billed charges ","90% of total billed charges ",2388.15,90,,1910.52,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2308.55,87,,1846.84,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1857.45,70,,1485.96,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,2467.76,
"CR SHOULDER DISLOC W/FX TUBER",4602330,"CDM ",450,RC,23665,HCPCS,OUTPATIENT,,,469.5,375.6,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",830.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",328.65,70,,262.92,,,0,"percent of total billed charges ","70% of total billed charges ",422.55,90,,338.04,,,0,"percent of total billed charges ","90% of total billed charges ",436.64,93,,349.31,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",399.08,85,,319.26,,,0,"percent of total billed charges ","85% of total billed charges ",352.13,90,,281.70,,,0,"percent of total billed charges ","90% of total billed charges ",422.55,90,,338.04,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",408.47,87,,326.78,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",328.65,70,,262.92,,,0,"percent of total billed charges ","70% of total billed charges ",327.08,1478.8,
"INSERT STRAIGHT URINARY CATH",4602340,"CDM ",450,RC,51701,HCPCS,OUTPATIENT,,,134.5,107.6,,41.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",144.89,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",53.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",94.15,70,,75.32,,,0,"percent of total billed charges ","70% of total billed charges ",121.05,90,,96.84,,,0,"percent of total billed charges ","90% of total billed charges ",125.09,93,,100.07,,,0,"percent of total billed charges ","93% of total billed charges ",41.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",114.33,85,,91.46,,,0,"percent of total billed charges ","85% of total billed charges ",100.88,90,,80.70,,,0,"percent of total billed charges ","90% of total billed charges ",121.05,90,,96.84,,,0,"percent of total billed charges ","90% of total billed charges ",31.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.02,87,,93.62,,,0,"percent of total billed charges ","87% of total billed charges ",31.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",94.15,70,,75.32,,,0,"percent of total billed charges ","70% of total billed charges ",31.19,144.89,
"I&D POST PROC WOUND INFECTION",4602350,"CDM ",450,RC,10180,HCPCS,OUTPATIENT,,,3767.5,3014,,920.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3784.47,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",362.58,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2637.25,70,,2109.80,,,0,"percent of total billed charges ","70% of total billed charges ",3390.75,90,,2712.60,,,0,"percent of total billed charges ","90% of total billed charges ",3503.78,93,,2803.02,,,0,"percent of total billed charges ","93% of total billed charges ",920.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3202.38,85,,2561.90,,,0,"percent of total billed charges ","85% of total billed charges ",2825.63,90,,2260.50,,,0,"percent of total billed charges ","90% of total billed charges ",3390.75,90,,2712.60,,,0,"percent of total billed charges ","90% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3277.73,87,,207.83,207.83,207.83,"1 through 10","percent of total billed charges ","87% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2671.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2637.25,70,,2109.80,,,0,"percent of total billed charges ","70% of total billed charges ",255.12,3784.47,
"FURTHER AMPUTATION",4602360,"CDM ",450,RC,26951,HCPCS,OUTPATIENT,,,2918,2334.4,,1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3595,100,,210.32,210.32,210.32,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1465.68,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2042.6,70,,1634.08,,,0,"percent of total billed charges ","70% of total billed charges ",2626.2,90,,2100.96,,,0,"percent of total billed charges ","90% of total billed charges ",2713.74,93,,2170.99,,,0,"percent of total billed charges ","93% of total billed charges ",1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2480.3,85,,1984.24,,,0,"percent of total billed charges ","85% of total billed charges ",2188.5,90,,1750.80,,,0,"percent of total billed charges ","90% of total billed charges ",2626.2,90,,2100.96,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2538.66,87,,2030.93,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3009.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2042.6,70,,1634.08,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,3595,
"RECONSTRUCT NAILBED W/GRAFT",4602390,"CDM ",450,RC,11762,HCPCS,OUTPATIENT,,,381.5,305.2,,590.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",371.68,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",392.61,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",267.05,70,,213.64,,,0,"percent of total billed charges ","70% of total billed charges ",343.35,90,,274.68,,,0,"percent of total billed charges ","90% of total billed charges ",354.8,93,,283.84,,,0,"percent of total billed charges ","93% of total billed charges ",590.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",324.28,85,,259.42,,,0,"percent of total billed charges ","85% of total billed charges ",286.13,90,,228.90,,,0,"percent of total billed charges ","90% of total billed charges ",343.35,90,,274.68,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",331.91,87,,265.53,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1897.5,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",267.05,70,,213.64,,,0,"percent of total billed charges ","70% of total billed charges ",267.05,1897.5,
"CLSD TX CALCANEAL FX W/O MANIP",4602400,"CDM ",450,RC,28400,HCPCS,OUTPATIENT,,,399.5,319.6,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",477.03,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",279.65,70,,223.72,,,0,"percent of total billed charges ","70% of total billed charges ",359.55,90,,287.64,,,0,"percent of total billed charges ","90% of total billed charges ",371.54,93,,297.23,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",339.58,85,,271.66,,,0,"percent of total billed charges ","85% of total billed charges ",299.63,90,,239.70,,,0,"percent of total billed charges ","90% of total billed charges ",359.55,90,,287.64,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",347.57,87,,278.06,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",279.65,70,,223.72,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,477.03,
"CLSD TX RADIAL/ULNA FX W/O MAN",4602410,"CDM ",450,RC,25560,HCPCS,OUTPATIENT,,,399.5,319.6,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",539.18,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",279.65,70,,223.72,,,0,"percent of total billed charges ","70% of total billed charges ",359.55,90,,287.64,,,0,"percent of total billed charges ","90% of total billed charges ",371.54,93,,297.23,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",339.58,85,,271.66,,,0,"percent of total billed charges ","85% of total billed charges ",299.63,90,,239.70,,,0,"percent of total billed charges ","90% of total billed charges ",359.55,90,,287.64,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",347.57,87,,278.06,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",279.65,70,,223.72,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1454.4,
"CLSD TX POST HIP DISLOC W/O AN",4602420,"CDM ",450,RC,27265,HCPCS,OUTPATIENT,,,432,345.6,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",848.94,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",302.4,70,,241.92,,,0,"percent of total billed charges ","70% of total billed charges ",388.8,90,,311.04,,,0,"percent of total billed charges ","90% of total billed charges ",401.76,93,,321.41,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",367.2,85,,293.76,,,0,"percent of total billed charges ","85% of total billed charges ",324,90,,259.20,,,0,"percent of total billed charges ","90% of total billed charges ",388.8,90,,311.04,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",375.84,87,,300.67,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",302.4,70,,241.92,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,848.94,
"OUTER EAR SURGERY",4602440,"CDM ",450,RC,69399,HCPCS,OUTPATIENT,,,495.5,396.4,,96.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",346.85,70,,277.48,,,0,"percent of total billed charges ","70% of total billed charges ",445.95,90,,356.76,,,0,"percent of total billed charges ","90% of total billed charges ",460.82,93,,368.66,,,0,"percent of total billed charges ","93% of total billed charges ",96.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",111.41,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",421.18,85,,336.94,,,0,"percent of total billed charges ","85% of total billed charges ",371.63,90,,297.30,,,0,"percent of total billed charges ","90% of total billed charges ",445.95,90,,356.76,,,0,"percent of total billed charges ","90% of total billed charges ",110.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",431.09,87,,344.87,,,0,"percent of total billed charges ","87% of total billed charges ",110.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.82,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",346.85,70,,277.48,,,0,"percent of total billed charges ","70% of total billed charges ",96.46,460.82,
"TX ULNA SHAFT FRACTURE",4602450,"CDM ",450,RC,25530,HCPCS,OUTPATIENT,,,1849.5,1479.6,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",504.55,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1294.65,70,,1035.72,,,0,"percent of total billed charges ","70% of total billed charges ",1664.55,90,,1331.64,,,0,"percent of total billed charges ","90% of total billed charges ",1720.04,93,,1376.03,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1572.08,85,,1257.66,,,0,"percent of total billed charges ","85% of total billed charges ",1387.13,90,,1109.70,,,0,"percent of total billed charges ","90% of total billed charges ",1664.55,90,,1331.64,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1609.07,87,,1287.26,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1294.65,70,,1035.72,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1720.04,
"I&D UPPER ELBOW/ARM",4602460,"CDM ",450,RC,23931,HCPCS,OUTPATIENT,,,2312,1849.6,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",330.29,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1618.4,70,,1294.72,,,0,"percent of total billed charges ","70% of total billed charges ",2080.8,90,,1664.64,,,0,"percent of total billed charges ","90% of total billed charges ",2150.16,93,,1720.13,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1965.2,85,,1572.16,,,0,"percent of total billed charges ","85% of total billed charges ",1734,90,,1387.20,,,0,"percent of total billed charges ","90% of total billed charges ",2080.8,90,,1664.64,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2011.44,87,,1609.15,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1618.4,70,,1294.72,,,0,"percent of total billed charges ","70% of total billed charges ",330.29,2150.16,
"CLSD TX BIMALLEOLAR ANKLE W/",4602470,"CDM ",450,RC,27810,HCPCS,OUTPATIENT,,,2523,2018.4,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",883.72,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1766.1,70,,1412.88,,,0,"percent of total billed charges ","70% of total billed charges ",2270.7,90,,1816.56,,,0,"percent of total billed charges ","90% of total billed charges ",2346.39,93,,1877.11,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2144.55,85,,1715.64,,,0,"percent of total billed charges ","85% of total billed charges ",1892.25,90,,1513.80,,,0,"percent of total billed charges ","90% of total billed charges ",2270.7,90,,1816.56,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2195.01,87,,1756.01,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1766.1,70,,1412.88,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,2346.39,
"I&D PERIANAL ABSCESS",4602480,"CDM ",450,RC,46050,HCPCS,OUTPATIENT,,,921.5,737.2,,296.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",919.1,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",206.45,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",645.05,70,,516.04,,,0,"percent of total billed charges ","70% of total billed charges ",829.35,90,,663.48,,,0,"percent of total billed charges ","90% of total billed charges ",857,93,,685.60,,,0,"percent of total billed charges ","93% of total billed charges ",296.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",783.28,85,,626.62,,,0,"percent of total billed charges ","85% of total billed charges ",691.13,90,,552.90,,,0,"percent of total billed charges ","90% of total billed charges ",829.35,90,,663.48,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",801.71,87,,641.37,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",855.24,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",645.05,70,,516.04,,,0,"percent of total billed charges ","70% of total billed charges ",206.45,919.1,
"TX HUMERUS FRACTURE",4602490,"CDM ",450,RC,23620,HCPCS,OUTPATIENT,,,399.5,319.6,,364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",542.34,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",279.65,70,,223.72,,,0,"percent of total billed charges ","70% of total billed charges ",359.55,90,,287.64,,,0,"percent of total billed charges ","90% of total billed charges ",371.54,93,,297.23,,,0,"percent of total billed charges ","93% of total billed charges ",364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",339.58,85,,271.66,,,0,"percent of total billed charges ","85% of total billed charges ",299.63,90,,239.70,,,0,"percent of total billed charges ","90% of total billed charges ",359.55,90,,287.64,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",347.57,87,,278.06,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",279.65,70,,223.72,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1454.4,
"ASPIRATION GANGLION CYST",4602500,"CDM ",450,RC,20612,HCPCS,OUTPATIENT,,,469,375.2,,192.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",142.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",85.12,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",328.3,70,,262.64,,,0,"percent of total billed charges ","70% of total billed charges ",422.1,90,,337.68,,,0,"percent of total billed charges ","90% of total billed charges ",436.17,93,,348.94,,,0,"percent of total billed charges ","93% of total billed charges ",192.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",222,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",398.65,85,,318.92,,,0,"percent of total billed charges ","85% of total billed charges ",351.75,90,,281.40,,,0,"percent of total billed charges ","90% of total billed charges ",422.1,90,,337.68,,,0,"percent of total billed charges ","90% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",408.03,87,,326.42,,,0,"percent of total billed charges ","87% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",282.29,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",328.3,70,,262.64,,,0,"percent of total billed charges ","70% of total billed charges ",85.12,436.17,
"HEMORRHAGE OROPHARYNGEAL SIMP",4602510,"CDM ",450,RC,42960,HCPCS,OUTPATIENT,,,299.5,239.6,,343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2738.11,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",335.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",209.65,70,,167.72,,,0,"percent of total billed charges ","70% of total billed charges ",269.55,90,,215.64,,,0,"percent of total billed charges ","90% of total billed charges ",278.54,93,,222.83,,,0,"percent of total billed charges ","93% of total billed charges ",343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",254.58,85,,203.66,,,0,"percent of total billed charges ","85% of total billed charges ",224.63,90,,179.70,,,0,"percent of total billed charges ","90% of total billed charges ",269.55,90,,215.64,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",260.57,87,,208.46,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",495.99,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",209.65,70,,167.72,,,0,"percent of total billed charges ","70% of total billed charges ",209.65,2738.11,
"APPLY CAST SHOULDER TO HAND",4602520,"CDM ",450,RC,29065,HCPCS,OUTPATIENT,,,598,478.4,,228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",432.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",138.86,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",418.6,70,,334.88,,,0,"percent of total billed charges ","70% of total billed charges ",538.2,90,,430.56,,,0,"percent of total billed charges ","90% of total billed charges ",556.14,93,,444.91,,,0,"percent of total billed charges ","93% of total billed charges ",228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",508.3,85,,406.64,,,0,"percent of total billed charges ","85% of total billed charges ",448.5,90,,358.80,,,0,"percent of total billed charges ","90% of total billed charges ",538.2,90,,430.56,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",520.26,87,,53.17,53.17,53.17,"1 through 10","percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.22,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",418.6,70,,334.88,,,0,"percent of total billed charges ","70% of total billed charges ",138.86,556.14,
"TX PATELLA FX IMMOBILIZATION",4602530,"CDM ",450,RC,27520,HCPCS,OUTPATIENT,,,399.5,319.6,,,,,,,,0,"other ","not separately reimbursment ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",627.04,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",279.65,70,,223.72,,,0,"percent of total billed charges ","70% of total billed charges ",359.55,90,,287.64,,,0,"percent of total billed charges ","90% of total billed charges ",371.54,93,,297.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",339.58,85,,271.66,,,0,"percent of total billed charges ","85% of total billed charges ",299.63,90,,239.70,,,0,"percent of total billed charges ","90% of total billed charges ",359.55,90,,287.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",347.57,87,,278.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",279.65,70,,223.72,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1454.4,
"PROCTOSIGMOIDOSCOPY REM FB",4602540,"CDM ",450,RC,45307,HCPCS,OUTPATIENT,,,700,560,,,,,,,,0,"other ","not separately reimbursment ",808,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",203.5,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",490,70,,392.00,,,0,"percent of total billed charges ","70% of total billed charges ",630,90,,504.00,,,0,"percent of total billed charges ","90% of total billed charges ",651,93,,520.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",595,85,,476.00,,,0,"percent of total billed charges ","85% of total billed charges ",525,90,,420.00,,,0,"percent of total billed charges ","90% of total billed charges ",630,90,,504.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",609,87,,487.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2552.65,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",490,70,,392.00,,,0,"percent of total billed charges ","70% of total billed charges ",203.5,2552.65,
"HAND TO LOWER ARM CAST APPLY",4602550,"CDM ",450,RC,29085,HCPCS,OUTPATIENT,,,598,478.4,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",432.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",137.13,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",418.6,70,,334.88,,,0,"percent of total billed charges ","70% of total billed charges ",538.2,90,,430.56,,,0,"percent of total billed charges ","90% of total billed charges ",556.14,93,,444.91,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",508.3,85,,406.64,,,0,"percent of total billed charges ","85% of total billed charges ",448.5,90,,358.80,,,0,"percent of total billed charges ","90% of total billed charges ",538.2,90,,430.56,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",520.26,87,,416.21,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",418.6,70,,334.88,,,0,"percent of total billed charges ","70% of total billed charges ",137.13,556.14,
"CARPOMETACARPAL FX THUMB W/MAN",4602560,"CDM ",450,RC,26645,HCPCS,OUTPATIENT,,,438.5,350.8,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",821.48,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",306.95,70,,245.56,,,0,"percent of total billed charges ","70% of total billed charges ",394.65,90,,315.72,,,0,"percent of total billed charges ","90% of total billed charges ",407.81,93,,326.25,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",372.73,85,,298.18,,,0,"percent of total billed charges ","85% of total billed charges ",328.88,90,,263.10,,,0,"percent of total billed charges ","90% of total billed charges ",394.65,90,,315.72,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",381.5,87,,305.20,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",306.95,70,,245.56,,,0,"percent of total billed charges ","70% of total billed charges ",306.95,1478.8,
"REP CENTRAL VEN DEVICE W/PUMP",4602570,"CDM ",450,RC,36576,HCPCS,OUTPATIENT,,,2952,2361.6,,163.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2224.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",377.48,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2066.4,70,,1653.12,,,0,"percent of total billed charges ","70% of total billed charges ",2656.8,90,,2125.44,,,0,"percent of total billed charges ","90% of total billed charges ",2745.36,93,,2196.29,,,0,"percent of total billed charges ","93% of total billed charges ",163.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",207.54,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2509.2,85,,2007.36,,,0,"percent of total billed charges ","85% of total billed charges ",2214,90,,1771.20,,,0,"percent of total billed charges ","90% of total billed charges ",2656.8,90,,2125.44,,,0,"percent of total billed charges ","90% of total billed charges ",205.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2568.24,87,,2054.59,,,0,"percent of total billed charges ","87% of total billed charges ",205.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1447.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2066.4,70,,1653.12,,,0,"percent of total billed charges ","70% of total billed charges ",163.35,2745.36,
"TX DISTAL RADIOULNAR W/MANIP",4602580,"CDM ",450,RC,25675,HCPCS,OUTPATIENT,,,1175,940,,338,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",844.38,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",822.5,70,,658.00,,,0,"percent of total billed charges ","70% of total billed charges ",1057.5,90,,846.00,,,0,"percent of total billed charges ","90% of total billed charges ",1092.75,93,,874.20,,,0,"percent of total billed charges ","93% of total billed charges ",338,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",429.45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",998.75,85,,799.00,,,0,"percent of total billed charges ","85% of total billed charges ",881.25,90,,705.00,,,0,"percent of total billed charges ","90% of total billed charges ",1057.5,90,,846.00,,,0,"percent of total billed charges ","90% of total billed charges ",425.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1022.25,87,,817.80,,,0,"percent of total billed charges ","87% of total billed charges ",425.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",822.5,70,,658.00,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1092.75,
"PARING BENIGN LESION",4602590,"CDM ",450,RC,11055,HCPCS,OUTPATIENT,,,273.5,218.8,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.71,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",33.55,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",191.45,70,,153.16,,,0,"percent of total billed charges ","70% of total billed charges ",246.15,90,,196.92,,,0,"percent of total billed charges ","90% of total billed charges ",254.36,93,,203.49,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",232.48,85,,185.98,,,0,"percent of total billed charges ","85% of total billed charges ",205.13,90,,164.10,,,0,"percent of total billed charges ","90% of total billed charges ",246.15,90,,196.92,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",237.95,87,,190.36,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",191.45,70,,153.16,,,0,"percent of total billed charges ","70% of total billed charges ",33.55,264.28,
"LEG/ANKLE SURGERY PROCEDURE",4602600,"CDM ",450,RC,27899,HCPCS,OUTPATIENT,,,474.5,379.6,,125.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",332.15,70,,265.72,,,0,"percent of total billed charges ","70% of total billed charges ",427.05,90,,341.64,,,0,"percent of total billed charges ","90% of total billed charges ",441.29,93,,353.03,,,0,"percent of total billed charges ","93% of total billed charges ",125.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",145.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",403.33,85,,322.66,,,0,"percent of total billed charges ","85% of total billed charges ",355.88,90,,284.70,,,0,"percent of total billed charges ","90% of total billed charges ",427.05,90,,341.64,,,0,"percent of total billed charges ","90% of total billed charges ",143.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",412.82,87,,330.26,,,0,"percent of total billed charges ","87% of total billed charges ",143.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",332.15,70,,265.72,,,0,"percent of total billed charges ","70% of total billed charges ",125.74,441.29,
"RPR COMPLEX FACE 2.6CM - 7.5CM",4602610,"CDM ",450,RC,13152,HCPCS,OUTPATIENT,,,1114,891.2,,,,,,,,0,"other ","not separately reimbursment ",1618.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",693.26,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",779.8,70,,623.84,,,0,"percent of total billed charges ","70% of total billed charges ",1002.6,90,,802.08,,,0,"percent of total billed charges ","90% of total billed charges ",1036.02,93,,828.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",946.9,85,,757.52,,,0,"percent of total billed charges ","85% of total billed charges ",835.5,90,,668.40,,,0,"percent of total billed charges ","90% of total billed charges ",1002.6,90,,802.08,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",969.18,87,,775.34,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",679.69,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",779.8,70,,623.84,,,0,"percent of total billed charges ","70% of total billed charges ",327.08,1618.02,
"CLSD TX FIBULA/SHAFT W/MANIP",4602620,"CDM ",450,RC,27781,HCPCS,OUTPATIENT,,,438.5,350.8,,,,,,,,0,"other ","not separately reimbursment ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",833.98,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",306.95,70,,245.56,,,0,"percent of total billed charges ","70% of total billed charges ",394.65,90,,315.72,,,0,"percent of total billed charges ","90% of total billed charges ",407.81,93,,326.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",372.73,85,,298.18,,,0,"percent of total billed charges ","85% of total billed charges ",328.88,90,,263.10,,,0,"percent of total billed charges ","90% of total billed charges ",394.65,90,,315.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",381.5,87,,305.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",306.95,70,,245.56,,,0,"percent of total billed charges ","70% of total billed charges ",306.95,1478.8,
"REPAIR OF HAND TENDON",4602630,"CDM ",450,RC,26410,HCPCS,OUTPATIENT,,,2671.5,2137.2,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1980.61,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1267.64,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1870.05,70,,1496.04,,,0,"percent of total billed charges ","70% of total billed charges ",2404.35,90,,1923.48,,,0,"percent of total billed charges ","90% of total billed charges ",2484.5,93,,1987.60,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2270.78,85,,1816.62,,,0,"percent of total billed charges ","85% of total billed charges ",2003.63,90,,1602.90,,,0,"percent of total billed charges ","90% of total billed charges ",2404.35,90,,1923.48,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2324.21,87,,1859.37,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1870.05,70,,1496.04,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,2484.5,
"FRACTURE HUMERUS/ELBOW",4602640,"CDM ",450,RC,24999,HCPCS,OUTPATIENT,,,474.5,379.6,,125.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",332.15,70,,265.72,,,0,"percent of total billed charges ","70% of total billed charges ",427.05,90,,341.64,,,0,"percent of total billed charges ","90% of total billed charges ",441.29,93,,353.03,,,0,"percent of total billed charges ","93% of total billed charges ",125.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",145.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",403.33,85,,322.66,,,0,"percent of total billed charges ","85% of total billed charges ",355.88,90,,284.70,,,0,"percent of total billed charges ","90% of total billed charges ",427.05,90,,341.64,,,0,"percent of total billed charges ","90% of total billed charges ",143.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",412.82,87,,330.26,,,0,"percent of total billed charges ","87% of total billed charges ",143.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",332.15,70,,265.72,,,0,"percent of total billed charges ","70% of total billed charges ",125.74,441.29,
"FOREIGN BODY REMOVAL EYELID",4602650,"CDM ",450,RC,67938,HCPCS,OUTPATIENT,,,302.5,242,,364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",346.43,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",241.6,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",211.75,70,,169.40,,,0,"percent of total billed charges ","70% of total billed charges ",272.25,90,,217.80,,,0,"percent of total billed charges ","90% of total billed charges ",281.33,93,,225.06,,,0,"percent of total billed charges ","93% of total billed charges ",364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",257.13,85,,205.70,,,0,"percent of total billed charges ","85% of total billed charges ",226.88,90,,181.50,,,0,"percent of total billed charges ","90% of total billed charges ",272.25,90,,217.80,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",263.18,87,,210.54,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",291.89,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",211.75,70,,169.40,,,0,"percent of total billed charges ","70% of total billed charges ",211.75,462.49,
"IUD REMOVAL",4602660,"CDM ",450,RC,58301,HCPCS,OUTPATIENT,,,462.5,370,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",137.52,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",323.75,70,,259.00,,,0,"percent of total billed charges ","70% of total billed charges ",416.25,90,,333.00,,,0,"percent of total billed charges ","90% of total billed charges ",430.13,93,,344.10,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",393.13,85,,314.50,,,0,"percent of total billed charges ","85% of total billed charges ",346.88,90,,277.50,,,0,"percent of total billed charges ","90% of total billed charges ",416.25,90,,333.00,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",402.38,87,,110.97,110.97,110.97,"1 through 10","percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",280.24,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",323.75,70,,259.00,,,0,"percent of total billed charges ","70% of total billed charges ",137.52,430.13,
"CLSD TX PATELLAR DISLOCATION",4602670,"CDM ",450,RC,27562,HCPCS,OUTPATIENT,,,2449.5,1959.6,,364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2526.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1013.52,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1714.65,70,,1371.72,,,0,"percent of total billed charges ","70% of total billed charges ",2204.55,90,,1763.64,,,0,"percent of total billed charges ","90% of total billed charges ",2278.04,93,,1822.43,,,0,"percent of total billed charges ","93% of total billed charges ",364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2082.08,85,,1665.66,,,0,"percent of total billed charges ","85% of total billed charges ",1837.13,90,,1469.70,,,0,"percent of total billed charges ","90% of total billed charges ",2204.55,90,,1763.64,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2131.07,87,,1704.86,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1714.65,70,,1371.72,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,2526.01,
"RPR TEND/MUSC UPPER ARM/ELBOW",4602680,"CDM ",450,RC,24341,HCPCS,OUTPATIENT,,,6169,4935.2,,2317.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4454.1,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1534.63,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4318.3,70,,3454.64,,,0,"percent of total billed charges ","70% of total billed charges ",5552.1,90,,4441.68,,,0,"percent of total billed charges ","90% of total billed charges ",5737.17,93,,4589.74,,,0,"percent of total billed charges ","93% of total billed charges ",2317.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",594.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5243.65,85,,4194.92,,,0,"percent of total billed charges ","85% of total billed charges ",4626.75,90,,3701.40,,,0,"percent of total billed charges ","90% of total billed charges ",5552.1,90,,4441.68,,,0,"percent of total billed charges ","90% of total billed charges ",588.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5367.03,87,,4293.62,,,0,"percent of total billed charges ","87% of total billed charges ",588.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6673.22,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4318.3,70,,3454.64,,,0,"percent of total billed charges ","70% of total billed charges ",588.74,6673.22,
"TENDON INJECTION",4602690,"CDM ",450,RC,20550,HCPCS,OUTPATIENT,,,469,375.2,,192.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",142.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",81.31,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",328.3,70,,262.64,,,0,"percent of total billed charges ","70% of total billed charges ",422.1,90,,337.68,,,0,"percent of total billed charges ","90% of total billed charges ",436.17,93,,348.94,,,0,"percent of total billed charges ","93% of total billed charges ",192.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",222,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",398.65,85,,318.92,,,0,"percent of total billed charges ","85% of total billed charges ",351.75,90,,281.40,,,0,"percent of total billed charges ","90% of total billed charges ",422.1,90,,337.68,,,0,"percent of total billed charges ","90% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",408.03,87,,326.42,,,0,"percent of total billed charges ","87% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",282.29,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",328.3,70,,262.64,,,0,"percent of total billed charges ","70% of total billed charges ",81.31,436.17,
"I&D PERITONSILLAR ABCESS",4602700,"CDM ",450,RC,42700,HCPCS,OUTPATIENT,,,417,333.6,,400.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",279.64,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",291.9,70,,233.52,,,0,"percent of total billed charges ","70% of total billed charges ",375.3,90,,300.24,,,0,"percent of total billed charges ","90% of total billed charges ",387.81,93,,310.25,,,0,"percent of total billed charges ","93% of total billed charges ",400.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",508.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",354.45,85,,283.56,,,0,"percent of total billed charges ","85% of total billed charges ",312.75,90,,250.20,,,0,"percent of total billed charges ","90% of total billed charges ",375.3,90,,300.24,,,0,"percent of total billed charges ","90% of total billed charges ",503.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",362.79,87,,290.23,,,0,"percent of total billed charges ","87% of total billed charges ",503.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.82,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",291.9,70,,233.52,,,0,"percent of total billed charges ","70% of total billed charges ",217.82,508.74,
"TX HUMERUS FX W/MANIP",4602710,"CDM ",450,RC,24505,HCPCS,OUTPATIENT,,,438.5,350.8,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",939.53,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",306.95,70,,245.56,,,0,"percent of total billed charges ","70% of total billed charges ",394.65,90,,315.72,,,0,"percent of total billed charges ","90% of total billed charges ",407.81,93,,326.25,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",372.73,85,,298.18,,,0,"percent of total billed charges ","85% of total billed charges ",328.88,90,,263.10,,,0,"percent of total billed charges ","90% of total billed charges ",394.65,90,,315.72,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",381.5,87,,305.20,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",306.95,70,,245.56,,,0,"percent of total billed charges ","70% of total billed charges ",306.95,1478.8,
"REDUCE RECTAL PROLAPSE W/O ANE",4602720,"CDM ",450,RC,45900,HCPCS,OUTPATIENT,,,1014.5,811.6,,296.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",434.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",710.15,70,,568.12,,,0,"percent of total billed charges ","70% of total billed charges ",913.05,90,,730.44,,,0,"percent of total billed charges ","90% of total billed charges ",943.49,93,,754.79,,,0,"percent of total billed charges ","93% of total billed charges ",296.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",862.33,85,,689.86,,,0,"percent of total billed charges ","85% of total billed charges ",760.88,90,,608.70,,,0,"percent of total billed charges ","90% of total billed charges ",913.05,90,,730.44,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",882.62,87,,706.10,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",855.24,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",710.15,70,,568.12,,,0,"percent of total billed charges ","70% of total billed charges ",294.37,943.49,
"INSERT TEMP TRNSVNS 1 CHMB ELT",4602730,"CDM ",450,RC,33210,HCPCS,OUTPATIENT,,,14670,11736,,,,,,,,0,"other ","not separately reimbursment ",1624.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",328.48,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",10269,70,,8215.20,,,0,"percent of total billed charges ","70% of total billed charges ",13203,90,,10562.40,,,0,"percent of total billed charges ","90% of total billed charges ",13643.1,93,,10914.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12469.5,85,,9975.60,,,0,"percent of total billed charges ","85% of total billed charges ",11002.5,90,,8802.00,,,0,"percent of total billed charges ","90% of total billed charges ",13203,90,,10562.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12762.9,87,,10210.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",7610.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",10269,70,,8215.20,,,0,"percent of total billed charges ","70% of total billed charges ",328.48,13643.1,
"ASPIRATION SMALL JOINT",4602740,"CDM ",450,RC,20600,HCPCS,OUTPATIENT,,,469,375.2,,192.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",74.12,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",328.3,70,,262.64,,,0,"percent of total billed charges ","70% of total billed charges ",422.1,90,,337.68,,,0,"percent of total billed charges ","90% of total billed charges ",436.17,93,,348.94,,,0,"percent of total billed charges ","93% of total billed charges ",192.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",222,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",398.65,85,,318.92,,,0,"percent of total billed charges ","85% of total billed charges ",351.75,90,,281.40,,,0,"percent of total billed charges ","90% of total billed charges ",422.1,90,,337.68,,,0,"percent of total billed charges ","90% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",408.03,87,,326.42,,,0,"percent of total billed charges ","87% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",282.29,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",328.3,70,,262.64,,,0,"percent of total billed charges ","70% of total billed charges ",74.12,436.17,
"DEBRIDE TISSUE/MUSCLE/BONE",4602750,"CDM ",450,RC,11044,HCPCS,OUTPATIENT,,,1627.5,1302,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1805.43,100,,40.42,40.42,40.42,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",462.68,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1139.25,70,,911.40,,,0,"percent of total billed charges ","70% of total billed charges ",1464.75,90,,1171.80,,,0,"percent of total billed charges ","90% of total billed charges ",1513.58,93,,1210.86,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1383.38,85,,1106.70,,,0,"percent of total billed charges ","85% of total billed charges ",1220.63,90,,976.50,,,0,"percent of total billed charges ","90% of total billed charges ",1464.75,90,,1171.80,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1415.93,87,,1132.74,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1139.25,70,,911.40,,,0,"percent of total billed charges ","70% of total billed charges ",261.66,1805.43,
"EXC TR-EXT BENIGN 3.1-4.0 CM",4602760,"CDM ",450,RC,11404,HCPCS,OUTPATIENT,,,2562.5,2050,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1513.99,100,,842.47,258.27,1426.67,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",336.31,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1793.75,70,,1435.00,,,0,"percent of total billed charges ","70% of total billed charges ",2306.25,90,,1845.00,,,0,"percent of total billed charges ","90% of total billed charges ",2383.13,93,,1906.50,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2178.13,85,,1742.50,,,0,"percent of total billed charges ","85% of total billed charges ",1921.88,90,,1537.50,,,0,"percent of total billed charges ","90% of total billed charges ",2306.25,90,,1845.00,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2229.38,87,,1783.50,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1793.75,70,,1435.00,,,0,"percent of total billed charges ","70% of total billed charges ",327.08,2383.13,
"CLSD TX HUMERAL EPIDONDYLAR FX",4602770,"CDM ",450,RC,24565,HCPCS,OUTPATIENT,,,438.5,350.8,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",964.7,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",306.95,70,,245.56,,,0,"percent of total billed charges ","70% of total billed charges ",394.65,90,,315.72,,,0,"percent of total billed charges ","90% of total billed charges ",407.81,93,,326.25,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",528.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",372.73,85,,298.18,,,0,"percent of total billed charges ","85% of total billed charges ",328.88,90,,263.10,,,0,"percent of total billed charges ","90% of total billed charges ",394.65,90,,315.72,,,0,"percent of total billed charges ","90% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",381.5,87,,305.20,,,0,"percent of total billed charges ","87% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",306.95,70,,245.56,,,0,"percent of total billed charges ","70% of total billed charges ",306.95,1478.8,
"CR KNEE DISLOCATION",4602780,"CDM ",450,RC,27550,HCPCS,OUTPATIENT,,,399.5,319.6,,364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",878.9,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",279.65,70,,223.72,,,0,"percent of total billed charges ","70% of total billed charges ",359.55,90,,287.64,,,0,"percent of total billed charges ","90% of total billed charges ",371.54,93,,297.23,,,0,"percent of total billed charges ","93% of total billed charges ",364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",339.58,85,,271.66,,,0,"percent of total billed charges ","85% of total billed charges ",299.63,90,,239.70,,,0,"percent of total billed charges ","90% of total billed charges ",359.55,90,,287.64,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",347.57,87,,278.06,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",279.65,70,,223.72,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,878.9,
"TOE NAIL BED REMOVAL",4602790,"CDM ",450,RC,11750,HCPCS,OUTPATIENT,,,1019.5,815.6,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",451.17,100,,238.35,238.35,238.35,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",212.26,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",713.65,70,,570.92,,,0,"percent of total billed charges ","70% of total billed charges ",917.55,90,,734.04,,,0,"percent of total billed charges ","90% of total billed charges ",948.14,93,,758.51,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",866.58,85,,693.26,,,0,"percent of total billed charges ","85% of total billed charges ",764.63,90,,611.70,,,0,"percent of total billed charges ","90% of total billed charges ",917.55,90,,734.04,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",886.97,87,,106.41,106.41,106.41,"1 through 10","percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",713.65,70,,570.92,,,0,"percent of total billed charges ","70% of total billed charges ",212.26,948.14,
"EXPLORE WOUND EXTREMITY",4602800,"CDM ",450,RC,20103,HCPCS,OUTPATIENT,,,862.5,690,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",310.07,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",708.6,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",603.75,70,,483.00,,,0,"percent of total billed charges ","70% of total billed charges ",776.25,90,,621.00,,,0,"percent of total billed charges ","90% of total billed charges ",802.13,93,,641.70,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",594.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",733.13,85,,586.50,,,0,"percent of total billed charges ","85% of total billed charges ",646.88,90,,517.50,,,0,"percent of total billed charges ","90% of total billed charges ",776.25,90,,621.00,,,0,"percent of total billed charges ","90% of total billed charges ",588.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",750.38,87,,600.30,,,0,"percent of total billed charges ","87% of total billed charges ",588.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",603.75,70,,483.00,,,0,"percent of total billed charges ","70% of total billed charges ",310.07,1518.9,
"TX CONDYLAR FX W/O MANIP",4602810,"CDM ",450,RC,24576,HCPCS,OUTPATIENT,,,385.5,308.4,,416,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",652.76,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",269.85,70,,215.88,,,0,"percent of total billed charges ","70% of total billed charges ",346.95,90,,277.56,,,0,"percent of total billed charges ","90% of total billed charges ",358.52,93,,286.82,,,0,"percent of total billed charges ","93% of total billed charges ",416,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",528.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",327.68,85,,262.14,,,0,"percent of total billed charges ","85% of total billed charges ",289.13,90,,231.30,,,0,"percent of total billed charges ","90% of total billed charges ",346.95,90,,277.56,,,0,"percent of total billed charges ","90% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",335.39,87,,268.31,,,0,"percent of total billed charges ","87% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",269.85,70,,215.88,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1454.4,
"CLSD TX SUPRACONDULAR W/MANIP",4602820,"CDM ",450,RC,24535,HCPCS,OUTPATIENT,,,2523,2018.4,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1178.08,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1766.1,70,,1412.88,,,0,"percent of total billed charges ","70% of total billed charges ",2270.7,90,,1816.56,,,0,"percent of total billed charges ","90% of total billed charges ",2346.39,93,,1877.11,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2144.55,85,,1715.64,,,0,"percent of total billed charges ","85% of total billed charges ",1892.25,90,,1513.80,,,0,"percent of total billed charges ","90% of total billed charges ",2270.7,90,,1816.56,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2195.01,87,,1756.01,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1766.1,70,,1412.88,,,0,"percent of total billed charges ","70% of total billed charges ",457.91,2346.39,
"MODERATE SEDATION < 5 YEARS",4602830,"CDM ",450,RC,99148,HCPCS,OUTPATIENT,,,1280,1024,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",896,70,,716.80,,,0,"percent of total billed charges ","70% of total billed charges ",1152,90,,921.60,,,0,"percent of total billed charges ","90% of total billed charges ",1190.4,93,,952.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1088,85,,870.40,,,0,"percent of total billed charges ","85% of total billed charges ",1152,90,,921.60,,,0,"percent of total billed charges ","90% of total billed charges ",1152,90,,921.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1113.6,87,,890.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",896,70,,716.80,,,0,"percent of total billed charges ","70% of total billed charges ",896,1190.4,
"DRAIN CEREBRAL SPINAL FLUID",4602850,"CDM ",450,RC,62272,HCPCS,OUTPATIENT,,,855,684,,224.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",433.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",179.5,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",598.5,70,,478.80,,,0,"percent of total billed charges ","70% of total billed charges ",769.5,90,,615.60,,,0,"percent of total billed charges ","90% of total billed charges ",795.15,93,,636.12,,,0,"percent of total billed charges ","93% of total billed charges ",224.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",165.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",726.75,85,,581.40,,,0,"percent of total billed charges ","85% of total billed charges ",641.25,90,,513.00,,,0,"percent of total billed charges ","90% of total billed charges ",769.5,90,,615.60,,,0,"percent of total billed charges ","90% of total billed charges ",163.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",743.85,87,,595.08,,,0,"percent of total billed charges ","87% of total billed charges ",163.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",649.16,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",598.5,70,,478.80,,,0,"percent of total billed charges ","70% of total billed charges ",163.54,795.15,
"GREAT TOE DISLOCATION W/O ANES",4602860,"CDM ",450,RC,28630,HCPCS,OUTPATIENT,,,368,294.4,,114.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",229.04,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",257.6,70,,206.08,,,0,"percent of total billed charges ","70% of total billed charges ",331.2,90,,264.96,,,0,"percent of total billed charges ","90% of total billed charges ",342.24,93,,273.79,,,0,"percent of total billed charges ","93% of total billed charges ",114.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",312.8,85,,250.24,,,0,"percent of total billed charges ","85% of total billed charges ",276,90,,220.80,,,0,"percent of total billed charges ","90% of total billed charges ",331.2,90,,264.96,,,0,"percent of total billed charges ","90% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",320.16,87,,256.13,,,0,"percent of total billed charges ","87% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",257.6,70,,206.08,,,0,"percent of total billed charges ","70% of total billed charges ",114.4,809.01,
"CLOSED TX FIBULAR FX W/MANIP",4602870,"CDM ",450,RC,27788,HCPCS,OUTPATIENT,,,399,319.2,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",800.8,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",279.3,70,,223.44,,,0,"percent of total billed charges ","70% of total billed charges ",359.1,90,,287.28,,,0,"percent of total billed charges ","90% of total billed charges ",371.07,93,,296.86,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",339.15,85,,271.32,,,0,"percent of total billed charges ","85% of total billed charges ",299.25,90,,239.40,,,0,"percent of total billed charges ","90% of total billed charges ",359.1,90,,287.28,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",347.13,87,,277.70,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",279.3,70,,223.44,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1454.4,
"REPAIR FOREARM TENDON/MUSCLE",4602880,"CDM ",450,RC,25270,HCPCS,OUTPATIENT,,,4096,3276.8,,1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1402.45,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1022.43,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2867.2,70,,2293.76,,,0,"percent of total billed charges ","70% of total billed charges ",3686.4,90,,2949.12,,,0,"percent of total billed charges ","90% of total billed charges ",3809.28,93,,3047.42,,,0,"percent of total billed charges ","93% of total billed charges ",1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3481.6,85,,2785.28,,,0,"percent of total billed charges ","85% of total billed charges ",3072,90,,2457.60,,,0,"percent of total billed charges ","90% of total billed charges ",3686.4,90,,2949.12,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3563.52,87,,2850.82,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3009.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2867.2,70,,2293.76,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,3809.28,
"INSERTION OF PICC 5 YRS & >",4602890,"CDM ",450,RC,36569,HCPCS,OUTPATIENT,,,2084,1667.2,,3211,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",773.97,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",194.48,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1458.8,70,,1167.04,,,0,"percent of total billed charges ","70% of total billed charges ",1875.6,90,,1500.48,,,0,"percent of total billed charges ","90% of total billed charges ",1938.12,93,,1550.50,,,0,"percent of total billed charges ","93% of total billed charges ",3211,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4079.83,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1771.4,85,,1417.12,,,0,"percent of total billed charges ","85% of total billed charges ",1563,90,,1250.40,,,0,"percent of total billed charges ","90% of total billed charges ",1875.6,90,,1500.48,,,0,"percent of total billed charges ","90% of total billed charges ",4039.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1813.08,87,,1450.46,,,0,"percent of total billed charges ","87% of total billed charges ",4039.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1447.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1458.8,70,,1167.04,,,0,"percent of total billed charges ","70% of total billed charges ",194.48,4079.83,
"CLSD TX SUPRACONDYLAR FEMORAL",4602900,"CDM ",450,RC,27501,HCPCS,OUTPATIENT,,,438,350.4,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",963.6,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",306.6,70,,245.28,,,0,"percent of total billed charges ","70% of total billed charges ",394.2,90,,315.36,,,0,"percent of total billed charges ","90% of total billed charges ",407.34,93,,325.87,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",372.3,85,,297.84,,,0,"percent of total billed charges ","85% of total billed charges ",328.5,90,,262.80,,,0,"percent of total billed charges ","90% of total billed charges ",394.2,90,,315.36,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",381.06,87,,304.85,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",306.6,70,,245.28,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,963.6,
"EXC TX EXT B9-MARG <0.5 CM",4602910,"CDM ",450,RC,11400,HCPCS,OUTPATIENT,,,882,705.6,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",783.57,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",171.89,220,,69.69,69.69,69.69,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",617.4,70,,493.92,,,0,"percent of total billed charges ","70% of total billed charges ",793.8,90,,635.04,,,0,"percent of total billed charges ","90% of total billed charges ",820.26,93,,656.21,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",749.7,85,,599.76,,,0,"percent of total billed charges ","85% of total billed charges ",661.5,90,,529.20,,,0,"percent of total billed charges ","90% of total billed charges ",793.8,90,,635.04,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",767.34,87,,613.87,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",617.4,70,,493.92,,,0,"percent of total billed charges ","70% of total billed charges ",171.89,820.26,
"SKIN FULL GRAFT SCALP/ARM/LEG",4602920,"CDM ",450,RC,15220,HCPCS,OUTPATIENT,,,3105,2484,,590.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",348.45,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1251.21,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2173.5,70,,1738.80,,,0,"percent of total billed charges ","70% of total billed charges ",2794.5,90,,2235.60,,,0,"percent of total billed charges ","90% of total billed charges ",2887.65,93,,2310.12,,,0,"percent of total billed charges ","93% of total billed charges ",590.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2639.25,85,,2111.40,,,0,"percent of total billed charges ","85% of total billed charges ",2328.75,90,,1863.00,,,0,"percent of total billed charges ","90% of total billed charges ",2794.5,90,,2235.60,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2701.35,87,,2161.08,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1897.5,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2173.5,70,,1738.80,,,0,"percent of total billed charges ","70% of total billed charges ",348.45,2887.65,
"TX CLOSED ANKLE FX W/MANIP",4602930,"CDM ",450,RC,27760,HCPCS,OUTPATIENT,,,1924,1539.2,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",641.7,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1346.8,70,,1077.44,,,0,"percent of total billed charges ","70% of total billed charges ",1731.6,90,,1385.28,,,0,"percent of total billed charges ","90% of total billed charges ",1789.32,93,,1431.46,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1635.4,85,,1308.32,,,0,"percent of total billed charges ","85% of total billed charges ",1443,90,,1154.40,,,0,"percent of total billed charges ","90% of total billed charges ",1731.6,90,,1385.28,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1673.88,87,,1339.10,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1346.8,70,,1077.44,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1789.32,
"SKIN LESION SHAVE",4602940,"CDM ",450,RC,11305,HCPCS,OUTPATIENT,,,233,186.4,,171.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.71,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",80.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",163.1,70,,130.48,,,0,"percent of total billed charges ","70% of total billed charges ",209.7,90,,167.76,,,0,"percent of total billed charges ","90% of total billed charges ",216.69,93,,173.35,,,0,"percent of total billed charges ","93% of total billed charges ",171.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",198.05,85,,158.44,,,0,"percent of total billed charges ","85% of total billed charges ",174.75,90,,139.80,,,0,"percent of total billed charges ","90% of total billed charges ",209.7,90,,167.76,,,0,"percent of total billed charges ","90% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",202.71,87,,162.17,,,0,"percent of total billed charges ","87% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",163.1,70,,130.48,,,0,"percent of total billed charges ","70% of total billed charges ",80.28,217.71,
"REPAIR WOUND OR LESION",4602950,"CDM ",450,RC,13131,HCPCS,OUTPATIENT,,,1041.5,833.2,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",787.8,100,,909.19,909.19,909.19,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",499.77,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",729.05,70,,583.24,,,0,"percent of total billed charges ","70% of total billed charges ",937.35,90,,749.88,,,0,"percent of total billed charges ","90% of total billed charges ",968.6,93,,774.88,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",885.28,85,,708.22,,,0,"percent of total billed charges ","85% of total billed charges ",781.13,90,,624.90,,,0,"percent of total billed charges ","90% of total billed charges ",937.35,90,,749.88,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",906.11,87,,724.89,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",729.05,70,,583.24,,,0,"percent of total billed charges ","70% of total billed charges ",286,968.6,
"REMOVE/BIVALVING ARM/LEG CAST",4602970,"CDM ",450,RC,29705,HCPCS,OUTPATIENT,,,385,308,,228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",278.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",92.11,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",269.5,70,,215.60,,,0,"percent of total billed charges ","70% of total billed charges ",346.5,90,,277.20,,,0,"percent of total billed charges ","90% of total billed charges ",358.05,93,,286.44,,,0,"percent of total billed charges ","93% of total billed charges ",228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",327.25,85,,261.80,,,0,"percent of total billed charges ","85% of total billed charges ",288.75,90,,231.00,,,0,"percent of total billed charges ","90% of total billed charges ",346.5,90,,277.20,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",334.95,87,,267.96,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.22,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",269.5,70,,215.60,,,0,"percent of total billed charges ","70% of total billed charges ",92.11,358.05,
"EXC H/F/NK/SP BENIGN MARGIN",4602980,"CDM ",450,RC,11422,HCPCS,OUTPATIENT,,,1363,1090.4,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1805.43,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",279,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",954.1,70,,763.28,,,0,"percent of total billed charges ","70% of total billed charges ",1226.7,90,,981.36,,,0,"percent of total billed charges ","90% of total billed charges ",1267.59,93,,1014.07,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1158.55,85,,926.84,,,0,"percent of total billed charges ","85% of total billed charges ",1022.25,90,,817.80,,,0,"percent of total billed charges ","90% of total billed charges ",1226.7,90,,981.36,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1185.81,87,,948.65,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",954.1,70,,763.28,,,0,"percent of total billed charges ","70% of total billed charges ",279,1805.43,
"DRAINAGE OF BREAST LESION",4602990,"CDM ",450,RC,19000,HCPCS,OUTPATIENT,,,1194,955.2,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",412.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",88.86,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",835.8,70,,668.64,,,0,"percent of total billed charges ","70% of total billed charges ",1074.6,90,,859.68,,,0,"percent of total billed charges ","90% of total billed charges ",1110.42,93,,888.34,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1014.9,85,,811.92,,,0,"percent of total billed charges ","85% of total billed charges ",895.5,90,,716.40,,,0,"percent of total billed charges ","90% of total billed charges ",1074.6,90,,859.68,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1038.78,87,,831.02,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",835.8,70,,668.64,,,0,"percent of total billed charges ","70% of total billed charges ",88.86,1110.42,
"REMOVAL OF FOREIGN BODY",4603000,"CDM ",450,RC,20525,HCPCS,OUTPATIENT,,,3405.5,2724.4,,920.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2288.66,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",507.5,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2383.85,70,,1907.08,,,0,"percent of total billed charges ","70% of total billed charges ",3064.95,90,,2451.96,,,0,"percent of total billed charges ","90% of total billed charges ",3167.12,93,,2533.70,,,0,"percent of total billed charges ","93% of total billed charges ",920.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2894.68,85,,2315.74,,,0,"percent of total billed charges ","85% of total billed charges ",2554.13,90,,2043.30,,,0,"percent of total billed charges ","90% of total billed charges ",3064.95,90,,2451.96,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2962.79,87,,4204.83,4204.83,4204.83,"1 through 10","percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2671.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2383.85,70,,1907.08,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,3167.12,
"RPR EXTRAOCULAR MUSCLE TENDON",4603010,"CDM ",450,RC,65290,HCPCS,OUTPATIENT,,,2876.5,2301.2,,1252.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1859.11,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1010.24,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2013.55,70,,1610.84,,,0,"percent of total billed charges ","70% of total billed charges ",2588.85,90,,2071.08,,,0,"percent of total billed charges ","90% of total billed charges ",2675.15,93,,2140.12,,,0,"percent of total billed charges ","93% of total billed charges ",1252.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",528.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2445.03,85,,1956.02,,,0,"percent of total billed charges ","85% of total billed charges ",2157.38,90,,1725.90,,,0,"percent of total billed charges ","90% of total billed charges ",2588.85,90,,2071.08,,,0,"percent of total billed charges ","90% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2502.56,87,,2002.05,,,0,"percent of total billed charges ","87% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3615.53,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2013.55,70,,1610.84,,,0,"percent of total billed charges ","70% of total billed charges ",523.33,3615.53,
"DRAINAGE GUM LESION",4603020,"CDM ",450,RC,41800,HCPCS,OUTPATIENT,,,449.5,359.6,,260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",315.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",314.65,70,,251.72,,,0,"percent of total billed charges ","70% of total billed charges ",404.55,90,,323.64,,,0,"percent of total billed charges ","90% of total billed charges ",418.04,93,,334.43,,,0,"percent of total billed charges ","93% of total billed charges ",260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",382.08,85,,305.66,,,0,"percent of total billed charges ","85% of total billed charges ",337.13,90,,269.70,,,0,"percent of total billed charges ","90% of total billed charges ",404.55,90,,323.64,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",391.07,87,,312.86,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",314.65,70,,251.72,,,0,"percent of total billed charges ","70% of total billed charges ",122.35,418.04,
"TREAT HIP DISORDER",4603030,"CDM ",450,RC,27266,HCPCS,OUTPATIENT,,,2453.5,1962.8,,572,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1077.67,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1207.01,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1717.45,70,,1373.96,,,0,"percent of total billed charges ","70% of total billed charges ",2208.15,90,,1766.52,,,0,"percent of total billed charges ","90% of total billed charges ",2281.76,93,,1825.41,,,0,"percent of total billed charges ","93% of total billed charges ",572,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",660.7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2085.48,85,,1668.38,,,0,"percent of total billed charges ","85% of total billed charges ",1840.13,90,,1472.10,,,0,"percent of total billed charges ","90% of total billed charges ",2208.15,90,,1766.52,,,0,"percent of total billed charges ","90% of total billed charges ",654.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2134.55,87,,1707.64,,,0,"percent of total billed charges ","87% of total billed charges ",654.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1717.45,70,,1373.96,,,0,"percent of total billed charges ","70% of total billed charges ",572,2281.76,
"INITIAL SINGLE IV PUSH",4603060,"CDM ",450,RC,96374,HCPCS,OUTPATIENT,,,308,246.4,,24.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",255.27,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",80.76,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",215.6,70,,172.48,,,0,"percent of total billed charges ","70% of total billed charges ",277.2,90,,221.76,,,0,"percent of total billed charges ","90% of total billed charges ",286.44,93,,229.15,,,0,"percent of total billed charges ","93% of total billed charges ",24.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.03,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",261.8,85,,209.44,,,0,"percent of total billed charges ","85% of total billed charges ",277.2,90,,221.76,,,0,"percent of total billed charges ","90% of total billed charges ",277.2,90,,221.76,,,0,"percent of total billed charges ","90% of total billed charges ",30.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",267.96,87,,168.95,93.31,211.19,17,"percent of total billed charges ","87% of total billed charges ",30.72,100,,141.50,141.50,141.50,"1 through 10","fee schedule ","100% of KS medicaid fee schedule ",195.61,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",215.6,70,,172.48,,,0,"percent of total billed charges ","70% of total billed charges ",24.42,286.44,
"IV PUSH - EACH NEW DRUG",4603070,"CDM ",450,RC,96375,HCPCS,OUTPATIENT,,,218,174.4,,24.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.57,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",32.85,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",152.6,70,,122.08,,,0,"percent of total billed charges ","70% of total billed charges ",196.2,90,,156.96,,,0,"percent of total billed charges ","90% of total billed charges ",202.74,93,,162.19,,,0,"percent of total billed charges ","93% of total billed charges ",24.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.03,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",185.3,85,,148.24,,,0,"percent of total billed charges ","85% of total billed charges ",196.2,90,,156.96,,,0,"percent of total billed charges ","90% of total billed charges ",196.2,90,,156.96,,,0,"percent of total billed charges ","90% of total billed charges ",30.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",189.66,87,,142.80,44.18,287.15,13,"percent of total billed charges ","87% of total billed charges ",30.72,100,,44.79,44.79,44.79,"1 through 10","fee schedule ","100% of KS medicaid fee schedule ",43.06,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",152.6,70,,122.08,,,0,"percent of total billed charges ","70% of total billed charges ",24.42,202.74,
"INITIAL - IV HYDRATION 1ST HR",4603080,"CDM ",450,RC,96360,HCPCS,OUTPATIENT,,,578,462.4,,49.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",255.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",70.31,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",404.6,70,,323.68,,,0,"percent of total billed charges ","70% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",537.54,93,,430.03,,,0,"percent of total billed charges ","93% of total billed charges ",49.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.29,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",491.3,85,,393.04,,,0,"percent of total billed charges ","85% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",62.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",502.86,87,,159.55,60.51,406.64,"1 through 10","percent of total billed charges ","87% of total billed charges ",62.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.61,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",404.6,70,,323.68,,,0,"percent of total billed charges ","70% of total billed charges ",49.81,537.54,
"IV HYDRATION EACH HOUR",4603090,"CDM ",450,RC,96361,HCPCS,OUTPATIENT,,,232,185.6,,16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",133.32,100,,9.14,9.14,9.14,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",26.55,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",215.76,93,,172.61,,,0,"percent of total billed charges ","93% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",197.2,85,,157.76,,,0,"percent of total billed charges ","85% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.84,87,,131.39,93.88,240.22,16,"percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.06,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,215.76,
"INITIAL - IV THERAPY 1ST HR",4603100,"CDM ",450,RC,96365,HCPCS,OUTPATIENT,,,578,462.4,,86.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",255.28,100,,41.74,41.74,41.74,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",138.36,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",404.6,70,,323.68,,,0,"percent of total billed charges ","70% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",537.54,93,,430.03,,,0,"percent of total billed charges ","93% of total billed charges ",86.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",110.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",491.3,85,,393.04,,,0,"percent of total billed charges ","85% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",109.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",502.86,87,,309.11,152.46,396.95,"1 through 10","percent of total billed charges ","87% of total billed charges ",109.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.61,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",404.6,70,,323.68,,,0,"percent of total billed charges ","70% of total billed charges ",86.94,537.54,
"IV THERAPY EACH HOUR",4603110,"CDM ",450,RC,96366,HCPCS,OUTPATIENT,,,232,185.6,,23.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",133.32,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",43.76,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",215.76,93,,172.61,,,0,"percent of total billed charges ","93% of total billed charges ",23.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",197.2,85,,157.76,,,0,"percent of total billed charges ","85% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.84,87,,159.47,159.47,159.47,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.06,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",21.17,215.76,
"IV THERAPY-SEQUENTIAL DRUGS",4603120,"CDM ",450,RC,96367,HCPCS,OUTPATIENT,,,232,185.6,,24.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",133.32,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",62.15,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",215.76,93,,172.61,,,0,"percent of total billed charges ","93% of total billed charges ",24.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.03,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",197.2,85,,157.76,,,0,"percent of total billed charges ","85% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",30.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.84,87,,161.47,,,0,"percent of total billed charges ","87% of total billed charges ",30.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.2,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",24.42,215.76,
"IV THERAPY-SIMULTANEOUS DRUGS",4603130,"CDM ",450,RC,96368,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",1.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",42.31,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",1.01,106.95,
"REMOVE PHARYNX FOREIGN BODY",4603140,"CDM ",450,RC,42809,HCPCS,OUTPATIENT,,,134.5,107.6,,264.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",261.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",94.15,70,,75.32,,,0,"percent of total billed charges ","70% of total billed charges ",121.05,90,,96.84,,,0,"percent of total billed charges ","90% of total billed charges ",125.09,93,,100.07,,,0,"percent of total billed charges ","93% of total billed charges ",264.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",305.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",114.33,85,,91.46,,,0,"percent of total billed charges ","85% of total billed charges ",100.88,90,,80.70,,,0,"percent of total billed charges ","90% of total billed charges ",121.05,90,,96.84,,,0,"percent of total billed charges ","90% of total billed charges ",302.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.02,87,,93.62,,,0,"percent of total billed charges ","87% of total billed charges ",302.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",410.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",94.15,70,,75.32,,,0,"percent of total billed charges ","70% of total billed charges ",94.15,410.83,
"CLSD TX PROX FIBULA W/O MANIP",4603150,"CDM ",450,RC,27780,HCPCS,OUTPATIENT,,,1936.5,1549.2,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",594.44,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1355.55,70,,1084.44,,,0,"percent of total billed charges ","70% of total billed charges ",1742.85,90,,1394.28,,,0,"percent of total billed charges ","90% of total billed charges ",1800.95,93,,1440.76,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1646.03,85,,1316.82,,,0,"percent of total billed charges ","85% of total billed charges ",1452.38,90,,1161.90,,,0,"percent of total billed charges ","90% of total billed charges ",1742.85,90,,1394.28,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1684.76,87,,1347.81,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1355.55,70,,1084.44,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1800.95,
"RPR LESION EA ADDL 5CM OR LESS",4603160,"CDM ",450,RC,13133,HCPCS,OUTPATIENT,,,318.5,254.8,,,,,,,,0,"other ","not separately reimbursment ",,,,2661.01,2661.01,2661.01,"1 through 10","other ","not separately reimbursment ",259.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",222.95,70,,178.36,,,0,"percent of total billed charges ","70% of total billed charges ",286.65,90,,229.32,,,0,"percent of total billed charges ","90% of total billed charges ",296.21,93,,236.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",107.9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",270.73,85,,216.58,,,0,"percent of total billed charges ","85% of total billed charges ",238.88,90,,191.10,,,0,"percent of total billed charges ","90% of total billed charges ",286.65,90,,229.32,,,0,"percent of total billed charges ","90% of total billed charges ",106.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.1,87,,221.68,,,0,"percent of total billed charges ","87% of total billed charges ",106.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",222.95,70,,178.36,,,0,"percent of total billed charges ","70% of total billed charges ",106.83,296.21,
"RPR EYELIDS,NOSE,EAR,LIPS COMP",4603170,"CDM ",450,RC,13151,HCPCS,OUTPATIENT,,,1019.5,815.6,,,,,,,,0,"other ","not separately reimbursment ",1315.02,100,,1640.80,1640.80,1640.80,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",574.6,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",713.65,70,,570.92,,,0,"percent of total billed charges ","70% of total billed charges ",917.55,90,,734.04,,,0,"percent of total billed charges ","90% of total billed charges ",948.14,93,,758.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",866.58,85,,693.26,,,0,"percent of total billed charges ","85% of total billed charges ",764.63,90,,611.70,,,0,"percent of total billed charges ","90% of total billed charges ",917.55,90,,734.04,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",886.97,87,,709.58,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",679.69,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",713.65,70,,570.92,,,0,"percent of total billed charges ","70% of total billed charges ",327.08,1315.02,
"EXCISION LIPOMA CHIN",4603180,"CDM ",450,RC,11442,HCPCS,OUTPATIENT,,,1297,1037.6,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1226.14,100,,360.64,360.64,360.64,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",300.74,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",907.9,70,,726.32,,,0,"percent of total billed charges ","70% of total billed charges ",1167.3,90,,933.84,,,0,"percent of total billed charges ","90% of total billed charges ",1206.21,93,,964.97,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1102.45,85,,881.96,,,0,"percent of total billed charges ","85% of total billed charges ",972.75,90,,778.20,,,0,"percent of total billed charges ","90% of total billed charges ",1167.3,90,,933.84,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1128.39,87,,902.71,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",907.9,70,,726.32,,,0,"percent of total billed charges ","70% of total billed charges ",257.4,1226.14,
"COMPLEX RPR LIP FULL THICKNESS",4603200,"CDM ",450,RC,40654,HCPCS,OUTPATIENT,,,1419.5,1135.6,,494.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1157.46,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",877.51,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",993.65,70,,794.92,,,0,"percent of total billed charges ","70% of total billed charges ",1277.55,90,,1022.04,,,0,"percent of total billed charges ","90% of total billed charges ",1320.14,93,,1056.11,,,0,"percent of total billed charges ","93% of total billed charges ",494.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1206.58,85,,965.26,,,0,"percent of total billed charges ","85% of total billed charges ",1064.63,90,,851.70,,,0,"percent of total billed charges ","90% of total billed charges ",1277.55,90,,1022.04,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1234.97,87,,987.98,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1426.92,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",993.65,70,,794.92,,,0,"percent of total billed charges ","70% of total billed charges ",457.91,1426.92,
"CLSD TX HIP DISLOCATION W/O",4603210,"CDM ",450,RC,27250,HCPCS,OUTPATIENT,,,361.5,289.2,,416,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",541.36,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",368.48,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",253.05,70,,202.44,,,0,"percent of total billed charges ","70% of total billed charges ",325.35,90,,260.28,,,0,"percent of total billed charges ","90% of total billed charges ",336.2,93,,268.96,,,0,"percent of total billed charges ","93% of total billed charges ",416,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",528.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",307.28,85,,245.82,,,0,"percent of total billed charges ","85% of total billed charges ",271.13,90,,216.90,,,0,"percent of total billed charges ","90% of total billed charges ",325.35,90,,260.28,,,0,"percent of total billed charges ","90% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",314.51,87,,251.61,,,0,"percent of total billed charges ","87% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",253.05,70,,202.44,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,541.36,
"DEBRIDE SKIN/MUSCLE FX",4603220,"CDM ",450,RC,11011,HCPCS,OUTPATIENT,,,964.5,771.6,,,,,,,,0,"other ","not separately reimbursment ",783.58,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",605.55,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",675.15,70,,540.12,,,0,"percent of total billed charges ","70% of total billed charges ",868.05,90,,694.44,,,0,"percent of total billed charges ","90% of total billed charges ",896.99,93,,717.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",819.83,85,,655.86,,,0,"percent of total billed charges ","85% of total billed charges ",723.38,90,,578.70,,,0,"percent of total billed charges ","90% of total billed charges ",868.05,90,,694.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",839.12,87,,671.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",675.15,70,,540.12,,,0,"percent of total billed charges ","70% of total billed charges ",605.55,896.99,
"APPLY LONG LEG CAST",4603230,"CDM ",450,RC,29345,HCPCS,OUTPATIENT,,,488.5,390.8,,228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",202.4,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",341.95,70,,273.56,,,0,"percent of total billed charges ","70% of total billed charges ",439.65,90,,351.72,,,0,"percent of total billed charges ","90% of total billed charges ",454.31,93,,363.45,,,0,"percent of total billed charges ","93% of total billed charges ",228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",415.23,85,,332.18,,,0,"percent of total billed charges ","85% of total billed charges ",366.38,90,,293.10,,,0,"percent of total billed charges ","90% of total billed charges ",439.65,90,,351.72,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",425,87,,340.00,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.22,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",341.95,70,,273.56,,,0,"percent of total billed charges ","70% of total billed charges ",202.4,454.31,
"TX FX RADIUS W/O MANIP",4603240,"CDM ",450,RC,25500,HCPCS,OUTPATIENT,,,361.5,289.2,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",536.14,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",253.05,70,,202.44,,,0,"percent of total billed charges ","70% of total billed charges ",325.35,90,,260.28,,,0,"percent of total billed charges ","90% of total billed charges ",336.2,93,,268.96,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",307.28,85,,245.82,,,0,"percent of total billed charges ","85% of total billed charges ",271.13,90,,216.90,,,0,"percent of total billed charges ","90% of total billed charges ",325.35,90,,260.28,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",314.51,87,,251.61,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",253.05,70,,202.44,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1454.4,
"LIGATION TEMPORAL ARTERY",4603250,"CDM ",450,RC,37609,HCPCS,OUTPATIENT,,,2600,2080,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",801,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",417.65,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1820,70,,1456.00,,,0,"percent of total billed charges ","70% of total billed charges ",2340,90,,1872.00,,,0,"percent of total billed charges ","90% of total billed charges ",2418,93,,1934.40,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",312.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2210,85,,1768.00,,,0,"percent of total billed charges ","85% of total billed charges ",1950,90,,1560.00,,,0,"percent of total billed charges ","90% of total billed charges ",2340,90,,1872.00,,,0,"percent of total billed charges ","90% of total billed charges ",309.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2262,87,,1809.60,,,0,"percent of total billed charges ","87% of total billed charges ",309.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1820,70,,1456.00,,,0,"percent of total billed charges ","70% of total billed charges ",309.09,2418,
"DESTRUCT B9 LESION, 1-14",4603260,"CDM ",450,RC,17110,HCPCS,OUTPATIENT,,,172,137.6,,189.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.71,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",136.95,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",120.4,70,,96.32,,,0,"percent of total billed charges ","70% of total billed charges ",154.8,90,,123.84,,,0,"percent of total billed charges ","90% of total billed charges ",159.96,93,,127.97,,,0,"percent of total billed charges ","93% of total billed charges ",189.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",146.2,85,,116.96,,,0,"percent of total billed charges ","85% of total billed charges ",129,90,,103.20,,,0,"percent of total billed charges ","90% of total billed charges ",154.8,90,,123.84,,,0,"percent of total billed charges ","90% of total billed charges ",217.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.64,87,,119.71,,,0,"percent of total billed charges ","87% of total billed charges ",217.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",120.4,70,,96.32,,,0,"percent of total billed charges ","70% of total billed charges ",120.4,219.23,
"REDUCTION WRIST FX",4603270,"CDM ",450,RC,25645,HCPCS,OUTPATIENT,,,6030.5,4824.4,,1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3839.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1180.61,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4221.35,70,,3377.08,,,0,"percent of total billed charges ","70% of total billed charges ",5427.45,90,,4341.96,,,0,"percent of total billed charges ","90% of total billed charges ",5608.37,93,,4486.70,,,0,"percent of total billed charges ","93% of total billed charges ",1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5125.93,85,,4100.74,,,0,"percent of total billed charges ","85% of total billed charges ",4522.88,90,,3618.30,,,0,"percent of total billed charges ","90% of total billed charges ",5427.45,90,,4341.96,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5246.54,87,,4197.23,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3009.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4221.35,70,,3377.08,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,5608.37,
"INSERT TUNNEL CV CATH",4603280,"CDM ",450,RC,36561,HCPCS,OUTPATIENT,,,4164,3331.2,,945.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3585.46,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",686.16,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2914.8,70,,2331.84,,,0,"percent of total billed charges ","70% of total billed charges ",3747.6,90,,2998.08,,,0,"percent of total billed charges ","90% of total billed charges ",3872.52,93,,3098.02,,,0,"percent of total billed charges ","93% of total billed charges ",945.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1201.75,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3539.4,85,,2831.52,,,0,"percent of total billed charges ","85% of total billed charges ",3123,90,,2498.40,,,0,"percent of total billed charges ","90% of total billed charges ",3747.6,90,,2998.08,,,0,"percent of total billed charges ","90% of total billed charges ",1189.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3622.68,87,,4935.15,1034.25,8836.05,"1 through 10","percent of total billed charges ","87% of total billed charges ",1189.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2903.79,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2914.8,70,,2331.84,,,0,"percent of total billed charges ","70% of total billed charges ",686.16,3872.52,
"CLSD TX FX GREAT TOE",4603290,"CDM ",450,RC,28495,HCPCS,OUTPATIENT,,,2143.5,1714.8,,76.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1617.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",309.76,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1500.45,70,,1200.36,,,0,"percent of total billed charges ","70% of total billed charges ",1929.15,90,,1543.32,,,0,"percent of total billed charges ","90% of total billed charges ",1993.46,93,,1594.77,,,0,"percent of total billed charges ","93% of total billed charges ",76.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",86.59,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1821.98,85,,1457.58,,,0,"percent of total billed charges ","85% of total billed charges ",1607.63,90,,1286.10,,,0,"percent of total billed charges ","90% of total billed charges ",1929.15,90,,1543.32,,,0,"percent of total billed charges ","90% of total billed charges ",85.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1864.85,87,,1491.88,,,0,"percent of total billed charges ","87% of total billed charges ",85.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1500.45,70,,1200.36,,,0,"percent of total billed charges ","70% of total billed charges ",76.39,1993.46,
"TX WOUND DEHIS, SIMPLE CLOSURE",4603300,"CDM ",450,RC,12020,HCPCS,OUTPATIENT,,,935,748,,370.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",216.14,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",386.23,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",654.5,70,,523.60,,,0,"percent of total billed charges ","70% of total billed charges ",841.5,90,,673.20,,,0,"percent of total billed charges ","90% of total billed charges ",869.55,93,,695.64,,,0,"percent of total billed charges ","93% of total billed charges ",370.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",428.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",794.75,85,,635.80,,,0,"percent of total billed charges ","85% of total billed charges ",701.25,90,,561.00,,,0,"percent of total billed charges ","90% of total billed charges ",841.5,90,,673.20,,,0,"percent of total billed charges ","90% of total billed charges ",423.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",813.45,87,,650.76,,,0,"percent of total billed charges ","87% of total billed charges ",423.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",679.69,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",654.5,70,,523.60,,,0,"percent of total billed charges ","70% of total billed charges ",216.14,869.55,
"CL TX MED ANKLE FX W/MANIP",4603310,"CDM ",450,RC,27762,HCPCS,OUTPATIENT,,,396.5,317.2,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",872.3,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",277.55,70,,222.04,,,0,"percent of total billed charges ","70% of total billed charges ",356.85,90,,285.48,,,0,"percent of total billed charges ","90% of total billed charges ",368.75,93,,295.00,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",337.03,85,,269.62,,,0,"percent of total billed charges ","85% of total billed charges ",297.38,90,,237.90,,,0,"percent of total billed charges ","90% of total billed charges ",356.85,90,,285.48,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",344.96,87,,275.97,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",277.55,70,,222.04,,,0,"percent of total billed charges ","70% of total billed charges ",277.55,1478.8,
"STRAPPING; THORAX",4603320,"CDM ",450,RC,29200,HCPCS,OUTPATIENT,,,227.5,182,,51.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",40.06,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",159.25,70,,127.40,,,0,"percent of total billed charges ","70% of total billed charges ",204.75,90,,163.80,,,0,"percent of total billed charges ","90% of total billed charges ",211.58,93,,169.26,,,0,"percent of total billed charges ","93% of total billed charges ",51.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.32,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",193.38,85,,154.70,,,0,"percent of total billed charges ","85% of total billed charges ",170.63,90,,136.50,,,0,"percent of total billed charges ","90% of total billed charges ",204.75,90,,163.80,,,0,"percent of total billed charges ","90% of total billed charges ",37.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",197.93,87,,158.34,,,0,"percent of total billed charges ","87% of total billed charges ",37.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",159.25,70,,127.40,,,0,"percent of total billed charges ","70% of total billed charges ",37.94,211.58,
"TX ULNAR FRACTURE",4603330,"CDM ",450,RC,24670,HCPCS,OUTPATIENT,,,366.5,293.2,,364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",558.21,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",256.55,70,,205.24,,,0,"percent of total billed charges ","70% of total billed charges ",329.85,90,,263.88,,,0,"percent of total billed charges ","90% of total billed charges ",340.85,93,,272.68,,,0,"percent of total billed charges ","93% of total billed charges ",364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",311.53,85,,249.22,,,0,"percent of total billed charges ","85% of total billed charges ",274.88,90,,219.90,,,0,"percent of total billed charges ","90% of total billed charges ",329.85,90,,263.88,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",318.86,87,,255.09,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",256.55,70,,205.24,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1454.4,
"IV PUSH SAME DRUG >30 MIN",4603340,"CDM ",450,RC,96376,HCPCS,OUTPATIENT,,,236.5,189.2,,,,,,,,0,"other ","not separately reimbursment ",43.43,100,,44.21,44.21,44.21,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",165.55,70,,132.44,,,0,"percent of total billed charges ","70% of total billed charges ",212.85,90,,170.28,,,0,"percent of total billed charges ","90% of total billed charges ",219.95,93,,175.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",15.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",201.03,85,,160.82,,,0,"percent of total billed charges ","85% of total billed charges ",212.85,90,,170.28,,,0,"percent of total billed charges ","90% of total billed charges ",212.85,90,,170.28,,,0,"percent of total billed charges ","90% of total billed charges ",15.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",205.76,87,,487.46,487.46,487.46,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",165.55,70,,132.44,,,0,"percent of total billed charges ","70% of total billed charges ",15.6,219.95,
"CLSD TX ACETEBULUM FX W/MANIP",4603350,"CDM ",450,RC,27220,HCPCS,OUTPATIENT,,,1024,819.2,,364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",852.15,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",716.8,70,,573.44,,,0,"percent of total billed charges ","70% of total billed charges ",921.6,90,,737.28,,,0,"percent of total billed charges ","90% of total billed charges ",952.32,93,,761.86,,,0,"percent of total billed charges ","93% of total billed charges ",364,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",870.4,85,,696.32,,,0,"percent of total billed charges ","85% of total billed charges ",768,90,,614.40,,,0,"percent of total billed charges ","90% of total billed charges ",921.6,90,,737.28,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",890.88,87,,712.70,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",716.8,70,,573.44,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,952.32,
"I&D VULVA/PERINEUM",4603360,"CDM ",450,RC,56405,HCPCS,OUTPATIENT,,,507.5,406,,228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",264.55,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",355.25,70,,284.20,,,0,"percent of total billed charges ","70% of total billed charges ",456.75,90,,365.40,,,0,"percent of total billed charges ","90% of total billed charges ",471.98,93,,377.58,,,0,"percent of total billed charges ","93% of total billed charges ",228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",431.38,85,,345.10,,,0,"percent of total billed charges ","85% of total billed charges ",380.63,90,,304.50,,,0,"percent of total billed charges ","90% of total billed charges ",456.75,90,,365.40,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",441.53,87,,353.22,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",280.24,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",355.25,70,,284.20,,,0,"percent of total billed charges ","70% of total billed charges ",228.8,471.98,
"TX SHOULDER BLADE FX W/O MANIP",4603370,"CDM ",450,RC,23570,HCPCS,OUTPATIENT,,,350,280,,114.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",504.37,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",245,70,,196.00,,,0,"percent of total billed charges ","70% of total billed charges ",315,90,,252.00,,,0,"percent of total billed charges ","90% of total billed charges ",325.5,93,,260.40,,,0,"percent of total billed charges ","93% of total billed charges ",114.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",297.5,85,,238.00,,,0,"percent of total billed charges ","85% of total billed charges ",262.5,90,,210.00,,,0,"percent of total billed charges ","90% of total billed charges ",315,90,,252.00,,,0,"percent of total billed charges ","90% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",304.5,87,,243.60,,,0,"percent of total billed charges ","87% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",245,70,,196.00,,,0,"percent of total billed charges ","70% of total billed charges ",114.4,809.01,
"ARTERY REPAIR FINGER",4603390,"CDM ",450,RC,35207,HCPCS,OUTPATIENT,,,6294,5035.2,,1032.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1538.23,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1551.77,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4405.8,70,,3524.64,,,0,"percent of total billed charges ","70% of total billed charges ",5664.6,90,,4531.68,,,0,"percent of total billed charges ","90% of total billed charges ",5853.42,93,,4682.74,,,0,"percent of total billed charges ","93% of total billed charges ",1032.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5349.9,85,,4279.92,,,0,"percent of total billed charges ","85% of total billed charges ",4720.5,90,,3776.40,,,0,"percent of total billed charges ","90% of total billed charges ",5664.6,90,,4531.68,,,0,"percent of total billed charges ","90% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5475.78,87,,4380.62,,,0,"percent of total billed charges ","87% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2903.79,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4405.8,70,,3524.64,,,0,"percent of total billed charges ","70% of total billed charges ",130.83,5853.42,
"REPAIR FINGER/HAND TENDON",4603400,"CDM ",450,RC,26350,HCPCS,OUTPATIENT,,,4145.5,3316.4,,1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1402.45,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1570.56,220,,642.75,642.75,642.75,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",2901.85,70,,2321.48,,,0,"percent of total billed charges ","70% of total billed charges ",3730.95,90,,2984.76,,,0,"percent of total billed charges ","90% of total billed charges ",3855.32,93,,3084.26,,,0,"percent of total billed charges ","93% of total billed charges ",1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3523.68,85,,2818.94,,,0,"percent of total billed charges ","85% of total billed charges ",3109.13,90,,2487.30,,,0,"percent of total billed charges ","90% of total billed charges ",3730.95,90,,2984.76,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3606.59,87,,2885.27,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3009.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2901.85,70,,2321.48,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,3855.32,
"EXC LESION TRUNK/EXT >4.0 CM",4603410,"CDM ",450,RC,11406,HCPCS,OUTPATIENT,,,2539,2031.2,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2077.57,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",507.72,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1777.3,70,,1421.84,,,0,"percent of total billed charges ","70% of total billed charges ",2285.1,90,,1828.08,,,0,"percent of total billed charges ","90% of total billed charges ",2361.27,93,,1889.02,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2158.15,85,,1726.52,,,0,"percent of total billed charges ","85% of total billed charges ",1904.25,90,,1523.40,,,0,"percent of total billed charges ","90% of total billed charges ",2285.1,90,,1828.08,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2208.93,87,,1258.19,1258.19,1258.19,"1 through 10","percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1777.3,70,,1421.84,,,0,"percent of total billed charges ","70% of total billed charges ",327.08,2361.27,
"TX HUMERUS FX W/O MANIP",4603420,"CDM ",450,RC,24560,HCPCS,OUTPATIENT,,,1784.5,1427.6,,416,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",614.17,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1249.15,70,,999.32,,,0,"percent of total billed charges ","70% of total billed charges ",1606.05,90,,1284.84,,,0,"percent of total billed charges ","90% of total billed charges ",1659.59,93,,1327.67,,,0,"percent of total billed charges ","93% of total billed charges ",416,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",528.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1516.83,85,,1213.46,,,0,"percent of total billed charges ","85% of total billed charges ",1338.38,90,,1070.70,,,0,"percent of total billed charges ","90% of total billed charges ",1606.05,90,,1284.84,,,0,"percent of total billed charges ","90% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1552.52,87,,1242.02,,,0,"percent of total billed charges ","87% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1249.15,70,,999.32,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1659.59,
"RPR TORN LIGA KNEE, COLLATERAL",4603430,"CDM ",450,RC,27405,HCPCS,OUTPATIENT,,,7306,5844.8,,2317.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5483.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1395.92,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",5114.2,70,,4091.36,,,0,"percent of total billed charges ","70% of total billed charges ",6575.4,90,,5260.32,,,0,"percent of total billed charges ","90% of total billed charges ",6794.58,93,,5435.66,,,0,"percent of total billed charges ","93% of total billed charges ",2317.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",6210.1,85,,4968.08,,,0,"percent of total billed charges ","85% of total billed charges ",5479.5,90,,4383.60,,,0,"percent of total billed charges ","90% of total billed charges ",6575.4,90,,5260.32,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6356.22,87,,5084.98,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6673.22,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",5114.2,70,,4091.36,,,0,"percent of total billed charges ","70% of total billed charges ",457.91,6794.58,
"REMOVAL OF SKIN TAGS",4603440,"CDM ",450,RC,11200,HCPCS,OUTPATIENT,,,174.5,139.6,,336.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.71,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",156.11,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",122.15,70,,97.72,,,0,"percent of total billed charges ","70% of total billed charges ",157.05,90,,125.64,,,0,"percent of total billed charges ","90% of total billed charges ",162.29,93,,129.83,,,0,"percent of total billed charges ","93% of total billed charges ",336.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",428.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",148.33,85,,118.66,,,0,"percent of total billed charges ","85% of total billed charges ",130.88,90,,104.70,,,0,"percent of total billed charges ","90% of total billed charges ",157.05,90,,125.64,,,0,"percent of total billed charges ","90% of total billed charges ",423.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",151.82,87,,121.46,,,0,"percent of total billed charges ","87% of total billed charges ",423.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",122.15,70,,97.72,,,0,"percent of total billed charges ","70% of total billed charges ",122.15,428.14,
"CHEST TUBE INSERTION",4603450,"CDM ",450,RC,32550,HCPCS,OUTPATIENT,,,4399.5,3519.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",423.04,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3079.65,70,,2463.72,,,0,"percent of total billed charges ","70% of total billed charges ",3959.55,90,,3167.64,,,0,"percent of total billed charges ","90% of total billed charges ",4091.54,93,,3273.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1335.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3739.58,85,,2991.66,,,0,"percent of total billed charges ","85% of total billed charges ",3299.63,90,,2639.70,,,0,"percent of total billed charges ","90% of total billed charges ",3959.55,90,,3167.64,,,0,"percent of total billed charges ","90% of total billed charges ",1322.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3827.57,87,,3062.06,,,0,"percent of total billed charges ","87% of total billed charges ",1322.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3292.74,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3079.65,70,,2463.72,,,0,"percent of total billed charges ","70% of total billed charges ",423.04,4091.54,
"BRONCHOSCOPY W/FLUORO",4603490,"CDM ",450,RC,31622,HCPCS,OUTPATIENT,,,2003.5,1602.8,,549.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1461.47,100,,23.71,23.71,23.71,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",274.27,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1402.45,70,,1121.96,,,0,"percent of total billed charges ","70% of total billed charges ",1803.15,90,,1442.52,,,0,"percent of total billed charges ","90% of total billed charges ",1863.26,93,,1490.61,,,0,"percent of total billed charges ","93% of total billed charges ",549.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1702.98,85,,1362.38,,,0,"percent of total billed charges ","85% of total billed charges ",1502.63,90,,1202.10,,,0,"percent of total billed charges ","90% of total billed charges ",1803.15,90,,1442.52,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1743.05,87,,1394.44,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1636.89,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1402.45,70,,1121.96,,,0,"percent of total billed charges ","70% of total billed charges ",274.27,1863.26,
"EXCISION BENIGN LESION",4603510,"CDM ",450,RC,11420,HCPCS,OUTPATIENT,,,1830,1464,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1805.43,100,,183.42,183.42,183.42,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",170.39,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1281,70,,1024.80,,,0,"percent of total billed charges ","70% of total billed charges ",1647,90,,1317.60,,,0,"percent of total billed charges ","90% of total billed charges ",1701.9,93,,1361.52,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1555.5,85,,1244.40,,,0,"percent of total billed charges ","85% of total billed charges ",1372.5,90,,1098.00,,,0,"percent of total billed charges ","90% of total billed charges ",1647,90,,1317.60,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1592.1,87,,1273.68,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1281,70,,1024.80,,,0,"percent of total billed charges ","70% of total billed charges ",170.39,1805.43,
"US GUIDED COMPRESSION RPR",4603520,"CDM ",450,RC,76936,HCPCS,OUTPATIENT,,,633,506.4,,,,,,,,0,"other ","not separately reimbursment ",416.12,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",546.99,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",443.1,70,,354.48,,,0,"percent of total billed charges ","70% of total billed charges ",569.7,90,,455.76,,,0,"percent of total billed charges ","90% of total billed charges ",588.69,93,,470.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",150.7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",538.05,85,,430.44,,,0,"percent of total billed charges ","85% of total billed charges ",569.7,90,,455.76,,,0,"percent of total billed charges ","90% of total billed charges ",569.7,90,,455.76,,,0,"percent of total billed charges ","90% of total billed charges ",149.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",550.71,87,,440.57,,,0,"percent of total billed charges ","87% of total billed charges ",149.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.57,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",443.1,70,,354.48,,,0,"percent of total billed charges ","70% of total billed charges ",149.21,588.69,
"TX FINGER FX PROX W/O MANIP",4603530,"CDM ",450,RC,26720,HCPCS,OUTPATIENT,,,1538.5,1230.8,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",391.93,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1076.95,70,,861.56,,,0,"percent of total billed charges ","70% of total billed charges ",1384.65,90,,1107.72,,,0,"percent of total billed charges ","90% of total billed charges ",1430.81,93,,1144.65,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1307.73,85,,1046.18,,,0,"percent of total billed charges ","85% of total billed charges ",1153.88,90,,923.10,,,0,"percent of total billed charges ","90% of total billed charges ",1384.65,90,,1107.72,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1338.5,87,,1070.80,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1076.95,70,,861.56,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1430.81,
"TX FX HUMERUS W/MANIP",4603540,"CDM ",450,RC,24577,HCPCS,OUTPATIENT,,,1282.5,1026,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1053.14,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",897.75,70,,718.20,,,0,"percent of total billed charges ","70% of total billed charges ",1154.25,90,,923.40,,,0,"percent of total billed charges ","90% of total billed charges ",1192.73,93,,954.18,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",528.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1090.13,85,,872.10,,,0,"percent of total billed charges ","85% of total billed charges ",961.88,90,,769.50,,,0,"percent of total billed charges ","90% of total billed charges ",1154.25,90,,923.40,,,0,"percent of total billed charges ","90% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1115.78,87,,892.62,,,0,"percent of total billed charges ","87% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",897.75,70,,718.20,,,0,"percent of total billed charges ","70% of total billed charges ",520.65,1478.8,
"I&D SKIN TISSUE EXPLORATORY",4603550,"CDM ",450,RC,17999,HCPCS,OUTPATIENT,,,81,64.8,,73.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.7,70,,45.36,,,0,"percent of total billed charges ","70% of total billed charges ",72.9,90,,58.32,,,0,"percent of total billed charges ","90% of total billed charges ",75.33,93,,60.26,,,0,"percent of total billed charges ","93% of total billed charges ",73.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",68.85,85,,55.08,,,0,"percent of total billed charges ","85% of total billed charges ",60.75,90,,48.60,,,0,"percent of total billed charges ","90% of total billed charges ",72.9,90,,58.32,,,0,"percent of total billed charges ","90% of total billed charges ",83.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.47,87,,56.38,,,0,"percent of total billed charges ","87% of total billed charges ",83.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",56.7,70,,45.36,,,0,"percent of total billed charges ","70% of total billed charges ",56.7,184.51,
"DRAINAGE SCROTUM ABSCESS",4603560,"CDM ",450,RC,55100,HCPCS,OUTPATIENT,,,1907.5,1526,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",345.27,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1335.25,70,,1068.20,,,0,"percent of total billed charges ","70% of total billed charges ",1716.75,90,,1373.40,,,0,"percent of total billed charges ","90% of total billed charges ",1773.98,93,,1419.18,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1621.38,85,,1297.10,,,0,"percent of total billed charges ","85% of total billed charges ",1430.63,90,,1144.50,,,0,"percent of total billed charges ","90% of total billed charges ",1716.75,90,,1373.40,,,0,"percent of total billed charges ","90% of total billed charges ",254.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1659.53,87,,1327.62,,,0,"percent of total billed charges ","87% of total billed charges ",254.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1335.25,70,,1068.20,,,0,"percent of total billed charges ","70% of total billed charges ",254.14,1773.98,
"REMOVAL NASAL PACKING",4603570,"CDM ",450,RC,30999,HCPCS,OUTPATIENT,,,254,203.2,,96.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.8,70,,142.24,,,0,"percent of total billed charges ","70% of total billed charges ",228.6,90,,182.88,,,0,"percent of total billed charges ","90% of total billed charges ",236.22,93,,188.98,,,0,"percent of total billed charges ","93% of total billed charges ",96.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",111.41,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",215.9,85,,172.72,,,0,"percent of total billed charges ","85% of total billed charges ",190.5,90,,152.40,,,0,"percent of total billed charges ","90% of total billed charges ",228.6,90,,182.88,,,0,"percent of total billed charges ","90% of total billed charges ",110.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",220.98,87,,176.78,,,0,"percent of total billed charges ","87% of total billed charges ",110.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.82,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",177.8,70,,142.24,,,0,"percent of total billed charges ","70% of total billed charges ",96.46,236.22,
"IRRIGATION OF EYE",4603580,"CDM ",450,RC,66999,HCPCS,OUTPATIENT,,,734.5,587.6,,754.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",514.15,70,,411.32,,,0,"percent of total billed charges ","70% of total billed charges ",661.05,90,,528.84,,,0,"percent of total billed charges ","90% of total billed charges ",683.09,93,,546.47,,,0,"percent of total billed charges ","93% of total billed charges ",754.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",646.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",624.33,85,,499.46,,,0,"percent of total billed charges ","85% of total billed charges ",550.88,90,,440.70,,,0,"percent of total billed charges ","90% of total billed charges ",661.05,90,,528.84,,,0,"percent of total billed charges ","90% of total billed charges ",639.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",639.02,87,,511.22,,,0,"percent of total billed charges ","87% of total billed charges ",639.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2122.4,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",514.15,70,,411.32,,,0,"percent of total billed charges ","70% of total billed charges ",514.15,2122.4,
"REVISE RENAL DIALYSIS SHUNT",4603590,"CDM ",450,RC,37607,HCPCS,OUTPATIENT,,,5871.5,4697.2,,1032.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",754.86,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4110.05,70,,3288.04,,,0,"percent of total billed charges ","70% of total billed charges ",5284.35,90,,4227.48,,,0,"percent of total billed charges ","90% of total billed charges ",5460.5,93,,4368.40,,,0,"percent of total billed charges ","93% of total billed charges ",1032.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4990.78,85,,3992.62,,,0,"percent of total billed charges ","85% of total billed charges ",4403.63,90,,3522.90,,,0,"percent of total billed charges ","90% of total billed charges ",5284.35,90,,4227.48,,,0,"percent of total billed charges ","90% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5108.21,87,,4086.57,,,0,"percent of total billed charges ","87% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2903.79,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4110.05,70,,3288.04,,,0,"percent of total billed charges ","70% of total billed charges ",130.83,5460.5,
"CLSD TX FEMORAL EPI W/O MANIP",4603610,"CDM ",450,RC,27516,HCPCS,OUTPATIENT,,,1924,1539.2,,,,,,,,0,"other ","not separately reimbursment ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1003.16,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1346.8,70,,1077.44,,,0,"percent of total billed charges ","70% of total billed charges ",1731.6,90,,1385.28,,,0,"percent of total billed charges ","90% of total billed charges ",1789.32,93,,1431.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1635.4,85,,1308.32,,,0,"percent of total billed charges ","85% of total billed charges ",1443,90,,1154.40,,,0,"percent of total billed charges ","90% of total billed charges ",1731.6,90,,1385.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1673.88,87,,1339.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1346.8,70,,1077.44,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1789.32,
"CLSD TX FX FINGER W/MANIP",4603620,"CDM ",450,RC,26742,HCPCS,OUTPATIENT,,,3327,2661.6,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2515.91,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",700.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2328.9,70,,1863.12,,,0,"percent of total billed charges ","70% of total billed charges ",2994.3,90,,2395.44,,,0,"percent of total billed charges ","90% of total billed charges ",3094.11,93,,2475.29,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2827.95,85,,2262.36,,,0,"percent of total billed charges ","85% of total billed charges ",2495.25,90,,1996.20,,,0,"percent of total billed charges ","90% of total billed charges ",2994.3,90,,2395.44,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2894.49,87,,2315.59,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2328.9,70,,1863.12,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,3094.11,
"CLSD TX REDUC RADIUS W/O GRAFT",4603630,"CDM ",450,RC,25400,HCPCS,OUTPATIENT,,,7469.5,5975.6,,2317.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3839.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1654.07,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",5228.65,70,,4182.92,,,0,"percent of total billed charges ","70% of total billed charges ",6722.55,90,,5378.04,,,0,"percent of total billed charges ","90% of total billed charges ",6946.64,93,,5557.31,,,0,"percent of total billed charges ","93% of total billed charges ",2317.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",594.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",6349.08,85,,5079.26,,,0,"percent of total billed charges ","85% of total billed charges ",5602.13,90,,4481.70,,,0,"percent of total billed charges ","90% of total billed charges ",6722.55,90,,5378.04,,,0,"percent of total billed charges ","90% of total billed charges ",588.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6498.47,87,,5198.78,,,0,"percent of total billed charges ","87% of total billed charges ",588.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6673.22,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",5228.65,70,,4182.92,,,0,"percent of total billed charges ","70% of total billed charges ",588.74,6946.64,
"FB REMOVAL PHARYN",4603640,"CDM ",450,RC,42999,HCPCS,OUTPATIENT,,,254,203.2,,96.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.8,70,,142.24,,,0,"percent of total billed charges ","70% of total billed charges ",228.6,90,,182.88,,,0,"percent of total billed charges ","90% of total billed charges ",236.22,93,,188.98,,,0,"percent of total billed charges ","93% of total billed charges ",96.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",111.41,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",215.9,85,,172.72,,,0,"percent of total billed charges ","85% of total billed charges ",190.5,90,,152.40,,,0,"percent of total billed charges ","90% of total billed charges ",228.6,90,,182.88,,,0,"percent of total billed charges ","90% of total billed charges ",110.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",220.98,87,,176.78,,,0,"percent of total billed charges ","87% of total billed charges ",110.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.82,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",177.8,70,,142.24,,,0,"percent of total billed charges ","70% of total billed charges ",96.46,236.22,
"BONE INCISION W/O DIV NEC",4603650,"CDM ",450,RC,26567,HCPCS,OUTPATIENT,,,4275,3420,,1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1402.45,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1513.16,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2992.5,70,,2394.00,,,0,"percent of total billed charges ","70% of total billed charges ",3847.5,90,,3078.00,,,0,"percent of total billed charges ","90% of total billed charges ",3975.75,93,,3180.60,,,0,"percent of total billed charges ","93% of total billed charges ",1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3633.75,85,,2907.00,,,0,"percent of total billed charges ","85% of total billed charges ",3206.25,90,,2565.00,,,0,"percent of total billed charges ","90% of total billed charges ",3847.5,90,,3078.00,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3719.25,87,,2975.40,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3009.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2992.5,70,,2394.00,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,3975.75,
"DEBRIDEMENT NAIL 1-5 ANY METH",4603660,"CDM ",450,RC,11720,HCPCS,OUTPATIENT,,,300.5,240.4,,,,,,,,0,"other ","not separately reimbursment ",69.46,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",30.58,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",210.35,70,,168.28,,,0,"percent of total billed charges ","70% of total billed charges ",270.45,90,,216.36,,,0,"percent of total billed charges ","90% of total billed charges ",279.47,93,,223.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",255.43,85,,204.34,,,0,"percent of total billed charges ","85% of total billed charges ",225.38,90,,180.30,,,0,"percent of total billed charges ","90% of total billed charges ",270.45,90,,216.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",261.44,87,,209.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",210.35,70,,168.28,,,0,"percent of total billed charges ","70% of total billed charges ",30.58,279.47,
"URINARY SYSTEM PROCEDURE",4603670,"CDM ",450,RC,53899,HCPCS,OUTPATIENT,,,237.5,190,,84.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",166.25,70,,133.00,,,0,"percent of total billed charges ","70% of total billed charges ",213.75,90,,171.00,,,0,"percent of total billed charges ","90% of total billed charges ",220.88,93,,176.70,,,0,"percent of total billed charges ","93% of total billed charges ",84.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",97.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",201.88,85,,161.50,,,0,"percent of total billed charges ","85% of total billed charges ",178.13,90,,142.50,,,0,"percent of total billed charges ","90% of total billed charges ",213.75,90,,171.00,,,0,"percent of total billed charges ","90% of total billed charges ",96.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",206.63,87,,165.30,,,0,"percent of total billed charges ","87% of total billed charges ",96.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",229.77,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",166.25,70,,133.00,,,0,"percent of total billed charges ","70% of total billed charges ",84.19,229.77,
"AVULSION NAILPLATE",4603680,"CDM ",450,RC,11732,HCPCS,OUTPATIENT,,,160,128,,19.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",36.54,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",112,70,,89.60,,,0,"percent of total billed charges ","70% of total billed charges ",144,90,,115.20,,,0,"percent of total billed charges ","90% of total billed charges ",148.8,93,,119.04,,,0,"percent of total billed charges ","93% of total billed charges ",19.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",136,85,,108.80,,,0,"percent of total billed charges ","85% of total billed charges ",120,90,,96.00,,,0,"percent of total billed charges ","90% of total billed charges ",144,90,,115.20,,,0,"percent of total billed charges ","90% of total billed charges ",24.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",139.2,87,,111.36,,,0,"percent of total billed charges ","87% of total billed charges ",24.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",112,70,,89.60,,,0,"percent of total billed charges ","70% of total billed charges ",19.61,148.8,
"INCISION FINGER TENDON",4603690,"CDM ",450,RC,26060,HCPCS,OUTPATIENT,,,2972.5,2378,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",764.26,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",535.17,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2080.75,70,,1664.60,,,0,"percent of total billed charges ","70% of total billed charges ",2675.25,90,,2140.20,,,0,"percent of total billed charges ","90% of total billed charges ",2764.43,93,,2211.54,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2526.63,85,,2021.30,,,0,"percent of total billed charges ","85% of total billed charges ",2229.38,90,,1783.50,,,0,"percent of total billed charges ","90% of total billed charges ",2675.25,90,,2140.20,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2586.08,87,,2068.86,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2080.75,70,,1664.60,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,2764.43,
"G-COLON TUBE FIX W/DEVICE",4603700,"CDM ",450,RC,49460,HCPCS,OUTPATIENT,,,1035,828,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.11,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",724.5,70,,579.60,,,0,"percent of total billed charges ","70% of total billed charges ",931.5,90,,745.20,,,0,"percent of total billed charges ","90% of total billed charges ",962.55,93,,770.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",140.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",879.75,85,,703.80,,,0,"percent of total billed charges ","85% of total billed charges ",776.25,90,,621.00,,,0,"percent of total billed charges ","90% of total billed charges ",931.5,90,,745.20,,,0,"percent of total billed charges ","90% of total billed charges ",139.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",900.45,87,,720.36,,,0,"percent of total billed charges ","87% of total billed charges ",139.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",834.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",724.5,70,,579.60,,,0,"percent of total billed charges ","70% of total billed charges ",101.11,962.55,
"STRAPPING OF KNEE",4603710,"CDM ",450,RC,29530,HCPCS,OUTPATIENT,,,384.5,307.6,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",38.68,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",357.59,93,,286.07,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",326.83,85,,261.46,,,0,"percent of total billed charges ","85% of total billed charges ",288.38,90,,230.70,,,0,"percent of total billed charges ","90% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",334.52,87,,267.62,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",38.68,357.59,
"REMOVAL OF DEEP IMPLANT",4603720,"CDM ",450,RC,20680,HCPCS,OUTPATIENT,,,3639,2911.2,,920.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2815.88,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",862.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2547.3,70,,2037.84,,,0,"percent of total billed charges ","70% of total billed charges ",3275.1,90,,2620.08,,,0,"percent of total billed charges ","90% of total billed charges ",3384.27,93,,2707.42,,,0,"percent of total billed charges ","93% of total billed charges ",920.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3093.15,85,,2474.52,,,0,"percent of total billed charges ","85% of total billed charges ",2729.25,90,,2183.40,,,0,"percent of total billed charges ","90% of total billed charges ",3275.1,90,,2620.08,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3165.93,87,,2532.74,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2671.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2547.3,70,,2037.84,,,0,"percent of total billed charges ","70% of total billed charges ",327.08,3384.27,
"STRAPPING; KNEE",4603730,"CDM ",450,RC,29530,HCPCS,OUTPATIENT,,,384.5,307.6,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",38.68,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",357.59,93,,286.07,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",326.83,85,,261.46,,,0,"percent of total billed charges ","85% of total billed charges ",288.38,90,,230.70,,,0,"percent of total billed charges ","90% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",334.52,87,,267.62,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",38.68,357.59,
"INJ ANESTHESIA PERIPHERAL",4603750,"CDM ",450,RC,64450,HCPCS,OUTPATIENT,,,1137.5,910,,224.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",859.51,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",87.89,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",796.25,70,,637.00,,,0,"percent of total billed charges ","70% of total billed charges ",1023.75,90,,819.00,,,0,"percent of total billed charges ","90% of total billed charges ",1057.88,93,,846.30,,,0,"percent of total billed charges ","93% of total billed charges ",224.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",222,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",966.88,85,,773.50,,,0,"percent of total billed charges ","85% of total billed charges ",853.13,90,,682.50,,,0,"percent of total billed charges ","90% of total billed charges ",1023.75,90,,819.00,,,0,"percent of total billed charges ","90% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",989.63,87,,791.70,,,0,"percent of total billed charges ","87% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",649.16,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",796.25,70,,637.00,,,0,"percent of total billed charges ","70% of total billed charges ",87.89,1057.88,
"EXC BARTHOLINS GLAND & CYST",4603760,"CDM ",450,RC,56740,HCPCS,OUTPATIENT,,,2901,2320.8,,1012.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1370.56,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",657.98,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2030.7,70,,1624.56,,,0,"percent of total billed charges ","70% of total billed charges ",2610.9,90,,2088.72,,,0,"percent of total billed charges ","90% of total billed charges ",2697.93,93,,2158.34,,,0,"percent of total billed charges ","93% of total billed charges ",1012.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2465.85,85,,1972.68,,,0,"percent of total billed charges ","85% of total billed charges ",2175.75,90,,1740.60,,,0,"percent of total billed charges ","90% of total billed charges ",2610.9,90,,2088.72,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2523.87,87,,2019.10,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2977.04,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2030.7,70,,1624.56,,,0,"percent of total billed charges ","70% of total billed charges ",294.37,2977.04,
"EXC EXTERNAL HEMORRHOID",4603770,"CDM ",450,RC,46083,HCPCS,OUTPATIENT,,,568,454.4,,222.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",116.15,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",226.95,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",397.6,70,,318.08,,,0,"percent of total billed charges ","70% of total billed charges ",511.2,90,,408.96,,,0,"percent of total billed charges ","90% of total billed charges ",528.24,93,,422.59,,,0,"percent of total billed charges ","93% of total billed charges ",222.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",482.8,85,,386.24,,,0,"percent of total billed charges ","85% of total billed charges ",426,90,,340.80,,,0,"percent of total billed charges ","90% of total billed charges ",511.2,90,,408.96,,,0,"percent of total billed charges ","90% of total billed charges ",254.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",494.16,87,,395.33,,,0,"percent of total billed charges ","87% of total billed charges ",254.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",229.77,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",397.6,70,,318.08,,,0,"percent of total billed charges ","70% of total billed charges ",116.15,528.24,
"WOUND PREP <100 CM",4603780,"CDM ",450,RC,15004,HCPCS,OUTPATIENT,,,2261.5,1809.2,,,,,,,,0,"other ","not separately reimbursment ",1025.15,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",540.01,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1583.05,70,,1266.44,,,0,"percent of total billed charges ","70% of total billed charges ",2035.35,90,,1628.28,,,0,"percent of total billed charges ","90% of total billed charges ",2103.2,93,,1682.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",220.73,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1922.28,85,,1537.82,,,0,"percent of total billed charges ","85% of total billed charges ",1696.13,90,,1356.90,,,0,"percent of total billed charges ","90% of total billed charges ",2035.35,90,,1628.28,,,0,"percent of total billed charges ","90% of total billed charges ",218.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1967.51,87,,297.09,297.09,297.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",218.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1583.05,70,,1266.44,,,0,"percent of total billed charges ","70% of total billed charges ",218.54,2103.2,
"TREAT RADIUS FRACTURE",4603790,"CDM ",450,RC,24655,HCPCS,OUTPATIENT,,,862.5,690,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1117.06,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",839.04,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",603.75,70,,483.00,,,0,"percent of total billed charges ","70% of total billed charges ",776.25,90,,621.00,,,0,"percent of total billed charges ","90% of total billed charges ",802.13,93,,641.70,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",733.13,85,,586.50,,,0,"percent of total billed charges ","85% of total billed charges ",646.88,90,,517.50,,,0,"percent of total billed charges ","90% of total billed charges ",776.25,90,,621.00,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",750.38,87,,600.30,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",603.75,70,,483.00,,,0,"percent of total billed charges ","70% of total billed charges ",457.91,1478.8,
"CLOSURE OF WOUND",4603800,"CDM ",450,RC,13160,HCPCS,OUTPATIENT,,,4283,3426.4,,590.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2038.18,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1641.4,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2998.1,70,,2398.48,,,0,"percent of total billed charges ","70% of total billed charges ",3854.7,90,,3083.76,,,0,"percent of total billed charges ","90% of total billed charges ",3983.19,93,,3186.55,,,0,"percent of total billed charges ","93% of total billed charges ",590.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",429.45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3640.55,85,,2912.44,,,0,"percent of total billed charges ","85% of total billed charges ",3212.25,90,,2569.80,,,0,"percent of total billed charges ","90% of total billed charges ",3854.7,90,,3083.76,,,0,"percent of total billed charges ","90% of total billed charges ",425.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3726.21,87,,2980.97,,,0,"percent of total billed charges ","87% of total billed charges ",425.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3259.01,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2998.1,70,,2398.48,,,0,"percent of total billed charges ","70% of total billed charges ",425.2,3983.19,
"REMOVAL FOREIGN BODY,FOOT,DEEP",4603810,"CDM ",450,RC,28192,HCPCS,OUTPATIENT,,,3133.5,2506.8,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1246.34,100,,771.70,771.70,771.70,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",648.85,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2193.45,70,,1754.76,,,0,"percent of total billed charges ","70% of total billed charges ",2820.15,90,,2256.12,,,0,"percent of total billed charges ","90% of total billed charges ",2914.16,93,,2331.33,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",528.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2663.48,85,,2130.78,,,0,"percent of total billed charges ","85% of total billed charges ",2350.13,90,,1880.10,,,0,"percent of total billed charges ","90% of total billed charges ",2820.15,90,,2256.12,,,0,"percent of total billed charges ","90% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2726.15,87,,2180.92,,,0,"percent of total billed charges ","87% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2193.45,70,,1754.76,,,0,"percent of total billed charges ","70% of total billed charges ",523.33,2914.16,
"DENTAL SURGERY PROCEDURE",4603820,"CDM ",450,RC,41899,HCPCS,OUTPATIENT,,,226,180.8,,228.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2859.31,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",158.2,70,,126.56,,,0,"percent of total billed charges ","70% of total billed charges ",203.4,90,,162.72,,,0,"percent of total billed charges ","90% of total billed charges ",210.18,93,,168.14,,,0,"percent of total billed charges ","93% of total billed charges ",228.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",121.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",192.1,85,,153.68,,,0,"percent of total billed charges ","85% of total billed charges ",169.5,90,,135.60,,,0,"percent of total billed charges ","90% of total billed charges ",203.4,90,,162.72,,,0,"percent of total billed charges ","90% of total billed charges ",120.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",196.62,87,,157.30,,,0,"percent of total billed charges ","87% of total billed charges ",120.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.82,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",158.2,70,,126.56,,,0,"percent of total billed charges ","70% of total billed charges ",120.67,2859.31,
"TX CLSD ELBOW REDUCTION",4603830,"CDM ",450,RC,24605,HCPCS,OUTPATIENT,,,2738,2190.4,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1117.06,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",991.74,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1916.6,70,,1533.28,,,0,"percent of total billed charges ","70% of total billed charges ",2464.2,90,,1971.36,,,0,"percent of total billed charges ","90% of total billed charges ",2546.34,93,,2037.07,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2327.3,85,,1861.84,,,0,"percent of total billed charges ","85% of total billed charges ",2053.5,90,,1642.80,,,0,"percent of total billed charges ","90% of total billed charges ",2464.2,90,,1971.36,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2382.06,87,,1905.65,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1916.6,70,,1533.28,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,2546.34,
"TREAT HIP DISLOCATION",4603840,"CDM ",450,RC,27257,HCPCS,OUTPATIENT,,,2738,2190.4,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1023.78,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",738.98,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1916.6,70,,1533.28,,,0,"percent of total billed charges ","70% of total billed charges ",2464.2,90,,1971.36,,,0,"percent of total billed charges ","90% of total billed charges ",2546.34,93,,2037.07,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",528.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2327.3,85,,1861.84,,,0,"percent of total billed charges ","85% of total billed charges ",2053.5,90,,1642.80,,,0,"percent of total billed charges ","90% of total billed charges ",2464.2,90,,1971.36,,,0,"percent of total billed charges ","90% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2382.06,87,,1905.65,,,0,"percent of total billed charges ","87% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1916.6,70,,1533.28,,,0,"percent of total billed charges ","70% of total billed charges ",520.65,2546.34,
"APPLY SHORT LEG CAST",4603850,"CDM ",450,RC,29405,HCPCS,OUTPATIENT,,,384.5,307.6,,228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",119,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",357.59,93,,286.07,,,0,"percent of total billed charges ","93% of total billed charges ",228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",326.83,85,,261.46,,,0,"percent of total billed charges ","85% of total billed charges ",288.38,90,,230.70,,,0,"percent of total billed charges ","90% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",334.52,87,,267.62,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.22,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",119,357.59,
"REPAIR FOREARM TENDON/MUSCLE",4603860,"CDM ",450,RC,25260,HCPCS,OUTPATIENT,,,4168.5,3334.8,,1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1402.45,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1311.82,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2917.95,70,,2334.36,,,0,"percent of total billed charges ","70% of total billed charges ",3751.65,90,,3001.32,,,0,"percent of total billed charges ","90% of total billed charges ",3876.71,93,,3101.37,,,0,"percent of total billed charges ","93% of total billed charges ",1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3543.23,85,,2834.58,,,0,"percent of total billed charges ","85% of total billed charges ",3126.38,90,,2501.10,,,0,"percent of total billed charges ","90% of total billed charges ",3751.65,90,,3001.32,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3626.6,87,,2901.28,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3009.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2917.95,70,,2334.36,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,3876.71,
"REPAIR NERVE HAND/FOOT",4603870,"CDM ",450,RC,64836,HCPCS,OUTPATIENT,,,6866.5,5493.2,,2157.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2573.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1674.93,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4806.55,70,,3845.24,,,0,"percent of total billed charges ","70% of total billed charges ",6179.85,90,,4943.88,,,0,"percent of total billed charges ","90% of total billed charges ",6385.85,93,,5108.68,,,0,"percent of total billed charges ","93% of total billed charges ",2157.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5836.53,85,,4669.22,,,0,"percent of total billed charges ","85% of total billed charges ",5149.88,90,,4119.90,,,0,"percent of total billed charges ","90% of total billed charges ",6179.85,90,,4943.88,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5973.86,87,,4779.09,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3141.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4806.55,70,,3845.24,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,6385.85,
"CLSD TX ULNAR STYLOID FX",4603880,"CDM ",450,RC,25650,HCPCS,OUTPATIENT,,,299.5,239.6,,338,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",637.71,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",209.65,70,,167.72,,,0,"percent of total billed charges ","70% of total billed charges ",269.55,90,,215.64,,,0,"percent of total billed charges ","90% of total billed charges ",278.54,93,,222.83,,,0,"percent of total billed charges ","93% of total billed charges ",338,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",429.45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",254.58,85,,203.66,,,0,"percent of total billed charges ","85% of total billed charges ",224.63,90,,179.70,,,0,"percent of total billed charges ","90% of total billed charges ",269.55,90,,215.64,,,0,"percent of total billed charges ","90% of total billed charges ",425.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",260.57,87,,208.46,,,0,"percent of total billed charges ","87% of total billed charges ",425.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",209.65,70,,167.72,,,0,"percent of total billed charges ","70% of total billed charges ",209.65,1454.4,
"CLSD TX FEMORAL FX W/MANIP",4603890,"CDM ",450,RC,27502,HCPCS,OUTPATIENT,,,3551.5,2841.2,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1562.04,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2486.05,70,,1988.84,,,0,"percent of total billed charges ","70% of total billed charges ",3196.35,90,,2557.08,,,0,"percent of total billed charges ","90% of total billed charges ",3302.9,93,,2642.32,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3018.78,85,,2415.02,,,0,"percent of total billed charges ","85% of total billed charges ",2663.63,90,,2130.90,,,0,"percent of total billed charges ","90% of total billed charges ",3196.35,90,,2557.08,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3089.81,87,,2471.85,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2486.05,70,,1988.84,,,0,"percent of total billed charges ","70% of total billed charges ",457.91,3302.9,
"GLAND ABSCESS DRAINAGE",4603900,"CDM ",450,RC,56420,HCPCS,OUTPATIENT,,,516.5,413.2,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",231.7,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",361.55,70,,289.24,,,0,"percent of total billed charges ","70% of total billed charges ",464.85,90,,371.88,,,0,"percent of total billed charges ","90% of total billed charges ",480.35,93,,384.28,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",439.03,85,,351.22,,,0,"percent of total billed charges ","85% of total billed charges ",387.38,90,,309.90,,,0,"percent of total billed charges ","90% of total billed charges ",464.85,90,,371.88,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",449.36,87,,359.49,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",185.92,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",361.55,70,,289.24,,,0,"percent of total billed charges ","70% of total billed charges ",185.92,480.35,
"DEBRIDEMENT <20CM",4603910,"CDM ",450,RC,97597,HCPCS,OUTPATIENT,,,344,275.2,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",278.76,100,,266.92,266.92,266.92,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",76.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",240.8,70,,192.64,,,0,"percent of total billed charges ","70% of total billed charges ",309.6,90,,247.68,,,0,"percent of total billed charges ","90% of total billed charges ",319.92,93,,255.94,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",292.4,85,,233.92,,,0,"percent of total billed charges ","85% of total billed charges ",309.6,90,,247.68,,,0,"percent of total billed charges ","90% of total billed charges ",309.6,90,,247.68,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",299.28,87,,239.42,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",240.8,70,,192.64,,,0,"percent of total billed charges ","70% of total billed charges ",76.25,319.92,
"CHEMICAL CAUTERIZATION TISSUE",4603920,"CDM ",450,RC,17250,HCPCS,OUTPATIENT,,,625.5,500.4,,85.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",388.85,100,,88.32,88.32,88.32,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",76.45,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",437.85,70,,350.28,,,0,"percent of total billed charges ","70% of total billed charges ",562.95,90,,450.36,,,0,"percent of total billed charges ","90% of total billed charges ",581.72,93,,465.38,,,0,"percent of total billed charges ","93% of total billed charges ",85.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",99.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",531.68,85,,425.34,,,0,"percent of total billed charges ","85% of total billed charges ",469.13,90,,375.30,,,0,"percent of total billed charges ","90% of total billed charges ",562.95,90,,450.36,,,0,"percent of total billed charges ","90% of total billed charges ",98.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",544.19,87,,435.35,,,0,"percent of total billed charges ","87% of total billed charges ",98.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",437.85,70,,350.28,,,0,"percent of total billed charges ","70% of total billed charges ",76.45,581.72,
"INITIAL TX FIRST DEGREE BURN",4603930,"CDM ",450,RC,16000,HCPCS,OUTPATIENT,,,167.5,134,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",93.37,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",117.25,70,,93.80,,,0,"percent of total billed charges ","70% of total billed charges ",150.75,90,,120.60,,,0,"percent of total billed charges ","90% of total billed charges ",155.78,93,,124.62,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",363.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",142.38,85,,113.90,,,0,"percent of total billed charges ","85% of total billed charges ",125.63,90,,100.50,,,0,"percent of total billed charges ","90% of total billed charges ",150.75,90,,120.60,,,0,"percent of total billed charges ","90% of total billed charges ",359.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",145.73,87,,116.58,,,0,"percent of total billed charges ","87% of total billed charges ",359.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",117.25,70,,93.80,,,0,"percent of total billed charges ","70% of total billed charges ",93.37,363.39,
"EXCISION BENIGN LESION",4603940,"CDM ",450,RC,11401,HCPCS,OUTPATIENT,,,929.5,743.6,,252.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",451.17,100,,192.97,192.97,192.97,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",217.43,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",650.65,70,,520.52,,,0,"percent of total billed charges ","70% of total billed charges ",836.55,90,,669.24,,,0,"percent of total billed charges ","90% of total billed charges ",864.44,93,,691.55,,,0,"percent of total billed charges ","93% of total billed charges ",252.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",291.36,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",790.08,85,,632.06,,,0,"percent of total billed charges ","85% of total billed charges ",697.13,90,,557.70,,,0,"percent of total billed charges ","90% of total billed charges ",836.55,90,,669.24,,,0,"percent of total billed charges ","90% of total billed charges ",288.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",808.67,87,,2242.58,2242.58,2242.58,"1 through 10","percent of total billed charges ","87% of total billed charges ",288.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",650.65,70,,520.52,,,0,"percent of total billed charges ","70% of total billed charges ",217.43,864.44,
"DRAIN OUTER EAR CANAL REGION",4603950,"CDM ",450,RC,69020,HCPCS,OUTPATIENT,,,277,221.6,,343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",298.34,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",193.9,70,,155.12,,,0,"percent of total billed charges ","70% of total billed charges ",249.3,90,,199.44,,,0,"percent of total billed charges ","90% of total billed charges ",257.61,93,,206.09,,,0,"percent of total billed charges ","93% of total billed charges ",343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",235.45,85,,188.36,,,0,"percent of total billed charges ","85% of total billed charges ",207.75,90,,166.20,,,0,"percent of total billed charges ","90% of total billed charges ",249.3,90,,199.44,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",240.99,87,,192.79,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",193.9,70,,155.12,,,0,"percent of total billed charges ","70% of total billed charges ",193.9,651.23,
"ANKLE FX CLOSED TX W/MANIP",4603960,"CDM ",450,RC,27818,HCPCS,OUTPATIENT,,,2512,2009.6,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1915.97,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",907.76,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1758.4,70,,1406.72,,,0,"percent of total billed charges ","70% of total billed charges ",2260.8,90,,1808.64,,,0,"percent of total billed charges ","90% of total billed charges ",2336.16,93,,1868.93,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2135.2,85,,1708.16,,,0,"percent of total billed charges ","85% of total billed charges ",1884,90,,1507.20,,,0,"percent of total billed charges ","90% of total billed charges ",2260.8,90,,1808.64,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2185.44,87,,1748.35,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1758.4,70,,1406.72,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,2336.16,
"APPLY CAST FIGURE EIGHT",4603970,"CDM ",450,RC,29049,HCPCS,OUTPATIENT,,,206.5,165.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.44,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",192.05,93,,153.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",175.53,85,,140.42,,,0,"percent of total billed charges ","85% of total billed charges ",154.88,90,,123.90,,,0,"percent of total billed charges ","90% of total billed charges ",185.85,90,,148.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",179.66,87,,143.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",257.22,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",144.55,70,,115.64,,,0,"percent of total billed charges ","70% of total billed charges ",141.44,257.22,
"CLSD TX TEMPOROMANDIBULAR DIS",4604000,"CDM ",450,RC,21480,HCPCS,OUTPATIENT,,,208,166.4,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",63.4,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",145.6,70,,116.48,,,0,"percent of total billed charges ","70% of total billed charges ",187.2,90,,149.76,,,0,"percent of total billed charges ","90% of total billed charges ",193.44,93,,154.75,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",176.8,85,,141.44,,,0,"percent of total billed charges ","85% of total billed charges ",156,90,,124.80,,,0,"percent of total billed charges ","90% of total billed charges ",187.2,90,,149.76,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",180.96,87,,144.77,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",145.6,70,,116.48,,,0,"percent of total billed charges ","70% of total billed charges ",63.4,396.43,
"DRAIN EAR ABSCESS SIMPLE",4604010,"CDM ",450,RC,69000,HCPCS,OUTPATIENT,,,273.5,218.8,,343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",256.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",191.45,70,,153.16,,,0,"percent of total billed charges ","70% of total billed charges ",246.15,90,,196.92,,,0,"percent of total billed charges ","90% of total billed charges ",254.36,93,,203.49,,,0,"percent of total billed charges ","93% of total billed charges ",343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",232.48,85,,185.98,,,0,"percent of total billed charges ","85% of total billed charges ",205.13,90,,164.10,,,0,"percent of total billed charges ","90% of total billed charges ",246.15,90,,196.92,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",237.95,87,,190.36,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",191.45,70,,153.16,,,0,"percent of total billed charges ","70% of total billed charges ",191.45,651.23,
"VACCINE ADMIN EACH ADD'L",4604030,"CDM ",450,RC,90472,HCPCS,OUTPATIENT,,,215,172,,14.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",26.27,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",199.95,93,,159.96,,,0,"percent of total billed charges ","93% of total billed charges ",14.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",182.75,85,,146.20,,,0,"percent of total billed charges ","85% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",187.05,87,,149.64,,,0,"percent of total billed charges ","87% of total billed charges ",21.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",8.08,199.95,
"EXPLORE FINGER JOINT",4604040,"CDM ",450,RC,26080,HCPCS,OUTPATIENT,,,314.5,251.6,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",691.9,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",220.15,70,,176.12,,,0,"percent of total billed charges ","70% of total billed charges ",283.05,90,,226.44,,,0,"percent of total billed charges ","90% of total billed charges ",292.49,93,,233.99,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",267.33,85,,213.86,,,0,"percent of total billed charges ","85% of total billed charges ",235.88,90,,188.70,,,0,"percent of total billed charges ","90% of total billed charges ",283.05,90,,226.44,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",273.62,87,,218.90,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",220.15,70,,176.12,,,0,"percent of total billed charges ","70% of total billed charges ",220.15,1478.8,
"STRAPPING UNA BOOT",4604050,"CDM ",450,RC,29580,HCPCS,OUTPATIENT,,,625.5,500.4,,57.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",55.7,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",437.85,70,,350.28,,,0,"percent of total billed charges ","70% of total billed charges ",562.95,90,,450.36,,,0,"percent of total billed charges ","90% of total billed charges ",581.72,93,,465.38,,,0,"percent of total billed charges ","93% of total billed charges ",57.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",531.68,85,,425.34,,,0,"percent of total billed charges ","85% of total billed charges ",469.13,90,,375.30,,,0,"percent of total billed charges ","90% of total billed charges ",562.95,90,,450.36,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",544.19,87,,435.35,,,0,"percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",437.85,70,,350.28,,,0,"percent of total billed charges ","70% of total billed charges ",55.7,581.72,
"CLSD TX FX GREAT TOE W/O MANIP",4604070,"CDM ",450,RC,28490,HCPCS,OUTPATIENT,,,281.5,225.2,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",257.44,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",197.05,70,,157.64,,,0,"percent of total billed charges ","70% of total billed charges ",253.35,90,,202.68,,,0,"percent of total billed charges ","90% of total billed charges ",261.8,93,,209.44,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",239.28,85,,191.42,,,0,"percent of total billed charges ","85% of total billed charges ",211.13,90,,168.90,,,0,"percent of total billed charges ","90% of total billed charges ",253.35,90,,202.68,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",244.91,87,,195.93,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",197.05,70,,157.64,,,0,"percent of total billed charges ","70% of total billed charges ",197.05,1454.4,
"RPR CENTRAL VENOUS ACCESS CATH",4604080,"CDM ",450,RC,36575,HCPCS,OUTPATIENT,,,1750,1400,,163.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1321.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",70.38,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1225,70,,980.00,,,0,"percent of total billed charges ","70% of total billed charges ",1575,90,,1260.00,,,0,"percent of total billed charges ","90% of total billed charges ",1627.5,93,,1302.00,,,0,"percent of total billed charges ","93% of total billed charges ",163.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",207.54,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1487.5,85,,1190.00,,,0,"percent of total billed charges ","85% of total billed charges ",1312.5,90,,1050.00,,,0,"percent of total billed charges ","90% of total billed charges ",1575,90,,1260.00,,,0,"percent of total billed charges ","90% of total billed charges ",205.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1522.5,87,,1218.00,,,0,"percent of total billed charges ","87% of total billed charges ",205.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",576.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1225,70,,980.00,,,0,"percent of total billed charges ","70% of total billed charges ",70.38,1627.5,
"CLSD TX FEMORAL FX",4604090,"CDM ",450,RC,27508,HCPCS,OUTPATIENT,,,281.5,225.2,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",619.3,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",197.05,70,,157.64,,,0,"percent of total billed charges ","70% of total billed charges ",253.35,90,,202.68,,,0,"percent of total billed charges ","90% of total billed charges ",261.8,93,,209.44,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",239.28,85,,191.42,,,0,"percent of total billed charges ","85% of total billed charges ",211.13,90,,168.90,,,0,"percent of total billed charges ","90% of total billed charges ",253.35,90,,202.68,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",244.91,87,,195.93,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",197.05,70,,157.64,,,0,"percent of total billed charges ","70% of total billed charges ",197.05,1454.4,
"OSTEOPATHIC MANIPULATION",4604100,"CDM ",450,RC,98925,HCPCS,OUTPATIENT,,,69.5,55.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.54,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",48.65,70,,38.92,,,0,"percent of total billed charges ","70% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",64.64,93,,51.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",59.08,85,,47.26,,,0,"percent of total billed charges ","85% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",60.47,87,,48.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",19.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",48.65,70,,38.92,,,0,"percent of total billed charges ","70% of total billed charges ",19.85,64.64,
"CLSD TX TIBIAL FX PROXIMAL",4604110,"CDM ",450,RC,27532,HCPCS,OUTPATIENT,,,3615,2892,,1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1196.73,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2530.5,70,,2024.40,,,0,"percent of total billed charges ","70% of total billed charges ",3253.5,90,,2602.80,,,0,"percent of total billed charges ","90% of total billed charges ",3361.95,93,,2689.56,,,0,"percent of total billed charges ","93% of total billed charges ",1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",528.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3072.75,85,,2458.20,,,0,"percent of total billed charges ","85% of total billed charges ",2711.25,90,,2169.00,,,0,"percent of total billed charges ","90% of total billed charges ",3253.5,90,,2602.80,,,0,"percent of total billed charges ","90% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3145.05,87,,2516.04,,,0,"percent of total billed charges ","87% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3009.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2530.5,70,,2024.40,,,0,"percent of total billed charges ","70% of total billed charges ",523.33,3361.95,
"I&D ABSCESS RETROPHARYNGEAL",4604120,"CDM ",450,RC,42720,HCPCS,OUTPATIENT,,,3140,2512,,1042.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",803.15,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2198,70,,1758.40,,,0,"percent of total billed charges ","70% of total billed charges ",2826,90,,2260.80,,,0,"percent of total billed charges ","90% of total billed charges ",2920.2,93,,2336.16,,,0,"percent of total billed charges ","93% of total billed charges ",1042.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",508.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2669,85,,2135.20,,,0,"percent of total billed charges ","85% of total billed charges ",2355,90,,1884.00,,,0,"percent of total billed charges ","90% of total billed charges ",2826,90,,2260.80,,,0,"percent of total billed charges ","90% of total billed charges ",503.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2731.8,87,,2185.44,,,0,"percent of total billed charges ","87% of total billed charges ",503.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3049.08,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2198,70,,1758.40,,,0,"percent of total billed charges ","70% of total billed charges ",503.7,3049.08,
"PROCEDURE OF ABDOMEN",4604130,"CDM ",450,RC,49999,HCPCS,OUTPATIENT,,,5000.5,4000.4,,1766.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3500.35,70,,2800.28,,,0,"percent of total billed charges ","70% of total billed charges ",4500.45,90,,3600.36,,,0,"percent of total billed charges ","90% of total billed charges ",4650.47,93,,3720.38,,,0,"percent of total billed charges ","93% of total billed charges ",1766.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2243.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4250.43,85,,3400.34,,,0,"percent of total billed charges ","85% of total billed charges ",3750.38,90,,3000.30,,,0,"percent of total billed charges ","90% of total billed charges ",4500.45,90,,3600.36,,,0,"percent of total billed charges ","90% of total billed charges ",2221.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4350.44,87,,3480.35,,,0,"percent of total billed charges ","87% of total billed charges ",2221.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",834.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3500.35,70,,2800.28,,,0,"percent of total billed charges ","70% of total billed charges ",834.11,4650.47,
"REMOVAL INPLANT CONTRACEPTIVE",4604140,"CDM ",450,RC,11976,HCPCS,OUTPATIENT,,,823,658.4,,343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",192.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",576.1,70,,460.88,,,0,"percent of total billed charges ","70% of total billed charges ",740.7,90,,592.56,,,0,"percent of total billed charges ","90% of total billed charges ",765.39,93,,612.31,,,0,"percent of total billed charges ","93% of total billed charges ",343.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",699.55,85,,559.64,,,0,"percent of total billed charges ","85% of total billed charges ",617.25,90,,493.80,,,0,"percent of total billed charges ","90% of total billed charges ",740.7,90,,592.56,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",716.01,87,,572.81,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",576.1,70,,460.88,,,0,"percent of total billed charges ","70% of total billed charges ",192.28,765.39,
"I&D SUBMUCOSAL ABSCESS,RECTUM",4604150,"CDM ",450,RC,45005,HCPCS,OUTPATIENT,,,4541,3632.8,,382.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",344.39,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3178.7,70,,2542.96,,,0,"percent of total billed charges ","70% of total billed charges ",4086.9,90,,3269.52,,,0,"percent of total billed charges ","90% of total billed charges ",4223.13,93,,3378.50,,,0,"percent of total billed charges ","93% of total billed charges ",382.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3859.85,85,,3087.88,,,0,"percent of total billed charges ","85% of total billed charges ",3405.75,90,,2724.60,,,0,"percent of total billed charges ","90% of total billed charges ",4086.9,90,,3269.52,,,0,"percent of total billed charges ","90% of total billed charges ",254.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3950.67,87,,3160.54,,,0,"percent of total billed charges ","87% of total billed charges ",254.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1100.5,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3178.7,70,,2542.96,,,0,"percent of total billed charges ","70% of total billed charges ",254.14,4223.13,
"CLSD TX NOSE FX W/O STABILIZ",4604160,"CDM ",450,RC,21315,HCPCS,OUTPATIENT,,,2908.5,2326.8,,494.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1955.36,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",122.21,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2035.95,70,,1628.76,,,0,"percent of total billed charges ","70% of total billed charges ",2617.65,90,,2094.12,,,0,"percent of total billed charges ","90% of total billed charges ",2704.91,93,,2163.93,,,0,"percent of total billed charges ","93% of total billed charges ",494.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2472.23,85,,1977.78,,,0,"percent of total billed charges ","85% of total billed charges ",2181.38,90,,1745.10,,,0,"percent of total billed charges ","90% of total billed charges ",2617.65,90,,2094.12,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2530.4,87,,2024.32,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1426.92,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2035.95,70,,1628.76,,,0,"percent of total billed charges ","70% of total billed charges ",122.21,2704.91,
"REPAIR FINGER TENDON",4604170,"CDM ",450,RC,26433,HCPCS,OUTPATIENT,,,3003.5,2402.8,,1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1402.45,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1205.95,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2102.45,70,,1681.96,,,0,"percent of total billed charges ","70% of total billed charges ",2703.15,90,,2162.52,,,0,"percent of total billed charges ","90% of total billed charges ",2793.26,93,,2234.61,,,0,"percent of total billed charges ","93% of total billed charges ",1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",528.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2552.98,85,,2042.38,,,0,"percent of total billed charges ","85% of total billed charges ",2252.63,90,,1802.10,,,0,"percent of total billed charges ","90% of total billed charges ",2703.15,90,,2162.52,,,0,"percent of total billed charges ","90% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2613.05,87,,2090.44,,,0,"percent of total billed charges ","87% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3009.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2102.45,70,,1681.96,,,0,"percent of total billed charges ","70% of total billed charges ",523.33,3009.11,
"NASAL SURGERY PROCEDURE",4604180,"CDM ",450,RC,30999,HCPCS,OUTPATIENT,,,254,203.2,,96.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.8,70,,142.24,,,0,"percent of total billed charges ","70% of total billed charges ",228.6,90,,182.88,,,0,"percent of total billed charges ","90% of total billed charges ",236.22,93,,188.98,,,0,"percent of total billed charges ","93% of total billed charges ",96.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",111.41,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",215.9,85,,172.72,,,0,"percent of total billed charges ","85% of total billed charges ",190.5,90,,152.40,,,0,"percent of total billed charges ","90% of total billed charges ",228.6,90,,182.88,,,0,"percent of total billed charges ","90% of total billed charges ",110.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",220.98,87,,176.78,,,0,"percent of total billed charges ","87% of total billed charges ",110.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.82,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",177.8,70,,142.24,,,0,"percent of total billed charges ","70% of total billed charges ",96.46,236.22,
"ABDOMINAL PARACENTESIS",4604190,"CDM ",450,RC,49082,HCPCS,OUTPATIENT,,,1108,886.4,,260.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1079.61,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",151.49,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",775.6,70,,620.48,,,0,"percent of total billed charges ","70% of total billed charges ",997.2,90,,797.76,,,0,"percent of total billed charges ","90% of total billed charges ",1030.44,93,,824.35,,,0,"percent of total billed charges ","93% of total billed charges ",260.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.95,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",941.8,85,,753.44,,,0,"percent of total billed charges ","85% of total billed charges ",831,90,,664.80,,,0,"percent of total billed charges ","90% of total billed charges ",997.2,90,,797.76,,,0,"percent of total billed charges ","90% of total billed charges ",327.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",963.96,87,,771.17,,,0,"percent of total billed charges ","87% of total billed charges ",327.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",834.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",775.6,70,,620.48,,,0,"percent of total billed charges ","70% of total billed charges ",151.49,1079.61,
"IRRIG DRUG DELIVERY DEVICE",4604200,"CDM ",450,RC,96523,HCPCS,OUTPATIENT,,,102,81.6,,,,,,,,0,"other ","not separately reimbursment ",54.54,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",54.19,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",71.4,70,,57.12,,,0,"percent of total billed charges ","70% of total billed charges ",91.8,90,,73.44,,,0,"percent of total billed charges ","90% of total billed charges ",94.86,93,,75.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",86.7,85,,69.36,,,0,"percent of total billed charges ","85% of total billed charges ",91.8,90,,73.44,,,0,"percent of total billed charges ","90% of total billed charges ",91.8,90,,73.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",88.74,87,,70.99,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",71.4,70,,57.12,,,0,"percent of total billed charges ","70% of total billed charges ",54.19,94.86,
"ASPIRATE PLEURA W/O IMAGING",4604220,"CDM ",450,RC,32554,HCPCS,OUTPATIENT,,,1362,1089.6,,278.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",742.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",187,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",953.4,70,,762.72,,,0,"percent of total billed charges ","70% of total billed charges ",1225.8,90,,980.64,,,0,"percent of total billed charges ","90% of total billed charges ",1266.66,93,,1013.33,,,0,"percent of total billed charges ","93% of total billed charges ",278.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",354.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1157.7,85,,926.16,,,0,"percent of total billed charges ","85% of total billed charges ",1021.5,90,,817.20,,,0,"percent of total billed charges ","90% of total billed charges ",1225.8,90,,980.64,,,0,"percent of total billed charges ","90% of total billed charges ",350.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1184.94,87,,947.95,,,0,"percent of total billed charges ","87% of total billed charges ",350.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",576.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",953.4,70,,762.72,,,0,"percent of total billed charges ","70% of total billed charges ",187,1266.66,
"STOMACH SURGERY PROCEDURE",4604230,"CDM ",450,RC,43999,HCPCS,OUTPATIENT,,,1550.5,1240.4,,554.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1085.35,70,,868.28,,,0,"percent of total billed charges ","70% of total billed charges ",1395.45,90,,1116.36,,,0,"percent of total billed charges ","90% of total billed charges ",1441.97,93,,1153.58,,,0,"percent of total billed charges ","93% of total billed charges ",554.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",640.41,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1317.93,85,,1054.34,,,0,"percent of total billed charges ","85% of total billed charges ",1162.88,90,,930.30,,,0,"percent of total billed charges ","90% of total billed charges ",1395.45,90,,1116.36,,,0,"percent of total billed charges ","90% of total billed charges ",634.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1348.94,87,,1079.15,,,0,"percent of total billed charges ","87% of total billed charges ",634.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",834.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1085.35,70,,868.28,,,0,"percent of total billed charges ","70% of total billed charges ",554.43,1441.97,
"PARTIAL AMPUTATION TOE",4604240,"CDM ",450,RC,28825,HCPCS,OUTPATIENT,,,4608,3686.4,,1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3963.24,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",362.74,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3225.6,70,,2580.48,,,0,"percent of total billed charges ","70% of total billed charges ",4147.2,90,,3317.76,,,0,"percent of total billed charges ","90% of total billed charges ",4285.44,93,,3428.35,,,0,"percent of total billed charges ","93% of total billed charges ",1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3916.8,85,,3133.44,,,0,"percent of total billed charges ","85% of total billed charges ",3456,90,,2764.80,,,0,"percent of total billed charges ","90% of total billed charges ",4147.2,90,,3317.76,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4008.96,87,,3207.17,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3009.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3225.6,70,,2580.48,,,0,"percent of total billed charges ","70% of total billed charges ",362.74,4285.44,
"EPISIOTOMY OR VAGINAL REPAIR",4604250,"CDM ",450,RC,59300,HCPCS,OUTPATIENT,,,3200,2560,,1012.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",292.91,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2240,70,,1792.00,,,0,"percent of total billed charges ","70% of total billed charges ",2880,90,,2304.00,,,0,"percent of total billed charges ","90% of total billed charges ",2976,93,,2380.80,,,0,"percent of total billed charges ","93% of total billed charges ",1012.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2720,85,,2176.00,,,0,"percent of total billed charges ","85% of total billed charges ",2400,90,,1920.00,,,0,"percent of total billed charges ","90% of total billed charges ",2880,90,,2304.00,,,0,"percent of total billed charges ","90% of total billed charges ",254.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2784,87,,2227.20,,,0,"percent of total billed charges ","87% of total billed charges ",254.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2977.04,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2240,70,,1792.00,,,0,"percent of total billed charges ","70% of total billed charges ",254.14,2977.04,
"REPLACE G/C TUBE PERC",4604260,"CDM ",450,RC,49450,HCPCS,OUTPATIENT,,,1085.5,868.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136.05,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",759.85,70,,607.88,,,0,"percent of total billed charges ","70% of total billed charges ",976.95,90,,781.56,,,0,"percent of total billed charges ","90% of total billed charges ",1009.52,93,,807.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",140.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",922.68,85,,738.14,,,0,"percent of total billed charges ","85% of total billed charges ",814.13,90,,651.30,,,0,"percent of total billed charges ","90% of total billed charges ",976.95,90,,781.56,,,0,"percent of total billed charges ","90% of total billed charges ",139.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",944.39,87,,755.51,,,0,"percent of total billed charges ","87% of total billed charges ",139.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",834.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",759.85,70,,607.88,,,0,"percent of total billed charges ","70% of total billed charges ",136.05,1009.52,
"COMPLEX RPR E/N/E/L ADDL <5CM",4604270,"CDM ",450,RC,13153,HCPCS,OUTPATIENT,,,352.5,282,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",281.53,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",246.75,70,,197.40,,,0,"percent of total billed charges ","70% of total billed charges ",317.25,90,,253.80,,,0,"percent of total billed charges ","90% of total billed charges ",327.83,93,,262.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",299.63,85,,239.70,,,0,"percent of total billed charges ","85% of total billed charges ",264.38,90,,211.50,,,0,"percent of total billed charges ","90% of total billed charges ",317.25,90,,253.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",306.68,87,,245.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",246.75,70,,197.40,,,0,"percent of total billed charges ","70% of total billed charges ",246.75,327.83,
"ASPIRATE PLEURA W/IMAGING",4604280,"CDM ",450,RC,32555,HCPCS,OUTPATIENT,,,1257.5,1006,,278.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",862.54,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",230.93,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",880.25,70,,704.20,,,0,"percent of total billed charges ","70% of total billed charges ",1131.75,90,,905.40,,,0,"percent of total billed charges ","90% of total billed charges ",1169.48,93,,935.58,,,0,"percent of total billed charges ","93% of total billed charges ",278.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",354.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1068.88,85,,855.10,,,0,"percent of total billed charges ","85% of total billed charges ",943.13,90,,754.50,,,0,"percent of total billed charges ","90% of total billed charges ",1131.75,90,,905.40,,,0,"percent of total billed charges ","90% of total billed charges ",350.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1094.03,87,,875.22,,,0,"percent of total billed charges ","87% of total billed charges ",350.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",576.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",880.25,70,,704.20,,,0,"percent of total billed charges ","70% of total billed charges ",230.93,1169.48,
"LARYNGOSCOPY W/FB REMOVAL",4604290,"CDM ",450,RC,31530,HCPCS,OUTPATIENT,,,4602,3681.6,,549.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4157.16,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",409.9,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3221.4,70,,2577.12,,,0,"percent of total billed charges ","70% of total billed charges ",4141.8,90,,3313.44,,,0,"percent of total billed charges ","90% of total billed charges ",4279.86,93,,3423.89,,,0,"percent of total billed charges ","93% of total billed charges ",549.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",249.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3911.7,85,,3129.36,,,0,"percent of total billed charges ","85% of total billed charges ",3451.5,90,,2761.20,,,0,"percent of total billed charges ","90% of total billed charges ",4141.8,90,,3313.44,,,0,"percent of total billed charges ","90% of total billed charges ",247.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4003.74,87,,3202.99,,,0,"percent of total billed charges ","87% of total billed charges ",247.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1636.89,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3221.4,70,,2577.12,,,0,"percent of total billed charges ","70% of total billed charges ",247.27,4279.86,
"TREATMENT THIGH FRACTURE",4604310,"CDM ",450,RC,27503,HCPCS,OUTPATIENT,,,397,317.6,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",873.4,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",277.9,70,,222.32,,,0,"percent of total billed charges ","70% of total billed charges ",357.3,90,,285.84,,,0,"percent of total billed charges ","90% of total billed charges ",369.21,93,,295.37,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",337.45,85,,269.96,,,0,"percent of total billed charges ","85% of total billed charges ",297.75,90,,238.20,,,0,"percent of total billed charges ","90% of total billed charges ",357.3,90,,285.84,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",345.39,87,,276.31,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",277.9,70,,222.32,,,0,"percent of total billed charges ","70% of total billed charges ",277.9,1478.8,
"FINE NEEDLE ASPIR WO IMAGE 1ST",4604320,"CDM ",450,RC,10021,HCPCS,OUTPATIENT,,,532.5,426,,129.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",113.7,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",372.75,70,,298.20,,,0,"percent of total billed charges ","70% of total billed charges ",479.25,90,,383.40,,,0,"percent of total billed charges ","90% of total billed charges ",495.23,93,,396.18,,,0,"percent of total billed charges ","93% of total billed charges ",129.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",452.63,85,,362.10,,,0,"percent of total billed charges ","85% of total billed charges ",399.38,90,,319.50,,,0,"percent of total billed charges ","90% of total billed charges ",479.25,90,,383.40,,,0,"percent of total billed charges ","90% of total billed charges ",99.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",463.28,87,,370.62,,,0,"percent of total billed charges ","87% of total billed charges ",99.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",372.75,70,,298.20,,,0,"percent of total billed charges ","70% of total billed charges ",99.94,495.23,
"INSERT CATH PLEURA W/O IMAGE",4604330,"CDM ",450,RC,32556,HCPCS,OUTPATIENT,,,2270.5,1816.4,,278.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",742.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",257.47,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1589.35,70,,1271.48,,,0,"percent of total billed charges ","70% of total billed charges ",2043.45,90,,1634.76,,,0,"percent of total billed charges ","90% of total billed charges ",2111.57,93,,1689.26,,,0,"percent of total billed charges ","93% of total billed charges ",278.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",354.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1929.93,85,,1543.94,,,0,"percent of total billed charges ","85% of total billed charges ",1702.88,90,,1362.30,,,0,"percent of total billed charges ","90% of total billed charges ",2043.45,90,,1634.76,,,0,"percent of total billed charges ","90% of total billed charges ",350.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1975.34,87,,1580.27,,,0,"percent of total billed charges ","87% of total billed charges ",350.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1764.73,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1589.35,70,,1271.48,,,0,"percent of total billed charges ","70% of total billed charges ",257.47,2111.57,
"VBAC DELIVERY ONLY",4604340,"CDM ",450,RC,59612,HCPCS,OUTPATIENT,,,3138,2510.4,,1012.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1806.38,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2196.6,70,,1757.28,,,0,"percent of total billed charges ","70% of total billed charges ",2824.2,90,,2259.36,,,0,"percent of total billed charges ","90% of total billed charges ",2918.34,93,,2334.67,,,0,"percent of total billed charges ","93% of total billed charges ",1012.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",594.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2667.3,85,,2133.84,,,0,"percent of total billed charges ","85% of total billed charges ",2353.5,90,,1882.80,,,0,"percent of total billed charges ","90% of total billed charges ",2824.2,90,,2259.36,,,0,"percent of total billed charges ","90% of total billed charges ",588.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2730.06,87,,2184.05,,,0,"percent of total billed charges ","87% of total billed charges ",588.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2977.04,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2196.6,70,,1757.28,,,0,"percent of total billed charges ","70% of total billed charges ",588.74,2977.04,
"NEG PRESS WOUND TX < 51CM",4604350,"CDM ",450,RC,97607,HCPCS,OUTPATIENT,,,533.5,426.8,,129.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",45.74,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",373.45,70,,298.76,,,0,"percent of total billed charges ","70% of total billed charges ",480.15,90,,384.12,,,0,"percent of total billed charges ","90% of total billed charges ",496.16,93,,396.93,,,0,"percent of total billed charges ","93% of total billed charges ",129.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",44.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",453.48,85,,362.78,,,0,"percent of total billed charges ","85% of total billed charges ",480.15,90,,384.12,,,0,"percent of total billed charges ","90% of total billed charges ",480.15,90,,384.12,,,0,"percent of total billed charges ","90% of total billed charges ",44.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",464.15,87,,371.32,,,0,"percent of total billed charges ","87% of total billed charges ",44.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",373.45,70,,298.76,,,0,"percent of total billed charges ","70% of total billed charges ",44.08,496.16,
"INJ SACROILIAC JOINT W/O",4604360,"CDM ",450,RC,G0260,HCPCS,OUTPATIENT,,,1392,1113.6,,,,,,,,0,"other ","not separately reimbursment ",310.07,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",974.4,70,,779.52,,,0,"percent of total billed charges ","70% of total billed charges ",1252.8,90,,1002.24,,,0,"percent of total billed charges ","90% of total billed charges ",1294.56,93,,1035.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1183.2,85,,946.56,,,0,"percent of total billed charges ","85% of total billed charges ",1252.8,90,,1002.24,,,0,"percent of total billed charges ","90% of total billed charges ",1252.8,90,,1002.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1211.04,87,,968.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",649.16,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",974.4,70,,779.52,,,0,"percent of total billed charges ","70% of total billed charges ",310.07,1294.56,
"REMOVAL ELBOW BURSA",4604370,"CDM ",450,RC,24105,HCPCS,OUTPATIENT,,,3811,3048.8,,1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2614.89,100,,553.57,553.57,553.57,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",743.91,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2667.7,70,,2134.16,,,0,"percent of total billed charges ","70% of total billed charges ",3429.9,90,,2743.92,,,0,"percent of total billed charges ","90% of total billed charges ",3544.23,93,,2835.38,,,0,"percent of total billed charges ","93% of total billed charges ",1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3239.35,85,,2591.48,,,0,"percent of total billed charges ","85% of total billed charges ",2858.25,90,,2286.60,,,0,"percent of total billed charges ","90% of total billed charges ",3429.9,90,,2743.92,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3315.57,87,,2652.46,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3009.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2667.7,70,,2134.16,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,3544.23,
"TREAT ULNAR FRACTURE",4604380,"CDM ",450,RC,24675,HCPCS,OUTPATIENT,,,2070,1656,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",874.61,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1449,70,,1159.20,,,0,"percent of total billed charges ","70% of total billed charges ",1863,90,,1490.40,,,0,"percent of total billed charges ","90% of total billed charges ",1925.1,93,,1540.08,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1759.5,85,,1407.60,,,0,"percent of total billed charges ","85% of total billed charges ",1552.5,90,,1242.00,,,0,"percent of total billed charges ","90% of total billed charges ",1863,90,,1490.40,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1800.9,87,,1440.72,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1449,70,,1159.20,,,0,"percent of total billed charges ","70% of total billed charges ",457.91,1925.1,
"TX ANKLE FX WO MANIPULATION",4604390,"CDM ",450,RC,27816,HCPCS,OUTPATIENT,,,1849.5,1479.6,,210.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",612.72,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1294.65,70,,1035.72,,,0,"percent of total billed charges ","70% of total billed charges ",1664.55,90,,1331.64,,,0,"percent of total billed charges ","90% of total billed charges ",1720.04,93,,1376.03,,,0,"percent of total billed charges ","93% of total billed charges ",210.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",243.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1572.08,85,,1257.66,,,0,"percent of total billed charges ","85% of total billed charges ",1387.13,90,,1109.70,,,0,"percent of total billed charges ","90% of total billed charges ",1664.55,90,,1331.64,,,0,"percent of total billed charges ","90% of total billed charges ",241.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1609.07,87,,1287.26,,,0,"percent of total billed charges ","87% of total billed charges ",241.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1294.65,70,,1035.72,,,0,"percent of total billed charges ","70% of total billed charges ",210.99,1720.04,
"REMOVAL FOREIGN BODY NASAL",4604400,"CDM ",450,RC,30310,HCPCS,OUTPATIENT,,,2940.5,2352.4,,1042.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",371.68,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",437.91,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2058.35,70,,1646.68,,,0,"percent of total billed charges ","70% of total billed charges ",2646.45,90,,2117.16,,,0,"percent of total billed charges ","90% of total billed charges ",2734.67,93,,2187.74,,,0,"percent of total billed charges ","93% of total billed charges ",1042.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2499.43,85,,1999.54,,,0,"percent of total billed charges ","85% of total billed charges ",2205.38,90,,1764.30,,,0,"percent of total billed charges ","90% of total billed charges ",2646.45,90,,2117.16,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2558.24,87,,2046.59,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3049.08,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2058.35,70,,1646.68,,,0,"percent of total billed charges ","70% of total billed charges ",261.66,3049.08,
"INSERT NEEDLE BONE CAVITY",4604410,"CDM ",450,RC,36680,HCPCS,OUTPATIENT,,,674.5,539.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",121.13,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",472.15,70,,377.72,,,0,"percent of total billed charges ","70% of total billed charges ",607.05,90,,485.64,,,0,"percent of total billed charges ","90% of total billed charges ",627.29,93,,501.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",573.33,85,,458.66,,,0,"percent of total billed charges ","85% of total billed charges ",505.88,90,,404.70,,,0,"percent of total billed charges ","90% of total billed charges ",607.05,90,,485.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",586.82,87,,469.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",410.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",472.15,70,,377.72,,,0,"percent of total billed charges ","70% of total billed charges ",121.13,627.29,
"TREAT FINGER DISLOCATION OPEN",4604420,"CDM ",450,RC,26785,HCPCS,OUTPATIENT,,,4790,3832,,1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3839.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1129.85,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3353,70,,2682.40,,,0,"percent of total billed charges ","70% of total billed charges ",4311,90,,3448.80,,,0,"percent of total billed charges ","90% of total billed charges ",4454.7,93,,3563.76,,,0,"percent of total billed charges ","93% of total billed charges ",1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4071.5,85,,3257.20,,,0,"percent of total billed charges ","85% of total billed charges ",3592.5,90,,2874.00,,,0,"percent of total billed charges ","90% of total billed charges ",4311,90,,3448.80,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4167.3,87,,3333.84,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3009.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3353,70,,2682.40,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,4454.7,
"RECTUM PROCEDURE",4604430,"CDM ",450,RC,45999,HCPCS,OUTPATIENT,,,1019,815.2,,329.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",713.3,70,,570.64,,,0,"percent of total billed charges ","70% of total billed charges ",917.1,90,,733.68,,,0,"percent of total billed charges ","90% of total billed charges ",947.67,93,,758.14,,,0,"percent of total billed charges ","93% of total billed charges ",329.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",380.08,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",866.15,85,,692.92,,,0,"percent of total billed charges ","85% of total billed charges ",764.25,90,,611.40,,,0,"percent of total billed charges ","90% of total billed charges ",917.1,90,,733.68,,,0,"percent of total billed charges ","90% of total billed charges ",376.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",886.53,87,,709.22,,,0,"percent of total billed charges ","87% of total billed charges ",376.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",855.24,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",713.3,70,,570.64,,,0,"percent of total billed charges ","70% of total billed charges ",329.05,947.67,
"IV THERAPY 1ST HR REPEAT VISIT",4604460,"CDM ",450,RC,96365,HCPCS,OUTPATIENT,,,578,462.4,,86.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",255.28,100,,41.74,41.74,41.74,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",138.36,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",404.6,70,,323.68,,,0,"percent of total billed charges ","70% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",537.54,93,,430.03,,,0,"percent of total billed charges ","93% of total billed charges ",86.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",110.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",491.3,85,,393.04,,,0,"percent of total billed charges ","85% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",520.2,90,,416.16,,,0,"percent of total billed charges ","90% of total billed charges ",109.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",502.86,87,,309.11,152.46,396.95,"1 through 10","percent of total billed charges ","87% of total billed charges ",109.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.61,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",404.6,70,,323.68,,,0,"percent of total billed charges ","70% of total billed charges ",86.94,537.54,
"IV THERAPY ADD HR REPEAT VISIT",4604470,"CDM ",450,RC,96366,HCPCS,OUTPATIENT,,,158,126.4,,23.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",133.32,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",43.76,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",110.6,70,,88.48,,,0,"percent of total billed charges ","70% of total billed charges ",142.2,90,,113.76,,,0,"percent of total billed charges ","90% of total billed charges ",146.94,93,,117.55,,,0,"percent of total billed charges ","93% of total billed charges ",23.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",134.3,85,,107.44,,,0,"percent of total billed charges ","85% of total billed charges ",142.2,90,,113.76,,,0,"percent of total billed charges ","90% of total billed charges ",142.2,90,,113.76,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",137.46,87,,159.47,159.47,159.47,"1 through 10","percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.06,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",110.6,70,,88.48,,,0,"percent of total billed charges ","70% of total billed charges ",21.17,146.94,
"ANTIBIOTIC IM W/IV",4604480,"CDM ",450,RC,96372,HCPCS,OUTPATIENT,,,240.5,192.4,,16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",29.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",223.67,93,,178.94,,,0,"percent of total billed charges ","93% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",204.43,85,,163.54,,,0,"percent of total billed charges ","85% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",209.24,87,,30.52,12.55,82.65,16,"percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,223.67,
"INJECTION IM/SQ W/IV",4604490,"CDM ",450,RC,96372,HCPCS,OUTPATIENT,,,240.5,192.4,,16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",29.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",223.67,93,,178.94,,,0,"percent of total billed charges ","93% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",204.43,85,,163.54,,,0,"percent of total billed charges ","85% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",209.24,87,,30.52,12.55,82.65,16,"percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,223.67,
"REMOVE IMPACTED CERUMEN UNI",4604500,"CDM ",450,RC,69209,HCPCS,OUTPATIENT,,,654.5,523.6,,37.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",586.49,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",30.76,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",458.15,70,,366.52,,,0,"percent of total billed charges ","70% of total billed charges ",589.05,90,,471.24,,,0,"percent of total billed charges ","90% of total billed charges ",608.69,93,,486.95,,,0,"percent of total billed charges ","93% of total billed charges ",37.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",48.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",556.33,85,,445.06,,,0,"percent of total billed charges ","85% of total billed charges ",490.88,90,,392.70,,,0,"percent of total billed charges ","90% of total billed charges ",589.05,90,,471.24,,,0,"percent of total billed charges ","90% of total billed charges ",47.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",569.42,87,,13.40,8.04,18.75,"1 through 10","percent of total billed charges ","87% of total billed charges ",47.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",458.15,70,,366.52,,,0,"percent of total billed charges ","70% of total billed charges ",30.76,608.69,
"EXC HEMORRHOID CLOT",4604510,"CDM ",450,RC,46320,HCPCS,OUTPATIENT,,,3595.5,2876.4,,382.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1691.75,100,,131.20,131.20,131.20,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",234.17,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2516.85,70,,2013.48,,,0,"percent of total billed charges ","70% of total billed charges ",3235.95,90,,2588.76,,,0,"percent of total billed charges ","90% of total billed charges ",3343.82,93,,2675.06,,,0,"percent of total billed charges ","93% of total billed charges ",382.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3056.18,85,,2444.94,,,0,"percent of total billed charges ","85% of total billed charges ",2696.63,90,,2157.30,,,0,"percent of total billed charges ","90% of total billed charges ",3235.95,90,,2588.76,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3128.09,87,,2502.47,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1100.5,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2516.85,70,,2013.48,,,0,"percent of total billed charges ","70% of total billed charges ",234.17,3343.82,
"REPAIR TENOTOMY PALM OPEN",4604520,"CDM ",450,RC,26450,HCPCS,OUTPATIENT,,,7118,5694.4,,1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1898.65,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",975.9,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4982.6,70,,3986.08,,,0,"percent of total billed charges ","70% of total billed charges ",6406.2,90,,5124.96,,,0,"percent of total billed charges ","90% of total billed charges ",6619.74,93,,5295.79,,,0,"percent of total billed charges ","93% of total billed charges ",1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",6050.3,85,,4840.24,,,0,"percent of total billed charges ","85% of total billed charges ",5338.5,90,,4270.80,,,0,"percent of total billed charges ","90% of total billed charges ",6406.2,90,,5124.96,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6192.66,87,,4954.13,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3009.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4982.6,70,,3986.08,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,6619.74,
"TX SCAPULA FX W/MANIPULATION",4604530,"CDM ",450,RC,23575,HCPCS,OUTPATIENT,,,2233.5,1786.8,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1077.67,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",788.59,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1563.45,70,,1250.76,,,0,"percent of total billed charges ","70% of total billed charges ",2010.15,90,,1608.12,,,0,"percent of total billed charges ","90% of total billed charges ",2077.16,93,,1661.73,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1898.48,85,,1518.78,,,0,"percent of total billed charges ","85% of total billed charges ",1675.13,90,,1340.10,,,0,"percent of total billed charges ","90% of total billed charges ",2010.15,90,,1608.12,,,0,"percent of total billed charges ","90% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1943.15,87,,1554.52,,,0,"percent of total billed charges ","87% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1563.45,70,,1250.76,,,0,"percent of total billed charges ","70% of total billed charges ",130.83,2077.16,
"URINE VOLUME MEASURE US",4604540,"CDM ",450,RC,51798,HCPCS,OUTPATIENT,,,161,128.8,,156,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",67.67,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",21.08,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",112.7,70,,90.16,,,0,"percent of total billed charges ","70% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",149.73,93,,119.78,,,0,"percent of total billed charges ","93% of total billed charges ",156,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",136.85,85,,109.48,,,0,"percent of total billed charges ","85% of total billed charges ",120.75,90,,96.60,,,0,"percent of total billed charges ","90% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",140.07,87,,112.06,,,0,"percent of total billed charges ","87% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",112.7,70,,90.16,,,0,"percent of total billed charges ","70% of total billed charges ",21.08,198.21,
"IMAGE GD FLD COL CATH SFT TISS",4604550,"CDM ",450,RC,10030,HCPCS,OUTPATIENT,,,1605.5,1284.4,,107.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",283.05,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1123.85,70,,899.08,,,0,"percent of total billed charges ","70% of total billed charges ",1444.95,90,,1155.96,,,0,"percent of total billed charges ","90% of total billed charges ",1493.12,93,,1194.50,,,0,"percent of total billed charges ","93% of total billed charges ",107.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",137.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1364.68,85,,1091.74,,,0,"percent of total billed charges ","85% of total billed charges ",1204.13,90,,963.30,,,0,"percent of total billed charges ","90% of total billed charges ",1444.95,90,,1155.96,,,0,"percent of total billed charges ","90% of total billed charges ",135.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1396.79,87,,1117.43,,,0,"percent of total billed charges ","87% of total billed charges ",135.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1123.85,70,,899.08,,,0,"percent of total billed charges ","70% of total billed charges ",107.93,1493.12,
"EXPLORE WOUND ABDOMEN FLNK BCK",4604560,"CDM ",450,RC,20102,HCPCS,OUTPATIENT,,,2764,2211.2,,590.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",310.07,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",521.73,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1934.8,70,,1547.84,,,0,"percent of total billed charges ","70% of total billed charges ",2487.6,90,,1990.08,,,0,"percent of total billed charges ","90% of total billed charges ",2570.52,93,,2056.42,,,0,"percent of total billed charges ","93% of total billed charges ",590.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",594.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2349.4,85,,1879.52,,,0,"percent of total billed charges ","85% of total billed charges ",2073,90,,1658.40,,,0,"percent of total billed charges ","90% of total billed charges ",2487.6,90,,1990.08,,,0,"percent of total billed charges ","90% of total billed charges ",588.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2404.68,87,,1923.74,,,0,"percent of total billed charges ","87% of total billed charges ",588.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1897.5,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1934.8,70,,1547.84,,,0,"percent of total billed charges ","70% of total billed charges ",310.07,2570.52,
"EXPLORE WOUND NECK",4604570,"CDM ",450,RC,20100,HCPCS,OUTPATIENT,,,1256,1004.8,,514.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",310.07,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1236.44,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",879.2,70,,703.36,,,0,"percent of total billed charges ","70% of total billed charges ",1130.4,90,,904.32,,,0,"percent of total billed charges ","90% of total billed charges ",1168.08,93,,934.46,,,0,"percent of total billed charges ","93% of total billed charges ",514.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",594.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1067.6,85,,854.08,,,0,"percent of total billed charges ","85% of total billed charges ",942,90,,753.60,,,0,"percent of total billed charges ","90% of total billed charges ",1130.4,90,,904.32,,,0,"percent of total billed charges ","90% of total billed charges ",588.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1092.72,87,,874.18,,,0,"percent of total billed charges ","87% of total billed charges ",588.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",495.99,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",879.2,70,,703.36,,,0,"percent of total billed charges ","70% of total billed charges ",310.07,1236.44,
"CESAREAN DELIVERY ONLY",4604580,"CDM ",450,RC,59514,HCPCS,OUTPATIENT,,,5366,4292.8,,1048.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1813.2,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3756.2,70,,3004.96,,,0,"percent of total billed charges ","70% of total billed charges ",4829.4,90,,3863.52,,,0,"percent of total billed charges ","90% of total billed charges ",4990.38,93,,3992.30,,,0,"percent of total billed charges ","93% of total billed charges ",1048.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",757.26,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4561.1,85,,3648.88,,,0,"percent of total billed charges ","85% of total billed charges ",4024.5,90,,3219.60,,,0,"percent of total billed charges ","90% of total billed charges ",4829.4,90,,3863.52,,,0,"percent of total billed charges ","90% of total billed charges ",749.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4668.42,87,,3734.74,,,0,"percent of total billed charges ","87% of total billed charges ",749.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5366,100,,,,,0,"fee schedule ","pays at line item charges due to status indicator C",3756.2,70,,3004.96,,,0,"percent of total billed charges ","70% of total billed charges ",749.76,5366,
"THROMBOLYTIC THERAPY IV",4604590,"CDM ",450,RC,37195,HCPCS,OUTPATIENT,,,727,581.6,,434.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",508.9,70,,407.12,,,0,"percent of total billed charges ","70% of total billed charges ",654.3,90,,523.44,,,0,"percent of total billed charges ","90% of total billed charges ",676.11,93,,540.89,,,0,"percent of total billed charges ","93% of total billed charges ",434.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",551.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",617.95,85,,494.36,,,0,"percent of total billed charges ","85% of total billed charges ",545.25,90,,436.20,,,0,"percent of total billed charges ","90% of total billed charges ",654.3,90,,523.44,,,0,"percent of total billed charges ","90% of total billed charges ",546.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",632.49,87,,505.99,,,0,"percent of total billed charges ","87% of total billed charges ",546.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",303.76,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",508.9,70,,407.12,,,0,"percent of total billed charges ","70% of total billed charges ",303.76,676.11,
"REPAIR PROFUNDUS TENDON",4604600,"CDM ",450,RC,26370,HCPCS,OUTPATIENT,,,4676,3740.8,,1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1402.45,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1652.42,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3273.2,70,,2618.56,,,0,"percent of total billed charges ","70% of total billed charges ",4208.4,90,,3366.72,,,0,"percent of total billed charges ","90% of total billed charges ",4348.68,93,,3478.94,,,0,"percent of total billed charges ","93% of total billed charges ",1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3974.6,85,,3179.68,,,0,"percent of total billed charges ","85% of total billed charges ",3507,90,,2805.60,,,0,"percent of total billed charges ","90% of total billed charges ",4208.4,90,,3366.72,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4068.12,87,,3254.50,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3009.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3273.2,70,,2618.56,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,4348.68,
"REPLANT DIGIT COMP AMPUTATION",4604610,"CDM ",450,RC,20822,HCPCS,OUTPATIENT,,,5213,4170.4,,1976,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3622.74,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3649.1,70,,2919.28,,,0,"percent of total billed charges ","70% of total billed charges ",4691.7,90,,3753.36,,,0,"percent of total billed charges ","90% of total billed charges ",4848.09,93,,3878.47,,,0,"percent of total billed charges ","93% of total billed charges ",1976,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2510.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4431.05,85,,3544.84,,,0,"percent of total billed charges ","85% of total billed charges ",3909.75,90,,3127.80,,,0,"percent of total billed charges ","90% of total billed charges ",4691.7,90,,3753.36,,,0,"percent of total billed charges ","90% of total billed charges ",2485.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4535.31,87,,3628.25,,,0,"percent of total billed charges ","87% of total billed charges ",2485.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3649.1,70,,2919.28,,,0,"percent of total billed charges ","70% of total billed charges ",1478.8,4848.09,
"INSERT DUOD/JEJ-TUBE W/FLUORO",4604620,"CDM ",450,RC,49441,HCPCS,OUTPATIENT,,,2624.5,2099.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",492.58,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1837.15,70,,1469.72,,,0,"percent of total billed charges ","70% of total billed charges ",2362.05,90,,1889.64,,,0,"percent of total billed charges ","90% of total billed charges ",2440.79,93,,1952.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",369.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2230.83,85,,1784.66,,,0,"percent of total billed charges ","85% of total billed charges ",1968.38,90,,1574.70,,,0,"percent of total billed charges ","90% of total billed charges ",2362.05,90,,1889.64,,,0,"percent of total billed charges ","90% of total billed charges ",366.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2283.32,87,,1826.66,,,0,"percent of total billed charges ","87% of total billed charges ",366.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1764.73,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1837.15,70,,1469.72,,,0,"percent of total billed charges ","70% of total billed charges ",366.11,2440.79,
"REPLACE COMP PICC WO PORT W/IM",4604630,"CDM ",450,RC,36584,HCPCS,OUTPATIENT,,,2722,2177.6,,423.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1440.26,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",122.83,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1905.4,70,,1524.32,,,0,"percent of total billed charges ","70% of total billed charges ",2449.8,90,,1959.84,,,0,"percent of total billed charges ","90% of total billed charges ",2531.46,93,,2025.17,,,0,"percent of total billed charges ","93% of total billed charges ",423.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",538.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2313.7,85,,1850.96,,,0,"percent of total billed charges ","85% of total billed charges ",2041.5,90,,1633.20,,,0,"percent of total billed charges ","90% of total billed charges ",2449.8,90,,1959.84,,,0,"percent of total billed charges ","90% of total billed charges ",533.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2368.14,87,,1894.51,,,0,"percent of total billed charges ","87% of total billed charges ",533.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1447.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1905.4,70,,1524.32,,,0,"percent of total billed charges ","70% of total billed charges ",122.83,2531.46,
CPR,4604640,"CDM ",450,RC,92950,HCPCS,OUTPATIENT,,,1300,1040,,114.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",309.49,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",386.91,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",910,70,,728.00,,,0,"percent of total billed charges ","70% of total billed charges ",1170,90,,936.00,,,0,"percent of total billed charges ","90% of total billed charges ",1209,93,,967.20,,,0,"percent of total billed charges ","93% of total billed charges ",114.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.53,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1105,85,,884.00,,,0,"percent of total billed charges ","85% of total billed charges ",1170,90,,936.00,,,0,"percent of total billed charges ","90% of total billed charges ",1170,90,,936.00,,,0,"percent of total billed charges ","90% of total billed charges ",131.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1131,87,,163.23,163.23,163.23,"1 through 10","percent of total billed charges ","87% of total billed charges ",131.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.57,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",910,70,,728.00,,,0,"percent of total billed charges ","70% of total billed charges ",114.74,1209,
"INDUCT HEMOSTATIC AGENT VAGINA",4604650,"CDM ",450,RC,57180,HCPCS,OUTPATIENT,,,300.5,240.4,,198.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",253.77,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",210.35,70,,168.28,,,0,"percent of total billed charges ","70% of total billed charges ",270.45,90,,216.36,,,0,"percent of total billed charges ","90% of total billed charges ",279.47,93,,223.58,,,0,"percent of total billed charges ","93% of total billed charges ",198.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",252.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",255.43,85,,204.34,,,0,"percent of total billed charges ","85% of total billed charges ",225.38,90,,180.30,,,0,"percent of total billed charges ","90% of total billed charges ",270.45,90,,216.36,,,0,"percent of total billed charges ","90% of total billed charges ",249.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",261.44,87,,209.15,,,0,"percent of total billed charges ","87% of total billed charges ",249.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",185.92,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",210.35,70,,168.28,,,0,"percent of total billed charges ","70% of total billed charges ",185.92,279.47,
"BLOOD ADM < 2 HRS",4604660,"CDM ",450,RC,36430,HCPCS,OUTPATIENT,,,355.5,284.4,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",515.69,100,,1227.22,1227.22,1227.22,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.42,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",248.85,70,,199.08,,,0,"percent of total billed charges ","70% of total billed charges ",319.95,90,,255.96,,,0,"percent of total billed charges ","90% of total billed charges ",330.62,93,,264.50,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",302.18,85,,241.74,,,0,"percent of total billed charges ","85% of total billed charges ",266.63,90,,213.30,,,0,"percent of total billed charges ","90% of total billed charges ",319.95,90,,255.96,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",309.29,87,,247.43,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",405.73,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",248.85,70,,199.08,,,0,"percent of total billed charges ","70% of total billed charges ",77.42,515.69,
"BLOOD ADM 2-4 HRS",4604670,"CDM ",450,RC,36430,HCPCS,OUTPATIENT,,,611.5,489.2,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",515.69,100,,1227.22,1227.22,1227.22,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.42,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",428.05,70,,342.44,,,0,"percent of total billed charges ","70% of total billed charges ",550.35,90,,440.28,,,0,"percent of total billed charges ","90% of total billed charges ",568.7,93,,454.96,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",519.78,85,,415.82,,,0,"percent of total billed charges ","85% of total billed charges ",458.63,90,,366.90,,,0,"percent of total billed charges ","90% of total billed charges ",550.35,90,,440.28,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",532.01,87,,425.61,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",405.73,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",428.05,70,,342.44,,,0,"percent of total billed charges ","70% of total billed charges ",77.42,568.7,
"BLOOD ADM 4-6 HRS",4604680,"CDM ",450,RC,36430,HCPCS,OUTPATIENT,,,914,731.2,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",515.69,100,,1227.22,1227.22,1227.22,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.42,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",639.8,70,,511.84,,,0,"percent of total billed charges ","70% of total billed charges ",822.6,90,,658.08,,,0,"percent of total billed charges ","90% of total billed charges ",850.02,93,,680.02,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",776.9,85,,621.52,,,0,"percent of total billed charges ","85% of total billed charges ",685.5,90,,548.40,,,0,"percent of total billed charges ","90% of total billed charges ",822.6,90,,658.08,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",795.18,87,,636.14,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",405.73,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",639.8,70,,511.84,,,0,"percent of total billed charges ","70% of total billed charges ",77.42,850.02,
"BLOOD ADM 6-8 HRS",4604690,"CDM ",450,RC,36430,HCPCS,OUTPATIENT,,,1217,973.6,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",515.69,100,,1227.22,1227.22,1227.22,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.42,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",851.9,70,,681.52,,,0,"percent of total billed charges ","70% of total billed charges ",1095.3,90,,876.24,,,0,"percent of total billed charges ","90% of total billed charges ",1131.81,93,,905.45,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1034.45,85,,827.56,,,0,"percent of total billed charges ","85% of total billed charges ",912.75,90,,730.20,,,0,"percent of total billed charges ","90% of total billed charges ",1095.3,90,,876.24,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1058.79,87,,847.03,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",405.73,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",851.9,70,,681.52,,,0,"percent of total billed charges ","70% of total billed charges ",77.42,1131.81,
"BLOOD ADM > 8 HRS",4604700,"CDM ",450,RC,36430,HCPCS,OUTPATIENT,,,1517.5,1214,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",515.69,100,,1227.22,1227.22,1227.22,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.42,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1062.25,70,,849.80,,,0,"percent of total billed charges ","70% of total billed charges ",1365.75,90,,1092.60,,,0,"percent of total billed charges ","90% of total billed charges ",1411.28,93,,1129.02,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1289.88,85,,1031.90,,,0,"percent of total billed charges ","85% of total billed charges ",1138.13,90,,910.50,,,0,"percent of total billed charges ","90% of total billed charges ",1365.75,90,,1092.60,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1320.23,87,,1056.18,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",405.73,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1062.25,70,,849.80,,,0,"percent of total billed charges ","70% of total billed charges ",77.42,1411.28,
"INJ TRIGGER POINT 3 OR MORE",4604710,"CDM ",450,RC,20553,HCPCS,OUTPATIENT,,,440,352,,192.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",88.92,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",308,70,,246.40,,,0,"percent of total billed charges ","70% of total billed charges ",396,90,,316.80,,,0,"percent of total billed charges ","90% of total billed charges ",409.2,93,,327.36,,,0,"percent of total billed charges ","93% of total billed charges ",192.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",222,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",374,85,,299.20,,,0,"percent of total billed charges ","85% of total billed charges ",330,90,,264.00,,,0,"percent of total billed charges ","90% of total billed charges ",396,90,,316.80,,,0,"percent of total billed charges ","90% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",382.8,87,,306.24,,,0,"percent of total billed charges ","87% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",282.29,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",308,70,,246.40,,,0,"percent of total billed charges ","70% of total billed charges ",88.92,409.2,
"MOD SED <5 YRS SAME PROV INIT",4604730,"CDM ",450,RC,99151,HCPCS,OUTPATIENT,,,334.5,267.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.58,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",234.15,70,,187.32,,,0,"percent of total billed charges ","70% of total billed charges ",301.05,90,,240.84,,,0,"percent of total billed charges ","90% of total billed charges ",311.09,93,,248.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",284.33,85,,227.46,,,0,"percent of total billed charges ","85% of total billed charges ",301.05,90,,240.84,,,0,"percent of total billed charges ","90% of total billed charges ",301.05,90,,240.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",291.02,87,,232.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",234.15,70,,187.32,,,0,"percent of total billed charges ","70% of total billed charges ",52.58,311.09,
"MOD SED >5 YRS SAME PROV INIT",4604740,"CDM ",450,RC,99152,HCPCS,OUTPATIENT,,,334.5,267.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.94,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",234.15,70,,187.32,,,0,"percent of total billed charges ","70% of total billed charges ",301.05,90,,240.84,,,0,"percent of total billed charges ","90% of total billed charges ",311.09,93,,248.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",284.33,85,,227.46,,,0,"percent of total billed charges ","85% of total billed charges ",301.05,90,,240.84,,,0,"percent of total billed charges ","90% of total billed charges ",301.05,90,,240.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",291.02,87,,232.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",234.15,70,,187.32,,,0,"percent of total billed charges ","70% of total billed charges ",25.94,311.09,
"MOD SED SAME PROV ADD 15 MIN",4604750,"CDM ",450,RC,99153,HCPCS,OUTPATIENT,,,66,52.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.43,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",46.2,70,,36.96,,,0,"percent of total billed charges ","70% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",61.38,93,,49.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",56.1,85,,44.88,,,0,"percent of total billed charges ","85% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",57.42,87,,45.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.2,70,,36.96,,,0,"percent of total billed charges ","70% of total billed charges ",21.43,61.38,
"MOD SED <5 YRS OTHER PROV INIT",4604760,"CDM ",450,RC,99155,HCPCS,OUTPATIENT,,,334.5,267.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",234.15,70,,187.32,,,0,"percent of total billed charges ","70% of total billed charges ",301.05,90,,240.84,,,0,"percent of total billed charges ","90% of total billed charges ",311.09,93,,248.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",284.33,85,,227.46,,,0,"percent of total billed charges ","85% of total billed charges ",301.05,90,,240.84,,,0,"percent of total billed charges ","90% of total billed charges ",301.05,90,,240.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",291.02,87,,232.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",234.15,70,,187.32,,,0,"percent of total billed charges ","70% of total billed charges ",174.09,311.09,
"MOD SED >5 YRS OTHER PROV INIT",4604770,"CDM ",450,RC,99156,HCPCS,OUTPATIENT,,,334.5,267.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",159.54,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",234.15,70,,187.32,,,0,"percent of total billed charges ","70% of total billed charges ",301.05,90,,240.84,,,0,"percent of total billed charges ","90% of total billed charges ",311.09,93,,248.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",284.33,85,,227.46,,,0,"percent of total billed charges ","85% of total billed charges ",301.05,90,,240.84,,,0,"percent of total billed charges ","90% of total billed charges ",301.05,90,,240.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",291.02,87,,232.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",234.15,70,,187.32,,,0,"percent of total billed charges ","70% of total billed charges ",159.54,311.09,
"MOD SED OTHER PROV ADD 15 MIN",4604780,"CDM ",450,RC,99157,HCPCS,OUTPATIENT,,,66,52.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",46.2,70,,36.96,,,0,"percent of total billed charges ","70% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",61.38,93,,49.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",56.1,85,,44.88,,,0,"percent of total billed charges ","85% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",57.42,87,,45.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.2,70,,36.96,,,0,"percent of total billed charges ","70% of total billed charges ",46.2,130.79,
"COMP RPR EA ADD 5CM OR LESS",4604790,"CDM ",450,RC,13102,HCPCS,OUTPATIENT,,,908,726.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.37,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",635.6,70,,508.48,,,0,"percent of total billed charges ","70% of total billed charges ",817.2,90,,653.76,,,0,"percent of total billed charges ","90% of total billed charges ",844.44,93,,675.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",771.8,85,,617.44,,,0,"percent of total billed charges ","85% of total billed charges ",681,90,,544.80,,,0,"percent of total billed charges ","90% of total billed charges ",817.2,90,,653.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",789.96,87,,631.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",635.6,70,,508.48,,,0,"percent of total billed charges ","70% of total billed charges ",148.37,844.44,
"REMOVE FB EXT AUDIT CANAL W/AN",4604800,"CDM ",450,RC,69205,HCPCS,OUTPATIENT,,,2408.5,1926.8,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",897.89,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",196.2,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1685.95,70,,1348.76,,,0,"percent of total billed charges ","70% of total billed charges ",2167.65,90,,1734.12,,,0,"percent of total billed charges ","90% of total billed charges ",2239.91,93,,1791.93,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",173.44,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2047.23,85,,1637.78,,,0,"percent of total billed charges ","85% of total billed charges ",1806.38,90,,1445.10,,,0,"percent of total billed charges ","90% of total billed charges ",2167.65,90,,1734.12,,,0,"percent of total billed charges ","90% of total billed charges ",171.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2095.4,87,,1676.32,,,0,"percent of total billed charges ","87% of total billed charges ",171.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1685.95,70,,1348.76,,,0,"percent of total billed charges ","70% of total billed charges ",171.72,2239.91,
"TX CLOSED FX KNEE W/WO MANIP",4604820,"CDM ",450,RC,27538,HCPCS,OUTPATIENT,,,2931.5,2345.2,,210.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",938.78,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2052.05,70,,1641.64,,,0,"percent of total billed charges ","70% of total billed charges ",2638.35,90,,2110.68,,,0,"percent of total billed charges ","90% of total billed charges ",2726.3,93,,2181.04,,,0,"percent of total billed charges ","93% of total billed charges ",210.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",243.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2491.78,85,,1993.42,,,0,"percent of total billed charges ","85% of total billed charges ",2198.63,90,,1758.90,,,0,"percent of total billed charges ","90% of total billed charges ",2638.35,90,,2110.68,,,0,"percent of total billed charges ","90% of total billed charges ",241.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2550.41,87,,2040.33,,,0,"percent of total billed charges ","87% of total billed charges ",241.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2052.05,70,,1641.64,,,0,"percent of total billed charges ","70% of total billed charges ",210.99,2726.3,
"INJ INTRLMNR CRV/THRC WO IMAGE",4604830,"CDM ",450,RC,62320,HCPCS,OUTPATIENT,,,1035,828,,377.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",588.83,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",206.93,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",724.5,70,,579.60,,,0,"percent of total billed charges ","70% of total billed charges ",931.5,90,,745.20,,,0,"percent of total billed charges ","90% of total billed charges ",962.55,93,,770.04,,,0,"percent of total billed charges ","93% of total billed charges ",377.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",435.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",879.75,85,,703.80,,,0,"percent of total billed charges ","85% of total billed charges ",776.25,90,,621.00,,,0,"percent of total billed charges ","90% of total billed charges ",931.5,90,,745.20,,,0,"percent of total billed charges ","90% of total billed charges ",431.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",900.45,87,,720.36,,,0,"percent of total billed charges ","87% of total billed charges ",431.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",649.16,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",724.5,70,,579.60,,,0,"percent of total billed charges ","70% of total billed charges ",206.93,962.55,
"PREPUTIAL STRETCHING",4604840,"CDM ",450,RC,54450,HCPCS,OUTPATIENT,,,418.5,334.8,,260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",117.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",292.95,70,,234.36,,,0,"percent of total billed charges ","70% of total billed charges ",376.65,90,,301.32,,,0,"percent of total billed charges ","90% of total billed charges ",389.21,93,,311.37,,,0,"percent of total billed charges ","93% of total billed charges ",260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",355.73,85,,284.58,,,0,"percent of total billed charges ","85% of total billed charges ",313.88,90,,251.10,,,0,"percent of total billed charges ","90% of total billed charges ",376.65,90,,301.32,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",364.1,87,,291.28,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",229.77,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",292.95,70,,234.36,,,0,"percent of total billed charges ","70% of total billed charges ",117.79,389.21,
"ASPIRATE/DRAIN BLADDER",4604850,"CDM ",450,RC,51100,HCPCS,OUTPATIENT,,,1062,849.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.48,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",743.4,70,,594.72,,,0,"percent of total billed charges ","70% of total billed charges ",955.8,90,,764.64,,,0,"percent of total billed charges ","90% of total billed charges ",987.66,93,,790.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",87.3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",902.7,85,,722.16,,,0,"percent of total billed charges ","85% of total billed charges ",796.5,90,,637.20,,,0,"percent of total billed charges ","90% of total billed charges ",955.8,90,,764.64,,,0,"percent of total billed charges ","90% of total billed charges ",86.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",923.94,87,,739.15,,,0,"percent of total billed charges ","87% of total billed charges ",86.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",229.77,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",743.4,70,,594.72,,,0,"percent of total billed charges ","70% of total billed charges ",80.48,987.66,
"TX CLOSED ANKLE FX WO MANIP",4604860,"CDM ",450,RC,28430,HCPCS,OUTPATIENT,,,2009.5,1607.6,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",439.05,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1406.65,70,,1125.32,,,0,"percent of total billed charges ","70% of total billed charges ",1808.55,90,,1446.84,,,0,"percent of total billed charges ","90% of total billed charges ",1868.84,93,,1495.07,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1708.08,85,,1366.46,,,0,"percent of total billed charges ","85% of total billed charges ",1507.13,90,,1205.70,,,0,"percent of total billed charges ","90% of total billed charges ",1808.55,90,,1446.84,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1748.27,87,,1398.62,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1406.65,70,,1125.32,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1868.84,
"TX OPEN FX PHALANGEAL JOINT EA",4604870,"CDM ",450,RC,26746,HCPCS,OUTPATIENT,,,5042.5,4034,,1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9667.72,100,,2461.60,2461.60,2461.60,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1533.33,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3529.75,70,,2823.80,,,0,"percent of total billed charges ","70% of total billed charges ",4538.25,90,,3630.60,,,0,"percent of total billed charges ","90% of total billed charges ",4689.53,93,,3751.62,,,0,"percent of total billed charges ","93% of total billed charges ",1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",429.45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4286.13,85,,3428.90,,,0,"percent of total billed charges ","85% of total billed charges ",3781.88,90,,3025.50,,,0,"percent of total billed charges ","90% of total billed charges ",4538.25,90,,3630.60,,,0,"percent of total billed charges ","90% of total billed charges ",425.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4386.98,87,,3509.58,,,0,"percent of total billed charges ","87% of total billed charges ",425.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3009.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3529.75,70,,2823.80,,,0,"percent of total billed charges ","70% of total billed charges ",425.2,9667.72,
"NON-SELECTIVE DEBRIDEMENT",4604880,"CDM ",450,RC,97602,HCPCS,OUTPATIENT,,,613,490.4,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.2,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,39.36,39.36,39.36,"1 through 10","other ","not separately reimbursment ",429.1,70,,343.28,,,0,"percent of total billed charges ","70% of total billed charges ",551.7,90,,441.36,,,0,"percent of total billed charges ","90% of total billed charges ",570.09,93,,456.07,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",521.05,85,,416.84,,,0,"percent of total billed charges ","85% of total billed charges ",551.7,90,,441.36,,,0,"percent of total billed charges ","90% of total billed charges ",551.7,90,,441.36,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",533.31,87,,426.65,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",429.1,70,,343.28,,,0,"percent of total billed charges ","70% of total billed charges ",184.51,570.09,
"REPLACE GASTRONOMY TUBE PERCUT",4604900,"CDM ",450,RC,43762,HCPCS,OUTPATIENT,,,441,352.8,,150.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.58,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",76.47,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",308.7,70,,246.96,,,0,"percent of total billed charges ","70% of total billed charges ",396.9,90,,317.52,,,0,"percent of total billed charges ","90% of total billed charges ",410.13,93,,328.10,,,0,"percent of total billed charges ","93% of total billed charges ",150.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",191.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",374.85,85,,299.88,,,0,"percent of total billed charges ","85% of total billed charges ",330.75,90,,264.60,,,0,"percent of total billed charges ","90% of total billed charges ",396.9,90,,317.52,,,0,"percent of total billed charges ","90% of total billed charges ",189.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",383.67,87,,306.94,,,0,"percent of total billed charges ","87% of total billed charges ",189.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",229.77,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",308.7,70,,246.96,,,0,"percent of total billed charges ","70% of total billed charges ",76.47,462.58,
"TX CLOSED CARPAL FX W/MANIP",4604910,"CDM ",450,RC,25624,HCPCS,OUTPATIENT,,,2504.5,2003.6,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",924.44,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1753.15,70,,1402.52,,,0,"percent of total billed charges ","70% of total billed charges ",2254.05,90,,1803.24,,,0,"percent of total billed charges ","90% of total billed charges ",2329.19,93,,1863.35,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2128.83,85,,1703.06,,,0,"percent of total billed charges ","85% of total billed charges ",1878.38,90,,1502.70,,,0,"percent of total billed charges ","90% of total billed charges ",2254.05,90,,1803.24,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2178.92,87,,1743.14,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1753.15,70,,1402.52,,,0,"percent of total billed charges ","70% of total billed charges ",327.08,2329.19,
"TX CLSD INTERPHALANG W/ANESTH",4604920,"CDM ",450,RC,26775,HCPCS,OUTPATIENT,,,1075,860,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",735.06,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",752.5,70,,602.00,,,0,"percent of total billed charges ","70% of total billed charges ",967.5,90,,774.00,,,0,"percent of total billed charges ","90% of total billed charges ",999.75,93,,799.80,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",913.75,85,,731.00,,,0,"percent of total billed charges ","85% of total billed charges ",806.25,90,,645.00,,,0,"percent of total billed charges ","90% of total billed charges ",967.5,90,,774.00,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",935.25,87,,748.20,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.22,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",752.5,70,,602.00,,,0,"percent of total billed charges ","70% of total billed charges ",257.22,999.75,
"TX CLOSED WRIST FX WO MANIPULA",4604930,"CDM ",450,RC,25622,HCPCS,OUTPATIENT,,,1924,1539.2,,260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",592.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1346.8,70,,1077.44,,,0,"percent of total billed charges ","70% of total billed charges ",1731.6,90,,1385.28,,,0,"percent of total billed charges ","90% of total billed charges ",1789.32,93,,1431.46,,,0,"percent of total billed charges ","93% of total billed charges ",260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1635.4,85,,1308.32,,,0,"percent of total billed charges ","85% of total billed charges ",1443,90,,1154.40,,,0,"percent of total billed charges ","90% of total billed charges ",1731.6,90,,1385.28,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1673.88,87,,1339.10,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1346.8,70,,1077.44,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1789.32,
"REMOVE FB MOUTH SIMPLE",4604940,"CDM ",450,RC,40804,HCPCS,OUTPATIENT,,,1456,1164.8,,293.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",232.43,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1019.2,70,,815.36,,,0,"percent of total billed charges ","70% of total billed charges ",1310.4,90,,1048.32,,,0,"percent of total billed charges ","90% of total billed charges ",1354.08,93,,1083.26,,,0,"percent of total billed charges ","93% of total billed charges ",293.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1237.6,85,,990.08,,,0,"percent of total billed charges ","85% of total billed charges ",1092,90,,873.60,,,0,"percent of total billed charges ","90% of total billed charges ",1310.4,90,,1048.32,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1266.72,87,,1013.38,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",834.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1019.2,70,,815.36,,,0,"percent of total billed charges ","70% of total billed charges ",232.43,1354.08,
"TX CLOSED CARPAL FX WO MANIPUL",4604950,"CDM ",450,RC,25630,HCPCS,OUTPATIENT,,,722,577.6,,114.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",541.36,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",592.75,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",505.4,70,,404.32,,,0,"percent of total billed charges ","70% of total billed charges ",649.8,90,,519.84,,,0,"percent of total billed charges ","90% of total billed charges ",671.46,93,,537.17,,,0,"percent of total billed charges ","93% of total billed charges ",114.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",613.7,85,,490.96,,,0,"percent of total billed charges ","85% of total billed charges ",541.5,90,,433.20,,,0,"percent of total billed charges ","90% of total billed charges ",649.8,90,,519.84,,,0,"percent of total billed charges ","90% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",628.14,87,,502.51,,,0,"percent of total billed charges ","87% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",505.4,70,,404.32,,,0,"percent of total billed charges ","70% of total billed charges ",114.4,671.46,
"DEBRIDEMENT EA ADD 20CM",4604960,"CDM ",450,RC,97598,HCPCS,OUTPATIENT,,,318.5,254.8,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",222.95,70,,178.36,,,0,"percent of total billed charges ","70% of total billed charges ",286.65,90,,229.32,,,0,"percent of total billed charges ","90% of total billed charges ",296.21,93,,236.97,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",270.73,85,,216.58,,,0,"percent of total billed charges ","85% of total billed charges ",286.65,90,,229.32,,,0,"percent of total billed charges ","90% of total billed charges ",286.65,90,,229.32,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.1,87,,221.68,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",222.95,70,,178.36,,,0,"percent of total billed charges ","70% of total billed charges ",52.25,296.21,
"TX CLSD METACARPO W/MANIP ANES",4604970,"CDM ",450,RC,26705,HCPCS,OUTPATIENT,,,2070,1656,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",809.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",802.74,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1449,70,,1159.20,,,0,"percent of total billed charges ","70% of total billed charges ",1863,90,,1490.40,,,0,"percent of total billed charges ","90% of total billed charges ",1925.1,93,,1540.08,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",363.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1759.5,85,,1407.60,,,0,"percent of total billed charges ","85% of total billed charges ",1552.5,90,,1242.00,,,0,"percent of total billed charges ","90% of total billed charges ",1863,90,,1490.40,,,0,"percent of total billed charges ","90% of total billed charges ",359.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1800.9,87,,1440.72,,,0,"percent of total billed charges ","87% of total billed charges ",359.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1449,70,,1159.20,,,0,"percent of total billed charges ","70% of total billed charges ",359.79,1925.1,
"REPAIR MOUTH > 2.5CM",4604980,"CDM ",450,RC,40831,HCPCS,OUTPATIENT,,,935.5,748.4,,457.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",431.84,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",654.85,70,,523.88,,,0,"percent of total billed charges ","70% of total billed charges ",841.95,90,,673.56,,,0,"percent of total billed charges ","90% of total billed charges ",870.02,93,,696.02,,,0,"percent of total billed charges ","93% of total billed charges ",457.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",528.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",795.18,85,,636.14,,,0,"percent of total billed charges ","85% of total billed charges ",701.63,90,,561.30,,,0,"percent of total billed charges ","90% of total billed charges ",841.95,90,,673.56,,,0,"percent of total billed charges ","90% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",813.89,87,,651.11,,,0,"percent of total billed charges ","87% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",495.99,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",654.85,70,,523.88,,,0,"percent of total billed charges ","70% of total billed charges ",431.84,870.02,
"RPR INFRAPATELLAR TENDON PRIME",4604990,"CDM ",450,RC,27380,HCPCS,OUTPATIENT,,,10818.5,8654.8,,2317.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3090.97,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1292.81,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",7572.95,70,,6058.36,,,0,"percent of total billed charges ","70% of total billed charges ",9736.65,90,,7789.32,,,0,"percent of total billed charges ","90% of total billed charges ",10061.21,93,,8048.97,,,0,"percent of total billed charges ","93% of total billed charges ",2317.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",9195.73,85,,7356.58,,,0,"percent of total billed charges ","85% of total billed charges ",8113.88,90,,6491.10,,,0,"percent of total billed charges ","90% of total billed charges ",9736.65,90,,7789.32,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9412.1,87,,7529.68,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6673.22,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",7572.95,70,,6058.36,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,10061.21,
"RPR COL LIGAMENT META/INTERPHA",4605000,"CDM ",450,RC,26540,HCPCS,OUTPATIENT,,,5956.5,4765.2,,1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3480.46,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1471.34,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4169.55,70,,3335.64,,,0,"percent of total billed charges ","70% of total billed charges ",5360.85,90,,4288.68,,,0,"percent of total billed charges ","90% of total billed charges ",5539.55,93,,4431.64,,,0,"percent of total billed charges ","93% of total billed charges ",1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5063.03,85,,4050.42,,,0,"percent of total billed charges ","85% of total billed charges ",4467.38,90,,3573.90,,,0,"percent of total billed charges ","90% of total billed charges ",5360.85,90,,4288.68,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5182.16,87,,4145.73,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3009.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4169.55,70,,3335.64,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,5539.55,
"TX CLSD TALUS FX W/MANIP",4605010,"CDM ",450,RC,28435,HCPCS,OUTPATIENT,,,2905,2324,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1617.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",678.63,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2033.5,70,,1626.80,,,0,"percent of total billed charges ","70% of total billed charges ",2614.5,90,,2091.60,,,0,"percent of total billed charges ","90% of total billed charges ",2701.65,93,,2161.32,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",360.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2469.25,85,,1975.40,,,0,"percent of total billed charges ","85% of total billed charges ",2178.75,90,,1743.00,,,0,"percent of total billed charges ","90% of total billed charges ",2614.5,90,,2091.60,,,0,"percent of total billed charges ","90% of total billed charges ",357.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2527.35,87,,2021.88,,,0,"percent of total billed charges ","87% of total billed charges ",357.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2033.5,70,,1626.80,,,0,"percent of total billed charges ","70% of total billed charges ",357.37,2701.65,
"NPWT < 50CM",4605020,"CDM ",450,RC,97605,HCPCS,OUTPATIENT,,,321,256.8,,64.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",223.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",53.61,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",224.7,70,,179.76,,,0,"percent of total billed charges ","70% of total billed charges ",288.9,90,,231.12,,,0,"percent of total billed charges ","90% of total billed charges ",298.53,93,,238.82,,,0,"percent of total billed charges ","93% of total billed charges ",64.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",44.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",272.85,85,,218.28,,,0,"percent of total billed charges ","85% of total billed charges ",288.9,90,,231.12,,,0,"percent of total billed charges ","90% of total billed charges ",288.9,90,,231.12,,,0,"percent of total billed charges ","90% of total billed charges ",44.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",279.27,87,,223.42,,,0,"percent of total billed charges ","87% of total billed charges ",44.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",224.7,70,,179.76,,,0,"percent of total billed charges ","70% of total billed charges ",44.08,298.53,
"LARYNGOSCOPY FLEX W/FB REMOVAL",4605030,"CDM ",450,RC,31577,HCPCS,OUTPATIENT,,,1502.5,1202,,371.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1358.45,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",279.16,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1051.75,70,,841.40,,,0,"percent of total billed charges ","70% of total billed charges ",1352.25,90,,1081.80,,,0,"percent of total billed charges ","90% of total billed charges ",1397.33,93,,1117.86,,,0,"percent of total billed charges ","93% of total billed charges ",371.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",429.45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1277.13,85,,1021.70,,,0,"percent of total billed charges ","85% of total billed charges ",1126.88,90,,901.50,,,0,"percent of total billed charges ","90% of total billed charges ",1352.25,90,,1081.80,,,0,"percent of total billed charges ","90% of total billed charges ",425.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1307.18,87,,1045.74,,,0,"percent of total billed charges ","87% of total billed charges ",425.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",359.69,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1051.75,70,,841.40,,,0,"percent of total billed charges ","70% of total billed charges ",279.16,1397.33,
"REPAIR BLD VESSEL LW EXTREMITY",4605040,"CDM ",450,RC,35221,HCPCS,OUTPATIENT,,,4712,3769.6,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1538.23,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",2968.11,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3298.4,70,,2638.72,,,0,"percent of total billed charges ","70% of total billed charges ",4240.8,90,,3392.64,,,0,"percent of total billed charges ","90% of total billed charges ",4382.16,93,,3505.73,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4005.2,85,,3204.16,,,0,"percent of total billed charges ","85% of total billed charges ",3534,90,,2827.20,,,0,"percent of total billed charges ","90% of total billed charges ",4240.8,90,,3392.64,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4099.44,87,,3279.55,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4712,100,,,,,0,"fee schedule ","pays at line item charges due to status indicator C",3298.4,70,,2638.72,,,0,"percent of total billed charges ","70% of total billed charges ",312,4712,
"VASCULAR SURGERY NOS",4605050,"CDM ",450,RC,37799,HCPCS,OUTPATIENT,,,3707.5,2966,,203.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2595.25,70,,2076.20,,,0,"percent of total billed charges ","70% of total billed charges ",3336.75,90,,2669.40,,,0,"percent of total billed charges ","90% of total billed charges ",3447.98,93,,2758.38,,,0,"percent of total billed charges ","93% of total billed charges ",203.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",67.7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3151.38,85,,2521.10,,,0,"percent of total billed charges ","85% of total billed charges ",2780.63,90,,2224.50,,,0,"percent of total billed charges ","90% of total billed charges ",3336.75,90,,2669.40,,,0,"percent of total billed charges ","90% of total billed charges ",67.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3225.53,87,,2580.42,,,0,"percent of total billed charges ","87% of total billed charges ",67.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",576.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2595.25,70,,2076.20,,,0,"percent of total billed charges ","70% of total billed charges ",67.03,3447.98,
"NERVOUS SYSTEM PROC NOS",4605060,"CDM ",450,RC,64999,HCPCS,OUTPATIENT,,,494,395.2,,157.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",345.8,70,,276.64,,,0,"percent of total billed charges ","70% of total billed charges ",444.6,90,,355.68,,,0,"percent of total billed charges ","90% of total billed charges ",459.42,93,,367.54,,,0,"percent of total billed charges ","93% of total billed charges ",157.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",181.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",419.9,85,,335.92,,,0,"percent of total billed charges ","85% of total billed charges ",370.5,90,,296.40,,,0,"percent of total billed charges ","90% of total billed charges ",444.6,90,,355.68,,,0,"percent of total billed charges ","90% of total billed charges ",179.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",429.78,87,,343.82,,,0,"percent of total billed charges ","87% of total billed charges ",179.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",282.29,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",345.8,70,,276.64,,,0,"percent of total billed charges ","70% of total billed charges ",157.06,459.42,
"APP HIP SPICA CAST 1 LEG",4605070,"CDM ",450,RC,29305,HCPCS,OUTPATIENT,,,431,344.8,,260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",319.53,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",301.7,70,,241.36,,,0,"percent of total billed charges ","70% of total billed charges ",387.9,90,,310.32,,,0,"percent of total billed charges ","90% of total billed charges ",400.83,93,,320.66,,,0,"percent of total billed charges ","93% of total billed charges ",260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",366.35,85,,293.08,,,0,"percent of total billed charges ","85% of total billed charges ",323.25,90,,258.60,,,0,"percent of total billed charges ","90% of total billed charges ",387.9,90,,310.32,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",374.97,87,,299.98,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.22,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",301.7,70,,241.36,,,0,"percent of total billed charges ","70% of total billed charges ",257.22,400.83,
"INJ INTRL CERV LUMBAR WO IMAGE",4605080,"CDM ",450,RC,62322,HCPCS,OUTPATIENT,,,1035,828,,377.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",588.83,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",168.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",724.5,70,,579.60,,,0,"percent of total billed charges ","70% of total billed charges ",931.5,90,,745.20,,,0,"percent of total billed charges ","90% of total billed charges ",962.55,93,,770.04,,,0,"percent of total billed charges ","93% of total billed charges ",377.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",435.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",879.75,85,,703.80,,,0,"percent of total billed charges ","85% of total billed charges ",776.25,90,,621.00,,,0,"percent of total billed charges ","90% of total billed charges ",931.5,90,,745.20,,,0,"percent of total billed charges ","90% of total billed charges ",431.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",900.45,87,,69.97,69.97,69.97,"1 through 10","percent of total billed charges ","87% of total billed charges ",431.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",813.41,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",724.5,70,,579.60,,,0,"percent of total billed charges ","70% of total billed charges ",168.87,962.55,
"INSERT TUNN CV CATH >5Y WO PRT",4605085,"CDM ",450,RC,36558,HCPCS,OUTPATIENT,,,4674.5,3739.6,,382.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3067.37,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",535.94,220,,46.31,46.31,46.31,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",3272.15,70,,2617.72,,,0,"percent of total billed charges ","70% of total billed charges ",4207.05,90,,3365.64,,,0,"percent of total billed charges ","90% of total billed charges ",4347.29,93,,3477.83,,,0,"percent of total billed charges ","93% of total billed charges ",382.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",485.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3973.33,85,,3178.66,,,0,"percent of total billed charges ","85% of total billed charges ",3505.88,90,,2804.70,,,0,"percent of total billed charges ","90% of total billed charges ",4207.05,90,,3365.64,,,0,"percent of total billed charges ","90% of total billed charges ",480.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4066.82,87,,3253.46,,,0,"percent of total billed charges ","87% of total billed charges ",480.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2903.79,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3272.15,70,,2617.72,,,0,"percent of total billed charges ","70% of total billed charges ",382.2,4347.29,
"EXC MULTI EXTERNAL ANAL GROWTH",4605090,"CDM ",450,RC,46230,HCPCS,OUTPATIENT,,,3118,2494.4,,909.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3101.16,100,,318.41,318.41,318.41,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",357.19,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2182.6,70,,1746.08,,,0,"percent of total billed charges ","70% of total billed charges ",2806.2,90,,2244.96,,,0,"percent of total billed charges ","90% of total billed charges ",2899.74,93,,2319.79,,,0,"percent of total billed charges ","93% of total billed charges ",909.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",291.36,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2650.3,85,,2120.24,,,0,"percent of total billed charges ","85% of total billed charges ",2338.5,90,,1870.80,,,0,"percent of total billed charges ","90% of total billed charges ",2806.2,90,,2244.96,,,0,"percent of total billed charges ","90% of total billed charges ",288.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2712.66,87,,2170.13,,,0,"percent of total billed charges ","87% of total billed charges ",288.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2552.65,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2182.6,70,,1746.08,,,0,"percent of total billed charges ","70% of total billed charges ",288.48,3101.16,
"CYSTOSTOMY W/DRAINAGE",4605095,"CDM ",450,RC,51040,HCPCS,OUTPATIENT,,,3492.5,2794,,659.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",603.66,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2444.75,70,,1955.80,,,0,"percent of total billed charges ","70% of total billed charges ",3143.25,90,,2514.60,,,0,"percent of total billed charges ","90% of total billed charges ",3248.03,93,,2598.42,,,0,"percent of total billed charges ","93% of total billed charges ",659.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2968.63,85,,2374.90,,,0,"percent of total billed charges ","85% of total billed charges ",2619.38,90,,2095.50,,,0,"percent of total billed charges ","90% of total billed charges ",3143.25,90,,2514.60,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3038.48,87,,2430.78,,,0,"percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1922.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2444.75,70,,1955.80,,,0,"percent of total billed charges ","70% of total billed charges ",457.91,3248.03,
"CLSD TX CARPAL BONE FX",4605100,"CDM ",450,RC,25635,HCPCS,OUTPATIENT,,,1734,1387.2,,520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",541.36,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",879.05,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1213.8,70,,971.04,,,0,"percent of total billed charges ","70% of total billed charges ",1560.6,90,,1248.48,,,0,"percent of total billed charges ","90% of total billed charges ",1612.62,93,,1290.10,,,0,"percent of total billed charges ","93% of total billed charges ",520.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1473.9,85,,1179.12,,,0,"percent of total billed charges ","85% of total billed charges ",1300.5,90,,1040.40,,,0,"percent of total billed charges ","90% of total billed charges ",1560.6,90,,1248.48,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1508.58,87,,1206.86,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1213.8,70,,971.04,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,1612.62,
"INJ TRIGEMINAL NERVE EA BRANCH",4605105,"CDM ",450,RC,64400,HCPCS,OUTPATIENT,,,763,610.4,,,,,,,,0,"other ","not separately reimbursment ",361.58,100,,90.92,90.92,90.92,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",101.4,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",534.1,70,,427.28,,,0,"percent of total billed charges ","70% of total billed charges ",686.7,90,,549.36,,,0,"percent of total billed charges ","90% of total billed charges ",709.59,93,,567.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",648.55,85,,518.84,,,0,"percent of total billed charges ","85% of total billed charges ",572.25,90,,457.80,,,0,"percent of total billed charges ","90% of total billed charges ",686.7,90,,549.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",663.81,87,,531.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",282.29,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",534.1,70,,427.28,,,0,"percent of total billed charges ","70% of total billed charges ",101.4,709.59,
"RPR LACERATION MOUTH <2.5CM",4605110,"CDM ",450,RC,40830,HCPCS,OUTPATIENT,,,1778.5,1422.8,,416,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",307.65,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1244.95,70,,995.96,,,0,"percent of total billed charges ","70% of total billed charges ",1600.65,90,,1280.52,,,0,"percent of total billed charges ","90% of total billed charges ",1654.01,93,,1323.21,,,0,"percent of total billed charges ","93% of total billed charges ",416,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",528.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1511.73,85,,1209.38,,,0,"percent of total billed charges ","85% of total billed charges ",1333.88,90,,1067.10,,,0,"percent of total billed charges ","90% of total billed charges ",1600.65,90,,1280.52,,,0,"percent of total billed charges ","90% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1547.3,87,,1237.84,,,0,"percent of total billed charges ","87% of total billed charges ",523.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.82,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1244.95,70,,995.96,,,0,"percent of total billed charges ","70% of total billed charges ",217.82,1654.01,
"EXC LIGATE VARICOSE VEIN 1 LEG",4605115,"CDM ",450,RC,37785,HCPCS,OUTPATIENT,,,5076,4060.8,,1032.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3719.83,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",518.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3553.2,70,,2842.56,,,0,"percent of total billed charges ","70% of total billed charges ",4568.4,90,,3654.72,,,0,"percent of total billed charges ","90% of total billed charges ",4720.68,93,,3776.54,,,0,"percent of total billed charges ","93% of total billed charges ",1032.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4314.6,85,,3451.68,,,0,"percent of total billed charges ","85% of total billed charges ",3807,90,,3045.60,,,0,"percent of total billed charges ","90% of total billed charges ",4568.4,90,,3654.72,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4416.12,87,,3532.90,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2903.79,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3553.2,70,,2842.56,,,0,"percent of total billed charges ","70% of total billed charges ",327.08,4720.68,
"DILATE URETHRA MALE INITIAL",4605120,"CDM ",450,RC,53600,HCPCS,OUTPATIENT,,,2426.5,1941.2,,228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1980.61,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",130.86,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1698.55,70,,1358.84,,,0,"percent of total billed charges ","70% of total billed charges ",2183.85,90,,1747.08,,,0,"percent of total billed charges ","90% of total billed charges ",2256.65,93,,1805.32,,,0,"percent of total billed charges ","93% of total billed charges ",228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2062.53,85,,1650.02,,,0,"percent of total billed charges ","85% of total billed charges ",1819.88,90,,1455.90,,,0,"percent of total billed charges ","90% of total billed charges ",2183.85,90,,1747.08,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2111.06,87,,1688.85,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",229.77,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1698.55,70,,1358.84,,,0,"percent of total billed charges ","70% of total billed charges ",130.86,2256.65,
"CIRCUMCISION CLAMP/OTHR DEVICE",4605125,"CDM ",450,RC,54150,HCPCS,OUTPATIENT,,,2157,1725.6,,659.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",600,100,,124.77,124.77,124.77,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",201.06,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1509.9,70,,1207.92,,,0,"percent of total billed charges ","70% of total billed charges ",1941.3,90,,1553.04,,,0,"percent of total billed charges ","90% of total billed charges ",2006.01,93,,1604.81,,,0,"percent of total billed charges ","93% of total billed charges ",659.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1833.45,85,,1466.76,,,0,"percent of total billed charges ","85% of total billed charges ",1617.75,90,,1294.20,,,0,"percent of total billed charges ","90% of total billed charges ",1941.3,90,,1553.04,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1876.59,87,,1501.27,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1922.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1509.9,70,,1207.92,,,0,"percent of total billed charges ","70% of total billed charges ",201.06,2006.01,
"OPEN TX TARSAL FX WO MAN",4605130,"CDM ",450,RC,28450,HCPCS,OUTPATIENT,,,1791,1432.8,,260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",398.66,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1253.7,70,,1002.96,,,0,"percent of total billed charges ","70% of total billed charges ",1611.9,90,,1289.52,,,0,"percent of total billed charges ","90% of total billed charges ",1665.63,93,,1332.50,,,0,"percent of total billed charges ","93% of total billed charges ",260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1522.35,85,,1217.88,,,0,"percent of total billed charges ","85% of total billed charges ",1343.25,90,,1074.60,,,0,"percent of total billed charges ","90% of total billed charges ",1611.9,90,,1289.52,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1558.17,87,,1246.54,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1253.7,70,,1002.96,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1665.63,
"CLSD TX ANKLE DISLOCATION W/AN",4605135,"CDM ",450,RC,27842,HCPCS,OUTPATIENT,,,2223,1778.4,,,,,,,,0,"other ","not separately reimbursment ",1077.67,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1028.3,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1556.1,70,,1244.88,,,0,"percent of total billed charges ","70% of total billed charges ",2000.7,90,,1600.56,,,0,"percent of total billed charges ","90% of total billed charges ",2067.39,93,,1653.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1889.55,85,,1511.64,,,0,"percent of total billed charges ","85% of total billed charges ",1667.25,90,,1333.80,,,0,"percent of total billed charges ","90% of total billed charges ",2000.7,90,,1600.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1934.01,87,,1547.21,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1478.8,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1556.1,70,,1244.88,,,0,"percent of total billed charges ","70% of total billed charges ",1028.3,2067.39,
"US ER FAST CHEST LIMITED",4605140,"CDM ",402,RC,76604,HCPCS,OUTPATIENT,,,764.5,611.6,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",111.1,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",122.69,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",535.15,70,,428.12,,,0,"percent of total billed charges ","70% of total billed charges ",688.05,90,,550.44,,,0,"percent of total billed charges ","90% of total billed charges ",710.99,93,,568.79,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",52.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",649.83,85,,519.86,,,0,"percent of total billed charges ","85% of total billed charges ",688.05,90,,550.44,,,0,"percent of total billed charges ","90% of total billed charges ",688.05,90,,550.44,,,0,"percent of total billed charges ","90% of total billed charges ",51.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",665.12,87,,532.10,,,0,"percent of total billed charges ","87% of total billed charges ",51.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",535.15,70,,428.12,,,0,"percent of total billed charges ","70% of total billed charges ",51.97,710.99,
"US ER FAST ABDOMEN LIMITED",4605145,"CDM ",402,RC,76705,HCPCS,OUTPATIENT,,,709,567.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.94,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",184.91,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",496.3,70,,397.04,,,0,"percent of total billed charges ","70% of total billed charges ",638.1,90,,510.48,,,0,"percent of total billed charges ","90% of total billed charges ",659.37,93,,527.50,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",49.3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",602.65,85,,482.12,,,0,"percent of total billed charges ","85% of total billed charges ",638.1,90,,510.48,,,0,"percent of total billed charges ","90% of total billed charges ",638.1,90,,510.48,,,0,"percent of total billed charges ","90% of total billed charges ",48.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",616.83,87,,871.19,418.96,1008.33,"1 through 10","percent of total billed charges ","87% of total billed charges ",48.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",496.3,70,,397.04,,,0,"percent of total billed charges ","70% of total billed charges ",48.81,659.37,
"US ER FAST ECHO TRANS 2D",4605150,"CDM ",480,RC,93308,HCPCS,OUTPATIENT,,,700,560,,180.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",575.7,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",205.92,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",490,70,,392.00,,,0,"percent of total billed charges ","70% of total billed charges ",630,90,,504.00,,,0,"percent of total billed charges ","90% of total billed charges ",651,93,,520.80,,,0,"percent of total billed charges ","93% of total billed charges ",180.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",79.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",595,85,,476.00,,,0,"percent of total billed charges ","85% of total billed charges ",630,90,,504.00,,,0,"percent of total billed charges ","90% of total billed charges ",630,90,,504.00,,,0,"percent of total billed charges ","90% of total billed charges ",78.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",609,87,,487.20,,,0,"percent of total billed charges ","87% of total billed charges ",78.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",490,70,,392.00,,,0,"percent of total billed charges ","70% of total billed charges ",78.73,651,
"US ER FAST RETROPERITONEAL",4605155,"CDM ",402,RC,76775,HCPCS,OUTPATIENT,,,610.5,488.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.16,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",121.92,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",427.35,70,,341.88,,,0,"percent of total billed charges ","70% of total billed charges ",549.45,90,,439.56,,,0,"percent of total billed charges ","90% of total billed charges ",567.77,93,,454.22,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",518.93,85,,415.14,,,0,"percent of total billed charges ","85% of total billed charges ",549.45,90,,439.56,,,0,"percent of total billed charges ","90% of total billed charges ",549.45,90,,439.56,,,0,"percent of total billed charges ","90% of total billed charges ",56.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",531.14,87,,424.91,,,0,"percent of total billed charges ","87% of total billed charges ",56.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",427.35,70,,341.88,,,0,"percent of total billed charges ","70% of total billed charges ",56.67,567.77,
"US ER THORAX/CHEST LIMITED",4605160,"CDM ",402,RC,76604,HCPCS,OUTPATIENT,,,536.5,429.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",111.1,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",122.69,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",375.55,70,,300.44,,,0,"percent of total billed charges ","70% of total billed charges ",482.85,90,,386.28,,,0,"percent of total billed charges ","90% of total billed charges ",498.95,93,,399.16,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",52.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",456.03,85,,364.82,,,0,"percent of total billed charges ","85% of total billed charges ",482.85,90,,386.28,,,0,"percent of total billed charges ","90% of total billed charges ",482.85,90,,386.28,,,0,"percent of total billed charges ","90% of total billed charges ",51.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",466.76,87,,373.41,,,0,"percent of total billed charges ","87% of total billed charges ",51.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",375.55,70,,300.44,,,0,"percent of total billed charges ","70% of total billed charges ",51.97,498.95,
"US ER GUIDED VASC ACCESS",4605165,"CDM ",402,RC,76937,HCPCS,OUTPATIENT,,,413.5,330.8,,23.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",82.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",289.45,70,,231.56,,,0,"percent of total billed charges ","70% of total billed charges ",372.15,90,,297.72,,,0,"percent of total billed charges ","90% of total billed charges ",384.56,93,,307.65,,,0,"percent of total billed charges ","93% of total billed charges ",23.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",351.48,85,,281.18,,,0,"percent of total billed charges ","85% of total billed charges ",372.15,90,,297.72,,,0,"percent of total billed charges ","90% of total billed charges ",372.15,90,,297.72,,,0,"percent of total billed charges ","90% of total billed charges ",15.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",359.75,87,,438.33,438.33,438.33,"1 through 10","percent of total billed charges ","87% of total billed charges ",15.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",289.45,70,,231.56,,,0,"percent of total billed charges ","70% of total billed charges ",15.47,384.56,
"US ER OB LIMITED",4605170,"CDM ",402,RC,76815,HCPCS,OUTPATIENT,,,512,409.6,,,,,,,,0,"other ","not separately reimbursment ",141.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",171.51,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",358.4,70,,286.72,,,0,"percent of total billed charges ","70% of total billed charges ",460.8,90,,368.64,,,0,"percent of total billed charges ","90% of total billed charges ",476.16,93,,380.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",51.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",435.2,85,,348.16,,,0,"percent of total billed charges ","85% of total billed charges ",460.8,90,,368.64,,,0,"percent of total billed charges ","90% of total billed charges ",460.8,90,,368.64,,,0,"percent of total billed charges ","90% of total billed charges ",50.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",445.44,87,,42.88,42.88,42.88,"1 through 10","percent of total billed charges ","87% of total billed charges ",50.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",358.4,70,,286.72,,,0,"percent of total billed charges ","70% of total billed charges ",50.74,476.16,
"ASP BLADDER W/CATH INSERT",4605175,"CDM ",450,RC,51102,HCPCS,OUTPATIENT,,,3180,2544,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.99,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2226,70,,1780.80,,,0,"percent of total billed charges ","70% of total billed charges ",2862,90,,2289.60,,,0,"percent of total billed charges ","90% of total billed charges ",2957.4,93,,2365.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",841.11,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2703,85,,2162.40,,,0,"percent of total billed charges ","85% of total billed charges ",2385,90,,1908.00,,,0,"percent of total billed charges ","90% of total billed charges ",2862,90,,2289.60,,,0,"percent of total billed charges ","90% of total billed charges ",832.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2766.6,87,,2213.28,,,0,"percent of total billed charges ","87% of total billed charges ",832.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1922.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2226,70,,1780.80,,,0,"percent of total billed charges ","70% of total billed charges ",299.99,2957.4,
"ABD PARACENTESIS W/IMAGING",4605190,"CDM ",450,RC,49083,HCPCS,OUTPATIENT,,,1107.5,886,,260.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1079.61,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",221.78,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",775.25,70,,620.20,,,0,"percent of total billed charges ","70% of total billed charges ",996.75,90,,797.40,,,0,"percent of total billed charges ","90% of total billed charges ",1029.98,93,,823.98,,,0,"percent of total billed charges ","93% of total billed charges ",260.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.95,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",941.38,85,,753.10,,,0,"percent of total billed charges ","85% of total billed charges ",830.63,90,,664.50,,,0,"percent of total billed charges ","90% of total billed charges ",996.75,90,,797.40,,,0,"percent of total billed charges ","90% of total billed charges ",327.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",963.53,87,,770.82,,,0,"percent of total billed charges ","87% of total billed charges ",327.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",834.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",775.25,70,,620.20,,,0,"percent of total billed charges ","70% of total billed charges ",221.78,1079.61,
"INJ ANESTH ILIO/GROIN NERVE",4605195,"CDM ",450,RC,64425,HCPCS,OUTPATIENT,,,1035,828,,224.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",310.07,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",114.86,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",724.5,70,,579.60,,,0,"percent of total billed charges ","70% of total billed charges ",931.5,90,,745.20,,,0,"percent of total billed charges ","90% of total billed charges ",962.55,93,,770.04,,,0,"percent of total billed charges ","93% of total billed charges ",224.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",222,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",879.75,85,,703.80,,,0,"percent of total billed charges ","85% of total billed charges ",776.25,90,,621.00,,,0,"percent of total billed charges ","90% of total billed charges ",931.5,90,,745.20,,,0,"percent of total billed charges ","90% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",900.45,87,,720.36,,,0,"percent of total billed charges ","87% of total billed charges ",219.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",649.16,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",724.5,70,,579.60,,,0,"percent of total billed charges ","70% of total billed charges ",114.86,962.55,
"US ER PELVIS LIMITED NON OB",4605200,"CDM ",402,RC,76857,HCPCS,OUTPATIENT,,,505.5,404.4,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",103.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",100.63,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",353.85,70,,283.08,,,0,"percent of total billed charges ","70% of total billed charges ",454.95,90,,363.96,,,0,"percent of total billed charges ","90% of total billed charges ",470.12,93,,376.10,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",429.68,85,,343.74,,,0,"percent of total billed charges ","85% of total billed charges ",454.95,90,,363.96,,,0,"percent of total billed charges ","90% of total billed charges ",454.95,90,,363.96,,,0,"percent of total billed charges ","90% of total billed charges ",42.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",439.79,87,,82.58,82.58,82.58,"1 through 10","percent of total billed charges ","87% of total billed charges ",42.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",353.85,70,,283.08,,,0,"percent of total billed charges ","70% of total billed charges ",42.24,470.12,
"US ER SOFT TISSUE HEAD/NECK",4605205,"CDM ",402,RC,76536,HCPCS,OUTPATIENT,,,696.5,557.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",480.76,100,,239.51,239.51,239.51,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",235.16,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",487.55,70,,390.04,,,0,"percent of total billed charges ","70% of total billed charges ",626.85,90,,501.48,,,0,"percent of total billed charges ","90% of total billed charges ",647.75,93,,518.20,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",592.03,85,,473.62,,,0,"percent of total billed charges ","85% of total billed charges ",626.85,90,,501.48,,,0,"percent of total billed charges ","90% of total billed charges ",626.85,90,,501.48,,,0,"percent of total billed charges ","90% of total billed charges ",25.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",605.96,87,,621.67,235.67,699.38,"1 through 10","percent of total billed charges ","87% of total billed charges ",25.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",487.55,70,,390.04,,,0,"percent of total billed charges ","70% of total billed charges ",25.9,647.75,
"US ER SOFT TISSUE EXTREMITY",4605210,"CDM ",402,RC,76882,HCPCS,OUTPATIENT,,,419.5,335.6,,,,,,,,0,"other ","not separately reimbursment ",117.16,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",117.83,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",293.65,70,,234.92,,,0,"percent of total billed charges ","70% of total billed charges ",377.55,90,,302.04,,,0,"percent of total billed charges ","90% of total billed charges ",390.14,93,,312.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",6.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",356.58,85,,285.26,,,0,"percent of total billed charges ","85% of total billed charges ",377.55,90,,302.04,,,0,"percent of total billed charges ","90% of total billed charges ",377.55,90,,302.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",364.97,87,,291.98,,,0,"percent of total billed charges ","87% of total billed charges ",6.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",293.65,70,,234.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.08,390.14,
"END TIDAL CO2",5000021,"CDM ",460,RC,94770,HCPCS,OUTPATIENT,,,51,40.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.8,80,,32.64,,,0,"percent of total billed charges ","80% of total billed charges ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",47.43,93,,37.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.35,85,,34.68,,,0,"percent of total billed charges ","85% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.37,87,,35.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",35.7,47.43,
"CARDIOPULMONARY EXERCISE TEST",5000104,"CDM ",460,RC,94621,HCPCS,OUTPATIENT,,,1123.5,898.8,,101.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",322.1,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",786.45,70,,629.16,,,0,"percent of total billed charges ","70% of total billed charges ",1011.15,90,,808.92,,,0,"percent of total billed charges ","90% of total billed charges ",1044.86,93,,835.89,,,0,"percent of total billed charges ","93% of total billed charges ",101.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",954.98,85,,763.98,,,0,"percent of total billed charges ","85% of total billed charges ",1011.15,90,,808.92,,,0,"percent of total billed charges ","90% of total billed charges ",1011.15,90,,808.92,,,0,"percent of total billed charges ","90% of total billed charges ",2.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",977.45,87,,781.96,,,0,"percent of total billed charges ","87% of total billed charges ",2.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",343.17,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",786.45,70,,629.16,,,0,"percent of total billed charges ","70% of total billed charges ",2.19,1044.86,
"O2 UPTAKE",5000120,"CDM ",460,RC,94680,HCPCS,OUTPATIENT,,,338,270.4,,50.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",108.61,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",236.6,70,,189.28,,,0,"percent of total billed charges ","70% of total billed charges ",304.2,90,,243.36,,,0,"percent of total billed charges ","90% of total billed charges ",314.34,93,,251.47,,,0,"percent of total billed charges ","93% of total billed charges ",50.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",287.3,85,,229.84,,,0,"percent of total billed charges ","85% of total billed charges ",304.2,90,,243.36,,,0,"percent of total billed charges ","90% of total billed charges ",304.2,90,,243.36,,,0,"percent of total billed charges ","90% of total billed charges ",14.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",294.06,87,,235.25,,,0,"percent of total billed charges ","87% of total billed charges ",14.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",118.33,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",236.6,70,,189.28,,,0,"percent of total billed charges ","70% of total billed charges ",14.61,314.34,
"CO2 PRODUCTION",5000146,"CDM ",460,RC,94681,HCPCS,OUTPATIENT,,,1075.5,860.4,,101.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",99.55,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",752.85,70,,602.28,,,0,"percent of total billed charges ","70% of total billed charges ",967.95,90,,774.36,,,0,"percent of total billed charges ","90% of total billed charges ",1000.22,93,,800.18,,,0,"percent of total billed charges ","93% of total billed charges ",101.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",914.18,85,,731.34,,,0,"percent of total billed charges ","85% of total billed charges ",967.95,90,,774.36,,,0,"percent of total billed charges ","90% of total billed charges ",967.95,90,,774.36,,,0,"percent of total billed charges ","90% of total billed charges ",14.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",935.69,87,,748.55,,,0,"percent of total billed charges ","87% of total billed charges ",14.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",343.17,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",752.85,70,,602.28,,,0,"percent of total billed charges ","70% of total billed charges ",14.61,1000.22,
"NAP / MSLT",5000187,"CDM ",920,RC,95805,HCPCS,OUTPATIENT,,,6257,5005.6,,,,,,,,0,"other ","not separately reimbursment ",1056.46,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",856.66,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4379.9,70,,3503.92,,,0,"percent of total billed charges ","70% of total billed charges ",5631.3,90,,4505.04,,,0,"percent of total billed charges ","90% of total billed charges ",5819.01,93,,4655.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",26.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5318.45,85,,4254.76,,,0,"percent of total billed charges ","85% of total billed charges ",5631.3,90,,4505.04,,,0,"percent of total billed charges ","90% of total billed charges ",5631.3,90,,4505.04,,,0,"percent of total billed charges ","90% of total billed charges ",26.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5443.59,87,,4354.87,,,0,"percent of total billed charges ","87% of total billed charges ",26.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",789.74,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4379.9,70,,3503.92,,,0,"percent of total billed charges ","70% of total billed charges ",26.12,5819.01,
"INC SPIRO TREATMENT IP",5000278,"CDM ",410,RC,94150,HCPCS,OUTPATIENT,,,161,128.8,,50.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",50.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",112.7,70,,90.16,,,0,"percent of total billed charges ","70% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",149.73,93,,119.78,,,0,"percent of total billed charges ","93% of total billed charges ",50.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",136.85,85,,109.48,,,0,"percent of total billed charges ","85% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",140.07,87,,112.06,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",118.33,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",112.7,70,,90.16,,,0,"percent of total billed charges ","70% of total billed charges ",6.87,149.73,
"SPUTUM COLLECTION",5000328,"CDM ",309,RC,89220,HCPCS,OUTPATIENT,,,107,85.6,,14.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.33,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",74.9,70,,59.92,,,0,"percent of total billed charges ","70% of total billed charges ",96.3,90,,77.04,,,0,"percent of total billed charges ","90% of total billed charges ",99.51,93,,79.61,,,0,"percent of total billed charges ","93% of total billed charges ",14.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",90.95,85,,72.76,,,0,"percent of total billed charges ","85% of total billed charges ",96.3,90,,77.04,,,0,"percent of total billed charges ","90% of total billed charges ",96.3,90,,77.04,,,0,"percent of total billed charges ","90% of total billed charges ",14.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.09,87,,74.47,,,0,"percent of total billed charges ","87% of total billed charges ",14.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",156.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",74.9,70,,59.92,,,0,"percent of total billed charges ","70% of total billed charges ",14.01,156.68,
"MECHAN VENT SUB/DAY",5000336,"CDM ",410,RC,94003,HCPCS,OUTPATIENT,,,1703.5,1362.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",137.17,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1192.45,70,,953.96,,,0,"percent of total billed charges ","70% of total billed charges ",1533.15,90,,1226.52,,,0,"percent of total billed charges ","90% of total billed charges ",1584.26,93,,1267.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",109.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1447.98,85,,1158.38,,,0,"percent of total billed charges ","85% of total billed charges ",1533.15,90,,1226.52,,,0,"percent of total billed charges ","90% of total billed charges ",1533.15,90,,1226.52,,,0,"percent of total billed charges ","90% of total billed charges ",108.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1482.05,87,,1185.64,,,0,"percent of total billed charges ","87% of total billed charges ",108.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",568.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1192.45,70,,953.96,,,0,"percent of total billed charges ","70% of total billed charges ",108.51,1584.26,
"MECH VENT 1ST DAY",5000344,"CDM ",410,RC,94002,HCPCS,OUTPATIENT,,,2089,1671.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",194.74,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1462.3,70,,1169.84,,,0,"percent of total billed charges ","70% of total billed charges ",1880.1,90,,1504.08,,,0,"percent of total billed charges ","90% of total billed charges ",1942.77,93,,1554.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",109.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1775.65,85,,1420.52,,,0,"percent of total billed charges ","85% of total billed charges ",1880.1,90,,1504.08,,,0,"percent of total billed charges ","90% of total billed charges ",1880.1,90,,1504.08,,,0,"percent of total billed charges ","90% of total billed charges ",108.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1817.43,87,,1453.94,,,0,"percent of total billed charges ","87% of total billed charges ",108.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",568.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1462.3,70,,1169.84,,,0,"percent of total billed charges ","70% of total billed charges ",108.51,1942.77,
SPIROMETRY,5000377,"CDM ",460,RC,94010,HCPCS,OUTPATIENT,,,362,289.6,,50.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",300.98,100,,31.00,31.00,31.00,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",55.11,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",253.4,70,,202.72,,,0,"percent of total billed charges ","70% of total billed charges ",325.8,90,,260.64,,,0,"percent of total billed charges ","90% of total billed charges ",336.66,93,,269.33,,,0,"percent of total billed charges ","93% of total billed charges ",50.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",307.7,85,,246.16,,,0,"percent of total billed charges ","85% of total billed charges ",325.8,90,,260.64,,,0,"percent of total billed charges ","90% of total billed charges ",325.8,90,,260.64,,,0,"percent of total billed charges ","90% of total billed charges ",19.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",314.94,87,,251.95,,,0,"percent of total billed charges ","87% of total billed charges ",19.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.57,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",253.4,70,,202.72,,,0,"percent of total billed charges ","70% of total billed charges ",19.51,336.66,
"SPIRO PRE & POST MED",5000385,"CDM ",460,RC,94060,HCPCS,OUTPATIENT,,,565.5,452.4,,101.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.83,100,,447.51,447.51,447.51,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",80.34,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",395.85,70,,316.68,,,0,"percent of total billed charges ","70% of total billed charges ",508.95,90,,407.16,,,0,"percent of total billed charges ","90% of total billed charges ",525.92,93,,420.74,,,0,"percent of total billed charges ","93% of total billed charges ",101.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.71,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",480.68,85,,384.54,,,0,"percent of total billed charges ","85% of total billed charges ",508.95,90,,407.16,,,0,"percent of total billed charges ","90% of total billed charges ",508.95,90,,407.16,,,0,"percent of total billed charges ","90% of total billed charges ",31.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",491.99,87,,310.57,264.74,356.40,"1 through 10","percent of total billed charges ","87% of total billed charges ",31.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",343.17,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",395.85,70,,316.68,,,0,"percent of total billed charges ","70% of total billed charges ",31.4,525.92,
"DIFFUSION CAPACITY",5000393,"CDM ",460,RC,94729,HCPCS,OUTPATIENT,,,508.5,406.8,,42.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",118.54,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",120.23,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",355.95,70,,284.76,,,0,"percent of total billed charges ","70% of total billed charges ",457.65,90,,366.12,,,0,"percent of total billed charges ","90% of total billed charges ",472.91,93,,378.33,,,0,"percent of total billed charges ","93% of total billed charges ",42.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",432.23,85,,345.78,,,0,"percent of total billed charges ","85% of total billed charges ",457.65,90,,366.12,,,0,"percent of total billed charges ","90% of total billed charges ",457.65,90,,366.12,,,0,"percent of total billed charges ","90% of total billed charges ",52.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",442.4,87,,353.92,,,0,"percent of total billed charges ","87% of total billed charges ",52.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",355.95,70,,284.76,,,0,"percent of total billed charges ","70% of total billed charges ",42.11,472.91,
ABG,5000419,"CDM ",301,RC,82803,HCPCS,OUTPATIENT,,,617.5,494,,22.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",432.25,70,,345.80,,,0,"percent of total billed charges ","70% of total billed charges ",555.75,90,,444.60,,,0,"percent of total billed charges ","90% of total billed charges ",574.28,93,,459.42,,,0,"percent of total billed charges ","93% of total billed charges ",22.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",524.88,85,,419.90,,,0,"percent of total billed charges ","85% of total billed charges ",555.75,90,,444.60,,,0,"percent of total billed charges ","90% of total billed charges ",555.75,90,,444.60,,,0,"percent of total billed charges ","90% of total billed charges ",27.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",537.23,87,,432.12,393.70,470.53,"1 through 10","percent of total billed charges ","87% of total billed charges ",27.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",432.25,70,,345.80,,,0,"percent of total billed charges ","70% of total billed charges ",22.16,574.28,
"CARBON MONOXIDE",5000492,"CDM ",301,RC,82375,HCPCS,OUTPATIENT,,,129.5,103.6,,12.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,61.55,61.55,61.55,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.65,70,,72.52,,,0,"percent of total billed charges ","70% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",120.44,93,,96.35,,,0,"percent of total billed charges ","93% of total billed charges ",12.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",110.08,85,,88.06,,,0,"percent of total billed charges ","85% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",20.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.67,87,,90.14,,,0,"percent of total billed charges ","87% of total billed charges ",20.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.32,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",90.65,70,,72.52,,,0,"percent of total billed charges ","70% of total billed charges ",12.32,120.44,
METHEHOBLOBIN,5000518,"CDM ",301,RC,83050,HCPCS,OUTPATIENT,,,54.5,43.6,,6.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.15,70,,30.52,,,0,"percent of total billed charges ","70% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",50.69,93,,40.55,,,0,"percent of total billed charges ","93% of total billed charges ",6.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.93,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",46.33,85,,37.06,,,0,"percent of total billed charges ","85% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",7.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.42,87,,37.94,,,0,"percent of total billed charges ","87% of total billed charges ",7.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",38.15,70,,30.52,,,0,"percent of total billed charges ","70% of total billed charges ",6.97,50.69,
"OXIMETRY EXERCISE",5000625,"CDM ",410,RC,94761,HCPCS,OUTPATIENT,,,314.5,251.6,,15.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.14,100,,18.45,18.45,18.45,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",6.56,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",220.15,70,,176.12,,,0,"percent of total billed charges ","70% of total billed charges ",283.05,90,,226.44,,,0,"percent of total billed charges ","90% of total billed charges ",292.49,93,,233.99,,,0,"percent of total billed charges ","93% of total billed charges ",15.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",267.33,85,,213.86,,,0,"percent of total billed charges ","85% of total billed charges ",283.05,90,,226.44,,,0,"percent of total billed charges ","90% of total billed charges ",283.05,90,,226.44,,,0,"percent of total billed charges ","90% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",273.62,87,,401.48,365.79,437.17,"1 through 10","percent of total billed charges ","87% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",220.15,70,,176.12,,,0,"percent of total billed charges ","70% of total billed charges ",6.56,292.49,
"BIPAP DAILY",5000691,"CDM ",410,RC,94660,HCPCS,OUTPATIENT,,,926,740.8,,,,,,,,0,"other ","not separately reimbursment ",270.54,100,,44.07,44.07,44.07,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",79.64,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",648.2,70,,518.56,,,0,"percent of total billed charges ","70% of total billed charges ",833.4,90,,666.72,,,0,"percent of total billed charges ","90% of total billed charges ",861.18,93,,688.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",787.1,85,,629.68,,,0,"percent of total billed charges ","85% of total billed charges ",833.4,90,,666.72,,,0,"percent of total billed charges ","90% of total billed charges ",833.4,90,,666.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",805.62,87,,644.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",201.38,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",648.2,70,,518.56,,,0,"percent of total billed charges ","70% of total billed charges ",79.64,861.18,
"CPAP DAILY",5000692,"CDM ",410,RC,94660,HCPCS,OUTPATIENT,,,926,740.8,,,,,,,,0,"other ","not separately reimbursment ",270.54,100,,44.07,44.07,44.07,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",79.64,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",648.2,70,,518.56,,,0,"percent of total billed charges ","70% of total billed charges ",833.4,90,,666.72,,,0,"percent of total billed charges ","90% of total billed charges ",861.18,93,,688.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",787.1,85,,629.68,,,0,"percent of total billed charges ","85% of total billed charges ",833.4,90,,666.72,,,0,"percent of total billed charges ","90% of total billed charges ",833.4,90,,666.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",805.62,87,,644.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",201.38,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",648.2,70,,518.56,,,0,"percent of total billed charges ","70% of total billed charges ",79.64,861.18,
"CPT INITIAL",5000815,"CDM ",410,RC,94667,HCPCS,OUTPATIENT,,,262,209.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.63,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",183.4,70,,146.72,,,0,"percent of total billed charges ","70% of total billed charges ",235.8,90,,188.64,,,0,"percent of total billed charges ","90% of total billed charges ",243.66,93,,194.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",222.7,85,,178.16,,,0,"percent of total billed charges ","85% of total billed charges ",235.8,90,,188.64,,,0,"percent of total billed charges ","90% of total billed charges ",235.8,90,,188.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",227.94,87,,182.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",183.4,70,,146.72,,,0,"percent of total billed charges ","70% of total billed charges ",45.63,243.66,
"MEMBRANE DIFFUSION",5000849,"CDM ",469,RC,94729,HCPCS,OUTPATIENT,,,508.5,406.8,,42.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",118.54,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",120.23,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",355.95,70,,284.76,,,0,"percent of total billed charges ","70% of total billed charges ",457.65,90,,366.12,,,0,"percent of total billed charges ","90% of total billed charges ",472.91,93,,378.33,,,0,"percent of total billed charges ","93% of total billed charges ",42.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",432.23,85,,345.78,,,0,"percent of total billed charges ","85% of total billed charges ",457.65,90,,366.12,,,0,"percent of total billed charges ","90% of total billed charges ",457.65,90,,366.12,,,0,"percent of total billed charges ","90% of total billed charges ",52.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",442.4,87,,353.92,,,0,"percent of total billed charges ","87% of total billed charges ",52.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",355.95,70,,284.76,,,0,"percent of total billed charges ","70% of total billed charges ",42.11,472.91,
"NITROGEN WASHOUT",5000856,"CDM ",469,RC,94727,HCPCS,OUTPATIENT,,,493.5,394.8,,,,,,,,0,"other ","not separately reimbursment ",93.84,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",90.31,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",345.45,70,,276.36,,,0,"percent of total billed charges ","70% of total billed charges ",444.15,90,,355.32,,,0,"percent of total billed charges ","90% of total billed charges ",458.96,93,,367.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",419.48,85,,335.58,,,0,"percent of total billed charges ","85% of total billed charges ",444.15,90,,355.32,,,0,"percent of total billed charges ","90% of total billed charges ",444.15,90,,355.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",429.35,87,,343.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",198.57,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",345.45,70,,276.36,,,0,"percent of total billed charges ","70% of total billed charges ",90.31,458.96,
"MAX VOL VENTILATION",5000872,"CDM ",460,RC,94200,HCPCS,OUTPATIENT,,,157.5,126,,19.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",61.59,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",30.76,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",110.25,70,,88.20,,,0,"percent of total billed charges ","70% of total billed charges ",141.75,90,,113.40,,,0,"percent of total billed charges ","90% of total billed charges ",146.48,93,,117.18,,,0,"percent of total billed charges ","93% of total billed charges ",19.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",133.88,85,,107.10,,,0,"percent of total billed charges ","85% of total billed charges ",141.75,90,,113.40,,,0,"percent of total billed charges ","90% of total billed charges ",141.75,90,,113.40,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",137.03,87,,109.62,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",110.25,70,,88.20,,,0,"percent of total billed charges ","70% of total billed charges ",6.87,146.48,
"VITAL CAPACITY TOTAL",5000898,"CDM ",460,RC,94150,HCPCS,OUTPATIENT,,,161,128.8,,50.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",50.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",112.7,70,,90.16,,,0,"percent of total billed charges ","70% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",149.73,93,,119.78,,,0,"percent of total billed charges ","93% of total billed charges ",50.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",136.85,85,,109.48,,,0,"percent of total billed charges ","85% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",140.07,87,,112.06,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",118.33,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",112.7,70,,90.16,,,0,"percent of total billed charges ","70% of total billed charges ",6.87,149.73,
OXIMETRY,5000930,"CDM ",410,RC,94760,HCPCS,OUTPATIENT,,,175.5,140.4,,9.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.13,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",4.49,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",122.85,70,,98.28,,,0,"percent of total billed charges ","70% of total billed charges ",157.95,90,,126.36,,,0,"percent of total billed charges ","90% of total billed charges ",163.22,93,,130.58,,,0,"percent of total billed charges ","93% of total billed charges ",9.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.47,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",149.18,85,,119.34,,,0,"percent of total billed charges ","85% of total billed charges ",157.95,90,,126.36,,,0,"percent of total billed charges ","90% of total billed charges ",157.95,90,,126.36,,,0,"percent of total billed charges ","90% of total billed charges ",11.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",152.69,87,,122.15,,,0,"percent of total billed charges ","87% of total billed charges ",11.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",122.85,70,,98.28,,,0,"percent of total billed charges ","70% of total billed charges ",4.49,163.22,
"AEROSOL TX INITIAL",5000948,"CDM ",412,RC,94640,HCPCS,OUTPATIENT,,,205.5,164.4,,69.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",254.03,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",22.46,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",143.85,70,,115.08,,,0,"percent of total billed charges ","70% of total billed charges ",184.95,90,,147.96,,,0,"percent of total billed charges ","90% of total billed charges ",191.12,93,,152.90,,,0,"percent of total billed charges ","93% of total billed charges ",69.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.01,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",174.68,85,,139.74,,,0,"percent of total billed charges ","85% of total billed charges ",184.95,90,,147.96,,,0,"percent of total billed charges ","90% of total billed charges ",184.95,90,,147.96,,,0,"percent of total billed charges ","90% of total billed charges ",12.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",178.79,87,,100.04,37.32,162.75,"1 through 10","percent of total billed charges ","87% of total billed charges ",12.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.38,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",143.85,70,,115.08,,,0,"percent of total billed charges ","70% of total billed charges ",12.88,254.03,
"AEROSOL TRMT SUBSEQ",5000963,"CDM ",412,RC,94640,HCPCS,OUTPATIENT,,,238,190.4,,69.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",254.03,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",22.46,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",166.6,70,,133.28,,,0,"percent of total billed charges ","70% of total billed charges ",214.2,90,,171.36,,,0,"percent of total billed charges ","90% of total billed charges ",221.34,93,,177.07,,,0,"percent of total billed charges ","93% of total billed charges ",69.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.01,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",202.3,85,,161.84,,,0,"percent of total billed charges ","85% of total billed charges ",214.2,90,,171.36,,,0,"percent of total billed charges ","90% of total billed charges ",214.2,90,,171.36,,,0,"percent of total billed charges ","90% of total billed charges ",12.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",207.06,87,,100.04,37.32,162.75,"1 through 10","percent of total billed charges ","87% of total billed charges ",12.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.38,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",166.6,70,,133.28,,,0,"percent of total billed charges ","70% of total billed charges ",12.88,254.03,
"MDI SUBSEQ",5000971,"CDM ",412,RC,94640,HCPCS,OUTPATIENT,,,205.5,164.4,,69.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",254.03,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",22.46,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",143.85,70,,115.08,,,0,"percent of total billed charges ","70% of total billed charges ",184.95,90,,147.96,,,0,"percent of total billed charges ","90% of total billed charges ",191.12,93,,152.90,,,0,"percent of total billed charges ","93% of total billed charges ",69.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.01,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",174.68,85,,139.74,,,0,"percent of total billed charges ","85% of total billed charges ",184.95,90,,147.96,,,0,"percent of total billed charges ","90% of total billed charges ",184.95,90,,147.96,,,0,"percent of total billed charges ","90% of total billed charges ",12.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",178.79,87,,100.04,37.32,162.75,"1 through 10","percent of total billed charges ","87% of total billed charges ",12.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.38,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",143.85,70,,115.08,,,0,"percent of total billed charges ","70% of total billed charges ",12.88,254.03,
SUCTIONING,5001011,"CDM ",410,RC,31720,HCPCS,OUTPATIENT,,,61,48.8,,69.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",692.86,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",124.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",56.73,93,,45.38,,,0,"percent of total billed charges ","93% of total billed charges ",69.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",51.85,85,,41.48,,,0,"percent of total billed charges ","85% of total billed charges ",45.75,90,,36.60,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",43.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.07,87,,42.46,,,0,"percent of total billed charges ","87% of total billed charges ",43.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.38,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",42.7,692.86,
"CAPILLARY BLOOD PH",5001094,"CDM ",301,RC,82800,HCPCS,OUTPATIENT,,,226,180.8,,9.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",158.2,70,,126.56,,,0,"percent of total billed charges ","70% of total billed charges ",203.4,90,,162.72,,,0,"percent of total billed charges ","90% of total billed charges ",210.18,93,,168.14,,,0,"percent of total billed charges ","93% of total billed charges ",9.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",192.1,85,,153.68,,,0,"percent of total billed charges ","85% of total billed charges ",203.4,90,,162.72,,,0,"percent of total billed charges ","90% of total billed charges ",203.4,90,,162.72,,,0,"percent of total billed charges ","90% of total billed charges ",8.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",196.62,87,,157.30,,,0,"percent of total billed charges ","87% of total billed charges ",8.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",158.2,70,,126.56,,,0,"percent of total billed charges ","70% of total billed charges ",8.79,210.18,
"CHEST PERCUSSION SUB",5001110,"CDM ",410,RC,94668,HCPCS,OUTPATIENT,,,180.5,144.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.19,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",126.35,70,,101.08,,,0,"percent of total billed charges ","70% of total billed charges ",162.45,90,,129.96,,,0,"percent of total billed charges ","90% of total billed charges ",167.87,93,,134.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",153.43,85,,122.74,,,0,"percent of total billed charges ","85% of total billed charges ",162.45,90,,129.96,,,0,"percent of total billed charges ","90% of total billed charges ",162.45,90,,129.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",157.04,87,,125.63,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",126.35,70,,101.08,,,0,"percent of total billed charges ","70% of total billed charges ",71.19,167.87,
"HEART NEBULIZER TX 1ST HOUR",5001201,"CDM ",412,RC,94644,HCPCS,OUTPATIENT,,,144.5,115.6,,,,,,,,0,"other ","not separately reimbursment ",140.95,100,,4.57,4.57,4.57,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",125.47,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",101.15,70,,80.92,,,0,"percent of total billed charges ","70% of total billed charges ",130.05,90,,104.04,,,0,"percent of total billed charges ","90% of total billed charges ",134.39,93,,107.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",47.03,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",122.83,85,,98.26,,,0,"percent of total billed charges ","85% of total billed charges ",130.05,90,,104.04,,,0,"percent of total billed charges ","90% of total billed charges ",130.05,90,,104.04,,,0,"percent of total billed charges ","90% of total billed charges ",46.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",125.72,87,,100.58,,,0,"percent of total billed charges ","87% of total billed charges ",46.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",101.15,70,,80.92,,,0,"percent of total billed charges ","70% of total billed charges ",46.56,140.95,
"HEART NEBULIZER HOURLY",5001219,"CDM ",412,RC,94645,HCPCS,OUTPATIENT,,,103,82.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.14,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",72.1,70,,57.68,,,0,"percent of total billed charges ","70% of total billed charges ",92.7,90,,74.16,,,0,"percent of total billed charges ","90% of total billed charges ",95.79,93,,76.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",47.03,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",87.55,85,,70.04,,,0,"percent of total billed charges ","85% of total billed charges ",92.7,90,,74.16,,,0,"percent of total billed charges ","90% of total billed charges ",92.7,90,,74.16,,,0,"percent of total billed charges ","90% of total billed charges ",46.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",89.61,87,,71.69,,,0,"percent of total billed charges ","87% of total billed charges ",46.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",72.1,70,,57.68,,,0,"percent of total billed charges ","70% of total billed charges ",32.14,95.79,
HELIOX/HOUR,5001235,"CDM ",412,RC,94640,HCPCS,OUTPATIENT,,,205.5,164.4,,69.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",254.03,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",22.46,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",143.85,70,,115.08,,,0,"percent of total billed charges ","70% of total billed charges ",184.95,90,,147.96,,,0,"percent of total billed charges ","90% of total billed charges ",191.12,93,,152.90,,,0,"percent of total billed charges ","93% of total billed charges ",69.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.01,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",174.68,85,,139.74,,,0,"percent of total billed charges ","85% of total billed charges ",184.95,90,,147.96,,,0,"percent of total billed charges ","90% of total billed charges ",184.95,90,,147.96,,,0,"percent of total billed charges ","90% of total billed charges ",12.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",178.79,87,,100.04,37.32,162.75,"1 through 10","percent of total billed charges ","87% of total billed charges ",12.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.38,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",143.85,70,,115.08,,,0,"percent of total billed charges ","70% of total billed charges ",12.88,254.03,
"NOCTURNAL OXIMETRY STUDY",5001243,"CDM ",410,RC,94762,HCPCS,OUTPATIENT,,,568.5,454.8,,50.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.16,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",53.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",397.95,70,,318.36,,,0,"percent of total billed charges ","70% of total billed charges ",511.65,90,,409.32,,,0,"percent of total billed charges ","90% of total billed charges ",528.71,93,,422.97,,,0,"percent of total billed charges ","93% of total billed charges ",50.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",483.23,85,,386.58,,,0,"percent of total billed charges ","85% of total billed charges ",511.65,90,,409.32,,,0,"percent of total billed charges ","90% of total billed charges ",511.65,90,,409.32,,,0,"percent of total billed charges ","90% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",494.6,87,,395.68,,,0,"percent of total billed charges ","87% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",118.33,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",397.95,70,,318.36,,,0,"percent of total billed charges ","70% of total billed charges ",39.25,528.71,
"EVENT MONITOR RECORDING",5001276,"CDM ",480,RC,93270,HCPCS,OUTPATIENT,,,397,317.6,,32.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",119.92,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",16.92,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",277.9,70,,222.32,,,0,"percent of total billed charges ","70% of total billed charges ",357.3,90,,285.84,,,0,"percent of total billed charges ","90% of total billed charges ",369.21,93,,295.37,,,0,"percent of total billed charges ","93% of total billed charges ",32.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",337.45,85,,269.96,,,0,"percent of total billed charges ","85% of total billed charges ",357.3,90,,285.84,,,0,"percent of total billed charges ","90% of total billed charges ",357.3,90,,285.84,,,0,"percent of total billed charges ","90% of total billed charges ",37.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",345.39,87,,276.31,,,0,"percent of total billed charges ","87% of total billed charges ",37.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.32,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",277.9,70,,222.32,,,0,"percent of total billed charges ","70% of total billed charges ",16.92,369.21,
"MDI INITIAL",5001284,"CDM ",412,RC,94640,HCPCS,OUTPATIENT,,,238,190.4,,69.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",254.03,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",22.46,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",166.6,70,,133.28,,,0,"percent of total billed charges ","70% of total billed charges ",214.2,90,,171.36,,,0,"percent of total billed charges ","90% of total billed charges ",221.34,93,,177.07,,,0,"percent of total billed charges ","93% of total billed charges ",69.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.01,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",202.3,85,,161.84,,,0,"percent of total billed charges ","85% of total billed charges ",214.2,90,,171.36,,,0,"percent of total billed charges ","90% of total billed charges ",214.2,90,,171.36,,,0,"percent of total billed charges ","90% of total billed charges ",12.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",207.06,87,,100.04,37.32,162.75,"1 through 10","percent of total billed charges ","87% of total billed charges ",12.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.38,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",166.6,70,,133.28,,,0,"percent of total billed charges ","70% of total billed charges ",12.88,254.03,
TGV,5001326,"CDM ",460,RC,94726,HCPCS,OUTPATIENT,,,493,394.4,,168.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.32,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",112.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",345.1,70,,276.08,,,0,"percent of total billed charges ","70% of total billed charges ",443.7,90,,354.96,,,0,"percent of total billed charges ","90% of total billed charges ",458.49,93,,366.79,,,0,"percent of total billed charges ","93% of total billed charges ",168.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",164.55,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",419.05,85,,335.24,,,0,"percent of total billed charges ","85% of total billed charges ",443.7,90,,354.96,,,0,"percent of total billed charges ","90% of total billed charges ",443.7,90,,354.96,,,0,"percent of total billed charges ","90% of total billed charges ",162.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",428.91,87,,343.13,,,0,"percent of total billed charges ","87% of total billed charges ",162.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",343.17,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",345.1,70,,276.08,,,0,"percent of total billed charges ","70% of total billed charges ",112.09,458.49,
CPR,5001342,"CDM ",410,RC,92950,HCPCS,OUTPATIENT,,,1460.5,1168.4,,114.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",309.49,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",386.91,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1022.35,70,,817.88,,,0,"percent of total billed charges ","70% of total billed charges ",1314.45,90,,1051.56,,,0,"percent of total billed charges ","90% of total billed charges ",1358.27,93,,1086.62,,,0,"percent of total billed charges ","93% of total billed charges ",114.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.53,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1241.43,85,,993.14,,,0,"percent of total billed charges ","85% of total billed charges ",1314.45,90,,1051.56,,,0,"percent of total billed charges ","90% of total billed charges ",1314.45,90,,1051.56,,,0,"percent of total billed charges ","90% of total billed charges ",131.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1270.64,87,,163.23,163.23,163.23,"1 through 10","percent of total billed charges ","87% of total billed charges ",131.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.57,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1022.35,70,,817.88,,,0,"percent of total billed charges ","70% of total billed charges ",114.74,1358.27,
"EXERCISE PFT CHALLENGE",5001359,"CDM ",460,RC,94618,HCPCS,OUTPATIENT,,,627.5,502,,71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",124.24,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",70.07,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",439.25,70,,351.40,,,0,"percent of total billed charges ","70% of total billed charges ",564.75,90,,451.80,,,0,"percent of total billed charges ","90% of total billed charges ",583.58,93,,466.86,,,0,"percent of total billed charges ","93% of total billed charges ",71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",90.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",533.38,85,,426.70,,,0,"percent of total billed charges ","85% of total billed charges ",564.75,90,,451.80,,,0,"percent of total billed charges ","90% of total billed charges ",564.75,90,,451.80,,,0,"percent of total billed charges ","90% of total billed charges ",89.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",545.93,87,,436.74,,,0,"percent of total billed charges ","87% of total billed charges ",89.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",439.25,70,,351.40,,,0,"percent of total billed charges ","70% of total billed charges ",70.07,583.58,
"ARTERIAL PUNCTURE",5001425,"CDM ",300,RC,36600,HCPCS,OUTPATIENT,,,105,84,,41.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",67.67,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",32.67,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",73.5,70,,58.80,,,0,"percent of total billed charges ","70% of total billed charges ",94.5,90,,75.60,,,0,"percent of total billed charges ","90% of total billed charges ",97.65,93,,78.12,,,0,"percent of total billed charges ","93% of total billed charges ",41.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",89.25,85,,71.40,,,0,"percent of total billed charges ","85% of total billed charges ",78.75,90,,63.00,,,0,"percent of total billed charges ","90% of total billed charges ",94.5,90,,75.60,,,0,"percent of total billed charges ","90% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",91.35,87,,70.21,63.97,76.45,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",73.5,70,,58.80,,,0,"percent of total billed charges ","70% of total billed charges ",13.74,122.35,
"AEROSOL TX DEMO & EVALUATION",5001433,"CDM ",412,RC,94664,HCPCS,OUTPATIENT,,,47.5,38,,69.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",211.17,100,,38.00,38.00,38.00,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",34.21,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",33.25,70,,26.60,,,0,"percent of total billed charges ","70% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",44.18,93,,35.34,,,0,"percent of total billed charges ","93% of total billed charges ",69.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.65,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",40.38,85,,32.30,,,0,"percent of total billed charges ","85% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",22.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.33,87,,32.76,31.53,40.95,"1 through 10","percent of total billed charges ","87% of total billed charges ",22.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.38,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",33.25,70,,26.60,,,0,"percent of total billed charges ","70% of total billed charges ",22.43,211.17,
"OXIMETRY MULTIPLE 2 OR MORE",5001458,"CDM ",410,RC,94761,HCPCS,OUTPATIENT,,,514,411.2,,15.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.14,100,,18.45,18.45,18.45,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",6.56,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",359.8,70,,287.84,,,0,"percent of total billed charges ","70% of total billed charges ",462.6,90,,370.08,,,0,"percent of total billed charges ","90% of total billed charges ",478.02,93,,382.42,,,0,"percent of total billed charges ","93% of total billed charges ",15.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",436.9,85,,349.52,,,0,"percent of total billed charges ","85% of total billed charges ",462.6,90,,370.08,,,0,"percent of total billed charges ","90% of total billed charges ",462.6,90,,370.08,,,0,"percent of total billed charges ","90% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",447.18,87,,401.48,365.79,437.17,"1 through 10","percent of total billed charges ","87% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",359.8,70,,287.84,,,0,"percent of total billed charges ","70% of total billed charges ",6.56,478.02,
"INC SPIRO SUBSEQ POST-OP",5001490,"CDM ",710,RC,94150,HCPCS,OUTPATIENT,,,161,128.8,,50.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",50.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",112.7,70,,90.16,,,0,"percent of total billed charges ","70% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",149.73,93,,119.78,,,0,"percent of total billed charges ","93% of total billed charges ",50.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",136.85,85,,109.48,,,0,"percent of total billed charges ","85% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",140.07,87,,112.06,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",118.33,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",112.7,70,,90.16,,,0,"percent of total billed charges ","70% of total billed charges ",6.87,149.73,
"CARDIOVASCULAR STRESS TEST",5001500,"CDM ",482,RC,93017,HCPCS,OUTPATIENT,,,985.5,788.4,,101.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",356.37,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",71.19,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",689.85,70,,551.88,,,0,"percent of total billed charges ","70% of total billed charges ",886.95,90,,709.56,,,0,"percent of total billed charges ","90% of total billed charges ",916.52,93,,733.22,,,0,"percent of total billed charges ","93% of total billed charges ",101.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",48.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",837.68,85,,670.14,,,0,"percent of total billed charges ","85% of total billed charges ",886.95,90,,709.56,,,0,"percent of total billed charges ","90% of total billed charges ",886.95,90,,709.56,,,0,"percent of total billed charges ","90% of total billed charges ",48.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",857.39,87,,855.54,855.54,855.54,"1 through 10","percent of total billed charges ","87% of total billed charges ",48.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.57,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",689.85,70,,551.88,,,0,"percent of total billed charges ","70% of total billed charges ",48.08,916.52,
"VENOUS BLOOD GASES",5001530,"CDM ",301,RC,82803,HCPCS,OUTPATIENT,,,617.5,494,,22.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",432.25,70,,345.80,,,0,"percent of total billed charges ","70% of total billed charges ",555.75,90,,444.60,,,0,"percent of total billed charges ","90% of total billed charges ",574.28,93,,459.42,,,0,"percent of total billed charges ","93% of total billed charges ",22.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",524.88,85,,419.90,,,0,"percent of total billed charges ","85% of total billed charges ",555.75,90,,444.60,,,0,"percent of total billed charges ","90% of total billed charges ",555.75,90,,444.60,,,0,"percent of total billed charges ","90% of total billed charges ",27.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",537.23,87,,432.12,393.70,470.53,"1 through 10","percent of total billed charges ","87% of total billed charges ",27.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",432.25,70,,345.80,,,0,"percent of total billed charges ","70% of total billed charges ",22.16,574.28,
"INC SPIRO POST-OP",5001540,"CDM ",710,RC,94150,HCPCS,OUTPATIENT,,,161,128.8,,50.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",50.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",112.7,70,,90.16,,,0,"percent of total billed charges ","70% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",149.73,93,,119.78,,,0,"percent of total billed charges ","93% of total billed charges ",50.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",136.85,85,,109.48,,,0,"percent of total billed charges ","85% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",140.07,87,,112.06,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",118.33,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",112.7,70,,90.16,,,0,"percent of total billed charges ","70% of total billed charges ",6.87,149.73,
"INC SPIRO SUBSEQ IP",5001550,"CDM ",410,RC,94150,HCPCS,OUTPATIENT,,,161,128.8,,50.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",50.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",112.7,70,,90.16,,,0,"percent of total billed charges ","70% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",149.73,93,,119.78,,,0,"percent of total billed charges ","93% of total billed charges ",50.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",136.85,85,,109.48,,,0,"percent of total billed charges ","85% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",144.9,90,,115.92,,,0,"percent of total billed charges ","90% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",140.07,87,,112.06,,,0,"percent of total billed charges ","87% of total billed charges ",6.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",118.33,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",112.7,70,,90.16,,,0,"percent of total billed charges ","70% of total billed charges ",6.87,149.73,
"AEROSOL TX DEMO & EVAL IP",5001560,"CDM ",412,RC,94664,HCPCS,OUTPATIENT,,,55,44,,69.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",211.17,100,,38.00,38.00,38.00,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",34.21,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",38.5,70,,30.80,,,0,"percent of total billed charges ","70% of total billed charges ",49.5,90,,39.60,,,0,"percent of total billed charges ","90% of total billed charges ",51.15,93,,40.92,,,0,"percent of total billed charges ","93% of total billed charges ",69.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.65,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",46.75,85,,37.40,,,0,"percent of total billed charges ","85% of total billed charges ",49.5,90,,39.60,,,0,"percent of total billed charges ","90% of total billed charges ",49.5,90,,39.60,,,0,"percent of total billed charges ","90% of total billed charges ",22.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.85,87,,32.76,31.53,40.95,"1 through 10","percent of total billed charges ","87% of total billed charges ",22.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.38,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",38.5,70,,30.80,,,0,"percent of total billed charges ","70% of total billed charges ",22.43,211.17,
*ABG,5001590,"CDM ",301,RC,82803,HCPCS,OUTPATIENT,,,617.5,494,,22.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",432.25,70,,345.80,,,0,"percent of total billed charges ","70% of total billed charges ",555.75,90,,444.60,,,0,"percent of total billed charges ","90% of total billed charges ",574.28,93,,459.42,,,0,"percent of total billed charges ","93% of total billed charges ",22.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",524.88,85,,419.90,,,0,"percent of total billed charges ","85% of total billed charges ",555.75,90,,444.60,,,0,"percent of total billed charges ","90% of total billed charges ",555.75,90,,444.60,,,0,"percent of total billed charges ","90% of total billed charges ",27.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",537.23,87,,432.12,393.70,470.53,"1 through 10","percent of total billed charges ","87% of total billed charges ",27.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",432.25,70,,345.80,,,0,"percent of total billed charges ","70% of total billed charges ",22.16,574.28,
"*CARBON MONOXIDE",5001600,"CDM ",301,RC,82365,HCPCS,OUTPATIENT,,,129.5,103.6,,12.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,47.95,47.95,47.95,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.65,70,,72.52,,,0,"percent of total billed charges ","70% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",120.44,93,,96.35,,,0,"percent of total billed charges ","93% of total billed charges ",12.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",110.08,85,,88.06,,,0,"percent of total billed charges ","85% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.67,87,,90.14,,,0,"percent of total billed charges ","87% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",12.9,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",90.65,70,,72.52,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,120.44,
*METHEMOGLOBIN,5001610,"CDM ",301,RC,83050,HCPCS,OUTPATIENT,,,54.5,43.6,,6.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.15,70,,30.52,,,0,"percent of total billed charges ","70% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",50.69,93,,40.55,,,0,"percent of total billed charges ","93% of total billed charges ",6.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.93,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",46.33,85,,37.06,,,0,"percent of total billed charges ","85% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",7.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.42,87,,37.94,,,0,"percent of total billed charges ","87% of total billed charges ",7.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.19,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",38.15,70,,30.52,,,0,"percent of total billed charges ","70% of total billed charges ",6.97,50.69,
"*ARTERIAL PUNCTURE",5001620,"CDM ",300,RC,36600,HCPCS,OUTPATIENT,,,105,84,,41.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",67.67,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",32.67,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",73.5,70,,58.80,,,0,"percent of total billed charges ","70% of total billed charges ",94.5,90,,75.60,,,0,"percent of total billed charges ","90% of total billed charges ",97.65,93,,78.12,,,0,"percent of total billed charges ","93% of total billed charges ",41.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",89.25,85,,71.40,,,0,"percent of total billed charges ","85% of total billed charges ",78.75,90,,63.00,,,0,"percent of total billed charges ","90% of total billed charges ",94.5,90,,75.60,,,0,"percent of total billed charges ","90% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",91.35,87,,70.21,63.97,76.45,"1 through 10","percent of total billed charges ","87% of total billed charges ",13.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",73.5,70,,58.80,,,0,"percent of total billed charges ","70% of total billed charges ",13.74,122.35,
"*VENOUS BLOOD GASES",5001625,"CDM ",301,RC,82803,HCPCS,OUTPATIENT,,,617.5,494,,22.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",432.25,70,,345.80,,,0,"percent of total billed charges ","70% of total billed charges ",555.75,90,,444.60,,,0,"percent of total billed charges ","90% of total billed charges ",574.28,93,,459.42,,,0,"percent of total billed charges ","93% of total billed charges ",22.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",524.88,85,,419.90,,,0,"percent of total billed charges ","85% of total billed charges ",555.75,90,,444.60,,,0,"percent of total billed charges ","90% of total billed charges ",555.75,90,,444.60,,,0,"percent of total billed charges ","90% of total billed charges ",27.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",537.23,87,,432.12,393.70,470.53,"1 through 10","percent of total billed charges ","87% of total billed charges ",27.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",432.25,70,,345.80,,,0,"percent of total billed charges ","70% of total billed charges ",22.16,574.28,
"TREADMILL/SUPERVISION ONLY",5050018,"CDM ",960,RC,93016,HCPCS,OUTPATIENT,,,102.5,82,,18.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.77,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",18.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",18.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.62,47,
"SPIROMETRY & LUNG VO",5050067,"CDM ",960,RC,94010,HCPCS,OUTPATIENT,,,96.5,77.2,,25.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,31.00,31.00,31.00,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",65,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",25.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",25.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.12,65,
"EKG INTERP",5050125,"CDM ",985,RC,93010,HCPCS,OUTPATIENT,,,52.5,42,,10.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.57,100,,7.45,7.45,7.45,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",26,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",10.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,7.51,7.03,10.71,19,other,"not separately reimbursment ",10.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.41,26,
"ECHOCARDIOGRAM;2D INTERP",5050133,"CDM ",960,RC,93307,HCPCS,OUTPATIENT,,,441,352.8,,200,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,585.73,585.73,585.73,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",200,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",433,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",200,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",200,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,433,
"TREADMILL: INTERPRET",5050141,"CDM ",960,RC,93018,HCPCS,OUTPATIENT,,,159,127.2,,30.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",50.65,100,,39.44,39.44,39.44,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",95,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",30.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.29,95,
"HOLTER MONITOR/INTERP",5050158,"CDM ",960,RC,93227,HCPCS,OUTPATIENT,,,124.5,99.6,,52.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",62,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",52.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5,62,
"HOLTER MONITOR/INTERP",5050158,"CDM ",960,RC,93227,HCPCS,OUTPATIENT,,,124.5,99.6,,52.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",62,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",52.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5,62,
"EVENT MONITOR/INTERP",5050174,"CDM ",960,RC,93272,HCPCS,OUTPATIENT,,,124.5,99.6,,17.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",53,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.32,53,
"ECHOCARDIOGRAM; COMPLETE",5050200,"CDM ",960,RC,93306,HCPCS,OUTPATIENT,,,596.5,477.2,,173.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,98.50,98.50,98.50,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",842,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",173.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2566.17,2566.17,2566.17,"1 through 10",other,"not separately reimbursment ",173.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.95,842,
"TREADMILL SUPERV INTERP REPORT",5050208,"CDM ",960,RC,93015,HCPCS,OUTPATIENT,,,168.5,134.8,,77.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",221,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",77.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",77.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.69,221,
"HOLTER 3-7 DAYS INTERP & RPRT",5050210,"CDM ",960,RC,93244,HCPCS,OUTPATIENT,,,120.5,96.4,,15.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.46,15.46,
"HOLTER 8-15 DAYS INTERP & RPRT",5050215,"CDM ",960,RC,93248,HCPCS,OUTPATIENT,,,131,104.8,,17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,17,
"TELEMETRY REMOTE INTERP & RPRT",5050220,"CDM ",960,RC,93228,HCPCS,OUTPATIENT,,,115,92,,16.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",16.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",16.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.65,41,
"ECG ROUTINE",5200050,"CDM ",730,RC,93005,HCPCS,OUTPATIENT,,,333,266.4,,20.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",164.48,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",12.1,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",233.1,70,,186.48,,,0,"percent of total billed charges ","70% of total billed charges ",299.7,90,,239.76,,,0,"percent of total billed charges ","90% of total billed charges ",309.69,93,,247.75,,,0,"percent of total billed charges ","93% of total billed charges ",20.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.27,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",283.05,85,,226.44,,,0,"percent of total billed charges ","85% of total billed charges ",299.7,90,,239.76,,,0,"percent of total billed charges ","90% of total billed charges ",299.7,90,,239.76,,,0,"percent of total billed charges ","90% of total billed charges ",19.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",289.71,87,,259.90,105.34,490.91,14,"percent of total billed charges ","87% of total billed charges ",19.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",233.1,70,,186.48,,,0,"percent of total billed charges ","70% of total billed charges ",12.1,309.69,
"ECHOCARDIOGRAM COMPLETE",5200068,"CDM ",483,RC,93306,HCPCS,OUTPATIENT,,,2955.5,2364.4,,,,,,,,0,"other ","not separately reimbursment ",1532.17,100,,98.50,98.50,98.50,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",417.05,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2068.85,70,,1655.08,,,0,"percent of total billed charges ","70% of total billed charges ",2659.95,90,,2127.96,,,0,"percent of total billed charges ","90% of total billed charges ",2748.62,93,,2198.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",370.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2512.18,85,,2009.74,,,0,"percent of total billed charges ","85% of total billed charges ",2659.95,90,,2127.96,,,0,"percent of total billed charges ","90% of total billed charges ",2659.95,90,,2127.96,,,0,"percent of total billed charges ","90% of total billed charges ",366.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2571.29,87,,2566.17,2566.17,2566.17,"1 through 10","percent of total billed charges ","87% of total billed charges ",366.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",502.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2068.85,70,,1655.08,,,0,"percent of total billed charges ","70% of total billed charges ",366.85,2748.62,
"TREADMILL - REGULAR",5200076,"CDM ",482,RC,93017,HCPCS,OUTPATIENT,,,985.5,788.4,,101.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",356.37,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",71.19,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",689.85,70,,551.88,,,0,"percent of total billed charges ","70% of total billed charges ",886.95,90,,709.56,,,0,"percent of total billed charges ","90% of total billed charges ",916.52,93,,733.22,,,0,"percent of total billed charges ","93% of total billed charges ",101.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",48.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",837.68,85,,670.14,,,0,"percent of total billed charges ","85% of total billed charges ",886.95,90,,709.56,,,0,"percent of total billed charges ","90% of total billed charges ",886.95,90,,709.56,,,0,"percent of total billed charges ","90% of total billed charges ",48.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",857.39,87,,855.54,855.54,855.54,"1 through 10","percent of total billed charges ","87% of total billed charges ",48.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.57,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",689.85,70,,551.88,,,0,"percent of total billed charges ","70% of total billed charges ",48.08,916.52,
"HOLTER RECORDING SHORT TERM",5200092,"CDM ",731,RC,93225,HCPCS,OUTPATIENT,,,429.5,343.6,,43.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",188.27,100,,13.74,13.74,13.74,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",39.05,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",300.65,70,,240.52,,,0,"percent of total billed charges ","70% of total billed charges ",386.55,90,,309.24,,,0,"percent of total billed charges ","90% of total billed charges ",399.44,93,,319.55,,,0,"percent of total billed charges ","93% of total billed charges ",43.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",50.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",365.08,85,,292.06,,,0,"percent of total billed charges ","85% of total billed charges ",386.55,90,,309.24,,,0,"percent of total billed charges ","90% of total billed charges ",386.55,90,,309.24,,,0,"percent of total billed charges ","90% of total billed charges ",50.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.67,87,,372.82,372.82,372.82,"1 through 10","percent of total billed charges ","87% of total billed charges ",50.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",300.65,70,,240.52,,,0,"percent of total billed charges ","70% of total billed charges ",39.05,399.44,
"RHYTHM STRIP ECG",5200134,"CDM ",730,RC,93041,HCPCS,OUTPATIENT,,,271.5,217.2,,19.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",73.1,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",11.4,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",190.05,70,,152.04,,,0,"percent of total billed charges ","70% of total billed charges ",244.35,90,,195.48,,,0,"percent of total billed charges ","90% of total billed charges ",252.5,93,,202.00,,,0,"percent of total billed charges ","93% of total billed charges ",19.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",230.78,85,,184.62,,,0,"percent of total billed charges ","85% of total billed charges ",244.35,90,,195.48,,,0,"percent of total billed charges ","90% of total billed charges ",244.35,90,,195.48,,,0,"percent of total billed charges ","90% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",236.21,87,,188.97,,,0,"percent of total billed charges ","87% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",190.05,70,,152.04,,,0,"percent of total billed charges ","70% of total billed charges ",10.32,252.5,
"SIGNAL AVERAGING ECG",5200142,"CDM ",730,RC,93278,HCPCS,OUTPATIENT,,,516.5,413.2,,72.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",59.82,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",361.55,70,,289.24,,,0,"percent of total billed charges ","70% of total billed charges ",464.85,90,,371.88,,,0,"percent of total billed charges ","90% of total billed charges ",480.35,93,,384.28,,,0,"percent of total billed charges ","93% of total billed charges ",72.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.84,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",439.03,85,,351.22,,,0,"percent of total billed charges ","85% of total billed charges ",464.85,90,,371.88,,,0,"percent of total billed charges ","90% of total billed charges ",464.85,90,,371.88,,,0,"percent of total billed charges ","90% of total billed charges ",45.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",449.36,87,,359.49,,,0,"percent of total billed charges ","87% of total billed charges ",45.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",361.55,70,,289.24,,,0,"percent of total billed charges ","70% of total billed charges ",45.39,480.35,
"EEG ROUTINE",5200274,"CDM ",740,RC,95819,HCPCS,OUTPATIENT,,,935,748,,109.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",349.91,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",924.24,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",654.5,70,,523.60,,,0,"percent of total billed charges ","70% of total billed charges ",841.5,90,,673.20,,,0,"percent of total billed charges ","90% of total billed charges ",869.55,93,,695.64,,,0,"percent of total billed charges ","93% of total billed charges ",109.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.03,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",794.75,85,,635.80,,,0,"percent of total billed charges ","85% of total billed charges ",841.5,90,,673.20,,,0,"percent of total billed charges ","90% of total billed charges ",841.5,90,,673.20,,,0,"percent of total billed charges ","90% of total billed charges ",58.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",813.45,87,,650.76,,,0,"percent of total billed charges ","87% of total billed charges ",58.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.57,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",654.5,70,,523.60,,,0,"percent of total billed charges ","70% of total billed charges ",58.45,924.24,
"EVENT MONITOR TRANSMISSIONS",5200308,"CDM ",731,RC,93271,HCPCS,OUTPATIENT,,,396.5,317.2,,139.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",202.99,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",310.73,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",277.55,70,,222.04,,,0,"percent of total billed charges ","70% of total billed charges ",356.85,90,,285.48,,,0,"percent of total billed charges ","90% of total billed charges ",368.75,93,,295.00,,,0,"percent of total billed charges ","93% of total billed charges ",139.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",337.03,85,,269.62,,,0,"percent of total billed charges ","85% of total billed charges ",356.85,90,,285.48,,,0,"percent of total billed charges ","90% of total billed charges ",356.85,90,,285.48,,,0,"percent of total billed charges ","90% of total billed charges ",175.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",344.96,87,,275.97,,,0,"percent of total billed charges ","87% of total billed charges ",175.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",87.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",277.55,70,,222.04,,,0,"percent of total billed charges ","70% of total billed charges ",87.43,368.75,
"ECS EEG",5200316,"CDM ",740,RC,95824,HCPCS,OUTPATIENT,,,786.5,629.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",550.55,70,,440.44,,,0,"percent of total billed charges ","70% of total billed charges ",707.85,90,,566.28,,,0,"percent of total billed charges ","90% of total billed charges ",731.45,93,,585.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",668.53,85,,534.82,,,0,"percent of total billed charges ","85% of total billed charges ",707.85,90,,566.28,,,0,"percent of total billed charges ","90% of total billed charges ",707.85,90,,566.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",684.26,87,,547.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",343.17,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",550.55,70,,440.44,,,0,"percent of total billed charges ","70% of total billed charges ",343.17,731.45,
"SPIKE-SEIZURE ANALYSIS",5200332,"CDM ",740,RC,95957,HCPCS,OUTPATIENT,,,477.5,382,,84.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",543.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",334.25,70,,267.40,,,0,"percent of total billed charges ","70% of total billed charges ",429.75,90,,343.80,,,0,"percent of total billed charges ","90% of total billed charges ",444.08,93,,355.26,,,0,"percent of total billed charges ","93% of total billed charges ",84.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.03,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",405.88,85,,324.70,,,0,"percent of total billed charges ","85% of total billed charges ",429.75,90,,343.80,,,0,"percent of total billed charges ","90% of total billed charges ",429.75,90,,343.80,,,0,"percent of total billed charges ","90% of total billed charges ",4.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",415.43,87,,332.34,,,0,"percent of total billed charges ","87% of total billed charges ",4.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",334.25,70,,267.40,,,0,"percent of total billed charges ","70% of total billed charges ",4.98,543.09,
"EVENT MONITOR RECORDING",5200340,"CDM ",731,RC,93270,HCPCS,OUTPATIENT,,,397,317.6,,32.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",119.92,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",16.92,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",277.9,70,,222.32,,,0,"percent of total billed charges ","70% of total billed charges ",357.3,90,,285.84,,,0,"percent of total billed charges ","90% of total billed charges ",369.21,93,,295.37,,,0,"percent of total billed charges ","93% of total billed charges ",32.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",37.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",337.45,85,,269.96,,,0,"percent of total billed charges ","85% of total billed charges ",357.3,90,,285.84,,,0,"percent of total billed charges ","90% of total billed charges ",357.3,90,,285.84,,,0,"percent of total billed charges ","90% of total billed charges ",37.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",345.39,87,,276.31,,,0,"percent of total billed charges ","87% of total billed charges ",37.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.32,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",277.9,70,,222.32,,,0,"percent of total billed charges ","70% of total billed charges ",16.92,369.21,
"TREADMILL - CARDIOLYTE",5200360,"CDM ",482,RC,93017,HCPCS,OUTPATIENT,,,985.5,788.4,,101.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",356.37,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",71.19,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",689.85,70,,551.88,,,0,"percent of total billed charges ","70% of total billed charges ",886.95,90,,709.56,,,0,"percent of total billed charges ","90% of total billed charges ",916.52,93,,733.22,,,0,"percent of total billed charges ","93% of total billed charges ",101.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",48.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",837.68,85,,670.14,,,0,"percent of total billed charges ","85% of total billed charges ",886.95,90,,709.56,,,0,"percent of total billed charges ","90% of total billed charges ",886.95,90,,709.56,,,0,"percent of total billed charges ","90% of total billed charges ",48.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",857.39,87,,855.54,855.54,855.54,"1 through 10","percent of total billed charges ","87% of total billed charges ",48.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.57,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",689.85,70,,551.88,,,0,"percent of total billed charges ","70% of total billed charges ",48.08,916.52,
"ECHOCARDIOGRAM 2D",5200370,"CDM ",483,RC,93307,HCPCS,OUTPATIENT,,,1426.5,1141.2,,,,,,,,0,"other ","not separately reimbursment ",575.7,100,,585.73,585.73,585.73,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",291.26,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",998.55,70,,798.84,,,0,"percent of total billed charges ","70% of total billed charges ",1283.85,90,,1027.08,,,0,"percent of total billed charges ","90% of total billed charges ",1326.65,93,,1061.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",132.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1212.53,85,,970.02,,,0,"percent of total billed charges ","85% of total billed charges ",1283.85,90,,1027.08,,,0,"percent of total billed charges ","90% of total billed charges ",1283.85,90,,1027.08,,,0,"percent of total billed charges ","90% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1241.06,87,,992.85,,,0,"percent of total billed charges ","87% of total billed charges ",130.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",998.55,70,,798.84,,,0,"percent of total billed charges ","70% of total billed charges ",130.83,1326.65,
"CARDIAC REHAB W/O EKG MONITOR",5200380,"CDM ",943,RC,93797,HCPCS,OUTPATIENT,,,353,282.4,,,,,,,,0,"other ","not separately reimbursment ",90.22,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",19.23,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",247.1,70,,197.68,,,0,"percent of total billed charges ","70% of total billed charges ",317.7,90,,254.16,,,0,"percent of total billed charges ","90% of total billed charges ",328.29,93,,262.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",300.05,85,,240.04,,,0,"percent of total billed charges ","85% of total billed charges ",317.7,90,,254.16,,,0,"percent of total billed charges ","90% of total billed charges ",317.7,90,,254.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",307.11,87,,245.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",118.54,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",247.1,70,,197.68,,,0,"percent of total billed charges ","70% of total billed charges ",19.23,328.29,
"CARDIAC REHAB W/ EKG MONITOR",5200390,"CDM ",943,RC,93798,HCPCS,OUTPATIENT,,,353,282.4,,42.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",28.91,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",247.1,70,,197.68,,,0,"percent of total billed charges ","70% of total billed charges ",317.7,90,,254.16,,,0,"percent of total billed charges ","90% of total billed charges ",328.29,93,,262.63,,,0,"percent of total billed charges ","93% of total billed charges ",42.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",300.05,85,,240.04,,,0,"percent of total billed charges ","85% of total billed charges ",317.7,90,,254.16,,,0,"percent of total billed charges ","90% of total billed charges ",317.7,90,,254.16,,,0,"percent of total billed charges ","90% of total billed charges ",27.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",307.11,87,,245.69,,,0,"percent of total billed charges ","87% of total billed charges ",27.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",118.54,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",247.1,70,,197.68,,,0,"percent of total billed charges ","70% of total billed charges ",27.81,328.29,
"HOLTER RECORDING 3-7 DAYS",5200420,"CDM ",731,RC,93242,HCPCS,OUTPATIENT,,,557,445.6,,22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",188.27,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",28.69,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",389.9,70,,311.92,,,0,"percent of total billed charges ","70% of total billed charges ",501.3,90,,401.04,,,0,"percent of total billed charges ","90% of total billed charges ",518.01,93,,414.41,,,0,"percent of total billed charges ","93% of total billed charges ",22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",473.45,85,,378.76,,,0,"percent of total billed charges ","85% of total billed charges ",501.3,90,,401.04,,,0,"percent of total billed charges ","90% of total billed charges ",501.3,90,,401.04,,,0,"percent of total billed charges ","90% of total billed charges ",27.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",484.59,87,,387.67,,,0,"percent of total billed charges ","87% of total billed charges ",27.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",389.9,70,,311.92,,,0,"percent of total billed charges ","70% of total billed charges ",22,518.01,
"HOLTER RECORDING 8-15 DAYS",5200440,"CDM ",731,RC,93246,HCPCS,OUTPATIENT,,,814,651.2,,36.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",188.27,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",28.69,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",569.8,70,,455.84,,,0,"percent of total billed charges ","70% of total billed charges ",732.6,90,,586.08,,,0,"percent of total billed charges ","90% of total billed charges ",757.02,93,,605.62,,,0,"percent of total billed charges ","93% of total billed charges ",36.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",691.9,85,,553.52,,,0,"percent of total billed charges ","85% of total billed charges ",732.6,90,,586.08,,,0,"percent of total billed charges ","90% of total billed charges ",732.6,90,,586.08,,,0,"percent of total billed charges ","90% of total billed charges ",45.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",708.18,87,,566.54,,,0,"percent of total billed charges ","87% of total billed charges ",45.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",569.8,70,,455.84,,,0,"percent of total billed charges ","70% of total billed charges ",28.69,757.02,
"TELEMETRY REMOTE 30DAYS",5200460,"CDM ",730,RC,93271,HCPCS,OUTPATIENT,,,323,258.4,,139.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",202.99,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",310.73,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",226.1,70,,180.88,,,0,"percent of total billed charges ","70% of total billed charges ",290.7,90,,232.56,,,0,"percent of total billed charges ","90% of total billed charges ",300.39,93,,240.31,,,0,"percent of total billed charges ","93% of total billed charges ",139.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",177.74,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",274.55,85,,219.64,,,0,"percent of total billed charges ","85% of total billed charges ",290.7,90,,232.56,,,0,"percent of total billed charges ","90% of total billed charges ",290.7,90,,232.56,,,0,"percent of total billed charges ","90% of total billed charges ",175.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",281.01,87,,224.81,,,0,"percent of total billed charges ","87% of total billed charges ",175.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",87.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",226.1,70,,180.88,,,0,"percent of total billed charges ","70% of total billed charges ",87.43,310.73,
"NEO CRIT CARE INIT <28 DAYS",5300460,"CDM ",960,RC,99468,HCPCS,OUTPATIENT,,,2140,1712,,756.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",756.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1267,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",756.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",756.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",756.28,1267,
"TX MISCARRIAGE 1ST TRIMEST",5800160,"CDM ",980,RC,59820,HCPCS,OUTPATIENT,,,837,669.6,,269.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",522.72,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",269.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",544,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",269.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",269.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",269.87,544,
"DILATION AND CURETTAGE NONOB",5800170,"CDM ",980,RC,58120,HCPCS,OUTPATIENT,,,586.5,469.2,,176.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",345.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",362,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",176.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",176.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.05,362,
"RPR ANTEROPOST COLPORRHAPHY",5800180,"CDM ",980,RC,57260,HCPCS,OUTPATIENT,,,1907.5,1526,,415.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1104.72,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",415.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1192,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",415.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",415.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",415.74,1192,
"I&D OVARY CYST ABD APPROACH",5800190,"CDM ",980,RC,58805,HCPCS,OUTPATIENT,,,915,732,,287.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",287.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",746,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",287.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",287.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",287.66,746,
"LAP TX ECTOPIC PREG W/SALPING",5800200,"CDM ",980,RC,59151,HCPCS,OUTPATIENT,,,1580,1264,,590.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,4635.81,4635.81,4635.81,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",590.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1174,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",590.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",590.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",590.7,1174,
"ENTEROLYSIS FREEING OF ADHES",5800210,"CDM ",980,RC,44005,HCPCS,OUTPATIENT,,,2619,2095.2,,744.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",744.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1525,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",744.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",744.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",744.74,1525,
"HYSTERECTOMY TOTAL",5800220,"CDM ",980,RC,58150,HCPCS,OUTPATIENT,,,2905.5,2324.4,,728.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1571.37,100,,1270.58,1270.58,1270.58,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",728.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1665,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",728.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,898.76,898.76,898.76,"1 through 10",other,"not separately reimbursment ",728.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",728.04,1665,
"HYSTERECTOMY TOTAL",5800220,"CDM ",980,RC,58150,HCPCS,OUTPATIENT,,,2905.5,2324.4,,728.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1571.37,100,,1270.58,1270.58,1270.58,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",728.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1665,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",728.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,898.76,898.76,898.76,"1 through 10",other,"not separately reimbursment ",728.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",728.04,1665,
"HYSTEROSCOPY DIAGNOSTIC",5800230,"CDM ",980,RC,58555,HCPCS,OUTPATIENT,,,617.5,494,,174.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",423,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",174.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",174.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174.68,423,
"HYSTEROSCOPY W/REMOVE FB",5800240,"CDM ",980,RC,58562,HCPCS,OUTPATIENT,,,664,531.2,,243.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",243.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",574,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",243.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",243.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",243.17,574,
"LAPAROSCOPY DIAGNOSTIC",5800250,"CDM ",980,RC,49320,HCPCS,OUTPATIENT,,,837,669.6,,225.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",225.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",533,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",225.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",225.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",225.35,533,
"LAPAROSCOPY SURG W/BIOPSY",5800260,"CDM ",980,RC,49321,HCPCS,OUTPATIENT,,,1451,1160.8,,236.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",236.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",568,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",236.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",236.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",236.56,568,
"LAP W/ASPIRATION CYST",5800270,"CDM ",980,RC,49322,HCPCS,OUTPATIENT,,,1016.5,813.2,,258.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",258.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",590,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",258.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",258.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",258.41,590,
"LAP HYSTERECTOMY TOTAL <250G",5800280,"CDM ",980,RC,58571,HCPCS,OUTPATIENT,,,2049,1639.2,,718.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1526.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",718.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1486,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",718.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",718.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",718.45,1526.76,
"LAP HYSTERECTOMY TOTAL >250G",5800290,"CDM ",980,RC,58572,HCPCS,OUTPATIENT,,,2338,1870.4,,813.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",813.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1681,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",813.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",813.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",813.56,1681,
"LAP W/LYESIS OF ADHESIONS",5800300,"CDM ",980,RC,58660,HCPCS,OUTPATIENT,,,1543,1234.4,,532.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",532.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1057,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",532.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",532.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",532.12,1057,
"LAP W/REMOVAL ADNEXAL STRUCT",5800310,"CDM ",980,RC,58661,HCPCS,OUTPATIENT,,,1524.5,1219.6,,519.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,790.00,790.00,790.00,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",519.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1037,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",519.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",519.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",519.33,1037,
"LAP W/EXC LESIONS",5800320,"CDM ",980,RC,58662,HCPCS,OUTPATIENT,,,1733.5,1386.8,,563.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1086.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",563.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1119,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",563.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",563.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",563.18,1119,
"LAP W/OCC OVIDUCTS",5800330,"CDM ",980,RC,58671,HCPCS,OUTPATIENT,,,956.5,765.2,,263.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",577.17,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",594,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",263.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",263.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.32,594,
"LAP EXPLORE CELIOTOMY W/WO BX",5800340,"CDM ",980,RC,49000,HCPCS,OUTPATIENT,,,1733.5,1386.8,,550.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",550.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1094,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",550.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",550.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",550.43,1094,
"DESTRUCT LESION VULVA SIMPLE",5800350,"CDM ",980,RC,56501,HCPCS,OUTPATIENT,,,299,239.2,,101.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",202,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",101.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",101.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.7,202,
"DESTRUCT LESION VULVA EXTENSIV",5800360,"CDM ",980,RC,56515,HCPCS,OUTPATIENT,,,467,373.6,,159.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",159.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",327,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",159.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",159.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",159.79,327,
"CONIZATION CERVIX LEEP",5800370,"CDM ",980,RC,57522,HCPCS,OUTPATIENT,,,719,575.2,,191.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",436.81,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",191.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",413,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",191.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",191.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",191.47,436.81,
"ENDOMETRIAL ABL WO HYSTEROSCOP",5800380,"CDM ",980,RC,58353,HCPCS,OUTPATIENT,,,867,693.6,,1109.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1109.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2205,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1109.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1109.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1109.69,2205,
"PELVIC EXAM W/ANESTHESIA",5800390,"CDM ",980,RC,57410,HCPCS,OUTPATIENT,,,478.5,382.8,,114.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",228,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",114.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",114.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.99,228,
SALPINGO-OOPHORECTOMY,5800400,"CDM ",980,RC,58720,HCPCS,OUTPATIENT,,,1674,1339.2,,548.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,15822.89,15822.89,15822.89,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",548.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1117,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",548.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",548.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",548.46,1117,
"OOPHORECTOMY REMOVAL OVARY",5800410,"CDM ",980,RC,58940,HCPCS,OUTPATIENT,,,1136,908.8,,363.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",363.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",826,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",363.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",363.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",363.36,826,
"ANTEPARTUM CARE 4-6 VISITS",5800420,"CDM ",980,RC,59425,HCPCS,OUTPATIENT,,,913,730.4,,293.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",543.04,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",293.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",640,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",293.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",293.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",293.29,640,
"ANTEPARTUM CARE >7 VISITS",5800430,"CDM ",980,RC,59426,HCPCS,OUTPATIENT,,,1541,1232.8,,513.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",513.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1157,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",513.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",513.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",513.91,1157,
"CERCLAGE/REVISION CERVIX",5800440,"CDM ",980,RC,59320,HCPCS,OUTPATIENT,,,359,287.2,,111.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",255,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",111.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",111.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.89,255,
"CESAREAN DELIVERY ONLY",5800460,"CDM ",980,RC,59514,HCPCS,OUTPATIENT,,,2391.5,1913.2,,916.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",916.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1611,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",916.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",916.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",916.91,1611,
"CESAREAN DLVRY W/PP CARE",5800470,"CDM ",980,RC,59515,HCPCS,OUTPATIENT,,,2630,2104,,940.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1270.89,1270.89,1270.89,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",940.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1808,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",940.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",940.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",940.91,1808,
"CESAREAN DLVRY ANTE/PP CARE",5800480,"CDM ",980,RC,59510,HCPCS,OUTPATIENT,,,4376,3500.8,,1496.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3079.06,100,,2370.59,2370.59,2370.59,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1496.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",3299,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1496.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2180.34,2180.34,2180.34,"1 through 10",other,"not separately reimbursment ",1496.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1496.23,3299,
"CESAREAN DLVRY AFTR FAILED VAG",5800490,"CDM ",980,RC,59618,HCPCS,OUTPATIENT,,,5260,4208,,1527.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1527.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",3344,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1527.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1527.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1527.79,3344,
"CESAREAN DLVRY ATTMPT VAG PR C",5800500,"CDM ",980,RC,59620,HCPCS,OUTPATIENT,,,2174,1739.2,,916.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",916.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1694,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",916.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",916.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",916.91,1694,
"VAGINAL DLVRY ANTE/PP CARE",5800510,"CDM ",980,RC,59400,HCPCS,OUTPATIENT,,,4124.5,3299.6,,1326.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2922.32,100,,2429.50,2429.50,2429.50,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1326.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2984,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1326.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1690.33,800.35,1745.36,"1 through 10",other,"not separately reimbursment ",1326.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1326.89,2984,
"VAGINAL DELIVERY ONLY",5800520,"CDM ",980,RC,59409,HCPCS,OUTPATIENT,,,1949,1559.2,,666.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1397.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",666.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1375,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",666.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",666.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",666.02,1397.08,
"VAGINAL DLVRY W/PP CARE ONLY",5800530,"CDM ",980,RC,59410,HCPCS,OUTPATIENT,,,2385.5,1908.4,,718.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1642.16,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",718.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1500,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",718.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",718.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",718.85,1642.16,
"LIGATION TUBES POSTPARTUM VAG",5800540,"CDM ",980,RC,58605,HCPCS,OUTPATIENT,,,956.5,765.2,,378.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",378.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",510,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",378.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",378.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",378.58,510,
"LIGATION TUBES POSTPARTUM CSEC",5800550,"CDM ",980,RC,58611,HCPCS,OUTPATIENT,,,478.5,382.8,,65.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",212.7,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",384,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",65.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",65.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.48,384,
"VAG DLVRY ANTE/PP CARE PREV CS",5800560,"CDM ",980,RC,59610,HCPCS,OUTPATIENT,,,3945,3156,,1346.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2777.68,2777.68,2777.68,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1346.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",3129,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1346.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1346.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1346.05,3129,
"VAG DLVRY PP CARE PREV CSECT",5800570,"CDM ",980,RC,59614,HCPCS,OUTPATIENT,,,2570.5,2056.4,,793.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",793.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1626,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",793.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",793.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",793.76,1626,
"OBS/HOSP LOW CMPLX SAME DAY",5800580,"CDM ",980,RC,99234,HCPCS,OUTPATIENT,,,124,99.2,,82.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",189,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",82.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",82.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.14,189,
"OBS/HOSP MOD CMPLX SAME DAY",5800590,"CDM ",980,RC,99235,HCPCS,OUTPATIENT,,,179.5,143.6,,102.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",254.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",249,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",102.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",102.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.88,254.28,
"OBS/HOSP HIGH CMPLX SAME DAY",5800600,"CDM ",980,RC,99236,HCPCS,OUTPATIENT,,,302,241.6,,132.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",319.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",311,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",132.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,112.10,52.82,171.38,"1 through 10",other,"not separately reimbursment ",132.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.85,319.41,
"INPT INITIAL COMPREHENSIVE",5800610,"CDM ",980,RC,99223,HCPCS,OUTPATIENT,,,399.5,319.6,,125.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",272.55,100,,158.84,158.84,158.84,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",265,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",125.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,155.67,140.10,195.67,"1 through 10",other,"not separately reimbursment ",125.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.52,272.55,
"INPT INITIAL MODERATE",5800620,"CDM ",980,RC,99222,HCPCS,OUTPATIENT,,,306.5,245.2,,90.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.28,100,,119.01,119.01,119.01,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",180,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",90.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,116.63,113.62,118.30,12,other,"not separately reimbursment ",90.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9,200.28,
"INPT SUBSEQUENT LOW COMPLEXITY",5800630,"CDM ",980,RC,99231,HCPCS,OUTPATIENT,,,97,77.6,,27.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",62,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",27.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",27.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.18,62,
"INPT SUBSEQUENT MOD COMPLEXITY",5800640,"CDM ",980,RC,99232,HCPCS,OUTPATIENT,,,178,142.4,,44.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.27,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",95,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,70.47,56.82,71.69,"1 through 10",other,"not separately reimbursment ",44.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.49,100.27,
"INPT SUBSEQUENT HIGH COMPLEX",5800650,"CDM ",980,RC,99233,HCPCS,OUTPATIENT,,,249.5,199.6,,63.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",141.16,100,,92.18,92.18,92.18,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",141,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",63.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,106.28,106.28,107.98,"1 through 10",other,"not separately reimbursment ",63.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.26,141.16,
"HOSPITAL DISCHARGE < 30MIN",5800660,"CDM ",980,RC,99238,HCPCS,OUTPATIENT,,,199,159.2,,56.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.49,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",98,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",56.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,67.59,62.60,72.58,"1 through 10",other,"not separately reimbursment ",56.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.34,107.49,
"HOSPITAL DISCHARGE > 30MIN",5800670,"CDM ",980,RC,99239,HCPCS,OUTPATIENT,,,252,201.6,,76.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",154.13,100,,89.14,89.14,89.14,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",141,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",76.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,102.78,93.99,103.17,13,other,"not separately reimbursment ",76.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.84,154.13,
"LAP SUR TOTAL HYSTERECTOMY W/T",5800680,"CDM ",980,RC,58573,HCPCS,OUTPATIENT,,,2929.5,2343.6,,919.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",919.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1906,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",919.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",919.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",919.88,1906,
"TX MISCARRIAGE D&C ANY TRIMEST",5800690,"CDM ",980,RC,59812,HCPCS,OUTPATIENT,,,837,669.6,,219.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",508.1,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",219.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",450,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",219.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",219.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",219.86,508.1,
"D&C HYDATIDFORM MOLE",5800700,"CDM ",980,RC,59870,HCPCS,OUTPATIENT,,,1052.5,842,,345.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",345.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",686,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",345.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",345.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",345.15,686,
"TX MISCARRIAGE D&C 2ND TRIMEST",5800710,"CDM ",980,RC,59821,HCPCS,OUTPATIENT,,,718,574.4,,282.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",282.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",562,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",282.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",282.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",282.71,562,
"TX MISCARRIAGE SEPTIC SURGICAL",5800715,"CDM ",980,RC,59830,HCPCS,OUTPATIENT,,,942.5,754,,313.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",313.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",665,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",313.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",313.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",313.23,665,
"CONIZATION OF CERVIX COLD KNIF",5800720,"CDM ",980,RC,57520,HCPCS,OUTPATIENT,,,718,574.4,,224.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",224.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",490,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",224.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",224.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",224.9,490,
"COLPORRHAPHY ANTERIOR REPAIR",5800730,"CDM ",980,RC,57240,HCPCS,OUTPATIENT,,,1453,1162.4,,310.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",310.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",976,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",310.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",310.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",310.36,976,
"COLPORRHAPHY POSTERIOR REPAIR",5800740,"CDM ",980,RC,57250,HCPCS,OUTPATIENT,,,1464.5,1171.6,,287.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",287.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",956,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",287.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",287.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",287.41,956,
"DRAIN OVARIAN ABCESS OPEN ABD",5800750,"CDM ",980,RC,58822,HCPCS,OUTPATIENT,,,1644,1315.2,,489.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",489.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1053,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",489.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",489.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",489.05,1053,
"TX ECTOPIC PREG W/SALPING OOPH",5800760,"CDM ",980,RC,59120,HCPCS,OUTPATIENT,,,1733.5,1386.8,,595.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",595.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1184,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",595.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",595.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",595.72,1184,
"TX ECTOPIC PREG WO SALPING OOP",5800770,"CDM ",980,RC,59121,HCPCS,OUTPATIENT,,,1733.5,1386.8,,604.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",604.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1202,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",604.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",604.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",604.95,1202,
"LAP TX ECTOPIC PREG WO SALPING",5800780,"CDM ",980,RC,59150,HCPCS,OUTPATIENT,,,1552.5,1242,,595.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",595.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1184,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",595.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",595.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",595.84,1184,
"HYSTERECTOMY SUPRACERVICAL",5800790,"CDM ",980,RC,58180,HCPCS,OUTPATIENT,,,2122.5,1698,,724.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",724.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1480,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",724.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",724.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",724.25,1480,
"HYSTERECTOMY VAG LAP <250G",5800800,"CDM ",980,RC,58550,HCPCS,OUTPATIENT,,,2212,1769.6,,687.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",687.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1365,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",687.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",687.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",687.02,1365,
"HYSTERECTOMY VAG <250G",5800810,"CDM ",980,RC,58260,HCPCS,OUTPATIENT,,,1913,1530.4,,628.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",628.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1492,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",628.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,783.36,783.36,783.36,"1 through 10",other,"not separately reimbursment ",628.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",628.96,1492,
"HYSTERECTOMY VAG <250G W/TUBES",5800820,"CDM ",980,RC,58262,HCPCS,OUTPATIENT,,,2182,1745.6,,709.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1501.38,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",709.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1409,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",709.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",709.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",709.35,1501.38,
"HYSTERECTOMY VAG <250G W/RPR E",5800830,"CDM ",980,RC,58263,HCPCS,OUTPATIENT,,,2212,1769.6,,767.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",767.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1524,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",767.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",767.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",767.17,1524,
"HYSTERECTOMY VAG <250G W/URINA",5800833,"CDM ",980,RC,58267,HCPCS,OUTPATIENT,,,2282,1825.6,,813.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",813.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1782,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",813.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",813.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",813.97,1782,
"HYSTERECTOMY VAG >250G W/TUBES",5800838,"CDM ",980,RC,58291,HCPCS,OUTPATIENT,,,2650,2120,,984.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1431.53,1431.53,1431.53,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",984.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1955,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",984.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",984.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",984.16,1955,
"HYSTEROSCOPY W/BX ENDOMETRIUM",5800840,"CDM ",980,RC,58558,HCPCS,OUTPATIENT,,,687.5,550,,222.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",357.27,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",222.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1861,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",222.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,203.51,203.51,203.51,"1 through 10",other,"not separately reimbursment ",222.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",222.36,1861,
"HYSTEROSCOPY W/LYSIS ADHESIONS",5800850,"CDM ",980,RC,58559,HCPCS,OUTPATIENT,,,747.5,598,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",569,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",569,569,
"HYSTEROSCOPY W/DIV IU SEPTUM",5800860,"CDM ",980,RC,58560,HCPCS,OUTPATIENT,,,837,669.6,,324.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",324.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",645,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",324.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",324.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",324.46,645,
"HYSTEROSCOPY REMOVE LEIOMYOMAT",5800870,"CDM ",980,RC,58561,HCPCS,OUTPATIENT,,,1208,966.4,,460.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",460.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",915,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",460.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",460.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",460.43,915,
"HYSTEROSCOPY W/ENDOMETRIAL ABL",5800880,"CDM ",980,RC,58563,HCPCS,OUTPATIENT,,,867,693.6,,1767.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",553.23,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1767.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",3512,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1767.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1767.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",553.23,3512,
"HYSTEROSCOPY W/BI TUBE CANNULA",5800890,"CDM ",980,RC,58565,HCPCS,OUTPATIENT,,,956.5,765.2,,1621.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1621.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",3221,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1621.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1621.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1621.37,3221,
"LAP HYSTERECTOMY TOTAL <250G",5800900,"CDM ",980,RC,58570,HCPCS,OUTPATIENT,,,1733.5,1386.8,,654.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",654.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1350,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",654.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",654.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",654.74,1350,
"LAP HYSTERECTOMY SUPRAC <250G",5800910,"CDM ",980,RC,58541,HCPCS,OUTPATIENT,,,1614.5,1291.6,,609.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",609.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1257,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",609.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",609.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",609.88,1257,
"LAP HYSTERECTOMY SUPRA W/TUBES",5800920,"CDM ",980,RC,58542,HCPCS,OUTPATIENT,,,1823.5,1458.8,,676.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",676.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1398,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",676.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",676.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",676.12,1398,
"LAP HYSTERECTOMY SUPRAC >250G",5800930,"CDM ",980,RC,58543,HCPCS,OUTPATIENT,,,1883,1506.4,,687.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",687.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1421,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",687.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",687.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",687.41,1421,
"LAP HYSTERECTOMY SUPRAC W/TUBE",5800940,"CDM ",980,RC,58544,HCPCS,OUTPATIENT,,,2128.5,1702.8,,743.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",743.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1537,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",743.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",743.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",743.46,1537,
"LAP W/LYSIS ADHESION FULG OVID",5800950,"CDM ",980,RC,58670,HCPCS,OUTPATIENT,,,897,717.6,,263.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",577,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",263.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",263.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.12,577,
"LAP W/LYSIS ADHESION FIMBRIOSP",5800960,"CDM ",980,RC,58672,HCPCS,OUTPATIENT,,,1584.5,1267.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1217,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1217,1217,
"LAP W/LYSIS ADHESION SALPINGOS",5800970,"CDM ",980,RC,58673,HCPCS,OUTPATIENT,,,1782,1425.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1296,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1296,1296,
"LYSIS OF ADHESIONS",5800980,"CDM ",980,RC,58740,HCPCS,OUTPATIENT,,,2002.5,1602,,676.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",676.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1344,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",676.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",676.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",676.4,1344,
"DESTRUCT VAG LESION SIMPLE",5800990,"CDM ",980,RC,57061,HCPCS,OUTPATIENT,,,215.5,172.4,,88.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",176,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",88.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",88.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.34,176,
"DESTRUCT VAG LESION EXTENSIVE",5801000,"CDM ",980,RC,57065,HCPCS,OUTPATIENT,,,371.5,297.2,,152.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",342,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",152.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",152.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.74,342,
"MARSUPIAL BARTHOLIN GLAND CYST",5801010,"CDM ",980,RC,56440,HCPCS,OUTPATIENT,,,359,287.2,,131.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",327,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",131.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",131.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.85,327,
"MYOMECTOMY ABD APPR <250G",5801020,"CDM ",980,RC,58140,HCPCS,OUTPATIENT,,,2062.5,1650,,696.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",696.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1384,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",696.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",696.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",696.72,1384,
"MYOMECTOMY ABD APPR >250G",5801030,"CDM ",980,RC,58146,HCPCS,OUTPATIENT,,,2391.5,1913.2,,899.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",899.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1787,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",899.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",899.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",899.25,1787,
"MYOMECTOMY EXC TUMOR VAG APPR",5801040,"CDM ",980,RC,58145,HCPCS,OUTPATIENT,,,1255.5,1004.4,,407.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",407.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",974,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",407.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",407.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",407.39,974,
"OVARIAN CYSTECTOMY",5801050,"CDM ",980,RC,58925,HCPCS,OUTPATIENT,,,1668,1334.4,,546.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1101.94,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",546.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1086,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",546.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",546.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",546.43,1101.94,
"CURETTAGE POSTPARTUM",5801060,"CDM ",980,RC,59160,HCPCS,OUTPATIENT,,,426,340.8,,162.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",379,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",162.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",162.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.18,379,
"HYSTERORRHAPHY RUPTURED UTERUS",5801070,"CDM ",980,RC,59350,HCPCS,OUTPATIENT,,,592.5,474,,203.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",203.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",508,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",203.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",203.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",203.78,508,
"HYSTERECTOMY POST CSECTOIN DEL",5801080,"CDM ",980,RC,59525,HCPCS,OUTPATIENT,,,1076.5,861.2,,403.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",403.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",803,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",403.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",403.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",403.97,803,
"INDUCED ABORTION DIL & EVAC",5801085,"CDM ",980,RC,59841,HCPCS,OUTPATIENT,,,973.5,778.8,,289.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",289.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",575,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",289.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",289.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",289.47,575,
"INDUCED ABORTION",5801090,"CDM ",980,RC,59855,HCPCS,OUTPATIENT,,,927,741.6,,298.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",298.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",642,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",298.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",298.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",298.82,642,
"VULVECTOMY SIMPLE PARTIAL",5801100,"CDM ",980,RC,56620,HCPCS,OUTPATIENT,,,1127,901.6,,387.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",387.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",838,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",387.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",387.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",387.86,838,
"HYMENECTOMY PRTL OR RVS RING",5801105,"CDM ",980,RC,56700,HCPCS,OUTPATIENT,,,419.5,335.6,,133.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",272,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",133.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",133.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.89,272,
"C SECT DELIV AFTR VAG ATTEMPT",5801110,"CDM ",980,RC,59622,HCPCS,OUTPATIENT,,,2557,2045.6,,940.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",940.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1860,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",940.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",940.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",940.91,1860,
"I&D VULVA OR PERINEAL ABCESS",5801120,"CDM ",980,RC,56405,HCPCS,OUTPATIENT,,,276,220.8,,85.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",171,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.93,171,
"EXC ABDOMINAL WALL DEEP <5CM",5801130,"CDM ",980,RC,22900,HCPCS,OUTPATIENT,,,246,196.8,,288.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,710.89,710.89,710.89,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",288.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",786,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",288.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",288.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",288.74,786,
"EXC ABDOMINAL WALL DEEP >5CM",5801140,"CDM ",980,RC,22901,HCPCS,OUTPATIENT,,,1530.5,1224.4,,331.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",331.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",927,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",331.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",331.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",331.79,927,
"EXC ABDOMINAL WALL SUBCUT <3CM",5801150,"CDM ",980,RC,22902,HCPCS,OUTPATIENT,,,990.5,792.4,,167.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",602,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",167.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",167.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.37,602,
"EXC ABDOMINAL WALL SUBCUT >3CM",5801160,"CDM ",980,RC,22903,HCPCS,OUTPATIENT,,,999,799.2,,219.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",219.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",604,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",219.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",219.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",219.22,604,
"EXC VAGINAL SEPTUM",5801168,"CDM ",980,RC,57130,HCPCS,OUTPATIENT,,,467.5,374,,131.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",307,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",131.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",131.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.13,307,
"EXC VAGINAL WALL LESION",5801170,"CDM ",980,RC,57135,HCPCS,OUTPATIENT,,,391,312.8,,140.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",306,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",140.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",140.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.68,306,
"DELIVER PLACENTA",5801180,"CDM ",980,RC,59414,HCPCS,OUTPATIENT,,,391,312.8,,76.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,135.15,135.15,135.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",165,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",76.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",76.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.99,165,
"EXC BARTHONLINS/VAGINAL GLAND",5801190,"CDM ",980,RC,56740,HCPCS,OUTPATIENT,,,1255.5,1004.4,,227.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",451,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",227.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",227.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.25,451,
"I&D ABSC BARTHOLINS GLAND",5801200,"CDM ",980,RC,56420,HCPCS,OUTPATIENT,,,329,263.2,,110.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",219,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",110.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",110.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.39,219,
"LYSIS LABIAL ADHESIONS",5801205,"CDM ",980,RC,56441,HCPCS,OUTPATIENT,,,334,267.2,,108.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",232,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",108.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",108.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.33,232,
"BX VULVA/PERINEUM",5801210,"CDM ",980,RC,56605,HCPCS,OUTPATIENT,,,190,152,,67.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",133,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",67.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",67.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.14,133,
"BX VULVA/PERINEUM EA ADD LES",5801215,"CDM ",980,RC,56606,HCPCS,OUTPATIENT,,,81,64.8,,32.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",64,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",32.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.44,64,
"RPR PERINEUM NON OB",5801220,"CDM ",980,RC,56810,HCPCS,OUTPATIENT,,,586.5,469.2,,204.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",204.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",406,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",204.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",204.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",204.35,406,
"COLPOSCOPY VULVA",5801225,"CDM ",980,RC,56820,HCPCS,OUTPATIENT,,,260,208,,87.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",174,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",87.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",87.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.5,174,
"COLPOSCOPY VULVA W/BX",5801230,"CDM ",980,RC,56821,HCPCS,OUTPATIENT,,,347.5,278,,118.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",236,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",118.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",118.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.83,236,
"FIT & INSRT PESSARY/OTH DEVICE",5801232,"CDM ",980,RC,57160,HCPCS,OUTPATIENT,,,161,128.8,,58.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",116,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",58.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.19,116,
"DIAPHRAGM/CERVICAL CAP FIT",5801235,"CDM ",980,RC,57170,HCPCS,OUTPATIENT,,,132.5,106,,72.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",143,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",72.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",72.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7,143,
"RPR COLPORRHAPHY VAGINA",5801240,"CDM ",980,RC,57200,HCPCS,OUTPATIENT,,,687.5,550,,214.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,450.02,450.02,450.02,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",430,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",214.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",214.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.27,430,
"RPR VAGINA EXTENSIVE",5801245,"CDM ",980,RC,57265,HCPCS,OUTPATIENT,,,2152,1721.6,,553.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1380.50,1380.50,1380.50,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",553.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1330,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",553.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",553.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",553.42,1330,
"RPR BOWEL ENTEROCELE VAG",5801250,"CDM ",980,RC,57268,HCPCS,OUTPATIENT,,,1100.5,880.4,,346.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",346.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",837,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",346.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",346.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",346.44,837,
"REVISE/RMV SLING STRESS INCONT",5801255,"CDM ",980,RC,57287,HCPCS,OUTPATIENT,,,1554.5,1243.6,,424.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",424.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1037,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",424.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",424.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",424.39,1037,
"RPR SLING OP INCONTINENCE",5801260,"CDM ",980,RC,57288,HCPCS,OUTPATIENT,,,1644,1315.2,,445.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",445.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1363,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",445.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",445.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",445.84,1363,
"COLPOSCOPY VAG W/CERVIX",5801265,"CDM ",980,RC,57420,HCPCS,OUTPATIENT,,,272.5,218,,91.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",183,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",91.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",91.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.98,183,
"COLPOSCOPY VAG/CERV W/BX",5801270,"CDM ",980,RC,57421,HCPCS,OUTPATIENT,,,367.5,294,,126.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",126.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",251,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",126.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",126.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",126.49,251,
"COLPOSCOPY CERVIX INCLD VAGINA",5801275,"CDM ",980,RC,57452,HCPCS,OUTPATIENT,,,238,190.4,,86.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",172,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",86.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",86.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.67,172,
"COLPOSCOPY ENDOCERV CURET W/BX",5801280,"CDM ",980,RC,57454,HCPCS,OUTPATIENT,,,405.5,324.4,,125.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",248,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",125.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,145.11,145.11,145.11,"1 through 10",other,"not separately reimbursment ",125.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.01,248,
"COLPOSCOPY CERVIX VAG W/BX",5801285,"CDM ",980,RC,57455,HCPCS,OUTPATIENT,,,378.5,302.8,,115.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,182.76,182.76,182.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",230,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",115.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",115.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.61,230,
"COLPOSCOPY END/CRV CURET WO BX",5801290,"CDM ",980,RC,57456,HCPCS,OUTPATIENT,,,350,280,,108.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",216,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",108.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",108.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.82,216,
"BX CERVIX",5801295,"CDM ",980,RC,57500,HCPCS,OUTPATIENT,,,290,232,,103.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",206,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",103.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",103.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.72,206,
"ENDOCERVICAL CURETTAGE",5801300,"CDM ",980,RC,57505,HCPCS,OUTPATIENT,,,1375,1100,,79.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",158,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",79.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",79.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.4,158,
"CRYOCAUTERY CERVIX",5801305,"CDM ",980,RC,57511,HCPCS,OUTPATIENT,,,359,287.2,,115.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",230,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",115.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",115.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.59,230,
"ENDOMETRIAL BIOPSY",5801310,"CDM ",980,RC,58100,HCPCS,OUTPATIENT,,,299,239.2,,88.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",176,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",88.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",88.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.71,176,
"ENDOMETRIAL BX W/COLPOSCOPY",5801313,"CDM ",980,RC,58110,HCPCS,OUTPATIENT,,,104,83.2,,41.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",82,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",41.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",41.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.47,82,
"IUD INSERTION",5801315,"CDM ",980,RC,58300,HCPCS,OUTPATIENT,,,299,239.2,,55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",147,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,98.87,98.87,98.87,"1 through 10",other,"not separately reimbursment ",55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5,147,
"IUD CHECK OR REMOVAL",5801320,"CDM ",980,RC,58301,HCPCS,OUTPATIENT,,,236,188.8,,79.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",159,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",79.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,110.97,110.97,110.97,"1 through 10",other,"not separately reimbursment ",79.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.86,159,
"LIGATION FALLOPIAN TUBE",5801325,"CDM ",980,RC,58600,HCPCS,OUTPATIENT,,,807.5,646,,434.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",434.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",563,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",434.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",434.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",434.96,563,
"OCCLUSION TUBE BAND/CLIP/RING",5801330,"CDM ",980,RC,58615,HCPCS,OUTPATIENT,,,559,447.2,,184.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",184.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",413,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",184.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",184.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",184.14,413,
"SALPINGECTOMY UNILAT/BILATERAL",5801335,"CDM ",980,RC,58700,HCPCS,OUTPATIENT,,,1736.5,1389.2,,578.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",578.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1150,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",578.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",578.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",578.71,1150,
"OOPHORECTOMY OVARIAN MALIG",5801340,"CDM ",980,RC,58943,HCPCS,OUTPATIENT,,,2627,2101.6,,805.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",805.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1808,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",805.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",805.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",805.42,1808,
"EXPLORITORY LAP ABDOMEN",5801345,"CDM ",980,RC,58960,HCPCS,OUTPATIENT,,,2218,1774.4,,661.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",661.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1673,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",661.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",661.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",661.91,1673,
"EPISIOTOMY RPR OTH ATTND DR",5801350,"CDM ",980,RC,59300,HCPCS,OUTPATIENT,,,335.5,268.4,,149.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",296,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",149.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",149.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.03,296,
"POST PARTUM VISIT",5801355,"CDM ",980,RC,59430,HCPCS,OUTPATIENT,,,281,224.8,,112.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",171.16,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",262,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",112.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",112.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.38,262,
"VAG DELIVERY PREV CESAREAN",5801360,"CDM ",980,RC,59612,HCPCS,OUTPATIENT,,,1873,1498.4,,722.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",722.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1458,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",722.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",722.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",722.35,1458,
"NON STRESS TEST OB",5801365,"CDM ",980,RC,59025,HCPCS,OUTPATIENT,,,100,80,,32.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",79,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,361.01,233.36,451.26,"1 through 10",other,"not separately reimbursment ",32.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.24,79,
"INSERT CERVICAL DILATOR",5801370,"CDM ",980,RC,59200,HCPCS,OUTPATIENT,,,205,164,,62.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",123,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",62.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",62.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6,123,
"INSERT CATH HYSTEROGRAPHY/SALP",5801375,"CDM ",980,RC,58340,HCPCS,OUTPATIENT,,,167.5,134,,100.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",100.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",233,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",100.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",100.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",100.22,233,
"EXC URETHRAL LESION",5801380,"CDM ",980,RC,53265,HCPCS,OUTPATIENT,,,489,391.2,,178.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",355,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",178.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",178.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.81,355,
"I&D VAG HEMATOMA OB POSTPARTUM",5801385,"CDM ",980,RC,57022,HCPCS,OUTPATIENT,,,391,312.8,,121.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",121.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",254,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",121.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",121.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",121.1,254,
"COLPOPEXY VAG INTRAPERITONEAL",5801390,"CDM ",980,RC,57283,HCPCS,OUTPATIENT,,,1494.5,1195.6,,528.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",528.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1049,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",528.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",528.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",528.19,1049,
"HYSTERECTOMY VAG >250G W/TUBES",5801395,"CDM ",980,RC,58291,HCPCS,OUTPATIENT,,,2650,2120,,984.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1431.53,1431.53,1431.53,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",984.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1955,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",984.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",984.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",984.16,1955,
"REMOVE CERCLAGE SUTURE W/ANEST",5801400,"CDM ",980,RC,59871,HCPCS,OUTPATIENT,,,282,225.6,,126.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",126.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",252,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",126.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",126.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",126.74,252,
"CYSTOTOMY W/INSRT CATH/STENT",5801405,"CDM ",980,RC,51045,HCPCS,OUTPATIENT,,,1130.5,904.4,,350.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",350.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",738,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",350.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",350.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",350.53,738,
"COLPOTOMY W/EXPLORATION",5801410,"CDM ",980,RC,57000,HCPCS,OUTPATIENT,,,437.5,350,,148.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",294,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",148.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",148.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.04,294,
"BX VAGINAL MUCOSA SIMPLE",5801413,"CDM ",980,RC,57100,HCPCS,OUTPATIENT,,,213,170.4,,70.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,15.66,15.66,15.66,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",141,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",70.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",70.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.79,141,
"SUTURE CLOSURE VAGINA",5801415,"CDM ",980,RC,57120,HCPCS,OUTPATIENT,,,1138.5,910.8,,380.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",380.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",870,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",380.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",380.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",380.49,870,
"COLPOSCOPY CERVIX LEEP W/BX",5801420,"CDM ",980,RC,57460,HCPCS,OUTPATIENT,,,320,256,,258.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",258.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",514,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",258.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",258.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",258.72,514,
"HYSTERECTOMY TOT ABD W/PRTL VA",5801425,"CDM ",980,RC,58200,HCPCS,OUTPATIENT,,,2874,2299.2,,1013.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1013.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2035,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1013.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1013.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1013.12,2035,
"HYSTERECTOMY >250G COMPLEX",5801430,"CDM ",980,RC,58290,HCPCS,OUTPATIENT,,,2454.5,1963.6,,901.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",901.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1792,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",901.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",901.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",901.88,1792,
"HYSTERECTOMY LAP 250G W/TUBE&O",5801435,"CDM ",980,RC,58552,HCPCS,OUTPATIENT,,,2092,1673.6,,763.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",763.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1518,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",763.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",763.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",763.89,1518,
"EXC SKIN & SUBCUT TISSUE OTH",5801440,"CDM ",980,RC,15839,HCPCS,OUTPATIENT,,,1375,1100,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1213,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1213,1213,
"INP-LOW SEVERITY (EST OR NEW)",5900040,"CDM ",960,RC,99221,HCPCS,OUTPATIENT,,,212,169.6,,54.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",137.15,100,,132.29,132.29,132.29,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",133,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",54.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,73.54,73.54,73.54,"1 through 10",other,"not separately reimbursment ",54.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.31,137.15,
"INP-LOW SEVERITY (EST OR NEW)",5900040,"CDM ",960,RC,99221,HCPCS,OUTPATIENT,,,212,169.6,,54.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",137.15,100,,132.29,132.29,132.29,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",133,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",54.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,73.54,73.54,73.54,"1 through 10",other,"not separately reimbursment ",54.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.31,137.15,
"INP-MOD SEVERITY (EST OR NEW)",5900050,"CDM ",960,RC,99222,HCPCS,OUTPATIENT,,,318.5,254.8,,90.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.28,100,,119.01,119.01,119.01,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",180,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",90.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,116.63,113.62,118.30,12,other,"not separately reimbursment ",90.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9,200.28,
"INP-MOD SEVERITY (EST OR NEW)",5900050,"CDM ",960,RC,99222,HCPCS,OUTPATIENT,,,318.5,254.8,,90.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.28,100,,119.01,119.01,119.01,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",180,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",90.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,116.63,113.62,118.30,12,other,"not separately reimbursment ",90.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9,200.28,
"INP-HIGH SEVERITY (EST OR NEW)",5900060,"CDM ",960,RC,99223,HCPCS,OUTPATIENT,,,416,332.8,,125.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",272.55,100,,158.84,158.84,158.84,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",265,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",125.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,155.67,140.10,195.67,"1 through 10",other,"not separately reimbursment ",125.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.52,272.55,
"INP-HIGH SEVERITY (EST OR NEW)",5900060,"CDM ",960,RC,99223,HCPCS,OUTPATIENT,,,416,332.8,,125.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",272.55,100,,158.84,158.84,158.84,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",265,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",125.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,155.67,140.10,195.67,"1 through 10",other,"not separately reimbursment ",125.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.52,272.55,
"SUBSEQUENT HOSP CARE, 15 MIN",5900070,"CDM ",960,RC,99231,HCPCS,OUTPATIENT,,,101.5,81.2,,27.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",62,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",27.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",27.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.18,62,
"SUBSEQUENT HOSP CARE, 25 MIN",5900080,"CDM ",960,RC,99232,HCPCS,OUTPATIENT,,,178,142.4,,44.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.27,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",95,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,70.47,56.82,71.69,"1 through 10",other,"not separately reimbursment ",44.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.49,100.27,
"SUBSEQUENT-MAJOR COMPLICATIONS",5900090,"CDM ",960,RC,99233,HCPCS,OUTPATIENT,,,249.5,199.6,,63.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",141.16,100,,92.18,92.18,92.18,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",141,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",63.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,106.28,106.28,107.98,"1 through 10",other,"not separately reimbursment ",63.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.26,141.16,
"OBS/INP - LOW SEVERITY",5900100,"CDM ",960,RC,99234,HCPCS,OUTPATIENT,,,165,132,,82.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",189,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",82.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",82.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.14,189,
"OBS/INP -MODERATE SEVERITY",5900110,"CDM ",960,RC,99235,HCPCS,OUTPATIENT,,,392,313.6,,102.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",254.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",249,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",102.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",102.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.88,254.28,
"OBS/INP - HIGH SEVERITY",5900120,"CDM ",960,RC,99236,HCPCS,OUTPATIENT,,,615.5,492.4,,132.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",319.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",311,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",132.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,112.10,52.82,171.38,"1 through 10",other,"not separately reimbursment ",132.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.85,319.41,
"DISCHARGE MGMT < 30 MINUTES",5900130,"CDM ",960,RC,99238,HCPCS,OUTPATIENT,,,206.5,165.2,,56.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.49,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",98,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",56.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,67.59,62.60,72.58,"1 through 10",other,"not separately reimbursment ",56.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.34,107.49,
"DISCHARGE MGMT > 30 MINUTES",5900140,"CDM ",960,RC,99239,HCPCS,OUTPATIENT,,,252,201.6,,76.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",154.13,100,,89.14,89.14,89.14,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",141,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",76.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,102.78,93.99,103.17,13,other,"not separately reimbursment ",76.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.84,154.13,
"ICU CRITICAL CARE - 34-75 MIN",5900150,"CDM ",960,RC,99291,HCPCS,OUTPATIENT,,,883.5,706.8,,165.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",326.6,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",165.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",358,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",165.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,190.97,190.97,190.97,"1 through 10",other,"not separately reimbursment ",165.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",165.4,358,
"ICU CRIT CARE - EA ADDL 30 MIN",5900160,"CDM ",960,RC,99292,HCPCS,OUTPATIENT,,,425,340,,74.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",161,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",74.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,95.60,95.60,95.60,"1 through 10",other,"not separately reimbursment ",74.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.48,161,
"INPATIENT CONSULT - 40 MIN",5900170,"CDM ",960,RC,99252,HCPCS,OUTPATIENT,,,205.5,164.4,,,,,,,,0,"other ","not separately reimbursment ",71.11,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",105,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.11,105,
"INPATIENT CONSULT - 55 MIN",5900180,"CDM ",960,RC,99253,HCPCS,OUTPATIENT,,,285.5,228.4,,,,,,,,0,"other ","not separately reimbursment ",97.69,100,,112.19,112.19,112.19,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",159,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.69,159,
"INPATIENT CONSULT - 80 MIN",5900190,"CDM ",960,RC,99254,HCPCS,OUTPATIENT,,,413,330.4,,,,,,,,0,"other ","not separately reimbursment ",,,,142.11,142.11,142.11,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",230,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",230,230,
"INPATIENT CONSULT - 110 MIN",5900200,"CDM ",960,RC,99255,HCPCS,OUTPATIENT,,,442,353.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",280,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",280,280,
"EMERGENCY DEPT VISIT 1",5900220,"CDM ",960,RC,99281,HCPCS,OUTPATIENT,,,45.5,36.4,,37.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,17.14,17.14,17.14,"1 through 10",other,"not separately reimbursment ",37.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30,37.14,
"EMERGENCY DEPT VISIT 2",5900230,"CDM ",960,RC,99282,HCPCS,OUTPATIENT,,,162.5,130,,37.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,356.16,356.16,356.16,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",58,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.23,32.69,256.09,"1 through 10",other,"not separately reimbursment ",37.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.14,58,
"EMERGENCY DEPT VISIT 3",5900240,"CDM ",960,RC,99283,HCPCS,OUTPATIENT,,,218.5,174.8,,37.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",120.45,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,301.39,301.39,301.39,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",91,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,569.33,146.28,782.15,22,other,"not separately reimbursment ",37.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.14,120.45,
"EMERGENCY DEPT VISIT 4",5900250,"CDM ",960,RC,99284,HCPCS,OUTPATIENT,,,348.5,278.8,,90.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.18,100,,413.32,413.32,413.32,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",168,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",90.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1040.95,353.74,1239.17,16,other,"not separately reimbursment ",90.35,100,,413.32,413.32,413.32,"1 through 10","fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.35,198.18,
"EMERGENCY DEPT VISIT 5",5900260,"CDM ",960,RC,99285,HCPCS,OUTPATIENT,,,448.5,358.8,,90.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,569.48,569.48,569.48,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",249,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",90.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1561.47,554.84,2094.62,"1 through 10",other,"not separately reimbursment ",90.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.35,249,
"INITIAL FACILITY CARE 25 MIN",5900270,"CDM ",960,RC,99304,HCPCS,OUTPATIENT,,,196.5,157.2,,52.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",121,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",52.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.44,121,
"INITIAL FACILITY CARE 35 MIN",5900280,"CDM ",960,RC,99305,HCPCS,OUTPATIENT,,,213,170.4,,69.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,24.41,24.41,24.41,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",171,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",69.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",69.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.67,171,
"INITIAL FACILITY CARE 50 MIN",5900290,"CDM ",960,RC,99306,HCPCS,OUTPATIENT,,,288.5,230.8,,86.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",223.61,100,,136.88,136.88,136.88,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",218,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",86.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",86.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8,223.61,
"SUBSEQUENT CARE 10 MIN",5900300,"CDM ",960,RC,99307,HCPCS,OUTPATIENT,,,95.5,76.4,,27.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",57,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",27.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",27.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,57,
"SUBSEQUENT CARE 20 MIN",5900310,"CDM ",960,RC,99308,HCPCS,OUTPATIENT,,,118.5,94.8,,44.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.83,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",89,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",44.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.81,100.83,
"SUBSEQUENT CARE 25 MIN",5900320,"CDM ",960,RC,99309,HCPCS,OUTPATIENT,,,202.5,162,,63.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",139.64,100,,19.73,19.73,19.73,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",117,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",63.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",63.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.19,139.64,
"SUBSEQUENT CARE 35 MIN",5900330,"CDM ",960,RC,99310,HCPCS,OUTPATIENT,,,207,165.6,,79.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",186.5,100,,110.66,110.66,110.66,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",174,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",79.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",79.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7,186.5,
"DISCHARGE <30 MIN",5900340,"CDM ",960,RC,99238,HCPCS,OUTPATIENT,,,199,159.2,,56.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.49,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",98,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",56.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,67.59,62.60,72.58,"1 through 10",other,"not separately reimbursment ",56.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.34,107.49,
"DISCHARGE >30 MIN",5900350,"CDM ",960,RC,99239,HCPCS,OUTPATIENT,,,252,201.6,,76.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",154.13,100,,89.14,89.14,89.14,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",141,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",76.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,102.78,93.99,103.17,13,other,"not separately reimbursment ",76.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.84,154.13,
"OUTPATIENT VISIT, 5 MIN, EST",5900430,"CDM ",960,RC,99211,HCPCS,OUTPATIENT,,,48,38.4,,16.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",29,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",16.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,18.91,17.74,20.08,"1 through 10",other,"not separately reimbursment ",16.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.36,29,
"OUTPATIENT VISIT 10 MIN, EST",5900440,"CDM ",960,RC,99212,HCPCS,OUTPATIENT,,,83.5,66.8,,29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",56,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,41.53,8.11,48.11,20,other,"not separately reimbursment ",29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.76,56,
"OUTPATIENT VISIT 15 MIN, EST",5900450,"CDM ",960,RC,99213,HCPCS,OUTPATIENT,,,159.5,127.6,,40.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",51.95,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,74.27,70.21,78.33,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",93,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",40.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,63.68,29.60,79.60,44,other,"not separately reimbursment ",40.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.84,93,
"OUTPATIENT VISIT 30 MIN EST",5900460,"CDM ",960,RC,99214,HCPCS,OUTPATIENT,,,200,160,,64.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",138,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",64.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,92.46,47.94,115.58,37,other,"not separately reimbursment ",64.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.22,138,
"OUTPATIENT VISIT 40 MIN EST",5900470,"CDM ",960,RC,99215,HCPCS,OUTPATIENT,,,273.5,218.8,,94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",186,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,157.63,127.56,162.13,"1 through 10",other,"not separately reimbursment ",94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9,186,
"SUBSEQUENT HOSP CARE, 35 MIN",5900480,"CDM ",960,RC,99233,HCPCS,OUTPATIENT,,,249.5,199.6,,63.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",141.16,100,,92.18,92.18,92.18,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",141,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",63.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,106.28,106.28,107.98,"1 through 10",other,"not separately reimbursment ",63.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.26,141.16,
"INTUBATION ENDOTRACHEAL",5900490,"CDM ",960,RC,31500,HCPCS,OUTPATIENT,,,261.5,209.2,,92.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.05,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",195,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",92.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",92.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.39,195.05,
"INSERT NON-TUNNEL CV CATH",5900500,"CDM ",960,RC,36556,HCPCS,OUTPATIENT,,,368,294.4,,191.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",180.69,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",191.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",475,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",191.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",191.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.69,475,
"INSERT PICC CATH 5 YRS & >",5900510,"CDM ",960,RC,36569,HCPCS,OUTPATIENT,,,474.5,379.6,,264.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",264.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",526,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",264.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",264.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",264.98,526,
"SPINAL PUNCTURE - LUMBAR",5900530,"CDM ",960,RC,62270,HCPCS,OUTPATIENT,,,302,241.6,,120.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,109.05,109.05,109.05,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",239,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",120.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",120.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.29,239,
"THORACENTESIS W/IMAGING GUIDE",5900540,"CDM ",960,RC,32555,HCPCS,OUTPATIENT,,,1028.5,822.8,,68.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",859,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",68.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.98,859,
"ARTHROCENTESIS SMALL JT/BURSA",5900550,"CDM ",960,RC,20600,HCPCS,OUTPATIENT,,,131.5,105.2,,40.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",81,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",40.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",40.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.55,81,
"ARTHRO INTERMEDIATE JT/BURSA",5900560,"CDM ",960,RC,20605,HCPCS,OUTPATIENT,,,224.5,179.6,,44.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",88,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",44.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.22,88,
"ARTHROCENTESIS MAJOR JT/BURSA",5900570,"CDM ",960,RC,20610,HCPCS,OUTPATIENT,,,237,189.6,,53.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.83,100,,11.66,11.66,11.66,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",107,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",53.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,35.16,16.84,51.43,"1 through 10",other,"not separately reimbursment ",53.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.61,107,
"THORACENTESIS W/O IMAGE GUIDE",5900610,"CDM ",960,RC,32554,HCPCS,OUTPATIENT,,,891,712.8,,55.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",744,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",55.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",55.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.17,744,
"PROLONG SERV WO CONTACT 1ST HR",5900640,"CDM ",960,RC,99358,HCPCS,OUTPATIENT,,,115.5,92.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",145,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",145,145,
"PROLONG SERV W/O EA ADD'L 30""",5900650,"CDM ",960,RC,99359,HCPCS,OUTPATIENT,,,57.5,46,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",70,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70,70,
"PRLNG CLINCAL STAFF OP 1ST HR",5900661,"CDM ",960,RC,99415,HCPCS,OUTPATIENT,,,166,132.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",11,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11,11,
"PRLNG CLINICAL STAFF EA ADD 30",5900662,"CDM ",960,RC,99416,HCPCS,OUTPATIENT,,,82.5,66,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",6,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6,6,
CPR,5900670,"CDM ",960,RC,92950,HCPCS,OUTPATIENT,,,2260.5,1808.4,,241.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",481,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",241.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,163.23,163.23,163.23,"1 through 10",other,"not separately reimbursment ",241.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.98,481,
CARDIOVERSION,5900680,"CDM ",960,RC,92960,HCPCS,OUTPATIENT,,,247.5,198,,247.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",247.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",491,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",247.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",247.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",247.33,491,
"EKG INTERP",5900690,"CDM ",985,RC,93010,HCPCS,OUTPATIENT,,,52.5,42,,10.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.57,100,,7.45,7.45,7.45,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",26,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",10.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,7.51,7.03,10.71,19,other,"not separately reimbursment ",10.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.41,26,
"VENT MANAGE INITIAL DAY",5900710,"CDM ",960,RC,94002,HCPCS,OUTPATIENT,,,204,163.2,,66.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",140,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",66.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",66.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.59,140,
"VENT MANAGE SUBSQ DAY",5900720,"CDM ",960,RC,94003,HCPCS,OUTPATIENT,,,159,127.2,,48.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",101,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",48.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",48.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.36,101,
"BIPAP MANAGEMENT",5900730,"CDM ",960,RC,94660,HCPCS,OUTPATIENT,,,104.5,83.6,,,,,,,,0,"other ","not separately reimbursment ",,,,44.07,44.07,44.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",86,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86,86,
"ARTERIAL LINE PLACEMENT",5900740,"CDM ",960,RC,36820,HCPCS,OUTPATIENT,,,2837.5,2270,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1313,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1313,1313,
"TRANSVENOUS PLACEMENT",5900750,"CDM ",960,RC,33211,HCPCS,OUTPATIENT,,,565.5,452.4,,139.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",378,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",139.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",139.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.1,378,
"US GUIDANCE VASCULAR ACCESS",5900770,"CDM ",960,RC,76937,HCPCS,OUTPATIENT,,,87.5,70,,25.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.68,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",55,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",25.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,438.33,438.33,438.33,"1 through 10",other,"not separately reimbursment ",25.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.68,55,
"BEHAVIOR CHANGE SMOKING 3-10MI",5900780,"CDM ",960,RC,99406,HCPCS,OUTPATIENT,,,31.5,25.2,,9.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",21,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",9.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,13.42,11.12,15.72,"1 through 10",other,"not separately reimbursment ",9.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9,21,
"ABD PARACENTESIS W/IMAGE",5900790,"CDM ",960,RC,49083,HCPCS,OUTPATIENT,,,658,526.4,,47.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",433,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",47.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",47.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.66,433,
"BRONCHOSCOPY TX ASPIRATE INIT",5900800,"CDM ",960,RC,31645,HCPCS,OUTPATIENT,,,549.5,439.6,,245.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",245.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",488,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",245.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",245.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",245.4,488,
"US GUIDANCE INTRAOPERATIVE",5900810,"CDM ",960,RC,76998,HCPCS,OUTPATIENT,,,121,96.8,,180.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",268,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",180.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",180.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.28,268,
"FINE NEEDLE ASP W/US 1ST LES",5910000,"CDM ",960,RC,10005,HCPCS,OUTPATIENT,,,276,220.8,,64.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",175,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",64.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,379.16,379.16,379.16,"1 through 10",other,"not separately reimbursment ",64.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.82,175,
"FINE NEEDLE ASP WO US 1ST LES",5910005,"CDM ",960,RC,10021,HCPCS,OUTPATIENT,,,287.5,230,,101.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",204,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",101.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",101.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.93,204,
"INCISION & DRAINAGE ACNE",5910015,"CDM ",960,RC,10040,HCPCS,OUTPATIENT,,,227.5,182,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",139,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139,139,
"I&D ABCESS SIMPLE",5910020,"CDM ",960,RC,10060,HCPCS,OUTPATIENT,,,263.5,210.8,,72.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.72,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",153,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",72.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,112.42,112.42,112.42,"1 through 10",other,"not separately reimbursment ",72.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.98,153,
"I&D ABCESS COMPLICATED",5910025,"CDM ",960,RC,10061,HCPCS,OUTPATIENT,,,557.5,446,,132.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",239.26,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",284,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",132.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",132.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.01,284,
"I&D PILONIDAL CYST SIMPLE",5910030,"CDM ",960,RC,10080,HCPCS,OUTPATIENT,,,610,488,,125.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,893.25,893.25,893.25,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",249,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",125.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",125.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.26,249,
"I&D PILONIDAL CYST COMPLICATED",5910035,"CDM ",960,RC,10081,HCPCS,OUTPATIENT,,,704,563.2,,195.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1441.29,1441.29,1441.29,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",195.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",388,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",195.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",195.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",195.31,388,
"REMOVAL FOREIGN BODY SIMPLE",5910040,"CDM ",960,RC,10120,HCPCS,OUTPATIENT,,,350,280,,101.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",201,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",101.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",101.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.36,201,
"REMOVE FOREIGN BODY COMPLEX",5910045,"CDM ",960,RC,10121,HCPCS,OUTPATIENT,,,622,497.6,,189.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",189.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",376,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",189.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",189.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",189.43,376,
"I&D HEMATOMA SEROMA OR FLUID",5910050,"CDM ",960,RC,10140,HCPCS,OUTPATIENT,,,347.5,278,,101.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,217.85,217.85,217.85,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",215,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",101.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",101.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.66,215,
"PUNCT ASPIR ABCESS HEMATOMA",5910055,"CDM ",960,RC,10160,HCPCS,OUTPATIENT,,,306.5,245.2,,85.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,79.15,79.15,79.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",173,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.16,173,
"COMP DRAIN WOUND/INFECTION",5910060,"CDM ",960,RC,10180,HCPCS,OUTPATIENT,,,543.5,434.8,,161.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",161.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",342,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",161.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,207.83,207.83,207.83,"1 through 10",other,"not separately reimbursment ",161.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",161.39,342,
"DEBRIDE INFECTED SKIN UPTO 10%",5910065,"CDM ",960,RC,11000,HCPCS,OUTPATIENT,,,94,75.2,,36.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",74,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",36.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",36.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.5,74,
"DEBRIDE SKIN EXTERN GENITALIA",5910070,"CDM ",960,RC,11004,HCPCS,OUTPATIENT,,,1235.5,988.4,,447.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",447.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",890,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",447.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",447.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",447.75,890,
"DEBRIDE ABDOM WALL",5910075,"CDM ",960,RC,11005,HCPCS,OUTPATIENT,,,1823.5,1458.8,,608.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",608.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1209,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",608.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",608.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",608.75,1209,
"DEBRIDE GENIT/PER/ABDOM WALL",5910080,"CDM ",960,RC,11006,HCPCS,OUTPATIENT,,,1674,1339.2,,560.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",560.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1113,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",560.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",560.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",560.24,1113,
"REMOVE PROSTH MATERIAL ABDOMIN",5910082,"CDM ",960,RC,11008,HCPCS,OUTPATIENT,,,564,451.2,,227.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",452,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",227.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",227.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.31,452,
"DEBRIDE SKIN AT FX SITE",5910085,"CDM ",960,RC,11010,HCPCS,OUTPATIENT,,,1065,852,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",682,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",682,682,
"DEBRIDE REMOVE FOREIGN MAT",5910090,"CDM ",960,RC,11011,HCPCS,OUTPATIENT,,,1172,937.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",791,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",791,791,
"DEBRIDE TISS MSCL FASC BONE",5910095,"CDM ",960,RC,11012,HCPCS,OUTPATIENT,,,1214.5,971.6,,261.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",261.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1148,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",261.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",261.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",261.72,1148,
"DEBRIDE SKIN SUBQ TISSUE",5910100,"CDM ",960,RC,11042,HCPCS,OUTPATIENT,,,242,193.6,,51.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",161,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,838.17,838.17,838.17,"1 through 10",other,"not separately reimbursment ",51.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.46,161,
"DEBRIDE MSCL FASCIA 20 SQCM",5910105,"CDM ",960,RC,11043,HCPCS,OUTPATIENT,,,402.5,322,,175.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",238.51,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",175.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",375,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",175.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",175.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",175.85,375,
"DEBRIDE SKIN TISSUE MSCL BONE",5910110,"CDM ",960,RC,11044,HCPCS,OUTPATIENT,,,851.5,681.2,,229.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,40.42,40.42,40.42,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",229.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",508,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",229.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",229.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",229.31,508,
"DEB SUBQ TISSUE",5910115,"CDM ",960,RC,11045,HCPCS,OUTPATIENT,,,96.5,77.2,,8.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,216.82,216.82,216.82,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",56,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.18,56,
"DEBRIDE EA ADD 20 SQCM",5910120,"CDM ",960,RC,11046,HCPCS,OUTPATIENT,,,170.5,136.4,,17.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,87.33,87.33,87.33,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",99,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.53,99,
"DEBRIDE BONE ADD-ON",5910125,"CDM ",960,RC,11047,HCPCS,OUTPATIENT,,,172.5,138,,30.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,120.00,120.00,120.00,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",168,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",30.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.36,168,
"PAIR/CUTG BENIGN LES CALLUS",5910130,"CDM ",960,RC,11055,HCPCS,OUTPATIENT,,,81,64.8,,30.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",67,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",30.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.15,67,
"PAIR/CUT BENIGN LES CALLUS 2-4",5910135,"CDM ",960,RC,11056,HCPCS,OUTPATIENT,,,98.5,78.8,,38.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",81,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",38.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",38.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.47,81,
"PAIR/CUT BENIGN LES CALLUS >4",5910140,"CDM ",960,RC,11057,HCPCS,OUTPATIENT,,,132,105.6,,47.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",98,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",47.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",47.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.58,98,
"TANG BX SKIN SINGLE LESION",5910145,"CDM ",960,RC,11102,HCPCS,OUTPATIENT,,,213,170.4,,25.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",135,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",25.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",25.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,135,
"TANG BX SKIN EA ADD LESION",5910150,"CDM ",960,RC,11103,HCPCS,OUTPATIENT,,,109.5,87.6,,14.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",73,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",14.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",14.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.53,73,
"BX PUNCH SKIN SINGLE LESION",5910155,"CDM ",960,RC,11104,HCPCS,OUTPATIENT,,,224.5,179.6,,31.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,21.90,21.90,21.90,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",170,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",31.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,90.82,90.82,90.82,"1 through 10",other,"not separately reimbursment ",31.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.49,170,
"BX PUNCH SKIN EA ADD LESION",5910160,"CDM ",960,RC,11105,HCPCS,OUTPATIENT,,,132.5,106,,17.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",84,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.17,84,
"REMOVAL SKIN TAG UP TO 15",5910165,"CDM ",960,RC,11200,HCPCS,OUTPATIENT,,,237,189.6,,53.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",116,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",53.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",53.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.88,116,
"REMOVE SKIN TAG ADD 10",5910170,"CDM ",960,RC,11201,HCPCS,OUTPATIENT,,,84,67.2,,14.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",28,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",14.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",14.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,28,
"SHAVE LES <0.5CM T/A/L",5910175,"CDM ",960,RC,11300,HCPCS,OUTPATIENT,,,209.5,167.6,,44.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",133,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",44.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4,133,
"SHAVE LES 0.6-1.0CM T/A/L",5910180,"CDM ",960,RC,11301,HCPCS,OUTPATIENT,,,263.5,210.8,,58.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",165,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",58.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.33,165,
"SHAVE LES 1.1-2.0CM T/A/L",5910185,"CDM ",960,RC,11302,HCPCS,OUTPATIENT,,,323.5,258.8,,70.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",194,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",70.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",70.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.1,194,
"SHAVE LES >2.0CM",5910190,"CDM ",960,RC,11303,HCPCS,OUTPATIENT,,,433,346.4,,84.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",214,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",84.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",84.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.28,214,
"SHAVE LES <0.5CM S/N/H/F",5910195,"CDM ",960,RC,11305,HCPCS,OUTPATIENT,,,215.5,172.4,,46.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",134,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",46.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",46.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.16,134,
"SHAVE LES 0.6-1.0CM S/N/H/F",5910200,"CDM ",960,RC,11306,HCPCS,OUTPATIENT,,,347.5,278,,63.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",166,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",63.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",63.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.14,166,
"SHAVE LES 1.1-2.0 CM",5910205,"CDM ",960,RC,11307,HCPCS,OUTPATIENT,,,293,234.4,,73.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",197,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",73.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",73.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.11,197,
"SHAVE LES >2.0CM S/N/H/F",5910210,"CDM ",960,RC,11308,HCPCS,OUTPATIENT,,,437.5,350,,87.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",210,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",87.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",87.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.4,210,
"SHAVE LES <0.5CM F/E/N/L",5910215,"CDM ",960,RC,11310,HCPCS,OUTPATIENT,,,246,196.8,,54.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",156,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",54.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",54.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.56,156,
"SHAVE LES 0.6-1.0CM F/E/N/L",5910220,"CDM ",960,RC,11311,HCPCS,OUTPATIENT,,,263.5,210.8,,68.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",145,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",68.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.17,145,
"SHAVE LES 1.1-2.0CM F/E/N/L",5910225,"CDM ",960,RC,11312,HCPCS,OUTPATIENT,,,359,287.2,,78.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",222,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",78.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",78.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.37,222,
"SHAVE LES >2.0CM F/E/N/L",5910230,"CDM ",960,RC,11313,HCPCS,OUTPATIENT,,,407,325.6,,103.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",256,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",103.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",103.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.28,256,
"EXC BENIGN LES <.5CM T/A/L",5910235,"CDM ",960,RC,11400,HCPCS,OUTPATIENT,,,251.5,201.2,,83.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,69.69,69.69,69.69,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",166,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",83.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",83.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.38,166,
"EXCI BENIGN LES .6-1.0CM T/A/L",5910240,"CDM ",960,RC,11401,HCPCS,OUTPATIENT,,,316.5,253.2,,97.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,192.97,192.97,192.97,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",198,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",97.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2242.58,2242.58,2242.58,"1 through 10",other,"not separately reimbursment ",97.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.91,198,
"EXC BENIGN LES 1.1-2.0CM T/A/L",5910245,"CDM ",960,RC,11402,HCPCS,OUTPATIENT,,,467,373.6,,112.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",223,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",112.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",112.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.1,223,
"EXC BENIGN LES 2.1-3.0CM T/A/L",5910250,"CDM ",960,RC,11403,HCPCS,OUTPATIENT,,,550.5,440.4,,126.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,468.70,468.70,468.70,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",126.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",255,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",126.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",126.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",126.52,255,
"EXC BENIGN LES 3.1-4.0CM T/A/L",5910255,"CDM ",960,RC,11404,HCPCS,OUTPATIENT,,,512.5,410,,144.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,842.47,258.27,1426.67,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",291,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",144.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",144.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.49,291,
"EXC BENIGN LES >4.0CM T/A/L",5910260,"CDM ",960,RC,11406,HCPCS,OUTPATIENT,,,624.5,499.6,,178.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",432,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",178.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1258.19,1258.19,1258.19,"1 through 10",other,"not separately reimbursment ",178.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.97,432,
"EXC BENIGN LES <0.5CM S/N/H/F",5910265,"CDM ",960,RC,11420,HCPCS,OUTPATIENT,,,227.5,182,,81.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,183.42,183.42,183.42,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",163,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",81.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",81.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.8,163,
"EXC BENIGN LES .6-1.0CM S/N/H",5910270,"CDM ",960,RC,11421,HCPCS,OUTPATIENT,,,304,243.2,,104.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",210,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",104.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",104.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.84,210,
"EXC BENIGN LES 1.1-2.0CM S/N",5910275,"CDM ",960,RC,11422,HCPCS,OUTPATIENT,,,353,282.4,,117.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",204.38,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",235,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",117.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",117.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.39,235,
"EXC BENIGN LES 2.1-3.0CM S/N",5910280,"CDM ",960,RC,11423,HCPCS,OUTPATIENT,,,418.5,334.8,,139.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",277,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",139.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",139.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.37,277,
"EXC BENIGN LES 3.1-4.0CM S/N",5910285,"CDM ",960,RC,11424,HCPCS,OUTPATIENT,,,527,421.6,,159.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",159.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",317,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",159.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",159.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",159.81,317,
"EXC BENIGN LES >4.0CM S/N/H/F",5910290,"CDM ",960,RC,11426,HCPCS,OUTPATIENT,,,825.5,660.4,,225.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1394.98,1394.98,1394.98,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",225.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",450,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",225.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",225.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",225.09,450,
"EXC BENIGN LES <.5CM F/E/N/L",5910295,"CDM ",960,RC,11440,HCPCS,OUTPATIENT,,,278,222.4,,96.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",191,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",96.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",96.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.25,191,
"EXC BENIGN LES .6-1.0CM F/E/N",5910300,"CDM ",960,RC,11441,HCPCS,OUTPATIENT,,,287.5,230,,114.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,20.57,20.57,20.57,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",227,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",114.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",114.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.2,227,
"EXC BENIGN LES 1.1-2.0CM F/E/N",5910305,"CDM ",960,RC,11442,HCPCS,OUTPATIENT,,,322.5,258,,128.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,360.64,360.64,360.64,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",255,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",128.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",128.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.23,255,
"EXC BENIGN LES 2.0-3.0CM F/E/N",5910310,"CDM ",960,RC,11443,HCPCS,OUTPATIENT,,,544.5,435.6,,157.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",313,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",157.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",157.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.76,313,
"EXC BENIGN LES 3.1-4.0CM F/E/N",5910315,"CDM ",960,RC,11444,HCPCS,OUTPATIENT,,,623,498.4,,201.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",201.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",401,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",201.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",201.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",201.81,401,
"EXC BENIGN LES >4.0CM F/E/N/L",5910320,"CDM ",960,RC,11446,HCPCS,OUTPATIENT,,,859,687.2,,262.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",538,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",262.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",262.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.68,538,
"EXC HIDRADENITIS/AXILLARY",5910325,"CDM ",960,RC,11450,HCPCS,OUTPATIENT,,,568,454.4,,232.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",232.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",525,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",232.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",232.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",232.92,525,
"EXC SWEAT GLAND LES COMPL",5910330,"CDM ",960,RC,11451,HCPCS,OUTPATIENT,,,724,579.2,,318.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",318.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",671,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",318.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",318.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",318.98,671,
"EXC SKIN HIDRA INGL W/COMP RPR",5910334,"CDM ",960,RC,11463,HCPCS,OUTPATIENT,,,719,575.2,,325.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,566.96,566.96,566.96,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",325.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",669,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",325.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",325.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",325.28,669,
"REMOVAL SWEAT GLAND LESION",5910335,"CDM ",960,RC,11470,HCPCS,OUTPATIENT,,,777,621.6,,251.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",251.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",572,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",251.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",251.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",251.47,572,
"EXC LES 0.5CM T/A/L MALIG",5910340,"CDM ",960,RC,11600,HCPCS,OUTPATIENT,,,425.5,340.4,,116.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",265,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",116.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",116.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.46,265,
"EXC LES 0.6-1.0CM T/A/L  MALIG",5910345,"CDM ",960,RC,11601,HCPCS,OUTPATIENT,,,500.5,400.4,,134.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",134.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",306,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",134.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",134.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",134.27,306,
"EXC LES 1.1-2.0CM T/A/L MALIG",5910350,"CDM ",960,RC,11602,HCPCS,OUTPATIENT,,,540.5,432.4,,142.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",334,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",142.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",142.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.31,334,
"EXC LES 2.1-3.0CM T/A/L MALIG",5910355,"CDM ",960,RC,11603,HCPCS,OUTPATIENT,,,604,483.2,,157.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",381,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",157.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",157.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.67,381,
"EXC LES 3.1-4.0CM T/A/L MALIG",5910360,"CDM ",960,RC,11604,HCPCS,OUTPATIENT,,,661,528.8,,173.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,77.23,77.23,77.23,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",435,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",173.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",173.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.48,435,
"EXC LES > 4CM T/A/L MALIG",5910365,"CDM ",960,RC,11606,HCPCS,OUTPATIENT,,,730,584,,228.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,320.96,320.96,320.96,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",228.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",623,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",228.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1219.81,1206.28,1233.34,"1 through 10",other,"not separately reimbursment ",228.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",228.28,623,
"EXC LES 0.5CM S/N/H/F MALIG",5910370,"CDM ",960,RC,11620,HCPCS,OUTPATIENT,,,414,331.2,,111.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",269,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",111.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",111.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.34,269,
"EXC LES .6-1.0 CM S/N/H MALIG",5910375,"CDM ",960,RC,11621,HCPCS,OUTPATIENT,,,418.5,334.8,,133.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",308,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",133.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",133.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.01,308,
"EXC LES 1.1-2.0CM S/N/H/F MAL",5910377,"CDM ",960,RC,11622,HCPCS,OUTPATIENT,,,454.5,363.6,,151.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",346,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",151.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",151.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.03,346,
"EXC LES 2.1-3.0CM S/N/H MALIG",5910380,"CDM ",960,RC,11623,HCPCS,OUTPATIENT,,,649.5,519.6,,178.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,113.87,113.87,113.87,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",406,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",178.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",178.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.99,406,
"EXC LES 3.1-4.0CM S/N/H MALIG",5910385,"CDM ",960,RC,11624,HCPCS,OUTPATIENT,,,689.5,551.6,,206.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,111.56,111.56,111.56,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",206.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",458,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",206.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1258.19,1258.19,1258.19,"1 through 10",other,"not separately reimbursment ",206.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",206.07,458,
"EXC LES >4CM S/N/H/F MALIG",5910390,"CDM ",960,RC,11626,HCPCS,OUTPATIENT,,,718,574.4,,273.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",555,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",273.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2753.62,2753.62,2753.62,"1 through 10",other,"not separately reimbursment ",273.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.46,555,
"EXC LES 0.5CM F/E/N/L MALIG",5910395,"CDM ",960,RC,11640,HCPCS,OUTPATIENT,,,402.5,322,,118.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",267,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",118.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",118.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.49,267,
"EXC LES .6-1.0CM F/E/N/L MALIG",5910400,"CDM ",960,RC,11641,HCPCS,OUTPATIENT,,,437.5,350,,155.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",321,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",155.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",155.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.35,321,
"EXC LES 1.1-2.0CM F/E/N MALIG",5910405,"CDM ",960,RC,11642,HCPCS,OUTPATIENT,,,465,372,,180.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,77.23,77.23,77.23,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",367,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",180.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",180.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.06,367,
"EXC LES 2.1-3.0CM F/E/N MALIG",5910410,"CDM ",960,RC,11643,HCPCS,OUTPATIENT,,,548,438.4,,208.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,115.52,115.52,115.52,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",208.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",435,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",208.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",208.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",208.76,435,
"EXC LES 3.1-4.0CM F/E/N MALIG",5910415,"CDM ",960,RC,11644,HCPCS,OUTPATIENT,,,676,540.8,,264.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",264.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",537,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",264.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",264.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",264.52,537,
"EXC LES > 4CM F/E/N/L MALIG",5910420,"CDM ",960,RC,11646,HCPCS,OUTPATIENT,,,1195.5,956.4,,360.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,210.59,210.59,210.59,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",360.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",716,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",360.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",360.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",360.25,716,
"TRIM NONDYSSTROPHIC NAIL",5910425,"CDM ",960,RC,11719,HCPCS,OUTPATIENT,,,36.5,29.2,,12.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.71,30,
"DEBRIDE NAIL 1-5",5910430,"CDM ",960,RC,11720,HCPCS,OUTPATIENT,,,67.5,54,,20.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.38,42,
"DEBRIDE NAIL >6",5910435,"CDM ",960,RC,11721,HCPCS,OUTPATIENT,,,96.5,77.2,,30.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",61,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",30.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.75,61,
"AVULSION NAIL PLATE SINGLE",5910440,"CDM ",960,RC,11730,HCPCS,OUTPATIENT,,,234,187.2,,67.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,157.01,157.01,157.01,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",135,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",67.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",67.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.21,135,
"AVULSION NAIL PLATE EA ADD",5910445,"CDM ",960,RC,11732,HCPCS,OUTPATIENT,,,98.5,78.8,,31.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",63,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",31.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",31.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.69,63,
"EVAC SUBUNGAL HEMATOMA",5910450,"CDM ",960,RC,11740,HCPCS,OUTPATIENT,,,84,67.2,,27.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,86.51,86.51,86.51,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",64,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",27.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",27.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.75,64,
"EXC NAIL PART/COMPL PERM",5910455,"CDM ",960,RC,11750,HCPCS,OUTPATIENT,,,488.5,390.8,,142.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",216.35,100,,238.35,238.35,238.35,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",307,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",142.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,106.41,106.41,106.41,"1 through 10",other,"not separately reimbursment ",142.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.39,307,
"BIOPSY OF NAIL UNIT",5910460,"CDM ",960,RC,11755,HCPCS,OUTPATIENT,,,296,236.8,,87.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",181,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",87.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",87.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.79,181,
"REPAIR OF NAIL BED",5910465,"CDM ",960,RC,11760,HCPCS,OUTPATIENT,,,478.5,382.8,,127.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1906.23,1906.23,1906.23,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",321,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",127.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",127.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.17,321,
"EXC WEDGE NAIL FOLD TOE",5910470,"CDM ",960,RC,11765,HCPCS,OUTPATIENT,,,430.5,344.4,,73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",227,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7,227,
"REMOVE PILONIDAL CYST SIMPLE",5910475,"CDM ",960,RC,11770,HCPCS,OUTPATIENT,,,879,703.2,,176.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",385,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",176.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",176.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.57,385,
"REMOVE PILONIDAL CYST EXTEN",5910480,"CDM ",960,RC,11771,HCPCS,OUTPATIENT,,,1318.5,1054.8,,353.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",353.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",791,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",353.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",353.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",353.55,791,
"EXC PILONIDAL CYST COMPLEX",5910485,"CDM ",960,RC,11772,HCPCS,OUTPATIENT,,,1332.5,1066,,447.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",447.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",963,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",447.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",447.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",447.38,963,
"REMOVE IMPLANT CONTRACPTIVE",5910490,"CDM ",960,RC,11976,HCPCS,OUTPATIENT,,,323.5,258.8,,108.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",215,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",108.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",108.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.32,215,
"BIOTE PELLET INSERT FEMALE",5910492,"CDM ",960,RC,11980,HCPCS,OUTPATIENT,,,375,300,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",197,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",197,197,
"BIOTE PELLET INSERT MALE",5910493,"CDM ",960,RC,11980,HCPCS,OUTPATIENT,,,775,620,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",197,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",197,197,
"INSERT DRG IMPLANT DEVICE",5910495,"CDM ",960,RC,11981,HCPCS,OUTPATIENT,,,237,189.6,,51.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,195.79,195.79,195.79,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",195,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,105.67,105.67,105.67,"1 through 10",other,"not separately reimbursment ",51.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.47,195,
"BIOTE PELLET INSRT MALE SM DS",5910499,"CDM ",960,RC,11980,HCPCS,OUTPATIENT,,,600,480,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",197,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",197,197,
"REMOVE DRG IMPLANT DEVICE",5910500,"CDM ",960,RC,11982,HCPCS,OUTPATIENT,,,385.5,308.4,,60.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,182.75,182.75,182.75,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",228,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",60.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,120.02,120.02,120.02,"1 through 10",other,"not separately reimbursment ",60.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.46,228,
"REMOVE/INSERT DRG IMPLANT DEV",5910505,"CDM ",960,RC,11983,HCPCS,OUTPATIENT,,,523,418.4,,104.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",348,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",104.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",104.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.9,348,
"REPAIR LACERATION <2.5CM SIMP",5910510,"CDM ",960,RC,12001,HCPCS,OUTPATIENT,,,200,160,,111.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,420.48,420.48,420.48,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",222,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",111.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",111.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.9,222,
"REPAIR LACERATION 2.6-7.5CM",5910515,"CDM ",960,RC,12002,HCPCS,OUTPATIENT,,,330.5,264.4,,119.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",237,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",119.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",119.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.05,237,
"REPAIR LACERATION 7.6-12.5CM",5910520,"CDM ",960,RC,12004,HCPCS,OUTPATIENT,,,302,241.6,,139.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",277,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",139.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",139.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.65,277,
"REPAIR LACERATION 12.6-20.0CM",5910525,"CDM ",960,RC,12005,HCPCS,OUTPATIENT,,,328,262.4,,174.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",346,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",174.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",174.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174.35,346,
"RPR LACERATION FACE <2.5 CM",5910530,"CDM ",960,RC,12011,HCPCS,OUTPATIENT,,,255,204,,118.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,359.50,359.50,359.50,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",235,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",118.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",118.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.16,235,
"RPR LACERATION FACE 2.6-5.0CM",5910535,"CDM ",960,RC,12013,HCPCS,OUTPATIENT,,,436,348.8,,129.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,547.40,547.40,547.40,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",258,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",129.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",129.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.73,258,
"RPR LACERATION FACE 5.1-7.5CM",5910540,"CDM ",960,RC,12014,HCPCS,OUTPATIENT,,,330.5,264.4,,153.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",306,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",153.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",153.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.94,306,
"RPR LACERATION FACE 7.6-12.5CM",5910543,"CDM ",960,RC,12015,HCPCS,OUTPATIENT,,,345,276,,193.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",193.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",385,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",193.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",193.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",193.76,385,
"TX WOUND DEHIS SIMPLE CLOSE",5910545,"CDM ",960,RC,12020,HCPCS,OUTPATIENT,,,636.5,509.2,,195.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",195.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",388,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",195.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",195.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",195.11,388,
"TX WOUND DEHIS W/PACKING",5910550,"CDM ",960,RC,12021,HCPCS,OUTPATIENT,,,472.5,378,,113.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",237,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",113.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",113.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.93,237,
"RPR INTERM <2.5CM S/A/T/E",5910555,"CDM ",960,RC,12031,HCPCS,OUTPATIENT,,,533.5,426.8,,134.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,112.22,112.22,112.22,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",134.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",318,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",134.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",134.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",134.81,318,
"RPR INTERM 2.6-7.5CM S/A/T/E",5910560,"CDM ",960,RC,12032,HCPCS,OUTPATIENT,,,797,637.6,,187.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",409,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",187.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",187.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.76,409,
"RPR INTERM 7.6-12.5CM S/A/T/E",5910565,"CDM ",960,RC,12034,HCPCS,OUTPATIENT,,,825.5,660.4,,186.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",186.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",431,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",186.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",186.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",186.01,431,
"RPR INTERM 12.5-20.0CM S/A/T",5910570,"CDM ",960,RC,12035,HCPCS,OUTPATIENT,,,851.5,681.2,,260.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",260.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",536,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",260.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",260.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",260.47,536,
"RPR INTERM <2.5CM N/H/F/G",5910575,"CDM ",960,RC,12041,HCPCS,OUTPATIENT,,,359,287.2,,149.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",334,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",149.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",149.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.37,334,
"RPR INTERM 2.6-7.5CM N/H/F/G",5910580,"CDM ",960,RC,12042,HCPCS,OUTPATIENT,,,628,502.4,,180.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",299.25,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",390,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",180.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",180.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.46,390,
"RPR INTERM 7.6-12.5CM N/H/F",5910585,"CDM ",960,RC,12044,HCPCS,OUTPATIENT,,,578,462.4,,193.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",193.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",496,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",193.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",193.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",193.94,496,
"RPR INTERM <2.5CM F/E/N/L",5910590,"CDM ",960,RC,12051,HCPCS,OUTPATIENT,,,574,459.2,,172.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,86.48,86.48,86.48,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",358,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",172.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",172.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.92,358,
"RPR INTERM 2.6-5.0CM F/E/N/L",5910595,"CDM ",960,RC,12052,HCPCS,OUTPATIENT,,,747.5,598,,180.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",406,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",180.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",180.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.3,406,
"RPR INTERMED F/E/E/N 5.1-7.5CM",5910597,"CDM ",960,RC,12053,HCPCS,OUTPATIENT,,,460,368,,212.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",212.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",478,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",212.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",212.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",212.47,478,
"RPR COMPL 1.1-2.5CM TRUNK",5910600,"CDM ",960,RC,13100,HCPCS,OUTPATIENT,,,956.5,765.2,,216.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",216.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",460,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",216.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",216.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",216.29,460,
"RPR COMPL 2.6-7.5CM TRUNK",5910605,"CDM ",960,RC,13101,HCPCS,OUTPATIENT,,,1100.5,880.4,,258.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",258.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",539,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",258.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",258.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",258.02,539,
"RPR COMPL TRUNK EA ADD 5CM",5910610,"CDM ",960,RC,13102,HCPCS,OUTPATIENT,,,247,197.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",169,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",169,169,
"COMPLEX RPR S/A/L 1.1-2.5CM",5910613,"CDM ",960,RC,13120,HCPCS,OUTPATIENT,,,621,496.8,,224.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",224.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",483,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",224.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",224.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",224.44,483,
"RPR COMPL 2.6-7.5CM S/A/L",5910615,"CDM ",960,RC,13121,HCPCS,OUTPATIENT,,,928.5,742.8,,275.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",275.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",601,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",275.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1172.38,1172.38,1172.38,"1 through 10",other,"not separately reimbursment ",275.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",275.95,601,
"RPR COMPL S/A/L EA ADD 5CM",5910620,"CDM ",960,RC,13122,HCPCS,OUTPATIENT,,,281.5,225.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",180,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,1345.66,1345.66,1345.66,"1 through 10",other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180,180,
"RPR COMPL  2.6CM-7.5CM F/C/M/N",5910625,"CDM ",960,RC,13132,HCPCS,OUTPATIENT,,,1160,928,,357.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2661.01,2661.01,2661.01,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",357.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",790,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",357.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",357.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",357.81,790,
"RPR COMPL F/C/M/N EA ADD 5CM",5910630,"CDM ",960,RC,13133,HCPCS,OUTPATIENT,,,299,239.2,,118.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2661.01,2661.01,2661.01,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",247,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",118.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",118.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.89,247,
"RPR COMPL 1.1-2.5CM E/N/E/L",5910635,"CDM ",960,RC,13151,HCPCS,OUTPATIENT,,,1182,945.6,,279.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1640.80,1640.80,1640.80,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",279.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",583,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",279.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",279.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",279.7,583,
"RPR COMPL 2.6-7.5CM E/N/E/L",5910640,"CDM ",960,RC,13152,HCPCS,OUTPATIENT,,,1225.5,980.4,,375.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",375.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",770,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",375.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",375.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",375.18,770,
"RPR WOUND EXTEN/COMPLEX",5910645,"CDM ",960,RC,13160,HCPCS,OUTPATIENT,,,1674,1339.2,,562.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1069.31,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",562.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1133,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",562.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",562.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",562.58,1133,
"TISS TRNFR <10SQCM TRUNK",5910650,"CDM ",960,RC,14000,HCPCS,OUTPATIENT,,,1752.5,1402,,415.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",415.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",866,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",415.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",415.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",415.94,866,
"TISS TRNFR 10.1-30.0SQCM TRUNK",5910655,"CDM ",960,RC,14001,HCPCS,OUTPATIENT,,,1517.5,1214,,545.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",545.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1129,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",545.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,117.60,117.60,117.60,"1 through 10",other,"not separately reimbursment ",545.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",545.74,1129,
"TISS TRNFR <10SQCM  S/A/L",5910660,"CDM ",960,RC,14020,HCPCS,OUTPATIENT,,,1255.5,1004.4,,460.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",460.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",966,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",460.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",460.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",460.11,966,
"TISS TRNFR 10.1-30.0SCM  S/A/L",5910665,"CDM ",960,RC,14021,HCPCS,OUTPATIENT,,,1644,1315.2,,611,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",611,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1273,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",611,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",611,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6,1273,
"TISS TRNFR  < 10CM F/C/M/N",5910670,"CDM ",960,RC,14040,HCPCS,OUTPATIENT,,,1642,1313.6,,505.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,983.60,983.60,983.60,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",505.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1059,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",505.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1432.59,1432.59,1432.59,"1 through 10",other,"not separately reimbursment ",505.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",505.46,1059,
"TISS TRNFR <10SQCM E/N/E/L",5910675,"CDM ",960,RC,14060,HCPCS,OUTPATIENT,,,1494.5,1195.6,,526.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,252.17,252.17,252.17,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",526.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1079,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",526.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",526.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",526.11,1079,
"SUR PREP CHILD <100SQCM T/A/L",5910680,"CDM ",960,RC,15002,HCPCS,OUTPATIENT,,,598,478.4,,228.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,358.31,358.31,358.31,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",228.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",483,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",228.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",228.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",228.79,483,
"SUR PREP CHILD <100SQCM F/S/E",5910685,"CDM ",960,RC,15004,HCPCS,OUTPATIENT,,,604.5,483.6,,275.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",275.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",550,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",275.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,297.09,297.09,297.09,"1 through 10",other,"not separately reimbursment ",275.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",275.69,550,
"HARVEST SKIN AUTOGRAFT <100SQ",5910690,"CDM ",960,RC,15040,HCPCS,OUTPATIENT,,,390.5,312.4,,194.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",194.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",387,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",194.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",194.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",194.68,387,
"SPLT THICK GRFT<100SQCM",5910695,"CDM ",960,RC,15100,HCPCS,OUTPATIENT,,,1479,1183.2,,662.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1009.97,1009.97,1009.97,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",662.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1316,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",662.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",662.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",662.31,1316,
"EPID GRFT CHILD <100SQCM T/A/L",5910700,"CDM ",960,RC,15110,HCPCS,OUTPATIENT,,,1895.5,1516.4,,624.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",624.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1241,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",624.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",624.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",624.42,1241,
"EPID GRFT CHILD <100SQCM F/S/E",5910705,"CDM ",960,RC,15115,HCPCS,OUTPATIENT,,,1650.5,1320.4,,590.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",590.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1207,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",590.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",590.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",590.47,1207,
"SPLT GRFT CHILD <100SQCM F/S/E",5910710,"CDM ",960,RC,15120,HCPCS,OUTPATIENT,,,1937,1549.6,,632.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,111.56,111.56,111.56,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",632.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1278,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",632.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",632.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",632.46,1278,
"DERM GRFT <100SQCM T/A/L",5910715,"CDM ",960,RC,15130,HCPCS,OUTPATIENT,,,1530.5,1224.4,,515.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",515.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1024,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",515.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",515.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",515.63,1024,
"FULL THICK GRAFT <20SQCM F/C/M",5910720,"CDM ",960,RC,15240,HCPCS,OUTPATIENT,,,2114,1691.2,,587.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,209.26,209.26,209.26,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",587.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1296,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",587.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1432.59,1432.59,1432.59,"1 through 10",other,"not separately reimbursment ",587.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",587.78,1296,
"FULL THICK GRFT <20 SQCM N/E/L",5910725,"CDM ",960,RC,15260,HCPCS,OUTPATIENT,,,1908.5,1526.8,,614.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,115.52,115.52,115.52,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",614.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1407,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",614.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",614.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",614.63,1407,
"APPLY SKIN GRAFT <25QCM T/A/L",5910730,"CDM ",960,RC,15271,HCPCS,OUTPATIENT,,,290,232,,62.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",196,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",62.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",62.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.68,196,
"APPLY SKIN GRAFT EA ADD 25SQCM",5910735,"CDM ",960,RC,15272,HCPCS,OUTPATIENT,,,74.5,59.6,,7.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,3.04,3.04,3.04,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",37,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",7.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",7.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.71,37,
"SKIN GRFT CHILD <25QCM T/A/L",5910740,"CDM ",960,RC,15273,HCPCS,OUTPATIENT,,,670,536,,92.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",405,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",92.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",92.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.61,405,
"SKIN  GRFT CHILD EA ADD 25SQCM",5910745,"CDM ",960,RC,15274,HCPCS,OUTPATIENT,,,160.5,128.4,,19.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",95,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.71,95,
"SKIN GRAFT <25SQCM F/S/E/M/N",5910750,"CDM ",960,RC,15275,HCPCS,OUTPATIENT,,,281.5,225.2,,45.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",211,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",45.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",45.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.18,211,
"SKIN GRAFT EA ADD 25SQCM F/S/E",5910755,"CDM ",960,RC,15276,HCPCS,OUTPATIENT,,,74.5,59.6,,11.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1497.91,1497.91,1497.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",11.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",11.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,46,
"RPR GRFT DONOR SITE F/C/M/N/A",5910760,"CDM ",960,RC,15574,HCPCS,OUTPATIENT,,,1684,1347.2,,633.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",633.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1259,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",633.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",633.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",633.84,1259,
"RPR GRFT DONOR SITE E/N/E/L",5910765,"CDM ",960,RC,15576,HCPCS,OUTPATIENT,,,1483.5,1186.8,,563.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",563.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1119,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",563.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",563.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",563.2,1119,
"DELAY FLAP F/C/N/A/G",5910770,"CDM ",960,RC,15620,HCPCS,OUTPATIENT,,,713,570.4,,316.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",316.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",629,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",316.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",316.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",316.02,629,
"SKIN GRAFT MUSCLE TRUNK",5910775,"CDM ",960,RC,15734,HCPCS,OUTPATIENT,,,3339.5,2671.6,,1120.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1120.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2225,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1120.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1120.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,2225,
"SKIN GRAFT MUSCLE LOW EXT",5910780,"CDM ",960,RC,15738,HCPCS,OUTPATIENT,,,2897,2317.6,,1121.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1121.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2227,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1121.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1121.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1121.17,2227,
"DRESSING CHANGE W/ANESTH",5910785,"CDM ",960,RC,15852,HCPCS,OUTPATIENT,,,144,115.2,,80.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",159,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",80.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.23,159,
"EXC COCCYGEAL PR ULC W/SUTR",5910790,"CDM ",960,RC,15920,HCPCS,OUTPATIENT,,,1345.5,1076.4,,427.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",427.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",849,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",427.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",427.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",427.42,849,
"EXC SACRUM PRESS SORE W/SUTR",5910795,"CDM ",960,RC,15931,HCPCS,OUTPATIENT,,,1566.5,1253.2,,476.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",476.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",946,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",476.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",476.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",476.39,946,
"EXC SACRUM PRESS SORE W/FLAP",5910800,"CDM ",960,RC,15934,HCPCS,OUTPATIENT,,,2122.5,1698,,661.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",661.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1315,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",661.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",661.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",661.9,1315,
"EXC SACRUM PRESS SORE W/OSTEC",5910805,"CDM ",960,RC,15935,HCPCS,OUTPATIENT,,,2493,1994.4,,791.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",791.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1572,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",791.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",791.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",791.39,1572,
"EXC SACRUM PRESS ULC PREP GRFT",5910810,"CDM ",960,RC,15936,HCPCS,OUTPATIENT,,,2033,1626.4,,656.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",656.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1348,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",656.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",656.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",656.67,1348,
"EXC SAC PR ULC PREP GRFT W/OST",5910815,"CDM ",960,RC,15937,HCPCS,OUTPATIENT,,,2361,1888.8,,720.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",720.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1658,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",720.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",720.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",720.19,1658,
"EXC ISCHIAL PRESS ULC W/SUTR",5910820,"CDM ",960,RC,15940,HCPCS,OUTPATIENT,,,1535,1228,,494.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",494.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",982,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",494.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",494.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",494.44,982,
"EXC ISCHIAL PRESS ULC PREP GFT",5910825,"CDM ",960,RC,15946,HCPCS,OUTPATIENT,,,3604,2883.2,,1147.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1147.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2292,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1147.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1147.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1147.87,2292,
"EXC THIGH PRESS ULCER W/SUTR",5910830,"CDM ",960,RC,15950,HCPCS,OUTPATIENT,,,1315,1052,,410.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",410.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",816,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",410.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",410.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",410.66,816,
"INITIAL TX FIRST DEGREE BURN",5910835,"CDM ",960,RC,16000,HCPCS,OUTPATIENT,,,115,92,,53.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",106,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",53.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",53.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.59,106,
"DRESS/DEBRIDE BURN <5% BODY",5910840,"CDM ",960,RC,16020,HCPCS,OUTPATIENT,,,218.5,174.8,,62.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,98.42,98.42,98.42,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",124,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",62.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",62.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.64,124,
"DRESS/DEBRIDE BURN 5-10% BODY",5910845,"CDM ",960,RC,16025,HCPCS,OUTPATIENT,,,371.5,297.2,,111.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",221,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",111.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",111.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.45,221,
"DRESS/DEBRIDE >10% BODY SURF",5910850,"CDM ",960,RC,16030,HCPCS,OUTPATIENT,,,419.5,335.6,,131.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",261,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",131.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",131.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.15,261,
"INCISION BURN INITIAL",5910855,"CDM ",960,RC,16035,HCPCS,OUTPATIENT,,,586.5,469.2,,152.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",381,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",152.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",152.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.19,381,
"DEST PREMALIG LESION 1ST",5910860,"CDM ",960,RC,17000,HCPCS,OUTPATIENT,,,213.5,170.8,,46.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",109,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",46.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",46.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.37,109,
"DEST PREMALIG LESIONS EA ADD 1",5910861,"CDM ",960,RC,17003,HCPCS,OUTPATIENT,,,48.5,38.8,,7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",16,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.99,16,
"DEST PREMALIG LESIONS EA ADD 2",5910862,"CDM ",960,RC,17003,HCPCS,OUTPATIENT,,,92.5,74,,7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",16,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.99,16,
"DEST PREMALIG LESIONS EA ADD 3",5910863,"CDM ",960,RC,17003,HCPCS,OUTPATIENT,,,126.5,101.2,,7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",16,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.99,16,
"DEST PREMALIG LESIONS EA ADD 4",5910864,"CDM ",960,RC,17003,HCPCS,OUTPATIENT,,,144,115.2,,7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",16,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.99,16,
"DEST PREMALIG LESIONS 2-14",5910865,"CDM ",960,RC,17003,HCPCS,OUTPATIENT,,,48.5,38.8,,7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",16,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.99,16,
"DEST PREMALIG LESIONS EA ADD 5",5910866,"CDM ",960,RC,17003,HCPCS,OUTPATIENT,,,158,126.4,,7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",16,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.99,16,
"DEST PREMALIG LESIONS EA ADD 6",5910867,"CDM ",960,RC,17003,HCPCS,OUTPATIENT,,,168.5,134.8,,7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",16,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.99,16,
"DEST PREMALIG LESIONS EA ADD 7",5910868,"CDM ",960,RC,17003,HCPCS,OUTPATIENT,,,180,144,,7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",16,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.99,16,
"DEST PREMALIG LESIONS EA ADD 8",5910869,"CDM ",960,RC,17003,HCPCS,OUTPATIENT,,,190,152,,7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",16,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.99,16,
"DEST PREMALIG LESIONS >15",5910870,"CDM ",960,RC,17004,HCPCS,OUTPATIENT,,,329,263.2,,154.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",306,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",154.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",154.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154.15,306,
"DEST PREMALIG LESIONS EA ADD 9",5910871,"CDM ",960,RC,17003,HCPCS,OUTPATIENT,,,200,160,,7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",16,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.99,16,
"DEST PREMALIG LESION EA ADD 11",5910873,"CDM ",960,RC,17003,HCPCS,OUTPATIENT,,,223.5,178.8,,7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",16,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.99,16,
"DEST PREMALIG LESION EA ADD 12",5910874,"CDM ",960,RC,17003,HCPCS,OUTPATIENT,,,235,188,,7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",16,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.99,16,
"DEST BENIGN LESION <14",5910875,"CDM ",960,RC,17110,HCPCS,OUTPATIENT,,,251.5,201.2,,66.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",148,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",66.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",66.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.36,148,
"DEST PREMALIG LESION EA ADD 13",5910876,"CDM ",960,RC,17003,HCPCS,OUTPATIENT,,,246.5,197.2,,7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",16,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",7.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.99,16,
"DEST BENIGN LESIONS >15",5910880,"CDM ",960,RC,17111,HCPCS,OUTPATIENT,,,287.5,230,,76.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,530.97,530.97,530.97,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",176,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",76.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",76.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.24,176,
"CHEMICAL CAUTERY TISSUE",5910885,"CDM ",960,RC,17250,HCPCS,OUTPATIENT,,,180,144,,50.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,88.32,88.32,88.32,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",104,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",50.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",50.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.81,104,
"DEST MALIG LESION <.5CM T/A/L",5910890,"CDM ",960,RC,17260,HCPCS,OUTPATIENT,,,189,151.2,,64.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",129,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",64.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.92,129,
"DEST MALIG LES .6-1.0CM T/A/L",5910895,"CDM ",960,RC,17261,HCPCS,OUTPATIENT,,,278,222.4,,82.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",194,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",82.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",82.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.45,194,
"DEST MALIG LES 1.1-2.0CM T/A/L",5910900,"CDM ",960,RC,17262,HCPCS,OUTPATIENT,,,383,306.4,,103.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",236,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",103.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",103.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.32,236,
"DEST MALIG LES 2.1-3.0CM T/A/L",5910905,"CDM ",960,RC,17263,HCPCS,OUTPATIENT,,,440.5,352.4,,114.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",259,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",114.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",114.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.86,259,
"DEST MALIG LES 3.1-4.0CM T/A/L",5910910,"CDM ",960,RC,17264,HCPCS,OUTPATIENT,,,488.5,390.8,,124.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",278,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",124.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",124.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.5,278,
"DEST MALIG LES > 4.0CM T/A/L",5910915,"CDM ",960,RC,17266,HCPCS,OUTPATIENT,,,276,220.8,,145.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",145.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",325,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",145.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",145.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",145.06,325,
"DEST MALIG LES <0.5CM S/N/H/F",5910920,"CDM ",960,RC,17270,HCPCS,OUTPATIENT,,,239.5,191.6,,89.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",89.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",203,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",89.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",89.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",89.66,203,
"DEST MALIG LES 0.6-1.0CM S/N/H",5910925,"CDM ",960,RC,17271,HCPCS,OUTPATIENT,,,359,287.2,,97.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",221,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",97.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",97.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.45,221,
"DEST MALIG LES 1.1-2.0CM S/N/H",5910930,"CDM ",960,RC,17272,HCPCS,OUTPATIENT,,,413,330.4,,112.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",253,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",112.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",112.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.57,253,
"DEST MALIG LES 2.1-3.0CM S/N/H",5910935,"CDM ",960,RC,17273,HCPCS,OUTPATIENT,,,461,368.8,,127.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",282,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",127.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",127.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.41,282,
"DEST MALIG LES 3.1-4.0CM S/N/H",5910940,"CDM ",960,RC,17274,HCPCS,OUTPATIENT,,,540.5,432.4,,154.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",334,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",154.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",154.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154.81,334,
"DEST MALIG LES >4.0CM S/N/H/F",5910945,"CDM ",960,RC,17276,HCPCS,OUTPATIENT,,,627,501.6,,185.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",185.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",389,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",185.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",185.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",185.87,389,
"DEST MALIG LES <0.5CM F/E/N/E",5910950,"CDM ",960,RC,17280,HCPCS,OUTPATIENT,,,311.5,249.2,,89.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",89.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",190,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",89.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",89.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",89.62,190,
"DEST MALIG LES 0.6-1.0CM F/E/N",5910955,"CDM ",960,RC,17281,HCPCS,OUTPATIENT,,,395,316,,114.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",241,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",114.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",114.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.37,241,
"DEST MALIG LES 1.1-2.0CM F/E/N",5910960,"CDM ",960,RC,17282,HCPCS,OUTPATIENT,,,455,364,,132.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",277,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",132.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",132.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.62,277,
"DEST MALIG LES 2.1-3.0CM F/E/N",5910965,"CDM ",960,RC,17283,HCPCS,OUTPATIENT,,,550.5,440.4,,161.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",161.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",336,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",161.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",161.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",161.11,336,
"DEST MALIG LES 3.1-4.0CM F/E/N",5910970,"CDM ",960,RC,17284,HCPCS,OUTPATIENT,,,615.5,492.4,,188.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",391,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",188.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",188.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.46,391,
"DEST MALIG LES > 4.0CM F/E/N/E",5910975,"CDM ",960,RC,17286,HCPCS,OUTPATIENT,,,787.5,630,,246.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",246.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",509,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",246.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",246.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",246.34,509,
"MASTOTOMY ABSCESS DEEP",5910980,"CDM ",960,RC,19020,HCPCS,OUTPATIENT,,,694,555.2,,297.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",297.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",657,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",297.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",297.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",297.74,657,
"BX BREAST W/DEVICE 1ST LESION",5910985,"CDM ",960,RC,19081,HCPCS,OUTPATIENT,,,1038.5,830.8,,85.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",903,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.7,903,
"BX BREAST W/DEV EA ADD LESION",5910990,"CDM ",960,RC,19082,HCPCS,OUTPATIENT,,,835,668,,41.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",726,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",41.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",41.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4,726,
"BX BREAST W/DEV 1ST LES W/US",5910995,"CDM ",960,RC,19083,HCPCS,OUTPATIENT,,,1030,824,,80.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",896,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",80.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.35,896,
"BX BREAST EA ADD LES W/IMAGE",5910997,"CDM ",960,RC,19084,HCPCS,OUTPATIENT,,,799,639.2,,38.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,608.28,608.28,608.28,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",716,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",38.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",38.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.6,716,
"BX BREAST PERCUT WO IMAGE",5911000,"CDM ",960,RC,19100,HCPCS,OUTPATIENT,,,263.5,210.8,,101.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",201,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",101.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",101.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.36,201,
"BX BREAST OPEN",5911005,"CDM ",960,RC,19101,HCPCS,OUTPATIENT,,,502.5,402,,233.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",233.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",475,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",233.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",233.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",233.57,475,
"NIPPLE EXPLORE EXC DUCT",5911010,"CDM ",960,RC,19110,HCPCS,OUTPATIENT,,,765.5,612.4,,308.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",308.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",679,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",308.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",308.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",308.51,679,
"EXC BREAST LESION OPEN",5911015,"CDM ",960,RC,19120,HCPCS,OUTPATIENT,,,1145.5,916.4,,316.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",582.61,100,,3653.56,3653.56,3653.56,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",316.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",685,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",316.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",316.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",316.98,685,
"EXC BREAST LESION MARKER PLMT",5911020,"CDM ",960,RC,19125,HCPCS,OUTPATIENT,,,1202,961.6,,340.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",644.26,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",340.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",761,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",340.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",340.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",340.94,761,
"EXC BREAST LES MKR PLMT EA ADD",5911025,"CDM ",960,RC,19126,HCPCS,OUTPATIENT,,,562.5,450,,128.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",255,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",128.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",128.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.47,255,
"MASTECTOMY PARTIAL",5911030,"CDM ",960,RC,19301,HCPCS,OUTPATIENT,,,1780,1424,,406.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,117.50,117.50,117.50,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",406.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",909,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",406.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",406.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",406.24,909,
"MASTECTOMY PART W/LYMPH",5911035,"CDM ",960,RC,19302,HCPCS,OUTPATIENT,,,2033,1626.4,,596.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",596.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1253,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",596.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",596.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",596.05,1253,
"MASTECTOMY SIMPLE COMPLETE",5911040,"CDM ",960,RC,19303,HCPCS,OUTPATIENT,,,2551.5,2041.2,,627.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",627.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1409,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",627.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",627.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",627.21,1409,
"MASTECTOMY MODIFIED RADICAL",5911045,"CDM ",960,RC,19307,HCPCS,OUTPATIENT,,,3008.5,2406.8,,778.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",778.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1667,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",778.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",778.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",778.8,1667,
"EXPLORE WOUND NECK",5911055,"CDM ",960,RC,20100,HCPCS,OUTPATIENT,,,1375,1100,,423.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",423.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",929,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",423.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",423.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",423.81,929,
"EXPLORE WOUND ABDOMEN",5911060,"CDM ",960,RC,20102,HCPCS,OUTPATIENT,,,1179,943.2,,341.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",341.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",679,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",341.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",341.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",341.52,679,
"EXPLORE WOUND EXTREMITY",5911065,"CDM ",960,RC,20103,HCPCS,OUTPATIENT,,,1628.5,1302.8,,421.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",421.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",837,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",421.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",421.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",421.17,837,
"BX MUSCLE DEEP",5911070,"CDM ",960,RC,20205,HCPCS,OUTPATIENT,,,335.5,268.4,,189.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",189.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",401,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",189.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",189.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",189.23,401,
"BX MUSCLE PERCUT NEEDLE",5911075,"CDM ",960,RC,20206,HCPCS,OUTPATIENT,,,527,421.6,,212.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",212.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",423,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",212.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",212.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",212.92,423,
"BX BONE OPEN SUPERFICIAL",5911080,"CDM ",960,RC,20240,HCPCS,OUTPATIENT,,,341,272.8,,182.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",182.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",362,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",182.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",182.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",182.39,362,
"BX BONE OPEN DEEP",5911085,"CDM ",960,RC,20245,HCPCS,OUTPATIENT,,,977.5,782,,456.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",456.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",907,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",456.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",456.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",456.39,907,
"REMOVE FB MUSCLE/TENDON SIMPLE",5911090,"CDM ",960,RC,20520,HCPCS,OUTPATIENT,,,449,359.2,,143.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,519.99,519.99,519.99,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",143.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",285,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",143.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",143.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",143.68,285,
"REMOVE FB MUSCLE/TENDON CMPLX",5911095,"CDM ",960,RC,20525,HCPCS,OUTPATIENT,,,999,799.2,,374.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",374.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",745,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",374.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,4204.83,4204.83,4204.83,"1 through 10",other,"not separately reimbursment ",374.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",374.82,745,
"INJ THERAPEUTIC CARPAL TUNNEL",5911100,"CDM ",960,RC,20526,HCPCS,OUTPATIENT,,,169.5,135.6,,59.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",118,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",59.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",59.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.34,118,
"INJ ENZYME DUPUYTREN CORD",5911105,"CDM ",960,RC,20527,HCPCS,OUTPATIENT,,,180,144,,26.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",116,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",26.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",26.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.33,116,
"INJ TENDON SHEATH/LIGAMENT",5911110,"CDM ",960,RC,20550,HCPCS,OUTPATIENT,,,132,105.6,,45.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",90,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",45.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",45.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.27,90,
"INJ TENDON ORIGIN/INSERTION",5911115,"CDM ",960,RC,20551,HCPCS,OUTPATIENT,,,132,105.6,,44.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",88,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",44.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.21,88,
"INJ TRIGGER POINT 1-2 MUSCLES",5911120,"CDM ",960,RC,20552,HCPCS,OUTPATIENT,,,138,110.4,,41.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",84,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",41.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,47.19,47.19,47.19,"1 through 10",other,"not separately reimbursment ",41.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.8,84,
"INJ TRIGGER POINT >3 MUSCLES",5911125,"CDM ",960,RC,20553,HCPCS,OUTPATIENT,,,149.5,119.6,,47.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",95.7,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",47.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",47.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.17,95.7,
"PLACE NDL MUSC/TIS FOR RT",5911130,"CDM ",960,RC,20555,HCPCS,OUTPATIENT,,,702.5,562,,236.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",236.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",494,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",236.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",236.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",236.22,494,
"DRAIN/INJ JOINT/BURSA SMALL",5911135,"CDM ",960,RC,20600,HCPCS,OUTPATIENT,,,126,100.8,,40.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",81,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",40.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",40.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.55,81,
"DRAIN/INJ JNT/BURSA SM W/US",5911140,"CDM ",960,RC,20604,HCPCS,OUTPATIENT,,,168.5,134.8,,28.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",100,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",28.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",28.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.72,100,
"DRAIN/INJ JNT/BURSA INTERMED",5911145,"CDM ",960,RC,20605,HCPCS,OUTPATIENT,,,215.5,172.4,,44.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",88,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",44.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.22,88,
"DRAIN/INJ JNT/BURSA INTRM W/US",5911150,"CDM ",960,RC,20606,HCPCS,OUTPATIENT,,,183.5,146.8,,32.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",110,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",32.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.55,110,
"DRAIN/INJ JOINT/BURSA MAJOR",5911155,"CDM ",960,RC,20610,HCPCS,OUTPATIENT,,,228.5,182.8,,53.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.83,100,,11.66,11.66,11.66,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",107,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",53.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,35.16,16.84,51.43,"1 through 10",other,"not separately reimbursment ",53.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.61,107,
"DRAIN/INJ JNT/BURSA  MJR W/US",5911160,"CDM ",960,RC,20611,HCPCS,OUTPATIENT,,,258,206.4,,38.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",127,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",38.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",38.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3,127,
"DRAIN/INJ GANGLION CYST",5911165,"CDM ",960,RC,20612,HCPCS,OUTPATIENT,,,117.5,94,,43.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",87,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",43.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",43.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.92,87,
"REMOVE IMPLANT DEEP",5911170,"CDM ",960,RC,20680,HCPCS,OUTPATIENT,,,897,717.6,,361.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",459.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",361.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",863,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",361.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",361.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",361.28,863,
"REMOVE BONE FIXATION DEVICE",5911175,"CDM ",960,RC,20694,HCPCS,OUTPATIENT,,,747.5,598,,344.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",344.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",685,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",344.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",344.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",344.59,685,
"REPLANT DIGIT COMPLETE AMP",5911180,"CDM ",960,RC,20822,HCPCS,OUTPATIENT,,,3931.5,3145.2,,1511.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1511.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",3691,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1511.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1511.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1511.13,3691,
"BONE GRFT DONOR MINOR",5911185,"CDM ",960,RC,20900,HCPCS,OUTPATIENT,,,414,331.2,,430.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",430.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",855,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",430.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",430.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",430.15,855,
"BONE GRFT DONOR MAJOR",5911190,"CDM ",960,RC,20902,HCPCS,OUTPATIENT,,,646.5,517.2,,457.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",457.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",909,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",457.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",457.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",457.49,909,
"SPINE BONE ALGRFT MORESEL",5911193,"CDM ",960,RC,20930,HCPCS,OUTPATIENT,,,1490.5,1192.4,,804,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",804,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",151,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",804,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",804,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8,804,
"OSTEOART ALGRFT W/SURF BONE",5911195,"CDM ",960,RC,20932,HCPCS,OUTPATIENT,,,1598.5,1278.8,,451.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",451.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1007,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",451.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",451.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",451.24,1007,
"SPINE BONE AUTOGRAFT MORSEL",5911197,"CDM ",960,RC,20937,HCPCS,OUTPATIENT,,,451,360.8,,123.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",321,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",123.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",123.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.65,321,
"ASP BONE MARROW SP SX",5911199,"CDM ",960,RC,20939,HCPCS,OUTPATIENT,,,165,132,,41.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",94,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",41.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",41.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.54,94,
"EXC TUMOR SC <2CM F/S",5911200,"CDM ",960,RC,21011,HCPCS,OUTPATIENT,,,574,459.2,,122.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",476,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",122.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",122.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.53,476,
"EXC TUMOR SC >2CM F/S",5911205,"CDM ",960,RC,21012,HCPCS,OUTPATIENT,,,883.5,706.8,,167.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",467,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",167.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",167.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.74,467,
"EXC TUMOR DEEP <2CM F/S",5911210,"CDM ",960,RC,21013,HCPCS,OUTPATIENT,,,704,563.2,,197.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",197.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",719,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",197.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",197.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",197.45,719,
"EXC TUMOR DEEP >2CM F/S",5911215,"CDM ",960,RC,21016,HCPCS,OUTPATIENT,,,2923.5,2338.8,,520.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",520.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1453,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",520.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",520.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",520.93,1453,
"PREP ORAL SURGICAL SPLINT",5911220,"CDM ",960,RC,21085,HCPCS,OUTPATIENT,,,1459,1167.2,,399.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",399.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1154,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",399.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",399.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",399.02,1154,
"GRAFT EAR CARTILAGE AUTOGENOUS",5911225,"CDM ",960,RC,21235,HCPCS,OUTPATIENT,,,1253.5,1002.8,,497.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",497.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1021,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",497.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",497.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",497.78,1021,
"CLOSED TX NASAL FX W/STABLZ",5911235,"CDM ",960,RC,21320,HCPCS,OUTPATIENT,,,573,458.4,,170.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2815.58,2815.58,2815.58,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",350,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",170.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",170.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.64,350,
"I&D NECK/CHEST LESION",5911240,"CDM ",960,RC,21501,HCPCS,OUTPATIENT,,,820.5,656.4,,307.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",307.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",637,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",307.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",307.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",307.32,637,
"BX SOFT TISS NECK/CHEST",5911245,"CDM ",960,RC,21550,HCPCS,OUTPATIENT,,,495.5,396.4,,167.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",363,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",167.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",167.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.68,363,
"EXC LES SC >3CM NECK/CHEST",5911250,"CDM ",960,RC,21552,HCPCS,OUTPATIENT,,,1285.5,1028.4,,224.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,695.81,695.81,695.81,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",224.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",620,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",224.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",224.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",224.02,620,
"EXC LES DEEP >5CM NECK/CHEST",5911255,"CDM ",960,RC,21554,HCPCS,OUTPATIENT,,,2382,1905.6,,367.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,566.96,566.96,566.96,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",367.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1017,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",367.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",367.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",367.96,1017,
"EXC LES SC <3CM NECK/CHEST",5911260,"CDM ",960,RC,21555,HCPCS,OUTPATIENT,,,1195.5,956.4,,302.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",302.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",600,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",302.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",302.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",302.12,600,
"EXC LES DEEP < 5CM NECK/CHEST",5911261,"CDM ",960,RC,21556,HCPCS,OUTPATIENT,,,1104,883.2,,303.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",747,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",303.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,3363.87,3363.87,3363.87,"1 through 10",other,"not separately reimbursment ",303.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.33,747,
"EXC LES SC <3CM BACK/FLANK",5911265,"CDM ",960,RC,21930,HCPCS,OUTPATIENT,,,837,669.6,,330.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,159.86,159.86,159.86,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",330.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",656,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",330.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",330.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",330.37,656,
"EXC LES SC >3CM BACK/FLANK",5911270,"CDM ",960,RC,21931,HCPCS,OUTPATIENT,,,1220,976,,234.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,320.96,320.96,320.96,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",234.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",653,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",234.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,414.18,414.18,414.18,"1 through 10",other,"not separately reimbursment ",234.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",234.54,653,
"EXC LES DEEP < 5CM BACK/FLANK",5911275,"CDM ",960,RC,21932,HCPCS,OUTPATIENT,,,1554.5,1243.6,,337.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",337.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",920,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",337.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",337.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",337.14,920,
"EXC LES DEEP >5CM BACK/FLANK",5911280,"CDM ",960,RC,21933,HCPCS,OUTPATIENT,,,1970.5,1576.4,,371.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1211.04,100,,2807.78,2807.78,2807.78,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",371.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1030,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",371.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2435.12,2435.12,2435.12,"1 through 10",other,"not separately reimbursment ",371.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",371.83,1211.04,
"RESECT TUMOR < 5CM BACK/FLANK",5911285,"CDM ",960,RC,21935,HCPCS,OUTPATIENT,,,2331.5,1865.2,,887.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",887.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1762,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",887.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",887.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",887.05,1762,
"I&D OPEN DEEP ABSC CERV/THORC",5911290,"CDM ",960,RC,22010,HCPCS,OUTPATIENT,,,3264.5,2611.6,,633.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",633.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1321,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",633.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",633.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",633.26,1321,
"I&D OPEN DEEP ABSC LUMB/SAC",5911295,"CDM ",960,RC,22015,HCPCS,OUTPATIENT,,,2600.5,2080.4,,627.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",627.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1278,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",627.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",627.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",627.7,1278,
"CLSD TX VERT BODY FX W/O MANIP",5911300,"CDM ",960,RC,22310,HCPCS,OUTPATIENT,,,622,497.6,,171.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",171.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",426,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",171.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",171.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",171.15,426,
"INJ PERQ CERV/THORACIC W/IMAGE",5911305,"CDM ",960,RC,22510,HCPCS,OUTPATIENT,,,983,786.4,,282.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",282.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2386,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",282.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",282.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",282.06,2386,
"INJ PERQ LUMBOSACRAL W/IMAGE",5911310,"CDM ",960,RC,22511,HCPCS,OUTPATIENT,,,919.5,735.6,,264.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",264.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2362,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",264.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",264.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",264.19,2362,
"PERQ VERTL AUG THOR W/IMAGE",5911315,"CDM ",960,RC,22513,HCPCS,OUTPATIENT,,,1132.5,906,,321.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",321.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",9838,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",321.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",321.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",321.42,9838,
"PERQ VERT AUG LUMBAR W/IMAGE",5911320,"CDM ",960,RC,22514,HCPCS,OUTPATIENT,,,1075.5,860.4,,300.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",9784,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",300.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,416.01,416.01,416.01,"1 through 10",other,"not separately reimbursment ",300.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.14,9784,
"EXC TUMOR ABDOMEN DEEP <5CM",5911325,"CDM ",960,RC,22900,HCPCS,OUTPATIENT,,,1150.5,920.4,,288.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,710.89,710.89,710.89,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",288.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",786,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",288.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",288.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",288.74,786,
"EXC TUMOR ABDOMEN DEEP >5CM",5911330,"CDM ",960,RC,22901,HCPCS,OUTPATIENT,,,1530.5,1224.4,,331.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",331.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",927,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",331.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",331.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",331.79,927,
"EXC TUMOR ABDOMEN SUBC<3CM",5911335,"CDM ",960,RC,22902,HCPCS,OUTPATIENT,,,990.5,792.4,,167.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",602,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",167.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",167.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.37,602,
"EXC TUMOR ABDOMEN SUBC >3CM",5911340,"CDM ",960,RC,22903,HCPCS,OUTPATIENT,,,999,799.2,,219.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",219.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",604,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",219.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",219.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",219.22,604,
"RESECT TUMOR ABDOMEN <5CM",5911345,"CDM ",960,RC,22904,HCPCS,OUTPATIENT,,,4208.5,3366.8,,519.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",519.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1470,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",519.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",519.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",519.64,1470,
"I&D SHOULDER DEEP",5911350,"CDM ",960,RC,23030,HCPCS,OUTPATIENT,,,564,451.2,,325.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",325.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",646,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",325.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",325.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",325.35,646,
"INCISION BONE CORTEX SHOULDER",5911353,"CDM ",960,RC,23035,HCPCS,OUTPATIENT,,,1442.5,1154,,533.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",533.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1059,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",533.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",533.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",533.12,1059,
"ARTHROTOMY SHOULDER JOINT",5911355,"CDM ",960,RC,23044,HCPCS,OUTPATIENT,,,1156.5,925.2,,430.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",430.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",855,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",430.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",430.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",430.16,855,
"EXC TUMOR SUBQ SHOULDER >3CM",5911360,"CDM ",960,RC,23071,HCPCS,OUTPATIENT,,,927,741.6,,208.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",679.45,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",208.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",580,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",208.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",208.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",208.34,679.45,
"EXC SHLDR TUMOR DEEP 5CM/>",5911363,"CDM ",960,RC,23073,HCPCS,OUTPATIENT,,,1477.5,1182,,345.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",345.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",962,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",345.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",345.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",345.44,962,
"EXC TUMOR SUBQ SHOULDER <3CM",5911365,"CDM ",960,RC,23075,HCPCS,OUTPATIENT,,,891,712.8,,184.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",184.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",653,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",184.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",184.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",184.35,653,
"REMOVE SHOULDER BONE PARTIAL",5911370,"CDM ",960,RC,23130,HCPCS,OUTPATIENT,,,1220,976,,464.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1193.67,1193.67,1193.67,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",464.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",923,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",464.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",464.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",464.4,923,
"PART EXC CLAVICLE BONE LESION",5911375,"CDM ",960,RC,23180,HCPCS,OUTPATIENT,,,1530.5,1224.4,,550.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",550.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1094,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",550.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",550.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",550.78,1094,
"REMOVE PROSTHS HUMERAL/GLENOID",5911380,"CDM ",960,RC,23335,HCPCS,OUTPATIENT,,,2805,2244,,597.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",597.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1793,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",597.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",597.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",597.97,1793,
"RPR TENDON SHOULDER SINGLE",5911385,"CDM ",960,RC,23405,HCPCS,OUTPATIENT,,,1368.5,1094.8,,487.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",487.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",969,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",487.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",487.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",487.81,969,
"RPR TENDON SHOULDER MULTI",5911390,"CDM ",960,RC,23406,HCPCS,OUTPATIENT,,,1707,1365.6,,612.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",612.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1217,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",612.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",612.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",612.43,1217,
"RPR ROTATOR CUFF ACUTE",5911395,"CDM ",960,RC,23410,HCPCS,OUTPATIENT,,,2025.5,1620.4,,700.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1433.26,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",700.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1392,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",700.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",700.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",700.83,1433.26,
"RPR ROTATOR CUFF CHRONIC",5911400,"CDM ",960,RC,23412,HCPCS,OUTPATIENT,,,2155,1724,,744.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1522.13,1522.13,1522.13,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",744.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1573,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",744.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,756.09,756.09,756.09,"1 through 10",other,"not separately reimbursment ",744.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",744.84,1573,
"RELEASE SHOULDER LIGAMENT",5911405,"CDM ",960,RC,23415,HCPCS,OUTPATIENT,,,1653,1322.4,,574.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",574.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1141,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",574.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",574.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",574.09,1141,
"RECONST SHOULDER JOINT CHRONIC",5911410,"CDM ",960,RC,23420,HCPCS,OUTPATIENT,,,2144,1715.2,,770.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",770.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1652,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",770.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",770.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",770.78,1652,
"RPR LONG TENDON BICEPS",5911415,"CDM ",960,RC,23430,HCPCS,OUTPATIENT,,,1686,1348.8,,577.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1415.15,1415.15,1415.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",577.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1147,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",577.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,330.93,330.93,330.93,"1 through 10",other,"not separately reimbursment ",577.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",577.45,1147,
"RPR SHLDR CAPSULE W/CORACOID",5911420,"CDM ",960,RC,23462,HCPCS,OUTPATIENT,,,2351.5,1881.2,,837.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",837.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1795,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",837.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",837.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",837.59,1795,
"RECONST SHLDR JOINT HEMI",5911425,"CDM ",960,RC,23470,HCPCS,OUTPATIENT,,,2655.5,2124.4,,946.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",946.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1993,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",946.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",946.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",946.08,1993,
"RECONST SHLDR JOINT TOTAL",5911430,"CDM ",960,RC,23472,HCPCS,OUTPATIENT,,,3433.5,2746.8,,1145.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1103.09,1103.09,1103.09,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1145.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2276,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1145.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1145.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1145.53,2276,
"REVISION/RECONS SHOULDER JOINT",5911432,"CDM ",960,RC,23473,HCPCS,OUTPATIENT,,,3339.5,2671.6,,998.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,1676.00,1676.00,1676.00,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",998.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2275,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",998.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",998.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",998.73,2275,
"REVISE SHOULDER ARTHROPLASTY",5911434,"CDM ",960,RC,23474,HCPCS,OUTPATIENT,,,3604,2883.2,,1079.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1079.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2459,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1079.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1079.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1079.43,2459,
"OSTEOTOMY CLAVICLE W/GRAFT",5911435,"CDM ",960,RC,23485,HCPCS,OUTPATIENT,,,2110,1688,,749.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1521.81,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",749.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1488,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",749.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",749.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",749.07,1521.81,
"REPAIR SHOULDER CAPSULE",5911436,"CDM ",960,RC,23465,HCPCS,OUTPATIENT,,,2893.5,2314.8,,870.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",870.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1758,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",870.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",870.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",870.64,1758,
"CLSD TX CLAVICLE FX WO MANIP",5911440,"CDM ",960,RC,23500,HCPCS,OUTPATIENT,,,455,364,,151.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",302,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",151.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",151.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.86,302,
"CLSD TX CLAVICLE FX W/MANIP",5911445,"CDM ",960,RC,23505,HCPCS,OUTPATIENT,,,750,600,,251.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",251.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",500,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",251.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",251.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",251.81,500,
"OPEN TX CLAVICLE FX",5911450,"CDM ",960,RC,23515,HCPCS,OUTPATIENT,,,1599,1279.2,,443.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,7897.37,7897.37,7897.37,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",443.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1003,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",443.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",443.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",443.51,1003,
"CLSD TX STRNCLAV DISLOC W/MAN",5911455,"CDM ",960,RC,23525,HCPCS,OUTPATIENT,,,670,536,,249.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",249.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",521,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",249.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",249.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",249.17,521,
"CLSD TX ACROMCLAV DISL WO MAN",5911460,"CDM ",960,RC,23540,HCPCS,OUTPATIENT,,,361,288.8,,156.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",310,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",156.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",156.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.08,310,
"OPEN TX ACROMCLAV DISLOCATION",5911465,"CDM ",960,RC,23550,HCPCS,OUTPATIENT,,,1242,993.6,,432.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",432.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",911,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",432.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",432.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",432.5,911,
"OPEN TX ACROMCLAV DISL W/GRFT",5911470,"CDM ",960,RC,23552,HCPCS,OUTPATIENT,,,1442.5,1154,,501.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",501.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",997,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",501.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",501.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",501.61,997,
"CLSD TX SCAPULAR FX WO MANIP",5911475,"CDM ",960,RC,23570,HCPCS,OUTPATIENT,,,438.5,350.8,,161.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",161.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",321,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",161.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",161.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",161.81,321,
"CLSD TX HUMERUS FX WO MANIP",5911480,"CDM ",960,RC,23600,HCPCS,OUTPATIENT,,,677.5,542,,229.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",229.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",455,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",229.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",229.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",229.12,455,
"CLSD TX HUERUS FX W/MANIP",5911485,"CDM ",960,RC,23605,HCPCS,OUTPATIENT,,,956.5,765.2,,342.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",342.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",681,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",342.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",342.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",342.53,681,
"OPEN TX HUMERUS FX",5911490,"CDM ",960,RC,23615,HCPCS,OUTPATIENT,,,1954,1563.2,,575.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",575.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1233,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",575.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,392.18,392.18,392.18,"1 through 10",other,"not separately reimbursment ",575.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",575.57,1233,
"OPEN TX HUMERUS FX W/REPLACE",5911495,"CDM ",960,RC,23616,HCPCS,OUTPATIENT,,,2742,2193.6,,1144.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1144.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2571,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1144.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1144.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1144.09,2571,
"OPEN ACUTE SHOLDER DISLC",5911497,"CDM ",960,RC,23660,HCPCS,OUTPATIENT,,,1529,1223.2,,441.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",441.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",935,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",441.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",441.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",441.56,935,
"CLSD TX HUM TBRSTY FX WO MAN",5911500,"CDM ",960,RC,23620,HCPCS,OUTPATIENT,,,435,348,,184.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",184.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",367,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",184.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",184.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",184.65,367,
"OPEN TX HUMERUS TUBEROSITY FX",5911505,"CDM ",960,RC,23630,HCPCS,OUTPATIENT,,,1719,1375.2,,443.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",443.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1090,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",443.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",443.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",443.6,1090,
"CLOSED TX SHLDR DISL WO MANIP",5911510,"CDM ",960,RC,23650,HCPCS,OUTPATIENT,,,632.5,506,,217.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",432,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",217.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",217.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.65,432,
"TREAT SHOULDER DISLOCATION",5911515,"CDM ",969,RC,23655,HCPCS,OUTPATIENT,,,850.5,680.4,,274.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2343.45,2343.45,2343.45,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",546,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",274.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",274.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.69,546,
"CLSD TX SHLDR DISL/FX W/MANIP",5911520,"CDM ",960,RC,23665,HCPCS,OUTPATIENT,,,905.5,724.4,,304.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",304.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",605,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",304.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",304.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",304.33,605,
"OPEN TX SHLDR DISL/FX",5911525,"CDM ",960,RC,23680,HCPCS,OUTPATIENT,,,2052,1641.6,,580.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",580.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1293,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",580.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",580.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",580.38,1293,
"MANIPULATION SHLDR W/ANESTH",5911530,"CDM ",960,RC,23700,HCPCS,OUTPATIENT,,,395,316,,136.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",297,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",136.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",136.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136.42,297,
"I&D BURSA DEEP ABSCESS",5911535,"CDM ",960,RC,23931,HCPCS,OUTPATIENT,,,359,287.2,,226.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",226.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",450,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",226.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",226.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",226.57,450,
"ARTHROTOMY ELBOW W/DRG/RMVL FB",5911537,"CDM ",960,RC,24000,HCPCS,OUTPATIENT,,,968,774.4,,354.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",354.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",749,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",354.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",354.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",354.93,749,
"BX ARM/ELBOW SUPERFICIAL",5911540,"CDM ",960,RC,24065,HCPCS,OUTPATIENT,,,383,306.4,,158.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",158.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",358,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",158.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",158.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",158.31,358,
"BX ARM/ELBOW DEEP",5911545,"CDM ",960,RC,24066,HCPCS,OUTPATIENT,,,1174.5,939.6,,429.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",429.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",864,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",429.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",429.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",429.42,864,
"EXC TUMOR ARM/ELBOW SC >3CM",5911550,"CDM ",960,RC,24071,HCPCS,OUTPATIENT,,,843.5,674.8,,202.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",202.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",563,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",202.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",202.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",202.25,563,
"EXC TUMOR ARM/ELBOW DEEP >5CM",5911555,"CDM ",960,RC,24073,HCPCS,OUTPATIENT,,,1554.5,1243.6,,347.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",347.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",962,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",347.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",347.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",347.1,962,
"EXC TUMOR ARM/ELBOW SC <3CM",5911560,"CDM ",960,RC,24075,HCPCS,OUTPATIENT,,,1100.5,880.4,,339.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",339.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",674,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",339.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",339.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",339.44,674,
"EXC TUMOR ARM/ELBOW DEEP <5CM",5911565,"CDM ",960,RC,24076,HCPCS,OUTPATIENT,,,1244,995.2,,354.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",354.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",756,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",354.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",354.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",354.11,756,
"RESECT TUMOR ARM/ELBOW <5CM",5911570,"CDM ",960,RC,24077,HCPCS,OUTPATIENT,,,2343.5,1874.8,,622.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",622.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1450,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",622.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",622.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",622.98,1450,
"EXCISION ELBOW BURSA",5911575,"CDM ",960,RC,24105,HCPCS,OUTPATIENT,,,777,621.6,,248.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,553.57,553.57,553.57,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",248.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",494,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",248.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",248.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",248.74,494,
"REMOVE ARM FOREIGN BODY",5911580,"CDM ",960,RC,24200,HCPCS,OUTPATIENT,,,350,280,,154.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",307,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",154.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",154.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154.44,307,
"REMOVE HIP FOREIGN BODY",5911583,"CDM ",960,RC,27086,HCPCS,OUTPATIENT,,,925.5,740.4,,190.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",190.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",379,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",190.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",190.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",190.54,379,
"RPR TEND/MSCL ARM/ELBOW",5911585,"CDM ",960,RC,24341,HCPCS,OUTPATIENT,,,1076.5,861.2,,498.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",498.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1039,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",498.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",498.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",498.61,1039,
"REINST RUPT BICEP/TRICEP TNDN",5911590,"CDM ",960,RC,24342,HCPCS,OUTPATIENT,,,1758,1406.4,,611.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",611.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1242,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",611.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",611.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",611.6,1242,
"RPR LAT LIGAMENT ELBOW",5911595,"CDM ",960,RC,24343,HCPCS,OUTPATIENT,,,1557.5,1246,,530.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,6100.45,6100.45,6100.45,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",530.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1201,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",530.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",530.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",530.16,1201,
"TENOTOMY ELBOW PERCUTANEOUS",5911600,"CDM ",960,RC,24357,HCPCS,OUTPATIENT,,,978.5,782.8,,308.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",308.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",614,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",308.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",308.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",308.76,614,
"TENOTOMY ELBOW W/DEBR OPEN",5911605,"CDM ",960,RC,24358,HCPCS,OUTPATIENT,,,1184,947.2,,363.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",363.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",722,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",363.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",363.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",363.05,722,
"TNOT ELBOW W/DEBR OPEN TDN RPR",5911610,"CDM ",960,RC,24359,HCPCS,OUTPATIENT,,,1489,1191.2,,447.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1061.32,1061.32,1061.32,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",447.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",908,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",447.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",447.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",447.42,908,
"RECONST HEAD  RADIUS W/IMPLANT",5911615,"CDM ",960,RC,24366,HCPCS,OUTPATIENT,,,1532,1225.6,,530.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,6100.45,6100.45,6100.45,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",530.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1146,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",530.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",530.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",530.45,1146,
"RPR MALUNION HUMERUS WO GRAFT",5911618,"CDM ",960,RC,24430,HCPCS,OUTPATIENT,,,2195.5,1756.4,,722.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",722.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1596,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",722.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",722.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",722.69,1596,
"RPR HUMEROUS W/GRAFT",5911620,"CDM ",960,RC,24435,HCPCS,OUTPATIENT,,,2380,1904,,744.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",744.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1669,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",744.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",744.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",744.13,1669,
"CLSD TX HUM SHAFT FX WO MANIP",5911625,"CDM ",960,RC,24500,HCPCS,OUTPATIENT,,,739,591.2,,246.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",246.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",490,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",246.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",246.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",246.68,490,
"CLSD TX HUM SHAFT FX W/MANIP",5911630,"CDM ",960,RC,24505,HCPCS,OUTPATIENT,,,983,786.4,,365.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",365.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",726,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",365.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",365.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",365.54,726,
"OPEN TX HUM SHFT FX W/PLT/SCRW",5911635,"CDM ",960,RC,24515,HCPCS,OUTPATIENT,,,1973,1578.4,,671.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",671.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1335,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",671.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",671.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",671.92,1335,
"TX HUM FX W/INSERT IMPLANT",5911640,"CDM ",960,RC,24516,HCPCS,OUTPATIENT,,,1902.5,1522,,664.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,944.00,944.00,944.00,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",664.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1320,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",664.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,761.34,761.34,761.34,"1 through 10",other,"not separately reimbursment ",664.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",664.45,1320,
"CLSD TX HUMEROUS FX WO MANIP",5911645,"CDM ",960,RC,24530,HCPCS,OUTPATIENT,,,796,636.8,,267.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,30.21,30.21,30.21,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",267.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",531,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",267.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",267.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",267.03,531,
"CLSD TX HUMEROUS FX W/MANIP",5911650,"CDM ",960,RC,24535,HCPCS,OUTPATIENT,,,1342,1073.6,,459.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",459.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",914,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",459.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",459.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",459.89,914,
"OPEN TX HUM FX WO INTERCON EXT",5911655,"CDM ",960,RC,24545,HCPCS,OUTPATIENT,,,2052,1641.6,,603.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",603.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1283,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",603.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",603.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",603.95,1283,
"OPEN TX HUM FX W/INTERCON EXT",5911660,"CDM ",960,RC,24546,HCPCS,OUTPATIENT,,,2384.5,1907.6,,868.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",868.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1726,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",868.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",868.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",868.8,1726,
"CLSD TX HUM EPICOND FX WO MAN",5911665,"CDM ",960,RC,24560,HCPCS,OUTPATIENT,,,666.5,533.2,,222.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",222.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",441,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",222.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",222.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",222.19,441,
"OPEN TX HUM EPICOND FX W/MAN",5911675,"CDM ",960,RC,24575,HCPCS,OUTPATIENT,,,1645.5,1316.4,,609.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",609.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1211,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",609.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",609.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",609.77,1211,
"CLSD TX HUM COND FX WO MANIP",5911680,"CDM ",960,RC,24576,HCPCS,OUTPATIENT,,,700.5,560.4,,232.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",232.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",472,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",232.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",232.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",232.27,472,
"OPEN TX HUM COND FX W/INT FIX",5911685,"CDM ",960,RC,24579,HCPCS,OUTPATIENT,,,1839,1471.2,,655.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",655.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1302,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",655.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",655.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",655.14,1302,
"CLSD TX ELBOW DISLOC WO ANESTH",5911690,"CDM ",960,RC,24600,HCPCS,OUTPATIENT,,,775,620,,278.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",278.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",554,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",278.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",278.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",278.75,554,
"CLSD TX ELBOW DISLOC W/ANESTH",5911695,"CDM ",960,RC,24605,HCPCS,OUTPATIENT,,,1030.5,824.4,,339.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",339.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",674,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",339.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",339.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",339.14,674,
"CLSD TX RADIUS FX WO MANIP",5911700,"CDM ",960,RC,24650,HCPCS,OUTPATIENT,,,538.5,430.8,,180.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",359,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",180.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",180.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.66,359,
"CLSD TX RADIUS FX W/MANIP",5911705,"CDM ",960,RC,24655,HCPCS,OUTPATIENT,,,929.5,743.6,,319.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",319.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",634,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",319.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",319.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",319.03,634,
"CLSD TX ULNAR FX WO MAN",5911710,"CDM ",960,RC,24670,HCPCS,OUTPATIENT,,,605.5,484.4,,203.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",203.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",404,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",203.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",203.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",203.1,404,
"CLSD TX ULNAR FX W/MANIP",5911715,"CDM ",960,RC,24675,HCPCS,OUTPATIENT,,,902.5,722,,332.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",332.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",662,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",332.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",332.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",332.98,662,
"OPEN TX ULNAR FX W/INT FIX",5911720,"CDM ",960,RC,24685,HCPCS,OUTPATIENT,,,1458,1166.4,,519.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",519.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1032,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",519.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",519.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",519.51,1032,
"INC EXT TENDON SHEATH WRIST",5911725,"CDM ",960,RC,25000,HCPCS,OUTPATIENT,,,715,572,,308.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,463.76,463.76,463.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",308.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",614,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",308.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",308.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",308.95,614,
"DECOMP FASCIOTOMY WO DEBRIDE",5911730,"CDM ",960,RC,25020,HCPCS,OUTPATIENT,,,1259,1007.2,,472.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",472.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",938,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",472.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",472.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",472.12,938,
"DECOMP FASCIOTOMY W/DEBRIDE",5911735,"CDM ",960,RC,25023,HCPCS,OUTPATIENT,,,2627,2101.6,,867.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",867.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1723,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",867.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",867.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",867.3,1723,
"I&D FOREARM WRIST DEEP ABSCESS",5911740,"CDM ",960,RC,25028,HCPCS,OUTPATIENT,,,556.5,445.2,,409.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",409.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",813,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",409.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",409.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",409.35,813,
"BX FOREARM WRIST SUPERFICIAL",5911745,"CDM ",960,RC,25065,HCPCS,OUTPATIENT,,,359,287.2,,155.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",354,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",155.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",155.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.3,354,
"BX FOREARM WRIST DEEP",5911750,"CDM ",960,RC,25066,HCPCS,OUTPATIENT,,,818.5,654.8,,339.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",339.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",675,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",339.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",339.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",339.85,675,
"EXC TUM FOREARM/WRIST SC >3CM",5911755,"CDM ",960,RC,25071,HCPCS,OUTPATIENT,,,937,749.6,,211.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",211.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",591,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",211.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",211.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",211.84,591,
"EXC TUM FOREARM/WRST DEEP >3CM",5911760,"CDM ",960,RC,25073,HCPCS,OUTPATIENT,,,610,488,,263.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",736,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",263.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",263.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.7,736,
"EXC TUM FOREARM/WRST SC <3CM",5911765,"CDM ",960,RC,25075,HCPCS,OUTPATIENT,,,685.5,548.4,,293.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",293.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",666,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",293.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",293.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",293.2,666,
"EXC TUM FOREARM/WRST DEEP <3CM",5911770,"CDM ",960,RC,25076,HCPCS,OUTPATIENT,,,886.5,709.2,,435.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",435.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",866,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",435.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",435.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",435.79,866,
"REMOVE WRIST TENDON LESION",5911775,"CDM ",960,RC,25111,HCPCS,OUTPATIENT,,,966.5,773.2,,248.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1293.76,1293.76,1293.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",248.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",494,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",248.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",248.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",248.57,494,
"EXC GANGLION LES WRIST RECUR",5911780,"CDM ",960,RC,25112,HCPCS,OUTPATIENT,,,845.5,676.4,,303.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",604,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",303.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",303.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.78,604,
"REMOVE WRIST FOREARM LESION",5911781,"CDM ",960,RC,25115,HCPCS,OUTPATIENT,,,1592.5,1274,,695.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,408.26,408.26,408.26,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",695.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1382,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",695.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",695.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",695.83,1382,
"EXC WRIST TENDON SHEATH",5911783,"CDM ",960,RC,25118,HCPCS,OUTPATIENT,,,816,652.8,,311.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",311.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",620,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",311.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",311.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",311.83,620,
"EXC CYST FOREARM",5911785,"CDM ",960,RC,25120,HCPCS,OUTPATIENT,,,1106,884.8,,549.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",549.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1091,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",549.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",549.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",549.29,1091,
"EXC RADIUS BONE PARTIAL",5911790,"CDM ",960,RC,25151,HCPCS,OUTPATIENT,,,1282,1025.6,,611.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",611.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1215,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",611.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",611.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",611.67,1215,
"EXC ULNA BONE PART/COMPL",5911795,"CDM ",960,RC,25240,HCPCS,OUTPATIENT,,,942.5,754,,373.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",373.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",742,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",373.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",373.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",373.4,742,
"REMOVE FB FOREARM/WRIST",5911800,"CDM ",960,RC,25248,HCPCS,OUTPATIENT,,,449,359.2,,413.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",413.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",822,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",413.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",413.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",413.8,822,
"TENODESIS WRIST FLEXOR FINGER",5911805,"CDM ",960,RC,25300,HCPCS,OUTPATIENT,,,1506,1204.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1071,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1071,1071,
"TRANSPLANT TENDON FOREARM EA",5911807,"CDM ",960,RC,25310,HCPCS,OUTPATIENT,,,1217.5,974,,644.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",644.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1280,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",644.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",644.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",644.52,1280,
"RPR WRIST JOINT OPEN",5911810,"CDM ",960,RC,25320,HCPCS,OUTPATIENT,,,2161.5,1729.2,,690.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",690.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1381,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",690.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",690.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",690.47,1381,
"OSTEOTOMY RADIUS DISTAL THIRD",5911815,"CDM ",960,RC,25350,HCPCS,OUTPATIENT,,,1489,1191.2,,696.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",696.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1383,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",696.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",696.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",696.31,1383,
"OSTEOPLASTY RADIUS OR ULNA",5911818,"CDM ",960,RC,25390,HCPCS,OUTPATIENT,,,1672,1337.6,,768.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",768.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1526,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",768.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",768.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",768.16,1526,
"OSTPLSTY RAD/ULNA LENGT W/GRFT",5911820,"CDM ",960,RC,25391,HCPCS,OUTPATIENT,,,2195.5,1756.4,,937.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",937.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1863,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",937.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",937.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",937.87,1863,
"RPR RADIUS/ULNA WO GRAFT",5911825,"CDM ",960,RC,25400,HCPCS,OUTPATIENT,,,1776.5,1421.2,,805.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",805.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1600,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",805.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",805.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",805.24,1600,
"RPR RAD/ULNA W/GRAFT",5911830,"CDM ",960,RC,25425,HCPCS,OUTPATIENT,,,2121.5,1697.2,,1055.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1055.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2096,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1055.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1055.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1055.09,2096,
"CLSD TX RADIUS SHAFT FX WO MAN",5911835,"CDM ",960,RC,25500,HCPCS,OUTPATIENT,,,554.5,443.6,,183.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",366,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",183.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",183.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.99,366,
"CLSD TX RADIUS SHAFT FX W/MAN",5911840,"CDM ",960,RC,25505,HCPCS,OUTPATIENT,,,1028.5,822.8,,365.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",365.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",726,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",365.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",365.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",365.37,726,
"OPEN TX RAD SHAFT FX W/INT FIX",5911845,"CDM ",960,RC,25515,HCPCS,OUTPATIENT,,,1493.5,1194.8,,531.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",531.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1056,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",531.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",531.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",531.4,1056,
"CLSD TX UNLAR SHAFT FX WO MAN",5911850,"CDM ",960,RC,25530,HCPCS,OUTPATIENT,,,550.5,440.4,,177.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",353,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",177.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",177.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.68,353,
"OPEN TX ULNAR SHAFT FX",5911855,"CDM ",960,RC,25545,HCPCS,OUTPATIENT,,,1392,1113.6,,526.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",526.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1047,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",526.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",526.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",526.75,1047,
"CLSD TX RAD/ULNAR FX WO MAN",5911860,"CDM ",960,RC,25560,HCPCS,OUTPATIENT,,,559,447.2,,186.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",186.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",386,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",186.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",186.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",186.99,386,
"CLSD TX RAD/ULNAR FX W/MAN",5911865,"CDM ",960,RC,25565,HCPCS,OUTPATIENT,,,1126,900.8,,383.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",676.68,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",383.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",762,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",383.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",383.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",383.69,762,
"OPEN TX RAD/ULNAR FX W/INT FIX",5911870,"CDM ",960,RC,25574,HCPCS,OUTPATIENT,,,1489,1191.2,,447.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",447.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",935,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",447.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",447.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",447.29,935,
"OPEN TX RAD/UNLAR FX W/INT FIX",5911875,"CDM ",960,RC,25575,HCPCS,OUTPATIENT,,,2033,1626.4,,632.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",632.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1273,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",632.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",632.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",632.98,1273,
"CLSD TX DIS RAD/ULNA FX WO MAN",5911880,"CDM ",960,RC,25600,HCPCS,OUTPATIENT,,,609,487.2,,205.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",205.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",454,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",205.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",205.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",205.61,454,
"CLSD TX DIS RAD/ULNA FX W/MAN",5911885,"CDM ",960,RC,25605,HCPCS,OUTPATIENT,,,1336,1068.8,,405.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",405.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",832,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",405.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",405.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",405.59,832,
"PERCUT FIX DIS RADIUS FX",5911890,"CDM ",960,RC,25606,HCPCS,OUTPATIENT,,,1441,1152.8,,468.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",468.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",974,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",468.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",468.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",468.63,974,
"OPN TX DIS RADIUS EXTRA ART FX",5911895,"CDM ",960,RC,25607,HCPCS,OUTPATIENT,,,1630,1304,,487.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",487.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1019,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",487.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",487.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",487.87,1019,
"OPN TX DIS RADIUS INTRA ART FX",5911900,"CDM ",960,RC,25608,HCPCS,OUTPATIENT,,,1833,1466.4,,556.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1157.83,100,,254.20,254.20,254.20,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",556.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1142,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",556.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,739.66,739.66,739.66,"1 through 10",other,"not separately reimbursment ",556.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",556.21,1157.83,
"OPN TX DIS RAD INTRA ART FX >3",5911905,"CDM ",960,RC,25609,HCPCS,OUTPATIENT,,,2368,1894.4,,709.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1449.55,1449.55,1449.55,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",709.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1442,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",709.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",709.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",709.53,1442,
"CLSD TX CAR SCAPHOID FX WO MAN",5911910,"CDM ",960,RC,25622,HCPCS,OUTPATIENT,,,628,502.4,,209.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",209.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",417,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",209.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",209.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",209.72,417,
"OPN TX CAR SCAPHOID FX",5911915,"CDM ",960,RC,25628,HCPCS,OUTPATIENT,,,1587,1269.6,,512.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",512.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1019,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",512.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",512.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",512.75,1019,
"CLSD TX CAR SCAPHOID FX WO MAN",5911920,"CDM ",960,RC,25630,HCPCS,OUTPATIENT,,,641.5,513.2,,216.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",216.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",430,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",216.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",216.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",216.65,430,
"PERCUT FIX ULNAR STYLOID FX",5911925,"CDM ",960,RC,25651,HCPCS,OUTPATIENT,,,1063.5,850.8,,339.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",339.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",675,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",339.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",339.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",339.89,675,
"CLOSED TX CARPAL FX W/MANIP",5911927,"CDM ",960,RC,25635,HCPCS,OUTPATIENT,,,908.5,726.8,,319.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",319.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",634,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",319.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",319.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",319.35,634,
"OPEN TX ULNAR STYLOID FX",5911930,"CDM ",960,RC,25652,HCPCS,OUTPATIENT,,,1374,1099.2,,460.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",460.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",915,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",460.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",460.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",460.33,915,
"CLSD TX TRANSSCAPHO FX W/MAN",5911935,"CDM ",960,RC,25680,HCPCS,OUTPATIENT,,,1144,915.2,,337.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",337.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",670,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",337.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",337.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",337.18,670,
"ARTHRODESIS WRIST WO GRAFT",5911940,"CDM ",960,RC,25800,HCPCS,OUTPATIENT,,,1615.5,1292.4,,594.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",594.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1218,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",594.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",594.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",594.52,1218,
"DRAIN FINGER ABSCESS SIMPLE",5911945,"CDM ",960,RC,26010,HCPCS,OUTPATIENT,,,747.5,598,,206.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",206.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",411,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",206.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",206.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",206.76,411,
"DRAIN FINGER ABSCESS COMPLEX",5911950,"CDM ",960,RC,26011,HCPCS,OUTPATIENT,,,980.5,784.4,,320.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",320.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",637,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",320.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",320.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",320.7,637,
"DRAIN TEND SHTH DIGIT/PALM EA",5911955,"CDM ",960,RC,26020,HCPCS,OUTPATIENT,,,980.5,784.4,,311.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2653.70,2653.70,2653.70,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",311.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",619,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",311.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,4485.50,4485.50,4485.50,"1 through 10",other,"not separately reimbursment ",311.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",311.63,619,
"INC BONE CORTEX FINGER/HAND",5911960,"CDM ",960,RC,26034,HCPCS,OUTPATIENT,,,1208,966.4,,394.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",394.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",784,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",394.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",394.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",394.72,784,
"DECOMP FASCIOTOMY HAND",5911965,"CDM ",960,RC,26037,HCPCS,OUTPATIENT,,,1292,1033.6,,428.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",428.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",852,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",428.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",428.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",428.72,852,
"FASCIOTOMY PALMAR PERC",5911970,"CDM ",960,RC,26040,HCPCS,OUTPATIENT,,,684,547.2,,229.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",229.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",455,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",229.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",229.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",229.03,455,
"FASCIOTOMY PALMAR OPEN PART",5911975,"CDM ",960,RC,26045,HCPCS,OUTPATIENT,,,1052.5,842,,352.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",352.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",700,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",352.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",352.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",352.19,700,
"INS TENDON SHEATH",5911980,"CDM ",960,RC,26055,HCPCS,OUTPATIENT,,,1204.5,963.6,,492.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",492.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",978,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",492.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,79.10,79.10,79.10,"1 through 10",other,"not separately reimbursment ",492.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",492.08,978,
"EXC TUM HND/FNGR SC >1.5CM",5911985,"CDM ",960,RC,26111,HCPCS,OUTPATIENT,,,1208,966.4,,205.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",205.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",579,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",205.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",205.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",205.2,579,
"EXC TUM HND/FNGR SC <1.5CM",5911990,"CDM ",960,RC,26115,HCPCS,OUTPATIENT,,,730.5,584.4,,497.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",454.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",497.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",988,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",497.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",497.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",454.29,988,
"I&D ABSC TRANAL UNDER ANES",5911994,"CDM ",960,RC,46045,HCPCS,OUTPATIENT,,,1042.65,834.12,,228.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",228.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",609,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",228.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",228.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",228.04,609,
"EXC TUM HND/FING DEEP <1.5CM",5911995,"CDM ",960,RC,26116,HCPCS,OUTPATIENT,,,1208,966.4,,359.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",748.3,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",359.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",719,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",359.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",359.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",359.15,748.3,
"FASC PALM W/WO ZPLASTY TISSUE",5911998,"CDM ",960,RC,26121,HCPCS,OUTPATIENT,,,1287.5,1030,,456.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",456.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",954,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",456.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",456.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",456.44,954,
"FASC PART PALMAR SINGLE DIGIT",5912000,"CDM ",960,RC,26123,HCPCS,OUTPATIENT,,,1839,1471.2,,569.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",569.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1141,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",569.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",569.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",569.92,1141,
"FASC PART PALM EA ADD DIGIT",5912002,"CDM ",960,RC,26125,HCPCS,OUTPATIENT,,,569.5,455.6,,202.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",202.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",454,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",202.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",202.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",202.17,454,
"EXC LES TENDON SHEATH HND/FING",5912005,"CDM ",960,RC,26160,HCPCS,OUTPATIENT,,,1614.5,1291.6,,453.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1681.28,1681.28,1681.28,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",453.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",900,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",453.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",453.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",453.2,900,
"EXC TUM/BONE CYST FINGER",5912010,"CDM ",960,RC,26210,HCPCS,OUTPATIENT,,,2444,1955.2,,330.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",330.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",656,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",330.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",330.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",330.03,656,
"REMOVE IMPLANT HAND/FINGER",5912015,"CDM ",960,RC,26320,HCPCS,OUTPATIENT,,,764.5,611.6,,257.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",257.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",512,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",257.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",257.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",257.72,512,
"RPR EXT TENDON HAND WO GRFT",5912020,"CDM ",960,RC,26410,HCPCS,OUTPATIENT,,,1255.5,1004.4,,492.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",492.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",979,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",492.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",492.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",492.76,979,
"RPR EXT TNDN FINGER WO GRFT EA",5912025,"CDM ",960,RC,26418,HCPCS,OUTPATIENT,,,1268,1014.4,,490.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2487.97,2487.97,2487.97,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",490.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",974,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",490.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",490.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",490.21,974,
"RPR EXT TNDN FNGR CENTRAL SLIP",5912030,"CDM ",960,RC,26426,HCPCS,OUTPATIENT,,,1136,908.8,,579.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",579.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1151,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",579.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",579.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",579.58,1151,
"RPR EXT TNDN FNGR WO GRAFT",5912035,"CDM ",960,RC,26433,HCPCS,OUTPATIENT,,,1172,937.6,,458.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",458.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",911,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",458.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",458.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",458.55,911,
"RPR LIGAMENT/JOINT HAND",5912040,"CDM ",960,RC,26540,HCPCS,OUTPATIENT,,,1420,1136,,553.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",553.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1099,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",553.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",553.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",553.37,1099,
"CLSD TX METACARPAL FX WO MANIP",5912045,"CDM ",960,RC,26600,HCPCS,OUTPATIENT,,,594.5,475.6,,168.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",168.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",407,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",168.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",168.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",168.54,407,
"CLSD TX METACARPAL FX W/MANIP",5912050,"CDM ",960,RC,26605,HCPCS,OUTPATIENT,,,676,540.8,,227.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",451,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",227.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",227.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.1,451,
"CLSD TX METACARPAL FX W/FIX",5912055,"CDM ",960,RC,26607,HCPCS,OUTPATIENT,,,1011,808.8,,361.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",694.33,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",361.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",719,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",361.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",361.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",361.95,719,
"PERCUT FIX METACARPAL FX EACH",5912060,"CDM ",960,RC,26608,HCPCS,OUTPATIENT,,,1036,828.8,,361.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,4148.60,4148.60,4148.60,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",361.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",718,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",361.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",361.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",361.62,718,
"OPEN TX METACARPAL FRACTURE",5912065,"CDM ",960,RC,26615,HCPCS,OUTPATIENT,,,1236.5,989.2,,333.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",821.9,100,,4270.24,4270.24,4270.24,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",333.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",796,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",333.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",333.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",333.97,821.9,
"CLOSED TX THUMB DISL W/MANIP",5912070,"CDM ",960,RC,26641,HCPCS,OUTPATIENT,,,747.5,598,,259.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",259.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",515,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",259.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",259.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",259.1,515,
"OPEN TX THUMB FX",5912075,"CDM ",960,RC,26665,HCPCS,OUTPATIENT,,,1379.5,1103.6,,442.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",442.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",879,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",442.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",442.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",442.53,879,
"PERC FIX CARPOMT DISL W/MAN EA",5912080,"CDM ",960,RC,26676,HCPCS,OUTPATIENT,,,1125,900,,379.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",379.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",754,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",379.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",379.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",379.49,754,
"CLSD TX FINGER FX WO MANIP EA",5912085,"CDM ",960,RC,26720,HCPCS,OUTPATIENT,,,406,324.8,,134.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",134.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",268,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",134.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",134.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",134.79,268,
"CLSD TX PHAL SHAFT FX W/MAN EA",5912090,"CDM ",960,RC,26725,HCPCS,OUTPATIENT,,,650.5,520.4,,248.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,4161.21,4161.21,4161.21,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",248.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",495,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",248.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",248.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",248.92,495,
"PERCUT FIX FINGER W/MANIP EA",5912095,"CDM ",960,RC,26727,HCPCS,OUTPATIENT,,,1015.5,812.4,,356.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",356.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",707,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",356.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",356.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",356.07,707,
"OPEN TX PHAL SHFT FX W/MAN EA",5912100,"CDM ",960,RC,26735,HCPCS,OUTPATIENT,,,1315,1052,,363.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",363.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",825,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",363.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",363.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",363.38,825,
"CLSD TX FNGR FX DIST WO MAN EA",5912105,"CDM ",960,RC,26750,HCPCS,OUTPATIENT,,,378.5,302.8,,127.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,86.51,86.51,86.51,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",253,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",127.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",127.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.31,253,
"CLSD TX PHAL FX DIST W/MAN EA",5912110,"CDM ",960,RC,26755,HCPCS,OUTPATIENT,,,656.5,525.2,,229.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",229.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",456,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",229.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",229.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",229.52,456,
"OPN TX PHAL FX DIST INT FIX EA",5912115,"CDM ",960,RC,26765,HCPCS,OUTPATIENT,,,1061,848.8,,267.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",647.04,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",267.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",693,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",267.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",267.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",267.5,693,
"CLSD TX INTRPHAL DISL W/MAN",5912120,"CDM ",960,RC,26770,HCPCS,OUTPATIENT,,,562.5,450,,196.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,696.03,696.03,696.03,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",196.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",390,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",196.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",196.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",196.24,390,
"CLSD TX INTRPHL DISL W/ANESTH",5912125,"CDM ",960,RC,26775,HCPCS,OUTPATIENT,,,759,607.2,,272.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",272.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",542,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",272.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",272.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",272.68,542,
"OPN TX INTRPHL DISL W/INT FIX",5912130,"CDM ",960,RC,26785,HCPCS,OUTPATIENT,,,1202,961.6,,273.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",756,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",273.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",273.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.08,756,
"AMP FINGER/THUMB SINGLE",5912132,"CDM ",960,RC,26910,HCPCS,OUTPATIENT,,,1621,1296.8,,576.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",576.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1145,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",576.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",576.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",576.1,1145,
"AMP FNGR/THUMB W/CLOS SINGLE",5912135,"CDM ",960,RC,26951,HCPCS,OUTPATIENT,,,1209,967.2,,441.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,210.32,210.32,210.32,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",441.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",895,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",441.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",441.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",441.58,895,
"AMP FNGR/THUMB W/FLAP SINGLE",5912140,"CDM ",960,RC,26952,HCPCS,OUTPATIENT,,,2444,1955.2,,542.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2461.60,2461.60,2461.60,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",542.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1079,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",542.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",542.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",542.89,1079,
"I&D PELV/HIP JOINT DEEP",5912145,"CDM ",960,RC,26990,HCPCS,OUTPATIENT,,,1793.5,1434.8,,462.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,519.64,519.64,519.64,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",462.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",919,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",462.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",462.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",462.59,919,
"I&D PELV/HIP BURSA",5912150,"CDM ",960,RC,26991,HCPCS,OUTPATIENT,,,1155.5,924.4,,544.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",544.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1081,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",544.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",544.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",544.35,1081,
"CAPSULECTOMY HIP",5912155,"CDM ",960,RC,27036,HCPCS,OUTPATIENT,,,2230.5,1784.4,,733.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",733.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1457,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",733.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",733.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",733.21,1457,
"EXC HIP PELVIS LES SC >3CM",5912160,"CDM ",960,RC,27043,HCPCS,OUTPATIENT,,,1195.5,956.4,,234.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",234.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",654,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",234.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",234.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",234.17,654,
"EXC HIP/PELVIC TUM DEEP >5CM",5912165,"CDM ",960,RC,27045,HCPCS,OUTPATIENT,,,2988.5,2390.8,,372.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",372.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1042,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",372.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",372.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",372.39,1042,
"EXC HIP/PELVIS LES SC <3CM",5912170,"CDM ",960,RC,27047,HCPCS,OUTPATIENT,,,1353.5,1082.8,,454.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",454.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",903,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",454.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",454.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",454.58,903,
"EXC HIP/PELV TUM DEEP <5CM",5912175,"CDM ",960,RC,27048,HCPCS,OUTPATIENT,,,1435,1148,,350.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",350.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",851,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",350.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",350.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",350.19,851,
"COCCYGECTOMY PRIMARY",5912180,"CDM ",960,RC,27080,HCPCS,OUTPATIENT,,,1127,901.6,,355.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",355.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",707,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",355.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",355.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",355.66,707,
"REMOVE FB PELVIS/HIP DEEP",5912185,"CDM ",960,RC,27087,HCPCS,OUTPATIENT,,,1351,1080.8,,483.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",483.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",961,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",483.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",483.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",483.7,961,
"REMOVE HIP PROSTHESIS COMPLEX",5912190,"CDM ",960,RC,27091,HCPCS,OUTPATIENT,,,3541,2832.8,,1170.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1170.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2457,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1170.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1170.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,2457,
"INJ HIP ARTHROGRAPHY WO ANESTH",5912195,"CDM ",960,RC,27093,HCPCS,OUTPATIENT,,,147,117.6,,167.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",333,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",167.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",167.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.39,333,
"INJ SACROILLIAC JOINT W/FLUORO",5912200,"CDM ",960,RC,27096,HCPCS,OUTPATIENT,,,278.5,222.8,,166.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",166.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",610,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",166.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",166.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",166.36,610,
"REVISE HIP TENDON PROXIMAL",5912202,"CDM ",960,RC,27097,HCPCS,OUTPATIENT,,,1431.5,1145.2,,489.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",489.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",973,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",489.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",489.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",489.98,973,
"HEMIARTHRO HIP PARTIAL",5912205,"CDM ",960,RC,27125,HCPCS,OUTPATIENT,,,2566,2052.8,,790.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",790.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1851,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",790.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",790.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",790.58,1851,
"ARTHROPLASTY HIP TOTAL",5912210,"CDM ",960,RC,27130,HCPCS,OUTPATIENT,,,3309,2647.2,,1020.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1020.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2564,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1020.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,904.15,723.32,1084.97,"1 through 10",other,"not separately reimbursment ",1020.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,2564,
"REVISE HIP ARTHRO BOTH COMPON",5912213,"CDM ",960,RC,27134,HCPCS,OUTPATIENT,,,3937.5,3150,,1501.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2740.00,2740.00,2740.00,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1501.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",3601,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1501.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1501.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1501.47,3601,
"REVISE HIP ARTHRO FEMORAL ONLY",5912215,"CDM ",960,RC,27138,HCPCS,OUTPATIENT,,,3544,2835.2,,1182.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1182.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2788,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1182.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1182.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1182.74,2788,
"PROPHYLACTIC TX HIP BONES",5912220,"CDM ",960,RC,27187,HCPCS,OUTPATIENT,,,2190,1752,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1705,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1705,1705,
"CLSD TX OF COCCYGEAL FX",5912225,"CDM ",960,RC,27200,HCPCS,OUTPATIENT,,,413,330.4,,125.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",250,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",125.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",125.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.89,250,
"CLSD TX ACETABULUM FX WO MAN",5912230,"CDM ",960,RC,27222,HCPCS,OUTPATIENT,,,2215,1772,,725.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",725.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1441,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",725.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",725.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",725.13,1441,
"CLSD TX FEMUR PROX FX WO MAN",5912235,"CDM ",960,RC,27230,HCPCS,OUTPATIENT,,,1034.5,827.6,,347.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",347.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",690,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",347.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",347.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",347.16,690,
"CLSD TX FEMUR FX W/MANIP",5912240,"CDM ",960,RC,27232,HCPCS,OUTPATIENT,,,1704,1363.2,,576.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",576.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1150,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",576.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",576.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",576.18,1150,
"PERCUT FIX FEMUR FX",5912245,"CDM ",960,RC,27235,HCPCS,OUTPATIENT,,,2061.5,1649.2,,691.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",691.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1539,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",691.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",691.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",691.95,1539,
"OPEN TX FEMUR FX PROX END",5912250,"CDM ",960,RC,27236,HCPCS,OUTPATIENT,,,2716.5,2173.2,,858.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",858.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1922,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",858.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",858.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",858.05,1922,
"CLSD TX INTR/PERI/SUB FX W/MAN",5912255,"CDM ",960,RC,27240,HCPCS,OUTPATIENT,,,2156,1724.8,,704.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",704.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1399,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",704.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",704.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",704.33,1399,
"TX INTER/PERI/SUB FEM FX W/PLT",5912260,"CDM ",960,RC,27244,HCPCS,OUTPATIENT,,,2643.5,2114.8,,877.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",877.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1901,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",877.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",877.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",877.02,1901,
"TX INTER/PERI/SUB FEM FX W/IMP",5912265,"CDM ",960,RC,27245,HCPCS,OUTPATIENT,,,3224.5,2579.6,,1098.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,220.72,220.72,220.72,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1098.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2183,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1098.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1098.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1098.97,2183,
"OPEN TX TROCHANTERIC FX",5912270,"CDM ",960,RC,27248,HCPCS,OUTPATIENT,,,1686,1348.8,,596.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",596.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1315,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",596.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",596.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",596.78,1315,
"CLOSED TX HIP DISLOCATE REQ AN",5912272,"CDM ",960,RC,27252,HCPCS,OUTPATIENT,,,1552,1241.6,,569.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",569.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1132,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",569.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",569.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",569.93,1132,
"TX HIP DISLC W/MAN W/ANESTH",5912275,"CDM ",960,RC,27257,HCPCS,OUTPATIENT,,,804.5,643.6,,257.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",257.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",576,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",257.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",257.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",257.56,576,
"CLSD TX POST HIP ARTH DISLC",5912280,"CDM ",960,RC,27265,HCPCS,OUTPATIENT,,,895,716,,305.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",305.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",607,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",305.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",305.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",305.57,607,
"CLSD TX POST HIP ARTH DIS W/AN",5912285,"CDM ",960,RC,27266,HCPCS,OUTPATIENT,,,1166,932.8,,440.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",440.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",875,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",440.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",440.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",440.45,875,
"UNLISTED PELVIS/HIP JOINT PROC",5912288,"CDM ",960,RC,27299,HCPCS,OUTPATIENT,,,1589.5,1271.6,,,,,,,,0,"other ","not separately reimbursment ",,,,7809.38,7809.38,7809.38,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1351.08,85,,1080.86,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1351.08,1351.08,
"I&D THIGH/KNEE DEEP",5912290,"CDM ",960,RC,27301,HCPCS,OUTPATIENT,,,1426.5,1141.2,,506.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",506.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1007,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",506.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",506.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",506.65,1007,
"FASCIOTOMY TENOTOMY OPEN",5912295,"CDM ",960,RC,27305,HCPCS,OUTPATIENT,,,1381.5,1105.2,,352.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",352.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",701,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",352.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",352.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",352.63,701,
"INCISION THIGH TENDON SINGLE",5912297,"CDM ",960,RC,27306,HCPCS,OUTPATIENT,,,736,588.8,,295.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",295.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",586,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",295.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",295.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",295.1,586,
"ARTHROTKNEE W/REMOVE FB",5912300,"CDM ",960,RC,27310,HCPCS,OUTPATIENT,,,1554.5,1243.6,,538.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",538.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1111,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",538.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",538.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",538.01,1111,
"BX THIGH TISSUE SUPERFICIAL",5912305,"CDM ",960,RC,27303,HCPCS,OUTPATIENT,,,389,311.2,,486.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",486.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",966,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",486.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",486.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",486.18,966,
"BX THIGH TISSUE SUPERFICIAL",5912305,"CDM ",960,RC,27323,HCPCS,OUTPATIENT,,,389,311.2,,174.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",379,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",174.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",174.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174.48,379,
"BX THIGH TISSUE DEEP",5912310,"CDM ",960,RC,27324,HCPCS,OUTPATIENT,,,855.5,684.4,,286.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",286.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",570,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",286.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",286.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",286.72,570,
"EXC TUM THIGH/KNEE <3CM",5912315,"CDM ",960,RC,27327,HCPCS,OUTPATIENT,,,895,716,,320.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",320.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",638,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",320.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",320.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",320.98,638,
"EXC THIGH/KNEE TUMOR <5CM",5912318,"CDM ",960,RC,27328,HCPCS,OUTPATIENT,,,1334,1067.2,,315.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",315.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",869,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",315.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",315.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",315.1,869,
"RESECT THIGH/KNEE <5CM",5912320,"CDM ",960,RC,27329,HCPCS,OUTPATIENT,,,2397.5,1918,,723.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",723.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1525,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",723.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",723.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",723.21,1525,
"ARTHROT KNEE REMOVE FB",5912325,"CDM ",960,RC,27331,HCPCS,OUTPATIENT,,,1054,843.2,,329.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",329.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",759,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",329.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",329.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",329.1,759,
"ARTHROT W/EXC CART KNEE",5912330,"CDM ",960,RC,27332,HCPCS,OUTPATIENT,,,1411.5,1129.2,,489.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",489.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1045,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",489.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",489.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",489.73,1045,
"EXC TUM THIGH/KNEE >3CM",5912335,"CDM ",960,RC,27337,HCPCS,OUTPATIENT,,,939,751.2,,208.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",208.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",583,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",208.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,37.89,37.89,37.89,"1 through 10",other,"not separately reimbursment ",208.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",208.89,583,
"EXC TUM THIGH/KNEE SF > 5CM",5912340,"CDM ",960,RC,27339,HCPCS,OUTPATIENT,,,1722,1377.6,,376.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",376.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1043,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",376.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",376.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",376.26,1043,
"EXC PREPATELLAR BURSA",5912345,"CDM ",960,RC,27340,HCPCS,OUTPATIENT,,,816,652.8,,273.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",544,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",273.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",273.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.88,544,
"EXC BONE CYST/BEN TUM FEMUR",5912350,"CDM ",960,RC,27355,HCPCS,OUTPATIENT,,,1334,1067.2,,458.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",458.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",910,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",458.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",458.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",458.06,910,
"EXC BONE LEG PARTIAL",5912355,"CDM ",960,RC,27360,HCPCS,OUTPATIENT,,,1897,1517.6,,636.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",636.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1264,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",636.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",636.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",636.11,1264,
"REMOVE FB THIGH/KNEE DEEP",5912360,"CDM ",960,RC,27372,HCPCS,OUTPATIENT,,,1268,1014.4,,456.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",456.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",908,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",456.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",456.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",456.87,908,
"RPR INFRAPATELLAR TENDON",5912365,"CDM ",960,RC,27380,HCPCS,OUTPATIENT,,,1313,1050.4,,454.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",454.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",904,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",454.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",454.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",454.91,904,
"RPR QUAD/HAMSTRING MSCL PRIME",5912370,"CDM ",960,RC,27385,HCPCS,OUTPATIENT,,,1242,993.6,,486.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",486.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",967,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",486.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",486.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",486.19,967,
"RPR/RECON QUAD/HAM W/GRAFT",5912375,"CDM ",960,RC,27386,HCPCS,OUTPATIENT,,,1822,1457.6,,637.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",637.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1322,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",637.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",637.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",637.34,1322,
"RPR KNEE ARTHROTOMY W/MENISCUS",5912380,"CDM ",960,RC,27403,HCPCS,OUTPATIENT,,,1441,1152.8,,493.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",493.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1013,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",493.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",493.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",493.51,1013,
"RPR KNEE PRIME LGMNT/CAPS COLL",5912385,"CDM ",960,RC,27405,HCPCS,OUTPATIENT,,,1489,1191.2,,513.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",513.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1084,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",513.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",513.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",513.74,1084,
"RPR KNEE CRUCIATE LIGAMENT",5912390,"CDM ",960,RC,27407,HCPCS,OUTPATIENT,,,1742,1393.6,,593.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",593.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1180,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",593.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",593.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",593.78,1180,
"RPR KNEE COL/CRUCIATE LIGAMENT",5912395,"CDM ",960,RC,27409,HCPCS,OUTPATIENT,,,2160,1728,,732.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",732.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1615,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",732.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",732.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",732.01,1615,
"OPEN OSTEOCH ALLOGRAFT KNEE",5912400,"CDM ",960,RC,27415,HCPCS,OUTPATIENT,,,3012,2409.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2044,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2044,2044,
"OSTEOCH AUTOGRAFT KNEE",5912403,"CDM ",960,RC,27416,HCPCS,OUTPATIENT,,,2052.15,1641.72,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1365,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1365,1365,
"RECONST DISLOCATING PATELLA",5912405,"CDM ",960,RC,27420,HCPCS,OUTPATIENT,,,1644,1315.2,,572.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2038.59,2038.59,2038.59,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",572.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1221,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",572.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",572.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",572.55,1221,
"RECON PATELLA W/EXT REALIGN",5912410,"CDM ",960,RC,27422,HCPCS,OUTPATIENT,,,1638.5,1310.8,,571.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",571.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1222,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",571.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",571.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",571.02,1222,
"REVISE REMOVE KNEECAP",5912413,"CDM ",960,RC,27424,HCPCS,OUTPATIENT,,,1580.5,1264.4,,571.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",571.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1229,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",571.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",571.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",571.14,1229,
"OPEN LAT RETINACULAR RELEASE",5912415,"CDM ",960,RC,27425,HCPCS,OUTPATIENT,,,976.5,781.2,,307.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",307.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",671,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",307.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",307.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",307.57,671,
"OPEN KNEE LIG RECON INTRAARTIC",5912420,"CDM ",960,RC,27428,HCPCS,OUTPATIENT,,,2466,1972.8,,806.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,488.66,488.66,488.66,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",806.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1661,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",806.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1311.07,1311.07,1311.07,"1 through 10",other,"not separately reimbursment ",806.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",806.36,1661,
"ARTHROP KNEE W/DEBRIDE",5912425,"CDM ",960,RC,27443,HCPCS,OUTPATIENT,,,1793.5,1434.8,,628.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",628.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1447,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",628.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",628.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",628.3,1447,
"ARTHOP KNEE COND/PLAT MED/LAT",5912428,"CDM ",960,RC,27446,HCPCS,OUTPATIENT,,,2425.5,1940.4,,795.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",795.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2035,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",795.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",795.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",795.13,2035,
"ARTHROP KNEE TOTAL",5912430,"CDM ",960,RC,27447,HCPCS,OUTPATIENT,,,3535.5,2828.4,,1095.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2812.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1095.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2742,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1095.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,12146.47,12146.47,12146.47,"1 through 10",other,"not separately reimbursment ",1095.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1095.82,2812.01,
"RPR FEMUR W/BONE GRAFT",5912435,"CDM ",960,RC,27472,HCPCS,OUTPATIENT,,,2793.5,2234.8,,977.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",977.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2203,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",977.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",977.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",977.95,2203,
"REVISE ARTHROP KNEE SINGLE",5912440,"CDM ",960,RC,27486,HCPCS,OUTPATIENT,,,3221.5,2577.2,,1055.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2802.00,2802.00,2802.00,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1055.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2448,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1055.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1055.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1055.7,2448,
"REVISE ARTHROP KNEE TOTAL",5912445,"CDM ",960,RC,27487,HCPCS,OUTPATIENT,,,4061,3248.8,,1352.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1352.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",3232,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1352.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1352.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1352.44,3232,
"REMOVE KNEE PROSTHESIS",5912450,"CDM ",960,RC,27488,HCPCS,OUTPATIENT,,,2722,2177.6,,881.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1134.72,1134.72,1134.72,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",881.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1880,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",881.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",881.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",881.1,1880,
"CLSD TX FEMUR FX WO MANIP",5912455,"CDM ",960,RC,27501,HCPCS,OUTPATIENT,,,1070.5,856.4,,369.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",369.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",735,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",369.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",369.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",369.94,735,
"OPEN TX FEMUR SHAFT FX",5912460,"CDM ",960,RC,27506,HCPCS,OUTPATIENT,,,3033.5,2426.8,,971.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",971.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1963,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",971.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",971.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",971.3,1963,
"OPN TX FEM SHFT FX W/ PLT/SCRW",5912465,"CDM ",960,RC,27507,HCPCS,OUTPATIENT,,,2237.5,1790,,767.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",767.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1744,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",767.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",767.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",767.36,1744,
"CLSD TX FEM FX D/M/L WO MANIP",5912470,"CDM ",960,RC,27508,HCPCS,OUTPATIENT,,,1143.5,914.8,,384.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",384.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",763,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",384.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",384.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",384.26,763,
"OPEN TX FEMUR FX",5912475,"CDM ",960,RC,27511,HCPCS,OUTPATIENT,,,2212,1769.6,,792.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",792.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1704,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",792.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",792.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",792.79,1704,
"OPEN TX FEMFX W/INTERCON EXT",5912480,"CDM ",960,RC,27513,HCPCS,OUTPATIENT,,,2748,2198.4,,1018.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,221.29,221.29,221.29,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1018.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2024,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1018.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1018.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1018.54,2024,
"OPEN TX FEM FX DIST/MED/LAT",5912485,"CDM ",960,RC,27514,HCPCS,OUTPATIENT,,,2242,1793.6,,981.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",981.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1950,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",981.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",981.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",981.66,1950,
"CLSD TX PATELLA FX WO MANIP",5912490,"CDM ",960,RC,27520,HCPCS,OUTPATIENT,,,682,545.6,,226.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",226.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",450,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",226.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",226.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",226.42,450,
"OPN TX PAT FX W/SFT TISS RPR",5912495,"CDM ",960,RC,27524,HCPCS,OUTPATIENT,,,1699.5,1359.6,,581.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1208.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",581.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1199,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",581.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",581.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",581.89,1208.75,
"CLSD TX TIBIAL FX PROX WO MAN",5912500,"CDM ",960,RC,27530,HCPCS,OUTPATIENT,,,847,677.6,,280.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",280.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",558,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",280.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",280.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",280.7,558,
"OPEN TX TIBIA FX PROX/UNICOND",5912505,"CDM ",960,RC,27535,HCPCS,OUTPATIENT,,,2039,1631.2,,686.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",686.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1367,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",686.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",686.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",686.92,1367,
"OPEN TX TIBIA FX BICOND",5912510,"CDM ",960,RC,27536,HCPCS,OUTPATIENT,,,2633,2106.4,,875.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",875.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1739,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",875.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",875.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",875.55,1739,
"OPEN TX KNEE FX INTERCOND/TUB",5912515,"CDM ",960,RC,27540,HCPCS,OUTPATIENT,,,1835.5,1468.4,,726.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",726.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1444,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",726.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",726.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",726.82,1444,
"CLSD TX KNEE DISLC W/ANESTH",5912520,"CDM ",960,RC,27552,HCPCS,OUTPATIENT,,,1374,1099.2,,471.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",471.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",937,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",471.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",471.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",471.8,937,
"CLSD TX PATELLA DISLC WO ANSTH",5912525,"CDM ",960,RC,27560,HCPCS,OUTPATIENT,,,736,588.8,,263.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",523,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",263.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",263.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.02,523,
"CLSD TX PATELLA DISLC W/ANSTH",5912530,"CDM ",960,RC,27562,HCPCS,OUTPATIENT,,,1076.5,861.2,,335.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",335.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",666,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",335.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",335.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",335.34,666,
"MANIPULATION KNEE W/ANSTH",5912535,"CDM ",960,RC,27570,HCPCS,OUTPATIENT,,,347.5,278,,110.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,28.15,28.15,28.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",220,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",110.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",110.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.76,220,
"DECOMPRESS FASC LEG ANT/LAT",5912540,"CDM ",960,RC,27600,HCPCS,OUTPATIENT,,,891,712.8,,322.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",322.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",641,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",322.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",322.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",322.49,641,
"DECOMP FASC LEG ANT/LAT/POST",5912545,"CDM ",960,RC,27602,HCPCS,OUTPATIENT,,,1106,884.8,,398.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",398.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",791,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",398.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",398.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",398.03,791,
"I&D LOWER LEG DEEP",5912550,"CDM ",960,RC,27603,HCPCS,OUTPATIENT,,,1195.5,956.4,,379.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,323.22,323.22,323.22,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",379.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",754,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",379.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",379.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",379.49,754,
"TENOTOMY ACHILLES UNDR ANESTH",5912554,"CDM ",960,RC,27606,HCPCS,OUTPATIENT,,,539,431.2,,238.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",238.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",474,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",238.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",238.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",238.77,474,
"ARTHROT ANKLE W/REMOVE FB",5912555,"CDM ",960,RC,27610,HCPCS,OUTPATIENT,,,1482.5,1186,,487.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",487.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",969,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",487.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",487.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",487.94,969,
"BX LOWER LEG TISS SUPERFICIAL",5912560,"CDM ",960,RC,27613,HCPCS,OUTPATIENT,,,574,459.2,,162.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",354,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",162.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",162.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.37,354,
"BX LOWER LEG TISSUE DEEP",5912565,"CDM ",960,RC,27614,HCPCS,OUTPATIENT,,,897,717.6,,393.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",393.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",813,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",393.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",393.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",393.11,813,
"ARTHROT ANKLE W/JNT EXPL",5912570,"CDM ",960,RC,27620,HCPCS,OUTPATIENT,,,1039.5,831.6,,361.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",361.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",718,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",361.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",361.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",361.35,718,
"ARTHROT ANKLE W/SYNOVECT TENOS",5912573,"CDM ",960,RC,27626,HCPCS,OUTPATIENT,,,1293.5,1034.8,,505.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,863.78,863.78,863.78,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",505.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1087,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",505.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",505.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",505.49,1087,
"EXC LEG/ANKLE LESS SC >3CM",5912575,"CDM ",960,RC,27632,HCPCS,OUTPATIENT,,,1052.5,842,,206.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",206.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",580,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",206.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",206.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",206.31,580,
"EXC BONE CYST TIBIA/FIBULA",5912580,"CDM ",960,RC,27635,HCPCS,OUTPATIENT,,,1315,1052,,461.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",461.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",932,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",461.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",461.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",461.09,932,
"EXC BONE TIBIA PARTIAL",5912585,"CDM ",960,RC,27640,HCPCS,OUTPATIENT,,,1925,1540,,685.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",685.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1362,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",685.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",685.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",685.63,1362,
"EXC BONE FIBULA PARTIAL",5912590,"CDM ",960,RC,27641,HCPCS,OUTPATIENT,,,1550,1240,,554.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",554.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1102,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",554.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",554.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",554.66,1102,
"RPR ACHILLES TENDON",5912595,"CDM ",960,RC,27650,HCPCS,OUTPATIENT,,,1460.5,1168.4,,548.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",548.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1094,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",548.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",548.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",548.83,1094,
"RPR ACHILLES TENDON W/GRAFT",5912600,"CDM ",960,RC,27652,HCPCS,OUTPATIENT,,,1512,1209.6,,585.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",585.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1215,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",585.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",585.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",585.75,1215,
"RPR ACHILLES TENDON SECONDARY",5912605,"CDM ",960,RC,27654,HCPCS,OUTPATIENT,,,1575,1260,,548.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1535.80,1535.80,1535.80,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",548.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1232,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",548.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",548.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",548.46,1232,
"REPAIR FLEX TENDON PRIME EACH",5912610,"CDM ",960,RC,27658,HCPCS,OUTPATIENT,,,870.5,696.4,,300.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",597,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",300.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",300.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.64,597,
"RPR PERONEAL TEND WO FIB OSTEO",5912615,"CDM ",960,RC,27675,HCPCS,OUTPATIENT,,,1098,878.4,,409.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",409.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",814,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",409.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",409.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",409.75,814,
"TENOLYSIS FLEX/EXT TENDON EACH",5912620,"CDM ",960,RC,27680,HCPCS,OUTPATIENT,,,942.5,754,,342.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",342.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",681,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",342.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",342.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",342.94,681,
"REVISE TENDON LEG/ANKLE SINGLE",5912625,"CDM ",960,RC,27685,HCPCS,OUTPATIENT,,,1034.5,827.6,,428.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1038.27,1038.27,1038.27,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",428.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",923,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",428.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",428.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",428.28,923,
"RPR PERONEAL TENDON W/FIB OSTE",5912627,"CDM ",960,RC,27676,HCPCS,OUTPATIENT,,,1282,1025.6,,482.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",482.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",959,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",482.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",482.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",482.87,959,
"REVISE LOW LEG TENDON DEEP",5912628,"CDM ",960,RC,27691,HCPCS,OUTPATIENT,,,1592.5,1274,,565.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1535.80,1535.80,1535.80,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",565.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1123,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",565.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",565.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",565.38,1123,
"RPR DISRUPT LIGAMENT ANKLE",5912630,"CDM ",960,RC,27695,HCPCS,OUTPATIENT,,,1057.5,846,,353.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1810.03,1810.03,1810.03,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",353.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",819,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",353.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",353.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",353.85,819,
"RPR DISRUPT LIG ANKLE BOTH",5912635,"CDM ",960,RC,27696,HCPCS,OUTPATIENT,,,1255.5,1004.4,,467.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",467.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",928,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",467.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",467.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",467.26,928,
"RPR DISRUPT LIG ANKLE 2NDARY",5912640,"CDM ",960,RC,27698,HCPCS,OUTPATIENT,,,1425.5,1140.4,,519.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1185.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",519.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1176,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",519.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",519.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",519.97,1185.41,
"OSTEOPLASTY FIBULA",5912645,"CDM ",960,RC,27707,HCPCS,OUTPATIENT,,,879.5,703.6,,291.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",291.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",579,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",291.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",291.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",291.26,579,
"CLSD TX TIBIA SHFT FX WO MANIP",5912650,"CDM ",960,RC,27750,HCPCS,OUTPATIENT,,,747.5,598,,244.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",244.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",486,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",244.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",244.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",244.7,486,
"CLSD TX TIBIAL SHFT FX W/MANIP",5912655,"CDM ",960,RC,27752,HCPCS,OUTPATIENT,,,1176,940.8,,390.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",390.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",776,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",390.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",390.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",390.73,776,
"PERCUT FIX TIBIAL SHFT FX",5912660,"CDM ",960,RC,27756,HCPCS,OUTPATIENT,,,1276,1020.8,,418.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",418.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",874,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",418.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",418.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",418.7,874,
"OPN TX TIBIA SHFT FX W/PLT/SCW",5912665,"CDM ",960,RC,27758,HCPCS,OUTPATIENT,,,1973,1578.4,,667.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",667.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1460,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",667.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",667.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",667.25,1460,
"TX TIBIA SHFT FX W/INTRMED IMP",5912670,"CDM ",960,RC,27759,HCPCS,OUTPATIENT,,,2281.5,1825.2,,772.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",772.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1621,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",772.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",772.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",772.19,1621,
"CLSD TX MED ANKLE FX WO MAN",5912675,"CDM ",960,RC,27760,HCPCS,OUTPATIENT,,,705,564,,235.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",235.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",467,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",235.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",235.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",235.23,467,
"CLSD TX MED ANKLE FX W/MAN",5912680,"CDM ",960,RC,27762,HCPCS,OUTPATIENT,,,1046,836.8,,359.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",359.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",715,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",359.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",359.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",359.69,715,
"OPN TX MED ANKLE WO MAN",5912685,"CDM ",960,RC,27766,HCPCS,OUTPATIENT,,,1373,1098.4,,495.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,5337.79,5337.79,5337.79,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",495.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",985,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",495.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",495.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",495.56,985,
"CLSD TX POST ANKLE FX WO MAN",5912690,"CDM ",960,RC,27767,HCPCS,OUTPATIENT,,,586.5,469.2,,176.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",391,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",176.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",176.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.36,391,
"CLSD TX PROX FIB FX WO MANIP",5912695,"CDM ",960,RC,27780,HCPCS,OUTPATIENT,,,628,502.4,,208.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",208.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",426,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",208.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",208.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",208.5,426,
"OPEN TX PROX FIB/SHAFT FX",5912700,"CDM ",960,RC,27784,HCPCS,OUTPATIENT,,,1569,1255.2,,430.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,396.77,396.77,396.77,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",430.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",997,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",430.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",430.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",430.72,997,
"CLSD TX DIST FIB FX WO MAN",5912705,"CDM ",960,RC,27786,HCPCS,OUTPATIENT,,,666.5,533.2,,223.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",223.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",444,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",223.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",223.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",223.35,444,
"OPEN TX DIST FIB FX W/INT FIX",5912710,"CDM ",960,RC,27792,HCPCS,OUTPATIENT,,,1586,1268.8,,463.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",989.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",463.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",978,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",463.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",463.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",463.61,989.53,
"CLSD TX BIMAL ANKLE FX WO MAN",5912715,"CDM ",960,RC,27808,HCPCS,OUTPATIENT,,,658,526.4,,232.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",232.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",462,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",232.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",232.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",232.43,462,
"CLSD TX BIMAL ANKLE FX W MANIP",5912720,"CDM ",960,RC,27810,HCPCS,OUTPATIENT,,,1025,820,,323.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",323.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",701,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",323.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",323.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",323.53,701,
"OPEN TX BIMAL ANKLE FX",5912725,"CDM ",960,RC,27814,HCPCS,OUTPATIENT,,,1754.5,1403.6,,614.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",614.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1221,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",614.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",614.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",614.59,1221,
"CLSD TX TRIMAL ANKLE FX WO MAN",5912730,"CDM ",960,RC,27816,HCPCS,OUTPATIENT,,,632.5,506,,222.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",222.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",441,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",222.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",222.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",222.03,441,
"CLSD TX TRIMAL ANKLE FX W MAN",5912735,"CDM ",960,RC,27818,HCPCS,OUTPATIENT,,,1067,853.6,,367.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",367.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",731,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",367.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",367.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",367.98,731,
"OPEN TX TRIMAL ANKLE FX WO FIX",5912740,"CDM ",960,RC,27822,HCPCS,OUTPATIENT,,,1943,1554.4,,684.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",684.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1359,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",684.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",684.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",684.06,1359,
"OPEN TX TRIMAL ANKLE FX W/FIX",5912745,"CDM ",960,RC,27823,HCPCS,OUTPATIENT,,,2212,1769.6,,777.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",777.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1544,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",777.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",777.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",777.38,1544,
"CLSD TX DIST TIBIA  WO MANIP",5912750,"CDM ",960,RC,27824,HCPCS,OUTPATIENT,,,676,540.8,,205.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",205.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",424,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",205.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",205.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",205.64,424,
"CLSD TX DIST TIBIA W/MANIP",5912755,"CDM ",960,RC,27825,HCPCS,OUTPATIENT,,,1202.5,962,,376.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,3659.25,3659.25,3659.25,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",376.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",796,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",376.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",376.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",376.44,796,
"OPN TX TIB FX ONLY W/INT FIX",5912760,"CDM ",960,RC,27827,HCPCS,OUTPATIENT,,,2425.5,1940.4,,850.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,499.70,499.70,499.70,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",850.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1690,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",850.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",850.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",850.76,1690,
"OPN TX TIB/FIB FX W/INT FIX",5912765,"CDM ",960,RC,27828,HCPCS,OUTPATIENT,,,2903,2322.4,,960.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",960.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1907,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",960.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",960.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",960.01,1907,
"OPEN TX DIST TIBIOFIB DISRUPT",5912770,"CDM ",960,RC,27829,HCPCS,OUTPATIENT,,,1554.5,1243.6,,451.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",451.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",987,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",451.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",451.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",451.16,987,
"CLSD TX ANKLE DISLC WO ANESTH",5912775,"CDM ",960,RC,27840,HCPCS,OUTPATIENT,,,831.5,665.2,,258.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",258.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",513,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",258.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",258.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",258.46,513,
"CLSD TX ANKLE DISLC W/ANESTH",5912780,"CDM ",960,RC,27842,HCPCS,OUTPATIENT,,,1093.5,874.8,,359.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",359.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",714,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",359.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",359.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",359.6,714,
"OPEN TX ANKLE DISLOCATION",5912785,"CDM ",960,RC,27846,HCPCS,OUTPATIENT,,,1598.5,1278.8,,566.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",566.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1125,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",566.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",566.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",566.08,1125,
"OPEN TX ANKLE DISLC W/RPR/FIX",5912790,"CDM ",960,RC,27848,HCPCS,OUTPATIENT,,,1770.5,1416.4,,665.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",665.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1321,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",665.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",665.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",665.06,1321,
"OPEN ARTHRODESIS/FUSION ANKLE",5912795,"CDM ",960,RC,27870,HCPCS,OUTPATIENT,,,2276.5,1821.2,,782.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",782.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1607,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",782.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",782.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",782.27,1607,
"AMPUTATION LEG TIBIA FIBULA",5912800,"CDM ",960,RC,27880,HCPCS,OUTPATIENT,,,2092,1673.6,,609.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",609.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1332,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",609.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",609.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",609.64,1332,
"REAMPUTATION TIBIA/FIBULA",5912805,"CDM ",960,RC,27886,HCPCS,OUTPATIENT,,,1448.5,1158.8,,505.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",505.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1004,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",505.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",505.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",505.24,1004,
"AMPUTATE FOOT AT ANKLE",5912808,"CDM ",960,RC,27889,HCPCS,OUTPATIENT,,,1322,1057.6,,526.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",526.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1088,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",526.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",526.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",526.27,1088,
"DECOMPRESS FASC LEG W/DEBRIDE",5912810,"CDM ",960,RC,27892,HCPCS,OUTPATIENT,,,1851,1480.8,,412.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",412.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",819,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",412.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",412.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",412.27,819,
"I&D BURSA FOOT",5912815,"CDM ",960,RC,28001,HCPCS,OUTPATIENT,,,1130.5,904.4,,176.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",382,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",176.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",176.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.04,382,
"I&D BELOW FASC FOOT SINGLE",5912820,"CDM ",960,RC,28002,HCPCS,OUTPATIENT,,,1524.5,1219.6,,297.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",297.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",688,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",297.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",297.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",297.11,688,
"FASCIOTOMY FOOT/TOE",5912825,"CDM ",960,RC,28008,HCPCS,OUTPATIENT,,,682,545.6,,278.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",278.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",601,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",278.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",278.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",278.69,601,
"RELEASE TARSAL TUNNEL",5912830,"CDM ",960,RC,28035,HCPCS,OUTPATIENT,,,799,639.2,,337.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",495.59,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",337.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",736,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",337.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",337.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",337.99,736,
"EXC TUM FOOT/TOE DEEP >1.5CM",5912835,"CDM ",960,RC,28041,HCPCS,OUTPATIENT,,,1368.5,1094.8,,223.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,377.60,377.60,377.60,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",223.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",653,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",223.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",223.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",223.1,653,
"EXC TUM FOOT/TOE DEEP <1.5CM",5912840,"CDM ",960,RC,28043,HCPCS,OUTPATIENT,,,897,717.6,,227.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",561,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",227.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",227.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.1,561,
"FASCIECTOMY PLANTAR FASCIA PRT",5912845,"CDM ",960,RC,28060,HCPCS,OUTPATIENT,,,804.5,643.6,,331.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",331.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",725,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",331.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",331.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",331.89,725,
"EXC INTRDGTL LESION FOOT EACH",5912847,"CDM ",960,RC,28080,HCPCS,OUTPATIENT,,,786.5,629.2,,264.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",264.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",736,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",264.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",264.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",264.51,736,
"SYNOVEC TEND SHTH FOOT FLEXOR",5912850,"CDM ",960,RC,28086,HCPCS,OUTPATIENT,,,799,639.2,,388.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",388.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",772,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",388.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",388.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",388.46,772,
"EXC LESION/TENDON FOOT",5912855,"CDM ",960,RC,28090,HCPCS,OUTPATIENT,,,706,564.8,,294.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",294.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",659,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",294.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",294.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",294.19,659,
"OSTECTOMY PART EXC 5TH METATAR",5912860,"CDM ",960,RC,28110,HCPCS,OUTPATIENT,,,649.5,519.6,,284.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",284.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",648,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",284.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",284.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",284.88,648,
"OSTECTOMY COMP EXC 5TH META",5912865,"CDM ",960,RC,28113,HCPCS,OUTPATIENT,,,954.5,763.6,,332.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",332.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",830,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",332.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",332.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",332.48,830,
"OSTECTOMY EXC TARSAL COALITION",5912870,"CDM ",960,RC,28116,HCPCS,OUTPATIENT,,,1299,1039.2,,455.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",455.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1075,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",455.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",455.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",455.17,1075,
"OSTECTOMY CALCANEUS",5912875,"CDM ",960,RC,28118,HCPCS,OUTPATIENT,,,927,741.6,,379.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1535.80,1535.80,1535.80,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",379.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",834,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",379.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",379.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",379.32,834,
"OSTECTOMY CALCANEUS HEEL SPUR",5912880,"CDM ",960,RC,28119,HCPCS,OUTPATIENT,,,804.5,643.6,,335.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",335.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",736,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",335.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",335.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",335.54,736,
"EXC PART BONE ANKLE/HEEL",5912885,"CDM ",960,RC,28120,HCPCS,OUTPATIENT,,,1150.5,920.4,,388.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",388.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",953,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",388.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",388.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",388.85,953,
"EXC PART TAR/METATAR BONE",5912890,"CDM ",960,RC,28122,HCPCS,OUTPATIENT,,,1612,1289.6,,440.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",440.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",900,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",440.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,4329.40,4329.40,4329.40,"1 through 10",other,"not separately reimbursment ",440.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",440.66,900,
"EXC PART PHALANX TOE",5912895,"CDM ",960,RC,28124,HCPCS,OUTPATIENT,,,747.5,598,,302.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",302.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",665,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",302.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",302.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",302.86,665,
"REMOVE FOOT FB SUBCUTANEOUS",5912900,"CDM ",960,RC,28190,HCPCS,OUTPATIENT,,,628,502.4,,160.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",187.17,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",160.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",358,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",160.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",160.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",160.64,358,
"REMOVE FOOT FB DEEP",5912905,"CDM ",960,RC,28192,HCPCS,OUTPATIENT,,,1088.5,870.8,,311.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,771.70,771.70,771.70,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",311.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",663,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",311.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",311.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",311.28,663,
"RPR FLEX TEND FOOT WO GRAFT",5912910,"CDM ",960,RC,28200,HCPCS,OUTPATIENT,,,724.5,579.6,,308.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",308.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",677,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",308.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",308.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",308.3,677,
"RECON POST TIB TEND W/BONE",5912915,"CDM ",960,RC,28238,HCPCS,OUTPATIENT,,,1552,1241.6,,467.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",467.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",929,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",467.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",467.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",467.66,929,
"TENOTOMY LENGTH/RELEASE ABDUCT",5912920,"CDM ",960,RC,28240,HCPCS,OUTPATIENT,,,1018,814.4,,278.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",278.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",610,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",278.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",278.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",278.3,610,
"CAPSULOTOMY METATARSOPHALANG",5912925,"CDM ",960,RC,28270,HCPCS,OUTPATIENT,,,1109,887.2,,298.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",298.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",690,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",298.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",298.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",298.98,690,
"RPR HAMMERTOE",5912930,"CDM ",960,RC,28285,HCPCS,OUTPATIENT,,,867,693.6,,302.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",302.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",745,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",302.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",302.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",302.34,745,
"RPR HALLUX VALGUS ANY METHOD",5912935,"CDM ",960,RC,28296,HCPCS,OUTPATIENT,,,1190,952,,541.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1001.52,1001.52,1001.52,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",541.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1076,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",541.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",541.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",541.39,1076,
"RPR HALLUX VALGUS DBL ANY METH",5912940,"CDM ",960,RC,28299,HCPCS,OUTPATIENT,,,1316.5,1053.2,,606.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1027.35,1027.35,1027.35,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",606.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1249,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",606.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",606.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",606.36,1249,
"OSTEOTOMY 1ST METATARSAL",5912945,"CDM ",960,RC,28306,HCPCS,OUTPATIENT,,,902.5,722,,392.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",392.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",864,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",392.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",392.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",392.48,864,
"OSTEOTOMY EA OTH THN 1ST METAT",5912950,"CDM ",960,RC,28308,HCPCS,OUTPATIENT,,,908.5,726.8,,341.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",533.84,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",341.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",787,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",341.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",341.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",341.24,787,
"RECONSTRUCT TOE SOFT TISSUE",5912955,"CDM ",960,RC,28313,HCPCS,OUTPATIENT,,,845.5,676.4,,320.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",320.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",735,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",320.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",320.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",320.12,735,
"REMOVE SESAMOID BONE",5912960,"CDM ",960,RC,28315,HCPCS,OUTPATIENT,,,730.5,584.4,,302.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",302.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",673,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",302.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",302.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",302.35,673,
"REPAIR METATARSALS",5912965,"CDM ",960,RC,28322,HCPCS,OUTPATIENT,,,1742.5,1394,,545.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",545.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1105,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",545.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,516.61,516.61,516.61,"1 through 10",other,"not separately reimbursment ",545.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",545.23,1105,
"CLSD TX CALCANEAL FX WO MANIP",5912970,"CDM ",960,RC,28400,HCPCS,OUTPATIENT,,,500.5,400.4,,176.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",351,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",176.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",176.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.51,351,
"OPEN TX CALCANEAL/HEEL FX",5912975,"CDM ",960,RC,28415,HCPCS,OUTPATIENT,,,2477,1981.6,,930.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",930.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1849,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",930.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",930.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",930.46,1849,
"CLSD TX TALUS FX WO MANIP",5912980,"CDM ",960,RC,28430,HCPCS,OUTPATIENT,,,500.5,400.4,,166.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",166.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",331,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",166.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",166.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",166.77,331,
"PERCU FIX TALUS FX W/MANIP",5912985,"CDM ",960,RC,28436,HCPCS,OUTPATIENT,,,994.5,795.6,,330.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",330.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",656,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",330.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",330.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",330.18,656,
"OPEN TX TALUS/ANKLE FX",5912990,"CDM ",960,RC,28445,HCPCS,OUTPATIENT,,,1225.5,980.4,,855.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",855.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1699,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",855.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",855.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",855.18,1699,
"OPEN TX TARSAL FX WO MAN",5912995,"CDM ",960,RC,28450,HCPCS,OUTPATIENT,,,462,369.6,,152.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",303,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",152.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",152.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.37,303,
"OPEN TX  TARSAL FX W/INT FIX",5913000,"CDM ",960,RC,28465,HCPCS,OUTPATIENT,,,1435,1148,,420.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",420.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",870,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",420.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",420.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",420.2,870,
"CLSD TX METATARSAL FX WO MAN",5913005,"CDM ",960,RC,28470,HCPCS,OUTPATIENT,,,457,365.6,,155.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",310,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",155.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",155.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.94,310,
"CLSD TX METATARSAL FX W/MAN",5913010,"CDM ",960,RC,28475,HCPCS,OUTPATIENT,,,500.5,400.4,,195.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",195.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",389,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",195.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",195.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",195.76,389,
"PERCU FIX METATARSAL FX W/MAN",5913015,"CDM ",960,RC,28476,HCPCS,OUTPATIENT,,,776,620.8,,256.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",256.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",509,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",256.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",256.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",256.22,509,
"OPEN TX METATARSAL FX",5913020,"CDM ",960,RC,28485,HCPCS,OUTPATIENT,,,1225.5,980.4,,349.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",767.16,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",349.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",750,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",349.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,6630.42,6630.42,6630.42,"1 through 10",other,"not separately reimbursment ",349.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",349.12,767.16,
"CLSD TX FX GREAT TOE WO MAN",5913025,"CDM ",960,RC,28490,HCPCS,OUTPATIENT,,,275.5,220.4,,93.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",203,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",93.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",93.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.31,203,
"CLSD TX FX GREAT TOE W/MAN",5913030,"CDM ",960,RC,28495,HCPCS,OUTPATIENT,,,384.5,307.6,,114.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",239,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",114.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",114.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.51,239,
"PERCU FIX GREAT TOE FX",5913035,"CDM ",960,RC,28496,HCPCS,OUTPATIENT,,,534.5,427.6,,310.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",310.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",616,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",310.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",310.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",310.04,616,
"CLSD TX TOE FX W/O MANIP EA",5913040,"CDM ",960,RC,28510,HCPCS,OUTPATIENT,,,264.5,211.6,,79.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",164,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",79.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",79.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.76,164,
"CLSD TX TOE FX W/MANIP EA",5913045,"CDM ",960,RC,28515,HCPCS,OUTPATIENT,,,316.5,253.2,,102.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",225,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",102.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",102.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.54,225,
"OPEN TX TOE FX EACH",5913050,"CDM ",960,RC,28525,HCPCS,OUTPATIENT,,,891,712.8,,323.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",323.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",795,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",323.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",323.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",323.7,795,
"CLSD TX ANKLE DISLC WO ANESTH",5913055,"CDM ",960,RC,28540,HCPCS,OUTPATIENT,,,764.5,611.6,,136.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",274,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",136.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",136.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136.7,274,
"OPEN TX FOOT DISLOCATION",5913060,"CDM ",960,RC,28555,HCPCS,OUTPATIENT,,,1937,1549.6,,495.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",495.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1234,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",495.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",495.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",495.98,1234,
"CLSD TX TALOTARSAL DISLC W/AN",5913065,"CDM ",960,RC,28575,HCPCS,OUTPATIENT,,,730.5,584.4,,219.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",219.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",506,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",219.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",219.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",219.96,506,
"PERCU FIX TARSOMET DISLC W/MAN",5913070,"CDM ",960,RC,28576,HCPCS,OUTPATIENT,,,862.5,690,,262.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",549,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",262.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",262.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.1,549,
"OPEN TX TARSOMETATARSAL DISLC",5913075,"CDM ",960,RC,28615,HCPCS,OUTPATIENT,,,1778,1422.4,,496.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",496.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1093,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",496.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",496.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",496.47,1093,
"CLSD TX TOE DISLC WO ANESTH",5913080,"CDM ",960,RC,28660,HCPCS,OUTPATIENT,,,201.5,161.2,,76.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",130.15,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",155,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",76.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",76.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.48,155,
"AMP FOOT MIDTARSAL",5913083,"CDM ",960,RC,28800,HCPCS,OUTPATIENT,,,1215.5,972.4,,444.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",444.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",884,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",444.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",444.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",444.74,884,
"AMPUTATION TRANSMETATARSAL",5913085,"CDM ",960,RC,28805,HCPCS,OUTPATIENT,,,2262.5,1810,,446.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",446.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1097,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",446.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",446.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",446.94,1097,
"AMP METATARSAL W/TOE SINGLE",5913090,"CDM ",960,RC,28810,HCPCS,OUTPATIENT,,,1224.5,979.6,,338.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",672,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",338.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",338.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.46,672,
"AMP METATARSOPHALANGEAL JOINT",5913095,"CDM ",960,RC,28820,HCPCS,OUTPATIENT,,,925.5,740.4,,361.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,416.22,416.22,416.22,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",361.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",805,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",361.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",361.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",361.52,805,
"AMPUTATION TOE PARTIAL",5913100,"CDM ",960,RC,28825,HCPCS,OUTPATIENT,,,1315,1052,,317.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",317.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",768,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",317.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",317.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",317.74,768,
"APPLY CAST LONG ARM",5913105,"CDM ",960,RC,29065,HCPCS,OUTPATIENT,,,207.5,166,,67.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",134,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",67.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,53.17,53.17,53.17,"1 through 10",other,"not separately reimbursment ",67.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.54,134,
"APPLY CAST SHORT ARM",5913110,"CDM ",960,RC,29075,HCPCS,OUTPATIENT,,,193,154.4,,62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",123,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,39.71,39.71,39.71,"1 through 10",other,"not separately reimbursment ",62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6,123,
"APPLY CAST GAUNTLET",5913115,"CDM ",960,RC,29085,HCPCS,OUTPATIENT,,,203.5,162.8,,65.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",131,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",65.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",65.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.93,131,
"APPLY CAST FINGER",5913120,"CDM ",960,RC,29086,HCPCS,OUTPATIENT,,,114,91.2,,47.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",103,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",47.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",47.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.63,103,
"APPLY LONG ARM SPLINT",5913125,"CDM ",960,RC,29105,HCPCS,OUTPATIENT,,,287.5,230,,64.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",127,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",64.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6,127,
"APPLY FOREARM SPLINT STATIC",5913130,"CDM ",960,RC,29125,HCPCS,OUTPATIENT,,,146.5,117.2,,48.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",96,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",48.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",48.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.35,96,
"APPLY FINGER SPLINT STATIC",5913135,"CDM ",960,RC,29130,HCPCS,OUTPATIENT,,,96.5,77.2,,30.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",60,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",30.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3,60,
"STRAPPING ELBOW/WRIST",5913140,"CDM ",960,RC,29260,HCPCS,OUTPATIENT,,,125,100,,38.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",77,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",38.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,5.27,5.27,5.27,"1 through 10",other,"not separately reimbursment ",38.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.9,77,
"STRAPPING HAND/FINGER",5913145,"CDM ",960,RC,29280,HCPCS,OUTPATIENT,,,63.5,50.8,,38.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",77,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",38.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",38.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.84,77,
"APPLY LONG LEG CAST",5913150,"CDM ",960,RC,29345,HCPCS,OUTPATIENT,,,297,237.6,,98.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",196,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",98.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",98.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.42,196,
"APPLY CYLINDER CAST LEG",5913155,"CDM ",960,RC,29365,HCPCS,OUTPATIENT,,,221.5,177.2,,87.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",174,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",87.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",87.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.55,174,
"APPLY SHORT LEG CAST",5913160,"CDM ",960,RC,29405,HCPCS,OUTPATIENT,,,198,158.4,,63.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",127,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",63.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",63.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.96,127,
"APPLY SHORT LEG WALK CAST",5913165,"CDM ",960,RC,29425,HCPCS,OUTPATIENT,,,214.5,171.6,,69.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",137,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",69.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",69.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.18,137,
"APPLY RIGID LEG CAST",5913170,"CDM ",960,RC,29445,HCPCS,OUTPATIENT,,,544.5,435.6,,112.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",223,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",112.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",112.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.17,223,
"APPLY LONG LEG SPLINT",5913175,"CDM ",960,RC,29505,HCPCS,OUTPATIENT,,,165.5,132.4,,56.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",112,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",56.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",56.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.14,112,
"APPLY SHORT LEG SPLINT",5913180,"CDM ",960,RC,29515,HCPCS,OUTPATIENT,,,163,130.4,,49.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",102,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",49.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,41.35,41.35,41.35,"1 through 10",other,"not separately reimbursment ",49.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4,102,
"STRAPPING KNEE BRACE",5913185,"CDM ",960,RC,29530,HCPCS,OUTPATIENT,,,114,91.2,,40.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.94,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",85,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",40.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",40.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.91,85,
"STRAPPING WALKING BOOT",5913190,"CDM ",960,RC,29580,HCPCS,OUTPATIENT,,,117.5,94,,37.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",76,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",37.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.49,76,
"APPL MULT LAY COMPRES LOW LEG",5913195,"CDM ",960,RC,29581,HCPCS,OUTPATIENT,,,174,139.2,,16.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.61,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",121,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",16.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",16.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.42,121,
"ARTHROSCOPY SHLDR/CAPSUL",5913200,"CDM ",960,RC,29806,HCPCS,OUTPATIENT,,,2229.5,1783.6,,817.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1634.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",817.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1624,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",817.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",817.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",817.38,1634.64,
"ARTHROSCOPY SHLDR RPR SLAP",5913205,"CDM ",960,RC,29807,HCPCS,OUTPATIENT,,,2121.5,1697.2,,796.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,415.12,415.12,415.12,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",796.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1582,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",796.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",796.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",796.08,1582,
"ARTHROSCOPY SHLDR W/LIM DEBR",5913210,"CDM ",960,RC,29822,HCPCS,OUTPATIENT,,,1193.5,954.8,,405.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",405.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",950,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",405.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",405.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",405.21,950,
"ARTHROSCOPY SHLDR W/EXT DEBR",5913215,"CDM ",960,RC,29823,HCPCS,OUTPATIENT,,,1306.5,1045.2,,488.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",488.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1070,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",488.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",488.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",488.9,1070,
"ARTHROSCOPY SHLDR DIST CLAVIC",5913220,"CDM ",960,RC,29824,HCPCS,OUTPATIENT,,,1396,1116.8,,500.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",500.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",994,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",500.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",500.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",500.21,994,
"ARTHROSCOPY SHLDR W/ADHES",5913225,"CDM ",960,RC,29825,HCPCS,OUTPATIENT,,,1183,946.4,,412.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",412.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",991,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",412.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",412.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",412.74,991,
"ARTHROSCOPY SHLDR W/DECOMP",5913230,"CDM ",960,RC,29826,HCPCS,OUTPATIENT,,,688,550.4,,526.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",520.77,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",526.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1162,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",526.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,7710.59,7710.59,7710.59,"1 through 10",other,"not separately reimbursment ",526.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",520.77,1162,
"ARTHROSCOPY ROTATOR CUFF RPR",5913235,"CDM ",960,RC,29827,HCPCS,OUTPATIENT,,,2280.5,1824.4,,862.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1654.27,100,,1413.82,1413.82,1413.82,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",862.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1714,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",862.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,7710.59,7710.59,7710.59,"1 through 10",other,"not separately reimbursment ",862.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",862.62,1714,
"ARTHROSCOPY BICEP TENODESIS",5913240,"CDM ",960,RC,29828,HCPCS,OUTPATIENT,,,1912.5,1530,,,,,,,,0,"other ","not separately reimbursment ",,,,594.60,594.60,594.60,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1290,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,7710.59,7710.59,7710.59,"1 through 10",other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1290,1290,
"ARTHROSCOPY ELBOW",5913245,"CDM ",960,RC,29834,HCPCS,OUTPATIENT,,,274.5,219.6,,383.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",383.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",762,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",383.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",383.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",383.51,762,
"ARTHROSCOPY ELBOW SYNOVECT",5913250,"CDM ",960,RC,29836,HCPCS,OUTPATIENT,,,1195.5,956.4,,408.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",408.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",900,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",408.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",408.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",408.01,900,
"ARTHROSCOPY ELBOW W/DEBRIDE",5913255,"CDM ",960,RC,29837,HCPCS,OUTPATIENT,,,1076.5,861.2,,372.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",372.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",820,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",372.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",372.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",372.26,820,
"ARTHROSCOPY ELBOW W/EXT DEBR",5913260,"CDM ",960,RC,29838,HCPCS,OUTPATIENT,,,1225.5,980.4,,417.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",417.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",919,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",417.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",417.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",417.1,919,
"ENDOSCOPY WRIST W/RELEASE",5913265,"CDM ",960,RC,29848,HCPCS,OUTPATIENT,,,1064.5,851.6,,345.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",740.6,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",345.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",698,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",345.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",345.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",345.72,740.6,
"ARTHROSCOPY TIBIA FX W/INT FIX",5913270,"CDM ",960,RC,29855,HCPCS,OUTPATIENT,,,1647,1317.6,,618.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",618.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1320,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",618.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",618.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",618.28,1320,
"ARTHROSCOPY KNEE W/AUTOGRAFT",5913275,"CDM ",960,RC,29866,HCPCS,OUTPATIENT,,,2148,1718.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1600,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1600,1600,
"ARTHROSCOPY KNEE W/ALLOGRAFT",5913280,"CDM ",960,RC,29867,HCPCS,OUTPATIENT,,,2622.5,2098,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1916,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1916,1916,
"ARTHROSCOPY KNEE DIAGNOSTIC",5913285,"CDM ",960,RC,29870,HCPCS,OUTPATIENT,,,844,675.2,,313.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",313.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",812,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",313.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",313.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",313.96,812,
"ARTHROSCOPY KNEE FOR INFECTION",5913290,"CDM ",960,RC,29871,HCPCS,OUTPATIENT,,,1064.5,851.6,,394.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",394.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",784,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",394.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",394.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",394.48,784,
"ARTHROSCOPY KNEE REMOVE FB",5913295,"CDM ",960,RC,29874,HCPCS,OUTPATIENT,,,1122,897.6,,415.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",415.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",893,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",415.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",415.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",415.06,893,
"ARTHROSCOPY KNEE SYNOVECT LMT",5913300,"CDM ",960,RC,29875,HCPCS,OUTPATIENT,,,1146,916.8,,348.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",348.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",815,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",348.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",348.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",348.36,815,
"ARTHROSCOPY KNEE SYNOVECT MJR",5913305,"CDM ",960,RC,29876,HCPCS,OUTPATIENT,,,1354,1083.2,,474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1019,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",474.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",474.59,1019,
"ARTHROSCOPY KNEE W/DEBRIDE",5913310,"CDM ",960,RC,29877,HCPCS,OUTPATIENT,,,1497,1197.6,,429.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1147.6,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",429.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",946,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",429.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",429.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",429.67,1147.6,
"ARTHROSCOPY KNEE W/ABRASION",5913315,"CDM ",960,RC,29879,HCPCS,OUTPATIENT,,,1369.5,1095.6,,481.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1244.07,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",481.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1047,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",481.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,143.70,143.70,143.70,"1 through 10",other,"not separately reimbursment ",481.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",481.59,1244.07,
"ARTHRO MENISC MED & LAT",5913320,"CDM ",960,RC,29880,HCPCS,OUTPATIENT,,,1430.5,1144.4,,480.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1241.56,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",480.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1101,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",480.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",480.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",480.44,1241.56,
"ARTHRO MENISC MED OR LAT",5913325,"CDM ",960,RC,29881,HCPCS,OUTPATIENT,,,1334,1067.2,,467.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1148.39,100,,1838.17,1838.17,1838.17,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",467.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",993,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",467.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",467.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",467.22,1148.39,
"ARTHRO MENISC RPR MED OR LAT",5913330,"CDM ",960,RC,29882,HCPCS,OUTPATIENT,,,1476.5,1181.2,,506.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",506.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1098,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",506.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",506.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",506.6,1098,
"ARTHRO MENISCUS RPR MED&LAT",5913335,"CDM ",960,RC,29883,HCPCS,OUTPATIENT,,,1774,1419.2,,641.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1569.79,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",641.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1275,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",641.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,494.30,494.30,494.30,"1 through 10",other,"not separately reimbursment ",641.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",641.92,1569.79,
"ARTHROSCOPY CRUC LIG RPR/RECON",5913340,"CDM ",960,RC,29888,HCPCS,OUTPATIENT,,,2064.5,1651.6,,774.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",774.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1773,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",774.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",774.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",774.25,1773,
"ARTHROSCOPY POST CRUC LIGAMENT",5913345,"CDM ",960,RC,29889,HCPCS,OUTPATIENT,,,2510,2008,,910.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",910.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1809,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",910.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",910.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",910.64,1809,
"ARTHRO ANKLE EXC OSTEOCH DFCT",5913350,"CDM ",960,RC,29891,HCPCS,OUTPATIENT,,,1385.5,1108.4,,503.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",503.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1041,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",503.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",503.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",503.7,1041,
"ARTHRO ANKLE OSTEOCH LESION",5913355,"CDM ",960,RC,29892,HCPCS,OUTPATIENT,,,1348.5,1078.8,,505.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",505.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1073,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",505.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",505.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",505.47,1073,
"ENDOSCOPIC PLANTAR FASCIOTOMY",5913360,"CDM ",960,RC,29893,HCPCS,OUTPATIENT,,,895.5,716.4,,352.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",352.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",852,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",352.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",352.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",352.37,852,
"ARTHROSCOPY ANKLE W/DEBR LMT",5913365,"CDM ",960,RC,29897,HCPCS,OUTPATIENT,,,1100,880,,415.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",415.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",924,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",415.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",415.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",415.26,924,
"ARTHROSCOPY ANKLE W/DEBR EXT",5913370,"CDM ",960,RC,29898,HCPCS,OUTPATIENT,,,1162.5,930,,462.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,3425.64,3425.64,3425.64,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",462.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1061,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",462.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",462.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",462.2,1061,
"ARTHROSCOPY SUBTALAR W/DEBR",5913375,"CDM ",960,RC,29906,HCPCS,OUTPATIENT,,,1396.5,1117.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",992,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",992,992,
"DRAINAGE NOSE LESION",5913380,"CDM ",960,RC,30000,HCPCS,OUTPATIENT,,,527,421.6,,160.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",160.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",319,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",160.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",160.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",160.48,319,
"BX INTRANASAL",5913385,"CDM ",960,RC,30100,HCPCS,OUTPATIENT,,,323.5,258.8,,85.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",193,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.89,193,
"INJ TURBINATE NOSE THERAPEUTIC",5913390,"CDM ",960,RC,30200,HCPCS,OUTPATIENT,,,253.5,202.8,,70.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",156,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",70.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",70.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.68,156,
"REMOVE FB INTRANASAL",5913395,"CDM ",960,RC,30300,HCPCS,OUTPATIENT,,,510,408,,162.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",323,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",162.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",162.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.77,323,
"REMOVE FB INTRANASAL W/ANESTH",5913400,"CDM ",960,RC,30310,HCPCS,OUTPATIENT,,,478.5,382.8,,151.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",301,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",151.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",151.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.26,301,
"ABLATION TURBINATES SUBMUCOSAL",5913405,"CDM ",960,RC,30802,HCPCS,OUTPATIENT,,,658,526.4,,195.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",195.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",398,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",195.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",195.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",195.19,398,
"CONTROL NASAL HEMORRHAGE SIMP",5913410,"CDM ",960,RC,30901,HCPCS,OUTPATIENT,,,191.5,153.2,,78.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",155,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",78.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",78.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.16,155,
"CONTROL NASAL HEMORRHAGE CMPLX",5913415,"CDM ",960,RC,30903,HCPCS,OUTPATIENT,,,180,144,,126.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",126.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",289,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",126.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",126.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",126.59,289,
"CONTROL NASAL HEMORRHAGE INITL",5913420,"CDM ",960,RC,30905,HCPCS,OUTPATIENT,,,414,331.2,,163.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,24.08,24.08,24.08,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",163.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",360,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",163.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",163.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",163.13,360,
"THER FX NASAL INF TURBINATE",5913425,"CDM ",960,RC,30930,HCPCS,OUTPATIENT,,,287.5,230,,87.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",173,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",87.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",87.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.15,173,
"LAVAGE CANNUL MAX SINUS",5913430,"CDM ",960,RC,31000,HCPCS,OUTPATIENT,,,405,324,,117,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",245,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",117,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",117,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,245,
"ENDOSCOPY NASAL DIAGNOSTIC",5913435,"CDM ",960,RC,31231,HCPCS,OUTPATIENT,,,309.5,247.6,,130.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",290,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",130.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",130.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.34,290,
"ENDOSCOPY NASAL W/BIOPSY",5913440,"CDM ",960,RC,31237,HCPCS,OUTPATIENT,,,333,266.4,,244.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",244.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",485,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",244.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",244.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",244.12,485,
"ENDOSCOPY NASAL W/CB RESECT",5913445,"CDM ",960,RC,31240,HCPCS,OUTPATIENT,,,355,284,,119.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",318,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",119.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",119.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.28,318,
"ENDOSCOPY NASAL W/ETHMOID PART",5913450,"CDM ",960,RC,31254,HCPCS,OUTPATIENT,,,599.5,479.6,,204.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",204.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",570,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",204.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",204.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",204.84,570,
"ENDOSCOPY NASAL W/ETHMD TOTAL",5913455,"CDM ",960,RC,31255,HCPCS,OUTPATIENT,,,832,665.6,,302.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",302.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",859,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",302.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",302.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",302.74,859,
"REMOVE TISSUE MAXILLARY SINUS",5913460,"CDM ",960,RC,31267,HCPCS,OUTPATIENT,,,692,553.6,,239.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",239.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",627,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",239.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",239.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",239.31,627,
"REMOVE TISSUE FRONTAL SINUS",5913465,"CDM ",960,RC,31276,HCPCS,OUTPATIENT,,,1108.5,886.8,,381.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",381.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",884,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",381.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",381.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",381.58,884,
"REMOVE TISSUE SPHENOID SINUS",5913470,"CDM ",960,RC,31288,HCPCS,OUTPATIENT,,,588,470.4,,232.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",232.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",567,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",232.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",232.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",232.2,567,
"ENDOSCOPY NASAL W/BALOON DIL",5913475,"CDM ",960,RC,31295,HCPCS,OUTPATIENT,,,360.5,288.4,,80.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2906,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",80.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.62,2906,
"ENDOSCOPY NASAL W/FRONT OSTIUM",5913480,"CDM ",960,RC,31296,HCPCS,OUTPATIENT,,,422,337.6,,96.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",5188,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",96.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",96.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.4,5188,
"ENDOSCOPY NASAL W/SPHENOID OST",5913485,"CDM ",960,RC,31297,HCPCS,OUTPATIENT,,,4989,3991.2,,78.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",5138,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",78.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",78.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.92,5138,
"INTUBATION EMERGENCY AIRWAY",5913490,"CDM ",960,RC,31500,HCPCS,OUTPATIENT,,,251.5,201.2,,92.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.05,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",195,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",92.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",92.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.39,195.05,
"LARYNGOSCOPY DX INDIRECT",5913495,"CDM ",960,RC,31505,HCPCS,OUTPATIENT,,,96.5,77.2,,60.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",120,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",60.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",60.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.4,120,
"LARYNGOSCOPY ASPIRATION",5913500,"CDM ",960,RC,31515,HCPCS,OUTPATIENT,,,335,268,,146.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",146.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",314,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",146.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",146.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",146.92,314,
"LARYNGOSCOPY ASPIRATE NEW BORN",5913505,"CDM ",960,RC,31525,HCPCS,OUTPATIENT,,,344.5,275.6,,188.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",374,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",188.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",188.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.41,374,
"LARYNGOSCOPY W/FB REMOVAL",5913510,"CDM ",960,RC,31530,HCPCS,OUTPATIENT,,,427.5,342,,167.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",403,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",167.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",167.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.13,403,
"LARYNGOSCOPY W/BIOPSY",5913515,"CDM ",960,RC,31535,HCPCS,OUTPATIENT,,,415,332,,140.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",389,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",386,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",140.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",140.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.98,389,
"DIAGNOSTIC LARYNGOSCOPY",5913518,"CDM ",960,RC,31575,HCPCS,OUTPATIENT,,,250,200,,82.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",178,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",82.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",82.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.59,178,
"LARYNGSCPY FLX RMV LES NNLSR",5913520,"CDM ",960,RC,31578,HCPCS,OUTPATIENT,,,316,252.8,,198.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",198.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",423,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",198.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",198.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",198.93,423,
"TRACHEOSTOMY PLANNED",5913525,"CDM ",960,RC,31600,HCPCS,OUTPATIENT,,,921.5,737.2,,332.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",332.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",660,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",332.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",332.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",332.25,660,
"TRACHEOSTOMY EMERGENT",5913530,"CDM ",960,RC,31603,HCPCS,OUTPATIENT,,,737,589.6,,164.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",164.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",493,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",164.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",164.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",164.56,493,
"TRACHEOBRONCH EST TRACH INC",5913535,"CDM ",960,RC,31615,HCPCS,OUTPATIENT,,,277.5,222,,141.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",281,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",141.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",141.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.26,281,
"BRONCHOSCOPY W/BRUSH",5913540,"CDM ",960,RC,31623,HCPCS,OUTPATIENT,,,698.5,558.8,,271.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",271.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",540,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",271.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",271.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",271.56,540,
"BRONCH W/ALVEOLAR LAVAGE",5913545,"CDM ",960,RC,31624,HCPCS,OUTPATIENT,,,532.5,426,,253.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",301.6,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",253.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",504,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",253.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,118.21,118.21,118.21,"1 through 10",other,"not separately reimbursment ",253.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",253.6,504,
"BRONCHOSCOPY W/BIOPSY",5913550,"CDM ",960,RC,31625,HCPCS,OUTPATIENT,,,358,286.4,,270.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",270.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",538,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",270.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",270.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",270.94,538,
"BRONCHOSCOPY/LUNG BX SINGLE",5913555,"CDM ",960,RC,31628,HCPCS,OUTPATIENT,,,720.5,576.4,,318.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",318.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",632,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",318.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",318.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",318.23,632,
"BRONCHOSCOPY W/FB REMOVAL",5913560,"CDM ",960,RC,31635,HCPCS,OUTPATIENT,,,610,488,,290.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",290.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",577,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",290.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",290.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",290.35,577,
"BRONCHOSCOPY TX ASPIRATE INIT",5913565,"CDM ",960,RC,31645,HCPCS,OUTPATIENT,,,549.5,439.6,,245.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",245.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",488,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",245.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",245.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",245.4,488,
"INSERT PLEURAL CATH W/CUFF",5913575,"CDM ",960,RC,32550,HCPCS,OUTPATIENT,,,1435,1148,,610.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",610.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1215,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",610.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",610.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",610.95,1215,
"INSERT TUBE THORACOSTOMY",5913580,"CDM ",960,RC,32551,HCPCS,OUTPATIENT,,,622,497.6,,132.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.24,60.24,60.24,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",269,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",132.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",132.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.58,269,
"REMOVE INDWELL TUNN PLRL CATH",5913585,"CDM ",960,RC,32552,HCPCS,OUTPATIENT,,,351,280.8,,81.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",266,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",81.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",81.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.93,266,
"THORACENTESIS WO IMAGE",5913590,"CDM ",960,RC,32554,HCPCS,OUTPATIENT,,,857,685.6,,55.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",744,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",55.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",55.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.17,744,
"THORACENTESIS W/IMAGE",5913595,"CDM ",960,RC,32555,HCPCS,OUTPATIENT,,,989,791.2,,68.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",859,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",68.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.98,859,
"INSERT PLEURA CATH WO IMAGE",5913600,"CDM ",960,RC,32556,HCPCS,OUTPATIENT,,,908.5,726.8,,75.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",788,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",75.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",75.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.68,788,
"INSERT CATH PLEURA W/IMAGE",5913605,"CDM ",960,RC,32557,HCPCS,OUTPATIENT,,,371.5,297.2,,102.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1275,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",102.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",102.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.13,1275,
"INSTILL CHEMICAL PLEURODESIS",5913610,"CDM ",960,RC,32560,HCPCS,OUTPATIENT,,,517.5,414,,226.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",226.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",449,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",226.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",226.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",226.03,449,
"THORACOSCOPY W/PLEURODESIS",5913615,"CDM ",960,RC,32650,HCPCS,OUTPATIENT,,,1413.5,1130.8,,560.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",560.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1114,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",560.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",560.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",560.93,1114,
"INSRT/RPLC TEMP TRANSVNS ELECT",5913620,"CDM ",960,RC,33211,HCPCS,OUTPATIENT,,,543.5,434.8,,139.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",378,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",139.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",139.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.1,378,
"RPR BLOOD VESSEL UP EXTREMITY",5913625,"CDM ",960,RC,35206,HCPCS,OUTPATIENT,,,1630.5,1304.4,,640.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",640.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1272,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",640.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",640.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",640.16,1272,
"RPR BLOOD VESSEL  HAND/FINGER",5913630,"CDM ",960,RC,35207,HCPCS,OUTPATIENT,,,1526,1220.8,,556.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",556.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1250,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",556.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",556.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",556.08,1250,
"RPR BLOOD VESSEL INTRAABD",5913635,"CDM ",960,RC,35221,HCPCS,OUTPATIENT,,,3525,2820,,1117.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1117.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2221,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1117.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1117.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1117.87,2221,
"THROMBO RECHANNEL FEM ART",5913640,"CDM ",960,RC,35371,HCPCS,OUTPATIENT,,,1739,1391.2,,637.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",637.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1458,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",637.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",637.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",637.67,1458,
"ART BYP GRFT FEM-POPLITEAL",5913645,"CDM ",960,RC,35556,HCPCS,OUTPATIENT,,,3302.5,2642,,1023.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1023.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2412,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1023.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1023.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1023.49,2412,
"ART BYP FEM-ANT-POST TIB/PRL",5913650,"CDM ",960,RC,35566,HCPCS,OUTPATIENT,,,4706.5,3765.2,,1248.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1248.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2815,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1248.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1248.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1248.02,2815,
"BYP GRFT COMPOSITE PROSTH VEIN",5913655,"CDM ",960,RC,35681,HCPCS,OUTPATIENT,,,172,137.6,,62.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1133,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",62.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",62.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.26,1133,
"PLACE CATH VEIN 1ST BRANCH",5913660,"CDM ",960,RC,36011,HCPCS,OUTPATIENT,,,2608.5,2086.8,,875.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",875.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1740,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",875.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",875.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",875.95,1740,
VENIPUNCTURE,5913665,"CDM ",960,RC,36415,HCPCS,OUTPATIENT,,,22,17.6,,,,,,,,0,"other ","not separately reimbursment ",7.8,100,,8.91,8.91,8.91,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",14,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,23.79,6.55,29.74,47,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.8,14,
"FINGER/HEAL/EAR STICK",5913670,"CDM ",960,RC,36416,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",35,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35,35,
"INJ SCLEROS MULTI VEIN ONE LEG",5913675,"CDM ",960,RC,36471,HCPCS,OUTPATIENT,,,359,287.2,,138.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",138.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",276,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",138.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",138.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",138.84,276,
"INSERT CATH UMBILICAL VEIN",5913680,"CDM ",960,RC,36510,HCPCS,OUTPATIENT,,,132,105.6,,144.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",287,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",144.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",144.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.35,287,
"INSERT NONTUNNEL CV CATH",5913685,"CDM ",960,RC,36555,HCPCS,OUTPATIENT,,,192.5,154,,209.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",209.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",489,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",209.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",209.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",209.92,489,
"INSERT NONTUNNEL CV CATH >5YR",5913690,"CDM ",960,RC,36556,HCPCS,OUTPATIENT,,,368,294.4,,191.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",180.69,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",191.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",475,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",191.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",191.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.69,475,
"INSRT TUNN CV CATH >5Y WO PRT",5913695,"CDM ",960,RC,36558,HCPCS,OUTPATIENT,,,4224.5,3379.6,,746.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,46.31,46.31,46.31,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",746.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1484,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",746.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",746.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",746.77,1484,
"INSRT TUNNEL CV CATH >5Y W/PRT",5913700,"CDM ",960,RC,36561,HCPCS,OUTPATIENT,,,2333.5,1866.8,,1021.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",947.79,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1021.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2029,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1021.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,4935.15,1034.25,8836.05,"1 through 10",other,"not separately reimbursment ",1021.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",947.79,2029,
"INSERT PICC >5 Y WO PORT",5913705,"CDM ",960,RC,36569,HCPCS,OUTPATIENT,,,456,364.8,,264.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",264.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",526,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",264.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",264.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",264.98,526,
"INSRT PICC NONTUN >5Y WO PRT",5913710,"CDM ",960,RC,36573,HCPCS,OUTPATIENT,,,196,156.8,,54.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,141.19,141.19,141.19,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",538,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",54.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1204.08,1204.08,1204.08,"1 through 10",other,"not separately reimbursment ",54.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.58,538,
"RPR CV CATH W/PORT INSRT SITE",5913715,"CDM ",960,RC,36576,HCPCS,OUTPATIENT,,,544.5,435.6,,297.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",297.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",590,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",297.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",297.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",297.04,590,
"INSERTION PICC W/RS&I <5YR",5913717,"CDM ",960,RC,36572,HCPCS,OUTPATIENT,,,374,299.2,,59.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",573,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",59.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",59.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.23,573,
"REPLACE CV CATH ONLY",5913720,"CDM ",960,RC,36578,HCPCS,OUTPATIENT,,,454.5,363.6,,422.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",422.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",840,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",422.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",422.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",422.55,840,
"REPLACE TUNNELED CV CATH CMPLT",5913725,"CDM ",960,RC,36582,HCPCS,OUTPATIENT,,,897,717.6,,888.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",888.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1766,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",888.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",888.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",888.64,1766,
"REMOVE TUN CV CATH WO PORT",5913730,"CDM ",960,RC,36589,HCPCS,OUTPATIENT,,,383,306.4,,139.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,224.38,224.38,224.38,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",276,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",139.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",139.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.07,276,
"REMOVE TUN CV CATH W/PORT",5913735,"CDM ",960,RC,36590,HCPCS,OUTPATIENT,,,689,551.2,,207.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",307.06,100,,1531.82,1531.82,1531.82,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",207.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",412,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",207.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",207.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",207.25,412,
"REPOSITION CV CATH W/IMAGE",5913740,"CDM ",960,RC,36597,HCPCS,OUTPATIENT,,,325.5,260.4,,106.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",211,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",106.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.27,211,
"ARTERIAL CATH/CANNULATION",5913745,"CDM ",960,RC,36620,HCPCS,OUTPATIENT,,,131,104.8,,44.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",106,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",44.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.14,106,
"INJ W/FLUOR EVAL CV DEVICE",5913747,"CDM ",960,RC,36598,HCPCS,OUTPATIENT,,,279.35,223.48,,97.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",194,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",97.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",97.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.66,194,
"INSERT CATH UMBILICAL ARTERY",5913750,"CDM ",960,RC,36660,HCPCS,OUTPATIENT,,,168.5,134.8,,53.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",118,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",53.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",53.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.38,118,
"INSERT NEEDLE INTRAOSSEOUS",5913755,"CDM ",960,RC,36680,HCPCS,OUTPATIENT,,,132,105.6,,46.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",138,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",46.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",46.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.57,138,
"AV FUSION FOREARM VEIN",5913760,"CDM ",960,RC,36820,HCPCS,OUTPATIENT,,,2728,2182.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1313,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1313,1313,
"LIGATION INT JUGULAR VEIN",5913765,"CDM ",960,RC,37565,HCPCS,OUTPATIENT,,,1522,1217.6,,527.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",527.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1090,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",527.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",527.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",527.85,1090,
"LIGATION TEMPORAL ARTERY",5913770,"CDM ",960,RC,37609,HCPCS,OUTPATIENT,,,771.5,617.2,,227.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",451,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",227.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",227.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.22,451,
"LIGATION EXTREMITY ARTERY",5913775,"CDM ",960,RC,37618,HCPCS,OUTPATIENT,,,1206.5,965.2,,267.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",267.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",596,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",267.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",267.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",267.26,596,
"LIGATION DVN SAPHENOUS VEIN",5913780,"CDM ",960,RC,37700,HCPCS,OUTPATIENT,,,540.5,432.4,,206.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",206.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",443,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",206.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",206.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",206.49,443,
"LIGATION DVN SAPHENOUS VEIN",5913780,"CDM ",960,RC,51102,HCPCS,OUTPATIENT,,,540.5,432.4,,256.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",256.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",510,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",256.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",256.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",256.74,510,
"STAB PHLEB VEINS XTR 10-20",5913785,"CDM ",960,RC,37765,HCPCS,OUTPATIENT,,,1296.5,1037.2,,369.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",369.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",934,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",369.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",369.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",369.85,934,
"REMOVAE SPLEEN TOTAL",5913790,"CDM ",960,RC,38100,HCPCS,OUTPATIENT,,,3320.5,2656.4,,670.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",670.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1615,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",670.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",670.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",670.14,1615,
"BX BONE MARROW",5913795,"CDM ",960,RC,38221,HCPCS,OUTPATIENT,,,174,139.2,,153.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",318,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",153.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",153.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.59,318,
"BONE MARROW HARV AUTOLOGOUS",5913800,"CDM ",960,RC,38232,HCPCS,OUTPATIENT,,,443,354.4,,82.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",291,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",82.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",82.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.21,291,
"HEMATOPOIEIC CELLS AUTOTRNSPT",5913805,"CDM ",960,RC,38241,HCPCS,OUTPATIENT,,,397,317.6,,92.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",239,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",92.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",92.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9,239,
"BX/EXC LYMPH NODE OPN SF",5913810,"CDM ",960,RC,38500,HCPCS,OUTPATIENT,,,665.5,532.4,,231.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",323.32,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",231.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",459,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",231.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",231.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",231.08,459,
"BX/EXC LYMPH NODE NEEDLE SF",5913815,"CDM ",960,RC,38505,HCPCS,OUTPATIENT,,,156,124.8,,94.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",188,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",94.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.85,188,
"BX/EXC LYMPH NODE OPN DEEP CRV",5913820,"CDM ",960,RC,38510,HCPCS,OUTPATIENT,,,2092,1673.6,,372.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2299.04,2299.04,2299.04,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",372.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",739,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",372.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,8389.59,8389.59,8389.59,"1 through 10",other,"not separately reimbursment ",372.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",372.05,739,
"BX EXC LYMPH NODE OPN DEEP AUX",5913825,"CDM ",960,RC,38525,HCPCS,OUTPATIENT,,,986.5,789.2,,300.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",611,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",300.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1291.88,1291.88,1291.88,"1 through 10",other,"not separately reimbursment ",300.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.08,611,
"BX/EXC LYMPH NODE OPN INGUINF",5913830,"CDM ",960,RC,38531,HCPCS,OUTPATIENT,,,972,777.6,,274.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",612,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",274.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",274.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.21,612,
"LYMPHADENECTOMY SUPRAHYOID",5913835,"CDM ",960,RC,38700,HCPCS,OUTPATIENT,,,1923,1538.4,,545.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",545.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1129,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",545.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",545.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",545.18,1129,
"LYMPHADENECTOMY CERVICAL",5913840,"CDM ",960,RC,38720,HCPCS,OUTPATIENT,,,4598,3678.4,,714.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",714.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1890,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",714.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",714.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",714.17,1890,
"LYMPHADEN AXILLARY SUPERFICIAL",5913845,"CDM ",960,RC,38740,HCPCS,OUTPATIENT,,,1596,1276.8,,481.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",481.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",968,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",481.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",481.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",481.8,968,
"LYMPHADEN AXILLARY COMPLETE",5913850,"CDM ",960,RC,38745,HCPCS,OUTPATIENT,,,2621.5,2097.2,,619.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",619.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1230,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",619.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",619.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",619.23,1230,
"LYMPHADEN INGNFEM SF",5913855,"CDM ",960,RC,38760,HCPCS,OUTPATIENT,,,1862.5,1490,,615.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",615.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1223,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",615.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",615.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",615.44,1223,
"INJ LYMPHPHAN RADIO TRACER",5913860,"CDM ",960,RC,38792,HCPCS,OUTPATIENT,,,82,65.6,,28.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2.90,2.90,2.90,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",235,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",28.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",28.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.55,235,
"INTRAOP SENT LYMPH NODE IMAGE",5913863,"CDM ",960,RC,38900,HCPCS,OUTPATIENT,,,282,225.6,,62.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",190,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",62.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",62.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.51,190,
"RPR DIAPHR HERNIA TRAUMA CHRC",5913865,"CDM ",960,RC,39541,HCPCS,OUTPATIENT,,,2152,1721.6,,678.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",678.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1579,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",678.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",678.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",678.87,1579,
"BIOPSY LIP",5913870,"CDM ",960,RC,40490,HCPCS,OUTPATIENT,,,276,220.8,,84.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",178,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",84.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",84.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.57,178,
"DRAIN MOUTH LESION COMPLEX",5913875,"CDM ",960,RC,40801,HCPCS,OUTPATIENT,,,921.5,737.2,,198.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",198.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",443,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",198.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",198.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",198.03,443,
"REMOVE FB MOUTH COMPLEX",5913880,"CDM ",960,RC,40805,HCPCS,OUTPATIENT,,,1007,805.6,,216,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",216,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",555,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",216,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",216,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,555,
"BIOPSY VESTIBULE MOUTH",5913885,"CDM ",960,RC,40808,HCPCS,OUTPATIENT,,,413,330.4,,105.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",105.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",264,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",105.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",105.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",105.99,264,
"EXC/RPR MOUTH LESION SIMPLE",5913890,"CDM ",960,RC,40812,HCPCS,OUTPATIENT,,,465,372,,182.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",268.13,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",182.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",405,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",182.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",182.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",182.13,405,
"EXCISE/REPAIR MOUTH LESION",5913895,"CDM ",960,RC,40814,HCPCS,OUTPATIENT,,,517,413.6,,253.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",253.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",542,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",253.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",253.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",253.42,542,
"EXC FRENUM/LABIAL/BUCCAL",5913900,"CDM ",960,RC,40819,HCPCS,OUTPATIENT,,,915,732,,195.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",195.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",436,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",195.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",195.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",195.45,436,
"RPR MOUTH LAC >2.5CM CMPLX",5913905,"CDM ",960,RC,40831,HCPCS,OUTPATIENT,,,777,621.6,,213.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",213.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",479,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",213.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",213.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",213.29,479,
"INC LINGUAL FRENUM FRENOTOMY",5913910,"CDM ",960,RC,41010,HCPCS,OUTPATIENT,,,253.5,202.8,,129.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",282,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",129.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",129.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.73,282,
"BX TONGUE POST ONE THIRD",5913915,"CDM ",960,RC,41105,HCPCS,OUTPATIENT,,,385.5,308.4,,111.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",234,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",111.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",111.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.48,234,
"BX FLOOR OF MOUTH",5913920,"CDM ",960,RC,41108,HCPCS,OUTPATIENT,,,335.5,268.4,,92.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",203,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",92.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",92.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.79,203,
"EXC TONGUE LESION W/CLOSURE",5913925,"CDM ",960,RC,41112,HCPCS,OUTPATIENT,,,568,454.4,,216.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2248.54,2248.54,2248.54,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",216.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",472,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",216.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",216.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",216.08,472,
"EXC LESION MOUTH FLOOR",5913930,"CDM ",960,RC,41116,HCPCS,OUTPATIENT,,,508,406.4,,202.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",202.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",469,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",202.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",202.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",202.5,469,
"RPR LAC <2.5CM POST ONE THIRD",5913935,"CDM ",960,RC,41251,HCPCS,OUTPATIENT,,,413,330.4,,167.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",417,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",167.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",167.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.07,417,
"EXCISION OF UVULA",5913940,"CDM ",960,RC,42140,HCPCS,OUTPATIENT,,,574,459.2,,157.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",363,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",157.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",157.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.02,363,
"BX SALVIARY GLAND NEEDLE",5913945,"CDM ",960,RC,42400,HCPCS,OUTPATIENT,,,121,96.8,,71.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",147,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",71.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",71.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.51,147,
"BX SALIVARY GLAND INCISIONAL",5913950,"CDM ",960,RC,42405,HCPCS,OUTPATIENT,,,861.5,689.2,,220.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",439,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",220.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",220.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.72,439,
"EXC PAROTID TUM/GLAND LAT LOBE",5913955,"CDM ",960,RC,42410,HCPCS,OUTPATIENT,,,1568.5,1254.8,,486.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",486.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",967,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",486.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",486.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",486.74,967,
"EXC PAROTID TUM/GLND TOTAL",5913960,"CDM ",960,RC,42420,HCPCS,OUTPATIENT,,,3497,2797.6,,996.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",996.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1979,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",996.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",996.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",996.01,1979,
"DILATION SALIVARY DUCT",5913965,"CDM ",960,RC,42650,HCPCS,OUTPATIENT,,,191.5,153.2,,56.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",116,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",56.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",56.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.22,116,
"DILATION & CATH SALVIVARY DUCT",5913970,"CDM ",960,RC,42660,HCPCS,OUTPATIENT,,,243.5,194.8,,74.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",172,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",74.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",74.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.92,172,
"I&D PERITONSILLAR",5913975,"CDM ",960,RC,42700,HCPCS,OUTPATIENT,,,432,345.6,,127.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",264,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",127.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",127.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.45,264,
"I&D THROAT ABCESS INTRAORAL",5913980,"CDM ",960,RC,42720,HCPCS,OUTPATIENT,,,921.5,737.2,,314.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",314.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",645,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",314.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",314.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",314.01,645,
"BX OROPHARYNX(THROAT)",5913985,"CDM ",960,RC,42800,HCPCS,OUTPATIENT,,,364,291.2,,106.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",221,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",106.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.77,221,
"BX NASOPHARYNX SIMPLE",5913990,"CDM ",960,RC,42804,HCPCS,OUTPATIENT,,,455,364,,144.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",288,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",144.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",144.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.92,288,
"EXC/DESTRCT LESION PHARYNX",5913995,"CDM ",960,RC,42808,HCPCS,OUTPATIENT,,,383,306.4,,162.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",323,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",162.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",162.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.37,323,
"TONSIL & ADNOIDECTOMY <12Y",5914000,"CDM ",960,RC,42820,HCPCS,OUTPATIENT,,,1016.5,813.2,,220.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,3911.05,3911.05,3911.05,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",439,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",220.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",220.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.98,439,
"TONSIL & ADNOIDECTOMY >12Y",5914005,"CDM ",960,RC,42821,HCPCS,OUTPATIENT,,,1028.5,822.8,,239.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",239.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",476,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",239.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",239.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",239.65,476,
"TONSILLECTOMY <12Y",5914010,"CDM ",960,RC,42825,HCPCS,OUTPATIENT,,,610,488,,200.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",200.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",399,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",200.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",200.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",200.87,399,
"TONSILLECTOMY >12Y",5914015,"CDM ",960,RC,42826,HCPCS,OUTPATIENT,,,1005,804,,196.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",196.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",410,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",196.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",196.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",196.2,410,
"ADENOIDECTOMY >12Y PRIME",5914020,"CDM ",960,RC,42830,HCPCS,OUTPATIENT,,,483.5,386.8,,156.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",311,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",156.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",156.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.44,311,
"ADENOIDECTOMY <12Y PRIME",5914025,"CDM ",960,RC,42835,HCPCS,OUTPATIENT,,,445,356,,145.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",145.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",289,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",145.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",145.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",145.41,289,
"ADENOIDECTOMY >12Y SECOND",5914030,"CDM ",960,RC,42836,HCPCS,OUTPATIENT,,,562.5,450,,188.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",374,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",188.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",188.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.06,374,
"CONTROL THROAT BLEEDING PRIME",5914035,"CDM ",960,RC,42960,HCPCS,OUTPATIENT,,,395,316,,132.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",262,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",132.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",132.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.08,262,
"CONTROL THROAT BLEEDING CMPLX",5914040,"CDM ",960,RC,42961,HCPCS,OUTPATIENT,,,980.5,784.4,,323.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",323.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",642,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",323.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",323.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",323.18,642,
"ESOPHAGOSCOPY W/DIVERTICUL",5914045,"CDM ",960,RC,43180,HCPCS,OUTPATIENT,,,1168.5,934.8,,347.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",347.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",787,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",347.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",347.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",347.07,787,
"ESOPHAGOSCOPY RGD TRNSORAL DX",5914050,"CDM ",960,RC,43191,HCPCS,OUTPATIENT,,,303.5,242.8,,59.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",218,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",59.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",59.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.79,218,
"ESOPHAGOSCOPY RGD W/BX",5914055,"CDM ",960,RC,43193,HCPCS,OUTPATIENT,,,383,306.4,,85.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",256,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8,256,
"ESOPHAGOSCP RGD W/RMV FB",5914060,"CDM ",960,RC,43194,HCPCS,OUTPATIENT,,,451.5,361.2,,77.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",273,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",77.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",77.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.43,273,
"ESOPHAGOSCOPY FLX W/RMV FB",5914065,"CDM ",960,RC,43215,HCPCS,OUTPATIENT,,,826.5,661.2,,111.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",550,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",111.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",111.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.32,550,
"ESOPHAGOSCOPY W/IMAGE NDL BX",5914070,"CDM ",960,RC,43232,HCPCS,OUTPATIENT,,,652.5,522,,198.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",198.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",651,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",198.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",198.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",198.7,651,
"EGD DX FLEX W/BRUSH WASH",5914075,"CDM ",960,RC,43235,HCPCS,OUTPATIENT,,,652.5,522,,222.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",222.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",463,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",222.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",222.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",222.68,463,
"EGD DX FLEX W/SUBMUCOSAL INJ",5914080,"CDM ",960,RC,43236,HCPCS,OUTPATIENT,,,372.5,298,,274.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",545,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",274.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",274.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.08,545,
"EGD DX FLEX W/BX",5914085,"CDM ",960,RC,43239,HCPCS,OUTPATIENT,,,924,739.2,,253.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",399.47,100,,765.30,765.30,765.30,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",253.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",535,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",253.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,667.17,116.78,2173.14,"1 through 10",other,"not separately reimbursment ",253.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",253.67,535,
"EGD W/TUBE/CATH INSERT",5914090,"CDM ",960,RC,43241,HCPCS,OUTPATIENT,,,560.5,448.4,,111.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",317,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",111.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",111.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.09,317,
"EGD DILATED STRICTURE",5914095,"CDM ",960,RC,43245,HCPCS,OUTPATIENT,,,839.5,671.6,,134.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",134.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",831,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",134.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",134.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",134.37,831,
"EGD W/PLACE GASTRO TUBE",5914100,"CDM ",960,RC,43246,HCPCS,OUTPATIENT,,,785,628,,190.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",531.55,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",190.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",522,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",190.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",190.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",190.38,531.55,
"EGD FLEX FB REMOVAL",5914105,"CDM ",960,RC,43247,HCPCS,OUTPATIENT,,,824,659.2,,143.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",420.72,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",143.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",554,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",143.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",143.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",143.6,554,
"EGD W/LESION CAUTERY",5914110,"CDM ",960,RC,43250,HCPCS,OUTPATIENT,,,1636,1308.8,,135,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,325.28,325.28,325.28,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",621,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",135,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",135,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,621,
"EGD REMOVE LESION SNARE",5914115,"CDM ",960,RC,43251,HCPCS,OUTPATIENT,,,1032.5,826,,155.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,325.27,325.27,325.27,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",685,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",155.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",155.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.88,685,
"EGD CONTROL BLEEDING",5914120,"CDM ",960,RC,43255,HCPCS,OUTPATIENT,,,475.5,380.4,,211.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",211.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",983,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",211.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",211.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",211.56,983,
"EGD FLEX LESION/ABLATION",5914125,"CDM ",960,RC,43270,HCPCS,OUTPATIENT,,,460,368,,116.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",979,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",116.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",116.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.04,979,
"ESOPHAGOGASTRIC FUNDOPLASTY",5914130,"CDM ",960,RC,43325,HCPCS,OUTPATIENT,,,2988.5,2390.8,,932.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",932.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1883,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",932.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",932.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",932.66,1883,
"DILATE ESOPHAGUS",5914135,"CDM ",960,RC,43450,HCPCS,OUTPATIENT,,,334,267.2,,118.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",289,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",118.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,455.04,455.04,455.04,"1 through 10",other,"not separately reimbursment ",118.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.89,289,
"EXC MALIG TUMOR STOMACH",5914140,"CDM ",960,RC,43611,HCPCS,OUTPATIENT,,,2661.5,2129.2,,823.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1785.01,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",823.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1711,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",823.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",823.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",823.35,1785.01,
"GASTRECTOMY PRT DST W/GASTROD",5914145,"CDM ",960,RC,43631,HCPCS,OUTPATIENT,,,3213,2570.4,,1031.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1031.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2049,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1031.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1031.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1031.36,2049,
"GASTRECTOMY PRT DST W/GASTROJ",5914150,"CDM ",960,RC,43633,HCPCS,OUTPATIENT,,,5027.5,4022,,1053.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,793.08,793.08,793.08,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1053.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2691,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1053.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1053.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1053.7,2691,
"NASO/OROGASTRIC TUBE PLMT",5914155,"CDM ",960,RC,43752,HCPCS,OUTPATIENT,,,251.5,201.2,,33.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",67,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",33.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.69,67,
"GASTRO INTUB W/ASP THERAPEUTIC",5914160,"CDM ",960,RC,43753,HCPCS,OUTPATIENT,,,77.5,62,,9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",29,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",9.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.61,29,
"REPLACE GTUBE PERCU WO IMAGE",5914170,"CDM ",960,RC,43762,HCPCS,OUTPATIENT,,,477.5,382,,24.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",302,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",24.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,302,
"REPLACE GTUBE W/RVSN GSTR TRCT",5914172,"CDM ",960,RC,43763,HCPCS,OUTPATIENT,,,339.5,271.6,,52.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",450,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",52.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.98,450,
"GASTROJEJU WO VAGOTOMY",5914175,"CDM ",960,RC,43820,HCPCS,OUTPATIENT,,,2988.5,2390.8,,706.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",706.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1878,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",706.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",706.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",706.61,1878,
"GASTROSTOMY OPN WO CONST GTUBE",5914180,"CDM ",960,RC,43830,HCPCS,OUTPATIENT,,,2012.5,1610,,462.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",462.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",980,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",462.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",462.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",462.02,980,
"REPAIR OF STOMACH LESION",5914185,"CDM ",960,RC,43840,HCPCS,OUTPATIENT,,,3501.5,2801.2,,722.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",722.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1904,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",722.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",722.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",722.99,1904,
"REPAIR STOMACH OPENING",5914190,"CDM ",960,RC,43870,HCPCS,OUTPATIENT,,,1674,1339.2,,458.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1037.07,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",458.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",999,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",458.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",458.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",458.39,1037.07,
"RPR STOMACH BOWEL FISTULA",5914193,"CDM ",960,RC,43880,HCPCS,OUTPATIENT,,,3265,2612,,1122.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1122.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2232,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1122.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1122.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1122.68,2232,
"FREEING BOWEL ADHESION",5914195,"CDM ",960,RC,44005,HCPCS,OUTPATIENT,,,2619,2095.2,,744.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",744.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1525,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",744.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",744.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",744.74,1525,
"DECOMPRESS SMALL BOWEL",5914200,"CDM ",960,RC,44021,HCPCS,OUTPATIENT,,,2271.5,1817.2,,649.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",649.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1362,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",649.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",649.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",649.99,1362,
"REDUCE BOWEL OBSTRUCTION",5914205,"CDM ",960,RC,44050,HCPCS,OUTPATIENT,,,3766,3012.8,,647.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",647.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1311,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",647.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",647.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",647.91,1311,
"EXC INTESTINE 1 OR MORE LESION",5914210,"CDM ",960,RC,44110,HCPCS,OUTPATIENT,,,1943,1554.4,,551.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",551.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1193,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",551.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",551.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",551.06,1193,
"EXC OMTESTOME  MULTI ENTEROT",5914215,"CDM ",960,RC,44111,HCPCS,OUTPATIENT,,,2127,1701.6,,660.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",660.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1384,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",660.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",660.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",660.46,1384,
"REMOVE SMALL INTESTINE",5914220,"CDM ",960,RC,44120,HCPCS,OUTPATIENT,,,4214,3371.2,,780.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1767.77,100,,280.38,280.38,280.38,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",780.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1715,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",780.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",780.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",780.87,1767.77,
"REMOVE SM INTEST EA ADD RSCT",5914225,"CDM ",960,RC,44121,HCPCS,OUTPATIENT,,,540.5,432.4,,171.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,42.26,42.26,42.26,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",171.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",398,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",171.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",171.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",171.95,398,
"RESECT SM INTESTINE W/ENTEROST",5914230,"CDM ",960,RC,44125,HCPCS,OUTPATIENT,,,2621.5,2097.2,,803.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",803.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1658,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",803.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",803.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",803.3,1658,
"MOBILIZE COLON W/PRT COLECTOMY",5914235,"CDM ",960,RC,44139,HCPCS,OUTPATIENT,,,380.5,304.4,,85.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",200,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.94,200,
"COLECTOMY PRT RMV COLON",5914240,"CDM ",960,RC,44140,HCPCS,OUTPATIENT,,,3395.5,2716.4,,960.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",960.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1909,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",960.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",960.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",960.87,1909,
"COLECTOMY PRT  W/CECOST/COLOS",5914245,"CDM ",960,RC,44141,HCPCS,OUTPATIENT,,,6276.5,5021.2,,948.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",948.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2563,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",948.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",948.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",948.58,2563,
"COLECTOMY PRT W/DST SEGMENT",5914250,"CDM ",960,RC,44143,HCPCS,OUTPATIENT,,,3900,3120,,1087.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2276.72,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1087.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2337,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1087.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1087.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1087.59,2337,
"COLECTOMY PRT W/RESECT",5914255,"CDM ",960,RC,44144,HCPCS,OUTPATIENT,,,7161.5,5729.2,,1007.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1007.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2488,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1007.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1007.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1007.76,2488,
"COLECTOMY PRT W/COLOPROCT",5914260,"CDM ",960,RC,44145,HCPCS,OUTPATIENT,,,4180,3344,,1203.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2398.13,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1203.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2392,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1203.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1203.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1203.99,2398.13,
"COLECTOMY PRT W/COLOPR/COLOST",5914265,"CDM ",960,RC,44146,HCPCS,OUTPATIENT,,,4926,3940.8,,1298.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1298.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2978,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1298.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1298.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1298.89,2978,
"COLECTOMY TOTAL ABDWO PROCTECT",5914270,"CDM ",960,RC,44150,HCPCS,OUTPATIENT,,,4144.5,3315.6,,1154.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1154.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2632,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1154.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1154.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1154.29,2632,
"COLECTOMY PRT W/ILEOCOLOSTOMY",5914275,"CDM ",960,RC,44160,HCPCS,OUTPATIENT,,,2858,2286.4,,853.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",853.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1743,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",853.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",853.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",853.1,1743,
"LAP ENTEROLYSIS",5914280,"CDM ",960,RC,44180,HCPCS,OUTPATIENT,,,2303.5,1842.8,,668.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",668.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1328,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",668.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",668.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",668.55,1328,
"LAP JEJUNOSTOMY",5914285,"CDM ",960,RC,44186,HCPCS,OUTPATIENT,,,1506.5,1205.2,,468.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",468.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",932,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",468.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",468.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",468.96,932,
"LAP ILEO/JEJUNOSTOMY",5914290,"CDM ",960,RC,44187,HCPCS,OUTPATIENT,,,2583,2066.4,,774.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",774.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1562,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",774.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",774.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",774.72,1562,
"LAP COLOSTOMY",5914295,"CDM ",960,RC,44188,HCPCS,OUTPATIENT,,,2696,2156.8,,849.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",849.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1728,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",849.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",849.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",849.97,1728,
"LAP ENTERECTOMY RESECT SM BWL",5914300,"CDM ",960,RC,44202,HCPCS,OUTPATIENT,,,3069.5,2455.6,,1004.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1004.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2067,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1004.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1004.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1004.52,2067,
"LAP RESECT SM BOWEL EA ADDL",5914305,"CDM ",960,RC,44203,HCPCS,OUTPATIENT,,,598,478.4,,171.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",171.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",386,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",171.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",171.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",171.48,386,
"LAP COLECTOMY PRT W/ANASTOM",5914310,"CDM ",960,RC,44204,HCPCS,OUTPATIENT,,,3557,2845.6,,1134.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1134.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2253,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1134.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1134.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1134.25,2253,
"LAP COLECTOMY PRT W/ILEOCOL",5914315,"CDM ",960,RC,44205,HCPCS,OUTPATIENT,,,2977.5,2382,,1006.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1006.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1999,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1006.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1006.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1006.02,1999,
"LAP COLECTOMY PRT W/END COLOST",5914320,"CDM ",960,RC,44206,HCPCS,OUTPATIENT,,,4065,3252,,1238.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2675.58,2675.58,2675.58,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1238.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2461,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1238.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1238.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1238.54,2461,
"LAP COLECTOMY PRTL W/COLOPROCT",5914323,"CDM ",960,RC,44207,HCPCS,OUTPATIENT,,,3724.5,2979.6,,1344.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1344.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2670,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1344.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1344.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1344.09,2670,
"LAP MOBIL SPLENIC FLXR ADD-ON",5914324,"CDM ",960,RC,44213,HCPCS,OUTPATIENT,,,474,379.2,,153.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,321.22,321.22,321.22,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",306,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",153.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",153.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.86,306,
"PLACE TUBE OPEN",5914325,"CDM ",960,RC,44300,HCPCS,OUTPATIENT,,,1949,1559.2,,568.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",568.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1183,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",568.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",568.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",568.81,1183,
ILEOSTOMY/JEJUNOSTOMY,5914330,"CDM ",960,RC,44310,HCPCS,OUTPATIENT,,,2673.5,2138.8,,731.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",731.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1458,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",731.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",731.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",731.74,1458,
"REVISE ILEOSTOMY SIMPLE",5914335,"CDM ",960,RC,44312,HCPCS,OUTPATIENT,,,1345.5,1076.4,,383.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",383.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",827,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",383.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",383.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",383.52,827,
"REVISE ILEOSTOMY COMPLEX",5914340,"CDM ",960,RC,44314,HCPCS,OUTPATIENT,,,2225,1780,,694.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",694.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1411,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",694.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",694.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",694.09,1411,
COLOSTOMY,5914345,"CDM ",960,RC,44320,HCPCS,OUTPATIENT,,,2690,2152,,817.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1628.56,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",817.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1690,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",817.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",817.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",817.27,1690,
"REVISE COLOSTOMY COMPLEX",5914350,"CDM ",960,RC,44345,HCPCS,OUTPATIENT,,,3037,2429.6,,720.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",720.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1481,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",720.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",720.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",720.17,1481,
"REVISE COLOSTOMY W/RPR HERNIA",5914355,"CDM ",960,RC,44346,HCPCS,OUTPATIENT,,,3426,2740.8,,786.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",786.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1665,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",786.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",786.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",786.4,1665,
"ENDOSC SM BOWEL W/PLACE JTUBE",5914360,"CDM ",960,RC,44372,HCPCS,OUTPATIENT,,,743,594.4,,183.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",605,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",183.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",183.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.08,605,
"ILEOSCOPY STOMA DX W/BLN DILAT",5914365,"CDM ",960,RC,44381,HCPCS,OUTPATIENT,,,194.5,155.6,,58.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1335,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",58.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.13,1335,
"COLONOSCOPY STOMA DX",5914370,"CDM ",960,RC,44388,HCPCS,OUTPATIENT,,,942,753.6,,235.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",235.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",500,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",235.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",235.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",235.32,500,
"COLONOSCOPY STOMA W/BX",5914375,"CDM ",960,RC,44389,HCPCS,OUTPATIENT,,,399.5,319.6,,288.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",288.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",572,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",288.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",288.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",288.14,572,
"COLONOSCOPY RMV LESION SNARE",5914380,"CDM ",960,RC,44394,HCPCS,OUTPATIENT,,,543,434.4,,364.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",364.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",723,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",364.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",364.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",364.11,723,
"COLONOSCOPY W/ENDOSC RESECT",5914385,"CDM ",960,RC,44403,HCPCS,OUTPATIENT,,,664,531.2,,1004.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1004.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",442,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1004.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1004.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",442,1004.52,
"COLONOSCOPY THRU STOMA W/DECOM",5914387,"CDM ",960,RC,44408,HCPCS,OUTPATIENT,,,461,368.8,,101.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",340,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",101.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",101.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.14,340,
"SUTURE SM INTEST SINGLE PERF",5914390,"CDM ",960,RC,44602,HCPCS,OUTPATIENT,,,3329.5,2663.6,,728.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1707.73,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",728.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1978,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",728.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",728.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",728.91,1978,
"SUTURE SM INTESTINE MULTI PERF",5914395,"CDM ",960,RC,44603,HCPCS,OUTPATIENT,,,3604,2883.2,,842.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",842.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2272,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",842.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",842.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",842.5,2272,
"RPR LG INTESTINE PERF INJURY",5914400,"CDM ",960,RC,44604,HCPCS,OUTPATIENT,,,2421,1936.8,,730.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",730.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1480,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",730.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",730.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",730.57,1480,
"RPR LG INTESTINE PERF W/COLOST",5914405,"CDM ",960,RC,44605,HCPCS,OUTPATIENT,,,2897,2317.6,,903.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",903.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1824,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",903.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",903.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",903.1,1824,
"RPR BOWEL OPENING",5914410,"CDM ",960,RC,44620,HCPCS,OUTPATIENT,,,2529,2023.2,,565.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",565.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1219,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",565.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",565.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",565.19,1219,
"RPR BOWEL OPN W/RESECT/ANASTOM",5914415,"CDM ",960,RC,44625,HCPCS,OUTPATIENT,,,2380,1904,,689.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",689.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1436,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",689.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",689.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",689.68,1436,
"RPR BOWEL OPN W/RESECT/COLOANS",5914420,"CDM ",960,RC,44626,HCPCS,OUTPATIENT,,,4346,3476.8,,1142.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1142.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2270,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1142.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1142.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1142.82,2270,
"EXCL SM BOWEL W/PROSTHESIS",5914425,"CDM ",960,RC,44700,HCPCS,OUTPATIENT,,,2236.5,1789.2,,732.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",732.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1535,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",732.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",732.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",732.54,1535,
"EXC MECKELS DIVERTICULUM",5914430,"CDM ",960,RC,44800,HCPCS,OUTPATIENT,,,1315,1052,,535.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",535.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1064,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",535.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",535.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",535.41,1064,
"EXC MESENTERY LESION",5914435,"CDM ",960,RC,44820,HCPCS,OUTPATIENT,,,1828,1462.4,,567.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",567.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1178,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",567.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",567.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",567.96,1178,
"DRAIN APPENDIX ABSCESS OPEN",5914440,"CDM ",960,RC,44900,HCPCS,OUTPATIENT,,,2230.5,1784.4,,478.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",478.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1087,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",478.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",478.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",478.58,1087,
APPENDECTOMY,5914445,"CDM ",960,RC,44950,HCPCS,OUTPATIENT,,,1853.5,1482.8,,463.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",463.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",921,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",463.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",463.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",463.54,921,
"APPENDECTOMY ADD ON",5914450,"CDM ",960,RC,44955,HCPCS,OUTPATIENT,,,311.5,249.2,,59.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",211,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",59.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",59.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.76,211,
"APPENDECTOMY RUPTURE W/ABSCESS",5914455,"CDM ",960,RC,44960,HCPCS,OUTPATIENT,,,2255,1804,,572.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",572.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1224,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",572.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1072.55,1072.55,1072.55,"1 through 10",other,"not separately reimbursment ",572.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",572.59,1224,
"LAPAROSCOPY APPENDECTOMY",5914460,"CDM ",960,RC,44970,HCPCS,OUTPATIENT,,,1803.5,1442.8,,412.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",876.49,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",412.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",841,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",412.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",412.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",412.41,876.49,
"BX ANORECTAL WALL ANAL",5914465,"CDM ",960,RC,45100,HCPCS,OUTPATIENT,,,661,528.8,,190.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",190.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",422,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",190.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",190.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",190.99,422,
"PROCTECTOMY CMPLT W/COLOSTOMY",5914470,"CDM ",960,RC,45110,HCPCS,OUTPATIENT,,,4069.5,3255.6,,1299.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2681.16,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1299.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2610,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1299.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1299.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1299.53,2681.16,
"EXC RECTAL PROLAPSE ABD/PRNL",5914475,"CDM ",960,RC,45135,HCPCS,OUTPATIENT,,,2903,2322.4,,892.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",892.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1962,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",892.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",892.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",892.16,1962,
"PROCTOSIGMOIRDOSCOPY RDG DX",5914480,"CDM ",960,RC,45300,HCPCS,OUTPATIENT,,,272.5,218,,55.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",67.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",173,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",55.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",55.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.15,173,
"PROCTOSIGMOIDOSCOPY RGD W/BX",5914485,"CDM ",960,RC,45305,HCPCS,OUTPATIENT,,,418.5,334.8,,107.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",107.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",277,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",107.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",107.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",107.24,277,
"PROCTOSIGMOIDOSCOPY W/RMV FB",5914490,"CDM ",960,RC,45307,HCPCS,OUTPATIENT,,,491.5,393.2,,116.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",326,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",116.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",116.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.09,326,
"SIGMOIDSOCOPY FLEX DX",5914495,"CDM ",960,RC,45330,HCPCS,OUTPATIENT,,,251.5,201.2,,95.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",191,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",95.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",95.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9,191,
"SIGMOIDOSCOPY FLEX DX W/BX",5914500,"CDM ",960,RC,45331,HCPCS,OUTPATIENT,,,542.5,434,,123.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,122.45,122.45,122.45,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",365,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",123.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",123.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.35,365,
"SIGMOIDOSCOPY FLX W/FB REMOVAL",5914503,"CDM ",960,RC,45332,HCPCS,OUTPATIENT,,,411.5,329.2,,198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",416,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",198.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",198.41,416,
"SIGMOIDOSCOPY FLX DX W/RMV LES",5914505,"CDM ",960,RC,45333,HCPCS,OUTPATIENT,,,402,321.6,,194.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,903.38,903.38,903.38,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",194.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",422,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",194.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",194.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",194.59,422,
"SIGMOIDOSCOPY FLX W/DECOMP",5914510,"CDM ",960,RC,45337,HCPCS,OUTPATIENT,,,272.5,218,,101.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",291,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",101.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",101.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.14,291,
"SIGMOIDOSCOPY SNARE W/RMV LES",5914515,"CDM ",960,RC,45338,HCPCS,OUTPATIENT,,,282.5,226,,222.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,21.59,21.59,21.59,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",222.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",445,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",222.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",222.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",222.49,445,
"COLONOSCOPY DIAGNOSTIC",5914520,"CDM ",960,RC,45378,HCPCS,OUTPATIENT,,,1032,825.6,,293.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",491.09,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",293.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",661.66,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",293.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,295.72,142.67,5452.84,"1 through 10",other,"not separately reimbursment ",293.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",293.17,661.66,
"COLONOSCOPY W/FB REMOVAL",5914525,"CDM ",960,RC,45379,HCPCS,OUTPATIENT,,,1032,825.6,,368.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",368.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",732,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",368.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",368.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",368.38,732,
"COLONSCOPY W/BX",5914530,"CDM ",960,RC,45380,HCPCS,OUTPATIENT,,,1032,825.6,,346.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",575.88,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",346.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",795,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",346.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,428.05,230.09,3789.24,"1 through 10",other,"not separately reimbursment ",346.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",346.62,795,
"COLONOSCOPY W/SUBMUC INJ",5914535,"CDM ",960,RC,45381,HCPCS,OUTPATIENT,,,1032,825.6,,335.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",335.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",718,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",335.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",335.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",335.72,718,
"COLONOSCOPY W/CONTROL BLEED",5914540,"CDM ",960,RC,45382,HCPCS,OUTPATIENT,,,1032,825.6,,463.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",463.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",921,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",463.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",463.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",463.59,921,
"COLONOSCOPY FRCPS W/RMV LES",5914550,"CDM ",960,RC,45384,HCPCS,OUTPATIENT,,,1032,825.6,,344.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,563.80,563.80,563.80,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",344.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",778,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",344.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,199.26,199.26,955.45,"1 through 10",other,"not separately reimbursment ",344.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",344.7,778,
"COLONOSCOPY SNARE W/RMV LES",5914555,"CDM ",960,RC,45385,HCPCS,OUTPATIENT,,,1032,825.6,,420.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",709.79,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",420.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",825,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",420.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,4051.40,591.49,6433.97,"1 through 10",other,"not separately reimbursment ",420.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",420.88,825,
"COLONOSCOPY W/TRNSDS DILATE",5914560,"CDM ",960,RC,45386,HCPCS,OUTPATIENT,,,1032,825.6,,496.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,595.40,595.40,595.40,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",496.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1046,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",496.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",496.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",496.46,1046,
"COLONOSCOPY W/ENDSC RESEC",5914565,"CDM ",960,RC,45390,HCPCS,OUTPATIENT,,,1032,825.6,,133.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",484,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",133.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",133.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.47,484,
"COLONOSCOPY W/DECOMPRESS",5914570,"CDM ",960,RC,45393,HCPCS,OUTPATIENT,,,570.5,456.4,,293.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",293.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",371,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",293.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,57.98,57.98,57.98,"1 through 10",other,"not separately reimbursment ",293.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",293.17,371,
"REDUCE PROCIDENTION W/ANESTH",5914575,"CDM ",960,RC,45900,HCPCS,OUTPATIENT,,,355.5,284.4,,130.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",278,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",130.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",130.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.4,278,
"DILATION ANAL SPHINCTER",5914580,"CDM ",960,RC,45905,HCPCS,OUTPATIENT,,,374,299.2,,118.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",234,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",118.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",118.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.03,234,
"REMOVE FECAL OBSTRUCT W/ANES",5914585,"CDM ",960,RC,45915,HCPCS,OUTPATIENT,,,933.5,746.8,,225.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",225.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",460,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",225.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",225.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",225.3,460,
"ANORECTAL EXAM W/ANESTH",5914590,"CDM ",960,RC,45990,HCPCS,OUTPATIENT,,,268,214.4,,82.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",164,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",82.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",82.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.35,164,
"PLACEMENT OF SETON",5914595,"CDM ",960,RC,46020,HCPCS,OUTPATIENT,,,801.5,641.2,,162.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",388,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",162.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",162.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.98,388,
"REMOVE ANAL SETON OTH MRKR",5914600,"CDM ",960,RC,46030,HCPCS,OUTPATIENT,,,201.5,161.2,,79.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",196,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",79.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",79.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.2,196,
"I&D RECTAL ABSCESS",5914605,"CDM ",960,RC,46040,HCPCS,OUTPATIENT,,,857,685.6,,322.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",546.16,100,,603.09,603.09,603.09,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",322.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",745,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",322.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",322.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",322.13,745,
"I&D ANAL ABSCESS W/FISTULECT",5914610,"CDM ",960,RC,46050,HCPCS,OUTPATIENT,,,478.5,382.8,,111.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",125.99,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",283,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",111.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",111.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.1,283,
"I&D PERIANAL ABSCESS SF",5914615,"CDM ",960,RC,46060,HCPCS,OUTPATIENT,,,1076.5,861.2,,283.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",283.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",665,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",283.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",283.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",283.79,665,
"INC ANAL SPHINCTER",5914620,"CDM ",960,RC,46080,HCPCS,OUTPATIENT,,,562.5,450,,150.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",150.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",349,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",150.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",150.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",150.68,349,
"INSC HEMORRHOID EXTERNAL",5914625,"CDM ",960,RC,46083,HCPCS,OUTPATIENT,,,414,331.2,,117.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",237,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",117.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",117.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.38,237,
"REMOVE ANAL FISSURE",5914630,"CDM ",960,RC,46200,HCPCS,OUTPATIENT,,,993,794.4,,222.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",417.61,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",222.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",620,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",222.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",222.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",222.84,620,
"EXC SNGL EXT PAPILLA TAG ANUS",5914635,"CDM ",960,RC,46220,HCPCS,OUTPATIENT,,,334,267.2,,116.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",289,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",116.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",116.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.52,289,
"LIGATION HEMORRHOID",5914640,"CDM ",960,RC,46221,HCPCS,OUTPATIENT,,,508,406.4,,142.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",378,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",142.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",142.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.65,378,
"EXC THROMB HEMORROID EXT",5914645,"CDM ",960,RC,46230,HCPCS,OUTPATIENT,,,496.5,397.2,,172.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,318.41,318.41,318.41,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",384,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",172.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",172.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.81,384,
"EXC THROMB HEMORROID EXT",5914645,"CDM ",960,RC,46230,HCPCS,OUTPATIENT,,,496.5,397.2,,172.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,318.41,318.41,318.41,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",384,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",172.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",172.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.81,384,
"RMV HEMORRHOID EXT >2 GRP",5914650,"CDM ",960,RC,46250,HCPCS,OUTPATIENT,,,1040.5,832.4,,280.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",280.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",645,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",280.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",280.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",280.03,645,
"RMV HEMORRHOID IN/EX SINGLE",5914655,"CDM ",960,RC,46255,HCPCS,OUTPATIENT,,,1172,937.6,,319.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",319.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",707,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",319.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",319.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",319.29,707,
"RMV HEMORRHOID IN/EX W/FISS",5914660,"CDM ",960,RC,46257,HCPCS,OUTPATIENT,,,956.5,765.2,,263.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",687,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",263.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",263.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.76,687,
"RMV HEMORRHOID IN/EX W/FIST",5914665,"CDM ",960,RC,46258,HCPCS,OUTPATIENT,,,1034.5,827.6,,286.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",286.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",752,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",286.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",286.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",286.1,752,
"RMV HEMORRHOID IN/EXT >2GRP",5914670,"CDM ",960,RC,46260,HCPCS,OUTPATIENT,,,1100.5,880.4,,305.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",305.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",805,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",305.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",305.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",305.57,805,
"REMOVE ANAL FIST SUBQ",5914675,"CDM ",960,RC,46270,HCPCS,OUTPATIENT,,,849,679.2,,265.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",265.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",706,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",265.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",265.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",265.38,706,
"REMOVE ANAL FIST INTERSPHINC",5914680,"CDM ",960,RC,46275,HCPCS,OUTPATIENT,,,1478,1182.4,,283.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",283.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",752,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",283.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",283.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",283.23,752,
"REMOVE HEMORRHOID CLOT",5914685,"CDM ",960,RC,46320,HCPCS,OUTPATIENT,,,538.5,430.8,,113.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,131.20,131.20,131.20,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",257,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",113.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",113.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.62,257,
"REMOVE ANAL FIST COMPLEX",5914687,"CDM ",960,RC,46280,HCPCS,OUTPATIENT,,,970,776,,292.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",292.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",728,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",292.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",292.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",292.96,728,
"CHEMODENERVATION INT ANAL SPH",5914690,"CDM ",960,RC,46505,HCPCS,OUTPATIENT,,,807.5,646,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",403,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",403,403,
"ANOSCOPY DIAGNOSTIC",5914695,"CDM ",960,RC,46600,HCPCS,OUTPATIENT,,,215.5,172.4,,59.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",119,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",59.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",59.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.98,119,
"ANOSCOPY AND BIOPSY",5914700,"CDM ",960,RC,46606,HCPCS,OUTPATIENT,,,364,291.2,,132.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",317,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",132.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",132.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.27,317,
"ANOSCOPY REMOVE FB",5914705,"CDM ",960,RC,46608,HCPCS,OUTPATIENT,,,477.5,382,,173.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",344,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",173.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",173.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.03,344,
"DESTRCT LES ANAL SMPL CHEMICAL",5914710,"CDM ",960,RC,46900,HCPCS,OUTPATIENT,,,538.5,430.8,,135.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",337,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",135.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",135.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.55,337,
"DESTRUCT LES ANAL ELECTRODESIC",5914715,"CDM ",960,RC,46910,HCPCS,OUTPATIENT,,,574,459.2,,143.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",143.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",356,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",143.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",143.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",143.27,356,
"DESTRUCT LES ANAL CRYOSURGERY",5914720,"CDM ",960,RC,46916,HCPCS,OUTPATIENT,,,515,412,,148.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",313,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",148.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",148.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.36,313,
"DESTRUCT LES ANAL SURG EXCIS",5914725,"CDM ",960,RC,46922,HCPCS,OUTPATIENT,,,753.5,602.8,,154.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,688.30,688.30,688.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",374,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",154.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",154.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154.17,374,
"DESTRUCT LES ANAL EXTENSIVE",5914730,"CDM ",960,RC,46924,HCPCS,OUTPATIENT,,,1195.5,956.4,,333.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",333.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",747,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",333.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",333.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",333.46,747,
"LIVER NEEDLE BIOPSY",5914735,"CDM ",960,RC,47000,HCPCS,OUTPATIENT,,,575,460,,147.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",497,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",147.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",147.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.64,497,
"NEEDLE BIOSPY LIVER ADD-ON",5914740,"CDM ",960,RC,47001,HCPCS,OUTPATIENT,,,316.5,253.2,,83.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",151.7,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",186,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",83.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",83.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.43,186,
"HEPATOTOMY DRAIN LIVER",5914745,"CDM ",960,RC,47010,HCPCS,OUTPATIENT,,,2732,2185.6,,776.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",776.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1684,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",776.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",776.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",776.52,1684,
"LAPAROTOMY W/ASP & INJ HEPATIC",5914750,"CDM ",960,RC,47015,HCPCS,OUTPATIENT,,,2642,2113.6,,723.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",723.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1627,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",723.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",723.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",723.73,1627,
"BIOPSY LIVER NEEDLE",5914755,"CDM ",960,RC,47100,HCPCS,OUTPATIENT,,,1913,1530.4,,568.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",568.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1183,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",568.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",568.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",568.58,1183,
"HEPATECT RSCT LIVER PRT LOBECT",5914760,"CDM ",960,RC,47120,HCPCS,OUTPATIENT,,,6231,4984.8,,1640.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1640.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3260,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1640.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1640.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,3260,
"MARSUPIALIZE CYST/ABSC LIVER",5914770,"CDM ",960,RC,47300,HCPCS,OUTPATIENT,,,3362,2689.6,,719,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",719,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1588,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",719,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",719,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7,1588,
"RPR LIVER WOUND EXT DEBRIDE",5914775,"CDM ",960,RC,47361,HCPCS,OUTPATIENT,,,5230.5,4184.4,,2126.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2126.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",4258,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2126.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",2126.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2126.5,4258,
"LAP ABLATION LIVER TUM RDFQ",5914780,"CDM ",960,RC,47370,HCPCS,OUTPATIENT,,,2152,1721.6,,901.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",901.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1792,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",901.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",901.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",901.86,1792,
"CHOLECYST GALLBLADDER OPN",5914785,"CDM ",960,RC,47480,HCPCS,OUTPATIENT,,,2282.5,1826,,535.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",535.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1228,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",535.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",535.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",535.74,1228,
"BILE DUCT ENDOSCOPY ADD ON",5914790,"CDM ",960,RC,47550,HCPCS,OUTPATIENT,,,621,496.8,,132.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",268,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",132.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",132.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.32,268,
"LAP CHOLECYSTECTOMY",5914795,"CDM ",960,RC,47562,HCPCS,OUTPATIENT,,,2128.5,1702.8,,519.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1040.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",519.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1077,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",519.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,9356.84,6401.98,16833.28,"1 through 10",other,"not separately reimbursment ",519.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",519.44,1077,
"LAP CHOLE W/CHOLANGRPHY",5914800,"CDM ",960,RC,47563,HCPCS,OUTPATIENT,,,2106.5,1685.2,,557.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,724.80,724.80,724.80,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",557.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1159,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",557.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",557.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",557.77,1159,
"LAP CHOLE W/EXPLR COM DUCT",5914805,"CDM ",960,RC,47564,HCPCS,OUTPATIENT,,,4477.5,3582,,654.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,273.53,273.53,273.53,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",654.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1560,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",654.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",654.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",654.61,1560,
"REMOVE GALLBLADDER",5914810,"CDM ",960,RC,47600,HCPCS,OUTPATIENT,,,2158,1726.4,,637.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",637.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1495,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",637.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",637.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",637.08,1495,
"REMOVE GALLBLADDER W/EXPL",5914815,"CDM ",960,RC,47610,HCPCS,OUTPATIENT,,,2158,1726.4,,867.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",867.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1758,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",867.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",867.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",867.09,1758,
"FUSE BILE DUCTS BOWEL EXTRAH",5914820,"CDM ",960,RC,47780,HCPCS,OUTPATIENT,,,5997,4797.6,,1222.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1222.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",3460,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1222.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1222.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1222.05,3460,
"FUSE BILE DUCTS BOWEL INTRAH",5914825,"CDM ",960,RC,47785,HCPCS,OUTPATIENT,,,8285,6628,,1429.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1429.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",4537,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1429.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1429.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1429.91,4537,
"BX PANCREAS OPEN",5914830,"CDM ",960,RC,48100,HCPCS,OUTPATIENT,,,2014.5,1611.6,,575.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",575.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1241,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",575.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",575.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",575.81,1241,
"EXPLORE LAP CELIOTOMY",5914835,"CDM ",960,RC,49000,HCPCS,OUTPATIENT,,,1733.5,1386.8,,550.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",550.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1094,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",550.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",550.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",550.43,1094,
"REOPEN RECENT LAPAROTOMY",5914840,"CDM ",960,RC,49002,HCPCS,OUTPATIENT,,,2361,1888.8,,499.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",499.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1466,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",499.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",499.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",499.35,1466,
"DRAINAGE ABDOM ABCESS OPEN",5914845,"CDM ",960,RC,49020,HCPCS,OUTPATIENT,,,4573.5,3658.8,,1064.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1064.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2228,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1064.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1064.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1064.51,2228,
"DRAIN RETROPERITONEAL ABSC OPN",5914850,"CDM ",960,RC,49060,HCPCS,OUTPATIENT,,,2437,1949.6,,743.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",743.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1550,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",743.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",743.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",743.63,1550,
"ABD PARACENTESIS WO IMAGE",5914855,"CDM ",960,RC,49082,HCPCS,OUTPATIENT,,,430.5,344.4,,30.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",241,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",30.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.86,241,
"ABD PARACENTESIS W/IMAGE",5914860,"CDM ",960,RC,49083,HCPCS,OUTPATIENT,,,632.5,506,,47.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",433,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",47.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",47.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.66,433,
"PERITONEAL LAVAGE W/IMAGE",5914865,"CDM ",960,RC,49084,HCPCS,OUTPATIENT,,,443,354.4,,43.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",139,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",43.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",43.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.8,139,
"BIOPSY ABD MASS PERCU NEEDLE",5914870,"CDM ",960,RC,49180,HCPCS,OUTPATIENT,,,461,368.8,,142.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",283,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",142.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",142.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.66,283,
"REMOVE OMENTUM",5914885,"CDM ",960,RC,49255,HCPCS,OUTPATIENT,,,2750,2200,,537.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",537.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1110,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",537.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",537.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",537.75,1110,
"LAP ABDOMEN DX W/BRUSH/WASH",5914890,"CDM ",960,RC,49320,HCPCS,OUTPATIENT,,,837,669.6,,225.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",225.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",533,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",225.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",225.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",225.35,533,
"LAP SURGICAL W/BIOPSY",5914895,"CDM ",960,RC,49321,HCPCS,OUTPATIENT,,,1451,1160.8,,236.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",236.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",568,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",236.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",236.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",236.56,568,
"LAP ASPIRATION CAVITY/CYST",5914900,"CDM ",960,RC,49322,HCPCS,OUTPATIENT,,,1016.5,813.2,,258.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",258.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",590,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",258.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",258.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",258.41,590,
"REMOVE TUNNELED IP CATH",5914905,"CDM ",960,RC,49422,HCPCS,OUTPATIENT,,,1052.5,842,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",610,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",610,610,
"INSERT GASTRO TUBE W/FLUORO",5914910,"CDM ",960,RC,49440,HCPCS,OUTPATIENT,,,1780,1424,,824.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",824.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1670,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",824.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",824.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",824.05,1670,
"INSERT DUOD/JTUBE W/FLUORO",5914915,"CDM ",960,RC,49441,HCPCS,OUTPATIENT,,,2619,2095.2,,977.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",977.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1979,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",977.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",977.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",977.7,1979,
"CONV GTUBE TO GJ TUBE W/FLUOR",5914920,"CDM ",960,RC,49446,HCPCS,OUTPATIENT,,,2182,1745.6,,813.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",813.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1642,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",813.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",813.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",813.57,1642,
"REPLACE G/C TUBE PERC W/FLUOR",5914925,"CDM ",960,RC,49450,HCPCS,OUTPATIENT,,,1129,903.2,,567.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",567.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1139,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",567.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",567.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",567.85,1139,
"REPLACE G-J TUBE PERC W/FLUOR",5914930,"CDM ",960,RC,49452,HCPCS,OUTPATIENT,,,1418.5,1134.8,,738.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",738.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1489,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",738.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",738.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",738.02,1489,
"MECH RMV OBSTRUCT COLON TUBE",5914935,"CDM ",960,RC,49460,HCPCS,OUTPATIENT,,,2845.5,2276.4,,601.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",601.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1202,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",601.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",601.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",601.31,1202,
"RPR ING HERNIA <6MO INC/STRNG",5914940,"CDM ",960,RC,49496,HCPCS,OUTPATIENT,,,1435,1148,,418.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",418.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",832,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",418.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",418.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",418.9,832,
"RPR ING HERNIA 6MO-5Y REDUCE",5914945,"CDM ",960,RC,49500,HCPCS,OUTPATIENT,,,1195.5,956.4,,274.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",580,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",274.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",274.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.49,580,
"RPR INT ING HERNIA >5Y REDUCE",5914950,"CDM ",960,RC,49505,HCPCS,OUTPATIENT,,,1614.5,1291.6,,365.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",768.68,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",365.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",727,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",365.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",365.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",365.89,768.68,
"RPR INT ING HERNIA >5Y INC/STG",5914955,"CDM ",960,RC,49507,HCPCS,OUTPATIENT,,,1676,1340.8,,452.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",914.06,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",452.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",900,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",452.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",452.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",452.96,914.06,
"RPR RECURRENT ING HERNIA",5914960,"CDM ",960,RC,49520,HCPCS,OUTPATIENT,,,1741.5,1393.2,,454.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,56.50,56.50,56.50,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",454.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",903,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",454.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",454.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",454.52,903,
"RPR HERNIA BLOCKED",5914965,"CDM ",960,RC,49521,HCPCS,OUTPATIENT,,,1871.5,1497.2,,557.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",557.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1107,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",557.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",557.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",557.28,1107,
"RPR FEM HERNIA INT REDUCE",5914970,"CDM ",960,RC,49550,HCPCS,OUTPATIENT,,,1745.5,1396.4,,411.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",411.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",817,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",411.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",411.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",411.3,817,
"RPR FEM HERNIA INT BLOCKED",5914975,"CDM ",960,RC,49553,HCPCS,OUTPATIENT,,,2176.5,1741.2,,447.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",447.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",888,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",447.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",447.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",447.08,888,
"RPR RECUR FEM HERNIA INCARCER",5914977,"CDM ",960,RC,49557,HCPCS,OUTPATIENT,,,1494.5,1195.6,,521.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",521.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1036,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",521.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",521.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",521.56,1036,
"LAP INITIAL ING HERNIA RPR",5915040,"CDM ",960,RC,49650,HCPCS,OUTPATIENT,,,1095.5,876.4,,306.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",306.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",623,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",306.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",306.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",306.56,623,
"LAP ING HERNIA RPR RECURRENT",5915045,"CDM ",960,RC,49651,HCPCS,OUTPATIENT,,,1602.5,1282,,396.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",817.46,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",396.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",800,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",396.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",396.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",396.82,817.46,
"OMENTAL FLAP INTRAABD",5915080,"CDM ",960,RC,49905,HCPCS,OUTPATIENT,,,1057,845.6,,286.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",286.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",586,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",286.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",286.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",286.42,586,
"DRAIN PERIRENAL RENAL ABSC OPN",5915085,"CDM ",960,RC,50020,HCPCS,OUTPATIENT,,,2293.5,1834.8,,705.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",705.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1570,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",705.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",705.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",705.63,1570,
"NEPHROSTOMY W/DRAIN",5915090,"CDM ",960,RC,50040,HCPCS,OUTPATIENT,,,2152,1721.6,,681.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",681.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1478,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",681.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",681.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",681.43,1478,
"BX RENAL PERCU TROCAR/NEEDLE",5915095,"CDM ",960,RC,50200,HCPCS,OUTPATIENT,,,293,234.4,,122.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",801,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",122.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",122.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.05,801,
"NEPHRECTOMY OPEN RADICAL",5915100,"CDM ",960,RC,50230,HCPCS,OUTPATIENT,,,2988.5,2390.8,,966.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",966.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2294,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",966.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",966.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",966.24,2294,
"NEPHRECTOMY PARTIAL",5915105,"CDM ",960,RC,50240,HCPCS,OUTPATIENT,,,2869.5,2295.6,,976.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2242.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",976.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2151,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",976.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",976.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",976.19,2242.64,
"EXC KIDNEY CYST",5915110,"CDM ",960,RC,50280,HCPCS,OUTPATIENT,,,2155.5,1724.4,,704.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",704.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1515,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",704.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",704.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",704.72,1515,
"REMOVE REPLACE URETERAL STENT",5915115,"CDM ",960,RC,50385,HCPCS,OUTPATIENT,,,3170,2536,,982.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",982.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1986,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",982.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",982.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",982.33,1986,
"RMV RPLC NEPHRTR CATH W/IMAGE",5915120,"CDM ",960,RC,50387,HCPCS,OUTPATIENT,,,190,152,,570.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",570.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1133,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",570.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",570.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",570.27,1133,
"DRAIN RENAL CYST NEEDLE PERCU",5915125,"CDM ",960,RC,50390,HCPCS,OUTPATIENT,,,403,322.4,,82.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",228.22,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",206,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",82.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",82.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.1,228.22,
"INSTILL AGENT RENAL/URETER",5915130,"CDM ",960,RC,50391,HCPCS,OUTPATIENT,,,213,170.4,,108.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",216,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",108.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",108.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.52,216,
"PYELOPLASTY RENAL PELVIS SMPL",5915135,"CDM ",960,RC,50400,HCPCS,OUTPATIENT,,,2627,2101.6,,862.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1945.18,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",862.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1869,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",862.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",862.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",862.14,1945.18,
"INJ NEPHRO/URETEROGRAM W/IMAGE",5915140,"CDM ",960,RC,50430,HCPCS,OUTPATIENT,,,319,255.2,,107.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",107.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",707,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",107.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",107.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",107.11,707,
"INJ NEPH/URETEROGRAM EXST ACC",5915145,"CDM ",960,RC,50431,HCPCS,OUTPATIENT,,,136,108.8,,42.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",220,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",42.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",42.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.3,220,
"PLACE NEPH CATH W/FLUORO",5915150,"CDM ",960,RC,50432,HCPCS,OUTPATIENT,,,520.5,416.4,,141.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1143,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",141.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",141.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.69,1143,
"EXCH NEPH CATH W/FLUORO",5915155,"CDM ",960,RC,50435,HCPCS,OUTPATIENT,,,239.5,191.6,,64.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",637,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",64.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.83,637,
"LAP NEPHRECTOMY PARTIAL",5915160,"CDM ",960,RC,50543,HCPCS,OUTPATIENT,,,3455.5,2764.4,,1124.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1124.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2618.53,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1124.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1124.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1124.6,2618.53,
"LAP NEPHRECTOMY RADICAL",5915165,"CDM ",960,RC,50545,HCPCS,OUTPATIENT,,,3079,2463.2,,1047.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2078.04,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1047.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2174,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1047.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1047.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1047.2,2174,
"LAP NEPHRECT RAD W/PRT URETER",5915170,"CDM ",960,RC,50546,HCPCS,OUTPATIENT,,,2779.5,2223.6,,910.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",910.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1925,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",910.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",910.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",910.85,1925,
"LAP NEPHRECT RAD W/TTL URETER",5915175,"CDM ",960,RC,50548,HCPCS,OUTPATIENT,,,2988.5,2390.8,,1059.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2095.68,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1059.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2193,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1059.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1059.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1059.97,2193,
"LITHOTRIPSY ESW",5915180,"CDM ",960,RC,50590,HCPCS,OUTPATIENT,,,2456.5,1965.2,,644.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",644.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1434,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",644.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",644.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",644.03,1434,
"INSERT URETERAL STENT",5915185,"CDM ",960,RC,50605,HCPCS,OUTPATIENT,,,2207,1765.6,,705.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",705.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1451,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",705.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",705.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",705.4,1451,
"REMOVE URETER STONE UPPER",5915190,"CDM ",960,RC,50610,HCPCS,OUTPATIENT,,,2469.5,1975.6,,725.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",725.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1563,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",725.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",725.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",725.77,1563,
"REMOVE URETER STONE MIDDLE",5915195,"CDM ",960,RC,50620,HCPCS,OUTPATIENT,,,2354.5,1883.6,,676.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",676.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1507,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",676.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",676.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",676.28,1507,
"REMOVE URETER STONE LOWER 1/3",5915200,"CDM ",960,RC,50630,HCPCS,OUTPATIENT,,,2276,1820.8,,668.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",668.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1567,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",668.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",668.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",668.14,1567,
"REMOVE URETER W/BLADDER CUFF",5915205,"CDM ",960,RC,50650,HCPCS,OUTPATIENT,,,2678.5,2142.8,,775,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",775,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1662,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",775,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",775,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7,1662,
"REMOVE URETER TOTAL",5915210,"CDM ",960,RC,50660,HCPCS,OUTPATIENT,,,2958,2366.4,,865.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",865.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1838,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",865.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",865.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",865.93,1838,
"REMOVE URETER TOTAL",5915210,"CDM ",960,RC,50688,HCPCS,OUTPATIENT,,,2958,2366.4,,67.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",135,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",67.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",67.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.7,135,
"INJ URETER X-RAY",5915215,"CDM ",960,RC,50684,HCPCS,OUTPATIENT,,,201.5,161.2,,162.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",323,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",162.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",162.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.67,323,
"MEASURE URETER PRESSURE",5915220,"CDM ",960,RC,50686,HCPCS,OUTPATIENT,,,352,281.6,,145.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",145.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",289,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",145.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",145.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",145.36,289,
"CHANGE URETER TUBE/STENT",5915225,"CDM ",960,RC,50688,HCPCS,OUTPATIENT,,,198,158.4,,67.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",135,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",67.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",67.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.7,135,
"INJ ILEAL/URETER EXCLSV IMAGE",5915230,"CDM ",960,RC,50690,HCPCS,OUTPATIENT,,,219,175.2,,88.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",176,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",88.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",88.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.67,176,
"PLACE URETER STENT W/IMAGE",5915235,"CDM ",960,RC,50693,HCPCS,OUTPATIENT,,,508,406.4,,140.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1428,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",140.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",140.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.34,1428,
"PLC URETER STNT NW ACC WO CATH",5915240,"CDM ",960,RC,50694,HCPCS,OUTPATIENT,,,615.5,492.4,,181.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",181.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1576,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",181.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",181.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",181.48,1576,
"PLC URETER STNT NW ACCS W/CATH",5915245,"CDM ",960,RC,50695,HCPCS,OUTPATIENT,,,813.5,650.8,,230.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",230.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1923,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",230.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",230.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",230.1,1923,
"BALLOON DLT URTR STRCT ADDON",5915250,"CDM ",960,RC,50706,HCPCS,OUTPATIENT,,,418.5,334.8,,120.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1034,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",120.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",120.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.54,1034,
"REVISE URINE CUTANEOUS ANAST",5915255,"CDM ",960,RC,50727,HCPCS,OUTPATIENT,,,1166,932.8,,378.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",378.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",798,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",378.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",378.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",378.73,798,
URETEROURETEROSTOMY,5915260,"CDM ",960,RC,50760,HCPCS,OUTPATIENT,,,2540.5,2032.4,,826.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",826.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1809,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",826.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",826.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",826.49,1809,
"URETERONEOCYSTOSTOMY SINGLE",5915265,"CDM ",960,RC,50780,HCPCS,OUTPATIENT,,,2583,2066.4,,821.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",821.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1821,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",821.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",821.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",821.2,1821,
"URETERONEOCYST W/VP HITCH/FLAP",5915270,"CDM ",960,RC,50785,HCPCS,OUTPATIENT,,,2753.5,2202.8,,907.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",907.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2047,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",907.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",907.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",907.44,2047,
"URETEROILEAL CONDUIT BLADDER",5915275,"CDM ",960,RC,50820,HCPCS,OUTPATIENT,,,2977.5,2382,,970.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",970.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2357,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",970.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",970.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",970.22,2357,
"ENDOSCOPY URETER",5915280,"CDM ",960,RC,50951,HCPCS,OUTPATIENT,,,920.5,736.4,,311.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",311.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",619,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",311.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",311.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",311.63,619,
"ENDOSCOPY URETER W/CATH",5915285,"CDM ",960,RC,50953,HCPCS,OUTPATIENT,,,964,771.2,,327.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",327.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",651,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",327.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",327.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",327.71,651,
"ENDOSCOPY URETER W/BX",5915290,"CDM ",960,RC,50955,HCPCS,OUTPATIENT,,,1029,823.2,,400.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",400.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",796,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",400.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",400.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",400.71,796,
"ENDOSCOPY URETER W/FULG/INC",5915295,"CDM ",960,RC,50957,HCPCS,OUTPATIENT,,,1051,840.8,,350.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",350.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",697,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",350.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",350.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",350.58,697,
"ENDOSCOPY URETER  W/RMV FB",5915300,"CDM ",960,RC,50961,HCPCS,OUTPATIENT,,,932,745.6,,320.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",320.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",636,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",320.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",320.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",320.17,636,
"ENDOSCOPY URETER EXCLSV IMAGE",5915305,"CDM ",960,RC,50970,HCPCS,OUTPATIENT,,,906.5,725.2,,304.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",304.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",695,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",304.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",304.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",304.47,695,
"ENDOSCOPY URETER W/CATH",5915310,"CDM ",960,RC,50972,HCPCS,OUTPATIENT,,,867.5,694,,295.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",295.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",588,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",295.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",295.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",295.91,588,
"ENDOSCOPY URETER W/BX",5915315,"CDM ",960,RC,50974,HCPCS,OUTPATIENT,,,1029,823.2,,388.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",388.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",911,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",388.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",388.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",388.77,911,
"ENDOSCOPY URETER W/FULG/INC",5915320,"CDM ",960,RC,50976,HCPCS,OUTPATIENT,,,1127,901.6,,384.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",384.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",870,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",384.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",384.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",384.03,870,
"ENDOSCOPY URETER W/RMV FB",5915325,"CDM ",960,RC,50980,HCPCS,OUTPATIENT,,,868.5,694.8,,291.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",291.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",587,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",291.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",291.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",291.95,587,
"CYSTOSTOMY W/FULG",5915330,"CDM ",960,RC,51020,HCPCS,OUTPATIENT,,,1088.5,870.8,,348.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",348.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",775,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",348.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",348.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",348.6,775,
"CYSTOSTOMY W/DRAINAGE",5915340,"CDM ",960,RC,51040,HCPCS,OUTPATIENT,,,664,531.2,,219.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",219.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",545,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",219.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",219.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",219.44,545,
"CYSTOTOMY W/INSRT CATH/STENT",5915345,"CDM ",960,RC,51045,HCPCS,OUTPATIENT,,,1130.5,904.4,,350.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",350.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",738,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",350.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",350.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",350.53,738,
"CYSTOTOMY W/REMOVE CALCULUS",5915350,"CDM ",960,RC,51050,HCPCS,OUTPATIENT,,,1094.5,875.6,,329.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",329.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",800,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",329.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",329.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",329.47,800,
"TRANSVESICAL URETEROLITHOTOMY",5915355,"CDM ",960,RC,51060,HCPCS,OUTPATIENT,,,1356.5,1085.2,,437.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",437.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1076,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",437.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",437.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",437.89,1076,
"CYSTOTOMY W/RMV CALC BASKET",5915360,"CDM ",960,RC,51065,HCPCS,OUTPATIENT,,,1344,1075.2,,413.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",413.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",921,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",413.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",413.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",413.02,921,
"DRAINAGE BLADDER ABSCESS",5915365,"CDM ",960,RC,51080,HCPCS,OUTPATIENT,,,951,760.8,,305.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",305.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",643,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",305.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",305.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",305.92,643,
"ASP/DRAIN BLADDER NEEDLE",5915370,"CDM ",960,RC,51100,HCPCS,OUTPATIENT,,,139,111.2,,48.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",96,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",48.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",48.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.43,96,
"ASP/DRAIN BLADDER TROCAR/CATH",5915375,"CDM ",960,RC,51101,HCPCS,OUTPATIENT,,,347.5,278,,97.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",194,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",97.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",97.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.57,194,
"ASPIR/DRAIN BLADDER W/CATH",5915380,"CDM ",960,RC,51102,HCPCS,OUTPATIENT,,,730,584,,256.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",256.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",510,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",256.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",256.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",256.74,510,
"EXCISION BLADDER CYST",5915385,"CDM ",960,RC,51500,HCPCS,OUTPATIENT,,,1483.5,1186.8,,480.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",480.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",993,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",480.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",480.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",480.34,993,
"CYSTECTOMY PART SIMPLE",5915390,"CDM ",960,RC,51550,HCPCS,OUTPATIENT,,,2242,1793.6,,708.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1610.98,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",708.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1516,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",708.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",708.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",708.23,1610.98,
"CYSECTOMY PART COMPLEX",5915395,"CDM ",960,RC,51555,HCPCS,OUTPATIENT,,,2868.5,2294.8,,945.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",945.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2017,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",945.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",945.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",945.46,2017,
"CYSTECTOMY COMPLETE",5915400,"CDM ",960,RC,51570,HCPCS,OUTPATIENT,,,3467,2773.6,,1070.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1070.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2358,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1070.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1070.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,2358,
"CYCSTECTOMY CMPLT W/URETEROIL",5915405,"CDM ",960,RC,51590,HCPCS,OUTPATIENT,,,4357,3485.6,,1427.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1427.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",3237,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1427.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1427.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1427.17,3237,
"CYSTECTOMY CMPLT W/BILAT LYMPH",5915410,"CDM ",960,RC,51595,HCPCS,OUTPATIENT,,,5141,4112.8,,1617.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1617.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",4029,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1617.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1617.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1617.13,4029,
"INJ CYSTO/URETHROCYSTOGRAPHY",5915415,"CDM ",960,RC,51600,HCPCS,OUTPATIENT,,,84,67.2,,168.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,313.61,313.61,313.61,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",168.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",336,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",168.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",168.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",168.88,336,
"IRRIGATION BLADDER SIMPLE",5915420,"CDM ",960,RC,51700,HCPCS,OUTPATIENT,,,186,148.8,,73.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",146,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",73.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",73.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.27,146,
"INSERT BLADDER NON DWELL CATH",5915425,"CDM ",960,RC,51701,HCPCS,OUTPATIENT,,,144,115.2,,60.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",123.05,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",60.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",60.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.31,123.05,
"INSERT TMP BLADDER CATH SIMPLE",5915430,"CDM ",960,RC,51702,HCPCS,OUTPATIENT,,,213.5,170.8,,74.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,11.03,11.03,11.03,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",162,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",74.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",74.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.4,162,
"INSERT TEMP BLADDER CATH CMPLX",5915435,"CDM ",960,RC,51703,HCPCS,OUTPATIENT,,,343,274.4,,124.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",264,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",124.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",124.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.25,264,
"CHANGE BLADDER TUBE SIMPLE",5915440,"CDM ",960,RC,51705,HCPCS,OUTPATIENT,,,205,164,,96.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",192,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",96.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",96.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.7,192,
"CHANGE BLADDER TUBE COMPLEX",5915445,"CDM ",960,RC,51710,HCPCS,OUTPATIENT,,,290,232,,141.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",282,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",141.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",141.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.69,282,
"ENDOSCOPIC INJ IMPLANT URETHRA",5915450,"CDM ",960,RC,51715,HCPCS,OUTPATIENT,,,610,488,,225.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",225.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",461,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",225.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",225.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",225.34,461,
"BLADDER INSTILL ANTICRCN AGENT",5915455,"CDM ",960,RC,51720,HCPCS,OUTPATIENT,,,223,178.4,,113.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",225,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",113.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",113.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.22,225,
"CYSTOMETROGRAM COMPLEX",5915460,"CDM ",960,RC,51726,HCPCS,OUTPATIENT,,,586.5,469.2,,265.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",265.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",528,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",265.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",265.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",265.72,528,
"CYSTOMETROGRAM W/URETH PRESS",5915465,"CDM ",960,RC,51727,HCPCS,OUTPATIENT,,,694,555.2,,148.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",424,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",148.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",148.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.92,424,
"CYCSTOMETROGRAM W/VOID PRESS",5915470,"CDM ",960,RC,51728,HCPCS,OUTPATIENT,,,706,564.8,,148.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",425,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",148.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",148.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.73,425,
"CYSTOMETROGRAM W/MEASURING",5915475,"CDM ",960,RC,51729,HCPCS,OUTPATIENT,,,759.5,607.6,,150.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",150.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",464,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",150.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",150.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",150.21,464,
"URINE FLOW MEASURE SIMPLE",5915480,"CDM ",960,RC,51736,HCPCS,OUTPATIENT,,,95.5,76.4,,36.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",83,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",36.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",36.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.59,83,
"URINE FLOW MEASURE COMPLEX",5915485,"CDM ",960,RC,51741,HCPCS,OUTPATIENT,,,155.5,124.4,,60.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.05,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",134,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",60.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",60.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.2,134,
"EMG ANAL/URETH SPHINCTER",5915490,"CDM ",960,RC,51784,HCPCS,OUTPATIENT,,,156,124.8,,162.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",325,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",162.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",162.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.05,325,
"EMG NEEDLE ANAL/URETH SPHINC",5915495,"CDM ",960,RC,51785,HCPCS,OUTPATIENT,,,592.5,474,,174.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",363,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",174.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",174.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174.53,363,
"URINARY RFLX STUDY EVOKED RESP",5915500,"CDM ",960,RC,51792,HCPCS,OUTPATIENT,,,467,373.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",408,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",408,408,
"INTRAABD PRESSURE TEST",5915505,"CDM ",960,RC,51797,HCPCS,OUTPATIENT,,,246,196.8,,214.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",427,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",214.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",214.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.5,427,
"US URINE CAPACITY MEASURE",5915510,"CDM ",960,RC,51798,HCPCS,OUTPATIENT,,,60,48,,14.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",29,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",14.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",14.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.69,29.4,
"ATTACH BLADDER/URETHRA SMPL",5915515,"CDM ",960,RC,51840,HCPCS,OUTPATIENT,,,1494.5,1195.6,,514.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",514.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1152,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",514.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",514.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",514.71,1152,
"CYSTORRHAPHY SUTURE WOUND",5915520,"CDM ",960,RC,51860,HCPCS,OUTPATIENT,,,1638.5,1310.8,,563.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",563.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1133,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",563.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",563.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",563.46,1133,
"CYSTORRHAPHY SUTURE WOUND SMP",5915525,"CDM ",960,RC,51865,HCPCS,OUTPATIENT,,,2033,1626.4,,685.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",685.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1479,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",685.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",685.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",685.53,1479,
ENTEROCYSTOPLASTY,5915530,"CDM ",960,RC,51960,HCPCS,OUTPATIENT,,,3144.5,2515.6,,1027.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1027.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2534,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1027.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1027.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1027.21,2534,
"LAP URETHRAL SUSPENSION",5915535,"CDM ",960,RC,51990,HCPCS,OUTPATIENT,,,1740,1392,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1181,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1181,1181,
"LAP SLING OPERATION",5915540,"CDM ",960,RC,51992,HCPCS,OUTPATIENT,,,1953.5,1562.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1280,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1280,1280,
CYSTOSCOPY,5915545,"CDM ",960,RC,52000,HCPCS,OUTPATIENT,,,427.5,342,,157.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",221.18,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",326,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",157.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",157.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.91,326,
"CYSTOSCOPY W/IRRIG RMV CLOTS",5915550,"CDM ",960,RC,52001,HCPCS,OUTPATIENT,,,789.5,631.6,,320.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",320.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",638,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",320.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",320.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",320.45,638,
"CYSTOSCOPY URETER CATH",5915555,"CDM ",960,RC,52005,HCPCS,OUTPATIENT,,,554.5,443.6,,232.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",232.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",462,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",232.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",232.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",232.65,462,
"CYSTOSCOPY CATH W/BX",5915560,"CDM ",960,RC,52007,HCPCS,OUTPATIENT,,,1829.5,1463.6,,555.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",555.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1104,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",555.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",555.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",555.73,1104,
"CYSTOSCOPY DUCT CATH",5915565,"CDM ",960,RC,52010,HCPCS,OUTPATIENT,,,776,620.8,,397.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",397.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",790,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",397.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",397.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",397.71,790,
"CYSTOSCOPY W/BX",5915570,"CDM ",960,RC,52204,HCPCS,OUTPATIENT,,,1552.5,1242,,480.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",480.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",955,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",480.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",480.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",480.53,955,
"CYSTOSCOPY W/FULGURATION",5915575,"CDM ",960,RC,52214,HCPCS,OUTPATIENT,,,1358,1086.4,,1178.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1178.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2341,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1178.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1178.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1178.26,2341,
"CYSTOSCOPY W/FULG <0.5CM",5915580,"CDM ",960,RC,52224,HCPCS,OUTPATIENT,,,1422,1137.6,,1114.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",626.91,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1114.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2213,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1114.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1114.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",626.91,2213,
"CYSTOSCOPY W/FULG 0.50-2.0CM",5915585,"CDM ",960,RC,52234,HCPCS,OUTPATIENT,,,582.5,466,,198.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",198.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",531,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",198.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",198.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",198.77,531,
"CYSTOSCOPY W/FULG 2.0-5.0CM",5915590,"CDM ",960,RC,52235,HCPCS,OUTPATIENT,,,627,501.6,,222.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",588,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",222.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",668,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",222.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",222.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",222.99,668,
"CYSTOSCOPY LRG TUMOR",5915595,"CDM ",960,RC,52240,HCPCS,OUTPATIENT,,,1275,1020,,390.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",390.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1163,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",390.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",390.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",390.46,1163,
"CYSTOSCOPY W/INSRT RDTRCR",5915600,"CDM ",960,RC,52250,HCPCS,OUTPATIENT,,,520,416,,194.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",194.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",414,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",194.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",194.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",194.18,414,
"CYSTOSCOPY W/DILATE GEN ANSTH",5915605,"CDM ",960,RC,52260,HCPCS,OUTPATIENT,,,456,364.8,,168.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",168.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",342,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",168.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",168.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",168.66,342,
"CYSTOSCOPY W/DILATE LOC ANSTH",5915610,"CDM ",960,RC,52265,HCPCS,OUTPATIENT,,,760,608,,467.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",467.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",928,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",467.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",467.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",467.27,928,
"CYSTOSCOPY W/REVISE URETH FML",5915615,"CDM ",960,RC,52270,HCPCS,OUTPATIENT,,,741,592.8,,416.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",416.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",828,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",416.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",416.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",416.83,828,
"CYSTOSCOPY W/REVISE URETH MALE",5915620,"CDM ",960,RC,52275,HCPCS,OUTPATIENT,,,999.5,799.6,,586.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",586.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1165,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",586.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",586.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",586.2,1165,
"CYSTOSCOPY W/INT URETHROTOMY",5915625,"CDM ",960,RC,52276,HCPCS,OUTPATIENT,,,575,460,,204.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",539,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",204.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",544,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",204.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",204.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",204.54,544,
"CYSTOSCOPY W/RSCT EXT SPHINCT",5915630,"CDM ",960,RC,52277,HCPCS,OUTPATIENT,,,702.5,562,,265.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",265.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",621,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",265.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",265.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",265.49,621,
"CYSTOSCOPY W/URT STRICT/STENO",5915635,"CDM ",960,RC,52281,HCPCS,OUTPATIENT,,,569.5,455.6,,289.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",289.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",574,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",289.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",289.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",289.14,574,
"CYSTOSCOPY STENT IMPLANT",5915640,"CDM ",960,RC,52282,HCPCS,OUTPATIENT,,,731,584.8,,273.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",619,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",273.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",273.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.23,619,
"CYSTOSCOPY W/STEROID INJ",5915645,"CDM ",960,RC,52283,HCPCS,OUTPATIENT,,,585,468,,232.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",232.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",462,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",232.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",232.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",232.46,462,
"CYSTOSCOPY W/FML URETHR SYNDR",5915650,"CDM ",960,RC,52285,HCPCS,OUTPATIENT,,,589,471.2,,230.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",230.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",458,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",230.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",230.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",230.3,458,
"CYSTOURETHRO W/CHEMODENERV",5915655,"CDM ",960,RC,52287,HCPCS,OUTPATIENT,,,637.5,510,,187.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",419,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",187.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",187.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.67,419,
"CYSTOSCOPY W/URETER MEATOTOMY",5915660,"CDM ",960,RC,52290,HCPCS,OUTPATIENT,,,635.5,508.4,,197.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",197.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",400,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",197.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",197.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",197.01,400,
"CYSTOSCOPY W/RSCT ORTH URETERO",5915665,"CDM ",960,RC,52300,HCPCS,OUTPATIENT,,,610,488,,228.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",228.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",495,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",228.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",228.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",228.22,495,
"CYSTOSCOPY W/RSCT ECTOP URET",5915670,"CDM ",960,RC,52301,HCPCS,OUTPATIENT,,,630.5,504.4,,238.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",238.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",506,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",238.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",238.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",238.54,506,
"CYSTOSCOPY W/INC/RSCT ORIFICE",5915675,"CDM ",960,RC,52305,HCPCS,OUTPATIENT,,,606,484.8,,215.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",215.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",496,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",215.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",215.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",215.66,496,
"CYSTOSCOPY W/RMV STENT SIMPLE",5915680,"CDM ",960,RC,52310,HCPCS,OUTPATIENT,,,626,500.8,,222.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",222.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",443,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",222.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",222.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",222.86,443,
"CYSTOSCOPY W/RMV STENT CMPLX",5915685,"CDM ",960,RC,52315,HCPCS,OUTPATIENT,,,1015,812,,412.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",412.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",819,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",412.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",412.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",412.21,819,
"LITHOPLAXY BLADDER STONE SMPL",5915690,"CDM ",960,RC,52317,HCPCS,OUTPATIENT,,,2018,1614.4,,1024.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1024.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2034,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1024.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1024.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1024.02,2034,
"LITHOPLAXY BLADDER STONE CMPLX",5915695,"CDM ",960,RC,52318,HCPCS,OUTPATIENT,,,1153.5,922.8,,389.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",389.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",967,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",389.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",389.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",389.35,967,
"CYSTOSCOPY W/RMV URET CALC",5915700,"CDM ",960,RC,52320,HCPCS,OUTPATIENT,,,601.5,481.2,,190.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",564,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",190.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",544,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",190.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",190.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",190.63,564,
"CYSTOSCOPY W/FRAG URET CALC",5915705,"CDM ",960,RC,52325,HCPCS,OUTPATIENT,,,780,624,,262.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",740,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",262.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",262.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.13,740,
"CYSTOSCOPY INJ MATERIAL",5915710,"CDM ",960,RC,52327,HCPCS,OUTPATIENT,,,631.5,505.2,,1052.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1052.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2092,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1052.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1052.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1052.96,2092,
"CYSTOSCOPY W/MANIP WO RMV CAL",5915715,"CDM ",960,RC,52330,HCPCS,OUTPATIENT,,,2145.5,1716.4,,1242.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1242.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2468,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1242.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1242.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1242.28,2468,
"CYSTOSCOPY W/INSERT STENT",5915720,"CDM ",960,RC,52332,HCPCS,OUTPATIENT,,,1286,1028.8,,253.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",503.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",253.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",734,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",253.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",253.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",253.01,734,
"CREATE PASSAGE TO KIDNEY",5915725,"CDM ",960,RC,52334,HCPCS,OUTPATIENT,,,625,500,,197.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",197.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",460,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",197.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",197.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",197.56,460,
"CYSTO W/URETER STRICTURE TX",5915730,"CDM ",960,RC,52341,HCPCS,OUTPATIENT,,,797.5,638,,259.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",259.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2174,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",259.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",259.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",259.63,2174,
"CYSTO W/UP STRICTURE TX",5915735,"CDM ",960,RC,52342,HCPCS,OUTPATIENT,,,858.5,686.8,,279.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",279.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",556,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",279.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",279.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",279.64,556,
"CYSTOURETEROSCOPY URET STRICT",5915740,"CDM ",960,RC,52344,HCPCS,OUTPATIENT,,,1020.5,816.4,,331.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",331.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",659,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",331.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",331.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",331.89,659,
"CYSTOURETEROSCOPY PYELOSCOPY",5915745,"CDM ",960,RC,52351,HCPCS,OUTPATIENT,,,766.5,613.2,,242.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",242.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",514,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",242.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",242.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",242.01,514,
"CYSTOURETHRO PYEL W/RMV CALC",5915750,"CDM ",960,RC,52352,HCPCS,OUTPATIENT,,,1164.5,931.6,,284.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",995.69,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",284.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",625,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",284.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",284.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",284.03,995.69,
"CYSTOURETHRO W/LITHOTRIPSY",5915755,"CDM ",960,RC,52353,HCPCS,OUTPATIENT,,,1663,1330.4,,327.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1050.13,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",327.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",724,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",327.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",327.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",327.13,1050.13,
"CYSTO W/BX/FULGURATION",5915760,"CDM ",960,RC,52354,HCPCS,OUTPATIENT,,,1119.5,895.6,,316.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",316.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",642,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",316.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",316.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",316.57,642,
"CYSTO W/LITHOTRIPSY",5915765,"CDM ",960,RC,52356,HCPCS,OUTPATIENT,,,2217.5,1774,,195.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1357.87,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",195.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",591,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",195.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",195.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",195.92,1357.87,
"CYSTOURETHRO W/TRNS RESCT",5915770,"CDM ",960,RC,52402,HCPCS,OUTPATIENT,,,651,520.8,,208.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",208.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",442,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",208.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",208.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",208.15,442,
"TRANSURETHRAL INC PROSTATE",5915775,"CDM ",960,RC,52450,HCPCS,OUTPATIENT,,,1224.5,979.6,,354.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",354.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",744,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",354.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",354.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",354.09,744,
"TRANSURETH RSCT BLADDER NECK",5915780,"CDM ",960,RC,52500,HCPCS,OUTPATIENT,,,1130.5,904.4,,388.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",388.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",902,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",388.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",388.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",388.49,902,
"TRANSURETH RSCT PROSTATE",5915785,"CDM ",960,RC,52601,HCPCS,OUTPATIENT,,,2190.5,1752.4,,549.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1461.89,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",549.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1378,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",549.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",549.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",549.66,1461.89,
"TRANSURETH RSCT OBST PROSTATE",5915790,"CDM ",960,RC,52630,HCPCS,OUTPATIENT,,,1162,929.6,,328.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",328.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",893,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",328.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",328.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",328.19,893,
"TRANSURETH RSCT POSTOP CONTR",5915795,"CDM ",960,RC,52640,HCPCS,OUTPATIENT,,,764.5,611.6,,300.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",742,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",300.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",300.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",300.79,742,
"DRAIN PROSTATIC ABSCESS",5915800,"CDM ",960,RC,52700,HCPCS,OUTPATIENT,,,1000.5,800.4,,312.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",312.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",692,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",312.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",312.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",312.76,692,
"INC MEATOTOMY EXCEPT INFANT",5915805,"CDM ",960,RC,53020,HCPCS,OUTPATIENT,,,221,176.8,,141.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",282,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",141.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",141.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.84,282,
"EXC/FULG URETHRAL CARUNCLE",5915810,"CDM ",960,RC,53265,HCPCS,OUTPATIENT,,,418.5,334.8,,178.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",355,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",178.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",178.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.81,355,
"EXC/FULG URETHRA SKENES GLAND",5915815,"CDM ",960,RC,53270,HCPCS,OUTPATIENT,,,414,331.2,,165.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",165.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",328,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",165.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",165.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",165.13,328,
"URETHROPLASTY 1 STAGE",5915820,"CDM ",960,RC,53415,HCPCS,OUTPATIENT,,,2569.5,2055.6,,844.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",844.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1822,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",844.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",844.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",844.17,1822,
"URETHROPLASTY RCNST FML URET",5915825,"CDM ",960,RC,53430,HCPCS,OUTPATIENT,,,2195.5,1756.4,,733.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",733.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1519,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",733.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",733.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",733.47,1519,
"URETHROMEATOPLSTY W/MUCO ADV",5915830,"CDM ",960,RC,53450,HCPCS,OUTPATIENT,,,925.5,740.4,,293.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",293.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",650,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",293.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",293.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",293.89,650,
"URETHROMEATO W/PRT EXC DST URE",5915835,"CDM ",960,RC,53460,HCPCS,OUTPATIENT,,,1029,823.2,,337.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",337.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",731,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",337.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",337.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",337.37,731,
"DILATE URETHRA STRICT MALE INT",5915840,"CDM ",960,RC,53600,HCPCS,OUTPATIENT,,,191.5,153.2,,71.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",142,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",71.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",71.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.63,142,
"DILATE URETHRA STRICT MALE SQ",5915845,"CDM ",960,RC,53601,HCPCS,OUTPATIENT,,,182.5,146,,67.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",134,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",67.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",67.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.53,134,
"DILATE URETHRA STRCT/VES MALE",5915850,"CDM ",960,RC,53605,HCPCS,OUTPATIENT,,,149.5,119.6,,53.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",107,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",53.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",53.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.66,107,
"DILATE URETHRA FLFRM MALE INT",5915855,"CDM ",960,RC,53620,HCPCS,OUTPATIENT,,,263.5,210.8,,108.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",216,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",108.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",108.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.75,216,
"DILATE URETHRA FLFRM MALE SQ",5915860,"CDM ",960,RC,53621,HCPCS,OUTPATIENT,,,246,196.8,,102.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",203,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",102.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",102.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.24,203,
"DILATE URETHRA FEMALE INITIAL",5915865,"CDM ",960,RC,53660,HCPCS,OUTPATIENT,,,158.5,126.8,,59.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",119,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",59.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",59.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.68,119,
"DILATE URETHRA FEMALE SUBSQ",5915870,"CDM ",960,RC,53661,HCPCS,OUTPATIENT,,,156,124.8,,59.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",119,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",59.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",59.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.72,119,
"DILATE URETHRA FML GEN ANSTH",5915875,"CDM ",960,RC,53665,HCPCS,OUTPATIENT,,,90,72,,32.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",64,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",32.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.19,64,
"URINARY SYSTEM PROCEDURE",5915880,"CDM ",960,RC,53899,HCPCS,OUTPATIENT,,,196,156.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",166.6,85,,133.28,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",166.6,166.6,
"SLITTING PREPUCE NEWBORN",5915885,"CDM ",960,RC,54000,HCPCS,OUTPATIENT,,,239.5,191.6,,131.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",262,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",131.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",131.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.66,262,
"SLITTING PREPUCE",5915890,"CDM ",960,RC,54001,HCPCS,OUTPATIENT,,,413,330.4,,160.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",160.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",319,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",160.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",160.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",160.49,319,
"DRAIN PENIS LESION",5915895,"CDM ",960,RC,54015,HCPCS,OUTPATIENT,,,1255.5,1004.4,,246.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",246.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",496,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",246.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",246.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",246.5,496,
"LESION PENIS SIMPLE CHEMICAL",5915900,"CDM ",960,RC,54050,HCPCS,OUTPATIENT,,,293,234.4,,86.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",183,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",86.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",86.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.71,183,
"LESION PENIS  SIMPLE ELECTRODE",5915905,"CDM ",960,RC,54055,HCPCS,OUTPATIENT,,,263.5,210.8,,83.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",175,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",83.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",83.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.6,175,
"LESION PENIS SIMPLE CRYO",5915910,"CDM ",960,RC,54056,HCPCS,OUTPATIENT,,,323.5,258.8,,87.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",191,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",87.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",87.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8,191,
"EXC PENILE LESION",5915915,"CDM ",960,RC,54060,HCPCS,OUTPATIENT,,,293,234.4,,149.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",297,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",149.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",149.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.64,297,
"LESION PENIS EXTENSIVE",5915920,"CDM ",960,RC,54065,HCPCS,OUTPATIENT,,,490.5,392.4,,152.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",313,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",152.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",152.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.07,313,
"BIOPSY PENIS",5915925,"CDM ",960,RC,54100,HCPCS,OUTPATIENT,,,478.5,382.8,,139.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,4146.30,4146.30,4146.30,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",285,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",139.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",139.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.72,285,
"REMOVE FB DEEP PENILE TISSUE",5915930,"CDM ",960,RC,54115,HCPCS,OUTPATIENT,,,1017.5,814,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",713,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",713,713,
"CIRCUMCISION CLAMP/OTH DEVICE",5915935,"CDM ",960,RC,54150,HCPCS,OUTPATIENT,,,418.5,334.8,,181.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,124.77,124.77,124.77,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",181.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",360,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",181.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",181.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",181.08,360,
"CIRCUMCISION < 28DAYS",5915940,"CDM ",960,RC,54160,HCPCS,OUTPATIENT,,,640,512,,197.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",197.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",391,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",197.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",197.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",197.05,391,
"CIRCUMCISION >28 DAYS",5915945,"CDM ",960,RC,54161,HCPCS,OUTPATIENT,,,640,512,,177.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1725.50,1725.50,1725.50,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",315,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",177.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",177.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.21,315,
"EXC LYSIS PENILE POST CIRC ADH",5915950,"CDM ",960,RC,54162,HCPCS,OUTPATIENT,,,455,364,,227.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",453,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",227.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",227.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.97,453,
"CIRCUMCISION REPAIR",5915955,"CDM ",960,RC,54163,HCPCS,OUTPATIENT,,,494.5,395.6,,154.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",344,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",154.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",154.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154.73,344,
"FRENULOTOMY OF PENIS",5915960,"CDM ",960,RC,54164,HCPCS,OUTPATIENT,,,568,454.4,,133.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",303,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",133.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",133.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.61,303,
"IRRIGATION CORPORA VACERNOSA",5915965,"CDM ",960,RC,54220,HCPCS,OUTPATIENT,,,311.5,249.2,,186.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",186.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",370,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",186.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",186.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",186.41,370,
"INJ PENIS CORPORA CAVERNOSA",5915970,"CDM ",960,RC,54235,HCPCS,OUTPATIENT,,,203.5,162.8,,65.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",142,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",65.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",65.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.8,142,
"RPR PENIS STRAIGHTEN CORDEE",5915975,"CDM ",960,RC,54300,HCPCS,OUTPATIENT,,,1420,1136,,498.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",498.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1039,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",498.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",498.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",498.46,1039,
"RPR PENIS CORRECT CORDEE/HYPO",5915980,"CDM ",960,RC,54304,HCPCS,OUTPATIENT,,,1701.5,1361.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1219,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1219,1219,
"INSERT MULTICOMP PENILE IMPNT",5915985,"CDM ",960,RC,54405,HCPCS,OUTPATIENT,,,1895.5,1516.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1651,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1651,1651,
"CORPORA CAV/SAPH VEIN SHUNT",5915990,"CDM ",960,RC,54420,HCPCS,OUTPATIENT,,,1598.5,1278.8,,531.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",531.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1137,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",531.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",531.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",531.39,1137,
"PREPUTIAL ADHESION STRETCHING",5915995,"CDM ",960,RC,54450,HCPCS,OUTPATIENT,,,209.5,167.6,,63.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",126,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",63.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",63.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.32,126,
"EXC EXTRAPARENCH LESION TESTIS",5916000,"CDM ",960,RC,54512,HCPCS,OUTPATIENT,,,1219,975.2,,399.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",399.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",858,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",399.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",399.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",399.07,858,
"ORCHIECTOMY SIMPLE",5916005,"CDM ",960,RC,54520,HCPCS,OUTPATIENT,,,751.5,601.2,,252.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",252.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",600,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",252.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",252.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",252.74,600,
"ORCHIECTOMY RADICAL INGUINAL",5916010,"CDM ",960,RC,54530,HCPCS,OUTPATIENT,,,1264.5,1011.6,,415.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",415.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",904,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",415.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",415.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",415.84,904,
"EXPLORE UNDESCENDED TESTIS",5916015,"CDM ",960,RC,54550,HCPCS,OUTPATIENT,,,1109.5,887.6,,363.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",363.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",781,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",363.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",363.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",363.23,781,
"REDUCE TESTIS TORSION",5916020,"CDM ",960,RC,54600,HCPCS,OUTPATIENT,,,1016.5,813.2,,329.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",799,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",329.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",722,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",329.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",329.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",329.99,799,
"FIXATION CONTRALATERAL TESTIS",5916025,"CDM ",960,RC,54620,HCPCS,OUTPATIENT,,,687.5,550,,229.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",229.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",485,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",229.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",229.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",229.73,485,
"ORCHIOPEXY INGUINAL APPROACH",5916030,"CDM ",960,RC,54640,HCPCS,OUTPATIENT,,,1076.5,861.2,,349.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",349.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",838,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",349.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",349.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",349.68,838,
"LAC REPAIR TESTICULAR INJURY",5916035,"CDM ",960,RC,54670,HCPCS,OUTPATIENT,,,919.5,735.6,,308.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",308.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",644,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",308.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",308.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",308.28,644,
"I&D EPIDIDY/TESTIS/SCROT SPACE",5916040,"CDM ",960,RC,54700,HCPCS,OUTPATIENT,,,483,386.4,,167.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",336,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",167.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",167.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.61,336,
"EXC EPIDIDYMIS LESION",5916045,"CDM ",960,RC,54830,HCPCS,OUTPATIENT,,,867,693.6,,261.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",548.82,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",261.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",586,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",261.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",261.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",261.77,586,
"EXCISION SPERMATOCELE",5916050,"CDM ",960,RC,54840,HCPCS,OUTPATIENT,,,3407.5,2726,,248.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",248.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",571,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",248.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",248.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",248.57,571,
"PUNCT ASP HYDROCELE TUNICA VAG",5916055,"CDM ",960,RC,55000,HCPCS,OUTPATIENT,,,186,148.8,,104.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",208,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",104.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",104.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.7,208,
"EXC HYDROCELE UNILATERAL",5916060,"CDM ",960,RC,55040,HCPCS,OUTPATIENT,,,747.5,598,,258.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",258.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",586,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",258.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",258.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",258.29,586,
"EXC HYDROCELE BILATERAL",5916065,"CDM ",960,RC,55041,HCPCS,OUTPATIENT,,,1127,901.6,,366.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",366.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",870,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",366.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",366.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",366.62,870,
"DRAIN SCROTUM ABSCESS",5916070,"CDM ",960,RC,55100,HCPCS,OUTPATIENT,,,687.5,550,,172.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",343,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",172.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",172.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.59,343,
"RESECTION SCROTOM",5916075,"CDM ",960,RC,55150,HCPCS,OUTPATIENT,,,1142.5,914,,345.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",345.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",772,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",345.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",345.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",345.75,772,
"VASECTOMY INCISION SPERM DUCT",5916080,"CDM ",960,RC,55200,HCPCS,OUTPATIENT,,,1016.5,813.2,,481.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",481.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",957,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",481.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",481.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",481.9,957,
"VASECTOMY UNI/BILATERAL",5916085,"CDM ",960,RC,55250,HCPCS,OUTPATIENT,,,944,755.2,,427.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",442.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",427.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",848,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",427.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",427.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",427.01,848,
"EXC HYDROCELE SPERM CORD UNI",5916090,"CDM ",960,RC,55500,HCPCS,OUTPATIENT,,,897,717.6,,273.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",593,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",273.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",273.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.49,593,
"EXC LESION SPERMATIC CORD",5916095,"CDM ",960,RC,55520,HCPCS,OUTPATIENT,,,1000.5,800.4,,296.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",634,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",296.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",296.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.3,634,
"EXC SPERMATIC CORD VEINS",5916100,"CDM ",960,RC,55530,HCPCS,OUTPATIENT,,,807.5,646,,271.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",660.03,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",271.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",622,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",271.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",271.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",271.22,660.03,
"EXC SPERM VEIN W/HERNIA RPR",5916105,"CDM ",960,RC,55540,HCPCS,OUTPATIENT,,,1213,970.4,,367.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",367.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",754,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",367.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",367.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",367.44,754,
"BIOPSY PROSTATE ANY APPROACH",5916115,"CDM ",960,RC,55705,HCPCS,OUTPATIENT,,,695,556,,214.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",449,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",214.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",214.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.34,449,
"BX PROSTATE NDL SMPL W/IMAGE",5916120,"CDM ",960,RC,55706,HCPCS,OUTPATIENT,,,845.5,676.4,,256.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",256.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",609,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",256.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",256.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",256.24,609,
"DRAIN PROSTATE ABSCESS SIMPLE",5916125,"CDM ",960,RC,55720,HCPCS,OUTPATIENT,,,1211.5,969.2,,367.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",367.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",737,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",367.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",367.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",367.27,737,
"DRAIN PROSTATE ABSCESS CMPLX",5916130,"CDM ",960,RC,55725,HCPCS,OUTPATIENT,,,1514,1211.2,,412.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",412.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",938,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",412.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",412.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",412.84,938,
"REMOVE PROSTATE PERIN SUBTTL",5916135,"CDM ",960,RC,55801,HCPCS,OUTPATIENT,,,2807,2245.6,,800.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",800.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1750,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",800.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",800.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",800.27,1750,
"REMOVE PROSTATE PERIN RADICAL",5916140,"CDM ",960,RC,55810,HCPCS,OUTPATIENT,,,3415,2732,,993.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",993.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2289,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",993.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",993.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",993.37,2289,
"REMOVE PROSTATE W/LYMPH BX",5916145,"CDM ",960,RC,55812,HCPCS,OUTPATIENT,,,4120,3296,,1214.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1214.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2605,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1214.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1214.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1214.58,2605,
"REMOVE PROSTATE W/BILAT LYMPH",5916150,"CDM ",960,RC,55815,HCPCS,OUTPATIENT,,,4583.5,3666.8,,1334.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1334.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",3148,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1334.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1334.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1334.99,3148,
"REMOVE PROSTATE SUPRAPUBIC 1/2",5916155,"CDM ",960,RC,55821,HCPCS,OUTPATIENT,,,2269.5,1815.6,,642.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",642.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1584,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",642.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",642.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",642.4,1584,
"REMOVE PROSTATE RETROPUBIC SUB",5916160,"CDM ",960,RC,55831,HCPCS,OUTPATIENT,,,2457.5,1966,,700,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",700,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1715,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",700,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",700,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7,1715,
"REMOVE PROSTATE RETROPUB RAD",5916165,"CDM ",960,RC,55840,HCPCS,OUTPATIENT,,,3475,2780,,1006.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1006.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2215,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1006.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1006.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1006.46,2215,
"REMOVE PROSTATE RAD W/LYMPH BX",5916170,"CDM ",960,RC,55842,HCPCS,OUTPATIENT,,,3723.5,2978.8,,1077.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1077.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2461,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1077.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1077.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1077.3,2461,
"RMV PROSATE RAD W/BILAT LYMPH",5916175,"CDM ",960,RC,55845,HCPCS,OUTPATIENT,,,3501,2800.8,,1245.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2793.47,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1245.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",3041,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1245.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1245.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1245.48,3041,
"EXPOSE PROSTATE INSRT RADIOACT",5916180,"CDM ",960,RC,55860,HCPCS,OUTPATIENT,,,2266,1812.8,,665.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",665.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1412,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",665.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",665.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",665.62,1412,
"LAP RADICAL PROSTATECTOMY",5916185,"CDM ",960,RC,55866,HCPCS,OUTPATIENT,,,4518.5,3614.8,,1339.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1339.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2818,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1339.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1339.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1339.1,2818,
"CRYOABLATE PROSTATE",5916190,"CDM ",960,RC,55873,HCPCS,OUTPATIENT,,,10698.5,8558.8,,890.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",890.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",9209,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",890.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",890.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",890.78,9209,
"TRANSPERI NEEDLE PLACE PROS",5916195,"CDM ",960,RC,55875,HCPCS,OUTPATIENT,,,1976.5,1581.2,,578.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",578.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1223,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",578.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",578.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",578.78,1223,
"PLACE RT DEVICE/MARKER PROS",5916200,"CDM ",960,RC,55876,HCPCS,OUTPATIENT,,,366.5,293.2,,111.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",222,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",111.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",111.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.29,222,
"GENITAL SURGERY MALE",5916205,"CDM ",960,RC,55899,HCPCS,OUTPATIENT,,,807.5,646,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",686.38,85,,549.10,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",686.38,686.38,
"BIOPSY THYROID",5916210,"CDM ",960,RC,60100,HCPCS,OUTPATIENT,,,330.5,264.4,,90.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",179,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",90.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",90.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9,179,
"EXC THYROID LESION",5916215,"CDM ",960,RC,60200,HCPCS,OUTPATIENT,,,1466,1172.8,,488.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",488.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",971,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",488.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",488.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",488.98,971,
"PRT THYROID EXC UNI W/WO ISTHM",5916220,"CDM ",960,RC,60210,HCPCS,OUTPATIENT,,,1614.5,1291.6,,525.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",525.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1156,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",525.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",525.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",525.85,1156,
"PRT THYROID EXCISION",5916225,"CDM ",960,RC,60212,HCPCS,OUTPATIENT,,,2391.5,1913.2,,760.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",760.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1511,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",760.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",760.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",760.43,1511,
"PARTIAL REMOVAL THYROID",5916230,"CDM ",960,RC,60220,HCPCS,OUTPATIENT,,,1939.5,1551.6,,574.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",574.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1141,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",574.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",574.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",574.1,1141,
"THYROIDECTOMY TOTAL COMPLETE",5916235,"CDM ",960,RC,60240,HCPCS,OUTPATIENT,,,2599.5,2079.6,,756.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",756.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1556,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",756.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,5359.46,5359.46,5359.46,"1 through 10",other,"not separately reimbursment ",756.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",756.85,1556,
"THYROIDECTOMY REPEAT SURGERY",5916240,"CDM ",960,RC,60260,HCPCS,OUTPATIENT,,,2505.5,2004.4,,832.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",832.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1654,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",832.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",832.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",832.29,1654,
"THYROID LOBECTOMY CERVICAL",5916245,"CDM ",960,RC,60271,HCPCS,OUTPATIENT,,,2442,1953.6,,805.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",805.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1601,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",805.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",805.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",805.9,1601,
"REMOVE THYROID DUCT LESION",5916250,"CDM ",960,RC,60281,HCPCS,OUTPATIENT,,,1026.5,821.2,,446.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",446.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",887,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",446.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",446.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",446.39,887,
"EXPLORE PARATHYROID GLAND",5916255,"CDM ",960,RC,60500,HCPCS,OUTPATIENT,,,2195,1756,,760.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",760.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1630,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",760.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",760.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",760.62,1630,
"SCAN PROC CRANIAL EXTRA",5916260,"CDM ",960,RC,61782,HCPCS,OUTPATIENT,,,409.5,327.6,,89.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",89.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",272,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",89.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",89.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",89.92,272,
"SCAN PROC SPINAL",5916261,"CDM ",960,RC,61783,HCPCS,OUTPATIENT,,,540,432,,95.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",331,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",95.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",95.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.28,331,
"SPINAL FLUID TAP",5916265,"CDM ",960,RC,62270,HCPCS,OUTPATIENT,,,290.5,232.4,,120.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,109.05,109.05,109.05,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",239,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",120.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",120.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.29,239,
"INJ INTERLAMINAR LUMBAR/SACRAL",5916270,"CDM ",960,RC,62322,HCPCS,OUTPATIENT,,,353,282.4,,55.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",213,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",55.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,69.97,69.97,69.97,"1 through 10",other,"not separately reimbursment ",55.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.77,213,
"INJ INTRL LUMB/SAC W/IMAGE",5916273,"CDM ",960,RC,62323,HCPCS,OUTPATIENT,,,259,207.2,,63.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",344,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",63.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",63.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.8,344,
"REMOVE SPINAL CATH",5916275,"CDM ",960,RC,62355,HCPCS,OUTPATIENT,,,592.5,474,,290.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",290.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",583,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",290.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",290.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",290.87,583,
"INJ SUPRASCAPULAR NERVE",5916280,"CDM ",960,RC,64418,HCPCS,OUTPATIENT,,,317.5,254,,115.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",230,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",115.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",115.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.81,230,
"INJ ILIOINGUINAL/HYPOGAS NERVE",5916285,"CDM ",960,RC,64425,HCPCS,OUTPATIENT,,,269.5,215.6,,103.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",206,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",103.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",103.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.63,206,
"INJ PERIPHERAL NERVE",5916290,"CDM ",960,RC,64450,HCPCS,OUTPATIENT,,,180,144,,77.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",153,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",77.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",77.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.19,153,
"INJ SACROILIAC JNT W/IMAGE",5916292,"CDM ",960,RC,64451,HCPCS,OUTPATIENT,,,178,142.4,,50.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",50.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.78,50.78,
"INJ PLANTAR DIGIT NERVE",5916295,"CDM ",960,RC,64555,HCPCS,OUTPATIENT,,,102,81.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2125,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2125,2125,
"INJ PLANTAR DIGIT NERVE",5916295,"CDM ",960,RC,64455,HCPCS,OUTPATIENT,,,102,81.6,,25.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",75,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",25.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",25.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.32,75,
"INJ PARAVERT CERV/THOR W/IM 2",5916297,"CDM ",960,RC,64491,HCPCS,OUTPATIENT,,,213,170.4,,23.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",134,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.8,134,
"INJ PARAVERT FAC LUMB/SAC W/IM",5916300,"CDM ",960,RC,64493,HCPCS,OUTPATIENT,,,383,306.4,,53.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",243,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",53.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",53.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.15,243,
"INJ CHEMODENERVE MSCL MIGRAINE",5916305,"CDM ",960,RC,64615,HCPCS,OUTPATIENT,,,322.5,258,,88.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,155.47,155.47,155.47,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",198,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",88.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",88.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.8,198,
"NEUROPLASTY HAND/FOOT",5916310,"CDM ",960,RC,64704,HCPCS,OUTPATIENT,,,719,575.2,,249.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",249.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",564,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",249.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",249.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",249.11,564,
"NEUROPLASTY PERIPHERAL NRV OPN",5916315,"CDM ",960,RC,64708,HCPCS,OUTPATIENT,,,1125,900,,348.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,290.52,290.52,290.52,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",348.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",772,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",348.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",348.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",348.67,772,
"REVISE SCIATIC NERVE OPEN",5916317,"CDM ",960,RC,64712,HCPCS,OUTPATIENT,,,1264.5,1011.6,,402.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",402.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",983,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",402.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",402.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",402.51,983,
"NEUROPLASTY ULNAR NERVE ELBOW",5916320,"CDM ",960,RC,64718,HCPCS,OUTPATIENT,,,1334,1067.2,,378.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",933.2,100,,564.33,564.33,564.33,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",378.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",824,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",378.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",378.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",378.12,933.2,
"NEUROPLASTT ULNAR NERVE WRIST",5916325,"CDM ",960,RC,64719,HCPCS,OUTPATIENT,,,879.5,703.6,,294.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",294.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",586,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",294.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",294.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",294.99,586,
"CARPAL TUNNEL SURGERY",5916330,"CDM ",960,RC,64721,HCPCS,OUTPATIENT,,,1144,915.2,,299.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,564.33,564.33,564.33,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",596,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",299.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",299.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.95,596,
"DECOMPRESSION NERVE",5916335,"CDM ",960,RC,64722,HCPCS,OUTPATIENT,,,793.5,634.8,,242.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",242.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",602,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",242.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",242.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",242.79,602,
"DECOMPRESS PLANTAR DGT NERVE",5916340,"CDM ",960,RC,64726,HCPCS,OUTPATIENT,,,604,483.2,,220.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",439,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",220.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",220.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.88,439,
"RPR DIGIT NERVE HAND/FOOT 1",5916345,"CDM ",960,RC,64831,HCPCS,OUTPATIENT,,,1517.5,1214,,524.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",524.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1042,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",524.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",524.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",524.72,1042,
"REMOVE FB EYE CONJUNCT SF",5916350,"CDM ",960,RC,65205,HCPCS,OUTPATIENT,,,99.5,79.6,,40.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",81,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",40.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",40.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.72,81,
"REMOVE FB EYE CONJUNCT EMBED",5916355,"CDM ",960,RC,65210,HCPCS,OUTPATIENT,,,131,104.8,,49.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",99,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",49.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",49.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.73,99,
"BIOPSY EXTERNAL EAR",5916360,"CDM ",960,RC,69100,HCPCS,OUTPATIENT,,,230,184,,73.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",146,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",73.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",73.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.43,146,
"EXC EXT EAR PARTIAL SIMPLE",5916365,"CDM ",960,RC,69110,HCPCS,OUTPATIENT,,,699.5,559.6,,301.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",301.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",643,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",301.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",301.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",301.57,643,
"REMOVE FB EXT EAR WO ANSTH",5916370,"CDM ",960,RC,69200,HCPCS,OUTPATIENT,,,278.5,222.8,,91.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",182,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",91.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",91.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.65,182,
"REMOVE FB EXT EAR W/GEN ANSTH",5916375,"CDM ",960,RC,69205,HCPCS,OUTPATIENT,,,234,187.2,,77.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",154,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",77.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",77.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.62,154,
"REMOVE IMPACTED CERUMEN UNI",5916380,"CDM ",960,RC,69209,HCPCS,OUTPATIENT,,,30.5,24.4,,7.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.72,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",17,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",7.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,13.40,8.04,18.75,"1 through 10",other,"not separately reimbursment ",7.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.51,17,
"REMOVE IMPACTED CERUMEN 1/BOTH",5916385,"CDM ",960,RC,69210,HCPCS,OUTPATIENT,,,115,92,,37.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",75,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,42.37,42.37,42.37,"1 through 10",other,"not separately reimbursment ",37.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.74,75,
"DEBRIDE MASTOIDECTOMY SIMPLE",5916390,"CDM ",960,RC,69220,HCPCS,OUTPATIENT,,,312.5,250,,93.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",189,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",93.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",93.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.2,189,
"DEBRIDE MASTOIDECTOMY COMPLEX",5916395,"CDM ",960,RC,69222,HCPCS,OUTPATIENT,,,500.5,400.4,,153.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",305,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",153.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",153.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.45,305,
"MICROSURGICAL TECHNIQUES",5916400,"CDM ",960,RC,69990,HCPCS,OUTPATIENT,,,457,365.6,,156.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2455.88,2455.88,2455.88,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",355,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",156.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",156.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.81,355,
"IM ADM THRU 18Y 1ST/ONLY  VAC",5916405,"CDM ",960,RC,90460,HCPCS,OUTPATIENT,,,35,28,,20.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.26,100,,89.51,89.51,89.51,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",33,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,28.20,14.10,42.30,"1 through 10",other,"not separately reimbursment ",20.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.26,33,
"IM ADM THRU 18Y EA ADDL VAC",5916410,"CDM ",960,RC,90461,HCPCS,OUTPATIENT,,,22,17.6,,,,,,,,0,"other ","not separately reimbursment ",12.95,100,,27.66,27.66,27.66,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",17,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,63.45,40.61,81.22,"1 through 10",other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.95,17,
"IM ADMIN 1 VACCINE",5916415,"CDM ",960,RC,90471,HCPCS,OUTPATIENT,,,35,28,,14.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.18,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",32,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",14.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,14.10,11.24,56.88,"1 through 10",other,"not separately reimbursment ",14.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.15,32,
"IM ADMIN EA ADDL VAC",5916420,"CDM ",960,RC,90472,HCPCS,OUTPATIENT,,,22,17.6,,14.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",11.94,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",17,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",14.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",14.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.94,17,
"IM ADMIN NASAL/ORAL 1ST VAC",5916425,"CDM ",960,RC,90473,HCPCS,OUTPATIENT,,,27,21.6,,14.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",34,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",14.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",14.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.15,34,
"IM ADMIN NASAL/ORAL EA ADDL",5916430,"CDM ",960,RC,90474,HCPCS,OUTPATIENT,,,27,21.6,,14.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",18,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",14.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",14.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.15,18,
"BCG VACCINE",5916435,"CDM ",960,RC,90586,HCPCS,OUTPATIENT,,,338.5,270.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",176,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176,176,
"BEXSERO MENING VAC 2 DOSE",5916440,"CDM ",960,RC,90620,HCPCS,OUTPATIENT,,,246,196.8,,165.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",165.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",165.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",165.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",165.75,165.75,
"HEPATITIS A VACCINE HAVRIX",5916445,"CDM ",960,RC,90632,HCPCS,OUTPATIENT,,,136,108.8,,66.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",136,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",66.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",66.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.28,136,
"HEPATITIS A VAC 2 DOSE HAVRIX",5916450,"CDM ",960,RC,90633,HCPCS,OUTPATIENT,,,71.5,57.2,,31.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,36.10,36.10,36.10,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",71.5,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",31.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,41.64,41.16,41.64,"1 through 10",other,"not separately reimbursment ",31.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.89,71.5,
PEDVAXHIB,5916455,"CDM ",960,RC,90647,HCPCS,OUTPATIENT,,,33,26.4,,26.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",32,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",26.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",26.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.12,32,
"HIB PRP-T VACCINE 4 DOSE",5916460,"CDM ",960,RC,90648,HCPCS,OUTPATIENT,,,56,44.8,,24.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,15.65,15.65,15.65,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",56,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,14.19,14.19,14.19,"1 through 10",other,"not separately reimbursment ",24.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.34,56,
"4VHPV VAC 3 DOSE GARDASIL",5916465,"CDM ",960,RC,90649,HCPCS,OUTPATIENT,,,82,65.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",82,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82,82,
"2VHPV VAC3 DOSE CERVARIX",5916470,"CDM ",960,RC,90650,HCPCS,OUTPATIENT,,,82,65.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",69.7,85,,55.76,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.7,69.7,
"9VHPV VAC 3 DOSE GARDASIL",5916475,"CDM ",960,RC,90651,HCPCS,OUTPATIENT,,,82,65.6,,204.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.00,78.00,78.00,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",204.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",204.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",204.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",204.87,204.87,
"INFLUENZA VAC FLUZONE 0.5ML",5916480,"CDM ",960,RC,90656,HCPCS,OUTPATIENT,,,42,33.6,,19.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",24,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,22.29,22.29,22.29,"1 through 10",other,"not separately reimbursment ",19.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.77,24,
"INFLUENZA VAC FLUZONE HD 0.5ML",5916485,"CDM ",960,RC,90662,HCPCS,OUTPATIENT,,,104,83.2,,65.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",88.4,85,,70.72,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",65.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",65.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",98.16,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",65.26,98.16,
"PNEUMONIA VAC PREVNAR 13",5916490,"CDM ",960,RC,90670,HCPCS,OUTPATIENT,,,305,244,,241.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",305,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",241.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",241.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.38,305,
"INFLUENZA RIV3 VAC FLUBLOK",5916495,"CDM ",960,RC,90673,HCPCS,OUTPATIENT,,,77.5,62,,40.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",40.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",98.16,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",40.61,98.16,
"ROTOVIRUS VAC ROTATEQ",5916500,"CDM ",960,RC,90680,HCPCS,OUTPATIENT,,,88.5,70.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",88.5,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.5,88.5,
"ROTAVIRUS VAC 2 DOSE ROTARIX",5916505,"CDM ",960,RC,90681,HCPCS,OUTPATIENT,,,234.5,187.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",199.33,85,,159.46,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,157.02,157.02,157.02,"1 through 10",other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",199.33,199.33,
"INFLUENZA VAC .25ML IIV4 SPLIT",5916515,"CDM ",960,RC,90685,HCPCS,OUTPATIENT,,,23,18.4,,21.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",21.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.13,21.13,
"KINRIX DTAP VACCINE",5916525,"CDM ",960,RC,90696,HCPCS,OUTPATIENT,,,109,87.2,,,,,,,,0,"other ","not separately reimbursment ",,,,74.79,74.79,74.79,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",92.65,85,,74.12,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,68.03,68.03,68.03,"1 through 10",other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.65,92.65,
"DTAP/IPV/HIB VAC  PENTACEL",5916530,"CDM ",960,RC,90698,HCPCS,OUTPATIENT,,,155,124,,,,,,,,0,"other ","not separately reimbursment ",,,,143.32,143.32,143.32,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",131.75,85,,105.40,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,125.27,122.90,127.63,"1 through 10",other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.75,131.75,
"DTAP VACCINE DAPTACEL",5916535,"CDM ",960,RC,90700,HCPCS,OUTPATIENT,,,59,47.2,,23.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,34.10,34.10,34.10,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",59,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,32.03,32.03,32.03,"1 through 10",other,"not separately reimbursment ",23.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.56,59,
"MMR VACCINE",5916540,"CDM ",960,RC,90707,HCPCS,OUTPATIENT,,,110,88,,70.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,105.00,105.00,105.00,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",110,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",70.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",70.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.92,110,
PROQUAD,5916545,"CDM ",960,RC,90710,HCPCS,OUTPATIENT,,,283,226.4,,133.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,270.50,270.50,270.50,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",240.55,85,,192.44,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",133.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,270.50,270.50,270.50,"1 through 10",other,"not separately reimbursment ",133.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.38,240.55,
IPOL,5916550,"CDM ",960,RC,90713,HCPCS,OUTPATIENT,,,35.5,28.4,,25.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",35.5,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",25.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",25.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.47,35.5,
TD,5916555,"CDM ",960,RC,90714,HCPCS,OUTPATIENT,,,35.5,28.4,,23.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",28,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.92,28,
"TDAP VACCINE BOOSTRIX",5916560,"CDM ",960,RC,90715,HCPCS,OUTPATIENT,,,87.5,70,,42.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",87.5,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",42.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,52.39,27.40,65.66,"1 through 10",other,"not separately reimbursment ",42.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.14,87.5,
"VARICELLA VIRUS VAC VARIVAX",5916565,"CDM ",960,RC,90716,HCPCS,OUTPATIENT,,,152,121.6,,122.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",152,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",122.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",122.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.02,152,
PEDIARIX,5916570,"CDM ",960,RC,90723,HCPCS,OUTPATIENT,,,147,117.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",147,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147,147,
"PNEUMONIA VAC PNEUMOVAX",5916575,"CDM ",960,RC,90732,HCPCS,OUTPATIENT,,,67.5,54,,94.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",67.5,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",94.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.5,94.51,
"MENINGOCOCCAL VAC MENACTRA",5916580,"CDM ",960,RC,90734,HCPCS,OUTPATIENT,,,223.5,178.8,,121.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,199.95,199.95,199.95,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",121.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",189.98,85,,151.98,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",121.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",121.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",121.63,189.98,
"HEPATITIS B VAC 3 DOSE ENGERIX",5916585,"CDM ",960,RC,90744,HCPCS,OUTPATIENT,,,37.5,30,,23.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",37.5,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.95,37.5,
"HEPATITIS B VAC ENGERIX",5916590,"CDM ",960,RC,90746,HCPCS,OUTPATIENT,,,85.5,68.4,,69.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",85.5,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",69.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",69.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.65,85.5,
"ZOSTER HZV VACCINE",5916595,"CDM ",960,RC,90750,HCPCS,OUTPATIENT,,,235.5,188.4,,140,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",140,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,140,
"HEART/LING RESUSCITATION CPR",5916610,"CDM ",960,RC,92950,HCPCS,OUTPATIENT,,,2174,1739.2,,241.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",481,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",241.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,163.23,163.23,163.23,"1 through 10",other,"not separately reimbursment ",241.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.98,481,
"EKG ROUTINE ECG 12 LEADS",5916620,"CDM ",960,RC,93000,HCPCS,OUTPATIENT,,,65.5,52.4,,24.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",52,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",24.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.16,52,
"US PENILE DOPPLER LIMITED",5916680,"CDM ",960,RC,93981,HCPCS,OUTPATIENT,,,161.5,129.2,,100.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",140.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",100.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",291,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",100.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",100.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",100.92,291,
"VENT MGMT INPAT INIT DAY",5916685,"CDM ",960,RC,94002,HCPCS,OUTPATIENT,,,196,156.8,,66.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",140,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",66.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",66.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.59,140,
"VENT MGMT INPAT SUBQ DAY",5916690,"CDM ",960,RC,94003,HCPCS,OUTPATIENT,,,153,122.4,,48.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",101,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",48.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",48.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.36,101,
"SPIROMETRY CAPACITY TESTING",5916695,"CDM ",960,RC,94010,HCPCS,OUTPATIENT,,,92.5,74,,25.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,31.00,31.00,31.00,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",65,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",25.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",25.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.12,65,
"BRONCHODILATION SPIRO PRE/POST",5916700,"CDM ",960,RC,94060,HCPCS,OUTPATIENT,,,155,124,,48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,447.51,447.51,447.51,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",101,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,310.57,264.74,356.40,"1 through 10",other,"not separately reimbursment ",48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4,101,
"MAX BREATHING CAPACITY VENT",5916705,"CDM ",960,RC,94200,HCPCS,OUTPATIENT,,,49.5,39.6,,16.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",38,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",16.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",16.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.3,38,
"INHALATION BREATHING TX",5916710,"CDM ",960,RC,94640,HCPCS,OUTPATIENT,,,60,48,,9.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.63,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",23,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",9.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,100.04,37.32,162.75,"1 through 10",other,"not separately reimbursment ",9.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.87,24.63,
"POS AIRWAY PRESSURE CPAP",5916715,"CDM ",960,RC,94660,HCPCS,OUTPATIENT,,,100.5,80.4,,,,,,,,0,"other ","not separately reimbursment ",,,,44.07,44.07,44.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",86,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86,86,
"INHALATION DEMONSTRATION",5916720,"CDM ",960,RC,94664,HCPCS,OUTPATIENT,,,40.5,32.4,,10.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,38.00,38.00,38.00,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",10.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,32.76,31.53,40.95,"1 through 10",other,"not separately reimbursment ",10.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.82,30,
"PULSE OX SATURATION SINGLE",5916725,"CDM ",960,RC,94760,HCPCS,OUTPATIENT,,,27.5,22,,1.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.79,15,
"ADMIN ALLERGEN SINGLE INJ",5916730,"CDM ",960,RC,95115,HCPCS,OUTPATIENT,,,21,16.8,,11.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.18,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",22,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",11.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",11.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.23,22,
"ADMIN ALLERGEN >2 INJ",5916735,"CDM ",960,RC,95117,HCPCS,OUTPATIENT,,,30.5,24.4,,14.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.94,100,,27.50,27.50,27.50,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",28,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",14.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",14.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.27,28,
"EMG 1 EXTEMITY",5916740,"CDM ",960,RC,95860,HCPCS,OUTPATIENT,,,270.5,216.4,,71.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",194,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",71.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",71.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7,194,
"EMG 2 EXTREMITIES",5916745,"CDM ",960,RC,95861,HCPCS,OUTPATIENT,,,379.5,303.6,,90.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",279,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",90.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",90.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.38,279,
"EMG 3 EXTREMITIES",5916750,"CDM ",960,RC,95863,HCPCS,OUTPATIENT,,,489,391.2,,110.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",333,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",110.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",110.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.34,333,
"EMG 4 EXTREMITITES",5916755,"CDM ",960,RC,95864,HCPCS,OUTPATIENT,,,546,436.8,,140.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",392,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",140.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",140.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.91,392,
"EMG LARYNX",5916760,"CDM ",960,RC,95865,HCPCS,OUTPATIENT,,,293,234.4,,91.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",216,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",91.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",91.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.98,216,
"EMG HEMIDIAPHRAGM",5916765,"CDM ",960,RC,95866,HCPCS,OUTPATIENT,,,266.5,213.2,,62.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",207,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",62.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",62.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.61,207,
"EMG CRANIAL NERVE UNILATERAL",5916770,"CDM ",960,RC,95867,HCPCS,OUTPATIENT,,,219,175.2,,52.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",175,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",52.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.16,175,
"EMG CRANIAL NERVE BILATERAL",5916775,"CDM ",960,RC,95868,HCPCS,OUTPATIENT,,,293,234.4,,72.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",246,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",72.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",72.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.85,246,
"EMG THOR PARASP EXCL T1/T12",5916780,"CDM ",960,RC,95869,HCPCS,OUTPATIENT,,,201.5,161.2,,22.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",128,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",22.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.78,128,
"EMG LIMITED NONPARASPINAL",5916785,"CDM ",960,RC,95870,HCPCS,OUTPATIENT,,,201.5,161.2,,22.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",134,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",22.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.78,134,
"EMG SINGLE FIBER ELECTRODE",5916790,"CDM ",960,RC,95872,HCPCS,OUTPATIENT,,,437.5,350,,84.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",287,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",84.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",84.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.16,287,
"EMG EA ADD FIBER ELECTRODE",5916795,"CDM ",960,RC,95885,HCPCS,OUTPATIENT,,,115,92,,23.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",82,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.91,82,
"EMG COMPLETE 5 OR MORE STUDIES",5916800,"CDM ",960,RC,95886,HCPCS,OUTPATIENT,,,183,146.4,,37.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",128,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",37.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.89,128,
"EMG NON EXTR W/NRV CONDUCT",5916805,"CDM ",960,RC,95887,HCPCS,OUTPATIENT,,,162,129.6,,33.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",113,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",33.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.66,113,
"NERVE CONDUCT EA EXT INTRP/RPT",5916810,"CDM ",960,RC,95905,HCPCS,OUTPATIENT,,,141.5,113.2,,38.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",105,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",38.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",38.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.94,105,
"NERVE CONDUCTION 1-2 STUDIES",5916815,"CDM ",960,RC,95907,HCPCS,OUTPATIENT,,,193.5,154.8,,56.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",128,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",56.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",56.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.55,128,
"NERVE CONDUCTION 3-4 STUDIES",5916820,"CDM ",960,RC,95908,HCPCS,OUTPATIENT,,,251,200.8,,69.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",171,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",69.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",69.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.79,171,
"NERVE CONDUCTION 5-6 STUDIES",5916825,"CDM ",960,RC,95909,HCPCS,OUTPATIENT,,,303.5,242.8,,83.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",189,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",83.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",83.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.64,189,
"NERVE CONDUCTION 7-8 STUDIES",5916830,"CDM ",960,RC,95910,HCPCS,OUTPATIENT,,,397.5,318,,110.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",270,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",110.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",110.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.13,270,
"NERVE CONDUCTION 9-10 STUDIES",5916835,"CDM ",960,RC,95911,HCPCS,OUTPATIENT,,,476,380.8,,133.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",332.34,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",302,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",133.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",133.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.47,332.34,
"NERVE CONDUCTION 11-12 STUDIES",5916840,"CDM ",960,RC,95912,HCPCS,OUTPATIENT,,,529,423.2,,156.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",355,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",156.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",156.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.4,355,
"NERVE CONDUCTION >13 STUDIES",5916845,"CDM ",960,RC,95913,HCPCS,OUTPATIENT,,,611.5,489.2,,184.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",184.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",411,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",184.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",184.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",184.4,411,
"DEVELOPMENT SCREENING LIMITED",5916850,"CDM ",960,RC,96110,HCPCS,OUTPATIENT,,,29,23.2,,31.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",113,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",31.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",31.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,113,
"IV 1ST HR HYDRATION",5916855,"CDM ",960,RC,96360,HCPCS,OUTPATIENT,,,96.5,77.2,,35.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",82,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",35.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,159.55,60.51,406.64,"1 through 10",other,"not separately reimbursment ",35.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.87,82,
"IV EA ADD HR HYDRATION",5916860,"CDM ",960,RC,96361,HCPCS,OUTPATIENT,,,80,64,,10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,9.14,9.14,9.14,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",24,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,131.39,93.88,240.22,16,other,"not separately reimbursment ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.32,24,
"IV 1ST HR THERAPEUTIC",5916865,"CDM ",960,RC,96365,HCPCS,OUTPATIENT,,,149.5,119.6,,43.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,41.74,41.74,41.74,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",100,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",43.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,309.11,152.46,396.95,"1 through 10",other,"not separately reimbursment ",43.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.6,100,
"IV EA ADD HR THERAPEUTIC",5916870,"CDM ",960,RC,96366,HCPCS,OUTPATIENT,,,80,64,,13.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",33,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",13.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,159.47,159.47,159.47,"1 through 10",other,"not separately reimbursment ",13.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.83,33,
"IV THERAPEUTIC SEQUENTIAL DRUG",5916875,"CDM ",960,RC,96367,HCPCS,OUTPATIENT,,,62,49.6,,21.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",51,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",21.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",21.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.33,51,
"THER/PROPH/DIAG INJ SQ/IM",5916880,"CDM ",960,RC,96372,HCPCS,OUTPATIENT,,,46,36.8,,14.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",32,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",14.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,30.52,12.55,82.65,16,other,"not separately reimbursment ",14.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.3,32,
"IV PUSH SINGLE/INITIAL",5916885,"CDM ",960,RC,96374,HCPCS,OUTPATIENT,,,96.5,77.2,,35.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",80,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",35.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,168.95,93.31,211.19,17,other,"not separately reimbursment ",35.17,100,,141.50,141.50,141.50,"1 through 10","fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.17,80,
"IV THERAP PUSH EA ADD NEW DRUG",5916890,"CDM ",960,RC,96375,HCPCS,OUTPATIENT,,,37.5,30,,19.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",35,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,142.80,44.18,287.15,13,other,"not separately reimbursment ",19.81,100,,44.79,44.79,44.79,"1 through 10","fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.81,35,
"IV THERAP PUSH SAME DRG ADDON",5916895,"CDM ",960,RC,96376,HCPCS,OUTPATIENT,,,35,28,,15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,44.21,44.21,44.21,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",29.75,85,,23.80,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,487.46,487.46,487.46,"1 through 10",other,"not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,29.75,
"INJ CHEMO ADM HORMONAL AGENT",5916900,"CDM ",960,RC,96402,HCPCS,OUTPATIENT,,,66.5,53.2,,26.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",68,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",26.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",26.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.66,68,
"IRRIGATE IMPLANT DRUG DEVICE",5916905,"CDM ",960,RC,96523,HCPCS,OUTPATIENT,,,52.5,42,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41,41,
"UNLISTED CHEMO PROCEDURE",5916910,"CDM ",960,RC,96549,HCPCS,OUTPATIENT,,,27.5,22,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",23.38,85,,18.70,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.38,23.38,
"US THERAPY MOIST HEAT EA 15MIN",5916915,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,26.5,21.2,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"THERAPEUTIC ACTIVITIES 15 MIN",5916920,"CDM ",960,RC,97530,HCPCS,OUTPATIENT,,,67.5,54,,22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,46,
"DEBRIDE WOUND <20 SQCM",5916925,"CDM ",960,RC,97597,HCPCS,OUTPATIENT,,,175,140,,37.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,266.92,266.92,266.92,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",100,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",37.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.63,100,
"DEBRIDE WOUND EA ADD 20SQCM",5916930,"CDM ",960,RC,97598,HCPCS,OUTPATIENT,,,149.5,119.6,,48.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",110,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",48.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",48.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.15,110,
"NEG PRESS WOUND TX <50SQCM",5916935,"CDM ",960,RC,97605,HCPCS,OUTPATIENT,,,65,52,,25.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",56,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",25.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",25.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.88,56,
"NEG PRESS WOUND TX >50SQCM",5916940,"CDM ",960,RC,97606,HCPCS,OUTPATIENT,,,110.5,88.4,,27.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",70,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",27.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",27.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.94,70,
"NEG PRESS WND <50CM SNAP VAC",5916945,"CDM ",960,RC,97607,HCPCS,OUTPATIENT,,,62.5,50,,25.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",25.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.88,25.88,
"NEG PRESS WND >50CM SNAP VAC",5916950,"CDM ",960,RC,97608,HCPCS,OUTPATIENT,,,110.5,88.4,,27.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",27.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.94,27.94,
"LOW FREQUENCY NONTHERMAL US",5916955,"CDM ",960,RC,97610,HCPCS,OUTPATIENT,,,26.5,21.2,,40,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",306,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",40,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",40,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4,306,
"OFFICE/OUTPATIENT NEW LEV 2",5917005,"CDM ",960,RC,99202,HCPCS,OUTPATIENT,,,130.5,104.4,,50.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",96,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",50.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,54.83,15.38,80.66,"1 through 10",other,"not separately reimbursment ",50.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.66,96,
"OFFICE/OUTPATIENT NEW LEV 3",5917010,"CDM ",960,RC,99203,HCPCS,OUTPATIENT,,,194.5,155.6,,75.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",139,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",75.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,69.36,34.13,104.06,20,other,"not separately reimbursment ",75.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.45,139,
"OFFICE/OUTPATIENT NEW LEV 4",5917015,"CDM ",960,RC,99204,HCPCS,OUTPATIENT,,,346,276.8,,107.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,154.69,154.69,154.69,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",107.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",214,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",107.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,135.17,78.68,154.59,15,other,"not separately reimbursment ",107.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",107.12,214,
"OFFICE/OUTPATIENT NEW LEV 5",5917020,"CDM ",960,RC,99205,HCPCS,OUTPATIENT,,,397.5,318,,136.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,264.13,264.13,264.13,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",266,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",136.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",136.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136.62,266,
"OFFICE/OUTPATIENT EST LEV 1",5917025,"CDM ",960,RC,99211,HCPCS,OUTPATIENT,,,46,36.8,,16.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",29,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",16.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,18.91,17.74,20.08,"1 through 10",other,"not separately reimbursment ",16.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.36,29,
"OFFICE/OUTPATIENT EST LEV 2",5917030,"CDM ",960,RC,99212,HCPCS,OUTPATIENT,,,80.5,64.4,,29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",56,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,41.53,8.11,48.11,20,other,"not separately reimbursment ",29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.76,56,
"OFFICE/OUTPATIENT EST LEV 3",5917035,"CDM ",960,RC,99213,HCPCS,OUTPATIENT,,,159.5,127.6,,40.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",51.95,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,74.27,70.21,78.33,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",93,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",40.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,63.68,29.60,79.60,44,other,"not separately reimbursment ",40.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.84,93,
"OFFICE/OUTPATIENT EST LEV 4",5917040,"CDM ",960,RC,99214,HCPCS,OUTPATIENT,,,192,153.6,,64.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",138,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",64.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,92.46,47.94,115.58,37,other,"not separately reimbursment ",64.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.22,138,
"OFFICE/OUTPATIENT EST LEV 5",5917045,"CDM ",960,RC,99215,HCPCS,OUTPATIENT,,,263,210.4,,94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",186,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,157.63,127.56,162.13,"1 through 10",other,"not separately reimbursment ",94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9,186,
"INITIAL HOSPITAL 30 MIN",5917070,"CDM ",960,RC,99221,HCPCS,OUTPATIENT,,,203.5,162.8,,54.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",137.15,100,,132.29,132.29,132.29,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",133,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",54.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,73.54,73.54,73.54,"1 through 10",other,"not separately reimbursment ",54.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.31,137.15,
"INITIAL HOSPITAL 50 MIN",5917075,"CDM ",960,RC,99222,HCPCS,OUTPATIENT,,,306.5,245.2,,90.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.28,100,,119.01,119.01,119.01,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",180,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",90.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,116.63,113.62,118.30,12,other,"not separately reimbursment ",90.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9,200.28,
"INITIAL HOSPITAL 70 MIN",5917080,"CDM ",960,RC,99223,HCPCS,OUTPATIENT,,,399.5,319.6,,125.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",272.55,100,,158.84,158.84,158.84,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",265,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",125.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,155.67,140.10,195.67,"1 through 10",other,"not separately reimbursment ",125.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.52,272.55,
"SUBSEQUENT INPT 15 MIN",5917100,"CDM ",960,RC,99231,HCPCS,OUTPATIENT,,,97,77.6,,27.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",62,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",27.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",27.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.18,62,
"SUBSEQUENT INPT 25 MIN",5917105,"CDM ",960,RC,99232,HCPCS,OUTPATIENT,,,178,142.4,,44.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.27,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",95,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,70.47,56.82,71.69,"1 through 10",other,"not separately reimbursment ",44.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.49,100.27,
"SUBSEQUENT INPT 35 MIN",5917110,"CDM ",960,RC,99233,HCPCS,OUTPATIENT,,,249.5,199.6,,63.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",141.16,100,,92.18,92.18,92.18,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",141,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",63.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,106.28,106.28,107.98,"1 through 10",other,"not separately reimbursment ",63.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.26,141.16,
"OBS/INPT ADMT/DC 40 MIN",5917115,"CDM ",960,RC,99234,HCPCS,OUTPATIENT,,,319,255.2,,82.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",189,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",82.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",82.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.14,189,
"OBS/INPT ADMT/DC 50 MIN",5917120,"CDM ",960,RC,99235,HCPCS,OUTPATIENT,,,377,301.6,,102.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",254.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",249,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",102.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",102.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.88,254.28,
"OBS/INPT ADMT/DC 55 MIN",5917125,"CDM ",960,RC,99236,HCPCS,OUTPATIENT,,,591.5,473.2,,132.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",319.41,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",311,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",132.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,112.10,52.82,171.38,"1 through 10",other,"not separately reimbursment ",132.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.85,319.41,
"HOSPITAL DISCHARGE < 30 MIN",5917130,"CDM ",960,RC,99238,HCPCS,OUTPATIENT,,,199,159.2,,56.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",107.49,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",98,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",56.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,67.59,62.60,72.58,"1 through 10",other,"not separately reimbursment ",56.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.34,107.49,
"HOSPITAL DISCHARGE >30 MIN",5917135,"CDM ",960,RC,99239,HCPCS,OUTPATIENT,,,252,201.6,,76.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",154.13,100,,89.14,89.14,89.14,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",141,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",76.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,102.78,93.99,103.17,13,other,"not separately reimbursment ",76.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.84,154.13,
"OFFICE/OUTPT CONSULT 30 MIN",5917145,"CDM ",960,RC,99242,HCPCS,OUTPATIENT,,,187,149.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",125,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125,125,
"OFFICE/OUTPT CONSULT 40 MIN",5917150,"CDM ",960,RC,99243,HCPCS,OUTPATIENT,,,237.5,190,,,,,,,,0,"other ","not separately reimbursment ",,,,125.31,125.31,125.31,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",177,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177,177,
"OFFICE/OUTPT CONSULT 60 MIN",5917155,"CDM ",960,RC,99244,HCPCS,OUTPATIENT,,,347,277.6,,,,,,,,0,"other ","not separately reimbursment ",136.06,100,,184.86,184.86,184.86,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",252,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136.06,252,
"OFFICE/OUTPT CONSULT 80 MIN",5917160,"CDM ",960,RC,99245,HCPCS,OUTPATIENT,,,374,299.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",309,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",309,309,
"INPATIENT CONSULT LEVEL 2",5917170,"CDM ",960,RC,99252,HCPCS,OUTPATIENT,,,198,158.4,,,,,,,,0,"other ","not separately reimbursment ",71.11,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",105,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.11,105,
"INPATIENT CONSULT LEVEL 3",5917175,"CDM ",960,RC,99253,HCPCS,OUTPATIENT,,,274.5,219.6,,,,,,,,0,"other ","not separately reimbursment ",97.69,100,,112.19,112.19,112.19,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",159,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.69,159,
"INPATIENT CONSULT LEVEL 4",5917180,"CDM ",960,RC,99254,HCPCS,OUTPATIENT,,,397.5,318,,,,,,,,0,"other ","not separately reimbursment ",,,,142.11,142.11,142.11,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",230,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",230,230,
"INPATIENT CONSULT LEVEL 5",5917185,"CDM ",960,RC,99255,HCPCS,OUTPATIENT,,,424.5,339.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",280,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",280,280,
"EMERGENCY DEPT VISIT 1",5917190,"CDM ",960,RC,99281,HCPCS,OUTPATIENT,,,44,35.2,,37.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,17.14,17.14,17.14,"1 through 10",other,"not separately reimbursment ",37.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30,37.14,
"EMERGENCY DEPT VISIT 2",5917195,"CDM ",960,RC,99282,HCPCS,OUTPATIENT,,,156,124.8,,37.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,356.16,356.16,356.16,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",58,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.23,32.69,256.09,"1 through 10",other,"not separately reimbursment ",37.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.14,58,
"EMERGENCY DEPT VISIT 3",5917200,"CDM ",960,RC,99283,HCPCS,OUTPATIENT,,,209.5,167.6,,37.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",120.45,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,301.39,301.39,301.39,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",91,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,569.33,146.28,782.15,22,other,"not separately reimbursment ",37.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.14,120.45,
"EMERGENCY DEPT VISIT 4",5917205,"CDM ",960,RC,99284,HCPCS,OUTPATIENT,,,335.5,268.4,,90.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.18,100,,413.32,413.32,413.32,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",168,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",90.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1040.95,353.74,1239.17,16,other,"not separately reimbursment ",90.35,100,,413.32,413.32,413.32,"1 through 10","fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.35,198.18,
"EMERGENCY DEPT VISIT 5",5917210,"CDM ",960,RC,99285,HCPCS,OUTPATIENT,,,430.5,344.4,,90.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,569.48,569.48,569.48,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",249,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",90.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1561.47,554.84,2094.62,"1 through 10",other,"not separately reimbursment ",90.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.35,249,
"CRITICAL CARE FIRST HOUR",5917215,"CDM ",960,RC,99291,HCPCS,OUTPATIENT,,,849,679.2,,165.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",326.6,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",165.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",358,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",165.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,190.97,190.97,190.97,"1 through 10",other,"not separately reimbursment ",165.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",165.4,358,
"CRITICAL CARE EA ADD 30 MIN",5917220,"CDM ",960,RC,99292,HCPCS,OUTPATIENT,,,425,340,,74.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",161,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",74.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,95.60,95.60,95.60,"1 through 10",other,"not separately reimbursment ",74.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.48,161,
"INITIAL NURSING FAC 25 MIN",5917225,"CDM ",960,RC,99304,HCPCS,OUTPATIENT,,,188.5,150.8,,52.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",121,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",52.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.44,121,
"INITIAL NURSING FAC 35 MIN",5917230,"CDM ",960,RC,99305,HCPCS,OUTPATIENT,,,205.5,164.4,,69.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,24.41,24.41,24.41,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",171,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",69.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",69.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.67,171,
"INITIAL NURSING FAC 50 MIN",5917235,"CDM ",960,RC,99306,HCPCS,OUTPATIENT,,,277.5,222,,86.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",223.61,100,,136.88,136.88,136.88,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",218,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",86.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",86.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8,223.61,
"SUBSEQUENT NURSING FAC 10 MIN",5917240,"CDM ",960,RC,99307,HCPCS,OUTPATIENT,,,91.5,73.2,,27.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",57,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",27.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",27.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,57,
"SUBSEQUENT NURSING FAC 20 MIN",5917245,"CDM ",960,RC,99308,HCPCS,OUTPATIENT,,,113.5,90.8,,44.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.83,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",89,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",44.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.81,100.83,
"SUBSEQUENT NURSING FAC 25 MIN",5917250,"CDM ",960,RC,99309,HCPCS,OUTPATIENT,,,194.5,155.6,,63.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",139.64,100,,19.73,19.73,19.73,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",117,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",63.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",63.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.19,139.64,
"SUBSEQUENT NURSING FAC 35 MIN",5917255,"CDM ",960,RC,99310,HCPCS,OUTPATIENT,,,199,159.2,,79.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",186.5,100,,110.66,110.66,110.66,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",174,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",79.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",79.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7,186.5,
"NURSING FAC DISCHARGE 30 MIN",5917260,"CDM ",960,RC,99315,HCPCS,OUTPATIENT,,,140.5,112.4,,,,,,,,0,"other ","not separately reimbursment ",,,,91.25,91.25,91.25,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",94,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94,94,
"NURSING FAC DISCHARGE >30 MIN",5917265,"CDM ",960,RC,99316,HCPCS,OUTPATIENT,,,180,144,,,,,,,,0,"other ","not separately reimbursment ",143.11,100,,159.57,159.57,159.57,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",135,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135,143.11,
"NURSING HOME VISIT EST 40 MIN",5917310,"CDM ",960,RC,99336,HCPCS,OUTPATIENT,,,274.5,219.6,,88.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",174,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",88.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",88.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.28,174,
"PROLONG SRV WO CONTACT 1ST HR",5917340,"CDM ",960,RC,99358,HCPCS,OUTPATIENT,,,111,88.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",145,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",145,145,
"PROLONG WO CNTCT EA ADD 30MIN",5917345,"CDM ",960,RC,99359,HCPCS,OUTPATIENT,,,55.5,44.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",70,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70,70,
"STANDBY SERVICE EA 30 MIN",5917350,"CDM ",960,RC,99360,HCPCS,OUTPATIENT,,,122.5,98,,35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",82,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3,82,
"PREVENTIVE MED UNDER 1YR NEW",5917355,"CDM ",960,RC,99381,HCPCS,OUTPATIENT,,,217.5,174,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",143,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,118.16,118.16,118.16,"1 through 10",other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",143,143,
"PREVENTIVE MED 1-4YRS NEW",5917360,"CDM ",960,RC,99382,HCPCS,OUTPATIENT,,,211.5,169.2,,,,,,,,0,"other ","not separately reimbursment ",,,,125.75,125.75,125.75,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",151,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,123.88,123.88,123.88,"1 through 10",other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151,151,
"PREVENTIVE MED 5-11YRS NEW",5917365,"CDM ",960,RC,99383,HCPCS,OUTPATIENT,,,234.5,187.6,,,,,,,,0,"other ","not separately reimbursment ",,,,103.96,103.96,103.96,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",155,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155,155,
"PREVENTIVE MED 12-17YRS NEW",5917370,"CDM ",960,RC,99384,HCPCS,OUTPATIENT,,,269,215.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",175,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,146.35,146.35,146.35,"1 through 10",other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",175,175,
"PREVENTIVE MED 18-39YRS NEW",5917375,"CDM ",960,RC,99385,HCPCS,OUTPATIENT,,,269,215.2,,30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",171,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,141.78,141.78,141.78,"1 through 10",other,"not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3,171,
"PREVENTIVE MED 40-64YRS NEW",5917380,"CDM ",960,RC,99386,HCPCS,OUTPATIENT,,,269,215.2,,30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,217.42,217.42,217.42,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",198,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,164.26,164.26,164.26,"1 through 10",other,"not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3,198,
"PREVENTIVE MED > 65YRS NEW",5917385,"CDM ",960,RC,99387,HCPCS,OUTPATIENT,,,269,215.2,,30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,222.63,222.63,222.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",215,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3,215,
"PREVENTIVE MED <1YR EST",5917390,"CDM ",960,RC,99391,HCPCS,OUTPATIENT,,,194.5,155.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",127,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,106.86,106.86,106.86,"1 through 10",other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127,127,
"PREVENTIVE MED 1-4YRS EST",5917395,"CDM ",960,RC,99392,HCPCS,OUTPATIENT,,,194.5,155.6,,,,,,,,0,"other ","not separately reimbursment ",,,,147.08,147.08,147.08,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",137,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,113.73,113.73,113.73,"1 through 10",other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",137,137,
"PREVENTIVE MED 5-11YRS EST",5917400,"CDM ",960,RC,99393,HCPCS,OUTPATIENT,,,194.5,155.6,,,,,,,,0,"other ","not separately reimbursment ",,,,145.09,145.09,145.09,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",136,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,113.36,113.36,113.36,"1 through 10",other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136,136,
"PREVENTIVE MED 12-17YRS EST",5917405,"CDM ",960,RC,99394,HCPCS,OUTPATIENT,,,234.5,187.6,,,,,,,,0,"other ","not separately reimbursment ",,,,119.82,119.82,119.82,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",149,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149,149,
"PREVENTIVE MED 18-39YRS EST",5917410,"CDM ",960,RC,99395,HCPCS,OUTPATIENT,,,269,215.2,,17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,192.41,192.41,192.41,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",152,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,127.82,127.82,127.82,"1 through 10",other,"not separately reimbursment ",17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,152,
"PREVENTIVE MED 40-64YRS EST",5917415,"CDM ",960,RC,99396,HCPCS,OUTPATIENT,,,269,215.2,,17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,207.96,207.96,207.96,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",163,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,136.20,132.09,136.20,"1 through 10",other,"not separately reimbursment ",17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,163,
"PREVENTIVE MED >65YRS EST",5917420,"CDM ",960,RC,99397,HCPCS,OUTPATIENT,,,269,215.2,,17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,184.37,184.37,184.37,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",176,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,135.47,126.77,144.17,"1 through 10",other,"not separately reimbursment ",17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,176,
"SMOKING CESSATION 3-10 MIN",5917425,"CDM ",960,RC,99406,HCPCS,OUTPATIENT,,,30.5,24.4,,9.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",21,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",9.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,13.42,11.12,15.72,"1 through 10",other,"not separately reimbursment ",9.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9,21,
"ALCOHOL/SUBST ABUSE SCREEN",5917430,"CDM ",960,RC,99408,HCPCS,OUTPATIENT,,,71.5,57.2,,24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1093,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,1093,
"ALCOHOL/SUBST ABUSE SCREEN",5917430,"CDM ",960,RC,99408,HCPCS,OUTPATIENT,,,71.5,57.2,,24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1093,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,1093,
"PHONE/INTRNT/EHR CONS 5-10 MIN",5917465,"CDM ",960,RC,99446,HCPCS,OUTPATIENT,,,46,36.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",25,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25,25,
"PHONE/INTRNT/EHR CONS 11-20MIN",5917470,"CDM ",960,RC,99447,HCPCS,OUTPATIENT,,,80.5,64.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",49,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49,49,
"PHONE/INTRNT/EHR CONS 21-30MIN",5917475,"CDM ",960,RC,99448,HCPCS,OUTPATIENT,,,129.5,103.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",74,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74,74,
"PHONE/INTRNT/EHR CONS >30 MIN",5917480,"CDM ",960,RC,99449,HCPCS,OUTPATIENT,,,192,153.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",98,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98,98,
"NEW BORN INITIAL HOSP CARE",5917485,"CDM ",960,RC,99460,HCPCS,OUTPATIENT,,,194.5,155.6,,75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,98.88,98.88,98.88,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",127,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7,127,
"NON FAC INT NEW BORN EM/DAY",5917490,"CDM ",960,RC,99461,HCPCS,OUTPATIENT,,,150,120,,66.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",124,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",66.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",66.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.75,124,
"SUBQ INPT NORMAL NB",5917495,"CDM ",960,RC,99462,HCPCS,OUTPATIENT,,,97,77.6,,19.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",57,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.46,57,
"NEWBORN INPT ADMIT/DC",5917500,"CDM ",960,RC,99463,HCPCS,OUTPATIENT,,,223,178.4,,75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",149,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7,149,
"ATTEND DELIVERY STABILIZE NB",5917505,"CDM ",960,RC,99464,HCPCS,OUTPATIENT,,,171.5,137.2,,61.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",99,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",61.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",61.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.56,99,
"NB RESUSCITATION",5917510,"CDM ",960,RC,99465,HCPCS,OUTPATIENT,,,314,251.2,,131.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",201,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",131.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",131.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.37,201,
"NEONATE CC INT <28 DAY",5917515,"CDM ",960,RC,99468,HCPCS,OUTPATIENT,,,2140,1712,,756.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",756.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1267,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",756.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",756.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",756.28,1267,
"NEONATE CC SUBSQ <28DAY",5917520,"CDM ",960,RC,99469,HCPCS,OUTPATIENT,,,839,671.2,,329.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",329.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",549,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",329.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",329.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",329.21,549,
"PEDIATRIC CC INT 29DAYS-24MO",5917525,"CDM ",960,RC,99471,HCPCS,OUTPATIENT,,,1740.5,1392.4,,659.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",659.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1128,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",659.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",659.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",659.91,1128,
"PEDIATRIC CC SUBSQ 29DAYS-24MO",5917530,"CDM ",960,RC,99472,HCPCS,OUTPATIENT,,,850.5,680.4,,328.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",328.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",533,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",328.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",328.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",328.29,533,
"PEDIATRIC CC INT 2-5 YRS",5917535,"CDM ",960,RC,99475,HCPCS,OUTPATIENT,,,1198.5,958.8,,455.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",455.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",744,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",455.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",455.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",455.35,744,
"PEDIATRIC CC SUBSQ 2-5 YRS",5917540,"CDM ",960,RC,99476,HCPCS,OUTPATIENT,,,713.5,570.8,,271.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",271.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",463,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",271.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",271.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",271.59,463,
"NEONATE ICU INITIAL <28 DAYS",5917545,"CDM ",960,RC,99477,HCPCS,OUTPATIENT,,,736.5,589.2,,256.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",256.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",509,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",256.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",256.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",256.27,509,
"NEONATE ICU SUBSQ BW <1500 GM",5917550,"CDM ",960,RC,99478,HCPCS,OUTPATIENT,,,291.5,233.2,,120,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",191,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",120,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",120,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,191,
"NEONATE ICU SUBSQ 1500-2500 GM",5917555,"CDM ",960,RC,99479,HCPCS,OUTPATIENT,,,257.5,206,,153.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",168,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",153.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",153.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.22,168,
"NEONATE ICU SUBSQ 2501-5000 GM",5917560,"CDM ",960,RC,99480,HCPCS,OUTPATIENT,,,234.5,187.6,,153.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",162,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",153.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",153.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.22,162,
"ADVNCD CARE PLAN 30 MIN",5917565,"CDM ",960,RC,99497,HCPCS,OUTPATIENT,,,144,115.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",115,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115,115,
"ADVNCD CARE PLAN EA ADD 30 MIN",5917570,"CDM ",960,RC,99498,HCPCS,OUTPATIENT,,,120,96,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",100,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",100,100,
"LIBERAL FIRE DEPT ANNUAL PHYS",5917647,"CDM ",960,RC,99499,HCPCS,OUTPATIENT,,,71.5,57.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",60.78,85,,48.62,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.78,60.78,
"OB MATERNITY VISIT",5918290,"CDM ",960,RC,100,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"NO CHARGE OFFICE VISIT",5918300,"CDM ",960,RC,103,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"NO CHARGE OFFICE VISIT",5918300,"CDM ",960,RC,103,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"US 4D OB",5918305,"CDM ",960,RC,104,HCPCS,OUTPATIENT,,,261.5,209.2,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"PLASTIC SURGERY PENIS",5918350,"CDM ",960,RC,54360,HCPCS,OUTPATIENT,,,1621,1296.8,,560.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",560.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1170,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",560.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",560.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",560.83,1170,
"FNA BX W/IMAGE 1ST LESION",5918355,"CDM ",960,RC,10007,HCPCS,OUTPATIENT,,,213,170.4,,60.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",391,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",60.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",60.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6,391,
"BONE GRFT ILIAC CREST MICROVAS",5918360,"CDM ",960,RC,20956,HCPCS,OUTPATIENT,,,5828.5,4662.8,,2078.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2078.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",4130,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2078.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",2078.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2078.78,4130,
"TX PERCU FIXATION HUMERAL FX",5918365,"CDM ",960,RC,24538,HCPCS,OUTPATIENT,,,1672.5,1338,,574.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",574.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1142,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",574.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",574.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",574.95,1142,
"RPR INTRINSIC MUSCLE HAND EACH",5918370,"CDM ",960,RC,26591,HCPCS,OUTPATIENT,,,989,791.2,,379.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,157.78,157.78,157.78,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",379.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",755,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",379.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",379.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",379.85,755,
"RPR TENDON EXTENSOR FOOT EACH",5918375,"CDM ",960,RC,28208,HCPCS,OUTPATIENT,,,707.5,566,,283.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",283.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",655,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",283.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",283.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",283.59,655,
"RPR TEND/MUSCLE FOREARM EACH",5918380,"CDM ",960,RC,25270,HCPCS,OUTPATIENT,,,1081,864.8,,543.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",543.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1080,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",543.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",543.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",543.36,1080,
"CLSD TX FEMORAL FX W/MANIP",5918385,"CDM ",960,RC,27502,HCPCS,OUTPATIENT,,,1672.5,1338,,597.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",597.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1187,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",597.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",597.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",597.42,1187,
"TX PERCU FIX HUMERAL FX DISTAL",5918390,"CDM ",960,RC,27509,HCPCS,OUTPATIENT,,,1448.5,1158.8,,493.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",493.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",980,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",493.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",493.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",493.28,980,
"BX BONE TROCAR/NEEDLE SUPERFIC",5918395,"CDM ",960,RC,20220,HCPCS,OUTPATIENT,,,201.5,161.2,,168.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",168.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",334,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",168.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",168.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",168.08,334,
"BX BONE TROCAR/NEEDLE DEEP",5918400,"CDM ",960,RC,20225,HCPCS,OUTPATIENT,,,299,239.2,,741.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",741.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1473,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",741.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",741.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",741.44,1473,
"PHLEBOTOMY THERAPEUTIC",5918405,"CDM ",960,RC,99195,HCPCS,OUTPATIENT,,,213,170.4,,78.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,22.57,22.57,22.57,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",133,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",78.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,91.49,65.99,116.99,"1 through 10",other,"not separately reimbursment ",78.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.87,133,
"RPR FLEX TENDON PRIME WO GRFT",5918410,"CDM ",960,RC,26356,HCPCS,OUTPATIENT,,,1742,1393.6,,790.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2079.71,2079.71,2079.71,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",790.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1576,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",790.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",790.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",790.16,1576,
"RPR FLEX TENDON SEC W/WO GRFT",5918415,"CDM ",960,RC,27659,HCPCS,OUTPATIENT,,,1046,836.8,,395.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",395.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",785,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",395.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",395.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",395.17,785,
"OPEN TX FINGER FX  INCLUDES JO",5918420,"CDM ",960,RC,26746,HCPCS,OUTPATIENT,,,1632.5,1306,,357.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2461.60,2461.60,2461.60,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",357.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1025,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",357.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",357.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",357.4,1025,
"CAPSULECTOMY/CAPSULOTOMY IPHA",5918423,"CDM ",960,RC,26525,HCPCS,OUTPATIENT,,,1690.5,1352.4,,572.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",572.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1138,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",572.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",572.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",572.97,1138,
"VERTEBROPLASTY CERV/LUM EA ADD",5918425,"CDM ",960,RC,22512,HCPCS,OUTPATIENT,,,466,372.8,,129.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1324,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",129.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",129.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.07,1324,
"CLSD TX FEMUR SEPARATION W/MAN",5918430,"CDM ",960,RC,27517,HCPCS,OUTPATIENT,,,1506,1204.8,,510.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",510.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1014,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",510.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",510.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",510.14,1014,
"ARTHROTOMY WRIST BX",5918435,"CDM ",960,RC,25100,HCPCS,OUTPATIENT,,,759,607.2,,282.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",282.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",560,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",282.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",282.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",282.01,560,
"ARTHROTOMY W/FB METACARPO JOIN",5918440,"CDM ",960,RC,26075,HCPCS,OUTPATIENT,,,736,588.8,,235.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",235.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",468,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",235.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",235.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",235.74,468,
"RPR FLEX TENDON W/GRAFT EACH",5918445,"CDM ",960,RC,26350,HCPCS,OUTPATIENT,,,1580.5,1264.4,,614.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,642.75,642.75,642.75,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",614.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1220,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",614.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",614.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",614.16,1220,
"ARTHROTOMY WRIST W/EXPLORE",5918450,"CDM ",960,RC,25101,HCPCS,OUTPATIENT,,,885.5,708.4,,327.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",327.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",651,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",327.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",327.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",327.63,651,
"ARTHROT DIST RADIOULNAR JOINT",5918454,"CDM ",960,RC,25107,HCPCS,OUTPATIENT,,,1305,1044,,455.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",455.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",909,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",455.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",455.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",455.55,909,
"RPR HALLUX W/CHEILECTOMY/DEBRI",5918455,"CDM ",960,RC,28289,HCPCS,OUTPATIENT,,,1023.5,818.8,,,,,,,,0,"other ","not separately reimbursment ",,,,712.00,712.00,712.00,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1033,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1033,1033,
"SHOULDER ARTHROSCOPY W/FB REMO",5918460,"CDM ",960,RC,29819,HCPCS,OUTPATIENT,,,1194,955.2,,413.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",413.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",971,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",413.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",413.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",413.02,971,
"ARTHROTOMY HIP W/DRAINAGE",5918485,"CDM ",960,RC,27030,HCPCS,OUTPATIENT,,,2063.5,1650.8,,727.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",727.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1445,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",727.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",727.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",727.35,1445,
"RPR PROFUNDUS TENDON PRIME EAC",5918490,"CDM ",960,RC,26370,HCPCS,OUTPATIENT,,,1672.5,1338,,667.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",667.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1326,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",667.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",667.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",667.54,1326,
"ESOPHAGOSCOPY FLEXIBLE DIAGNOS",5918495,"CDM ",960,RC,43200,HCPCS,OUTPATIENT,,,446,356.8,,156.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",369,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",156.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",156.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.31,369,
"ESOPHAGOSCOPY FLEX W/BX",5918497,"CDM ",960,RC,43202,HCPCS,OUTPATIENT,,,204,163.2,,216.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",216.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",488,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",216.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",216.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",216.53,488,
"MASTECTOMY RADICAL",5918500,"CDM ",960,RC,19305,HCPCS,OUTPATIENT,,,2500.5,2000.4,,742.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",742.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1576,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",742.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",742.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",742.04,1576,
"BX/EXC LYMPH NODE OPEN DEEP W/",5918505,"CDM ",960,RC,38520,HCPCS,OUTPATIENT,,,1023.5,818.8,,340.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",340.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",677,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",340.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",340.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",340.87,677,
"FLUCELVAX VACCINE 0.5ML",5918510,"CDM ",960,RC,90674,HCPCS,OUTPATIENT,,,52.5,42,,22.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",22.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.94,22.94,
"FLUAD VACCINE 0.5ML",5918515,"CDM ",960,RC,90694,HCPCS,OUTPATIENT,,,110,88,,66.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",66.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.43,66.43,
"APPLY HOT/COLD PACK",5918520,"CDM ",960,RC,97010,HCPCS,OUTPATIENT,,,10.5,8.4,,10.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",16,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",10.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",10.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.88,16,
"CLSD TX TIBIAL FX PROX W/TRACT",5918525,"CDM ",960,RC,27532,HCPCS,OUTPATIENT,,,1264.5,1011.6,,461.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",461.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",918,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",461.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",461.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",461.98,918,
"OSTEOTOMY PROX TIBIA PRIOR EPI",5918530,"CDM ",960,RC,27455,HCPCS,OUTPATIENT,,,2092,1673.6,,727.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",727.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1460,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",727.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",727.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",727.55,1460,
"MOHS 1 STAGE H/N/HF/G",5918535,"CDM ",960,RC,17311,HCPCS,OUTPATIENT,,,1242,993.6,,475.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",475.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",953,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",475.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",475.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",475.67,953,
"MOHS 1 STAGE T/A/L",5918540,"CDM ",960,RC,17313,HCPCS,OUTPATIENT,,,1242,993.6,,434.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",434.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",870,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",434.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",434.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",434.46,870,
"MOHS T/A/L EA ADD BLOCK",5918545,"CDM ",960,RC,17315,HCPCS,OUTPATIENT,,,201.5,161.2,,56.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",113,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",56.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",56.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.69,113,
"MOHS T/A/L EA ADD STAGE",5918548,"CDM ",960,RC,17314,HCPCS,OUTPATIENT,,,719,575.2,,264.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",264.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",530,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",264.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",264.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",264.84,530,
"MOHS H/N/H/F/G EA ADD STAGE",5918550,"CDM ",960,RC,17312,HCPCS,OUTPATIENT,,,719,575.2,,286.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",286.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",572,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",286.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",286.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",286.47,572,
"INJ SKIN LESION(S) 1-7",5918555,"CDM ",960,RC,11900,HCPCS,OUTPATIENT,,,126.5,101.2,,34.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",76,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",34.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.78,76,
"INJ SKIN LESIONS >7",5918557,"CDM ",960,RC,11901,HCPCS,OUTPATIENT,,,138,110.4,,44.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",97,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",44.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.1,97,
"LAP ABLATION RENAL CYST",5918565,"CDM ",960,RC,50541,HCPCS,OUTPATIENT,,,2069,1655.2,,708.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",708.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1483,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",708.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",708.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",708.22,1483,
"PULSE OXIMETRY MULTIPLE",5918570,"CDM ",960,RC,94761,HCPCS,OUTPATIENT,,,10.5,8.4,,3.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,18.45,18.45,18.45,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",38,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,401.48,365.79,437.17,"1 through 10",other,"not separately reimbursment ",3.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3,38,
"CHEST WALL MANIP DEMO/EVAL",5918575,"CDM ",960,RC,94667,HCPCS,OUTPATIENT,,,75,60,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",33,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33,33,
"CHEST WALL MANIP SUBSQ",5918580,"CDM ",960,RC,94668,HCPCS,OUTPATIENT,,,58,46.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",35,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35,35,
"VISION SCREENING",5918585,"CDM ",960,RC,99173,HCPCS,OUTPATIENT,,,42,33.6,,5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",18,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5,18,
"RPR TIBIA WO GRAFT",5918590,"CDM ",960,RC,27720,HCPCS,OUTPATIENT,,,1925.5,1540.4,,677.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",677.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1475,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",677.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",677.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",677.33,1475,
"RPR NON/MALUNION TIBIA W/GRFT",5918592,"CDM ",960,RC,27722,HCPCS,OUTPATIENT,,,1862.5,1490,,671.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",671.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1333,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",671.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",671.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",671.04,1333,
"RPR SLING OP INCONTINENCE",5918595,"CDM ",960,RC,57288,HCPCS,OUTPATIENT,,,1644,1315.2,,445.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",445.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1363,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",445.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",445.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",445.84,1363,
"REMOVE SUPPORT IMPLANT",5918600,"CDM ",960,RC,20670,HCPCS,OUTPATIENT,,,632.5,506,,380.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",380.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",757,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",380.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",380.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",380.84,757,
"PRLNG CLINCAL STAFF OP 1ST HR",5918608,"CDM ",960,RC,99415,HCPCS,OUTPATIENT,,,166,132.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",11,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11,11,
"PRLNG CLINICAL STAFF EA ADD 30",5918609,"CDM ",960,RC,99416,HCPCS,OUTPATIENT,,,82.5,66,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",6,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6,6,
"RPR COMPL 1.1-2.5CM F/C/M/N",5918615,"CDM ",960,RC,13131,HCPCS,OUTPATIENT,,,862.5,690,,245.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,909.19,909.19,909.19,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",245.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",532,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",245.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",245.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",245.64,532,
"PATIENT FOCUSED RISK ASSESSMNT",5918620,"CDM ",960,RC,96160,HCPCS,OUTPATIENT,,,31.5,25.2,,21.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",4,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",21.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",21.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4,21.86,
"CAREGIVER RISK ASSESSMNT",5918625,"CDM ",960,RC,96161,HCPCS,OUTPATIENT,,,33,26.4,,21.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",4,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",21.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",21.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4,21.86,
"BRIEF EMOTIONAL/BEHAVIOR ASSMT",5918630,"CDM ",960,RC,96127,HCPCS,OUTPATIENT,,,30.5,24.4,,3.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",7,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",3.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.09,7,
"MENINGOCOCCAL MENVEO",5918635,"CDM ",960,RC,90734,HCPCS,OUTPATIENT,,,223.5,178.8,,121.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,199.95,199.95,199.95,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",121.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",189.98,85,,151.98,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",121.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",121.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",121.63,189.98,
"CLSD TX BIMALL ANKLE FX W/MAN",5918645,"CDM ",960,RC,27788,HCPCS,OUTPATIENT,,,919.5,735.6,,312.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",312.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",622,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",312.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",312.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",312.95,622,
"PERCU FIX INTERPHAL JOINT DISL",5918650,"CDM ",960,RC,26776,HCPCS,OUTPATIENT,,,977.5,782,,334.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,4934.05,4934.05,4934.05,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",334.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",665,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",334.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",334.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",334.59,665,
"OSTEOT PROX TIBIA  AFTR EPIPHY",5918655,"CDM ",960,RC,27457,HCPCS,OUTPATIENT,,,2069,1655.2,,750.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",750.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1575,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",750.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",750.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",750.76,1575,
"OSTEOTOMY METACARPAL EACH",5918660,"CDM ",960,RC,26565,HCPCS,OUTPATIENT,,,1587,1269.6,,567.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",567.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1127,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",567.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",567.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",567.23,1127,
"RPR ING HERNIA SLIDING ANY AGE",5918665,"CDM ",960,RC,49525,HCPCS,OUTPATIENT,,,1224.5,979.6,,407.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",407.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",810,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",407.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",407.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",407.8,810,
"BX INCISION 1ST LESION",5918670,"CDM ",960,RC,11106,HCPCS,OUTPATIENT,,,236,188.8,,38.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",205,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",38.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",38.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.27,205,
"BX INCISION EA ADD LESION",5918675,"CDM ",960,RC,11107,HCPCS,OUTPATIENT,,,114,91.2,,20.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",99,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.49,99,
"REALIGNMNT FING TENDON WO GRFT",5918680,"CDM ",960,RC,26437,HCPCS,OUTPATIENT,,,1448.5,1158.8,,523.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",523.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1040,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",523.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",523.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",523.62,1040,
"RPR ABD CAVITY TISSUE",5918685,"CDM ",960,RC,44850,HCPCS,OUTPATIENT,,,1598.5,1278.8,,507.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",507.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1056,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",507.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",507.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",507.39,1056,
"RPR MED LIGAMENT ELBOW",5918690,"CDM ",960,RC,24345,HCPCS,OUTPATIENT,,,1529,1223.2,,526.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",526.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1047,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",526.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",526.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",526.79,1047,
"RPR RECONSTRUCT FEMORAL HEAD",5918695,"CDM ",960,RC,27122,HCPCS,OUTPATIENT,,,2374,1899.2,,781.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",781.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1880,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",781.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",781.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",781.69,1880,
"RPR RUPTURED UTERUS NON OB",5918700,"CDM ",960,RC,58520,HCPCS,OUTPATIENT,,,1742,1393.6,,575.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",575.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1148,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",575.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",575.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",575.09,1148,
"ARTHRODESIS TRIPLE ANKLE",5918701,"CDM ",960,RC,28715,HCPCS,OUTPATIENT,,,1965.5,1572.4,,730.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,261.08,261.08,261.08,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",730.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1488,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",730.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",730.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",730.96,1488,
"ENDOSC SM BOWEL W/ILEUM",5918705,"CDM ",960,RC,44376,HCPCS,OUTPATIENT,,,576,460.8,,230.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",230.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",540,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",230.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",230.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",230.86,540,
"ARTHRODESIS FOOT BONES",5918710,"CDM ",960,RC,28725,HCPCS,OUTPATIENT,,,1684,1347.2,,635.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",635.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1262,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",635.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",635.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",635.25,1262,
"FUSION MULTI FOOT BONES",5918713,"CDM ",960,RC,28730,HCPCS,OUTPATIENT,,,1529,1223.2,,611.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",611.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1220,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",611.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",611.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",611.5,1220,
"PERC FIX FX DISLOCATION THUMB",5918715,"CDM ",960,RC,26650,HCPCS,OUTPATIENT,,,1379.5,1103.6,,386.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",386.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",768,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",386.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",386.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",386.47,768,
"RPR NONUNION WRIST BONE",5918720,"CDM ",960,RC,25440,HCPCS,OUTPATIENT,,,1661.5,1329.2,,625.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",625.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1243,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",625.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",625.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",625.54,1243,
"SPLT THCK GRFT EA ADD 100SQCM",5918730,"CDM ",960,RC,15101,HCPCS,OUTPATIENT,,,241.5,193.2,,162.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",324,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",162.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",162.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.93,324,
"INJ ANESTH GENICULAR NERVE",5918735,"CDM ",960,RC,64454,HCPCS,OUTPATIENT,,,180,144,,52.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",52.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.27,52.27,
"CLSD TX FINGER FX EACH",5918740,"CDM ",960,RC,26740,HCPCS,OUTPATIENT,,,477.5,382,,154.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",308,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",154.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",154.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154.87,308,
"DILATE URINARY TRACT W/IMAGE",5918745,"CDM ",960,RC,50436,HCPCS,OUTPATIENT,,,328,262.4,,97.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",217,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",97.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",97.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.18,217,
"SCREENING HEARING AABR",5918750,"CDM ",960,RC,92587,HCPCS,OUTPATIENT,,,47.5,38,,44.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",102,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",44.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.67,102,
"OSTECTOMY COMPL 1ST METATARSAL",5918753,"CDM ",960,RC,28111,HCPCS,OUTPATIENT,,,661,528.8,,346.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",346.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",707,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",346.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",346.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",346.39,707,
"OSTECTOMY CMPT EXC METATARSAL",5918755,"CDM ",960,RC,28112,HCPCS,OUTPATIENT,,,617,493.6,,315.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",315.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",691,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",315.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",315.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",315.68,691,
"LIGATE STRIP SAPH VEIN",5918760,"CDM ",960,RC,37718,HCPCS,OUTPATIENT,,,897,717.6,,328.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",328.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",652,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",328.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",328.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",328.42,652,
"OPEN TX POST MALLEOLUS FX",5918765,"CDM ",960,RC,27769,HCPCS,OUTPATIENT,,,1580.5,1264.4,,476.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",476.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1022,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",476.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",476.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",476.8,1022,
"EXPL POST OP HEMORRHAGE ABD",5918767,"CDM ",960,RC,35840,HCPCS,OUTPATIENT,,,2030,1624,,484.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",484.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1693,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",484.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",484.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",484.06,1693,
"EXPL ARM/LEG PO BLEED/CLOT/INF",5918770,"CDM ",960,RC,35860,HCPCS,OUTPATIENT,,,1599,1279.2,,306.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",306.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1226,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",306.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",306.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",306.05,1226,
"OPN TX RAD SHFT FX W/TX JT DSL",5918775,"CDM ",960,RC,25525,HCPCS,OUTPATIENT,,,1701.5,1361.2,,709.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",709.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1410,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",709.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",709.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",709.62,1410,
"CORRECT BUNION 1ST METATARSAL",5918780,"CDM ",960,RC,28297,HCPCS,OUTPATIENT,,,1310.5,1048.4,,566.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",566.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1147,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",566.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",566.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",566.45,1147,
"CORRECT BUNION W/RESECT PROX P",5918785,"CDM ",960,RC,28292,HCPCS,OUTPATIENT,,,1052,841.6,,509.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",509.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1104,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",509.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",509.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",509.11,1104,
"ASPIRATE BONE MARROW DX",5918800,"CDM ",960,RC,38220,HCPCS,OUTPATIENT,,,362.5,290,,138.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",138.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",288,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",138.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",138.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",138.2,288,
"EXCISION STOMACH LESION",5918805,"CDM ",960,RC,43610,HCPCS,OUTPATIENT,,,2098.5,1678.8,,672.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",672.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1374,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",672.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",672.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",672.91,1374,
"AMPUTATION LWR LEG OPEN",5918810,"CDM ",960,RC,27882,HCPCS,OUTPATIENT,,,1259,1007.2,,489.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",489.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",973,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",489.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",489.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",489.96,973,
"ARTHRODESIS/FUSION BIG TOE JNT",5918815,"CDM ",960,RC,28750,HCPCS,OUTPATIENT,,,2299,1839.2,,585.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",585.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1162,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",585.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",585.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",585.04,1162,
"EXC UMBILICUS",5918820,"CDM ",960,RC,49250,HCPCS,OUTPATIENT,,,1264.5,1011.6,,405,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",405,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",818,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",405,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",405,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4,818,
"EGD GUIDEWIRE INSERT",5918825,"CDM ",960,RC,43248,HCPCS,OUTPATIENT,,,329.5,263.6,,135.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,582.57,582.57,582.57,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",561,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",135.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",135.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.05,561,
"REPLACE TUNNELED CV CATH",5918830,"CDM ",960,RC,36581,HCPCS,OUTPATIENT,,,397,317.6,,652.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",652.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1296,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",652.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",652.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",652.52,1296,
"SMALL BOWEL ENDOSCOPY W/BX",5918835,"CDM ",960,RC,44361,HCPCS,OUTPATIENT,,,320,256,,123.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",387,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",123.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",123.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.45,387,
"RPR BLOOD VESSEL LOWER EXTRMTY",5918840,"CDM ",960,RC,35226,HCPCS,OUTPATIENT,,,1588.5,1270.8,,707.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",707.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1405,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",707.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",707.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",707.23,1405,
"APPLY BONE FIX DEVICE",5918845,"CDM ",960,RC,20690,HCPCS,OUTPATIENT,,,1287.5,1030,,193.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,271.24,271.24,271.24,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",193.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",823,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",193.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",193.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",193.5,823,
"ATHRO ANKLE SYNOVECTOMY PART",5918850,"CDM ",960,RC,29895,HCPCS,OUTPATIENT,,,943.5,754.8,,396.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",396.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",886,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",396.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",396.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",396.59,886,
"ARTHROTOMY SHOULDER JOINT",5918855,"CDM ",960,RC,23040,HCPCS,OUTPATIENT,,,1546.5,1237.2,,543.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",543.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1087,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",543.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",543.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",543.32,1087,
"CLSD TX ELBOW DISLOCATION CHLD",5918860,"CDM ",960,RC,24640,HCPCS,OUTPATIENT,,,178,142.4,,91.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",197,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",91.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",91.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.61,197,
"CLSD TX TALUS FX W/MANIP",5918865,"CDM ",960,RC,28435,HCPCS,OUTPATIENT,,,638,510.4,,226.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",226.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",499,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",226.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",226.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",226.68,499,
"RPR COMPL EA ADD 5CM E/N/E/L",5918870,"CDM ",960,RC,13153,HCPCS,OUTPATIENT,,,299,239.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",266,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",266,266,
"OPEN TX RADIUS FX W/INT FIX",5918875,"CDM ",960,RC,24665,HCPCS,OUTPATIENT,,,1420,1136,,495.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",495.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",985,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",495.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",495.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",495.97,985,
"CLSD TX POST ANKLE FX W/MANIP",5918880,"CDM ",960,RC,27768,HCPCS,OUTPATIENT,,,966,772.8,,274.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",610,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",274.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",274.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.63,610,
"EGD FLEX W/INJ VARICES",5918885,"CDM ",960,RC,43243,HCPCS,OUTPATIENT,,,470.5,376.4,,191.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",191.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",542,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",191.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",191.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",191.61,542,
"ARTHROT MENISCECTOMY MED/LAT",5918890,"CDM ",960,RC,27333,HCPCS,OUTPATIENT,,,1270.5,1016.4,,442.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",442.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",984,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",442.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",442.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",442.91,984,
"ARTHROTOMY KNEE W/SYNOVECTOMY",5918893,"CDM ",960,RC,27334,HCPCS,OUTPATIENT,,,1442.5,1154,,513.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",513.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1096,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",513.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",513.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",513.1,1096,
"UNLISTED STOMACH SURG PROC",5918895,"CDM ",960,RC,43999,HCPCS,OUTPATIENT,,,3293.5,2634.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2799.48,85,,2239.58,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2799.48,2799.48,
"RPR RADIUS/ULNA WO GRAFT",5918900,"CDM ",960,RC,25415,HCPCS,OUTPATIENT,,,2086.5,1669.2,,926.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",926.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1841,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",926.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",926.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",926.41,1841,
"CLSD TX ULNAR/STYLOID FX",5918905,"CDM ",960,RC,25650,HCPCS,OUTPATIENT,,,661,528.8,,225.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",225.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",448,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",225.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",225.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",225.59,448,
"OSTEOTOMY HUMEROUS",5918910,"CDM ",960,RC,24400,HCPCS,OUTPATIENT,,,1782,1425.6,,636.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",636.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1264,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",636.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",636.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",636.43,1264,
"INCISION BONE CORTEX PELV/HIP",5918915,"CDM ",960,RC,26992,HCPCS,OUTPATIENT,,,2167,1733.6,,745.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",745.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1482,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",745.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",745.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",745.85,1482,
"I&D EYELID ABSCESS",5918920,"CDM ",960,RC,67700,HCPCS,OUTPATIENT,,,632.5,506,,210.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",419,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",210.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",210.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.99,419,
"CORRECT TRICHIASIS EPI FORCEPS",5918923,"CDM ",960,RC,67820,HCPCS,OUTPATIENT,,,60.5,48.4,,45.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",90,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",45.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",45.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.5,90,
"BUNIONECTOMY CORRECTION W/SESA",5918925,"CDM ",960,RC,28298,HCPCS,OUTPATIENT,,,1092.5,874,,473.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",473.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1010,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",473.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",473.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",473.21,1010,
"OPEN TXSCAPULAR FX W/FIXATION",5918930,"CDM ",960,RC,23585,HCPCS,OUTPATIENT,,,2104,1683.2,,528.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",528.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1370,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",528.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",528.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",528.32,1370,
"DESTROY GENICULAR NRV W/IMG",5918933,"CDM ",960,RC,64624,HCPCS,OUTPATIENT,,,345,276,,93.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",93.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.47,93.47,
"RADIOFREQ ABL NRV SAC JNT W/IM",5918935,"CDM ",960,RC,64625,HCPCS,OUTPATIENT,,,425.5,340.4,,123.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",123.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.68,123.68,
"ENDOVENOUS ABL 1ST VEIN",5918940,"CDM ",960,RC,36475,HCPCS,OUTPATIENT,,,592.5,474,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",3267,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3267,3267,
"ENDOVENOUS ABL ADD ON",5918945,"CDM ",960,RC,36476,HCPCS,OUTPATIENT,,,282,225.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",653,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",653,653,
"TENOTOMY OPEN WRIST/FOREARM EA",5918950,"CDM ",960,RC,25290,HCPCS,OUTPATIENT,,,942.5,754,,600.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",600.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1192,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",600.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",600.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",600.13,1192,
"OPEN TX BIG TOE FX",5918955,"CDM ",960,RC,28505,HCPCS,OUTPATIENT,,,1081,864.8,,356.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",356.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",934,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",356.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",356.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",356.7,934,
"HOME VISIT NEW PT LEV 1",5918960,"CDM ",960,RC,99341,HCPCS,OUTPATIENT,,,123,98.4,,46.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",81,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",46.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",46.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.19,81,
"HOME VISIT NEW PT LEV 2",5918961,"CDM ",960,RC,99342,HCPCS,OUTPATIENT,,,176,140.8,,68.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",119,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",68.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.22,119,
"HOME VISIT NEW PT LEV 4",5918963,"CDM ",960,RC,99344,HCPCS,OUTPATIENT,,,389,311.2,,130.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",238,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",130.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",130.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.93,238,
"HOME VISIT NEW PT LEV 5",5918964,"CDM ",960,RC,99345,HCPCS,OUTPATIENT,,,464,371.2,,162.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",285,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",162.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",162.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.12,285,
"HOME VISIT EST PT LEV 1",5918965,"CDM ",960,RC,99347,HCPCS,OUTPATIENT,,,112,89.6,,40.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",73,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",40.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",40.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4,73,
"HOME VISIT EST PT LEV 2",5918966,"CDM ",960,RC,99348,HCPCS,OUTPATIENT,,,171,136.8,,60.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",111,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",60.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",60.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.38,111,
"HOME VISIT EST PT LEV 3",5918967,"CDM ",960,RC,99349,HCPCS,OUTPATIENT,,,261.5,209.2,,88.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",166,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",88.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",88.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.33,166,
"HOME VISIT EST PT LEV 4",5918968,"CDM ",960,RC,99350,HCPCS,OUTPATIENT,,,362.5,290,,123.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",232,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",123.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",123.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.75,232,
"RPR TIBIAL TUBERCLEPLASTY",5918970,"CDM ",960,RC,27418,HCPCS,OUTPATIENT,,,1793.5,1434.8,,630.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",630.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1344,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",630.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,486.94,486.94,486.94,"1 through 10",other,"not separately reimbursment ",630.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",630.3,1344,
"OPEN TX RADIUS FX",5918975,"CDM ",960,RC,24666,HCPCS,OUTPATIENT,,,1587,1269.6,,558.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",558.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1165,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",558.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",558.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",558.7,1165,
"REMOVE TENDON FOR GRAFT",5918980,"CDM ",960,RC,20924,HCPCS,OUTPATIENT,,,1092.5,874,,390.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",390.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",775,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",390.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",390.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",390.28,775,
"RPR BICEPS TENDON AT ELBOW",5918985,"CDM ",960,RC,24340,HCPCS,OUTPATIENT,,,1334,1067.2,,472.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",472.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",938,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",472.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",472.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",472.31,938,
"UNLISTED LAP PROC LIVER",5918990,"CDM ",960,RC,47379,HCPCS,OUTPATIENT,,,1420,1136,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1207,85,,965.60,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1207,1207,
"PERCUTANEOUS VERTEBRAL AUGMENT",5918995,"CDM ",960,RC,22515,HCPCS,OUTPATIENT,,,471.5,377.2,,134.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",134.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",5933,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",134.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",134.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",134.48,5933,
"EGD BALLOON DILATE ESOPH <30MM",5919000,"CDM ",960,RC,43249,HCPCS,OUTPATIENT,,,408,326.4,,124.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1403,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",124.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",124.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.28,1403,
"APPLY MULTI EXT FIXATION",5919005,"CDM ",960,RC,20692,HCPCS,OUTPATIENT,,,2420,1936,,329.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",329.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1557,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",329.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",329.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",329.72,1557,
"REVISE EXT BONE FIXATION SYST",5919007,"CDM ",960,RC,20693,HCPCS,OUTPATIENT,,,966,772.8,,357.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",357.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",710,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",357.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",357.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",357.25,710,
"CLOSED TX HUMERAL FX W/MANIP",5919010,"CDM ",960,RC,23625,HCPCS,OUTPATIENT,,,759,607.2,,275.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",275.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",547,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",275.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",275.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",275.37,547,
"GRAFT COMP W/PRIME CLOSURE",5919015,"CDM ",960,RC,15760,HCPCS,OUTPATIENT,,,1512,1209.6,,571.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",571.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1191,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",571.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",571.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",571.78,1191,
"ACELLULAR DERM MATRIX IMPLT",5919018,"CDM ",960,RC,15777,HCPCS,OUTPATIENT,,,563,450.4,,94.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",299,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",94.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.93,299,
"AMPUTATE THIGH/FEMUR",5919020,"CDM ",960,RC,27590,HCPCS,OUTPATIENT,,,1672.5,1338,,602.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",602.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1251,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",602.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",602.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",602.36,1251,
"SIGMOIDOSCOPY FLX W/SUBMUC INJ",5919025,"CDM ",960,RC,45335,HCPCS,OUTPATIENT,,,137.5,110,,137.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",137.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",393,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",137.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",137.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",137.43,393,
"OPEN TX SHLDR DISLC W/HUM FX",5919030,"CDM ",960,RC,23670,HCPCS,OUTPATIENT,,,1880,1504,,468.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",468.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1223,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",468.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",468.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",468.49,1223,
"ARTHROSCOPY KNEE W/LAT RELEASE",5919035,"CDM ",960,RC,29873,HCPCS,OUTPATIENT,,,1073.5,858.8,,394.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,557.94,557.94,557.94,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",394.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",783,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",394.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",394.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",394.24,783,
"ARTHROSCOPY SHLDR W/WO SYNO BX",5919040,"CDM ",960,RC,29805,HCPCS,OUTPATIENT,,,938.5,750.8,,365.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",365.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",726,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",365.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",365.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",365.45,726,
"BRONCHOSCOPY DX W/IMAGE",5919045,"CDM ",960,RC,31622,HCPCS,OUTPATIENT,,,266.5,213.2,,248.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,23.71,23.71,23.71,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",248.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",493,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",248.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",248.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",248.27,493,
"SIMP RPR S/N/A/GEN 20.1-30.0CM",5919050,"CDM ",960,RC,12006,HCPCS,OUTPATIENT,,,253,202.4,,217.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",431,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",217.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",217.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.09,431,
"HEMIPHALNG PART EXC TOE JNT",5919055,"CDM ",960,RC,28160,HCPCS,OUTPATIENT,,,581,464.8,,254.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",254.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",587,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",254.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",254.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",254.81,587,
"APPLY FINGER SPLINT DYNAMIC",5919060,"CDM ",960,RC,29131,HCPCS,OUTPATIENT,,,115,92,,38.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",76,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",38.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",38.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.44,76,
"DECLOT VASCULAR DEVICE",5919070,"CDM ",960,RC,36593,HCPCS,OUTPATIENT,,,75,60,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",50,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50,50,
"UNLISTED LAP ABD PERTO OMENTUM",5919075,"CDM ",960,RC,49329,HCPCS,OUTPATIENT,,,837,669.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",711.45,85,,569.16,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",711.45,711.45,
"LAP CLOSE ENTEROSTOMY W/RESECT",5919080,"CDM ",960,RC,44227,HCPCS,OUTPATIENT,,,3541,2832.8,,1204.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1204.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2394,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1204.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1204.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1204.84,2394,
"TISS TRNSFR 10.1-30SQCM E/N/E/",5919085,"CDM ",960,RC,14061,HCPCS,OUTPATIENT,,,2144,1715.2,,724.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",724.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1519,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",724.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",724.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",724.81,1519,
"TISS TRNFR 10.1-30SQCM F/C/C/M",5919090,"CDM ",960,RC,14041,HCPCS,OUTPATIENT,,,1989,1591.2,,671.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",671.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1400,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",671.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",671.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",671.05,1400,
"UNLISTED ABDOMINAL PROCEDURE",5919095,"CDM ",960,RC,49999,HCPCS,OUTPATIENT,,,2328,1862.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1978.8,85,,1583.04,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.25,1978.8,
"INSERT TUNLD IP CATH W/IMAGE",5919100,"CDM ",960,RC,49418,HCPCS,OUTPATIENT,,,437.5,350,,107.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",107.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2090,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",107.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",107.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",107.38,2090,
"TISS TRNFR 30.1-60.0SQCM",5919105,"CDM ",960,RC,14301,HCPCS,OUTPATIENT,,,2339.5,1871.6,,445.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",445.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1495,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",445.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",445.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",445.46,1495,
"PART REMOVE CLAVICAL BONE",5919110,"CDM ",960,RC,23120,HCPCS,OUTPATIENT,,,1264.5,1011.6,,430.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1205.76,1205.76,1205.76,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",430.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",855,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",430.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",430.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",430.45,855,
"EXC SHLDR TUMOR SOFT TISS <5CM",5919115,"CDM ",960,RC,23076,HCPCS,OUTPATIENT,,,1167,933.6,,419.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",419.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",833,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",419.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",419.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",419.4,833,
"RESECT RAD `SHLDR TUMOR 5 CM/>",5919118,"CDM ",960,RC,23078,HCPCS,OUTPATIENT,,,3018,2414.4,,700.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",700.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2011,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",700.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",700.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",700.85,2011,
"OPEN TX RADIAL FX W/RPR FIBROC",5919120,"CDM ",960,RC,25526,HCPCS,OUTPATIENT,,,2052,1641.6,,831.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",831.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1653,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",831.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",831.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",831.76,1653,
"RPR TNDN/MUSC F/ARM WRST 1 EA",5919125,"CDM ",960,RC,25260,HCPCS,OUTPATIENT,,,1374,1099.2,,641.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",641.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1274,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",641.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",641.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",641.1,1274,
"GRAFT AUTOLOG SFT TISS DIR EXC",5919130,"CDM ",960,RC,15769,HCPCS,OUTPATIENT,,,1029,823.2,,299.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",299.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.97,299.97,
"ARTHRT INTERPHAL JOINT EA",5919135,"CDM ",960,RC,26080,HCPCS,OUTPATIENT,,,862.5,690,,282.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",282.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",561,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",282.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",282.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",282.41,561,
"UNLISTED ARTHROSCOPY JOINT",5919140,"CDM ",960,RC,29999,HCPCS,OUTPATIENT,,,1146,916.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",974.1,85,,779.28,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",974.1,974.1,
"RPR TENDON FINGER AND/OR HAND",5919145,"CDM ",960,RC,26145,HCPCS,OUTPATIENT,,,1115.5,892.4,,388.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",388.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",772,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",388.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",388.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",388.35,772,
"CLSD TX ULNAR SHAFT FX W/MANIP",5919150,"CDM ",960,RC,25535,HCPCS,OUTPATIENT,,,994.5,795.6,,348.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",348.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",692,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",348.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",348.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",348.3,692,
"EXC RECTAL TUMOR TRANSANAL APP",5919155,"CDM ",960,RC,45171,HCPCS,OUTPATIENT,,,1339.5,1071.6,,296.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",835,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",296.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",296.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.91,835,
"EXC RECTAL TUMOR TRANSANAL FUL",5919158,"CDM ",960,RC,45172,HCPCS,OUTPATIENT,,,1985.5,1588.4,,408,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",408,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1135,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",408,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",408,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4,1135,
"CLSD TX HUM EPICOND FX MED/LAT",5919160,"CDM ",960,RC,24565,HCPCS,OUTPATIENT,,,1075.5,860.4,,379,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",379,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",753,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",379,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",379,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3,753,
"EXC LESION TONGUE W/O CLOSURE",5919165,"CDM ",960,RC,41110,HCPCS,OUTPATIENT,,,282,225.6,,133.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",293,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",133.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",133.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.1,293,
"FINE NEEDLE ASP BX W/US EA ADD",5919170,"CDM ",960,RC,10006,HCPCS,OUTPATIENT,,,109.5,87.6,,31.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",85,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",31.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",31.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.91,85,
"OSTECTOMY PART METAR HEAD",5919180,"CDM ",960,RC,28288,HCPCS,OUTPATIENT,,,942.5,754,,328.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",328.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",846,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",328.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",328.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",328.04,846,
"INSERT CV CATH W/PORT >/5YR",5919185,"CDM ",960,RC,36571,HCPCS,OUTPATIENT,,,672.5,538,,1100.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1100.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2187,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1100.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1100.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,2187,
"RECONSTRUCT LIGAMENT KNEE",5919190,"CDM ",960,RC,27427,HCPCS,OUTPATIENT,,,1529,1223.2,,547.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",547.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1201,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",547.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",547.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",547.37,1201,
"UNLISTED LAPHERNIA REPAIR",5919195,"CDM ",960,RC,49659,HCPCS,OUTPATIENT,,,2052,1641.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1744.2,85,,1395.36,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1744.2,1744.2,
"EXC ELBOW LESION",5919200,"CDM ",960,RC,24120,HCPCS,OUTPATIENT,,,1155.5,924.4,,398.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",398.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",791,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",398.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",398.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",398.09,791,
"PERCUT FIX RADIAL/ULNAR DISLOC",5919205,"CDM ",960,RC,25671,HCPCS,OUTPATIENT,,,1144,915.2,,381.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",381.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",758,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",381.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",381.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",381.72,758,
"OPEN TX DIST RADIOULNAR DISLOC",5919208,"CDM ",960,RC,25676,HCPCS,OUTPATIENT,,,1248.5,998.8,,485.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",485.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",964,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",485.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",485.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",485.43,964,
"COLECTOMY TOTAL W/NEORECTUM PO",5919210,"CDM ",960,RC,44158,HCPCS,OUTPATIENT,,,4765,3812,,1582.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1582.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",3146,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1582.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1582.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1582.53,3146,
"ENTERECTOMY LIVE DONOR",5919215,"CDM ",960,RC,44133,HCPCS,OUTPATIENT,,,4213,3370.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",3581.05,85,,2864.84,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3581.05,3581.05,
"CONT GLUCOSE MNTR PT EQUIP",5919232,"CDM ",960,RC,95249,HCPCS,OUTPATIENT,,,133.5,106.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",74,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74,74,
"CONT GLUCOSE MNTR PROV EQUIP",5919235,"CDM ",960,RC,95250,HCPCS,OUTPATIENT,,,282.5,226,,,,,,,,0,"other ","not separately reimbursment ",,,,230.53,230.53,230.53,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",226,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",226,226,
"CONT GLUCOSE MNTR INTERP RPRT",5919240,"CDM ",960,RC,95251,HCPCS,OUTPATIENT,,,75,60,,,,,,,,0,"other ","not separately reimbursment ",,,,49.88,49.88,49.88,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",63,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,31.21,10.57,42.63,"1 through 10",other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,63,
"CANALITH REPOSITIONING",5919275,"CDM ",960,RC,95992,HCPCS,OUTPATIENT,,,99.5,79.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",60,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60,60,
"DISABILITY EXAM BY TX PROVIDER",5919280,"CDM ",960,RC,99455,HCPCS,OUTPATIENT,,,663,530.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",563.55,85,,450.84,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",563.55,563.55,
"DISABILITY EXAM BY DIFF PROVID",5919285,"CDM ",960,RC,99456,HCPCS,OUTPATIENT,,,714,571.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",606.9,85,,485.52,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",606.9,606.9,
"INC BONE FOREARM/WRSIT LESION",5919290,"CDM ",960,RC,25035,HCPCS,OUTPATIENT,,,2299,1839.2,,636.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",636.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1264,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",636.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",636.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",636.13,1264,
"RPR WRIST JOINTS",5919295,"CDM ",960,RC,25447,HCPCS,OUTPATIENT,,,1787.5,1430,,602.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",602.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1196,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",602.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",602.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",602.15,1196,
"ARTHRODESIS WRIST LMTD WO GRFT",5919300,"CDM ",960,RC,25820,HCPCS,OUTPATIENT,,,1402.5,1122,,479.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",479.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",952,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",479.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",479.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",479.34,952,
"ARTHROSCOPY WRIST SYNOVEC PART",5919305,"CDM ",960,RC,29844,HCPCS,OUTPATIENT,,,1002,801.6,,348.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1411.72,1411.72,1411.72,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",348.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",765,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",348.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",348.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",348.38,765,
"ARTHROSCOPY WRIST EXC/RPR FIBR",5919310,"CDM ",960,RC,29846,HCPCS,OUTPATIENT,,,1045,836,,366.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",366.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",902,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",366.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",366.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",366.42,902,
"CAPSULOTOMY MIDFOOT JOINT",5919350,"CDM ",960,RC,28260,HCPCS,OUTPATIENT,,,1155.5,924.4,,451.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",451.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",946,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",451.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",451.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",451.29,946,
"OSTEOTOMY CALCANEUS",5919360,"CDM ",960,RC,28300,HCPCS,OUTPATIENT,,,1402.5,1122,,529.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",529.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1052,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",529.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,4329.40,4329.40,4329.40,"1 through 10",other,"not separately reimbursment ",529.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",529.72,1052,
"OSTEOTOMY TARSAL BONES",5919365,"CDM ",960,RC,28304,HCPCS,OUTPATIENT,,,1327.5,1062,,536.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,798.28,798.28,798.28,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",536.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1136,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",536.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",536.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",536.77,1136,
"MUSCLE TRNSFR SHLDR/ARM SINGLE",5919370,"CDM ",960,RC,23395,HCPCS,OUTPATIENT,,,2736.5,2189.2,,952.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,935.79,935.79,935.79,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",952.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1892,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",952.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",952.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",952.36,1892,
"APP MULTIPLANE EXT FIX UNILAT",5919375,"CDM ",960,RC,20696,HCPCS,OUTPATIENT,,,2512,2009.6,,659.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,158.79,158.79,158.79,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",659.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1598,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",659.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",659.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",659.69,1598,
"RPR NONUNION HAND/FINGER BONE",5919380,"CDM ",960,RC,26546,HCPCS,OUTPATIENT,,,2242,1793.6,,729.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",729.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1449,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",729.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",729.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",729.56,1449,
"RPR FIBULA NONUNION W/INT FIX",5919385,"CDM ",960,RC,27726,HCPCS,OUTPATIENT,,,2046.5,1637.2,,637.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",637.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1361,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",637.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",637.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",637.61,1361,
"MANIPULATION ELBOW UNDER ANEST",5919390,"CDM ",960,RC,24300,HCPCS,OUTPATIENT,,,949,759.2,,290.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",290.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",578,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",290.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",290.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",290.81,578,
"ANOSCOPY CONTROL BLEEDING",5919400,"CDM ",960,RC,46614,HCPCS,OUTPATIENT,,,126,100.8,,132.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",263,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",132.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",132.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.19,263,
"LAP RPR PARAESHPHAG HERNIA",5919410,"CDM ",960,RC,43281,HCPCS,OUTPATIENT,,,2910,2328,,788.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,205.62,205.62,205.62,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",788.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2172,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",788.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",788.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",788.14,2172,
"LAP RPR PARAESOPH HERNIA W/MES",5919415,"CDM ",960,RC,43282,HCPCS,OUTPATIENT,,,3278,2622.4,,886.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",886.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2443,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",886.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",886.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",886.49,2443,
"ARTHROPLASTY PATELLA W/PROSTH",5919420,"CDM ",960,RC,27438,HCPCS,OUTPATIENT,,,1599,1279.2,,633.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",633.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1405,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",633.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",633.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",633.62,1405,
"RECONSTRUCT ULNA/RADIOULNA",5919425,"CDM ",960,RC,25337,HCPCS,OUTPATIENT,,,1868.5,1494.8,,663.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,1415.15,1415.15,1415.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",663.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1317,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",663.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",663.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",663.01,1317,
"AMPUTATION FOLLOW UP SURGERY",5919430,"CDM ",960,RC,27596,HCPCS,OUTPATIENT,,,1466,1172.8,,557.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",557.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1107,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",557.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",557.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",557.37,1107,
TALECTOMY,5919435,"CDM ",960,RC,28130,HCPCS,OUTPATIENT,,,1316.5,1053.2,,469.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",469.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1012,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",469.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",469.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",469.51,1012,
"REVISION AV FISTULA",5919440,"CDM ",960,RC,36832,HCPCS,OUTPATIENT,,,1390,1112,,438.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",438.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",980,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",438.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",438.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",438.99,980,
"ANAL PROCEDURE UNLISTED",5919450,"CDM ",960,RC,46999,HCPCS,OUTPATIENT,,,684,547.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",581.4,85,,465.12,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",581.4,581.4,
"EXC LIP PARTIAL",5919460,"CDM ",960,RC,40520,HCPCS,OUTPATIENT,,,764.5,611.6,,367.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",367.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",730,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",367.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",367.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",367.38,730,
"OPEN TX DISLOCATED WRIST",5919465,"CDM ",960,RC,25695,HCPCS,OUTPATIENT,,,1357,1085.6,,488.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",488.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",971,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",488.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",488.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",488.61,971,
"RELEASE FLEXOR TENDON EACH",5919470,"CDM ",960,RC,26442,HCPCS,OUTPATIENT,,,2104,1683.2,,725.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",725.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1442,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",725.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",725.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",725.61,1442,
"REMOVE WRIST BONES",5919475,"CDM ",960,RC,25215,HCPCS,OUTPATIENT,,,1327.5,1062,,517.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1759.82,648.10,2871.53,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",517.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1028,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",517.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",517.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",517.65,1028,
"RELEASE FOOT TENDON SINGLE",5919477,"CDM ",960,RC,28225,HCPCS,OUTPATIENT,,,707.5,566,,243.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,36.94,36.94,36.94,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",243.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",575,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",243.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",243.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",243.87,575,
"PROCTOSIGMDSC RGD W/DECOMP VOL",5919480,"CDM ",960,RC,45321,HCPCS,OUTPATIENT,,,209,167.2,,71.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",210,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",71.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",71.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7,210,
"DESTROY LUM/SAC FACET W/IMG",5919485,"CDM ",960,RC,64635,HCPCS,OUTPATIENT,,,414,331.2,,101.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",597,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",101.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",101.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.65,597,
"DESTROY LUMB/SAC FACET ADDL",5919487,"CDM ",960,RC,64636,HCPCS,OUTPATIENT,,,126.5,101.2,,27.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",248,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",27.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",27.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.16,248,
"EXC LESION KNEE MENSICUS/CAPSU",5919495,"CDM ",960,RC,27347,HCPCS,OUTPATIENT,,,1132.5,906,,351.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",351.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",734,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",351.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",351.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",351.34,734,
"ARTHRODESIS BIG TOE INTERPH JT",5919500,"CDM ",960,RC,28755,HCPCS,OUTPATIENT,,,724.5,579.6,,332.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",332.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",710,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",332.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",332.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",332.74,710,
"CLSD TX FX/DISLOC ELBOW W/MANI",5919505,"CDM ",960,RC,24620,HCPCS,OUTPATIENT,,,1264.5,1011.6,,416.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",416.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",828,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",416.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",416.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",416.92,828,
"UNLISTED TRACHEA BRONCHI PROC",5919510,"CDM ",960,RC,31899,HCPCS,OUTPATIENT,,,345,276,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",293.25,85,,234.60,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",293.25,293.25,
"ARTHRO KNEE W/LYSIS ADHESIONS",5919515,"CDM ",960,RC,29884,HCPCS,OUTPATIENT,,,1226,980.8,,428.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",428.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",927,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",428.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",428.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",428.01,927,
"ARTHROTOMY TOE JOINT W/FB",5919520,"CDM ",960,RC,28024,HCPCS,OUTPATIENT,,,678.5,542.8,,295.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",295.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",643,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",295.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",295.23,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",295.23,643,
"ARTHRT ELB W/BX",5919540,"CDM ",960,RC,24101,HCPCS,OUTPATIENT,,,1087,869.6,,380.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",380.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",782,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",380.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",380.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",380.42,782,
"INCISION SPINAL NERVE EXTRADUR",5919545,"CDM ",960,RC,64772,HCPCS,OUTPATIENT,,,1144,915.2,,394.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",394.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",835,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",394.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",394.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",394.62,835,
"EXC NEUROMA PERIPHERAL NERVE",5919548,"CDM ",960,RC,64784,HCPCS,OUTPATIENT,,,1512.5,1210,,522.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",522.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1039,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",522.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",522.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",522.74,1039,
"EXC BONE ELBOW PARTIAL",5919565,"CDM ",960,RC,24147,HCPCS,OUTPATIENT,,,1322,1057.6,,504.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",504.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1003,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",504.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",504.7,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",504.7,1003,
"REVISION CALF TENDON",5919570,"CDM ",960,RC,27687,HCPCS,OUTPATIENT,,,604,483.2,,366.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",366.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",727,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",366.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",366.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",366.07,727,
"REVISION CALF TENDON",5919570,"CDM ",960,RC,27687,HCPCS,OUTPATIENT,,,604,483.2,,366.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",366.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",727,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",366.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",366.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",366.07,727,
"TRANSPLANT/GRAFT HAND TENDON",5919575,"CDM ",960,RC,26483,HCPCS,OUTPATIENT,,,825,660,,718.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",718.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1428,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",718.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",718.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",718.63,1428,
"CHRONIC CARE MGT STAFF 1ST 20M",5919650,"CDM ",960,RC,99490,HCPCS,OUTPATIENT,,,121,96.8,,,,,,,,0,"other ","not separately reimbursment ",,,,0.10,0.10,0.10,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",57,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,56.13,45.08,56.13,12,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57,57,
"INC HIP/THIGH FASCIA",5919660,"CDM ",960,RC,27025,HCPCS,OUTPATIENT,,,1948.5,1558.8,,629.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",629.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1282,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",629.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",629.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",629.2,1282,
"FUSION OF FOOT BONES",5919665,"CDM ",960,RC,28740,HCPCS,OUTPATIENT,,,1437,1149.6,,580.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",580.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1189,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",580.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",580.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",580.73,1189,
"AMP LEG TIB&FIB 2 CLO/SCAR REV",5919670,"CDM ",960,RC,27884,HCPCS,OUTPATIENT,,,1184,947.2,,445.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",445.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",885,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",445.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",445.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",445.22,885,
"RECONSTRUCT ELBOW MED LGIMNT",5919675,"CDM ",960,RC,24346,HCPCS,OUTPATIENT,,,7811,6248.8,,761.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",761.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1603,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",761.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",761.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",761.12,1603,
"I&D BELOW FASC FOOT MULTIPLE",5919690,"CDM ",960,RC,28003,HCPCS,OUTPATIENT,,,804.5,643.6,,462.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",462.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1022,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",462.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",462.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",462.51,1022,
"EXC TENDON LESION LEG/ANKLE",5919695,"CDM ",960,RC,27630,HCPCS,OUTPATIENT,,,698.5,558.8,,377.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",377.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",778,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",377.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",377.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",377.02,778,
"LAP RMVL GASTR ADJ ALL PARTS",5919700,"CDM ",960,RC,43774,HCPCS,OUTPATIENT,,,1798.5,1438.8,,585.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",585.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1382,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",585.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",585.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",585.61,1382,
"OSTEOTOMY SP 1VRT CERVICAL",5919705,"CDM ",960,RC,22210,HCPCS,OUTPATIENT,,,3344,2675.2,,1298.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1298.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2580,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1298.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1298.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1298.85,2580,
"OSTEOTOMY 1VRT THORACIC",5919710,"CDM ",960,RC,22212,HCPCS,OUTPATIENT,,,2854.5,2283.6,,1066.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1066.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2154,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1066.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1066.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1066.59,2154,
"OSTEOTOMY 1VRT LUMBAR",5919715,"CDM ",960,RC,22214,HCPCS,OUTPATIENT,,,3976.5,3181.2,,1082.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1082.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2151,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1082.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1082.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1082.69,2151,
"OSTEOTOMY EA ADD VRT",5919720,"CDM ",960,RC,22216,HCPCS,OUTPATIENT,,,627,501.6,,269.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",269.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",654,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",269.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",269.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",269.67,654,
"ARTHRD ANT INTRBDY CERV BLW C2",5919730,"CDM ",960,RC,22551,HCPCS,OUTPATIENT,,,4625.5,3700.4,,784.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",784.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2406,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",784.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",784.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",784.58,2406,
"ARTHRD ANT INTRBDY CERV EA ADD",5919735,"CDM ",960,RC,22552,HCPCS,OUTPATIENT,,,1078,862.4,,183.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",555,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",183.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",183.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.05,555,
"ARTHRD ANT INTRBDY CERV BLW C2",5919737,"CDM ",960,RC,22554,HCPCS,OUTPATIENT,,,3580.5,2864.4,,1028.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1028.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2291,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1028.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1028.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1028.19,2291,
"ARTHRD ANT INTRBDY LUMBAR",5919740,"CDM ",960,RC,22558,HCPCS,OUTPATIENT,,,3861,3088.8,,1140.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1140.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2498,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1140.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1140.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,2498,
"ARTHRD ANT INTRBDY EA ADD DISC",5919745,"CDM ",960,RC,22585,HCPCS,OUTPATIENT,,,847,677.6,,246.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",246.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",647,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",246.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",246.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",246.29,647,
"ARTHRD POST 1CRV BLW C2",5919750,"CDM ",960,RC,22600,HCPCS,OUTPATIENT,,,3250.5,2600.4,,901.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",901.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2035,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",901.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",901.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",901.83,2035,
"ARTHRD POST 1VRT CERV BLW C2",5919755,"CDM ",960,RC,22610,HCPCS,OUTPATIENT,,,3360.5,2688.4,,899.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",899.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1985,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",899.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",899.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",899.6,1985,
"ARTHRD POST 1VRT LUMBAR",5919760,"CDM ",960,RC,22612,HCPCS,OUTPATIENT,,,4004,3203.2,,1154.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1154.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2450,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1154.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1154.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1154.73,2450,
"ARTHRD POST EA ADD",5919765,"CDM ",960,RC,22614,HCPCS,OUTPATIENT,,,1001,800.8,,287.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",287.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",709,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",287.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",287.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",287.26,709,
"ARTHRD POST 1VRT LUMBAR",5919770,"CDM ",960,RC,22630,HCPCS,OUTPATIENT,,,3971,3176.8,,1139.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1139.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2313,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1139.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1139.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1139.01,2313,
"ARTHRD POST EA ADD",5919775,"CDM ",960,RC,22632,HCPCS,OUTPATIENT,,,814,651.2,,233.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",233.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",602,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",233.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",233.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",233.48,602,
"ARTHRD COMB 1VRT LUMBAR",5919780,"CDM ",960,RC,22633,HCPCS,OUTPATIENT,,,5065.5,4052.4,,822.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",822.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2586,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",822.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",822.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",822.75,2586,
"ARTHRD COMB EA ADD",5919785,"CDM ",960,RC,22634,HCPCS,OUTPATIENT,,,1358.5,1086.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",702,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",702,702,
"EXPLORE SPINAL FUSION",5919790,"CDM ",960,RC,22830,HCPCS,OUTPATIENT,,,2112,1689.6,,613.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",613.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1365,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",613.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",613.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",613.35,1365,
"INSERT POST SPINE DEVICE",5919795,"CDM ",960,RC,22840,HCPCS,OUTPATIENT,,,2112,1689.6,,561.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",561.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1266,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",561.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",561.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",561.5,1266,
"INSERT POST SPINE DVC 3-6 SG",5919797,"CDM ",960,RC,22842,HCPCS,OUTPATIENT,,,2073.5,1658.8,,561.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",561.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1267,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",561.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",561.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",561.93,1267,
"INSERT POST SPINE DVC 1-12 SG",5919799,"CDM ",960,RC,22843,HCPCS,OUTPATIENT,,,2112,1689.6,,595.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",595.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1332,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",595.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",595.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",595.18,1332,
"INSERT ANT SPINE DEVICE 2-3 SG",5919800,"CDM ",960,RC,22845,HCPCS,OUTPATIENT,,,1870,1496,,536.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",536.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1209,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",536.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",536.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",536.44,1209,
"INSERT ANT SPINE DEVICE 4-7 SG",5919805,"CDM ",960,RC,22846,HCPCS,OUTPATIENT,,,1947,1557.6,,557.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",557.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1257,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",557.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",557.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",557.52,1257,
"INSERT PELVIC FIX DEVICE",5919807,"CDM ",960,RC,22848,HCPCS,OUTPATIENT,,,979,783.2,,266.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",266.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",690,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",266.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",266.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",266.44,690,
"REMOVE POST SPINE FIX DEVICE",5919810,"CDM ",960,RC,22850,HCPCS,OUTPATIENT,,,1760,1408,,539.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",539.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1101,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",539.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",539.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",539.33,1101,
"REMOVE POST FIX DEVICE",5919815,"CDM ",960,RC,22852,HCPCS,OUTPATIENT,,,1721.5,1377.2,,514.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",514.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1112,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",514.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",514.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",514.34,1112,
"INSERT BIOMECH DVC W/ARTHRD",5919820,"CDM ",960,RC,22853,HCPCS,OUTPATIENT,,,621.5,497.2,,162.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",360,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",162.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",162.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.36,360,
"INSERT BIOMECH DVC CORPCT W/AR",5919825,"CDM ",960,RC,22854,HCPCS,OUTPATIENT,,,803,642.4,,210.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",465,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",210.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",210.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.18,465,
"REMOVE ANT SPINE INSTRUMENT",5919830,"CDM ",960,RC,22855,HCPCS,OUTPATIENT,,,2491.5,1993.2,,823,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",823,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1635,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",823,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",823,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8,1635,
"TOTAL DISC ARTHRP ANT 1VRT CRV",5919835,"CDM ",960,RC,22856,HCPCS,OUTPATIENT,,,3899.5,3119.6,,1011.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1011.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2324,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1011.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1011.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1011.58,2324,
"TOTAL DISC ARTHRP ANT 1VRT LUM",5919840,"CDM ",960,RC,22857,HCPCS,OUTPATIENT,,,4306.5,3445.2,,1233.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1233.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2452,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1233.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1233.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1233.4,2452,
"TOTAL DISC ARTHRP ANT 2LVL CRV",5919845,"CDM ",960,RC,22858,HCPCS,OUTPATIENT,,,1193.5,954.8,,374.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",374.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",694,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",374.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",374.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",374.86,694,
"LAMINECTOMY 1 OR 2 VRT CERV",5919850,"CDM ",960,RC,63001,HCPCS,OUTPATIENT,,,3470.5,2776.4,,846.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",846.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2005,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",846.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",846.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",846.24,2005,
"LAMINCTMY W/REMOVE FACETS LUMB",5919855,"CDM ",960,RC,63012,HCPCS,OUTPATIENT,,,2843.5,2274.8,,843.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",843.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1940,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",843.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",843.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",843.53,1940,
"LAMINCTMY REMOVE 2 VRT CERV",5919860,"CDM ",960,RC,63015,HCPCS,OUTPATIENT,,,3630,2904,,1044.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1044.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2449,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1044.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1044.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1044.71,2449,
"LAMINOTOMY DCMP RT 1 CERV",5919865,"CDM ",960,RC,63020,HCPCS,OUTPATIENT,,,2596,2076.8,,817.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",817.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1875,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",817.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",817.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",817.74,1875,
"LAMINOTOMY DCMP RT 1 LUMBAR",5919870,"CDM ",960,RC,63030,HCPCS,OUTPATIENT,,,2409,1927.2,,678.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",678.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2500,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",678.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",678.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",678.37,2500,
"LAMINOTOMY DCMP RT EA ADD",5919875,"CDM ",960,RC,63035,HCPCS,OUTPATIENT,,,500.5,400.4,,142.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",404,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",142.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",142.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.06,404,
"LAMINOTOMY 1VRT LUMBAR",5919880,"CDM ",960,RC,63042,HCPCS,OUTPATIENT,,,3206.5,2565.2,,959.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",959.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2547,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",959.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",959.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",959.55,2547,
"LAMINOTOMY EA ADD LUMBAR",5919885,"CDM ",960,RC,63044,HCPCS,OUTPATIENT,,,671,536.8,,397.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",397.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",801,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",397.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",397.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",397.94,801,
"LAMIN FACECT FORAMOT 1VRT CERV",5919890,"CDM ",960,RC,63045,HCPCS,OUTPATIENT,,,3234,2587.2,,863.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",863.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2142,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",863.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",863.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",863.96,2142,
"LAM FACETEC FORAMOT 1VRT THORC",5919895,"CDM ",960,RC,63046,HCPCS,OUTPATIENT,,,3454,2763.2,,826.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",826.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2076,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",826.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",826.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",826.07,2076,
"LAM FACETEC FORAMOT 1VRT LUMB",5919900,"CDM ",960,RC,63047,HCPCS,OUTPATIENT,,,3247,2597.6,,756.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",756.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1935,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",756.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",756.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",756.25,1935,
"LAM FACETEC FORAMOT EA ADD",5919905,"CDM ",960,RC,63048,HCPCS,OUTPATIENT,,,522.5,418,,152.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",434,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",152.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",152.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.61,434,
"DECOMPRESS SPINAL CORD LUMBAR",5919920,"CDM ",960,RC,63056,HCPCS,OUTPATIENT,,,3800.5,3040.4,,1095.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1095.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2510,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1095.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1095.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1095.84,2510,
"CORPECTOMY ANT DECOMP 1VRT CRV",5919925,"CDM ",960,RC,63081,HCPCS,OUTPATIENT,,,4642,3713.6,,1268.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1268.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2967,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1268.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1268.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1268.16,2967,
"REMOVE THORACOLMBR DCMP LW T/L",5919930,"CDM ",960,RC,63087,HCPCS,OUTPATIENT,,,6000.5,4800.4,,1797.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1797.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",3740,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1797.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1797.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1797.79,3740,
"REMOVE VRT DCMP THRC LUM/SAC",5919935,"CDM ",960,RC,63090,HCPCS,OUTPATIENT,,,4966.5,3973.2,,1424.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1424.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",3400,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1424.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",1424.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1424.94,3400,
"REMOVE VRT THRC LUM/SAC EA",5919940,"CDM ",960,RC,63091,HCPCS,OUTPATIENT,,,467.5,374,,130.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",339,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",130.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",130.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.2,339,
"LAM EXC/EVAC INTRSPNL LES LUMB",5919945,"CDM ",960,RC,63267,HCPCS,OUTPATIENT,,,3448.5,2758.8,,969.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",969.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",2295,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",969.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",969.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",969.92,2295,
"RPR PSINAL FLUID LEAKAGE",5919950,"CDM ",960,RC,63707,HCPCS,OUTPATIENT,,,2722.5,2178,,615.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",615.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1435,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",615.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",615.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",615.43,1435,
"INJ TRANSFORMINAL EPIDURAL",5919955,"CDM ",960,RC,64483,HCPCS,OUTPATIENT,,,668.5,534.8,,280.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",280.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",558,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",280.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",280.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",280.88,558,
"INJ TRANSFRML EPID L/S EA ADD",5919957,"CDM ",960,RC,64484,HCPCS,OUTPATIENT,,,225,180,,134.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",134.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",285,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",134.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",134.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",134.59,285,
"EXC OF TONGUE FOLD",5919960,"CDM ",960,RC,41115,HCPCS,OUTPATIENT,,,642.5,514,,150.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",150.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",354,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",150.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",150.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",150.04,354,
"REPAIR/GRAFT KNEECAP TENDON",5919965,"CDM ",960,RC,27381,HCPCS,OUTPATIENT,,,1939.5,1551.6,,617.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",617.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1279,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",617.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",617.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",617.46,1279,
"REV/RMV IMP SP NPG/R DTCH CONN",5919970,"CDM ",960,RC,63688,HCPCS,OUTPATIENT,,,827.11,661.688,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",689,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",689,689,
"REMOVE SPINE ELTRD PERQ ARAY",5919975,"CDM ",960,RC,63661,HCPCS,OUTPATIENT,,,1687.27,1349.816,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",808,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",808,808,
"REMOVE SPINE ELTRD PLATE",5919980,"CDM ",960,RC,63662,HCPCS,OUTPATIENT,,,1877.12,1501.696,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1082,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1082,1082,
"REMOVE SPINE ELTRD PLATE",5919980,"CDM ",960,RC,63662,HCPCS,OUTPATIENT,,,1877.12,1501.696,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1082,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1082,1082,
"UROGRAPHY ANTEGRADE XRAY",5970000,"CDM ",960,RC,74425,HCPCS,OUTPATIENT,,,36,28.8,,52.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",105,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",52.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.89,105,
"US GUIDE DRAIN W/CATH PLACE",5970005,"CDM ",960,RC,75989,HCPCS,OUTPATIENT,,,310,248,,140.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",279,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",140.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",140.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.55,279,
"FLUOROSCOPY < 1HR PHYS",5970010,"CDM ",960,RC,76000,HCPCS,OUTPATIENT,,,94.5,75.6,,44.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",142,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,446.52,307.90,585.13,"1 through 10",other,"not separately reimbursment ",44.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.75,142,
"US RETROPERITONEEAL COMPLETE",5970013,"CDM ",960,RC,76770,HCPCS,OUTPATIENT,,,236.5,189.2,,94.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",211,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,495.14,165.09,825.18,"1 through 10",other,"not separately reimbursment ",94.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.92,211,
"US RETROPERITONEAL LIMITED",5970015,"CDM ",960,RC,76775,HCPCS,OUTPATIENT,,,190.5,152.4,,74.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",119.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",164,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",74.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",74.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.3,164,
"OB US 0-14 WEEKS SINGLE FETUS",5970020,"CDM ",960,RC,76801,HCPCS,OUTPATIENT,,,323.5,258.8,,116.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",162.34,100,,89.77,89.77,89.77,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",206,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",116.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,75.41,75.41,75.41,"1 through 10",other,"not separately reimbursment ",116.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.17,206,
"OB US 0-14 WEEKS EA ADD FETUS",5970025,"CDM ",960,RC,76802,HCPCS,OUTPATIENT,,,177,141.6,,66.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",134,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",66.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",66.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.78,134,
"OB US > 14 WEEKS SINGLE FETUS",5970030,"CDM ",960,RC,76805,HCPCS,OUTPATIENT,,,362,289.6,,116.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,113.44,113.44,113.44,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",220,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",116.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,93.89,93.89,537.35,"1 through 10",other,"not separately reimbursment ",116.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.17,220,
"OB US > 14 WEEKS EA ADD FETUS",5970035,"CDM ",960,RC,76810,HCPCS,OUTPATIENT,,,242,193.6,,228.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",228.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",393,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",228.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",228.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",228.15,393,
"OB US LMT ONE OR MORE FETUSES",5970040,"CDM ",960,RC,76815,HCPCS,OUTPATIENT,,,223,178.4,,77.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",137,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",77.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,42.88,42.88,42.88,"1 through 10",other,"not separately reimbursment ",77.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.55,137,
"OB US FOLLOW UP EA FETUS",5970045,"CDM ",960,RC,76816,HCPCS,OUTPATIENT,,,281.5,225.2,,68.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",176,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,58.86,55.92,58.86,"1 through 10",other,"not separately reimbursment ",68.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.54,176,
"OB US TRANSVAGINAL",5970050,"CDM ",960,RC,76817,HCPCS,OUTPATIENT,,,252.5,202,,83.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.67,100,,47.43,47.43,47.43,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",153,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",83.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,130.68,130.68,130.68,"1 through 10",other,"not separately reimbursment ",83.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.3,153,
"US TV OB W/TRANSABDOMINAL",5970052,"CDM ",960,RC,76817,HCPCS,OUTPATIENT,,,304.5,243.6,,83.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.67,100,,47.43,47.43,47.43,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",153,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",83.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,130.68,130.68,130.68,"1 through 10",other,"not separately reimbursment ",83.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.3,153,
"FETAL BIOPHY PROF WO NONSTRESS",5970055,"CDM ",960,RC,76819,HCPCS,OUTPATIENT,,,207.5,166,,79.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",158,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",79.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,925.79,925.79,925.79,"1 through 10",other,"not separately reimbursment ",79.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.41,158,
"US TRANSVAGINAL NON OB",5970060,"CDM ",960,RC,76830,HCPCS,OUTPATIENT,,,299,239.2,,84.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",181,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",84.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,607.70,76.05,980.53,"1 through 10",other,"not separately reimbursment ",84.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.83,181,
"US TV PELVIC W/TRANSABDOMINAL",5970062,"CDM ",960,RC,76830,HCPCS,OUTPATIENT,,,356.5,285.2,,84.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",181,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",84.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,607.70,76.05,980.53,"1 through 10",other,"not separately reimbursment ",84.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.83,181,
"US PELVIC COMPLETE NON OB",5970063,"CDM ",960,RC,76856,HCPCS,OUTPATIENT,,,270.5,216.4,,85.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",191,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,974.79,888.14,1061.44,"1 through 10",other,"not separately reimbursment ",85.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.1,191,
"US PELVIC LIMITED",5970065,"CDM ",960,RC,76857,HCPCS,OUTPATIENT,,,246,196.8,,64.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",109.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",141,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",64.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,82.58,82.58,82.58,"1 through 10",other,"not separately reimbursment ",64.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.35,141,
"US SCROTUM / TESTICULAR",5970070,"CDM ",960,RC,76870,HCPCS,OUTPATIENT,,,149.5,119.6,,70.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,118.02,118.02,118.02,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",177,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",70.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,156.14,156.14,156.14,"1 through 10",other,"not separately reimbursment ",70.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.9,177,
"US TRANSRECTAL",5970075,"CDM ",960,RC,76872,HCPCS,OUTPATIENT,,,351,280.8,,87.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",151.19,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",198,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",87.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",87.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8,198,
"US EXTREMITY LIMITED",5970080,"CDM ",960,RC,76882,HCPCS,OUTPATIENT,,,84,67.2,,13.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",79,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",13.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",13.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.92,79,
"US GUIDE VASCULAR ACCESS",5970085,"CDM ",960,RC,76937,HCPCS,OUTPATIENT,,,84,67.2,,25.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.68,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",55,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",25.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,438.33,438.33,438.33,"1 through 10",other,"not separately reimbursment ",25.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.68,55,
"US GUIDE BX INJ ASPIRATION",5970090,"CDM ",960,RC,76942,HCPCS,OUTPATIENT,,,323.5,258.8,,108.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.07,100,,143.86,143.86,143.86,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",281,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",108.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,219.38,219.38,219.38,"1 through 10",other,"not separately reimbursment ",108.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.07,281,
"FLUORO GUIDE VEIN DEVICE",5970095,"CDM ",960,RC,77001,HCPCS,OUTPATIENT,,,247.5,198,,70.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.27,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",161,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",70.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,782.27,782.27,782.27,"1 through 10",other,"not separately reimbursment ",70.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.27,161,
"FLUORO NEEDLE PLACE ADDON",5970100,"CDM ",960,RC,77002,HCPCS,OUTPATIENT,,,157,125.6,,54.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",61.12,100,,24.51,24.51,24.51,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",140,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",54.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",54.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.57,140,
"CT SCAN NEEDLE BIOPSY",5970105,"CDM ",960,RC,77012,HCPCS,OUTPATIENT,,,120,96,,194.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",194.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",473,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",194.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",194.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",194.54,473,
"US JOINT COMPLETE",5970110,"CDM ",960,RC,76881,HCPCS,OUTPATIENT,,,230,184,,53.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",163,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",53.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",53.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5,163,
"XR MANDIBLE/JAW <4V",5970115,"CDM ",960,RC,70100,HCPCS,OUTPATIENT,,,57.5,46,,22.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,280.28,280.28,280.28,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",49,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",22.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.64,49,
"XR MANDIBLE/JAW MIN 4V",5970120,"CDM ",960,RC,70110,HCPCS,OUTPATIENT,,,61,48.8,,28.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",60,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",28.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",28.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.84,60,
"XR PARANASAL SINUS <3 V",5970125,"CDM ",960,RC,70210,HCPCS,OUTPATIENT,,,47.5,38,,23.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",50,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,50,
"XR FACIAL BONES MIN 3V",5970130,"CDM ",960,RC,70150,HCPCS,OUTPATIENT,,,66,52.8,,32.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",67,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",32.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.15,67,
"XR FACIAL BONES <3V",5970135,"CDM ",960,RC,70140,HCPCS,OUTPATIENT,,,43,34.4,,23.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",52,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,3.86,3.86,3.86,"1 through 10",other,"not separately reimbursment ",23.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.64,52,
"XR NASAL BONES MIN 3V",5970140,"CDM ",960,RC,70160,HCPCS,OUTPATIENT,,,56.5,45.2,,23.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.17,47,
"XR PARANASAL SINUS MIN 3V",5970145,"CDM ",960,RC,70220,HCPCS,OUTPATIENT,,,52.5,42,,30.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,70.92,70.92,70.92,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",66,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",30.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.44,66,
"XR SKULL <4V",5970150,"CDM ",960,RC,70250,HCPCS,OUTPATIENT,,,52.5,42,,26.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",56,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",26.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",26.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.85,56,
"XR SKULL MIN 4V",5970155,"CDM ",960,RC,70260,HCPCS,OUTPATIENT,,,60,48,,37.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",80,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",37.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.26,80,
"XR CHEST 1V AP/PA",5970160,"CDM ",960,RC,71045,HCPCS,OUTPATIENT,,,31.5,25.2,,12.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,17.44,17.44,17.44,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,311.35,85.32,389.19,"1 through 10",other,"not separately reimbursment ",12.03,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,34,
"XR CHEST 2V AP/PA LAT",5970165,"CDM ",960,RC,71046,HCPCS,OUTPATIENT,,,44,35.2,,18.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",43,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",18.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,170.90,60.28,497.81,12,other,"not separately reimbursment ",18.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.48,43,
"XR RIBS BILAT 3V",5970170,"CDM ",960,RC,71110,HCPCS,OUTPATIENT,,,57.5,46,,31.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",68,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",31.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",31.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.62,68,
"XR RIBS BILAT MIN 4V",5970175,"CDM ",960,RC,71111,HCPCS,OUTPATIENT,,,71.5,57.2,,38.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,220.25,220.25,220.25,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",81,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",38.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",38.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.94,81,
"XR STERNUM MIN 2V",5970180,"CDM ",960,RC,71120,HCPCS,OUTPATIENT,,,46,36.8,,25.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",54,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",25.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",25.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.63,54,
"XR STERNOCLAVICULAR JNT 3V",5970185,"CDM ",960,RC,71130,HCPCS,OUTPATIENT,,,60,48,,28.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,288.15,288.15,288.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",59,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",28.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",28.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.17,59,
"XR SOFT TISSUE NECK",5970190,"CDM ",960,RC,70360,HCPCS,OUTPATIENT,,,43,34.4,,19.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",40,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.82,40,
"XR CERVICAL SPINE 2-3V",5970195,"CDM ",960,RC,72040,HCPCS,OUTPATIENT,,,54.5,43.6,,27.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,153.06,153.06,153.06,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",56,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",27.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,230.12,98.72,361.52,"1 through 10",other,"not separately reimbursment ",27.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,56,
"XR THORACIC SPINE 3V",5970200,"CDM ",960,RC,72072,HCPCS,OUTPATIENT,,,54.5,43.6,,28.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",60,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",28.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,48.59,48.59,48.59,"1 through 10",other,"not separately reimbursment ",28.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.93,60,
"XR LUMBOSACRAL 2-3V",5970205,"CDM ",960,RC,72100,HCPCS,OUTPATIENT,,,55.5,44.4,,28.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,11.60,11.60,11.60,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",58,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",28.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,246.43,52.74,487.03,"1 through 10",other,"not separately reimbursment ",28.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.45,58,
"XR LUMBOSACRAL MIN 4V",5970210,"CDM ",960,RC,72110,HCPCS,OUTPATIENT,,,73.5,58.8,,39.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",116,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",39.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,76.96,76.96,76.96,"1 through 10",other,"not separately reimbursment ",39.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.73,116,
"XR SACROILIAC JOINTS MIN 3V",5970215,"CDM ",960,RC,72202,HCPCS,OUTPATIENT,,,57.5,46,,26.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,138.82,138.82,138.82,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",54,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",26.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",26.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.15,54,
"XR PELVIS 1-2V",5970220,"CDM ",960,RC,72170,HCPCS,OUTPATIENT,,,37,29.6,,20.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",49,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,403.85,403.85,403.85,"1 through 10",other,"not separately reimbursment ",20.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.38,49,
"XR SACRUM COCCYX MIN 2V",5970225,"CDM ",960,RC,72220,HCPCS,OUTPATIENT,,,45,36,,22.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",22.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.73,47,
"XR AC JOINT BILAT",5970230,"CDM ",960,RC,73050,HCPCS,OUTPATIENT,,,37,29.6,,27.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",56,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",27.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",27.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,56,
"XR ABDOMEN FLAT 1V",5970235,"CDM ",960,RC,74018,HCPCS,OUTPATIENT,,,40,32,,16.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",39,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",16.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,195.25,195.25,195.25,"1 through 10",other,"not separately reimbursment ",16.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.51,39,
"XR ABDOMEN 2V",5970240,"CDM ",960,RC,74019,HCPCS,OUTPATIENT,,,49.5,39.6,,20.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.2,47,
"XR SPINE 1V",5970245,"CDM ",960,RC,72020,HCPCS,OUTPATIENT,,,32.5,26,,17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",37,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.8,37,
"XR C SPINE 6 OR MORE VIEWS",5970250,"CDM ",960,RC,72052,HCPCS,OUTPATIENT,,,92,73.6,,48.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",99,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",48.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",48.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.48,99,
"XR ORBITS COMPLETE MIN 4V",5970255,"CDM ",960,RC,70200,HCPCS,OUTPATIENT,,,67,53.6,,33.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",68,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",33.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.33,68,
"XR RIBS RT",5970260,"CDM ",960,RC,71100,HCPCS,OUTPATIENT,,,49.5,39.6,,24.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,9.47,9.47,9.47,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",51,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,225.57,97.81,360.61,"1 through 10",other,"not separately reimbursment ",24.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.55,51,
"XR UNILAT RIBS/CHEST MIN 3V",5970265,"CDM ",960,RC,71101,HCPCS,OUTPATIENT,,,55.5,44.4,,29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",62,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,93.43,93.43,93.43,"1 through 10",other,"not separately reimbursment ",29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.76,62,
"XR CLAVICLE COMPLETE",5970270,"CDM ",960,RC,73000,HCPCS,OUTPATIENT,,,46,36.8,,20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.62,42,
"XR SCAPULA COMPLETE",5970275,"CDM ",960,RC,73010,HCPCS,OUTPATIENT,,,28.5,22.8,,21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",44,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.5,44,
"XR SHOULDER RT 2V",5970280,"CDM ",960,RC,73030,HCPCS,OUTPATIENT,,,47.5,38,,22.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,52.33,24.42,80.23,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",52,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,323.08,125.15,387.70,"1 through 10",other,"not separately reimbursment ",22.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.77,52,
"XR HUMERUS RT MIN 2V",5970285,"CDM ",960,RC,73060,HCPCS,OUTPATIENT,,,46,36.8,,22.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,65.87,61.95,81.55,"1 through 10",other,"not separately reimbursment ",22.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.45,47,
"XR ELBOW RT 2V",5970290,"CDM ",960,RC,73070,HCPCS,OUTPATIENT,,,40,32,,20.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,46.65,15.59,77.71,"1 through 10",other,"not separately reimbursment ",20.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.3,42,
"XR ELBOW RT MIN 3V",5970295,"CDM ",960,RC,73080,HCPCS,OUTPATIENT,,,45,36,,24.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,154.12,154.12,154.12,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",50,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,141.07,141.07,141.07,"1 through 10",other,"not separately reimbursment ",24.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.96,50,
"XR FOREARM RT 2V",5970300,"CDM ",960,RC,73090,HCPCS,OUTPATIENT,,,41,32.8,,20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,126.68,126.68,126.68,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,146.97,36.80,330.06,"1 through 10",other,"not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.62,42,
"XR WRIST LT 2V",5970302,"CDM ",960,RC,73100,HCPCS,OUTPATIENT,,,52.5,42,,20.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",43,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.9,43,
"XR WRIST RT 2V",5970303,"CDM ",960,RC,73100,HCPCS,OUTPATIENT,,,52.5,42,,20.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",43,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.9,43,
"XR WRIST RT MIN 3V",5970305,"CDM ",960,RC,73110,HCPCS,OUTPATIENT,,,62,49.6,,24.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",52,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,122.02,33.24,351.91,"1 through 10",other,"not separately reimbursment ",24.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.28,52,
"XR WRIST LT 3V",5970306,"CDM ",960,RC,73110,HCPCS,OUTPATIENT,,,62,49.6,,24.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",52,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,122.02,33.24,351.91,"1 through 10",other,"not separately reimbursment ",24.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.28,52,
"XR HAND RT MIN 3V",5970310,"CDM ",960,RC,73130,HCPCS,OUTPATIENT,,,53.5,42.8,,22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,85.47,85.47,85.47,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,75.67,46.84,355.39,"1 through 10",other,"not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.88,46,
"XR FINGER LFT 5TH DIGIT",5970315,"CDM ",960,RC,73140,HCPCS,OUTPATIENT,,,59,47.2,,19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,47,
"XR FINGER LFT 4TH DIGIT",5970320,"CDM ",960,RC,73140,HCPCS,OUTPATIENT,,,59,47.2,,19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,47,
"XR FINGER LFT 3RD DIGIT",5970325,"CDM ",960,RC,73140,HCPCS,OUTPATIENT,,,59,47.2,,19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,47,
"XR FINGER RT 1ST DIGIT",5970330,"CDM ",960,RC,73140,HCPCS,OUTPATIENT,,,59,47.2,,19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,47,
"XR FINGER LT 2ND DIGIT",5970335,"CDM ",960,RC,73140,HCPCS,OUTPATIENT,,,59,47.2,,19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,47,
"XR FINGER RT 3RD DIGIT",5970340,"CDM ",960,RC,73140,HCPCS,OUTPATIENT,,,59,47.2,,19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,47,
"XR FINGER RT 4TH DIGIT",5970345,"CDM ",960,RC,73140,HCPCS,OUTPATIENT,,,59,47.2,,19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,47,
"XR FINGER RT 5TH DIGIT",5970350,"CDM ",960,RC,73140,HCPCS,OUTPATIENT,,,59,47.2,,19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,47,
"XR HIP RT 2-3V W/PELVIS",5970355,"CDM ",960,RC,73502,HCPCS,OUTPATIENT,,,69,55.2,,24.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",55,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.97,60.97,60.97,"1 through 10",other,"not separately reimbursment ",24.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.78,55,
"XR HIP RT 4+V +- PELVIS",5970357,"CDM ",960,RC,73503,HCPCS,OUTPATIENT,,,90,72,,30.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",69,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.73,77.31,82.65,"1 through 10",other,"not separately reimbursment ",30.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.93,69,
"XR FEMUR RT 2V",5970360,"CDM ",960,RC,73552,HCPCS,OUTPATIENT,,,50.5,40.4,,19.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",43,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,59.51,59.51,59.51,"1 through 10",other,"not separately reimbursment ",19.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.43,43,
"XR KNEE RT 4V",5970365,"CDM ",960,RC,73564,HCPCS,OUTPATIENT,,,67,53.6,,28.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",71,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",28.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,88.53,41.62,278.54,"1 through 10",other,"not separately reimbursment ",28.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.45,71,
"XR KNEE RT 1 OR 2V",5970370,"CDM ",960,RC,73560,HCPCS,OUTPATIENT,,,50.5,40.4,,21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",50,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,158.93,80.56,237.29,"1 through 10",other,"not separately reimbursment ",21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.5,50,
"XR LOW LEG RT 2V",5970375,"CDM ",960,RC,73590,HCPCS,OUTPATIENT,,,45,36,,20.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",43,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.94,43,
"XR LOW LEG INFANT RT MIN 2V",5970380,"CDM ",960,RC,73592,HCPCS,OUTPATIENT,,,45,36,,20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",44,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.62,44,
"XR ANKLE RT 2V",5970383,"CDM ",960,RC,73600,HCPCS,OUTPATIENT,,,47.5,38,,20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.34,41,
"XR ANKLE LT 2V",5970384,"CDM ",960,RC,73600,HCPCS,OUTPATIENT,,,47.5,38,,20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.34,41,
"XR ANKLE RT MIN 3V",5970385,"CDM ",960,RC,73610,HCPCS,OUTPATIENT,,,54.5,43.6,,22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",53,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.88,53,
"XR FOOT RT MIN 3V",5970390,"CDM ",960,RC,73630,HCPCS,OUTPATIENT,,,50.5,40.4,,22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",52,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,377.99,128.29,377.99,"1 through 10",other,"not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.88,52,
"XR CALCANEUS/HEEL RT MIN 3V",5970395,"CDM ",960,RC,73650,HCPCS,OUTPATIENT,,,40,32,,19.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",40,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.79,40,
"XR CALACANEUS/HEEL LT MIN 3V",5970398,"CDM ",960,RC,73650,HCPCS,OUTPATIENT,,,40,32,,19.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",40,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.79,40,
"XR TOE MIN 2V LT 2ND DIGIT",5970400,"CDM ",960,RC,73660,HCPCS,OUTPATIENT,,,43,34.4,,19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.51,64.51,64.51,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,42,
"XR TOE MIN 2V LT 3RD DIGIT",5970405,"CDM ",960,RC,73660,HCPCS,OUTPATIENT,,,43,34.4,,19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.51,64.51,64.51,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,42,
"XR TOE MIN 2V LT 4TH DIGIT",5970410,"CDM ",960,RC,73660,HCPCS,OUTPATIENT,,,43,34.4,,19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.51,64.51,64.51,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,42,
"XR TOE MIN 2V LT 5TH DIGIT",5970415,"CDM ",960,RC,73660,HCPCS,OUTPATIENT,,,43,34.4,,19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.51,64.51,64.51,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,42,
"XR TOE MIN 2V RT 1ST DIGIT",5970420,"CDM ",960,RC,73660,HCPCS,OUTPATIENT,,,43,34.4,,19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.51,64.51,64.51,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,42,
"XR TOE RT 2ND DIGIT",5970425,"CDM ",960,RC,73660,HCPCS,OUTPATIENT,,,43,34.4,,19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.51,64.51,64.51,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,42,
"XR TOE RT 3RD DIGIT",5970430,"CDM ",960,RC,73660,HCPCS,OUTPATIENT,,,43,34.4,,19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.51,64.51,64.51,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,42,
"XR TOE RT 4TH DIGIT",5970435,"CDM ",960,RC,73660,HCPCS,OUTPATIENT,,,43,34.4,,19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.51,64.51,64.51,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,42,
"XR TOE RT 5TH DIGIT",5970440,"CDM ",960,RC,73660,HCPCS,OUTPATIENT,,,43,34.4,,19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.51,64.51,64.51,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,42,
"XR LOW LEG INFANT LT MIN 2V",5970445,"CDM ",960,RC,73592,HCPCS,OUTPATIENT,,,45,36,,20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",44,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.62,44,
"XR FINGER LT 1ST DIGIT",5970465,"CDM ",960,RC,73140,HCPCS,OUTPATIENT,,,59,47.2,,19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,47,
"XR LOW LEG LT 2V",5970470,"CDM ",960,RC,73590,HCPCS,OUTPATIENT,,,45,36,,20.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",43,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.94,43,
"XR TOE LT 1ST DIGIT",5970475,"CDM ",960,RC,73660,HCPCS,OUTPATIENT,,,43,34.4,,19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.51,64.51,64.51,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.4,42,
"XR CALCANEUS/HEEL LT MIN 2V",5970480,"CDM ",960,RC,73650,HCPCS,OUTPATIENT,,,40,32,,19.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",40,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.79,40,
"XR KNEE LT 1 OR 2V",5970485,"CDM ",960,RC,73560,HCPCS,OUTPATIENT,,,50.5,40.4,,21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",50,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,158.93,80.56,237.29,"1 through 10",other,"not separately reimbursment ",21.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.5,50,
"XR FOOT LT MIN 3V",5970490,"CDM ",960,RC,73630,HCPCS,OUTPATIENT,,,50.5,40.4,,22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",52,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,377.99,128.29,377.99,"1 through 10",other,"not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.88,52,
"XR FOOT LT 2V",5970491,"CDM ",960,RC,73620,HCPCS,OUTPATIENT,,,42,33.6,,20.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,41,
"XR FOOT RT 2V",5970493,"CDM ",960,RC,73620,HCPCS,OUTPATIENT,,,42,33.6,,20.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,41,
"XR KNEE LT 4V",5970495,"CDM ",960,RC,73564,HCPCS,OUTPATIENT,,,67,53.6,,28.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",71,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",28.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,88.53,41.62,278.54,"1 through 10",other,"not separately reimbursment ",28.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.45,71,
"XR HIP LT 2-3V W/PELVIS",5970500,"CDM ",960,RC,73502,HCPCS,OUTPATIENT,,,69,55.2,,24.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",55,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.97,60.97,60.97,"1 through 10",other,"not separately reimbursment ",24.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.78,55,
"XR HIP LT 4+V +- PELVIS",5970502,"CDM ",960,RC,73503,HCPCS,OUTPATIENT,,,90,72,,30.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",69,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.73,77.31,82.65,"1 through 10",other,"not separately reimbursment ",30.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.93,69,
"XR HAND RT 2V",5970503,"CDM ",960,RC,73120,HCPCS,OUTPATIENT,,,47.5,38,,20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,99.64,99.64,99.64,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.34,41,
"XR HAND LT 2V",5970504,"CDM ",960,RC,73120,HCPCS,OUTPATIENT,,,47.5,38,,20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,99.64,99.64,99.64,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.34,41,
"XR HAND LT MIN 3V",5970505,"CDM ",960,RC,73130,HCPCS,OUTPATIENT,,,53.5,42.8,,22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,85.47,85.47,85.47,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,75.67,46.84,355.39,"1 through 10",other,"not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.88,46,
"XR FOREARM LT 2V",5970510,"CDM ",960,RC,73090,HCPCS,OUTPATIENT,,,41,32.8,,20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,126.68,126.68,126.68,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,146.97,36.80,330.06,"1 through 10",other,"not separately reimbursment ",20.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.62,42,
"XR HUMERUS LT 2V",5970515,"CDM ",960,RC,73060,HCPCS,OUTPATIENT,,,46,36.8,,22.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,65.87,61.95,81.55,"1 through 10",other,"not separately reimbursment ",22.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.45,47,
"XR FEMUR LT 2V",5970520,"CDM ",960,RC,73552,HCPCS,OUTPATIENT,,,50.5,40.4,,19.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",43,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,59.51,59.51,59.51,"1 through 10",other,"not separately reimbursment ",19.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.43,43,
"XR FINGER LT 2ND DIGIT",5970525,"CDM ",960,RC,73140,HCPCS,OUTPATIENT,,,59,47.2,,19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.95,47,
"XR ELBOW LT 2V",5970530,"CDM ",960,RC,73080,HCPCS,OUTPATIENT,,,40,32,,24.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,154.12,154.12,154.12,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",50,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,141.07,141.07,141.07,"1 through 10",other,"not separately reimbursment ",24.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.96,50,
"XR ELBOW LT MIN 3V",5970535,"CDM ",960,RC,73080,HCPCS,OUTPATIENT,,,45,36,,24.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,154.12,154.12,154.12,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",50,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,141.07,141.07,141.07,"1 through 10",other,"not separately reimbursment ",24.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.96,50,
"XR ANKLE LT MIN 3V",5970545,"CDM ",960,RC,73610,HCPCS,OUTPATIENT,,,54.5,43.6,,22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",53,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.88,53,
"XR LUMBOSACRAL BENDING ONLY",5970550,"CDM ",960,RC,72120,HCPCS,OUTPATIENT,,,57.5,46,,35.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",72,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",35.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",35.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.53,72,
"XR KNEE LT 3V",5970555,"CDM ",960,RC,73562,HCPCS,OUTPATIENT,,,60,48,,24.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",57,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,413.76,413.76,413.76,"1 through 10",other,"not separately reimbursment ",24.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.99,57,
"XR KNEE RT 3V",5970560,"CDM ",960,RC,73562,HCPCS,OUTPATIENT,,,60,48,,24.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",57,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,413.76,413.76,413.76,"1 through 10",other,"not separately reimbursment ",24.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.99,57,
"XR PELVIS MIN 3V",5970565,"CDM ",960,RC,72190,HCPCS,OUTPATIENT,,,56.5,45.2,,28.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,3.12,3.12,3.12,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",58,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",28.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",28.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.69,58,
"XR UP LEG INFANT LFT",5970570,"CDM ",960,RC,73092,HCPCS,OUTPATIENT,,,45,36,,20.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.64,46,
"XR UP LEG INFANT RT",5970575,"CDM ",960,RC,73092,HCPCS,OUTPATIENT,,,45,36,,20.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.64,46,
"XR ABDOMEN UPRIGHT ONLY",5970580,"CDM ",960,RC,74018,HCPCS,OUTPATIENT,,,40,32,,16.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",39,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",16.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,195.25,195.25,195.25,"1 through 10",other,"not separately reimbursment ",16.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.51,39,
"XR THORACIC SPINE MIN 4V",5970585,"CDM ",960,RC,72074,HCPCS,OUTPATIENT,,,63,50.4,,34.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,141.67,141.67,141.67,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",71,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",34.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.14,71,
"XR KNEE BILAT WEIGHT ONLY",5970590,"CDM ",960,RC,73565,HCPCS,OUTPATIENT,,,62,49.6,,22.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,131.24,131.24,131.24,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,270.67,270.67,270.67,"1 through 10",other,"not separately reimbursment ",22.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,51,
"US HEAD/NECK",5970595,"CDM ",960,RC,76536,HCPCS,OUTPATIENT,,,178,142.4,,64.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,239.51,239.51,239.51,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",171,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",64.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,621.67,235.67,699.38,"1 through 10",other,"not separately reimbursment ",64.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.11,171,
"US BREAST LIMITED",5970600,"CDM ",960,RC,76642,HCPCS,OUTPATIENT,,,109.5,87.6,,53.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,87.47,84.70,90.23,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",121,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",53.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,186.19,156.40,186.19,"1 through 10",other,"not separately reimbursment ",53.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.48,121,
"OB US DETAIL SINGLE FETUS",5970605,"CDM ",960,RC,76811,HCPCS,OUTPATIENT,,,379.5,303.6,,189.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",189.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",377,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",189.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",189.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",189.04,377,
"OB US DETAIL EA ADD FETUS",5970607,"CDM ",960,RC,76812,HCPCS,OUTPATIENT,,,241.5,193.2,,114.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",313,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",114.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",114.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.4,313,
"US ABDOMINAL COMPLETE",5970610,"CDM ",960,RC,76700,HCPCS,OUTPATIENT,,,167,133.6,,98.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,36.27,36.27,36.27,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",215,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",98.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,733.16,733.16,733.16,"1 through 10",other,"not separately reimbursment ",98.69,100,,82.57,82.57,82.57,"1 through 10","fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.69,215,
"US ABDOMINAL LIMITED",5970615,"CDM ",960,RC,76705,HCPCS,OUTPATIENT,,,126.5,101.2,,73.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",168,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",73.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,871.19,418.96,1008.33,"1 through 10",other,"not separately reimbursment ",73.78,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.78,168,
"US VENOUS EXT BILATERAL",5970620,"CDM ",960,RC,93970,HCPCS,OUTPATIENT,,,460,368,,177.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",355,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",177.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,230.63,230.63,230.63,"1 through 10",other,"not separately reimbursment ",177.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.19,355,
"US VENOUS EXT UNILAT RIGHT",5970625,"CDM ",960,RC,93971,HCPCS,OUTPATIENT,,,291,232.8,,120.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",243,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",120.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,21.07,21.07,21.07,"1 through 10",other,"not separately reimbursment ",120.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.45,243,
"US VENOUS EXT UNILAT LEFT",5970630,"CDM ",960,RC,93971,HCPCS,OUTPATIENT,,,291,232.8,,120.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",243,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",120.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,21.07,21.07,21.07,"1 through 10",other,"not separately reimbursment ",120.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.45,243,
"US CAROTID DOPPLER BILATERAL",5970635,"CDM ",960,RC,93880,HCPCS,OUTPATIENT,,,430.18,344.144,,181.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",181.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",367,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",181.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,143.99,32.76,744.51,"1 through 10",other,"not separately reimbursment ",181.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",181.66,367,
"URINALYSIS AUTO WITH MICRO",5980000,"CDM ",960,RC,81001,HCPCS,OUTPATIENT,,,38.5,30.8,,4.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",4.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,73.31,3.00,104.73,29,other,"not separately reimbursment ",4.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.37,15,
"URINALYSIS NON AUTOMATED",5980005,"CDM ",960,RC,81002,HCPCS,OUTPATIENT,,,16,12.8,,3.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.17,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",6.5,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,3.42,3.42,3.47,13,other,"not separately reimbursment ",3.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.01,6.5,
"URINALYSIS AUTOMATED",5980010,"CDM ",960,RC,81003,HCPCS,OUTPATIENT,,,16,12.8,,1.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4.66,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,7.08,7.08,7.08,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,43.45,2.21,54.31,33,other,"not separately reimbursment ",1.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,8,
"URINE PREGNANCY TEST",5980015,"CDM ",960,RC,81025,HCPCS,OUTPATIENT,,,27.5,22,,7.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.75,100,,6.20,6.20,6.20,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",20,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",7.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,130.34,86.68,162.92,"1 through 10",other,"not separately reimbursment ",7.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.43,20,
"OCCULT BLOOD FECES",5980020,"CDM ",960,RC,82270,HCPCS,OUTPATIENT,,,10,8,,3.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",9,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,10.94,4.30,51.43,"1 through 10",other,"not separately reimbursment ",3.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.82,9,
"BLOOD OCCULT BY PEROXIDASE",5980025,"CDM ",960,RC,82272,HCPCS,OUTPATIENT,,,11,8.8,,3.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",8,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",3.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.86,8,
"BLOOD OCCULT ASSAY",5980030,"CDM ",960,RC,82274,HCPCS,OUTPATIENT,,,11,8.8,,3.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",38,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",3.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.82,38,
"GLUCOSE FASTING",5980035,"CDM ",960,RC,82947,HCPCS,OUTPATIENT,,,27.5,22,,4.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",12,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",4.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.65,40.33,64.65,"1 through 10",other,"not separately reimbursment ",4.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.61,12,
"BLOOD GLUCOSE REAGENT STRIP",5980040,"CDM ",960,RC,82948,HCPCS,OUTPATIENT,,,17,13.6,,1.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,51.00,51.00,51.00,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",8,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.65,29.81,93.10,"1 through 10",other,"not separately reimbursment ",1.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.58,8,
"GLUCOSE BLOOD TEST",5980045,"CDM ",960,RC,82948,HCPCS,OUTPATIENT,,,17,13.6,,1.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,51.00,51.00,51.00,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",8,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,64.65,29.81,93.10,"1 through 10",other,"not separately reimbursment ",1.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.58,8,
A1C,5980050,"CDM ",960,RC,83037,HCPCS,OUTPATIENT,,,34,27.2,,11.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,13.24,13.24,13.24,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",32,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",11.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,9.71,9.56,9.71,"1 through 10",other,"not separately reimbursment ",11.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.53,32,
"HEMOGLOBIN (HGB)",5980055,"CDM ",960,RC,85018,HCPCS,OUTPATIENT,,,8,6.4,,1.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",7,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,2.37,1.90,14.74,11,other,"not separately reimbursment ",1.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.31,7,
PROTIME/INR,5980060,"CDM ",960,RC,85610,HCPCS,OUTPATIENT,,,11,8.8,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",12,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,50.34,4.21,62.93,"1 through 10",other,"not separately reimbursment ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.25,12,
"HPYLORI IGG ANTIBODIES",5980065,"CDM ",960,RC,86318,HCPCS,OUTPATIENT,,,42,33.6,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,22.00,22.00,22.00,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",31,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,31,
"TB SKIN TEST 01 ML",5980070,"CDM ",960,RC,86580,HCPCS,OUTPATIENT,,,17,13.6,,5.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",5.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",5.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.97,15,
KOH,5980075,"CDM ",960,RC,87220,HCPCS,OUTPATIENT,,,24,19.2,,3.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",14,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",3.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3,14,
"STREP A",5980080,"CDM ",960,RC,87430,HCPCS,OUTPATIENT,,,102,81.6,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,41,
"INFLUENZA A & B SWAB",5980085,"CDM ",960,RC,87804,HCPCS,OUTPATIENT,,,48.5,38.8,,14.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.81,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",14.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",14.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.89,41,
"RSV SWAB",5980090,"CDM ",960,RC,87807,HCPCS,OUTPATIENT,,,30.5,24.4,,14.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.51,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",29,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",14.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,7.08,6.45,7.70,"1 through 10",other,"not separately reimbursment ",14.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.25,29,
"RAPID STREP",5980095,"CDM ",960,RC,87880,HCPCS,OUTPATIENT,,,61.5,49.2,,7.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.39,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",7.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",7.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7,41,
"SARS COV2 RNA QLT RT PCR",5980100,"CDM ",960,RC,87635,HCPCS,OUTPATIENT,,,144,115.2,,43.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,50.29,48.84,128.07,"1 through 10",other,"not separately reimbursment ",43.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.61,43.61,
"MONO TEST SURE VUE",5980105,"CDM ",960,RC,86308,HCPCS,OUTPATIENT,,,17,13.6,,7.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,109.48,109.48,109.48,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",7.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,138.78,31.07,138.78,"1 through 10",other,"not separately reimbursment ",7.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.15,15,
"INFLUENZA A&B RAPID ID NOW",5980110,"CDM ",960,RC,87502,HCPCS,OUTPATIENT,,,184,147.2,,101.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",175,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",101.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,57.48,45.67,106.34,"1 through 10",other,"not separately reimbursment ",101.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.79,175,
"STREP A RAPID ID NOW",5980115,"CDM ",960,RC,87651,HCPCS,OUTPATIENT,,,86.5,69.2,,10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,35.09,30.36,96.48,"1 through 10",other,"not separately reimbursment ",10,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,85,
"RSV RAPID ID NOW",5980120,"CDM ",960,RC,87634,HCPCS,OUTPATIENT,,,82.5,66,,73.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,99.95,59.27,173.69,"1 through 10",other,"not separately reimbursment ",73.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.76,73.76,
"CYTO EXAM LEVEL 4",5980125,"CDM ",960,RC,88305,HCPCS,OUTPATIENT,,,287.5,230,,77.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",183,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",77.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",77.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.13,183,
"SPECIAL STAIN GPI",5980130,"CDM ",960,RC,88312,HCPCS,OUTPATIENT,,,125.5,100.4,,68.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",143,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",68.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.69,143,
"GLUCOSE POST GLUGOSE DOSE",5980135,"CDM ",960,RC,82950,HCPCS,OUTPATIENT,,,16,12.8,,6.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",6.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,4.75,4.75,4.75,"1 through 10",other,"not separately reimbursment ",6.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.57,15,
"GLUCOSE TOLEANCE 3 SPC",5980140,"CDM ",960,RC,82951,HCPCS,OUTPATIENT,,,37,29.6,,17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",35,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,125.42,125.42,125.42,"1 through 10",other,"not separately reimbursment ",17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.8,35,
"GLUCOSE TOL EA ADD > 3SPC",5980145,"CDM ",960,RC,82952,HCPCS,OUTPATIENT,,,10.5,8.4,,5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",10,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",5.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.25,10,
"ENDOSCOPY CAPSULE",6007611,"CDM ",271,RC,99070,HCPCS,OUTPATIENT,,,1008.54,806.832,,7.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",705.98,70,,564.78,,,0,"percent of total billed charges ","70% of total billed charges ",907.69,90,,726.15,,,0,"percent of total billed charges ","90% of total billed charges ",937.94,93,,750.35,,,0,"percent of total billed charges ","93% of total billed charges ",7.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.61,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",857.26,85,,685.81,,,0,"percent of total billed charges ","85% of total billed charges ",907.69,90,,726.15,,,0,"percent of total billed charges ","90% of total billed charges ",907.69,90,,726.15,,,0,"percent of total billed charges ","90% of total billed charges ",6.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",877.43,87,,701.94,,,0,"percent of total billed charges ","87% of total billed charges ",6.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",705.98,70,,564.78,,,0,"percent of total billed charges ","70% of total billed charges ",6.54,937.94,
"KNEE FEMORAL LPS H-LT",6102414,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,3618.5,2894.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2532.95,70,,2026.36,,,0,"percent of total billed charges ","70% of total billed charges ",3256.65,90,,2605.32,,,0,"percent of total billed charges ","90% of total billed charges ",3365.21,93,,2692.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3075.73,85,,2460.58,,,0,"percent of total billed charges ","85% of total billed charges ",3075.73,85,,2460.58,,,0,"percent of total billed charges ","85% of total billed charges ",3256.65,90,,2605.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3148.1,87,,2518.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2532.95,70,,2026.36,,,0,"percent of total billed charges ","70% of total billed charges ",2532.95,3365.21,
"KNEE FEMORAL LPS H-LT",6102414,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,3618.5,2894.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2532.95,70,,2026.36,,,0,"percent of total billed charges ","70% of total billed charges ",3256.65,90,,2605.32,,,0,"percent of total billed charges ","90% of total billed charges ",3365.21,93,,2692.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3075.73,85,,2460.58,,,0,"percent of total billed charges ","85% of total billed charges ",3075.73,85,,2460.58,,,0,"percent of total billed charges ","85% of total billed charges ",3256.65,90,,2605.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3148.1,87,,2518.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2532.95,70,,2026.36,,,0,"percent of total billed charges ","70% of total billed charges ",2532.95,3365.21,
"STENT SOFT-FLEX 7X26",6104224,"CDM ",278,RC,C2617,HCPCS,OUTPATIENT,,,377,301.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.9,70,,211.12,,,0,"percent of total billed charges ","70% of total billed charges ",339.3,90,,271.44,,,0,"percent of total billed charges ","90% of total billed charges ",350.61,93,,280.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",320.45,85,,256.36,,,0,"percent of total billed charges ","85% of total billed charges ",320.45,85,,256.36,,,0,"percent of total billed charges ","85% of total billed charges ",339.3,90,,271.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",327.99,87,,262.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.9,70,,211.12,,,0,"percent of total billed charges ","70% of total billed charges ",263.9,350.61,
"ART SURF MC CD 6-7 LT 10MM",6106602,"CDM ",278,RC,C1776,HCPCS,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"SCR COMP 2.4 X 40MM PT SHRT",6109647,"CDM ",278,RC,C1713,HCPCS,OUTPATIENT,,,737.01,589.608,,,,,,,,0,"other ","not separately reimbursment ",,,,714.91,714.91,714.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",685.42,93,,548.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",626.46,85,,501.17,,,0,"percent of total billed charges ","85% of total billed charges ",663.31,90,,530.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",641.2,87,,3120.78,3120.78,3120.78,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",515.91,70,,412.73,,,0,"percent of total billed charges ","70% of total billed charges ",515.91,685.42,
"ANESTH OUTPT CONSULT LEVEL 2",6400020,"CDM ",960,RC,99242,HCPCS,OUTPATIENT,,,172.5,138,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",125,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125,125,
"ANESTH OUTPT CONSULT LEVEL 3",6400030,"CDM ",960,RC,99243,HCPCS,OUTPATIENT,,,237.5,190,,,,,,,,0,"other ","not separately reimbursment ",,,,125.31,125.31,125.31,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",177,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177,177,
"ANESTH OUTPT CONSULT LEVEL 4",6400040,"CDM ",960,RC,99244,HCPCS,OUTPATIENT,,,347,277.6,,,,,,,,0,"other ","not separately reimbursment ",136.06,100,,184.86,184.86,184.86,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",252,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136.06,252,
"ANESTH OUTPT CONSULT LEVEL 5",6400050,"CDM ",960,RC,99245,HCPCS,OUTPATIENT,,,374,299.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",309,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",309,309,
"ZERO DOLLAR CHARGE ANESTH",6400070,"CDM ",960,RC,103,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH BLEPHAROPLASTY",6400073,"CDM ",963,RC,103,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH SALIVARY GLAND W/BX",6400075,"CDM ",963,RC,100,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH PROC EXT MIDDLE IN EAR",6400080,"CDM ",963,RC,124,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH NOSE/SINUS NOS",6400090,"CDM ",963,RC,160,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH INTRAORAL PROCEDURE",6400100,"CDM ",963,RC,170,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH PROC FACIAL BONES/SKULL",6400110,"CDM ",963,RC,190,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH HEAD/NECK/POST TRUNK",6400120,"CDM ",963,RC,300,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH NECK > 1YR",6400130,"CDM ",963,RC,320,HCPCS,OUTPATIENT,,,,,,127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",127.1,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,127.1,
"ANSTH NECK VESSEL SIMPLE LIG",6400140,"CDM ",963,RC,352,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH SKIN EXT/TRUNK/PERINEUM",6400150,"CDM ",963,RC,400,HCPCS,OUTPATIENT,,,,,,64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.25,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,64.25,
"ANSTH RECONSTRUCT BREAST",6400160,"CDM ",963,RC,402,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH RADICAL MODIFIED BREAST",6400170,"CDM ",963,RC,404,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH CORRECT ABN HEART RYTHM",6400180,"CDM ",963,RC,410,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH CLAVICLE/SCAPULA",6400190,"CDM ",963,RC,450,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH CLOSED CHEST PROCEDURES",6400200,"CDM ",963,RC,520,HCPCS,OUTPATIENT,,,,,,127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",127.1,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,127.1,
"ANSTH CLOSED PNEUMOCENTESIS",6400210,"CDM ",963,RC,524,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH VASCULAR ACCESS",6400220,"CDM ",963,RC,532,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH UP ANT ABDOMINAL WALL",6400230,"CDM ",963,RC,700,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH FOR LIVER BIOPSY",6400240,"CDM ",963,RC,702,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH UGI ENDOSCOPY",6400250,"CDM ",963,RC,731,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH HERNIA RPR UP ABD",6400260,"CDM ",963,RC,750,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH HERNIA RPR LUMB/VENT",6400270,"CDM ",963,RC,752,HCPCS,OUTPATIENT,,,,,,127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",127.1,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,127.1,
"ANSTH UPPER ABDOMEN",6400280,"CDM ",963,RC,790,HCPCS,OUTPATIENT,,,,,,148.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",148.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",148.05,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.05,148.05,
"ANSTH INTRAPERITONEAL UP ABD",6400290,"CDM ",963,RC,792,HCPCS,OUTPATIENT,,,,,,273.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",273.75,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",273.75,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.75,273.75,
"ANSTH INTRAPER UP ABD GASTRIC",6400297,"CDM ",963,RC,797,HCPCS,OUTPATIENT,,,,,,231.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",231.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",231.85,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",231.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",231.85,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",231.85,231.85,
"ANSTH LOW ABDOMINAL WALL",6400300,"CDM ",963,RC,800,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH PANNICULECTOMY",6400310,"CDM ",963,RC,802,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH LOW BOWEL ENDOSCOPY",6400320,"CDM ",963,RC,811,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH COLONOSCOPY SCREEN",6400330,"CDM ",963,RC,812,HCPCS,OUTPATIENT,,,,,,64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.25,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,64.25,
"ANSTH UP/LOW GI ENDOSCOPY",6400340,"CDM ",963,RC,813,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH RPR LOW ABDOMEN",6400350,"CDM ",963,RC,830,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH HERNIA RPR VENT/INC",6400360,"CDM ",963,RC,832,HCPCS,OUTPATIENT,,,,,,127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",127.1,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,127.1,
"ANSTH INTRAPERITONEAL LOW ABD",6400370,"CDM ",963,RC,840,HCPCS,OUTPATIENT,,,,,,127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",127.1,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,127.1,
"ANSTH LOW ABD INCLUDE RESECT",6400380,"CDM ",963,RC,844,HCPCS,OUTPATIENT,,,,,,148.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",148.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",148.05,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.05,148.05,
"ANSTH TUBAL LIGATION/TRANSECT",6400390,"CDM ",963,RC,851,HCPCS,OUTPATIENT,,,,,,127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",127.1,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,127.1,
"ANSTH EXTRAPERITONEAL LOW ABD",6400400,"CDM ",963,RC,860,HCPCS,OUTPATIENT,,,,,,127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",127.1,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,127.1,
"ANSTH RENAL OR UP 1/3 URETER",6400410,"CDM ",963,RC,862,HCPCS,OUTPATIENT,,,,,,148.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",148.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",148.05,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.05,148.05,
"ANSTH LOW ABD CYSTECTOMY",6400420,"CDM ",963,RC,864,HCPCS,OUTPATIENT,,,,,,169,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",169,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",169,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",169,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",169,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",169,169,
"ANSTH RAD PROSTATECTOMY",6400430,"CDM ",963,RC,865,HCPCS,OUTPATIENT,,,,,,148.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",148.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",148.05,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.05,148.05,
"ANSTH ANORECTAL PROCEDURE",6400440,"CDM ",963,RC,902,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH RAD PERINEAL PROCEDURE",6400450,"CDM ",963,RC,904,HCPCS,OUTPATIENT,,,,,,148.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",148.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",148.05,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.05,148.05,
"ANSTH VULVECTOMY",6400460,"CDM ",963,RC,906,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH TRANSURETHRAL PROC",6400470,"CDM ",963,RC,910,HCPCS,OUTPATIENT,,,,,,64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.25,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,64.25,
"ANSTH TRANSURETH RSCT BLADDER",6400480,"CDM ",963,RC,912,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH RESECTION PROSTATE",6400490,"CDM ",963,RC,914,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH PST TRANSURTH RSCT BLEED",6400500,"CDM ",963,RC,916,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH FRAG URERTER CALCULUS",6400510,"CDM ",963,RC,918,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH MALE GENITALIA PROC",6400520,"CDM ",963,RC,920,HCPCS,OUTPATIENT,,,,,,64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.25,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,64.25,
"ANSTH RAD ORCHIECTOMY ING",6400530,"CDM ",963,RC,926,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH MALE GENITALORCHIOPEXY",6400540,"CDM ",963,RC,930,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH INSERT PENILE PROSTHESIS",6400550,"CDM ",963,RC,938,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH VAGINAL PROCEDURES",6400560,"CDM ",963,RC,940,HCPCS,OUTPATIENT,,,,,,64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.25,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,64.25,
"ANSTH COPOTOMY VAG COLPOR",6400570,"CDM ",963,RC,942,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH VAG HYSTERECTOMY",6400580,"CDM ",963,RC,944,HCPCS,OUTPATIENT,,,,,,127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",127.1,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,127.1,
"ANSTH CERVICAL CERCLAGE",6400590,"CDM ",963,RC,948,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH HYSTEROSCOPY/GRAPHY",6400600,"CDM ",963,RC,952,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH BONY PELVIS",6400610,"CDM ",963,RC,1120,HCPCS,OUTPATIENT,,,,,,127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",127.1,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,127.1,
"ANSTH BODY CAST APPLY/REVISE",6400620,"CDM ",963,RC,1130,HCPCS,OUTPATIENT,,,,,,64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.25,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,64.25,
"ANSTH ORIF PELVIS ACETABULUM",6400630,"CDM ",963,RC,1173,HCPCS,OUTPATIENT,,,,,,252.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",252.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",252.8,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",252.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",252.8,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",252.8,252.8,
"ANSTH HIP JOINT CLOSED PROC",6400640,"CDM ",963,RC,1200,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH HIP JOINT OPEN PROC",6400650,"CDM ",963,RC,1210,HCPCS,OUTPATIENT,,,,,,127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",127.1,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,127.1,
"ANSTH TOTAL HIP ARTHROPLASTY",6400660,"CDM ",963,RC,1214,HCPCS,OUTPATIENT,,,,,,169,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",169,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",169,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",169,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",169,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",169,169,
"ANSTH REVISE TOTAL HIP ARTHROP",6400670,"CDM ",963,RC,1215,HCPCS,OUTPATIENT,,,,,,210.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",210.9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",210.9,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.9,210.9,
"ANSTH CLOSED UPPER 2/3 FEMUR",6400680,"CDM ",963,RC,1220,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH OPEN FEMUR PROCEDURE",6400690,"CDM ",963,RC,1230,HCPCS,OUTPATIENT,,,,,,127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",127.1,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,127.1,
"ANSTH AMPUTATION FEMUR",6400700,"CDM ",963,RC,1232,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH NRV MSCL TEND UP LEG",6400710,"CDM ",963,RC,1250,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH ARTERY UPPER LEG",6400720,"CDM ",963,RC,1270,HCPCS,OUTPATIENT,,,,,,169,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",169,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",169,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",169,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",169,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",169,169,
"ANSTH KNEE POPLITEAL PROC",6400730,"CDM ",963,RC,1320,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH OPEN LOW KNEE PROC",6400740,"CDM ",963,RC,1360,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH CLOSED KNEE JOINT PROC",6400750,"CDM ",963,RC,1380,HCPCS,OUTPATIENT,,,,,,64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.25,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,64.25,
"ANSTH DX ARTHROSCOPE KNEE PROC",6400760,"CDM ",963,RC,1382,HCPCS,OUTPATIENT,,,,,,64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.25,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,64.25,
"ANSTH CLOSED UPPER KNEE",6400770,"CDM ",963,RC,1390,HCPCS,OUTPATIENT,,,,,,64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.25,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,64.25,
"ANSTH OPEN UPPER KNEE",6400780,"CDM ",963,RC,1392,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH ARTERY KNEE/POPLITEAL",6400790,"CDM ",963,RC,1400,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH TOTAL KNEE ARTHROPLASTY",6400800,"CDM ",963,RC,1402,HCPCS,OUTPATIENT,,,,,,148.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",148.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",148.05,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.05,148.05,
"ANSTH CAST KNEE",6400805,"CDM ",963,RC,1420,HCPCS,OUTPATIENT,,,,,,64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.25,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,64.25,
"ANSTH ARTERY/VEIN KNEE",6400810,"CDM ",963,RC,1432,HCPCS,OUTPATIENT,,,,,,127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",127.1,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,127.1,
"ANSTH CLSD LOW LEG ANKLE FOOT",6400820,"CDM ",963,RC,1462,HCPCS,OUTPATIENT,,,,,,64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.25,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,64.25,
"ANSTH ANKLE FOOT ARTHROSCOPY",6400830,"CDM ",963,RC,1464,HCPCS,OUTPATIENT,,,,,,64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.25,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,64.25,
"ANSTH LOW LEG ANKLE/FOOT",6400840,"CDM ",963,RC,1470,HCPCS,OUTPATIENT,,,,,,64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.25,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,64.25,
"ANSTH RPR ACHILLES TENDON",6400850,"CDM ",963,RC,1472,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH OPEN LOW LEG ANKLE FOOT",6400860,"CDM ",963,RC,1480,HCPCS,OUTPATIENT,,,,,,64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.25,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,64.25,
"ANSTH OPEN RAD RSCT LOW LEG",6400870,"CDM ",963,RC,1482,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH LOW LEG ANKLE FOOT/OSTEO",6400880,"CDM ",963,RC,1484,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH LOW LEG ARTERIES",6400883,"CDM ",963,RC,1500,HCPCS,OUTPATIENT,,,,,,169,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",169,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",169,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",169,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",169,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",169,169,
"ANSTH NERVE MSCL TNDN SHOULDER",6400890,"CDM ",963,RC,1610,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH CLOSED SHOULDER PROC",6400900,"CDM ",963,RC,1620,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH OPEN/ARTHRO SHOULDER",6400910,"CDM ",963,RC,1630,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH OPEN ARTHRO SHLDR/TSR",6400920,"CDM ",963,RC,1638,HCPCS,OUTPATIENT,,,,,,210.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",210.9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",210.9,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.9,210.9,
"ANSTH NRV MSCL TNDN UP ARM/ELB",6400930,"CDM ",963,RC,1710,HCPCS,OUTPATIENT,,,,,,64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.25,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,64.25,
"ANSTH NECK/MSCL/UP ARM/ELBOW",6400940,"CDM ",963,RC,1712,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH NRV/MSCL/TEND UP ARM",6400950,"CDM ",963,RC,1716,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH CLSD HUMERUS/ELBOW",6400960,"CDM ",963,RC,1730,HCPCS,OUTPATIENT,,,,,,64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.25,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,64.25,
"ANSTH OPEN ARTHRO ELBOW",6400970,"CDM ",963,RC,1740,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH OPEN ARTHRO HUMEROUS",6400980,"CDM ",963,RC,1744,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH ARTERIES UP ARM/ELBOW",6400985,"CDM ",963,RC,1770,HCPCS,OUTPATIENT,,,,,,127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",127.1,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,127.1,
"ANSTH NRV/MSCL/TNDN LOW ARM",6400990,"CDM ",963,RC,1810,HCPCS,OUTPATIENT,,,,,,64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.25,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,64.25,
"ANSTH CLOSED LOW ARM/HAND",6401000,"CDM ",963,RC,1820,HCPCS,OUTPATIENT,,,,,,64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.25,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,64.25,
"ANSTH OPEN LOW ARM/HAND",6401010,"CDM ",963,RC,1830,HCPCS,OUTPATIENT,,,,,,64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.25,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,64.25,
"ANSTH TOTAL WRIST REPLACE",6401020,"CDM ",963,RC,1832,HCPCS,OUTPATIENT,,,,,,127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",127.1,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,127.1,
"ANSTH ARTERY FOREARM/WRST/HND",6401030,"CDM ",963,RC,1840,HCPCS,OUTPATIENT,,,,,,127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",127.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",127.1,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.1,127.1,
"ANSTH PERCU IMAGE SPINE THERAP",6401040,"CDM ",963,RC,1936,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH 2-3 DEGREE BURN/I&D",6401050,"CDM ",963,RC,1951,HCPCS,OUTPATIENT,,,,,,64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.25,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,64.25,
"ANSTH CSECTION DELIVERY",6401060,"CDM ",963,RC,1961,HCPCS,OUTPATIENT,,,,,,148.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",148.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",148.05,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.05,148.05,
"ANSTH INCMPLT/MISSED ABORTION",6401070,"CDM ",963,RC,1965,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH INDUCED ABORTION PROC",6401080,"CDM ",963,RC,1966,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH VAGINAL DELIVERY",6401090,"CDM ",963,RC,1967,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH VAGINAL DELIVERY MCD",6401100,"CDM ",963,RC,1967,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH CSECTION DELV ADDON",6401110,"CDM ",963,RC,1968,HCPCS,OUTPATIENT,,,,,,64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.25,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,64.25,
"ANSTH HOSP MGMT CONT DRUG ADM",6401120,"CDM ",963,RC,1996,HCPCS,OUTPATIENT,,,,,,64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.25,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,64.25,
"ANSTH INSERT EMERGENT AIRWAY",6401160,"CDM ",960,RC,31500,HCPCS,OUTPATIENT,,,251.5,201.2,,92.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.05,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",195,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",92.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",92.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.39,195.05,
"ANSTH INSERT PICC CATH",6401180,"CDM ",960,RC,36569,HCPCS,OUTPATIENT,,,456,364.8,,264.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",264.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",526,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",264.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",264.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",264.98,526,
"ANSTH SPINAL FLUID TAP DX",6401210,"CDM ",960,RC,62270,HCPCS,OUTPATIENT,,,632.5,506,,120.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,109.05,109.05,109.05,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",239,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",120.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",120.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.29,239,
"ANSTH INJ EPIDURAL PATCH",6401220,"CDM ",960,RC,62273,HCPCS,OUTPATIENT,,,632.5,506,,145.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",145.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",290,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",145.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",145.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",145.79,290,
"ANSTH INJ INTRLMN CERV/THORC",6401230,"CDM ",960,RC,62320,HCPCS,OUTPATIENT,,,224.5,179.6,,64.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",229,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",64.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.73,229,
"ANSTH INJ INTRLM LUMB/SAC",6401240,"CDM ",960,RC,62322,HCPCS,OUTPATIENT,,,201.5,161.2,,55.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",213,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",55.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,69.97,69.97,69.97,"1 through 10",other,"not separately reimbursment ",55.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.77,213,
"ANSTH INJ INTRLM LUM/SAC W/IMG",6401250,"CDM ",960,RC,62323,HCPCS,OUTPATIENT,,,259,207.2,,63.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",344,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",63.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",63.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.8,344,
"ANSTH INJ INTRLM CRV/THR W/IMG",6401260,"CDM ",960,RC,62324,HCPCS,OUTPATIENT,,,224.5,179.6,,59.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",203,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",59.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",59.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.31,203,
"ANSTH INJ W/CATH PLACE LUM/SAC",6401270,"CDM ",960,RC,62326,HCPCS,OUTPATIENT,,,632.5,506,,58.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",210,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",58.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.19,210,
"ANSTH BRACHIAL PLEXUS INJ",6401280,"CDM ",960,RC,64415,HCPCS,OUTPATIENT,,,506,404.8,,126.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",126.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",251,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",126.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,65.17,65.17,65.17,"1 through 10",other,"not separately reimbursment ",126.27,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",126.27,251,
"ANSTH ILIOHYPOGASTRIC NERVE",6401290,"CDM ",960,RC,64425,HCPCS,OUTPATIENT,,,506,404.8,,103.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",206,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",103.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",103.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.63,206,
"ANSTH INJECT FEM NERVE SINGLE",6401300,"CDM ",960,RC,64447,HCPCS,OUTPATIENT,,,155.5,124.4,,61.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",169,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",61.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",61.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.13,169,
"ANSTH INJ OTH PERIPHERAL NRV",6401310,"CDM ",960,RC,64450,HCPCS,OUTPATIENT,,,506,404.8,,77.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",153,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",77.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",77.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.19,153,
"ANSTH INJ LUMB/SAC SINGLE LEV",6401320,"CDM ",960,RC,64483,HCPCS,OUTPATIENT,,,241.5,193.2,,280.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",280.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",558,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",280.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",280.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",280.88,558,
"ANSTH INJ LUMB/SAC EA ADD LEV",6401330,"CDM ",960,RC,64484,HCPCS,OUTPATIENT,,,345,276,,134.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",134.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",285,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",134.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",134.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",134.59,285,
"ANSTH TAP BLOCK UNILAT W/IMAGE",6401340,"CDM ",960,RC,64486,HCPCS,OUTPATIENT,,,276,220.8,,40.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",171,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",40.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",40.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.5,171,
"ANSTH TAP BLOCK BILAT W/IMAGE",6401350,"CDM ",960,RC,64488,HCPCS,OUTPATIENT,,,287.5,230,,50.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",211,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",50.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",50.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.49,211,
"ANSTH TAP BLOCK BILATW/IMAGE",6401360,"CDM ",960,RC,64489,HCPCS,OUTPATIENT,,,287.5,230,,56.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",291,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",56.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",56.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.34,291,
"ANSTH INJ PVRT FCT  L/S 1 LEV",6401370,"CDM ",960,RC,64493,HCPCS,OUTPATIENT,,,506,404.8,,53.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",243,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",53.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",53.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.15,243,
"ANSTH INJ PVRT FCT L/S 2ND LEV",6401380,"CDM ",960,RC,64494,HCPCS,OUTPATIENT,,,345,276,,22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",122,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",22.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.88,122,
"ANSTH US GUIDE NEEDLE PLCMNT",6401390,"CDM ",960,RC,76942,HCPCS,OUTPATIENT,,,323.5,258.8,,108.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.07,100,,143.86,143.86,143.86,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",281,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",108.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,219.38,219.38,219.38,"1 through 10",other,"not separately reimbursment ",108.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.07,281,
"ANSTH EXTRM <1YR & >70YRS",6401410,"CDM ",960,RC,99100,HCPCS,OUTPATIENT,,,340,272,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",289,85,,231.20,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",289,289,
"ANSTH COMPLICATED BY HTN ADDON",6401420,"CDM ",960,RC,99135,HCPCS,OUTPATIENT,,,340,272,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",289,85,,231.20,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",289,289,
"ANSTH EMERGENT COND ADDON",6401430,"CDM ",960,RC,99140,HCPCS,OUTPATIENT,,,575,460,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",488.75,85,,391.00,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",488.75,488.75,
"ANSTH VEIN UPPER LEG",6401450,"CDM ",963,RC,1260,HCPCS,OUTPATIENT,,,,,,64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.25,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,64.25,
"ANSTH LUMBAR PUNCTURE",6401455,"CDM ",963,RC,635,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH ARTERIAL CATH/CANNULATI",6401460,"CDM ",960,RC,36620,HCPCS,OUTPATIENT,,,131,104.8,,44.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",106,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",44.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.14,106,
"ANSTH INJ FEMORAL NERVE CATH",6401465,"CDM ",960,RC,64448,HCPCS,OUTPATIENT,,,138,110.4,,120.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",246,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",120.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",120.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.89,246,
"ANSTH INJ AXILLARY NRV UP ARM",6401470,"CDM ",960,RC,64417,HCPCS,OUTPATIENT,,,506,404.8,,131.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",262,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",131.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",131.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.82,262,
"ANSTH INJ SCIATIC NERVE",6401475,"CDM ",960,RC,64445,HCPCS,OUTPATIENT,,,121,96.8,,122.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",244,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",122.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",122.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.91,244,
"ANSTH MALE GENITALIA",6401485,"CDM ",963,RC,921,HCPCS,OUTPATIENT,,,,,,64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.25,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,64.25,
"ANSTH MALE GENITALIA",6401485,"CDM ",963,RC,921,HCPCS,OUTPATIENT,,,,,,64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.25,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,64.25,
"ANSTH MOD SED INITIAL 5/>YRS",6401490,"CDM ",960,RC,99156,HCPCS,OUTPATIENT,,,157,125.6,,48.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",112,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",48.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",48.13,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.13,112,
"ANSTH NERVE BLOCK/INJ",6401495,"CDM ",963,RC,1991,HCPCS,OUTPATIENT,,,,,,64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.25,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,64.25,
"ANSTH MOD SED OTHR PROV ADD 15",6401500,"CDM ",960,RC,99157,HCPCS,OUTPATIENT,,,125.5,100.4,,36.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",91,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",36.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",36.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.51,91,
"ANSTH MOD SED OTH PROV INIT 15",6401505,"CDM ",960,RC,99155,HCPCS,OUTPATIENT,,,172.5,138,,58.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",127,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",58.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.71,127,
"ANSTH UPPR ARM TENDON SURG",6401510,"CDM ",963,RC,1714,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH EAR W/BX",6401515,"CDM ",963,RC,120,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH INSERT NONTUNN CV CATH",6401520,"CDM ",960,RC,36556,HCPCS,OUTPATIENT,,,368,294.4,,191.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",180.69,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",191.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",475,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",191.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",191.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.69,475,
"ANSTH LOW ARM CAST",6401525,"CDM ",963,RC,1860,HCPCS,OUTPATIENT,,,,,,64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",64.25,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.25,64.25,
"ANSTH PELVIS",6401530,"CDM ",963,RC,1160,HCPCS,OUTPATIENT,,,,,,85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",85.2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.2,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.2,85.2,
"ANSTH LOW LEG",6401540,"CDM ",963,RC,1474,HCPCS,OUTPATIENT,,,,,,106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",106.15,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.15,106.15,
"ANSTH SPINAL PUNCTURE CSF",6401545,"CDM ",960,RC,62272,HCPCS,OUTPATIENT,,,302,241.6,,146.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",146.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",291,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",146.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",146.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",146.61,291,
"ANSTH CERVICAL SPINE PROC NOS",6401550,"CDM ",963,RC,600,HCPCS,OUTPATIENT,,,,,,210.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",210.9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",210.9,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.9,210.9,
"ANSTH THORACIC SPINE/CORD NOS",6401560,"CDM ",963,RC,620,HCPCS,OUTPATIENT,,,,,,210.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",210.9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",210.9,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.9,210.9,
"ANSTH LUMBAR REGION NOS",6401570,"CDM ",963,RC,630,HCPCS,OUTPATIENT,,,,,,169,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",169,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",169,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",169,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",169,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",169,169,
"ANSTH EXTENSIVE SPINE/CORD",6401580,"CDM ",963,RC,670,HCPCS,OUTPATIENT,,,,,,273.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",273.75,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",273.75,100,,,,,0," fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.75,273.75,
"TETANUS/DIPTHERIA >7YRS 0.5ML",7006661,"CDM ",636,RC,90715,HCPCS,OUTPATIENT,,,53,42.4,,,,,,,,0,"other ","not separately reimbursment ",67.14,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",49.29,93,,39.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",42.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.05,85,,36.04,,,0,"percent of total billed charges ","85% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",42.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.11,87,,52.39,27.40,65.66,"1 through 10","percent of total billed charges ","87% of total billed charges ",42.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",37.1,67.14,
"FLUARIX 26-27 0.5ML PFS",7009797,"CDM ",636,RC,90656,HCPCS,OUTPATIENT,,,65.5,52.4,,,,,,,,0,"other ","not separately reimbursment ",24.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",45.85,70,,36.68,,,0,"percent of total billed charges ","70% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",60.92,93,,48.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",55.68,85,,44.54,,,0,"percent of total billed charges ","85% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",56.99,87,,22.29,22.29,22.29,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",23.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",45.85,70,,36.68,,,0,"percent of total billed charges ","70% of total billed charges ",23.22,60.92,
"Fluarix 26-27 0.5ML PFS",7009798,"CDM ",636,RC,90658,HCPCS,OUTPATIENT,,,65.5,52.4,,,,,,,,0,"other ","not separately reimbursment ",22.85,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",45.85,70,,36.68,,,0,"percent of total billed charges ","70% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",60.92,93,,48.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",20.36,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",55.68,85,,44.54,,,0,"percent of total billed charges ","85% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",20.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.99,87,,45.59,,,0,"percent of total billed charges ","87% of total billed charges ",20.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.07,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",45.85,70,,36.68,,,0,"percent of total billed charges ","70% of total billed charges ",20.16,60.92,
"COVID 19 VAC 23-24 AGE 12+",7026373,"CDM ",636,RC,91320,HCPCS,OUTPATIENT,,,160,128,,,,,,,,0,"other ","not separately reimbursment ",164.22,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",112,70,,89.60,,,0,"percent of total billed charges ","70% of total billed charges ",144,90,,115.20,,,0,"percent of total billed charges ","90% of total billed charges ",148.8,93,,119.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136,85,,108.80,,,0,"percent of total billed charges ","85% of total billed charges ",144,90,,115.20,,,0,"percent of total billed charges ","90% of total billed charges ",144,90,,115.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.2,87,,111.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112,70,,89.60,,,0,"percent of total billed charges ","70% of total billed charges ",112,164.22,
"RABIES VACCINE (RABAVERT)",7026685,"CDM ",636,RC,90675,HCPCS,OUTPATIENT,,,599.5,479.6,,,,,,,,0,"other ","not separately reimbursment ",591.06,100,,460.70,460.70,460.70,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",419.65,70,,335.72,,,0,"percent of total billed charges ","70% of total billed charges ",539.55,90,,431.64,,,0,"percent of total billed charges ","90% of total billed charges ",557.54,93,,446.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",509.58,85,,407.66,,,0,"percent of total billed charges ","85% of total billed charges ",539.55,90,,431.64,,,0,"percent of total billed charges ","90% of total billed charges ",539.55,90,,431.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",521.57,87,,417.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",319.75,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",419.65,70,,335.72,,,0,"percent of total billed charges ","70% of total billed charges ",319.75,591.06,
"HEP B VAC 10MCG/ML ADULT 1ML",7027097,"CDM ",636,RC,90746,HCPCS,OUTPATIENT,,,159,127.2,,,,,,,,0,"other ","not separately reimbursment ",95.25,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",111.3,70,,89.04,,,0,"percent of total billed charges ","70% of total billed charges ",143.1,90,,114.48,,,0,"percent of total billed charges ","90% of total billed charges ",147.87,93,,118.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",70.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",135.15,85,,108.12,,,0,"percent of total billed charges ","85% of total billed charges ",143.1,90,,114.48,,,0,"percent of total billed charges ","90% of total billed charges ",143.1,90,,114.48,,,0,"percent of total billed charges ","90% of total billed charges ",69.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",138.33,87,,110.66,,,0,"percent of total billed charges ","87% of total billed charges ",69.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",111.3,70,,89.04,,,0,"percent of total billed charges ","70% of total billed charges ",69.65,147.87,
"BUPIVACAINE MELOXICAM 200/6MG",7031980,"CDM ",636,RC,C9088,HCPCS,OUTPATIENT,,,180.5,144.4,,,,,,,,0,"other ","not separately reimbursment ",0.86,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",126.35,70,,101.08,,,0,"percent of total billed charges ","70% of total billed charges ",162.45,90,,129.96,,,0,"percent of total billed charges ","90% of total billed charges ",167.87,93,,134.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",153.43,85,,122.74,,,0,"percent of total billed charges ","85% of total billed charges ",162.45,90,,129.96,,,0,"percent of total billed charges ","90% of total billed charges ",162.45,90,,129.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",157.04,87,,125.63,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",126.35,70,,101.08,,,0,"percent of total billed charges ","70% of total billed charges ",0.86,167.87,
"T-DAP 0.5ML VAC >7YRS",7042443,"CDM ",636,RC,90715,HCPCS,OUTPATIENT,,,248.5,198.8,,,,,,,,0,"other ","not separately reimbursment ",67.14,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",173.95,70,,139.16,,,0,"percent of total billed charges ","70% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",231.11,93,,184.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",42.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",211.23,85,,168.98,,,0,"percent of total billed charges ","85% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",223.65,90,,178.92,,,0,"percent of total billed charges ","90% of total billed charges ",42.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",216.2,87,,52.39,27.40,65.66,"1 through 10","percent of total billed charges ","87% of total billed charges ",42.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",173.95,70,,139.16,,,0,"percent of total billed charges ","70% of total billed charges ",42.14,231.11,
"HEP B 1ML IMMUNEGLOBULIN",7044969,"CDM ",636,RC,90371,HCPCS,OUTPATIENT,,,361,288.8,,,,,,,,0,"other ","not separately reimbursment ",168.23,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",252.7,70,,202.16,,,0,"percent of total billed charges ","70% of total billed charges ",324.9,90,,259.92,,,0,"percent of total billed charges ","90% of total billed charges ",335.73,93,,268.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",306.85,85,,245.48,,,0,"percent of total billed charges ","85% of total billed charges ",324.9,90,,259.92,,,0,"percent of total billed charges ","90% of total billed charges ",324.9,90,,259.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",314.07,87,,251.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",137.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",252.7,70,,202.16,,,0,"percent of total billed charges ","70% of total billed charges ",137.83,335.73,
"TETANUS IMMUNEGLOB 250U/ML 1ML",7045123,"CDM ",636,RC,90389,HCPCS,OUTPATIENT,,,932.5,746,,,,,,,,0,"other ","not separately reimbursment ",787.96,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",652.75,70,,522.20,,,0,"percent of total billed charges ","70% of total billed charges ",839.25,90,,671.40,,,0,"percent of total billed charges ","90% of total billed charges ",867.23,93,,693.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",109.08,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",792.63,85,,634.10,,,0,"percent of total billed charges ","85% of total billed charges ",839.25,90,,671.40,,,0,"percent of total billed charges ","90% of total billed charges ",839.25,90,,671.40,,,0,"percent of total billed charges ","90% of total billed charges ",108,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",811.28,87,,649.02,,,0,"percent of total billed charges ","87% of total billed charges ",108,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",652.75,70,,522.20,,,0,"percent of total billed charges ","70% of total billed charges ",108,867.23,
"MENINGOCOCCAL VAC",7060411,"CDM ",636,RC,90733,HCPCS,OUTPATIENT,,,246.5,197.2,,,,,,,,0,"other ","not separately reimbursment ",174.48,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",172.55,70,,138.04,,,0,"percent of total billed charges ","70% of total billed charges ",221.85,90,,177.48,,,0,"percent of total billed charges ","90% of total billed charges ",229.25,93,,183.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",209.53,85,,167.62,,,0,"percent of total billed charges ","85% of total billed charges ",221.85,90,,177.48,,,0,"percent of total billed charges ","90% of total billed charges ",221.85,90,,177.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",214.46,87,,171.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.55,70,,138.04,,,0,"percent of total billed charges ","70% of total billed charges ",172.55,229.25,
"FLUZONE 26-27 0.5ML PFS",7061443,"CDM ",636,RC,90656,HCPCS,OUTPATIENT,,,65.5,52.4,,,,,,,,0,"other ","not separately reimbursment ",24.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",45.85,70,,36.68,,,0,"percent of total billed charges ","70% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",60.92,93,,48.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",55.68,85,,44.54,,,0,"percent of total billed charges ","85% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",56.99,87,,22.29,22.29,22.29,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",23.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",45.85,70,,36.68,,,0,"percent of total billed charges ","70% of total billed charges ",23.22,60.92,
"VAQTA 50 UNIT/ML VIAL (ADULT)",7061500,"CDM ",636,RC,90633,HCPCS,OUTPATIENT,,,168.5,134.8,,,,,,,,0,"other ","not separately reimbursment ",53.7,100,,36.10,36.10,36.10,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",156.71,93,,125.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",143.23,85,,114.58,,,0,"percent of total billed charges ","85% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",151.65,90,,121.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",146.6,87,,41.64,41.16,41.64,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.95,70,,94.36,,,0,"percent of total billed charges ","70% of total billed charges ",53.7,156.71,
"CEFOXITIN 1GM 50ML PRE-MIX BAG",7061849,"CDM ",636,RC,J0694,HCPCS,OUTPATIENT,,,79,63.2,,,,,,,,0,"other ","not separately reimbursment ",7.39,100,,5.97,5.97,5.97,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",55.3,70,,44.24,,,0,"percent of total billed charges ","70% of total billed charges ",71.1,90,,56.88,,,0,"percent of total billed charges ","90% of total billed charges ",73.47,93,,58.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",4.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",67.15,85,,53.72,,,0,"percent of total billed charges ","85% of total billed charges ",71.1,90,,56.88,,,0,"percent of total billed charges ","90% of total billed charges ",71.1,90,,56.88,,,0,"percent of total billed charges ","90% of total billed charges ",4.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",68.73,87,,54.98,,,0,"percent of total billed charges ","87% of total billed charges ",4.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",55.3,70,,44.24,,,0,"percent of total billed charges ","70% of total billed charges ",4.61,73.47,
"ZOSTAVAX INJ .065ML",7062128,"CDM ",636,RC,90736,HCPCS,OUTPATIENT,,,363.5,290.8,,,,,,,,0,"other ","not separately reimbursment ",303.69,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",254.45,70,,203.56,,,0,"percent of total billed charges ","70% of total billed charges ",327.15,90,,261.72,,,0,"percent of total billed charges ","90% of total billed charges ",338.06,93,,270.45,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",308.98,85,,247.18,,,0,"percent of total billed charges ","85% of total billed charges ",327.15,90,,261.72,,,0,"percent of total billed charges ","90% of total billed charges ",327.15,90,,261.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",316.25,87,,253.00,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",254.45,70,,203.56,,,0,"percent of total billed charges ","70% of total billed charges ",254.45,338.06,
"VARIVAX INJ 0.7ML",7062359,"CDM ",250,RC,90716,HCPCS,OUTPATIENT,,,208,166.4,,,,,,,,0,"other ","not separately reimbursment ",248.76,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",145.6,70,,116.48,,,0,"percent of total billed charges ","70% of total billed charges ",187.2,90,,149.76,,,0,"percent of total billed charges ","90% of total billed charges ",193.44,93,,154.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",176.8,85,,141.44,,,0,"percent of total billed charges ","85% of total billed charges ",187.2,90,,149.76,,,0,"percent of total billed charges ","90% of total billed charges ",187.2,90,,149.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",180.96,87,,144.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",145.6,70,,116.48,,,0,"percent of total billed charges ","70% of total billed charges ",145.6,248.76,
"HEMOPHILUS B VACCINE 0.5ML",7063140,"CDM ",636,RC,90648,HCPCS,OUTPATIENT,,,64.5,51.6,,,,,,,,0,"other ","not separately reimbursment ",17.6,100,,15.65,15.65,15.65,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",45.15,70,,36.12,,,0,"percent of total billed charges ","70% of total billed charges ",58.05,90,,46.44,,,0,"percent of total billed charges ","90% of total billed charges ",59.99,93,,47.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",54.83,85,,43.86,,,0,"percent of total billed charges ","85% of total billed charges ",58.05,90,,46.44,,,0,"percent of total billed charges ","90% of total billed charges ",58.05,90,,46.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",56.12,87,,14.19,14.19,14.19,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.15,70,,36.12,,,0,"percent of total billed charges ","70% of total billed charges ",17.6,59.99,
"ADACEL 0.5MG INJ",7064060,"CDM ",636,RC,90715,HCPCS,OUTPATIENT,,,109,87.2,,,,,,,,0,"other ","not separately reimbursment ",67.14,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",76.3,70,,61.04,,,0,"percent of total billed charges ","70% of total billed charges ",98.1,90,,78.48,,,0,"percent of total billed charges ","90% of total billed charges ",101.37,93,,81.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",42.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",92.65,85,,74.12,,,0,"percent of total billed charges ","85% of total billed charges ",98.1,90,,78.48,,,0,"percent of total billed charges ","90% of total billed charges ",98.1,90,,78.48,,,0,"percent of total billed charges ","90% of total billed charges ",42.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",94.83,87,,52.39,27.40,65.66,"1 through 10","percent of total billed charges ","87% of total billed charges ",42.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",76.3,70,,61.04,,,0,"percent of total billed charges ","70% of total billed charges ",42.14,101.37,
"PNEUMOVAX 23 25MCG/0.5ML INJ",7065110,"CDM ",636,RC,90732,HCPCS,OUTPATIENT,,,187,149.6,,,,,,,,0,"other ","not separately reimbursment ",167.2,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",173.91,93,,139.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",95.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",158.95,85,,127.16,,,0,"percent of total billed charges ","85% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",94.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",162.69,87,,130.15,,,0,"percent of total billed charges ","87% of total billed charges ",94.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",94.51,173.91,
"PNEUMOCOCCAL 13-VALENT 0.5ML",7065150,"CDM ",636,RC,90670,HCPCS,OUTPATIENT,,,279,223.2,,,,,,,,0,"other ","not separately reimbursment ",323.17,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",195.3,70,,156.24,,,0,"percent of total billed charges ","70% of total billed charges ",251.1,90,,200.88,,,0,"percent of total billed charges ","90% of total billed charges ",259.47,93,,207.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",243.79,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",237.15,85,,189.72,,,0,"percent of total billed charges ","85% of total billed charges ",251.1,90,,200.88,,,0,"percent of total billed charges ","90% of total billed charges ",251.1,90,,200.88,,,0,"percent of total billed charges ","90% of total billed charges ",241.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",242.73,87,,194.18,,,0,"percent of total billed charges ","87% of total billed charges ",241.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",195.3,70,,156.24,,,0,"percent of total billed charges ","70% of total billed charges ",195.3,323.17,
"BOOSTRIX 0.5ML INJ > 7 YEARS",7065220,"CDM ",636,RC,90715,HCPCS,OUTPATIENT,,,100.5,80.4,,,,,,,,0,"other ","not separately reimbursment ",67.14,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",70.35,70,,56.28,,,0,"percent of total billed charges ","70% of total billed charges ",90.45,90,,72.36,,,0,"percent of total billed charges ","90% of total billed charges ",93.47,93,,74.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",42.56,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",85.43,85,,68.34,,,0,"percent of total billed charges ","85% of total billed charges ",90.45,90,,72.36,,,0,"percent of total billed charges ","90% of total billed charges ",90.45,90,,72.36,,,0,"percent of total billed charges ","90% of total billed charges ",42.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",87.44,87,,52.39,27.40,65.66,"1 through 10","percent of total billed charges ","87% of total billed charges ",42.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",70.35,70,,56.28,,,0,"percent of total billed charges ","70% of total billed charges ",42.14,93.47,
"FLUZONE HD 26-27 0.5ML PFS",7065350,"CDM ",636,RC,90662,HCPCS,OUTPATIENT,,,152,121.6,,,,,,,,0,"other ","not separately reimbursment ",91.95,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",141.36,93,,113.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",129.2,85,,103.36,,,0,"percent of total billed charges ","85% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",132.24,87,,105.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",98.16,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",91.95,141.36,
"HEPATITIS A VAC 0.5ML (PED)",7065530,"CDM ",636,RC,90633,HCPCS,OUTPATIENT,,,72,57.6,,,,,,,,0,"other ","not separately reimbursment ",53.7,100,,36.10,36.10,36.10,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",50.4,70,,40.32,,,0,"percent of total billed charges ","70% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",66.96,93,,53.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",61.2,85,,48.96,,,0,"percent of total billed charges ","85% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",62.64,87,,41.64,41.16,41.64,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.4,70,,40.32,,,0,"percent of total billed charges ","70% of total billed charges ",50.4,66.96,
"HUMULIN-N 100U  3ML VIAL",7066090,"CDM ",636,RC,J1815,HCPCS,OUTPATIENT,,,33,26.4,,,,,,,,0,"other ","not separately reimbursment ",0.27,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.1,70,,18.48,,,0,"percent of total billed charges ","70% of total billed charges ",29.7,90,,23.76,,,0,"percent of total billed charges ","90% of total billed charges ",30.69,93,,24.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",28.05,85,,22.44,,,0,"percent of total billed charges ","85% of total billed charges ",29.7,90,,23.76,,,0,"percent of total billed charges ","90% of total billed charges ",29.7,90,,23.76,,,0,"percent of total billed charges ","90% of total billed charges ",0.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",28.71,87,,22.97,,,0,"percent of total billed charges ","87% of total billed charges ",0.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.1,70,,18.48,,,0,"percent of total billed charges ","70% of total billed charges ",0.27,30.69,
"SAPHNELO ANIFROL 300MG VIAL",7066264,"CDM ",636,RC,J0491,HCPCS,OUTPATIENT,,,8860.5,7088.4,,,,,,,,0,"other ","not separately reimbursment ",21.13,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",6202.35,70,,4961.88,,,0,"percent of total billed charges ","70% of total billed charges ",7974.45,90,,6379.56,,,0,"percent of total billed charges ","90% of total billed charges ",8240.27,93,,6592.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7531.43,85,,6025.14,,,0,"percent of total billed charges ","85% of total billed charges ",7974.45,90,,6379.56,,,0,"percent of total billed charges ","90% of total billed charges ",7974.45,90,,6379.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7708.64,87,,6166.91,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",18.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",6202.35,70,,4961.88,,,0,"percent of total billed charges ","70% of total billed charges ",18.34,8240.27,
"BCG TICE 50MG VIAL VACCINE",7066350,"CDM ",636,RC,90585,HCPCS,OUTPATIENT,,,343,274.4,,,,,,,,0,"other ","not separately reimbursment ",224.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",240.1,70,,192.08,,,0,"percent of total billed charges ","70% of total billed charges ",308.7,90,,246.96,,,0,"percent of total billed charges ","90% of total billed charges ",318.99,93,,255.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",291.55,85,,233.24,,,0,"percent of total billed charges ","85% of total billed charges ",308.7,90,,246.96,,,0,"percent of total billed charges ","90% of total billed charges ",308.7,90,,246.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",298.41,87,,238.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",240.1,70,,192.08,,,0,"percent of total billed charges ","70% of total billed charges ",224.29,318.99,
"RABIES IMMUNE GLOBULIN 1500IU",7066580,"CDM ",636,RC,90375,HCPCS,OUTPATIENT,,,4719.5,3775.6,,,,,,,,0,"other ","not separately reimbursment ",398.51,100,,321.80,321.80,321.80,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3303.65,70,,2642.92,,,0,"percent of total billed charges ","70% of total billed charges ",4247.55,90,,3398.04,,,0,"percent of total billed charges ","90% of total billed charges ",4389.14,93,,3511.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",269.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4011.58,85,,3209.26,,,0,"percent of total billed charges ","85% of total billed charges ",4247.55,90,,3398.04,,,0,"percent of total billed charges ","90% of total billed charges ",4247.55,90,,3398.04,,,0,"percent of total billed charges ","90% of total billed charges ",267.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4105.97,87,,3284.78,,,0,"percent of total billed charges ","87% of total billed charges ",267.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",279.95,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3303.65,70,,2642.92,,,0,"percent of total billed charges ","70% of total billed charges ",267.3,4389.14,
"FLUBLOK 26-27 0.5ML PFS",7066600,"CDM ",636,RC,90673,HCPCS,OUTPATIENT,,,152,121.6,,,,,,,,0,"other ","not separately reimbursment ",50.87,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",141.36,93,,113.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",129.2,85,,103.36,,,0,"percent of total billed charges ","85% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",132.24,87,,105.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",98.16,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",50.87,141.36,
"RABIES IMMUNE GLOBULIN 300UN",7067290,"CDM ",636,RC,90375,HCPCS,OUTPATIENT,,,1108,886.4,,,,,,,,0,"other ","not separately reimbursment ",398.51,100,,321.80,321.80,321.80,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",775.6,70,,620.48,,,0,"percent of total billed charges ","70% of total billed charges ",997.2,90,,797.76,,,0,"percent of total billed charges ","90% of total billed charges ",1030.44,93,,824.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",269.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",941.8,85,,753.44,,,0,"percent of total billed charges ","85% of total billed charges ",997.2,90,,797.76,,,0,"percent of total billed charges ","90% of total billed charges ",997.2,90,,797.76,,,0,"percent of total billed charges ","90% of total billed charges ",267.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",963.96,87,,771.17,,,0,"percent of total billed charges ","87% of total billed charges ",267.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",279.95,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",775.6,70,,620.48,,,0,"percent of total billed charges ","70% of total billed charges ",267.3,1030.44,
"RABIES IMMUNE GLOB 900U 3ML VL",7067292,"CDM ",636,RC,90375,HCPCS,OUTPATIENT,,,2086.5,1669.2,,,,,,,,0,"other ","not separately reimbursment ",398.51,100,,321.80,321.80,321.80,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1460.55,70,,1168.44,,,0,"percent of total billed charges ","70% of total billed charges ",1877.85,90,,1502.28,,,0,"percent of total billed charges ","90% of total billed charges ",1940.45,93,,1552.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",269.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1773.53,85,,1418.82,,,0,"percent of total billed charges ","85% of total billed charges ",1877.85,90,,1502.28,,,0,"percent of total billed charges ","90% of total billed charges ",1877.85,90,,1502.28,,,0,"percent of total billed charges ","90% of total billed charges ",267.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1815.26,87,,1452.21,,,0,"percent of total billed charges ","87% of total billed charges ",267.3,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",279.95,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1460.55,70,,1168.44,,,0,"percent of total billed charges ","70% of total billed charges ",267.3,1940.45,
"PROPOFOL 500MG 50ML BTL",7067570,"CDM ",636,RC,J2704,HCPCS,OUTPATIENT,,,75,60,,,,,,,,0,"other ","not separately reimbursment ",0.18,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.5,70,,42.00,,,0,"percent of total billed charges ","70% of total billed charges ",67.5,90,,54.00,,,0,"percent of total billed charges ","90% of total billed charges ",69.75,93,,55.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",63.75,85,,51.00,,,0,"percent of total billed charges ","85% of total billed charges ",67.5,90,,54.00,,,0,"percent of total billed charges ","90% of total billed charges ",67.5,90,,54.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",65.25,87,,0.01,0.01,47.06,15,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.5,70,,42.00,,,0,"percent of total billed charges ","70% of total billed charges ",0.18,69.75,
"AMIODARONE HCL 450MG VIAL",7067950,"CDM ",636,RC,J0282,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",0.57,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",0.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",0.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",0.31,106.95,
"PREVNAR 20 0.5ML PFS",7068400,"CDM ",636,RC,90677,HCPCS,OUTPATIENT,,,301.5,241.2,,,,,,,,0,"other ","not separately reimbursment ",373.39,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",211.05,70,,168.84,,,0,"percent of total billed charges ","70% of total billed charges ",271.35,90,,217.08,,,0,"percent of total billed charges ","90% of total billed charges ",280.4,93,,224.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",256.28,85,,205.02,,,0,"percent of total billed charges ","85% of total billed charges ",271.35,90,,217.08,,,0,"percent of total billed charges ","90% of total billed charges ",271.35,90,,217.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",262.31,87,,291.50,285.67,291.50,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",211.05,70,,168.84,,,0,"percent of total billed charges ","70% of total billed charges ",211.05,373.39,
"SOL-D5W 250ML FREEFLEX BAG",7400180,"CDM ",258,RC,J7060,HCPCS,OUTPATIENT,,,75,60,,,,,,,,0,"other ","not separately reimbursment ",2.32,100,,1.76,1.76,1.76,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.5,70,,42.00,,,0,"percent of total billed charges ","70% of total billed charges ",67.5,90,,54.00,,,0,"percent of total billed charges ","90% of total billed charges ",69.75,93,,55.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",63.75,85,,51.00,,,0,"percent of total billed charges ","85% of total billed charges ",67.5,90,,54.00,,,0,"percent of total billed charges ","90% of total billed charges ",67.5,90,,54.00,,,0,"percent of total billed charges ","90% of total billed charges ",1.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.25,87,,52.20,,,0,"percent of total billed charges ","87% of total billed charges ",1.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.5,70,,42.00,,,0,"percent of total billed charges ","70% of total billed charges ",1.74,69.75,
"SOL-D5W 500ML FREEFLEX BAG",7400181,"CDM ",258,RC,J7060,HCPCS,OUTPATIENT,,,75,60,,,,,,,,0,"other ","not separately reimbursment ",2.32,100,,1.76,1.76,1.76,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.5,70,,42.00,,,0,"percent of total billed charges ","70% of total billed charges ",67.5,90,,54.00,,,0,"percent of total billed charges ","90% of total billed charges ",69.75,93,,55.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",63.75,85,,51.00,,,0,"percent of total billed charges ","85% of total billed charges ",67.5,90,,54.00,,,0,"percent of total billed charges ","90% of total billed charges ",67.5,90,,54.00,,,0,"percent of total billed charges ","90% of total billed charges ",1.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",65.25,87,,52.20,,,0,"percent of total billed charges ","87% of total billed charges ",1.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.5,70,,42.00,,,0,"percent of total billed charges ","70% of total billed charges ",1.74,69.75,
"HYPERBARIC TX FACILITY",7500020,"CDM ",413,RC,99183,HCPCS,OUTPATIENT,,,1144.5,915.6,,136.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,135.88,135.88,135.88,"1 through 10","other ","not separately reimbursment ",223.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",801.15,70,,640.92,,,0,"percent of total billed charges ","70% of total billed charges ",1030.05,90,,824.04,,,0,"percent of total billed charges ","90% of total billed charges ",1064.39,93,,851.51,,,0,"percent of total billed charges ","93% of total billed charges ",136.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",173.46,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",972.83,85,,778.26,,,0,"percent of total billed charges ","85% of total billed charges ",1030.05,90,,824.04,,,0,"percent of total billed charges ","90% of total billed charges ",1030.05,90,,824.04,,,0,"percent of total billed charges ","90% of total billed charges ",171.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",995.72,87,,796.58,,,0,"percent of total billed charges ","87% of total billed charges ",171.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",801.15,70,,640.92,,,0,"percent of total billed charges ","70% of total billed charges ",136.52,1064.39,
"WOUND CARE FAC LEVEL 1 NEW PAT",7500030,"CDM ",761,RC,99201,HCPCS,OUTPATIENT,,,288.5,230.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",201.95,70,,161.56,,,0,"percent of total billed charges ","70% of total billed charges ",259.65,90,,207.72,,,0,"percent of total billed charges ","90% of total billed charges ",268.31,93,,214.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",245.23,85,,196.18,,,0,"percent of total billed charges ","85% of total billed charges ",259.65,90,,207.72,,,0,"percent of total billed charges ","90% of total billed charges ",259.65,90,,207.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",251,87,,200.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",201.95,70,,161.56,,,0,"percent of total billed charges ","70% of total billed charges ",201.95,268.31,
"WOUND CARE FAC LEVEL 1 ESTAB",7500080,"CDM ",761,RC,99211,HCPCS,OUTPATIENT,,,192.5,154,,,,,,,,0,"other ","not separately reimbursment ",42.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",18.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",134.75,70,,107.80,,,0,"percent of total billed charges ","70% of total billed charges ",173.25,90,,138.60,,,0,"percent of total billed charges ","90% of total billed charges ",179.03,93,,143.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",17.72,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",163.63,85,,130.90,,,0,"percent of total billed charges ","85% of total billed charges ",173.25,90,,138.60,,,0,"percent of total billed charges ","90% of total billed charges ",173.25,90,,138.60,,,0,"percent of total billed charges ","90% of total billed charges ",17.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",167.48,87,,18.91,17.74,20.08,"1 through 10","percent of total billed charges ","87% of total billed charges ",17.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",134.75,70,,107.80,,,0,"percent of total billed charges ","70% of total billed charges ",17.54,179.03,
"ECG MONITORING",7500130,"CDM ",761,RC,93041,HCPCS,OUTPATIENT,,,325,260,,19.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",73.1,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",11.4,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",227.5,70,,182.00,,,0,"percent of total billed charges ","70% of total billed charges ",292.5,90,,234.00,,,0,"percent of total billed charges ","90% of total billed charges ",302.25,93,,241.80,,,0,"percent of total billed charges ","93% of total billed charges ",19.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",276.25,85,,221.00,,,0,"percent of total billed charges ","85% of total billed charges ",292.5,90,,234.00,,,0,"percent of total billed charges ","90% of total billed charges ",292.5,90,,234.00,,,0,"percent of total billed charges ","90% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",282.75,87,,226.20,,,0,"percent of total billed charges ","87% of total billed charges ",10.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",227.5,70,,182.00,,,0,"percent of total billed charges ","70% of total billed charges ",10.32,302.25,
CPR,7500190,"CDM ",761,RC,92950,HCPCS,OUTPATIENT,,,1460.5,1168.4,,114.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",309.49,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",386.91,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1022.35,70,,817.88,,,0,"percent of total billed charges ","70% of total billed charges ",1314.45,90,,1051.56,,,0,"percent of total billed charges ","90% of total billed charges ",1358.27,93,,1086.62,,,0,"percent of total billed charges ","93% of total billed charges ",114.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.53,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1241.43,85,,993.14,,,0,"percent of total billed charges ","85% of total billed charges ",1314.45,90,,1051.56,,,0,"percent of total billed charges ","90% of total billed charges ",1314.45,90,,1051.56,,,0,"percent of total billed charges ","90% of total billed charges ",131.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1270.64,87,,163.23,163.23,163.23,"1 through 10","percent of total billed charges ","87% of total billed charges ",131.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.57,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1022.35,70,,817.88,,,0,"percent of total billed charges ","70% of total billed charges ",114.74,1358.27,
"CHEST TUBE PLACEMENT",7500200,"CDM ",761,RC,32551,HCPCS,OUTPATIENT,,,3037.5,2430,,,,,,,,0,"other ","not separately reimbursment ",,,,60.24,60.24,60.24,"1 through 10","other ","not separately reimbursment ",321.13,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2126.25,70,,1701.00,,,0,"percent of total billed charges ","70% of total billed charges ",2733.75,90,,2187.00,,,0,"percent of total billed charges ","90% of total billed charges ",2824.88,93,,2259.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",226.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2581.88,85,,2065.50,,,0,"percent of total billed charges ","85% of total billed charges ",2278.13,90,,1822.50,,,0,"percent of total billed charges ","90% of total billed charges ",2733.75,90,,2187.00,,,0,"percent of total billed charges ","90% of total billed charges ",224,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2642.63,87,,2114.10,,,0,"percent of total billed charges ","87% of total billed charges ",224,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1447.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2126.25,70,,1701.00,,,0,"percent of total billed charges ","70% of total billed charges ",224,2824.88,
"ET TUBE INSERTION",7500210,"CDM ",761,RC,31500,HCPCS,OUTPATIENT,,,603.5,482.8,,234,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",293.5,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",422.45,70,,337.96,,,0,"percent of total billed charges ","70% of total billed charges ",543.15,90,,434.52,,,0,"percent of total billed charges ","90% of total billed charges ",561.26,93,,449.01,,,0,"percent of total billed charges ","93% of total billed charges ",234,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",512.98,85,,410.38,,,0,"percent of total billed charges ","85% of total billed charges ",452.63,90,,362.10,,,0,"percent of total billed charges ","90% of total billed charges ",543.15,90,,434.52,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",525.05,87,,420.04,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.82,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",422.45,70,,337.96,,,0,"percent of total billed charges ","70% of total billed charges ",217.82,561.26,
"BLOOD GLUCOSE",7500220,"CDM ",761,RC,82948,HCPCS,OUTPATIENT,,,83,66.4,,4.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,51.00,51.00,51.00,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",4.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2.08,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",2.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",72.21,87,,64.65,29.81,93.10,"1 through 10","percent of total billed charges ","87% of total billed charges ",2.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.04,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",2.06,77.19,
"DEBRIDE WOUND < 20 CM",7500230,"CDM ",761,RC,97597,HCPCS,OUTPATIENT,,,344,275.2,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",278.76,100,,266.92,266.92,266.92,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",76.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",240.8,70,,192.64,,,0,"percent of total billed charges ","70% of total billed charges ",309.6,90,,247.68,,,0,"percent of total billed charges ","90% of total billed charges ",319.92,93,,255.94,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",292.4,85,,233.92,,,0,"percent of total billed charges ","85% of total billed charges ",309.6,90,,247.68,,,0,"percent of total billed charges ","90% of total billed charges ",309.6,90,,247.68,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",299.28,87,,239.42,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",240.8,70,,192.64,,,0,"percent of total billed charges ","70% of total billed charges ",76.25,319.92,
"CHEMICAL CAUTERIZATION TISSUE",7500240,"CDM ",761,RC,17250,HCPCS,OUTPATIENT,,,625.5,500.4,,85.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",388.85,100,,88.32,88.32,88.32,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",76.45,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",437.85,70,,350.28,,,0,"percent of total billed charges ","70% of total billed charges ",562.95,90,,450.36,,,0,"percent of total billed charges ","90% of total billed charges ",581.72,93,,465.38,,,0,"percent of total billed charges ","93% of total billed charges ",85.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",99.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",531.68,85,,425.34,,,0,"percent of total billed charges ","85% of total billed charges ",469.13,90,,375.30,,,0,"percent of total billed charges ","90% of total billed charges ",562.95,90,,450.36,,,0,"percent of total billed charges ","90% of total billed charges ",98.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",544.19,87,,435.35,,,0,"percent of total billed charges ","87% of total billed charges ",98.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",437.85,70,,350.28,,,0,"percent of total billed charges ","70% of total billed charges ",76.45,581.72,
"DEBRIDE WOUND, EA ADD'L 20 CM",7500250,"CDM ",761,RC,97598,HCPCS,OUTPATIENT,,,318.5,254.8,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",222.95,70,,178.36,,,0,"percent of total billed charges ","70% of total billed charges ",286.65,90,,229.32,,,0,"percent of total billed charges ","90% of total billed charges ",296.21,93,,236.97,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",270.73,85,,216.58,,,0,"percent of total billed charges ","85% of total billed charges ",286.65,90,,229.32,,,0,"percent of total billed charges ","90% of total billed charges ",286.65,90,,229.32,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.1,87,,221.68,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",222.95,70,,178.36,,,0,"percent of total billed charges ","70% of total billed charges ",52.25,296.21,
"DEBRIDE SUBQ TISSUE <20 CM",7500260,"CDM ",761,RC,11042,HCPCS,OUTPATIENT,,,604.5,483.6,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",451.17,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",124.63,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",423.15,70,,338.52,,,0,"percent of total billed charges ","70% of total billed charges ",544.05,90,,435.24,,,0,"percent of total billed charges ","90% of total billed charges ",562.19,93,,449.75,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",513.83,85,,411.06,,,0,"percent of total billed charges ","85% of total billed charges ",453.38,90,,362.70,,,0,"percent of total billed charges ","90% of total billed charges ",544.05,90,,435.24,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",525.92,87,,838.17,838.17,838.17,"1 through 10","percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",423.15,70,,338.52,,,0,"percent of total billed charges ","70% of total billed charges ",124.63,562.19,
"DEBRIDE SUBQ TISS EA ADDL 20CM",7500270,"CDM ",761,RC,11045,HCPCS,OUTPATIENT,,,547.5,438,,101.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",278.76,100,,216.82,216.82,216.82,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",53.64,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",383.25,70,,306.60,,,0,"percent of total billed charges ","70% of total billed charges ",492.75,90,,394.20,,,0,"percent of total billed charges ","90% of total billed charges ",509.18,93,,407.34,,,0,"percent of total billed charges ","93% of total billed charges ",101.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",128.47,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",465.38,85,,372.30,,,0,"percent of total billed charges ","85% of total billed charges ",410.63,90,,328.50,,,0,"percent of total billed charges ","90% of total billed charges ",492.75,90,,394.20,,,0,"percent of total billed charges ","90% of total billed charges ",127.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",476.33,87,,381.06,,,0,"percent of total billed charges ","87% of total billed charges ",127.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",383.25,70,,306.60,,,0,"percent of total billed charges ","70% of total billed charges ",53.64,509.18,
"CERUMEN REMOVAL BILATERAL",7500280,"CDM ",761,RC,69210,HCPCS,OUTPATIENT,,,175,140,,140.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",543.31,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",68.24,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",162.75,93,,130.20,,,0,"percent of total billed charges ","93% of total billed charges ",140.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",178.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",148.75,85,,119.00,,,0,"percent of total billed charges ","85% of total billed charges ",131.25,90,,105.00,,,0,"percent of total billed charges ","90% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",176.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",152.25,87,,42.37,42.37,42.37,"1 through 10","percent of total billed charges ","87% of total billed charges ",176.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",54.25,543.31,
"DEBRIDE NAILS, 1-5",7500410,"CDM ",761,RC,11720,HCPCS,OUTPATIENT,,,300.5,240.4,,,,,,,,0,"other ","not separately reimbursment ",69.46,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",30.58,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",210.35,70,,168.28,,,0,"percent of total billed charges ","70% of total billed charges ",270.45,90,,216.36,,,0,"percent of total billed charges ","90% of total billed charges ",279.47,93,,223.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",255.43,85,,204.34,,,0,"percent of total billed charges ","85% of total billed charges ",225.38,90,,180.30,,,0,"percent of total billed charges ","90% of total billed charges ",270.45,90,,216.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",261.44,87,,209.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",210.35,70,,168.28,,,0,"percent of total billed charges ","70% of total billed charges ",30.58,279.47,
"DEBRIDE NAILS, 1-5",7500410,"CDM ",761,RC,11720,HCPCS,OUTPATIENT,,,302.5,242,,,,,,,,0,"other ","not separately reimbursment ",69.46,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",30.58,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",211.75,70,,169.40,,,0,"percent of total billed charges ","70% of total billed charges ",272.25,90,,217.80,,,0,"percent of total billed charges ","90% of total billed charges ",281.33,93,,225.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",257.13,85,,205.70,,,0,"percent of total billed charges ","85% of total billed charges ",226.88,90,,181.50,,,0,"percent of total billed charges ","90% of total billed charges ",272.25,90,,217.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",263.18,87,,210.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",211.75,70,,169.40,,,0,"percent of total billed charges ","70% of total billed charges ",30.58,281.33,
"DEBRIDE NAILS 6 OR MORE",7500420,"CDM ",761,RC,11721,HCPCS,OUTPATIENT,,,625.5,500.4,,,,,,,,0,"other ","not separately reimbursment ",69.46,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",50.8,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",437.85,70,,350.28,,,0,"percent of total billed charges ","70% of total billed charges ",562.95,90,,450.36,,,0,"percent of total billed charges ","90% of total billed charges ",581.72,93,,465.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",531.68,85,,425.34,,,0,"percent of total billed charges ","85% of total billed charges ",469.13,90,,375.30,,,0,"percent of total billed charges ","90% of total billed charges ",562.95,90,,450.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",544.19,87,,435.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",437.85,70,,350.28,,,0,"percent of total billed charges ","70% of total billed charges ",50.8,581.72,
"AVULSION NAILPLATE, SINGLE",7500430,"CDM ",761,RC,11730,HCPCS,OUTPATIENT,,,286.5,229.2,,260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.71,100,,157.01,157.01,157.01,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",112.79,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",200.55,70,,160.44,,,0,"percent of total billed charges ","70% of total billed charges ",257.85,90,,206.28,,,0,"percent of total billed charges ","90% of total billed charges ",266.45,93,,213.16,,,0,"percent of total billed charges ","93% of total billed charges ",260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",243.53,85,,194.82,,,0,"percent of total billed charges ","85% of total billed charges ",214.88,90,,171.90,,,0,"percent of total billed charges ","90% of total billed charges ",257.85,90,,206.28,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",249.26,87,,199.41,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",200.55,70,,160.44,,,0,"percent of total billed charges ","70% of total billed charges ",112.79,330.35,
"AVULSION NAIL PLATE, EA ADD'L",7500440,"CDM ",761,RC,11732,HCPCS,OUTPATIENT,,,160,128,,19.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",36.54,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",112,70,,89.60,,,0,"percent of total billed charges ","70% of total billed charges ",144,90,,115.20,,,0,"percent of total billed charges ","90% of total billed charges ",148.8,93,,119.04,,,0,"percent of total billed charges ","93% of total billed charges ",19.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",24.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",136,85,,108.80,,,0,"percent of total billed charges ","85% of total billed charges ",120,90,,96.00,,,0,"percent of total billed charges ","90% of total billed charges ",144,90,,115.20,,,0,"percent of total billed charges ","90% of total billed charges ",24.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",139.2,87,,111.36,,,0,"percent of total billed charges ","87% of total billed charges ",24.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",112,70,,89.60,,,0,"percent of total billed charges ","70% of total billed charges ",19.61,148.8,
"EXCISION NAIL, PART/COMPLETE",7500450,"CDM ",761,RC,11750,HCPCS,OUTPATIENT,,,1019.5,815.6,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",451.17,100,,238.35,238.35,238.35,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",212.26,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",713.65,70,,570.92,,,0,"percent of total billed charges ","70% of total billed charges ",917.55,90,,734.04,,,0,"percent of total billed charges ","90% of total billed charges ",948.14,93,,758.51,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",866.58,85,,693.26,,,0,"percent of total billed charges ","85% of total billed charges ",764.63,90,,611.70,,,0,"percent of total billed charges ","90% of total billed charges ",917.55,90,,734.04,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",886.97,87,,106.41,106.41,106.41,"1 through 10","percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",713.65,70,,570.92,,,0,"percent of total billed charges ","70% of total billed charges ",212.26,948.14,
"PARING/CUTTING CALLOUS, SINGLE",7500460,"CDM ",761,RC,11055,HCPCS,OUTPATIENT,,,273.5,218.8,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.71,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",33.55,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",191.45,70,,153.16,,,0,"percent of total billed charges ","70% of total billed charges ",246.15,90,,196.92,,,0,"percent of total billed charges ","90% of total billed charges ",254.36,93,,203.49,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",232.48,85,,185.98,,,0,"percent of total billed charges ","85% of total billed charges ",205.13,90,,164.10,,,0,"percent of total billed charges ","90% of total billed charges ",246.15,90,,196.92,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",237.95,87,,190.36,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",191.45,70,,153.16,,,0,"percent of total billed charges ","70% of total billed charges ",33.55,264.28,
"PARING/CUTTING CALLOUS, 2-4",7500470,"CDM ",761,RC,11056,HCPCS,OUTPATIENT,,,305.5,244.4,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.71,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",47.06,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",213.85,70,,171.08,,,0,"percent of total billed charges ","70% of total billed charges ",274.95,90,,219.96,,,0,"percent of total billed charges ","90% of total billed charges ",284.12,93,,227.30,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",259.68,85,,207.74,,,0,"percent of total billed charges ","85% of total billed charges ",229.13,90,,183.30,,,0,"percent of total billed charges ","90% of total billed charges ",274.95,90,,219.96,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",265.79,87,,212.63,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",213.85,70,,171.08,,,0,"percent of total billed charges ","70% of total billed charges ",47.06,284.12,
"PARING/CUTTING, >4",7500480,"CDM ",761,RC,11057,HCPCS,OUTPATIENT,,,665,532,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.71,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",60.9,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",465.5,70,,372.40,,,0,"percent of total billed charges ","70% of total billed charges ",598.5,90,,478.80,,,0,"percent of total billed charges ","90% of total billed charges ",618.45,93,,494.76,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",565.25,85,,452.20,,,0,"percent of total billed charges ","85% of total billed charges ",498.75,90,,399.00,,,0,"percent of total billed charges ","90% of total billed charges ",598.5,90,,478.80,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",578.55,87,,462.84,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",465.5,70,,372.40,,,0,"percent of total billed charges ","70% of total billed charges ",60.9,618.45,
"RIGID, TOTAL CONTACT LEG CAST",7500490,"CDM ",761,RC,29445,HCPCS,OUTPATIENT,,,549,439.2,,228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",87.18,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",206.78,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",384.3,70,,307.44,,,0,"percent of total billed charges ","70% of total billed charges ",494.1,90,,395.28,,,0,"percent of total billed charges ","90% of total billed charges ",510.57,93,,408.46,,,0,"percent of total billed charges ","93% of total billed charges ",228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",466.65,85,,373.32,,,0,"percent of total billed charges ","85% of total billed charges ",411.75,90,,329.40,,,0,"percent of total billed charges ","90% of total billed charges ",494.1,90,,395.28,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",477.63,87,,382.10,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.22,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",384.3,70,,307.44,,,0,"percent of total billed charges ","70% of total billed charges ",87.18,510.57,
"APPLY PASTE BOOT",7500500,"CDM ",761,RC,29580,HCPCS,OUTPATIENT,,,630,504,,57.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",55.7,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",441,70,,352.80,,,0,"percent of total billed charges ","70% of total billed charges ",567,90,,453.60,,,0,"percent of total billed charges ","90% of total billed charges ",585.9,93,,468.72,,,0,"percent of total billed charges ","93% of total billed charges ",57.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",535.5,85,,428.40,,,0,"percent of total billed charges ","85% of total billed charges ",472.5,90,,378.00,,,0,"percent of total billed charges ","90% of total billed charges ",567,90,,453.60,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",548.1,87,,438.48,,,0,"percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",441,70,,352.80,,,0,"percent of total billed charges ","70% of total billed charges ",55.7,585.9,
"APPLY PASTE BOOT",7500500,"CDM ",761,RC,29580,HCPCS,OUTPATIENT,,,598.5,478.8,,57.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",55.7,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",418.95,70,,335.16,,,0,"percent of total billed charges ","70% of total billed charges ",538.65,90,,430.92,,,0,"percent of total billed charges ","90% of total billed charges ",556.61,93,,445.29,,,0,"percent of total billed charges ","93% of total billed charges ",57.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",508.73,85,,406.98,,,0,"percent of total billed charges ","85% of total billed charges ",448.88,90,,359.10,,,0,"percent of total billed charges ","90% of total billed charges ",538.65,90,,430.92,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",520.7,87,,416.56,,,0,"percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",418.95,70,,335.16,,,0,"percent of total billed charges ","70% of total billed charges ",55.7,556.61,
"APPL MULT LAY COMPRES LOW LEG",7500510,"CDM ",761,RC,29581,HCPCS,OUTPATIENT,,,625.5,500.4,,38.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",58.81,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",437.85,70,,350.28,,,0,"percent of total billed charges ","70% of total billed charges ",562.95,90,,450.36,,,0,"percent of total billed charges ","90% of total billed charges ",581.72,93,,465.38,,,0,"percent of total billed charges ","93% of total billed charges ",38.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",48.5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",531.68,85,,425.34,,,0,"percent of total billed charges ","85% of total billed charges ",469.13,90,,375.30,,,0,"percent of total billed charges ","90% of total billed charges ",562.95,90,,450.36,,,0,"percent of total billed charges ","90% of total billed charges ",48.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",544.19,87,,435.35,,,0,"percent of total billed charges ","87% of total billed charges ",48.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",437.85,70,,350.28,,,0,"percent of total billed charges ","70% of total billed charges ",38.17,581.72,
"NPWT <50 SQ CM",7500520,"CDM ",761,RC,97605,HCPCS,OUTPATIENT,,,321,256.8,,64.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",223.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",53.61,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",224.7,70,,179.76,,,0,"percent of total billed charges ","70% of total billed charges ",288.9,90,,231.12,,,0,"percent of total billed charges ","90% of total billed charges ",298.53,93,,238.82,,,0,"percent of total billed charges ","93% of total billed charges ",64.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",44.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",272.85,85,,218.28,,,0,"percent of total billed charges ","85% of total billed charges ",288.9,90,,231.12,,,0,"percent of total billed charges ","90% of total billed charges ",288.9,90,,231.12,,,0,"percent of total billed charges ","90% of total billed charges ",44.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",279.27,87,,223.42,,,0,"percent of total billed charges ","87% of total billed charges ",44.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",224.7,70,,179.76,,,0,"percent of total billed charges ","70% of total billed charges ",44.08,298.53,
"NPWT >50 SQ CM",7500530,"CDM ",761,RC,97606,HCPCS,OUTPATIENT,,,588.5,470.8,,45.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",331.25,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",58.81,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",411.95,70,,329.56,,,0,"percent of total billed charges ","70% of total billed charges ",529.65,90,,423.72,,,0,"percent of total billed charges ","90% of total billed charges ",547.31,93,,437.85,,,0,"percent of total billed charges ","93% of total billed charges ",45.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",500.23,85,,400.18,,,0,"percent of total billed charges ","85% of total billed charges ",529.65,90,,423.72,,,0,"percent of total billed charges ","90% of total billed charges ",529.65,90,,423.72,,,0,"percent of total billed charges ","90% of total billed charges ",57.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",512,87,,409.60,,,0,"percent of total billed charges ","87% of total billed charges ",57.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",411.95,70,,329.56,,,0,"percent of total billed charges ","70% of total billed charges ",45.36,547.31,
"NPWT <50 SQ CM; NON DME",7500540,"CDM ",761,RC,97607,HCPCS,OUTPATIENT,,,533.5,426.8,,129.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",45.74,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",373.45,70,,298.76,,,0,"percent of total billed charges ","70% of total billed charges ",480.15,90,,384.12,,,0,"percent of total billed charges ","90% of total billed charges ",496.16,93,,396.93,,,0,"percent of total billed charges ","93% of total billed charges ",129.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",44.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",453.48,85,,362.78,,,0,"percent of total billed charges ","85% of total billed charges ",480.15,90,,384.12,,,0,"percent of total billed charges ","90% of total billed charges ",480.15,90,,384.12,,,0,"percent of total billed charges ","90% of total billed charges ",44.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",464.15,87,,371.32,,,0,"percent of total billed charges ","87% of total billed charges ",44.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",373.45,70,,298.76,,,0,"percent of total billed charges ","70% of total billed charges ",44.08,496.16,
"NPWT >50 SQ CM; NON DME",7500550,"CDM ",761,RC,97608,HCPCS,OUTPATIENT,,,566,452.8,,45.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",396.2,70,,316.96,,,0,"percent of total billed charges ","70% of total billed charges ",509.4,90,,407.52,,,0,"percent of total billed charges ","90% of total billed charges ",526.38,93,,421.10,,,0,"percent of total billed charges ","93% of total billed charges ",45.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",481.1,85,,384.88,,,0,"percent of total billed charges ","85% of total billed charges ",509.4,90,,407.52,,,0,"percent of total billed charges ","90% of total billed charges ",509.4,90,,407.52,,,0,"percent of total billed charges ","90% of total billed charges ",57.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",492.42,87,,393.94,,,0,"percent of total billed charges ","87% of total billed charges ",57.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",396.2,70,,316.96,,,0,"percent of total billed charges ","70% of total billed charges ",45.36,526.38,
"I&D ABSCESS SIMPLE/SINGLE",7500580,"CDM ",761,RC,10060,HCPCS,OUTPATIENT,,,789.5,631.6,,202.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.72,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",217.34,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",552.65,70,,442.12,,,0,"percent of total billed charges ","70% of total billed charges ",710.55,90,,568.44,,,0,"percent of total billed charges ","90% of total billed charges ",734.24,93,,587.39,,,0,"percent of total billed charges ","93% of total billed charges ",202.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",671.08,85,,536.86,,,0,"percent of total billed charges ","85% of total billed charges ",592.13,90,,473.70,,,0,"percent of total billed charges ","90% of total billed charges ",710.55,90,,568.44,,,0,"percent of total billed charges ","90% of total billed charges ",254.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",686.87,87,,112.42,112.42,112.42,"1 through 10","percent of total billed charges ","87% of total billed charges ",254.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",552.65,70,,442.12,,,0,"percent of total billed charges ","70% of total billed charges ",184.51,734.24,
"I&D ABSCESS COMP/MULT",7500590,"CDM ",761,RC,10061,HCPCS,OUTPATIENT,,,1484.5,1187.6,,222.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1484.7,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",379.48,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1039.15,70,,831.32,,,0,"percent of total billed charges ","70% of total billed charges ",1336.05,90,,1068.84,,,0,"percent of total billed charges ","90% of total billed charges ",1380.59,93,,1104.47,,,0,"percent of total billed charges ","93% of total billed charges ",222.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",256.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1261.83,85,,1009.46,,,0,"percent of total billed charges ","85% of total billed charges ",1113.38,90,,890.70,,,0,"percent of total billed charges ","90% of total billed charges ",1336.05,90,,1068.84,,,0,"percent of total billed charges ","90% of total billed charges ",254.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1291.52,87,,1033.22,,,0,"percent of total billed charges ","87% of total billed charges ",254.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1039.15,70,,831.32,,,0,"percent of total billed charges ","70% of total billed charges ",222.22,1484.7,
"I&D REMOVAL FB",7500600,"CDM ",761,RC,10120,HCPCS,OUTPATIENT,,,1077.5,862,,223.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1075.65,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",214.57,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",754.25,70,,603.40,,,0,"percent of total billed charges ","70% of total billed charges ",969.75,90,,775.80,,,0,"percent of total billed charges ","90% of total billed charges ",1002.08,93,,801.66,,,0,"percent of total billed charges ","93% of total billed charges ",223.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",915.88,85,,732.70,,,0,"percent of total billed charges ","85% of total billed charges ",808.13,90,,646.50,,,0,"percent of total billed charges ","90% of total billed charges ",969.75,90,,775.80,,,0,"percent of total billed charges ","90% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",937.43,87,,749.94,,,0,"percent of total billed charges ","87% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",754.25,70,,603.40,,,0,"percent of total billed charges ","70% of total billed charges ",214.57,1075.65,
"I&D HEMATOMA SEROMA/FLUID",7500610,"CDM ",761,RC,10140,HCPCS,OUTPATIENT,,,2443,1954.4,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1186.75,100,,217.85,217.85,217.85,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",243.74,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1710.1,70,,1368.08,,,0,"percent of total billed charges ","70% of total billed charges ",2198.7,90,,1758.96,,,0,"percent of total billed charges ","90% of total billed charges ",2271.99,93,,1817.59,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2076.55,85,,1661.24,,,0,"percent of total billed charges ","85% of total billed charges ",1832.25,90,,1465.80,,,0,"percent of total billed charges ","90% of total billed charges ",2198.7,90,,1758.96,,,0,"percent of total billed charges ","90% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2125.41,87,,1700.33,,,0,"percent of total billed charges ","87% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1710.1,70,,1368.08,,,0,"percent of total billed charges ","70% of total billed charges ",243.74,2271.99,
"PUNC/ASPIRATE ABSCESS",7500620,"CDM ",761,RC,10160,HCPCS,OUTPATIENT,,,948,758.4,,223.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",947.38,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",196.81,220,,79.15,79.15,79.15,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",663.6,70,,530.88,,,0,"percent of total billed charges ","70% of total billed charges ",853.2,90,,682.56,,,0,"percent of total billed charges ","90% of total billed charges ",881.64,93,,705.31,,,0,"percent of total billed charges ","93% of total billed charges ",223.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",805.8,85,,644.64,,,0,"percent of total billed charges ","85% of total billed charges ",711,90,,568.80,,,0,"percent of total billed charges ","90% of total billed charges ",853.2,90,,682.56,,,0,"percent of total billed charges ","90% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",824.76,87,,659.81,,,0,"percent of total billed charges ","87% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",663.6,70,,530.88,,,0,"percent of total billed charges ","70% of total billed charges ",196.81,947.38,
"I&D COMPLEX, POST-OP WOUND",7500630,"CDM ",761,RC,10180,HCPCS,OUTPATIENT,,,3767.5,3014,,920.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3784.47,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",362.58,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2637.25,70,,2109.80,,,0,"percent of total billed charges ","70% of total billed charges ",3390.75,90,,2712.60,,,0,"percent of total billed charges ","90% of total billed charges ",3503.78,93,,2803.02,,,0,"percent of total billed charges ","93% of total billed charges ",920.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3202.38,85,,2561.90,,,0,"percent of total billed charges ","85% of total billed charges ",2825.63,90,,2260.50,,,0,"percent of total billed charges ","90% of total billed charges ",3390.75,90,,2712.60,,,0,"percent of total billed charges ","90% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3277.73,87,,207.83,207.83,207.83,"1 through 10","percent of total billed charges ","87% of total billed charges ",255.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2671.34,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2637.25,70,,2109.80,,,0,"percent of total billed charges ","70% of total billed charges ",255.12,3784.47,
"DEBRIDE TISSUE NON-SELECT",7500640,"CDM ",761,RC,97602,HCPCS,OUTPATIENT,,,613,490.4,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.2,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,39.36,39.36,39.36,"1 through 10","other ","not separately reimbursment ",429.1,70,,343.28,,,0,"percent of total billed charges ","70% of total billed charges ",551.7,90,,441.36,,,0,"percent of total billed charges ","90% of total billed charges ",570.09,93,,456.07,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",521.05,85,,416.84,,,0,"percent of total billed charges ","85% of total billed charges ",551.7,90,,441.36,,,0,"percent of total billed charges ","90% of total billed charges ",551.7,90,,441.36,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",533.31,87,,426.65,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",429.1,70,,343.28,,,0,"percent of total billed charges ","70% of total billed charges ",184.51,570.09,
"DEBRIDE TISSUE NON-SELECT",7500640,"CDM ",761,RC,97602,HCPCS,OUTPATIENT,,,617.5,494,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.2,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,39.36,39.36,39.36,"1 through 10","other ","not separately reimbursment ",432.25,70,,345.80,,,0,"percent of total billed charges ","70% of total billed charges ",555.75,90,,444.60,,,0,"percent of total billed charges ","90% of total billed charges ",574.28,93,,459.42,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",524.88,85,,419.90,,,0,"percent of total billed charges ","85% of total billed charges ",555.75,90,,444.60,,,0,"percent of total billed charges ","90% of total billed charges ",555.75,90,,444.60,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",537.23,87,,429.78,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",432.25,70,,345.80,,,0,"percent of total billed charges ","70% of total billed charges ",184.51,574.28,
"DEBRIDE LOW FREQ US/DAY",7500650,"CDM ",761,RC,97610,HCPCS,OUTPATIENT,,,209.5,167.6,,56.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",39.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",146.65,70,,117.32,,,0,"percent of total billed charges ","70% of total billed charges ",188.55,90,,150.84,,,0,"percent of total billed charges ","90% of total billed charges ",194.84,93,,155.87,,,0,"percent of total billed charges ","93% of total billed charges ",56.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",71.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",178.08,85,,142.46,,,0,"percent of total billed charges ","85% of total billed charges ",188.55,90,,150.84,,,0,"percent of total billed charges ","90% of total billed charges ",188.55,90,,150.84,,,0,"percent of total billed charges ","90% of total billed charges ",71.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",182.27,87,,145.82,,,0,"percent of total billed charges ","87% of total billed charges ",71.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",146.65,70,,117.32,,,0,"percent of total billed charges ","70% of total billed charges ",39.09,194.84,
"DEBRIDE MUSCLE/FASCIA <20CM",7500660,"CDM ",761,RC,11043,HCPCS,OUTPATIENT,,,941,752.8,,228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",700.21,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",316.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",658.7,70,,526.96,,,0,"percent of total billed charges ","70% of total billed charges ",846.9,90,,677.52,,,0,"percent of total billed charges ","90% of total billed charges ",875.13,93,,700.10,,,0,"percent of total billed charges ","93% of total billed charges ",228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",799.85,85,,639.88,,,0,"percent of total billed charges ","85% of total billed charges ",705.75,90,,564.60,,,0,"percent of total billed charges ","90% of total billed charges ",846.9,90,,677.52,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",818.67,87,,654.94,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",679.69,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",658.7,70,,526.96,,,0,"percent of total billed charges ","70% of total billed charges ",228.8,875.13,
"DEBRIDE MUSC/FAS EA ADD'L 20CM",7500670,"CDM ",761,RC,11046,HCPCS,OUTPATIENT,,,574.5,459.6,,101.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",278.76,100,,87.33,87.33,87.33,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",113.04,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",402.15,70,,321.72,,,0,"percent of total billed charges ","70% of total billed charges ",517.05,90,,413.64,,,0,"percent of total billed charges ","90% of total billed charges ",534.29,93,,427.43,,,0,"percent of total billed charges ","93% of total billed charges ",101.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",128.47,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",488.33,85,,390.66,,,0,"percent of total billed charges ","85% of total billed charges ",430.88,90,,344.70,,,0,"percent of total billed charges ","90% of total billed charges ",517.05,90,,413.64,,,0,"percent of total billed charges ","90% of total billed charges ",127.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",499.82,87,,399.86,,,0,"percent of total billed charges ","87% of total billed charges ",127.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",402.15,70,,321.72,,,0,"percent of total billed charges ","70% of total billed charges ",101.11,534.29,
"DEBRIDE BONE <21 CM",7500680,"CDM ",761,RC,11044,HCPCS,OUTPATIENT,,,1627.5,1302,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1805.43,100,,40.42,40.42,40.42,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",462.68,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1139.25,70,,911.40,,,0,"percent of total billed charges ","70% of total billed charges ",1464.75,90,,1171.80,,,0,"percent of total billed charges ","90% of total billed charges ",1513.58,93,,1210.86,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1383.38,85,,1106.70,,,0,"percent of total billed charges ","85% of total billed charges ",1220.63,90,,976.50,,,0,"percent of total billed charges ","90% of total billed charges ",1464.75,90,,1171.80,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1415.93,87,,1132.74,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1139.25,70,,911.40,,,0,"percent of total billed charges ","70% of total billed charges ",261.66,1805.43,
"DEBRIDE BONE EA ADD'L 20CM",7500690,"CDM ",761,RC,11047,HCPCS,OUTPATIENT,,,783,626.4,,314.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",278.76,100,,120.00,120.00,120.00,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",197.96,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",548.1,70,,438.48,,,0,"percent of total billed charges ","70% of total billed charges ",704.7,90,,563.76,,,0,"percent of total billed charges ","90% of total billed charges ",728.19,93,,582.55,,,0,"percent of total billed charges ","93% of total billed charges ",314.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",399.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",665.55,85,,532.44,,,0,"percent of total billed charges ","85% of total billed charges ",587.25,90,,469.80,,,0,"percent of total billed charges ","90% of total billed charges ",704.7,90,,563.76,,,0,"percent of total billed charges ","90% of total billed charges ",395.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",681.21,87,,544.97,,,0,"percent of total billed charges ","87% of total billed charges ",395.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",548.1,70,,438.48,,,0,"percent of total billed charges ","70% of total billed charges ",197.96,728.19,
"INITIAL TX 1ST DEG BURN",7500700,"CDM ",761,RC,16000,HCPCS,OUTPATIENT,,,167.5,134,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",93.37,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",117.25,70,,93.80,,,0,"percent of total billed charges ","70% of total billed charges ",150.75,90,,120.60,,,0,"percent of total billed charges ","90% of total billed charges ",155.78,93,,124.62,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",363.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",142.38,85,,113.90,,,0,"percent of total billed charges ","85% of total billed charges ",125.63,90,,100.50,,,0,"percent of total billed charges ","90% of total billed charges ",150.75,90,,120.60,,,0,"percent of total billed charges ","90% of total billed charges ",359.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",145.73,87,,116.58,,,0,"percent of total billed charges ","87% of total billed charges ",359.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",117.25,70,,93.80,,,0,"percent of total billed charges ","70% of total billed charges ",93.37,363.39,
"DRSG/DEBRIDE SMALL BURN",7500710,"CDM ",761,RC,16020,HCPCS,OUTPATIENT,,,783,626.4,,189.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",371.68,100,,98.42,98.42,98.42,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",111.8,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",548.1,70,,438.48,,,0,"percent of total billed charges ","70% of total billed charges ",704.7,90,,563.76,,,0,"percent of total billed charges ","90% of total billed charges ",728.19,93,,582.55,,,0,"percent of total billed charges ","93% of total billed charges ",189.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",665.55,85,,532.44,,,0,"percent of total billed charges ","85% of total billed charges ",587.25,90,,469.80,,,0,"percent of total billed charges ","90% of total billed charges ",704.7,90,,563.76,,,0,"percent of total billed charges ","90% of total billed charges ",217.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",681.21,87,,544.97,,,0,"percent of total billed charges ","87% of total billed charges ",217.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",548.1,70,,438.48,,,0,"percent of total billed charges ","70% of total billed charges ",111.8,728.19,
"DRSG/DEBRIDE MEDIUM BURNS",7500720,"CDM ",761,RC,16025,HCPCS,OUTPATIENT,,,783,626.4,,189.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",371.68,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",228.98,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",548.1,70,,438.48,,,0,"percent of total billed charges ","70% of total billed charges ",704.7,90,,563.76,,,0,"percent of total billed charges ","90% of total billed charges ",728.19,93,,582.55,,,0,"percent of total billed charges ","93% of total billed charges ",189.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",665.55,85,,532.44,,,0,"percent of total billed charges ","85% of total billed charges ",587.25,90,,469.80,,,0,"percent of total billed charges ","90% of total billed charges ",704.7,90,,563.76,,,0,"percent of total billed charges ","90% of total billed charges ",217.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",681.21,87,,544.97,,,0,"percent of total billed charges ","87% of total billed charges ",217.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",548.1,70,,438.48,,,0,"percent of total billed charges ","70% of total billed charges ",184.51,728.19,
"DRSG/DEBRIDE LARGE BURNS",7500730,"CDM ",761,RC,16030,HCPCS,OUTPATIENT,,,821,656.8,,314.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",371.68,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",268.73,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",574.7,70,,459.76,,,0,"percent of total billed charges ","70% of total billed charges ",738.9,90,,591.12,,,0,"percent of total billed charges ","90% of total billed charges ",763.53,93,,610.82,,,0,"percent of total billed charges ","93% of total billed charges ",314.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",363.39,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",697.85,85,,558.28,,,0,"percent of total billed charges ","85% of total billed charges ",615.75,90,,492.60,,,0,"percent of total billed charges ","90% of total billed charges ",738.9,90,,591.12,,,0,"percent of total billed charges ","90% of total billed charges ",359.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",714.27,87,,571.42,,,0,"percent of total billed charges ","87% of total billed charges ",359.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",574.7,70,,459.76,,,0,"percent of total billed charges ","70% of total billed charges ",268.73,763.53,
"FINE NEEDLE ASPIR WO IMAGE 1ST",7500740,"CDM ",761,RC,10021,HCPCS,OUTPATIENT,,,532.5,426,,129.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",113.7,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",372.75,70,,298.20,,,0,"percent of total billed charges ","70% of total billed charges ",479.25,90,,383.40,,,0,"percent of total billed charges ","90% of total billed charges ",495.23,93,,396.18,,,0,"percent of total billed charges ","93% of total billed charges ",129.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.94,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",452.63,85,,362.10,,,0,"percent of total billed charges ","85% of total billed charges ",399.38,90,,319.50,,,0,"percent of total billed charges ","90% of total billed charges ",479.25,90,,383.40,,,0,"percent of total billed charges ","90% of total billed charges ",99.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",463.28,87,,370.62,,,0,"percent of total billed charges ","87% of total billed charges ",99.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",372.75,70,,298.20,,,0,"percent of total billed charges ","70% of total billed charges ",99.94,495.23,
"SHAVE SKIN LESION SINGLE 0.5CM",7500750,"CDM ",761,RC,11300,HCPCS,OUTPATIENT,,,532.5,426,,171.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",451.17,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",70.93,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",372.75,70,,298.20,,,0,"percent of total billed charges ","70% of total billed charges ",479.25,90,,383.40,,,0,"percent of total billed charges ","90% of total billed charges ",495.23,93,,396.18,,,0,"percent of total billed charges ","93% of total billed charges ",171.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",452.63,85,,362.10,,,0,"percent of total billed charges ","85% of total billed charges ",399.38,90,,319.50,,,0,"percent of total billed charges ","90% of total billed charges ",479.25,90,,383.40,,,0,"percent of total billed charges ","90% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",463.28,87,,370.62,,,0,"percent of total billed charges ","87% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",372.75,70,,298.20,,,0,"percent of total billed charges ","70% of total billed charges ",70.93,495.23,
"SKIN SUB GRAFT TRUNK/ARM/LEG",7500760,"CDM ",761,RC,15271,HCPCS,OUTPATIENT,,,3794,3035.2,,153.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3014.85,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",173.01,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2655.8,70,,2124.64,,,0,"percent of total billed charges ","70% of total billed charges ",3414.6,90,,2731.68,,,0,"percent of total billed charges ","90% of total billed charges ",3528.42,93,,2822.74,,,0,"percent of total billed charges ","93% of total billed charges ",153.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3224.9,85,,2579.92,,,0,"percent of total billed charges ","85% of total billed charges ",2845.5,90,,2276.40,,,0,"percent of total billed charges ","90% of total billed charges ",3414.6,90,,2731.68,,,0,"percent of total billed charges ","90% of total billed charges ",193.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3300.78,87,,2640.62,,,0,"percent of total billed charges ","87% of total billed charges ",193.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",679.69,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2655.8,70,,2124.64,,,0,"percent of total billed charges ","70% of total billed charges ",153.99,3528.42,
"INJECTION IM/SUBQ",7500770,"CDM ",761,RC,96372,HCPCS,OUTPATIENT,,,240.5,192.4,,16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",29.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",223.67,93,,178.94,,,0,"percent of total billed charges ","93% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",204.43,85,,163.54,,,0,"percent of total billed charges ","85% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",209.24,87,,30.52,12.55,82.65,16,"percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,223.67,
"ANTIBIOTIC IM",7500780,"CDM ",761,RC,96372,HCPCS,OUTPATIENT,,,240.5,192.4,,16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",29.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",223.67,93,,178.94,,,0,"percent of total billed charges ","93% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",204.43,85,,163.54,,,0,"percent of total billed charges ","85% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",209.24,87,,30.52,12.55,82.65,16,"percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,223.67,
"SKIN GRAFT T/A/L CH 1ST 100 SQ",7500790,"CDM ",761,RC,15273,HCPCS,OUTPATIENT,,,5461,4368.8,,235,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2471.47,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",404.56,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3822.7,70,,3058.16,,,0,"percent of total billed charges ","70% of total billed charges ",4914.9,90,,3931.92,,,0,"percent of total billed charges ","90% of total billed charges ",5078.73,93,,4062.98,,,0,"percent of total billed charges ","93% of total billed charges ",235,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",298.59,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4641.85,85,,3713.48,,,0,"percent of total billed charges ","85% of total billed charges ",4095.75,90,,3276.60,,,0,"percent of total billed charges ","90% of total billed charges ",4914.9,90,,3931.92,,,0,"percent of total billed charges ","90% of total billed charges ",295.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4751.07,87,,3800.86,,,0,"percent of total billed charges ","87% of total billed charges ",295.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1897.5,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3822.7,70,,3058.16,,,0,"percent of total billed charges ","70% of total billed charges ",235,5078.73,
"SKIN GRFT TRNK/ARM ADD 100 CM",7500800,"CDM ",761,RC,15274,HCPCS,OUTPATIENT,,,1844.5,1475.6,,153.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",92.05,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1291.15,70,,1032.92,,,0,"percent of total billed charges ","70% of total billed charges ",1660.05,90,,1328.04,,,0,"percent of total billed charges ","90% of total billed charges ",1715.39,93,,1372.31,,,0,"percent of total billed charges ","93% of total billed charges ",153.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1567.83,85,,1254.26,,,0,"percent of total billed charges ","85% of total billed charges ",1383.38,90,,1106.70,,,0,"percent of total billed charges ","90% of total billed charges ",1660.05,90,,1328.04,,,0,"percent of total billed charges ","90% of total billed charges ",193.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1604.72,87,,1283.78,,,0,"percent of total billed charges ","87% of total billed charges ",193.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1291.15,70,,1032.92,,,0,"percent of total billed charges ","70% of total billed charges ",92.05,1715.39,
"SKIN SUB GRFT TRNK/ARM ADD 25",7501350,"CDM ",761,RC,15272,HCPCS,OUTPATIENT,,,1106.5,885.2,,56.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,3.04,3.04,3.04,"1 through 10","other ","not separately reimbursment ",35.86,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",774.55,70,,619.64,,,0,"percent of total billed charges ","70% of total billed charges ",995.85,90,,796.68,,,0,"percent of total billed charges ","90% of total billed charges ",1029.05,93,,823.24,,,0,"percent of total billed charges ","93% of total billed charges ",56.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",71.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",940.53,85,,752.42,,,0,"percent of total billed charges ","85% of total billed charges ",829.88,90,,663.90,,,0,"percent of total billed charges ","90% of total billed charges ",995.85,90,,796.68,,,0,"percent of total billed charges ","90% of total billed charges ",71.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",962.66,87,,770.13,,,0,"percent of total billed charges ","87% of total billed charges ",71.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",774.55,70,,619.64,,,0,"percent of total billed charges ","70% of total billed charges ",35.86,1029.05,
"SKIN SUB GRFT FACE/SCLP <25CM",7501400,"CDM ",761,RC,15275,HCPCS,OUTPATIENT,,,5637,4509.6,,153.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4483.39,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",195.36,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3945.9,70,,3156.72,,,0,"percent of total billed charges ","70% of total billed charges ",5073.3,90,,4058.64,,,0,"percent of total billed charges ","90% of total billed charges ",5242.41,93,,4193.93,,,0,"percent of total billed charges ","93% of total billed charges ",153.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4791.45,85,,3833.16,,,0,"percent of total billed charges ","85% of total billed charges ",4227.75,90,,3382.20,,,0,"percent of total billed charges ","90% of total billed charges ",5073.3,90,,4058.64,,,0,"percent of total billed charges ","90% of total billed charges ",193.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4904.19,87,,3923.35,,,0,"percent of total billed charges ","87% of total billed charges ",193.72,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",679.69,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3945.9,70,,3156.72,,,0,"percent of total billed charges ","70% of total billed charges ",153.99,5242.41,
"SKIN SUB GRAFT FC/SCLP ADD 25",7501410,"CDM ",761,RC,15276,HCPCS,OUTPATIENT,,,1244.5,995.6,,56.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1497.91,1497.91,1497.91,"1 through 10","other ","not separately reimbursment ",52.6,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",871.15,70,,696.92,,,0,"percent of total billed charges ","70% of total billed charges ",1120.05,90,,896.04,,,0,"percent of total billed charges ","90% of total billed charges ",1157.39,93,,925.91,,,0,"percent of total billed charges ","93% of total billed charges ",56.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",71.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1057.83,85,,846.26,,,0,"percent of total billed charges ","85% of total billed charges ",933.38,90,,746.70,,,0,"percent of total billed charges ","90% of total billed charges ",1120.05,90,,896.04,,,0,"percent of total billed charges ","90% of total billed charges ",71.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1082.72,87,,866.18,,,0,"percent of total billed charges ","87% of total billed charges ",71.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",871.15,70,,696.92,,,0,"percent of total billed charges ","70% of total billed charges ",52.6,1157.39,
"NPWT <50 SQ CM",7501430,"CDM ",761,RC,97605,HCPCS,OUTPATIENT,,,321,256.8,,64.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",223.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",53.61,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",224.7,70,,179.76,,,0,"percent of total billed charges ","70% of total billed charges ",288.9,90,,231.12,,,0,"percent of total billed charges ","90% of total billed charges ",298.53,93,,238.82,,,0,"percent of total billed charges ","93% of total billed charges ",64.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",44.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",272.85,85,,218.28,,,0,"percent of total billed charges ","85% of total billed charges ",288.9,90,,231.12,,,0,"percent of total billed charges ","90% of total billed charges ",288.9,90,,231.12,,,0,"percent of total billed charges ","90% of total billed charges ",44.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",279.27,87,,223.42,,,0,"percent of total billed charges ","87% of total billed charges ",44.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",224.7,70,,179.76,,,0,"percent of total billed charges ","70% of total billed charges ",44.08,298.53,
"NPWT >50 SQ CM NON DME",7501460,"CDM ",761,RC,97608,HCPCS,OUTPATIENT,,,566,452.8,,45.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",396.2,70,,316.96,,,0,"percent of total billed charges ","70% of total billed charges ",509.4,90,,407.52,,,0,"percent of total billed charges ","90% of total billed charges ",526.38,93,,421.10,,,0,"percent of total billed charges ","93% of total billed charges ",45.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",481.1,85,,384.88,,,0,"percent of total billed charges ","85% of total billed charges ",509.4,90,,407.52,,,0,"percent of total billed charges ","90% of total billed charges ",509.4,90,,407.52,,,0,"percent of total billed charges ","90% of total billed charges ",57.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",492.42,87,,393.94,,,0,"percent of total billed charges ","87% of total billed charges ",57.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",396.2,70,,316.96,,,0,"percent of total billed charges ","70% of total billed charges ",45.36,526.38,
"SIMPL RPR SNTE 7.6CM - 12.5CM",7501470,"CDM ",761,RC,12004,HCPCS,OUTPATIENT,,,677.5,542,,207.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",577.72,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",149.45,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",474.25,70,,379.40,,,0,"percent of total billed charges ","70% of total billed charges ",609.75,90,,487.80,,,0,"percent of total billed charges ","90% of total billed charges ",630.08,93,,504.06,,,0,"percent of total billed charges ","93% of total billed charges ",207.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",263.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",575.88,85,,460.70,,,0,"percent of total billed charges ","85% of total billed charges ",508.13,90,,406.50,,,0,"percent of total billed charges ","90% of total billed charges ",609.75,90,,487.80,,,0,"percent of total billed charges ","90% of total billed charges ",261.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",589.43,87,,471.54,,,0,"percent of total billed charges ","87% of total billed charges ",261.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",474.25,70,,379.40,,,0,"percent of total billed charges ","70% of total billed charges ",149.45,630.08,
"RPR TRUNK/EXT <2.6CM SIMPLE",7501490,"CDM ",761,RC,12001,HCPCS,OUTPATIENT,,,577.5,462,,207.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",382.79,100,,420.48,420.48,420.48,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",91.98,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",404.25,70,,323.40,,,0,"percent of total billed charges ","70% of total billed charges ",519.75,90,,415.80,,,0,"percent of total billed charges ","90% of total billed charges ",537.08,93,,429.66,,,0,"percent of total billed charges ","93% of total billed charges ",207.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",263.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",490.88,85,,392.70,,,0,"percent of total billed charges ","85% of total billed charges ",433.13,90,,346.50,,,0,"percent of total billed charges ","90% of total billed charges ",519.75,90,,415.80,,,0,"percent of total billed charges ","90% of total billed charges ",261.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",502.43,87,,401.94,,,0,"percent of total billed charges ","87% of total billed charges ",261.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",404.25,70,,323.40,,,0,"percent of total billed charges ","70% of total billed charges ",91.98,537.08,
"EXC H/F/N/SP BNGN 0.6-1.0CM",7501510,"CDM ",761,RC,11421,HCPCS,OUTPATIENT,,,2116.5,1693.2,,257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",783.57,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",225.68,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1481.55,70,,1185.24,,,0,"percent of total billed charges ","70% of total billed charges ",1904.85,90,,1523.88,,,0,"percent of total billed charges ","90% of total billed charges ",1968.35,93,,1574.68,,,0,"percent of total billed charges ","93% of total billed charges ",257.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1799.03,85,,1439.22,,,0,"percent of total billed charges ","85% of total billed charges ",1587.38,90,,1269.90,,,0,"percent of total billed charges ","90% of total billed charges ",1904.85,90,,1523.88,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1841.36,87,,1473.09,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1481.55,70,,1185.24,,,0,"percent of total billed charges ","70% of total billed charges ",225.68,1968.35,
"EXC H/F/NK/SP BENIGN <0.5CM",7501530,"CDM ",761,RC,11420,HCPCS,OUTPATIENT,,,1669.5,1335.6,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1805.43,100,,183.42,183.42,183.42,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",170.39,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1168.65,70,,934.92,,,0,"percent of total billed charges ","70% of total billed charges ",1502.55,90,,1202.04,,,0,"percent of total billed charges ","90% of total billed charges ",1552.64,93,,1242.11,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",297.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1419.08,85,,1135.26,,,0,"percent of total billed charges ","85% of total billed charges ",1252.13,90,,1001.70,,,0,"percent of total billed charges ","90% of total billed charges ",1502.55,90,,1202.04,,,0,"percent of total billed charges ","90% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1452.47,87,,1161.98,,,0,"percent of total billed charges ","87% of total billed charges ",294.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1168.65,70,,934.92,,,0,"percent of total billed charges ","70% of total billed charges ",170.39,1805.43,
"WOUND PREP F/N/HF/G < 100SQCM",7501550,"CDM ",761,RC,15004,HCPCS,OUTPATIENT,,,2261.5,1809.2,,,,,,,,0,"other ","not separately reimbursment ",1025.15,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",540.01,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1583.05,70,,1266.44,,,0,"percent of total billed charges ","70% of total billed charges ",2035.35,90,,1628.28,,,0,"percent of total billed charges ","90% of total billed charges ",2103.2,93,,1682.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",220.73,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1922.28,85,,1537.82,,,0,"percent of total billed charges ","85% of total billed charges ",1696.13,90,,1356.90,,,0,"percent of total billed charges ","90% of total billed charges ",2035.35,90,,1628.28,,,0,"percent of total billed charges ","90% of total billed charges ",218.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1967.51,87,,297.09,297.09,297.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",218.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1583.05,70,,1266.44,,,0,"percent of total billed charges ","70% of total billed charges ",218.54,2103.2,
"REMOVE TUNNELED CV CATH",7501570,"CDM ",761,RC,36590,HCPCS,OUTPATIENT,,,2785,2228,,275.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1906.88,100,,1531.82,1531.82,1531.82,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",390.68,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1949.5,70,,1559.60,,,0,"percent of total billed charges ","70% of total billed charges ",2506.5,90,,2005.20,,,0,"percent of total billed charges ","90% of total billed charges ",2590.05,93,,2072.04,,,0,"percent of total billed charges ","93% of total billed charges ",275.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",350.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2367.25,85,,1893.80,,,0,"percent of total billed charges ","85% of total billed charges ",2088.75,90,,1671.00,,,0,"percent of total billed charges ","90% of total billed charges ",2506.5,90,,2005.20,,,0,"percent of total billed charges ","90% of total billed charges ",346.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2422.95,87,,1938.36,,,0,"percent of total billed charges ","87% of total billed charges ",346.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1447.68,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1949.5,70,,1559.60,,,0,"percent of total billed charges ","70% of total billed charges ",275.54,2590.05,
"SIMP RPR TRK EXT 2.6-7.5CM",7501590,"CDM ",761,RC,12002,HCPCS,OUTPATIENT,,,803,642.4,,260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",457.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",120.71,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",562.1,70,,449.68,,,0,"percent of total billed charges ","70% of total billed charges ",722.7,90,,578.16,,,0,"percent of total billed charges ","90% of total billed charges ",746.79,93,,597.43,,,0,"percent of total billed charges ","93% of total billed charges ",260,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",682.55,85,,546.04,,,0,"percent of total billed charges ","85% of total billed charges ",602.25,90,,481.80,,,0,"percent of total billed charges ","90% of total billed charges ",722.7,90,,578.16,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",698.61,87,,558.89,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",562.1,70,,449.68,,,0,"percent of total billed charges ","70% of total billed charges ",120.71,746.79,
"SHAVE SKIN LESION 0.6-1.0 CM",7501620,"CDM ",761,RC,11301,HCPCS,OUTPATIENT,,,321,256.8,,171.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",217.71,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",106.22,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",224.7,70,,179.76,,,0,"percent of total billed charges ","70% of total billed charges ",288.9,90,,231.12,,,0,"percent of total billed charges ","90% of total billed charges ",298.53,93,,238.82,,,0,"percent of total billed charges ","93% of total billed charges ",171.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.21,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",272.85,85,,218.28,,,0,"percent of total billed charges ","85% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",288.9,90,,231.12,,,0,"percent of total billed charges ","90% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",279.27,87,,223.42,,,0,"percent of total billed charges ","87% of total billed charges ",196.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",224.7,70,,179.76,,,0,"percent of total billed charges ","70% of total billed charges ",106.22,298.53,
"REPLACE CV CATH",7501640,"CDM ",761,RC,36578,HCPCS,OUTPATIENT,,,4674.5,3739.6,,163.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1321.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",415.54,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3272.15,70,,2617.72,,,0,"percent of total billed charges ","70% of total billed charges ",4207.05,90,,3365.64,,,0,"percent of total billed charges ","90% of total billed charges ",4347.29,93,,3477.83,,,0,"percent of total billed charges ","93% of total billed charges ",163.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",207.54,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3973.33,85,,3178.66,,,0,"percent of total billed charges ","85% of total billed charges ",3505.88,90,,2804.70,,,0,"percent of total billed charges ","90% of total billed charges ",4207.05,90,,3365.64,,,0,"percent of total billed charges ","90% of total billed charges ",205.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4066.82,87,,3253.46,,,0,"percent of total billed charges ","87% of total billed charges ",205.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2903.79,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3272.15,70,,2617.72,,,0,"percent of total billed charges ","70% of total billed charges ",163.35,4347.29,
"TOE FX WO MANIP PHALANGE",7501660,"CDM ",761,RC,28510,HCPCS,OUTPATIENT,,,575,460,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",432.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",247.41,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",402.5,70,,322.00,,,0,"percent of total billed charges ","70% of total billed charges ",517.5,90,,414.00,,,0,"percent of total billed charges ","90% of total billed charges ",534.75,93,,427.80,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",488.75,85,,391.00,,,0,"percent of total billed charges ","85% of total billed charges ",431.25,90,,345.00,,,0,"percent of total billed charges ","90% of total billed charges ",517.5,90,,414.00,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",500.25,87,,400.20,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",402.5,70,,322.00,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,534.75,
"TX WOUND DEHIS SIMPLE CLOSE",7501680,"CDM ",761,RC,12020,HCPCS,OUTPATIENT,,,935,748,,370.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",216.14,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",386.23,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",654.5,70,,523.60,,,0,"percent of total billed charges ","70% of total billed charges ",841.5,90,,673.20,,,0,"percent of total billed charges ","90% of total billed charges ",869.55,93,,695.64,,,0,"percent of total billed charges ","93% of total billed charges ",370.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",428.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",794.75,85,,635.80,,,0,"percent of total billed charges ","85% of total billed charges ",701.25,90,,561.00,,,0,"percent of total billed charges ","90% of total billed charges ",841.5,90,,673.20,,,0,"percent of total billed charges ","90% of total billed charges ",423.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",813.45,87,,650.76,,,0,"percent of total billed charges ","87% of total billed charges ",423.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",679.69,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",654.5,70,,523.60,,,0,"percent of total billed charges ","70% of total billed charges ",216.14,869.55,
"PARTIAL AMPUTATION TOE",7501700,"CDM ",761,RC,28825,HCPCS,OUTPATIENT,,,4608,3686.4,,1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3963.24,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",362.74,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3225.6,70,,2580.48,,,0,"percent of total billed charges ","70% of total billed charges ",4147.2,90,,3317.76,,,0,"percent of total billed charges ","90% of total billed charges ",4285.44,93,,3428.35,,,0,"percent of total billed charges ","93% of total billed charges ",1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3916.8,85,,3133.44,,,0,"percent of total billed charges ","85% of total billed charges ",3456,90,,2764.80,,,0,"percent of total billed charges ","90% of total billed charges ",4147.2,90,,3317.76,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4008.96,87,,3207.17,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3009.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3225.6,70,,2580.48,,,0,"percent of total billed charges ","70% of total billed charges ",362.74,4285.44,
"BX PUNCH SKIN SINGLE LESION",7501770,"CDM ",761,RC,11104,HCPCS,OUTPATIENT,,,803,642.4,,129.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",451.17,100,,21.90,21.90,21.90,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",97.42,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",562.1,70,,449.68,,,0,"percent of total billed charges ","70% of total billed charges ",722.7,90,,578.16,,,0,"percent of total billed charges ","90% of total billed charges ",746.79,93,,597.43,,,0,"percent of total billed charges ","93% of total billed charges ",129.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",145.72,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",682.55,85,,546.04,,,0,"percent of total billed charges ","85% of total billed charges ",602.25,90,,481.80,,,0,"percent of total billed charges ","90% of total billed charges ",722.7,90,,578.16,,,0,"percent of total billed charges ","90% of total billed charges ",144.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",698.61,87,,90.82,90.82,90.82,"1 through 10","percent of total billed charges ","87% of total billed charges ",144.28,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",562.1,70,,449.68,,,0,"percent of total billed charges ","70% of total billed charges ",97.42,746.79,
"BX PUNCH SKIN EA ADD LESION",7501780,"CDM ",761,RC,11105,HCPCS,OUTPATIENT,,,227.5,182,,,,,,,,0,"other ","not separately reimbursment ",451.17,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",53.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",159.25,70,,127.40,,,0,"percent of total billed charges ","70% of total billed charges ",204.75,90,,163.80,,,0,"percent of total billed charges ","90% of total billed charges ",211.58,93,,169.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",193.38,85,,154.70,,,0,"percent of total billed charges ","85% of total billed charges ",170.63,90,,136.50,,,0,"percent of total billed charges ","90% of total billed charges ",204.75,90,,163.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",197.93,87,,158.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",159.25,70,,127.40,,,0,"percent of total billed charges ","70% of total billed charges ",53.28,451.17,
"REMOVE IMPACTED CERUMEN UNI",7501800,"CDM ",761,RC,69209,HCPCS,OUTPATIENT,,,654.5,523.6,,37.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",586.49,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",30.76,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",458.15,70,,366.52,,,0,"percent of total billed charges ","70% of total billed charges ",589.05,90,,471.24,,,0,"percent of total billed charges ","90% of total billed charges ",608.69,93,,486.95,,,0,"percent of total billed charges ","93% of total billed charges ",37.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",48.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",556.33,85,,445.06,,,0,"percent of total billed charges ","85% of total billed charges ",490.88,90,,392.70,,,0,"percent of total billed charges ","90% of total billed charges ",589.05,90,,471.24,,,0,"percent of total billed charges ","90% of total billed charges ",47.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",569.42,87,,13.40,8.04,18.75,"1 through 10","percent of total billed charges ","87% of total billed charges ",47.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",458.15,70,,366.52,,,0,"percent of total billed charges ","70% of total billed charges ",30.76,608.69,
"ADJ TISS TX TRUNK 10.1-30.0",7501820,"CDM ",761,RC,14001,HCPCS,OUTPATIENT,,,6675.5,5340.4,,590.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4594.49,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1333.6,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",4672.85,70,,3738.28,,,0,"percent of total billed charges ","70% of total billed charges ",6007.95,90,,4806.36,,,0,"percent of total billed charges ","90% of total billed charges ",6208.22,93,,4966.58,,,0,"percent of total billed charges ","93% of total billed charges ",590.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",462.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",5674.18,85,,4539.34,,,0,"percent of total billed charges ","85% of total billed charges ",5006.63,90,,4005.30,,,0,"percent of total billed charges ","90% of total billed charges ",6007.95,90,,4806.36,,,0,"percent of total billed charges ","90% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5807.69,87,,117.60,117.60,117.60,"1 through 10","percent of total billed charges ","87% of total billed charges ",457.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1897.5,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4672.85,70,,3738.28,,,0,"percent of total billed charges ","70% of total billed charges ",457.91,6208.22,
"INSERT BLADDER CATH SIMPLE",7501840,"CDM ",761,RC,51702,HCPCS,OUTPATIENT,,,339.5,271.6,,41.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",144.89,100,,11.03,11.03,11.03,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",52.93,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",237.65,70,,190.12,,,0,"percent of total billed charges ","70% of total billed charges ",305.55,90,,244.44,,,0,"percent of total billed charges ","90% of total billed charges ",315.74,93,,252.59,,,0,"percent of total billed charges ","93% of total billed charges ",41.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",288.58,85,,230.86,,,0,"percent of total billed charges ","85% of total billed charges ",254.63,90,,203.70,,,0,"percent of total billed charges ","90% of total billed charges ",305.55,90,,244.44,,,0,"percent of total billed charges ","90% of total billed charges ",31.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",295.37,87,,236.30,,,0,"percent of total billed charges ","87% of total billed charges ",31.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",237.65,70,,190.12,,,0,"percent of total billed charges ","70% of total billed charges ",31.19,315.74,
"SURG PREP RCPT SITE",7501860,"CDM ",761,RC,15002,HCPCS,OUTPATIENT,,,2347,1877.6,,,,,,,,0,"other ","not separately reimbursment ",809.01,100,,358.31,358.31,358.31,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",449.17,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1642.9,70,,1314.32,,,0,"percent of total billed charges ","70% of total billed charges ",2112.3,90,,1689.84,,,0,"percent of total billed charges ","90% of total billed charges ",2182.71,93,,1746.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",220.73,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1994.95,85,,1595.96,,,0,"percent of total billed charges ","85% of total billed charges ",1760.25,90,,1408.20,,,0,"percent of total billed charges ","90% of total billed charges ",2112.3,90,,1689.84,,,0,"percent of total billed charges ","90% of total billed charges ",218.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2041.89,87,,1633.51,,,0,"percent of total billed charges ","87% of total billed charges ",218.54,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",679.69,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1642.9,70,,1314.32,,,0,"percent of total billed charges ","70% of total billed charges ",218.54,2182.71,
"APPLY SHORT LEG SPLINT",7501880,"CDM ",761,RC,29515,HCPCS,OUTPATIENT,,,370,296,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",230.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",100.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",344.1,93,,275.28,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",314.5,85,,251.60,,,0,"percent of total billed charges ","85% of total billed charges ",277.5,90,,222.00,,,0,"percent of total billed charges ","90% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",321.9,87,,41.35,41.35,41.35,"1 through 10","percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",100.87,344.1,
"PART EXCISION PHALANX TOE",7501900,"CDM ",761,RC,28124,HCPCS,OUTPATIENT,,,4937.5,3950,,1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2157.36,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",695.33,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3456.25,70,,2765.00,,,0,"percent of total billed charges ","70% of total billed charges ",4443.75,90,,3555.00,,,0,"percent of total billed charges ","90% of total billed charges ",4591.88,93,,3673.50,,,0,"percent of total billed charges ","93% of total billed charges ",1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4196.88,85,,3357.50,,,0,"percent of total billed charges ","85% of total billed charges ",3703.13,90,,2962.50,,,0,"percent of total billed charges ","90% of total billed charges ",4443.75,90,,3555.00,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4295.63,87,,3436.50,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3009.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3456.25,70,,2765.00,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,4591.88,
"WOUND CARE FAC LEVEL 2 NEW PT",7501920,"CDM ",761,RC,99202,HCPCS,OUTPATIENT,,,375,300,,,,,,,,0,"other ","not separately reimbursment ",67.67,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",102.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",262.5,70,,210.00,,,0,"percent of total billed charges ","70% of total billed charges ",337.5,90,,270.00,,,0,"percent of total billed charges ","90% of total billed charges ",348.75,93,,279.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",318.75,85,,255.00,,,0,"percent of total billed charges ","85% of total billed charges ",337.5,90,,270.00,,,0,"percent of total billed charges ","90% of total billed charges ",337.5,90,,270.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",326.25,87,,54.83,15.38,80.66,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.5,70,,210.00,,,0,"percent of total billed charges ","70% of total billed charges ",67.67,348.75,
"WOUND CARE FAC LEVEL 3 NEW PT",7501930,"CDM ",761,RC,99203,HCPCS,OUTPATIENT,,,438,350.4,,,,,,,,0,"other ","not separately reimbursment ",101,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",174.04,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",306.6,70,,245.28,,,0,"percent of total billed charges ","70% of total billed charges ",394.2,90,,315.36,,,0,"percent of total billed charges ","90% of total billed charges ",407.34,93,,325.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",372.3,85,,297.84,,,0,"percent of total billed charges ","85% of total billed charges ",394.2,90,,315.36,,,0,"percent of total billed charges ","90% of total billed charges ",394.2,90,,315.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",381.06,87,,69.36,34.13,104.06,20,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",306.6,70,,245.28,,,0,"percent of total billed charges ","70% of total billed charges ",101,407.34,
"WOUND CARE FAC LEVEL 4 NEW PT",7501940,"CDM ",761,RC,99204,HCPCS,OUTPATIENT,,,550,440,,,,,,,,0,"other ","not separately reimbursment ",101,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",283.03,220,,154.69,154.69,154.69,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",385,70,,308.00,,,0,"percent of total billed charges ","70% of total billed charges ",495,90,,396.00,,,0,"percent of total billed charges ","90% of total billed charges ",511.5,93,,409.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",467.5,85,,374.00,,,0,"percent of total billed charges ","85% of total billed charges ",495,90,,396.00,,,0,"percent of total billed charges ","90% of total billed charges ",495,90,,396.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",478.5,87,,135.17,78.68,154.59,15,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",385,70,,308.00,,,0,"percent of total billed charges ","70% of total billed charges ",101,511.5,
"WOUND CARE FAC LEVEL 5 NEW PT",7501950,"CDM ",761,RC,99205,HCPCS,OUTPATIENT,,,699.5,559.6,,,,,,,,0,"other ","not separately reimbursment ",168.67,100,,264.13,264.13,264.13,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",384.08,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",489.65,70,,391.72,,,0,"percent of total billed charges ","70% of total billed charges ",629.55,90,,503.64,,,0,"percent of total billed charges ","90% of total billed charges ",650.54,93,,520.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",594.58,85,,475.66,,,0,"percent of total billed charges ","85% of total billed charges ",629.55,90,,503.64,,,0,"percent of total billed charges ","90% of total billed charges ",629.55,90,,503.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",608.57,87,,486.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",489.65,70,,391.72,,,0,"percent of total billed charges ","70% of total billed charges ",168.67,650.54,
"WOUND CARE FAC LEVEL 2 ESTAB",7501960,"CDM ",761,RC,99212,HCPCS,OUTPATIENT,,,292,233.6,,,,,,,,0,"other ","not separately reimbursment ",85.38,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",75.77,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",204.4,70,,163.52,,,0,"percent of total billed charges ","70% of total billed charges ",262.8,90,,210.24,,,0,"percent of total billed charges ","90% of total billed charges ",271.56,93,,217.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",248.2,85,,198.56,,,0,"percent of total billed charges ","85% of total billed charges ",262.8,90,,210.24,,,0,"percent of total billed charges ","90% of total billed charges ",262.8,90,,210.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",254.04,87,,41.53,8.11,48.11,20,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",204.4,70,,163.52,,,0,"percent of total billed charges ","70% of total billed charges ",75.77,271.56,
"WOUND CARE FAC LEVEL 3 ESTAB",7501970,"CDM ",761,RC,99213,HCPCS,OUTPATIENT,,,292,233.6,,,,,,,,0,"other ","not separately reimbursment ",133.49,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",140.47,220,,74.27,70.21,78.33,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",204.4,70,,163.52,,,0,"percent of total billed charges ","70% of total billed charges ",262.8,90,,210.24,,,0,"percent of total billed charges ","90% of total billed charges ",271.56,93,,217.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",248.2,85,,198.56,,,0,"percent of total billed charges ","85% of total billed charges ",262.8,90,,210.24,,,0,"percent of total billed charges ","90% of total billed charges ",262.8,90,,210.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",254.04,87,,63.68,29.60,79.60,44,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",204.4,70,,163.52,,,0,"percent of total billed charges ","70% of total billed charges ",133.49,271.56,
"WOUND CARE FAC LEVEL 4 ESTAB",7501980,"CDM ",761,RC,99214,HCPCS,OUTPATIENT,,,367.5,294,,,,,,,,0,"other ","not separately reimbursment ",188.57,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",207.04,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",257.25,70,,205.80,,,0,"percent of total billed charges ","70% of total billed charges ",330.75,90,,264.60,,,0,"percent of total billed charges ","90% of total billed charges ",341.78,93,,273.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",312.38,85,,249.90,,,0,"percent of total billed charges ","85% of total billed charges ",330.75,90,,264.60,,,0,"percent of total billed charges ","90% of total billed charges ",330.75,90,,264.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",319.73,87,,92.46,47.94,115.58,37,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",257.25,70,,205.80,,,0,"percent of total billed charges ","70% of total billed charges ",188.57,341.78,
"WOUND CARE FAC LEVEL 5 ESTAB",7501990,"CDM ",761,RC,99215,HCPCS,OUTPATIENT,,,467,373.6,,,,,,,,0,"other ","not separately reimbursment ",266.24,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",306.2,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",326.9,70,,261.52,,,0,"percent of total billed charges ","70% of total billed charges ",420.3,90,,336.24,,,0,"percent of total billed charges ","90% of total billed charges ",434.31,93,,347.45,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",396.95,85,,317.56,,,0,"percent of total billed charges ","85% of total billed charges ",420.3,90,,336.24,,,0,"percent of total billed charges ","90% of total billed charges ",420.3,90,,336.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",406.29,87,,157.63,127.56,162.13,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",326.9,70,,261.52,,,0,"percent of total billed charges ","70% of total billed charges ",266.24,434.31,
"SIMPLE REPAIR FACE 2.6-5 CM",7502000,"CDM ",761,RC,12013,HCPCS,OUTPATIENT,,,639.5,511.6,,336.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",475.71,100,,547.40,547.40,547.40,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",119.22,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",447.65,70,,358.12,,,0,"percent of total billed charges ","70% of total billed charges ",575.55,90,,460.44,,,0,"percent of total billed charges ","90% of total billed charges ",594.74,93,,475.79,,,0,"percent of total billed charges ","93% of total billed charges ",336.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",428.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",543.58,85,,434.86,,,0,"percent of total billed charges ","85% of total billed charges ",479.63,90,,383.70,,,0,"percent of total billed charges ","90% of total billed charges ",575.55,90,,460.44,,,0,"percent of total billed charges ","90% of total billed charges ",423.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",556.37,87,,445.10,,,0,"percent of total billed charges ","87% of total billed charges ",423.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",447.65,70,,358.12,,,0,"percent of total billed charges ","70% of total billed charges ",119.22,594.74,
"IRRIGATE IMPLANT DRUG DEVICE",7502020,"CDM ",761,RC,96523,HCPCS,OUTPATIENT,,,86.5,69.2,,,,,,,,0,"other ","not separately reimbursment ",54.54,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",54.19,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",60.55,70,,48.44,,,0,"percent of total billed charges ","70% of total billed charges ",77.85,90,,62.28,,,0,"percent of total billed charges ","90% of total billed charges ",80.45,93,,64.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",73.53,85,,58.82,,,0,"percent of total billed charges ","85% of total billed charges ",77.85,90,,62.28,,,0,"percent of total billed charges ","90% of total billed charges ",77.85,90,,62.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",75.26,87,,60.21,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",60.55,70,,48.44,,,0,"percent of total billed charges ","70% of total billed charges ",54.19,80.45,
"EXC BONE ANKLE/HEEL PARTIAL",7502040,"CDM ",761,RC,28120,HCPCS,OUTPATIENT,,,3659.5,2927.6,,1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2157.36,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1031.73,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2561.65,70,,2049.32,,,0,"percent of total billed charges ","70% of total billed charges ",3293.55,90,,2634.84,,,0,"percent of total billed charges ","90% of total billed charges ",3403.34,93,,2722.67,,,0,"percent of total billed charges ","93% of total billed charges ",1048.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3110.58,85,,2488.46,,,0,"percent of total billed charges ","85% of total billed charges ",2744.63,90,,2195.70,,,0,"percent of total billed charges ","90% of total billed charges ",3293.55,90,,2634.84,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3183.77,87,,2547.02,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3009.11,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2561.65,70,,2049.32,,,0,"percent of total billed charges ","70% of total billed charges ",392.5,3403.34,
"BX BREAST OPEN INCISIONAL",7502060,"CDM ",761,RC,19101,HCPCS,OUTPATIENT,,,4033,3226.4,,1234.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1509.95,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",458.02,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2823.1,70,,2258.48,,,0,"percent of total billed charges ","70% of total billed charges ",3629.7,90,,2903.76,,,0,"percent of total billed charges ","90% of total billed charges ",3750.69,93,,3000.55,,,0,"percent of total billed charges ","93% of total billed charges ",1234.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",594.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3428.05,85,,2742.44,,,0,"percent of total billed charges ","85% of total billed charges ",3024.75,90,,2419.80,,,0,"percent of total billed charges ","90% of total billed charges ",3629.7,90,,2903.76,,,0,"percent of total billed charges ","90% of total billed charges ",588.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3508.71,87,,2806.97,,,0,"percent of total billed charges ","87% of total billed charges ",588.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3600.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2823.1,70,,2258.48,,,0,"percent of total billed charges ","70% of total billed charges ",458.02,3750.69,
"LATE/SEC WOUND CLOSURE CMPLX",7502080,"CDM ",761,RC,13160,HCPCS,OUTPATIENT,,,3808,3046.4,,590.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2038.18,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",1641.4,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",2665.6,70,,2132.48,,,0,"percent of total billed charges ","70% of total billed charges ",3427.2,90,,2741.76,,,0,"percent of total billed charges ","90% of total billed charges ",3541.44,93,,2833.15,,,0,"percent of total billed charges ","93% of total billed charges ",590.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",429.45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3236.8,85,,2589.44,,,0,"percent of total billed charges ","85% of total billed charges ",2856,90,,2284.80,,,0,"percent of total billed charges ","90% of total billed charges ",3427.2,90,,2741.76,,,0,"percent of total billed charges ","90% of total billed charges ",425.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3312.96,87,,2650.37,,,0,"percent of total billed charges ","87% of total billed charges ",425.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3259.01,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2665.6,70,,2132.48,,,0,"percent of total billed charges ","70% of total billed charges ",425.2,3541.44,
"APPLY SHORT ARM SPLINT",7502085,"CDM ",761,RC,29125,HCPCS,OUTPATIENT,,,370,296,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",230.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",81.29,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",344.1,93,,275.28,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",314.5,85,,251.60,,,0,"percent of total billed charges ","85% of total billed charges ",277.5,90,,222.00,,,0,"percent of total billed charges ","90% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",321.9,87,,257.52,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",81.29,344.1,
"CLSD TX DISTAL TIBIA WO MANIP",7502095,"CDM ",761,RC,27824,HCPCS,OUTPATIENT,,,1791,1432.8,,312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1454.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",634.81,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1253.7,70,,1002.96,,,0,"percent of total billed charges ","70% of total billed charges ",1611.9,90,,1289.52,,,0,"percent of total billed charges ","90% of total billed charges ",1665.63,93,,1332.50,,,0,"percent of total billed charges ","93% of total billed charges ",312,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",396.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1522.35,85,,1217.88,,,0,"percent of total billed charges ","85% of total billed charges ",1343.25,90,,1074.60,,,0,"percent of total billed charges ","90% of total billed charges ",1611.9,90,,1289.52,,,0,"percent of total billed charges ","90% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1558.17,87,,1246.54,,,0,"percent of total billed charges ","87% of total billed charges ",392.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",226.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1253.7,70,,1002.96,,,0,"percent of total billed charges ","70% of total billed charges ",226.85,1665.63,
"REMOVE TUNNEL CV CATH",7502100,"CDM ",761,RC,36589,HCPCS,OUTPATIENT,,,1268.5,1014.8,,163.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",958.49,100,,224.38,224.38,224.38,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",283.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",887.95,70,,710.36,,,0,"percent of total billed charges ","70% of total billed charges ",1141.65,90,,913.32,,,0,"percent of total billed charges ","90% of total billed charges ",1179.71,93,,943.77,,,0,"percent of total billed charges ","93% of total billed charges ",163.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",208.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1078.23,85,,862.58,,,0,"percent of total billed charges ","85% of total billed charges ",951.38,90,,761.10,,,0,"percent of total billed charges ","90% of total billed charges ",1141.65,90,,913.32,,,0,"percent of total billed charges ","90% of total billed charges ",206.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1103.6,87,,882.88,,,0,"percent of total billed charges ","87% of total billed charges ",206.29,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",576.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",887.95,70,,710.36,,,0,"percent of total billed charges ","70% of total billed charges ",163.98,1179.71,
"APPLY SHORT LEG CAST",7502105,"CDM ",761,RC,29405,HCPCS,OUTPATIENT,,,384.5,307.6,,228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",119,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",357.59,93,,286.07,,,0,"percent of total billed charges ","93% of total billed charges ",228.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",326.83,85,,261.46,,,0,"percent of total billed charges ","85% of total billed charges ",288.38,90,,230.70,,,0,"percent of total billed charges ","90% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",334.52,87,,267.62,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",257.22,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",119,357.59,
"EXC BENIGN LES <.5CM F/E/N/L",7502110,"CDM ",761,RC,11440,HCPCS,OUTPATIENT,,,1437.5,1150,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",783.57,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",217.18,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1006.25,70,,805.00,,,0,"percent of total billed charges ","70% of total billed charges ",1293.75,90,,1035.00,,,0,"percent of total billed charges ","90% of total billed charges ",1336.88,93,,1069.50,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1221.88,85,,977.50,,,0,"percent of total billed charges ","85% of total billed charges ",1078.13,90,,862.50,,,0,"percent of total billed charges ","90% of total billed charges ",1293.75,90,,1035.00,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1250.63,87,,1000.50,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1006.25,70,,805.00,,,0,"percent of total billed charges ","70% of total billed charges ",217.18,1336.88,
"EXC BENIGN LES <.5CM F/E/N/L",7502110,"CDM ",761,RC,11440,HCPCS,OUTPATIENT,,,1210,968,,286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",783.57,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",217.18,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",847,70,,677.60,,,0,"percent of total billed charges ","70% of total billed charges ",1089,90,,871.20,,,0,"percent of total billed charges ","90% of total billed charges ",1125.3,93,,900.24,,,0,"percent of total billed charges ","93% of total billed charges ",286,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1028.5,85,,822.80,,,0,"percent of total billed charges ","85% of total billed charges ",907.5,90,,726.00,,,0,"percent of total billed charges ","90% of total billed charges ",1089,90,,871.20,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1052.7,87,,842.16,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",651.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",847,70,,677.60,,,0,"percent of total billed charges ","70% of total billed charges ",217.18,1125.3,
"REMOVE SUTURES OR STAPLES",7502115,"CDM ",761,RC,15853,HCPCS,OUTPATIENT,,,107.5,86,,,,,,,,0,"other ","not separately reimbursment ",,,,17.99,17.99,17.99,"1 through 10","other ","not separately reimbursment ",86,80,,68.80,,,0,"percent of total billed charges ","80% of total billed charges ",75.25,70,,60.20,,,0,"percent of total billed charges ","70% of total billed charges ",96.75,90,,77.40,,,0,"percent of total billed charges ","90% of total billed charges ",99.98,93,,79.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",91.38,85,,73.10,,,0,"percent of total billed charges ","85% of total billed charges ",80.63,90,,64.50,,,0,"percent of total billed charges ","90% of total billed charges ",96.75,90,,77.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",93.53,87,,4.68,4.68,4.68,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.25,70,,60.20,,,0,"percent of total billed charges ","70% of total billed charges ",75.25,99.98,
"REMOVE SUTURES AND STAPLES",7502120,"CDM ",761,RC,15854,HCPCS,OUTPATIENT,,,130.5,104.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.4,80,,83.52,,,0,"percent of total billed charges ","80% of total billed charges ",91.35,70,,73.08,,,0,"percent of total billed charges ","70% of total billed charges ",117.45,90,,93.96,,,0,"percent of total billed charges ","90% of total billed charges ",121.37,93,,97.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",110.93,85,,88.74,,,0,"percent of total billed charges ","85% of total billed charges ",97.88,90,,78.30,,,0,"percent of total billed charges ","90% of total billed charges ",117.45,90,,93.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",113.54,87,,90.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.35,70,,73.08,,,0,"percent of total billed charges ","70% of total billed charges ",91.35,121.37,
"TRIM NAIL ANY NUMBER",7502125,"CDM ",761,RC,11719,HCPCS,OUTPATIENT,,,94.5,75.6,,,,,,,,0,"other ","not separately reimbursment ",74.74,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",16.04,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",66.15,70,,52.92,,,0,"percent of total billed charges ","70% of total billed charges ",85.05,90,,68.04,,,0,"percent of total billed charges ","90% of total billed charges ",87.89,93,,70.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.33,85,,64.26,,,0,"percent of total billed charges ","85% of total billed charges ",70.88,90,,56.70,,,0,"percent of total billed charges ","90% of total billed charges ",85.05,90,,68.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.22,87,,65.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",66.15,70,,52.92,,,0,"percent of total billed charges ","70% of total billed charges ",16.04,87.89,
"TRIM NAIL ANY NUMBER",7502125,"CDM ",761,RC,11719,HCPCS,OUTPATIENT,,,95,76,,,,,,,,0,"other ","not separately reimbursment ",74.74,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",16.04,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",66.5,70,,53.20,,,0,"percent of total billed charges ","70% of total billed charges ",85.5,90,,68.40,,,0,"percent of total billed charges ","90% of total billed charges ",88.35,93,,70.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.75,85,,64.60,,,0,"percent of total billed charges ","85% of total billed charges ",71.25,90,,57.00,,,0,"percent of total billed charges ","90% of total billed charges ",85.5,90,,68.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.65,87,,66.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",66.5,70,,53.20,,,0,"percent of total billed charges ","70% of total billed charges ",16.04,88.35,
"REMOVE SUPPORT IMPLANT",7502130,"CDM ",761,RC,20670,HCPCS,OUTPATIENT,,,2071.5,1657.2,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1038.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",297.07,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1450.05,70,,1160.04,,,0,"percent of total billed charges ","70% of total billed charges ",1864.35,90,,1491.48,,,0,"percent of total billed charges ","90% of total billed charges ",1926.5,93,,1541.20,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1760.78,85,,1408.62,,,0,"percent of total billed charges ","85% of total billed charges ",1553.63,90,,1242.90,,,0,"percent of total billed charges ","90% of total billed charges ",1864.35,90,,1491.48,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1802.21,87,,1441.77,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1450.05,70,,1160.04,,,0,"percent of total billed charges ","70% of total billed charges ",297.07,1926.5,
"REMOVE SUPPORT IMPLANT",7502130,"CDM ",761,RC,20670,HCPCS,OUTPATIENT,,,2057,1645.6,,525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1038.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",297.07,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1439.9,70,,1151.92,,,0,"percent of total billed charges ","70% of total billed charges ",1851.3,90,,1481.04,,,0,"percent of total billed charges ","90% of total billed charges ",1913.01,93,,1530.41,,,0,"percent of total billed charges ","93% of total billed charges ",525.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",330.35,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1748.45,85,,1398.76,,,0,"percent of total billed charges ","85% of total billed charges ",1542.75,90,,1234.20,,,0,"percent of total billed charges ","90% of total billed charges ",1851.3,90,,1481.04,,,0,"percent of total billed charges ","90% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1789.59,87,,1431.67,,,0,"percent of total billed charges ","87% of total billed charges ",327.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1518.9,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1439.9,70,,1151.92,,,0,"percent of total billed charges ","70% of total billed charges ",297.07,1913.01,
CPR,7510040,"CDM ",761,RC,92950,HCPCS,OUTPATIENT,,,1300,1040,,114.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",309.49,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",386.91,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",910,70,,728.00,,,0,"percent of total billed charges ","70% of total billed charges ",1170,90,,936.00,,,0,"percent of total billed charges ","90% of total billed charges ",1209,93,,967.20,,,0,"percent of total billed charges ","93% of total billed charges ",114.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.53,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1105,85,,884.00,,,0,"percent of total billed charges ","85% of total billed charges ",1170,90,,936.00,,,0,"percent of total billed charges ","90% of total billed charges ",1170,90,,936.00,,,0,"percent of total billed charges ","90% of total billed charges ",131.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1131,87,,163.23,163.23,163.23,"1 through 10","percent of total billed charges ","87% of total billed charges ",131.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.57,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",910,70,,728.00,,,0,"percent of total billed charges ","70% of total billed charges ",114.74,1209,
CPR,7510040,"CDM ",761,RC,92950,HCPCS,OUTPATIENT,,,2109,1687.2,,114.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",309.49,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",386.91,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1476.3,70,,1181.04,,,0,"percent of total billed charges ","70% of total billed charges ",1898.1,90,,1518.48,,,0,"percent of total billed charges ","90% of total billed charges ",1961.37,93,,1569.10,,,0,"percent of total billed charges ","93% of total billed charges ",114.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",132.53,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1792.65,85,,1434.12,,,0,"percent of total billed charges ","85% of total billed charges ",1898.1,90,,1518.48,,,0,"percent of total billed charges ","90% of total billed charges ",1898.1,90,,1518.48,,,0,"percent of total billed charges ","90% of total billed charges ",131.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1834.83,87,,163.23,163.23,163.23,"1 through 10","percent of total billed charges ","87% of total billed charges ",131.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",198.57,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1476.3,70,,1181.04,,,0,"percent of total billed charges ","70% of total billed charges ",114.74,1961.37,
"WOUND CARE LEVEL 2 NEW PAT",7550020,"CDM ",982,RC,99202,HCPCS,OUTPATIENT,,,130.5,104.4,,50.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",96,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",50.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,54.83,15.38,80.66,"1 through 10",other,"not separately reimbursment ",50.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.66,96,
"WOUND CARE LEVEL 3 NEW PAT",7550030,"CDM ",982,RC,99203,HCPCS,OUTPATIENT,,,194.5,155.6,,75.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",139,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",75.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,69.36,34.13,104.06,20,other,"not separately reimbursment ",75.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.45,139,
"WOUND CARE LEVEL 4 NEW PAT",7550040,"CDM ",982,RC,99204,HCPCS,OUTPATIENT,,,274.5,219.6,,107.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,154.69,154.69,154.69,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",107.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",214,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",107.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,135.17,78.68,154.59,15,other,"not separately reimbursment ",107.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",107.12,214,
"WOUND CARE LEVEL 5 NEW PAT",7550050,"CDM ",982,RC,99205,HCPCS,OUTPATIENT,,,397.5,318,,136.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,264.13,264.13,264.13,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",266,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",136.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",136.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136.62,266,
"WOUND CARE LEVEL 1 ESTABLISH",7550060,"CDM ",982,RC,99211,HCPCS,OUTPATIENT,,,46,36.8,,16.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",29,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",16.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,18.91,17.74,20.08,"1 through 10",other,"not separately reimbursment ",16.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.36,29,
"WOUND CARE LEVEL 2 ESTABLISH",7550070,"CDM ",982,RC,99212,HCPCS,OUTPATIENT,,,80.5,64.4,,29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",56,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,41.53,8.11,48.11,20,other,"not separately reimbursment ",29.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.76,56,
"WOUND CARE LEVEL 3 ESTABLISH",7550080,"CDM ",982,RC,99213,HCPCS,OUTPATIENT,,,130.5,104.4,,40.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",51.95,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,74.27,70.21,78.33,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",93,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",40.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,63.68,29.60,79.60,44,other,"not separately reimbursment ",40.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.84,93,
"WOUND CARE LEVEL 4 ESTABLISH",7550090,"CDM ",982,RC,99214,HCPCS,OUTPATIENT,,,192,153.6,,64.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",138,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",64.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,92.46,47.94,115.58,37,other,"not separately reimbursment ",64.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.22,138,
"WOUND CARE LEVEL 5 ESTABLISH",7550100,"CDM ",982,RC,99215,HCPCS,OUTPATIENT,,,263,210.4,,94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",186,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,157.63,127.56,162.13,"1 through 10",other,"not separately reimbursment ",94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9,186,
"FIT-DIVE 18-39 YEARS NEW PAT",7550110,"CDM ",982,RC,99385,HCPCS,OUTPATIENT,,,269,215.2,,30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",171,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,141.78,141.78,141.78,"1 through 10",other,"not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3,171,
"FIT-DIVE 40-64 YEARS NEW PAT",7550120,"CDM ",982,RC,99386,HCPCS,OUTPATIENT,,,269,215.2,,30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,217.42,217.42,217.42,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",198,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,164.26,164.26,164.26,"1 through 10",other,"not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3,198,
"FIT-DIVE >65 YEARS NEW PAT",7550130,"CDM ",982,RC,99387,HCPCS,OUTPATIENT,,,269,215.2,,30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,222.63,222.63,222.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",215,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3,215,
"FIT-DIVE 18-39 YEARS ESTABLISH",7550140,"CDM ",982,RC,99395,HCPCS,OUTPATIENT,,,269,215.2,,17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,192.41,192.41,192.41,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",152,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,127.82,127.82,127.82,"1 through 10",other,"not separately reimbursment ",17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,152,
"FIT-DIVE 40-64 YEARS ESTABLISH",7550150,"CDM ",982,RC,99396,HCPCS,OUTPATIENT,,,269,215.2,,17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,207.96,207.96,207.96,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",163,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,136.20,132.09,136.20,"1 through 10",other,"not separately reimbursment ",17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,163,
"FIT-DIVE >65 YEARS ESTABLISH",7550160,"CDM ",982,RC,99397,HCPCS,OUTPATIENT,,,269,215.2,,17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,184.37,184.37,184.37,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",176,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,135.47,126.77,144.17,"1 through 10",other,"not separately reimbursment ",17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,176,
"HBO - TX SUPERVISION",7550170,"CDM ",982,RC,99183,HCPCS,OUTPATIENT,,,287.5,230,,167.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,135.88,135.88,135.88,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",332,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",167.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",167.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.09,332,
"ET TUBE",7550210,"CDM ",982,RC,31500,HCPCS,OUTPATIENT,,,251.5,201.2,,92.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",195.05,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",195,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",92.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",92.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.39,195.05,
CPR,7550220,"CDM ",982,RC,92950,HCPCS,OUTPATIENT,,,418,334.4,,241.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",481,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",241.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,163.23,163.23,163.23,"1 through 10",other,"not separately reimbursment ",241.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.98,481,
"CHEST TUBE PLACEMENT",7550230,"CDM ",982,RC,32551,HCPCS,OUTPATIENT,,,622,497.6,,132.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.24,60.24,60.24,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",269,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",132.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",132.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.58,269,
"CERUMEN REMOVAL",7550250,"CDM ",982,RC,69210,HCPCS,OUTPATIENT,,,115,92,,37.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",75,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,42.37,42.37,42.37,"1 through 10",other,"not separately reimbursment ",37.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.74,75,
"ATTENDANCE/SUPERVISION HBO",7550290,"CDM ",982,RC,99183,HCPCS,OUTPATIENT,,,287.5,230,,167.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,135.88,135.88,135.88,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",332,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",167.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",167.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.09,332,
"I&D ABSCESS - SIMPLE",7550300,"CDM ",982,RC,10060,HCPCS,OUTPATIENT,,,263.5,210.8,,72.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.72,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",153,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",72.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,112.42,112.42,112.42,"1 through 10",other,"not separately reimbursment ",72.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.98,153,
"I&D ABSCESS - COMPLICATED",7550310,"CDM ",982,RC,10061,HCPCS,OUTPATIENT,,,431,344.8,,132.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",239.26,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",284,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",132.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",132.01,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.01,284,
"INCISION & REMOVAL FB",7550320,"CDM ",982,RC,10120,HCPCS,OUTPATIENT,,,350,280,,101.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",201,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",101.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",101.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.36,201,
"I&D HEMATOMA SEROMA/FLUID",7550330,"CDM ",982,RC,10140,HCPCS,OUTPATIENT,,,347.5,278,,101.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,217.85,217.85,217.85,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",215,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",101.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",101.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.66,215,
"PUNCTURE/ASPIRATE ABSCESS",7550340,"CDM ",982,RC,10160,HCPCS,OUTPATIENT,,,306.5,245.2,,85.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,79.15,79.15,79.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",173,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",85.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.16,173,
"I&D POST-OP WOUND",7550350,"CDM ",982,RC,10180,HCPCS,OUTPATIENT,,,543.5,434.8,,161.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",161.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",342,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",161.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,207.83,207.83,207.83,"1 through 10",other,"not separately reimbursment ",161.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",161.39,342,
"DEBRIDE INFECTED SKIN",7550360,"CDM ",982,RC,11000,HCPCS,OUTPATIENT,,,94,75.2,,36.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",74,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",36.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",36.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.5,74,
"DEBRIDE WOUND <21 SQ CM",7550370,"CDM ",982,RC,97597,HCPCS,OUTPATIENT,,,175,140,,37.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,266.92,266.92,266.92,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",100,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",37.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.63,100,
"DEBRIDE WOUND EA ADD'L 20 CM",7550380,"CDM ",982,RC,97598,HCPCS,OUTPATIENT,,,149.5,119.6,,48.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",110,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",48.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",48.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.15,110,
"DEBRIDE LOW FREQ US/DAY",7550390,"CDM ",982,RC,97610,HCPCS,OUTPATIENT,,,26.5,21.2,,40,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",306,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",40,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",40,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4,306,
"DEBRIDE SUBQ <21 SQ CM",7550400,"CDM ",982,RC,11042,HCPCS,OUTPATIENT,,,242,193.6,,51.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",106.4,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",161,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,838.17,838.17,838.17,"1 through 10",other,"not separately reimbursment ",51.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.46,161,
"DEBRIDE SUBQ EA ADD'L 20CM",7550410,"CDM ",982,RC,11045,HCPCS,OUTPATIENT,,,96.5,77.2,,8.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,216.82,216.82,216.82,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",56,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.18,56,
"DEBRIDE MUSCLE <21 SQ CM",7550420,"CDM ",982,RC,11043,HCPCS,OUTPATIENT,,,402.5,322,,175.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",238.51,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",175.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",375,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",175.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",175.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",175.85,375,
"DEBRIDE MUSCLE EA ADD'L 20CM",7550430,"CDM ",982,RC,11046,HCPCS,OUTPATIENT,,,155.5,124.4,,17.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,87.33,87.33,87.33,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",99,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.53,99,
"DEBRIDE BONE <21 SQ CM",7550440,"CDM ",982,RC,11044,HCPCS,OUTPATIENT,,,737,589.6,,229.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,40.42,40.42,40.42,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",229.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",508,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",229.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",229.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",229.31,508,
"DEBRIDE BONE EA ADD'L 20CM",7550450,"CDM ",982,RC,11047,HCPCS,OUTPATIENT,,,201.5,161.2,,30.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,120.00,120.00,120.00,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",168,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",30.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.36,168,
"DRSG/DEBRIDE BURN 1ST DEGREE",7550460,"CDM ",982,RC,16000,HCPCS,OUTPATIENT,,,115,92,,53.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",106,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",53.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",53.59,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.59,106,
"DEBRIDE BURN - SMALL",7550470,"CDM ",982,RC,16020,HCPCS,OUTPATIENT,,,218.5,174.8,,62.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,98.42,98.42,98.42,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",124,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",62.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",62.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.64,124,
"DEBRIDE BURN - MEDIUM",7550480,"CDM ",982,RC,16025,HCPCS,OUTPATIENT,,,371.5,297.2,,111.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",221,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",111.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",111.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.45,221,
"DEBRIDE BURN - LARGE",7550490,"CDM ",982,RC,16030,HCPCS,OUTPATIENT,,,371.5,297.2,,131.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",261,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",131.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",131.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.15,261,
"DEBRIDE NAILS 1-5",7550530,"CDM ",982,RC,11720,HCPCS,OUTPATIENT,,,67.5,54,,20.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.38,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.38,42,
"DEBRIDE NAILS >5",7550540,"CDM ",982,RC,11721,HCPCS,OUTPATIENT,,,96.5,77.2,,30.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",61,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",30.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.75,61,
"*PARING/CUTTING CALLUS-SINGLE",7550550,"CDM ",982,RC,11055,HCPCS,OUTPATIENT,,,81,64.8,,30.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",67,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",30.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.15,67,
"PARING/CUTTING CALLUS 2-4",7550560,"CDM ",982,RC,11056,HCPCS,OUTPATIENT,,,96.5,77.2,,38.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",81,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",38.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",38.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.47,81,
"PARING/CUTTING CALLUS >4",7550570,"CDM ",982,RC,11057,HCPCS,OUTPATIENT,,,132,105.6,,47.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",98,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",47.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",47.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.58,98,
"AVULSION NAIL PLATE SINGLE",7550580,"CDM ",982,RC,11730,HCPCS,OUTPATIENT,,,234,187.2,,67.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,157.01,157.01,157.01,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",135,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",67.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",67.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.21,135,
"AVULSION NAIL PLATE EA ADD'L",7550590,"CDM ",982,RC,11732,HCPCS,OUTPATIENT,,,98.5,78.8,,31.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",63,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",31.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",31.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.69,63,
"EXCISION NAIL PART/COMPLETE",7550600,"CDM ",982,RC,11750,HCPCS,OUTPATIENT,,,488.5,390.8,,142.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",216.35,100,,238.35,238.35,238.35,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",307,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",142.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,106.41,106.41,106.41,"1 through 10",other,"not separately reimbursment ",142.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.39,307,
"RIGID TOTAL CONTACT LEG CAST",7550610,"CDM ",982,RC,29445,HCPCS,OUTPATIENT,,,259,207.2,,112.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",223,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",112.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",112.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.17,223,
"APPLY UNNA BOOT",7550620,"CDM ",982,RC,29580,HCPCS,OUTPATIENT,,,117.5,94,,37.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",76,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",37.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.49,76,
"APPL MULT LAY COMPRES LOW LEG",7550630,"CDM ",982,RC,29581,HCPCS,OUTPATIENT,,,174,139.2,,16.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.61,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",121,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",16.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",16.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.42,121,
"WOUND CAUTERIZATION",7550640,"CDM ",982,RC,17250,HCPCS,OUTPATIENT,,,180,144,,50.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,88.32,88.32,88.32,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",104,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",50.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",50.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.81,104,
"SKIN SUB GRAFT TRUNK/ARM/LEG",7550650,"CDM ",982,RC,15271,HCPCS,OUTPATIENT,,,290,232,,62.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",196,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",62.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",62.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.68,196,
"FINE NEEDLE ASPIR WO IMAGE 1S",7550660,"CDM ",982,RC,10021,HCPCS,OUTPATIENT,,,287.5,230,,101.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",204,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",101.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",101.93,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.93,204,
"SHAVE SKIN LESION SINGLE 0.5C",7550670,"CDM ",982,RC,11310,HCPCS,OUTPATIENT,,,246,196.8,,54.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",156,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",54.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",54.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.56,156,
"SKIN SUB GRAFT TRNK/ARM <100C",7550680,"CDM ",982,RC,15273,HCPCS,OUTPATIENT,,,670,536,,92.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",405,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",92.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",92.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.61,405,
"*SKIN SUB GRAFT TRNK/ARM >100C",7550690,"CDM ",982,RC,15274,HCPCS,OUTPATIENT,,,160.5,128.4,,19.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",95,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.71,95,
"SKIN SUB GRFT TRNK/ARM ADD 25",7550700,"CDM ",982,RC,15272,HCPCS,OUTPATIENT,,,281.5,225.2,,7.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,3.04,3.04,3.04,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",37,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",7.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",7.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.71,37,
"SKIN SUB GRFT FACE/SCLP <25CM",7550710,"CDM ",982,RC,15275,HCPCS,OUTPATIENT,,,281.5,225.2,,45.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",211,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",45.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",45.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.18,211,
"SKIN SUB GRFT FC/SCLP ADD 25",7550720,"CDM ",982,RC,15276,HCPCS,OUTPATIENT,,,74.5,59.6,,11.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1497.91,1497.91,1497.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",11.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",11.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,46,
"NPWT <50 SQ CM",7550730,"CDM ",982,RC,97605,HCPCS,OUTPATIENT,,,65,52,,25.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",56,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",25.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",25.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.88,56,
"NPWT >50 SQ CM",7550740,"CDM ",982,RC,97606,HCPCS,OUTPATIENT,,,110.5,88.4,,27.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",70,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",27.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",27.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.94,70,
"NPWT <50 SQ CM NON DME",7550750,"CDM ",982,RC,97607,HCPCS,OUTPATIENT,,,62.5,50,,25.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",25.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.88,25.88,
"NPWT >50 SQ CM NON DME",7550760,"CDM ",982,RC,97608,HCPCS,OUTPATIENT,,,110.5,88.4,,27.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",27.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.94,27.94,
"SIMP RPR SNTE 7.6CM - 12.5CM",7550770,"CDM ",982,RC,12004,HCPCS,OUTPATIENT,,,302,241.6,,139.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",277,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",139.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",139.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.65,277,
"RPR TRUNK/EXT <2.6CM SIMPLE",7550780,"CDM ",982,RC,12001,HCPCS,OUTPATIENT,,,200,160,,111.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,420.48,420.48,420.48,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",222,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",111.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",111.9,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.9,222,
"*EXC H/F/N/SP BNGN 0.6-1.0CM",7550790,"CDM ",982,RC,11421,HCPCS,OUTPATIENT,,,304,243.2,,104.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",210,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",104.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",104.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.84,210,
"EXC H/F/NK/SP BNGN <0.5CM",7550800,"CDM ",982,RC,11420,HCPCS,OUTPATIENT,,,227.5,182,,81.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,183.42,183.42,183.42,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",163,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",81.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",81.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.8,163,
"WOUND PREP F/N/HF/G < 100SQCM",7550810,"CDM ",982,RC,15004,HCPCS,OUTPATIENT,,,604.5,483.6,,275.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",275.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",550,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",275.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,297.09,297.09,297.09,"1 through 10",other,"not separately reimbursment ",275.69,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",275.69,550,
"REMOVE TUNNELED CV CATH",7550820,"CDM ",982,RC,36590,HCPCS,OUTPATIENT,,,689,551.2,,207.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",307.06,100,,1531.82,1531.82,1531.82,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",207.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",412,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",207.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",207.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",207.25,412,
"SIMP RPR TRK EXT 2.6-7.5CM",7550830,"CDM ",982,RC,12002,HCPCS,OUTPATIENT,,,330.5,264.4,,119.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",237,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",119.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",119.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.05,237,
"SHAVE SKIN LESION 0.6-1.0 CM",7550840,"CDM ",982,RC,11301,HCPCS,OUTPATIENT,,,263.5,210.8,,58.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",165,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",58.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.33,165,
"REPLACE CV CATH",7550850,"CDM ",982,RC,36578,HCPCS,OUTPATIENT,,,454.5,363.6,,422.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",422.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",840,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",422.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",422.55,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",422.55,840,
"TOE FX WO MANIP PHALANGE",7550860,"CDM ",982,RC,28510,HCPCS,OUTPATIENT,,,264.5,211.6,,79.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",164,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",79.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",79.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.76,164,
"TX WOUND DEHIS SIMPLE CLOSE",7550870,"CDM ",982,RC,12020,HCPCS,OUTPATIENT,,,636.5,509.2,,195.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",195.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",388,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",195.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",195.11,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",195.11,388,
"PARTIAL AMPUTATION TOE",7550880,"CDM ",982,RC,28825,HCPCS,OUTPATIENT,,,1315,1052,,317.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",317.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",768,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",317.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",317.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",317.74,768,
"BX PUNCH SKIN SINGLE LESION",7550890,"CDM ",982,RC,11104,HCPCS,OUTPATIENT,,,224.5,179.6,,31.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,21.90,21.90,21.90,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",170,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",31.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,90.82,90.82,90.82,"1 through 10",other,"not separately reimbursment ",31.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.49,170,
"BX PUNCH SKIN EA ADD LESION",7550900,"CDM ",982,RC,11105,HCPCS,OUTPATIENT,,,132.5,106,,17.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",84,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.17,84,
"REMOVE IMPACTED CERUMEN UNI",7550910,"CDM ",982,RC,69209,HCPCS,OUTPATIENT,,,30.5,24.4,,7.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",15.72,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",17,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",7.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,13.40,8.04,18.75,"1 through 10",other,"not separately reimbursment ",7.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.51,17,
"ADJ TISS TX TRUNK 10.1-30.0",7550920,"CDM ",982,RC,14001,HCPCS,OUTPATIENT,,,1517.5,1214,,545.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",545.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1129,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",545.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,117.60,117.60,117.60,"1 through 10",other,"not separately reimbursment ",545.74,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",545.74,1129,
"INSERT BLADDER CATH SIMPLE",7550930,"CDM ",982,RC,51702,HCPCS,OUTPATIENT,,,213.5,170.8,,74.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,11.03,11.03,11.03,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",162,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",74.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",74.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.4,162,
"*SURG PREP RCPT SITE",7550940,"CDM ",982,RC,15002,HCPCS,OUTPATIENT,,,598,478.4,,228.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,358.31,358.31,358.31,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",228.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",483,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",228.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",228.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",228.79,483,
"APPLY SHORT LEG SPLINT",7550950,"CDM ",982,RC,29515,HCPCS,OUTPATIENT,,,141.5,113.2,,49.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",102,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",49.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,41.35,41.35,41.35,"1 through 10",other,"not separately reimbursment ",49.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4,102,
"APPLY SHORT LEG SPLINT",7550950,"CDM ",982,RC,29515,HCPCS,OUTPATIENT,,,163,130.4,,49.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",102,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",49.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,41.35,41.35,41.35,"1 through 10",other,"not separately reimbursment ",49.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4,102,
"PART EXCISION PHALANX TOE",7550960,"CDM ",982,RC,28124,HCPCS,OUTPATIENT,,,747.5,598,,302.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",302.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",665,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",302.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",302.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",302.86,665,
"SIMPLE REPAIR FACE 2.6-5 CM",7550970,"CDM ",982,RC,12013,HCPCS,OUTPATIENT,,,247.5,198,,129.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,547.40,547.40,547.40,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",258,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",129.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",129.73,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.73,258,
"IRRIGATE IMPLANT DRUG DEVICE",7550980,"CDM ",982,RC,96523,HCPCS,OUTPATIENT,,,52.5,42,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41,41,
"EXC BONE ANKLE/HEEL PARTIAL",7550990,"CDM ",982,RC,28120,HCPCS,OUTPATIENT,,,1150.5,920.4,,388.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",388.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",953,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",388.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",388.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",388.85,953,
"BX BREAST OPEN INCISIONAL",7551010,"CDM ",982,RC,19101,HCPCS,OUTPATIENT,,,502.5,402,,233.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",233.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",475,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",233.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",233.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",233.57,475,
"LATE/SEC WOUND CLOSURE CMPLX",7551020,"CDM ",982,RC,13160,HCPCS,OUTPATIENT,,,1674,1339.2,,562.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1069.31,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",562.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",1133,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",562.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",562.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",562.58,1133,
"APPLY SHORT ARM SPLINT",7551025,"CDM ",982,RC,29125,HCPCS,OUTPATIENT,,,146.5,117.2,,48.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",96,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",48.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",48.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.35,96,
"CLSD TX DISTAL TIBIA WO MANIP",7551030,"CDM ",982,RC,27824,HCPCS,OUTPATIENT,,,676,540.8,,205.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",205.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",424,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",205.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",205.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",205.64,424,
"CLSD TX DISTAL TIBIA WO MANIP",7551030,"CDM ",982,RC,27824,HCPCS,OUTPATIENT,,,676,540.8,,205.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",205.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",424,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",205.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",205.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",205.64,424,
"REMOVE TUNNEL CV CATH",7551035,"CDM ",980,RC,36589,HCPCS,OUTPATIENT,,,383,306.4,,139.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,224.38,224.38,224.38,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",276,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",139.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",139.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.07,276,
"APPLY SHORT LEG CAST",7551040,"CDM ",982,RC,29405,HCPCS,OUTPATIENT,,,198,158.4,,63.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",127,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",63.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",63.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.96,127,
"EXC BENIGN LES <.5CM F/E/N/L",7551045,"CDM ",982,RC,11440,HCPCS,OUTPATIENT,,,278,222.4,,96.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",191,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",96.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",96.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.25,191,
"TRIM NAIL ANY NUMBER",7551060,"CDM ",982,RC,11719,HCPCS,OUTPATIENT,,,29,23.2,,12.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.71,30,
"REMOVE SUPPORT IMPLANT",7551065,"CDM ",982,RC,20670,HCPCS,OUTPATIENT,,,632.5,506,,380.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",380.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",757,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",380.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",380.84,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",380.84,757,
"CONT GLUCOSE MNTR INTERP RPRT",7551070,"CDM ",982,RC,95251,HCPCS,OUTPATIENT,,,75,60,,,,,,,,0,"other ","not separately reimbursment ",,,,49.88,49.88,49.88,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",63,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,31.21,10.57,42.63,"1 through 10",other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63,63,
"ULTRASOUND-PT 15 MIN",8000036,"CDM ",420,RC,97035,HCPCS,OUTPATIENT,,,71.5,57.2,,12.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",30.16,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",66.5,93,,53.20,,,0,"percent of total billed charges ","93% of total billed charges ",12.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",60.78,85,,48.62,,,0,"percent of total billed charges ","85% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",14.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.21,87,,49.77,,,0,"percent of total billed charges ","87% of total billed charges ",14.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",12.33,66.5,
"PELVIC/CERV TRACTION 1 OR MORE",8000044,"CDM ",420,RC,97012,HCPCS,OUTPATIENT,,,68.5,54.8,,14.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.36,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",30.43,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",47.95,70,,38.36,,,0,"percent of total billed charges ","70% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",63.71,93,,50.97,,,0,"percent of total billed charges ","93% of total billed charges ",14.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.06,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",58.23,85,,46.58,,,0,"percent of total billed charges ","85% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",16.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.6,87,,47.24,47.24,47.24,"1 through 10","percent of total billed charges ","87% of total billed charges ",16.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",47.95,70,,38.36,,,0,"percent of total billed charges ","70% of total billed charges ",14.77,63.71,
"GAIT TRAINING  15 MIN",8000168,"CDM ",420,RC,97116,HCPCS,OUTPATIENT,,,64.5,51.6,,24.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.46,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",62.59,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",45.15,70,,36.12,,,0,"percent of total billed charges ","70% of total billed charges ",58.05,90,,46.44,,,0,"percent of total billed charges ","90% of total billed charges ",59.99,93,,47.99,,,0,"percent of total billed charges ","93% of total billed charges ",24.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.4,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",54.83,85,,43.86,,,0,"percent of total billed charges ","85% of total billed charges ",58.05,90,,46.44,,,0,"percent of total billed charges ","90% of total billed charges ",58.05,90,,46.44,,,0,"percent of total billed charges ","90% of total billed charges ",22.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.12,87,,44.90,,,0,"percent of total billed charges ","87% of total billed charges ",22.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",45.15,70,,36.12,,,0,"percent of total billed charges ","70% of total billed charges ",22.18,62.59,
"PHYS PERF TEST 15 MIN (FCE)",8000176,"CDM ",420,RC,97750,HCPCS,OUTPATIENT,,,93,74.4,,17.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",70.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",65.1,70,,52.08,,,0,"percent of total billed charges ","70% of total billed charges ",83.7,90,,66.96,,,0,"percent of total billed charges ","90% of total billed charges ",86.49,93,,69.19,,,0,"percent of total billed charges ","93% of total billed charges ",17.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",79.05,85,,63.24,,,0,"percent of total billed charges ","85% of total billed charges ",83.7,90,,66.96,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,90,,66.96,,,0,"percent of total billed charges ","90% of total billed charges ",20.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.91,87,,64.73,,,0,"percent of total billed charges ","87% of total billed charges ",20.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",65.1,70,,52.08,,,0,"percent of total billed charges ","70% of total billed charges ",17.56,86.49,
"WHIRLPOOL EXT",8000184,"CDM ",420,RC,97022,HCPCS,OUTPATIENT,,,120,96,,14.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.33,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",36.1,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",84,70,,67.20,,,0,"percent of total billed charges ","70% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",111.6,93,,89.28,,,0,"percent of total billed charges ","93% of total billed charges ",14.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",102,85,,81.60,,,0,"percent of total billed charges ","85% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",104.4,87,,83.52,,,0,"percent of total billed charges ","87% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",84,70,,67.20,,,0,"percent of total billed charges ","70% of total billed charges ",14.41,111.6,
"WHIRLPOOL FULL",8000192,"CDM ",420,RC,97022,HCPCS,OUTPATIENT,,,145,116,,14.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.33,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",36.1,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",14.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",126.15,87,,100.92,,,0,"percent of total billed charges ","87% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",14.41,134.85,
"WHIRLPOOL BODY; PER 15 MIN",8000200,"CDM ",420,RC,97036,HCPCS,OUTPATIENT,,,307.5,246,,12.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.43,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",71.43,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",215.25,70,,172.20,,,0,"percent of total billed charges ","70% of total billed charges ",276.75,90,,221.40,,,0,"percent of total billed charges ","90% of total billed charges ",285.98,93,,228.78,,,0,"percent of total billed charges ","93% of total billed charges ",12.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",261.38,85,,209.10,,,0,"percent of total billed charges ","85% of total billed charges ",276.75,90,,221.40,,,0,"percent of total billed charges ","90% of total billed charges ",276.75,90,,221.40,,,0,"percent of total billed charges ","90% of total billed charges ",14.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",267.53,87,,214.02,,,0,"percent of total billed charges ","87% of total billed charges ",14.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",215.25,70,,172.20,,,0,"percent of total billed charges ","70% of total billed charges ",12.45,285.98,
"ELECTRICAL STIM UNATTENDED",8000291,"CDM ",420,RC,97014,HCPCS,OUTPATIENT,,,58.5,46.8,,14.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.31,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",26.49,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",40.95,70,,32.76,,,0,"percent of total billed charges ","70% of total billed charges ",52.65,90,,42.12,,,0,"percent of total billed charges ","90% of total billed charges ",54.41,93,,43.53,,,0,"percent of total billed charges ","93% of total billed charges ",14.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",49.73,85,,39.78,,,0,"percent of total billed charges ","85% of total billed charges ",52.65,90,,42.12,,,0,"percent of total billed charges ","90% of total billed charges ",52.65,90,,42.12,,,0,"percent of total billed charges ","90% of total billed charges ",16.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",50.9,87,,40.72,,,0,"percent of total billed charges ","87% of total billed charges ",16.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",40.95,70,,32.76,,,0,"percent of total billed charges ","70% of total billed charges ",14.75,54.41,
"THERAP EXER STRENGTH 15 M",8000309,"CDM ",420,RC,97110,HCPCS,OUTPATIENT,,,129.5,103.6,,28.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.91,100,,272.47,272.47,272.47,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",62.59,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",90.65,70,,72.52,,,0,"percent of total billed charges ","70% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",120.44,93,,96.35,,,0,"percent of total billed charges ","93% of total billed charges ",28.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",110.08,85,,88.06,,,0,"percent of total billed charges ","85% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",25.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.67,87,,89.99,65.45,287.97,"1 through 10","percent of total billed charges ","87% of total billed charges ",25.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",90.65,70,,72.52,,,0,"percent of total billed charges ","70% of total billed charges ",25.65,120.44,
"INITIAL THEREX W/MATERIAL 15MI",8000310,"CDM ",420,RC,97110,HCPCS,OUTPATIENT,,,129.5,103.6,,28.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.91,100,,272.47,272.47,272.47,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",62.59,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",90.65,70,,72.52,,,0,"percent of total billed charges ","70% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",120.44,93,,96.35,,,0,"percent of total billed charges ","93% of total billed charges ",28.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",110.08,85,,88.06,,,0,"percent of total billed charges ","85% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",25.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.67,87,,89.99,65.45,287.97,"1 through 10","percent of total billed charges ","87% of total billed charges ",25.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",90.65,70,,72.52,,,0,"percent of total billed charges ","70% of total billed charges ",25.65,120.44,
"JOBST PUMP",8000366,"CDM ",420,RC,97016,HCPCS,OUTPATIENT,,,69.5,55.6,,16.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.33,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",25.1,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",48.65,70,,38.92,,,0,"percent of total billed charges ","70% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",64.64,93,,51.71,,,0,"percent of total billed charges ","93% of total billed charges ",16.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.06,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",59.08,85,,47.26,,,0,"percent of total billed charges ","85% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",18.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60.47,87,,48.38,,,0,"percent of total billed charges ","87% of total billed charges ",18.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",48.65,70,,38.92,,,0,"percent of total billed charges ","70% of total billed charges ",16.5,64.64,
"IONTOPHORESIS PER 15MIN",8000564,"CDM ",420,RC,97033,HCPCS,OUTPATIENT,,,73,58.4,,8.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.38,100,,36.73,36.73,36.73,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",41.56,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",51.1,70,,40.88,,,0,"percent of total billed charges ","70% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",67.89,93,,54.31,,,0,"percent of total billed charges ","93% of total billed charges ",8.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.05,85,,49.64,,,0,"percent of total billed charges ","85% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.51,87,,50.81,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.1,70,,40.88,,,0,"percent of total billed charges ","70% of total billed charges ",8.58,67.89,
"PT RE-EVALUATION",8000713,"CDM ",424,RC,97164,HCPCS,OUTPATIENT,,,118,94.4,,,,,,,,0,"other ","not separately reimbursment ",81.34,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",146.37,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",82.6,70,,66.08,,,0,"percent of total billed charges ","70% of total billed charges ",106.2,90,,84.96,,,0,"percent of total billed charges ","90% of total billed charges ",109.74,93,,87.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",35.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",100.3,85,,80.24,,,0,"percent of total billed charges ","85% of total billed charges ",106.2,90,,84.96,,,0,"percent of total billed charges ","90% of total billed charges ",106.2,90,,84.96,,,0,"percent of total billed charges ","90% of total billed charges ",35.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",102.66,87,,82.13,,,0,"percent of total billed charges ","87% of total billed charges ",35.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",82.6,70,,66.08,,,0,"percent of total billed charges ","70% of total billed charges ",35.34,146.37,
"WORK HARDEN/COND 1ST 2 HR",8000754,"CDM ",420,RC,97545,HCPCS,OUTPATIENT,,,267.5,214,,34.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.16,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",248.78,93,,199.02,,,0,"percent of total billed charges ","93% of total billed charges ",34.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",227.38,85,,181.90,,,0,"percent of total billed charges ","85% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",232.73,87,,186.18,,,0,"percent of total billed charges ","87% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",16.16,248.78,
"WORK HARDEN/COND EA ADD'L HR",8000762,"CDM ",420,RC,97546,HCPCS,OUTPATIENT,,,115,92,,17.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",17.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",17.16,106.95,
FLUIDOTHERAPY,8000788,"CDM ",420,RC,97022,HCPCS,OUTPATIENT,,,120,96,,14.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.33,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",36.1,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",84,70,,67.20,,,0,"percent of total billed charges ","70% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",111.6,93,,89.28,,,0,"percent of total billed charges ","93% of total billed charges ",14.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",102,85,,81.60,,,0,"percent of total billed charges ","85% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",104.4,87,,83.52,,,0,"percent of total billed charges ","87% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",84,70,,67.20,,,0,"percent of total billed charges ","70% of total billed charges ",14.41,111.6,
"PHONOPHORESIS; EA 15 MIN",8000796,"CDM ",420,RC,97035,HCPCS,OUTPATIENT,,,71.5,57.2,,12.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",30.16,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",66.5,93,,53.20,,,0,"percent of total billed charges ","93% of total billed charges ",12.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",60.78,85,,48.62,,,0,"percent of total billed charges ","85% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",14.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.21,87,,49.77,,,0,"percent of total billed charges ","87% of total billed charges ",14.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",12.33,66.5,
"MASSAGE 15 MIN",8000812,"CDM ",420,RC,97124,HCPCS,OUTPATIENT,,,80.5,64.4,,11.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.42,100,,50.46,50.46,50.46,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",62.94,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",56.35,70,,45.08,,,0,"percent of total billed charges ","70% of total billed charges ",72.45,90,,57.96,,,0,"percent of total billed charges ","90% of total billed charges ",74.87,93,,59.90,,,0,"percent of total billed charges ","93% of total billed charges ",11.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",68.43,85,,54.74,,,0,"percent of total billed charges ","85% of total billed charges ",72.45,90,,57.96,,,0,"percent of total billed charges ","90% of total billed charges ",72.45,90,,57.96,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.04,87,,56.03,,,0,"percent of total billed charges ","87% of total billed charges ",13.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",56.35,70,,45.08,,,0,"percent of total billed charges ","70% of total billed charges ",11.41,74.87,
"AQUATIC THERAPY 15 MIN",8000853,"CDM ",420,RC,97113,HCPCS,OUTPATIENT,,,74.5,59.6,,29.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",78.01,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",69.29,93,,55.43,,,0,"percent of total billed charges ","93% of total billed charges ",29.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",63.33,85,,50.66,,,0,"percent of total billed charges ","85% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",27.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.82,87,,51.86,,,0,"percent of total billed charges ","87% of total billed charges ",27.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",27.4,78.01,
"NEURO-MUSC RE-EDUC 15 MIN",8000861,"CDM ",420,RC,97112,HCPCS,OUTPATIENT,,,83.5,66.8,,27.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",50.5,100,,60.46,60.46,60.46,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",72.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",77.66,93,,62.13,,,0,"percent of total billed charges ","93% of total billed charges ",27.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.98,85,,56.78,,,0,"percent of total billed charges ","85% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",24.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",72.65,87,,65.17,59.38,70.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",24.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",24.87,77.66,
BIOFEEDBACK,8000879,"CDM ",420,RC,90901,HCPCS,OUTPATIENT,,,107,85.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.9,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",74.9,70,,59.92,,,0,"percent of total billed charges ","70% of total billed charges ",96.3,90,,77.04,,,0,"percent of total billed charges ","90% of total billed charges ",99.51,93,,79.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",90.95,85,,72.76,,,0,"percent of total billed charges ","85% of total billed charges ",96.3,90,,77.04,,,0,"percent of total billed charges ","90% of total billed charges ",96.3,90,,77.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",93.09,87,,74.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.9,70,,59.92,,,0,"percent of total billed charges ","70% of total billed charges ",40.9,99.51,
"CONTRAST BATH; EA 15 MIN",8000895,"CDM ",420,RC,97034,HCPCS,OUTPATIENT,,,53.5,42.8,,7.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.3,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",30.84,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",49.76,93,,39.81,,,0,"percent of total billed charges ","93% of total billed charges ",7.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.48,85,,36.38,,,0,"percent of total billed charges ","85% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",8.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.55,87,,37.24,,,0,"percent of total billed charges ","87% of total billed charges ",8.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",7.06,49.76,
"E-STIM: MANUAL 15 MIN",8000937,"CDM ",420,RC,97032,HCPCS,OUTPATIENT,,,53.5,42.8,,8.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.34,100,,41.07,41.07,41.07,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",31.13,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",49.76,93,,39.81,,,0,"percent of total billed charges ","93% of total billed charges ",8.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.48,85,,36.38,,,0,"percent of total billed charges ","85% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.55,87,,37.24,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",8.58,49.76,
"MANUAL THERAPY TECH 15 MIN",8000945,"CDM ",420,RC,97140,HCPCS,OUTPATIENT,,,97.5,78,,22.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",58.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",57.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",68.25,70,,54.60,,,0,"percent of total billed charges ","70% of total billed charges ",87.75,90,,70.20,,,0,"percent of total billed charges ","90% of total billed charges ",90.68,93,,72.54,,,0,"percent of total billed charges ","93% of total billed charges ",22.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",82.88,85,,66.30,,,0,"percent of total billed charges ","85% of total billed charges ",87.75,90,,70.20,,,0,"percent of total billed charges ","90% of total billed charges ",87.75,90,,70.20,,,0,"percent of total billed charges ","90% of total billed charges ",20.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.83,87,,67.86,,,0,"percent of total billed charges ","87% of total billed charges ",20.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.25,70,,54.60,,,0,"percent of total billed charges ","70% of total billed charges ",20.47,90.68,
"ORTHO FIT/TRAIN 15 MIN",8000994,"CDM ",420,RC,97760,HCPCS,OUTPATIENT,,,83.5,66.8,,,,,,,,0,"other ","not separately reimbursment ",39.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",102.34,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",77.66,93,,62.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.98,85,,56.78,,,0,"percent of total billed charges ","85% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",72.65,87,,58.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",39.64,102.34,
"ORTHO/PROSTHETIC CHECK 15 MIN",8001000,"CDM ",420,RC,97763,HCPCS,OUTPATIENT,,,69.5,55.6,,,,,,,,0,"other ","not separately reimbursment ",29.21,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",113.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",48.65,70,,38.92,,,0,"percent of total billed charges ","70% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",64.64,93,,51.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",59.08,85,,47.26,,,0,"percent of total billed charges ","85% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",60.47,87,,48.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.65,70,,38.92,,,0,"percent of total billed charges ","70% of total billed charges ",29.21,113.28,
"PARAFFIN BATH THERAPY",8001018,"CDM ",420,RC,97018,HCPCS,OUTPATIENT,,,53.5,42.8,,13.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.23,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",11.81,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",49.76,93,,39.81,,,0,"percent of total billed charges ","93% of total billed charges ",13.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.48,85,,36.38,,,0,"percent of total billed charges ","85% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",15.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.55,87,,37.24,,,0,"percent of total billed charges ","87% of total billed charges ",15.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.81,49.76,
"PROSTHETIC TRAINING 15 MIN",8001026,"CDM ",420,RC,97761,HCPCS,OUTPATIENT,,,70.5,56.4,,20.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",50.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",87.85,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",65.57,93,,52.46,,,0,"percent of total billed charges ","93% of total billed charges ",20.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",59.93,85,,47.94,,,0,"percent of total billed charges ","85% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",23.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",61.34,87,,49.07,,,0,"percent of total billed charges ","87% of total billed charges ",23.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",20.19,87.85,
"THERAPUTIC ACTIVITY 15 MIN",8001067,"CDM ",420,RC,97530,HCPCS,OUTPATIENT,,,87.5,70,,28.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.91,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",78.43,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",61.25,70,,49.00,,,0,"percent of total billed charges ","70% of total billed charges ",78.75,90,,63.00,,,0,"percent of total billed charges ","90% of total billed charges ",81.38,93,,65.10,,,0,"percent of total billed charges ","93% of total billed charges ",28.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",74.38,85,,59.50,,,0,"percent of total billed charges ","85% of total billed charges ",78.75,90,,63.00,,,0,"percent of total billed charges ","90% of total billed charges ",78.75,90,,63.00,,,0,"percent of total billed charges ","90% of total billed charges ",26.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",76.13,87,,60.90,,,0,"percent of total billed charges ","87% of total billed charges ",26.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",61.25,70,,49.00,,,0,"percent of total billed charges ","70% of total billed charges ",26.02,81.38,
"WC MGMT (ASSESS,FIT,TRAIN) 15M",8001083,"CDM ",420,RC,97542,HCPCS,OUTPATIENT,,,70.5,56.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.65,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",65.57,93,,52.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",59.93,85,,47.94,,,0,"percent of total billed charges ","85% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",61.34,87,,49.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",49.35,67.65,
"DEBRIDEMENT 20 CM OR LESS",8001091,"CDM ",420,RC,97597,HCPCS,OUTPATIENT,,,344,275.2,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",278.76,100,,266.92,266.92,266.92,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",76.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",240.8,70,,192.64,,,0,"percent of total billed charges ","70% of total billed charges ",309.6,90,,247.68,,,0,"percent of total billed charges ","90% of total billed charges ",319.92,93,,255.94,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",292.4,85,,233.92,,,0,"percent of total billed charges ","85% of total billed charges ",309.6,90,,247.68,,,0,"percent of total billed charges ","90% of total billed charges ",309.6,90,,247.68,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",299.28,87,,239.42,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",240.8,70,,192.64,,,0,"percent of total billed charges ","70% of total billed charges ",76.25,319.92,
"ROM HAND",8001109,"CDM ",420,RC,95852,HCPCS,OUTPATIENT,,,68.5,54.8,,5.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",11.48,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",47.95,70,,38.36,,,0,"percent of total billed charges ","70% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",63.71,93,,50.97,,,0,"percent of total billed charges ","93% of total billed charges ",5.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.86,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",58.23,85,,46.58,,,0,"percent of total billed charges ","85% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",6.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.6,87,,47.68,,,0,"percent of total billed charges ","87% of total billed charges ",6.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",47.95,70,,38.36,,,0,"percent of total billed charges ","70% of total billed charges ",5.94,63.71,
"ROM EXTREMITY/TRUNK",8001117,"CDM ",420,RC,95851,HCPCS,OUTPATIENT,,,68,54.4,,8.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.83,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",16.68,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",47.6,70,,38.08,,,0,"percent of total billed charges ","70% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",63.24,93,,50.59,,,0,"percent of total billed charges ","93% of total billed charges ",8.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",57.8,85,,46.24,,,0,"percent of total billed charges ","85% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",9.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.16,87,,47.33,,,0,"percent of total billed charges ","87% of total billed charges ",9.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",47.6,70,,38.08,,,0,"percent of total billed charges ","70% of total billed charges ",8.46,63.24,
"ORTHO APPLICATION SHORT LEG",8001141,"CDM ",420,RC,29515,HCPCS,OUTPATIENT,,,370,296,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",230.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",100.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",344.1,93,,275.28,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",314.5,85,,251.60,,,0,"percent of total billed charges ","85% of total billed charges ",277.5,90,,222.00,,,0,"percent of total billed charges ","90% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",321.9,87,,41.35,41.35,41.35,"1 through 10","percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",100.87,344.1,
"ORTHO APPLICATION LONG LEG",8001158,"CDM ",420,RC,29505,HCPCS,OUTPATIENT,,,370,296,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",230.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",104.74,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",344.1,93,,275.28,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",314.5,85,,251.60,,,0,"percent of total billed charges ","85% of total billed charges ",277.5,90,,222.00,,,0,"percent of total billed charges ","90% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",321.9,87,,257.52,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",104.74,344.1,
"ASSIST TECH ASSESS/15 MIN",8001166,"CDM ",420,RC,97755,HCPCS,OUTPATIENT,,,99,79.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.07,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",69.3,70,,55.44,,,0,"percent of total billed charges ","70% of total billed charges ",89.1,90,,71.28,,,0,"percent of total billed charges ","90% of total billed charges ",92.07,93,,73.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",84.15,85,,67.32,,,0,"percent of total billed charges ","85% of total billed charges ",89.1,90,,71.28,,,0,"percent of total billed charges ","90% of total billed charges ",89.1,90,,71.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",86.13,87,,68.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.3,70,,55.44,,,0,"percent of total billed charges ","70% of total billed charges ",69.3,92.07,
"DEBRIDE EA ADD 20CM OR PART OF",8001170,"CDM ",420,RC,97598,HCPCS,OUTPATIENT,,,318.5,254.8,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",222.95,70,,178.36,,,0,"percent of total billed charges ","70% of total billed charges ",286.65,90,,229.32,,,0,"percent of total billed charges ","90% of total billed charges ",296.21,93,,236.97,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",270.73,85,,216.58,,,0,"percent of total billed charges ","85% of total billed charges ",286.65,90,,229.32,,,0,"percent of total billed charges ","90% of total billed charges ",286.65,90,,229.32,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.1,87,,221.68,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",222.95,70,,178.36,,,0,"percent of total billed charges ","70% of total billed charges ",52.25,296.21,
"HOT/COLD E-STIM UNATTENDED",8001180,"CDM ",420,RC,97014,HCPCS,OUTPATIENT,,,58.5,46.8,,14.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.31,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",26.49,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",40.95,70,,32.76,,,0,"percent of total billed charges ","70% of total billed charges ",52.65,90,,42.12,,,0,"percent of total billed charges ","90% of total billed charges ",54.41,93,,43.53,,,0,"percent of total billed charges ","93% of total billed charges ",14.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",49.73,85,,39.78,,,0,"percent of total billed charges ","85% of total billed charges ",52.65,90,,42.12,,,0,"percent of total billed charges ","90% of total billed charges ",52.65,90,,42.12,,,0,"percent of total billed charges ","90% of total billed charges ",16.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",50.9,87,,40.72,,,0,"percent of total billed charges ","87% of total billed charges ",16.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",40.95,70,,32.76,,,0,"percent of total billed charges ","70% of total billed charges ",14.75,54.41,
"HOT MANUAL THERAPY TECH/15 MIN",8001190,"CDM ",420,RC,97140,HCPCS,OUTPATIENT,,,97.5,78,,22.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",58.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",57.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",68.25,70,,54.60,,,0,"percent of total billed charges ","70% of total billed charges ",87.75,90,,70.20,,,0,"percent of total billed charges ","90% of total billed charges ",90.68,93,,72.54,,,0,"percent of total billed charges ","93% of total billed charges ",22.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",82.88,85,,66.30,,,0,"percent of total billed charges ","85% of total billed charges ",87.75,90,,70.20,,,0,"percent of total billed charges ","90% of total billed charges ",87.75,90,,70.20,,,0,"percent of total billed charges ","90% of total billed charges ",20.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.83,87,,67.86,,,0,"percent of total billed charges ","87% of total billed charges ",20.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.25,70,,54.60,,,0,"percent of total billed charges ","70% of total billed charges ",20.47,90.68,
"HOT/COLD ULTRASOUND 15 MIN",8001200,"CDM ",420,RC,97035,HCPCS,OUTPATIENT,,,71.5,57.2,,12.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",30.16,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",66.5,93,,53.20,,,0,"percent of total billed charges ","93% of total billed charges ",12.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",60.78,85,,48.62,,,0,"percent of total billed charges ","85% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",14.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.21,87,,49.77,,,0,"percent of total billed charges ","87% of total billed charges ",14.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",12.33,66.5,
"WOUND VAC </= 50 CM",8001220,"CDM ",420,RC,97607,HCPCS,OUTPATIENT,,,533.5,426.8,,129.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",45.74,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",373.45,70,,298.76,,,0,"percent of total billed charges ","70% of total billed charges ",480.15,90,,384.12,,,0,"percent of total billed charges ","90% of total billed charges ",496.16,93,,396.93,,,0,"percent of total billed charges ","93% of total billed charges ",129.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",44.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",453.48,85,,362.78,,,0,"percent of total billed charges ","85% of total billed charges ",480.15,90,,384.12,,,0,"percent of total billed charges ","90% of total billed charges ",480.15,90,,384.12,,,0,"percent of total billed charges ","90% of total billed charges ",44.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",464.15,87,,371.32,,,0,"percent of total billed charges ","87% of total billed charges ",44.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",373.45,70,,298.76,,,0,"percent of total billed charges ","70% of total billed charges ",44.08,496.16,
"WOUND VAC >50 CM",8001230,"CDM ",420,RC,97606,HCPCS,OUTPATIENT,,,588.5,470.8,,45.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",331.25,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",58.81,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",411.95,70,,329.56,,,0,"percent of total billed charges ","70% of total billed charges ",529.65,90,,423.72,,,0,"percent of total billed charges ","90% of total billed charges ",547.31,93,,437.85,,,0,"percent of total billed charges ","93% of total billed charges ",45.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",500.23,85,,400.18,,,0,"percent of total billed charges ","85% of total billed charges ",529.65,90,,423.72,,,0,"percent of total billed charges ","90% of total billed charges ",529.65,90,,423.72,,,0,"percent of total billed charges ","90% of total billed charges ",57.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",512,87,,409.60,,,0,"percent of total billed charges ","87% of total billed charges ",57.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",411.95,70,,329.56,,,0,"percent of total billed charges ","70% of total billed charges ",45.36,547.31,
"DRSG CHANGE NON-SELECTIVE",8001240,"CDM ",420,RC,97602,HCPCS,OUTPATIENT,,,613,490.4,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.2,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,39.36,39.36,39.36,"1 through 10","other ","not separately reimbursment ",429.1,70,,343.28,,,0,"percent of total billed charges ","70% of total billed charges ",551.7,90,,441.36,,,0,"percent of total billed charges ","90% of total billed charges ",570.09,93,,456.07,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",521.05,85,,416.84,,,0,"percent of total billed charges ","85% of total billed charges ",551.7,90,,441.36,,,0,"percent of total billed charges ","90% of total billed charges ",551.7,90,,441.36,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",533.31,87,,426.65,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",429.1,70,,343.28,,,0,"percent of total billed charges ","70% of total billed charges ",184.51,570.09,
"MULTI LAYER COMPRESSION",8001250,"CDM ",420,RC,29581,HCPCS,OUTPATIENT,,,625.5,500.4,,38.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",58.81,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",437.85,70,,350.28,,,0,"percent of total billed charges ","70% of total billed charges ",562.95,90,,450.36,,,0,"percent of total billed charges ","90% of total billed charges ",581.72,93,,465.38,,,0,"percent of total billed charges ","93% of total billed charges ",38.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",48.5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",531.68,85,,425.34,,,0,"percent of total billed charges ","85% of total billed charges ",469.13,90,,375.30,,,0,"percent of total billed charges ","90% of total billed charges ",562.95,90,,450.36,,,0,"percent of total billed charges ","90% of total billed charges ",48.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",544.19,87,,435.35,,,0,"percent of total billed charges ","87% of total billed charges ",48.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",437.85,70,,350.28,,,0,"percent of total billed charges ","70% of total billed charges ",38.17,581.72,
"STRAPPING; UNA BOOT",8001260,"CDM ",420,RC,29580,HCPCS,OUTPATIENT,,,625.5,500.4,,57.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",55.7,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",437.85,70,,350.28,,,0,"percent of total billed charges ","70% of total billed charges ",562.95,90,,450.36,,,0,"percent of total billed charges ","90% of total billed charges ",581.72,93,,465.38,,,0,"percent of total billed charges ","93% of total billed charges ",57.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",531.68,85,,425.34,,,0,"percent of total billed charges ","85% of total billed charges ",469.13,90,,375.30,,,0,"percent of total billed charges ","90% of total billed charges ",562.95,90,,450.36,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",544.19,87,,435.35,,,0,"percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",437.85,70,,350.28,,,0,"percent of total billed charges ","70% of total billed charges ",55.7,581.72,
"SENSORY INTEGRATION EA 15 MIN",8001290,"CDM ",420,RC,97533,HCPCS,OUTPATIENT,,,74.5,59.6,,,,,,,,0,"other ","not separately reimbursment ",53.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",134.71,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",69.29,93,,55.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",5.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",63.33,85,,50.66,,,0,"percent of total billed charges ","85% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",5.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.82,87,,51.86,,,0,"percent of total billed charges ","87% of total billed charges ",5.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",5.82,134.71,
"PT THERAPEUTIC PROC GROUP",8001300,"CDM ",420,RC,97150,HCPCS,OUTPATIENT,,,52,41.6,,17.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.51,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",37.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",36.4,70,,29.12,,,0,"percent of total billed charges ","70% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",48.36,93,,38.69,,,0,"percent of total billed charges ","93% of total billed charges ",17.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",44.2,85,,35.36,,,0,"percent of total billed charges ","85% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.24,87,,36.19,,,0,"percent of total billed charges ","87% of total billed charges ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",36.4,70,,29.12,,,0,"percent of total billed charges ","70% of total billed charges ",17.45,48.36,
"PHYS THERAPY EVAL LOW COMP",8001310,"CDM ",424,RC,97161,HCPCS,OUTPATIENT,,,169,135.2,,71.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",138.69,100,,166.04,166.04,166.04,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",213,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",157.17,93,,125.74,,,0,"percent of total billed charges ","93% of total billed charges ",71.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.37,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.65,85,,114.92,,,0,"percent of total billed charges ","85% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",65.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.03,87,,117.23,67.63,134.82,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",65.71,213,
"PHYS THERAPY EVAL MOD COMP",8001320,"CDM ",424,RC,97162,HCPCS,OUTPATIENT,,,213,170.4,,71.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",120.6,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",213,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",149.1,70,,119.28,,,0,"percent of total billed charges ","70% of total billed charges ",191.7,90,,153.36,,,0,"percent of total billed charges ","90% of total billed charges ",198.09,93,,158.47,,,0,"percent of total billed charges ","93% of total billed charges ",71.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.37,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",181.05,85,,144.84,,,0,"percent of total billed charges ","85% of total billed charges ",191.7,90,,153.36,,,0,"percent of total billed charges ","90% of total billed charges ",191.7,90,,153.36,,,0,"percent of total billed charges ","90% of total billed charges ",65.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",185.31,87,,66.65,66.65,66.65,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",149.1,70,,119.28,,,0,"percent of total billed charges ","70% of total billed charges ",65.71,213,
"PHYS THERAPY EVAL HIGH COMP",8001330,"CDM ",424,RC,97163,HCPCS,OUTPATIENT,,,266.5,213.2,,57.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",120.6,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",213,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",186.55,70,,149.24,,,0,"percent of total billed charges ","70% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",247.85,93,,198.28,,,0,"percent of total billed charges ","93% of total billed charges ",57.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.37,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",226.53,85,,181.22,,,0,"percent of total billed charges ","85% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",65.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",231.86,87,,51.95,51.95,51.95,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",186.55,70,,149.24,,,0,"percent of total billed charges ","70% of total billed charges ",57.45,247.85,
"CANALITH REPOSITIONING",8001340,"CDM ",420,RC,95992,HCPCS,OUTPATIENT,,,147,117.6,,,,,,,,0,"other ","not separately reimbursment ",40.14,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.84,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",102.9,70,,82.32,,,0,"percent of total billed charges ","70% of total billed charges ",132.3,90,,105.84,,,0,"percent of total billed charges ","90% of total billed charges ",136.71,93,,109.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",124.95,85,,99.96,,,0,"percent of total billed charges ","85% of total billed charges ",132.3,90,,105.84,,,0,"percent of total billed charges ","90% of total billed charges ",132.3,90,,105.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",127.89,87,,102.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.9,70,,82.32,,,0,"percent of total billed charges ","70% of total billed charges ",40.14,136.71,
"DRY NEEDLING 1-2 MUSCLES",8001360,"CDM ",420,RC,20560,HCPCS,OUTPATIENT,,,70.5,56.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.97,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",65.57,93,,52.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",59.93,85,,47.94,,,0,"percent of total billed charges ","85% of total billed charges ",52.88,90,,42.30,,,0,"percent of total billed charges ","90% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",61.34,87,,49.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",26.59,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",26.59,65.57,
"ADL TRAINING 15MIN",8001370,"CDM ",420,RC,97535,HCPCS,OUTPATIENT,,,71.5,57.2,,19.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.17,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",69.52,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",66.5,93,,53.20,,,0,"percent of total billed charges ","93% of total billed charges ",19.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",60.78,85,,48.62,,,0,"percent of total billed charges ","85% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.21,87,,49.77,,,0,"percent of total billed charges ","87% of total billed charges ",17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",17.8,69.52,
"US PHYS THERAPY 15 MIN",8100036,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,65,52,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"US PHYS THERAPY 30 MIN",8100037,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,129,103.2,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"US PHYS THERAPY 45 MIN",8100038,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,193.5,154.8,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"US PHYS THERAPY 1 HOUR",8100039,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,258,206.4,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"US PHYS THERAPY 75 MIN",8100040,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,322.5,258,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"US PHYS THERAPY 90 MIN",8100041,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,386.5,309.2,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"PELVIC/CERV TRACTION 1 OR MORE",8100044,"CDM ",960,RC,97012,HCPCS,OUTPATIENT,,,62.5,50,,11.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",25,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",11.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,47.24,47.24,47.24,"1 through 10",other,"not separately reimbursment ",11.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,25,
"GAIT TRAINING 15 MIN",8100168,"CDM ",960,RC,97116,HCPCS,OUTPATIENT,,,59.5,47.6,,19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",39,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,39,
"GAIT TRAINING 30 MIN",8100170,"CDM ",960,RC,97116,HCPCS,OUTPATIENT,,,119,95.2,,19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",39,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,39,
"GAIT TRAINING 45 MIN",8100172,"CDM ",960,RC,97116,HCPCS,OUTPATIENT,,,178.5,142.8,,19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",39,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,39,
"GAIT TRAINING 1 HOUR",8100173,"CDM ",960,RC,97116,HCPCS,OUTPATIENT,,,237.5,190,,19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",39,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,39,
"GAIT TRAINING 75 MIN",8100174,"CDM ",960,RC,97116,HCPCS,OUTPATIENT,,,297.5,238,,19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",39,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,39,
"GAIT TRAINING 75 MIN",8100174,"CDM ",960,RC,97116,HCPCS,OUTPATIENT,,,297,237.6,,19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",39,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,39,
"GAIT TRAINING 90 MIN",8100175,"CDM ",960,RC,97116,HCPCS,OUTPATIENT,,,356,284.8,,19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",39,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,39,
"PHYS PERF TEST 15 MIN FCE",8100176,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,85.5,68.4,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 30 MIN",8100177,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,171,136.8,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 45 MIN",8100178,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,256.5,205.2,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 1 HOUR",8100179,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,341.5,273.2,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 75 MIN",8100180,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,426.5,341.2,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 90 MIN",8100181,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,512.5,410,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 1 HR 45 MIN",8100182,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,597.5,478,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 2 HRS",8100183,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,682.5,546,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 2 HRS 15 MIN",8100184,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,768.5,614.8,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 2 HRS 30 MIN",8100185,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,853.5,682.8,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 2 HRS 45 MIN",8100186,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,938.5,750.8,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 3 HOURS",8100187,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,1024,819.2,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 3 HRS 15 MIN",8100188,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,1110,888,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 3 HRS 30 MIN",8100189,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,1195,956,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 3 HRS 45 MIN",8100190,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,1280.5,1024.4,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 4 HOURS",8100191,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,1366,1092.8,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 4 HRS 15 MIN",8100192,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,1451,1160.8,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"ELECT STIM UNATTENDED",8100291,"CDM ",960,RC,97014,HCPCS,OUTPATIENT,,,53.5,42.8,,12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",22,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,22,
"ELECT STIM UNATTEND 30 MIN",8100293,"CDM ",960,RC,97014,HCPCS,OUTPATIENT,,,107,85.6,,12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",22,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,22,
"ELECT STIM UNATTEND 45 MIN",8100295,"CDM ",960,RC,97014,HCPCS,OUTPATIENT,,,159.5,127.6,,12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",22,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,22,
"ELECT STIM UNATTEND 1 HOUR",8100297,"CDM ",960,RC,97014,HCPCS,OUTPATIENT,,,213,170.4,,12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",22,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,22,
"ELECT STIM UNATTEND 75 MIN",8100299,"CDM ",960,RC,97014,HCPCS,OUTPATIENT,,,266,212.8,,12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",22,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,22,
"ELECT STIM UNATTEND 90 MIN",8100301,"CDM ",960,RC,97014,HCPCS,OUTPATIENT,,,319,255.2,,12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",22,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,22,
"THERAP EXER STRENGTH 15 MIN",8100309,"CDM ",960,RC,97110,HCPCS,OUTPATIENT,,,119,95.2,,22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,272.47,272.47,272.47,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,89.99,65.45,287.97,"1 through 10",other,"not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,44,
"INITIAL THER W/MATERIAL 15MIN",8100310,"CDM ",960,RC,97110,HCPCS,OUTPATIENT,,,119,95.2,,22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,272.47,272.47,272.47,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,89.99,65.45,287.97,"1 through 10",other,"not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,44,
"THERAP EXER STRENGTH 30 MIN",8100311,"CDM ",960,RC,97110,HCPCS,OUTPATIENT,,,237.5,190,,22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,272.47,272.47,272.47,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,89.99,65.45,287.97,"1 through 10",other,"not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,44,
"THERAP EXER STRENGTH 45 MIN",8100313,"CDM ",960,RC,97110,HCPCS,OUTPATIENT,,,356,284.8,,22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,272.47,272.47,272.47,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,89.99,65.45,287.97,"1 through 10",other,"not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,44,
"THERAP EXER STRENGTH 1 HOUR",8100315,"CDM ",960,RC,97110,HCPCS,OUTPATIENT,,,475,380,,22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,272.47,272.47,272.47,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,89.99,65.45,287.97,"1 through 10",other,"not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,44,
"THERAP EXER STRENGTH 75 MIN",8100317,"CDM ",960,RC,97110,HCPCS,OUTPATIENT,,,594,475.2,,22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,272.47,272.47,272.47,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,89.99,65.45,287.97,"1 through 10",other,"not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,44,
"THERAP EXER STRENGTH 90 MIN",8100319,"CDM ",960,RC,97110,HCPCS,OUTPATIENT,,,712,569.6,,22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,272.47,272.47,272.47,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,89.99,65.45,287.97,"1 through 10",other,"not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,44,
"IONTOPHORESIS 15 MIN",8100564,"CDM ",960,RC,97033,HCPCS,OUTPATIENT,,,67,53.6,,15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,36.73,36.73,36.73,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.87,41,
"IONTOPHORESIS 30 MIN",8100566,"CDM ",960,RC,97033,HCPCS,OUTPATIENT,,,133.5,106.8,,15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,36.73,36.73,36.73,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.87,41,
"IONTOPHORESIS 45 MIN",8100568,"CDM ",960,RC,97033,HCPCS,OUTPATIENT,,,200.5,160.4,,15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,36.73,36.73,36.73,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.87,41,
"IONTOPHORESIS 1 HOUR",8100570,"CDM ",960,RC,97033,HCPCS,OUTPATIENT,,,267,213.6,,15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,36.73,36.73,36.73,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.87,41,
"IONTOPHORESIS 75 MIN",8100572,"CDM ",960,RC,97033,HCPCS,OUTPATIENT,,,334,267.2,,15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,36.73,36.73,36.73,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.87,41,
"IONTOPHORESIS 90 MIN",8100574,"CDM ",960,RC,97033,HCPCS,OUTPATIENT,,,400,320,,15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,36.73,36.73,36.73,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.87,41,
"PT RE-EVALUATION",8100713,"CDM ",960,RC,97164,HCPCS,OUTPATIENT,,,108,86.4,,48.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",81,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",48.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",48.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.35,81,
"WORK HARDEN/COND 1ST 2HR",8100754,"CDM ",960,RC,97545,HCPCS,OUTPATIENT,,,209,167.2,,30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",141,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3,141,
"WORK HARDEN/COND ADDL 1 HR",8100762,"CDM ",960,RC,97546,HCPCS,OUTPATIENT,,,105.5,84.4,,15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",71,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,71,
"WORK HARDEN/COND ADDL 2 HRS",8100764,"CDM ",960,RC,97546,HCPCS,OUTPATIENT,,,210.5,168.4,,15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",71,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,71,
"WORK HARDEN/COND ADDL 3 HRS",8100766,"CDM ",960,RC,97546,HCPCS,OUTPATIENT,,,315.5,252.4,,15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",71,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,71,
"WORK HARDEN/COND ADDL 4 HRS",8100768,"CDM ",960,RC,97546,HCPCS,OUTPATIENT,,,421,336.8,,15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",71,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,71,
"WORK HARDEN/COND ADDL 5 HRS",8100770,"CDM ",960,RC,97546,HCPCS,OUTPATIENT,,,526,420.8,,15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",71,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,71,
"WORK HARDEN/COND ADDL 6 HRS",8100772,"CDM ",960,RC,97546,HCPCS,OUTPATIENT,,,631,504.8,,15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",71,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,71,
"PHONOPHORESIS 15 MIN",8100796,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,65,52,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"PHONOPHORESIS 30 MIN",8100798,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,129,103.2,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"PHONOPHORESIS 45 MIN",8100800,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,193.5,154.8,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"PHONOPHORESIS 1 HOUR",8100802,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,258,206.4,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"PHONOPHORESIS 75 MIN",8100804,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,322.5,258,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"PHONOPHORESIS 90 MIN",8100806,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,386.5,309.2,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"MASSAGE 15 MIN",8100812,"CDM ",960,RC,97124,HCPCS,OUTPATIENT,,,73.5,58.8,,17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,50.46,50.46,50.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",35,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,35,
"MASSAGE 30 MIN",8100814,"CDM ",960,RC,97124,HCPCS,OUTPATIENT,,,147,117.6,,17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,50.46,50.46,50.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",35,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,35,
"MASSAGE 45 MIN",8100816,"CDM ",960,RC,97124,HCPCS,OUTPATIENT,,,220.5,176.4,,17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,50.46,50.46,50.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",35,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,35,
"MASSAGE 1 HOUR",8100818,"CDM ",960,RC,97124,HCPCS,OUTPATIENT,,,294.5,235.6,,17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,50.46,50.46,50.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",35,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,35,
"MASSAGE 45 MIN",8100820,"CDM ",960,RC,97124,HCPCS,OUTPATIENT,,,367.5,294,,17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,50.46,50.46,50.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",35,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,35,
"MASSAGE 45 MIN",8100820,"CDM ",960,RC,97124,HCPCS,OUTPATIENT,,,367.5,294,,17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,50.46,50.46,50.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",35,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,35,
"MASSAGE 90 MIN",8100822,"CDM ",960,RC,97124,HCPCS,OUTPATIENT,,,440.5,352.4,,17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,50.46,50.46,50.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",35,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,35,
"AQUATIC THERAPY 15 MIN",8100853,"CDM ",960,RC,97113,HCPCS,OUTPATIENT,,,68,54.4,,24.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",55,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",24.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.86,55,
"NEURO MUSC RE-EDUC 15 MIN",8100861,"CDM ",960,RC,97112,HCPCS,OUTPATIENT,,,76.5,61.2,,22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.46,60.46,60.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,65.17,59.38,70.96,"1 through 10",other,"not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.96,46,
"NEURO MUSC RE-EDUC 30 MIN",8100863,"CDM ",960,RC,97112,HCPCS,OUTPATIENT,,,153,122.4,,22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.46,60.46,60.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,65.17,59.38,70.96,"1 through 10",other,"not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.96,46,
"NEURO MUSC RE-EDUC 45 MIN",8100865,"CDM ",960,RC,97112,HCPCS,OUTPATIENT,,,229,183.2,,22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.46,60.46,60.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,65.17,59.38,70.96,"1 through 10",other,"not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.96,46,
"NEURO MUSC RE-EDUC 1 HOUR",8100867,"CDM ",960,RC,97112,HCPCS,OUTPATIENT,,,305.5,244.4,,22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.46,60.46,60.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,65.17,59.38,70.96,"1 through 10",other,"not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.96,46,
"NEURO MUSC RE-EDUC 75 MIN",8100869,"CDM ",960,RC,97112,HCPCS,OUTPATIENT,,,381.5,305.2,,22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.46,60.46,60.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,65.17,59.38,70.96,"1 through 10",other,"not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.96,46,
"NEURO MUSC RE-EDUC 90 MIN",8100871,"CDM ",960,RC,97112,HCPCS,OUTPATIENT,,,458,366.4,,22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.46,60.46,60.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,65.17,59.38,70.96,"1 through 10",other,"not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.96,46,
BIOFEEDBACK,8100879,"CDM ",960,RC,90901,HCPCS,OUTPATIENT,,,98,78.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",79,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79,79,
"CONTRAST BATH 15 MIN",8100895,"CDM ",960,RC,97034,HCPCS,OUTPATIENT,,,49.5,39.6,,10.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",23,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",10.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",10.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.98,23,
"ELECT STIM MANUAL 15 MIN",8100937,"CDM ",960,RC,97032,HCPCS,OUTPATIENT,,,49.5,39.6,,12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,41.07,41.07,41.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",25,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.52,25,
"ELECT STIM MANUAL 30 MIN",8100938,"CDM ",960,RC,97032,HCPCS,OUTPATIENT,,,98.5,78.8,,12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,41.07,41.07,41.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",25,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.52,25,
"ELECT STIM MANUAL 45 MIN",8100939,"CDM ",960,RC,97032,HCPCS,OUTPATIENT,,,147.5,118,,12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,41.07,41.07,41.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",25,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.52,25,
"ELECT STIM MANUAL 1 HOUR",8100940,"CDM ",960,RC,97032,HCPCS,OUTPATIENT,,,196.5,157.2,,12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,41.07,41.07,41.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",25,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.52,25,
"ELECT STIM MANUAL 75 MIN",8100941,"CDM ",960,RC,97032,HCPCS,OUTPATIENT,,,246,196.8,,12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,41.07,41.07,41.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",25,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.52,25,
"ELECT STIM MANUAL 90 MIN",8100942,"CDM ",960,RC,97032,HCPCS,OUTPATIENT,,,295.5,236.4,,12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,41.07,41.07,41.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",25,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.52,25,
"MANUAL THERAPY TECH 15MIN",8100945,"CDM ",960,RC,97140,HCPCS,OUTPATIENT,,,89,71.2,,20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,41,
"MANUAL THERAPY TECH 30 MIN",8100947,"CDM ",960,RC,97140,HCPCS,OUTPATIENT,,,178,142.4,,20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,41,
"MANUAL THERAPY TECH 45MIN",8100949,"CDM ",960,RC,97140,HCPCS,OUTPATIENT,,,266.5,213.2,,20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,41,
"MANUAL THERAPY TECH 1 HOUR",8100951,"CDM ",960,RC,97140,HCPCS,OUTPATIENT,,,355,284,,20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,41,
"MANUAL THERAPY TECH 75 MIN",8100953,"CDM ",960,RC,97140,HCPCS,OUTPATIENT,,,444,355.2,,20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,41,
"MANUAL THERAPY TECH 90 MIN",8100955,"CDM ",960,RC,97140,HCPCS,OUTPATIENT,,,532.5,426,,20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,41,
"PARAFFIN BATH THERAPY",8101018,"CDM ",960,RC,97018,HCPCS,OUTPATIENT,,,49.5,39.6,,5.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",18,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",5.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",5.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5,18,
"PROSTHETIC TRAINING 15MIN",8101026,"CDM ",960,RC,97761,HCPCS,OUTPATIENT,,,64.5,51.6,,21.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",44,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",21.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",21.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.4,44,
"THERAPUTIC ACTIVITY 15MIN",8101067,"CDM ",960,RC,97530,HCPCS,OUTPATIENT,,,80,64,,22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,46,
"THERAPUTIC ACTIVITY 30MIN",8101069,"CDM ",960,RC,97530,HCPCS,OUTPATIENT,,,159.5,127.6,,22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,46,
"THERAPUTIC ACTIVITY 45MIN",8101071,"CDM ",960,RC,97530,HCPCS,OUTPATIENT,,,239.5,191.6,,22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,46,
"THERAPUTIC ACTIVITY 1 HOUR",8101073,"CDM ",960,RC,97530,HCPCS,OUTPATIENT,,,307,245.6,,22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,46,
"THERAPUTIC ACTIVITY 1 HOUR",8101073,"CDM ",960,RC,97530,HCPCS,OUTPATIENT,,,319,255.2,,22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,46,
"THERAPUTIC ACTIVITY 75MIN",8101075,"CDM ",960,RC,97530,HCPCS,OUTPATIENT,,,398.5,318.8,,22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,46,
"THERAPUTIC ACTIVITY 90 MIN",8101079,"CDM ",960,RC,97530,HCPCS,OUTPATIENT,,,444.5,355.6,,22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,46,
"WC MGT ASSESS FIT TRAIN 15MIN",8101083,"CDM ",960,RC,97542,HCPCS,OUTPATIENT,,,64.5,51.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",44,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44,44,
"DEBRIDEMENT 20CM OR LESS",8101091,"CDM ",960,RC,97597,HCPCS,OUTPATIENT,,,346.5,277.2,,37.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,266.92,266.92,266.92,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",100,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",37.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.63,100,
"ROM HAND",8101109,"CDM ",960,RC,95852,HCPCS,OUTPATIENT,,,71,56.8,,10.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",23,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",10.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",10.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.88,23,
"ROM HAND",8101109,"CDM ",960,RC,95852,HCPCS,OUTPATIENT,,,71,56.8,,10.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",23,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",10.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",10.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.88,23,
"ROM EXTREMITY/TRUNK",8101117,"CDM ",960,RC,95851,HCPCS,OUTPATIENT,,,70.5,56.4,,15.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.21,30,
"DEBRIDE EA ADD 20CM",8101170,"CDM ",960,RC,97598,HCPCS,OUTPATIENT,,,320.5,256.4,,48.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",110,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",48.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",48.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.15,110,
"DEBRIDE EA ADD 20CM",8101170,"CDM ",960,RC,97598,HCPCS,OUTPATIENT,,,320.5,256.4,,48.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",110,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",48.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",48.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.15,110,
"ELECT STIM HOT/COLD UNATTENDED",8101180,"CDM ",960,RC,97014,HCPCS,OUTPATIENT,,,53.5,42.8,,12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",22,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,22,
"ELECT STIM HOT/COLD UNATTENDED",8101180,"CDM ",960,RC,97014,HCPCS,OUTPATIENT,,,53.5,42.8,,12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",22,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,22,
"MANUAL THERAPY TECH HOT 15MIN",8101190,"CDM ",960,RC,97140,HCPCS,OUTPATIENT,,,89,71.2,,20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,41,
"MANUAL THERAPY TECH HOT 15MIN",8101190,"CDM ",960,RC,97140,HCPCS,OUTPATIENT,,,89,71.2,,20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,41,
"US HOT/COLD 15MIN",8101200,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,65,52,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"US HOT/COLD 15MIN",8101200,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,65,52,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"WOUND VAC </= 50CM",8101220,"CDM ",960,RC,97607,HCPCS,OUTPATIENT,,,373,298.4,,25.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",25.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.88,25.88,
"WOUND VAC > 50CM",8101230,"CDM ",960,RC,97606,HCPCS,OUTPATIENT,,,346,276.8,,27.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",70,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",27.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",27.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.94,70,
"DRSG CHANGE NON SELECTIVE",8101240,"CDM ",960,RC,97602,HCPCS,OUTPATIENT,,,617.5,494,,17.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,39.36,39.36,39.36,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",52,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.44,52,
"MULTI LAYER COMPRESSION",8101250,"CDM ",960,RC,29581,HCPCS,OUTPATIENT,,,630.5,504.4,,16.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.61,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",121,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",16.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",16.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.42,121,
"MULTI LAYER COMPRESSION",8101250,"CDM ",960,RC,29581,HCPCS,OUTPATIENT,,,630.5,504.4,,16.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.61,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",121,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",16.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",16.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.42,121,
"SENSORY INTEGRATION 15MIN",8101290,"CDM ",960,RC,97533,HCPCS,OUTPATIENT,,,68,54.4,,19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.49,42,
"SENSORY INTEGRATION 30 MIN",8101292,"CDM ",960,RC,97533,HCPCS,OUTPATIENT,,,136,108.8,,19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.49,42,
"SENSORY INTEGRATION 45 MIN",8101294,"CDM ",960,RC,97533,HCPCS,OUTPATIENT,,,203.5,162.8,,19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.49,42,
"SENSORY INTEGRATION 1 HOUR",8101296,"CDM ",960,RC,97533,HCPCS,OUTPATIENT,,,271.5,217.2,,19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.49,42,
"SENSORY INTEGRATION 75 MIN",8101298,"CDM ",960,RC,97533,HCPCS,OUTPATIENT,,,339.5,271.6,,19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.49,42,
"SENSORY INTEGRATION 90 MIN",8101299,"CDM ",960,RC,97533,HCPCS,OUTPATIENT,,,407.5,326,,19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.49,42,
"PT THERAPUTIC PROC GROUP",8101300,"CDM ",960,RC,97150,HCPCS,OUTPATIENT,,,47.5,38,,13.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",27,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",13.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",13.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.35,27,
"PHS THERAPY EVAL LOW COMP",8101310,"CDM ",960,RC,97161,HCPCS,OUTPATIENT,,,155,124,,70.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,166.04,166.04,166.04,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",119,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",70.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,117.23,67.63,134.82,"1 through 10",other,"not separately reimbursment ",70.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.58,119,
"PHYS THERAPY EVAL MOD COMP",8101320,"CDM ",960,RC,97162,HCPCS,OUTPATIENT,,,194.5,155.6,,70.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",119,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",70.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,66.65,66.65,66.65,"1 through 10",other,"not separately reimbursment ",70.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.58,119,
"PHYS THERAPY EVAL HIGH COMP",8101330,"CDM ",960,RC,97163,HCPCS,OUTPATIENT,,,243.5,194.8,,70.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",119,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",70.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,51.95,51.95,51.95,"1 through 10",other,"not separately reimbursment ",70.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.58,119,
"CANALITH REPOSITIONING",8101340,"CDM ",960,RC,95992,HCPCS,OUTPATIENT,,,152.5,122,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",60,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60,60,
"ADL TRAINING 15MIN",8101370,"CDM ",960,RC,97535,HCPCS,OUTPATIENT,,,65.5,52.4,,23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.51,47,
"ADL TRAINING 30MIN",8101371,"CDM ",960,RC,97535,HCPCS,OUTPATIENT,,,130.5,104.4,,23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.51,47,
"ADL TRAINING 45MIN",8101372,"CDM ",960,RC,97535,HCPCS,OUTPATIENT,,,195,156,,23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.51,47,
"ADL TRAINING 1 HOUR",8101373,"CDM ",960,RC,97535,HCPCS,OUTPATIENT,,,260,208,,23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.51,47,
"ADL TRAINING 75MIN",8101374,"CDM ",960,RC,97535,HCPCS,OUTPATIENT,,,325,260,,23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.51,47,
"ADL TRAINING 90MIN",8101375,"CDM ",960,RC,97535,HCPCS,OUTPATIENT,,,390.5,312.4,,23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.51,47,
"TREATMENT-SPEECH LANG INDIVIDU",8200024,"CDM ",441,RC,92507,HCPCS,OUTPATIENT,,,147.5,118,,76.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",77.77,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",163.61,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",103.25,70,,82.60,,,0,"percent of total billed charges ","70% of total billed charges ",132.75,90,,106.20,,,0,"percent of total billed charges ","90% of total billed charges ",137.18,93,,109.74,,,0,"percent of total billed charges ","93% of total billed charges ",76.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.86,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",125.38,85,,100.30,,,0,"percent of total billed charges ","85% of total billed charges ",132.75,90,,106.20,,,0,"percent of total billed charges ","90% of total billed charges ",132.75,90,,106.20,,,0,"percent of total billed charges ","90% of total billed charges ",70.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",128.33,87,,102.66,,,0,"percent of total billed charges ","87% of total billed charges ",70.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",103.25,70,,82.60,,,0,"percent of total billed charges ","70% of total billed charges ",70.16,163.61,
"EVAL AAC DEVICE, 1ST HOUR",8200040,"CDM ",444,RC,92607,HCPCS,OUTPATIENT,,,236,188.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.23,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",165.2,70,,132.16,,,0,"percent of total billed charges ","70% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",219.48,93,,175.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",200.6,85,,160.48,,,0,"percent of total billed charges ","85% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",205.32,87,,164.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",165.2,70,,132.16,,,0,"percent of total billed charges ","70% of total billed charges ",165.2,263.23,
"ASSESS BEDSIDE SWALLOW EVAL",8200065,"CDM ",444,RC,92610,HCPCS,OUTPATIENT,,,202.5,162,,88.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",128.71,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",149.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",141.75,70,,113.40,,,0,"percent of total billed charges ","70% of total billed charges ",182.25,90,,145.80,,,0,"percent of total billed charges ","90% of total billed charges ",188.33,93,,150.66,,,0,"percent of total billed charges ","93% of total billed charges ",88.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.37,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",172.13,85,,137.70,,,0,"percent of total billed charges ","85% of total billed charges ",182.25,90,,145.80,,,0,"percent of total billed charges ","90% of total billed charges ",182.25,90,,145.80,,,0,"percent of total billed charges ","90% of total billed charges ",111.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",176.18,87,,140.94,,,0,"percent of total billed charges ","87% of total billed charges ",111.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",141.75,70,,113.40,,,0,"percent of total billed charges ","70% of total billed charges ",88.44,188.33,
"ASSESS SPEECH LANG/AUDIT PROC",8200081,"CDM ",444,RC,92523,HCPCS,OUTPATIENT,,,397,317.6,,,,,,,,0,"other ","not separately reimbursment ",116.15,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",485.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",277.9,70,,222.32,,,0,"percent of total billed charges ","70% of total billed charges ",357.3,90,,285.84,,,0,"percent of total billed charges ","90% of total billed charges ",369.21,93,,295.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",169.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",337.45,85,,269.96,,,0,"percent of total billed charges ","85% of total billed charges ",357.3,90,,285.84,,,0,"percent of total billed charges ","90% of total billed charges ",357.3,90,,285.84,,,0,"percent of total billed charges ","90% of total billed charges ",167.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",345.39,87,,276.31,,,0,"percent of total billed charges ","87% of total billed charges ",167.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",277.9,70,,222.32,,,0,"percent of total billed charges ","70% of total billed charges ",116.15,485.25,
TREATMENT-SWALLOW,8200198,"CDM ",441,RC,92526,HCPCS,OUTPATIENT,,,172.5,138,,,,,,,,0,"other ","not separately reimbursment ",65.44,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",181.17,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",120.75,70,,96.60,,,0,"percent of total billed charges ","70% of total billed charges ",155.25,90,,124.20,,,0,"percent of total billed charges ","90% of total billed charges ",160.43,93,,128.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",146.63,85,,117.30,,,0,"percent of total billed charges ","85% of total billed charges ",155.25,90,,124.20,,,0,"percent of total billed charges ","90% of total billed charges ",155.25,90,,124.20,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",150.08,87,,120.06,,,0,"percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",120.75,70,,96.60,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,181.17,
"ASSESS SWALLOW-MBS",8200255,"CDM ",444,RC,92611,HCPCS,OUTPATIENT,,,232.5,186,,88.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",178.22,100,,6.06,6.06,6.06,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",193.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",162.75,70,,130.20,,,0,"percent of total billed charges ","70% of total billed charges ",209.25,90,,167.40,,,0,"percent of total billed charges ","90% of total billed charges ",216.23,93,,172.98,,,0,"percent of total billed charges ","93% of total billed charges ",88.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.37,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",197.63,85,,158.10,,,0,"percent of total billed charges ","85% of total billed charges ",209.25,90,,167.40,,,0,"percent of total billed charges ","90% of total billed charges ",209.25,90,,167.40,,,0,"percent of total billed charges ","90% of total billed charges ",111.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",202.28,87,,161.82,,,0,"percent of total billed charges ","87% of total billed charges ",111.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",162.75,70,,130.20,,,0,"percent of total billed charges ","70% of total billed charges ",88.44,216.23,
"ASSESSMENT OF APHASIA PER HR",8200263,"CDM ",444,RC,96105,HCPCS,OUTPATIENT,,,209,167.2,,32.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",208.6,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",146.3,70,,117.04,,,0,"percent of total billed charges ","70% of total billed charges ",188.1,90,,150.48,,,0,"percent of total billed charges ","90% of total billed charges ",194.37,93,,155.50,,,0,"percent of total billed charges ","93% of total billed charges ",32.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",177.65,85,,142.12,,,0,"percent of total billed charges ","85% of total billed charges ",188.1,90,,150.48,,,0,"percent of total billed charges ","90% of total billed charges ",188.1,90,,150.48,,,0,"percent of total billed charges ","90% of total billed charges ",41.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",181.83,87,,145.46,,,0,"percent of total billed charges ","87% of total billed charges ",41.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",146.3,70,,117.04,,,0,"percent of total billed charges ","70% of total billed charges ",32.76,208.6,
"TREATMENT AAC DEVICES",8200271,"CDM ",441,RC,92609,HCPCS,OUTPATIENT,,,179.5,143.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.33,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",125.65,70,,100.52,,,0,"percent of total billed charges ","70% of total billed charges ",161.55,90,,129.24,,,0,"percent of total billed charges ","90% of total billed charges ",166.94,93,,133.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",152.58,85,,122.06,,,0,"percent of total billed charges ","85% of total billed charges ",161.55,90,,129.24,,,0,"percent of total billed charges ","90% of total billed charges ",161.55,90,,129.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",156.17,87,,124.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.65,70,,100.52,,,0,"percent of total billed charges ","70% of total billed charges ",125.65,220.33,
"EVAL AAC DEVICES ADD'L 30MIN",8200297,"CDM ",444,RC,92608,HCPCS,OUTPATIENT,,,117,93.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.75,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",81.9,70,,65.52,,,0,"percent of total billed charges ","70% of total billed charges ",105.3,90,,84.24,,,0,"percent of total billed charges ","90% of total billed charges ",108.81,93,,87.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.45,85,,79.56,,,0,"percent of total billed charges ","85% of total billed charges ",105.3,90,,84.24,,,0,"percent of total billed charges ","90% of total billed charges ",105.3,90,,84.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.79,87,,81.43,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.9,70,,65.52,,,0,"percent of total billed charges ","70% of total billed charges ",81.9,108.81,
"TREATMENT NON SPEECH GEN DEVIC",8200305,"CDM ",441,RC,92606,HCPCS,OUTPATIENT,,,208,166.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.75,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",145.6,70,,116.48,,,0,"percent of total billed charges ","70% of total billed charges ",187.2,90,,149.76,,,0,"percent of total billed charges ","90% of total billed charges ",193.44,93,,154.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",176.8,85,,141.44,,,0,"percent of total billed charges ","85% of total billed charges ",187.2,90,,149.76,,,0,"percent of total billed charges ","90% of total billed charges ",187.2,90,,149.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",180.96,87,,144.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",145.6,70,,116.48,,,0,"percent of total billed charges ","70% of total billed charges ",145.6,193.44,
"EVAL SPEECH FLUENCY",8200310,"CDM ",444,RC,92521,HCPCS,OUTPATIENT,,,241,192.8,,,,,,,,0,"other ","not separately reimbursment ",116.15,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",283.58,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",168.7,70,,134.96,,,0,"percent of total billed charges ","70% of total billed charges ",216.9,90,,173.52,,,0,"percent of total billed charges ","90% of total billed charges ",224.13,93,,179.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",204.85,85,,163.88,,,0,"percent of total billed charges ","85% of total billed charges ",216.9,90,,173.52,,,0,"percent of total billed charges ","90% of total billed charges ",216.9,90,,173.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",209.67,87,,167.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",168.7,70,,134.96,,,0,"percent of total billed charges ","70% of total billed charges ",116.15,283.58,
"EVAL SPEECH SOUND PROD/LANG",8200320,"CDM ",444,RC,92522,HCPCS,OUTPATIENT,,,214,171.2,,,,,,,,0,"other ","not separately reimbursment ",116.15,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",237.8,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",149.8,70,,119.84,,,0,"percent of total billed charges ","70% of total billed charges ",192.6,90,,154.08,,,0,"percent of total billed charges ","90% of total billed charges ",199.02,93,,159.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",44.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",181.9,85,,145.52,,,0,"percent of total billed charges ","85% of total billed charges ",192.6,90,,154.08,,,0,"percent of total billed charges ","90% of total billed charges ",192.6,90,,154.08,,,0,"percent of total billed charges ","90% of total billed charges ",44.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",186.18,87,,148.94,,,0,"percent of total billed charges ","87% of total billed charges ",44.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",149.8,70,,119.84,,,0,"percent of total billed charges ","70% of total billed charges ",44.53,237.8,
"BEHAVIOR/QUANT ANALYSIS VOICE",8200330,"CDM ",441,RC,92524,HCPCS,OUTPATIENT,,,202.5,162,,,,,,,,0,"other ","not separately reimbursment ",116.15,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",234.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",141.75,70,,113.40,,,0,"percent of total billed charges ","70% of total billed charges ",182.25,90,,145.80,,,0,"percent of total billed charges ","90% of total billed charges ",188.33,93,,150.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.13,85,,137.70,,,0,"percent of total billed charges ","85% of total billed charges ",182.25,90,,145.80,,,0,"percent of total billed charges ","90% of total billed charges ",182.25,90,,145.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.18,87,,140.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.75,70,,113.40,,,0,"percent of total billed charges ","70% of total billed charges ",116.15,234.32,
"EVAL SPEECH SOUND PROD LANG CO",8200340,"CDM ",444,RC,92523,HCPCS,OUTPATIENT,,,397,317.6,,,,,,,,0,"other ","not separately reimbursment ",116.15,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",485.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",277.9,70,,222.32,,,0,"percent of total billed charges ","70% of total billed charges ",357.3,90,,285.84,,,0,"percent of total billed charges ","90% of total billed charges ",369.21,93,,295.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",169.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",337.45,85,,269.96,,,0,"percent of total billed charges ","85% of total billed charges ",357.3,90,,285.84,,,0,"percent of total billed charges ","90% of total billed charges ",357.3,90,,285.84,,,0,"percent of total billed charges ","90% of total billed charges ",167.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",345.39,87,,276.31,,,0,"percent of total billed charges ","87% of total billed charges ",167.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",277.9,70,,222.32,,,0,"percent of total billed charges ","70% of total billed charges ",116.15,485.25,
"ADD 30 MINS NONSPEECH",8200360,"CDM ",444,RC,92618,HCPCS,OUTPATIENT,,,74.5,59.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.51,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",69.29,93,,55.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",63.33,85,,50.66,,,0,"percent of total billed charges ","85% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",64.82,87,,51.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",52.15,69.29,
"COGNITIVE TEST",8200370,"CDM ",441,RC,96125,HCPCS,OUTPATIENT,,,233.5,186.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",163.45,70,,130.76,,,0,"percent of total billed charges ","70% of total billed charges ",210.15,90,,168.12,,,0,"percent of total billed charges ","90% of total billed charges ",217.16,93,,173.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",198.48,85,,158.78,,,0,"percent of total billed charges ","85% of total billed charges ",210.15,90,,168.12,,,0,"percent of total billed charges ","90% of total billed charges ",210.15,90,,168.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",203.15,87,,162.52,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",163.45,70,,130.76,,,0,"percent of total billed charges ","70% of total billed charges ",163.45,220.35,
"THERAP INVTJ 1ST 15MIN",8200380,"CDM ",441,RC,97129,HCPCS,OUTPATIENT,,,74.5,59.6,,,,,,,,0,"other ","not separately reimbursment ",50.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",49.13,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",69.29,93,,55.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",63.33,85,,50.66,,,0,"percent of total billed charges ","85% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",64.82,87,,51.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",49.13,69.29,
"THER IVNTJ EA ADD 15 MIN",8200390,"CDM ",441,RC,97130,HCPCS,OUTPATIENT,,,74.5,59.6,,,,,,,,0,"other ","not separately reimbursment ",50.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",46.9,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",69.29,93,,55.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",63.33,85,,50.66,,,0,"percent of total billed charges ","85% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",64.82,87,,51.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",46.9,69.29,
"EVAL NON SPEECH GEN DEVI 1 HR",8209991,"CDM ",444,RC,92605,HCPCS,OUTPATIENT,,,220,176,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",184.43,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",154,70,,123.20,,,0,"percent of total billed charges ","70% of total billed charges ",198,90,,158.40,,,0,"percent of total billed charges ","90% of total billed charges ",204.6,93,,163.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",187,85,,149.60,,,0,"percent of total billed charges ","85% of total billed charges ",198,90,,158.40,,,0,"percent of total billed charges ","90% of total billed charges ",198,90,,158.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",191.4,87,,153.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154,70,,123.20,,,0,"percent of total billed charges ","70% of total billed charges ",154,204.6,
"NEURO-MUSC RE-EDUC 15MIN",8400129,"CDM ",430,RC,97112,HCPCS,OUTPATIENT,,,83.5,66.8,,27.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",50.5,100,,60.46,60.46,60.46,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",72.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",77.66,93,,62.13,,,0,"percent of total billed charges ","93% of total billed charges ",27.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.98,85,,56.78,,,0,"percent of total billed charges ","85% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",24.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",72.65,87,,65.17,59.38,70.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",24.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",24.87,77.66,
"ORTHO FIT/TRAIN 15 MIN",8400137,"CDM ",430,RC,97760,HCPCS,OUTPATIENT,,,83.5,66.8,,,,,,,,0,"other ","not separately reimbursment ",39.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",102.34,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",77.66,93,,62.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.98,85,,56.78,,,0,"percent of total billed charges ","85% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",72.65,87,,58.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",39.64,102.34,
"PARAFIN BATH-OT",8400145,"CDM ",430,RC,97018,HCPCS,OUTPATIENT,,,53.5,42.8,,13.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.23,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",11.81,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",49.76,93,,39.81,,,0,"percent of total billed charges ","93% of total billed charges ",13.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.48,85,,36.38,,,0,"percent of total billed charges ","85% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",15.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.55,87,,37.24,,,0,"percent of total billed charges ","87% of total billed charges ",15.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.81,49.76,
"THERAPUTIC ACTIVITY/15MIN",8400244,"CDM ",430,RC,97530,HCPCS,OUTPATIENT,,,71.5,57.2,,28.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.91,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",78.43,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",66.5,93,,53.20,,,0,"percent of total billed charges ","93% of total billed charges ",28.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",60.78,85,,48.62,,,0,"percent of total billed charges ","85% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",26.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.21,87,,49.77,,,0,"percent of total billed charges ","87% of total billed charges ",26.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",26.02,78.43,
"ADL TRAINING 15MIN",8400483,"CDM ",430,RC,97535,HCPCS,OUTPATIENT,,,71.5,57.2,,19.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.17,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",69.52,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",66.5,93,,53.20,,,0,"percent of total billed charges ","93% of total billed charges ",19.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",60.78,85,,48.62,,,0,"percent of total billed charges ","85% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.21,87,,49.77,,,0,"percent of total billed charges ","87% of total billed charges ",17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",17.8,69.52,
"OT RE-EVALUATION",8400608,"CDM ",434,RC,97168,HCPCS,OUTPATIENT,,,118,94.4,,,,,,,,0,"other ","not separately reimbursment ",77.42,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",147.05,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",82.6,70,,66.08,,,0,"percent of total billed charges ","70% of total billed charges ",106.2,90,,84.96,,,0,"percent of total billed charges ","90% of total billed charges ",109.74,93,,87.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",33.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",100.3,85,,80.24,,,0,"percent of total billed charges ","85% of total billed charges ",106.2,90,,84.96,,,0,"percent of total billed charges ","90% of total billed charges ",106.2,90,,84.96,,,0,"percent of total billed charges ","90% of total billed charges ",33.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",102.66,87,,82.13,,,0,"percent of total billed charges ","87% of total billed charges ",33.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",82.6,70,,66.08,,,0,"percent of total billed charges ","70% of total billed charges ",33.43,147.05,
"WORK HARDEN/COND 1ST 2 HRS",8400754,"CDM ",430,RC,97545,HCPCS,OUTPATIENT,,,267.5,214,,34.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.16,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",248.78,93,,199.02,,,0,"percent of total billed charges ","93% of total billed charges ",34.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",227.38,85,,181.90,,,0,"percent of total billed charges ","85% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",232.73,87,,186.18,,,0,"percent of total billed charges ","87% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",16.16,248.78,
"ULTRASOUND OT 15 MIN",8400772,"CDM ",430,RC,97035,HCPCS,OUTPATIENT,,,71.5,57.2,,12.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",30.16,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",66.5,93,,53.20,,,0,"percent of total billed charges ","93% of total billed charges ",12.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",60.78,85,,48.62,,,0,"percent of total billed charges ","85% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",14.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.21,87,,49.77,,,0,"percent of total billed charges ","87% of total billed charges ",14.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",12.33,66.5,
"OT GROUP THERAPY",8400780,"CDM ",430,RC,97150,HCPCS,OUTPATIENT,,,52,41.6,,17.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.51,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",37.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",36.4,70,,29.12,,,0,"percent of total billed charges ","70% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",48.36,93,,38.69,,,0,"percent of total billed charges ","93% of total billed charges ",17.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",44.2,85,,35.36,,,0,"percent of total billed charges ","85% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.24,87,,36.19,,,0,"percent of total billed charges ","87% of total billed charges ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",36.4,70,,29.12,,,0,"percent of total billed charges ","70% of total billed charges ",17.45,48.36,
"THERAPY EXER STRENGTH 15 MIN",8400798,"CDM ",430,RC,97110,HCPCS,OUTPATIENT,,,129.5,103.6,,28.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.91,100,,272.47,272.47,272.47,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",62.59,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",90.65,70,,72.52,,,0,"percent of total billed charges ","70% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",120.44,93,,96.35,,,0,"percent of total billed charges ","93% of total billed charges ",28.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",110.08,85,,88.06,,,0,"percent of total billed charges ","85% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",25.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.67,87,,89.99,65.45,287.97,"1 through 10","percent of total billed charges ","87% of total billed charges ",25.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",90.65,70,,72.52,,,0,"percent of total billed charges ","70% of total billed charges ",25.65,120.44,
"SENSORY INTEG TECH 15 MIN",8400806,"CDM ",430,RC,97533,HCPCS,OUTPATIENT,,,74.5,59.6,,,,,,,,0,"other ","not separately reimbursment ",53.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",134.71,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",69.29,93,,55.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",5.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",63.33,85,,50.66,,,0,"percent of total billed charges ","85% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",5.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.82,87,,51.86,,,0,"percent of total billed charges ","87% of total billed charges ",5.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",5.82,134.71,
"MANUAL THERAPY 15 MIN",8400814,"CDM ",430,RC,97140,HCPCS,OUTPATIENT,,,97.5,78,,22.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",58.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",57.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",68.25,70,,54.60,,,0,"percent of total billed charges ","70% of total billed charges ",87.75,90,,70.20,,,0,"percent of total billed charges ","90% of total billed charges ",90.68,93,,72.54,,,0,"percent of total billed charges ","93% of total billed charges ",22.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",82.88,85,,66.30,,,0,"percent of total billed charges ","85% of total billed charges ",87.75,90,,70.20,,,0,"percent of total billed charges ","90% of total billed charges ",87.75,90,,70.20,,,0,"percent of total billed charges ","90% of total billed charges ",20.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.83,87,,67.86,,,0,"percent of total billed charges ","87% of total billed charges ",20.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.25,70,,54.60,,,0,"percent of total billed charges ","70% of total billed charges ",20.47,90.68,
WHIRLPOOL,8400822,"CDM ",430,RC,97022,HCPCS,OUTPATIENT,,,120,96,,14.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.33,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",36.1,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",84,70,,67.20,,,0,"percent of total billed charges ","70% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",111.6,93,,89.28,,,0,"percent of total billed charges ","93% of total billed charges ",14.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",102,85,,81.60,,,0,"percent of total billed charges ","85% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",104.4,87,,83.52,,,0,"percent of total billed charges ","87% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",84,70,,67.20,,,0,"percent of total billed charges ","70% of total billed charges ",14.41,111.6,
"WOUND DEBRIDEMENT < 20 CM",8400830,"CDM ",430,RC,97597,HCPCS,OUTPATIENT,,,344,275.2,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",278.76,100,,266.92,266.92,266.92,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",76.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",240.8,70,,192.64,,,0,"percent of total billed charges ","70% of total billed charges ",309.6,90,,247.68,,,0,"percent of total billed charges ","90% of total billed charges ",319.92,93,,255.94,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",292.4,85,,233.92,,,0,"percent of total billed charges ","85% of total billed charges ",309.6,90,,247.68,,,0,"percent of total billed charges ","90% of total billed charges ",309.6,90,,247.68,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",299.28,87,,239.42,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",240.8,70,,192.64,,,0,"percent of total billed charges ","70% of total billed charges ",76.25,319.92,
"ELECTRICAL STIM UNATTENDED",8400848,"CDM ",430,RC,97014,HCPCS,OUTPATIENT,,,58.5,46.8,,14.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",31.31,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",26.49,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",40.95,70,,32.76,,,0,"percent of total billed charges ","70% of total billed charges ",52.65,90,,42.12,,,0,"percent of total billed charges ","90% of total billed charges ",54.41,93,,43.53,,,0,"percent of total billed charges ","93% of total billed charges ",14.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.04,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",49.73,85,,39.78,,,0,"percent of total billed charges ","85% of total billed charges ",52.65,90,,42.12,,,0,"percent of total billed charges ","90% of total billed charges ",52.65,90,,42.12,,,0,"percent of total billed charges ","90% of total billed charges ",16.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",50.9,87,,40.72,,,0,"percent of total billed charges ","87% of total billed charges ",16.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",40.95,70,,32.76,,,0,"percent of total billed charges ","70% of total billed charges ",14.75,54.41,
"WC MGMT/ASSESS,FIT,TRAIN 15MIN",8400855,"CDM ",430,RC,97542,HCPCS,OUTPATIENT,,,70.5,56.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.65,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",65.57,93,,52.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",59.93,85,,47.94,,,0,"percent of total billed charges ","85% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",61.34,87,,49.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",49.35,67.65,
"PHYS PERF TEST 15 MIN",8400863,"CDM ",430,RC,97750,HCPCS,OUTPATIENT,,,93,74.4,,17.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",70.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",65.1,70,,52.08,,,0,"percent of total billed charges ","70% of total billed charges ",83.7,90,,66.96,,,0,"percent of total billed charges ","90% of total billed charges ",86.49,93,,69.19,,,0,"percent of total billed charges ","93% of total billed charges ",17.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",79.05,85,,63.24,,,0,"percent of total billed charges ","85% of total billed charges ",83.7,90,,66.96,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,90,,66.96,,,0,"percent of total billed charges ","90% of total billed charges ",20.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.91,87,,64.73,,,0,"percent of total billed charges ","87% of total billed charges ",20.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",65.1,70,,52.08,,,0,"percent of total billed charges ","70% of total billed charges ",17.56,86.49,
"ROM TESTING HAND",8400871,"CDM ",430,RC,95852,HCPCS,OUTPATIENT,,,68.5,54.8,,5.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",11.48,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",47.95,70,,38.36,,,0,"percent of total billed charges ","70% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",63.71,93,,50.97,,,0,"percent of total billed charges ","93% of total billed charges ",5.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.86,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",58.23,85,,46.58,,,0,"percent of total billed charges ","85% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",6.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.6,87,,47.68,,,0,"percent of total billed charges ","87% of total billed charges ",6.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",47.95,70,,38.36,,,0,"percent of total billed charges ","70% of total billed charges ",5.94,63.71,
"ROM TESTING EXTREMITY/TRUNK",8400889,"CDM ",430,RC,95851,HCPCS,OUTPATIENT,,,68,54.4,,8.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.83,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",16.68,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",47.6,70,,38.08,,,0,"percent of total billed charges ","70% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",63.24,93,,50.59,,,0,"percent of total billed charges ","93% of total billed charges ",8.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",57.8,85,,46.24,,,0,"percent of total billed charges ","85% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",9.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.16,87,,47.33,,,0,"percent of total billed charges ","87% of total billed charges ",9.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",47.6,70,,38.08,,,0,"percent of total billed charges ","70% of total billed charges ",8.46,63.24,
"SPLINT FINGER DYNAMIC",8400897,"CDM ",430,RC,29131,HCPCS,OUTPATIENT,,,305,244,,19.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",230.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",70.58,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",213.5,70,,170.80,,,0,"percent of total billed charges ","70% of total billed charges ",274.5,90,,219.60,,,0,"percent of total billed charges ","90% of total billed charges ",283.65,93,,226.92,,,0,"percent of total billed charges ","93% of total billed charges ",19.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",10.57,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",259.25,85,,207.40,,,0,"percent of total billed charges ","85% of total billed charges ",228.75,90,,183.00,,,0,"percent of total billed charges ","90% of total billed charges ",274.5,90,,219.60,,,0,"percent of total billed charges ","90% of total billed charges ",10.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",265.35,87,,212.28,,,0,"percent of total billed charges ","87% of total billed charges ",10.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",54.25,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",213.5,70,,170.80,,,0,"percent of total billed charges ","70% of total billed charges ",10.47,283.65,
"SPLINT FOREARM-HAND,DYNAMIC",8400913,"CDM ",430,RC,29126,HCPCS,OUTPATIENT,,,305,244,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",230.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",100.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",213.5,70,,170.80,,,0,"percent of total billed charges ","70% of total billed charges ",274.5,90,,219.60,,,0,"percent of total billed charges ","90% of total billed charges ",283.65,93,,226.92,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",259.25,85,,207.40,,,0,"percent of total billed charges ","85% of total billed charges ",228.75,90,,183.00,,,0,"percent of total billed charges ","90% of total billed charges ",274.5,90,,219.60,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",265.35,87,,212.28,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.35,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",213.5,70,,170.80,,,0,"percent of total billed charges ","70% of total billed charges ",100.87,283.65,
"ASSIST TECH ASSESS/15 MIN",8400962,"CDM ",430,RC,97755,HCPCS,OUTPATIENT,,,99,79.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.07,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",69.3,70,,55.44,,,0,"percent of total billed charges ","70% of total billed charges ",89.1,90,,71.28,,,0,"percent of total billed charges ","90% of total billed charges ",92.07,93,,73.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",84.15,85,,67.32,,,0,"percent of total billed charges ","85% of total billed charges ",89.1,90,,71.28,,,0,"percent of total billed charges ","90% of total billed charges ",89.1,90,,71.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",86.13,87,,68.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.3,70,,55.44,,,0,"percent of total billed charges ","70% of total billed charges ",69.3,92.07,
"IONTOPHORESIS 15 MIN",8400970,"CDM ",430,RC,97033,HCPCS,OUTPATIENT,,,73,58.4,,8.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.38,100,,36.73,36.73,36.73,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",41.56,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",51.1,70,,40.88,,,0,"percent of total billed charges ","70% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",67.89,93,,54.31,,,0,"percent of total billed charges ","93% of total billed charges ",8.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.05,85,,49.64,,,0,"percent of total billed charges ","85% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.51,87,,50.81,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.1,70,,40.88,,,0,"percent of total billed charges ","70% of total billed charges ",8.58,67.89,
"PROSTHETIC TRAINING 15 MIN",8400988,"CDM ",430,RC,97761,HCPCS,OUTPATIENT,,,70.5,56.4,,20.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",50.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",87.85,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",65.57,93,,52.46,,,0,"percent of total billed charges ","93% of total billed charges ",20.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",59.93,85,,47.94,,,0,"percent of total billed charges ","85% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",23.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",61.34,87,,49.07,,,0,"percent of total billed charges ","87% of total billed charges ",23.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",20.19,87.85,
"PHONOPHORESIS 15 MIN",8401002,"CDM ",430,RC,97035,HCPCS,OUTPATIENT,,,71.5,57.2,,12.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",30.16,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",66.5,93,,53.20,,,0,"percent of total billed charges ","93% of total billed charges ",12.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",60.78,85,,48.62,,,0,"percent of total billed charges ","85% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",14.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.21,87,,49.77,,,0,"percent of total billed charges ","87% of total billed charges ",14.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",12.33,66.5,
FLUIDOTHERAPY,8401010,"CDM ",430,RC,97022,HCPCS,OUTPATIENT,,,120,96,,14.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.33,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",36.1,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",84,70,,67.20,,,0,"percent of total billed charges ","70% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",111.6,93,,89.28,,,0,"percent of total billed charges ","93% of total billed charges ",14.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",102,85,,81.60,,,0,"percent of total billed charges ","85% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",104.4,87,,83.52,,,0,"percent of total billed charges ","87% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",84,70,,67.20,,,0,"percent of total billed charges ","70% of total billed charges ",14.41,111.6,
"INITIAL OT THEREX W/MAT 15 MIN",8401030,"CDM ",430,RC,97110,HCPCS,OUTPATIENT,,,129.5,103.6,,28.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.91,100,,272.47,272.47,272.47,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",62.59,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",90.65,70,,72.52,,,0,"percent of total billed charges ","70% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",120.44,93,,96.35,,,0,"percent of total billed charges ","93% of total billed charges ",28.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",110.08,85,,88.06,,,0,"percent of total billed charges ","85% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",25.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.67,87,,89.99,65.45,287.97,"1 through 10","percent of total billed charges ","87% of total billed charges ",25.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",90.65,70,,72.52,,,0,"percent of total billed charges ","70% of total billed charges ",25.65,120.44,
"OT ASSESS SWALLOW - MBS",8401050,"CDM ",430,RC,92611,HCPCS,OUTPATIENT,,,344,275.2,,88.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",178.22,100,,6.06,6.06,6.06,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",193.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",240.8,70,,192.64,,,0,"percent of total billed charges ","70% of total billed charges ",309.6,90,,247.68,,,0,"percent of total billed charges ","90% of total billed charges ",319.92,93,,255.94,,,0,"percent of total billed charges ","93% of total billed charges ",88.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.37,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",292.4,85,,233.92,,,0,"percent of total billed charges ","85% of total billed charges ",309.6,90,,247.68,,,0,"percent of total billed charges ","90% of total billed charges ",309.6,90,,247.68,,,0,"percent of total billed charges ","90% of total billed charges ",111.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",299.28,87,,239.42,,,0,"percent of total billed charges ","87% of total billed charges ",111.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",240.8,70,,192.64,,,0,"percent of total billed charges ","70% of total billed charges ",88.44,319.92,
"OT - ASSESS BEDSIDE SWALLOW",8401070,"CDM ",430,RC,92610,HCPCS,OUTPATIENT,,,344,275.2,,88.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",128.71,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",149.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",240.8,70,,192.64,,,0,"percent of total billed charges ","70% of total billed charges ",309.6,90,,247.68,,,0,"percent of total billed charges ","90% of total billed charges ",319.92,93,,255.94,,,0,"percent of total billed charges ","93% of total billed charges ",88.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.37,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",292.4,85,,233.92,,,0,"percent of total billed charges ","85% of total billed charges ",309.6,90,,247.68,,,0,"percent of total billed charges ","90% of total billed charges ",309.6,90,,247.68,,,0,"percent of total billed charges ","90% of total billed charges ",111.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",299.28,87,,239.42,,,0,"percent of total billed charges ","87% of total billed charges ",111.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",240.8,70,,192.64,,,0,"percent of total billed charges ","70% of total billed charges ",88.44,319.92,
"OCC THERAPY EVAL LOW COMP",8401080,"CDM ",434,RC,97165,HCPCS,OUTPATIENT,,,169,135.2,,55.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.24,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",214.39,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",157.17,93,,125.74,,,0,"percent of total billed charges ","93% of total billed charges ",55.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.41,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.65,85,,114.92,,,0,"percent of total billed charges ","85% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",63.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.03,87,,117.62,,,0,"percent of total billed charges ","87% of total billed charges ",63.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",55.76,214.39,
"OCC THERAPY EVAL MOD COMP",8401090,"CDM ",434,RC,97166,HCPCS,OUTPATIENT,,,213,170.4,,55.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.24,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",214.39,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",149.1,70,,119.28,,,0,"percent of total billed charges ","70% of total billed charges ",191.7,90,,153.36,,,0,"percent of total billed charges ","90% of total billed charges ",198.09,93,,158.47,,,0,"percent of total billed charges ","93% of total billed charges ",55.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.41,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",181.05,85,,144.84,,,0,"percent of total billed charges ","85% of total billed charges ",191.7,90,,153.36,,,0,"percent of total billed charges ","90% of total billed charges ",191.7,90,,153.36,,,0,"percent of total billed charges ","90% of total billed charges ",63.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",185.31,87,,148.25,,,0,"percent of total billed charges ","87% of total billed charges ",63.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",149.1,70,,119.28,,,0,"percent of total billed charges ","70% of total billed charges ",55.76,214.39,
"OCC THERAPY EVAL HIGH COMP",8401100,"CDM ",434,RC,97167,HCPCS,OUTPATIENT,,,266.5,213.2,,55.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.24,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",214.39,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",186.55,70,,149.24,,,0,"percent of total billed charges ","70% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",247.85,93,,198.28,,,0,"percent of total billed charges ","93% of total billed charges ",55.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.41,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",226.53,85,,181.22,,,0,"percent of total billed charges ","85% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",63.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",231.86,87,,185.49,,,0,"percent of total billed charges ","87% of total billed charges ",63.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",186.55,70,,149.24,,,0,"percent of total billed charges ","70% of total billed charges ",55.76,247.85,
"LIBERAL FIRE DEPT PHYSICAL",8601260,"CDM ",510,RC,99499,HCPCS,OUTPATIENT,,,,,,,,,,,,0,"other ","not separately reimbursment ",38.38,,,,,,0,"case rate ","pays based on per visit rate ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.38,38.38,
"NUTRITION THERAPY-DIA/HYP",9000019,"CDM ",942,RC,97802,HCPCS,OUTPATIENT,,,95,76,,,,,,,,0,"other ","not separately reimbursment ",14.7,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",68.68,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",66.5,70,,53.20,,,0,"percent of total billed charges ","70% of total billed charges ",85.5,90,,68.40,,,0,"percent of total billed charges ","90% of total billed charges ",88.35,93,,70.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.75,85,,64.60,,,0,"percent of total billed charges ","85% of total billed charges ",85.5,90,,68.40,,,0,"percent of total billed charges ","90% of total billed charges ",85.5,90,,68.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.65,87,,66.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.5,70,,53.20,,,0,"percent of total billed charges ","70% of total billed charges ",14.7,88.35,
"WOUND CARE MGMT NEW PATIENT",1700020,"CDM ",761,RC,G0463,HCPCS,OUTPATIENT,,,457.5,366,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",320.25,70,,256.20,,,0,"percent of total billed charges ","70% of total billed charges ",411.75,90,,329.40,,,0,"percent of total billed charges ","90% of total billed charges ",425.48,93,,340.38,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",388.88,85,,311.10,,,0,"percent of total billed charges ","85% of total billed charges ",411.75,90,,329.40,,,0,"percent of total billed charges ","90% of total billed charges ",411.75,90,,329.40,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",398.03,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",320.25,70,,256.20,,,0,"percent of total billed charges ","70% of total billed charges ",45.57,425.48,
"TREATMENT ROOM LESI ASSESSMENT",1700046,"CDM ",761,RC,G0463,HCPCS,OUTPATIENT,,,217.5,174,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",152.25,70,,121.80,,,0,"percent of total billed charges ","70% of total billed charges ",195.75,90,,156.60,,,0,"percent of total billed charges ","90% of total billed charges ",202.28,93,,161.82,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",184.88,85,,147.90,,,0,"percent of total billed charges ","85% of total billed charges ",195.75,90,,156.60,,,0,"percent of total billed charges ","90% of total billed charges ",195.75,90,,156.60,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",189.23,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",152.25,70,,121.80,,,0,"percent of total billed charges ","70% of total billed charges ",45.57,202.28,
"TREATMENT ROOM LEVEL 3",1700061,"CDM ",761,RC,G0463,HCPCS,OUTPATIENT,,,292,233.6,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",204.4,70,,163.52,,,0,"percent of total billed charges ","70% of total billed charges ",262.8,90,,210.24,,,0,"percent of total billed charges ","90% of total billed charges ",271.56,93,,217.25,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",248.2,85,,198.56,,,0,"percent of total billed charges ","85% of total billed charges ",262.8,90,,210.24,,,0,"percent of total billed charges ","90% of total billed charges ",262.8,90,,210.24,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",254.04,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",204.4,70,,163.52,,,0,"percent of total billed charges ","70% of total billed charges ",45.57,271.56,
"TX ROOM EST PATIENT LEVEL 1",1700533,"CDM ",761,RC,G0463,HCPCS,OUTPATIENT,,,64.5,51.6,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",45.15,70,,36.12,,,0,"percent of total billed charges ","70% of total billed charges ",58.05,90,,46.44,,,0,"percent of total billed charges ","90% of total billed charges ",59.99,93,,47.99,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",54.83,85,,43.86,,,0,"percent of total billed charges ","85% of total billed charges ",58.05,90,,46.44,,,0,"percent of total billed charges ","90% of total billed charges ",58.05,90,,46.44,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.12,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",45.15,70,,36.12,,,0,"percent of total billed charges ","70% of total billed charges ",45.15,122.44,
"OBSERVATION DIRECT ADMIT",1700730,"CDM ",762,RC,G0379,HCPCS,OUTPATIENT,,,336.5,269.2,,,,,,,,0,"other ","not separately reimbursment ",1986.51,,,2570.08,2570.08,2570.08,"1 through 10","case rate ","pays based on per visit rate ",,,,,,,0,"other ","not separately reimbursment ",235.55,70,,188.44,,,0,"percent of total billed charges ","70% of total billed charges ",302.85,90,,242.28,,,0,"percent of total billed charges ","90% of total billed charges ",312.95,93,,250.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",286.03,85,,228.82,,,0,"percent of total billed charges ","85% of total billed charges ",302.85,90,,242.28,,,0,"percent of total billed charges ","90% of total billed charges ",302.85,90,,242.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",292.76,87,,222.05,222.05,2014.91,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",547.66,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",235.55,70,,188.44,,,0,"percent of total billed charges ","70% of total billed charges ",235.55,1986.51,
"WOUND CARE MGMT ESTABLISHED PT",1700780,"CDM ",761,RC,G0463,HCPCS,OUTPATIENT,,,217.5,174,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",152.25,70,,121.80,,,0,"percent of total billed charges ","70% of total billed charges ",195.75,90,,156.60,,,0,"percent of total billed charges ","90% of total billed charges ",202.28,93,,161.82,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",184.88,85,,147.90,,,0,"percent of total billed charges ","85% of total billed charges ",195.75,90,,156.60,,,0,"percent of total billed charges ","90% of total billed charges ",195.75,90,,156.60,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",189.23,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",152.25,70,,121.80,,,0,"percent of total billed charges ","70% of total billed charges ",45.57,202.28,
"VACCINE PNEUMO ADMINISTRATION",1701050,"CDM ",771,RC,G0009,HCPCS,OUTPATIENT,,,215,172,,,,,,,,0,"other ","not separately reimbursment ",8.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",199.95,93,,159.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",182.75,85,,146.20,,,0,"percent of total billed charges ","85% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",187.05,87,,149.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",43.06,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",8.08,199.95,
"VACCINE INFLUENZA ADMIN",1701060,"CDM ",771,RC,G0008,HCPCS,OUTPATIENT,,,215,172,,,,,,,,0,"other ","not separately reimbursment ",8.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",199.95,93,,159.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",182.75,85,,146.20,,,0,"percent of total billed charges ","85% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",187.05,87,,149.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",43.06,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",8.08,199.95,
"OBS PER HOUR NON-BILLABLE",1701250,"CDM ",762,RC,G0378,HCPCS,OUTPATIENT,,,,,,,,,,,,0,"other ","not separately reimbursment ",1985.5,,,,,,0,"case rate ","pays based on per visit rate ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,1536.51,868.38,1816.06,"1 through 10",other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1985.5,1985.5,
"OUTPATIENT MISCELLANEOUS",1701290,"CDM ",761,RC,G0463,HCPCS,OUTPATIENT,,,217.5,174,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",152.25,70,,121.80,,,0,"percent of total billed charges ","70% of total billed charges ",195.75,90,,156.60,,,0,"percent of total billed charges ","90% of total billed charges ",202.28,93,,161.82,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",184.88,85,,147.90,,,0,"percent of total billed charges ","85% of total billed charges ",195.75,90,,156.60,,,0,"percent of total billed charges ","90% of total billed charges ",195.75,90,,156.60,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",189.23,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",152.25,70,,121.80,,,0,"percent of total billed charges ","70% of total billed charges ",45.57,202.28,
"ANTIBIOTIC IM W/IV",1701640,"CDM ",761,RC,96372,HCPCS,OUTPATIENT,,,240.5,192.4,,16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",29.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",223.67,93,,178.94,,,0,"percent of total billed charges ","93% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",204.43,85,,163.54,,,0,"percent of total billed charges ","85% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",209.24,87,,30.52,12.55,82.65,16,"percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,223.67,
"INJECTION IM/SQ W/IV",1701650,"CDM ",761,RC,96372,HCPCS,OUTPATIENT,,,240.5,192.4,,16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",29.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",223.67,93,,178.94,,,0,"percent of total billed charges ","93% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",204.43,85,,163.54,,,0,"percent of total billed charges ","85% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",209.24,87,,30.52,12.55,82.65,16,"percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,223.67,
"INJ SACROILIAC JOINT",1701740,"CDM ",761,RC,G0260,HCPCS,OUTPATIENT,,,991,792.8,,,,,,,,0,"other ","not separately reimbursment ",310.07,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",693.7,70,,554.96,,,0,"percent of total billed charges ","70% of total billed charges ",891.9,90,,713.52,,,0,"percent of total billed charges ","90% of total billed charges ",921.63,93,,737.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",842.35,85,,673.88,,,0,"percent of total billed charges ","85% of total billed charges ",891.9,90,,713.52,,,0,"percent of total billed charges ","90% of total billed charges ",891.9,90,,713.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",862.17,87,,689.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",649.16,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",693.7,70,,554.96,,,0,"percent of total billed charges ","70% of total billed charges ",310.07,921.63,
"BLOOD ALCOHOL",2000081,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,210.5,168.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",195.77,93,,156.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",178.93,85,,143.14,,,0,"percent of total billed charges ","85% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",183.14,87,,146.51,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",114.43,195.77,
SALICYLATES,2000750,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,137.5,110,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.25,70,,77.00,,,0,"percent of total billed charges ","70% of total billed charges ",123.75,90,,99.00,,,0,"percent of total billed charges ","90% of total billed charges ",127.88,93,,102.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",116.88,85,,93.50,,,0,"percent of total billed charges ","85% of total billed charges ",123.75,90,,99.00,,,0,"percent of total billed charges ","90% of total billed charges ",123.75,90,,99.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",119.63,87,,95.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",96.25,70,,77.00,,,0,"percent of total billed charges ","70% of total billed charges ",96.25,127.88,
VENIPUNCTURE,2001840,"CDM ",300,RC,36415,HCPCS,OUTPATIENT,,,36.5,29.2,,,,,,,,0,"other ","not separately reimbursment ",,,,8.91,8.91,8.91,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.55,70,,20.44,,,0,"percent of total billed charges ","70% of total billed charges ",32.85,90,,26.28,,,0,"percent of total billed charges ","90% of total billed charges ",33.95,93,,27.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",31.03,85,,24.82,,,0,"percent of total billed charges ","85% of total billed charges ",27.38,90,,21.90,,,0,"percent of total billed charges ","90% of total billed charges ",32.85,90,,26.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",31.76,87,,23.79,6.55,29.74,47,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",9.34,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",25.55,70,,20.44,,,0,"percent of total billed charges ","70% of total billed charges ",9.34,33.95,
ACETAMINOPHEN,2003382,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,167,133.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.9,70,,93.52,,,0,"percent of total billed charges ","70% of total billed charges ",150.3,90,,120.24,,,0,"percent of total billed charges ","90% of total billed charges ",155.31,93,,124.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",141.95,85,,113.56,,,0,"percent of total billed charges ","85% of total billed charges ",150.3,90,,120.24,,,0,"percent of total billed charges ","90% of total billed charges ",150.3,90,,120.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",145.29,87,,116.23,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",116.9,70,,93.52,,,0,"percent of total billed charges ","70% of total billed charges ",114.43,155.31,
"AMPHETAMINES QL URINE",2003432,"CDM ",300,RC,G0479,HCPCS,OUTPATIENT,,,160.5,128.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.4,80,,102.72,,,0,"percent of total billed charges ","80% of total billed charges ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",149.27,93,,119.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.43,85,,109.14,,,0,"percent of total billed charges ","85% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.64,87,,111.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",112.35,149.27,
"BARBITURATES SERUM QT",2003465,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,98.5,78.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",68.95,114.43,
BENZODIAZEPINE,2003473,"CDM ",300,RC,G0480,HCPCS,OUTPATIENT,,,98.5,78.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",68.95,114.43,
"COCAINE BLOOD QT",2003531,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,98.5,78.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",68.95,114.43,
"CODEINE BLOOD QT",2003549,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,249,199.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174.3,70,,139.44,,,0,"percent of total billed charges ","70% of total billed charges ",224.1,90,,179.28,,,0,"percent of total billed charges ","90% of total billed charges ",231.57,93,,185.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",211.65,85,,169.32,,,0,"percent of total billed charges ","85% of total billed charges ",224.1,90,,179.28,,,0,"percent of total billed charges ","90% of total billed charges ",224.1,90,,179.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",216.63,87,,173.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",174.3,70,,139.44,,,0,"percent of total billed charges ","70% of total billed charges ",114.43,231.57,
MORPHINE,2003879,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,431,344.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",301.7,70,,241.36,,,0,"percent of total billed charges ","70% of total billed charges ",387.9,90,,310.32,,,0,"percent of total billed charges ","90% of total billed charges ",400.83,93,,320.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",366.35,85,,293.08,,,0,"percent of total billed charges ","85% of total billed charges ",387.9,90,,310.32,,,0,"percent of total billed charges ","90% of total billed charges ",387.9,90,,310.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",374.97,87,,299.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",301.7,70,,241.36,,,0,"percent of total billed charges ","70% of total billed charges ",114.43,400.83,
"*NORTRIPTYLINE (AVENTYL)",2004554,"CDM ",300,RC,G0480,HCPCS,OUTPATIENT,,,122.5,98,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",113.93,93,,91.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",104.13,85,,83.30,,,0,"percent of total billed charges ","85% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",106.58,87,,85.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",85.75,114.43,
"*AMITRIPTYLINE (ELAVIL)",2004588,"CDM ",300,RC,G0480,HCPCS,OUTPATIENT,,,122.5,98,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",113.93,93,,91.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",104.13,85,,83.30,,,0,"percent of total billed charges ","85% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",106.58,87,,85.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",85.75,114.43,
"DESIPRAMINE (NORPRAMIN)",2004620,"CDM ",300,RC,G0480,HCPCS,OUTPATIENT,,,122.5,98,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",113.93,93,,91.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",104.13,85,,83.30,,,0,"percent of total billed charges ","85% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",106.58,87,,85.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",85.75,114.43,
"CLONAZEPAM  (KLONOPIN)",2004653,"CDM ",300,RC,G0480,HCPCS,OUTPATIENT,,,98.5,78.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",68.95,114.43,
"DIAZEPAM (VALIUM)",2004968,"CDM ",300,RC,G0480,HCPCS,OUTPATIENT,,,98.5,78.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",68.95,114.43,
"CANNABINOID URINE",2005882,"CDM ",300,RC,G0479,HCPCS,OUTPATIENT,,,404.5,323.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",283.15,70,,226.52,,,0,"percent of total billed charges ","70% of total billed charges ",364.05,90,,291.24,,,0,"percent of total billed charges ","90% of total billed charges ",376.19,93,,300.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",343.83,85,,275.06,,,0,"percent of total billed charges ","85% of total billed charges ",364.05,90,,291.24,,,0,"percent of total billed charges ","90% of total billed charges ",364.05,90,,291.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",351.92,87,,281.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",283.15,70,,226.52,,,0,"percent of total billed charges ","70% of total billed charges ",283.15,376.19,
"CHLORDIAZEPOXIDE #7682",2008548,"CDM ",300,RC,G0480,HCPCS,OUTPATIENT,,,104.5,83.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.15,70,,58.52,,,0,"percent of total billed charges ","70% of total billed charges ",94.05,90,,75.24,,,0,"percent of total billed charges ","90% of total billed charges ",97.19,93,,77.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",88.83,85,,71.06,,,0,"percent of total billed charges ","85% of total billed charges ",94.05,90,,75.24,,,0,"percent of total billed charges ","90% of total billed charges ",94.05,90,,75.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",90.92,87,,72.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",73.15,70,,58.52,,,0,"percent of total billed charges ","70% of total billed charges ",73.15,114.43,
"CLORAZEPATE (TRANXENE)",2008993,"CDM ",300,RC,G0480,HCPCS,OUTPATIENT,,,98.5,78.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",68.95,114.43,
"AMPHETAMINES SERUM",2009611,"CDM ",300,RC,G0479,HCPCS,OUTPATIENT,,,160.5,128.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",149.27,93,,119.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.43,85,,109.14,,,0,"percent of total billed charges ","85% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.64,87,,111.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",112.35,149.27,
"DRUG ABUSE QUAL URINE",2010049,"CDM ",300,RC,80306,HCPCS,OUTPATIENT,,,338,270.4,,15.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",236.6,70,,189.28,,,0,"percent of total billed charges ","70% of total billed charges ",304.2,90,,243.36,,,0,"percent of total billed charges ","90% of total billed charges ",314.34,93,,251.47,,,0,"percent of total billed charges ","93% of total billed charges ",15.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",287.3,85,,229.84,,,0,"percent of total billed charges ","85% of total billed charges ",304.2,90,,243.36,,,0,"percent of total billed charges ","90% of total billed charges ",304.2,90,,243.36,,,0,"percent of total billed charges ","90% of total billed charges ",20.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",294.06,87,,242.05,112.41,268.94,"1 through 10","percent of total billed charges ","87% of total billed charges ",20.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.14,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",236.6,70,,189.28,,,0,"percent of total billed charges ","70% of total billed charges ",15.94,314.34,
"URINALYSIS, AUTOMATED",2013183,"CDM ",307,RC,81003,HCPCS,OUTPATIENT,,,79.5,63.6,,1.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,7.08,7.08,7.08,"1 through 10","other ","not separately reimbursment ",55.65,70,,44.52,,,0,"percent of total billed charges ","70% of total billed charges ",71.55,90,,57.24,,,0,"percent of total billed charges ","90% of total billed charges ",73.94,93,,59.15,,,0,"percent of total billed charges ","93% of total billed charges ",1.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",67.58,85,,54.06,,,0,"percent of total billed charges ","85% of total billed charges ",71.55,90,,57.24,,,0,"percent of total billed charges ","90% of total billed charges ",71.55,90,,57.24,,,0,"percent of total billed charges ","90% of total billed charges ",1.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",69.17,87,,43.45,2.21,54.31,33,"percent of total billed charges ","87% of total billed charges ",1.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2.25,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",55.65,70,,44.52,,,0,"percent of total billed charges ","70% of total billed charges ",1.91,73.94,
"SULFONYL UREA SERUM",2014561,"CDM ",300,RC,G0479,HCPCS,OUTPATIENT,,,686,548.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",480.2,70,,384.16,,,0,"percent of total billed charges ","70% of total billed charges ",617.4,90,,493.92,,,0,"percent of total billed charges ","90% of total billed charges ",637.98,93,,510.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",583.1,85,,466.48,,,0,"percent of total billed charges ","85% of total billed charges ",617.4,90,,493.92,,,0,"percent of total billed charges ","90% of total billed charges ",617.4,90,,493.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",596.82,87,,477.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",480.2,70,,384.16,,,0,"percent of total billed charges ","70% of total billed charges ",480.2,637.98,
"DRUG SCREEN CONFIRMATION",2015147,"CDM ",300,RC,G0479,HCPCS,OUTPATIENT,,,642,513.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",449.4,70,,359.52,,,0,"percent of total billed charges ","70% of total billed charges ",577.8,90,,462.24,,,0,"percent of total billed charges ","90% of total billed charges ",597.06,93,,477.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",545.7,85,,436.56,,,0,"percent of total billed charges ","85% of total billed charges ",577.8,90,,462.24,,,0,"percent of total billed charges ","90% of total billed charges ",577.8,90,,462.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",558.54,87,,446.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",449.4,70,,359.52,,,0,"percent of total billed charges ","70% of total billed charges ",449.4,597.06,
"METHADONE #007781",2019060,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,109,87.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.3,70,,61.04,,,0,"percent of total billed charges ","70% of total billed charges ",98.1,90,,78.48,,,0,"percent of total billed charges ","90% of total billed charges ",101.37,93,,81.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",92.65,85,,74.12,,,0,"percent of total billed charges ","85% of total billed charges ",98.1,90,,78.48,,,0,"percent of total billed charges ","90% of total billed charges ",98.1,90,,78.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",94.83,87,,75.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",76.3,70,,61.04,,,0,"percent of total billed charges ","70% of total billed charges ",76.3,114.43,
*DOXEPIN,2021390,"CDM ",300,RC,G0480,HCPCS,OUTPATIENT,,,122.5,98,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",113.93,93,,91.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",104.13,85,,83.30,,,0,"percent of total billed charges ","85% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",106.58,87,,85.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",85.75,114.43,
"*MECONIUM STOOL",2021410,"CDM ",300,RC,G0479,HCPCS,OUTPATIENT,,,185,148,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",172.05,93,,137.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",157.25,85,,125.80,,,0,"percent of total billed charges ","85% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",160.95,87,,128.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",129.5,172.05,
*IMIPRAMINE,2021580,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,122.5,98,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",113.93,93,,91.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",104.13,85,,83.30,,,0,"percent of total billed charges ","85% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",106.58,87,,85.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",85.75,114.43,
*DESIPRAMINE,2021590,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,122.5,98,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",113.93,93,,91.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",104.13,85,,83.30,,,0,"percent of total billed charges ","85% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",106.58,87,,85.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",85.75,114.43,
"*AMPHETAMINES URINE",2023520,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,73.5,58.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",51.45,114.43,
"*METHAMPHETAMINE URINE",2023530,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,73.5,58.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",51.45,114.43,
BUTABARBITAL,2023960,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,239.5,191.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.65,70,,134.12,,,0,"percent of total billed charges ","70% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",222.74,93,,178.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",203.58,85,,162.86,,,0,"percent of total billed charges ","85% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",208.37,87,,166.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",167.65,70,,134.12,,,0,"percent of total billed charges ","70% of total billed charges ",114.43,222.74,
"BARBITURATES CONF-URINE S50811",2024040,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,208.5,166.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",145.95,70,,116.76,,,0,"percent of total billed charges ","70% of total billed charges ",187.65,90,,150.12,,,0,"percent of total billed charges ","90% of total billed charges ",193.91,93,,155.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",177.23,85,,141.78,,,0,"percent of total billed charges ","85% of total billed charges ",187.65,90,,150.12,,,0,"percent of total billed charges ","90% of total billed charges ",187.65,90,,150.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",181.4,87,,145.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",145.95,70,,116.76,,,0,"percent of total billed charges ","70% of total billed charges ",114.43,193.91,
"DRUG SCREEN DOT-URINE AFTER HR",2024090,"CDM ",300,RC,G0434,HCPCS,OUTPATIENT,,,136,108.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.2,70,,76.16,,,0,"percent of total billed charges ","70% of total billed charges ",122.4,90,,97.92,,,0,"percent of total billed charges ","90% of total billed charges ",126.48,93,,101.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",115.6,85,,92.48,,,0,"percent of total billed charges ","85% of total billed charges ",122.4,90,,97.92,,,0,"percent of total billed charges ","90% of total billed charges ",122.4,90,,97.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",118.32,87,,94.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.2,70,,76.16,,,0,"percent of total billed charges ","70% of total billed charges ",95.2,126.48,
"TRICYCLICS CONF, SERUM #S46565",2024200,"CDM ",301,RC,G0479,HCPCS,OUTPATIENT,,,438.5,350.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",306.95,70,,245.56,,,0,"percent of total billed charges ","70% of total billed charges ",394.65,90,,315.72,,,0,"percent of total billed charges ","90% of total billed charges ",407.81,93,,326.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",372.73,85,,298.18,,,0,"percent of total billed charges ","85% of total billed charges ",394.65,90,,315.72,,,0,"percent of total billed charges ","90% of total billed charges ",394.65,90,,315.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",381.5,87,,305.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",306.95,70,,245.56,,,0,"percent of total billed charges ","70% of total billed charges ",306.95,407.81,
*CODEINE,2024490,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,98.5,78.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",68.95,114.43,
*ETHYLMORPHINE,2024500,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,98.5,78.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",68.95,114.43,
*HYDROMORPHOME,2024510,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,98.5,78.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",68.95,114.43,
*MORPHINE,2024520,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,98.5,78.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",68.95,114.43,
*NORCODEINE,2024530,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,98.5,78.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",68.95,114.43,
*NORMORPHINE,2024540,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,98.5,78.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",68.95,114.43,
*DIHYDROCODEINE,2024550,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,98.5,78.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",68.95,114.43,
*HYDROCODONE,2024560,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,98.5,78.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",68.95,114.43,
*OXYCODONE,2024570,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,98.5,78.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",68.95,114.43,
*AMOBARBITAL,2024620,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,98.5,78.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",68.95,114.43,
*BUTALBITAL,2024630,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,98.5,78.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",68.95,114.43,
*BUTABARBITAL,2024640,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,98.5,78.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",68.95,114.43,
*PHENOBARBITAL,2024650,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,98.5,78.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",68.95,114.43,
*SEROBARBITAL,2024660,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,98.5,78.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",68.95,114.43,
*PENTOBARBITAL,2024670,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,98.5,78.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",68.95,114.43,
*MEPHOBARBITAL,2024680,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,98.5,78.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",68.95,114.43,
*AMPHETAMINE,2024700,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,73.5,58.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",51.45,114.43,
*METHAMPHETAMINE,2024710,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,73.5,58.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",51.45,114.43,
*EPHEDRINE/PSEUDOEPHEDRINE,2024720,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,73.5,58.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",51.45,114.43,
*PPA,2024730,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,73.5,58.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",51.45,114.43,
*PHENTERMINE,2024740,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,73.5,58.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",51.45,114.43,
*CHLOROAMPHETAMINE,2024750,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,73.5,58.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",51.45,114.43,
*PHENMETRAZINE,2024760,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,73.5,58.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",51.45,114.43,
*PHENDIMETRAZINE,2024770,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,73.5,58.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",51.45,114.43,
*BENZPHETAMINE,2024780,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,73.5,58.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",51.45,114.43,
*METHAMPHENTAMINE,2024790,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,73.5,58.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",51.45,114.43,
*MDA,2024800,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,73.5,58.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",51.45,114.43,
*MDMA,2024810,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,73.5,58.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",51.45,114.43,
*MDEA,2024820,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,73.5,58.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",51.45,114.43,
*DESIPRAMINE,2025590,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,122.5,98,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",113.93,93,,91.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",104.13,85,,83.30,,,0,"percent of total billed charges ","85% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",106.58,87,,85.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",85.75,114.43,
*IMIPRAMINE,2025600,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,122.5,98,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",113.93,93,,91.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",104.13,85,,83.30,,,0,"percent of total billed charges ","85% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",106.58,87,,85.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",85.75,114.43,
*AMITRIPTYLINE,2025610,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,122.5,98,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",113.93,93,,91.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",104.13,85,,83.30,,,0,"percent of total billed charges ","85% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",106.58,87,,85.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",85.75,114.43,
*NORTRIPTYLINE,2025620,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,122.5,98,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",113.93,93,,91.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",104.13,85,,83.30,,,0,"percent of total billed charges ","85% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",106.58,87,,85.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",85.75,114.43,
"PHENCYCLIDINE CONF #4101U",2025740,"CDM ",301,RC,G0479,HCPCS,OUTPATIENT,,,160.5,128.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",149.27,93,,119.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.43,85,,109.14,,,0,"percent of total billed charges ","85% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.64,87,,111.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",112.35,149.27,
"FENTANYL&/ORFENTANYL UR #4302U",2025920,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,128,102.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",89.6,70,,71.68,,,0,"percent of total billed charges ","70% of total billed charges ",115.2,90,,92.16,,,0,"percent of total billed charges ","90% of total billed charges ",119.04,93,,95.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",108.8,85,,87.04,,,0,"percent of total billed charges ","85% of total billed charges ",115.2,90,,92.16,,,0,"percent of total billed charges ","90% of total billed charges ",115.2,90,,92.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",111.36,87,,89.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",89.6,70,,71.68,,,0,"percent of total billed charges ","70% of total billed charges ",89.6,119.04,
"CANNABINOIDS #S51482",2026380,"CDM ",301,RC,G0479,HCPCS,OUTPATIENT,,,202,161.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.4,70,,113.12,,,0,"percent of total billed charges ","70% of total billed charges ",181.8,90,,145.44,,,0,"percent of total billed charges ","90% of total billed charges ",187.86,93,,150.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",171.7,85,,137.36,,,0,"percent of total billed charges ","85% of total billed charges ",181.8,90,,145.44,,,0,"percent of total billed charges ","90% of total billed charges ",181.8,90,,145.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",175.74,87,,140.59,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.4,70,,113.12,,,0,"percent of total billed charges ","70% of total billed charges ",141.4,187.86,
"*SINGLE DRUG CLASS METHOD,EACH",2027250,"CDM ",301,RC,G0479,HCPCS,OUTPATIENT,,,160.5,128.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",149.27,93,,119.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.43,85,,109.14,,,0,"percent of total billed charges ","85% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.64,87,,111.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",112.35,149.27,
"MCOMO-OPIATES CONFIRM, URINE",2027630,"CDM ",301,RC,G0479,HCPCS,OUTPATIENT,,,216,172.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.2,70,,120.96,,,0,"percent of total billed charges ","70% of total billed charges ",194.4,90,,155.52,,,0,"percent of total billed charges ","90% of total billed charges ",200.88,93,,160.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",183.6,85,,146.88,,,0,"percent of total billed charges ","85% of total billed charges ",194.4,90,,155.52,,,0,"percent of total billed charges ","90% of total billed charges ",194.4,90,,155.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",187.92,87,,150.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.2,70,,120.96,,,0,"percent of total billed charges ","70% of total billed charges ",151.2,200.88,
"MBENZ-BENZODIAZAPINE CONF URIN",2027640,"CDM ",301,RC,G0479,HCPCS,OUTPATIENT,,,216,172.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.2,70,,120.96,,,0,"percent of total billed charges ","70% of total billed charges ",194.4,90,,155.52,,,0,"percent of total billed charges ","90% of total billed charges ",200.88,93,,160.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",183.6,85,,146.88,,,0,"percent of total billed charges ","85% of total billed charges ",194.4,90,,155.52,,,0,"percent of total billed charges ","90% of total billed charges ",194.4,90,,155.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",187.92,87,,150.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.2,70,,120.96,,,0,"percent of total billed charges ","70% of total billed charges ",151.2,200.88,
"MTHCC-THC-CANNABINOIDS-CONF UR",2027650,"CDM ",301,RC,G0479,HCPCS,OUTPATIENT,,,216,172.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.2,70,,120.96,,,0,"percent of total billed charges ","70% of total billed charges ",194.4,90,,155.52,,,0,"percent of total billed charges ","90% of total billed charges ",200.88,93,,160.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",183.6,85,,146.88,,,0,"percent of total billed charges ","85% of total billed charges ",194.4,90,,155.52,,,0,"percent of total billed charges ","90% of total billed charges ",194.4,90,,155.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",187.92,87,,150.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.2,70,,120.96,,,0,"percent of total billed charges ","70% of total billed charges ",151.2,200.88,
"NICOTINE/COTININE METABO NICOT",2028320,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,152.5,122,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.75,70,,85.40,,,0,"percent of total billed charges ","70% of total billed charges ",137.25,90,,109.80,,,0,"percent of total billed charges ","90% of total billed charges ",141.83,93,,113.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",129.63,85,,103.70,,,0,"percent of total billed charges ","85% of total billed charges ",137.25,90,,109.80,,,0,"percent of total billed charges ","90% of total billed charges ",137.25,90,,109.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",132.68,87,,106.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",106.75,70,,85.40,,,0,"percent of total billed charges ","70% of total billed charges ",106.75,141.83,
"*DRUG SCREEN; SINGLE; QUAL",2028420,"CDM ",301,RC,G0479,HCPCS,OUTPATIENT,,,160.5,128.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",149.27,93,,119.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.43,85,,109.14,,,0,"percent of total billed charges ","85% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.64,87,,111.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",112.35,149.27,
"*DRUG ANALYSIS; TISSUE PREP",2028430,"CDM ",301,RC,G0434,HCPCS,OUTPATIENT,,,80,64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56,70,,44.80,,,0,"percent of total billed charges ","70% of total billed charges ",72,90,,57.60,,,0,"percent of total billed charges ","90% of total billed charges ",74.4,93,,59.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",68,85,,54.40,,,0,"percent of total billed charges ","85% of total billed charges ",72,90,,57.60,,,0,"percent of total billed charges ","90% of total billed charges ",72,90,,57.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",69.6,87,,55.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56,70,,44.80,,,0,"percent of total billed charges ","70% of total billed charges ",56,74.4,
"*SINGLE DRUG CLASS; EACH",2029180,"CDM ",301,RC,G0479,HCPCS,OUTPATIENT,,,160.5,128.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",149.27,93,,119.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.43,85,,109.14,,,0,"percent of total billed charges ","85% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.64,87,,111.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",112.35,149.27,
"*TISSUE PREP DRUG ANALYSIS",2029190,"CDM ",301,RC,G0434,HCPCS,OUTPATIENT,,,42.5,34,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.75,70,,23.80,,,0,"percent of total billed charges ","70% of total billed charges ",38.25,90,,30.60,,,0,"percent of total billed charges ","90% of total billed charges ",39.53,93,,31.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",36.13,85,,28.90,,,0,"percent of total billed charges ","85% of total billed charges ",38.25,90,,30.60,,,0,"percent of total billed charges ","90% of total billed charges ",38.25,90,,30.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",36.98,87,,29.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.75,70,,23.80,,,0,"percent of total billed charges ","70% of total billed charges ",29.75,39.53,
"*CYTOPATHOLOGY THIN LAYER",2029390,"CDM ",300,RC,G0145,HCPCS,OUTPATIENT,,,74.5,59.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",69.29,93,,55.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",63.33,85,,50.66,,,0,"percent of total billed charges ","85% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",64.82,87,,51.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",26.49,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",26.49,69.29,
"*CYTOPATHOLOGY INTERP",2029400,"CDM ",300,RC,G0124,HCPCS,OUTPATIENT,,,99.5,79.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.4,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",69.65,70,,55.72,,,0,"percent of total billed charges ","70% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",92.54,93,,74.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",84.58,85,,67.66,,,0,"percent of total billed charges ","85% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",86.57,87,,69.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.65,70,,55.72,,,0,"percent of total billed charges ","70% of total billed charges ",46.4,92.54,
"OXYCODONE URINE SCREEN",2029870,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,98.5,78.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",68.95,114.43,
"TRAMADOL LEVEL",2029910,"CDM ",301,RC,G0479,HCPCS,OUTPATIENT,,,160.5,128.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",149.27,93,,119.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.43,85,,109.14,,,0,"percent of total billed charges ","85% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.64,87,,111.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",112.35,149.27,
NORTRIPTYLINE,2030050,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,122.5,98,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",113.93,93,,91.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",104.13,85,,83.30,,,0,"percent of total billed charges ","85% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",110.25,90,,88.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",106.58,87,,85.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",85.75,70,,68.60,,,0,"percent of total billed charges ","70% of total billed charges ",85.75,114.43,
"*ALCOHOL; EXCEPT BREATH",2030560,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,259.5,207.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",181.65,70,,145.32,,,0,"percent of total billed charges ","70% of total billed charges ",233.55,90,,186.84,,,0,"percent of total billed charges ","90% of total billed charges ",241.34,93,,193.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",220.58,85,,176.46,,,0,"percent of total billed charges ","85% of total billed charges ",233.55,90,,186.84,,,0,"percent of total billed charges ","90% of total billed charges ",233.55,90,,186.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",225.77,87,,180.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",181.65,70,,145.32,,,0,"percent of total billed charges ","70% of total billed charges ",114.43,241.34,
DIHYDROTESTOSTERONE,2030880,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,237.5,190,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",166.25,70,,133.00,,,0,"percent of total billed charges ","70% of total billed charges ",213.75,90,,171.00,,,0,"percent of total billed charges ","90% of total billed charges ",220.88,93,,176.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",201.88,85,,161.50,,,0,"percent of total billed charges ","85% of total billed charges ",213.75,90,,171.00,,,0,"percent of total billed charges ","90% of total billed charges ",213.75,90,,171.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",206.63,87,,165.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",166.25,70,,133.00,,,0,"percent of total billed charges ","70% of total billed charges ",114.43,220.88,
"ECSTACY RANDOM URINE",2031380,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,179.5,143.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.65,70,,100.52,,,0,"percent of total billed charges ","70% of total billed charges ",161.55,90,,129.24,,,0,"percent of total billed charges ","90% of total billed charges ",166.94,93,,133.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",152.58,85,,122.06,,,0,"percent of total billed charges ","85% of total billed charges ",161.55,90,,129.24,,,0,"percent of total billed charges ","90% of total billed charges ",161.55,90,,129.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",156.17,87,,124.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",125.65,70,,100.52,,,0,"percent of total billed charges ","70% of total billed charges ",114.43,166.94,
"ROHYNOL, QUANT URINE",2031390,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,304,243.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",212.8,70,,170.24,,,0,"percent of total billed charges ","70% of total billed charges ",273.6,90,,218.88,,,0,"percent of total billed charges ","90% of total billed charges ",282.72,93,,226.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",258.4,85,,206.72,,,0,"percent of total billed charges ","85% of total billed charges ",273.6,90,,218.88,,,0,"percent of total billed charges ","90% of total billed charges ",273.6,90,,218.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",264.48,87,,211.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",212.8,70,,170.24,,,0,"percent of total billed charges ","70% of total billed charges ",114.43,282.72,
"*SINGLE DRUG CLASS EACH",2031840,"CDM ",301,RC,G0479,HCPCS,OUTPATIENT,,,160.5,128.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",149.27,93,,119.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.43,85,,109.14,,,0,"percent of total billed charges ","85% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.64,87,,111.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",112.35,149.27,
"*DRUG SCREEN QUAL EACH CLASS",2032890,"CDM ",301,RC,G0479,HCPCS,OUTPATIENT,,,160.5,128.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",149.27,93,,119.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.43,85,,109.14,,,0,"percent of total billed charges ","85% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.64,87,,111.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",112.35,149.27,
"CLOBAZAM LEVEL",2033210,"CDM ",301,RC,80299,HCPCS,OUTPATIENT,,,165.5,132.4,,18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,78.63,78.63,78.63,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.85,70,,92.68,,,0,"percent of total billed charges ","70% of total billed charges ",148.95,90,,119.16,,,0,"percent of total billed charges ","90% of total billed charges ",153.92,93,,123.14,,,0,"percent of total billed charges ","93% of total billed charges ",18.64,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.43,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",140.68,85,,112.54,,,0,"percent of total billed charges ","85% of total billed charges ",148.95,90,,119.16,,,0,"percent of total billed charges ","90% of total billed charges ",148.95,90,,119.16,,,0,"percent of total billed charges ","90% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",143.99,87,,115.19,,,0,"percent of total billed charges ","87% of total billed charges ",26.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",18.64,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",115.85,70,,92.68,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,153.92,
"YEAST ALLERGEN IGE",2033530,"CDM ",302,RC,86003,HCPCS,OUTPATIENT,,,15.5,12.4,,5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,1318.15,1318.15,1318.15,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.85,70,,8.68,,,0,"percent of total billed charges ","70% of total billed charges ",13.95,90,,11.16,,,0,"percent of total billed charges ","90% of total billed charges ",14.42,93,,11.54,,,0,"percent of total billed charges ","93% of total billed charges ",5.22,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",13.18,85,,10.54,,,0,"percent of total billed charges ","85% of total billed charges ",13.95,90,,11.16,,,0,"percent of total billed charges ","90% of total billed charges ",13.95,90,,11.16,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.49,87,,572.14,261.32,882.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5.22,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",10.85,70,,8.68,,,0,"percent of total billed charges ","70% of total billed charges ",5.22,14.42,
"MDMA/METABOLITES, SERUM",2034250,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,172.5,138,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.75,70,,96.60,,,0,"percent of total billed charges ","70% of total billed charges ",155.25,90,,124.20,,,0,"percent of total billed charges ","90% of total billed charges ",160.43,93,,128.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",146.63,85,,117.30,,,0,"percent of total billed charges ","85% of total billed charges ",155.25,90,,124.20,,,0,"percent of total billed charges ","90% of total billed charges ",155.25,90,,124.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",150.08,87,,120.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",120.75,70,,96.60,,,0,"percent of total billed charges ","70% of total billed charges ",114.43,160.43,
"*DRUG SCREEN, SINGLE",2034630,"CDM ",301,RC,G0479,HCPCS,OUTPATIENT,,,160.5,128.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",149.27,93,,119.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.43,85,,109.14,,,0,"percent of total billed charges ","85% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",144.45,90,,115.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.64,87,,111.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.35,70,,89.88,,,0,"percent of total billed charges ","70% of total billed charges ",112.35,149.27,
"FLUNITRAZEPAM QUANT URINE",2035700,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,424.5,339.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",297.15,70,,237.72,,,0,"percent of total billed charges ","70% of total billed charges ",382.05,90,,305.64,,,0,"percent of total billed charges ","90% of total billed charges ",394.79,93,,315.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",360.83,85,,288.66,,,0,"percent of total billed charges ","85% of total billed charges ",382.05,90,,305.64,,,0,"percent of total billed charges ","90% of total billed charges ",382.05,90,,305.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",369.32,87,,295.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",297.15,70,,237.72,,,0,"percent of total billed charges ","70% of total billed charges ",114.43,394.79,
"*DRUG SCREEN QUAL/MULTI",2035710,"CDM ",301,RC,G0479,HCPCS,OUTPATIENT,,,414,331.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",289.8,70,,231.84,,,0,"percent of total billed charges ","70% of total billed charges ",372.6,90,,298.08,,,0,"percent of total billed charges ","90% of total billed charges ",385.02,93,,308.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",351.9,85,,281.52,,,0,"percent of total billed charges ","85% of total billed charges ",372.6,90,,298.08,,,0,"percent of total billed charges ","90% of total billed charges ",372.6,90,,298.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",360.18,87,,288.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",289.8,70,,231.84,,,0,"percent of total billed charges ","70% of total billed charges ",289.8,385.02,
"*PAP THIN PREP",2036030,"CDM ",300,RC,G0145,HCPCS,OUTPATIENT,,,139,111.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.3,70,,77.84,,,0,"percent of total billed charges ","70% of total billed charges ",125.1,90,,100.08,,,0,"percent of total billed charges ","90% of total billed charges ",129.27,93,,103.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",118.15,85,,94.52,,,0,"percent of total billed charges ","85% of total billed charges ",125.1,90,,100.08,,,0,"percent of total billed charges ","90% of total billed charges ",125.1,90,,100.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",120.93,87,,96.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",26.49,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",97.3,70,,77.84,,,0,"percent of total billed charges ","70% of total billed charges ",26.49,129.27,
"ALPRAZOLAM (XANAX)",2038010,"CDM ",301,RC,G6031,HCPCS,OUTPATIENT,,,98.5,78.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",68.95,91.61,
"*AMPHETAMINES 5 OR MORE",2038780,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,219,175.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.3,70,,122.64,,,0,"percent of total billed charges ","70% of total billed charges ",197.1,90,,157.68,,,0,"percent of total billed charges ","90% of total billed charges ",203.67,93,,162.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",186.15,85,,148.92,,,0,"percent of total billed charges ","85% of total billed charges ",197.1,90,,157.68,,,0,"percent of total billed charges ","90% of total billed charges ",197.1,90,,157.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",190.53,87,,152.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",153.3,70,,122.64,,,0,"percent of total billed charges ","70% of total billed charges ",114.43,203.67,
METHYLENEDIOXYAMPHETAMINES/MDA,2038790,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,182.5,146,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.75,70,,102.20,,,0,"percent of total billed charges ","70% of total billed charges ",164.25,90,,131.40,,,0,"percent of total billed charges ","90% of total billed charges ",169.73,93,,135.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",155.13,85,,124.10,,,0,"percent of total billed charges ","85% of total billed charges ",164.25,90,,131.40,,,0,"percent of total billed charges ","90% of total billed charges ",164.25,90,,131.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",158.78,87,,127.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",127.75,70,,102.20,,,0,"percent of total billed charges ","70% of total billed charges ",114.43,169.73,
"BARBITURATES PANEL BLOOD",2038800,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,378.5,302.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",264.95,70,,211.96,,,0,"percent of total billed charges ","70% of total billed charges ",340.65,90,,272.52,,,0,"percent of total billed charges ","90% of total billed charges ",352.01,93,,281.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",321.73,85,,257.38,,,0,"percent of total billed charges ","85% of total billed charges ",340.65,90,,272.52,,,0,"percent of total billed charges ","90% of total billed charges ",340.65,90,,272.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",329.3,87,,263.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",264.95,70,,211.96,,,0,"percent of total billed charges ","70% of total billed charges ",114.43,352.01,
"AMPHET/METHAMPHET QUANT URINE",2038820,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,90.5,72.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.35,70,,50.68,,,0,"percent of total billed charges ","70% of total billed charges ",81.45,90,,65.16,,,0,"percent of total billed charges ","90% of total billed charges ",84.17,93,,67.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",76.93,85,,61.54,,,0,"percent of total billed charges ","85% of total billed charges ",81.45,90,,65.16,,,0,"percent of total billed charges ","90% of total billed charges ",81.45,90,,65.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",78.74,87,,62.99,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",63.35,70,,50.68,,,0,"percent of total billed charges ","70% of total billed charges ",63.35,114.43,
"*OPIATE URINE",2039200,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,88.5,70.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.95,70,,49.56,,,0,"percent of total billed charges ","70% of total billed charges ",79.65,90,,63.72,,,0,"percent of total billed charges ","90% of total billed charges ",82.31,93,,65.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",75.23,85,,60.18,,,0,"percent of total billed charges ","85% of total billed charges ",79.65,90,,63.72,,,0,"percent of total billed charges ","90% of total billed charges ",79.65,90,,63.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",77,87,,61.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",61.95,70,,49.56,,,0,"percent of total billed charges ","70% of total billed charges ",61.95,114.43,
"*OXYCODONE SCREEN URINE",2039210,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,48.5,38.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.95,70,,27.16,,,0,"percent of total billed charges ","70% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",45.11,93,,36.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.23,85,,32.98,,,0,"percent of total billed charges ","85% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.2,87,,33.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",33.95,70,,27.16,,,0,"percent of total billed charges ","70% of total billed charges ",33.95,114.43,
"PROPOXYPHENE DRUG SCREEN URINE",2039460,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,215,172,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",199.95,93,,159.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",182.75,85,,146.20,,,0,"percent of total billed charges ","85% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",193.5,90,,154.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",187.05,87,,149.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",150.5,70,,120.40,,,0,"percent of total billed charges ","70% of total billed charges ",114.43,199.95,
"SYNTH CANNABINOIDS QUAL BLD >7",2039720,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,82.5,66,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.75,70,,46.20,,,0,"percent of total billed charges ","70% of total billed charges ",74.25,90,,59.40,,,0,"percent of total billed charges ","90% of total billed charges ",76.73,93,,61.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.13,85,,56.10,,,0,"percent of total billed charges ","85% of total billed charges ",74.25,90,,59.40,,,0,"percent of total billed charges ","90% of total billed charges ",74.25,90,,59.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",71.78,87,,57.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",57.75,70,,46.20,,,0,"percent of total billed charges ","70% of total billed charges ",57.75,114.43,
"DRUG MONITOR METHYLPHENIDATE",2039740,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,44.5,35.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.15,70,,24.92,,,0,"percent of total billed charges ","70% of total billed charges ",40.05,90,,32.04,,,0,"percent of total billed charges ","90% of total billed charges ",41.39,93,,33.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",37.83,85,,30.26,,,0,"percent of total billed charges ","85% of total billed charges ",40.05,90,,32.04,,,0,"percent of total billed charges ","90% of total billed charges ",40.05,90,,32.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",38.72,87,,30.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",31.15,70,,24.92,,,0,"percent of total billed charges ","70% of total billed charges ",31.15,114.43,
"PROSTATE BX PATHOLOGY",2039760,"CDM ",310,RC,G0416,HCPCS,OUTPATIENT,,,458,366.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",737.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",320.6,70,,256.48,,,0,"percent of total billed charges ","70% of total billed charges ",412.2,90,,329.76,,,0,"percent of total billed charges ","90% of total billed charges ",425.94,93,,340.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",389.3,85,,311.44,,,0,"percent of total billed charges ","85% of total billed charges ",412.2,90,,329.76,,,0,"percent of total billed charges ","90% of total billed charges ",412.2,90,,329.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",398.46,87,,318.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",329.64,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",320.6,70,,256.48,,,0,"percent of total billed charges ","70% of total billed charges ",320.6,737.62,
"DRUG SCRN METHAMPH QUANT URINE",2039770,"CDM ",300,RC,G0480,HCPCS,OUTPATIENT,,,55.5,44.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.85,70,,31.08,,,0,"percent of total billed charges ","70% of total billed charges ",49.95,90,,39.96,,,0,"percent of total billed charges ","90% of total billed charges ",51.62,93,,41.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",47.18,85,,37.74,,,0,"percent of total billed charges ","85% of total billed charges ",49.95,90,,39.96,,,0,"percent of total billed charges ","90% of total billed charges ",49.95,90,,39.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",48.29,87,,38.63,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",38.85,70,,31.08,,,0,"percent of total billed charges ","70% of total billed charges ",38.85,114.43,
"DRUG SCRN BUPRENOPHINE QT URIN",2039780,"CDM ",300,RC,G0480,HCPCS,OUTPATIENT,,,55.5,44.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.85,70,,31.08,,,0,"percent of total billed charges ","70% of total billed charges ",49.95,90,,39.96,,,0,"percent of total billed charges ","90% of total billed charges ",51.62,93,,41.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",47.18,85,,37.74,,,0,"percent of total billed charges ","85% of total billed charges ",49.95,90,,39.96,,,0,"percent of total billed charges ","90% of total billed charges ",49.95,90,,39.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",48.29,87,,38.63,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",38.85,70,,31.08,,,0,"percent of total billed charges ","70% of total billed charges ",38.85,114.43,
"SARS COV2 RNA QLT RT PCR",2039960,"CDM ",306,RC,87635,HCPCS,OUTPATIENT,,,203,162.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.1,70,,113.68,,,0,"percent of total billed charges ","70% of total billed charges ",182.7,90,,146.16,,,0,"percent of total billed charges ","90% of total billed charges ",188.79,93,,151.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",44.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",172.55,85,,138.04,,,0,"percent of total billed charges ","85% of total billed charges ",182.7,90,,146.16,,,0,"percent of total billed charges ","90% of total billed charges ",182.7,90,,146.16,,,0,"percent of total billed charges ","90% of total billed charges ",43.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",176.61,87,,50.29,48.84,128.07,"1 through 10","percent of total billed charges ","87% of total billed charges ",43.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",51.31,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.1,70,,113.68,,,0,"percent of total billed charges ","70% of total billed charges ",43.61,188.79,
"SARS COV2 RNA QLT RT PCR INHS",2040080,"CDM ",306,RC,87635,HCPCS,OUTPATIENT,,,203,162.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.1,70,,113.68,,,0,"percent of total billed charges ","70% of total billed charges ",182.7,90,,146.16,,,0,"percent of total billed charges ","90% of total billed charges ",188.79,93,,151.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",44.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",172.55,85,,138.04,,,0,"percent of total billed charges ","85% of total billed charges ",182.7,90,,146.16,,,0,"percent of total billed charges ","90% of total billed charges ",182.7,90,,146.16,,,0,"percent of total billed charges ","90% of total billed charges ",43.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",176.61,87,,50.29,48.84,128.07,"1 through 10","percent of total billed charges ","87% of total billed charges ",43.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",51.31,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",142.1,70,,113.68,,,0,"percent of total billed charges ","70% of total billed charges ",43.61,188.79,
"NICOTINE COTININE URINE",2040210,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,152.5,122,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.75,70,,85.40,,,0,"percent of total billed charges ","70% of total billed charges ",137.25,90,,109.80,,,0,"percent of total billed charges ","90% of total billed charges ",141.83,93,,113.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",129.63,85,,103.70,,,0,"percent of total billed charges ","85% of total billed charges ",137.25,90,,109.80,,,0,"percent of total billed charges ","90% of total billed charges ",137.25,90,,109.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",132.68,87,,106.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",106.75,70,,85.40,,,0,"percent of total billed charges ","70% of total billed charges ",106.75,141.83,
"NICOTINE & EXP METAB LC/MS URI",2040385,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,152.5,122,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.75,70,,85.40,,,0,"percent of total billed charges ","70% of total billed charges ",137.25,90,,109.80,,,0,"percent of total billed charges ","90% of total billed charges ",141.83,93,,113.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",129.63,85,,103.70,,,0,"percent of total billed charges ","85% of total billed charges ",137.25,90,,109.80,,,0,"percent of total billed charges ","90% of total billed charges ",137.25,90,,109.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",132.68,87,,106.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",106.75,70,,85.40,,,0,"percent of total billed charges ","70% of total billed charges ",106.75,141.83,
"PHOSPHATIDYLETHANOL BLOOD",2040485,"CDM ",301,RC,G0480,HCPCS,OUTPATIENT,,,210.5,168.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",195.77,93,,156.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",178.93,85,,143.14,,,0,"percent of total billed charges ","85% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",189.45,90,,151.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",183.14,87,,146.51,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",114.43,100,,,,,0,"fee schedule ","100% of CMS fee schedule ",147.35,70,,117.88,,,0,"percent of total billed charges ","70% of total billed charges ",114.43,195.77,
"SCOLIOSIS STUDY S&U-ONE VIEW",3001799,"CDM ",320,RC,72082,HCPCS,OUTPATIENT,,,832,665.6,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,408.16,408.16,408.16,"1 through 10","other ","not separately reimbursment ",146.3,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",582.4,70,,465.92,,,0,"percent of total billed charges ","70% of total billed charges ",748.8,90,,599.04,,,0,"percent of total billed charges ","90% of total billed charges ",773.76,93,,619.01,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",86.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",707.2,85,,565.76,,,0,"percent of total billed charges ","85% of total billed charges ",748.8,90,,599.04,,,0,"percent of total billed charges ","90% of total billed charges ",748.8,90,,599.04,,,0,"percent of total billed charges ","90% of total billed charges ",85.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",723.84,87,,579.07,,,0,"percent of total billed charges ","87% of total billed charges ",85.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",582.4,70,,465.92,,,0,"percent of total billed charges ","70% of total billed charges ",85.63,773.76,
"SACROILIAC JOINT INJECTION RT",3010320,"CDM ",320,RC,G0260,HCPCS,OUTPATIENT,,,991,792.8,,,,,,,,0,"other ","not separately reimbursment ",310.07,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",693.7,70,,554.96,,,0,"percent of total billed charges ","70% of total billed charges ",891.9,90,,713.52,,,0,"percent of total billed charges ","90% of total billed charges ",921.63,93,,737.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",842.35,85,,673.88,,,0,"percent of total billed charges ","85% of total billed charges ",891.9,90,,713.52,,,0,"percent of total billed charges ","90% of total billed charges ",891.9,90,,713.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",862.17,87,,689.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",649.16,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",693.7,70,,554.96,,,0,"percent of total billed charges ","70% of total billed charges ",310.07,921.63,
"SACROILIAC JOINT INJECTION LT",3010330,"CDM ",320,RC,G0260,HCPCS,OUTPATIENT,,,991,792.8,,,,,,,,0,"other ","not separately reimbursment ",310.07,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",693.7,70,,554.96,,,0,"percent of total billed charges ","70% of total billed charges ",891.9,90,,713.52,,,0,"percent of total billed charges ","90% of total billed charges ",921.63,93,,737.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",842.35,85,,673.88,,,0,"percent of total billed charges ","85% of total billed charges ",891.9,90,,713.52,,,0,"percent of total billed charges ","90% of total billed charges ",891.9,90,,713.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",862.17,87,,689.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",649.16,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",693.7,70,,554.96,,,0,"percent of total billed charges ","70% of total billed charges ",310.07,921.63,
"SCOLIOSIS STUDY - 2-3 VIEWS",3010480,"CDM ",320,RC,72082,HCPCS,OUTPATIENT,,,1249,999.2,,90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,408.16,408.16,408.16,"1 through 10","other ","not separately reimbursment ",146.3,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",874.3,70,,699.44,,,0,"percent of total billed charges ","70% of total billed charges ",1124.1,90,,899.28,,,0,"percent of total billed charges ","90% of total billed charges ",1161.57,93,,929.26,,,0,"percent of total billed charges ","93% of total billed charges ",90.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",86.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1061.65,85,,849.32,,,0,"percent of total billed charges ","85% of total billed charges ",1124.1,90,,899.28,,,0,"percent of total billed charges ","90% of total billed charges ",1124.1,90,,899.28,,,0,"percent of total billed charges ","90% of total billed charges ",85.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1086.63,87,,869.30,,,0,"percent of total billed charges ","87% of total billed charges ",85.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",96.14,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",874.3,70,,699.44,,,0,"percent of total billed charges ","70% of total billed charges ",85.63,1161.57,
"MAMMO DIAG DIGITAL TOMO UNI RT",3010690,"CDM ",401,RC,G0279,HCPCS,OUTPATIENT,,,101.5,81.2,,,,,,,,0,"other ","not separately reimbursment ",26.66,100,,13.49,13.49,13.49,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",110.66,220,,2.75,2.75,2.75,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",71.05,70,,56.84,,,0,"percent of total billed charges ","70% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",94.4,93,,75.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",86.28,85,,69.02,,,0,"percent of total billed charges ","85% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",88.31,87,,13.50,13.50,13.50,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.05,70,,56.84,,,0,"percent of total billed charges ","70% of total billed charges ",26.66,110.66,
"MAMMO DIAG DIGITAL TOMO UNI LT",3010700,"CDM ",401,RC,G0279,HCPCS,OUTPATIENT,,,101.5,81.2,,,,,,,,0,"other ","not separately reimbursment ",26.66,100,,13.49,13.49,13.49,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",110.66,220,,2.75,2.75,2.75,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",71.05,70,,56.84,,,0,"percent of total billed charges ","70% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",94.4,93,,75.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",86.28,85,,69.02,,,0,"percent of total billed charges ","85% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",88.31,87,,13.50,13.50,13.50,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.05,70,,56.84,,,0,"percent of total billed charges ","70% of total billed charges ",26.66,110.66,
"MAMMO DIAG DIGITAL TOMO BILAT",3010710,"CDM ",401,RC,G0279,HCPCS,OUTPATIENT,,,126.5,101.2,,,,,,,,0,"other ","not separately reimbursment ",26.66,100,,13.49,13.49,13.49,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",110.66,220,,2.75,2.75,2.75,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",88.55,70,,70.84,,,0,"percent of total billed charges ","70% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",117.65,93,,94.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",107.53,85,,86.02,,,0,"percent of total billed charges ","85% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",113.85,90,,91.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",110.06,87,,13.50,13.50,13.50,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.55,70,,70.84,,,0,"percent of total billed charges ","70% of total billed charges ",26.66,117.65,
"MRA UPPER EXT RT W&WO CONTRAST",3800265,"CDM ",618,RC,C8936,HCPCS,OUTPATIENT,,,3294,2635.2,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2305.8,70,,1844.64,,,0,"percent of total billed charges ","70% of total billed charges ",2964.6,90,,2371.68,,,0,"percent of total billed charges ","90% of total billed charges ",3063.42,93,,2450.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2799.9,85,,2239.92,,,0,"percent of total billed charges ","85% of total billed charges ",2964.6,90,,2371.68,,,0,"percent of total billed charges ","90% of total billed charges ",2964.6,90,,2371.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2865.78,87,,2292.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2305.8,70,,1844.64,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,3063.42,
"MRA UPPER EXT RT W/0 CONTRAST",3800323,"CDM ",618,RC,C8935,HCPCS,OUTPATIENT,,,2427,1941.6,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1698.9,70,,1359.12,,,0,"percent of total billed charges ","70% of total billed charges ",2184.3,90,,1747.44,,,0,"percent of total billed charges ","90% of total billed charges ",2257.11,93,,1805.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2062.95,85,,1650.36,,,0,"percent of total billed charges ","85% of total billed charges ",2184.3,90,,1747.44,,,0,"percent of total billed charges ","90% of total billed charges ",2184.3,90,,1747.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2111.49,87,,1689.19,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1698.9,70,,1359.12,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,2257.11,
"MRA UPPER EXT RIGHT W CONTRAST",3800356,"CDM ",618,RC,C8934,HCPCS,OUTPATIENT,,,2753,2202.4,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1927.1,70,,1541.68,,,0,"percent of total billed charges ","70% of total billed charges ",2477.7,90,,1982.16,,,0,"percent of total billed charges ","90% of total billed charges ",2560.29,93,,2048.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2340.05,85,,1872.04,,,0,"percent of total billed charges ","85% of total billed charges ",2477.7,90,,1982.16,,,0,"percent of total billed charges ","90% of total billed charges ",2477.7,90,,1982.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2395.11,87,,1916.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1927.1,70,,1541.68,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,2560.29,
"MRA ABDOMEN ANGIO WO CONTRAST",3800380,"CDM ",618,RC,C8901,HCPCS,OUTPATIENT,,,5048,4038.4,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3533.6,70,,2826.88,,,0,"percent of total billed charges ","70% of total billed charges ",4543.2,90,,3634.56,,,0,"percent of total billed charges ","90% of total billed charges ",4694.64,93,,3755.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4290.8,85,,3432.64,,,0,"percent of total billed charges ","85% of total billed charges ",4543.2,90,,3634.56,,,0,"percent of total billed charges ","90% of total billed charges ",4543.2,90,,3634.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4391.76,87,,3513.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3533.6,70,,2826.88,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,4694.64,
"MRI BREAST-BIL W/O CONT",3800414,"CDM ",610,RC,77047,HCPCS,OUTPATIENT,,,5397.5,4318,,,,,,,,0,"other ","not separately reimbursment ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",484.07,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3778.25,70,,3022.60,,,0,"percent of total billed charges ","70% of total billed charges ",4857.75,90,,3886.20,,,0,"percent of total billed charges ","90% of total billed charges ",5019.68,93,,4015.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",151.36,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4587.88,85,,3670.30,,,0,"percent of total billed charges ","85% of total billed charges ",4857.75,90,,3886.20,,,0,"percent of total billed charges ","90% of total billed charges ",4857.75,90,,3886.20,,,0,"percent of total billed charges ","90% of total billed charges ",149.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4695.83,87,,3756.66,,,0,"percent of total billed charges ","87% of total billed charges ",149.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3778.25,70,,3022.60,,,0,"percent of total billed charges ","70% of total billed charges ",149.86,5019.68,
"MRI BREAST LEFT W/O CONT",3800422,"CDM ",610,RC,77046,HCPCS,OUTPATIENT,,,4392.5,3514,,,,,,,,0,"other ","not separately reimbursment ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",470.58,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3074.75,70,,2459.80,,,0,"percent of total billed charges ","70% of total billed charges ",3953.25,90,,3162.60,,,0,"percent of total billed charges ","90% of total billed charges ",4085.03,93,,3268.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",151.36,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3733.63,85,,2986.90,,,0,"percent of total billed charges ","85% of total billed charges ",3953.25,90,,3162.60,,,0,"percent of total billed charges ","90% of total billed charges ",3953.25,90,,3162.60,,,0,"percent of total billed charges ","90% of total billed charges ",149.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3821.48,87,,3057.18,,,0,"percent of total billed charges ","87% of total billed charges ",149.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3074.75,70,,2459.80,,,0,"percent of total billed charges ","70% of total billed charges ",149.86,4085.03,
"MRI BREAST RIGHT W/O CONT",3800430,"CDM ",610,RC,77046,HCPCS,OUTPATIENT,,,4392.5,3514,,,,,,,,0,"other ","not separately reimbursment ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",470.58,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",3074.75,70,,2459.80,,,0,"percent of total billed charges ","70% of total billed charges ",3953.25,90,,3162.60,,,0,"percent of total billed charges ","90% of total billed charges ",4085.03,93,,3268.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",151.36,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",3733.63,85,,2986.90,,,0,"percent of total billed charges ","85% of total billed charges ",3953.25,90,,3162.60,,,0,"percent of total billed charges ","90% of total billed charges ",3953.25,90,,3162.60,,,0,"percent of total billed charges ","90% of total billed charges ",149.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3821.48,87,,3057.18,,,0,"percent of total billed charges ","87% of total billed charges ",149.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3074.75,70,,2459.80,,,0,"percent of total billed charges ","70% of total billed charges ",149.86,4085.03,
"MRI BREAST LEFT W&WO CONT",3800737,"CDM ",610,RC,C8905,HCPCS,OUTPATIENT,,,5030,4024,,,,,,,,0,"other ","not separately reimbursment ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3521,70,,2816.80,,,0,"percent of total billed charges ","70% of total billed charges ",4527,90,,3621.60,,,0,"percent of total billed charges ","90% of total billed charges ",4677.9,93,,3742.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4275.5,85,,3420.40,,,0,"percent of total billed charges ","85% of total billed charges ",4527,90,,3621.60,,,0,"percent of total billed charges ","90% of total billed charges ",4527,90,,3621.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4376.1,87,,3500.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3521,70,,2816.80,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,4677.9,
"MRI BREAST RT W&W/O CONT",3800745,"CDM ",610,RC,C8905,HCPCS,OUTPATIENT,,,5030,4024,,,,,,,,0,"other ","not separately reimbursment ",552.52,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3521,70,,2816.80,,,0,"percent of total billed charges ","70% of total billed charges ",4527,90,,3621.60,,,0,"percent of total billed charges ","90% of total billed charges ",4677.9,93,,3742.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4275.5,85,,3420.40,,,0,"percent of total billed charges ","85% of total billed charges ",4527,90,,3621.60,,,0,"percent of total billed charges ","90% of total billed charges ",4527,90,,3621.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4376.1,87,,3500.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3521,70,,2816.80,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,4677.9,
"MRI BREAST BIL W&W/O CONT",3800786,"CDM ",610,RC,C8908,HCPCS,OUTPATIENT,,,6179.5,4943.6,,,,,,,,0,"other ","not separately reimbursment ",552.52,100,,67.01,67.01,67.01,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",4325.65,70,,3460.52,,,0,"percent of total billed charges ","70% of total billed charges ",5561.55,90,,4449.24,,,0,"percent of total billed charges ","90% of total billed charges ",5746.94,93,,4597.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5252.58,85,,4202.06,,,0,"percent of total billed charges ","85% of total billed charges ",5561.55,90,,4449.24,,,0,"percent of total billed charges ","90% of total billed charges ",5561.55,90,,4449.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5376.17,87,,4300.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4325.65,70,,3460.52,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,5746.94,
"MRA ABDOMEN ANGIO W/CONTRAST",3800794,"CDM ",618,RC,C8900,HCPCS,OUTPATIENT,,,5403,4322.4,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3782.1,70,,3025.68,,,0,"percent of total billed charges ","70% of total billed charges ",4862.7,90,,3890.16,,,0,"percent of total billed charges ","90% of total billed charges ",5024.79,93,,4019.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4592.55,85,,3674.04,,,0,"percent of total billed charges ","85% of total billed charges ",4862.7,90,,3890.16,,,0,"percent of total billed charges ","90% of total billed charges ",4862.7,90,,3890.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4700.61,87,,3760.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3782.1,70,,3025.68,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,5024.79,
"MRA ABDOMEN ANGIO W&WO CONTRAS",3800802,"CDM ",618,RC,C8902,HCPCS,OUTPATIENT,,,5779,4623.2,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",4045.3,70,,3236.24,,,0,"percent of total billed charges ","70% of total billed charges ",5201.1,90,,4160.88,,,0,"percent of total billed charges ","90% of total billed charges ",5374.47,93,,4299.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4912.15,85,,3929.72,,,0,"percent of total billed charges ","85% of total billed charges ",5201.1,90,,4160.88,,,0,"percent of total billed charges ","90% of total billed charges ",5201.1,90,,4160.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5027.73,87,,4022.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4045.3,70,,3236.24,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,5374.47,
"MRA UPPER EXT LEFT W/CONT",3800844,"CDM ",618,RC,C8934,HCPCS,OUTPATIENT,,,2753,2202.4,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1927.1,70,,1541.68,,,0,"percent of total billed charges ","70% of total billed charges ",2477.7,90,,1982.16,,,0,"percent of total billed charges ","90% of total billed charges ",2560.29,93,,2048.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2340.05,85,,1872.04,,,0,"percent of total billed charges ","85% of total billed charges ",2477.7,90,,1982.16,,,0,"percent of total billed charges ","90% of total billed charges ",2477.7,90,,1982.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2395.11,87,,1916.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1927.1,70,,1541.68,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,2560.29,
"MRA UPPER EXT LEFT W/O CONTRAS",3800851,"CDM ",618,RC,C8935,HCPCS,OUTPATIENT,,,2427,1941.6,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1698.9,70,,1359.12,,,0,"percent of total billed charges ","70% of total billed charges ",2184.3,90,,1747.44,,,0,"percent of total billed charges ","90% of total billed charges ",2257.11,93,,1805.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2062.95,85,,1650.36,,,0,"percent of total billed charges ","85% of total billed charges ",2184.3,90,,1747.44,,,0,"percent of total billed charges ","90% of total billed charges ",2184.3,90,,1747.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2111.49,87,,1689.19,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1698.9,70,,1359.12,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,2257.11,
"MRA UPPER EXT LEFT W&WO CONTRA",3800869,"CDM ",618,RC,C8936,HCPCS,OUTPATIENT,,,3294,2635.2,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2305.8,70,,1844.64,,,0,"percent of total billed charges ","70% of total billed charges ",2964.6,90,,2371.68,,,0,"percent of total billed charges ","90% of total billed charges ",3063.42,93,,2450.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2799.9,85,,2239.92,,,0,"percent of total billed charges ","85% of total billed charges ",2964.6,90,,2371.68,,,0,"percent of total billed charges ","90% of total billed charges ",2964.6,90,,2371.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2865.78,87,,2292.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2305.8,70,,1844.64,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,3063.42,
"MRA UPPER EXT BIL W/CONT",3800877,"CDM ",618,RC,C8934,HCPCS,OUTPATIENT,,,5502,4401.6,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3851.4,70,,3081.12,,,0,"percent of total billed charges ","70% of total billed charges ",4951.8,90,,3961.44,,,0,"percent of total billed charges ","90% of total billed charges ",5116.86,93,,4093.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4676.7,85,,3741.36,,,0,"percent of total billed charges ","85% of total billed charges ",4951.8,90,,3961.44,,,0,"percent of total billed charges ","90% of total billed charges ",4951.8,90,,3961.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4786.74,87,,3829.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3851.4,70,,3081.12,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,5116.86,
"MRA UPPER EXT BIL W/O CONTO CO",3800885,"CDM ",610,RC,C8935,HCPCS,OUTPATIENT,,,4845.5,3876.4,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3391.85,70,,2713.48,,,0,"percent of total billed charges ","70% of total billed charges ",4360.95,90,,3488.76,,,0,"percent of total billed charges ","90% of total billed charges ",4506.32,93,,3605.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4118.68,85,,3294.94,,,0,"percent of total billed charges ","85% of total billed charges ",4360.95,90,,3488.76,,,0,"percent of total billed charges ","90% of total billed charges ",4360.95,90,,3488.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4215.59,87,,3372.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3391.85,70,,2713.48,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,4506.32,
"MRA UPPER EXT BIL W/WO CONT",3800893,"CDM ",618,RC,C8936,HCPCS,OUTPATIENT,,,6580,5264,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",4606,70,,3684.80,,,0,"percent of total billed charges ","70% of total billed charges ",5922,90,,4737.60,,,0,"percent of total billed charges ","90% of total billed charges ",6119.4,93,,4895.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5593,85,,4474.40,,,0,"percent of total billed charges ","85% of total billed charges ",5922,90,,4737.60,,,0,"percent of total billed charges ","90% of total billed charges ",5922,90,,4737.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5724.6,87,,4579.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4606,70,,3684.80,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,6119.4,
"MRA CHEST W CONTRAST",3801453,"CDM ",618,RC,C8909,HCPCS,OUTPATIENT,,,4617,3693.6,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3231.9,70,,2585.52,,,0,"percent of total billed charges ","70% of total billed charges ",4155.3,90,,3324.24,,,0,"percent of total billed charges ","90% of total billed charges ",4293.81,93,,3435.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3924.45,85,,3139.56,,,0,"percent of total billed charges ","85% of total billed charges ",4155.3,90,,3324.24,,,0,"percent of total billed charges ","90% of total billed charges ",4155.3,90,,3324.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4016.79,87,,3213.43,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3231.9,70,,2585.52,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,4293.81,
"MRA CHEST + WO CONTRAST",3801461,"CDM ",618,RC,C8910,HCPCS,OUTPATIENT,,,3573.5,2858.8,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2501.45,70,,2001.16,,,0,"percent of total billed charges ","70% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",3323.36,93,,2658.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3037.48,85,,2429.98,,,0,"percent of total billed charges ","85% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3108.95,87,,2487.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2501.45,70,,2001.16,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,3323.36,
"MRA CHEST W/WO CONTRAST",3801479,"CDM ",618,RC,C8911,HCPCS,OUTPATIENT,,,5680,4544,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3976,70,,3180.80,,,0,"percent of total billed charges ","70% of total billed charges ",5112,90,,4089.60,,,0,"percent of total billed charges ","90% of total billed charges ",5282.4,93,,4225.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4828,85,,3862.40,,,0,"percent of total billed charges ","85% of total billed charges ",5112,90,,4089.60,,,0,"percent of total billed charges ","90% of total billed charges ",5112,90,,4089.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4941.6,87,,3953.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3976,70,,3180.80,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,5282.4,
"MRA SPINAL CANAL W/WO CONTR",3801487,"CDM ",618,RC,C8933,HCPCS,OUTPATIENT,,,3573.5,2858.8,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2501.45,70,,2001.16,,,0,"percent of total billed charges ","70% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",3323.36,93,,2658.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3037.48,85,,2429.98,,,0,"percent of total billed charges ","85% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3108.95,87,,2487.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2501.45,70,,2001.16,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,3323.36,
"MRA LOWER EXT W/CONTRAST RIGHT",3801495,"CDM ",616,RC,C8912,HCPCS,OUTPATIENT,,,2935,2348,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2054.5,70,,1643.60,,,0,"percent of total billed charges ","70% of total billed charges ",2641.5,90,,2113.20,,,0,"percent of total billed charges ","90% of total billed charges ",2729.55,93,,2183.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2494.75,85,,1995.80,,,0,"percent of total billed charges ","85% of total billed charges ",2641.5,90,,2113.20,,,0,"percent of total billed charges ","90% of total billed charges ",2641.5,90,,2113.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2553.45,87,,2042.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2054.5,70,,1643.60,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,2729.55,
"MRA LOWER EXT WO CONTRAST RIGH",3801503,"CDM ",616,RC,C8913,HCPCS,OUTPATIENT,,,2668,2134.4,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1867.6,70,,1494.08,,,0,"percent of total billed charges ","70% of total billed charges ",2401.2,90,,1920.96,,,0,"percent of total billed charges ","90% of total billed charges ",2481.24,93,,1984.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2267.8,85,,1814.24,,,0,"percent of total billed charges ","85% of total billed charges ",2401.2,90,,1920.96,,,0,"percent of total billed charges ","90% of total billed charges ",2401.2,90,,1920.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2321.16,87,,1856.93,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1867.6,70,,1494.08,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,2481.24,
"MRA LOWER EXT W/WO CONTRAST RI",3801511,"CDM ",616,RC,C8914,HCPCS,OUTPATIENT,,,3573.5,2858.8,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2501.45,70,,2001.16,,,0,"percent of total billed charges ","70% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",3323.36,93,,2658.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3037.48,85,,2429.98,,,0,"percent of total billed charges ","85% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3108.95,87,,2487.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2501.45,70,,2001.16,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,3323.36,
"MRA LOWER EXT W/CONTRAST LEFT",3801529,"CDM ",616,RC,C8912,HCPCS,OUTPATIENT,,,2935,2348,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2054.5,70,,1643.60,,,0,"percent of total billed charges ","70% of total billed charges ",2641.5,90,,2113.20,,,0,"percent of total billed charges ","90% of total billed charges ",2729.55,93,,2183.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2494.75,85,,1995.80,,,0,"percent of total billed charges ","85% of total billed charges ",2641.5,90,,2113.20,,,0,"percent of total billed charges ","90% of total billed charges ",2641.5,90,,2113.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2553.45,87,,2042.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2054.5,70,,1643.60,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,2729.55,
"MRA LOWER EXT WO CONTRAST LEFT",3801537,"CDM ",616,RC,C8913,HCPCS,OUTPATIENT,,,2668,2134.4,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1867.6,70,,1494.08,,,0,"percent of total billed charges ","70% of total billed charges ",2401.2,90,,1920.96,,,0,"percent of total billed charges ","90% of total billed charges ",2481.24,93,,1984.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2267.8,85,,1814.24,,,0,"percent of total billed charges ","85% of total billed charges ",2401.2,90,,1920.96,,,0,"percent of total billed charges ","90% of total billed charges ",2401.2,90,,1920.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2321.16,87,,1856.93,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1867.6,70,,1494.08,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,2481.24,
"MRA LOWER EXT W/WO CONTRAST LE",3801545,"CDM ",616,RC,C8914,HCPCS,OUTPATIENT,,,3573.5,2858.8,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2501.45,70,,2001.16,,,0,"percent of total billed charges ","70% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",3323.36,93,,2658.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3037.48,85,,2429.98,,,0,"percent of total billed charges ","85% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",3216.15,90,,2572.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3108.95,87,,2487.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2501.45,70,,2001.16,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,3323.36,
"MRA RENAL ARTERIES W/WO CONT",3801570,"CDM ",618,RC,C8902,HCPCS,OUTPATIENT,,,6926,5540.8,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",4848.2,70,,3878.56,,,0,"percent of total billed charges ","70% of total billed charges ",6233.4,90,,4986.72,,,0,"percent of total billed charges ","90% of total billed charges ",6441.18,93,,5152.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5887.1,85,,4709.68,,,0,"percent of total billed charges ","85% of total billed charges ",6233.4,90,,4986.72,,,0,"percent of total billed charges ","90% of total billed charges ",6233.4,90,,4986.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6025.62,87,,4820.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",4848.2,70,,3878.56,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,6441.18,
"MRA LOWER EXT BILAT W/WO CONTR",3801680,"CDM ",616,RC,C8914,HCPCS,OUTPATIENT,,,5361.5,4289.2,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3753.05,70,,3002.44,,,0,"percent of total billed charges ","70% of total billed charges ",4825.35,90,,3860.28,,,0,"percent of total billed charges ","90% of total billed charges ",4986.2,93,,3988.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4557.28,85,,3645.82,,,0,"percent of total billed charges ","85% of total billed charges ",4825.35,90,,3860.28,,,0,"percent of total billed charges ","90% of total billed charges ",4825.35,90,,3860.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4664.51,87,,3731.61,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",320.83,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3753.05,70,,3002.44,,,0,"percent of total billed charges ","70% of total billed charges ",320.83,4986.2,
"MRA LOWER EXT BILAT W/O CONTRA",3801690,"CDM ",616,RC,C8913,HCPCS,OUTPATIENT,,,4004.5,3203.6,,,,,,,,0,"other ","not separately reimbursment ",664.93,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2803.15,70,,2242.52,,,0,"percent of total billed charges ","70% of total billed charges ",3604.05,90,,2883.24,,,0,"percent of total billed charges ","90% of total billed charges ",3724.19,93,,2979.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3403.83,85,,2723.06,,,0,"percent of total billed charges ","85% of total billed charges ",3604.05,90,,2883.24,,,0,"percent of total billed charges ","90% of total billed charges ",3604.05,90,,2883.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3483.92,87,,2787.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",219.43,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2803.15,70,,2242.52,,,0,"percent of total billed charges ","70% of total billed charges ",219.43,3724.19,
"OB MONITOR NEW LEVEL 1, 1ST HR",4000340,"CDM ",729,RC,G0463,HCPCS,OUTPATIENT,,,219,175.2,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",153.3,70,,122.64,,,0,"percent of total billed charges ","70% of total billed charges ",197.1,90,,157.68,,,0,"percent of total billed charges ","90% of total billed charges ",203.67,93,,162.94,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",186.15,85,,148.92,,,0,"percent of total billed charges ","85% of total billed charges ",197.1,90,,157.68,,,0,"percent of total billed charges ","90% of total billed charges ",197.1,90,,157.68,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",190.53,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",153.3,70,,122.64,,,0,"percent of total billed charges ","70% of total billed charges ",45.57,203.67,
"OB MON NEW LEVEL 1 EA ADD'L HR",4000350,"CDM ",729,RC,G0463,HCPCS,OUTPATIENT,,,61,48.8,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",56.73,93,,45.38,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",51.85,85,,41.48,,,0,"percent of total billed charges ","85% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.07,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",42.7,122.44,
"OB MONITOR NEW LEVEL 2, 1ST HR",4000360,"CDM ",729,RC,G0463,HCPCS,OUTPATIENT,,,247.5,198,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",173.25,70,,138.60,,,0,"percent of total billed charges ","70% of total billed charges ",222.75,90,,178.20,,,0,"percent of total billed charges ","90% of total billed charges ",230.18,93,,184.14,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",210.38,85,,168.30,,,0,"percent of total billed charges ","85% of total billed charges ",222.75,90,,178.20,,,0,"percent of total billed charges ","90% of total billed charges ",222.75,90,,178.20,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",215.33,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",173.25,70,,138.60,,,0,"percent of total billed charges ","70% of total billed charges ",45.57,230.18,
"OB MON NEW LEVEL 2 EA ADD'L HR",4000370,"CDM ",729,RC,G0463,HCPCS,OUTPATIENT,,,61,48.8,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",56.73,93,,45.38,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",51.85,85,,41.48,,,0,"percent of total billed charges ","85% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.07,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",42.7,122.44,
"OB MONITOR NEW LEVEL 3, 1ST HR",4000380,"CDM ",729,RC,G0463,HCPCS,OUTPATIENT,,,266.5,213.2,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",186.55,70,,149.24,,,0,"percent of total billed charges ","70% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",247.85,93,,198.28,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",226.53,85,,181.22,,,0,"percent of total billed charges ","85% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",231.86,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",186.55,70,,149.24,,,0,"percent of total billed charges ","70% of total billed charges ",45.57,247.85,
"OB MON NEW LEVEL 3 EA ADD'L HR",4000390,"CDM ",729,RC,G0463,HCPCS,OUTPATIENT,,,61,48.8,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",56.73,93,,45.38,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",51.85,85,,41.48,,,0,"percent of total billed charges ","85% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.07,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",42.7,122.44,
"OB MONITOR NEW LEVEL 4, 1ST HR",4000400,"CDM ",729,RC,G0463,HCPCS,OUTPATIENT,,,339,271.2,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",237.3,70,,189.84,,,0,"percent of total billed charges ","70% of total billed charges ",305.1,90,,244.08,,,0,"percent of total billed charges ","90% of total billed charges ",315.27,93,,252.22,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",288.15,85,,230.52,,,0,"percent of total billed charges ","85% of total billed charges ",305.1,90,,244.08,,,0,"percent of total billed charges ","90% of total billed charges ",305.1,90,,244.08,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",294.93,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",237.3,70,,189.84,,,0,"percent of total billed charges ","70% of total billed charges ",45.57,315.27,
"OB MON NEW LEVEL 4 EA ADD'L HR",4000410,"CDM ",729,RC,G0463,HCPCS,OUTPATIENT,,,61,48.8,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",56.73,93,,45.38,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",51.85,85,,41.48,,,0,"percent of total billed charges ","85% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.07,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",42.7,122.44,
"OB MONITOR NEW LEVEL 5 1ST HR",4000420,"CDM ",729,RC,G0463,HCPCS,OUTPATIENT,,,367,293.6,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",256.9,70,,205.52,,,0,"percent of total billed charges ","70% of total billed charges ",330.3,90,,264.24,,,0,"percent of total billed charges ","90% of total billed charges ",341.31,93,,273.05,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",311.95,85,,249.56,,,0,"percent of total billed charges ","85% of total billed charges ",330.3,90,,264.24,,,0,"percent of total billed charges ","90% of total billed charges ",330.3,90,,264.24,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",319.29,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",256.9,70,,205.52,,,0,"percent of total billed charges ","70% of total billed charges ",45.57,341.31,
"OB MONITOR EST LEVEL 1, 1ST HR",4000423,"CDM ",729,RC,G0463,HCPCS,OUTPATIENT,,,219,175.2,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",153.3,70,,122.64,,,0,"percent of total billed charges ","70% of total billed charges ",197.1,90,,157.68,,,0,"percent of total billed charges ","90% of total billed charges ",203.67,93,,162.94,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",186.15,85,,148.92,,,0,"percent of total billed charges ","85% of total billed charges ",197.1,90,,157.68,,,0,"percent of total billed charges ","90% of total billed charges ",197.1,90,,157.68,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",190.53,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",153.3,70,,122.64,,,0,"percent of total billed charges ","70% of total billed charges ",45.57,203.67,
"OB MON NEW LEVEL 1 EA ADD'L HR",4000425,"CDM ",729,RC,G0463,HCPCS,OUTPATIENT,,,61,48.8,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",56.73,93,,45.38,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",51.85,85,,41.48,,,0,"percent of total billed charges ","85% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.07,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",42.7,122.44,
"OB MON NEW LEVEL 5 EA ADD'L HR",4000430,"CDM ",729,RC,G0463,HCPCS,OUTPATIENT,,,61,48.8,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",56.73,93,,45.38,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",51.85,85,,41.48,,,0,"percent of total billed charges ","85% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.07,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",42.7,122.44,
"OB MONITOR EST LEVEL 3, 1ST HR",4000440,"CDM ",729,RC,G0463,HCPCS,OUTPATIENT,,,266.5,213.2,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",186.55,70,,149.24,,,0,"percent of total billed charges ","70% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",247.85,93,,198.28,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",226.53,85,,181.22,,,0,"percent of total billed charges ","85% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",231.86,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",186.55,70,,149.24,,,0,"percent of total billed charges ","70% of total billed charges ",45.57,247.85,
"OB MON EST LEVEL 3 EA ADD'L HR",4000450,"CDM ",729,RC,G0463,HCPCS,OUTPATIENT,,,61,48.8,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",56.73,93,,45.38,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",51.85,85,,41.48,,,0,"percent of total billed charges ","85% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.07,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",42.7,122.44,
"OB MONITOR EST LEVEL 4 1ST HR",4000460,"CDM ",729,RC,G0463,HCPCS,OUTPATIENT,,,339,271.2,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",237.3,70,,189.84,,,0,"percent of total billed charges ","70% of total billed charges ",305.1,90,,244.08,,,0,"percent of total billed charges ","90% of total billed charges ",315.27,93,,252.22,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",288.15,85,,230.52,,,0,"percent of total billed charges ","85% of total billed charges ",305.1,90,,244.08,,,0,"percent of total billed charges ","90% of total billed charges ",305.1,90,,244.08,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",294.93,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",237.3,70,,189.84,,,0,"percent of total billed charges ","70% of total billed charges ",45.57,315.27,
"OB MON EST LEV 4, EA ADD'L HR",4000470,"CDM ",729,RC,G0463,HCPCS,OUTPATIENT,,,61,48.8,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",56.73,93,,45.38,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",51.85,85,,41.48,,,0,"percent of total billed charges ","85% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.07,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",42.7,122.44,
"OB MONITOR EST LEVEL 5, 1ST HR",4000480,"CDM ",729,RC,G0463,HCPCS,OUTPATIENT,,,367,293.6,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",256.9,70,,205.52,,,0,"percent of total billed charges ","70% of total billed charges ",330.3,90,,264.24,,,0,"percent of total billed charges ","90% of total billed charges ",341.31,93,,273.05,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",311.95,85,,249.56,,,0,"percent of total billed charges ","85% of total billed charges ",330.3,90,,264.24,,,0,"percent of total billed charges ","90% of total billed charges ",330.3,90,,264.24,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",319.29,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",256.9,70,,205.52,,,0,"percent of total billed charges ","70% of total billed charges ",45.57,341.31,
"OB MON EST LEVEL 5 EA ADD'L HR",4000490,"CDM ",729,RC,G0463,HCPCS,OUTPATIENT,,,61,48.8,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",56.73,93,,45.38,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",51.85,85,,41.48,,,0,"percent of total billed charges ","85% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.07,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",42.7,122.44,
"ANTIBIOTIC IM W/IV",4000690,"CDM ",729,RC,96372,HCPCS,OUTPATIENT,,,240.5,192.4,,16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",29.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",223.67,93,,178.94,,,0,"percent of total billed charges ","93% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",204.43,85,,163.54,,,0,"percent of total billed charges ","85% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",209.24,87,,30.52,12.55,82.65,16,"percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,223.67,
"INJECTION IM/SQ W/IV",4000700,"CDM ",729,RC,96372,HCPCS,OUTPATIENT,,,240.5,192.4,,16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",29.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",223.67,93,,178.94,,,0,"percent of total billed charges ","93% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",204.43,85,,163.54,,,0,"percent of total billed charges ","85% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",209.24,87,,30.52,12.55,82.65,16,"percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,223.67,
"ER FACILITY LEVEL 1",4600011,"CDM ",450,RC,99281,HCPCS,OUTPATIENT,,,510.5,408.4,,105,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",170.31,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",45.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",357.35,70,,285.88,,,0,"percent of total billed charges ","70% of total billed charges ",459.45,90,,367.56,,,0,"percent of total billed charges ","90% of total billed charges ",474.77,93,,379.82,,,0,"percent of total billed charges ","93% of total billed charges ",105,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.75,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",433.93,85,,347.14,,,0,"percent of total billed charges ","85% of total billed charges ",459.45,90,,367.56,,,0,"percent of total billed charges ","90% of total billed charges ",459.45,90,,367.56,,,0,"percent of total billed charges ","90% of total billed charges ",57.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",444.14,87,,17.14,17.14,17.14,"1 through 10","percent of total billed charges ","87% of total billed charges ",57.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",77.54,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",357.35,70,,285.88,,,0,"percent of total billed charges ","70% of total billed charges ",45.87,474.77,
"ER FACILITY LEVEL 4",4600110,"CDM ",450,RC,99284,HCPCS,OUTPATIENT,,,1893,1514.4,,105,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",695.24,100,,413.32,413.32,413.32,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",255.68,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",1325.1,70,,1060.08,,,0,"percent of total billed charges ","70% of total billed charges ",1703.7,90,,1362.96,,,0,"percent of total billed charges ","90% of total billed charges ",1760.49,93,,1408.39,,,0,"percent of total billed charges ","93% of total billed charges ",105,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.75,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",1609.05,85,,1287.24,,,0,"percent of total billed charges ","85% of total billed charges ",1703.7,90,,1362.96,,,0,"percent of total billed charges ","90% of total billed charges ",1703.7,90,,1362.96,,,0,"percent of total billed charges ","90% of total billed charges ",57.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1646.91,87,,1040.95,353.74,1239.17,16,"percent of total billed charges ","87% of total billed charges ",57.18,100,,413.32,413.32,413.32,"1 through 10","fee schedule ","100% of KS medicaid fee schedule ",383.73,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1325.1,70,,1060.08,,,0,"percent of total billed charges ","70% of total billed charges ",57.18,1760.49,
"ER FACILITY LEVEL 2",4600201,"CDM ",450,RC,99282,HCPCS,OUTPATIENT,,,698.5,558.8,,105,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",265.31,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",88.79,220,,356.16,356.16,356.16,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",488.95,70,,391.16,,,0,"percent of total billed charges ","70% of total billed charges ",628.65,90,,502.92,,,0,"percent of total billed charges ","90% of total billed charges ",649.61,93,,519.69,,,0,"percent of total billed charges ","93% of total billed charges ",105,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.75,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",593.73,85,,474.98,,,0,"percent of total billed charges ","85% of total billed charges ",628.65,90,,502.92,,,0,"percent of total billed charges ","90% of total billed charges ",628.65,90,,502.92,,,0,"percent of total billed charges ","90% of total billed charges ",57.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",607.7,87,,60.23,32.69,256.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",57.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",141.19,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",488.95,70,,391.16,,,0,"percent of total billed charges ","70% of total billed charges ",57.18,649.61,
"ER FACILITY LEVEL 3",4600227,"CDM ",450,RC,99283,HCPCS,OUTPATIENT,,,1155.5,924.4,,105,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",407.79,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",150.9,220,,301.39,301.39,301.39,"1 through 10","fee schedule ","220% of COVENTRY AETNA fee schedule ",808.85,70,,647.08,,,0,"percent of total billed charges ","70% of total billed charges ",1039.95,90,,831.96,,,0,"percent of total billed charges ","90% of total billed charges ",1074.62,93,,859.70,,,0,"percent of total billed charges ","93% of total billed charges ",105,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",58.01,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",982.18,85,,785.74,,,0,"percent of total billed charges ","85% of total billed charges ",1039.95,90,,831.96,,,0,"percent of total billed charges ","90% of total billed charges ",1039.95,90,,831.96,,,0,"percent of total billed charges ","90% of total billed charges ",57.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1005.29,87,,569.33,146.28,782.15,22,"percent of total billed charges ","87% of total billed charges ",57.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",251.04,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",808.85,70,,647.08,,,0,"percent of total billed charges ","70% of total billed charges ",57.44,1074.62,
"ANTIBIOTIC IM W/IV",4604480,"CDM ",450,RC,96372,HCPCS,OUTPATIENT,,,240.5,192.4,,16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",29.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",223.67,93,,178.94,,,0,"percent of total billed charges ","93% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",204.43,85,,163.54,,,0,"percent of total billed charges ","85% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",209.24,87,,30.52,12.55,82.65,16,"percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,223.67,
"INJECTION IM/SQ W/IV",4604490,"CDM ",450,RC,96372,HCPCS,OUTPATIENT,,,240.5,192.4,,16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.9,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",29.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",223.67,93,,178.94,,,0,"percent of total billed charges ","93% of total billed charges ",16.83,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",204.43,85,,163.54,,,0,"percent of total billed charges ","85% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",216.45,90,,173.16,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",209.24,87,,30.52,12.55,82.65,16,"percent of total billed charges ","87% of total billed charges ",21.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.21,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",168.35,70,,134.68,,,0,"percent of total billed charges ","70% of total billed charges ",16.83,223.67,
"AEROSOL TX INITIAL",5000948,"CDM ",412,RC,94640,HCPCS,OUTPATIENT,,,205.5,164.4,,69.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",254.03,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",22.46,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",143.85,70,,115.08,,,0,"percent of total billed charges ","70% of total billed charges ",184.95,90,,147.96,,,0,"percent of total billed charges ","90% of total billed charges ",191.12,93,,152.90,,,0,"percent of total billed charges ","93% of total billed charges ",69.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.01,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",174.68,85,,139.74,,,0,"percent of total billed charges ","85% of total billed charges ",184.95,90,,147.96,,,0,"percent of total billed charges ","90% of total billed charges ",184.95,90,,147.96,,,0,"percent of total billed charges ","90% of total billed charges ",12.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",178.79,87,,100.04,37.32,162.75,"1 through 10","percent of total billed charges ","87% of total billed charges ",12.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.38,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",143.85,70,,115.08,,,0,"percent of total billed charges ","70% of total billed charges ",12.88,254.03,
"AEROSOL TX DEMO & EVALUATION",5001433,"CDM ",412,RC,94664,HCPCS,OUTPATIENT,,,47.5,38,,69.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",211.17,100,,38.00,38.00,38.00,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",34.21,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",33.25,70,,26.60,,,0,"percent of total billed charges ","70% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",44.18,93,,35.34,,,0,"percent of total billed charges ","93% of total billed charges ",69.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.65,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",40.38,85,,32.30,,,0,"percent of total billed charges ","85% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",22.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.33,87,,32.76,31.53,40.95,"1 through 10","percent of total billed charges ","87% of total billed charges ",22.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",201.38,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",33.25,70,,26.60,,,0,"percent of total billed charges ","70% of total billed charges ",22.43,211.17,
"INP-LOW SEVERITY (EST OR NEW)",5900040,"CDM ",960,RC,99221,HCPCS,OUTPATIENT,,,212,169.6,,54.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",137.15,100,,132.29,132.29,132.29,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",133,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",54.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,73.54,73.54,73.54,"1 through 10",other,"not separately reimbursment ",54.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.31,137.15,
"INP-MOD SEVERITY (EST OR NEW)",5900050,"CDM ",960,RC,99222,HCPCS,OUTPATIENT,,,318.5,254.8,,90.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.28,100,,119.01,119.01,119.01,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",180,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",90.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,116.63,113.62,118.30,12,other,"not separately reimbursment ",90.07,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9,200.28,
"INP-HIGH SEVERITY (EST OR NEW)",5900060,"CDM ",960,RC,99223,HCPCS,OUTPATIENT,,,416,332.8,,125.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",272.55,100,,158.84,158.84,158.84,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",265,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",125.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,155.67,140.10,195.67,"1 through 10",other,"not separately reimbursment ",125.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.52,272.55,
"REMOVE ANAL FIST COMPLEX",5914687,"CDM ",960,RC,46280,HCPCS,OUTPATIENT,,,970,776,,292.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",292.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",728,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",292.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",292.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",292.96,728,
"SARS COV2 RNA QLT RT PCR",5980100,"CDM ",960,RC,87635,HCPCS,OUTPATIENT,,,144,115.2,,43.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,50.29,48.84,128.07,"1 through 10",other,"not separately reimbursment ",43.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.61,43.61,
"CONT MEDIA MULTIHANCE 20ML",6001423,"CDM ",255,RC,A9579,HCPCS,OUTPATIENT,,,197.5,158,,,,,,,,0,"other ","not separately reimbursment ",9.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",138.25,70,,110.60,,,0,"percent of total billed charges ","70% of total billed charges ",177.75,90,,142.20,,,0,"percent of total billed charges ","90% of total billed charges ",183.68,93,,146.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",167.88,85,,134.30,,,0,"percent of total billed charges ","85% of total billed charges ",177.75,90,,142.20,,,0,"percent of total billed charges ","90% of total billed charges ",177.75,90,,142.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",171.83,87,,120.80,96.64,171.65,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",138.25,70,,110.60,,,0,"percent of total billed charges ","70% of total billed charges ",9.5,183.68,
"CONT MEDIA MULTIHANCE 15ML",6001527,"CDM ",255,RC,A9579,HCPCS,OUTPATIENT,,,147.5,118,,,,,,,,0,"other ","not separately reimbursment ",9.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",103.25,70,,82.60,,,0,"percent of total billed charges ","70% of total billed charges ",132.75,90,,106.20,,,0,"percent of total billed charges ","90% of total billed charges ",137.18,93,,109.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",125.38,85,,100.30,,,0,"percent of total billed charges ","85% of total billed charges ",132.75,90,,106.20,,,0,"percent of total billed charges ","90% of total billed charges ",132.75,90,,106.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",128.33,87,,120.80,96.64,171.65,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.25,70,,82.60,,,0,"percent of total billed charges ","70% of total billed charges ",9.5,137.18,
"CONT MED ISOVUE 300/100ML",6001754,"CDM ",255,RC,Q9967,HCPCS,OUTPATIENT,,,520,416,,,,,,,,0,"other ","not separately reimbursment ",5.05,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",364,70,,291.20,,,0,"percent of total billed charges ","70% of total billed charges ",468,90,,374.40,,,0,"percent of total billed charges ","90% of total billed charges ",483.6,93,,386.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",442,85,,353.60,,,0,"percent of total billed charges ","85% of total billed charges ",468,90,,374.40,,,0,"percent of total billed charges ","90% of total billed charges ",468,90,,374.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",452.4,87,,358.59,260.46,448.24,15,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",364,70,,291.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.05,483.6,
"ENDOSCOPY CAPSULE",6007611,"CDM ",271,RC,A4649,HCPCS,OUTPATIENT,,,1008.54,806.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",705.98,70,,564.78,,,0,"percent of total billed charges ","70% of total billed charges ",907.69,90,,726.15,,,0,"percent of total billed charges ","90% of total billed charges ",937.94,93,,750.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",857.26,85,,685.81,,,0,"percent of total billed charges ","85% of total billed charges ",907.69,90,,726.15,,,0,"percent of total billed charges ","90% of total billed charges ",907.69,90,,726.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",877.43,87,,701.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",705.98,70,,564.78,,,0,"percent of total billed charges ","70% of total billed charges ",705.98,937.94,
"CATH BARTHOLIN 10FR",6106211,"CDM ",272,RC,C1729,HCPCS,OUTPATIENT,,,100.86,80.688,,,,,,,,0,"other ","not separately reimbursment ",,,,93.87,93.87,93.87,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.6,70,,56.48,,,0,"percent of total billed charges ","70% of total billed charges ",90.77,90,,72.62,,,0,"percent of total billed charges ","90% of total billed charges ",93.8,93,,75.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",85.73,85,,68.58,,,0,"percent of total billed charges ","85% of total billed charges ",90.77,90,,72.62,,,0,"percent of total billed charges ","90% of total billed charges ",90.77,90,,72.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",87.75,87,,70.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.6,70,,56.48,,,0,"percent of total billed charges ","70% of total billed charges ",70.6,93.8,
"A&D OINTMENT 60GM",7000094,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,41,32.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.7,70,,22.96,,,0,"percent of total billed charges ","70% of total billed charges ",36.9,90,,29.52,,,0,"percent of total billed charges ","90% of total billed charges ",38.13,93,,30.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34.85,85,,27.88,,,0,"percent of total billed charges ","85% of total billed charges ",36.9,90,,29.52,,,0,"percent of total billed charges ","90% of total billed charges ",36.9,90,,29.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",35.67,87,,28.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.7,70,,22.96,,,0,"percent of total billed charges ","70% of total billed charges ",28.7,38.13,
"ACETAMINOPH SUPP 5GR",7000144,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"ACETAMINO SUPP 10GR",7000169,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,11.5,9.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.05,70,,6.44,,,0,"percent of total billed charges ","70% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.7,93,,8.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.78,85,,7.82,,,0,"percent of total billed charges ","85% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.01,87,,8.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.05,70,,6.44,,,0,"percent of total billed charges ","70% of total billed charges ",8.05,10.7,
"ALDACTONE TAB 25MG",7000656,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"ALDOMET TAB 250MG",7000698,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"ALLBEE WITH C CAPS",7000797,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"ALLOPURINOL 100MG TA",7000821,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"ALLOPURINOL 300MG TA",7000839,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"AMINOPHY IV 500MG",7001126,"CDM ",636,RC,J0280,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",11.36,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",8.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",8.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",8.57,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",8.57,45.57,
"ASCORB ACID 500MG TA",7002025,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"ASPIRIN CHIL 1-1/4GR",7002132,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"ASPIRIN TAB 5GR",7002140,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"ASPIRIN ENTERIC 5GR",7002157,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"ATARAX SYRUP 1 OZ",7002249,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,1.5,1.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.05,70,,0.84,,,0,"percent of total billed charges ","70% of total billed charges ",1.35,90,,1.08,,,0,"percent of total billed charges ","90% of total billed charges ",1.4,93,,1.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1.28,85,,1.02,,,0,"percent of total billed charges ","85% of total billed charges ",1.35,90,,1.08,,,0,"percent of total billed charges ","90% of total billed charges ",1.35,90,,1.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1.31,87,,1.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.05,70,,0.84,,,0,"percent of total billed charges ","70% of total billed charges ",1.05,1.4,
"AZULFIDINE 500MG TAB",7002488,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"BACID CAP",7002546,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"BENADRYL ELIXIR 12.5MG/5ML 4OZ",7002819,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,38.5,30.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,93,,28.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.73,85,,26.18,,,0,"percent of total billed charges ","85% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.5,87,,26.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",26.95,35.81,
"BENEMID TAB 500MG",7002843,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"BENTYL CAP 10MG",7002918,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"BRETHINE TAB 2.5MG",7003262,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"BUPRENORPHINE 8 MG SL TAB",7003268,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,15,12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.95,93,,11.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.75,85,,10.20,,,0,"percent of total billed charges ","85% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.05,87,,10.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",10.5,13.95,
"CELESTONE SOLUSPAN 5ML INJ",7003841,"CDM ",636,RC,J0702,HCPCS,OUTPATIENT,,,90,72,,,,,,,,0,"other ","not separately reimbursment ",8.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",8.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",8.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",8.04,83.7,
"CEPACOL THT LOZ/BX",7003874,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,4,3.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.8,70,,2.24,,,0,"percent of total billed charges ","70% of total billed charges ",3.6,90,,2.88,,,0,"percent of total billed charges ","90% of total billed charges ",3.72,93,,2.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3.4,85,,2.72,,,0,"percent of total billed charges ","85% of total billed charges ",3.6,90,,2.88,,,0,"percent of total billed charges ","90% of total billed charges ",3.6,90,,2.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3.48,87,,2.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.8,70,,2.24,,,0,"percent of total billed charges ","70% of total billed charges ",2.8,3.72,
"CHLORASEPTIC AEROSOL",7004039,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,15,12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.95,93,,11.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.75,85,,10.20,,,0,"percent of total billed charges ","85% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.05,87,,10.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",10.5,13.95,
"CITRATE OF MAG 10 OZ",7004260,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"CLEOCIN CAP 150MG",7004328,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"KLONOPIN 0.5MG TAB",7004393,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"COUMADIN TAB 2MG",7005119,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"COUMADIN TAB 2.5MG",7005127,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"COUMADIN TAB 5MG",7005135,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"COUMADIN TAB 7.5MG",7005143,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"COUMADIN TAB 10MG",7005150,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"CYCLOGEL 1% 2ML OPH",7005234,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,33.5,26.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",31.16,93,,24.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.48,85,,22.78,,,0,"percent of total billed charges ","85% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.15,87,,23.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",23.45,31.16,
"DEBROX DROP 6.5% 15ML",7005630,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"DECADRON TAB 4MG",7005689,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"DEMEROL TAB 50MG",7005911,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"DEPAKENE LIQUID 250MG/5ML 30ML",7005945,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,38.5,30.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,93,,28.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.73,85,,26.18,,,0,"percent of total billed charges ","85% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.5,87,,26.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",26.95,35.81,
"DEPO-MEDROL 40MG/ML 1ML VIAL",7005978,"CDM ",636,RC,J1010,HCPCS,OUTPATIENT,,,49.5,39.6,,,,,,,,0,"other ","not separately reimbursment ",,,,1.90,1.90,1.90,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",46.04,93,,36.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.08,85,,33.66,,,0,"percent of total billed charges ","85% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.07,87,,9.41,0.22,39.57,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,46.04,
"DEPO-MEDROL 80MG/ML 1ML VIAL",7005986,"CDM ",636,RC,J1010,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,1.90,1.90,1.90,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,9.41,0.22,39.57,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"DIAMOX TAB 250MG",7006257,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"DILANTIN 100MG CAP",7006471,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,9,7.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.3,70,,5.04,,,0,"percent of total billed charges ","70% of total billed charges ",8.1,90,,6.48,,,0,"percent of total billed charges ","90% of total billed charges ",8.37,93,,6.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7.65,85,,6.12,,,0,"percent of total billed charges ","85% of total billed charges ",8.1,90,,6.48,,,0,"percent of total billed charges ","90% of total billed charges ",8.1,90,,6.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7.83,87,,6.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.3,70,,5.04,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,8.37,
"DILANTIN 200MG VIAL",7006489,"CDM ",636,RC,J1165,HCPCS,OUTPATIENT,,,32,25.6,,,,,,,,0,"other ","not separately reimbursment ",0.81,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.4,70,,17.92,,,0,"percent of total billed charges ","70% of total billed charges ",28.8,90,,23.04,,,0,"percent of total billed charges ","90% of total billed charges ",29.76,93,,23.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",27.2,85,,21.76,,,0,"percent of total billed charges ","85% of total billed charges ",28.8,90,,23.04,,,0,"percent of total billed charges ","90% of total billed charges ",28.8,90,,23.04,,,0,"percent of total billed charges ","90% of total billed charges ",0.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.84,87,,22.27,,,0,"percent of total billed charges ","87% of total billed charges ",0.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.4,70,,17.92,,,0,"percent of total billed charges ","70% of total billed charges ",0.45,29.76,
"DILANTIN 100MG VIAL",7006505,"CDM ",636,RC,J1165,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",0.81,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.45,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",0.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.45,45.57,
"DILAUDID 2MG TAB",7006521,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"DITROPAN TAB 5MG",7006679,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"DYAZIDE 37.5/25MG CAP",7007073,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"EMPAGLIFLOZIN 10MG TAB",7007540,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,31,24.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.7,70,,17.36,,,0,"percent of total billed charges ","70% of total billed charges ",27.9,90,,22.32,,,0,"percent of total billed charges ","90% of total billed charges ",28.83,93,,23.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.35,85,,21.08,,,0,"percent of total billed charges ","85% of total billed charges ",27.9,90,,22.32,,,0,"percent of total billed charges ","90% of total billed charges ",27.9,90,,22.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.97,87,,21.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.7,70,,17.36,,,0,"percent of total billed charges ","70% of total billed charges ",21.7,28.83,
"JARDIANCE EMPAGLIFLOZIN 25MG T",7007542,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,31,24.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.7,70,,17.36,,,0,"percent of total billed charges ","70% of total billed charges ",27.9,90,,22.32,,,0,"percent of total billed charges ","90% of total billed charges ",28.83,93,,23.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.35,85,,21.08,,,0,"percent of total billed charges ","85% of total billed charges ",27.9,90,,22.32,,,0,"percent of total billed charges ","90% of total billed charges ",27.9,90,,22.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.97,87,,21.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.7,70,,17.36,,,0,"percent of total billed charges ","70% of total billed charges ",21.7,28.83,
"ERYTHROCIN TAB 250MG",7007727,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"EXCEDRIN ES",7007925,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"FEOSOL 325 MG TAB",7007990,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"FERGON TAB 5GR",7008006,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"FLEXERIL 10MG TAB",7008196,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"FLORINEF TAB",7008212,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"FOLIC ACID TAB 1MG",7008303,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"GAVISCON FOAM TAB",7008758,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"INDOCIN CAP 25MG",7009780,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"Fluarix 26-27 0.5ML PFS",7009798,"CDM ",636,RC,Q2038,HCPCS,OUTPATIENT,,,65.5,52.4,,,,,,,,0,"other ","not separately reimbursment ",22.85,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",45.85,70,,36.68,,,0,"percent of total billed charges ","70% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",60.92,93,,48.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",20.36,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",55.68,85,,44.54,,,0,"percent of total billed charges ","85% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",20.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.99,87,,45.59,,,0,"percent of total billed charges ","87% of total billed charges ",20.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",45.85,70,,36.68,,,0,"percent of total billed charges ","70% of total billed charges ",20.16,60.92,
"ISONIAZID 300MG TAB",7009921,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"KEFLEX CAP 250MG",7010481,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"KEFLEX SUS125MG/100ML",7010523,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,39.5,31.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.65,70,,22.12,,,0,"percent of total billed charges ","70% of total billed charges ",35.55,90,,28.44,,,0,"percent of total billed charges ","90% of total billed charges ",36.74,93,,29.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.58,85,,26.86,,,0,"percent of total billed charges ","85% of total billed charges ",35.55,90,,28.44,,,0,"percent of total billed charges ","90% of total billed charges ",35.55,90,,28.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",34.37,87,,27.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.65,70,,22.12,,,0,"percent of total billed charges ","70% of total billed charges ",27.65,36.74,
"KEFZOL 1GM INJ",7010572,"CDM ",636,RC,J0690,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",1.23,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,40.51,32.13,122.92,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.75,45.57,
"CEFAZOLIN 1GM VIAL",7010573,"CDM ",636,RC,J0690,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",1.23,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,40.51,32.13,122.92,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",0.75,106.95,
"CEFAZOLIN 2MG VIAL",7010574,"CDM ",636,RC,J0687,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",80.5,106.95,
"CEFAZOLIN 3MG VIAL",7010575,"CDM ",636,RC,J0687,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",80.5,106.95,
"LACTINEX GRANU/PKT",7010903,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"LANOXIN TAB 0.125MG",7010952,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,16,12.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.88,93,,11.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.6,85,,10.88,,,0,"percent of total billed charges ","85% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.92,87,,11.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,14.88,
"LANOXIN TAB 0.25MG",7010960,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"LANOXIN ELIX 0.05MG/ML 60ML",7010994,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,2.5,2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.75,70,,1.40,,,0,"percent of total billed charges ","70% of total billed charges ",2.25,90,,1.80,,,0,"percent of total billed charges ","90% of total billed charges ",2.33,93,,1.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2.13,85,,1.70,,,0,"percent of total billed charges ","85% of total billed charges ",2.25,90,,1.80,,,0,"percent of total billed charges ","90% of total billed charges ",2.25,90,,1.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2.18,87,,1.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.75,70,,1.40,,,0,"percent of total billed charges ","70% of total billed charges ",1.75,2.33,
"LASIX ORAL SOL 10MG/ML 120ML",7011091,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,0.5,0.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.35,70,,0.28,,,0,"percent of total billed charges ","70% of total billed charges ",0.45,90,,0.36,,,0,"percent of total billed charges ","90% of total billed charges ",0.47,93,,0.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",0.43,85,,0.34,,,0,"percent of total billed charges ","85% of total billed charges ",0.45,90,,0.36,,,0,"percent of total billed charges ","90% of total billed charges ",0.45,90,,0.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",0.44,87,,0.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.35,70,,0.28,,,0,"percent of total billed charges ","70% of total billed charges ",0.35,0.47,
"LASIX TAB 20MG",7011109,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"LASIX TAB 40MG",7011117,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"LETROZOLE 2.5MG TAB",7011170,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,11.5,9.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.05,70,,6.44,,,0,"percent of total billed charges ","70% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.7,93,,8.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.78,85,,7.82,,,0,"percent of total billed charges ","85% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.01,87,,8.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.05,70,,6.44,,,0,"percent of total billed charges ","70% of total billed charges ",8.05,10.7,
"LIBRIUM CAP 10MG",7011240,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"LIBRIUM CAP 25MG",7011257,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"LIORESAL TAB",7011422,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,11.5,9.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.05,70,,6.44,,,0,"percent of total billed charges ","70% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.7,93,,8.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.78,85,,7.82,,,0,"percent of total billed charges ","85% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.01,87,,8.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.05,70,,6.44,,,0,"percent of total billed charges ","70% of total billed charges ",8.05,10.7,
"LOMOTIL TAB 2.5MG",7011505,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"MACRODANTIN CAP 50MG",7011679,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"CEFOXITIN 2GM IV",7012073,"CDM ",636,RC,J0694,HCPCS,OUTPATIENT,,,135,108,,,,,,,,0,"other ","not separately reimbursment ",7.39,100,,5.97,5.97,5.97,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",125.55,93,,100.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",4.66,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",114.75,85,,91.80,,,0,"percent of total billed charges ","85% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",4.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.45,87,,93.96,,,0,"percent of total billed charges ","87% of total billed charges ",4.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",4.61,125.55,
"METAMUCIL PACKET",7012255,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"METHERGINE 0.2 MG TAB",7012297,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"MINIPRESS CAP 1MG",7012453,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"MINERAL OIL 30ML",7012461,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,25.5,20.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.85,70,,14.28,,,0,"percent of total billed charges ","70% of total billed charges ",22.95,90,,18.36,,,0,"percent of total billed charges ","90% of total billed charges ",23.72,93,,18.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.68,85,,17.34,,,0,"percent of total billed charges ","85% of total billed charges ",22.95,90,,18.36,,,0,"percent of total billed charges ","90% of total billed charges ",22.95,90,,18.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.19,87,,17.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.85,70,,14.28,,,0,"percent of total billed charges ","70% of total billed charges ",17.85,23.72,
"MORPHINE SULF 4MG/ML",7012628,"CDM ",636,RC,J2274,HCPCS,OUTPATIENT,,,48.5,38.8,,,,,,,,0,"other ","not separately reimbursment ",18.56,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.95,70,,27.16,,,0,"percent of total billed charges ","70% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",45.11,93,,36.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",11.19,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.23,85,,32.98,,,0,"percent of total billed charges ","85% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.2,87,,36.85,33.58,40.13,"1 through 10","percent of total billed charges ","87% of total billed charges ",11.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.95,70,,27.16,,,0,"percent of total billed charges ","70% of total billed charges ",11.08,45.11,
"MORPHINE GR1/6 AMP-I",7012636,"CDM ",636,RC,J2270,HCPCS,OUTPATIENT,,,50,40,,,,,,,,0,"other ","not separately reimbursment ",5.74,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",46.5,93,,37.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",3.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",42.5,85,,34.00,,,0,"percent of total billed charges ","85% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",3.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.5,87,,37.24,33.93,40.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",3.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",3.39,46.5,
"MOTRIN TAB 400MG",7012677,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"MYAMBUTOL TAB 400MG",7012776,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"MYLICON GAS 80MG TAB",7012974,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"MYLICON DROPS 30ML",7012990,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"MYSOLINE TAB 50MG",7013022,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"MYSOLINE TAB 250MG",7013030,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"NITROSTAT 0.4MGSL Z5",7013949,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,21,16.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.7,70,,11.76,,,0,"percent of total billed charges ","70% of total billed charges ",18.9,90,,15.12,,,0,"percent of total billed charges ","90% of total billed charges ",19.53,93,,15.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.85,85,,14.28,,,0,"percent of total billed charges ","85% of total billed charges ",18.9,90,,15.12,,,0,"percent of total billed charges ","90% of total billed charges ",18.9,90,,15.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.27,87,,14.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.7,70,,11.76,,,0,"percent of total billed charges ","70% of total billed charges ",14.7,19.53,
"NOLVADEX 10MG TAB",7013998,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"NORPARMIN TAB 25MG",7014095,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"PENICILLIN G (K) 5MU/VIAL",7014855,"CDM ",636,RC,J2540,HCPCS,OUTPATIENT,,,49.5,39.6,,,,,,,,0,"other ","not separately reimbursment ",1.25,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",46.04,93,,36.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.93,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",42.08,85,,33.66,,,0,"percent of total billed charges ","85% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",0.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.07,87,,34.46,,,0,"percent of total billed charges ","87% of total billed charges ",0.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",0.92,46.04,
"OLANZADINE 10MG ODT",7014900,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"PRILOSEC 2.5 MG SUSP PKT",7014902,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,24.5,19.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.15,70,,13.72,,,0,"percent of total billed charges ","70% of total billed charges ",22.05,90,,17.64,,,0,"percent of total billed charges ","90% of total billed charges ",22.79,93,,18.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.83,85,,16.66,,,0,"percent of total billed charges ","85% of total billed charges ",22.05,90,,17.64,,,0,"percent of total billed charges ","90% of total billed charges ",22.05,90,,17.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.32,87,,17.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.15,70,,13.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.15,22.79,
"PENVEE K TAB 500MG",7014970,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"PEPPERMINT SPIRIT/OZ",7014988,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,18,14.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.74,93,,13.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.3,85,,12.24,,,0,"percent of total billed charges ","85% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.66,87,,12.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,16.74,
"PERCODAN TAB 5MG",7015019,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"PHENERGAN TAB 25MG",7015266,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"PHENERGAN PLAIN 4OZ",7015340,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"PLAQUENTIL TAB 200MG",7015605,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"POTASS CHLO 40MEQ INJ 20ML",7015944,"CDM ",636,RC,J3480,HCPCS,OUTPATIENT,,,44,35.2,,,,,,,,0,"other ","not separately reimbursment ",0.15,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30.8,70,,24.64,,,0,"percent of total billed charges ","70% of total billed charges ",39.6,90,,31.68,,,0,"percent of total billed charges ","90% of total billed charges ",40.92,93,,32.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",37.4,85,,29.92,,,0,"percent of total billed charges ","85% of total billed charges ",39.6,90,,31.68,,,0,"percent of total billed charges ","90% of total billed charges ",39.6,90,,31.68,,,0,"percent of total billed charges ","90% of total billed charges ",0.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.28,87,,30.62,,,0,"percent of total billed charges ","87% of total billed charges ",0.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30.8,70,,24.64,,,0,"percent of total billed charges ","70% of total billed charges ",0.14,40.92,
"POTASS CHLO 20MEQ-INJ 10ML",7015951,"CDM ",636,RC,J3480,HCPCS,OUTPATIENT,,,38,30.4,,,,,,,,0,"other ","not separately reimbursment ",0.15,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",26.6,70,,21.28,,,0,"percent of total billed charges ","70% of total billed charges ",34.2,90,,27.36,,,0,"percent of total billed charges ","90% of total billed charges ",35.34,93,,28.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.14,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",32.3,85,,25.84,,,0,"percent of total billed charges ","85% of total billed charges ",34.2,90,,27.36,,,0,"percent of total billed charges ","90% of total billed charges ",34.2,90,,27.36,,,0,"percent of total billed charges ","90% of total billed charges ",0.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.06,87,,26.45,,,0,"percent of total billed charges ","87% of total billed charges ",0.14,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",26.6,70,,21.28,,,0,"percent of total billed charges ","70% of total billed charges ",0.14,35.34,
"PREDNISONE TAB 5MG",7016074,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"PREDNISONE TAB 10MG",7016082,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"PREMARIN TAB 0.625MG",7016116,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"AMPICILLIN 250MG CAP",7016199,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"PROPYL-THIOUR 50MG TAB",7016421,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"ROBAXIN TAB 500MG",7017031,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"SACUBITRIL VALSARTAN 24/26 TAB",7017300,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,22,17.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.4,70,,12.32,,,0,"percent of total billed charges ","70% of total billed charges ",19.8,90,,15.84,,,0,"percent of total billed charges ","90% of total billed charges ",20.46,93,,16.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.7,85,,14.96,,,0,"percent of total billed charges ","85% of total billed charges ",19.8,90,,15.84,,,0,"percent of total billed charges ","90% of total billed charges ",19.8,90,,15.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.14,87,,15.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.4,70,,12.32,,,0,"percent of total billed charges ","70% of total billed charges ",15.4,20.46,
"SENOKOT TAB",7017387,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"SERAX CAP 10MG",7017437,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"SERAX CAP 15MG",7017445,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"SINEMET 10/100 TAB",7017643,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"SINEMET 25/250 TAB",7017650,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"SINEQUAN CAP 25MG",7017668,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"SOD BICARB 648MG TAB",7017783,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"SOD CHL 15 1/2GR TAB",7017825,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"SOL-CORTEF 125 MG/ML 2ML",7017932,"CDM ",636,RC,J1720,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",23.74,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",14.96,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",14.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",14.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",14.81,45.57,
"SOL-CORTEF 125 MG/ML 4ML",7017940,"CDM ",636,RC,J0720,HCPCS,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",59.05,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",36.68,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",36.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",36.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",50.26,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",33.6,59.05,
"SOLU-MEDRO 500MGVIAL",7017981,"CDM ",636,RC,J2919,HCPCS,OUTPATIENT,,,51,40.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",47.43,93,,37.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.35,85,,34.68,,,0,"percent of total billed charges ","85% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.37,87,,5.40,0.58,57.18,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",35.7,47.43,
"SOLU-MEDROL 1GM VIAL",7017999,"CDM ",636,RC,J2919,HCPCS,OUTPATIENT,,,66.5,53.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.55,70,,37.24,,,0,"percent of total billed charges ","70% of total billed charges ",59.85,90,,47.88,,,0,"percent of total billed charges ","90% of total billed charges ",61.85,93,,49.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",56.53,85,,45.22,,,0,"percent of total billed charges ","85% of total billed charges ",59.85,90,,47.88,,,0,"percent of total billed charges ","90% of total billed charges ",59.85,90,,47.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",57.86,87,,5.40,0.58,57.18,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.55,70,,37.24,,,0,"percent of total billed charges ","70% of total billed charges ",46.55,61.85,
"SOMA TAB 350MG",7018021,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"MULTIVITAMIN TABS",7018377,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"SURFAK 240MG CAP",7018526,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"SYNTHROID TAB .025MG",7018690,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"SYNTHROID TAB 0.05MG",7018708,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"SYNTHROID TAB 0.1MG",7018716,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"SYNTHROID TAB 0.15MG",7018724,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"TEGRETOL TAB 200MG",7018997,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"TESSALON PERLE 100MG",7019193,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"MULTIVITAMIN/MINERAL TAB",7019342,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"THIAMINE TAB 100MG",7019367,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"THIAMINE 100MG/ML 1ML",7019375,"CDM ",636,RC,J3411,HCPCS,OUTPATIENT,,,47.5,38,,,,,,,,0,"other ","not separately reimbursment ",2.9,100,,2.76,2.76,2.76,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.25,70,,26.60,,,0,"percent of total billed charges ","70% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",44.18,93,,35.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.38,85,,32.30,,,0,"percent of total billed charges ","85% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",42.75,90,,34.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.33,87,,33.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.25,70,,26.60,,,0,"percent of total billed charges ","70% of total billed charges ",2.9,44.18,
"ARMOUR THYROID 60MG TAB",7019623,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"SUZETRIGINE 50 MG TABLET",7020077,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,26,20.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.2,70,,14.56,,,0,"percent of total billed charges ","70% of total billed charges ",23.4,90,,18.72,,,0,"percent of total billed charges ","90% of total billed charges ",24.18,93,,19.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",22.1,85,,17.68,,,0,"percent of total billed charges ","85% of total billed charges ",23.4,90,,18.72,,,0,"percent of total billed charges ","90% of total billed charges ",23.4,90,,18.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.62,87,,18.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.2,70,,14.56,,,0,"percent of total billed charges ","70% of total billed charges ",18.2,24.18,
"TYLENOL TAB 325MG",7020365,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"ACETAMINOPHEN 80MG CHEWTAB",7020366,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,11.5,9.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.05,70,,6.44,,,0,"percent of total billed charges ","70% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.7,93,,8.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.78,85,,7.82,,,0,"percent of total billed charges ","85% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.01,87,,8.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.05,70,,6.44,,,0,"percent of total billed charges ","70% of total billed charges ",8.05,10.7,
"ACETAMINOPHEN 160MG CHEWTAB",7020367,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,11,8.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",10.23,93,,8.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.35,85,,7.48,,,0,"percent of total billed charges ","85% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.57,87,,7.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.7,10.23,
"TYLENOL EX ST SUS 120ML",7020373,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,23,18.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.1,70,,12.88,,,0,"percent of total billed charges ","70% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",21.39,93,,17.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.55,85,,15.64,,,0,"percent of total billed charges ","85% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.01,87,,16.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.1,70,,12.88,,,0,"percent of total billed charges ","70% of total billed charges ",16.1,21.39,
"TYLENOL EX STR 500MG TAB",7020381,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"TYLENOL #3 TAB",7020407,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"URECHOLINE TAB 10MG",7020597,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"VALIUM TAB 2MG",7020704,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"VALIUM TAB 5MG",7020712,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"VALIUM TAB 10MG",7020720,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"LOPRESSPR TAB 50MG",7021850,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"LOPRESSOR TAB 100MG",7021868,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"CORGARD TAB 40MG",7021892,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"COLCHICINE TAB 0.6MG",7022114,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,19,15.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.3,70,,10.64,,,0,"percent of total billed charges ","70% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.67,93,,14.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.15,85,,12.92,,,0,"percent of total billed charges ","85% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.53,87,,13.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.3,70,,10.64,,,0,"percent of total billed charges ","70% of total billed charges ",13.3,17.67,
"INDERAL TAB 20MG",7022197,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"SINEQUAN CAP 10MG",7022296,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"SINEMET TAB 25/100",7022379,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13,10.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.1,70,,7.28,,,0,"percent of total billed charges ","70% of total billed charges ",11.7,90,,9.36,,,0,"percent of total billed charges ","90% of total billed charges ",12.09,93,,9.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.05,85,,8.84,,,0,"percent of total billed charges ","85% of total billed charges ",11.7,90,,9.36,,,0,"percent of total billed charges ","90% of total billed charges ",11.7,90,,9.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.31,87,,9.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.1,70,,7.28,,,0,"percent of total billed charges ","70% of total billed charges ",9.1,12.09,
"EFFERDENT TAB",7022411,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"MEGACE TAB 40MG",7022783,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"MOTRIN TAB 600MG",7023179,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"IMODIUM CAP 2MG",7023252,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"THEODUR TAB 100MG",7023393,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"PERCOCET TAB",7023476,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"REGLAN TAB 10MG",7023765,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,11,8.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",10.23,93,,8.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.35,85,,7.48,,,0,"percent of total billed charges ","85% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.57,87,,7.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.7,10.23,
"MUCO-MYST 20% 30ML",7023773,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,51,40.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",47.43,93,,37.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.35,85,,34.68,,,0,"percent of total billed charges ","85% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.37,87,,35.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",35.7,47.43,
"REGLAN 5MG TAB",7023955,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"CARAFATE TAB 1GM",7024078,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"VITAM E 400 I U CAP",7024425,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"NITROSTAT TAB 0.3MG",7024540,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"PROVERA TAB 2.5MG",7024623,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"PROLIXIN TAB 1MG",7024631,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"SENOKOT S TAB",7024664,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"CAPOTEN TAB 25MG",7024912,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"PP MEDROL DOSEPAK 4MG 21 TABS",7024987,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,30,24,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21,70,,16.80,,,0,"percent of total billed charges ","70% of total billed charges ",27,90,,21.60,,,0,"percent of total billed charges ","90% of total billed charges ",27.9,93,,22.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.5,85,,20.40,,,0,"percent of total billed charges ","85% of total billed charges ",27,90,,21.60,,,0,"percent of total billed charges ","90% of total billed charges ",27,90,,21.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.1,87,,20.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21,70,,16.80,,,0,"percent of total billed charges ","70% of total billed charges ",21,27.9,
"PROVERA TAB 10MG",7025018,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"CEPASTAT CHERRY LOZ BOX",7025778,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,1,0.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.7,70,,0.56,,,0,"percent of total billed charges ","70% of total billed charges ",0.9,90,,0.72,,,0,"percent of total billed charges ","90% of total billed charges ",0.93,93,,0.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",0.85,85,,0.68,,,0,"percent of total billed charges ","85% of total billed charges ",0.9,90,,0.72,,,0,"percent of total billed charges ","90% of total billed charges ",0.9,90,,0.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",0.87,87,,0.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.7,70,,0.56,,,0,"percent of total billed charges ","70% of total billed charges ",0.7,0.93,
"SUBLIMAZE AMP 2ML/100MCG",7026453,"CDM ",636,RC,J3010,HCPCS,OUTPATIENT,,,52.5,42,,,,,,,,0,"other ","not separately reimbursment ",1.25,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",48.83,93,,39.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",44.63,85,,35.70,,,0,"percent of total billed charges ","85% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",0.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.68,87,,40.95,30.39,42.84,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",0.63,48.83,
"HYDROCORTISONE 1%OINT 28G",7026512,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,33.5,26.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",31.16,93,,24.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.48,85,,22.78,,,0,"percent of total billed charges ","85% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.15,87,,23.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",23.45,31.16,
"PROCARDIA CAP 10MG",7026644,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"CALAN TAB 80MG",7026701,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"VERAPAMIL 120MG TAB",7026719,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"MICRO K TAB 8MEQ",7026784,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"TUSSINEX ELIX 30ML",7026990,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,30,24,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21,70,,16.80,,,0,"percent of total billed charges ","70% of total billed charges ",27,90,,21.60,,,0,"percent of total billed charges ","90% of total billed charges ",27.9,93,,22.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.5,85,,20.40,,,0,"percent of total billed charges ","85% of total billed charges ",27,90,,21.60,,,0,"percent of total billed charges ","90% of total billed charges ",27,90,,21.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.1,87,,20.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21,70,,16.80,,,0,"percent of total billed charges ","70% of total billed charges ",21,27.9,
"XANAX TAB 0.5MG",7027113,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"CARDIZEM TAB 30MG",7027451,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"BUMEX TAB 1MG",7027543,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"ZANTAC TAB 150MG",7027626,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"INDERAL LA CAP 80MG",7027683,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"NAPROSYN TAB 375MG",7027766,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"NORMODYNE TAB 200MG",7027774,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"GLUCOTROL TAB 5MG",7027873,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"AUGMENTIN 250MG/5ML 75ML",7027949,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,226,180.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",158.2,70,,126.56,,,0,"percent of total billed charges ","70% of total billed charges ",203.4,90,,162.72,,,0,"percent of total billed charges ","90% of total billed charges ",210.18,93,,168.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",192.1,85,,153.68,,,0,"percent of total billed charges ","85% of total billed charges ",203.4,90,,162.72,,,0,"percent of total billed charges ","90% of total billed charges ",203.4,90,,162.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",196.62,87,,157.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",158.2,70,,126.56,,,0,"percent of total billed charges ","70% of total billed charges ",158.2,210.18,
"ACYCLOVIR 200MG CAP",7028012,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"MAXZIDE TAB",7028020,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"TRENTAL TAB 400MG",7028038,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"ROCEPHIN 1GM VIAL",7028152,"CDM ",636,RC,J0696,HCPCS,OUTPATIENT,,,47,37.6,,,,,,,,0,"other ","not separately reimbursment ",0.69,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",43.71,93,,34.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.51,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.95,85,,31.96,,,0,"percent of total billed charges ","85% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.89,87,,1.83,0.39,41.08,12,"percent of total billed charges ","87% of total billed charges ",0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",0.5,43.71,
"CEFTRIAXONE 2GM VIAL",7028154,"CDM ",636,RC,J0696,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",0.69,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.51,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,1.83,0.39,41.08,12,"percent of total billed charges ","87% of total billed charges ",0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",0.5,106.95,
"MICRO K TAB 10MEQ",7028194,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"FIORICET TAB",7028269,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"LONITEN TAB 2.5MG",7028335,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"XANAX 1MG TAB",7028434,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"MICRONASE 5MG TAB",7028491,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"MORPHINE PCA 1MG/ML 30ML",7028533,"CDM ",636,RC,J2270,HCPCS,OUTPATIENT,,,70,56,,,,,,,,0,"other ","not separately reimbursment ",5.74,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",49,70,,39.20,,,0,"percent of total billed charges ","70% of total billed charges ",63,90,,50.40,,,0,"percent of total billed charges ","90% of total billed charges ",65.1,93,,52.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",3.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",59.5,85,,47.60,,,0,"percent of total billed charges ","85% of total billed charges ",63,90,,50.40,,,0,"percent of total billed charges ","90% of total billed charges ",63,90,,50.40,,,0,"percent of total billed charges ","90% of total billed charges ",3.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60.9,87,,37.24,33.93,40.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",3.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",49,70,,39.20,,,0,"percent of total billed charges ","70% of total billed charges ",3.39,65.1,
"MEPERIDINE PCA 10MG/ML 30ML",7028541,"CDM ",636,RC,J2175,HCPCS,OUTPATIENT,,,112.5,90,,,,,,,,0,"other ","not separately reimbursment ",8.88,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",104.63,93,,83.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",6.54,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",95.63,85,,76.50,,,0,"percent of total billed charges ","85% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",6.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",97.88,87,,71.55,43.55,99.54,"1 through 10","percent of total billed charges ","87% of total billed charges ",6.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",6.48,104.63,
"AUGMENTIN 500MG TAB",7028582,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"VASOTEC 5MG TAB",7028699,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"MYCELEX TROCHE 10MG TAB",7028723,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14,11.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",13.02,93,,10.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.9,85,,9.52,,,0,"percent of total billed charges ","85% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.18,87,,9.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",9.8,13.02,
"ROXANL 20MG/ML30ML",7028798,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,50,40,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",46.5,93,,37.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.5,85,,34.00,,,0,"percent of total billed charges ","85% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.5,87,,34.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",35,46.5,
"HUMIBID LA TAB 600MG",7028830,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"XANAX 0.25MG TAB",7028921,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"MORPHINE HIGH STR 5MG/ML 30ML",7028947,"CDM ",636,RC,J2270,HCPCS,OUTPATIENT,,,69.5,55.6,,,,,,,,0,"other ","not separately reimbursment ",5.74,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",48.65,70,,38.92,,,0,"percent of total billed charges ","70% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",64.64,93,,51.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",3.42,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",59.08,85,,47.26,,,0,"percent of total billed charges ","85% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",3.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60.47,87,,37.24,33.93,40.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",3.39,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",48.65,70,,38.92,,,0,"percent of total billed charges ","70% of total billed charges ",3.39,64.64,
"TAMBOCOR 100 MG TAB",7029069,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"CALAN SR 240 MG CAP",7029267,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"BUSPAR TABLET 5MG",7029275,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"PEPCID 20MG TAB",7029382,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"CEPHALEXIN 500MG CAP",7029630,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"MEVACOR 20MG TAB",7029804,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"FORTAZ GM ADD/VAN",7029853,"CDM ",636,RC,J0713,HCPCS,OUTPATIENT,,,46.5,37.2,,,,,,,,0,"other ","not separately reimbursment ",2.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",43.25,93,,34.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.53,85,,31.62,,,0,"percent of total billed charges ","85% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",1.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.46,87,,32.37,,,0,"percent of total billed charges ","87% of total billed charges ",1.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",1.97,43.25,
"CIPRO 250MG TAB",7029986,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,15,12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.95,93,,11.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.75,85,,10.20,,,0,"percent of total billed charges ","85% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.05,87,,10.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",10.5,13.95,
"CIPRO 500MG TAB",7029994,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,17,13.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.9,70,,9.52,,,0,"percent of total billed charges ","70% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.81,93,,12.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.45,85,,11.56,,,0,"percent of total billed charges ","85% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.79,87,,11.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.9,70,,9.52,,,0,"percent of total billed charges ","70% of total billed charges ",11.9,15.81,
"TEGRETOL 100MG TAB",7030141,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"MINIPRESS CAP 5MG",7030158,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"MOTRIN 800MG TAB",7030208,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"CEFTIN TAB 250MG",7030273,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"PROZAC TAB 20MG",7030455,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"VASOTEC 10MG TAB",7030653,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"UNASYN 3GM ADD/VAN",7030679,"CDM ",636,RC,J0295,HCPCS,OUTPATIENT,,,46.5,37.2,,,,,,,,0,"other ","not separately reimbursment ",2.33,100,,1.77,1.77,1.77,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",43.25,93,,34.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.53,85,,31.62,,,0,"percent of total billed charges ","85% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",2.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.46,87,,32.37,,,0,"percent of total billed charges ","87% of total billed charges ",2.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",2.21,43.25,
"VASOTEC 2.5MG TAB",7030729,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"PEPTO-BISMOL TAB",7030786,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7.5,6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.25,70,,4.20,,,0,"percent of total billed charges ","70% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",6.98,93,,5.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6.38,85,,5.10,,,0,"percent of total billed charges ","85% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.53,87,,5.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.25,70,,4.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,6.98,
"CYTOTEC 200MCG TAB",7030943,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"DILTIAZEM SR 90MG CAP",7031024,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"LOPERAMIDE 1MG/5ML 120ML BTL",7031057,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,34.5,27.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.15,70,,19.32,,,0,"percent of total billed charges ","70% of total billed charges ",31.05,90,,24.84,,,0,"percent of total billed charges ","90% of total billed charges ",32.09,93,,25.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",29.33,85,,23.46,,,0,"percent of total billed charges ","85% of total billed charges ",31.05,90,,24.84,,,0,"percent of total billed charges ","90% of total billed charges ",31.05,90,,24.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.02,87,,24.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.15,70,,19.32,,,0,"percent of total billed charges ","70% of total billed charges ",24.15,32.09,
"K-DUR 20MEG TAB",7031123,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"NORMODYNE 100MG TAB",7031230,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"VOLTAREN 50MG TAB",7031271,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"MICRONASE 2.5MG CAP",7031313,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"SUPRAX SUSP 100MG/5ML 50ML",7031347,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,320,256,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",224,70,,179.20,,,0,"percent of total billed charges ","70% of total billed charges ",288,90,,230.40,,,0,"percent of total billed charges ","90% of total billed charges ",297.6,93,,238.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",272,85,,217.60,,,0,"percent of total billed charges ","85% of total billed charges ",288,90,,230.40,,,0,"percent of total billed charges ","90% of total billed charges ",288,90,,230.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",278.4,87,,222.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",224,70,,179.20,,,0,"percent of total billed charges ","70% of total billed charges ",224,297.6,
"TEGRETOL SUSP 30ML",7031453,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,38.5,30.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,93,,28.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.73,85,,26.18,,,0,"percent of total billed charges ","85% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.5,87,,26.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",26.95,35.81,
"PROCARDIA XL 30MG",7031578,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"FORTAZ 2GM ADD/VAN",7031693,"CDM ",636,RC,J0713,HCPCS,OUTPATIENT,,,66,52.8,,,,,,,,0,"other ","not separately reimbursment ",2.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",46.2,70,,36.96,,,0,"percent of total billed charges ","70% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",61.38,93,,49.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.99,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",56.1,85,,44.88,,,0,"percent of total billed charges ","85% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",1.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.42,87,,45.94,,,0,"percent of total billed charges ","87% of total billed charges ",1.97,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",46.2,70,,36.96,,,0,"percent of total billed charges ","70% of total billed charges ",1.97,61.38,
"TORADOL 30MG INJ",7031875,"CDM ",636,RC,J1885,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",0.9,100,,0.98,0.98,0.98,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,35.86,1.27,44.82,17,"percent of total billed charges ","87% of total billed charges ",0.48,100,,0.49,0.49,0.49,"1 through 10","fee schedule ","100% of KS medicaid fee schedule ",0.28,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.28,45.57,
"TORADOL 60MG INJ 2ML",7031958,"CDM ",636,RC,J1885,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",0.9,100,,0.98,0.98,0.98,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,35.86,1.27,44.82,17,"percent of total billed charges ","87% of total billed charges ",0.48,100,,0.49,0.49,0.49,"1 through 10","fee schedule ","100% of KS medicaid fee schedule ",0.28,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.28,45.57,
"DIFLUCAN 100MG TAB",7031966,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,24,19.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.8,70,,13.44,,,0,"percent of total billed charges ","70% of total billed charges ",21.6,90,,17.28,,,0,"percent of total billed charges ","90% of total billed charges ",22.32,93,,17.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.4,85,,16.32,,,0,"percent of total billed charges ","85% of total billed charges ",21.6,90,,17.28,,,0,"percent of total billed charges ","90% of total billed charges ",21.6,90,,17.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.88,87,,16.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.8,70,,13.44,,,0,"percent of total billed charges ","70% of total billed charges ",16.8,22.32,
"CALAN SR 180MG TAB",7032048,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"LOPID 600 MG TAB",7032139,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,11.5,9.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.05,70,,6.44,,,0,"percent of total billed charges ","70% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.7,93,,8.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.78,85,,7.82,,,0,"percent of total billed charges ","85% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.01,87,,8.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.05,70,,6.44,,,0,"percent of total billed charges ","70% of total billed charges ",8.05,10.7,
"WELLBUTRIN 100MG TAB",7032196,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"CARDIZEM SR 60MG CAP",7032287,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"MONOPRIL 10MG TAB",7032527,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"ALTACE 2.5MG CAPS",7032543,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"CITRUCEL ORAN 16OZ",7032626,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"CORDARONE 200MG TAB",7032725,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"COUMADIN 1MG TAB",7032881,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"PRIVIGEN 10% 5GM/50ML",7032915,"CDM ",636,RC,J1459,HCPCS,OUTPATIENT,,,1512,1209.6,,,,,,,,0,"other ","not separately reimbursment ",61.96,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",1058.4,70,,846.72,,,0,"percent of total billed charges ","70% of total billed charges ",1360.8,90,,1088.64,,,0,"percent of total billed charges ","90% of total billed charges ",1406.16,93,,1124.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1285.2,85,,1028.16,,,0,"percent of total billed charges ","85% of total billed charges ",1360.8,90,,1088.64,,,0,"percent of total billed charges ","90% of total billed charges ",1360.8,90,,1088.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1315.44,87,,1052.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",50.28,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1058.4,70,,846.72,,,0,"percent of total billed charges ","70% of total billed charges ",50.28,1406.16,
"HALLS COUGH DROP/PKG",7032931,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,1,0.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.7,70,,0.56,,,0,"percent of total billed charges ","70% of total billed charges ",0.9,90,,0.72,,,0,"percent of total billed charges ","90% of total billed charges ",0.93,93,,0.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",0.85,85,,0.68,,,0,"percent of total billed charges ","85% of total billed charges ",0.9,90,,0.72,,,0,"percent of total billed charges ","90% of total billed charges ",0.9,90,,0.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",0.87,87,,0.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.7,70,,0.56,,,0,"percent of total billed charges ","70% of total billed charges ",0.7,0.93,
"DEPAKOTE SPR 125MG CAP",7032949,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"CARDIZEM CD 180MG CAP",7033111,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"CARDIZEM CD 240MG CAP",7033129,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"HYDREA 500MG CAP",7033152,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"NAPROSYN 500MG TABS",7033350,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"CEFZIL 125MG/5ML SUSP 50ML",7033368,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,75.5,60.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",70.22,93,,56.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",64.18,85,,51.34,,,0,"percent of total billed charges ","85% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",65.69,87,,52.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",52.85,70.22,
"ROCEPHIN GM2 VIAL",7033392,"CDM ",636,RC,J0696,HCPCS,OUTPATIENT,,,111.5,89.2,,,,,,,,0,"other ","not separately reimbursment ",0.69,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",78.05,70,,62.44,,,0,"percent of total billed charges ","70% of total billed charges ",100.35,90,,80.28,,,0,"percent of total billed charges ","90% of total billed charges ",103.7,93,,82.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.51,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",94.78,85,,75.82,,,0,"percent of total billed charges ","85% of total billed charges ",100.35,90,,80.28,,,0,"percent of total billed charges ","90% of total billed charges ",100.35,90,,80.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",97.01,87,,1.83,0.39,41.08,12,"percent of total billed charges ","87% of total billed charges ",0.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",78.05,70,,62.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.5,103.7,
"TORADOL 10MG TAB",7033475,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"ROWASA 4GM/60ML",7033509,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,54,43.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.8,70,,30.24,,,0,"percent of total billed charges ","70% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",50.22,93,,40.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",45.9,85,,36.72,,,0,"percent of total billed charges ","85% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",46.98,87,,37.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.8,70,,30.24,,,0,"percent of total billed charges ","70% of total billed charges ",37.8,50.22,
"PROSCAR 5MG TABLET",7033665,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"ZOCOR 10MG TAB",7033681,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"SLOW-MAG TABLET",7033731,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"GLYNASE 3MG TAB",7033772,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"CALAN SR 120MG CAP",7033798,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"LOTENSIN 10MG TAB",7033822,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"ATENOLOL TAB 25MG",7033871,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"VANCOMYCIN 1GM INJ",7033905,"CDM ",636,RC,J3373,HCPCS,OUTPATIENT,,,51,40.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",47.43,93,,37.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.35,85,,34.68,,,0,"percent of total billed charges ","85% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.37,87,,35.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",35.7,47.43,
"BIAXIN 500MG TAB",7033913,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"CARDURA 1MG TAB",7034044,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"ACCUPRIL 10MG TAB",7034077,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"RYTHMOL TAB 150MG",7034119,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13,10.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.1,70,,7.28,,,0,"percent of total billed charges ","70% of total billed charges ",11.7,90,,9.36,,,0,"percent of total billed charges ","90% of total billed charges ",12.09,93,,9.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.05,85,,8.84,,,0,"percent of total billed charges ","85% of total billed charges ",11.7,90,,9.36,,,0,"percent of total billed charges ","90% of total billed charges ",11.7,90,,9.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.31,87,,9.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.1,70,,7.28,,,0,"percent of total billed charges ","70% of total billed charges ",9.1,12.09,
"PHOSLO TAB 667MG",7034234,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"PAXIL 20MG TAB",7034382,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"CARDIZEM CD 120MG",7034499,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"CLARITIN 10MG TAB",7034580,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"PROZAC 10MG CAP",7034622,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"NORVASC 5MG TAB",7034713,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"PRELONE SYRUP 15MG/5ML 30ML",7034721,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"LOVENOX 30MG/0.3ML SYR",7034762,"CDM ",636,RC,J1650,HCPCS,OUTPATIENT,,,54.5,43.6,,,,,,,,0,"other ","not separately reimbursment ",0.8,100,,2.74,2.74,2.74,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",38.15,70,,30.52,,,0,"percent of total billed charges ","70% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",50.69,93,,40.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",46.33,85,,37.06,,,0,"percent of total billed charges ","85% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",47.42,87,,37.24,33.93,40.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",38.15,70,,30.52,,,0,"percent of total billed charges ","70% of total billed charges ",0.76,50.69,
"PERIDEX ORAL RINSEPT",7034853,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,38.5,30.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,93,,28.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.73,85,,26.18,,,0,"percent of total billed charges ","85% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.5,87,,26.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",26.95,35.81,
"PRIVIGEN 10% 20GM",7035025,"CDM ",636,RC,J1459,HCPCS,OUTPATIENT,,,5400,4320,,,,,,,,0,"other ","not separately reimbursment ",61.96,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3780,70,,3024.00,,,0,"percent of total billed charges ","70% of total billed charges ",4860,90,,3888.00,,,0,"percent of total billed charges ","90% of total billed charges ",5022,93,,4017.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4590,85,,3672.00,,,0,"percent of total billed charges ","85% of total billed charges ",4860,90,,3888.00,,,0,"percent of total billed charges ","90% of total billed charges ",4860,90,,3888.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4698,87,,3758.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",50.28,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3780,70,,3024.00,,,0,"percent of total billed charges ","70% of total billed charges ",50.28,5022,
"DEPAKOTE TAB 250 MG",7035140,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"ZOVIRAX SUSP 30MLS",7035157,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"SPORANOX 100 MG CAP",7035215,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,27.5,22,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.25,70,,15.40,,,0,"percent of total billed charges ","70% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",25.58,93,,20.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.38,85,,18.70,,,0,"percent of total billed charges ","85% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",23.93,87,,19.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.25,70,,15.40,,,0,"percent of total billed charges ","70% of total billed charges ",19.25,25.58,
"PYRAZINAMIDE 500MG TAB",7035223,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"RISPERDAL 1MG TAB",7035322,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"HYTRIN 1MG TAB",7035371,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"AMBIEN 5MG. TAB",7035397,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"ZOFRAN 2MG/ML  2ML VIAL",7035462,"CDM ",636,RC,J2405,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",0.13,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.09,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,39.65,21.78,39.65,14,"percent of total billed charges ","87% of total billed charges ",0.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.09,45.57,
"BETAPACE 80MG TABLET",7035512,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"RIFADIN 150MG CAP",7035587,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"RIFABUTIN 150MG CAP",7035589,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,23.5,18.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.45,70,,13.16,,,0,"percent of total billed charges ","70% of total billed charges ",21.15,90,,16.92,,,0,"percent of total billed charges ","90% of total billed charges ",21.86,93,,17.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.98,85,,15.98,,,0,"percent of total billed charges ","85% of total billed charges ",21.15,90,,16.92,,,0,"percent of total billed charges ","90% of total billed charges ",21.15,90,,16.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.45,87,,16.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.45,70,,13.16,,,0,"percent of total billed charges ","70% of total billed charges ",16.45,21.86,
"SORBITOL 70% 480ML",7035629,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,38.5,30.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,93,,28.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.73,85,,26.18,,,0,"percent of total billed charges ","85% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.5,87,,26.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",26.95,35.81,
"CAFFINE CIT SOL 20MG/ML 3ML",7035645,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,38.5,30.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,93,,28.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.73,85,,26.18,,,0,"percent of total billed charges ","85% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.5,87,,26.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",26.95,35.81,
"DEMADEX 20MG TAB",7035710,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"TOPROL XL 50MG TAB",7035744,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"ASACOL 400MG TAB",7035793,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"MIDAMOR TAB 5MG",7035892,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"CALCIMAR 400U VIAL-I 2ML",7035983,"CDM ",636,RC,A9270,HCPCS,OUTPATIENT,,,3847,3077.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2692.9,70,,2154.32,,,0,"percent of total billed charges ","70% of total billed charges ",3462.3,90,,2769.84,,,0,"percent of total billed charges ","90% of total billed charges ",3577.71,93,,2862.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3269.95,85,,2615.96,,,0,"percent of total billed charges ","85% of total billed charges ",3462.3,90,,2769.84,,,0,"percent of total billed charges ","90% of total billed charges ",3462.3,90,,2769.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3346.89,87,,2677.51,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2692.9,70,,2154.32,,,0,"percent of total billed charges ","70% of total billed charges ",2692.9,3577.71,
"CARDIZEM TAB 60MG",7036106,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"HCTZ 25MG TAB",7036205,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"CHLORTHALIDONE 25MG TAB",7036213,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"LITHIUM CARB 300MG TAB",7036247,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"ERYTHROMICIN OPH OIN 0.5% 35GM",7036254,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,61,48.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",56.73,93,,45.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51.85,85,,41.48,,,0,"percent of total billed charges ","85% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",53.07,87,,42.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",42.7,56.73,
"BICITRA SF 30ML UDC",7036379,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"FML FORTE LIQ 0/55ML",7036429,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,65.5,52.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.85,70,,36.68,,,0,"percent of total billed charges ","70% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",60.92,93,,48.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",55.68,85,,44.54,,,0,"percent of total billed charges ","85% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",56.99,87,,45.59,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.85,70,,36.68,,,0,"percent of total billed charges ","70% of total billed charges ",45.85,60.92,
"NICODERM TRANS 21MG",7036536,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"PHILLIPS MOM 30ML",7036577,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"PINK BISMUTH LI20ML",7036585,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,16,12.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.88,93,,11.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.6,85,,10.88,,,0,"percent of total billed charges ","85% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.92,87,,11.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,14.88,
"NITROGLYCERIN SR6.5M",7036635,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"ALBUTEROL SULFA 2MG",7036726,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"DOPAMINE 200MG/5ML",7036759,"CDM ",636,RC,J1265,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",0.37,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.37,45.57,
"PSEUDOEPHEDRINE 30MG TAB",7036973,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"PSEUDOEPHEDRINE 60MG TAB",7036981,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7.5,6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.25,70,,4.20,,,0,"percent of total billed charges ","70% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",6.98,93,,5.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6.38,85,,5.10,,,0,"percent of total billed charges ","85% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.53,87,,5.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.25,70,,4.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,6.98,
"PREDNISONE 20MG TAB",7037039,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"NIFEREX 150MG CAP",7037146,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"OS-CAL 500+D TAB",7037179,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"PYRIDIATE 100MG TAB",7037211,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"SECTRAL 200MG CAP",7037237,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"HYDROXYZINE 25MG TAB",7037351,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"CHERRY SYRUP 30ML",7037369,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"LACTULOSE SYRUP 30ML",7037385,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,38.5,30.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,93,,28.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.73,85,,26.18,,,0,"percent of total billed charges ","85% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.5,87,,26.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",26.95,35.81,
"DOXYCYCLINE HYC100MG",7037393,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,15,12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.95,93,,11.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.75,85,,10.20,,,0,"percent of total billed charges ","85% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.05,87,,10.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",10.5,13.95,
"BETHANECOL CL 25MG TAB",7037427,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"HYDRALAZINE 50MG TAB",7037450,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"HYDRALAZINE 25MG TAB",7037468,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"HYDRALAZINE 10MG TAB",7037476,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"MECLIZINE 25MG TAB",7037484,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"MECLIZINE 12.5MG TAB",7037492,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"DEXAMETH INTENS 30ML",7037583,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,62.5,50,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.75,70,,35.00,,,0,"percent of total billed charges ","70% of total billed charges ",56.25,90,,45.00,,,0,"percent of total billed charges ","90% of total billed charges ",58.13,93,,46.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",53.13,85,,42.50,,,0,"percent of total billed charges ","85% of total billed charges ",56.25,90,,45.00,,,0,"percent of total billed charges ","90% of total billed charges ",56.25,90,,45.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",54.38,87,,43.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.75,70,,35.00,,,0,"percent of total billed charges ","70% of total billed charges ",43.75,58.13,
"FERROUS SULF 90MG/5ML SYR 30ML",7037658,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,1.5,1.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.05,70,,0.84,,,0,"percent of total billed charges ","70% of total billed charges ",1.35,90,,1.08,,,0,"percent of total billed charges ","90% of total billed charges ",1.4,93,,1.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1.28,85,,1.02,,,0,"percent of total billed charges ","85% of total billed charges ",1.35,90,,1.08,,,0,"percent of total billed charges ","90% of total billed charges ",1.35,90,,1.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1.31,87,,1.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.05,70,,0.84,,,0,"percent of total billed charges ","70% of total billed charges ",1.05,1.4,
"ZEXTERIL 5MG TAB",7037815,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"ZESTERIL 10MG TAB",7037823,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"ZESTERIL 20MG TAB",7037831,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"HYDROXYZINE 25MG TAB",7037849,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"HYDROXYZINE 10MG TAB",7037864,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"SULFA/TRIMETH 800/160MG TAB",7037898,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"DIPHENHYDRAMINE 25MG TAB",7037906,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"AMITRIPTYLINE 10MG TAB",7038003,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"AMITRIPTYLINE 25MG TAB",7038011,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"AMITRIPTYLINE 50MG TAB",7038029,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"HALOPERIDOL 5MG TAB",7038052,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"HALOPERIDOL 2MG TAB",7038060,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"DOCUSATE SOD 100MG CAP",7038078,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"LEVSIN DROPS 0.125MG/ML",7038243,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,115.5,92.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.85,70,,64.68,,,0,"percent of total billed charges ","70% of total billed charges ",103.95,90,,83.16,,,0,"percent of total billed charges ","90% of total billed charges ",107.42,93,,85.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",98.18,85,,78.54,,,0,"percent of total billed charges ","85% of total billed charges ",103.95,90,,83.16,,,0,"percent of total billed charges ","90% of total billed charges ",103.95,90,,83.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.49,87,,80.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.85,70,,64.68,,,0,"percent of total billed charges ","70% of total billed charges ",80.85,107.42,
"SULFAMYLON S-153 1OZ",7038417,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,38.5,30.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,93,,28.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.73,85,,26.18,,,0,"percent of total billed charges ","85% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.5,87,,26.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",26.95,35.81,
"SUSPENDOL-S 30ML",7038433,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,56.5,45.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.55,70,,31.64,,,0,"percent of total billed charges ","70% of total billed charges ",50.85,90,,40.68,,,0,"percent of total billed charges ","90% of total billed charges ",52.55,93,,42.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",48.03,85,,38.42,,,0,"percent of total billed charges ","85% of total billed charges ",50.85,90,,40.68,,,0,"percent of total billed charges ","90% of total billed charges ",50.85,90,,40.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",49.16,87,,39.33,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.55,70,,31.64,,,0,"percent of total billed charges ","70% of total billed charges ",39.55,52.55,
"VERSED 5MG/MLVIAL 1ML",7038524,"CDM ",636,RC,J2250,HCPCS,OUTPATIENT,,,50,40,,,,,,,,0,"other ","not separately reimbursment ",0.18,100,,1.60,1.60,1.60,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",46.5,93,,37.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.5,85,,34.00,,,0,"percent of total billed charges ","85% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.5,87,,39.65,15.27,43.62,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",0.18,46.5,
"METHADONE 10MG TAB",7038631,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,11,8.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",10.23,93,,8.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.35,85,,7.48,,,0,"percent of total billed charges ","85% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.57,87,,7.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.7,10.23,
"HUMULIN R 100U/ML 10ML",7039092,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,34,27.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.8,70,,19.04,,,0,"percent of total billed charges ","70% of total billed charges ",30.6,90,,24.48,,,0,"percent of total billed charges ","90% of total billed charges ",31.62,93,,25.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.9,85,,23.12,,,0,"percent of total billed charges ","85% of total billed charges ",30.6,90,,24.48,,,0,"percent of total billed charges ","90% of total billed charges ",30.6,90,,24.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.58,87,,23.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.8,70,,19.04,,,0,"percent of total billed charges ","70% of total billed charges ",23.8,31.62,
"MAG-OX 400MG TAB",7039167,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"NOVULIN 70/30 100UML",7039233,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,42,33.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.4,70,,23.52,,,0,"percent of total billed charges ","70% of total billed charges ",37.8,90,,30.24,,,0,"percent of total billed charges ","90% of total billed charges ",39.06,93,,31.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",35.7,85,,28.56,,,0,"percent of total billed charges ","85% of total billed charges ",37.8,90,,30.24,,,0,"percent of total billed charges ","90% of total billed charges ",37.8,90,,30.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",36.54,87,,29.23,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.4,70,,23.52,,,0,"percent of total billed charges ","70% of total billed charges ",29.4,39.06,
"OCUVITE TAB",7039274,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"SYNTHROID 125MCG TAB",7039431,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"TUMS ASSORT/ ROLL",7039530,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"UNASYN 3GM VIAL",7039555,"CDM ",636,RC,J0295,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",2.33,100,,1.77,1.77,1.77,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",2.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",2.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",2.21,45.57,
"VERSED 2MG/2ML AMP",7039621,"CDM ",636,RC,J2250,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",0.18,100,,1.60,1.60,1.60,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,39.65,15.27,43.62,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.18,45.57,
"METRONIDAZOLE 500MG TAB",7039738,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"NEURONTIN 100MG CAP",7039779,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"PENTASA 250MG CAP",7039795,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
BETAMETHASONE0.1%15G,7039944,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,81,64.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.7,70,,45.36,,,0,"percent of total billed charges ","70% of total billed charges ",72.9,90,,58.32,,,0,"percent of total billed charges ","90% of total billed charges ",75.33,93,,60.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",68.85,85,,55.08,,,0,"percent of total billed charges ","85% of total billed charges ",72.9,90,,58.32,,,0,"percent of total billed charges ","90% of total billed charges ",72.9,90,,58.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",70.47,87,,56.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.7,70,,45.36,,,0,"percent of total billed charges ","70% of total billed charges ",56.7,75.33,
"METHADONE 5MG TAB",7040132,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"LORAZEPAM 1MG TAB",7040140,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"LORAZEPAM 2MG TAB",7040157,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"TEMAZEPAM 15MG CAP",7040181,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"AMPICILLIN 500MG CAP",7040215,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"IBUPROFEN 100MG CHEWTAB",7040248,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,11,8.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",10.23,93,,8.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.35,85,,7.48,,,0,"percent of total billed charges ","85% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.57,87,,7.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.7,10.23,
"IBUPROFEN 200MG TAB",7040249,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"HALOPERIDOL 1MG TAB",7040264,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"THIOTHIXENE 5MG CAP",7040272,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"AMANTADINE 100MG CAP",7040322,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"AMPICILLIN 1GM ADVL",7040439,"CDM ",636,RC,J0290,HCPCS,OUTPATIENT,,,60,48,,,,,,,,0,"other ","not separately reimbursment ",1.04,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",42,70,,33.60,,,0,"percent of total billed charges ","70% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",55.8,93,,44.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",51,85,,40.80,,,0,"percent of total billed charges ","85% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",0.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",52.2,87,,41.76,,,0,"percent of total billed charges ","87% of total billed charges ",0.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",42,70,,33.60,,,0,"percent of total billed charges ","70% of total billed charges ",0.81,55.8,
"AMOXC125MG/5ML 100ML",7040470,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"AMOXC250MG/5ML 100ML",7040488,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"LORAZEPAM 0.5MG TAB",7040520,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"ALBUMARC 25% 100ML",7040629,"CDM ",636,RC,P9046,HCPCS,OUTPATIENT,,,387.5,310,,,,,,,,0,"other ","not separately reimbursment ",27.69,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",271.25,70,,217.00,,,0,"percent of total billed charges ","70% of total billed charges ",348.75,90,,279.00,,,0,"percent of total billed charges ","90% of total billed charges ",360.38,93,,288.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",21.19,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",329.38,85,,263.50,,,0,"percent of total billed charges ","85% of total billed charges ",348.75,90,,279.00,,,0,"percent of total billed charges ","90% of total billed charges ",348.75,90,,279.00,,,0,"percent of total billed charges ","90% of total billed charges ",20.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",337.13,87,,269.70,,,0,"percent of total billed charges ","87% of total billed charges ",20.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",271.25,70,,217.00,,,0,"percent of total billed charges ","70% of total billed charges ",20.98,360.38,
ACTIDOSE-AQUA50G/8OZ,7040702,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,68.5,54.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.95,70,,38.36,,,0,"percent of total billed charges ","70% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",63.71,93,,50.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",58.23,85,,46.58,,,0,"percent of total billed charges ","85% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",59.6,87,,47.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.95,70,,38.36,,,0,"percent of total billed charges ","70% of total billed charges ",47.95,63.71,
"CORTEF 10MG TAB",7040926,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"COUMADIN 4MG TAB",7040942,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"AMPICILLIN 2GM ADVL",7041601,"CDM ",636,RC,J0290,HCPCS,OUTPATIENT,,,74.5,59.6,,,,,,,,0,"other ","not separately reimbursment ",1.04,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",69.29,93,,55.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",63.33,85,,50.66,,,0,"percent of total billed charges ","85% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",0.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.82,87,,51.86,,,0,"percent of total billed charges ","87% of total billed charges ",0.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",0.81,69.29,
"OS-CAL 500MG TAB",7041635,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"PROSTIN VR PED 500MCG/ML 5ML",7041817,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,212,169.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.4,70,,118.72,,,0,"percent of total billed charges ","70% of total billed charges ",190.8,90,,152.64,,,0,"percent of total billed charges ","90% of total billed charges ",197.16,93,,157.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",180.2,85,,144.16,,,0,"percent of total billed charges ","85% of total billed charges ",190.8,90,,152.64,,,0,"percent of total billed charges ","90% of total billed charges ",190.8,90,,152.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",184.44,87,,147.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.4,70,,118.72,,,0,"percent of total billed charges ","70% of total billed charges ",148.4,197.16,
"TYLENOL PM 500/25MG TAB",7041965,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"VENTOLIN 2.5MG/3ML NEB",7041999,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"STADOL 2MG/ML 1ML",7042096,"CDM ",636,RC,J0595,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",4.61,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",2.97,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",2.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",2.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",2.94,45.57,
"EFFEXOR 25MG TAB",7042112,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"MS CONTIN TAB 15MG",7042211,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"CORTEF 5MG TAB",7042237,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"PREDNISONE 1MG TAB",7042252,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"ATENOLOL 100MG TAB",7042286,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"DAPSONE 100MG TAB",7042328,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"ZOLOFT 50MG TAB",7042351,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"ULTRAM 50MG TAB",7042476,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
ACTIDOSE/SORBITOL25G,7042484,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,53,42.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",49.29,93,,39.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",45.05,85,,36.04,,,0,"percent of total billed charges ","85% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",46.11,87,,36.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",37.1,49.29,
"LACTULOSE 30ML DSCUP",7042518,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"DIFLUCAN SUSP 35ML",7042559,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,100,80,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70,70,,56.00,,,0,"percent of total billed charges ","70% of total billed charges ",90,90,,72.00,,,0,"percent of total billed charges ","90% of total billed charges ",93,93,,74.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",85,85,,68.00,,,0,"percent of total billed charges ","85% of total billed charges ",90,90,,72.00,,,0,"percent of total billed charges ","90% of total billed charges ",90,90,,72.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",87,87,,69.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70,70,,56.00,,,0,"percent of total billed charges ","70% of total billed charges ",70,93,
"GLUCOPHAGE 500MG TAB",7042567,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"TYLENOL E.R. CAPLET",7042625,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"LOTENSIN 5MG TAB",7042682,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"EPOGEN 10,000UNIT/ML",7042781,"CDM ",636,RC,J0885,HCPCS,OUTPATIENT,,,512.5,410,,,,,,,,0,"other ","not separately reimbursment ",10.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",358.75,70,,287.00,,,0,"percent of total billed charges ","70% of total billed charges ",461.25,90,,369.00,,,0,"percent of total billed charges ","90% of total billed charges ",476.63,93,,381.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",8.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",435.63,85,,348.50,,,0,"percent of total billed charges ","85% of total billed charges ",461.25,90,,369.00,,,0,"percent of total billed charges ","90% of total billed charges ",461.25,90,,369.00,,,0,"percent of total billed charges ","90% of total billed charges ",8.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",445.88,87,,356.70,,,0,"percent of total billed charges ","87% of total billed charges ",8.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.74,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",358.75,70,,287.00,,,0,"percent of total billed charges ","70% of total billed charges ",7.74,476.63,
"NON ESRD EPOETIN 10,000UN 1MLV",7042784,"CDM ",636,RC,J0885,HCPCS,OUTPATIENT,,,211,168.8,,,,,,,,0,"other ","not separately reimbursment ",10.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",147.7,70,,118.16,,,0,"percent of total billed charges ","70% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",196.23,93,,156.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",8.23,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",179.35,85,,143.48,,,0,"percent of total billed charges ","85% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",8.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",183.57,87,,146.86,,,0,"percent of total billed charges ","87% of total billed charges ",8.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",7.74,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",147.7,70,,118.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.74,196.23,
"ESRD EPIETIN 100 UNINTS 1MLVL",7042785,"CDM ",636,RC,Q4081,HCPCS,OUTPATIENT,,,211,168.8,,,,,,,,0,"other ","not separately reimbursment ",1.06,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",147.7,70,,118.16,,,0,"percent of total billed charges ","70% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",196.23,93,,156.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.83,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",179.35,85,,143.48,,,0,"percent of total billed charges ","85% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",189.9,90,,151.92,,,0,"percent of total billed charges ","90% of total billed charges ",0.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",183.57,87,,146.86,,,0,"percent of total billed charges ","87% of total billed charges ",0.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",147.7,70,,118.16,,,0,"percent of total billed charges ","70% of total billed charges ",0.82,196.23,
"AMOXICILLIN 500MGCAP",7042799,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"ATENOLOL 50MG TAB",7042807,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"BISACODYL 5MG TAB",7042856,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"STUARTNATAL PLUS",7042948,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"SYNTHROID 112MCG TAB",7042989,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"CLONIDINE 0.2MG TAB",7043177,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"INDERAL LA 60MG CAP",7043201,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"TRAZODONE 50MG TAB",7043227,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"PROPRANOL 10MG TAB",7043276,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"VITAMIN K 10MG/ML",7043292,"CDM ",636,RC,J3430,HCPCS,OUTPATIENT,,,85,68,,,,,,,,0,"other ","not separately reimbursment ",3.61,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",59.5,70,,47.60,,,0,"percent of total billed charges ","70% of total billed charges ",76.5,90,,61.20,,,0,"percent of total billed charges ","90% of total billed charges ",79.05,93,,63.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",3.6,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",72.25,85,,57.80,,,0,"percent of total billed charges ","85% of total billed charges ",76.5,90,,61.20,,,0,"percent of total billed charges ","90% of total billed charges ",76.5,90,,61.20,,,0,"percent of total billed charges ","90% of total billed charges ",3.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",73.95,87,,59.16,,,0,"percent of total billed charges ","87% of total billed charges ",3.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",59.5,70,,47.60,,,0,"percent of total billed charges ","70% of total billed charges ",3.56,79.05,
"LAMICTAL 25MG TAB",7043342,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"NEURONTIN 300MG CAP",7043375,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"TRAZODONE 100MG TAB",7043508,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"ISOSORBIDE 20MG ORAL TAB",7043565,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"SYNTHROID 75MCG TAB",7043573,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"CEPHALEXIN 250MG/5ML 100ML",7043672,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,83,66.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",72.21,87,,57.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",58.1,77.19,
"PEN VK 250/5ML 100ML",7043706,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,42.5,34,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.75,70,,23.80,,,0,"percent of total billed charges ","70% of total billed charges ",38.25,90,,30.60,,,0,"percent of total billed charges ","90% of total billed charges ",39.53,93,,31.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",36.13,85,,28.90,,,0,"percent of total billed charges ","85% of total billed charges ",38.25,90,,30.60,,,0,"percent of total billed charges ","90% of total billed charges ",38.25,90,,30.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",36.98,87,,29.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.75,70,,23.80,,,0,"percent of total billed charges ","70% of total billed charges ",29.75,39.53,
"IMITREX 25MG TAB",7043862,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,60,48,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42,70,,33.60,,,0,"percent of total billed charges ","70% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",55.8,93,,44.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51,85,,40.80,,,0,"percent of total billed charges ","85% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",52.2,87,,41.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42,70,,33.60,,,0,"percent of total billed charges ","70% of total billed charges ",42,55.8,
"COZAAR 50MG TAB",7043946,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"NORVASC 10MG TAB",7043979,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"ALEVE 200MG TAB",7044019,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"MELATONIN 1MG TAB",7044092,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"HALOPERIDOL 0.5MG TAB",7044167,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"CYTOMEL 5MCG TAB",7044175,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,11,8.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",10.23,93,,8.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.35,85,,7.48,,,0,"percent of total billed charges ","85% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.57,87,,7.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.7,10.23,
"IMDUR 30MG TAB",7044266,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"RISPERDAL 2MG TAB",7044399,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,20.5,16.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.35,70,,11.48,,,0,"percent of total billed charges ","70% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",19.07,93,,15.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.43,85,,13.94,,,0,"percent of total billed charges ","85% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.84,87,,14.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.35,70,,11.48,,,0,"percent of total billed charges ","70% of total billed charges ",14.35,19.07,
"KLONOPIN 1MG TAB",7044464,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"COZAAR 25MG TAB",7044472,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"DIPYRIDAMOLE 25MG TAB",7044589,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"ZINC 50MG TAB",7044597,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"CALTRATE +VIT D TAB 600MG",7044654,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"ZESTRIL 2.5MG TAB",7044720,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"HYTRIN 5MG TAB",7044761,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"DIFLUCAN 150 MG TAB",7044779,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,34,27.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.8,70,,19.04,,,0,"percent of total billed charges ","70% of total billed charges ",30.6,90,,24.48,,,0,"percent of total billed charges ","90% of total billed charges ",31.62,93,,25.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.9,85,,23.12,,,0,"percent of total billed charges ","85% of total billed charges ",30.6,90,,24.48,,,0,"percent of total billed charges ","90% of total billed charges ",30.6,90,,24.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.58,87,,23.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.8,70,,19.04,,,0,"percent of total billed charges ","70% of total billed charges ",23.8,31.62,
"LIDOCAINE 2% VISC 100ML",7044878,"CDM ",250,RC,A9270,HCPCS,OUTPATIENT,,,16.5,13.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.55,70,,9.24,,,0,"percent of total billed charges ","70% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",15.35,93,,12.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.03,85,,11.22,,,0,"percent of total billed charges ","85% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.36,87,,11.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.55,70,,9.24,,,0,"percent of total billed charges ","70% of total billed charges ",11.55,15.35,
"CLONIDINE HCL 0.1MG",7044977,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"ZYRTEC 10MG TAB",7045115,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"OXYIR 5MG CAP",7045131,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"OXYCONTIN 10MG TAB",7045149,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"OXYCONTIN 20MG TAB",7045156,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,15,12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.95,93,,11.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.75,85,,10.20,,,0,"percent of total billed charges ","85% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.05,87,,10.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",10.5,13.95,
"OXYCONTIN 40MG TAB",7045164,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,18.5,14.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.95,70,,10.36,,,0,"percent of total billed charges ","70% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",17.21,93,,13.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.73,85,,12.58,,,0,"percent of total billed charges ","85% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.1,87,,12.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.95,70,,10.36,,,0,"percent of total billed charges ","70% of total billed charges ",12.95,17.21,
"ASPIRIN ENTERIC 81MG",7045198,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"ALTACE 5MG CAP",7045263,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"ZITHROMAX 100MG/5ML  15ML",7045305,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,101,80.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.7,70,,56.56,,,0,"percent of total billed charges ","70% of total billed charges ",90.9,90,,72.72,,,0,"percent of total billed charges ","90% of total billed charges ",93.93,93,,75.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",85.85,85,,68.68,,,0,"percent of total billed charges ","85% of total billed charges ",90.9,90,,72.72,,,0,"percent of total billed charges ","90% of total billed charges ",90.9,90,,72.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",87.87,87,,70.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.7,70,,56.56,,,0,"percent of total billed charges ","70% of total billed charges ",70.7,93.93,
"ZOSYN 2.25GM VIAL",7045313,"CDM ",636,RC,J2543,HCPCS,OUTPATIENT,,,62,49.6,,,,,,,,0,"other ","not separately reimbursment ",1.58,100,,9.01,9.01,9.01,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",43.4,70,,34.72,,,0,"percent of total billed charges ","70% of total billed charges ",55.8,90,,44.64,,,0,"percent of total billed charges ","90% of total billed charges ",57.66,93,,46.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",52.7,85,,42.16,,,0,"percent of total billed charges ","85% of total billed charges ",55.8,90,,44.64,,,0,"percent of total billed charges ","90% of total billed charges ",55.8,90,,44.64,,,0,"percent of total billed charges ","90% of total billed charges ",1.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.94,87,,218.09,202.23,233.95,"1 through 10","percent of total billed charges ","87% of total billed charges ",1.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",43.4,70,,34.72,,,0,"percent of total billed charges ","70% of total billed charges ",1.48,57.66,
"PIPERACILLIN-TAZOBACT 2.25GMVL",7045314,"CDM ",636,RC,J2543,HCPCS,OUTPATIENT,,,135,108,,,,,,,,0,"other ","not separately reimbursment ",1.58,100,,9.01,9.01,9.01,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",125.55,93,,100.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",114.75,85,,91.80,,,0,"percent of total billed charges ","85% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",1.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.45,87,,218.09,202.23,233.95,"1 through 10","percent of total billed charges ","87% of total billed charges ",1.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",1.48,125.55,
"PIPERAIL TAZO 3.375GM VL",7045315,"CDM ",636,RC,J2543,HCPCS,OUTPATIENT,,,135,108,,,,,,,,0,"other ","not separately reimbursment ",1.58,100,,9.01,9.01,9.01,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",125.55,93,,100.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",114.75,85,,91.80,,,0,"percent of total billed charges ","85% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",1.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.45,87,,218.09,202.23,233.95,"1 through 10","percent of total billed charges ","87% of total billed charges ",1.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",1.48,125.55,
"ZYPREXA 10MG TAB",7045339,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,32,25.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.4,70,,17.92,,,0,"percent of total billed charges ","70% of total billed charges ",28.8,90,,23.04,,,0,"percent of total billed charges ","90% of total billed charges ",29.76,93,,23.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",27.2,85,,21.76,,,0,"percent of total billed charges ","85% of total billed charges ",28.8,90,,23.04,,,0,"percent of total billed charges ","90% of total billed charges ",28.8,90,,23.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",27.84,87,,22.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.4,70,,17.92,,,0,"percent of total billed charges ","70% of total billed charges ",22.4,29.76,
"FUROSEMIDE 40MG/4ML",7045388,"CDM ",636,RC,J1938,HCPCS,OUTPATIENT,,,50,40,,,,,,,,0,"other ","not separately reimbursment ",,,,2.22,2.22,2.22,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",46.5,93,,37.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.5,85,,34.00,,,0,"percent of total billed charges ","85% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.5,87,,34.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",35,46.5,
"CALAN 40MG TAB",7045560,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"NORTRIPTYLINE 25MG CAP",7045685,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"ZAROXOLYN 2.5MG TAB",7045693,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"MASTISOL LIQ 2/3CC",7045701,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,15,12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.95,93,,11.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.75,85,,10.20,,,0,"percent of total billed charges ","85% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.05,87,,10.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",10.5,13.95,
"ARICEPT 5MG TAB",7045735,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"AUGMENTIN 875MG TAB",7045792,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"ZITHROMAX 200MG/5ML 30ML",7046014,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,101,80.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.7,70,,56.56,,,0,"percent of total billed charges ","70% of total billed charges ",90.9,90,,72.72,,,0,"percent of total billed charges ","90% of total billed charges ",93.93,93,,75.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",85.85,85,,68.68,,,0,"percent of total billed charges ","85% of total billed charges ",90.9,90,,72.72,,,0,"percent of total billed charges ","90% of total billed charges ",90.9,90,,72.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",87.87,87,,70.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.7,70,,56.56,,,0,"percent of total billed charges ","70% of total billed charges ",70.7,93.93,
"LOTREL 5/10MG CAP",7046097,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"REMERON 15MG TAB",7046105,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"DEPAKOTE 125MG TAB",7046139,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"ZIDOVUDINE SYRUP 10 MG/ML 30ML",7046147,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,21.5,17.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.05,70,,12.04,,,0,"percent of total billed charges ","70% of total billed charges ",19.35,90,,15.48,,,0,"percent of total billed charges ","90% of total billed charges ",20,93,,16.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.28,85,,14.62,,,0,"percent of total billed charges ","85% of total billed charges ",19.35,90,,15.48,,,0,"percent of total billed charges ","90% of total billed charges ",19.35,90,,15.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.71,87,,14.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.05,70,,12.04,,,0,"percent of total billed charges ","70% of total billed charges ",15.05,20,
"ZOCOR 20MG TAB",7046287,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"CARDURA 2MG TAB",7046360,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"LEVAQUIN 500MG TAB",7046402,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,45,36,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.15,87,,31.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",31.5,41.85,
"LIPITOR 10MG TAB",7046451,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"GLUCOPHAGE 850MG TAB",7046550,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"THERAPEUTIC MULTIVITAMIN TAB",7046568,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"COREG 3.125MG TAB",7046600,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"ZYPREXA 2.5MG  TAB",7046683,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,26.5,21.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.55,70,,14.84,,,0,"percent of total billed charges ","70% of total billed charges ",23.85,90,,19.08,,,0,"percent of total billed charges ","90% of total billed charges ",24.65,93,,19.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",22.53,85,,18.02,,,0,"percent of total billed charges ","85% of total billed charges ",23.85,90,,19.08,,,0,"percent of total billed charges ","90% of total billed charges ",23.85,90,,19.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",23.06,87,,18.45,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.55,70,,14.84,,,0,"percent of total billed charges ","70% of total billed charges ",18.55,24.65,
"ZITHROMAX 250MG TAB",7046733,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,20,16,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14,70,,11.20,,,0,"percent of total billed charges ","70% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",18.6,93,,14.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17,85,,13.60,,,0,"percent of total billed charges ","85% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.4,87,,13.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14,70,,11.20,,,0,"percent of total billed charges ","70% of total billed charges ",14,18.6,
"PYRIDOXINE HCL 50MG TAB",7046774,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"ROCALTROL 0.25 MCG",7046816,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"AMARYL 2 MG TAB",7046824,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"ZYBAN 150MG",7046907,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"SEROQUEL 25MG TAB",7046915,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"SEROQUEL 100MG TAB",7046931,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,18,14.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.74,93,,13.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.3,85,,12.24,,,0,"percent of total billed charges ","85% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.66,87,,12.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,16.74,
"FLOMAX 0.4MG CAP",7046949,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"TOPAMAX 25MG TABLET",7046980,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"TOPAMAX 100MG TABLET",7046998,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,18.5,14.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.95,70,,10.36,,,0,"percent of total billed charges ","70% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",17.21,93,,13.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.73,85,,12.58,,,0,"percent of total billed charges ","85% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.1,87,,12.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.95,70,,10.36,,,0,"percent of total billed charges ","70% of total billed charges ",12.95,17.21,
"NEUTRO PHOS.PACKETS",7047038,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"TRIMETHOPRIM 100MG TAB",7047079,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"TEGNETOL XR 200MG TAB",7047145,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"TEGNETOL XR 100MG TAB",7047152,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"EFFEXOR 37.5MG XR CAP",7047376,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"NAROPIN 0.5% 5MG/ML 30ML",7047558,"CDM ",636,RC,J2795,HCPCS,OUTPATIENT,,,50.5,40.4,,,,,,,,0,"other ","not separately reimbursment ",0.11,100,,15.68,15.68,15.68,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",35.35,70,,28.28,,,0,"percent of total billed charges ","70% of total billed charges ",45.45,90,,36.36,,,0,"percent of total billed charges ","90% of total billed charges ",46.97,93,,37.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.93,85,,34.34,,,0,"percent of total billed charges ","85% of total billed charges ",45.45,90,,36.36,,,0,"percent of total billed charges ","90% of total billed charges ",45.45,90,,36.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.94,87,,35.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.35,70,,28.28,,,0,"percent of total billed charges ","70% of total billed charges ",0.11,46.97,
"NAROPIN 0.2% 2MG/ML 100ML",7047566,"CDM ",636,RC,J2795,HCPCS,OUTPATIENT,,,121.5,97.2,,,,,,,,0,"other ","not separately reimbursment ",0.11,100,,15.68,15.68,15.68,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",85.05,70,,68.04,,,0,"percent of total billed charges ","70% of total billed charges ",109.35,90,,87.48,,,0,"percent of total billed charges ","90% of total billed charges ",113,93,,90.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",103.28,85,,82.62,,,0,"percent of total billed charges ","85% of total billed charges ",109.35,90,,87.48,,,0,"percent of total billed charges ","90% of total billed charges ",109.35,90,,87.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",105.71,87,,84.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.05,70,,68.04,,,0,"percent of total billed charges ","70% of total billed charges ",0.11,113,
"LOVENOX 40MG/0.4ML SYR",7047640,"CDM ",636,RC,J1650,HCPCS,OUTPATIENT,,,70.5,56.4,,,,,,,,0,"other ","not separately reimbursment ",0.8,100,,2.74,2.74,2.74,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",65.57,93,,52.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",59.93,85,,47.94,,,0,"percent of total billed charges ","85% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",61.34,87,,37.24,33.93,40.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",0.76,65.57,
"CEREBYX 75MG/ML 10ML",7047723,"CDM ",250,RC,A9270,HCPCS,OUTPATIENT,,,195,156,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136.5,70,,109.20,,,0,"percent of total billed charges ","70% of total billed charges ",175.5,90,,140.40,,,0,"percent of total billed charges ","90% of total billed charges ",181.35,93,,145.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",165.75,85,,132.60,,,0,"percent of total billed charges ","85% of total billed charges ",175.5,90,,140.40,,,0,"percent of total billed charges ","90% of total billed charges ",175.5,90,,140.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",169.65,87,,135.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136.5,70,,109.20,,,0,"percent of total billed charges ","70% of total billed charges ",136.5,181.35,
"CORDARONE IV 150MG/3ML",7047731,"CDM ",636,RC,J0282,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",0.57,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",0.31,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.31,45.57,
"LEVAQUIN IV 500MG/100ML PREMIX",7047749,"CDM ",636,RC,J1956,HCPCS,OUTPATIENT,,,87.5,70,,,,,,,,0,"other ","not separately reimbursment ",1.45,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",61.25,70,,49.00,,,0,"percent of total billed charges ","70% of total billed charges ",78.75,90,,63.00,,,0,"percent of total billed charges ","90% of total billed charges ",81.38,93,,65.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.92,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",74.38,85,,59.50,,,0,"percent of total billed charges ","85% of total billed charges ",78.75,90,,63.00,,,0,"percent of total billed charges ","90% of total billed charges ",78.75,90,,63.00,,,0,"percent of total billed charges ","90% of total billed charges ",0.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",76.13,87,,60.90,,,0,"percent of total billed charges ","87% of total billed charges ",0.91,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",61.25,70,,49.00,,,0,"percent of total billed charges ","70% of total billed charges ",0.91,81.38,
"HUMALOG 100U/ML INSULIN",7047871,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,33,26.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.1,70,,18.48,,,0,"percent of total billed charges ","70% of total billed charges ",29.7,90,,23.76,,,0,"percent of total billed charges ","90% of total billed charges ",30.69,93,,24.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.05,85,,22.44,,,0,"percent of total billed charges ","85% of total billed charges ",29.7,90,,23.76,,,0,"percent of total billed charges ","90% of total billed charges ",29.7,90,,23.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",28.71,87,,22.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.1,70,,18.48,,,0,"percent of total billed charges ","70% of total billed charges ",23.1,30.69,
"IMITREX 6MG SQ INJ",7047954,"CDM ",636,RC,A9270,HCPCS,OUTPATIENT,,,181.5,145.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.05,70,,101.64,,,0,"percent of total billed charges ","70% of total billed charges ",163.35,90,,130.68,,,0,"percent of total billed charges ","90% of total billed charges ",168.8,93,,135.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",154.28,85,,123.42,,,0,"percent of total billed charges ","85% of total billed charges ",163.35,90,,130.68,,,0,"percent of total billed charges ","90% of total billed charges ",163.35,90,,130.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",157.91,87,,126.33,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.05,70,,101.64,,,0,"percent of total billed charges ","70% of total billed charges ",127.05,168.8,
"COUMADIN 3MG TAB",7048028,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"PLAVIX 75MG TAB",7048044,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,21,16.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.7,70,,11.76,,,0,"percent of total billed charges ","70% of total billed charges ",18.9,90,,15.12,,,0,"percent of total billed charges ","90% of total billed charges ",19.53,93,,15.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.85,85,,14.28,,,0,"percent of total billed charges ","85% of total billed charges ",18.9,90,,15.12,,,0,"percent of total billed charges ","90% of total billed charges ",18.9,90,,15.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.27,87,,14.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.7,70,,11.76,,,0,"percent of total billed charges ","70% of total billed charges ",14.7,19.53,
"PERMETHRIN 1% RINSE 60ML",7048070,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,33.5,26.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",31.16,93,,24.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.48,85,,22.78,,,0,"percent of total billed charges ","85% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.15,87,,23.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",23.45,31.16,
"CALCARB 600MG TABLET",7048077,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"SINGULAIR 10MG TABLET",7048085,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,15,12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.95,93,,11.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.75,85,,10.20,,,0,"percent of total billed charges ","85% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.05,87,,10.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",10.5,13.95,
"POLY-VI-SOL 50ML BTL",7048093,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,38.5,30.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,93,,28.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.73,85,,26.18,,,0,"percent of total billed charges ","85% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.5,87,,26.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",26.95,35.81,
"ZITHROMAX 1GM ORAL SUSPENSION",7048135,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,154,123.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",107.8,70,,86.24,,,0,"percent of total billed charges ","70% of total billed charges ",138.6,90,,110.88,,,0,"percent of total billed charges ","90% of total billed charges ",143.22,93,,114.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",130.9,85,,104.72,,,0,"percent of total billed charges ","85% of total billed charges ",138.6,90,,110.88,,,0,"percent of total billed charges ","90% of total billed charges ",138.6,90,,110.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",133.98,87,,107.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",107.8,70,,86.24,,,0,"percent of total billed charges ","70% of total billed charges ",107.8,143.22,
"LEVOTHYROXIN SODIUM",7048143,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"ZOMIG 2.5MG TAB",7048234,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,50,40,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",46.5,93,,37.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.5,85,,34.00,,,0,"percent of total billed charges ","85% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.5,87,,34.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",35,46.5,
"DICLOXACILLIN 250MG CAP",7048267,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"CELEXA 20MG TAB",7048317,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"VICOPROFEN 7.5/200MG TAB",7048440,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"CELEBREX 100MG CAP",7048531,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,15.5,12.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.85,70,,8.68,,,0,"percent of total billed charges ","70% of total billed charges ",13.95,90,,11.16,,,0,"percent of total billed charges ","90% of total billed charges ",14.42,93,,11.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.18,85,,10.54,,,0,"percent of total billed charges ","85% of total billed charges ",13.95,90,,11.16,,,0,"percent of total billed charges ","90% of total billed charges ",13.95,90,,11.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.49,87,,10.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.85,70,,8.68,,,0,"percent of total billed charges ","70% of total billed charges ",10.85,14.42,
"DIOVAN 80MG TAB",7048614,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,16.5,13.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.55,70,,9.24,,,0,"percent of total billed charges ","70% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",15.35,93,,12.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.03,85,,11.22,,,0,"percent of total billed charges ","85% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.36,87,,11.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.55,70,,9.24,,,0,"percent of total billed charges ","70% of total billed charges ",11.55,15.35,
"MIRAPEX 0.25MG TAB",7048648,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"ATACAND 16MG TAB",7048655,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"MAXALT-MLT 5MG TAB",7048697,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,91.5,73.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.05,70,,51.24,,,0,"percent of total billed charges ","70% of total billed charges ",82.35,90,,65.88,,,0,"percent of total billed charges ","90% of total billed charges ",85.1,93,,68.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",77.78,85,,62.22,,,0,"percent of total billed charges ","85% of total billed charges ",82.35,90,,65.88,,,0,"percent of total billed charges ","90% of total billed charges ",82.35,90,,65.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",79.61,87,,63.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.05,70,,51.24,,,0,"percent of total billed charges ","70% of total billed charges ",64.05,85.1,
"EVISTA 60MG TAB",7048705,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,21.5,17.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.05,70,,12.04,,,0,"percent of total billed charges ","70% of total billed charges ",19.35,90,,15.48,,,0,"percent of total billed charges ","90% of total billed charges ",20,93,,16.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.28,85,,14.62,,,0,"percent of total billed charges ","85% of total billed charges ",19.35,90,,15.48,,,0,"percent of total billed charges ","90% of total billed charges ",19.35,90,,15.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.71,87,,14.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.05,70,,12.04,,,0,"percent of total billed charges ","70% of total billed charges ",15.05,20,
"CEROVITE SENIOR TAB",7048713,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"DITROPAN XL 5MG TAB",7048747,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"SUCRALFATE 1GM/10ML UDC",7048754,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,21,16.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.7,70,,11.76,,,0,"percent of total billed charges ","70% of total billed charges ",18.9,90,,15.12,,,0,"percent of total billed charges ","90% of total billed charges ",19.53,93,,15.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.85,85,,14.28,,,0,"percent of total billed charges ","85% of total billed charges ",18.9,90,,15.12,,,0,"percent of total billed charges ","90% of total billed charges ",18.9,90,,15.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.27,87,,14.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.7,70,,11.76,,,0,"percent of total billed charges ","70% of total billed charges ",14.7,19.53,
"PROMETHAZINE/CODEINE SYRUP 5ML",7048762,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"NEURONTIN 400 MG CAP",7048846,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"TAMIFLU 75MG CAP",7048853,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,35.5,28.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.85,70,,19.88,,,0,"percent of total billed charges ","70% of total billed charges ",31.95,90,,25.56,,,0,"percent of total billed charges ","90% of total billed charges ",33.02,93,,26.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",30.18,85,,24.14,,,0,"percent of total billed charges ","85% of total billed charges ",31.95,90,,25.56,,,0,"percent of total billed charges ","90% of total billed charges ",31.95,90,,25.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.89,87,,24.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.85,70,,19.88,,,0,"percent of total billed charges ","70% of total billed charges ",24.85,33.02,
"OSELTAMIVIR 30 MG CAP",7048854,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,25,20,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.5,70,,14.00,,,0,"percent of total billed charges ","70% of total billed charges ",22.5,90,,18.00,,,0,"percent of total billed charges ","90% of total billed charges ",23.25,93,,18.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.25,85,,17.00,,,0,"percent of total billed charges ","85% of total billed charges ",22.5,90,,18.00,,,0,"percent of total billed charges ","90% of total billed charges ",22.5,90,,18.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.75,87,,17.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.5,70,,14.00,,,0,"percent of total billed charges ","70% of total billed charges ",17.5,23.25,
"METHYLPHENIDATE 5MG TAB",7048895,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"PREVALITE ORAL SUSP 4GM PKT",7048903,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"FUROSEMIDE 80MG TAB",7048937,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"PIOGLITAZONE 15MG TAB",7048960,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,16.5,13.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.55,70,,9.24,,,0,"percent of total billed charges ","70% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",15.35,93,,12.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.03,85,,11.22,,,0,"percent of total billed charges ","85% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.36,87,,11.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.55,70,,9.24,,,0,"percent of total billed charges ","70% of total billed charges ",11.55,15.35,
"LOTREL 5/20 CAP",7049000,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"PREVEN EMER CONTRACEPTIVE KIT",7049018,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,51,40.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",47.43,93,,37.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.35,85,,34.68,,,0,"percent of total billed charges ","85% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.37,87,,35.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",35.7,47.43,
"NEURONTIN 600MG TAB",7049034,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"AGGRENOX 200/25MG CAP",7049067,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,22,17.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.4,70,,12.32,,,0,"percent of total billed charges ","70% of total billed charges ",19.8,90,,15.84,,,0,"percent of total billed charges ","90% of total billed charges ",20.46,93,,16.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.7,85,,14.96,,,0,"percent of total billed charges ","85% of total billed charges ",19.8,90,,15.84,,,0,"percent of total billed charges ","90% of total billed charges ",19.8,90,,15.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.14,87,,15.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.4,70,,12.32,,,0,"percent of total billed charges ","70% of total billed charges ",15.4,20.46,
"PROTONIX 40MG TAB",7049075,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"EXELON 3MG CAP",7049083,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"VENLAFAXINE XL 75MG CAP",7049117,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,16,12.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.88,93,,11.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.6,85,,10.88,,,0,"percent of total billed charges ","85% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.92,87,,11.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,14.88,
"ALTACE 1.25 MG CAP",7049125,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"SERTRALINE 25MG",7049158,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"VENLAFAXINE HCL 150MG CAP",7049182,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,18.5,14.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.95,70,,10.36,,,0,"percent of total billed charges ","70% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",17.21,93,,13.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.73,85,,12.58,,,0,"percent of total billed charges ","85% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.1,87,,12.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.95,70,,10.36,,,0,"percent of total billed charges ","70% of total billed charges ",12.95,17.21,
"LAMISIL 250MG TAB",7049232,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,31,24.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.7,70,,17.36,,,0,"percent of total billed charges ","70% of total billed charges ",27.9,90,,22.32,,,0,"percent of total billed charges ","90% of total billed charges ",28.83,93,,23.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.35,85,,21.08,,,0,"percent of total billed charges ","85% of total billed charges ",27.9,90,,22.32,,,0,"percent of total billed charges ","90% of total billed charges ",27.9,90,,22.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.97,87,,21.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.7,70,,17.36,,,0,"percent of total billed charges ","70% of total billed charges ",21.7,28.83,
"XOPENEX 0.63MG/3ML",7049265,"CDM ",250,RC,A9270,HCPCS,OUTPATIENT,,,18,14.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.74,93,,13.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.3,85,,12.24,,,0,"percent of total billed charges ","85% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.66,87,,12.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,16.74,
"PRAVACHOL 20MG TAB",7049273,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"GLUCOPHAGE XR 500MG TABLET",7049307,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"VALTREX 500MG TAB",7049398,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,20,16,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14,70,,11.20,,,0,"percent of total billed charges ","70% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",18.6,93,,14.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17,85,,13.60,,,0,"percent of total billed charges ","85% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.4,87,,13.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14,70,,11.20,,,0,"percent of total billed charges ","70% of total billed charges ",14,18.6,
"XOPENEX 1.25MG/3ML",7049406,"CDM ",250,RC,A9270,HCPCS,OUTPATIENT,,,18,14.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.74,93,,13.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.3,85,,12.24,,,0,"percent of total billed charges ","85% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.66,87,,12.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,16.74,
"LAMICTAL 100MG TAB",7049448,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"ACETAMINOPHEN/CODEINE SOL 5ML1",7049471,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13,10.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.1,70,,7.28,,,0,"percent of total billed charges ","70% of total billed charges ",11.7,90,,9.36,,,0,"percent of total billed charges ","90% of total billed charges ",12.09,93,,9.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.05,85,,8.84,,,0,"percent of total billed charges ","85% of total billed charges ",11.7,90,,9.36,,,0,"percent of total billed charges ","90% of total billed charges ",11.7,90,,9.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.31,87,,9.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.1,70,,7.28,,,0,"percent of total billed charges ","70% of total billed charges ",9.1,12.09,
"FOSAMAX 70MG TABLET",7049505,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,45,36,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.15,87,,31.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",31.5,41.85,
"GEODON 20MG CAPSULE",7049513,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,25.5,20.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.85,70,,14.28,,,0,"percent of total billed charges ","70% of total billed charges ",22.95,90,,18.36,,,0,"percent of total billed charges ","90% of total billed charges ",23.72,93,,18.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.68,85,,17.34,,,0,"percent of total billed charges ","85% of total billed charges ",22.95,90,,18.36,,,0,"percent of total billed charges ","90% of total billed charges ",22.95,90,,18.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.19,87,,17.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.85,70,,14.28,,,0,"percent of total billed charges ","70% of total billed charges ",17.85,23.72,
"ALLEGRA-D 60/120MG TABLET",7049521,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"ZANAFLEX 4MG TAB",7049588,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"MIRALAX 17GM",7049596,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"TRILEPTAL 150MG TAB",7049620,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"KADIAN 30MG CAP",7049646,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"SINEMET CR 25/100MG TAB",7049745,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"GLUCOTROL 10MG TAB",7049802,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"GLUCOTROL XL 2.5MG TAB",7049885,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"LEVAQUIN 250MG TAB",7049919,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,39.5,31.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.65,70,,22.12,,,0,"percent of total billed charges ","70% of total billed charges ",35.55,90,,28.44,,,0,"percent of total billed charges ","90% of total billed charges ",36.74,93,,29.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.58,85,,26.86,,,0,"percent of total billed charges ","85% of total billed charges ",35.55,90,,28.44,,,0,"percent of total billed charges ","90% of total billed charges ",35.55,90,,28.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",34.37,87,,27.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.65,70,,22.12,,,0,"percent of total billed charges ","70% of total billed charges ",27.65,36.74,
"DIFLUCAN SUSP 40MG/ML 35ML",7049935,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,260.5,208.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",182.35,70,,145.88,,,0,"percent of total billed charges ","70% of total billed charges ",234.45,90,,187.56,,,0,"percent of total billed charges ","90% of total billed charges ",242.27,93,,193.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",221.43,85,,177.14,,,0,"percent of total billed charges ","85% of total billed charges ",234.45,90,,187.56,,,0,"percent of total billed charges ","90% of total billed charges ",234.45,90,,187.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",226.64,87,,181.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",182.35,70,,145.88,,,0,"percent of total billed charges ","70% of total billed charges ",182.35,242.27,
"RISPERDAL 0.5MG TAB",7049943,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"CORTISONE ACETATE 25MG TAB",7049992,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"PROVIGIL 200MG TAB",7050057,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,73.5,58.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",51.45,68.36,
"NORVASC 2.5MG TAB",7050073,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"COCAINE 4% SOL 4ML",7050198,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,440.5,352.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",308.35,70,,246.68,,,0,"percent of total billed charges ","70% of total billed charges ",396.45,90,,317.16,,,0,"percent of total billed charges ","90% of total billed charges ",409.67,93,,327.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",374.43,85,,299.54,,,0,"percent of total billed charges ","85% of total billed charges ",396.45,90,,317.16,,,0,"percent of total billed charges ","90% of total billed charges ",396.45,90,,317.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",383.24,87,,306.59,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",308.35,70,,246.68,,,0,"percent of total billed charges ","70% of total billed charges ",308.35,409.67,
"SEROQUEL 200MG TAB",7050214,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,30.5,24.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.35,70,,17.08,,,0,"percent of total billed charges ","70% of total billed charges ",27.45,90,,21.96,,,0,"percent of total billed charges ","90% of total billed charges ",28.37,93,,22.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.93,85,,20.74,,,0,"percent of total billed charges ","85% of total billed charges ",27.45,90,,21.96,,,0,"percent of total billed charges ","90% of total billed charges ",27.45,90,,21.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.54,87,,21.23,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.35,70,,17.08,,,0,"percent of total billed charges ","70% of total billed charges ",21.35,28.37,
"PAXIL 10MG TAB",7050271,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"LEXAPRO 10MG TAB",7050313,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"CELEXA 10MG TAB",7050362,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"PP AZITHROMYCIN 500MG 3 TABS",7050370,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,24.5,19.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.15,70,,13.72,,,0,"percent of total billed charges ","70% of total billed charges ",22.05,90,,17.64,,,0,"percent of total billed charges ","90% of total billed charges ",22.79,93,,18.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.83,85,,16.66,,,0,"percent of total billed charges ","85% of total billed charges ",22.05,90,,17.64,,,0,"percent of total billed charges ","90% of total billed charges ",22.05,90,,17.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.32,87,,17.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.15,70,,13.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.15,22.79,
"PAXIL CR 12.5MG TAB",7050396,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"ZINC SULFATE 220MG CAP",7050446,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"COREG 12.5MG TAB",7050511,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"COREG 25MG TAB",7050529,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"VASOTEC 20MG TAB",7050586,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"PENICILLIN-VK 50MG/ML SUSP",7050594,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,38.5,30.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,93,,28.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.73,85,,26.18,,,0,"percent of total billed charges ","85% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.5,87,,26.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",26.95,35.81,
"CASODEX 50MG TAB",7050685,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,44,35.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.8,70,,24.64,,,0,"percent of total billed charges ","70% of total billed charges ",39.6,90,,31.68,,,0,"percent of total billed charges ","90% of total billed charges ",40.92,93,,32.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",37.4,85,,29.92,,,0,"percent of total billed charges ","85% of total billed charges ",39.6,90,,31.68,,,0,"percent of total billed charges ","90% of total billed charges ",39.6,90,,31.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",38.28,87,,30.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.8,70,,24.64,,,0,"percent of total billed charges ","70% of total billed charges ",30.8,40.92,
"KEPPRA 500MG TAB",7050818,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"TOPROL XL 25MG TAB",7050958,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"DEPAKOTE ER 250MG TAB",7050990,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"OMEGA-3 FATTY ACID 1000MG CAP",7051014,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"ALBUTEROL SULFATE 2.5MG/0.5ML",7051030,"CDM ",250,RC,A9270,HCPCS,OUTPATIENT,,,15.5,12.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.85,70,,8.68,,,0,"percent of total billed charges ","70% of total billed charges ",13.95,90,,11.16,,,0,"percent of total billed charges ","90% of total billed charges ",14.42,93,,11.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.18,85,,10.54,,,0,"percent of total billed charges ","85% of total billed charges ",13.95,90,,11.16,,,0,"percent of total billed charges ","90% of total billed charges ",13.95,90,,11.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.49,87,,10.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.85,70,,8.68,,,0,"percent of total billed charges ","70% of total billed charges ",10.85,14.42,
"AUGMENTIN ES 600MG/5ML SUSP 50",7051063,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,130,104,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91,70,,72.80,,,0,"percent of total billed charges ","70% of total billed charges ",117,90,,93.60,,,0,"percent of total billed charges ","90% of total billed charges ",120.9,93,,96.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",110.5,85,,88.40,,,0,"percent of total billed charges ","85% of total billed charges ",117,90,,93.60,,,0,"percent of total billed charges ","90% of total billed charges ",117,90,,93.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",113.1,87,,90.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91,70,,72.80,,,0,"percent of total billed charges ","70% of total billed charges ",91,120.9,
"BENICAR 20MG TAB",7051097,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,15.5,12.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.85,70,,8.68,,,0,"percent of total billed charges ","70% of total billed charges ",13.95,90,,11.16,,,0,"percent of total billed charges ","90% of total billed charges ",14.42,93,,11.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.18,85,,10.54,,,0,"percent of total billed charges ","85% of total billed charges ",13.95,90,,11.16,,,0,"percent of total billed charges ","90% of total billed charges ",13.95,90,,11.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.49,87,,10.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.85,70,,8.68,,,0,"percent of total billed charges ","70% of total billed charges ",10.85,14.42,
"ZYVOX 600MG TAB",7051139,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,377,301.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.9,70,,211.12,,,0,"percent of total billed charges ","70% of total billed charges ",339.3,90,,271.44,,,0,"percent of total billed charges ","90% of total billed charges ",350.61,93,,280.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",320.45,85,,256.36,,,0,"percent of total billed charges ","85% of total billed charges ",339.3,90,,271.44,,,0,"percent of total billed charges ","90% of total billed charges ",339.3,90,,271.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",327.99,87,,262.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.9,70,,211.12,,,0,"percent of total billed charges ","70% of total billed charges ",263.9,350.61,
"EFFEXOR 75MG TAB",7051212,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"ZETIA 10MG TAB",7051220,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,24,19.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.8,70,,13.44,,,0,"percent of total billed charges ","70% of total billed charges ",21.6,90,,17.28,,,0,"percent of total billed charges ","90% of total billed charges ",22.32,93,,17.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.4,85,,16.32,,,0,"percent of total billed charges ","85% of total billed charges ",21.6,90,,17.28,,,0,"percent of total billed charges ","90% of total billed charges ",21.6,90,,17.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.88,87,,16.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.8,70,,13.44,,,0,"percent of total billed charges ","70% of total billed charges ",16.8,22.32,
"AMOXICILLIN 875MG TAB",7051261,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"ESTRADIOL 1MG TAB",7051287,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"HCTZ 12.5MG CAP",7051311,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"QLUCOSAMINE SULFATE 500MG CAP",7051345,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"MOBIC 7.5MG TAB",7051360,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"NIACIN ER 500MG CAP",7051386,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"PRANDIN 0.5MG TAB",7051394,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"ZEBETA 5MG TAB",7051451,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"ZOCAR 40MG TAB",7051469,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"SINGULAIR 4MG TAB",7051543,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,15.5,12.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.85,70,,8.68,,,0,"percent of total billed charges ","70% of total billed charges ",13.95,90,,11.16,,,0,"percent of total billed charges ","90% of total billed charges ",14.42,93,,11.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.18,85,,10.54,,,0,"percent of total billed charges ","85% of total billed charges ",13.95,90,,11.16,,,0,"percent of total billed charges ","90% of total billed charges ",13.95,90,,11.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.49,87,,10.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.85,70,,8.68,,,0,"percent of total billed charges ","70% of total billed charges ",10.85,14.42,
"SINGULAIR 4MG GRANULES",7051592,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,20.5,16.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.35,70,,11.48,,,0,"percent of total billed charges ","70% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",19.07,93,,15.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.43,85,,13.94,,,0,"percent of total billed charges ","85% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.84,87,,14.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.35,70,,11.48,,,0,"percent of total billed charges ","70% of total billed charges ",14.35,19.07,
"HYDROCODONE/APAP 10/325MG TAB",7051642,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"XOPENEX 0.31MG/3ML INH",7051691,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,18,14.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.74,93,,13.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.3,85,,12.24,,,0,"percent of total billed charges ","85% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.66,87,,12.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,16.74,
"ZONEGRAN 100MG CAP",7051709,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14,11.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",13.02,93,,10.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.9,85,,9.52,,,0,"percent of total billed charges ","85% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.18,87,,9.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",9.8,13.02,
"NAMENDA 5MG TAB",7051717,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,18,14.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.74,93,,13.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.3,85,,12.24,,,0,"percent of total billed charges ","85% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.66,87,,12.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,16.74,
"LIPITOR 20 MG TAB",7051790,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14,11.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",13.02,93,,10.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.9,85,,9.52,,,0,"percent of total billed charges ","85% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.18,87,,9.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",9.8,13.02,
"ATORVASTATIN 40MG TAB",7051791,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,11.5,9.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.05,70,,6.44,,,0,"percent of total billed charges ","70% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.7,93,,8.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.78,85,,7.82,,,0,"percent of total billed charges ","85% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.01,87,,8.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.05,70,,6.44,,,0,"percent of total billed charges ","70% of total billed charges ",8.05,10.7,
"LEVA-PAK 750 MG TAB",7051816,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,44.5,35.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.15,70,,24.92,,,0,"percent of total billed charges ","70% of total billed charges ",40.05,90,,32.04,,,0,"percent of total billed charges ","90% of total billed charges ",41.39,93,,33.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",37.83,85,,30.26,,,0,"percent of total billed charges ","85% of total billed charges ",40.05,90,,32.04,,,0,"percent of total billed charges ","90% of total billed charges ",40.05,90,,32.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",38.72,87,,30.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.15,70,,24.92,,,0,"percent of total billed charges ","70% of total billed charges ",31.15,41.39,
"SPS 60 ML BOTTLE",7051857,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,40,32,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28,70,,22.40,,,0,"percent of total billed charges ","70% of total billed charges ",36,90,,28.80,,,0,"percent of total billed charges ","90% of total billed charges ",37.2,93,,29.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34,85,,27.20,,,0,"percent of total billed charges ","85% of total billed charges ",36,90,,28.80,,,0,"percent of total billed charges ","90% of total billed charges ",36,90,,28.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",34.8,87,,27.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28,70,,22.40,,,0,"percent of total billed charges ","70% of total billed charges ",28,37.2,
"ORAJEL MAX STRENGTH LIQUID",7051899,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,23,18.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.1,70,,12.88,,,0,"percent of total billed charges ","70% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",21.39,93,,17.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.55,85,,15.64,,,0,"percent of total billed charges ","85% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.01,87,,16.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.1,70,,12.88,,,0,"percent of total billed charges ","70% of total billed charges ",16.1,21.39,
"MIRAPEX 0.5MG TAB",7051998,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"PERCOCET 10MG/325MG TAB",7052020,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"GLYSET 25MG TAB",7052038,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"GLUCOSE TABS 5GM CHEW (10 TAB)",7052079,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,16,12.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.88,93,,11.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.6,85,,10.88,,,0,"percent of total billed charges ","85% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.92,87,,11.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,14.88,
"CILOSTAZOL 100MG TAB",7052103,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"MINOCYCLINE HCL 50MG CAP",7052160,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"RENAGEL 800MG TAB",7052277,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,19,15.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.3,70,,10.64,,,0,"percent of total billed charges ","70% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.67,93,,14.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.15,85,,12.92,,,0,"percent of total billed charges ","85% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.53,87,,13.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.3,70,,10.64,,,0,"percent of total billed charges ","70% of total billed charges ",13.3,17.67,
"SEVELAMER CARBONATE 800MG TAB",7052278,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,19,15.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.3,70,,10.64,,,0,"percent of total billed charges ","70% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.67,93,,14.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.15,85,,12.92,,,0,"percent of total billed charges ","85% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.53,87,,13.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.3,70,,10.64,,,0,"percent of total billed charges ","70% of total billed charges ",13.3,17.67,
"TYLENOL SINUS X-STR GELCAP",7052285,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7.5,6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.25,70,,4.20,,,0,"percent of total billed charges ","70% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",6.98,93,,5.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6.38,85,,5.10,,,0,"percent of total billed charges ","85% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.53,87,,5.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.25,70,,4.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,6.98,
"TRICOR 145MG TAB",7052376,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14,11.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",13.02,93,,10.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.9,85,,9.52,,,0,"percent of total billed charges ","85% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.18,87,,9.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",9.8,13.02,
"LOPRESSOR 25MG TAB",7052384,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"CALCIONATE SYRUP",7052558,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,1,0.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.7,70,,0.56,,,0,"percent of total billed charges ","70% of total billed charges ",0.9,90,,0.72,,,0,"percent of total billed charges ","90% of total billed charges ",0.93,93,,0.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",0.85,85,,0.68,,,0,"percent of total billed charges ","85% of total billed charges ",0.9,90,,0.72,,,0,"percent of total billed charges ","90% of total billed charges ",0.9,90,,0.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",0.87,87,,0.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.7,70,,0.56,,,0,"percent of total billed charges ","70% of total billed charges ",0.7,0.93,
"ARIMIDEX 1MG TAB",7052566,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"CYANOCOBALAMIN 100MCG TAB",7052657,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"DECADRON 1MG TAB",7052855,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"ORA-SWEET SF 30ML BOTTLE",7052863,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,38.5,30.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,93,,28.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.73,85,,26.18,,,0,"percent of total billed charges ","85% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.5,87,,26.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",26.95,35.81,
"ORA-PLUS 30ML BOTTLE",7052871,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,38.5,30.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,93,,28.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.73,85,,26.18,,,0,"percent of total billed charges ","85% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.5,87,,26.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",26.95,35.81,
"NIACIN 250MG TAB",7053036,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"ACYCLOVIR 5% CRM 5GM TUBE",7053093,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,450,360,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",315,70,,252.00,,,0,"percent of total billed charges ","70% of total billed charges ",405,90,,324.00,,,0,"percent of total billed charges ","90% of total billed charges ",418.5,93,,334.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",382.5,85,,306.00,,,0,"percent of total billed charges ","85% of total billed charges ",405,90,,324.00,,,0,"percent of total billed charges ","90% of total billed charges ",405,90,,324.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",391.5,87,,313.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",315,70,,252.00,,,0,"percent of total billed charges ","70% of total billed charges ",315,418.5,
"PREGABALIN 50MG CAP",7053184,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,19,15.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.3,70,,10.64,,,0,"percent of total billed charges ","70% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.67,93,,14.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.15,85,,12.92,,,0,"percent of total billed charges ","85% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.53,87,,13.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.3,70,,10.64,,,0,"percent of total billed charges ","70% of total billed charges ",13.3,17.67,
"DIPHENHYDRA ELIX 12.5MG/5ML UD",7053341,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"TRIAMCINOLONE ACET 0.1% CR 15G",7053358,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"CYANOCABALAMIN 1000MCG TAB",7053374,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"CYANOCOBALAMIN 500 MCG TAB",7053564,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"DAKIN'S SOL 473ML 1/2 STRENGTH",7053614,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"DOMEBORO PWD PKT",7053615,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,11.5,9.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.05,70,,6.44,,,0,"percent of total billed charges ","70% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.7,93,,8.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.78,85,,7.82,,,0,"percent of total billed charges ","85% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.01,87,,8.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.05,70,,6.44,,,0,"percent of total billed charges ","70% of total billed charges ",8.05,10.7,
"CLEOCIN PHOSPHATE 150MG/ML 4ML",7060080,"CDM ",250,RC,J0736,HCPCS,OUTPATIENT,,,47,37.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",43.71,93,,34.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.95,85,,31.96,,,0,"percent of total billed charges ","85% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.89,87,,32.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",32.9,43.71,
"ZANTAC IV 50MG (1MG/ML) BAG",7060288,"CDM ",636,RC,J2780,HCPCS,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",6.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",6.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",6.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",6.12,44.64,
"AMPICILLIN SODIUM 1GM VIAL",7060429,"CDM ",636,RC,J0290,HCPCS,OUTPATIENT,,,46.5,37.2,,,,,,,,0,"other ","not separately reimbursment ",1.04,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",43.25,93,,34.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",39.53,85,,31.62,,,0,"percent of total billed charges ","85% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",0.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",40.46,87,,32.37,,,0,"percent of total billed charges ","87% of total billed charges ",0.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",0.81,43.25,
"VERSED 50MG VIAL",7060437,"CDM ",636,RC,J2250,HCPCS,OUTPATIENT,,,51.5,41.2,,,,,,,,0,"other ","not separately reimbursment ",0.18,100,,1.60,1.60,1.60,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",36.05,70,,28.84,,,0,"percent of total billed charges ","70% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",47.9,93,,38.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.78,85,,35.02,,,0,"percent of total billed charges ","85% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.81,87,,39.65,15.27,43.62,"1 through 10","percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.05,70,,28.84,,,0,"percent of total billed charges ","70% of total billed charges ",0.18,47.9,
"VANCOMYCIN 1GM ADV",7060577,"CDM ",636,RC,J3373,HCPCS,OUTPATIENT,,,46.5,37.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",43.25,93,,34.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.53,85,,31.62,,,0,"percent of total billed charges ","85% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.46,87,,32.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",32.55,43.25,
"HEPARIN 5000U/ML 1ML VIAL",7060700,"CDM ",636,RC,J1644,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",0.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.25,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",0.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.25,45.57,
"LOVENOX SYR 100MG/ML",7060783,"CDM ",636,RC,J1650,HCPCS,OUTPATIENT,,,166,132.8,,,,,,,,0,"other ","not separately reimbursment ",0.8,100,,2.74,2.74,2.74,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",116.2,70,,92.96,,,0,"percent of total billed charges ","70% of total billed charges ",149.4,90,,119.52,,,0,"percent of total billed charges ","90% of total billed charges ",154.38,93,,123.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",141.1,85,,112.88,,,0,"percent of total billed charges ","85% of total billed charges ",149.4,90,,119.52,,,0,"percent of total billed charges ","90% of total billed charges ",149.4,90,,119.52,,,0,"percent of total billed charges ","90% of total billed charges ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",144.42,87,,37.24,33.93,40.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",116.2,70,,92.96,,,0,"percent of total billed charges ","70% of total billed charges ",0.76,154.38,
"DEXAMETHASONE 10MG/ML INJ 1ML",7060809,"CDM ",636,RC,J1100,HCPCS,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",0.15,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,0.24,0.24,0.24,"1 through 10","other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",0.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.63,87,,0.08,0.01,37.21,14,"percent of total billed charges ","87% of total billed charges ",0.12,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",0.12,45.57,
"LANTUS INSULIN 100U/ML",7060825,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,33,26.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.1,70,,18.48,,,0,"percent of total billed charges ","70% of total billed charges ",29.7,90,,23.76,,,0,"percent of total billed charges ","90% of total billed charges ",30.69,93,,24.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.05,85,,22.44,,,0,"percent of total billed charges ","85% of total billed charges ",29.7,90,,23.76,,,0,"percent of total billed charges ","90% of total billed charges ",29.7,90,,23.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",28.71,87,,22.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.1,70,,18.48,,,0,"percent of total billed charges ","70% of total billed charges ",23.1,30.69,
"HUMLOG 75/25 10 ML VIAL",7060890,"CDM ",636,RC,A9270,HCPCS,OUTPATIENT,,,45,36,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.15,87,,31.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",31.5,41.85,
"LOVENOX 80 MG/0.8ML SYR",7060908,"CDM ",636,RC,J1650,HCPCS,OUTPATIENT,,,141,112.8,,,,,,,,0,"other ","not separately reimbursment ",0.8,100,,2.74,2.74,2.74,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",98.7,70,,78.96,,,0,"percent of total billed charges ","70% of total billed charges ",126.9,90,,101.52,,,0,"percent of total billed charges ","90% of total billed charges ",131.13,93,,104.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",119.85,85,,95.88,,,0,"percent of total billed charges ","85% of total billed charges ",126.9,90,,101.52,,,0,"percent of total billed charges ","90% of total billed charges ",126.9,90,,101.52,,,0,"percent of total billed charges ","90% of total billed charges ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.67,87,,37.24,33.93,40.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",98.7,70,,78.96,,,0,"percent of total billed charges ","70% of total billed charges ",0.76,131.13,
"LOVENOX 60MG/0.6ML SYR",7060981,"CDM ",636,RC,J1650,HCPCS,OUTPATIENT,,,107.5,86,,,,,,,,0,"other ","not separately reimbursment ",0.8,100,,2.74,2.74,2.74,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",75.25,70,,60.20,,,0,"percent of total billed charges ","70% of total billed charges ",96.75,90,,77.40,,,0,"percent of total billed charges ","90% of total billed charges ",99.98,93,,79.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",91.38,85,,73.10,,,0,"percent of total billed charges ","85% of total billed charges ",96.75,90,,77.40,,,0,"percent of total billed charges ","90% of total billed charges ",96.75,90,,77.40,,,0,"percent of total billed charges ","90% of total billed charges ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.53,87,,37.24,33.93,40.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",75.25,70,,60.20,,,0,"percent of total billed charges ","70% of total billed charges ",0.76,99.98,
"PRIMAXIN 500MG IM INJ",7061070,"CDM ",636,RC,J0743,HCPCS,OUTPATIENT,,,90,72,,,,,,,,0,"other ","not separately reimbursment ",9.72,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,93,,66.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",7.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",76.5,85,,61.20,,,0,"percent of total billed charges ","85% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",81,90,,64.80,,,0,"percent of total billed charges ","90% of total billed charges ",7.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",78.3,87,,62.64,,,0,"percent of total billed charges ","87% of total billed charges ",7.61,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",63,70,,50.40,,,0,"percent of total billed charges ","70% of total billed charges ",7.61,83.7,
"CEFEPIME 1GM VIAL",7061097,"CDM ",636,RC,J0692,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",2.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.87,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",1.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",1.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",1.85,106.95,
"CEFEPINE 2GM VIAL",7061098,"CDM ",636,RC,J0692,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",2.02,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.87,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",1.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",1.85,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",1.85,106.95,
"LOVENOX SYR 150MG/ML 1ML",7061104,"CDM ",636,RC,J1650,HCPCS,OUTPATIENT,,,107,85.6,,,,,,,,0,"other ","not separately reimbursment ",0.8,100,,2.74,2.74,2.74,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",74.9,70,,59.92,,,0,"percent of total billed charges ","70% of total billed charges ",96.3,90,,77.04,,,0,"percent of total billed charges ","90% of total billed charges ",99.51,93,,79.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",90.95,85,,72.76,,,0,"percent of total billed charges ","85% of total billed charges ",96.3,90,,77.04,,,0,"percent of total billed charges ","90% of total billed charges ",96.3,90,,77.04,,,0,"percent of total billed charges ","90% of total billed charges ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",93.09,87,,37.24,33.93,40.55,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",74.9,70,,59.92,,,0,"percent of total billed charges ","70% of total billed charges ",0.76,99.51,
"INVANZ 1GM INJ",7061138,"CDM ",636,RC,J1335,HCPCS,OUTPATIENT,,,193,154.4,,,,,,,,0,"other ","not separately reimbursment ",17.97,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",135.1,70,,108.08,,,0,"percent of total billed charges ","70% of total billed charges ",173.7,90,,138.96,,,0,"percent of total billed charges ","90% of total billed charges ",179.49,93,,143.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",28.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",164.05,85,,131.24,,,0,"percent of total billed charges ","85% of total billed charges ",173.7,90,,138.96,,,0,"percent of total billed charges ","90% of total billed charges ",173.7,90,,138.96,,,0,"percent of total billed charges ","90% of total billed charges ",28.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",167.91,87,,134.33,,,0,"percent of total billed charges ","87% of total billed charges ",28.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",135.1,70,,108.08,,,0,"percent of total billed charges ","70% of total billed charges ",17.97,179.49,
"MAGNESIUM SULFATE 20GM/500CC W",7061229,"CDM ",636,RC,J3475,HCPCS,OUTPATIENT,,,96.5,77.2,,,,,,,,0,"other ","not separately reimbursment ",0.83,100,,1.35,1.35,1.35,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",67.55,70,,54.04,,,0,"percent of total billed charges ","70% of total billed charges ",86.85,90,,69.48,,,0,"percent of total billed charges ","90% of total billed charges ",89.75,93,,71.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",82.03,85,,65.62,,,0,"percent of total billed charges ","85% of total billed charges ",86.85,90,,69.48,,,0,"percent of total billed charges ","90% of total billed charges ",86.85,90,,69.48,,,0,"percent of total billed charges ","90% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",83.96,87,,158.61,158.61,158.61,"1 through 10","percent of total billed charges ","87% of total billed charges ",0.75,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",67.55,70,,54.04,,,0,"percent of total billed charges ","70% of total billed charges ",0.75,89.75,
"ZOSYN 3.375 GM VIAL INJ",7061302,"CDM ",636,RC,J2543,HCPCS,OUTPATIENT,,,127,101.6,,,,,,,,0,"other ","not separately reimbursment ",1.58,100,,9.01,9.01,9.01,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",88.9,70,,71.12,,,0,"percent of total billed charges ","70% of total billed charges ",114.3,90,,91.44,,,0,"percent of total billed charges ","90% of total billed charges ",118.11,93,,94.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1.49,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",107.95,85,,86.36,,,0,"percent of total billed charges ","85% of total billed charges ",114.3,90,,91.44,,,0,"percent of total billed charges ","90% of total billed charges ",114.3,90,,91.44,,,0,"percent of total billed charges ","90% of total billed charges ",1.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",110.49,87,,218.09,202.23,233.95,"1 through 10","percent of total billed charges ","87% of total billed charges ",1.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",88.9,70,,71.12,,,0,"percent of total billed charges ","70% of total billed charges ",1.48,118.11,
"CALCIUM GLUCONATE 10% 50 ML",7061336,"CDM ",636,RC,J0612,HCPCS,OUTPATIENT,,,60,48,,,,,,,,0,"other ","not separately reimbursment ",0.06,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",42,70,,33.60,,,0,"percent of total billed charges ","70% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",55.8,93,,44.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51,85,,40.80,,,0,"percent of total billed charges ","85% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",52.2,87,,41.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42,70,,33.60,,,0,"percent of total billed charges ","70% of total billed charges ",0.06,55.8,
"LUPRON DEPOT 22.5MG KIT IM",7061583,"CDM ",636,RC,J9217,HCPCS,OUTPATIENT,,,5227,4181.6,,,,,,,,0,"other ","not separately reimbursment ",238.83,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",3658.9,70,,2927.12,,,0,"percent of total billed charges ","70% of total billed charges ",4704.3,90,,3763.44,,,0,"percent of total billed charges ","90% of total billed charges ",4861.11,93,,3888.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",140.48,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",4442.95,85,,3554.36,,,0,"percent of total billed charges ","85% of total billed charges ",4704.3,90,,3763.44,,,0,"percent of total billed charges ","90% of total billed charges ",4704.3,90,,3763.44,,,0,"percent of total billed charges ","90% of total billed charges ",139.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",4547.49,87,,3637.99,,,0,"percent of total billed charges ","87% of total billed charges ",139.09,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",170.78,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",3658.9,70,,2927.12,,,0,"percent of total billed charges ","70% of total billed charges ",139.09,4861.11,
"JANUVIA 100MG TAB",7062060,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,31.5,25.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.05,70,,17.64,,,0,"percent of total billed charges ","70% of total billed charges ",28.35,90,,22.68,,,0,"percent of total billed charges ","90% of total billed charges ",29.3,93,,23.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.78,85,,21.42,,,0,"percent of total billed charges ","85% of total billed charges ",28.35,90,,22.68,,,0,"percent of total billed charges ","90% of total billed charges ",28.35,90,,22.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",27.41,87,,21.93,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.05,70,,17.64,,,0,"percent of total billed charges ","70% of total billed charges ",22.05,29.3,
"IBUPROFEN SUSP 100MG/5ML UD",7062070,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7.5,6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.25,70,,4.20,,,0,"percent of total billed charges ","70% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",6.98,93,,5.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6.38,85,,5.10,,,0,"percent of total billed charges ","85% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.53,87,,5.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.25,70,,4.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,6.98,
"IBUPROFEN INFANT SUSP 15ML BTL",7062071,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,18.5,14.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.95,70,,10.36,,,0,"percent of total billed charges ","70% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",17.21,93,,13.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.73,85,,12.58,,,0,"percent of total billed charges ","85% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.1,87,,12.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.95,70,,10.36,,,0,"percent of total billed charges ","70% of total billed charges ",12.95,17.21,
"PHENTOLAMINE 5MG INJ",7062078,"CDM ",636,RC,A9270,HCPCS,OUTPATIENT,,,145.5,116.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.85,70,,81.48,,,0,"percent of total billed charges ","70% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",135.32,93,,108.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.68,85,,98.94,,,0,"percent of total billed charges ","85% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",130.95,90,,104.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.59,87,,101.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.85,70,,81.48,,,0,"percent of total billed charges ","70% of total billed charges ",101.85,135.32,
"DURAGESIC PATCH 12MCG",7062090,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,45,36,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.15,87,,31.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",31.5,41.85,
"COENZYME Q10 100MG CAP",7062169,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"AVODART 0.5MG CAP",7062190,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,16,12.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.88,93,,11.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.6,85,,10.88,,,0,"percent of total billed charges ","85% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.92,87,,11.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,14.88,
"REQUIP 0.25MG TAB",7062270,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"BROVANA 15MCG/2ML NEB",7062280,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,30,24,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21,70,,16.80,,,0,"percent of total billed charges ","70% of total billed charges ",27,90,,21.60,,,0,"percent of total billed charges ","90% of total billed charges ",27.9,93,,22.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.5,85,,20.40,,,0,"percent of total billed charges ","85% of total billed charges ",27,90,,21.60,,,0,"percent of total billed charges ","90% of total billed charges ",27,90,,21.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.1,87,,20.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21,70,,16.80,,,0,"percent of total billed charges ","70% of total billed charges ",21,27.9,
"TOBRAMYCIN 300MG NEB AMP",7062282,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,20.5,16.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.35,70,,11.48,,,0,"percent of total billed charges ","70% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",19.07,93,,15.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.43,85,,13.94,,,0,"percent of total billed charges ","85% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.84,87,,14.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.35,70,,11.48,,,0,"percent of total billed charges ","70% of total billed charges ",14.35,19.07,
"BENADRYL 2% CREAM 28.3 GM TUBE",7062310,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,10,8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7,70,,5.60,,,0,"percent of total billed charges ","70% of total billed charges ",9,90,,7.20,,,0,"percent of total billed charges ","90% of total billed charges ",9.3,93,,7.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.5,85,,6.80,,,0,"percent of total billed charges ","85% of total billed charges ",9,90,,7.20,,,0,"percent of total billed charges ","90% of total billed charges ",9,90,,7.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",8.7,87,,6.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7,70,,5.60,,,0,"percent of total billed charges ","70% of total billed charges ",7,9.3,
"KEPPRA 100MG/ML 30ML ORAL",7062360,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,471.5,377.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",330.05,70,,264.04,,,0,"percent of total billed charges ","70% of total billed charges ",424.35,90,,339.48,,,0,"percent of total billed charges ","90% of total billed charges ",438.5,93,,350.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",400.78,85,,320.62,,,0,"percent of total billed charges ","85% of total billed charges ",424.35,90,,339.48,,,0,"percent of total billed charges ","90% of total billed charges ",424.35,90,,339.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",410.21,87,,328.17,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",330.05,70,,264.04,,,0,"percent of total billed charges ","70% of total billed charges ",330.05,438.5,
"LORAZEPAM 2MG/ML 30ML SOL PO",7062370,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,148,118.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.6,70,,82.88,,,0,"percent of total billed charges ","70% of total billed charges ",133.2,90,,106.56,,,0,"percent of total billed charges ","90% of total billed charges ",137.64,93,,110.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",125.8,85,,100.64,,,0,"percent of total billed charges ","85% of total billed charges ",133.2,90,,106.56,,,0,"percent of total billed charges ","90% of total billed charges ",133.2,90,,106.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",128.76,87,,103.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.6,70,,82.88,,,0,"percent of total billed charges ","70% of total billed charges ",103.6,137.64,
"ACYCLOVIR 400MG TAB",7062380,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"PHENOBARBITAL 20MG/5ML ELIX UD",7062490,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,3.5,2.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.45,70,,1.96,,,0,"percent of total billed charges ","70% of total billed charges ",3.15,90,,2.52,,,0,"percent of total billed charges ","90% of total billed charges ",3.26,93,,2.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2.98,85,,2.38,,,0,"percent of total billed charges ","85% of total billed charges ",3.15,90,,2.52,,,0,"percent of total billed charges ","90% of total billed charges ",3.15,90,,2.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3.05,87,,2.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.45,70,,1.96,,,0,"percent of total billed charges ","70% of total billed charges ",2.45,3.26,
"ZYVOX SUSP 100MG/5ML 150ML BOT",7062500,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,78,62.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.6,70,,43.68,,,0,"percent of total billed charges ","70% of total billed charges ",70.2,90,,56.16,,,0,"percent of total billed charges ","90% of total billed charges ",72.54,93,,58.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",66.3,85,,53.04,,,0,"percent of total billed charges ","85% of total billed charges ",70.2,90,,56.16,,,0,"percent of total billed charges ","90% of total billed charges ",70.2,90,,56.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",67.86,87,,54.29,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.6,70,,43.68,,,0,"percent of total billed charges ","70% of total billed charges ",54.6,72.54,
"DDAVP 0.2MG TAB",7062570,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14,11.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",13.02,93,,10.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.9,85,,9.52,,,0,"percent of total billed charges ","85% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.18,87,,9.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",9.8,13.02,
"DIABETIC TUSSIN EX 100MG/5ML",7062600,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"DESITIN OINT 113GM TUBE",7062610,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,10.5,8.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.35,70,,5.88,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,90,,7.56,,,0,"percent of total billed charges ","90% of total billed charges ",9.77,93,,7.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.93,85,,7.14,,,0,"percent of total billed charges ","85% of total billed charges ",9.45,90,,7.56,,,0,"percent of total billed charges ","90% of total billed charges ",9.45,90,,7.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.14,87,,7.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.35,70,,5.88,,,0,"percent of total billed charges ","70% of total billed charges ",7.35,9.77,
"GUAIFENESIN DM 100MG/10MG 5ML",7062670,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"EMETROL 118ML BTL",7062690,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,23.5,18.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.45,70,,13.16,,,0,"percent of total billed charges ","70% of total billed charges ",21.15,90,,16.92,,,0,"percent of total billed charges ","90% of total billed charges ",21.86,93,,17.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.98,85,,15.98,,,0,"percent of total billed charges ","85% of total billed charges ",21.15,90,,16.92,,,0,"percent of total billed charges ","90% of total billed charges ",21.15,90,,16.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.45,87,,16.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.45,70,,13.16,,,0,"percent of total billed charges ","70% of total billed charges ",16.45,21.86,
"LOPERAMIDE HCL 2MG/10ML SOL UD",7062710,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"ALBUTEROL/IPRATROPIUM 3ML NEB",7062800,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"MOVIPREP SOLN 1000ML BTL",7062830,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,196.5,157.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",137.55,70,,110.04,,,0,"percent of total billed charges ","70% of total billed charges ",176.85,90,,141.48,,,0,"percent of total billed charges ","90% of total billed charges ",182.75,93,,146.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",167.03,85,,133.62,,,0,"percent of total billed charges ","85% of total billed charges ",176.85,90,,141.48,,,0,"percent of total billed charges ","90% of total billed charges ",176.85,90,,141.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",170.96,87,,136.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",137.55,70,,110.04,,,0,"percent of total billed charges ","70% of total billed charges ",137.55,182.75,
"DILANTIN 30MG CAP",7062890,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14,11.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",13.02,93,,10.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.9,85,,9.52,,,0,"percent of total billed charges ","85% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.18,87,,9.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",9.8,13.02,
"ECONAZOLE NITRATE 1% CR 30GM",7062930,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,95,76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.5,70,,53.20,,,0,"percent of total billed charges ","70% of total billed charges ",85.5,90,,68.40,,,0,"percent of total billed charges ","90% of total billed charges ",88.35,93,,70.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.75,85,,64.60,,,0,"percent of total billed charges ","85% of total billed charges ",85.5,90,,68.40,,,0,"percent of total billed charges ","90% of total billed charges ",85.5,90,,68.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.65,87,,66.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.5,70,,53.20,,,0,"percent of total billed charges ","70% of total billed charges ",66.5,88.35,
"QUALAQUIN 324MG CAP",7062950,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"LIDOCAINE VISCOUS 2% 20ML SOLN",7063020,"CDM ",250,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"VOLTAREN GEL 1% 100 GM",7063230,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,40.5,32.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.35,70,,22.68,,,0,"percent of total billed charges ","70% of total billed charges ",36.45,90,,29.16,,,0,"percent of total billed charges ","90% of total billed charges ",37.67,93,,30.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34.43,85,,27.54,,,0,"percent of total billed charges ","85% of total billed charges ",36.45,90,,29.16,,,0,"percent of total billed charges ","90% of total billed charges ",36.45,90,,29.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",35.24,87,,28.19,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.35,70,,22.68,,,0,"percent of total billed charges ","70% of total billed charges ",28.35,37.67,
"CAFFEINE CITRATE 20MG/ML 3 ML",7063260,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,101.5,81.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.05,70,,56.84,,,0,"percent of total billed charges ","70% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",94.4,93,,75.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",86.28,85,,69.02,,,0,"percent of total billed charges ","85% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",88.31,87,,70.65,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.05,70,,56.84,,,0,"percent of total billed charges ","70% of total billed charges ",71.05,94.4,
"AVEENO BAR SOAP",7063320,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,8.5,6.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.95,70,,4.76,,,0,"percent of total billed charges ","70% of total billed charges ",7.65,90,,6.12,,,0,"percent of total billed charges ","90% of total billed charges ",7.91,93,,6.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7.23,85,,5.78,,,0,"percent of total billed charges ","85% of total billed charges ",7.65,90,,6.12,,,0,"percent of total billed charges ","90% of total billed charges ",7.65,90,,6.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7.4,87,,5.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.95,70,,4.76,,,0,"percent of total billed charges ","70% of total billed charges ",5.95,7.91,
"LOTRISONE CR 1%/0.5% 45 GM",7063330,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,132.5,106,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.75,70,,74.20,,,0,"percent of total billed charges ","70% of total billed charges ",119.25,90,,95.40,,,0,"percent of total billed charges ","90% of total billed charges ",123.23,93,,98.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",112.63,85,,90.10,,,0,"percent of total billed charges ","85% of total billed charges ",119.25,90,,95.40,,,0,"percent of total billed charges ","90% of total billed charges ",119.25,90,,95.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",115.28,87,,92.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.75,70,,74.20,,,0,"percent of total billed charges ","70% of total billed charges ",92.75,123.23,
"PROAMATINE 5MG TAB",7063370,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14,11.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",13.02,93,,10.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.9,85,,9.52,,,0,"percent of total billed charges ","85% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.18,87,,9.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",9.8,13.02,
"TUMS EX 750MG TAB PER ROLL",7063480,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"DIABETIC TUSSIN DM 120ML BTL",7063490,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,20,16,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14,70,,11.20,,,0,"percent of total billed charges ","70% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",18.6,93,,14.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17,85,,13.60,,,0,"percent of total billed charges ","85% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.4,87,,13.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14,70,,11.20,,,0,"percent of total billed charges ","70% of total billed charges ",14,18.6,
"BETHAMETHASONE CR 0.05% 15GM",7063560,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"VALPROIC ACID SYR 250MG/5ML UD",7063650,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,11.5,9.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.05,70,,6.44,,,0,"percent of total billed charges ","70% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.7,93,,8.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.78,85,,7.82,,,0,"percent of total billed charges ","85% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.01,87,,8.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.05,70,,6.44,,,0,"percent of total billed charges ","70% of total billed charges ",8.05,10.7,
"SYMBICORT 160MCG/4.5MCG 120 IN",7063700,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,249.5,199.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174.65,70,,139.72,,,0,"percent of total billed charges ","70% of total billed charges ",224.55,90,,179.64,,,0,"percent of total billed charges ","90% of total billed charges ",232.04,93,,185.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",212.08,85,,169.66,,,0,"percent of total billed charges ","85% of total billed charges ",224.55,90,,179.64,,,0,"percent of total billed charges ","90% of total billed charges ",224.55,90,,179.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",217.07,87,,173.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174.65,70,,139.72,,,0,"percent of total billed charges ","70% of total billed charges ",174.65,232.04,
"CLEOCIN PED 75MG/5ML ORAL SOL",7063720,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,185,148,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",172.05,93,,137.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",157.25,85,,125.80,,,0,"percent of total billed charges ","85% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",166.5,90,,133.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",160.95,87,,128.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.5,70,,103.60,,,0,"percent of total billed charges ","70% of total billed charges ",129.5,172.05,
"METRONIDAZOLE PED SUSP 150ML",7063725,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,207,165.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.9,70,,115.92,,,0,"percent of total billed charges ","70% of total billed charges ",186.3,90,,149.04,,,0,"percent of total billed charges ","90% of total billed charges ",192.51,93,,154.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",175.95,85,,140.76,,,0,"percent of total billed charges ","85% of total billed charges ",186.3,90,,149.04,,,0,"percent of total billed charges ","90% of total billed charges ",186.3,90,,149.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",180.09,87,,144.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.9,70,,115.92,,,0,"percent of total billed charges ","70% of total billed charges ",144.9,192.51,
"KCL 20MEQ/15ML UD LIQUID",7063800,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,15,12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.95,93,,11.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.75,85,,10.20,,,0,"percent of total billed charges ","85% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.05,87,,10.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",10.5,13.95,
"HUMULIN R INSULIN 100U/ML 3ML",7063840,"CDM ",636,RC,A9270,HCPCS,OUTPATIENT,,,33.5,26.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",31.16,93,,24.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.48,85,,22.78,,,0,"percent of total billed charges ","85% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.15,87,,23.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",23.45,31.16,
"INSULIN R MYXREDLIN 100U/100ML",7063842,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",80.5,106.95,
"CALCIUM CARBON 1250MG/5ML SUSP",7063900,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,1,0.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.7,70,,0.56,,,0,"percent of total billed charges ","70% of total billed charges ",0.9,90,,0.72,,,0,"percent of total billed charges ","90% of total billed charges ",0.93,93,,0.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",0.85,85,,0.68,,,0,"percent of total billed charges ","85% of total billed charges ",0.9,90,,0.72,,,0,"percent of total billed charges ","90% of total billed charges ",0.9,90,,0.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",0.87,87,,0.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.7,70,,0.56,,,0,"percent of total billed charges ","70% of total billed charges ",0.7,0.93,
"BYSTOLIC 10MG TAB",7063940,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"CULTURELLE CAP",7064040,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"SEROQUEL XR 50MG TAB",7064090,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"NIMODIPINE 30MG CAP",7064150,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,26,20.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.2,70,,14.56,,,0,"percent of total billed charges ","70% of total billed charges ",23.4,90,,18.72,,,0,"percent of total billed charges ","90% of total billed charges ",24.18,93,,19.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",22.1,85,,17.68,,,0,"percent of total billed charges ","85% of total billed charges ",23.4,90,,18.72,,,0,"percent of total billed charges ","90% of total billed charges ",23.4,90,,18.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.62,87,,18.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.2,70,,14.56,,,0,"percent of total billed charges ","70% of total billed charges ",18.2,24.18,
"BRIMONIDINE (COMBIGAN)OPTH 5ML",7064190,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,208.5,166.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",145.95,70,,116.76,,,0,"percent of total billed charges ","70% of total billed charges ",187.65,90,,150.12,,,0,"percent of total billed charges ","90% of total billed charges ",193.91,93,,155.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",177.23,85,,141.78,,,0,"percent of total billed charges ","85% of total billed charges ",187.65,90,,150.12,,,0,"percent of total billed charges ","90% of total billed charges ",187.65,90,,150.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",181.4,87,,145.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",145.95,70,,116.76,,,0,"percent of total billed charges ","70% of total billed charges ",145.95,193.91,
"CREON 24000 UNITS CAPSULE",7064340,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,16.5,13.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.55,70,,9.24,,,0,"percent of total billed charges ","70% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",15.35,93,,12.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.03,85,,11.22,,,0,"percent of total billed charges ","85% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.36,87,,11.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.55,70,,9.24,,,0,"percent of total billed charges ","70% of total billed charges ",11.55,15.35,
"GLUCOSAMINE/CHONDR 1500/1200MG",7064360,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"HYDROCODONE/APAP 7.5/325MG",7064370,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"CETIRIZINE SOL 1MG/ML 5ML UDC",7064430,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"HYDROCODONE/APAP 5/325MG TAB",7064450,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"AMPICILLIN 2GM VIAL",7064470,"CDM ",636,RC,J0290,HCPCS,OUTPATIENT,,,66,52.8,,,,,,,,0,"other ","not separately reimbursment ",1.04,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",46.2,70,,36.96,,,0,"percent of total billed charges ","70% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",61.38,93,,49.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",0.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",56.1,85,,44.88,,,0,"percent of total billed charges ","85% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",0.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.42,87,,45.94,,,0,"percent of total billed charges ","87% of total billed charges ",0.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",46.2,70,,36.96,,,0,"percent of total billed charges ","70% of total billed charges ",0.81,61.38,
"CHLORHEXIDINE 0.12% 15ML ORAL",7064490,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"BRINZOLAMIDE 1% SUSP 10ML",7064500,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,622.5,498,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",435.75,70,,348.60,,,0,"percent of total billed charges ","70% of total billed charges ",560.25,90,,448.20,,,0,"percent of total billed charges ","90% of total billed charges ",578.93,93,,463.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",529.13,85,,423.30,,,0,"percent of total billed charges ","85% of total billed charges ",560.25,90,,448.20,,,0,"percent of total billed charges ","90% of total billed charges ",560.25,90,,448.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",541.58,87,,433.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",435.75,70,,348.60,,,0,"percent of total billed charges ","70% of total billed charges ",435.75,578.93,
"DORZOLAMIDE HCL 2% ML OPHTH",7064530,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,178,142.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.6,70,,99.68,,,0,"percent of total billed charges ","70% of total billed charges ",160.2,90,,128.16,,,0,"percent of total billed charges ","90% of total billed charges ",165.54,93,,132.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",151.3,85,,121.04,,,0,"percent of total billed charges ","85% of total billed charges ",160.2,90,,128.16,,,0,"percent of total billed charges ","90% of total billed charges ",160.2,90,,128.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",154.86,87,,123.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.6,70,,99.68,,,0,"percent of total billed charges ","70% of total billed charges ",124.6,165.54,
"DIAZEPAM 5MG/5ML 5ML ORAL",7064560,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,9,7.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.3,70,,5.04,,,0,"percent of total billed charges ","70% of total billed charges ",8.1,90,,6.48,,,0,"percent of total billed charges ","90% of total billed charges ",8.37,93,,6.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7.65,85,,6.12,,,0,"percent of total billed charges ","85% of total billed charges ",8.1,90,,6.48,,,0,"percent of total billed charges ","90% of total billed charges ",8.1,90,,6.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7.83,87,,6.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.3,70,,5.04,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,8.37,
"TIMOLOL MALEATE OPHTH 10ML SOL",7064580,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,93.5,74.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.45,70,,52.36,,,0,"percent of total billed charges ","70% of total billed charges ",84.15,90,,67.32,,,0,"percent of total billed charges ","90% of total billed charges ",86.96,93,,69.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",79.48,85,,63.58,,,0,"percent of total billed charges ","85% of total billed charges ",84.15,90,,67.32,,,0,"percent of total billed charges ","90% of total billed charges ",84.15,90,,67.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.35,87,,65.08,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.45,70,,52.36,,,0,"percent of total billed charges ","70% of total billed charges ",65.45,86.96,
"MOMETASONE FUROATE 220MG/INH",7064610,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,215.5,172.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",150.85,70,,120.68,,,0,"percent of total billed charges ","70% of total billed charges ",193.95,90,,155.16,,,0,"percent of total billed charges ","90% of total billed charges ",200.42,93,,160.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",183.18,85,,146.54,,,0,"percent of total billed charges ","85% of total billed charges ",193.95,90,,155.16,,,0,"percent of total billed charges ","90% of total billed charges ",193.95,90,,155.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",187.49,87,,149.99,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",150.85,70,,120.68,,,0,"percent of total billed charges ","70% of total billed charges ",150.85,200.42,
"DIPHEN/LODOCAIN/ALUM 237ML BTL",7064620,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,122,97.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.4,70,,68.32,,,0,"percent of total billed charges ","70% of total billed charges ",109.8,90,,87.84,,,0,"percent of total billed charges ","90% of total billed charges ",113.46,93,,90.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",103.7,85,,82.96,,,0,"percent of total billed charges ","85% of total billed charges ",109.8,90,,87.84,,,0,"percent of total billed charges ","90% of total billed charges ",109.8,90,,87.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",106.14,87,,84.91,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.4,70,,68.32,,,0,"percent of total billed charges ","70% of total billed charges ",85.4,113.46,
"DIPHEN LIDOC AL MG HYDRA SIMET",7064621,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,207,165.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.9,70,,115.92,,,0,"percent of total billed charges ","70% of total billed charges ",186.3,90,,149.04,,,0,"percent of total billed charges ","90% of total billed charges ",192.51,93,,154.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",175.95,85,,140.76,,,0,"percent of total billed charges ","85% of total billed charges ",186.3,90,,149.04,,,0,"percent of total billed charges ","90% of total billed charges ",186.3,90,,149.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",180.09,87,,144.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.9,70,,115.92,,,0,"percent of total billed charges ","70% of total billed charges ",144.9,192.51,
"MAGIC MOUTH WASH 120ML BTL",7064622,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,49.5,39.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",46.04,93,,36.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.08,85,,33.66,,,0,"percent of total billed charges ","85% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.07,87,,34.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,46.04,
"DONNATAL ELIXIR 4 OZ",7064680,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,76,60.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.2,70,,42.56,,,0,"percent of total billed charges ","70% of total billed charges ",68.4,90,,54.72,,,0,"percent of total billed charges ","90% of total billed charges ",70.68,93,,56.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",64.6,85,,51.68,,,0,"percent of total billed charges ","85% of total billed charges ",68.4,90,,54.72,,,0,"percent of total billed charges ","90% of total billed charges ",68.4,90,,54.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",66.12,87,,52.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.2,70,,42.56,,,0,"percent of total billed charges ","70% of total billed charges ",53.2,70.68,
"CEFPROZIL 250MG/5ML BTL",7064700,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,140.5,112.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",130.67,93,,104.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",119.43,85,,95.54,,,0,"percent of total billed charges ","85% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",126.45,90,,101.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",122.24,87,,97.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.35,70,,78.68,,,0,"percent of total billed charges ","70% of total billed charges ",98.35,130.67,
"ZINC OXIDE (TOPICAL) 2OZ JAR",7064710,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,38.5,30.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,93,,28.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.73,85,,26.18,,,0,"percent of total billed charges ","85% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.5,87,,26.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",26.95,35.81,
"BENZTROPINE 0.5MG TAB",7064720,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"GLYCERIN (LAX) 1.2 GM SUPP",7064790,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"SILVER SULFADIAZINE 1% CR 25GM",7064900,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"OSELTAMIVIR 6MG/ML 60ML SUSP",7064930,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,296,236.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",207.2,70,,165.76,,,0,"percent of total billed charges ","70% of total billed charges ",266.4,90,,213.12,,,0,"percent of total billed charges ","90% of total billed charges ",275.28,93,,220.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",251.6,85,,201.28,,,0,"percent of total billed charges ","85% of total billed charges ",266.4,90,,213.12,,,0,"percent of total billed charges ","90% of total billed charges ",266.4,90,,213.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",257.52,87,,206.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",207.2,70,,165.76,,,0,"percent of total billed charges ","70% of total billed charges ",207.2,275.28,
"CHOLECALCIFEROL 1000 IU TAB",7065040,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"PHENOBARBITAL 16.2MG TAB",7065070,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"AZITHROMYCIN SUSP 40MG/ML 22.5",7065090,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,99.5,79.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.65,70,,55.72,,,0,"percent of total billed charges ","70% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",92.54,93,,74.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",84.58,85,,67.66,,,0,"percent of total billed charges ","85% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",86.57,87,,69.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.65,70,,55.72,,,0,"percent of total billed charges ","70% of total billed charges ",69.65,92.54,
"GUAIFENESIN 100MG/5ML UDC",7065100,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,8.5,6.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.95,70,,4.76,,,0,"percent of total billed charges ","70% of total billed charges ",7.65,90,,6.12,,,0,"percent of total billed charges ","90% of total billed charges ",7.91,93,,6.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7.23,85,,5.78,,,0,"percent of total billed charges ","85% of total billed charges ",7.65,90,,6.12,,,0,"percent of total billed charges ","90% of total billed charges ",7.65,90,,6.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7.4,87,,5.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.95,70,,4.76,,,0,"percent of total billed charges ","70% of total billed charges ",5.95,7.91,
"DABIGATRAN EXTEXILATE 75MG CAP",7065370,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,16.5,13.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.55,70,,9.24,,,0,"percent of total billed charges ","70% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",15.35,93,,12.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.03,85,,11.22,,,0,"percent of total billed charges ","85% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.36,87,,11.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.55,70,,9.24,,,0,"percent of total billed charges ","70% of total billed charges ",11.55,15.35,
"HYDROCERIN CREAM 113GM JAR",7065390,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,15.5,12.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.85,70,,8.68,,,0,"percent of total billed charges ","70% of total billed charges ",13.95,90,,11.16,,,0,"percent of total billed charges ","90% of total billed charges ",14.42,93,,11.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.18,85,,10.54,,,0,"percent of total billed charges ","85% of total billed charges ",13.95,90,,11.16,,,0,"percent of total billed charges ","90% of total billed charges ",13.95,90,,11.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.49,87,,10.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.85,70,,8.68,,,0,"percent of total billed charges ","70% of total billed charges ",10.85,14.42,
"NYSTATIN OINT 15GM TUBE",7065430,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,57.5,46,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.25,70,,32.20,,,0,"percent of total billed charges ","70% of total billed charges ",51.75,90,,41.40,,,0,"percent of total billed charges ","90% of total billed charges ",53.48,93,,42.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",48.88,85,,39.10,,,0,"percent of total billed charges ","85% of total billed charges ",51.75,90,,41.40,,,0,"percent of total billed charges ","90% of total billed charges ",51.75,90,,41.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",50.03,87,,40.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.25,70,,32.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.25,53.48,
"RIVAROXABAN 10MG TAB",7065460,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,31,24.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.7,70,,17.36,,,0,"percent of total billed charges ","70% of total billed charges ",27.9,90,,22.32,,,0,"percent of total billed charges ","90% of total billed charges ",28.83,93,,23.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.35,85,,21.08,,,0,"percent of total billed charges ","85% of total billed charges ",27.9,90,,22.32,,,0,"percent of total billed charges ","90% of total billed charges ",27.9,90,,22.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.97,87,,21.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.7,70,,17.36,,,0,"percent of total billed charges ","70% of total billed charges ",21.7,28.83,
"COLLAGEN 250 UNIT/GM 30GM OINT",7065470,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,469.5,375.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",328.65,70,,262.92,,,0,"percent of total billed charges ","70% of total billed charges ",422.55,90,,338.04,,,0,"percent of total billed charges ","90% of total billed charges ",436.64,93,,349.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",399.08,85,,319.26,,,0,"percent of total billed charges ","85% of total billed charges ",422.55,90,,338.04,,,0,"percent of total billed charges ","90% of total billed charges ",422.55,90,,338.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",408.47,87,,326.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",328.65,70,,262.92,,,0,"percent of total billed charges ","70% of total billed charges ",328.65,436.64,
"CLOTRIMAZOLE-BETAMETH 1-0.05%",7065480,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,64.5,51.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.15,70,,36.12,,,0,"percent of total billed charges ","70% of total billed charges ",58.05,90,,46.44,,,0,"percent of total billed charges ","90% of total billed charges ",59.99,93,,47.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",54.83,85,,43.86,,,0,"percent of total billed charges ","85% of total billed charges ",58.05,90,,46.44,,,0,"percent of total billed charges ","90% of total billed charges ",58.05,90,,46.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",56.12,87,,44.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.15,70,,36.12,,,0,"percent of total billed charges ","70% of total billed charges ",45.15,59.99,
"POLYETHYLENE GLYCOL 3350 238GM",7065490,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,33.5,26.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",31.16,93,,24.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.48,85,,22.78,,,0,"percent of total billed charges ","85% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.15,87,,23.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",23.45,31.16,
"OMEPRAZOLE 2MG/ML 150ML BTL",7065540,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,182,145.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.4,70,,101.92,,,0,"percent of total billed charges ","70% of total billed charges ",163.8,90,,131.04,,,0,"percent of total billed charges ","90% of total billed charges ",169.26,93,,135.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",154.7,85,,123.76,,,0,"percent of total billed charges ","85% of total billed charges ",163.8,90,,131.04,,,0,"percent of total billed charges ","90% of total billed charges ",163.8,90,,131.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",158.34,87,,126.67,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.4,70,,101.92,,,0,"percent of total billed charges ","70% of total billed charges ",127.4,169.26,
"BIOTENE ARTIFI SALIVA 44.3ML",7065650,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"VITAMIN D 50,000 UNIT CAPS",7065710,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"INSULIN DETEMIR 100 UNIT/ML PE",7065810,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,41,32.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.7,70,,22.96,,,0,"percent of total billed charges ","70% of total billed charges ",36.9,90,,29.52,,,0,"percent of total billed charges ","90% of total billed charges ",38.13,93,,30.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34.85,85,,27.88,,,0,"percent of total billed charges ","85% of total billed charges ",36.9,90,,29.52,,,0,"percent of total billed charges ","90% of total billed charges ",36.9,90,,29.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",35.67,87,,28.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.7,70,,22.96,,,0,"percent of total billed charges ","70% of total billed charges ",28.7,38.13,
"ARIPIPRAZOLE 5MG TAB",7065820,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,78.5,62.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.95,70,,43.96,,,0,"percent of total billed charges ","70% of total billed charges ",70.65,90,,56.52,,,0,"percent of total billed charges ","90% of total billed charges ",73.01,93,,58.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",66.73,85,,53.38,,,0,"percent of total billed charges ","85% of total billed charges ",70.65,90,,56.52,,,0,"percent of total billed charges ","90% of total billed charges ",70.65,90,,56.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",68.3,87,,54.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.95,70,,43.96,,,0,"percent of total billed charges ","70% of total billed charges ",54.95,73.01,
"RANOLAZINE 500MG TAB",7065830,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,15,12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.95,93,,11.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.75,85,,10.20,,,0,"percent of total billed charges ","85% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.05,87,,10.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",10.5,13.95,
"MORPHINE SULFATE 10MG CAP ER",7065860,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14,11.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",13.02,93,,10.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.9,85,,9.52,,,0,"percent of total billed charges ","85% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.18,87,,9.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",9.8,13.02,
"LUBIPROSTONE 8MEQ CAPSULE",7065870,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,17,13.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.9,70,,9.52,,,0,"percent of total billed charges ","70% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.81,93,,12.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.45,85,,11.56,,,0,"percent of total billed charges ","85% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.79,87,,11.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.9,70,,9.52,,,0,"percent of total billed charges ","70% of total billed charges ",11.9,15.81,
"LEVOCARNITINE 1GM/10ML 118ML",7065880,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,98,78.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.6,70,,54.88,,,0,"percent of total billed charges ","70% of total billed charges ",88.2,90,,70.56,,,0,"percent of total billed charges ","90% of total billed charges ",91.14,93,,72.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.3,85,,66.64,,,0,"percent of total billed charges ","85% of total billed charges ",88.2,90,,70.56,,,0,"percent of total billed charges ","90% of total billed charges ",88.2,90,,70.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.26,87,,68.21,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.6,70,,54.88,,,0,"percent of total billed charges ","70% of total billed charges ",68.6,91.14,
"POTASSIUM ACID PHOS 500MG TAB",7065900,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"LEFLUNO 20MG TAB",7065910,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,39.5,31.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.65,70,,22.12,,,0,"percent of total billed charges ","70% of total billed charges ",35.55,90,,28.44,,,0,"percent of total billed charges ","90% of total billed charges ",36.74,93,,29.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.58,85,,26.86,,,0,"percent of total billed charges ","85% of total billed charges ",35.55,90,,28.44,,,0,"percent of total billed charges ","90% of total billed charges ",35.55,90,,28.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",34.37,87,,27.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.65,70,,22.12,,,0,"percent of total billed charges ","70% of total billed charges ",27.65,36.74,
"NEBIVOLOL HCL 5MG TAB",7065930,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"URSODIOL 250MG TAB",7065940,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"VANCOMYCIN  50MG/ML 300ML BTL",7065950,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,250,200,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",175,70,,140.00,,,0,"percent of total billed charges ","70% of total billed charges ",225,90,,180.00,,,0,"percent of total billed charges ","90% of total billed charges ",232.5,93,,186.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",212.5,85,,170.00,,,0,"percent of total billed charges ","85% of total billed charges ",225,90,,180.00,,,0,"percent of total billed charges ","90% of total billed charges ",225,90,,180.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",217.5,87,,174.00,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",175,70,,140.00,,,0,"percent of total billed charges ","70% of total billed charges ",175,232.5,
"HYDROCOD-ACETA 7.5/325MG 15ML",7065980,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,8,6.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.6,70,,4.48,,,0,"percent of total billed charges ","70% of total billed charges ",7.2,90,,5.76,,,0,"percent of total billed charges ","90% of total billed charges ",7.44,93,,5.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6.8,85,,5.44,,,0,"percent of total billed charges ","85% of total billed charges ",7.2,90,,5.76,,,0,"percent of total billed charges ","90% of total billed charges ",7.2,90,,5.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.96,87,,5.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.6,70,,4.48,,,0,"percent of total billed charges ","70% of total billed charges ",5.6,7.44,
"PHENOBARBITAL 97.2 MG TAB",7065990,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,11.5,9.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.05,70,,6.44,,,0,"percent of total billed charges ","70% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.7,93,,8.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.78,85,,7.82,,,0,"percent of total billed charges ","85% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.01,87,,8.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.05,70,,6.44,,,0,"percent of total billed charges ","70% of total billed charges ",8.05,10.7,
"ELIQUIS 2.5 MG TAB",7066100,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,17.5,14,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",16.28,93,,13.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.88,85,,11.90,,,0,"percent of total billed charges ","85% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.23,87,,12.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",12.25,16.28,
"CIALIS 5MG TAB",7066140,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,23.5,18.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.45,70,,13.16,,,0,"percent of total billed charges ","70% of total billed charges ",21.15,90,,16.92,,,0,"percent of total billed charges ","90% of total billed charges ",21.86,93,,17.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.98,85,,15.98,,,0,"percent of total billed charges ","85% of total billed charges ",21.15,90,,16.92,,,0,"percent of total billed charges ","90% of total billed charges ",21.15,90,,16.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.45,87,,16.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.45,70,,13.16,,,0,"percent of total billed charges ","70% of total billed charges ",16.45,21.86,
"DIFICID 200MG TAB",7066150,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,366.5,293.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",256.55,70,,205.24,,,0,"percent of total billed charges ","70% of total billed charges ",329.85,90,,263.88,,,0,"percent of total billed charges ","90% of total billed charges ",340.85,93,,272.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",311.53,85,,249.22,,,0,"percent of total billed charges ","85% of total billed charges ",329.85,90,,263.88,,,0,"percent of total billed charges ","90% of total billed charges ",329.85,90,,263.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",318.86,87,,255.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",256.55,70,,205.24,,,0,"percent of total billed charges ","70% of total billed charges ",256.55,340.85,
"RISPERIDONE 0.25MG TAB",7066160,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"CODEINE 15 MG TAB",7066240,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,11.5,9.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.05,70,,6.44,,,0,"percent of total billed charges ","70% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.7,93,,8.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.78,85,,7.82,,,0,"percent of total billed charges ","85% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.01,87,,8.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.05,70,,6.44,,,0,"percent of total billed charges ","70% of total billed charges ",8.05,10.7,
"JUBBONTI DENOSUMAB BBDZ 60MG",7066258,"CDM ",636,RC,Q5136,HCPCS,OUTPATIENT,,,1649.5,1319.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1154.65,70,,923.72,,,0,"percent of total billed charges ","70% of total billed charges ",1484.55,90,,1187.64,,,0,"percent of total billed charges ","90% of total billed charges ",1534.04,93,,1227.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1402.08,85,,1121.66,,,0,"percent of total billed charges ","85% of total billed charges ",1484.55,90,,1187.64,,,0,"percent of total billed charges ","90% of total billed charges ",1484.55,90,,1187.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1435.07,87,,1148.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",28.23,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",1154.65,70,,923.72,,,0,"percent of total billed charges ","70% of total billed charges ",28.23,1534.04,
"XOLAIR 300 MG PFS 2ML",7066268,"CDM ",636,RC,J2357,HCPCS,OUTPATIENT,,,3153,2522.4,,,,,,,,0,"other ","not separately reimbursment ",47.35,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",2207.1,70,,1765.68,,,0,"percent of total billed charges ","70% of total billed charges ",2837.7,90,,2270.16,,,0,"percent of total billed charges ","90% of total billed charges ",2932.29,93,,2345.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",38.05,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",2680.05,85,,2144.04,,,0,"percent of total billed charges ","85% of total billed charges ",2837.7,90,,2270.16,,,0,"percent of total billed charges ","90% of total billed charges ",2837.7,90,,2270.16,,,0,"percent of total billed charges ","90% of total billed charges ",37.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2743.11,87,,2194.49,,,0,"percent of total billed charges ","87% of total billed charges ",37.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.5,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",2207.1,70,,1765.68,,,0,"percent of total billed charges ","70% of total billed charges ",37.67,2932.29,
"ELLA 30 MG TAB",7066290,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,89.5,71.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.65,70,,50.12,,,0,"percent of total billed charges ","70% of total billed charges ",80.55,90,,64.44,,,0,"percent of total billed charges ","90% of total billed charges ",83.24,93,,66.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",76.08,85,,60.86,,,0,"percent of total billed charges ","85% of total billed charges ",80.55,90,,64.44,,,0,"percent of total billed charges ","90% of total billed charges ",80.55,90,,64.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",77.87,87,,62.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.65,70,,50.12,,,0,"percent of total billed charges ","70% of total billed charges ",62.65,83.24,
"MEROPENEM 2GM VIALS",7066303,"CDM ",636,RC,J2183,HCPCS,OUTPATIENT,,,135,108,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",125.55,93,,100.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",114.75,85,,91.80,,,0,"percent of total billed charges ","85% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",117.45,87,,93.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",94.5,125.55,
"VORICONAZOLE 200MG TAB",7066430,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,99,79.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.3,70,,55.44,,,0,"percent of total billed charges ","70% of total billed charges ",89.1,90,,71.28,,,0,"percent of total billed charges ","90% of total billed charges ",92.07,93,,73.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",84.15,85,,67.32,,,0,"percent of total billed charges ","85% of total billed charges ",89.1,90,,71.28,,,0,"percent of total billed charges ","90% of total billed charges ",89.1,90,,71.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",86.13,87,,68.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.3,70,,55.44,,,0,"percent of total billed charges ","70% of total billed charges ",69.3,92.07,
"PHENOL LIQUID 100ML BTL",7066460,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,142,113.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.4,70,,79.52,,,0,"percent of total billed charges ","70% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",132.06,93,,105.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",120.7,85,,96.56,,,0,"percent of total billed charges ","85% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",127.8,90,,102.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",123.54,87,,98.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.4,70,,79.52,,,0,"percent of total billed charges ","70% of total billed charges ",99.4,132.06,
"COUMADIN 6MG TAB",7066470,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,11.5,9.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.05,70,,6.44,,,0,"percent of total billed charges ","70% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.7,93,,8.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.78,85,,7.82,,,0,"percent of total billed charges ","85% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.01,87,,8.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.05,70,,6.44,,,0,"percent of total billed charges ","70% of total billed charges ",8.05,10.7,
"MYRBETRIQ 50 MG TAB",7066480,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,25,20,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.5,70,,14.00,,,0,"percent of total billed charges ","70% of total billed charges ",22.5,90,,18.00,,,0,"percent of total billed charges ","90% of total billed charges ",23.25,93,,18.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.25,85,,17.00,,,0,"percent of total billed charges ","85% of total billed charges ",22.5,90,,18.00,,,0,"percent of total billed charges ","90% of total billed charges ",22.5,90,,18.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.75,87,,17.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.5,70,,14.00,,,0,"percent of total billed charges ","70% of total billed charges ",17.5,23.25,
"MODAFINIL 100 MG TAB",7066540,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,43.5,34.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.45,70,,24.36,,,0,"percent of total billed charges ","70% of total billed charges ",39.15,90,,31.32,,,0,"percent of total billed charges ","90% of total billed charges ",40.46,93,,32.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",36.98,85,,29.58,,,0,"percent of total billed charges ","85% of total billed charges ",39.15,90,,31.32,,,0,"percent of total billed charges ","90% of total billed charges ",39.15,90,,31.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",37.85,87,,30.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.45,70,,24.36,,,0,"percent of total billed charges ","70% of total billed charges ",30.45,40.46,
"BRILINTA 90 MG TAB",7066560,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"PP HYDRO/ACET 5/325MG 6 TABS",7066640,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,18,14.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.74,93,,13.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.3,85,,12.24,,,0,"percent of total billed charges ","85% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.66,87,,12.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,16.74,
"PP AMOXICILLIN 500MG 3 TABS",7066650,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,16,12.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.88,93,,11.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.6,85,,10.88,,,0,"percent of total billed charges ","85% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.92,87,,11.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,14.88,
"PP AMOXICILLIN/CLA 875MG 2 TAB",7066660,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,17.5,14,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",16.28,93,,13.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.88,85,,11.90,,,0,"percent of total billed charges ","85% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.23,87,,12.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",12.25,16.28,
"PP CIPROFLOXACIN 500MG 2 TABS",7066690,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,16,12.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.88,93,,11.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.6,85,,10.88,,,0,"percent of total billed charges ","85% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.92,87,,11.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,14.88,
"PP CLINDAMYCIN 150MG 8 TABS",7066700,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,17.5,14,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",16.28,93,,13.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.88,85,,11.90,,,0,"percent of total billed charges ","85% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.23,87,,12.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",12.25,16.28,
"PP DOXYCYCLINE 100MG 2 TABS",7066710,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,21,16.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.7,70,,11.76,,,0,"percent of total billed charges ","70% of total billed charges ",18.9,90,,15.12,,,0,"percent of total billed charges ","90% of total billed charges ",19.53,93,,15.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.85,85,,14.28,,,0,"percent of total billed charges ","85% of total billed charges ",18.9,90,,15.12,,,0,"percent of total billed charges ","90% of total billed charges ",18.9,90,,15.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.27,87,,14.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.7,70,,11.76,,,0,"percent of total billed charges ","70% of total billed charges ",14.7,19.53,
"PP LEVOFLOXACIN 500MG 1 TAB",7066720,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,16,12.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.88,93,,11.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.6,85,,10.88,,,0,"percent of total billed charges ","85% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.92,87,,11.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,14.88,
"PP LEVOFLOXACIN 750MG 1 TAB",7066730,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,16.5,13.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.55,70,,9.24,,,0,"percent of total billed charges ","70% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",15.35,93,,12.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.03,85,,11.22,,,0,"percent of total billed charges ","85% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.36,87,,11.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.55,70,,9.24,,,0,"percent of total billed charges ","70% of total billed charges ",11.55,15.35,
"PP METRONIDAZOLE 250MG 4 TABS",7066740,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,17,13.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.9,70,,9.52,,,0,"percent of total billed charges ","70% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.81,93,,12.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.45,85,,11.56,,,0,"percent of total billed charges ","85% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.79,87,,11.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.9,70,,9.52,,,0,"percent of total billed charges ","70% of total billed charges ",11.9,15.81,
"PP METRONIDAZOLE 500MG 4 TABS",7066750,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,17.5,14,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",16.28,93,,13.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.88,85,,11.90,,,0,"percent of total billed charges ","85% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.23,87,,12.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",12.25,16.28,
"PP NITROFURANTOIN 100MG 2 TABS",7066760,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,20,16,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14,70,,11.20,,,0,"percent of total billed charges ","70% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",18.6,93,,14.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17,85,,13.60,,,0,"percent of total billed charges ","85% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.4,87,,13.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14,70,,11.20,,,0,"percent of total billed charges ","70% of total billed charges ",14,18.6,
"PP SMZ TMP SUSP 30ML BTL",7066770,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,16,12.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.88,93,,11.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.6,85,,10.88,,,0,"percent of total billed charges ","85% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.92,87,,11.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,14.88,
"PP SMZ TMP SUSP 30ML BTL",7066780,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,22,17.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.4,70,,12.32,,,0,"percent of total billed charges ","70% of total billed charges ",19.8,90,,15.84,,,0,"percent of total billed charges ","90% of total billed charges ",20.46,93,,16.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.7,85,,14.96,,,0,"percent of total billed charges ","85% of total billed charges ",19.8,90,,15.84,,,0,"percent of total billed charges ","90% of total billed charges ",19.8,90,,15.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.14,87,,15.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.4,70,,12.32,,,0,"percent of total billed charges ","70% of total billed charges ",15.4,20.46,
"PP DEXAMETHASONE 4MG 4 TABS",7066790,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,16.5,13.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.55,70,,9.24,,,0,"percent of total billed charges ","70% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",15.35,93,,12.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.03,85,,11.22,,,0,"percent of total billed charges ","85% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.36,87,,11.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.55,70,,9.24,,,0,"percent of total billed charges ","70% of total billed charges ",11.55,15.35,
"PP PREDNISONE 20MG 2 TABS",7066800,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,16,12.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.88,93,,11.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.6,85,,10.88,,,0,"percent of total billed charges ","85% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.92,87,,11.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,14.88,
"PP ACYCLOVIR SUSP 200MG/5ML",7066810,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"PP ACYCLOVIR 400MG 4 TABS",7066820,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,16.5,13.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.55,70,,9.24,,,0,"percent of total billed charges ","70% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",15.35,93,,12.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.03,85,,11.22,,,0,"percent of total billed charges ","85% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.36,87,,11.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.55,70,,9.24,,,0,"percent of total billed charges ","70% of total billed charges ",11.55,15.35,
"PP OSELTAMIVIR 75MG 10CAPS",7066830,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,117.5,94,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.25,70,,65.80,,,0,"percent of total billed charges ","70% of total billed charges ",105.75,90,,84.60,,,0,"percent of total billed charges ","90% of total billed charges ",109.28,93,,87.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.88,85,,79.90,,,0,"percent of total billed charges ","85% of total billed charges ",105.75,90,,84.60,,,0,"percent of total billed charges ","90% of total billed charges ",105.75,90,,84.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",102.23,87,,81.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.25,70,,65.80,,,0,"percent of total billed charges ","70% of total billed charges ",82.25,109.28,
"PP VALACYCLOVIR 500MG 2 TABS",7066840,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,21,16.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.7,70,,11.76,,,0,"percent of total billed charges ","70% of total billed charges ",18.9,90,,15.12,,,0,"percent of total billed charges ","90% of total billed charges ",19.53,93,,15.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.85,85,,14.28,,,0,"percent of total billed charges ","85% of total billed charges ",18.9,90,,15.12,,,0,"percent of total billed charges ","90% of total billed charges ",18.9,90,,15.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.27,87,,14.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.7,70,,11.76,,,0,"percent of total billed charges ","70% of total billed charges ",14.7,19.53,
"PP ALPRAZOLAM .25MG 2TABS",7066850,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,16,12.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.88,93,,11.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.6,85,,10.88,,,0,"percent of total billed charges ","85% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.92,87,,11.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,14.88,
"PP DIAZEPAM 5MG 2 TABS",7066860,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,16,12.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.88,93,,11.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.6,85,,10.88,,,0,"percent of total billed charges ","85% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.92,87,,11.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,14.88,
"PP GUAIFENESIN DM ELIXIR 5ML",7066870,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,17.5,14,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",16.28,93,,13.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.88,85,,11.90,,,0,"percent of total billed charges ","85% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.23,87,,12.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",12.25,16.28,
"PP GUAIFENESIN CODINE ELIXIR",7066880,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,17.5,14,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",16.28,93,,13.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.88,85,,11.90,,,0,"percent of total billed charges ","85% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.23,87,,12.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",12.25,16.28,
"PP PROMETH COD SYRUP 30ML BTL",7066890,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,17,13.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.9,70,,9.52,,,0,"percent of total billed charges ","70% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.81,93,,12.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.45,85,,11.56,,,0,"percent of total billed charges ","85% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.79,87,,11.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.9,70,,9.52,,,0,"percent of total billed charges ","70% of total billed charges ",11.9,15.81,
"PP MECLIZINE 25MG 4 TABS",7066900,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,17.5,14,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",16.28,93,,13.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.88,85,,11.90,,,0,"percent of total billed charges ","85% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.23,87,,12.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",12.25,16.28,
"PP PHENAZOPYRIDINE 100MG 3 TAB",7066910,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,18,14.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.74,93,,13.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.3,85,,12.24,,,0,"percent of total billed charges ","85% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.66,87,,12.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,16.74,
"PP DICYCLOMINE 10MG 3 CAPS",7066920,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,16,12.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.88,93,,11.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.6,85,,10.88,,,0,"percent of total billed charges ","85% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.92,87,,11.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,14.88,
"PP ONDANSETRON ODT 4MG 4 TABS",7066930,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,18.5,14.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.95,70,,10.36,,,0,"percent of total billed charges ","70% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",17.21,93,,13.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.73,85,,12.58,,,0,"percent of total billed charges ","85% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.1,87,,12.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.95,70,,10.36,,,0,"percent of total billed charges ","70% of total billed charges ",12.95,17.21,
"PP ACETAMIN/CODEINE #3  6 TABS",7066940,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,17,13.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.9,70,,9.52,,,0,"percent of total billed charges ","70% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.81,93,,12.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.45,85,,11.56,,,0,"percent of total billed charges ","85% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.79,87,,11.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.9,70,,9.52,,,0,"percent of total billed charges ","70% of total billed charges ",11.9,15.81,
"PP ACETAMIN/CODEINE 5ML 1 BTL",7066950,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,34,27.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.8,70,,19.04,,,0,"percent of total billed charges ","70% of total billed charges ",30.6,90,,24.48,,,0,"percent of total billed charges ","90% of total billed charges ",31.62,93,,25.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.9,85,,23.12,,,0,"percent of total billed charges ","85% of total billed charges ",30.6,90,,24.48,,,0,"percent of total billed charges ","90% of total billed charges ",30.6,90,,24.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.58,87,,23.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.8,70,,19.04,,,0,"percent of total billed charges ","70% of total billed charges ",23.8,31.62,
"PP COLCHICINE 0.6MG 3 TABS",7066960,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,34,27.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.8,70,,19.04,,,0,"percent of total billed charges ","70% of total billed charges ",30.6,90,,24.48,,,0,"percent of total billed charges ","90% of total billed charges ",31.62,93,,25.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.9,85,,23.12,,,0,"percent of total billed charges ","85% of total billed charges ",30.6,90,,24.48,,,0,"percent of total billed charges ","90% of total billed charges ",30.6,90,,24.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.58,87,,23.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.8,70,,19.04,,,0,"percent of total billed charges ","70% of total billed charges ",23.8,31.62,
"PP CYCLOBENZAPRINE 10MG 3 TABS",7066970,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,16,12.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.88,93,,11.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.6,85,,10.88,,,0,"percent of total billed charges ","85% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.92,87,,11.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,14.88,
"PP FIORICET 4 TABS",7066980,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,20.5,16.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.35,70,,11.48,,,0,"percent of total billed charges ","70% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",19.07,93,,15.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.43,85,,13.94,,,0,"percent of total billed charges ","85% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.84,87,,14.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.35,70,,11.48,,,0,"percent of total billed charges ","70% of total billed charges ",14.35,19.07,
"PP HYDROCODONE/ACET SOLU 15ML",7066990,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,24.5,19.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.15,70,,13.72,,,0,"percent of total billed charges ","70% of total billed charges ",22.05,90,,17.64,,,0,"percent of total billed charges ","90% of total billed charges ",22.79,93,,18.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.83,85,,16.66,,,0,"percent of total billed charges ","85% of total billed charges ",22.05,90,,17.64,,,0,"percent of total billed charges ","90% of total billed charges ",22.05,90,,17.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.32,87,,17.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.15,70,,13.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.15,22.79,
"PP HYDROCO/ACET 10/325MG 6 TAB",7067000,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,18.5,14.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.95,70,,10.36,,,0,"percent of total billed charges ","70% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",17.21,93,,13.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.73,85,,12.58,,,0,"percent of total billed charges ","85% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.1,87,,12.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.95,70,,10.36,,,0,"percent of total billed charges ","70% of total billed charges ",12.95,17.21,
"PP IBUPROFEN 600MG 4 TABS",7067010,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,16,12.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.88,93,,11.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.6,85,,10.88,,,0,"percent of total billed charges ","85% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.92,87,,11.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,14.88,
"PP IBUPROFEN 800MG 3 TABS",7067020,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,16,12.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.88,93,,11.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.6,85,,10.88,,,0,"percent of total billed charges ","85% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.92,87,,11.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,14.88,
"PP KETOROLAC 10MG 3 TABS",7067030,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,17.5,14,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",16.28,93,,13.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.88,85,,11.90,,,0,"percent of total billed charges ","85% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.23,87,,12.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",12.25,16.28,
"PP OXYCOD/ACET 5/325MG 6 TABS",7067040,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,17.5,14,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",16.28,93,,13.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.88,85,,11.90,,,0,"percent of total billed charges ","85% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.23,87,,12.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",12.25,16.28,
"PP OXYCOD/ASA 4.84/325MG 6 TAB",7067050,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,21.5,17.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.05,70,,12.04,,,0,"percent of total billed charges ","70% of total billed charges ",19.35,90,,15.48,,,0,"percent of total billed charges ","90% of total billed charges ",20,93,,16.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.28,85,,14.62,,,0,"percent of total billed charges ","85% of total billed charges ",19.35,90,,15.48,,,0,"percent of total billed charges ","90% of total billed charges ",19.35,90,,15.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.71,87,,14.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.05,70,,12.04,,,0,"percent of total billed charges ","70% of total billed charges ",15.05,20,
"PP TRAMADOL 50MG 4 TABS",7067060,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,16,12.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.88,93,,11.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.6,85,,10.88,,,0,"percent of total billed charges ","85% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.92,87,,11.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,14.88,
"XOFLUZA 40MG TAB",7067070,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,89,71.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",82.77,93,,66.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",75.65,85,,60.52,,,0,"percent of total billed charges ","85% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",77.43,87,,61.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",62.3,82.77,
"PP LORAZEPAM 1MG 4 TABS",7067080,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,16,12.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.88,93,,11.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.6,85,,10.88,,,0,"percent of total billed charges ","85% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.92,87,,11.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,14.88,
"XOFLUZA 20MG TAB",7067090,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,89,71.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",82.77,93,,66.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",75.65,85,,60.52,,,0,"percent of total billed charges ","85% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",80.1,90,,64.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",77.43,87,,61.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.3,70,,49.84,,,0,"percent of total billed charges ","70% of total billed charges ",62.3,82.77,
"NEPHRO VITE TAB",7067160,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,11,8.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",10.23,93,,8.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.35,85,,7.48,,,0,"percent of total billed charges ","85% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.57,87,,7.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.7,10.23,
"PP DIFLUCAN 150MG TAB",7067200,"CDM ",253,RC,A9270,HCPCS,OUTPATIENT,,,16,12.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.88,93,,11.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.6,85,,10.88,,,0,"percent of total billed charges ","85% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.92,87,,11.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,14.88,
"VITAMIN D SUPPLEMENT DROPS",7067230,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,22,17.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.4,70,,12.32,,,0,"percent of total billed charges ","70% of total billed charges ",19.8,90,,15.84,,,0,"percent of total billed charges ","90% of total billed charges ",20.46,93,,16.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.7,85,,14.96,,,0,"percent of total billed charges ","85% of total billed charges ",19.8,90,,15.84,,,0,"percent of total billed charges ","90% of total billed charges ",19.8,90,,15.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.14,87,,15.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.4,70,,12.32,,,0,"percent of total billed charges ","70% of total billed charges ",15.4,20.46,
"ARIPIPRAZOLE 2MG TAB",7067240,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,11,8.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",10.23,93,,8.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.35,85,,7.48,,,0,"percent of total billed charges ","85% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.57,87,,7.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.7,10.23,
"PREGABALIN 100MG CAP",7067250,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13,10.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.1,70,,7.28,,,0,"percent of total billed charges ","70% of total billed charges ",11.7,90,,9.36,,,0,"percent of total billed charges ","90% of total billed charges ",12.09,93,,9.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.05,85,,8.84,,,0,"percent of total billed charges ","85% of total billed charges ",11.7,90,,9.36,,,0,"percent of total billed charges ","90% of total billed charges ",11.7,90,,9.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.31,87,,9.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.1,70,,7.28,,,0,"percent of total billed charges ","70% of total billed charges ",9.1,12.09,
"PREGABALIN 150MG CAP",7067280,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,13,10.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.1,70,,7.28,,,0,"percent of total billed charges ","70% of total billed charges ",11.7,90,,9.36,,,0,"percent of total billed charges ","90% of total billed charges ",12.09,93,,9.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.05,85,,8.84,,,0,"percent of total billed charges ","85% of total billed charges ",11.7,90,,9.36,,,0,"percent of total billed charges ","90% of total billed charges ",11.7,90,,9.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.31,87,,9.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.1,70,,7.28,,,0,"percent of total billed charges ","70% of total billed charges ",9.1,12.09,
"LAMIVUDINE 10MG/ML SOLN 30ML",7067320,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,24,19.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.8,70,,13.44,,,0,"percent of total billed charges ","70% of total billed charges ",21.6,90,,17.28,,,0,"percent of total billed charges ","90% of total billed charges ",22.32,93,,17.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.4,85,,16.32,,,0,"percent of total billed charges ","85% of total billed charges ",21.6,90,,17.28,,,0,"percent of total billed charges ","90% of total billed charges ",21.6,90,,17.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.88,87,,16.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.8,70,,13.44,,,0,"percent of total billed charges ","70% of total billed charges ",16.8,22.32,
"NEVIRAPINE 10MG/ML SUSP 30ML",7067330,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,40.5,32.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.35,70,,22.68,,,0,"percent of total billed charges ","70% of total billed charges ",36.45,90,,29.16,,,0,"percent of total billed charges ","90% of total billed charges ",37.67,93,,30.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34.43,85,,27.54,,,0,"percent of total billed charges ","85% of total billed charges ",36.45,90,,29.16,,,0,"percent of total billed charges ","90% of total billed charges ",36.45,90,,29.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",35.24,87,,28.19,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.35,70,,22.68,,,0,"percent of total billed charges ","70% of total billed charges ",28.35,37.67,
"LUTEIN 20MG CAP",7067340,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,11,8.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",10.23,93,,8.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.35,85,,7.48,,,0,"percent of total billed charges ","85% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.57,87,,7.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.7,10.23,
"ZINC CHELATED 30MG CAP",7067460,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,10.5,8.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.35,70,,5.88,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,90,,7.56,,,0,"percent of total billed charges ","90% of total billed charges ",9.77,93,,7.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.93,85,,7.14,,,0,"percent of total billed charges ","85% of total billed charges ",9.45,90,,7.56,,,0,"percent of total billed charges ","90% of total billed charges ",9.45,90,,7.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.14,87,,7.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.35,70,,5.88,,,0,"percent of total billed charges ","70% of total billed charges ",7.35,9.77,
"KALETRA 200MG/50MG TAB",7067530,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,20,16,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14,70,,11.20,,,0,"percent of total billed charges ","70% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",18.6,93,,14.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17,85,,13.60,,,0,"percent of total billed charges ","85% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.4,87,,13.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14,70,,11.20,,,0,"percent of total billed charges ","70% of total billed charges ",14,18.6,
"IVERMECTIN 3MG TAB",7067560,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,11.5,9.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.05,70,,6.44,,,0,"percent of total billed charges ","70% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.7,93,,8.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.78,85,,7.82,,,0,"percent of total billed charges ","85% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.01,87,,8.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.05,70,,6.44,,,0,"percent of total billed charges ","70% of total billed charges ",8.05,10.7,
"FAMOTIDINE 40MG/5ML SUSPENSION",7068070,"CDM ",259,RC,A9270,HCPCS,OUTPATIENT,,,33.5,26.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",31.16,93,,24.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.48,85,,22.78,,,0,"percent of total billed charges ","85% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.15,87,,23.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",23.45,31.16,
"SMZ TMP SUSPENSION 20ML",7068080,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,18.5,14.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.95,70,,10.36,,,0,"percent of total billed charges ","70% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",17.21,93,,13.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.73,85,,12.58,,,0,"percent of total billed charges ","85% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.1,87,,12.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.95,70,,10.36,,,0,"percent of total billed charges ","70% of total billed charges ",12.95,17.21,
"CHOLECALCIFEROL VIT D3 1250MCG",7068090,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,11,8.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",10.23,93,,8.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.35,85,,7.48,,,0,"percent of total billed charges ","85% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.57,87,,7.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.7,10.23,
"MIDAZOLAM 5MG 2.5ML ORAL SOLUT",7068210,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,17,13.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.9,70,,9.52,,,0,"percent of total billed charges ","70% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.81,93,,12.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.45,85,,11.56,,,0,"percent of total billed charges ","85% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.79,87,,11.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.9,70,,9.52,,,0,"percent of total billed charges ","70% of total billed charges ",11.9,15.81,
"MORPHINE SULF 10MG ORAL SOLN",7068220,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"GI COCKTAIL ER 45ML BTL",7068300,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,49.5,39.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",46.04,93,,36.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.08,85,,33.66,,,0,"percent of total billed charges ","85% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.07,87,,34.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,46.04,
"BENZOIN CMPD TINCTURE 58ML BTL",7068320,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,33.5,26.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",31.16,93,,24.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.48,85,,22.78,,,0,"percent of total billed charges ","85% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.15,87,,23.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",23.45,31.16,
"XARELTO RIVAROXADAN 2.5MG TAB",7068370,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,19.5,15.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.65,70,,10.92,,,0,"percent of total billed charges ","70% of total billed charges ",17.55,90,,14.04,,,0,"percent of total billed charges ","90% of total billed charges ",18.14,93,,14.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.58,85,,13.26,,,0,"percent of total billed charges ","85% of total billed charges ",17.55,90,,14.04,,,0,"percent of total billed charges ","90% of total billed charges ",17.55,90,,14.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.97,87,,13.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.65,70,,10.92,,,0,"percent of total billed charges ","70% of total billed charges ",13.65,18.14,
"URE-NA 15GM PKT",7068390,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,14,11.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",13.02,93,,10.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.9,85,,9.52,,,0,"percent of total billed charges ","85% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.18,87,,9.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",9.8,13.02,
"LOKELMA 10GM PKT",7068415,"CDM ",637,RC,A9270,HCPCS,OUTPATIENT,,,35,28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.5,70,,19.60,,,0,"percent of total billed charges ","70% of total billed charges ",31.5,90,,25.20,,,0,"percent of total billed charges ","90% of total billed charges ",32.55,93,,26.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",29.75,85,,23.80,,,0,"percent of total billed charges ","85% of total billed charges ",31.5,90,,25.20,,,0,"percent of total billed charges ","90% of total billed charges ",31.5,90,,25.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.45,87,,24.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.5,70,,19.60,,,0,"percent of total billed charges ","70% of total billed charges ",24.5,32.55,
"WOUND CARE FAC LEVEL 1 NEW PAT",7500030,"CDM ",761,RC,G0463,HCPCS,OUTPATIENT,,,288.5,230.8,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",201.95,70,,161.56,,,0,"percent of total billed charges ","70% of total billed charges ",259.65,90,,207.72,,,0,"percent of total billed charges ","90% of total billed charges ",268.31,93,,214.65,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",245.23,85,,196.18,,,0,"percent of total billed charges ","85% of total billed charges ",259.65,90,,207.72,,,0,"percent of total billed charges ","90% of total billed charges ",259.65,90,,207.72,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",251,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",201.95,70,,161.56,,,0,"percent of total billed charges ","70% of total billed charges ",45.57,268.31,
"WOUND CARE FAC LEVEL 1 ESTAB",7500080,"CDM ",761,RC,G0463,HCPCS,OUTPATIENT,,,192.5,154,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",134.75,70,,107.80,,,0,"percent of total billed charges ","70% of total billed charges ",173.25,90,,138.60,,,0,"percent of total billed charges ","90% of total billed charges ",179.03,93,,143.22,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",163.63,85,,130.90,,,0,"percent of total billed charges ","85% of total billed charges ",173.25,90,,138.60,,,0,"percent of total billed charges ","90% of total billed charges ",173.25,90,,138.60,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",167.48,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",134.75,70,,107.80,,,0,"percent of total billed charges ","70% of total billed charges ",45.57,179.03,
"WOUND CARE FAC LEVEL 2 NEW PT",7501920,"CDM ",761,RC,G0463,HCPCS,OUTPATIENT,,,375,300,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",262.5,70,,210.00,,,0,"percent of total billed charges ","70% of total billed charges ",337.5,90,,270.00,,,0,"percent of total billed charges ","90% of total billed charges ",348.75,93,,279.00,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",318.75,85,,255.00,,,0,"percent of total billed charges ","85% of total billed charges ",337.5,90,,270.00,,,0,"percent of total billed charges ","90% of total billed charges ",337.5,90,,270.00,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",326.25,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",262.5,70,,210.00,,,0,"percent of total billed charges ","70% of total billed charges ",45.57,348.75,
"WOUND CARE FAC LEVEL 3 NEW PT",7501930,"CDM ",761,RC,G0463,HCPCS,OUTPATIENT,,,438,350.4,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",306.6,70,,245.28,,,0,"percent of total billed charges ","70% of total billed charges ",394.2,90,,315.36,,,0,"percent of total billed charges ","90% of total billed charges ",407.34,93,,325.87,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",372.3,85,,297.84,,,0,"percent of total billed charges ","85% of total billed charges ",394.2,90,,315.36,,,0,"percent of total billed charges ","90% of total billed charges ",394.2,90,,315.36,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",381.06,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",306.6,70,,245.28,,,0,"percent of total billed charges ","70% of total billed charges ",45.57,407.34,
"WOUND CARE FAC LEVEL 4 NEW PT",7501940,"CDM ",761,RC,G0463,HCPCS,OUTPATIENT,,,550,440,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",385,70,,308.00,,,0,"percent of total billed charges ","70% of total billed charges ",495,90,,396.00,,,0,"percent of total billed charges ","90% of total billed charges ",511.5,93,,409.20,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",467.5,85,,374.00,,,0,"percent of total billed charges ","85% of total billed charges ",495,90,,396.00,,,0,"percent of total billed charges ","90% of total billed charges ",495,90,,396.00,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",478.5,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",385,70,,308.00,,,0,"percent of total billed charges ","70% of total billed charges ",45.57,511.5,
"WOUND CARE FAC LEVEL 5 NEW PT",7501950,"CDM ",761,RC,G0463,HCPCS,OUTPATIENT,,,699.5,559.6,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",489.65,70,,391.72,,,0,"percent of total billed charges ","70% of total billed charges ",629.55,90,,503.64,,,0,"percent of total billed charges ","90% of total billed charges ",650.54,93,,520.43,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",594.58,85,,475.66,,,0,"percent of total billed charges ","85% of total billed charges ",629.55,90,,503.64,,,0,"percent of total billed charges ","90% of total billed charges ",629.55,90,,503.64,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",608.57,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",489.65,70,,391.72,,,0,"percent of total billed charges ","70% of total billed charges ",45.57,650.54,
"WOUND CARE FAC LEVEL 2 ESTAB",7501960,"CDM ",761,RC,G0463,HCPCS,OUTPATIENT,,,292,233.6,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",204.4,70,,163.52,,,0,"percent of total billed charges ","70% of total billed charges ",262.8,90,,210.24,,,0,"percent of total billed charges ","90% of total billed charges ",271.56,93,,217.25,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",248.2,85,,198.56,,,0,"percent of total billed charges ","85% of total billed charges ",262.8,90,,210.24,,,0,"percent of total billed charges ","90% of total billed charges ",262.8,90,,210.24,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",254.04,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",204.4,70,,163.52,,,0,"percent of total billed charges ","70% of total billed charges ",45.57,271.56,
"WOUND CARE FAC LEVEL 3 ESTAB",7501970,"CDM ",761,RC,G0463,HCPCS,OUTPATIENT,,,292,233.6,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",204.4,70,,163.52,,,0,"percent of total billed charges ","70% of total billed charges ",262.8,90,,210.24,,,0,"percent of total billed charges ","90% of total billed charges ",271.56,93,,217.25,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",248.2,85,,198.56,,,0,"percent of total billed charges ","85% of total billed charges ",262.8,90,,210.24,,,0,"percent of total billed charges ","90% of total billed charges ",262.8,90,,210.24,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",254.04,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",204.4,70,,163.52,,,0,"percent of total billed charges ","70% of total billed charges ",45.57,271.56,
"WOUND CARE FAC LEVEL 4 ESTAB",7501980,"CDM ",761,RC,G0463,HCPCS,OUTPATIENT,,,367.5,294,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",257.25,70,,205.80,,,0,"percent of total billed charges ","70% of total billed charges ",330.75,90,,264.60,,,0,"percent of total billed charges ","90% of total billed charges ",341.78,93,,273.42,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",312.38,85,,249.90,,,0,"percent of total billed charges ","85% of total billed charges ",330.75,90,,264.60,,,0,"percent of total billed charges ","90% of total billed charges ",330.75,90,,264.60,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",319.73,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",257.25,70,,205.80,,,0,"percent of total billed charges ","70% of total billed charges ",45.57,341.78,
"WOUND CARE FAC LEVEL 5 ESTAB",7501990,"CDM ",761,RC,G0463,HCPCS,OUTPATIENT,,,467,373.6,,52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.57,100,,25.53,25.53,25.53,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",326.9,70,,261.52,,,0,"percent of total billed charges ","70% of total billed charges ",420.3,90,,336.24,,,0,"percent of total billed charges ","90% of total billed charges ",434.31,93,,347.45,,,0,"percent of total billed charges ","93% of total billed charges ",52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",396.95,85,,317.56,,,0,"percent of total billed charges ","85% of total billed charges ",420.3,90,,336.24,,,0,"percent of total billed charges ","90% of total billed charges ",420.3,90,,336.24,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",406.29,87,,125.09,125.09,125.09,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",122.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",326.9,70,,261.52,,,0,"percent of total billed charges ","70% of total billed charges ",45.57,434.31,
"ULTRASOUND-PT 15 MIN",8000036,"CDM ",420,RC,97035,HCPCS,OUTPATIENT,,,71.5,57.2,,12.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",30.16,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",66.5,93,,53.20,,,0,"percent of total billed charges ","93% of total billed charges ",12.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",60.78,85,,48.62,,,0,"percent of total billed charges ","85% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",14.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.21,87,,49.77,,,0,"percent of total billed charges ","87% of total billed charges ",14.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",12.33,66.5,
"PELVIC/CERV TRACTION 1 OR MORE",8000044,"CDM ",420,RC,97012,HCPCS,OUTPATIENT,,,68.5,54.8,,14.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",36.36,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",30.43,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",47.95,70,,38.36,,,0,"percent of total billed charges ","70% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",63.71,93,,50.97,,,0,"percent of total billed charges ","93% of total billed charges ",14.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.06,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",58.23,85,,46.58,,,0,"percent of total billed charges ","85% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",16.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.6,87,,47.24,47.24,47.24,"1 through 10","percent of total billed charges ","87% of total billed charges ",16.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",47.95,70,,38.36,,,0,"percent of total billed charges ","70% of total billed charges ",14.77,63.71,
"GAIT TRAINING  15 MIN",8000168,"CDM ",420,RC,97116,HCPCS,OUTPATIENT,,,64.5,51.6,,24.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.46,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",62.59,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",45.15,70,,36.12,,,0,"percent of total billed charges ","70% of total billed charges ",58.05,90,,46.44,,,0,"percent of total billed charges ","90% of total billed charges ",59.99,93,,47.99,,,0,"percent of total billed charges ","93% of total billed charges ",24.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",22.4,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",54.83,85,,43.86,,,0,"percent of total billed charges ","85% of total billed charges ",58.05,90,,46.44,,,0,"percent of total billed charges ","90% of total billed charges ",58.05,90,,46.44,,,0,"percent of total billed charges ","90% of total billed charges ",22.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.12,87,,44.90,,,0,"percent of total billed charges ","87% of total billed charges ",22.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",45.15,70,,36.12,,,0,"percent of total billed charges ","70% of total billed charges ",22.18,62.59,
"PHYS PERF TEST 15 MIN (FCE)",8000176,"CDM ",420,RC,97750,HCPCS,OUTPATIENT,,,93,74.4,,17.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",70.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",65.1,70,,52.08,,,0,"percent of total billed charges ","70% of total billed charges ",83.7,90,,66.96,,,0,"percent of total billed charges ","90% of total billed charges ",86.49,93,,69.19,,,0,"percent of total billed charges ","93% of total billed charges ",17.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",79.05,85,,63.24,,,0,"percent of total billed charges ","85% of total billed charges ",83.7,90,,66.96,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,90,,66.96,,,0,"percent of total billed charges ","90% of total billed charges ",20.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.91,87,,64.73,,,0,"percent of total billed charges ","87% of total billed charges ",20.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",65.1,70,,52.08,,,0,"percent of total billed charges ","70% of total billed charges ",17.56,86.49,
"WHIRLPOOL EXT",8000184,"CDM ",420,RC,97022,HCPCS,OUTPATIENT,,,120,96,,14.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.33,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",36.1,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",84,70,,67.20,,,0,"percent of total billed charges ","70% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",111.6,93,,89.28,,,0,"percent of total billed charges ","93% of total billed charges ",14.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",102,85,,81.60,,,0,"percent of total billed charges ","85% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",104.4,87,,83.52,,,0,"percent of total billed charges ","87% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",84,70,,67.20,,,0,"percent of total billed charges ","70% of total billed charges ",14.41,111.6,
"WHIRLPOOL FULL",8000192,"CDM ",420,RC,97022,HCPCS,OUTPATIENT,,,145,116,,14.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.33,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",36.1,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",14.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",126.15,87,,100.92,,,0,"percent of total billed charges ","87% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",14.41,134.85,
"WHIRLPOOL BODY; PER 15 MIN",8000200,"CDM ",420,RC,97036,HCPCS,OUTPATIENT,,,307.5,246,,12.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",43.43,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",71.43,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",215.25,70,,172.20,,,0,"percent of total billed charges ","70% of total billed charges ",276.75,90,,221.40,,,0,"percent of total billed charges ","90% of total billed charges ",285.98,93,,228.78,,,0,"percent of total billed charges ","93% of total billed charges ",12.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",261.38,85,,209.10,,,0,"percent of total billed charges ","85% of total billed charges ",276.75,90,,221.40,,,0,"percent of total billed charges ","90% of total billed charges ",276.75,90,,221.40,,,0,"percent of total billed charges ","90% of total billed charges ",14.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",267.53,87,,214.02,,,0,"percent of total billed charges ","87% of total billed charges ",14.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",215.25,70,,172.20,,,0,"percent of total billed charges ","70% of total billed charges ",12.45,285.98,
"ELECTRICAL STIM UNATTENDED",8000291,"CDM ",420,RC,G0283,HCPCS,OUTPATIENT,,,58.5,46.8,,,,,,,,0,"other ","not separately reimbursment ",31.31,100,,2.33,2.33,2.33,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",25.78,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",40.95,70,,32.76,,,0,"percent of total billed charges ","70% of total billed charges ",52.65,90,,42.12,,,0,"percent of total billed charges ","90% of total billed charges ",54.41,93,,43.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",49.73,85,,39.78,,,0,"percent of total billed charges ","85% of total billed charges ",52.65,90,,42.12,,,0,"percent of total billed charges ","90% of total billed charges ",52.65,90,,42.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",50.9,87,,40.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.95,70,,32.76,,,0,"percent of total billed charges ","70% of total billed charges ",25.78,54.41,
"THERAP EXER STRENGTH 15 M",8000309,"CDM ",420,RC,97110,HCPCS,OUTPATIENT,,,129.5,103.6,,28.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.91,100,,272.47,272.47,272.47,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",62.59,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",90.65,70,,72.52,,,0,"percent of total billed charges ","70% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",120.44,93,,96.35,,,0,"percent of total billed charges ","93% of total billed charges ",28.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",110.08,85,,88.06,,,0,"percent of total billed charges ","85% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",25.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.67,87,,89.99,65.45,287.97,"1 through 10","percent of total billed charges ","87% of total billed charges ",25.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",90.65,70,,72.52,,,0,"percent of total billed charges ","70% of total billed charges ",25.65,120.44,
"INITIAL THEREX W/MATERIAL 15MI",8000310,"CDM ",420,RC,97110,HCPCS,OUTPATIENT,,,129.5,103.6,,28.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.91,100,,272.47,272.47,272.47,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",62.59,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",90.65,70,,72.52,,,0,"percent of total billed charges ","70% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",120.44,93,,96.35,,,0,"percent of total billed charges ","93% of total billed charges ",28.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",110.08,85,,88.06,,,0,"percent of total billed charges ","85% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",25.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.67,87,,89.99,65.45,287.97,"1 through 10","percent of total billed charges ","87% of total billed charges ",25.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",90.65,70,,72.52,,,0,"percent of total billed charges ","70% of total billed charges ",25.65,120.44,
"JOBST PUMP",8000366,"CDM ",420,RC,97016,HCPCS,OUTPATIENT,,,69.5,55.6,,16.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.33,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",25.1,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",48.65,70,,38.92,,,0,"percent of total billed charges ","70% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",64.64,93,,51.71,,,0,"percent of total billed charges ","93% of total billed charges ",16.5,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.06,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",59.08,85,,47.26,,,0,"percent of total billed charges ","85% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",18.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",60.47,87,,48.38,,,0,"percent of total billed charges ","87% of total billed charges ",18.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",48.65,70,,38.92,,,0,"percent of total billed charges ","70% of total billed charges ",16.5,64.64,
"IONTOPHORESIS PER 15MIN",8000564,"CDM ",420,RC,97033,HCPCS,OUTPATIENT,,,73,58.4,,8.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.38,100,,36.73,36.73,36.73,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",41.56,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",51.1,70,,40.88,,,0,"percent of total billed charges ","70% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",67.89,93,,54.31,,,0,"percent of total billed charges ","93% of total billed charges ",8.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.05,85,,49.64,,,0,"percent of total billed charges ","85% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.51,87,,50.81,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.1,70,,40.88,,,0,"percent of total billed charges ","70% of total billed charges ",8.58,67.89,
"PT RE-EVALUATION",8000713,"CDM ",424,RC,97164,HCPCS,OUTPATIENT,,,118,94.4,,,,,,,,0,"other ","not separately reimbursment ",81.34,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",146.37,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",82.6,70,,66.08,,,0,"percent of total billed charges ","70% of total billed charges ",106.2,90,,84.96,,,0,"percent of total billed charges ","90% of total billed charges ",109.74,93,,87.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",35.69,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",100.3,85,,80.24,,,0,"percent of total billed charges ","85% of total billed charges ",106.2,90,,84.96,,,0,"percent of total billed charges ","90% of total billed charges ",106.2,90,,84.96,,,0,"percent of total billed charges ","90% of total billed charges ",35.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",102.66,87,,82.13,,,0,"percent of total billed charges ","87% of total billed charges ",35.34,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",82.6,70,,66.08,,,0,"percent of total billed charges ","70% of total billed charges ",35.34,146.37,
"WORK HARDEN/COND 1ST 2 HR",8000754,"CDM ",420,RC,97545,HCPCS,OUTPATIENT,,,267.5,214,,34.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.16,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",248.78,93,,199.02,,,0,"percent of total billed charges ","93% of total billed charges ",34.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",227.38,85,,181.90,,,0,"percent of total billed charges ","85% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",232.73,87,,186.18,,,0,"percent of total billed charges ","87% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",16.16,248.78,
"WORK HARDEN/COND EA ADD'L HR",8000762,"CDM ",420,RC,97546,HCPCS,OUTPATIENT,,,115,92,,17.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",17.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",19.82,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",19.62,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",17.16,106.95,
FLUIDOTHERAPY,8000788,"CDM ",420,RC,97024,HCPCS,OUTPATIENT,,,120,96,,12.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",21.21,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",14.59,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",84,70,,67.20,,,0,"percent of total billed charges ","70% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",111.6,93,,89.28,,,0,"percent of total billed charges ","93% of total billed charges ",12.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.38,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",102,85,,81.60,,,0,"percent of total billed charges ","85% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",14.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",104.4,87,,83.52,,,0,"percent of total billed charges ","87% of total billed charges ",14.24,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",84,70,,67.20,,,0,"percent of total billed charges ","70% of total billed charges ",12.45,111.6,
"PHONOPHORESIS; EA 15 MIN",8000796,"CDM ",420,RC,97035,HCPCS,OUTPATIENT,,,71.5,57.2,,12.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",30.16,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",66.5,93,,53.20,,,0,"percent of total billed charges ","93% of total billed charges ",12.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",60.78,85,,48.62,,,0,"percent of total billed charges ","85% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",14.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.21,87,,49.77,,,0,"percent of total billed charges ","87% of total billed charges ",14.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",12.33,66.5,
"MASSAGE 15 MIN",8000812,"CDM ",420,RC,97124,HCPCS,OUTPATIENT,,,80.5,64.4,,11.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",42.42,100,,50.46,50.46,50.46,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",62.94,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",56.35,70,,45.08,,,0,"percent of total billed charges ","70% of total billed charges ",72.45,90,,57.96,,,0,"percent of total billed charges ","90% of total billed charges ",74.87,93,,59.90,,,0,"percent of total billed charges ","93% of total billed charges ",11.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",13.18,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",68.43,85,,54.74,,,0,"percent of total billed charges ","85% of total billed charges ",72.45,90,,57.96,,,0,"percent of total billed charges ","90% of total billed charges ",72.45,90,,57.96,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.04,87,,56.03,,,0,"percent of total billed charges ","87% of total billed charges ",13.05,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",56.35,70,,45.08,,,0,"percent of total billed charges ","70% of total billed charges ",11.41,74.87,
"AQUATIC THERAPY 15 MIN",8000853,"CDM ",420,RC,97113,HCPCS,OUTPATIENT,,,74.5,59.6,,29.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",78.01,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",69.29,93,,55.43,,,0,"percent of total billed charges ","93% of total billed charges ",29.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",27.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",63.33,85,,50.66,,,0,"percent of total billed charges ","85% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",27.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.82,87,,51.86,,,0,"percent of total billed charges ","87% of total billed charges ",27.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",27.4,78.01,
"NEURO-MUSC RE-EDUC 15 MIN",8000861,"CDM ",420,RC,97112,HCPCS,OUTPATIENT,,,83.5,66.8,,27.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",50.5,100,,60.46,60.46,60.46,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",72.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",77.66,93,,62.13,,,0,"percent of total billed charges ","93% of total billed charges ",27.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.98,85,,56.78,,,0,"percent of total billed charges ","85% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",24.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",72.65,87,,65.17,59.38,70.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",24.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",24.87,77.66,
BIOFEEDBACK,8000879,"CDM ",420,RC,90901,HCPCS,OUTPATIENT,,,107,85.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.9,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",74.9,70,,59.92,,,0,"percent of total billed charges ","70% of total billed charges ",96.3,90,,77.04,,,0,"percent of total billed charges ","90% of total billed charges ",99.51,93,,79.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",90.95,85,,72.76,,,0,"percent of total billed charges ","85% of total billed charges ",96.3,90,,77.04,,,0,"percent of total billed charges ","90% of total billed charges ",96.3,90,,77.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",93.09,87,,74.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.9,70,,59.92,,,0,"percent of total billed charges ","70% of total billed charges ",40.9,99.51,
"CONTRAST BATH; EA 15 MIN",8000895,"CDM ",420,RC,97034,HCPCS,OUTPATIENT,,,53.5,42.8,,7.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",30.3,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",30.84,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",49.76,93,,39.81,,,0,"percent of total billed charges ","93% of total billed charges ",7.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",8.16,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.48,85,,36.38,,,0,"percent of total billed charges ","85% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",8.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.55,87,,37.24,,,0,"percent of total billed charges ","87% of total billed charges ",8.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",7.06,49.76,
"E-STIM: MANUAL 15 MIN",8000937,"CDM ",420,RC,97032,HCPCS,OUTPATIENT,,,53.5,42.8,,8.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.34,100,,41.07,41.07,41.07,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",31.13,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",49.76,93,,39.81,,,0,"percent of total billed charges ","93% of total billed charges ",8.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.48,85,,36.38,,,0,"percent of total billed charges ","85% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.55,87,,37.24,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",8.58,49.76,
"MANUAL THERAPY TECH 15 MIN",8000945,"CDM ",420,RC,97140,HCPCS,OUTPATIENT,,,97.5,78,,22.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",58.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",57.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",68.25,70,,54.60,,,0,"percent of total billed charges ","70% of total billed charges ",87.75,90,,70.20,,,0,"percent of total billed charges ","90% of total billed charges ",90.68,93,,72.54,,,0,"percent of total billed charges ","93% of total billed charges ",22.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",82.88,85,,66.30,,,0,"percent of total billed charges ","85% of total billed charges ",87.75,90,,70.20,,,0,"percent of total billed charges ","90% of total billed charges ",87.75,90,,70.20,,,0,"percent of total billed charges ","90% of total billed charges ",20.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.83,87,,67.86,,,0,"percent of total billed charges ","87% of total billed charges ",20.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.25,70,,54.60,,,0,"percent of total billed charges ","70% of total billed charges ",20.47,90.68,
"ORTHO FIT/TRAIN 15 MIN",8000994,"CDM ",420,RC,97760,HCPCS,OUTPATIENT,,,83.5,66.8,,,,,,,,0,"other ","not separately reimbursment ",39.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",102.34,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",77.66,93,,62.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.98,85,,56.78,,,0,"percent of total billed charges ","85% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",72.65,87,,58.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",39.64,102.34,
"ORTHO/PROSTHETIC CHECK 15 MIN",8001000,"CDM ",420,RC,97763,HCPCS,OUTPATIENT,,,69.5,55.6,,,,,,,,0,"other ","not separately reimbursment ",29.21,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",113.28,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",48.65,70,,38.92,,,0,"percent of total billed charges ","70% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",64.64,93,,51.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",59.08,85,,47.26,,,0,"percent of total billed charges ","85% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",62.55,90,,50.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",60.47,87,,48.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.65,70,,38.92,,,0,"percent of total billed charges ","70% of total billed charges ",29.21,113.28,
"PARAFFIN BATH THERAPY",8001018,"CDM ",420,RC,97018,HCPCS,OUTPATIENT,,,53.5,42.8,,13.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.23,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",11.81,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",49.76,93,,39.81,,,0,"percent of total billed charges ","93% of total billed charges ",13.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.48,85,,36.38,,,0,"percent of total billed charges ","85% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",15.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.55,87,,37.24,,,0,"percent of total billed charges ","87% of total billed charges ",15.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.81,49.76,
"PROSTHETIC TRAINING 15 MIN",8001026,"CDM ",420,RC,97761,HCPCS,OUTPATIENT,,,70.5,56.4,,20.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",50.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",87.85,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",65.57,93,,52.46,,,0,"percent of total billed charges ","93% of total billed charges ",20.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",59.93,85,,47.94,,,0,"percent of total billed charges ","85% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",23.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",61.34,87,,49.07,,,0,"percent of total billed charges ","87% of total billed charges ",23.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",20.19,87.85,
"THERAPUTIC ACTIVITY 15 MIN",8001067,"CDM ",420,RC,97530,HCPCS,OUTPATIENT,,,87.5,70,,28.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.91,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",78.43,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",61.25,70,,49.00,,,0,"percent of total billed charges ","70% of total billed charges ",78.75,90,,63.00,,,0,"percent of total billed charges ","90% of total billed charges ",81.38,93,,65.10,,,0,"percent of total billed charges ","93% of total billed charges ",28.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",74.38,85,,59.50,,,0,"percent of total billed charges ","85% of total billed charges ",78.75,90,,63.00,,,0,"percent of total billed charges ","90% of total billed charges ",78.75,90,,63.00,,,0,"percent of total billed charges ","90% of total billed charges ",26.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",76.13,87,,60.90,,,0,"percent of total billed charges ","87% of total billed charges ",26.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",61.25,70,,49.00,,,0,"percent of total billed charges ","70% of total billed charges ",26.02,81.38,
"WC MGMT (ASSESS,FIT,TRAIN) 15M",8001083,"CDM ",420,RC,97542,HCPCS,OUTPATIENT,,,70.5,56.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.65,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",65.57,93,,52.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",59.93,85,,47.94,,,0,"percent of total billed charges ","85% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",61.34,87,,49.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",49.35,67.65,
"DEBRIDEMENT 20 CM OR LESS",8001091,"CDM ",420,RC,97597,HCPCS,OUTPATIENT,,,344,275.2,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",278.76,100,,266.92,266.92,266.92,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",76.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",240.8,70,,192.64,,,0,"percent of total billed charges ","70% of total billed charges ",309.6,90,,247.68,,,0,"percent of total billed charges ","90% of total billed charges ",319.92,93,,255.94,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",292.4,85,,233.92,,,0,"percent of total billed charges ","85% of total billed charges ",309.6,90,,247.68,,,0,"percent of total billed charges ","90% of total billed charges ",309.6,90,,247.68,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",299.28,87,,239.42,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",240.8,70,,192.64,,,0,"percent of total billed charges ","70% of total billed charges ",76.25,319.92,
"ROM HAND",8001109,"CDM ",420,RC,95852,HCPCS,OUTPATIENT,,,68.5,54.8,,5.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",11.48,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",47.95,70,,38.36,,,0,"percent of total billed charges ","70% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",63.71,93,,50.97,,,0,"percent of total billed charges ","93% of total billed charges ",5.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.86,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",58.23,85,,46.58,,,0,"percent of total billed charges ","85% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",6.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.6,87,,47.68,,,0,"percent of total billed charges ","87% of total billed charges ",6.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",47.95,70,,38.36,,,0,"percent of total billed charges ","70% of total billed charges ",5.94,63.71,
"ROM EXTREMITY/TRUNK",8001117,"CDM ",420,RC,95851,HCPCS,OUTPATIENT,,,68,54.4,,8.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.83,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",16.68,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",47.6,70,,38.08,,,0,"percent of total billed charges ","70% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",63.24,93,,50.59,,,0,"percent of total billed charges ","93% of total billed charges ",8.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",57.8,85,,46.24,,,0,"percent of total billed charges ","85% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",9.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.16,87,,47.33,,,0,"percent of total billed charges ","87% of total billed charges ",9.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",47.6,70,,38.08,,,0,"percent of total billed charges ","70% of total billed charges ",8.46,63.24,
"ORTHO APPLICATION SHORT LEG",8001141,"CDM ",420,RC,29515,HCPCS,OUTPATIENT,,,370,296,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",230.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",100.87,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",344.1,93,,275.28,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",314.5,85,,251.60,,,0,"percent of total billed charges ","85% of total billed charges ",277.5,90,,222.00,,,0,"percent of total billed charges ","90% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",321.9,87,,41.35,41.35,41.35,"1 through 10","percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",100.87,344.1,
"ORTHO APPLICATION LONG LEG",8001158,"CDM ",420,RC,29505,HCPCS,OUTPATIENT,,,370,296,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",230.28,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",104.74,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",344.1,93,,275.28,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",314.5,85,,251.60,,,0,"percent of total billed charges ","85% of total billed charges ",277.5,90,,222.00,,,0,"percent of total billed charges ","90% of total billed charges ",333,90,,266.40,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",321.9,87,,257.52,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",259,70,,207.20,,,0,"percent of total billed charges ","70% of total billed charges ",104.74,344.1,
"ASSIST TECH ASSESS/15 MIN",8001166,"CDM ",420,RC,97755,HCPCS,OUTPATIENT,,,99,79.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.07,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",69.3,70,,55.44,,,0,"percent of total billed charges ","70% of total billed charges ",89.1,90,,71.28,,,0,"percent of total billed charges ","90% of total billed charges ",92.07,93,,73.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",84.15,85,,67.32,,,0,"percent of total billed charges ","85% of total billed charges ",89.1,90,,71.28,,,0,"percent of total billed charges ","90% of total billed charges ",89.1,90,,71.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",86.13,87,,68.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.3,70,,55.44,,,0,"percent of total billed charges ","70% of total billed charges ",69.3,92.07,
"HOT/COLD E-STIM UNATTENDED",8001180,"CDM ",420,RC,G0283,HCPCS,OUTPATIENT,,,58.5,46.8,,,,,,,,0,"other ","not separately reimbursment ",31.31,100,,2.33,2.33,2.33,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",25.78,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",40.95,70,,32.76,,,0,"percent of total billed charges ","70% of total billed charges ",52.65,90,,42.12,,,0,"percent of total billed charges ","90% of total billed charges ",54.41,93,,43.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",49.73,85,,39.78,,,0,"percent of total billed charges ","85% of total billed charges ",52.65,90,,42.12,,,0,"percent of total billed charges ","90% of total billed charges ",52.65,90,,42.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",50.9,87,,40.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.95,70,,32.76,,,0,"percent of total billed charges ","70% of total billed charges ",25.78,54.41,
"WOUND VAC </= 50 CM",8001220,"CDM ",420,RC,97607,HCPCS,OUTPATIENT,,,533.5,426.8,,129.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",45.74,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",373.45,70,,298.76,,,0,"percent of total billed charges ","70% of total billed charges ",480.15,90,,384.12,,,0,"percent of total billed charges ","90% of total billed charges ",496.16,93,,396.93,,,0,"percent of total billed charges ","93% of total billed charges ",129.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",44.52,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",453.48,85,,362.78,,,0,"percent of total billed charges ","85% of total billed charges ",480.15,90,,384.12,,,0,"percent of total billed charges ","90% of total billed charges ",480.15,90,,384.12,,,0,"percent of total billed charges ","90% of total billed charges ",44.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",464.15,87,,371.32,,,0,"percent of total billed charges ","87% of total billed charges ",44.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",373.45,70,,298.76,,,0,"percent of total billed charges ","70% of total billed charges ",44.08,496.16,
"WOUND VAC >50 CM",8001230,"CDM ",420,RC,97606,HCPCS,OUTPATIENT,,,588.5,470.8,,45.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",331.25,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",58.81,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",411.95,70,,329.56,,,0,"percent of total billed charges ","70% of total billed charges ",529.65,90,,423.72,,,0,"percent of total billed charges ","90% of total billed charges ",547.31,93,,437.85,,,0,"percent of total billed charges ","93% of total billed charges ",45.36,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",57.63,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",500.23,85,,400.18,,,0,"percent of total billed charges ","85% of total billed charges ",529.65,90,,423.72,,,0,"percent of total billed charges ","90% of total billed charges ",529.65,90,,423.72,,,0,"percent of total billed charges ","90% of total billed charges ",57.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",512,87,,409.60,,,0,"percent of total billed charges ","87% of total billed charges ",57.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",373.85,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",411.95,70,,329.56,,,0,"percent of total billed charges ","70% of total billed charges ",45.36,547.31,
"DRSG CHANGE NON-SELECTIVE",8001240,"CDM ",420,RC,97602,HCPCS,OUTPATIENT,,,613,490.4,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",200.2,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,39.36,39.36,39.36,"1 through 10","other ","not separately reimbursment ",429.1,70,,343.28,,,0,"percent of total billed charges ","70% of total billed charges ",551.7,90,,441.36,,,0,"percent of total billed charges ","90% of total billed charges ",570.09,93,,456.07,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",521.05,85,,416.84,,,0,"percent of total billed charges ","85% of total billed charges ",551.7,90,,441.36,,,0,"percent of total billed charges ","90% of total billed charges ",551.7,90,,441.36,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",533.31,87,,426.65,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",429.1,70,,343.28,,,0,"percent of total billed charges ","70% of total billed charges ",184.51,570.09,
"MULTI LAYER COMPRESSION",8001250,"CDM ",420,RC,29581,HCPCS,OUTPATIENT,,,625.5,500.4,,38.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",58.81,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",437.85,70,,350.28,,,0,"percent of total billed charges ","70% of total billed charges ",562.95,90,,450.36,,,0,"percent of total billed charges ","90% of total billed charges ",581.72,93,,465.38,,,0,"percent of total billed charges ","93% of total billed charges ",38.17,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",48.5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",531.68,85,,425.34,,,0,"percent of total billed charges ","85% of total billed charges ",469.13,90,,375.30,,,0,"percent of total billed charges ","90% of total billed charges ",562.95,90,,450.36,,,0,"percent of total billed charges ","90% of total billed charges ",48.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",544.19,87,,435.35,,,0,"percent of total billed charges ","87% of total billed charges ",48.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",437.85,70,,350.28,,,0,"percent of total billed charges ","70% of total billed charges ",38.17,581.72,
"STRAPPING; UNA BOOT",8001260,"CDM ",420,RC,29580,HCPCS,OUTPATIENT,,,625.5,500.4,,57.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",277.75,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",55.7,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",437.85,70,,350.28,,,0,"percent of total billed charges ","70% of total billed charges ",562.95,90,,450.36,,,0,"percent of total billed charges ","90% of total billed charges ",581.72,93,,465.38,,,0,"percent of total billed charges ","93% of total billed charges ",57.2,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.07,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",531.68,85,,425.34,,,0,"percent of total billed charges ","85% of total billed charges ",469.13,90,,375.30,,,0,"percent of total billed charges ","90% of total billed charges ",562.95,90,,450.36,,,0,"percent of total billed charges ","90% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",544.19,87,,435.35,,,0,"percent of total billed charges ","87% of total billed charges ",65.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",149.44,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",437.85,70,,350.28,,,0,"percent of total billed charges ","70% of total billed charges ",55.7,581.72,
"SENSORY INTEGRATION EA 15 MIN",8001290,"CDM ",420,RC,97533,HCPCS,OUTPATIENT,,,74.5,59.6,,,,,,,,0,"other ","not separately reimbursment ",53.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",134.71,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",69.29,93,,55.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",5.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",63.33,85,,50.66,,,0,"percent of total billed charges ","85% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",5.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.82,87,,51.86,,,0,"percent of total billed charges ","87% of total billed charges ",5.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",5.82,134.71,
"PT THERAPEUTIC PROC GROUP",8001300,"CDM ",420,RC,97150,HCPCS,OUTPATIENT,,,52,41.6,,17.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.51,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",37.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",36.4,70,,29.12,,,0,"percent of total billed charges ","70% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",48.36,93,,38.69,,,0,"percent of total billed charges ","93% of total billed charges ",17.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",44.2,85,,35.36,,,0,"percent of total billed charges ","85% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.24,87,,36.19,,,0,"percent of total billed charges ","87% of total billed charges ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",36.4,70,,29.12,,,0,"percent of total billed charges ","70% of total billed charges ",17.45,48.36,
"PHYS THERAPY EVAL LOW COMP",8001310,"CDM ",424,RC,97161,HCPCS,OUTPATIENT,,,169,135.2,,71.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",138.69,100,,166.04,166.04,166.04,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",213,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",157.17,93,,125.74,,,0,"percent of total billed charges ","93% of total billed charges ",71.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.37,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.65,85,,114.92,,,0,"percent of total billed charges ","85% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",65.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.03,87,,117.23,67.63,134.82,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",65.71,213,
"PHYS THERAPY EVAL MOD COMP",8001320,"CDM ",424,RC,97162,HCPCS,OUTPATIENT,,,213,170.4,,71.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",120.6,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",213,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",149.1,70,,119.28,,,0,"percent of total billed charges ","70% of total billed charges ",191.7,90,,153.36,,,0,"percent of total billed charges ","90% of total billed charges ",198.09,93,,158.47,,,0,"percent of total billed charges ","93% of total billed charges ",71.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.37,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",181.05,85,,144.84,,,0,"percent of total billed charges ","85% of total billed charges ",191.7,90,,153.36,,,0,"percent of total billed charges ","90% of total billed charges ",191.7,90,,153.36,,,0,"percent of total billed charges ","90% of total billed charges ",65.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",185.31,87,,66.65,66.65,66.65,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",149.1,70,,119.28,,,0,"percent of total billed charges ","70% of total billed charges ",65.71,213,
"PHYS THERAPY EVAL HIGH COMP",8001330,"CDM ",424,RC,97163,HCPCS,OUTPATIENT,,,266.5,213.2,,57.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",120.6,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",213,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",186.55,70,,149.24,,,0,"percent of total billed charges ","70% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",247.85,93,,198.28,,,0,"percent of total billed charges ","93% of total billed charges ",57.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",66.37,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",226.53,85,,181.22,,,0,"percent of total billed charges ","85% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",65.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",231.86,87,,51.95,51.95,51.95,"1 through 10","percent of total billed charges ","87% of total billed charges ",65.71,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",186.55,70,,149.24,,,0,"percent of total billed charges ","70% of total billed charges ",57.45,247.85,
"CANALITH REPOSITIONING",8001340,"CDM ",420,RC,95992,HCPCS,OUTPATIENT,,,147,117.6,,,,,,,,0,"other ","not separately reimbursment ",40.14,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",77.84,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",102.9,70,,82.32,,,0,"percent of total billed charges ","70% of total billed charges ",132.3,90,,105.84,,,0,"percent of total billed charges ","90% of total billed charges ",136.71,93,,109.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",124.95,85,,99.96,,,0,"percent of total billed charges ","85% of total billed charges ",132.3,90,,105.84,,,0,"percent of total billed charges ","90% of total billed charges ",132.3,90,,105.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",127.89,87,,102.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.9,70,,82.32,,,0,"percent of total billed charges ","70% of total billed charges ",40.14,136.71,
"ADL TRAINING 15MIN",8001370,"CDM ",420,RC,97535,HCPCS,OUTPATIENT,,,71.5,57.2,,19.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.17,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",69.52,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",66.5,93,,53.20,,,0,"percent of total billed charges ","93% of total billed charges ",19.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",60.78,85,,48.62,,,0,"percent of total billed charges ","85% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.21,87,,49.77,,,0,"percent of total billed charges ","87% of total billed charges ",17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",17.8,69.52,
"US PHYS THERAPY 15 MIN",8100036,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,65,52,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"US PHYS THERAPY 30 MIN",8100037,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,129,103.2,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"US PHYS THERAPY 45 MIN",8100038,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,193.5,154.8,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"US PHYS THERAPY 1 HOUR",8100039,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,258,206.4,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"US PHYS THERAPY 75 MIN",8100040,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,322.5,258,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"US PHYS THERAPY 90 MIN",8100041,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,386.5,309.2,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"PELVIC/CERV TRACTION 1 OR MORE",8100044,"CDM ",960,RC,97012,HCPCS,OUTPATIENT,,,62.5,50,,11.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",25,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",11.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,47.24,47.24,47.24,"1 through 10",other,"not separately reimbursment ",11.06,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,25,
"GAIT TRAINING 15 MIN",8100168,"CDM ",960,RC,97116,HCPCS,OUTPATIENT,,,59.5,47.6,,19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",39,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,39,
"GAIT TRAINING 30 MIN",8100170,"CDM ",960,RC,97116,HCPCS,OUTPATIENT,,,119,95.2,,19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",39,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,39,
"GAIT TRAINING 45 MIN",8100172,"CDM ",960,RC,97116,HCPCS,OUTPATIENT,,,178.5,142.8,,19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",39,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,39,
"GAIT TRAINING 1 HOUR",8100173,"CDM ",960,RC,97116,HCPCS,OUTPATIENT,,,237.5,190,,19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",39,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,39,
"GAIT TRAINING 75 MIN",8100174,"CDM ",960,RC,97116,HCPCS,OUTPATIENT,,,297.5,238,,19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",39,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,39,
"GAIT TRAINING 75 MIN",8100174,"CDM ",960,RC,97116,HCPCS,OUTPATIENT,,,297,237.6,,19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",39,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,39,
"GAIT TRAINING 90 MIN",8100175,"CDM ",960,RC,97116,HCPCS,OUTPATIENT,,,356,284.8,,19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",39,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.44,39,
"PHYS PERF TEST 15 MIN FCE",8100176,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,85.5,68.4,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 30 MIN",8100177,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,171,136.8,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 45 MIN",8100178,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,256.5,205.2,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 1 HOUR",8100179,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,341.5,273.2,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 75 MIN",8100180,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,426.5,341.2,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 90 MIN",8100181,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,512.5,410,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 1 HR 45 MIN",8100182,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,597.5,478,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 2 HRS",8100183,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,682.5,546,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 2 HRS 15 MIN",8100184,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,768.5,614.8,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 2 HRS 30 MIN",8100185,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,853.5,682.8,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 2 HRS 45 MIN",8100186,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,938.5,750.8,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 3 HOURS",8100187,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,1024,819.2,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 3 HRS 15 MIN",8100188,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,1110,888,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 3 HRS 30 MIN",8100189,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,1195,956,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 3 HRS 45 MIN",8100190,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,1280.5,1024.4,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 4 HOURS",8100191,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,1366,1092.8,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"PHYS PERF TEST 4 HRS 15 MIN",8100192,"CDM ",960,RC,97750,HCPCS,OUTPATIENT,,,1451,1160.8,,23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.46,47,
"ELECT STIM UNATTENDED",8100291,"CDM ",960,RC,97014,HCPCS,OUTPATIENT,,,53.5,42.8,,12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",22,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,22,
"ELECT STIM UNATTEND 30 MIN",8100293,"CDM ",960,RC,97014,HCPCS,OUTPATIENT,,,107,85.6,,12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",22,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,22,
"ELECT STIM UNATTEND 45 MIN",8100295,"CDM ",960,RC,97014,HCPCS,OUTPATIENT,,,159.5,127.6,,12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",22,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,22,
"ELECT STIM UNATTEND 1 HOUR",8100297,"CDM ",960,RC,97014,HCPCS,OUTPATIENT,,,213,170.4,,12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",22,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,22,
"ELECT STIM UNATTEND 75 MIN",8100299,"CDM ",960,RC,97014,HCPCS,OUTPATIENT,,,266,212.8,,12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",22,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,22,
"ELECT STIM UNATTEND 90 MIN",8100301,"CDM ",960,RC,97014,HCPCS,OUTPATIENT,,,319,255.2,,12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",22,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,22,
"THERAP EXER STRENGTH 15 MIN",8100309,"CDM ",960,RC,97110,HCPCS,OUTPATIENT,,,119,95.2,,22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,272.47,272.47,272.47,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,89.99,65.45,287.97,"1 through 10",other,"not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,44,
"INITIAL THER W/MATERIAL 15MIN",8100310,"CDM ",960,RC,97110,HCPCS,OUTPATIENT,,,119,95.2,,22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,272.47,272.47,272.47,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,89.99,65.45,287.97,"1 through 10",other,"not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,44,
"THERAP EXER STRENGTH 30 MIN",8100311,"CDM ",960,RC,97110,HCPCS,OUTPATIENT,,,237.5,190,,22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,272.47,272.47,272.47,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,89.99,65.45,287.97,"1 through 10",other,"not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,44,
"THERAP EXER STRENGTH 45 MIN",8100313,"CDM ",960,RC,97110,HCPCS,OUTPATIENT,,,356,284.8,,22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,272.47,272.47,272.47,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,89.99,65.45,287.97,"1 through 10",other,"not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,44,
"THERAP EXER STRENGTH 1 HOUR",8100315,"CDM ",960,RC,97110,HCPCS,OUTPATIENT,,,475,380,,22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,272.47,272.47,272.47,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,89.99,65.45,287.97,"1 through 10",other,"not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,44,
"THERAP EXER STRENGTH 75 MIN",8100317,"CDM ",960,RC,97110,HCPCS,OUTPATIENT,,,594,475.2,,22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,272.47,272.47,272.47,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,89.99,65.45,287.97,"1 through 10",other,"not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,44,
"THERAP EXER STRENGTH 90 MIN",8100319,"CDM ",960,RC,97110,HCPCS,OUTPATIENT,,,712,569.6,,22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,272.47,272.47,272.47,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",2,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",44,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,89.99,65.45,287.97,"1 through 10",other,"not separately reimbursment ",22.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2,44,
"IONTOPHORESIS 15 MIN",8100564,"CDM ",960,RC,97033,HCPCS,OUTPATIENT,,,67,53.6,,15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,36.73,36.73,36.73,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.87,41,
"IONTOPHORESIS 30 MIN",8100566,"CDM ",960,RC,97033,HCPCS,OUTPATIENT,,,133.5,106.8,,15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,36.73,36.73,36.73,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.87,41,
"IONTOPHORESIS 45 MIN",8100568,"CDM ",960,RC,97033,HCPCS,OUTPATIENT,,,200.5,160.4,,15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,36.73,36.73,36.73,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.87,41,
"IONTOPHORESIS 1 HOUR",8100570,"CDM ",960,RC,97033,HCPCS,OUTPATIENT,,,267,213.6,,15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,36.73,36.73,36.73,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.87,41,
"IONTOPHORESIS 75 MIN",8100572,"CDM ",960,RC,97033,HCPCS,OUTPATIENT,,,334,267.2,,15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,36.73,36.73,36.73,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.87,41,
"IONTOPHORESIS 90 MIN",8100574,"CDM ",960,RC,97033,HCPCS,OUTPATIENT,,,400,320,,15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,36.73,36.73,36.73,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.87,41,
"PT RE-EVALUATION",8100713,"CDM ",960,RC,97164,HCPCS,OUTPATIENT,,,108,86.4,,48.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",81,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",48.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",48.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.35,81,
"WORK HARDEN/COND 1ST 2HR",8100754,"CDM ",960,RC,97545,HCPCS,OUTPATIENT,,,209,167.2,,30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",3,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",141,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3,141,
"WORK HARDEN/COND ADDL 1 HR",8100762,"CDM ",960,RC,97546,HCPCS,OUTPATIENT,,,105.5,84.4,,15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",71,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,71,
"WORK HARDEN/COND ADDL 2 HRS",8100764,"CDM ",960,RC,97546,HCPCS,OUTPATIENT,,,210.5,168.4,,15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",71,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,71,
"WORK HARDEN/COND ADDL 3 HRS",8100766,"CDM ",960,RC,97546,HCPCS,OUTPATIENT,,,315.5,252.4,,15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",71,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,71,
"WORK HARDEN/COND ADDL 4 HRS",8100768,"CDM ",960,RC,97546,HCPCS,OUTPATIENT,,,421,336.8,,15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",71,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,71,
"WORK HARDEN/COND ADDL 5 HRS",8100770,"CDM ",960,RC,97546,HCPCS,OUTPATIENT,,,526,420.8,,15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",71,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,71,
"WORK HARDEN/COND ADDL 6 HRS",8100772,"CDM ",960,RC,97546,HCPCS,OUTPATIENT,,,631,504.8,,15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",71,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1,71,
"PHONOPHORESIS 15 MIN",8100796,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,65,52,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"PHONOPHORESIS 30 MIN",8100798,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,129,103.2,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"PHONOPHORESIS 45 MIN",8100800,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,193.5,154.8,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"PHONOPHORESIS 1 HOUR",8100802,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,258,206.4,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"PHONOPHORESIS 75 MIN",8100804,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,322.5,258,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"PHONOPHORESIS 90 MIN",8100806,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,386.5,309.2,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"MASSAGE 15 MIN",8100812,"CDM ",960,RC,97124,HCPCS,OUTPATIENT,,,73.5,58.8,,17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,50.46,50.46,50.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",35,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,35,
"MASSAGE 30 MIN",8100814,"CDM ",960,RC,97124,HCPCS,OUTPATIENT,,,147,117.6,,17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,50.46,50.46,50.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",35,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,35,
"MASSAGE 45 MIN",8100816,"CDM ",960,RC,97124,HCPCS,OUTPATIENT,,,220.5,176.4,,17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,50.46,50.46,50.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",35,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,35,
"MASSAGE 1 HOUR",8100818,"CDM ",960,RC,97124,HCPCS,OUTPATIENT,,,294.5,235.6,,17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,50.46,50.46,50.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",35,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,35,
"MASSAGE 45 MIN",8100820,"CDM ",960,RC,97124,HCPCS,OUTPATIENT,,,367.5,294,,17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,50.46,50.46,50.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",35,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,35,
"MASSAGE 90 MIN",8100822,"CDM ",960,RC,97124,HCPCS,OUTPATIENT,,,440.5,352.4,,17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,50.46,50.46,50.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",35,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17.6,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,35,
"AQUATIC THERAPY 15 MIN",8100853,"CDM ",960,RC,97113,HCPCS,OUTPATIENT,,,68,54.4,,24.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",55,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",24.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",24.86,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.86,55,
"NEURO MUSC RE-EDUC 15 MIN",8100861,"CDM ",960,RC,97112,HCPCS,OUTPATIENT,,,76.5,61.2,,22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.46,60.46,60.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,65.17,59.38,70.96,"1 through 10",other,"not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.96,46,
"NEURO MUSC RE-EDUC 30 MIN",8100863,"CDM ",960,RC,97112,HCPCS,OUTPATIENT,,,153,122.4,,22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.46,60.46,60.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,65.17,59.38,70.96,"1 through 10",other,"not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.96,46,
"NEURO MUSC RE-EDUC 45 MIN",8100865,"CDM ",960,RC,97112,HCPCS,OUTPATIENT,,,229,183.2,,22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.46,60.46,60.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,65.17,59.38,70.96,"1 through 10",other,"not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.96,46,
"NEURO MUSC RE-EDUC 1 HOUR",8100867,"CDM ",960,RC,97112,HCPCS,OUTPATIENT,,,305.5,244.4,,22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.46,60.46,60.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,65.17,59.38,70.96,"1 through 10",other,"not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.96,46,
"NEURO MUSC RE-EDUC 75 MIN",8100869,"CDM ",960,RC,97112,HCPCS,OUTPATIENT,,,381.5,305.2,,22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.46,60.46,60.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,65.17,59.38,70.96,"1 through 10",other,"not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.96,46,
"NEURO MUSC RE-EDUC 90 MIN",8100871,"CDM ",960,RC,97112,HCPCS,OUTPATIENT,,,458,366.4,,22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,60.46,60.46,60.46,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,65.17,59.38,70.96,"1 through 10",other,"not separately reimbursment ",22.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.96,46,
BIOFEEDBACK,8100879,"CDM ",960,RC,90901,HCPCS,OUTPATIENT,,,98,78.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",79,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79,79,
"CONTRAST BATH 15 MIN",8100895,"CDM ",960,RC,97034,HCPCS,OUTPATIENT,,,49.5,39.6,,10.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",23,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",10.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",10.98,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.98,23,
"ELECT STIM MANUAL 15 MIN",8100937,"CDM ",960,RC,97032,HCPCS,OUTPATIENT,,,49.5,39.6,,12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,41.07,41.07,41.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",25,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.52,25,
"ELECT STIM MANUAL 30 MIN",8100938,"CDM ",960,RC,97032,HCPCS,OUTPATIENT,,,98.5,78.8,,12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,41.07,41.07,41.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",25,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.52,25,
"ELECT STIM MANUAL 45 MIN",8100939,"CDM ",960,RC,97032,HCPCS,OUTPATIENT,,,147.5,118,,12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,41.07,41.07,41.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",25,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.52,25,
"ELECT STIM MANUAL 1 HOUR",8100940,"CDM ",960,RC,97032,HCPCS,OUTPATIENT,,,196.5,157.2,,12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,41.07,41.07,41.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",25,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.52,25,
"ELECT STIM MANUAL 75 MIN",8100941,"CDM ",960,RC,97032,HCPCS,OUTPATIENT,,,246,196.8,,12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,41.07,41.07,41.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",25,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.52,25,
"ELECT STIM MANUAL 90 MIN",8100942,"CDM ",960,RC,97032,HCPCS,OUTPATIENT,,,295.5,236.4,,12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,41.07,41.07,41.07,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",25,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.52,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.52,25,
"MANUAL THERAPY TECH 15MIN",8100945,"CDM ",960,RC,97140,HCPCS,OUTPATIENT,,,89,71.2,,20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,41,
"MANUAL THERAPY TECH 30 MIN",8100947,"CDM ",960,RC,97140,HCPCS,OUTPATIENT,,,178,142.4,,20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,41,
"MANUAL THERAPY TECH 45MIN",8100949,"CDM ",960,RC,97140,HCPCS,OUTPATIENT,,,266.5,213.2,,20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,41,
"MANUAL THERAPY TECH 1 HOUR",8100951,"CDM ",960,RC,97140,HCPCS,OUTPATIENT,,,355,284,,20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,41,
"MANUAL THERAPY TECH 75 MIN",8100953,"CDM ",960,RC,97140,HCPCS,OUTPATIENT,,,444,355.2,,20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,41,
"MANUAL THERAPY TECH 90 MIN",8100955,"CDM ",960,RC,97140,HCPCS,OUTPATIENT,,,532.5,426,,20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,41,
"PARAFFIN BATH THERAPY",8101018,"CDM ",960,RC,97018,HCPCS,OUTPATIENT,,,49.5,39.6,,5.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",5,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",18,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",5.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",5.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5,18,
"PROSTHETIC TRAINING 15MIN",8101026,"CDM ",960,RC,97761,HCPCS,OUTPATIENT,,,64.5,51.6,,21.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",44,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",21.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",21.4,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.4,44,
"THERAPUTIC ACTIVITY 15MIN",8101067,"CDM ",960,RC,97530,HCPCS,OUTPATIENT,,,80,64,,22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,46,
"THERAPUTIC ACTIVITY 30MIN",8101069,"CDM ",960,RC,97530,HCPCS,OUTPATIENT,,,159.5,127.6,,22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,46,
"THERAPUTIC ACTIVITY 45MIN",8101071,"CDM ",960,RC,97530,HCPCS,OUTPATIENT,,,239.5,191.6,,22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,46,
"THERAPUTIC ACTIVITY 1 HOUR",8101073,"CDM ",960,RC,97530,HCPCS,OUTPATIENT,,,307,245.6,,22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,46,
"THERAPUTIC ACTIVITY 1 HOUR",8101073,"CDM ",960,RC,97530,HCPCS,OUTPATIENT,,,319,255.2,,22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,46,
"THERAPUTIC ACTIVITY 75MIN",8101075,"CDM ",960,RC,97530,HCPCS,OUTPATIENT,,,398.5,318.8,,22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,46,
"THERAPUTIC ACTIVITY 90 MIN",8101079,"CDM ",960,RC,97530,HCPCS,OUTPATIENT,,,444.5,355.6,,22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",46,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",22.92,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.92,46,
"WC MGT ASSESS FIT TRAIN 15MIN",8101083,"CDM ",960,RC,97542,HCPCS,OUTPATIENT,,,64.5,51.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",44,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44,44,
"DEBRIDEMENT 20CM OR LESS",8101091,"CDM ",960,RC,97597,HCPCS,OUTPATIENT,,,346.5,277.2,,37.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,266.92,266.92,266.92,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",100,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",37.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.63,100,
"ROM HAND",8101109,"CDM ",960,RC,95852,HCPCS,OUTPATIENT,,,71,56.8,,10.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",23,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",10.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",10.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.88,23,
"ROM EXTREMITY/TRUNK",8101117,"CDM ",960,RC,95851,HCPCS,OUTPATIENT,,,70.5,56.4,,15.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",30,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",15.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",15.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.21,30,
"DEBRIDE EA ADD 20CM",8101170,"CDM ",960,RC,97598,HCPCS,OUTPATIENT,,,320.5,256.4,,48.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",110,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",48.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",48.15,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.15,110,
"ELECT STIM HOT/COLD UNATTENDED",8101180,"CDM ",960,RC,97014,HCPCS,OUTPATIENT,,,53.5,42.8,,12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",22,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",12.89,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,22,
"MANUAL THERAPY TECH HOT 15MIN",8101190,"CDM ",960,RC,97140,HCPCS,OUTPATIENT,,,89,71.2,,20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",41,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",20.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.67,41,
"US HOT/COLD 15MIN",8101200,"CDM ",960,RC,97035,HCPCS,OUTPATIENT,,,65,52,,8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",19,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",8.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.67,19,
"WOUND VAC </= 50CM",8101220,"CDM ",960,RC,97607,HCPCS,OUTPATIENT,,,373,298.4,,25.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",25.88,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.88,25.88,
"WOUND VAC > 50CM",8101230,"CDM ",960,RC,97606,HCPCS,OUTPATIENT,,,346,276.8,,27.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",70,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",27.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",27.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.94,70,
"DRSG CHANGE NON SELECTIVE",8101240,"CDM ",960,RC,97602,HCPCS,OUTPATIENT,,,617.5,494,,17.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,39.36,39.36,39.36,"1 through 10","other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",52,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",17.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",17.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.44,52,
"MULTI LAYER COMPRESSION",8101250,"CDM ",960,RC,29581,HCPCS,OUTPATIENT,,,630.5,504.4,,16.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",32.61,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",121,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",16.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",16.42,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.42,121,
"SENSORY INTEGRATION 15MIN",8101290,"CDM ",960,RC,97533,HCPCS,OUTPATIENT,,,68,54.4,,19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.49,42,
"SENSORY INTEGRATION 30 MIN",8101292,"CDM ",960,RC,97533,HCPCS,OUTPATIENT,,,136,108.8,,19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.49,42,
"SENSORY INTEGRATION 45 MIN",8101294,"CDM ",960,RC,97533,HCPCS,OUTPATIENT,,,203.5,162.8,,19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.49,42,
"SENSORY INTEGRATION 1 HOUR",8101296,"CDM ",960,RC,97533,HCPCS,OUTPATIENT,,,271.5,217.2,,19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.49,42,
"SENSORY INTEGRATION 75 MIN",8101298,"CDM ",960,RC,97533,HCPCS,OUTPATIENT,,,339.5,271.6,,19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.49,42,
"SENSORY INTEGRATION 90 MIN",8101299,"CDM ",960,RC,97533,HCPCS,OUTPATIENT,,,407.5,326,,19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",42,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",19.49,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.49,42,
"PT THERAPUTIC PROC GROUP",8101300,"CDM ",960,RC,97150,HCPCS,OUTPATIENT,,,47.5,38,,13.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",27,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",13.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",13.35,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.35,27,
"PHS THERAPY EVAL LOW COMP",8101310,"CDM ",960,RC,97161,HCPCS,OUTPATIENT,,,155,124,,70.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,166.04,166.04,166.04,"1 through 10","other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",119,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",70.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,117.23,67.63,134.82,"1 through 10",other,"not separately reimbursment ",70.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.58,119,
"PHYS THERAPY EVAL MOD COMP",8101320,"CDM ",960,RC,97162,HCPCS,OUTPATIENT,,,194.5,155.6,,70.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",119,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",70.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,66.65,66.65,66.65,"1 through 10",other,"not separately reimbursment ",70.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.58,119,
"PHYS THERAPY EVAL HIGH COMP",8101330,"CDM ",960,RC,97163,HCPCS,OUTPATIENT,,,243.5,194.8,,70.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",119,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",70.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,51.95,51.95,51.95,"1 through 10",other,"not separately reimbursment ",70.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.58,119,
"CANALITH REPOSITIONING",8101340,"CDM ",960,RC,95992,HCPCS,OUTPATIENT,,,152.5,122,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",60,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60,60,
"ADL TRAINING 15MIN",8101370,"CDM ",960,RC,97535,HCPCS,OUTPATIENT,,,65.5,52.4,,23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.51,47,
"ADL TRAINING 30MIN",8101371,"CDM ",960,RC,97535,HCPCS,OUTPATIENT,,,130.5,104.4,,23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.51,47,
"ADL TRAINING 45MIN",8101372,"CDM ",960,RC,97535,HCPCS,OUTPATIENT,,,195,156,,23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.51,47,
"ADL TRAINING 1 HOUR",8101373,"CDM ",960,RC,97535,HCPCS,OUTPATIENT,,,260,208,,23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.51,47,
"ADL TRAINING 75MIN",8101374,"CDM ",960,RC,97535,HCPCS,OUTPATIENT,,,325,260,,23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.51,47,
"ADL TRAINING 90MIN",8101375,"CDM ",960,RC,97535,HCPCS,OUTPATIENT,,,390.5,312.4,,23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",47,100,,,,,0,"fee schedule ","100% of NATIONAL BEEF PACKING fee schedule ",,,,,,,0,"other ","not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,other,"not separately reimbursment ",23.51,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.51,47,
"TREATMENT-SPEECH LANG INDIVIDU",8200024,"CDM ",441,RC,92507,HCPCS,OUTPATIENT,,,147.5,118,,76.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",77.77,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",163.61,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",103.25,70,,82.60,,,0,"percent of total billed charges ","70% of total billed charges ",132.75,90,,106.20,,,0,"percent of total billed charges ","90% of total billed charges ",137.18,93,,109.74,,,0,"percent of total billed charges ","93% of total billed charges ",76.68,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",70.86,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",125.38,85,,100.30,,,0,"percent of total billed charges ","85% of total billed charges ",132.75,90,,106.20,,,0,"percent of total billed charges ","90% of total billed charges ",132.75,90,,106.20,,,0,"percent of total billed charges ","90% of total billed charges ",70.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",128.33,87,,102.66,,,0,"percent of total billed charges ","87% of total billed charges ",70.16,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",103.25,70,,82.60,,,0,"percent of total billed charges ","70% of total billed charges ",70.16,163.61,
"EVAL AAC DEVICE, 1ST HOUR",8200040,"CDM ",444,RC,92607,HCPCS,OUTPATIENT,,,236,188.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.23,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",165.2,70,,132.16,,,0,"percent of total billed charges ","70% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",219.48,93,,175.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",200.6,85,,160.48,,,0,"percent of total billed charges ","85% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",212.4,90,,169.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",205.32,87,,164.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",165.2,70,,132.16,,,0,"percent of total billed charges ","70% of total billed charges ",165.2,263.23,
"ASSESS BEDSIDE SWALLOW EVAL",8200065,"CDM ",444,RC,92610,HCPCS,OUTPATIENT,,,202.5,162,,88.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",128.71,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",149.09,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",141.75,70,,113.40,,,0,"percent of total billed charges ","70% of total billed charges ",182.25,90,,145.80,,,0,"percent of total billed charges ","90% of total billed charges ",188.33,93,,150.66,,,0,"percent of total billed charges ","93% of total billed charges ",88.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.37,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",172.13,85,,137.70,,,0,"percent of total billed charges ","85% of total billed charges ",182.25,90,,145.80,,,0,"percent of total billed charges ","90% of total billed charges ",182.25,90,,145.80,,,0,"percent of total billed charges ","90% of total billed charges ",111.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",176.18,87,,140.94,,,0,"percent of total billed charges ","87% of total billed charges ",111.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",141.75,70,,113.40,,,0,"percent of total billed charges ","70% of total billed charges ",88.44,188.33,
"ASSESS SPEECH LANG/AUDIT PROC",8200081,"CDM ",444,RC,92523,HCPCS,OUTPATIENT,,,397,317.6,,,,,,,,0,"other ","not separately reimbursment ",116.15,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",485.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",277.9,70,,222.32,,,0,"percent of total billed charges ","70% of total billed charges ",357.3,90,,285.84,,,0,"percent of total billed charges ","90% of total billed charges ",369.21,93,,295.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",169.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",337.45,85,,269.96,,,0,"percent of total billed charges ","85% of total billed charges ",357.3,90,,285.84,,,0,"percent of total billed charges ","90% of total billed charges ",357.3,90,,285.84,,,0,"percent of total billed charges ","90% of total billed charges ",167.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",345.39,87,,276.31,,,0,"percent of total billed charges ","87% of total billed charges ",167.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",277.9,70,,222.32,,,0,"percent of total billed charges ","70% of total billed charges ",116.15,485.25,
TREATMENT-SWALLOW,8200198,"CDM ",441,RC,92526,HCPCS,OUTPATIENT,,,172.5,138,,,,,,,,0,"other ","not separately reimbursment ",65.44,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",181.17,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",120.75,70,,96.60,,,0,"percent of total billed charges ","70% of total billed charges ",155.25,90,,124.20,,,0,"percent of total billed charges ","90% of total billed charges ",160.43,93,,128.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",11.1,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",146.63,85,,117.30,,,0,"percent of total billed charges ","85% of total billed charges ",155.25,90,,124.20,,,0,"percent of total billed charges ","90% of total billed charges ",155.25,90,,124.20,,,0,"percent of total billed charges ","90% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",150.08,87,,120.06,,,0,"percent of total billed charges ","87% of total billed charges ",10.99,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",120.75,70,,96.60,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,181.17,
"ASSESS SWALLOW-MBS",8200255,"CDM ",444,RC,92611,HCPCS,OUTPATIENT,,,232.5,186,,88.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",178.22,100,,6.06,6.06,6.06,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",193.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",162.75,70,,130.20,,,0,"percent of total billed charges ","70% of total billed charges ",209.25,90,,167.40,,,0,"percent of total billed charges ","90% of total billed charges ",216.23,93,,172.98,,,0,"percent of total billed charges ","93% of total billed charges ",88.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.37,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",197.63,85,,158.10,,,0,"percent of total billed charges ","85% of total billed charges ",209.25,90,,167.40,,,0,"percent of total billed charges ","90% of total billed charges ",209.25,90,,167.40,,,0,"percent of total billed charges ","90% of total billed charges ",111.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",202.28,87,,161.82,,,0,"percent of total billed charges ","87% of total billed charges ",111.26,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",162.75,70,,130.20,,,0,"percent of total billed charges ","70% of total billed charges ",88.44,216.23,
"ASSESSMENT OF APHASIA PER HR",8200263,"CDM ",444,RC,96105,HCPCS,OUTPATIENT,,,209,167.2,,32.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",208.6,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",146.3,70,,117.04,,,0,"percent of total billed charges ","70% of total billed charges ",188.1,90,,150.48,,,0,"percent of total billed charges ","90% of total billed charges ",194.37,93,,155.50,,,0,"percent of total billed charges ","93% of total billed charges ",32.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",41.62,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",177.65,85,,142.12,,,0,"percent of total billed charges ","85% of total billed charges ",188.1,90,,150.48,,,0,"percent of total billed charges ","90% of total billed charges ",188.1,90,,150.48,,,0,"percent of total billed charges ","90% of total billed charges ",41.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",181.83,87,,145.46,,,0,"percent of total billed charges ","87% of total billed charges ",41.21,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",146.3,70,,117.04,,,0,"percent of total billed charges ","70% of total billed charges ",32.76,208.6,
"TREATMENT AAC DEVICES",8200271,"CDM ",441,RC,92609,HCPCS,OUTPATIENT,,,179.5,143.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.33,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",125.65,70,,100.52,,,0,"percent of total billed charges ","70% of total billed charges ",161.55,90,,129.24,,,0,"percent of total billed charges ","90% of total billed charges ",166.94,93,,133.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",152.58,85,,122.06,,,0,"percent of total billed charges ","85% of total billed charges ",161.55,90,,129.24,,,0,"percent of total billed charges ","90% of total billed charges ",161.55,90,,129.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",156.17,87,,124.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.65,70,,100.52,,,0,"percent of total billed charges ","70% of total billed charges ",125.65,220.33,
"EVAL AAC DEVICES ADD'L 30MIN",8200297,"CDM ",444,RC,92608,HCPCS,OUTPATIENT,,,117,93.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.75,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",81.9,70,,65.52,,,0,"percent of total billed charges ","70% of total billed charges ",105.3,90,,84.24,,,0,"percent of total billed charges ","90% of total billed charges ",108.81,93,,87.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.45,85,,79.56,,,0,"percent of total billed charges ","85% of total billed charges ",105.3,90,,84.24,,,0,"percent of total billed charges ","90% of total billed charges ",105.3,90,,84.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.79,87,,81.43,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.9,70,,65.52,,,0,"percent of total billed charges ","70% of total billed charges ",81.9,108.81,
"TREATMENT NON SPEECH GEN DEVIC",8200305,"CDM ",441,RC,92606,HCPCS,OUTPATIENT,,,208,166.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.75,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",145.6,70,,116.48,,,0,"percent of total billed charges ","70% of total billed charges ",187.2,90,,149.76,,,0,"percent of total billed charges ","90% of total billed charges ",193.44,93,,154.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",176.8,85,,141.44,,,0,"percent of total billed charges ","85% of total billed charges ",187.2,90,,149.76,,,0,"percent of total billed charges ","90% of total billed charges ",187.2,90,,149.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",180.96,87,,144.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",145.6,70,,116.48,,,0,"percent of total billed charges ","70% of total billed charges ",145.6,193.44,
"EVAL SPEECH FLUENCY",8200310,"CDM ",444,RC,92521,HCPCS,OUTPATIENT,,,241,192.8,,,,,,,,0,"other ","not separately reimbursment ",116.15,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",283.58,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",168.7,70,,134.96,,,0,"percent of total billed charges ","70% of total billed charges ",216.9,90,,173.52,,,0,"percent of total billed charges ","90% of total billed charges ",224.13,93,,179.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",204.85,85,,163.88,,,0,"percent of total billed charges ","85% of total billed charges ",216.9,90,,173.52,,,0,"percent of total billed charges ","90% of total billed charges ",216.9,90,,173.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",209.67,87,,167.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",168.7,70,,134.96,,,0,"percent of total billed charges ","70% of total billed charges ",116.15,283.58,
"EVAL SPEECH SOUND PROD/LANG",8200320,"CDM ",444,RC,92522,HCPCS,OUTPATIENT,,,214,171.2,,,,,,,,0,"other ","not separately reimbursment ",116.15,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",237.8,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",149.8,70,,119.84,,,0,"percent of total billed charges ","70% of total billed charges ",192.6,90,,154.08,,,0,"percent of total billed charges ","90% of total billed charges ",199.02,93,,159.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",44.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",181.9,85,,145.52,,,0,"percent of total billed charges ","85% of total billed charges ",192.6,90,,154.08,,,0,"percent of total billed charges ","90% of total billed charges ",192.6,90,,154.08,,,0,"percent of total billed charges ","90% of total billed charges ",44.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",186.18,87,,148.94,,,0,"percent of total billed charges ","87% of total billed charges ",44.53,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",149.8,70,,119.84,,,0,"percent of total billed charges ","70% of total billed charges ",44.53,237.8,
"BEHAVIOR/QUANT ANALYSIS VOICE",8200330,"CDM ",441,RC,92524,HCPCS,OUTPATIENT,,,202.5,162,,,,,,,,0,"other ","not separately reimbursment ",116.15,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",234.32,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",141.75,70,,113.40,,,0,"percent of total billed charges ","70% of total billed charges ",182.25,90,,145.80,,,0,"percent of total billed charges ","90% of total billed charges ",188.33,93,,150.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.13,85,,137.70,,,0,"percent of total billed charges ","85% of total billed charges ",182.25,90,,145.80,,,0,"percent of total billed charges ","90% of total billed charges ",182.25,90,,145.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.18,87,,140.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.75,70,,113.40,,,0,"percent of total billed charges ","70% of total billed charges ",116.15,234.32,
"EVAL SPEECH SOUND PROD LANG CO",8200340,"CDM ",444,RC,92523,HCPCS,OUTPATIENT,,,397,317.6,,,,,,,,0,"other ","not separately reimbursment ",116.15,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",485.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",277.9,70,,222.32,,,0,"percent of total billed charges ","70% of total billed charges ",357.3,90,,285.84,,,0,"percent of total billed charges ","90% of total billed charges ",369.21,93,,295.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",169.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",337.45,85,,269.96,,,0,"percent of total billed charges ","85% of total billed charges ",357.3,90,,285.84,,,0,"percent of total billed charges ","90% of total billed charges ",357.3,90,,285.84,,,0,"percent of total billed charges ","90% of total billed charges ",167.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",345.39,87,,276.31,,,0,"percent of total billed charges ","87% of total billed charges ",167.63,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",277.9,70,,222.32,,,0,"percent of total billed charges ","70% of total billed charges ",116.15,485.25,
"ADD 30 MINS NONSPEECH",8200360,"CDM ",444,RC,92618,HCPCS,OUTPATIENT,,,74.5,59.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.51,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",69.29,93,,55.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",63.33,85,,50.66,,,0,"percent of total billed charges ","85% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",64.82,87,,51.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",52.15,69.29,
"COGNITIVE TEST",8200370,"CDM ",441,RC,96125,HCPCS,OUTPATIENT,,,233.5,186.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.35,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",163.45,70,,130.76,,,0,"percent of total billed charges ","70% of total billed charges ",210.15,90,,168.12,,,0,"percent of total billed charges ","90% of total billed charges ",217.16,93,,173.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",198.48,85,,158.78,,,0,"percent of total billed charges ","85% of total billed charges ",210.15,90,,168.12,,,0,"percent of total billed charges ","90% of total billed charges ",210.15,90,,168.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",203.15,87,,162.52,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",163.45,70,,130.76,,,0,"percent of total billed charges ","70% of total billed charges ",163.45,220.35,
"THERAP INVTJ 1ST 15MIN",8200380,"CDM ",441,RC,97129,HCPCS,OUTPATIENT,,,74.5,59.6,,,,,,,,0,"other ","not separately reimbursment ",50.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",49.13,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",69.29,93,,55.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",63.33,85,,50.66,,,0,"percent of total billed charges ","85% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",64.82,87,,51.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",49.13,69.29,
"THER IVNTJ EA ADD 15 MIN",8200390,"CDM ",441,RC,97130,HCPCS,OUTPATIENT,,,74.5,59.6,,,,,,,,0,"other ","not separately reimbursment ",50.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",46.9,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",69.29,93,,55.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",63.33,85,,50.66,,,0,"percent of total billed charges ","85% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",64.82,87,,51.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",46.9,69.29,
"EVAL NON SPEECH GEN DEVI 1 HR",8209991,"CDM ",444,RC,92605,HCPCS,OUTPATIENT,,,220,176,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",184.43,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",154,70,,123.20,,,0,"percent of total billed charges ","70% of total billed charges ",198,90,,158.40,,,0,"percent of total billed charges ","90% of total billed charges ",204.6,93,,163.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",187,85,,149.60,,,0,"percent of total billed charges ","85% of total billed charges ",198,90,,158.40,,,0,"percent of total billed charges ","90% of total billed charges ",198,90,,158.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",191.4,87,,153.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154,70,,123.20,,,0,"percent of total billed charges ","70% of total billed charges ",154,204.6,
"NEURO-MUSC RE-EDUC 15MIN",8400129,"CDM ",430,RC,97112,HCPCS,OUTPATIENT,,,83.5,66.8,,27.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",50.5,100,,60.46,60.46,60.46,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",72.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",77.66,93,,62.13,,,0,"percent of total billed charges ","93% of total billed charges ",27.18,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",70.98,85,,56.78,,,0,"percent of total billed charges ","85% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",24.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",72.65,87,,65.17,59.38,70.96,"1 through 10","percent of total billed charges ","87% of total billed charges ",24.87,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",24.87,77.66,
"ORTHO FIT/TRAIN 15 MIN",8400137,"CDM ",430,RC,97760,HCPCS,OUTPATIENT,,,83.5,66.8,,,,,,,,0,"other ","not separately reimbursment ",39.64,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",102.34,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",77.66,93,,62.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.98,85,,56.78,,,0,"percent of total billed charges ","85% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",72.65,87,,58.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",39.64,102.34,
"PARAFIN BATH-OT",8400145,"CDM ",430,RC,97018,HCPCS,OUTPATIENT,,,53.5,42.8,,13.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.23,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",11.81,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",49.76,93,,39.81,,,0,"percent of total billed charges ","93% of total billed charges ",13.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.12,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",45.48,85,,36.38,,,0,"percent of total billed charges ","85% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",15.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",46.55,87,,37.24,,,0,"percent of total billed charges ","87% of total billed charges ",15.96,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.81,49.76,
"THERAPUTIC ACTIVITY/15MIN",8400244,"CDM ",430,RC,97530,HCPCS,OUTPATIENT,,,71.5,57.2,,28.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.91,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",78.43,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",66.5,93,,53.20,,,0,"percent of total billed charges ","93% of total billed charges ",28.44,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",60.78,85,,48.62,,,0,"percent of total billed charges ","85% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",26.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.21,87,,49.77,,,0,"percent of total billed charges ","87% of total billed charges ",26.02,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",26.02,78.43,
"ADL TRAINING 15MIN",8400483,"CDM ",430,RC,97535,HCPCS,OUTPATIENT,,,71.5,57.2,,19.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",34.17,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",69.52,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",66.5,93,,53.20,,,0,"percent of total billed charges ","93% of total billed charges ",19.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",17.98,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",60.78,85,,48.62,,,0,"percent of total billed charges ","85% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.21,87,,49.77,,,0,"percent of total billed charges ","87% of total billed charges ",17.8,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",17.8,69.52,
"OT RE-EVALUATION",8400608,"CDM ",434,RC,97168,HCPCS,OUTPATIENT,,,118,94.4,,,,,,,,0,"other ","not separately reimbursment ",77.42,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",147.05,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",82.6,70,,66.08,,,0,"percent of total billed charges ","70% of total billed charges ",106.2,90,,84.96,,,0,"percent of total billed charges ","90% of total billed charges ",109.74,93,,87.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",33.76,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",100.3,85,,80.24,,,0,"percent of total billed charges ","85% of total billed charges ",106.2,90,,84.96,,,0,"percent of total billed charges ","90% of total billed charges ",106.2,90,,84.96,,,0,"percent of total billed charges ","90% of total billed charges ",33.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",102.66,87,,82.13,,,0,"percent of total billed charges ","87% of total billed charges ",33.43,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",82.6,70,,66.08,,,0,"percent of total billed charges ","70% of total billed charges ",33.43,147.05,
"WORK HARDEN/COND 1ST 2 HRS",8400754,"CDM ",430,RC,97545,HCPCS,OUTPATIENT,,,267.5,214,,34.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.16,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",,,,,,,0,"other ","not separately reimbursment ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",248.78,93,,199.02,,,0,"percent of total billed charges ","93% of total billed charges ",34.32,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",39.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",227.38,85,,181.90,,,0,"percent of total billed charges ","85% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",240.75,90,,192.60,,,0,"percent of total billed charges ","90% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",232.73,87,,186.18,,,0,"percent of total billed charges ","87% of total billed charges ",39.25,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",187.25,70,,149.80,,,0,"percent of total billed charges ","70% of total billed charges ",16.16,248.78,
"ULTRASOUND OT 15 MIN",8400772,"CDM ",430,RC,97035,HCPCS,OUTPATIENT,,,71.5,57.2,,12.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",30.16,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",66.5,93,,53.20,,,0,"percent of total billed charges ","93% of total billed charges ",12.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",60.78,85,,48.62,,,0,"percent of total billed charges ","85% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",14.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.21,87,,49.77,,,0,"percent of total billed charges ","87% of total billed charges ",14.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",12.33,66.5,
"OT GROUP THERAPY",8400780,"CDM ",430,RC,97150,HCPCS,OUTPATIENT,,,52,41.6,,17.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",26.51,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",37.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",36.4,70,,29.12,,,0,"percent of total billed charges ","70% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",48.36,93,,38.69,,,0,"percent of total billed charges ","93% of total billed charges ",17.45,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.15,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",44.2,85,,35.36,,,0,"percent of total billed charges ","85% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",45.24,87,,36.19,,,0,"percent of total billed charges ","87% of total billed charges ",19.95,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",36.4,70,,29.12,,,0,"percent of total billed charges ","70% of total billed charges ",17.45,48.36,
"THERAPY EXER STRENGTH 15 MIN",8400798,"CDM ",430,RC,97110,HCPCS,OUTPATIENT,,,129.5,103.6,,28.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.91,100,,272.47,272.47,272.47,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",62.59,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",90.65,70,,72.52,,,0,"percent of total billed charges ","70% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",120.44,93,,96.35,,,0,"percent of total billed charges ","93% of total billed charges ",28.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",110.08,85,,88.06,,,0,"percent of total billed charges ","85% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",25.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.67,87,,89.99,65.45,287.97,"1 through 10","percent of total billed charges ","87% of total billed charges ",25.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",90.65,70,,72.52,,,0,"percent of total billed charges ","70% of total billed charges ",25.65,120.44,
"SENSORY INTEG TECH 15 MIN",8400806,"CDM ",430,RC,97533,HCPCS,OUTPATIENT,,,74.5,59.6,,,,,,,,0,"other ","not separately reimbursment ",53.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",134.71,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",69.29,93,,55.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",5.88,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",63.33,85,,50.66,,,0,"percent of total billed charges ","85% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",5.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.82,87,,51.86,,,0,"percent of total billed charges ","87% of total billed charges ",5.82,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",5.82,134.71,
"MANUAL THERAPY 15 MIN",8400814,"CDM ",430,RC,97140,HCPCS,OUTPATIENT,,,97.5,78,,22.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",58.08,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",57.62,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",68.25,70,,54.60,,,0,"percent of total billed charges ","70% of total billed charges ",87.75,90,,70.20,,,0,"percent of total billed charges ","90% of total billed charges ",90.68,93,,72.54,,,0,"percent of total billed charges ","93% of total billed charges ",22.37,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.67,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",82.88,85,,66.30,,,0,"percent of total billed charges ","85% of total billed charges ",87.75,90,,70.20,,,0,"percent of total billed charges ","90% of total billed charges ",87.75,90,,70.20,,,0,"percent of total billed charges ","90% of total billed charges ",20.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",84.83,87,,67.86,,,0,"percent of total billed charges ","87% of total billed charges ",20.47,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",68.25,70,,54.60,,,0,"percent of total billed charges ","70% of total billed charges ",20.47,90.68,
WHIRLPOOL,8400822,"CDM ",430,RC,97022,HCPCS,OUTPATIENT,,,120,96,,14.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.33,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",36.1,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",84,70,,67.20,,,0,"percent of total billed charges ","70% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",111.6,93,,89.28,,,0,"percent of total billed charges ","93% of total billed charges ",14.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",102,85,,81.60,,,0,"percent of total billed charges ","85% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",104.4,87,,83.52,,,0,"percent of total billed charges ","87% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",84,70,,67.20,,,0,"percent of total billed charges ","70% of total billed charges ",14.41,111.6,
"WOUND DEBRIDEMENT < 20 CM",8400830,"CDM ",430,RC,97597,HCPCS,OUTPATIENT,,,344,275.2,,208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",278.76,100,,266.92,266.92,266.92,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",76.25,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",240.8,70,,192.64,,,0,"percent of total billed charges ","70% of total billed charges ",309.6,90,,247.68,,,0,"percent of total billed charges ","90% of total billed charges ",319.92,93,,255.94,,,0,"percent of total billed charges ","93% of total billed charges ",208,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",264.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",292.4,85,,233.92,,,0,"percent of total billed charges ","85% of total billed charges ",309.6,90,,247.68,,,0,"percent of total billed charges ","90% of total billed charges ",309.6,90,,247.68,,,0,"percent of total billed charges ","90% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",299.28,87,,239.42,,,0,"percent of total billed charges ","87% of total billed charges ",261.66,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",184.51,100,,,,,0,"fee schedule ","100% of CMS OPPS rate ",240.8,70,,192.64,,,0,"percent of total billed charges ","70% of total billed charges ",76.25,319.92,
"ELECTRICAL STIM UNATTENDED",8400848,"CDM ",430,RC,G0283,HCPCS,OUTPATIENT,,,58.5,46.8,,,,,,,,0,"other ","not separately reimbursment ",31.31,100,,2.33,2.33,2.33,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",25.78,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",40.95,70,,32.76,,,0,"percent of total billed charges ","70% of total billed charges ",52.65,90,,42.12,,,0,"percent of total billed charges ","90% of total billed charges ",54.41,93,,43.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",49.73,85,,39.78,,,0,"percent of total billed charges ","85% of total billed charges ",52.65,90,,42.12,,,0,"percent of total billed charges ","90% of total billed charges ",52.65,90,,42.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",50.9,87,,40.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.95,70,,32.76,,,0,"percent of total billed charges ","70% of total billed charges ",25.78,54.41,
"WC MGMT/ASSESS,FIT,TRAIN 15MIN",8400855,"CDM ",430,RC,97542,HCPCS,OUTPATIENT,,,70.5,56.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.65,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",65.57,93,,52.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",59.93,85,,47.94,,,0,"percent of total billed charges ","85% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",61.34,87,,49.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",49.35,67.65,
"PHYS PERF TEST 15 MIN",8400863,"CDM ",430,RC,97750,HCPCS,OUTPATIENT,,,93,74.4,,17.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",53.53,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",70.88,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",65.1,70,,52.08,,,0,"percent of total billed charges ","70% of total billed charges ",83.7,90,,66.96,,,0,"percent of total billed charges ","90% of total billed charges ",86.49,93,,69.19,,,0,"percent of total billed charges ","93% of total billed charges ",17.56,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",20.28,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",79.05,85,,63.24,,,0,"percent of total billed charges ","85% of total billed charges ",83.7,90,,66.96,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,90,,66.96,,,0,"percent of total billed charges ","90% of total billed charges ",20.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",80.91,87,,64.73,,,0,"percent of total billed charges ","87% of total billed charges ",20.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",65.1,70,,52.08,,,0,"percent of total billed charges ","70% of total billed charges ",17.56,86.49,
"ROM TESTING HAND",8400871,"CDM ",430,RC,95852,HCPCS,OUTPATIENT,,,68.5,54.8,,5.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",11.48,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",47.95,70,,38.36,,,0,"percent of total billed charges ","70% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",63.71,93,,50.97,,,0,"percent of total billed charges ","93% of total billed charges ",5.94,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",6.86,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",58.23,85,,46.58,,,0,"percent of total billed charges ","85% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",6.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.6,87,,47.68,,,0,"percent of total billed charges ","87% of total billed charges ",6.79,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",47.95,70,,38.36,,,0,"percent of total billed charges ","70% of total billed charges ",5.94,63.71,
"ROM TESTING EXTREMITY/TRUNK",8400889,"CDM ",430,RC,95851,HCPCS,OUTPATIENT,,,68,54.4,,8.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.83,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",16.68,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",47.6,70,,38.08,,,0,"percent of total billed charges ","70% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",63.24,93,,50.59,,,0,"percent of total billed charges ","93% of total billed charges ",8.46,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.77,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",57.8,85,,46.24,,,0,"percent of total billed charges ","85% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",9.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",59.16,87,,47.33,,,0,"percent of total billed charges ","87% of total billed charges ",9.67,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",47.6,70,,38.08,,,0,"percent of total billed charges ","70% of total billed charges ",8.46,63.24,
"ASSIST TECH ASSESS/15 MIN",8400962,"CDM ",430,RC,97755,HCPCS,OUTPATIENT,,,99,79.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.07,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",69.3,70,,55.44,,,0,"percent of total billed charges ","70% of total billed charges ",89.1,90,,71.28,,,0,"percent of total billed charges ","90% of total billed charges ",92.07,93,,73.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",84.15,85,,67.32,,,0,"percent of total billed charges ","85% of total billed charges ",89.1,90,,71.28,,,0,"percent of total billed charges ","90% of total billed charges ",89.1,90,,71.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",86.13,87,,68.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.3,70,,55.44,,,0,"percent of total billed charges ","70% of total billed charges ",69.3,92.07,
"IONTOPHORESIS 15 MIN",8400970,"CDM ",430,RC,97033,HCPCS,OUTPATIENT,,,73,58.4,,8.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",38.38,100,,36.73,36.73,36.73,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",41.56,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",51.1,70,,40.88,,,0,"percent of total billed charges ","70% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",67.89,93,,54.31,,,0,"percent of total billed charges ","93% of total billed charges ",8.58,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",9.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",62.05,85,,49.64,,,0,"percent of total billed charges ","85% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",63.51,87,,50.81,,,0,"percent of total billed charges ","87% of total billed charges ",9.81,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",51.1,70,,40.88,,,0,"percent of total billed charges ","70% of total billed charges ",8.58,67.89,
"PROSTHETIC TRAINING 15 MIN",8400988,"CDM ",430,RC,97761,HCPCS,OUTPATIENT,,,70.5,56.4,,20.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",50.5,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",87.85,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",65.57,93,,52.46,,,0,"percent of total billed charges ","93% of total billed charges ",20.19,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",23.31,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",59.93,85,,47.94,,,0,"percent of total billed charges ","85% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",63.45,90,,50.76,,,0,"percent of total billed charges ","90% of total billed charges ",23.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",61.34,87,,49.07,,,0,"percent of total billed charges ","87% of total billed charges ",23.08,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",49.35,70,,39.48,,,0,"percent of total billed charges ","70% of total billed charges ",20.19,87.85,
"PHONOPHORESIS 15 MIN",8401002,"CDM ",430,RC,97035,HCPCS,OUTPATIENT,,,71.5,57.2,,12.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",29.29,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",30.16,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",66.5,93,,53.20,,,0,"percent of total billed charges ","93% of total billed charges ",12.33,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",14.24,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",60.78,85,,48.62,,,0,"percent of total billed charges ","85% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",14.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",62.21,87,,49.77,,,0,"percent of total billed charges ","87% of total billed charges ",14.1,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",12.33,66.5,
FLUIDOTHERAPY,8401010,"CDM ",430,RC,97022,HCPCS,OUTPATIENT,,,120,96,,14.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",33.33,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",36.1,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",84,70,,67.20,,,0,"percent of total billed charges ","70% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",111.6,93,,89.28,,,0,"percent of total billed charges ","93% of total billed charges ",14.41,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",16.64,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",102,85,,81.60,,,0,"percent of total billed charges ","85% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",108,90,,86.40,,,0,"percent of total billed charges ","90% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",104.4,87,,83.52,,,0,"percent of total billed charges ","87% of total billed charges ",16.48,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",84,70,,67.20,,,0,"percent of total billed charges ","70% of total billed charges ",14.41,111.6,
"INITIAL OT THEREX W/MAT 15 MIN",8401030,"CDM ",430,RC,97110,HCPCS,OUTPATIENT,,,129.5,103.6,,28.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",56.91,100,,272.47,272.47,272.47,"1 through 10"," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",62.59,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",90.65,70,,72.52,,,0,"percent of total billed charges ","70% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",120.44,93,,96.35,,,0,"percent of total billed charges ","93% of total billed charges ",28.04,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",25.91,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",110.08,85,,88.06,,,0,"percent of total billed charges ","85% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",25.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",112.67,87,,89.99,65.45,287.97,"1 through 10","percent of total billed charges ","87% of total billed charges ",25.65,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",90.65,70,,72.52,,,0,"percent of total billed charges ","70% of total billed charges ",25.65,120.44,
"OCC THERAPY EVAL LOW COMP",8401080,"CDM ",434,RC,97165,HCPCS,OUTPATIENT,,,169,135.2,,55.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.24,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",214.39,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",157.17,93,,125.74,,,0,"percent of total billed charges ","93% of total billed charges ",55.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.41,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",143.65,85,,114.92,,,0,"percent of total billed charges ","85% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",63.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",147.03,87,,117.62,,,0,"percent of total billed charges ","87% of total billed charges ",63.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",55.76,214.39,
"OCC THERAPY EVAL MOD COMP",8401090,"CDM ",434,RC,97166,HCPCS,OUTPATIENT,,,213,170.4,,55.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.24,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",214.39,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",149.1,70,,119.28,,,0,"percent of total billed charges ","70% of total billed charges ",191.7,90,,153.36,,,0,"percent of total billed charges ","90% of total billed charges ",198.09,93,,158.47,,,0,"percent of total billed charges ","93% of total billed charges ",55.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.41,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",181.05,85,,144.84,,,0,"percent of total billed charges ","85% of total billed charges ",191.7,90,,153.36,,,0,"percent of total billed charges ","90% of total billed charges ",191.7,90,,153.36,,,0,"percent of total billed charges ","90% of total billed charges ",63.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",185.31,87,,148.25,,,0,"percent of total billed charges ","87% of total billed charges ",63.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",149.1,70,,119.28,,,0,"percent of total billed charges ","70% of total billed charges ",55.76,214.39,
"OCC THERAPY EVAL HIGH COMP",8401100,"CDM ",434,RC,97167,HCPCS,OUTPATIENT,,,266.5,213.2,,55.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",117.24,100,,,,,0," fee schedule ","100% of BLUE CROSS BLUE SHIELD KANSAS fee schedule ",214.39,220,,,,,0,"fee schedule ","220% of COVENTRY AETNA fee schedule ",186.55,70,,149.24,,,0,"percent of total billed charges ","70% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",247.85,93,,198.28,,,0,"percent of total billed charges ","93% of total billed charges ",55.76,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",64.41,101,,,,,0,"fee schedule ","101% of KS medicaid fee schedule ",226.53,85,,181.22,,,0,"percent of total billed charges ","85% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",239.85,90,,191.88,,,0,"percent of total billed charges ","90% of total billed charges ",63.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",231.86,87,,185.49,,,0,"percent of total billed charges ","87% of total billed charges ",63.77,100,,,,,0,"fee schedule ","100% of KS medicaid fee schedule ",,,,,,,0,"other ","not separately reimbursment ",186.55,70,,149.24,,,0,"percent of total billed charges ","70% of total billed charges ",55.76,247.85,
"ROOM & BOARD MEDICAL",12005,"CDM ",111,RC,,,INPATIENT,,,1395.5,1116.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1116.4,80,,893.12,,,0,"percent of total billed charges ","80% of total billed charges ",,,,,,,0,other,"not separately reimbursment ",1255.95,90,,1004.76,,,0,"percent of total billed charges ","90% of total billed charges ",1297.82,93,,1038.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1186.18,85,,948.94,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1255.95,90,,1004.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1214.09,87,,971.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",976.85,70,,781.48,,,0,"percent of total billed charges ","70% of total billed charges ",976.85,1297.82,
"ROOM & BOARD SURGERY",13003,"CDM ",111,RC,,,INPATIENT,,,1395.5,1116.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1116.4,80,,893.12,,,0,"percent of total billed charges ","80% of total billed charges ",,,,,,,0,other,"not separately reimbursment ",1255.95,90,,1004.76,,,0,"percent of total billed charges ","90% of total billed charges ",1297.82,93,,1038.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1186.18,85,,948.94,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1255.95,90,,1004.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1214.09,87,,971.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",976.85,70,,781.48,,,0,"percent of total billed charges ","70% of total billed charges ",976.85,1297.82,
"ROOM & BOARD OBSTETRICS",14001,"CDM ",112,RC,,,INPATIENT,,,1535,1228,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1228,80,,982.40,,,0,"percent of total billed charges ","80% of total billed charges ",,,,,,,0,other,"not separately reimbursment ",1381.5,90,,1105.20,,,0,"percent of total billed charges ","90% of total billed charges ",1427.55,93,,1142.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1304.75,85,,1043.80,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1381.5,90,,1105.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1335.45,87,,1068.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1074.5,70,,859.60,,,0,"percent of total billed charges ","70% of total billed charges ",1074.5,1427.55,
"ROOM & BOARD ICU",15008,"CDM ",200,RC,,,INPATIENT,,,4566,3652.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3652.8,80,,2922.24,,,0,"percent of total billed charges ","80% of total billed charges ",,,,,,,0,other,"not separately reimbursment ",4109.4,90,,3287.52,,,0,"percent of total billed charges ","90% of total billed charges ",4246.38,93,,3397.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3881.1,85,,3104.88,,,0,"percent of total billed charges ","85% of total billed charges ",3582.85,,,,,,0,"per diem ","pays based on per day  rate ",4109.4,90,,3287.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3972.42,87,,3177.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3196.2,70,,2556.96,,,0,"percent of total billed charges ","70% of total billed charges ",3196.2,4246.38,
"ROOM & BOARD SNF",16006,"CDM ",110,RC,,,INPATIENT,,,821,656.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",656.8,80,,525.44,,,0,"percent of total billed charges ","80% of total billed charges ",,,,,,,0,other,"not separately reimbursment ",738.9,90,,591.12,,,0,"percent of total billed charges ","90% of total billed charges ",763.53,93,,610.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",697.85,85,,558.28,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",738.9,90,,591.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",714.27,87,,571.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",574.7,70,,459.76,,,0,"percent of total billed charges ","70% of total billed charges ",574.7,763.53,
"ROOM & BD MED OVERFLOW SNU PTS",16007,"CDM ",110,RC,,,INPATIENT,,,821,656.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",656.8,80,,525.44,,,0,"percent of total billed charges ","80% of total billed charges ",,,,,,,0,other,"not separately reimbursment ",738.9,90,,591.12,,,0,"percent of total billed charges ","90% of total billed charges ",763.53,93,,610.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",697.85,85,,558.28,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",738.9,90,,591.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",714.27,87,,571.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",574.7,70,,459.76,,,0,"percent of total billed charges ","70% of total billed charges ",574.7,763.53,
"ROOM & BOARD NURSERY LEVEL 1",17010,"CDM ",171,RC,,,INPATIENT,,,1750,1400,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1400,80,,1120.00,,,0,"percent of total billed charges ","80% of total billed charges ",,,,,,,0,other,"not separately reimbursment ",1575,90,,1260.00,,,0,"percent of total billed charges ","90% of total billed charges ",1627.5,93,,1302.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1487.5,85,,1190.00,,,0,"percent of total billed charges ","85% of total billed charges ",1037.23,,,,,,0,"per diem ","pays based on per day  rate ",1575,90,,1260.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1522.5,87,,1218.00,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1225,70,,980.00,,,0,"percent of total billed charges ","70% of total billed charges ",1037.23,1627.5,
"ROOM & BOARD NURSERY LEVEL 2",17020,"CDM ",172,RC,,,INPATIENT,,,2149.5,1719.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1719.6,80,,1375.68,,,0,"percent of total billed charges ","80% of total billed charges ",,,,,,,0,other,"not separately reimbursment ",1934.55,90,,1547.64,,,0,"percent of total billed charges ","90% of total billed charges ",1999.04,93,,1599.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1827.08,85,,1461.66,,,0,"percent of total billed charges ","85% of total billed charges ",3582.85,,,,,,0,"per diem ","pays based on per day  rate ",1934.55,90,,1547.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1870.07,87,,1496.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1504.65,70,,1203.72,,,0,"percent of total billed charges ","70% of total billed charges ",1504.65,3582.85,
"ROOM & BOARD NURSERY LEVEL 2A",17030,"CDM ",173,RC,,,INPATIENT,,,2696.5,2157.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2157.2,80,,1725.76,,,0,"percent of total billed charges ","80% of total billed charges ",,,,,,,0,other,"not separately reimbursment ",2426.85,90,,1941.48,,,0,"percent of total billed charges ","90% of total billed charges ",2507.75,93,,2006.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2292.03,85,,1833.62,,,0,"percent of total billed charges ","85% of total billed charges ",3582.85,,,,,,0,"per diem ","pays based on per day  rate ",2426.85,90,,1941.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2345.96,87,,1876.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1887.55,70,,1510.04,,,0,"percent of total billed charges ","70% of total billed charges ",1887.55,3582.85,
"ROOM & BOARD MED SUR PED PR",18000,"CDM ",111,RC,,,INPATIENT,,,1395.5,1116.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1116.4,80,,893.12,,,0,"percent of total billed charges ","80% of total billed charges ",,,,,,,0,other,"not separately reimbursment ",1255.95,90,,1004.76,,,0,"percent of total billed charges ","90% of total billed charges ",1297.82,93,,1038.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1186.18,85,,948.94,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1255.95,90,,1004.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1214.09,87,,971.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",976.85,70,,781.48,,,0,"percent of total billed charges ","70% of total billed charges ",976.85,1297.82,
"ROOM & BOARD TELE OB",34009,"CDM ",112,RC,,,INPATIENT,,,1969,1575.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1575.2,80,,1260.16,,,0,"percent of total billed charges ","80% of total billed charges ",,,,,,,0,other,"not separately reimbursment ",1772.1,90,,1417.68,,,0,"percent of total billed charges ","90% of total billed charges ",1831.17,93,,1464.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1673.65,85,,1338.92,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1772.1,90,,1417.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1713.03,87,,1370.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1378.3,70,,1102.64,,,0,"percent of total billed charges ","70% of total billed charges ",1378.3,1831.17,
"ROOM & BOARD TELE MED SURG PED",37000,"CDM ",111,RC,,,INPATIENT,,,1875.5,1500.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1500.4,80,,1200.32,,,0,"percent of total billed charges ","80% of total billed charges ",,,,,,,0,other,"not separately reimbursment ",1687.95,90,,1350.36,,,0,"percent of total billed charges ","90% of total billed charges ",1744.22,93,,1395.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1594.18,85,,1275.34,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1687.95,90,,1350.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1631.69,87,,1305.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1312.85,70,,1050.28,,,0,"percent of total billed charges ","70% of total billed charges ",1312.85,1744.22,
"ROOM & BOARD PEDS SPECIAL NURS",44000,"CDM ",113,RC,,,INPATIENT,,,2075,1660,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1660,80,,1328.00,,,0,"percent of total billed charges ","80% of total billed charges ",,,,,,,0,other,"not separately reimbursment ",1867.5,90,,1494.00,,,0,"percent of total billed charges ","90% of total billed charges ",1929.75,93,,1543.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1763.75,85,,1411.00,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1867.5,90,,1494.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1805.25,87,,1444.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1452.5,70,,1162.00,,,0,"percent of total billed charges ","70% of total billed charges ",1452.5,1929.75,
"ROOM & BOARD PEDS NURSERY",45000,"CDM ",113,RC,,,INPATIENT,,,1315,1052,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1052,80,,841.60,,,0,"percent of total billed charges ","80% of total billed charges ",,,,,,,0,other,"not separately reimbursment ",1183.5,90,,946.80,,,0,"percent of total billed charges ","90% of total billed charges ",1222.95,93,,978.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1117.75,85,,894.20,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1183.5,90,,946.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1144.05,87,,915.24,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",920.5,70,,736.40,,,0,"percent of total billed charges ","70% of total billed charges ",920.5,1222.95,
"ROOM & BOARD OB ISOLATION",50000,"CDM ",112,RC,,,INPATIENT,,,1862,1489.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1489.6,80,,1191.68,,,0,"percent of total billed charges ","80% of total billed charges ",,,,,,,0,other,"not separately reimbursment ",1675.8,90,,1340.64,,,0,"percent of total billed charges ","90% of total billed charges ",1731.66,93,,1385.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1582.7,85,,1266.16,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1675.8,90,,1340.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1619.94,87,,1295.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1303.4,70,,1042.72,,,0,"percent of total billed charges ","70% of total billed charges ",1303.4,1731.66,
"ROOM & BOARD ICU ISOLATION",51000,"CDM ",200,RC,,,INPATIENT,,,4859.5,3887.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3887.6,80,,3110.08,,,0,"percent of total billed charges ","80% of total billed charges ",,,,,,,0,other,"not separately reimbursment ",4373.55,90,,3498.84,,,0,"percent of total billed charges ","90% of total billed charges ",4519.34,93,,3615.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4130.58,85,,3304.46,,,0,"percent of total billed charges ","85% of total billed charges ",3582.85,,,,,,0,"per diem ","pays based on per day  rate ",4373.55,90,,3498.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4227.77,87,,3382.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3401.65,70,,2721.32,,,0,"percent of total billed charges ","70% of total billed charges ",3401.65,4519.34,
"ROOM & BOARD SNF ISOLATION",54000,"CDM ",110,RC,,,INPATIENT,,,1116.5,893.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",893.2,80,,714.56,,,0,"percent of total billed charges ","80% of total billed charges ",,,,,,,0,other,"not separately reimbursment ",1004.85,90,,803.88,,,0,"percent of total billed charges ","90% of total billed charges ",1038.35,93,,830.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",949.03,85,,759.22,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1004.85,90,,803.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",971.36,87,,777.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",781.55,70,,625.24,,,0,"percent of total billed charges ","70% of total billed charges ",781.55,1038.35,
"ROOM & BOARD ISO MED SUR PED",56000,"CDM ",111,RC,,,INPATIENT,,,1692.5,1354,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1354,80,,1083.20,,,0,"percent of total billed charges ","80% of total billed charges ",,,,,,,0,other,"not separately reimbursment ",1523.25,90,,1218.60,,,0,"percent of total billed charges ","90% of total billed charges ",1574.03,93,,1259.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1438.63,85,,1150.90,,,0,"percent of total billed charges ","85% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",1523.25,90,,1218.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1472.48,87,,1177.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1184.75,70,,947.80,,,0,"percent of total billed charges ","70% of total billed charges ",1184.75,1574.03,
"POST SDC CARE/1-6 HOURS",130021,"CDM ",710,RC,,,OUTPATIENT,,,349.5,279.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",279.6,80,,223.68,,,0,"percent of total billed charges ","80% of total billed charges ",244.65,70,,195.72,,,0,"percent of total billed charges ","70% of total billed charges ",314.55,90,,251.64,,,0,"percent of total billed charges ","90% of total billed charges ",325.04,93,,260.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",297.08,85,,237.66,,,0,"percent of total billed charges ","85% of total billed charges ",314.55,90,,251.64,,,0,"percent of total billed charges ","90% of total billed charges ",314.55,90,,251.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",304.07,87,,243.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",244.65,70,,195.72,,,0,"percent of total billed charges ","70% of total billed charges ",244.65,325.04,
NITROUS,1000777,"CDM ",250,RC,,,OUTPATIENT,,,71.5,57.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.2,80,,45.76,,,0,"percent of total billed charges ","80% of total billed charges ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",66.5,93,,53.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",60.78,85,,48.62,,,0,"percent of total billed charges ","85% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",64.35,90,,51.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",62.21,87,,49.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.05,70,,40.04,,,0,"percent of total billed charges ","70% of total billed charges ",50.05,66.5,
"MINOR PROCEDURE",1000892,"CDM ",360,RC,,,OUTPATIENT,,,2165,1732,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1732,80,,1385.60,,,0,"percent of total billed charges ","80% of total billed charges ",1515.5,70,,1212.40,,,0,"percent of total billed charges ","70% of total billed charges ",1948.5,90,,1558.80,,,0,"percent of total billed charges ","90% of total billed charges ",2013.45,93,,1610.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1840.25,85,,1472.20,,,0,"percent of total billed charges ","85% of total billed charges ",1948.5,90,,1558.80,,,0,"percent of total billed charges ","90% of total billed charges ",1948.5,90,,1558.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1883.55,87,,1506.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1515.5,70,,1212.40,,,0,"percent of total billed charges ","70% of total billed charges ",1515.5,2013.45,
"CYSTO FLUOROSCOPY",1000959,"CDM ",360,RC,,,OUTPATIENT,,,556,444.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",444.8,80,,355.84,,,0,"percent of total billed charges ","80% of total billed charges ",389.2,70,,311.36,,,0,"percent of total billed charges ","70% of total billed charges ",500.4,90,,400.32,,,0,"percent of total billed charges ","90% of total billed charges ",517.08,93,,413.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",472.6,85,,378.08,,,0,"percent of total billed charges ","85% of total billed charges ",500.4,90,,400.32,,,0,"percent of total billed charges ","90% of total billed charges ",500.4,90,,400.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",483.72,87,,386.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",389.2,70,,311.36,,,0,"percent of total billed charges ","70% of total billed charges ",389.2,517.08,
"AUGMENTATION PROCEDURE",1001007,"CDM ",360,RC,,,OUTPATIENT,,,3741.5,2993.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2993.2,80,,2394.56,,,0,"percent of total billed charges ","80% of total billed charges ",2619.05,70,,2095.24,,,0,"percent of total billed charges ","70% of total billed charges ",3367.35,90,,2693.88,,,0,"percent of total billed charges ","90% of total billed charges ",3479.6,93,,2783.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3180.28,85,,2544.22,,,0,"percent of total billed charges ","85% of total billed charges ",3367.35,90,,2693.88,,,0,"percent of total billed charges ","90% of total billed charges ",3367.35,90,,2693.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3255.11,87,,2604.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2619.05,70,,2095.24,,,0,"percent of total billed charges ","70% of total billed charges ",2619.05,3479.6,
"BRACHIOPLASTY PROCEDURE",1001008,"CDM ",360,RC,,,OUTPATIENT,,,3231.5,2585.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2585.2,80,,2068.16,,,0,"percent of total billed charges ","80% of total billed charges ",2262.05,70,,1809.64,,,0,"percent of total billed charges ","70% of total billed charges ",2908.35,90,,2326.68,,,0,"percent of total billed charges ","90% of total billed charges ",3005.3,93,,2404.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2746.78,85,,2197.42,,,0,"percent of total billed charges ","85% of total billed charges ",2908.35,90,,2326.68,,,0,"percent of total billed charges ","90% of total billed charges ",2908.35,90,,2326.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2811.41,87,,2249.13,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2262.05,70,,1809.64,,,0,"percent of total billed charges ","70% of total billed charges ",2262.05,3005.3,
"ABDOMINOPLASTY PROCEDURE",1001015,"CDM ",360,RC,,,OUTPATIENT,,,3741.5,2993.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2993.2,80,,2394.56,,,0,"percent of total billed charges ","80% of total billed charges ",2619.05,70,,2095.24,,,0,"percent of total billed charges ","70% of total billed charges ",3367.35,90,,2693.88,,,0,"percent of total billed charges ","90% of total billed charges ",3479.6,93,,2783.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3180.28,85,,2544.22,,,0,"percent of total billed charges ","85% of total billed charges ",3367.35,90,,2693.88,,,0,"percent of total billed charges ","90% of total billed charges ",3367.35,90,,2693.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3255.11,87,,2604.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2619.05,70,,2095.24,,,0,"percent of total billed charges ","70% of total billed charges ",2619.05,3479.6,
PANNICULECTOMY,1001017,"CDM ",360,RC,,,OUTPATIENT,,,3597.5,2878,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2878,80,,2302.40,,,0,"percent of total billed charges ","80% of total billed charges ",2518.25,70,,2014.60,,,0,"percent of total billed charges ","70% of total billed charges ",3237.75,90,,2590.20,,,0,"percent of total billed charges ","90% of total billed charges ",3345.68,93,,2676.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3057.88,85,,2446.30,,,0,"percent of total billed charges ","85% of total billed charges ",3237.75,90,,2590.20,,,0,"percent of total billed charges ","90% of total billed charges ",3237.75,90,,2590.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3129.83,87,,2503.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2518.25,70,,2014.60,,,0,"percent of total billed charges ","70% of total billed charges ",2518.25,3345.68,
"RHINOPLASTY PROCEDURE",1001023,"CDM ",360,RC,,,OUTPATIENT,,,3597.5,2878,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2878,80,,2302.40,,,0,"percent of total billed charges ","80% of total billed charges ",2518.25,70,,2014.60,,,0,"percent of total billed charges ","70% of total billed charges ",3237.75,90,,2590.20,,,0,"percent of total billed charges ","90% of total billed charges ",3345.68,93,,2676.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3057.88,85,,2446.30,,,0,"percent of total billed charges ","85% of total billed charges ",3237.75,90,,2590.20,,,0,"percent of total billed charges ","90% of total billed charges ",3237.75,90,,2590.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3129.83,87,,2503.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2518.25,70,,2014.60,,,0,"percent of total billed charges ","70% of total billed charges ",2518.25,3345.68,
"LIPOSUCTION PROCEDURE",1001031,"CDM ",360,RC,,,OUTPATIENT,,,3597.5,2878,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2878,80,,2302.40,,,0,"percent of total billed charges ","80% of total billed charges ",2518.25,70,,2014.60,,,0,"percent of total billed charges ","70% of total billed charges ",3237.75,90,,2590.20,,,0,"percent of total billed charges ","90% of total billed charges ",3345.68,93,,2676.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3057.88,85,,2446.30,,,0,"percent of total billed charges ","85% of total billed charges ",3237.75,90,,2590.20,,,0,"percent of total billed charges ","90% of total billed charges ",3237.75,90,,2590.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3129.83,87,,2503.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2518.25,70,,2014.60,,,0,"percent of total billed charges ","70% of total billed charges ",2518.25,3345.68,
MASTOPEXY,1001049,"CDM ",360,RC,,,OUTPATIENT,,,3597.5,2878,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2878,80,,2302.40,,,0,"percent of total billed charges ","80% of total billed charges ",2518.25,70,,2014.60,,,0,"percent of total billed charges ","70% of total billed charges ",3237.75,90,,2590.20,,,0,"percent of total billed charges ","90% of total billed charges ",3345.68,93,,2676.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3057.88,85,,2446.30,,,0,"percent of total billed charges ","85% of total billed charges ",3237.75,90,,2590.20,,,0,"percent of total billed charges ","90% of total billed charges ",3237.75,90,,2590.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3129.83,87,,2503.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2518.25,70,,2014.60,,,0,"percent of total billed charges ","70% of total billed charges ",2518.25,3345.68,
"REDUCTION (NONINCLUSIVE)",1001056,"CDM ",360,RC,,,OUTPATIENT,,,3597.5,2878,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2878,80,,2302.40,,,0,"percent of total billed charges ","80% of total billed charges ",2518.25,70,,2014.60,,,0,"percent of total billed charges ","70% of total billed charges ",3237.75,90,,2590.20,,,0,"percent of total billed charges ","90% of total billed charges ",3345.68,93,,2676.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3057.88,85,,2446.30,,,0,"percent of total billed charges ","85% of total billed charges ",3237.75,90,,2590.20,,,0,"percent of total billed charges ","90% of total billed charges ",3237.75,90,,2590.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3129.83,87,,2503.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2518.25,70,,2014.60,,,0,"percent of total billed charges ","70% of total billed charges ",2518.25,3345.68,
"BREAST IMPLANT REMOVAL",1001058,"CDM ",360,RC,,,OUTPATIENT,,,3597.5,2878,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2878,80,,2302.40,,,0,"percent of total billed charges ","80% of total billed charges ",2518.25,70,,2014.60,,,0,"percent of total billed charges ","70% of total billed charges ",3237.75,90,,2590.20,,,0,"percent of total billed charges ","90% of total billed charges ",3345.68,93,,2676.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3057.88,85,,2446.30,,,0,"percent of total billed charges ","85% of total billed charges ",3237.75,90,,2590.20,,,0,"percent of total billed charges ","90% of total billed charges ",3237.75,90,,2590.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3129.83,87,,2503.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2518.25,70,,2014.60,,,0,"percent of total billed charges ","70% of total billed charges ",2518.25,3345.68,
"MASTOPEXY & ABDOMINOPLASTY",1001064,"CDM ",360,RC,,,OUTPATIENT,,,5395,4316,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4316,80,,3452.80,,,0,"percent of total billed charges ","80% of total billed charges ",3776.5,70,,3021.20,,,0,"percent of total billed charges ","70% of total billed charges ",4855.5,90,,3884.40,,,0,"percent of total billed charges ","90% of total billed charges ",5017.35,93,,4013.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4585.75,85,,3668.60,,,0,"percent of total billed charges ","85% of total billed charges ",4855.5,90,,3884.40,,,0,"percent of total billed charges ","90% of total billed charges ",4855.5,90,,3884.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4693.65,87,,3754.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3776.5,70,,3021.20,,,0,"percent of total billed charges ","70% of total billed charges ",3776.5,5017.35,
BLEPHAROPLASTY,1001070,"CDM ",360,RC,,,OUTPATIENT,,,3597.5,2878,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2878,80,,2302.40,,,0,"percent of total billed charges ","80% of total billed charges ",2518.25,70,,2014.60,,,0,"percent of total billed charges ","70% of total billed charges ",3237.75,90,,2590.20,,,0,"percent of total billed charges ","90% of total billed charges ",3345.68,93,,2676.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3057.88,85,,2446.30,,,0,"percent of total billed charges ","85% of total billed charges ",3237.75,90,,2590.20,,,0,"percent of total billed charges ","90% of total billed charges ",3237.75,90,,2590.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3129.83,87,,2503.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2518.25,70,,2014.60,,,0,"percent of total billed charges ","70% of total billed charges ",2518.25,3345.68,
"FACE LIFT",1001072,"CDM ",360,RC,,,OUTPATIENT,,,6294.5,5035.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5035.6,80,,4028.48,,,0,"percent of total billed charges ","80% of total billed charges ",4406.15,70,,3524.92,,,0,"percent of total billed charges ","70% of total billed charges ",5665.05,90,,4532.04,,,0,"percent of total billed charges ","90% of total billed charges ",5853.89,93,,4683.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5350.33,85,,4280.26,,,0,"percent of total billed charges ","85% of total billed charges ",5665.05,90,,4532.04,,,0,"percent of total billed charges ","90% of total billed charges ",5665.05,90,,4532.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5476.22,87,,4380.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4406.15,70,,3524.92,,,0,"percent of total billed charges ","70% of total billed charges ",4406.15,5853.89,
"FOREHEAD LIFT",1001074,"CDM ",360,RC,,,OUTPATIENT,,,3597.5,2878,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2878,80,,2302.40,,,0,"percent of total billed charges ","80% of total billed charges ",2518.25,70,,2014.60,,,0,"percent of total billed charges ","70% of total billed charges ",3237.75,90,,2590.20,,,0,"percent of total billed charges ","90% of total billed charges ",3345.68,93,,2676.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3057.88,85,,2446.30,,,0,"percent of total billed charges ","85% of total billed charges ",3237.75,90,,2590.20,,,0,"percent of total billed charges ","90% of total billed charges ",3237.75,90,,2590.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3129.83,87,,2503.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2518.25,70,,2014.60,,,0,"percent of total billed charges ","70% of total billed charges ",2518.25,3345.68,
"AUGMENTATION WITH MASTOPEXY",1001080,"CDM ",360,RC,,,OUTPATIENT,,,6294.5,5035.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5035.6,80,,4028.48,,,0,"percent of total billed charges ","80% of total billed charges ",4406.15,70,,3524.92,,,0,"percent of total billed charges ","70% of total billed charges ",5665.05,90,,4532.04,,,0,"percent of total billed charges ","90% of total billed charges ",5853.89,93,,4683.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5350.33,85,,4280.26,,,0,"percent of total billed charges ","85% of total billed charges ",5665.05,90,,4532.04,,,0,"percent of total billed charges ","90% of total billed charges ",5665.05,90,,4532.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5476.22,87,,4380.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4406.15,70,,3524.92,,,0,"percent of total billed charges ","70% of total billed charges ",4406.15,5853.89,
"BILATERAL GLUTEAL LIFT",1001081,"CDM ",360,RC,,,OUTPATIENT,,,3759.5,3007.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3007.6,80,,2406.08,,,0,"percent of total billed charges ","80% of total billed charges ",2631.65,70,,2105.32,,,0,"percent of total billed charges ","70% of total billed charges ",3383.55,90,,2706.84,,,0,"percent of total billed charges ","90% of total billed charges ",3496.34,93,,2797.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3195.58,85,,2556.46,,,0,"percent of total billed charges ","85% of total billed charges ",3383.55,90,,2706.84,,,0,"percent of total billed charges ","90% of total billed charges ",3383.55,90,,2706.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3270.77,87,,2616.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2631.65,70,,2105.32,,,0,"percent of total billed charges ","70% of total billed charges ",2631.65,3496.34,
"CARDIOVASCULAR SURG L1 1ST 15M",1003300,"CDM ",360,RC,,,OUTPATIENT,,,1924,1539.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1539.2,80,,1231.36,,,0,"percent of total billed charges ","80% of total billed charges ",1346.8,70,,1077.44,,,0,"percent of total billed charges ","70% of total billed charges ",1731.6,90,,1385.28,,,0,"percent of total billed charges ","90% of total billed charges ",1789.32,93,,1431.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1635.4,85,,1308.32,,,0,"percent of total billed charges ","85% of total billed charges ",1731.6,90,,1385.28,,,0,"percent of total billed charges ","90% of total billed charges ",1731.6,90,,1385.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1673.88,87,,1339.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1346.8,70,,1077.44,,,0,"percent of total billed charges ","70% of total billed charges ",1346.8,1789.32,
"CARDIOVASCULAR SURG L1 SUB 15M",1003305,"CDM ",360,RC,,,OUTPATIENT,,,961.5,769.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",769.2,80,,615.36,,,0,"percent of total billed charges ","80% of total billed charges ",673.05,70,,538.44,,,0,"percent of total billed charges ","70% of total billed charges ",865.35,90,,692.28,,,0,"percent of total billed charges ","90% of total billed charges ",894.2,93,,715.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",817.28,85,,653.82,,,0,"percent of total billed charges ","85% of total billed charges ",865.35,90,,692.28,,,0,"percent of total billed charges ","90% of total billed charges ",865.35,90,,692.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",836.51,87,,669.21,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",673.05,70,,538.44,,,0,"percent of total billed charges ","70% of total billed charges ",673.05,894.2,
"CARDIOVASCULAR SURG L2 1ST 15M",1003310,"CDM ",360,RC,,,OUTPATIENT,,,2404.5,1923.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1923.6,80,,1538.88,,,0,"percent of total billed charges ","80% of total billed charges ",1683.15,70,,1346.52,,,0,"percent of total billed charges ","70% of total billed charges ",2164.05,90,,1731.24,,,0,"percent of total billed charges ","90% of total billed charges ",2236.19,93,,1788.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2043.83,85,,1635.06,,,0,"percent of total billed charges ","85% of total billed charges ",2164.05,90,,1731.24,,,0,"percent of total billed charges ","90% of total billed charges ",2164.05,90,,1731.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2091.92,87,,1673.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1683.15,70,,1346.52,,,0,"percent of total billed charges ","70% of total billed charges ",1683.15,2236.19,
"CARDIOVASCULAR SURG L2 SUB 15M",1003315,"CDM ",360,RC,,,OUTPATIENT,,,1202.5,962,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",962,80,,769.60,,,0,"percent of total billed charges ","80% of total billed charges ",841.75,70,,673.40,,,0,"percent of total billed charges ","70% of total billed charges ",1082.25,90,,865.80,,,0,"percent of total billed charges ","90% of total billed charges ",1118.33,93,,894.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1022.13,85,,817.70,,,0,"percent of total billed charges ","85% of total billed charges ",1082.25,90,,865.80,,,0,"percent of total billed charges ","90% of total billed charges ",1082.25,90,,865.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1046.18,87,,836.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",841.75,70,,673.40,,,0,"percent of total billed charges ","70% of total billed charges ",841.75,1118.33,
"CARDIOVASCULAR SURG L3 1ST 15M",1003320,"CDM ",360,RC,,,OUTPATIENT,,,3004,2403.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2403.2,80,,1922.56,,,0,"percent of total billed charges ","80% of total billed charges ",2102.8,70,,1682.24,,,0,"percent of total billed charges ","70% of total billed charges ",2703.6,90,,2162.88,,,0,"percent of total billed charges ","90% of total billed charges ",2793.72,93,,2234.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2553.4,85,,2042.72,,,0,"percent of total billed charges ","85% of total billed charges ",2703.6,90,,2162.88,,,0,"percent of total billed charges ","90% of total billed charges ",2703.6,90,,2162.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2613.48,87,,2090.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2102.8,70,,1682.24,,,0,"percent of total billed charges ","70% of total billed charges ",2102.8,2793.72,
"CARDIOVASCULAR SURG L3 SUB 15M",1003325,"CDM ",360,RC,,,OUTPATIENT,,,1679.5,1343.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1343.6,80,,1074.88,,,0,"percent of total billed charges ","80% of total billed charges ",1175.65,70,,940.52,,,0,"percent of total billed charges ","70% of total billed charges ",1511.55,90,,1209.24,,,0,"percent of total billed charges ","90% of total billed charges ",1561.94,93,,1249.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1427.58,85,,1142.06,,,0,"percent of total billed charges ","85% of total billed charges ",1511.55,90,,1209.24,,,0,"percent of total billed charges ","90% of total billed charges ",1511.55,90,,1209.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1461.17,87,,1168.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1175.65,70,,940.52,,,0,"percent of total billed charges ","70% of total billed charges ",1175.65,1561.94,
"CARDIOVASCULAR SURG L4 1ST 15M",1003330,"CDM ",360,RC,,,OUTPATIENT,,,3754.5,3003.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3003.6,80,,2402.88,,,0,"percent of total billed charges ","80% of total billed charges ",2628.15,70,,2102.52,,,0,"percent of total billed charges ","70% of total billed charges ",3379.05,90,,2703.24,,,0,"percent of total billed charges ","90% of total billed charges ",3491.69,93,,2793.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3191.33,85,,2553.06,,,0,"percent of total billed charges ","85% of total billed charges ",3379.05,90,,2703.24,,,0,"percent of total billed charges ","90% of total billed charges ",3379.05,90,,2703.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3266.42,87,,2613.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2628.15,70,,2102.52,,,0,"percent of total billed charges ","70% of total billed charges ",2628.15,3491.69,
"CARDIOVASCULAR SURG L4 SUB 15M",1003335,"CDM ",360,RC,,,OUTPATIENT,,,1877.5,1502,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1502,80,,1201.60,,,0,"percent of total billed charges ","80% of total billed charges ",1314.25,70,,1051.40,,,0,"percent of total billed charges ","70% of total billed charges ",1689.75,90,,1351.80,,,0,"percent of total billed charges ","90% of total billed charges ",1746.08,93,,1396.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1595.88,85,,1276.70,,,0,"percent of total billed charges ","85% of total billed charges ",1689.75,90,,1351.80,,,0,"percent of total billed charges ","90% of total billed charges ",1689.75,90,,1351.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1633.43,87,,1306.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1314.25,70,,1051.40,,,0,"percent of total billed charges ","70% of total billed charges ",1314.25,1746.08,
"CARDIOVASCULAR SURG L5 1ST 15M",1003340,"CDM ",360,RC,,,OUTPATIENT,,,4692.5,3754,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3754,80,,3003.20,,,0,"percent of total billed charges ","80% of total billed charges ",3284.75,70,,2627.80,,,0,"percent of total billed charges ","70% of total billed charges ",4223.25,90,,3378.60,,,0,"percent of total billed charges ","90% of total billed charges ",4364.03,93,,3491.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3988.63,85,,3190.90,,,0,"percent of total billed charges ","85% of total billed charges ",4223.25,90,,3378.60,,,0,"percent of total billed charges ","90% of total billed charges ",4223.25,90,,3378.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4082.48,87,,3265.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3284.75,70,,2627.80,,,0,"percent of total billed charges ","70% of total billed charges ",3284.75,4364.03,
"CARDIOVASCULAR SURG L5 SUB 15M",1003345,"CDM ",360,RC,,,OUTPATIENT,,,2346,1876.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1876.8,80,,1501.44,,,0,"percent of total billed charges ","80% of total billed charges ",1642.2,70,,1313.76,,,0,"percent of total billed charges ","70% of total billed charges ",2111.4,90,,1689.12,,,0,"percent of total billed charges ","90% of total billed charges ",2181.78,93,,1745.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1994.1,85,,1595.28,,,0,"percent of total billed charges ","85% of total billed charges ",2111.4,90,,1689.12,,,0,"percent of total billed charges ","90% of total billed charges ",2111.4,90,,1689.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2041.02,87,,1632.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1642.2,70,,1313.76,,,0,"percent of total billed charges ","70% of total billed charges ",1642.2,2181.78,
"ENT SURGERY L1 1ST 15 MIN",1003350,"CDM ",360,RC,,,OUTPATIENT,,,2634.5,2107.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2107.6,80,,1686.08,,,0,"percent of total billed charges ","80% of total billed charges ",1844.15,70,,1475.32,,,0,"percent of total billed charges ","70% of total billed charges ",2371.05,90,,1896.84,,,0,"percent of total billed charges ","90% of total billed charges ",2450.09,93,,1960.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2239.33,85,,1791.46,,,0,"percent of total billed charges ","85% of total billed charges ",2371.05,90,,1896.84,,,0,"percent of total billed charges ","90% of total billed charges ",2371.05,90,,1896.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2292.02,87,,1833.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1844.15,70,,1475.32,,,0,"percent of total billed charges ","70% of total billed charges ",1844.15,2450.09,
"ENT SURGERY L1 SUB 15 MIN",1003355,"CDM ",360,RC,,,OUTPATIENT,,,1316,1052.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1052.8,80,,842.24,,,0,"percent of total billed charges ","80% of total billed charges ",921.2,70,,736.96,,,0,"percent of total billed charges ","70% of total billed charges ",1184.4,90,,947.52,,,0,"percent of total billed charges ","90% of total billed charges ",1223.88,93,,979.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1118.6,85,,894.88,,,0,"percent of total billed charges ","85% of total billed charges ",1184.4,90,,947.52,,,0,"percent of total billed charges ","90% of total billed charges ",1184.4,90,,947.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1144.92,87,,915.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",921.2,70,,736.96,,,0,"percent of total billed charges ","70% of total billed charges ",921.2,1223.88,
"ENT SURGERY L2 1ST 15 MIN",1003360,"CDM ",360,RC,,,OUTPATIENT,,,3290,2632,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2632,80,,2105.60,,,0,"percent of total billed charges ","80% of total billed charges ",2303,70,,1842.40,,,0,"percent of total billed charges ","70% of total billed charges ",2961,90,,2368.80,,,0,"percent of total billed charges ","90% of total billed charges ",3059.7,93,,2447.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2796.5,85,,2237.20,,,0,"percent of total billed charges ","85% of total billed charges ",2961,90,,2368.80,,,0,"percent of total billed charges ","90% of total billed charges ",2961,90,,2368.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2862.3,87,,2289.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2303,70,,1842.40,,,0,"percent of total billed charges ","70% of total billed charges ",2303,3059.7,
"ENT SURGERY L2 SUB 15 MIN",1003365,"CDM ",360,RC,,,OUTPATIENT,,,1645.5,1316.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1316.4,80,,1053.12,,,0,"percent of total billed charges ","80% of total billed charges ",1151.85,70,,921.48,,,0,"percent of total billed charges ","70% of total billed charges ",1480.95,90,,1184.76,,,0,"percent of total billed charges ","90% of total billed charges ",1530.32,93,,1224.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1398.68,85,,1118.94,,,0,"percent of total billed charges ","85% of total billed charges ",1480.95,90,,1184.76,,,0,"percent of total billed charges ","90% of total billed charges ",1480.95,90,,1184.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1431.59,87,,1145.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1151.85,70,,921.48,,,0,"percent of total billed charges ","70% of total billed charges ",1151.85,1530.32,
"ENT SURGERY L3 1ST 15 MIN",1003370,"CDM ",360,RC,,,OUTPATIENT,,,4111.5,3289.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3289.2,80,,2631.36,,,0,"percent of total billed charges ","80% of total billed charges ",2878.05,70,,2302.44,,,0,"percent of total billed charges ","70% of total billed charges ",3700.35,90,,2960.28,,,0,"percent of total billed charges ","90% of total billed charges ",3823.7,93,,3058.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3494.78,85,,2795.82,,,0,"percent of total billed charges ","85% of total billed charges ",3700.35,90,,2960.28,,,0,"percent of total billed charges ","90% of total billed charges ",3700.35,90,,2960.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3577.01,87,,2861.61,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2878.05,70,,2302.44,,,0,"percent of total billed charges ","70% of total billed charges ",2878.05,3823.7,
"ENT SURGERY L3 SUB 15 MIN",1003375,"CDM ",360,RC,,,OUTPATIENT,,,2056,1644.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1644.8,80,,1315.84,,,0,"percent of total billed charges ","80% of total billed charges ",1439.2,70,,1151.36,,,0,"percent of total billed charges ","70% of total billed charges ",1850.4,90,,1480.32,,,0,"percent of total billed charges ","90% of total billed charges ",1912.08,93,,1529.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1747.6,85,,1398.08,,,0,"percent of total billed charges ","85% of total billed charges ",1850.4,90,,1480.32,,,0,"percent of total billed charges ","90% of total billed charges ",1850.4,90,,1480.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1788.72,87,,1430.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1439.2,70,,1151.36,,,0,"percent of total billed charges ","70% of total billed charges ",1439.2,1912.08,
"ENT SURGERY L4 1ST 15 MIN",1003380,"CDM ",360,RC,,,OUTPATIENT,,,5138,4110.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4110.4,80,,3288.32,,,0,"percent of total billed charges ","80% of total billed charges ",3596.6,70,,2877.28,,,0,"percent of total billed charges ","70% of total billed charges ",4624.2,90,,3699.36,,,0,"percent of total billed charges ","90% of total billed charges ",4778.34,93,,3822.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4367.3,85,,3493.84,,,0,"percent of total billed charges ","85% of total billed charges ",4624.2,90,,3699.36,,,0,"percent of total billed charges ","90% of total billed charges ",4624.2,90,,3699.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4470.06,87,,3576.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3596.6,70,,2877.28,,,0,"percent of total billed charges ","70% of total billed charges ",3596.6,4778.34,
"ENT SURGERY L4 SUB 15 MIN",1003385,"CDM ",360,RC,,,OUTPATIENT,,,2568.5,2054.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2054.8,80,,1643.84,,,0,"percent of total billed charges ","80% of total billed charges ",1797.95,70,,1438.36,,,0,"percent of total billed charges ","70% of total billed charges ",2311.65,90,,1849.32,,,0,"percent of total billed charges ","90% of total billed charges ",2388.71,93,,1910.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2183.23,85,,1746.58,,,0,"percent of total billed charges ","85% of total billed charges ",2311.65,90,,1849.32,,,0,"percent of total billed charges ","90% of total billed charges ",2311.65,90,,1849.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2234.6,87,,1787.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1797.95,70,,1438.36,,,0,"percent of total billed charges ","70% of total billed charges ",1797.95,2388.71,
"ENT SURGERY L5 1ST 15 MIN",1003390,"CDM ",360,RC,,,OUTPATIENT,,,6422,5137.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5137.6,80,,4110.08,,,0,"percent of total billed charges ","80% of total billed charges ",4495.4,70,,3596.32,,,0,"percent of total billed charges ","70% of total billed charges ",5779.8,90,,4623.84,,,0,"percent of total billed charges ","90% of total billed charges ",5972.46,93,,4777.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5458.7,85,,4366.96,,,0,"percent of total billed charges ","85% of total billed charges ",5779.8,90,,4623.84,,,0,"percent of total billed charges ","90% of total billed charges ",5779.8,90,,4623.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5587.14,87,,4469.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4495.4,70,,3596.32,,,0,"percent of total billed charges ","70% of total billed charges ",4495.4,5972.46,
"ENT SURGERY L5 SUB 15 MIN",1003395,"CDM ",360,RC,,,OUTPATIENT,,,3211.5,2569.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2569.2,80,,2055.36,,,0,"percent of total billed charges ","80% of total billed charges ",2248.05,70,,1798.44,,,0,"percent of total billed charges ","70% of total billed charges ",2890.35,90,,2312.28,,,0,"percent of total billed charges ","90% of total billed charges ",2986.7,93,,2389.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2729.78,85,,2183.82,,,0,"percent of total billed charges ","85% of total billed charges ",2890.35,90,,2312.28,,,0,"percent of total billed charges ","90% of total billed charges ",2890.35,90,,2312.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2794.01,87,,2235.21,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2248.05,70,,1798.44,,,0,"percent of total billed charges ","70% of total billed charges ",2248.05,2986.7,
"GENERAL SURGERY L1 1ST 15 MIN",1003400,"CDM ",360,RC,,,OUTPATIENT,,,2855,2284,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2284,80,,1827.20,,,0,"percent of total billed charges ","80% of total billed charges ",1998.5,70,,1598.80,,,0,"percent of total billed charges ","70% of total billed charges ",2569.5,90,,2055.60,,,0,"percent of total billed charges ","90% of total billed charges ",2655.15,93,,2124.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2426.75,85,,1941.40,,,0,"percent of total billed charges ","85% of total billed charges ",2569.5,90,,2055.60,,,0,"percent of total billed charges ","90% of total billed charges ",2569.5,90,,2055.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2483.85,87,,1987.08,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1998.5,70,,1598.80,,,0,"percent of total billed charges ","70% of total billed charges ",1998.5,2655.15,
"GENERAL SURGERY L1 SUB 15 MIN",1003405,"CDM ",360,RC,,,OUTPATIENT,,,1428,1142.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1142.4,80,,913.92,,,0,"percent of total billed charges ","80% of total billed charges ",999.6,70,,799.68,,,0,"percent of total billed charges ","70% of total billed charges ",1285.2,90,,1028.16,,,0,"percent of total billed charges ","90% of total billed charges ",1328.04,93,,1062.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1213.8,85,,971.04,,,0,"percent of total billed charges ","85% of total billed charges ",1285.2,90,,1028.16,,,0,"percent of total billed charges ","90% of total billed charges ",1285.2,90,,1028.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1242.36,87,,993.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",999.6,70,,799.68,,,0,"percent of total billed charges ","70% of total billed charges ",999.6,1328.04,
"GENERAL SURGERY L2 1ST 15 MIN",1003410,"CDM ",360,RC,,,OUTPATIENT,,,3568.5,2854.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2854.8,80,,2283.84,,,0,"percent of total billed charges ","80% of total billed charges ",2497.95,70,,1998.36,,,0,"percent of total billed charges ","70% of total billed charges ",3211.65,90,,2569.32,,,0,"percent of total billed charges ","90% of total billed charges ",3318.71,93,,2654.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3033.23,85,,2426.58,,,0,"percent of total billed charges ","85% of total billed charges ",3211.65,90,,2569.32,,,0,"percent of total billed charges ","90% of total billed charges ",3211.65,90,,2569.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3104.6,87,,2483.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2497.95,70,,1998.36,,,0,"percent of total billed charges ","70% of total billed charges ",2497.95,3318.71,
"GENERAL SURGERY L2 SUB 15 MIN",1003415,"CDM ",360,RC,,,OUTPATIENT,,,1784.5,1427.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1427.6,80,,1142.08,,,0,"percent of total billed charges ","80% of total billed charges ",1249.15,70,,999.32,,,0,"percent of total billed charges ","70% of total billed charges ",1606.05,90,,1284.84,,,0,"percent of total billed charges ","90% of total billed charges ",1659.59,93,,1327.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1516.83,85,,1213.46,,,0,"percent of total billed charges ","85% of total billed charges ",1606.05,90,,1284.84,,,0,"percent of total billed charges ","90% of total billed charges ",1606.05,90,,1284.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1552.52,87,,1242.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1249.15,70,,999.32,,,0,"percent of total billed charges ","70% of total billed charges ",1249.15,1659.59,
"GENERAL SURGERY L3 1ST 15 MIN",1003420,"CDM ",360,RC,,,OUTPATIENT,,,4461,3568.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3568.8,80,,2855.04,,,0,"percent of total billed charges ","80% of total billed charges ",3122.7,70,,2498.16,,,0,"percent of total billed charges ","70% of total billed charges ",4014.9,90,,3211.92,,,0,"percent of total billed charges ","90% of total billed charges ",4148.73,93,,3318.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3791.85,85,,3033.48,,,0,"percent of total billed charges ","85% of total billed charges ",4014.9,90,,3211.92,,,0,"percent of total billed charges ","90% of total billed charges ",4014.9,90,,3211.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3881.07,87,,3104.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3122.7,70,,2498.16,,,0,"percent of total billed charges ","70% of total billed charges ",3122.7,4148.73,
"GENERAL SURGERY L3 SUB 15 MIN",1003425,"CDM ",360,RC,,,OUTPATIENT,,,2229.5,1783.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1783.6,80,,1426.88,,,0,"percent of total billed charges ","80% of total billed charges ",1560.65,70,,1248.52,,,0,"percent of total billed charges ","70% of total billed charges ",2006.55,90,,1605.24,,,0,"percent of total billed charges ","90% of total billed charges ",2073.44,93,,1658.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1895.08,85,,1516.06,,,0,"percent of total billed charges ","85% of total billed charges ",2006.55,90,,1605.24,,,0,"percent of total billed charges ","90% of total billed charges ",2006.55,90,,1605.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1939.67,87,,1551.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1560.65,70,,1248.52,,,0,"percent of total billed charges ","70% of total billed charges ",1560.65,2073.44,
"GENERAL SURGERY L4 1ST 15 MIN",1003430,"CDM ",360,RC,,,OUTPATIENT,,,5575.5,4460.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4460.4,80,,3568.32,,,0,"percent of total billed charges ","80% of total billed charges ",3902.85,70,,3122.28,,,0,"percent of total billed charges ","70% of total billed charges ",5017.95,90,,4014.36,,,0,"percent of total billed charges ","90% of total billed charges ",5185.22,93,,4148.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4739.18,85,,3791.34,,,0,"percent of total billed charges ","85% of total billed charges ",5017.95,90,,4014.36,,,0,"percent of total billed charges ","90% of total billed charges ",5017.95,90,,4014.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4850.69,87,,3880.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3902.85,70,,3122.28,,,0,"percent of total billed charges ","70% of total billed charges ",3902.85,5185.22,
"GENERAL SURGERY L4 SUB 15 MIN",1003435,"CDM ",360,RC,,,OUTPATIENT,,,2788.5,2230.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2230.8,80,,1784.64,,,0,"percent of total billed charges ","80% of total billed charges ",1951.95,70,,1561.56,,,0,"percent of total billed charges ","70% of total billed charges ",2509.65,90,,2007.72,,,0,"percent of total billed charges ","90% of total billed charges ",2593.31,93,,2074.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2370.23,85,,1896.18,,,0,"percent of total billed charges ","85% of total billed charges ",2509.65,90,,2007.72,,,0,"percent of total billed charges ","90% of total billed charges ",2509.65,90,,2007.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2426,87,,1940.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1951.95,70,,1561.56,,,0,"percent of total billed charges ","70% of total billed charges ",1951.95,2593.31,
"GENERAL SURGERY L5 1ST 15 MIN",1003440,"CDM ",360,RC,,,OUTPATIENT,,,6969.5,5575.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5575.6,80,,4460.48,,,0,"percent of total billed charges ","80% of total billed charges ",4878.65,70,,3902.92,,,0,"percent of total billed charges ","70% of total billed charges ",6272.55,90,,5018.04,,,0,"percent of total billed charges ","90% of total billed charges ",6481.64,93,,5185.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5924.08,85,,4739.26,,,0,"percent of total billed charges ","85% of total billed charges ",6272.55,90,,5018.04,,,0,"percent of total billed charges ","90% of total billed charges ",6272.55,90,,5018.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6063.47,87,,4850.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4878.65,70,,3902.92,,,0,"percent of total billed charges ","70% of total billed charges ",4878.65,6481.64,
"GENERAL SURGERY L5 SUB 15 MIN",1003445,"CDM ",360,RC,,,OUTPATIENT,,,3484,2787.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2787.2,80,,2229.76,,,0,"percent of total billed charges ","80% of total billed charges ",2438.8,70,,1951.04,,,0,"percent of total billed charges ","70% of total billed charges ",3135.6,90,,2508.48,,,0,"percent of total billed charges ","90% of total billed charges ",3240.12,93,,2592.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2961.4,85,,2369.12,,,0,"percent of total billed charges ","85% of total billed charges ",3135.6,90,,2508.48,,,0,"percent of total billed charges ","90% of total billed charges ",3135.6,90,,2508.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3031.08,87,,2424.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2438.8,70,,1951.04,,,0,"percent of total billed charges ","70% of total billed charges ",2438.8,3240.12,
"GYNECOLOGY SURG L1 1ST 15 MIN",1003450,"CDM ",360,RC,,,OUTPATIENT,,,2438,1950.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1950.4,80,,1560.32,,,0,"percent of total billed charges ","80% of total billed charges ",1706.6,70,,1365.28,,,0,"percent of total billed charges ","70% of total billed charges ",2194.2,90,,1755.36,,,0,"percent of total billed charges ","90% of total billed charges ",2267.34,93,,1813.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2072.3,85,,1657.84,,,0,"percent of total billed charges ","85% of total billed charges ",2194.2,90,,1755.36,,,0,"percent of total billed charges ","90% of total billed charges ",2194.2,90,,1755.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2121.06,87,,1696.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1706.6,70,,1365.28,,,0,"percent of total billed charges ","70% of total billed charges ",1706.6,2267.34,
"GYNECOLOGY SURG L1 SUB 15 MIN",1003455,"CDM ",360,RC,,,OUTPATIENT,,,1219,975.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",975.2,80,,780.16,,,0,"percent of total billed charges ","80% of total billed charges ",853.3,70,,682.64,,,0,"percent of total billed charges ","70% of total billed charges ",1097.1,90,,877.68,,,0,"percent of total billed charges ","90% of total billed charges ",1133.67,93,,906.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1036.15,85,,828.92,,,0,"percent of total billed charges ","85% of total billed charges ",1097.1,90,,877.68,,,0,"percent of total billed charges ","90% of total billed charges ",1097.1,90,,877.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1060.53,87,,848.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",853.3,70,,682.64,,,0,"percent of total billed charges ","70% of total billed charges ",853.3,1133.67,
"GYNECOLOGY SURG L2 1ST 15 MIN",1003460,"CDM ",360,RC,,,OUTPATIENT,,,3048.5,2438.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2438.8,80,,1951.04,,,0,"percent of total billed charges ","80% of total billed charges ",2133.95,70,,1707.16,,,0,"percent of total billed charges ","70% of total billed charges ",2743.65,90,,2194.92,,,0,"percent of total billed charges ","90% of total billed charges ",2835.11,93,,2268.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2591.23,85,,2072.98,,,0,"percent of total billed charges ","85% of total billed charges ",2743.65,90,,2194.92,,,0,"percent of total billed charges ","90% of total billed charges ",2743.65,90,,2194.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2652.2,87,,2121.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2133.95,70,,1707.16,,,0,"percent of total billed charges ","70% of total billed charges ",2133.95,2835.11,
"GYNECOLOGY SURG L2 SUB 15 MIN",1003465,"CDM ",360,RC,,,OUTPATIENT,,,1524.5,1219.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1219.6,80,,975.68,,,0,"percent of total billed charges ","80% of total billed charges ",1067.15,70,,853.72,,,0,"percent of total billed charges ","70% of total billed charges ",1372.05,90,,1097.64,,,0,"percent of total billed charges ","90% of total billed charges ",1417.79,93,,1134.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1295.83,85,,1036.66,,,0,"percent of total billed charges ","85% of total billed charges ",1372.05,90,,1097.64,,,0,"percent of total billed charges ","90% of total billed charges ",1372.05,90,,1097.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1326.32,87,,1061.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1067.15,70,,853.72,,,0,"percent of total billed charges ","70% of total billed charges ",1067.15,1417.79,
"GYNECOLOGY SURG L3 1ST 15 MIN",1003470,"CDM ",360,RC,,,OUTPATIENT,,,3811,3048.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3048.8,80,,2439.04,,,0,"percent of total billed charges ","80% of total billed charges ",2667.7,70,,2134.16,,,0,"percent of total billed charges ","70% of total billed charges ",3429.9,90,,2743.92,,,0,"percent of total billed charges ","90% of total billed charges ",3544.23,93,,2835.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3239.35,85,,2591.48,,,0,"percent of total billed charges ","85% of total billed charges ",3429.9,90,,2743.92,,,0,"percent of total billed charges ","90% of total billed charges ",3429.9,90,,2743.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3315.57,87,,2652.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2667.7,70,,2134.16,,,0,"percent of total billed charges ","70% of total billed charges ",2667.7,3544.23,
"GYNECOLOGY SURG L3 SUB 15 MIN",1003475,"CDM ",360,RC,,,OUTPATIENT,,,1906,1524.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1524.8,80,,1219.84,,,0,"percent of total billed charges ","80% of total billed charges ",1334.2,70,,1067.36,,,0,"percent of total billed charges ","70% of total billed charges ",1715.4,90,,1372.32,,,0,"percent of total billed charges ","90% of total billed charges ",1772.58,93,,1418.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1620.1,85,,1296.08,,,0,"percent of total billed charges ","85% of total billed charges ",1715.4,90,,1372.32,,,0,"percent of total billed charges ","90% of total billed charges ",1715.4,90,,1372.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1658.22,87,,1326.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1334.2,70,,1067.36,,,0,"percent of total billed charges ","70% of total billed charges ",1334.2,1772.58,
"GYNECOLOGY SURG L4 1ST 15 MIN",1003480,"CDM ",360,RC,,,OUTPATIENT,,,4762.5,3810,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3810,80,,3048.00,,,0,"percent of total billed charges ","80% of total billed charges ",3333.75,70,,2667.00,,,0,"percent of total billed charges ","70% of total billed charges ",4286.25,90,,3429.00,,,0,"percent of total billed charges ","90% of total billed charges ",4429.13,93,,3543.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4048.13,85,,3238.50,,,0,"percent of total billed charges ","85% of total billed charges ",4286.25,90,,3429.00,,,0,"percent of total billed charges ","90% of total billed charges ",4286.25,90,,3429.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4143.38,87,,3314.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3333.75,70,,2667.00,,,0,"percent of total billed charges ","70% of total billed charges ",3333.75,4429.13,
"GYNECOLOGY SURG L4 SUB 15 MIN",1003485,"CDM ",360,RC,,,OUTPATIENT,,,2382,1905.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1905.6,80,,1524.48,,,0,"percent of total billed charges ","80% of total billed charges ",1667.4,70,,1333.92,,,0,"percent of total billed charges ","70% of total billed charges ",2143.8,90,,1715.04,,,0,"percent of total billed charges ","90% of total billed charges ",2215.26,93,,1772.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2024.7,85,,1619.76,,,0,"percent of total billed charges ","85% of total billed charges ",2143.8,90,,1715.04,,,0,"percent of total billed charges ","90% of total billed charges ",2143.8,90,,1715.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2072.34,87,,1657.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1667.4,70,,1333.92,,,0,"percent of total billed charges ","70% of total billed charges ",1667.4,2215.26,
"GYNECOLOGY SURG L5 1ST 15 MIN",1003490,"CDM ",360,RC,,,OUTPATIENT,,,5952,4761.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4761.6,80,,3809.28,,,0,"percent of total billed charges ","80% of total billed charges ",4166.4,70,,3333.12,,,0,"percent of total billed charges ","70% of total billed charges ",5356.8,90,,4285.44,,,0,"percent of total billed charges ","90% of total billed charges ",5535.36,93,,4428.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5059.2,85,,4047.36,,,0,"percent of total billed charges ","85% of total billed charges ",5356.8,90,,4285.44,,,0,"percent of total billed charges ","90% of total billed charges ",5356.8,90,,4285.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5178.24,87,,4142.59,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4166.4,70,,3333.12,,,0,"percent of total billed charges ","70% of total billed charges ",4166.4,5535.36,
"GYNECOLOGY SURG L5 SUB 15 MIN",1003495,"CDM ",360,RC,,,OUTPATIENT,,,2977.5,2382,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2382,80,,1905.60,,,0,"percent of total billed charges ","80% of total billed charges ",2084.25,70,,1667.40,,,0,"percent of total billed charges ","70% of total billed charges ",2679.75,90,,2143.80,,,0,"percent of total billed charges ","90% of total billed charges ",2769.08,93,,2215.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2530.88,85,,2024.70,,,0,"percent of total billed charges ","85% of total billed charges ",2679.75,90,,2143.80,,,0,"percent of total billed charges ","90% of total billed charges ",2679.75,90,,2143.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2590.43,87,,2072.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2084.25,70,,1667.40,,,0,"percent of total billed charges ","70% of total billed charges ",2084.25,2769.08,
"ORTHOPEDIC SURG L1 1ST 15 MIN",1003500,"CDM ",360,RC,,,OUTPATIENT,,,2017,1613.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1613.6,80,,1290.88,,,0,"percent of total billed charges ","80% of total billed charges ",1411.9,70,,1129.52,,,0,"percent of total billed charges ","70% of total billed charges ",1815.3,90,,1452.24,,,0,"percent of total billed charges ","90% of total billed charges ",1875.81,93,,1500.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1714.45,85,,1371.56,,,0,"percent of total billed charges ","85% of total billed charges ",1815.3,90,,1452.24,,,0,"percent of total billed charges ","90% of total billed charges ",1815.3,90,,1452.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1754.79,87,,1403.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1411.9,70,,1129.52,,,0,"percent of total billed charges ","70% of total billed charges ",1411.9,1875.81,
"ORTHOPEDIC SURG L1 SUB 15 MIN",1003505,"CDM ",360,RC,,,OUTPATIENT,,,1008.5,806.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",806.8,80,,645.44,,,0,"percent of total billed charges ","80% of total billed charges ",705.95,70,,564.76,,,0,"percent of total billed charges ","70% of total billed charges ",907.65,90,,726.12,,,0,"percent of total billed charges ","90% of total billed charges ",937.91,93,,750.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",857.23,85,,685.78,,,0,"percent of total billed charges ","85% of total billed charges ",907.65,90,,726.12,,,0,"percent of total billed charges ","90% of total billed charges ",907.65,90,,726.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",877.4,87,,701.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",705.95,70,,564.76,,,0,"percent of total billed charges ","70% of total billed charges ",705.95,937.91,
"ORTHOPEDIC SURG L2 1ST 15 MIN",1003510,"CDM ",360,RC,,,OUTPATIENT,,,2520,2016,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2016,80,,1612.80,,,0,"percent of total billed charges ","80% of total billed charges ",1764,70,,1411.20,,,0,"percent of total billed charges ","70% of total billed charges ",2268,90,,1814.40,,,0,"percent of total billed charges ","90% of total billed charges ",2343.6,93,,1874.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2142,85,,1713.60,,,0,"percent of total billed charges ","85% of total billed charges ",2268,90,,1814.40,,,0,"percent of total billed charges ","90% of total billed charges ",2268,90,,1814.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2192.4,87,,1753.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1764,70,,1411.20,,,0,"percent of total billed charges ","70% of total billed charges ",1764,2343.6,
"ORTHOPEDIC SURG L2 SUB 15 MIN",1003515,"CDM ",360,RC,,,OUTPATIENT,,,1260.5,1008.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1008.4,80,,806.72,,,0,"percent of total billed charges ","80% of total billed charges ",882.35,70,,705.88,,,0,"percent of total billed charges ","70% of total billed charges ",1134.45,90,,907.56,,,0,"percent of total billed charges ","90% of total billed charges ",1172.27,93,,937.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1071.43,85,,857.14,,,0,"percent of total billed charges ","85% of total billed charges ",1134.45,90,,907.56,,,0,"percent of total billed charges ","90% of total billed charges ",1134.45,90,,907.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1096.64,87,,877.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",882.35,70,,705.88,,,0,"percent of total billed charges ","70% of total billed charges ",882.35,1172.27,
"ORTHOPEDIC SURG L3 1ST 15 MIN",1003520,"CDM ",360,RC,,,OUTPATIENT,,,3149.5,2519.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2519.6,80,,2015.68,,,0,"percent of total billed charges ","80% of total billed charges ",2204.65,70,,1763.72,,,0,"percent of total billed charges ","70% of total billed charges ",2834.55,90,,2267.64,,,0,"percent of total billed charges ","90% of total billed charges ",2929.04,93,,2343.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2677.08,85,,2141.66,,,0,"percent of total billed charges ","85% of total billed charges ",2834.55,90,,2267.64,,,0,"percent of total billed charges ","90% of total billed charges ",2834.55,90,,2267.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2740.07,87,,2192.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2204.65,70,,1763.72,,,0,"percent of total billed charges ","70% of total billed charges ",2204.65,2929.04,
"ORTHOPEDIC SURG L3 SUB 15 MIN",1003525,"CDM ",360,RC,,,OUTPATIENT,,,1575,1260,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1260,80,,1008.00,,,0,"percent of total billed charges ","80% of total billed charges ",1102.5,70,,882.00,,,0,"percent of total billed charges ","70% of total billed charges ",1417.5,90,,1134.00,,,0,"percent of total billed charges ","90% of total billed charges ",1464.75,93,,1171.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1338.75,85,,1071.00,,,0,"percent of total billed charges ","85% of total billed charges ",1417.5,90,,1134.00,,,0,"percent of total billed charges ","90% of total billed charges ",1417.5,90,,1134.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1370.25,87,,1096.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1102.5,70,,882.00,,,0,"percent of total billed charges ","70% of total billed charges ",1102.5,1464.75,
"ORTHOPEDIC SURG L4 1ST 15 MIN",1003530,"CDM ",360,RC,,,OUTPATIENT,,,3936,3148.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3148.8,80,,2519.04,,,0,"percent of total billed charges ","80% of total billed charges ",2755.2,70,,2204.16,,,0,"percent of total billed charges ","70% of total billed charges ",3542.4,90,,2833.92,,,0,"percent of total billed charges ","90% of total billed charges ",3660.48,93,,2928.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3345.6,85,,2676.48,,,0,"percent of total billed charges ","85% of total billed charges ",3542.4,90,,2833.92,,,0,"percent of total billed charges ","90% of total billed charges ",3542.4,90,,2833.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3424.32,87,,2739.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2755.2,70,,2204.16,,,0,"percent of total billed charges ","70% of total billed charges ",2755.2,3660.48,
"ORTHOPEDIC SURG L4 SUB 15 MIN",1003535,"CDM ",360,RC,,,OUTPATIENT,,,1969.5,1575.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1575.6,80,,1260.48,,,0,"percent of total billed charges ","80% of total billed charges ",1378.65,70,,1102.92,,,0,"percent of total billed charges ","70% of total billed charges ",1772.55,90,,1418.04,,,0,"percent of total billed charges ","90% of total billed charges ",1831.64,93,,1465.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1674.08,85,,1339.26,,,0,"percent of total billed charges ","85% of total billed charges ",1772.55,90,,1418.04,,,0,"percent of total billed charges ","90% of total billed charges ",1772.55,90,,1418.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1713.47,87,,1370.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1378.65,70,,1102.92,,,0,"percent of total billed charges ","70% of total billed charges ",1378.65,1831.64,
"ORTHOPEDIC SURG L5 1ST 15 MIN",1003540,"CDM ",360,RC,,,OUTPATIENT,,,4920,3936,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3936,80,,3148.80,,,0,"percent of total billed charges ","80% of total billed charges ",3444,70,,2755.20,,,0,"percent of total billed charges ","70% of total billed charges ",4428,90,,3542.40,,,0,"percent of total billed charges ","90% of total billed charges ",4575.6,93,,3660.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4182,85,,3345.60,,,0,"percent of total billed charges ","85% of total billed charges ",4428,90,,3542.40,,,0,"percent of total billed charges ","90% of total billed charges ",4428,90,,3542.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4280.4,87,,3424.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3444,70,,2755.20,,,0,"percent of total billed charges ","70% of total billed charges ",3444,4575.6,
"ORTHOPEDIC SURG L5 SUB 15 MIN",1003545,"CDM ",360,RC,,,OUTPATIENT,,,2459.5,1967.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1967.6,80,,1574.08,,,0,"percent of total billed charges ","80% of total billed charges ",1721.65,70,,1377.32,,,0,"percent of total billed charges ","70% of total billed charges ",2213.55,90,,1770.84,,,0,"percent of total billed charges ","90% of total billed charges ",2287.34,93,,1829.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2090.58,85,,1672.46,,,0,"percent of total billed charges ","85% of total billed charges ",2213.55,90,,1770.84,,,0,"percent of total billed charges ","90% of total billed charges ",2213.55,90,,1770.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2139.77,87,,1711.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1721.65,70,,1377.32,,,0,"percent of total billed charges ","70% of total billed charges ",1721.65,2287.34,
"PLASTIC SURGERY L1 1ST 15 MIN",1003550,"CDM ",360,RC,,,OUTPATIENT,,,2476.5,1981.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1981.2,80,,1584.96,,,0,"percent of total billed charges ","80% of total billed charges ",1733.55,70,,1386.84,,,0,"percent of total billed charges ","70% of total billed charges ",2228.85,90,,1783.08,,,0,"percent of total billed charges ","90% of total billed charges ",2303.15,93,,1842.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2105.03,85,,1684.02,,,0,"percent of total billed charges ","85% of total billed charges ",2228.85,90,,1783.08,,,0,"percent of total billed charges ","90% of total billed charges ",2228.85,90,,1783.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2154.56,87,,1723.65,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1733.55,70,,1386.84,,,0,"percent of total billed charges ","70% of total billed charges ",1733.55,2303.15,
"PLASTIC SURGERY L1 SUB 15 MIN",1003555,"CDM ",360,RC,,,OUTPATIENT,,,1238,990.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",990.4,80,,792.32,,,0,"percent of total billed charges ","80% of total billed charges ",866.6,70,,693.28,,,0,"percent of total billed charges ","70% of total billed charges ",1114.2,90,,891.36,,,0,"percent of total billed charges ","90% of total billed charges ",1151.34,93,,921.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1052.3,85,,841.84,,,0,"percent of total billed charges ","85% of total billed charges ",1114.2,90,,891.36,,,0,"percent of total billed charges ","90% of total billed charges ",1114.2,90,,891.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1077.06,87,,861.65,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",866.6,70,,693.28,,,0,"percent of total billed charges ","70% of total billed charges ",866.6,1151.34,
"PLASTIC SURGERY L2 1ST 15 MIN",1003560,"CDM ",360,RC,,,OUTPATIENT,,,3095,2476,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2476,80,,1980.80,,,0,"percent of total billed charges ","80% of total billed charges ",2166.5,70,,1733.20,,,0,"percent of total billed charges ","70% of total billed charges ",2785.5,90,,2228.40,,,0,"percent of total billed charges ","90% of total billed charges ",2878.35,93,,2302.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2630.75,85,,2104.60,,,0,"percent of total billed charges ","85% of total billed charges ",2785.5,90,,2228.40,,,0,"percent of total billed charges ","90% of total billed charges ",2785.5,90,,2228.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2692.65,87,,2154.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2166.5,70,,1733.20,,,0,"percent of total billed charges ","70% of total billed charges ",2166.5,2878.35,
"PLASTIC SURGERY L2 SUB 15 MIN",1003565,"CDM ",360,RC,,,OUTPATIENT,,,1546.5,1237.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1237.2,80,,989.76,,,0,"percent of total billed charges ","80% of total billed charges ",1082.55,70,,866.04,,,0,"percent of total billed charges ","70% of total billed charges ",1391.85,90,,1113.48,,,0,"percent of total billed charges ","90% of total billed charges ",1438.25,93,,1150.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1314.53,85,,1051.62,,,0,"percent of total billed charges ","85% of total billed charges ",1391.85,90,,1113.48,,,0,"percent of total billed charges ","90% of total billed charges ",1391.85,90,,1113.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1345.46,87,,1076.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1082.55,70,,866.04,,,0,"percent of total billed charges ","70% of total billed charges ",1082.55,1438.25,
"PLASTIC SURGERY L3 1ST 15 MIN",1003570,"CDM ",360,RC,,,OUTPATIENT,,,3868.5,3094.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3094.8,80,,2475.84,,,0,"percent of total billed charges ","80% of total billed charges ",2707.95,70,,2166.36,,,0,"percent of total billed charges ","70% of total billed charges ",3481.65,90,,2785.32,,,0,"percent of total billed charges ","90% of total billed charges ",3597.71,93,,2878.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3288.23,85,,2630.58,,,0,"percent of total billed charges ","85% of total billed charges ",3481.65,90,,2785.32,,,0,"percent of total billed charges ","90% of total billed charges ",3481.65,90,,2785.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3365.6,87,,2692.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2707.95,70,,2166.36,,,0,"percent of total billed charges ","70% of total billed charges ",2707.95,3597.71,
"PLASTIC SURGERY L3 SUB 15 MIN",1003575,"CDM ",360,RC,,,OUTPATIENT,,,1934.5,1547.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1547.6,80,,1238.08,,,0,"percent of total billed charges ","80% of total billed charges ",1354.15,70,,1083.32,,,0,"percent of total billed charges ","70% of total billed charges ",1741.05,90,,1392.84,,,0,"percent of total billed charges ","90% of total billed charges ",1799.09,93,,1439.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1644.33,85,,1315.46,,,0,"percent of total billed charges ","85% of total billed charges ",1741.05,90,,1392.84,,,0,"percent of total billed charges ","90% of total billed charges ",1741.05,90,,1392.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1683.02,87,,1346.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1354.15,70,,1083.32,,,0,"percent of total billed charges ","70% of total billed charges ",1354.15,1799.09,
"PLASTIC SURGERY L4 1ST 15 MIN",1003580,"CDM ",360,RC,,,OUTPATIENT,,,4835.5,3868.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3868.4,80,,3094.72,,,0,"percent of total billed charges ","80% of total billed charges ",3384.85,70,,2707.88,,,0,"percent of total billed charges ","70% of total billed charges ",4351.95,90,,3481.56,,,0,"percent of total billed charges ","90% of total billed charges ",4497.02,93,,3597.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4110.18,85,,3288.14,,,0,"percent of total billed charges ","85% of total billed charges ",4351.95,90,,3481.56,,,0,"percent of total billed charges ","90% of total billed charges ",4351.95,90,,3481.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4206.89,87,,3365.51,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3384.85,70,,2707.88,,,0,"percent of total billed charges ","70% of total billed charges ",3384.85,4497.02,
"PLASTIC SURGERY L4 SUB 15 MIN",1003585,"CDM ",360,RC,,,OUTPATIENT,,,2418.5,1934.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1934.8,80,,1547.84,,,0,"percent of total billed charges ","80% of total billed charges ",1692.95,70,,1354.36,,,0,"percent of total billed charges ","70% of total billed charges ",2176.65,90,,1741.32,,,0,"percent of total billed charges ","90% of total billed charges ",2249.21,93,,1799.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2055.73,85,,1644.58,,,0,"percent of total billed charges ","85% of total billed charges ",2176.65,90,,1741.32,,,0,"percent of total billed charges ","90% of total billed charges ",2176.65,90,,1741.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2104.1,87,,1683.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1692.95,70,,1354.36,,,0,"percent of total billed charges ","70% of total billed charges ",1692.95,2249.21,
"PLASTIC SURGERY L5 1ST 15 MIN",1003590,"CDM ",360,RC,,,OUTPATIENT,,,6044,4835.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4835.2,80,,3868.16,,,0,"percent of total billed charges ","80% of total billed charges ",4230.8,70,,3384.64,,,0,"percent of total billed charges ","70% of total billed charges ",5439.6,90,,4351.68,,,0,"percent of total billed charges ","90% of total billed charges ",5620.92,93,,4496.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5137.4,85,,4109.92,,,0,"percent of total billed charges ","85% of total billed charges ",5439.6,90,,4351.68,,,0,"percent of total billed charges ","90% of total billed charges ",5439.6,90,,4351.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5258.28,87,,4206.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4230.8,70,,3384.64,,,0,"percent of total billed charges ","70% of total billed charges ",4230.8,5620.92,
"PLASTIC SURGERY L5 SUB 15 MIN",1003595,"CDM ",360,RC,,,OUTPATIENT,,,3022,2417.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2417.6,80,,1934.08,,,0,"percent of total billed charges ","80% of total billed charges ",2115.4,70,,1692.32,,,0,"percent of total billed charges ","70% of total billed charges ",2719.8,90,,2175.84,,,0,"percent of total billed charges ","90% of total billed charges ",2810.46,93,,2248.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2568.7,85,,2054.96,,,0,"percent of total billed charges ","85% of total billed charges ",2719.8,90,,2175.84,,,0,"percent of total billed charges ","90% of total billed charges ",2719.8,90,,2175.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2629.14,87,,2103.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2115.4,70,,1692.32,,,0,"percent of total billed charges ","70% of total billed charges ",2115.4,2810.46,
"UROLOGY SURGERY L1 1ST 15 MIN",1003600,"CDM ",360,RC,,,OUTPATIENT,,,2520,2016,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2016,80,,1612.80,,,0,"percent of total billed charges ","80% of total billed charges ",1764,70,,1411.20,,,0,"percent of total billed charges ","70% of total billed charges ",2268,90,,1814.40,,,0,"percent of total billed charges ","90% of total billed charges ",2343.6,93,,1874.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2142,85,,1713.60,,,0,"percent of total billed charges ","85% of total billed charges ",2268,90,,1814.40,,,0,"percent of total billed charges ","90% of total billed charges ",2268,90,,1814.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2192.4,87,,1753.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1764,70,,1411.20,,,0,"percent of total billed charges ","70% of total billed charges ",1764,2343.6,
"UROLOGY SURGERY L1 SUB 15 MIN",1003605,"CDM ",360,RC,,,OUTPATIENT,,,1260.5,1008.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1008.4,80,,806.72,,,0,"percent of total billed charges ","80% of total billed charges ",882.35,70,,705.88,,,0,"percent of total billed charges ","70% of total billed charges ",1134.45,90,,907.56,,,0,"percent of total billed charges ","90% of total billed charges ",1172.27,93,,937.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1071.43,85,,857.14,,,0,"percent of total billed charges ","85% of total billed charges ",1134.45,90,,907.56,,,0,"percent of total billed charges ","90% of total billed charges ",1134.45,90,,907.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1096.64,87,,877.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",882.35,70,,705.88,,,0,"percent of total billed charges ","70% of total billed charges ",882.35,1172.27,
"UROLOGY SURGERY L2 1ST 15 MIN",1003610,"CDM ",360,RC,,,OUTPATIENT,,,3149.5,2519.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2519.6,80,,2015.68,,,0,"percent of total billed charges ","80% of total billed charges ",2204.65,70,,1763.72,,,0,"percent of total billed charges ","70% of total billed charges ",2834.55,90,,2267.64,,,0,"percent of total billed charges ","90% of total billed charges ",2929.04,93,,2343.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2677.08,85,,2141.66,,,0,"percent of total billed charges ","85% of total billed charges ",2834.55,90,,2267.64,,,0,"percent of total billed charges ","90% of total billed charges ",2834.55,90,,2267.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2740.07,87,,2192.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2204.65,70,,1763.72,,,0,"percent of total billed charges ","70% of total billed charges ",2204.65,2929.04,
"UROLOGY SURGERY L2 SUB 15 MIN",1003615,"CDM ",360,RC,,,OUTPATIENT,,,1575,1260,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1260,80,,1008.00,,,0,"percent of total billed charges ","80% of total billed charges ",1102.5,70,,882.00,,,0,"percent of total billed charges ","70% of total billed charges ",1417.5,90,,1134.00,,,0,"percent of total billed charges ","90% of total billed charges ",1464.75,93,,1171.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1338.75,85,,1071.00,,,0,"percent of total billed charges ","85% of total billed charges ",1417.5,90,,1134.00,,,0,"percent of total billed charges ","90% of total billed charges ",1417.5,90,,1134.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1370.25,87,,1096.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1102.5,70,,882.00,,,0,"percent of total billed charges ","70% of total billed charges ",1102.5,1464.75,
"UROLOGY SURGERY L3 1ST 15 MIN",1003620,"CDM ",360,RC,,,OUTPATIENT,,,3936,3148.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3148.8,80,,2519.04,,,0,"percent of total billed charges ","80% of total billed charges ",2755.2,70,,2204.16,,,0,"percent of total billed charges ","70% of total billed charges ",3542.4,90,,2833.92,,,0,"percent of total billed charges ","90% of total billed charges ",3660.48,93,,2928.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3345.6,85,,2676.48,,,0,"percent of total billed charges ","85% of total billed charges ",3542.4,90,,2833.92,,,0,"percent of total billed charges ","90% of total billed charges ",3542.4,90,,2833.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3424.32,87,,2739.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2755.2,70,,2204.16,,,0,"percent of total billed charges ","70% of total billed charges ",2755.2,3660.48,
"UROLOGY SURGERY L3 SUB 15 MIN",1003625,"CDM ",360,RC,,,OUTPATIENT,,,1969.5,1575.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1575.6,80,,1260.48,,,0,"percent of total billed charges ","80% of total billed charges ",1378.65,70,,1102.92,,,0,"percent of total billed charges ","70% of total billed charges ",1772.55,90,,1418.04,,,0,"percent of total billed charges ","90% of total billed charges ",1831.64,93,,1465.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1674.08,85,,1339.26,,,0,"percent of total billed charges ","85% of total billed charges ",1772.55,90,,1418.04,,,0,"percent of total billed charges ","90% of total billed charges ",1772.55,90,,1418.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1713.47,87,,1370.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1378.65,70,,1102.92,,,0,"percent of total billed charges ","70% of total billed charges ",1378.65,1831.64,
"UROLOGY SURGERY L4 1ST 15 MIN",1003630,"CDM ",360,RC,,,OUTPATIENT,,,4920,3936,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3936,80,,3148.80,,,0,"percent of total billed charges ","80% of total billed charges ",3444,70,,2755.20,,,0,"percent of total billed charges ","70% of total billed charges ",4428,90,,3542.40,,,0,"percent of total billed charges ","90% of total billed charges ",4575.6,93,,3660.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4182,85,,3345.60,,,0,"percent of total billed charges ","85% of total billed charges ",4428,90,,3542.40,,,0,"percent of total billed charges ","90% of total billed charges ",4428,90,,3542.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4280.4,87,,3424.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3444,70,,2755.20,,,0,"percent of total billed charges ","70% of total billed charges ",3444,4575.6,
"UROLOGY SURGERY L4 SUB 15 MIN",1003635,"CDM ",360,RC,,,OUTPATIENT,,,2459.5,1967.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1967.6,80,,1574.08,,,0,"percent of total billed charges ","80% of total billed charges ",1721.65,70,,1377.32,,,0,"percent of total billed charges ","70% of total billed charges ",2213.55,90,,1770.84,,,0,"percent of total billed charges ","90% of total billed charges ",2287.34,93,,1829.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2090.58,85,,1672.46,,,0,"percent of total billed charges ","85% of total billed charges ",2213.55,90,,1770.84,,,0,"percent of total billed charges ","90% of total billed charges ",2213.55,90,,1770.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2139.77,87,,1711.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1721.65,70,,1377.32,,,0,"percent of total billed charges ","70% of total billed charges ",1721.65,2287.34,
"UROLOGY SURGERY L5 1ST 15 MIN",1003640,"CDM ",360,RC,,,OUTPATIENT,,,6747,5397.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5397.6,80,,4318.08,,,0,"percent of total billed charges ","80% of total billed charges ",4722.9,70,,3778.32,,,0,"percent of total billed charges ","70% of total billed charges ",6072.3,90,,4857.84,,,0,"percent of total billed charges ","90% of total billed charges ",6274.71,93,,5019.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5734.95,85,,4587.96,,,0,"percent of total billed charges ","85% of total billed charges ",6072.3,90,,4857.84,,,0,"percent of total billed charges ","90% of total billed charges ",6072.3,90,,4857.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5869.89,87,,4695.91,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4722.9,70,,3778.32,,,0,"percent of total billed charges ","70% of total billed charges ",4722.9,6274.71,
"UROLOGY SURGERY L5 SUB 15 MIN",1003645,"CDM ",360,RC,,,OUTPATIENT,,,3373,2698.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2698.4,80,,2158.72,,,0,"percent of total billed charges ","80% of total billed charges ",2361.1,70,,1888.88,,,0,"percent of total billed charges ","70% of total billed charges ",3035.7,90,,2428.56,,,0,"percent of total billed charges ","90% of total billed charges ",3136.89,93,,2509.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2867.05,85,,2293.64,,,0,"percent of total billed charges ","85% of total billed charges ",3035.7,90,,2428.56,,,0,"percent of total billed charges ","90% of total billed charges ",3035.7,90,,2428.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2934.51,87,,2347.61,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2361.1,70,,1888.88,,,0,"percent of total billed charges ","70% of total billed charges ",2361.1,3136.89,
"EMERG/UNSCHED SUR CASE/30MIN",1100005,"CDM ",360,RC,,,OUTPATIENT,,,343,274.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.4,80,,219.52,,,0,"percent of total billed charges ","80% of total billed charges ",240.1,70,,192.08,,,0,"percent of total billed charges ","70% of total billed charges ",308.7,90,,246.96,,,0,"percent of total billed charges ","90% of total billed charges ",318.99,93,,255.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",291.55,85,,233.24,,,0,"percent of total billed charges ","85% of total billed charges ",308.7,90,,246.96,,,0,"percent of total billed charges ","90% of total billed charges ",308.7,90,,246.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",298.41,87,,238.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",240.1,70,,192.08,,,0,"percent of total billed charges ","70% of total billed charges ",240.1,318.99,
"SURGERY EXTRA PERSON EA 30 MIN",1100007,"CDM ",360,RC,,,OUTPATIENT,,,99,79.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.2,80,,63.36,,,0,"percent of total billed charges ","80% of total billed charges ",69.3,70,,55.44,,,0,"percent of total billed charges ","70% of total billed charges ",89.1,90,,71.28,,,0,"percent of total billed charges ","90% of total billed charges ",92.07,93,,73.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",84.15,85,,67.32,,,0,"percent of total billed charges ","85% of total billed charges ",89.1,90,,71.28,,,0,"percent of total billed charges ","90% of total billed charges ",89.1,90,,71.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",86.13,87,,68.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.3,70,,55.44,,,0,"percent of total billed charges ","70% of total billed charges ",69.3,92.07,
"ANESTH GENERAL TECH 15 MIN",1100010,"CDM ",370,RC,,,OUTPATIENT,,,366,292.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",292.8,80,,234.24,,,0,"percent of total billed charges ","80% of total billed charges ",256.2,70,,204.96,,,0,"percent of total billed charges ","70% of total billed charges ",329.4,90,,263.52,,,0,"percent of total billed charges ","90% of total billed charges ",340.38,93,,272.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",311.1,85,,248.88,,,0,"percent of total billed charges ","85% of total billed charges ",329.4,90,,263.52,,,0,"percent of total billed charges ","90% of total billed charges ",329.4,90,,263.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",318.42,87,,254.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",256.2,70,,204.96,,,0,"percent of total billed charges ","70% of total billed charges ",256.2,340.38,
"ANESTH TECH SPINAL/EPIDURAL",1100015,"CDM ",370,RC,,,OUTPATIENT,,,470.5,376.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",376.4,80,,301.12,,,0,"percent of total billed charges ","80% of total billed charges ",329.35,70,,263.48,,,0,"percent of total billed charges ","70% of total billed charges ",423.45,90,,338.76,,,0,"percent of total billed charges ","90% of total billed charges ",437.57,93,,350.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",399.93,85,,319.94,,,0,"percent of total billed charges ","85% of total billed charges ",423.45,90,,338.76,,,0,"percent of total billed charges ","90% of total billed charges ",423.45,90,,338.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",409.34,87,,327.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",329.35,70,,263.48,,,0,"percent of total billed charges ","70% of total billed charges ",329.35,437.57,
"ANESTH TECH BLOCK",1100020,"CDM ",370,RC,,,OUTPATIENT,,,366,292.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",292.8,80,,234.24,,,0,"percent of total billed charges ","80% of total billed charges ",256.2,70,,204.96,,,0,"percent of total billed charges ","70% of total billed charges ",329.4,90,,263.52,,,0,"percent of total billed charges ","90% of total billed charges ",340.38,93,,272.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",311.1,85,,248.88,,,0,"percent of total billed charges ","85% of total billed charges ",329.4,90,,263.52,,,0,"percent of total billed charges ","90% of total billed charges ",329.4,90,,263.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",318.42,87,,254.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",256.2,70,,204.96,,,0,"percent of total billed charges ","70% of total billed charges ",256.2,340.38,
"ANESTH TC MOD SEDATION 1ST 15M",1100025,"CDM ",370,RC,,,OUTPATIENT,,,312.5,250,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",250,80,,200.00,,,0,"percent of total billed charges ","80% of total billed charges ",218.75,70,,175.00,,,0,"percent of total billed charges ","70% of total billed charges ",281.25,90,,225.00,,,0,"percent of total billed charges ","90% of total billed charges ",290.63,93,,232.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",265.63,85,,212.50,,,0,"percent of total billed charges ","85% of total billed charges ",281.25,90,,225.00,,,0,"percent of total billed charges ","90% of total billed charges ",281.25,90,,225.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",271.88,87,,217.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",218.75,70,,175.00,,,0,"percent of total billed charges ","70% of total billed charges ",218.75,290.63,
"ANESTH TC MOD SEDATION SUB 15M",1100030,"CDM ",370,RC,,,OUTPATIENT,,,62,49.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.6,80,,39.68,,,0,"percent of total billed charges ","80% of total billed charges ",43.4,70,,34.72,,,0,"percent of total billed charges ","70% of total billed charges ",55.8,90,,44.64,,,0,"percent of total billed charges ","90% of total billed charges ",57.66,93,,46.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",52.7,85,,42.16,,,0,"percent of total billed charges ","85% of total billed charges ",55.8,90,,44.64,,,0,"percent of total billed charges ","90% of total billed charges ",55.8,90,,44.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",53.94,87,,43.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.4,70,,34.72,,,0,"percent of total billed charges ","70% of total billed charges ",43.4,57.66,
"SPECIAL EQUIP RFA/VAPR/COOLCUT",1100500,"CDM ",360,RC,,,OUTPATIENT,,,272,217.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.6,80,,174.08,,,0,"percent of total billed charges ","80% of total billed charges ",190.4,70,,152.32,,,0,"percent of total billed charges ","70% of total billed charges ",244.8,90,,195.84,,,0,"percent of total billed charges ","90% of total billed charges ",252.96,93,,202.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",231.2,85,,184.96,,,0,"percent of total billed charges ","85% of total billed charges ",244.8,90,,195.84,,,0,"percent of total billed charges ","90% of total billed charges ",244.8,90,,195.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",236.64,87,,189.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",190.4,70,,152.32,,,0,"percent of total billed charges ","70% of total billed charges ",190.4,252.96,
"SPECIAL EQUIP ARTHRO SHAVER",1100505,"CDM ",360,RC,,,OUTPATIENT,,,99.5,79.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.6,80,,63.68,,,0,"percent of total billed charges ","80% of total billed charges ",69.65,70,,55.72,,,0,"percent of total billed charges ","70% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",92.54,93,,74.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",84.58,85,,67.66,,,0,"percent of total billed charges ","85% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",86.57,87,,69.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.65,70,,55.72,,,0,"percent of total billed charges ","70% of total billed charges ",69.65,92.54,
"SPECIAL EQUIP ENT COBLATOR",1100510,"CDM ",360,RC,,,OUTPATIENT,,,261.5,209.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",209.2,80,,167.36,,,0,"percent of total billed charges ","80% of total billed charges ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",243.2,93,,194.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",222.28,85,,177.82,,,0,"percent of total billed charges ","85% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",235.35,90,,188.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",227.51,87,,182.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.05,70,,146.44,,,0,"percent of total billed charges ","70% of total billed charges ",183.05,243.2,
"SPECIAL EQUIP INSUFFLATOR",1100515,"CDM ",360,RC,,,OUTPATIENT,,,78.5,62.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.8,80,,50.24,,,0,"percent of total billed charges ","80% of total billed charges ",54.95,70,,43.96,,,0,"percent of total billed charges ","70% of total billed charges ",70.65,90,,56.52,,,0,"percent of total billed charges ","90% of total billed charges ",73.01,93,,58.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",66.73,85,,53.38,,,0,"percent of total billed charges ","85% of total billed charges ",70.65,90,,56.52,,,0,"percent of total billed charges ","90% of total billed charges ",70.65,90,,56.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",68.3,87,,54.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.95,70,,43.96,,,0,"percent of total billed charges ","70% of total billed charges ",54.95,73.01,
"SPECIAL EQUIP LASER(S)",1100520,"CDM ",360,RC,,,OUTPATIENT,,,1567.5,1254,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1254,80,,1003.20,,,0,"percent of total billed charges ","80% of total billed charges ",1097.25,70,,877.80,,,0,"percent of total billed charges ","70% of total billed charges ",1410.75,90,,1128.60,,,0,"percent of total billed charges ","90% of total billed charges ",1457.78,93,,1166.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1332.38,85,,1065.90,,,0,"percent of total billed charges ","85% of total billed charges ",1410.75,90,,1128.60,,,0,"percent of total billed charges ","90% of total billed charges ",1410.75,90,,1128.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1363.73,87,,1090.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1097.25,70,,877.80,,,0,"percent of total billed charges ","70% of total billed charges ",1097.25,1457.78,
"SPECIAL EQUIP MICROSCOPE(S)",1100525,"CDM ",360,RC,,,OUTPATIENT,,,366,292.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",292.8,80,,234.24,,,0,"percent of total billed charges ","80% of total billed charges ",256.2,70,,204.96,,,0,"percent of total billed charges ","70% of total billed charges ",329.4,90,,263.52,,,0,"percent of total billed charges ","90% of total billed charges ",340.38,93,,272.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",311.1,85,,248.88,,,0,"percent of total billed charges ","85% of total billed charges ",329.4,90,,263.52,,,0,"percent of total billed charges ","90% of total billed charges ",329.4,90,,263.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",318.42,87,,254.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",256.2,70,,204.96,,,0,"percent of total billed charges ","70% of total billed charges ",256.2,340.38,
"SPECIAL EQUIP PHACO",1100530,"CDM ",360,RC,,,OUTPATIENT,,,652.5,522,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",522,80,,417.60,,,0,"percent of total billed charges ","80% of total billed charges ",456.75,70,,365.40,,,0,"percent of total billed charges ","70% of total billed charges ",587.25,90,,469.80,,,0,"percent of total billed charges ","90% of total billed charges ",606.83,93,,485.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",554.63,85,,443.70,,,0,"percent of total billed charges ","85% of total billed charges ",587.25,90,,469.80,,,0,"percent of total billed charges ","90% of total billed charges ",587.25,90,,469.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",567.68,87,,454.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",456.75,70,,365.40,,,0,"percent of total billed charges ","70% of total billed charges ",456.75,606.83,
"SPECIAL EQUIP SCOPE(S) EACH",1100535,"CDM ",360,RC,,,OUTPATIENT,,,324,259.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",259.2,80,,207.36,,,0,"percent of total billed charges ","80% of total billed charges ",226.8,70,,181.44,,,0,"percent of total billed charges ","70% of total billed charges ",291.6,90,,233.28,,,0,"percent of total billed charges ","90% of total billed charges ",301.32,93,,241.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",275.4,85,,220.32,,,0,"percent of total billed charges ","85% of total billed charges ",291.6,90,,233.28,,,0,"percent of total billed charges ","90% of total billed charges ",291.6,90,,233.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",281.88,87,,225.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",226.8,70,,181.44,,,0,"percent of total billed charges ","70% of total billed charges ",226.8,301.32,
"SPECIAL EQUIP VENTILATOR",1100540,"CDM ",360,RC,,,OUTPATIENT,,,157,125.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.6,80,,100.48,,,0,"percent of total billed charges ","80% of total billed charges ",109.9,70,,87.92,,,0,"percent of total billed charges ","70% of total billed charges ",141.3,90,,113.04,,,0,"percent of total billed charges ","90% of total billed charges ",146.01,93,,116.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.45,85,,106.76,,,0,"percent of total billed charges ","85% of total billed charges ",141.3,90,,113.04,,,0,"percent of total billed charges ","90% of total billed charges ",141.3,90,,113.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",136.59,87,,109.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.9,70,,87.92,,,0,"percent of total billed charges ","70% of total billed charges ",109.9,146.01,
"SPECIAL EQUIP VIDEO TOWER",1100545,"CDM ",360,RC,,,OUTPATIENT,,,679.5,543.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",543.6,80,,434.88,,,0,"percent of total billed charges ","80% of total billed charges ",475.65,70,,380.52,,,0,"percent of total billed charges ","70% of total billed charges ",611.55,90,,489.24,,,0,"percent of total billed charges ","90% of total billed charges ",631.94,93,,505.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",577.58,85,,462.06,,,0,"percent of total billed charges ","85% of total billed charges ",611.55,90,,489.24,,,0,"percent of total billed charges ","90% of total billed charges ",611.55,90,,489.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",591.17,87,,472.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",475.65,70,,380.52,,,0,"percent of total billed charges ","70% of total billed charges ",475.65,631.94,
"STEP DOWN RECOVERY-PER 15 MINU",1200120,"CDM ",710,RC,,,OUTPATIENT,,,53.5,42.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.8,80,,34.24,,,0,"percent of total billed charges ","80% of total billed charges ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",49.76,93,,39.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",45.48,85,,36.38,,,0,"percent of total billed charges ","85% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",46.55,87,,37.24,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",37.45,49.76,
"PACU 0-60 MINUTES",1400118,"CDM ",710,RC,,,OUTPATIENT,,,1149,919.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",919.2,80,,735.36,,,0,"percent of total billed charges ","80% of total billed charges ",804.3,70,,643.44,,,0,"percent of total billed charges ","70% of total billed charges ",1034.1,90,,827.28,,,0,"percent of total billed charges ","90% of total billed charges ",1068.57,93,,854.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",976.65,85,,781.32,,,0,"percent of total billed charges ","85% of total billed charges ",1034.1,90,,827.28,,,0,"percent of total billed charges ","90% of total billed charges ",1034.1,90,,827.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",999.63,87,,799.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",804.3,70,,643.44,,,0,"percent of total billed charges ","70% of total billed charges ",804.3,1068.57,
"PACU EA ADD 15 MIN",1400134,"CDM ",710,RC,,,OUTPATIENT,,,187,149.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.6,80,,119.68,,,0,"percent of total billed charges ","80% of total billed charges ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",173.91,93,,139.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",158.95,85,,127.16,,,0,"percent of total billed charges ","85% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",168.3,90,,134.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",162.69,87,,130.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.9,70,,104.72,,,0,"percent of total billed charges ","70% of total billed charges ",130.9,173.91,
"PAIN MGT INIT 15 MIN",1600300,"CDM ",761,RC,,,OUTPATIENT,,,294.5,235.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",235.6,80,,188.48,,,0,"percent of total billed charges ","80% of total billed charges ",206.15,70,,164.92,,,0,"percent of total billed charges ","70% of total billed charges ",265.05,90,,212.04,,,0,"percent of total billed charges ","90% of total billed charges ",273.89,93,,219.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",250.33,85,,200.26,,,0,"percent of total billed charges ","85% of total billed charges ",265.05,90,,212.04,,,0,"percent of total billed charges ","90% of total billed charges ",265.05,90,,212.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",256.22,87,,204.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",206.15,70,,164.92,,,0,"percent of total billed charges ","70% of total billed charges ",206.15,273.89,
"PAIN MGT SUBSQ 15 MIN",1600305,"CDM ",761,RC,,,OUTPATIENT,,,169.5,135.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.6,80,,108.48,,,0,"percent of total billed charges ","80% of total billed charges ",118.65,70,,94.92,,,0,"percent of total billed charges ","70% of total billed charges ",152.55,90,,122.04,,,0,"percent of total billed charges ","90% of total billed charges ",157.64,93,,126.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",144.08,85,,115.26,,,0,"percent of total billed charges ","85% of total billed charges ",152.55,90,,122.04,,,0,"percent of total billed charges ","90% of total billed charges ",152.55,90,,122.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",147.47,87,,117.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.65,70,,94.92,,,0,"percent of total billed charges ","70% of total billed charges ",118.65,157.64,
SDC,1799980,"CDM ",762,RC,,,OUTPATIENT,,,,,,,,,,,,0,"other ","not separately reimbursment ",1985.5,,,,,,0,"case rate ","pays based on per visit rate ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1985.5,1985.5,
OBSERVATION,1799990,"CDM ",762,RC,,,OUTPATIENT,,,,,,,,,,,,0,"other ","not separately reimbursment ",1985.5,,,,,,0,"case rate ","pays based on per visit rate ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1985.5,1985.5,
"LIBERAL FIRE DEPT LAB PANEL",2000003,"CDM ",300,RC,,,OUTPATIENT,,,345,276,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",276,80,,220.80,,,0,"percent of total billed charges ","80% of total billed charges ",241.5,70,,193.20,,,0,"percent of total billed charges ","70% of total billed charges ",310.5,90,,248.40,,,0,"percent of total billed charges ","90% of total billed charges ",320.85,93,,256.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",293.25,85,,234.60,,,0,"percent of total billed charges ","85% of total billed charges ",310.5,90,,248.40,,,0,"percent of total billed charges ","90% of total billed charges ",310.5,90,,248.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",300.15,87,,240.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.5,70,,193.20,,,0,"percent of total billed charges ","70% of total billed charges ",241.5,320.85,
"COLLECTION SPECIMEN DNA",2022630,"CDM ",300,RC,,,OUTPATIENT,,,56.5,45.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.2,80,,36.16,,,0,"percent of total billed charges ","80% of total billed charges ",39.55,70,,31.64,,,0,"percent of total billed charges ","70% of total billed charges ",50.85,90,,40.68,,,0,"percent of total billed charges ","90% of total billed charges ",52.55,93,,42.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",48.03,85,,38.42,,,0,"percent of total billed charges ","85% of total billed charges ",50.85,90,,40.68,,,0,"percent of total billed charges ","90% of total billed charges ",50.85,90,,40.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",49.16,87,,39.33,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.55,70,,31.64,,,0,"percent of total billed charges ","70% of total billed charges ",39.55,52.55,
"DONOR RBC NEG HIGH INCIDENT AG",2022680,"CDM ",300,RC,,,OUTPATIENT,,,778,622.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",622.4,80,,497.92,,,0,"percent of total billed charges ","80% of total billed charges ",544.6,70,,435.68,,,0,"percent of total billed charges ","70% of total billed charges ",700.2,90,,560.16,,,0,"percent of total billed charges ","90% of total billed charges ",723.54,93,,578.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",661.3,85,,529.04,,,0,"percent of total billed charges ","85% of total billed charges ",700.2,90,,560.16,,,0,"percent of total billed charges ","90% of total billed charges ",700.2,90,,560.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",676.86,87,,541.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",544.6,70,,435.68,,,0,"percent of total billed charges ","70% of total billed charges ",544.6,723.54,
"SPECIMEN COLLECTION & PREP",2023360,"CDM ",300,RC,,,OUTPATIENT,,,36.5,29.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.2,80,,23.36,,,0,"percent of total billed charges ","80% of total billed charges ",25.55,70,,20.44,,,0,"percent of total billed charges ","70% of total billed charges ",32.85,90,,26.28,,,0,"percent of total billed charges ","90% of total billed charges ",33.95,93,,27.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",31.03,85,,24.82,,,0,"percent of total billed charges ","85% of total billed charges ",32.85,90,,26.28,,,0,"percent of total billed charges ","90% of total billed charges ",32.85,90,,26.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",31.76,87,,25.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.55,70,,20.44,,,0,"percent of total billed charges ","70% of total billed charges ",25.55,33.95,
"DNA PATERNITY COLLECTION",2023370,"CDM ",300,RC,,,OUTPATIENT,,,36,28.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.8,80,,23.04,,,0,"percent of total billed charges ","80% of total billed charges ",25.2,70,,20.16,,,0,"percent of total billed charges ","70% of total billed charges ",32.4,90,,25.92,,,0,"percent of total billed charges ","90% of total billed charges ",33.48,93,,26.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",30.6,85,,24.48,,,0,"percent of total billed charges ","85% of total billed charges ",32.4,90,,25.92,,,0,"percent of total billed charges ","90% of total billed charges ",32.4,90,,25.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",31.32,87,,25.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.2,70,,20.16,,,0,"percent of total billed charges ","70% of total billed charges ",25.2,33.48,
"PROSTATE CANCER GENE 3 (PCA3)",2032310,"CDM ",300,RC,,,OUTPATIENT,,,1253,1002.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1002.4,80,,801.92,,,0,"percent of total billed charges ","80% of total billed charges ",877.1,70,,701.68,,,0,"percent of total billed charges ","70% of total billed charges ",1127.7,90,,902.16,,,0,"percent of total billed charges ","90% of total billed charges ",1165.29,93,,932.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1065.05,85,,852.04,,,0,"percent of total billed charges ","85% of total billed charges ",1127.7,90,,902.16,,,0,"percent of total billed charges ","90% of total billed charges ",1127.7,90,,902.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1090.11,87,,872.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",877.1,70,,701.68,,,0,"percent of total billed charges ","70% of total billed charges ",877.1,1165.29,
"ALLERGY SHELL FISH PANEL",2038065,"CDM ",302,RC,,,OUTPATIENT,,,31,24.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.8,80,,19.84,,,0,"percent of total billed charges ","80% of total billed charges ",21.7,70,,17.36,,,0,"percent of total billed charges ","70% of total billed charges ",27.9,90,,22.32,,,0,"percent of total billed charges ","90% of total billed charges ",28.83,93,,23.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.35,85,,21.08,,,0,"percent of total billed charges ","85% of total billed charges ",27.9,90,,22.32,,,0,"percent of total billed charges ","90% of total billed charges ",27.9,90,,22.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.97,87,,21.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.7,70,,17.36,,,0,"percent of total billed charges ","70% of total billed charges ",21.7,28.83,
"PSA TOTAL W/RFLX TO PSA FREE",2040980,"CDM ",301,RC,,,OUTPATIENT,,,188.5,150.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",150.8,80,,120.64,,,0,"percent of total billed charges ","80% of total billed charges ",131.95,70,,105.56,,,0,"percent of total billed charges ","70% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",175.31,93,,140.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",160.23,85,,128.18,,,0,"percent of total billed charges ","85% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",169.65,90,,135.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",164,87,,131.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.95,70,,105.56,,,0,"percent of total billed charges ","70% of total billed charges ",131.95,175.31,
"ROOM & BOARD TELE ICU",35006,"CDM ",206,RC,,,INPATIENT,,,1734,1387.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1387.2,80,,1109.76,,,0,"percent of total billed charges ","80% of total billed charges ",,,,,,,0,other,"not separately reimbursment ",1560.6,90,,1248.48,,,0,"percent of total billed charges ","90% of total billed charges ",1612.62,93,,1290.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1473.9,85,,1179.12,,,0,"percent of total billed charges ","85% of total billed charges ",2451.85,,,,,,0,"per diem ","pays based on per day  rate ",1560.6,90,,1248.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1508.58,87,,1206.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1213.8,70,,971.04,,,0,"percent of total billed charges ","70% of total billed charges ",1213.8,2451.85,
"VAGINAL DELIVERY PROCEDURE",4000212,"CDM ",720,RC,,,OUTPATIENT,,,7183,5746.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5746.4,80,,4597.12,,,0,"percent of total billed charges ","80% of total billed charges ",5028.1,70,,4022.48,,,0,"percent of total billed charges ","70% of total billed charges ",6464.7,90,,5171.76,,,0,"percent of total billed charges ","90% of total billed charges ",6680.19,93,,5344.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6105.55,85,,4884.44,,,0,"percent of total billed charges ","85% of total billed charges ",6464.7,90,,5171.76,,,0,"percent of total billed charges ","90% of total billed charges ",6464.7,90,,5171.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6249.21,87,,4999.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5028.1,70,,4022.48,,,0,"percent of total billed charges ","70% of total billed charges ",5028.1,6680.19,
"LABOR WITH C-SECTION PROCEDURE",4000220,"CDM ",720,RC,,,OUTPATIENT,,,4774.5,3819.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3819.6,80,,3055.68,,,0,"percent of total billed charges ","80% of total billed charges ",3342.15,70,,2673.72,,,0,"percent of total billed charges ","70% of total billed charges ",4297.05,90,,3437.64,,,0,"percent of total billed charges ","90% of total billed charges ",4440.29,93,,3552.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4058.33,85,,3246.66,,,0,"percent of total billed charges ","85% of total billed charges ",4297.05,90,,3437.64,,,0,"percent of total billed charges ","90% of total billed charges ",4297.05,90,,3437.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4153.82,87,,3323.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3342.15,70,,2673.72,,,0,"percent of total billed charges ","70% of total billed charges ",3342.15,4440.29,
"EPIDURAL PROCEDURE",4000238,"CDM ",720,RC,,,OUTPATIENT,,,668.5,534.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",534.8,80,,427.84,,,0,"percent of total billed charges ","80% of total billed charges ",467.95,70,,374.36,,,0,"percent of total billed charges ","70% of total billed charges ",601.65,90,,481.32,,,0,"percent of total billed charges ","90% of total billed charges ",621.71,93,,497.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",568.23,85,,454.58,,,0,"percent of total billed charges ","85% of total billed charges ",601.65,90,,481.32,,,0,"percent of total billed charges ","90% of total billed charges ",601.65,90,,481.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",581.6,87,,465.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",467.95,70,,374.36,,,0,"percent of total billed charges ","70% of total billed charges ",467.95,621.71,
"OB RECOVERY",4000240,"CDM ",710,RC,,,OUTPATIENT,,,1149,919.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",919.2,80,,735.36,,,0,"percent of total billed charges ","80% of total billed charges ",804.3,70,,643.44,,,0,"percent of total billed charges ","70% of total billed charges ",1034.1,90,,827.28,,,0,"percent of total billed charges ","90% of total billed charges ",1068.57,93,,854.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",976.65,85,,781.32,,,0,"percent of total billed charges ","85% of total billed charges ",1034.1,90,,827.28,,,0,"percent of total billed charges ","90% of total billed charges ",1034.1,90,,827.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",999.63,87,,799.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",804.3,70,,643.44,,,0,"percent of total billed charges ","70% of total billed charges ",804.3,1068.57,
"OB DELIVERY PACK",4000610,"CDM ",720,RC,,,OUTPATIENT,,,326.5,261.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",261.2,80,,208.96,,,0,"percent of total billed charges ","80% of total billed charges ",228.55,70,,182.84,,,0,"percent of total billed charges ","70% of total billed charges ",293.85,90,,235.08,,,0,"percent of total billed charges ","90% of total billed charges ",303.65,93,,242.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",277.53,85,,222.02,,,0,"percent of total billed charges ","85% of total billed charges ",293.85,90,,235.08,,,0,"percent of total billed charges ","90% of total billed charges ",293.85,90,,235.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",284.06,87,,227.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",228.55,70,,182.84,,,0,"percent of total billed charges ","70% of total billed charges ",228.55,303.65,
"CSECTION 1ST 15 MIN",4000800,"CDM ",360,RC,,,OUTPATIENT,,,3528.5,2822.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2822.8,80,,2258.24,,,0,"percent of total billed charges ","80% of total billed charges ",2469.95,70,,1975.96,,,0,"percent of total billed charges ","70% of total billed charges ",3175.65,90,,2540.52,,,0,"percent of total billed charges ","90% of total billed charges ",3281.51,93,,2625.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2999.23,85,,2399.38,,,0,"percent of total billed charges ","85% of total billed charges ",3175.65,90,,2540.52,,,0,"percent of total billed charges ","90% of total billed charges ",3175.65,90,,2540.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3069.8,87,,2455.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2469.95,70,,1975.96,,,0,"percent of total billed charges ","70% of total billed charges ",2469.95,3281.51,
"CSECTION SUB 15 MIN",4000805,"CDM ",360,RC,,,OUTPATIENT,,,1764,1411.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1411.2,80,,1128.96,,,0,"percent of total billed charges ","80% of total billed charges ",1234.8,70,,987.84,,,0,"percent of total billed charges ","70% of total billed charges ",1587.6,90,,1270.08,,,0,"percent of total billed charges ","90% of total billed charges ",1640.52,93,,1312.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1499.4,85,,1199.52,,,0,"percent of total billed charges ","85% of total billed charges ",1587.6,90,,1270.08,,,0,"percent of total billed charges ","90% of total billed charges ",1587.6,90,,1270.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1534.68,87,,1227.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1234.8,70,,987.84,,,0,"percent of total billed charges ","70% of total billed charges ",1234.8,1640.52,
"CSECTION W/TUBAL 1ST 15 MIN",4000810,"CDM ",360,RC,,,OUTPATIENT,,,3528.5,2822.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2822.8,80,,2258.24,,,0,"percent of total billed charges ","80% of total billed charges ",2469.95,70,,1975.96,,,0,"percent of total billed charges ","70% of total billed charges ",3175.65,90,,2540.52,,,0,"percent of total billed charges ","90% of total billed charges ",3281.51,93,,2625.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2999.23,85,,2399.38,,,0,"percent of total billed charges ","85% of total billed charges ",3175.65,90,,2540.52,,,0,"percent of total billed charges ","90% of total billed charges ",3175.65,90,,2540.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3069.8,87,,2455.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2469.95,70,,1975.96,,,0,"percent of total billed charges ","70% of total billed charges ",2469.95,3281.51,
"CSECTION W/TUBAL SUB 15 MIN",4000815,"CDM ",360,RC,,,OUTPATIENT,,,1764,1411.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1411.2,80,,1128.96,,,0,"percent of total billed charges ","80% of total billed charges ",1234.8,70,,987.84,,,0,"percent of total billed charges ","70% of total billed charges ",1587.6,90,,1270.08,,,0,"percent of total billed charges ","90% of total billed charges ",1640.52,93,,1312.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1499.4,85,,1199.52,,,0,"percent of total billed charges ","85% of total billed charges ",1587.6,90,,1270.08,,,0,"percent of total billed charges ","90% of total billed charges ",1587.6,90,,1270.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1534.68,87,,1227.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1234.8,70,,987.84,,,0,"percent of total billed charges ","70% of total billed charges ",1234.8,1640.52,
"CHILDBIRTH CLASS",4000820,"CDM ",250,RC,,,OUTPATIENT,,,50,40,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40,80,,32.00,,,0,"percent of total billed charges ","80% of total billed charges ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",46.5,93,,37.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.5,85,,34.00,,,0,"percent of total billed charges ","85% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.5,87,,34.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",35,46.5,
"EXTRA SUTURE",4600078,"CDM ",272,RC,,,OUTPATIENT,,,91.5,73.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.2,80,,58.56,,,0,"percent of total billed charges ","80% of total billed charges ",64.05,70,,51.24,,,0,"percent of total billed charges ","70% of total billed charges ",82.35,90,,65.88,,,0,"percent of total billed charges ","90% of total billed charges ",85.1,93,,68.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",77.78,85,,62.22,,,0,"percent of total billed charges ","85% of total billed charges ",82.35,90,,65.88,,,0,"percent of total billed charges ","90% of total billed charges ",82.35,90,,65.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",79.61,87,,63.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.05,70,,51.24,,,0,"percent of total billed charges ","70% of total billed charges ",64.05,85.1,
"TRAUMA ACT WO CRT CARE",4600235,"CDM ",684,RC,,,OUTPATIENT,,,,,,,,,,,,0,"other ","not separately reimbursment ",1.01,,,,,,0,"case rate ","pays based on per visit rate ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.01,1.01,
"IV PUSH SAME DRUG < 30 MIN",4603500,"CDM ",450,RC,,,OUTPATIENT,,,166,132.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.8,80,,106.24,,,0,"percent of total billed charges ","80% of total billed charges ",116.2,70,,92.96,,,0,"percent of total billed charges ","70% of total billed charges ",149.4,90,,119.52,,,0,"percent of total billed charges ","90% of total billed charges ",154.38,93,,123.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",141.1,85,,112.88,,,0,"percent of total billed charges ","85% of total billed charges ",149.4,90,,119.52,,,0,"percent of total billed charges ","90% of total billed charges ",149.4,90,,119.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",144.42,87,,115.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.2,70,,92.96,,,0,"percent of total billed charges ","70% of total billed charges ",116.2,154.38,
"OXYGEN PER HOUR",5000013,"CDM ",271,RC,,,OUTPATIENT,,,33,26.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.4,80,,21.12,,,0,"percent of total billed charges ","80% of total billed charges ",23.1,70,,18.48,,,0,"percent of total billed charges ","70% of total billed charges ",29.7,90,,23.76,,,0,"percent of total billed charges ","90% of total billed charges ",30.69,93,,24.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.05,85,,22.44,,,0,"percent of total billed charges ","85% of total billed charges ",29.7,90,,23.76,,,0,"percent of total billed charges ","90% of total billed charges ",29.7,90,,23.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",28.71,87,,22.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.1,70,,18.48,,,0,"percent of total billed charges ","70% of total billed charges ",23.1,30.69,
"OXYGEN DAILY",5001630,"CDM ",271,RC,,,OUTPATIENT,,,823,658.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",658.4,80,,526.72,,,0,"percent of total billed charges ","80% of total billed charges ",576.1,70,,460.88,,,0,"percent of total billed charges ","70% of total billed charges ",740.7,90,,592.56,,,0,"percent of total billed charges ","90% of total billed charges ",765.39,93,,612.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",699.55,85,,559.64,,,0,"percent of total billed charges ","85% of total billed charges ",740.7,90,,592.56,,,0,"percent of total billed charges ","90% of total billed charges ",740.7,90,,592.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",716.01,87,,572.81,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",576.1,70,,460.88,,,0,"percent of total billed charges ","70% of total billed charges ",576.1,765.39,
"OXYGEN UPTO 12 HOURS",5001640,"CDM ",271,RC,,,OUTPATIENT,,,411.5,329.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",329.2,80,,263.36,,,0,"percent of total billed charges ","80% of total billed charges ",288.05,70,,230.44,,,0,"percent of total billed charges ","70% of total billed charges ",370.35,90,,296.28,,,0,"percent of total billed charges ","90% of total billed charges ",382.7,93,,306.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",349.78,85,,279.82,,,0,"percent of total billed charges ","85% of total billed charges ",370.35,90,,296.28,,,0,"percent of total billed charges ","90% of total billed charges ",370.35,90,,296.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",358.01,87,,286.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",288.05,70,,230.44,,,0,"percent of total billed charges ","70% of total billed charges ",288.05,382.7,
"CATH TRAY IRRIGATION 16FR",6000004,"CDM ",272,RC,,,OUTPATIENT,,,60.01,48.008,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.01,80,,38.41,,,0,"percent of total billed charges ","80% of total billed charges ",42.01,70,,33.61,,,0,"percent of total billed charges ","70% of total billed charges ",54.01,90,,43.21,,,0,"percent of total billed charges ","90% of total billed charges ",55.81,93,,44.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51.01,85,,40.81,,,0,"percent of total billed charges ","85% of total billed charges ",54.01,90,,43.21,,,0,"percent of total billed charges ","90% of total billed charges ",54.01,90,,43.21,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",52.21,87,,41.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.01,70,,33.61,,,0,"percent of total billed charges ","70% of total billed charges ",42.01,55.81,
"CATH TRAY IRRIGATION 16FR",6000004,"CDM ",272,RC,,,OUTPATIENT,,,60.01,48.008,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.01,80,,38.41,,,0,"percent of total billed charges ","80% of total billed charges ",42.01,70,,33.61,,,0,"percent of total billed charges ","70% of total billed charges ",54.01,90,,43.21,,,0,"percent of total billed charges ","90% of total billed charges ",55.81,93,,44.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51.01,85,,40.81,,,0,"percent of total billed charges ","85% of total billed charges ",54.01,90,,43.21,,,0,"percent of total billed charges ","90% of total billed charges ",54.01,90,,43.21,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",52.21,87,,41.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.01,70,,33.61,,,0,"percent of total billed charges ","70% of total billed charges ",42.01,55.81,
"PROTECTOR FINGER TIP, LRG",6000018,"CDM ",272,RC,,,OUTPATIENT,,,20.16,16.128,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.13,80,,12.90,,,0,"percent of total billed charges ","80% of total billed charges ",14.11,70,,11.29,,,0,"percent of total billed charges ","70% of total billed charges ",18.14,90,,14.51,,,0,"percent of total billed charges ","90% of total billed charges ",18.75,93,,15.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.14,85,,13.71,,,0,"percent of total billed charges ","85% of total billed charges ",18.14,90,,14.51,,,0,"percent of total billed charges ","90% of total billed charges ",18.14,90,,14.51,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.54,87,,14.03,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.11,70,,11.29,,,0,"percent of total billed charges ","70% of total billed charges ",14.11,18.75,
"PROTECTOR FINGER TIP MED",6000021,"CDM ",272,RC,,,OUTPATIENT,,,19.76,15.808,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.81,80,,12.65,,,0,"percent of total billed charges ","80% of total billed charges ",13.83,70,,11.06,,,0,"percent of total billed charges ","70% of total billed charges ",17.78,90,,14.22,,,0,"percent of total billed charges ","90% of total billed charges ",18.38,93,,14.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.8,85,,13.44,,,0,"percent of total billed charges ","85% of total billed charges ",17.78,90,,14.22,,,0,"percent of total billed charges ","90% of total billed charges ",17.78,90,,14.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.19,87,,13.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.83,70,,11.06,,,0,"percent of total billed charges ","70% of total billed charges ",13.83,18.38,
"BAG CYSTO DRAINAGE",6000028,"CDM ",272,RC,,,OUTPATIENT,,,17.15,13.72,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.72,80,,10.98,,,0,"percent of total billed charges ","80% of total billed charges ",12.01,70,,9.61,,,0,"percent of total billed charges ","70% of total billed charges ",15.44,90,,12.35,,,0,"percent of total billed charges ","90% of total billed charges ",15.95,93,,12.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.58,85,,11.66,,,0,"percent of total billed charges ","85% of total billed charges ",15.44,90,,12.35,,,0,"percent of total billed charges ","90% of total billed charges ",15.44,90,,12.35,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.92,87,,11.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.01,70,,9.61,,,0,"percent of total billed charges ","70% of total billed charges ",12.01,15.95,
"SUTURE 1856G 6.0 ETH PC3",6000031,"CDM ",272,RC,,,OUTPATIENT,,,14.19,11.352,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.35,80,,9.08,,,0,"percent of total billed charges ","80% of total billed charges ",9.93,70,,7.94,,,0,"percent of total billed charges ","70% of total billed charges ",12.77,90,,10.22,,,0,"percent of total billed charges ","90% of total billed charges ",13.2,93,,10.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.06,85,,9.65,,,0,"percent of total billed charges ","85% of total billed charges ",12.77,90,,10.22,,,0,"percent of total billed charges ","90% of total billed charges ",12.77,90,,10.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.35,87,,9.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.93,70,,7.94,,,0,"percent of total billed charges ","70% of total billed charges ",9.93,13.2,
"BAG URINE METER",6000035,"CDM ",272,RC,,,OUTPATIENT,,,49.3,39.44,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.44,80,,31.55,,,0,"percent of total billed charges ","80% of total billed charges ",34.51,70,,27.61,,,0,"percent of total billed charges ","70% of total billed charges ",44.37,90,,35.50,,,0,"percent of total billed charges ","90% of total billed charges ",45.85,93,,36.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.91,85,,33.53,,,0,"percent of total billed charges ","85% of total billed charges ",44.37,90,,35.50,,,0,"percent of total billed charges ","90% of total billed charges ",44.37,90,,35.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.89,87,,34.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.51,70,,27.61,,,0,"percent of total billed charges ","70% of total billed charges ",34.51,45.85,
"TRAY LUMBAR PUNCT PEDI",6000042,"CDM ",272,RC,,,OUTPATIENT,,,44.83,35.864,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.86,80,,28.69,,,0,"percent of total billed charges ","80% of total billed charges ",31.38,70,,25.10,,,0,"percent of total billed charges ","70% of total billed charges ",40.35,90,,32.28,,,0,"percent of total billed charges ","90% of total billed charges ",41.69,93,,33.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.11,85,,30.49,,,0,"percent of total billed charges ","85% of total billed charges ",40.35,90,,32.28,,,0,"percent of total billed charges ","90% of total billed charges ",40.35,90,,32.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39,87,,31.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.38,70,,25.10,,,0,"percent of total billed charges ","70% of total billed charges ",31.38,41.69,
"SPRAY ADHESIVE REMOVER",6000045,"CDM ",270,RC,,,OUTPATIENT,,,12.64,10.112,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.11,80,,8.09,,,0,"percent of total billed charges ","80% of total billed charges ",8.85,70,,7.08,,,0,"percent of total billed charges ","70% of total billed charges ",11.38,90,,9.10,,,0,"percent of total billed charges ","90% of total billed charges ",11.76,93,,9.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.74,85,,8.59,,,0,"percent of total billed charges ","85% of total billed charges ",11.38,90,,9.10,,,0,"percent of total billed charges ","90% of total billed charges ",11.38,90,,9.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11,87,,8.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.85,70,,7.08,,,0,"percent of total billed charges ","70% of total billed charges ",8.85,11.76,
"SPRAY ADHESIVE REMOVER",6000045,"CDM ",270,RC,,,OUTPATIENT,,,12.64,10.112,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.11,80,,8.09,,,0,"percent of total billed charges ","80% of total billed charges ",8.85,70,,7.08,,,0,"percent of total billed charges ","70% of total billed charges ",11.38,90,,9.10,,,0,"percent of total billed charges ","90% of total billed charges ",11.76,93,,9.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.74,85,,8.59,,,0,"percent of total billed charges ","85% of total billed charges ",11.38,90,,9.10,,,0,"percent of total billed charges ","90% of total billed charges ",11.38,90,,9.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11,87,,8.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.85,70,,7.08,,,0,"percent of total billed charges ","70% of total billed charges ",8.85,11.76,
"BINDER ABDOMINAL LG",6000047,"CDM ",272,RC,,,OUTPATIENT,,,36.81,29.448,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.45,80,,23.56,,,0,"percent of total billed charges ","80% of total billed charges ",25.77,70,,20.62,,,0,"percent of total billed charges ","70% of total billed charges ",33.13,90,,26.50,,,0,"percent of total billed charges ","90% of total billed charges ",34.23,93,,27.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",31.29,85,,25.03,,,0,"percent of total billed charges ","85% of total billed charges ",33.13,90,,26.50,,,0,"percent of total billed charges ","90% of total billed charges ",33.13,90,,26.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",32.02,87,,25.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.77,70,,20.62,,,0,"percent of total billed charges ","70% of total billed charges ",25.77,34.23,
"SPLINT WRIST SM RT",6000049,"CDM ",271,RC,,,OUTPATIENT,,,19.46,15.568,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.57,80,,12.46,,,0,"percent of total billed charges ","80% of total billed charges ",13.62,70,,10.90,,,0,"percent of total billed charges ","70% of total billed charges ",17.51,90,,14.01,,,0,"percent of total billed charges ","90% of total billed charges ",18.1,93,,14.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.54,85,,13.23,,,0,"percent of total billed charges ","85% of total billed charges ",17.51,90,,14.01,,,0,"percent of total billed charges ","90% of total billed charges ",17.51,90,,14.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.93,87,,13.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.62,70,,10.90,,,0,"percent of total billed charges ","70% of total billed charges ",13.62,18.1,
"SPLINT WRIST MED RIGHT",6000053,"CDM ",271,RC,,,OUTPATIENT,,,19.76,15.808,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.81,80,,12.65,,,0,"percent of total billed charges ","80% of total billed charges ",13.83,70,,11.06,,,0,"percent of total billed charges ","70% of total billed charges ",17.78,90,,14.22,,,0,"percent of total billed charges ","90% of total billed charges ",18.38,93,,14.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.8,85,,13.44,,,0,"percent of total billed charges ","85% of total billed charges ",17.78,90,,14.22,,,0,"percent of total billed charges ","90% of total billed charges ",17.78,90,,14.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.19,87,,13.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.83,70,,11.06,,,0,"percent of total billed charges ","70% of total billed charges ",13.83,18.38,
"SPLINT WRIST MED LEFT",6000054,"CDM ",271,RC,,,OUTPATIENT,,,19.76,15.808,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.81,80,,12.65,,,0,"percent of total billed charges ","80% of total billed charges ",13.83,70,,11.06,,,0,"percent of total billed charges ","70% of total billed charges ",17.78,90,,14.22,,,0,"percent of total billed charges ","90% of total billed charges ",18.38,93,,14.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.8,85,,13.44,,,0,"percent of total billed charges ","85% of total billed charges ",17.78,90,,14.22,,,0,"percent of total billed charges ","90% of total billed charges ",17.78,90,,14.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.19,87,,13.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.83,70,,11.06,,,0,"percent of total billed charges ","70% of total billed charges ",13.83,18.38,
"SET EXTENSION W/Y SITE",6000070,"CDM ",272,RC,,,OUTPATIENT,,,6.92,5.536,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.54,80,,4.43,,,0,"percent of total billed charges ","80% of total billed charges ",4.84,70,,3.87,,,0,"percent of total billed charges ","70% of total billed charges ",6.23,90,,4.98,,,0,"percent of total billed charges ","90% of total billed charges ",6.44,93,,5.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.88,85,,4.70,,,0,"percent of total billed charges ","85% of total billed charges ",6.23,90,,4.98,,,0,"percent of total billed charges ","90% of total billed charges ",6.23,90,,4.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.02,87,,4.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.84,70,,3.87,,,0,"percent of total billed charges ","70% of total billed charges ",4.84,6.44,
"SOLUTION H20 IRRIGATION BOTTLE",6000074,"CDM ",272,RC,,,OUTPATIENT,,,15.05,12.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.04,80,,9.63,,,0,"percent of total billed charges ","80% of total billed charges ",10.54,70,,8.43,,,0,"percent of total billed charges ","70% of total billed charges ",13.55,90,,10.84,,,0,"percent of total billed charges ","90% of total billed charges ",14,93,,11.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.79,85,,10.23,,,0,"percent of total billed charges ","85% of total billed charges ",13.55,90,,10.84,,,0,"percent of total billed charges ","90% of total billed charges ",13.55,90,,10.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.09,87,,10.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.54,70,,8.43,,,0,"percent of total billed charges ","70% of total billed charges ",10.54,14,
"NEEDLE MONOPTY 18GX9CM",6000082,"CDM ",270,RC,,,OUTPATIENT,,,163.35,130.68,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.68,80,,104.54,,,0,"percent of total billed charges ","80% of total billed charges ",114.35,70,,91.48,,,0,"percent of total billed charges ","70% of total billed charges ",147.02,90,,117.62,,,0,"percent of total billed charges ","90% of total billed charges ",151.92,93,,121.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",138.85,85,,111.08,,,0,"percent of total billed charges ","85% of total billed charges ",147.02,90,,117.62,,,0,"percent of total billed charges ","90% of total billed charges ",147.02,90,,117.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",142.11,87,,113.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.35,70,,91.48,,,0,"percent of total billed charges ","70% of total billed charges ",114.35,151.92,
"SET VENOSET SURGICAL N-V",6000087,"CDM ",272,RC,,,OUTPATIENT,,,8.88,7.104,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.1,80,,5.68,,,0,"percent of total billed charges ","80% of total billed charges ",6.22,70,,4.98,,,0,"percent of total billed charges ","70% of total billed charges ",7.99,90,,6.39,,,0,"percent of total billed charges ","90% of total billed charges ",8.26,93,,6.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7.55,85,,6.04,,,0,"percent of total billed charges ","85% of total billed charges ",7.99,90,,6.39,,,0,"percent of total billed charges ","90% of total billed charges ",7.99,90,,6.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7.73,87,,6.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.22,70,,4.98,,,0,"percent of total billed charges ","70% of total billed charges ",6.22,8.26,
"TRAY CATH 16FR COUDE",6000089,"CDM ",272,RC,,,OUTPATIENT,,,14.34,11.472,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.47,80,,9.18,,,0,"percent of total billed charges ","80% of total billed charges ",10.04,70,,8.03,,,0,"percent of total billed charges ","70% of total billed charges ",12.91,90,,10.33,,,0,"percent of total billed charges ","90% of total billed charges ",13.34,93,,10.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.19,85,,9.75,,,0,"percent of total billed charges ","85% of total billed charges ",12.91,90,,10.33,,,0,"percent of total billed charges ","90% of total billed charges ",12.91,90,,10.33,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.48,87,,9.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.04,70,,8.03,,,0,"percent of total billed charges ","70% of total billed charges ",10.04,13.34,
"REMOVER STAPLE SURGICAL",6000093,"CDM ",272,RC,,,OUTPATIENT,,,11.28,9.024,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.02,80,,7.22,,,0,"percent of total billed charges ","80% of total billed charges ",7.9,70,,6.32,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,90,,8.12,,,0,"percent of total billed charges ","90% of total billed charges ",10.49,93,,8.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.59,85,,7.67,,,0,"percent of total billed charges ","85% of total billed charges ",10.15,90,,8.12,,,0,"percent of total billed charges ","90% of total billed charges ",10.15,90,,8.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.81,87,,7.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.9,70,,6.32,,,0,"percent of total billed charges ","70% of total billed charges ",7.9,10.49,
"REMOVER STAPLE SURGICAL",6000093,"CDM ",272,RC,,,OUTPATIENT,,,11.28,9.024,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.02,80,,7.22,,,0,"percent of total billed charges ","80% of total billed charges ",7.9,70,,6.32,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,90,,8.12,,,0,"percent of total billed charges ","90% of total billed charges ",10.49,93,,8.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.59,85,,7.67,,,0,"percent of total billed charges ","85% of total billed charges ",10.15,90,,8.12,,,0,"percent of total billed charges ","90% of total billed charges ",10.15,90,,8.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.81,87,,7.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.9,70,,6.32,,,0,"percent of total billed charges ","70% of total billed charges ",7.9,10.49,
"KIT ARTERIAL CATH",6000105,"CDM ",272,RC,,,OUTPATIENT,,,38.72,30.976,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.98,80,,24.78,,,0,"percent of total billed charges ","80% of total billed charges ",27.1,70,,21.68,,,0,"percent of total billed charges ","70% of total billed charges ",34.85,90,,27.88,,,0,"percent of total billed charges ","90% of total billed charges ",36.01,93,,28.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.91,85,,26.33,,,0,"percent of total billed charges ","85% of total billed charges ",34.85,90,,27.88,,,0,"percent of total billed charges ","90% of total billed charges ",34.85,90,,27.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.69,87,,26.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.1,70,,21.68,,,0,"percent of total billed charges ","70% of total billed charges ",27.1,36.01,
"PAD EYE OVAL",6000116,"CDM ",271,RC,,,OUTPATIENT,,,1.05,0.84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.84,80,,0.67,,,0,"percent of total billed charges ","80% of total billed charges ",0.74,70,,0.59,,,0,"percent of total billed charges ","70% of total billed charges ",0.95,90,,0.76,,,0,"percent of total billed charges ","90% of total billed charges ",0.98,93,,0.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",0.89,85,,0.71,,,0,"percent of total billed charges ","85% of total billed charges ",0.95,90,,0.76,,,0,"percent of total billed charges ","90% of total billed charges ",0.95,90,,0.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",0.91,87,,0.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.74,70,,0.59,,,0,"percent of total billed charges ","70% of total billed charges ",0.74,0.98,
"BOTTLE PERI",6000139,"CDM ",272,RC,,,OUTPATIENT,,,1.61,1.288,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.29,80,,1.03,,,0,"percent of total billed charges ","80% of total billed charges ",1.13,70,,0.90,,,0,"percent of total billed charges ","70% of total billed charges ",1.45,90,,1.16,,,0,"percent of total billed charges ","90% of total billed charges ",1.5,93,,1.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1.37,85,,1.10,,,0,"percent of total billed charges ","85% of total billed charges ",1.45,90,,1.16,,,0,"percent of total billed charges ","90% of total billed charges ",1.45,90,,1.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1.4,87,,1.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.13,70,,0.90,,,0,"percent of total billed charges ","70% of total billed charges ",1.13,1.5,
"GLIDESCOPE BFLEX BRONCH 5.8",6000142,"CDM ",270,RC,,,OUTPATIENT,,,624.95,499.96,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",499.96,80,,399.97,,,0,"percent of total billed charges ","80% of total billed charges ",437.47,70,,349.98,,,0,"percent of total billed charges ","70% of total billed charges ",562.46,90,,449.97,,,0,"percent of total billed charges ","90% of total billed charges ",581.2,93,,464.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",531.21,85,,424.97,,,0,"percent of total billed charges ","85% of total billed charges ",562.46,90,,449.97,,,0,"percent of total billed charges ","90% of total billed charges ",562.46,90,,449.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",543.71,87,,434.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",437.47,70,,349.98,,,0,"percent of total billed charges ","70% of total billed charges ",437.47,581.2,
"GLIDESCOPE BFLEX BRONCH 5.0",6000143,"CDM ",270,RC,,,OUTPATIENT,,,559.22,447.376,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",447.38,80,,357.90,,,0,"percent of total billed charges ","80% of total billed charges ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",520.07,93,,416.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",475.34,85,,380.27,,,0,"percent of total billed charges ","85% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",503.3,90,,402.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",486.52,87,,389.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",391.45,70,,313.16,,,0,"percent of total billed charges ","70% of total billed charges ",391.45,520.07,
"GLIDESCOPE SPECTRUM DVM S3",6000152,"CDM ",270,RC,,,OUTPATIENT,,,168.91,135.128,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.13,80,,108.10,,,0,"percent of total billed charges ","80% of total billed charges ",118.24,70,,94.59,,,0,"percent of total billed charges ","70% of total billed charges ",152.02,90,,121.62,,,0,"percent of total billed charges ","90% of total billed charges ",157.09,93,,125.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",143.57,85,,114.86,,,0,"percent of total billed charges ","85% of total billed charges ",152.02,90,,121.62,,,0,"percent of total billed charges ","90% of total billed charges ",152.02,90,,121.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",146.95,87,,117.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.24,70,,94.59,,,0,"percent of total billed charges ","70% of total billed charges ",118.24,157.09,
"GLIDESCOPE SPECTRUM DVMS4",6000163,"CDM ",270,RC,,,OUTPATIENT,,,168.91,135.128,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.13,80,,108.10,,,0,"percent of total billed charges ","80% of total billed charges ",118.24,70,,94.59,,,0,"percent of total billed charges ","70% of total billed charges ",152.02,90,,121.62,,,0,"percent of total billed charges ","90% of total billed charges ",157.09,93,,125.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",143.57,85,,114.86,,,0,"percent of total billed charges ","85% of total billed charges ",152.02,90,,121.62,,,0,"percent of total billed charges ","90% of total billed charges ",152.02,90,,121.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",146.95,87,,117.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.24,70,,94.59,,,0,"percent of total billed charges ","70% of total billed charges ",118.24,157.09,
"CANNULA HIGH FLOW ADULT",6000168,"CDM ",270,RC,,,OUTPATIENT,,,14.44,11.552,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.55,80,,9.24,,,0,"percent of total billed charges ","80% of total billed charges ",10.11,70,,8.09,,,0,"percent of total billed charges ","70% of total billed charges ",13,90,,10.40,,,0,"percent of total billed charges ","90% of total billed charges ",13.43,93,,10.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.27,85,,9.82,,,0,"percent of total billed charges ","85% of total billed charges ",13,90,,10.40,,,0,"percent of total billed charges ","90% of total billed charges ",13,90,,10.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.56,87,,10.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.11,70,,8.09,,,0,"percent of total billed charges ","70% of total billed charges ",10.11,13.43,
"STYLET GLIDERITE SU LG",6000172,"CDM ",270,RC,,,OUTPATIENT,,,47.64,38.112,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.11,80,,30.49,,,0,"percent of total billed charges ","80% of total billed charges ",33.35,70,,26.68,,,0,"percent of total billed charges ","70% of total billed charges ",42.88,90,,34.30,,,0,"percent of total billed charges ","90% of total billed charges ",44.31,93,,35.45,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.49,85,,32.39,,,0,"percent of total billed charges ","85% of total billed charges ",42.88,90,,34.30,,,0,"percent of total billed charges ","90% of total billed charges ",42.88,90,,34.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.45,87,,33.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.35,70,,26.68,,,0,"percent of total billed charges ","70% of total billed charges ",33.35,44.31,
"AIRWAY 90MM",6000183,"CDM ",272,RC,,,OUTPATIENT,,,1.1,0.88,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.88,80,,0.70,,,0,"percent of total billed charges ","80% of total billed charges ",0.77,70,,0.62,,,0,"percent of total billed charges ","70% of total billed charges ",0.99,90,,0.79,,,0,"percent of total billed charges ","90% of total billed charges ",1.02,93,,0.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",0.94,85,,0.75,,,0,"percent of total billed charges ","85% of total billed charges ",0.99,90,,0.79,,,0,"percent of total billed charges ","90% of total billed charges ",0.99,90,,0.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",0.96,87,,0.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.77,70,,0.62,,,0,"percent of total billed charges ","70% of total billed charges ",0.77,1.02,
"HOLDER CATH FOLEY",6000206,"CDM ",272,RC,,,OUTPATIENT,,,17.9,14.32,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.32,80,,11.46,,,0,"percent of total billed charges ","80% of total billed charges ",12.53,70,,10.02,,,0,"percent of total billed charges ","70% of total billed charges ",16.11,90,,12.89,,,0,"percent of total billed charges ","90% of total billed charges ",16.65,93,,13.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.22,85,,12.18,,,0,"percent of total billed charges ","85% of total billed charges ",16.11,90,,12.89,,,0,"percent of total billed charges ","90% of total billed charges ",16.11,90,,12.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.57,87,,12.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.53,70,,10.02,,,0,"percent of total billed charges ","70% of total billed charges ",12.53,16.65,
"TUB TRACH SHILEY 7.0MM",6000229,"CDM ",272,RC,,,OUTPATIENT,,,161.84,129.472,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.47,80,,103.58,,,0,"percent of total billed charges ","80% of total billed charges ",113.29,70,,90.63,,,0,"percent of total billed charges ","70% of total billed charges ",145.66,90,,116.53,,,0,"percent of total billed charges ","90% of total billed charges ",150.51,93,,120.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",137.56,85,,110.05,,,0,"percent of total billed charges ","85% of total billed charges ",145.66,90,,116.53,,,0,"percent of total billed charges ","90% of total billed charges ",145.66,90,,116.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",140.8,87,,112.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.29,70,,90.63,,,0,"percent of total billed charges ","70% of total billed charges ",113.29,150.51,
"TUBE TRACH SHILEY 7.5MM",6000230,"CDM ",272,RC,,,OUTPATIENT,,,161.84,129.472,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.47,80,,103.58,,,0,"percent of total billed charges ","80% of total billed charges ",113.29,70,,90.63,,,0,"percent of total billed charges ","70% of total billed charges ",145.66,90,,116.53,,,0,"percent of total billed charges ","90% of total billed charges ",150.51,93,,120.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",137.56,85,,110.05,,,0,"percent of total billed charges ","85% of total billed charges ",145.66,90,,116.53,,,0,"percent of total billed charges ","90% of total billed charges ",145.66,90,,116.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",140.8,87,,112.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.29,70,,90.63,,,0,"percent of total billed charges ","70% of total billed charges ",113.29,150.51,
"BOOT CAST X-SML",6000232,"CDM ",271,RC,,,OUTPATIENT,,,17.5,14,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14,80,,11.20,,,0,"percent of total billed charges ","80% of total billed charges ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",16.28,93,,13.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.88,85,,11.90,,,0,"percent of total billed charges ","85% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.23,87,,12.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",12.25,16.28,
"KIT DIGNISHEILD",6000235,"CDM ",272,RC,,,OUTPATIENT,,,351.46,281.168,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",281.17,80,,224.94,,,0,"percent of total billed charges ","80% of total billed charges ",246.02,70,,196.82,,,0,"percent of total billed charges ","70% of total billed charges ",316.31,90,,253.05,,,0,"percent of total billed charges ","90% of total billed charges ",326.86,93,,261.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",298.74,85,,238.99,,,0,"percent of total billed charges ","85% of total billed charges ",316.31,90,,253.05,,,0,"percent of total billed charges ","90% of total billed charges ",316.31,90,,253.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",305.77,87,,244.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",246.02,70,,196.82,,,0,"percent of total billed charges ","70% of total billed charges ",246.02,326.86,
"TUBE TRACH SHILEY 8.0",6000239,"CDM ",272,RC,,,OUTPATIENT,,,161.84,129.472,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.47,80,,103.58,,,0,"percent of total billed charges ","80% of total billed charges ",113.29,70,,90.63,,,0,"percent of total billed charges ","70% of total billed charges ",145.66,90,,116.53,,,0,"percent of total billed charges ","90% of total billed charges ",150.51,93,,120.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",137.56,85,,110.05,,,0,"percent of total billed charges ","85% of total billed charges ",145.66,90,,116.53,,,0,"percent of total billed charges ","90% of total billed charges ",145.66,90,,116.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",140.8,87,,112.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.29,70,,90.63,,,0,"percent of total billed charges ","70% of total billed charges ",113.29,150.51,
"CIRCUIT BREATHING W/LINE",6000241,"CDM ",272,RC,,,OUTPATIENT,,,52.5,42,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42,80,,33.60,,,0,"percent of total billed charges ","80% of total billed charges ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",48.83,93,,39.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",44.63,85,,35.70,,,0,"percent of total billed charges ","85% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",45.68,87,,36.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",36.75,48.83,
"TUBE TRACH SHILEY 8.5MM",6000242,"CDM ",272,RC,,,OUTPATIENT,,,161.84,129.472,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.47,80,,103.58,,,0,"percent of total billed charges ","80% of total billed charges ",113.29,70,,90.63,,,0,"percent of total billed charges ","70% of total billed charges ",145.66,90,,116.53,,,0,"percent of total billed charges ","90% of total billed charges ",150.51,93,,120.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",137.56,85,,110.05,,,0,"percent of total billed charges ","85% of total billed charges ",145.66,90,,116.53,,,0,"percent of total billed charges ","90% of total billed charges ",145.66,90,,116.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",140.8,87,,112.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.29,70,,90.63,,,0,"percent of total billed charges ","70% of total billed charges ",113.29,150.51,
"TUBE TRACH SHILEY 9.0",6000243,"CDM ",272,RC,,,OUTPATIENT,,,161.84,129.472,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.47,80,,103.58,,,0,"percent of total billed charges ","80% of total billed charges ",113.29,70,,90.63,,,0,"percent of total billed charges ","70% of total billed charges ",145.66,90,,116.53,,,0,"percent of total billed charges ","90% of total billed charges ",150.51,93,,120.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",137.56,85,,110.05,,,0,"percent of total billed charges ","85% of total billed charges ",145.66,90,,116.53,,,0,"percent of total billed charges ","90% of total billed charges ",145.66,90,,116.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",140.8,87,,112.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.29,70,,90.63,,,0,"percent of total billed charges ","70% of total billed charges ",113.29,150.51,
"SPECULUM SIGMODISCOPE DISP.",6000244,"CDM ",272,RC,,,OUTPATIENT,,,15.95,12.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.76,80,,10.21,,,0,"percent of total billed charges ","80% of total billed charges ",11.17,70,,8.94,,,0,"percent of total billed charges ","70% of total billed charges ",14.36,90,,11.49,,,0,"percent of total billed charges ","90% of total billed charges ",14.83,93,,11.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.56,85,,10.85,,,0,"percent of total billed charges ","85% of total billed charges ",14.36,90,,11.49,,,0,"percent of total billed charges ","90% of total billed charges ",14.36,90,,11.49,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.88,87,,11.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.17,70,,8.94,,,0,"percent of total billed charges ","70% of total billed charges ",11.17,14.83,
"TAPE CAST 4"" BLUE",6000245,"CDM ",272,RC,,,OUTPATIENT,,,18.3,14.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.64,80,,11.71,,,0,"percent of total billed charges ","80% of total billed charges ",12.81,70,,10.25,,,0,"percent of total billed charges ","70% of total billed charges ",16.47,90,,13.18,,,0,"percent of total billed charges ","90% of total billed charges ",17.02,93,,13.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.56,85,,12.45,,,0,"percent of total billed charges ","85% of total billed charges ",16.47,90,,13.18,,,0,"percent of total billed charges ","90% of total billed charges ",16.47,90,,13.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.92,87,,12.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.81,70,,10.25,,,0,"percent of total billed charges ","70% of total billed charges ",12.81,17.02,
"TUBE TRACH SHILEY 10.0MM",6000248,"CDM ",272,RC,,,OUTPATIENT,,,161.84,129.472,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.47,80,,103.58,,,0,"percent of total billed charges ","80% of total billed charges ",113.29,70,,90.63,,,0,"percent of total billed charges ","70% of total billed charges ",145.66,90,,116.53,,,0,"percent of total billed charges ","90% of total billed charges ",150.51,93,,120.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",137.56,85,,110.05,,,0,"percent of total billed charges ","85% of total billed charges ",145.66,90,,116.53,,,0,"percent of total billed charges ","90% of total billed charges ",145.66,90,,116.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",140.8,87,,112.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.29,70,,90.63,,,0,"percent of total billed charges ","70% of total billed charges ",113.29,150.51,
"DRESSING TELFA PAD 3*8",6000254,"CDM ",272,RC,,,OUTPATIENT,,,0.58,0.464,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.46,80,,0.37,,,0,"percent of total billed charges ","80% of total billed charges ",0.41,70,,0.33,,,0,"percent of total billed charges ","70% of total billed charges ",0.52,90,,0.42,,,0,"percent of total billed charges ","90% of total billed charges ",0.54,93,,0.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",0.49,85,,0.39,,,0,"percent of total billed charges ","85% of total billed charges ",0.52,90,,0.42,,,0,"percent of total billed charges ","90% of total billed charges ",0.52,90,,0.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",0.5,87,,0.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.41,70,,0.33,,,0,"percent of total billed charges ","70% of total billed charges ",0.41,0.54,
"KIT SHEATH INTRODUCER",6000255,"CDM ",272,RC,,,OUTPATIENT,,,181.58,145.264,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",145.26,80,,116.21,,,0,"percent of total billed charges ","80% of total billed charges ",127.11,70,,101.69,,,0,"percent of total billed charges ","70% of total billed charges ",163.42,90,,130.74,,,0,"percent of total billed charges ","90% of total billed charges ",168.87,93,,135.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",154.34,85,,123.47,,,0,"percent of total billed charges ","85% of total billed charges ",163.42,90,,130.74,,,0,"percent of total billed charges ","90% of total billed charges ",163.42,90,,130.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",157.97,87,,126.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.11,70,,101.69,,,0,"percent of total billed charges ","70% of total billed charges ",127.11,168.87,
"TIP ENEMA DUAL FLEX",6000274,"CDM ",272,RC,,,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.2,80,,31.36,,,0,"percent of total billed charges ","80% of total billed charges ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"NEBULIZER NEBUTECH HDN",6000288,"CDM ",271,RC,,,OUTPATIENT,,,35.11,28.088,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.09,80,,22.47,,,0,"percent of total billed charges ","80% of total billed charges ",24.58,70,,19.66,,,0,"percent of total billed charges ","70% of total billed charges ",31.6,90,,25.28,,,0,"percent of total billed charges ","90% of total billed charges ",32.65,93,,26.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",29.84,85,,23.87,,,0,"percent of total billed charges ","85% of total billed charges ",31.6,90,,25.28,,,0,"percent of total billed charges ","90% of total billed charges ",31.6,90,,25.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.55,87,,24.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.58,70,,19.66,,,0,"percent of total billed charges ","70% of total billed charges ",24.58,32.65,
"RENT FLOTATION MATTRESS DAILY",6000310,"CDM ",271,RC,,,OUTPATIENT,,,76.81,61.448,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.45,80,,49.16,,,0,"percent of total billed charges ","80% of total billed charges ",53.77,70,,43.02,,,0,"percent of total billed charges ","70% of total billed charges ",69.13,90,,55.30,,,0,"percent of total billed charges ","90% of total billed charges ",71.43,93,,57.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",65.29,85,,52.23,,,0,"percent of total billed charges ","85% of total billed charges ",69.13,90,,55.30,,,0,"percent of total billed charges ","90% of total billed charges ",69.13,90,,55.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",66.82,87,,53.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.77,70,,43.02,,,0,"percent of total billed charges ","70% of total billed charges ",53.77,71.43,
"DRAIN T-TUBE 18FR",6000320,"CDM ",272,RC,,,OUTPATIENT,,,35.96,28.768,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.77,80,,23.02,,,0,"percent of total billed charges ","80% of total billed charges ",25.17,70,,20.14,,,0,"percent of total billed charges ","70% of total billed charges ",32.36,90,,25.89,,,0,"percent of total billed charges ","90% of total billed charges ",33.44,93,,26.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",30.57,85,,24.46,,,0,"percent of total billed charges ","85% of total billed charges ",32.36,90,,25.89,,,0,"percent of total billed charges ","90% of total billed charges ",32.36,90,,25.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",31.29,87,,25.03,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.17,70,,20.14,,,0,"percent of total billed charges ","70% of total billed charges ",25.17,33.44,
"PACK LITHOTOMY DISP",6000329,"CDM ",272,RC,,,OUTPATIENT,,,25.98,20.784,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.78,80,,16.62,,,0,"percent of total billed charges ","80% of total billed charges ",18.19,70,,14.55,,,0,"percent of total billed charges ","70% of total billed charges ",23.38,90,,18.70,,,0,"percent of total billed charges ","90% of total billed charges ",24.16,93,,19.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",22.08,85,,17.66,,,0,"percent of total billed charges ","85% of total billed charges ",23.38,90,,18.70,,,0,"percent of total billed charges ","90% of total billed charges ",23.38,90,,18.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.6,87,,18.08,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.19,70,,14.55,,,0,"percent of total billed charges ","70% of total billed charges ",18.19,24.16,
"PROTECTOR EYE OPTI GARD",6000356,"CDM ",272,RC,,,OUTPATIENT,,,23.37,18.696,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.7,80,,14.96,,,0,"percent of total billed charges ","80% of total billed charges ",16.36,70,,13.09,,,0,"percent of total billed charges ","70% of total billed charges ",21.03,90,,16.82,,,0,"percent of total billed charges ","90% of total billed charges ",21.73,93,,17.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.86,85,,15.89,,,0,"percent of total billed charges ","85% of total billed charges ",21.03,90,,16.82,,,0,"percent of total billed charges ","90% of total billed charges ",21.03,90,,16.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.33,87,,16.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.36,70,,13.09,,,0,"percent of total billed charges ","70% of total billed charges ",16.36,21.73,
"KIT DRESSING CHANGE",6000371,"CDM ",272,RC,,,OUTPATIENT,,,19.51,15.608,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.61,80,,12.49,,,0,"percent of total billed charges ","80% of total billed charges ",13.66,70,,10.93,,,0,"percent of total billed charges ","70% of total billed charges ",17.56,90,,14.05,,,0,"percent of total billed charges ","90% of total billed charges ",18.14,93,,14.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.58,85,,13.26,,,0,"percent of total billed charges ","85% of total billed charges ",17.56,90,,14.05,,,0,"percent of total billed charges ","90% of total billed charges ",17.56,90,,14.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.97,87,,13.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.66,70,,10.93,,,0,"percent of total billed charges ","70% of total billed charges ",13.66,18.14,
"NEEDLE PORT-A-CATH 19GA",6000401,"CDM ",272,RC,,,OUTPATIENT,,,31.39,25.112,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.11,80,,20.09,,,0,"percent of total billed charges ","80% of total billed charges ",21.97,70,,17.58,,,0,"percent of total billed charges ","70% of total billed charges ",28.25,90,,22.60,,,0,"percent of total billed charges ","90% of total billed charges ",29.19,93,,23.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.68,85,,21.34,,,0,"percent of total billed charges ","85% of total billed charges ",28.25,90,,22.60,,,0,"percent of total billed charges ","90% of total billed charges ",28.25,90,,22.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",27.31,87,,21.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.97,70,,17.58,,,0,"percent of total billed charges ","70% of total billed charges ",21.97,29.19,
"CAUTERY PEN ELECTRODE",6000405,"CDM ",272,RC,,,OUTPATIENT,,,12.44,9.952,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.95,80,,7.96,,,0,"percent of total billed charges ","80% of total billed charges ",8.71,70,,6.97,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,90,,8.96,,,0,"percent of total billed charges ","90% of total billed charges ",11.57,93,,9.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.57,85,,8.46,,,0,"percent of total billed charges ","85% of total billed charges ",11.2,90,,8.96,,,0,"percent of total billed charges ","90% of total billed charges ",11.2,90,,8.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.82,87,,8.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.71,70,,6.97,,,0,"percent of total billed charges ","70% of total billed charges ",8.71,11.57,
"SPLINT WRIST-SM L",6000435,"CDM ",271,RC,,,OUTPATIENT,,,19.76,15.808,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.81,80,,12.65,,,0,"percent of total billed charges ","80% of total billed charges ",13.83,70,,11.06,,,0,"percent of total billed charges ","70% of total billed charges ",17.78,90,,14.22,,,0,"percent of total billed charges ","90% of total billed charges ",18.38,93,,14.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.8,85,,13.44,,,0,"percent of total billed charges ","85% of total billed charges ",17.78,90,,14.22,,,0,"percent of total billed charges ","90% of total billed charges ",17.78,90,,14.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.19,87,,13.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.83,70,,11.06,,,0,"percent of total billed charges ","70% of total billed charges ",13.83,18.38,
"SET TUR Y TYPE",6000436,"CDM ",272,RC,,,OUTPATIENT,,,30.09,24.072,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.07,80,,19.26,,,0,"percent of total billed charges ","80% of total billed charges ",21.06,70,,16.85,,,0,"percent of total billed charges ","70% of total billed charges ",27.08,90,,21.66,,,0,"percent of total billed charges ","90% of total billed charges ",27.98,93,,22.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.58,85,,20.46,,,0,"percent of total billed charges ","85% of total billed charges ",27.08,90,,21.66,,,0,"percent of total billed charges ","90% of total billed charges ",27.08,90,,21.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.18,87,,20.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.06,70,,16.85,,,0,"percent of total billed charges ","70% of total billed charges ",21.06,27.98,
"SET IV DIAL-A-FLOW",6000449,"CDM ",272,RC,,,OUTPATIENT,,,20.16,16.128,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.13,80,,12.90,,,0,"percent of total billed charges ","80% of total billed charges ",14.11,70,,11.29,,,0,"percent of total billed charges ","70% of total billed charges ",18.14,90,,14.51,,,0,"percent of total billed charges ","90% of total billed charges ",18.75,93,,15.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.14,85,,13.71,,,0,"percent of total billed charges ","85% of total billed charges ",18.14,90,,14.51,,,0,"percent of total billed charges ","90% of total billed charges ",18.14,90,,14.51,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.54,87,,14.03,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.11,70,,11.29,,,0,"percent of total billed charges ","70% of total billed charges ",14.11,18.75,
"KIT PERITONEAL LAVAGE",6000450,"CDM ",272,RC,,,OUTPATIENT,,,151.13,120.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.9,80,,96.72,,,0,"percent of total billed charges ","80% of total billed charges ",105.79,70,,84.63,,,0,"percent of total billed charges ","70% of total billed charges ",136.02,90,,108.82,,,0,"percent of total billed charges ","90% of total billed charges ",140.55,93,,112.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",128.46,85,,102.77,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,90,,108.82,,,0,"percent of total billed charges ","90% of total billed charges ",136.02,90,,108.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",131.48,87,,105.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",105.79,70,,84.63,,,0,"percent of total billed charges ","70% of total billed charges ",105.79,140.55,
"SET PCA MINI-BORE",6000453,"CDM ",272,RC,,,OUTPATIENT,,,21.66,17.328,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.33,80,,13.86,,,0,"percent of total billed charges ","80% of total billed charges ",15.16,70,,12.13,,,0,"percent of total billed charges ","70% of total billed charges ",19.49,90,,15.59,,,0,"percent of total billed charges ","90% of total billed charges ",20.14,93,,16.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.41,85,,14.73,,,0,"percent of total billed charges ","85% of total billed charges ",19.49,90,,15.59,,,0,"percent of total billed charges ","90% of total billed charges ",19.49,90,,15.59,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.84,87,,15.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.16,70,,12.13,,,0,"percent of total billed charges ","70% of total billed charges ",15.16,20.14,
"NEEDLE BUTTERFLY 25GA",6000476,"CDM ",272,RC,,,OUTPATIENT,,,4.62,3.696,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.7,80,,2.96,,,0,"percent of total billed charges ","80% of total billed charges ",3.23,70,,2.58,,,0,"percent of total billed charges ","70% of total billed charges ",4.16,90,,3.33,,,0,"percent of total billed charges ","90% of total billed charges ",4.3,93,,3.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3.93,85,,3.14,,,0,"percent of total billed charges ","85% of total billed charges ",4.16,90,,3.33,,,0,"percent of total billed charges ","90% of total billed charges ",4.16,90,,3.33,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4.02,87,,3.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.23,70,,2.58,,,0,"percent of total billed charges ","70% of total billed charges ",3.23,4.3,
"NEEDLE BUTTERFLY 23GA",6000477,"CDM ",272,RC,,,OUTPATIENT,,,4.74,3.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.79,80,,3.03,,,0,"percent of total billed charges ","80% of total billed charges ",3.32,70,,2.66,,,0,"percent of total billed charges ","70% of total billed charges ",4.27,90,,3.42,,,0,"percent of total billed charges ","90% of total billed charges ",4.41,93,,3.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4.03,85,,3.22,,,0,"percent of total billed charges ","85% of total billed charges ",4.27,90,,3.42,,,0,"percent of total billed charges ","90% of total billed charges ",4.27,90,,3.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4.12,87,,3.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.32,70,,2.66,,,0,"percent of total billed charges ","70% of total billed charges ",3.32,4.41,
"NEEDLE BUTTERFLY 21 GA",6000478,"CDM ",272,RC,,,OUTPATIENT,,,4.68,3.744,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.74,80,,2.99,,,0,"percent of total billed charges ","80% of total billed charges ",3.28,70,,2.62,,,0,"percent of total billed charges ","70% of total billed charges ",4.21,90,,3.37,,,0,"percent of total billed charges ","90% of total billed charges ",4.35,93,,3.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3.98,85,,3.18,,,0,"percent of total billed charges ","85% of total billed charges ",4.21,90,,3.37,,,0,"percent of total billed charges ","90% of total billed charges ",4.21,90,,3.37,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4.07,87,,3.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.28,70,,2.62,,,0,"percent of total billed charges ","70% of total billed charges ",3.28,4.35,
"TUBE NASAL CUFFED 6.0 MM",6000481,"CDM ",272,RC,,,OUTPATIENT,,,24.97,19.976,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.98,80,,15.98,,,0,"percent of total billed charges ","80% of total billed charges ",17.48,70,,13.98,,,0,"percent of total billed charges ","70% of total billed charges ",22.47,90,,17.98,,,0,"percent of total billed charges ","90% of total billed charges ",23.22,93,,18.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.22,85,,16.98,,,0,"percent of total billed charges ","85% of total billed charges ",22.47,90,,17.98,,,0,"percent of total billed charges ","90% of total billed charges ",22.47,90,,17.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.72,87,,17.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.48,70,,13.98,,,0,"percent of total billed charges ","70% of total billed charges ",17.48,23.22,
"SET BLOOD Y-TYPE 78""",6000482,"CDM ",272,RC,,,OUTPATIENT,,,27.58,22.064,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.06,80,,17.65,,,0,"percent of total billed charges ","80% of total billed charges ",19.31,70,,15.45,,,0,"percent of total billed charges ","70% of total billed charges ",24.82,90,,19.86,,,0,"percent of total billed charges ","90% of total billed charges ",25.65,93,,20.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.44,85,,18.75,,,0,"percent of total billed charges ","85% of total billed charges ",24.82,90,,19.86,,,0,"percent of total billed charges ","90% of total billed charges ",24.82,90,,19.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",23.99,87,,19.19,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.31,70,,15.45,,,0,"percent of total billed charges ","70% of total billed charges ",19.31,25.65,
"SET PLASMA BLOOD",6000483,"CDM ",272,RC,,,OUTPATIENT,,,23.82,19.056,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.06,80,,15.25,,,0,"percent of total billed charges ","80% of total billed charges ",16.67,70,,13.34,,,0,"percent of total billed charges ","70% of total billed charges ",21.44,90,,17.15,,,0,"percent of total billed charges ","90% of total billed charges ",22.15,93,,17.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.25,85,,16.20,,,0,"percent of total billed charges ","85% of total billed charges ",21.44,90,,17.15,,,0,"percent of total billed charges ","90% of total billed charges ",21.44,90,,17.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.72,87,,16.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.67,70,,13.34,,,0,"percent of total billed charges ","70% of total billed charges ",16.67,22.15,
"TUBE ENDO BRONCHIAL 37FR",6000484,"CDM ",272,RC,,,OUTPATIENT,,,322.28,257.824,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",257.82,80,,206.26,,,0,"percent of total billed charges ","80% of total billed charges ",225.6,70,,180.48,,,0,"percent of total billed charges ","70% of total billed charges ",290.05,90,,232.04,,,0,"percent of total billed charges ","90% of total billed charges ",299.72,93,,239.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",273.94,85,,219.15,,,0,"percent of total billed charges ","85% of total billed charges ",290.05,90,,232.04,,,0,"percent of total billed charges ","90% of total billed charges ",290.05,90,,232.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",280.38,87,,224.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",225.6,70,,180.48,,,0,"percent of total billed charges ","70% of total billed charges ",225.6,299.72,
"TUBE NASAL CUFFED 6.5 MM",6000486,"CDM ",272,RC,,,OUTPATIENT,,,25.78,20.624,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.62,80,,16.50,,,0,"percent of total billed charges ","80% of total billed charges ",18.05,70,,14.44,,,0,"percent of total billed charges ","70% of total billed charges ",23.2,90,,18.56,,,0,"percent of total billed charges ","90% of total billed charges ",23.98,93,,19.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.91,85,,17.53,,,0,"percent of total billed charges ","85% of total billed charges ",23.2,90,,18.56,,,0,"percent of total billed charges ","90% of total billed charges ",23.2,90,,18.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.43,87,,17.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.05,70,,14.44,,,0,"percent of total billed charges ","70% of total billed charges ",18.05,23.98,
"TUBE NASAL CUFFED 8.0 MM",6000487,"CDM ",272,RC,,,OUTPATIENT,,,29.39,23.512,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.51,80,,18.81,,,0,"percent of total billed charges ","80% of total billed charges ",20.57,70,,16.46,,,0,"percent of total billed charges ","70% of total billed charges ",26.45,90,,21.16,,,0,"percent of total billed charges ","90% of total billed charges ",27.33,93,,21.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",24.98,85,,19.98,,,0,"percent of total billed charges ","85% of total billed charges ",26.45,90,,21.16,,,0,"percent of total billed charges ","90% of total billed charges ",26.45,90,,21.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",25.57,87,,20.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.57,70,,16.46,,,0,"percent of total billed charges ","70% of total billed charges ",20.57,27.33,
"SOLUTION IRRG NS 3000ML",6000489,"CDM ",258,RC,,,OUTPATIENT,,,21.21,16.968,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.97,80,,13.58,,,0,"percent of total billed charges ","80% of total billed charges ",14.85,70,,11.88,,,0,"percent of total billed charges ","70% of total billed charges ",19.09,90,,15.27,,,0,"percent of total billed charges ","90% of total billed charges ",19.73,93,,15.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.03,85,,14.42,,,0,"percent of total billed charges ","85% of total billed charges ",19.09,90,,15.27,,,0,"percent of total billed charges ","90% of total billed charges ",19.09,90,,15.27,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.45,87,,14.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.85,70,,11.88,,,0,"percent of total billed charges ","70% of total billed charges ",14.85,19.73,
"PROTECTOR FINGER TIP SMALL",6000490,"CDM ",271,RC,,,OUTPATIENT,,,19.56,15.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.65,80,,12.52,,,0,"percent of total billed charges ","80% of total billed charges ",13.69,70,,10.95,,,0,"percent of total billed charges ","70% of total billed charges ",17.6,90,,14.08,,,0,"percent of total billed charges ","90% of total billed charges ",18.19,93,,14.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.63,85,,13.30,,,0,"percent of total billed charges ","85% of total billed charges ",17.6,90,,14.08,,,0,"percent of total billed charges ","90% of total billed charges ",17.6,90,,14.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.02,87,,13.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.69,70,,10.95,,,0,"percent of total billed charges ","70% of total billed charges ",13.69,18.19,
"SOLUTION IRRG NS 1000ML",6000491,"CDM ",272,RC,,,OUTPATIENT,,,10.98,8.784,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.78,80,,7.02,,,0,"percent of total billed charges ","80% of total billed charges ",7.69,70,,6.15,,,0,"percent of total billed charges ","70% of total billed charges ",9.88,90,,7.90,,,0,"percent of total billed charges ","90% of total billed charges ",10.21,93,,8.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.33,85,,7.46,,,0,"percent of total billed charges ","85% of total billed charges ",9.88,90,,7.90,,,0,"percent of total billed charges ","90% of total billed charges ",9.88,90,,7.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.55,87,,7.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.69,70,,6.15,,,0,"percent of total billed charges ","70% of total billed charges ",7.69,10.21,
"TUBE ENDO BRONCHIAL 41FR",6000493,"CDM ",272,RC,,,OUTPATIENT,,,434.3,347.44,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",347.44,80,,277.95,,,0,"percent of total billed charges ","80% of total billed charges ",304.01,70,,243.21,,,0,"percent of total billed charges ","70% of total billed charges ",390.87,90,,312.70,,,0,"percent of total billed charges ","90% of total billed charges ",403.9,93,,323.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",369.16,85,,295.33,,,0,"percent of total billed charges ","85% of total billed charges ",390.87,90,,312.70,,,0,"percent of total billed charges ","90% of total billed charges ",390.87,90,,312.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",377.84,87,,302.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",304.01,70,,243.21,,,0,"percent of total billed charges ","70% of total billed charges ",304.01,403.9,
"SOLUTION NS IRRIGATION BOTTLE",6000494,"CDM ",272,RC,,,OUTPATIENT,,,15.05,12.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.04,80,,9.63,,,0,"percent of total billed charges ","80% of total billed charges ",10.54,70,,8.43,,,0,"percent of total billed charges ","70% of total billed charges ",13.55,90,,10.84,,,0,"percent of total billed charges ","90% of total billed charges ",14,93,,11.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.79,85,,10.23,,,0,"percent of total billed charges ","85% of total billed charges ",13.55,90,,10.84,,,0,"percent of total billed charges ","90% of total billed charges ",13.55,90,,10.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.09,87,,10.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.54,70,,8.43,,,0,"percent of total billed charges ","70% of total billed charges ",10.54,14,
"SPLINT BURNAM LEFT",6000499,"CDM ",271,RC,,,OUTPATIENT,,,71.3,57.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.04,80,,45.63,,,0,"percent of total billed charges ","80% of total billed charges ",49.91,70,,39.93,,,0,"percent of total billed charges ","70% of total billed charges ",64.17,90,,51.34,,,0,"percent of total billed charges ","90% of total billed charges ",66.31,93,,53.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",60.61,85,,48.49,,,0,"percent of total billed charges ","85% of total billed charges ",64.17,90,,51.34,,,0,"percent of total billed charges ","90% of total billed charges ",64.17,90,,51.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",62.03,87,,49.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.91,70,,39.93,,,0,"percent of total billed charges ","70% of total billed charges ",49.91,66.31,
"PROTECTOR HEEL/ELBOW DISP",6000521,"CDM ",271,RC,,,OUTPATIENT,,,91.48,73.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.18,80,,58.54,,,0,"percent of total billed charges ","80% of total billed charges ",64.04,70,,51.23,,,0,"percent of total billed charges ","70% of total billed charges ",82.33,90,,65.86,,,0,"percent of total billed charges ","90% of total billed charges ",85.08,93,,68.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",77.76,85,,62.21,,,0,"percent of total billed charges ","85% of total billed charges ",82.33,90,,65.86,,,0,"percent of total billed charges ","90% of total billed charges ",82.33,90,,65.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",79.59,87,,63.67,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.04,70,,51.23,,,0,"percent of total billed charges ","70% of total billed charges ",64.04,85.08,
"PROTECTOR HEEL/ELBOW-KNIT",6000522,"CDM ",271,RC,,,OUTPATIENT,,,23.37,18.696,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.7,80,,14.96,,,0,"percent of total billed charges ","80% of total billed charges ",16.36,70,,13.09,,,0,"percent of total billed charges ","70% of total billed charges ",21.03,90,,16.82,,,0,"percent of total billed charges ","90% of total billed charges ",21.73,93,,17.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.86,85,,15.89,,,0,"percent of total billed charges ","85% of total billed charges ",21.03,90,,16.82,,,0,"percent of total billed charges ","90% of total billed charges ",21.03,90,,16.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.33,87,,16.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.36,70,,13.09,,,0,"percent of total billed charges ","70% of total billed charges ",16.36,21.73,
"BANDAGE ACE 3""",6000546,"CDM ",271,RC,,,OUTPATIENT,,,2.56,2.048,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.05,80,,1.64,,,0,"percent of total billed charges ","80% of total billed charges ",1.79,70,,1.43,,,0,"percent of total billed charges ","70% of total billed charges ",2.3,90,,1.84,,,0,"percent of total billed charges ","90% of total billed charges ",2.38,93,,1.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2.18,85,,1.74,,,0,"percent of total billed charges ","85% of total billed charges ",2.3,90,,1.84,,,0,"percent of total billed charges ","90% of total billed charges ",2.3,90,,1.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2.23,87,,1.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.79,70,,1.43,,,0,"percent of total billed charges ","70% of total billed charges ",1.79,2.38,
"SUTURE ETHILON 5.0 1865G",6000584,"CDM ",272,RC,,,OUTPATIENT,,,14.04,11.232,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.23,80,,8.98,,,0,"percent of total billed charges ","80% of total billed charges ",9.83,70,,7.86,,,0,"percent of total billed charges ","70% of total billed charges ",12.64,90,,10.11,,,0,"percent of total billed charges ","90% of total billed charges ",13.06,93,,10.45,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.93,85,,9.54,,,0,"percent of total billed charges ","85% of total billed charges ",12.64,90,,10.11,,,0,"percent of total billed charges ","90% of total billed charges ",12.64,90,,10.11,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.21,87,,9.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.83,70,,7.86,,,0,"percent of total billed charges ","70% of total billed charges ",9.83,13.06,
"TUBE SALEM 18FR",6000591,"CDM ",272,RC,,,OUTPATIENT,,,13.34,10.672,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.67,80,,8.54,,,0,"percent of total billed charges ","80% of total billed charges ",9.34,70,,7.47,,,0,"percent of total billed charges ","70% of total billed charges ",12.01,90,,9.61,,,0,"percent of total billed charges ","90% of total billed charges ",12.41,93,,9.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.34,85,,9.07,,,0,"percent of total billed charges ","85% of total billed charges ",12.01,90,,9.61,,,0,"percent of total billed charges ","90% of total billed charges ",12.01,90,,9.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.61,87,,9.29,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.34,70,,7.47,,,0,"percent of total billed charges ","70% of total billed charges ",9.34,12.41,
"PAD DEFIBULATOR",6000596,"CDM ",272,RC,,,OUTPATIENT,,,16.15,12.92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.92,80,,10.34,,,0,"percent of total billed charges ","80% of total billed charges ",11.31,70,,9.05,,,0,"percent of total billed charges ","70% of total billed charges ",14.54,90,,11.63,,,0,"percent of total billed charges ","90% of total billed charges ",15.02,93,,12.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.73,85,,10.98,,,0,"percent of total billed charges ","85% of total billed charges ",14.54,90,,11.63,,,0,"percent of total billed charges ","90% of total billed charges ",14.54,90,,11.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.05,87,,11.24,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.31,70,,9.05,,,0,"percent of total billed charges ","70% of total billed charges ",11.31,15.02,
"SPLINT BURNAM RIGHT",6000615,"CDM ",271,RC,,,OUTPATIENT,,,34.75,27.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.8,80,,22.24,,,0,"percent of total billed charges ","80% of total billed charges ",24.33,70,,19.46,,,0,"percent of total billed charges ","70% of total billed charges ",31.28,90,,25.02,,,0,"percent of total billed charges ","90% of total billed charges ",32.32,93,,25.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",29.54,85,,23.63,,,0,"percent of total billed charges ","85% of total billed charges ",31.28,90,,25.02,,,0,"percent of total billed charges ","90% of total billed charges ",31.28,90,,25.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.23,87,,24.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.33,70,,19.46,,,0,"percent of total billed charges ","70% of total billed charges ",24.33,32.32,
"SET HYPODERMOCLYSIS",6000624,"CDM ",272,RC,,,OUTPATIENT,,,40.37,32.296,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.3,80,,25.84,,,0,"percent of total billed charges ","80% of total billed charges ",28.26,70,,22.61,,,0,"percent of total billed charges ","70% of total billed charges ",36.33,90,,29.06,,,0,"percent of total billed charges ","90% of total billed charges ",37.54,93,,30.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34.31,85,,27.45,,,0,"percent of total billed charges ","85% of total billed charges ",36.33,90,,29.06,,,0,"percent of total billed charges ","90% of total billed charges ",36.33,90,,29.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",35.12,87,,28.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.26,70,,22.61,,,0,"percent of total billed charges ","70% of total billed charges ",28.26,37.54,
"SET ENTERAL FEEDING BAG",6000630,"CDM ",272,RC,,,OUTPATIENT,,,21.92,17.536,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.54,80,,14.03,,,0,"percent of total billed charges ","80% of total billed charges ",15.34,70,,12.27,,,0,"percent of total billed charges ","70% of total billed charges ",19.73,90,,15.78,,,0,"percent of total billed charges ","90% of total billed charges ",20.39,93,,16.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.63,85,,14.90,,,0,"percent of total billed charges ","85% of total billed charges ",19.73,90,,15.78,,,0,"percent of total billed charges ","90% of total billed charges ",19.73,90,,15.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.07,87,,15.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.34,70,,12.27,,,0,"percent of total billed charges ","70% of total billed charges ",15.34,20.39,
"CATH UMBILICAL VESSEL 3.5FR",6000634,"CDM ",272,RC,,,OUTPATIENT,,,45.56,36.448,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.45,80,,29.16,,,0,"percent of total billed charges ","80% of total billed charges ",31.89,70,,25.51,,,0,"percent of total billed charges ","70% of total billed charges ",41,90,,32.80,,,0,"percent of total billed charges ","90% of total billed charges ",42.37,93,,33.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.73,85,,30.98,,,0,"percent of total billed charges ","85% of total billed charges ",41,90,,32.80,,,0,"percent of total billed charges ","90% of total billed charges ",41,90,,32.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.64,87,,31.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.89,70,,25.51,,,0,"percent of total billed charges ","70% of total billed charges ",31.89,42.37,
"TUBE FEEDING 8FR CORPAC",6000636,"CDM ",272,RC,,,OUTPATIENT,,,43.43,34.744,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.74,80,,27.79,,,0,"percent of total billed charges ","80% of total billed charges ",30.4,70,,24.32,,,0,"percent of total billed charges ","70% of total billed charges ",39.09,90,,31.27,,,0,"percent of total billed charges ","90% of total billed charges ",40.39,93,,32.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",36.92,85,,29.54,,,0,"percent of total billed charges ","85% of total billed charges ",39.09,90,,31.27,,,0,"percent of total billed charges ","90% of total billed charges ",39.09,90,,31.27,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",37.78,87,,30.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.4,70,,24.32,,,0,"percent of total billed charges ","70% of total billed charges ",30.4,40.39,
"NEEDLE STERNAL ILIAC 15GA",6000640,"CDM ",272,RC,,,OUTPATIENT,,,50.81,40.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.65,80,,32.52,,,0,"percent of total billed charges ","80% of total billed charges ",35.57,70,,28.46,,,0,"percent of total billed charges ","70% of total billed charges ",45.73,90,,36.58,,,0,"percent of total billed charges ","90% of total billed charges ",47.25,93,,37.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.19,85,,34.55,,,0,"percent of total billed charges ","85% of total billed charges ",45.73,90,,36.58,,,0,"percent of total billed charges ","90% of total billed charges ",45.73,90,,36.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.2,87,,35.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.57,70,,28.46,,,0,"percent of total billed charges ","70% of total billed charges ",35.57,47.25,
"NEEDLE STERNAL ILIAC 18GA",6000641,"CDM ",272,RC,,,OUTPATIENT,,,48.01,38.408,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.41,80,,30.73,,,0,"percent of total billed charges ","80% of total billed charges ",33.61,70,,26.89,,,0,"percent of total billed charges ","70% of total billed charges ",43.21,90,,34.57,,,0,"percent of total billed charges ","90% of total billed charges ",44.65,93,,35.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.81,85,,32.65,,,0,"percent of total billed charges ","85% of total billed charges ",43.21,90,,34.57,,,0,"percent of total billed charges ","90% of total billed charges ",43.21,90,,34.57,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.77,87,,33.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.61,70,,26.89,,,0,"percent of total billed charges ","70% of total billed charges ",33.61,44.65,
"SHOE POST OP MEN MEDIUM",6000669,"CDM ",271,RC,,,OUTPATIENT,,,19.66,15.728,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.73,80,,12.58,,,0,"percent of total billed charges ","80% of total billed charges ",13.76,70,,11.01,,,0,"percent of total billed charges ","70% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",18.28,93,,14.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.71,85,,13.37,,,0,"percent of total billed charges ","85% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.1,87,,13.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.76,70,,11.01,,,0,"percent of total billed charges ","70% of total billed charges ",13.76,18.28,
"SHOE POST OP MEN MEDIUM",6000669,"CDM ",271,RC,,,OUTPATIENT,,,19.66,15.728,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.73,80,,12.58,,,0,"percent of total billed charges ","80% of total billed charges ",13.76,70,,11.01,,,0,"percent of total billed charges ","70% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",18.28,93,,14.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.71,85,,13.37,,,0,"percent of total billed charges ","85% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.1,87,,13.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.76,70,,11.01,,,0,"percent of total billed charges ","70% of total billed charges ",13.76,18.28,
"SHOE POST OP MEN SMALL",6000670,"CDM ",271,RC,,,OUTPATIENT,,,19.46,15.568,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.57,80,,12.46,,,0,"percent of total billed charges ","80% of total billed charges ",13.62,70,,10.90,,,0,"percent of total billed charges ","70% of total billed charges ",17.51,90,,14.01,,,0,"percent of total billed charges ","90% of total billed charges ",18.1,93,,14.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.54,85,,13.23,,,0,"percent of total billed charges ","85% of total billed charges ",17.51,90,,14.01,,,0,"percent of total billed charges ","90% of total billed charges ",17.51,90,,14.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.93,87,,13.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.62,70,,10.90,,,0,"percent of total billed charges ","70% of total billed charges ",13.62,18.1,
"SHOE POST OP MEN SMALL",6000670,"CDM ",271,RC,,,OUTPATIENT,,,19.46,15.568,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.57,80,,12.46,,,0,"percent of total billed charges ","80% of total billed charges ",13.62,70,,10.90,,,0,"percent of total billed charges ","70% of total billed charges ",17.51,90,,14.01,,,0,"percent of total billed charges ","90% of total billed charges ",18.1,93,,14.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.54,85,,13.23,,,0,"percent of total billed charges ","85% of total billed charges ",17.51,90,,14.01,,,0,"percent of total billed charges ","90% of total billed charges ",17.51,90,,14.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.93,87,,13.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.62,70,,10.90,,,0,"percent of total billed charges ","70% of total billed charges ",13.62,18.1,
"SHOE POST OP WOMEN MEDIUM",6000672,"CDM ",271,RC,,,OUTPATIENT,,,19.66,15.728,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.73,80,,12.58,,,0,"percent of total billed charges ","80% of total billed charges ",13.76,70,,11.01,,,0,"percent of total billed charges ","70% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",18.28,93,,14.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.71,85,,13.37,,,0,"percent of total billed charges ","85% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.1,87,,13.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.76,70,,11.01,,,0,"percent of total billed charges ","70% of total billed charges ",13.76,18.28,
"SHOE POST OP WOMENS LARGE",6000673,"CDM ",271,RC,,,OUTPATIENT,,,19.66,15.728,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.73,80,,12.58,,,0,"percent of total billed charges ","80% of total billed charges ",13.76,70,,11.01,,,0,"percent of total billed charges ","70% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",18.28,93,,14.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.71,85,,13.37,,,0,"percent of total billed charges ","85% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.1,87,,13.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.76,70,,11.01,,,0,"percent of total billed charges ","70% of total billed charges ",13.76,18.28,
"KIT GASTRIC LAVAGE 24F",6000675,"CDM ",270,RC,,,OUTPATIENT,,,30.79,24.632,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.63,80,,19.70,,,0,"percent of total billed charges ","80% of total billed charges ",21.55,70,,17.24,,,0,"percent of total billed charges ","70% of total billed charges ",27.71,90,,22.17,,,0,"percent of total billed charges ","90% of total billed charges ",28.63,93,,22.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.17,85,,20.94,,,0,"percent of total billed charges ","85% of total billed charges ",27.71,90,,22.17,,,0,"percent of total billed charges ","90% of total billed charges ",27.71,90,,22.17,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.79,87,,21.43,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.55,70,,17.24,,,0,"percent of total billed charges ","70% of total billed charges ",21.55,28.63,
"CATH 3-WAY 24FR",6000691,"CDM ",272,RC,,,OUTPATIENT,,,45.38,36.304,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.3,80,,29.04,,,0,"percent of total billed charges ","80% of total billed charges ",31.77,70,,25.42,,,0,"percent of total billed charges ","70% of total billed charges ",40.84,90,,32.67,,,0,"percent of total billed charges ","90% of total billed charges ",42.2,93,,33.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.57,85,,30.86,,,0,"percent of total billed charges ","85% of total billed charges ",40.84,90,,32.67,,,0,"percent of total billed charges ","90% of total billed charges ",40.84,90,,32.67,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.48,87,,31.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.77,70,,25.42,,,0,"percent of total billed charges ","70% of total billed charges ",31.77,42.2,
"TRAP WATER D-FEND",6000738,"CDM ",271,RC,,,OUTPATIENT,,,72.45,57.96,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.96,80,,46.37,,,0,"percent of total billed charges ","80% of total billed charges ",50.72,70,,40.58,,,0,"percent of total billed charges ","70% of total billed charges ",65.21,90,,52.17,,,0,"percent of total billed charges ","90% of total billed charges ",67.38,93,,53.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",61.58,85,,49.26,,,0,"percent of total billed charges ","85% of total billed charges ",65.21,90,,52.17,,,0,"percent of total billed charges ","90% of total billed charges ",65.21,90,,52.17,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.03,87,,50.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.72,70,,40.58,,,0,"percent of total billed charges ","70% of total billed charges ",50.72,67.38,
"NEEDLE BIOPSY SZ 7 21GA",6000746,"CDM ",621,RC,,,OUTPATIENT,,,177.8,142.24,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.24,80,,113.79,,,0,"percent of total billed charges ","80% of total billed charges ",124.46,70,,99.57,,,0,"percent of total billed charges ","70% of total billed charges ",160.02,90,,128.02,,,0,"percent of total billed charges ","90% of total billed charges ",165.35,93,,132.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",151.13,85,,120.90,,,0,"percent of total billed charges ","85% of total billed charges ",160.02,90,,128.02,,,0,"percent of total billed charges ","90% of total billed charges ",160.02,90,,128.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",154.69,87,,123.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.46,70,,99.57,,,0,"percent of total billed charges ","70% of total billed charges ",124.46,165.35,
"TUBE TRACH 7MM",6000750,"CDM ",272,RC,,,OUTPATIENT,,,156.24,124.992,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.99,80,,99.99,,,0,"percent of total billed charges ","80% of total billed charges ",109.37,70,,87.50,,,0,"percent of total billed charges ","70% of total billed charges ",140.62,90,,112.50,,,0,"percent of total billed charges ","90% of total billed charges ",145.3,93,,116.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",132.8,85,,106.24,,,0,"percent of total billed charges ","85% of total billed charges ",140.62,90,,112.50,,,0,"percent of total billed charges ","90% of total billed charges ",140.62,90,,112.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",135.93,87,,108.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.37,70,,87.50,,,0,"percent of total billed charges ","70% of total billed charges ",109.37,145.3,
"DRESSING SOFWICK",6000756,"CDM ",272,RC,,,OUTPATIENT,,,0.73,0.584,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.58,80,,0.46,,,0,"percent of total billed charges ","80% of total billed charges ",0.51,70,,0.41,,,0,"percent of total billed charges ","70% of total billed charges ",0.66,90,,0.53,,,0,"percent of total billed charges ","90% of total billed charges ",0.68,93,,0.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",0.62,85,,0.50,,,0,"percent of total billed charges ","85% of total billed charges ",0.66,90,,0.53,,,0,"percent of total billed charges ","90% of total billed charges ",0.66,90,,0.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",0.64,87,,0.51,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.51,70,,0.41,,,0,"percent of total billed charges ","70% of total billed charges ",0.51,0.68,
"COVER UPPER WARMING",6000758,"CDM ",271,RC,,,OUTPATIENT,,,25.93,20.744,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.74,80,,16.59,,,0,"percent of total billed charges ","80% of total billed charges ",18.15,70,,14.52,,,0,"percent of total billed charges ","70% of total billed charges ",23.34,90,,18.67,,,0,"percent of total billed charges ","90% of total billed charges ",24.11,93,,19.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",22.04,85,,17.63,,,0,"percent of total billed charges ","85% of total billed charges ",23.34,90,,18.67,,,0,"percent of total billed charges ","90% of total billed charges ",23.34,90,,18.67,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.56,87,,18.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.15,70,,14.52,,,0,"percent of total billed charges ","70% of total billed charges ",18.15,24.11,
"STAPLER SKIN 35W",6000763,"CDM ",272,RC,,,OUTPATIENT,,,46.19,36.952,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.95,80,,29.56,,,0,"percent of total billed charges ","80% of total billed charges ",32.33,70,,25.86,,,0,"percent of total billed charges ","70% of total billed charges ",41.57,90,,33.26,,,0,"percent of total billed charges ","90% of total billed charges ",42.96,93,,34.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.26,85,,31.41,,,0,"percent of total billed charges ","85% of total billed charges ",41.57,90,,33.26,,,0,"percent of total billed charges ","90% of total billed charges ",41.57,90,,33.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.19,87,,32.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.33,70,,25.86,,,0,"percent of total billed charges ","70% of total billed charges ",32.33,42.96,
"STAPLER SKIN 35W",6000763,"CDM ",272,RC,,,OUTPATIENT,,,46.19,36.952,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.95,80,,29.56,,,0,"percent of total billed charges ","80% of total billed charges ",32.33,70,,25.86,,,0,"percent of total billed charges ","70% of total billed charges ",41.57,90,,33.26,,,0,"percent of total billed charges ","90% of total billed charges ",42.96,93,,34.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.26,85,,31.41,,,0,"percent of total billed charges ","85% of total billed charges ",41.57,90,,33.26,,,0,"percent of total billed charges ","90% of total billed charges ",41.57,90,,33.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.19,87,,32.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.33,70,,25.86,,,0,"percent of total billed charges ","70% of total billed charges ",32.33,42.96,
"ELECTRODE NEONATE",6000771,"CDM ",272,RC,,,OUTPATIENT,,,19.56,15.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.65,80,,12.52,,,0,"percent of total billed charges ","80% of total billed charges ",13.69,70,,10.95,,,0,"percent of total billed charges ","70% of total billed charges ",17.6,90,,14.08,,,0,"percent of total billed charges ","90% of total billed charges ",18.19,93,,14.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.63,85,,13.30,,,0,"percent of total billed charges ","85% of total billed charges ",17.6,90,,14.08,,,0,"percent of total billed charges ","90% of total billed charges ",17.6,90,,14.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.02,87,,13.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.69,70,,10.95,,,0,"percent of total billed charges ","70% of total billed charges ",13.69,18.19,
"SPLINT WRIST LRG RIGHT",6000775,"CDM ",271,RC,,,OUTPATIENT,,,19.46,15.568,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.57,80,,12.46,,,0,"percent of total billed charges ","80% of total billed charges ",13.62,70,,10.90,,,0,"percent of total billed charges ","70% of total billed charges ",17.51,90,,14.01,,,0,"percent of total billed charges ","90% of total billed charges ",18.1,93,,14.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.54,85,,13.23,,,0,"percent of total billed charges ","85% of total billed charges ",17.51,90,,14.01,,,0,"percent of total billed charges ","90% of total billed charges ",17.51,90,,14.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.93,87,,13.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.62,70,,10.90,,,0,"percent of total billed charges ","70% of total billed charges ",13.62,18.1,
"TUBE TRACH 9MM W/CANNULLA",6000794,"CDM ",272,RC,,,OUTPATIENT,,,156.24,124.992,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.99,80,,99.99,,,0,"percent of total billed charges ","80% of total billed charges ",109.37,70,,87.50,,,0,"percent of total billed charges ","70% of total billed charges ",140.62,90,,112.50,,,0,"percent of total billed charges ","90% of total billed charges ",145.3,93,,116.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",132.8,85,,106.24,,,0,"percent of total billed charges ","85% of total billed charges ",140.62,90,,112.50,,,0,"percent of total billed charges ","90% of total billed charges ",140.62,90,,112.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",135.93,87,,108.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.37,70,,87.50,,,0,"percent of total billed charges ","70% of total billed charges ",109.37,145.3,
"TUBE TRACH 10MM W/CANNULLA",6000795,"CDM ",272,RC,,,OUTPATIENT,,,156.24,124.992,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.99,80,,99.99,,,0,"percent of total billed charges ","80% of total billed charges ",109.37,70,,87.50,,,0,"percent of total billed charges ","70% of total billed charges ",140.62,90,,112.50,,,0,"percent of total billed charges ","90% of total billed charges ",145.3,93,,116.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",132.8,85,,106.24,,,0,"percent of total billed charges ","85% of total billed charges ",140.62,90,,112.50,,,0,"percent of total billed charges ","90% of total billed charges ",140.62,90,,112.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",135.93,87,,108.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.37,70,,87.50,,,0,"percent of total billed charges ","70% of total billed charges ",109.37,145.3,
"NEEDLE SPINAL 26GA*5""",6000796,"CDM ",272,RC,,,OUTPATIENT,,,25.08,20.064,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.06,80,,16.05,,,0,"percent of total billed charges ","80% of total billed charges ",17.56,70,,14.05,,,0,"percent of total billed charges ","70% of total billed charges ",22.57,90,,18.06,,,0,"percent of total billed charges ","90% of total billed charges ",23.32,93,,18.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.32,85,,17.06,,,0,"percent of total billed charges ","85% of total billed charges ",22.57,90,,18.06,,,0,"percent of total billed charges ","90% of total billed charges ",22.57,90,,18.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.82,87,,17.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.56,70,,14.05,,,0,"percent of total billed charges ","70% of total billed charges ",17.56,23.32,
"NEEDLE SPINAL 24GAX5""",6000798,"CDM ",272,RC,,,OUTPATIENT,,,24.02,19.216,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.22,80,,15.38,,,0,"percent of total billed charges ","80% of total billed charges ",16.81,70,,13.45,,,0,"percent of total billed charges ","70% of total billed charges ",21.62,90,,17.30,,,0,"percent of total billed charges ","90% of total billed charges ",22.34,93,,17.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.42,85,,16.34,,,0,"percent of total billed charges ","85% of total billed charges ",21.62,90,,17.30,,,0,"percent of total billed charges ","90% of total billed charges ",21.62,90,,17.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.9,87,,16.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.81,70,,13.45,,,0,"percent of total billed charges ","70% of total billed charges ",16.81,22.34,
"TRAY LUMBAR PUNCT ADULT",6000818,"CDM ",272,RC,,,OUTPATIENT,,,40.82,32.656,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.66,80,,26.13,,,0,"percent of total billed charges ","80% of total billed charges ",28.57,70,,22.86,,,0,"percent of total billed charges ","70% of total billed charges ",36.74,90,,29.39,,,0,"percent of total billed charges ","90% of total billed charges ",37.96,93,,30.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34.7,85,,27.76,,,0,"percent of total billed charges ","85% of total billed charges ",36.74,90,,29.39,,,0,"percent of total billed charges ","90% of total billed charges ",36.74,90,,29.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",35.51,87,,28.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.57,70,,22.86,,,0,"percent of total billed charges ","70% of total billed charges ",28.57,37.96,
"GARMENT COMPRESSION BARIATRIC",6000832,"CDM ",272,RC,,,OUTPATIENT,,,80.94,64.752,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.75,80,,51.80,,,0,"percent of total billed charges ","80% of total billed charges ",56.66,70,,45.33,,,0,"percent of total billed charges ","70% of total billed charges ",72.85,90,,58.28,,,0,"percent of total billed charges ","90% of total billed charges ",75.27,93,,60.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",68.8,85,,55.04,,,0,"percent of total billed charges ","85% of total billed charges ",72.85,90,,58.28,,,0,"percent of total billed charges ","90% of total billed charges ",72.85,90,,58.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",70.42,87,,56.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.66,70,,45.33,,,0,"percent of total billed charges ","70% of total billed charges ",56.66,75.27,
"CATH FOLEY 8FR 3CC PEDI",6000838,"CDM ",272,RC,,,OUTPATIENT,,,30.99,24.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.79,80,,19.83,,,0,"percent of total billed charges ","80% of total billed charges ",21.69,70,,17.35,,,0,"percent of total billed charges ","70% of total billed charges ",27.89,90,,22.31,,,0,"percent of total billed charges ","90% of total billed charges ",28.82,93,,23.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.34,85,,21.07,,,0,"percent of total billed charges ","85% of total billed charges ",27.89,90,,22.31,,,0,"percent of total billed charges ","90% of total billed charges ",27.89,90,,22.31,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.96,87,,21.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.69,70,,17.35,,,0,"percent of total billed charges ","70% of total billed charges ",21.69,28.82,
"BAG DRAINAGE CLOSED",6000860,"CDM ",272,RC,,,OUTPATIENT,,,14.64,11.712,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.71,80,,9.37,,,0,"percent of total billed charges ","80% of total billed charges ",10.25,70,,8.20,,,0,"percent of total billed charges ","70% of total billed charges ",13.18,90,,10.54,,,0,"percent of total billed charges ","90% of total billed charges ",13.62,93,,10.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.44,85,,9.95,,,0,"percent of total billed charges ","85% of total billed charges ",13.18,90,,10.54,,,0,"percent of total billed charges ","90% of total billed charges ",13.18,90,,10.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.74,87,,10.19,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.25,70,,8.20,,,0,"percent of total billed charges ","70% of total billed charges ",10.25,13.62,
"AIRWAY DESC 20FR",6000876,"CDM ",272,RC,,,OUTPATIENT,,,14.74,11.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.79,80,,9.43,,,0,"percent of total billed charges ","80% of total billed charges ",10.32,70,,8.26,,,0,"percent of total billed charges ","70% of total billed charges ",13.27,90,,10.62,,,0,"percent of total billed charges ","90% of total billed charges ",13.71,93,,10.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.53,85,,10.02,,,0,"percent of total billed charges ","85% of total billed charges ",13.27,90,,10.62,,,0,"percent of total billed charges ","90% of total billed charges ",13.27,90,,10.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.82,87,,10.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.32,70,,8.26,,,0,"percent of total billed charges ","70% of total billed charges ",10.32,13.71,
"BAG BILE",6000883,"CDM ",272,RC,,,OUTPATIENT,,,37.46,29.968,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.97,80,,23.98,,,0,"percent of total billed charges ","80% of total billed charges ",26.22,70,,20.98,,,0,"percent of total billed charges ","70% of total billed charges ",33.71,90,,26.97,,,0,"percent of total billed charges ","90% of total billed charges ",34.84,93,,27.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",31.84,85,,25.47,,,0,"percent of total billed charges ","85% of total billed charges ",33.71,90,,26.97,,,0,"percent of total billed charges ","90% of total billed charges ",33.71,90,,26.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",32.59,87,,26.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.22,70,,20.98,,,0,"percent of total billed charges ","70% of total billed charges ",26.22,34.84,
"TRAY THORANCENTESES DISP",6000886,"CDM ",272,RC,,,OUTPATIENT,,,238.93,191.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",191.14,80,,152.91,,,0,"percent of total billed charges ","80% of total billed charges ",167.25,70,,133.80,,,0,"percent of total billed charges ","70% of total billed charges ",215.04,90,,172.03,,,0,"percent of total billed charges ","90% of total billed charges ",222.2,93,,177.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",203.09,85,,162.47,,,0,"percent of total billed charges ","85% of total billed charges ",215.04,90,,172.03,,,0,"percent of total billed charges ","90% of total billed charges ",215.04,90,,172.03,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",207.87,87,,166.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.25,70,,133.80,,,0,"percent of total billed charges ","70% of total billed charges ",167.25,222.2,
"COVER WARMING",6000893,"CDM ",271,RC,,,OUTPATIENT,,,22.62,18.096,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.1,80,,14.48,,,0,"percent of total billed charges ","80% of total billed charges ",15.83,70,,12.66,,,0,"percent of total billed charges ","70% of total billed charges ",20.36,90,,16.29,,,0,"percent of total billed charges ","90% of total billed charges ",21.04,93,,16.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.23,85,,15.38,,,0,"percent of total billed charges ","85% of total billed charges ",20.36,90,,16.29,,,0,"percent of total billed charges ","90% of total billed charges ",20.36,90,,16.29,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.68,87,,15.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.83,70,,12.66,,,0,"percent of total billed charges ","70% of total billed charges ",15.83,21.04,
"BANDAGE ACE 2""",6000904,"CDM ",271,RC,,,OUTPATIENT,,,1.97,1.576,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.58,80,,1.26,,,0,"percent of total billed charges ","80% of total billed charges ",1.38,70,,1.10,,,0,"percent of total billed charges ","70% of total billed charges ",1.77,90,,1.42,,,0,"percent of total billed charges ","90% of total billed charges ",1.83,93,,1.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1.67,85,,1.34,,,0,"percent of total billed charges ","85% of total billed charges ",1.77,90,,1.42,,,0,"percent of total billed charges ","90% of total billed charges ",1.77,90,,1.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1.71,87,,1.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.38,70,,1.10,,,0,"percent of total billed charges ","70% of total billed charges ",1.38,1.83,
"BANDAGE ACE 4""",6000905,"CDM ",271,RC,,,OUTPATIENT,,,3.07,2.456,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.46,80,,1.97,,,0,"percent of total billed charges ","80% of total billed charges ",2.15,70,,1.72,,,0,"percent of total billed charges ","70% of total billed charges ",2.76,90,,2.21,,,0,"percent of total billed charges ","90% of total billed charges ",2.86,93,,2.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2.61,85,,2.09,,,0,"percent of total billed charges ","85% of total billed charges ",2.76,90,,2.21,,,0,"percent of total billed charges ","90% of total billed charges ",2.76,90,,2.21,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2.67,87,,2.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.15,70,,1.72,,,0,"percent of total billed charges ","70% of total billed charges ",2.15,2.86,
"BANDAGE ACE 6""",6000906,"CDM ",271,RC,,,OUTPATIENT,,,4.8,3.84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.84,80,,3.07,,,0,"percent of total billed charges ","80% of total billed charges ",3.36,70,,2.69,,,0,"percent of total billed charges ","70% of total billed charges ",4.32,90,,3.46,,,0,"percent of total billed charges ","90% of total billed charges ",4.46,93,,3.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4.08,85,,3.26,,,0,"percent of total billed charges ","85% of total billed charges ",4.32,90,,3.46,,,0,"percent of total billed charges ","90% of total billed charges ",4.32,90,,3.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4.18,87,,3.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.36,70,,2.69,,,0,"percent of total billed charges ","70% of total billed charges ",3.36,4.46,
"SPLINT WRIST LEFT LRG",6000907,"CDM ",271,RC,,,OUTPATIENT,,,19.76,15.808,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.81,80,,12.65,,,0,"percent of total billed charges ","80% of total billed charges ",13.83,70,,11.06,,,0,"percent of total billed charges ","70% of total billed charges ",17.78,90,,14.22,,,0,"percent of total billed charges ","90% of total billed charges ",18.38,93,,14.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.8,85,,13.44,,,0,"percent of total billed charges ","85% of total billed charges ",17.78,90,,14.22,,,0,"percent of total billed charges ","90% of total billed charges ",17.78,90,,14.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.19,87,,13.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.83,70,,11.06,,,0,"percent of total billed charges ","70% of total billed charges ",13.83,18.38,
"BINDER ABDOMINAL-XLG",6000909,"CDM ",272,RC,,,OUTPATIENT,,,36.11,28.888,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.89,80,,23.11,,,0,"percent of total billed charges ","80% of total billed charges ",25.28,70,,20.22,,,0,"percent of total billed charges ","70% of total billed charges ",32.5,90,,26.00,,,0,"percent of total billed charges ","90% of total billed charges ",33.58,93,,26.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",30.69,85,,24.55,,,0,"percent of total billed charges ","85% of total billed charges ",32.5,90,,26.00,,,0,"percent of total billed charges ","90% of total billed charges ",32.5,90,,26.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",31.42,87,,25.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.28,70,,20.22,,,0,"percent of total billed charges ","70% of total billed charges ",25.28,33.58,
"MASK ANESTHESIA X-SM INFANT",6000923,"CDM ",270,RC,,,OUTPATIENT,,,16.5,13.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.2,80,,10.56,,,0,"percent of total billed charges ","80% of total billed charges ",11.55,70,,9.24,,,0,"percent of total billed charges ","70% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",15.35,93,,12.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.03,85,,11.22,,,0,"percent of total billed charges ","85% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.36,87,,11.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.55,70,,9.24,,,0,"percent of total billed charges ","70% of total billed charges ",11.55,15.35,
"MASK ANESTHESIA NEONATE",6000924,"CDM ",270,RC,,,OUTPATIENT,,,25.33,20.264,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.26,80,,16.21,,,0,"percent of total billed charges ","80% of total billed charges ",17.73,70,,14.18,,,0,"percent of total billed charges ","70% of total billed charges ",22.8,90,,18.24,,,0,"percent of total billed charges ","90% of total billed charges ",23.56,93,,18.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.53,85,,17.22,,,0,"percent of total billed charges ","85% of total billed charges ",22.8,90,,18.24,,,0,"percent of total billed charges ","90% of total billed charges ",22.8,90,,18.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.04,87,,17.63,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.73,70,,14.18,,,0,"percent of total billed charges ","70% of total billed charges ",17.73,23.56,
"NEEDLE BIOPSY 14GA*4.5""",6000933,"CDM ",272,RC,,,OUTPATIENT,,,119.75,95.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.8,80,,76.64,,,0,"percent of total billed charges ","80% of total billed charges ",83.83,70,,67.06,,,0,"percent of total billed charges ","70% of total billed charges ",107.78,90,,86.22,,,0,"percent of total billed charges ","90% of total billed charges ",111.37,93,,89.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",101.79,85,,81.43,,,0,"percent of total billed charges ","85% of total billed charges ",107.78,90,,86.22,,,0,"percent of total billed charges ","90% of total billed charges ",107.78,90,,86.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",104.18,87,,83.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.83,70,,67.06,,,0,"percent of total billed charges ","70% of total billed charges ",83.83,111.37,
"CATH FOLEY 30FR 30CC",6000955,"CDM ",272,RC,,,OUTPATIENT,,,20.46,16.368,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.37,80,,13.10,,,0,"percent of total billed charges ","80% of total billed charges ",14.32,70,,11.46,,,0,"percent of total billed charges ","70% of total billed charges ",18.41,90,,14.73,,,0,"percent of total billed charges ","90% of total billed charges ",19.03,93,,15.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.39,85,,13.91,,,0,"percent of total billed charges ","85% of total billed charges ",18.41,90,,14.73,,,0,"percent of total billed charges ","90% of total billed charges ",18.41,90,,14.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.8,87,,14.24,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.32,70,,11.46,,,0,"percent of total billed charges ","70% of total billed charges ",14.32,19.03,
"COLLECTOR URINE MIDSTREAM",6000962,"CDM ",272,RC,,,OUTPATIENT,,,3.5,2.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.8,80,,2.24,,,0,"percent of total billed charges ","80% of total billed charges ",2.45,70,,1.96,,,0,"percent of total billed charges ","70% of total billed charges ",3.15,90,,2.52,,,0,"percent of total billed charges ","90% of total billed charges ",3.26,93,,2.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2.98,85,,2.38,,,0,"percent of total billed charges ","85% of total billed charges ",3.15,90,,2.52,,,0,"percent of total billed charges ","90% of total billed charges ",3.15,90,,2.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3.05,87,,2.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.45,70,,1.96,,,0,"percent of total billed charges ","70% of total billed charges ",2.45,3.26,
"PACK BASIC SET-UP III",6000972,"CDM ",272,RC,,,OUTPATIENT,,,26,20.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.8,80,,16.64,,,0,"percent of total billed charges ","80% of total billed charges ",18.2,70,,14.56,,,0,"percent of total billed charges ","70% of total billed charges ",23.4,90,,18.72,,,0,"percent of total billed charges ","90% of total billed charges ",24.18,93,,19.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",22.1,85,,17.68,,,0,"percent of total billed charges ","85% of total billed charges ",23.4,90,,18.72,,,0,"percent of total billed charges ","90% of total billed charges ",23.4,90,,18.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.62,87,,18.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.2,70,,14.56,,,0,"percent of total billed charges ","70% of total billed charges ",18.2,24.18,
"KIT SHOULDER SUSPENSION",6000989,"CDM ",272,RC,,,OUTPATIENT,,,168.91,135.128,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.13,80,,108.10,,,0,"percent of total billed charges ","80% of total billed charges ",118.24,70,,94.59,,,0,"percent of total billed charges ","70% of total billed charges ",152.02,90,,121.62,,,0,"percent of total billed charges ","90% of total billed charges ",157.09,93,,125.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",143.57,85,,114.86,,,0,"percent of total billed charges ","85% of total billed charges ",152.02,90,,121.62,,,0,"percent of total billed charges ","90% of total billed charges ",152.02,90,,121.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",146.95,87,,117.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.24,70,,94.59,,,0,"percent of total billed charges ","70% of total billed charges ",118.24,157.09,
"PANT BLADDER CONTROL",6001019,"CDM ",271,RC,,,OUTPATIENT,,,11.74,9.392,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.39,80,,7.51,,,0,"percent of total billed charges ","80% of total billed charges ",8.22,70,,6.58,,,0,"percent of total billed charges ","70% of total billed charges ",10.57,90,,8.46,,,0,"percent of total billed charges ","90% of total billed charges ",10.92,93,,8.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.98,85,,7.98,,,0,"percent of total billed charges ","85% of total billed charges ",10.57,90,,8.46,,,0,"percent of total billed charges ","90% of total billed charges ",10.57,90,,8.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.21,87,,8.17,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.22,70,,6.58,,,0,"percent of total billed charges ","70% of total billed charges ",8.22,10.92,
"OXYGEN SYSTEM F10 ADULT",6001030,"CDM ",270,RC,,,OUTPATIENT,,,48.9,39.12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.12,80,,31.30,,,0,"percent of total billed charges ","80% of total billed charges ",34.23,70,,27.38,,,0,"percent of total billed charges ","70% of total billed charges ",44.01,90,,35.21,,,0,"percent of total billed charges ","90% of total billed charges ",45.48,93,,36.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.57,85,,33.26,,,0,"percent of total billed charges ","85% of total billed charges ",44.01,90,,35.21,,,0,"percent of total billed charges ","90% of total billed charges ",44.01,90,,35.21,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.54,87,,34.03,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.23,70,,27.38,,,0,"percent of total billed charges ","70% of total billed charges ",34.23,45.48,
"NEEDLE SPINAL 24GA",6001040,"CDM ",272,RC,,,OUTPATIENT,,,47.39,37.912,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.91,80,,30.33,,,0,"percent of total billed charges ","80% of total billed charges ",33.17,70,,26.54,,,0,"percent of total billed charges ","70% of total billed charges ",42.65,90,,34.12,,,0,"percent of total billed charges ","90% of total billed charges ",44.07,93,,35.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.28,85,,32.22,,,0,"percent of total billed charges ","85% of total billed charges ",42.65,90,,34.12,,,0,"percent of total billed charges ","90% of total billed charges ",42.65,90,,34.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.23,87,,32.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.17,70,,26.54,,,0,"percent of total billed charges ","70% of total billed charges ",33.17,44.07,
"OXYGEN SYSTEM F10 KID",6001042,"CDM ",270,RC,,,OUTPATIENT,,,43.38,34.704,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.7,80,,27.76,,,0,"percent of total billed charges ","80% of total billed charges ",30.37,70,,24.30,,,0,"percent of total billed charges ","70% of total billed charges ",39.04,90,,31.23,,,0,"percent of total billed charges ","90% of total billed charges ",40.34,93,,32.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",36.87,85,,29.50,,,0,"percent of total billed charges ","85% of total billed charges ",39.04,90,,31.23,,,0,"percent of total billed charges ","90% of total billed charges ",39.04,90,,31.23,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",37.74,87,,30.19,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.37,70,,24.30,,,0,"percent of total billed charges ","70% of total billed charges ",30.37,40.34,
"BOOT CAST X-LRG",6001053,"CDM ",271,RC,,,OUTPATIENT,,,17.5,14,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14,80,,11.20,,,0,"percent of total billed charges ","80% of total billed charges ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",16.28,93,,13.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.88,85,,11.90,,,0,"percent of total billed charges ","85% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.23,87,,12.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",12.25,16.28,
"BAG PRESSURE INFUSION 1000ML",6001120,"CDM ",270,RC,,,OUTPATIENT,,,30.64,24.512,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.51,80,,19.61,,,0,"percent of total billed charges ","80% of total billed charges ",21.45,70,,17.16,,,0,"percent of total billed charges ","70% of total billed charges ",27.58,90,,22.06,,,0,"percent of total billed charges ","90% of total billed charges ",28.5,93,,22.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.04,85,,20.83,,,0,"percent of total billed charges ","85% of total billed charges ",27.58,90,,22.06,,,0,"percent of total billed charges ","90% of total billed charges ",27.58,90,,22.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.66,87,,21.33,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.45,70,,17.16,,,0,"percent of total billed charges ","70% of total billed charges ",21.45,28.5,
"INFUSOR PRESSURE DISP",6001127,"CDM ",271,RC,,,OUTPATIENT,,,30.64,24.512,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.51,80,,19.61,,,0,"percent of total billed charges ","80% of total billed charges ",21.45,70,,17.16,,,0,"percent of total billed charges ","70% of total billed charges ",27.58,90,,22.06,,,0,"percent of total billed charges ","90% of total billed charges ",28.5,93,,22.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.04,85,,20.83,,,0,"percent of total billed charges ","85% of total billed charges ",27.58,90,,22.06,,,0,"percent of total billed charges ","90% of total billed charges ",27.58,90,,22.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.66,87,,21.33,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.45,70,,17.16,,,0,"percent of total billed charges ","70% of total billed charges ",21.45,28.5,
"CANISTER VAC FREEDOM",6001132,"CDM ",272,RC,,,OUTPATIENT,,,119.84,95.872,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.87,80,,76.70,,,0,"percent of total billed charges ","80% of total billed charges ",83.89,70,,67.11,,,0,"percent of total billed charges ","70% of total billed charges ",107.86,90,,86.29,,,0,"percent of total billed charges ","90% of total billed charges ",111.45,93,,89.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",101.86,85,,81.49,,,0,"percent of total billed charges ","85% of total billed charges ",107.86,90,,86.29,,,0,"percent of total billed charges ","90% of total billed charges ",107.86,90,,86.29,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",104.26,87,,83.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.89,70,,67.11,,,0,"percent of total billed charges ","70% of total billed charges ",83.89,111.45,
"PAD ULP LATEX FREE",6001139,"CDM ",272,RC,,,OUTPATIENT,,,109.66,87.728,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.73,80,,70.18,,,0,"percent of total billed charges ","80% of total billed charges ",76.76,70,,61.41,,,0,"percent of total billed charges ","70% of total billed charges ",98.69,90,,78.95,,,0,"percent of total billed charges ","90% of total billed charges ",101.98,93,,81.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",93.21,85,,74.57,,,0,"percent of total billed charges ","85% of total billed charges ",98.69,90,,78.95,,,0,"percent of total billed charges ","90% of total billed charges ",98.69,90,,78.95,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",95.4,87,,76.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.76,70,,61.41,,,0,"percent of total billed charges ","70% of total billed charges ",76.76,101.98,
"SHIELD NIPPLE X-SMALL",6001151,"CDM ",271,RC,,,OUTPATIENT,,,25.83,20.664,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.66,80,,16.53,,,0,"percent of total billed charges ","80% of total billed charges ",18.08,70,,14.46,,,0,"percent of total billed charges ","70% of total billed charges ",23.25,90,,18.60,,,0,"percent of total billed charges ","90% of total billed charges ",24.02,93,,19.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.96,85,,17.57,,,0,"percent of total billed charges ","85% of total billed charges ",23.25,90,,18.60,,,0,"percent of total billed charges ","90% of total billed charges ",23.25,90,,18.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.47,87,,17.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.08,70,,14.46,,,0,"percent of total billed charges ","70% of total billed charges ",18.08,24.02,
"NEEDLE PORT-A-CATH 19G",6001155,"CDM ",272,RC,,,OUTPATIENT,,,31.39,25.112,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.11,80,,20.09,,,0,"percent of total billed charges ","80% of total billed charges ",21.97,70,,17.58,,,0,"percent of total billed charges ","70% of total billed charges ",28.25,90,,22.60,,,0,"percent of total billed charges ","90% of total billed charges ",29.19,93,,23.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.68,85,,21.34,,,0,"percent of total billed charges ","85% of total billed charges ",28.25,90,,22.60,,,0,"percent of total billed charges ","90% of total billed charges ",28.25,90,,22.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",27.31,87,,21.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.97,70,,17.58,,,0,"percent of total billed charges ","70% of total billed charges ",21.97,29.19,
"CONNECTOR ""T""",6001162,"CDM ",271,RC,,,OUTPATIENT,,,26.03,20.824,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.82,80,,16.66,,,0,"percent of total billed charges ","80% of total billed charges ",18.22,70,,14.58,,,0,"percent of total billed charges ","70% of total billed charges ",23.43,90,,18.74,,,0,"percent of total billed charges ","90% of total billed charges ",24.21,93,,19.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",22.13,85,,17.70,,,0,"percent of total billed charges ","85% of total billed charges ",23.43,90,,18.74,,,0,"percent of total billed charges ","90% of total billed charges ",23.43,90,,18.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.65,87,,18.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.22,70,,14.58,,,0,"percent of total billed charges ","70% of total billed charges ",18.22,24.21,
"SUTURE 1866G",6001167,"CDM ",272,RC,,,OUTPATIENT,,,17.3,13.84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.84,80,,11.07,,,0,"percent of total billed charges ","80% of total billed charges ",12.11,70,,9.69,,,0,"percent of total billed charges ","70% of total billed charges ",15.57,90,,12.46,,,0,"percent of total billed charges ","90% of total billed charges ",16.09,93,,12.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.71,85,,11.77,,,0,"percent of total billed charges ","85% of total billed charges ",15.57,90,,12.46,,,0,"percent of total billed charges ","90% of total billed charges ",15.57,90,,12.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.05,87,,12.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.11,70,,9.69,,,0,"percent of total billed charges ","70% of total billed charges ",12.11,16.09,
"BARIUM POLIBAR PLUS",6001175,"CDM ",272,RC,,,OUTPATIENT,,,56.81,45.448,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.45,80,,36.36,,,0,"percent of total billed charges ","80% of total billed charges ",39.77,70,,31.82,,,0,"percent of total billed charges ","70% of total billed charges ",51.13,90,,40.90,,,0,"percent of total billed charges ","90% of total billed charges ",52.83,93,,42.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",48.29,85,,38.63,,,0,"percent of total billed charges ","85% of total billed charges ",51.13,90,,40.90,,,0,"percent of total billed charges ","90% of total billed charges ",51.13,90,,40.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",49.42,87,,39.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.77,70,,31.82,,,0,"percent of total billed charges ","70% of total billed charges ",39.77,52.83,
"TRAY UNBILICAL CATH 3.5FR",6001189,"CDM ",272,RC,,,OUTPATIENT,,,197.24,157.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.79,80,,126.23,,,0,"percent of total billed charges ","80% of total billed charges ",138.07,70,,110.46,,,0,"percent of total billed charges ","70% of total billed charges ",177.52,90,,142.02,,,0,"percent of total billed charges ","90% of total billed charges ",183.43,93,,146.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",167.65,85,,134.12,,,0,"percent of total billed charges ","85% of total billed charges ",177.52,90,,142.02,,,0,"percent of total billed charges ","90% of total billed charges ",177.52,90,,142.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",171.6,87,,137.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",138.07,70,,110.46,,,0,"percent of total billed charges ","70% of total billed charges ",138.07,183.43,
"CATH FOLEY 16FR 5CC",6001192,"CDM ",272,RC,,,OUTPATIENT,,,30.99,24.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.79,80,,19.83,,,0,"percent of total billed charges ","80% of total billed charges ",21.69,70,,17.35,,,0,"percent of total billed charges ","70% of total billed charges ",27.89,90,,22.31,,,0,"percent of total billed charges ","90% of total billed charges ",28.82,93,,23.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.34,85,,21.07,,,0,"percent of total billed charges ","85% of total billed charges ",27.89,90,,22.31,,,0,"percent of total billed charges ","90% of total billed charges ",27.89,90,,22.31,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.96,87,,21.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.69,70,,17.35,,,0,"percent of total billed charges ","70% of total billed charges ",21.69,28.82,
"CATH FOLEY 18FR 5CC",6001193,"CDM ",272,RC,,,OUTPATIENT,,,30.99,24.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.79,80,,19.83,,,0,"percent of total billed charges ","80% of total billed charges ",21.69,70,,17.35,,,0,"percent of total billed charges ","70% of total billed charges ",27.89,90,,22.31,,,0,"percent of total billed charges ","90% of total billed charges ",28.82,93,,23.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.34,85,,21.07,,,0,"percent of total billed charges ","85% of total billed charges ",27.89,90,,22.31,,,0,"percent of total billed charges ","90% of total billed charges ",27.89,90,,22.31,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.96,87,,21.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.69,70,,17.35,,,0,"percent of total billed charges ","70% of total billed charges ",21.69,28.82,
"DRESSING SURGIPAD 8*10",6001229,"CDM ",272,RC,,,OUTPATIENT,,,0.88,0.704,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.7,80,,0.56,,,0,"percent of total billed charges ","80% of total billed charges ",0.62,70,,0.50,,,0,"percent of total billed charges ","70% of total billed charges ",0.79,90,,0.63,,,0,"percent of total billed charges ","90% of total billed charges ",0.82,93,,0.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",0.75,85,,0.60,,,0,"percent of total billed charges ","85% of total billed charges ",0.79,90,,0.63,,,0,"percent of total billed charges ","90% of total billed charges ",0.79,90,,0.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",0.77,87,,0.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",0.62,70,,0.50,,,0,"percent of total billed charges ","70% of total billed charges ",0.62,0.82,
"CATH FOLEY 28F 30CC",6001249,"CDM ",272,RC,,,OUTPATIENT,,,20.46,16.368,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.37,80,,13.10,,,0,"percent of total billed charges ","80% of total billed charges ",14.32,70,,11.46,,,0,"percent of total billed charges ","70% of total billed charges ",18.41,90,,14.73,,,0,"percent of total billed charges ","90% of total billed charges ",19.03,93,,15.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.39,85,,13.91,,,0,"percent of total billed charges ","85% of total billed charges ",18.41,90,,14.73,,,0,"percent of total billed charges ","90% of total billed charges ",18.41,90,,14.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.8,87,,14.24,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.32,70,,11.46,,,0,"percent of total billed charges ","70% of total billed charges ",14.32,19.03,
"ELECTRODE NEONATAL PRE-WIRED",6001250,"CDM ",272,RC,,,OUTPATIENT,,,33.6,26.88,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.88,80,,21.50,,,0,"percent of total billed charges ","80% of total billed charges ",23.52,70,,18.82,,,0,"percent of total billed charges ","70% of total billed charges ",30.24,90,,24.19,,,0,"percent of total billed charges ","90% of total billed charges ",31.25,93,,25.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.56,85,,22.85,,,0,"percent of total billed charges ","85% of total billed charges ",30.24,90,,24.19,,,0,"percent of total billed charges ","90% of total billed charges ",30.24,90,,24.19,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.23,87,,23.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.52,70,,18.82,,,0,"percent of total billed charges ","70% of total billed charges ",23.52,31.25,
"SPLINT WRIST LEATHER ML",6001259,"CDM ",271,RC,,,OUTPATIENT,,,23.77,19.016,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.02,80,,15.22,,,0,"percent of total billed charges ","80% of total billed charges ",16.64,70,,13.31,,,0,"percent of total billed charges ","70% of total billed charges ",21.39,90,,17.11,,,0,"percent of total billed charges ","90% of total billed charges ",22.11,93,,17.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.2,85,,16.16,,,0,"percent of total billed charges ","85% of total billed charges ",21.39,90,,17.11,,,0,"percent of total billed charges ","90% of total billed charges ",21.39,90,,17.11,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.68,87,,16.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.64,70,,13.31,,,0,"percent of total billed charges ","70% of total billed charges ",16.64,22.11,
"SPLINT WRIST LEATHER LR",6001261,"CDM ",271,RC,,,OUTPATIENT,,,23.77,19.016,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.02,80,,15.22,,,0,"percent of total billed charges ","80% of total billed charges ",16.64,70,,13.31,,,0,"percent of total billed charges ","70% of total billed charges ",21.39,90,,17.11,,,0,"percent of total billed charges ","90% of total billed charges ",22.11,93,,17.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.2,85,,16.16,,,0,"percent of total billed charges ","85% of total billed charges ",21.39,90,,17.11,,,0,"percent of total billed charges ","90% of total billed charges ",21.39,90,,17.11,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.68,87,,16.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.64,70,,13.31,,,0,"percent of total billed charges ","70% of total billed charges ",16.64,22.11,
"TRAY ARTHROGRAM",6001284,"CDM ",272,RC,,,OUTPATIENT,,,32.65,26.12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.12,80,,20.90,,,0,"percent of total billed charges ","80% of total billed charges ",22.86,70,,18.29,,,0,"percent of total billed charges ","70% of total billed charges ",29.39,90,,23.51,,,0,"percent of total billed charges ","90% of total billed charges ",30.36,93,,24.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",27.75,85,,22.20,,,0,"percent of total billed charges ","85% of total billed charges ",29.39,90,,23.51,,,0,"percent of total billed charges ","90% of total billed charges ",29.39,90,,23.51,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",28.41,87,,22.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.86,70,,18.29,,,0,"percent of total billed charges ","70% of total billed charges ",22.86,30.36,
"TUBE ORAL 6.0 CUFFED",6001304,"CDM ",272,RC,,,OUTPATIENT,,,34.15,27.32,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.32,80,,21.86,,,0,"percent of total billed charges ","80% of total billed charges ",23.91,70,,19.13,,,0,"percent of total billed charges ","70% of total billed charges ",30.74,90,,24.59,,,0,"percent of total billed charges ","90% of total billed charges ",31.76,93,,25.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",29.03,85,,23.22,,,0,"percent of total billed charges ","85% of total billed charges ",30.74,90,,24.59,,,0,"percent of total billed charges ","90% of total billed charges ",30.74,90,,24.59,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.71,87,,23.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.91,70,,19.13,,,0,"percent of total billed charges ","70% of total billed charges ",23.91,31.76,
"MASK BILI",6001313,"CDM ",270,RC,,,OUTPATIENT,,,45.54,36.432,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.43,80,,29.14,,,0,"percent of total billed charges ","80% of total billed charges ",31.88,70,,25.50,,,0,"percent of total billed charges ","70% of total billed charges ",40.99,90,,32.79,,,0,"percent of total billed charges ","90% of total billed charges ",42.35,93,,33.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.71,85,,30.97,,,0,"percent of total billed charges ","85% of total billed charges ",40.99,90,,32.79,,,0,"percent of total billed charges ","90% of total billed charges ",40.99,90,,32.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.62,87,,31.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.88,70,,25.50,,,0,"percent of total billed charges ","70% of total billed charges ",31.88,42.35,
"CATH FOLEY 20FR 5CC",6001345,"CDM ",272,RC,,,OUTPATIENT,,,30.99,24.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.79,80,,19.83,,,0,"percent of total billed charges ","80% of total billed charges ",21.69,70,,17.35,,,0,"percent of total billed charges ","70% of total billed charges ",27.89,90,,22.31,,,0,"percent of total billed charges ","90% of total billed charges ",28.82,93,,23.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.34,85,,21.07,,,0,"percent of total billed charges ","85% of total billed charges ",27.89,90,,22.31,,,0,"percent of total billed charges ","90% of total billed charges ",27.89,90,,22.31,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.96,87,,21.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.69,70,,17.35,,,0,"percent of total billed charges ","70% of total billed charges ",21.69,28.82,
"PADDING CAST 3""",6001350,"CDM ",271,RC,,,OUTPATIENT,,,3.39,2.712,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.71,80,,2.17,,,0,"percent of total billed charges ","80% of total billed charges ",2.37,70,,1.90,,,0,"percent of total billed charges ","70% of total billed charges ",3.05,90,,2.44,,,0,"percent of total billed charges ","90% of total billed charges ",3.15,93,,2.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2.88,85,,2.30,,,0,"percent of total billed charges ","85% of total billed charges ",3.05,90,,2.44,,,0,"percent of total billed charges ","90% of total billed charges ",3.05,90,,2.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2.95,87,,2.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.37,70,,1.90,,,0,"percent of total billed charges ","70% of total billed charges ",2.37,3.15,
"PADDING CAST 4""",6001351,"CDM ",271,RC,,,OUTPATIENT,,,4.49,3.592,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.59,80,,2.87,,,0,"percent of total billed charges ","80% of total billed charges ",3.14,70,,2.51,,,0,"percent of total billed charges ","70% of total billed charges ",4.04,90,,3.23,,,0,"percent of total billed charges ","90% of total billed charges ",4.18,93,,3.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3.82,85,,3.06,,,0,"percent of total billed charges ","85% of total billed charges ",4.04,90,,3.23,,,0,"percent of total billed charges ","90% of total billed charges ",4.04,90,,3.23,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3.91,87,,3.13,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.14,70,,2.51,,,0,"percent of total billed charges ","70% of total billed charges ",3.14,4.18,
"PADDING CAST 6""",6001352,"CDM ",271,RC,,,OUTPATIENT,,,5.87,4.696,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.7,80,,3.76,,,0,"percent of total billed charges ","80% of total billed charges ",4.11,70,,3.29,,,0,"percent of total billed charges ","70% of total billed charges ",5.28,90,,4.22,,,0,"percent of total billed charges ","90% of total billed charges ",5.46,93,,4.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4.99,85,,3.99,,,0,"percent of total billed charges ","85% of total billed charges ",5.28,90,,4.22,,,0,"percent of total billed charges ","90% of total billed charges ",5.28,90,,4.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5.11,87,,4.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.11,70,,3.29,,,0,"percent of total billed charges ","70% of total billed charges ",4.11,5.46,
"TUBE TRACH 9.0 ORAL",6001373,"CDM ",272,RC,,,OUTPATIENT,,,42.08,33.664,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.66,80,,26.93,,,0,"percent of total billed charges ","80% of total billed charges ",29.46,70,,23.57,,,0,"percent of total billed charges ","70% of total billed charges ",37.87,90,,30.30,,,0,"percent of total billed charges ","90% of total billed charges ",39.13,93,,31.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",35.77,85,,28.62,,,0,"percent of total billed charges ","85% of total billed charges ",37.87,90,,30.30,,,0,"percent of total billed charges ","90% of total billed charges ",37.87,90,,30.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",36.61,87,,29.29,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.46,70,,23.57,,,0,"percent of total billed charges ","70% of total billed charges ",29.46,39.13,
"SPLINT WRIST LEATHER MR",6001379,"CDM ",271,RC,,,OUTPATIENT,,,23.77,19.016,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.02,80,,15.22,,,0,"percent of total billed charges ","80% of total billed charges ",16.64,70,,13.31,,,0,"percent of total billed charges ","70% of total billed charges ",21.39,90,,17.11,,,0,"percent of total billed charges ","90% of total billed charges ",22.11,93,,17.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.2,85,,16.16,,,0,"percent of total billed charges ","85% of total billed charges ",21.39,90,,17.11,,,0,"percent of total billed charges ","90% of total billed charges ",21.39,90,,17.11,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.68,87,,16.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.64,70,,13.31,,,0,"percent of total billed charges ","70% of total billed charges ",16.64,22.11,
"VALVE ANTE REFLEX",6001384,"CDM ",272,RC,,,OUTPATIENT,,,14.84,11.872,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.87,80,,9.50,,,0,"percent of total billed charges ","80% of total billed charges ",10.39,70,,8.31,,,0,"percent of total billed charges ","70% of total billed charges ",13.36,90,,10.69,,,0,"percent of total billed charges ","90% of total billed charges ",13.8,93,,11.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.61,85,,10.09,,,0,"percent of total billed charges ","85% of total billed charges ",13.36,90,,10.69,,,0,"percent of total billed charges ","90% of total billed charges ",13.36,90,,10.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.91,87,,10.33,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.39,70,,8.31,,,0,"percent of total billed charges ","70% of total billed charges ",10.39,13.8,
"VALVE HEIMLICH",6001391,"CDM ",272,RC,,,OUTPATIENT,,,142.37,113.896,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.9,80,,91.12,,,0,"percent of total billed charges ","80% of total billed charges ",99.66,70,,79.73,,,0,"percent of total billed charges ","70% of total billed charges ",128.13,90,,102.50,,,0,"percent of total billed charges ","90% of total billed charges ",132.4,93,,105.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",121.01,85,,96.81,,,0,"percent of total billed charges ","85% of total billed charges ",128.13,90,,102.50,,,0,"percent of total billed charges ","90% of total billed charges ",128.13,90,,102.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",123.86,87,,99.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.66,70,,79.73,,,0,"percent of total billed charges ","70% of total billed charges ",99.66,132.4,
"SUTURE ETHILON 4.0 X 1667H",6001405,"CDM ",272,RC,,,OUTPATIENT,,,12.64,10.112,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.11,80,,8.09,,,0,"percent of total billed charges ","80% of total billed charges ",8.85,70,,7.08,,,0,"percent of total billed charges ","70% of total billed charges ",11.38,90,,9.10,,,0,"percent of total billed charges ","90% of total billed charges ",11.76,93,,9.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.74,85,,8.59,,,0,"percent of total billed charges ","85% of total billed charges ",11.38,90,,9.10,,,0,"percent of total billed charges ","90% of total billed charges ",11.38,90,,9.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11,87,,8.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.85,70,,7.08,,,0,"percent of total billed charges ","70% of total billed charges ",8.85,11.76,
"KIT CHEST NEWBORN",6001412,"CDM ",272,RC,,,OUTPATIENT,,,55.78,44.624,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.62,80,,35.70,,,0,"percent of total billed charges ","80% of total billed charges ",39.05,70,,31.24,,,0,"percent of total billed charges ","70% of total billed charges ",50.2,90,,40.16,,,0,"percent of total billed charges ","90% of total billed charges ",51.88,93,,41.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",47.41,85,,37.93,,,0,"percent of total billed charges ","85% of total billed charges ",50.2,90,,40.16,,,0,"percent of total billed charges ","90% of total billed charges ",50.2,90,,40.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",48.53,87,,38.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.05,70,,31.24,,,0,"percent of total billed charges ","70% of total billed charges ",39.05,51.88,
"SUTURE 811H 2.0 CHROMIC",6001431,"CDM ",272,RC,,,OUTPATIENT,,,10.98,8.784,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.78,80,,7.02,,,0,"percent of total billed charges ","80% of total billed charges ",7.69,70,,6.15,,,0,"percent of total billed charges ","70% of total billed charges ",9.88,90,,7.90,,,0,"percent of total billed charges ","90% of total billed charges ",10.21,93,,8.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.33,85,,7.46,,,0,"percent of total billed charges ","85% of total billed charges ",9.88,90,,7.90,,,0,"percent of total billed charges ","90% of total billed charges ",9.88,90,,7.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.55,87,,7.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.69,70,,6.15,,,0,"percent of total billed charges ","70% of total billed charges ",7.69,10.21,
"CATH MALE EXTERNAL PRIMOFIT",6001434,"CDM ",270,RC,,,OUTPATIENT,,,96.77,77.416,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.42,80,,61.94,,,0,"percent of total billed charges ","80% of total billed charges ",67.74,70,,54.19,,,0,"percent of total billed charges ","70% of total billed charges ",87.09,90,,69.67,,,0,"percent of total billed charges ","90% of total billed charges ",90,93,,72.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",82.25,85,,65.80,,,0,"percent of total billed charges ","85% of total billed charges ",87.09,90,,69.67,,,0,"percent of total billed charges ","90% of total billed charges ",87.09,90,,69.67,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",84.19,87,,67.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.74,70,,54.19,,,0,"percent of total billed charges ","70% of total billed charges ",67.74,90,
"SET MORGAN LENS DELIVERY",6001466,"CDM ",272,RC,,,OUTPATIENT,,,27.88,22.304,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.3,80,,17.84,,,0,"percent of total billed charges ","80% of total billed charges ",19.52,70,,15.62,,,0,"percent of total billed charges ","70% of total billed charges ",25.09,90,,20.07,,,0,"percent of total billed charges ","90% of total billed charges ",25.93,93,,20.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.7,85,,18.96,,,0,"percent of total billed charges ","85% of total billed charges ",25.09,90,,20.07,,,0,"percent of total billed charges ","90% of total billed charges ",25.09,90,,20.07,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",24.26,87,,19.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.52,70,,15.62,,,0,"percent of total billed charges ","70% of total billed charges ",19.52,25.93,
"TRAY SPINAL 26GA",6001481,"CDM ",272,RC,,,OUTPATIENT,,,88.38,70.704,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.7,80,,56.56,,,0,"percent of total billed charges ","80% of total billed charges ",61.87,70,,49.50,,,0,"percent of total billed charges ","70% of total billed charges ",79.54,90,,63.63,,,0,"percent of total billed charges ","90% of total billed charges ",82.19,93,,65.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",75.12,85,,60.10,,,0,"percent of total billed charges ","85% of total billed charges ",79.54,90,,63.63,,,0,"percent of total billed charges ","90% of total billed charges ",79.54,90,,63.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",76.89,87,,61.51,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.87,70,,49.50,,,0,"percent of total billed charges ","70% of total billed charges ",61.87,82.19,
"STOCKINETTE IMPERV LARGE",6001487,"CDM ",272,RC,,,OUTPATIENT,,,16.25,13,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13,80,,10.40,,,0,"percent of total billed charges ","80% of total billed charges ",11.38,70,,9.10,,,0,"percent of total billed charges ","70% of total billed charges ",14.63,90,,11.70,,,0,"percent of total billed charges ","90% of total billed charges ",15.11,93,,12.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.81,85,,11.05,,,0,"percent of total billed charges ","85% of total billed charges ",14.63,90,,11.70,,,0,"percent of total billed charges ","90% of total billed charges ",14.63,90,,11.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.14,87,,11.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.38,70,,9.10,,,0,"percent of total billed charges ","70% of total billed charges ",11.38,15.11,
"SET CLOSED INJECTION",6001490,"CDM ",272,RC,,,OUTPATIENT,,,203.44,162.752,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.75,80,,130.20,,,0,"percent of total billed charges ","80% of total billed charges ",142.41,70,,113.93,,,0,"percent of total billed charges ","70% of total billed charges ",183.1,90,,146.48,,,0,"percent of total billed charges ","90% of total billed charges ",189.2,93,,151.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",172.92,85,,138.34,,,0,"percent of total billed charges ","85% of total billed charges ",183.1,90,,146.48,,,0,"percent of total billed charges ","90% of total billed charges ",183.1,90,,146.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",176.99,87,,141.59,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.41,70,,113.93,,,0,"percent of total billed charges ","70% of total billed charges ",142.41,189.2,
"STOCKINETTE IMPERV MED",6001509,"CDM ",272,RC,,,OUTPATIENT,,,24.67,19.736,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.74,80,,15.79,,,0,"percent of total billed charges ","80% of total billed charges ",17.27,70,,13.82,,,0,"percent of total billed charges ","70% of total billed charges ",22.2,90,,17.76,,,0,"percent of total billed charges ","90% of total billed charges ",22.94,93,,18.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.97,85,,16.78,,,0,"percent of total billed charges ","85% of total billed charges ",22.2,90,,17.76,,,0,"percent of total billed charges ","90% of total billed charges ",22.2,90,,17.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.46,87,,17.17,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.27,70,,13.82,,,0,"percent of total billed charges ","70% of total billed charges ",17.27,22.94,
"CATH FOLEY 24FR 5CC",6001576,"CDM ",272,RC,,,OUTPATIENT,,,30.99,24.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.79,80,,19.83,,,0,"percent of total billed charges ","80% of total billed charges ",21.69,70,,17.35,,,0,"percent of total billed charges ","70% of total billed charges ",27.89,90,,22.31,,,0,"percent of total billed charges ","90% of total billed charges ",28.82,93,,23.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.34,85,,21.07,,,0,"percent of total billed charges ","85% of total billed charges ",27.89,90,,22.31,,,0,"percent of total billed charges ","90% of total billed charges ",27.89,90,,22.31,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.96,87,,21.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.69,70,,17.35,,,0,"percent of total billed charges ","70% of total billed charges ",21.69,28.82,
"SUTURE CHROMIC 2.0 816H",6001585,"CDM ",272,RC,,,OUTPATIENT,,,8.17,6.536,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.54,80,,5.23,,,0,"percent of total billed charges ","80% of total billed charges ",5.72,70,,4.58,,,0,"percent of total billed charges ","70% of total billed charges ",7.35,90,,5.88,,,0,"percent of total billed charges ","90% of total billed charges ",7.6,93,,6.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6.94,85,,5.55,,,0,"percent of total billed charges ","85% of total billed charges ",7.35,90,,5.88,,,0,"percent of total billed charges ","90% of total billed charges ",7.35,90,,5.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7.11,87,,5.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.72,70,,4.58,,,0,"percent of total billed charges ","70% of total billed charges ",5.72,7.6,
"SPLINT WRIST LEATHER LL",6001607,"CDM ",271,RC,,,OUTPATIENT,,,23.77,19.016,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.02,80,,15.22,,,0,"percent of total billed charges ","80% of total billed charges ",16.64,70,,13.31,,,0,"percent of total billed charges ","70% of total billed charges ",21.39,90,,17.11,,,0,"percent of total billed charges ","90% of total billed charges ",22.11,93,,17.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.2,85,,16.16,,,0,"percent of total billed charges ","85% of total billed charges ",21.39,90,,17.11,,,0,"percent of total billed charges ","90% of total billed charges ",21.39,90,,17.11,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.68,87,,16.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.64,70,,13.31,,,0,"percent of total billed charges ","70% of total billed charges ",16.64,22.11,
"BAG LEG",6001608,"CDM ",272,RC,,,OUTPATIENT,,,14.59,11.672,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.67,80,,9.34,,,0,"percent of total billed charges ","80% of total billed charges ",10.21,70,,8.17,,,0,"percent of total billed charges ","70% of total billed charges ",13.13,90,,10.50,,,0,"percent of total billed charges ","90% of total billed charges ",13.57,93,,10.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.4,85,,9.92,,,0,"percent of total billed charges ","85% of total billed charges ",13.13,90,,10.50,,,0,"percent of total billed charges ","90% of total billed charges ",13.13,90,,10.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.69,87,,10.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.21,70,,8.17,,,0,"percent of total billed charges ","70% of total billed charges ",10.21,13.57,
"GAUZE FLUFFS STRL 4 PK",6001659,"CDM ",272,RC,,,OUTPATIENT,,,28.94,23.152,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.15,80,,18.52,,,0,"percent of total billed charges ","80% of total billed charges ",20.26,70,,16.21,,,0,"percent of total billed charges ","70% of total billed charges ",26.05,90,,20.84,,,0,"percent of total billed charges ","90% of total billed charges ",26.91,93,,21.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",24.6,85,,19.68,,,0,"percent of total billed charges ","85% of total billed charges ",26.05,90,,20.84,,,0,"percent of total billed charges ","90% of total billed charges ",26.05,90,,20.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",25.18,87,,20.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.26,70,,16.21,,,0,"percent of total billed charges ","70% of total billed charges ",20.26,26.91,
"SUTURE 810H 3.0 CHROMIC",6001666,"CDM ",272,RC,,,OUTPATIENT,,,11.38,9.104,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.1,80,,7.28,,,0,"percent of total billed charges ","80% of total billed charges ",7.97,70,,6.38,,,0,"percent of total billed charges ","70% of total billed charges ",10.24,90,,8.19,,,0,"percent of total billed charges ","90% of total billed charges ",10.58,93,,8.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.67,85,,7.74,,,0,"percent of total billed charges ","85% of total billed charges ",10.24,90,,8.19,,,0,"percent of total billed charges ","90% of total billed charges ",10.24,90,,8.19,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.9,87,,7.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.97,70,,6.38,,,0,"percent of total billed charges ","70% of total billed charges ",7.97,10.58,
"ANCHOR W/SUTURE 5.0M SIZE 2",6001707,"CDM ",272,RC,,,OUTPATIENT,,,583.88,467.104,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",467.1,80,,373.68,,,0,"percent of total billed charges ","80% of total billed charges ",408.72,70,,326.98,,,0,"percent of total billed charges ","70% of total billed charges ",525.49,90,,420.39,,,0,"percent of total billed charges ","90% of total billed charges ",543.01,93,,434.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",496.3,85,,397.04,,,0,"percent of total billed charges ","85% of total billed charges ",525.49,90,,420.39,,,0,"percent of total billed charges ","90% of total billed charges ",525.49,90,,420.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",507.98,87,,406.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",408.72,70,,326.98,,,0,"percent of total billed charges ","70% of total billed charges ",408.72,543.01,
"KIT DELIVERY VACUME",6001709,"CDM ",272,RC,,,OUTPATIENT,,,92.59,74.072,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.07,80,,59.26,,,0,"percent of total billed charges ","80% of total billed charges ",64.81,70,,51.85,,,0,"percent of total billed charges ","70% of total billed charges ",83.33,90,,66.66,,,0,"percent of total billed charges ","90% of total billed charges ",86.11,93,,68.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",78.7,85,,62.96,,,0,"percent of total billed charges ","85% of total billed charges ",83.33,90,,66.66,,,0,"percent of total billed charges ","90% of total billed charges ",83.33,90,,66.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",80.55,87,,64.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.81,70,,51.85,,,0,"percent of total billed charges ","70% of total billed charges ",64.81,86.11,
"HOLDER LIMB ADULT DISP.",6001716,"CDM ",272,RC,,,OUTPATIENT,,,13.49,10.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.79,80,,8.63,,,0,"percent of total billed charges ","80% of total billed charges ",9.44,70,,7.55,,,0,"percent of total billed charges ","70% of total billed charges ",12.14,90,,9.71,,,0,"percent of total billed charges ","90% of total billed charges ",12.55,93,,10.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.47,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.14,90,,9.71,,,0,"percent of total billed charges ","90% of total billed charges ",12.14,90,,9.71,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.74,87,,9.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.44,70,,7.55,,,0,"percent of total billed charges ","70% of total billed charges ",9.44,12.55,
"COLLAR CERVICAL PEDI RIGID",6001717,"CDM ",270,RC,,,OUTPATIENT,,,25.02,20.016,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.02,80,,16.02,,,0,"percent of total billed charges ","80% of total billed charges ",17.51,70,,14.01,,,0,"percent of total billed charges ","70% of total billed charges ",22.52,90,,18.02,,,0,"percent of total billed charges ","90% of total billed charges ",23.27,93,,18.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.27,85,,17.02,,,0,"percent of total billed charges ","85% of total billed charges ",22.52,90,,18.02,,,0,"percent of total billed charges ","90% of total billed charges ",22.52,90,,18.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.77,87,,17.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.51,70,,14.01,,,0,"percent of total billed charges ","70% of total billed charges ",17.51,23.27,
"BLADE REAMER PATELLA 26M",6001722,"CDM ",272,RC,,,OUTPATIENT,,,344.8,275.84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",275.84,80,,220.67,,,0,"percent of total billed charges ","80% of total billed charges ",241.36,70,,193.09,,,0,"percent of total billed charges ","70% of total billed charges ",310.32,90,,248.26,,,0,"percent of total billed charges ","90% of total billed charges ",320.66,93,,256.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",293.08,85,,234.46,,,0,"percent of total billed charges ","85% of total billed charges ",310.32,90,,248.26,,,0,"percent of total billed charges ","90% of total billed charges ",310.32,90,,248.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",299.98,87,,239.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.36,70,,193.09,,,0,"percent of total billed charges ","70% of total billed charges ",241.36,320.66,
"TRAY BONE MARROW DISP.",6001735,"CDM ",272,RC,,,OUTPATIENT,,,103.12,82.496,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.5,80,,66.00,,,0,"percent of total billed charges ","80% of total billed charges ",72.18,70,,57.74,,,0,"percent of total billed charges ","70% of total billed charges ",92.81,90,,74.25,,,0,"percent of total billed charges ","90% of total billed charges ",95.9,93,,76.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",87.65,85,,70.12,,,0,"percent of total billed charges ","85% of total billed charges ",92.81,90,,74.25,,,0,"percent of total billed charges ","90% of total billed charges ",92.81,90,,74.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",89.71,87,,71.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.18,70,,57.74,,,0,"percent of total billed charges ","70% of total billed charges ",72.18,95.9,
"DRESSING VAC SMALL",6001737,"CDM ",272,RC,,,OUTPATIENT,,,135.26,108.208,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.21,80,,86.57,,,0,"percent of total billed charges ","80% of total billed charges ",94.68,70,,75.74,,,0,"percent of total billed charges ","70% of total billed charges ",121.73,90,,97.38,,,0,"percent of total billed charges ","90% of total billed charges ",125.79,93,,100.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",114.97,85,,91.98,,,0,"percent of total billed charges ","85% of total billed charges ",121.73,90,,97.38,,,0,"percent of total billed charges ","90% of total billed charges ",121.73,90,,97.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",117.68,87,,94.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.68,70,,75.74,,,0,"percent of total billed charges ","70% of total billed charges ",94.68,125.79,
"DRESSING VAC MEDIUM",6001738,"CDM ",272,RC,,,OUTPATIENT,,,170.38,136.304,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136.3,80,,109.04,,,0,"percent of total billed charges ","80% of total billed charges ",119.27,70,,95.42,,,0,"percent of total billed charges ","70% of total billed charges ",153.34,90,,122.67,,,0,"percent of total billed charges ","90% of total billed charges ",158.45,93,,126.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",144.82,85,,115.86,,,0,"percent of total billed charges ","85% of total billed charges ",153.34,90,,122.67,,,0,"percent of total billed charges ","90% of total billed charges ",153.34,90,,122.67,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",148.23,87,,118.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.27,70,,95.42,,,0,"percent of total billed charges ","70% of total billed charges ",119.27,158.45,
"CATH THORACIC 10FR ST",6001753,"CDM ",272,RC,,,OUTPATIENT,,,19.86,15.888,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.89,80,,12.71,,,0,"percent of total billed charges ","80% of total billed charges ",13.9,70,,11.12,,,0,"percent of total billed charges ","70% of total billed charges ",17.87,90,,14.30,,,0,"percent of total billed charges ","90% of total billed charges ",18.47,93,,14.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.88,85,,13.50,,,0,"percent of total billed charges ","85% of total billed charges ",17.87,90,,14.30,,,0,"percent of total billed charges ","90% of total billed charges ",17.87,90,,14.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.28,87,,13.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.9,70,,11.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.9,18.47,
"CATH THORACIC W/TROCAR 32 FR",6001760,"CDM ",272,RC,,,OUTPATIENT,,,62.14,49.712,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.71,80,,39.77,,,0,"percent of total billed charges ","80% of total billed charges ",43.5,70,,34.80,,,0,"percent of total billed charges ","70% of total billed charges ",55.93,90,,44.74,,,0,"percent of total billed charges ","90% of total billed charges ",57.79,93,,46.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",52.82,85,,42.26,,,0,"percent of total billed charges ","85% of total billed charges ",55.93,90,,44.74,,,0,"percent of total billed charges ","90% of total billed charges ",55.93,90,,44.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",54.06,87,,43.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.5,70,,34.80,,,0,"percent of total billed charges ","70% of total billed charges ",43.5,57.79,
"SUTURE 698H 5-0 P-3",6001766,"CDM ",272,RC,,,OUTPATIENT,,,11.43,9.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.14,80,,7.31,,,0,"percent of total billed charges ","80% of total billed charges ",8,70,,6.40,,,0,"percent of total billed charges ","70% of total billed charges ",10.29,90,,8.23,,,0,"percent of total billed charges ","90% of total billed charges ",10.63,93,,8.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.72,85,,7.78,,,0,"percent of total billed charges ","85% of total billed charges ",10.29,90,,8.23,,,0,"percent of total billed charges ","90% of total billed charges ",10.29,90,,8.23,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.94,87,,7.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8,70,,6.40,,,0,"percent of total billed charges ","70% of total billed charges ",8,10.63,
"TROCAR THORACIC 28F",6001797,"CDM ",272,RC,,,OUTPATIENT,,,60.76,48.608,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.61,80,,38.89,,,0,"percent of total billed charges ","80% of total billed charges ",42.53,70,,34.02,,,0,"percent of total billed charges ","70% of total billed charges ",54.68,90,,43.74,,,0,"percent of total billed charges ","90% of total billed charges ",56.51,93,,45.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51.65,85,,41.32,,,0,"percent of total billed charges ","85% of total billed charges ",54.68,90,,43.74,,,0,"percent of total billed charges ","90% of total billed charges ",54.68,90,,43.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",52.86,87,,42.29,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.53,70,,34.02,,,0,"percent of total billed charges ","70% of total billed charges ",42.53,56.51,
"CATH FOLEY 24FR 30C",6001832,"CDM ",272,RC,,,OUTPATIENT,,,16.45,13.16,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.16,80,,10.53,,,0,"percent of total billed charges ","80% of total billed charges ",11.52,70,,9.22,,,0,"percent of total billed charges ","70% of total billed charges ",14.81,90,,11.85,,,0,"percent of total billed charges ","90% of total billed charges ",15.3,93,,12.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.98,85,,11.18,,,0,"percent of total billed charges ","85% of total billed charges ",14.81,90,,11.85,,,0,"percent of total billed charges ","90% of total billed charges ",14.81,90,,11.85,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.31,87,,11.45,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.52,70,,9.22,,,0,"percent of total billed charges ","70% of total billed charges ",11.52,15.3,
"TIP CAUTERY",6001859,"CDM ",272,RC,,,OUTPATIENT,,,49.87,39.896,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.9,80,,31.92,,,0,"percent of total billed charges ","80% of total billed charges ",34.91,70,,27.93,,,0,"percent of total billed charges ","70% of total billed charges ",44.88,90,,35.90,,,0,"percent of total billed charges ","90% of total billed charges ",46.38,93,,37.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.39,85,,33.91,,,0,"percent of total billed charges ","85% of total billed charges ",44.88,90,,35.90,,,0,"percent of total billed charges ","90% of total billed charges ",44.88,90,,35.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.39,87,,34.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.91,70,,27.93,,,0,"percent of total billed charges ","70% of total billed charges ",34.91,46.38,
"NEEDLE BIOPSY BREAST",6001864,"CDM ",621,RC,,,OUTPATIENT,,,123.48,98.784,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.78,80,,79.02,,,0,"percent of total billed charges ","80% of total billed charges ",86.44,70,,69.15,,,0,"percent of total billed charges ","70% of total billed charges ",111.13,90,,88.90,,,0,"percent of total billed charges ","90% of total billed charges ",114.84,93,,91.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",104.96,85,,83.97,,,0,"percent of total billed charges ","85% of total billed charges ",111.13,90,,88.90,,,0,"percent of total billed charges ","90% of total billed charges ",111.13,90,,88.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",107.43,87,,85.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.44,70,,69.15,,,0,"percent of total billed charges ","70% of total billed charges ",86.44,114.84,
"INTERFACE CPAP LYRA ASSEMBLY",6001868,"CDM ",272,RC,,,OUTPATIENT,,,368.13,294.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",294.5,80,,235.60,,,0,"percent of total billed charges ","80% of total billed charges ",257.69,70,,206.15,,,0,"percent of total billed charges ","70% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",342.36,93,,273.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",312.91,85,,250.33,,,0,"percent of total billed charges ","85% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",320.27,87,,256.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",257.69,70,,206.15,,,0,"percent of total billed charges ","70% of total billed charges ",257.69,342.36,
"STAPLER 5 SHOT",6001869,"CDM ",272,RC,,,OUTPATIENT,,,17.4,13.92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.92,80,,11.14,,,0,"percent of total billed charges ","80% of total billed charges ",12.18,70,,9.74,,,0,"percent of total billed charges ","70% of total billed charges ",15.66,90,,12.53,,,0,"percent of total billed charges ","90% of total billed charges ",16.18,93,,12.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.79,85,,11.83,,,0,"percent of total billed charges ","85% of total billed charges ",15.66,90,,12.53,,,0,"percent of total billed charges ","90% of total billed charges ",15.66,90,,12.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.14,87,,12.11,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.18,70,,9.74,,,0,"percent of total billed charges ","70% of total billed charges ",12.18,16.18,
"PAIL COMMODE DISP",6001874,"CDM ",271,RC,,,OUTPATIENT,,,40.47,32.376,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.38,80,,25.90,,,0,"percent of total billed charges ","80% of total billed charges ",28.33,70,,22.66,,,0,"percent of total billed charges ","70% of total billed charges ",36.42,90,,29.14,,,0,"percent of total billed charges ","90% of total billed charges ",37.64,93,,30.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34.4,85,,27.52,,,0,"percent of total billed charges ","85% of total billed charges ",36.42,90,,29.14,,,0,"percent of total billed charges ","90% of total billed charges ",36.42,90,,29.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",35.21,87,,28.17,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.33,70,,22.66,,,0,"percent of total billed charges ","70% of total billed charges ",28.33,37.64,
"HUMIDIFIER 350CC HIGH",6001880,"CDM ",272,RC,,,OUTPATIENT,,,23.87,19.096,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.1,80,,15.28,,,0,"percent of total billed charges ","80% of total billed charges ",16.71,70,,13.37,,,0,"percent of total billed charges ","70% of total billed charges ",21.48,90,,17.18,,,0,"percent of total billed charges ","90% of total billed charges ",22.2,93,,17.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.29,85,,16.23,,,0,"percent of total billed charges ","85% of total billed charges ",21.48,90,,17.18,,,0,"percent of total billed charges ","90% of total billed charges ",21.48,90,,17.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.77,87,,16.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.71,70,,13.37,,,0,"percent of total billed charges ","70% of total billed charges ",16.71,22.2,
"CATH FOLEY 26FR 5CC",6001885,"CDM ",272,RC,,,OUTPATIENT,,,33.8,27.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.04,80,,21.63,,,0,"percent of total billed charges ","80% of total billed charges ",23.66,70,,18.93,,,0,"percent of total billed charges ","70% of total billed charges ",30.42,90,,24.34,,,0,"percent of total billed charges ","90% of total billed charges ",31.43,93,,25.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.73,85,,22.98,,,0,"percent of total billed charges ","85% of total billed charges ",30.42,90,,24.34,,,0,"percent of total billed charges ","90% of total billed charges ",30.42,90,,24.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.41,87,,23.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.66,70,,18.93,,,0,"percent of total billed charges ","70% of total billed charges ",23.66,31.43,
"CURRETTE EAR SCOPE",6001895,"CDM ",272,RC,,,OUTPATIENT,,,5,4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4,80,,3.20,,,0,"percent of total billed charges ","80% of total billed charges ",3.5,70,,2.80,,,0,"percent of total billed charges ","70% of total billed charges ",4.5,90,,3.60,,,0,"percent of total billed charges ","90% of total billed charges ",4.65,93,,3.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4.25,85,,3.40,,,0,"percent of total billed charges ","85% of total billed charges ",4.5,90,,3.60,,,0,"percent of total billed charges ","90% of total billed charges ",4.5,90,,3.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4.35,87,,3.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.5,70,,2.80,,,0,"percent of total billed charges ","70% of total billed charges ",3.5,4.65,
"SUTURE SILK 4.0",6001904,"CDM ",272,RC,,,OUTPATIENT,,,12.09,9.672,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.67,80,,7.74,,,0,"percent of total billed charges ","80% of total billed charges ",8.46,70,,6.77,,,0,"percent of total billed charges ","70% of total billed charges ",10.88,90,,8.70,,,0,"percent of total billed charges ","90% of total billed charges ",11.24,93,,8.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.28,85,,8.22,,,0,"percent of total billed charges ","85% of total billed charges ",10.88,90,,8.70,,,0,"percent of total billed charges ","90% of total billed charges ",10.88,90,,8.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.52,87,,8.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.46,70,,6.77,,,0,"percent of total billed charges ","70% of total billed charges ",8.46,11.24,
"MASK PERFORMS TASK MEDIUM",6001941,"CDM ",270,RC,,,OUTPATIENT,,,109.7,87.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.76,80,,70.21,,,0,"percent of total billed charges ","80% of total billed charges ",76.79,70,,61.43,,,0,"percent of total billed charges ","70% of total billed charges ",98.73,90,,78.98,,,0,"percent of total billed charges ","90% of total billed charges ",102.02,93,,81.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",93.25,85,,74.60,,,0,"percent of total billed charges ","85% of total billed charges ",98.73,90,,78.98,,,0,"percent of total billed charges ","90% of total billed charges ",98.73,90,,78.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",95.44,87,,76.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.79,70,,61.43,,,0,"percent of total billed charges ","70% of total billed charges ",76.79,102.02,
"MASK PERFORMS TASK LARGE",6001942,"CDM ",270,RC,,,OUTPATIENT,,,106.01,84.808,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.81,80,,67.85,,,0,"percent of total billed charges ","80% of total billed charges ",74.21,70,,59.37,,,0,"percent of total billed charges ","70% of total billed charges ",95.41,90,,76.33,,,0,"percent of total billed charges ","90% of total billed charges ",98.59,93,,78.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",90.11,85,,72.09,,,0,"percent of total billed charges ","85% of total billed charges ",95.41,90,,76.33,,,0,"percent of total billed charges ","90% of total billed charges ",95.41,90,,76.33,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",92.23,87,,73.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.21,70,,59.37,,,0,"percent of total billed charges ","70% of total billed charges ",74.21,98.59,
"CATH FOLEY 12FR 5CC",6001958,"CDM ",272,RC,,,OUTPATIENT,,,30.99,24.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.79,80,,19.83,,,0,"percent of total billed charges ","80% of total billed charges ",21.69,70,,17.35,,,0,"percent of total billed charges ","70% of total billed charges ",27.89,90,,22.31,,,0,"percent of total billed charges ","90% of total billed charges ",28.82,93,,23.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.34,85,,21.07,,,0,"percent of total billed charges ","85% of total billed charges ",27.89,90,,22.31,,,0,"percent of total billed charges ","90% of total billed charges ",27.89,90,,22.31,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.96,87,,21.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.69,70,,17.35,,,0,"percent of total billed charges ","70% of total billed charges ",21.69,28.82,
"CATH 22FR 3 WAY",6001973,"CDM ",272,RC,,,OUTPATIENT,,,45.38,36.304,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.3,80,,29.04,,,0,"percent of total billed charges ","80% of total billed charges ",31.77,70,,25.42,,,0,"percent of total billed charges ","70% of total billed charges ",40.84,90,,32.67,,,0,"percent of total billed charges ","90% of total billed charges ",42.2,93,,33.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.57,85,,30.86,,,0,"percent of total billed charges ","85% of total billed charges ",40.84,90,,32.67,,,0,"percent of total billed charges ","90% of total billed charges ",40.84,90,,32.67,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.48,87,,31.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.77,70,,25.42,,,0,"percent of total billed charges ","70% of total billed charges ",31.77,42.2,
"ADAPTOR SWIVEL PORTEX",6001980,"CDM ",272,RC,,,OUTPATIENT,,,52.58,42.064,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.06,80,,33.65,,,0,"percent of total billed charges ","80% of total billed charges ",36.81,70,,29.45,,,0,"percent of total billed charges ","70% of total billed charges ",47.32,90,,37.86,,,0,"percent of total billed charges ","90% of total billed charges ",48.9,93,,39.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",44.69,85,,35.75,,,0,"percent of total billed charges ","85% of total billed charges ",47.32,90,,37.86,,,0,"percent of total billed charges ","90% of total billed charges ",47.32,90,,37.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",45.74,87,,36.59,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.81,70,,29.45,,,0,"percent of total billed charges ","70% of total billed charges ",36.81,48.9,
"DRAINAGE POUCH SET",6001982,"CDM ",272,RC,,,OUTPATIENT,,,126.68,101.344,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.34,80,,81.07,,,0,"percent of total billed charges ","80% of total billed charges ",88.68,70,,70.94,,,0,"percent of total billed charges ","70% of total billed charges ",114.01,90,,91.21,,,0,"percent of total billed charges ","90% of total billed charges ",117.81,93,,94.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",107.68,85,,86.14,,,0,"percent of total billed charges ","85% of total billed charges ",114.01,90,,91.21,,,0,"percent of total billed charges ","90% of total billed charges ",114.01,90,,91.21,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",110.21,87,,88.17,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.68,70,,70.94,,,0,"percent of total billed charges ","70% of total billed charges ",88.68,117.81,
"TUBE VINYL CONNECTING",6001996,"CDM ",272,RC,,,OUTPATIENT,,,59.03,47.224,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.22,80,,37.78,,,0,"percent of total billed charges ","80% of total billed charges ",41.32,70,,33.06,,,0,"percent of total billed charges ","70% of total billed charges ",53.13,90,,42.50,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,93,,43.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",50.18,85,,40.14,,,0,"percent of total billed charges ","85% of total billed charges ",53.13,90,,42.50,,,0,"percent of total billed charges ","90% of total billed charges ",53.13,90,,42.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",51.36,87,,41.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.32,70,,33.06,,,0,"percent of total billed charges ","70% of total billed charges ",41.32,54.9,
"DRESSING NUGAUZE IODO 1""",6001997,"CDM ",272,RC,,,OUTPATIENT,,,10.08,8.064,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.06,80,,6.45,,,0,"percent of total billed charges ","80% of total billed charges ",7.06,70,,5.65,,,0,"percent of total billed charges ","70% of total billed charges ",9.07,90,,7.26,,,0,"percent of total billed charges ","90% of total billed charges ",9.37,93,,7.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.57,85,,6.86,,,0,"percent of total billed charges ","85% of total billed charges ",9.07,90,,7.26,,,0,"percent of total billed charges ","90% of total billed charges ",9.07,90,,7.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",8.77,87,,7.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.06,70,,5.65,,,0,"percent of total billed charges ","70% of total billed charges ",7.06,9.37,
"CATH FOLEY 14FR 5CC",6002024,"CDM ",272,RC,,,OUTPATIENT,,,31.39,25.112,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.11,80,,20.09,,,0,"percent of total billed charges ","80% of total billed charges ",21.97,70,,17.58,,,0,"percent of total billed charges ","70% of total billed charges ",28.25,90,,22.60,,,0,"percent of total billed charges ","90% of total billed charges ",29.19,93,,23.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.68,85,,21.34,,,0,"percent of total billed charges ","85% of total billed charges ",28.25,90,,22.60,,,0,"percent of total billed charges ","90% of total billed charges ",28.25,90,,22.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",27.31,87,,21.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.97,70,,17.58,,,0,"percent of total billed charges ","70% of total billed charges ",21.97,29.19,
"SYRINGE TOOMEY DISP",6002042,"CDM ",272,RC,,,OUTPATIENT,,,5.52,4.416,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.42,80,,3.54,,,0,"percent of total billed charges ","80% of total billed charges ",3.86,70,,3.09,,,0,"percent of total billed charges ","70% of total billed charges ",4.97,90,,3.98,,,0,"percent of total billed charges ","90% of total billed charges ",5.13,93,,4.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4.69,85,,3.75,,,0,"percent of total billed charges ","85% of total billed charges ",4.97,90,,3.98,,,0,"percent of total billed charges ","90% of total billed charges ",4.97,90,,3.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4.8,87,,3.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.86,70,,3.09,,,0,"percent of total billed charges ","70% of total billed charges ",3.86,5.13,
"TRAY CIRCUMCISION",6002112,"CDM ",272,RC,,,OUTPATIENT,,,48.45,38.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.76,80,,31.01,,,0,"percent of total billed charges ","80% of total billed charges ",33.92,70,,27.14,,,0,"percent of total billed charges ","70% of total billed charges ",43.61,90,,34.89,,,0,"percent of total billed charges ","90% of total billed charges ",45.06,93,,36.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.18,85,,32.94,,,0,"percent of total billed charges ","85% of total billed charges ",43.61,90,,34.89,,,0,"percent of total billed charges ","90% of total billed charges ",43.61,90,,34.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.15,87,,33.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.92,70,,27.14,,,0,"percent of total billed charges ","70% of total billed charges ",33.92,45.06,
"KIT PLEURX DRESSING",6002152,"CDM ",272,RC,,,OUTPATIENT,,,217,173.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.6,80,,138.88,,,0,"percent of total billed charges ","80% of total billed charges ",151.9,70,,121.52,,,0,"percent of total billed charges ","70% of total billed charges ",195.3,90,,156.24,,,0,"percent of total billed charges ","90% of total billed charges ",201.81,93,,161.45,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",184.45,85,,147.56,,,0,"percent of total billed charges ","85% of total billed charges ",195.3,90,,156.24,,,0,"percent of total billed charges ","90% of total billed charges ",195.3,90,,156.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",188.79,87,,151.03,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.9,70,,121.52,,,0,"percent of total billed charges ","70% of total billed charges ",151.9,201.81,
"REMOVER FOREIGN BODY",6002157,"CDM ",272,RC,,,OUTPATIENT,,,122.24,97.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.79,80,,78.23,,,0,"percent of total billed charges ","80% of total billed charges ",85.57,70,,68.46,,,0,"percent of total billed charges ","70% of total billed charges ",110.02,90,,88.02,,,0,"percent of total billed charges ","90% of total billed charges ",113.68,93,,90.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",103.9,85,,83.12,,,0,"percent of total billed charges ","85% of total billed charges ",110.02,90,,88.02,,,0,"percent of total billed charges ","90% of total billed charges ",110.02,90,,88.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",106.35,87,,85.08,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.57,70,,68.46,,,0,"percent of total billed charges ","70% of total billed charges ",85.57,113.68,
"BINDER PELVIC",6002158,"CDM ",272,RC,,,OUTPATIENT,,,387.9,310.32,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",310.32,80,,248.26,,,0,"percent of total billed charges ","80% of total billed charges ",271.53,70,,217.22,,,0,"percent of total billed charges ","70% of total billed charges ",349.11,90,,279.29,,,0,"percent of total billed charges ","90% of total billed charges ",360.75,93,,288.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",329.72,85,,263.78,,,0,"percent of total billed charges ","85% of total billed charges ",349.11,90,,279.29,,,0,"percent of total billed charges ","90% of total billed charges ",349.11,90,,279.29,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",337.47,87,,269.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",271.53,70,,217.22,,,0,"percent of total billed charges ","70% of total billed charges ",271.53,360.75,
"BOOT BUCKS TRACTION SML",6002168,"CDM ",271,RC,,,OUTPATIENT,,,39.32,31.456,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.46,80,,25.17,,,0,"percent of total billed charges ","80% of total billed charges ",27.52,70,,22.02,,,0,"percent of total billed charges ","70% of total billed charges ",35.39,90,,28.31,,,0,"percent of total billed charges ","90% of total billed charges ",36.57,93,,29.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.42,85,,26.74,,,0,"percent of total billed charges ","85% of total billed charges ",35.39,90,,28.31,,,0,"percent of total billed charges ","90% of total billed charges ",35.39,90,,28.31,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",34.21,87,,27.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.52,70,,22.02,,,0,"percent of total billed charges ","70% of total billed charges ",27.52,36.57,
"BOOT BUCKS TRACTION-MED",6002169,"CDM ",271,RC,,,OUTPATIENT,,,39.82,31.856,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.86,80,,25.49,,,0,"percent of total billed charges ","80% of total billed charges ",27.87,70,,22.30,,,0,"percent of total billed charges ","70% of total billed charges ",35.84,90,,28.67,,,0,"percent of total billed charges ","90% of total billed charges ",37.03,93,,29.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.85,85,,27.08,,,0,"percent of total billed charges ","85% of total billed charges ",35.84,90,,28.67,,,0,"percent of total billed charges ","90% of total billed charges ",35.84,90,,28.67,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",34.64,87,,27.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.87,70,,22.30,,,0,"percent of total billed charges ","70% of total billed charges ",27.87,37.03,
"BOOT BUCKS TRACTION-LG",6002170,"CDM ",271,RC,,,OUTPATIENT,,,185.53,148.424,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.42,80,,118.74,,,0,"percent of total billed charges ","80% of total billed charges ",129.87,70,,103.90,,,0,"percent of total billed charges ","70% of total billed charges ",166.98,90,,133.58,,,0,"percent of total billed charges ","90% of total billed charges ",172.54,93,,138.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",157.7,85,,126.16,,,0,"percent of total billed charges ","85% of total billed charges ",166.98,90,,133.58,,,0,"percent of total billed charges ","90% of total billed charges ",166.98,90,,133.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",161.41,87,,129.13,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.87,70,,103.90,,,0,"percent of total billed charges ","70% of total billed charges ",129.87,172.54,
"ADAPTOR CLOSEPIN CANNULA",6002178,"CDM ",272,RC,,,OUTPATIENT,,,10.93,8.744,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.74,80,,6.99,,,0,"percent of total billed charges ","80% of total billed charges ",7.65,70,,6.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.84,90,,7.87,,,0,"percent of total billed charges ","90% of total billed charges ",10.16,93,,8.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.29,85,,7.43,,,0,"percent of total billed charges ","85% of total billed charges ",9.84,90,,7.87,,,0,"percent of total billed charges ","90% of total billed charges ",9.84,90,,7.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.51,87,,7.61,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.65,70,,6.12,,,0,"percent of total billed charges ","70% of total billed charges ",7.65,10.16,
"TUBE MURPHY CUFFED 9.0",6002186,"CDM ",272,RC,,,OUTPATIENT,,,24.52,19.616,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.62,80,,15.70,,,0,"percent of total billed charges ","80% of total billed charges ",17.16,70,,13.73,,,0,"percent of total billed charges ","70% of total billed charges ",22.07,90,,17.66,,,0,"percent of total billed charges ","90% of total billed charges ",22.8,93,,18.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.84,85,,16.67,,,0,"percent of total billed charges ","85% of total billed charges ",22.07,90,,17.66,,,0,"percent of total billed charges ","90% of total billed charges ",22.07,90,,17.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.33,87,,17.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.16,70,,13.73,,,0,"percent of total billed charges ","70% of total billed charges ",17.16,22.8,
"CATH FOLEY 16FR LATEX FREE",6002210,"CDM ",272,RC,,,OUTPATIENT,,,15.7,12.56,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.56,80,,10.05,,,0,"percent of total billed charges ","80% of total billed charges ",10.99,70,,8.79,,,0,"percent of total billed charges ","70% of total billed charges ",14.13,90,,11.30,,,0,"percent of total billed charges ","90% of total billed charges ",14.6,93,,11.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.35,85,,10.68,,,0,"percent of total billed charges ","85% of total billed charges ",14.13,90,,11.30,,,0,"percent of total billed charges ","90% of total billed charges ",14.13,90,,11.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.66,87,,10.93,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.99,70,,8.79,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,14.6,
"TUBE NASAL CUFFED 7.5MM",6002233,"CDM ",272,RC,,,OUTPATIENT,,,23.57,18.856,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.86,80,,15.09,,,0,"percent of total billed charges ","80% of total billed charges ",16.5,70,,13.20,,,0,"percent of total billed charges ","70% of total billed charges ",21.21,90,,16.97,,,0,"percent of total billed charges ","90% of total billed charges ",21.92,93,,17.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.03,85,,16.02,,,0,"percent of total billed charges ","85% of total billed charges ",21.21,90,,16.97,,,0,"percent of total billed charges ","90% of total billed charges ",21.21,90,,16.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.51,87,,16.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.5,70,,13.20,,,0,"percent of total billed charges ","70% of total billed charges ",16.5,21.92,
"SET COLLECTION W/HANDLE DISP",6002234,"CDM ",272,RC,,,OUTPATIENT,,,53.74,42.992,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.99,80,,34.39,,,0,"percent of total billed charges ","80% of total billed charges ",37.62,70,,30.10,,,0,"percent of total billed charges ","70% of total billed charges ",48.37,90,,38.70,,,0,"percent of total billed charges ","90% of total billed charges ",49.98,93,,39.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",45.68,85,,36.54,,,0,"percent of total billed charges ","85% of total billed charges ",48.37,90,,38.70,,,0,"percent of total billed charges ","90% of total billed charges ",48.37,90,,38.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",46.75,87,,37.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.62,70,,30.10,,,0,"percent of total billed charges ","70% of total billed charges ",37.62,49.98,
"PROBE SKIN TEMP",6002244,"CDM ",272,RC,,,OUTPATIENT,,,14.99,11.992,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.99,80,,9.59,,,0,"percent of total billed charges ","80% of total billed charges ",10.49,70,,8.39,,,0,"percent of total billed charges ","70% of total billed charges ",13.49,90,,10.79,,,0,"percent of total billed charges ","90% of total billed charges ",13.94,93,,11.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.74,85,,10.19,,,0,"percent of total billed charges ","85% of total billed charges ",13.49,90,,10.79,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,90,,10.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.04,87,,10.43,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.49,70,,8.39,,,0,"percent of total billed charges ","70% of total billed charges ",10.49,13.94,
"ADAPTOR AIRWAY",6002245,"CDM ",272,RC,,,OUTPATIENT,,,37.91,30.328,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.33,80,,24.26,,,0,"percent of total billed charges ","80% of total billed charges ",26.54,70,,21.23,,,0,"percent of total billed charges ","70% of total billed charges ",34.12,90,,27.30,,,0,"percent of total billed charges ","90% of total billed charges ",35.26,93,,28.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.22,85,,25.78,,,0,"percent of total billed charges ","85% of total billed charges ",34.12,90,,27.30,,,0,"percent of total billed charges ","90% of total billed charges ",34.12,90,,27.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",32.98,87,,26.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.54,70,,21.23,,,0,"percent of total billed charges ","70% of total billed charges ",26.54,35.26,
"BELT GAIT HEAVY DUTY DISP",6002252,"CDM ",272,RC,,,OUTPATIENT,,,50.05,40.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.04,80,,32.03,,,0,"percent of total billed charges ","80% of total billed charges ",35.04,70,,28.03,,,0,"percent of total billed charges ","70% of total billed charges ",45.05,90,,36.04,,,0,"percent of total billed charges ","90% of total billed charges ",46.55,93,,37.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.54,85,,34.03,,,0,"percent of total billed charges ","85% of total billed charges ",45.05,90,,36.04,,,0,"percent of total billed charges ","90% of total billed charges ",45.05,90,,36.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.54,87,,34.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.04,70,,28.03,,,0,"percent of total billed charges ","70% of total billed charges ",35.04,46.55,
"PADDING CAST 2""",6002255,"CDM ",271,RC,,,OUTPATIENT,,,3.58,2.864,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.86,80,,2.29,,,0,"percent of total billed charges ","80% of total billed charges ",2.51,70,,2.01,,,0,"percent of total billed charges ","70% of total billed charges ",3.22,90,,2.58,,,0,"percent of total billed charges ","90% of total billed charges ",3.33,93,,2.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3.04,85,,2.43,,,0,"percent of total billed charges ","85% of total billed charges ",3.22,90,,2.58,,,0,"percent of total billed charges ","90% of total billed charges ",3.22,90,,2.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3.11,87,,2.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.51,70,,2.01,,,0,"percent of total billed charges ","70% of total billed charges ",2.51,3.33,
"BARRIER 1 3/4"" SURFIT",6002257,"CDM ",271,RC,,,OUTPATIENT,,,9.33,7.464,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.46,80,,5.97,,,0,"percent of total billed charges ","80% of total billed charges ",6.53,70,,5.22,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,90,,6.72,,,0,"percent of total billed charges ","90% of total billed charges ",8.68,93,,6.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7.93,85,,6.34,,,0,"percent of total billed charges ","85% of total billed charges ",8.4,90,,6.72,,,0,"percent of total billed charges ","90% of total billed charges ",8.4,90,,6.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",8.12,87,,6.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.53,70,,5.22,,,0,"percent of total billed charges ","70% of total billed charges ",6.53,8.68,
"BARRIER ANTIFUNGAL",6002280,"CDM ",271,RC,,,OUTPATIENT,,,18.2,14.56,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.56,80,,11.65,,,0,"percent of total billed charges ","80% of total billed charges ",12.74,70,,10.19,,,0,"percent of total billed charges ","70% of total billed charges ",16.38,90,,13.10,,,0,"percent of total billed charges ","90% of total billed charges ",16.93,93,,13.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.47,85,,12.38,,,0,"percent of total billed charges ","85% of total billed charges ",16.38,90,,13.10,,,0,"percent of total billed charges ","90% of total billed charges ",16.38,90,,13.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.83,87,,12.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.74,70,,10.19,,,0,"percent of total billed charges ","70% of total billed charges ",12.74,16.93,
"TUBE MURPHY CUFFED 7.0",6002283,"CDM ",272,RC,,,OUTPATIENT,,,180.47,144.376,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.38,80,,115.50,,,0,"percent of total billed charges ","80% of total billed charges ",126.33,70,,101.06,,,0,"percent of total billed charges ","70% of total billed charges ",162.42,90,,129.94,,,0,"percent of total billed charges ","90% of total billed charges ",167.84,93,,134.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",153.4,85,,122.72,,,0,"percent of total billed charges ","85% of total billed charges ",162.42,90,,129.94,,,0,"percent of total billed charges ","90% of total billed charges ",162.42,90,,129.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",157.01,87,,125.61,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",126.33,70,,101.06,,,0,"percent of total billed charges ","70% of total billed charges ",126.33,167.84,
"DRESSING FILM 8X10",6002296,"CDM ",272,RC,,,OUTPATIENT,,,414.84,331.872,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",331.87,80,,265.50,,,0,"percent of total billed charges ","80% of total billed charges ",290.39,70,,232.31,,,0,"percent of total billed charges ","70% of total billed charges ",373.36,90,,298.69,,,0,"percent of total billed charges ","90% of total billed charges ",385.8,93,,308.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",352.61,85,,282.09,,,0,"percent of total billed charges ","85% of total billed charges ",373.36,90,,298.69,,,0,"percent of total billed charges ","90% of total billed charges ",373.36,90,,298.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",360.91,87,,288.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",290.39,70,,232.31,,,0,"percent of total billed charges ","70% of total billed charges ",290.39,385.8,
"MASK 02 NONREBREATHER INF",6002307,"CDM ",270,RC,,,OUTPATIENT,,,30.34,24.272,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.27,80,,19.42,,,0,"percent of total billed charges ","80% of total billed charges ",21.24,70,,16.99,,,0,"percent of total billed charges ","70% of total billed charges ",27.31,90,,21.85,,,0,"percent of total billed charges ","90% of total billed charges ",28.22,93,,22.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.79,85,,20.63,,,0,"percent of total billed charges ","85% of total billed charges ",27.31,90,,21.85,,,0,"percent of total billed charges ","90% of total billed charges ",27.31,90,,21.85,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.4,87,,21.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.24,70,,16.99,,,0,"percent of total billed charges ","70% of total billed charges ",21.24,28.22,
"KIT EPIDURAL ARROW",6002311,"CDM ",272,RC,,,OUTPATIENT,,,123.08,98.464,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.46,80,,78.77,,,0,"percent of total billed charges ","80% of total billed charges ",86.16,70,,68.93,,,0,"percent of total billed charges ","70% of total billed charges ",110.77,90,,88.62,,,0,"percent of total billed charges ","90% of total billed charges ",114.46,93,,91.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",104.62,85,,83.70,,,0,"percent of total billed charges ","85% of total billed charges ",110.77,90,,88.62,,,0,"percent of total billed charges ","90% of total billed charges ",110.77,90,,88.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",107.08,87,,85.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.16,70,,68.93,,,0,"percent of total billed charges ","70% of total billed charges ",86.16,114.46,
"SPRAY MICRO KLENZ",6002328,"CDM ",271,RC,,,OUTPATIENT,,,15.75,12.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.6,80,,10.08,,,0,"percent of total billed charges ","80% of total billed charges ",11.03,70,,8.82,,,0,"percent of total billed charges ","70% of total billed charges ",14.18,90,,11.34,,,0,"percent of total billed charges ","90% of total billed charges ",14.65,93,,11.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.39,85,,10.71,,,0,"percent of total billed charges ","85% of total billed charges ",14.18,90,,11.34,,,0,"percent of total billed charges ","90% of total billed charges ",14.18,90,,11.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.7,87,,10.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.03,70,,8.82,,,0,"percent of total billed charges ","70% of total billed charges ",11.03,14.65,
"NEEDLE SPINAL 25GA 3 1/2'",6002340,"CDM ",272,RC,,,OUTPATIENT,,,19.71,15.768,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.77,80,,12.62,,,0,"percent of total billed charges ","80% of total billed charges ",13.8,70,,11.04,,,0,"percent of total billed charges ","70% of total billed charges ",17.74,90,,14.19,,,0,"percent of total billed charges ","90% of total billed charges ",18.33,93,,14.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.75,85,,13.40,,,0,"percent of total billed charges ","85% of total billed charges ",17.74,90,,14.19,,,0,"percent of total billed charges ","90% of total billed charges ",17.74,90,,14.19,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.15,87,,13.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.8,70,,11.04,,,0,"percent of total billed charges ","70% of total billed charges ",13.8,18.33,
"KIWI MITY VAC",6002361,"CDM ",272,RC,,,OUTPATIENT,,,109.52,87.616,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.62,80,,70.10,,,0,"percent of total billed charges ","80% of total billed charges ",76.66,70,,61.33,,,0,"percent of total billed charges ","70% of total billed charges ",98.57,90,,78.86,,,0,"percent of total billed charges ","90% of total billed charges ",101.85,93,,81.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",93.09,85,,74.47,,,0,"percent of total billed charges ","85% of total billed charges ",98.57,90,,78.86,,,0,"percent of total billed charges ","90% of total billed charges ",98.57,90,,78.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",95.28,87,,76.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.66,70,,61.33,,,0,"percent of total billed charges ","70% of total billed charges ",76.66,101.85,
"NEEDLE GRIPPER",6002364,"CDM ",272,RC,,,OUTPATIENT,,,60.27,48.216,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.22,80,,38.58,,,0,"percent of total billed charges ","80% of total billed charges ",42.19,70,,33.75,,,0,"percent of total billed charges ","70% of total billed charges ",54.24,90,,43.39,,,0,"percent of total billed charges ","90% of total billed charges ",56.05,93,,44.84,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51.23,85,,40.98,,,0,"percent of total billed charges ","85% of total billed charges ",54.24,90,,43.39,,,0,"percent of total billed charges ","90% of total billed charges ",54.24,90,,43.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",52.43,87,,41.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.19,70,,33.75,,,0,"percent of total billed charges ","70% of total billed charges ",42.19,56.05,
"KITS EMPTY E-Z EM ENEMA",6002369,"CDM ",272,RC,,,OUTPATIENT,,,10.43,8.344,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.34,80,,6.67,,,0,"percent of total billed charges ","80% of total billed charges ",7.3,70,,5.84,,,0,"percent of total billed charges ","70% of total billed charges ",9.39,90,,7.51,,,0,"percent of total billed charges ","90% of total billed charges ",9.7,93,,7.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.87,85,,7.10,,,0,"percent of total billed charges ","85% of total billed charges ",9.39,90,,7.51,,,0,"percent of total billed charges ","90% of total billed charges ",9.39,90,,7.51,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.07,87,,7.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.3,70,,5.84,,,0,"percent of total billed charges ","70% of total billed charges ",7.3,9.7,
"TUBE MURPHY CUFFED 6.5",6002375,"CDM ",272,RC,,,OUTPATIENT,,,201.5,161.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",161.2,80,,128.96,,,0,"percent of total billed charges ","80% of total billed charges ",141.05,70,,112.84,,,0,"percent of total billed charges ","70% of total billed charges ",181.35,90,,145.08,,,0,"percent of total billed charges ","90% of total billed charges ",187.4,93,,149.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",171.28,85,,137.02,,,0,"percent of total billed charges ","85% of total billed charges ",181.35,90,,145.08,,,0,"percent of total billed charges ","90% of total billed charges ",181.35,90,,145.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",175.31,87,,140.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.05,70,,112.84,,,0,"percent of total billed charges ","70% of total billed charges ",141.05,187.4,
"VERIBAR THIN LIQUID",6002391,"CDM ",621,RC,,,OUTPATIENT,,,32.8,26.24,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.24,80,,20.99,,,0,"percent of total billed charges ","80% of total billed charges ",22.96,70,,18.37,,,0,"percent of total billed charges ","70% of total billed charges ",29.52,90,,23.62,,,0,"percent of total billed charges ","90% of total billed charges ",30.5,93,,24.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",27.88,85,,22.30,,,0,"percent of total billed charges ","85% of total billed charges ",29.52,90,,23.62,,,0,"percent of total billed charges ","90% of total billed charges ",29.52,90,,23.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",28.54,87,,22.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.96,70,,18.37,,,0,"percent of total billed charges ","70% of total billed charges ",22.96,30.5,
"KIT TRANSPAC SINGLE LINE",6002402,"CDM ",272,RC,,,OUTPATIENT,,,51.34,41.072,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.07,80,,32.86,,,0,"percent of total billed charges ","80% of total billed charges ",35.94,70,,28.75,,,0,"percent of total billed charges ","70% of total billed charges ",46.21,90,,36.97,,,0,"percent of total billed charges ","90% of total billed charges ",47.75,93,,38.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.64,85,,34.91,,,0,"percent of total billed charges ","85% of total billed charges ",46.21,90,,36.97,,,0,"percent of total billed charges ","90% of total billed charges ",46.21,90,,36.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.67,87,,35.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.94,70,,28.75,,,0,"percent of total billed charges ","70% of total billed charges ",35.94,47.75,
"ARMBOARD 3.5X1.5 PEDI SM",6002411,"CDM ",271,RC,,,OUTPATIENT,,,12.19,9.752,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.75,80,,7.80,,,0,"percent of total billed charges ","80% of total billed charges ",8.53,70,,6.82,,,0,"percent of total billed charges ","70% of total billed charges ",10.97,90,,8.78,,,0,"percent of total billed charges ","90% of total billed charges ",11.34,93,,9.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.36,85,,8.29,,,0,"percent of total billed charges ","85% of total billed charges ",10.97,90,,8.78,,,0,"percent of total billed charges ","90% of total billed charges ",10.97,90,,8.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.61,87,,8.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.53,70,,6.82,,,0,"percent of total billed charges ","70% of total billed charges ",8.53,11.34,
"ARMBOARD 5.5X2 PEDI MED",6002412,"CDM ",271,RC,,,OUTPATIENT,,,26.18,20.944,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.94,80,,16.75,,,0,"percent of total billed charges ","80% of total billed charges ",18.33,70,,14.66,,,0,"percent of total billed charges ","70% of total billed charges ",23.56,90,,18.85,,,0,"percent of total billed charges ","90% of total billed charges ",24.35,93,,19.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",22.25,85,,17.80,,,0,"percent of total billed charges ","85% of total billed charges ",23.56,90,,18.85,,,0,"percent of total billed charges ","90% of total billed charges ",23.56,90,,18.85,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.78,87,,18.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.33,70,,14.66,,,0,"percent of total billed charges ","70% of total billed charges ",18.33,24.35,
"SOLUTION SORBITOL 3000ML",6002422,"CDM ",272,RC,,,OUTPATIENT,,,34.95,27.96,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.96,80,,22.37,,,0,"percent of total billed charges ","80% of total billed charges ",24.47,70,,19.58,,,0,"percent of total billed charges ","70% of total billed charges ",31.46,90,,25.17,,,0,"percent of total billed charges ","90% of total billed charges ",32.5,93,,26.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",29.71,85,,23.77,,,0,"percent of total billed charges ","85% of total billed charges ",31.46,90,,25.17,,,0,"percent of total billed charges ","90% of total billed charges ",31.46,90,,25.17,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.41,87,,24.33,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.47,70,,19.58,,,0,"percent of total billed charges ","70% of total billed charges ",24.47,32.5,
"SPLINT CAST 4X30",6002453,"CDM ",271,RC,,,OUTPATIENT,,,75.61,60.488,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.49,80,,48.39,,,0,"percent of total billed charges ","80% of total billed charges ",52.93,70,,42.34,,,0,"percent of total billed charges ","70% of total billed charges ",68.05,90,,54.44,,,0,"percent of total billed charges ","90% of total billed charges ",70.32,93,,56.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",64.27,85,,51.42,,,0,"percent of total billed charges ","85% of total billed charges ",68.05,90,,54.44,,,0,"percent of total billed charges ","90% of total billed charges ",68.05,90,,54.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",65.78,87,,52.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.93,70,,42.34,,,0,"percent of total billed charges ","70% of total billed charges ",52.93,70.32,
"BAG EMPTY ENEMA",6002470,"CDM ",621,RC,,,OUTPATIENT,,,31.39,25.112,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.11,80,,20.09,,,0,"percent of total billed charges ","80% of total billed charges ",21.97,70,,17.58,,,0,"percent of total billed charges ","70% of total billed charges ",28.25,90,,22.60,,,0,"percent of total billed charges ","90% of total billed charges ",29.19,93,,23.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.68,85,,21.34,,,0,"percent of total billed charges ","85% of total billed charges ",28.25,90,,22.60,,,0,"percent of total billed charges ","90% of total billed charges ",28.25,90,,22.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",27.31,87,,21.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.97,70,,17.58,,,0,"percent of total billed charges ","70% of total billed charges ",21.97,29.19,
"TIP ENEMA",6002471,"CDM ",272,RC,,,OUTPATIENT,,,9.43,7.544,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.54,80,,6.03,,,0,"percent of total billed charges ","80% of total billed charges ",6.6,70,,5.28,,,0,"percent of total billed charges ","70% of total billed charges ",8.49,90,,6.79,,,0,"percent of total billed charges ","90% of total billed charges ",8.77,93,,7.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.02,85,,6.42,,,0,"percent of total billed charges ","85% of total billed charges ",8.49,90,,6.79,,,0,"percent of total billed charges ","90% of total billed charges ",8.49,90,,6.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",8.2,87,,6.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.6,70,,5.28,,,0,"percent of total billed charges ","70% of total billed charges ",6.6,8.77,
"TUBE MURPHY CUFFED 6.0",6002499,"CDM ",272,RC,,,OUTPATIENT,,,112.37,89.896,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",89.9,80,,71.92,,,0,"percent of total billed charges ","80% of total billed charges ",78.66,70,,62.93,,,0,"percent of total billed charges ","70% of total billed charges ",101.13,90,,80.90,,,0,"percent of total billed charges ","90% of total billed charges ",104.5,93,,83.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",95.51,85,,76.41,,,0,"percent of total billed charges ","85% of total billed charges ",101.13,90,,80.90,,,0,"percent of total billed charges ","90% of total billed charges ",101.13,90,,80.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",97.76,87,,78.21,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.66,70,,62.93,,,0,"percent of total billed charges ","70% of total billed charges ",78.66,104.5,
"ELECTRODE DEFIB ADULT",6002522,"CDM ",272,RC,,,OUTPATIENT,,,177.44,141.952,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.95,80,,113.56,,,0,"percent of total billed charges ","80% of total billed charges ",124.21,70,,99.37,,,0,"percent of total billed charges ","70% of total billed charges ",159.7,90,,127.76,,,0,"percent of total billed charges ","90% of total billed charges ",165.02,93,,132.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",150.82,85,,120.66,,,0,"percent of total billed charges ","85% of total billed charges ",159.7,90,,127.76,,,0,"percent of total billed charges ","90% of total billed charges ",159.7,90,,127.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",154.37,87,,123.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.21,70,,99.37,,,0,"percent of total billed charges ","70% of total billed charges ",124.21,165.02,
"ELECTRODE DEFIB PEDI",6002523,"CDM ",272,RC,,,OUTPATIENT,,,132.82,106.256,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.26,80,,85.01,,,0,"percent of total billed charges ","80% of total billed charges ",92.97,70,,74.38,,,0,"percent of total billed charges ","70% of total billed charges ",119.54,90,,95.63,,,0,"percent of total billed charges ","90% of total billed charges ",123.52,93,,98.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",112.9,85,,90.32,,,0,"percent of total billed charges ","85% of total billed charges ",119.54,90,,95.63,,,0,"percent of total billed charges ","90% of total billed charges ",119.54,90,,95.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",115.55,87,,92.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.97,70,,74.38,,,0,"percent of total billed charges ","70% of total billed charges ",92.97,123.52,
"SUTURE VICRYL 6.0",6002545,"CDM ",272,RC,,,OUTPATIENT,,,19.81,15.848,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.85,80,,12.68,,,0,"percent of total billed charges ","80% of total billed charges ",13.87,70,,11.10,,,0,"percent of total billed charges ","70% of total billed charges ",17.83,90,,14.26,,,0,"percent of total billed charges ","90% of total billed charges ",18.42,93,,14.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.84,85,,13.47,,,0,"percent of total billed charges ","85% of total billed charges ",17.83,90,,14.26,,,0,"percent of total billed charges ","90% of total billed charges ",17.83,90,,14.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.23,87,,13.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.87,70,,11.10,,,0,"percent of total billed charges ","70% of total billed charges ",13.87,18.42,
"DRESSING TEGADERM 6CM X 6CM",6002549,"CDM ",272,RC,,,OUTPATIENT,,,2.26,1.808,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.81,80,,1.45,,,0,"percent of total billed charges ","80% of total billed charges ",1.58,70,,1.26,,,0,"percent of total billed charges ","70% of total billed charges ",2.03,90,,1.62,,,0,"percent of total billed charges ","90% of total billed charges ",2.1,93,,1.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1.92,85,,1.54,,,0,"percent of total billed charges ","85% of total billed charges ",2.03,90,,1.62,,,0,"percent of total billed charges ","90% of total billed charges ",2.03,90,,1.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1.97,87,,1.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.58,70,,1.26,,,0,"percent of total billed charges ","70% of total billed charges ",1.58,2.1,
"DRESSING TEGADERM 5CM X 5.7CM",6002553,"CDM ",272,RC,,,OUTPATIENT,,,2.19,1.752,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.75,80,,1.40,,,0,"percent of total billed charges ","80% of total billed charges ",1.53,70,,1.22,,,0,"percent of total billed charges ","70% of total billed charges ",1.97,90,,1.58,,,0,"percent of total billed charges ","90% of total billed charges ",2.04,93,,1.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1.86,85,,1.49,,,0,"percent of total billed charges ","85% of total billed charges ",1.97,90,,1.58,,,0,"percent of total billed charges ","90% of total billed charges ",1.97,90,,1.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1.91,87,,1.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.53,70,,1.22,,,0,"percent of total billed charges ","70% of total billed charges ",1.53,2.04,
"DRESSING FOAM 4X4",6002558,"CDM ",272,RC,,,OUTPATIENT,,,16.9,13.52,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.52,80,,10.82,,,0,"percent of total billed charges ","80% of total billed charges ",11.83,70,,9.46,,,0,"percent of total billed charges ","70% of total billed charges ",15.21,90,,12.17,,,0,"percent of total billed charges ","90% of total billed charges ",15.72,93,,12.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.37,85,,11.50,,,0,"percent of total billed charges ","85% of total billed charges ",15.21,90,,12.17,,,0,"percent of total billed charges ","90% of total billed charges ",15.21,90,,12.17,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.7,87,,11.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.83,70,,9.46,,,0,"percent of total billed charges ","70% of total billed charges ",11.83,15.72,
"CANNULA SET CPAP",6002605,"CDM ",272,RC,,,OUTPATIENT,,,155.58,124.464,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.46,80,,99.57,,,0,"percent of total billed charges ","80% of total billed charges ",108.91,70,,87.13,,,0,"percent of total billed charges ","70% of total billed charges ",140.02,90,,112.02,,,0,"percent of total billed charges ","90% of total billed charges ",144.69,93,,115.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",132.24,85,,105.79,,,0,"percent of total billed charges ","85% of total billed charges ",140.02,90,,112.02,,,0,"percent of total billed charges ","90% of total billed charges ",140.02,90,,112.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",135.35,87,,108.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.91,70,,87.13,,,0,"percent of total billed charges ","70% of total billed charges ",108.91,144.69,
"NEEDLE HOMER MAMMOLOK 7.5",6002610,"CDM ",621,RC,,,OUTPATIENT,,,124.46,99.568,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.57,80,,79.66,,,0,"percent of total billed charges ","80% of total billed charges ",87.12,70,,69.70,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,90,,89.61,,,0,"percent of total billed charges ","90% of total billed charges ",115.75,93,,92.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",105.79,85,,84.63,,,0,"percent of total billed charges ","85% of total billed charges ",112.01,90,,89.61,,,0,"percent of total billed charges ","90% of total billed charges ",112.01,90,,89.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",108.28,87,,86.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.12,70,,69.70,,,0,"percent of total billed charges ","70% of total billed charges ",87.12,115.75,
"CLEANSER SKIN CAVILON",6002612,"CDM ",270,RC,,,OUTPATIENT,,,22.27,17.816,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.82,80,,14.26,,,0,"percent of total billed charges ","80% of total billed charges ",15.59,70,,12.47,,,0,"percent of total billed charges ","70% of total billed charges ",20.04,90,,16.03,,,0,"percent of total billed charges ","90% of total billed charges ",20.71,93,,16.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.93,85,,15.14,,,0,"percent of total billed charges ","85% of total billed charges ",20.04,90,,16.03,,,0,"percent of total billed charges ","90% of total billed charges ",20.04,90,,16.03,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.37,87,,15.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.59,70,,12.47,,,0,"percent of total billed charges ","70% of total billed charges ",15.59,20.71,
"DRESSING BARRIER FILM",6002615,"CDM ",272,RC,,,OUTPATIENT,,,31.49,25.192,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.19,80,,20.15,,,0,"percent of total billed charges ","80% of total billed charges ",22.04,70,,17.63,,,0,"percent of total billed charges ","70% of total billed charges ",28.34,90,,22.67,,,0,"percent of total billed charges ","90% of total billed charges ",29.29,93,,23.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.77,85,,21.42,,,0,"percent of total billed charges ","85% of total billed charges ",28.34,90,,22.67,,,0,"percent of total billed charges ","90% of total billed charges ",28.34,90,,22.67,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",27.4,87,,21.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.04,70,,17.63,,,0,"percent of total billed charges ","70% of total billed charges ",22.04,29.29,
"CREAM SKIN CAVILON",6002616,"CDM ",270,RC,,,OUTPATIENT,,,19.26,15.408,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.41,80,,12.33,,,0,"percent of total billed charges ","80% of total billed charges ",13.48,70,,10.78,,,0,"percent of total billed charges ","70% of total billed charges ",17.33,90,,13.86,,,0,"percent of total billed charges ","90% of total billed charges ",17.91,93,,14.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.37,85,,13.10,,,0,"percent of total billed charges ","85% of total billed charges ",17.33,90,,13.86,,,0,"percent of total billed charges ","90% of total billed charges ",17.33,90,,13.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.76,87,,13.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.48,70,,10.78,,,0,"percent of total billed charges ","70% of total billed charges ",13.48,17.91,
"DRESSING IV W/LABEL",6002618,"CDM ",272,RC,,,OUTPATIENT,,,6.22,4.976,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.98,80,,3.98,,,0,"percent of total billed charges ","80% of total billed charges ",4.35,70,,3.48,,,0,"percent of total billed charges ","70% of total billed charges ",5.6,90,,4.48,,,0,"percent of total billed charges ","90% of total billed charges ",5.78,93,,4.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.29,85,,4.23,,,0,"percent of total billed charges ","85% of total billed charges ",5.6,90,,4.48,,,0,"percent of total billed charges ","90% of total billed charges ",5.6,90,,4.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5.41,87,,4.33,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.35,70,,3.48,,,0,"percent of total billed charges ","70% of total billed charges ",4.35,5.78,
"TEGADERM ACRYLIC SACRAL",6002626,"CDM ",272,RC,,,OUTPATIENT,,,43.18,34.544,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.54,80,,27.63,,,0,"percent of total billed charges ","80% of total billed charges ",30.23,70,,24.18,,,0,"percent of total billed charges ","70% of total billed charges ",38.86,90,,31.09,,,0,"percent of total billed charges ","90% of total billed charges ",40.16,93,,32.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",36.7,85,,29.36,,,0,"percent of total billed charges ","85% of total billed charges ",38.86,90,,31.09,,,0,"percent of total billed charges ","90% of total billed charges ",38.86,90,,31.09,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",37.57,87,,30.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.23,70,,24.18,,,0,"percent of total billed charges ","70% of total billed charges ",30.23,40.16,
"TEGADERM ACRYLIC 3 X 3-3/4",6002627,"CDM ",272,RC,,,OUTPATIENT,,,10.53,8.424,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.42,80,,6.74,,,0,"percent of total billed charges ","80% of total billed charges ",7.37,70,,5.90,,,0,"percent of total billed charges ","70% of total billed charges ",9.48,90,,7.58,,,0,"percent of total billed charges ","90% of total billed charges ",9.79,93,,7.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.95,85,,7.16,,,0,"percent of total billed charges ","85% of total billed charges ",9.48,90,,7.58,,,0,"percent of total billed charges ","90% of total billed charges ",9.48,90,,7.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.16,87,,7.33,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.37,70,,5.90,,,0,"percent of total billed charges ","70% of total billed charges ",7.37,9.79,
"TEGADERM ACRYLIC 7-7/8 X 8",6002629,"CDM ",272,RC,,,OUTPATIENT,,,47.59,38.072,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.07,80,,30.46,,,0,"percent of total billed charges ","80% of total billed charges ",33.31,70,,26.65,,,0,"percent of total billed charges ","70% of total billed charges ",42.83,90,,34.26,,,0,"percent of total billed charges ","90% of total billed charges ",44.26,93,,35.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.45,85,,32.36,,,0,"percent of total billed charges ","85% of total billed charges ",42.83,90,,34.26,,,0,"percent of total billed charges ","90% of total billed charges ",42.83,90,,34.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.4,87,,33.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.31,70,,26.65,,,0,"percent of total billed charges ","70% of total billed charges ",33.31,44.26,
"TUBE TRACH 8MM W/CANNULA",6002641,"CDM ",272,RC,,,OUTPATIENT,,,139.84,111.872,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.87,80,,89.50,,,0,"percent of total billed charges ","80% of total billed charges ",97.89,70,,78.31,,,0,"percent of total billed charges ","70% of total billed charges ",125.86,90,,100.69,,,0,"percent of total billed charges ","90% of total billed charges ",130.05,93,,104.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",118.86,85,,95.09,,,0,"percent of total billed charges ","85% of total billed charges ",125.86,90,,100.69,,,0,"percent of total billed charges ","90% of total billed charges ",125.86,90,,100.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",121.66,87,,97.33,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.89,70,,78.31,,,0,"percent of total billed charges ","70% of total billed charges ",97.89,130.05,
"DRESSING FOAM OVAL 4X4-1/2",6002648,"CDM ",270,RC,,,OUTPATIENT,,,21.21,16.968,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.97,80,,13.58,,,0,"percent of total billed charges ","80% of total billed charges ",14.85,70,,11.88,,,0,"percent of total billed charges ","70% of total billed charges ",19.09,90,,15.27,,,0,"percent of total billed charges ","90% of total billed charges ",19.73,93,,15.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.03,85,,14.42,,,0,"percent of total billed charges ","85% of total billed charges ",19.09,90,,15.27,,,0,"percent of total billed charges ","90% of total billed charges ",19.09,90,,15.27,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.45,87,,14.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.85,70,,11.88,,,0,"percent of total billed charges ","70% of total billed charges ",14.85,19.73,
"DRESSING FOAM OVAL 5-5/8X6-1/8",6002649,"CDM ",270,RC,,,OUTPATIENT,,,24.52,19.616,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.62,80,,15.70,,,0,"percent of total billed charges ","80% of total billed charges ",17.16,70,,13.73,,,0,"percent of total billed charges ","70% of total billed charges ",22.07,90,,17.66,,,0,"percent of total billed charges ","90% of total billed charges ",22.8,93,,18.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.84,85,,16.67,,,0,"percent of total billed charges ","85% of total billed charges ",22.07,90,,17.66,,,0,"percent of total billed charges ","90% of total billed charges ",22.07,90,,17.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.33,87,,17.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.16,70,,13.73,,,0,"percent of total billed charges ","70% of total billed charges ",17.16,22.8,
"DRESSING HYDROCOLLOIN THIN",6002654,"CDM ",272,RC,,,OUTPATIENT,,,17.5,14,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14,80,,11.20,,,0,"percent of total billed charges ","80% of total billed charges ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",16.28,93,,13.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.88,85,,11.90,,,0,"percent of total billed charges ","85% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.23,87,,12.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",12.25,16.28,
"TEGADERM HI 4X4",6002655,"CDM ",272,RC,,,OUTPATIENT,,,14.39,11.512,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.51,80,,9.21,,,0,"percent of total billed charges ","80% of total billed charges ",10.07,70,,8.06,,,0,"percent of total billed charges ","70% of total billed charges ",12.95,90,,10.36,,,0,"percent of total billed charges ","90% of total billed charges ",13.38,93,,10.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.23,85,,9.78,,,0,"percent of total billed charges ","85% of total billed charges ",12.95,90,,10.36,,,0,"percent of total billed charges ","90% of total billed charges ",12.95,90,,10.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.52,87,,10.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.07,70,,8.06,,,0,"percent of total billed charges ","70% of total billed charges ",10.07,13.38,
"TEGAPORE WOUND MATERIAL",6002657,"CDM ",272,RC,,,OUTPATIENT,,,11.58,9.264,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.26,80,,7.41,,,0,"percent of total billed charges ","80% of total billed charges ",8.11,70,,6.49,,,0,"percent of total billed charges ","70% of total billed charges ",10.42,90,,8.34,,,0,"percent of total billed charges ","90% of total billed charges ",10.77,93,,8.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.84,85,,7.87,,,0,"percent of total billed charges ","85% of total billed charges ",10.42,90,,8.34,,,0,"percent of total billed charges ","90% of total billed charges ",10.42,90,,8.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.07,87,,8.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.11,70,,6.49,,,0,"percent of total billed charges ","70% of total billed charges ",8.11,10.77,
"SENSOR QUATRO BIS XP",6002659,"CDM ",272,RC,,,OUTPATIENT,,,81.12,64.896,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.9,80,,51.92,,,0,"percent of total billed charges ","80% of total billed charges ",56.78,70,,45.42,,,0,"percent of total billed charges ","70% of total billed charges ",73.01,90,,58.41,,,0,"percent of total billed charges ","90% of total billed charges ",75.44,93,,60.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",68.95,85,,55.16,,,0,"percent of total billed charges ","85% of total billed charges ",73.01,90,,58.41,,,0,"percent of total billed charges ","90% of total billed charges ",73.01,90,,58.41,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",70.57,87,,56.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.78,70,,45.42,,,0,"percent of total billed charges ","70% of total billed charges ",56.78,75.44,
"KING AIRWAY SIZE 4",6002681,"CDM ",272,RC,,,OUTPATIENT,,,180.2,144.16,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.16,80,,115.33,,,0,"percent of total billed charges ","80% of total billed charges ",126.14,70,,100.91,,,0,"percent of total billed charges ","70% of total billed charges ",162.18,90,,129.74,,,0,"percent of total billed charges ","90% of total billed charges ",167.59,93,,134.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",153.17,85,,122.54,,,0,"percent of total billed charges ","85% of total billed charges ",162.18,90,,129.74,,,0,"percent of total billed charges ","90% of total billed charges ",162.18,90,,129.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",156.77,87,,125.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",126.14,70,,100.91,,,0,"percent of total billed charges ","70% of total billed charges ",126.14,167.59,
"KING AIRWAY SIZE 3",6002684,"CDM ",272,RC,,,OUTPATIENT,,,180.2,144.16,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.16,80,,115.33,,,0,"percent of total billed charges ","80% of total billed charges ",126.14,70,,100.91,,,0,"percent of total billed charges ","70% of total billed charges ",162.18,90,,129.74,,,0,"percent of total billed charges ","90% of total billed charges ",167.59,93,,134.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",153.17,85,,122.54,,,0,"percent of total billed charges ","85% of total billed charges ",162.18,90,,129.74,,,0,"percent of total billed charges ","90% of total billed charges ",162.18,90,,129.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",156.77,87,,125.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",126.14,70,,100.91,,,0,"percent of total billed charges ","70% of total billed charges ",126.14,167.59,
"KING AIRWAY SIZE 5",6002685,"CDM ",272,RC,,,OUTPATIENT,,,180.2,144.16,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.16,80,,115.33,,,0,"percent of total billed charges ","80% of total billed charges ",126.14,70,,100.91,,,0,"percent of total billed charges ","70% of total billed charges ",162.18,90,,129.74,,,0,"percent of total billed charges ","90% of total billed charges ",167.59,93,,134.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",153.17,85,,122.54,,,0,"percent of total billed charges ","85% of total billed charges ",162.18,90,,129.74,,,0,"percent of total billed charges ","90% of total billed charges ",162.18,90,,129.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",156.77,87,,125.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",126.14,70,,100.91,,,0,"percent of total billed charges ","70% of total billed charges ",126.14,167.59,
"TUBE SALEM NG 8FR",6002686,"CDM ",272,RC,,,OUTPATIENT,,,21.97,17.576,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.58,80,,14.06,,,0,"percent of total billed charges ","80% of total billed charges ",15.38,70,,12.30,,,0,"percent of total billed charges ","70% of total billed charges ",19.77,90,,15.82,,,0,"percent of total billed charges ","90% of total billed charges ",20.43,93,,16.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.67,85,,14.94,,,0,"percent of total billed charges ","85% of total billed charges ",19.77,90,,15.82,,,0,"percent of total billed charges ","90% of total billed charges ",19.77,90,,15.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.11,87,,15.29,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.38,70,,12.30,,,0,"percent of total billed charges ","70% of total billed charges ",15.38,20.43,
"STYLETTE CHILD",6002690,"CDM ",272,RC,,,OUTPATIENT,,,14.69,11.752,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.75,80,,9.40,,,0,"percent of total billed charges ","80% of total billed charges ",10.28,70,,8.22,,,0,"percent of total billed charges ","70% of total billed charges ",13.22,90,,10.58,,,0,"percent of total billed charges ","90% of total billed charges ",13.66,93,,10.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.49,85,,9.99,,,0,"percent of total billed charges ","85% of total billed charges ",13.22,90,,10.58,,,0,"percent of total billed charges ","90% of total billed charges ",13.22,90,,10.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.78,87,,10.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.28,70,,8.22,,,0,"percent of total billed charges ","70% of total billed charges ",10.28,13.66,
"EXTRACTORS KATZ",6002701,"CDM ",272,RC,,,OUTPATIENT,,,228.63,182.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",182.9,80,,146.32,,,0,"percent of total billed charges ","80% of total billed charges ",160.04,70,,128.03,,,0,"percent of total billed charges ","70% of total billed charges ",205.77,90,,164.62,,,0,"percent of total billed charges ","90% of total billed charges ",212.63,93,,170.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",194.34,85,,155.47,,,0,"percent of total billed charges ","85% of total billed charges ",205.77,90,,164.62,,,0,"percent of total billed charges ","90% of total billed charges ",205.77,90,,164.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",198.91,87,,159.13,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",160.04,70,,128.03,,,0,"percent of total billed charges ","70% of total billed charges ",160.04,212.63,
"SET SECONDARY PIGGYBACK W/CONN",6002702,"CDM ",272,RC,,,OUTPATIENT,,,3.57,2.856,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.86,80,,2.29,,,0,"percent of total billed charges ","80% of total billed charges ",2.5,70,,2.00,,,0,"percent of total billed charges ","70% of total billed charges ",3.21,90,,2.57,,,0,"percent of total billed charges ","90% of total billed charges ",3.32,93,,2.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3.03,85,,2.42,,,0,"percent of total billed charges ","85% of total billed charges ",3.21,90,,2.57,,,0,"percent of total billed charges ","90% of total billed charges ",3.21,90,,2.57,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3.11,87,,2.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.5,70,,2.00,,,0,"percent of total billed charges ","70% of total billed charges ",2.5,3.32,
"TRAY MYELOGRAM",6002736,"CDM ",272,RC,,,OUTPATIENT,,,43.03,34.424,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.42,80,,27.54,,,0,"percent of total billed charges ","80% of total billed charges ",30.12,70,,24.10,,,0,"percent of total billed charges ","70% of total billed charges ",38.73,90,,30.98,,,0,"percent of total billed charges ","90% of total billed charges ",40.02,93,,32.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",36.58,85,,29.26,,,0,"percent of total billed charges ","85% of total billed charges ",38.73,90,,30.98,,,0,"percent of total billed charges ","90% of total billed charges ",38.73,90,,30.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",37.44,87,,29.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.12,70,,24.10,,,0,"percent of total billed charges ","70% of total billed charges ",30.12,40.02,
"CONNECTOR AIRHOSE MALE",6002765,"CDM ",272,RC,,,OUTPATIENT,,,12.69,10.152,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,80,,8.12,,,0,"percent of total billed charges ","80% of total billed charges ",8.88,70,,7.10,,,0,"percent of total billed charges ","70% of total billed charges ",11.42,90,,9.14,,,0,"percent of total billed charges ","90% of total billed charges ",11.8,93,,9.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.79,85,,8.63,,,0,"percent of total billed charges ","85% of total billed charges ",11.42,90,,9.14,,,0,"percent of total billed charges ","90% of total billed charges ",11.42,90,,9.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.04,87,,8.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.88,70,,7.10,,,0,"percent of total billed charges ","70% of total billed charges ",8.88,11.8,
"DRESSING OPTI WOUND SPONGE",6002771,"CDM ",272,RC,,,OUTPATIENT,,,5.37,4.296,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.3,80,,3.44,,,0,"percent of total billed charges ","80% of total billed charges ",3.76,70,,3.01,,,0,"percent of total billed charges ","70% of total billed charges ",4.83,90,,3.86,,,0,"percent of total billed charges ","90% of total billed charges ",4.99,93,,3.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4.56,85,,3.65,,,0,"percent of total billed charges ","85% of total billed charges ",4.83,90,,3.86,,,0,"percent of total billed charges ","90% of total billed charges ",4.83,90,,3.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4.67,87,,3.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.76,70,,3.01,,,0,"percent of total billed charges ","70% of total billed charges ",3.76,4.99,
"FEEDER HABERMAN W/80ML CONTAIN",6002774,"CDM ",272,RC,,,OUTPATIENT,,,55.03,44.024,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.02,80,,35.22,,,0,"percent of total billed charges ","80% of total billed charges ",38.52,70,,30.82,,,0,"percent of total billed charges ","70% of total billed charges ",49.53,90,,39.62,,,0,"percent of total billed charges ","90% of total billed charges ",51.18,93,,40.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",46.78,85,,37.42,,,0,"percent of total billed charges ","85% of total billed charges ",49.53,90,,39.62,,,0,"percent of total billed charges ","90% of total billed charges ",49.53,90,,39.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",47.88,87,,38.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.52,70,,30.82,,,0,"percent of total billed charges ","70% of total billed charges ",38.52,51.18,
"FEEDER MINI-HABERMAN W/80ML CT",6002775,"CDM ",272,RC,,,OUTPATIENT,,,69.16,55.328,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.33,80,,44.26,,,0,"percent of total billed charges ","80% of total billed charges ",48.41,70,,38.73,,,0,"percent of total billed charges ","70% of total billed charges ",62.24,90,,49.79,,,0,"percent of total billed charges ","90% of total billed charges ",64.32,93,,51.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",58.79,85,,47.03,,,0,"percent of total billed charges ","85% of total billed charges ",62.24,90,,49.79,,,0,"percent of total billed charges ","90% of total billed charges ",62.24,90,,49.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",60.17,87,,48.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.41,70,,38.73,,,0,"percent of total billed charges ","70% of total billed charges ",48.41,64.32,
"CANNULA CPAP NASAL LRG INFANT",6002818,"CDM ",270,RC,,,OUTPATIENT,,,123.04,98.432,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.43,80,,78.74,,,0,"percent of total billed charges ","80% of total billed charges ",86.13,70,,68.90,,,0,"percent of total billed charges ","70% of total billed charges ",110.74,90,,88.59,,,0,"percent of total billed charges ","90% of total billed charges ",114.43,93,,91.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",104.58,85,,83.66,,,0,"percent of total billed charges ","85% of total billed charges ",110.74,90,,88.59,,,0,"percent of total billed charges ","90% of total billed charges ",110.74,90,,88.59,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",107.04,87,,85.63,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.13,70,,68.90,,,0,"percent of total billed charges ","70% of total billed charges ",86.13,114.43,
"CANNULA CPAP SM INFANT",6002827,"CDM ",270,RC,,,OUTPATIENT,,,169.4,135.52,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.52,80,,108.42,,,0,"percent of total billed charges ","80% of total billed charges ",118.58,70,,94.86,,,0,"percent of total billed charges ","70% of total billed charges ",152.46,90,,121.97,,,0,"percent of total billed charges ","90% of total billed charges ",157.54,93,,126.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",143.99,85,,115.19,,,0,"percent of total billed charges ","85% of total billed charges ",152.46,90,,121.97,,,0,"percent of total billed charges ","90% of total billed charges ",152.46,90,,121.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",147.38,87,,117.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.58,70,,94.86,,,0,"percent of total billed charges ","70% of total billed charges ",118.58,157.54,
"AIRWAY DESC 36FR",6002856,"CDM ",272,RC,,,OUTPATIENT,,,14.74,11.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.79,80,,9.43,,,0,"percent of total billed charges ","80% of total billed charges ",10.32,70,,8.26,,,0,"percent of total billed charges ","70% of total billed charges ",13.27,90,,10.62,,,0,"percent of total billed charges ","90% of total billed charges ",13.71,93,,10.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.53,85,,10.02,,,0,"percent of total billed charges ","85% of total billed charges ",13.27,90,,10.62,,,0,"percent of total billed charges ","90% of total billed charges ",13.27,90,,10.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.82,87,,10.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.32,70,,8.26,,,0,"percent of total billed charges ","70% of total billed charges ",10.32,13.71,
"MASK ANESTHESIA TODDLER",6002868,"CDM ",270,RC,,,OUTPATIENT,,,10.58,8.464,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.46,80,,6.77,,,0,"percent of total billed charges ","80% of total billed charges ",7.41,70,,5.93,,,0,"percent of total billed charges ","70% of total billed charges ",9.52,90,,7.62,,,0,"percent of total billed charges ","90% of total billed charges ",9.84,93,,7.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.99,85,,7.19,,,0,"percent of total billed charges ","85% of total billed charges ",9.52,90,,7.62,,,0,"percent of total billed charges ","90% of total billed charges ",9.52,90,,7.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.2,87,,7.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.41,70,,5.93,,,0,"percent of total billed charges ","70% of total billed charges ",7.41,9.84,
"SET ARTERIAL CATH",6002891,"CDM ",272,RC,,,OUTPATIENT,,,58.99,47.192,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.19,80,,37.75,,,0,"percent of total billed charges ","80% of total billed charges ",41.29,70,,33.03,,,0,"percent of total billed charges ","70% of total billed charges ",53.09,90,,42.47,,,0,"percent of total billed charges ","90% of total billed charges ",54.86,93,,43.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",50.14,85,,40.11,,,0,"percent of total billed charges ","85% of total billed charges ",53.09,90,,42.47,,,0,"percent of total billed charges ","90% of total billed charges ",53.09,90,,42.47,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",51.32,87,,41.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.29,70,,33.03,,,0,"percent of total billed charges ","70% of total billed charges ",41.29,54.86,
"LENS THERAPUTIC MORGAN",6002897,"CDM ",272,RC,,,OUTPATIENT,,,120.24,96.192,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.19,80,,76.95,,,0,"percent of total billed charges ","80% of total billed charges ",84.17,70,,67.34,,,0,"percent of total billed charges ","70% of total billed charges ",108.22,90,,86.58,,,0,"percent of total billed charges ","90% of total billed charges ",111.82,93,,89.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",102.2,85,,81.76,,,0,"percent of total billed charges ","85% of total billed charges ",108.22,90,,86.58,,,0,"percent of total billed charges ","90% of total billed charges ",108.22,90,,86.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",104.61,87,,83.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.17,70,,67.34,,,0,"percent of total billed charges ","70% of total billed charges ",84.17,111.82,
"KIT TRIPEL LUMEN 7FR",6002904,"CDM ",272,RC,,,OUTPATIENT,,,173.31,138.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",138.65,80,,110.92,,,0,"percent of total billed charges ","80% of total billed charges ",121.32,70,,97.06,,,0,"percent of total billed charges ","70% of total billed charges ",155.98,90,,124.78,,,0,"percent of total billed charges ","90% of total billed charges ",161.18,93,,128.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",147.31,85,,117.85,,,0,"percent of total billed charges ","85% of total billed charges ",155.98,90,,124.78,,,0,"percent of total billed charges ","90% of total billed charges ",155.98,90,,124.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",150.78,87,,120.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",121.32,70,,97.06,,,0,"percent of total billed charges ","70% of total billed charges ",121.32,161.18,
"SET BASIN DOUBLE PAN",6002906,"CDM ",272,RC,,,OUTPATIENT,,,59.25,47.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.4,80,,37.92,,,0,"percent of total billed charges ","80% of total billed charges ",41.48,70,,33.18,,,0,"percent of total billed charges ","70% of total billed charges ",53.33,90,,42.66,,,0,"percent of total billed charges ","90% of total billed charges ",55.1,93,,44.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",50.36,85,,40.29,,,0,"percent of total billed charges ","85% of total billed charges ",53.33,90,,42.66,,,0,"percent of total billed charges ","90% of total billed charges ",53.33,90,,42.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",51.55,87,,41.24,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.48,70,,33.18,,,0,"percent of total billed charges ","70% of total billed charges ",41.48,55.1,
"ASPIRATION MECONIUM",6002935,"CDM ",272,RC,,,OUTPATIENT,,,19.11,15.288,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.29,80,,12.23,,,0,"percent of total billed charges ","80% of total billed charges ",13.38,70,,10.70,,,0,"percent of total billed charges ","70% of total billed charges ",17.2,90,,13.76,,,0,"percent of total billed charges ","90% of total billed charges ",17.77,93,,14.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.24,85,,12.99,,,0,"percent of total billed charges ","85% of total billed charges ",17.2,90,,13.76,,,0,"percent of total billed charges ","90% of total billed charges ",17.2,90,,13.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.63,87,,13.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.38,70,,10.70,,,0,"percent of total billed charges ","70% of total billed charges ",13.38,17.77,
"DRESSING COBAN 6 INCH STERILE",6002936,"CDM ",272,RC,,,OUTPATIENT,,,13.89,11.112,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.11,80,,8.89,,,0,"percent of total billed charges ","80% of total billed charges ",9.72,70,,7.78,,,0,"percent of total billed charges ","70% of total billed charges ",12.5,90,,10.00,,,0,"percent of total billed charges ","90% of total billed charges ",12.92,93,,10.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.81,85,,9.45,,,0,"percent of total billed charges ","85% of total billed charges ",12.5,90,,10.00,,,0,"percent of total billed charges ","90% of total billed charges ",12.5,90,,10.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.08,87,,9.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.72,70,,7.78,,,0,"percent of total billed charges ","70% of total billed charges ",9.72,12.92,
"SYRINGE CT INJECTOR",6002955,"CDM ",621,RC,,,OUTPATIENT,,,45.92,36.736,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.74,80,,29.39,,,0,"percent of total billed charges ","80% of total billed charges ",32.14,70,,25.71,,,0,"percent of total billed charges ","70% of total billed charges ",41.33,90,,33.06,,,0,"percent of total billed charges ","90% of total billed charges ",42.71,93,,34.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.03,85,,31.22,,,0,"percent of total billed charges ","85% of total billed charges ",41.33,90,,33.06,,,0,"percent of total billed charges ","90% of total billed charges ",41.33,90,,33.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.95,87,,31.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.14,70,,25.71,,,0,"percent of total billed charges ","70% of total billed charges ",32.14,42.71,
"TRAY TRACH CHANGE KIT",6002970,"CDM ",272,RC,,,OUTPATIENT,,,10.63,8.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.5,80,,6.80,,,0,"percent of total billed charges ","80% of total billed charges ",7.44,70,,5.95,,,0,"percent of total billed charges ","70% of total billed charges ",9.57,90,,7.66,,,0,"percent of total billed charges ","90% of total billed charges ",9.89,93,,7.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.04,85,,7.23,,,0,"percent of total billed charges ","85% of total billed charges ",9.57,90,,7.66,,,0,"percent of total billed charges ","90% of total billed charges ",9.57,90,,7.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.25,87,,7.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.44,70,,5.95,,,0,"percent of total billed charges ","70% of total billed charges ",7.44,9.89,
"MASK ANESTHESIA ADULT",6002992,"CDM ",270,RC,,,OUTPATIENT,,,14.14,11.312,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.31,80,,9.05,,,0,"percent of total billed charges ","80% of total billed charges ",9.9,70,,7.92,,,0,"percent of total billed charges ","70% of total billed charges ",12.73,90,,10.18,,,0,"percent of total billed charges ","90% of total billed charges ",13.15,93,,10.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.02,85,,9.62,,,0,"percent of total billed charges ","85% of total billed charges ",12.73,90,,10.18,,,0,"percent of total billed charges ","90% of total billed charges ",12.73,90,,10.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.3,87,,9.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.9,70,,7.92,,,0,"percent of total billed charges ","70% of total billed charges ",9.9,13.15,
"TROCAR CATH 24FR",6003020,"CDM ",272,RC,,,OUTPATIENT,,,44.94,35.952,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.95,80,,28.76,,,0,"percent of total billed charges ","80% of total billed charges ",31.46,70,,25.17,,,0,"percent of total billed charges ","70% of total billed charges ",40.45,90,,32.36,,,0,"percent of total billed charges ","90% of total billed charges ",41.79,93,,33.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.2,85,,30.56,,,0,"percent of total billed charges ","85% of total billed charges ",40.45,90,,32.36,,,0,"percent of total billed charges ","90% of total billed charges ",40.45,90,,32.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.1,87,,31.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.46,70,,25.17,,,0,"percent of total billed charges ","70% of total billed charges ",31.46,41.79,
"TUBE MURPHY CUFFED 7.5",6003030,"CDM ",272,RC,,,OUTPATIENT,,,168.6,134.88,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",134.88,80,,107.90,,,0,"percent of total billed charges ","80% of total billed charges ",118.02,70,,94.42,,,0,"percent of total billed charges ","70% of total billed charges ",151.74,90,,121.39,,,0,"percent of total billed charges ","90% of total billed charges ",156.8,93,,125.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",143.31,85,,114.65,,,0,"percent of total billed charges ","85% of total billed charges ",151.74,90,,121.39,,,0,"percent of total billed charges ","90% of total billed charges ",151.74,90,,121.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",146.68,87,,117.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.02,70,,94.42,,,0,"percent of total billed charges ","70% of total billed charges ",118.02,156.8,
"CATH FEMALE EXTRNL PUREWICK",6003034,"CDM ",270,RC,,,OUTPATIENT,,,33.25,26.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.6,80,,21.28,,,0,"percent of total billed charges ","80% of total billed charges ",23.28,70,,18.62,,,0,"percent of total billed charges ","70% of total billed charges ",29.93,90,,23.94,,,0,"percent of total billed charges ","90% of total billed charges ",30.92,93,,24.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.26,85,,22.61,,,0,"percent of total billed charges ","85% of total billed charges ",29.93,90,,23.94,,,0,"percent of total billed charges ","90% of total billed charges ",29.93,90,,23.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",28.93,87,,23.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.28,70,,18.62,,,0,"percent of total billed charges ","70% of total billed charges ",23.28,30.92,
"CATH PEDIATRIC 6FR",6003078,"CDM ",272,RC,,,OUTPATIENT,,,104.81,83.848,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.85,80,,67.08,,,0,"percent of total billed charges ","80% of total billed charges ",73.37,70,,58.70,,,0,"percent of total billed charges ","70% of total billed charges ",94.33,90,,75.46,,,0,"percent of total billed charges ","90% of total billed charges ",97.47,93,,77.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",89.09,85,,71.27,,,0,"percent of total billed charges ","85% of total billed charges ",94.33,90,,75.46,,,0,"percent of total billed charges ","90% of total billed charges ",94.33,90,,75.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",91.18,87,,72.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.37,70,,58.70,,,0,"percent of total billed charges ","70% of total billed charges ",73.37,97.47,
"SET PLUMSET SOLVSET 5000",6003100,"CDM ",272,RC,,,OUTPATIENT,,,31.24,24.992,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.99,80,,19.99,,,0,"percent of total billed charges ","80% of total billed charges ",21.87,70,,17.50,,,0,"percent of total billed charges ","70% of total billed charges ",28.12,90,,22.50,,,0,"percent of total billed charges ","90% of total billed charges ",29.05,93,,23.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.55,85,,21.24,,,0,"percent of total billed charges ","85% of total billed charges ",28.12,90,,22.50,,,0,"percent of total billed charges ","90% of total billed charges ",28.12,90,,22.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",27.18,87,,21.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.87,70,,17.50,,,0,"percent of total billed charges ","70% of total billed charges ",21.87,29.05,
"SET WARMING IV HOTLINE",6003116,"CDM ",272,RC,,,OUTPATIENT,,,52.23,41.784,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.78,80,,33.42,,,0,"percent of total billed charges ","80% of total billed charges ",36.56,70,,29.25,,,0,"percent of total billed charges ","70% of total billed charges ",47.01,90,,37.61,,,0,"percent of total billed charges ","90% of total billed charges ",48.57,93,,38.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",44.4,85,,35.52,,,0,"percent of total billed charges ","85% of total billed charges ",47.01,90,,37.61,,,0,"percent of total billed charges ","90% of total billed charges ",47.01,90,,37.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",45.44,87,,36.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.56,70,,29.25,,,0,"percent of total billed charges ","70% of total billed charges ",36.56,48.57,
"SUTURE PROLENE 4.0 8699G",6003137,"CDM ",272,RC,,,OUTPATIENT,,,18.51,14.808,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.81,80,,11.85,,,0,"percent of total billed charges ","80% of total billed charges ",12.96,70,,10.37,,,0,"percent of total billed charges ","70% of total billed charges ",16.66,90,,13.33,,,0,"percent of total billed charges ","90% of total billed charges ",17.21,93,,13.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.73,85,,12.58,,,0,"percent of total billed charges ","85% of total billed charges ",16.66,90,,13.33,,,0,"percent of total billed charges ","90% of total billed charges ",16.66,90,,13.33,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.1,87,,12.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.96,70,,10.37,,,0,"percent of total billed charges ","70% of total billed charges ",12.96,17.21,
"WATER HUMIDIFIER 1500ML",6003170,"CDM ",272,RC,,,OUTPATIENT,,,15.05,12.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.04,80,,9.63,,,0,"percent of total billed charges ","80% of total billed charges ",10.54,70,,8.43,,,0,"percent of total billed charges ","70% of total billed charges ",13.55,90,,10.84,,,0,"percent of total billed charges ","90% of total billed charges ",14,93,,11.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.79,85,,10.23,,,0,"percent of total billed charges ","85% of total billed charges ",13.55,90,,10.84,,,0,"percent of total billed charges ","90% of total billed charges ",13.55,90,,10.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.09,87,,10.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.54,70,,8.43,,,0,"percent of total billed charges ","70% of total billed charges ",10.54,14,
"AIRWAY DESC 24FR",6003173,"CDM ",272,RC,,,OUTPATIENT,,,14.74,11.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.79,80,,9.43,,,0,"percent of total billed charges ","80% of total billed charges ",10.32,70,,8.26,,,0,"percent of total billed charges ","70% of total billed charges ",13.27,90,,10.62,,,0,"percent of total billed charges ","90% of total billed charges ",13.71,93,,10.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.53,85,,10.02,,,0,"percent of total billed charges ","85% of total billed charges ",13.27,90,,10.62,,,0,"percent of total billed charges ","90% of total billed charges ",13.27,90,,10.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.82,87,,10.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.32,70,,8.26,,,0,"percent of total billed charges ","70% of total billed charges ",10.32,13.71,
"SET IV PRIMARY LIFE SHIELD",6003204,"CDM ",272,RC,,,OUTPATIENT,,,21.31,17.048,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.05,80,,13.64,,,0,"percent of total billed charges ","80% of total billed charges ",14.92,70,,11.94,,,0,"percent of total billed charges ","70% of total billed charges ",19.18,90,,15.34,,,0,"percent of total billed charges ","90% of total billed charges ",19.82,93,,15.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.11,85,,14.49,,,0,"percent of total billed charges ","85% of total billed charges ",19.18,90,,15.34,,,0,"percent of total billed charges ","90% of total billed charges ",19.18,90,,15.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.54,87,,14.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.92,70,,11.94,,,0,"percent of total billed charges ","70% of total billed charges ",14.92,19.82,
"INTRAUTERINE PRESSURE MONITOR",6003205,"CDM ",272,RC,,,OUTPATIENT,,,133.35,106.68,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.68,80,,85.34,,,0,"percent of total billed charges ","80% of total billed charges ",93.35,70,,74.68,,,0,"percent of total billed charges ","70% of total billed charges ",120.02,90,,96.02,,,0,"percent of total billed charges ","90% of total billed charges ",124.02,93,,99.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",113.35,85,,90.68,,,0,"percent of total billed charges ","85% of total billed charges ",120.02,90,,96.02,,,0,"percent of total billed charges ","90% of total billed charges ",120.02,90,,96.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",116.01,87,,92.81,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.35,70,,74.68,,,0,"percent of total billed charges ","70% of total billed charges ",93.35,124.02,
"SET NITROSET VEN 2-CHANN",6003220,"CDM ",272,RC,,,OUTPATIENT,,,29.84,23.872,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.87,80,,19.10,,,0,"percent of total billed charges ","80% of total billed charges ",20.89,70,,16.71,,,0,"percent of total billed charges ","70% of total billed charges ",26.86,90,,21.49,,,0,"percent of total billed charges ","90% of total billed charges ",27.75,93,,22.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.36,85,,20.29,,,0,"percent of total billed charges ","85% of total billed charges ",26.86,90,,21.49,,,0,"percent of total billed charges ","90% of total billed charges ",26.86,90,,21.49,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",25.96,87,,20.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.89,70,,16.71,,,0,"percent of total billed charges ","70% of total billed charges ",20.89,27.75,
"GAUZE VAGINAL STERILE",6003245,"CDM ",272,RC,,,OUTPATIENT,,,12.44,9.952,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.95,80,,7.96,,,0,"percent of total billed charges ","80% of total billed charges ",8.71,70,,6.97,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,90,,8.96,,,0,"percent of total billed charges ","90% of total billed charges ",11.57,93,,9.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.57,85,,8.46,,,0,"percent of total billed charges ","85% of total billed charges ",11.2,90,,8.96,,,0,"percent of total billed charges ","90% of total billed charges ",11.2,90,,8.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.82,87,,8.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.71,70,,6.97,,,0,"percent of total billed charges ","70% of total billed charges ",8.71,11.57,
"STETH.ESOPH 18FR DISP (OLD)",6003266,"CDM ",272,RC,,,OUTPATIENT,,,17.75,14.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.2,80,,11.36,,,0,"percent of total billed charges ","80% of total billed charges ",12.43,70,,9.94,,,0,"percent of total billed charges ","70% of total billed charges ",15.98,90,,12.78,,,0,"percent of total billed charges ","90% of total billed charges ",16.51,93,,13.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.09,85,,12.07,,,0,"percent of total billed charges ","85% of total billed charges ",15.98,90,,12.78,,,0,"percent of total billed charges ","90% of total billed charges ",15.98,90,,12.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.44,87,,12.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.43,70,,9.94,,,0,"percent of total billed charges ","70% of total billed charges ",12.43,16.51,
"CATH FOGERTY 4FR",6003271,"CDM ",272,RC,,,OUTPATIENT,,,82.54,66.032,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.03,80,,52.82,,,0,"percent of total billed charges ","80% of total billed charges ",57.78,70,,46.22,,,0,"percent of total billed charges ","70% of total billed charges ",74.29,90,,59.43,,,0,"percent of total billed charges ","90% of total billed charges ",76.76,93,,61.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.16,85,,56.13,,,0,"percent of total billed charges ","85% of total billed charges ",74.29,90,,59.43,,,0,"percent of total billed charges ","90% of total billed charges ",74.29,90,,59.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",71.81,87,,57.45,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.78,70,,46.22,,,0,"percent of total billed charges ","70% of total billed charges ",57.78,76.76,
"CORD ACTIVE DISP.",6003273,"CDM ",272,RC,,,OUTPATIENT,,,111.13,88.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.9,80,,71.12,,,0,"percent of total billed charges ","80% of total billed charges ",77.79,70,,62.23,,,0,"percent of total billed charges ","70% of total billed charges ",100.02,90,,80.02,,,0,"percent of total billed charges ","90% of total billed charges ",103.35,93,,82.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",94.46,85,,75.57,,,0,"percent of total billed charges ","85% of total billed charges ",100.02,90,,80.02,,,0,"percent of total billed charges ","90% of total billed charges ",100.02,90,,80.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",96.68,87,,77.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.79,70,,62.23,,,0,"percent of total billed charges ","70% of total billed charges ",77.79,103.35,
"CBL SURGICAL 12' DISP",6003276,"CDM ",278,RC,,,OUTPATIENT,,,244.12,195.296,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",195.3,80,,156.24,,,0,"percent of total billed charges ","80% of total billed charges ",170.88,70,,136.70,,,0,"percent of total billed charges ","70% of total billed charges ",219.71,90,,175.77,,,0,"percent of total billed charges ","90% of total billed charges ",227.03,93,,181.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",207.5,85,,166.00,,,0,"percent of total billed charges ","85% of total billed charges ",207.5,85,,166.00,,,0,"percent of total billed charges ","85% of total billed charges ",219.71,90,,175.77,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",212.38,87,,169.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.88,70,,136.70,,,0,"percent of total billed charges ","70% of total billed charges ",170.88,227.03,
"BELT GAIT 54 INCH",6003298,"CDM ",271,RC,,,OUTPATIENT,,,48.14,38.512,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.51,80,,30.81,,,0,"percent of total billed charges ","80% of total billed charges ",33.7,70,,26.96,,,0,"percent of total billed charges ","70% of total billed charges ",43.33,90,,34.66,,,0,"percent of total billed charges ","90% of total billed charges ",44.77,93,,35.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.92,85,,32.74,,,0,"percent of total billed charges ","85% of total billed charges ",43.33,90,,34.66,,,0,"percent of total billed charges ","90% of total billed charges ",43.33,90,,34.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.88,87,,33.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.7,70,,26.96,,,0,"percent of total billed charges ","70% of total billed charges ",33.7,44.77,
"ARMBOARD ADULT",6003301,"CDM ",271,RC,,,OUTPATIENT,,,29.19,23.352,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.35,80,,18.68,,,0,"percent of total billed charges ","80% of total billed charges ",20.43,70,,16.34,,,0,"percent of total billed charges ","70% of total billed charges ",26.27,90,,21.02,,,0,"percent of total billed charges ","90% of total billed charges ",27.15,93,,21.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",24.81,85,,19.85,,,0,"percent of total billed charges ","85% of total billed charges ",26.27,90,,21.02,,,0,"percent of total billed charges ","90% of total billed charges ",26.27,90,,21.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",25.4,87,,20.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.43,70,,16.34,,,0,"percent of total billed charges ","70% of total billed charges ",20.43,27.15,
"KIT RESUS NEONATE 42MM",6003315,"CDM ",270,RC,,,OUTPATIENT,,,26.73,21.384,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.38,80,,17.10,,,0,"percent of total billed charges ","80% of total billed charges ",18.71,70,,14.97,,,0,"percent of total billed charges ","70% of total billed charges ",24.06,90,,19.25,,,0,"percent of total billed charges ","90% of total billed charges ",24.86,93,,19.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",22.72,85,,18.18,,,0,"percent of total billed charges ","85% of total billed charges ",24.06,90,,19.25,,,0,"percent of total billed charges ","90% of total billed charges ",24.06,90,,19.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",23.26,87,,18.61,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.71,70,,14.97,,,0,"percent of total billed charges ","70% of total billed charges ",18.71,24.86,
"KIT RESUS NEONATE 50MM",6003316,"CDM ",270,RC,,,OUTPATIENT,,,26.73,21.384,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.38,80,,17.10,,,0,"percent of total billed charges ","80% of total billed charges ",18.71,70,,14.97,,,0,"percent of total billed charges ","70% of total billed charges ",24.06,90,,19.25,,,0,"percent of total billed charges ","90% of total billed charges ",24.86,93,,19.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",22.72,85,,18.18,,,0,"percent of total billed charges ","85% of total billed charges ",24.06,90,,19.25,,,0,"percent of total billed charges ","90% of total billed charges ",24.06,90,,19.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",23.26,87,,18.61,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.71,70,,14.97,,,0,"percent of total billed charges ","70% of total billed charges ",18.71,24.86,
"CATH THORACIC PVP 36FR STRG'T",6003328,"CDM ",272,RC,,,OUTPATIENT,,,19.21,15.368,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.37,80,,12.30,,,0,"percent of total billed charges ","80% of total billed charges ",13.45,70,,10.76,,,0,"percent of total billed charges ","70% of total billed charges ",17.29,90,,13.83,,,0,"percent of total billed charges ","90% of total billed charges ",17.87,93,,14.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.33,85,,13.06,,,0,"percent of total billed charges ","85% of total billed charges ",17.29,90,,13.83,,,0,"percent of total billed charges ","90% of total billed charges ",17.29,90,,13.83,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.71,87,,13.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.45,70,,10.76,,,0,"percent of total billed charges ","70% of total billed charges ",13.45,17.87,
"CATH THORACIC PVP 40FR STRG'T",6003336,"CDM ",272,RC,,,OUTPATIENT,,,19.21,15.368,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.37,80,,12.30,,,0,"percent of total billed charges ","80% of total billed charges ",13.45,70,,10.76,,,0,"percent of total billed charges ","70% of total billed charges ",17.29,90,,13.83,,,0,"percent of total billed charges ","90% of total billed charges ",17.87,93,,14.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.33,85,,13.06,,,0,"percent of total billed charges ","85% of total billed charges ",17.29,90,,13.83,,,0,"percent of total billed charges ","90% of total billed charges ",17.29,90,,13.83,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.71,87,,13.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.45,70,,10.76,,,0,"percent of total billed charges ","70% of total billed charges ",13.45,17.87,
"KIT RESUS NEONATE 60MM",6003345,"CDM ",270,RC,,,OUTPATIENT,,,32.6,26.08,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.08,80,,20.86,,,0,"percent of total billed charges ","80% of total billed charges ",22.82,70,,18.26,,,0,"percent of total billed charges ","70% of total billed charges ",29.34,90,,23.47,,,0,"percent of total billed charges ","90% of total billed charges ",30.32,93,,24.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",27.71,85,,22.17,,,0,"percent of total billed charges ","85% of total billed charges ",29.34,90,,23.47,,,0,"percent of total billed charges ","90% of total billed charges ",29.34,90,,23.47,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",28.36,87,,22.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.82,70,,18.26,,,0,"percent of total billed charges ","70% of total billed charges ",22.82,30.32,
"INSTRUMENT IMPACT TRI-OD LIG",6003349,"CDM ",272,RC,,,OUTPATIENT,,,1121.47,897.176,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",897.18,80,,717.74,,,0,"percent of total billed charges ","80% of total billed charges ",785.03,70,,628.02,,,0,"percent of total billed charges ","70% of total billed charges ",1009.32,90,,807.46,,,0,"percent of total billed charges ","90% of total billed charges ",1042.97,93,,834.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",953.25,85,,762.60,,,0,"percent of total billed charges ","85% of total billed charges ",1009.32,90,,807.46,,,0,"percent of total billed charges ","90% of total billed charges ",1009.32,90,,807.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",975.68,87,,780.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",785.03,70,,628.02,,,0,"percent of total billed charges ","70% of total billed charges ",785.03,1042.97,
"ADAPTER AIRWAY CAPNOCHECK",6003370,"CDM ",272,RC,,,OUTPATIENT,,,126.68,101.344,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.34,80,,81.07,,,0,"percent of total billed charges ","80% of total billed charges ",88.68,70,,70.94,,,0,"percent of total billed charges ","70% of total billed charges ",114.01,90,,91.21,,,0,"percent of total billed charges ","90% of total billed charges ",117.81,93,,94.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",107.68,85,,86.14,,,0,"percent of total billed charges ","85% of total billed charges ",114.01,90,,91.21,,,0,"percent of total billed charges ","90% of total billed charges ",114.01,90,,91.21,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",110.21,87,,88.17,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.68,70,,70.94,,,0,"percent of total billed charges ","70% of total billed charges ",88.68,117.81,
"SPECULUM PLASTIC VAG STERILE",6003378,"CDM ",272,RC,,,OUTPATIENT,,,14.99,11.992,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.99,80,,9.59,,,0,"percent of total billed charges ","80% of total billed charges ",10.49,70,,8.39,,,0,"percent of total billed charges ","70% of total billed charges ",13.49,90,,10.79,,,0,"percent of total billed charges ","90% of total billed charges ",13.94,93,,11.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.74,85,,10.19,,,0,"percent of total billed charges ","85% of total billed charges ",13.49,90,,10.79,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,90,,10.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.04,87,,10.43,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.49,70,,8.39,,,0,"percent of total billed charges ","70% of total billed charges ",10.49,13.94,
"TAPE CAST 4"" RED",6003387,"CDM ",272,RC,,,OUTPATIENT,,,18.3,14.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.64,80,,11.71,,,0,"percent of total billed charges ","80% of total billed charges ",12.81,70,,10.25,,,0,"percent of total billed charges ","70% of total billed charges ",16.47,90,,13.18,,,0,"percent of total billed charges ","90% of total billed charges ",17.02,93,,13.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.56,85,,12.45,,,0,"percent of total billed charges ","85% of total billed charges ",16.47,90,,13.18,,,0,"percent of total billed charges ","90% of total billed charges ",16.47,90,,13.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.92,87,,12.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.81,70,,10.25,,,0,"percent of total billed charges ","70% of total billed charges ",12.81,17.02,
"AIRWAY DESC 32FR",6003430,"CDM ",272,RC,,,OUTPATIENT,,,14.74,11.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.79,80,,9.43,,,0,"percent of total billed charges ","80% of total billed charges ",10.32,70,,8.26,,,0,"percent of total billed charges ","70% of total billed charges ",13.27,90,,10.62,,,0,"percent of total billed charges ","90% of total billed charges ",13.71,93,,10.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.53,85,,10.02,,,0,"percent of total billed charges ","85% of total billed charges ",13.27,90,,10.62,,,0,"percent of total billed charges ","90% of total billed charges ",13.27,90,,10.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.82,87,,10.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.32,70,,8.26,,,0,"percent of total billed charges ","70% of total billed charges ",10.32,13.71,
"CATH FOLEY SILICONE 18FR",6003457,"CDM ",272,RC,,,OUTPATIENT,,,15.7,12.56,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.56,80,,10.05,,,0,"percent of total billed charges ","80% of total billed charges ",10.99,70,,8.79,,,0,"percent of total billed charges ","70% of total billed charges ",14.13,90,,11.30,,,0,"percent of total billed charges ","90% of total billed charges ",14.6,93,,11.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.35,85,,10.68,,,0,"percent of total billed charges ","85% of total billed charges ",14.13,90,,11.30,,,0,"percent of total billed charges ","90% of total billed charges ",14.13,90,,11.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.66,87,,10.93,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.99,70,,8.79,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,14.6,
"GRID ACCU DISP",6003537,"CDM ",621,RC,,,OUTPATIENT,,,96.32,77.056,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.06,80,,61.65,,,0,"percent of total billed charges ","80% of total billed charges ",67.42,70,,53.94,,,0,"percent of total billed charges ","70% of total billed charges ",86.69,90,,69.35,,,0,"percent of total billed charges ","90% of total billed charges ",89.58,93,,71.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",81.87,85,,65.50,,,0,"percent of total billed charges ","85% of total billed charges ",86.69,90,,69.35,,,0,"percent of total billed charges ","90% of total billed charges ",86.69,90,,69.35,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",83.8,87,,67.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.42,70,,53.94,,,0,"percent of total billed charges ","70% of total billed charges ",67.42,89.58,
"AIRWAY DESC 28FR",6003604,"CDM ",272,RC,,,OUTPATIENT,,,14.74,11.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.79,80,,9.43,,,0,"percent of total billed charges ","80% of total billed charges ",10.32,70,,8.26,,,0,"percent of total billed charges ","70% of total billed charges ",13.27,90,,10.62,,,0,"percent of total billed charges ","90% of total billed charges ",13.71,93,,10.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.53,85,,10.02,,,0,"percent of total billed charges ","85% of total billed charges ",13.27,90,,10.62,,,0,"percent of total billed charges ","90% of total billed charges ",13.27,90,,10.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.82,87,,10.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.32,70,,8.26,,,0,"percent of total billed charges ","70% of total billed charges ",10.32,13.71,
"SET INFUSION POWER PORT 19G",6003624,"CDM ",270,RC,,,OUTPATIENT,,,46.14,36.912,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.91,80,,29.53,,,0,"percent of total billed charges ","80% of total billed charges ",32.3,70,,25.84,,,0,"percent of total billed charges ","70% of total billed charges ",41.53,90,,33.22,,,0,"percent of total billed charges ","90% of total billed charges ",42.91,93,,34.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.22,85,,31.38,,,0,"percent of total billed charges ","85% of total billed charges ",41.53,90,,33.22,,,0,"percent of total billed charges ","90% of total billed charges ",41.53,90,,33.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.14,87,,32.11,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.3,70,,25.84,,,0,"percent of total billed charges ","70% of total billed charges ",32.3,42.91,
"TEST AMNISURE",6003630,"CDM ",272,RC,,,OUTPATIENT,,,215.84,172.672,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.67,80,,138.14,,,0,"percent of total billed charges ","80% of total billed charges ",151.09,70,,120.87,,,0,"percent of total billed charges ","70% of total billed charges ",194.26,90,,155.41,,,0,"percent of total billed charges ","90% of total billed charges ",200.73,93,,160.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",183.46,85,,146.77,,,0,"percent of total billed charges ","85% of total billed charges ",194.26,90,,155.41,,,0,"percent of total billed charges ","90% of total billed charges ",194.26,90,,155.41,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",187.78,87,,150.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.09,70,,120.87,,,0,"percent of total billed charges ","70% of total billed charges ",151.09,200.73,
"MARK BREAST 17GA X 12CM COIL",6003646,"CDM ",270,RC,,,OUTPATIENT,,,290.55,232.44,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",232.44,80,,185.95,,,0,"percent of total billed charges ","80% of total billed charges ",203.39,70,,162.71,,,0,"percent of total billed charges ","70% of total billed charges ",261.5,90,,209.20,,,0,"percent of total billed charges ","90% of total billed charges ",270.21,93,,216.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",246.97,85,,197.58,,,0,"percent of total billed charges ","85% of total billed charges ",261.5,90,,209.20,,,0,"percent of total billed charges ","90% of total billed charges ",261.5,90,,209.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",252.78,87,,202.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",203.39,70,,162.71,,,0,"percent of total billed charges ","70% of total billed charges ",203.39,270.21,
"TUBE NASAL UNCUFFED 5.0MM",6003652,"CDM ",272,RC,,,OUTPATIENT,,,17.65,14.12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.12,80,,11.30,,,0,"percent of total billed charges ","80% of total billed charges ",12.36,70,,9.89,,,0,"percent of total billed charges ","70% of total billed charges ",15.89,90,,12.71,,,0,"percent of total billed charges ","90% of total billed charges ",16.41,93,,13.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15,85,,12.00,,,0,"percent of total billed charges ","85% of total billed charges ",15.89,90,,12.71,,,0,"percent of total billed charges ","90% of total billed charges ",15.89,90,,12.71,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.36,87,,12.29,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.36,70,,9.89,,,0,"percent of total billed charges ","70% of total billed charges ",12.36,16.41,
"TRACE CART VAG DELIVERY",6003654,"CDM ",272,RC,,,OUTPATIENT,,,356.07,284.856,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",284.86,80,,227.89,,,0,"percent of total billed charges ","80% of total billed charges ",249.25,70,,199.40,,,0,"percent of total billed charges ","70% of total billed charges ",320.46,90,,256.37,,,0,"percent of total billed charges ","90% of total billed charges ",331.15,93,,264.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",302.66,85,,242.13,,,0,"percent of total billed charges ","85% of total billed charges ",320.46,90,,256.37,,,0,"percent of total billed charges ","90% of total billed charges ",320.46,90,,256.37,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",309.78,87,,247.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",249.25,70,,199.40,,,0,"percent of total billed charges ","70% of total billed charges ",249.25,331.15,
"TRACE CART C-SECTION DELIVER",6003655,"CDM ",272,RC,,,OUTPATIENT,,,248.47,198.776,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",198.78,80,,159.02,,,0,"percent of total billed charges ","80% of total billed charges ",173.93,70,,139.14,,,0,"percent of total billed charges ","70% of total billed charges ",223.62,90,,178.90,,,0,"percent of total billed charges ","90% of total billed charges ",231.08,93,,184.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",211.2,85,,168.96,,,0,"percent of total billed charges ","85% of total billed charges ",223.62,90,,178.90,,,0,"percent of total billed charges ","90% of total billed charges ",223.62,90,,178.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",216.17,87,,172.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.93,70,,139.14,,,0,"percent of total billed charges ","70% of total billed charges ",173.93,231.08,
"MASK OPEN OXYGEN",6003666,"CDM ",270,RC,,,OUTPATIENT,,,17.05,13.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.64,80,,10.91,,,0,"percent of total billed charges ","80% of total billed charges ",11.94,70,,9.55,,,0,"percent of total billed charges ","70% of total billed charges ",15.35,90,,12.28,,,0,"percent of total billed charges ","90% of total billed charges ",15.86,93,,12.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.49,85,,11.59,,,0,"percent of total billed charges ","85% of total billed charges ",15.35,90,,12.28,,,0,"percent of total billed charges ","90% of total billed charges ",15.35,90,,12.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.83,87,,11.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.94,70,,9.55,,,0,"percent of total billed charges ","70% of total billed charges ",11.94,15.86,
"NEEDLE EPIDURAL 17GA X 5""",6003679,"CDM ",272,RC,,,OUTPATIENT,,,35.51,28.408,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.41,80,,22.73,,,0,"percent of total billed charges ","80% of total billed charges ",24.86,70,,19.89,,,0,"percent of total billed charges ","70% of total billed charges ",31.96,90,,25.57,,,0,"percent of total billed charges ","90% of total billed charges ",33.02,93,,26.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",30.18,85,,24.14,,,0,"percent of total billed charges ","85% of total billed charges ",31.96,90,,25.57,,,0,"percent of total billed charges ","90% of total billed charges ",31.96,90,,25.57,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.89,87,,24.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.86,70,,19.89,,,0,"percent of total billed charges ","70% of total billed charges ",24.86,33.02,
"NEEDLE SPINAL 22G X 5""",6003705,"CDM ",272,RC,,,OUTPATIENT,,,13.19,10.552,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.55,80,,8.44,,,0,"percent of total billed charges ","80% of total billed charges ",9.23,70,,7.38,,,0,"percent of total billed charges ","70% of total billed charges ",11.87,90,,9.50,,,0,"percent of total billed charges ","90% of total billed charges ",12.27,93,,9.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.21,85,,8.97,,,0,"percent of total billed charges ","85% of total billed charges ",11.87,90,,9.50,,,0,"percent of total billed charges ","90% of total billed charges ",11.87,90,,9.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.48,87,,9.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.23,70,,7.38,,,0,"percent of total billed charges ","70% of total billed charges ",9.23,12.27,
"AIRWAY NASAL 30FR",6003763,"CDM ",272,RC,,,OUTPATIENT,,,24.02,19.216,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.22,80,,15.38,,,0,"percent of total billed charges ","80% of total billed charges ",16.81,70,,13.45,,,0,"percent of total billed charges ","70% of total billed charges ",21.62,90,,17.30,,,0,"percent of total billed charges ","90% of total billed charges ",22.34,93,,17.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.42,85,,16.34,,,0,"percent of total billed charges ","85% of total billed charges ",21.62,90,,17.30,,,0,"percent of total billed charges ","90% of total billed charges ",21.62,90,,17.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.9,87,,16.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.81,70,,13.45,,,0,"percent of total billed charges ","70% of total billed charges ",16.81,22.34,
"TUBE ORAL 5.5",6003764,"CDM ",272,RC,,,OUTPATIENT,,,11.68,9.344,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.34,80,,7.47,,,0,"percent of total billed charges ","80% of total billed charges ",8.18,70,,6.54,,,0,"percent of total billed charges ","70% of total billed charges ",10.51,90,,8.41,,,0,"percent of total billed charges ","90% of total billed charges ",10.86,93,,8.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.93,85,,7.94,,,0,"percent of total billed charges ","85% of total billed charges ",10.51,90,,8.41,,,0,"percent of total billed charges ","90% of total billed charges ",10.51,90,,8.41,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.16,87,,8.13,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.18,70,,6.54,,,0,"percent of total billed charges ","70% of total billed charges ",8.18,10.86,
"CUSHION PODUS MED GRAY",6003801,"CDM ",271,RC,,,OUTPATIENT,,,368.13,294.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",294.5,80,,235.60,,,0,"percent of total billed charges ","80% of total billed charges ",257.69,70,,206.15,,,0,"percent of total billed charges ","70% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",342.36,93,,273.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",312.91,85,,250.33,,,0,"percent of total billed charges ","85% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",320.27,87,,256.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",257.69,70,,206.15,,,0,"percent of total billed charges ","70% of total billed charges ",257.69,342.36,
"SURGINEEDLE 120MM",6003803,"CDM ",272,RC,,,OUTPATIENT,,,208.83,167.064,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.06,80,,133.65,,,0,"percent of total billed charges ","80% of total billed charges ",146.18,70,,116.94,,,0,"percent of total billed charges ","70% of total billed charges ",187.95,90,,150.36,,,0,"percent of total billed charges ","90% of total billed charges ",194.21,93,,155.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",177.51,85,,142.01,,,0,"percent of total billed charges ","85% of total billed charges ",187.95,90,,150.36,,,0,"percent of total billed charges ","90% of total billed charges ",187.95,90,,150.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",181.68,87,,145.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",146.18,70,,116.94,,,0,"percent of total billed charges ","70% of total billed charges ",146.18,194.21,
"NASAL AIRWAY 34 FR",6003820,"CDM ",272,RC,,,OUTPATIENT,,,24.97,19.976,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.98,80,,15.98,,,0,"percent of total billed charges ","80% of total billed charges ",17.48,70,,13.98,,,0,"percent of total billed charges ","70% of total billed charges ",22.47,90,,17.98,,,0,"percent of total billed charges ","90% of total billed charges ",23.22,93,,18.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.22,85,,16.98,,,0,"percent of total billed charges ","85% of total billed charges ",22.47,90,,17.98,,,0,"percent of total billed charges ","90% of total billed charges ",22.47,90,,17.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.72,87,,17.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.48,70,,13.98,,,0,"percent of total billed charges ","70% of total billed charges ",17.48,23.22,
"SUTURE G121H 4.0 CHROMIC",6003821,"CDM ",272,RC,,,OUTPATIENT,,,13.34,10.672,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.67,80,,8.54,,,0,"percent of total billed charges ","80% of total billed charges ",9.34,70,,7.47,,,0,"percent of total billed charges ","70% of total billed charges ",12.01,90,,9.61,,,0,"percent of total billed charges ","90% of total billed charges ",12.41,93,,9.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.34,85,,9.07,,,0,"percent of total billed charges ","85% of total billed charges ",12.01,90,,9.61,,,0,"percent of total billed charges ","90% of total billed charges ",12.01,90,,9.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.61,87,,9.29,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.34,70,,7.47,,,0,"percent of total billed charges ","70% of total billed charges ",9.34,12.41,
"AIRWAY DESC 22FR",6003835,"CDM ",272,RC,,,OUTPATIENT,,,14.74,11.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.79,80,,9.43,,,0,"percent of total billed charges ","80% of total billed charges ",10.32,70,,8.26,,,0,"percent of total billed charges ","70% of total billed charges ",13.27,90,,10.62,,,0,"percent of total billed charges ","90% of total billed charges ",13.71,93,,10.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.53,85,,10.02,,,0,"percent of total billed charges ","85% of total billed charges ",13.27,90,,10.62,,,0,"percent of total billed charges ","90% of total billed charges ",13.27,90,,10.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.82,87,,10.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.32,70,,8.26,,,0,"percent of total billed charges ","70% of total billed charges ",10.32,13.71,
"CRUTCHES ADULT",6003906,"CDM ",271,RC,,,OUTPATIENT,,,57.87,46.296,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.3,80,,37.04,,,0,"percent of total billed charges ","80% of total billed charges ",40.51,70,,32.41,,,0,"percent of total billed charges ","70% of total billed charges ",52.08,90,,41.66,,,0,"percent of total billed charges ","90% of total billed charges ",53.82,93,,43.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",49.19,85,,39.35,,,0,"percent of total billed charges ","85% of total billed charges ",52.08,90,,41.66,,,0,"percent of total billed charges ","90% of total billed charges ",52.08,90,,41.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",50.35,87,,40.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.51,70,,32.41,,,0,"percent of total billed charges ","70% of total billed charges ",40.51,53.82,
"SUTURE 697G 6.0",6003928,"CDM ",272,RC,,,OUTPATIENT,,,12.94,10.352,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.35,80,,8.28,,,0,"percent of total billed charges ","80% of total billed charges ",9.06,70,,7.25,,,0,"percent of total billed charges ","70% of total billed charges ",11.65,90,,9.32,,,0,"percent of total billed charges ","90% of total billed charges ",12.03,93,,9.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11,85,,8.80,,,0,"percent of total billed charges ","85% of total billed charges ",11.65,90,,9.32,,,0,"percent of total billed charges ","90% of total billed charges ",11.65,90,,9.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.26,87,,9.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.06,70,,7.25,,,0,"percent of total billed charges ","70% of total billed charges ",9.06,12.03,
"CAST TAPE 2"" BLACK",6003960,"CDM ",271,RC,,,OUTPATIENT,,,24.22,19.376,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.38,80,,15.50,,,0,"percent of total billed charges ","80% of total billed charges ",16.95,70,,13.56,,,0,"percent of total billed charges ","70% of total billed charges ",21.8,90,,17.44,,,0,"percent of total billed charges ","90% of total billed charges ",22.52,93,,18.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.59,85,,16.47,,,0,"percent of total billed charges ","85% of total billed charges ",21.8,90,,17.44,,,0,"percent of total billed charges ","90% of total billed charges ",21.8,90,,17.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.07,87,,16.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.95,70,,13.56,,,0,"percent of total billed charges ","70% of total billed charges ",16.95,22.52,
"EXTENSION J-LOOP NEEDLESS",6003966,"CDM ",272,RC,,,OUTPATIENT,,,11.18,8.944,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.94,80,,7.15,,,0,"percent of total billed charges ","80% of total billed charges ",7.83,70,,6.26,,,0,"percent of total billed charges ","70% of total billed charges ",10.06,90,,8.05,,,0,"percent of total billed charges ","90% of total billed charges ",10.4,93,,8.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.5,85,,7.60,,,0,"percent of total billed charges ","85% of total billed charges ",10.06,90,,8.05,,,0,"percent of total billed charges ","90% of total billed charges ",10.06,90,,8.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.73,87,,7.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.83,70,,6.26,,,0,"percent of total billed charges ","70% of total billed charges ",7.83,10.4,
"PAD TENS",6004016,"CDM ",271,RC,,,OUTPATIENT,,,22.92,18.336,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.34,80,,14.67,,,0,"percent of total billed charges ","80% of total billed charges ",16.04,70,,12.83,,,0,"percent of total billed charges ","70% of total billed charges ",20.63,90,,16.50,,,0,"percent of total billed charges ","90% of total billed charges ",21.32,93,,17.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.48,85,,15.58,,,0,"percent of total billed charges ","85% of total billed charges ",20.63,90,,16.50,,,0,"percent of total billed charges ","90% of total billed charges ",20.63,90,,16.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.94,87,,15.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.04,70,,12.83,,,0,"percent of total billed charges ","70% of total billed charges ",16.04,21.32,
"CATH FOLEY STRAIGHT 16FR",6004030,"CDM ",272,RC,,,OUTPATIENT,,,17.85,14.28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.28,80,,11.42,,,0,"percent of total billed charges ","80% of total billed charges ",12.5,70,,10.00,,,0,"percent of total billed charges ","70% of total billed charges ",16.07,90,,12.86,,,0,"percent of total billed charges ","90% of total billed charges ",16.6,93,,13.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.17,85,,12.14,,,0,"percent of total billed charges ","85% of total billed charges ",16.07,90,,12.86,,,0,"percent of total billed charges ","90% of total billed charges ",16.07,90,,12.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.53,87,,12.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.5,70,,10.00,,,0,"percent of total billed charges ","70% of total billed charges ",12.5,16.6,
"SET INFU POWER PORT 19GA 3/4""",6004076,"CDM ",270,RC,,,OUTPATIENT,,,30.14,24.112,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.11,80,,19.29,,,0,"percent of total billed charges ","80% of total billed charges ",21.1,70,,16.88,,,0,"percent of total billed charges ","70% of total billed charges ",27.13,90,,21.70,,,0,"percent of total billed charges ","90% of total billed charges ",28.03,93,,22.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.62,85,,20.50,,,0,"percent of total billed charges ","85% of total billed charges ",27.13,90,,21.70,,,0,"percent of total billed charges ","90% of total billed charges ",27.13,90,,21.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.22,87,,20.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.1,70,,16.88,,,0,"percent of total billed charges ","70% of total billed charges ",21.1,28.03,
"CATH EPIDURAL FLEXTIP",6004101,"CDM ",272,RC,,,OUTPATIENT,,,51.12,40.896,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.9,80,,32.72,,,0,"percent of total billed charges ","80% of total billed charges ",35.78,70,,28.62,,,0,"percent of total billed charges ","70% of total billed charges ",46.01,90,,36.81,,,0,"percent of total billed charges ","90% of total billed charges ",47.54,93,,38.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.45,85,,34.76,,,0,"percent of total billed charges ","85% of total billed charges ",46.01,90,,36.81,,,0,"percent of total billed charges ","90% of total billed charges ",46.01,90,,36.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.47,87,,35.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.78,70,,28.62,,,0,"percent of total billed charges ","70% of total billed charges ",35.78,47.54,
"ADAPTER STRAIGHT T",6004112,"CDM ",272,RC,,,OUTPATIENT,,,50.05,40.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.04,80,,32.03,,,0,"percent of total billed charges ","80% of total billed charges ",35.04,70,,28.03,,,0,"percent of total billed charges ","70% of total billed charges ",45.05,90,,36.04,,,0,"percent of total billed charges ","90% of total billed charges ",46.55,93,,37.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.54,85,,34.03,,,0,"percent of total billed charges ","85% of total billed charges ",45.05,90,,36.04,,,0,"percent of total billed charges ","90% of total billed charges ",45.05,90,,36.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.54,87,,34.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.04,70,,28.03,,,0,"percent of total billed charges ","70% of total billed charges ",35.04,46.55,
"NEEDLE SPINAL 22GA X 3 1/2",6004122,"CDM ",272,RC,,,OUTPATIENT,,,41.88,33.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.5,80,,26.80,,,0,"percent of total billed charges ","80% of total billed charges ",29.32,70,,23.46,,,0,"percent of total billed charges ","70% of total billed charges ",37.69,90,,30.15,,,0,"percent of total billed charges ","90% of total billed charges ",38.95,93,,31.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",35.6,85,,28.48,,,0,"percent of total billed charges ","85% of total billed charges ",37.69,90,,30.15,,,0,"percent of total billed charges ","90% of total billed charges ",37.69,90,,30.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",36.44,87,,29.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.32,70,,23.46,,,0,"percent of total billed charges ","70% of total billed charges ",29.32,38.95,
"TUBE ENDO ORAL 7.0",6004123,"CDM ",272,RC,,,OUTPATIENT,,,19.76,15.808,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.81,80,,12.65,,,0,"percent of total billed charges ","80% of total billed charges ",13.83,70,,11.06,,,0,"percent of total billed charges ","70% of total billed charges ",17.78,90,,14.22,,,0,"percent of total billed charges ","90% of total billed charges ",18.38,93,,14.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.8,85,,13.44,,,0,"percent of total billed charges ","85% of total billed charges ",17.78,90,,14.22,,,0,"percent of total billed charges ","90% of total billed charges ",17.78,90,,14.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.19,87,,13.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.83,70,,11.06,,,0,"percent of total billed charges ","70% of total billed charges ",13.83,18.38,
"TUBE ENDO ORAL 7.5",6004124,"CDM ",272,RC,,,OUTPATIENT,,,20.01,16.008,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.01,80,,12.81,,,0,"percent of total billed charges ","80% of total billed charges ",14.01,70,,11.21,,,0,"percent of total billed charges ","70% of total billed charges ",18.01,90,,14.41,,,0,"percent of total billed charges ","90% of total billed charges ",18.61,93,,14.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.01,85,,13.61,,,0,"percent of total billed charges ","85% of total billed charges ",18.01,90,,14.41,,,0,"percent of total billed charges ","90% of total billed charges ",18.01,90,,14.41,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.41,87,,13.93,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.01,70,,11.21,,,0,"percent of total billed charges ","70% of total billed charges ",14.01,18.61,
"TUBE ENDO ORAL 8.0",6004125,"CDM ",272,RC,,,OUTPATIENT,,,20.86,16.688,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.69,80,,13.35,,,0,"percent of total billed charges ","80% of total billed charges ",14.6,70,,11.68,,,0,"percent of total billed charges ","70% of total billed charges ",18.77,90,,15.02,,,0,"percent of total billed charges ","90% of total billed charges ",19.4,93,,15.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.73,85,,14.18,,,0,"percent of total billed charges ","85% of total billed charges ",18.77,90,,15.02,,,0,"percent of total billed charges ","90% of total billed charges ",18.77,90,,15.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.15,87,,14.52,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.6,70,,11.68,,,0,"percent of total billed charges ","70% of total billed charges ",14.6,19.4,
"TUBE ORAL UNCUFFED 5.0MM",6004139,"CDM ",272,RC,,,OUTPATIENT,,,14.04,11.232,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.23,80,,8.98,,,0,"percent of total billed charges ","80% of total billed charges ",9.83,70,,7.86,,,0,"percent of total billed charges ","70% of total billed charges ",12.64,90,,10.11,,,0,"percent of total billed charges ","90% of total billed charges ",13.06,93,,10.45,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.93,85,,9.54,,,0,"percent of total billed charges ","85% of total billed charges ",12.64,90,,10.11,,,0,"percent of total billed charges ","90% of total billed charges ",12.64,90,,10.11,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.21,87,,9.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.83,70,,7.86,,,0,"percent of total billed charges ","70% of total billed charges ",9.83,13.06,
"SHIELD NIPPLE",6004146,"CDM ",271,RC,,,OUTPATIENT,,,21.87,17.496,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.5,80,,14.00,,,0,"percent of total billed charges ","80% of total billed charges ",15.31,70,,12.25,,,0,"percent of total billed charges ","70% of total billed charges ",19.68,90,,15.74,,,0,"percent of total billed charges ","90% of total billed charges ",20.34,93,,16.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.59,85,,14.87,,,0,"percent of total billed charges ","85% of total billed charges ",19.68,90,,15.74,,,0,"percent of total billed charges ","90% of total billed charges ",19.68,90,,15.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.03,87,,15.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.31,70,,12.25,,,0,"percent of total billed charges ","70% of total billed charges ",15.31,20.34,
"KIT NIPPLE",6004147,"CDM ",272,RC,,,OUTPATIENT,,,37.91,30.328,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.33,80,,24.26,,,0,"percent of total billed charges ","80% of total billed charges ",26.54,70,,21.23,,,0,"percent of total billed charges ","70% of total billed charges ",34.12,90,,27.30,,,0,"percent of total billed charges ","90% of total billed charges ",35.26,93,,28.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.22,85,,25.78,,,0,"percent of total billed charges ","85% of total billed charges ",34.12,90,,27.30,,,0,"percent of total billed charges ","90% of total billed charges ",34.12,90,,27.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",32.98,87,,26.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.54,70,,21.23,,,0,"percent of total billed charges ","70% of total billed charges ",26.54,35.26,
"SECUREMENT DEVICE FOLEY CATH",6004151,"CDM ",271,RC,,,OUTPATIENT,,,13.59,10.872,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.87,80,,8.70,,,0,"percent of total billed charges ","80% of total billed charges ",9.51,70,,7.61,,,0,"percent of total billed charges ","70% of total billed charges ",12.23,90,,9.78,,,0,"percent of total billed charges ","90% of total billed charges ",12.64,93,,10.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.55,85,,9.24,,,0,"percent of total billed charges ","85% of total billed charges ",12.23,90,,9.78,,,0,"percent of total billed charges ","90% of total billed charges ",12.23,90,,9.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.82,87,,9.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.51,70,,7.61,,,0,"percent of total billed charges ","70% of total billed charges ",9.51,12.64,
"NEEDLE BIOPSY SZ 9CM X 21GA",6004163,"CDM ",621,RC,,,OUTPATIENT,,,177.8,142.24,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.24,80,,113.79,,,0,"percent of total billed charges ","80% of total billed charges ",124.46,70,,99.57,,,0,"percent of total billed charges ","70% of total billed charges ",160.02,90,,128.02,,,0,"percent of total billed charges ","90% of total billed charges ",165.35,93,,132.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",151.13,85,,120.90,,,0,"percent of total billed charges ","85% of total billed charges ",160.02,90,,128.02,,,0,"percent of total billed charges ","90% of total billed charges ",160.02,90,,128.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",154.69,87,,123.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.46,70,,99.57,,,0,"percent of total billed charges ","70% of total billed charges ",124.46,165.35,
"STYLETTE PEDI",6004175,"CDM ",272,RC,,,OUTPATIENT,,,14.24,11.392,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.39,80,,9.11,,,0,"percent of total billed charges ","80% of total billed charges ",9.97,70,,7.98,,,0,"percent of total billed charges ","70% of total billed charges ",12.82,90,,10.26,,,0,"percent of total billed charges ","90% of total billed charges ",13.24,93,,10.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.1,85,,9.68,,,0,"percent of total billed charges ","85% of total billed charges ",12.82,90,,10.26,,,0,"percent of total billed charges ","90% of total billed charges ",12.82,90,,10.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.39,87,,9.91,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.97,70,,7.98,,,0,"percent of total billed charges ","70% of total billed charges ",9.97,13.24,
"CUP HEEL DUAL STYLE MEDIUM",6004200,"CDM ",272,RC,,,OUTPATIENT,,,12.79,10.232,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.23,80,,8.18,,,0,"percent of total billed charges ","80% of total billed charges ",8.95,70,,7.16,,,0,"percent of total billed charges ","70% of total billed charges ",11.51,90,,9.21,,,0,"percent of total billed charges ","90% of total billed charges ",11.89,93,,9.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.87,85,,8.70,,,0,"percent of total billed charges ","85% of total billed charges ",11.51,90,,9.21,,,0,"percent of total billed charges ","90% of total billed charges ",11.51,90,,9.21,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.13,87,,8.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.95,70,,7.16,,,0,"percent of total billed charges ","70% of total billed charges ",8.95,11.89,
"SOLN STERILE WATER 3000ML",6004206,"CDM ",270,RC,,,OUTPATIENT,,,27.68,22.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.14,80,,17.71,,,0,"percent of total billed charges ","80% of total billed charges ",19.38,70,,15.50,,,0,"percent of total billed charges ","70% of total billed charges ",24.91,90,,19.93,,,0,"percent of total billed charges ","90% of total billed charges ",25.74,93,,20.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.53,85,,18.82,,,0,"percent of total billed charges ","85% of total billed charges ",24.91,90,,19.93,,,0,"percent of total billed charges ","90% of total billed charges ",24.91,90,,19.93,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",24.08,87,,19.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.38,70,,15.50,,,0,"percent of total billed charges ","70% of total billed charges ",19.38,25.74,
"SUTURE 699H 4.0 P-3",6004208,"CDM ",272,RC,,,OUTPATIENT,,,12.79,10.232,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.23,80,,8.18,,,0,"percent of total billed charges ","80% of total billed charges ",8.95,70,,7.16,,,0,"percent of total billed charges ","70% of total billed charges ",11.51,90,,9.21,,,0,"percent of total billed charges ","90% of total billed charges ",11.89,93,,9.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.87,85,,8.70,,,0,"percent of total billed charges ","85% of total billed charges ",11.51,90,,9.21,,,0,"percent of total billed charges ","90% of total billed charges ",11.51,90,,9.21,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.13,87,,8.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.95,70,,7.16,,,0,"percent of total billed charges ","70% of total billed charges ",8.95,11.89,
"SUTURE PROLENE 4.0 8682H",6004210,"CDM ",272,RC,,,OUTPATIENT,,,19.11,15.288,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.29,80,,12.23,,,0,"percent of total billed charges ","80% of total billed charges ",13.38,70,,10.70,,,0,"percent of total billed charges ","70% of total billed charges ",17.2,90,,13.76,,,0,"percent of total billed charges ","90% of total billed charges ",17.77,93,,14.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.24,85,,12.99,,,0,"percent of total billed charges ","85% of total billed charges ",17.2,90,,13.76,,,0,"percent of total billed charges ","90% of total billed charges ",17.2,90,,13.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.63,87,,13.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.38,70,,10.70,,,0,"percent of total billed charges ","70% of total billed charges ",13.38,17.77,
"SUTURE PROLENE 5.0 8686H",6004211,"CDM ",272,RC,,,OUTPATIENT,,,7.12,5.696,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.7,80,,4.56,,,0,"percent of total billed charges ","80% of total billed charges ",4.98,70,,3.98,,,0,"percent of total billed charges ","70% of total billed charges ",6.41,90,,5.13,,,0,"percent of total billed charges ","90% of total billed charges ",6.62,93,,5.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6.05,85,,4.84,,,0,"percent of total billed charges ","85% of total billed charges ",6.41,90,,5.13,,,0,"percent of total billed charges ","90% of total billed charges ",6.41,90,,5.13,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.19,87,,4.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.98,70,,3.98,,,0,"percent of total billed charges ","70% of total billed charges ",4.98,6.62,
"SUTURE PROLENE 5.0 8698H",6004212,"CDM ",272,RC,,,OUTPATIENT,,,26.93,21.544,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.54,80,,17.23,,,0,"percent of total billed charges ","80% of total billed charges ",18.85,70,,15.08,,,0,"percent of total billed charges ","70% of total billed charges ",24.24,90,,19.39,,,0,"percent of total billed charges ","90% of total billed charges ",25.04,93,,20.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",22.89,85,,18.31,,,0,"percent of total billed charges ","85% of total billed charges ",24.24,90,,19.39,,,0,"percent of total billed charges ","90% of total billed charges ",24.24,90,,19.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",23.43,87,,18.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.85,70,,15.08,,,0,"percent of total billed charges ","70% of total billed charges ",18.85,25.04,
"PICC STATLOCK PLUS DEVICE",6004217,"CDM ",272,RC,,,OUTPATIENT,,,36.21,28.968,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.97,80,,23.18,,,0,"percent of total billed charges ","80% of total billed charges ",25.35,70,,20.28,,,0,"percent of total billed charges ","70% of total billed charges ",32.59,90,,26.07,,,0,"percent of total billed charges ","90% of total billed charges ",33.68,93,,26.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",30.78,85,,24.62,,,0,"percent of total billed charges ","85% of total billed charges ",32.59,90,,26.07,,,0,"percent of total billed charges ","90% of total billed charges ",32.59,90,,26.07,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",31.5,87,,25.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.35,70,,20.28,,,0,"percent of total billed charges ","70% of total billed charges ",25.35,33.68,
"NEEDLE EZ IO ADULT",6004218,"CDM ",272,RC,,,OUTPATIENT,,,294.37,235.496,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",235.5,80,,188.40,,,0,"percent of total billed charges ","80% of total billed charges ",206.06,70,,164.85,,,0,"percent of total billed charges ","70% of total billed charges ",264.93,90,,211.94,,,0,"percent of total billed charges ","90% of total billed charges ",273.76,93,,219.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",250.21,85,,200.17,,,0,"percent of total billed charges ","85% of total billed charges ",264.93,90,,211.94,,,0,"percent of total billed charges ","90% of total billed charges ",264.93,90,,211.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",256.1,87,,204.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",206.06,70,,164.85,,,0,"percent of total billed charges ","70% of total billed charges ",206.06,273.76,
"NEEDLE EZ IO PEDIATRIC",6004220,"CDM ",272,RC,,,OUTPATIENT,,,294.37,235.496,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",235.5,80,,188.40,,,0,"percent of total billed charges ","80% of total billed charges ",206.06,70,,164.85,,,0,"percent of total billed charges ","70% of total billed charges ",264.93,90,,211.94,,,0,"percent of total billed charges ","90% of total billed charges ",273.76,93,,219.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",250.21,85,,200.17,,,0,"percent of total billed charges ","85% of total billed charges ",264.93,90,,211.94,,,0,"percent of total billed charges ","90% of total billed charges ",264.93,90,,211.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",256.1,87,,204.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",206.06,70,,164.85,,,0,"percent of total billed charges ","70% of total billed charges ",206.06,273.76,
"NEEDLE BIOPSY SZ 5X21 GA",6004246,"CDM ",621,RC,,,OUTPATIENT,,,168.91,135.128,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.13,80,,108.10,,,0,"percent of total billed charges ","80% of total billed charges ",118.24,70,,94.59,,,0,"percent of total billed charges ","70% of total billed charges ",152.02,90,,121.62,,,0,"percent of total billed charges ","90% of total billed charges ",157.09,93,,125.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",143.57,85,,114.86,,,0,"percent of total billed charges ","85% of total billed charges ",152.02,90,,121.62,,,0,"percent of total billed charges ","90% of total billed charges ",152.02,90,,121.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",146.95,87,,117.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.24,70,,94.59,,,0,"percent of total billed charges ","70% of total billed charges ",118.24,157.09,
"LEAD PACING UNIPOLAR PED 525MM",6004285,"CDM ",278,RC,,,OUTPATIENT,,,64.81,51.848,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.85,80,,41.48,,,0,"percent of total billed charges ","80% of total billed charges ",45.37,70,,36.30,,,0,"percent of total billed charges ","70% of total billed charges ",58.33,90,,46.66,,,0,"percent of total billed charges ","90% of total billed charges ",60.27,93,,48.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",55.09,85,,44.07,,,0,"percent of total billed charges ","85% of total billed charges ",55.09,85,,44.07,,,0,"percent of total billed charges ","85% of total billed charges ",58.33,90,,46.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",56.38,87,,45.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.37,70,,36.30,,,0,"percent of total billed charges ","70% of total billed charges ",45.37,60.27,
"ELECTRODE SMART TRACE",6004300,"CDM ",272,RC,,,OUTPATIENT,,,18.5,14.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.8,80,,11.84,,,0,"percent of total billed charges ","80% of total billed charges ",12.95,70,,10.36,,,0,"percent of total billed charges ","70% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",17.21,93,,13.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.73,85,,12.58,,,0,"percent of total billed charges ","85% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.1,87,,12.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.95,70,,10.36,,,0,"percent of total billed charges ","70% of total billed charges ",12.95,17.21,
"SENSOR FINGER DISP",6004301,"CDM ",272,RC,,,OUTPATIENT,,,67,53.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.6,80,,42.88,,,0,"percent of total billed charges ","80% of total billed charges ",46.9,70,,37.52,,,0,"percent of total billed charges ","70% of total billed charges ",60.3,90,,48.24,,,0,"percent of total billed charges ","90% of total billed charges ",62.31,93,,49.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",56.95,85,,45.56,,,0,"percent of total billed charges ","85% of total billed charges ",60.3,90,,48.24,,,0,"percent of total billed charges ","90% of total billed charges ",60.3,90,,48.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",58.29,87,,46.63,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.9,70,,37.52,,,0,"percent of total billed charges ","70% of total billed charges ",46.9,62.31,
"BOTTLE PLEURX VACUUM 1000ML",6004324,"CDM ",272,RC,,,OUTPATIENT,,,164.47,131.576,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.58,80,,105.26,,,0,"percent of total billed charges ","80% of total billed charges ",115.13,70,,92.10,,,0,"percent of total billed charges ","70% of total billed charges ",148.02,90,,118.42,,,0,"percent of total billed charges ","90% of total billed charges ",152.96,93,,122.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",139.8,85,,111.84,,,0,"percent of total billed charges ","85% of total billed charges ",148.02,90,,118.42,,,0,"percent of total billed charges ","90% of total billed charges ",148.02,90,,118.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",143.09,87,,114.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.13,70,,92.10,,,0,"percent of total billed charges ","70% of total billed charges ",115.13,152.96,
"CLAMP CORD STERILE",6004375,"CDM ",272,RC,,,OUTPATIENT,,,5.48,4.384,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.38,80,,3.50,,,0,"percent of total billed charges ","80% of total billed charges ",3.84,70,,3.07,,,0,"percent of total billed charges ","70% of total billed charges ",4.93,90,,3.94,,,0,"percent of total billed charges ","90% of total billed charges ",5.1,93,,4.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4.66,85,,3.73,,,0,"percent of total billed charges ","85% of total billed charges ",4.93,90,,3.94,,,0,"percent of total billed charges ","90% of total billed charges ",4.93,90,,3.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4.77,87,,3.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.84,70,,3.07,,,0,"percent of total billed charges ","70% of total billed charges ",3.84,5.1,
"DRAIN THAL-QUICK ABCESS 20 FR",6004378,"CDM ",272,RC,,,OUTPATIENT,,,282.35,225.88,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",225.88,80,,180.70,,,0,"percent of total billed charges ","80% of total billed charges ",197.65,70,,158.12,,,0,"percent of total billed charges ","70% of total billed charges ",254.12,90,,203.30,,,0,"percent of total billed charges ","90% of total billed charges ",262.59,93,,210.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",240,85,,192.00,,,0,"percent of total billed charges ","85% of total billed charges ",254.12,90,,203.30,,,0,"percent of total billed charges ","90% of total billed charges ",254.12,90,,203.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",245.64,87,,196.51,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",197.65,70,,158.12,,,0,"percent of total billed charges ","70% of total billed charges ",197.65,262.59,
"SPLINT ULNAR DEVIATION LT SM",6004392,"CDM ",272,RC,,,OUTPATIENT,,,119.79,95.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.83,80,,76.66,,,0,"percent of total billed charges ","80% of total billed charges ",83.85,70,,67.08,,,0,"percent of total billed charges ","70% of total billed charges ",107.81,90,,86.25,,,0,"percent of total billed charges ","90% of total billed charges ",111.4,93,,89.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",101.82,85,,81.46,,,0,"percent of total billed charges ","85% of total billed charges ",107.81,90,,86.25,,,0,"percent of total billed charges ","90% of total billed charges ",107.81,90,,86.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",104.22,87,,83.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.85,70,,67.08,,,0,"percent of total billed charges ","70% of total billed charges ",83.85,111.4,
"SPLINT ULNAR DEVIATION LT MED",6004393,"CDM ",272,RC,,,OUTPATIENT,,,119.79,95.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.83,80,,76.66,,,0,"percent of total billed charges ","80% of total billed charges ",83.85,70,,67.08,,,0,"percent of total billed charges ","70% of total billed charges ",107.81,90,,86.25,,,0,"percent of total billed charges ","90% of total billed charges ",111.4,93,,89.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",101.82,85,,81.46,,,0,"percent of total billed charges ","85% of total billed charges ",107.81,90,,86.25,,,0,"percent of total billed charges ","90% of total billed charges ",107.81,90,,86.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",104.22,87,,83.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.85,70,,67.08,,,0,"percent of total billed charges ","70% of total billed charges ",83.85,111.4,
"SPLINT ULNAR DEVIATION LT LG",6004394,"CDM ",272,RC,,,OUTPATIENT,,,119.79,95.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.83,80,,76.66,,,0,"percent of total billed charges ","80% of total billed charges ",83.85,70,,67.08,,,0,"percent of total billed charges ","70% of total billed charges ",107.81,90,,86.25,,,0,"percent of total billed charges ","90% of total billed charges ",111.4,93,,89.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",101.82,85,,81.46,,,0,"percent of total billed charges ","85% of total billed charges ",107.81,90,,86.25,,,0,"percent of total billed charges ","90% of total billed charges ",107.81,90,,86.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",104.22,87,,83.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.85,70,,67.08,,,0,"percent of total billed charges ","70% of total billed charges ",83.85,111.4,
"SPLINT ULNAR DEVIATION RT LG",6004395,"CDM ",272,RC,,,OUTPATIENT,,,119.79,95.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.83,80,,76.66,,,0,"percent of total billed charges ","80% of total billed charges ",83.85,70,,67.08,,,0,"percent of total billed charges ","70% of total billed charges ",107.81,90,,86.25,,,0,"percent of total billed charges ","90% of total billed charges ",111.4,93,,89.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",101.82,85,,81.46,,,0,"percent of total billed charges ","85% of total billed charges ",107.81,90,,86.25,,,0,"percent of total billed charges ","90% of total billed charges ",107.81,90,,86.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",104.22,87,,83.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.85,70,,67.08,,,0,"percent of total billed charges ","70% of total billed charges ",83.85,111.4,
"EXCHANGER HUMID-FLO GIBEK",6004427,"CDM ",272,RC,,,OUTPATIENT,,,19.46,15.568,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.57,80,,12.46,,,0,"percent of total billed charges ","80% of total billed charges ",13.62,70,,10.90,,,0,"percent of total billed charges ","70% of total billed charges ",17.51,90,,14.01,,,0,"percent of total billed charges ","90% of total billed charges ",18.1,93,,14.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.54,85,,13.23,,,0,"percent of total billed charges ","85% of total billed charges ",17.51,90,,14.01,,,0,"percent of total billed charges ","90% of total billed charges ",17.51,90,,14.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.93,87,,13.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.62,70,,10.90,,,0,"percent of total billed charges ","70% of total billed charges ",13.62,18.1,
"MASK NEBU SYSTEM ADULT",6004429,"CDM ",270,RC,,,OUTPATIENT,,,47.12,37.696,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.7,80,,30.16,,,0,"percent of total billed charges ","80% of total billed charges ",32.98,70,,26.38,,,0,"percent of total billed charges ","70% of total billed charges ",42.41,90,,33.93,,,0,"percent of total billed charges ","90% of total billed charges ",43.82,93,,35.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.05,85,,32.04,,,0,"percent of total billed charges ","85% of total billed charges ",42.41,90,,33.93,,,0,"percent of total billed charges ","90% of total billed charges ",42.41,90,,33.93,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.99,87,,32.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.98,70,,26.38,,,0,"percent of total billed charges ","70% of total billed charges ",32.98,43.82,
"MASK NEBU SYSTEM PEDIATRIC",6004430,"CDM ",270,RC,,,OUTPATIENT,,,84.37,67.496,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.5,80,,54.00,,,0,"percent of total billed charges ","80% of total billed charges ",59.06,70,,47.25,,,0,"percent of total billed charges ","70% of total billed charges ",75.93,90,,60.74,,,0,"percent of total billed charges ","90% of total billed charges ",78.46,93,,62.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",71.71,85,,57.37,,,0,"percent of total billed charges ","85% of total billed charges ",75.93,90,,60.74,,,0,"percent of total billed charges ","90% of total billed charges ",75.93,90,,60.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",73.4,87,,58.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.06,70,,47.25,,,0,"percent of total billed charges ","70% of total billed charges ",59.06,78.46,
"DRSG ABD WOUND VAC LARGE",6004463,"CDM ",272,RC,,,OUTPATIENT,,,703.91,563.128,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",563.13,80,,450.50,,,0,"percent of total billed charges ","80% of total billed charges ",492.74,70,,394.19,,,0,"percent of total billed charges ","70% of total billed charges ",633.52,90,,506.82,,,0,"percent of total billed charges ","90% of total billed charges ",654.64,93,,523.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",598.32,85,,478.66,,,0,"percent of total billed charges ","85% of total billed charges ",633.52,90,,506.82,,,0,"percent of total billed charges ","90% of total billed charges ",633.52,90,,506.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",612.4,87,,489.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",492.74,70,,394.19,,,0,"percent of total billed charges ","70% of total billed charges ",492.74,654.64,
"DRSG GRANUFOAM BRIDGE",6004470,"CDM ",272,RC,,,OUTPATIENT,,,192.34,153.872,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.87,80,,123.10,,,0,"percent of total billed charges ","80% of total billed charges ",134.64,70,,107.71,,,0,"percent of total billed charges ","70% of total billed charges ",173.11,90,,138.49,,,0,"percent of total billed charges ","90% of total billed charges ",178.88,93,,143.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",163.49,85,,130.79,,,0,"percent of total billed charges ","85% of total billed charges ",173.11,90,,138.49,,,0,"percent of total billed charges ","90% of total billed charges ",173.11,90,,138.49,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",167.34,87,,133.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",134.64,70,,107.71,,,0,"percent of total billed charges ","70% of total billed charges ",134.64,178.88,
"BOOT UNA 4X10YD W/CALAMINE",6004490,"CDM ",272,RC,,,OUTPATIENT,,,20.76,16.608,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.61,80,,13.29,,,0,"percent of total billed charges ","80% of total billed charges ",14.53,70,,11.62,,,0,"percent of total billed charges ","70% of total billed charges ",18.68,90,,14.94,,,0,"percent of total billed charges ","90% of total billed charges ",19.31,93,,15.45,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.65,85,,14.12,,,0,"percent of total billed charges ","85% of total billed charges ",18.68,90,,14.94,,,0,"percent of total billed charges ","90% of total billed charges ",18.68,90,,14.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.06,87,,14.45,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.53,70,,11.62,,,0,"percent of total billed charges ","70% of total billed charges ",14.53,19.31,
"BOOT UNA 4X10YD W/CALAMINE",6004490,"CDM ",272,RC,,,OUTPATIENT,,,20.76,16.608,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.61,80,,13.29,,,0,"percent of total billed charges ","80% of total billed charges ",14.53,70,,11.62,,,0,"percent of total billed charges ","70% of total billed charges ",18.68,90,,14.94,,,0,"percent of total billed charges ","90% of total billed charges ",19.31,93,,15.45,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.65,85,,14.12,,,0,"percent of total billed charges ","85% of total billed charges ",18.68,90,,14.94,,,0,"percent of total billed charges ","90% of total billed charges ",18.68,90,,14.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.06,87,,14.45,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.53,70,,11.62,,,0,"percent of total billed charges ","70% of total billed charges ",14.53,19.31,
"SET TRANSFER SWABBABLE VALVE",6004491,"CDM ",272,RC,,,OUTPATIENT,,,17.5,14,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14,80,,11.20,,,0,"percent of total billed charges ","80% of total billed charges ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",16.28,93,,13.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.88,85,,11.90,,,0,"percent of total billed charges ","85% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.23,87,,12.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",12.25,16.28,
"PROTECTOR HEEL AIR BOOT",6004494,"CDM ",272,RC,,,OUTPATIENT,,,119.35,95.48,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.48,80,,76.38,,,0,"percent of total billed charges ","80% of total billed charges ",83.55,70,,66.84,,,0,"percent of total billed charges ","70% of total billed charges ",107.42,90,,85.94,,,0,"percent of total billed charges ","90% of total billed charges ",111,93,,88.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",101.45,85,,81.16,,,0,"percent of total billed charges ","85% of total billed charges ",107.42,90,,85.94,,,0,"percent of total billed charges ","90% of total billed charges ",107.42,90,,85.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",103.83,87,,83.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.55,70,,66.84,,,0,"percent of total billed charges ","70% of total billed charges ",83.55,111,
"MASK MIRAGE QUATTRO LARGE",6004540,"CDM ",270,RC,,,OUTPATIENT,,,312.48,249.984,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",249.98,80,,199.98,,,0,"percent of total billed charges ","80% of total billed charges ",218.74,70,,174.99,,,0,"percent of total billed charges ","70% of total billed charges ",281.23,90,,224.98,,,0,"percent of total billed charges ","90% of total billed charges ",290.61,93,,232.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",265.61,85,,212.49,,,0,"percent of total billed charges ","85% of total billed charges ",281.23,90,,224.98,,,0,"percent of total billed charges ","90% of total billed charges ",281.23,90,,224.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",271.86,87,,217.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",218.74,70,,174.99,,,0,"percent of total billed charges ","70% of total billed charges ",218.74,290.61,
"MASK MIRAGE QUATTRO MEDIUM",6004542,"CDM ",270,RC,,,OUTPATIENT,,,312.48,249.984,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",249.98,80,,199.98,,,0,"percent of total billed charges ","80% of total billed charges ",218.74,70,,174.99,,,0,"percent of total billed charges ","70% of total billed charges ",281.23,90,,224.98,,,0,"percent of total billed charges ","90% of total billed charges ",290.61,93,,232.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",265.61,85,,212.49,,,0,"percent of total billed charges ","85% of total billed charges ",281.23,90,,224.98,,,0,"percent of total billed charges ","90% of total billed charges ",281.23,90,,224.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",271.86,87,,217.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",218.74,70,,174.99,,,0,"percent of total billed charges ","70% of total billed charges ",218.74,290.61,
"DRESSING VAC WHITE FOAM LG",6004554,"CDM ",272,RC,,,OUTPATIENT,,,48.5,38.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.8,80,,31.04,,,0,"percent of total billed charges ","80% of total billed charges ",33.95,70,,27.16,,,0,"percent of total billed charges ","70% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",45.11,93,,36.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.23,85,,32.98,,,0,"percent of total billed charges ","85% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.2,87,,33.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.95,70,,27.16,,,0,"percent of total billed charges ","70% of total billed charges ",33.95,45.11,
"TEGADERM ABSORBENT 5.7"" X 7.7""",6004555,"CDM ",272,RC,,,OUTPATIENT,,,28.99,23.192,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.19,80,,18.55,,,0,"percent of total billed charges ","80% of total billed charges ",20.29,70,,16.23,,,0,"percent of total billed charges ","70% of total billed charges ",26.09,90,,20.87,,,0,"percent of total billed charges ","90% of total billed charges ",26.96,93,,21.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",24.64,85,,19.71,,,0,"percent of total billed charges ","85% of total billed charges ",26.09,90,,20.87,,,0,"percent of total billed charges ","90% of total billed charges ",26.09,90,,20.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",25.22,87,,20.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.29,70,,16.23,,,0,"percent of total billed charges ","70% of total billed charges ",20.29,26.96,
"CANNULA NUCLEUS 30GA (EYE)",6004582,"CDM ",272,RC,,,OUTPATIENT,,,30.09,24.072,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.07,80,,19.26,,,0,"percent of total billed charges ","80% of total billed charges ",21.06,70,,16.85,,,0,"percent of total billed charges ","70% of total billed charges ",27.08,90,,21.66,,,0,"percent of total billed charges ","90% of total billed charges ",27.98,93,,22.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.58,85,,20.46,,,0,"percent of total billed charges ","85% of total billed charges ",27.08,90,,21.66,,,0,"percent of total billed charges ","90% of total billed charges ",27.08,90,,21.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.18,87,,20.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.06,70,,16.85,,,0,"percent of total billed charges ","70% of total billed charges ",21.06,27.98,
"CATH FOLEY 3 WAY 20FR",6004629,"CDM ",272,RC,,,OUTPATIENT,,,72,57.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.6,80,,46.08,,,0,"percent of total billed charges ","80% of total billed charges ",50.4,70,,40.32,,,0,"percent of total billed charges ","70% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",66.96,93,,53.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",61.2,85,,48.96,,,0,"percent of total billed charges ","85% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",62.64,87,,50.11,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.4,70,,40.32,,,0,"percent of total billed charges ","70% of total billed charges ",50.4,66.96,
"KIT PARACENTESIS LG VOLUME",6004641,"CDM ",272,RC,,,OUTPATIENT,,,272.99,218.392,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",218.39,80,,174.71,,,0,"percent of total billed charges ","80% of total billed charges ",191.09,70,,152.87,,,0,"percent of total billed charges ","70% of total billed charges ",245.69,90,,196.55,,,0,"percent of total billed charges ","90% of total billed charges ",253.88,93,,203.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",232.04,85,,185.63,,,0,"percent of total billed charges ","85% of total billed charges ",245.69,90,,196.55,,,0,"percent of total billed charges ","90% of total billed charges ",245.69,90,,196.55,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",237.5,87,,190.00,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",191.09,70,,152.87,,,0,"percent of total billed charges ","70% of total billed charges ",191.09,253.88,
"PERCUSSOR PALMCUPS MED 60MM",6004644,"CDM ",272,RC,,,OUTPATIENT,,,19.61,15.688,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.69,80,,12.55,,,0,"percent of total billed charges ","80% of total billed charges ",13.73,70,,10.98,,,0,"percent of total billed charges ","70% of total billed charges ",17.65,90,,14.12,,,0,"percent of total billed charges ","90% of total billed charges ",18.24,93,,14.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.67,85,,13.34,,,0,"percent of total billed charges ","85% of total billed charges ",17.65,90,,14.12,,,0,"percent of total billed charges ","90% of total billed charges ",17.65,90,,14.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.06,87,,13.65,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.73,70,,10.98,,,0,"percent of total billed charges ","70% of total billed charges ",13.73,18.24,
"BRIDGE OSTOMY LOOP",6004673,"CDM ",272,RC,,,OUTPATIENT,,,6.87,5.496,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.5,80,,4.40,,,0,"percent of total billed charges ","80% of total billed charges ",4.81,70,,3.85,,,0,"percent of total billed charges ","70% of total billed charges ",6.18,90,,4.94,,,0,"percent of total billed charges ","90% of total billed charges ",6.39,93,,5.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.84,85,,4.67,,,0,"percent of total billed charges ","85% of total billed charges ",6.18,90,,4.94,,,0,"percent of total billed charges ","90% of total billed charges ",6.18,90,,4.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5.98,87,,4.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.81,70,,3.85,,,0,"percent of total billed charges ","70% of total billed charges ",4.81,6.39,
"INSTRUMENT DISP BIOPSY",6004677,"CDM ",272,RC,,,OUTPATIENT,,,131,104.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.8,80,,83.84,,,0,"percent of total billed charges ","80% of total billed charges ",91.7,70,,73.36,,,0,"percent of total billed charges ","70% of total billed charges ",117.9,90,,94.32,,,0,"percent of total billed charges ","90% of total billed charges ",121.83,93,,97.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",111.35,85,,89.08,,,0,"percent of total billed charges ","85% of total billed charges ",117.9,90,,94.32,,,0,"percent of total billed charges ","90% of total billed charges ",117.9,90,,94.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",113.97,87,,91.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.7,70,,73.36,,,0,"percent of total billed charges ","70% of total billed charges ",91.7,121.83,
"NEEDLE TRUGUIDE 19G X 13.8CM",6004678,"CDM ",272,RC,,,OUTPATIENT,,,67.25,53.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.8,80,,43.04,,,0,"percent of total billed charges ","80% of total billed charges ",47.08,70,,37.66,,,0,"percent of total billed charges ","70% of total billed charges ",60.53,90,,48.42,,,0,"percent of total billed charges ","90% of total billed charges ",62.54,93,,50.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",57.16,85,,45.73,,,0,"percent of total billed charges ","85% of total billed charges ",60.53,90,,48.42,,,0,"percent of total billed charges ","90% of total billed charges ",60.53,90,,48.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",58.51,87,,46.81,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.08,70,,37.66,,,0,"percent of total billed charges ","70% of total billed charges ",47.08,62.54,
"ARMBOARD CHILD 2.75X6.5 LG",6004681,"CDM ",271,RC,,,OUTPATIENT,,,21.56,17.248,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.25,80,,13.80,,,0,"percent of total billed charges ","80% of total billed charges ",15.09,70,,12.07,,,0,"percent of total billed charges ","70% of total billed charges ",19.4,90,,15.52,,,0,"percent of total billed charges ","90% of total billed charges ",20.05,93,,16.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.33,85,,14.66,,,0,"percent of total billed charges ","85% of total billed charges ",19.4,90,,15.52,,,0,"percent of total billed charges ","90% of total billed charges ",19.4,90,,15.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.76,87,,15.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.09,70,,12.07,,,0,"percent of total billed charges ","70% of total billed charges ",15.09,20.05,
"SOLUTION H2O IRRIG BTL 250ML",6004690,"CDM ",272,RC,,,OUTPATIENT,,,6.16,4.928,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.93,80,,3.94,,,0,"percent of total billed charges ","80% of total billed charges ",4.31,70,,3.45,,,0,"percent of total billed charges ","70% of total billed charges ",5.54,90,,4.43,,,0,"percent of total billed charges ","90% of total billed charges ",5.73,93,,4.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.24,85,,4.19,,,0,"percent of total billed charges ","85% of total billed charges ",5.54,90,,4.43,,,0,"percent of total billed charges ","90% of total billed charges ",5.54,90,,4.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5.36,87,,4.29,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.31,70,,3.45,,,0,"percent of total billed charges ","70% of total billed charges ",4.31,5.73,
"PRESSURE MONITORING KIT (OB)",6004698,"CDM ",272,RC,,,OUTPATIENT,,,82.77,66.216,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.22,80,,52.98,,,0,"percent of total billed charges ","80% of total billed charges ",57.94,70,,46.35,,,0,"percent of total billed charges ","70% of total billed charges ",74.49,90,,59.59,,,0,"percent of total billed charges ","90% of total billed charges ",76.98,93,,61.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.35,85,,56.28,,,0,"percent of total billed charges ","85% of total billed charges ",74.49,90,,59.59,,,0,"percent of total billed charges ","90% of total billed charges ",74.49,90,,59.59,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",72.01,87,,57.61,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.94,70,,46.35,,,0,"percent of total billed charges ","70% of total billed charges ",57.94,76.98,
"NEEDLE BIOPSY 18*16",6004701,"CDM ",272,RC,,,OUTPATIENT,,,126.64,101.312,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.31,80,,81.05,,,0,"percent of total billed charges ","80% of total billed charges ",88.65,70,,70.92,,,0,"percent of total billed charges ","70% of total billed charges ",113.98,90,,91.18,,,0,"percent of total billed charges ","90% of total billed charges ",117.78,93,,94.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",107.64,85,,86.11,,,0,"percent of total billed charges ","85% of total billed charges ",113.98,90,,91.18,,,0,"percent of total billed charges ","90% of total billed charges ",113.98,90,,91.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",110.18,87,,88.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.65,70,,70.92,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,117.78,
"CATH UMBILICAL VESSEL 5.0FR",6004712,"CDM ",272,RC,,,OUTPATIENT,,,48.49,38.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.79,80,,31.03,,,0,"percent of total billed charges ","80% of total billed charges ",33.94,70,,27.15,,,0,"percent of total billed charges ","70% of total billed charges ",43.64,90,,34.91,,,0,"percent of total billed charges ","90% of total billed charges ",45.1,93,,36.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.22,85,,32.98,,,0,"percent of total billed charges ","85% of total billed charges ",43.64,90,,34.91,,,0,"percent of total billed charges ","90% of total billed charges ",43.64,90,,34.91,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.19,87,,33.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.94,70,,27.15,,,0,"percent of total billed charges ","70% of total billed charges ",33.94,45.1,
"STAPLER SKIN INSORB",6004717,"CDM ",272,RC,,,OUTPATIENT,,,196.56,157.248,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.25,80,,125.80,,,0,"percent of total billed charges ","80% of total billed charges ",137.59,70,,110.07,,,0,"percent of total billed charges ","70% of total billed charges ",176.9,90,,141.52,,,0,"percent of total billed charges ","90% of total billed charges ",182.8,93,,146.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",167.08,85,,133.66,,,0,"percent of total billed charges ","85% of total billed charges ",176.9,90,,141.52,,,0,"percent of total billed charges ","90% of total billed charges ",176.9,90,,141.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",171.01,87,,136.81,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",137.59,70,,110.07,,,0,"percent of total billed charges ","70% of total billed charges ",137.59,182.8,
"SPLINT ULNAR RT MED",6004756,"CDM ",271,RC,,,OUTPATIENT,,,119.79,95.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.83,80,,76.66,,,0,"percent of total billed charges ","80% of total billed charges ",83.85,70,,67.08,,,0,"percent of total billed charges ","70% of total billed charges ",107.81,90,,86.25,,,0,"percent of total billed charges ","90% of total billed charges ",111.4,93,,89.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",101.82,85,,81.46,,,0,"percent of total billed charges ","85% of total billed charges ",107.81,90,,86.25,,,0,"percent of total billed charges ","90% of total billed charges ",107.81,90,,86.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",104.22,87,,83.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.85,70,,67.08,,,0,"percent of total billed charges ","70% of total billed charges ",83.85,111.4,
"CATH HSG 5FR",6004759,"CDM ",272,RC,,,OUTPATIENT,,,106.68,85.344,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.34,80,,68.27,,,0,"percent of total billed charges ","80% of total billed charges ",74.68,70,,59.74,,,0,"percent of total billed charges ","70% of total billed charges ",96.01,90,,76.81,,,0,"percent of total billed charges ","90% of total billed charges ",99.21,93,,79.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",90.68,85,,72.54,,,0,"percent of total billed charges ","85% of total billed charges ",96.01,90,,76.81,,,0,"percent of total billed charges ","90% of total billed charges ",96.01,90,,76.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",92.81,87,,74.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.68,70,,59.74,,,0,"percent of total billed charges ","70% of total billed charges ",74.68,99.21,
"SPLINT ULNAR RT SM",6004762,"CDM ",271,RC,,,OUTPATIENT,,,119.79,95.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.83,80,,76.66,,,0,"percent of total billed charges ","80% of total billed charges ",83.85,70,,67.08,,,0,"percent of total billed charges ","70% of total billed charges ",107.81,90,,86.25,,,0,"percent of total billed charges ","90% of total billed charges ",111.4,93,,89.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",101.82,85,,81.46,,,0,"percent of total billed charges ","85% of total billed charges ",107.81,90,,86.25,,,0,"percent of total billed charges ","90% of total billed charges ",107.81,90,,86.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",104.22,87,,83.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.85,70,,67.08,,,0,"percent of total billed charges ","70% of total billed charges ",83.85,111.4,
"BREAST PUMP ACCESSORIES",6004776,"CDM ",272,RC,,,OUTPATIENT,,,133.26,106.608,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.61,80,,85.29,,,0,"percent of total billed charges ","80% of total billed charges ",93.28,70,,74.62,,,0,"percent of total billed charges ","70% of total billed charges ",119.93,90,,95.94,,,0,"percent of total billed charges ","90% of total billed charges ",123.93,93,,99.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",113.27,85,,90.62,,,0,"percent of total billed charges ","85% of total billed charges ",119.93,90,,95.94,,,0,"percent of total billed charges ","90% of total billed charges ",119.93,90,,95.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",115.94,87,,92.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.28,70,,74.62,,,0,"percent of total billed charges ","70% of total billed charges ",93.28,123.93,
"BRUSH EVACUATOR",6004777,"CDM ",272,RC,,,OUTPATIENT,,,21.01,16.808,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.81,80,,13.45,,,0,"percent of total billed charges ","80% of total billed charges ",14.71,70,,11.77,,,0,"percent of total billed charges ","70% of total billed charges ",18.91,90,,15.13,,,0,"percent of total billed charges ","90% of total billed charges ",19.54,93,,15.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.86,85,,14.29,,,0,"percent of total billed charges ","85% of total billed charges ",18.91,90,,15.13,,,0,"percent of total billed charges ","90% of total billed charges ",18.91,90,,15.13,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.28,87,,14.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.71,70,,11.77,,,0,"percent of total billed charges ","70% of total billed charges ",14.71,19.54,
"ELECTRODES PELLET",6004788,"CDM ",272,RC,,,OUTPATIENT,,,3.5,2.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.8,80,,2.24,,,0,"percent of total billed charges ","80% of total billed charges ",2.45,70,,1.96,,,0,"percent of total billed charges ","70% of total billed charges ",3.15,90,,2.52,,,0,"percent of total billed charges ","90% of total billed charges ",3.26,93,,2.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2.98,85,,2.38,,,0,"percent of total billed charges ","85% of total billed charges ",3.15,90,,2.52,,,0,"percent of total billed charges ","90% of total billed charges ",3.15,90,,2.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3.05,87,,2.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.45,70,,1.96,,,0,"percent of total billed charges ","70% of total billed charges ",2.45,3.26,
"TRAY WOUND/LACERATION",6004792,"CDM ",272,RC,,,OUTPATIENT,,,13.99,11.192,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.19,80,,8.95,,,0,"percent of total billed charges ","80% of total billed charges ",9.79,70,,7.83,,,0,"percent of total billed charges ","70% of total billed charges ",12.59,90,,10.07,,,0,"percent of total billed charges ","90% of total billed charges ",13.01,93,,10.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.89,85,,9.51,,,0,"percent of total billed charges ","85% of total billed charges ",12.59,90,,10.07,,,0,"percent of total billed charges ","90% of total billed charges ",12.59,90,,10.07,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.17,87,,9.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.79,70,,7.83,,,0,"percent of total billed charges ","70% of total billed charges ",9.79,13.01,
"ADAPTOR HAND SWITCHING DISP",6004816,"CDM ",272,RC,,,OUTPATIENT,,,201.54,161.232,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",161.23,80,,128.98,,,0,"percent of total billed charges ","80% of total billed charges ",141.08,70,,112.86,,,0,"percent of total billed charges ","70% of total billed charges ",181.39,90,,145.11,,,0,"percent of total billed charges ","90% of total billed charges ",187.43,93,,149.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",171.31,85,,137.05,,,0,"percent of total billed charges ","85% of total billed charges ",181.39,90,,145.11,,,0,"percent of total billed charges ","90% of total billed charges ",181.39,90,,145.11,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",175.34,87,,140.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.08,70,,112.86,,,0,"percent of total billed charges ","70% of total billed charges ",141.08,187.43,
"GRAFT SURGISIS 13CM X 22CM",6004843,"CDM ",278,RC,,,OUTPATIENT,,,5917.5,4734,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4734,80,,3787.20,,,0,"percent of total billed charges ","80% of total billed charges ",4142.25,70,,3313.80,,,0,"percent of total billed charges ","70% of total billed charges ",5325.75,90,,4260.60,,,0,"percent of total billed charges ","90% of total billed charges ",5503.28,93,,4402.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5029.88,85,,4023.90,,,0,"percent of total billed charges ","85% of total billed charges ",5029.88,85,,4023.90,,,0,"percent of total billed charges ","85% of total billed charges ",5325.75,90,,4260.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5148.23,87,,4118.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4142.25,70,,3313.80,,,0,"percent of total billed charges ","70% of total billed charges ",4142.25,5503.28,
"DRESSING TRANSPARENT DECUBITUS",6004846,"CDM ",272,RC,,,OUTPATIENT,,,10.58,8.464,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.46,80,,6.77,,,0,"percent of total billed charges ","80% of total billed charges ",7.41,70,,5.93,,,0,"percent of total billed charges ","70% of total billed charges ",9.52,90,,7.62,,,0,"percent of total billed charges ","90% of total billed charges ",9.84,93,,7.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.99,85,,7.19,,,0,"percent of total billed charges ","85% of total billed charges ",9.52,90,,7.62,,,0,"percent of total billed charges ","90% of total billed charges ",9.52,90,,7.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.2,87,,7.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.41,70,,5.93,,,0,"percent of total billed charges ","70% of total billed charges ",7.41,9.84,
"TUBE JEJUNAL FEED 18FR 2.5CM",6004885,"CDM ",270,RC,,,OUTPATIENT,,,356.39,285.112,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",285.11,80,,228.09,,,0,"percent of total billed charges ","80% of total billed charges ",249.47,70,,199.58,,,0,"percent of total billed charges ","70% of total billed charges ",320.75,90,,256.60,,,0,"percent of total billed charges ","90% of total billed charges ",331.44,93,,265.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",302.93,85,,242.34,,,0,"percent of total billed charges ","85% of total billed charges ",320.75,90,,256.60,,,0,"percent of total billed charges ","90% of total billed charges ",320.75,90,,256.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",310.06,87,,248.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",249.47,70,,199.58,,,0,"percent of total billed charges ","70% of total billed charges ",249.47,331.44,
"TUBE JEJUNAL FEED 18FR 3.5 CM",6004888,"CDM ",270,RC,,,OUTPATIENT,,,358.55,286.84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",286.84,80,,229.47,,,0,"percent of total billed charges ","80% of total billed charges ",250.99,70,,200.79,,,0,"percent of total billed charges ","70% of total billed charges ",322.7,90,,258.16,,,0,"percent of total billed charges ","90% of total billed charges ",333.45,93,,266.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",304.77,85,,243.82,,,0,"percent of total billed charges ","85% of total billed charges ",322.7,90,,258.16,,,0,"percent of total billed charges ","90% of total billed charges ",322.7,90,,258.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",311.94,87,,249.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",250.99,70,,200.79,,,0,"percent of total billed charges ","70% of total billed charges ",250.99,333.45,
"TUBE JEJUNAL FEED 18FR 4.5CM",6004890,"CDM ",270,RC,,,OUTPATIENT,,,357.19,285.752,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",285.75,80,,228.60,,,0,"percent of total billed charges ","80% of total billed charges ",250.03,70,,200.02,,,0,"percent of total billed charges ","70% of total billed charges ",321.47,90,,257.18,,,0,"percent of total billed charges ","90% of total billed charges ",332.19,93,,265.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",303.61,85,,242.89,,,0,"percent of total billed charges ","85% of total billed charges ",321.47,90,,257.18,,,0,"percent of total billed charges ","90% of total billed charges ",321.47,90,,257.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",310.76,87,,248.61,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",250.03,70,,200.02,,,0,"percent of total billed charges ","70% of total billed charges ",250.03,332.19,
"OINTMENT ALOE VESTA 8 OZ",6004901,"CDM ",272,RC,,,OUTPATIENT,,,26.13,20.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.9,80,,16.72,,,0,"percent of total billed charges ","80% of total billed charges ",18.29,70,,14.63,,,0,"percent of total billed charges ","70% of total billed charges ",23.52,90,,18.82,,,0,"percent of total billed charges ","90% of total billed charges ",24.3,93,,19.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",22.21,85,,17.77,,,0,"percent of total billed charges ","85% of total billed charges ",23.52,90,,18.82,,,0,"percent of total billed charges ","90% of total billed charges ",23.52,90,,18.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.73,87,,18.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.29,70,,14.63,,,0,"percent of total billed charges ","70% of total billed charges ",18.29,24.3,
"DECLOGGER FEED TUBE 18-24 FR",6004939,"CDM ",272,RC,,,OUTPATIENT,,,24.5,19.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.6,80,,15.68,,,0,"percent of total billed charges ","80% of total billed charges ",17.15,70,,13.72,,,0,"percent of total billed charges ","70% of total billed charges ",22.05,90,,17.64,,,0,"percent of total billed charges ","90% of total billed charges ",22.79,93,,18.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.83,85,,16.66,,,0,"percent of total billed charges ","85% of total billed charges ",22.05,90,,17.64,,,0,"percent of total billed charges ","90% of total billed charges ",22.05,90,,17.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.32,87,,17.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.15,70,,13.72,,,0,"percent of total billed charges ","70% of total billed charges ",17.15,22.79,
"CATH MALECOT 34FR",6004945,"CDM ",272,RC,,,OUTPATIENT,,,43.78,35.024,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.02,80,,28.02,,,0,"percent of total billed charges ","80% of total billed charges ",30.65,70,,24.52,,,0,"percent of total billed charges ","70% of total billed charges ",39.4,90,,31.52,,,0,"percent of total billed charges ","90% of total billed charges ",40.72,93,,32.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",37.21,85,,29.77,,,0,"percent of total billed charges ","85% of total billed charges ",39.4,90,,31.52,,,0,"percent of total billed charges ","90% of total billed charges ",39.4,90,,31.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",38.09,87,,30.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.65,70,,24.52,,,0,"percent of total billed charges ","70% of total billed charges ",30.65,40.72,
"HOLDER DRAIN BAG",6004960,"CDM ",272,RC,,,OUTPATIENT,,,64.14,51.312,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.31,80,,41.05,,,0,"percent of total billed charges ","80% of total billed charges ",44.9,70,,35.92,,,0,"percent of total billed charges ","70% of total billed charges ",57.73,90,,46.18,,,0,"percent of total billed charges ","90% of total billed charges ",59.65,93,,47.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",54.52,85,,43.62,,,0,"percent of total billed charges ","85% of total billed charges ",57.73,90,,46.18,,,0,"percent of total billed charges ","90% of total billed charges ",57.73,90,,46.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",55.8,87,,44.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.9,70,,35.92,,,0,"percent of total billed charges ","70% of total billed charges ",44.9,59.65,
"SET DECANTING",6004967,"CDM ",272,RC,,,OUTPATIENT,,,21.51,17.208,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.21,80,,13.77,,,0,"percent of total billed charges ","80% of total billed charges ",15.06,70,,12.05,,,0,"percent of total billed charges ","70% of total billed charges ",19.36,90,,15.49,,,0,"percent of total billed charges ","90% of total billed charges ",20,93,,16.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.28,85,,14.62,,,0,"percent of total billed charges ","85% of total billed charges ",19.36,90,,15.49,,,0,"percent of total billed charges ","90% of total billed charges ",19.36,90,,15.49,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.71,87,,14.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.06,70,,12.05,,,0,"percent of total billed charges ","70% of total billed charges ",15.06,20,
"SET CATHETERIZATION",6004972,"CDM ",272,RC,,,OUTPATIENT,,,51.43,41.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.14,80,,32.91,,,0,"percent of total billed charges ","80% of total billed charges ",36,70,,28.80,,,0,"percent of total billed charges ","70% of total billed charges ",46.29,90,,37.03,,,0,"percent of total billed charges ","90% of total billed charges ",47.83,93,,38.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.72,85,,34.98,,,0,"percent of total billed charges ","85% of total billed charges ",46.29,90,,37.03,,,0,"percent of total billed charges ","90% of total billed charges ",46.29,90,,37.03,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.74,87,,35.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36,70,,28.80,,,0,"percent of total billed charges ","70% of total billed charges ",36,47.83,
THERAPEP,6004975,"CDM ",272,RC,,,OUTPATIENT,,,91.74,73.392,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.39,80,,58.71,,,0,"percent of total billed charges ","80% of total billed charges ",64.22,70,,51.38,,,0,"percent of total billed charges ","70% of total billed charges ",82.57,90,,66.06,,,0,"percent of total billed charges ","90% of total billed charges ",85.32,93,,68.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",77.98,85,,62.38,,,0,"percent of total billed charges ","85% of total billed charges ",82.57,90,,66.06,,,0,"percent of total billed charges ","90% of total billed charges ",82.57,90,,66.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",79.81,87,,63.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.22,70,,51.38,,,0,"percent of total billed charges ","70% of total billed charges ",64.22,85.32,
"HOLDER THOMAS ET PEDIATRIC",6005021,"CDM ",270,RC,,,OUTPATIENT,,,17.55,14.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.04,80,,11.23,,,0,"percent of total billed charges ","80% of total billed charges ",12.29,70,,9.83,,,0,"percent of total billed charges ","70% of total billed charges ",15.8,90,,12.64,,,0,"percent of total billed charges ","90% of total billed charges ",16.32,93,,13.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.92,85,,11.94,,,0,"percent of total billed charges ","85% of total billed charges ",15.8,90,,12.64,,,0,"percent of total billed charges ","90% of total billed charges ",15.8,90,,12.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.27,87,,12.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.29,70,,9.83,,,0,"percent of total billed charges ","70% of total billed charges ",12.29,16.32,
"SET GEMSTAR IV (NEW)",6005050,"CDM ",272,RC,,,OUTPATIENT,,,46.67,37.336,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.34,80,,29.87,,,0,"percent of total billed charges ","80% of total billed charges ",32.67,70,,26.14,,,0,"percent of total billed charges ","70% of total billed charges ",42,90,,33.60,,,0,"percent of total billed charges ","90% of total billed charges ",43.4,93,,34.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.67,85,,31.74,,,0,"percent of total billed charges ","85% of total billed charges ",42,90,,33.60,,,0,"percent of total billed charges ","90% of total billed charges ",42,90,,33.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.6,87,,32.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.67,70,,26.14,,,0,"percent of total billed charges ","70% of total billed charges ",32.67,43.4,
"ELECTRODE RESUSITATION ONE STE",6005051,"CDM ",278,RC,,,OUTPATIENT,,,282.14,225.712,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",225.71,80,,180.57,,,0,"percent of total billed charges ","80% of total billed charges ",197.5,70,,158.00,,,0,"percent of total billed charges ","70% of total billed charges ",253.93,90,,203.14,,,0,"percent of total billed charges ","90% of total billed charges ",262.39,93,,209.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",239.82,85,,191.86,,,0,"percent of total billed charges ","85% of total billed charges ",239.82,85,,191.86,,,0,"percent of total billed charges ","85% of total billed charges ",253.93,90,,203.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",245.46,87,,196.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",197.5,70,,158.00,,,0,"percent of total billed charges ","70% of total billed charges ",197.5,262.39,
"FOAM CARRA SMART 6X8",6005056,"CDM ",272,RC,,,OUTPATIENT,,,38.52,30.816,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.82,80,,24.66,,,0,"percent of total billed charges ","80% of total billed charges ",26.96,70,,21.57,,,0,"percent of total billed charges ","70% of total billed charges ",34.67,90,,27.74,,,0,"percent of total billed charges ","90% of total billed charges ",35.82,93,,28.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.74,85,,26.19,,,0,"percent of total billed charges ","85% of total billed charges ",34.67,90,,27.74,,,0,"percent of total billed charges ","90% of total billed charges ",34.67,90,,27.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.51,87,,26.81,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.96,70,,21.57,,,0,"percent of total billed charges ","70% of total billed charges ",26.96,35.82,
"CONTAINER EMPTY EVACUATED",6005057,"CDM ",272,RC,,,OUTPATIENT,,,32.6,26.08,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.08,80,,20.86,,,0,"percent of total billed charges ","80% of total billed charges ",22.82,70,,18.26,,,0,"percent of total billed charges ","70% of total billed charges ",29.34,90,,23.47,,,0,"percent of total billed charges ","90% of total billed charges ",30.32,93,,24.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",27.71,85,,22.17,,,0,"percent of total billed charges ","85% of total billed charges ",29.34,90,,23.47,,,0,"percent of total billed charges ","90% of total billed charges ",29.34,90,,23.47,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",28.36,87,,22.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.82,70,,18.26,,,0,"percent of total billed charges ","70% of total billed charges ",22.82,30.32,
"SUTURE NEEDLES CHROMIC",6005068,"CDM ",272,RC,,,OUTPATIENT,,,15,12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12,80,,9.60,,,0,"percent of total billed charges ","80% of total billed charges ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.95,93,,11.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.75,85,,10.20,,,0,"percent of total billed charges ","85% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.05,87,,10.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",10.5,13.95,
"SUTURE NEEDLE VICRYL",6005069,"CDM ",272,RC,,,OUTPATIENT,,,20.5,16.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.4,80,,13.12,,,0,"percent of total billed charges ","80% of total billed charges ",14.35,70,,11.48,,,0,"percent of total billed charges ","70% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",19.07,93,,15.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.43,85,,13.94,,,0,"percent of total billed charges ","85% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.84,87,,14.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.35,70,,11.48,,,0,"percent of total billed charges ","70% of total billed charges ",14.35,19.07,
"SUTURE MULTI-PACK ETHIBOND",6005078,"CDM ",272,RC,,,OUTPATIENT,,,67.5,54,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54,80,,43.20,,,0,"percent of total billed charges ","80% of total billed charges ",47.25,70,,37.80,,,0,"percent of total billed charges ","70% of total billed charges ",60.75,90,,48.60,,,0,"percent of total billed charges ","90% of total billed charges ",62.78,93,,50.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",57.38,85,,45.90,,,0,"percent of total billed charges ","85% of total billed charges ",60.75,90,,48.60,,,0,"percent of total billed charges ","90% of total billed charges ",60.75,90,,48.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",58.73,87,,46.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.25,70,,37.80,,,0,"percent of total billed charges ","70% of total billed charges ",47.25,62.78,
"TUBING IV ANESTHESIA",6005086,"CDM ",272,RC,,,OUTPATIENT,,,40.5,32.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.4,80,,25.92,,,0,"percent of total billed charges ","80% of total billed charges ",28.35,70,,22.68,,,0,"percent of total billed charges ","70% of total billed charges ",36.45,90,,29.16,,,0,"percent of total billed charges ","90% of total billed charges ",37.67,93,,30.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34.43,85,,27.54,,,0,"percent of total billed charges ","85% of total billed charges ",36.45,90,,29.16,,,0,"percent of total billed charges ","90% of total billed charges ",36.45,90,,29.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",35.24,87,,28.19,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.35,70,,22.68,,,0,"percent of total billed charges ","70% of total billed charges ",28.35,37.67,
"SUTURE MONOCRYL",6005098,"CDM ",272,RC,,,OUTPATIENT,,,33,26.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.4,80,,21.12,,,0,"percent of total billed charges ","80% of total billed charges ",23.1,70,,18.48,,,0,"percent of total billed charges ","70% of total billed charges ",29.7,90,,23.76,,,0,"percent of total billed charges ","90% of total billed charges ",30.69,93,,24.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.05,85,,22.44,,,0,"percent of total billed charges ","85% of total billed charges ",29.7,90,,23.76,,,0,"percent of total billed charges ","90% of total billed charges ",29.7,90,,23.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",28.71,87,,22.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.1,70,,18.48,,,0,"percent of total billed charges ","70% of total billed charges ",23.1,30.69,
"SUCTION WALL",6005107,"CDM ",271,RC,,,OUTPATIENT,,,41,32.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.8,80,,26.24,,,0,"percent of total billed charges ","80% of total billed charges ",28.7,70,,22.96,,,0,"percent of total billed charges ","70% of total billed charges ",36.9,90,,29.52,,,0,"percent of total billed charges ","90% of total billed charges ",38.13,93,,30.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34.85,85,,27.88,,,0,"percent of total billed charges ","85% of total billed charges ",36.9,90,,29.52,,,0,"percent of total billed charges ","90% of total billed charges ",36.9,90,,29.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",35.67,87,,28.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.7,70,,22.96,,,0,"percent of total billed charges ","70% of total billed charges ",28.7,38.13,
"DRSING HYDROCOLLOID 4X4",6005119,"CDM ",272,RC,,,OUTPATIENT,,,17.25,13.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.8,80,,11.04,,,0,"percent of total billed charges ","80% of total billed charges ",12.08,70,,9.66,,,0,"percent of total billed charges ","70% of total billed charges ",15.53,90,,12.42,,,0,"percent of total billed charges ","90% of total billed charges ",16.04,93,,12.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.66,85,,11.73,,,0,"percent of total billed charges ","85% of total billed charges ",15.53,90,,12.42,,,0,"percent of total billed charges ","90% of total billed charges ",15.53,90,,12.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.01,87,,12.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.08,70,,9.66,,,0,"percent of total billed charges ","70% of total billed charges ",12.08,16.04,
"DRSING HYDROCOLLIOD 6X6",6005120,"CDM ",272,RC,,,OUTPATIENT,,,34.8,27.84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.84,80,,22.27,,,0,"percent of total billed charges ","80% of total billed charges ",24.36,70,,19.49,,,0,"percent of total billed charges ","70% of total billed charges ",31.32,90,,25.06,,,0,"percent of total billed charges ","90% of total billed charges ",32.36,93,,25.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",29.58,85,,23.66,,,0,"percent of total billed charges ","85% of total billed charges ",31.32,90,,25.06,,,0,"percent of total billed charges ","90% of total billed charges ",31.32,90,,25.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.28,87,,24.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.36,70,,19.49,,,0,"percent of total billed charges ","70% of total billed charges ",24.36,32.36,
"TRACE PK OB DELIVERY",6005125,"CDM ",272,RC,,,OUTPATIENT,,,200.84,160.672,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",160.67,80,,128.54,,,0,"percent of total billed charges ","80% of total billed charges ",140.59,70,,112.47,,,0,"percent of total billed charges ","70% of total billed charges ",180.76,90,,144.61,,,0,"percent of total billed charges ","90% of total billed charges ",186.78,93,,149.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",170.71,85,,136.57,,,0,"percent of total billed charges ","85% of total billed charges ",180.76,90,,144.61,,,0,"percent of total billed charges ","90% of total billed charges ",180.76,90,,144.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",174.73,87,,139.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.59,70,,112.47,,,0,"percent of total billed charges ","70% of total billed charges ",140.59,186.78,
"KIT NEEDLE GUIDE 21 GAUGE",6005132,"CDM ",272,RC,,,OUTPATIENT,,,111.61,89.288,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",89.29,80,,71.43,,,0,"percent of total billed charges ","80% of total billed charges ",78.13,70,,62.50,,,0,"percent of total billed charges ","70% of total billed charges ",100.45,90,,80.36,,,0,"percent of total billed charges ","90% of total billed charges ",103.8,93,,83.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",94.87,85,,75.90,,,0,"percent of total billed charges ","85% of total billed charges ",100.45,90,,80.36,,,0,"percent of total billed charges ","90% of total billed charges ",100.45,90,,80.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",97.1,87,,77.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.13,70,,62.50,,,0,"percent of total billed charges ","70% of total billed charges ",78.13,103.8,
"DISK BIOPATCH",6005139,"CDM ",272,RC,,,OUTPATIENT,,,34.4,27.52,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.52,80,,22.02,,,0,"percent of total billed charges ","80% of total billed charges ",24.08,70,,19.26,,,0,"percent of total billed charges ","70% of total billed charges ",30.96,90,,24.77,,,0,"percent of total billed charges ","90% of total billed charges ",31.99,93,,25.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",29.24,85,,23.39,,,0,"percent of total billed charges ","85% of total billed charges ",30.96,90,,24.77,,,0,"percent of total billed charges ","90% of total billed charges ",30.96,90,,24.77,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.93,87,,23.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.08,70,,19.26,,,0,"percent of total billed charges ","70% of total billed charges ",24.08,31.99,
"DECLOGGER 18-24 FR X 21.5CM",6005156,"CDM ",272,RC,,,OUTPATIENT,,,29.84,23.872,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.87,80,,19.10,,,0,"percent of total billed charges ","80% of total billed charges ",20.89,70,,16.71,,,0,"percent of total billed charges ","70% of total billed charges ",26.86,90,,21.49,,,0,"percent of total billed charges ","90% of total billed charges ",27.75,93,,22.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.36,85,,20.29,,,0,"percent of total billed charges ","85% of total billed charges ",26.86,90,,21.49,,,0,"percent of total billed charges ","90% of total billed charges ",26.86,90,,21.49,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",25.96,87,,20.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.89,70,,16.71,,,0,"percent of total billed charges ","70% of total billed charges ",20.89,27.75,
"DECLOGGER 20-22FR X 39.5CM",6005162,"CDM ",272,RC,,,OUTPATIENT,,,28.99,23.192,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.19,80,,18.55,,,0,"percent of total billed charges ","80% of total billed charges ",20.29,70,,16.23,,,0,"percent of total billed charges ","70% of total billed charges ",26.09,90,,20.87,,,0,"percent of total billed charges ","90% of total billed charges ",26.96,93,,21.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",24.64,85,,19.71,,,0,"percent of total billed charges ","85% of total billed charges ",26.09,90,,20.87,,,0,"percent of total billed charges ","90% of total billed charges ",26.09,90,,20.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",25.22,87,,20.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.29,70,,16.23,,,0,"percent of total billed charges ","70% of total billed charges ",20.29,26.96,
"STYLETTE ADULT",6005163,"CDM ",272,RC,,,OUTPATIENT,,,14.04,11.232,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.23,80,,8.98,,,0,"percent of total billed charges ","80% of total billed charges ",9.83,70,,7.86,,,0,"percent of total billed charges ","70% of total billed charges ",12.64,90,,10.11,,,0,"percent of total billed charges ","90% of total billed charges ",13.06,93,,10.45,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.93,85,,9.54,,,0,"percent of total billed charges ","85% of total billed charges ",12.64,90,,10.11,,,0,"percent of total billed charges ","90% of total billed charges ",12.64,90,,10.11,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.21,87,,9.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.83,70,,7.86,,,0,"percent of total billed charges ","70% of total billed charges ",9.83,13.06,
"SET EXTENSION W/CLAMP",6005195,"CDM ",272,RC,,,OUTPATIENT,,,11,8.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.8,80,,7.04,,,0,"percent of total billed charges ","80% of total billed charges ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",10.23,93,,8.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.35,85,,7.48,,,0,"percent of total billed charges ","85% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.57,87,,7.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.7,10.23,
"SYRINGE MR",6005208,"CDM ",272,RC,,,OUTPATIENT,,,50.72,40.576,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.58,80,,32.46,,,0,"percent of total billed charges ","80% of total billed charges ",35.5,70,,28.40,,,0,"percent of total billed charges ","70% of total billed charges ",45.65,90,,36.52,,,0,"percent of total billed charges ","90% of total billed charges ",47.17,93,,37.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.11,85,,34.49,,,0,"percent of total billed charges ","85% of total billed charges ",45.65,90,,36.52,,,0,"percent of total billed charges ","90% of total billed charges ",45.65,90,,36.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.13,87,,35.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.5,70,,28.40,,,0,"percent of total billed charges ","70% of total billed charges ",35.5,47.17,
"INFUSION PUMP LINE MR",6005209,"CDM ",272,RC,,,OUTPATIENT,,,52,41.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.6,80,,33.28,,,0,"percent of total billed charges ","80% of total billed charges ",36.4,70,,29.12,,,0,"percent of total billed charges ","70% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",48.36,93,,38.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",44.2,85,,35.36,,,0,"percent of total billed charges ","85% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",45.24,87,,36.19,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.4,70,,29.12,,,0,"percent of total billed charges ","70% of total billed charges ",36.4,48.36,
"SUTURE PLAIN GUT 4-0 1828H",6005213,"CDM ",272,RC,,,OUTPATIENT,,,29.5,23.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.6,80,,18.88,,,0,"percent of total billed charges ","80% of total billed charges ",20.65,70,,16.52,,,0,"percent of total billed charges ","70% of total billed charges ",26.55,90,,21.24,,,0,"percent of total billed charges ","90% of total billed charges ",27.44,93,,21.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.08,85,,20.06,,,0,"percent of total billed charges ","85% of total billed charges ",26.55,90,,21.24,,,0,"percent of total billed charges ","90% of total billed charges ",26.55,90,,21.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",25.67,87,,20.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.65,70,,16.52,,,0,"percent of total billed charges ","70% of total billed charges ",20.65,27.44,
"CRUTCH ADULT TALL",6005218,"CDM ",271,RC,,,OUTPATIENT,,,53.74,42.992,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.99,80,,34.39,,,0,"percent of total billed charges ","80% of total billed charges ",37.62,70,,30.10,,,0,"percent of total billed charges ","70% of total billed charges ",48.37,90,,38.70,,,0,"percent of total billed charges ","90% of total billed charges ",49.98,93,,39.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",45.68,85,,36.54,,,0,"percent of total billed charges ","85% of total billed charges ",48.37,90,,38.70,,,0,"percent of total billed charges ","90% of total billed charges ",48.37,90,,38.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",46.75,87,,37.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.62,70,,30.10,,,0,"percent of total billed charges ","70% of total billed charges ",37.62,49.98,
"CRUTCH CHILD",6005219,"CDM ",271,RC,,,OUTPATIENT,,,50.54,40.432,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.43,80,,32.34,,,0,"percent of total billed charges ","80% of total billed charges ",35.38,70,,28.30,,,0,"percent of total billed charges ","70% of total billed charges ",45.49,90,,36.39,,,0,"percent of total billed charges ","90% of total billed charges ",47,93,,37.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.96,85,,34.37,,,0,"percent of total billed charges ","85% of total billed charges ",45.49,90,,36.39,,,0,"percent of total billed charges ","90% of total billed charges ",45.49,90,,36.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.97,87,,35.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.38,70,,28.30,,,0,"percent of total billed charges ","70% of total billed charges ",35.38,47,
"SUTURE PROLENE 3.0 8762H",6005238,"CDM ",272,RC,,,OUTPATIENT,,,20.51,16.408,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.41,80,,13.13,,,0,"percent of total billed charges ","80% of total billed charges ",14.36,70,,11.49,,,0,"percent of total billed charges ","70% of total billed charges ",18.46,90,,14.77,,,0,"percent of total billed charges ","90% of total billed charges ",19.07,93,,15.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.43,85,,13.94,,,0,"percent of total billed charges ","85% of total billed charges ",18.46,90,,14.77,,,0,"percent of total billed charges ","90% of total billed charges ",18.46,90,,14.77,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.84,87,,14.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.36,70,,11.49,,,0,"percent of total billed charges ","70% of total billed charges ",14.36,19.07,
"TUBE GASTROSTOMY MIC 16FR",6005248,"CDM ",272,RC,,,OUTPATIENT,,,155,124,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124,80,,99.20,,,0,"percent of total billed charges ","80% of total billed charges ",108.5,70,,86.80,,,0,"percent of total billed charges ","70% of total billed charges ",139.5,90,,111.60,,,0,"percent of total billed charges ","90% of total billed charges ",144.15,93,,115.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",131.75,85,,105.40,,,0,"percent of total billed charges ","85% of total billed charges ",139.5,90,,111.60,,,0,"percent of total billed charges ","90% of total billed charges ",139.5,90,,111.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",134.85,87,,107.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.5,70,,86.80,,,0,"percent of total billed charges ","70% of total billed charges ",108.5,144.15,
"KIT PICC DRESSING CHANGE",6005249,"CDM ",272,RC,,,OUTPATIENT,,,59.43,47.544,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.54,80,,38.03,,,0,"percent of total billed charges ","80% of total billed charges ",41.6,70,,33.28,,,0,"percent of total billed charges ","70% of total billed charges ",53.49,90,,42.79,,,0,"percent of total billed charges ","90% of total billed charges ",55.27,93,,44.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",50.52,85,,40.42,,,0,"percent of total billed charges ","85% of total billed charges ",53.49,90,,42.79,,,0,"percent of total billed charges ","90% of total billed charges ",53.49,90,,42.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",51.7,87,,41.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.6,70,,33.28,,,0,"percent of total billed charges ","70% of total billed charges ",41.6,55.27,
"KIT PICC DRESSING CHANGE",6005249,"CDM ",272,RC,,,OUTPATIENT,,,59.43,47.544,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.54,80,,38.03,,,0,"percent of total billed charges ","80% of total billed charges ",41.6,70,,33.28,,,0,"percent of total billed charges ","70% of total billed charges ",53.49,90,,42.79,,,0,"percent of total billed charges ","90% of total billed charges ",55.27,93,,44.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",50.52,85,,40.42,,,0,"percent of total billed charges ","85% of total billed charges ",53.49,90,,42.79,,,0,"percent of total billed charges ","90% of total billed charges ",53.49,90,,42.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",51.7,87,,41.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.6,70,,33.28,,,0,"percent of total billed charges ","70% of total billed charges ",41.6,55.27,
"KIT CENTRAL LINE INSERTION",6005251,"CDM ",270,RC,,,OUTPATIENT,,,357.7,286.16,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",286.16,80,,228.93,,,0,"percent of total billed charges ","80% of total billed charges ",250.39,70,,200.31,,,0,"percent of total billed charges ","70% of total billed charges ",321.93,90,,257.54,,,0,"percent of total billed charges ","90% of total billed charges ",332.66,93,,266.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",304.05,85,,243.24,,,0,"percent of total billed charges ","85% of total billed charges ",321.93,90,,257.54,,,0,"percent of total billed charges ","90% of total billed charges ",321.93,90,,257.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",311.2,87,,248.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",250.39,70,,200.31,,,0,"percent of total billed charges ","70% of total billed charges ",250.39,332.66,
"NEEDLE EZ IO LARGE ADULT",6005252,"CDM ",272,RC,,,OUTPATIENT,,,294.37,235.496,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",235.5,80,,188.40,,,0,"percent of total billed charges ","80% of total billed charges ",206.06,70,,164.85,,,0,"percent of total billed charges ","70% of total billed charges ",264.93,90,,211.94,,,0,"percent of total billed charges ","90% of total billed charges ",273.76,93,,219.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",250.21,85,,200.17,,,0,"percent of total billed charges ","85% of total billed charges ",264.93,90,,211.94,,,0,"percent of total billed charges ","90% of total billed charges ",264.93,90,,211.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",256.1,87,,204.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",206.06,70,,164.85,,,0,"percent of total billed charges ","70% of total billed charges ",206.06,273.76,
"TUBE TRACH CUFFED SZ 6",6005260,"CDM ",272,RC,,,OUTPATIENT,,,132.73,106.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.18,80,,84.94,,,0,"percent of total billed charges ","80% of total billed charges ",92.91,70,,74.33,,,0,"percent of total billed charges ","70% of total billed charges ",119.46,90,,95.57,,,0,"percent of total billed charges ","90% of total billed charges ",123.44,93,,98.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",112.82,85,,90.26,,,0,"percent of total billed charges ","85% of total billed charges ",119.46,90,,95.57,,,0,"percent of total billed charges ","90% of total billed charges ",119.46,90,,95.57,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",115.48,87,,92.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.91,70,,74.33,,,0,"percent of total billed charges ","70% of total billed charges ",92.91,123.44,
"TUBE TRACH CUFFED SHILEY SZ 8",6005261,"CDM ",272,RC,,,OUTPATIENT,,,132.73,106.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.18,80,,84.94,,,0,"percent of total billed charges ","80% of total billed charges ",92.91,70,,74.33,,,0,"percent of total billed charges ","70% of total billed charges ",119.46,90,,95.57,,,0,"percent of total billed charges ","90% of total billed charges ",123.44,93,,98.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",112.82,85,,90.26,,,0,"percent of total billed charges ","85% of total billed charges ",119.46,90,,95.57,,,0,"percent of total billed charges ","90% of total billed charges ",119.46,90,,95.57,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",115.48,87,,92.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.91,70,,74.33,,,0,"percent of total billed charges ","70% of total billed charges ",92.91,123.44,
"OXYHOOD STANDARD NECK",6005271,"CDM ",270,RC,,,OUTPATIENT,,,50.45,40.36,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.36,80,,32.29,,,0,"percent of total billed charges ","80% of total billed charges ",35.32,70,,28.26,,,0,"percent of total billed charges ","70% of total billed charges ",45.41,90,,36.33,,,0,"percent of total billed charges ","90% of total billed charges ",46.92,93,,37.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.88,85,,34.30,,,0,"percent of total billed charges ","85% of total billed charges ",45.41,90,,36.33,,,0,"percent of total billed charges ","90% of total billed charges ",45.41,90,,36.33,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.89,87,,35.11,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.32,70,,28.26,,,0,"percent of total billed charges ","70% of total billed charges ",35.32,46.92,
"OXYHOOD WIDE NECK",6005272,"CDM ",270,RC,,,OUTPATIENT,,,50.45,40.36,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.36,80,,32.29,,,0,"percent of total billed charges ","80% of total billed charges ",35.32,70,,28.26,,,0,"percent of total billed charges ","70% of total billed charges ",45.41,90,,36.33,,,0,"percent of total billed charges ","90% of total billed charges ",46.92,93,,37.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.88,85,,34.30,,,0,"percent of total billed charges ","85% of total billed charges ",45.41,90,,36.33,,,0,"percent of total billed charges ","90% of total billed charges ",45.41,90,,36.33,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.89,87,,35.11,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.32,70,,28.26,,,0,"percent of total billed charges ","70% of total billed charges ",35.32,46.92,
"WOUND VAC KIT PREVENA",6005354,"CDM ",272,RC,,,OUTPATIENT,,,832.05,665.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",665.64,80,,532.51,,,0,"percent of total billed charges ","80% of total billed charges ",582.44,70,,465.95,,,0,"percent of total billed charges ","70% of total billed charges ",748.85,90,,599.08,,,0,"percent of total billed charges ","90% of total billed charges ",773.81,93,,619.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",707.24,85,,565.79,,,0,"percent of total billed charges ","85% of total billed charges ",748.85,90,,599.08,,,0,"percent of total billed charges ","90% of total billed charges ",748.85,90,,599.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",723.88,87,,579.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",582.44,70,,465.95,,,0,"percent of total billed charges ","70% of total billed charges ",582.44,773.81,
"WOUND VAC KIT VIA",6005370,"CDM ",272,RC,,,OUTPATIENT,,,1181.57,945.256,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",945.26,80,,756.21,,,0,"percent of total billed charges ","80% of total billed charges ",827.1,70,,661.68,,,0,"percent of total billed charges ","70% of total billed charges ",1063.41,90,,850.73,,,0,"percent of total billed charges ","90% of total billed charges ",1098.86,93,,879.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1004.33,85,,803.46,,,0,"percent of total billed charges ","85% of total billed charges ",1063.41,90,,850.73,,,0,"percent of total billed charges ","90% of total billed charges ",1063.41,90,,850.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1027.97,87,,822.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",827.1,70,,661.68,,,0,"percent of total billed charges ","70% of total billed charges ",827.1,1098.86,
"CATH IV INSYTE 20GA",6005374,"CDM ",272,RC,,,OUTPATIENT,,,10,8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8,80,,6.40,,,0,"percent of total billed charges ","80% of total billed charges ",7,70,,5.60,,,0,"percent of total billed charges ","70% of total billed charges ",9,90,,7.20,,,0,"percent of total billed charges ","90% of total billed charges ",9.3,93,,7.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.5,85,,6.80,,,0,"percent of total billed charges ","85% of total billed charges ",9,90,,7.20,,,0,"percent of total billed charges ","90% of total billed charges ",9,90,,7.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",8.7,87,,6.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7,70,,5.60,,,0,"percent of total billed charges ","70% of total billed charges ",7,9.3,
"CONNECTOR BULB SUCTION",6005423,"CDM ",272,RC,,,OUTPATIENT,,,57.79,46.232,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.23,80,,36.98,,,0,"percent of total billed charges ","80% of total billed charges ",40.45,70,,32.36,,,0,"percent of total billed charges ","70% of total billed charges ",52.01,90,,41.61,,,0,"percent of total billed charges ","90% of total billed charges ",53.74,93,,42.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",49.12,85,,39.30,,,0,"percent of total billed charges ","85% of total billed charges ",52.01,90,,41.61,,,0,"percent of total billed charges ","90% of total billed charges ",52.01,90,,41.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",50.28,87,,40.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.45,70,,32.36,,,0,"percent of total billed charges ","70% of total billed charges ",40.45,53.74,
"PAD ALARM BED",6005581,"CDM ",271,RC,,,OUTPATIENT,,,124.46,99.568,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.57,80,,79.66,,,0,"percent of total billed charges ","80% of total billed charges ",87.12,70,,69.70,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,90,,89.61,,,0,"percent of total billed charges ","90% of total billed charges ",115.75,93,,92.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",105.79,85,,84.63,,,0,"percent of total billed charges ","85% of total billed charges ",112.01,90,,89.61,,,0,"percent of total billed charges ","90% of total billed charges ",112.01,90,,89.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",108.28,87,,86.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.12,70,,69.70,,,0,"percent of total billed charges ","70% of total billed charges ",87.12,115.75,
"PAD ALARM CHAIR",6005582,"CDM ",271,RC,,,OUTPATIENT,,,106.68,85.344,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.34,80,,68.27,,,0,"percent of total billed charges ","80% of total billed charges ",74.68,70,,59.74,,,0,"percent of total billed charges ","70% of total billed charges ",96.01,90,,76.81,,,0,"percent of total billed charges ","90% of total billed charges ",99.21,93,,79.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",90.68,85,,72.54,,,0,"percent of total billed charges ","85% of total billed charges ",96.01,90,,76.81,,,0,"percent of total billed charges ","90% of total billed charges ",96.01,90,,76.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",92.81,87,,74.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.68,70,,59.74,,,0,"percent of total billed charges ","70% of total billed charges ",74.68,99.21,
UNICATH,6005598,"CDM ",272,RC,,,OUTPATIENT,,,19.36,15.488,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.49,80,,12.39,,,0,"percent of total billed charges ","80% of total billed charges ",13.55,70,,10.84,,,0,"percent of total billed charges ","70% of total billed charges ",17.42,90,,13.94,,,0,"percent of total billed charges ","90% of total billed charges ",18,93,,14.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.46,85,,13.17,,,0,"percent of total billed charges ","85% of total billed charges ",17.42,90,,13.94,,,0,"percent of total billed charges ","90% of total billed charges ",17.42,90,,13.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.84,87,,13.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.55,70,,10.84,,,0,"percent of total billed charges ","70% of total billed charges ",13.55,18,
"ADHESIVE DERMA BOND",6005605,"CDM ",272,RC,,,OUTPATIENT,,,105,84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84,80,,67.20,,,0,"percent of total billed charges ","80% of total billed charges ",73.5,70,,58.80,,,0,"percent of total billed charges ","70% of total billed charges ",94.5,90,,75.60,,,0,"percent of total billed charges ","90% of total billed charges ",97.65,93,,78.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",89.25,85,,71.40,,,0,"percent of total billed charges ","85% of total billed charges ",94.5,90,,75.60,,,0,"percent of total billed charges ","90% of total billed charges ",94.5,90,,75.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",91.35,87,,73.08,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.5,70,,58.80,,,0,"percent of total billed charges ","70% of total billed charges ",73.5,97.65,
"ADHESIVE DERMA BOND",6005605,"CDM ",272,RC,,,OUTPATIENT,,,105,84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84,80,,67.20,,,0,"percent of total billed charges ","80% of total billed charges ",73.5,70,,58.80,,,0,"percent of total billed charges ","70% of total billed charges ",94.5,90,,75.60,,,0,"percent of total billed charges ","90% of total billed charges ",97.65,93,,78.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",89.25,85,,71.40,,,0,"percent of total billed charges ","85% of total billed charges ",94.5,90,,75.60,,,0,"percent of total billed charges ","90% of total billed charges ",94.5,90,,75.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",91.35,87,,73.08,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.5,70,,58.80,,,0,"percent of total billed charges ","70% of total billed charges ",73.5,97.65,
"SUTURE VR844 5.0 PC-3 RAPIDE",6005608,"CDM ",272,RC,,,OUTPATIENT,,,23.37,18.696,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.7,80,,14.96,,,0,"percent of total billed charges ","80% of total billed charges ",16.36,70,,13.09,,,0,"percent of total billed charges ","70% of total billed charges ",21.03,90,,16.82,,,0,"percent of total billed charges ","90% of total billed charges ",21.73,93,,17.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.86,85,,15.89,,,0,"percent of total billed charges ","85% of total billed charges ",21.03,90,,16.82,,,0,"percent of total billed charges ","90% of total billed charges ",21.03,90,,16.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.33,87,,16.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.36,70,,13.09,,,0,"percent of total billed charges ","70% of total billed charges ",16.36,21.73,
"NEEDLE BIOPSY",6005613,"CDM ",272,RC,,,OUTPATIENT,,,67.25,53.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.8,80,,43.04,,,0,"percent of total billed charges ","80% of total billed charges ",47.08,70,,37.66,,,0,"percent of total billed charges ","70% of total billed charges ",60.53,90,,48.42,,,0,"percent of total billed charges ","90% of total billed charges ",62.54,93,,50.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",57.16,85,,45.73,,,0,"percent of total billed charges ","85% of total billed charges ",60.53,90,,48.42,,,0,"percent of total billed charges ","90% of total billed charges ",60.53,90,,48.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",58.51,87,,46.81,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.08,70,,37.66,,,0,"percent of total billed charges ","70% of total billed charges ",47.08,62.54,
"NEEDLE SPINE SPROTTE 22G 4-3/4",6005634,"CDM ",272,RC,,,OUTPATIENT,,,45.21,36.168,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.17,80,,28.94,,,0,"percent of total billed charges ","80% of total billed charges ",31.65,70,,25.32,,,0,"percent of total billed charges ","70% of total billed charges ",40.69,90,,32.55,,,0,"percent of total billed charges ","90% of total billed charges ",42.05,93,,33.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.43,85,,30.74,,,0,"percent of total billed charges ","85% of total billed charges ",40.69,90,,32.55,,,0,"percent of total billed charges ","90% of total billed charges ",40.69,90,,32.55,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.33,87,,31.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.65,70,,25.32,,,0,"percent of total billed charges ","70% of total billed charges ",31.65,42.05,
"SPLINT CAST 3"" X 35""",6005637,"CDM ",272,RC,,,OUTPATIENT,,,78.54,62.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.83,80,,50.26,,,0,"percent of total billed charges ","80% of total billed charges ",54.98,70,,43.98,,,0,"percent of total billed charges ","70% of total billed charges ",70.69,90,,56.55,,,0,"percent of total billed charges ","90% of total billed charges ",73.04,93,,58.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",66.76,85,,53.41,,,0,"percent of total billed charges ","85% of total billed charges ",70.69,90,,56.55,,,0,"percent of total billed charges ","90% of total billed charges ",70.69,90,,56.55,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",68.33,87,,54.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.98,70,,43.98,,,0,"percent of total billed charges ","70% of total billed charges ",54.98,73.04,
"RETRACTOR WOUND ALEXIS 5-9CM",6005638,"CDM ",272,RC,,,OUTPATIENT,,,219.6,175.68,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",175.68,80,,140.54,,,0,"percent of total billed charges ","80% of total billed charges ",153.72,70,,122.98,,,0,"percent of total billed charges ","70% of total billed charges ",197.64,90,,158.11,,,0,"percent of total billed charges ","90% of total billed charges ",204.23,93,,163.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",186.66,85,,149.33,,,0,"percent of total billed charges ","85% of total billed charges ",197.64,90,,158.11,,,0,"percent of total billed charges ","90% of total billed charges ",197.64,90,,158.11,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",191.05,87,,152.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.72,70,,122.98,,,0,"percent of total billed charges ","70% of total billed charges ",153.72,204.23,
"SENSOR NEONATAL MASIMO",6005685,"CDM ",272,RC,,,OUTPATIENT,,,55.56,44.448,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.45,80,,35.56,,,0,"percent of total billed charges ","80% of total billed charges ",38.89,70,,31.11,,,0,"percent of total billed charges ","70% of total billed charges ",50,90,,40.00,,,0,"percent of total billed charges ","90% of total billed charges ",51.67,93,,41.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",47.23,85,,37.78,,,0,"percent of total billed charges ","85% of total billed charges ",50,90,,40.00,,,0,"percent of total billed charges ","90% of total billed charges ",50,90,,40.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",48.34,87,,38.67,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.89,70,,31.11,,,0,"percent of total billed charges ","70% of total billed charges ",38.89,51.67,
"DRESSING AQUACEL AG 3.5""X10""",6005699,"CDM ",272,RC,,,OUTPATIENT,,,149.31,119.448,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.45,80,,95.56,,,0,"percent of total billed charges ","80% of total billed charges ",104.52,70,,83.62,,,0,"percent of total billed charges ","70% of total billed charges ",134.38,90,,107.50,,,0,"percent of total billed charges ","90% of total billed charges ",138.86,93,,111.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",126.91,85,,101.53,,,0,"percent of total billed charges ","85% of total billed charges ",134.38,90,,107.50,,,0,"percent of total billed charges ","90% of total billed charges ",134.38,90,,107.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",129.9,87,,103.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.52,70,,83.62,,,0,"percent of total billed charges ","70% of total billed charges ",104.52,138.86,
"DRESSING AQUACEL AG 3.5""X10""",6005699,"CDM ",272,RC,,,OUTPATIENT,,,149.31,119.448,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.45,80,,95.56,,,0,"percent of total billed charges ","80% of total billed charges ",104.52,70,,83.62,,,0,"percent of total billed charges ","70% of total billed charges ",134.38,90,,107.50,,,0,"percent of total billed charges ","90% of total billed charges ",138.86,93,,111.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",126.91,85,,101.53,,,0,"percent of total billed charges ","85% of total billed charges ",134.38,90,,107.50,,,0,"percent of total billed charges ","90% of total billed charges ",134.38,90,,107.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",129.9,87,,103.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.52,70,,83.62,,,0,"percent of total billed charges ","70% of total billed charges ",104.52,138.86,
"DRESSING GRANUFOAM SILVER LG",6005700,"CDM ",272,RC,,,OUTPATIENT,,,238.86,191.088,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",191.09,80,,152.87,,,0,"percent of total billed charges ","80% of total billed charges ",167.2,70,,133.76,,,0,"percent of total billed charges ","70% of total billed charges ",214.97,90,,171.98,,,0,"percent of total billed charges ","90% of total billed charges ",222.14,93,,177.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",203.03,85,,162.42,,,0,"percent of total billed charges ","85% of total billed charges ",214.97,90,,171.98,,,0,"percent of total billed charges ","90% of total billed charges ",214.97,90,,171.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",207.81,87,,166.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.2,70,,133.76,,,0,"percent of total billed charges ","70% of total billed charges ",167.2,222.14,
"DRESSING GRANUFOAM SILVER LG",6005700,"CDM ",272,RC,,,OUTPATIENT,,,238.86,191.088,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",191.09,80,,152.87,,,0,"percent of total billed charges ","80% of total billed charges ",167.2,70,,133.76,,,0,"percent of total billed charges ","70% of total billed charges ",214.97,90,,171.98,,,0,"percent of total billed charges ","90% of total billed charges ",222.14,93,,177.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",203.03,85,,162.42,,,0,"percent of total billed charges ","85% of total billed charges ",214.97,90,,171.98,,,0,"percent of total billed charges ","90% of total billed charges ",214.97,90,,171.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",207.81,87,,166.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.2,70,,133.76,,,0,"percent of total billed charges ","70% of total billed charges ",167.2,222.14,
"DRESSING WHITEFOAM SM",6005701,"CDM ",272,RC,,,OUTPATIENT,,,38.31,30.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.65,80,,24.52,,,0,"percent of total billed charges ","80% of total billed charges ",26.82,70,,21.46,,,0,"percent of total billed charges ","70% of total billed charges ",34.48,90,,27.58,,,0,"percent of total billed charges ","90% of total billed charges ",35.63,93,,28.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.56,85,,26.05,,,0,"percent of total billed charges ","85% of total billed charges ",34.48,90,,27.58,,,0,"percent of total billed charges ","90% of total billed charges ",34.48,90,,27.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.33,87,,26.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.82,70,,21.46,,,0,"percent of total billed charges ","70% of total billed charges ",26.82,35.63,
"DRESSING WHITEFOAM SM",6005701,"CDM ",272,RC,,,OUTPATIENT,,,38.31,30.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.65,80,,24.52,,,0,"percent of total billed charges ","80% of total billed charges ",26.82,70,,21.46,,,0,"percent of total billed charges ","70% of total billed charges ",34.48,90,,27.58,,,0,"percent of total billed charges ","90% of total billed charges ",35.63,93,,28.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.56,85,,26.05,,,0,"percent of total billed charges ","85% of total billed charges ",34.48,90,,27.58,,,0,"percent of total billed charges ","90% of total billed charges ",34.48,90,,27.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.33,87,,26.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.82,70,,21.46,,,0,"percent of total billed charges ","70% of total billed charges ",26.82,35.63,
"LEAD PACING UNIPOLAR 610MM",6005743,"CDM ",278,RC,,,OUTPATIENT,,,64.81,51.848,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.85,80,,41.48,,,0,"percent of total billed charges ","80% of total billed charges ",45.37,70,,36.30,,,0,"percent of total billed charges ","70% of total billed charges ",58.33,90,,46.66,,,0,"percent of total billed charges ","90% of total billed charges ",60.27,93,,48.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",55.09,85,,44.07,,,0,"percent of total billed charges ","85% of total billed charges ",55.09,85,,44.07,,,0,"percent of total billed charges ","85% of total billed charges ",58.33,90,,46.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",56.38,87,,45.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.37,70,,36.30,,,0,"percent of total billed charges ","70% of total billed charges ",45.37,60.27,
"CATH FILIFORM SPIRAL 4FR",6005746,"CDM ",272,RC,,,OUTPATIENT,,,244.32,195.456,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",195.46,80,,156.37,,,0,"percent of total billed charges ","80% of total billed charges ",171.02,70,,136.82,,,0,"percent of total billed charges ","70% of total billed charges ",219.89,90,,175.91,,,0,"percent of total billed charges ","90% of total billed charges ",227.22,93,,181.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",207.67,85,,166.14,,,0,"percent of total billed charges ","85% of total billed charges ",219.89,90,,175.91,,,0,"percent of total billed charges ","90% of total billed charges ",219.89,90,,175.91,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",212.56,87,,170.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",171.02,70,,136.82,,,0,"percent of total billed charges ","70% of total billed charges ",171.02,227.22,
"CATH FILIFORM SPIRAL 5FR COUDE",6005747,"CDM ",272,RC,,,OUTPATIENT,,,254.08,203.264,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",203.26,80,,162.61,,,0,"percent of total billed charges ","80% of total billed charges ",177.86,70,,142.29,,,0,"percent of total billed charges ","70% of total billed charges ",228.67,90,,182.94,,,0,"percent of total billed charges ","90% of total billed charges ",236.29,93,,189.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",215.97,85,,172.78,,,0,"percent of total billed charges ","85% of total billed charges ",228.67,90,,182.94,,,0,"percent of total billed charges ","90% of total billed charges ",228.67,90,,182.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",221.05,87,,176.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.86,70,,142.29,,,0,"percent of total billed charges ","70% of total billed charges ",177.86,236.29,
"CATH FILIFORM COUDE 4FR",6005748,"CDM ",272,RC,,,OUTPATIENT,,,254.08,203.264,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",203.26,80,,162.61,,,0,"percent of total billed charges ","80% of total billed charges ",177.86,70,,142.29,,,0,"percent of total billed charges ","70% of total billed charges ",228.67,90,,182.94,,,0,"percent of total billed charges ","90% of total billed charges ",236.29,93,,189.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",215.97,85,,172.78,,,0,"percent of total billed charges ","85% of total billed charges ",228.67,90,,182.94,,,0,"percent of total billed charges ","90% of total billed charges ",228.67,90,,182.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",221.05,87,,176.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.86,70,,142.29,,,0,"percent of total billed charges ","70% of total billed charges ",177.86,236.29,
"CATH FILIFORM ST 4FR",6005749,"CDM ",272,RC,,,OUTPATIENT,,,184.5,147.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.6,80,,118.08,,,0,"percent of total billed charges ","80% of total billed charges ",129.15,70,,103.32,,,0,"percent of total billed charges ","70% of total billed charges ",166.05,90,,132.84,,,0,"percent of total billed charges ","90% of total billed charges ",171.59,93,,137.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",156.83,85,,125.46,,,0,"percent of total billed charges ","85% of total billed charges ",166.05,90,,132.84,,,0,"percent of total billed charges ","90% of total billed charges ",166.05,90,,132.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",160.52,87,,128.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.15,70,,103.32,,,0,"percent of total billed charges ","70% of total billed charges ",129.15,171.59,
"PORT 24"" SAFE SET SAMPLING",6005751,"CDM ",272,RC,,,OUTPATIENT,,,54.41,43.528,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.53,80,,34.82,,,0,"percent of total billed charges ","80% of total billed charges ",38.09,70,,30.47,,,0,"percent of total billed charges ","70% of total billed charges ",48.97,90,,39.18,,,0,"percent of total billed charges ","90% of total billed charges ",50.6,93,,40.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",46.25,85,,37.00,,,0,"percent of total billed charges ","85% of total billed charges ",48.97,90,,39.18,,,0,"percent of total billed charges ","90% of total billed charges ",48.97,90,,39.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",47.34,87,,37.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.09,70,,30.47,,,0,"percent of total billed charges ","70% of total billed charges ",38.09,50.6,
"KIT OSTOMY 1-3/4""",6005767,"CDM ",272,RC,,,OUTPATIENT,,,6.62,5.296,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.3,80,,4.24,,,0,"percent of total billed charges ","80% of total billed charges ",4.63,70,,3.70,,,0,"percent of total billed charges ","70% of total billed charges ",5.96,90,,4.77,,,0,"percent of total billed charges ","90% of total billed charges ",6.16,93,,4.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.63,85,,4.50,,,0,"percent of total billed charges ","85% of total billed charges ",5.96,90,,4.77,,,0,"percent of total billed charges ","90% of total billed charges ",5.96,90,,4.77,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5.76,87,,4.61,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.63,70,,3.70,,,0,"percent of total billed charges ","70% of total billed charges ",4.63,6.16,
"BAG OSTOMY 1-3/4""",6005770,"CDM ",272,RC,,,OUTPATIENT,,,1.46,1.168,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.17,80,,0.94,,,0,"percent of total billed charges ","80% of total billed charges ",1.02,70,,0.82,,,0,"percent of total billed charges ","70% of total billed charges ",1.31,90,,1.05,,,0,"percent of total billed charges ","90% of total billed charges ",1.36,93,,1.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1.24,85,,0.99,,,0,"percent of total billed charges ","85% of total billed charges ",1.31,90,,1.05,,,0,"percent of total billed charges ","90% of total billed charges ",1.31,90,,1.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1.27,87,,1.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.02,70,,0.82,,,0,"percent of total billed charges ","70% of total billed charges ",1.02,1.36,
"UTENSIL - FORK",6005775,"CDM ",271,RC,,,OUTPATIENT,,,27.5,22,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22,80,,17.60,,,0,"percent of total billed charges ","80% of total billed charges ",19.25,70,,15.40,,,0,"percent of total billed charges ","70% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",25.58,93,,20.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.38,85,,18.70,,,0,"percent of total billed charges ","85% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",23.93,87,,19.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.25,70,,15.40,,,0,"percent of total billed charges ","70% of total billed charges ",19.25,25.58,
"UTENSIL - KNIFE",6005776,"CDM ",271,RC,,,OUTPATIENT,,,27.5,22,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22,80,,17.60,,,0,"percent of total billed charges ","80% of total billed charges ",19.25,70,,15.40,,,0,"percent of total billed charges ","70% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",25.58,93,,20.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.38,85,,18.70,,,0,"percent of total billed charges ","85% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",23.93,87,,19.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.25,70,,15.40,,,0,"percent of total billed charges ","70% of total billed charges ",19.25,25.58,
"UTENSIL - TABLESPOON",6005777,"CDM ",271,RC,,,OUTPATIENT,,,27.5,22,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22,80,,17.60,,,0,"percent of total billed charges ","80% of total billed charges ",19.25,70,,15.40,,,0,"percent of total billed charges ","70% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",25.58,93,,20.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.38,85,,18.70,,,0,"percent of total billed charges ","85% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",23.93,87,,19.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.25,70,,15.40,,,0,"percent of total billed charges ","70% of total billed charges ",19.25,25.58,
"SET BRONCHIAL DL 39FR",6005781,"CDM ",272,RC,,,OUTPATIENT,,,251.53,201.224,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",201.22,80,,160.98,,,0,"percent of total billed charges ","80% of total billed charges ",176.07,70,,140.86,,,0,"percent of total billed charges ","70% of total billed charges ",226.38,90,,181.10,,,0,"percent of total billed charges ","90% of total billed charges ",233.92,93,,187.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",213.8,85,,171.04,,,0,"percent of total billed charges ","85% of total billed charges ",226.38,90,,181.10,,,0,"percent of total billed charges ","90% of total billed charges ",226.38,90,,181.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",218.83,87,,175.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.07,70,,140.86,,,0,"percent of total billed charges ","70% of total billed charges ",176.07,233.92,
"NEEDLE CENTURION 1 1/2""",6005818,"CDM ",272,RC,,,OUTPATIENT,,,34.5,27.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.6,80,,22.08,,,0,"percent of total billed charges ","80% of total billed charges ",24.15,70,,19.32,,,0,"percent of total billed charges ","70% of total billed charges ",31.05,90,,24.84,,,0,"percent of total billed charges ","90% of total billed charges ",32.09,93,,25.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",29.33,85,,23.46,,,0,"percent of total billed charges ","85% of total billed charges ",31.05,90,,24.84,,,0,"percent of total billed charges ","90% of total billed charges ",31.05,90,,24.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.02,87,,24.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.15,70,,19.32,,,0,"percent of total billed charges ","70% of total billed charges ",24.15,32.09,
"SET LAVAGE TUM-E-VAC",6005882,"CDM ",272,RC,,,OUTPATIENT,,,95.39,76.312,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.31,80,,61.05,,,0,"percent of total billed charges ","80% of total billed charges ",66.77,70,,53.42,,,0,"percent of total billed charges ","70% of total billed charges ",85.85,90,,68.68,,,0,"percent of total billed charges ","90% of total billed charges ",88.71,93,,70.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",81.08,85,,64.86,,,0,"percent of total billed charges ","85% of total billed charges ",85.85,90,,68.68,,,0,"percent of total billed charges ","90% of total billed charges ",85.85,90,,68.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.99,87,,66.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.77,70,,53.42,,,0,"percent of total billed charges ","70% of total billed charges ",66.77,88.71,
"SENSOR DISP O2 SAT",6005887,"CDM ",272,RC,,,OUTPATIENT,,,60.01,48.008,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.01,80,,38.41,,,0,"percent of total billed charges ","80% of total billed charges ",42.01,70,,33.61,,,0,"percent of total billed charges ","70% of total billed charges ",54.01,90,,43.21,,,0,"percent of total billed charges ","90% of total billed charges ",55.81,93,,44.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51.01,85,,40.81,,,0,"percent of total billed charges ","85% of total billed charges ",54.01,90,,43.21,,,0,"percent of total billed charges ","90% of total billed charges ",54.01,90,,43.21,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",52.21,87,,41.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.01,70,,33.61,,,0,"percent of total billed charges ","70% of total billed charges ",42.01,55.81,
"SUTURE VICRYL 4.0 RAPIDE",6005888,"CDM ",272,RC,,,OUTPATIENT,,,21.36,17.088,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.09,80,,13.67,,,0,"percent of total billed charges ","80% of total billed charges ",14.95,70,,11.96,,,0,"percent of total billed charges ","70% of total billed charges ",19.22,90,,15.38,,,0,"percent of total billed charges ","90% of total billed charges ",19.86,93,,15.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.16,85,,14.53,,,0,"percent of total billed charges ","85% of total billed charges ",19.22,90,,15.38,,,0,"percent of total billed charges ","90% of total billed charges ",19.22,90,,15.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.58,87,,14.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.95,70,,11.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.95,19.86,
"CREAM CAVILON SKIN 16OZ",6005912,"CDM ",271,RC,,,OUTPATIENT,,,39.62,31.696,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.7,80,,25.36,,,0,"percent of total billed charges ","80% of total billed charges ",27.73,70,,22.18,,,0,"percent of total billed charges ","70% of total billed charges ",35.66,90,,28.53,,,0,"percent of total billed charges ","90% of total billed charges ",36.85,93,,29.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.68,85,,26.94,,,0,"percent of total billed charges ","85% of total billed charges ",35.66,90,,28.53,,,0,"percent of total billed charges ","90% of total billed charges ",35.66,90,,28.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",34.47,87,,27.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.73,70,,22.18,,,0,"percent of total billed charges ","70% of total billed charges ",27.73,36.85,
"SET CRICOTHYROTOMY CATH 9FR",6005919,"CDM ",272,RC,,,OUTPATIENT,,,358.44,286.752,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",286.75,80,,229.40,,,0,"percent of total billed charges ","80% of total billed charges ",250.91,70,,200.73,,,0,"percent of total billed charges ","70% of total billed charges ",322.6,90,,258.08,,,0,"percent of total billed charges ","90% of total billed charges ",333.35,93,,266.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",304.67,85,,243.74,,,0,"percent of total billed charges ","85% of total billed charges ",322.6,90,,258.08,,,0,"percent of total billed charges ","90% of total billed charges ",322.6,90,,258.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",311.84,87,,249.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",250.91,70,,200.73,,,0,"percent of total billed charges ","70% of total billed charges ",250.91,333.35,
"SET RETROGRADE INTUBATION 14FR",6005920,"CDM ",272,RC,,,OUTPATIENT,,,329.72,263.776,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.78,80,,211.02,,,0,"percent of total billed charges ","80% of total billed charges ",230.8,70,,184.64,,,0,"percent of total billed charges ","70% of total billed charges ",296.75,90,,237.40,,,0,"percent of total billed charges ","90% of total billed charges ",306.64,93,,245.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",280.26,85,,224.21,,,0,"percent of total billed charges ","85% of total billed charges ",296.75,90,,237.40,,,0,"percent of total billed charges ","90% of total billed charges ",296.75,90,,237.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",286.86,87,,229.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",230.8,70,,184.64,,,0,"percent of total billed charges ","70% of total billed charges ",230.8,306.64,
"CATH AIRWAY EXCHANGE 14FR",6005921,"CDM ",272,RC,,,OUTPATIENT,,,137.8,110.24,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.24,80,,88.19,,,0,"percent of total billed charges ","80% of total billed charges ",96.46,70,,77.17,,,0,"percent of total billed charges ","70% of total billed charges ",124.02,90,,99.22,,,0,"percent of total billed charges ","90% of total billed charges ",128.15,93,,102.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",117.13,85,,93.70,,,0,"percent of total billed charges ","85% of total billed charges ",124.02,90,,99.22,,,0,"percent of total billed charges ","90% of total billed charges ",124.02,90,,99.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",119.89,87,,95.91,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.46,70,,77.17,,,0,"percent of total billed charges ","70% of total billed charges ",96.46,128.15,
"CATH AIRWAY EXCHANGE 19FR",6005922,"CDM ",272,RC,,,OUTPATIENT,,,137.8,110.24,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.24,80,,88.19,,,0,"percent of total billed charges ","80% of total billed charges ",96.46,70,,77.17,,,0,"percent of total billed charges ","70% of total billed charges ",124.02,90,,99.22,,,0,"percent of total billed charges ","90% of total billed charges ",128.15,93,,102.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",117.13,85,,93.70,,,0,"percent of total billed charges ","85% of total billed charges ",124.02,90,,99.22,,,0,"percent of total billed charges ","90% of total billed charges ",124.02,90,,99.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",119.89,87,,95.91,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.46,70,,77.17,,,0,"percent of total billed charges ","70% of total billed charges ",96.46,128.15,
"SENSOR BIS",6005947,"CDM ",272,RC,,,OUTPATIENT,,,67.39,53.912,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.91,80,,43.13,,,0,"percent of total billed charges ","80% of total billed charges ",47.17,70,,37.74,,,0,"percent of total billed charges ","70% of total billed charges ",60.65,90,,48.52,,,0,"percent of total billed charges ","90% of total billed charges ",62.67,93,,50.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",57.28,85,,45.82,,,0,"percent of total billed charges ","85% of total billed charges ",60.65,90,,48.52,,,0,"percent of total billed charges ","90% of total billed charges ",60.65,90,,48.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",58.63,87,,46.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.17,70,,37.74,,,0,"percent of total billed charges ","70% of total billed charges ",47.17,62.67,
"CATH INSYTE 16GA X 1 1/2""",6005967,"CDM ",272,RC,,,OUTPATIENT,,,10,8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8,80,,6.40,,,0,"percent of total billed charges ","80% of total billed charges ",7,70,,5.60,,,0,"percent of total billed charges ","70% of total billed charges ",9,90,,7.20,,,0,"percent of total billed charges ","90% of total billed charges ",9.3,93,,7.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.5,85,,6.80,,,0,"percent of total billed charges ","85% of total billed charges ",9,90,,7.20,,,0,"percent of total billed charges ","90% of total billed charges ",9,90,,7.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",8.7,87,,6.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7,70,,5.60,,,0,"percent of total billed charges ","70% of total billed charges ",7,9.3,
"THORA-CATH W/TROCAR 9.6FR",6006031,"CDM ",272,RC,,,OUTPATIENT,,,71.21,56.968,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.97,80,,45.58,,,0,"percent of total billed charges ","80% of total billed charges ",49.85,70,,39.88,,,0,"percent of total billed charges ","70% of total billed charges ",64.09,90,,51.27,,,0,"percent of total billed charges ","90% of total billed charges ",66.23,93,,52.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",60.53,85,,48.42,,,0,"percent of total billed charges ","85% of total billed charges ",64.09,90,,51.27,,,0,"percent of total billed charges ","90% of total billed charges ",64.09,90,,51.27,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",61.95,87,,49.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.85,70,,39.88,,,0,"percent of total billed charges ","70% of total billed charges ",49.85,66.23,
"DRESSING DUO DERM 1.5"" X 1.5""",6006058,"CDM ",272,RC,,,OUTPATIENT,,,4,3.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.2,80,,2.56,,,0,"percent of total billed charges ","80% of total billed charges ",2.8,70,,2.24,,,0,"percent of total billed charges ","70% of total billed charges ",3.6,90,,2.88,,,0,"percent of total billed charges ","90% of total billed charges ",3.72,93,,2.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3.4,85,,2.72,,,0,"percent of total billed charges ","85% of total billed charges ",3.6,90,,2.88,,,0,"percent of total billed charges ","90% of total billed charges ",3.6,90,,2.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3.48,87,,2.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.8,70,,2.24,,,0,"percent of total billed charges ","70% of total billed charges ",2.8,3.72,
"ADAPTER ML SHORT PLUG",6006067,"CDM ",272,RC,,,OUTPATIENT,,,4.06,3.248,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.25,80,,2.60,,,0,"percent of total billed charges ","80% of total billed charges ",2.84,70,,2.27,,,0,"percent of total billed charges ","70% of total billed charges ",3.65,90,,2.92,,,0,"percent of total billed charges ","90% of total billed charges ",3.78,93,,3.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3.45,85,,2.76,,,0,"percent of total billed charges ","85% of total billed charges ",3.65,90,,2.92,,,0,"percent of total billed charges ","90% of total billed charges ",3.65,90,,2.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3.53,87,,2.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.84,70,,2.27,,,0,"percent of total billed charges ","70% of total billed charges ",2.84,3.78,
"ADAPTER ML LONG PLUG",6006068,"CDM ",272,RC,,,OUTPATIENT,,,13.49,10.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.79,80,,8.63,,,0,"percent of total billed charges ","80% of total billed charges ",9.44,70,,7.55,,,0,"percent of total billed charges ","70% of total billed charges ",12.14,90,,9.71,,,0,"percent of total billed charges ","90% of total billed charges ",12.55,93,,10.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.47,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.14,90,,9.71,,,0,"percent of total billed charges ","90% of total billed charges ",12.14,90,,9.71,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.74,87,,9.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.44,70,,7.55,,,0,"percent of total billed charges ","70% of total billed charges ",9.44,12.55,
"TUBE TRACH HI-LO 8.0",6006072,"CDM ",272,RC,,,OUTPATIENT,,,74.36,59.488,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.49,80,,47.59,,,0,"percent of total billed charges ","80% of total billed charges ",52.05,70,,41.64,,,0,"percent of total billed charges ","70% of total billed charges ",66.92,90,,53.54,,,0,"percent of total billed charges ","90% of total billed charges ",69.15,93,,55.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",63.21,85,,50.57,,,0,"percent of total billed charges ","85% of total billed charges ",66.92,90,,53.54,,,0,"percent of total billed charges ","90% of total billed charges ",66.92,90,,53.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",64.69,87,,51.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.05,70,,41.64,,,0,"percent of total billed charges ","70% of total billed charges ",52.05,69.15,
"SPLINT LOW LEG WALKER SM",6006077,"CDM ",271,RC,,,OUTPATIENT,,,157.31,125.848,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.85,80,,100.68,,,0,"percent of total billed charges ","80% of total billed charges ",110.12,70,,88.10,,,0,"percent of total billed charges ","70% of total billed charges ",141.58,90,,113.26,,,0,"percent of total billed charges ","90% of total billed charges ",146.3,93,,117.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.71,85,,106.97,,,0,"percent of total billed charges ","85% of total billed charges ",141.58,90,,113.26,,,0,"percent of total billed charges ","90% of total billed charges ",141.58,90,,113.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",136.86,87,,109.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.12,70,,88.10,,,0,"percent of total billed charges ","70% of total billed charges ",110.12,146.3,
"SPLINT LOW LEG WALKER MED/LG",6006078,"CDM ",271,RC,,,OUTPATIENT,,,157.31,125.848,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.85,80,,100.68,,,0,"percent of total billed charges ","80% of total billed charges ",110.12,70,,88.10,,,0,"percent of total billed charges ","70% of total billed charges ",141.58,90,,113.26,,,0,"percent of total billed charges ","90% of total billed charges ",146.3,93,,117.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.71,85,,106.97,,,0,"percent of total billed charges ","85% of total billed charges ",141.58,90,,113.26,,,0,"percent of total billed charges ","90% of total billed charges ",141.58,90,,113.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",136.86,87,,109.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.12,70,,88.10,,,0,"percent of total billed charges ","70% of total billed charges ",110.12,146.3,
"SPLINT LOW LEG WALKER XLGE",6006079,"CDM ",271,RC,,,OUTPATIENT,,,157.31,125.848,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.85,80,,100.68,,,0,"percent of total billed charges ","80% of total billed charges ",110.12,70,,88.10,,,0,"percent of total billed charges ","70% of total billed charges ",141.58,90,,113.26,,,0,"percent of total billed charges ","90% of total billed charges ",146.3,93,,117.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.71,85,,106.97,,,0,"percent of total billed charges ","85% of total billed charges ",141.58,90,,113.26,,,0,"percent of total billed charges ","90% of total billed charges ",141.58,90,,113.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",136.86,87,,109.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.12,70,,88.10,,,0,"percent of total billed charges ","70% of total billed charges ",110.12,146.3,
"KIT HOLTER",6006095,"CDM ",272,RC,,,OUTPATIENT,,,14.44,11.552,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.55,80,,9.24,,,0,"percent of total billed charges ","80% of total billed charges ",10.11,70,,8.09,,,0,"percent of total billed charges ","70% of total billed charges ",13,90,,10.40,,,0,"percent of total billed charges ","90% of total billed charges ",13.43,93,,10.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.27,85,,9.82,,,0,"percent of total billed charges ","85% of total billed charges ",13,90,,10.40,,,0,"percent of total billed charges ","90% of total billed charges ",13,90,,10.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.56,87,,10.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.11,70,,8.09,,,0,"percent of total billed charges ","70% of total billed charges ",10.11,13.43,
"BARIUM SM BOWEL ENTROEASE DRY",6006098,"CDM ",272,RC,,,OUTPATIENT,,,182.78,146.224,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",146.22,80,,116.98,,,0,"percent of total billed charges ","80% of total billed charges ",127.95,70,,102.36,,,0,"percent of total billed charges ","70% of total billed charges ",164.5,90,,131.60,,,0,"percent of total billed charges ","90% of total billed charges ",169.99,93,,135.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",155.36,85,,124.29,,,0,"percent of total billed charges ","85% of total billed charges ",164.5,90,,131.60,,,0,"percent of total billed charges ","90% of total billed charges ",164.5,90,,131.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",159.02,87,,127.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.95,70,,102.36,,,0,"percent of total billed charges ","70% of total billed charges ",127.95,169.99,
"MASK SOFTCAP WHITE MED",6006106,"CDM ",271,RC,,,OUTPATIENT,,,121.79,97.432,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.43,80,,77.94,,,0,"percent of total billed charges ","80% of total billed charges ",85.25,70,,68.20,,,0,"percent of total billed charges ","70% of total billed charges ",109.61,90,,87.69,,,0,"percent of total billed charges ","90% of total billed charges ",113.26,93,,90.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",103.52,85,,82.82,,,0,"percent of total billed charges ","85% of total billed charges ",109.61,90,,87.69,,,0,"percent of total billed charges ","90% of total billed charges ",109.61,90,,87.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",105.96,87,,84.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.25,70,,68.20,,,0,"percent of total billed charges ","70% of total billed charges ",85.25,113.26,
"MASK SOFTCAP WHITE LARGE",6006107,"CDM ",271,RC,,,OUTPATIENT,,,109.79,87.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.83,80,,70.26,,,0,"percent of total billed charges ","80% of total billed charges ",76.85,70,,61.48,,,0,"percent of total billed charges ","70% of total billed charges ",98.81,90,,79.05,,,0,"percent of total billed charges ","90% of total billed charges ",102.1,93,,81.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",93.32,85,,74.66,,,0,"percent of total billed charges ","85% of total billed charges ",98.81,90,,79.05,,,0,"percent of total billed charges ","90% of total billed charges ",98.81,90,,79.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",95.52,87,,76.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.85,70,,61.48,,,0,"percent of total billed charges ","70% of total billed charges ",76.85,102.1,
"MASK SOFTCAP WHITE CHILD",6006108,"CDM ",271,RC,,,OUTPATIENT,,,135.35,108.28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.28,80,,86.62,,,0,"percent of total billed charges ","80% of total billed charges ",94.75,70,,75.80,,,0,"percent of total billed charges ","70% of total billed charges ",121.82,90,,97.46,,,0,"percent of total billed charges ","90% of total billed charges ",125.88,93,,100.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",115.05,85,,92.04,,,0,"percent of total billed charges ","85% of total billed charges ",121.82,90,,97.46,,,0,"percent of total billed charges ","90% of total billed charges ",121.82,90,,97.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",117.75,87,,94.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.75,70,,75.80,,,0,"percent of total billed charges ","70% of total billed charges ",94.75,125.88,
"REPLACEMENT TAPES RI-25L",6006114,"CDM ",272,RC,,,OUTPATIENT,,,10.03,8.024,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.02,80,,6.42,,,0,"percent of total billed charges ","80% of total billed charges ",7.02,70,,5.62,,,0,"percent of total billed charges ","70% of total billed charges ",9.03,90,,7.22,,,0,"percent of total billed charges ","90% of total billed charges ",9.33,93,,7.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.53,85,,6.82,,,0,"percent of total billed charges ","85% of total billed charges ",9.03,90,,7.22,,,0,"percent of total billed charges ","90% of total billed charges ",9.03,90,,7.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",8.73,87,,6.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.02,70,,5.62,,,0,"percent of total billed charges ","70% of total billed charges ",7.02,9.33,
"MASK NASAL GOLD SEAL SMALL",6006119,"CDM ",271,RC,,,OUTPATIENT,,,368.13,294.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",294.5,80,,235.60,,,0,"percent of total billed charges ","80% of total billed charges ",257.69,70,,206.15,,,0,"percent of total billed charges ","70% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",342.36,93,,273.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",312.91,85,,250.33,,,0,"percent of total billed charges ","85% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",320.27,87,,256.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",257.69,70,,206.15,,,0,"percent of total billed charges ","70% of total billed charges ",257.69,342.36,
"MASK NASAL GOLD SEAL MED",6006120,"CDM ",271,RC,,,OUTPATIENT,,,368.13,294.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",294.5,80,,235.60,,,0,"percent of total billed charges ","80% of total billed charges ",257.69,70,,206.15,,,0,"percent of total billed charges ","70% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",342.36,93,,273.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",312.91,85,,250.33,,,0,"percent of total billed charges ","85% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",320.27,87,,256.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",257.69,70,,206.15,,,0,"percent of total billed charges ","70% of total billed charges ",257.69,342.36,
"MASK NASAL GOLD SEAL LG",6006121,"CDM ",271,RC,,,OUTPATIENT,,,368.13,294.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",294.5,80,,235.60,,,0,"percent of total billed charges ","80% of total billed charges ",257.69,70,,206.15,,,0,"percent of total billed charges ","70% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",342.36,93,,273.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",312.91,85,,250.33,,,0,"percent of total billed charges ","85% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",320.27,87,,256.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",257.69,70,,206.15,,,0,"percent of total billed charges ","70% of total billed charges ",257.69,342.36,
THERAPEP,6006125,"CDM ",271,RC,,,OUTPATIENT,,,109.5,87.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.6,80,,70.08,,,0,"percent of total billed charges ","80% of total billed charges ",76.65,70,,61.32,,,0,"percent of total billed charges ","70% of total billed charges ",98.55,90,,78.84,,,0,"percent of total billed charges ","90% of total billed charges ",101.84,93,,81.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",93.08,85,,74.46,,,0,"percent of total billed charges ","85% of total billed charges ",98.55,90,,78.84,,,0,"percent of total billed charges ","90% of total billed charges ",98.55,90,,78.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",95.27,87,,76.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.65,70,,61.32,,,0,"percent of total billed charges ","70% of total billed charges ",76.65,101.84,
"AIRWAY SIZE 8",6006127,"CDM ",271,RC,,,OUTPATIENT,,,3.5,2.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.8,80,,2.24,,,0,"percent of total billed charges ","80% of total billed charges ",2.45,70,,1.96,,,0,"percent of total billed charges ","70% of total billed charges ",3.15,90,,2.52,,,0,"percent of total billed charges ","90% of total billed charges ",3.26,93,,2.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2.98,85,,2.38,,,0,"percent of total billed charges ","85% of total billed charges ",3.15,90,,2.52,,,0,"percent of total billed charges ","90% of total billed charges ",3.15,90,,2.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3.05,87,,2.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.45,70,,1.96,,,0,"percent of total billed charges ","70% of total billed charges ",2.45,3.26,
"AIRWAY SIZE 9",6006128,"CDM ",271,RC,,,OUTPATIENT,,,3.5,2.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.8,80,,2.24,,,0,"percent of total billed charges ","80% of total billed charges ",2.45,70,,1.96,,,0,"percent of total billed charges ","70% of total billed charges ",3.15,90,,2.52,,,0,"percent of total billed charges ","90% of total billed charges ",3.26,93,,2.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2.98,85,,2.38,,,0,"percent of total billed charges ","85% of total billed charges ",3.15,90,,2.52,,,0,"percent of total billed charges ","90% of total billed charges ",3.15,90,,2.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3.05,87,,2.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.45,70,,1.96,,,0,"percent of total billed charges ","70% of total billed charges ",2.45,3.26,
"AIRWAY SIZE 10",6006129,"CDM ",271,RC,,,OUTPATIENT,,,3.5,2.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.8,80,,2.24,,,0,"percent of total billed charges ","80% of total billed charges ",2.45,70,,1.96,,,0,"percent of total billed charges ","70% of total billed charges ",3.15,90,,2.52,,,0,"percent of total billed charges ","90% of total billed charges ",3.26,93,,2.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2.98,85,,2.38,,,0,"percent of total billed charges ","85% of total billed charges ",3.15,90,,2.52,,,0,"percent of total billed charges ","90% of total billed charges ",3.15,90,,2.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3.05,87,,2.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.45,70,,1.96,,,0,"percent of total billed charges ","70% of total billed charges ",2.45,3.26,
"AIRWAY SIZE 11",6006130,"CDM ",271,RC,,,OUTPATIENT,,,5,4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4,80,,3.20,,,0,"percent of total billed charges ","80% of total billed charges ",3.5,70,,2.80,,,0,"percent of total billed charges ","70% of total billed charges ",4.5,90,,3.60,,,0,"percent of total billed charges ","90% of total billed charges ",4.65,93,,3.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4.25,85,,3.40,,,0,"percent of total billed charges ","85% of total billed charges ",4.5,90,,3.60,,,0,"percent of total billed charges ","90% of total billed charges ",4.5,90,,3.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4.35,87,,3.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.5,70,,2.80,,,0,"percent of total billed charges ","70% of total billed charges ",3.5,4.65,
"AIRWAY SIZE 15",6006131,"CDM ",271,RC,,,OUTPATIENT,,,4.5,3.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.6,80,,2.88,,,0,"percent of total billed charges ","80% of total billed charges ",3.15,70,,2.52,,,0,"percent of total billed charges ","70% of total billed charges ",4.05,90,,3.24,,,0,"percent of total billed charges ","90% of total billed charges ",4.19,93,,3.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3.83,85,,3.06,,,0,"percent of total billed charges ","85% of total billed charges ",4.05,90,,3.24,,,0,"percent of total billed charges ","90% of total billed charges ",4.05,90,,3.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3.92,87,,3.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.15,70,,2.52,,,0,"percent of total billed charges ","70% of total billed charges ",3.15,4.19,
"AIRWAY GUEDEL SIZE 3.5",6006132,"CDM ",272,RC,,,OUTPATIENT,,,45,36,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36,80,,28.80,,,0,"percent of total billed charges ","80% of total billed charges ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.15,87,,31.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",31.5,41.85,
"AIRWAY GUEDEL SIZE 5.5",6006133,"CDM ",272,RC,,,OUTPATIENT,,,4.5,3.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.6,80,,2.88,,,0,"percent of total billed charges ","80% of total billed charges ",3.15,70,,2.52,,,0,"percent of total billed charges ","70% of total billed charges ",4.05,90,,3.24,,,0,"percent of total billed charges ","90% of total billed charges ",4.19,93,,3.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3.83,85,,3.06,,,0,"percent of total billed charges ","85% of total billed charges ",4.05,90,,3.24,,,0,"percent of total billed charges ","90% of total billed charges ",4.05,90,,3.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3.92,87,,3.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.15,70,,2.52,,,0,"percent of total billed charges ","70% of total billed charges ",3.15,4.19,
"AIRWAY GUEDEL SIZE 5",6006134,"CDM ",272,RC,,,OUTPATIENT,,,3.5,2.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.8,80,,2.24,,,0,"percent of total billed charges ","80% of total billed charges ",2.45,70,,1.96,,,0,"percent of total billed charges ","70% of total billed charges ",3.15,90,,2.52,,,0,"percent of total billed charges ","90% of total billed charges ",3.26,93,,2.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2.98,85,,2.38,,,0,"percent of total billed charges ","85% of total billed charges ",3.15,90,,2.52,,,0,"percent of total billed charges ","90% of total billed charges ",3.15,90,,2.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3.05,87,,2.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.45,70,,1.96,,,0,"percent of total billed charges ","70% of total billed charges ",2.45,3.26,
"AIRWAY GUEDEL SIZE 6",6006135,"CDM ",272,RC,,,OUTPATIENT,,,3.5,2.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.8,80,,2.24,,,0,"percent of total billed charges ","80% of total billed charges ",2.45,70,,1.96,,,0,"percent of total billed charges ","70% of total billed charges ",3.15,90,,2.52,,,0,"percent of total billed charges ","90% of total billed charges ",3.26,93,,2.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2.98,85,,2.38,,,0,"percent of total billed charges ","85% of total billed charges ",3.15,90,,2.52,,,0,"percent of total billed charges ","90% of total billed charges ",3.15,90,,2.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3.05,87,,2.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.45,70,,1.96,,,0,"percent of total billed charges ","70% of total billed charges ",2.45,3.26,
"AIRWAY GUEDEL SIZE 7",6006136,"CDM ",272,RC,,,OUTPATIENT,,,3.5,2.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.8,80,,2.24,,,0,"percent of total billed charges ","80% of total billed charges ",2.45,70,,1.96,,,0,"percent of total billed charges ","70% of total billed charges ",3.15,90,,2.52,,,0,"percent of total billed charges ","90% of total billed charges ",3.26,93,,2.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2.98,85,,2.38,,,0,"percent of total billed charges ","85% of total billed charges ",3.15,90,,2.52,,,0,"percent of total billed charges ","90% of total billed charges ",3.15,90,,2.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3.05,87,,2.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.45,70,,1.96,,,0,"percent of total billed charges ","70% of total billed charges ",2.45,3.26,
"BAG RESUSITATOR INFANT",6006140,"CDM ",271,RC,,,OUTPATIENT,,,71.12,56.896,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.9,80,,45.52,,,0,"percent of total billed charges ","80% of total billed charges ",49.78,70,,39.82,,,0,"percent of total billed charges ","70% of total billed charges ",64.01,90,,51.21,,,0,"percent of total billed charges ","90% of total billed charges ",66.14,93,,52.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",60.45,85,,48.36,,,0,"percent of total billed charges ","85% of total billed charges ",64.01,90,,51.21,,,0,"percent of total billed charges ","90% of total billed charges ",64.01,90,,51.21,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",61.87,87,,49.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.78,70,,39.82,,,0,"percent of total billed charges ","70% of total billed charges ",49.78,66.14,
"BAG RESUSITATOR CHILD",6006141,"CDM ",271,RC,,,OUTPATIENT,,,100.72,80.576,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.58,80,,64.46,,,0,"percent of total billed charges ","80% of total billed charges ",70.5,70,,56.40,,,0,"percent of total billed charges ","70% of total billed charges ",90.65,90,,72.52,,,0,"percent of total billed charges ","90% of total billed charges ",93.67,93,,74.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",85.61,85,,68.49,,,0,"percent of total billed charges ","85% of total billed charges ",90.65,90,,72.52,,,0,"percent of total billed charges ","90% of total billed charges ",90.65,90,,72.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",87.63,87,,70.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.5,70,,56.40,,,0,"percent of total billed charges ","70% of total billed charges ",70.5,93.67,
"BAG RESUSITATOR ADULT",6006142,"CDM ",271,RC,,,OUTPATIENT,,,79.61,63.688,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.69,80,,50.95,,,0,"percent of total billed charges ","80% of total billed charges ",55.73,70,,44.58,,,0,"percent of total billed charges ","70% of total billed charges ",71.65,90,,57.32,,,0,"percent of total billed charges ","90% of total billed charges ",74.04,93,,59.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",67.67,85,,54.14,,,0,"percent of total billed charges ","85% of total billed charges ",71.65,90,,57.32,,,0,"percent of total billed charges ","90% of total billed charges ",71.65,90,,57.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",69.26,87,,55.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.73,70,,44.58,,,0,"percent of total billed charges ","70% of total billed charges ",55.73,74.04,
"BAG RESUSITATOR ADULT",6006142,"CDM ",271,RC,,,OUTPATIENT,,,79.61,63.688,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.69,80,,50.95,,,0,"percent of total billed charges ","80% of total billed charges ",55.73,70,,44.58,,,0,"percent of total billed charges ","70% of total billed charges ",71.65,90,,57.32,,,0,"percent of total billed charges ","90% of total billed charges ",74.04,93,,59.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",67.67,85,,54.14,,,0,"percent of total billed charges ","85% of total billed charges ",71.65,90,,57.32,,,0,"percent of total billed charges ","90% of total billed charges ",71.65,90,,57.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",69.26,87,,55.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.73,70,,44.58,,,0,"percent of total billed charges ","70% of total billed charges ",55.73,74.04,
"SUCTION INLINE ADULT",6006162,"CDM ",272,RC,,,OUTPATIENT,,,29.79,23.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.83,80,,19.06,,,0,"percent of total billed charges ","80% of total billed charges ",20.85,70,,16.68,,,0,"percent of total billed charges ","70% of total billed charges ",26.81,90,,21.45,,,0,"percent of total billed charges ","90% of total billed charges ",27.7,93,,22.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.32,85,,20.26,,,0,"percent of total billed charges ","85% of total billed charges ",26.81,90,,21.45,,,0,"percent of total billed charges ","90% of total billed charges ",26.81,90,,21.45,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",25.92,87,,20.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.85,70,,16.68,,,0,"percent of total billed charges ","70% of total billed charges ",20.85,27.7,
"SUCTION INLINE INFANT 6FR",6006163,"CDM ",272,RC,,,OUTPATIENT,,,59.92,47.936,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.94,80,,38.35,,,0,"percent of total billed charges ","80% of total billed charges ",41.94,70,,33.55,,,0,"percent of total billed charges ","70% of total billed charges ",53.93,90,,43.14,,,0,"percent of total billed charges ","90% of total billed charges ",55.73,93,,44.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",50.93,85,,40.74,,,0,"percent of total billed charges ","85% of total billed charges ",53.93,90,,43.14,,,0,"percent of total billed charges ","90% of total billed charges ",53.93,90,,43.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",52.13,87,,41.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.94,70,,33.55,,,0,"percent of total billed charges ","70% of total billed charges ",41.94,55.73,
"CPAP NASAL INFANT SIZE 0",6006175,"CDM ",272,RC,,,OUTPATIENT,,,112.5,90,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90,80,,72.00,,,0,"percent of total billed charges ","80% of total billed charges ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",104.63,93,,83.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",95.63,85,,76.50,,,0,"percent of total billed charges ","85% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",101.25,90,,81.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",97.88,87,,78.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.75,70,,63.00,,,0,"percent of total billed charges ","70% of total billed charges ",78.75,104.63,
"CPAP NASAL INFANT SIZE 1",6006179,"CDM ",272,RC,,,OUTPATIENT,,,91.03,72.824,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.82,80,,58.26,,,0,"percent of total billed charges ","80% of total billed charges ",63.72,70,,50.98,,,0,"percent of total billed charges ","70% of total billed charges ",81.93,90,,65.54,,,0,"percent of total billed charges ","90% of total billed charges ",84.66,93,,67.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",77.38,85,,61.90,,,0,"percent of total billed charges ","85% of total billed charges ",81.93,90,,65.54,,,0,"percent of total billed charges ","90% of total billed charges ",81.93,90,,65.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",79.2,87,,63.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.72,70,,50.98,,,0,"percent of total billed charges ","70% of total billed charges ",63.72,84.66,
"CANNULA NASAL INFANT",6006180,"CDM ",270,RC,,,OUTPATIENT,,,11.08,8.864,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.86,80,,7.09,,,0,"percent of total billed charges ","80% of total billed charges ",7.76,70,,6.21,,,0,"percent of total billed charges ","70% of total billed charges ",9.97,90,,7.98,,,0,"percent of total billed charges ","90% of total billed charges ",10.3,93,,8.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.42,85,,7.54,,,0,"percent of total billed charges ","85% of total billed charges ",9.97,90,,7.98,,,0,"percent of total billed charges ","90% of total billed charges ",9.97,90,,7.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.64,87,,7.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.76,70,,6.21,,,0,"percent of total billed charges ","70% of total billed charges ",7.76,10.3,
"CPAP NASAL INFANT SIZE 2",6006182,"CDM ",272,RC,,,OUTPATIENT,,,90.63,72.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.5,80,,58.00,,,0,"percent of total billed charges ","80% of total billed charges ",63.44,70,,50.75,,,0,"percent of total billed charges ","70% of total billed charges ",81.57,90,,65.26,,,0,"percent of total billed charges ","90% of total billed charges ",84.29,93,,67.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",77.04,85,,61.63,,,0,"percent of total billed charges ","85% of total billed charges ",81.57,90,,65.26,,,0,"percent of total billed charges ","90% of total billed charges ",81.57,90,,65.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",78.85,87,,63.08,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.44,70,,50.75,,,0,"percent of total billed charges ","70% of total billed charges ",63.44,84.29,
"NEBULIZER HIGH FLOW",6006183,"CDM ",272,RC,,,OUTPATIENT,,,20,16,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16,80,,12.80,,,0,"percent of total billed charges ","80% of total billed charges ",14,70,,11.20,,,0,"percent of total billed charges ","70% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",18.6,93,,14.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17,85,,13.60,,,0,"percent of total billed charges ","85% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.4,87,,13.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14,70,,11.20,,,0,"percent of total billed charges ","70% of total billed charges ",14,18.6,
"TENT CANOPY",6006184,"CDM ",271,RC,,,OUTPATIENT,,,72.45,57.96,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.96,80,,46.37,,,0,"percent of total billed charges ","80% of total billed charges ",50.72,70,,40.58,,,0,"percent of total billed charges ","70% of total billed charges ",65.21,90,,52.17,,,0,"percent of total billed charges ","90% of total billed charges ",67.38,93,,53.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",61.58,85,,49.26,,,0,"percent of total billed charges ","85% of total billed charges ",65.21,90,,52.17,,,0,"percent of total billed charges ","90% of total billed charges ",65.21,90,,52.17,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.03,87,,50.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.72,70,,40.58,,,0,"percent of total billed charges ","70% of total billed charges ",50.72,67.38,
"SPACER MDI",6006185,"CDM ",272,RC,,,OUTPATIENT,,,27.93,22.344,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.34,80,,17.87,,,0,"percent of total billed charges ","80% of total billed charges ",19.55,70,,15.64,,,0,"percent of total billed charges ","70% of total billed charges ",25.14,90,,20.11,,,0,"percent of total billed charges ","90% of total billed charges ",25.97,93,,20.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.74,85,,18.99,,,0,"percent of total billed charges ","85% of total billed charges ",25.14,90,,20.11,,,0,"percent of total billed charges ","90% of total billed charges ",25.14,90,,20.11,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",24.3,87,,19.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.55,70,,15.64,,,0,"percent of total billed charges ","70% of total billed charges ",19.55,25.97,
"CPAP NASAL INFANT SIZE 3",6006186,"CDM ",272,RC,,,OUTPATIENT,,,44.85,35.88,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.88,80,,28.70,,,0,"percent of total billed charges ","80% of total billed charges ",31.4,70,,25.12,,,0,"percent of total billed charges ","70% of total billed charges ",40.37,90,,32.30,,,0,"percent of total billed charges ","90% of total billed charges ",41.71,93,,33.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.12,85,,30.50,,,0,"percent of total billed charges ","85% of total billed charges ",40.37,90,,32.30,,,0,"percent of total billed charges ","90% of total billed charges ",40.37,90,,32.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.02,87,,31.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.4,70,,25.12,,,0,"percent of total billed charges ","70% of total billed charges ",31.4,41.71,
"SPACER MDI CHILD SM",6006187,"CDM ",272,RC,,,OUTPATIENT,,,54.85,43.88,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.88,80,,35.10,,,0,"percent of total billed charges ","80% of total billed charges ",38.4,70,,30.72,,,0,"percent of total billed charges ","70% of total billed charges ",49.37,90,,39.50,,,0,"percent of total billed charges ","90% of total billed charges ",51.01,93,,40.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",46.62,85,,37.30,,,0,"percent of total billed charges ","85% of total billed charges ",49.37,90,,39.50,,,0,"percent of total billed charges ","90% of total billed charges ",49.37,90,,39.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",47.72,87,,38.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.4,70,,30.72,,,0,"percent of total billed charges ","70% of total billed charges ",38.4,51.01,
"METER PEAK FLOW",6006188,"CDM ",272,RC,,,OUTPATIENT,,,40.02,32.016,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.02,80,,25.62,,,0,"percent of total billed charges ","80% of total billed charges ",28.01,70,,22.41,,,0,"percent of total billed charges ","70% of total billed charges ",36.02,90,,28.82,,,0,"percent of total billed charges ","90% of total billed charges ",37.22,93,,29.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34.02,85,,27.22,,,0,"percent of total billed charges ","85% of total billed charges ",36.02,90,,28.82,,,0,"percent of total billed charges ","90% of total billed charges ",36.02,90,,28.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",34.82,87,,27.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.01,70,,22.41,,,0,"percent of total billed charges ","70% of total billed charges ",28.01,37.22,
"CPAP NASAL INFANT SIZE 4",6006190,"CDM ",272,RC,,,OUTPATIENT,,,90.63,72.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.5,80,,58.00,,,0,"percent of total billed charges ","80% of total billed charges ",63.44,70,,50.75,,,0,"percent of total billed charges ","70% of total billed charges ",81.57,90,,65.26,,,0,"percent of total billed charges ","90% of total billed charges ",84.29,93,,67.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",77.04,85,,61.63,,,0,"percent of total billed charges ","85% of total billed charges ",81.57,90,,65.26,,,0,"percent of total billed charges ","90% of total billed charges ",81.57,90,,65.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",78.85,87,,63.08,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.44,70,,50.75,,,0,"percent of total billed charges ","70% of total billed charges ",63.44,84.29,
"CPAP NASAL INFANT SIZE 5",6006192,"CDM ",272,RC,,,OUTPATIENT,,,90.23,72.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.18,80,,57.74,,,0,"percent of total billed charges ","80% of total billed charges ",63.16,70,,50.53,,,0,"percent of total billed charges ","70% of total billed charges ",81.21,90,,64.97,,,0,"percent of total billed charges ","90% of total billed charges ",83.91,93,,67.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",76.7,85,,61.36,,,0,"percent of total billed charges ","85% of total billed charges ",81.21,90,,64.97,,,0,"percent of total billed charges ","90% of total billed charges ",81.21,90,,64.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",78.5,87,,62.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.16,70,,50.53,,,0,"percent of total billed charges ","70% of total billed charges ",63.16,83.91,
"PROBE OXISENSOR ADULT",6006193,"CDM ",272,RC,,,OUTPATIENT,,,48.44,38.752,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.75,80,,31.00,,,0,"percent of total billed charges ","80% of total billed charges ",33.91,70,,27.13,,,0,"percent of total billed charges ","70% of total billed charges ",43.6,90,,34.88,,,0,"percent of total billed charges ","90% of total billed charges ",45.05,93,,36.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.17,85,,32.94,,,0,"percent of total billed charges ","85% of total billed charges ",43.6,90,,34.88,,,0,"percent of total billed charges ","90% of total billed charges ",43.6,90,,34.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.14,87,,33.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.91,70,,27.13,,,0,"percent of total billed charges ","70% of total billed charges ",33.91,45.05,
"PROBE OXISENSOR NEONATAL",6006194,"CDM ",272,RC,,,OUTPATIENT,,,55.83,44.664,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.66,80,,35.73,,,0,"percent of total billed charges ","80% of total billed charges ",39.08,70,,31.26,,,0,"percent of total billed charges ","70% of total billed charges ",50.25,90,,40.20,,,0,"percent of total billed charges ","90% of total billed charges ",51.92,93,,41.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",47.46,85,,37.97,,,0,"percent of total billed charges ","85% of total billed charges ",50.25,90,,40.20,,,0,"percent of total billed charges ","90% of total billed charges ",50.25,90,,40.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",48.57,87,,38.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.08,70,,31.26,,,0,"percent of total billed charges ","70% of total billed charges ",39.08,51.92,
"BAG RESUSITATIOR NEWBORN",6006197,"CDM ",271,RC,,,OUTPATIENT,,,35.81,28.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.65,80,,22.92,,,0,"percent of total billed charges ","80% of total billed charges ",25.07,70,,20.06,,,0,"percent of total billed charges ","70% of total billed charges ",32.23,90,,25.78,,,0,"percent of total billed charges ","90% of total billed charges ",33.3,93,,26.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",30.44,85,,24.35,,,0,"percent of total billed charges ","85% of total billed charges ",32.23,90,,25.78,,,0,"percent of total billed charges ","90% of total billed charges ",32.23,90,,25.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",31.15,87,,24.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.07,70,,20.06,,,0,"percent of total billed charges ","70% of total billed charges ",25.07,33.3,
"ADAPTER VALVED TEE",6006200,"CDM ",272,RC,,,OUTPATIENT,,,7.77,6.216,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.22,80,,4.98,,,0,"percent of total billed charges ","80% of total billed charges ",5.44,70,,4.35,,,0,"percent of total billed charges ","70% of total billed charges ",6.99,90,,5.59,,,0,"percent of total billed charges ","90% of total billed charges ",7.23,93,,5.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6.6,85,,5.28,,,0,"percent of total billed charges ","85% of total billed charges ",6.99,90,,5.59,,,0,"percent of total billed charges ","90% of total billed charges ",6.99,90,,5.59,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.76,87,,5.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.44,70,,4.35,,,0,"percent of total billed charges ","70% of total billed charges ",5.44,7.23,
"ELECTRODE EEG",6006201,"CDM ",272,RC,,,OUTPATIENT,,,48.5,38.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.8,80,,31.04,,,0,"percent of total billed charges ","80% of total billed charges ",33.95,70,,27.16,,,0,"percent of total billed charges ","70% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",45.11,93,,36.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.23,85,,32.98,,,0,"percent of total billed charges ","85% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.2,87,,33.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.95,70,,27.16,,,0,"percent of total billed charges ","70% of total billed charges ",33.95,45.11,
"DRESSING DUO DERM 2X4",6006210,"CDM ",272,RC,,,OUTPATIENT,,,5.22,4.176,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.18,80,,3.34,,,0,"percent of total billed charges ","80% of total billed charges ",3.65,70,,2.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.7,90,,3.76,,,0,"percent of total billed charges ","90% of total billed charges ",4.85,93,,3.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4.44,85,,3.55,,,0,"percent of total billed charges ","85% of total billed charges ",4.7,90,,3.76,,,0,"percent of total billed charges ","90% of total billed charges ",4.7,90,,3.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4.54,87,,3.63,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.65,70,,2.92,,,0,"percent of total billed charges ","70% of total billed charges ",3.65,4.85,
"ELECTRODE PEDI",6006212,"CDM ",272,RC,,,OUTPATIENT,,,18,14.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.4,80,,11.52,,,0,"percent of total billed charges ","80% of total billed charges ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.74,93,,13.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.3,85,,12.24,,,0,"percent of total billed charges ","85% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.66,87,,12.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,16.74,
"HUMIDIFIER THERAMIST",6006213,"CDM ",272,RC,,,OUTPATIENT,,,49.47,39.576,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.58,80,,31.66,,,0,"percent of total billed charges ","80% of total billed charges ",34.63,70,,27.70,,,0,"percent of total billed charges ","70% of total billed charges ",44.52,90,,35.62,,,0,"percent of total billed charges ","90% of total billed charges ",46.01,93,,36.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.05,85,,33.64,,,0,"percent of total billed charges ","85% of total billed charges ",44.52,90,,35.62,,,0,"percent of total billed charges ","90% of total billed charges ",44.52,90,,35.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.04,87,,34.43,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.63,70,,27.70,,,0,"percent of total billed charges ","70% of total billed charges ",34.63,46.01,
"SPRAY 3.4OZ MEDICAL ADHESIVE",6006223,"CDM ",272,RC,,,OUTPATIENT,,,98.19,78.552,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.55,80,,62.84,,,0,"percent of total billed charges ","80% of total billed charges ",68.73,70,,54.98,,,0,"percent of total billed charges ","70% of total billed charges ",88.37,90,,70.70,,,0,"percent of total billed charges ","90% of total billed charges ",91.32,93,,73.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.46,85,,66.77,,,0,"percent of total billed charges ","85% of total billed charges ",88.37,90,,70.70,,,0,"percent of total billed charges ","90% of total billed charges ",88.37,90,,70.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.43,87,,68.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.73,70,,54.98,,,0,"percent of total billed charges ","70% of total billed charges ",68.73,91.32,
"DRAIN CLOSE CIRCUIT",6006225,"CDM ",272,RC,,,OUTPATIENT,,,8.63,6.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.9,80,,5.52,,,0,"percent of total billed charges ","80% of total billed charges ",6.04,70,,4.83,,,0,"percent of total billed charges ","70% of total billed charges ",7.77,90,,6.22,,,0,"percent of total billed charges ","90% of total billed charges ",8.03,93,,6.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7.34,85,,5.87,,,0,"percent of total billed charges ","85% of total billed charges ",7.77,90,,6.22,,,0,"percent of total billed charges ","90% of total billed charges ",7.77,90,,6.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7.51,87,,6.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.04,70,,4.83,,,0,"percent of total billed charges ","70% of total billed charges ",6.04,8.03,
"DRAIN CLOSE CIRCUIT W/TUBING",6006226,"CDM ",272,RC,,,OUTPATIENT,,,13.24,10.592,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.59,80,,8.47,,,0,"percent of total billed charges ","80% of total billed charges ",9.27,70,,7.42,,,0,"percent of total billed charges ","70% of total billed charges ",11.92,90,,9.54,,,0,"percent of total billed charges ","90% of total billed charges ",12.31,93,,9.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.25,85,,9.00,,,0,"percent of total billed charges ","85% of total billed charges ",11.92,90,,9.54,,,0,"percent of total billed charges ","90% of total billed charges ",11.92,90,,9.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.52,87,,9.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.27,70,,7.42,,,0,"percent of total billed charges ","70% of total billed charges ",9.27,12.31,
"CARTRIDGE HUMIDIFIER W/WATER",6006229,"CDM ",272,RC,,,OUTPATIENT,,,33.45,26.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.76,80,,21.41,,,0,"percent of total billed charges ","80% of total billed charges ",23.42,70,,18.74,,,0,"percent of total billed charges ","70% of total billed charges ",30.11,90,,24.09,,,0,"percent of total billed charges ","90% of total billed charges ",31.11,93,,24.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.43,85,,22.74,,,0,"percent of total billed charges ","85% of total billed charges ",30.11,90,,24.09,,,0,"percent of total billed charges ","90% of total billed charges ",30.11,90,,24.09,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.1,87,,23.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.42,70,,18.74,,,0,"percent of total billed charges ","70% of total billed charges ",23.42,31.11,
"SUCTION INLINE INFANT 8FR",6006231,"CDM ",272,RC,,,OUTPATIENT,,,59.92,47.936,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.94,80,,38.35,,,0,"percent of total billed charges ","80% of total billed charges ",41.94,70,,33.55,,,0,"percent of total billed charges ","70% of total billed charges ",53.93,90,,43.14,,,0,"percent of total billed charges ","90% of total billed charges ",55.73,93,,44.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",50.93,85,,40.74,,,0,"percent of total billed charges ","85% of total billed charges ",53.93,90,,43.14,,,0,"percent of total billed charges ","90% of total billed charges ",53.93,90,,43.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",52.13,87,,41.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.94,70,,33.55,,,0,"percent of total billed charges ","70% of total billed charges ",41.94,55.73,
"AIRWAY OVASSAPIAN",6006232,"CDM ",272,RC,,,OUTPATIENT,,,21.36,17.088,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.09,80,,13.67,,,0,"percent of total billed charges ","80% of total billed charges ",14.95,70,,11.96,,,0,"percent of total billed charges ","70% of total billed charges ",19.22,90,,15.38,,,0,"percent of total billed charges ","90% of total billed charges ",19.86,93,,15.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.16,85,,14.53,,,0,"percent of total billed charges ","85% of total billed charges ",19.22,90,,15.38,,,0,"percent of total billed charges ","90% of total billed charges ",19.22,90,,15.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.58,87,,14.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.95,70,,11.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.95,19.86,
"KIT POST-OP AUTOLOCK",6006235,"CDM ",272,RC,,,OUTPATIENT,,,208.17,166.536,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",166.54,80,,133.23,,,0,"percent of total billed charges ","80% of total billed charges ",145.72,70,,116.58,,,0,"percent of total billed charges ","70% of total billed charges ",187.35,90,,149.88,,,0,"percent of total billed charges ","90% of total billed charges ",193.6,93,,154.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",176.94,85,,141.55,,,0,"percent of total billed charges ","85% of total billed charges ",187.35,90,,149.88,,,0,"percent of total billed charges ","90% of total billed charges ",187.35,90,,149.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",181.11,87,,144.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",145.72,70,,116.58,,,0,"percent of total billed charges ","70% of total billed charges ",145.72,193.6,
"DRESSING HYDROPOLLY 4.25 X 4.2",6006252,"CDM ",272,RC,,,OUTPATIENT,,,27.73,22.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.18,80,,17.74,,,0,"percent of total billed charges ","80% of total billed charges ",19.41,70,,15.53,,,0,"percent of total billed charges ","70% of total billed charges ",24.96,90,,19.97,,,0,"percent of total billed charges ","90% of total billed charges ",25.79,93,,20.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.57,85,,18.86,,,0,"percent of total billed charges ","85% of total billed charges ",24.96,90,,19.97,,,0,"percent of total billed charges ","90% of total billed charges ",24.96,90,,19.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",24.13,87,,19.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.41,70,,15.53,,,0,"percent of total billed charges ","70% of total billed charges ",19.41,25.79,
"DRESSING HYDROPOLLY 2.75 X 3.5",6006253,"CDM ",272,RC,,,OUTPATIENT,,,17.2,13.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.76,80,,11.01,,,0,"percent of total billed charges ","80% of total billed charges ",12.04,70,,9.63,,,0,"percent of total billed charges ","70% of total billed charges ",15.48,90,,12.38,,,0,"percent of total billed charges ","90% of total billed charges ",16,93,,12.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.62,85,,11.70,,,0,"percent of total billed charges ","85% of total billed charges ",15.48,90,,12.38,,,0,"percent of total billed charges ","90% of total billed charges ",15.48,90,,12.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.96,87,,11.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.04,70,,9.63,,,0,"percent of total billed charges ","70% of total billed charges ",12.04,16,
"SLING UNIVERSAL SMALL",6006287,"CDM ",271,RC,,,OUTPATIENT,,,58.27,46.616,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.62,80,,37.30,,,0,"percent of total billed charges ","80% of total billed charges ",40.79,70,,32.63,,,0,"percent of total billed charges ","70% of total billed charges ",52.44,90,,41.95,,,0,"percent of total billed charges ","90% of total billed charges ",54.19,93,,43.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",49.53,85,,39.62,,,0,"percent of total billed charges ","85% of total billed charges ",52.44,90,,41.95,,,0,"percent of total billed charges ","90% of total billed charges ",52.44,90,,41.95,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",50.69,87,,40.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.79,70,,32.63,,,0,"percent of total billed charges ","70% of total billed charges ",40.79,54.19,
"KIT DURA PREP W/APPLICATOR",6006322,"CDM ",272,RC,,,OUTPATIENT,,,27.73,22.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.18,80,,17.74,,,0,"percent of total billed charges ","80% of total billed charges ",19.41,70,,15.53,,,0,"percent of total billed charges ","70% of total billed charges ",24.96,90,,19.97,,,0,"percent of total billed charges ","90% of total billed charges ",25.79,93,,20.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.57,85,,18.86,,,0,"percent of total billed charges ","85% of total billed charges ",24.96,90,,19.97,,,0,"percent of total billed charges ","90% of total billed charges ",24.96,90,,19.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",24.13,87,,19.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.41,70,,15.53,,,0,"percent of total billed charges ","70% of total billed charges ",19.41,25.79,
"KIT DURA PREP W/APPLICATOR",6006322,"CDM ",272,RC,,,OUTPATIENT,,,27.73,22.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.18,80,,17.74,,,0,"percent of total billed charges ","80% of total billed charges ",19.41,70,,15.53,,,0,"percent of total billed charges ","70% of total billed charges ",24.96,90,,19.97,,,0,"percent of total billed charges ","90% of total billed charges ",25.79,93,,20.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.57,85,,18.86,,,0,"percent of total billed charges ","85% of total billed charges ",24.96,90,,19.97,,,0,"percent of total billed charges ","90% of total billed charges ",24.96,90,,19.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",24.13,87,,19.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.41,70,,15.53,,,0,"percent of total billed charges ","70% of total billed charges ",19.41,25.79,
"CBL PATIENT 12' DISP",6006323,"CDM ",278,RC,,,OUTPATIENT,,,88.9,71.12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.12,80,,56.90,,,0,"percent of total billed charges ","80% of total billed charges ",62.23,70,,49.78,,,0,"percent of total billed charges ","70% of total billed charges ",80.01,90,,64.01,,,0,"percent of total billed charges ","90% of total billed charges ",82.68,93,,66.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",75.57,85,,60.46,,,0,"percent of total billed charges ","85% of total billed charges ",75.57,85,,60.46,,,0,"percent of total billed charges ","85% of total billed charges ",80.01,90,,64.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",77.34,87,,61.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.23,70,,49.78,,,0,"percent of total billed charges ","70% of total billed charges ",62.23,82.68,
"CATH PER-Q PICK LINE 4FR",6006326,"CDM ",278,RC,,,OUTPATIENT,,,323,258.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",258.4,80,,206.72,,,0,"percent of total billed charges ","80% of total billed charges ",226.1,70,,180.88,,,0,"percent of total billed charges ","70% of total billed charges ",290.7,90,,232.56,,,0,"percent of total billed charges ","90% of total billed charges ",300.39,93,,240.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",274.55,85,,219.64,,,0,"percent of total billed charges ","85% of total billed charges ",274.55,85,,219.64,,,0,"percent of total billed charges ","85% of total billed charges ",290.7,90,,232.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",281.01,87,,224.81,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",226.1,70,,180.88,,,0,"percent of total billed charges ","70% of total billed charges ",226.1,300.39,
"CATH 8FR J-TIP NIT",6006333,"CDM ",278,RC,,,OUTPATIENT,,,329.38,263.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.5,80,,210.80,,,0,"percent of total billed charges ","80% of total billed charges ",230.57,70,,184.46,,,0,"percent of total billed charges ","70% of total billed charges ",296.44,90,,237.15,,,0,"percent of total billed charges ","90% of total billed charges ",306.32,93,,245.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",279.97,85,,223.98,,,0,"percent of total billed charges ","85% of total billed charges ",279.97,85,,223.98,,,0,"percent of total billed charges ","85% of total billed charges ",296.44,90,,237.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",286.56,87,,229.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",230.57,70,,184.46,,,0,"percent of total billed charges ","70% of total billed charges ",230.57,306.32,
"GAUZE BORDER",6006336,"CDM ",272,RC,,,OUTPATIENT,,,5.67,4.536,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.54,80,,3.63,,,0,"percent of total billed charges ","80% of total billed charges ",3.97,70,,3.18,,,0,"percent of total billed charges ","70% of total billed charges ",5.1,90,,4.08,,,0,"percent of total billed charges ","90% of total billed charges ",5.27,93,,4.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4.82,85,,3.86,,,0,"percent of total billed charges ","85% of total billed charges ",5.1,90,,4.08,,,0,"percent of total billed charges ","90% of total billed charges ",5.1,90,,4.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4.93,87,,3.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.97,70,,3.18,,,0,"percent of total billed charges ","70% of total billed charges ",3.97,5.27,
"ELECTRODE FETAL SCALP (OB)",6006341,"CDM ",272,RC,,,OUTPATIENT,,,17.35,13.88,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.88,80,,11.10,,,0,"percent of total billed charges ","80% of total billed charges ",12.15,70,,9.72,,,0,"percent of total billed charges ","70% of total billed charges ",15.62,90,,12.50,,,0,"percent of total billed charges ","90% of total billed charges ",16.14,93,,12.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.75,85,,11.80,,,0,"percent of total billed charges ","85% of total billed charges ",15.62,90,,12.50,,,0,"percent of total billed charges ","90% of total billed charges ",15.62,90,,12.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.09,87,,12.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.15,70,,9.72,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,16.14,
"RINSE ORAL WOUND RADIACARE",6006343,"CDM ",272,RC,,,OUTPATIENT,,,48.18,38.544,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.54,80,,30.83,,,0,"percent of total billed charges ","80% of total billed charges ",33.73,70,,26.98,,,0,"percent of total billed charges ","70% of total billed charges ",43.36,90,,34.69,,,0,"percent of total billed charges ","90% of total billed charges ",44.81,93,,35.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.95,85,,32.76,,,0,"percent of total billed charges ","85% of total billed charges ",43.36,90,,34.69,,,0,"percent of total billed charges ","90% of total billed charges ",43.36,90,,34.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.92,87,,33.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.73,70,,26.98,,,0,"percent of total billed charges ","70% of total billed charges ",33.73,44.81,
"CREAM CAVILON FOOT OSTOMY",6006356,"CDM ",271,RC,,,OUTPATIENT,,,17.2,13.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.76,80,,11.01,,,0,"percent of total billed charges ","80% of total billed charges ",12.04,70,,9.63,,,0,"percent of total billed charges ","70% of total billed charges ",15.48,90,,12.38,,,0,"percent of total billed charges ","90% of total billed charges ",16,93,,12.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.62,85,,11.70,,,0,"percent of total billed charges ","85% of total billed charges ",15.48,90,,12.38,,,0,"percent of total billed charges ","90% of total billed charges ",15.48,90,,12.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.96,87,,11.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.04,70,,9.63,,,0,"percent of total billed charges ","70% of total billed charges ",12.04,16,
"GARMENT CALF COMPRESSIONS",6006358,"CDM ",271,RC,,,OUTPATIENT,,,54.9,43.92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.92,80,,35.14,,,0,"percent of total billed charges ","80% of total billed charges ",38.43,70,,30.74,,,0,"percent of total billed charges ","70% of total billed charges ",49.41,90,,39.53,,,0,"percent of total billed charges ","90% of total billed charges ",51.06,93,,40.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",46.67,85,,37.34,,,0,"percent of total billed charges ","85% of total billed charges ",49.41,90,,39.53,,,0,"percent of total billed charges ","90% of total billed charges ",49.41,90,,39.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",47.76,87,,38.21,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.43,70,,30.74,,,0,"percent of total billed charges ","70% of total billed charges ",38.43,51.06,
"DEVICE FOR CO2 DETECTION",6006370,"CDM ",271,RC,,,OUTPATIENT,,,32.4,25.92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.92,80,,20.74,,,0,"percent of total billed charges ","80% of total billed charges ",22.68,70,,18.14,,,0,"percent of total billed charges ","70% of total billed charges ",29.16,90,,23.33,,,0,"percent of total billed charges ","90% of total billed charges ",30.13,93,,24.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",27.54,85,,22.03,,,0,"percent of total billed charges ","85% of total billed charges ",29.16,90,,23.33,,,0,"percent of total billed charges ","90% of total billed charges ",29.16,90,,23.33,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",28.19,87,,22.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.68,70,,18.14,,,0,"percent of total billed charges ","70% of total billed charges ",22.68,30.13,
"DEODORIZER DROP M9 OSTOMY",6006387,"CDM ",271,RC,,,OUTPATIENT,,,13.79,11.032,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.03,80,,8.82,,,0,"percent of total billed charges ","80% of total billed charges ",9.65,70,,7.72,,,0,"percent of total billed charges ","70% of total billed charges ",12.41,90,,9.93,,,0,"percent of total billed charges ","90% of total billed charges ",12.82,93,,10.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.72,85,,9.38,,,0,"percent of total billed charges ","85% of total billed charges ",12.41,90,,9.93,,,0,"percent of total billed charges ","90% of total billed charges ",12.41,90,,9.93,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12,87,,9.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.65,70,,7.72,,,0,"percent of total billed charges ","70% of total billed charges ",9.65,12.82,
"BARRIER 4X4 FLEXTEND",6006405,"CDM ",272,RC,,,OUTPATIENT,,,25.48,20.384,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.38,80,,16.30,,,0,"percent of total billed charges ","80% of total billed charges ",17.84,70,,14.27,,,0,"percent of total billed charges ","70% of total billed charges ",22.93,90,,18.34,,,0,"percent of total billed charges ","90% of total billed charges ",23.7,93,,18.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.66,85,,17.33,,,0,"percent of total billed charges ","85% of total billed charges ",22.93,90,,18.34,,,0,"percent of total billed charges ","90% of total billed charges ",22.93,90,,18.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.17,87,,17.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.84,70,,14.27,,,0,"percent of total billed charges ","70% of total billed charges ",17.84,23.7,
"SPECULUM ANOSCOPE DISP",6006413,"CDM ",272,RC,,,OUTPATIENT,,,14.79,11.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.83,80,,9.46,,,0,"percent of total billed charges ","80% of total billed charges ",10.35,70,,8.28,,,0,"percent of total billed charges ","70% of total billed charges ",13.31,90,,10.65,,,0,"percent of total billed charges ","90% of total billed charges ",13.75,93,,11.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.57,85,,10.06,,,0,"percent of total billed charges ","85% of total billed charges ",13.31,90,,10.65,,,0,"percent of total billed charges ","90% of total billed charges ",13.31,90,,10.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.87,87,,10.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.35,70,,8.28,,,0,"percent of total billed charges ","70% of total billed charges ",10.35,13.75,
"DRESSING COMBIDERM ACD",6006423,"CDM ",272,RC,,,OUTPATIENT,,,23.12,18.496,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.5,80,,14.80,,,0,"percent of total billed charges ","80% of total billed charges ",16.18,70,,12.94,,,0,"percent of total billed charges ","70% of total billed charges ",20.81,90,,16.65,,,0,"percent of total billed charges ","90% of total billed charges ",21.5,93,,17.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.65,85,,15.72,,,0,"percent of total billed charges ","85% of total billed charges ",20.81,90,,16.65,,,0,"percent of total billed charges ","90% of total billed charges ",20.81,90,,16.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.11,87,,16.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.18,70,,12.94,,,0,"percent of total billed charges ","70% of total billed charges ",16.18,21.5,
"DRESSING HYDROFIBER AQUACEL",6006424,"CDM ",272,RC,,,OUTPATIENT,,,30.99,24.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.79,80,,19.83,,,0,"percent of total billed charges ","80% of total billed charges ",21.69,70,,17.35,,,0,"percent of total billed charges ","70% of total billed charges ",27.89,90,,22.31,,,0,"percent of total billed charges ","90% of total billed charges ",28.82,93,,23.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.34,85,,21.07,,,0,"percent of total billed charges ","85% of total billed charges ",27.89,90,,22.31,,,0,"percent of total billed charges ","90% of total billed charges ",27.89,90,,22.31,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.96,87,,21.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.69,70,,17.35,,,0,"percent of total billed charges ","70% of total billed charges ",21.69,28.82,
"PROBE OXIMETER (RS-10)",6006428,"CDM ",272,RC,,,OUTPATIENT,,,93.03,74.424,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.42,80,,59.54,,,0,"percent of total billed charges ","80% of total billed charges ",65.12,70,,52.10,,,0,"percent of total billed charges ","70% of total billed charges ",83.73,90,,66.98,,,0,"percent of total billed charges ","90% of total billed charges ",86.52,93,,69.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",79.08,85,,63.26,,,0,"percent of total billed charges ","85% of total billed charges ",83.73,90,,66.98,,,0,"percent of total billed charges ","90% of total billed charges ",83.73,90,,66.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",80.94,87,,64.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.12,70,,52.10,,,0,"percent of total billed charges ","70% of total billed charges ",65.12,86.52,
"PAD 4X4 POLYMEN",6006429,"CDM ",272,RC,,,OUTPATIENT,,,17.15,13.72,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.72,80,,10.98,,,0,"percent of total billed charges ","80% of total billed charges ",12.01,70,,9.61,,,0,"percent of total billed charges ","70% of total billed charges ",15.44,90,,12.35,,,0,"percent of total billed charges ","90% of total billed charges ",15.95,93,,12.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.58,85,,11.66,,,0,"percent of total billed charges ","85% of total billed charges ",15.44,90,,12.35,,,0,"percent of total billed charges ","90% of total billed charges ",15.44,90,,12.35,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.92,87,,11.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.01,70,,9.61,,,0,"percent of total billed charges ","70% of total billed charges ",12.01,15.95,
"PAD 3X3 POLYMEM",6006430,"CDM ",272,RC,,,OUTPATIENT,,,12.74,10.192,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.19,80,,8.15,,,0,"percent of total billed charges ","80% of total billed charges ",8.92,70,,7.14,,,0,"percent of total billed charges ","70% of total billed charges ",11.47,90,,9.18,,,0,"percent of total billed charges ","90% of total billed charges ",11.85,93,,9.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.83,85,,8.66,,,0,"percent of total billed charges ","85% of total billed charges ",11.47,90,,9.18,,,0,"percent of total billed charges ","90% of total billed charges ",11.47,90,,9.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.08,87,,8.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.92,70,,7.14,,,0,"percent of total billed charges ","70% of total billed charges ",8.92,11.85,
"DRESSING ISLAND",6006431,"CDM ",272,RC,,,OUTPATIENT,,,19.81,15.848,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.85,80,,12.68,,,0,"percent of total billed charges ","80% of total billed charges ",13.87,70,,11.10,,,0,"percent of total billed charges ","70% of total billed charges ",17.83,90,,14.26,,,0,"percent of total billed charges ","90% of total billed charges ",18.42,93,,14.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.84,85,,13.47,,,0,"percent of total billed charges ","85% of total billed charges ",17.83,90,,14.26,,,0,"percent of total billed charges ","90% of total billed charges ",17.83,90,,14.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.23,87,,13.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.87,70,,11.10,,,0,"percent of total billed charges ","70% of total billed charges ",13.87,18.42,
"TRACH CUFFID FENSTID SZ8",6006440,"CDM ",272,RC,,,OUTPATIENT,,,192.11,153.688,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.69,80,,122.95,,,0,"percent of total billed charges ","80% of total billed charges ",134.48,70,,107.58,,,0,"percent of total billed charges ","70% of total billed charges ",172.9,90,,138.32,,,0,"percent of total billed charges ","90% of total billed charges ",178.66,93,,142.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",163.29,85,,130.63,,,0,"percent of total billed charges ","85% of total billed charges ",172.9,90,,138.32,,,0,"percent of total billed charges ","90% of total billed charges ",172.9,90,,138.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",167.14,87,,133.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",134.48,70,,107.58,,,0,"percent of total billed charges ","70% of total billed charges ",134.48,178.66,
"TRACH CUFFLIS FENSTID SZ6",6006441,"CDM ",272,RC,,,OUTPATIENT,,,168.69,134.952,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",134.95,80,,107.96,,,0,"percent of total billed charges ","80% of total billed charges ",118.08,70,,94.46,,,0,"percent of total billed charges ","70% of total billed charges ",151.82,90,,121.46,,,0,"percent of total billed charges ","90% of total billed charges ",156.88,93,,125.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",143.39,85,,114.71,,,0,"percent of total billed charges ","85% of total billed charges ",151.82,90,,121.46,,,0,"percent of total billed charges ","90% of total billed charges ",151.82,90,,121.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",146.76,87,,117.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.08,70,,94.46,,,0,"percent of total billed charges ","70% of total billed charges ",118.08,156.88,
"TRACH CUFFLIS FENSTID SZ4",6006442,"CDM ",272,RC,,,OUTPATIENT,,,165.58,132.464,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.46,80,,105.97,,,0,"percent of total billed charges ","80% of total billed charges ",115.91,70,,92.73,,,0,"percent of total billed charges ","70% of total billed charges ",149.02,90,,119.22,,,0,"percent of total billed charges ","90% of total billed charges ",153.99,93,,123.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",140.74,85,,112.59,,,0,"percent of total billed charges ","85% of total billed charges ",149.02,90,,119.22,,,0,"percent of total billed charges ","90% of total billed charges ",149.02,90,,119.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",144.05,87,,115.24,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.91,70,,92.73,,,0,"percent of total billed charges ","70% of total billed charges ",115.91,153.99,
"VALVE SPEAK F/TRACH",6006443,"CDM ",272,RC,,,OUTPATIENT,,,141.48,113.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.18,80,,90.54,,,0,"percent of total billed charges ","80% of total billed charges ",99.04,70,,79.23,,,0,"percent of total billed charges ","70% of total billed charges ",127.33,90,,101.86,,,0,"percent of total billed charges ","90% of total billed charges ",131.58,93,,105.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",120.26,85,,96.21,,,0,"percent of total billed charges ","85% of total billed charges ",127.33,90,,101.86,,,0,"percent of total billed charges ","90% of total billed charges ",127.33,90,,101.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",123.09,87,,98.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.04,70,,79.23,,,0,"percent of total billed charges ","70% of total billed charges ",99.04,131.58,
"CANNULA INNER DISP SZ4",6006444,"CDM ",270,RC,,,OUTPATIENT,,,14.94,11.952,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.95,80,,9.56,,,0,"percent of total billed charges ","80% of total billed charges ",10.46,70,,8.37,,,0,"percent of total billed charges ","70% of total billed charges ",13.45,90,,10.76,,,0,"percent of total billed charges ","90% of total billed charges ",13.89,93,,11.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.7,85,,10.16,,,0,"percent of total billed charges ","85% of total billed charges ",13.45,90,,10.76,,,0,"percent of total billed charges ","90% of total billed charges ",13.45,90,,10.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13,87,,10.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.46,70,,8.37,,,0,"percent of total billed charges ","70% of total billed charges ",10.46,13.89,
"CANNULA INNER DISP SZ6",6006445,"CDM ",270,RC,,,OUTPATIENT,,,14.94,11.952,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.95,80,,9.56,,,0,"percent of total billed charges ","80% of total billed charges ",10.46,70,,8.37,,,0,"percent of total billed charges ","70% of total billed charges ",13.45,90,,10.76,,,0,"percent of total billed charges ","90% of total billed charges ",13.89,93,,11.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.7,85,,10.16,,,0,"percent of total billed charges ","85% of total billed charges ",13.45,90,,10.76,,,0,"percent of total billed charges ","90% of total billed charges ",13.45,90,,10.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13,87,,10.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.46,70,,8.37,,,0,"percent of total billed charges ","70% of total billed charges ",10.46,13.89,
"CANNULA INNER DISP SZ8",6006446,"CDM ",270,RC,,,OUTPATIENT,,,14.94,11.952,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.95,80,,9.56,,,0,"percent of total billed charges ","80% of total billed charges ",10.46,70,,8.37,,,0,"percent of total billed charges ","70% of total billed charges ",13.45,90,,10.76,,,0,"percent of total billed charges ","90% of total billed charges ",13.89,93,,11.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.7,85,,10.16,,,0,"percent of total billed charges ","85% of total billed charges ",13.45,90,,10.76,,,0,"percent of total billed charges ","90% of total billed charges ",13.45,90,,10.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13,87,,10.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.46,70,,8.37,,,0,"percent of total billed charges ","70% of total billed charges ",10.46,13.89,
"CIRCUIT BIPAP",6006458,"CDM ",272,RC,,,OUTPATIENT,,,28.94,23.152,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.15,80,,18.52,,,0,"percent of total billed charges ","80% of total billed charges ",20.26,70,,16.21,,,0,"percent of total billed charges ","70% of total billed charges ",26.05,90,,20.84,,,0,"percent of total billed charges ","90% of total billed charges ",26.91,93,,21.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",24.6,85,,19.68,,,0,"percent of total billed charges ","85% of total billed charges ",26.05,90,,20.84,,,0,"percent of total billed charges ","90% of total billed charges ",26.05,90,,20.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",25.18,87,,20.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.26,70,,16.21,,,0,"percent of total billed charges ","70% of total billed charges ",20.26,26.91,
"DRESSING MESALT RIBBON 3/4 X 3",6006460,"CDM ",272,RC,,,OUTPATIENT,,,12.44,9.952,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.95,80,,7.96,,,0,"percent of total billed charges ","80% of total billed charges ",8.71,70,,6.97,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,90,,8.96,,,0,"percent of total billed charges ","90% of total billed charges ",11.57,93,,9.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.57,85,,8.46,,,0,"percent of total billed charges ","85% of total billed charges ",11.2,90,,8.96,,,0,"percent of total billed charges ","90% of total billed charges ",11.2,90,,8.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.82,87,,8.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.71,70,,6.97,,,0,"percent of total billed charges ","70% of total billed charges ",8.71,11.57,
"DRESSING MESALT 3X3",6006461,"CDM ",272,RC,,,OUTPATIENT,,,5.52,4.416,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.42,80,,3.54,,,0,"percent of total billed charges ","80% of total billed charges ",3.86,70,,3.09,,,0,"percent of total billed charges ","70% of total billed charges ",4.97,90,,3.98,,,0,"percent of total billed charges ","90% of total billed charges ",5.13,93,,4.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4.69,85,,3.75,,,0,"percent of total billed charges ","85% of total billed charges ",4.97,90,,3.98,,,0,"percent of total billed charges ","90% of total billed charges ",4.97,90,,3.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4.8,87,,3.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.86,70,,3.09,,,0,"percent of total billed charges ","70% of total billed charges ",3.86,5.13,
"DRESSING MESALT 2X2",6006462,"CDM ",272,RC,,,OUTPATIENT,,,5.97,4.776,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.78,80,,3.82,,,0,"percent of total billed charges ","80% of total billed charges ",4.18,70,,3.34,,,0,"percent of total billed charges ","70% of total billed charges ",5.37,90,,4.30,,,0,"percent of total billed charges ","90% of total billed charges ",5.55,93,,4.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.07,85,,4.06,,,0,"percent of total billed charges ","85% of total billed charges ",5.37,90,,4.30,,,0,"percent of total billed charges ","90% of total billed charges ",5.37,90,,4.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5.19,87,,4.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.18,70,,3.34,,,0,"percent of total billed charges ","70% of total billed charges ",4.18,5.55,
"NEBULIZER PEDI W/BT",6006469,"CDM ",272,RC,,,OUTPATIENT,,,27.58,22.064,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.06,80,,17.65,,,0,"percent of total billed charges ","80% of total billed charges ",19.31,70,,15.45,,,0,"percent of total billed charges ","70% of total billed charges ",24.82,90,,19.86,,,0,"percent of total billed charges ","90% of total billed charges ",25.65,93,,20.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.44,85,,18.75,,,0,"percent of total billed charges ","85% of total billed charges ",24.82,90,,19.86,,,0,"percent of total billed charges ","90% of total billed charges ",24.82,90,,19.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",23.99,87,,19.19,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.31,70,,15.45,,,0,"percent of total billed charges ","70% of total billed charges ",19.31,25.65,
"SLING PEDI",6006478,"CDM ",271,RC,,,OUTPATIENT,,,45.64,36.512,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.51,80,,29.21,,,0,"percent of total billed charges ","80% of total billed charges ",31.95,70,,25.56,,,0,"percent of total billed charges ","70% of total billed charges ",41.08,90,,32.86,,,0,"percent of total billed charges ","90% of total billed charges ",42.45,93,,33.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.79,85,,31.03,,,0,"percent of total billed charges ","85% of total billed charges ",41.08,90,,32.86,,,0,"percent of total billed charges ","90% of total billed charges ",41.08,90,,32.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.71,87,,31.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.95,70,,25.56,,,0,"percent of total billed charges ","70% of total billed charges ",31.95,42.45,
"DEVICE SUCTION TUBE ATTACHMENT",6006481,"CDM ",272,RC,,,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.6,80,,7.68,,,0,"percent of total billed charges ","80% of total billed charges ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"GAUZE VASELINE 1/2X72",6006482,"CDM ",272,RC,,,OUTPATIENT,,,6.37,5.096,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.1,80,,4.08,,,0,"percent of total billed charges ","80% of total billed charges ",4.46,70,,3.57,,,0,"percent of total billed charges ","70% of total billed charges ",5.73,90,,4.58,,,0,"percent of total billed charges ","90% of total billed charges ",5.92,93,,4.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.41,85,,4.33,,,0,"percent of total billed charges ","85% of total billed charges ",5.73,90,,4.58,,,0,"percent of total billed charges ","90% of total billed charges ",5.73,90,,4.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5.54,87,,4.43,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.46,70,,3.57,,,0,"percent of total billed charges ","70% of total billed charges ",4.46,5.92,
"HOLSTER SUCTION-TIP",6006483,"CDM ",272,RC,,,OUTPATIENT,,,15.75,12.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.6,80,,10.08,,,0,"percent of total billed charges ","80% of total billed charges ",11.03,70,,8.82,,,0,"percent of total billed charges ","70% of total billed charges ",14.18,90,,11.34,,,0,"percent of total billed charges ","90% of total billed charges ",14.65,93,,11.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.39,85,,10.71,,,0,"percent of total billed charges ","85% of total billed charges ",14.18,90,,11.34,,,0,"percent of total billed charges ","90% of total billed charges ",14.18,90,,11.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.7,87,,10.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.03,70,,8.82,,,0,"percent of total billed charges ","70% of total billed charges ",11.03,14.65,
"DRESSING FILM 2 3/4X2-3/8",6006502,"CDM ",272,RC,,,OUTPATIENT,,,2.26,1.808,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.81,80,,1.45,,,0,"percent of total billed charges ","80% of total billed charges ",1.58,70,,1.26,,,0,"percent of total billed charges ","70% of total billed charges ",2.03,90,,1.62,,,0,"percent of total billed charges ","90% of total billed charges ",2.1,93,,1.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1.92,85,,1.54,,,0,"percent of total billed charges ","85% of total billed charges ",2.03,90,,1.62,,,0,"percent of total billed charges ","90% of total billed charges ",2.03,90,,1.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1.97,87,,1.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.58,70,,1.26,,,0,"percent of total billed charges ","70% of total billed charges ",1.58,2.1,
"DRESSING FILM 5X7",6006503,"CDM ",272,RC,,,OUTPATIENT,,,6.92,5.536,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.54,80,,4.43,,,0,"percent of total billed charges ","80% of total billed charges ",4.84,70,,3.87,,,0,"percent of total billed charges ","70% of total billed charges ",6.23,90,,4.98,,,0,"percent of total billed charges ","90% of total billed charges ",6.44,93,,5.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.88,85,,4.70,,,0,"percent of total billed charges ","85% of total billed charges ",6.23,90,,4.98,,,0,"percent of total billed charges ","90% of total billed charges ",6.23,90,,4.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.02,87,,4.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.84,70,,3.87,,,0,"percent of total billed charges ","70% of total billed charges ",4.84,6.44,
"SUTURE SILK 4.0 1677H",6006506,"CDM ",272,RC,,,OUTPATIENT,,,16.05,12.84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.84,80,,10.27,,,0,"percent of total billed charges ","80% of total billed charges ",11.24,70,,8.99,,,0,"percent of total billed charges ","70% of total billed charges ",14.45,90,,11.56,,,0,"percent of total billed charges ","90% of total billed charges ",14.93,93,,11.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.64,85,,10.91,,,0,"percent of total billed charges ","85% of total billed charges ",14.45,90,,11.56,,,0,"percent of total billed charges ","90% of total billed charges ",14.45,90,,11.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.96,87,,11.17,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.24,70,,8.99,,,0,"percent of total billed charges ","70% of total billed charges ",11.24,14.93,
"SUTURE SILK 5.0 1676H",6006507,"CDM ",272,RC,,,OUTPATIENT,,,12.24,9.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.79,80,,7.83,,,0,"percent of total billed charges ","80% of total billed charges ",8.57,70,,6.86,,,0,"percent of total billed charges ","70% of total billed charges ",11.02,90,,8.82,,,0,"percent of total billed charges ","90% of total billed charges ",11.38,93,,9.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.4,85,,8.32,,,0,"percent of total billed charges ","85% of total billed charges ",11.02,90,,8.82,,,0,"percent of total billed charges ","90% of total billed charges ",11.02,90,,8.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.65,87,,8.52,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.57,70,,6.86,,,0,"percent of total billed charges ","70% of total billed charges ",8.57,11.38,
"SUTURE SILK 6.0 1675H",6006508,"CDM ",272,RC,,,OUTPATIENT,,,18.41,14.728,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.73,80,,11.78,,,0,"percent of total billed charges ","80% of total billed charges ",12.89,70,,10.31,,,0,"percent of total billed charges ","70% of total billed charges ",16.57,90,,13.26,,,0,"percent of total billed charges ","90% of total billed charges ",17.12,93,,13.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.65,85,,12.52,,,0,"percent of total billed charges ","85% of total billed charges ",16.57,90,,13.26,,,0,"percent of total billed charges ","90% of total billed charges ",16.57,90,,13.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.02,87,,12.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,70,,10.31,,,0,"percent of total billed charges ","70% of total billed charges ",12.89,17.12,
"SUTURE CHROMIC 2.0 887H",6006509,"CDM ",272,RC,,,OUTPATIENT,,,9.28,7.424,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.42,80,,5.94,,,0,"percent of total billed charges ","80% of total billed charges ",6.5,70,,5.20,,,0,"percent of total billed charges ","70% of total billed charges ",8.35,90,,6.68,,,0,"percent of total billed charges ","90% of total billed charges ",8.63,93,,6.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7.89,85,,6.31,,,0,"percent of total billed charges ","85% of total billed charges ",8.35,90,,6.68,,,0,"percent of total billed charges ","90% of total billed charges ",8.35,90,,6.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",8.07,87,,6.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.5,70,,5.20,,,0,"percent of total billed charges ","70% of total billed charges ",6.5,8.63,
"SUTURE CHROMIC 3.0 636G",6006510,"CDM ",272,RC,,,OUTPATIENT,,,9.53,7.624,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.62,80,,6.10,,,0,"percent of total billed charges ","80% of total billed charges ",6.67,70,,5.34,,,0,"percent of total billed charges ","70% of total billed charges ",8.58,90,,6.86,,,0,"percent of total billed charges ","90% of total billed charges ",8.86,93,,7.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.1,85,,6.48,,,0,"percent of total billed charges ","85% of total billed charges ",8.58,90,,6.86,,,0,"percent of total billed charges ","90% of total billed charges ",8.58,90,,6.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",8.29,87,,6.63,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.67,70,,5.34,,,0,"percent of total billed charges ","70% of total billed charges ",6.67,8.86,
"SUTURE PLAIN GUT 3.0 H822G",6006511,"CDM ",272,RC,,,OUTPATIENT,,,9.53,7.624,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.62,80,,6.10,,,0,"percent of total billed charges ","80% of total billed charges ",6.67,70,,5.34,,,0,"percent of total billed charges ","70% of total billed charges ",8.58,90,,6.86,,,0,"percent of total billed charges ","90% of total billed charges ",8.86,93,,7.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.1,85,,6.48,,,0,"percent of total billed charges ","85% of total billed charges ",8.58,90,,6.86,,,0,"percent of total billed charges ","90% of total billed charges ",8.58,90,,6.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",8.29,87,,6.63,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.67,70,,5.34,,,0,"percent of total billed charges ","70% of total billed charges ",6.67,8.86,
"SUTURE PLAIN GUT 4.0 H821G",6006512,"CDM ",272,RC,,,OUTPATIENT,,,9.53,7.624,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.62,80,,6.10,,,0,"percent of total billed charges ","80% of total billed charges ",6.67,70,,5.34,,,0,"percent of total billed charges ","70% of total billed charges ",8.58,90,,6.86,,,0,"percent of total billed charges ","90% of total billed charges ",8.86,93,,7.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.1,85,,6.48,,,0,"percent of total billed charges ","85% of total billed charges ",8.58,90,,6.86,,,0,"percent of total billed charges ","90% of total billed charges ",8.58,90,,6.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",8.29,87,,6.63,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.67,70,,5.34,,,0,"percent of total billed charges ","70% of total billed charges ",6.67,8.86,
"SUTURE PROLENE 6.0 P-3 8695G",6006515,"CDM ",272,RC,,,OUTPATIENT,,,19.96,15.968,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.97,80,,12.78,,,0,"percent of total billed charges ","80% of total billed charges ",13.97,70,,11.18,,,0,"percent of total billed charges ","70% of total billed charges ",17.96,90,,14.37,,,0,"percent of total billed charges ","90% of total billed charges ",18.56,93,,14.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.97,85,,13.58,,,0,"percent of total billed charges ","85% of total billed charges ",17.96,90,,14.37,,,0,"percent of total billed charges ","90% of total billed charges ",17.96,90,,14.37,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.37,87,,13.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.97,70,,11.18,,,0,"percent of total billed charges ","70% of total billed charges ",13.97,18.56,
"SUTURE VICRYL 6.0 P-3 J492G",6006516,"CDM ",272,RC,,,OUTPATIENT,,,16.8,13.44,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.44,80,,10.75,,,0,"percent of total billed charges ","80% of total billed charges ",11.76,70,,9.41,,,0,"percent of total billed charges ","70% of total billed charges ",15.12,90,,12.10,,,0,"percent of total billed charges ","90% of total billed charges ",15.62,93,,12.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.28,85,,11.42,,,0,"percent of total billed charges ","85% of total billed charges ",15.12,90,,12.10,,,0,"percent of total billed charges ","90% of total billed charges ",15.12,90,,12.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.62,87,,11.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.76,70,,9.41,,,0,"percent of total billed charges ","70% of total billed charges ",11.76,15.62,
"SUTURE RAPIDE 4.0 PC-3 VR845",6006518,"CDM ",272,RC,,,OUTPATIENT,,,22.97,18.376,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.38,80,,14.70,,,0,"percent of total billed charges ","80% of total billed charges ",16.08,70,,12.86,,,0,"percent of total billed charges ","70% of total billed charges ",20.67,90,,16.54,,,0,"percent of total billed charges ","90% of total billed charges ",21.36,93,,17.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.52,85,,15.62,,,0,"percent of total billed charges ","85% of total billed charges ",20.67,90,,16.54,,,0,"percent of total billed charges ","90% of total billed charges ",20.67,90,,16.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.98,87,,15.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.08,70,,12.86,,,0,"percent of total billed charges ","70% of total billed charges ",16.08,21.36,
"DRESSING TUBIFAST",6006519,"CDM ",272,RC,,,OUTPATIENT,,,1.61,1.288,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.29,80,,1.03,,,0,"percent of total billed charges ","80% of total billed charges ",1.13,70,,0.90,,,0,"percent of total billed charges ","70% of total billed charges ",1.45,90,,1.16,,,0,"percent of total billed charges ","90% of total billed charges ",1.5,93,,1.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1.37,85,,1.10,,,0,"percent of total billed charges ","85% of total billed charges ",1.45,90,,1.16,,,0,"percent of total billed charges ","90% of total billed charges ",1.45,90,,1.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1.4,87,,1.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.13,70,,0.90,,,0,"percent of total billed charges ","70% of total billed charges ",1.13,1.5,
"DRESSING POLYMEN DOT 2X2",6006520,"CDM ",272,RC,,,OUTPATIENT,,,4.31,3.448,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.45,80,,2.76,,,0,"percent of total billed charges ","80% of total billed charges ",3.02,70,,2.42,,,0,"percent of total billed charges ","70% of total billed charges ",3.88,90,,3.10,,,0,"percent of total billed charges ","90% of total billed charges ",4.01,93,,3.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3.66,85,,2.93,,,0,"percent of total billed charges ","85% of total billed charges ",3.88,90,,3.10,,,0,"percent of total billed charges ","90% of total billed charges ",3.88,90,,3.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3.75,87,,3.00,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.02,70,,2.42,,,0,"percent of total billed charges ","70% of total billed charges ",3.02,4.01,
"DRESSING ISLAND 6X6",6006521,"CDM ",272,RC,,,OUTPATIENT,,,32.8,26.24,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.24,80,,20.99,,,0,"percent of total billed charges ","80% of total billed charges ",22.96,70,,18.37,,,0,"percent of total billed charges ","70% of total billed charges ",29.52,90,,23.62,,,0,"percent of total billed charges ","90% of total billed charges ",30.5,93,,24.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",27.88,85,,22.30,,,0,"percent of total billed charges ","85% of total billed charges ",29.52,90,,23.62,,,0,"percent of total billed charges ","90% of total billed charges ",29.52,90,,23.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",28.54,87,,22.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.96,70,,18.37,,,0,"percent of total billed charges ","70% of total billed charges ",22.96,30.5,
"DRESSING TEGARDERM HP",6006527,"CDM ",272,RC,,,OUTPATIENT,,,5.11,4.088,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.09,80,,3.27,,,0,"percent of total billed charges ","80% of total billed charges ",3.58,70,,2.86,,,0,"percent of total billed charges ","70% of total billed charges ",4.6,90,,3.68,,,0,"percent of total billed charges ","90% of total billed charges ",4.75,93,,3.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4.34,85,,3.47,,,0,"percent of total billed charges ","85% of total billed charges ",4.6,90,,3.68,,,0,"percent of total billed charges ","90% of total billed charges ",4.6,90,,3.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4.45,87,,3.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.58,70,,2.86,,,0,"percent of total billed charges ","70% of total billed charges ",3.58,4.75,
"ELECTRODE BIPHASIC ADULT",6006537,"CDM ",272,RC,,,OUTPATIENT,,,123.3,98.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.64,80,,78.91,,,0,"percent of total billed charges ","80% of total billed charges ",86.31,70,,69.05,,,0,"percent of total billed charges ","70% of total billed charges ",110.97,90,,88.78,,,0,"percent of total billed charges ","90% of total billed charges ",114.67,93,,91.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",104.81,85,,83.85,,,0,"percent of total billed charges ","85% of total billed charges ",110.97,90,,88.78,,,0,"percent of total billed charges ","90% of total billed charges ",110.97,90,,88.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",107.27,87,,85.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.31,70,,69.05,,,0,"percent of total billed charges ","70% of total billed charges ",86.31,114.67,
"SET IRRIGATION LOW PSI",6006538,"CDM ",272,RC,,,OUTPATIENT,,,42.63,34.104,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.1,80,,27.28,,,0,"percent of total billed charges ","80% of total billed charges ",29.84,70,,23.87,,,0,"percent of total billed charges ","70% of total billed charges ",38.37,90,,30.70,,,0,"percent of total billed charges ","90% of total billed charges ",39.65,93,,31.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",36.24,85,,28.99,,,0,"percent of total billed charges ","85% of total billed charges ",38.37,90,,30.70,,,0,"percent of total billed charges ","90% of total billed charges ",38.37,90,,30.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",37.09,87,,29.67,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.84,70,,23.87,,,0,"percent of total billed charges ","70% of total billed charges ",29.84,39.65,
"DRESSING CURAFOAM 4X4",6006572,"CDM ",272,RC,,,OUTPATIENT,,,11.13,8.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.9,80,,7.12,,,0,"percent of total billed charges ","80% of total billed charges ",7.79,70,,6.23,,,0,"percent of total billed charges ","70% of total billed charges ",10.02,90,,8.02,,,0,"percent of total billed charges ","90% of total billed charges ",10.35,93,,8.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.46,85,,7.57,,,0,"percent of total billed charges ","85% of total billed charges ",10.02,90,,8.02,,,0,"percent of total billed charges ","90% of total billed charges ",10.02,90,,8.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.68,87,,7.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.79,70,,6.23,,,0,"percent of total billed charges ","70% of total billed charges ",7.79,10.35,
"DRESSING SACRAL TAPERED HYDRO",6006574,"CDM ",272,RC,,,OUTPATIENT,,,18.41,14.728,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.73,80,,11.78,,,0,"percent of total billed charges ","80% of total billed charges ",12.89,70,,10.31,,,0,"percent of total billed charges ","70% of total billed charges ",16.57,90,,13.26,,,0,"percent of total billed charges ","90% of total billed charges ",17.12,93,,13.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.65,85,,12.52,,,0,"percent of total billed charges ","85% of total billed charges ",16.57,90,,13.26,,,0,"percent of total billed charges ","90% of total billed charges ",16.57,90,,13.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.02,87,,12.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.89,70,,10.31,,,0,"percent of total billed charges ","70% of total billed charges ",12.89,17.12,
"DRESSING HYDROCOLLOID 6X6",6006575,"CDM ",272,RC,,,OUTPATIENT,,,38.5,30.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.8,80,,24.64,,,0,"percent of total billed charges ","80% of total billed charges ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,93,,28.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.73,85,,26.18,,,0,"percent of total billed charges ","85% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.5,87,,26.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",26.95,35.81,
"BANDAGE PROFORE LAYERED",6006580,"CDM ",272,RC,,,OUTPATIENT,,,52,41.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.6,80,,33.28,,,0,"percent of total billed charges ","80% of total billed charges ",36.4,70,,29.12,,,0,"percent of total billed charges ","70% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",48.36,93,,38.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",44.2,85,,35.36,,,0,"percent of total billed charges ","85% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",45.24,87,,36.19,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.4,70,,29.12,,,0,"percent of total billed charges ","70% of total billed charges ",36.4,48.36,
"CREAM EMOLLIANT CAVILON",6006723,"CDM ",271,RC,,,OUTPATIENT,,,18.96,15.168,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.17,80,,12.14,,,0,"percent of total billed charges ","80% of total billed charges ",13.27,70,,10.62,,,0,"percent of total billed charges ","70% of total billed charges ",17.06,90,,13.65,,,0,"percent of total billed charges ","90% of total billed charges ",17.63,93,,14.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.12,85,,12.90,,,0,"percent of total billed charges ","85% of total billed charges ",17.06,90,,13.65,,,0,"percent of total billed charges ","90% of total billed charges ",17.06,90,,13.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.5,87,,13.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.27,70,,10.62,,,0,"percent of total billed charges ","70% of total billed charges ",13.27,17.63,
"OINTMENT CALMOSEPTINE 2.5OZ",6006725,"CDM ",271,RC,,,OUTPATIENT,,,20.41,16.328,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.33,80,,13.06,,,0,"percent of total billed charges ","80% of total billed charges ",14.29,70,,11.43,,,0,"percent of total billed charges ","70% of total billed charges ",18.37,90,,14.70,,,0,"percent of total billed charges ","90% of total billed charges ",18.98,93,,15.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.35,85,,13.88,,,0,"percent of total billed charges ","85% of total billed charges ",18.37,90,,14.70,,,0,"percent of total billed charges ","90% of total billed charges ",18.37,90,,14.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.76,87,,14.21,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.29,70,,11.43,,,0,"percent of total billed charges ","70% of total billed charges ",14.29,18.98,
"ACEPELLA LOW FLOW",6006737,"CDM ",272,RC,,,OUTPATIENT,,,179.09,143.272,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",143.27,80,,114.62,,,0,"percent of total billed charges ","80% of total billed charges ",125.36,70,,100.29,,,0,"percent of total billed charges ","70% of total billed charges ",161.18,90,,128.94,,,0,"percent of total billed charges ","90% of total billed charges ",166.55,93,,133.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",152.23,85,,121.78,,,0,"percent of total billed charges ","85% of total billed charges ",161.18,90,,128.94,,,0,"percent of total billed charges ","90% of total billed charges ",161.18,90,,128.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",155.81,87,,124.65,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.36,70,,100.29,,,0,"percent of total billed charges ","70% of total billed charges ",125.36,166.55,
"ACEPELLA HIGH FLOW",6006738,"CDM ",272,RC,,,OUTPATIENT,,,179.09,143.272,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",143.27,80,,114.62,,,0,"percent of total billed charges ","80% of total billed charges ",125.36,70,,100.29,,,0,"percent of total billed charges ","70% of total billed charges ",161.18,90,,128.94,,,0,"percent of total billed charges ","90% of total billed charges ",166.55,93,,133.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",152.23,85,,121.78,,,0,"percent of total billed charges ","85% of total billed charges ",161.18,90,,128.94,,,0,"percent of total billed charges ","90% of total billed charges ",161.18,90,,128.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",155.81,87,,124.65,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.36,70,,100.29,,,0,"percent of total billed charges ","70% of total billed charges ",125.36,166.55,
"CATH 5FR LATEX FREE PEDI",6006746,"CDM ",272,RC,,,OUTPATIENT,,,20.91,16.728,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.73,80,,13.38,,,0,"percent of total billed charges ","80% of total billed charges ",14.64,70,,11.71,,,0,"percent of total billed charges ","70% of total billed charges ",18.82,90,,15.06,,,0,"percent of total billed charges ","90% of total billed charges ",19.45,93,,15.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.77,85,,14.22,,,0,"percent of total billed charges ","85% of total billed charges ",18.82,90,,15.06,,,0,"percent of total billed charges ","90% of total billed charges ",18.82,90,,15.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.19,87,,14.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.64,70,,11.71,,,0,"percent of total billed charges ","70% of total billed charges ",14.64,19.45,
"DRSG BIOPOLYMERIC HYALOFILL F",6006754,"CDM ",272,RC,,,OUTPATIENT,,,97.75,78.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.2,80,,62.56,,,0,"percent of total billed charges ","80% of total billed charges ",68.43,70,,54.74,,,0,"percent of total billed charges ","70% of total billed charges ",87.98,90,,70.38,,,0,"percent of total billed charges ","90% of total billed charges ",90.91,93,,72.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.09,85,,66.47,,,0,"percent of total billed charges ","85% of total billed charges ",87.98,90,,70.38,,,0,"percent of total billed charges ","90% of total billed charges ",87.98,90,,70.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.04,87,,68.03,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.43,70,,54.74,,,0,"percent of total billed charges ","70% of total billed charges ",68.43,90.91,
"PAD CPM (PT)",6006756,"CDM ",271,RC,,,OUTPATIENT,,,122.24,97.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.79,80,,78.23,,,0,"percent of total billed charges ","80% of total billed charges ",85.57,70,,68.46,,,0,"percent of total billed charges ","70% of total billed charges ",110.02,90,,88.02,,,0,"percent of total billed charges ","90% of total billed charges ",113.68,93,,90.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",103.9,85,,83.12,,,0,"percent of total billed charges ","85% of total billed charges ",110.02,90,,88.02,,,0,"percent of total billed charges ","90% of total billed charges ",110.02,90,,88.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",106.35,87,,85.08,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.57,70,,68.46,,,0,"percent of total billed charges ","70% of total billed charges ",85.57,113.68,
"DRESSING TEGADERM PAD",6006762,"CDM ",272,RC,,,OUTPATIENT,,,2.48,1.984,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.98,80,,1.58,,,0,"percent of total billed charges ","80% of total billed charges ",1.74,70,,1.39,,,0,"percent of total billed charges ","70% of total billed charges ",2.23,90,,1.78,,,0,"percent of total billed charges ","90% of total billed charges ",2.31,93,,1.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2.11,85,,1.69,,,0,"percent of total billed charges ","85% of total billed charges ",2.23,90,,1.78,,,0,"percent of total billed charges ","90% of total billed charges ",2.23,90,,1.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2.16,87,,1.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.74,70,,1.39,,,0,"percent of total billed charges ","70% of total billed charges ",1.74,2.31,
"BAG RESUSITATION MANUAL INFANT",6006763,"CDM ",271,RC,,,OUTPATIENT,,,109.61,87.688,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.69,80,,70.15,,,0,"percent of total billed charges ","80% of total billed charges ",76.73,70,,61.38,,,0,"percent of total billed charges ","70% of total billed charges ",98.65,90,,78.92,,,0,"percent of total billed charges ","90% of total billed charges ",101.94,93,,81.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",93.17,85,,74.54,,,0,"percent of total billed charges ","85% of total billed charges ",98.65,90,,78.92,,,0,"percent of total billed charges ","90% of total billed charges ",98.65,90,,78.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",95.36,87,,76.29,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.73,70,,61.38,,,0,"percent of total billed charges ","70% of total billed charges ",76.73,101.94,
"NASAL PACK ANTER/POST 7.5CM",6006764,"CDM ",272,RC,,,OUTPATIENT,,,170.24,136.192,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136.19,80,,108.95,,,0,"percent of total billed charges ","80% of total billed charges ",119.17,70,,95.34,,,0,"percent of total billed charges ","70% of total billed charges ",153.22,90,,122.58,,,0,"percent of total billed charges ","90% of total billed charges ",158.32,93,,126.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",144.7,85,,115.76,,,0,"percent of total billed charges ","85% of total billed charges ",153.22,90,,122.58,,,0,"percent of total billed charges ","90% of total billed charges ",153.22,90,,122.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",148.11,87,,118.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.17,70,,95.34,,,0,"percent of total billed charges ","70% of total billed charges ",119.17,158.32,
"NASAL PACK ANTERIOR 5.5CM",6006765,"CDM ",272,RC,,,OUTPATIENT,,,164.91,131.928,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.93,80,,105.54,,,0,"percent of total billed charges ","80% of total billed charges ",115.44,70,,92.35,,,0,"percent of total billed charges ","70% of total billed charges ",148.42,90,,118.74,,,0,"percent of total billed charges ","90% of total billed charges ",153.37,93,,122.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",140.17,85,,112.14,,,0,"percent of total billed charges ","85% of total billed charges ",148.42,90,,118.74,,,0,"percent of total billed charges ","90% of total billed charges ",148.42,90,,118.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",143.47,87,,114.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.44,70,,92.35,,,0,"percent of total billed charges ","70% of total billed charges ",115.44,153.37,
"NASAL PACK ANTERIOR 4.5CM",6006766,"CDM ",272,RC,,,OUTPATIENT,,,158.24,126.592,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",126.59,80,,101.27,,,0,"percent of total billed charges ","80% of total billed charges ",110.77,70,,88.62,,,0,"percent of total billed charges ","70% of total billed charges ",142.42,90,,113.94,,,0,"percent of total billed charges ","90% of total billed charges ",147.16,93,,117.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",134.5,85,,107.60,,,0,"percent of total billed charges ","85% of total billed charges ",142.42,90,,113.94,,,0,"percent of total billed charges ","90% of total billed charges ",142.42,90,,113.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",137.67,87,,110.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.77,70,,88.62,,,0,"percent of total billed charges ","70% of total billed charges ",110.77,147.16,
"SUTURE ETHILON 4-0 562H",6006775,"CDM ",272,RC,,,OUTPATIENT,,,20.01,16.008,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.01,80,,12.81,,,0,"percent of total billed charges ","80% of total billed charges ",14.01,70,,11.21,,,0,"percent of total billed charges ","70% of total billed charges ",18.01,90,,14.41,,,0,"percent of total billed charges ","90% of total billed charges ",18.61,93,,14.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.01,85,,13.61,,,0,"percent of total billed charges ","85% of total billed charges ",18.01,90,,14.41,,,0,"percent of total billed charges ","90% of total billed charges ",18.01,90,,14.41,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.41,87,,13.93,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.01,70,,11.21,,,0,"percent of total billed charges ","70% of total billed charges ",14.01,18.61,
"FILTER SYRINGE/WEEDLE 0.22",6006781,"CDM ",272,RC,,,OUTPATIENT,,,20.5,16.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.4,80,,13.12,,,0,"percent of total billed charges ","80% of total billed charges ",14.35,70,,11.48,,,0,"percent of total billed charges ","70% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",19.07,93,,15.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.43,85,,13.94,,,0,"percent of total billed charges ","85% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.84,87,,14.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.35,70,,11.48,,,0,"percent of total billed charges ","70% of total billed charges ",14.35,19.07,
"DRESSING ALLEVYN HEEL",6006786,"CDM ",272,RC,,,OUTPATIENT,,,33.8,27.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.04,80,,21.63,,,0,"percent of total billed charges ","80% of total billed charges ",23.66,70,,18.93,,,0,"percent of total billed charges ","70% of total billed charges ",30.42,90,,24.34,,,0,"percent of total billed charges ","90% of total billed charges ",31.43,93,,25.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.73,85,,22.98,,,0,"percent of total billed charges ","85% of total billed charges ",30.42,90,,24.34,,,0,"percent of total billed charges ","90% of total billed charges ",30.42,90,,24.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.41,87,,23.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.66,70,,18.93,,,0,"percent of total billed charges ","70% of total billed charges ",23.66,31.43,
"DRESSING ALLEVYN HEEL",6006786,"CDM ",272,RC,,,OUTPATIENT,,,33.8,27.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.04,80,,21.63,,,0,"percent of total billed charges ","80% of total billed charges ",23.66,70,,18.93,,,0,"percent of total billed charges ","70% of total billed charges ",30.42,90,,24.34,,,0,"percent of total billed charges ","90% of total billed charges ",31.43,93,,25.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.73,85,,22.98,,,0,"percent of total billed charges ","85% of total billed charges ",30.42,90,,24.34,,,0,"percent of total billed charges ","90% of total billed charges ",30.42,90,,24.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.41,87,,23.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.66,70,,18.93,,,0,"percent of total billed charges ","70% of total billed charges ",23.66,31.43,
"DRESSING ALLEVYN SACRUM",6006787,"CDM ",272,RC,,,OUTPATIENT,,,26.48,21.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.18,80,,16.94,,,0,"percent of total billed charges ","80% of total billed charges ",18.54,70,,14.83,,,0,"percent of total billed charges ","70% of total billed charges ",23.83,90,,19.06,,,0,"percent of total billed charges ","90% of total billed charges ",24.63,93,,19.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",22.51,85,,18.01,,,0,"percent of total billed charges ","85% of total billed charges ",23.83,90,,19.06,,,0,"percent of total billed charges ","90% of total billed charges ",23.83,90,,19.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",23.04,87,,18.43,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.54,70,,14.83,,,0,"percent of total billed charges ","70% of total billed charges ",18.54,24.63,
"SOLUTION BSS 18ML (EYE)",6006827,"CDM ",272,RC,,,OUTPATIENT,,,20.06,16.048,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.05,80,,12.84,,,0,"percent of total billed charges ","80% of total billed charges ",14.04,70,,11.23,,,0,"percent of total billed charges ","70% of total billed charges ",18.05,90,,14.44,,,0,"percent of total billed charges ","90% of total billed charges ",18.66,93,,14.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.05,85,,13.64,,,0,"percent of total billed charges ","85% of total billed charges ",18.05,90,,14.44,,,0,"percent of total billed charges ","90% of total billed charges ",18.05,90,,14.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.45,87,,13.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.04,70,,11.23,,,0,"percent of total billed charges ","70% of total billed charges ",14.04,18.66,
"DRAIN CHEST ATRIUM 2002",6006838,"CDM ",272,RC,,,OUTPATIENT,,,116.59,93.272,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.27,80,,74.62,,,0,"percent of total billed charges ","80% of total billed charges ",81.61,70,,65.29,,,0,"percent of total billed charges ","70% of total billed charges ",104.93,90,,83.94,,,0,"percent of total billed charges ","90% of total billed charges ",108.43,93,,86.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.1,85,,79.28,,,0,"percent of total billed charges ","85% of total billed charges ",104.93,90,,83.94,,,0,"percent of total billed charges ","90% of total billed charges ",104.93,90,,83.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.43,87,,81.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.61,70,,65.29,,,0,"percent of total billed charges ","70% of total billed charges ",81.61,108.43,
"MAT PROXIMITY SENSING",6006873,"CDM ",272,RC,,,OUTPATIENT,,,374.6,299.68,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.68,80,,239.74,,,0,"percent of total billed charges ","80% of total billed charges ",262.22,70,,209.78,,,0,"percent of total billed charges ","70% of total billed charges ",337.14,90,,269.71,,,0,"percent of total billed charges ","90% of total billed charges ",348.38,93,,278.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",318.41,85,,254.73,,,0,"percent of total billed charges ","85% of total billed charges ",337.14,90,,269.71,,,0,"percent of total billed charges ","90% of total billed charges ",337.14,90,,269.71,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",325.9,87,,260.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.22,70,,209.78,,,0,"percent of total billed charges ","70% of total billed charges ",262.22,348.38,
"DRESSING DURAHESIVE 57MM",6006874,"CDM ",272,RC,,,OUTPATIENT,,,19.96,15.968,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.97,80,,12.78,,,0,"percent of total billed charges ","80% of total billed charges ",13.97,70,,11.18,,,0,"percent of total billed charges ","70% of total billed charges ",17.96,90,,14.37,,,0,"percent of total billed charges ","90% of total billed charges ",18.56,93,,14.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.97,85,,13.58,,,0,"percent of total billed charges ","85% of total billed charges ",17.96,90,,14.37,,,0,"percent of total billed charges ","90% of total billed charges ",17.96,90,,14.37,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.37,87,,13.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.97,70,,11.18,,,0,"percent of total billed charges ","70% of total billed charges ",13.97,18.56,
"UNIT DOSE PACK 57MM",6006876,"CDM ",272,RC,,,OUTPATIENT,,,48.55,38.84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.84,80,,31.07,,,0,"percent of total billed charges ","80% of total billed charges ",33.99,70,,27.19,,,0,"percent of total billed charges ","70% of total billed charges ",43.7,90,,34.96,,,0,"percent of total billed charges ","90% of total billed charges ",45.15,93,,36.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.27,85,,33.02,,,0,"percent of total billed charges ","85% of total billed charges ",43.7,90,,34.96,,,0,"percent of total billed charges ","90% of total billed charges ",43.7,90,,34.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.24,87,,33.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.99,70,,27.19,,,0,"percent of total billed charges ","70% of total billed charges ",33.99,45.15,
"KIT GASTROSTOMY 18FR * 1.7",6006878,"CDM ",270,RC,,,OUTPATIENT,,,220.63,176.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.5,80,,141.20,,,0,"percent of total billed charges ","80% of total billed charges ",154.44,70,,123.55,,,0,"percent of total billed charges ","70% of total billed charges ",198.57,90,,158.86,,,0,"percent of total billed charges ","90% of total billed charges ",205.19,93,,164.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",187.54,85,,150.03,,,0,"percent of total billed charges ","85% of total billed charges ",198.57,90,,158.86,,,0,"percent of total billed charges ","90% of total billed charges ",198.57,90,,158.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",191.95,87,,153.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154.44,70,,123.55,,,0,"percent of total billed charges ","70% of total billed charges ",154.44,205.19,
"DRESSING ACTICOAT 4X4",6006890,"CDM ",272,RC,,,OUTPATIENT,,,43.88,35.104,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.1,80,,28.08,,,0,"percent of total billed charges ","80% of total billed charges ",30.72,70,,24.58,,,0,"percent of total billed charges ","70% of total billed charges ",39.49,90,,31.59,,,0,"percent of total billed charges ","90% of total billed charges ",40.81,93,,32.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",37.3,85,,29.84,,,0,"percent of total billed charges ","85% of total billed charges ",39.49,90,,31.59,,,0,"percent of total billed charges ","90% of total billed charges ",39.49,90,,31.59,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",38.18,87,,30.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.72,70,,24.58,,,0,"percent of total billed charges ","70% of total billed charges ",30.72,40.81,
"NEEDLE HUBER 19G X 1.0 LEURLOC",6006892,"CDM ",272,RC,,,OUTPATIENT,,,29.5,23.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.6,80,,18.88,,,0,"percent of total billed charges ","80% of total billed charges ",20.65,70,,16.52,,,0,"percent of total billed charges ","70% of total billed charges ",26.55,90,,21.24,,,0,"percent of total billed charges ","90% of total billed charges ",27.44,93,,21.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.08,85,,20.06,,,0,"percent of total billed charges ","85% of total billed charges ",26.55,90,,21.24,,,0,"percent of total billed charges ","90% of total billed charges ",26.55,90,,21.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",25.67,87,,20.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.65,70,,16.52,,,0,"percent of total billed charges ","70% of total billed charges ",20.65,27.44,
"FLANGE STOMAFLEX 2 3/4""",6006898,"CDM ",272,RC,,,OUTPATIENT,,,14.99,11.992,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.99,80,,9.59,,,0,"percent of total billed charges ","80% of total billed charges ",10.49,70,,8.39,,,0,"percent of total billed charges ","70% of total billed charges ",13.49,90,,10.79,,,0,"percent of total billed charges ","90% of total billed charges ",13.94,93,,11.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.74,85,,10.19,,,0,"percent of total billed charges ","85% of total billed charges ",13.49,90,,10.79,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,90,,10.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.04,87,,10.43,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.49,70,,8.39,,,0,"percent of total billed charges ","70% of total billed charges ",10.49,13.94,
"ARMBOARD 6.25X2 PEDI LG",6006899,"CDM ",271,RC,,,OUTPATIENT,,,12.29,9.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.83,80,,7.86,,,0,"percent of total billed charges ","80% of total billed charges ",8.6,70,,6.88,,,0,"percent of total billed charges ","70% of total billed charges ",11.06,90,,8.85,,,0,"percent of total billed charges ","90% of total billed charges ",11.43,93,,9.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.45,85,,8.36,,,0,"percent of total billed charges ","85% of total billed charges ",11.06,90,,8.85,,,0,"percent of total billed charges ","90% of total billed charges ",11.06,90,,8.85,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.69,87,,8.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.6,70,,6.88,,,0,"percent of total billed charges ","70% of total billed charges ",8.6,11.43,
"DRESSING ACTICOAT 4X8",6006924,"CDM ",272,RC,,,OUTPATIENT,,,59.79,47.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.83,80,,38.26,,,0,"percent of total billed charges ","80% of total billed charges ",41.85,70,,33.48,,,0,"percent of total billed charges ","70% of total billed charges ",53.81,90,,43.05,,,0,"percent of total billed charges ","90% of total billed charges ",55.6,93,,44.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",50.82,85,,40.66,,,0,"percent of total billed charges ","85% of total billed charges ",53.81,90,,43.05,,,0,"percent of total billed charges ","90% of total billed charges ",53.81,90,,43.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",52.02,87,,41.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.85,70,,33.48,,,0,"percent of total billed charges ","70% of total billed charges ",41.85,55.6,
"DRESSING ADAPTIC 3X60",6006925,"CDM ",272,RC,,,OUTPATIENT,,,19.16,15.328,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.33,80,,12.26,,,0,"percent of total billed charges ","80% of total billed charges ",13.41,70,,10.73,,,0,"percent of total billed charges ","70% of total billed charges ",17.24,90,,13.79,,,0,"percent of total billed charges ","90% of total billed charges ",17.82,93,,14.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.29,85,,13.03,,,0,"percent of total billed charges ","85% of total billed charges ",17.24,90,,13.79,,,0,"percent of total billed charges ","90% of total billed charges ",17.24,90,,13.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.67,87,,13.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.41,70,,10.73,,,0,"percent of total billed charges ","70% of total billed charges ",13.41,17.82,
"RESUSCITATOR PRO W/MAN",6006935,"CDM ",271,RC,,,OUTPATIENT,,,199.36,159.488,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",159.49,80,,127.59,,,0,"percent of total billed charges ","80% of total billed charges ",139.55,70,,111.64,,,0,"percent of total billed charges ","70% of total billed charges ",179.42,90,,143.54,,,0,"percent of total billed charges ","90% of total billed charges ",185.4,93,,148.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",169.46,85,,135.57,,,0,"percent of total billed charges ","85% of total billed charges ",179.42,90,,143.54,,,0,"percent of total billed charges ","90% of total billed charges ",179.42,90,,143.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",173.44,87,,138.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.55,70,,111.64,,,0,"percent of total billed charges ","70% of total billed charges ",139.55,185.4,
"CATH PER-Q-LINE 4FR",6006936,"CDM ",272,RC,,,OUTPATIENT,,,1610.45,1288.36,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1288.36,80,,1030.69,,,0,"percent of total billed charges ","80% of total billed charges ",1127.32,70,,901.86,,,0,"percent of total billed charges ","70% of total billed charges ",1449.41,90,,1159.53,,,0,"percent of total billed charges ","90% of total billed charges ",1497.72,93,,1198.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1368.88,85,,1095.10,,,0,"percent of total billed charges ","85% of total billed charges ",1449.41,90,,1159.53,,,0,"percent of total billed charges ","90% of total billed charges ",1449.41,90,,1159.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1401.09,87,,1120.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1127.32,70,,901.86,,,0,"percent of total billed charges ","70% of total billed charges ",1127.32,1497.72,
"INTRODUCER PER-Q-CATH LINE 4FR",6006937,"CDM ",272,RC,,,OUTPATIENT,,,120.02,96.016,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.02,80,,76.82,,,0,"percent of total billed charges ","80% of total billed charges ",84.01,70,,67.21,,,0,"percent of total billed charges ","70% of total billed charges ",108.02,90,,86.42,,,0,"percent of total billed charges ","90% of total billed charges ",111.62,93,,89.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",102.02,85,,81.62,,,0,"percent of total billed charges ","85% of total billed charges ",108.02,90,,86.42,,,0,"percent of total billed charges ","90% of total billed charges ",108.02,90,,86.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",104.42,87,,83.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.01,70,,67.21,,,0,"percent of total billed charges ","70% of total billed charges ",84.01,111.62,
"COVER TRANSDUCER (X RAY)",6006939,"CDM ",272,RC,,,OUTPATIENT,,,40.87,32.696,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.7,80,,26.16,,,0,"percent of total billed charges ","80% of total billed charges ",28.61,70,,22.89,,,0,"percent of total billed charges ","70% of total billed charges ",36.78,90,,29.42,,,0,"percent of total billed charges ","90% of total billed charges ",38.01,93,,30.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34.74,85,,27.79,,,0,"percent of total billed charges ","85% of total billed charges ",36.78,90,,29.42,,,0,"percent of total billed charges ","90% of total billed charges ",36.78,90,,29.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",35.56,87,,28.45,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.61,70,,22.89,,,0,"percent of total billed charges ","70% of total billed charges ",28.61,38.01,
"DRESSING FLEXIGEL 4X4",6006942,"CDM ",272,RC,,,OUTPATIENT,,,17.85,14.28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.28,80,,11.42,,,0,"percent of total billed charges ","80% of total billed charges ",12.5,70,,10.00,,,0,"percent of total billed charges ","70% of total billed charges ",16.07,90,,12.86,,,0,"percent of total billed charges ","90% of total billed charges ",16.6,93,,13.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.17,85,,12.14,,,0,"percent of total billed charges ","85% of total billed charges ",16.07,90,,12.86,,,0,"percent of total billed charges ","90% of total billed charges ",16.07,90,,12.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.53,87,,12.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.5,70,,10.00,,,0,"percent of total billed charges ","70% of total billed charges ",12.5,16.6,
"MULTI-PODUS ACTIVE 2000 SMALL",6007178,"CDM ",271,RC,,,OUTPATIENT,,,334.5,267.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",267.6,80,,214.08,,,0,"percent of total billed charges ","80% of total billed charges ",234.15,70,,187.32,,,0,"percent of total billed charges ","70% of total billed charges ",301.05,90,,240.84,,,0,"percent of total billed charges ","90% of total billed charges ",311.09,93,,248.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",284.33,85,,227.46,,,0,"percent of total billed charges ","85% of total billed charges ",301.05,90,,240.84,,,0,"percent of total billed charges ","90% of total billed charges ",301.05,90,,240.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",291.02,87,,232.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",234.15,70,,187.32,,,0,"percent of total billed charges ","70% of total billed charges ",234.15,311.09,
"TUBE NASAL UNCUFFED 3.0",6007219,"CDM ",272,RC,,,OUTPATIENT,,,16.95,13.56,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.56,80,,10.85,,,0,"percent of total billed charges ","80% of total billed charges ",11.87,70,,9.50,,,0,"percent of total billed charges ","70% of total billed charges ",15.26,90,,12.21,,,0,"percent of total billed charges ","90% of total billed charges ",15.76,93,,12.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.41,85,,11.53,,,0,"percent of total billed charges ","85% of total billed charges ",15.26,90,,12.21,,,0,"percent of total billed charges ","90% of total billed charges ",15.26,90,,12.21,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.75,87,,11.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.87,70,,9.50,,,0,"percent of total billed charges ","70% of total billed charges ",11.87,15.76,
"TENNIS ELBOW",6007221,"CDM ",271,RC,,,OUTPATIENT,,,80.99,64.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.79,80,,51.83,,,0,"percent of total billed charges ","80% of total billed charges ",56.69,70,,45.35,,,0,"percent of total billed charges ","70% of total billed charges ",72.89,90,,58.31,,,0,"percent of total billed charges ","90% of total billed charges ",75.32,93,,60.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",68.84,85,,55.07,,,0,"percent of total billed charges ","85% of total billed charges ",72.89,90,,58.31,,,0,"percent of total billed charges ","90% of total billed charges ",72.89,90,,58.31,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",70.46,87,,56.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.69,70,,45.35,,,0,"percent of total billed charges ","70% of total billed charges ",56.69,75.32,
"WRIST WRAP NEOPRENE",6007222,"CDM ",271,RC,,,OUTPATIENT,,,37.21,29.768,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.77,80,,23.82,,,0,"percent of total billed charges ","80% of total billed charges ",26.05,70,,20.84,,,0,"percent of total billed charges ","70% of total billed charges ",33.49,90,,26.79,,,0,"percent of total billed charges ","90% of total billed charges ",34.61,93,,27.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",31.63,85,,25.30,,,0,"percent of total billed charges ","85% of total billed charges ",33.49,90,,26.79,,,0,"percent of total billed charges ","90% of total billed charges ",33.49,90,,26.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",32.37,87,,25.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.05,70,,20.84,,,0,"percent of total billed charges ","70% of total billed charges ",26.05,34.61,
"PROBE OXIMETER (R-15)",6007234,"CDM ",272,RC,,,OUTPATIENT,,,56.05,44.84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.84,80,,35.87,,,0,"percent of total billed charges ","80% of total billed charges ",39.24,70,,31.39,,,0,"percent of total billed charges ","70% of total billed charges ",50.45,90,,40.36,,,0,"percent of total billed charges ","90% of total billed charges ",52.13,93,,41.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",47.64,85,,38.11,,,0,"percent of total billed charges ","85% of total billed charges ",50.45,90,,40.36,,,0,"percent of total billed charges ","90% of total billed charges ",50.45,90,,40.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",48.76,87,,39.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.24,70,,31.39,,,0,"percent of total billed charges ","70% of total billed charges ",39.24,52.13,
"MASK NASAL GOLDSEAL PETITE",6007235,"CDM ",271,RC,,,OUTPATIENT,,,368.13,294.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",294.5,80,,235.60,,,0,"percent of total billed charges ","80% of total billed charges ",257.69,70,,206.15,,,0,"percent of total billed charges ","70% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",342.36,93,,273.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",312.91,85,,250.33,,,0,"percent of total billed charges ","85% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",320.27,87,,256.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",257.69,70,,206.15,,,0,"percent of total billed charges ","70% of total billed charges ",257.69,342.36,
"MASK NASAL GOLDSEAL MED-SML",6007236,"CDM ",271,RC,,,OUTPATIENT,,,368.13,294.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",294.5,80,,235.60,,,0,"percent of total billed charges ","80% of total billed charges ",257.69,70,,206.15,,,0,"percent of total billed charges ","70% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",342.36,93,,273.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",312.91,85,,250.33,,,0,"percent of total billed charges ","85% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",320.27,87,,256.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",257.69,70,,206.15,,,0,"percent of total billed charges ","70% of total billed charges ",257.69,342.36,
"MASK NASAL GOLDSEAL MED-WIDE",6007237,"CDM ",271,RC,,,OUTPATIENT,,,368.13,294.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",294.5,80,,235.60,,,0,"percent of total billed charges ","80% of total billed charges ",257.69,70,,206.15,,,0,"percent of total billed charges ","70% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",342.36,93,,273.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",312.91,85,,250.33,,,0,"percent of total billed charges ","85% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",320.27,87,,256.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",257.69,70,,206.15,,,0,"percent of total billed charges ","70% of total billed charges ",257.69,342.36,
"MASK NASAL GOLDSEAL NARROW-LRG",6007238,"CDM ",271,RC,,,OUTPATIENT,,,368.13,294.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",294.5,80,,235.60,,,0,"percent of total billed charges ","80% of total billed charges ",257.69,70,,206.15,,,0,"percent of total billed charges ","70% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",342.36,93,,273.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",312.91,85,,250.33,,,0,"percent of total billed charges ","85% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",320.27,87,,256.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",257.69,70,,206.15,,,0,"percent of total billed charges ","70% of total billed charges ",257.69,342.36,
"MASK FULL-FACE W/STRAP MED",6007239,"CDM ",271,RC,,,OUTPATIENT,,,99.66,79.728,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.73,80,,63.78,,,0,"percent of total billed charges ","80% of total billed charges ",69.76,70,,55.81,,,0,"percent of total billed charges ","70% of total billed charges ",89.69,90,,71.75,,,0,"percent of total billed charges ","90% of total billed charges ",92.68,93,,74.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",84.71,85,,67.77,,,0,"percent of total billed charges ","85% of total billed charges ",89.69,90,,71.75,,,0,"percent of total billed charges ","90% of total billed charges ",89.69,90,,71.75,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",86.7,87,,69.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.76,70,,55.81,,,0,"percent of total billed charges ","70% of total billed charges ",69.76,92.68,
"MASK FULL-FACE W/STRAP SML",6007240,"CDM ",271,RC,,,OUTPATIENT,,,109.44,87.552,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.55,80,,70.04,,,0,"percent of total billed charges ","80% of total billed charges ",76.61,70,,61.29,,,0,"percent of total billed charges ","70% of total billed charges ",98.5,90,,78.80,,,0,"percent of total billed charges ","90% of total billed charges ",101.78,93,,81.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",93.02,85,,74.42,,,0,"percent of total billed charges ","85% of total billed charges ",98.5,90,,78.80,,,0,"percent of total billed charges ","90% of total billed charges ",98.5,90,,78.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",95.21,87,,76.17,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.61,70,,61.29,,,0,"percent of total billed charges ","70% of total billed charges ",76.61,101.78,
"MASK NASAL CONTOUR DLX MED",6007241,"CDM ",271,RC,,,OUTPATIENT,,,54.58,43.664,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.66,80,,34.93,,,0,"percent of total billed charges ","80% of total billed charges ",38.21,70,,30.57,,,0,"percent of total billed charges ","70% of total billed charges ",49.12,90,,39.30,,,0,"percent of total billed charges ","90% of total billed charges ",50.76,93,,40.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",46.39,85,,37.11,,,0,"percent of total billed charges ","85% of total billed charges ",49.12,90,,39.30,,,0,"percent of total billed charges ","90% of total billed charges ",49.12,90,,39.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",47.48,87,,37.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.21,70,,30.57,,,0,"percent of total billed charges ","70% of total billed charges ",38.21,50.76,
"MASK NASAL CONTOUR DXL SMALL",6007242,"CDM ",271,RC,,,OUTPATIENT,,,54.58,43.664,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.66,80,,34.93,,,0,"percent of total billed charges ","80% of total billed charges ",38.21,70,,30.57,,,0,"percent of total billed charges ","70% of total billed charges ",49.12,90,,39.30,,,0,"percent of total billed charges ","90% of total billed charges ",50.76,93,,40.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",46.39,85,,37.11,,,0,"percent of total billed charges ","85% of total billed charges ",49.12,90,,39.30,,,0,"percent of total billed charges ","90% of total billed charges ",49.12,90,,39.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",47.48,87,,37.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.21,70,,30.57,,,0,"percent of total billed charges ","70% of total billed charges ",38.21,50.76,
"MASK NASAL CONTOUR DLX LRG",6007243,"CDM ",271,RC,,,OUTPATIENT,,,72.45,57.96,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.96,80,,46.37,,,0,"percent of total billed charges ","80% of total billed charges ",50.72,70,,40.58,,,0,"percent of total billed charges ","70% of total billed charges ",65.21,90,,52.17,,,0,"percent of total billed charges ","90% of total billed charges ",67.38,93,,53.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",61.58,85,,49.26,,,0,"percent of total billed charges ","85% of total billed charges ",65.21,90,,52.17,,,0,"percent of total billed charges ","90% of total billed charges ",65.21,90,,52.17,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.03,87,,50.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.72,70,,40.58,,,0,"percent of total billed charges ","70% of total billed charges ",50.72,67.38,
"HEADSTRAP MASK DISP",6007244,"CDM ",272,RC,,,OUTPATIENT,,,40.27,32.216,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.22,80,,25.78,,,0,"percent of total billed charges ","80% of total billed charges ",28.19,70,,22.55,,,0,"percent of total billed charges ","70% of total billed charges ",36.24,90,,28.99,,,0,"percent of total billed charges ","90% of total billed charges ",37.45,93,,29.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34.23,85,,27.38,,,0,"percent of total billed charges ","85% of total billed charges ",36.24,90,,28.99,,,0,"percent of total billed charges ","90% of total billed charges ",36.24,90,,28.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",35.03,87,,28.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.19,70,,22.55,,,0,"percent of total billed charges ","70% of total billed charges ",28.19,37.45,
"MASK SOFTCAP DELUXE 3-STRAP",6007246,"CDM ",271,RC,,,OUTPATIENT,,,129.62,103.696,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.7,80,,82.96,,,0,"percent of total billed charges ","80% of total billed charges ",90.73,70,,72.58,,,0,"percent of total billed charges ","70% of total billed charges ",116.66,90,,93.33,,,0,"percent of total billed charges ","90% of total billed charges ",120.55,93,,96.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",110.18,85,,88.14,,,0,"percent of total billed charges ","85% of total billed charges ",116.66,90,,93.33,,,0,"percent of total billed charges ","90% of total billed charges ",116.66,90,,93.33,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",112.77,87,,90.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.73,70,,72.58,,,0,"percent of total billed charges ","70% of total billed charges ",90.73,120.55,
"HEADSTRAP DISPOSAL",6007247,"CDM ",271,RC,,,OUTPATIENT,,,29.19,23.352,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.35,80,,18.68,,,0,"percent of total billed charges ","80% of total billed charges ",20.43,70,,16.34,,,0,"percent of total billed charges ","70% of total billed charges ",26.27,90,,21.02,,,0,"percent of total billed charges ","90% of total billed charges ",27.15,93,,21.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",24.81,85,,19.85,,,0,"percent of total billed charges ","85% of total billed charges ",26.27,90,,21.02,,,0,"percent of total billed charges ","90% of total billed charges ",26.27,90,,21.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",25.4,87,,20.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.43,70,,16.34,,,0,"percent of total billed charges ","70% of total billed charges ",20.43,27.15,
"GAUGE SIZING MASK GOLDSEAL",6007248,"CDM ",272,RC,,,OUTPATIENT,,,32.85,26.28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.28,80,,21.02,,,0,"percent of total billed charges ","80% of total billed charges ",23,70,,18.40,,,0,"percent of total billed charges ","70% of total billed charges ",29.57,90,,23.66,,,0,"percent of total billed charges ","90% of total billed charges ",30.55,93,,24.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",27.92,85,,22.34,,,0,"percent of total billed charges ","85% of total billed charges ",29.57,90,,23.66,,,0,"percent of total billed charges ","90% of total billed charges ",29.57,90,,23.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",28.58,87,,22.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23,70,,18.40,,,0,"percent of total billed charges ","70% of total billed charges ",23,30.55,
"HOLDER THOMAS ET ADULT",6007310,"CDM ",272,RC,,,OUTPATIENT,,,17.55,14.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.04,80,,11.23,,,0,"percent of total billed charges ","80% of total billed charges ",12.29,70,,9.83,,,0,"percent of total billed charges ","70% of total billed charges ",15.8,90,,12.64,,,0,"percent of total billed charges ","90% of total billed charges ",16.32,93,,13.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.92,85,,11.94,,,0,"percent of total billed charges ","85% of total billed charges ",15.8,90,,12.64,,,0,"percent of total billed charges ","90% of total billed charges ",15.8,90,,12.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.27,87,,12.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.29,70,,9.83,,,0,"percent of total billed charges ","70% of total billed charges ",12.29,16.32,
"MASK FULL FACE SPECTRUM LG",6007333,"CDM ",271,RC,,,OUTPATIENT,,,111.13,88.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.9,80,,71.12,,,0,"percent of total billed charges ","80% of total billed charges ",77.79,70,,62.23,,,0,"percent of total billed charges ","70% of total billed charges ",100.02,90,,80.02,,,0,"percent of total billed charges ","90% of total billed charges ",103.35,93,,82.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",94.46,85,,75.57,,,0,"percent of total billed charges ","85% of total billed charges ",100.02,90,,80.02,,,0,"percent of total billed charges ","90% of total billed charges ",100.02,90,,80.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",96.68,87,,77.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.79,70,,62.23,,,0,"percent of total billed charges ","70% of total billed charges ",77.79,103.35,
"PAD MAMMO 10"" X 11"" LARGE",6007398,"CDM ",621,RC,,,OUTPATIENT,,,31.34,25.072,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.07,80,,20.06,,,0,"percent of total billed charges ","80% of total billed charges ",21.94,70,,17.55,,,0,"percent of total billed charges ","70% of total billed charges ",28.21,90,,22.57,,,0,"percent of total billed charges ","90% of total billed charges ",29.15,93,,23.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.64,85,,21.31,,,0,"percent of total billed charges ","85% of total billed charges ",28.21,90,,22.57,,,0,"percent of total billed charges ","90% of total billed charges ",28.21,90,,22.57,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",27.27,87,,21.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.94,70,,17.55,,,0,"percent of total billed charges ","70% of total billed charges ",21.94,29.15,
"MUCUS TRAP 8FR FOR INFANTS",6007399,"CDM ",272,RC,,,OUTPATIENT,,,52.05,41.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.64,80,,33.31,,,0,"percent of total billed charges ","80% of total billed charges ",36.44,70,,29.15,,,0,"percent of total billed charges ","70% of total billed charges ",46.85,90,,37.48,,,0,"percent of total billed charges ","90% of total billed charges ",48.41,93,,38.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",44.24,85,,35.39,,,0,"percent of total billed charges ","85% of total billed charges ",46.85,90,,37.48,,,0,"percent of total billed charges ","90% of total billed charges ",46.85,90,,37.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",45.28,87,,36.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.44,70,,29.15,,,0,"percent of total billed charges ","70% of total billed charges ",36.44,48.41,
"KIT CATH PICC LINE 4FR",6007407,"CDM ",270,RC,,,OUTPATIENT,,,407.3,325.84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",325.84,80,,260.67,,,0,"percent of total billed charges ","80% of total billed charges ",285.11,70,,228.09,,,0,"percent of total billed charges ","70% of total billed charges ",366.57,90,,293.26,,,0,"percent of total billed charges ","90% of total billed charges ",378.79,93,,303.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",346.21,85,,276.97,,,0,"percent of total billed charges ","85% of total billed charges ",366.57,90,,293.26,,,0,"percent of total billed charges ","90% of total billed charges ",366.57,90,,293.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",354.35,87,,283.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",285.11,70,,228.09,,,0,"percent of total billed charges ","70% of total billed charges ",285.11,378.79,
"KIT CATH PICC 5FR DBL LUMEN",6007410,"CDM ",270,RC,,,OUTPATIENT,,,314,251.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",251.2,80,,200.96,,,0,"percent of total billed charges ","80% of total billed charges ",219.8,70,,175.84,,,0,"percent of total billed charges ","70% of total billed charges ",282.6,90,,226.08,,,0,"percent of total billed charges ","90% of total billed charges ",292.02,93,,233.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",266.9,85,,213.52,,,0,"percent of total billed charges ","85% of total billed charges ",282.6,90,,226.08,,,0,"percent of total billed charges ","90% of total billed charges ",282.6,90,,226.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",273.18,87,,218.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",219.8,70,,175.84,,,0,"percent of total billed charges ","70% of total billed charges ",219.8,292.02,
"DRESSING FISTULA",6007416,"CDM ",272,RC,,,OUTPATIENT,,,62.05,49.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.64,80,,39.71,,,0,"percent of total billed charges ","80% of total billed charges ",43.44,70,,34.75,,,0,"percent of total billed charges ","70% of total billed charges ",55.85,90,,44.68,,,0,"percent of total billed charges ","90% of total billed charges ",57.71,93,,46.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",52.74,85,,42.19,,,0,"percent of total billed charges ","85% of total billed charges ",55.85,90,,44.68,,,0,"percent of total billed charges ","90% of total billed charges ",55.85,90,,44.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",53.98,87,,43.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.44,70,,34.75,,,0,"percent of total billed charges ","70% of total billed charges ",43.44,57.71,
"BYPASS CIRCUIT CIRCU-VENT",6007454,"CDM ",272,RC,,,OUTPATIENT,,,35.11,28.088,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.09,80,,22.47,,,0,"percent of total billed charges ","80% of total billed charges ",24.58,70,,19.66,,,0,"percent of total billed charges ","70% of total billed charges ",31.6,90,,25.28,,,0,"percent of total billed charges ","90% of total billed charges ",32.65,93,,26.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",29.84,85,,23.87,,,0,"percent of total billed charges ","85% of total billed charges ",31.6,90,,25.28,,,0,"percent of total billed charges ","90% of total billed charges ",31.6,90,,25.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.55,87,,24.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.58,70,,19.66,,,0,"percent of total billed charges ","70% of total billed charges ",24.58,32.65,
"MASK ADULT BAG RES.FLEX NECK",6007455,"CDM ",270,RC,,,OUTPATIENT,,,66.68,53.344,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.34,80,,42.67,,,0,"percent of total billed charges ","80% of total billed charges ",46.68,70,,37.34,,,0,"percent of total billed charges ","70% of total billed charges ",60.01,90,,48.01,,,0,"percent of total billed charges ","90% of total billed charges ",62.01,93,,49.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",56.68,85,,45.34,,,0,"percent of total billed charges ","85% of total billed charges ",60.01,90,,48.01,,,0,"percent of total billed charges ","90% of total billed charges ",60.01,90,,48.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",58.01,87,,46.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.68,70,,37.34,,,0,"percent of total billed charges ","70% of total billed charges ",46.68,62.01,
"CATH UMBILICAL VESSEL 8.0 FR",6007458,"CDM ",272,RC,,,OUTPATIENT,,,95.57,76.456,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.46,80,,61.17,,,0,"percent of total billed charges ","80% of total billed charges ",66.9,70,,53.52,,,0,"percent of total billed charges ","70% of total billed charges ",86.01,90,,68.81,,,0,"percent of total billed charges ","90% of total billed charges ",88.88,93,,71.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",81.23,85,,64.98,,,0,"percent of total billed charges ","85% of total billed charges ",86.01,90,,68.81,,,0,"percent of total billed charges ","90% of total billed charges ",86.01,90,,68.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",83.15,87,,66.52,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.9,70,,53.52,,,0,"percent of total billed charges ","70% of total billed charges ",66.9,88.88,
"SOLUTION SUCROSE SWEET-EASE",6007464,"CDM ",637,RC,,,OUTPATIENT,,,4,3.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.2,80,,2.56,,,0,"percent of total billed charges ","80% of total billed charges ",2.8,70,,2.24,,,0,"percent of total billed charges ","70% of total billed charges ",3.6,90,,2.88,,,0,"percent of total billed charges ","90% of total billed charges ",3.72,93,,2.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3.4,85,,2.72,,,0,"percent of total billed charges ","85% of total billed charges ",3.6,90,,2.88,,,0,"percent of total billed charges ","90% of total billed charges ",3.6,90,,2.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3.48,87,,2.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.8,70,,2.24,,,0,"percent of total billed charges ","70% of total billed charges ",2.8,3.72,
"RETRACTOR VAGINAL",6007467,"CDM ",272,RC,,,OUTPATIENT,,,102.24,81.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.79,80,,65.43,,,0,"percent of total billed charges ","80% of total billed charges ",71.57,70,,57.26,,,0,"percent of total billed charges ","70% of total billed charges ",92.02,90,,73.62,,,0,"percent of total billed charges ","90% of total billed charges ",95.08,93,,76.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",86.9,85,,69.52,,,0,"percent of total billed charges ","85% of total billed charges ",92.02,90,,73.62,,,0,"percent of total billed charges ","90% of total billed charges ",92.02,90,,73.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",88.95,87,,71.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.57,70,,57.26,,,0,"percent of total billed charges ","70% of total billed charges ",71.57,95.08,
"SPACER MDI W/LG MASK",6007472,"CDM ",272,RC,,,OUTPATIENT,,,60.99,48.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.79,80,,39.03,,,0,"percent of total billed charges ","80% of total billed charges ",42.69,70,,34.15,,,0,"percent of total billed charges ","70% of total billed charges ",54.89,90,,43.91,,,0,"percent of total billed charges ","90% of total billed charges ",56.72,93,,45.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51.84,85,,41.47,,,0,"percent of total billed charges ","85% of total billed charges ",54.89,90,,43.91,,,0,"percent of total billed charges ","90% of total billed charges ",54.89,90,,43.91,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",53.06,87,,42.45,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.69,70,,34.15,,,0,"percent of total billed charges ","70% of total billed charges ",42.69,56.72,
"NEBULIZER HOPE W/RESERVOIR",6007473,"CDM ",272,RC,,,OUTPATIENT,,,55.96,44.768,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.77,80,,35.82,,,0,"percent of total billed charges ","80% of total billed charges ",39.17,70,,31.34,,,0,"percent of total billed charges ","70% of total billed charges ",50.36,90,,40.29,,,0,"percent of total billed charges ","90% of total billed charges ",52.04,93,,41.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",47.57,85,,38.06,,,0,"percent of total billed charges ","85% of total billed charges ",50.36,90,,40.29,,,0,"percent of total billed charges ","90% of total billed charges ",50.36,90,,40.29,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",48.69,87,,38.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.17,70,,31.34,,,0,"percent of total billed charges ","70% of total billed charges ",39.17,52.04,
"NEBULIZER HEART 240ML",6007474,"CDM ",272,RC,,,OUTPATIENT,,,47.29,37.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.83,80,,30.26,,,0,"percent of total billed charges ","80% of total billed charges ",33.1,70,,26.48,,,0,"percent of total billed charges ","70% of total billed charges ",42.56,90,,34.05,,,0,"percent of total billed charges ","90% of total billed charges ",43.98,93,,35.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.2,85,,32.16,,,0,"percent of total billed charges ","85% of total billed charges ",42.56,90,,34.05,,,0,"percent of total billed charges ","90% of total billed charges ",42.56,90,,34.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.14,87,,32.91,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.1,70,,26.48,,,0,"percent of total billed charges ","70% of total billed charges ",33.1,43.98,
"TUBE FEEDING 4.4 CM (W-C)",6007482,"CDM ",272,RC,,,OUTPATIENT,,,324.11,259.288,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",259.29,80,,207.43,,,0,"percent of total billed charges ","80% of total billed charges ",226.88,70,,181.50,,,0,"percent of total billed charges ","70% of total billed charges ",291.7,90,,233.36,,,0,"percent of total billed charges ","90% of total billed charges ",301.42,93,,241.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",275.49,85,,220.39,,,0,"percent of total billed charges ","85% of total billed charges ",291.7,90,,233.36,,,0,"percent of total billed charges ","90% of total billed charges ",291.7,90,,233.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",281.98,87,,225.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",226.88,70,,181.50,,,0,"percent of total billed charges ","70% of total billed charges ",226.88,301.42,
"SPLINT THUMB RIGHT LARGE",6007486,"CDM ",271,RC,,,OUTPATIENT,,,91.5,73.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.2,80,,58.56,,,0,"percent of total billed charges ","80% of total billed charges ",64.05,70,,51.24,,,0,"percent of total billed charges ","70% of total billed charges ",82.35,90,,65.88,,,0,"percent of total billed charges ","90% of total billed charges ",85.1,93,,68.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",77.78,85,,62.22,,,0,"percent of total billed charges ","85% of total billed charges ",82.35,90,,65.88,,,0,"percent of total billed charges ","90% of total billed charges ",82.35,90,,65.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",79.61,87,,63.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.05,70,,51.24,,,0,"percent of total billed charges ","70% of total billed charges ",64.05,85.1,
"MASK 02 NONREBREATHING PE",6007510,"CDM ",270,RC,,,OUTPATIENT,,,14.94,11.952,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.95,80,,9.56,,,0,"percent of total billed charges ","80% of total billed charges ",10.46,70,,8.37,,,0,"percent of total billed charges ","70% of total billed charges ",13.45,90,,10.76,,,0,"percent of total billed charges ","90% of total billed charges ",13.89,93,,11.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.7,85,,10.16,,,0,"percent of total billed charges ","85% of total billed charges ",13.45,90,,10.76,,,0,"percent of total billed charges ","90% of total billed charges ",13.45,90,,10.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13,87,,10.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.46,70,,8.37,,,0,"percent of total billed charges ","70% of total billed charges ",10.46,13.89,
"MASK LARGE SPECTRUM FF W/STRAP",6007608,"CDM ",270,RC,,,OUTPATIENT,,,133.13,106.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.5,80,,85.20,,,0,"percent of total billed charges ","80% of total billed charges ",93.19,70,,74.55,,,0,"percent of total billed charges ","70% of total billed charges ",119.82,90,,95.86,,,0,"percent of total billed charges ","90% of total billed charges ",123.81,93,,99.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",113.16,85,,90.53,,,0,"percent of total billed charges ","85% of total billed charges ",119.82,90,,95.86,,,0,"percent of total billed charges ","90% of total billed charges ",119.82,90,,95.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",115.82,87,,92.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.19,70,,74.55,,,0,"percent of total billed charges ","70% of total billed charges ",93.19,123.81,
"MASK IMAGE 3 FF LARGE",6007609,"CDM ",270,RC,,,OUTPATIENT,,,109.44,87.552,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.55,80,,70.04,,,0,"percent of total billed charges ","80% of total billed charges ",76.61,70,,61.29,,,0,"percent of total billed charges ","70% of total billed charges ",98.5,90,,78.80,,,0,"percent of total billed charges ","90% of total billed charges ",101.78,93,,81.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",93.02,85,,74.42,,,0,"percent of total billed charges ","85% of total billed charges ",98.5,90,,78.80,,,0,"percent of total billed charges ","90% of total billed charges ",98.5,90,,78.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",95.21,87,,76.17,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.61,70,,61.29,,,0,"percent of total billed charges ","70% of total billed charges ",76.61,101.78,
"RENTAL BARIATRIC EQUIPT",6007634,"CDM ",271,RC,,,OUTPATIENT,,,301.7,241.36,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.36,80,,193.09,,,0,"percent of total billed charges ","80% of total billed charges ",211.19,70,,168.95,,,0,"percent of total billed charges ","70% of total billed charges ",271.53,90,,217.22,,,0,"percent of total billed charges ","90% of total billed charges ",280.58,93,,224.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",256.45,85,,205.16,,,0,"percent of total billed charges ","85% of total billed charges ",271.53,90,,217.22,,,0,"percent of total billed charges ","90% of total billed charges ",271.53,90,,217.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",262.48,87,,209.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",211.19,70,,168.95,,,0,"percent of total billed charges ","70% of total billed charges ",211.19,280.58,
"INFANT/TODD O2 DEL SYSTEM RED",6007640,"CDM ",272,RC,,,OUTPATIENT,,,51.03,40.824,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.82,80,,32.66,,,0,"percent of total billed charges ","80% of total billed charges ",35.72,70,,28.58,,,0,"percent of total billed charges ","70% of total billed charges ",45.93,90,,36.74,,,0,"percent of total billed charges ","90% of total billed charges ",47.46,93,,37.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.38,85,,34.70,,,0,"percent of total billed charges ","85% of total billed charges ",45.93,90,,36.74,,,0,"percent of total billed charges ","90% of total billed charges ",45.93,90,,36.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.4,87,,35.52,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.72,70,,28.58,,,0,"percent of total billed charges ","70% of total billed charges ",35.72,47.46,
"INTUBATION MODULE PINK RED",6007641,"CDM ",272,RC,,,OUTPATIENT,,,216.81,173.448,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.45,80,,138.76,,,0,"percent of total billed charges ","80% of total billed charges ",151.77,70,,121.42,,,0,"percent of total billed charges ","70% of total billed charges ",195.13,90,,156.10,,,0,"percent of total billed charges ","90% of total billed charges ",201.63,93,,161.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",184.29,85,,147.43,,,0,"percent of total billed charges ","85% of total billed charges ",195.13,90,,156.10,,,0,"percent of total billed charges ","90% of total billed charges ",195.13,90,,156.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",188.62,87,,150.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.77,70,,121.42,,,0,"percent of total billed charges ","70% of total billed charges ",151.77,201.63,
"IV DELIVERY MODULE PK/RD PVR",6007642,"CDM ",272,RC,,,OUTPATIENT,,,137.8,110.24,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110.24,80,,88.19,,,0,"percent of total billed charges ","80% of total billed charges ",96.46,70,,77.17,,,0,"percent of total billed charges ","70% of total billed charges ",124.02,90,,99.22,,,0,"percent of total billed charges ","90% of total billed charges ",128.15,93,,102.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",117.13,85,,93.70,,,0,"percent of total billed charges ","85% of total billed charges ",124.02,90,,99.22,,,0,"percent of total billed charges ","90% of total billed charges ",124.02,90,,99.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",119.89,87,,95.91,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.46,70,,77.17,,,0,"percent of total billed charges ","70% of total billed charges ",96.46,128.15,
"INTRAOSSEOUS MODULE PINK/RED",6007643,"CDM ",272,RC,,,OUTPATIENT,,,302.06,241.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.65,80,,193.32,,,0,"percent of total billed charges ","80% of total billed charges ",211.44,70,,169.15,,,0,"percent of total billed charges ","70% of total billed charges ",271.85,90,,217.48,,,0,"percent of total billed charges ","90% of total billed charges ",280.92,93,,224.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",256.75,85,,205.40,,,0,"percent of total billed charges ","85% of total billed charges ",271.85,90,,217.48,,,0,"percent of total billed charges ","90% of total billed charges ",271.85,90,,217.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",262.79,87,,210.23,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",211.44,70,,169.15,,,0,"percent of total billed charges ","70% of total billed charges ",211.44,280.92,
"INFANT/TODD 02 DEL SYS PURPLE",6007644,"CDM ",272,RC,,,OUTPATIENT,,,51.03,40.824,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.82,80,,32.66,,,0,"percent of total billed charges ","80% of total billed charges ",35.72,70,,28.58,,,0,"percent of total billed charges ","70% of total billed charges ",45.93,90,,36.74,,,0,"percent of total billed charges ","90% of total billed charges ",47.46,93,,37.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.38,85,,34.70,,,0,"percent of total billed charges ","85% of total billed charges ",45.93,90,,36.74,,,0,"percent of total billed charges ","90% of total billed charges ",45.93,90,,36.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.4,87,,35.52,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.72,70,,28.58,,,0,"percent of total billed charges ","70% of total billed charges ",35.72,47.46,
"INTUBATION MODULE PURPLE",6007645,"CDM ",272,RC,,,OUTPATIENT,,,216.81,173.448,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.45,80,,138.76,,,0,"percent of total billed charges ","80% of total billed charges ",151.77,70,,121.42,,,0,"percent of total billed charges ","70% of total billed charges ",195.13,90,,156.10,,,0,"percent of total billed charges ","90% of total billed charges ",201.63,93,,161.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",184.29,85,,147.43,,,0,"percent of total billed charges ","85% of total billed charges ",195.13,90,,156.10,,,0,"percent of total billed charges ","90% of total billed charges ",195.13,90,,156.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",188.62,87,,150.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.77,70,,121.42,,,0,"percent of total billed charges ","70% of total billed charges ",151.77,201.63,
"INFANT/TODD 02 DEL SYS YEL/WHT",6007646,"CDM ",272,RC,,,OUTPATIENT,,,51.03,40.824,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.82,80,,32.66,,,0,"percent of total billed charges ","80% of total billed charges ",35.72,70,,28.58,,,0,"percent of total billed charges ","70% of total billed charges ",45.93,90,,36.74,,,0,"percent of total billed charges ","90% of total billed charges ",47.46,93,,37.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.38,85,,34.70,,,0,"percent of total billed charges ","85% of total billed charges ",45.93,90,,36.74,,,0,"percent of total billed charges ","90% of total billed charges ",45.93,90,,36.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.4,87,,35.52,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.72,70,,28.58,,,0,"percent of total billed charges ","70% of total billed charges ",35.72,47.46,
"INTUBATION MODULE YELLOW",6007647,"CDM ",272,RC,,,OUTPATIENT,,,124.37,99.496,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.5,80,,79.60,,,0,"percent of total billed charges ","80% of total billed charges ",87.06,70,,69.65,,,0,"percent of total billed charges ","70% of total billed charges ",111.93,90,,89.54,,,0,"percent of total billed charges ","90% of total billed charges ",115.66,93,,92.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",105.71,85,,84.57,,,0,"percent of total billed charges ","85% of total billed charges ",111.93,90,,89.54,,,0,"percent of total billed charges ","90% of total billed charges ",111.93,90,,89.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",108.2,87,,86.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.06,70,,69.65,,,0,"percent of total billed charges ","70% of total billed charges ",87.06,115.66,
"IV DELIVERY MODULE YELLOW",6007648,"CDM ",272,RC,,,OUTPATIENT,,,240.25,192.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.2,80,,153.76,,,0,"percent of total billed charges ","80% of total billed charges ",168.18,70,,134.54,,,0,"percent of total billed charges ","70% of total billed charges ",216.23,90,,172.98,,,0,"percent of total billed charges ","90% of total billed charges ",223.43,93,,178.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",204.21,85,,163.37,,,0,"percent of total billed charges ","85% of total billed charges ",216.23,90,,172.98,,,0,"percent of total billed charges ","90% of total billed charges ",216.23,90,,172.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",209.02,87,,167.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",168.18,70,,134.54,,,0,"percent of total billed charges ","70% of total billed charges ",168.18,223.43,
"INTUBATION MODULE WHITE",6007649,"CDM ",272,RC,,,OUTPATIENT,,,216.81,173.448,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.45,80,,138.76,,,0,"percent of total billed charges ","80% of total billed charges ",151.77,70,,121.42,,,0,"percent of total billed charges ","70% of total billed charges ",195.13,90,,156.10,,,0,"percent of total billed charges ","90% of total billed charges ",201.63,93,,161.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",184.29,85,,147.43,,,0,"percent of total billed charges ","85% of total billed charges ",195.13,90,,156.10,,,0,"percent of total billed charges ","90% of total billed charges ",195.13,90,,156.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",188.62,87,,150.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.77,70,,121.42,,,0,"percent of total billed charges ","70% of total billed charges ",151.77,201.63,
"IV DELIVERY MODULE WHT/BL/OR",6007650,"CDM ",272,RC,,,OUTPATIENT,,,240.25,192.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.2,80,,153.76,,,0,"percent of total billed charges ","80% of total billed charges ",168.18,70,,134.54,,,0,"percent of total billed charges ","70% of total billed charges ",216.23,90,,172.98,,,0,"percent of total billed charges ","90% of total billed charges ",223.43,93,,178.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",204.21,85,,163.37,,,0,"percent of total billed charges ","85% of total billed charges ",216.23,90,,172.98,,,0,"percent of total billed charges ","90% of total billed charges ",216.23,90,,172.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",209.02,87,,167.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",168.18,70,,134.54,,,0,"percent of total billed charges ","70% of total billed charges ",168.18,223.43,
"INTRAOSSEOUS MODULE WHITE",6007651,"CDM ",272,RC,,,OUTPATIENT,,,173.27,138.616,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",138.62,80,,110.90,,,0,"percent of total billed charges ","80% of total billed charges ",121.29,70,,97.03,,,0,"percent of total billed charges ","70% of total billed charges ",155.94,90,,124.75,,,0,"percent of total billed charges ","90% of total billed charges ",161.14,93,,128.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",147.28,85,,117.82,,,0,"percent of total billed charges ","85% of total billed charges ",155.94,90,,124.75,,,0,"percent of total billed charges ","90% of total billed charges ",155.94,90,,124.75,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",150.74,87,,120.59,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",121.29,70,,97.03,,,0,"percent of total billed charges ","70% of total billed charges ",121.29,161.14,
"INFANT/TODD 02 DEL SYSTEM BLUE",6007652,"CDM ",272,RC,,,OUTPATIENT,,,51.03,40.824,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.82,80,,32.66,,,0,"percent of total billed charges ","80% of total billed charges ",35.72,70,,28.58,,,0,"percent of total billed charges ","70% of total billed charges ",45.93,90,,36.74,,,0,"percent of total billed charges ","90% of total billed charges ",47.46,93,,37.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.38,85,,34.70,,,0,"percent of total billed charges ","85% of total billed charges ",45.93,90,,36.74,,,0,"percent of total billed charges ","90% of total billed charges ",45.93,90,,36.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.4,87,,35.52,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.72,70,,28.58,,,0,"percent of total billed charges ","70% of total billed charges ",35.72,47.46,
"INTUBATION MODULE BLUE",6007653,"CDM ",272,RC,,,OUTPATIENT,,,216.81,173.448,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.45,80,,138.76,,,0,"percent of total billed charges ","80% of total billed charges ",151.77,70,,121.42,,,0,"percent of total billed charges ","70% of total billed charges ",195.13,90,,156.10,,,0,"percent of total billed charges ","90% of total billed charges ",201.63,93,,161.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",184.29,85,,147.43,,,0,"percent of total billed charges ","85% of total billed charges ",195.13,90,,156.10,,,0,"percent of total billed charges ","90% of total billed charges ",195.13,90,,156.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",188.62,87,,150.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.77,70,,121.42,,,0,"percent of total billed charges ","70% of total billed charges ",151.77,201.63,
"INTUBATION MODULE ORANGE",6007654,"CDM ",272,RC,,,OUTPATIENT,,,216.81,173.448,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.45,80,,138.76,,,0,"percent of total billed charges ","80% of total billed charges ",151.77,70,,121.42,,,0,"percent of total billed charges ","70% of total billed charges ",195.13,90,,156.10,,,0,"percent of total billed charges ","90% of total billed charges ",201.63,93,,161.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",184.29,85,,147.43,,,0,"percent of total billed charges ","85% of total billed charges ",195.13,90,,156.10,,,0,"percent of total billed charges ","90% of total billed charges ",195.13,90,,156.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",188.62,87,,150.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.77,70,,121.42,,,0,"percent of total billed charges ","70% of total billed charges ",151.77,201.63,
"INFANT/TODD 02 DEL SYS GREEN",6007655,"CDM ",272,RC,,,OUTPATIENT,,,51.03,40.824,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.82,80,,32.66,,,0,"percent of total billed charges ","80% of total billed charges ",35.72,70,,28.58,,,0,"percent of total billed charges ","70% of total billed charges ",45.93,90,,36.74,,,0,"percent of total billed charges ","90% of total billed charges ",47.46,93,,37.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.38,85,,34.70,,,0,"percent of total billed charges ","85% of total billed charges ",45.93,90,,36.74,,,0,"percent of total billed charges ","90% of total billed charges ",45.93,90,,36.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.4,87,,35.52,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.72,70,,28.58,,,0,"percent of total billed charges ","70% of total billed charges ",35.72,47.46,
"INTUBATION MODULE GREEN",6007656,"CDM ",272,RC,,,OUTPATIENT,,,216.81,173.448,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.45,80,,138.76,,,0,"percent of total billed charges ","80% of total billed charges ",151.77,70,,121.42,,,0,"percent of total billed charges ","70% of total billed charges ",195.13,90,,156.10,,,0,"percent of total billed charges ","90% of total billed charges ",201.63,93,,161.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",184.29,85,,147.43,,,0,"percent of total billed charges ","85% of total billed charges ",195.13,90,,156.10,,,0,"percent of total billed charges ","90% of total billed charges ",195.13,90,,156.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",188.62,87,,150.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.77,70,,121.42,,,0,"percent of total billed charges ","70% of total billed charges ",151.77,201.63,
"IV DELIVERY MODULE GREEN",6007657,"CDM ",272,RC,,,OUTPATIENT,,,240.25,192.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.2,80,,153.76,,,0,"percent of total billed charges ","80% of total billed charges ",168.18,70,,134.54,,,0,"percent of total billed charges ","70% of total billed charges ",216.23,90,,172.98,,,0,"percent of total billed charges ","90% of total billed charges ",223.43,93,,178.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",204.21,85,,163.37,,,0,"percent of total billed charges ","85% of total billed charges ",216.23,90,,172.98,,,0,"percent of total billed charges ","90% of total billed charges ",216.23,90,,172.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",209.02,87,,167.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",168.18,70,,134.54,,,0,"percent of total billed charges ","70% of total billed charges ",168.18,223.43,
"CAST ONE-STEP 2X10",6007669,"CDM ",272,RC,,,OUTPATIENT,,,22.57,18.056,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.06,80,,14.45,,,0,"percent of total billed charges ","80% of total billed charges ",15.8,70,,12.64,,,0,"percent of total billed charges ","70% of total billed charges ",20.31,90,,16.25,,,0,"percent of total billed charges ","90% of total billed charges ",20.99,93,,16.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.18,85,,15.34,,,0,"percent of total billed charges ","85% of total billed charges ",20.31,90,,16.25,,,0,"percent of total billed charges ","90% of total billed charges ",20.31,90,,16.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.64,87,,15.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.8,70,,12.64,,,0,"percent of total billed charges ","70% of total billed charges ",15.8,20.99,
"CAST ONE-STEP 5X30",6007670,"CDM ",272,RC,,,OUTPATIENT,,,69.7,55.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.76,80,,44.61,,,0,"percent of total billed charges ","80% of total billed charges ",48.79,70,,39.03,,,0,"percent of total billed charges ","70% of total billed charges ",62.73,90,,50.18,,,0,"percent of total billed charges ","90% of total billed charges ",64.82,93,,51.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",59.25,85,,47.40,,,0,"percent of total billed charges ","85% of total billed charges ",62.73,90,,50.18,,,0,"percent of total billed charges ","90% of total billed charges ",62.73,90,,50.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",60.64,87,,48.51,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.79,70,,39.03,,,0,"percent of total billed charges ","70% of total billed charges ",48.79,64.82,
"DERMABOND HIGH VISCOSITY",6007671,"CDM ",272,RC,,,OUTPATIENT,,,70.01,56.008,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.01,80,,44.81,,,0,"percent of total billed charges ","80% of total billed charges ",49.01,70,,39.21,,,0,"percent of total billed charges ","70% of total billed charges ",63.01,90,,50.41,,,0,"percent of total billed charges ","90% of total billed charges ",65.11,93,,52.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",59.51,85,,47.61,,,0,"percent of total billed charges ","85% of total billed charges ",63.01,90,,50.41,,,0,"percent of total billed charges ","90% of total billed charges ",63.01,90,,50.41,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",60.91,87,,48.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.01,70,,39.21,,,0,"percent of total billed charges ","70% of total billed charges ",49.01,65.11,
"ESOPHAGEAL AIRWAY ROLLUP KIT",6007672,"CDM ",272,RC,,,OUTPATIENT,,,213.67,170.936,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.94,80,,136.75,,,0,"percent of total billed charges ","80% of total billed charges ",149.57,70,,119.66,,,0,"percent of total billed charges ","70% of total billed charges ",192.3,90,,153.84,,,0,"percent of total billed charges ","90% of total billed charges ",198.71,93,,158.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",181.62,85,,145.30,,,0,"percent of total billed charges ","85% of total billed charges ",192.3,90,,153.84,,,0,"percent of total billed charges ","90% of total billed charges ",192.3,90,,153.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",185.89,87,,148.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.57,70,,119.66,,,0,"percent of total billed charges ","70% of total billed charges ",149.57,198.71,
"MASK LARYNGEAL AIRWAY SZ 3",6007673,"CDM ",270,RC,,,OUTPATIENT,,,77.79,62.232,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.23,80,,49.78,,,0,"percent of total billed charges ","80% of total billed charges ",54.45,70,,43.56,,,0,"percent of total billed charges ","70% of total billed charges ",70.01,90,,56.01,,,0,"percent of total billed charges ","90% of total billed charges ",72.34,93,,57.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",66.12,85,,52.90,,,0,"percent of total billed charges ","85% of total billed charges ",70.01,90,,56.01,,,0,"percent of total billed charges ","90% of total billed charges ",70.01,90,,56.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",67.68,87,,54.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.45,70,,43.56,,,0,"percent of total billed charges ","70% of total billed charges ",54.45,72.34,
"DRSNG KALGINATE 12IN",6007675,"CDM ",272,RC,,,OUTPATIENT,,,29,23.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.2,80,,18.56,,,0,"percent of total billed charges ","80% of total billed charges ",20.3,70,,16.24,,,0,"percent of total billed charges ","70% of total billed charges ",26.1,90,,20.88,,,0,"percent of total billed charges ","90% of total billed charges ",26.97,93,,21.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",24.65,85,,19.72,,,0,"percent of total billed charges ","85% of total billed charges ",26.1,90,,20.88,,,0,"percent of total billed charges ","90% of total billed charges ",26.1,90,,20.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",25.23,87,,20.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.3,70,,16.24,,,0,"percent of total billed charges ","70% of total billed charges ",20.3,26.97,
"DRSNG AQUASORB 3.75 X 5.5",6007676,"CDM ",272,RC,,,OUTPATIENT,,,89.97,71.976,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.98,80,,57.58,,,0,"percent of total billed charges ","80% of total billed charges ",62.98,70,,50.38,,,0,"percent of total billed charges ","70% of total billed charges ",80.97,90,,64.78,,,0,"percent of total billed charges ","90% of total billed charges ",83.67,93,,66.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",76.47,85,,61.18,,,0,"percent of total billed charges ","85% of total billed charges ",80.97,90,,64.78,,,0,"percent of total billed charges ","90% of total billed charges ",80.97,90,,64.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",78.27,87,,62.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.98,70,,50.38,,,0,"percent of total billed charges ","70% of total billed charges ",62.98,83.67,
"DRSNG POLYDERM PLUS 4X4",6007680,"CDM ",272,RC,,,OUTPATIENT,,,27.63,22.104,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.1,80,,17.68,,,0,"percent of total billed charges ","80% of total billed charges ",19.34,70,,15.47,,,0,"percent of total billed charges ","70% of total billed charges ",24.87,90,,19.90,,,0,"percent of total billed charges ","90% of total billed charges ",25.7,93,,20.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.49,85,,18.79,,,0,"percent of total billed charges ","85% of total billed charges ",24.87,90,,19.90,,,0,"percent of total billed charges ","90% of total billed charges ",24.87,90,,19.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",24.04,87,,19.23,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.34,70,,15.47,,,0,"percent of total billed charges ","70% of total billed charges ",19.34,25.7,
"DRSNG MULTIDEX POWDER",6007681,"CDM ",272,RC,,,OUTPATIENT,,,22.52,18.016,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.02,80,,14.42,,,0,"percent of total billed charges ","80% of total billed charges ",15.76,70,,12.61,,,0,"percent of total billed charges ","70% of total billed charges ",20.27,90,,16.22,,,0,"percent of total billed charges ","90% of total billed charges ",20.94,93,,16.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.14,85,,15.31,,,0,"percent of total billed charges ","85% of total billed charges ",20.27,90,,16.22,,,0,"percent of total billed charges ","90% of total billed charges ",20.27,90,,16.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.59,87,,15.67,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.76,70,,12.61,,,0,"percent of total billed charges ","70% of total billed charges ",15.76,20.94,
"DRSNG MULTIDEX GEL",6007682,"CDM ",272,RC,,,OUTPATIENT,,,19.76,15.808,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.81,80,,12.65,,,0,"percent of total billed charges ","80% of total billed charges ",13.83,70,,11.06,,,0,"percent of total billed charges ","70% of total billed charges ",17.78,90,,14.22,,,0,"percent of total billed charges ","90% of total billed charges ",18.38,93,,14.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.8,85,,13.44,,,0,"percent of total billed charges ","85% of total billed charges ",17.78,90,,14.22,,,0,"percent of total billed charges ","90% of total billed charges ",17.78,90,,14.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.19,87,,13.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.83,70,,11.06,,,0,"percent of total billed charges ","70% of total billed charges ",13.83,18.38,
"MASK LARYNGEAL AIRWAY SZ 4",6007683,"CDM ",270,RC,,,OUTPATIENT,,,377.13,301.704,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",301.7,80,,241.36,,,0,"percent of total billed charges ","80% of total billed charges ",263.99,70,,211.19,,,0,"percent of total billed charges ","70% of total billed charges ",339.42,90,,271.54,,,0,"percent of total billed charges ","90% of total billed charges ",350.73,93,,280.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",320.56,85,,256.45,,,0,"percent of total billed charges ","85% of total billed charges ",339.42,90,,271.54,,,0,"percent of total billed charges ","90% of total billed charges ",339.42,90,,271.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",328.1,87,,262.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.99,70,,211.19,,,0,"percent of total billed charges ","70% of total billed charges ",263.99,350.73,
"MASK LARYNGEAL AIRWAY SZ 5",6007684,"CDM ",270,RC,,,OUTPATIENT,,,377.13,301.704,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",301.7,80,,241.36,,,0,"percent of total billed charges ","80% of total billed charges ",263.99,70,,211.19,,,0,"percent of total billed charges ","70% of total billed charges ",339.42,90,,271.54,,,0,"percent of total billed charges ","90% of total billed charges ",350.73,93,,280.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",320.56,85,,256.45,,,0,"percent of total billed charges ","85% of total billed charges ",339.42,90,,271.54,,,0,"percent of total billed charges ","90% of total billed charges ",339.42,90,,271.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",328.1,87,,262.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.99,70,,211.19,,,0,"percent of total billed charges ","70% of total billed charges ",263.99,350.73,
"POWDER MULTIDEX 12GM",6007688,"CDM ",272,RC,,,OUTPATIENT,,,34.55,27.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.64,80,,22.11,,,0,"percent of total billed charges ","80% of total billed charges ",24.19,70,,19.35,,,0,"percent of total billed charges ","70% of total billed charges ",31.1,90,,24.88,,,0,"percent of total billed charges ","90% of total billed charges ",32.13,93,,25.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",29.37,85,,23.50,,,0,"percent of total billed charges ","85% of total billed charges ",31.1,90,,24.88,,,0,"percent of total billed charges ","90% of total billed charges ",31.1,90,,24.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.06,87,,24.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.19,70,,19.35,,,0,"percent of total billed charges ","70% of total billed charges ",24.19,32.13,
"GEL MULTIDEX 1/2 OZ",6007689,"CDM ",272,RC,,,OUTPATIENT,,,34.55,27.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.64,80,,22.11,,,0,"percent of total billed charges ","80% of total billed charges ",24.19,70,,19.35,,,0,"percent of total billed charges ","70% of total billed charges ",31.1,90,,24.88,,,0,"percent of total billed charges ","90% of total billed charges ",32.13,93,,25.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",29.37,85,,23.50,,,0,"percent of total billed charges ","85% of total billed charges ",31.1,90,,24.88,,,0,"percent of total billed charges ","90% of total billed charges ",31.1,90,,24.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.06,87,,24.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.19,70,,19.35,,,0,"percent of total billed charges ","70% of total billed charges ",24.19,32.13,
"FLUTER VALUE W/VIDEO",6007701,"CDM ",271,RC,,,OUTPATIENT,,,214.47,171.576,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",171.58,80,,137.26,,,0,"percent of total billed charges ","80% of total billed charges ",150.13,70,,120.10,,,0,"percent of total billed charges ","70% of total billed charges ",193.02,90,,154.42,,,0,"percent of total billed charges ","90% of total billed charges ",199.46,93,,159.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",182.3,85,,145.84,,,0,"percent of total billed charges ","85% of total billed charges ",193.02,90,,154.42,,,0,"percent of total billed charges ","90% of total billed charges ",193.02,90,,154.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",186.59,87,,149.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",150.13,70,,120.10,,,0,"percent of total billed charges ","70% of total billed charges ",150.13,199.46,
"FLUTER VALUE W/O VIDEO",6007702,"CDM ",271,RC,,,OUTPATIENT,,,214.47,171.576,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",171.58,80,,137.26,,,0,"percent of total billed charges ","80% of total billed charges ",150.13,70,,120.10,,,0,"percent of total billed charges ","70% of total billed charges ",193.02,90,,154.42,,,0,"percent of total billed charges ","90% of total billed charges ",199.46,93,,159.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",182.3,85,,145.84,,,0,"percent of total billed charges ","85% of total billed charges ",193.02,90,,154.42,,,0,"percent of total billed charges ","90% of total billed charges ",193.02,90,,154.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",186.59,87,,149.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",150.13,70,,120.10,,,0,"percent of total billed charges ","70% of total billed charges ",150.13,199.46,
"DRESSING COVADERM 4X4",6007720,"CDM ",272,RC,,,OUTPATIENT,,,6.77,5.416,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.42,80,,4.34,,,0,"percent of total billed charges ","80% of total billed charges ",4.74,70,,3.79,,,0,"percent of total billed charges ","70% of total billed charges ",6.09,90,,4.87,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,93,,5.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.75,85,,4.60,,,0,"percent of total billed charges ","85% of total billed charges ",6.09,90,,4.87,,,0,"percent of total billed charges ","90% of total billed charges ",6.09,90,,4.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5.89,87,,4.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.74,70,,3.79,,,0,"percent of total billed charges ","70% of total billed charges ",4.74,6.3,
"SUCTION NEO VAC MECONIUN",6007721,"CDM ",272,RC,,,OUTPATIENT,,,50.23,40.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.18,80,,32.14,,,0,"percent of total billed charges ","80% of total billed charges ",35.16,70,,28.13,,,0,"percent of total billed charges ","70% of total billed charges ",45.21,90,,36.17,,,0,"percent of total billed charges ","90% of total billed charges ",46.71,93,,37.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.7,85,,34.16,,,0,"percent of total billed charges ","85% of total billed charges ",45.21,90,,36.17,,,0,"percent of total billed charges ","90% of total billed charges ",45.21,90,,36.17,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.7,87,,34.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.16,70,,28.13,,,0,"percent of total billed charges ","70% of total billed charges ",35.16,46.71,
"DRESSING SOLOSITE GEL 4X4",6007729,"CDM ",272,RC,,,OUTPATIENT,,,13.69,10.952,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.95,80,,8.76,,,0,"percent of total billed charges ","80% of total billed charges ",9.58,70,,7.66,,,0,"percent of total billed charges ","70% of total billed charges ",12.32,90,,9.86,,,0,"percent of total billed charges ","90% of total billed charges ",12.73,93,,10.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.64,85,,9.31,,,0,"percent of total billed charges ","85% of total billed charges ",12.32,90,,9.86,,,0,"percent of total billed charges ","90% of total billed charges ",12.32,90,,9.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.91,87,,9.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.58,70,,7.66,,,0,"percent of total billed charges ","70% of total billed charges ",9.58,12.73,
"SET ORTHOPAT POST-OP",6007748,"CDM ",272,RC,,,OUTPATIENT,,,52.5,42,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42,80,,33.60,,,0,"percent of total billed charges ","80% of total billed charges ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",48.83,93,,39.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",44.63,85,,35.70,,,0,"percent of total billed charges ","85% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",45.68,87,,36.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",36.75,48.83,
"ANTECUBITAL IV SUPPORT",6007778,"CDM ",271,RC,,,OUTPATIENT,,,50.63,40.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.5,80,,32.40,,,0,"percent of total billed charges ","80% of total billed charges ",35.44,70,,28.35,,,0,"percent of total billed charges ","70% of total billed charges ",45.57,90,,36.46,,,0,"percent of total billed charges ","90% of total billed charges ",47.09,93,,37.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.04,85,,34.43,,,0,"percent of total billed charges ","85% of total billed charges ",45.57,90,,36.46,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,90,,36.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.05,87,,35.24,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.44,70,,28.35,,,0,"percent of total billed charges ","70% of total billed charges ",35.44,47.09,
"SENSOR ADULT MASIMO",6007807,"CDM ",272,RC,,,OUTPATIENT,,,35.81,28.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.65,80,,22.92,,,0,"percent of total billed charges ","80% of total billed charges ",25.07,70,,20.06,,,0,"percent of total billed charges ","70% of total billed charges ",32.23,90,,25.78,,,0,"percent of total billed charges ","90% of total billed charges ",33.3,93,,26.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",30.44,85,,24.35,,,0,"percent of total billed charges ","85% of total billed charges ",32.23,90,,25.78,,,0,"percent of total billed charges ","90% of total billed charges ",32.23,90,,25.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",31.15,87,,24.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.07,70,,20.06,,,0,"percent of total billed charges ","70% of total billed charges ",25.07,33.3,
"SENSOR PEDIATRIC MASIMO",6007808,"CDM ",272,RC,,,OUTPATIENT,,,39.67,31.736,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.74,80,,25.39,,,0,"percent of total billed charges ","80% of total billed charges ",27.77,70,,22.22,,,0,"percent of total billed charges ","70% of total billed charges ",35.7,90,,28.56,,,0,"percent of total billed charges ","90% of total billed charges ",36.89,93,,29.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.72,85,,26.98,,,0,"percent of total billed charges ","85% of total billed charges ",35.7,90,,28.56,,,0,"percent of total billed charges ","90% of total billed charges ",35.7,90,,28.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",34.51,87,,27.61,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.77,70,,22.22,,,0,"percent of total billed charges ","70% of total billed charges ",27.77,36.89,
"SENSOR NEONATE MASIMO",6007809,"CDM ",272,RC,,,OUTPATIENT,,,47.34,37.872,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.87,80,,30.30,,,0,"percent of total billed charges ","80% of total billed charges ",33.14,70,,26.51,,,0,"percent of total billed charges ","70% of total billed charges ",42.61,90,,34.09,,,0,"percent of total billed charges ","90% of total billed charges ",44.03,93,,35.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.24,85,,32.19,,,0,"percent of total billed charges ","85% of total billed charges ",42.61,90,,34.09,,,0,"percent of total billed charges ","90% of total billed charges ",42.61,90,,34.09,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.19,87,,32.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.14,70,,26.51,,,0,"percent of total billed charges ","70% of total billed charges ",33.14,44.03,
"BARIUM NECTAR THICK",6007813,"CDM ",270,RC,,,OUTPATIENT,,,72.28,57.824,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.82,80,,46.26,,,0,"percent of total billed charges ","80% of total billed charges ",50.6,70,,40.48,,,0,"percent of total billed charges ","70% of total billed charges ",65.05,90,,52.04,,,0,"percent of total billed charges ","90% of total billed charges ",67.22,93,,53.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",61.44,85,,49.15,,,0,"percent of total billed charges ","85% of total billed charges ",65.05,90,,52.04,,,0,"percent of total billed charges ","90% of total billed charges ",65.05,90,,52.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",62.88,87,,50.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.6,70,,40.48,,,0,"percent of total billed charges ","70% of total billed charges ",50.6,67.22,
"BARIUM HONEY THICK",6007814,"CDM ",270,RC,,,OUTPATIENT,,,200.47,160.376,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",160.38,80,,128.30,,,0,"percent of total billed charges ","80% of total billed charges ",140.33,70,,112.26,,,0,"percent of total billed charges ","70% of total billed charges ",180.42,90,,144.34,,,0,"percent of total billed charges ","90% of total billed charges ",186.44,93,,149.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",170.4,85,,136.32,,,0,"percent of total billed charges ","85% of total billed charges ",180.42,90,,144.34,,,0,"percent of total billed charges ","90% of total billed charges ",180.42,90,,144.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",174.41,87,,139.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.33,70,,112.26,,,0,"percent of total billed charges ","70% of total billed charges ",140.33,186.44,
"BARIUM PUDDING THICK",6007815,"CDM ",270,RC,,,OUTPATIENT,,,232.04,185.632,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",185.63,80,,148.50,,,0,"percent of total billed charges ","80% of total billed charges ",162.43,70,,129.94,,,0,"percent of total billed charges ","70% of total billed charges ",208.84,90,,167.07,,,0,"percent of total billed charges ","90% of total billed charges ",215.8,93,,172.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",197.23,85,,157.78,,,0,"percent of total billed charges ","85% of total billed charges ",208.84,90,,167.07,,,0,"percent of total billed charges ","90% of total billed charges ",208.84,90,,167.07,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",201.87,87,,161.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.43,70,,129.94,,,0,"percent of total billed charges ","70% of total billed charges ",162.43,215.8,
"VENTILATOR SMARTSYNC",6007821,"CDM ",272,RC,,,OUTPATIENT,,,143.71,114.968,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.97,80,,91.98,,,0,"percent of total billed charges ","80% of total billed charges ",100.6,70,,80.48,,,0,"percent of total billed charges ","70% of total billed charges ",129.34,90,,103.47,,,0,"percent of total billed charges ","90% of total billed charges ",133.65,93,,106.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",122.15,85,,97.72,,,0,"percent of total billed charges ","85% of total billed charges ",129.34,90,,103.47,,,0,"percent of total billed charges ","90% of total billed charges ",129.34,90,,103.47,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",125.03,87,,100.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",100.6,70,,80.48,,,0,"percent of total billed charges ","70% of total billed charges ",100.6,133.65,
"CATH IUP KOALA",6007827,"CDM ",272,RC,,,OUTPATIENT,,,120.37,96.296,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.3,80,,77.04,,,0,"percent of total billed charges ","80% of total billed charges ",84.26,70,,67.41,,,0,"percent of total billed charges ","70% of total billed charges ",108.33,90,,86.66,,,0,"percent of total billed charges ","90% of total billed charges ",111.94,93,,89.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",102.31,85,,81.85,,,0,"percent of total billed charges ","85% of total billed charges ",108.33,90,,86.66,,,0,"percent of total billed charges ","90% of total billed charges ",108.33,90,,86.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",104.72,87,,83.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.26,70,,67.41,,,0,"percent of total billed charges ","70% of total billed charges ",84.26,111.94,
"IONTOPATCH 80",6007897,"CDM ",270,RC,,,OUTPATIENT,,,25.41,20.328,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.33,80,,16.26,,,0,"percent of total billed charges ","80% of total billed charges ",17.79,70,,14.23,,,0,"percent of total billed charges ","70% of total billed charges ",22.87,90,,18.30,,,0,"percent of total billed charges ","90% of total billed charges ",23.63,93,,18.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.6,85,,17.28,,,0,"percent of total billed charges ","85% of total billed charges ",22.87,90,,18.30,,,0,"percent of total billed charges ","90% of total billed charges ",22.87,90,,18.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.11,87,,17.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.79,70,,14.23,,,0,"percent of total billed charges ","70% of total billed charges ",17.79,23.63,
"ULTRASOUND NEEDLE GUIDE",6007912,"CDM ",272,RC,,,OUTPATIENT,,,71.3,57.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.04,80,,45.63,,,0,"percent of total billed charges ","80% of total billed charges ",49.91,70,,39.93,,,0,"percent of total billed charges ","70% of total billed charges ",64.17,90,,51.34,,,0,"percent of total billed charges ","90% of total billed charges ",66.31,93,,53.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",60.61,85,,48.49,,,0,"percent of total billed charges ","85% of total billed charges ",64.17,90,,51.34,,,0,"percent of total billed charges ","90% of total billed charges ",64.17,90,,51.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",62.03,87,,49.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.91,70,,39.93,,,0,"percent of total billed charges ","70% of total billed charges ",49.91,66.31,
"MASK AEROSOL PEDI DEVILBISS",6007940,"CDM ",270,RC,,,OUTPATIENT,,,10.28,8.224,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.22,80,,6.58,,,0,"percent of total billed charges ","80% of total billed charges ",7.2,70,,5.76,,,0,"percent of total billed charges ","70% of total billed charges ",9.25,90,,7.40,,,0,"percent of total billed charges ","90% of total billed charges ",9.56,93,,7.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.74,85,,6.99,,,0,"percent of total billed charges ","85% of total billed charges ",9.25,90,,7.40,,,0,"percent of total billed charges ","90% of total billed charges ",9.25,90,,7.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",8.94,87,,7.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.2,70,,5.76,,,0,"percent of total billed charges ","70% of total billed charges ",7.2,9.56,
"SYSTEM DRAINAGE SAFETY TURKEL",6007941,"CDM ",272,RC,,,OUTPATIENT,,,149.8,119.84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.84,80,,95.87,,,0,"percent of total billed charges ","80% of total billed charges ",104.86,70,,83.89,,,0,"percent of total billed charges ","70% of total billed charges ",134.82,90,,107.86,,,0,"percent of total billed charges ","90% of total billed charges ",139.31,93,,111.45,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",127.33,85,,101.86,,,0,"percent of total billed charges ","85% of total billed charges ",134.82,90,,107.86,,,0,"percent of total billed charges ","90% of total billed charges ",134.82,90,,107.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",130.33,87,,104.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.86,70,,83.89,,,0,"percent of total billed charges ","70% of total billed charges ",104.86,139.31,
"STABILIZER EZ IO",6007942,"CDM ",272,RC,,,OUTPATIENT,,,80.01,64.008,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.01,80,,51.21,,,0,"percent of total billed charges ","80% of total billed charges ",56.01,70,,44.81,,,0,"percent of total billed charges ","70% of total billed charges ",72.01,90,,57.61,,,0,"percent of total billed charges ","90% of total billed charges ",74.41,93,,59.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",68.01,85,,54.41,,,0,"percent of total billed charges ","85% of total billed charges ",72.01,90,,57.61,,,0,"percent of total billed charges ","90% of total billed charges ",72.01,90,,57.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",69.61,87,,55.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.01,70,,44.81,,,0,"percent of total billed charges ","70% of total billed charges ",56.01,74.41,
"MASK MIRAGE QUATTRO SMALL",6007943,"CDM ",270,RC,,,OUTPATIENT,,,312.48,249.984,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",249.98,80,,199.98,,,0,"percent of total billed charges ","80% of total billed charges ",218.74,70,,174.99,,,0,"percent of total billed charges ","70% of total billed charges ",281.23,90,,224.98,,,0,"percent of total billed charges ","90% of total billed charges ",290.61,93,,232.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",265.61,85,,212.49,,,0,"percent of total billed charges ","85% of total billed charges ",281.23,90,,224.98,,,0,"percent of total billed charges ","90% of total billed charges ",281.23,90,,224.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",271.86,87,,217.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",218.74,70,,174.99,,,0,"percent of total billed charges ","70% of total billed charges ",218.74,290.61,
"TRAY RADIAL ARTERIAL LINE",6007946,"CDM ",272,RC,,,OUTPATIENT,,,197.63,158.104,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",158.1,80,,126.48,,,0,"percent of total billed charges ","80% of total billed charges ",138.34,70,,110.67,,,0,"percent of total billed charges ","70% of total billed charges ",177.87,90,,142.30,,,0,"percent of total billed charges ","90% of total billed charges ",183.8,93,,147.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",167.99,85,,134.39,,,0,"percent of total billed charges ","85% of total billed charges ",177.87,90,,142.30,,,0,"percent of total billed charges ","90% of total billed charges ",177.87,90,,142.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",171.94,87,,137.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",138.34,70,,110.67,,,0,"percent of total billed charges ","70% of total billed charges ",138.34,183.8,
"TRAY FEMORAL ARTERIAL LINE",6007947,"CDM ",272,RC,,,OUTPATIENT,,,376.69,301.352,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",301.35,80,,241.08,,,0,"percent of total billed charges ","80% of total billed charges ",263.68,70,,210.94,,,0,"percent of total billed charges ","70% of total billed charges ",339.02,90,,271.22,,,0,"percent of total billed charges ","90% of total billed charges ",350.32,93,,280.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",320.19,85,,256.15,,,0,"percent of total billed charges ","85% of total billed charges ",339.02,90,,271.22,,,0,"percent of total billed charges ","90% of total billed charges ",339.02,90,,271.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",327.72,87,,262.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.68,70,,210.94,,,0,"percent of total billed charges ","70% of total billed charges ",263.68,350.32,
"BINDER ABDOMINAL 46-62""",6007948,"CDM ",272,RC,,,OUTPATIENT,,,25.38,20.304,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.3,80,,16.24,,,0,"percent of total billed charges ","80% of total billed charges ",17.77,70,,14.22,,,0,"percent of total billed charges ","70% of total billed charges ",22.84,90,,18.27,,,0,"percent of total billed charges ","90% of total billed charges ",23.6,93,,18.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.57,85,,17.26,,,0,"percent of total billed charges ","85% of total billed charges ",22.84,90,,18.27,,,0,"percent of total billed charges ","90% of total billed charges ",22.84,90,,18.27,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.08,87,,17.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.77,70,,14.22,,,0,"percent of total billed charges ","70% of total billed charges ",17.77,23.6,
"GLIDESCOPE GVL 3 STAT",6007953,"CDM ",272,RC,,,OUTPATIENT,,,168.91,135.128,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.13,80,,108.10,,,0,"percent of total billed charges ","80% of total billed charges ",118.24,70,,94.59,,,0,"percent of total billed charges ","70% of total billed charges ",152.02,90,,121.62,,,0,"percent of total billed charges ","90% of total billed charges ",157.09,93,,125.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",143.57,85,,114.86,,,0,"percent of total billed charges ","85% of total billed charges ",152.02,90,,121.62,,,0,"percent of total billed charges ","90% of total billed charges ",152.02,90,,121.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",146.95,87,,117.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.24,70,,94.59,,,0,"percent of total billed charges ","70% of total billed charges ",118.24,157.09,
"GLIDESCOPE GVL 4 STAT",6007954,"CDM ",272,RC,,,OUTPATIENT,,,168.91,135.128,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.13,80,,108.10,,,0,"percent of total billed charges ","80% of total billed charges ",118.24,70,,94.59,,,0,"percent of total billed charges ","70% of total billed charges ",152.02,90,,121.62,,,0,"percent of total billed charges ","90% of total billed charges ",157.09,93,,125.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",143.57,85,,114.86,,,0,"percent of total billed charges ","85% of total billed charges ",152.02,90,,121.62,,,0,"percent of total billed charges ","90% of total billed charges ",152.02,90,,121.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",146.95,87,,117.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.24,70,,94.59,,,0,"percent of total billed charges ","70% of total billed charges ",118.24,157.09,
"SET BIOPSY 20G X 9CM",6007966,"CDM ",270,RC,,,OUTPATIENT,,,302.25,241.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.8,80,,193.44,,,0,"percent of total billed charges ","80% of total billed charges ",211.58,70,,169.26,,,0,"percent of total billed charges ","70% of total billed charges ",272.03,90,,217.62,,,0,"percent of total billed charges ","90% of total billed charges ",281.09,93,,224.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",256.91,85,,205.53,,,0,"percent of total billed charges ","85% of total billed charges ",272.03,90,,217.62,,,0,"percent of total billed charges ","90% of total billed charges ",272.03,90,,217.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",262.96,87,,210.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",211.58,70,,169.26,,,0,"percent of total billed charges ","70% of total billed charges ",211.58,281.09,
"QUICK-CORE BIOPSY NEEDLE 9CM",6007967,"CDM ",272,RC,,,OUTPATIENT,,,209.25,167.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.4,80,,133.92,,,0,"percent of total billed charges ","80% of total billed charges ",146.48,70,,117.18,,,0,"percent of total billed charges ","70% of total billed charges ",188.33,90,,150.66,,,0,"percent of total billed charges ","90% of total billed charges ",194.6,93,,155.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",177.86,85,,142.29,,,0,"percent of total billed charges ","85% of total billed charges ",188.33,90,,150.66,,,0,"percent of total billed charges ","90% of total billed charges ",188.33,90,,150.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",182.05,87,,145.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",146.48,70,,117.18,,,0,"percent of total billed charges ","70% of total billed charges ",146.48,194.6,
"CUREWRAP ADULT CRITICOOL",6007977,"CDM ",272,RC,,,OUTPATIENT,,,1010.74,808.592,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",808.59,80,,646.87,,,0,"percent of total billed charges ","80% of total billed charges ",707.52,70,,566.02,,,0,"percent of total billed charges ","70% of total billed charges ",909.67,90,,727.74,,,0,"percent of total billed charges ","90% of total billed charges ",939.99,93,,751.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",859.13,85,,687.30,,,0,"percent of total billed charges ","85% of total billed charges ",909.67,90,,727.74,,,0,"percent of total billed charges ","90% of total billed charges ",909.67,90,,727.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",879.34,87,,703.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",707.52,70,,566.02,,,0,"percent of total billed charges ","70% of total billed charges ",707.52,939.99,
"SENSOR SURFACE TEMP CRITICOOL",6007978,"CDM ",272,RC,,,OUTPATIENT,,,27.08,21.664,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.66,80,,17.33,,,0,"percent of total billed charges ","80% of total billed charges ",18.96,70,,15.17,,,0,"percent of total billed charges ","70% of total billed charges ",24.37,90,,19.50,,,0,"percent of total billed charges ","90% of total billed charges ",25.18,93,,20.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.02,85,,18.42,,,0,"percent of total billed charges ","85% of total billed charges ",24.37,90,,19.50,,,0,"percent of total billed charges ","90% of total billed charges ",24.37,90,,19.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",23.56,87,,18.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.96,70,,15.17,,,0,"percent of total billed charges ","70% of total billed charges ",18.96,25.18,
"SENSOR CORE TEMP CRITICOOL",6007979,"CDM ",272,RC,,,OUTPATIENT,,,27.08,21.664,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.66,80,,17.33,,,0,"percent of total billed charges ","80% of total billed charges ",18.96,70,,15.17,,,0,"percent of total billed charges ","70% of total billed charges ",24.37,90,,19.50,,,0,"percent of total billed charges ","90% of total billed charges ",25.18,93,,20.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.02,85,,18.42,,,0,"percent of total billed charges ","85% of total billed charges ",24.37,90,,19.50,,,0,"percent of total billed charges ","90% of total billed charges ",24.37,90,,19.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",23.56,87,,18.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.96,70,,15.17,,,0,"percent of total billed charges ","70% of total billed charges ",18.96,25.18,
"DRSG SILVERCEL 4"" X 8""",6007992,"CDM ",272,RC,,,OUTPATIENT,,,52.5,42,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42,80,,33.60,,,0,"percent of total billed charges ","80% of total billed charges ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",48.83,93,,39.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",44.63,85,,35.70,,,0,"percent of total billed charges ","85% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",45.68,87,,36.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",36.75,48.83,
"DRSG SILVERCEL 4.25"" X 4.25""",6007993,"CDM ",272,RC,,,OUTPATIENT,,,37,29.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.6,80,,23.68,,,0,"percent of total billed charges ","80% of total billed charges ",25.9,70,,20.72,,,0,"percent of total billed charges ","70% of total billed charges ",33.3,90,,26.64,,,0,"percent of total billed charges ","90% of total billed charges ",34.41,93,,27.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",31.45,85,,25.16,,,0,"percent of total billed charges ","85% of total billed charges ",33.3,90,,26.64,,,0,"percent of total billed charges ","90% of total billed charges ",33.3,90,,26.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",32.19,87,,25.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.9,70,,20.72,,,0,"percent of total billed charges ","70% of total billed charges ",25.9,34.41,
"DRSG AQUACEL AG 1CM X 45CM",6007994,"CDM ",272,RC,,,OUTPATIENT,,,42.18,33.744,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.74,80,,26.99,,,0,"percent of total billed charges ","80% of total billed charges ",29.53,70,,23.62,,,0,"percent of total billed charges ","70% of total billed charges ",37.96,90,,30.37,,,0,"percent of total billed charges ","90% of total billed charges ",39.23,93,,31.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",35.85,85,,28.68,,,0,"percent of total billed charges ","85% of total billed charges ",37.96,90,,30.37,,,0,"percent of total billed charges ","90% of total billed charges ",37.96,90,,30.37,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",36.7,87,,29.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.53,70,,23.62,,,0,"percent of total billed charges ","70% of total billed charges ",29.53,39.23,
"DRSG AQUACEL AG 1CM X 45CM",6007994,"CDM ",272,RC,,,OUTPATIENT,,,42.18,33.744,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.74,80,,26.99,,,0,"percent of total billed charges ","80% of total billed charges ",29.53,70,,23.62,,,0,"percent of total billed charges ","70% of total billed charges ",37.96,90,,30.37,,,0,"percent of total billed charges ","90% of total billed charges ",39.23,93,,31.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",35.85,85,,28.68,,,0,"percent of total billed charges ","85% of total billed charges ",37.96,90,,30.37,,,0,"percent of total billed charges ","90% of total billed charges ",37.96,90,,30.37,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",36.7,87,,29.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.53,70,,23.62,,,0,"percent of total billed charges ","70% of total billed charges ",29.53,39.23,
"DRSG AQUACEL AG 4"" X 5""",6007995,"CDM ",272,RC,,,OUTPATIENT,,,35.21,28.168,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.17,80,,22.54,,,0,"percent of total billed charges ","80% of total billed charges ",24.65,70,,19.72,,,0,"percent of total billed charges ","70% of total billed charges ",31.69,90,,25.35,,,0,"percent of total billed charges ","90% of total billed charges ",32.75,93,,26.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",29.93,85,,23.94,,,0,"percent of total billed charges ","85% of total billed charges ",31.69,90,,25.35,,,0,"percent of total billed charges ","90% of total billed charges ",31.69,90,,25.35,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.63,87,,24.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.65,70,,19.72,,,0,"percent of total billed charges ","70% of total billed charges ",24.65,32.75,
"DRSG AQUACEL AG 4"" X 5""",6007995,"CDM ",272,RC,,,OUTPATIENT,,,35.21,28.168,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.17,80,,22.54,,,0,"percent of total billed charges ","80% of total billed charges ",24.65,70,,19.72,,,0,"percent of total billed charges ","70% of total billed charges ",31.69,90,,25.35,,,0,"percent of total billed charges ","90% of total billed charges ",32.75,93,,26.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",29.93,85,,23.94,,,0,"percent of total billed charges ","85% of total billed charges ",31.69,90,,25.35,,,0,"percent of total billed charges ","90% of total billed charges ",31.69,90,,25.35,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.63,87,,24.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.65,70,,19.72,,,0,"percent of total billed charges ","70% of total billed charges ",24.65,32.75,
"DRSG AQUACEL FOAM 5"" X 5""",6007997,"CDM ",272,RC,,,OUTPATIENT,,,12.29,9.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.83,80,,7.86,,,0,"percent of total billed charges ","80% of total billed charges ",8.6,70,,6.88,,,0,"percent of total billed charges ","70% of total billed charges ",11.06,90,,8.85,,,0,"percent of total billed charges ","90% of total billed charges ",11.43,93,,9.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.45,85,,8.36,,,0,"percent of total billed charges ","85% of total billed charges ",11.06,90,,8.85,,,0,"percent of total billed charges ","90% of total billed charges ",11.06,90,,8.85,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.69,87,,8.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.6,70,,6.88,,,0,"percent of total billed charges ","70% of total billed charges ",8.6,11.43,
"DRSG AQUACEL FOAM 5"" X 5""",6007997,"CDM ",272,RC,,,OUTPATIENT,,,12.29,9.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.83,80,,7.86,,,0,"percent of total billed charges ","80% of total billed charges ",8.6,70,,6.88,,,0,"percent of total billed charges ","70% of total billed charges ",11.06,90,,8.85,,,0,"percent of total billed charges ","90% of total billed charges ",11.43,93,,9.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.45,85,,8.36,,,0,"percent of total billed charges ","85% of total billed charges ",11.06,90,,8.85,,,0,"percent of total billed charges ","90% of total billed charges ",11.06,90,,8.85,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.69,87,,8.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.6,70,,6.88,,,0,"percent of total billed charges ","70% of total billed charges ",8.6,11.43,
"DRSG AQUACEL FOAM SACRAL 8""X7""",6007998,"CDM ",272,RC,,,OUTPATIENT,,,21.97,17.576,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.58,80,,14.06,,,0,"percent of total billed charges ","80% of total billed charges ",15.38,70,,12.30,,,0,"percent of total billed charges ","70% of total billed charges ",19.77,90,,15.82,,,0,"percent of total billed charges ","90% of total billed charges ",20.43,93,,16.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.67,85,,14.94,,,0,"percent of total billed charges ","85% of total billed charges ",19.77,90,,15.82,,,0,"percent of total billed charges ","90% of total billed charges ",19.77,90,,15.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.11,87,,15.29,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.38,70,,12.30,,,0,"percent of total billed charges ","70% of total billed charges ",15.38,20.43,
"DRSG AQUACEL FOAM SACRAL 8""X7""",6007998,"CDM ",272,RC,,,OUTPATIENT,,,21.97,17.576,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.58,80,,14.06,,,0,"percent of total billed charges ","80% of total billed charges ",15.38,70,,12.30,,,0,"percent of total billed charges ","70% of total billed charges ",19.77,90,,15.82,,,0,"percent of total billed charges ","90% of total billed charges ",20.43,93,,16.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.67,85,,14.94,,,0,"percent of total billed charges ","85% of total billed charges ",19.77,90,,15.82,,,0,"percent of total billed charges ","90% of total billed charges ",19.77,90,,15.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.11,87,,15.29,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.38,70,,12.30,,,0,"percent of total billed charges ","70% of total billed charges ",15.38,20.43,
"PURAPLY AM 6X9CM",6008003,"CDM ",636,RC,,,OUTPATIENT,,,9310.95,7448.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7448.76,80,,5959.01,,,0,"percent of total billed charges ","80% of total billed charges ",6517.67,70,,5214.14,,,0,"percent of total billed charges ","70% of total billed charges ",8379.86,90,,6703.89,,,0,"percent of total billed charges ","90% of total billed charges ",8659.18,93,,6927.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7914.31,85,,6331.45,,,0,"percent of total billed charges ","85% of total billed charges ",8379.86,90,,6703.89,,,0,"percent of total billed charges ","90% of total billed charges ",8379.86,90,,6703.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",8100.53,87,,6480.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6517.67,70,,5214.14,,,0,"percent of total billed charges ","70% of total billed charges ",6517.67,8659.18,
"DRSG MH 1.8"" X 1.8"" NON-AD",6008004,"CDM ",272,RC,,,OUTPATIENT,,,16,12.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.8,80,,10.24,,,0,"percent of total billed charges ","80% of total billed charges ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.88,93,,11.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.6,85,,10.88,,,0,"percent of total billed charges ","85% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.92,87,,11.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,14.88,
"DRSG MH 2.4"" X 2.4"" NON-AD",6008005,"CDM ",272,RC,,,OUTPATIENT,,,19.5,15.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.6,80,,12.48,,,0,"percent of total billed charges ","80% of total billed charges ",13.65,70,,10.92,,,0,"percent of total billed charges ","70% of total billed charges ",17.55,90,,14.04,,,0,"percent of total billed charges ","90% of total billed charges ",18.14,93,,14.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.58,85,,13.26,,,0,"percent of total billed charges ","85% of total billed charges ",17.55,90,,14.04,,,0,"percent of total billed charges ","90% of total billed charges ",17.55,90,,14.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.97,87,,13.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.65,70,,10.92,,,0,"percent of total billed charges ","70% of total billed charges ",13.65,18.14,
"DRSG MH 4.3"" X 4.3"" NON-AD",6008006,"CDM ",272,RC,,,OUTPATIENT,,,47,37.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.6,80,,30.08,,,0,"percent of total billed charges ","80% of total billed charges ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",43.71,93,,34.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.95,85,,31.96,,,0,"percent of total billed charges ","85% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",42.3,90,,33.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.89,87,,32.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.9,70,,26.32,,,0,"percent of total billed charges ","70% of total billed charges ",32.9,43.71,
"DRSG MH 2.8"" X 2.8"" ADHES",6008007,"CDM ",272,RC,,,OUTPATIENT,,,25,20,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20,80,,16.00,,,0,"percent of total billed charges ","80% of total billed charges ",17.5,70,,14.00,,,0,"percent of total billed charges ","70% of total billed charges ",22.5,90,,18.00,,,0,"percent of total billed charges ","90% of total billed charges ",23.25,93,,18.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.25,85,,17.00,,,0,"percent of total billed charges ","85% of total billed charges ",22.5,90,,18.00,,,0,"percent of total billed charges ","90% of total billed charges ",22.5,90,,18.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.75,87,,17.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.5,70,,14.00,,,0,"percent of total billed charges ","70% of total billed charges ",17.5,23.25,
"DRSG MH 2"" X 2"" NON-ADH",6008008,"CDM ",272,RC,,,OUTPATIENT,,,20,16,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16,80,,12.80,,,0,"percent of total billed charges ","80% of total billed charges ",14,70,,11.20,,,0,"percent of total billed charges ","70% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",18.6,93,,14.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17,85,,13.60,,,0,"percent of total billed charges ","85% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.4,87,,13.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14,70,,11.20,,,0,"percent of total billed charges ","70% of total billed charges ",14,18.6,
"DRSG HYDRO BLUE 2"" X 2""",6008009,"CDM ",272,RC,,,OUTPATIENT,,,20.41,16.328,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.33,80,,13.06,,,0,"percent of total billed charges ","80% of total billed charges ",14.29,70,,11.43,,,0,"percent of total billed charges ","70% of total billed charges ",18.37,90,,14.70,,,0,"percent of total billed charges ","90% of total billed charges ",18.98,93,,15.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.35,85,,13.88,,,0,"percent of total billed charges ","85% of total billed charges ",18.37,90,,14.70,,,0,"percent of total billed charges ","90% of total billed charges ",18.37,90,,14.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.76,87,,14.21,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.29,70,,11.43,,,0,"percent of total billed charges ","70% of total billed charges ",14.29,18.98,
"DRSG HYDRO BLUE 6"" X 6""",6008010,"CDM ",272,RC,,,OUTPATIENT,,,60.01,48.008,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.01,80,,38.41,,,0,"percent of total billed charges ","80% of total billed charges ",42.01,70,,33.61,,,0,"percent of total billed charges ","70% of total billed charges ",54.01,90,,43.21,,,0,"percent of total billed charges ","90% of total billed charges ",55.81,93,,44.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51.01,85,,40.81,,,0,"percent of total billed charges ","85% of total billed charges ",54.01,90,,43.21,,,0,"percent of total billed charges ","90% of total billed charges ",54.01,90,,43.21,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",52.21,87,,41.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.01,70,,33.61,,,0,"percent of total billed charges ","70% of total billed charges ",42.01,55.81,
"SPRAY SENSI-CARE",6008011,"CDM ",272,RC,,,OUTPATIENT,,,28.54,22.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.83,80,,18.26,,,0,"percent of total billed charges ","80% of total billed charges ",19.98,70,,15.98,,,0,"percent of total billed charges ","70% of total billed charges ",25.69,90,,20.55,,,0,"percent of total billed charges ","90% of total billed charges ",26.54,93,,21.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",24.26,85,,19.41,,,0,"percent of total billed charges ","85% of total billed charges ",25.69,90,,20.55,,,0,"percent of total billed charges ","90% of total billed charges ",25.69,90,,20.55,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",24.83,87,,19.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.98,70,,15.98,,,0,"percent of total billed charges ","70% of total billed charges ",19.98,26.54,
"SPRAY SENSI-CARE",6008011,"CDM ",272,RC,,,OUTPATIENT,,,28.54,22.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.83,80,,18.26,,,0,"percent of total billed charges ","80% of total billed charges ",19.98,70,,15.98,,,0,"percent of total billed charges ","70% of total billed charges ",25.69,90,,20.55,,,0,"percent of total billed charges ","90% of total billed charges ",26.54,93,,21.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",24.26,85,,19.41,,,0,"percent of total billed charges ","85% of total billed charges ",25.69,90,,20.55,,,0,"percent of total billed charges ","90% of total billed charges ",25.69,90,,20.55,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",24.83,87,,19.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.98,70,,15.98,,,0,"percent of total billed charges ","70% of total billed charges ",19.98,26.54,
"KIT SUTURE",6008015,"CDM ",272,RC,,,OUTPATIENT,,,29,23.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.2,80,,18.56,,,0,"percent of total billed charges ","80% of total billed charges ",20.3,70,,16.24,,,0,"percent of total billed charges ","70% of total billed charges ",26.1,90,,20.88,,,0,"percent of total billed charges ","90% of total billed charges ",26.97,93,,21.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",24.65,85,,19.72,,,0,"percent of total billed charges ","85% of total billed charges ",26.1,90,,20.88,,,0,"percent of total billed charges ","90% of total billed charges ",26.1,90,,20.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",25.23,87,,20.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.3,70,,16.24,,,0,"percent of total billed charges ","70% of total billed charges ",20.3,26.97,
"SOLUTION NS IRRIG BTL 250ML",6008016,"CDM ",272,RC,,,OUTPATIENT,,,17.65,14.12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.12,80,,11.30,,,0,"percent of total billed charges ","80% of total billed charges ",12.36,70,,9.89,,,0,"percent of total billed charges ","70% of total billed charges ",15.89,90,,12.71,,,0,"percent of total billed charges ","90% of total billed charges ",16.41,93,,13.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15,85,,12.00,,,0,"percent of total billed charges ","85% of total billed charges ",15.89,90,,12.71,,,0,"percent of total billed charges ","90% of total billed charges ",15.89,90,,12.71,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.36,87,,12.29,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.36,70,,9.89,,,0,"percent of total billed charges ","70% of total billed charges ",12.36,16.41,
"SOLUTION NS IRRIG BTL 250ML",6008016,"CDM ",272,RC,,,OUTPATIENT,,,17.65,14.12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.12,80,,11.30,,,0,"percent of total billed charges ","80% of total billed charges ",12.36,70,,9.89,,,0,"percent of total billed charges ","70% of total billed charges ",15.89,90,,12.71,,,0,"percent of total billed charges ","90% of total billed charges ",16.41,93,,13.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15,85,,12.00,,,0,"percent of total billed charges ","85% of total billed charges ",15.89,90,,12.71,,,0,"percent of total billed charges ","90% of total billed charges ",15.89,90,,12.71,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.36,87,,12.29,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.36,70,,9.89,,,0,"percent of total billed charges ","70% of total billed charges ",12.36,16.41,
"DRSG MH 3/4"" X 12"" CALC AL",6008023,"CDM ",272,RC,,,OUTPATIENT,,,33.35,26.68,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.68,80,,21.34,,,0,"percent of total billed charges ","80% of total billed charges ",23.35,70,,18.68,,,0,"percent of total billed charges ","70% of total billed charges ",30.02,90,,24.02,,,0,"percent of total billed charges ","90% of total billed charges ",31.02,93,,24.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.35,85,,22.68,,,0,"percent of total billed charges ","85% of total billed charges ",30.02,90,,24.02,,,0,"percent of total billed charges ","90% of total billed charges ",30.02,90,,24.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.01,87,,23.21,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.35,70,,18.68,,,0,"percent of total billed charges ","70% of total billed charges ",23.35,31.02,
"DRSG MH 2"" X 2"" CALC ALG",6008024,"CDM ",272,RC,,,OUTPATIENT,,,20,16,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16,80,,12.80,,,0,"percent of total billed charges ","80% of total billed charges ",14,70,,11.20,,,0,"percent of total billed charges ","70% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",18.6,93,,14.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17,85,,13.60,,,0,"percent of total billed charges ","85% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.4,87,,13.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14,70,,11.20,,,0,"percent of total billed charges ","70% of total billed charges ",14,18.6,
"DRSG MH 4"" X 5"" CALC ALG",6008025,"CDM ",272,RC,,,OUTPATIENT,,,41.72,33.376,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.38,80,,26.70,,,0,"percent of total billed charges ","80% of total billed charges ",29.2,70,,23.36,,,0,"percent of total billed charges ","70% of total billed charges ",37.55,90,,30.04,,,0,"percent of total billed charges ","90% of total billed charges ",38.8,93,,31.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",35.46,85,,28.37,,,0,"percent of total billed charges ","85% of total billed charges ",37.55,90,,30.04,,,0,"percent of total billed charges ","90% of total billed charges ",37.55,90,,30.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",36.3,87,,29.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.2,70,,23.36,,,0,"percent of total billed charges ","70% of total billed charges ",29.2,38.8,
"DRSG MH GEL 0.5 OZ",6008026,"CDM ",272,RC,,,OUTPATIENT,,,20.26,16.208,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.21,80,,12.97,,,0,"percent of total billed charges ","80% of total billed charges ",14.18,70,,11.34,,,0,"percent of total billed charges ","70% of total billed charges ",18.23,90,,14.58,,,0,"percent of total billed charges ","90% of total billed charges ",18.84,93,,15.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.22,85,,13.78,,,0,"percent of total billed charges ","85% of total billed charges ",18.23,90,,14.58,,,0,"percent of total billed charges ","90% of total billed charges ",18.23,90,,14.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.63,87,,14.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.18,70,,11.34,,,0,"percent of total billed charges ","70% of total billed charges ",14.18,18.84,
"DRSG MH GEL 0.5 OZ",6008026,"CDM ",272,RC,,,OUTPATIENT,,,20.26,16.208,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.21,80,,12.97,,,0,"percent of total billed charges ","80% of total billed charges ",14.18,70,,11.34,,,0,"percent of total billed charges ","70% of total billed charges ",18.23,90,,14.58,,,0,"percent of total billed charges ","90% of total billed charges ",18.84,93,,15.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.22,85,,13.78,,,0,"percent of total billed charges ","85% of total billed charges ",18.23,90,,14.58,,,0,"percent of total billed charges ","90% of total billed charges ",18.23,90,,14.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.63,87,,14.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.18,70,,11.34,,,0,"percent of total billed charges ","70% of total billed charges ",14.18,18.84,
"DRSG AQUACEL FOAM 7"" X 7""",6008029,"CDM ",272,RC,,,OUTPATIENT,,,19.66,15.728,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.73,80,,12.58,,,0,"percent of total billed charges ","80% of total billed charges ",13.76,70,,11.01,,,0,"percent of total billed charges ","70% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",18.28,93,,14.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.71,85,,13.37,,,0,"percent of total billed charges ","85% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.1,87,,13.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.76,70,,11.01,,,0,"percent of total billed charges ","70% of total billed charges ",13.76,18.28,
"DRSG AQUACEL FOAM 7"" X 7""",6008029,"CDM ",272,RC,,,OUTPATIENT,,,19.66,15.728,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.73,80,,12.58,,,0,"percent of total billed charges ","80% of total billed charges ",13.76,70,,11.01,,,0,"percent of total billed charges ","70% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",18.28,93,,14.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.71,85,,13.37,,,0,"percent of total billed charges ","85% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.1,87,,13.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.76,70,,11.01,,,0,"percent of total billed charges ","70% of total billed charges ",13.76,18.28,
"DRSG AQUACEL FOAM AG 5"" X 5""",6008030,"CDM ",272,RC,,,OUTPATIENT,,,33.5,26.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.8,80,,21.44,,,0,"percent of total billed charges ","80% of total billed charges ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",31.16,93,,24.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.48,85,,22.78,,,0,"percent of total billed charges ","85% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.15,87,,23.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",23.45,31.16,
"DRESSING DUODERM 6X7",6008044,"CDM ",272,RC,,,OUTPATIENT,,,16.7,13.36,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.36,80,,10.69,,,0,"percent of total billed charges ","80% of total billed charges ",11.69,70,,9.35,,,0,"percent of total billed charges ","70% of total billed charges ",15.03,90,,12.02,,,0,"percent of total billed charges ","90% of total billed charges ",15.53,93,,12.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.2,85,,11.36,,,0,"percent of total billed charges ","85% of total billed charges ",15.03,90,,12.02,,,0,"percent of total billed charges ","90% of total billed charges ",15.03,90,,12.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.53,87,,11.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.69,70,,9.35,,,0,"percent of total billed charges ","70% of total billed charges ",11.69,15.53,
"DRESSING AQUACEL AG 3.5"" X 6""",6008045,"CDM ",272,RC,,,OUTPATIENT,,,102.24,81.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.79,80,,65.43,,,0,"percent of total billed charges ","80% of total billed charges ",71.57,70,,57.26,,,0,"percent of total billed charges ","70% of total billed charges ",92.02,90,,73.62,,,0,"percent of total billed charges ","90% of total billed charges ",95.08,93,,76.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",86.9,85,,69.52,,,0,"percent of total billed charges ","85% of total billed charges ",92.02,90,,73.62,,,0,"percent of total billed charges ","90% of total billed charges ",92.02,90,,73.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",88.95,87,,71.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.57,70,,57.26,,,0,"percent of total billed charges ","70% of total billed charges ",71.57,95.08,
"DRESSING AQUACEL AG 3.5"" X 6""",6008045,"CDM ",272,RC,,,OUTPATIENT,,,102.24,81.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.79,80,,65.43,,,0,"percent of total billed charges ","80% of total billed charges ",71.57,70,,57.26,,,0,"percent of total billed charges ","70% of total billed charges ",92.02,90,,73.62,,,0,"percent of total billed charges ","90% of total billed charges ",95.08,93,,76.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",86.9,85,,69.52,,,0,"percent of total billed charges ","85% of total billed charges ",92.02,90,,73.62,,,0,"percent of total billed charges ","90% of total billed charges ",92.02,90,,73.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",88.95,87,,71.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.57,70,,57.26,,,0,"percent of total billed charges ","70% of total billed charges ",71.57,95.08,
"PURAPLY AM 5X5 CM",6008047,"CDM ",636,RC,,,OUTPATIENT,,,4719,3775.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3775.2,80,,3020.16,,,0,"percent of total billed charges ","80% of total billed charges ",3303.3,70,,2642.64,,,0,"percent of total billed charges ","70% of total billed charges ",4247.1,90,,3397.68,,,0,"percent of total billed charges ","90% of total billed charges ",4388.67,93,,3510.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4011.15,85,,3208.92,,,0,"percent of total billed charges ","85% of total billed charges ",4247.1,90,,3397.68,,,0,"percent of total billed charges ","90% of total billed charges ",4247.1,90,,3397.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4105.53,87,,3284.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3303.3,70,,2642.64,,,0,"percent of total billed charges ","70% of total billed charges ",3303.3,4388.67,
"DRESSING PRISMA MATRIX 4.34""",6008048,"CDM ",272,RC,,,OUTPATIENT,,,42.18,33.744,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.74,80,,26.99,,,0,"percent of total billed charges ","80% of total billed charges ",29.53,70,,23.62,,,0,"percent of total billed charges ","70% of total billed charges ",37.96,90,,30.37,,,0,"percent of total billed charges ","90% of total billed charges ",39.23,93,,31.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",35.85,85,,28.68,,,0,"percent of total billed charges ","85% of total billed charges ",37.96,90,,30.37,,,0,"percent of total billed charges ","90% of total billed charges ",37.96,90,,30.37,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",36.7,87,,29.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.53,70,,23.62,,,0,"percent of total billed charges ","70% of total billed charges ",29.53,39.23,
"DRESSING PRISMA MATRIX 4.34""",6008048,"CDM ",272,RC,,,OUTPATIENT,,,42.18,33.744,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.74,80,,26.99,,,0,"percent of total billed charges ","80% of total billed charges ",29.53,70,,23.62,,,0,"percent of total billed charges ","70% of total billed charges ",37.96,90,,30.37,,,0,"percent of total billed charges ","90% of total billed charges ",39.23,93,,31.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",35.85,85,,28.68,,,0,"percent of total billed charges ","85% of total billed charges ",37.96,90,,30.37,,,0,"percent of total billed charges ","90% of total billed charges ",37.96,90,,30.37,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",36.7,87,,29.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.53,70,,23.62,,,0,"percent of total billed charges ","70% of total billed charges ",29.53,39.23,
"CHAMBER CONCHATHERM DISP",6008065,"CDM ",272,RC,,,OUTPATIENT,,,64.14,51.312,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.31,80,,41.05,,,0,"percent of total billed charges ","80% of total billed charges ",44.9,70,,35.92,,,0,"percent of total billed charges ","70% of total billed charges ",57.73,90,,46.18,,,0,"percent of total billed charges ","90% of total billed charges ",59.65,93,,47.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",54.52,85,,43.62,,,0,"percent of total billed charges ","85% of total billed charges ",57.73,90,,46.18,,,0,"percent of total billed charges ","90% of total billed charges ",57.73,90,,46.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",55.8,87,,44.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.9,70,,35.92,,,0,"percent of total billed charges ","70% of total billed charges ",44.9,59.65,
"CATH 3 WAY 20FR",6008067,"CDM ",272,RC,,,OUTPATIENT,,,45.38,36.304,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.3,80,,29.04,,,0,"percent of total billed charges ","80% of total billed charges ",31.77,70,,25.42,,,0,"percent of total billed charges ","70% of total billed charges ",40.84,90,,32.67,,,0,"percent of total billed charges ","90% of total billed charges ",42.2,93,,33.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.57,85,,30.86,,,0,"percent of total billed charges ","85% of total billed charges ",40.84,90,,32.67,,,0,"percent of total billed charges ","90% of total billed charges ",40.84,90,,32.67,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.48,87,,31.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.77,70,,25.42,,,0,"percent of total billed charges ","70% of total billed charges ",31.77,42.2,
"CATH 3 WAY 18FR",6008068,"CDM ",272,RC,,,OUTPATIENT,,,45.38,36.304,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.3,80,,29.04,,,0,"percent of total billed charges ","80% of total billed charges ",31.77,70,,25.42,,,0,"percent of total billed charges ","70% of total billed charges ",40.84,90,,32.67,,,0,"percent of total billed charges ","90% of total billed charges ",42.2,93,,33.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.57,85,,30.86,,,0,"percent of total billed charges ","85% of total billed charges ",40.84,90,,32.67,,,0,"percent of total billed charges ","90% of total billed charges ",40.84,90,,32.67,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.48,87,,31.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.77,70,,25.42,,,0,"percent of total billed charges ","70% of total billed charges ",31.77,42.2,
"FASTENER TUBE ENDOTRACHEAL",6008086,"CDM ",272,RC,,,OUTPATIENT,,,37.51,30.008,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.01,80,,24.01,,,0,"percent of total billed charges ","80% of total billed charges ",26.26,70,,21.01,,,0,"percent of total billed charges ","70% of total billed charges ",33.76,90,,27.01,,,0,"percent of total billed charges ","90% of total billed charges ",34.88,93,,27.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",31.88,85,,25.50,,,0,"percent of total billed charges ","85% of total billed charges ",33.76,90,,27.01,,,0,"percent of total billed charges ","90% of total billed charges ",33.76,90,,27.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",32.63,87,,26.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.26,70,,21.01,,,0,"percent of total billed charges ","70% of total billed charges ",26.26,34.88,
"BOOT FT WAFFLE HEEL PROTECT LG",6008096,"CDM ",271,RC,,,OUTPATIENT,,,119.35,95.48,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.48,80,,76.38,,,0,"percent of total billed charges ","80% of total billed charges ",83.55,70,,66.84,,,0,"percent of total billed charges ","70% of total billed charges ",107.42,90,,85.94,,,0,"percent of total billed charges ","90% of total billed charges ",111,93,,88.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",101.45,85,,81.16,,,0,"percent of total billed charges ","85% of total billed charges ",107.42,90,,85.94,,,0,"percent of total billed charges ","90% of total billed charges ",107.42,90,,85.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",103.83,87,,83.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.55,70,,66.84,,,0,"percent of total billed charges ","70% of total billed charges ",83.55,111,
"GLIDESCOPE GVL 1 STAT",6008105,"CDM ",272,RC,,,OUTPATIENT,,,219.58,175.664,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",175.66,80,,140.53,,,0,"percent of total billed charges ","80% of total billed charges ",153.71,70,,122.97,,,0,"percent of total billed charges ","70% of total billed charges ",197.62,90,,158.10,,,0,"percent of total billed charges ","90% of total billed charges ",204.21,93,,163.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",186.64,85,,149.31,,,0,"percent of total billed charges ","85% of total billed charges ",197.62,90,,158.10,,,0,"percent of total billed charges ","90% of total billed charges ",197.62,90,,158.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",191.03,87,,152.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.71,70,,122.97,,,0,"percent of total billed charges ","70% of total billed charges ",153.71,204.21,
"GLIDESCOPE GVL 2 STAT",6008106,"CDM ",272,RC,,,OUTPATIENT,,,197.47,157.976,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.98,80,,126.38,,,0,"percent of total billed charges ","80% of total billed charges ",138.23,70,,110.58,,,0,"percent of total billed charges ","70% of total billed charges ",177.72,90,,142.18,,,0,"percent of total billed charges ","90% of total billed charges ",183.65,93,,146.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",167.85,85,,134.28,,,0,"percent of total billed charges ","85% of total billed charges ",177.72,90,,142.18,,,0,"percent of total billed charges ","90% of total billed charges ",177.72,90,,142.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",171.8,87,,137.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",138.23,70,,110.58,,,0,"percent of total billed charges ","70% of total billed charges ",138.23,183.65,
"GUIDE NEEDLE ENDOCAVITY",6008140,"CDM ",272,RC,,,OUTPATIENT,,,67.61,54.088,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.09,80,,43.27,,,0,"percent of total billed charges ","80% of total billed charges ",47.33,70,,37.86,,,0,"percent of total billed charges ","70% of total billed charges ",60.85,90,,48.68,,,0,"percent of total billed charges ","90% of total billed charges ",62.88,93,,50.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",57.47,85,,45.98,,,0,"percent of total billed charges ","85% of total billed charges ",60.85,90,,48.68,,,0,"percent of total billed charges ","90% of total billed charges ",60.85,90,,48.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",58.82,87,,47.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.33,70,,37.86,,,0,"percent of total billed charges ","70% of total billed charges ",47.33,62.88,
"COVER TRANSRECTAL PROBE",6008141,"CDM ",272,RC,,,OUTPATIENT,,,42.63,34.104,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.1,80,,27.28,,,0,"percent of total billed charges ","80% of total billed charges ",29.84,70,,23.87,,,0,"percent of total billed charges ","70% of total billed charges ",38.37,90,,30.70,,,0,"percent of total billed charges ","90% of total billed charges ",39.65,93,,31.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",36.24,85,,28.99,,,0,"percent of total billed charges ","85% of total billed charges ",38.37,90,,30.70,,,0,"percent of total billed charges ","90% of total billed charges ",38.37,90,,30.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",37.09,87,,29.67,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.84,70,,23.87,,,0,"percent of total billed charges ","70% of total billed charges ",29.84,39.65,
"NEEDLE WILLIAMS 23GA X 35CM",6008142,"CDM ",272,RC,,,OUTPATIENT,,,121.39,97.112,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.11,80,,77.69,,,0,"percent of total billed charges ","80% of total billed charges ",84.97,70,,67.98,,,0,"percent of total billed charges ","70% of total billed charges ",109.25,90,,87.40,,,0,"percent of total billed charges ","90% of total billed charges ",112.89,93,,90.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",103.18,85,,82.54,,,0,"percent of total billed charges ","85% of total billed charges ",109.25,90,,87.40,,,0,"percent of total billed charges ","90% of total billed charges ",109.25,90,,87.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",105.61,87,,84.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.97,70,,67.98,,,0,"percent of total billed charges ","70% of total billed charges ",84.97,112.89,
"NEEDLE SPINAL 22GA X 20CM",6008143,"CDM ",272,RC,,,OUTPATIENT,,,45.25,36.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.2,80,,28.96,,,0,"percent of total billed charges ","80% of total billed charges ",31.68,70,,25.34,,,0,"percent of total billed charges ","70% of total billed charges ",40.73,90,,32.58,,,0,"percent of total billed charges ","90% of total billed charges ",42.08,93,,33.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.46,85,,30.77,,,0,"percent of total billed charges ","85% of total billed charges ",40.73,90,,32.58,,,0,"percent of total billed charges ","90% of total billed charges ",40.73,90,,32.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.37,87,,31.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.68,70,,25.34,,,0,"percent of total billed charges ","70% of total billed charges ",31.68,42.08,
"SET URETHRAL DILATOR 8FR-24FR",6008144,"CDM ",272,RC,,,OUTPATIENT,,,612.32,489.856,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",489.86,80,,391.89,,,0,"percent of total billed charges ","80% of total billed charges ",428.62,70,,342.90,,,0,"percent of total billed charges ","70% of total billed charges ",551.09,90,,440.87,,,0,"percent of total billed charges ","90% of total billed charges ",569.46,93,,455.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",520.47,85,,416.38,,,0,"percent of total billed charges ","85% of total billed charges ",551.09,90,,440.87,,,0,"percent of total billed charges ","90% of total billed charges ",551.09,90,,440.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",532.72,87,,426.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",428.62,70,,342.90,,,0,"percent of total billed charges ","70% of total billed charges ",428.62,569.46,
"CATH FOLEY DOVER 14FR 5CC",6008146,"CDM ",272,RC,,,OUTPATIENT,,,66.41,53.128,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.13,80,,42.50,,,0,"percent of total billed charges ","80% of total billed charges ",46.49,70,,37.19,,,0,"percent of total billed charges ","70% of total billed charges ",59.77,90,,47.82,,,0,"percent of total billed charges ","90% of total billed charges ",61.76,93,,49.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",56.45,85,,45.16,,,0,"percent of total billed charges ","85% of total billed charges ",59.77,90,,47.82,,,0,"percent of total billed charges ","90% of total billed charges ",59.77,90,,47.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",57.78,87,,46.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.49,70,,37.19,,,0,"percent of total billed charges ","70% of total billed charges ",46.49,61.76,
"CATH FOLEY DOVER 16FR 5CC",6008147,"CDM ",272,RC,,,OUTPATIENT,,,66.41,53.128,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.13,80,,42.50,,,0,"percent of total billed charges ","80% of total billed charges ",46.49,70,,37.19,,,0,"percent of total billed charges ","70% of total billed charges ",59.77,90,,47.82,,,0,"percent of total billed charges ","90% of total billed charges ",61.76,93,,49.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",56.45,85,,45.16,,,0,"percent of total billed charges ","85% of total billed charges ",59.77,90,,47.82,,,0,"percent of total billed charges ","90% of total billed charges ",59.77,90,,47.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",57.78,87,,46.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.49,70,,37.19,,,0,"percent of total billed charges ","70% of total billed charges ",46.49,61.76,
"CATH FOLEY DOVER 18FR 5CC",6008148,"CDM ",272,RC,,,OUTPATIENT,,,66.41,53.128,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.13,80,,42.50,,,0,"percent of total billed charges ","80% of total billed charges ",46.49,70,,37.19,,,0,"percent of total billed charges ","70% of total billed charges ",59.77,90,,47.82,,,0,"percent of total billed charges ","90% of total billed charges ",61.76,93,,49.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",56.45,85,,45.16,,,0,"percent of total billed charges ","85% of total billed charges ",59.77,90,,47.82,,,0,"percent of total billed charges ","90% of total billed charges ",59.77,90,,47.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",57.78,87,,46.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.49,70,,37.19,,,0,"percent of total billed charges ","70% of total billed charges ",46.49,61.76,
"SET IRRIGATION CYSTO",6008151,"CDM ",272,RC,,,OUTPATIENT,,,38.01,30.408,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.41,80,,24.33,,,0,"percent of total billed charges ","80% of total billed charges ",26.61,70,,21.29,,,0,"percent of total billed charges ","70% of total billed charges ",34.21,90,,27.37,,,0,"percent of total billed charges ","90% of total billed charges ",35.35,93,,28.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.31,85,,25.85,,,0,"percent of total billed charges ","85% of total billed charges ",34.21,90,,27.37,,,0,"percent of total billed charges ","90% of total billed charges ",34.21,90,,27.37,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.07,87,,26.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.61,70,,21.29,,,0,"percent of total billed charges ","70% of total billed charges ",26.61,35.35,
"SECURRING SNAP HYDROCOLLOID",6008165,"CDM ",272,RC,,,OUTPATIENT,,,22.57,18.056,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.06,80,,14.45,,,0,"percent of total billed charges ","80% of total billed charges ",15.8,70,,12.64,,,0,"percent of total billed charges ","70% of total billed charges ",20.31,90,,16.25,,,0,"percent of total billed charges ","90% of total billed charges ",20.99,93,,16.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.18,85,,15.34,,,0,"percent of total billed charges ","85% of total billed charges ",20.31,90,,16.25,,,0,"percent of total billed charges ","90% of total billed charges ",20.31,90,,16.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.64,87,,15.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.8,70,,12.64,,,0,"percent of total billed charges ","70% of total billed charges ",15.8,20.99,
"SECURRING SNAP HYDROCOLLOID",6008165,"CDM ",272,RC,,,OUTPATIENT,,,22.57,18.056,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.06,80,,14.45,,,0,"percent of total billed charges ","80% of total billed charges ",15.8,70,,12.64,,,0,"percent of total billed charges ","70% of total billed charges ",20.31,90,,16.25,,,0,"percent of total billed charges ","90% of total billed charges ",20.99,93,,16.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.18,85,,15.34,,,0,"percent of total billed charges ","85% of total billed charges ",20.31,90,,16.25,,,0,"percent of total billed charges ","90% of total billed charges ",20.31,90,,16.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.64,87,,15.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.8,70,,12.64,,,0,"percent of total billed charges ","70% of total billed charges ",15.8,20.99,
"CLEANSER WOUND DERMAL",6008197,"CDM ",272,RC,,,OUTPATIENT,,,23.62,18.896,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.9,80,,15.12,,,0,"percent of total billed charges ","80% of total billed charges ",16.53,70,,13.22,,,0,"percent of total billed charges ","70% of total billed charges ",21.26,90,,17.01,,,0,"percent of total billed charges ","90% of total billed charges ",21.97,93,,17.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.08,85,,16.06,,,0,"percent of total billed charges ","85% of total billed charges ",21.26,90,,17.01,,,0,"percent of total billed charges ","90% of total billed charges ",21.26,90,,17.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.55,87,,16.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.53,70,,13.22,,,0,"percent of total billed charges ","70% of total billed charges ",16.53,21.97,
"CLEANSER WOUND DERMAL",6008197,"CDM ",272,RC,,,OUTPATIENT,,,23.62,18.896,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.9,80,,15.12,,,0,"percent of total billed charges ","80% of total billed charges ",16.53,70,,13.22,,,0,"percent of total billed charges ","70% of total billed charges ",21.26,90,,17.01,,,0,"percent of total billed charges ","90% of total billed charges ",21.97,93,,17.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.08,85,,16.06,,,0,"percent of total billed charges ","85% of total billed charges ",21.26,90,,17.01,,,0,"percent of total billed charges ","90% of total billed charges ",21.26,90,,17.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.55,87,,16.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.53,70,,13.22,,,0,"percent of total billed charges ","70% of total billed charges ",16.53,21.97,
"SECUREMENT FOLEY CATH 3WAY",6008212,"CDM ",272,RC,,,OUTPATIENT,,,13.74,10.992,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.99,80,,8.79,,,0,"percent of total billed charges ","80% of total billed charges ",9.62,70,,7.70,,,0,"percent of total billed charges ","70% of total billed charges ",12.37,90,,9.90,,,0,"percent of total billed charges ","90% of total billed charges ",12.78,93,,10.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.68,85,,9.34,,,0,"percent of total billed charges ","85% of total billed charges ",12.37,90,,9.90,,,0,"percent of total billed charges ","90% of total billed charges ",12.37,90,,9.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.95,87,,9.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.62,70,,7.70,,,0,"percent of total billed charges ","70% of total billed charges ",9.62,12.78,
"DRESSING FOAM NON-ADH 4""X4""",6008213,"CDM ",272,RC,,,OUTPATIENT,,,15.65,12.52,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.52,80,,10.02,,,0,"percent of total billed charges ","80% of total billed charges ",10.96,70,,8.77,,,0,"percent of total billed charges ","70% of total billed charges ",14.09,90,,11.27,,,0,"percent of total billed charges ","90% of total billed charges ",14.55,93,,11.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.3,85,,10.64,,,0,"percent of total billed charges ","85% of total billed charges ",14.09,90,,11.27,,,0,"percent of total billed charges ","90% of total billed charges ",14.09,90,,11.27,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.62,87,,10.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.96,70,,8.77,,,0,"percent of total billed charges ","70% of total billed charges ",10.96,14.55,
"DRESSING FOAM NON-ADH 4""X4""",6008213,"CDM ",272,RC,,,OUTPATIENT,,,15.65,12.52,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.52,80,,10.02,,,0,"percent of total billed charges ","80% of total billed charges ",10.96,70,,8.77,,,0,"percent of total billed charges ","70% of total billed charges ",14.09,90,,11.27,,,0,"percent of total billed charges ","90% of total billed charges ",14.55,93,,11.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.3,85,,10.64,,,0,"percent of total billed charges ","85% of total billed charges ",14.09,90,,11.27,,,0,"percent of total billed charges ","90% of total billed charges ",14.09,90,,11.27,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.62,87,,10.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.96,70,,8.77,,,0,"percent of total billed charges ","70% of total billed charges ",10.96,14.55,
"DRESSING FOAM NON-ADH 6""X6""",6008214,"CDM ",272,RC,,,OUTPATIENT,,,20.81,16.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.65,80,,13.32,,,0,"percent of total billed charges ","80% of total billed charges ",14.57,70,,11.66,,,0,"percent of total billed charges ","70% of total billed charges ",18.73,90,,14.98,,,0,"percent of total billed charges ","90% of total billed charges ",19.35,93,,15.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.69,85,,14.15,,,0,"percent of total billed charges ","85% of total billed charges ",18.73,90,,14.98,,,0,"percent of total billed charges ","90% of total billed charges ",18.73,90,,14.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.1,87,,14.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.57,70,,11.66,,,0,"percent of total billed charges ","70% of total billed charges ",14.57,19.35,
"DRESSING FOAM NON ADH 6X8",6008215,"CDM ",272,RC,,,OUTPATIENT,,,24.92,19.936,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.94,80,,15.95,,,0,"percent of total billed charges ","80% of total billed charges ",17.44,70,,13.95,,,0,"percent of total billed charges ","70% of total billed charges ",22.43,90,,17.94,,,0,"percent of total billed charges ","90% of total billed charges ",23.18,93,,18.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.18,85,,16.94,,,0,"percent of total billed charges ","85% of total billed charges ",22.43,90,,17.94,,,0,"percent of total billed charges ","90% of total billed charges ",22.43,90,,17.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.68,87,,17.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.44,70,,13.95,,,0,"percent of total billed charges ","70% of total billed charges ",17.44,23.18,
"TRAY CATH URINE METER 16FR",6008232,"CDM ",272,RC,,,OUTPATIENT,,,77.83,62.264,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.26,80,,49.81,,,0,"percent of total billed charges ","80% of total billed charges ",54.48,70,,43.58,,,0,"percent of total billed charges ","70% of total billed charges ",70.05,90,,56.04,,,0,"percent of total billed charges ","90% of total billed charges ",72.38,93,,57.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",66.16,85,,52.93,,,0,"percent of total billed charges ","85% of total billed charges ",70.05,90,,56.04,,,0,"percent of total billed charges ","90% of total billed charges ",70.05,90,,56.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",67.71,87,,54.17,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.48,70,,43.58,,,0,"percent of total billed charges ","70% of total billed charges ",54.48,72.38,
"CANNULA INNER SHILEY SZ 8",6008233,"CDM ",270,RC,,,OUTPATIENT,,,14.29,11.432,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.43,80,,9.14,,,0,"percent of total billed charges ","80% of total billed charges ",10,70,,8.00,,,0,"percent of total billed charges ","70% of total billed charges ",12.86,90,,10.29,,,0,"percent of total billed charges ","90% of total billed charges ",13.29,93,,10.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.15,85,,9.72,,,0,"percent of total billed charges ","85% of total billed charges ",12.86,90,,10.29,,,0,"percent of total billed charges ","90% of total billed charges ",12.86,90,,10.29,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.43,87,,9.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,70,,8.00,,,0,"percent of total billed charges ","70% of total billed charges ",10,13.29,
"TRACH CARE T-PIECE 14FR",6008234,"CDM ",272,RC,,,OUTPATIENT,,,34.95,27.96,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.96,80,,22.37,,,0,"percent of total billed charges ","80% of total billed charges ",24.47,70,,19.58,,,0,"percent of total billed charges ","70% of total billed charges ",31.46,90,,25.17,,,0,"percent of total billed charges ","90% of total billed charges ",32.5,93,,26.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",29.71,85,,23.77,,,0,"percent of total billed charges ","85% of total billed charges ",31.46,90,,25.17,,,0,"percent of total billed charges ","90% of total billed charges ",31.46,90,,25.17,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.41,87,,24.33,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.47,70,,19.58,,,0,"percent of total billed charges ","70% of total billed charges ",24.47,32.5,
"PROBE TEMP GENERAL PURPOSE 9FR",6008237,"CDM ",272,RC,,,OUTPATIENT,,,22.37,17.896,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.9,80,,14.32,,,0,"percent of total billed charges ","80% of total billed charges ",15.66,70,,12.53,,,0,"percent of total billed charges ","70% of total billed charges ",20.13,90,,16.10,,,0,"percent of total billed charges ","90% of total billed charges ",20.8,93,,16.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.01,85,,15.21,,,0,"percent of total billed charges ","85% of total billed charges ",20.13,90,,16.10,,,0,"percent of total billed charges ","90% of total billed charges ",20.13,90,,16.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.46,87,,15.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.66,70,,12.53,,,0,"percent of total billed charges ","70% of total billed charges ",15.66,20.8,
"BALLOON BAKRI 24FR X 54CM",6008239,"CDM ",272,RC,,,OUTPATIENT,,,560.3,448.24,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",448.24,80,,358.59,,,0,"percent of total billed charges ","80% of total billed charges ",392.21,70,,313.77,,,0,"percent of total billed charges ","70% of total billed charges ",504.27,90,,403.42,,,0,"percent of total billed charges ","90% of total billed charges ",521.08,93,,416.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",476.26,85,,381.01,,,0,"percent of total billed charges ","85% of total billed charges ",504.27,90,,403.42,,,0,"percent of total billed charges ","90% of total billed charges ",504.27,90,,403.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",487.46,87,,389.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",392.21,70,,313.77,,,0,"percent of total billed charges ","70% of total billed charges ",392.21,521.08,
"MITTS PROTECTIVE RESTRAINT",6008240,"CDM ",272,RC,,,OUTPATIENT,,,68.28,54.624,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.62,80,,43.70,,,0,"percent of total billed charges ","80% of total billed charges ",47.8,70,,38.24,,,0,"percent of total billed charges ","70% of total billed charges ",61.45,90,,49.16,,,0,"percent of total billed charges ","90% of total billed charges ",63.5,93,,50.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",58.04,85,,46.43,,,0,"percent of total billed charges ","85% of total billed charges ",61.45,90,,49.16,,,0,"percent of total billed charges ","90% of total billed charges ",61.45,90,,49.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",59.4,87,,47.52,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.8,70,,38.24,,,0,"percent of total billed charges ","70% of total billed charges ",47.8,63.5,
"KIT PLEURX CATH PLEURAL",6008241,"CDM ",272,RC,,,OUTPATIENT,,,1403.38,1122.704,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1122.7,80,,898.16,,,0,"percent of total billed charges ","80% of total billed charges ",982.37,70,,785.90,,,0,"percent of total billed charges ","70% of total billed charges ",1263.04,90,,1010.43,,,0,"percent of total billed charges ","90% of total billed charges ",1305.14,93,,1044.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1192.87,85,,954.30,,,0,"percent of total billed charges ","85% of total billed charges ",1263.04,90,,1010.43,,,0,"percent of total billed charges ","90% of total billed charges ",1263.04,90,,1010.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1220.94,87,,976.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",982.37,70,,785.90,,,0,"percent of total billed charges ","70% of total billed charges ",982.37,1305.14,
"KIT PLEURX CATH ACCESS",6008243,"CDM ",270,RC,,,OUTPATIENT,,,96.23,76.984,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.98,80,,61.58,,,0,"percent of total billed charges ","80% of total billed charges ",67.36,70,,53.89,,,0,"percent of total billed charges ","70% of total billed charges ",86.61,90,,69.29,,,0,"percent of total billed charges ","90% of total billed charges ",89.49,93,,71.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",81.8,85,,65.44,,,0,"percent of total billed charges ","85% of total billed charges ",86.61,90,,69.29,,,0,"percent of total billed charges ","90% of total billed charges ",86.61,90,,69.29,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",83.72,87,,66.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.36,70,,53.89,,,0,"percent of total billed charges ","70% of total billed charges ",67.36,89.49,
"KIT PLEURX LOCKABLE DRAIN LINE",6008244,"CDM ",272,RC,,,OUTPATIENT,,,157,125.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.6,80,,100.48,,,0,"percent of total billed charges ","80% of total billed charges ",109.9,70,,87.92,,,0,"percent of total billed charges ","70% of total billed charges ",141.3,90,,113.04,,,0,"percent of total billed charges ","90% of total billed charges ",146.01,93,,116.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.45,85,,106.76,,,0,"percent of total billed charges ","85% of total billed charges ",141.3,90,,113.04,,,0,"percent of total billed charges ","90% of total billed charges ",141.3,90,,113.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",136.59,87,,109.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.9,70,,87.92,,,0,"percent of total billed charges ","70% of total billed charges ",109.9,146.01,
"NEEDLE SPINAL 22G X 7"" BLACK",6008255,"CDM ",272,RC,,,OUTPATIENT,,,13.19,10.552,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.55,80,,8.44,,,0,"percent of total billed charges ","80% of total billed charges ",9.23,70,,7.38,,,0,"percent of total billed charges ","70% of total billed charges ",11.87,90,,9.50,,,0,"percent of total billed charges ","90% of total billed charges ",12.27,93,,9.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.21,85,,8.97,,,0,"percent of total billed charges ","85% of total billed charges ",11.87,90,,9.50,,,0,"percent of total billed charges ","90% of total billed charges ",11.87,90,,9.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.48,87,,9.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.23,70,,7.38,,,0,"percent of total billed charges ","70% of total billed charges ",9.23,12.27,
"RETRACTOR WOUND ALEXIS 2-4CM",6008276,"CDM ",272,RC,,,OUTPATIENT,,,201.5,161.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",161.2,80,,128.96,,,0,"percent of total billed charges ","80% of total billed charges ",141.05,70,,112.84,,,0,"percent of total billed charges ","70% of total billed charges ",181.35,90,,145.08,,,0,"percent of total billed charges ","90% of total billed charges ",187.4,93,,149.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",171.28,85,,137.02,,,0,"percent of total billed charges ","85% of total billed charges ",181.35,90,,145.08,,,0,"percent of total billed charges ","90% of total billed charges ",181.35,90,,145.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",175.31,87,,140.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.05,70,,112.84,,,0,"percent of total billed charges ","70% of total billed charges ",141.05,187.4,
"TUBE RECTAL 24FR X 30""",6008277,"CDM ",272,RC,,,OUTPATIENT,,,91.66,73.328,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.33,80,,58.66,,,0,"percent of total billed charges ","80% of total billed charges ",64.16,70,,51.33,,,0,"percent of total billed charges ","70% of total billed charges ",82.49,90,,65.99,,,0,"percent of total billed charges ","90% of total billed charges ",85.24,93,,68.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",77.91,85,,62.33,,,0,"percent of total billed charges ","85% of total billed charges ",82.49,90,,65.99,,,0,"percent of total billed charges ","90% of total billed charges ",82.49,90,,65.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",79.74,87,,63.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.16,70,,51.33,,,0,"percent of total billed charges ","70% of total billed charges ",64.16,85.24,
"TUBE RECTAL 30FR X 18""",6008278,"CDM ",272,RC,,,OUTPATIENT,,,211.77,169.416,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",169.42,80,,135.54,,,0,"percent of total billed charges ","80% of total billed charges ",148.24,70,,118.59,,,0,"percent of total billed charges ","70% of total billed charges ",190.59,90,,152.47,,,0,"percent of total billed charges ","90% of total billed charges ",196.95,93,,157.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",180,85,,144.00,,,0,"percent of total billed charges ","85% of total billed charges ",190.59,90,,152.47,,,0,"percent of total billed charges ","90% of total billed charges ",190.59,90,,152.47,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",184.24,87,,147.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.24,70,,118.59,,,0,"percent of total billed charges ","70% of total billed charges ",148.24,196.95,
"TUBE RECTAL 30FR X 30""",6008279,"CDM ",272,RC,,,OUTPATIENT,,,91.66,73.328,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.33,80,,58.66,,,0,"percent of total billed charges ","80% of total billed charges ",64.16,70,,51.33,,,0,"percent of total billed charges ","70% of total billed charges ",82.49,90,,65.99,,,0,"percent of total billed charges ","90% of total billed charges ",85.24,93,,68.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",77.91,85,,62.33,,,0,"percent of total billed charges ","85% of total billed charges ",82.49,90,,65.99,,,0,"percent of total billed charges ","90% of total billed charges ",82.49,90,,65.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",79.74,87,,63.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.16,70,,51.33,,,0,"percent of total billed charges ","70% of total billed charges ",64.16,85.24,
"KIT CIRCUIT NEONATAL T-PIECE",6008281,"CDM ",272,RC,,,OUTPATIENT,,,48.98,39.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.18,80,,31.34,,,0,"percent of total billed charges ","80% of total billed charges ",34.29,70,,27.43,,,0,"percent of total billed charges ","70% of total billed charges ",44.08,90,,35.26,,,0,"percent of total billed charges ","90% of total billed charges ",45.55,93,,36.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.63,85,,33.30,,,0,"percent of total billed charges ","85% of total billed charges ",44.08,90,,35.26,,,0,"percent of total billed charges ","90% of total billed charges ",44.08,90,,35.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.61,87,,34.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.29,70,,27.43,,,0,"percent of total billed charges ","70% of total billed charges ",34.29,45.55,
"PROBE SKIN TEMP GIRAFFE DISP",6008282,"CDM ",272,RC,,,OUTPATIENT,,,34.55,27.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.64,80,,22.11,,,0,"percent of total billed charges ","80% of total billed charges ",24.19,70,,19.35,,,0,"percent of total billed charges ","70% of total billed charges ",31.1,90,,24.88,,,0,"percent of total billed charges ","90% of total billed charges ",32.13,93,,25.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",29.37,85,,23.50,,,0,"percent of total billed charges ","85% of total billed charges ",31.1,90,,24.88,,,0,"percent of total billed charges ","90% of total billed charges ",31.1,90,,24.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.06,87,,24.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.19,70,,19.35,,,0,"percent of total billed charges ","70% of total billed charges ",24.19,32.13,
"MARKER ULTRACLIP BREAST 17GA",6008284,"CDM ",270,RC,,,OUTPATIENT,,,286.75,229.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",229.4,80,,183.52,,,0,"percent of total billed charges ","80% of total billed charges ",200.73,70,,160.58,,,0,"percent of total billed charges ","70% of total billed charges ",258.08,90,,206.46,,,0,"percent of total billed charges ","90% of total billed charges ",266.68,93,,213.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",243.74,85,,194.99,,,0,"percent of total billed charges ","85% of total billed charges ",258.08,90,,206.46,,,0,"percent of total billed charges ","90% of total billed charges ",258.08,90,,206.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",249.47,87,,199.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",200.73,70,,160.58,,,0,"percent of total billed charges ","70% of total billed charges ",200.73,266.68,
"CANNULA INNER PORTEX SZ9",6008296,"CDM ",270,RC,,,OUTPATIENT,,,14.59,11.672,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.67,80,,9.34,,,0,"percent of total billed charges ","80% of total billed charges ",10.21,70,,8.17,,,0,"percent of total billed charges ","70% of total billed charges ",13.13,90,,10.50,,,0,"percent of total billed charges ","90% of total billed charges ",13.57,93,,10.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.4,85,,9.92,,,0,"percent of total billed charges ","85% of total billed charges ",13.13,90,,10.50,,,0,"percent of total billed charges ","90% of total billed charges ",13.13,90,,10.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.69,87,,10.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.21,70,,8.17,,,0,"percent of total billed charges ","70% of total billed charges ",10.21,13.57,
"ANCHOR TUBING 7 SLOTS FOAM",6008308,"CDM ",272,RC,,,OUTPATIENT,,,30.69,24.552,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.55,80,,19.64,,,0,"percent of total billed charges ","80% of total billed charges ",21.48,70,,17.18,,,0,"percent of total billed charges ","70% of total billed charges ",27.62,90,,22.10,,,0,"percent of total billed charges ","90% of total billed charges ",28.54,93,,22.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.09,85,,20.87,,,0,"percent of total billed charges ","85% of total billed charges ",27.62,90,,22.10,,,0,"percent of total billed charges ","90% of total billed charges ",27.62,90,,22.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.7,87,,21.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.48,70,,17.18,,,0,"percent of total billed charges ","70% of total billed charges ",21.48,28.54,
"NEEDLE SPINAL 25G X 1""",6008352,"CDM ",272,RC,,,OUTPATIENT,,,30.94,24.752,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.75,80,,19.80,,,0,"percent of total billed charges ","80% of total billed charges ",21.66,70,,17.33,,,0,"percent of total billed charges ","70% of total billed charges ",27.85,90,,22.28,,,0,"percent of total billed charges ","90% of total billed charges ",28.77,93,,23.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.3,85,,21.04,,,0,"percent of total billed charges ","85% of total billed charges ",27.85,90,,22.28,,,0,"percent of total billed charges ","90% of total billed charges ",27.85,90,,22.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.92,87,,21.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.66,70,,17.33,,,0,"percent of total billed charges ","70% of total billed charges ",21.66,28.77,
"NEEDLE SPINAL 18G X 5""",6008356,"CDM ",272,RC,,,OUTPATIENT,,,12.89,10.312,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.31,80,,8.25,,,0,"percent of total billed charges ","80% of total billed charges ",9.02,70,,7.22,,,0,"percent of total billed charges ","70% of total billed charges ",11.6,90,,9.28,,,0,"percent of total billed charges ","90% of total billed charges ",11.99,93,,9.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.96,85,,8.77,,,0,"percent of total billed charges ","85% of total billed charges ",11.6,90,,9.28,,,0,"percent of total billed charges ","90% of total billed charges ",11.6,90,,9.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.21,87,,8.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.02,70,,7.22,,,0,"percent of total billed charges ","70% of total billed charges ",9.02,11.99,
"HOLDER TRANSDUCER 3 COLOR",6008421,"CDM ",272,RC,,,OUTPATIENT,,,31.34,25.072,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.07,80,,20.06,,,0,"percent of total billed charges ","80% of total billed charges ",21.94,70,,17.55,,,0,"percent of total billed charges ","70% of total billed charges ",28.21,90,,22.57,,,0,"percent of total billed charges ","90% of total billed charges ",29.15,93,,23.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.64,85,,21.31,,,0,"percent of total billed charges ","85% of total billed charges ",28.21,90,,22.57,,,0,"percent of total billed charges ","90% of total billed charges ",28.21,90,,22.57,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",27.27,87,,21.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.94,70,,17.55,,,0,"percent of total billed charges ","70% of total billed charges ",21.94,29.15,
"CATH TROCAR 8FR",6008437,"CDM ",272,RC,,,OUTPATIENT,,,64.63,51.704,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.7,80,,41.36,,,0,"percent of total billed charges ","80% of total billed charges ",45.24,70,,36.19,,,0,"percent of total billed charges ","70% of total billed charges ",58.17,90,,46.54,,,0,"percent of total billed charges ","90% of total billed charges ",60.11,93,,48.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",54.94,85,,43.95,,,0,"percent of total billed charges ","85% of total billed charges ",58.17,90,,46.54,,,0,"percent of total billed charges ","90% of total billed charges ",58.17,90,,46.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",56.23,87,,44.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.24,70,,36.19,,,0,"percent of total billed charges ","70% of total billed charges ",45.24,60.11,
"CIRCUIT CPAP",6008444,"CDM ",272,RC,,,OUTPATIENT,,,19.51,15.608,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.61,80,,12.49,,,0,"percent of total billed charges ","80% of total billed charges ",13.66,70,,10.93,,,0,"percent of total billed charges ","70% of total billed charges ",17.56,90,,14.05,,,0,"percent of total billed charges ","90% of total billed charges ",18.14,93,,14.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.58,85,,13.26,,,0,"percent of total billed charges ","85% of total billed charges ",17.56,90,,14.05,,,0,"percent of total billed charges ","90% of total billed charges ",17.56,90,,14.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.97,87,,13.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.66,70,,10.93,,,0,"percent of total billed charges ","70% of total billed charges ",13.66,18.14,
"NEEDLE TRUGUIDE 17G X 17.8CM",6008506,"CDM ",272,RC,,,OUTPATIENT,,,67.25,53.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.8,80,,43.04,,,0,"percent of total billed charges ","80% of total billed charges ",47.08,70,,37.66,,,0,"percent of total billed charges ","70% of total billed charges ",60.53,90,,48.42,,,0,"percent of total billed charges ","90% of total billed charges ",62.54,93,,50.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",57.16,85,,45.73,,,0,"percent of total billed charges ","85% of total billed charges ",60.53,90,,48.42,,,0,"percent of total billed charges ","90% of total billed charges ",60.53,90,,48.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",58.51,87,,46.81,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.08,70,,37.66,,,0,"percent of total billed charges ","70% of total billed charges ",47.08,62.54,
"INSTRUMENT BIOPSY 18G X 20CM",6008507,"CDM ",272,RC,,,OUTPATIENT,,,205.71,164.568,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",164.57,80,,131.66,,,0,"percent of total billed charges ","80% of total billed charges ",144,70,,115.20,,,0,"percent of total billed charges ","70% of total billed charges ",185.14,90,,148.11,,,0,"percent of total billed charges ","90% of total billed charges ",191.31,93,,153.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",174.85,85,,139.88,,,0,"percent of total billed charges ","85% of total billed charges ",185.14,90,,148.11,,,0,"percent of total billed charges ","90% of total billed charges ",185.14,90,,148.11,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",178.97,87,,143.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144,70,,115.20,,,0,"percent of total billed charges ","70% of total billed charges ",144,191.31,
"SET MIC KEY EXTENSION 12""",6008508,"CDM ",272,RC,,,OUTPATIENT,,,38.87,31.096,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.1,80,,24.88,,,0,"percent of total billed charges ","80% of total billed charges ",27.21,70,,21.77,,,0,"percent of total billed charges ","70% of total billed charges ",34.98,90,,27.98,,,0,"percent of total billed charges ","90% of total billed charges ",36.15,93,,28.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.04,85,,26.43,,,0,"percent of total billed charges ","85% of total billed charges ",34.98,90,,27.98,,,0,"percent of total billed charges ","90% of total billed charges ",34.98,90,,27.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.82,87,,27.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.21,70,,21.77,,,0,"percent of total billed charges ","70% of total billed charges ",27.21,36.15,
"NEEDLE MONOPTY 20G X 20CM",6008511,"CDM ",272,RC,,,OUTPATIENT,,,136.99,109.592,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.59,80,,87.67,,,0,"percent of total billed charges ","80% of total billed charges ",95.89,70,,76.71,,,0,"percent of total billed charges ","70% of total billed charges ",123.29,90,,98.63,,,0,"percent of total billed charges ","90% of total billed charges ",127.4,93,,101.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",116.44,85,,93.15,,,0,"percent of total billed charges ","85% of total billed charges ",123.29,90,,98.63,,,0,"percent of total billed charges ","90% of total billed charges ",123.29,90,,98.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",119.18,87,,95.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.89,70,,76.71,,,0,"percent of total billed charges ","70% of total billed charges ",95.89,127.4,
"NEEDLE TRUGUIDE 13G X 7.8CM",6008512,"CDM ",272,RC,,,OUTPATIENT,,,75.97,60.776,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.78,80,,48.62,,,0,"percent of total billed charges ","80% of total billed charges ",53.18,70,,42.54,,,0,"percent of total billed charges ","70% of total billed charges ",68.37,90,,54.70,,,0,"percent of total billed charges ","90% of total billed charges ",70.65,93,,56.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",64.57,85,,51.66,,,0,"percent of total billed charges ","85% of total billed charges ",68.37,90,,54.70,,,0,"percent of total billed charges ","90% of total billed charges ",68.37,90,,54.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",66.09,87,,52.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.18,70,,42.54,,,0,"percent of total billed charges ","70% of total billed charges ",53.18,70.65,
"NEEDLE MONOPTY 14G X 9CM",6008513,"CDM ",272,RC,,,OUTPATIENT,,,182.38,145.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",145.9,80,,116.72,,,0,"percent of total billed charges ","80% of total billed charges ",127.67,70,,102.14,,,0,"percent of total billed charges ","70% of total billed charges ",164.14,90,,131.31,,,0,"percent of total billed charges ","90% of total billed charges ",169.61,93,,135.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",155.02,85,,124.02,,,0,"percent of total billed charges ","85% of total billed charges ",164.14,90,,131.31,,,0,"percent of total billed charges ","90% of total billed charges ",164.14,90,,131.31,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",158.67,87,,126.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.67,70,,102.14,,,0,"percent of total billed charges ","70% of total billed charges ",127.67,169.61,
"SET DRAINAGE CATH 8.5FR/25CM",6008514,"CDM ",272,RC,,,OUTPATIENT,,,320.71,256.568,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",256.57,80,,205.26,,,0,"percent of total billed charges ","80% of total billed charges ",224.5,70,,179.60,,,0,"percent of total billed charges ","70% of total billed charges ",288.64,90,,230.91,,,0,"percent of total billed charges ","90% of total billed charges ",298.26,93,,238.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",272.6,85,,218.08,,,0,"percent of total billed charges ","85% of total billed charges ",288.64,90,,230.91,,,0,"percent of total billed charges ","90% of total billed charges ",288.64,90,,230.91,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",279.02,87,,223.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",224.5,70,,179.60,,,0,"percent of total billed charges ","70% of total billed charges ",224.5,298.26,
"SET DRAINAGE CATH 12.0FR/25CM",6008515,"CDM ",272,RC,,,OUTPATIENT,,,320.71,256.568,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",256.57,80,,205.26,,,0,"percent of total billed charges ","80% of total billed charges ",224.5,70,,179.60,,,0,"percent of total billed charges ","70% of total billed charges ",288.64,90,,230.91,,,0,"percent of total billed charges ","90% of total billed charges ",298.26,93,,238.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",272.6,85,,218.08,,,0,"percent of total billed charges ","85% of total billed charges ",288.64,90,,230.91,,,0,"percent of total billed charges ","90% of total billed charges ",288.64,90,,230.91,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",279.02,87,,223.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",224.5,70,,179.60,,,0,"percent of total billed charges ","70% of total billed charges ",224.5,298.26,
"SET DRAINAGE CATH 12.0FR/25CM",6008516,"CDM ",272,RC,,,OUTPATIENT,,,307.78,246.224,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",246.22,80,,196.98,,,0,"percent of total billed charges ","80% of total billed charges ",215.45,70,,172.36,,,0,"percent of total billed charges ","70% of total billed charges ",277,90,,221.60,,,0,"percent of total billed charges ","90% of total billed charges ",286.24,93,,228.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.61,85,,209.29,,,0,"percent of total billed charges ","85% of total billed charges ",277,90,,221.60,,,0,"percent of total billed charges ","90% of total billed charges ",277,90,,221.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.77,87,,214.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",215.45,70,,172.36,,,0,"percent of total billed charges ","70% of total billed charges ",215.45,286.24,
"GUIDEWIRE AMPLATZ EXTRA STIFF",6008517,"CDM ",272,RC,,,OUTPATIENT,,,81.92,65.536,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.54,80,,52.43,,,0,"percent of total billed charges ","80% of total billed charges ",57.34,70,,45.87,,,0,"percent of total billed charges ","70% of total billed charges ",73.73,90,,58.98,,,0,"percent of total billed charges ","90% of total billed charges ",76.19,93,,60.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",69.63,85,,55.70,,,0,"percent of total billed charges ","85% of total billed charges ",73.73,90,,58.98,,,0,"percent of total billed charges ","90% of total billed charges ",73.73,90,,58.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",71.27,87,,57.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.34,70,,45.87,,,0,"percent of total billed charges ","70% of total billed charges ",57.34,76.19,
"GUIDEWIRE AMPLATZ ULTRA STIFF",6008518,"CDM ",272,RC,,,OUTPATIENT,,,79.48,63.584,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.58,80,,50.86,,,0,"percent of total billed charges ","80% of total billed charges ",55.64,70,,44.51,,,0,"percent of total billed charges ","70% of total billed charges ",71.53,90,,57.22,,,0,"percent of total billed charges ","90% of total billed charges ",73.92,93,,59.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",67.56,85,,54.05,,,0,"percent of total billed charges ","85% of total billed charges ",71.53,90,,57.22,,,0,"percent of total billed charges ","90% of total billed charges ",71.53,90,,57.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",69.15,87,,55.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.64,70,,44.51,,,0,"percent of total billed charges ","70% of total billed charges ",55.64,73.92,
"DILATOR 5.0FR / 20CM",6008519,"CDM ",272,RC,,,OUTPATIENT,,,59.03,47.224,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.22,80,,37.78,,,0,"percent of total billed charges ","80% of total billed charges ",41.32,70,,33.06,,,0,"percent of total billed charges ","70% of total billed charges ",53.13,90,,42.50,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,93,,43.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",50.18,85,,40.14,,,0,"percent of total billed charges ","85% of total billed charges ",53.13,90,,42.50,,,0,"percent of total billed charges ","90% of total billed charges ",53.13,90,,42.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",51.36,87,,41.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.32,70,,33.06,,,0,"percent of total billed charges ","70% of total billed charges ",41.32,54.9,
"DILATOR 6.0FR / 20CM",6008520,"CDM ",272,RC,,,OUTPATIENT,,,59.03,47.224,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.22,80,,37.78,,,0,"percent of total billed charges ","80% of total billed charges ",41.32,70,,33.06,,,0,"percent of total billed charges ","70% of total billed charges ",53.13,90,,42.50,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,93,,43.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",50.18,85,,40.14,,,0,"percent of total billed charges ","85% of total billed charges ",53.13,90,,42.50,,,0,"percent of total billed charges ","90% of total billed charges ",53.13,90,,42.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",51.36,87,,41.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.32,70,,33.06,,,0,"percent of total billed charges ","70% of total billed charges ",41.32,54.9,
"DILATOR 7.0FR / 20CM",6008521,"CDM ",272,RC,,,OUTPATIENT,,,59.03,47.224,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.22,80,,37.78,,,0,"percent of total billed charges ","80% of total billed charges ",41.32,70,,33.06,,,0,"percent of total billed charges ","70% of total billed charges ",53.13,90,,42.50,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,93,,43.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",50.18,85,,40.14,,,0,"percent of total billed charges ","85% of total billed charges ",53.13,90,,42.50,,,0,"percent of total billed charges ","90% of total billed charges ",53.13,90,,42.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",51.36,87,,41.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.32,70,,33.06,,,0,"percent of total billed charges ","70% of total billed charges ",41.32,54.9,
"DILATOR 8.0FR / 20CM",6008522,"CDM ",272,RC,,,OUTPATIENT,,,59.03,47.224,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.22,80,,37.78,,,0,"percent of total billed charges ","80% of total billed charges ",41.32,70,,33.06,,,0,"percent of total billed charges ","70% of total billed charges ",53.13,90,,42.50,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,93,,43.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",50.18,85,,40.14,,,0,"percent of total billed charges ","85% of total billed charges ",53.13,90,,42.50,,,0,"percent of total billed charges ","90% of total billed charges ",53.13,90,,42.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",51.36,87,,41.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.32,70,,33.06,,,0,"percent of total billed charges ","70% of total billed charges ",41.32,54.9,
"DILATOR 9.0FR / 20CM",6008523,"CDM ",272,RC,,,OUTPATIENT,,,59.03,47.224,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.22,80,,37.78,,,0,"percent of total billed charges ","80% of total billed charges ",41.32,70,,33.06,,,0,"percent of total billed charges ","70% of total billed charges ",53.13,90,,42.50,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,93,,43.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",50.18,85,,40.14,,,0,"percent of total billed charges ","85% of total billed charges ",53.13,90,,42.50,,,0,"percent of total billed charges ","90% of total billed charges ",53.13,90,,42.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",51.36,87,,41.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.32,70,,33.06,,,0,"percent of total billed charges ","70% of total billed charges ",41.32,54.9,
"DILATOR 10.0FR / 20CM",6008524,"CDM ",272,RC,,,OUTPATIENT,,,59.03,47.224,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.22,80,,37.78,,,0,"percent of total billed charges ","80% of total billed charges ",41.32,70,,33.06,,,0,"percent of total billed charges ","70% of total billed charges ",53.13,90,,42.50,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,93,,43.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",50.18,85,,40.14,,,0,"percent of total billed charges ","85% of total billed charges ",53.13,90,,42.50,,,0,"percent of total billed charges ","90% of total billed charges ",53.13,90,,42.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",51.36,87,,41.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.32,70,,33.06,,,0,"percent of total billed charges ","70% of total billed charges ",41.32,54.9,
"DILATOR 12.0FR / 20CM",6008525,"CDM ",272,RC,,,OUTPATIENT,,,59.03,47.224,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.22,80,,37.78,,,0,"percent of total billed charges ","80% of total billed charges ",41.32,70,,33.06,,,0,"percent of total billed charges ","70% of total billed charges ",53.13,90,,42.50,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,93,,43.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",50.18,85,,40.14,,,0,"percent of total billed charges ","85% of total billed charges ",53.13,90,,42.50,,,0,"percent of total billed charges ","90% of total billed charges ",53.13,90,,42.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",51.36,87,,41.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.32,70,,33.06,,,0,"percent of total billed charges ","70% of total billed charges ",41.32,54.9,
"DILATOR 14.0FR / 20CM",6008526,"CDM ",272,RC,,,OUTPATIENT,,,59.03,47.224,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.22,80,,37.78,,,0,"percent of total billed charges ","80% of total billed charges ",41.32,70,,33.06,,,0,"percent of total billed charges ","70% of total billed charges ",53.13,90,,42.50,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,93,,43.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",50.18,85,,40.14,,,0,"percent of total billed charges ","85% of total billed charges ",53.13,90,,42.50,,,0,"percent of total billed charges ","90% of total billed charges ",53.13,90,,42.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",51.36,87,,41.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.32,70,,33.06,,,0,"percent of total billed charges ","70% of total billed charges ",41.32,54.9,
"PROBE STEROTACTIC 10G X 12CM",6008567,"CDM ",270,RC,,,OUTPATIENT,,,696.07,556.856,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",556.86,80,,445.49,,,0,"percent of total billed charges ","80% of total billed charges ",487.25,70,,389.80,,,0,"percent of total billed charges ","70% of total billed charges ",626.46,90,,501.17,,,0,"percent of total billed charges ","90% of total billed charges ",647.35,93,,517.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",591.66,85,,473.33,,,0,"percent of total billed charges ","85% of total billed charges ",626.46,90,,501.17,,,0,"percent of total billed charges ","90% of total billed charges ",626.46,90,,501.17,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",605.58,87,,484.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",487.25,70,,389.80,,,0,"percent of total billed charges ","70% of total billed charges ",487.25,647.35,
"GUIDE PROBE 10G",6008569,"CDM ",270,RC,,,OUTPATIENT,,,26.03,20.824,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.82,80,,16.66,,,0,"percent of total billed charges ","80% of total billed charges ",18.22,70,,14.58,,,0,"percent of total billed charges ","70% of total billed charges ",23.43,90,,18.74,,,0,"percent of total billed charges ","90% of total billed charges ",24.21,93,,19.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",22.13,85,,17.70,,,0,"percent of total billed charges ","85% of total billed charges ",23.43,90,,18.74,,,0,"percent of total billed charges ","90% of total billed charges ",23.43,90,,18.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.65,87,,18.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.22,70,,14.58,,,0,"percent of total billed charges ","70% of total billed charges ",18.22,24.21,
"CANISTER VACUUM 800CC",6008570,"CDM ",270,RC,,,OUTPATIENT,,,36.11,28.888,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.89,80,,23.11,,,0,"percent of total billed charges ","80% of total billed charges ",25.28,70,,20.22,,,0,"percent of total billed charges ","70% of total billed charges ",32.5,90,,26.00,,,0,"percent of total billed charges ","90% of total billed charges ",33.58,93,,26.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",30.69,85,,24.55,,,0,"percent of total billed charges ","85% of total billed charges ",32.5,90,,26.00,,,0,"percent of total billed charges ","90% of total billed charges ",32.5,90,,26.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",31.42,87,,25.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.28,70,,20.22,,,0,"percent of total billed charges ","70% of total billed charges ",25.28,33.58,
"NEEDLE TRUGUIDE 19G X 7.8CM",6008598,"CDM ",272,RC,,,OUTPATIENT,,,67.25,53.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.8,80,,43.04,,,0,"percent of total billed charges ","80% of total billed charges ",47.08,70,,37.66,,,0,"percent of total billed charges ","70% of total billed charges ",60.53,90,,48.42,,,0,"percent of total billed charges ","90% of total billed charges ",62.54,93,,50.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",57.16,85,,45.73,,,0,"percent of total billed charges ","85% of total billed charges ",60.53,90,,48.42,,,0,"percent of total billed charges ","90% of total billed charges ",60.53,90,,48.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",58.51,87,,46.81,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.08,70,,37.66,,,0,"percent of total billed charges ","70% of total billed charges ",47.08,62.54,
"NEEDLE MONOPTY 20G X 10CM",6008599,"CDM ",272,RC,,,OUTPATIENT,,,136.99,109.592,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.59,80,,87.67,,,0,"percent of total billed charges ","80% of total billed charges ",95.89,70,,76.71,,,0,"percent of total billed charges ","70% of total billed charges ",123.29,90,,98.63,,,0,"percent of total billed charges ","90% of total billed charges ",127.4,93,,101.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",116.44,85,,93.15,,,0,"percent of total billed charges ","85% of total billed charges ",123.29,90,,98.63,,,0,"percent of total billed charges ","90% of total billed charges ",123.29,90,,98.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",119.18,87,,95.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.89,70,,76.71,,,0,"percent of total billed charges ","70% of total billed charges ",95.89,127.4,
"SPRAY TOUCHLESS CARE SKIN",6008603,"CDM ",272,RC,,,OUTPATIENT,,,28.89,23.112,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.11,80,,18.49,,,0,"percent of total billed charges ","80% of total billed charges ",20.22,70,,16.18,,,0,"percent of total billed charges ","70% of total billed charges ",26,90,,20.80,,,0,"percent of total billed charges ","90% of total billed charges ",26.87,93,,21.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",24.56,85,,19.65,,,0,"percent of total billed charges ","85% of total billed charges ",26,90,,20.80,,,0,"percent of total billed charges ","90% of total billed charges ",26,90,,20.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",25.13,87,,20.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.22,70,,16.18,,,0,"percent of total billed charges ","70% of total billed charges ",20.22,26.87,
"MASK CPAP AMARA VIEW SM",6008609,"CDM ",270,RC,,,OUTPATIENT,,,275.84,220.672,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.67,80,,176.54,,,0,"percent of total billed charges ","80% of total billed charges ",193.09,70,,154.47,,,0,"percent of total billed charges ","70% of total billed charges ",248.26,90,,198.61,,,0,"percent of total billed charges ","90% of total billed charges ",256.53,93,,205.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",234.46,85,,187.57,,,0,"percent of total billed charges ","85% of total billed charges ",248.26,90,,198.61,,,0,"percent of total billed charges ","90% of total billed charges ",248.26,90,,198.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",239.98,87,,191.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",193.09,70,,154.47,,,0,"percent of total billed charges ","70% of total billed charges ",193.09,256.53,
"MASK CPAP AMARA VIEW MED",6008610,"CDM ",270,RC,,,OUTPATIENT,,,275.84,220.672,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.67,80,,176.54,,,0,"percent of total billed charges ","80% of total billed charges ",193.09,70,,154.47,,,0,"percent of total billed charges ","70% of total billed charges ",248.26,90,,198.61,,,0,"percent of total billed charges ","90% of total billed charges ",256.53,93,,205.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",234.46,85,,187.57,,,0,"percent of total billed charges ","85% of total billed charges ",248.26,90,,198.61,,,0,"percent of total billed charges ","90% of total billed charges ",248.26,90,,198.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",239.98,87,,191.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",193.09,70,,154.47,,,0,"percent of total billed charges ","70% of total billed charges ",193.09,256.53,
"MASK CPAP AMARA VIEW LG",6008611,"CDM ",270,RC,,,OUTPATIENT,,,275.84,220.672,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.67,80,,176.54,,,0,"percent of total billed charges ","80% of total billed charges ",193.09,70,,154.47,,,0,"percent of total billed charges ","70% of total billed charges ",248.26,90,,198.61,,,0,"percent of total billed charges ","90% of total billed charges ",256.53,93,,205.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",234.46,85,,187.57,,,0,"percent of total billed charges ","85% of total billed charges ",248.26,90,,198.61,,,0,"percent of total billed charges ","90% of total billed charges ",248.26,90,,198.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",239.98,87,,191.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",193.09,70,,154.47,,,0,"percent of total billed charges ","70% of total billed charges ",193.09,256.53,
"CIRCUIT VAPOTHERM LOW FLOW",6008612,"CDM ",272,RC,,,OUTPATIENT,,,337.13,269.704,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",269.7,80,,215.76,,,0,"percent of total billed charges ","80% of total billed charges ",235.99,70,,188.79,,,0,"percent of total billed charges ","70% of total billed charges ",303.42,90,,242.74,,,0,"percent of total billed charges ","90% of total billed charges ",313.53,93,,250.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",286.56,85,,229.25,,,0,"percent of total billed charges ","85% of total billed charges ",303.42,90,,242.74,,,0,"percent of total billed charges ","90% of total billed charges ",303.42,90,,242.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",293.3,87,,234.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",235.99,70,,188.79,,,0,"percent of total billed charges ","70% of total billed charges ",235.99,313.53,
"CANNULA VAPORTHERM INFANT",6008613,"CDM ",270,RC,,,OUTPATIENT,,,21.06,16.848,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.85,80,,13.48,,,0,"percent of total billed charges ","80% of total billed charges ",14.74,70,,11.79,,,0,"percent of total billed charges ","70% of total billed charges ",18.95,90,,15.16,,,0,"percent of total billed charges ","90% of total billed charges ",19.59,93,,15.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.9,85,,14.32,,,0,"percent of total billed charges ","85% of total billed charges ",18.95,90,,15.16,,,0,"percent of total billed charges ","90% of total billed charges ",18.95,90,,15.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.32,87,,14.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.74,70,,11.79,,,0,"percent of total billed charges ","70% of total billed charges ",14.74,19.59,
"CANNULA VAPORTHERM INFANT SP",6008614,"CDM ",270,RC,,,OUTPATIENT,,,24.87,19.896,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.9,80,,15.92,,,0,"percent of total billed charges ","80% of total billed charges ",17.41,70,,13.93,,,0,"percent of total billed charges ","70% of total billed charges ",22.38,90,,17.90,,,0,"percent of total billed charges ","90% of total billed charges ",23.13,93,,18.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.14,85,,16.91,,,0,"percent of total billed charges ","85% of total billed charges ",22.38,90,,17.90,,,0,"percent of total billed charges ","90% of total billed charges ",22.38,90,,17.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.64,87,,17.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.41,70,,13.93,,,0,"percent of total billed charges ","70% of total billed charges ",17.41,23.13,
"CANNULA VAPOTHERM NEONATAL",6008615,"CDM ",270,RC,,,OUTPATIENT,,,21.06,16.848,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.85,80,,13.48,,,0,"percent of total billed charges ","80% of total billed charges ",14.74,70,,11.79,,,0,"percent of total billed charges ","70% of total billed charges ",18.95,90,,15.16,,,0,"percent of total billed charges ","90% of total billed charges ",19.59,93,,15.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.9,85,,14.32,,,0,"percent of total billed charges ","85% of total billed charges ",18.95,90,,15.16,,,0,"percent of total billed charges ","90% of total billed charges ",18.95,90,,15.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.32,87,,14.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.74,70,,11.79,,,0,"percent of total billed charges ","70% of total billed charges ",14.74,19.59,
"CANNULA VAPOTHERM PREMATURE",6008616,"CDM ",270,RC,,,OUTPATIENT,,,21.06,16.848,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.85,80,,13.48,,,0,"percent of total billed charges ","80% of total billed charges ",14.74,70,,11.79,,,0,"percent of total billed charges ","70% of total billed charges ",18.95,90,,15.16,,,0,"percent of total billed charges ","90% of total billed charges ",19.59,93,,15.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.9,85,,14.32,,,0,"percent of total billed charges ","85% of total billed charges ",18.95,90,,15.16,,,0,"percent of total billed charges ","90% of total billed charges ",18.95,90,,15.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.32,87,,14.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.74,70,,11.79,,,0,"percent of total billed charges ","70% of total billed charges ",14.74,19.59,
"GUIDE NEEDLE SAMSUNG XDCR",6008639,"CDM ",270,RC,,,OUTPATIENT,,,66.32,53.056,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.06,80,,42.45,,,0,"percent of total billed charges ","80% of total billed charges ",46.42,70,,37.14,,,0,"percent of total billed charges ","70% of total billed charges ",59.69,90,,47.75,,,0,"percent of total billed charges ","90% of total billed charges ",61.68,93,,49.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",56.37,85,,45.10,,,0,"percent of total billed charges ","85% of total billed charges ",59.69,90,,47.75,,,0,"percent of total billed charges ","90% of total billed charges ",59.69,90,,47.75,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",57.7,87,,46.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.42,70,,37.14,,,0,"percent of total billed charges ","70% of total billed charges ",46.42,61.68,
"GUIDE NEEDLE ULTRA PRO II",6008646,"CDM ",272,RC,,,OUTPATIENT,,,68.54,54.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.83,80,,43.86,,,0,"percent of total billed charges ","80% of total billed charges ",47.98,70,,38.38,,,0,"percent of total billed charges ","70% of total billed charges ",61.69,90,,49.35,,,0,"percent of total billed charges ","90% of total billed charges ",63.74,93,,50.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",58.26,85,,46.61,,,0,"percent of total billed charges ","85% of total billed charges ",61.69,90,,49.35,,,0,"percent of total billed charges ","90% of total billed charges ",61.69,90,,49.35,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",59.63,87,,47.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.98,70,,38.38,,,0,"percent of total billed charges ","70% of total billed charges ",47.98,63.74,
"DRESSING OASIS 3CM X 3.5CM",6008648,"CDM ",272,RC,,,OUTPATIENT,,,247.74,198.192,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",198.19,80,,158.55,,,0,"percent of total billed charges ","80% of total billed charges ",173.42,70,,138.74,,,0,"percent of total billed charges ","70% of total billed charges ",222.97,90,,178.38,,,0,"percent of total billed charges ","90% of total billed charges ",230.4,93,,184.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",210.58,85,,168.46,,,0,"percent of total billed charges ","85% of total billed charges ",222.97,90,,178.38,,,0,"percent of total billed charges ","90% of total billed charges ",222.97,90,,178.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",215.53,87,,172.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.42,70,,138.74,,,0,"percent of total billed charges ","70% of total billed charges ",173.42,230.4,
"CANNULA RAM NASAL NEONATAL",6008987,"CDM ",270,RC,,,OUTPATIENT,,,50.27,40.216,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.22,80,,32.18,,,0,"percent of total billed charges ","80% of total billed charges ",35.19,70,,28.15,,,0,"percent of total billed charges ","70% of total billed charges ",45.24,90,,36.19,,,0,"percent of total billed charges ","90% of total billed charges ",46.75,93,,37.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.73,85,,34.18,,,0,"percent of total billed charges ","85% of total billed charges ",45.24,90,,36.19,,,0,"percent of total billed charges ","90% of total billed charges ",45.24,90,,36.19,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.73,87,,34.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.19,70,,28.15,,,0,"percent of total billed charges ","70% of total billed charges ",35.19,46.75,
"CANNULA RAM NASAL MEDIUM",6008988,"CDM ",270,RC,,,OUTPATIENT,,,55.7,44.56,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.56,80,,35.65,,,0,"percent of total billed charges ","80% of total billed charges ",38.99,70,,31.19,,,0,"percent of total billed charges ","70% of total billed charges ",50.13,90,,40.10,,,0,"percent of total billed charges ","90% of total billed charges ",51.8,93,,41.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",47.35,85,,37.88,,,0,"percent of total billed charges ","85% of total billed charges ",50.13,90,,40.10,,,0,"percent of total billed charges ","90% of total billed charges ",50.13,90,,40.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",48.46,87,,38.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.99,70,,31.19,,,0,"percent of total billed charges ","70% of total billed charges ",38.99,51.8,
"CANNULA RAM NASAL LARGE",6008989,"CDM ",270,RC,,,OUTPATIENT,,,55.7,44.56,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.56,80,,35.65,,,0,"percent of total billed charges ","80% of total billed charges ",38.99,70,,31.19,,,0,"percent of total billed charges ","70% of total billed charges ",50.13,90,,40.10,,,0,"percent of total billed charges ","90% of total billed charges ",51.8,93,,41.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",47.35,85,,37.88,,,0,"percent of total billed charges ","85% of total billed charges ",50.13,90,,40.10,,,0,"percent of total billed charges ","90% of total billed charges ",50.13,90,,40.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",48.46,87,,38.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.99,70,,31.19,,,0,"percent of total billed charges ","70% of total billed charges ",38.99,51.8,
"CANNULA HIGH FLOW ADLT VAPOTH",6009616,"CDM ",270,RC,,,OUTPATIENT,,,16.05,12.84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.84,80,,10.27,,,0,"percent of total billed charges ","80% of total billed charges ",11.24,70,,8.99,,,0,"percent of total billed charges ","70% of total billed charges ",14.45,90,,11.56,,,0,"percent of total billed charges ","90% of total billed charges ",14.93,93,,11.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.64,85,,10.91,,,0,"percent of total billed charges ","85% of total billed charges ",14.45,90,,11.56,,,0,"percent of total billed charges ","90% of total billed charges ",14.45,90,,11.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.96,87,,11.17,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.24,70,,8.99,,,0,"percent of total billed charges ","70% of total billed charges ",11.24,14.93,
"CIRCUIT VAPOTHERM HIGH FLOW",6009618,"CDM ",270,RC,,,OUTPATIENT,,,347.2,277.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",277.76,80,,222.21,,,0,"percent of total billed charges ","80% of total billed charges ",243.04,70,,194.43,,,0,"percent of total billed charges ","70% of total billed charges ",312.48,90,,249.98,,,0,"percent of total billed charges ","90% of total billed charges ",322.9,93,,258.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",295.12,85,,236.10,,,0,"percent of total billed charges ","85% of total billed charges ",312.48,90,,249.98,,,0,"percent of total billed charges ","90% of total billed charges ",312.48,90,,249.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",302.06,87,,241.65,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",243.04,70,,194.43,,,0,"percent of total billed charges ","70% of total billed charges ",243.04,322.9,
"CHAMBER AEROVENT PLUS",6009648,"CDM ",270,RC,,,OUTPATIENT,,,50.01,40.008,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.01,80,,32.01,,,0,"percent of total billed charges ","80% of total billed charges ",35.01,70,,28.01,,,0,"percent of total billed charges ","70% of total billed charges ",45.01,90,,36.01,,,0,"percent of total billed charges ","90% of total billed charges ",46.51,93,,37.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.51,85,,34.01,,,0,"percent of total billed charges ","85% of total billed charges ",45.01,90,,36.01,,,0,"percent of total billed charges ","90% of total billed charges ",45.01,90,,36.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.51,87,,34.81,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.01,70,,28.01,,,0,"percent of total billed charges ","70% of total billed charges ",35.01,46.51,
"SET INFU POWER PORT 22GA 3/4""",6009649,"CDM ",270,RC,,,OUTPATIENT,,,27.73,22.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.18,80,,17.74,,,0,"percent of total billed charges ","80% of total billed charges ",19.41,70,,15.53,,,0,"percent of total billed charges ","70% of total billed charges ",24.96,90,,19.97,,,0,"percent of total billed charges ","90% of total billed charges ",25.79,93,,20.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.57,85,,18.86,,,0,"percent of total billed charges ","85% of total billed charges ",24.96,90,,19.97,,,0,"percent of total billed charges ","90% of total billed charges ",24.96,90,,19.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",24.13,87,,19.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.41,70,,15.53,,,0,"percent of total billed charges ","70% of total billed charges ",19.41,25.79,
"CIRCUIT CPAP WO FILTER",6009656,"CDM ",270,RC,,,OUTPATIENT,,,29.68,23.744,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.74,80,,18.99,,,0,"percent of total billed charges ","80% of total billed charges ",20.78,70,,16.62,,,0,"percent of total billed charges ","70% of total billed charges ",26.71,90,,21.37,,,0,"percent of total billed charges ","90% of total billed charges ",27.6,93,,22.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.23,85,,20.18,,,0,"percent of total billed charges ","85% of total billed charges ",26.71,90,,21.37,,,0,"percent of total billed charges ","90% of total billed charges ",26.71,90,,21.37,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",25.82,87,,20.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.78,70,,16.62,,,0,"percent of total billed charges ","70% of total billed charges ",20.78,27.6,
"MASK AF421 W/SE ELBOW MD",6009658,"CDM ",270,RC,,,OUTPATIENT,,,93.57,74.856,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.86,80,,59.89,,,0,"percent of total billed charges ","80% of total billed charges ",65.5,70,,52.40,,,0,"percent of total billed charges ","70% of total billed charges ",84.21,90,,67.37,,,0,"percent of total billed charges ","90% of total billed charges ",87.02,93,,69.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",79.53,85,,63.62,,,0,"percent of total billed charges ","85% of total billed charges ",84.21,90,,67.37,,,0,"percent of total billed charges ","90% of total billed charges ",84.21,90,,67.37,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.41,87,,65.13,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.5,70,,52.40,,,0,"percent of total billed charges ","70% of total billed charges ",65.5,87.02,
"MASK AF541 SE ELBOW LG",6009659,"CDM ",270,RC,,,OUTPATIENT,,,99.65,79.72,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.72,80,,63.78,,,0,"percent of total billed charges ","80% of total billed charges ",69.76,70,,55.81,,,0,"percent of total billed charges ","70% of total billed charges ",89.69,90,,71.75,,,0,"percent of total billed charges ","90% of total billed charges ",92.67,93,,74.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",84.7,85,,67.76,,,0,"percent of total billed charges ","85% of total billed charges ",89.69,90,,71.75,,,0,"percent of total billed charges ","90% of total billed charges ",89.69,90,,71.75,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",86.7,87,,69.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.76,70,,55.81,,,0,"percent of total billed charges ","70% of total billed charges ",69.76,92.67,
"MASK AF421 W/SE ELBOW XLG",6009660,"CDM ",270,RC,,,OUTPATIENT,,,100.77,80.616,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.62,80,,64.50,,,0,"percent of total billed charges ","80% of total billed charges ",70.54,70,,56.43,,,0,"percent of total billed charges ","70% of total billed charges ",90.69,90,,72.55,,,0,"percent of total billed charges ","90% of total billed charges ",93.72,93,,74.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",85.65,85,,68.52,,,0,"percent of total billed charges ","85% of total billed charges ",90.69,90,,72.55,,,0,"percent of total billed charges ","90% of total billed charges ",90.69,90,,72.55,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",87.67,87,,70.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.54,70,,56.43,,,0,"percent of total billed charges ","70% of total billed charges ",70.54,93.72,
"SLING ARM ULTRA IV 11"" SM",6009954,"CDM ",270,RC,,,OUTPATIENT,,,219.33,175.464,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",175.46,80,,140.37,,,0,"percent of total billed charges ","80% of total billed charges ",153.53,70,,122.82,,,0,"percent of total billed charges ","70% of total billed charges ",197.4,90,,157.92,,,0,"percent of total billed charges ","90% of total billed charges ",203.98,93,,163.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",186.43,85,,149.14,,,0,"percent of total billed charges ","85% of total billed charges ",197.4,90,,157.92,,,0,"percent of total billed charges ","90% of total billed charges ",197.4,90,,157.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",190.82,87,,152.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.53,70,,122.82,,,0,"percent of total billed charges ","70% of total billed charges ",153.53,203.98,
"SLING ARM ULTRA IV 11-13""MD",6009955,"CDM ",271,RC,,,OUTPATIENT,,,219.33,175.464,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",175.46,80,,140.37,,,0,"percent of total billed charges ","80% of total billed charges ",153.53,70,,122.82,,,0,"percent of total billed charges ","70% of total billed charges ",197.4,90,,157.92,,,0,"percent of total billed charges ","90% of total billed charges ",203.98,93,,163.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",186.43,85,,149.14,,,0,"percent of total billed charges ","85% of total billed charges ",197.4,90,,157.92,,,0,"percent of total billed charges ","90% of total billed charges ",197.4,90,,157.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",190.82,87,,152.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.53,70,,122.82,,,0,"percent of total billed charges ","70% of total billed charges ",153.53,203.98,
"SLING ARM ULTRA 13-15"" LG",6009956,"CDM ",271,RC,,,OUTPATIENT,,,219.33,175.464,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",175.46,80,,140.37,,,0,"percent of total billed charges ","80% of total billed charges ",153.53,70,,122.82,,,0,"percent of total billed charges ","70% of total billed charges ",197.4,90,,157.92,,,0,"percent of total billed charges ","90% of total billed charges ",203.98,93,,163.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",186.43,85,,149.14,,,0,"percent of total billed charges ","85% of total billed charges ",197.4,90,,157.92,,,0,"percent of total billed charges ","90% of total billed charges ",197.4,90,,157.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",190.82,87,,152.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.53,70,,122.82,,,0,"percent of total billed charges ","70% of total billed charges ",153.53,203.98,
"CONNECTOR ENFIT TRANSITION",6009960,"CDM ",270,RC,,,OUTPATIENT,,,11.28,9.024,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.02,80,,7.22,,,0,"percent of total billed charges ","80% of total billed charges ",7.9,70,,6.32,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,90,,8.12,,,0,"percent of total billed charges ","90% of total billed charges ",10.49,93,,8.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.59,85,,7.67,,,0,"percent of total billed charges ","85% of total billed charges ",10.15,90,,8.12,,,0,"percent of total billed charges ","90% of total billed charges ",10.15,90,,8.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.81,87,,7.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.9,70,,6.32,,,0,"percent of total billed charges ","70% of total billed charges ",7.9,10.49,
"DRSG CONVAMAX NON ADH 4""X4""",6009963,"CDM ",272,RC,,,OUTPATIENT,,,16.38,13.104,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.1,80,,10.48,,,0,"percent of total billed charges ","80% of total billed charges ",11.47,70,,9.18,,,0,"percent of total billed charges ","70% of total billed charges ",14.74,90,,11.79,,,0,"percent of total billed charges ","90% of total billed charges ",15.23,93,,12.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.92,85,,11.14,,,0,"percent of total billed charges ","85% of total billed charges ",14.74,90,,11.79,,,0,"percent of total billed charges ","90% of total billed charges ",14.74,90,,11.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.25,87,,11.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.47,70,,9.18,,,0,"percent of total billed charges ","70% of total billed charges ",11.47,15.23,
"DRSG CONVAMAX NON ADH 4""X4""",6009963,"CDM ",272,RC,,,OUTPATIENT,,,16.38,13.104,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.1,80,,10.48,,,0,"percent of total billed charges ","80% of total billed charges ",11.47,70,,9.18,,,0,"percent of total billed charges ","70% of total billed charges ",14.74,90,,11.79,,,0,"percent of total billed charges ","90% of total billed charges ",15.23,93,,12.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.92,85,,11.14,,,0,"percent of total billed charges ","85% of total billed charges ",14.74,90,,11.79,,,0,"percent of total billed charges ","90% of total billed charges ",14.74,90,,11.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.25,87,,11.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.47,70,,9.18,,,0,"percent of total billed charges ","70% of total billed charges ",11.47,15.23,
"DRSG CONVAMAX NON ADH 6""X8""",6009964,"CDM ",272,RC,,,OUTPATIENT,,,48.11,38.488,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.49,80,,30.79,,,0,"percent of total billed charges ","80% of total billed charges ",33.68,70,,26.94,,,0,"percent of total billed charges ","70% of total billed charges ",43.3,90,,34.64,,,0,"percent of total billed charges ","90% of total billed charges ",44.74,93,,35.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.89,85,,32.71,,,0,"percent of total billed charges ","85% of total billed charges ",43.3,90,,34.64,,,0,"percent of total billed charges ","90% of total billed charges ",43.3,90,,34.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.86,87,,33.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.68,70,,26.94,,,0,"percent of total billed charges ","70% of total billed charges ",33.68,44.74,
"DRSG CONVAMAX NON ADH 6""X8""",6009964,"CDM ",272,RC,,,OUTPATIENT,,,48.11,38.488,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.49,80,,30.79,,,0,"percent of total billed charges ","80% of total billed charges ",33.68,70,,26.94,,,0,"percent of total billed charges ","70% of total billed charges ",43.3,90,,34.64,,,0,"percent of total billed charges ","90% of total billed charges ",44.74,93,,35.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.89,85,,32.71,,,0,"percent of total billed charges ","85% of total billed charges ",43.3,90,,34.64,,,0,"percent of total billed charges ","90% of total billed charges ",43.3,90,,34.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.86,87,,33.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.68,70,,26.94,,,0,"percent of total billed charges ","70% of total billed charges ",33.68,44.74,
"SURGIFOAM 2X6CM",6009974,"CDM ",270,RC,,,OUTPATIENT,,,19.66,15.728,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.73,80,,12.58,,,0,"percent of total billed charges ","80% of total billed charges ",13.76,70,,11.01,,,0,"percent of total billed charges ","70% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",18.28,93,,14.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.71,85,,13.37,,,0,"percent of total billed charges ","85% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.1,87,,13.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.76,70,,11.01,,,0,"percent of total billed charges ","70% of total billed charges ",13.76,18.28,
"NEEDLE TRUGUIDE 17G X 7.8CM",6009979,"CDM ",270,RC,,,OUTPATIENT,,,67.25,53.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.8,80,,43.04,,,0,"percent of total billed charges ","80% of total billed charges ",47.08,70,,37.66,,,0,"percent of total billed charges ","70% of total billed charges ",60.53,90,,48.42,,,0,"percent of total billed charges ","90% of total billed charges ",62.54,93,,50.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",57.16,85,,45.73,,,0,"percent of total billed charges ","85% of total billed charges ",60.53,90,,48.42,,,0,"percent of total billed charges ","90% of total billed charges ",60.53,90,,48.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",58.51,87,,46.81,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.08,70,,37.66,,,0,"percent of total billed charges ","70% of total billed charges ",47.08,62.54,
"KIT CVC MULTI-LUMEN 7FR X 16CM",6009987,"CDM ",270,RC,,,OUTPATIENT,,,255.5,204.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",204.4,80,,163.52,,,0,"percent of total billed charges ","80% of total billed charges ",178.85,70,,143.08,,,0,"percent of total billed charges ","70% of total billed charges ",229.95,90,,183.96,,,0,"percent of total billed charges ","90% of total billed charges ",237.62,93,,190.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",217.18,85,,173.74,,,0,"percent of total billed charges ","85% of total billed charges ",229.95,90,,183.96,,,0,"percent of total billed charges ","90% of total billed charges ",229.95,90,,183.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",222.29,87,,177.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.85,70,,143.08,,,0,"percent of total billed charges ","70% of total billed charges ",178.85,237.62,
"NEEDLE MONOPTY 18G X 10CM",6009991,"CDM ",270,RC,,,OUTPATIENT,,,126.63,101.304,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.3,80,,81.04,,,0,"percent of total billed charges ","80% of total billed charges ",88.64,70,,70.91,,,0,"percent of total billed charges ","70% of total billed charges ",113.97,90,,91.18,,,0,"percent of total billed charges ","90% of total billed charges ",117.77,93,,94.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",107.64,85,,86.11,,,0,"percent of total billed charges ","85% of total billed charges ",113.97,90,,91.18,,,0,"percent of total billed charges ","90% of total billed charges ",113.97,90,,91.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",110.17,87,,88.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.64,70,,70.91,,,0,"percent of total billed charges ","70% of total billed charges ",88.64,117.77,
"KIT PLEURX LOCKABLE DRAIN LINE",608244,"CDM ",272,RC,,,OUTPATIENT,,,132.91,106.328,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.33,80,,85.06,,,0,"percent of total billed charges ","80% of total billed charges ",93.04,70,,74.43,,,0,"percent of total billed charges ","70% of total billed charges ",119.62,90,,95.70,,,0,"percent of total billed charges ","90% of total billed charges ",123.61,93,,98.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",112.97,85,,90.38,,,0,"percent of total billed charges ","85% of total billed charges ",119.62,90,,95.70,,,0,"percent of total billed charges ","90% of total billed charges ",119.62,90,,95.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",115.63,87,,92.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.04,70,,74.43,,,0,"percent of total billed charges ","70% of total billed charges ",93.04,123.61,
"MISC CHARGE STERILE",6099920,"CDM ",272,RC,,,OUTPATIENT,,,40,32,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32,80,,25.60,,,0,"percent of total billed charges ","80% of total billed charges ",28,70,,22.40,,,0,"percent of total billed charges ","70% of total billed charges ",36,90,,28.80,,,0,"percent of total billed charges ","90% of total billed charges ",37.2,93,,29.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34,85,,27.20,,,0,"percent of total billed charges ","85% of total billed charges ",36,90,,28.80,,,0,"percent of total billed charges ","90% of total billed charges ",36,90,,28.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",34.8,87,,27.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28,70,,22.40,,,0,"percent of total billed charges ","70% of total billed charges ",28,37.2,
"SOLN NS 1000ML SLUSH",6100002,"CDM ",270,RC,,,OUTPATIENT,,,351.39,281.112,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",281.11,80,,224.89,,,0,"percent of total billed charges ","80% of total billed charges ",245.97,70,,196.78,,,0,"percent of total billed charges ","70% of total billed charges ",316.25,90,,253.00,,,0,"percent of total billed charges ","90% of total billed charges ",326.79,93,,261.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",298.68,85,,238.94,,,0,"percent of total billed charges ","85% of total billed charges ",316.25,90,,253.00,,,0,"percent of total billed charges ","90% of total billed charges ",316.25,90,,253.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",305.71,87,,244.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",245.97,70,,196.78,,,0,"percent of total billed charges ","70% of total billed charges ",245.97,326.79,
"DRESSING TELFA PAD 2*3",6100003,"CDM ",272,RC,,,OUTPATIENT,,,1.5,1.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.2,80,,0.96,,,0,"percent of total billed charges ","80% of total billed charges ",1.05,70,,0.84,,,0,"percent of total billed charges ","70% of total billed charges ",1.35,90,,1.08,,,0,"percent of total billed charges ","90% of total billed charges ",1.4,93,,1.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1.28,85,,1.02,,,0,"percent of total billed charges ","85% of total billed charges ",1.35,90,,1.08,,,0,"percent of total billed charges ","90% of total billed charges ",1.35,90,,1.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1.31,87,,1.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.05,70,,0.84,,,0,"percent of total billed charges ","70% of total billed charges ",1.05,1.4,
"CATH GROSHONG 8.0FR",6100027,"CDM ",270,RC,,,OUTPATIENT,,,374.97,299.976,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.98,80,,239.98,,,0,"percent of total billed charges ","80% of total billed charges ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",348.72,93,,278.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",318.72,85,,254.98,,,0,"percent of total billed charges ","85% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",337.47,90,,269.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",326.22,87,,260.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.48,70,,209.98,,,0,"percent of total billed charges ","70% of total billed charges ",262.48,348.72,
"SUTURE ETH 6.0 PC3 1856G",6100031,"CDM ",272,RC,,,OUTPATIENT,,,23.5,18.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.8,80,,15.04,,,0,"percent of total billed charges ","80% of total billed charges ",16.45,70,,13.16,,,0,"percent of total billed charges ","70% of total billed charges ",21.15,90,,16.92,,,0,"percent of total billed charges ","90% of total billed charges ",21.86,93,,17.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.98,85,,15.98,,,0,"percent of total billed charges ","85% of total billed charges ",21.15,90,,16.92,,,0,"percent of total billed charges ","90% of total billed charges ",21.15,90,,16.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.45,87,,16.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.45,70,,13.16,,,0,"percent of total billed charges ","70% of total billed charges ",16.45,21.86,
"SUTURE SILKTIE 4.0 J103T",6100037,"CDM ",272,RC,,,OUTPATIENT,,,43.23,34.584,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.58,80,,27.66,,,0,"percent of total billed charges ","80% of total billed charges ",30.26,70,,24.21,,,0,"percent of total billed charges ","70% of total billed charges ",38.91,90,,31.13,,,0,"percent of total billed charges ","90% of total billed charges ",40.2,93,,32.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",36.75,85,,29.40,,,0,"percent of total billed charges ","85% of total billed charges ",38.91,90,,31.13,,,0,"percent of total billed charges ","90% of total billed charges ",38.91,90,,31.13,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",37.61,87,,30.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.26,70,,24.21,,,0,"percent of total billed charges ","70% of total billed charges ",30.26,40.2,
"BINDER ABDOMINAL",6100047,"CDM ",271,RC,,,OUTPATIENT,,,49.5,39.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.6,80,,31.68,,,0,"percent of total billed charges ","80% of total billed charges ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",46.04,93,,36.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.08,85,,33.66,,,0,"percent of total billed charges ","85% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.07,87,,34.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,46.04,
"SPLINT WRIST SM RT",6100049,"CDM ",271,RC,,,OUTPATIENT,,,46.5,37.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.2,80,,29.76,,,0,"percent of total billed charges ","80% of total billed charges ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",43.25,93,,34.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.53,85,,31.62,,,0,"percent of total billed charges ","85% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.46,87,,32.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",32.55,43.25,
"SPLINT WRIST MED RIGHT",6100053,"CDM ",271,RC,,,OUTPATIENT,,,46.5,37.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.2,80,,29.76,,,0,"percent of total billed charges ","80% of total billed charges ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",43.25,93,,34.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.53,85,,31.62,,,0,"percent of total billed charges ","85% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.46,87,,32.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",32.55,43.25,
"SPLINT WRIST MED LEFT",6100054,"CDM ",271,RC,,,OUTPATIENT,,,46.5,37.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.2,80,,29.76,,,0,"percent of total billed charges ","80% of total billed charges ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",43.25,93,,34.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.53,85,,31.62,,,0,"percent of total billed charges ","85% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.46,87,,32.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",32.55,43.25,
"BURR 4MM ROUND FLUTED SHORT",6100065,"CDM ",272,RC,,,OUTPATIENT,,,292.45,233.96,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",233.96,80,,187.17,,,0,"percent of total billed charges ","80% of total billed charges ",204.72,70,,163.78,,,0,"percent of total billed charges ","70% of total billed charges ",263.21,90,,210.57,,,0,"percent of total billed charges ","90% of total billed charges ",271.98,93,,217.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",248.58,85,,198.86,,,0,"percent of total billed charges ","85% of total billed charges ",263.21,90,,210.57,,,0,"percent of total billed charges ","90% of total billed charges ",263.21,90,,210.57,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",254.43,87,,203.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",204.72,70,,163.78,,,0,"percent of total billed charges ","70% of total billed charges ",204.72,271.98,
"SET VENOSET PRIM PIGBK",6100071,"CDM ",272,RC,,,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.6,80,,4.48,,,0,"percent of total billed charges ","80% of total billed charges ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"TRAY URETHERAL",6100092,"CDM ",272,RC,,,OUTPATIENT,,,11,8.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.8,80,,7.04,,,0,"percent of total billed charges ","80% of total billed charges ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",10.23,93,,8.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.35,85,,7.48,,,0,"percent of total billed charges ","85% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.57,87,,7.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.7,10.23,
"REMOVER STAPLE SURGICAL",6100093,"CDM ",272,RC,,,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.6,80,,9.28,,,0,"percent of total billed charges ","80% of total billed charges ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"PAD AQUA LARGE",6100111,"CDM ",271,RC,,,OUTPATIENT,,,27.5,22,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22,80,,17.60,,,0,"percent of total billed charges ","80% of total billed charges ",19.25,70,,15.40,,,0,"percent of total billed charges ","70% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",25.58,93,,20.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.38,85,,18.70,,,0,"percent of total billed charges ","85% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",23.93,87,,19.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.25,70,,15.40,,,0,"percent of total billed charges ","70% of total billed charges ",19.25,25.58,
"PAD AQUA MEDIUM",6100112,"CDM ",271,RC,,,OUTPATIENT,,,25.5,20.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.4,80,,16.32,,,0,"percent of total billed charges ","80% of total billed charges ",17.85,70,,14.28,,,0,"percent of total billed charges ","70% of total billed charges ",22.95,90,,18.36,,,0,"percent of total billed charges ","90% of total billed charges ",23.72,93,,18.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.68,85,,17.34,,,0,"percent of total billed charges ","85% of total billed charges ",22.95,90,,18.36,,,0,"percent of total billed charges ","90% of total billed charges ",22.95,90,,18.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.19,87,,17.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.85,70,,14.28,,,0,"percent of total billed charges ","70% of total billed charges ",17.85,23.72,
"SUTURE SILK 3.0 C013T",6100130,"CDM ",272,RC,,,OUTPATIENT,,,29.74,23.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.79,80,,19.03,,,0,"percent of total billed charges ","80% of total billed charges ",20.82,70,,16.66,,,0,"percent of total billed charges ","70% of total billed charges ",26.77,90,,21.42,,,0,"percent of total billed charges ","90% of total billed charges ",27.66,93,,22.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.28,85,,20.22,,,0,"percent of total billed charges ","85% of total billed charges ",26.77,90,,21.42,,,0,"percent of total billed charges ","90% of total billed charges ",26.77,90,,21.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",25.87,87,,20.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.82,70,,16.66,,,0,"percent of total billed charges ","70% of total billed charges ",20.82,27.66,
"SUTURE CHROMIC O 884H",6100133,"CDM ",272,RC,,,OUTPATIENT,,,11.33,9.064,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.06,80,,7.25,,,0,"percent of total billed charges ","80% of total billed charges ",7.93,70,,6.34,,,0,"percent of total billed charges ","70% of total billed charges ",10.2,90,,8.16,,,0,"percent of total billed charges ","90% of total billed charges ",10.54,93,,8.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.63,85,,7.70,,,0,"percent of total billed charges ","85% of total billed charges ",10.2,90,,8.16,,,0,"percent of total billed charges ","90% of total billed charges ",10.2,90,,8.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.86,87,,7.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.93,70,,6.34,,,0,"percent of total billed charges ","70% of total billed charges ",7.93,10.54,
"SUTURE RETENTION BRIDGE",6100160,"CDM ",272,RC,,,OUTPATIENT,,,36.91,29.528,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.53,80,,23.62,,,0,"percent of total billed charges ","80% of total billed charges ",25.84,70,,20.67,,,0,"percent of total billed charges ","70% of total billed charges ",33.22,90,,26.58,,,0,"percent of total billed charges ","90% of total billed charges ",34.33,93,,27.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",31.37,85,,25.10,,,0,"percent of total billed charges ","85% of total billed charges ",33.22,90,,26.58,,,0,"percent of total billed charges ","90% of total billed charges ",33.22,90,,26.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",32.11,87,,25.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.84,70,,20.67,,,0,"percent of total billed charges ","70% of total billed charges ",25.84,34.33,
"ENSEAL X1 CURVED 13MM X 20CM",6100184,"CDM ",270,RC,,,OUTPATIENT,,,914.4,731.52,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",731.52,80,,585.22,,,0,"percent of total billed charges ","80% of total billed charges ",640.08,70,,512.06,,,0,"percent of total billed charges ","70% of total billed charges ",822.96,90,,658.37,,,0,"percent of total billed charges ","90% of total billed charges ",850.39,93,,680.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",777.24,85,,621.79,,,0,"percent of total billed charges ","85% of total billed charges ",822.96,90,,658.37,,,0,"percent of total billed charges ","90% of total billed charges ",822.96,90,,658.37,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",795.53,87,,636.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",640.08,70,,512.06,,,0,"percent of total billed charges ","70% of total billed charges ",640.08,850.39,
"MARKER SKIN VIOLET STER",6100189,"CDM ",272,RC,,,OUTPATIENT,,,3.73,2.984,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.98,80,,2.38,,,0,"percent of total billed charges ","80% of total billed charges ",2.61,70,,2.09,,,0,"percent of total billed charges ","70% of total billed charges ",3.36,90,,2.69,,,0,"percent of total billed charges ","90% of total billed charges ",3.47,93,,2.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3.17,85,,2.54,,,0,"percent of total billed charges ","85% of total billed charges ",3.36,90,,2.69,,,0,"percent of total billed charges ","90% of total billed charges ",3.36,90,,2.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3.25,87,,2.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.61,70,,2.09,,,0,"percent of total billed charges ","70% of total billed charges ",2.61,3.47,
"MARKER SKIN VIOLET STER",6100189,"CDM ",272,RC,,,OUTPATIENT,,,3.73,2.984,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.98,80,,2.38,,,0,"percent of total billed charges ","80% of total billed charges ",2.61,70,,2.09,,,0,"percent of total billed charges ","70% of total billed charges ",3.36,90,,2.69,,,0,"percent of total billed charges ","90% of total billed charges ",3.47,93,,2.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3.17,85,,2.54,,,0,"percent of total billed charges ","85% of total billed charges ",3.36,90,,2.69,,,0,"percent of total billed charges ","90% of total billed charges ",3.36,90,,2.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3.25,87,,2.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.61,70,,2.09,,,0,"percent of total billed charges ","70% of total billed charges ",2.61,3.47,
"CLIP LIGATING LT100",6100193,"CDM ",272,RC,,,OUTPATIENT,,,15.25,12.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.2,80,,9.76,,,0,"percent of total billed charges ","80% of total billed charges ",10.68,70,,8.54,,,0,"percent of total billed charges ","70% of total billed charges ",13.73,90,,10.98,,,0,"percent of total billed charges ","90% of total billed charges ",14.18,93,,11.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.96,85,,10.37,,,0,"percent of total billed charges ","85% of total billed charges ",13.73,90,,10.98,,,0,"percent of total billed charges ","90% of total billed charges ",13.73,90,,10.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.27,87,,10.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.68,70,,8.54,,,0,"percent of total billed charges ","70% of total billed charges ",10.68,14.18,
"SUTURE CHROMIC 1.0 813H",6100194,"CDM ",272,RC,,,OUTPATIENT,,,10.93,8.744,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.74,80,,6.99,,,0,"percent of total billed charges ","80% of total billed charges ",7.65,70,,6.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.84,90,,7.87,,,0,"percent of total billed charges ","90% of total billed charges ",10.16,93,,8.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.29,85,,7.43,,,0,"percent of total billed charges ","85% of total billed charges ",9.84,90,,7.87,,,0,"percent of total billed charges ","90% of total billed charges ",9.84,90,,7.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.51,87,,7.61,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.65,70,,6.12,,,0,"percent of total billed charges ","70% of total billed charges ",7.65,10.16,
"SUTURE 8556H PROLENE 5.0",6100213,"CDM ",272,RC,,,OUTPATIENT,,,21.41,17.128,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.13,80,,13.70,,,0,"percent of total billed charges ","80% of total billed charges ",14.99,70,,11.99,,,0,"percent of total billed charges ","70% of total billed charges ",19.27,90,,15.42,,,0,"percent of total billed charges ","90% of total billed charges ",19.91,93,,15.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.2,85,,14.56,,,0,"percent of total billed charges ","85% of total billed charges ",19.27,90,,15.42,,,0,"percent of total billed charges ","90% of total billed charges ",19.27,90,,15.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.63,87,,14.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.99,70,,11.99,,,0,"percent of total billed charges ","70% of total billed charges ",14.99,19.91,
"ARWY I-GEL SUPRAGLOTTIC SZ 2.5",6100221,"CDM ",270,RC,,,OUTPATIENT,,,94.23,75.384,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.38,80,,60.30,,,0,"percent of total billed charges ","80% of total billed charges ",65.96,70,,52.77,,,0,"percent of total billed charges ","70% of total billed charges ",84.81,90,,67.85,,,0,"percent of total billed charges ","90% of total billed charges ",87.63,93,,70.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.1,85,,64.08,,,0,"percent of total billed charges ","85% of total billed charges ",84.81,90,,67.85,,,0,"percent of total billed charges ","90% of total billed charges ",84.81,90,,67.85,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.98,87,,65.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.96,70,,52.77,,,0,"percent of total billed charges ","70% of total billed charges ",65.96,87.63,
"NEEDLE SPINAL 22G 6 INCH",6100251,"CDM ",272,RC,,,OUTPATIENT,,,48.5,38.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.8,80,,31.04,,,0,"percent of total billed charges ","80% of total billed charges ",33.95,70,,27.16,,,0,"percent of total billed charges ","70% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",45.11,93,,36.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.23,85,,32.98,,,0,"percent of total billed charges ","85% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",43.65,90,,34.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.2,87,,33.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.95,70,,27.16,,,0,"percent of total billed charges ","70% of total billed charges ",33.95,45.11,
"KIT SHEATH INTRODUCER",6100255,"CDM ",272,RC,,,OUTPATIENT,,,168,134.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",134.4,80,,107.52,,,0,"percent of total billed charges ","80% of total billed charges ",117.6,70,,94.08,,,0,"percent of total billed charges ","70% of total billed charges ",151.2,90,,120.96,,,0,"percent of total billed charges ","90% of total billed charges ",156.24,93,,124.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",142.8,85,,114.24,,,0,"percent of total billed charges ","85% of total billed charges ",151.2,90,,120.96,,,0,"percent of total billed charges ","90% of total billed charges ",151.2,90,,120.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",146.16,87,,116.93,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.6,70,,94.08,,,0,"percent of total billed charges ","70% of total billed charges ",117.6,156.24,
"ENSEAL X1 CURVED 5MM X 37CM",6100260,"CDM ",270,RC,,,OUTPATIENT,,,852.36,681.888,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",681.89,80,,545.51,,,0,"percent of total billed charges ","80% of total billed charges ",596.65,70,,477.32,,,0,"percent of total billed charges ","70% of total billed charges ",767.12,90,,613.70,,,0,"percent of total billed charges ","90% of total billed charges ",792.69,93,,634.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",724.51,85,,579.61,,,0,"percent of total billed charges ","85% of total billed charges ",767.12,90,,613.70,,,0,"percent of total billed charges ","90% of total billed charges ",767.12,90,,613.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",741.55,87,,593.24,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",596.65,70,,477.32,,,0,"percent of total billed charges ","70% of total billed charges ",596.65,792.69,
"IMMOBILIZER KNEE SMALL",6100263,"CDM ",271,RC,,,OUTPATIENT,,,81,64.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.8,80,,51.84,,,0,"percent of total billed charges ","80% of total billed charges ",56.7,70,,45.36,,,0,"percent of total billed charges ","70% of total billed charges ",72.9,90,,58.32,,,0,"percent of total billed charges ","90% of total billed charges ",75.33,93,,60.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",68.85,85,,55.08,,,0,"percent of total billed charges ","85% of total billed charges ",72.9,90,,58.32,,,0,"percent of total billed charges ","90% of total billed charges ",72.9,90,,58.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",70.47,87,,56.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.7,70,,45.36,,,0,"percent of total billed charges ","70% of total billed charges ",56.7,75.33,
"CARRIER DERMA 1.5 TO 1 DEPTH",6100267,"CDM ",272,RC,,,OUTPATIENT,,,90.46,72.368,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.37,80,,57.90,,,0,"percent of total billed charges ","80% of total billed charges ",63.32,70,,50.66,,,0,"percent of total billed charges ","70% of total billed charges ",81.41,90,,65.13,,,0,"percent of total billed charges ","90% of total billed charges ",84.13,93,,67.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",76.89,85,,61.51,,,0,"percent of total billed charges ","85% of total billed charges ",81.41,90,,65.13,,,0,"percent of total billed charges ","90% of total billed charges ",81.41,90,,65.13,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",78.7,87,,62.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.32,70,,50.66,,,0,"percent of total billed charges ","70% of total billed charges ",63.32,84.13,
"CAUTERY EYE OPITEMP",6100276,"CDM ",272,RC,,,OUTPATIENT,,,105.5,84.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.4,80,,67.52,,,0,"percent of total billed charges ","80% of total billed charges ",73.85,70,,59.08,,,0,"percent of total billed charges ","70% of total billed charges ",94.95,90,,75.96,,,0,"percent of total billed charges ","90% of total billed charges ",98.12,93,,78.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",89.68,85,,71.74,,,0,"percent of total billed charges ","85% of total billed charges ",94.95,90,,75.96,,,0,"percent of total billed charges ","90% of total billed charges ",94.95,90,,75.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",91.79,87,,73.43,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.85,70,,59.08,,,0,"percent of total billed charges ","70% of total billed charges ",73.85,98.12,
"INJECTOR BONE CEMENT",6100278,"CDM ",272,RC,,,OUTPATIENT,,,155.58,124.464,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.46,80,,99.57,,,0,"percent of total billed charges ","80% of total billed charges ",108.91,70,,87.13,,,0,"percent of total billed charges ","70% of total billed charges ",140.02,90,,112.02,,,0,"percent of total billed charges ","90% of total billed charges ",144.69,93,,115.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",132.24,85,,105.79,,,0,"percent of total billed charges ","85% of total billed charges ",140.02,90,,112.02,,,0,"percent of total billed charges ","90% of total billed charges ",140.02,90,,112.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",135.35,87,,108.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.91,70,,87.13,,,0,"percent of total billed charges ","70% of total billed charges ",108.91,144.69,
"STAPLER 21MM",6100281,"CDM ",272,RC,,,OUTPATIENT,,,765.22,612.176,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",612.18,80,,489.74,,,0,"percent of total billed charges ","80% of total billed charges ",535.65,70,,428.52,,,0,"percent of total billed charges ","70% of total billed charges ",688.7,90,,550.96,,,0,"percent of total billed charges ","90% of total billed charges ",711.65,93,,569.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",650.44,85,,520.35,,,0,"percent of total billed charges ","85% of total billed charges ",688.7,90,,550.96,,,0,"percent of total billed charges ","90% of total billed charges ",688.7,90,,550.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",665.74,87,,532.59,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",535.65,70,,428.52,,,0,"percent of total billed charges ","70% of total billed charges ",535.65,711.65,
"SOLN IRRISEPT 0.05% CHG 450ML",6100284,"CDM ",270,RC,,,OUTPATIENT,,,298.38,238.704,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",238.7,80,,190.96,,,0,"percent of total billed charges ","80% of total billed charges ",208.87,70,,167.10,,,0,"percent of total billed charges ","70% of total billed charges ",268.54,90,,214.83,,,0,"percent of total billed charges ","90% of total billed charges ",277.49,93,,221.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",253.62,85,,202.90,,,0,"percent of total billed charges ","85% of total billed charges ",268.54,90,,214.83,,,0,"percent of total billed charges ","90% of total billed charges ",268.54,90,,214.83,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",259.59,87,,207.67,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",208.87,70,,167.10,,,0,"percent of total billed charges ","70% of total billed charges ",208.87,277.49,
"DRAIN T TUBE 14FR",6100298,"CDM ",272,RC,,,OUTPATIENT,,,36.31,29.048,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.05,80,,23.24,,,0,"percent of total billed charges ","80% of total billed charges ",25.42,70,,20.34,,,0,"percent of total billed charges ","70% of total billed charges ",32.68,90,,26.14,,,0,"percent of total billed charges ","90% of total billed charges ",33.77,93,,27.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",30.86,85,,24.69,,,0,"percent of total billed charges ","85% of total billed charges ",32.68,90,,26.14,,,0,"percent of total billed charges ","90% of total billed charges ",32.68,90,,26.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",31.59,87,,25.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.42,70,,20.34,,,0,"percent of total billed charges ","70% of total billed charges ",25.42,33.77,
"DRAIN T TUBE 16FR",6100299,"CDM ",272,RC,,,OUTPATIENT,,,33.9,27.12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.12,80,,21.70,,,0,"percent of total billed charges ","80% of total billed charges ",23.73,70,,18.98,,,0,"percent of total billed charges ","70% of total billed charges ",30.51,90,,24.41,,,0,"percent of total billed charges ","90% of total billed charges ",31.53,93,,25.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.82,85,,23.06,,,0,"percent of total billed charges ","85% of total billed charges ",30.51,90,,24.41,,,0,"percent of total billed charges ","90% of total billed charges ",30.51,90,,24.41,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.49,87,,23.59,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.73,70,,18.98,,,0,"percent of total billed charges ","70% of total billed charges ",23.73,31.53,
"SET DRAIN THORA-SEAL III",6100301,"CDM ",272,RC,,,OUTPATIENT,,,174,139.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.2,80,,111.36,,,0,"percent of total billed charges ","80% of total billed charges ",121.8,70,,97.44,,,0,"percent of total billed charges ","70% of total billed charges ",156.6,90,,125.28,,,0,"percent of total billed charges ","90% of total billed charges ",161.82,93,,129.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",147.9,85,,118.32,,,0,"percent of total billed charges ","85% of total billed charges ",156.6,90,,125.28,,,0,"percent of total billed charges ","90% of total billed charges ",156.6,90,,125.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",151.38,87,,121.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",121.8,70,,97.44,,,0,"percent of total billed charges ","70% of total billed charges ",121.8,161.82,
"BURR 3.0MM",6100305,"CDM ",272,RC,,,OUTPATIENT,,,292.45,233.96,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",233.96,80,,187.17,,,0,"percent of total billed charges ","80% of total billed charges ",204.72,70,,163.78,,,0,"percent of total billed charges ","70% of total billed charges ",263.21,90,,210.57,,,0,"percent of total billed charges ","90% of total billed charges ",271.98,93,,217.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",248.58,85,,198.86,,,0,"percent of total billed charges ","85% of total billed charges ",263.21,90,,210.57,,,0,"percent of total billed charges ","90% of total billed charges ",263.21,90,,210.57,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",254.43,87,,203.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",204.72,70,,163.78,,,0,"percent of total billed charges ","70% of total billed charges ",204.72,271.98,
"DRAIN SURG 19FR ROUND FLUTED",6100312,"CDM ",270,RC,,,OUTPATIENT,,,52.27,41.816,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.82,80,,33.46,,,0,"percent of total billed charges ","80% of total billed charges ",36.59,70,,29.27,,,0,"percent of total billed charges ","70% of total billed charges ",47.04,90,,37.63,,,0,"percent of total billed charges ","90% of total billed charges ",48.61,93,,38.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",44.43,85,,35.54,,,0,"percent of total billed charges ","85% of total billed charges ",47.04,90,,37.63,,,0,"percent of total billed charges ","90% of total billed charges ",47.04,90,,37.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",45.47,87,,36.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.59,70,,29.27,,,0,"percent of total billed charges ","70% of total billed charges ",36.59,48.61,
INSUFLOW,6100313,"CDM ",270,RC,,,OUTPATIENT,,,232.5,186,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",186,80,,148.80,,,0,"percent of total billed charges ","80% of total billed charges ",162.75,70,,130.20,,,0,"percent of total billed charges ","70% of total billed charges ",209.25,90,,167.40,,,0,"percent of total billed charges ","90% of total billed charges ",216.23,93,,172.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",197.63,85,,158.10,,,0,"percent of total billed charges ","85% of total billed charges ",209.25,90,,167.40,,,0,"percent of total billed charges ","90% of total billed charges ",209.25,90,,167.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",202.28,87,,161.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.75,70,,130.20,,,0,"percent of total billed charges ","70% of total billed charges ",162.75,216.23,
"BURR ARTHROPLASTY 3.5MM",6100314,"CDM ",272,RC,,,OUTPATIENT,,,213.36,170.688,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.69,80,,136.55,,,0,"percent of total billed charges ","80% of total billed charges ",149.35,70,,119.48,,,0,"percent of total billed charges ","70% of total billed charges ",192.02,90,,153.62,,,0,"percent of total billed charges ","90% of total billed charges ",198.42,93,,158.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",181.36,85,,145.09,,,0,"percent of total billed charges ","85% of total billed charges ",192.02,90,,153.62,,,0,"percent of total billed charges ","90% of total billed charges ",192.02,90,,153.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",185.62,87,,148.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.35,70,,119.48,,,0,"percent of total billed charges ","70% of total billed charges ",149.35,198.42,
"EXTRACTOR BALLOON 12MM",6100315,"CDM ",272,RC,,,OUTPATIENT,,,234.12,187.296,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.3,80,,149.84,,,0,"percent of total billed charges ","80% of total billed charges ",163.88,70,,131.10,,,0,"percent of total billed charges ","70% of total billed charges ",210.71,90,,168.57,,,0,"percent of total billed charges ","90% of total billed charges ",217.73,93,,174.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",199,85,,159.20,,,0,"percent of total billed charges ","85% of total billed charges ",210.71,90,,168.57,,,0,"percent of total billed charges ","90% of total billed charges ",210.71,90,,168.57,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",203.68,87,,162.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",163.88,70,,131.10,,,0,"percent of total billed charges ","70% of total billed charges ",163.88,217.73,
"TUBING INSUFLOW",6100316,"CDM ",270,RC,,,OUTPATIENT,,,53.34,42.672,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.67,80,,34.14,,,0,"percent of total billed charges ","80% of total billed charges ",37.34,70,,29.87,,,0,"percent of total billed charges ","70% of total billed charges ",48.01,90,,38.41,,,0,"percent of total billed charges ","90% of total billed charges ",49.61,93,,39.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",45.34,85,,36.27,,,0,"percent of total billed charges ","85% of total billed charges ",48.01,90,,38.41,,,0,"percent of total billed charges ","90% of total billed charges ",48.01,90,,38.41,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",46.41,87,,37.13,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.34,70,,29.87,,,0,"percent of total billed charges ","70% of total billed charges ",37.34,49.61,
"KIT POSITIONING PIGAZZI",6100318,"CDM ",270,RC,,,OUTPATIENT,,,342.43,273.944,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.94,80,,219.15,,,0,"percent of total billed charges ","80% of total billed charges ",239.7,70,,191.76,,,0,"percent of total billed charges ","70% of total billed charges ",308.19,90,,246.55,,,0,"percent of total billed charges ","90% of total billed charges ",318.46,93,,254.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",291.07,85,,232.86,,,0,"percent of total billed charges ","85% of total billed charges ",308.19,90,,246.55,,,0,"percent of total billed charges ","90% of total billed charges ",308.19,90,,246.55,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",297.91,87,,238.33,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",239.7,70,,191.76,,,0,"percent of total billed charges ","70% of total billed charges ",239.7,318.46,
"KIT GASTRIC LAVAGE QUICK STEP",6100325,"CDM ",270,RC,,,OUTPATIENT,,,205.23,164.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",164.18,80,,131.34,,,0,"percent of total billed charges ","80% of total billed charges ",143.66,70,,114.93,,,0,"percent of total billed charges ","70% of total billed charges ",184.71,90,,147.77,,,0,"percent of total billed charges ","90% of total billed charges ",190.86,93,,152.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",174.45,85,,139.56,,,0,"percent of total billed charges ","85% of total billed charges ",184.71,90,,147.77,,,0,"percent of total billed charges ","90% of total billed charges ",184.71,90,,147.77,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",178.55,87,,142.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",143.66,70,,114.93,,,0,"percent of total billed charges ","70% of total billed charges ",143.66,190.86,
"SUTURE 626H 4.0 NYLON",6100348,"CDM ",272,RC,,,OUTPATIENT,,,7.17,5.736,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.74,80,,4.59,,,0,"percent of total billed charges ","80% of total billed charges ",5.02,70,,4.02,,,0,"percent of total billed charges ","70% of total billed charges ",6.45,90,,5.16,,,0,"percent of total billed charges ","90% of total billed charges ",6.67,93,,5.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6.09,85,,4.87,,,0,"percent of total billed charges ","85% of total billed charges ",6.45,90,,5.16,,,0,"percent of total billed charges ","90% of total billed charges ",6.45,90,,5.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.24,87,,4.99,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.02,70,,4.02,,,0,"percent of total billed charges ","70% of total billed charges ",5.02,6.67,
"WIPE SKIN GEL OSTOMY",6100353,"CDM ",272,RC,,,OUTPATIENT,,,1.5,1.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.2,80,,0.96,,,0,"percent of total billed charges ","80% of total billed charges ",1.05,70,,0.84,,,0,"percent of total billed charges ","70% of total billed charges ",1.35,90,,1.08,,,0,"percent of total billed charges ","90% of total billed charges ",1.4,93,,1.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1.28,85,,1.02,,,0,"percent of total billed charges ","85% of total billed charges ",1.35,90,,1.08,,,0,"percent of total billed charges ","90% of total billed charges ",1.35,90,,1.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1.31,87,,1.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.05,70,,0.84,,,0,"percent of total billed charges ","70% of total billed charges ",1.05,1.4,
"HARMONIC SCALPEL 5MM HAND ACT",6100357,"CDM ",272,RC,,,OUTPATIENT,,,641.65,513.32,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",513.32,80,,410.66,,,0,"percent of total billed charges ","80% of total billed charges ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",596.73,93,,477.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",545.4,85,,436.32,,,0,"percent of total billed charges ","85% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",577.49,90,,461.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",558.24,87,,446.59,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",449.16,70,,359.33,,,0,"percent of total billed charges ","70% of total billed charges ",449.16,596.73,
"SUTURE R832H 3.0 MERSILENE",6100358,"CDM ",272,RC,,,OUTPATIENT,,,8.73,6.984,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.98,80,,5.58,,,0,"percent of total billed charges ","80% of total billed charges ",6.11,70,,4.89,,,0,"percent of total billed charges ","70% of total billed charges ",7.86,90,,6.29,,,0,"percent of total billed charges ","90% of total billed charges ",8.12,93,,6.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7.42,85,,5.94,,,0,"percent of total billed charges ","85% of total billed charges ",7.86,90,,6.29,,,0,"percent of total billed charges ","90% of total billed charges ",7.86,90,,6.29,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7.6,87,,6.08,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.11,70,,4.89,,,0,"percent of total billed charges ","70% of total billed charges ",6.11,8.12,
"MASKMETER IPPN",6100359,"CDM ",270,RC,,,OUTPATIENT,,,319.69,255.752,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",255.75,80,,204.60,,,0,"percent of total billed charges ","80% of total billed charges ",223.78,70,,179.02,,,0,"percent of total billed charges ","70% of total billed charges ",287.72,90,,230.18,,,0,"percent of total billed charges ","90% of total billed charges ",297.31,93,,237.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",271.74,85,,217.39,,,0,"percent of total billed charges ","85% of total billed charges ",287.72,90,,230.18,,,0,"percent of total billed charges ","90% of total billed charges ",287.72,90,,230.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",278.13,87,,222.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",223.78,70,,179.02,,,0,"percent of total billed charges ","70% of total billed charges ",223.78,297.31,
"SUTURE MB66G 5 ETHIBOND",6100361,"CDM ",272,RC,,,OUTPATIENT,,,52.81,42.248,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.25,80,,33.80,,,0,"percent of total billed charges ","80% of total billed charges ",36.97,70,,29.58,,,0,"percent of total billed charges ","70% of total billed charges ",47.53,90,,38.02,,,0,"percent of total billed charges ","90% of total billed charges ",49.11,93,,39.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",44.89,85,,35.91,,,0,"percent of total billed charges ","85% of total billed charges ",47.53,90,,38.02,,,0,"percent of total billed charges ","90% of total billed charges ",47.53,90,,38.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",45.94,87,,36.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.97,70,,29.58,,,0,"percent of total billed charges ","70% of total billed charges ",36.97,49.11,
"SUTURE CHROMIC 5.0 U202H",6100362,"CDM ",272,RC,,,OUTPATIENT,,,11.89,9.512,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.51,80,,7.61,,,0,"percent of total billed charges ","80% of total billed charges ",8.32,70,,6.66,,,0,"percent of total billed charges ","70% of total billed charges ",10.7,90,,8.56,,,0,"percent of total billed charges ","90% of total billed charges ",11.06,93,,8.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.11,85,,8.09,,,0,"percent of total billed charges ","85% of total billed charges ",10.7,90,,8.56,,,0,"percent of total billed charges ","90% of total billed charges ",10.7,90,,8.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.34,87,,8.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.32,70,,6.66,,,0,"percent of total billed charges ","70% of total billed charges ",8.32,11.06,
"SUTURE J405G VICRYL 8.0",6100369,"CDM ",272,RC,,,OUTPATIENT,,,55.87,44.696,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.7,80,,35.76,,,0,"percent of total billed charges ","80% of total billed charges ",39.11,70,,31.29,,,0,"percent of total billed charges ","70% of total billed charges ",50.28,90,,40.22,,,0,"percent of total billed charges ","90% of total billed charges ",51.96,93,,41.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",47.49,85,,37.99,,,0,"percent of total billed charges ","85% of total billed charges ",50.28,90,,40.22,,,0,"percent of total billed charges ","90% of total billed charges ",50.28,90,,40.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",48.61,87,,38.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.11,70,,31.29,,,0,"percent of total billed charges ","70% of total billed charges ",39.11,51.96,
"SUTURE V448G VICRYL 10.0",6100370,"CDM ",272,RC,,,OUTPATIENT,,,116.5,93.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.2,80,,74.56,,,0,"percent of total billed charges ","80% of total billed charges ",81.55,70,,65.24,,,0,"percent of total billed charges ","70% of total billed charges ",104.85,90,,83.88,,,0,"percent of total billed charges ","90% of total billed charges ",108.35,93,,86.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.03,85,,79.22,,,0,"percent of total billed charges ","85% of total billed charges ",104.85,90,,83.88,,,0,"percent of total billed charges ","90% of total billed charges ",104.85,90,,83.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.36,87,,81.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.55,70,,65.24,,,0,"percent of total billed charges ","70% of total billed charges ",81.55,108.35,
"REDUCER CAP UNIVERSAL",6100388,"CDM ",272,RC,,,OUTPATIENT,,,22.62,18.096,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.1,80,,14.48,,,0,"percent of total billed charges ","80% of total billed charges ",15.83,70,,12.66,,,0,"percent of total billed charges ","70% of total billed charges ",20.36,90,,16.29,,,0,"percent of total billed charges ","90% of total billed charges ",21.04,93,,16.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.23,85,,15.38,,,0,"percent of total billed charges ","85% of total billed charges ",20.36,90,,16.29,,,0,"percent of total billed charges ","90% of total billed charges ",20.36,90,,16.29,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.68,87,,15.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.83,70,,12.66,,,0,"percent of total billed charges ","70% of total billed charges ",15.83,21.04,
"DRAIN HEMOVAC 15 FR",6100408,"CDM ",272,RC,,,OUTPATIENT,,,38.11,30.488,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.49,80,,24.39,,,0,"percent of total billed charges ","80% of total billed charges ",26.68,70,,21.34,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,90,,27.44,,,0,"percent of total billed charges ","90% of total billed charges ",35.44,93,,28.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.39,85,,25.91,,,0,"percent of total billed charges ","85% of total billed charges ",34.3,90,,27.44,,,0,"percent of total billed charges ","90% of total billed charges ",34.3,90,,27.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.16,87,,26.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.68,70,,21.34,,,0,"percent of total billed charges ","70% of total billed charges ",26.68,35.44,
"IMPLANT BIOSTINGER 16MM",6100412,"CDM ",278,RC,,,OUTPATIENT,,,356.5,285.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",285.2,80,,228.16,,,0,"percent of total billed charges ","80% of total billed charges ",249.55,70,,199.64,,,0,"percent of total billed charges ","70% of total billed charges ",320.85,90,,256.68,,,0,"percent of total billed charges ","90% of total billed charges ",331.55,93,,265.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",303.03,85,,242.42,,,0,"percent of total billed charges ","85% of total billed charges ",303.03,85,,242.42,,,0,"percent of total billed charges ","85% of total billed charges ",320.85,90,,256.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",310.16,87,,248.13,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",249.55,70,,199.64,,,0,"percent of total billed charges ","70% of total billed charges ",249.55,331.55,
"KIT OATS DISP 6MM",6100413,"CDM ",270,RC,,,OUTPATIENT,,,1179.75,943.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",943.8,80,,755.04,,,0,"percent of total billed charges ","80% of total billed charges ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",1097.17,93,,877.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1002.79,85,,802.23,,,0,"percent of total billed charges ","85% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1026.38,87,,821.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",825.83,1097.17,
"KIT OATS DISP 8MM",6100414,"CDM ",270,RC,,,OUTPATIENT,,,1179.75,943.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",943.8,80,,755.04,,,0,"percent of total billed charges ","80% of total billed charges ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",1097.17,93,,877.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1002.79,85,,802.23,,,0,"percent of total billed charges ","85% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1026.38,87,,821.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",825.83,1097.17,
"KIT OATS DISP 10MM",6100415,"CDM ",270,RC,,,OUTPATIENT,,,1179.75,943.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",943.8,80,,755.04,,,0,"percent of total billed charges ","80% of total billed charges ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",1097.17,93,,877.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1002.79,85,,802.23,,,0,"percent of total billed charges ","85% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1026.38,87,,821.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",825.83,1097.17,
"SUTURE 3846T",6100422,"CDM ",272,RC,,,OUTPATIENT,,,38.21,30.568,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.57,80,,24.46,,,0,"percent of total billed charges ","80% of total billed charges ",26.75,70,,21.40,,,0,"percent of total billed charges ","70% of total billed charges ",34.39,90,,27.51,,,0,"percent of total billed charges ","90% of total billed charges ",35.54,93,,28.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.48,85,,25.98,,,0,"percent of total billed charges ","85% of total billed charges ",34.39,90,,27.51,,,0,"percent of total billed charges ","90% of total billed charges ",34.39,90,,27.51,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.24,87,,26.59,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.75,70,,21.40,,,0,"percent of total billed charges ","70% of total billed charges ",26.75,35.54,
"BURR 3.5MM ROUND FLUTED MED",6100427,"CDM ",272,RC,,,OUTPATIENT,,,292.45,233.96,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",233.96,80,,187.17,,,0,"percent of total billed charges ","80% of total billed charges ",204.72,70,,163.78,,,0,"percent of total billed charges ","70% of total billed charges ",263.21,90,,210.57,,,0,"percent of total billed charges ","90% of total billed charges ",271.98,93,,217.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",248.58,85,,198.86,,,0,"percent of total billed charges ","85% of total billed charges ",263.21,90,,210.57,,,0,"percent of total billed charges ","90% of total billed charges ",263.21,90,,210.57,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",254.43,87,,203.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",204.72,70,,163.78,,,0,"percent of total billed charges ","70% of total billed charges ",204.72,271.98,
"IMMOBILIZER KNEE LRG",6100434,"CDM ",271,RC,,,OUTPATIENT,,,73.5,58.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.8,80,,47.04,,,0,"percent of total billed charges ","80% of total billed charges ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",51.45,68.36,
"SPLINT WRIST-SM L",6100435,"CDM ",271,RC,,,OUTPATIENT,,,46.5,37.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.2,80,,29.76,,,0,"percent of total billed charges ","80% of total billed charges ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",43.25,93,,34.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.53,85,,31.62,,,0,"percent of total billed charges ","85% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.46,87,,32.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",32.55,43.25,
"BLADE SAW GIGLI",6100466,"CDM ",272,RC,,,OUTPATIENT,,,85.17,68.136,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.14,80,,54.51,,,0,"percent of total billed charges ","80% of total billed charges ",59.62,70,,47.70,,,0,"percent of total billed charges ","70% of total billed charges ",76.65,90,,61.32,,,0,"percent of total billed charges ","90% of total billed charges ",79.21,93,,63.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",72.39,85,,57.91,,,0,"percent of total billed charges ","85% of total billed charges ",76.65,90,,61.32,,,0,"percent of total billed charges ","90% of total billed charges ",76.65,90,,61.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",74.1,87,,59.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.62,70,,47.70,,,0,"percent of total billed charges ","70% of total billed charges ",59.62,79.21,
"FIBERTAK SLF-PUNCH TRIPLE LOAD",6100492,"CDM ",278,RC,,,OUTPATIENT,,,927.73,742.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",742.18,80,,593.74,,,0,"percent of total billed charges ","80% of total billed charges ",649.41,70,,519.53,,,0,"percent of total billed charges ","70% of total billed charges ",834.96,90,,667.97,,,0,"percent of total billed charges ","90% of total billed charges ",862.79,93,,690.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",788.57,85,,630.86,,,0,"percent of total billed charges ","85% of total billed charges ",788.57,85,,630.86,,,0,"percent of total billed charges ","85% of total billed charges ",834.96,90,,667.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",807.13,87,,645.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",649.41,70,,519.53,,,0,"percent of total billed charges ","70% of total billed charges ",649.41,862.79,
"SPLINT BURNAM LEFT",6100499,"CDM ",271,RC,,,OUTPATIENT,,,63.5,50.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.8,80,,40.64,,,0,"percent of total billed charges ","80% of total billed charges ",44.45,70,,35.56,,,0,"percent of total billed charges ","70% of total billed charges ",57.15,90,,45.72,,,0,"percent of total billed charges ","90% of total billed charges ",59.06,93,,47.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",53.98,85,,43.18,,,0,"percent of total billed charges ","85% of total billed charges ",57.15,90,,45.72,,,0,"percent of total billed charges ","90% of total billed charges ",57.15,90,,45.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",55.25,87,,44.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.45,70,,35.56,,,0,"percent of total billed charges ","70% of total billed charges ",44.45,59.06,
"SUTURE Z339H PDSII",6100517,"CDM ",272,RC,,,OUTPATIENT,,,12.59,10.072,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.07,80,,8.06,,,0,"percent of total billed charges ","80% of total billed charges ",8.81,70,,7.05,,,0,"percent of total billed charges ","70% of total billed charges ",11.33,90,,9.06,,,0,"percent of total billed charges ","90% of total billed charges ",11.71,93,,9.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.7,85,,8.56,,,0,"percent of total billed charges ","85% of total billed charges ",11.33,90,,9.06,,,0,"percent of total billed charges ","90% of total billed charges ",11.33,90,,9.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.95,87,,8.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.81,70,,7.05,,,0,"percent of total billed charges ","70% of total billed charges ",8.81,11.71,
"SUTUTE SILK 4.0 CO 14D",6100528,"CDM ",272,RC,,,OUTPATIENT,,,45.39,36.312,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.31,80,,29.05,,,0,"percent of total billed charges ","80% of total billed charges ",31.77,70,,25.42,,,0,"percent of total billed charges ","70% of total billed charges ",40.85,90,,32.68,,,0,"percent of total billed charges ","90% of total billed charges ",42.21,93,,33.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.58,85,,30.86,,,0,"percent of total billed charges ","85% of total billed charges ",40.85,90,,32.68,,,0,"percent of total billed charges ","90% of total billed charges ",40.85,90,,32.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.49,87,,31.59,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.77,70,,25.42,,,0,"percent of total billed charges ","70% of total billed charges ",31.77,42.21,
"DRAPE STERI 1017",6100529,"CDM ",272,RC,,,OUTPATIENT,,,47.87,38.296,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.3,80,,30.64,,,0,"percent of total billed charges ","80% of total billed charges ",33.51,70,,26.81,,,0,"percent of total billed charges ","70% of total billed charges ",43.08,90,,34.46,,,0,"percent of total billed charges ","90% of total billed charges ",44.52,93,,35.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.69,85,,32.55,,,0,"percent of total billed charges ","85% of total billed charges ",43.08,90,,34.46,,,0,"percent of total billed charges ","90% of total billed charges ",43.08,90,,34.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.65,87,,33.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.51,70,,26.81,,,0,"percent of total billed charges ","70% of total billed charges ",33.51,44.52,
"SUTURE ENDO LOOP PDSII",6100543,"CDM ",272,RC,,,OUTPATIENT,,,136.42,109.136,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.14,80,,87.31,,,0,"percent of total billed charges ","80% of total billed charges ",95.49,70,,76.39,,,0,"percent of total billed charges ","70% of total billed charges ",122.78,90,,98.22,,,0,"percent of total billed charges ","90% of total billed charges ",126.87,93,,101.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",115.96,85,,92.77,,,0,"percent of total billed charges ","85% of total billed charges ",122.78,90,,98.22,,,0,"percent of total billed charges ","90% of total billed charges ",122.78,90,,98.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",118.69,87,,94.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.49,70,,76.39,,,0,"percent of total billed charges ","70% of total billed charges ",95.49,126.87,
"SUTURE CHROMIC MILD 6.0 326-13",6100564,"CDM ",272,RC,,,OUTPATIENT,,,14.19,11.352,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.35,80,,9.08,,,0,"percent of total billed charges ","80% of total billed charges ",9.93,70,,7.94,,,0,"percent of total billed charges ","70% of total billed charges ",12.77,90,,10.22,,,0,"percent of total billed charges ","90% of total billed charges ",13.2,93,,10.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.06,85,,9.65,,,0,"percent of total billed charges ","85% of total billed charges ",12.77,90,,10.22,,,0,"percent of total billed charges ","90% of total billed charges ",12.77,90,,10.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.35,87,,9.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.93,70,,7.94,,,0,"percent of total billed charges ","70% of total billed charges ",9.93,13.2,
"SUTURE ETH 5.0 PC3 1865G",6100584,"CDM ",272,RC,,,OUTPATIENT,,,23,18.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.4,80,,14.72,,,0,"percent of total billed charges ","80% of total billed charges ",16.1,70,,12.88,,,0,"percent of total billed charges ","70% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",21.39,93,,17.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.55,85,,15.64,,,0,"percent of total billed charges ","85% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.01,87,,16.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.1,70,,12.88,,,0,"percent of total billed charges ","70% of total billed charges ",16.1,21.39,
"SUTURE IPDSII Z371T",6100598,"CDM ",272,RC,,,OUTPATIENT,,,10.48,8.384,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.38,80,,6.70,,,0,"percent of total billed charges ","80% of total billed charges ",7.34,70,,5.87,,,0,"percent of total billed charges ","70% of total billed charges ",9.43,90,,7.54,,,0,"percent of total billed charges ","90% of total billed charges ",9.75,93,,7.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.91,85,,7.13,,,0,"percent of total billed charges ","85% of total billed charges ",9.43,90,,7.54,,,0,"percent of total billed charges ","90% of total billed charges ",9.43,90,,7.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.12,87,,7.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.34,70,,5.87,,,0,"percent of total billed charges ","70% of total billed charges ",7.34,9.75,
"PACK ARTHROSCOPY",6100608,"CDM ",272,RC,,,OUTPATIENT,,,106.72,85.376,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.38,80,,68.30,,,0,"percent of total billed charges ","80% of total billed charges ",74.7,70,,59.76,,,0,"percent of total billed charges ","70% of total billed charges ",96.05,90,,76.84,,,0,"percent of total billed charges ","90% of total billed charges ",99.25,93,,79.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",90.71,85,,72.57,,,0,"percent of total billed charges ","85% of total billed charges ",96.05,90,,76.84,,,0,"percent of total billed charges ","90% of total billed charges ",96.05,90,,76.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",92.85,87,,74.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.7,70,,59.76,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,99.25,
"SUTURE 8697G PROLENE 6.0",6100617,"CDM ",272,RC,,,OUTPATIENT,,,20.51,16.408,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.41,80,,13.13,,,0,"percent of total billed charges ","80% of total billed charges ",14.36,70,,11.49,,,0,"percent of total billed charges ","70% of total billed charges ",18.46,90,,14.77,,,0,"percent of total billed charges ","90% of total billed charges ",19.07,93,,15.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.43,85,,13.94,,,0,"percent of total billed charges ","85% of total billed charges ",18.46,90,,14.77,,,0,"percent of total billed charges ","90% of total billed charges ",18.46,90,,14.77,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.84,87,,14.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.36,70,,11.49,,,0,"percent of total billed charges ","70% of total billed charges ",14.36,19.07,
"TUBE FEEDING 8FR CORPAC",6100636,"CDM ",272,RC,,,OUTPATIENT,,,700.38,560.304,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",560.3,80,,448.24,,,0,"percent of total billed charges ","80% of total billed charges ",490.27,70,,392.22,,,0,"percent of total billed charges ","70% of total billed charges ",630.34,90,,504.27,,,0,"percent of total billed charges ","90% of total billed charges ",651.35,93,,521.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",595.32,85,,476.26,,,0,"percent of total billed charges ","85% of total billed charges ",630.34,90,,504.27,,,0,"percent of total billed charges ","90% of total billed charges ",630.34,90,,504.27,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",609.33,87,,487.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",490.27,70,,392.22,,,0,"percent of total billed charges ","70% of total billed charges ",490.27,651.35,
"ELECTRODE LAPROSCOPIC L-HOOK",6100659,"CDM ",270,RC,,,OUTPATIENT,,,215.23,172.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.18,80,,137.74,,,0,"percent of total billed charges ","80% of total billed charges ",150.66,70,,120.53,,,0,"percent of total billed charges ","70% of total billed charges ",193.71,90,,154.97,,,0,"percent of total billed charges ","90% of total billed charges ",200.16,93,,160.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",182.95,85,,146.36,,,0,"percent of total billed charges ","85% of total billed charges ",193.71,90,,154.97,,,0,"percent of total billed charges ","90% of total billed charges ",193.71,90,,154.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",187.25,87,,149.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",150.66,70,,120.53,,,0,"percent of total billed charges ","70% of total billed charges ",150.66,200.16,
"KIT SPINEJACK 5.8MM",6100660,"CDM ",278,RC,,,OUTPATIENT,,,7143.71,5714.968,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5714.97,80,,4571.98,,,0,"percent of total billed charges ","80% of total billed charges ",5000.6,70,,4000.48,,,0,"percent of total billed charges ","70% of total billed charges ",6429.34,90,,5143.47,,,0,"percent of total billed charges ","90% of total billed charges ",6643.65,93,,5314.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6072.15,85,,4857.72,,,0,"percent of total billed charges ","85% of total billed charges ",6072.15,85,,4857.72,,,0,"percent of total billed charges ","85% of total billed charges ",6429.34,90,,5143.47,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6215.03,87,,4972.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5000.6,70,,4000.48,,,0,"percent of total billed charges ","70% of total billed charges ",5000.6,6643.65,
"SHOE POST OP MEN MEDIUM",6100669,"CDM ",271,RC,,,OUTPATIENT,,,50,40,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40,80,,32.00,,,0,"percent of total billed charges ","80% of total billed charges ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",46.5,93,,37.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.5,85,,34.00,,,0,"percent of total billed charges ","85% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.5,87,,34.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",35,46.5,
"SHOE POST OP MEN SMALL",6100670,"CDM ",271,RC,,,OUTPATIENT,,,52,41.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.6,80,,33.28,,,0,"percent of total billed charges ","80% of total billed charges ",36.4,70,,29.12,,,0,"percent of total billed charges ","70% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",48.36,93,,38.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",44.2,85,,35.36,,,0,"percent of total billed charges ","85% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",45.24,87,,36.19,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.4,70,,29.12,,,0,"percent of total billed charges ","70% of total billed charges ",36.4,48.36,
"SHOE POST OP WOMEN MEDIUM",6100672,"CDM ",271,RC,,,OUTPATIENT,,,50,40,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40,80,,32.00,,,0,"percent of total billed charges ","80% of total billed charges ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",46.5,93,,37.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.5,85,,34.00,,,0,"percent of total billed charges ","85% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.5,87,,34.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",35,46.5,
"SHOE POST OP WOMENS LARGE",6100673,"CDM ",271,RC,,,OUTPATIENT,,,50,40,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40,80,,32.00,,,0,"percent of total billed charges ","80% of total billed charges ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",46.5,93,,37.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.5,85,,34.00,,,0,"percent of total billed charges ","85% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.5,87,,34.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",35,46.5,
"ELECTRODE VAPORIZATION FLUTED",6100681,"CDM ",272,RC,,,OUTPATIENT,,,301.7,241.36,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.36,80,,193.09,,,0,"percent of total billed charges ","80% of total billed charges ",211.19,70,,168.95,,,0,"percent of total billed charges ","70% of total billed charges ",271.53,90,,217.22,,,0,"percent of total billed charges ","90% of total billed charges ",280.58,93,,224.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",256.45,85,,205.16,,,0,"percent of total billed charges ","85% of total billed charges ",271.53,90,,217.22,,,0,"percent of total billed charges ","90% of total billed charges ",271.53,90,,217.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",262.48,87,,209.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",211.19,70,,168.95,,,0,"percent of total billed charges ","70% of total billed charges ",211.19,280.58,
"STAPLER SKIN PRECISE VISTA 35W",6100762,"CDM ",270,RC,,,OUTPATIENT,,,48.49,38.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.79,80,,31.03,,,0,"percent of total billed charges ","80% of total billed charges ",33.94,70,,27.15,,,0,"percent of total billed charges ","70% of total billed charges ",43.64,90,,34.91,,,0,"percent of total billed charges ","90% of total billed charges ",45.1,93,,36.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.22,85,,32.98,,,0,"percent of total billed charges ","85% of total billed charges ",43.64,90,,34.91,,,0,"percent of total billed charges ","90% of total billed charges ",43.64,90,,34.91,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.19,87,,33.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.94,70,,27.15,,,0,"percent of total billed charges ","70% of total billed charges ",33.94,45.1,
"NEEDLE MAYO HALF CIRCLE TAPER",6100767,"CDM ",272,RC,,,OUTPATIENT,,,24.62,19.696,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.7,80,,15.76,,,0,"percent of total billed charges ","80% of total billed charges ",17.23,70,,13.78,,,0,"percent of total billed charges ","70% of total billed charges ",22.16,90,,17.73,,,0,"percent of total billed charges ","90% of total billed charges ",22.9,93,,18.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.93,85,,16.74,,,0,"percent of total billed charges ","85% of total billed charges ",22.16,90,,17.73,,,0,"percent of total billed charges ","90% of total billed charges ",22.16,90,,17.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.42,87,,17.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.23,70,,13.78,,,0,"percent of total billed charges ","70% of total billed charges ",17.23,22.9,
"IMMOBILIZER KNEE UNIVERSAL",6100773,"CDM ",271,RC,,,OUTPATIENT,,,98.5,78.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.8,80,,63.04,,,0,"percent of total billed charges ","80% of total billed charges ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",68.95,91.61,
"SPLINT WRIST LRG RIGHT",6100775,"CDM ",271,RC,,,OUTPATIENT,,,46.5,37.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.2,80,,29.76,,,0,"percent of total billed charges ","80% of total billed charges ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",43.25,93,,34.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.53,85,,31.62,,,0,"percent of total billed charges ","85% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.46,87,,32.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",32.55,43.25,
"TUBE TRACH 10M W/CANNULOR",6100795,"CDM ",272,RC,,,OUTPATIENT,,,175,140,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140,80,,112.00,,,0,"percent of total billed charges ","80% of total billed charges ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",162.75,93,,130.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",148.75,85,,119.00,,,0,"percent of total billed charges ","85% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",157.5,90,,126.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",152.25,87,,121.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.5,70,,98.00,,,0,"percent of total billed charges ","70% of total billed charges ",122.5,162.75,
"SUCTION SIGMOID DISP",6100797,"CDM ",272,RC,,,OUTPATIENT,,,25,20,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20,80,,16.00,,,0,"percent of total billed charges ","80% of total billed charges ",17.5,70,,14.00,,,0,"percent of total billed charges ","70% of total billed charges ",22.5,90,,18.00,,,0,"percent of total billed charges ","90% of total billed charges ",23.25,93,,18.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.25,85,,17.00,,,0,"percent of total billed charges ","85% of total billed charges ",22.5,90,,18.00,,,0,"percent of total billed charges ","90% of total billed charges ",22.5,90,,18.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.75,87,,17.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.5,70,,14.00,,,0,"percent of total billed charges ","70% of total billed charges ",17.5,23.25,
"SPONGE MICRO SPEAR",6100823,"CDM ",272,RC,,,OUTPATIENT,,,12.19,9.752,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.75,80,,7.80,,,0,"percent of total billed charges ","80% of total billed charges ",8.53,70,,6.82,,,0,"percent of total billed charges ","70% of total billed charges ",10.97,90,,8.78,,,0,"percent of total billed charges ","90% of total billed charges ",11.34,93,,9.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.36,85,,8.29,,,0,"percent of total billed charges ","85% of total billed charges ",10.97,90,,8.78,,,0,"percent of total billed charges ","90% of total billed charges ",10.97,90,,8.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.61,87,,8.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.53,70,,6.82,,,0,"percent of total billed charges ","70% of total billed charges ",8.53,11.34,
"SUTURE 8558H PROLENE 3.0",6100834,"CDM ",272,RC,,,OUTPATIENT,,,21.56,17.248,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.25,80,,13.80,,,0,"percent of total billed charges ","80% of total billed charges ",15.09,70,,12.07,,,0,"percent of total billed charges ","70% of total billed charges ",19.4,90,,15.52,,,0,"percent of total billed charges ","90% of total billed charges ",20.05,93,,16.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.33,85,,14.66,,,0,"percent of total billed charges ","85% of total billed charges ",19.4,90,,15.52,,,0,"percent of total billed charges ","90% of total billed charges ",19.4,90,,15.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.76,87,,15.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.09,70,,12.07,,,0,"percent of total billed charges ","70% of total billed charges ",15.09,20.05,
"PLATE COMPRS'N 3.5 7H 85M",6100856,"CDM ",278,RC,,,OUTPATIENT,,,568.01,454.408,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",454.41,80,,363.53,,,0,"percent of total billed charges ","80% of total billed charges ",397.61,70,,318.09,,,0,"percent of total billed charges ","70% of total billed charges ",511.21,90,,408.97,,,0,"percent of total billed charges ","90% of total billed charges ",528.25,93,,422.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",482.81,85,,386.25,,,0,"percent of total billed charges ","85% of total billed charges ",482.81,85,,386.25,,,0,"percent of total billed charges ","85% of total billed charges ",511.21,90,,408.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",494.17,87,,395.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",397.61,70,,318.09,,,0,"percent of total billed charges ","70% of total billed charges ",397.61,528.25,
"SHEET IMPERVIOUS SPLIT",6100861,"CDM ",272,RC,,,OUTPATIENT,,,18.71,14.968,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.97,80,,11.98,,,0,"percent of total billed charges ","80% of total billed charges ",13.1,70,,10.48,,,0,"percent of total billed charges ","70% of total billed charges ",16.84,90,,13.47,,,0,"percent of total billed charges ","90% of total billed charges ",17.4,93,,13.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.9,85,,12.72,,,0,"percent of total billed charges ","85% of total billed charges ",16.84,90,,13.47,,,0,"percent of total billed charges ","90% of total billed charges ",16.84,90,,13.47,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.28,87,,13.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.1,70,,10.48,,,0,"percent of total billed charges ","70% of total billed charges ",13.1,17.4,
"STAPLE RELOAD EZ35W",6100870,"CDM ",272,RC,,,OUTPATIENT,,,452.4,361.92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",361.92,80,,289.54,,,0,"percent of total billed charges ","80% of total billed charges ",316.68,70,,253.34,,,0,"percent of total billed charges ","70% of total billed charges ",407.16,90,,325.73,,,0,"percent of total billed charges ","90% of total billed charges ",420.73,93,,336.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",384.54,85,,307.63,,,0,"percent of total billed charges ","85% of total billed charges ",407.16,90,,325.73,,,0,"percent of total billed charges ","90% of total billed charges ",407.16,90,,325.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",393.59,87,,314.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",316.68,70,,253.34,,,0,"percent of total billed charges ","70% of total billed charges ",316.68,420.73,
"TRAY THORANCENTESES DISP",6100886,"CDM ",272,RC,,,OUTPATIENT,,,151,120.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.8,80,,96.64,,,0,"percent of total billed charges ","80% of total billed charges ",105.7,70,,84.56,,,0,"percent of total billed charges ","70% of total billed charges ",135.9,90,,108.72,,,0,"percent of total billed charges ","90% of total billed charges ",140.43,93,,112.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",128.35,85,,102.68,,,0,"percent of total billed charges ","85% of total billed charges ",135.9,90,,108.72,,,0,"percent of total billed charges ","90% of total billed charges ",135.9,90,,108.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",131.37,87,,105.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",105.7,70,,84.56,,,0,"percent of total billed charges ","70% of total billed charges ",105.7,140.43,
"ELECTRODE VAPORIZATION",6100892,"CDM ",272,RC,,,OUTPATIENT,,,290.93,232.744,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",232.74,80,,186.19,,,0,"percent of total billed charges ","80% of total billed charges ",203.65,70,,162.92,,,0,"percent of total billed charges ","70% of total billed charges ",261.84,90,,209.47,,,0,"percent of total billed charges ","90% of total billed charges ",270.56,93,,216.45,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",247.29,85,,197.83,,,0,"percent of total billed charges ","85% of total billed charges ",261.84,90,,209.47,,,0,"percent of total billed charges ","90% of total billed charges ",261.84,90,,209.47,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",253.11,87,,202.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",203.65,70,,162.92,,,0,"percent of total billed charges ","70% of total billed charges ",203.65,270.56,
"COVER WARMING",6100893,"CDM ",271,RC,,,OUTPATIENT,,,72,57.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.6,80,,46.08,,,0,"percent of total billed charges ","80% of total billed charges ",50.4,70,,40.32,,,0,"percent of total billed charges ","70% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",66.96,93,,53.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",61.2,85,,48.96,,,0,"percent of total billed charges ","85% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",62.64,87,,50.11,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.4,70,,40.32,,,0,"percent of total billed charges ","70% of total billed charges ",50.4,66.96,
"SUTURE Z338H 3.0 PPS",6100900,"CDM ",272,RC,,,OUTPATIENT,,,10.93,8.744,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.74,80,,6.99,,,0,"percent of total billed charges ","80% of total billed charges ",7.65,70,,6.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.84,90,,7.87,,,0,"percent of total billed charges ","90% of total billed charges ",10.16,93,,8.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.29,85,,7.43,,,0,"percent of total billed charges ","85% of total billed charges ",9.84,90,,7.87,,,0,"percent of total billed charges ","90% of total billed charges ",9.84,90,,7.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.51,87,,7.61,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.65,70,,6.12,,,0,"percent of total billed charges ","70% of total billed charges ",7.65,10.16,
"IMMOBILIZER SHOULDER PEDI",6100914,"CDM ",271,RC,,,OUTPATIENT,,,51.5,41.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.2,80,,32.96,,,0,"percent of total billed charges ","80% of total billed charges ",36.05,70,,28.84,,,0,"percent of total billed charges ","70% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",47.9,93,,38.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.78,85,,35.02,,,0,"percent of total billed charges ","85% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.81,87,,35.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.05,70,,28.84,,,0,"percent of total billed charges ","70% of total billed charges ",36.05,47.9,
"IMMOBILIZER SHOULDER UNIVERSAL",6100915,"CDM ",271,RC,,,OUTPATIENT,,,86,68.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.8,80,,55.04,,,0,"percent of total billed charges ","80% of total billed charges ",60.2,70,,48.16,,,0,"percent of total billed charges ","70% of total billed charges ",77.4,90,,61.92,,,0,"percent of total billed charges ","90% of total billed charges ",79.98,93,,63.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",73.1,85,,58.48,,,0,"percent of total billed charges ","85% of total billed charges ",77.4,90,,61.92,,,0,"percent of total billed charges ","90% of total billed charges ",77.4,90,,61.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",74.82,87,,59.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.2,70,,48.16,,,0,"percent of total billed charges ","70% of total billed charges ",60.2,79.98,
"TUBE GASTRIC 34FR",6100919,"CDM ",272,RC,,,OUTPATIENT,,,49.25,39.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.4,80,,31.52,,,0,"percent of total billed charges ","80% of total billed charges ",34.48,70,,27.58,,,0,"percent of total billed charges ","70% of total billed charges ",44.33,90,,35.46,,,0,"percent of total billed charges ","90% of total billed charges ",45.8,93,,36.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.86,85,,33.49,,,0,"percent of total billed charges ","85% of total billed charges ",44.33,90,,35.46,,,0,"percent of total billed charges ","90% of total billed charges ",44.33,90,,35.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.85,87,,34.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.48,70,,27.58,,,0,"percent of total billed charges ","70% of total billed charges ",34.48,45.8,
"PACK LAP CUSTOM",6100929,"CDM ",272,RC,,,OUTPATIENT,,,170.73,136.584,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136.58,80,,109.26,,,0,"percent of total billed charges ","80% of total billed charges ",119.51,70,,95.61,,,0,"percent of total billed charges ","70% of total billed charges ",153.66,90,,122.93,,,0,"percent of total billed charges ","90% of total billed charges ",158.78,93,,127.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",145.12,85,,116.10,,,0,"percent of total billed charges ","85% of total billed charges ",153.66,90,,122.93,,,0,"percent of total billed charges ","90% of total billed charges ",153.66,90,,122.93,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",148.54,87,,118.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.51,70,,95.61,,,0,"percent of total billed charges ","70% of total billed charges ",119.51,158.78,
"BIOPSY NEEDLE TRUE CUT 14GX4.5",6100933,"CDM ",272,RC,,,OUTPATIENT,,,183,146.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",146.4,80,,117.12,,,0,"percent of total billed charges ","80% of total billed charges ",128.1,70,,102.48,,,0,"percent of total billed charges ","70% of total billed charges ",164.7,90,,131.76,,,0,"percent of total billed charges ","90% of total billed charges ",170.19,93,,136.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",155.55,85,,124.44,,,0,"percent of total billed charges ","85% of total billed charges ",164.7,90,,131.76,,,0,"percent of total billed charges ","90% of total billed charges ",164.7,90,,131.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",159.21,87,,127.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.1,70,,102.48,,,0,"percent of total billed charges ","70% of total billed charges ",128.1,170.19,
"PACK BASIC SET-UP III",6100972,"CDM ",272,RC,,,OUTPATIENT,,,51.16,40.928,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.93,80,,32.74,,,0,"percent of total billed charges ","80% of total billed charges ",35.81,70,,28.65,,,0,"percent of total billed charges ","70% of total billed charges ",46.04,90,,36.83,,,0,"percent of total billed charges ","90% of total billed charges ",47.58,93,,38.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.49,85,,34.79,,,0,"percent of total billed charges ","85% of total billed charges ",46.04,90,,36.83,,,0,"percent of total billed charges ","90% of total billed charges ",46.04,90,,36.83,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.51,87,,35.61,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.81,70,,28.65,,,0,"percent of total billed charges ","70% of total billed charges ",35.81,47.58,
"PACK LAP III",6100973,"CDM ",272,RC,,,OUTPATIENT,,,29.44,23.552,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.55,80,,18.84,,,0,"percent of total billed charges ","80% of total billed charges ",20.61,70,,16.49,,,0,"percent of total billed charges ","70% of total billed charges ",26.5,90,,21.20,,,0,"percent of total billed charges ","90% of total billed charges ",27.38,93,,21.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.02,85,,20.02,,,0,"percent of total billed charges ","85% of total billed charges ",26.5,90,,21.20,,,0,"percent of total billed charges ","90% of total billed charges ",26.5,90,,21.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",25.61,87,,20.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.61,70,,16.49,,,0,"percent of total billed charges ","70% of total billed charges ",20.61,27.38,
"PIN STEINMAN 1/8"" X 9""",6101017,"CDM ",278,RC,,,OUTPATIENT,,,40.37,32.296,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.3,80,,25.84,,,0,"percent of total billed charges ","80% of total billed charges ",28.26,70,,22.61,,,0,"percent of total billed charges ","70% of total billed charges ",36.33,90,,29.06,,,0,"percent of total billed charges ","90% of total billed charges ",37.54,93,,30.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34.31,85,,27.45,,,0,"percent of total billed charges ","85% of total billed charges ",34.31,85,,27.45,,,0,"percent of total billed charges ","85% of total billed charges ",36.33,90,,29.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",35.12,87,,28.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.26,70,,22.61,,,0,"percent of total billed charges ","70% of total billed charges ",28.26,37.54,
"SUPPORTER ALTHELIC MED",6101045,"CDM ",271,RC,,,OUTPATIENT,,,24.97,19.976,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.98,80,,15.98,,,0,"percent of total billed charges ","80% of total billed charges ",17.48,70,,13.98,,,0,"percent of total billed charges ","70% of total billed charges ",22.47,90,,17.98,,,0,"percent of total billed charges ","90% of total billed charges ",23.22,93,,18.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.22,85,,16.98,,,0,"percent of total billed charges ","85% of total billed charges ",22.47,90,,17.98,,,0,"percent of total billed charges ","90% of total billed charges ",22.47,90,,17.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.72,87,,17.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.48,70,,13.98,,,0,"percent of total billed charges ","70% of total billed charges ",17.48,23.22,
"SUPPORTER ATHLETIC LARGE",6101047,"CDM ",271,RC,,,OUTPATIENT,,,25.08,20.064,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.06,80,,16.05,,,0,"percent of total billed charges ","80% of total billed charges ",17.56,70,,14.05,,,0,"percent of total billed charges ","70% of total billed charges ",22.57,90,,18.06,,,0,"percent of total billed charges ","90% of total billed charges ",23.32,93,,18.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.32,85,,17.06,,,0,"percent of total billed charges ","85% of total billed charges ",22.57,90,,18.06,,,0,"percent of total billed charges ","90% of total billed charges ",22.57,90,,18.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.82,87,,17.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.56,70,,14.05,,,0,"percent of total billed charges ","70% of total billed charges ",17.56,23.32,
"INFUSOR PRESSURE DISP",6101127,"CDM ",272,RC,,,OUTPATIENT,,,85,68,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68,80,,54.40,,,0,"percent of total billed charges ","80% of total billed charges ",59.5,70,,47.60,,,0,"percent of total billed charges ","70% of total billed charges ",76.5,90,,61.20,,,0,"percent of total billed charges ","90% of total billed charges ",79.05,93,,63.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",72.25,85,,57.80,,,0,"percent of total billed charges ","85% of total billed charges ",76.5,90,,61.20,,,0,"percent of total billed charges ","90% of total billed charges ",76.5,90,,61.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",73.95,87,,59.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.5,70,,47.60,,,0,"percent of total billed charges ","70% of total billed charges ",59.5,79.05,
"SUTURE CHROMIC 3.0 892H",6101168,"CDM ",272,RC,,,OUTPATIENT,,,10.5,8.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,80,,6.72,,,0,"percent of total billed charges ","80% of total billed charges ",7.35,70,,5.88,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,90,,7.56,,,0,"percent of total billed charges ","90% of total billed charges ",9.77,93,,7.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.93,85,,7.14,,,0,"percent of total billed charges ","85% of total billed charges ",9.45,90,,7.56,,,0,"percent of total billed charges ","90% of total billed charges ",9.45,90,,7.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.14,87,,7.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.35,70,,5.88,,,0,"percent of total billed charges ","70% of total billed charges ",7.35,9.77,
"TRAY UMBILICAL CATH 3.5FR",6101189,"CDM ",272,RC,,,OUTPATIENT,,,213.5,170.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.8,80,,136.64,,,0,"percent of total billed charges ","80% of total billed charges ",149.45,70,,119.56,,,0,"percent of total billed charges ","70% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",198.56,93,,158.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",181.48,85,,145.18,,,0,"percent of total billed charges ","85% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",192.15,90,,153.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",185.75,87,,148.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.45,70,,119.56,,,0,"percent of total billed charges ","70% of total billed charges ",149.45,198.56,
"SUTURE 667H 6.0 NYLON",6101211,"CDM ",272,RC,,,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,80,,8.00,,,0,"percent of total billed charges ","80% of total billed charges ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"SUTURE PDS II O Z334H",6101212,"CDM ",272,RC,,,OUTPATIENT,,,40.32,32.256,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.26,80,,25.81,,,0,"percent of total billed charges ","80% of total billed charges ",28.22,70,,22.58,,,0,"percent of total billed charges ","70% of total billed charges ",36.29,90,,29.03,,,0,"percent of total billed charges ","90% of total billed charges ",37.5,93,,30.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34.27,85,,27.42,,,0,"percent of total billed charges ","85% of total billed charges ",36.29,90,,29.03,,,0,"percent of total billed charges ","90% of total billed charges ",36.29,90,,29.03,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",35.08,87,,28.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.22,70,,22.58,,,0,"percent of total billed charges ","70% of total billed charges ",28.22,37.5,
"SUTURE Z315H 4.0 PDSII",6101213,"CDM ",272,RC,,,OUTPATIENT,,,11.03,8.824,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.82,80,,7.06,,,0,"percent of total billed charges ","80% of total billed charges ",7.72,70,,6.18,,,0,"percent of total billed charges ","70% of total billed charges ",9.93,90,,7.94,,,0,"percent of total billed charges ","90% of total billed charges ",10.26,93,,8.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.38,85,,7.50,,,0,"percent of total billed charges ","85% of total billed charges ",9.93,90,,7.94,,,0,"percent of total billed charges ","90% of total billed charges ",9.93,90,,7.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.6,87,,7.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.72,70,,6.18,,,0,"percent of total billed charges ","70% of total billed charges ",7.72,10.26,
"REAMER BLADE PATELLA 35M",6101218,"CDM ",272,RC,,,OUTPATIENT,,,581.85,465.48,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",465.48,80,,372.38,,,0,"percent of total billed charges ","80% of total billed charges ",407.3,70,,325.84,,,0,"percent of total billed charges ","70% of total billed charges ",523.67,90,,418.94,,,0,"percent of total billed charges ","90% of total billed charges ",541.12,93,,432.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",494.57,85,,395.66,,,0,"percent of total billed charges ","85% of total billed charges ",523.67,90,,418.94,,,0,"percent of total billed charges ","90% of total billed charges ",523.67,90,,418.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",506.21,87,,404.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",407.3,70,,325.84,,,0,"percent of total billed charges ","70% of total billed charges ",407.3,541.12,
"SUTURE OPDSII Z371T",6101232,"CDM ",272,RC,,,OUTPATIENT,,,11.53,9.224,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.22,80,,7.38,,,0,"percent of total billed charges ","80% of total billed charges ",8.07,70,,6.46,,,0,"percent of total billed charges ","70% of total billed charges ",10.38,90,,8.30,,,0,"percent of total billed charges ","90% of total billed charges ",10.72,93,,8.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.8,85,,7.84,,,0,"percent of total billed charges ","85% of total billed charges ",10.38,90,,8.30,,,0,"percent of total billed charges ","90% of total billed charges ",10.38,90,,8.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.03,87,,8.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.07,70,,6.46,,,0,"percent of total billed charges ","70% of total billed charges ",8.07,10.72,
"KIT NAVITRACKER KNEE",6101314,"CDM ",270,RC,,,OUTPATIENT,,,905.1,724.08,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",724.08,80,,579.26,,,0,"percent of total billed charges ","80% of total billed charges ",633.57,70,,506.86,,,0,"percent of total billed charges ","70% of total billed charges ",814.59,90,,651.67,,,0,"percent of total billed charges ","90% of total billed charges ",841.74,93,,673.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",769.34,85,,615.47,,,0,"percent of total billed charges ","85% of total billed charges ",814.59,90,,651.67,,,0,"percent of total billed charges ","90% of total billed charges ",814.59,90,,651.67,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",787.44,87,,629.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",633.57,70,,506.86,,,0,"percent of total billed charges ","70% of total billed charges ",633.57,841.74,
"TAP 6.5MM",6101319,"CDM ",272,RC,,,OUTPATIENT,,,225.14,180.112,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.11,80,,144.09,,,0,"percent of total billed charges ","80% of total billed charges ",157.6,70,,126.08,,,0,"percent of total billed charges ","70% of total billed charges ",202.63,90,,162.10,,,0,"percent of total billed charges ","90% of total billed charges ",209.38,93,,167.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",191.37,85,,153.10,,,0,"percent of total billed charges ","85% of total billed charges ",202.63,90,,162.10,,,0,"percent of total billed charges ","90% of total billed charges ",202.63,90,,162.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",195.87,87,,156.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.6,70,,126.08,,,0,"percent of total billed charges ","70% of total billed charges ",157.6,209.38,
"CANNULA SHOULDER 7 CM",6101333,"CDM ",272,RC,,,OUTPATIENT,,,47.83,38.264,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.26,80,,30.61,,,0,"percent of total billed charges ","80% of total billed charges ",33.48,70,,26.78,,,0,"percent of total billed charges ","70% of total billed charges ",43.05,90,,34.44,,,0,"percent of total billed charges ","90% of total billed charges ",44.48,93,,35.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.66,85,,32.53,,,0,"percent of total billed charges ","85% of total billed charges ",43.05,90,,34.44,,,0,"percent of total billed charges ","90% of total billed charges ",43.05,90,,34.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.61,87,,33.29,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.48,70,,26.78,,,0,"percent of total billed charges ","70% of total billed charges ",33.48,44.48,
"TUBE EAR 0.76 MINI",6101336,"CDM ",272,RC,,,OUTPATIENT,,,136.73,109.384,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.38,80,,87.50,,,0,"percent of total billed charges ","80% of total billed charges ",95.71,70,,76.57,,,0,"percent of total billed charges ","70% of total billed charges ",123.06,90,,98.45,,,0,"percent of total billed charges ","90% of total billed charges ",127.16,93,,101.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",116.22,85,,92.98,,,0,"percent of total billed charges ","85% of total billed charges ",123.06,90,,98.45,,,0,"percent of total billed charges ","90% of total billed charges ",123.06,90,,98.45,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",118.96,87,,95.17,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.71,70,,76.57,,,0,"percent of total billed charges ","70% of total billed charges ",95.71,127.16,
"TUBE EAR 1.14 MM",6101338,"CDM ",272,RC,,,OUTPATIENT,,,140.82,112.656,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.66,80,,90.13,,,0,"percent of total billed charges ","80% of total billed charges ",98.57,70,,78.86,,,0,"percent of total billed charges ","70% of total billed charges ",126.74,90,,101.39,,,0,"percent of total billed charges ","90% of total billed charges ",130.96,93,,104.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",119.7,85,,95.76,,,0,"percent of total billed charges ","85% of total billed charges ",126.74,90,,101.39,,,0,"percent of total billed charges ","90% of total billed charges ",126.74,90,,101.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",122.51,87,,98.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.57,70,,78.86,,,0,"percent of total billed charges ","70% of total billed charges ",98.57,130.96,
"TUBE EAR 1.27 MM",6101341,"CDM ",272,RC,,,OUTPATIENT,,,140.82,112.656,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.66,80,,90.13,,,0,"percent of total billed charges ","80% of total billed charges ",98.57,70,,78.86,,,0,"percent of total billed charges ","70% of total billed charges ",126.74,90,,101.39,,,0,"percent of total billed charges ","90% of total billed charges ",130.96,93,,104.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",119.7,85,,95.76,,,0,"percent of total billed charges ","85% of total billed charges ",126.74,90,,101.39,,,0,"percent of total billed charges ","90% of total billed charges ",126.74,90,,101.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",122.51,87,,98.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.57,70,,78.86,,,0,"percent of total billed charges ","70% of total billed charges ",98.57,130.96,
"TAP CANNULATED BONE",6101342,"CDM ",272,RC,,,OUTPATIENT,,,416.76,333.408,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",333.41,80,,266.73,,,0,"percent of total billed charges ","80% of total billed charges ",291.73,70,,233.38,,,0,"percent of total billed charges ","70% of total billed charges ",375.08,90,,300.06,,,0,"percent of total billed charges ","90% of total billed charges ",387.59,93,,310.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",354.25,85,,283.40,,,0,"percent of total billed charges ","85% of total billed charges ",375.08,90,,300.06,,,0,"percent of total billed charges ","90% of total billed charges ",375.08,90,,300.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",362.58,87,,290.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",291.73,70,,233.38,,,0,"percent of total billed charges ","70% of total billed charges ",291.73,387.59,
"SHEATH ENDOSCOPE 40M 0DG",6101346,"CDM ",272,RC,,,OUTPATIENT,,,221.65,177.32,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.32,80,,141.86,,,0,"percent of total billed charges ","80% of total billed charges ",155.16,70,,124.13,,,0,"percent of total billed charges ","70% of total billed charges ",199.49,90,,159.59,,,0,"percent of total billed charges ","90% of total billed charges ",206.13,93,,164.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",188.4,85,,150.72,,,0,"percent of total billed charges ","85% of total billed charges ",199.49,90,,159.59,,,0,"percent of total billed charges ","90% of total billed charges ",199.49,90,,159.59,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",192.84,87,,154.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.16,70,,124.13,,,0,"percent of total billed charges ","70% of total billed charges ",155.16,206.13,
"SHEATH ENDOSCOPE 4MM 30DG",6101348,"CDM ",272,RC,,,OUTPATIENT,,,206.93,165.544,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",165.54,80,,132.43,,,0,"percent of total billed charges ","80% of total billed charges ",144.85,70,,115.88,,,0,"percent of total billed charges ","70% of total billed charges ",186.24,90,,148.99,,,0,"percent of total billed charges ","90% of total billed charges ",192.44,93,,153.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",175.89,85,,140.71,,,0,"percent of total billed charges ","85% of total billed charges ",186.24,90,,148.99,,,0,"percent of total billed charges ","90% of total billed charges ",186.24,90,,148.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",180.03,87,,144.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.85,70,,115.88,,,0,"percent of total billed charges ","70% of total billed charges ",144.85,192.44,
"REAMER BLADE PATELLA 32MM",6101374,"CDM ",272,RC,,,OUTPATIENT,,,581.85,465.48,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",465.48,80,,372.38,,,0,"percent of total billed charges ","80% of total billed charges ",407.3,70,,325.84,,,0,"percent of total billed charges ","70% of total billed charges ",523.67,90,,418.94,,,0,"percent of total billed charges ","90% of total billed charges ",541.12,93,,432.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",494.57,85,,395.66,,,0,"percent of total billed charges ","85% of total billed charges ",523.67,90,,418.94,,,0,"percent of total billed charges ","90% of total billed charges ",523.67,90,,418.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",506.21,87,,404.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",407.3,70,,325.84,,,0,"percent of total billed charges ","70% of total billed charges ",407.3,541.12,
"BOOT CAST MED",6101403,"CDM ",271,RC,,,OUTPATIENT,,,37,29.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.6,80,,23.68,,,0,"percent of total billed charges ","80% of total billed charges ",25.9,70,,20.72,,,0,"percent of total billed charges ","70% of total billed charges ",33.3,90,,26.64,,,0,"percent of total billed charges ","90% of total billed charges ",34.41,93,,27.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",31.45,85,,25.16,,,0,"percent of total billed charges ","85% of total billed charges ",33.3,90,,26.64,,,0,"percent of total billed charges ","90% of total billed charges ",33.3,90,,26.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",32.19,87,,25.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.9,70,,20.72,,,0,"percent of total billed charges ","70% of total billed charges ",25.9,34.41,
"SUTURE NYLON 4.0 1667H",6101405,"CDM ",272,RC,,,OUTPATIENT,,,18.5,14.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.8,80,,11.84,,,0,"percent of total billed charges ","80% of total billed charges ",12.95,70,,10.36,,,0,"percent of total billed charges ","70% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",17.21,93,,13.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.73,85,,12.58,,,0,"percent of total billed charges ","85% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",16.65,90,,13.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.1,87,,12.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.95,70,,10.36,,,0,"percent of total billed charges ","70% of total billed charges ",12.95,17.21,
"SUTURE CHROMIC 3.0 G122H",6101406,"CDM ",272,RC,,,OUTPATIENT,,,11.33,9.064,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.06,80,,7.25,,,0,"percent of total billed charges ","80% of total billed charges ",7.93,70,,6.34,,,0,"percent of total billed charges ","70% of total billed charges ",10.2,90,,8.16,,,0,"percent of total billed charges ","90% of total billed charges ",10.54,93,,8.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.63,85,,7.70,,,0,"percent of total billed charges ","85% of total billed charges ",10.2,90,,8.16,,,0,"percent of total billed charges ","90% of total billed charges ",10.2,90,,8.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.86,87,,7.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.93,70,,6.34,,,0,"percent of total billed charges ","70% of total billed charges ",7.93,10.54,
"ENDOCUTTER 60MM",6101426,"CDM ",272,RC,,,OUTPATIENT,,,568.92,455.136,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",455.14,80,,364.11,,,0,"percent of total billed charges ","80% of total billed charges ",398.24,70,,318.59,,,0,"percent of total billed charges ","70% of total billed charges ",512.03,90,,409.62,,,0,"percent of total billed charges ","90% of total billed charges ",529.1,93,,423.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",483.58,85,,386.86,,,0,"percent of total billed charges ","85% of total billed charges ",512.03,90,,409.62,,,0,"percent of total billed charges ","90% of total billed charges ",512.03,90,,409.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",494.96,87,,395.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",398.24,70,,318.59,,,0,"percent of total billed charges ","70% of total billed charges ",398.24,529.1,
"RELOAD ENDO 60MM WHITE",6101427,"CDM ",272,RC,,,OUTPATIENT,,,258.92,207.136,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",207.14,80,,165.71,,,0,"percent of total billed charges ","80% of total billed charges ",181.24,70,,144.99,,,0,"percent of total billed charges ","70% of total billed charges ",233.03,90,,186.42,,,0,"percent of total billed charges ","90% of total billed charges ",240.8,93,,192.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",220.08,85,,176.06,,,0,"percent of total billed charges ","85% of total billed charges ",233.03,90,,186.42,,,0,"percent of total billed charges ","90% of total billed charges ",233.03,90,,186.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",225.26,87,,180.21,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",181.24,70,,144.99,,,0,"percent of total billed charges ","70% of total billed charges ",181.24,240.8,
"RELOAD ENDO 60MM BLUE",6101430,"CDM ",272,RC,,,OUTPATIENT,,,295.17,236.136,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",236.14,80,,188.91,,,0,"percent of total billed charges ","80% of total billed charges ",206.62,70,,165.30,,,0,"percent of total billed charges ","70% of total billed charges ",265.65,90,,212.52,,,0,"percent of total billed charges ","90% of total billed charges ",274.51,93,,219.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",250.89,85,,200.71,,,0,"percent of total billed charges ","85% of total billed charges ",265.65,90,,212.52,,,0,"percent of total billed charges ","90% of total billed charges ",265.65,90,,212.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",256.8,87,,205.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",206.62,70,,165.30,,,0,"percent of total billed charges ","70% of total billed charges ",206.62,274.51,
"SUTURE CHROMIC O 904H",6101432,"CDM ",272,RC,,,OUTPATIENT,,,12.54,10.032,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.03,80,,8.02,,,0,"percent of total billed charges ","80% of total billed charges ",8.78,70,,7.02,,,0,"percent of total billed charges ","70% of total billed charges ",11.29,90,,9.03,,,0,"percent of total billed charges ","90% of total billed charges ",11.66,93,,9.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.66,85,,8.53,,,0,"percent of total billed charges ","85% of total billed charges ",11.29,90,,9.03,,,0,"percent of total billed charges ","90% of total billed charges ",11.29,90,,9.03,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.91,87,,8.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.78,70,,7.02,,,0,"percent of total billed charges ","70% of total billed charges ",8.78,11.66,
"SUTURE VICRYL 5.0 J506G",6101446,"CDM ",272,RC,,,OUTPATIENT,,,21.26,17.008,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.01,80,,13.61,,,0,"percent of total billed charges ","80% of total billed charges ",14.88,70,,11.90,,,0,"percent of total billed charges ","70% of total billed charges ",19.13,90,,15.30,,,0,"percent of total billed charges ","90% of total billed charges ",19.77,93,,15.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.07,85,,14.46,,,0,"percent of total billed charges ","85% of total billed charges ",19.13,90,,15.30,,,0,"percent of total billed charges ","90% of total billed charges ",19.13,90,,15.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.5,87,,14.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.88,70,,11.90,,,0,"percent of total billed charges ","70% of total billed charges ",14.88,19.77,
"SUTURE CHROMIC 812H",6101484,"CDM ",272,RC,,,OUTPATIENT,,,11.33,9.064,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.06,80,,7.25,,,0,"percent of total billed charges ","80% of total billed charges ",7.93,70,,6.34,,,0,"percent of total billed charges ","70% of total billed charges ",10.2,90,,8.16,,,0,"percent of total billed charges ","90% of total billed charges ",10.54,93,,8.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.63,85,,7.70,,,0,"percent of total billed charges ","85% of total billed charges ",10.2,90,,8.16,,,0,"percent of total billed charges ","90% of total billed charges ",10.2,90,,8.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.86,87,,7.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.93,70,,6.34,,,0,"percent of total billed charges ","70% of total billed charges ",7.93,10.54,
"REAMER CANNULATED 5.0MM",6101486,"CDM ",278,RC,,,OUTPATIENT,,,522.26,417.808,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",417.81,80,,334.25,,,0,"percent of total billed charges ","80% of total billed charges ",365.58,70,,292.46,,,0,"percent of total billed charges ","70% of total billed charges ",470.03,90,,376.02,,,0,"percent of total billed charges ","90% of total billed charges ",485.7,93,,388.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",443.92,85,,355.14,,,0,"percent of total billed charges ","85% of total billed charges ",443.92,85,,355.14,,,0,"percent of total billed charges ","85% of total billed charges ",470.03,90,,376.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",454.37,87,,363.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",365.58,70,,292.46,,,0,"percent of total billed charges ","70% of total billed charges ",365.58,485.7,
"TAP CANNULATED 7.0MM",6101488,"CDM ",272,RC,,,OUTPATIENT,,,307.73,246.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",246.18,80,,196.94,,,0,"percent of total billed charges ","80% of total billed charges ",215.41,70,,172.33,,,0,"percent of total billed charges ","70% of total billed charges ",276.96,90,,221.57,,,0,"percent of total billed charges ","90% of total billed charges ",286.19,93,,228.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.57,85,,209.26,,,0,"percent of total billed charges ","85% of total billed charges ",276.96,90,,221.57,,,0,"percent of total billed charges ","90% of total billed charges ",276.96,90,,221.57,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.73,87,,214.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",215.41,70,,172.33,,,0,"percent of total billed charges ","70% of total billed charges ",215.41,286.19,
"CUTTER CURVED CONTOUR",6101494,"CDM ",272,RC,,,OUTPATIENT,,,713.07,570.456,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",570.46,80,,456.37,,,0,"percent of total billed charges ","80% of total billed charges ",499.15,70,,399.32,,,0,"percent of total billed charges ","70% of total billed charges ",641.76,90,,513.41,,,0,"percent of total billed charges ","90% of total billed charges ",663.16,93,,530.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",606.11,85,,484.89,,,0,"percent of total billed charges ","85% of total billed charges ",641.76,90,,513.41,,,0,"percent of total billed charges ","90% of total billed charges ",641.76,90,,513.41,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",620.37,87,,496.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",499.15,70,,399.32,,,0,"percent of total billed charges ","70% of total billed charges ",499.15,663.16,
"RELOAD CONTOUR BLUE",6101495,"CDM ",272,RC,,,OUTPATIENT,,,397.08,317.664,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",317.66,80,,254.13,,,0,"percent of total billed charges ","80% of total billed charges ",277.96,70,,222.37,,,0,"percent of total billed charges ","70% of total billed charges ",357.37,90,,285.90,,,0,"percent of total billed charges ","90% of total billed charges ",369.28,93,,295.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",337.52,85,,270.02,,,0,"percent of total billed charges ","85% of total billed charges ",357.37,90,,285.90,,,0,"percent of total billed charges ","90% of total billed charges ",357.37,90,,285.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",345.46,87,,276.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",277.96,70,,222.37,,,0,"percent of total billed charges ","70% of total billed charges ",277.96,369.28,
"BLADE CLIPPER SURGICAL",6101497,"CDM ",272,RC,,,OUTPATIENT,,,9.68,7.744,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.74,80,,6.19,,,0,"percent of total billed charges ","80% of total billed charges ",6.78,70,,5.42,,,0,"percent of total billed charges ","70% of total billed charges ",8.71,90,,6.97,,,0,"percent of total billed charges ","90% of total billed charges ",9,93,,7.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.23,85,,6.58,,,0,"percent of total billed charges ","85% of total billed charges ",8.71,90,,6.97,,,0,"percent of total billed charges ","90% of total billed charges ",8.71,90,,6.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",8.42,87,,6.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.78,70,,5.42,,,0,"percent of total billed charges ","70% of total billed charges ",6.78,9,
"BLADE ROLLER 22/24",6101499,"CDM ",272,RC,,,OUTPATIENT,,,253.17,202.536,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",202.54,80,,162.03,,,0,"percent of total billed charges ","80% of total billed charges ",177.22,70,,141.78,,,0,"percent of total billed charges ","70% of total billed charges ",227.85,90,,182.28,,,0,"percent of total billed charges ","90% of total billed charges ",235.45,93,,188.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",215.19,85,,172.15,,,0,"percent of total billed charges ","85% of total billed charges ",227.85,90,,182.28,,,0,"percent of total billed charges ","90% of total billed charges ",227.85,90,,182.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",220.26,87,,176.21,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.22,70,,141.78,,,0,"percent of total billed charges ","70% of total billed charges ",177.22,235.45,
"SUTURE CHROMIC 2.0 883H",6101511,"CDM ",272,RC,,,OUTPATIENT,,,8.58,6.864,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.86,80,,5.49,,,0,"percent of total billed charges ","80% of total billed charges ",6.01,70,,4.81,,,0,"percent of total billed charges ","70% of total billed charges ",7.72,90,,6.18,,,0,"percent of total billed charges ","90% of total billed charges ",7.98,93,,6.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7.29,85,,5.83,,,0,"percent of total billed charges ","85% of total billed charges ",7.72,90,,6.18,,,0,"percent of total billed charges ","90% of total billed charges ",7.72,90,,6.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7.46,87,,5.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.01,70,,4.81,,,0,"percent of total billed charges ","70% of total billed charges ",6.01,7.98,
"SUTURE SILK 6.0 780 G",6101512,"CDM ",272,RC,,,OUTPATIENT,,,39.42,31.536,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.54,80,,25.23,,,0,"percent of total billed charges ","80% of total billed charges ",27.59,70,,22.07,,,0,"percent of total billed charges ","70% of total billed charges ",35.48,90,,28.38,,,0,"percent of total billed charges ","90% of total billed charges ",36.66,93,,29.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.51,85,,26.81,,,0,"percent of total billed charges ","85% of total billed charges ",35.48,90,,28.38,,,0,"percent of total billed charges ","90% of total billed charges ",35.48,90,,28.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",34.3,87,,27.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.59,70,,22.07,,,0,"percent of total billed charges ","70% of total billed charges ",27.59,36.66,
"SUTURE NYLON 5.0 1666H",6101514,"CDM ",272,RC,,,OUTPATIENT,,,12.44,9.952,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.95,80,,7.96,,,0,"percent of total billed charges ","80% of total billed charges ",8.71,70,,6.97,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,90,,8.96,,,0,"percent of total billed charges ","90% of total billed charges ",11.57,93,,9.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.57,85,,8.46,,,0,"percent of total billed charges ","85% of total billed charges ",11.2,90,,8.96,,,0,"percent of total billed charges ","90% of total billed charges ",11.2,90,,8.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.82,87,,8.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.71,70,,6.97,,,0,"percent of total billed charges ","70% of total billed charges ",8.71,11.57,
"RELOAD CONTOUR GREEN",6101517,"CDM ",272,RC,,,OUTPATIENT,,,534.33,427.464,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",427.46,80,,341.97,,,0,"percent of total billed charges ","80% of total billed charges ",374.03,70,,299.22,,,0,"percent of total billed charges ","70% of total billed charges ",480.9,90,,384.72,,,0,"percent of total billed charges ","90% of total billed charges ",496.93,93,,397.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",454.18,85,,363.34,,,0,"percent of total billed charges ","85% of total billed charges ",480.9,90,,384.72,,,0,"percent of total billed charges ","90% of total billed charges ",480.9,90,,384.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",464.87,87,,371.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",374.03,70,,299.22,,,0,"percent of total billed charges ","70% of total billed charges ",374.03,496.93,
"SHEAR CURVED 36MM",6101518,"CDM ",272,RC,,,OUTPATIENT,,,1053.86,843.088,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",843.09,80,,674.47,,,0,"percent of total billed charges ","80% of total billed charges ",737.7,70,,590.16,,,0,"percent of total billed charges ","70% of total billed charges ",948.47,90,,758.78,,,0,"percent of total billed charges ","90% of total billed charges ",980.09,93,,784.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",895.78,85,,716.62,,,0,"percent of total billed charges ","85% of total billed charges ",948.47,90,,758.78,,,0,"percent of total billed charges ","90% of total billed charges ",948.47,90,,758.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",916.86,87,,733.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",737.7,70,,590.16,,,0,"percent of total billed charges ","70% of total billed charges ",737.7,980.09,
"SHEAR CURVED 23MM",6101529,"CDM ",272,RC,,,OUTPATIENT,,,996.52,797.216,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",797.22,80,,637.78,,,0,"percent of total billed charges ","80% of total billed charges ",697.56,70,,558.05,,,0,"percent of total billed charges ","70% of total billed charges ",896.87,90,,717.50,,,0,"percent of total billed charges ","90% of total billed charges ",926.76,93,,741.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",847.04,85,,677.63,,,0,"percent of total billed charges ","85% of total billed charges ",896.87,90,,717.50,,,0,"percent of total billed charges ","90% of total billed charges ",896.87,90,,717.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",866.97,87,,693.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",697.56,70,,558.05,,,0,"percent of total billed charges ","70% of total billed charges ",697.56,926.76,
"SUTURE BONE WAX",6101545,"CDM ",272,RC,,,OUTPATIENT,,,18.81,15.048,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.05,80,,12.04,,,0,"percent of total billed charges ","80% of total billed charges ",13.17,70,,10.54,,,0,"percent of total billed charges ","70% of total billed charges ",16.93,90,,13.54,,,0,"percent of total billed charges ","90% of total billed charges ",17.49,93,,13.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.99,85,,12.79,,,0,"percent of total billed charges ","85% of total billed charges ",16.93,90,,13.54,,,0,"percent of total billed charges ","90% of total billed charges ",16.93,90,,13.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.36,87,,13.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.17,70,,10.54,,,0,"percent of total billed charges ","70% of total billed charges ",13.17,17.49,
"SUTURE 816H 2.0 CHROMIC",6101585,"CDM ",272,RC,,,OUTPATIENT,,,9,7.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.2,80,,5.76,,,0,"percent of total billed charges ","80% of total billed charges ",6.3,70,,5.04,,,0,"percent of total billed charges ","70% of total billed charges ",8.1,90,,6.48,,,0,"percent of total billed charges ","90% of total billed charges ",8.37,93,,6.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7.65,85,,6.12,,,0,"percent of total billed charges ","85% of total billed charges ",8.1,90,,6.48,,,0,"percent of total billed charges ","90% of total billed charges ",8.1,90,,6.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7.83,87,,6.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.3,70,,5.04,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,8.37,
"PROTECTOR EYE SMALL OPTI-GUARD",6101600,"CDM ",272,RC,,,OUTPATIENT,,,24.97,19.976,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.98,80,,15.98,,,0,"percent of total billed charges ","80% of total billed charges ",17.48,70,,13.98,,,0,"percent of total billed charges ","70% of total billed charges ",22.47,90,,17.98,,,0,"percent of total billed charges ","90% of total billed charges ",23.22,93,,18.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.22,85,,16.98,,,0,"percent of total billed charges ","85% of total billed charges ",22.47,90,,17.98,,,0,"percent of total billed charges ","90% of total billed charges ",22.47,90,,17.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.72,87,,17.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.48,70,,13.98,,,0,"percent of total billed charges ","70% of total billed charges ",17.48,23.22,
"NEEDLE FERG CIRCLE TAPER",6101612,"CDM ",272,RC,,,OUTPATIENT,,,20.21,16.168,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.17,80,,12.94,,,0,"percent of total billed charges ","80% of total billed charges ",14.15,70,,11.32,,,0,"percent of total billed charges ","70% of total billed charges ",18.19,90,,14.55,,,0,"percent of total billed charges ","90% of total billed charges ",18.8,93,,15.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.18,85,,13.74,,,0,"percent of total billed charges ","85% of total billed charges ",18.19,90,,14.55,,,0,"percent of total billed charges ","90% of total billed charges ",18.19,90,,14.55,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.58,87,,14.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.15,70,,11.32,,,0,"percent of total billed charges ","70% of total billed charges ",14.15,18.8,
"IMMOBILIZER SHOULDER LARGE",6101653,"CDM ",272,RC,,,OUTPATIENT,,,69.21,55.368,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.37,80,,44.30,,,0,"percent of total billed charges ","80% of total billed charges ",48.45,70,,38.76,,,0,"percent of total billed charges ","70% of total billed charges ",62.29,90,,49.83,,,0,"percent of total billed charges ","90% of total billed charges ",64.37,93,,51.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",58.83,85,,47.06,,,0,"percent of total billed charges ","85% of total billed charges ",62.29,90,,49.83,,,0,"percent of total billed charges ","90% of total billed charges ",62.29,90,,49.83,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",60.21,87,,48.17,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.45,70,,38.76,,,0,"percent of total billed charges ","70% of total billed charges ",48.45,64.37,
"DRAPE LAP ADOLESCENT",6101665,"CDM ",272,RC,,,OUTPATIENT,,,18.3,14.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.64,80,,11.71,,,0,"percent of total billed charges ","80% of total billed charges ",12.81,70,,10.25,,,0,"percent of total billed charges ","70% of total billed charges ",16.47,90,,13.18,,,0,"percent of total billed charges ","90% of total billed charges ",17.02,93,,13.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.56,85,,12.45,,,0,"percent of total billed charges ","85% of total billed charges ",16.47,90,,13.18,,,0,"percent of total billed charges ","90% of total billed charges ",16.47,90,,13.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.92,87,,12.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.81,70,,10.25,,,0,"percent of total billed charges ","70% of total billed charges ",12.81,17.02,
"NEEDLE HALF CIRCLE TAPER HEAVY",6101669,"CDM ",272,RC,,,OUTPATIENT,,,23.52,18.816,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.82,80,,15.06,,,0,"percent of total billed charges ","80% of total billed charges ",16.46,70,,13.17,,,0,"percent of total billed charges ","70% of total billed charges ",21.17,90,,16.94,,,0,"percent of total billed charges ","90% of total billed charges ",21.87,93,,17.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.99,85,,15.99,,,0,"percent of total billed charges ","85% of total billed charges ",21.17,90,,16.94,,,0,"percent of total billed charges ","90% of total billed charges ",21.17,90,,16.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.46,87,,16.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.46,70,,13.17,,,0,"percent of total billed charges ","70% of total billed charges ",16.46,21.87,
"ELECTRODE VAPOR CUT 24 FR",6101699,"CDM ",272,RC,,,OUTPATIENT,,,312.48,249.984,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",249.98,80,,199.98,,,0,"percent of total billed charges ","80% of total billed charges ",218.74,70,,174.99,,,0,"percent of total billed charges ","70% of total billed charges ",281.23,90,,224.98,,,0,"percent of total billed charges ","90% of total billed charges ",290.61,93,,232.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",265.61,85,,212.49,,,0,"percent of total billed charges ","85% of total billed charges ",281.23,90,,224.98,,,0,"percent of total billed charges ","90% of total billed charges ",281.23,90,,224.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",271.86,87,,217.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",218.74,70,,174.99,,,0,"percent of total billed charges ","70% of total billed charges ",218.74,290.61,
"ELECTRODE VAPOR 27F",6101700,"CDM ",272,RC,,,OUTPATIENT,,,312.48,249.984,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",249.98,80,,199.98,,,0,"percent of total billed charges ","80% of total billed charges ",218.74,70,,174.99,,,0,"percent of total billed charges ","70% of total billed charges ",281.23,90,,224.98,,,0,"percent of total billed charges ","90% of total billed charges ",290.61,93,,232.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",265.61,85,,212.49,,,0,"percent of total billed charges ","85% of total billed charges ",281.23,90,,224.98,,,0,"percent of total billed charges ","90% of total billed charges ",281.23,90,,224.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",271.86,87,,217.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",218.74,70,,174.99,,,0,"percent of total billed charges ","70% of total billed charges ",218.74,290.61,
"IMMOBILIZER SHOULDER F XLG",6101702,"CDM ",272,RC,,,OUTPATIENT,,,64.59,51.672,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.67,80,,41.34,,,0,"percent of total billed charges ","80% of total billed charges ",45.21,70,,36.17,,,0,"percent of total billed charges ","70% of total billed charges ",58.13,90,,46.50,,,0,"percent of total billed charges ","90% of total billed charges ",60.07,93,,48.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",54.9,85,,43.92,,,0,"percent of total billed charges ","85% of total billed charges ",58.13,90,,46.50,,,0,"percent of total billed charges ","90% of total billed charges ",58.13,90,,46.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",56.19,87,,44.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.21,70,,36.17,,,0,"percent of total billed charges ","70% of total billed charges ",45.21,60.07,
"SUTURE 8706H PROLENE 6.0",6101704,"CDM ",272,RC,,,OUTPATIENT,,,29.49,23.592,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.59,80,,18.87,,,0,"percent of total billed charges ","80% of total billed charges ",20.64,70,,16.51,,,0,"percent of total billed charges ","70% of total billed charges ",26.54,90,,21.23,,,0,"percent of total billed charges ","90% of total billed charges ",27.43,93,,21.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.07,85,,20.06,,,0,"percent of total billed charges ","85% of total billed charges ",26.54,90,,21.23,,,0,"percent of total billed charges ","90% of total billed charges ",26.54,90,,21.23,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",25.66,87,,20.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.64,70,,16.51,,,0,"percent of total billed charges ","70% of total billed charges ",20.64,27.43,
"KIT DELIVERY VACUUM",6101709,"CDM ",272,RC,,,OUTPATIENT,,,73.5,58.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.8,80,,47.04,,,0,"percent of total billed charges ","80% of total billed charges ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",51.45,68.36,
"IMMOBILIZER SHOULDER",6101714,"CDM ",272,RC,,,OUTPATIENT,,,68.68,54.944,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.94,80,,43.95,,,0,"percent of total billed charges ","80% of total billed charges ",48.08,70,,38.46,,,0,"percent of total billed charges ","70% of total billed charges ",61.81,90,,49.45,,,0,"percent of total billed charges ","90% of total billed charges ",63.87,93,,51.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",58.38,85,,46.70,,,0,"percent of total billed charges ","85% of total billed charges ",61.81,90,,49.45,,,0,"percent of total billed charges ","90% of total billed charges ",61.81,90,,49.45,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",59.75,87,,47.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.08,70,,38.46,,,0,"percent of total billed charges ","70% of total billed charges ",48.08,63.87,
"IMMOBILIZER SHOULDER XLG",6101723,"CDM ",272,RC,,,OUTPATIENT,,,64.59,51.672,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.67,80,,41.34,,,0,"percent of total billed charges ","80% of total billed charges ",45.21,70,,36.17,,,0,"percent of total billed charges ","70% of total billed charges ",58.13,90,,46.50,,,0,"percent of total billed charges ","90% of total billed charges ",60.07,93,,48.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",54.9,85,,43.92,,,0,"percent of total billed charges ","85% of total billed charges ",58.13,90,,46.50,,,0,"percent of total billed charges ","90% of total billed charges ",58.13,90,,46.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",56.19,87,,44.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.21,70,,36.17,,,0,"percent of total billed charges ","70% of total billed charges ",45.21,60.07,
"SPERE STERILE 5 PACK",6101726,"CDM ",272,RC,,,OUTPATIENT,,,339.06,271.248,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",271.25,80,,217.00,,,0,"percent of total billed charges ","80% of total billed charges ",237.34,70,,189.87,,,0,"percent of total billed charges ","70% of total billed charges ",305.15,90,,244.12,,,0,"percent of total billed charges ","90% of total billed charges ",315.33,93,,252.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",288.2,85,,230.56,,,0,"percent of total billed charges ","85% of total billed charges ",305.15,90,,244.12,,,0,"percent of total billed charges ","90% of total billed charges ",305.15,90,,244.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",294.98,87,,235.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",237.34,70,,189.87,,,0,"percent of total billed charges ","70% of total billed charges ",237.34,315.33,
"TRAY BONE MARROW DISP.",6101735,"CDM ",272,RC,,,OUTPATIENT,,,191,152.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.8,80,,122.24,,,0,"percent of total billed charges ","80% of total billed charges ",133.7,70,,106.96,,,0,"percent of total billed charges ","70% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",177.63,93,,142.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",162.35,85,,129.88,,,0,"percent of total billed charges ","85% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",171.9,90,,137.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",166.17,87,,132.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.7,70,,106.96,,,0,"percent of total billed charges ","70% of total billed charges ",133.7,177.63,
"BURR TAPERED 6MM",6101745,"CDM ",272,RC,,,OUTPATIENT,,,213.36,170.688,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.69,80,,136.55,,,0,"percent of total billed charges ","80% of total billed charges ",149.35,70,,119.48,,,0,"percent of total billed charges ","70% of total billed charges ",192.02,90,,153.62,,,0,"percent of total billed charges ","90% of total billed charges ",198.42,93,,158.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",181.36,85,,145.09,,,0,"percent of total billed charges ","85% of total billed charges ",192.02,90,,153.62,,,0,"percent of total billed charges ","90% of total billed charges ",192.02,90,,153.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",185.62,87,,148.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.35,70,,119.48,,,0,"percent of total billed charges ","70% of total billed charges ",149.35,198.42,
"TROCAR RIBBED 5MM",6101771,"CDM ",272,RC,,,OUTPATIENT,,,31.29,25.032,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.03,80,,20.02,,,0,"percent of total billed charges ","80% of total billed charges ",21.9,70,,17.52,,,0,"percent of total billed charges ","70% of total billed charges ",28.16,90,,22.53,,,0,"percent of total billed charges ","90% of total billed charges ",29.1,93,,23.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.6,85,,21.28,,,0,"percent of total billed charges ","85% of total billed charges ",28.16,90,,22.53,,,0,"percent of total billed charges ","90% of total billed charges ",28.16,90,,22.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",27.22,87,,21.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.9,70,,17.52,,,0,"percent of total billed charges ","70% of total billed charges ",21.9,29.1,
"FORCEP IRIS DISP",6101780,"CDM ",272,RC,,,OUTPATIENT,,,76.5,61.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.2,80,,48.96,,,0,"percent of total billed charges ","80% of total billed charges ",53.55,70,,42.84,,,0,"percent of total billed charges ","70% of total billed charges ",68.85,90,,55.08,,,0,"percent of total billed charges ","90% of total billed charges ",71.15,93,,56.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",65.03,85,,52.02,,,0,"percent of total billed charges ","85% of total billed charges ",68.85,90,,55.08,,,0,"percent of total billed charges ","90% of total billed charges ",68.85,90,,55.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",66.56,87,,53.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.55,70,,42.84,,,0,"percent of total billed charges ","70% of total billed charges ",53.55,71.15,
"SPERE STERILE 3 PACK",6101789,"CDM ",272,RC,,,OUTPATIENT,,,220.88,176.704,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.7,80,,141.36,,,0,"percent of total billed charges ","80% of total billed charges ",154.62,70,,123.70,,,0,"percent of total billed charges ","70% of total billed charges ",198.79,90,,159.03,,,0,"percent of total billed charges ","90% of total billed charges ",205.42,93,,164.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",187.75,85,,150.20,,,0,"percent of total billed charges ","85% of total billed charges ",198.79,90,,159.03,,,0,"percent of total billed charges ","90% of total billed charges ",198.79,90,,159.03,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",192.17,87,,153.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154.62,70,,123.70,,,0,"percent of total billed charges ","70% of total billed charges ",154.62,205.42,
"SET ARTHOSCOPY TUBING",6101798,"CDM ",272,RC,,,OUTPATIENT,,,162,129.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.6,80,,103.68,,,0,"percent of total billed charges ","80% of total billed charges ",113.4,70,,90.72,,,0,"percent of total billed charges ","70% of total billed charges ",145.8,90,,116.64,,,0,"percent of total billed charges ","90% of total billed charges ",150.66,93,,120.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",137.7,85,,110.16,,,0,"percent of total billed charges ","85% of total billed charges ",145.8,90,,116.64,,,0,"percent of total billed charges ","90% of total billed charges ",145.8,90,,116.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",140.94,87,,112.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.4,70,,90.72,,,0,"percent of total billed charges ","70% of total billed charges ",113.4,150.66,
"CATH FOLEY 22FR 30CC",6101831,"CDM ",272,RC,,,OUTPATIENT,,,32.8,26.24,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.24,80,,20.99,,,0,"percent of total billed charges ","80% of total billed charges ",22.96,70,,18.37,,,0,"percent of total billed charges ","70% of total billed charges ",29.52,90,,23.62,,,0,"percent of total billed charges ","90% of total billed charges ",30.5,93,,24.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",27.88,85,,22.30,,,0,"percent of total billed charges ","85% of total billed charges ",29.52,90,,23.62,,,0,"percent of total billed charges ","90% of total billed charges ",29.52,90,,23.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",28.54,87,,22.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.96,70,,18.37,,,0,"percent of total billed charges ","70% of total billed charges ",22.96,30.5,
"TAP QC 3.5MM CORTICAL",6101839,"CDM ",272,RC,,,OUTPATIENT,,,244.81,195.848,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",195.85,80,,156.68,,,0,"percent of total billed charges ","80% of total billed charges ",171.37,70,,137.10,,,0,"percent of total billed charges ","70% of total billed charges ",220.33,90,,176.26,,,0,"percent of total billed charges ","90% of total billed charges ",227.67,93,,182.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",208.09,85,,166.47,,,0,"percent of total billed charges ","85% of total billed charges ",220.33,90,,176.26,,,0,"percent of total billed charges ","90% of total billed charges ",220.33,90,,176.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",212.98,87,,170.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",171.37,70,,137.10,,,0,"percent of total billed charges ","70% of total billed charges ",171.37,227.67,
"TAP QC 3.5MM CANCELLOUS",6101840,"CDM ",272,RC,,,OUTPATIENT,,,266,212.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",212.8,80,,170.24,,,0,"percent of total billed charges ","80% of total billed charges ",186.2,70,,148.96,,,0,"percent of total billed charges ","70% of total billed charges ",239.4,90,,191.52,,,0,"percent of total billed charges ","90% of total billed charges ",247.38,93,,197.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",226.1,85,,180.88,,,0,"percent of total billed charges ","85% of total billed charges ",239.4,90,,191.52,,,0,"percent of total billed charges ","90% of total billed charges ",239.4,90,,191.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",231.42,87,,185.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",186.2,70,,148.96,,,0,"percent of total billed charges ","70% of total billed charges ",186.2,247.38,
"DEVICE FOG REDUCTION",6101841,"CDM ",272,RC,,,OUTPATIENT,,,26.38,21.104,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.1,80,,16.88,,,0,"percent of total billed charges ","80% of total billed charges ",18.47,70,,14.78,,,0,"percent of total billed charges ","70% of total billed charges ",23.74,90,,18.99,,,0,"percent of total billed charges ","90% of total billed charges ",24.53,93,,19.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",22.42,85,,17.94,,,0,"percent of total billed charges ","85% of total billed charges ",23.74,90,,18.99,,,0,"percent of total billed charges ","90% of total billed charges ",23.74,90,,18.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.95,87,,18.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.47,70,,14.78,,,0,"percent of total billed charges ","70% of total billed charges ",18.47,24.53,
"SIG TKA GDE/MDL SET 03-05",6101844,"CDM ",278,RC,,,OUTPATIENT,,,1724.25,1379.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1379.4,80,,1103.52,,,0,"percent of total billed charges ","80% of total billed charges ",1206.98,70,,965.58,,,0,"percent of total billed charges ","70% of total billed charges ",1551.83,90,,1241.46,,,0,"percent of total billed charges ","90% of total billed charges ",1603.55,93,,1282.84,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1465.61,85,,1172.49,,,0,"percent of total billed charges ","85% of total billed charges ",1465.61,85,,1172.49,,,0,"percent of total billed charges ","85% of total billed charges ",1551.83,90,,1241.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1500.1,87,,1200.08,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1206.98,70,,965.58,,,0,"percent of total billed charges ","70% of total billed charges ",1206.98,1603.55,
"NEEDLE BIOPSY COAXIAL",6101851,"CDM ",272,RC,,,OUTPATIENT,,,193.8,155.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.04,80,,124.03,,,0,"percent of total billed charges ","80% of total billed charges ",135.66,70,,108.53,,,0,"percent of total billed charges ","70% of total billed charges ",174.42,90,,139.54,,,0,"percent of total billed charges ","90% of total billed charges ",180.23,93,,144.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",164.73,85,,131.78,,,0,"percent of total billed charges ","85% of total billed charges ",174.42,90,,139.54,,,0,"percent of total billed charges ","90% of total billed charges ",174.42,90,,139.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",168.61,87,,134.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.66,70,,108.53,,,0,"percent of total billed charges ","70% of total billed charges ",135.66,180.23,
"SUTURE 9000G ETHILON 10.0",6101862,"CDM ",272,RC,,,OUTPATIENT,,,56.76,45.408,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.41,80,,36.33,,,0,"percent of total billed charges ","80% of total billed charges ",39.73,70,,31.78,,,0,"percent of total billed charges ","70% of total billed charges ",51.08,90,,40.86,,,0,"percent of total billed charges ","90% of total billed charges ",52.79,93,,42.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",48.25,85,,38.60,,,0,"percent of total billed charges ","85% of total billed charges ",51.08,90,,40.86,,,0,"percent of total billed charges ","90% of total billed charges ",51.08,90,,40.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",49.38,87,,39.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.73,70,,31.78,,,0,"percent of total billed charges ","70% of total billed charges ",39.73,52.79,
"DEVICE LONG GTR CABLE",6101865,"CDM ",278,RC,,,OUTPATIENT,,,4975.46,3980.368,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3980.37,80,,3184.30,,,0,"percent of total billed charges ","80% of total billed charges ",3482.82,70,,2786.26,,,0,"percent of total billed charges ","70% of total billed charges ",4477.91,90,,3582.33,,,0,"percent of total billed charges ","90% of total billed charges ",4627.18,93,,3701.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4229.14,85,,3383.31,,,0,"percent of total billed charges ","85% of total billed charges ",4229.14,85,,3383.31,,,0,"percent of total billed charges ","85% of total billed charges ",4477.91,90,,3582.33,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4328.65,87,,3462.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3482.82,70,,2786.26,,,0,"percent of total billed charges ","70% of total billed charges ",3482.82,4627.18,
"DEVICE SHORT GTR CABLE",6101866,"CDM ",278,RC,,,OUTPATIENT,,,2953.73,2362.984,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2362.98,80,,1890.38,,,0,"percent of total billed charges ","80% of total billed charges ",2067.61,70,,1654.09,,,0,"percent of total billed charges ","70% of total billed charges ",2658.36,90,,2126.69,,,0,"percent of total billed charges ","90% of total billed charges ",2746.97,93,,2197.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2510.67,85,,2008.54,,,0,"percent of total billed charges ","85% of total billed charges ",2510.67,85,,2008.54,,,0,"percent of total billed charges ","85% of total billed charges ",2658.36,90,,2126.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2569.75,87,,2055.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2067.61,70,,1654.09,,,0,"percent of total billed charges ","70% of total billed charges ",2067.61,2746.97,
"TUBING ENDO FLOW IRRIGATION",6101877,"CDM ",272,RC,,,OUTPATIENT,,,160.02,128.016,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.02,80,,102.42,,,0,"percent of total billed charges ","80% of total billed charges ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",148.82,93,,119.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.02,85,,108.82,,,0,"percent of total billed charges ","85% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",144.02,90,,115.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.22,87,,111.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.01,70,,89.61,,,0,"percent of total billed charges ","70% of total billed charges ",112.01,148.82,
"CANNULA 9MM X 75 MM DISP",6101883,"CDM ",270,RC,,,OUTPATIENT,,,137.26,109.808,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.81,80,,87.85,,,0,"percent of total billed charges ","80% of total billed charges ",96.08,70,,76.86,,,0,"percent of total billed charges ","70% of total billed charges ",123.53,90,,98.82,,,0,"percent of total billed charges ","90% of total billed charges ",127.65,93,,102.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",116.67,85,,93.34,,,0,"percent of total billed charges ","85% of total billed charges ",123.53,90,,98.82,,,0,"percent of total billed charges ","90% of total billed charges ",123.53,90,,98.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",119.42,87,,95.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.08,70,,76.86,,,0,"percent of total billed charges ","70% of total billed charges ",96.08,127.65,
"PROBE ENDO FLO IRRIGATOR",6101905,"CDM ",272,RC,,,OUTPATIENT,,,222.25,177.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.8,80,,142.24,,,0,"percent of total billed charges ","80% of total billed charges ",155.58,70,,124.46,,,0,"percent of total billed charges ","70% of total billed charges ",200.03,90,,160.02,,,0,"percent of total billed charges ","90% of total billed charges ",206.69,93,,165.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",188.91,85,,151.13,,,0,"percent of total billed charges ","85% of total billed charges ",200.03,90,,160.02,,,0,"percent of total billed charges ","90% of total billed charges ",200.03,90,,160.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",193.36,87,,154.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.58,70,,124.46,,,0,"percent of total billed charges ","70% of total billed charges ",155.58,206.69,
"TROCAR ENDO BLUNT 10/11 MM",6101912,"CDM ",272,RC,,,OUTPATIENT,,,31.94,25.552,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.55,80,,20.44,,,0,"percent of total billed charges ","80% of total billed charges ",22.36,70,,17.89,,,0,"percent of total billed charges ","70% of total billed charges ",28.75,90,,23.00,,,0,"percent of total billed charges ","90% of total billed charges ",29.7,93,,23.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",27.15,85,,21.72,,,0,"percent of total billed charges ","85% of total billed charges ",28.75,90,,23.00,,,0,"percent of total billed charges ","90% of total billed charges ",28.75,90,,23.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",27.79,87,,22.23,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.36,70,,17.89,,,0,"percent of total billed charges ","70% of total billed charges ",22.36,29.7,
"SUTURE VICRYL 4.0 J214H",6101917,"CDM ",272,RC,,,OUTPATIENT,,,10.5,8.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,80,,6.72,,,0,"percent of total billed charges ","80% of total billed charges ",7.35,70,,5.88,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,90,,7.56,,,0,"percent of total billed charges ","90% of total billed charges ",9.77,93,,7.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.93,85,,7.14,,,0,"percent of total billed charges ","85% of total billed charges ",9.45,90,,7.56,,,0,"percent of total billed charges ","90% of total billed charges ",9.45,90,,7.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.14,87,,7.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.35,70,,5.88,,,0,"percent of total billed charges ","70% of total billed charges ",7.35,9.77,
"SUTURE VICRYL 2.0 J333H",6101921,"CDM ",272,RC,,,OUTPATIENT,,,9.5,7.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.6,80,,6.08,,,0,"percent of total billed charges ","80% of total billed charges ",6.65,70,,5.32,,,0,"percent of total billed charges ","70% of total billed charges ",8.55,90,,6.84,,,0,"percent of total billed charges ","90% of total billed charges ",8.84,93,,7.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.08,85,,6.46,,,0,"percent of total billed charges ","85% of total billed charges ",8.55,90,,6.84,,,0,"percent of total billed charges ","90% of total billed charges ",8.55,90,,6.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",8.27,87,,6.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.65,70,,5.32,,,0,"percent of total billed charges ","70% of total billed charges ",6.65,8.84,
"SUTURE ETHILON 8.0 2815G",6101922,"CDM ",272,RC,,,OUTPATIENT,,,50.1,40.08,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.08,80,,32.06,,,0,"percent of total billed charges ","80% of total billed charges ",35.07,70,,28.06,,,0,"percent of total billed charges ","70% of total billed charges ",45.09,90,,36.07,,,0,"percent of total billed charges ","90% of total billed charges ",46.59,93,,37.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.59,85,,34.07,,,0,"percent of total billed charges ","85% of total billed charges ",45.09,90,,36.07,,,0,"percent of total billed charges ","90% of total billed charges ",45.09,90,,36.07,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.59,87,,34.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.07,70,,28.06,,,0,"percent of total billed charges ","70% of total billed charges ",35.07,46.59,
"BANDAGE ESMARK 6X9",6101943,"CDM ",272,RC,,,OUTPATIENT,,,24.17,19.336,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.34,80,,15.47,,,0,"percent of total billed charges ","80% of total billed charges ",16.92,70,,13.54,,,0,"percent of total billed charges ","70% of total billed charges ",21.75,90,,17.40,,,0,"percent of total billed charges ","90% of total billed charges ",22.48,93,,17.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.54,85,,16.43,,,0,"percent of total billed charges ","85% of total billed charges ",21.75,90,,17.40,,,0,"percent of total billed charges ","90% of total billed charges ",21.75,90,,17.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.03,87,,16.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.92,70,,13.54,,,0,"percent of total billed charges ","70% of total billed charges ",16.92,22.48,
"SUTURE 1716G ETHILON 8.0",6101967,"CDM ",272,RC,,,OUTPATIENT,,,49.38,39.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.5,80,,31.60,,,0,"percent of total billed charges ","80% of total billed charges ",34.57,70,,27.66,,,0,"percent of total billed charges ","70% of total billed charges ",44.44,90,,35.55,,,0,"percent of total billed charges ","90% of total billed charges ",45.92,93,,36.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.97,85,,33.58,,,0,"percent of total billed charges ","85% of total billed charges ",44.44,90,,35.55,,,0,"percent of total billed charges ","90% of total billed charges ",44.44,90,,35.55,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.96,87,,34.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.57,70,,27.66,,,0,"percent of total billed charges ","70% of total billed charges ",34.57,45.92,
"TUBING INSUFLATION",6101969,"CDM ",272,RC,,,OUTPATIENT,,,68.72,54.976,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.98,80,,43.98,,,0,"percent of total billed charges ","80% of total billed charges ",48.1,70,,38.48,,,0,"percent of total billed charges ","70% of total billed charges ",61.85,90,,49.48,,,0,"percent of total billed charges ","90% of total billed charges ",63.91,93,,51.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",58.41,85,,46.73,,,0,"percent of total billed charges ","85% of total billed charges ",61.85,90,,49.48,,,0,"percent of total billed charges ","90% of total billed charges ",61.85,90,,49.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",59.79,87,,47.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.1,70,,38.48,,,0,"percent of total billed charges ","70% of total billed charges ",48.1,63.91,
"TROCAR BLADL'S W/STAR SLV 5MM",6101970,"CDM ",272,RC,,,OUTPATIENT,,,31.94,25.552,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.55,80,,20.44,,,0,"percent of total billed charges ","80% of total billed charges ",22.36,70,,17.89,,,0,"percent of total billed charges ","70% of total billed charges ",28.75,90,,23.00,,,0,"percent of total billed charges ","90% of total billed charges ",29.7,93,,23.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",27.15,85,,21.72,,,0,"percent of total billed charges ","85% of total billed charges ",28.75,90,,23.00,,,0,"percent of total billed charges ","90% of total billed charges ",28.75,90,,23.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",27.79,87,,22.23,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.36,70,,17.89,,,0,"percent of total billed charges ","70% of total billed charges ",22.36,29.7,
"PISTON FLUOROPLASTIC 0.8 MM",6101979,"CDM ",272,RC,,,OUTPATIENT,,,334.14,267.312,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",267.31,80,,213.85,,,0,"percent of total billed charges ","80% of total billed charges ",233.9,70,,187.12,,,0,"percent of total billed charges ","70% of total billed charges ",300.73,90,,240.58,,,0,"percent of total billed charges ","90% of total billed charges ",310.75,93,,248.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",284.02,85,,227.22,,,0,"percent of total billed charges ","85% of total billed charges ",300.73,90,,240.58,,,0,"percent of total billed charges ","90% of total billed charges ",300.73,90,,240.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",290.7,87,,232.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",233.9,70,,187.12,,,0,"percent of total billed charges ","70% of total billed charges ",233.9,310.75,
"SLEEVE STABILITY 100M X 5MM",6101984,"CDM ",272,RC,,,OUTPATIENT,,,22.35,17.88,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.88,80,,14.30,,,0,"percent of total billed charges ","80% of total billed charges ",15.65,70,,12.52,,,0,"percent of total billed charges ","70% of total billed charges ",20.12,90,,16.10,,,0,"percent of total billed charges ","90% of total billed charges ",20.79,93,,16.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19,85,,15.20,,,0,"percent of total billed charges ","85% of total billed charges ",20.12,90,,16.10,,,0,"percent of total billed charges ","90% of total billed charges ",20.12,90,,16.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.44,87,,15.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.65,70,,12.52,,,0,"percent of total billed charges ","70% of total billed charges ",15.65,20.79,
"TROCAR BLADL'S W/SLEEVE 12M",6101988,"CDM ",272,RC,,,OUTPATIENT,,,31.94,25.552,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.55,80,,20.44,,,0,"percent of total billed charges ","80% of total billed charges ",22.36,70,,17.89,,,0,"percent of total billed charges ","70% of total billed charges ",28.75,90,,23.00,,,0,"percent of total billed charges ","90% of total billed charges ",29.7,93,,23.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",27.15,85,,21.72,,,0,"percent of total billed charges ","85% of total billed charges ",28.75,90,,23.00,,,0,"percent of total billed charges ","90% of total billed charges ",28.75,90,,23.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",27.79,87,,22.23,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.36,70,,17.89,,,0,"percent of total billed charges ","70% of total billed charges ",22.36,29.7,
"SUTURE VICRYL 2.0 J532H",6101990,"CDM ",272,RC,,,OUTPATIENT,,,18.35,14.68,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.68,80,,11.74,,,0,"percent of total billed charges ","80% of total billed charges ",12.85,70,,10.28,,,0,"percent of total billed charges ","70% of total billed charges ",16.52,90,,13.22,,,0,"percent of total billed charges ","90% of total billed charges ",17.07,93,,13.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.6,85,,12.48,,,0,"percent of total billed charges ","85% of total billed charges ",16.52,90,,13.22,,,0,"percent of total billed charges ","90% of total billed charges ",16.52,90,,13.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.96,87,,12.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.85,70,,10.28,,,0,"percent of total billed charges ","70% of total billed charges ",12.85,17.07,
"DRESSING NUGAUSE IODO 1""",6101997,"CDM ",272,RC,,,OUTPATIENT,,,21,16.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.8,80,,13.44,,,0,"percent of total billed charges ","80% of total billed charges ",14.7,70,,11.76,,,0,"percent of total billed charges ","70% of total billed charges ",18.9,90,,15.12,,,0,"percent of total billed charges ","90% of total billed charges ",19.53,93,,15.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.85,85,,14.28,,,0,"percent of total billed charges ","85% of total billed charges ",18.9,90,,15.12,,,0,"percent of total billed charges ","90% of total billed charges ",18.9,90,,15.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.27,87,,14.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.7,70,,11.76,,,0,"percent of total billed charges ","70% of total billed charges ",14.7,19.53,
"SUTURE VICRYL 0 JJ91G",6102019,"CDM ",272,RC,,,OUTPATIENT,,,83.79,67.032,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.03,80,,53.62,,,0,"percent of total billed charges ","80% of total billed charges ",58.65,70,,46.92,,,0,"percent of total billed charges ","70% of total billed charges ",75.41,90,,60.33,,,0,"percent of total billed charges ","90% of total billed charges ",77.92,93,,62.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",71.22,85,,56.98,,,0,"percent of total billed charges ","85% of total billed charges ",75.41,90,,60.33,,,0,"percent of total billed charges ","90% of total billed charges ",75.41,90,,60.33,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",72.9,87,,58.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.65,70,,46.92,,,0,"percent of total billed charges ","70% of total billed charges ",58.65,77.92,
"CANNULA THREADED 6MM X 75MM",6102035,"CDM ",272,RC,,,OUTPATIENT,,,88.9,71.12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.12,80,,56.90,,,0,"percent of total billed charges ","80% of total billed charges ",62.23,70,,49.78,,,0,"percent of total billed charges ","70% of total billed charges ",80.01,90,,64.01,,,0,"percent of total billed charges ","90% of total billed charges ",82.68,93,,66.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",75.57,85,,60.46,,,0,"percent of total billed charges ","85% of total billed charges ",80.01,90,,64.01,,,0,"percent of total billed charges ","90% of total billed charges ",80.01,90,,64.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",77.34,87,,61.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.23,70,,49.78,,,0,"percent of total billed charges ","70% of total billed charges ",62.23,82.68,
"SUTURE CHROMIC 3.0 G172H",6102040,"CDM ",272,RC,,,OUTPATIENT,,,18.71,14.968,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.97,80,,11.98,,,0,"percent of total billed charges ","80% of total billed charges ",13.1,70,,10.48,,,0,"percent of total billed charges ","70% of total billed charges ",16.84,90,,13.47,,,0,"percent of total billed charges ","90% of total billed charges ",17.4,93,,13.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.9,85,,12.72,,,0,"percent of total billed charges ","85% of total billed charges ",16.84,90,,13.47,,,0,"percent of total billed charges ","90% of total billed charges ",16.84,90,,13.47,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.28,87,,13.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.1,70,,10.48,,,0,"percent of total billed charges ","70% of total billed charges ",13.1,17.4,
"LOOP ELECTRODE GYN 20 X 13M",6102080,"CDM ",272,RC,,,OUTPATIENT,,,47.96,38.368,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.37,80,,30.70,,,0,"percent of total billed charges ","80% of total billed charges ",33.57,70,,26.86,,,0,"percent of total billed charges ","70% of total billed charges ",43.16,90,,34.53,,,0,"percent of total billed charges ","90% of total billed charges ",44.6,93,,35.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.77,85,,32.62,,,0,"percent of total billed charges ","85% of total billed charges ",43.16,90,,34.53,,,0,"percent of total billed charges ","90% of total billed charges ",43.16,90,,34.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.73,87,,33.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.57,70,,26.86,,,0,"percent of total billed charges ","70% of total billed charges ",33.57,44.6,
"SUTURE 8557H PROLENE 4.0",6102102,"CDM ",272,RC,,,OUTPATIENT,,,25.83,20.664,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.66,80,,16.53,,,0,"percent of total billed charges ","80% of total billed charges ",18.08,70,,14.46,,,0,"percent of total billed charges ","70% of total billed charges ",23.25,90,,18.60,,,0,"percent of total billed charges ","90% of total billed charges ",24.02,93,,19.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.96,85,,17.57,,,0,"percent of total billed charges ","85% of total billed charges ",23.25,90,,18.60,,,0,"percent of total billed charges ","90% of total billed charges ",23.25,90,,18.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.47,87,,17.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.08,70,,14.46,,,0,"percent of total billed charges ","70% of total billed charges ",18.08,24.02,
"LOOP VESSEL YELLOW",6102118,"CDM ",272,RC,,,OUTPATIENT,,,10.73,8.584,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.58,80,,6.86,,,0,"percent of total billed charges ","80% of total billed charges ",7.51,70,,6.01,,,0,"percent of total billed charges ","70% of total billed charges ",9.66,90,,7.73,,,0,"percent of total billed charges ","90% of total billed charges ",9.98,93,,7.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.12,85,,7.30,,,0,"percent of total billed charges ","85% of total billed charges ",9.66,90,,7.73,,,0,"percent of total billed charges ","90% of total billed charges ",9.66,90,,7.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.34,87,,7.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.51,70,,6.01,,,0,"percent of total billed charges ","70% of total billed charges ",7.51,9.98,
"TAP SHORT 4.5MM",6102136,"CDM ",272,RC,,,OUTPATIENT,,,136,108.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.8,80,,87.04,,,0,"percent of total billed charges ","80% of total billed charges ",95.2,70,,76.16,,,0,"percent of total billed charges ","70% of total billed charges ",122.4,90,,97.92,,,0,"percent of total billed charges ","90% of total billed charges ",126.48,93,,101.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",115.6,85,,92.48,,,0,"percent of total billed charges ","85% of total billed charges ",122.4,90,,97.92,,,0,"percent of total billed charges ","90% of total billed charges ",122.4,90,,97.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",118.32,87,,94.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.2,70,,76.16,,,0,"percent of total billed charges ","70% of total billed charges ",95.2,126.48,
"DRESSING NASAL 8CM LAMINATED",6102137,"CDM ",272,RC,,,OUTPATIENT,,,73.34,58.672,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.67,80,,46.94,,,0,"percent of total billed charges ","80% of total billed charges ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",68.21,93,,54.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.34,85,,49.87,,,0,"percent of total billed charges ","85% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",66.01,90,,52.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.81,87,,51.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.34,70,,41.07,,,0,"percent of total billed charges ","70% of total billed charges ",51.34,68.21,
"FIXATOR DISTAL RADIUS",6102138,"CDM ",278,RC,,,OUTPATIENT,,,3757.05,3005.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3005.64,80,,2404.51,,,0,"percent of total billed charges ","80% of total billed charges ",2629.94,70,,2103.95,,,0,"percent of total billed charges ","70% of total billed charges ",3381.35,90,,2705.08,,,0,"percent of total billed charges ","90% of total billed charges ",3494.06,93,,2795.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3193.49,85,,2554.79,,,0,"percent of total billed charges ","85% of total billed charges ",3193.49,85,,2554.79,,,0,"percent of total billed charges ","85% of total billed charges ",3381.35,90,,2705.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3268.63,87,,2614.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2629.94,70,,2103.95,,,0,"percent of total billed charges ","70% of total billed charges ",2629.94,3494.06,
"DEVICE NOVASURE CAUTERY",6102149,"CDM ",279,RC,,,OUTPATIENT,,,1869.78,1495.824,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1495.82,80,,1196.66,,,0,"percent of total billed charges ","80% of total billed charges ",1308.85,70,,1047.08,,,0,"percent of total billed charges ","70% of total billed charges ",1682.8,90,,1346.24,,,0,"percent of total billed charges ","90% of total billed charges ",1738.9,93,,1391.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1589.31,85,,1271.45,,,0,"percent of total billed charges ","85% of total billed charges ",1682.8,90,,1346.24,,,0,"percent of total billed charges ","90% of total billed charges ",1682.8,90,,1346.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1626.71,87,,1301.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1308.85,70,,1047.08,,,0,"percent of total billed charges ","70% of total billed charges ",1308.85,1738.9,
"KIT DRAIN PLEURX",6102152,"CDM ",272,RC,,,OUTPATIENT,,,229.5,183.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.6,80,,146.88,,,0,"percent of total billed charges ","80% of total billed charges ",160.65,70,,128.52,,,0,"percent of total billed charges ","70% of total billed charges ",206.55,90,,165.24,,,0,"percent of total billed charges ","90% of total billed charges ",213.44,93,,170.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",195.08,85,,156.06,,,0,"percent of total billed charges ","85% of total billed charges ",206.55,90,,165.24,,,0,"percent of total billed charges ","90% of total billed charges ",206.55,90,,165.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",199.67,87,,159.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",160.65,70,,128.52,,,0,"percent of total billed charges ","70% of total billed charges ",160.65,213.44,
"SUTURE CHROMIC 2.0 G123H",6102165,"CDM ",272,RC,,,OUTPATIENT,,,11.13,8.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.9,80,,7.12,,,0,"percent of total billed charges ","80% of total billed charges ",7.79,70,,6.23,,,0,"percent of total billed charges ","70% of total billed charges ",10.02,90,,8.02,,,0,"percent of total billed charges ","90% of total billed charges ",10.35,93,,8.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.46,85,,7.57,,,0,"percent of total billed charges ","85% of total billed charges ",10.02,90,,8.02,,,0,"percent of total billed charges ","90% of total billed charges ",10.02,90,,8.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.68,87,,7.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.79,70,,6.23,,,0,"percent of total billed charges ","70% of total billed charges ",7.79,10.35,
"BURR SEPTOPLASTY 32M",6102174,"CDM ",272,RC,,,OUTPATIENT,,,380.72,304.576,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",304.58,80,,243.66,,,0,"percent of total billed charges ","80% of total billed charges ",266.5,70,,213.20,,,0,"percent of total billed charges ","70% of total billed charges ",342.65,90,,274.12,,,0,"percent of total billed charges ","90% of total billed charges ",354.07,93,,283.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",323.61,85,,258.89,,,0,"percent of total billed charges ","85% of total billed charges ",342.65,90,,274.12,,,0,"percent of total billed charges ","90% of total billed charges ",342.65,90,,274.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",331.23,87,,264.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",266.5,70,,213.20,,,0,"percent of total billed charges ","70% of total billed charges ",266.5,354.07,
"BLADE LARYNGEAL 3.5",6102175,"CDM ",272,RC,,,OUTPATIENT,,,662.3,529.84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",529.84,80,,423.87,,,0,"percent of total billed charges ","80% of total billed charges ",463.61,70,,370.89,,,0,"percent of total billed charges ","70% of total billed charges ",596.07,90,,476.86,,,0,"percent of total billed charges ","90% of total billed charges ",615.94,93,,492.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",562.96,85,,450.37,,,0,"percent of total billed charges ","85% of total billed charges ",596.07,90,,476.86,,,0,"percent of total billed charges ","90% of total billed charges ",596.07,90,,476.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",576.2,87,,460.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",463.61,70,,370.89,,,0,"percent of total billed charges ","70% of total billed charges ",463.61,615.94,
"PAD GROUNDING PEDIATRIC",6102184,"CDM ",272,RC,,,OUTPATIENT,,,21.51,17.208,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.21,80,,13.77,,,0,"percent of total billed charges ","80% of total billed charges ",15.06,70,,12.05,,,0,"percent of total billed charges ","70% of total billed charges ",19.36,90,,15.49,,,0,"percent of total billed charges ","90% of total billed charges ",20,93,,16.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.28,85,,14.62,,,0,"percent of total billed charges ","85% of total billed charges ",19.36,90,,15.49,,,0,"percent of total billed charges ","90% of total billed charges ",19.36,90,,15.49,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.71,87,,14.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.06,70,,12.05,,,0,"percent of total billed charges ","70% of total billed charges ",15.06,20,
"LOOP ENDO CHROMIC",6102187,"CDM ",272,RC,,,OUTPATIENT,,,50.27,40.216,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.22,80,,32.18,,,0,"percent of total billed charges ","80% of total billed charges ",35.19,70,,28.15,,,0,"percent of total billed charges ","70% of total billed charges ",45.24,90,,36.19,,,0,"percent of total billed charges ","90% of total billed charges ",46.75,93,,37.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.73,85,,34.18,,,0,"percent of total billed charges ","85% of total billed charges ",45.24,90,,36.19,,,0,"percent of total billed charges ","90% of total billed charges ",45.24,90,,36.19,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.73,87,,34.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.19,70,,28.15,,,0,"percent of total billed charges ","70% of total billed charges ",35.19,46.75,
"BLADE SET T&S POWERED",6102189,"CDM ",272,RC,,,OUTPATIENT,,,256.88,205.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",205.5,80,,164.40,,,0,"percent of total billed charges ","80% of total billed charges ",179.82,70,,143.86,,,0,"percent of total billed charges ","70% of total billed charges ",231.19,90,,184.95,,,0,"percent of total billed charges ","90% of total billed charges ",238.9,93,,191.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",218.35,85,,174.68,,,0,"percent of total billed charges ","85% of total billed charges ",231.19,90,,184.95,,,0,"percent of total billed charges ","90% of total billed charges ",231.19,90,,184.95,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",223.49,87,,178.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",179.82,70,,143.86,,,0,"percent of total billed charges ","70% of total billed charges ",179.82,238.9,
"OSTEO KYPHOPLASTY SUPPLY",6102194,"CDM ",272,RC,,,OUTPATIENT,,,4346.93,3477.544,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3477.54,80,,2782.03,,,0,"percent of total billed charges ","80% of total billed charges ",3042.85,70,,2434.28,,,0,"percent of total billed charges ","70% of total billed charges ",3912.24,90,,3129.79,,,0,"percent of total billed charges ","90% of total billed charges ",4042.64,93,,3234.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3694.89,85,,2955.91,,,0,"percent of total billed charges ","85% of total billed charges ",3912.24,90,,3129.79,,,0,"percent of total billed charges ","90% of total billed charges ",3912.24,90,,3129.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3781.83,87,,3025.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3042.85,70,,2434.28,,,0,"percent of total billed charges ","70% of total billed charges ",3042.85,4042.64,
"SUTURE R496T MERSILENE 2.0",6102199,"CDM ",272,RC,,,OUTPATIENT,,,16.4,13.12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.12,80,,10.50,,,0,"percent of total billed charges ","80% of total billed charges ",11.48,70,,9.18,,,0,"percent of total billed charges ","70% of total billed charges ",14.76,90,,11.81,,,0,"percent of total billed charges ","90% of total billed charges ",15.25,93,,12.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.94,85,,11.15,,,0,"percent of total billed charges ","85% of total billed charges ",14.76,90,,11.81,,,0,"percent of total billed charges ","90% of total billed charges ",14.76,90,,11.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.27,87,,11.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.48,70,,9.18,,,0,"percent of total billed charges ","70% of total billed charges ",11.48,15.25,
"GUIDE 3.5MM TAP SLEEVE/DRILL",6102213,"CDM ",272,RC,,,OUTPATIENT,,,382.46,305.968,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",305.97,80,,244.78,,,0,"percent of total billed charges ","80% of total billed charges ",267.72,70,,214.18,,,0,"percent of total billed charges ","70% of total billed charges ",344.21,90,,275.37,,,0,"percent of total billed charges ","90% of total billed charges ",355.69,93,,284.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",325.09,85,,260.07,,,0,"percent of total billed charges ","85% of total billed charges ",344.21,90,,275.37,,,0,"percent of total billed charges ","90% of total billed charges ",344.21,90,,275.37,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",332.74,87,,266.19,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",267.72,70,,214.18,,,0,"percent of total billed charges ","70% of total billed charges ",267.72,355.69,
"SLEEVE COMPRESSION MED",6102231,"CDM ",271,RC,,,OUTPATIENT,,,99.21,79.368,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.37,80,,63.50,,,0,"percent of total billed charges ","80% of total billed charges ",69.45,70,,55.56,,,0,"percent of total billed charges ","70% of total billed charges ",89.29,90,,71.43,,,0,"percent of total billed charges ","90% of total billed charges ",92.27,93,,73.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",84.33,85,,67.46,,,0,"percent of total billed charges ","85% of total billed charges ",89.29,90,,71.43,,,0,"percent of total billed charges ","90% of total billed charges ",89.29,90,,71.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",86.31,87,,69.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.45,70,,55.56,,,0,"percent of total billed charges ","70% of total billed charges ",69.45,92.27,
"CURRETTE CURVED 7MM",6102235,"CDM ",272,RC,,,OUTPATIENT,,,17.7,14.16,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.16,80,,11.33,,,0,"percent of total billed charges ","80% of total billed charges ",12.39,70,,9.91,,,0,"percent of total billed charges ","70% of total billed charges ",15.93,90,,12.74,,,0,"percent of total billed charges ","90% of total billed charges ",16.46,93,,13.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.05,85,,12.04,,,0,"percent of total billed charges ","85% of total billed charges ",15.93,90,,12.74,,,0,"percent of total billed charges ","90% of total billed charges ",15.93,90,,12.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.4,87,,12.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.39,70,,9.91,,,0,"percent of total billed charges ","70% of total billed charges ",12.39,16.46,
"CURRETTE CURVED 9MM",6102240,"CDM ",272,RC,,,OUTPATIENT,,,17.7,14.16,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.16,80,,11.33,,,0,"percent of total billed charges ","80% of total billed charges ",12.39,70,,9.91,,,0,"percent of total billed charges ","70% of total billed charges ",15.93,90,,12.74,,,0,"percent of total billed charges ","90% of total billed charges ",16.46,93,,13.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.05,85,,12.04,,,0,"percent of total billed charges ","85% of total billed charges ",15.93,90,,12.74,,,0,"percent of total billed charges ","90% of total billed charges ",15.93,90,,12.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.4,87,,12.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.39,70,,9.91,,,0,"percent of total billed charges ","70% of total billed charges ",12.39,16.46,
"BOTTLE W/CAP-SUCTION",6102248,"CDM ",272,RC,,,OUTPATIENT,,,47.03,37.624,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.62,80,,30.10,,,0,"percent of total billed charges ","80% of total billed charges ",32.92,70,,26.34,,,0,"percent of total billed charges ","70% of total billed charges ",42.33,90,,33.86,,,0,"percent of total billed charges ","90% of total billed charges ",43.74,93,,34.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.98,85,,31.98,,,0,"percent of total billed charges ","85% of total billed charges ",42.33,90,,33.86,,,0,"percent of total billed charges ","90% of total billed charges ",42.33,90,,33.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.92,87,,32.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.92,70,,26.34,,,0,"percent of total billed charges ","70% of total billed charges ",32.92,43.74,
"SUTURE PLAIN GUT 3.0 842H",6102270,"CDM ",272,RC,,,OUTPATIENT,,,10.93,8.744,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.74,80,,6.99,,,0,"percent of total billed charges ","80% of total billed charges ",7.65,70,,6.12,,,0,"percent of total billed charges ","70% of total billed charges ",9.84,90,,7.87,,,0,"percent of total billed charges ","90% of total billed charges ",10.16,93,,8.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.29,85,,7.43,,,0,"percent of total billed charges ","85% of total billed charges ",9.84,90,,7.87,,,0,"percent of total billed charges ","90% of total billed charges ",9.84,90,,7.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.51,87,,7.61,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.65,70,,6.12,,,0,"percent of total billed charges ","70% of total billed charges ",7.65,10.16,
"PACK EYE CUSTOM B&L",6102272,"CDM ",272,RC,,,OUTPATIENT,,,160.15,128.12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.12,80,,102.50,,,0,"percent of total billed charges ","80% of total billed charges ",112.11,70,,89.69,,,0,"percent of total billed charges ","70% of total billed charges ",144.14,90,,115.31,,,0,"percent of total billed charges ","90% of total billed charges ",148.94,93,,119.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.13,85,,108.90,,,0,"percent of total billed charges ","85% of total billed charges ",144.14,90,,115.31,,,0,"percent of total billed charges ","90% of total billed charges ",144.14,90,,115.31,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.33,87,,111.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.11,70,,89.69,,,0,"percent of total billed charges ","70% of total billed charges ",112.11,148.94,
"CURRETTE CURVED 11MM",6102273,"CDM ",272,RC,,,OUTPATIENT,,,17.7,14.16,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.16,80,,11.33,,,0,"percent of total billed charges ","80% of total billed charges ",12.39,70,,9.91,,,0,"percent of total billed charges ","70% of total billed charges ",15.93,90,,12.74,,,0,"percent of total billed charges ","90% of total billed charges ",16.46,93,,13.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.05,85,,12.04,,,0,"percent of total billed charges ","85% of total billed charges ",15.93,90,,12.74,,,0,"percent of total billed charges ","90% of total billed charges ",15.93,90,,12.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.4,87,,12.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.39,70,,9.91,,,0,"percent of total billed charges ","70% of total billed charges ",12.39,16.46,
"CEMENT BONE KYPHON",6102317,"CDM ",272,RC,,,OUTPATIENT,,,283.92,227.136,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.14,80,,181.71,,,0,"percent of total billed charges ","80% of total billed charges ",198.74,70,,158.99,,,0,"percent of total billed charges ","70% of total billed charges ",255.53,90,,204.42,,,0,"percent of total billed charges ","90% of total billed charges ",264.05,93,,211.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",241.33,85,,193.06,,,0,"percent of total billed charges ","85% of total billed charges ",255.53,90,,204.42,,,0,"percent of total billed charges ","90% of total billed charges ",255.53,90,,204.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",247.01,87,,197.61,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",198.74,70,,158.99,,,0,"percent of total billed charges ","70% of total billed charges ",198.74,264.05,
"ADAPTER DRAIN TUBE",6102319,"CDM ",271,RC,,,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,80,,8.00,,,0,"percent of total billed charges ","80% of total billed charges ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"APPLIER CLIP ENDO 5MM",6102323,"CDM ",272,RC,,,OUTPATIENT,,,252.29,201.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",201.83,80,,161.46,,,0,"percent of total billed charges ","80% of total billed charges ",176.6,70,,141.28,,,0,"percent of total billed charges ","70% of total billed charges ",227.06,90,,181.65,,,0,"percent of total billed charges ","90% of total billed charges ",234.63,93,,187.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",214.45,85,,171.56,,,0,"percent of total billed charges ","85% of total billed charges ",227.06,90,,181.65,,,0,"percent of total billed charges ","90% of total billed charges ",227.06,90,,181.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",219.49,87,,175.59,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.6,70,,141.28,,,0,"percent of total billed charges ","70% of total billed charges ",176.6,234.63,
"ENDOCUTTER ECHELON 60MM SHORT",6102334,"CDM ",272,RC,,,OUTPATIENT,,,796.57,637.256,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",637.26,80,,509.81,,,0,"percent of total billed charges ","80% of total billed charges ",557.6,70,,446.08,,,0,"percent of total billed charges ","70% of total billed charges ",716.91,90,,573.53,,,0,"percent of total billed charges ","90% of total billed charges ",740.81,93,,592.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",677.08,85,,541.66,,,0,"percent of total billed charges ","85% of total billed charges ",716.91,90,,573.53,,,0,"percent of total billed charges ","90% of total billed charges ",716.91,90,,573.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",693.02,87,,554.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",557.6,70,,446.08,,,0,"percent of total billed charges ","70% of total billed charges ",557.6,740.81,
"NEEDLE ABD TRIANGULAR POINT",6102336,"CDM ",272,RC,,,OUTPATIENT,,,19.76,15.808,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.81,80,,12.65,,,0,"percent of total billed charges ","80% of total billed charges ",13.83,70,,11.06,,,0,"percent of total billed charges ","70% of total billed charges ",17.78,90,,14.22,,,0,"percent of total billed charges ","90% of total billed charges ",18.38,93,,14.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.8,85,,13.44,,,0,"percent of total billed charges ","85% of total billed charges ",17.78,90,,14.22,,,0,"percent of total billed charges ","90% of total billed charges ",17.78,90,,14.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.19,87,,13.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.83,70,,11.06,,,0,"percent of total billed charges ","70% of total billed charges ",13.83,18.38,
"SUTURE ETHB 2.0",6102342,"CDM ",272,RC,,,OUTPATIENT,,,39.82,31.856,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.86,80,,25.49,,,0,"percent of total billed charges ","80% of total billed charges ",27.87,70,,22.30,,,0,"percent of total billed charges ","70% of total billed charges ",35.84,90,,28.67,,,0,"percent of total billed charges ","90% of total billed charges ",37.03,93,,29.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.85,85,,27.08,,,0,"percent of total billed charges ","85% of total billed charges ",35.84,90,,28.67,,,0,"percent of total billed charges ","90% of total billed charges ",35.84,90,,28.67,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",34.64,87,,27.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.87,70,,22.30,,,0,"percent of total billed charges ","70% of total billed charges ",27.87,37.03,
"INSERTER MESH",6102344,"CDM ",272,RC,,,OUTPATIENT,,,368.13,294.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",294.5,80,,235.60,,,0,"percent of total billed charges ","80% of total billed charges ",257.69,70,,206.15,,,0,"percent of total billed charges ","70% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",342.36,93,,273.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",312.91,85,,250.33,,,0,"percent of total billed charges ","85% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",320.27,87,,256.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",257.69,70,,206.15,,,0,"percent of total billed charges ","70% of total billed charges ",257.69,342.36,
"TROCAR 5MM X 150MM",6102349,"CDM ",272,RC,,,OUTPATIENT,,,133.35,106.68,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.68,80,,85.34,,,0,"percent of total billed charges ","80% of total billed charges ",93.35,70,,74.68,,,0,"percent of total billed charges ","70% of total billed charges ",120.02,90,,96.02,,,0,"percent of total billed charges ","90% of total billed charges ",124.02,93,,99.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",113.35,85,,90.68,,,0,"percent of total billed charges ","85% of total billed charges ",120.02,90,,96.02,,,0,"percent of total billed charges ","90% of total billed charges ",120.02,90,,96.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",116.01,87,,92.81,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.35,70,,74.68,,,0,"percent of total billed charges ","70% of total billed charges ",93.35,124.02,
"TROCAR 12MM X 150MM",6102350,"CDM ",272,RC,,,OUTPATIENT,,,172.38,137.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",137.9,80,,110.32,,,0,"percent of total billed charges ","80% of total billed charges ",120.67,70,,96.54,,,0,"percent of total billed charges ","70% of total billed charges ",155.14,90,,124.11,,,0,"percent of total billed charges ","90% of total billed charges ",160.31,93,,128.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",146.52,85,,117.22,,,0,"percent of total billed charges ","85% of total billed charges ",155.14,90,,124.11,,,0,"percent of total billed charges ","90% of total billed charges ",155.14,90,,124.11,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",149.97,87,,119.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.67,70,,96.54,,,0,"percent of total billed charges ","70% of total billed charges ",120.67,160.31,
"DRAPE STERI IOBAN",6102368,"CDM ",272,RC,,,OUTPATIENT,,,34.6,27.68,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.68,80,,22.14,,,0,"percent of total billed charges ","80% of total billed charges ",24.22,70,,19.38,,,0,"percent of total billed charges ","70% of total billed charges ",31.14,90,,24.91,,,0,"percent of total billed charges ","90% of total billed charges ",32.18,93,,25.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",29.41,85,,23.53,,,0,"percent of total billed charges ","85% of total billed charges ",31.14,90,,24.91,,,0,"percent of total billed charges ","90% of total billed charges ",31.14,90,,24.91,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.1,87,,24.08,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.22,70,,19.38,,,0,"percent of total billed charges ","70% of total billed charges ",24.22,32.18,
"INJECTOR VARICIES DISP 7FR",6102377,"CDM ",272,RC,,,OUTPATIENT,,,123.35,98.68,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.68,80,,78.94,,,0,"percent of total billed charges ","80% of total billed charges ",86.35,70,,69.08,,,0,"percent of total billed charges ","70% of total billed charges ",111.02,90,,88.82,,,0,"percent of total billed charges ","90% of total billed charges ",114.72,93,,91.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",104.85,85,,83.88,,,0,"percent of total billed charges ","85% of total billed charges ",111.02,90,,88.82,,,0,"percent of total billed charges ","90% of total billed charges ",111.02,90,,88.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",107.31,87,,85.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.35,70,,69.08,,,0,"percent of total billed charges ","70% of total billed charges ",86.35,114.72,
"SUTURE ETH 3.0 PS-2",6102385,"CDM ",272,RC,,,OUTPATIENT,,,12.54,10.032,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.03,80,,8.02,,,0,"percent of total billed charges ","80% of total billed charges ",8.78,70,,7.02,,,0,"percent of total billed charges ","70% of total billed charges ",11.29,90,,9.03,,,0,"percent of total billed charges ","90% of total billed charges ",11.66,93,,9.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.66,85,,8.53,,,0,"percent of total billed charges ","85% of total billed charges ",11.29,90,,9.03,,,0,"percent of total billed charges ","90% of total billed charges ",11.29,90,,9.03,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.91,87,,8.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.78,70,,7.02,,,0,"percent of total billed charges ","70% of total billed charges ",8.78,11.66,
"INTRODUCER OSTEO 15/13",6102389,"CDM ",272,RC,,,OUTPATIENT,,,6524.93,5219.944,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5219.94,80,,4175.95,,,0,"percent of total billed charges ","80% of total billed charges ",4567.45,70,,3653.96,,,0,"percent of total billed charges ","70% of total billed charges ",5872.44,90,,4697.95,,,0,"percent of total billed charges ","90% of total billed charges ",6068.18,93,,4854.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5546.19,85,,4436.95,,,0,"percent of total billed charges ","85% of total billed charges ",5872.44,90,,4697.95,,,0,"percent of total billed charges ","90% of total billed charges ",5872.44,90,,4697.95,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5676.69,87,,4541.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4567.45,70,,3653.96,,,0,"percent of total billed charges ","70% of total billed charges ",4567.45,6068.18,
"COVER CIV-FLEX STERILE",6102394,"CDM ",272,RC,,,OUTPATIENT,,,29.89,23.912,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.91,80,,19.13,,,0,"percent of total billed charges ","80% of total billed charges ",20.92,70,,16.74,,,0,"percent of total billed charges ","70% of total billed charges ",26.9,90,,21.52,,,0,"percent of total billed charges ","90% of total billed charges ",27.8,93,,22.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.41,85,,20.33,,,0,"percent of total billed charges ","85% of total billed charges ",26.9,90,,21.52,,,0,"percent of total billed charges ","90% of total billed charges ",26.9,90,,21.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26,87,,20.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.92,70,,16.74,,,0,"percent of total billed charges ","70% of total billed charges ",20.92,27.8,
"SUTURE J552G 6.0 VICRYL",6102399,"CDM ",272,RC,,,OUTPATIENT,,,45.21,36.168,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.17,80,,28.94,,,0,"percent of total billed charges ","80% of total billed charges ",31.65,70,,25.32,,,0,"percent of total billed charges ","70% of total billed charges ",40.69,90,,32.55,,,0,"percent of total billed charges ","90% of total billed charges ",42.05,93,,33.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.43,85,,30.74,,,0,"percent of total billed charges ","85% of total billed charges ",40.69,90,,32.55,,,0,"percent of total billed charges ","90% of total billed charges ",40.69,90,,32.55,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.33,87,,31.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.65,70,,25.32,,,0,"percent of total billed charges ","70% of total billed charges ",31.65,42.05,
"TAMP BONE INF 15M",6102403,"CDM ",278,RC,,,OUTPATIENT,,,2168.93,1735.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1735.14,80,,1388.11,,,0,"percent of total billed charges ","80% of total billed charges ",1518.25,70,,1214.60,,,0,"percent of total billed charges ","70% of total billed charges ",1952.04,90,,1561.63,,,0,"percent of total billed charges ","90% of total billed charges ",2017.1,93,,1613.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1843.59,85,,1474.87,,,0,"percent of total billed charges ","85% of total billed charges ",1843.59,85,,1474.87,,,0,"percent of total billed charges ","85% of total billed charges ",1952.04,90,,1561.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1886.97,87,,1509.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1518.25,70,,1214.60,,,0,"percent of total billed charges ","70% of total billed charges ",1518.25,2017.1,
"CLIP MULTI ENDO",6102409,"CDM ",272,RC,,,OUTPATIENT,,,264.35,211.48,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",211.48,80,,169.18,,,0,"percent of total billed charges ","80% of total billed charges ",185.05,70,,148.04,,,0,"percent of total billed charges ","70% of total billed charges ",237.92,90,,190.34,,,0,"percent of total billed charges ","90% of total billed charges ",245.85,93,,196.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",224.7,85,,179.76,,,0,"percent of total billed charges ","85% of total billed charges ",237.92,90,,190.34,,,0,"percent of total billed charges ","90% of total billed charges ",237.92,90,,190.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",229.98,87,,183.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",185.05,70,,148.04,,,0,"percent of total billed charges ","70% of total billed charges ",185.05,245.85,
"ROD CARBON FIBER 200MM",6102421,"CDM ",278,RC,,,OUTPATIENT,,,300.5,240.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",240.4,80,,192.32,,,0,"percent of total billed charges ","80% of total billed charges ",210.35,70,,168.28,,,0,"percent of total billed charges ","70% of total billed charges ",270.45,90,,216.36,,,0,"percent of total billed charges ","90% of total billed charges ",279.47,93,,223.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",255.43,85,,204.34,,,0,"percent of total billed charges ","85% of total billed charges ",255.43,85,,204.34,,,0,"percent of total billed charges ","85% of total billed charges ",270.45,90,,216.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",261.44,87,,209.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.35,70,,168.28,,,0,"percent of total billed charges ","70% of total billed charges ",210.35,279.47,
"ROD CARBON FIBER 220MM",6102423,"CDM ",278,RC,,,OUTPATIENT,,,300.5,240.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",240.4,80,,192.32,,,0,"percent of total billed charges ","80% of total billed charges ",210.35,70,,168.28,,,0,"percent of total billed charges ","70% of total billed charges ",270.45,90,,216.36,,,0,"percent of total billed charges ","90% of total billed charges ",279.47,93,,223.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",255.43,85,,204.34,,,0,"percent of total billed charges ","85% of total billed charges ",255.43,85,,204.34,,,0,"percent of total billed charges ","85% of total billed charges ",270.45,90,,216.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",261.44,87,,209.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.35,70,,168.28,,,0,"percent of total billed charges ","70% of total billed charges ",210.35,279.47,
"ROD CARBON FIBER 240MM",6102427,"CDM ",278,RC,,,OUTPATIENT,,,300.5,240.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",240.4,80,,192.32,,,0,"percent of total billed charges ","80% of total billed charges ",210.35,70,,168.28,,,0,"percent of total billed charges ","70% of total billed charges ",270.45,90,,216.36,,,0,"percent of total billed charges ","90% of total billed charges ",279.47,93,,223.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",255.43,85,,204.34,,,0,"percent of total billed charges ","85% of total billed charges ",255.43,85,,204.34,,,0,"percent of total billed charges ","85% of total billed charges ",270.45,90,,216.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",261.44,87,,209.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.35,70,,168.28,,,0,"percent of total billed charges ","70% of total billed charges ",210.35,279.47,
"ELECTRODE TIP 90 D. ANGLES",6102432,"CDM ",272,RC,,,OUTPATIENT,,,329.38,263.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.5,80,,210.80,,,0,"percent of total billed charges ","80% of total billed charges ",230.57,70,,184.46,,,0,"percent of total billed charges ","70% of total billed charges ",296.44,90,,237.15,,,0,"percent of total billed charges ","90% of total billed charges ",306.32,93,,245.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",279.97,85,,223.98,,,0,"percent of total billed charges ","85% of total billed charges ",296.44,90,,237.15,,,0,"percent of total billed charges ","90% of total billed charges ",296.44,90,,237.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",286.56,87,,229.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",230.57,70,,184.46,,,0,"percent of total billed charges ","70% of total billed charges ",230.57,306.32,
"RENTAL TRANSFER BARIATRIC",6102438,"CDM ",271,RC,,,OUTPATIENT,,,85.34,68.272,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.27,80,,54.62,,,0,"percent of total billed charges ","80% of total billed charges ",59.74,70,,47.79,,,0,"percent of total billed charges ","70% of total billed charges ",76.81,90,,61.45,,,0,"percent of total billed charges ","90% of total billed charges ",79.37,93,,63.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",72.54,85,,58.03,,,0,"percent of total billed charges ","85% of total billed charges ",76.81,90,,61.45,,,0,"percent of total billed charges ","90% of total billed charges ",76.81,90,,61.45,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",74.25,87,,59.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.74,70,,47.79,,,0,"percent of total billed charges ","70% of total billed charges ",59.74,79.37,
"CAPS PROTECTIVE",6102441,"CDM ",272,RC,,,OUTPATIENT,,,17,13.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.6,80,,10.88,,,0,"percent of total billed charges ","80% of total billed charges ",11.9,70,,9.52,,,0,"percent of total billed charges ","70% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.81,93,,12.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.45,85,,11.56,,,0,"percent of total billed charges ","85% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.79,87,,11.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.9,70,,9.52,,,0,"percent of total billed charges ","70% of total billed charges ",11.9,15.81,
"CLAMP 4.0MM ADJUSTABLE",6102445,"CDM ",278,RC,,,OUTPATIENT,,,1327,1061.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1061.6,80,,849.28,,,0,"percent of total billed charges ","80% of total billed charges ",928.9,70,,743.12,,,0,"percent of total billed charges ","70% of total billed charges ",1194.3,90,,955.44,,,0,"percent of total billed charges ","90% of total billed charges ",1234.11,93,,987.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1127.95,85,,902.36,,,0,"percent of total billed charges ","85% of total billed charges ",1127.95,85,,902.36,,,0,"percent of total billed charges ","85% of total billed charges ",1194.3,90,,955.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1154.49,87,,923.59,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",928.9,70,,743.12,,,0,"percent of total billed charges ","70% of total billed charges ",928.9,1234.11,
"TRAY PREP WET SKIN",6102469,"CDM ",272,RC,,,OUTPATIENT,,,85.92,68.736,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.74,80,,54.99,,,0,"percent of total billed charges ","80% of total billed charges ",60.14,70,,48.11,,,0,"percent of total billed charges ","70% of total billed charges ",77.33,90,,61.86,,,0,"percent of total billed charges ","90% of total billed charges ",79.91,93,,63.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",73.03,85,,58.42,,,0,"percent of total billed charges ","85% of total billed charges ",77.33,90,,61.86,,,0,"percent of total billed charges ","90% of total billed charges ",77.33,90,,61.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",74.75,87,,59.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.14,70,,48.11,,,0,"percent of total billed charges ","70% of total billed charges ",60.14,79.91,
"BALL PIN .7MM",6102472,"CDM ",278,RC,,,OUTPATIENT,,,32.6,26.08,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.08,80,,20.86,,,0,"percent of total billed charges ","80% of total billed charges ",22.82,70,,18.26,,,0,"percent of total billed charges ","70% of total billed charges ",29.34,90,,23.47,,,0,"percent of total billed charges ","90% of total billed charges ",30.32,93,,24.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",27.71,85,,22.17,,,0,"percent of total billed charges ","85% of total billed charges ",27.71,85,,22.17,,,0,"percent of total billed charges ","85% of total billed charges ",29.34,90,,23.47,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",28.36,87,,22.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.82,70,,18.26,,,0,"percent of total billed charges ","70% of total billed charges ",22.82,30.32,
"BALL PIN .8MM",6102473,"CDM ",278,RC,,,OUTPATIENT,,,32.6,26.08,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.08,80,,20.86,,,0,"percent of total billed charges ","80% of total billed charges ",22.82,70,,18.26,,,0,"percent of total billed charges ","70% of total billed charges ",29.34,90,,23.47,,,0,"percent of total billed charges ","90% of total billed charges ",30.32,93,,24.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",27.71,85,,22.17,,,0,"percent of total billed charges ","85% of total billed charges ",27.71,85,,22.17,,,0,"percent of total billed charges ","85% of total billed charges ",29.34,90,,23.47,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",28.36,87,,22.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.82,70,,18.26,,,0,"percent of total billed charges ","70% of total billed charges ",22.82,30.32,
"BALL PIN 1.1 MM",6102474,"CDM ",278,RC,,,OUTPATIENT,,,32.6,26.08,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.08,80,,20.86,,,0,"percent of total billed charges ","80% of total billed charges ",22.82,70,,18.26,,,0,"percent of total billed charges ","70% of total billed charges ",29.34,90,,23.47,,,0,"percent of total billed charges ","90% of total billed charges ",30.32,93,,24.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",27.71,85,,22.17,,,0,"percent of total billed charges ","85% of total billed charges ",27.71,85,,22.17,,,0,"percent of total billed charges ","85% of total billed charges ",29.34,90,,23.47,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",28.36,87,,22.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.82,70,,18.26,,,0,"percent of total billed charges ","70% of total billed charges ",22.82,30.32,
"SET MINOR BASIN",6102480,"CDM ",272,RC,,,OUTPATIENT,,,41.32,33.056,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.06,80,,26.45,,,0,"percent of total billed charges ","80% of total billed charges ",28.92,70,,23.14,,,0,"percent of total billed charges ","70% of total billed charges ",37.19,90,,29.75,,,0,"percent of total billed charges ","90% of total billed charges ",38.43,93,,30.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",35.12,85,,28.10,,,0,"percent of total billed charges ","85% of total billed charges ",37.19,90,,29.75,,,0,"percent of total billed charges ","90% of total billed charges ",37.19,90,,29.75,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",35.95,87,,28.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.92,70,,23.14,,,0,"percent of total billed charges ","70% of total billed charges ",28.92,38.43,
"KIT INTERNAL BRACE",6102492,"CDM ",270,RC,,,OUTPATIENT,,,2849.1,2279.28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2279.28,80,,1823.42,,,0,"percent of total billed charges ","80% of total billed charges ",1994.37,70,,1595.50,,,0,"percent of total billed charges ","70% of total billed charges ",2564.19,90,,2051.35,,,0,"percent of total billed charges ","90% of total billed charges ",2649.66,93,,2119.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2421.74,85,,1937.39,,,0,"percent of total billed charges ","85% of total billed charges ",2564.19,90,,2051.35,,,0,"percent of total billed charges ","90% of total billed charges ",2564.19,90,,2051.35,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2478.72,87,,1982.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1994.37,70,,1595.50,,,0,"percent of total billed charges ","70% of total billed charges ",1994.37,2649.66,
"KIT INTERNAL BRACE PLUS",6102493,"CDM ",270,RC,,,OUTPATIENT,,,2849.1,2279.28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2279.28,80,,1823.42,,,0,"percent of total billed charges ","80% of total billed charges ",1994.37,70,,1595.50,,,0,"percent of total billed charges ","70% of total billed charges ",2564.19,90,,2051.35,,,0,"percent of total billed charges ","90% of total billed charges ",2649.66,93,,2119.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2421.74,85,,1937.39,,,0,"percent of total billed charges ","85% of total billed charges ",2564.19,90,,2051.35,,,0,"percent of total billed charges ","90% of total billed charges ",2564.19,90,,2051.35,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2478.72,87,,1982.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1994.37,70,,1595.50,,,0,"percent of total billed charges ","70% of total billed charges ",1994.37,2649.66,
"PILLOW ABDUCTION LARGE",6102510,"CDM ",271,RC,,,OUTPATIENT,,,65.16,52.128,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.13,80,,41.70,,,0,"percent of total billed charges ","80% of total billed charges ",45.61,70,,36.49,,,0,"percent of total billed charges ","70% of total billed charges ",58.64,90,,46.91,,,0,"percent of total billed charges ","90% of total billed charges ",60.6,93,,48.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",55.39,85,,44.31,,,0,"percent of total billed charges ","85% of total billed charges ",58.64,90,,46.91,,,0,"percent of total billed charges ","90% of total billed charges ",58.64,90,,46.91,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",56.69,87,,45.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.61,70,,36.49,,,0,"percent of total billed charges ","70% of total billed charges ",45.61,60.6,
"PILLOW ABDUCTION SMALL",6102511,"CDM ",271,RC,,,OUTPATIENT,,,50.36,40.288,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.29,80,,32.23,,,0,"percent of total billed charges ","80% of total billed charges ",35.25,70,,28.20,,,0,"percent of total billed charges ","70% of total billed charges ",45.32,90,,36.26,,,0,"percent of total billed charges ","90% of total billed charges ",46.83,93,,37.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.81,85,,34.25,,,0,"percent of total billed charges ","85% of total billed charges ",45.32,90,,36.26,,,0,"percent of total billed charges ","90% of total billed charges ",45.32,90,,36.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.81,87,,35.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.25,70,,28.20,,,0,"percent of total billed charges ","70% of total billed charges ",35.25,46.83,
"PILLOW ABDUCTION MED",6102512,"CDM ",271,RC,,,OUTPATIENT,,,55.96,44.768,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.77,80,,35.82,,,0,"percent of total billed charges ","80% of total billed charges ",39.17,70,,31.34,,,0,"percent of total billed charges ","70% of total billed charges ",50.36,90,,40.29,,,0,"percent of total billed charges ","90% of total billed charges ",52.04,93,,41.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",47.57,85,,38.06,,,0,"percent of total billed charges ","85% of total billed charges ",50.36,90,,40.29,,,0,"percent of total billed charges ","90% of total billed charges ",50.36,90,,40.29,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",48.69,87,,38.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.17,70,,31.34,,,0,"percent of total billed charges ","70% of total billed charges ",39.17,52.04,
"DISSECTOR BLUNT TIP",6102515,"CDM ",272,RC,,,OUTPATIENT,,,56.76,45.408,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.41,80,,36.33,,,0,"percent of total billed charges ","80% of total billed charges ",39.73,70,,31.78,,,0,"percent of total billed charges ","70% of total billed charges ",51.08,90,,40.86,,,0,"percent of total billed charges ","90% of total billed charges ",52.79,93,,42.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",48.25,85,,38.60,,,0,"percent of total billed charges ","85% of total billed charges ",51.08,90,,40.86,,,0,"percent of total billed charges ","90% of total billed charges ",51.08,90,,40.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",49.38,87,,39.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.73,70,,31.78,,,0,"percent of total billed charges ","70% of total billed charges ",39.73,52.79,
"EVACUATOR BULBS",6102526,"CDM ",272,RC,,,OUTPATIENT,,,18.66,14.928,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.93,80,,11.94,,,0,"percent of total billed charges ","80% of total billed charges ",13.06,70,,10.45,,,0,"percent of total billed charges ","70% of total billed charges ",16.79,90,,13.43,,,0,"percent of total billed charges ","90% of total billed charges ",17.35,93,,13.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.86,85,,12.69,,,0,"percent of total billed charges ","85% of total billed charges ",16.79,90,,13.43,,,0,"percent of total billed charges ","90% of total billed charges ",16.79,90,,13.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.23,87,,12.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.06,70,,10.45,,,0,"percent of total billed charges ","70% of total billed charges ",13.06,17.35,
"BRNG TIBIA PS 14X63/67MM",6102535,"CDM ",278,RC,,,OUTPATIENT,,,1633.5,1306.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1306.8,80,,1045.44,,,0,"percent of total billed charges ","80% of total billed charges ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",1519.16,93,,1215.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1421.15,87,,1136.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,1519.16,
"WASHER 17 X 1.3",6102539,"CDM ",278,RC,,,OUTPATIENT,,,351.27,281.016,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",281.02,80,,224.82,,,0,"percent of total billed charges ","80% of total billed charges ",245.89,70,,196.71,,,0,"percent of total billed charges ","70% of total billed charges ",316.14,90,,252.91,,,0,"percent of total billed charges ","90% of total billed charges ",326.68,93,,261.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",298.58,85,,238.86,,,0,"percent of total billed charges ","85% of total billed charges ",298.58,85,,238.86,,,0,"percent of total billed charges ","85% of total billed charges ",316.14,90,,252.91,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",305.6,87,,244.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",245.89,70,,196.71,,,0,"percent of total billed charges ","70% of total billed charges ",245.89,326.68,
"SUTURE MAXBRAID PE C-2",6102544,"CDM ",272,RC,,,OUTPATIENT,,,97.61,78.088,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.09,80,,62.47,,,0,"percent of total billed charges ","80% of total billed charges ",68.33,70,,54.66,,,0,"percent of total billed charges ","70% of total billed charges ",87.85,90,,70.28,,,0,"percent of total billed charges ","90% of total billed charges ",90.78,93,,72.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",82.97,85,,66.38,,,0,"percent of total billed charges ","85% of total billed charges ",87.85,90,,70.28,,,0,"percent of total billed charges ","90% of total billed charges ",87.85,90,,70.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",84.92,87,,67.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.33,70,,54.66,,,0,"percent of total billed charges ","70% of total billed charges ",68.33,90.78,
"SUTURE VICRYL 6.0 J556G",6102545,"CDM ",272,RC,,,OUTPATIENT,,,19,15.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.2,80,,12.16,,,0,"percent of total billed charges ","80% of total billed charges ",13.3,70,,10.64,,,0,"percent of total billed charges ","70% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.67,93,,14.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.15,85,,12.92,,,0,"percent of total billed charges ","85% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.53,87,,13.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.3,70,,10.64,,,0,"percent of total billed charges ","70% of total billed charges ",13.3,17.67,
"KIT PORT A CATH PLASTIC",6102556,"CDM ",272,RC,,,OUTPATIENT,,,379.28,303.424,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.42,80,,242.74,,,0,"percent of total billed charges ","80% of total billed charges ",265.5,70,,212.40,,,0,"percent of total billed charges ","70% of total billed charges ",341.35,90,,273.08,,,0,"percent of total billed charges ","90% of total billed charges ",352.73,93,,282.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",322.39,85,,257.91,,,0,"percent of total billed charges ","85% of total billed charges ",341.35,90,,273.08,,,0,"percent of total billed charges ","90% of total billed charges ",341.35,90,,273.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",329.97,87,,263.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",265.5,70,,212.40,,,0,"percent of total billed charges ","70% of total billed charges ",265.5,352.73,
"SUTURE PDS II Z417H",6102561,"CDM ",272,RC,,,OUTPATIENT,,,11.89,9.512,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.51,80,,7.61,,,0,"percent of total billed charges ","80% of total billed charges ",8.32,70,,6.66,,,0,"percent of total billed charges ","70% of total billed charges ",10.7,90,,8.56,,,0,"percent of total billed charges ","90% of total billed charges ",11.06,93,,8.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.11,85,,8.09,,,0,"percent of total billed charges ","85% of total billed charges ",10.7,90,,8.56,,,0,"percent of total billed charges ","90% of total billed charges ",10.7,90,,8.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.34,87,,8.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.32,70,,6.66,,,0,"percent of total billed charges ","70% of total billed charges ",8.32,11.06,
"DRAPE SHOULDER 162"" x 103""",6102575,"CDM ",272,RC,,,OUTPATIENT,,,87.61,70.088,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.09,80,,56.07,,,0,"percent of total billed charges ","80% of total billed charges ",61.33,70,,49.06,,,0,"percent of total billed charges ","70% of total billed charges ",78.85,90,,63.08,,,0,"percent of total billed charges ","90% of total billed charges ",81.48,93,,65.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",74.47,85,,59.58,,,0,"percent of total billed charges ","85% of total billed charges ",78.85,90,,63.08,,,0,"percent of total billed charges ","90% of total billed charges ",78.85,90,,63.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",76.22,87,,60.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.33,70,,49.06,,,0,"percent of total billed charges ","70% of total billed charges ",61.33,81.48,
"BAR ARCH ERICH",6102581,"CDM ",272,RC,,,OUTPATIENT,,,28.44,22.752,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.75,80,,18.20,,,0,"percent of total billed charges ","80% of total billed charges ",19.91,70,,15.93,,,0,"percent of total billed charges ","70% of total billed charges ",25.6,90,,20.48,,,0,"percent of total billed charges ","90% of total billed charges ",26.45,93,,21.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",24.17,85,,19.34,,,0,"percent of total billed charges ","85% of total billed charges ",25.6,90,,20.48,,,0,"percent of total billed charges ","90% of total billed charges ",25.6,90,,20.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",24.74,87,,19.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.91,70,,15.93,,,0,"percent of total billed charges ","70% of total billed charges ",19.91,26.45,
"NEEDLE PRECISION 18G 3 INCH",6102582,"CDM ",272,RC,,,OUTPATIENT,,,55.83,44.664,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.66,80,,35.73,,,0,"percent of total billed charges ","80% of total billed charges ",39.08,70,,31.26,,,0,"percent of total billed charges ","70% of total billed charges ",50.25,90,,40.20,,,0,"percent of total billed charges ","90% of total billed charges ",51.92,93,,41.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",47.46,85,,37.97,,,0,"percent of total billed charges ","85% of total billed charges ",50.25,90,,40.20,,,0,"percent of total billed charges ","90% of total billed charges ",50.25,90,,40.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",48.57,87,,38.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.08,70,,31.26,,,0,"percent of total billed charges ","70% of total billed charges ",39.08,51.92,
"VACUUM OB SOFT CUP",6102594,"CDM ",272,RC,,,OUTPATIENT,,,138.91,111.128,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.13,80,,88.90,,,0,"percent of total billed charges ","80% of total billed charges ",97.24,70,,77.79,,,0,"percent of total billed charges ","70% of total billed charges ",125.02,90,,100.02,,,0,"percent of total billed charges ","90% of total billed charges ",129.19,93,,103.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",118.07,85,,94.46,,,0,"percent of total billed charges ","85% of total billed charges ",125.02,90,,100.02,,,0,"percent of total billed charges ","90% of total billed charges ",125.02,90,,100.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",120.85,87,,96.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.24,70,,77.79,,,0,"percent of total billed charges ","70% of total billed charges ",97.24,129.19,
"SYRINGE INFLATION KYPHON",6102607,"CDM ",272,RC,,,OUTPATIENT,,,258.6,206.88,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",206.88,80,,165.50,,,0,"percent of total billed charges ","80% of total billed charges ",181.02,70,,144.82,,,0,"percent of total billed charges ","70% of total billed charges ",232.74,90,,186.19,,,0,"percent of total billed charges ","90% of total billed charges ",240.5,93,,192.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",219.81,85,,175.85,,,0,"percent of total billed charges ","85% of total billed charges ",232.74,90,,186.19,,,0,"percent of total billed charges ","90% of total billed charges ",232.74,90,,186.19,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",224.98,87,,179.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",181.02,70,,144.82,,,0,"percent of total billed charges ","70% of total billed charges ",181.02,240.5,
"BURR ARTHROPLASTY 5.5MM",6102647,"CDM ",272,RC,,,OUTPATIENT,,,213.36,170.688,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.69,80,,136.55,,,0,"percent of total billed charges ","80% of total billed charges ",149.35,70,,119.48,,,0,"percent of total billed charges ","70% of total billed charges ",192.02,90,,153.62,,,0,"percent of total billed charges ","90% of total billed charges ",198.42,93,,158.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",181.36,85,,145.09,,,0,"percent of total billed charges ","85% of total billed charges ",192.02,90,,153.62,,,0,"percent of total billed charges ","90% of total billed charges ",192.02,90,,153.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",185.62,87,,148.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.35,70,,119.48,,,0,"percent of total billed charges ","70% of total billed charges ",149.35,198.42,
"SUTURE VICRYL 2.0 J306H",6102675,"CDM ",272,RC,,,OUTPATIENT,,,10.73,8.584,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.58,80,,6.86,,,0,"percent of total billed charges ","80% of total billed charges ",7.51,70,,6.01,,,0,"percent of total billed charges ","70% of total billed charges ",9.66,90,,7.73,,,0,"percent of total billed charges ","90% of total billed charges ",9.98,93,,7.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.12,85,,7.30,,,0,"percent of total billed charges ","85% of total billed charges ",9.66,90,,7.73,,,0,"percent of total billed charges ","90% of total billed charges ",9.66,90,,7.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.34,87,,7.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.51,70,,6.01,,,0,"percent of total billed charges ","70% of total billed charges ",7.51,9.98,
"TUBE SALEM NG 8FR",6102686,"CDM ",272,RC,,,OUTPATIENT,,,27.5,22,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22,80,,17.60,,,0,"percent of total billed charges ","80% of total billed charges ",19.25,70,,15.40,,,0,"percent of total billed charges ","70% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",25.58,93,,20.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.38,85,,18.70,,,0,"percent of total billed charges ","85% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",23.93,87,,19.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.25,70,,15.40,,,0,"percent of total billed charges ","70% of total billed charges ",19.25,25.58,
"PISTON PLATINUM 4.25",6102689,"CDM ",272,RC,,,OUTPATIENT,,,323.25,258.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",258.6,80,,206.88,,,0,"percent of total billed charges ","80% of total billed charges ",226.28,70,,181.02,,,0,"percent of total billed charges ","70% of total billed charges ",290.93,90,,232.74,,,0,"percent of total billed charges ","90% of total billed charges ",300.62,93,,240.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",274.76,85,,219.81,,,0,"percent of total billed charges ","85% of total billed charges ",290.93,90,,232.74,,,0,"percent of total billed charges ","90% of total billed charges ",290.93,90,,232.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",281.23,87,,224.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",226.28,70,,181.02,,,0,"percent of total billed charges ","70% of total billed charges ",226.28,300.62,
"SUTURE VICRYL J207G",6102691,"CDM ",272,RC,,,OUTPATIENT,,,8.17,6.536,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.54,80,,5.23,,,0,"percent of total billed charges ","80% of total billed charges ",5.72,70,,4.58,,,0,"percent of total billed charges ","70% of total billed charges ",7.35,90,,5.88,,,0,"percent of total billed charges ","90% of total billed charges ",7.6,93,,6.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6.94,85,,5.55,,,0,"percent of total billed charges ","85% of total billed charges ",7.35,90,,5.88,,,0,"percent of total billed charges ","90% of total billed charges ",7.35,90,,5.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7.11,87,,5.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.72,70,,4.58,,,0,"percent of total billed charges ","70% of total billed charges ",5.72,7.6,
"KYPHON INTRODUCER",6102698,"CDM ",272,RC,,,OUTPATIENT,,,6524.93,5219.944,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5219.94,80,,4175.95,,,0,"percent of total billed charges ","80% of total billed charges ",4567.45,70,,3653.96,,,0,"percent of total billed charges ","70% of total billed charges ",5872.44,90,,4697.95,,,0,"percent of total billed charges ","90% of total billed charges ",6068.18,93,,4854.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5546.19,85,,4436.95,,,0,"percent of total billed charges ","85% of total billed charges ",5872.44,90,,4697.95,,,0,"percent of total billed charges ","90% of total billed charges ",5872.44,90,,4697.95,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5676.69,87,,4541.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4567.45,70,,3653.96,,,0,"percent of total billed charges ","70% of total billed charges ",4567.45,6068.18,
"STAPLE LINEAR TP60",6102733,"CDM ",272,RC,,,OUTPATIENT,,,269.2,215.36,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",215.36,80,,172.29,,,0,"percent of total billed charges ","80% of total billed charges ",188.44,70,,150.75,,,0,"percent of total billed charges ","70% of total billed charges ",242.28,90,,193.82,,,0,"percent of total billed charges ","90% of total billed charges ",250.36,93,,200.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",228.82,85,,183.06,,,0,"percent of total billed charges ","85% of total billed charges ",242.28,90,,193.82,,,0,"percent of total billed charges ","90% of total billed charges ",242.28,90,,193.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.2,87,,187.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.44,70,,150.75,,,0,"percent of total billed charges ","70% of total billed charges ",188.44,250.36,
"BURR ARTHROPLASTY 4.5MM",6102751,"CDM ",272,RC,,,OUTPATIENT,,,210.6,168.48,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",168.48,80,,134.78,,,0,"percent of total billed charges ","80% of total billed charges ",147.42,70,,117.94,,,0,"percent of total billed charges ","70% of total billed charges ",189.54,90,,151.63,,,0,"percent of total billed charges ","90% of total billed charges ",195.86,93,,156.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",179.01,85,,143.21,,,0,"percent of total billed charges ","85% of total billed charges ",189.54,90,,151.63,,,0,"percent of total billed charges ","90% of total billed charges ",189.54,90,,151.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",183.22,87,,146.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.42,70,,117.94,,,0,"percent of total billed charges ","70% of total billed charges ",147.42,195.86,
"BLADE DERMATONE BROWN",6102783,"CDM ",272,RC,,,OUTPATIENT,,,78.68,62.944,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.94,80,,50.35,,,0,"percent of total billed charges ","80% of total billed charges ",55.08,70,,44.06,,,0,"percent of total billed charges ","70% of total billed charges ",70.81,90,,56.65,,,0,"percent of total billed charges ","90% of total billed charges ",73.17,93,,58.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",66.88,85,,53.50,,,0,"percent of total billed charges ","85% of total billed charges ",70.81,90,,56.65,,,0,"percent of total billed charges ","90% of total billed charges ",70.81,90,,56.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",68.45,87,,54.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.08,70,,44.06,,,0,"percent of total billed charges ","70% of total billed charges ",55.08,73.17,
"FORCEP BX DISP",6102790,"CDM ",272,RC,,,OUTPATIENT,,,30.09,24.072,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.07,80,,19.26,,,0,"percent of total billed charges ","80% of total billed charges ",21.06,70,,16.85,,,0,"percent of total billed charges ","70% of total billed charges ",27.08,90,,21.66,,,0,"percent of total billed charges ","90% of total billed charges ",27.98,93,,22.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.58,85,,20.46,,,0,"percent of total billed charges ","85% of total billed charges ",27.08,90,,21.66,,,0,"percent of total billed charges ","90% of total billed charges ",27.08,90,,21.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.18,87,,20.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.06,70,,16.85,,,0,"percent of total billed charges ","70% of total billed charges ",21.06,27.98,
"FORCEP ALLIGATOR DISP",6102792,"CDM ",272,RC,,,OUTPATIENT,,,30.09,24.072,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.07,80,,19.26,,,0,"percent of total billed charges ","80% of total billed charges ",21.06,70,,16.85,,,0,"percent of total billed charges ","70% of total billed charges ",27.08,90,,21.66,,,0,"percent of total billed charges ","90% of total billed charges ",27.98,93,,22.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.58,85,,20.46,,,0,"percent of total billed charges ","85% of total billed charges ",27.08,90,,21.66,,,0,"percent of total billed charges ","90% of total billed charges ",27.08,90,,21.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.18,87,,20.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.06,70,,16.85,,,0,"percent of total billed charges ","70% of total billed charges ",21.06,27.98,
"DERMA CARRIER 8 INCH",6102811,"CDM ",272,RC,,,OUTPATIENT,,,90.99,72.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.79,80,,58.23,,,0,"percent of total billed charges ","80% of total billed charges ",63.69,70,,50.95,,,0,"percent of total billed charges ","70% of total billed charges ",81.89,90,,65.51,,,0,"percent of total billed charges ","90% of total billed charges ",84.62,93,,67.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",77.34,85,,61.87,,,0,"percent of total billed charges ","85% of total billed charges ",81.89,90,,65.51,,,0,"percent of total billed charges ","90% of total billed charges ",81.89,90,,65.51,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",79.16,87,,63.33,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.69,70,,50.95,,,0,"percent of total billed charges ","70% of total billed charges ",63.69,84.62,
"DERMA CARRIER 16 INCH",6102812,"CDM ",272,RC,,,OUTPATIENT,,,194.02,155.216,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.22,80,,124.18,,,0,"percent of total billed charges ","80% of total billed charges ",135.81,70,,108.65,,,0,"percent of total billed charges ","70% of total billed charges ",174.62,90,,139.70,,,0,"percent of total billed charges ","90% of total billed charges ",180.44,93,,144.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",164.92,85,,131.94,,,0,"percent of total billed charges ","85% of total billed charges ",174.62,90,,139.70,,,0,"percent of total billed charges ","90% of total billed charges ",174.62,90,,139.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",168.8,87,,135.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.81,70,,108.65,,,0,"percent of total billed charges ","70% of total billed charges ",135.81,180.44,
"WASHER  20 X 1.3",6102815,"CDM ",278,RC,,,OUTPATIENT,,,351.27,281.016,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",281.02,80,,224.82,,,0,"percent of total billed charges ","80% of total billed charges ",245.89,70,,196.71,,,0,"percent of total billed charges ","70% of total billed charges ",316.14,90,,252.91,,,0,"percent of total billed charges ","90% of total billed charges ",326.68,93,,261.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",298.58,85,,238.86,,,0,"percent of total billed charges ","85% of total billed charges ",298.58,85,,238.86,,,0,"percent of total billed charges ","85% of total billed charges ",316.14,90,,252.91,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",305.6,87,,244.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",245.89,70,,196.71,,,0,"percent of total billed charges ","70% of total billed charges ",245.89,326.68,
"BANDAGE ESMARK 4X9",6102819,"CDM ",272,RC,,,OUTPATIENT,,,17.45,13.96,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.96,80,,11.17,,,0,"percent of total billed charges ","80% of total billed charges ",12.22,70,,9.78,,,0,"percent of total billed charges ","70% of total billed charges ",15.71,90,,12.57,,,0,"percent of total billed charges ","90% of total billed charges ",16.23,93,,12.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.83,85,,11.86,,,0,"percent of total billed charges ","85% of total billed charges ",15.71,90,,12.57,,,0,"percent of total billed charges ","90% of total billed charges ",15.71,90,,12.57,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.18,87,,12.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.22,70,,9.78,,,0,"percent of total billed charges ","70% of total billed charges ",12.22,16.23,
"CATH PER-Q PICK LINE 3FR",6102826,"CDM ",278,RC,,,OUTPATIENT,,,213.13,170.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.5,80,,136.40,,,0,"percent of total billed charges ","80% of total billed charges ",149.19,70,,119.35,,,0,"percent of total billed charges ","70% of total billed charges ",191.82,90,,153.46,,,0,"percent of total billed charges ","90% of total billed charges ",198.21,93,,158.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",181.16,85,,144.93,,,0,"percent of total billed charges ","85% of total billed charges ",181.16,85,,144.93,,,0,"percent of total billed charges ","85% of total billed charges ",191.82,90,,153.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",185.42,87,,148.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.19,70,,119.35,,,0,"percent of total billed charges ","70% of total billed charges ",149.19,198.21,
"DRILL BONE 2X200 MM",6102828,"CDM ",272,RC,,,OUTPATIENT,,,224.12,179.296,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",179.3,80,,143.44,,,0,"percent of total billed charges ","80% of total billed charges ",156.88,70,,125.50,,,0,"percent of total billed charges ","70% of total billed charges ",201.71,90,,161.37,,,0,"percent of total billed charges ","90% of total billed charges ",208.43,93,,166.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",190.5,85,,152.40,,,0,"percent of total billed charges ","85% of total billed charges ",201.71,90,,161.37,,,0,"percent of total billed charges ","90% of total billed charges ",201.71,90,,161.37,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",194.98,87,,155.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.88,70,,125.50,,,0,"percent of total billed charges ","70% of total billed charges ",156.88,208.43,
"DRILL BONE 0X200 MM",6102831,"CDM ",272,RC,,,OUTPATIENT,,,224.12,179.296,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",179.3,80,,143.44,,,0,"percent of total billed charges ","80% of total billed charges ",156.88,70,,125.50,,,0,"percent of total billed charges ","70% of total billed charges ",201.71,90,,161.37,,,0,"percent of total billed charges ","90% of total billed charges ",208.43,93,,166.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",190.5,85,,152.40,,,0,"percent of total billed charges ","85% of total billed charges ",201.71,90,,161.37,,,0,"percent of total billed charges ","90% of total billed charges ",201.71,90,,161.37,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",194.98,87,,155.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.88,70,,125.50,,,0,"percent of total billed charges ","70% of total billed charges ",156.88,208.43,
"DRILL BONE 5X200 MM",6102832,"CDM ",272,RC,,,OUTPATIENT,,,224.12,179.296,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",179.3,80,,143.44,,,0,"percent of total billed charges ","80% of total billed charges ",156.88,70,,125.50,,,0,"percent of total billed charges ","70% of total billed charges ",201.71,90,,161.37,,,0,"percent of total billed charges ","90% of total billed charges ",208.43,93,,166.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",190.5,85,,152.40,,,0,"percent of total billed charges ","85% of total billed charges ",201.71,90,,161.37,,,0,"percent of total billed charges ","90% of total billed charges ",201.71,90,,161.37,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",194.98,87,,155.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.88,70,,125.50,,,0,"percent of total billed charges ","70% of total billed charges ",156.88,208.43,
"PIN APEX H.A. 200X60 MM",6102833,"CDM ",278,RC,,,OUTPATIENT,,,263.99,211.192,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",211.19,80,,168.95,,,0,"percent of total billed charges ","80% of total billed charges ",184.79,70,,147.83,,,0,"percent of total billed charges ","70% of total billed charges ",237.59,90,,190.07,,,0,"percent of total billed charges ","90% of total billed charges ",245.51,93,,196.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",224.39,85,,179.51,,,0,"percent of total billed charges ","85% of total billed charges ",224.39,85,,179.51,,,0,"percent of total billed charges ","85% of total billed charges ",237.59,90,,190.07,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",229.67,87,,183.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",184.79,70,,147.83,,,0,"percent of total billed charges ","70% of total billed charges ",184.79,245.51,
"PIN APEX H.A. 150X50 MM",6102835,"CDM ",278,RC,,,OUTPATIENT,,,256.45,205.16,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",205.16,80,,164.13,,,0,"percent of total billed charges ","80% of total billed charges ",179.52,70,,143.62,,,0,"percent of total billed charges ","70% of total billed charges ",230.81,90,,184.65,,,0,"percent of total billed charges ","90% of total billed charges ",238.5,93,,190.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",217.98,85,,174.38,,,0,"percent of total billed charges ","85% of total billed charges ",217.98,85,,174.38,,,0,"percent of total billed charges ","85% of total billed charges ",230.81,90,,184.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",223.11,87,,178.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",179.52,70,,143.62,,,0,"percent of total billed charges ","70% of total billed charges ",179.52,238.5,
"IMPLANT EYE ORBITAL",6102836,"CDM ",272,RC,,,OUTPATIENT,,,85.5,68.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.4,80,,54.72,,,0,"percent of total billed charges ","80% of total billed charges ",59.85,70,,47.88,,,0,"percent of total billed charges ","70% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",79.52,93,,63.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",72.68,85,,58.14,,,0,"percent of total billed charges ","85% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",74.39,87,,59.51,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.85,70,,47.88,,,0,"percent of total billed charges ","70% of total billed charges ",59.85,79.52,
"BLADE TURBINITE 2.9MM",6102838,"CDM ",272,RC,,,OUTPATIENT,,,407.73,326.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",326.18,80,,260.94,,,0,"percent of total billed charges ","80% of total billed charges ",285.41,70,,228.33,,,0,"percent of total billed charges ","70% of total billed charges ",366.96,90,,293.57,,,0,"percent of total billed charges ","90% of total billed charges ",379.19,93,,303.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",346.57,85,,277.26,,,0,"percent of total billed charges ","85% of total billed charges ",366.96,90,,293.57,,,0,"percent of total billed charges ","90% of total billed charges ",366.96,90,,293.57,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",354.73,87,,283.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",285.41,70,,228.33,,,0,"percent of total billed charges ","70% of total billed charges ",285.41,379.19,
"PLATE 2.4MM STRAIGHT/LONG",6102853,"CDM ",278,RC,,,OUTPATIENT,,,907.26,725.808,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",725.81,80,,580.65,,,0,"percent of total billed charges ","80% of total billed charges ",635.08,70,,508.06,,,0,"percent of total billed charges ","70% of total billed charges ",816.53,90,,653.22,,,0,"percent of total billed charges ","90% of total billed charges ",843.75,93,,675.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",771.17,85,,616.94,,,0,"percent of total billed charges ","85% of total billed charges ",771.17,85,,616.94,,,0,"percent of total billed charges ","85% of total billed charges ",816.53,90,,653.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",789.32,87,,631.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",635.08,70,,508.06,,,0,"percent of total billed charges ","70% of total billed charges ",635.08,843.75,
"TAPE CAST 4"" GREEN",6102896,"CDM ",271,RC,,,OUTPATIENT,,,27.5,22,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22,80,,17.60,,,0,"percent of total billed charges ","80% of total billed charges ",19.25,70,,15.40,,,0,"percent of total billed charges ","70% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",25.58,93,,20.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.38,85,,18.70,,,0,"percent of total billed charges ","85% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",23.93,87,,19.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.25,70,,15.40,,,0,"percent of total billed charges ","70% of total billed charges ",19.25,25.58,
"TROCAR CATH 32FR",6102908,"CDM ",272,RC,,,OUTPATIENT,,,46.5,37.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.2,80,,29.76,,,0,"percent of total billed charges ","80% of total billed charges ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",43.25,93,,34.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.53,85,,31.62,,,0,"percent of total billed charges ","85% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.46,87,,32.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",32.55,43.25,
"SUTURE PDS II 5.0Z844G",6102921,"CDM ",272,RC,,,OUTPATIENT,,,26.13,20.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.9,80,,16.72,,,0,"percent of total billed charges ","80% of total billed charges ",18.29,70,,14.63,,,0,"percent of total billed charges ","70% of total billed charges ",23.52,90,,18.82,,,0,"percent of total billed charges ","90% of total billed charges ",24.3,93,,19.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",22.21,85,,17.77,,,0,"percent of total billed charges ","85% of total billed charges ",23.52,90,,18.82,,,0,"percent of total billed charges ","90% of total billed charges ",23.52,90,,18.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.73,87,,18.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.29,70,,14.63,,,0,"percent of total billed charges ","70% of total billed charges ",18.29,24.3,
"PIN STEINMAN 5/32X9",6102923,"CDM ",278,RC,,,OUTPATIENT,,,43.48,34.784,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.78,80,,27.82,,,0,"percent of total billed charges ","80% of total billed charges ",30.44,70,,24.35,,,0,"percent of total billed charges ","70% of total billed charges ",39.13,90,,31.30,,,0,"percent of total billed charges ","90% of total billed charges ",40.44,93,,32.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",36.96,85,,29.57,,,0,"percent of total billed charges ","85% of total billed charges ",36.96,85,,29.57,,,0,"percent of total billed charges ","85% of total billed charges ",39.13,90,,31.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",37.83,87,,30.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.44,70,,24.35,,,0,"percent of total billed charges ","70% of total billed charges ",30.44,40.44,
"SET EXTENSION ANESTHESIA",6102937,"CDM ",272,RC,,,OUTPATIENT,,,14,11.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,80,,8.96,,,0,"percent of total billed charges ","80% of total billed charges ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",13.02,93,,10.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.9,85,,9.52,,,0,"percent of total billed charges ","85% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.18,87,,9.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",9.8,13.02,
"SUTURE PDS 5.0 Z421H",6102946,"CDM ",272,RC,,,OUTPATIENT,,,15,12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12,80,,9.60,,,0,"percent of total billed charges ","80% of total billed charges ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.95,93,,11.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.75,85,,10.20,,,0,"percent of total billed charges ","85% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.05,87,,10.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",10.5,13.95,
"SUTURE NYLON 4.0 1629H",6102947,"CDM ",272,RC,,,OUTPATIENT,,,8.88,7.104,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.1,80,,5.68,,,0,"percent of total billed charges ","80% of total billed charges ",6.22,70,,4.98,,,0,"percent of total billed charges ","70% of total billed charges ",7.99,90,,6.39,,,0,"percent of total billed charges ","90% of total billed charges ",8.26,93,,6.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7.55,85,,6.04,,,0,"percent of total billed charges ","85% of total billed charges ",7.99,90,,6.39,,,0,"percent of total billed charges ","90% of total billed charges ",7.99,90,,6.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7.73,87,,6.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.22,70,,4.98,,,0,"percent of total billed charges ","70% of total billed charges ",6.22,8.26,
"SUTURE NYLON 4.0 662H",6102948,"CDM ",272,RC,,,OUTPATIENT,,,10.63,8.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.5,80,,6.80,,,0,"percent of total billed charges ","80% of total billed charges ",7.44,70,,5.95,,,0,"percent of total billed charges ","70% of total billed charges ",9.57,90,,7.66,,,0,"percent of total billed charges ","90% of total billed charges ",9.89,93,,7.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.04,85,,7.23,,,0,"percent of total billed charges ","85% of total billed charges ",9.57,90,,7.66,,,0,"percent of total billed charges ","90% of total billed charges ",9.57,90,,7.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.25,87,,7.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.44,70,,5.95,,,0,"percent of total billed charges ","70% of total billed charges ",7.44,9.89,
"SUTURE SILK 4.0 629G",6102949,"CDM ",272,RC,,,OUTPATIENT,,,7.62,6.096,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.1,80,,4.88,,,0,"percent of total billed charges ","80% of total billed charges ",5.33,70,,4.26,,,0,"percent of total billed charges ","70% of total billed charges ",6.86,90,,5.49,,,0,"percent of total billed charges ","90% of total billed charges ",7.09,93,,5.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6.48,85,,5.18,,,0,"percent of total billed charges ","85% of total billed charges ",6.86,90,,5.49,,,0,"percent of total billed charges ","90% of total billed charges ",6.86,90,,5.49,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.63,87,,5.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.33,70,,4.26,,,0,"percent of total billed charges ","70% of total billed charges ",5.33,7.09,
"SUTURE SILK 3.0 684G",6102950,"CDM ",272,RC,,,OUTPATIENT,,,7.42,5.936,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.94,80,,4.75,,,0,"percent of total billed charges ","80% of total billed charges ",5.19,70,,4.15,,,0,"percent of total billed charges ","70% of total billed charges ",6.68,90,,5.34,,,0,"percent of total billed charges ","90% of total billed charges ",6.9,93,,5.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6.31,85,,5.05,,,0,"percent of total billed charges ","85% of total billed charges ",6.68,90,,5.34,,,0,"percent of total billed charges ","90% of total billed charges ",6.68,90,,5.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.46,87,,5.17,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.19,70,,4.15,,,0,"percent of total billed charges ","70% of total billed charges ",5.19,6.9,
"SUTURE NYLON 5.0 661G",6102951,"CDM ",272,RC,,,OUTPATIENT,,,8.27,6.616,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.62,80,,5.30,,,0,"percent of total billed charges ","80% of total billed charges ",5.79,70,,4.63,,,0,"percent of total billed charges ","70% of total billed charges ",7.44,90,,5.95,,,0,"percent of total billed charges ","90% of total billed charges ",7.69,93,,6.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7.03,85,,5.62,,,0,"percent of total billed charges ","85% of total billed charges ",7.44,90,,5.95,,,0,"percent of total billed charges ","90% of total billed charges ",7.44,90,,5.95,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7.19,87,,5.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.79,70,,4.63,,,0,"percent of total billed charges ","70% of total billed charges ",5.79,7.69,
"SUTURE SILK 4.0 683G",6102956,"CDM ",272,RC,,,OUTPATIENT,,,10,8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8,80,,6.40,,,0,"percent of total billed charges ","80% of total billed charges ",7,70,,5.60,,,0,"percent of total billed charges ","70% of total billed charges ",9,90,,7.20,,,0,"percent of total billed charges ","90% of total billed charges ",9.3,93,,7.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.5,85,,6.80,,,0,"percent of total billed charges ","85% of total billed charges ",9,90,,7.20,,,0,"percent of total billed charges ","90% of total billed charges ",9,90,,7.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",8.7,87,,6.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7,70,,5.60,,,0,"percent of total billed charges ","70% of total billed charges ",7,9.3,
"POUCH COLLECTION",6102967,"CDM ",272,RC,,,OUTPATIENT,,,16.45,13.16,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.16,80,,10.53,,,0,"percent of total billed charges ","80% of total billed charges ",11.52,70,,9.22,,,0,"percent of total billed charges ","70% of total billed charges ",14.81,90,,11.85,,,0,"percent of total billed charges ","90% of total billed charges ",15.3,93,,12.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.98,85,,11.18,,,0,"percent of total billed charges ","85% of total billed charges ",14.81,90,,11.85,,,0,"percent of total billed charges ","90% of total billed charges ",14.81,90,,11.85,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.31,87,,11.45,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.52,70,,9.22,,,0,"percent of total billed charges ","70% of total billed charges ",11.52,15.3,
"BRNG TIBIA PS 12X59MM",6102988,"CDM ",278,RC,,,OUTPATIENT,,,1633.5,1306.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1306.8,80,,1045.44,,,0,"percent of total billed charges ","80% of total billed charges ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",1519.16,93,,1215.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1421.15,87,,1136.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,1519.16,
"PATELLA STD 3 PEG 28X8MM",6102991,"CDM ",278,RC,,,OUTPATIENT,,,969.75,775.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",775.8,80,,620.64,,,0,"percent of total billed charges ","80% of total billed charges ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",901.87,93,,721.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",843.68,87,,674.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",678.83,901.87,
"BRNG TIBIA PS 14X59MM",6103000,"CDM ",278,RC,,,OUTPATIENT,,,1633.5,1306.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1306.8,80,,1045.44,,,0,"percent of total billed charges ","80% of total billed charges ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",1519.16,93,,1215.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1421.15,87,,1136.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,1519.16,
"TROCAR CATH 28FR",6103004,"CDM ",272,RC,,,OUTPATIENT,,,302.97,242.376,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",242.38,80,,193.90,,,0,"percent of total billed charges ","80% of total billed charges ",212.08,70,,169.66,,,0,"percent of total billed charges ","70% of total billed charges ",272.67,90,,218.14,,,0,"percent of total billed charges ","90% of total billed charges ",281.76,93,,225.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",257.52,85,,206.02,,,0,"percent of total billed charges ","85% of total billed charges ",272.67,90,,218.14,,,0,"percent of total billed charges ","90% of total billed charges ",272.67,90,,218.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",263.58,87,,210.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",212.08,70,,169.66,,,0,"percent of total billed charges ","70% of total billed charges ",212.08,281.76,
"PATELLA STD 3 PEG 31X8MM",6103012,"CDM ",278,RC,,,OUTPATIENT,,,969.75,775.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",775.8,80,,620.64,,,0,"percent of total billed charges ","80% of total billed charges ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",901.87,93,,721.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",843.68,87,,674.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",678.83,901.87,
"BRNG TIBIA PS 16X59MM",6103013,"CDM ",278,RC,,,OUTPATIENT,,,1633.5,1306.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1306.8,80,,1045.44,,,0,"percent of total billed charges ","80% of total billed charges ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",1519.16,93,,1215.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1421.15,87,,1136.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,1519.16,
"SUTURE 1 PROLENE D6731",6103018,"CDM ",272,RC,,,OUTPATIENT,,,64.27,51.416,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.42,80,,41.14,,,0,"percent of total billed charges ","80% of total billed charges ",44.99,70,,35.99,,,0,"percent of total billed charges ","70% of total billed charges ",57.84,90,,46.27,,,0,"percent of total billed charges ","90% of total billed charges ",59.77,93,,47.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",54.63,85,,43.70,,,0,"percent of total billed charges ","85% of total billed charges ",57.84,90,,46.27,,,0,"percent of total billed charges ","90% of total billed charges ",57.84,90,,46.27,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",55.91,87,,44.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.99,70,,35.99,,,0,"percent of total billed charges ","70% of total billed charges ",44.99,59.77,
"BLADE CUDA 4.2MM",6103036,"CDM ",272,RC,,,OUTPATIENT,,,200.03,160.024,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",160.02,80,,128.02,,,0,"percent of total billed charges ","80% of total billed charges ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",186.03,93,,148.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",174.03,87,,139.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",140.02,186.03,
"BRNG TIBIA PS 18X59MM",6103045,"CDM ",278,RC,,,OUTPATIENT,,,1633.5,1306.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1306.8,80,,1045.44,,,0,"percent of total billed charges ","80% of total billed charges ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",1519.16,93,,1215.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1421.15,87,,1136.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,1519.16,
"FIXATOR EBI",6103047,"CDM ",272,RC,,,OUTPATIENT,,,1127.26,901.808,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",901.81,80,,721.45,,,0,"percent of total billed charges ","80% of total billed charges ",789.08,70,,631.26,,,0,"percent of total billed charges ","70% of total billed charges ",1014.53,90,,811.62,,,0,"percent of total billed charges ","90% of total billed charges ",1048.35,93,,838.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",958.17,85,,766.54,,,0,"percent of total billed charges ","85% of total billed charges ",1014.53,90,,811.62,,,0,"percent of total billed charges ","90% of total billed charges ",1014.53,90,,811.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",980.72,87,,784.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",789.08,70,,631.26,,,0,"percent of total billed charges ","70% of total billed charges ",789.08,1048.35,
"FIXATOR EBI",6103048,"CDM ",272,RC,,,OUTPATIENT,,,1127.26,901.808,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",901.81,80,,721.45,,,0,"percent of total billed charges ","80% of total billed charges ",789.08,70,,631.26,,,0,"percent of total billed charges ","70% of total billed charges ",1014.53,90,,811.62,,,0,"percent of total billed charges ","90% of total billed charges ",1048.35,93,,838.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",958.17,85,,766.54,,,0,"percent of total billed charges ","85% of total billed charges ",1014.53,90,,811.62,,,0,"percent of total billed charges ","90% of total billed charges ",1014.53,90,,811.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",980.72,87,,784.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",789.08,70,,631.26,,,0,"percent of total billed charges ","70% of total billed charges ",789.08,1048.35,
"SUTURE J593G 5.0 VICRYL",6103062,"CDM ",272,RC,,,OUTPATIENT,,,22.67,18.136,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.14,80,,14.51,,,0,"percent of total billed charges ","80% of total billed charges ",15.87,70,,12.70,,,0,"percent of total billed charges ","70% of total billed charges ",20.4,90,,16.32,,,0,"percent of total billed charges ","90% of total billed charges ",21.08,93,,16.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.27,85,,15.42,,,0,"percent of total billed charges ","85% of total billed charges ",20.4,90,,16.32,,,0,"percent of total billed charges ","90% of total billed charges ",20.4,90,,16.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.72,87,,15.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.87,70,,12.70,,,0,"percent of total billed charges ","70% of total billed charges ",15.87,21.08,
"PLATE 2.4MM STRAIGHT/SHORT",6103070,"CDM ",278,RC,,,OUTPATIENT,,,859.85,687.88,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",687.88,80,,550.30,,,0,"percent of total billed charges ","80% of total billed charges ",601.9,70,,481.52,,,0,"percent of total billed charges ","70% of total billed charges ",773.87,90,,619.10,,,0,"percent of total billed charges ","90% of total billed charges ",799.66,93,,639.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",730.87,85,,584.70,,,0,"percent of total billed charges ","85% of total billed charges ",730.87,85,,584.70,,,0,"percent of total billed charges ","85% of total billed charges ",773.87,90,,619.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",748.07,87,,598.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",601.9,70,,481.52,,,0,"percent of total billed charges ","70% of total billed charges ",601.9,799.66,
"REMOVER POLYP 2.5 DISP",6103080,"CDM ",272,RC,,,OUTPATIENT,,,362.12,289.696,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",289.7,80,,231.76,,,0,"percent of total billed charges ","80% of total billed charges ",253.48,70,,202.78,,,0,"percent of total billed charges ","70% of total billed charges ",325.91,90,,260.73,,,0,"percent of total billed charges ","90% of total billed charges ",336.77,93,,269.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",307.8,85,,246.24,,,0,"percent of total billed charges ","85% of total billed charges ",325.91,90,,260.73,,,0,"percent of total billed charges ","90% of total billed charges ",325.91,90,,260.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",315.04,87,,252.03,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",253.48,70,,202.78,,,0,"percent of total billed charges ","70% of total billed charges ",253.48,336.77,
"CORD  BIPOLAR CAUTERY",6103117,"CDM ",272,RC,,,OUTPATIENT,,,13,10.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.4,80,,8.32,,,0,"percent of total billed charges ","80% of total billed charges ",9.1,70,,7.28,,,0,"percent of total billed charges ","70% of total billed charges ",11.7,90,,9.36,,,0,"percent of total billed charges ","90% of total billed charges ",12.09,93,,9.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.05,85,,8.84,,,0,"percent of total billed charges ","85% of total billed charges ",11.7,90,,9.36,,,0,"percent of total billed charges ","90% of total billed charges ",11.7,90,,9.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.31,87,,9.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.1,70,,7.28,,,0,"percent of total billed charges ","70% of total billed charges ",9.1,12.09,
"SUTURE PROLENE 4.0 8699G",6103137,"CDM ",272,RC,,,OUTPATIENT,,,23,18.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.4,80,,14.72,,,0,"percent of total billed charges ","80% of total billed charges ",16.1,70,,12.88,,,0,"percent of total billed charges ","70% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",21.39,93,,17.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.55,85,,15.64,,,0,"percent of total billed charges ","85% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.01,87,,16.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.1,70,,12.88,,,0,"percent of total billed charges ","70% of total billed charges ",16.1,21.39,
"DRILL BIT",6103154,"CDM ",272,RC,,,OUTPATIENT,,,297,237.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",237.6,80,,190.08,,,0,"percent of total billed charges ","80% of total billed charges ",207.9,70,,166.32,,,0,"percent of total billed charges ","70% of total billed charges ",267.3,90,,213.84,,,0,"percent of total billed charges ","90% of total billed charges ",276.21,93,,220.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",252.45,85,,201.96,,,0,"percent of total billed charges ","85% of total billed charges ",267.3,90,,213.84,,,0,"percent of total billed charges ","90% of total billed charges ",267.3,90,,213.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",258.39,87,,206.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",207.9,70,,166.32,,,0,"percent of total billed charges ","70% of total billed charges ",207.9,276.21,
"SUTURE VICRYL 5.0 J283G",6103159,"CDM ",272,RC,,,OUTPATIENT,,,12.69,10.152,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,80,,8.12,,,0,"percent of total billed charges ","80% of total billed charges ",8.88,70,,7.10,,,0,"percent of total billed charges ","70% of total billed charges ",11.42,90,,9.14,,,0,"percent of total billed charges ","90% of total billed charges ",11.8,93,,9.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.79,85,,8.63,,,0,"percent of total billed charges ","85% of total billed charges ",11.42,90,,9.14,,,0,"percent of total billed charges ","90% of total billed charges ",11.42,90,,9.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.04,87,,8.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.88,70,,7.10,,,0,"percent of total billed charges ","70% of total billed charges ",8.88,11.8,
"WASHER 17X2.5",6103160,"CDM ",278,RC,,,OUTPATIENT,,,413.76,331.008,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",331.01,80,,264.81,,,0,"percent of total billed charges ","80% of total billed charges ",289.63,70,,231.70,,,0,"percent of total billed charges ","70% of total billed charges ",372.38,90,,297.90,,,0,"percent of total billed charges ","90% of total billed charges ",384.8,93,,307.84,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",351.7,85,,281.36,,,0,"percent of total billed charges ","85% of total billed charges ",351.7,85,,281.36,,,0,"percent of total billed charges ","85% of total billed charges ",372.38,90,,297.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",359.97,87,,287.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",289.63,70,,231.70,,,0,"percent of total billed charges ","70% of total billed charges ",289.63,384.8,
"SUTURE 311981 2TI-CRON",6103163,"CDM ",272,RC,,,OUTPATIENT,,,27.48,21.984,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.98,80,,17.58,,,0,"percent of total billed charges ","80% of total billed charges ",19.24,70,,15.39,,,0,"percent of total billed charges ","70% of total billed charges ",24.73,90,,19.78,,,0,"percent of total billed charges ","90% of total billed charges ",25.56,93,,20.45,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.36,85,,18.69,,,0,"percent of total billed charges ","85% of total billed charges ",24.73,90,,19.78,,,0,"percent of total billed charges ","90% of total billed charges ",24.73,90,,19.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",23.91,87,,19.13,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.24,70,,15.39,,,0,"percent of total billed charges ","70% of total billed charges ",19.24,25.56,
"WATER HUMIDIFIER 1500ML",6103170,"CDM ",272,RC,,,OUTPATIENT,,,6,4.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.8,80,,3.84,,,0,"percent of total billed charges ","80% of total billed charges ",4.2,70,,3.36,,,0,"percent of total billed charges ","70% of total billed charges ",5.4,90,,4.32,,,0,"percent of total billed charges ","90% of total billed charges ",5.58,93,,4.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.1,85,,4.08,,,0,"percent of total billed charges ","85% of total billed charges ",5.4,90,,4.32,,,0,"percent of total billed charges ","90% of total billed charges ",5.4,90,,4.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5.22,87,,4.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.2,70,,3.36,,,0,"percent of total billed charges ","70% of total billed charges ",4.2,5.58,
"SUTURE 10-0 ETHILON",6103189,"CDM ",272,RC,,,OUTPATIENT,,,65.65,52.52,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.52,80,,42.02,,,0,"percent of total billed charges ","80% of total billed charges ",45.96,70,,36.77,,,0,"percent of total billed charges ","70% of total billed charges ",59.09,90,,47.27,,,0,"percent of total billed charges ","90% of total billed charges ",61.05,93,,48.84,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",55.8,85,,44.64,,,0,"percent of total billed charges ","85% of total billed charges ",59.09,90,,47.27,,,0,"percent of total billed charges ","90% of total billed charges ",59.09,90,,47.27,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",57.12,87,,45.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.96,70,,36.77,,,0,"percent of total billed charges ","70% of total billed charges ",45.96,61.05,
"SUTURE 539G 4.0 STEEL",6103211,"CDM ",272,RC,,,OUTPATIENT,,,45.69,36.552,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.55,80,,29.24,,,0,"percent of total billed charges ","80% of total billed charges ",31.98,70,,25.58,,,0,"percent of total billed charges ","70% of total billed charges ",41.12,90,,32.90,,,0,"percent of total billed charges ","90% of total billed charges ",42.49,93,,33.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.84,85,,31.07,,,0,"percent of total billed charges ","85% of total billed charges ",41.12,90,,32.90,,,0,"percent of total billed charges ","90% of total billed charges ",41.12,90,,32.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.75,87,,31.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.98,70,,25.58,,,0,"percent of total billed charges ","70% of total billed charges ",31.98,42.49,
"SUTURE PROLENE 3.0 8522H",6103217,"CDM ",272,RC,,,OUTPATIENT,,,21.41,17.128,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.13,80,,13.70,,,0,"percent of total billed charges ","80% of total billed charges ",14.99,70,,11.99,,,0,"percent of total billed charges ","70% of total billed charges ",19.27,90,,15.42,,,0,"percent of total billed charges ","90% of total billed charges ",19.91,93,,15.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.2,85,,14.56,,,0,"percent of total billed charges ","85% of total billed charges ",19.27,90,,15.42,,,0,"percent of total billed charges ","90% of total billed charges ",19.27,90,,15.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.63,87,,14.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.99,70,,11.99,,,0,"percent of total billed charges ","70% of total billed charges ",14.99,19.91,
"SUTURE ETHIBOND 2 D6090",6103254,"CDM ",272,RC,,,OUTPATIENT,,,363.75,291,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",291,80,,232.80,,,0,"percent of total billed charges ","80% of total billed charges ",254.63,70,,203.70,,,0,"percent of total billed charges ","70% of total billed charges ",327.38,90,,261.90,,,0,"percent of total billed charges ","90% of total billed charges ",338.29,93,,270.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",309.19,85,,247.35,,,0,"percent of total billed charges ","85% of total billed charges ",327.38,90,,261.90,,,0,"percent of total billed charges ","90% of total billed charges ",327.38,90,,261.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",316.46,87,,253.17,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",254.63,70,,203.70,,,0,"percent of total billed charges ","70% of total billed charges ",254.63,338.29,
"DRESSING NU GAUZE PLAIN 1""",6103265,"CDM ",272,RC,,,OUTPATIENT,,,18,14.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.4,80,,11.52,,,0,"percent of total billed charges ","80% of total billed charges ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.74,93,,13.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.3,85,,12.24,,,0,"percent of total billed charges ","85% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.66,87,,12.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,16.74,
"RETAINER VISCERA LG",6103272,"CDM ",272,RC,,,OUTPATIENT,,,86.1,68.88,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.88,80,,55.10,,,0,"percent of total billed charges ","80% of total billed charges ",60.27,70,,48.22,,,0,"percent of total billed charges ","70% of total billed charges ",77.49,90,,61.99,,,0,"percent of total billed charges ","90% of total billed charges ",80.07,93,,64.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",73.19,85,,58.55,,,0,"percent of total billed charges ","85% of total billed charges ",77.49,90,,61.99,,,0,"percent of total billed charges ","90% of total billed charges ",77.49,90,,61.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",74.91,87,,59.93,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.27,70,,48.22,,,0,"percent of total billed charges ","70% of total billed charges ",60.27,80.07,
"ELECTRODE CUTTING LOOP 26FR",6103275,"CDM ",272,RC,,,OUTPATIENT,,,361.65,289.32,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",289.32,80,,231.46,,,0,"percent of total billed charges ","80% of total billed charges ",253.16,70,,202.53,,,0,"percent of total billed charges ","70% of total billed charges ",325.49,90,,260.39,,,0,"percent of total billed charges ","90% of total billed charges ",336.33,93,,269.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",307.4,85,,245.92,,,0,"percent of total billed charges ","85% of total billed charges ",325.49,90,,260.39,,,0,"percent of total billed charges ","90% of total billed charges ",325.49,90,,260.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",314.64,87,,251.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",253.16,70,,202.53,,,0,"percent of total billed charges ","70% of total billed charges ",253.16,336.33,
"TUBE BLAKEMORE ESOPHAGEAL 20FR",6103278,"CDM ",272,RC,,,OUTPATIENT,,,800.09,640.072,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",640.07,80,,512.06,,,0,"percent of total billed charges ","80% of total billed charges ",560.06,70,,448.05,,,0,"percent of total billed charges ","70% of total billed charges ",720.08,90,,576.06,,,0,"percent of total billed charges ","90% of total billed charges ",744.08,93,,595.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",680.08,85,,544.06,,,0,"percent of total billed charges ","85% of total billed charges ",720.08,90,,576.06,,,0,"percent of total billed charges ","90% of total billed charges ",720.08,90,,576.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",696.08,87,,556.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",560.06,70,,448.05,,,0,"percent of total billed charges ","70% of total billed charges ",560.06,744.08,
"REAMER CANNULATED 11MM",6103302,"CDM ",272,RC,,,OUTPATIENT,,,250.17,200.136,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",200.14,80,,160.11,,,0,"percent of total billed charges ","80% of total billed charges ",175.12,70,,140.10,,,0,"percent of total billed charges ","70% of total billed charges ",225.15,90,,180.12,,,0,"percent of total billed charges ","90% of total billed charges ",232.66,93,,186.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",212.64,85,,170.11,,,0,"percent of total billed charges ","85% of total billed charges ",225.15,90,,180.12,,,0,"percent of total billed charges ","90% of total billed charges ",225.15,90,,180.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",217.65,87,,174.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",175.12,70,,140.10,,,0,"percent of total billed charges ","70% of total billed charges ",175.12,232.66,
"BURR OVAL 3.0MM X 7CM",6103306,"CDM ",272,RC,,,OUTPATIENT,,,208.92,167.136,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.14,80,,133.71,,,0,"percent of total billed charges ","80% of total billed charges ",146.24,70,,116.99,,,0,"percent of total billed charges ","70% of total billed charges ",188.03,90,,150.42,,,0,"percent of total billed charges ","90% of total billed charges ",194.3,93,,155.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",177.58,85,,142.06,,,0,"percent of total billed charges ","85% of total billed charges ",188.03,90,,150.42,,,0,"percent of total billed charges ","90% of total billed charges ",188.03,90,,150.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",181.76,87,,145.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",146.24,70,,116.99,,,0,"percent of total billed charges ","70% of total billed charges ",146.24,194.3,
"CEMENT BONE KYPHX",6103308,"CDM ",272,RC,,,OUTPATIENT,,,319.49,255.592,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",255.59,80,,204.47,,,0,"percent of total billed charges ","80% of total billed charges ",223.64,70,,178.91,,,0,"percent of total billed charges ","70% of total billed charges ",287.54,90,,230.03,,,0,"percent of total billed charges ","90% of total billed charges ",297.13,93,,237.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",271.57,85,,217.26,,,0,"percent of total billed charges ","85% of total billed charges ",287.54,90,,230.03,,,0,"percent of total billed charges ","90% of total billed charges ",287.54,90,,230.03,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",277.96,87,,222.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",223.64,70,,178.91,,,0,"percent of total billed charges ","70% of total billed charges ",223.64,297.13,
"OSTEO INTRODUCER SZ 3",6103311,"CDM ",272,RC,,,OUTPATIENT,,,2087.25,1669.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1669.8,80,,1335.84,,,0,"percent of total billed charges ","80% of total billed charges ",1461.08,70,,1168.86,,,0,"percent of total billed charges ","70% of total billed charges ",1878.53,90,,1502.82,,,0,"percent of total billed charges ","90% of total billed charges ",1941.14,93,,1552.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1774.16,85,,1419.33,,,0,"percent of total billed charges ","85% of total billed charges ",1878.53,90,,1502.82,,,0,"percent of total billed charges ","90% of total billed charges ",1878.53,90,,1502.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1815.91,87,,1452.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1461.08,70,,1168.86,,,0,"percent of total billed charges ","70% of total billed charges ",1461.08,1941.14,
"BONE TAMP 1ST FRACTURE 2013",6103314,"CDM ",272,RC,,,OUTPATIENT,,,6524.93,5219.944,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5219.94,80,,4175.95,,,0,"percent of total billed charges ","80% of total billed charges ",4567.45,70,,3653.96,,,0,"percent of total billed charges ","70% of total billed charges ",5872.44,90,,4697.95,,,0,"percent of total billed charges ","90% of total billed charges ",6068.18,93,,4854.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5546.19,85,,4436.95,,,0,"percent of total billed charges ","85% of total billed charges ",5872.44,90,,4697.95,,,0,"percent of total billed charges ","90% of total billed charges ",5872.44,90,,4697.95,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5676.69,87,,4541.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4567.45,70,,3653.96,,,0,"percent of total billed charges ","70% of total billed charges ",4567.45,6068.18,
"C-REAMER CANNULATED 12MM",6103321,"CDM ",272,RC,,,OUTPATIENT,,,272.96,218.368,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",218.37,80,,174.70,,,0,"percent of total billed charges ","80% of total billed charges ",191.07,70,,152.86,,,0,"percent of total billed charges ","70% of total billed charges ",245.66,90,,196.53,,,0,"percent of total billed charges ","90% of total billed charges ",253.85,93,,203.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",232.02,85,,185.62,,,0,"percent of total billed charges ","85% of total billed charges ",245.66,90,,196.53,,,0,"percent of total billed charges ","90% of total billed charges ",245.66,90,,196.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",237.48,87,,189.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",191.07,70,,152.86,,,0,"percent of total billed charges ","70% of total billed charges ",191.07,253.85,
"TROCAR 10/12MM",6103337,"CDM ",272,RC,,,OUTPATIENT,,,61.11,48.888,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.89,80,,39.11,,,0,"percent of total billed charges ","80% of total billed charges ",42.78,70,,34.22,,,0,"percent of total billed charges ","70% of total billed charges ",55,90,,44.00,,,0,"percent of total billed charges ","90% of total billed charges ",56.83,93,,45.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51.94,85,,41.55,,,0,"percent of total billed charges ","85% of total billed charges ",55,90,,44.00,,,0,"percent of total billed charges ","90% of total billed charges ",55,90,,44.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",53.17,87,,42.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.78,70,,34.22,,,0,"percent of total billed charges ","70% of total billed charges ",42.78,56.83,
"REAMER BLADE PATELLA 38MM",6103350,"CDM ",272,RC,,,OUTPATIENT,,,581.85,465.48,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",465.48,80,,372.38,,,0,"percent of total billed charges ","80% of total billed charges ",407.3,70,,325.84,,,0,"percent of total billed charges ","70% of total billed charges ",523.67,90,,418.94,,,0,"percent of total billed charges ","90% of total billed charges ",541.12,93,,432.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",494.57,85,,395.66,,,0,"percent of total billed charges ","85% of total billed charges ",523.67,90,,418.94,,,0,"percent of total billed charges ","90% of total billed charges ",523.67,90,,418.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",506.21,87,,404.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",407.3,70,,325.84,,,0,"percent of total billed charges ","70% of total billed charges ",407.3,541.12,
"BALL PIN 5/64",6103353,"CDM ",278,RC,,,OUTPATIENT,,,32.6,26.08,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.08,80,,20.86,,,0,"percent of total billed charges ","80% of total billed charges ",22.82,70,,18.26,,,0,"percent of total billed charges ","70% of total billed charges ",29.34,90,,23.47,,,0,"percent of total billed charges ","90% of total billed charges ",30.32,93,,24.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",27.71,85,,22.17,,,0,"percent of total billed charges ","85% of total billed charges ",27.71,85,,22.17,,,0,"percent of total billed charges ","85% of total billed charges ",29.34,90,,23.47,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",28.36,87,,22.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.82,70,,18.26,,,0,"percent of total billed charges ","70% of total billed charges ",22.82,30.32,
"BALL PIN 3/32",6103354,"CDM ",278,RC,,,OUTPATIENT,,,32.6,26.08,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.08,80,,20.86,,,0,"percent of total billed charges ","80% of total billed charges ",22.82,70,,18.26,,,0,"percent of total billed charges ","70% of total billed charges ",29.34,90,,23.47,,,0,"percent of total billed charges ","90% of total billed charges ",30.32,93,,24.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",27.71,85,,22.17,,,0,"percent of total billed charges ","85% of total billed charges ",27.71,85,,22.17,,,0,"percent of total billed charges ","85% of total billed charges ",29.34,90,,23.47,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",28.36,87,,22.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.82,70,,18.26,,,0,"percent of total billed charges ","70% of total billed charges ",22.82,30.32,
"ROD CONNECT 8X250",6103355,"CDM ",278,RC,,,OUTPATIENT,,,913.72,730.976,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",730.98,80,,584.78,,,0,"percent of total billed charges ","80% of total billed charges ",639.6,70,,511.68,,,0,"percent of total billed charges ","70% of total billed charges ",822.35,90,,657.88,,,0,"percent of total billed charges ","90% of total billed charges ",849.76,93,,679.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",776.66,85,,621.33,,,0,"percent of total billed charges ","85% of total billed charges ",776.66,85,,621.33,,,0,"percent of total billed charges ","85% of total billed charges ",822.35,90,,657.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",794.94,87,,635.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",639.6,70,,511.68,,,0,"percent of total billed charges ","70% of total billed charges ",639.6,849.76,
"ROD CONNECTING 8X400",6103357,"CDM ",278,RC,,,OUTPATIENT,,,660.53,528.424,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",528.42,80,,422.74,,,0,"percent of total billed charges ","80% of total billed charges ",462.37,70,,369.90,,,0,"percent of total billed charges ","70% of total billed charges ",594.48,90,,475.58,,,0,"percent of total billed charges ","90% of total billed charges ",614.29,93,,491.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",561.45,85,,449.16,,,0,"percent of total billed charges ","85% of total billed charges ",561.45,85,,449.16,,,0,"percent of total billed charges ","85% of total billed charges ",594.48,90,,475.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",574.66,87,,459.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",462.37,70,,369.90,,,0,"percent of total billed charges ","70% of total billed charges ",462.37,614.29,
"PIN STEINMAN 9/64 X 9""",6103358,"CDM ",278,RC,,,OUTPATIENT,,,43.28,34.624,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.62,80,,27.70,,,0,"percent of total billed charges ","80% of total billed charges ",30.3,70,,24.24,,,0,"percent of total billed charges ","70% of total billed charges ",38.95,90,,31.16,,,0,"percent of total billed charges ","90% of total billed charges ",40.25,93,,32.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",36.79,85,,29.43,,,0,"percent of total billed charges ","85% of total billed charges ",36.79,85,,29.43,,,0,"percent of total billed charges ","85% of total billed charges ",38.95,90,,31.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",37.65,87,,30.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.3,70,,24.24,,,0,"percent of total billed charges ","70% of total billed charges ",30.3,40.25,
"COUPLING PIN TO ROD",6103363,"CDM ",278,RC,,,OUTPATIENT,,,909.91,727.928,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",727.93,80,,582.34,,,0,"percent of total billed charges ","80% of total billed charges ",636.94,70,,509.55,,,0,"percent of total billed charges ","70% of total billed charges ",818.92,90,,655.14,,,0,"percent of total billed charges ","90% of total billed charges ",846.22,93,,676.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",773.42,85,,618.74,,,0,"percent of total billed charges ","85% of total billed charges ",773.42,85,,618.74,,,0,"percent of total billed charges ","85% of total billed charges ",818.92,90,,655.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",791.62,87,,633.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",636.94,70,,509.55,,,0,"percent of total billed charges ","70% of total billed charges ",636.94,846.22,
"TUBE GASTROSTOMY 18FR MOSS",6103368,"CDM ",272,RC,,,OUTPATIENT,,,549.53,439.624,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",439.62,80,,351.70,,,0,"percent of total billed charges ","80% of total billed charges ",384.67,70,,307.74,,,0,"percent of total billed charges ","70% of total billed charges ",494.58,90,,395.66,,,0,"percent of total billed charges ","90% of total billed charges ",511.06,93,,408.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",467.1,85,,373.68,,,0,"percent of total billed charges ","85% of total billed charges ",494.58,90,,395.66,,,0,"percent of total billed charges ","90% of total billed charges ",494.58,90,,395.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",478.09,87,,382.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",384.67,70,,307.74,,,0,"percent of total billed charges ","70% of total billed charges ",384.67,511.06,
"ADAPTER 4 SPIKE",6103371,"CDM ",272,RC,,,OUTPATIENT,,,32.75,26.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.2,80,,20.96,,,0,"percent of total billed charges ","80% of total billed charges ",22.93,70,,18.34,,,0,"percent of total billed charges ","70% of total billed charges ",29.48,90,,23.58,,,0,"percent of total billed charges ","90% of total billed charges ",30.46,93,,24.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",27.84,85,,22.27,,,0,"percent of total billed charges ","85% of total billed charges ",29.48,90,,23.58,,,0,"percent of total billed charges ","90% of total billed charges ",29.48,90,,23.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",28.49,87,,22.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.93,70,,18.34,,,0,"percent of total billed charges ","70% of total billed charges ",22.93,30.46,
"ROD COUPLING ROD",6103372,"CDM ",278,RC,,,OUTPATIENT,,,976.56,781.248,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",781.25,80,,625.00,,,0,"percent of total billed charges ","80% of total billed charges ",683.59,70,,546.87,,,0,"percent of total billed charges ","70% of total billed charges ",878.9,90,,703.12,,,0,"percent of total billed charges ","90% of total billed charges ",908.2,93,,726.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",830.08,85,,664.06,,,0,"percent of total billed charges ","85% of total billed charges ",830.08,85,,664.06,,,0,"percent of total billed charges ","85% of total billed charges ",878.9,90,,703.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",849.61,87,,679.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",683.59,70,,546.87,,,0,"percent of total billed charges ","70% of total billed charges ",683.59,908.2,
"RING FALOPIAN",6103374,"CDM ",272,RC,,,OUTPATIENT,,,305.39,244.312,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",244.31,80,,195.45,,,0,"percent of total billed charges ","80% of total billed charges ",213.77,70,,171.02,,,0,"percent of total billed charges ","70% of total billed charges ",274.85,90,,219.88,,,0,"percent of total billed charges ","90% of total billed charges ",284.01,93,,227.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",259.58,85,,207.66,,,0,"percent of total billed charges ","85% of total billed charges ",274.85,90,,219.88,,,0,"percent of total billed charges ","90% of total billed charges ",274.85,90,,219.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",265.69,87,,212.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",213.77,70,,171.02,,,0,"percent of total billed charges ","70% of total billed charges ",213.77,284.01,
"CATH URETERAL OPEN 4FRX70CM",6103375,"CDM ",272,RC,,,OUTPATIENT,,,129.88,103.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.9,80,,83.12,,,0,"percent of total billed charges ","80% of total billed charges ",90.92,70,,72.74,,,0,"percent of total billed charges ","70% of total billed charges ",116.89,90,,93.51,,,0,"percent of total billed charges ","90% of total billed charges ",120.79,93,,96.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",110.4,85,,88.32,,,0,"percent of total billed charges ","85% of total billed charges ",116.89,90,,93.51,,,0,"percent of total billed charges ","90% of total billed charges ",116.89,90,,93.51,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",113,87,,90.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.92,70,,72.74,,,0,"percent of total billed charges ","70% of total billed charges ",90.92,120.79,
"PIN DIS 4X120 M SD/ST",6103386,"CDM ",278,RC,,,OUTPATIENT,,,308.17,246.536,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",246.54,80,,197.23,,,0,"percent of total billed charges ","80% of total billed charges ",215.72,70,,172.58,,,0,"percent of total billed charges ","70% of total billed charges ",277.35,90,,221.88,,,0,"percent of total billed charges ","90% of total billed charges ",286.6,93,,229.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",261.94,85,,209.55,,,0,"percent of total billed charges ","85% of total billed charges ",261.94,85,,209.55,,,0,"percent of total billed charges ","85% of total billed charges ",277.35,90,,221.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",268.11,87,,214.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",215.72,70,,172.58,,,0,"percent of total billed charges ","70% of total billed charges ",215.72,286.6,
"PIN DIA 5X180 SD/ST",6103390,"CDM ",278,RC,,,OUTPATIENT,,,355.7,284.56,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",284.56,80,,227.65,,,0,"percent of total billed charges ","80% of total billed charges ",248.99,70,,199.19,,,0,"percent of total billed charges ","70% of total billed charges ",320.13,90,,256.10,,,0,"percent of total billed charges ","90% of total billed charges ",330.8,93,,264.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",302.35,85,,241.88,,,0,"percent of total billed charges ","85% of total billed charges ",302.35,85,,241.88,,,0,"percent of total billed charges ","85% of total billed charges ",320.13,90,,256.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",309.46,87,,247.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",248.99,70,,199.19,,,0,"percent of total billed charges ","70% of total billed charges ",248.99,330.8,
"PIN DIA 4X250 TRANSFIX",6103391,"CDM ",278,RC,,,OUTPATIENT,,,331.48,265.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",265.18,80,,212.14,,,0,"percent of total billed charges ","80% of total billed charges ",232.04,70,,185.63,,,0,"percent of total billed charges ","70% of total billed charges ",298.33,90,,238.66,,,0,"percent of total billed charges ","90% of total billed charges ",308.28,93,,246.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",281.76,85,,225.41,,,0,"percent of total billed charges ","85% of total billed charges ",281.76,85,,225.41,,,0,"percent of total billed charges ","85% of total billed charges ",298.33,90,,238.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",288.39,87,,230.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",232.04,70,,185.63,,,0,"percent of total billed charges ","70% of total billed charges ",232.04,308.28,
"BLADE INDONE TOME",6103400,"CDM ",272,RC,,,OUTPATIENT,,,258.6,206.88,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",206.88,80,,165.50,,,0,"percent of total billed charges ","80% of total billed charges ",181.02,70,,144.82,,,0,"percent of total billed charges ","70% of total billed charges ",232.74,90,,186.19,,,0,"percent of total billed charges ","90% of total billed charges ",240.5,93,,192.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",219.81,85,,175.85,,,0,"percent of total billed charges ","85% of total billed charges ",232.74,90,,186.19,,,0,"percent of total billed charges ","90% of total billed charges ",232.74,90,,186.19,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",224.98,87,,179.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",181.02,70,,144.82,,,0,"percent of total billed charges ","70% of total billed charges ",181.02,240.5,
"GATOR 4.2 MERLIN 30 DEGREE",6103403,"CDM ",272,RC,,,OUTPATIENT,,,333.25,266.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",266.6,80,,213.28,,,0,"percent of total billed charges ","80% of total billed charges ",233.28,70,,186.62,,,0,"percent of total billed charges ","70% of total billed charges ",299.93,90,,239.94,,,0,"percent of total billed charges ","90% of total billed charges ",309.92,93,,247.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",283.26,85,,226.61,,,0,"percent of total billed charges ","85% of total billed charges ",299.93,90,,239.94,,,0,"percent of total billed charges ","90% of total billed charges ",299.93,90,,239.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",289.93,87,,231.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",233.28,70,,186.62,,,0,"percent of total billed charges ","70% of total billed charges ",233.28,309.92,
"BLADE LONG-MED SAW",6103409,"CDM ",272,RC,,,OUTPATIENT,,,111.3,89.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",89.04,80,,71.23,,,0,"percent of total billed charges ","80% of total billed charges ",77.91,70,,62.33,,,0,"percent of total billed charges ","70% of total billed charges ",100.17,90,,80.14,,,0,"percent of total billed charges ","90% of total billed charges ",103.51,93,,82.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",94.61,85,,75.69,,,0,"percent of total billed charges ","85% of total billed charges ",100.17,90,,80.14,,,0,"percent of total billed charges ","90% of total billed charges ",100.17,90,,80.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",96.83,87,,77.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.91,70,,62.33,,,0,"percent of total billed charges ","70% of total billed charges ",77.91,103.51,
"BLADE LONG NARROW SAW",6103410,"CDM ",272,RC,,,OUTPATIENT,,,111.3,89.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",89.04,80,,71.23,,,0,"percent of total billed charges ","80% of total billed charges ",77.91,70,,62.33,,,0,"percent of total billed charges ","70% of total billed charges ",100.17,90,,80.14,,,0,"percent of total billed charges ","90% of total billed charges ",103.51,93,,82.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",94.61,85,,75.69,,,0,"percent of total billed charges ","85% of total billed charges ",100.17,90,,80.14,,,0,"percent of total billed charges ","90% of total billed charges ",100.17,90,,80.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",96.83,87,,77.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.91,70,,62.33,,,0,"percent of total billed charges ","70% of total billed charges ",77.91,103.51,
"BLADE LONG NARROW",6103411,"CDM ",272,RC,,,OUTPATIENT,,,111.3,89.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",89.04,80,,71.23,,,0,"percent of total billed charges ","80% of total billed charges ",77.91,70,,62.33,,,0,"percent of total billed charges ","70% of total billed charges ",100.17,90,,80.14,,,0,"percent of total billed charges ","90% of total billed charges ",103.51,93,,82.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",94.61,85,,75.69,,,0,"percent of total billed charges ","85% of total billed charges ",100.17,90,,80.14,,,0,"percent of total billed charges ","90% of total billed charges ",100.17,90,,80.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",96.83,87,,77.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.91,70,,62.33,,,0,"percent of total billed charges ","70% of total billed charges ",77.91,103.51,
"BLADE 18.5X9MM MED-MED",6103412,"CDM ",272,RC,,,OUTPATIENT,,,111.3,89.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",89.04,80,,71.23,,,0,"percent of total billed charges ","80% of total billed charges ",77.91,70,,62.33,,,0,"percent of total billed charges ","70% of total billed charges ",100.17,90,,80.14,,,0,"percent of total billed charges ","90% of total billed charges ",103.51,93,,82.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",94.61,85,,75.69,,,0,"percent of total billed charges ","85% of total billed charges ",100.17,90,,80.14,,,0,"percent of total billed charges ","90% of total billed charges ",100.17,90,,80.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",96.83,87,,77.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.91,70,,62.33,,,0,"percent of total billed charges ","70% of total billed charges ",77.91,103.51,
"ROD CONNECTING 8X300M",6103414,"CDM ",278,RC,,,OUTPATIENT,,,644.04,515.232,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",515.23,80,,412.18,,,0,"percent of total billed charges ","80% of total billed charges ",450.83,70,,360.66,,,0,"percent of total billed charges ","70% of total billed charges ",579.64,90,,463.71,,,0,"percent of total billed charges ","90% of total billed charges ",598.96,93,,479.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",547.43,85,,437.94,,,0,"percent of total billed charges ","85% of total billed charges ",547.43,85,,437.94,,,0,"percent of total billed charges ","85% of total billed charges ",579.64,90,,463.71,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",560.31,87,,448.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",450.83,70,,360.66,,,0,"percent of total billed charges ","70% of total billed charges ",450.83,598.96,
"BURR SWANSON PILOT 2MM SHORT",6103415,"CDM ",272,RC,,,OUTPATIENT,,,312.91,250.328,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",250.33,80,,200.26,,,0,"percent of total billed charges ","80% of total billed charges ",219.04,70,,175.23,,,0,"percent of total billed charges ","70% of total billed charges ",281.62,90,,225.30,,,0,"percent of total billed charges ","90% of total billed charges ",291.01,93,,232.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",265.97,85,,212.78,,,0,"percent of total billed charges ","85% of total billed charges ",281.62,90,,225.30,,,0,"percent of total billed charges ","90% of total billed charges ",281.62,90,,225.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",272.23,87,,217.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",219.04,70,,175.23,,,0,"percent of total billed charges ","70% of total billed charges ",219.04,291.01,
"ROD CONNECTING 8X350",6103418,"CDM ",278,RC,,,OUTPATIENT,,,644.04,515.232,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",515.23,80,,412.18,,,0,"percent of total billed charges ","80% of total billed charges ",450.83,70,,360.66,,,0,"percent of total billed charges ","70% of total billed charges ",579.64,90,,463.71,,,0,"percent of total billed charges ","90% of total billed charges ",598.96,93,,479.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",547.43,85,,437.94,,,0,"percent of total billed charges ","85% of total billed charges ",547.43,85,,437.94,,,0,"percent of total billed charges ","85% of total billed charges ",579.64,90,,463.71,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",560.31,87,,448.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",450.83,70,,360.66,,,0,"percent of total billed charges ","70% of total billed charges ",450.83,598.96,
"ROD CONNECTING 8X450",6103423,"CDM ",278,RC,,,OUTPATIENT,,,660.53,528.424,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",528.42,80,,422.74,,,0,"percent of total billed charges ","80% of total billed charges ",462.37,70,,369.90,,,0,"percent of total billed charges ","70% of total billed charges ",594.48,90,,475.58,,,0,"percent of total billed charges ","90% of total billed charges ",614.29,93,,491.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",561.45,85,,449.16,,,0,"percent of total billed charges ","85% of total billed charges ",561.45,85,,449.16,,,0,"percent of total billed charges ","85% of total billed charges ",594.48,90,,475.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",574.66,87,,459.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",462.37,70,,369.90,,,0,"percent of total billed charges ","70% of total billed charges ",462.37,614.29,
"ROD CONNECTING 8X500",6103432,"CDM ",278,RC,,,OUTPATIENT,,,697.9,558.32,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",558.32,80,,446.66,,,0,"percent of total billed charges ","80% of total billed charges ",488.53,70,,390.82,,,0,"percent of total billed charges ","70% of total billed charges ",628.11,90,,502.49,,,0,"percent of total billed charges ","90% of total billed charges ",649.05,93,,519.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",593.22,85,,474.58,,,0,"percent of total billed charges ","85% of total billed charges ",593.22,85,,474.58,,,0,"percent of total billed charges ","85% of total billed charges ",628.11,90,,502.49,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",607.17,87,,485.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",488.53,70,,390.82,,,0,"percent of total billed charges ","70% of total billed charges ",488.53,649.05,
"SHOE POST OP MENS LG",6103433,"CDM ",271,RC,,,OUTPATIENT,,,49.5,39.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.6,80,,31.68,,,0,"percent of total billed charges ","80% of total billed charges ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",46.04,93,,36.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.08,85,,33.66,,,0,"percent of total billed charges ","85% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.07,87,,34.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,46.04,
"POST DG ANGLED 30DG",6103441,"CDM ",278,RC,,,OUTPATIENT,,,369.56,295.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",295.65,80,,236.52,,,0,"percent of total billed charges ","80% of total billed charges ",258.69,70,,206.95,,,0,"percent of total billed charges ","70% of total billed charges ",332.6,90,,266.08,,,0,"percent of total billed charges ","90% of total billed charges ",343.69,93,,274.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",314.13,85,,251.30,,,0,"percent of total billed charges ","85% of total billed charges ",314.13,85,,251.30,,,0,"percent of total billed charges ","85% of total billed charges ",332.6,90,,266.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",321.52,87,,257.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",258.69,70,,206.95,,,0,"percent of total billed charges ","70% of total billed charges ",258.69,343.69,
"MAT INSTRUMENT",6103442,"CDM ",272,RC,,,OUTPATIENT,,,19.81,15.848,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.85,80,,12.68,,,0,"percent of total billed charges ","80% of total billed charges ",13.87,70,,11.10,,,0,"percent of total billed charges ","70% of total billed charges ",17.83,90,,14.26,,,0,"percent of total billed charges ","90% of total billed charges ",18.42,93,,14.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.84,85,,13.47,,,0,"percent of total billed charges ","85% of total billed charges ",17.83,90,,14.26,,,0,"percent of total billed charges ","90% of total billed charges ",17.83,90,,14.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.23,87,,13.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.87,70,,11.10,,,0,"percent of total billed charges ","70% of total billed charges ",13.87,18.42,
"MAT ECOSUCTIONER 28"" X 40""",6103447,"CDM ",270,RC,,,OUTPATIENT,,,267.38,213.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",213.9,80,,171.12,,,0,"percent of total billed charges ","80% of total billed charges ",187.17,70,,149.74,,,0,"percent of total billed charges ","70% of total billed charges ",240.64,90,,192.51,,,0,"percent of total billed charges ","90% of total billed charges ",248.66,93,,198.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",227.27,85,,181.82,,,0,"percent of total billed charges ","85% of total billed charges ",240.64,90,,192.51,,,0,"percent of total billed charges ","90% of total billed charges ",240.64,90,,192.51,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",232.62,87,,186.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.17,70,,149.74,,,0,"percent of total billed charges ","70% of total billed charges ",187.17,248.66,
"POST STRAIGHT",6103448,"CDM ",278,RC,,,OUTPATIENT,,,374.33,299.464,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.46,80,,239.57,,,0,"percent of total billed charges ","80% of total billed charges ",262.03,70,,209.62,,,0,"percent of total billed charges ","70% of total billed charges ",336.9,90,,269.52,,,0,"percent of total billed charges ","90% of total billed charges ",348.13,93,,278.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",318.18,85,,254.54,,,0,"percent of total billed charges ","85% of total billed charges ",318.18,85,,254.54,,,0,"percent of total billed charges ","85% of total billed charges ",336.9,90,,269.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",325.67,87,,260.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.03,70,,209.62,,,0,"percent of total billed charges ","70% of total billed charges ",262.03,348.13,
"PIN STEINMAN 2.4 MM X 229 MM",6103453,"CDM ",278,RC,,,OUTPATIENT,,,23,18.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.4,80,,14.72,,,0,"percent of total billed charges ","80% of total billed charges ",16.1,70,,12.88,,,0,"percent of total billed charges ","70% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",21.39,93,,17.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.55,85,,15.64,,,0,"percent of total billed charges ","85% of total billed charges ",19.55,85,,15.64,,,0,"percent of total billed charges ","85% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.01,87,,16.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.1,70,,12.88,,,0,"percent of total billed charges ","70% of total billed charges ",16.1,21.39,
"POST DG 90G",6103462,"CDM ",278,RC,,,OUTPATIENT,,,248.9,199.12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",199.12,80,,159.30,,,0,"percent of total billed charges ","80% of total billed charges ",174.23,70,,139.38,,,0,"percent of total billed charges ","70% of total billed charges ",224.01,90,,179.21,,,0,"percent of total billed charges ","90% of total billed charges ",231.48,93,,185.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",211.57,85,,169.26,,,0,"percent of total billed charges ","85% of total billed charges ",211.57,85,,169.26,,,0,"percent of total billed charges ","85% of total billed charges ",224.01,90,,179.21,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",216.54,87,,173.23,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174.23,70,,139.38,,,0,"percent of total billed charges ","70% of total billed charges ",174.23,231.48,
"NEEDLE ABDOM STRAIGHT CUTTING",6103463,"CDM ",272,RC,,,OUTPATIENT,,,24.62,19.696,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.7,80,,15.76,,,0,"percent of total billed charges ","80% of total billed charges ",17.23,70,,13.78,,,0,"percent of total billed charges ","70% of total billed charges ",22.16,90,,17.73,,,0,"percent of total billed charges ","90% of total billed charges ",22.9,93,,18.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.93,85,,16.74,,,0,"percent of total billed charges ","85% of total billed charges ",22.16,90,,17.73,,,0,"percent of total billed charges ","90% of total billed charges ",22.16,90,,17.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.42,87,,17.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.23,70,,13.78,,,0,"percent of total billed charges ","70% of total billed charges ",17.23,22.9,
"CLAMP PIN S HOLE",6103466,"CDM ",278,RC,,,OUTPATIENT,,,1035.8,828.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",828.64,80,,662.91,,,0,"percent of total billed charges ","80% of total billed charges ",725.06,70,,580.05,,,0,"percent of total billed charges ","70% of total billed charges ",932.22,90,,745.78,,,0,"percent of total billed charges ","90% of total billed charges ",963.29,93,,770.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",880.43,85,,704.34,,,0,"percent of total billed charges ","85% of total billed charges ",880.43,85,,704.34,,,0,"percent of total billed charges ","85% of total billed charges ",932.22,90,,745.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",901.15,87,,720.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",725.06,70,,580.05,,,0,"percent of total billed charges ","70% of total billed charges ",725.06,963.29,
"CLAMP PIN 10 HOLE",6103469,"CDM ",278,RC,,,OUTPATIENT,,,1380.14,1104.112,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1104.11,80,,883.29,,,0,"percent of total billed charges ","80% of total billed charges ",966.1,70,,772.88,,,0,"percent of total billed charges ","70% of total billed charges ",1242.13,90,,993.70,,,0,"percent of total billed charges ","90% of total billed charges ",1283.53,93,,1026.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1173.12,85,,938.50,,,0,"percent of total billed charges ","85% of total billed charges ",1173.12,85,,938.50,,,0,"percent of total billed charges ","85% of total billed charges ",1242.13,90,,993.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1200.72,87,,960.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",966.1,70,,772.88,,,0,"percent of total billed charges ","70% of total billed charges ",966.1,1283.53,
"PIN DIS 5X150M SD/ST",6103472,"CDM ",278,RC,,,OUTPATIENT,,,372.82,298.256,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",298.26,80,,238.61,,,0,"percent of total billed charges ","80% of total billed charges ",260.97,70,,208.78,,,0,"percent of total billed charges ","70% of total billed charges ",335.54,90,,268.43,,,0,"percent of total billed charges ","90% of total billed charges ",346.72,93,,277.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",316.9,85,,253.52,,,0,"percent of total billed charges ","85% of total billed charges ",316.9,85,,253.52,,,0,"percent of total billed charges ","85% of total billed charges ",335.54,90,,268.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",324.35,87,,259.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",260.97,70,,208.78,,,0,"percent of total billed charges ","70% of total billed charges ",260.97,346.72,
"PIN DIA 5X200M SD/ST",6103473,"CDM ",278,RC,,,OUTPATIENT,,,352.63,282.104,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",282.1,80,,225.68,,,0,"percent of total billed charges ","80% of total billed charges ",246.84,70,,197.47,,,0,"percent of total billed charges ","70% of total billed charges ",317.37,90,,253.90,,,0,"percent of total billed charges ","90% of total billed charges ",327.95,93,,262.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",299.74,85,,239.79,,,0,"percent of total billed charges ","85% of total billed charges ",299.74,85,,239.79,,,0,"percent of total billed charges ","85% of total billed charges ",317.37,90,,253.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",306.79,87,,245.43,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",246.84,70,,197.47,,,0,"percent of total billed charges ","70% of total billed charges ",246.84,327.95,
"TUBE COMPRESSION/DISTRACTION",6103474,"CDM ",278,RC,,,OUTPATIENT,,,969.5,775.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",775.6,80,,620.48,,,0,"percent of total billed charges ","80% of total billed charges ",678.65,70,,542.92,,,0,"percent of total billed charges ","70% of total billed charges ",872.55,90,,698.04,,,0,"percent of total billed charges ","90% of total billed charges ",901.64,93,,721.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",824.08,85,,659.26,,,0,"percent of total billed charges ","85% of total billed charges ",824.08,85,,659.26,,,0,"percent of total billed charges ","85% of total billed charges ",872.55,90,,698.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",843.47,87,,674.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",678.65,70,,542.92,,,0,"percent of total billed charges ","70% of total billed charges ",678.65,901.64,
"COUPLER ROD - TUBE",6103475,"CDM ",278,RC,,,OUTPATIENT,,,932.25,745.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",745.8,80,,596.64,,,0,"percent of total billed charges ","80% of total billed charges ",652.58,70,,522.06,,,0,"percent of total billed charges ","70% of total billed charges ",839.03,90,,671.22,,,0,"percent of total billed charges ","90% of total billed charges ",866.99,93,,693.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",792.41,85,,633.93,,,0,"percent of total billed charges ","85% of total billed charges ",792.41,85,,633.93,,,0,"percent of total billed charges ","85% of total billed charges ",839.03,90,,671.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",811.06,87,,648.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",652.58,70,,522.06,,,0,"percent of total billed charges ","70% of total billed charges ",652.58,866.99,
"ROD SEMI-CIRCULAR 8X174",6103476,"CDM ",278,RC,,,OUTPATIENT,,,422.38,337.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",337.9,80,,270.32,,,0,"percent of total billed charges ","80% of total billed charges ",295.67,70,,236.54,,,0,"percent of total billed charges ","70% of total billed charges ",380.14,90,,304.11,,,0,"percent of total billed charges ","90% of total billed charges ",392.81,93,,314.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.02,85,,287.22,,,0,"percent of total billed charges ","85% of total billed charges ",359.02,85,,287.22,,,0,"percent of total billed charges ","85% of total billed charges ",380.14,90,,304.11,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",367.47,87,,293.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",295.67,70,,236.54,,,0,"percent of total billed charges ","70% of total billed charges ",295.67,392.81,
"DRILL BIT 2.8MM X 40MM",6103479,"CDM ",272,RC,,,OUTPATIENT,,,244,195.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",195.2,80,,156.16,,,0,"percent of total billed charges ","80% of total billed charges ",170.8,70,,136.64,,,0,"percent of total billed charges ","70% of total billed charges ",219.6,90,,175.68,,,0,"percent of total billed charges ","90% of total billed charges ",226.92,93,,181.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",207.4,85,,165.92,,,0,"percent of total billed charges ","85% of total billed charges ",219.6,90,,175.68,,,0,"percent of total billed charges ","90% of total billed charges ",219.6,90,,175.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",212.28,87,,169.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.8,70,,136.64,,,0,"percent of total billed charges ","70% of total billed charges ",170.8,226.92,
"KIT JEJUNOSTOMY 5FR",6103493,"CDM ",272,RC,,,OUTPATIENT,,,342.05,273.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.64,80,,218.91,,,0,"percent of total billed charges ","80% of total billed charges ",239.44,70,,191.55,,,0,"percent of total billed charges ","70% of total billed charges ",307.85,90,,246.28,,,0,"percent of total billed charges ","90% of total billed charges ",318.11,93,,254.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",290.74,85,,232.59,,,0,"percent of total billed charges ","85% of total billed charges ",307.85,90,,246.28,,,0,"percent of total billed charges ","90% of total billed charges ",307.85,90,,246.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",297.58,87,,238.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",239.44,70,,191.55,,,0,"percent of total billed charges ","70% of total billed charges ",239.44,318.11,
"SUTURE ETHIBOND CT-2 CX27D",6103600,"CDM ",272,RC,,,OUTPATIENT,,,59.7,47.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.76,80,,38.21,,,0,"percent of total billed charges ","80% of total billed charges ",41.79,70,,33.43,,,0,"percent of total billed charges ","70% of total billed charges ",53.73,90,,42.98,,,0,"percent of total billed charges ","90% of total billed charges ",55.52,93,,44.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",50.75,85,,40.60,,,0,"percent of total billed charges ","85% of total billed charges ",53.73,90,,42.98,,,0,"percent of total billed charges ","90% of total billed charges ",53.73,90,,42.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",51.94,87,,41.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.79,70,,33.43,,,0,"percent of total billed charges ","70% of total billed charges ",41.79,55.52,
"STANDARD ANKLE CLAMP",6103602,"CDM ",272,RC,,,OUTPATIENT,,,1824.5,1459.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1459.6,80,,1167.68,,,0,"percent of total billed charges ","80% of total billed charges ",1277.15,70,,1021.72,,,0,"percent of total billed charges ","70% of total billed charges ",1642.05,90,,1313.64,,,0,"percent of total billed charges ","90% of total billed charges ",1696.79,93,,1357.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1550.83,85,,1240.66,,,0,"percent of total billed charges ","85% of total billed charges ",1642.05,90,,1313.64,,,0,"percent of total billed charges ","90% of total billed charges ",1642.05,90,,1313.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1587.32,87,,1269.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1277.15,70,,1021.72,,,0,"percent of total billed charges ","70% of total billed charges ",1277.15,1696.79,
"STANDARD INNER BODY ROTATOR",6103609,"CDM ",272,RC,,,OUTPATIENT,,,852.5,682,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",682,80,,545.60,,,0,"percent of total billed charges ","80% of total billed charges ",596.75,70,,477.40,,,0,"percent of total billed charges ","70% of total billed charges ",767.25,90,,613.80,,,0,"percent of total billed charges ","90% of total billed charges ",792.83,93,,634.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",724.63,85,,579.70,,,0,"percent of total billed charges ","85% of total billed charges ",767.25,90,,613.80,,,0,"percent of total billed charges ","90% of total billed charges ",767.25,90,,613.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",741.68,87,,593.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",596.75,70,,477.40,,,0,"percent of total billed charges ","70% of total billed charges ",596.75,792.83,
"CATH EMBOLECTOMY 5 FR",6103612,"CDM ",272,RC,,,OUTPATIENT,,,174.42,139.536,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.54,80,,111.63,,,0,"percent of total billed charges ","80% of total billed charges ",122.09,70,,97.67,,,0,"percent of total billed charges ","70% of total billed charges ",156.98,90,,125.58,,,0,"percent of total billed charges ","90% of total billed charges ",162.21,93,,129.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",148.26,85,,118.61,,,0,"percent of total billed charges ","85% of total billed charges ",156.98,90,,125.58,,,0,"percent of total billed charges ","90% of total billed charges ",156.98,90,,125.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",151.75,87,,121.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.09,70,,97.67,,,0,"percent of total billed charges ","70% of total billed charges ",122.09,162.21,
"SUTURE 2-0 SILK FSL 677G",6103613,"CDM ",272,RC,,,OUTPATIENT,,,8.38,6.704,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.7,80,,5.36,,,0,"percent of total billed charges ","80% of total billed charges ",5.87,70,,4.70,,,0,"percent of total billed charges ","70% of total billed charges ",7.54,90,,6.03,,,0,"percent of total billed charges ","90% of total billed charges ",7.79,93,,6.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7.12,85,,5.70,,,0,"percent of total billed charges ","85% of total billed charges ",7.54,90,,6.03,,,0,"percent of total billed charges ","90% of total billed charges ",7.54,90,,6.03,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7.29,87,,5.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.87,70,,4.70,,,0,"percent of total billed charges ","70% of total billed charges ",5.87,7.79,
"PIN ABSORBABLE 40MMX1.3MM",6103615,"CDM ",278,RC,,,OUTPATIENT,,,762,609.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",609.6,80,,487.68,,,0,"percent of total billed charges ","80% of total billed charges ",533.4,70,,426.72,,,0,"percent of total billed charges ","70% of total billed charges ",685.8,90,,548.64,,,0,"percent of total billed charges ","90% of total billed charges ",708.66,93,,566.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",647.7,85,,518.16,,,0,"percent of total billed charges ","85% of total billed charges ",647.7,85,,518.16,,,0,"percent of total billed charges ","85% of total billed charges ",685.8,90,,548.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",662.94,87,,530.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",533.4,70,,426.72,,,0,"percent of total billed charges ","70% of total billed charges ",533.4,708.66,
"TRACEPAK LATEX FREE SURG",6103617,"CDM ",272,RC,,,OUTPATIENT,,,517.5,414,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",414,80,,331.20,,,0,"percent of total billed charges ","80% of total billed charges ",362.25,70,,289.80,,,0,"percent of total billed charges ","70% of total billed charges ",465.75,90,,372.60,,,0,"percent of total billed charges ","90% of total billed charges ",481.28,93,,385.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",439.88,85,,351.90,,,0,"percent of total billed charges ","85% of total billed charges ",465.75,90,,372.60,,,0,"percent of total billed charges ","90% of total billed charges ",465.75,90,,372.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",450.23,87,,360.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",362.25,70,,289.80,,,0,"percent of total billed charges ","70% of total billed charges ",362.25,481.28,
"SUTURE B-PASS BIOMET",6103623,"CDM ",272,RC,,,OUTPATIENT,,,368.13,294.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",294.5,80,,235.60,,,0,"percent of total billed charges ","80% of total billed charges ",257.69,70,,206.15,,,0,"percent of total billed charges ","70% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",342.36,93,,273.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",312.91,85,,250.33,,,0,"percent of total billed charges ","85% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",320.27,87,,256.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",257.69,70,,206.15,,,0,"percent of total billed charges ","70% of total billed charges ",257.69,342.36,
"TUBE PASSPORT 2.4 24FR",6103626,"CDM ",272,RC,,,OUTPATIENT,,,379.17,303.336,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.34,80,,242.67,,,0,"percent of total billed charges ","80% of total billed charges ",265.42,70,,212.34,,,0,"percent of total billed charges ","70% of total billed charges ",341.25,90,,273.00,,,0,"percent of total billed charges ","90% of total billed charges ",352.63,93,,282.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",322.29,85,,257.83,,,0,"percent of total billed charges ","85% of total billed charges ",341.25,90,,273.00,,,0,"percent of total billed charges ","90% of total billed charges ",341.25,90,,273.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",329.88,87,,263.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",265.42,70,,212.34,,,0,"percent of total billed charges ","70% of total billed charges ",265.42,352.63,
"FIXATOR 38CM 30-Q RING",6103633,"CDM ",272,RC,,,OUTPATIENT,,,742,593.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",593.6,80,,474.88,,,0,"percent of total billed charges ","80% of total billed charges ",519.4,70,,415.52,,,0,"percent of total billed charges ","70% of total billed charges ",667.8,90,,534.24,,,0,"percent of total billed charges ","90% of total billed charges ",690.06,93,,552.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",630.7,85,,504.56,,,0,"percent of total billed charges ","85% of total billed charges ",667.8,90,,534.24,,,0,"percent of total billed charges ","90% of total billed charges ",667.8,90,,534.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",645.54,87,,516.43,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",519.4,70,,415.52,,,0,"percent of total billed charges ","70% of total billed charges ",519.4,690.06,
"FIXATOR 18CM 30 Q RING",6103635,"CDM ",272,RC,,,OUTPATIENT,,,762.87,610.296,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",610.3,80,,488.24,,,0,"percent of total billed charges ","80% of total billed charges ",534.01,70,,427.21,,,0,"percent of total billed charges ","70% of total billed charges ",686.58,90,,549.26,,,0,"percent of total billed charges ","90% of total billed charges ",709.47,93,,567.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",648.44,85,,518.75,,,0,"percent of total billed charges ","85% of total billed charges ",686.58,90,,549.26,,,0,"percent of total billed charges ","90% of total billed charges ",686.58,90,,549.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",663.7,87,,530.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",534.01,70,,427.21,,,0,"percent of total billed charges ","70% of total billed charges ",534.01,709.47,
"ROD CONNECTING 8X100M HUFF",6103636,"CDM ",278,RC,,,OUTPATIENT,,,435.31,348.248,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",348.25,80,,278.60,,,0,"percent of total billed charges ","80% of total billed charges ",304.72,70,,243.78,,,0,"percent of total billed charges ","70% of total billed charges ",391.78,90,,313.42,,,0,"percent of total billed charges ","90% of total billed charges ",404.84,93,,323.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",370.01,85,,296.01,,,0,"percent of total billed charges ","85% of total billed charges ",370.01,85,,296.01,,,0,"percent of total billed charges ","85% of total billed charges ",391.78,90,,313.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",378.72,87,,302.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",304.72,70,,243.78,,,0,"percent of total billed charges ","70% of total billed charges ",304.72,404.84,
"ROD CONNECTING 8X200M HUFF",6103637,"CDM ",278,RC,,,OUTPATIENT,,,448.24,358.592,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",358.59,80,,286.87,,,0,"percent of total billed charges ","80% of total billed charges ",313.77,70,,251.02,,,0,"percent of total billed charges ","70% of total billed charges ",403.42,90,,322.74,,,0,"percent of total billed charges ","90% of total billed charges ",416.86,93,,333.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",381,85,,304.80,,,0,"percent of total billed charges ","85% of total billed charges ",381,85,,304.80,,,0,"percent of total billed charges ","85% of total billed charges ",403.42,90,,322.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",389.97,87,,311.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",313.77,70,,251.02,,,0,"percent of total billed charges ","70% of total billed charges ",313.77,416.86,
"RETRACTOR ABDOMINAL MOBIUS",6103641,"CDM ",272,RC,,,OUTPATIENT,,,269.61,215.688,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",215.69,80,,172.55,,,0,"percent of total billed charges ","80% of total billed charges ",188.73,70,,150.98,,,0,"percent of total billed charges ","70% of total billed charges ",242.65,90,,194.12,,,0,"percent of total billed charges ","90% of total billed charges ",250.74,93,,200.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",229.17,85,,183.34,,,0,"percent of total billed charges ","85% of total billed charges ",242.65,90,,194.12,,,0,"percent of total billed charges ","90% of total billed charges ",242.65,90,,194.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.56,87,,187.65,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.73,70,,150.98,,,0,"percent of total billed charges ","70% of total billed charges ",188.73,250.74,
"CANNULA HYDRO'TION",6103681,"CDM ",272,RC,,,OUTPATIENT,,,20,16,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16,80,,12.80,,,0,"percent of total billed charges ","80% of total billed charges ",14,70,,11.20,,,0,"percent of total billed charges ","70% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",18.6,93,,14.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17,85,,13.60,,,0,"percent of total billed charges ","85% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",18,90,,14.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.4,87,,13.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14,70,,11.20,,,0,"percent of total billed charges ","70% of total billed charges ",14,18.6,
"KNIFE IMPLANT 3.2 AG",6103685,"CDM ",272,RC,,,OUTPATIENT,,,116.15,92.92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.92,80,,74.34,,,0,"percent of total billed charges ","80% of total billed charges ",81.31,70,,65.05,,,0,"percent of total billed charges ","70% of total billed charges ",104.54,90,,83.63,,,0,"percent of total billed charges ","90% of total billed charges ",108.02,93,,86.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",98.73,85,,78.98,,,0,"percent of total billed charges ","85% of total billed charges ",104.54,90,,83.63,,,0,"percent of total billed charges ","90% of total billed charges ",104.54,90,,83.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.05,87,,80.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.31,70,,65.05,,,0,"percent of total billed charges ","70% of total billed charges ",81.31,108.02,
"I-KNIFE 11",6103687,"CDM ",272,RC,,,OUTPATIENT,,,36,28.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.8,80,,23.04,,,0,"percent of total billed charges ","80% of total billed charges ",25.2,70,,20.16,,,0,"percent of total billed charges ","70% of total billed charges ",32.4,90,,25.92,,,0,"percent of total billed charges ","90% of total billed charges ",33.48,93,,26.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",30.6,85,,24.48,,,0,"percent of total billed charges ","85% of total billed charges ",32.4,90,,25.92,,,0,"percent of total billed charges ","90% of total billed charges ",32.4,90,,25.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",31.32,87,,25.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.2,70,,20.16,,,0,"percent of total billed charges ","70% of total billed charges ",25.2,33.48,
"CANNULA HYDRO 1.7 DISP",6103688,"CDM ",272,RC,,,OUTPATIENT,,,39.87,31.896,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.9,80,,25.52,,,0,"percent of total billed charges ","80% of total billed charges ",27.91,70,,22.33,,,0,"percent of total billed charges ","70% of total billed charges ",35.88,90,,28.70,,,0,"percent of total billed charges ","90% of total billed charges ",37.08,93,,29.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.89,85,,27.11,,,0,"percent of total billed charges ","85% of total billed charges ",35.88,90,,28.70,,,0,"percent of total billed charges ","90% of total billed charges ",35.88,90,,28.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",34.69,87,,27.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.91,70,,22.33,,,0,"percent of total billed charges ","70% of total billed charges ",27.91,37.08,
"CYSTOTOME IRRIG 25G",6103690,"CDM ",272,RC,,,OUTPATIENT,,,12.04,9.632,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.63,80,,7.70,,,0,"percent of total billed charges ","80% of total billed charges ",8.43,70,,6.74,,,0,"percent of total billed charges ","70% of total billed charges ",10.84,90,,8.67,,,0,"percent of total billed charges ","90% of total billed charges ",11.2,93,,8.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.23,85,,8.18,,,0,"percent of total billed charges ","85% of total billed charges ",10.84,90,,8.67,,,0,"percent of total billed charges ","90% of total billed charges ",10.84,90,,8.67,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.47,87,,8.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.43,70,,6.74,,,0,"percent of total billed charges ","70% of total billed charges ",8.43,11.2,
"ELECTRODE LOOP CUTTING THIN SS",6103695,"CDM ",272,RC,,,OUTPATIENT,,,223.36,178.688,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.69,80,,142.95,,,0,"percent of total billed charges ","80% of total billed charges ",156.35,70,,125.08,,,0,"percent of total billed charges ","70% of total billed charges ",201.02,90,,160.82,,,0,"percent of total billed charges ","90% of total billed charges ",207.72,93,,166.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",189.86,85,,151.89,,,0,"percent of total billed charges ","85% of total billed charges ",201.02,90,,160.82,,,0,"percent of total billed charges ","90% of total billed charges ",201.02,90,,160.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",194.32,87,,155.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.35,70,,125.08,,,0,"percent of total billed charges ","70% of total billed charges ",156.35,207.72,
"POLISHER TIP SILICONE",6103699,"CDM ",272,RC,,,OUTPATIENT,,,13.79,11.032,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.03,80,,8.82,,,0,"percent of total billed charges ","80% of total billed charges ",9.65,70,,7.72,,,0,"percent of total billed charges ","70% of total billed charges ",12.41,90,,9.93,,,0,"percent of total billed charges ","90% of total billed charges ",12.82,93,,10.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.72,85,,9.38,,,0,"percent of total billed charges ","85% of total billed charges ",12.41,90,,9.93,,,0,"percent of total billed charges ","90% of total billed charges ",12.41,90,,9.93,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12,87,,9.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.65,70,,7.72,,,0,"percent of total billed charges ","70% of total billed charges ",9.65,12.82,
"CANNULA NUCLEUS 25G",6103702,"CDM ",272,RC,,,OUTPATIENT,,,20.06,16.048,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.05,80,,12.84,,,0,"percent of total billed charges ","80% of total billed charges ",14.04,70,,11.23,,,0,"percent of total billed charges ","70% of total billed charges ",18.05,90,,14.44,,,0,"percent of total billed charges ","90% of total billed charges ",18.66,93,,14.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.05,85,,13.64,,,0,"percent of total billed charges ","85% of total billed charges ",18.05,90,,14.44,,,0,"percent of total billed charges ","90% of total billed charges ",18.05,90,,14.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.45,87,,13.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.04,70,,11.23,,,0,"percent of total billed charges ","70% of total billed charges ",14.04,18.66,
"PIN STEINMAN 3/32 X 9""",6103708,"CDM ",278,RC,,,OUTPATIENT,,,34.5,27.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.6,80,,22.08,,,0,"percent of total billed charges ","80% of total billed charges ",24.15,70,,19.32,,,0,"percent of total billed charges ","70% of total billed charges ",31.05,90,,24.84,,,0,"percent of total billed charges ","90% of total billed charges ",32.09,93,,25.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",29.33,85,,23.46,,,0,"percent of total billed charges ","85% of total billed charges ",29.33,85,,23.46,,,0,"percent of total billed charges ","85% of total billed charges ",31.05,90,,24.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.02,87,,24.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.15,70,,19.32,,,0,"percent of total billed charges ","70% of total billed charges ",24.15,32.09,
"PIN STEINMAN 5/32 X 9""",6103709,"CDM ",278,RC,,,OUTPATIENT,,,43.28,34.624,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.62,80,,27.70,,,0,"percent of total billed charges ","80% of total billed charges ",30.3,70,,24.24,,,0,"percent of total billed charges ","70% of total billed charges ",38.95,90,,31.16,,,0,"percent of total billed charges ","90% of total billed charges ",40.25,93,,32.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",36.79,85,,29.43,,,0,"percent of total billed charges ","85% of total billed charges ",36.79,85,,29.43,,,0,"percent of total billed charges ","85% of total billed charges ",38.95,90,,31.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",37.65,87,,30.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.3,70,,24.24,,,0,"percent of total billed charges ","70% of total billed charges ",30.3,40.25,
"EXPANDER PUPIL",6103711,"CDM ",272,RC,,,OUTPATIENT,,,368.13,294.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",294.5,80,,235.60,,,0,"percent of total billed charges ","80% of total billed charges ",257.69,70,,206.15,,,0,"percent of total billed charges ","70% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",342.36,93,,273.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",312.91,85,,250.33,,,0,"percent of total billed charges ","85% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",331.32,90,,265.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",320.27,87,,256.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",257.69,70,,206.15,,,0,"percent of total billed charges ","70% of total billed charges ",257.69,342.36,
"BLADE CORNEAL 2.9",6103712,"CDM ",272,RC,,,OUTPATIENT,,,65.43,52.344,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.34,80,,41.87,,,0,"percent of total billed charges ","80% of total billed charges ",45.8,70,,36.64,,,0,"percent of total billed charges ","70% of total billed charges ",58.89,90,,47.11,,,0,"percent of total billed charges ","90% of total billed charges ",60.85,93,,48.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",55.62,85,,44.50,,,0,"percent of total billed charges ","85% of total billed charges ",58.89,90,,47.11,,,0,"percent of total billed charges ","90% of total billed charges ",58.89,90,,47.11,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",56.92,87,,45.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.8,70,,36.64,,,0,"percent of total billed charges ","70% of total billed charges ",45.8,60.85,
"PACK PHACO",6103714,"CDM ",272,RC,,,OUTPATIENT,,,267.44,213.952,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",213.95,80,,171.16,,,0,"percent of total billed charges ","80% of total billed charges ",187.21,70,,149.77,,,0,"percent of total billed charges ","70% of total billed charges ",240.7,90,,192.56,,,0,"percent of total billed charges ","90% of total billed charges ",248.72,93,,198.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",227.32,85,,181.86,,,0,"percent of total billed charges ","85% of total billed charges ",240.7,90,,192.56,,,0,"percent of total billed charges ","90% of total billed charges ",240.7,90,,192.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",232.67,87,,186.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.21,70,,149.77,,,0,"percent of total billed charges ","70% of total billed charges ",187.21,248.72,
"SPONGE GAUZE X-R 4X4-TRAY",6103724,"CDM ",272,RC,,,OUTPATIENT,,,3.65,2.92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.92,80,,2.34,,,0,"percent of total billed charges ","80% of total billed charges ",2.56,70,,2.05,,,0,"percent of total billed charges ","70% of total billed charges ",3.29,90,,2.63,,,0,"percent of total billed charges ","90% of total billed charges ",3.39,93,,2.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3.1,85,,2.48,,,0,"percent of total billed charges ","85% of total billed charges ",3.29,90,,2.63,,,0,"percent of total billed charges ","90% of total billed charges ",3.29,90,,2.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3.18,87,,2.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.56,70,,2.05,,,0,"percent of total billed charges ","70% of total billed charges ",2.56,3.39,
"CLOSURE SYSTEM CARTER-THOMASON",6103733,"CDM ",272,RC,,,OUTPATIENT,,,241.36,193.088,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",193.09,80,,154.47,,,0,"percent of total billed charges ","80% of total billed charges ",168.95,70,,135.16,,,0,"percent of total billed charges ","70% of total billed charges ",217.22,90,,173.78,,,0,"percent of total billed charges ","90% of total billed charges ",224.46,93,,179.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",205.16,85,,164.13,,,0,"percent of total billed charges ","85% of total billed charges ",217.22,90,,173.78,,,0,"percent of total billed charges ","90% of total billed charges ",217.22,90,,173.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",209.98,87,,167.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",168.95,70,,135.16,,,0,"percent of total billed charges ","70% of total billed charges ",168.95,224.46,
"LIGA CLIP 20/20 MED",6103748,"CDM ",272,RC,,,OUTPATIENT,,,137,109.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.6,80,,87.68,,,0,"percent of total billed charges ","80% of total billed charges ",95.9,70,,76.72,,,0,"percent of total billed charges ","70% of total billed charges ",123.3,90,,98.64,,,0,"percent of total billed charges ","90% of total billed charges ",127.41,93,,101.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",116.45,85,,93.16,,,0,"percent of total billed charges ","85% of total billed charges ",123.3,90,,98.64,,,0,"percent of total billed charges ","90% of total billed charges ",123.3,90,,98.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",119.19,87,,95.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.9,70,,76.72,,,0,"percent of total billed charges ","70% of total billed charges ",95.9,127.41,
"GUIDE PIN GRAFT PASSING",6103752,"CDM ",278,RC,,,OUTPATIENT,,,298.92,239.136,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",239.14,80,,191.31,,,0,"percent of total billed charges ","80% of total billed charges ",209.24,70,,167.39,,,0,"percent of total billed charges ","70% of total billed charges ",269.03,90,,215.22,,,0,"percent of total billed charges ","90% of total billed charges ",278,93,,222.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",254.08,85,,203.26,,,0,"percent of total billed charges ","85% of total billed charges ",254.08,85,,203.26,,,0,"percent of total billed charges ","85% of total billed charges ",269.03,90,,215.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",260.06,87,,208.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",209.24,70,,167.39,,,0,"percent of total billed charges ","70% of total billed charges ",209.24,278,
"TUBE QUANTURN (10MMX30FR)",6103753,"CDM ",272,RC,,,OUTPATIENT,,,234.12,187.296,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.3,80,,149.84,,,0,"percent of total billed charges ","80% of total billed charges ",163.88,70,,131.10,,,0,"percent of total billed charges ","70% of total billed charges ",210.71,90,,168.57,,,0,"percent of total billed charges ","90% of total billed charges ",217.73,93,,174.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",199,85,,159.20,,,0,"percent of total billed charges ","85% of total billed charges ",210.71,90,,168.57,,,0,"percent of total billed charges ","90% of total billed charges ",210.71,90,,168.57,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",203.68,87,,162.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",163.88,70,,131.10,,,0,"percent of total billed charges ","70% of total billed charges ",163.88,217.73,
"TUBE QUANTURN 12MMX36FR",6103755,"CDM ",272,RC,,,OUTPATIENT,,,234.12,187.296,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.3,80,,149.84,,,0,"percent of total billed charges ","80% of total billed charges ",163.88,70,,131.10,,,0,"percent of total billed charges ","70% of total billed charges ",210.71,90,,168.57,,,0,"percent of total billed charges ","90% of total billed charges ",217.73,93,,174.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",199,85,,159.20,,,0,"percent of total billed charges ","85% of total billed charges ",210.71,90,,168.57,,,0,"percent of total billed charges ","90% of total billed charges ",210.71,90,,168.57,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",203.68,87,,162.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",163.88,70,,131.10,,,0,"percent of total billed charges ","70% of total billed charges ",163.88,217.73,
"TUBE QUANTURN 14MMX42FR",6103756,"CDM ",272,RC,,,OUTPATIENT,,,234.36,187.488,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.49,80,,149.99,,,0,"percent of total billed charges ","80% of total billed charges ",164.05,70,,131.24,,,0,"percent of total billed charges ","70% of total billed charges ",210.92,90,,168.74,,,0,"percent of total billed charges ","90% of total billed charges ",217.95,93,,174.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",199.21,85,,159.37,,,0,"percent of total billed charges ","85% of total billed charges ",210.92,90,,168.74,,,0,"percent of total billed charges ","90% of total billed charges ",210.92,90,,168.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",203.89,87,,163.11,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",164.05,70,,131.24,,,0,"percent of total billed charges ","70% of total billed charges ",164.05,217.95,
"TUBE QUANTURN 16MMX48FR",6103757,"CDM ",272,RC,,,OUTPATIENT,,,234.36,187.488,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.49,80,,149.99,,,0,"percent of total billed charges ","80% of total billed charges ",164.05,70,,131.24,,,0,"percent of total billed charges ","70% of total billed charges ",210.92,90,,168.74,,,0,"percent of total billed charges ","90% of total billed charges ",217.95,93,,174.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",199.21,85,,159.37,,,0,"percent of total billed charges ","85% of total billed charges ",210.92,90,,168.74,,,0,"percent of total billed charges ","90% of total billed charges ",210.92,90,,168.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",203.89,87,,163.11,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",164.05,70,,131.24,,,0,"percent of total billed charges ","70% of total billed charges ",164.05,217.95,
"KNIFE IMP ROUND TIP 3.2M",6103758,"CDM ",272,RC,,,OUTPATIENT,,,87.3,69.84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.84,80,,55.87,,,0,"percent of total billed charges ","80% of total billed charges ",61.11,70,,48.89,,,0,"percent of total billed charges ","70% of total billed charges ",78.57,90,,62.86,,,0,"percent of total billed charges ","90% of total billed charges ",81.19,93,,64.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",74.21,85,,59.37,,,0,"percent of total billed charges ","85% of total billed charges ",78.57,90,,62.86,,,0,"percent of total billed charges ","90% of total billed charges ",78.57,90,,62.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",75.95,87,,60.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.11,70,,48.89,,,0,"percent of total billed charges ","70% of total billed charges ",61.11,81.19,
"TUBE QUANTUM (18 X 5.5 )",6103759,"CDM ",272,RC,,,OUTPATIENT,,,234.36,187.488,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.49,80,,149.99,,,0,"percent of total billed charges ","80% of total billed charges ",164.05,70,,131.24,,,0,"percent of total billed charges ","70% of total billed charges ",210.92,90,,168.74,,,0,"percent of total billed charges ","90% of total billed charges ",217.95,93,,174.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",199.21,85,,159.37,,,0,"percent of total billed charges ","85% of total billed charges ",210.92,90,,168.74,,,0,"percent of total billed charges ","90% of total billed charges ",210.92,90,,168.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",203.89,87,,163.11,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",164.05,70,,131.24,,,0,"percent of total billed charges ","70% of total billed charges ",164.05,217.95,
"PACK CUTTER ANT VIT",6103765,"CDM ",272,RC,,,OUTPATIENT,,,255.15,204.12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",204.12,80,,163.30,,,0,"percent of total billed charges ","80% of total billed charges ",178.61,70,,142.89,,,0,"percent of total billed charges ","70% of total billed charges ",229.64,90,,183.71,,,0,"percent of total billed charges ","90% of total billed charges ",237.29,93,,189.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",216.88,85,,173.50,,,0,"percent of total billed charges ","85% of total billed charges ",229.64,90,,183.71,,,0,"percent of total billed charges ","90% of total billed charges ",229.64,90,,183.71,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",221.98,87,,177.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.61,70,,142.89,,,0,"percent of total billed charges ","70% of total billed charges ",178.61,237.29,
"CANNULATOME DBL LUMEN",6103772,"CDM ",272,RC,,,OUTPATIENT,,,274.5,219.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",219.6,80,,175.68,,,0,"percent of total billed charges ","80% of total billed charges ",192.15,70,,153.72,,,0,"percent of total billed charges ","70% of total billed charges ",247.05,90,,197.64,,,0,"percent of total billed charges ","90% of total billed charges ",255.29,93,,204.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",233.33,85,,186.66,,,0,"percent of total billed charges ","85% of total billed charges ",247.05,90,,197.64,,,0,"percent of total billed charges ","90% of total billed charges ",247.05,90,,197.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",238.82,87,,191.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.15,70,,153.72,,,0,"percent of total billed charges ","70% of total billed charges ",192.15,255.29,
"SPONGE PEANUT",6103774,"CDM ",272,RC,,,OUTPATIENT,,,7.4,5.92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.92,80,,4.74,,,0,"percent of total billed charges ","80% of total billed charges ",5.18,70,,4.14,,,0,"percent of total billed charges ","70% of total billed charges ",6.66,90,,5.33,,,0,"percent of total billed charges ","90% of total billed charges ",6.88,93,,5.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6.29,85,,5.03,,,0,"percent of total billed charges ","85% of total billed charges ",6.66,90,,5.33,,,0,"percent of total billed charges ","90% of total billed charges ",6.66,90,,5.33,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.44,87,,5.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.18,70,,4.14,,,0,"percent of total billed charges ","70% of total billed charges ",5.18,6.88,
"FIXATOR EXTERNAL TRAUMA FIX",6103790,"CDM ",278,RC,,,OUTPATIENT,,,1451.5,1161.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1161.2,80,,928.96,,,0,"percent of total billed charges ","80% of total billed charges ",1016.05,70,,812.84,,,0,"percent of total billed charges ","70% of total billed charges ",1306.35,90,,1045.08,,,0,"percent of total billed charges ","90% of total billed charges ",1349.9,93,,1079.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1233.78,85,,987.02,,,0,"percent of total billed charges ","85% of total billed charges ",1233.78,85,,987.02,,,0,"percent of total billed charges ","85% of total billed charges ",1306.35,90,,1045.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1262.81,87,,1010.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1016.05,70,,812.84,,,0,"percent of total billed charges ","70% of total billed charges ",1016.05,1349.9,
"PIN STEINMAN 5/64",6103794,"CDM ",278,RC,,,OUTPATIENT,,,34.5,27.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.6,80,,22.08,,,0,"percent of total billed charges ","80% of total billed charges ",24.15,70,,19.32,,,0,"percent of total billed charges ","70% of total billed charges ",31.05,90,,24.84,,,0,"percent of total billed charges ","90% of total billed charges ",32.09,93,,25.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",29.33,85,,23.46,,,0,"percent of total billed charges ","85% of total billed charges ",29.33,85,,23.46,,,0,"percent of total billed charges ","85% of total billed charges ",31.05,90,,24.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.02,87,,24.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.15,70,,19.32,,,0,"percent of total billed charges ","70% of total billed charges ",24.15,32.09,
"BLADE 31.0 MM X 9.0MM",6103809,"CDM ",272,RC,,,OUTPATIENT,,,111.3,89.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",89.04,80,,71.23,,,0,"percent of total billed charges ","80% of total billed charges ",77.91,70,,62.33,,,0,"percent of total billed charges ","70% of total billed charges ",100.17,90,,80.14,,,0,"percent of total billed charges ","90% of total billed charges ",103.51,93,,82.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",94.61,85,,75.69,,,0,"percent of total billed charges ","85% of total billed charges ",100.17,90,,80.14,,,0,"percent of total billed charges ","90% of total billed charges ",100.17,90,,80.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",96.83,87,,77.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.91,70,,62.33,,,0,"percent of total billed charges ","70% of total billed charges ",77.91,103.51,
"STAPLE LINEAR XR60B",6103822,"CDM ",272,RC,,,OUTPATIENT,,,166.02,132.816,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.82,80,,106.26,,,0,"percent of total billed charges ","80% of total billed charges ",116.21,70,,92.97,,,0,"percent of total billed charges ","70% of total billed charges ",149.42,90,,119.54,,,0,"percent of total billed charges ","90% of total billed charges ",154.4,93,,123.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",141.12,85,,112.90,,,0,"percent of total billed charges ","85% of total billed charges ",149.42,90,,119.54,,,0,"percent of total billed charges ","90% of total billed charges ",149.42,90,,119.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",144.44,87,,115.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.21,70,,92.97,,,0,"percent of total billed charges ","70% of total billed charges ",116.21,154.4,
"TACKER MESH FIX 5MM",6103840,"CDM ",272,RC,,,OUTPATIENT,,,1342.1,1073.68,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1073.68,80,,858.94,,,0,"percent of total billed charges ","80% of total billed charges ",939.47,70,,751.58,,,0,"percent of total billed charges ","70% of total billed charges ",1207.89,90,,966.31,,,0,"percent of total billed charges ","90% of total billed charges ",1248.15,93,,998.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1140.79,85,,912.63,,,0,"percent of total billed charges ","85% of total billed charges ",1207.89,90,,966.31,,,0,"percent of total billed charges ","90% of total billed charges ",1207.89,90,,966.31,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1167.63,87,,934.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",939.47,70,,751.58,,,0,"percent of total billed charges ","70% of total billed charges ",939.47,1248.15,
"CONTAINER SPECIMEN TRAP",6103841,"CDM ",272,RC,,,OUTPATIENT,,,13.69,10.952,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.95,80,,8.76,,,0,"percent of total billed charges ","80% of total billed charges ",9.58,70,,7.66,,,0,"percent of total billed charges ","70% of total billed charges ",12.32,90,,9.86,,,0,"percent of total billed charges ","90% of total billed charges ",12.73,93,,10.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.64,85,,9.31,,,0,"percent of total billed charges ","85% of total billed charges ",12.32,90,,9.86,,,0,"percent of total billed charges ","90% of total billed charges ",12.32,90,,9.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.91,87,,9.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.58,70,,7.66,,,0,"percent of total billed charges ","70% of total billed charges ",9.58,12.73,
"TACKER A OR B TRACK 5MM",6103846,"CDM ",272,RC,,,OUTPATIENT,,,924.11,739.288,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",739.29,80,,591.43,,,0,"percent of total billed charges ","80% of total billed charges ",646.88,70,,517.50,,,0,"percent of total billed charges ","70% of total billed charges ",831.7,90,,665.36,,,0,"percent of total billed charges ","90% of total billed charges ",859.42,93,,687.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",785.49,85,,628.39,,,0,"percent of total billed charges ","85% of total billed charges ",831.7,90,,665.36,,,0,"percent of total billed charges ","90% of total billed charges ",831.7,90,,665.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",803.98,87,,643.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",646.88,70,,517.50,,,0,"percent of total billed charges ","70% of total billed charges ",646.88,859.42,
"NEEDLE TAPER HUB 30 DG (EYE)",6103854,"CDM ",272,RC,,,OUTPATIENT,,,151.13,120.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.9,80,,96.72,,,0,"percent of total billed charges ","80% of total billed charges ",105.79,70,,84.63,,,0,"percent of total billed charges ","70% of total billed charges ",136.02,90,,108.82,,,0,"percent of total billed charges ","90% of total billed charges ",140.55,93,,112.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",128.46,85,,102.77,,,0,"percent of total billed charges ","85% of total billed charges ",136.02,90,,108.82,,,0,"percent of total billed charges ","90% of total billed charges ",136.02,90,,108.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",131.48,87,,105.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",105.79,70,,84.63,,,0,"percent of total billed charges ","70% of total billed charges ",105.79,140.55,
"KIT LAVAGE PULSE W/TIP IRRIGAT",6103855,"CDM ",272,RC,,,OUTPATIENT,,,142.24,113.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.79,80,,91.03,,,0,"percent of total billed charges ","80% of total billed charges ",99.57,70,,79.66,,,0,"percent of total billed charges ","70% of total billed charges ",128.02,90,,102.42,,,0,"percent of total billed charges ","90% of total billed charges ",132.28,93,,105.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",120.9,85,,96.72,,,0,"percent of total billed charges ","85% of total billed charges ",128.02,90,,102.42,,,0,"percent of total billed charges ","90% of total billed charges ",128.02,90,,102.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",123.75,87,,99.00,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.57,70,,79.66,,,0,"percent of total billed charges ","70% of total billed charges ",99.57,132.28,
"STAPLER LIGASURE PRECISE",6103858,"CDM ",272,RC,,,OUTPATIENT,,,703.39,562.712,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",562.71,80,,450.17,,,0,"percent of total billed charges ","80% of total billed charges ",492.37,70,,393.90,,,0,"percent of total billed charges ","70% of total billed charges ",633.05,90,,506.44,,,0,"percent of total billed charges ","90% of total billed charges ",654.15,93,,523.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",597.88,85,,478.30,,,0,"percent of total billed charges ","85% of total billed charges ",633.05,90,,506.44,,,0,"percent of total billed charges ","90% of total billed charges ",633.05,90,,506.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",611.95,87,,489.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",492.37,70,,393.90,,,0,"percent of total billed charges ","70% of total billed charges ",492.37,654.15,
"SUTURE SILK 4.0 SA83H",6103922,"CDM ",272,RC,,,OUTPATIENT,,,8.58,6.864,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.86,80,,5.49,,,0,"percent of total billed charges ","80% of total billed charges ",6.01,70,,4.81,,,0,"percent of total billed charges ","70% of total billed charges ",7.72,90,,6.18,,,0,"percent of total billed charges ","90% of total billed charges ",7.98,93,,6.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7.29,85,,5.83,,,0,"percent of total billed charges ","85% of total billed charges ",7.72,90,,6.18,,,0,"percent of total billed charges ","90% of total billed charges ",7.72,90,,6.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7.46,87,,5.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.01,70,,4.81,,,0,"percent of total billed charges ","70% of total billed charges ",6.01,7.98,
"SUTURE SILK 2.0 411H",6103942,"CDM ",272,RC,,,OUTPATIENT,,,9.08,7.264,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.26,80,,5.81,,,0,"percent of total billed charges ","80% of total billed charges ",6.36,70,,5.09,,,0,"percent of total billed charges ","70% of total billed charges ",8.17,90,,6.54,,,0,"percent of total billed charges ","90% of total billed charges ",8.44,93,,6.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7.72,85,,6.18,,,0,"percent of total billed charges ","85% of total billed charges ",8.17,90,,6.54,,,0,"percent of total billed charges ","90% of total billed charges ",8.17,90,,6.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7.9,87,,6.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.36,70,,5.09,,,0,"percent of total billed charges ","70% of total billed charges ",6.36,8.44,
"SUTURE SILK 4.0 K581H",6103944,"CDM ",272,RC,,,OUTPATIENT,,,16.45,13.16,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.16,80,,10.53,,,0,"percent of total billed charges ","80% of total billed charges ",11.52,70,,9.22,,,0,"percent of total billed charges ","70% of total billed charges ",14.81,90,,11.85,,,0,"percent of total billed charges ","90% of total billed charges ",15.3,93,,12.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.98,85,,11.18,,,0,"percent of total billed charges ","85% of total billed charges ",14.81,90,,11.85,,,0,"percent of total billed charges ","90% of total billed charges ",14.81,90,,11.85,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.31,87,,11.45,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.52,70,,9.22,,,0,"percent of total billed charges ","70% of total billed charges ",11.52,15.3,
"SUTURE SILK 6.0 706G",6103946,"CDM ",272,RC,,,OUTPATIENT,,,24.02,19.216,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.22,80,,15.38,,,0,"percent of total billed charges ","80% of total billed charges ",16.81,70,,13.45,,,0,"percent of total billed charges ","70% of total billed charges ",21.62,90,,17.30,,,0,"percent of total billed charges ","90% of total billed charges ",22.34,93,,17.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.42,85,,16.34,,,0,"percent of total billed charges ","85% of total billed charges ",21.62,90,,17.30,,,0,"percent of total billed charges ","90% of total billed charges ",21.62,90,,17.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.9,87,,16.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.81,70,,13.45,,,0,"percent of total billed charges ","70% of total billed charges ",16.81,22.34,
"SUTURE PROLENE 0 8444H",6103947,"CDM ",272,RC,,,OUTPATIENT,,,15.3,12.24,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.24,80,,9.79,,,0,"percent of total billed charges ","80% of total billed charges ",10.71,70,,8.57,,,0,"percent of total billed charges ","70% of total billed charges ",13.77,90,,11.02,,,0,"percent of total billed charges ","90% of total billed charges ",14.23,93,,11.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.01,85,,10.41,,,0,"percent of total billed charges ","85% of total billed charges ",13.77,90,,11.02,,,0,"percent of total billed charges ","90% of total billed charges ",13.77,90,,11.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.31,87,,10.65,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.71,70,,8.57,,,0,"percent of total billed charges ","70% of total billed charges ",10.71,14.23,
"SUTURE PROLENE 2.0 8523H",6103948,"CDM ",272,RC,,,OUTPATIENT,,,20.71,16.568,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.57,80,,13.26,,,0,"percent of total billed charges ","80% of total billed charges ",14.5,70,,11.60,,,0,"percent of total billed charges ","70% of total billed charges ",18.64,90,,14.91,,,0,"percent of total billed charges ","90% of total billed charges ",19.26,93,,15.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.6,85,,14.08,,,0,"percent of total billed charges ","85% of total billed charges ",18.64,90,,14.91,,,0,"percent of total billed charges ","90% of total billed charges ",18.64,90,,14.91,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.02,87,,14.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.5,70,,11.60,,,0,"percent of total billed charges ","70% of total billed charges ",14.5,19.26,
"SUTURE PLAIN O S143H",6103951,"CDM ",272,RC,,,OUTPATIENT,,,12.04,9.632,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.63,80,,7.70,,,0,"percent of total billed charges ","80% of total billed charges ",8.43,70,,6.74,,,0,"percent of total billed charges ","70% of total billed charges ",10.84,90,,8.67,,,0,"percent of total billed charges ","90% of total billed charges ",11.2,93,,8.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.23,85,,8.18,,,0,"percent of total billed charges ","85% of total billed charges ",10.84,90,,8.67,,,0,"percent of total billed charges ","90% of total billed charges ",10.84,90,,8.67,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.47,87,,8.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.43,70,,6.74,,,0,"percent of total billed charges ","70% of total billed charges ",8.43,11.2,
"SUTURE PLAIN 3.0 N862H",6103952,"CDM ",272,RC,,,OUTPATIENT,,,8.98,7.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.18,80,,5.74,,,0,"percent of total billed charges ","80% of total billed charges ",6.29,70,,5.03,,,0,"percent of total billed charges ","70% of total billed charges ",8.08,90,,6.46,,,0,"percent of total billed charges ","90% of total billed charges ",8.35,93,,6.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7.63,85,,6.10,,,0,"percent of total billed charges ","85% of total billed charges ",8.08,90,,6.46,,,0,"percent of total billed charges ","90% of total billed charges ",8.08,90,,6.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7.81,87,,6.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.29,70,,5.03,,,0,"percent of total billed charges ","70% of total billed charges ",6.29,8.35,
"SUTURE CHROMIC 4.0 U203H",6103953,"CDM ",272,RC,,,OUTPATIENT,,,11.89,9.512,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.51,80,,7.61,,,0,"percent of total billed charges ","80% of total billed charges ",8.32,70,,6.66,,,0,"percent of total billed charges ","70% of total billed charges ",10.7,90,,8.56,,,0,"percent of total billed charges ","90% of total billed charges ",11.06,93,,8.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.11,85,,8.09,,,0,"percent of total billed charges ","85% of total billed charges ",10.7,90,,8.56,,,0,"percent of total billed charges ","90% of total billed charges ",10.7,90,,8.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.34,87,,8.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.32,70,,6.66,,,0,"percent of total billed charges ","70% of total billed charges ",8.32,11.06,
STOCKINETTE,6103970,"CDM ",271,RC,,,OUTPATIENT,,,14,11.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,80,,8.96,,,0,"percent of total billed charges ","80% of total billed charges ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",13.02,93,,10.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.9,85,,9.52,,,0,"percent of total billed charges ","85% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.18,87,,9.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",9.8,13.02,
"SOLUTION ADEPT ADHESION REDI'N",6103992,"CDM ",272,RC,,,OUTPATIENT,,,420.61,336.488,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",336.49,80,,269.19,,,0,"percent of total billed charges ","80% of total billed charges ",294.43,70,,235.54,,,0,"percent of total billed charges ","70% of total billed charges ",378.55,90,,302.84,,,0,"percent of total billed charges ","90% of total billed charges ",391.17,93,,312.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",357.52,85,,286.02,,,0,"percent of total billed charges ","85% of total billed charges ",378.55,90,,302.84,,,0,"percent of total billed charges ","90% of total billed charges ",378.55,90,,302.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",365.93,87,,292.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",294.43,70,,235.54,,,0,"percent of total billed charges ","70% of total billed charges ",294.43,391.17,
"SUTURE PDSP 3.50 Z493G",6104001,"CDM ",272,RC,,,OUTPATIENT,,,25.73,20.584,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.58,80,,16.46,,,0,"percent of total billed charges ","80% of total billed charges ",18.01,70,,14.41,,,0,"percent of total billed charges ","70% of total billed charges ",23.16,90,,18.53,,,0,"percent of total billed charges ","90% of total billed charges ",23.93,93,,19.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.87,85,,17.50,,,0,"percent of total billed charges ","85% of total billed charges ",23.16,90,,18.53,,,0,"percent of total billed charges ","90% of total billed charges ",23.16,90,,18.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.39,87,,17.91,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.01,70,,14.41,,,0,"percent of total billed charges ","70% of total billed charges ",18.01,23.93,
"TAPER STEM PLUG",6104024,"CDM ",278,RC,,,OUTPATIENT,,,1151.47,921.176,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",921.18,80,,736.94,,,0,"percent of total billed charges ","80% of total billed charges ",806.03,70,,644.82,,,0,"percent of total billed charges ","70% of total billed charges ",1036.32,90,,829.06,,,0,"percent of total billed charges ","90% of total billed charges ",1070.87,93,,856.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",978.75,85,,783.00,,,0,"percent of total billed charges ","85% of total billed charges ",978.75,85,,783.00,,,0,"percent of total billed charges ","85% of total billed charges ",1036.32,90,,829.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1001.78,87,,801.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",806.03,70,,644.82,,,0,"percent of total billed charges ","70% of total billed charges ",806.03,1070.87,
"NEEDLE 12""",6104059,"CDM ",272,RC,,,OUTPATIENT,,,105.5,84.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.4,80,,67.52,,,0,"percent of total billed charges ","80% of total billed charges ",73.85,70,,59.08,,,0,"percent of total billed charges ","70% of total billed charges ",94.95,90,,75.96,,,0,"percent of total billed charges ","90% of total billed charges ",98.12,93,,78.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",89.68,85,,71.74,,,0,"percent of total billed charges ","85% of total billed charges ",94.95,90,,75.96,,,0,"percent of total billed charges ","90% of total billed charges ",94.95,90,,75.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",91.79,87,,73.43,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.85,70,,59.08,,,0,"percent of total billed charges ","70% of total billed charges ",73.85,98.12,
"STOPCOCK DOUBLE",6104138,"CDM ",272,RC,,,OUTPATIENT,,,5.62,4.496,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.5,80,,3.60,,,0,"percent of total billed charges ","80% of total billed charges ",3.93,70,,3.14,,,0,"percent of total billed charges ","70% of total billed charges ",5.06,90,,4.05,,,0,"percent of total billed charges ","90% of total billed charges ",5.23,93,,4.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4.78,85,,3.82,,,0,"percent of total billed charges ","85% of total billed charges ",5.06,90,,4.05,,,0,"percent of total billed charges ","90% of total billed charges ",5.06,90,,4.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4.89,87,,3.91,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.93,70,,3.14,,,0,"percent of total billed charges ","70% of total billed charges ",3.93,5.23,
"BASKET GEMINI O TIP 2.4 X 90",6104166,"CDM ",272,RC,,,OUTPATIENT,,,482,385.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",385.6,80,,308.48,,,0,"percent of total billed charges ","80% of total billed charges ",337.4,70,,269.92,,,0,"percent of total billed charges ","70% of total billed charges ",433.8,90,,347.04,,,0,"percent of total billed charges ","90% of total billed charges ",448.26,93,,358.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",409.7,85,,327.76,,,0,"percent of total billed charges ","85% of total billed charges ",433.8,90,,347.04,,,0,"percent of total billed charges ","90% of total billed charges ",433.8,90,,347.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",419.34,87,,335.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",337.4,70,,269.92,,,0,"percent of total billed charges ","70% of total billed charges ",337.4,448.26,
"BASKET GEMINI 0 TIP 2.4X120",6104167,"CDM ",272,RC,,,OUTPATIENT,,,482,385.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",385.6,80,,308.48,,,0,"percent of total billed charges ","80% of total billed charges ",337.4,70,,269.92,,,0,"percent of total billed charges ","70% of total billed charges ",433.8,90,,347.04,,,0,"percent of total billed charges ","90% of total billed charges ",448.26,93,,358.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",409.7,85,,327.76,,,0,"percent of total billed charges ","85% of total billed charges ",433.8,90,,347.04,,,0,"percent of total billed charges ","90% of total billed charges ",433.8,90,,347.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",419.34,87,,335.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",337.4,70,,269.92,,,0,"percent of total billed charges ","70% of total billed charges ",337.4,448.26,
"BASKET SEGURA 3.0 X 90",6104172,"CDM ",272,RC,,,OUTPATIENT,,,504.5,403.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",403.6,80,,322.88,,,0,"percent of total billed charges ","80% of total billed charges ",353.15,70,,282.52,,,0,"percent of total billed charges ","70% of total billed charges ",454.05,90,,363.24,,,0,"percent of total billed charges ","90% of total billed charges ",469.19,93,,375.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",428.83,85,,343.06,,,0,"percent of total billed charges ","85% of total billed charges ",454.05,90,,363.24,,,0,"percent of total billed charges ","90% of total billed charges ",454.05,90,,363.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",438.92,87,,351.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",353.15,70,,282.52,,,0,"percent of total billed charges ","70% of total billed charges ",353.15,469.19,
"SUTURE NUROLON 3.0 SH",6104173,"CDM ",272,RC,,,OUTPATIENT,,,58.41,46.728,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.73,80,,37.38,,,0,"percent of total billed charges ","80% of total billed charges ",40.89,70,,32.71,,,0,"percent of total billed charges ","70% of total billed charges ",52.57,90,,42.06,,,0,"percent of total billed charges ","90% of total billed charges ",54.32,93,,43.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",49.65,85,,39.72,,,0,"percent of total billed charges ","85% of total billed charges ",52.57,90,,42.06,,,0,"percent of total billed charges ","90% of total billed charges ",52.57,90,,42.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",50.82,87,,40.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.89,70,,32.71,,,0,"percent of total billed charges ","70% of total billed charges ",40.89,54.32,
"STOCKINETTE 6""X 25",6104177,"CDM ",271,RC,,,OUTPATIENT,,,17,13.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.6,80,,10.88,,,0,"percent of total billed charges ","80% of total billed charges ",11.9,70,,9.52,,,0,"percent of total billed charges ","70% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.81,93,,12.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.45,85,,11.56,,,0,"percent of total billed charges ","85% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.79,87,,11.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.9,70,,9.52,,,0,"percent of total billed charges ","70% of total billed charges ",11.9,15.81,
"IMMOBILIZER SHOULDER SM",6104190,"CDM ",271,RC,,,OUTPATIENT,,,25.88,20.704,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.7,80,,16.56,,,0,"percent of total billed charges ","80% of total billed charges ",18.12,70,,14.50,,,0,"percent of total billed charges ","70% of total billed charges ",23.29,90,,18.63,,,0,"percent of total billed charges ","90% of total billed charges ",24.07,93,,19.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",22,85,,17.60,,,0,"percent of total billed charges ","85% of total billed charges ",23.29,90,,18.63,,,0,"percent of total billed charges ","90% of total billed charges ",23.29,90,,18.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.52,87,,18.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.12,70,,14.50,,,0,"percent of total billed charges ","70% of total billed charges ",18.12,24.07,
"CUP HEEL DUAL STYLE SMALL",6104198,"CDM ",272,RC,,,OUTPATIENT,,,11.53,9.224,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.22,80,,7.38,,,0,"percent of total billed charges ","80% of total billed charges ",8.07,70,,6.46,,,0,"percent of total billed charges ","70% of total billed charges ",10.38,90,,8.30,,,0,"percent of total billed charges ","90% of total billed charges ",10.72,93,,8.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.8,85,,7.84,,,0,"percent of total billed charges ","85% of total billed charges ",10.38,90,,8.30,,,0,"percent of total billed charges ","90% of total billed charges ",10.38,90,,8.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.03,87,,8.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.07,70,,6.46,,,0,"percent of total billed charges ","70% of total billed charges ",8.07,10.72,
"BLADE DERMATOME",6104205,"CDM ",272,RC,,,OUTPATIENT,,,123.17,98.536,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.54,80,,78.83,,,0,"percent of total billed charges ","80% of total billed charges ",86.22,70,,68.98,,,0,"percent of total billed charges ","70% of total billed charges ",110.85,90,,88.68,,,0,"percent of total billed charges ","90% of total billed charges ",114.55,93,,91.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",104.69,85,,83.75,,,0,"percent of total billed charges ","85% of total billed charges ",110.85,90,,88.68,,,0,"percent of total billed charges ","90% of total billed charges ",110.85,90,,88.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",107.16,87,,85.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.22,70,,68.98,,,0,"percent of total billed charges ","70% of total billed charges ",86.22,114.55,
"SUTURE 8682H 4.0 PS-2",6104210,"CDM ",272,RC,,,OUTPATIENT,,,23,18.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.4,80,,14.72,,,0,"percent of total billed charges ","80% of total billed charges ",16.1,70,,12.88,,,0,"percent of total billed charges ","70% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",21.39,93,,17.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.55,85,,15.64,,,0,"percent of total billed charges ","85% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.01,87,,16.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.1,70,,12.88,,,0,"percent of total billed charges ","70% of total billed charges ",16.1,21.39,
"SUTURE 5.0 PS-2",6104211,"CDM ",272,RC,,,OUTPATIENT,,,23,18.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.4,80,,14.72,,,0,"percent of total billed charges ","80% of total billed charges ",16.1,70,,12.88,,,0,"percent of total billed charges ","70% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",21.39,93,,17.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.55,85,,15.64,,,0,"percent of total billed charges ","85% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.01,87,,16.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.1,70,,12.88,,,0,"percent of total billed charges ","70% of total billed charges ",16.1,21.39,
"SUTURE PROLENE 5.0 8696G",6104212,"CDM ",272,RC,,,OUTPATIENT,,,60,48,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48,80,,38.40,,,0,"percent of total billed charges ","80% of total billed charges ",42,70,,33.60,,,0,"percent of total billed charges ","70% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",55.8,93,,44.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51,85,,40.80,,,0,"percent of total billed charges ","85% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",54,90,,43.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",52.2,87,,41.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42,70,,33.60,,,0,"percent of total billed charges ","70% of total billed charges ",42,55.8,
"DILATOR URETERAL",6104221,"CDM ",272,RC,,,OUTPATIENT,,,201.5,161.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",161.2,80,,128.96,,,0,"percent of total billed charges ","80% of total billed charges ",141.05,70,,112.84,,,0,"percent of total billed charges ","70% of total billed charges ",181.35,90,,145.08,,,0,"percent of total billed charges ","90% of total billed charges ",187.4,93,,149.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",171.28,85,,137.02,,,0,"percent of total billed charges ","85% of total billed charges ",181.35,90,,145.08,,,0,"percent of total billed charges ","90% of total billed charges ",181.35,90,,145.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",175.31,87,,140.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.05,70,,112.84,,,0,"percent of total billed charges ","70% of total billed charges ",141.05,187.4,
"SOL IODINE LUGULS'S",6104229,"CDM ",272,RC,,,OUTPATIENT,,,39.27,31.416,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.42,80,,25.14,,,0,"percent of total billed charges ","80% of total billed charges ",27.49,70,,21.99,,,0,"percent of total billed charges ","70% of total billed charges ",35.34,90,,28.27,,,0,"percent of total billed charges ","90% of total billed charges ",36.52,93,,29.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.38,85,,26.70,,,0,"percent of total billed charges ","85% of total billed charges ",35.34,90,,28.27,,,0,"percent of total billed charges ","90% of total billed charges ",35.34,90,,28.27,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",34.16,87,,27.33,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.49,70,,21.99,,,0,"percent of total billed charges ","70% of total billed charges ",27.49,36.52,
"BLADE 2.85 SPLIT (EYE)",6104233,"CDM ",272,RC,,,OUTPATIENT,,,58.59,46.872,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.87,80,,37.50,,,0,"percent of total billed charges ","80% of total billed charges ",41.01,70,,32.81,,,0,"percent of total billed charges ","70% of total billed charges ",52.73,90,,42.18,,,0,"percent of total billed charges ","90% of total billed charges ",54.49,93,,43.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",49.8,85,,39.84,,,0,"percent of total billed charges ","85% of total billed charges ",52.73,90,,42.18,,,0,"percent of total billed charges ","90% of total billed charges ",52.73,90,,42.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",50.97,87,,40.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.01,70,,32.81,,,0,"percent of total billed charges ","70% of total billed charges ",41.01,54.49,
"BIOCARTILAGE 0.75CC",6104244,"CDM ",278,RC,,,OUTPATIENT,,,1361.25,1089,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1089,80,,871.20,,,0,"percent of total billed charges ","80% of total billed charges ",952.88,70,,762.30,,,0,"percent of total billed charges ","70% of total billed charges ",1225.13,90,,980.10,,,0,"percent of total billed charges ","90% of total billed charges ",1265.96,93,,1012.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1157.06,85,,925.65,,,0,"percent of total billed charges ","85% of total billed charges ",1157.06,85,,925.65,,,0,"percent of total billed charges ","85% of total billed charges ",1225.13,90,,980.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1184.29,87,,947.43,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",952.88,70,,762.30,,,0,"percent of total billed charges ","70% of total billed charges ",952.88,1265.96,
"APPLICATOR CONE",6104250,"CDM ",272,RC,,,OUTPATIENT,,,232.5,186,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",186,80,,148.80,,,0,"percent of total billed charges ","80% of total billed charges ",162.75,70,,130.20,,,0,"percent of total billed charges ","70% of total billed charges ",209.25,90,,167.40,,,0,"percent of total billed charges ","90% of total billed charges ",216.23,93,,172.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",197.63,85,,158.10,,,0,"percent of total billed charges ","85% of total billed charges ",209.25,90,,167.40,,,0,"percent of total billed charges ","90% of total billed charges ",209.25,90,,167.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",202.28,87,,161.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.75,70,,130.20,,,0,"percent of total billed charges ","70% of total billed charges ",162.75,216.23,
"TUBING NEO PUFF",6104259,"CDM ",272,RC,,,OUTPATIENT,,,30.09,24.072,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.07,80,,19.26,,,0,"percent of total billed charges ","80% of total billed charges ",21.06,70,,16.85,,,0,"percent of total billed charges ","70% of total billed charges ",27.08,90,,21.66,,,0,"percent of total billed charges ","90% of total billed charges ",27.98,93,,22.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.58,85,,20.46,,,0,"percent of total billed charges ","85% of total billed charges ",27.08,90,,21.66,,,0,"percent of total billed charges ","90% of total billed charges ",27.08,90,,21.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.18,87,,20.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.06,70,,16.85,,,0,"percent of total billed charges ","70% of total billed charges ",21.06,27.98,
"SUTURE RELOAD SWI22",6104268,"CDM ",272,RC,,,OUTPATIENT,,,124.28,99.424,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.42,80,,79.54,,,0,"percent of total billed charges ","80% of total billed charges ",87,70,,69.60,,,0,"percent of total billed charges ","70% of total billed charges ",111.85,90,,89.48,,,0,"percent of total billed charges ","90% of total billed charges ",115.58,93,,92.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",105.64,85,,84.51,,,0,"percent of total billed charges ","85% of total billed charges ",111.85,90,,89.48,,,0,"percent of total billed charges ","90% of total billed charges ",111.85,90,,89.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",108.12,87,,86.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87,70,,69.60,,,0,"percent of total billed charges ","70% of total billed charges ",87,115.58,
"BLADE CUDA 3.5MM",6104275,"CDM ",272,RC,,,OUTPATIENT,,,200.03,160.024,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",160.02,80,,128.02,,,0,"percent of total billed charges ","80% of total billed charges ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",186.03,93,,148.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",174.03,87,,139.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",140.02,186.03,
"SURGICEL ABSORB HEMOSTAT 2X14",6104281,"CDM ",272,RC,,,OUTPATIENT,,,209.37,167.496,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.5,80,,134.00,,,0,"percent of total billed charges ","80% of total billed charges ",146.56,70,,117.25,,,0,"percent of total billed charges ","70% of total billed charges ",188.43,90,,150.74,,,0,"percent of total billed charges ","90% of total billed charges ",194.71,93,,155.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",177.96,85,,142.37,,,0,"percent of total billed charges ","85% of total billed charges ",188.43,90,,150.74,,,0,"percent of total billed charges ","90% of total billed charges ",188.43,90,,150.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",182.15,87,,145.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",146.56,70,,117.25,,,0,"percent of total billed charges ","70% of total billed charges ",146.56,194.71,
"BAG DRAIN UROLOGY",6104282,"CDM ",272,RC,,,OUTPATIENT,,,71.12,56.896,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.9,80,,45.52,,,0,"percent of total billed charges ","80% of total billed charges ",49.78,70,,39.82,,,0,"percent of total billed charges ","70% of total billed charges ",64.01,90,,51.21,,,0,"percent of total billed charges ","90% of total billed charges ",66.14,93,,52.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",60.45,85,,48.36,,,0,"percent of total billed charges ","85% of total billed charges ",64.01,90,,51.21,,,0,"percent of total billed charges ","90% of total billed charges ",64.01,90,,51.21,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",61.87,87,,49.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.78,70,,39.82,,,0,"percent of total billed charges ","70% of total billed charges ",49.78,66.14,
"TORP MICRON II CENTERED 3MM",6104283,"CDM ",278,RC,,,OUTPATIENT,,,777.63,622.104,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",622.1,80,,497.68,,,0,"percent of total billed charges ","80% of total billed charges ",544.34,70,,435.47,,,0,"percent of total billed charges ","70% of total billed charges ",699.87,90,,559.90,,,0,"percent of total billed charges ","90% of total billed charges ",723.2,93,,578.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",660.99,85,,528.79,,,0,"percent of total billed charges ","85% of total billed charges ",660.99,85,,528.79,,,0,"percent of total billed charges ","85% of total billed charges ",699.87,90,,559.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",676.54,87,,541.23,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",544.34,70,,435.47,,,0,"percent of total billed charges ","70% of total billed charges ",544.34,723.2,
"TORP MICRON II OFF-CENTER 3MM",6104284,"CDM ",278,RC,,,OUTPATIENT,,,777.63,622.104,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",622.1,80,,497.68,,,0,"percent of total billed charges ","80% of total billed charges ",544.34,70,,435.47,,,0,"percent of total billed charges ","70% of total billed charges ",699.87,90,,559.90,,,0,"percent of total billed charges ","90% of total billed charges ",723.2,93,,578.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",660.99,85,,528.79,,,0,"percent of total billed charges ","85% of total billed charges ",660.99,85,,528.79,,,0,"percent of total billed charges ","85% of total billed charges ",699.87,90,,559.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",676.54,87,,541.23,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",544.34,70,,435.47,,,0,"percent of total billed charges ","70% of total billed charges ",544.34,723.2,
"BANDAGE ELASTOPLAST 4INX5YDS",6104286,"CDM ",272,RC,,,OUTPATIENT,,,20.5,16.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.4,80,,13.12,,,0,"percent of total billed charges ","80% of total billed charges ",14.35,70,,11.48,,,0,"percent of total billed charges ","70% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",19.07,93,,15.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.43,85,,13.94,,,0,"percent of total billed charges ","85% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.84,87,,14.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.35,70,,11.48,,,0,"percent of total billed charges ","70% of total billed charges ",14.35,19.07,
"TIP PHACO",6104290,"CDM ",272,RC,,,OUTPATIENT,,,177,141.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.6,80,,113.28,,,0,"percent of total billed charges ","80% of total billed charges ",123.9,70,,99.12,,,0,"percent of total billed charges ","70% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",164.61,93,,131.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",150.45,85,,120.36,,,0,"percent of total billed charges ","85% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",159.3,90,,127.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",153.99,87,,123.19,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.9,70,,99.12,,,0,"percent of total billed charges ","70% of total billed charges ",123.9,164.61,
"SET TURP TUBING LG BORE",6104302,"CDM ",272,RC,,,OUTPATIENT,,,69.7,55.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.76,80,,44.61,,,0,"percent of total billed charges ","80% of total billed charges ",48.79,70,,39.03,,,0,"percent of total billed charges ","70% of total billed charges ",62.73,90,,50.18,,,0,"percent of total billed charges ","90% of total billed charges ",64.82,93,,51.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",59.25,85,,47.40,,,0,"percent of total billed charges ","85% of total billed charges ",62.73,90,,50.18,,,0,"percent of total billed charges ","90% of total billed charges ",62.73,90,,50.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",60.64,87,,48.51,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.79,70,,39.03,,,0,"percent of total billed charges ","70% of total billed charges ",48.79,64.82,
"BASKET GEMINI 0 TIP 3.0X120",6104304,"CDM ",272,RC,,,OUTPATIENT,,,504.5,403.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",403.6,80,,322.88,,,0,"percent of total billed charges ","80% of total billed charges ",353.15,70,,282.52,,,0,"percent of total billed charges ","70% of total billed charges ",454.05,90,,363.24,,,0,"percent of total billed charges ","90% of total billed charges ",469.19,93,,375.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",428.83,85,,343.06,,,0,"percent of total billed charges ","85% of total billed charges ",454.05,90,,363.24,,,0,"percent of total billed charges ","90% of total billed charges ",454.05,90,,363.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",438.92,87,,351.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",353.15,70,,282.52,,,0,"percent of total billed charges ","70% of total billed charges ",353.15,469.19,
"TUBE NASAL RAE 8.0 CUFFED",6104307,"CDM ",272,RC,,,OUTPATIENT,,,27.68,22.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.14,80,,17.71,,,0,"percent of total billed charges ","80% of total billed charges ",19.38,70,,15.50,,,0,"percent of total billed charges ","70% of total billed charges ",24.91,90,,19.93,,,0,"percent of total billed charges ","90% of total billed charges ",25.74,93,,20.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.53,85,,18.82,,,0,"percent of total billed charges ","85% of total billed charges ",24.91,90,,19.93,,,0,"percent of total billed charges ","90% of total billed charges ",24.91,90,,19.93,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",24.08,87,,19.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.38,70,,15.50,,,0,"percent of total billed charges ","70% of total billed charges ",19.38,25.74,
"PIN ABSORBABLE",6104312,"CDM ",278,RC,,,OUTPATIENT,,,78.45,62.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.76,80,,50.21,,,0,"percent of total billed charges ","80% of total billed charges ",54.92,70,,43.94,,,0,"percent of total billed charges ","70% of total billed charges ",70.61,90,,56.49,,,0,"percent of total billed charges ","90% of total billed charges ",72.96,93,,58.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",66.68,85,,53.34,,,0,"percent of total billed charges ","85% of total billed charges ",66.68,85,,53.34,,,0,"percent of total billed charges ","85% of total billed charges ",70.61,90,,56.49,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",68.25,87,,54.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.92,70,,43.94,,,0,"percent of total billed charges ","70% of total billed charges ",54.92,72.96,
"SUPPORTER ATHLETIC X-LG",6104315,"CDM ",271,RC,,,OUTPATIENT,,,40.62,32.496,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.5,80,,26.00,,,0,"percent of total billed charges ","80% of total billed charges ",28.43,70,,22.74,,,0,"percent of total billed charges ","70% of total billed charges ",36.56,90,,29.25,,,0,"percent of total billed charges ","90% of total billed charges ",37.78,93,,30.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34.53,85,,27.62,,,0,"percent of total billed charges ","85% of total billed charges ",36.56,90,,29.25,,,0,"percent of total billed charges ","90% of total billed charges ",36.56,90,,29.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",35.34,87,,28.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.43,70,,22.74,,,0,"percent of total billed charges ","70% of total billed charges ",28.43,37.78,
"CUTTING LOOP 26 FR (ACMI)",6104317,"CDM ",272,RC,,,OUTPATIENT,,,321.32,257.056,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",257.06,80,,205.65,,,0,"percent of total billed charges ","80% of total billed charges ",224.92,70,,179.94,,,0,"percent of total billed charges ","70% of total billed charges ",289.19,90,,231.35,,,0,"percent of total billed charges ","90% of total billed charges ",298.83,93,,239.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",273.12,85,,218.50,,,0,"percent of total billed charges ","85% of total billed charges ",289.19,90,,231.35,,,0,"percent of total billed charges ","90% of total billed charges ",289.19,90,,231.35,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",279.55,87,,223.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",224.92,70,,179.94,,,0,"percent of total billed charges ","70% of total billed charges ",224.92,298.83,
"SEALER LIGASURE ATLAS 10MM",6104323,"CDM ",272,RC,,,OUTPATIENT,,,819.42,655.536,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",655.54,80,,524.43,,,0,"percent of total billed charges ","80% of total billed charges ",573.59,70,,458.87,,,0,"percent of total billed charges ","70% of total billed charges ",737.48,90,,589.98,,,0,"percent of total billed charges ","90% of total billed charges ",762.06,93,,609.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",696.51,85,,557.21,,,0,"percent of total billed charges ","85% of total billed charges ",737.48,90,,589.98,,,0,"percent of total billed charges ","90% of total billed charges ",737.48,90,,589.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",712.9,87,,570.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",573.59,70,,458.87,,,0,"percent of total billed charges ","70% of total billed charges ",573.59,762.06,
"BOTTLE VACUUM DRAIN LINE",6104324,"CDM ",272,RC,,,OUTPATIENT,,,204,163.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",163.2,80,,130.56,,,0,"percent of total billed charges ","80% of total billed charges ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",189.72,93,,151.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",173.4,85,,138.72,,,0,"percent of total billed charges ","85% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",183.6,90,,146.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",177.48,87,,141.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,70,,114.24,,,0,"percent of total billed charges ","70% of total billed charges ",142.8,189.72,
"NEEDLE STIMU QUIK NERVE BLOCK",6104329,"CDM ",272,RC,,,OUTPATIENT,,,41.52,33.216,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.22,80,,26.58,,,0,"percent of total billed charges ","80% of total billed charges ",29.06,70,,23.25,,,0,"percent of total billed charges ","70% of total billed charges ",37.37,90,,29.90,,,0,"percent of total billed charges ","90% of total billed charges ",38.61,93,,30.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",35.29,85,,28.23,,,0,"percent of total billed charges ","85% of total billed charges ",37.37,90,,29.90,,,0,"percent of total billed charges ","90% of total billed charges ",37.37,90,,29.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",36.12,87,,28.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.06,70,,23.25,,,0,"percent of total billed charges ","70% of total billed charges ",29.06,38.61,
"APPLICATOR LAP EXTENDED",6104337,"CDM ",272,RC,,,OUTPATIENT,,,199,159.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",159.2,80,,127.36,,,0,"percent of total billed charges ","80% of total billed charges ",139.3,70,,111.44,,,0,"percent of total billed charges ","70% of total billed charges ",179.1,90,,143.28,,,0,"percent of total billed charges ","90% of total billed charges ",185.07,93,,148.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",169.15,85,,135.32,,,0,"percent of total billed charges ","85% of total billed charges ",179.1,90,,143.28,,,0,"percent of total billed charges ","90% of total billed charges ",179.1,90,,143.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",173.13,87,,138.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.3,70,,111.44,,,0,"percent of total billed charges ","70% of total billed charges ",139.3,185.07,
"KIT DOUBLE VALVE ASCITES SHUNT",6104342,"CDM ",272,RC,,,OUTPATIENT,,,3139.95,2511.96,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2511.96,80,,2009.57,,,0,"percent of total billed charges ","80% of total billed charges ",2197.97,70,,1758.38,,,0,"percent of total billed charges ","70% of total billed charges ",2825.96,90,,2260.77,,,0,"percent of total billed charges ","90% of total billed charges ",2920.15,93,,2336.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2668.96,85,,2135.17,,,0,"percent of total billed charges ","85% of total billed charges ",2825.96,90,,2260.77,,,0,"percent of total billed charges ","90% of total billed charges ",2825.96,90,,2260.77,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2731.76,87,,2185.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2197.97,70,,1758.38,,,0,"percent of total billed charges ","70% of total billed charges ",2197.97,2920.15,
"NEEDLE MONOPTY 18GA X 20CM",6104349,"CDM ",272,RC,,,OUTPATIENT,,,126.64,101.312,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.31,80,,81.05,,,0,"percent of total billed charges ","80% of total billed charges ",88.65,70,,70.92,,,0,"percent of total billed charges ","70% of total billed charges ",113.98,90,,91.18,,,0,"percent of total billed charges ","90% of total billed charges ",117.78,93,,94.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",107.64,85,,86.11,,,0,"percent of total billed charges ","85% of total billed charges ",113.98,90,,91.18,,,0,"percent of total billed charges ","90% of total billed charges ",113.98,90,,91.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",110.18,87,,88.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.65,70,,70.92,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,117.78,
"GUIDE PIN 3.2MM THREADED ITST",6104374,"CDM ",278,RC,,,OUTPATIENT,,,298.68,238.944,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",238.94,80,,191.15,,,0,"percent of total billed charges ","80% of total billed charges ",209.08,70,,167.26,,,0,"percent of total billed charges ","70% of total billed charges ",268.81,90,,215.05,,,0,"percent of total billed charges ","90% of total billed charges ",277.77,93,,222.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",253.88,85,,203.10,,,0,"percent of total billed charges ","85% of total billed charges ",253.88,85,,203.10,,,0,"percent of total billed charges ","85% of total billed charges ",268.81,90,,215.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",259.85,87,,207.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",209.08,70,,167.26,,,0,"percent of total billed charges ","70% of total billed charges ",209.08,277.77,
"WAND TONSIL",6104383,"CDM ",272,RC,,,OUTPATIENT,,,384,307.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",307.2,80,,245.76,,,0,"percent of total billed charges ","80% of total billed charges ",268.8,70,,215.04,,,0,"percent of total billed charges ","70% of total billed charges ",345.6,90,,276.48,,,0,"percent of total billed charges ","90% of total billed charges ",357.12,93,,285.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",326.4,85,,261.12,,,0,"percent of total billed charges ","85% of total billed charges ",345.6,90,,276.48,,,0,"percent of total billed charges ","90% of total billed charges ",345.6,90,,276.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",334.08,87,,267.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",268.8,70,,215.04,,,0,"percent of total billed charges ","70% of total billed charges ",268.8,357.12,
"WAND TURBINATE",6104384,"CDM ",272,RC,,,OUTPATIENT,,,527.98,422.384,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",422.38,80,,337.90,,,0,"percent of total billed charges ","80% of total billed charges ",369.59,70,,295.67,,,0,"percent of total billed charges ","70% of total billed charges ",475.18,90,,380.14,,,0,"percent of total billed charges ","90% of total billed charges ",491.02,93,,392.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",448.78,85,,359.02,,,0,"percent of total billed charges ","85% of total billed charges ",475.18,90,,380.14,,,0,"percent of total billed charges ","90% of total billed charges ",475.18,90,,380.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",459.34,87,,367.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",369.59,70,,295.67,,,0,"percent of total billed charges ","70% of total billed charges ",369.59,491.02,
"WAND SINUS",6104391,"CDM ",272,RC,,,OUTPATIENT,,,420.23,336.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",336.18,80,,268.94,,,0,"percent of total billed charges ","80% of total billed charges ",294.16,70,,235.33,,,0,"percent of total billed charges ","70% of total billed charges ",378.21,90,,302.57,,,0,"percent of total billed charges ","90% of total billed charges ",390.81,93,,312.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",357.2,85,,285.76,,,0,"percent of total billed charges ","85% of total billed charges ",378.21,90,,302.57,,,0,"percent of total billed charges ","90% of total billed charges ",378.21,90,,302.57,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",365.6,87,,292.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",294.16,70,,235.33,,,0,"percent of total billed charges ","70% of total billed charges ",294.16,390.81,
"DEVICE MAXFIRE W/ZIP LOOP",6104422,"CDM ",272,RC,,,OUTPATIENT,,,617.41,493.928,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",493.93,80,,395.14,,,0,"percent of total billed charges ","80% of total billed charges ",432.19,70,,345.75,,,0,"percent of total billed charges ","70% of total billed charges ",555.67,90,,444.54,,,0,"percent of total billed charges ","90% of total billed charges ",574.19,93,,459.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",524.8,85,,419.84,,,0,"percent of total billed charges ","85% of total billed charges ",555.67,90,,444.54,,,0,"percent of total billed charges ","90% of total billed charges ",555.67,90,,444.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",537.15,87,,429.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",432.19,70,,345.75,,,0,"percent of total billed charges ","70% of total billed charges ",432.19,574.19,
"KIT EPIDURAL SINGLE SHOT",6104426,"CDM ",272,RC,,,OUTPATIENT,,,81.12,64.896,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.9,80,,51.92,,,0,"percent of total billed charges ","80% of total billed charges ",56.78,70,,45.42,,,0,"percent of total billed charges ","70% of total billed charges ",73.01,90,,58.41,,,0,"percent of total billed charges ","90% of total billed charges ",75.44,93,,60.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",68.95,85,,55.16,,,0,"percent of total billed charges ","85% of total billed charges ",73.01,90,,58.41,,,0,"percent of total billed charges ","90% of total billed charges ",73.01,90,,58.41,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",70.57,87,,56.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.78,70,,45.42,,,0,"percent of total billed charges ","70% of total billed charges ",56.78,75.44,
"TUBING LAP SMOKE EVACUATOR",6104448,"CDM ",272,RC,,,OUTPATIENT,,,88.14,70.512,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.51,80,,56.41,,,0,"percent of total billed charges ","80% of total billed charges ",61.7,70,,49.36,,,0,"percent of total billed charges ","70% of total billed charges ",79.33,90,,63.46,,,0,"percent of total billed charges ","90% of total billed charges ",81.97,93,,65.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",74.92,85,,59.94,,,0,"percent of total billed charges ","85% of total billed charges ",79.33,90,,63.46,,,0,"percent of total billed charges ","90% of total billed charges ",79.33,90,,63.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",76.68,87,,61.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.7,70,,49.36,,,0,"percent of total billed charges ","70% of total billed charges ",61.7,81.97,
"PENCIL W/HOSE SMOKE EVACUATOR",6104450,"CDM ",272,RC,,,OUTPATIENT,,,66.81,53.448,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.45,80,,42.76,,,0,"percent of total billed charges ","80% of total billed charges ",46.77,70,,37.42,,,0,"percent of total billed charges ","70% of total billed charges ",60.13,90,,48.10,,,0,"percent of total billed charges ","90% of total billed charges ",62.13,93,,49.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",56.79,85,,45.43,,,0,"percent of total billed charges ","85% of total billed charges ",60.13,90,,48.10,,,0,"percent of total billed charges ","90% of total billed charges ",60.13,90,,48.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",58.12,87,,46.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.77,70,,37.42,,,0,"percent of total billed charges ","70% of total billed charges ",46.77,62.13,
"TUBING SPONGE GUARD SMOKE EVAC",6104452,"CDM ",272,RC,,,OUTPATIENT,,,44.38,35.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.5,80,,28.40,,,0,"percent of total billed charges ","80% of total billed charges ",31.07,70,,24.86,,,0,"percent of total billed charges ","70% of total billed charges ",39.94,90,,31.95,,,0,"percent of total billed charges ","90% of total billed charges ",41.27,93,,33.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",37.72,85,,30.18,,,0,"percent of total billed charges ","85% of total billed charges ",39.94,90,,31.95,,,0,"percent of total billed charges ","90% of total billed charges ",39.94,90,,31.95,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",38.61,87,,30.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.07,70,,24.86,,,0,"percent of total billed charges ","70% of total billed charges ",31.07,41.27,
"TUBING SMOKE EVACUATOR 10 FT",6104453,"CDM ",272,RC,,,OUTPATIENT,,,48.85,39.08,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.08,80,,31.26,,,0,"percent of total billed charges ","80% of total billed charges ",34.2,70,,27.36,,,0,"percent of total billed charges ","70% of total billed charges ",43.97,90,,35.18,,,0,"percent of total billed charges ","90% of total billed charges ",45.43,93,,36.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.52,85,,33.22,,,0,"percent of total billed charges ","85% of total billed charges ",43.97,90,,35.18,,,0,"percent of total billed charges ","90% of total billed charges ",43.97,90,,35.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.5,87,,34.00,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.2,70,,27.36,,,0,"percent of total billed charges ","70% of total billed charges ",34.2,45.43,
"TUBING W/CONNECTORS SMOKE EVAC",6104454,"CDM ",272,RC,,,OUTPATIENT,,,14.19,11.352,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.35,80,,9.08,,,0,"percent of total billed charges ","80% of total billed charges ",9.93,70,,7.94,,,0,"percent of total billed charges ","70% of total billed charges ",12.77,90,,10.22,,,0,"percent of total billed charges ","90% of total billed charges ",13.2,93,,10.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.06,85,,9.65,,,0,"percent of total billed charges ","85% of total billed charges ",12.77,90,,10.22,,,0,"percent of total billed charges ","90% of total billed charges ",12.77,90,,10.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.35,87,,9.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.93,70,,7.94,,,0,"percent of total billed charges ","70% of total billed charges ",9.93,13.2,
"KIT EXPRESS INTRODUCER 10/2",6104464,"CDM ",272,RC,,,OUTPATIENT,,,6524.93,5219.944,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5219.94,80,,4175.95,,,0,"percent of total billed charges ","80% of total billed charges ",4567.45,70,,3653.96,,,0,"percent of total billed charges ","70% of total billed charges ",5872.44,90,,4697.95,,,0,"percent of total billed charges ","90% of total billed charges ",6068.18,93,,4854.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5546.19,85,,4436.95,,,0,"percent of total billed charges ","85% of total billed charges ",5872.44,90,,4697.95,,,0,"percent of total billed charges ","90% of total billed charges ",5872.44,90,,4697.95,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5676.69,87,,4541.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4567.45,70,,3653.96,,,0,"percent of total billed charges ","70% of total billed charges ",4567.45,6068.18,
"KIT EXPRESS ADD FRACTURE 10/2",6104465,"CDM ",272,RC,,,OUTPATIENT,,,4346.93,3477.544,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3477.54,80,,2782.03,,,0,"percent of total billed charges ","80% of total billed charges ",3042.85,70,,2434.28,,,0,"percent of total billed charges ","70% of total billed charges ",3912.24,90,,3129.79,,,0,"percent of total billed charges ","90% of total billed charges ",4042.64,93,,3234.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3694.89,85,,2955.91,,,0,"percent of total billed charges ","85% of total billed charges ",3912.24,90,,3129.79,,,0,"percent of total billed charges ","90% of total billed charges ",3912.24,90,,3129.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3781.83,87,,3025.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3042.85,70,,2434.28,,,0,"percent of total billed charges ","70% of total billed charges ",3042.85,4042.64,
"DEVICE EXPRESS BONE BIOPSY",6104466,"CDM ",272,RC,,,OUTPATIENT,,,362.31,289.848,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",289.85,80,,231.88,,,0,"percent of total billed charges ","80% of total billed charges ",253.62,70,,202.90,,,0,"percent of total billed charges ","70% of total billed charges ",326.08,90,,260.86,,,0,"percent of total billed charges ","90% of total billed charges ",336.95,93,,269.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",307.96,85,,246.37,,,0,"percent of total billed charges ","85% of total billed charges ",326.08,90,,260.86,,,0,"percent of total billed charges ","90% of total billed charges ",326.08,90,,260.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",315.21,87,,252.17,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",253.62,70,,202.90,,,0,"percent of total billed charges ","70% of total billed charges ",253.62,336.95,
"KNIFE SICKLE DISPOSABLE",6104477,"CDM ",272,RC,,,OUTPATIENT,,,262.22,209.776,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",209.78,80,,167.82,,,0,"percent of total billed charges ","80% of total billed charges ",183.55,70,,146.84,,,0,"percent of total billed charges ","70% of total billed charges ",236,90,,188.80,,,0,"percent of total billed charges ","90% of total billed charges ",243.86,93,,195.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",222.89,85,,178.31,,,0,"percent of total billed charges ","85% of total billed charges ",236,90,,188.80,,,0,"percent of total billed charges ","90% of total billed charges ",236,90,,188.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",228.13,87,,182.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.55,70,,146.84,,,0,"percent of total billed charges ","70% of total billed charges ",183.55,243.86,
"CATH FOLEY 10FR 3CC 2WAY STYLE",6104479,"CDM ",272,RC,,,OUTPATIENT,,,43.63,34.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.9,80,,27.92,,,0,"percent of total billed charges ","80% of total billed charges ",30.54,70,,24.43,,,0,"percent of total billed charges ","70% of total billed charges ",39.27,90,,31.42,,,0,"percent of total billed charges ","90% of total billed charges ",40.58,93,,32.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",37.09,85,,29.67,,,0,"percent of total billed charges ","85% of total billed charges ",39.27,90,,31.42,,,0,"percent of total billed charges ","90% of total billed charges ",39.27,90,,31.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",37.96,87,,30.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.54,70,,24.43,,,0,"percent of total billed charges ","70% of total billed charges ",30.54,40.58,
"KIT EXPRESS INTRODUCER 15/2",6104502,"CDM ",272,RC,,,OUTPATIENT,,,4975.37,3980.296,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3980.3,80,,3184.24,,,0,"percent of total billed charges ","80% of total billed charges ",3482.76,70,,2786.21,,,0,"percent of total billed charges ","70% of total billed charges ",4477.83,90,,3582.26,,,0,"percent of total billed charges ","90% of total billed charges ",4627.09,93,,3701.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4229.06,85,,3383.25,,,0,"percent of total billed charges ","85% of total billed charges ",4477.83,90,,3582.26,,,0,"percent of total billed charges ","90% of total billed charges ",4477.83,90,,3582.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4328.57,87,,3462.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3482.76,70,,2786.21,,,0,"percent of total billed charges ","70% of total billed charges ",3482.76,4627.09,
"BASKET 4WIRE HELICAL STONE",6104506,"CDM ",272,RC,,,OUTPATIENT,,,476.47,381.176,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",381.18,80,,304.94,,,0,"percent of total billed charges ","80% of total billed charges ",333.53,70,,266.82,,,0,"percent of total billed charges ","70% of total billed charges ",428.82,90,,343.06,,,0,"percent of total billed charges ","90% of total billed charges ",443.12,93,,354.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",405,85,,324.00,,,0,"percent of total billed charges ","85% of total billed charges ",428.82,90,,343.06,,,0,"percent of total billed charges ","90% of total billed charges ",428.82,90,,343.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",414.53,87,,331.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",333.53,70,,266.82,,,0,"percent of total billed charges ","70% of total billed charges ",333.53,443.12,
"IMMOBILIZER SHOULDER MED",6104541,"CDM ",271,RC,,,OUTPATIENT,,,25.88,20.704,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.7,80,,16.56,,,0,"percent of total billed charges ","80% of total billed charges ",18.12,70,,14.50,,,0,"percent of total billed charges ","70% of total billed charges ",23.29,90,,18.63,,,0,"percent of total billed charges ","90% of total billed charges ",24.07,93,,19.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",22,85,,17.60,,,0,"percent of total billed charges ","85% of total billed charges ",23.29,90,,18.63,,,0,"percent of total billed charges ","90% of total billed charges ",23.29,90,,18.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.52,87,,18.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.12,70,,14.50,,,0,"percent of total billed charges ","70% of total billed charges ",18.12,24.07,
"DRAPE HIP W/POCKET",6104551,"CDM ",272,RC,,,OUTPATIENT,,,112.68,90.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.14,80,,72.11,,,0,"percent of total billed charges ","80% of total billed charges ",78.88,70,,63.10,,,0,"percent of total billed charges ","70% of total billed charges ",101.41,90,,81.13,,,0,"percent of total billed charges ","90% of total billed charges ",104.79,93,,83.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",95.78,85,,76.62,,,0,"percent of total billed charges ","85% of total billed charges ",101.41,90,,81.13,,,0,"percent of total billed charges ","90% of total billed charges ",101.41,90,,81.13,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",98.03,87,,78.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.88,70,,63.10,,,0,"percent of total billed charges ","70% of total billed charges ",78.88,104.79,
"ELECTRODE EXTENDED",6104562,"CDM ",272,RC,,,OUTPATIENT,,,12.24,9.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.79,80,,7.83,,,0,"percent of total billed charges ","80% of total billed charges ",8.57,70,,6.86,,,0,"percent of total billed charges ","70% of total billed charges ",11.02,90,,8.82,,,0,"percent of total billed charges ","90% of total billed charges ",11.38,93,,9.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.4,85,,8.32,,,0,"percent of total billed charges ","85% of total billed charges ",11.02,90,,8.82,,,0,"percent of total billed charges ","90% of total billed charges ",11.02,90,,8.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.65,87,,8.52,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.57,70,,6.86,,,0,"percent of total billed charges ","70% of total billed charges ",8.57,11.38,
"BURR 3.0MM",6104568,"CDM ",272,RC,,,OUTPATIENT,,,227.93,182.344,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",182.34,80,,145.87,,,0,"percent of total billed charges ","80% of total billed charges ",159.55,70,,127.64,,,0,"percent of total billed charges ","70% of total billed charges ",205.14,90,,164.11,,,0,"percent of total billed charges ","90% of total billed charges ",211.97,93,,169.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",193.74,85,,154.99,,,0,"percent of total billed charges ","85% of total billed charges ",205.14,90,,164.11,,,0,"percent of total billed charges ","90% of total billed charges ",205.14,90,,164.11,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",198.3,87,,158.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",159.55,70,,127.64,,,0,"percent of total billed charges ","70% of total billed charges ",159.55,211.97,
"BUTTON NASAL SEPTAL",6104573,"CDM ",272,RC,,,OUTPATIENT,,,385.75,308.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",308.6,80,,246.88,,,0,"percent of total billed charges ","80% of total billed charges ",270.03,70,,216.02,,,0,"percent of total billed charges ","70% of total billed charges ",347.18,90,,277.74,,,0,"percent of total billed charges ","90% of total billed charges ",358.75,93,,287.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",327.89,85,,262.31,,,0,"percent of total billed charges ","85% of total billed charges ",347.18,90,,277.74,,,0,"percent of total billed charges ","90% of total billed charges ",347.18,90,,277.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",335.6,87,,268.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",270.03,70,,216.02,,,0,"percent of total billed charges ","70% of total billed charges ",270.03,358.75,
"BLADE SAW WIDE MED",6104577,"CDM ",272,RC,,,OUTPATIENT,,,179,143.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",143.2,80,,114.56,,,0,"percent of total billed charges ","80% of total billed charges ",125.3,70,,100.24,,,0,"percent of total billed charges ","70% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",166.47,93,,133.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",152.15,85,,121.72,,,0,"percent of total billed charges ","85% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",155.73,87,,124.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.3,70,,100.24,,,0,"percent of total billed charges ","70% of total billed charges ",125.3,166.47,
"BLADE SAW  LONG-THICK",6104578,"CDM ",272,RC,,,OUTPATIENT,,,177.8,142.24,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.24,80,,113.79,,,0,"percent of total billed charges ","80% of total billed charges ",124.46,70,,99.57,,,0,"percent of total billed charges ","70% of total billed charges ",160.02,90,,128.02,,,0,"percent of total billed charges ","90% of total billed charges ",165.35,93,,132.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",151.13,85,,120.90,,,0,"percent of total billed charges ","85% of total billed charges ",160.02,90,,128.02,,,0,"percent of total billed charges ","90% of total billed charges ",160.02,90,,128.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",154.69,87,,123.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.46,70,,99.57,,,0,"percent of total billed charges ","70% of total billed charges ",124.46,165.35,
"BLADE SAW WIDE EX-THICK",6104579,"CDM ",272,RC,,,OUTPATIENT,,,179,143.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",143.2,80,,114.56,,,0,"percent of total billed charges ","80% of total billed charges ",125.3,70,,100.24,,,0,"percent of total billed charges ","70% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",166.47,93,,133.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",152.15,85,,121.72,,,0,"percent of total billed charges ","85% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",161.1,90,,128.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",155.73,87,,124.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.3,70,,100.24,,,0,"percent of total billed charges ","70% of total billed charges ",125.3,166.47,
"ELECTRODE CUTTING LOOP 24FR",6104585,"CDM ",272,RC,,,OUTPATIENT,,,377.81,302.248,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",302.25,80,,241.80,,,0,"percent of total billed charges ","80% of total billed charges ",264.47,70,,211.58,,,0,"percent of total billed charges ","70% of total billed charges ",340.03,90,,272.02,,,0,"percent of total billed charges ","90% of total billed charges ",351.36,93,,281.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",321.14,85,,256.91,,,0,"percent of total billed charges ","85% of total billed charges ",340.03,90,,272.02,,,0,"percent of total billed charges ","90% of total billed charges ",340.03,90,,272.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",328.69,87,,262.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",264.47,70,,211.58,,,0,"percent of total billed charges ","70% of total billed charges ",264.47,351.36,
"BURR 3.5MM ROUND FLUTED SHORT",6104587,"CDM ",272,RC,,,OUTPATIENT,,,312.91,250.328,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",250.33,80,,200.26,,,0,"percent of total billed charges ","80% of total billed charges ",219.04,70,,175.23,,,0,"percent of total billed charges ","70% of total billed charges ",281.62,90,,225.30,,,0,"percent of total billed charges ","90% of total billed charges ",291.01,93,,232.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",265.97,85,,212.78,,,0,"percent of total billed charges ","85% of total billed charges ",281.62,90,,225.30,,,0,"percent of total billed charges ","90% of total billed charges ",281.62,90,,225.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",272.23,87,,217.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",219.04,70,,175.23,,,0,"percent of total billed charges ","70% of total billed charges ",219.04,291.01,
"ENDOCUTTER ECHELON 60MM X-LONG",6104588,"CDM ",272,RC,,,OUTPATIENT,,,768.04,614.432,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",614.43,80,,491.54,,,0,"percent of total billed charges ","80% of total billed charges ",537.63,70,,430.10,,,0,"percent of total billed charges ","70% of total billed charges ",691.24,90,,552.99,,,0,"percent of total billed charges ","90% of total billed charges ",714.28,93,,571.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",652.83,85,,522.26,,,0,"percent of total billed charges ","85% of total billed charges ",691.24,90,,552.99,,,0,"percent of total billed charges ","90% of total billed charges ",691.24,90,,552.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",668.19,87,,534.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",537.63,70,,430.10,,,0,"percent of total billed charges ","70% of total billed charges ",537.63,714.28,
"REAMER C 6MM",6104597,"CDM ",272,RC,,,OUTPATIENT,,,272.96,218.368,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",218.37,80,,174.70,,,0,"percent of total billed charges ","80% of total billed charges ",191.07,70,,152.86,,,0,"percent of total billed charges ","70% of total billed charges ",245.66,90,,196.53,,,0,"percent of total billed charges ","90% of total billed charges ",253.85,93,,203.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",232.02,85,,185.62,,,0,"percent of total billed charges ","85% of total billed charges ",245.66,90,,196.53,,,0,"percent of total billed charges ","90% of total billed charges ",245.66,90,,196.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",237.48,87,,189.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",191.07,70,,152.86,,,0,"percent of total billed charges ","70% of total billed charges ",191.07,253.85,
"CAPSULE BRAVO PH DELIVERY SYS",6104610,"CDM ",272,RC,,,OUTPATIENT,,,484.88,387.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",387.9,80,,310.32,,,0,"percent of total billed charges ","80% of total billed charges ",339.42,70,,271.54,,,0,"percent of total billed charges ","70% of total billed charges ",436.39,90,,349.11,,,0,"percent of total billed charges ","90% of total billed charges ",450.94,93,,360.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",412.15,85,,329.72,,,0,"percent of total billed charges ","85% of total billed charges ",436.39,90,,349.11,,,0,"percent of total billed charges ","90% of total billed charges ",436.39,90,,349.11,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",421.85,87,,337.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",339.42,70,,271.54,,,0,"percent of total billed charges ","70% of total billed charges ",339.42,450.94,
"LMA SUPREME SIZE 3",6104612,"CDM ",272,RC,,,OUTPATIENT,,,72.1,57.68,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.68,80,,46.14,,,0,"percent of total billed charges ","80% of total billed charges ",50.47,70,,40.38,,,0,"percent of total billed charges ","70% of total billed charges ",64.89,90,,51.91,,,0,"percent of total billed charges ","90% of total billed charges ",67.05,93,,53.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",61.29,85,,49.03,,,0,"percent of total billed charges ","85% of total billed charges ",64.89,90,,51.91,,,0,"percent of total billed charges ","90% of total billed charges ",64.89,90,,51.91,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",62.73,87,,50.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.47,70,,40.38,,,0,"percent of total billed charges ","70% of total billed charges ",50.47,67.05,
"LMA SUPREME SIZE 4",6104613,"CDM ",272,RC,,,OUTPATIENT,,,72.1,57.68,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.68,80,,46.14,,,0,"percent of total billed charges ","80% of total billed charges ",50.47,70,,40.38,,,0,"percent of total billed charges ","70% of total billed charges ",64.89,90,,51.91,,,0,"percent of total billed charges ","90% of total billed charges ",67.05,93,,53.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",61.29,85,,49.03,,,0,"percent of total billed charges ","85% of total billed charges ",64.89,90,,51.91,,,0,"percent of total billed charges ","90% of total billed charges ",64.89,90,,51.91,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",62.73,87,,50.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.47,70,,40.38,,,0,"percent of total billed charges ","70% of total billed charges ",50.47,67.05,
"LMA SUPREME SIZE 5",6104614,"CDM ",272,RC,,,OUTPATIENT,,,72.1,57.68,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.68,80,,46.14,,,0,"percent of total billed charges ","80% of total billed charges ",50.47,70,,40.38,,,0,"percent of total billed charges ","70% of total billed charges ",64.89,90,,51.91,,,0,"percent of total billed charges ","90% of total billed charges ",67.05,93,,53.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",61.29,85,,49.03,,,0,"percent of total billed charges ","85% of total billed charges ",64.89,90,,51.91,,,0,"percent of total billed charges ","90% of total billed charges ",64.89,90,,51.91,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",62.73,87,,50.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.47,70,,40.38,,,0,"percent of total billed charges ","70% of total billed charges ",50.47,67.05,
"BASKET SPIRAL 3 WIRE 11MM",6104623,"CDM ",272,RC,,,OUTPATIENT,,,502,401.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",401.6,80,,321.28,,,0,"percent of total billed charges ","80% of total billed charges ",351.4,70,,281.12,,,0,"percent of total billed charges ","70% of total billed charges ",451.8,90,,361.44,,,0,"percent of total billed charges ","90% of total billed charges ",466.86,93,,373.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",426.7,85,,341.36,,,0,"percent of total billed charges ","85% of total billed charges ",451.8,90,,361.44,,,0,"percent of total billed charges ","90% of total billed charges ",451.8,90,,361.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",436.74,87,,349.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",351.4,70,,281.12,,,0,"percent of total billed charges ","70% of total billed charges ",351.4,466.86,
"FORCEP GRASPING 3 NAIL 10MM",6104624,"CDM ",272,RC,,,OUTPATIENT,,,515.05,412.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",412.04,80,,329.63,,,0,"percent of total billed charges ","80% of total billed charges ",360.54,70,,288.43,,,0,"percent of total billed charges ","70% of total billed charges ",463.55,90,,370.84,,,0,"percent of total billed charges ","90% of total billed charges ",479,93,,383.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",437.79,85,,350.23,,,0,"percent of total billed charges ","85% of total billed charges ",463.55,90,,370.84,,,0,"percent of total billed charges ","90% of total billed charges ",463.55,90,,370.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",448.09,87,,358.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",360.54,70,,288.43,,,0,"percent of total billed charges ","70% of total billed charges ",360.54,479,
"KIT ENDO LIGATOR",6104638,"CDM ",272,RC,,,OUTPATIENT,,,387.9,310.32,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",310.32,80,,248.26,,,0,"percent of total billed charges ","80% of total billed charges ",271.53,70,,217.22,,,0,"percent of total billed charges ","70% of total billed charges ",349.11,90,,279.29,,,0,"percent of total billed charges ","90% of total billed charges ",360.75,93,,288.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",329.72,85,,263.78,,,0,"percent of total billed charges ","85% of total billed charges ",349.11,90,,279.29,,,0,"percent of total billed charges ","90% of total billed charges ",349.11,90,,279.29,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",337.47,87,,269.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",271.53,70,,217.22,,,0,"percent of total billed charges ","70% of total billed charges ",271.53,360.75,
"KIT CHLORAPREP W/APP ORANGE",6104642,"CDM ",272,RC,,,OUTPATIENT,,,36.66,29.328,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.33,80,,23.46,,,0,"percent of total billed charges ","80% of total billed charges ",25.66,70,,20.53,,,0,"percent of total billed charges ","70% of total billed charges ",32.99,90,,26.39,,,0,"percent of total billed charges ","90% of total billed charges ",34.09,93,,27.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",31.16,85,,24.93,,,0,"percent of total billed charges ","85% of total billed charges ",32.99,90,,26.39,,,0,"percent of total billed charges ","90% of total billed charges ",32.99,90,,26.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",31.89,87,,25.51,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.66,70,,20.53,,,0,"percent of total billed charges ","70% of total billed charges ",25.66,34.09,
"KIT VITRECTOMY DISP",6104647,"CDM ",272,RC,,,OUTPATIENT,,,546.5,437.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",437.2,80,,349.76,,,0,"percent of total billed charges ","80% of total billed charges ",382.55,70,,306.04,,,0,"percent of total billed charges ","70% of total billed charges ",491.85,90,,393.48,,,0,"percent of total billed charges ","90% of total billed charges ",508.25,93,,406.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",464.53,85,,371.62,,,0,"percent of total billed charges ","85% of total billed charges ",491.85,90,,393.48,,,0,"percent of total billed charges ","90% of total billed charges ",491.85,90,,393.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",475.46,87,,380.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",382.55,70,,306.04,,,0,"percent of total billed charges ","70% of total billed charges ",382.55,508.25,
"NEEDLE BIOPSY",6104678,"CDM ",272,RC,,,OUTPATIENT,,,64,51.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.2,80,,40.96,,,0,"percent of total billed charges ","80% of total billed charges ",44.8,70,,35.84,,,0,"percent of total billed charges ","70% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",59.52,93,,47.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",54.4,85,,43.52,,,0,"percent of total billed charges ","85% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",55.68,87,,44.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.8,70,,35.84,,,0,"percent of total billed charges ","70% of total billed charges ",44.8,59.52,
"LIGACLIP MED 20/20",6104689,"CDM ",272,RC,,,OUTPATIENT,,,308.5,246.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",246.8,80,,197.44,,,0,"percent of total billed charges ","80% of total billed charges ",215.95,70,,172.76,,,0,"percent of total billed charges ","70% of total billed charges ",277.65,90,,222.12,,,0,"percent of total billed charges ","90% of total billed charges ",286.91,93,,229.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",262.23,85,,209.78,,,0,"percent of total billed charges ","85% of total billed charges ",277.65,90,,222.12,,,0,"percent of total billed charges ","90% of total billed charges ",277.65,90,,222.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",268.4,87,,214.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",215.95,70,,172.76,,,0,"percent of total billed charges ","70% of total billed charges ",215.95,286.91,
"IMMOBILIZER SHOULDER LG",6104693,"CDM ",271,RC,,,OUTPATIENT,,,25.88,20.704,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.7,80,,16.56,,,0,"percent of total billed charges ","80% of total billed charges ",18.12,70,,14.50,,,0,"percent of total billed charges ","70% of total billed charges ",23.29,90,,18.63,,,0,"percent of total billed charges ","90% of total billed charges ",24.07,93,,19.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",22,85,,17.60,,,0,"percent of total billed charges ","85% of total billed charges ",23.29,90,,18.63,,,0,"percent of total billed charges ","90% of total billed charges ",23.29,90,,18.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.52,87,,18.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.12,70,,14.50,,,0,"percent of total billed charges ","70% of total billed charges ",18.12,24.07,
"SUTURE Z259H PDSII",6104694,"CDM ",272,RC,,,OUTPATIENT,,,10.83,8.664,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.66,80,,6.93,,,0,"percent of total billed charges ","80% of total billed charges ",7.58,70,,6.06,,,0,"percent of total billed charges ","70% of total billed charges ",9.75,90,,7.80,,,0,"percent of total billed charges ","90% of total billed charges ",10.07,93,,8.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.21,85,,7.37,,,0,"percent of total billed charges ","85% of total billed charges ",9.75,90,,7.80,,,0,"percent of total billed charges ","90% of total billed charges ",9.75,90,,7.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.42,87,,7.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.58,70,,6.06,,,0,"percent of total billed charges ","70% of total billed charges ",7.58,10.07,
"CATH FOGARTY EMB IRRIG 6FR",6104697,"CDM ",272,RC,,,OUTPATIENT,,,67.43,53.944,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.94,80,,43.15,,,0,"percent of total billed charges ","80% of total billed charges ",47.2,70,,37.76,,,0,"percent of total billed charges ","70% of total billed charges ",60.69,90,,48.55,,,0,"percent of total billed charges ","90% of total billed charges ",62.71,93,,50.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",57.32,85,,45.86,,,0,"percent of total billed charges ","85% of total billed charges ",60.69,90,,48.55,,,0,"percent of total billed charges ","90% of total billed charges ",60.69,90,,48.55,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",58.66,87,,46.93,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.2,70,,37.76,,,0,"percent of total billed charges ","70% of total billed charges ",47.2,62.71,
"TUBE GASTROSTOMY 16FR",6104700,"CDM ",272,RC,,,OUTPATIENT,,,271.25,217,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217,80,,173.60,,,0,"percent of total billed charges ","80% of total billed charges ",189.88,70,,151.90,,,0,"percent of total billed charges ","70% of total billed charges ",244.13,90,,195.30,,,0,"percent of total billed charges ","90% of total billed charges ",252.26,93,,201.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",230.56,85,,184.45,,,0,"percent of total billed charges ","85% of total billed charges ",244.13,90,,195.30,,,0,"percent of total billed charges ","90% of total billed charges ",244.13,90,,195.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",235.99,87,,188.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",189.88,70,,151.90,,,0,"percent of total billed charges ","70% of total billed charges ",189.88,252.26,
"NEEDLE BIOPSY 18 X 16",6104701,"CDM ",272,RC,,,OUTPATIENT,,,147,117.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.6,80,,94.08,,,0,"percent of total billed charges ","80% of total billed charges ",102.9,70,,82.32,,,0,"percent of total billed charges ","70% of total billed charges ",132.3,90,,105.84,,,0,"percent of total billed charges ","90% of total billed charges ",136.71,93,,109.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",124.95,85,,99.96,,,0,"percent of total billed charges ","85% of total billed charges ",132.3,90,,105.84,,,0,"percent of total billed charges ","90% of total billed charges ",132.3,90,,105.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",127.89,87,,102.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.9,70,,82.32,,,0,"percent of total billed charges ","70% of total billed charges ",102.9,136.71,
"SUTURE 783G 4.0 SILK",6104704,"CDM ",272,RC,,,OUTPATIENT,,,39.37,31.496,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,80,,25.20,,,0,"percent of total billed charges ","80% of total billed charges ",27.56,70,,22.05,,,0,"percent of total billed charges ","70% of total billed charges ",35.43,90,,28.34,,,0,"percent of total billed charges ","90% of total billed charges ",36.61,93,,29.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.46,85,,26.77,,,0,"percent of total billed charges ","85% of total billed charges ",35.43,90,,28.34,,,0,"percent of total billed charges ","90% of total billed charges ",35.43,90,,28.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",34.25,87,,27.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.56,70,,22.05,,,0,"percent of total billed charges ","70% of total billed charges ",27.56,36.61,
"SUTURE Z304H 4.0 PDS",6104706,"CDM ",272,RC,,,OUTPATIENT,,,10.88,8.704,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.7,80,,6.96,,,0,"percent of total billed charges ","80% of total billed charges ",7.62,70,,6.10,,,0,"percent of total billed charges ","70% of total billed charges ",9.79,90,,7.83,,,0,"percent of total billed charges ","90% of total billed charges ",10.12,93,,8.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.25,85,,7.40,,,0,"percent of total billed charges ","85% of total billed charges ",9.79,90,,7.83,,,0,"percent of total billed charges ","90% of total billed charges ",9.79,90,,7.83,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.47,87,,7.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.62,70,,6.10,,,0,"percent of total billed charges ","70% of total billed charges ",7.62,10.12,
"SUTURE J548G VICRYL 8.0",6104707,"CDM ",272,RC,,,OUTPATIENT,,,59.79,47.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.83,80,,38.26,,,0,"percent of total billed charges ","80% of total billed charges ",41.85,70,,33.48,,,0,"percent of total billed charges ","70% of total billed charges ",53.81,90,,43.05,,,0,"percent of total billed charges ","90% of total billed charges ",55.6,93,,44.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",50.82,85,,40.66,,,0,"percent of total billed charges ","85% of total billed charges ",53.81,90,,43.05,,,0,"percent of total billed charges ","90% of total billed charges ",53.81,90,,43.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",52.02,87,,41.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.85,70,,33.48,,,0,"percent of total billed charges ","70% of total billed charges ",41.85,55.6,
"FILTER SUCTION",6104716,"CDM ",271,RC,,,OUTPATIENT,,,21.5,17.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.2,80,,13.76,,,0,"percent of total billed charges ","80% of total billed charges ",15.05,70,,12.04,,,0,"percent of total billed charges ","70% of total billed charges ",19.35,90,,15.48,,,0,"percent of total billed charges ","90% of total billed charges ",20,93,,16.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.28,85,,14.62,,,0,"percent of total billed charges ","85% of total billed charges ",19.35,90,,15.48,,,0,"percent of total billed charges ","90% of total billed charges ",19.35,90,,15.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.71,87,,14.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.05,70,,12.04,,,0,"percent of total billed charges ","70% of total billed charges ",15.05,20,
"BRUSH FEMORAL BONE",6104721,"CDM ",272,RC,,,OUTPATIENT,,,57.34,45.872,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.87,80,,36.70,,,0,"percent of total billed charges ","80% of total billed charges ",40.14,70,,32.11,,,0,"percent of total billed charges ","70% of total billed charges ",51.61,90,,41.29,,,0,"percent of total billed charges ","90% of total billed charges ",53.33,93,,42.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",48.74,85,,38.99,,,0,"percent of total billed charges ","85% of total billed charges ",51.61,90,,41.29,,,0,"percent of total billed charges ","90% of total billed charges ",51.61,90,,41.29,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",49.89,87,,39.91,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.14,70,,32.11,,,0,"percent of total billed charges ","70% of total billed charges ",40.14,53.33,
"CATHETER TROCAR 10FR",6104728,"CDM ",272,RC,,,OUTPATIENT,,,64.63,51.704,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.7,80,,41.36,,,0,"percent of total billed charges ","80% of total billed charges ",45.24,70,,36.19,,,0,"percent of total billed charges ","70% of total billed charges ",58.17,90,,46.54,,,0,"percent of total billed charges ","90% of total billed charges ",60.11,93,,48.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",54.94,85,,43.95,,,0,"percent of total billed charges ","85% of total billed charges ",58.17,90,,46.54,,,0,"percent of total billed charges ","90% of total billed charges ",58.17,90,,46.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",56.23,87,,44.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.24,70,,36.19,,,0,"percent of total billed charges ","70% of total billed charges ",45.24,60.11,
"TUBE PNEUMOTHORAX",6104733,"CDM ",272,RC,,,OUTPATIENT,,,220.89,176.712,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",176.71,80,,141.37,,,0,"percent of total billed charges ","80% of total billed charges ",154.62,70,,123.70,,,0,"percent of total billed charges ","70% of total billed charges ",198.8,90,,159.04,,,0,"percent of total billed charges ","90% of total billed charges ",205.43,93,,164.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",187.76,85,,150.21,,,0,"percent of total billed charges ","85% of total billed charges ",198.8,90,,159.04,,,0,"percent of total billed charges ","90% of total billed charges ",198.8,90,,159.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",192.17,87,,153.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",154.62,70,,123.70,,,0,"percent of total billed charges ","70% of total billed charges ",154.62,205.43,
"TUBE PNEUMOTHORAX",6104734,"CDM ",272,RC,,,OUTPATIENT,,,407.3,325.84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",325.84,80,,260.67,,,0,"percent of total billed charges ","80% of total billed charges ",285.11,70,,228.09,,,0,"percent of total billed charges ","70% of total billed charges ",366.57,90,,293.26,,,0,"percent of total billed charges ","90% of total billed charges ",378.79,93,,303.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",346.21,85,,276.97,,,0,"percent of total billed charges ","85% of total billed charges ",366.57,90,,293.26,,,0,"percent of total billed charges ","90% of total billed charges ",366.57,90,,293.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",354.35,87,,283.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",285.11,70,,228.09,,,0,"percent of total billed charges ","70% of total billed charges ",285.11,378.79,
"LIGACLIP TITANIUM LG",6104741,"CDM ",272,RC,,,OUTPATIENT,,,76.94,61.552,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.55,80,,49.24,,,0,"percent of total billed charges ","80% of total billed charges ",53.86,70,,43.09,,,0,"percent of total billed charges ","70% of total billed charges ",69.25,90,,55.40,,,0,"percent of total billed charges ","90% of total billed charges ",71.55,93,,57.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",65.4,85,,52.32,,,0,"percent of total billed charges ","85% of total billed charges ",69.25,90,,55.40,,,0,"percent of total billed charges ","90% of total billed charges ",69.25,90,,55.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",66.94,87,,53.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.86,70,,43.09,,,0,"percent of total billed charges ","70% of total billed charges ",53.86,71.55,
"TROCAR ENDO 18MM",6104747,"CDM ",272,RC,,,OUTPATIENT,,,86.97,69.576,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.58,80,,55.66,,,0,"percent of total billed charges ","80% of total billed charges ",60.88,70,,48.70,,,0,"percent of total billed charges ","70% of total billed charges ",78.27,90,,62.62,,,0,"percent of total billed charges ","90% of total billed charges ",80.88,93,,64.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",73.92,85,,59.14,,,0,"percent of total billed charges ","85% of total billed charges ",78.27,90,,62.62,,,0,"percent of total billed charges ","90% of total billed charges ",78.27,90,,62.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",75.66,87,,60.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.88,70,,48.70,,,0,"percent of total billed charges ","70% of total billed charges ",60.88,80.88,
"NEEDLE ACCESS 3MM",6104774,"CDM ",272,RC,,,OUTPATIENT,,,162.2,129.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.76,80,,103.81,,,0,"percent of total billed charges ","80% of total billed charges ",113.54,70,,90.83,,,0,"percent of total billed charges ","70% of total billed charges ",145.98,90,,116.78,,,0,"percent of total billed charges ","90% of total billed charges ",150.85,93,,120.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",137.87,85,,110.30,,,0,"percent of total billed charges ","85% of total billed charges ",145.98,90,,116.78,,,0,"percent of total billed charges ","90% of total billed charges ",145.98,90,,116.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",141.11,87,,112.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.54,70,,90.83,,,0,"percent of total billed charges ","70% of total billed charges ",113.54,150.85,
"TROCAR BLADELESS 100MM",6104775,"CDM ",272,RC,,,OUTPATIENT,,,54.33,43.464,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.46,80,,34.77,,,0,"percent of total billed charges ","80% of total billed charges ",38.03,70,,30.42,,,0,"percent of total billed charges ","70% of total billed charges ",48.9,90,,39.12,,,0,"percent of total billed charges ","90% of total billed charges ",50.53,93,,40.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",46.18,85,,36.94,,,0,"percent of total billed charges ","85% of total billed charges ",48.9,90,,39.12,,,0,"percent of total billed charges ","90% of total billed charges ",48.9,90,,39.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",47.27,87,,37.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.03,70,,30.42,,,0,"percent of total billed charges ","70% of total billed charges ",38.03,50.53,
"BLADE HS CURVED SYNERGY",6104814,"CDM ",272,RC,,,OUTPATIENT,,,644.35,515.48,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",515.48,80,,412.38,,,0,"percent of total billed charges ","80% of total billed charges ",451.05,70,,360.84,,,0,"percent of total billed charges ","70% of total billed charges ",579.92,90,,463.94,,,0,"percent of total billed charges ","90% of total billed charges ",599.25,93,,479.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",547.7,85,,438.16,,,0,"percent of total billed charges ","85% of total billed charges ",579.92,90,,463.94,,,0,"percent of total billed charges ","90% of total billed charges ",579.92,90,,463.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",560.58,87,,448.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",451.05,70,,360.84,,,0,"percent of total billed charges ","70% of total billed charges ",451.05,599.25,
"DEVICE INFLATION",6104818,"CDM ",272,RC,,,OUTPATIENT,,,229,183.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.2,80,,146.56,,,0,"percent of total billed charges ","80% of total billed charges ",160.3,70,,128.24,,,0,"percent of total billed charges ","70% of total billed charges ",206.1,90,,164.88,,,0,"percent of total billed charges ","90% of total billed charges ",212.97,93,,170.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",194.65,85,,155.72,,,0,"percent of total billed charges ","85% of total billed charges ",206.1,90,,164.88,,,0,"percent of total billed charges ","90% of total billed charges ",206.1,90,,164.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",199.23,87,,159.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",160.3,70,,128.24,,,0,"percent of total billed charges ","70% of total billed charges ",160.3,212.97,
"SET LACRIMAL INTUBATION CRAF'D",6104831,"CDM ",272,RC,,,OUTPATIENT,,,260.5,208.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",208.4,80,,166.72,,,0,"percent of total billed charges ","80% of total billed charges ",182.35,70,,145.88,,,0,"percent of total billed charges ","70% of total billed charges ",234.45,90,,187.56,,,0,"percent of total billed charges ","90% of total billed charges ",242.27,93,,193.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",221.43,85,,177.14,,,0,"percent of total billed charges ","85% of total billed charges ",234.45,90,,187.56,,,0,"percent of total billed charges ","90% of total billed charges ",234.45,90,,187.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",226.64,87,,181.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",182.35,70,,145.88,,,0,"percent of total billed charges ","70% of total billed charges ",182.35,242.27,
"STAPLER 25MM",6104833,"CDM ",272,RC,,,OUTPATIENT,,,486.23,388.984,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",388.98,80,,311.18,,,0,"percent of total billed charges ","80% of total billed charges ",340.36,70,,272.29,,,0,"percent of total billed charges ","70% of total billed charges ",437.61,90,,350.09,,,0,"percent of total billed charges ","90% of total billed charges ",452.19,93,,361.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",413.3,85,,330.64,,,0,"percent of total billed charges ","85% of total billed charges ",437.61,90,,350.09,,,0,"percent of total billed charges ","90% of total billed charges ",437.61,90,,350.09,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",423.02,87,,338.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",340.36,70,,272.29,,,0,"percent of total billed charges ","70% of total billed charges ",340.36,452.19,
"STAPLER 29MM",6104834,"CDM ",272,RC,,,OUTPATIENT,,,452.18,361.744,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",361.74,80,,289.39,,,0,"percent of total billed charges ","80% of total billed charges ",316.53,70,,253.22,,,0,"percent of total billed charges ","70% of total billed charges ",406.96,90,,325.57,,,0,"percent of total billed charges ","90% of total billed charges ",420.53,93,,336.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",384.35,85,,307.48,,,0,"percent of total billed charges ","85% of total billed charges ",406.96,90,,325.57,,,0,"percent of total billed charges ","90% of total billed charges ",406.96,90,,325.57,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",393.4,87,,314.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",316.53,70,,253.22,,,0,"percent of total billed charges ","70% of total billed charges ",316.53,420.53,
"TRAY SKIN PREP DRY",6104838,"CDM ",272,RC,,,OUTPATIENT,,,17.95,14.36,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.36,80,,11.49,,,0,"percent of total billed charges ","80% of total billed charges ",12.57,70,,10.06,,,0,"percent of total billed charges ","70% of total billed charges ",16.16,90,,12.93,,,0,"percent of total billed charges ","90% of total billed charges ",16.69,93,,13.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.26,85,,12.21,,,0,"percent of total billed charges ","85% of total billed charges ",16.16,90,,12.93,,,0,"percent of total billed charges ","90% of total billed charges ",16.16,90,,12.93,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.62,87,,12.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.57,70,,10.06,,,0,"percent of total billed charges ","70% of total billed charges ",12.57,16.69,
"TUBE MALONEY BOUGIE",6104840,"CDM ",272,RC,,,OUTPATIENT,,,413.2,330.56,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",330.56,80,,264.45,,,0,"percent of total billed charges ","80% of total billed charges ",289.24,70,,231.39,,,0,"percent of total billed charges ","70% of total billed charges ",371.88,90,,297.50,,,0,"percent of total billed charges ","90% of total billed charges ",384.28,93,,307.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",351.22,85,,280.98,,,0,"percent of total billed charges ","85% of total billed charges ",371.88,90,,297.50,,,0,"percent of total billed charges ","90% of total billed charges ",371.88,90,,297.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",359.48,87,,287.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",289.24,70,,231.39,,,0,"percent of total billed charges ","70% of total billed charges ",289.24,384.28,
"SUTURE Y844G MONOCRYL 5.0",6104841,"CDM ",272,RC,,,OUTPATIENT,,,21.11,16.888,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.89,80,,13.51,,,0,"percent of total billed charges ","80% of total billed charges ",14.78,70,,11.82,,,0,"percent of total billed charges ","70% of total billed charges ",19,90,,15.20,,,0,"percent of total billed charges ","90% of total billed charges ",19.63,93,,15.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.94,85,,14.35,,,0,"percent of total billed charges ","85% of total billed charges ",19,90,,15.20,,,0,"percent of total billed charges ","90% of total billed charges ",19,90,,15.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.37,87,,14.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.78,70,,11.82,,,0,"percent of total billed charges ","70% of total billed charges ",14.78,19.63,
"REAMER CANNULATED 9MM",6104844,"CDM ",272,RC,,,OUTPATIENT,,,250.17,200.136,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",200.14,80,,160.11,,,0,"percent of total billed charges ","80% of total billed charges ",175.12,70,,140.10,,,0,"percent of total billed charges ","70% of total billed charges ",225.15,90,,180.12,,,0,"percent of total billed charges ","90% of total billed charges ",232.66,93,,186.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",212.64,85,,170.11,,,0,"percent of total billed charges ","85% of total billed charges ",225.15,90,,180.12,,,0,"percent of total billed charges ","90% of total billed charges ",225.15,90,,180.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",217.65,87,,174.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",175.12,70,,140.10,,,0,"percent of total billed charges ","70% of total billed charges ",175.12,232.66,
"WASHER SMALL 2.7, 3.5, 4.0 MM",6104871,"CDM ",278,RC,,,OUTPATIENT,,,83.34,66.672,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.67,80,,53.34,,,0,"percent of total billed charges ","80% of total billed charges ",58.34,70,,46.67,,,0,"percent of total billed charges ","70% of total billed charges ",75.01,90,,60.01,,,0,"percent of total billed charges ","90% of total billed charges ",77.51,93,,62.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.84,85,,56.67,,,0,"percent of total billed charges ","85% of total billed charges ",70.84,85,,56.67,,,0,"percent of total billed charges ","85% of total billed charges ",75.01,90,,60.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",72.51,87,,58.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.34,70,,46.67,,,0,"percent of total billed charges ","70% of total billed charges ",58.34,77.51,
"DRAPE LASER ARM",6104872,"CDM ",272,RC,,,OUTPATIENT,,,42.13,33.704,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.7,80,,26.96,,,0,"percent of total billed charges ","80% of total billed charges ",29.49,70,,23.59,,,0,"percent of total billed charges ","70% of total billed charges ",37.92,90,,30.34,,,0,"percent of total billed charges ","90% of total billed charges ",39.18,93,,31.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",35.81,85,,28.65,,,0,"percent of total billed charges ","85% of total billed charges ",37.92,90,,30.34,,,0,"percent of total billed charges ","90% of total billed charges ",37.92,90,,30.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",36.65,87,,29.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.49,70,,23.59,,,0,"percent of total billed charges ","70% of total billed charges ",29.49,39.18,
"DRILL 2.0 MM Q-C",6104875,"CDM ",272,RC,,,OUTPATIENT,,,368.9,295.12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",295.12,80,,236.10,,,0,"percent of total billed charges ","80% of total billed charges ",258.23,70,,206.58,,,0,"percent of total billed charges ","70% of total billed charges ",332.01,90,,265.61,,,0,"percent of total billed charges ","90% of total billed charges ",343.08,93,,274.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",313.57,85,,250.86,,,0,"percent of total billed charges ","85% of total billed charges ",332.01,90,,265.61,,,0,"percent of total billed charges ","90% of total billed charges ",332.01,90,,265.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",320.94,87,,256.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",258.23,70,,206.58,,,0,"percent of total billed charges ","70% of total billed charges ",258.23,343.08,
"DRILL 2.0MM STANDARD",6104883,"CDM ",272,RC,,,OUTPATIENT,,,451.04,360.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",360.83,80,,288.66,,,0,"percent of total billed charges ","80% of total billed charges ",315.73,70,,252.58,,,0,"percent of total billed charges ","70% of total billed charges ",405.94,90,,324.75,,,0,"percent of total billed charges ","90% of total billed charges ",419.47,93,,335.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",383.38,85,,306.70,,,0,"percent of total billed charges ","85% of total billed charges ",405.94,90,,324.75,,,0,"percent of total billed charges ","90% of total billed charges ",405.94,90,,324.75,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",392.4,87,,313.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",315.73,70,,252.58,,,0,"percent of total billed charges ","70% of total billed charges ",315.73,419.47,
"SUTURE Z466H PDS 2.0",6104889,"CDM ",272,RC,,,OUTPATIENT,,,13.84,11.072,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.07,80,,8.86,,,0,"percent of total billed charges ","80% of total billed charges ",9.69,70,,7.75,,,0,"percent of total billed charges ","70% of total billed charges ",12.46,90,,9.97,,,0,"percent of total billed charges ","90% of total billed charges ",12.87,93,,10.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.76,85,,9.41,,,0,"percent of total billed charges ","85% of total billed charges ",12.46,90,,9.97,,,0,"percent of total billed charges ","90% of total billed charges ",12.46,90,,9.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.04,87,,9.63,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.69,70,,7.75,,,0,"percent of total billed charges ","70% of total billed charges ",9.69,12.87,
"TUBE GASTROSTOMY MIC 18FR",6104922,"CDM ",272,RC,,,OUTPATIENT,,,95.66,76.528,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.53,80,,61.22,,,0,"percent of total billed charges ","80% of total billed charges ",66.96,70,,53.57,,,0,"percent of total billed charges ","70% of total billed charges ",86.09,90,,68.87,,,0,"percent of total billed charges ","90% of total billed charges ",88.96,93,,71.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",81.31,85,,65.05,,,0,"percent of total billed charges ","85% of total billed charges ",86.09,90,,68.87,,,0,"percent of total billed charges ","90% of total billed charges ",86.09,90,,68.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",83.22,87,,66.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.96,70,,53.57,,,0,"percent of total billed charges ","70% of total billed charges ",66.96,88.96,
"TUBE GASTROSTOMY MIC 20FR",6104923,"CDM ",272,RC,,,OUTPATIENT,,,95.66,76.528,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.53,80,,61.22,,,0,"percent of total billed charges ","80% of total billed charges ",66.96,70,,53.57,,,0,"percent of total billed charges ","70% of total billed charges ",86.09,90,,68.87,,,0,"percent of total billed charges ","90% of total billed charges ",88.96,93,,71.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",81.31,85,,65.05,,,0,"percent of total billed charges ","85% of total billed charges ",86.09,90,,68.87,,,0,"percent of total billed charges ","90% of total billed charges ",86.09,90,,68.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",83.22,87,,66.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.96,70,,53.57,,,0,"percent of total billed charges ","70% of total billed charges ",66.96,88.96,
"SUTURE LAP QUILL",6104927,"CDM ",272,RC,,,OUTPATIENT,,,199.56,159.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",159.65,80,,127.72,,,0,"percent of total billed charges ","80% of total billed charges ",139.69,70,,111.75,,,0,"percent of total billed charges ","70% of total billed charges ",179.6,90,,143.68,,,0,"percent of total billed charges ","90% of total billed charges ",185.59,93,,148.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",169.63,85,,135.70,,,0,"percent of total billed charges ","85% of total billed charges ",179.6,90,,143.68,,,0,"percent of total billed charges ","90% of total billed charges ",179.6,90,,143.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",173.62,87,,138.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.69,70,,111.75,,,0,"percent of total billed charges ","70% of total billed charges ",139.69,185.59,
"SUTURE VICRYL 0 J346H",6104937,"CDM ",272,RC,,,OUTPATIENT,,,10.68,8.544,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.54,80,,6.83,,,0,"percent of total billed charges ","80% of total billed charges ",7.48,70,,5.98,,,0,"percent of total billed charges ","70% of total billed charges ",9.61,90,,7.69,,,0,"percent of total billed charges ","90% of total billed charges ",9.93,93,,7.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.08,85,,7.26,,,0,"percent of total billed charges ","85% of total billed charges ",9.61,90,,7.69,,,0,"percent of total billed charges ","90% of total billed charges ",9.61,90,,7.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.29,87,,7.43,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.48,70,,5.98,,,0,"percent of total billed charges ","70% of total billed charges ",7.48,9.93,
"DRAPE STERI 1100 CAMERA LASER",6104938,"CDM ",272,RC,,,OUTPATIENT,,,46.14,36.912,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.91,80,,29.53,,,0,"percent of total billed charges ","80% of total billed charges ",32.3,70,,25.84,,,0,"percent of total billed charges ","70% of total billed charges ",41.53,90,,33.22,,,0,"percent of total billed charges ","90% of total billed charges ",42.91,93,,34.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.22,85,,31.38,,,0,"percent of total billed charges ","85% of total billed charges ",41.53,90,,33.22,,,0,"percent of total billed charges ","90% of total billed charges ",41.53,90,,33.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.14,87,,32.11,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.3,70,,25.84,,,0,"percent of total billed charges ","70% of total billed charges ",32.3,42.91,
"TUBE JEJUNOSTOMY",6104939,"CDM ",270,RC,,,OUTPATIENT,,,393,314.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",314.4,80,,251.52,,,0,"percent of total billed charges ","80% of total billed charges ",275.1,70,,220.08,,,0,"percent of total billed charges ","70% of total billed charges ",353.7,90,,282.96,,,0,"percent of total billed charges ","90% of total billed charges ",365.49,93,,292.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",334.05,85,,267.24,,,0,"percent of total billed charges ","85% of total billed charges ",353.7,90,,282.96,,,0,"percent of total billed charges ","90% of total billed charges ",353.7,90,,282.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",341.91,87,,273.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",275.1,70,,220.08,,,0,"percent of total billed charges ","70% of total billed charges ",275.1,365.49,
"APPLIER CLIP",6104947,"CDM ",272,RC,,,OUTPATIENT,,,174.2,139.36,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",139.36,80,,111.49,,,0,"percent of total billed charges ","80% of total billed charges ",121.94,70,,97.55,,,0,"percent of total billed charges ","70% of total billed charges ",156.78,90,,125.42,,,0,"percent of total billed charges ","90% of total billed charges ",162.01,93,,129.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",148.07,85,,118.46,,,0,"percent of total billed charges ","85% of total billed charges ",156.78,90,,125.42,,,0,"percent of total billed charges ","90% of total billed charges ",156.78,90,,125.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",151.55,87,,121.24,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",121.94,70,,97.55,,,0,"percent of total billed charges ","70% of total billed charges ",121.94,162.01,
"HANDPIECE THERMACHOICE",6104964,"CDM ",272,RC,,,OUTPATIENT,,,2388.01,1910.408,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1910.41,80,,1528.33,,,0,"percent of total billed charges ","80% of total billed charges ",1671.61,70,,1337.29,,,0,"percent of total billed charges ","70% of total billed charges ",2149.21,90,,1719.37,,,0,"percent of total billed charges ","90% of total billed charges ",2220.85,93,,1776.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2029.81,85,,1623.85,,,0,"percent of total billed charges ","85% of total billed charges ",2149.21,90,,1719.37,,,0,"percent of total billed charges ","90% of total billed charges ",2149.21,90,,1719.37,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2077.57,87,,1662.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1671.61,70,,1337.29,,,0,"percent of total billed charges ","70% of total billed charges ",1671.61,2220.85,
"REAMER CANNULATED 10MM",6104969,"CDM ",272,RC,,,OUTPATIENT,,,250.17,200.136,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",200.14,80,,160.11,,,0,"percent of total billed charges ","80% of total billed charges ",175.12,70,,140.10,,,0,"percent of total billed charges ","70% of total billed charges ",225.15,90,,180.12,,,0,"percent of total billed charges ","90% of total billed charges ",232.66,93,,186.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",212.64,85,,170.11,,,0,"percent of total billed charges ","85% of total billed charges ",225.15,90,,180.12,,,0,"percent of total billed charges ","90% of total billed charges ",225.15,90,,180.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",217.65,87,,174.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",175.12,70,,140.10,,,0,"percent of total billed charges ","70% of total billed charges ",175.12,232.66,
"SHUNT PERITONE-VENOUS",6104976,"CDM ",278,RC,,,OUTPATIENT,,,831.5,665.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",665.2,80,,532.16,,,0,"percent of total billed charges ","80% of total billed charges ",582.05,70,,465.64,,,0,"percent of total billed charges ","70% of total billed charges ",748.35,90,,598.68,,,0,"percent of total billed charges ","90% of total billed charges ",773.3,93,,618.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",706.78,85,,565.42,,,0,"percent of total billed charges ","85% of total billed charges ",706.78,85,,565.42,,,0,"percent of total billed charges ","85% of total billed charges ",748.35,90,,598.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",723.41,87,,578.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",582.05,70,,465.64,,,0,"percent of total billed charges ","70% of total billed charges ",582.05,773.3,
"TIP RUMI GREEN 6.7MM X 10CM",6104977,"CDM ",272,RC,,,OUTPATIENT,,,184.47,147.576,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.58,80,,118.06,,,0,"percent of total billed charges ","80% of total billed charges ",129.13,70,,103.30,,,0,"percent of total billed charges ","70% of total billed charges ",166.02,90,,132.82,,,0,"percent of total billed charges ","90% of total billed charges ",171.56,93,,137.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",156.8,85,,125.44,,,0,"percent of total billed charges ","85% of total billed charges ",166.02,90,,132.82,,,0,"percent of total billed charges ","90% of total billed charges ",166.02,90,,132.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",160.49,87,,128.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.13,70,,103.30,,,0,"percent of total billed charges ","70% of total billed charges ",129.13,171.56,
"TIP RUMI BLUE 6.7MM X 8CM",6104979,"CDM ",272,RC,,,OUTPATIENT,,,184.47,147.576,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.58,80,,118.06,,,0,"percent of total billed charges ","80% of total billed charges ",129.13,70,,103.30,,,0,"percent of total billed charges ","70% of total billed charges ",166.02,90,,132.82,,,0,"percent of total billed charges ","90% of total billed charges ",171.56,93,,137.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",156.8,85,,125.44,,,0,"percent of total billed charges ","85% of total billed charges ",166.02,90,,132.82,,,0,"percent of total billed charges ","90% of total billed charges ",166.02,90,,132.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",160.49,87,,128.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.13,70,,103.30,,,0,"percent of total billed charges ","70% of total billed charges ",129.13,171.56,
"TIP RUMI WHITE 6.7MM X 6CM",6104980,"CDM ",272,RC,,,OUTPATIENT,,,191.14,152.912,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.91,80,,122.33,,,0,"percent of total billed charges ","80% of total billed charges ",133.8,70,,107.04,,,0,"percent of total billed charges ","70% of total billed charges ",172.03,90,,137.62,,,0,"percent of total billed charges ","90% of total billed charges ",177.76,93,,142.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",162.47,85,,129.98,,,0,"percent of total billed charges ","85% of total billed charges ",172.03,90,,137.62,,,0,"percent of total billed charges ","90% of total billed charges ",172.03,90,,137.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",166.29,87,,133.03,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.8,70,,107.04,,,0,"percent of total billed charges ","70% of total billed charges ",133.8,177.76,
"TIP RUMI LAVENDER 5.1MM X 6CM",6104981,"CDM ",272,RC,,,OUTPATIENT,,,191.14,152.912,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.91,80,,122.33,,,0,"percent of total billed charges ","80% of total billed charges ",133.8,70,,107.04,,,0,"percent of total billed charges ","70% of total billed charges ",172.03,90,,137.62,,,0,"percent of total billed charges ","90% of total billed charges ",177.76,93,,142.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",162.47,85,,129.98,,,0,"percent of total billed charges ","85% of total billed charges ",172.03,90,,137.62,,,0,"percent of total billed charges ","90% of total billed charges ",172.03,90,,137.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",166.29,87,,133.03,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",133.8,70,,107.04,,,0,"percent of total billed charges ","70% of total billed charges ",133.8,177.76,
"DRAPE EYE W/ INSIDE POCKET",6104988,"CDM ",272,RC,,,OUTPATIENT,,,47.39,37.912,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.91,80,,30.33,,,0,"percent of total billed charges ","80% of total billed charges ",33.17,70,,26.54,,,0,"percent of total billed charges ","70% of total billed charges ",42.65,90,,34.12,,,0,"percent of total billed charges ","90% of total billed charges ",44.07,93,,35.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.28,85,,32.22,,,0,"percent of total billed charges ","85% of total billed charges ",42.65,90,,34.12,,,0,"percent of total billed charges ","90% of total billed charges ",42.65,90,,34.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.23,87,,32.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.17,70,,26.54,,,0,"percent of total billed charges ","70% of total billed charges ",33.17,44.07,
"SUTURE VICRYL 3-0 J527H",6104991,"CDM ",272,RC,,,OUTPATIENT,,,20.56,16.448,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.45,80,,13.16,,,0,"percent of total billed charges ","80% of total billed charges ",14.39,70,,11.51,,,0,"percent of total billed charges ","70% of total billed charges ",18.5,90,,14.80,,,0,"percent of total billed charges ","90% of total billed charges ",19.12,93,,15.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.48,85,,13.98,,,0,"percent of total billed charges ","85% of total billed charges ",18.5,90,,14.80,,,0,"percent of total billed charges ","90% of total billed charges ",18.5,90,,14.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.89,87,,14.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.39,70,,11.51,,,0,"percent of total billed charges ","70% of total billed charges ",14.39,19.12,
"SUTURE ETHIBOND 0 36"" DOUBLE",6104996,"CDM ",272,RC,,,OUTPATIENT,,,194.38,155.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.5,80,,124.40,,,0,"percent of total billed charges ","80% of total billed charges ",136.07,70,,108.86,,,0,"percent of total billed charges ","70% of total billed charges ",174.94,90,,139.95,,,0,"percent of total billed charges ","90% of total billed charges ",180.77,93,,144.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",165.22,85,,132.18,,,0,"percent of total billed charges ","85% of total billed charges ",174.94,90,,139.95,,,0,"percent of total billed charges ","90% of total billed charges ",174.94,90,,139.95,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",169.11,87,,135.29,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136.07,70,,108.86,,,0,"percent of total billed charges ","70% of total billed charges ",136.07,180.77,
"GRAFT SURGISIS CURA 7CM X 10CM",6105002,"CDM ",278,RC,,,OUTPATIENT,,,1614,1291.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1291.2,80,,1032.96,,,0,"percent of total billed charges ","80% of total billed charges ",1129.8,70,,903.84,,,0,"percent of total billed charges ","70% of total billed charges ",1452.6,90,,1162.08,,,0,"percent of total billed charges ","90% of total billed charges ",1501.02,93,,1200.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1371.9,85,,1097.52,,,0,"percent of total billed charges ","85% of total billed charges ",1371.9,85,,1097.52,,,0,"percent of total billed charges ","85% of total billed charges ",1452.6,90,,1162.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1404.18,87,,1123.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1129.8,70,,903.84,,,0,"percent of total billed charges ","70% of total billed charges ",1129.8,1501.02,
"GRAFT SURGISIS 4CM X 7CM",6105003,"CDM ",278,RC,,,OUTPATIENT,,,1227,981.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",981.6,80,,785.28,,,0,"percent of total billed charges ","80% of total billed charges ",858.9,70,,687.12,,,0,"percent of total billed charges ","70% of total billed charges ",1104.3,90,,883.44,,,0,"percent of total billed charges ","90% of total billed charges ",1141.11,93,,912.89,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1042.95,85,,834.36,,,0,"percent of total billed charges ","85% of total billed charges ",1042.95,85,,834.36,,,0,"percent of total billed charges ","85% of total billed charges ",1104.3,90,,883.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1067.49,87,,853.99,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",858.9,70,,687.12,,,0,"percent of total billed charges ","70% of total billed charges ",858.9,1141.11,
"DILATOR SAVARY GILLIARD 54FR",6105010,"CDM ",272,RC,,,OUTPATIENT,,,619.5,495.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",495.6,80,,396.48,,,0,"percent of total billed charges ","80% of total billed charges ",433.65,70,,346.92,,,0,"percent of total billed charges ","70% of total billed charges ",557.55,90,,446.04,,,0,"percent of total billed charges ","90% of total billed charges ",576.14,93,,460.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",526.58,85,,421.26,,,0,"percent of total billed charges ","85% of total billed charges ",557.55,90,,446.04,,,0,"percent of total billed charges ","90% of total billed charges ",557.55,90,,446.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",538.97,87,,431.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",433.65,70,,346.92,,,0,"percent of total billed charges ","70% of total billed charges ",433.65,576.14,
"SUTURE SURG STEEL 18""GAGE",6105023,"CDM ",272,RC,,,OUTPATIENT,,,25.02,20.016,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.02,80,,16.02,,,0,"percent of total billed charges ","80% of total billed charges ",17.51,70,,14.01,,,0,"percent of total billed charges ","70% of total billed charges ",22.52,90,,18.02,,,0,"percent of total billed charges ","90% of total billed charges ",23.27,93,,18.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.27,85,,17.02,,,0,"percent of total billed charges ","85% of total billed charges ",22.52,90,,18.02,,,0,"percent of total billed charges ","90% of total billed charges ",22.52,90,,18.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.77,87,,17.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.51,70,,14.01,,,0,"percent of total billed charges ","70% of total billed charges ",17.51,23.27,
"GARMENT COMPRESSION FOOT",6105048,"CDM ",272,RC,,,OUTPATIENT,,,118.24,94.592,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.59,80,,75.67,,,0,"percent of total billed charges ","80% of total billed charges ",82.77,70,,66.22,,,0,"percent of total billed charges ","70% of total billed charges ",106.42,90,,85.14,,,0,"percent of total billed charges ","90% of total billed charges ",109.96,93,,87.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",100.5,85,,80.40,,,0,"percent of total billed charges ","85% of total billed charges ",106.42,90,,85.14,,,0,"percent of total billed charges ","90% of total billed charges ",106.42,90,,85.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",102.87,87,,82.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.77,70,,66.22,,,0,"percent of total billed charges ","70% of total billed charges ",82.77,109.96,
"COAGULATOR SUCTION DISP 6",6105055,"CDM ",272,RC,,,OUTPATIENT,,,39.32,31.456,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.46,80,,25.17,,,0,"percent of total billed charges ","80% of total billed charges ",27.52,70,,22.02,,,0,"percent of total billed charges ","70% of total billed charges ",35.39,90,,28.31,,,0,"percent of total billed charges ","90% of total billed charges ",36.57,93,,29.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.42,85,,26.74,,,0,"percent of total billed charges ","85% of total billed charges ",35.39,90,,28.31,,,0,"percent of total billed charges ","90% of total billed charges ",35.39,90,,28.31,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",34.21,87,,27.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.52,70,,22.02,,,0,"percent of total billed charges ","70% of total billed charges ",27.52,36.57,
"BLOCK CANCELLOUS",6105059,"CDM ",272,RC,,,OUTPATIENT,,,754.25,603.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",603.4,80,,482.72,,,0,"percent of total billed charges ","80% of total billed charges ",527.98,70,,422.38,,,0,"percent of total billed charges ","70% of total billed charges ",678.83,90,,543.06,,,0,"percent of total billed charges ","90% of total billed charges ",701.45,93,,561.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",641.11,85,,512.89,,,0,"percent of total billed charges ","85% of total billed charges ",678.83,90,,543.06,,,0,"percent of total billed charges ","90% of total billed charges ",678.83,90,,543.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",656.2,87,,524.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",527.98,70,,422.38,,,0,"percent of total billed charges ","70% of total billed charges ",527.98,701.45,
"SYSTEM ABSORB FXTN 15 FASTENER",6105081,"CDM ",272,RC,,,OUTPATIENT,,,1055.95,844.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",844.76,80,,675.81,,,0,"percent of total billed charges ","80% of total billed charges ",739.17,70,,591.34,,,0,"percent of total billed charges ","70% of total billed charges ",950.36,90,,760.29,,,0,"percent of total billed charges ","90% of total billed charges ",982.03,93,,785.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",897.56,85,,718.05,,,0,"percent of total billed charges ","85% of total billed charges ",950.36,90,,760.29,,,0,"percent of total billed charges ","90% of total billed charges ",950.36,90,,760.29,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",918.68,87,,734.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",739.17,70,,591.34,,,0,"percent of total billed charges ","70% of total billed charges ",739.17,982.03,
"FIXATION SYS SORBAFIX 30 CLIP",6105082,"CDM ",272,RC,,,OUTPATIENT,,,1334.03,1067.224,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1067.22,80,,853.78,,,0,"percent of total billed charges ","80% of total billed charges ",933.82,70,,747.06,,,0,"percent of total billed charges ","70% of total billed charges ",1200.63,90,,960.50,,,0,"percent of total billed charges ","90% of total billed charges ",1240.65,93,,992.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1133.93,85,,907.14,,,0,"percent of total billed charges ","85% of total billed charges ",1200.63,90,,960.50,,,0,"percent of total billed charges ","90% of total billed charges ",1200.63,90,,960.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1160.61,87,,928.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",933.82,70,,747.06,,,0,"percent of total billed charges ","70% of total billed charges ",933.82,1240.65,
"KIT BIOCART MIX / DELIVERY LG",6105101,"CDM ",278,RC,,,OUTPATIENT,,,527.97,422.376,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",422.38,80,,337.90,,,0,"percent of total billed charges ","80% of total billed charges ",369.58,70,,295.66,,,0,"percent of total billed charges ","70% of total billed charges ",475.17,90,,380.14,,,0,"percent of total billed charges ","90% of total billed charges ",491.01,93,,392.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",448.77,85,,359.02,,,0,"percent of total billed charges ","85% of total billed charges ",448.77,85,,359.02,,,0,"percent of total billed charges ","85% of total billed charges ",475.17,90,,380.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",459.33,87,,367.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",369.58,70,,295.66,,,0,"percent of total billed charges ","70% of total billed charges ",369.58,491.01,
"SLEEVE FEMORAL CENTERING",6105150,"CDM ",272,RC,,,OUTPATIENT,,,379,303.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.2,80,,242.56,,,0,"percent of total billed charges ","80% of total billed charges ",265.3,70,,212.24,,,0,"percent of total billed charges ","70% of total billed charges ",341.1,90,,272.88,,,0,"percent of total billed charges ","90% of total billed charges ",352.47,93,,281.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",322.15,85,,257.72,,,0,"percent of total billed charges ","85% of total billed charges ",341.1,90,,272.88,,,0,"percent of total billed charges ","90% of total billed charges ",341.1,90,,272.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",329.73,87,,263.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",265.3,70,,212.24,,,0,"percent of total billed charges ","70% of total billed charges ",265.3,352.47,
"SEPRAFILM  MEMBRANE",6105151,"CDM ",272,RC,,,OUTPATIENT,,,307,245.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",245.6,80,,196.48,,,0,"percent of total billed charges ","80% of total billed charges ",214.9,70,,171.92,,,0,"percent of total billed charges ","70% of total billed charges ",276.3,90,,221.04,,,0,"percent of total billed charges ","90% of total billed charges ",285.51,93,,228.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",260.95,85,,208.76,,,0,"percent of total billed charges ","85% of total billed charges ",276.3,90,,221.04,,,0,"percent of total billed charges ","90% of total billed charges ",276.3,90,,221.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",267.09,87,,213.67,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.9,70,,171.92,,,0,"percent of total billed charges ","70% of total billed charges ",214.9,285.51,
"DRAPE LAP CHOLE",6105152,"CDM ",272,RC,,,OUTPATIENT,,,57.79,46.232,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.23,80,,36.98,,,0,"percent of total billed charges ","80% of total billed charges ",40.45,70,,32.36,,,0,"percent of total billed charges ","70% of total billed charges ",52.01,90,,41.61,,,0,"percent of total billed charges ","90% of total billed charges ",53.74,93,,42.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",49.12,85,,39.30,,,0,"percent of total billed charges ","85% of total billed charges ",52.01,90,,41.61,,,0,"percent of total billed charges ","90% of total billed charges ",52.01,90,,41.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",50.28,87,,40.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.45,70,,32.36,,,0,"percent of total billed charges ","70% of total billed charges ",40.45,53.74,
"BONE CHIP CANCELLOUS",6105153,"CDM ",278,RC,,,OUTPATIENT,,,825.37,660.296,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",660.3,80,,528.24,,,0,"percent of total billed charges ","80% of total billed charges ",577.76,70,,462.21,,,0,"percent of total billed charges ","70% of total billed charges ",742.83,90,,594.26,,,0,"percent of total billed charges ","90% of total billed charges ",767.59,93,,614.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",701.56,85,,561.25,,,0,"percent of total billed charges ","85% of total billed charges ",701.56,85,,561.25,,,0,"percent of total billed charges ","85% of total billed charges ",742.83,90,,594.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",718.07,87,,574.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",577.76,70,,462.21,,,0,"percent of total billed charges ","70% of total billed charges ",577.76,767.59,
"PIN FIXATION GRAFT HARVESTING",6105155,"CDM ",278,RC,,,OUTPATIENT,,,222.25,177.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.8,80,,142.24,,,0,"percent of total billed charges ","80% of total billed charges ",155.58,70,,124.46,,,0,"percent of total billed charges ","70% of total billed charges ",200.03,90,,160.02,,,0,"percent of total billed charges ","90% of total billed charges ",206.69,93,,165.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",188.91,85,,151.13,,,0,"percent of total billed charges ","85% of total billed charges ",188.91,85,,151.13,,,0,"percent of total billed charges ","85% of total billed charges ",200.03,90,,160.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",193.36,87,,154.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.58,70,,124.46,,,0,"percent of total billed charges ","70% of total billed charges ",155.58,206.69,
"GRAFT 5X6 SEPRA FILM",6105157,"CDM ",278,RC,,,OUTPATIENT,,,576,460.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",460.8,80,,368.64,,,0,"percent of total billed charges ","80% of total billed charges ",403.2,70,,322.56,,,0,"percent of total billed charges ","70% of total billed charges ",518.4,90,,414.72,,,0,"percent of total billed charges ","90% of total billed charges ",535.68,93,,428.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",489.6,85,,391.68,,,0,"percent of total billed charges ","85% of total billed charges ",489.6,85,,391.68,,,0,"percent of total billed charges ","85% of total billed charges ",518.4,90,,414.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",501.12,87,,400.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",403.2,70,,322.56,,,0,"percent of total billed charges ","70% of total billed charges ",403.2,535.68,
"BIO ANCHOR 3.5MM X 10.5M",6105158,"CDM ",278,RC,,,OUTPATIENT,,,293.08,234.464,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",234.46,80,,187.57,,,0,"percent of total billed charges ","80% of total billed charges ",205.16,70,,164.13,,,0,"percent of total billed charges ","70% of total billed charges ",263.77,90,,211.02,,,0,"percent of total billed charges ","90% of total billed charges ",272.56,93,,218.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",249.12,85,,199.30,,,0,"percent of total billed charges ","85% of total billed charges ",249.12,85,,199.30,,,0,"percent of total billed charges ","85% of total billed charges ",263.77,90,,211.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",254.98,87,,203.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",205.16,70,,164.13,,,0,"percent of total billed charges ","70% of total billed charges ",205.16,272.56,
"ELECTRODE VAPOR",6105159,"CDM ",272,RC,,,OUTPATIENT,,,530.13,424.104,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",424.1,80,,339.28,,,0,"percent of total billed charges ","80% of total billed charges ",371.09,70,,296.87,,,0,"percent of total billed charges ","70% of total billed charges ",477.12,90,,381.70,,,0,"percent of total billed charges ","90% of total billed charges ",493.02,93,,394.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",450.61,85,,360.49,,,0,"percent of total billed charges ","85% of total billed charges ",477.12,90,,381.70,,,0,"percent of total billed charges ","90% of total billed charges ",477.12,90,,381.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",461.21,87,,368.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",371.09,70,,296.87,,,0,"percent of total billed charges ","70% of total billed charges ",371.09,493.02,
"VAPORTRODE GROOVED",6105161,"CDM ",272,RC,,,OUTPATIENT,,,301.7,241.36,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.36,80,,193.09,,,0,"percent of total billed charges ","80% of total billed charges ",211.19,70,,168.95,,,0,"percent of total billed charges ","70% of total billed charges ",271.53,90,,217.22,,,0,"percent of total billed charges ","90% of total billed charges ",280.58,93,,224.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",256.45,85,,205.16,,,0,"percent of total billed charges ","85% of total billed charges ",271.53,90,,217.22,,,0,"percent of total billed charges ","90% of total billed charges ",271.53,90,,217.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",262.48,87,,209.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",211.19,70,,168.95,,,0,"percent of total billed charges ","70% of total billed charges ",211.19,280.58,
"RUSH ROD 3/16"" - G",6105170,"CDM ",278,RC,,,OUTPATIENT,,,306.5,245.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",245.2,80,,196.16,,,0,"percent of total billed charges ","80% of total billed charges ",214.55,70,,171.64,,,0,"percent of total billed charges ","70% of total billed charges ",275.85,90,,220.68,,,0,"percent of total billed charges ","90% of total billed charges ",285.05,93,,228.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",260.53,85,,208.42,,,0,"percent of total billed charges ","85% of total billed charges ",260.53,85,,208.42,,,0,"percent of total billed charges ","85% of total billed charges ",275.85,90,,220.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",266.66,87,,213.33,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.55,70,,171.64,,,0,"percent of total billed charges ","70% of total billed charges ",214.55,285.05,
"FIXATOR AGEE-WRISTJACK",6105182,"CDM ",272,RC,,,OUTPATIENT,,,2209,1767.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1767.2,80,,1413.76,,,0,"percent of total billed charges ","80% of total billed charges ",1546.3,70,,1237.04,,,0,"percent of total billed charges ","70% of total billed charges ",1988.1,90,,1590.48,,,0,"percent of total billed charges ","90% of total billed charges ",2054.37,93,,1643.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1877.65,85,,1502.12,,,0,"percent of total billed charges ","85% of total billed charges ",1988.1,90,,1590.48,,,0,"percent of total billed charges ","90% of total billed charges ",1988.1,90,,1590.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1921.83,87,,1537.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1546.3,70,,1237.04,,,0,"percent of total billed charges ","70% of total billed charges ",1546.3,2054.37,
"ADAPTER D/F W/LUER LOCK",6105184,"CDM ",272,RC,,,OUTPATIENT,,,5,4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4,80,,3.20,,,0,"percent of total billed charges ","80% of total billed charges ",3.5,70,,2.80,,,0,"percent of total billed charges ","70% of total billed charges ",4.5,90,,3.60,,,0,"percent of total billed charges ","90% of total billed charges ",4.65,93,,3.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4.25,85,,3.40,,,0,"percent of total billed charges ","85% of total billed charges ",4.5,90,,3.60,,,0,"percent of total billed charges ","90% of total billed charges ",4.5,90,,3.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4.35,87,,3.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.5,70,,2.80,,,0,"percent of total billed charges ","70% of total billed charges ",3.5,4.65,
"FERRIC SUBSULFATE SOLUTION",6105185,"CDM ",272,RC,,,OUTPATIENT,,,60.01,48.008,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.01,80,,38.41,,,0,"percent of total billed charges ","80% of total billed charges ",42.01,70,,33.61,,,0,"percent of total billed charges ","70% of total billed charges ",54.01,90,,43.21,,,0,"percent of total billed charges ","90% of total billed charges ",55.81,93,,44.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51.01,85,,40.81,,,0,"percent of total billed charges ","85% of total billed charges ",54.01,90,,43.21,,,0,"percent of total billed charges ","90% of total billed charges ",54.01,90,,43.21,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",52.21,87,,41.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.01,70,,33.61,,,0,"percent of total billed charges ","70% of total billed charges ",42.01,55.81,
"ELECTRODE LOOP 15MM X 5MM",6105186,"CDM ",272,RC,,,OUTPATIENT,,,50.63,40.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.5,80,,32.40,,,0,"percent of total billed charges ","80% of total billed charges ",35.44,70,,28.35,,,0,"percent of total billed charges ","70% of total billed charges ",45.57,90,,36.46,,,0,"percent of total billed charges ","90% of total billed charges ",47.09,93,,37.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.04,85,,34.43,,,0,"percent of total billed charges ","85% of total billed charges ",45.57,90,,36.46,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,90,,36.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.05,87,,35.24,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.44,70,,28.35,,,0,"percent of total billed charges ","70% of total billed charges ",35.44,47.09,
"ELECTRODE LOOP 20MM X 10MM",6105187,"CDM ",272,RC,,,OUTPATIENT,,,53.3,42.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.64,80,,34.11,,,0,"percent of total billed charges ","80% of total billed charges ",37.31,70,,29.85,,,0,"percent of total billed charges ","70% of total billed charges ",47.97,90,,38.38,,,0,"percent of total billed charges ","90% of total billed charges ",49.57,93,,39.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",45.31,85,,36.25,,,0,"percent of total billed charges ","85% of total billed charges ",47.97,90,,38.38,,,0,"percent of total billed charges ","90% of total billed charges ",47.97,90,,38.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",46.37,87,,37.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.31,70,,29.85,,,0,"percent of total billed charges ","70% of total billed charges ",37.31,49.57,
"ELECTRODE BALL 5MM",6105190,"CDM ",272,RC,,,OUTPATIENT,,,53.3,42.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.64,80,,34.11,,,0,"percent of total billed charges ","80% of total billed charges ",37.31,70,,29.85,,,0,"percent of total billed charges ","70% of total billed charges ",47.97,90,,38.38,,,0,"percent of total billed charges ","90% of total billed charges ",49.57,93,,39.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",45.31,85,,36.25,,,0,"percent of total billed charges ","85% of total billed charges ",47.97,90,,38.38,,,0,"percent of total billed charges ","90% of total billed charges ",47.97,90,,38.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",46.37,87,,37.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.31,70,,29.85,,,0,"percent of total billed charges ","70% of total billed charges ",37.31,49.57,
"DRILL BIT 2.5MM *8",6105191,"CDM ",272,RC,,,OUTPATIENT,,,297,237.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",237.6,80,,190.08,,,0,"percent of total billed charges ","80% of total billed charges ",207.9,70,,166.32,,,0,"percent of total billed charges ","70% of total billed charges ",267.3,90,,213.84,,,0,"percent of total billed charges ","90% of total billed charges ",276.21,93,,220.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",252.45,85,,201.96,,,0,"percent of total billed charges ","85% of total billed charges ",267.3,90,,213.84,,,0,"percent of total billed charges ","90% of total billed charges ",267.3,90,,213.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",258.39,87,,206.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",207.9,70,,166.32,,,0,"percent of total billed charges ","70% of total billed charges ",207.9,276.21,
"SENSOR RAINBOW MASIMO ADUL/NEO",6105193,"CDM ",272,RC,,,OUTPATIENT,,,301.7,241.36,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.36,80,,193.09,,,0,"percent of total billed charges ","80% of total billed charges ",211.19,70,,168.95,,,0,"percent of total billed charges ","70% of total billed charges ",271.53,90,,217.22,,,0,"percent of total billed charges ","90% of total billed charges ",280.58,93,,224.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",256.45,85,,205.16,,,0,"percent of total billed charges ","85% of total billed charges ",271.53,90,,217.22,,,0,"percent of total billed charges ","90% of total billed charges ",271.53,90,,217.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",262.48,87,,209.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",211.19,70,,168.95,,,0,"percent of total billed charges ","70% of total billed charges ",211.19,280.58,
"TUBE TRACH W/CANNULA SIZE 6",6105194,"CDM ",272,RC,,,OUTPATIENT,,,194.5,155.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.6,80,,124.48,,,0,"percent of total billed charges ","80% of total billed charges ",136.15,70,,108.92,,,0,"percent of total billed charges ","70% of total billed charges ",175.05,90,,140.04,,,0,"percent of total billed charges ","90% of total billed charges ",180.89,93,,144.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",165.33,85,,132.26,,,0,"percent of total billed charges ","85% of total billed charges ",175.05,90,,140.04,,,0,"percent of total billed charges ","90% of total billed charges ",175.05,90,,140.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",169.22,87,,135.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136.15,70,,108.92,,,0,"percent of total billed charges ","70% of total billed charges ",136.15,180.89,
"MESH VENTRALIGHT 6""X8"" ECHO",6105199,"CDM ",278,RC,,,OUTPATIENT,,,2634.02,2107.216,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2107.22,80,,1685.78,,,0,"percent of total billed charges ","80% of total billed charges ",1843.81,70,,1475.05,,,0,"percent of total billed charges ","70% of total billed charges ",2370.62,90,,1896.50,,,0,"percent of total billed charges ","90% of total billed charges ",2449.64,93,,1959.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2238.92,85,,1791.14,,,0,"percent of total billed charges ","85% of total billed charges ",2238.92,85,,1791.14,,,0,"percent of total billed charges ","85% of total billed charges ",2370.62,90,,1896.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2291.6,87,,1833.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1843.81,70,,1475.05,,,0,"percent of total billed charges ","70% of total billed charges ",1843.81,2449.64,
"MESH VENTRALIGHT 4.5"" CIRCLE",6105200,"CDM ",278,RC,,,OUTPATIENT,,,883.55,706.84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",706.84,80,,565.47,,,0,"percent of total billed charges ","80% of total billed charges ",618.49,70,,494.79,,,0,"percent of total billed charges ","70% of total billed charges ",795.2,90,,636.16,,,0,"percent of total billed charges ","90% of total billed charges ",821.7,93,,657.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",751.02,85,,600.82,,,0,"percent of total billed charges ","85% of total billed charges ",751.02,85,,600.82,,,0,"percent of total billed charges ","85% of total billed charges ",795.2,90,,636.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",768.69,87,,614.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",618.49,70,,494.79,,,0,"percent of total billed charges ","70% of total billed charges ",618.49,821.7,
"TUBE JEJUNAL PEG-24",6105207,"CDM ",270,RC,,,OUTPATIENT,,,226.23,180.984,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.98,80,,144.78,,,0,"percent of total billed charges ","80% of total billed charges ",158.36,70,,126.69,,,0,"percent of total billed charges ","70% of total billed charges ",203.61,90,,162.89,,,0,"percent of total billed charges ","90% of total billed charges ",210.39,93,,168.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",192.3,85,,153.84,,,0,"percent of total billed charges ","85% of total billed charges ",203.61,90,,162.89,,,0,"percent of total billed charges ","90% of total billed charges ",203.61,90,,162.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",196.82,87,,157.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",158.36,70,,126.69,,,0,"percent of total billed charges ","70% of total billed charges ",158.36,210.39,
"SUTURE PLAIN GUT 4-0 1828H",6105213,"CDM ",272,RC,,,OUTPATIENT,,,28.49,22.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.79,80,,18.23,,,0,"percent of total billed charges ","80% of total billed charges ",19.94,70,,15.95,,,0,"percent of total billed charges ","70% of total billed charges ",25.64,90,,20.51,,,0,"percent of total billed charges ","90% of total billed charges ",26.5,93,,21.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",24.22,85,,19.38,,,0,"percent of total billed charges ","85% of total billed charges ",25.64,90,,20.51,,,0,"percent of total billed charges ","90% of total billed charges ",25.64,90,,20.51,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",24.79,87,,19.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.94,70,,15.95,,,0,"percent of total billed charges ","70% of total billed charges ",19.94,26.5,
"BLADE CRESENTIC 9.5 MM",6105215,"CDM ",272,RC,,,OUTPATIENT,,,259.46,207.568,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",207.57,80,,166.06,,,0,"percent of total billed charges ","80% of total billed charges ",181.62,70,,145.30,,,0,"percent of total billed charges ","70% of total billed charges ",233.51,90,,186.81,,,0,"percent of total billed charges ","90% of total billed charges ",241.3,93,,193.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",220.54,85,,176.43,,,0,"percent of total billed charges ","85% of total billed charges ",233.51,90,,186.81,,,0,"percent of total billed charges ","90% of total billed charges ",233.51,90,,186.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",225.73,87,,180.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",181.62,70,,145.30,,,0,"percent of total billed charges ","70% of total billed charges ",181.62,241.3,
"BLADE CRESENTIC 18.0 MM",6105217,"CDM ",272,RC,,,OUTPATIENT,,,259.46,207.568,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",207.57,80,,166.06,,,0,"percent of total billed charges ","80% of total billed charges ",181.62,70,,145.30,,,0,"percent of total billed charges ","70% of total billed charges ",233.51,90,,186.81,,,0,"percent of total billed charges ","90% of total billed charges ",241.3,93,,193.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",220.54,85,,176.43,,,0,"percent of total billed charges ","85% of total billed charges ",233.51,90,,186.81,,,0,"percent of total billed charges ","90% of total billed charges ",233.51,90,,186.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",225.73,87,,180.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",181.62,70,,145.30,,,0,"percent of total billed charges ","70% of total billed charges ",181.62,241.3,
"SUTURE PROLENE 7.0 8704H",6105220,"CDM ",272,RC,,,OUTPATIENT,,,46.94,37.552,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.55,80,,30.04,,,0,"percent of total billed charges ","80% of total billed charges ",32.86,70,,26.29,,,0,"percent of total billed charges ","70% of total billed charges ",42.25,90,,33.80,,,0,"percent of total billed charges ","90% of total billed charges ",43.65,93,,34.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.9,85,,31.92,,,0,"percent of total billed charges ","85% of total billed charges ",42.25,90,,33.80,,,0,"percent of total billed charges ","90% of total billed charges ",42.25,90,,33.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.84,87,,32.67,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.86,70,,26.29,,,0,"percent of total billed charges ","70% of total billed charges ",32.86,43.65,
"SUTURE PROLENE 4.0 9741H",6105221,"CDM ",272,RC,,,OUTPATIENT,,,104.01,83.208,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.21,80,,66.57,,,0,"percent of total billed charges ","80% of total billed charges ",72.81,70,,58.25,,,0,"percent of total billed charges ","70% of total billed charges ",93.61,90,,74.89,,,0,"percent of total billed charges ","90% of total billed charges ",96.73,93,,77.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",88.41,85,,70.73,,,0,"percent of total billed charges ","85% of total billed charges ",93.61,90,,74.89,,,0,"percent of total billed charges ","90% of total billed charges ",93.61,90,,74.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",90.49,87,,72.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.81,70,,58.25,,,0,"percent of total billed charges ","70% of total billed charges ",72.81,96.73,
"SUTURE PROLENE 9.0 2793G",6105222,"CDM ",272,RC,,,OUTPATIENT,,,75.83,60.664,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.66,80,,48.53,,,0,"percent of total billed charges ","80% of total billed charges ",53.08,70,,42.46,,,0,"percent of total billed charges ","70% of total billed charges ",68.25,90,,54.60,,,0,"percent of total billed charges ","90% of total billed charges ",70.52,93,,56.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",64.46,85,,51.57,,,0,"percent of total billed charges ","85% of total billed charges ",68.25,90,,54.60,,,0,"percent of total billed charges ","90% of total billed charges ",68.25,90,,54.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",65.97,87,,52.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.08,70,,42.46,,,0,"percent of total billed charges ","70% of total billed charges ",53.08,70.52,
"SPLINT NASAL SIMPLE INTERNAL",6105223,"CDM ",272,RC,,,OUTPATIENT,,,48.45,38.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.76,80,,31.01,,,0,"percent of total billed charges ","80% of total billed charges ",33.92,70,,27.14,,,0,"percent of total billed charges ","70% of total billed charges ",43.61,90,,34.89,,,0,"percent of total billed charges ","90% of total billed charges ",45.06,93,,36.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.18,85,,32.94,,,0,"percent of total billed charges ","85% of total billed charges ",43.61,90,,34.89,,,0,"percent of total billed charges ","90% of total billed charges ",43.61,90,,34.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.15,87,,33.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.92,70,,27.14,,,0,"percent of total billed charges ","70% of total billed charges ",33.92,45.06,
"GROMMET SHEPARD SILICONE *",6105224,"CDM ",272,RC,,,OUTPATIENT,,,154.69,123.752,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.75,80,,99.00,,,0,"percent of total billed charges ","80% of total billed charges ",108.28,70,,86.62,,,0,"percent of total billed charges ","70% of total billed charges ",139.22,90,,111.38,,,0,"percent of total billed charges ","90% of total billed charges ",143.86,93,,115.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",131.49,85,,105.19,,,0,"percent of total billed charges ","85% of total billed charges ",139.22,90,,111.38,,,0,"percent of total billed charges ","90% of total billed charges ",139.22,90,,111.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",134.58,87,,107.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.28,70,,86.62,,,0,"percent of total billed charges ","70% of total billed charges ",108.28,143.86,
"SUTURE SILK 4.0 641G",6105225,"CDM ",272,RC,,,OUTPATIENT,,,20.11,16.088,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.09,80,,12.87,,,0,"percent of total billed charges ","80% of total billed charges ",14.08,70,,11.26,,,0,"percent of total billed charges ","70% of total billed charges ",18.1,90,,14.48,,,0,"percent of total billed charges ","90% of total billed charges ",18.7,93,,14.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.09,85,,13.67,,,0,"percent of total billed charges ","85% of total billed charges ",18.1,90,,14.48,,,0,"percent of total billed charges ","90% of total billed charges ",18.1,90,,14.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.5,87,,14.00,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.08,70,,11.26,,,0,"percent of total billed charges ","70% of total billed charges ",14.08,18.7,
"SUTURE SILK 5.0 640G",6105226,"CDM ",272,RC,,,OUTPATIENT,,,19.66,15.728,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.73,80,,12.58,,,0,"percent of total billed charges ","80% of total billed charges ",13.76,70,,11.01,,,0,"percent of total billed charges ","70% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",18.28,93,,14.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.71,85,,13.37,,,0,"percent of total billed charges ","85% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",17.69,90,,14.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.1,87,,13.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.76,70,,11.01,,,0,"percent of total billed charges ","70% of total billed charges ",13.76,18.28,
"SUTURE SURGICAL STEEL 2 467G",6105227,"CDM ",272,RC,,,OUTPATIENT,,,19.81,15.848,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.85,80,,12.68,,,0,"percent of total billed charges ","80% of total billed charges ",13.87,70,,11.10,,,0,"percent of total billed charges ","70% of total billed charges ",17.83,90,,14.26,,,0,"percent of total billed charges ","90% of total billed charges ",18.42,93,,14.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.84,85,,13.47,,,0,"percent of total billed charges ","85% of total billed charges ",17.83,90,,14.26,,,0,"percent of total billed charges ","90% of total billed charges ",17.83,90,,14.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.23,87,,13.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.87,70,,11.10,,,0,"percent of total billed charges ","70% of total billed charges ",13.87,18.42,
"SUTURE VICRYL 1.0 J650G",6105229,"CDM ",272,RC,,,OUTPATIENT,,,62.94,50.352,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.35,80,,40.28,,,0,"percent of total billed charges ","80% of total billed charges ",44.06,70,,35.25,,,0,"percent of total billed charges ","70% of total billed charges ",56.65,90,,45.32,,,0,"percent of total billed charges ","90% of total billed charges ",58.53,93,,46.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",53.5,85,,42.80,,,0,"percent of total billed charges ","85% of total billed charges ",56.65,90,,45.32,,,0,"percent of total billed charges ","90% of total billed charges ",56.65,90,,45.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",54.76,87,,43.81,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.06,70,,35.25,,,0,"percent of total billed charges ","70% of total billed charges ",44.06,58.53,
"SUTURE VICRYL 2.0 J339H",6105230,"CDM ",272,RC,,,OUTPATIENT,,,9.63,7.704,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,80,,6.16,,,0,"percent of total billed charges ","80% of total billed charges ",6.74,70,,5.39,,,0,"percent of total billed charges ","70% of total billed charges ",8.67,90,,6.94,,,0,"percent of total billed charges ","90% of total billed charges ",8.96,93,,7.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.19,85,,6.55,,,0,"percent of total billed charges ","85% of total billed charges ",8.67,90,,6.94,,,0,"percent of total billed charges ","90% of total billed charges ",8.67,90,,6.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",8.38,87,,6.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.74,70,,5.39,,,0,"percent of total billed charges ","70% of total billed charges ",6.74,8.96,
"SUTURE CHROMIC 2.0 SC13T",6105232,"CDM ",272,RC,,,OUTPATIENT,,,33.15,26.52,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.52,80,,21.22,,,0,"percent of total billed charges ","80% of total billed charges ",23.21,70,,18.57,,,0,"percent of total billed charges ","70% of total billed charges ",29.84,90,,23.87,,,0,"percent of total billed charges ","90% of total billed charges ",30.83,93,,24.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.18,85,,22.54,,,0,"percent of total billed charges ","85% of total billed charges ",29.84,90,,23.87,,,0,"percent of total billed charges ","90% of total billed charges ",29.84,90,,23.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",28.84,87,,23.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.21,70,,18.57,,,0,"percent of total billed charges ","70% of total billed charges ",23.21,30.83,
"SUTURE CHROMIC 2.0 X523H",6105235,"CDM ",272,RC,,,OUTPATIENT,,,19.46,15.568,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.57,80,,12.46,,,0,"percent of total billed charges ","80% of total billed charges ",13.62,70,,10.90,,,0,"percent of total billed charges ","70% of total billed charges ",17.51,90,,14.01,,,0,"percent of total billed charges ","90% of total billed charges ",18.1,93,,14.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.54,85,,13.23,,,0,"percent of total billed charges ","85% of total billed charges ",17.51,90,,14.01,,,0,"percent of total billed charges ","90% of total billed charges ",17.51,90,,14.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.93,87,,13.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.62,70,,10.90,,,0,"percent of total billed charges ","70% of total billed charges ",13.62,18.1,
"SUTURE PDSII Z881G",6105236,"CDM ",272,RC,,,OUTPATIENT,,,18.86,15.088,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.09,80,,12.07,,,0,"percent of total billed charges ","80% of total billed charges ",13.2,70,,10.56,,,0,"percent of total billed charges ","70% of total billed charges ",16.97,90,,13.58,,,0,"percent of total billed charges ","90% of total billed charges ",17.54,93,,14.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.03,85,,12.82,,,0,"percent of total billed charges ","85% of total billed charges ",16.97,90,,13.58,,,0,"percent of total billed charges ","90% of total billed charges ",16.97,90,,13.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.41,87,,13.13,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.2,70,,10.56,,,0,"percent of total billed charges ","70% of total billed charges ",13.2,17.54,
"SUTURE PROLENE 2.0 8977N",6105237,"CDM ",272,RC,,,OUTPATIENT,,,30.34,24.272,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.27,80,,19.42,,,0,"percent of total billed charges ","80% of total billed charges ",21.24,70,,16.99,,,0,"percent of total billed charges ","70% of total billed charges ",27.31,90,,21.85,,,0,"percent of total billed charges ","90% of total billed charges ",28.22,93,,22.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.79,85,,20.63,,,0,"percent of total billed charges ","85% of total billed charges ",27.31,90,,21.85,,,0,"percent of total billed charges ","90% of total billed charges ",27.31,90,,21.85,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.4,87,,21.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.24,70,,16.99,,,0,"percent of total billed charges ","70% of total billed charges ",21.24,28.22,
"SUTURE PROLENE 3.0 8762H",6105238,"CDM ",272,RC,,,OUTPATIENT,,,23.5,18.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.8,80,,15.04,,,0,"percent of total billed charges ","80% of total billed charges ",16.45,70,,13.16,,,0,"percent of total billed charges ","70% of total billed charges ",21.15,90,,16.92,,,0,"percent of total billed charges ","90% of total billed charges ",21.86,93,,17.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.98,85,,15.98,,,0,"percent of total billed charges ","85% of total billed charges ",21.15,90,,16.92,,,0,"percent of total billed charges ","90% of total billed charges ",21.15,90,,16.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.45,87,,16.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.45,70,,13.16,,,0,"percent of total billed charges ","70% of total billed charges ",16.45,21.86,
"TUBE GASTROSTOMY MIC 16FR",6105248,"CDM ",272,RC,,,OUTPATIENT,,,95.66,76.528,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.53,80,,61.22,,,0,"percent of total billed charges ","80% of total billed charges ",66.96,70,,53.57,,,0,"percent of total billed charges ","70% of total billed charges ",86.09,90,,68.87,,,0,"percent of total billed charges ","90% of total billed charges ",88.96,93,,71.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",81.31,85,,65.05,,,0,"percent of total billed charges ","85% of total billed charges ",86.09,90,,68.87,,,0,"percent of total billed charges ","90% of total billed charges ",86.09,90,,68.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",83.22,87,,66.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.96,70,,53.57,,,0,"percent of total billed charges ","70% of total billed charges ",66.96,88.96,
"SEALER BIPOLAR 6.0 AQUAMANTYS",6105253,"CDM ",272,RC,,,OUTPATIENT,,,933.12,746.496,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",746.5,80,,597.20,,,0,"percent of total billed charges ","80% of total billed charges ",653.18,70,,522.54,,,0,"percent of total billed charges ","70% of total billed charges ",839.81,90,,671.85,,,0,"percent of total billed charges ","90% of total billed charges ",867.8,93,,694.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",793.15,85,,634.52,,,0,"percent of total billed charges ","85% of total billed charges ",839.81,90,,671.85,,,0,"percent of total billed charges ","90% of total billed charges ",839.81,90,,671.85,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",811.81,87,,649.45,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",653.18,70,,522.54,,,0,"percent of total billed charges ","70% of total billed charges ",653.18,867.8,
"TUBE TRACH CUFFL'S SHILEY SZ 8",6105257,"CDM ",272,RC,,,OUTPATIENT,,,129.26,103.408,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.41,80,,82.73,,,0,"percent of total billed charges ","80% of total billed charges ",90.48,70,,72.38,,,0,"percent of total billed charges ","70% of total billed charges ",116.33,90,,93.06,,,0,"percent of total billed charges ","90% of total billed charges ",120.21,93,,96.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",109.87,85,,87.90,,,0,"percent of total billed charges ","85% of total billed charges ",116.33,90,,93.06,,,0,"percent of total billed charges ","90% of total billed charges ",116.33,90,,93.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",112.46,87,,89.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.48,70,,72.38,,,0,"percent of total billed charges ","70% of total billed charges ",90.48,120.21,
"BALL JURGAN PIN .062",6105303,"CDM ",278,RC,,,OUTPATIENT,,,32.6,26.08,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.08,80,,20.86,,,0,"percent of total billed charges ","80% of total billed charges ",22.82,70,,18.26,,,0,"percent of total billed charges ","70% of total billed charges ",29.34,90,,23.47,,,0,"percent of total billed charges ","90% of total billed charges ",30.32,93,,24.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",27.71,85,,22.17,,,0,"percent of total billed charges ","85% of total billed charges ",27.71,85,,22.17,,,0,"percent of total billed charges ","85% of total billed charges ",29.34,90,,23.47,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",28.36,87,,22.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.82,70,,18.26,,,0,"percent of total billed charges ","70% of total billed charges ",22.82,30.32,
"SCALPEL HARMONIC 5MM SHEATH",6105309,"CDM ",272,RC,,,OUTPATIENT,,,486.56,389.248,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",389.25,80,,311.40,,,0,"percent of total billed charges ","80% of total billed charges ",340.59,70,,272.47,,,0,"percent of total billed charges ","70% of total billed charges ",437.9,90,,350.32,,,0,"percent of total billed charges ","90% of total billed charges ",452.5,93,,362.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",413.58,85,,330.86,,,0,"percent of total billed charges ","85% of total billed charges ",437.9,90,,350.32,,,0,"percent of total billed charges ","90% of total billed charges ",437.9,90,,350.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",423.31,87,,338.65,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",340.59,70,,272.47,,,0,"percent of total billed charges ","70% of total billed charges ",340.59,452.5,
"SUTURE ETHIBOND 0 X 844H",6105310,"CDM ",272,RC,,,OUTPATIENT,,,13.19,10.552,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.55,80,,8.44,,,0,"percent of total billed charges ","80% of total billed charges ",9.23,70,,7.38,,,0,"percent of total billed charges ","70% of total billed charges ",11.87,90,,9.50,,,0,"percent of total billed charges ","90% of total billed charges ",12.27,93,,9.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.21,85,,8.97,,,0,"percent of total billed charges ","85% of total billed charges ",11.87,90,,9.50,,,0,"percent of total billed charges ","90% of total billed charges ",11.87,90,,9.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.48,87,,9.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.23,70,,7.38,,,0,"percent of total billed charges ","70% of total billed charges ",9.23,12.27,
"ENSEAL 5MM ROUND NOSE",6105311,"CDM ",272,RC,,,OUTPATIENT,,,991.77,793.416,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",793.42,80,,634.74,,,0,"percent of total billed charges ","80% of total billed charges ",694.24,70,,555.39,,,0,"percent of total billed charges ","70% of total billed charges ",892.59,90,,714.07,,,0,"percent of total billed charges ","90% of total billed charges ",922.35,93,,737.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",843,85,,674.40,,,0,"percent of total billed charges ","85% of total billed charges ",892.59,90,,714.07,,,0,"percent of total billed charges ","90% of total billed charges ",892.59,90,,714.07,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",862.84,87,,690.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",694.24,70,,555.39,,,0,"percent of total billed charges ","70% of total billed charges ",694.24,922.35,
"RUMI KOH-EFFICIENT 3.0 CM",6105335,"CDM ",272,RC,,,OUTPATIENT,,,332.82,266.256,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",266.26,80,,213.01,,,0,"percent of total billed charges ","80% of total billed charges ",232.97,70,,186.38,,,0,"percent of total billed charges ","70% of total billed charges ",299.54,90,,239.63,,,0,"percent of total billed charges ","90% of total billed charges ",309.52,93,,247.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",282.9,85,,226.32,,,0,"percent of total billed charges ","85% of total billed charges ",299.54,90,,239.63,,,0,"percent of total billed charges ","90% of total billed charges ",299.54,90,,239.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",289.55,87,,231.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",232.97,70,,186.38,,,0,"percent of total billed charges ","70% of total billed charges ",232.97,309.52,
"RUMI KOH-EFFICIENT 3.5CM",6105336,"CDM ",272,RC,,,OUTPATIENT,,,332.82,266.256,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",266.26,80,,213.01,,,0,"percent of total billed charges ","80% of total billed charges ",232.97,70,,186.38,,,0,"percent of total billed charges ","70% of total billed charges ",299.54,90,,239.63,,,0,"percent of total billed charges ","90% of total billed charges ",309.52,93,,247.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",282.9,85,,226.32,,,0,"percent of total billed charges ","85% of total billed charges ",299.54,90,,239.63,,,0,"percent of total billed charges ","90% of total billed charges ",299.54,90,,239.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",289.55,87,,231.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",232.97,70,,186.38,,,0,"percent of total billed charges ","70% of total billed charges ",232.97,309.52,
"RUMI KOH-EFFICIENT 4.0CM",6105337,"CDM ",272,RC,,,OUTPATIENT,,,344.88,275.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",275.9,80,,220.72,,,0,"percent of total billed charges ","80% of total billed charges ",241.42,70,,193.14,,,0,"percent of total billed charges ","70% of total billed charges ",310.39,90,,248.31,,,0,"percent of total billed charges ","90% of total billed charges ",320.74,93,,256.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",293.15,85,,234.52,,,0,"percent of total billed charges ","85% of total billed charges ",310.39,90,,248.31,,,0,"percent of total billed charges ","90% of total billed charges ",310.39,90,,248.31,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",300.05,87,,240.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.42,70,,193.14,,,0,"percent of total billed charges ","70% of total billed charges ",241.42,320.74,
"ELECTRODE ANGLED END EFFECT",6105345,"CDM ",272,RC,,,OUTPATIENT,,,596.94,477.552,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",477.55,80,,382.04,,,0,"percent of total billed charges ","80% of total billed charges ",417.86,70,,334.29,,,0,"percent of total billed charges ","70% of total billed charges ",537.25,90,,429.80,,,0,"percent of total billed charges ","90% of total billed charges ",555.15,93,,444.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",507.4,85,,405.92,,,0,"percent of total billed charges ","85% of total billed charges ",537.25,90,,429.80,,,0,"percent of total billed charges ","90% of total billed charges ",537.25,90,,429.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",519.34,87,,415.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",417.86,70,,334.29,,,0,"percent of total billed charges ","70% of total billed charges ",417.86,555.15,
"ELECTRODE STRAIGHT END EFFECT",6105346,"CDM ",272,RC,,,OUTPATIENT,,,596.94,477.552,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",477.55,80,,382.04,,,0,"percent of total billed charges ","80% of total billed charges ",417.86,70,,334.29,,,0,"percent of total billed charges ","70% of total billed charges ",537.25,90,,429.80,,,0,"percent of total billed charges ","90% of total billed charges ",555.15,93,,444.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",507.4,85,,405.92,,,0,"percent of total billed charges ","85% of total billed charges ",537.25,90,,429.80,,,0,"percent of total billed charges ","90% of total billed charges ",537.25,90,,429.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",519.34,87,,415.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",417.86,70,,334.29,,,0,"percent of total billed charges ","70% of total billed charges ",417.86,555.15,
"ELECTRODE ANGLED SIDE EFFECT",6105347,"CDM ",272,RC,,,OUTPATIENT,,,530.13,424.104,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",424.1,80,,339.28,,,0,"percent of total billed charges ","80% of total billed charges ",371.09,70,,296.87,,,0,"percent of total billed charges ","70% of total billed charges ",477.12,90,,381.70,,,0,"percent of total billed charges ","90% of total billed charges ",493.02,93,,394.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",450.61,85,,360.49,,,0,"percent of total billed charges ","85% of total billed charges ",477.12,90,,381.70,,,0,"percent of total billed charges ","90% of total billed charges ",477.12,90,,381.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",461.21,87,,368.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",371.09,70,,296.87,,,0,"percent of total billed charges ","70% of total billed charges ",371.09,493.02,
"PLATE 3.5MM LOCK COM 7 HOLE",6105350,"CDM ",278,RC,,,OUTPATIENT,,,517.37,413.896,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",413.9,80,,331.12,,,0,"percent of total billed charges ","80% of total billed charges ",362.16,70,,289.73,,,0,"percent of total billed charges ","70% of total billed charges ",465.63,90,,372.50,,,0,"percent of total billed charges ","90% of total billed charges ",481.15,93,,384.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",439.76,85,,351.81,,,0,"percent of total billed charges ","85% of total billed charges ",439.76,85,,351.81,,,0,"percent of total billed charges ","85% of total billed charges ",465.63,90,,372.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",450.11,87,,360.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",362.16,70,,289.73,,,0,"percent of total billed charges ","70% of total billed charges ",362.16,481.15,
"SUTURE 3.0 STEEL FS2",6105351,"CDM ",272,RC,,,OUTPATIENT,,,8.07,6.456,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.46,80,,5.17,,,0,"percent of total billed charges ","80% of total billed charges ",5.65,70,,4.52,,,0,"percent of total billed charges ","70% of total billed charges ",7.26,90,,5.81,,,0,"percent of total billed charges ","90% of total billed charges ",7.51,93,,6.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6.86,85,,5.49,,,0,"percent of total billed charges ","85% of total billed charges ",7.26,90,,5.81,,,0,"percent of total billed charges ","90% of total billed charges ",7.26,90,,5.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7.02,87,,5.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.65,70,,4.52,,,0,"percent of total billed charges ","70% of total billed charges ",5.65,7.51,
"BLADE MICRO OTOLOGIC STRAIGHT",6105352,"CDM ",272,RC,,,OUTPATIENT,,,89.79,71.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.83,80,,57.46,,,0,"percent of total billed charges ","80% of total billed charges ",62.85,70,,50.28,,,0,"percent of total billed charges ","70% of total billed charges ",80.81,90,,64.65,,,0,"percent of total billed charges ","90% of total billed charges ",83.5,93,,66.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",76.32,85,,61.06,,,0,"percent of total billed charges ","85% of total billed charges ",80.81,90,,64.65,,,0,"percent of total billed charges ","90% of total billed charges ",80.81,90,,64.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",78.12,87,,62.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.85,70,,50.28,,,0,"percent of total billed charges ","70% of total billed charges ",62.85,83.5,
"BLADE MICRO OTOLOGIC ANGLED",6105353,"CDM ",272,RC,,,OUTPATIENT,,,95.12,76.096,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.1,80,,60.88,,,0,"percent of total billed charges ","80% of total billed charges ",66.58,70,,53.26,,,0,"percent of total billed charges ","70% of total billed charges ",85.61,90,,68.49,,,0,"percent of total billed charges ","90% of total billed charges ",88.46,93,,70.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.85,85,,64.68,,,0,"percent of total billed charges ","85% of total billed charges ",85.61,90,,68.49,,,0,"percent of total billed charges ","90% of total billed charges ",85.61,90,,68.49,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.75,87,,66.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.58,70,,53.26,,,0,"percent of total billed charges ","70% of total billed charges ",66.58,88.46,
"KIT INTEGRITY PATCH 25 X 30MM",6105368,"CDM ",278,RC,,,OUTPATIENT,,,5354.24,4283.392,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4283.39,80,,3426.71,,,0,"percent of total billed charges ","80% of total billed charges ",3747.97,70,,2998.38,,,0,"percent of total billed charges ","70% of total billed charges ",4818.82,90,,3855.06,,,0,"percent of total billed charges ","90% of total billed charges ",4979.44,93,,3983.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4551.1,85,,3640.88,,,0,"percent of total billed charges ","85% of total billed charges ",4551.1,85,,3640.88,,,0,"percent of total billed charges ","85% of total billed charges ",4818.82,90,,3855.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4658.19,87,,3726.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3747.97,70,,2998.38,,,0,"percent of total billed charges ","70% of total billed charges ",3747.97,4979.44,
"SEALER TISSUE ENSEAL G2",6105371,"CDM ",272,RC,,,OUTPATIENT,,,914.76,731.808,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",731.81,80,,585.45,,,0,"percent of total billed charges ","80% of total billed charges ",640.33,70,,512.26,,,0,"percent of total billed charges ","70% of total billed charges ",823.28,90,,658.62,,,0,"percent of total billed charges ","90% of total billed charges ",850.73,93,,680.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",777.55,85,,622.04,,,0,"percent of total billed charges ","85% of total billed charges ",823.28,90,,658.62,,,0,"percent of total billed charges ","90% of total billed charges ",823.28,90,,658.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",795.84,87,,636.67,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",640.33,70,,512.26,,,0,"percent of total billed charges ","70% of total billed charges ",640.33,850.73,
"SHEETING SILICONE 1.0",6105372,"CDM ",272,RC,,,OUTPATIENT,,,32.85,26.28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.28,80,,21.02,,,0,"percent of total billed charges ","80% of total billed charges ",23,70,,18.40,,,0,"percent of total billed charges ","70% of total billed charges ",29.57,90,,23.66,,,0,"percent of total billed charges ","90% of total billed charges ",30.55,93,,24.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",27.92,85,,22.34,,,0,"percent of total billed charges ","85% of total billed charges ",29.57,90,,23.66,,,0,"percent of total billed charges ","90% of total billed charges ",29.57,90,,23.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",28.58,87,,22.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23,70,,18.40,,,0,"percent of total billed charges ","70% of total billed charges ",23,30.55,
"SHEETING SILICONE 0.5",6105373,"CDM ",272,RC,,,OUTPATIENT,,,32.1,25.68,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.68,80,,20.54,,,0,"percent of total billed charges ","80% of total billed charges ",22.47,70,,17.98,,,0,"percent of total billed charges ","70% of total billed charges ",28.89,90,,23.11,,,0,"percent of total billed charges ","90% of total billed charges ",29.85,93,,23.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",27.29,85,,21.83,,,0,"percent of total billed charges ","85% of total billed charges ",28.89,90,,23.11,,,0,"percent of total billed charges ","90% of total billed charges ",28.89,90,,23.11,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",27.93,87,,22.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.47,70,,17.98,,,0,"percent of total billed charges ","70% of total billed charges ",22.47,29.85,
"PAD KNEE POSITIONER STERILE",6105377,"CDM ",272,RC,,,OUTPATIENT,,,153.35,122.68,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.68,80,,98.14,,,0,"percent of total billed charges ","80% of total billed charges ",107.35,70,,85.88,,,0,"percent of total billed charges ","70% of total billed charges ",138.02,90,,110.42,,,0,"percent of total billed charges ","90% of total billed charges ",142.62,93,,114.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",130.35,85,,104.28,,,0,"percent of total billed charges ","85% of total billed charges ",138.02,90,,110.42,,,0,"percent of total billed charges ","90% of total billed charges ",138.02,90,,110.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",133.41,87,,106.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",107.35,70,,85.88,,,0,"percent of total billed charges ","70% of total billed charges ",107.35,142.62,
"ELECTRODE VAPR SIDE EFFECT STR",6105380,"CDM ",272,RC,,,OUTPATIENT,,,504.27,403.416,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",403.42,80,,322.74,,,0,"percent of total billed charges ","80% of total billed charges ",352.99,70,,282.39,,,0,"percent of total billed charges ","70% of total billed charges ",453.84,90,,363.07,,,0,"percent of total billed charges ","90% of total billed charges ",468.97,93,,375.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",428.63,85,,342.90,,,0,"percent of total billed charges ","85% of total billed charges ",453.84,90,,363.07,,,0,"percent of total billed charges ","90% of total billed charges ",453.84,90,,363.07,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",438.71,87,,350.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",352.99,70,,282.39,,,0,"percent of total billed charges ","70% of total billed charges ",352.99,468.97,
"ELECTRODE VAPR SIDE EFFECT ANG",6105381,"CDM ",272,RC,,,OUTPATIENT,,,504.27,403.416,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",403.42,80,,322.74,,,0,"percent of total billed charges ","80% of total billed charges ",352.99,70,,282.39,,,0,"percent of total billed charges ","70% of total billed charges ",453.84,90,,363.07,,,0,"percent of total billed charges ","90% of total billed charges ",468.97,93,,375.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",428.63,85,,342.90,,,0,"percent of total billed charges ","85% of total billed charges ",453.84,90,,363.07,,,0,"percent of total billed charges ","90% of total billed charges ",453.84,90,,363.07,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",438.71,87,,350.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",352.99,70,,282.39,,,0,"percent of total billed charges ","70% of total billed charges ",352.99,468.97,
"LOCATOR NERVE NEURO PULSE 0003",6105382,"CDM ",272,RC,,,OUTPATIENT,,,155.58,124.464,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.46,80,,99.57,,,0,"percent of total billed charges ","80% of total billed charges ",108.91,70,,87.13,,,0,"percent of total billed charges ","70% of total billed charges ",140.02,90,,112.02,,,0,"percent of total billed charges ","90% of total billed charges ",144.69,93,,115.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",132.24,85,,105.79,,,0,"percent of total billed charges ","85% of total billed charges ",140.02,90,,112.02,,,0,"percent of total billed charges ","90% of total billed charges ",140.02,90,,112.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",135.35,87,,108.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.91,70,,87.13,,,0,"percent of total billed charges ","70% of total billed charges ",108.91,144.69,
"WAND PLASMA PROCISE MAX",6105383,"CDM ",272,RC,,,OUTPATIENT,,,538.75,431,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",431,80,,344.80,,,0,"percent of total billed charges ","80% of total billed charges ",377.13,70,,301.70,,,0,"percent of total billed charges ","70% of total billed charges ",484.88,90,,387.90,,,0,"percent of total billed charges ","90% of total billed charges ",501.04,93,,400.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",457.94,85,,366.35,,,0,"percent of total billed charges ","85% of total billed charges ",484.88,90,,387.90,,,0,"percent of total billed charges ","90% of total billed charges ",484.88,90,,387.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",468.71,87,,374.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",377.13,70,,301.70,,,0,"percent of total billed charges ","70% of total billed charges ",377.13,501.04,
"DRESSING STAMMBERGER SINU-FOAM",6105385,"CDM ",272,RC,,,OUTPATIENT,,,259.63,207.704,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",207.7,80,,166.16,,,0,"percent of total billed charges ","80% of total billed charges ",181.74,70,,145.39,,,0,"percent of total billed charges ","70% of total billed charges ",233.67,90,,186.94,,,0,"percent of total billed charges ","90% of total billed charges ",241.46,93,,193.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",220.69,85,,176.55,,,0,"percent of total billed charges ","85% of total billed charges ",233.67,90,,186.94,,,0,"percent of total billed charges ","90% of total billed charges ",233.67,90,,186.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",225.88,87,,180.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",181.74,70,,145.39,,,0,"percent of total billed charges ","70% of total billed charges ",181.74,241.46,
"TUBE EAR PAPRELA 1.14MM 2/PK",6105386,"CDM ",272,RC,,,OUTPATIENT,,,202.28,161.824,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",161.82,80,,129.46,,,0,"percent of total billed charges ","80% of total billed charges ",141.6,70,,113.28,,,0,"percent of total billed charges ","70% of total billed charges ",182.05,90,,145.64,,,0,"percent of total billed charges ","90% of total billed charges ",188.12,93,,150.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",171.94,85,,137.55,,,0,"percent of total billed charges ","85% of total billed charges ",182.05,90,,145.64,,,0,"percent of total billed charges ","90% of total billed charges ",182.05,90,,145.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",175.98,87,,140.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.6,70,,113.28,,,0,"percent of total billed charges ","70% of total billed charges ",141.6,188.12,
"TUBE EAR DNLDSON 1.14MM 2/PK",6105387,"CDM ",272,RC,,,OUTPATIENT,,,144.91,115.928,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.93,80,,92.74,,,0,"percent of total billed charges ","80% of total billed charges ",101.44,70,,81.15,,,0,"percent of total billed charges ","70% of total billed charges ",130.42,90,,104.34,,,0,"percent of total billed charges ","90% of total billed charges ",134.77,93,,107.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.17,85,,98.54,,,0,"percent of total billed charges ","85% of total billed charges ",130.42,90,,104.34,,,0,"percent of total billed charges ","90% of total billed charges ",130.42,90,,104.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.07,87,,100.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.44,70,,81.15,,,0,"percent of total billed charges ","70% of total billed charges ",101.44,134.77,
"TUBE EAR PAPRELA 1.14MM 1/PK",6105388,"CDM ",272,RC,,,OUTPATIENT,,,135.13,108.104,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.1,80,,86.48,,,0,"percent of total billed charges ","80% of total billed charges ",94.59,70,,75.67,,,0,"percent of total billed charges ","70% of total billed charges ",121.62,90,,97.30,,,0,"percent of total billed charges ","90% of total billed charges ",125.67,93,,100.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",114.86,85,,91.89,,,0,"percent of total billed charges ","85% of total billed charges ",121.62,90,,97.30,,,0,"percent of total billed charges ","90% of total billed charges ",121.62,90,,97.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",117.56,87,,94.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.59,70,,75.67,,,0,"percent of total billed charges ","70% of total billed charges ",94.59,125.67,
"TUBE EAR DNLDSON 1.14MM 1/PK",6105389,"CDM ",272,RC,,,OUTPATIENT,,,79.12,63.296,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.3,80,,50.64,,,0,"percent of total billed charges ","80% of total billed charges ",55.38,70,,44.30,,,0,"percent of total billed charges ","70% of total billed charges ",71.21,90,,56.97,,,0,"percent of total billed charges ","90% of total billed charges ",73.58,93,,58.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",67.25,85,,53.80,,,0,"percent of total billed charges ","85% of total billed charges ",71.21,90,,56.97,,,0,"percent of total billed charges ","90% of total billed charges ",71.21,90,,56.97,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",68.83,87,,55.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.38,70,,44.30,,,0,"percent of total billed charges ","70% of total billed charges ",55.38,73.58,
"HANDPIECE HYDROBRIDER",6105394,"CDM ",272,RC,,,OUTPATIENT,,,659.43,527.544,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",527.54,80,,422.03,,,0,"percent of total billed charges ","80% of total billed charges ",461.6,70,,369.28,,,0,"percent of total billed charges ","70% of total billed charges ",593.49,90,,474.79,,,0,"percent of total billed charges ","90% of total billed charges ",613.27,93,,490.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",560.52,85,,448.42,,,0,"percent of total billed charges ","85% of total billed charges ",593.49,90,,474.79,,,0,"percent of total billed charges ","90% of total billed charges ",593.49,90,,474.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",573.7,87,,458.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",461.6,70,,369.28,,,0,"percent of total billed charges ","70% of total billed charges ",461.6,613.27,
"TAP Z QC 2.7MM",6105403,"CDM ",272,RC,,,OUTPATIENT,,,244.81,195.848,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",195.85,80,,156.68,,,0,"percent of total billed charges ","80% of total billed charges ",171.37,70,,137.10,,,0,"percent of total billed charges ","70% of total billed charges ",220.33,90,,176.26,,,0,"percent of total billed charges ","90% of total billed charges ",227.67,93,,182.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",208.09,85,,166.47,,,0,"percent of total billed charges ","85% of total billed charges ",220.33,90,,176.26,,,0,"percent of total billed charges ","90% of total billed charges ",220.33,90,,176.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",212.98,87,,170.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",171.37,70,,137.10,,,0,"percent of total billed charges ","70% of total billed charges ",171.37,227.67,
"HANDPIECE TISSUE MORCELLATOR",6105421,"CDM ",272,RC,,,OUTPATIENT,,,1631.69,1305.352,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1305.35,80,,1044.28,,,0,"percent of total billed charges ","80% of total billed charges ",1142.18,70,,913.74,,,0,"percent of total billed charges ","70% of total billed charges ",1468.52,90,,1174.82,,,0,"percent of total billed charges ","90% of total billed charges ",1517.47,93,,1213.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1386.94,85,,1109.55,,,0,"percent of total billed charges ","85% of total billed charges ",1468.52,90,,1174.82,,,0,"percent of total billed charges ","90% of total billed charges ",1468.52,90,,1174.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1419.57,87,,1135.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1142.18,70,,913.74,,,0,"percent of total billed charges ","70% of total billed charges ",1142.18,1517.47,
"KIT BIOCART MIX / DELIVERY SM",6105505,"CDM ",278,RC,,,OUTPATIENT,,,527.97,422.376,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",422.38,80,,337.90,,,0,"percent of total billed charges ","80% of total billed charges ",369.58,70,,295.66,,,0,"percent of total billed charges ","70% of total billed charges ",475.17,90,,380.14,,,0,"percent of total billed charges ","90% of total billed charges ",491.01,93,,392.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",448.77,85,,359.02,,,0,"percent of total billed charges ","85% of total billed charges ",448.77,85,,359.02,,,0,"percent of total billed charges ","85% of total billed charges ",475.17,90,,380.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",459.33,87,,367.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",369.58,70,,295.66,,,0,"percent of total billed charges ","70% of total billed charges ",369.58,491.01,
"BIOCARTILAGE 1CC",6105534,"CDM ",278,RC,,,OUTPATIENT,,,1778.7,1422.96,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1422.96,80,,1138.37,,,0,"percent of total billed charges ","80% of total billed charges ",1245.09,70,,996.07,,,0,"percent of total billed charges ","70% of total billed charges ",1600.83,90,,1280.66,,,0,"percent of total billed charges ","90% of total billed charges ",1654.19,93,,1323.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1511.9,85,,1209.52,,,0,"percent of total billed charges ","85% of total billed charges ",1511.9,85,,1209.52,,,0,"percent of total billed charges ","85% of total billed charges ",1600.83,90,,1280.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1547.47,87,,1237.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1245.09,70,,996.07,,,0,"percent of total billed charges ","70% of total billed charges ",1245.09,1654.19,
"DRAPE THYROID",6105571,"CDM ",272,RC,,,OUTPATIENT,,,21.46,17.168,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.17,80,,13.74,,,0,"percent of total billed charges ","80% of total billed charges ",15.02,70,,12.02,,,0,"percent of total billed charges ","70% of total billed charges ",19.31,90,,15.45,,,0,"percent of total billed charges ","90% of total billed charges ",19.96,93,,15.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.24,85,,14.59,,,0,"percent of total billed charges ","85% of total billed charges ",19.31,90,,15.45,,,0,"percent of total billed charges ","90% of total billed charges ",19.31,90,,15.45,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.67,87,,14.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.02,70,,12.02,,,0,"percent of total billed charges ","70% of total billed charges ",15.02,19.96,
"STAPLER ENTACT SEPTAL",6105572,"CDM ",272,RC,,,OUTPATIENT,,,355.58,284.464,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",284.46,80,,227.57,,,0,"percent of total billed charges ","80% of total billed charges ",248.91,70,,199.13,,,0,"percent of total billed charges ","70% of total billed charges ",320.02,90,,256.02,,,0,"percent of total billed charges ","90% of total billed charges ",330.69,93,,264.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",302.24,85,,241.79,,,0,"percent of total billed charges ","85% of total billed charges ",320.02,90,,256.02,,,0,"percent of total billed charges ","90% of total billed charges ",320.02,90,,256.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",309.35,87,,247.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",248.91,70,,199.13,,,0,"percent of total billed charges ","70% of total billed charges ",248.91,330.69,
"CATH SINUS BALLOON ULTIRRA",6105575,"CDM ",272,RC,,,OUTPATIENT,,,1417.52,1134.016,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1134.02,80,,907.22,,,0,"percent of total billed charges ","80% of total billed charges ",992.26,70,,793.81,,,0,"percent of total billed charges ","70% of total billed charges ",1275.77,90,,1020.62,,,0,"percent of total billed charges ","90% of total billed charges ",1318.29,93,,1054.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1204.89,85,,963.91,,,0,"percent of total billed charges ","85% of total billed charges ",1275.77,90,,1020.62,,,0,"percent of total billed charges ","90% of total billed charges ",1275.77,90,,1020.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1233.24,87,,986.59,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",992.26,70,,793.81,,,0,"percent of total billed charges ","70% of total billed charges ",992.26,1318.29,
"SYSTEM ILLUMINATION SINUS",6105576,"CDM ",272,RC,,,OUTPATIENT,,,924.5,739.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",739.6,80,,591.68,,,0,"percent of total billed charges ","80% of total billed charges ",647.15,70,,517.72,,,0,"percent of total billed charges ","70% of total billed charges ",832.05,90,,665.64,,,0,"percent of total billed charges ","90% of total billed charges ",859.79,93,,687.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",785.83,85,,628.66,,,0,"percent of total billed charges ","85% of total billed charges ",832.05,90,,665.64,,,0,"percent of total billed charges ","90% of total billed charges ",832.05,90,,665.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",804.32,87,,643.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",647.15,70,,517.72,,,0,"percent of total billed charges ","70% of total billed charges ",647.15,859.79,
"CATH SINUS GUIDE F-70",6105577,"CDM ",272,RC,,,OUTPATIENT,,,797.35,637.88,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",637.88,80,,510.30,,,0,"percent of total billed charges ","80% of total billed charges ",558.15,70,,446.52,,,0,"percent of total billed charges ","70% of total billed charges ",717.62,90,,574.10,,,0,"percent of total billed charges ","90% of total billed charges ",741.54,93,,593.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",677.75,85,,542.20,,,0,"percent of total billed charges ","85% of total billed charges ",717.62,90,,574.10,,,0,"percent of total billed charges ","90% of total billed charges ",717.62,90,,574.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",693.69,87,,554.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",558.15,70,,446.52,,,0,"percent of total billed charges ","70% of total billed charges ",558.15,741.54,
"CATH SINUS GUIDE M-110",6105578,"CDM ",272,RC,,,OUTPATIENT,,,797.35,637.88,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",637.88,80,,510.30,,,0,"percent of total billed charges ","80% of total billed charges ",558.15,70,,446.52,,,0,"percent of total billed charges ","70% of total billed charges ",717.62,90,,574.10,,,0,"percent of total billed charges ","90% of total billed charges ",741.54,93,,593.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",677.75,85,,542.20,,,0,"percent of total billed charges ","85% of total billed charges ",717.62,90,,574.10,,,0,"percent of total billed charges ","90% of total billed charges ",717.62,90,,574.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",693.69,87,,554.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",558.15,70,,446.52,,,0,"percent of total billed charges ","70% of total billed charges ",558.15,741.54,
"GRAFTON PUTTY 5CC",6105580,"CDM ",278,RC,,,OUTPATIENT,,,1035.62,828.496,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",828.5,80,,662.80,,,0,"percent of total billed charges ","80% of total billed charges ",724.93,70,,579.94,,,0,"percent of total billed charges ","70% of total billed charges ",932.06,90,,745.65,,,0,"percent of total billed charges ","90% of total billed charges ",963.13,93,,770.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",880.28,85,,704.22,,,0,"percent of total billed charges ","85% of total billed charges ",880.28,85,,704.22,,,0,"percent of total billed charges ","85% of total billed charges ",932.06,90,,745.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",900.99,87,,720.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",724.93,70,,579.94,,,0,"percent of total billed charges ","70% of total billed charges ",724.93,963.13,
"HARMONIC SCALPEL 5MM LOAG SHEA",6105583,"CDM ",272,RC,,,OUTPATIENT,,,735.39,588.312,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",588.31,80,,470.65,,,0,"percent of total billed charges ","80% of total billed charges ",514.77,70,,411.82,,,0,"percent of total billed charges ","70% of total billed charges ",661.85,90,,529.48,,,0,"percent of total billed charges ","90% of total billed charges ",683.91,93,,547.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",625.08,85,,500.06,,,0,"percent of total billed charges ","85% of total billed charges ",661.85,90,,529.48,,,0,"percent of total billed charges ","90% of total billed charges ",661.85,90,,529.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",639.79,87,,511.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",514.77,70,,411.82,,,0,"percent of total billed charges ","70% of total billed charges ",514.77,683.91,
"HANDLE CATH SINUS GUIDE",6105584,"CDM ",272,RC,,,OUTPATIENT,,,213.13,170.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.5,80,,136.40,,,0,"percent of total billed charges ","80% of total billed charges ",149.19,70,,119.35,,,0,"percent of total billed charges ","70% of total billed charges ",191.82,90,,153.46,,,0,"percent of total billed charges ","90% of total billed charges ",198.21,93,,158.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",181.16,85,,144.93,,,0,"percent of total billed charges ","85% of total billed charges ",191.82,90,,153.46,,,0,"percent of total billed charges ","90% of total billed charges ",191.82,90,,153.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",185.42,87,,148.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.19,70,,119.35,,,0,"percent of total billed charges ","70% of total billed charges ",149.19,198.21,
"DEVICE INFLATION SINUS BALLOON",6105585,"CDM ",272,RC,,,OUTPATIENT,,,288.88,231.104,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",231.1,80,,184.88,,,0,"percent of total billed charges ","80% of total billed charges ",202.22,70,,161.78,,,0,"percent of total billed charges ","70% of total billed charges ",259.99,90,,207.99,,,0,"percent of total billed charges ","90% of total billed charges ",268.66,93,,214.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",245.55,85,,196.44,,,0,"percent of total billed charges ","85% of total billed charges ",259.99,90,,207.99,,,0,"percent of total billed charges ","90% of total billed charges ",259.99,90,,207.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",251.33,87,,201.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",202.22,70,,161.78,,,0,"percent of total billed charges ","70% of total billed charges ",202.22,268.66,
"PATTY SURGICAL 1/2"" X 3""",6105587,"CDM ",272,RC,,,OUTPATIENT,,,36.61,29.288,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.29,80,,23.43,,,0,"percent of total billed charges ","80% of total billed charges ",25.63,70,,20.50,,,0,"percent of total billed charges ","70% of total billed charges ",32.95,90,,26.36,,,0,"percent of total billed charges ","90% of total billed charges ",34.05,93,,27.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",31.12,85,,24.90,,,0,"percent of total billed charges ","85% of total billed charges ",32.95,90,,26.36,,,0,"percent of total billed charges ","90% of total billed charges ",32.95,90,,26.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",31.85,87,,25.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.63,70,,20.50,,,0,"percent of total billed charges ","70% of total billed charges ",25.63,34.05,
"PATTY SURGICAL 1"" X 3""",6105588,"CDM ",272,RC,,,OUTPATIENT,,,35.61,28.488,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.49,80,,22.79,,,0,"percent of total billed charges ","80% of total billed charges ",24.93,70,,19.94,,,0,"percent of total billed charges ","70% of total billed charges ",32.05,90,,25.64,,,0,"percent of total billed charges ","90% of total billed charges ",33.12,93,,26.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",30.27,85,,24.22,,,0,"percent of total billed charges ","85% of total billed charges ",32.05,90,,25.64,,,0,"percent of total billed charges ","90% of total billed charges ",32.05,90,,25.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.98,87,,24.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.93,70,,19.94,,,0,"percent of total billed charges ","70% of total billed charges ",24.93,33.12,
"SUTURE STEEL 20GA X 18""",6105594,"CDM ",272,RC,,,OUTPATIENT,,,30.04,24.032,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.03,80,,19.22,,,0,"percent of total billed charges ","80% of total billed charges ",21.03,70,,16.82,,,0,"percent of total billed charges ","70% of total billed charges ",27.04,90,,21.63,,,0,"percent of total billed charges ","90% of total billed charges ",27.94,93,,22.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.53,85,,20.42,,,0,"percent of total billed charges ","85% of total billed charges ",27.04,90,,21.63,,,0,"percent of total billed charges ","90% of total billed charges ",27.04,90,,21.63,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.13,87,,20.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.03,70,,16.82,,,0,"percent of total billed charges ","70% of total billed charges ",21.03,27.94,
"CUTTER LINEAR ENDO BLUE",6105595,"CDM ",272,RC,,,OUTPATIENT,,,359.25,287.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",287.4,80,,229.92,,,0,"percent of total billed charges ","80% of total billed charges ",251.48,70,,201.18,,,0,"percent of total billed charges ","70% of total billed charges ",323.33,90,,258.66,,,0,"percent of total billed charges ","90% of total billed charges ",334.1,93,,267.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",305.36,85,,244.29,,,0,"percent of total billed charges ","85% of total billed charges ",323.33,90,,258.66,,,0,"percent of total billed charges ","90% of total billed charges ",323.33,90,,258.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",312.55,87,,250.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",251.48,70,,201.18,,,0,"percent of total billed charges ","70% of total billed charges ",251.48,334.1,
"CUTTER LINEAR ENDO WHITE",6105596,"CDM ",272,RC,,,OUTPATIENT,,,359.25,287.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",287.4,80,,229.92,,,0,"percent of total billed charges ","80% of total billed charges ",251.48,70,,201.18,,,0,"percent of total billed charges ","70% of total billed charges ",323.33,90,,258.66,,,0,"percent of total billed charges ","90% of total billed charges ",334.1,93,,267.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",305.36,85,,244.29,,,0,"percent of total billed charges ","85% of total billed charges ",323.33,90,,258.66,,,0,"percent of total billed charges ","90% of total billed charges ",323.33,90,,258.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",312.55,87,,250.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",251.48,70,,201.18,,,0,"percent of total billed charges ","70% of total billed charges ",251.48,334.1,
"TISSUE TYMPANOPLASTY 2X3 CM",6105604,"CDM ",272,RC,,,OUTPATIENT,,,754.25,603.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",603.4,80,,482.72,,,0,"percent of total billed charges ","80% of total billed charges ",527.98,70,,422.38,,,0,"percent of total billed charges ","70% of total billed charges ",678.83,90,,543.06,,,0,"percent of total billed charges ","90% of total billed charges ",701.45,93,,561.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",641.11,85,,512.89,,,0,"percent of total billed charges ","85% of total billed charges ",678.83,90,,543.06,,,0,"percent of total billed charges ","90% of total billed charges ",678.83,90,,543.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",656.2,87,,524.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",527.98,70,,422.38,,,0,"percent of total billed charges ","70% of total billed charges ",527.98,701.45,
"TISSUE SEPTAL PERF 2X3 CM",6105606,"CDM ",272,RC,,,OUTPATIENT,,,431,344.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",344.8,80,,275.84,,,0,"percent of total billed charges ","80% of total billed charges ",301.7,70,,241.36,,,0,"percent of total billed charges ","70% of total billed charges ",387.9,90,,310.32,,,0,"percent of total billed charges ","90% of total billed charges ",400.83,93,,320.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",366.35,85,,293.08,,,0,"percent of total billed charges ","85% of total billed charges ",387.9,90,,310.32,,,0,"percent of total billed charges ","90% of total billed charges ",387.9,90,,310.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",374.97,87,,299.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",301.7,70,,241.36,,,0,"percent of total billed charges ","70% of total billed charges ",301.7,400.83,
"BLADE 2.0 X 2.2MM TRAPEZOID",6105609,"CDM ",272,RC,,,OUTPATIENT,,,85.57,68.456,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.46,80,,54.77,,,0,"percent of total billed charges ","80% of total billed charges ",59.9,70,,47.92,,,0,"percent of total billed charges ","70% of total billed charges ",77.01,90,,61.61,,,0,"percent of total billed charges ","90% of total billed charges ",79.58,93,,63.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",72.73,85,,58.18,,,0,"percent of total billed charges ","85% of total billed charges ",77.01,90,,61.61,,,0,"percent of total billed charges ","90% of total billed charges ",77.01,90,,61.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",74.45,87,,59.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.9,70,,47.92,,,0,"percent of total billed charges ","70% of total billed charges ",59.9,79.58,
"DRILL WIRE PASS 1.1 SHORT",6105610,"CDM ",272,RC,,,OUTPATIENT,,,217.5,174,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174,80,,139.20,,,0,"percent of total billed charges ","80% of total billed charges ",152.25,70,,121.80,,,0,"percent of total billed charges ","70% of total billed charges ",195.75,90,,156.60,,,0,"percent of total billed charges ","90% of total billed charges ",202.28,93,,161.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",184.88,85,,147.90,,,0,"percent of total billed charges ","85% of total billed charges ",195.75,90,,156.60,,,0,"percent of total billed charges ","90% of total billed charges ",195.75,90,,156.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",189.23,87,,151.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.25,70,,121.80,,,0,"percent of total billed charges ","70% of total billed charges ",152.25,202.28,
"DRAPE LEGGING",6105611,"CDM ",272,RC,,,OUTPATIENT,,,16.65,13.32,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.32,80,,10.66,,,0,"percent of total billed charges ","80% of total billed charges ",11.66,70,,9.33,,,0,"percent of total billed charges ","70% of total billed charges ",14.99,90,,11.99,,,0,"percent of total billed charges ","90% of total billed charges ",15.48,93,,12.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.15,85,,11.32,,,0,"percent of total billed charges ","85% of total billed charges ",14.99,90,,11.99,,,0,"percent of total billed charges ","90% of total billed charges ",14.99,90,,11.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.49,87,,11.59,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.66,70,,9.33,,,0,"percent of total billed charges ","70% of total billed charges ",11.66,15.48,
"GRAFTON PUTTY  1CC",6105612,"CDM ",272,RC,,,OUTPATIENT,,,310.82,248.656,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",248.66,80,,198.93,,,0,"percent of total billed charges ","80% of total billed charges ",217.57,70,,174.06,,,0,"percent of total billed charges ","70% of total billed charges ",279.74,90,,223.79,,,0,"percent of total billed charges ","90% of total billed charges ",289.06,93,,231.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",264.2,85,,211.36,,,0,"percent of total billed charges ","85% of total billed charges ",279.74,90,,223.79,,,0,"percent of total billed charges ","90% of total billed charges ",279.74,90,,223.79,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",270.41,87,,216.33,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.57,70,,174.06,,,0,"percent of total billed charges ","70% of total billed charges ",217.57,289.06,
"CORD MONOPOLAR DISP 10'",6105614,"CDM ",272,RC,,,OUTPATIENT,,,46.14,36.912,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.91,80,,29.53,,,0,"percent of total billed charges ","80% of total billed charges ",32.3,70,,25.84,,,0,"percent of total billed charges ","70% of total billed charges ",41.53,90,,33.22,,,0,"percent of total billed charges ","90% of total billed charges ",42.91,93,,34.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.22,85,,31.38,,,0,"percent of total billed charges ","85% of total billed charges ",41.53,90,,33.22,,,0,"percent of total billed charges ","90% of total billed charges ",41.53,90,,33.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.14,87,,32.11,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.3,70,,25.84,,,0,"percent of total billed charges ","70% of total billed charges ",32.3,42.91,
"NEEDLE ACCESS PORT 2""",6105629,"CDM ",272,RC,,,OUTPATIENT,,,30.09,24.072,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.07,80,,19.26,,,0,"percent of total billed charges ","80% of total billed charges ",21.06,70,,16.85,,,0,"percent of total billed charges ","70% of total billed charges ",27.08,90,,21.66,,,0,"percent of total billed charges ","90% of total billed charges ",27.98,93,,22.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.58,85,,20.46,,,0,"percent of total billed charges ","85% of total billed charges ",27.08,90,,21.66,,,0,"percent of total billed charges ","90% of total billed charges ",27.08,90,,21.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.18,87,,20.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.06,70,,16.85,,,0,"percent of total billed charges ","70% of total billed charges ",21.06,27.98,
"THERMABASIN DRAPE 44""X66""",6105630,"CDM ",272,RC,,,OUTPATIENT,,,213.13,170.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.5,80,,136.40,,,0,"percent of total billed charges ","80% of total billed charges ",149.19,70,,119.35,,,0,"percent of total billed charges ","70% of total billed charges ",191.82,90,,153.46,,,0,"percent of total billed charges ","90% of total billed charges ",198.21,93,,158.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",181.16,85,,144.93,,,0,"percent of total billed charges ","85% of total billed charges ",191.82,90,,153.46,,,0,"percent of total billed charges ","90% of total billed charges ",191.82,90,,153.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",185.42,87,,148.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.19,70,,119.35,,,0,"percent of total billed charges ","70% of total billed charges ",149.19,198.21,
"SUTURE CHROMIC 4.0 1637G",6105633,"CDM ",272,RC,,,OUTPATIENT,,,27.43,21.944,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.94,80,,17.55,,,0,"percent of total billed charges ","80% of total billed charges ",19.2,70,,15.36,,,0,"percent of total billed charges ","70% of total billed charges ",24.69,90,,19.75,,,0,"percent of total billed charges ","90% of total billed charges ",25.51,93,,20.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.32,85,,18.66,,,0,"percent of total billed charges ","85% of total billed charges ",24.69,90,,19.75,,,0,"percent of total billed charges ","90% of total billed charges ",24.69,90,,19.75,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",23.86,87,,19.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.2,70,,15.36,,,0,"percent of total billed charges ","70% of total billed charges ",19.2,25.51,
"DRAPE STERI 1019",6105646,"CDM ",272,RC,,,OUTPATIENT,,,23.72,18.976,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.98,80,,15.18,,,0,"percent of total billed charges ","80% of total billed charges ",16.6,70,,13.28,,,0,"percent of total billed charges ","70% of total billed charges ",21.35,90,,17.08,,,0,"percent of total billed charges ","90% of total billed charges ",22.06,93,,17.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.16,85,,16.13,,,0,"percent of total billed charges ","85% of total billed charges ",21.35,90,,17.08,,,0,"percent of total billed charges ","90% of total billed charges ",21.35,90,,17.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.64,87,,16.51,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.6,70,,13.28,,,0,"percent of total billed charges ","70% of total billed charges ",16.6,22.06,
"POSITIONER DONUT 9""",6105647,"CDM ",272,RC,,,OUTPATIENT,,,11.94,9.552,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.55,80,,7.64,,,0,"percent of total billed charges ","80% of total billed charges ",8.36,70,,6.69,,,0,"percent of total billed charges ","70% of total billed charges ",10.75,90,,8.60,,,0,"percent of total billed charges ","90% of total billed charges ",11.1,93,,8.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.15,85,,8.12,,,0,"percent of total billed charges ","85% of total billed charges ",10.75,90,,8.60,,,0,"percent of total billed charges ","90% of total billed charges ",10.75,90,,8.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.39,87,,8.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.36,70,,6.69,,,0,"percent of total billed charges ","70% of total billed charges ",8.36,11.1,
"MESH PLUG PERFIX SMALL",6105649,"CDM ",272,RC,,,OUTPATIENT,,,331.22,264.976,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",264.98,80,,211.98,,,0,"percent of total billed charges ","80% of total billed charges ",231.85,70,,185.48,,,0,"percent of total billed charges ","70% of total billed charges ",298.1,90,,238.48,,,0,"percent of total billed charges ","90% of total billed charges ",308.03,93,,246.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",281.54,85,,225.23,,,0,"percent of total billed charges ","85% of total billed charges ",298.1,90,,238.48,,,0,"percent of total billed charges ","90% of total billed charges ",298.1,90,,238.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",288.16,87,,230.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",231.85,70,,185.48,,,0,"percent of total billed charges ","70% of total billed charges ",231.85,308.03,
"SEALANT TISSEEL VH 2ML",6105650,"CDM ",272,RC,,,OUTPATIENT,,,471.95,377.56,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",377.56,80,,302.05,,,0,"percent of total billed charges ","80% of total billed charges ",330.37,70,,264.30,,,0,"percent of total billed charges ","70% of total billed charges ",424.76,90,,339.81,,,0,"percent of total billed charges ","90% of total billed charges ",438.91,93,,351.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",401.16,85,,320.93,,,0,"percent of total billed charges ","85% of total billed charges ",424.76,90,,339.81,,,0,"percent of total billed charges ","90% of total billed charges ",424.76,90,,339.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",410.6,87,,328.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",330.37,70,,264.30,,,0,"percent of total billed charges ","70% of total billed charges ",330.37,438.91,
"SUTURE VICRYL 2.0 J602H",6105651,"CDM ",272,RC,,,OUTPATIENT,,,7.72,6.176,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.18,80,,4.94,,,0,"percent of total billed charges ","80% of total billed charges ",5.4,70,,4.32,,,0,"percent of total billed charges ","70% of total billed charges ",6.95,90,,5.56,,,0,"percent of total billed charges ","90% of total billed charges ",7.18,93,,5.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6.56,85,,5.25,,,0,"percent of total billed charges ","85% of total billed charges ",6.95,90,,5.56,,,0,"percent of total billed charges ","90% of total billed charges ",6.95,90,,5.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.72,87,,5.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.4,70,,4.32,,,0,"percent of total billed charges ","70% of total billed charges ",5.4,7.18,
"CATH SINUS BALLOON ULTIRRA 5MM",6105654,"CDM ",272,RC,,,OUTPATIENT,,,1707.55,1366.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1366.04,80,,1092.83,,,0,"percent of total billed charges ","80% of total billed charges ",1195.29,70,,956.23,,,0,"percent of total billed charges ","70% of total billed charges ",1536.8,90,,1229.44,,,0,"percent of total billed charges ","90% of total billed charges ",1588.02,93,,1270.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1451.42,85,,1161.14,,,0,"percent of total billed charges ","85% of total billed charges ",1536.8,90,,1229.44,,,0,"percent of total billed charges ","90% of total billed charges ",1536.8,90,,1229.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1485.57,87,,1188.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1195.29,70,,956.23,,,0,"percent of total billed charges ","70% of total billed charges ",1195.29,1588.02,
"CATH SINUS BALLOON ULTIRRA 7MM",6105656,"CDM ",272,RC,,,OUTPATIENT,,,1707.55,1366.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1366.04,80,,1092.83,,,0,"percent of total billed charges ","80% of total billed charges ",1195.29,70,,956.23,,,0,"percent of total billed charges ","70% of total billed charges ",1536.8,90,,1229.44,,,0,"percent of total billed charges ","90% of total billed charges ",1588.02,93,,1270.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1451.42,85,,1161.14,,,0,"percent of total billed charges ","85% of total billed charges ",1536.8,90,,1229.44,,,0,"percent of total billed charges ","90% of total billed charges ",1536.8,90,,1229.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1485.57,87,,1188.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1195.29,70,,956.23,,,0,"percent of total billed charges ","70% of total billed charges ",1195.29,1588.02,
"GRAFTON GEL 5CC",6105657,"CDM ",278,RC,,,OUTPATIENT,,,1452,1161.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1161.6,80,,929.28,,,0,"percent of total billed charges ","80% of total billed charges ",1016.4,70,,813.12,,,0,"percent of total billed charges ","70% of total billed charges ",1306.8,90,,1045.44,,,0,"percent of total billed charges ","90% of total billed charges ",1350.36,93,,1080.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1234.2,85,,987.36,,,0,"percent of total billed charges ","85% of total billed charges ",1234.2,85,,987.36,,,0,"percent of total billed charges ","85% of total billed charges ",1306.8,90,,1045.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1263.24,87,,1010.59,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1016.4,70,,813.12,,,0,"percent of total billed charges ","70% of total billed charges ",1016.4,1350.36,
"DRAPE ENDOSCOPY ENDODRAPE",6105661,"CDM ",272,RC,,,OUTPATIENT,,,64.45,51.56,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.56,80,,41.25,,,0,"percent of total billed charges ","80% of total billed charges ",45.12,70,,36.10,,,0,"percent of total billed charges ","70% of total billed charges ",58.01,90,,46.41,,,0,"percent of total billed charges ","90% of total billed charges ",59.94,93,,47.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",54.78,85,,43.82,,,0,"percent of total billed charges ","85% of total billed charges ",58.01,90,,46.41,,,0,"percent of total billed charges ","90% of total billed charges ",58.01,90,,46.41,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",56.07,87,,44.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.12,70,,36.10,,,0,"percent of total billed charges ","70% of total billed charges ",45.12,59.94,
"CUTTER LINEAR 75MM",6105664,"CDM ",272,RC,,,OUTPATIENT,,,191.58,153.264,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.26,80,,122.61,,,0,"percent of total billed charges ","80% of total billed charges ",134.11,70,,107.29,,,0,"percent of total billed charges ","70% of total billed charges ",172.42,90,,137.94,,,0,"percent of total billed charges ","90% of total billed charges ",178.17,93,,142.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",162.84,85,,130.27,,,0,"percent of total billed charges ","85% of total billed charges ",172.42,90,,137.94,,,0,"percent of total billed charges ","90% of total billed charges ",172.42,90,,137.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",166.67,87,,133.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",134.11,70,,107.29,,,0,"percent of total billed charges ","70% of total billed charges ",134.11,178.17,
"GRAFTON FLEX 2.5CM X 10CM",6105666,"CDM ",278,RC,,,OUTPATIENT,,,1517.34,1213.872,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1213.87,80,,971.10,,,0,"percent of total billed charges ","80% of total billed charges ",1062.14,70,,849.71,,,0,"percent of total billed charges ","70% of total billed charges ",1365.61,90,,1092.49,,,0,"percent of total billed charges ","90% of total billed charges ",1411.13,93,,1128.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1289.74,85,,1031.79,,,0,"percent of total billed charges ","85% of total billed charges ",1289.74,85,,1031.79,,,0,"percent of total billed charges ","85% of total billed charges ",1365.61,90,,1092.49,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1320.09,87,,1056.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1062.14,70,,849.71,,,0,"percent of total billed charges ","70% of total billed charges ",1062.14,1411.13,
"RELOAD LINEAR CUTTER 75MM",6105680,"CDM ",272,RC,,,OUTPATIENT,,,250.17,200.136,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",200.14,80,,160.11,,,0,"percent of total billed charges ","80% of total billed charges ",175.12,70,,140.10,,,0,"percent of total billed charges ","70% of total billed charges ",225.15,90,,180.12,,,0,"percent of total billed charges ","90% of total billed charges ",232.66,93,,186.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",212.64,85,,170.11,,,0,"percent of total billed charges ","85% of total billed charges ",225.15,90,,180.12,,,0,"percent of total billed charges ","90% of total billed charges ",225.15,90,,180.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",217.65,87,,174.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",175.12,70,,140.10,,,0,"percent of total billed charges ","70% of total billed charges ",175.12,232.66,
"FIXATOR EXTERNAL",6105684,"CDM ",272,RC,,,OUTPATIENT,,,2627.46,2101.968,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2101.97,80,,1681.58,,,0,"percent of total billed charges ","80% of total billed charges ",1839.22,70,,1471.38,,,0,"percent of total billed charges ","70% of total billed charges ",2364.71,90,,1891.77,,,0,"percent of total billed charges ","90% of total billed charges ",2443.54,93,,1954.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2233.34,85,,1786.67,,,0,"percent of total billed charges ","85% of total billed charges ",2364.71,90,,1891.77,,,0,"percent of total billed charges ","90% of total billed charges ",2364.71,90,,1891.77,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2285.89,87,,1828.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1839.22,70,,1471.38,,,0,"percent of total billed charges ","70% of total billed charges ",1839.22,2443.54,
"CLAMP FIXATOR",6105686,"CDM ",272,RC,,,OUTPATIENT,,,2527.99,2022.392,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2022.39,80,,1617.91,,,0,"percent of total billed charges ","80% of total billed charges ",1769.59,70,,1415.67,,,0,"percent of total billed charges ","70% of total billed charges ",2275.19,90,,1820.15,,,0,"percent of total billed charges ","90% of total billed charges ",2351.03,93,,1880.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2148.79,85,,1719.03,,,0,"percent of total billed charges ","85% of total billed charges ",2275.19,90,,1820.15,,,0,"percent of total billed charges ","90% of total billed charges ",2275.19,90,,1820.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2199.35,87,,1759.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1769.59,70,,1415.67,,,0,"percent of total billed charges ","70% of total billed charges ",1769.59,2351.03,
"CATH BAKER 16FR 15CC ADULT",6105691,"CDM ",272,RC,,,OUTPATIENT,,,854.82,683.856,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",683.86,80,,547.09,,,0,"percent of total billed charges ","80% of total billed charges ",598.37,70,,478.70,,,0,"percent of total billed charges ","70% of total billed charges ",769.34,90,,615.47,,,0,"percent of total billed charges ","90% of total billed charges ",794.98,93,,635.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",726.6,85,,581.28,,,0,"percent of total billed charges ","85% of total billed charges ",769.34,90,,615.47,,,0,"percent of total billed charges ","90% of total billed charges ",769.34,90,,615.47,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",743.69,87,,594.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",598.37,70,,478.70,,,0,"percent of total billed charges ","70% of total billed charges ",598.37,794.98,
"SET DISP JUGGERKNOT SZ 1.5",6105693,"CDM ",272,RC,,,OUTPATIENT,,,550.5,440.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",440.4,80,,352.32,,,0,"percent of total billed charges ","80% of total billed charges ",385.35,70,,308.28,,,0,"percent of total billed charges ","70% of total billed charges ",495.45,90,,396.36,,,0,"percent of total billed charges ","90% of total billed charges ",511.97,93,,409.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",467.93,85,,374.34,,,0,"percent of total billed charges ","85% of total billed charges ",495.45,90,,396.36,,,0,"percent of total billed charges ","90% of total billed charges ",495.45,90,,396.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",478.94,87,,383.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",385.35,70,,308.28,,,0,"percent of total billed charges ","70% of total billed charges ",385.35,511.97,
"SUTURE LARIAT 30 DEGREE UP",6105695,"CDM ",272,RC,,,OUTPATIENT,,,377.13,301.704,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",301.7,80,,241.36,,,0,"percent of total billed charges ","80% of total billed charges ",263.99,70,,211.19,,,0,"percent of total billed charges ","70% of total billed charges ",339.42,90,,271.54,,,0,"percent of total billed charges ","90% of total billed charges ",350.73,93,,280.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",320.56,85,,256.45,,,0,"percent of total billed charges ","85% of total billed charges ",339.42,90,,271.54,,,0,"percent of total billed charges ","90% of total billed charges ",339.42,90,,271.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",328.1,87,,262.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.99,70,,211.19,,,0,"percent of total billed charges ","70% of total billed charges ",263.99,350.73,
"BLADE CURVED RAD 40 4MM",6105696,"CDM ",272,RC,,,OUTPATIENT,,,409.45,327.56,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",327.56,80,,262.05,,,0,"percent of total billed charges ","80% of total billed charges ",286.62,70,,229.30,,,0,"percent of total billed charges ","70% of total billed charges ",368.51,90,,294.81,,,0,"percent of total billed charges ","90% of total billed charges ",380.79,93,,304.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",348.03,85,,278.42,,,0,"percent of total billed charges ","85% of total billed charges ",368.51,90,,294.81,,,0,"percent of total billed charges ","90% of total billed charges ",368.51,90,,294.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",356.22,87,,284.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",286.62,70,,229.30,,,0,"percent of total billed charges ","70% of total billed charges ",286.62,380.79,
"DEVICE MAXFIRE MARXMEN STRGHT",6105697,"CDM ",272,RC,,,OUTPATIENT,,,793.04,634.432,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",634.43,80,,507.54,,,0,"percent of total billed charges ","80% of total billed charges ",555.13,70,,444.10,,,0,"percent of total billed charges ","70% of total billed charges ",713.74,90,,570.99,,,0,"percent of total billed charges ","90% of total billed charges ",737.53,93,,590.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",674.08,85,,539.26,,,0,"percent of total billed charges ","85% of total billed charges ",713.74,90,,570.99,,,0,"percent of total billed charges ","90% of total billed charges ",713.74,90,,570.99,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",689.94,87,,551.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",555.13,70,,444.10,,,0,"percent of total billed charges ","70% of total billed charges ",555.13,737.53,
"DEVICE MAXFIRE MARXMEN CURVED",6105698,"CDM ",272,RC,,,OUTPATIENT,,,674.08,539.264,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",539.26,80,,431.41,,,0,"percent of total billed charges ","80% of total billed charges ",471.86,70,,377.49,,,0,"percent of total billed charges ","70% of total billed charges ",606.67,90,,485.34,,,0,"percent of total billed charges ","90% of total billed charges ",626.89,93,,501.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",572.97,85,,458.38,,,0,"percent of total billed charges ","85% of total billed charges ",606.67,90,,485.34,,,0,"percent of total billed charges ","90% of total billed charges ",606.67,90,,485.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",586.45,87,,469.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",471.86,70,,377.49,,,0,"percent of total billed charges ","70% of total billed charges ",471.86,626.89,
"SUTURE PDSII  5.0 Z303H",6105702,"CDM ",272,RC,,,OUTPATIENT,,,11.08,8.864,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.86,80,,7.09,,,0,"percent of total billed charges ","80% of total billed charges ",7.76,70,,6.21,,,0,"percent of total billed charges ","70% of total billed charges ",9.97,90,,7.98,,,0,"percent of total billed charges ","90% of total billed charges ",10.3,93,,8.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.42,85,,7.54,,,0,"percent of total billed charges ","85% of total billed charges ",9.97,90,,7.98,,,0,"percent of total billed charges ","90% of total billed charges ",9.97,90,,7.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.64,87,,7.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.76,70,,6.21,,,0,"percent of total billed charges ","70% of total billed charges ",7.76,10.3,
"SUTURE ETHIBOND JH 0X524H",6105703,"CDM ",272,RC,,,OUTPATIENT,,,16,12.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.8,80,,10.24,,,0,"percent of total billed charges ","80% of total billed charges ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.88,93,,11.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.6,85,,10.88,,,0,"percent of total billed charges ","85% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.92,87,,11.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,14.88,
"BLADE SICKLE EDGE STRAIGHT",6105704,"CDM ",272,RC,,,OUTPATIENT,,,51.47,41.176,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.18,80,,32.94,,,0,"percent of total billed charges ","80% of total billed charges ",36.03,70,,28.82,,,0,"percent of total billed charges ","70% of total billed charges ",46.32,90,,37.06,,,0,"percent of total billed charges ","90% of total billed charges ",47.87,93,,38.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.75,85,,35.00,,,0,"percent of total billed charges ","85% of total billed charges ",46.32,90,,37.06,,,0,"percent of total billed charges ","90% of total billed charges ",46.32,90,,37.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.78,87,,35.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.03,70,,28.82,,,0,"percent of total billed charges ","70% of total billed charges ",36.03,47.87,
"BLADE TYMPANOPLASTY 50 DEGREE",6105707,"CDM ",272,RC,,,OUTPATIENT,,,60.63,48.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.5,80,,38.80,,,0,"percent of total billed charges ","80% of total billed charges ",42.44,70,,33.95,,,0,"percent of total billed charges ","70% of total billed charges ",54.57,90,,43.66,,,0,"percent of total billed charges ","90% of total billed charges ",56.39,93,,45.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51.54,85,,41.23,,,0,"percent of total billed charges ","85% of total billed charges ",54.57,90,,43.66,,,0,"percent of total billed charges ","90% of total billed charges ",54.57,90,,43.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",52.75,87,,42.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.44,70,,33.95,,,0,"percent of total billed charges ","70% of total billed charges ",42.44,56.39,
"BLADE TYMPANOPLASTY 60 DEGREE",6105708,"CDM ",272,RC,,,OUTPATIENT,,,60.63,48.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.5,80,,38.80,,,0,"percent of total billed charges ","80% of total billed charges ",42.44,70,,33.95,,,0,"percent of total billed charges ","70% of total billed charges ",54.57,90,,43.66,,,0,"percent of total billed charges ","90% of total billed charges ",56.39,93,,45.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51.54,85,,41.23,,,0,"percent of total billed charges ","85% of total billed charges ",54.57,90,,43.66,,,0,"percent of total billed charges ","90% of total billed charges ",54.57,90,,43.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",52.75,87,,42.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.44,70,,33.95,,,0,"percent of total billed charges ","70% of total billed charges ",42.44,56.39,
"BURR 2.0MM MICRO-AIRE",6105710,"CDM ",272,RC,,,OUTPATIENT,,,73.96,59.168,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.17,80,,47.34,,,0,"percent of total billed charges ","80% of total billed charges ",51.77,70,,41.42,,,0,"percent of total billed charges ","70% of total billed charges ",66.56,90,,53.25,,,0,"percent of total billed charges ","90% of total billed charges ",68.78,93,,55.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.87,85,,50.30,,,0,"percent of total billed charges ","85% of total billed charges ",66.56,90,,53.25,,,0,"percent of total billed charges ","90% of total billed charges ",66.56,90,,53.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",64.35,87,,51.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.77,70,,41.42,,,0,"percent of total billed charges ","70% of total billed charges ",51.77,68.78,
"SNARE OVAL ROTATABLE 2.5X5.4",6105754,"CDM ",272,RC,,,OUTPATIENT,,,154.6,123.68,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.68,80,,98.94,,,0,"percent of total billed charges ","80% of total billed charges ",108.22,70,,86.58,,,0,"percent of total billed charges ","70% of total billed charges ",139.14,90,,111.31,,,0,"percent of total billed charges ","90% of total billed charges ",143.78,93,,115.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",131.41,85,,105.13,,,0,"percent of total billed charges ","85% of total billed charges ",139.14,90,,111.31,,,0,"percent of total billed charges ","90% of total billed charges ",139.14,90,,111.31,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",134.5,87,,107.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.22,70,,86.58,,,0,"percent of total billed charges ","70% of total billed charges ",108.22,143.78,
"BASKET STONE ROTATABLE",6105755,"CDM ",272,RC,,,OUTPATIENT,,,247.83,198.264,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",198.26,80,,158.61,,,0,"percent of total billed charges ","80% of total billed charges ",173.48,70,,138.78,,,0,"percent of total billed charges ","70% of total billed charges ",223.05,90,,178.44,,,0,"percent of total billed charges ","90% of total billed charges ",230.48,93,,184.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",210.66,85,,168.53,,,0,"percent of total billed charges ","85% of total billed charges ",223.05,90,,178.44,,,0,"percent of total billed charges ","90% of total billed charges ",223.05,90,,178.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",215.61,87,,172.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.48,70,,138.78,,,0,"percent of total billed charges ","70% of total billed charges ",173.48,230.48,
"GRASPER DISP RAT TOOTH",6105757,"CDM ",272,RC,,,OUTPATIENT,,,280.15,224.12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",224.12,80,,179.30,,,0,"percent of total billed charges ","80% of total billed charges ",196.11,70,,156.89,,,0,"percent of total billed charges ","70% of total billed charges ",252.14,90,,201.71,,,0,"percent of total billed charges ","90% of total billed charges ",260.54,93,,208.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",238.13,85,,190.50,,,0,"percent of total billed charges ","85% of total billed charges ",252.14,90,,201.71,,,0,"percent of total billed charges ","90% of total billed charges ",252.14,90,,201.71,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",243.73,87,,194.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",196.11,70,,156.89,,,0,"percent of total billed charges ","70% of total billed charges ",196.11,260.54,
"TUBE GASTROSTOMY MIC 14FR",6105758,"CDM ",272,RC,,,OUTPATIENT,,,201.58,161.264,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",161.26,80,,129.01,,,0,"percent of total billed charges ","80% of total billed charges ",141.11,70,,112.89,,,0,"percent of total billed charges ","70% of total billed charges ",181.42,90,,145.14,,,0,"percent of total billed charges ","90% of total billed charges ",187.47,93,,149.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",171.34,85,,137.07,,,0,"percent of total billed charges ","85% of total billed charges ",181.42,90,,145.14,,,0,"percent of total billed charges ","90% of total billed charges ",181.42,90,,145.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",175.37,87,,140.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.11,70,,112.89,,,0,"percent of total billed charges ","70% of total billed charges ",141.11,187.47,
"CATH IV CATHLON 20GA",6105760,"CDM ",272,RC,,,OUTPATIENT,,,14.09,11.272,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.27,80,,9.02,,,0,"percent of total billed charges ","80% of total billed charges ",9.86,70,,7.89,,,0,"percent of total billed charges ","70% of total billed charges ",12.68,90,,10.14,,,0,"percent of total billed charges ","90% of total billed charges ",13.1,93,,10.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.98,85,,9.58,,,0,"percent of total billed charges ","85% of total billed charges ",12.68,90,,10.14,,,0,"percent of total billed charges ","90% of total billed charges ",12.68,90,,10.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.26,87,,9.81,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.86,70,,7.89,,,0,"percent of total billed charges ","70% of total billed charges ",9.86,13.1,
"PIN STEINMAN 3/16 X 9",6105761,"CDM ",278,RC,,,OUTPATIENT,,,37.01,29.608,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.61,80,,23.69,,,0,"percent of total billed charges ","80% of total billed charges ",25.91,70,,20.73,,,0,"percent of total billed charges ","70% of total billed charges ",33.31,90,,26.65,,,0,"percent of total billed charges ","90% of total billed charges ",34.42,93,,27.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",31.46,85,,25.17,,,0,"percent of total billed charges ","85% of total billed charges ",31.46,85,,25.17,,,0,"percent of total billed charges ","85% of total billed charges ",33.31,90,,26.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",32.2,87,,25.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.91,70,,20.73,,,0,"percent of total billed charges ","70% of total billed charges ",25.91,34.42,
"TUBE VENT T 5MM X 4MM",6105772,"CDM ",272,RC,,,OUTPATIENT,,,81.48,65.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.18,80,,52.14,,,0,"percent of total billed charges ","80% of total billed charges ",57.04,70,,45.63,,,0,"percent of total billed charges ","70% of total billed charges ",73.33,90,,58.66,,,0,"percent of total billed charges ","90% of total billed charges ",75.78,93,,60.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",69.26,85,,55.41,,,0,"percent of total billed charges ","85% of total billed charges ",73.33,90,,58.66,,,0,"percent of total billed charges ","90% of total billed charges ",73.33,90,,58.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",70.89,87,,56.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.04,70,,45.63,,,0,"percent of total billed charges ","70% of total billed charges ",57.04,75.78,
"TUBE VENT T 5MM X 8MM",6105773,"CDM ",272,RC,,,OUTPATIENT,,,81.48,65.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.18,80,,52.14,,,0,"percent of total billed charges ","80% of total billed charges ",57.04,70,,45.63,,,0,"percent of total billed charges ","70% of total billed charges ",73.33,90,,58.66,,,0,"percent of total billed charges ","90% of total billed charges ",75.78,93,,60.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",69.26,85,,55.41,,,0,"percent of total billed charges ","85% of total billed charges ",73.33,90,,58.66,,,0,"percent of total billed charges ","90% of total billed charges ",73.33,90,,58.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",70.89,87,,56.71,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.04,70,,45.63,,,0,"percent of total billed charges ","70% of total billed charges ",57.04,75.78,
"FIXATOR RING LOC",6105786,"CDM ",272,RC,,,OUTPATIENT,,,2661.39,2129.112,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2129.11,80,,1703.29,,,0,"percent of total billed charges ","80% of total billed charges ",1862.97,70,,1490.38,,,0,"percent of total billed charges ","70% of total billed charges ",2395.25,90,,1916.20,,,0,"percent of total billed charges ","90% of total billed charges ",2475.09,93,,1980.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2262.18,85,,1809.74,,,0,"percent of total billed charges ","85% of total billed charges ",2395.25,90,,1916.20,,,0,"percent of total billed charges ","90% of total billed charges ",2395.25,90,,1916.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2315.41,87,,1852.33,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1862.97,70,,1490.38,,,0,"percent of total billed charges ","70% of total billed charges ",1862.97,2475.09,
"BAG RETREVAL ENDO CATCH III",6105790,"CDM ",272,RC,,,OUTPATIENT,,,364.2,291.36,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",291.36,80,,233.09,,,0,"percent of total billed charges ","80% of total billed charges ",254.94,70,,203.95,,,0,"percent of total billed charges ","70% of total billed charges ",327.78,90,,262.22,,,0,"percent of total billed charges ","90% of total billed charges ",338.71,93,,270.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",309.57,85,,247.66,,,0,"percent of total billed charges ","85% of total billed charges ",327.78,90,,262.22,,,0,"percent of total billed charges ","90% of total billed charges ",327.78,90,,262.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",316.85,87,,253.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",254.94,70,,203.95,,,0,"percent of total billed charges ","70% of total billed charges ",254.94,338.71,
"SUTURE PROLENE 4.0 8935",6105799,"CDM ",272,RC,,,OUTPATIENT,,,29.99,23.992,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.99,80,,19.19,,,0,"percent of total billed charges ","80% of total billed charges ",20.99,70,,16.79,,,0,"percent of total billed charges ","70% of total billed charges ",26.99,90,,21.59,,,0,"percent of total billed charges ","90% of total billed charges ",27.89,93,,22.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.49,85,,20.39,,,0,"percent of total billed charges ","85% of total billed charges ",26.99,90,,21.59,,,0,"percent of total billed charges ","90% of total billed charges ",26.99,90,,21.59,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.09,87,,20.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.99,70,,16.79,,,0,"percent of total billed charges ","70% of total billed charges ",20.99,27.89,
"SUTURE O CHROMIC 47T",6105827,"CDM ",272,RC,,,OUTPATIENT,,,32,25.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.6,80,,20.48,,,0,"percent of total billed charges ","80% of total billed charges ",22.4,70,,17.92,,,0,"percent of total billed charges ","70% of total billed charges ",28.8,90,,23.04,,,0,"percent of total billed charges ","90% of total billed charges ",29.76,93,,23.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",27.2,85,,21.76,,,0,"percent of total billed charges ","85% of total billed charges ",28.8,90,,23.04,,,0,"percent of total billed charges ","90% of total billed charges ",28.8,90,,23.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",27.84,87,,22.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.4,70,,17.92,,,0,"percent of total billed charges ","70% of total billed charges ",22.4,29.76,
"CATHETER S-L 6.6FR",6105828,"CDM ",272,RC,,,OUTPATIENT,,,320.51,256.408,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",256.41,80,,205.13,,,0,"percent of total billed charges ","80% of total billed charges ",224.36,70,,179.49,,,0,"percent of total billed charges ","70% of total billed charges ",288.46,90,,230.77,,,0,"percent of total billed charges ","90% of total billed charges ",298.07,93,,238.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",272.43,85,,217.94,,,0,"percent of total billed charges ","85% of total billed charges ",288.46,90,,230.77,,,0,"percent of total billed charges ","90% of total billed charges ",288.46,90,,230.77,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",278.84,87,,223.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",224.36,70,,179.49,,,0,"percent of total billed charges ","70% of total billed charges ",224.36,298.07,
"SUTURETAPE 2-0 MENISCUS REPR",6105829,"CDM ",270,RC,,,OUTPATIENT,,,260.22,208.176,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",208.18,80,,166.54,,,0,"percent of total billed charges ","80% of total billed charges ",182.15,70,,145.72,,,0,"percent of total billed charges ","70% of total billed charges ",234.2,90,,187.36,,,0,"percent of total billed charges ","90% of total billed charges ",242,93,,193.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",221.19,85,,176.95,,,0,"percent of total billed charges ","85% of total billed charges ",234.2,90,,187.36,,,0,"percent of total billed charges ","90% of total billed charges ",234.2,90,,187.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",226.39,87,,181.11,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",182.15,70,,145.72,,,0,"percent of total billed charges ","70% of total billed charges ",182.15,242,
"SCALPEL CURVED HARMONIC",6105839,"CDM ",272,RC,,,OUTPATIENT,,,355.58,284.464,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",284.46,80,,227.57,,,0,"percent of total billed charges ","80% of total billed charges ",248.91,70,,199.13,,,0,"percent of total billed charges ","70% of total billed charges ",320.02,90,,256.02,,,0,"percent of total billed charges ","90% of total billed charges ",330.69,93,,264.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",302.24,85,,241.79,,,0,"percent of total billed charges ","85% of total billed charges ",320.02,90,,256.02,,,0,"percent of total billed charges ","90% of total billed charges ",320.02,90,,256.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",309.35,87,,247.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",248.91,70,,199.13,,,0,"percent of total billed charges ","70% of total billed charges ",248.91,330.69,
"STRAP ANKLE DISTRACTOR",6105843,"CDM ",270,RC,,,OUTPATIENT,,,200.02,160.016,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",160.02,80,,128.02,,,0,"percent of total billed charges ","80% of total billed charges ",140.01,70,,112.01,,,0,"percent of total billed charges ","70% of total billed charges ",180.02,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",186.02,93,,148.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",170.02,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",180.02,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",180.02,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",174.02,87,,139.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.01,70,,112.01,,,0,"percent of total billed charges ","70% of total billed charges ",140.01,186.02,
"STAPLER CURVED CIRCULAT",6105845,"CDM ",272,RC,,,OUTPATIENT,,,746,596.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",596.8,80,,477.44,,,0,"percent of total billed charges ","80% of total billed charges ",522.2,70,,417.76,,,0,"percent of total billed charges ","70% of total billed charges ",671.4,90,,537.12,,,0,"percent of total billed charges ","90% of total billed charges ",693.78,93,,555.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",634.1,85,,507.28,,,0,"percent of total billed charges ","85% of total billed charges ",671.4,90,,537.12,,,0,"percent of total billed charges ","90% of total billed charges ",671.4,90,,537.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",649.02,87,,519.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",522.2,70,,417.76,,,0,"percent of total billed charges ","70% of total billed charges ",522.2,693.78,
"CLAMP MODIFIED 10MM ALLIS",6105846,"CDM ",272,RC,,,OUTPATIENT,,,365.06,292.048,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",292.05,80,,233.64,,,0,"percent of total billed charges ","80% of total billed charges ",255.54,70,,204.43,,,0,"percent of total billed charges ","70% of total billed charges ",328.55,90,,262.84,,,0,"percent of total billed charges ","90% of total billed charges ",339.51,93,,271.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",310.3,85,,248.24,,,0,"percent of total billed charges ","85% of total billed charges ",328.55,90,,262.84,,,0,"percent of total billed charges ","90% of total billed charges ",328.55,90,,262.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",317.6,87,,254.08,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",255.54,70,,204.43,,,0,"percent of total billed charges ","70% of total billed charges ",255.54,339.51,
"BLADE 2.0MM CUDA",6105879,"CDM ",272,RC,,,OUTPATIENT,,,209.25,167.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.4,80,,133.92,,,0,"percent of total billed charges ","80% of total billed charges ",146.48,70,,117.18,,,0,"percent of total billed charges ","70% of total billed charges ",188.33,90,,150.66,,,0,"percent of total billed charges ","90% of total billed charges ",194.6,93,,155.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",177.86,85,,142.29,,,0,"percent of total billed charges ","85% of total billed charges ",188.33,90,,150.66,,,0,"percent of total billed charges ","90% of total billed charges ",188.33,90,,150.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",182.05,87,,145.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",146.48,70,,117.18,,,0,"percent of total billed charges ","70% of total billed charges ",146.48,194.6,
"DISSECTOR 3.0MM X 7CM",6105880,"CDM ",272,RC,,,OUTPATIENT,,,208.92,167.136,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.14,80,,133.71,,,0,"percent of total billed charges ","80% of total billed charges ",146.24,70,,116.99,,,0,"percent of total billed charges ","70% of total billed charges ",188.03,90,,150.42,,,0,"percent of total billed charges ","90% of total billed charges ",194.3,93,,155.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",177.58,85,,142.06,,,0,"percent of total billed charges ","85% of total billed charges ",188.03,90,,150.42,,,0,"percent of total billed charges ","90% of total billed charges ",188.03,90,,150.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",181.76,87,,145.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",146.24,70,,116.99,,,0,"percent of total billed charges ","70% of total billed charges ",146.24,194.3,
"SOLN WOUND LAVAGE BACTISURE",6105882,"CDM ",270,RC,,,OUTPATIENT,,,1542.75,1234.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1234.2,80,,987.36,,,0,"percent of total billed charges ","80% of total billed charges ",1079.93,70,,863.94,,,0,"percent of total billed charges ","70% of total billed charges ",1388.48,90,,1110.78,,,0,"percent of total billed charges ","90% of total billed charges ",1434.76,93,,1147.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1311.34,85,,1049.07,,,0,"percent of total billed charges ","85% of total billed charges ",1388.48,90,,1110.78,,,0,"percent of total billed charges ","90% of total billed charges ",1388.48,90,,1110.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1342.19,87,,1073.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1079.93,70,,863.94,,,0,"percent of total billed charges ","70% of total billed charges ",1079.93,1434.76,
"BARRIER SKIN STICK NON-STING",6105909,"CDM ",272,RC,,,OUTPATIENT,,,11,8.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.8,80,,7.04,,,0,"percent of total billed charges ","80% of total billed charges ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",10.23,93,,8.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.35,85,,7.48,,,0,"percent of total billed charges ","85% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.57,87,,7.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.7,10.23,
"ELECTRODE ENDO CONE",6105958,"CDM ",272,RC,,,OUTPATIENT,,,101.5,81.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.2,80,,64.96,,,0,"percent of total billed charges ","80% of total billed charges ",71.05,70,,56.84,,,0,"percent of total billed charges ","70% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",94.4,93,,75.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",86.28,85,,69.02,,,0,"percent of total billed charges ","85% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",91.35,90,,73.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",88.31,87,,70.65,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.05,70,,56.84,,,0,"percent of total billed charges ","70% of total billed charges ",71.05,94.4,
"DISSECTOR BALLOON",6105961,"CDM ",272,RC,,,OUTPATIENT,,,1062.03,849.624,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",849.62,80,,679.70,,,0,"percent of total billed charges ","80% of total billed charges ",743.42,70,,594.74,,,0,"percent of total billed charges ","70% of total billed charges ",955.83,90,,764.66,,,0,"percent of total billed charges ","90% of total billed charges ",987.69,93,,790.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",902.73,85,,722.18,,,0,"percent of total billed charges ","85% of total billed charges ",955.83,90,,764.66,,,0,"percent of total billed charges ","90% of total billed charges ",955.83,90,,764.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",923.97,87,,739.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",743.42,70,,594.74,,,0,"percent of total billed charges ","70% of total billed charges ",743.42,987.69,
"SUTR VICRYL ENDOLOOP 18"" EJ10G",6105966,"CDM ",270,RC,,,OUTPATIENT,,,120.33,96.264,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.26,80,,77.01,,,0,"percent of total billed charges ","80% of total billed charges ",84.23,70,,67.38,,,0,"percent of total billed charges ","70% of total billed charges ",108.3,90,,86.64,,,0,"percent of total billed charges ","90% of total billed charges ",111.91,93,,89.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",102.28,85,,81.82,,,0,"percent of total billed charges ","85% of total billed charges ",108.3,90,,86.64,,,0,"percent of total billed charges ","90% of total billed charges ",108.3,90,,86.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",104.69,87,,83.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.23,70,,67.38,,,0,"percent of total billed charges ","70% of total billed charges ",84.23,111.91,
"FIXATOR SR INNER BODY",6105982,"CDM ",272,RC,,,OUTPATIENT,,,475.18,380.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",380.14,80,,304.11,,,0,"percent of total billed charges ","80% of total billed charges ",332.63,70,,266.10,,,0,"percent of total billed charges ","70% of total billed charges ",427.66,90,,342.13,,,0,"percent of total billed charges ","90% of total billed charges ",441.92,93,,353.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",403.9,85,,323.12,,,0,"percent of total billed charges ","85% of total billed charges ",427.66,90,,342.13,,,0,"percent of total billed charges ","90% of total billed charges ",427.66,90,,342.13,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",413.41,87,,330.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",332.63,70,,266.10,,,0,"percent of total billed charges ","70% of total billed charges ",332.63,441.92,
"FIXATOR SM END CAP",6105984,"CDM ",272,RC,,,OUTPATIENT,,,475.18,380.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",380.14,80,,304.11,,,0,"percent of total billed charges ","80% of total billed charges ",332.63,70,,266.10,,,0,"percent of total billed charges ","70% of total billed charges ",427.66,90,,342.13,,,0,"percent of total billed charges ","90% of total billed charges ",441.92,93,,353.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",403.9,85,,323.12,,,0,"percent of total billed charges ","85% of total billed charges ",427.66,90,,342.13,,,0,"percent of total billed charges ","90% of total billed charges ",427.66,90,,342.13,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",413.41,87,,330.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",332.63,70,,266.10,,,0,"percent of total billed charges ","70% of total billed charges ",332.63,441.92,
"FIXATOR SM DYNAMIZATION COMP",6105986,"CDM ",272,RC,,,OUTPATIENT,,,595.87,476.696,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",476.7,80,,381.36,,,0,"percent of total billed charges ","80% of total billed charges ",417.11,70,,333.69,,,0,"percent of total billed charges ","70% of total billed charges ",536.28,90,,429.02,,,0,"percent of total billed charges ","90% of total billed charges ",554.16,93,,443.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",506.49,85,,405.19,,,0,"percent of total billed charges ","85% of total billed charges ",536.28,90,,429.02,,,0,"percent of total billed charges ","90% of total billed charges ",536.28,90,,429.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",518.41,87,,414.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",417.11,70,,333.69,,,0,"percent of total billed charges ","70% of total billed charges ",417.11,554.16,
"FIXATOR STANDARD END CAP",6105988,"CDM ",272,RC,,,OUTPATIENT,,,588.32,470.656,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",470.66,80,,376.53,,,0,"percent of total billed charges ","80% of total billed charges ",411.82,70,,329.46,,,0,"percent of total billed charges ","70% of total billed charges ",529.49,90,,423.59,,,0,"percent of total billed charges ","90% of total billed charges ",547.14,93,,437.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",500.07,85,,400.06,,,0,"percent of total billed charges ","85% of total billed charges ",529.49,90,,423.59,,,0,"percent of total billed charges ","90% of total billed charges ",529.49,90,,423.59,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",511.84,87,,409.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",411.82,70,,329.46,,,0,"percent of total billed charges ","70% of total billed charges ",411.82,547.14,
"BRNG TIBIA PS 20X63/67MM",6105990,"CDM ",278,RC,,,OUTPATIENT,,,1633.5,1306.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1306.8,80,,1045.44,,,0,"percent of total billed charges ","80% of total billed charges ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",1519.16,93,,1215.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1388.48,85,,1110.78,,,0,"percent of total billed charges ","85% of total billed charges ",1470.15,90,,1176.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1421.15,87,,1136.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1143.45,70,,914.76,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,1519.16,
"FIXATOR STD-R DUAL LOCK COMP",6105993,"CDM ",272,RC,,,OUTPATIENT,,,316.79,253.432,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",253.43,80,,202.74,,,0,"percent of total billed charges ","80% of total billed charges ",221.75,70,,177.40,,,0,"percent of total billed charges ","70% of total billed charges ",285.11,90,,228.09,,,0,"percent of total billed charges ","90% of total billed charges ",294.61,93,,235.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",269.27,85,,215.42,,,0,"percent of total billed charges ","85% of total billed charges ",285.11,90,,228.09,,,0,"percent of total billed charges ","90% of total billed charges ",285.11,90,,228.09,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",275.61,87,,220.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",221.75,70,,177.40,,,0,"percent of total billed charges ","70% of total billed charges ",221.75,294.61,
"KNOT PUSHER / SUTURE CUTTER",6106015,"CDM ",270,RC,,,OUTPATIENT,,,341.35,273.08,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.08,80,,218.46,,,0,"percent of total billed charges ","80% of total billed charges ",238.95,70,,191.16,,,0,"percent of total billed charges ","70% of total billed charges ",307.22,90,,245.78,,,0,"percent of total billed charges ","90% of total billed charges ",317.46,93,,253.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",290.15,85,,232.12,,,0,"percent of total billed charges ","85% of total billed charges ",307.22,90,,245.78,,,0,"percent of total billed charges ","90% of total billed charges ",307.22,90,,245.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",296.97,87,,237.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",238.95,70,,191.16,,,0,"percent of total billed charges ","70% of total billed charges ",238.95,317.46,
"KNIFE COLD 24FR",6106026,"CDM ",272,RC,,,OUTPATIENT,,,242.44,193.952,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",193.95,80,,155.16,,,0,"percent of total billed charges ","80% of total billed charges ",169.71,70,,135.77,,,0,"percent of total billed charges ","70% of total billed charges ",218.2,90,,174.56,,,0,"percent of total billed charges ","90% of total billed charges ",225.47,93,,180.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",206.07,85,,164.86,,,0,"percent of total billed charges ","85% of total billed charges ",218.2,90,,174.56,,,0,"percent of total billed charges ","90% of total billed charges ",218.2,90,,174.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",210.92,87,,168.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",169.71,70,,135.77,,,0,"percent of total billed charges ","70% of total billed charges ",169.71,225.47,
"KNIFE COLD 26FR",6106027,"CDM ",272,RC,,,OUTPATIENT,,,258.23,206.584,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",206.58,80,,165.26,,,0,"percent of total billed charges ","80% of total billed charges ",180.76,70,,144.61,,,0,"percent of total billed charges ","70% of total billed charges ",232.41,90,,185.93,,,0,"percent of total billed charges ","90% of total billed charges ",240.15,93,,192.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",219.5,85,,175.60,,,0,"percent of total billed charges ","85% of total billed charges ",232.41,90,,185.93,,,0,"percent of total billed charges ","90% of total billed charges ",232.41,90,,185.93,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",224.66,87,,179.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.76,70,,144.61,,,0,"percent of total billed charges ","70% of total billed charges ",180.76,240.15,
"RETRIEVER SUTURE BLITZ 45 DEG",6106028,"CDM ",272,RC,,,OUTPATIENT,,,348.75,279,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",279,80,,223.20,,,0,"percent of total billed charges ","80% of total billed charges ",244.13,70,,195.30,,,0,"percent of total billed charges ","70% of total billed charges ",313.88,90,,251.10,,,0,"percent of total billed charges ","90% of total billed charges ",324.34,93,,259.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",296.44,85,,237.15,,,0,"percent of total billed charges ","85% of total billed charges ",313.88,90,,251.10,,,0,"percent of total billed charges ","90% of total billed charges ",313.88,90,,251.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",303.41,87,,242.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",244.13,70,,195.30,,,0,"percent of total billed charges ","70% of total billed charges ",244.13,324.34,
"PAPILLOTOME SOEHENDRA",6106054,"CDM ",272,RC,,,OUTPATIENT,,,282.2,225.76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",225.76,80,,180.61,,,0,"percent of total billed charges ","80% of total billed charges ",197.54,70,,158.03,,,0,"percent of total billed charges ","70% of total billed charges ",253.98,90,,203.18,,,0,"percent of total billed charges ","90% of total billed charges ",262.45,93,,209.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",239.87,85,,191.90,,,0,"percent of total billed charges ","85% of total billed charges ",253.98,90,,203.18,,,0,"percent of total billed charges ","90% of total billed charges ",253.98,90,,203.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",245.51,87,,196.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",197.54,70,,158.03,,,0,"percent of total billed charges ","70% of total billed charges ",197.54,262.45,
"TACKER LAPRO",6106055,"CDM ",272,RC,,,OUTPATIENT,,,754.25,603.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",603.4,80,,482.72,,,0,"percent of total billed charges ","80% of total billed charges ",527.98,70,,422.38,,,0,"percent of total billed charges ","70% of total billed charges ",678.83,90,,543.06,,,0,"percent of total billed charges ","90% of total billed charges ",701.45,93,,561.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",641.11,85,,512.89,,,0,"percent of total billed charges ","85% of total billed charges ",678.83,90,,543.06,,,0,"percent of total billed charges ","90% of total billed charges ",678.83,90,,543.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",656.2,87,,524.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",527.98,70,,422.38,,,0,"percent of total billed charges ","70% of total billed charges ",527.98,701.45,
"DRESSING DUO DERM 1.25X1.5",6106058,"CDM ",272,RC,,,OUTPATIENT,,,5.5,4.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.4,80,,3.52,,,0,"percent of total billed charges ","80% of total billed charges ",3.85,70,,3.08,,,0,"percent of total billed charges ","70% of total billed charges ",4.95,90,,3.96,,,0,"percent of total billed charges ","90% of total billed charges ",5.12,93,,4.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4.68,85,,3.74,,,0,"percent of total billed charges ","85% of total billed charges ",4.95,90,,3.96,,,0,"percent of total billed charges ","90% of total billed charges ",4.95,90,,3.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4.79,87,,3.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.85,70,,3.08,,,0,"percent of total billed charges ","70% of total billed charges ",3.85,5.12,
"DRIVER MENISCAL STAPLE",6106063,"CDM ",272,RC,,,OUTPATIENT,,,286.75,229.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",229.4,80,,183.52,,,0,"percent of total billed charges ","80% of total billed charges ",200.73,70,,160.58,,,0,"percent of total billed charges ","70% of total billed charges ",258.08,90,,206.46,,,0,"percent of total billed charges ","90% of total billed charges ",266.68,93,,213.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",243.74,85,,194.99,,,0,"percent of total billed charges ","85% of total billed charges ",258.08,90,,206.46,,,0,"percent of total billed charges ","90% of total billed charges ",258.08,90,,206.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",249.47,87,,199.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",200.73,70,,160.58,,,0,"percent of total billed charges ","70% of total billed charges ",200.73,266.68,
"STAPLE MENISCAL 13MM",6106064,"CDM ",272,RC,,,OUTPATIENT,,,301.7,241.36,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.36,80,,193.09,,,0,"percent of total billed charges ","80% of total billed charges ",211.19,70,,168.95,,,0,"percent of total billed charges ","70% of total billed charges ",271.53,90,,217.22,,,0,"percent of total billed charges ","90% of total billed charges ",280.58,93,,224.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",256.45,85,,205.16,,,0,"percent of total billed charges ","85% of total billed charges ",271.53,90,,217.22,,,0,"percent of total billed charges ","90% of total billed charges ",271.53,90,,217.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",262.48,87,,209.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",211.19,70,,168.95,,,0,"percent of total billed charges ","70% of total billed charges ",211.19,280.58,
"STAPLE MENISCAL 11MM",6106065,"CDM ",272,RC,,,OUTPATIENT,,,311.03,248.824,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",248.82,80,,199.06,,,0,"percent of total billed charges ","80% of total billed charges ",217.72,70,,174.18,,,0,"percent of total billed charges ","70% of total billed charges ",279.93,90,,223.94,,,0,"percent of total billed charges ","90% of total billed charges ",289.26,93,,231.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",264.38,85,,211.50,,,0,"percent of total billed charges ","85% of total billed charges ",279.93,90,,223.94,,,0,"percent of total billed charges ","90% of total billed charges ",279.93,90,,223.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",270.6,87,,216.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.72,70,,174.18,,,0,"percent of total billed charges ","70% of total billed charges ",217.72,289.26,
"ENDO POUCH-PRO",6106073,"CDM ",272,RC,,,OUTPATIENT,,,200.03,160.024,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",160.02,80,,128.02,,,0,"percent of total billed charges ","80% of total billed charges ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",186.03,93,,148.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",174.03,87,,139.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",140.02,186.03,
"KNIFE TRIANGLE LIGAMENT",6106074,"CDM ",272,RC,,,OUTPATIENT,,,176.33,141.064,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.06,80,,112.85,,,0,"percent of total billed charges ","80% of total billed charges ",123.43,70,,98.74,,,0,"percent of total billed charges ","70% of total billed charges ",158.7,90,,126.96,,,0,"percent of total billed charges ","90% of total billed charges ",163.99,93,,131.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",149.88,85,,119.90,,,0,"percent of total billed charges ","85% of total billed charges ",158.7,90,,126.96,,,0,"percent of total billed charges ","90% of total billed charges ",158.7,90,,126.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",153.41,87,,122.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.43,70,,98.74,,,0,"percent of total billed charges ","70% of total billed charges ",123.43,163.99,
"SNARE DISP OVAL OLYMPUS",6106097,"CDM ",272,RC,,,OUTPATIENT,,,42.38,33.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.9,80,,27.12,,,0,"percent of total billed charges ","80% of total billed charges ",29.67,70,,23.74,,,0,"percent of total billed charges ","70% of total billed charges ",38.14,90,,30.51,,,0,"percent of total billed charges ","90% of total billed charges ",39.41,93,,31.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",36.02,85,,28.82,,,0,"percent of total billed charges ","85% of total billed charges ",38.14,90,,30.51,,,0,"percent of total billed charges ","90% of total billed charges ",38.14,90,,30.51,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",36.87,87,,29.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.67,70,,23.74,,,0,"percent of total billed charges ","70% of total billed charges ",29.67,39.41,
"PLASMABLADE PEAK 4.0",6106117,"CDM ",272,RC,,,OUTPATIENT,,,253.54,202.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",202.83,80,,162.26,,,0,"percent of total billed charges ","80% of total billed charges ",177.48,70,,141.98,,,0,"percent of total billed charges ","70% of total billed charges ",228.19,90,,182.55,,,0,"percent of total billed charges ","90% of total billed charges ",235.79,93,,188.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",215.51,85,,172.41,,,0,"percent of total billed charges ","85% of total billed charges ",228.19,90,,182.55,,,0,"percent of total billed charges ","90% of total billed charges ",228.19,90,,182.55,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",220.58,87,,176.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.48,70,,141.98,,,0,"percent of total billed charges ","70% of total billed charges ",177.48,235.79,
"AIR+ MENISCAL REPAIR",6106118,"CDM ",270,RC,,,OUTPATIENT,,,981.39,785.112,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",785.11,80,,628.09,,,0,"percent of total billed charges ","80% of total billed charges ",686.97,70,,549.58,,,0,"percent of total billed charges ","70% of total billed charges ",883.25,90,,706.60,,,0,"percent of total billed charges ","90% of total billed charges ",912.69,93,,730.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",834.18,85,,667.34,,,0,"percent of total billed charges ","85% of total billed charges ",883.25,90,,706.60,,,0,"percent of total billed charges ","90% of total billed charges ",883.25,90,,706.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",853.81,87,,683.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",686.97,70,,549.58,,,0,"percent of total billed charges ","70% of total billed charges ",686.97,912.69,
"BALLOON QUANTUM TIC",6106206,"CDM ",272,RC,,,OUTPATIENT,,,374.91,299.928,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",299.93,80,,239.94,,,0,"percent of total billed charges ","80% of total billed charges ",262.44,70,,209.95,,,0,"percent of total billed charges ","70% of total billed charges ",337.42,90,,269.94,,,0,"percent of total billed charges ","90% of total billed charges ",348.67,93,,278.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",318.67,85,,254.94,,,0,"percent of total billed charges ","85% of total billed charges ",337.42,90,,269.94,,,0,"percent of total billed charges ","90% of total billed charges ",337.42,90,,269.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",326.17,87,,260.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.44,70,,209.95,,,0,"percent of total billed charges ","70% of total billed charges ",262.44,348.67,
"FLANGE 2"" K",6106207,"CDM ",271,RC,,,OUTPATIENT,,,27,21.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.6,80,,17.28,,,0,"percent of total billed charges ","80% of total billed charges ",18.9,70,,15.12,,,0,"percent of total billed charges ","70% of total billed charges ",24.3,90,,19.44,,,0,"percent of total billed charges ","90% of total billed charges ",25.11,93,,20.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",22.95,85,,18.36,,,0,"percent of total billed charges ","85% of total billed charges ",24.3,90,,19.44,,,0,"percent of total billed charges ","90% of total billed charges ",24.3,90,,19.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",23.49,87,,18.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.9,70,,15.12,,,0,"percent of total billed charges ","70% of total billed charges ",18.9,25.11,
"LEAD NEURO BIPOLAR 20FR",6106216,"CDM ",278,RC,,,OUTPATIENT,,,3459.5,2767.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2767.6,80,,2214.08,,,0,"percent of total billed charges ","80% of total billed charges ",2421.65,70,,1937.32,,,0,"percent of total billed charges ","70% of total billed charges ",3113.55,90,,2490.84,,,0,"percent of total billed charges ","90% of total billed charges ",3217.34,93,,2573.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2940.58,85,,2352.46,,,0,"percent of total billed charges ","85% of total billed charges ",2940.58,85,,2352.46,,,0,"percent of total billed charges ","85% of total billed charges ",3113.55,90,,2490.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3009.77,87,,2407.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2421.65,70,,1937.32,,,0,"percent of total billed charges ","70% of total billed charges ",2421.65,3217.34,
"LEAD NEURO BIPOLAR 30 FR",6106217,"CDM ",278,RC,,,OUTPATIENT,,,3459.5,2767.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2767.6,80,,2214.08,,,0,"percent of total billed charges ","80% of total billed charges ",2421.65,70,,1937.32,,,0,"percent of total billed charges ","70% of total billed charges ",3113.55,90,,2490.84,,,0,"percent of total billed charges ","90% of total billed charges ",3217.34,93,,2573.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2940.58,85,,2352.46,,,0,"percent of total billed charges ","85% of total billed charges ",2940.58,85,,2352.46,,,0,"percent of total billed charges ","85% of total billed charges ",3113.55,90,,2490.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3009.77,87,,2407.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2421.65,70,,1937.32,,,0,"percent of total billed charges ","70% of total billed charges ",2421.65,3217.34,
"TOOL NERVE TUNNELING DISP",6106218,"CDM ",272,RC,,,OUTPATIENT,,,351.5,281.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",281.2,80,,224.96,,,0,"percent of total billed charges ","80% of total billed charges ",246.05,70,,196.84,,,0,"percent of total billed charges ","70% of total billed charges ",316.35,90,,253.08,,,0,"percent of total billed charges ","90% of total billed charges ",326.9,93,,261.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",298.78,85,,239.02,,,0,"percent of total billed charges ","85% of total billed charges ",316.35,90,,253.08,,,0,"percent of total billed charges ","90% of total billed charges ",316.35,90,,253.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",305.81,87,,244.65,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",246.05,70,,196.84,,,0,"percent of total billed charges ","70% of total billed charges ",246.05,326.9,
"KIT FIBULINK SYNDESMOSIS REPR",6106220,"CDM ",270,RC,,,OUTPATIENT,,,2787.84,2230.272,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2230.27,80,,1784.22,,,0,"percent of total billed charges ","80% of total billed charges ",1951.49,70,,1561.19,,,0,"percent of total billed charges ","70% of total billed charges ",2509.06,90,,2007.25,,,0,"percent of total billed charges ","90% of total billed charges ",2592.69,93,,2074.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2369.66,85,,1895.73,,,0,"percent of total billed charges ","85% of total billed charges ",2509.06,90,,2007.25,,,0,"percent of total billed charges ","90% of total billed charges ",2509.06,90,,2007.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2425.42,87,,1940.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1951.49,70,,1561.19,,,0,"percent of total billed charges ","70% of total billed charges ",1951.49,2592.69,
"KIT POST-OP AUTOLOCK",6106235,"CDM ",272,RC,,,OUTPATIENT,,,222.5,178,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178,80,,142.40,,,0,"percent of total billed charges ","80% of total billed charges ",155.75,70,,124.60,,,0,"percent of total billed charges ","70% of total billed charges ",200.25,90,,160.20,,,0,"percent of total billed charges ","90% of total billed charges ",206.93,93,,165.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",189.13,85,,151.30,,,0,"percent of total billed charges ","85% of total billed charges ",200.25,90,,160.20,,,0,"percent of total billed charges ","90% of total billed charges ",200.25,90,,160.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",193.58,87,,154.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.75,70,,124.60,,,0,"percent of total billed charges ","70% of total billed charges ",155.75,206.93,
"SUTURE MONOCRYL 4.0 Y845G",6106240,"CDM ",272,RC,,,OUTPATIENT,,,20.81,16.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.65,80,,13.32,,,0,"percent of total billed charges ","80% of total billed charges ",14.57,70,,11.66,,,0,"percent of total billed charges ","70% of total billed charges ",18.73,90,,14.98,,,0,"percent of total billed charges ","90% of total billed charges ",19.35,93,,15.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.69,85,,14.15,,,0,"percent of total billed charges ","85% of total billed charges ",18.73,90,,14.98,,,0,"percent of total billed charges ","90% of total billed charges ",18.73,90,,14.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.1,87,,14.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.57,70,,11.66,,,0,"percent of total billed charges ","70% of total billed charges ",14.57,19.35,
"FORCEP HOT BIOPSY 2.5 X 230CM",6106242,"CDM ",272,RC,,,OUTPATIENT,,,80.01,64.008,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.01,80,,51.21,,,0,"percent of total billed charges ","80% of total billed charges ",56.01,70,,44.81,,,0,"percent of total billed charges ","70% of total billed charges ",72.01,90,,57.61,,,0,"percent of total billed charges ","90% of total billed charges ",74.41,93,,59.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",68.01,85,,54.41,,,0,"percent of total billed charges ","85% of total billed charges ",72.01,90,,57.61,,,0,"percent of total billed charges ","90% of total billed charges ",72.01,90,,57.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",69.61,87,,55.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.01,70,,44.81,,,0,"percent of total billed charges ","70% of total billed charges ",56.01,74.41,
"SHEAR CURVED HARMONIC",6106254,"CDM ",272,RC,,,OUTPATIENT,,,733.56,586.848,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",586.85,80,,469.48,,,0,"percent of total billed charges ","80% of total billed charges ",513.49,70,,410.79,,,0,"percent of total billed charges ","70% of total billed charges ",660.2,90,,528.16,,,0,"percent of total billed charges ","90% of total billed charges ",682.21,93,,545.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",623.53,85,,498.82,,,0,"percent of total billed charges ","85% of total billed charges ",660.2,90,,528.16,,,0,"percent of total billed charges ","90% of total billed charges ",660.2,90,,528.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",638.2,87,,510.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",513.49,70,,410.79,,,0,"percent of total billed charges ","70% of total billed charges ",513.49,682.21,
"SUTURE ETHIBOND 0 EC21",6106256,"CDM ",272,RC,,,OUTPATIENT,,,98.59,78.872,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.87,80,,63.10,,,0,"percent of total billed charges ","80% of total billed charges ",69.01,70,,55.21,,,0,"percent of total billed charges ","70% of total billed charges ",88.73,90,,70.98,,,0,"percent of total billed charges ","90% of total billed charges ",91.69,93,,73.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.8,85,,67.04,,,0,"percent of total billed charges ","85% of total billed charges ",88.73,90,,70.98,,,0,"percent of total billed charges ","90% of total billed charges ",88.73,90,,70.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.77,87,,68.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.01,70,,55.21,,,0,"percent of total billed charges ","70% of total billed charges ",69.01,91.69,
"SUTURE VICRYL D 07857",6106257,"CDM ",272,RC,,,OUTPATIENT,,,88.23,70.584,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.58,80,,56.46,,,0,"percent of total billed charges ","80% of total billed charges ",61.76,70,,49.41,,,0,"percent of total billed charges ","70% of total billed charges ",79.41,90,,63.53,,,0,"percent of total billed charges ","90% of total billed charges ",82.05,93,,65.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",75,85,,60.00,,,0,"percent of total billed charges ","85% of total billed charges ",79.41,90,,63.53,,,0,"percent of total billed charges ","90% of total billed charges ",79.41,90,,63.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",76.76,87,,61.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.76,70,,49.41,,,0,"percent of total billed charges ","70% of total billed charges ",61.76,82.05,
"SUTURE VICRYL 3.0 D7795",6106259,"CDM ",272,RC,,,OUTPATIENT,,,88.23,70.584,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.58,80,,56.46,,,0,"percent of total billed charges ","80% of total billed charges ",61.76,70,,49.41,,,0,"percent of total billed charges ","70% of total billed charges ",79.41,90,,63.53,,,0,"percent of total billed charges ","90% of total billed charges ",82.05,93,,65.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",75,85,,60.00,,,0,"percent of total billed charges ","85% of total billed charges ",79.41,90,,63.53,,,0,"percent of total billed charges ","90% of total billed charges ",79.41,90,,63.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",76.76,87,,61.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.76,70,,49.41,,,0,"percent of total billed charges ","70% of total billed charges ",61.76,82.05,
"TROCAR 75MM 35HS",6106270,"CDM ",272,RC,,,OUTPATIENT,,,43.68,34.944,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.94,80,,27.95,,,0,"percent of total billed charges ","80% of total billed charges ",30.58,70,,24.46,,,0,"percent of total billed charges ","70% of total billed charges ",39.31,90,,31.45,,,0,"percent of total billed charges ","90% of total billed charges ",40.62,93,,32.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",37.13,85,,29.70,,,0,"percent of total billed charges ","85% of total billed charges ",39.31,90,,31.45,,,0,"percent of total billed charges ","90% of total billed charges ",39.31,90,,31.45,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",38,87,,30.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.58,70,,24.46,,,0,"percent of total billed charges ","70% of total billed charges ",30.58,40.62,
"BAG ENDO PRO46",6106271,"CDM ",272,RC,,,OUTPATIENT,,,313,250.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",250.4,80,,200.32,,,0,"percent of total billed charges ","80% of total billed charges ",219.1,70,,175.28,,,0,"percent of total billed charges ","70% of total billed charges ",281.7,90,,225.36,,,0,"percent of total billed charges ","90% of total billed charges ",291.09,93,,232.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",266.05,85,,212.84,,,0,"percent of total billed charges ","85% of total billed charges ",281.7,90,,225.36,,,0,"percent of total billed charges ","90% of total billed charges ",281.7,90,,225.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",272.31,87,,217.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",219.1,70,,175.28,,,0,"percent of total billed charges ","70% of total billed charges ",219.1,291.09,
"IRRIGATOR CAUTERY SUCTION",6106275,"CDM ",272,RC,,,OUTPATIENT,,,248.74,198.992,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",198.99,80,,159.19,,,0,"percent of total billed charges ","80% of total billed charges ",174.12,70,,139.30,,,0,"percent of total billed charges ","70% of total billed charges ",223.87,90,,179.10,,,0,"percent of total billed charges ","90% of total billed charges ",231.33,93,,185.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",211.43,85,,169.14,,,0,"percent of total billed charges ","85% of total billed charges ",223.87,90,,179.10,,,0,"percent of total billed charges ","90% of total billed charges ",223.87,90,,179.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",216.4,87,,173.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174.12,70,,139.30,,,0,"percent of total billed charges ","70% of total billed charges ",174.12,231.33,
"HANDLE IRRIGATOR",6106276,"CDM ",272,RC,,,OUTPATIENT,,,264.53,211.624,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",211.62,80,,169.30,,,0,"percent of total billed charges ","80% of total billed charges ",185.17,70,,148.14,,,0,"percent of total billed charges ","70% of total billed charges ",238.08,90,,190.46,,,0,"percent of total billed charges ","90% of total billed charges ",246.01,93,,196.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",224.85,85,,179.88,,,0,"percent of total billed charges ","85% of total billed charges ",238.08,90,,190.46,,,0,"percent of total billed charges ","90% of total billed charges ",238.08,90,,190.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",230.14,87,,184.11,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",185.17,70,,148.14,,,0,"percent of total billed charges ","70% of total billed charges ",185.17,246.01,
"DRAIN BLAKE 10FR ROUND",6106278,"CDM ",272,RC,,,OUTPATIENT,,,59.96,47.968,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.97,80,,38.38,,,0,"percent of total billed charges ","80% of total billed charges ",41.97,70,,33.58,,,0,"percent of total billed charges ","70% of total billed charges ",53.96,90,,43.17,,,0,"percent of total billed charges ","90% of total billed charges ",55.76,93,,44.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",50.97,85,,40.78,,,0,"percent of total billed charges ","85% of total billed charges ",53.96,90,,43.17,,,0,"percent of total billed charges ","90% of total billed charges ",53.96,90,,43.17,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",52.17,87,,41.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.97,70,,33.58,,,0,"percent of total billed charges ","70% of total billed charges ",41.97,55.76,
"DRAIN BLAKE 10MM FLAT",6106279,"CDM ",272,RC,,,OUTPATIENT,,,59.96,47.968,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.97,80,,38.38,,,0,"percent of total billed charges ","80% of total billed charges ",41.97,70,,33.58,,,0,"percent of total billed charges ","70% of total billed charges ",53.96,90,,43.17,,,0,"percent of total billed charges ","90% of total billed charges ",55.76,93,,44.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",50.97,85,,40.78,,,0,"percent of total billed charges ","85% of total billed charges ",53.96,90,,43.17,,,0,"percent of total billed charges ","90% of total billed charges ",53.96,90,,43.17,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",52.17,87,,41.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.97,70,,33.58,,,0,"percent of total billed charges ","70% of total billed charges ",41.97,55.76,
"SUTURE ETHIBOND O ASSIST",6106283,"CDM ",272,RC,,,OUTPATIENT,,,340.94,272.752,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",272.75,80,,218.20,,,0,"percent of total billed charges ","80% of total billed charges ",238.66,70,,190.93,,,0,"percent of total billed charges ","70% of total billed charges ",306.85,90,,245.48,,,0,"percent of total billed charges ","90% of total billed charges ",317.07,93,,253.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",289.8,85,,231.84,,,0,"percent of total billed charges ","85% of total billed charges ",306.85,90,,245.48,,,0,"percent of total billed charges ","90% of total billed charges ",306.85,90,,245.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",296.62,87,,237.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",238.66,70,,190.93,,,0,"percent of total billed charges ","70% of total billed charges ",238.66,317.07,
"SUTURE ASSIST RELOAD",6106284,"CDM ",272,RC,,,OUTPATIENT,,,118.64,94.912,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.91,80,,75.93,,,0,"percent of total billed charges ","80% of total billed charges ",83.05,70,,66.44,,,0,"percent of total billed charges ","70% of total billed charges ",106.78,90,,85.42,,,0,"percent of total billed charges ","90% of total billed charges ",110.34,93,,88.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",100.84,85,,80.67,,,0,"percent of total billed charges ","85% of total billed charges ",106.78,90,,85.42,,,0,"percent of total billed charges ","90% of total billed charges ",106.78,90,,85.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",103.22,87,,82.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.05,70,,66.44,,,0,"percent of total billed charges ","70% of total billed charges ",83.05,110.34,
"PUMP ON-Q PAIN 270MLX2ML",6106286,"CDM ",272,RC,,,OUTPATIENT,,,366.35,293.08,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",293.08,80,,234.46,,,0,"percent of total billed charges ","80% of total billed charges ",256.45,70,,205.16,,,0,"percent of total billed charges ","70% of total billed charges ",329.72,90,,263.78,,,0,"percent of total billed charges ","90% of total billed charges ",340.71,93,,272.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",311.4,85,,249.12,,,0,"percent of total billed charges ","85% of total billed charges ",329.72,90,,263.78,,,0,"percent of total billed charges ","90% of total billed charges ",329.72,90,,263.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",318.72,87,,254.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",256.45,70,,205.16,,,0,"percent of total billed charges ","70% of total billed charges ",256.45,340.71,
"SUTURE CHROMIC MILD 6.0 351-13",6106308,"CDM ",272,RC,,,OUTPATIENT,,,40.52,32.416,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.42,80,,25.94,,,0,"percent of total billed charges ","80% of total billed charges ",28.36,70,,22.69,,,0,"percent of total billed charges ","70% of total billed charges ",36.47,90,,29.18,,,0,"percent of total billed charges ","90% of total billed charges ",37.68,93,,30.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34.44,85,,27.55,,,0,"percent of total billed charges ","85% of total billed charges ",36.47,90,,29.18,,,0,"percent of total billed charges ","90% of total billed charges ",36.47,90,,29.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",35.25,87,,28.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.36,70,,22.69,,,0,"percent of total billed charges ","70% of total billed charges ",28.36,37.68,
"SHEAR 5MM X 14MM CURVED",6106311,"CDM ",272,RC,,,OUTPATIENT,,,1116.9,893.52,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",893.52,80,,714.82,,,0,"percent of total billed charges ","80% of total billed charges ",781.83,70,,625.46,,,0,"percent of total billed charges ","70% of total billed charges ",1005.21,90,,804.17,,,0,"percent of total billed charges ","90% of total billed charges ",1038.72,93,,830.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",949.37,85,,759.50,,,0,"percent of total billed charges ","85% of total billed charges ",1005.21,90,,804.17,,,0,"percent of total billed charges ","90% of total billed charges ",1005.21,90,,804.17,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",971.7,87,,777.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",781.83,70,,625.46,,,0,"percent of total billed charges ","70% of total billed charges ",781.83,1038.72,
"SHEAR 5MM X 23MM CURVED",6106312,"CDM ",272,RC,,,OUTPATIENT,,,855.32,684.256,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",684.26,80,,547.41,,,0,"percent of total billed charges ","80% of total billed charges ",598.72,70,,478.98,,,0,"percent of total billed charges ","70% of total billed charges ",769.79,90,,615.83,,,0,"percent of total billed charges ","90% of total billed charges ",795.45,93,,636.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",727.02,85,,581.62,,,0,"percent of total billed charges ","85% of total billed charges ",769.79,90,,615.83,,,0,"percent of total billed charges ","90% of total billed charges ",769.79,90,,615.83,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",744.13,87,,595.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",598.72,70,,478.98,,,0,"percent of total billed charges ","70% of total billed charges ",598.72,795.45,
"CATH PER-Q PICK LINE 4FR",6106326,"CDM ",272,RC,,,OUTPATIENT,,,386.53,309.224,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",309.22,80,,247.38,,,0,"percent of total billed charges ","80% of total billed charges ",270.57,70,,216.46,,,0,"percent of total billed charges ","70% of total billed charges ",347.88,90,,278.30,,,0,"percent of total billed charges ","90% of total billed charges ",359.47,93,,287.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",328.55,85,,262.84,,,0,"percent of total billed charges ","85% of total billed charges ",347.88,90,,278.30,,,0,"percent of total billed charges ","90% of total billed charges ",347.88,90,,278.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",336.28,87,,269.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",270.57,70,,216.46,,,0,"percent of total billed charges ","70% of total billed charges ",270.57,359.47,
"SUTURE ETHIBOND 0",6106345,"CDM ",272,RC,,,OUTPATIENT,,,153.09,122.472,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.47,80,,97.98,,,0,"percent of total billed charges ","80% of total billed charges ",107.16,70,,85.73,,,0,"percent of total billed charges ","70% of total billed charges ",137.78,90,,110.22,,,0,"percent of total billed charges ","90% of total billed charges ",142.37,93,,113.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",130.13,85,,104.10,,,0,"percent of total billed charges ","85% of total billed charges ",137.78,90,,110.22,,,0,"percent of total billed charges ","90% of total billed charges ",137.78,90,,110.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",133.19,87,,106.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",107.16,70,,85.73,,,0,"percent of total billed charges ","70% of total billed charges ",107.16,142.37,
"GARMENT COMPRESSION CALF LGE",6106359,"CDM ",271,RC,,,OUTPATIENT,,,64.19,51.352,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.35,80,,41.08,,,0,"percent of total billed charges ","80% of total billed charges ",44.93,70,,35.94,,,0,"percent of total billed charges ","70% of total billed charges ",57.77,90,,46.22,,,0,"percent of total billed charges ","90% of total billed charges ",59.7,93,,47.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",54.56,85,,43.65,,,0,"percent of total billed charges ","85% of total billed charges ",57.77,90,,46.22,,,0,"percent of total billed charges ","90% of total billed charges ",57.77,90,,46.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",55.85,87,,44.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.93,70,,35.94,,,0,"percent of total billed charges ","70% of total billed charges ",44.93,59.7,
"BONE CEMENT PALCOS R",6106380,"CDM ",278,RC,,,OUTPATIENT,,,263.5,210.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.8,80,,168.64,,,0,"percent of total billed charges ","80% of total billed charges ",184.45,70,,147.56,,,0,"percent of total billed charges ","70% of total billed charges ",237.15,90,,189.72,,,0,"percent of total billed charges ","90% of total billed charges ",245.06,93,,196.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",223.98,85,,179.18,,,0,"percent of total billed charges ","85% of total billed charges ",223.98,85,,179.18,,,0,"percent of total billed charges ","85% of total billed charges ",237.15,90,,189.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",229.25,87,,183.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",184.45,70,,147.56,,,0,"percent of total billed charges ","70% of total billed charges ",184.45,245.06,
"KIT OPTIVA DOUBLE MIX 80 GM",6106381,"CDM ",272,RC,,,OUTPATIENT,,,372.82,298.256,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",298.26,80,,238.61,,,0,"percent of total billed charges ","80% of total billed charges ",260.97,70,,208.78,,,0,"percent of total billed charges ","70% of total billed charges ",335.54,90,,268.43,,,0,"percent of total billed charges ","90% of total billed charges ",346.72,93,,277.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",316.9,85,,253.52,,,0,"percent of total billed charges ","85% of total billed charges ",335.54,90,,268.43,,,0,"percent of total billed charges ","90% of total billed charges ",335.54,90,,268.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",324.35,87,,259.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",260.97,70,,208.78,,,0,"percent of total billed charges ","70% of total billed charges ",260.97,346.72,
"TRIPOD 5.5 X 240 CM",6106382,"CDM ",272,RC,,,OUTPATIENT,,,263.77,211.016,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",211.02,80,,168.82,,,0,"percent of total billed charges ","80% of total billed charges ",184.64,70,,147.71,,,0,"percent of total billed charges ","70% of total billed charges ",237.39,90,,189.91,,,0,"percent of total billed charges ","90% of total billed charges ",245.31,93,,196.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",224.2,85,,179.36,,,0,"percent of total billed charges ","85% of total billed charges ",237.39,90,,189.91,,,0,"percent of total billed charges ","90% of total billed charges ",237.39,90,,189.91,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",229.48,87,,183.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",184.64,70,,147.71,,,0,"percent of total billed charges ","70% of total billed charges ",184.64,245.31,
"PUMP ON-Q PAIN 270ML X 4ML",6106389,"CDM ",272,RC,,,OUTPATIENT,,,327.56,262.048,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.05,80,,209.64,,,0,"percent of total billed charges ","80% of total billed charges ",229.29,70,,183.43,,,0,"percent of total billed charges ","70% of total billed charges ",294.8,90,,235.84,,,0,"percent of total billed charges ","90% of total billed charges ",304.63,93,,243.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",278.43,85,,222.74,,,0,"percent of total billed charges ","85% of total billed charges ",294.8,90,,235.84,,,0,"percent of total billed charges ","90% of total billed charges ",294.8,90,,235.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",284.98,87,,227.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",229.29,70,,183.43,,,0,"percent of total billed charges ","70% of total billed charges ",229.29,304.63,
"SUTURE ETHIBOND 1.0X538H",6106400,"CDM ",272,RC,,,OUTPATIENT,,,13.74,10.992,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.99,80,,8.79,,,0,"percent of total billed charges ","80% of total billed charges ",9.62,70,,7.70,,,0,"percent of total billed charges ","70% of total billed charges ",12.37,90,,9.90,,,0,"percent of total billed charges ","90% of total billed charges ",12.78,93,,10.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.68,85,,9.34,,,0,"percent of total billed charges ","85% of total billed charges ",12.37,90,,9.90,,,0,"percent of total billed charges ","90% of total billed charges ",12.37,90,,9.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.95,87,,9.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.62,70,,7.70,,,0,"percent of total billed charges ","70% of total billed charges ",9.62,12.78,
"IMPLANT FLEX HINGE TOE SET",6106402,"CDM ",278,RC,,,OUTPATIENT,,,1470.15,1176.12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1176.12,80,,940.90,,,0,"percent of total billed charges ","80% of total billed charges ",1029.11,70,,823.29,,,0,"percent of total billed charges ","70% of total billed charges ",1323.14,90,,1058.51,,,0,"percent of total billed charges ","90% of total billed charges ",1367.24,93,,1093.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1249.63,85,,999.70,,,0,"percent of total billed charges ","85% of total billed charges ",1249.63,85,,999.70,,,0,"percent of total billed charges ","85% of total billed charges ",1323.14,90,,1058.51,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1279.03,87,,1023.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1029.11,70,,823.29,,,0,"percent of total billed charges ","70% of total billed charges ",1029.11,1367.24,
"CUFF DISP W/PLC 18""",6106407,"CDM ",272,RC,,,OUTPATIENT,,,72.32,57.856,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.86,80,,46.29,,,0,"percent of total billed charges ","80% of total billed charges ",50.62,70,,40.50,,,0,"percent of total billed charges ","70% of total billed charges ",65.09,90,,52.07,,,0,"percent of total billed charges ","90% of total billed charges ",67.26,93,,53.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",61.47,85,,49.18,,,0,"percent of total billed charges ","85% of total billed charges ",65.09,90,,52.07,,,0,"percent of total billed charges ","90% of total billed charges ",65.09,90,,52.07,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",62.92,87,,50.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.62,70,,40.50,,,0,"percent of total billed charges ","70% of total billed charges ",50.62,67.26,
"SUTURE PDS 3.0 SH D6264",6106411,"CDM ",272,RC,,,OUTPATIENT,,,109.35,87.48,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.48,80,,69.98,,,0,"percent of total billed charges ","80% of total billed charges ",76.55,70,,61.24,,,0,"percent of total billed charges ","70% of total billed charges ",98.42,90,,78.74,,,0,"percent of total billed charges ","90% of total billed charges ",101.7,93,,81.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",92.95,85,,74.36,,,0,"percent of total billed charges ","85% of total billed charges ",98.42,90,,78.74,,,0,"percent of total billed charges ","90% of total billed charges ",98.42,90,,78.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",95.13,87,,76.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.55,70,,61.24,,,0,"percent of total billed charges ","70% of total billed charges ",76.55,101.7,
"TUBING INSUFFLATION W/FILTER",6106412,"CDM ",272,RC,,,OUTPATIENT,,,101.12,80.896,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.9,80,,64.72,,,0,"percent of total billed charges ","80% of total billed charges ",70.78,70,,56.62,,,0,"percent of total billed charges ","70% of total billed charges ",91.01,90,,72.81,,,0,"percent of total billed charges ","90% of total billed charges ",94.04,93,,75.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",85.95,85,,68.76,,,0,"percent of total billed charges ","85% of total billed charges ",91.01,90,,72.81,,,0,"percent of total billed charges ","90% of total billed charges ",91.01,90,,72.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",87.97,87,,70.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.78,70,,56.62,,,0,"percent of total billed charges ","70% of total billed charges ",70.78,94.04,
"TROCAR 10MM SHARP",6106414,"CDM ",272,RC,,,OUTPATIENT,,,61.45,49.16,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.16,80,,39.33,,,0,"percent of total billed charges ","80% of total billed charges ",43.02,70,,34.42,,,0,"percent of total billed charges ","70% of total billed charges ",55.31,90,,44.25,,,0,"percent of total billed charges ","90% of total billed charges ",57.15,93,,45.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",52.23,85,,41.78,,,0,"percent of total billed charges ","85% of total billed charges ",55.31,90,,44.25,,,0,"percent of total billed charges ","90% of total billed charges ",55.31,90,,44.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",53.46,87,,42.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.02,70,,34.42,,,0,"percent of total billed charges ","70% of total billed charges ",43.02,57.15,
"LOOP CUTTING 22FR",6106434,"CDM ",272,RC,,,OUTPATIENT,,,332.59,266.072,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",266.07,80,,212.86,,,0,"percent of total billed charges ","80% of total billed charges ",232.81,70,,186.25,,,0,"percent of total billed charges ","70% of total billed charges ",299.33,90,,239.46,,,0,"percent of total billed charges ","90% of total billed charges ",309.31,93,,247.45,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",282.7,85,,226.16,,,0,"percent of total billed charges ","85% of total billed charges ",299.33,90,,239.46,,,0,"percent of total billed charges ","90% of total billed charges ",299.33,90,,239.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",289.35,87,,231.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",232.81,70,,186.25,,,0,"percent of total billed charges ","70% of total billed charges ",232.81,309.31,
"BALL ROLLER (COAG ELECTRODE)",6106435,"CDM ",272,RC,,,OUTPATIENT,,,305.3,244.24,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",244.24,80,,195.39,,,0,"percent of total billed charges ","80% of total billed charges ",213.71,70,,170.97,,,0,"percent of total billed charges ","70% of total billed charges ",274.77,90,,219.82,,,0,"percent of total billed charges ","90% of total billed charges ",283.93,93,,227.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",259.51,85,,207.61,,,0,"percent of total billed charges ","85% of total billed charges ",274.77,90,,219.82,,,0,"percent of total billed charges ","90% of total billed charges ",274.77,90,,219.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",265.61,87,,212.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",213.71,70,,170.97,,,0,"percent of total billed charges ","70% of total billed charges ",213.71,283.93,
"OPTIFLOW FILTERED W/CO2",6106444,"CDM ",278,RC,,,OUTPATIENT,,,160.24,128.192,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.19,80,,102.55,,,0,"percent of total billed charges ","80% of total billed charges ",112.17,70,,89.74,,,0,"percent of total billed charges ","70% of total billed charges ",144.22,90,,115.38,,,0,"percent of total billed charges ","90% of total billed charges ",149.02,93,,119.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136.2,85,,108.96,,,0,"percent of total billed charges ","85% of total billed charges ",136.2,85,,108.96,,,0,"percent of total billed charges ","85% of total billed charges ",144.22,90,,115.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.41,87,,111.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112.17,70,,89.74,,,0,"percent of total billed charges ","70% of total billed charges ",112.17,149.02,
"OPTIFLOW OXYGEN KIT",6106445,"CDM ",278,RC,,,OUTPATIENT,,,267.38,213.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",213.9,80,,171.12,,,0,"percent of total billed charges ","80% of total billed charges ",187.17,70,,149.74,,,0,"percent of total billed charges ","70% of total billed charges ",240.64,90,,192.51,,,0,"percent of total billed charges ","90% of total billed charges ",248.66,93,,198.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",227.27,85,,181.82,,,0,"percent of total billed charges ","85% of total billed charges ",227.27,85,,181.82,,,0,"percent of total billed charges ","85% of total billed charges ",240.64,90,,192.51,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",232.62,87,,186.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",187.17,70,,149.74,,,0,"percent of total billed charges ","70% of total billed charges ",187.17,248.66,
"OPTIFLOW O2 TUBING LOW FLOW",6106446,"CDM ",278,RC,,,OUTPATIENT,,,18.05,14.44,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.44,80,,11.55,,,0,"percent of total billed charges ","80% of total billed charges ",12.64,70,,10.11,,,0,"percent of total billed charges ","70% of total billed charges ",16.25,90,,13.00,,,0,"percent of total billed charges ","90% of total billed charges ",16.79,93,,13.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.34,85,,12.27,,,0,"percent of total billed charges ","85% of total billed charges ",15.34,85,,12.27,,,0,"percent of total billed charges ","85% of total billed charges ",16.25,90,,13.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.7,87,,12.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.64,70,,10.11,,,0,"percent of total billed charges ","70% of total billed charges ",12.64,16.79,
"SUTURE MERSILENE 5.0 R499T",6106447,"CDM ",272,RC,,,OUTPATIENT,,,16.75,13.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.4,80,,10.72,,,0,"percent of total billed charges ","80% of total billed charges ",11.73,70,,9.38,,,0,"percent of total billed charges ","70% of total billed charges ",15.08,90,,12.06,,,0,"percent of total billed charges ","90% of total billed charges ",15.58,93,,12.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.24,85,,11.39,,,0,"percent of total billed charges ","85% of total billed charges ",15.08,90,,12.06,,,0,"percent of total billed charges ","90% of total billed charges ",15.08,90,,12.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.57,87,,11.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.73,70,,9.38,,,0,"percent of total billed charges ","70% of total billed charges ",11.73,15.58,
"SUTURE MERSILENE 5MM WHITE-WOY",6106450,"CDM ",272,RC,,,OUTPATIENT,,,118.06,94.448,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.45,80,,75.56,,,0,"percent of total billed charges ","80% of total billed charges ",82.64,70,,66.11,,,0,"percent of total billed charges ","70% of total billed charges ",106.25,90,,85.00,,,0,"percent of total billed charges ","90% of total billed charges ",109.8,93,,87.84,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",100.35,85,,80.28,,,0,"percent of total billed charges ","85% of total billed charges ",106.25,90,,85.00,,,0,"percent of total billed charges ","90% of total billed charges ",106.25,90,,85.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",102.71,87,,82.17,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.64,70,,66.11,,,0,"percent of total billed charges ","70% of total billed charges ",82.64,109.8,
"CUFF DISP W/PLC 34""",6106457,"CDM ",272,RC,,,OUTPATIENT,,,93.08,74.464,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.46,80,,59.57,,,0,"percent of total billed charges ","80% of total billed charges ",65.16,70,,52.13,,,0,"percent of total billed charges ","70% of total billed charges ",83.77,90,,67.02,,,0,"percent of total billed charges ","90% of total billed charges ",86.56,93,,69.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",79.12,85,,63.30,,,0,"percent of total billed charges ","85% of total billed charges ",83.77,90,,67.02,,,0,"percent of total billed charges ","90% of total billed charges ",83.77,90,,67.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",80.98,87,,64.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.16,70,,52.13,,,0,"percent of total billed charges ","70% of total billed charges ",65.16,86.56,
"TROCAR 5MM X 75MM",6106459,"CDM ",272,RC,,,OUTPATIENT,,,116.12,92.896,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.9,80,,74.32,,,0,"percent of total billed charges ","80% of total billed charges ",81.28,70,,65.02,,,0,"percent of total billed charges ","70% of total billed charges ",104.51,90,,83.61,,,0,"percent of total billed charges ","90% of total billed charges ",107.99,93,,86.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",98.7,85,,78.96,,,0,"percent of total billed charges ","85% of total billed charges ",104.51,90,,83.61,,,0,"percent of total billed charges ","90% of total billed charges ",104.51,90,,83.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.02,87,,80.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.28,70,,65.02,,,0,"percent of total billed charges ","70% of total billed charges ",81.28,107.99,
"SUTURE STEEL 26GA M414G",6106471,"CDM ",272,RC,,,OUTPATIENT,,,46.76,37.408,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.41,80,,29.93,,,0,"percent of total billed charges ","80% of total billed charges ",32.73,70,,26.18,,,0,"percent of total billed charges ","70% of total billed charges ",42.08,90,,33.66,,,0,"percent of total billed charges ","90% of total billed charges ",43.49,93,,34.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.75,85,,31.80,,,0,"percent of total billed charges ","85% of total billed charges ",42.08,90,,33.66,,,0,"percent of total billed charges ","90% of total billed charges ",42.08,90,,33.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.68,87,,32.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.73,70,,26.18,,,0,"percent of total billed charges ","70% of total billed charges ",32.73,43.49,
"SUTURE STEEL 28GA M682G",6106472,"CDM ",272,RC,,,OUTPATIENT,,,46.41,37.128,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.13,80,,29.70,,,0,"percent of total billed charges ","80% of total billed charges ",32.49,70,,25.99,,,0,"percent of total billed charges ","70% of total billed charges ",41.77,90,,33.42,,,0,"percent of total billed charges ","90% of total billed charges ",43.16,93,,34.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.45,85,,31.56,,,0,"percent of total billed charges ","85% of total billed charges ",41.77,90,,33.42,,,0,"percent of total billed charges ","90% of total billed charges ",41.77,90,,33.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.38,87,,32.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.49,70,,25.99,,,0,"percent of total billed charges ","70% of total billed charges ",32.49,43.16,
"SYSTEM PEG 18.61FR",6106479,"CDM ",272,RC,,,OUTPATIENT,,,221.97,177.576,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.58,80,,142.06,,,0,"percent of total billed charges ","80% of total billed charges ",155.38,70,,124.30,,,0,"percent of total billed charges ","70% of total billed charges ",199.77,90,,159.82,,,0,"percent of total billed charges ","90% of total billed charges ",206.43,93,,165.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",188.67,85,,150.94,,,0,"percent of total billed charges ","85% of total billed charges ",199.77,90,,159.82,,,0,"percent of total billed charges ","90% of total billed charges ",199.77,90,,159.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",193.11,87,,154.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.38,70,,124.30,,,0,"percent of total billed charges ","70% of total billed charges ",155.38,206.43,
"HOOD FILTER EFFICIENCY",6106480,"CDM ",272,RC,,,OUTPATIENT,,,128.06,102.448,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.45,80,,81.96,,,0,"percent of total billed charges ","80% of total billed charges ",89.64,70,,71.71,,,0,"percent of total billed charges ","70% of total billed charges ",115.25,90,,92.20,,,0,"percent of total billed charges ","90% of total billed charges ",119.1,93,,95.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",108.85,85,,87.08,,,0,"percent of total billed charges ","85% of total billed charges ",115.25,90,,92.20,,,0,"percent of total billed charges ","90% of total billed charges ",115.25,90,,92.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",111.41,87,,89.13,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",89.64,70,,71.71,,,0,"percent of total billed charges ","70% of total billed charges ",89.64,119.1,
"SUTURE SURG STEEL 22GAX18""",6106484,"CDM ",272,RC,,,OUTPATIENT,,,31.14,24.912,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.91,80,,19.93,,,0,"percent of total billed charges ","80% of total billed charges ",21.8,70,,17.44,,,0,"percent of total billed charges ","70% of total billed charges ",28.03,90,,22.42,,,0,"percent of total billed charges ","90% of total billed charges ",28.96,93,,23.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.47,85,,21.18,,,0,"percent of total billed charges ","85% of total billed charges ",28.03,90,,22.42,,,0,"percent of total billed charges ","90% of total billed charges ",28.03,90,,22.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",27.09,87,,21.67,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.8,70,,17.44,,,0,"percent of total billed charges ","70% of total billed charges ",21.8,28.96,
"SUTURE PANACRYL 36""XLH T583G",6106504,"CDM ",272,RC,,,OUTPATIENT,,,18.3,14.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.64,80,,11.71,,,0,"percent of total billed charges ","80% of total billed charges ",12.81,70,,10.25,,,0,"percent of total billed charges ","70% of total billed charges ",16.47,90,,13.18,,,0,"percent of total billed charges ","90% of total billed charges ",17.02,93,,13.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.56,85,,12.45,,,0,"percent of total billed charges ","85% of total billed charges ",16.47,90,,13.18,,,0,"percent of total billed charges ","90% of total billed charges ",16.47,90,,13.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.92,87,,12.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.81,70,,10.25,,,0,"percent of total billed charges ","70% of total billed charges ",12.81,17.02,
"SUTURE PAMACRYL 60/LOOP T992G",6106505,"CDM ",272,RC,,,OUTPATIENT,,,35.86,28.688,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.69,80,,22.95,,,0,"percent of total billed charges ","80% of total billed charges ",25.1,70,,20.08,,,0,"percent of total billed charges ","70% of total billed charges ",32.27,90,,25.82,,,0,"percent of total billed charges ","90% of total billed charges ",33.35,93,,26.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",30.48,85,,24.38,,,0,"percent of total billed charges ","85% of total billed charges ",32.27,90,,25.82,,,0,"percent of total billed charges ","90% of total billed charges ",32.27,90,,25.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",31.2,87,,24.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.1,70,,20.08,,,0,"percent of total billed charges ","70% of total billed charges ",25.1,33.35,
"SUTURE PANACRYL 1 OS-6 T535H",6106513,"CDM ",272,RC,,,OUTPATIENT,,,21.46,17.168,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.17,80,,13.74,,,0,"percent of total billed charges ","80% of total billed charges ",15.02,70,,12.02,,,0,"percent of total billed charges ","70% of total billed charges ",19.31,90,,15.45,,,0,"percent of total billed charges ","90% of total billed charges ",19.96,93,,15.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.24,85,,14.59,,,0,"percent of total billed charges ","85% of total billed charges ",19.31,90,,15.45,,,0,"percent of total billed charges ","90% of total billed charges ",19.31,90,,15.45,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",18.67,87,,14.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.02,70,,12.02,,,0,"percent of total billed charges ","70% of total billed charges ",15.02,19.96,
"SUTURE PANACRYL 2-0 OS-4 T693H",6106514,"CDM ",272,RC,,,OUTPATIENT,,,22.22,17.776,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.78,80,,14.22,,,0,"percent of total billed charges ","80% of total billed charges ",15.55,70,,12.44,,,0,"percent of total billed charges ","70% of total billed charges ",20,90,,16.00,,,0,"percent of total billed charges ","90% of total billed charges ",20.66,93,,16.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.89,85,,15.11,,,0,"percent of total billed charges ","85% of total billed charges ",20,90,,16.00,,,0,"percent of total billed charges ","90% of total billed charges ",20,90,,16.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.33,87,,15.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.55,70,,12.44,,,0,"percent of total billed charges ","70% of total billed charges ",15.55,20.66,
"STAPLE MENISCAL 11MM",6106529,"CDM ",272,RC,,,OUTPATIENT,,,409.45,327.56,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",327.56,80,,262.05,,,0,"percent of total billed charges ","80% of total billed charges ",286.62,70,,229.30,,,0,"percent of total billed charges ","70% of total billed charges ",368.51,90,,294.81,,,0,"percent of total billed charges ","90% of total billed charges ",380.79,93,,304.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",348.03,85,,278.42,,,0,"percent of total billed charges ","85% of total billed charges ",368.51,90,,294.81,,,0,"percent of total billed charges ","90% of total billed charges ",368.51,90,,294.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",356.22,87,,284.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",286.62,70,,229.30,,,0,"percent of total billed charges ","70% of total billed charges ",286.62,380.79,
"SPLINT NASAL SM/MED",6106530,"CDM ",272,RC,,,OUTPATIENT,,,213.05,170.44,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.44,80,,136.35,,,0,"percent of total billed charges ","80% of total billed charges ",149.14,70,,119.31,,,0,"percent of total billed charges ","70% of total billed charges ",191.75,90,,153.40,,,0,"percent of total billed charges ","90% of total billed charges ",198.14,93,,158.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",181.09,85,,144.87,,,0,"percent of total billed charges ","85% of total billed charges ",191.75,90,,153.40,,,0,"percent of total billed charges ","90% of total billed charges ",191.75,90,,153.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",185.35,87,,148.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.14,70,,119.31,,,0,"percent of total billed charges ","70% of total billed charges ",149.14,198.14,
"SPLINT NASAL LG",6106531,"CDM ",272,RC,,,OUTPATIENT,,,214.07,171.256,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",171.26,80,,137.01,,,0,"percent of total billed charges ","80% of total billed charges ",149.85,70,,119.88,,,0,"percent of total billed charges ","70% of total billed charges ",192.66,90,,154.13,,,0,"percent of total billed charges ","90% of total billed charges ",199.09,93,,159.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",181.96,85,,145.57,,,0,"percent of total billed charges ","85% of total billed charges ",192.66,90,,154.13,,,0,"percent of total billed charges ","90% of total billed charges ",192.66,90,,154.13,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",186.24,87,,148.99,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.85,70,,119.88,,,0,"percent of total billed charges ","70% of total billed charges ",149.85,199.09,
"BLADE SAGITAL 19.5MX55M",6106540,"CDM ",272,RC,,,OUTPATIENT,,,86.59,69.272,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.27,80,,55.42,,,0,"percent of total billed charges ","80% of total billed charges ",60.61,70,,48.49,,,0,"percent of total billed charges ","70% of total billed charges ",77.93,90,,62.34,,,0,"percent of total billed charges ","90% of total billed charges ",80.53,93,,64.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",73.6,85,,58.88,,,0,"percent of total billed charges ","85% of total billed charges ",77.93,90,,62.34,,,0,"percent of total billed charges ","90% of total billed charges ",77.93,90,,62.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",75.33,87,,60.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.61,70,,48.49,,,0,"percent of total billed charges ","70% of total billed charges ",60.61,80.53,
"TUBE EAR ARMSTRONG BEVELED GRO",6106546,"CDM ",272,RC,,,OUTPATIENT,,,45.65,36.52,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.52,80,,29.22,,,0,"percent of total billed charges ","80% of total billed charges ",31.96,70,,25.57,,,0,"percent of total billed charges ","70% of total billed charges ",41.09,90,,32.87,,,0,"percent of total billed charges ","90% of total billed charges ",42.45,93,,33.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.8,85,,31.04,,,0,"percent of total billed charges ","85% of total billed charges ",41.09,90,,32.87,,,0,"percent of total billed charges ","90% of total billed charges ",41.09,90,,32.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.72,87,,31.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.96,70,,25.57,,,0,"percent of total billed charges ","70% of total billed charges ",31.96,42.45,
"PROSTHESIS PISTON 60X4.25",6106547,"CDM ",278,RC,,,OUTPATIENT,,,278,222.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",222.4,80,,177.92,,,0,"percent of total billed charges ","80% of total billed charges ",194.6,70,,155.68,,,0,"percent of total billed charges ","70% of total billed charges ",250.2,90,,200.16,,,0,"percent of total billed charges ","90% of total billed charges ",258.54,93,,206.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",236.3,85,,189.04,,,0,"percent of total billed charges ","85% of total billed charges ",236.3,85,,189.04,,,0,"percent of total billed charges ","85% of total billed charges ",250.2,90,,200.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",241.86,87,,193.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",194.6,70,,155.68,,,0,"percent of total billed charges ","70% of total billed charges ",194.6,258.54,
"PROSTHESIS PISTON 60X4.50",6106548,"CDM ",278,RC,,,OUTPATIENT,,,278,222.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",222.4,80,,177.92,,,0,"percent of total billed charges ","80% of total billed charges ",194.6,70,,155.68,,,0,"percent of total billed charges ","70% of total billed charges ",250.2,90,,200.16,,,0,"percent of total billed charges ","90% of total billed charges ",258.54,93,,206.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",236.3,85,,189.04,,,0,"percent of total billed charges ","85% of total billed charges ",236.3,85,,189.04,,,0,"percent of total billed charges ","85% of total billed charges ",250.2,90,,200.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",241.86,87,,193.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",194.6,70,,155.68,,,0,"percent of total billed charges ","70% of total billed charges ",194.6,258.54,
"PROSTHESIS PISTON 60X4.75",6106549,"CDM ",278,RC,,,OUTPATIENT,,,278,222.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",222.4,80,,177.92,,,0,"percent of total billed charges ","80% of total billed charges ",194.6,70,,155.68,,,0,"percent of total billed charges ","70% of total billed charges ",250.2,90,,200.16,,,0,"percent of total billed charges ","90% of total billed charges ",258.54,93,,206.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",236.3,85,,189.04,,,0,"percent of total billed charges ","85% of total billed charges ",236.3,85,,189.04,,,0,"percent of total billed charges ","85% of total billed charges ",250.2,90,,200.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",241.86,87,,193.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",194.6,70,,155.68,,,0,"percent of total billed charges ","70% of total billed charges ",194.6,258.54,
"PROSTHESIS PISTON 60X4.00",6106550,"CDM ",278,RC,,,OUTPATIENT,,,278,222.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",222.4,80,,177.92,,,0,"percent of total billed charges ","80% of total billed charges ",194.6,70,,155.68,,,0,"percent of total billed charges ","70% of total billed charges ",250.2,90,,200.16,,,0,"percent of total billed charges ","90% of total billed charges ",258.54,93,,206.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",236.3,85,,189.04,,,0,"percent of total billed charges ","85% of total billed charges ",236.3,85,,189.04,,,0,"percent of total billed charges ","85% of total billed charges ",250.2,90,,200.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",241.86,87,,193.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",194.6,70,,155.68,,,0,"percent of total billed charges ","70% of total billed charges ",194.6,258.54,
"PROSTHESIS PISTON 60X5.00",6106551,"CDM ",278,RC,,,OUTPATIENT,,,278,222.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",222.4,80,,177.92,,,0,"percent of total billed charges ","80% of total billed charges ",194.6,70,,155.68,,,0,"percent of total billed charges ","70% of total billed charges ",250.2,90,,200.16,,,0,"percent of total billed charges ","90% of total billed charges ",258.54,93,,206.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",236.3,85,,189.04,,,0,"percent of total billed charges ","85% of total billed charges ",236.3,85,,189.04,,,0,"percent of total billed charges ","85% of total billed charges ",250.2,90,,200.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",241.86,87,,193.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",194.6,70,,155.68,,,0,"percent of total billed charges ","70% of total billed charges ",194.6,258.54,
"PROSTHESIS PISTON 60X3.75",6106552,"CDM ",278,RC,,,OUTPATIENT,,,278,222.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",222.4,80,,177.92,,,0,"percent of total billed charges ","80% of total billed charges ",194.6,70,,155.68,,,0,"percent of total billed charges ","70% of total billed charges ",250.2,90,,200.16,,,0,"percent of total billed charges ","90% of total billed charges ",258.54,93,,206.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",236.3,85,,189.04,,,0,"percent of total billed charges ","85% of total billed charges ",236.3,85,,189.04,,,0,"percent of total billed charges ","85% of total billed charges ",250.2,90,,200.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",241.86,87,,193.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",194.6,70,,155.68,,,0,"percent of total billed charges ","70% of total billed charges ",194.6,258.54,
"PROSTHESIS EAR OFF CENTED PP",6106553,"CDM ",278,RC,,,OUTPATIENT,,,770.22,616.176,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",616.18,80,,492.94,,,0,"percent of total billed charges ","80% of total billed charges ",539.15,70,,431.32,,,0,"percent of total billed charges ","70% of total billed charges ",693.2,90,,554.56,,,0,"percent of total billed charges ","90% of total billed charges ",716.3,93,,573.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",654.69,85,,523.75,,,0,"percent of total billed charges ","85% of total billed charges ",654.69,85,,523.75,,,0,"percent of total billed charges ","85% of total billed charges ",693.2,90,,554.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",670.09,87,,536.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",539.15,70,,431.32,,,0,"percent of total billed charges ","70% of total billed charges ",539.15,716.3,
"PROSTHESIS EAR MAL OFF PP",6106555,"CDM ",278,RC,,,OUTPATIENT,,,793.32,634.656,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",634.66,80,,507.73,,,0,"percent of total billed charges ","80% of total billed charges ",555.32,70,,444.26,,,0,"percent of total billed charges ","70% of total billed charges ",713.99,90,,571.19,,,0,"percent of total billed charges ","90% of total billed charges ",737.79,93,,590.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",674.32,85,,539.46,,,0,"percent of total billed charges ","85% of total billed charges ",674.32,85,,539.46,,,0,"percent of total billed charges ","85% of total billed charges ",713.99,90,,571.19,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",690.19,87,,552.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",555.32,70,,444.26,,,0,"percent of total billed charges ","70% of total billed charges ",555.32,737.79,
"PROSTHESIS EAR MAL OFF TD",6106556,"CDM ",278,RC,,,OUTPATIENT,,,770.22,616.176,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",616.18,80,,492.94,,,0,"percent of total billed charges ","80% of total billed charges ",539.15,70,,431.32,,,0,"percent of total billed charges ","70% of total billed charges ",693.2,90,,554.56,,,0,"percent of total billed charges ","90% of total billed charges ",716.3,93,,573.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",654.69,85,,523.75,,,0,"percent of total billed charges ","85% of total billed charges ",654.69,85,,523.75,,,0,"percent of total billed charges ","85% of total billed charges ",693.2,90,,554.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",670.09,87,,536.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",539.15,70,,431.32,,,0,"percent of total billed charges ","70% of total billed charges ",539.15,716.3,
"PROSTHESIS STAPEDIAL LG HA",6106557,"CDM ",278,RC,,,OUTPATIENT,,,678.83,543.064,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",543.06,80,,434.45,,,0,"percent of total billed charges ","80% of total billed charges ",475.18,70,,380.14,,,0,"percent of total billed charges ","70% of total billed charges ",610.95,90,,488.76,,,0,"percent of total billed charges ","90% of total billed charges ",631.31,93,,505.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",577.01,85,,461.61,,,0,"percent of total billed charges ","85% of total billed charges ",577.01,85,,461.61,,,0,"percent of total billed charges ","85% of total billed charges ",610.95,90,,488.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",590.58,87,,472.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",475.18,70,,380.14,,,0,"percent of total billed charges ","70% of total billed charges ",475.18,631.31,
"PROSTHESIS STAPEDIAL SM HA",6106558,"CDM ",278,RC,,,OUTPATIENT,,,678.83,543.064,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",543.06,80,,434.45,,,0,"percent of total billed charges ","80% of total billed charges ",475.18,70,,380.14,,,0,"percent of total billed charges ","70% of total billed charges ",610.95,90,,488.76,,,0,"percent of total billed charges ","90% of total billed charges ",631.31,93,,505.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",577.01,85,,461.61,,,0,"percent of total billed charges ","85% of total billed charges ",577.01,85,,461.61,,,0,"percent of total billed charges ","85% of total billed charges ",610.95,90,,488.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",590.58,87,,472.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",475.18,70,,380.14,,,0,"percent of total billed charges ","70% of total billed charges ",475.18,631.31,
"NDL STIMUPLEX 22G X 3 1/8""",6106560,"CDM ",270,RC,,,OUTPATIENT,,,62.12,49.696,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.7,80,,39.76,,,0,"percent of total billed charges ","80% of total billed charges ",43.48,70,,34.78,,,0,"percent of total billed charges ","70% of total billed charges ",55.91,90,,44.73,,,0,"percent of total billed charges ","90% of total billed charges ",57.77,93,,46.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",52.8,85,,42.24,,,0,"percent of total billed charges ","85% of total billed charges ",55.91,90,,44.73,,,0,"percent of total billed charges ","90% of total billed charges ",55.91,90,,44.73,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",54.04,87,,43.23,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.48,70,,34.78,,,0,"percent of total billed charges ","70% of total billed charges ",43.48,57.77,
"NDL STIMUPLEX 22G X 2""",6106561,"CDM ",270,RC,,,OUTPATIENT,,,56.8,45.44,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.44,80,,36.35,,,0,"percent of total billed charges ","80% of total billed charges ",39.76,70,,31.81,,,0,"percent of total billed charges ","70% of total billed charges ",51.12,90,,40.90,,,0,"percent of total billed charges ","90% of total billed charges ",52.82,93,,42.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",48.28,85,,38.62,,,0,"percent of total billed charges ","85% of total billed charges ",51.12,90,,40.90,,,0,"percent of total billed charges ","90% of total billed charges ",51.12,90,,40.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",49.42,87,,39.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.76,70,,31.81,,,0,"percent of total billed charges ","70% of total billed charges ",39.76,52.82,
"NDL STIMUPLEX 20G X 4""",6106562,"CDM ",270,RC,,,OUTPATIENT,,,64.69,51.752,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.75,80,,41.40,,,0,"percent of total billed charges ","80% of total billed charges ",45.28,70,,36.22,,,0,"percent of total billed charges ","70% of total billed charges ",58.22,90,,46.58,,,0,"percent of total billed charges ","90% of total billed charges ",60.16,93,,48.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",54.99,85,,43.99,,,0,"percent of total billed charges ","85% of total billed charges ",58.22,90,,46.58,,,0,"percent of total billed charges ","90% of total billed charges ",58.22,90,,46.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",56.28,87,,45.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.28,70,,36.22,,,0,"percent of total billed charges ","70% of total billed charges ",45.28,60.16,
"PACKING NASAL 10.0 CM",6106568,"CDM ",272,RC,,,OUTPATIENT,,,43.13,34.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.5,80,,27.60,,,0,"percent of total billed charges ","80% of total billed charges ",30.19,70,,24.15,,,0,"percent of total billed charges ","70% of total billed charges ",38.82,90,,31.06,,,0,"percent of total billed charges ","90% of total billed charges ",40.11,93,,32.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",36.66,85,,29.33,,,0,"percent of total billed charges ","85% of total billed charges ",38.82,90,,31.06,,,0,"percent of total billed charges ","90% of total billed charges ",38.82,90,,31.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",37.52,87,,30.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.19,70,,24.15,,,0,"percent of total billed charges ","70% of total billed charges ",30.19,40.11,
"PACKING NASAL 3.5 CM",6106569,"CDM ",272,RC,,,OUTPATIENT,,,53.34,42.672,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.67,80,,34.14,,,0,"percent of total billed charges ","80% of total billed charges ",37.34,70,,29.87,,,0,"percent of total billed charges ","70% of total billed charges ",48.01,90,,38.41,,,0,"percent of total billed charges ","90% of total billed charges ",49.61,93,,39.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",45.34,85,,36.27,,,0,"percent of total billed charges ","85% of total billed charges ",48.01,90,,38.41,,,0,"percent of total billed charges ","90% of total billed charges ",48.01,90,,38.41,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",46.41,87,,37.13,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.34,70,,29.87,,,0,"percent of total billed charges ","70% of total billed charges ",37.34,49.61,
"TUBE TRACH CUFFED SHILEY SZ 2",6106571,"CDM ",272,RC,,,OUTPATIENT,,,141.97,113.576,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.58,80,,90.86,,,0,"percent of total billed charges ","80% of total billed charges ",99.38,70,,79.50,,,0,"percent of total billed charges ","70% of total billed charges ",127.77,90,,102.22,,,0,"percent of total billed charges ","90% of total billed charges ",132.03,93,,105.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",120.67,85,,96.54,,,0,"percent of total billed charges ","85% of total billed charges ",127.77,90,,102.22,,,0,"percent of total billed charges ","90% of total billed charges ",127.77,90,,102.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",123.51,87,,98.81,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.38,70,,79.50,,,0,"percent of total billed charges ","70% of total billed charges ",99.38,132.03,
"BRNG TIBIA VE PS 10X63/67MM",6106611,"CDM ",278,RC,,,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"BRNG TIBIA VE PS 12X63/67MM",6106612,"CDM ",278,RC,,,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"BRNG TIBIA VE PS 10X71/75MM",6106625,"CDM ",278,RC,,,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"BRNG TIBIA VE PS 12X71/75MM",6106626,"CDM ",278,RC,,,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"BRNG TIBIA VE PS 14X71/75MM",6106632,"CDM ",272,RC,,,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"BRNG TIBIA VE PS 16X71/75MM",6106633,"CDM ",278,RC,,,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"BRNG TIBIA VE PS 18X71/75MM",6106640,"CDM ",278,RC,,,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"BRNG TIBIA VE PS 10X79/83MM",6106641,"CDM ",278,RC,,,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"BRNG TIBIA VE PS 12X79/83MM",6106642,"CDM ",278,RC,,,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"BRNG TIBIA VE PS 14X79/83MM",6106643,"CDM ",278,RC,,,OUTPATIENT,,,2450.25,1960.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1960.2,80,,1568.16,,,0,"percent of total billed charges ","80% of total billed charges ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",2278.73,93,,1822.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2082.71,85,,1666.17,,,0,"percent of total billed charges ","85% of total billed charges ",2205.23,90,,1764.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2131.72,87,,1705.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1715.18,70,,1372.14,,,0,"percent of total billed charges ","70% of total billed charges ",1715.18,2278.73,
"SEALANT HEMOSTATIC MATRIX",6106672,"CDM ",272,RC,,,OUTPATIENT,,,344.8,275.84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",275.84,80,,220.67,,,0,"percent of total billed charges ","80% of total billed charges ",241.36,70,,193.09,,,0,"percent of total billed charges ","70% of total billed charges ",310.32,90,,248.26,,,0,"percent of total billed charges ","90% of total billed charges ",320.66,93,,256.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",293.08,85,,234.46,,,0,"percent of total billed charges ","85% of total billed charges ",310.32,90,,248.26,,,0,"percent of total billed charges ","90% of total billed charges ",310.32,90,,248.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",299.98,87,,239.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.36,70,,193.09,,,0,"percent of total billed charges ","70% of total billed charges ",241.36,320.66,
"DRAPE MICROSCOPE 54 X 150""",6106729,"CDM ",272,RC,,,OUTPATIENT,,,195.14,156.112,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.11,80,,124.89,,,0,"percent of total billed charges ","80% of total billed charges ",136.6,70,,109.28,,,0,"percent of total billed charges ","70% of total billed charges ",175.63,90,,140.50,,,0,"percent of total billed charges ","90% of total billed charges ",181.48,93,,145.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",165.87,85,,132.70,,,0,"percent of total billed charges ","85% of total billed charges ",175.63,90,,140.50,,,0,"percent of total billed charges ","90% of total billed charges ",175.63,90,,140.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",169.77,87,,135.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136.6,70,,109.28,,,0,"percent of total billed charges ","70% of total billed charges ",136.6,181.48,
"BURR ROUND DIAMOND 1.5",6106739,"CDM ",272,RC,,,OUTPATIENT,,,326.43,261.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",261.14,80,,208.91,,,0,"percent of total billed charges ","80% of total billed charges ",228.5,70,,182.80,,,0,"percent of total billed charges ","70% of total billed charges ",293.79,90,,235.03,,,0,"percent of total billed charges ","90% of total billed charges ",303.58,93,,242.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",277.47,85,,221.98,,,0,"percent of total billed charges ","85% of total billed charges ",293.79,90,,235.03,,,0,"percent of total billed charges ","90% of total billed charges ",293.79,90,,235.03,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",283.99,87,,227.19,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",228.5,70,,182.80,,,0,"percent of total billed charges ","70% of total billed charges ",228.5,303.58,
"APOLLO RF 50 DEGREE ASP ABLATR",6106740,"CDM ",272,RC,,,OUTPATIENT,,,538.75,431,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",431,80,,344.80,,,0,"percent of total billed charges ","80% of total billed charges ",377.13,70,,301.70,,,0,"percent of total billed charges ","70% of total billed charges ",484.88,90,,387.90,,,0,"percent of total billed charges ","90% of total billed charges ",501.04,93,,400.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",457.94,85,,366.35,,,0,"percent of total billed charges ","85% of total billed charges ",484.88,90,,387.90,,,0,"percent of total billed charges ","90% of total billed charges ",484.88,90,,387.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",468.71,87,,374.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",377.13,70,,301.70,,,0,"percent of total billed charges ","70% of total billed charges ",377.13,501.04,
"BURR ROUND DIAMOND 5.0",6106741,"CDM ",272,RC,,,OUTPATIENT,,,355.34,284.272,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",284.27,80,,227.42,,,0,"percent of total billed charges ","80% of total billed charges ",248.74,70,,198.99,,,0,"percent of total billed charges ","70% of total billed charges ",319.81,90,,255.85,,,0,"percent of total billed charges ","90% of total billed charges ",330.47,93,,264.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",302.04,85,,241.63,,,0,"percent of total billed charges ","85% of total billed charges ",319.81,90,,255.85,,,0,"percent of total billed charges ","90% of total billed charges ",319.81,90,,255.85,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",309.15,87,,247.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",248.74,70,,198.99,,,0,"percent of total billed charges ","70% of total billed charges ",248.74,330.47,
"BURR ROUND  5.5",6106742,"CDM ",272,RC,,,OUTPATIENT,,,147.84,118.272,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.27,80,,94.62,,,0,"percent of total billed charges ","80% of total billed charges ",103.49,70,,82.79,,,0,"percent of total billed charges ","70% of total billed charges ",133.06,90,,106.45,,,0,"percent of total billed charges ","90% of total billed charges ",137.49,93,,109.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",125.66,85,,100.53,,,0,"percent of total billed charges ","85% of total billed charges ",133.06,90,,106.45,,,0,"percent of total billed charges ","90% of total billed charges ",133.06,90,,106.45,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",128.62,87,,102.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.49,70,,82.79,,,0,"percent of total billed charges ","70% of total billed charges ",103.49,137.49,
"BURR FISSURE",6106744,"CDM ",272,RC,,,OUTPATIENT,,,223.67,178.936,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.94,80,,143.15,,,0,"percent of total billed charges ","80% of total billed charges ",156.57,70,,125.26,,,0,"percent of total billed charges ","70% of total billed charges ",201.3,90,,161.04,,,0,"percent of total billed charges ","90% of total billed charges ",208.01,93,,166.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",190.12,85,,152.10,,,0,"percent of total billed charges ","85% of total billed charges ",201.3,90,,161.04,,,0,"percent of total billed charges ","90% of total billed charges ",201.3,90,,161.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",194.59,87,,155.67,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.57,70,,125.26,,,0,"percent of total billed charges ","70% of total billed charges ",156.57,208.01,
"SUTURE RELOAD O-VICRYL SW210",6106747,"CDM ",272,RC,,,OUTPATIENT,,,102.41,81.928,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.93,80,,65.54,,,0,"percent of total billed charges ","80% of total billed charges ",71.69,70,,57.35,,,0,"percent of total billed charges ","70% of total billed charges ",92.17,90,,73.74,,,0,"percent of total billed charges ","90% of total billed charges ",95.24,93,,76.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",87.05,85,,69.64,,,0,"percent of total billed charges ","85% of total billed charges ",92.17,90,,73.74,,,0,"percent of total billed charges ","90% of total billed charges ",92.17,90,,73.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",89.1,87,,71.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.69,70,,57.35,,,0,"percent of total billed charges ","70% of total billed charges ",71.69,95.24,
"SUTURE VICRYL 2-0 SW212",6106748,"CDM ",272,RC,,,OUTPATIENT,,,128.77,103.016,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.02,80,,82.42,,,0,"percent of total billed charges ","80% of total billed charges ",90.14,70,,72.11,,,0,"percent of total billed charges ","70% of total billed charges ",115.89,90,,92.71,,,0,"percent of total billed charges ","90% of total billed charges ",119.76,93,,95.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",109.45,85,,87.56,,,0,"percent of total billed charges ","85% of total billed charges ",115.89,90,,92.71,,,0,"percent of total billed charges ","90% of total billed charges ",115.89,90,,92.71,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",112.03,87,,89.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.14,70,,72.11,,,0,"percent of total billed charges ","70% of total billed charges ",90.14,119.76,
"TUBE FEED/COMPRESSION PULL",6106752,"CDM ",272,RC,,,OUTPATIENT,,,213.13,170.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.5,80,,136.40,,,0,"percent of total billed charges ","80% of total billed charges ",149.19,70,,119.35,,,0,"percent of total billed charges ","70% of total billed charges ",191.82,90,,153.46,,,0,"percent of total billed charges ","90% of total billed charges ",198.21,93,,158.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",181.16,85,,144.93,,,0,"percent of total billed charges ","85% of total billed charges ",191.82,90,,153.46,,,0,"percent of total billed charges ","90% of total billed charges ",191.82,90,,153.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",185.42,87,,148.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.19,70,,119.35,,,0,"percent of total billed charges ","70% of total billed charges ",149.19,198.21,
"PATELLA STD 3 PEG 37X10MM",6106771,"CDM ",278,RC,,,OUTPATIENT,,,969.75,775.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",775.8,80,,620.64,,,0,"percent of total billed charges ","80% of total billed charges ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",901.87,93,,721.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",843.68,87,,674.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",678.83,901.87,
"CANNULA J 25 GAUGE STRAIGHT",6106800,"CDM ",272,RC,,,OUTPATIENT,,,13.54,10.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.83,80,,8.66,,,0,"percent of total billed charges ","80% of total billed charges ",9.48,70,,7.58,,,0,"percent of total billed charges ","70% of total billed charges ",12.19,90,,9.75,,,0,"percent of total billed charges ","90% of total billed charges ",12.59,93,,10.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.51,85,,9.21,,,0,"percent of total billed charges ","85% of total billed charges ",12.19,90,,9.75,,,0,"percent of total billed charges ","90% of total billed charges ",12.19,90,,9.75,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.78,87,,9.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.48,70,,7.58,,,0,"percent of total billed charges ","70% of total billed charges ",9.48,12.59,
"SUTURE 2-0 VICRYL 6""",6106815,"CDM ",272,RC,,,OUTPATIENT,,,102.41,81.928,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.93,80,,65.54,,,0,"percent of total billed charges ","80% of total billed charges ",71.69,70,,57.35,,,0,"percent of total billed charges ","70% of total billed charges ",92.17,90,,73.74,,,0,"percent of total billed charges ","90% of total billed charges ",95.24,93,,76.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",87.05,85,,69.64,,,0,"percent of total billed charges ","85% of total billed charges ",92.17,90,,73.74,,,0,"percent of total billed charges ","90% of total billed charges ",92.17,90,,73.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",89.1,87,,71.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.69,70,,57.35,,,0,"percent of total billed charges ","70% of total billed charges ",71.69,95.24,
"BLADE CORNEA ANGLE 3.0MM",6106816,"CDM ",272,RC,,,OUTPATIENT,,,61.83,49.464,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.46,80,,39.57,,,0,"percent of total billed charges ","80% of total billed charges ",43.28,70,,34.62,,,0,"percent of total billed charges ","70% of total billed charges ",55.65,90,,44.52,,,0,"percent of total billed charges ","90% of total billed charges ",57.5,93,,46.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",52.56,85,,42.05,,,0,"percent of total billed charges ","85% of total billed charges ",55.65,90,,44.52,,,0,"percent of total billed charges ","90% of total billed charges ",55.65,90,,44.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",53.79,87,,43.03,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.28,70,,34.62,,,0,"percent of total billed charges ","70% of total billed charges ",43.28,57.5,
"DRESSING DURAHESIVE 57MM",6106874,"CDM ",272,RC,,,OUTPATIENT,,,22,17.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,80,,14.08,,,0,"percent of total billed charges ","80% of total billed charges ",15.4,70,,12.32,,,0,"percent of total billed charges ","70% of total billed charges ",19.8,90,,15.84,,,0,"percent of total billed charges ","90% of total billed charges ",20.46,93,,16.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.7,85,,14.96,,,0,"percent of total billed charges ","85% of total billed charges ",19.8,90,,15.84,,,0,"percent of total billed charges ","90% of total billed charges ",19.8,90,,15.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.14,87,,15.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.4,70,,12.32,,,0,"percent of total billed charges ","70% of total billed charges ",15.4,20.46,
"UNIT DOSE PACK 57MM",6106876,"CDM ",272,RC,,,OUTPATIENT,,,53.5,42.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.8,80,,34.24,,,0,"percent of total billed charges ","80% of total billed charges ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",49.76,93,,39.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",45.48,85,,36.38,,,0,"percent of total billed charges ","85% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",48.15,90,,38.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",46.55,87,,37.24,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.45,70,,29.96,,,0,"percent of total billed charges ","70% of total billed charges ",37.45,49.76,
"SUTURE ANCHOR 3.0MM BIOPHASE",6106888,"CDM ",272,RC,,,OUTPATIENT,,,571.08,456.864,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",456.86,80,,365.49,,,0,"percent of total billed charges ","80% of total billed charges ",399.76,70,,319.81,,,0,"percent of total billed charges ","70% of total billed charges ",513.97,90,,411.18,,,0,"percent of total billed charges ","90% of total billed charges ",531.1,93,,424.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",485.42,85,,388.34,,,0,"percent of total billed charges ","85% of total billed charges ",513.97,90,,411.18,,,0,"percent of total billed charges ","90% of total billed charges ",513.97,90,,411.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",496.84,87,,397.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",399.76,70,,319.81,,,0,"percent of total billed charges ","70% of total billed charges ",399.76,531.1,
"PIN HALF 4MM X CM THDX15CM DAL",6106902,"CDM ",278,RC,,,OUTPATIENT,,,328.1,262.48,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",262.48,80,,209.98,,,0,"percent of total billed charges ","80% of total billed charges ",229.67,70,,183.74,,,0,"percent of total billed charges ","70% of total billed charges ",295.29,90,,236.23,,,0,"percent of total billed charges ","90% of total billed charges ",305.13,93,,244.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",278.89,85,,223.11,,,0,"percent of total billed charges ","85% of total billed charges ",278.89,85,,223.11,,,0,"percent of total billed charges ","85% of total billed charges ",295.29,90,,236.23,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",285.45,87,,228.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",229.67,70,,183.74,,,0,"percent of total billed charges ","70% of total billed charges ",229.67,305.13,
"PIN TRANSFIXION 5MMX8""""",6106903,"CDM ",278,RC,,,OUTPATIENT,,,341,272.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",272.8,80,,218.24,,,0,"percent of total billed charges ","80% of total billed charges ",238.7,70,,190.96,,,0,"percent of total billed charges ","70% of total billed charges ",306.9,90,,245.52,,,0,"percent of total billed charges ","90% of total billed charges ",317.13,93,,253.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",289.85,85,,231.88,,,0,"percent of total billed charges ","85% of total billed charges ",289.85,85,,231.88,,,0,"percent of total billed charges ","85% of total billed charges ",306.9,90,,245.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",296.67,87,,237.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",238.7,70,,190.96,,,0,"percent of total billed charges ","70% of total billed charges ",238.7,317.13,
"PIN HALF 4MMX4CM THDX16CM OAL",6106919,"CDM ",278,RC,,,OUTPATIENT,,,390.15,312.12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",312.12,80,,249.70,,,0,"percent of total billed charges ","80% of total billed charges ",273.11,70,,218.49,,,0,"percent of total billed charges ","70% of total billed charges ",351.14,90,,280.91,,,0,"percent of total billed charges ","90% of total billed charges ",362.84,93,,290.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",331.63,85,,265.30,,,0,"percent of total billed charges ","85% of total billed charges ",331.63,85,,265.30,,,0,"percent of total billed charges ","85% of total billed charges ",351.14,90,,280.91,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",339.43,87,,271.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.11,70,,218.49,,,0,"percent of total billed charges ","70% of total billed charges ",273.11,362.84,
"PIN HALF 5MMX5C THDX20CM OAL",6106920,"CDM ",278,RC,,,OUTPATIENT,,,373.35,298.68,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",298.68,80,,238.94,,,0,"percent of total billed charges ","80% of total billed charges ",261.35,70,,209.08,,,0,"percent of total billed charges ","70% of total billed charges ",336.02,90,,268.82,,,0,"percent of total billed charges ","90% of total billed charges ",347.22,93,,277.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",317.35,85,,253.88,,,0,"percent of total billed charges ","85% of total billed charges ",317.35,85,,253.88,,,0,"percent of total billed charges ","85% of total billed charges ",336.02,90,,268.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",324.81,87,,259.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",261.35,70,,209.08,,,0,"percent of total billed charges ","70% of total billed charges ",261.35,347.22,
"PIN HALF 5MM X 30MM FINE",6106921,"CDM ",278,RC,,,OUTPATIENT,,,392.02,313.616,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",313.62,80,,250.90,,,0,"percent of total billed charges ","80% of total billed charges ",274.41,70,,219.53,,,0,"percent of total billed charges ","70% of total billed charges ",352.82,90,,282.26,,,0,"percent of total billed charges ","90% of total billed charges ",364.58,93,,291.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",333.22,85,,266.58,,,0,"percent of total billed charges ","85% of total billed charges ",333.22,85,,266.58,,,0,"percent of total billed charges ","85% of total billed charges ",352.82,90,,282.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",341.06,87,,272.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",274.41,70,,219.53,,,0,"percent of total billed charges ","70% of total billed charges ",274.41,364.58,
"PIN HALF 5MM X 50MM FINE",6106923,"CDM ",278,RC,,,OUTPATIENT,,,298.38,238.704,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",238.7,80,,190.96,,,0,"percent of total billed charges ","80% of total billed charges ",208.87,70,,167.10,,,0,"percent of total billed charges ","70% of total billed charges ",268.54,90,,214.83,,,0,"percent of total billed charges ","90% of total billed charges ",277.49,93,,221.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",253.62,85,,202.90,,,0,"percent of total billed charges ","85% of total billed charges ",253.62,85,,202.90,,,0,"percent of total billed charges ","85% of total billed charges ",268.54,90,,214.83,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",259.59,87,,207.67,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",208.87,70,,167.10,,,0,"percent of total billed charges ","70% of total billed charges ",208.87,277.49,
"ADAPTER PIN",6106932,"CDM ",272,RC,,,OUTPATIENT,,,475.18,380.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",380.14,80,,304.11,,,0,"percent of total billed charges ","80% of total billed charges ",332.63,70,,266.10,,,0,"percent of total billed charges ","70% of total billed charges ",427.66,90,,342.13,,,0,"percent of total billed charges ","90% of total billed charges ",441.92,93,,353.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",403.9,85,,323.12,,,0,"percent of total billed charges ","85% of total billed charges ",427.66,90,,342.13,,,0,"percent of total billed charges ","90% of total billed charges ",427.66,90,,342.13,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",413.41,87,,330.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",332.63,70,,266.10,,,0,"percent of total billed charges ","70% of total billed charges ",332.63,441.92,
"PATELLA STD 3 PEG 40X10MM",6106954,"CDM ",278,RC,,,OUTPATIENT,,,969.75,775.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",775.8,80,,620.64,,,0,"percent of total billed charges ","80% of total billed charges ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",901.87,93,,721.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",843.68,87,,674.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",678.83,901.87,
"CANNULA J 25 GAUGE ANGLED",6106955,"CDM ",272,RC,,,OUTPATIENT,,,15.05,12.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.04,80,,9.63,,,0,"percent of total billed charges ","80% of total billed charges ",10.54,70,,8.43,,,0,"percent of total billed charges ","70% of total billed charges ",13.55,90,,10.84,,,0,"percent of total billed charges ","90% of total billed charges ",14,93,,11.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.79,85,,10.23,,,0,"percent of total billed charges ","85% of total billed charges ",13.55,90,,10.84,,,0,"percent of total billed charges ","90% of total billed charges ",13.55,90,,10.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.09,87,,10.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.54,70,,8.43,,,0,"percent of total billed charges ","70% of total billed charges ",10.54,14,
"CUTTING LOOP 24FR (CIRCON)",6106964,"CDM ",272,RC,,,OUTPATIENT,,,321.32,257.056,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",257.06,80,,205.65,,,0,"percent of total billed charges ","80% of total billed charges ",224.92,70,,179.94,,,0,"percent of total billed charges ","70% of total billed charges ",289.19,90,,231.35,,,0,"percent of total billed charges ","90% of total billed charges ",298.83,93,,239.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",273.12,85,,218.50,,,0,"percent of total billed charges ","85% of total billed charges ",289.19,90,,231.35,,,0,"percent of total billed charges ","90% of total billed charges ",289.19,90,,231.35,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",279.55,87,,223.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",224.92,70,,179.94,,,0,"percent of total billed charges ","70% of total billed charges ",224.92,298.83,
"CABLE STEEL FOR BONE PLATE",6107182,"CDM ",278,RC,,,OUTPATIENT,,,481.21,384.968,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",384.97,80,,307.98,,,0,"percent of total billed charges ","80% of total billed charges ",336.85,70,,269.48,,,0,"percent of total billed charges ","70% of total billed charges ",433.09,90,,346.47,,,0,"percent of total billed charges ","90% of total billed charges ",447.53,93,,358.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",409.03,85,,327.22,,,0,"percent of total billed charges ","85% of total billed charges ",409.03,85,,327.22,,,0,"percent of total billed charges ","85% of total billed charges ",433.09,90,,346.47,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",418.65,87,,334.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",336.85,70,,269.48,,,0,"percent of total billed charges ","70% of total billed charges ",336.85,447.53,
"CABLE ASSEMBLY STAINLESS STEEL",6107183,"CDM ",278,RC,,,OUTPATIENT,,,668.27,534.616,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",534.62,80,,427.70,,,0,"percent of total billed charges ","80% of total billed charges ",467.79,70,,374.23,,,0,"percent of total billed charges ","70% of total billed charges ",601.44,90,,481.15,,,0,"percent of total billed charges ","90% of total billed charges ",621.49,93,,497.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",568.03,85,,454.42,,,0,"percent of total billed charges ","85% of total billed charges ",568.03,85,,454.42,,,0,"percent of total billed charges ","85% of total billed charges ",601.44,90,,481.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",581.39,87,,465.11,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",467.79,70,,374.23,,,0,"percent of total billed charges ","70% of total billed charges ",467.79,621.49,
"HEX BUTTON 3.5MM",6107184,"CDM ",278,RC,,,OUTPATIENT,,,240.21,192.168,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",192.17,80,,153.74,,,0,"percent of total billed charges ","80% of total billed charges ",168.15,70,,134.52,,,0,"percent of total billed charges ","70% of total billed charges ",216.19,90,,172.95,,,0,"percent of total billed charges ","90% of total billed charges ",223.4,93,,178.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",204.18,85,,163.34,,,0,"percent of total billed charges ","85% of total billed charges ",204.18,85,,163.34,,,0,"percent of total billed charges ","85% of total billed charges ",216.19,90,,172.95,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",208.98,87,,167.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",168.15,70,,134.52,,,0,"percent of total billed charges ","70% of total billed charges ",168.15,223.4,
"HEMIBONE-TENDON W/O QUADRICEP",6107220,"CDM ",278,RC,,,OUTPATIENT,,,4119.31,3295.448,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3295.45,80,,2636.36,,,0,"percent of total billed charges ","80% of total billed charges ",2883.52,70,,2306.82,,,0,"percent of total billed charges ","70% of total billed charges ",3707.38,90,,2965.90,,,0,"percent of total billed charges ","90% of total billed charges ",3830.96,93,,3064.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3501.41,85,,2801.13,,,0,"percent of total billed charges ","85% of total billed charges ",3501.41,85,,2801.13,,,0,"percent of total billed charges ","85% of total billed charges ",3707.38,90,,2965.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3583.8,87,,2867.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2883.52,70,,2306.82,,,0,"percent of total billed charges ","70% of total billed charges ",2883.52,3830.96,
"PLASMA WAND EVAC 70",6107229,"CDM ",272,RC,,,OUTPATIENT,,,344.8,275.84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",275.84,80,,220.67,,,0,"percent of total billed charges ","80% of total billed charges ",241.36,70,,193.09,,,0,"percent of total billed charges ","70% of total billed charges ",310.32,90,,248.26,,,0,"percent of total billed charges ","90% of total billed charges ",320.66,93,,256.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",293.08,85,,234.46,,,0,"percent of total billed charges ","85% of total billed charges ",310.32,90,,248.26,,,0,"percent of total billed charges ","90% of total billed charges ",310.32,90,,248.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",299.98,87,,239.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.36,70,,193.09,,,0,"percent of total billed charges ","70% of total billed charges ",241.36,320.66,
"PROBE JACKET FOR HEMOSONIC",6107303,"CDM ",272,RC,,,OUTPATIENT,,,269.38,215.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",215.5,80,,172.40,,,0,"percent of total billed charges ","80% of total billed charges ",188.57,70,,150.86,,,0,"percent of total billed charges ","70% of total billed charges ",242.44,90,,193.95,,,0,"percent of total billed charges ","90% of total billed charges ",250.52,93,,200.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",228.97,85,,183.18,,,0,"percent of total billed charges ","85% of total billed charges ",242.44,90,,193.95,,,0,"percent of total billed charges ","90% of total billed charges ",242.44,90,,193.95,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.36,87,,187.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.57,70,,150.86,,,0,"percent of total billed charges ","70% of total billed charges ",188.57,250.52,
"GRASPER 10MM ANVIL 33CM",6107313,"CDM ",272,RC,,,OUTPATIENT,,,194.42,155.536,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.54,80,,124.43,,,0,"percent of total billed charges ","80% of total billed charges ",136.09,70,,108.87,,,0,"percent of total billed charges ","70% of total billed charges ",174.98,90,,139.98,,,0,"percent of total billed charges ","90% of total billed charges ",180.81,93,,144.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",165.26,85,,132.21,,,0,"percent of total billed charges ","85% of total billed charges ",174.98,90,,139.98,,,0,"percent of total billed charges ","90% of total billed charges ",174.98,90,,139.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",169.15,87,,135.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136.09,70,,108.87,,,0,"percent of total billed charges ","70% of total billed charges ",136.09,180.81,
"REAMER BLADE PATELLA 46MM",6107315,"CDM ",272,RC,,,OUTPATIENT,,,581.85,465.48,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",465.48,80,,372.38,,,0,"percent of total billed charges ","80% of total billed charges ",407.3,70,,325.84,,,0,"percent of total billed charges ","70% of total billed charges ",523.67,90,,418.94,,,0,"percent of total billed charges ","90% of total billed charges ",541.12,93,,432.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",494.57,85,,395.66,,,0,"percent of total billed charges ","85% of total billed charges ",523.67,90,,418.94,,,0,"percent of total billed charges ","90% of total billed charges ",523.67,90,,418.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",506.21,87,,404.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",407.3,70,,325.84,,,0,"percent of total billed charges ","70% of total billed charges ",407.3,541.12,
"REAMER BLADE PATELLA 51MM",6107316,"CDM ",272,RC,,,OUTPATIENT,,,581.85,465.48,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",465.48,80,,372.38,,,0,"percent of total billed charges ","80% of total billed charges ",407.3,70,,325.84,,,0,"percent of total billed charges ","70% of total billed charges ",523.67,90,,418.94,,,0,"percent of total billed charges ","90% of total billed charges ",541.12,93,,432.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",494.57,85,,395.66,,,0,"percent of total billed charges ","85% of total billed charges ",523.67,90,,418.94,,,0,"percent of total billed charges ","90% of total billed charges ",523.67,90,,418.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",506.21,87,,404.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",407.3,70,,325.84,,,0,"percent of total billed charges ","70% of total billed charges ",407.3,541.12,
"REAMER BLADE PATELLA 41MM",6107317,"CDM ",272,RC,,,OUTPATIENT,,,581.85,465.48,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",465.48,80,,372.38,,,0,"percent of total billed charges ","80% of total billed charges ",407.3,70,,325.84,,,0,"percent of total billed charges ","70% of total billed charges ",523.67,90,,418.94,,,0,"percent of total billed charges ","90% of total billed charges ",541.12,93,,432.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",494.57,85,,395.66,,,0,"percent of total billed charges ","85% of total billed charges ",523.67,90,,418.94,,,0,"percent of total billed charges ","90% of total billed charges ",523.67,90,,418.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",506.21,87,,404.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",407.3,70,,325.84,,,0,"percent of total billed charges ","70% of total billed charges ",407.3,541.12,
"LUMEN TRIPLE CHRONIC 10FR",6107318,"CDM ",272,RC,,,OUTPATIENT,,,538.75,431,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",431,80,,344.80,,,0,"percent of total billed charges ","80% of total billed charges ",377.13,70,,301.70,,,0,"percent of total billed charges ","70% of total billed charges ",484.88,90,,387.90,,,0,"percent of total billed charges ","90% of total billed charges ",501.04,93,,400.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",457.94,85,,366.35,,,0,"percent of total billed charges ","85% of total billed charges ",484.88,90,,387.90,,,0,"percent of total billed charges ","90% of total billed charges ",484.88,90,,387.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",468.71,87,,374.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",377.13,70,,301.70,,,0,"percent of total billed charges ","70% of total billed charges ",377.13,501.04,
"BLADE EYE ANGLED EDGE",6107364,"CDM ",272,RC,,,OUTPATIENT,,,40.52,32.416,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.42,80,,25.94,,,0,"percent of total billed charges ","80% of total billed charges ",28.36,70,,22.69,,,0,"percent of total billed charges ","70% of total billed charges ",36.47,90,,29.18,,,0,"percent of total billed charges ","90% of total billed charges ",37.68,93,,30.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34.44,85,,27.55,,,0,"percent of total billed charges ","85% of total billed charges ",36.47,90,,29.18,,,0,"percent of total billed charges ","90% of total billed charges ",36.47,90,,29.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",35.25,87,,28.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.36,70,,22.69,,,0,"percent of total billed charges ","70% of total billed charges ",28.36,37.68,
"REAMER-C 8MM",6107367,"CDM ",272,RC,,,OUTPATIENT,,,223.67,178.936,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.94,80,,143.15,,,0,"percent of total billed charges ","80% of total billed charges ",156.57,70,,125.26,,,0,"percent of total billed charges ","70% of total billed charges ",201.3,90,,161.04,,,0,"percent of total billed charges ","90% of total billed charges ",208.01,93,,166.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",190.12,85,,152.10,,,0,"percent of total billed charges ","85% of total billed charges ",201.3,90,,161.04,,,0,"percent of total billed charges ","90% of total billed charges ",201.3,90,,161.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",194.59,87,,155.67,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.57,70,,125.26,,,0,"percent of total billed charges ","70% of total billed charges ",156.57,208.01,
"ROD CARBON FIBER 60MM",6107378,"CDM ",278,RC,,,OUTPATIENT,,,121.5,97.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.2,80,,77.76,,,0,"percent of total billed charges ","80% of total billed charges ",85.05,70,,68.04,,,0,"percent of total billed charges ","70% of total billed charges ",109.35,90,,87.48,,,0,"percent of total billed charges ","90% of total billed charges ",113,93,,90.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",103.28,85,,82.62,,,0,"percent of total billed charges ","85% of total billed charges ",103.28,85,,82.62,,,0,"percent of total billed charges ","85% of total billed charges ",109.35,90,,87.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",105.71,87,,84.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.05,70,,68.04,,,0,"percent of total billed charges ","70% of total billed charges ",85.05,113,
"ROD CARBON FIBER 80MM",6107379,"CDM ",278,RC,,,OUTPATIENT,,,121.5,97.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.2,80,,77.76,,,0,"percent of total billed charges ","80% of total billed charges ",85.05,70,,68.04,,,0,"percent of total billed charges ","70% of total billed charges ",109.35,90,,87.48,,,0,"percent of total billed charges ","90% of total billed charges ",113,93,,90.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",103.28,85,,82.62,,,0,"percent of total billed charges ","85% of total billed charges ",103.28,85,,82.62,,,0,"percent of total billed charges ","85% of total billed charges ",109.35,90,,87.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",105.71,87,,84.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.05,70,,68.04,,,0,"percent of total billed charges ","70% of total billed charges ",85.05,113,
"ROD CARBON FIBER 100MM",6107380,"CDM ",278,RC,,,OUTPATIENT,,,121.5,97.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.2,80,,77.76,,,0,"percent of total billed charges ","80% of total billed charges ",85.05,70,,68.04,,,0,"percent of total billed charges ","70% of total billed charges ",109.35,90,,87.48,,,0,"percent of total billed charges ","90% of total billed charges ",113,93,,90.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",103.28,85,,82.62,,,0,"percent of total billed charges ","85% of total billed charges ",103.28,85,,82.62,,,0,"percent of total billed charges ","85% of total billed charges ",109.35,90,,87.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",105.71,87,,84.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.05,70,,68.04,,,0,"percent of total billed charges ","70% of total billed charges ",85.05,113,
"ROD CARBON FIBER 120MM",6107381,"CDM ",278,RC,,,OUTPATIENT,,,121.5,97.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.2,80,,77.76,,,0,"percent of total billed charges ","80% of total billed charges ",85.05,70,,68.04,,,0,"percent of total billed charges ","70% of total billed charges ",109.35,90,,87.48,,,0,"percent of total billed charges ","90% of total billed charges ",113,93,,90.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",103.28,85,,82.62,,,0,"percent of total billed charges ","85% of total billed charges ",103.28,85,,82.62,,,0,"percent of total billed charges ","85% of total billed charges ",109.35,90,,87.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",105.71,87,,84.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.05,70,,68.04,,,0,"percent of total billed charges ","70% of total billed charges ",85.05,113,
"ROD CARBON FIBER 140MM",6107382,"CDM ",278,RC,,,OUTPATIENT,,,165.5,132.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.4,80,,105.92,,,0,"percent of total billed charges ","80% of total billed charges ",115.85,70,,92.68,,,0,"percent of total billed charges ","70% of total billed charges ",148.95,90,,119.16,,,0,"percent of total billed charges ","90% of total billed charges ",153.92,93,,123.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",140.68,85,,112.54,,,0,"percent of total billed charges ","85% of total billed charges ",140.68,85,,112.54,,,0,"percent of total billed charges ","85% of total billed charges ",148.95,90,,119.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",143.99,87,,115.19,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.85,70,,92.68,,,0,"percent of total billed charges ","70% of total billed charges ",115.85,153.92,
"ROD CARBON FIBER 180MM",6107383,"CDM ",278,RC,,,OUTPATIENT,,,165.5,132.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.4,80,,105.92,,,0,"percent of total billed charges ","80% of total billed charges ",115.85,70,,92.68,,,0,"percent of total billed charges ","70% of total billed charges ",148.95,90,,119.16,,,0,"percent of total billed charges ","90% of total billed charges ",153.92,93,,123.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",140.68,85,,112.54,,,0,"percent of total billed charges ","85% of total billed charges ",140.68,85,,112.54,,,0,"percent of total billed charges ","85% of total billed charges ",148.95,90,,119.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",143.99,87,,115.19,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.85,70,,92.68,,,0,"percent of total billed charges ","70% of total billed charges ",115.85,153.92,
"ROD CARBON FIBER 200MM",6107384,"CDM ",278,RC,,,OUTPATIENT,,,165.5,132.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",132.4,80,,105.92,,,0,"percent of total billed charges ","80% of total billed charges ",115.85,70,,92.68,,,0,"percent of total billed charges ","70% of total billed charges ",148.95,90,,119.16,,,0,"percent of total billed charges ","90% of total billed charges ",153.92,93,,123.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",140.68,85,,112.54,,,0,"percent of total billed charges ","85% of total billed charges ",140.68,85,,112.54,,,0,"percent of total billed charges ","85% of total billed charges ",148.95,90,,119.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",143.99,87,,115.19,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",115.85,70,,92.68,,,0,"percent of total billed charges ","70% of total billed charges ",115.85,153.92,
"CLAMP 4.0MM X 2.5MM",6107386,"CDM ",272,RC,,,OUTPATIENT,,,450.5,360.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",360.4,80,,288.32,,,0,"percent of total billed charges ","80% of total billed charges ",315.35,70,,252.28,,,0,"percent of total billed charges ","70% of total billed charges ",405.45,90,,324.36,,,0,"percent of total billed charges ","90% of total billed charges ",418.97,93,,335.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",382.93,85,,306.34,,,0,"percent of total billed charges ","85% of total billed charges ",405.45,90,,324.36,,,0,"percent of total billed charges ","90% of total billed charges ",405.45,90,,324.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",391.94,87,,313.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",315.35,70,,252.28,,,0,"percent of total billed charges ","70% of total billed charges ",315.35,418.97,
"COMPRESSOR OPEN FOR AM FIXATOR",6107387,"CDM ",272,RC,,,OUTPATIENT,,,813.5,650.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",650.8,80,,520.64,,,0,"percent of total billed charges ","80% of total billed charges ",569.45,70,,455.56,,,0,"percent of total billed charges ","70% of total billed charges ",732.15,90,,585.72,,,0,"percent of total billed charges ","90% of total billed charges ",756.56,93,,605.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",691.48,85,,553.18,,,0,"percent of total billed charges ","85% of total billed charges ",732.15,90,,585.72,,,0,"percent of total billed charges ","90% of total billed charges ",732.15,90,,585.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",707.75,87,,566.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",569.45,70,,455.56,,,0,"percent of total billed charges ","70% of total billed charges ",569.45,756.56,
"NUT SPRING-LOADED",6107388,"CDM ",272,RC,,,OUTPATIENT,,,99.5,79.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.6,80,,63.68,,,0,"percent of total billed charges ","80% of total billed charges ",69.65,70,,55.72,,,0,"percent of total billed charges ","70% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",92.54,93,,74.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",84.58,85,,67.66,,,0,"percent of total billed charges ","85% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",89.55,90,,71.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",86.57,87,,69.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.65,70,,55.72,,,0,"percent of total billed charges ","70% of total billed charges ",69.65,92.54,
"CAP PROTECTIVE BLUE",6107389,"CDM ",272,RC,,,OUTPATIENT,,,68,54.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.4,80,,43.52,,,0,"percent of total billed charges ","80% of total billed charges ",47.6,70,,38.08,,,0,"percent of total billed charges ","70% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",63.24,93,,50.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",57.8,85,,46.24,,,0,"percent of total billed charges ","85% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",61.2,90,,48.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",59.16,87,,47.33,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.6,70,,38.08,,,0,"percent of total billed charges ","70% of total billed charges ",47.6,63.24,
"CAP PROTECTIVE BLACK 4.0MM",6107390,"CDM ",271,RC,,,OUTPATIENT,,,51,40.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.8,80,,32.64,,,0,"percent of total billed charges ","80% of total billed charges ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",47.43,93,,37.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.35,85,,34.68,,,0,"percent of total billed charges ","85% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",45.9,90,,36.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.37,87,,35.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.7,70,,28.56,,,0,"percent of total billed charges ","70% of total billed charges ",35.7,47.43,
"DRILL BIT 2.0MM X 100MM",6107391,"CDM ",272,RC,,,OUTPATIENT,,,366.19,292.952,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",292.95,80,,234.36,,,0,"percent of total billed charges ","80% of total billed charges ",256.33,70,,205.06,,,0,"percent of total billed charges ","70% of total billed charges ",329.57,90,,263.66,,,0,"percent of total billed charges ","90% of total billed charges ",340.56,93,,272.45,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",311.26,85,,249.01,,,0,"percent of total billed charges ","85% of total billed charges ",329.57,90,,263.66,,,0,"percent of total billed charges ","90% of total billed charges ",329.57,90,,263.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",318.59,87,,254.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",256.33,70,,205.06,,,0,"percent of total billed charges ","70% of total billed charges ",256.33,340.56,
"TRAP WATER D-FEND BLACK",6107399,"CDM ",278,RC,,,OUTPATIENT,,,53.87,43.096,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.1,80,,34.48,,,0,"percent of total billed charges ","80% of total billed charges ",37.71,70,,30.17,,,0,"percent of total billed charges ","70% of total billed charges ",48.48,90,,38.78,,,0,"percent of total billed charges ","90% of total billed charges ",50.1,93,,40.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",45.79,85,,36.63,,,0,"percent of total billed charges ","85% of total billed charges ",45.79,85,,36.63,,,0,"percent of total billed charges ","85% of total billed charges ",48.48,90,,38.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",46.87,87,,37.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.71,70,,30.17,,,0,"percent of total billed charges ","70% of total billed charges ",37.71,50.1,
"KIT CATH PICC LINE 4FR",6107407,"CDM ",270,RC,,,OUTPATIENT,,,239.5,191.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",191.6,80,,153.28,,,0,"percent of total billed charges ","80% of total billed charges ",167.65,70,,134.12,,,0,"percent of total billed charges ","70% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",222.74,93,,178.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",203.58,85,,162.86,,,0,"percent of total billed charges ","85% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",215.55,90,,172.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",208.37,87,,166.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.65,70,,134.12,,,0,"percent of total billed charges ","70% of total billed charges ",167.65,222.74,
"KIT CATH PICC 5FR DBL LUMEN",6107410,"CDM ",270,RC,,,OUTPATIENT,,,426.69,341.352,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",341.35,80,,273.08,,,0,"percent of total billed charges ","80% of total billed charges ",298.68,70,,238.94,,,0,"percent of total billed charges ","70% of total billed charges ",384.02,90,,307.22,,,0,"percent of total billed charges ","90% of total billed charges ",396.82,93,,317.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",362.69,85,,290.15,,,0,"percent of total billed charges ","85% of total billed charges ",384.02,90,,307.22,,,0,"percent of total billed charges ","90% of total billed charges ",384.02,90,,307.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",371.22,87,,296.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",298.68,70,,238.94,,,0,"percent of total billed charges ","70% of total billed charges ",298.68,396.82,
"KIT WRIST FRACTURE",6107412,"CDM ",272,RC,,,OUTPATIENT,,,3220,2576,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2576,80,,2060.80,,,0,"percent of total billed charges ","80% of total billed charges ",2254,70,,1803.20,,,0,"percent of total billed charges ","70% of total billed charges ",2898,90,,2318.40,,,0,"percent of total billed charges ","90% of total billed charges ",2994.6,93,,2395.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2737,85,,2189.60,,,0,"percent of total billed charges ","85% of total billed charges ",2898,90,,2318.40,,,0,"percent of total billed charges ","90% of total billed charges ",2898,90,,2318.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2801.4,87,,2241.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2254,70,,1803.20,,,0,"percent of total billed charges ","70% of total billed charges ",2254,2994.6,
"SUTURE VICRYL 2.0 J345H",6107453,"CDM ",272,RC,,,OUTPATIENT,,,10.53,8.424,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.42,80,,6.74,,,0,"percent of total billed charges ","80% of total billed charges ",7.37,70,,5.90,,,0,"percent of total billed charges ","70% of total billed charges ",9.48,90,,7.58,,,0,"percent of total billed charges ","90% of total billed charges ",9.79,93,,7.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.95,85,,7.16,,,0,"percent of total billed charges ","85% of total billed charges ",9.48,90,,7.58,,,0,"percent of total billed charges ","90% of total billed charges ",9.48,90,,7.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.16,87,,7.33,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.37,70,,5.90,,,0,"percent of total billed charges ","70% of total billed charges ",7.37,9.79,
"RADIAL HEAD EVOLVE MODULAR",6107456,"CDM ",278,RC,,,OUTPATIENT,,,4310.63,3448.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3448.5,80,,2758.80,,,0,"percent of total billed charges ","80% of total billed charges ",3017.44,70,,2413.95,,,0,"percent of total billed charges ","70% of total billed charges ",3879.57,90,,3103.66,,,0,"percent of total billed charges ","90% of total billed charges ",4008.89,93,,3207.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3664.04,85,,2931.23,,,0,"percent of total billed charges ","85% of total billed charges ",3664.04,85,,2931.23,,,0,"percent of total billed charges ","85% of total billed charges ",3879.57,90,,3103.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3750.25,87,,3000.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3017.44,70,,2413.95,,,0,"percent of total billed charges ","70% of total billed charges ",3017.44,4008.89,
"TUBE GASTROSTOMY D1.7CM",6107476,"CDM ",272,RC,,,OUTPATIENT,,,324.11,259.288,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",259.29,80,,207.43,,,0,"percent of total billed charges ","80% of total billed charges ",226.88,70,,181.50,,,0,"percent of total billed charges ","70% of total billed charges ",291.7,90,,233.36,,,0,"percent of total billed charges ","90% of total billed charges ",301.42,93,,241.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",275.49,85,,220.39,,,0,"percent of total billed charges ","85% of total billed charges ",291.7,90,,233.36,,,0,"percent of total billed charges ","90% of total billed charges ",291.7,90,,233.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",281.98,87,,225.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",226.88,70,,181.50,,,0,"percent of total billed charges ","70% of total billed charges ",226.88,301.42,
"TUBE GASTROSTOMY D 2.4CM",6107477,"CDM ",272,RC,,,OUTPATIENT,,,324.11,259.288,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",259.29,80,,207.43,,,0,"percent of total billed charges ","80% of total billed charges ",226.88,70,,181.50,,,0,"percent of total billed charges ","70% of total billed charges ",291.7,90,,233.36,,,0,"percent of total billed charges ","90% of total billed charges ",301.42,93,,241.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",275.49,85,,220.39,,,0,"percent of total billed charges ","85% of total billed charges ",291.7,90,,233.36,,,0,"percent of total billed charges ","90% of total billed charges ",291.7,90,,233.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",281.98,87,,225.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",226.88,70,,181.50,,,0,"percent of total billed charges ","70% of total billed charges ",226.88,301.42,
"TUBE GASTROSTIOMY D 3.4CM",6107478,"CDM ",272,RC,,,OUTPATIENT,,,379.17,303.336,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",303.34,80,,242.67,,,0,"percent of total billed charges ","80% of total billed charges ",265.42,70,,212.34,,,0,"percent of total billed charges ","70% of total billed charges ",341.25,90,,273.00,,,0,"percent of total billed charges ","90% of total billed charges ",352.63,93,,282.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",322.29,85,,257.83,,,0,"percent of total billed charges ","85% of total billed charges ",341.25,90,,273.00,,,0,"percent of total billed charges ","90% of total billed charges ",341.25,90,,273.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",329.88,87,,263.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",265.42,70,,212.34,,,0,"percent of total billed charges ","70% of total billed charges ",265.42,352.63,
"TUBE BALLOON REPLACEMENT 24FR",6107479,"CDM ",272,RC,,,OUTPATIENT,,,381.69,305.352,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",305.35,80,,244.28,,,0,"percent of total billed charges ","80% of total billed charges ",267.18,70,,213.74,,,0,"percent of total billed charges ","70% of total billed charges ",343.52,90,,274.82,,,0,"percent of total billed charges ","90% of total billed charges ",354.97,93,,283.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",324.44,85,,259.55,,,0,"percent of total billed charges ","85% of total billed charges ",343.52,90,,274.82,,,0,"percent of total billed charges ","90% of total billed charges ",343.52,90,,274.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",332.07,87,,265.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",267.18,70,,213.74,,,0,"percent of total billed charges ","70% of total billed charges ",267.18,354.97,
"TUBE FEEDING 4.4CM (W-C)",6107482,"CDM ",272,RC,,,OUTPATIENT,,,316,252.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",252.8,80,,202.24,,,0,"percent of total billed charges ","80% of total billed charges ",221.2,70,,176.96,,,0,"percent of total billed charges ","70% of total billed charges ",284.4,90,,227.52,,,0,"percent of total billed charges ","90% of total billed charges ",293.88,93,,235.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",268.6,85,,214.88,,,0,"percent of total billed charges ","85% of total billed charges ",284.4,90,,227.52,,,0,"percent of total billed charges ","90% of total billed charges ",284.4,90,,227.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",274.92,87,,219.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",221.2,70,,176.96,,,0,"percent of total billed charges ","70% of total billed charges ",221.2,293.88,
"SUTURE PLAIN 5-0 PC-1 191G",6107509,"CDM ",272,RC,,,OUTPATIENT,,,20.41,16.328,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.33,80,,13.06,,,0,"percent of total billed charges ","80% of total billed charges ",14.29,70,,11.43,,,0,"percent of total billed charges ","70% of total billed charges ",18.37,90,,14.70,,,0,"percent of total billed charges ","90% of total billed charges ",18.98,93,,15.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.35,85,,13.88,,,0,"percent of total billed charges ","85% of total billed charges ",18.37,90,,14.70,,,0,"percent of total billed charges ","90% of total billed charges ",18.37,90,,14.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.76,87,,14.21,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.29,70,,11.43,,,0,"percent of total billed charges ","70% of total billed charges ",14.29,18.98,
"KIT RADIAL ARTERY CATH PEDI",6107548,"CDM ",272,RC,,,OUTPATIENT,,,59.56,47.648,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.65,80,,38.12,,,0,"percent of total billed charges ","80% of total billed charges ",41.69,70,,33.35,,,0,"percent of total billed charges ","70% of total billed charges ",53.6,90,,42.88,,,0,"percent of total billed charges ","90% of total billed charges ",55.39,93,,44.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",50.63,85,,40.50,,,0,"percent of total billed charges ","85% of total billed charges ",53.6,90,,42.88,,,0,"percent of total billed charges ","90% of total billed charges ",53.6,90,,42.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",51.82,87,,41.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.69,70,,33.35,,,0,"percent of total billed charges ","70% of total billed charges ",41.69,55.39,
"SET COMMON DUCT EXLOR",6107561,"CDM ",272,RC,,,OUTPATIENT,,,1626.24,1300.992,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1300.99,80,,1040.79,,,0,"percent of total billed charges ","80% of total billed charges ",1138.37,70,,910.70,,,0,"percent of total billed charges ","70% of total billed charges ",1463.62,90,,1170.90,,,0,"percent of total billed charges ","90% of total billed charges ",1512.4,93,,1209.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1382.3,85,,1105.84,,,0,"percent of total billed charges ","85% of total billed charges ",1463.62,90,,1170.90,,,0,"percent of total billed charges ","90% of total billed charges ",1463.62,90,,1170.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1414.83,87,,1131.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1138.37,70,,910.70,,,0,"percent of total billed charges ","70% of total billed charges ",1138.37,1512.4,
"CANNULA 3.0 DISPOSABLE",6107565,"CDM ",270,RC,,,OUTPATIENT,,,222.25,177.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.8,80,,142.24,,,0,"percent of total billed charges ","80% of total billed charges ",155.58,70,,124.46,,,0,"percent of total billed charges ","70% of total billed charges ",200.03,90,,160.02,,,0,"percent of total billed charges ","90% of total billed charges ",206.69,93,,165.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",188.91,85,,151.13,,,0,"percent of total billed charges ","85% of total billed charges ",200.03,90,,160.02,,,0,"percent of total billed charges ","90% of total billed charges ",200.03,90,,160.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",193.36,87,,154.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.58,70,,124.46,,,0,"percent of total billed charges ","70% of total billed charges ",155.58,206.69,
"CANNULA 5.0 DISPOSABLE",6107566,"CDM ",270,RC,,,OUTPATIENT,,,208.92,167.136,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.14,80,,133.71,,,0,"percent of total billed charges ","80% of total billed charges ",146.24,70,,116.99,,,0,"percent of total billed charges ","70% of total billed charges ",188.03,90,,150.42,,,0,"percent of total billed charges ","90% of total billed charges ",194.3,93,,155.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",177.58,85,,142.06,,,0,"percent of total billed charges ","85% of total billed charges ",188.03,90,,150.42,,,0,"percent of total billed charges ","90% of total billed charges ",188.03,90,,150.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",181.76,87,,145.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",146.24,70,,116.99,,,0,"percent of total billed charges ","70% of total billed charges ",146.24,194.3,
"TUBING ASPIRATION",6107567,"CDM ",272,RC,,,OUTPATIENT,,,50.15,40.12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.12,80,,32.10,,,0,"percent of total billed charges ","80% of total billed charges ",35.11,70,,28.09,,,0,"percent of total billed charges ","70% of total billed charges ",45.14,90,,36.11,,,0,"percent of total billed charges ","90% of total billed charges ",46.64,93,,37.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.63,85,,34.10,,,0,"percent of total billed charges ","85% of total billed charges ",45.14,90,,36.11,,,0,"percent of total billed charges ","90% of total billed charges ",45.14,90,,36.11,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.63,87,,34.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.11,70,,28.09,,,0,"percent of total billed charges ","70% of total billed charges ",35.11,46.64,
"SUTURE PROLENE 2.0 8623H",6107568,"CDM ",272,RC,,,OUTPATIENT,,,9.53,7.624,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.62,80,,6.10,,,0,"percent of total billed charges ","80% of total billed charges ",6.67,70,,5.34,,,0,"percent of total billed charges ","70% of total billed charges ",8.58,90,,6.86,,,0,"percent of total billed charges ","90% of total billed charges ",8.86,93,,7.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.1,85,,6.48,,,0,"percent of total billed charges ","85% of total billed charges ",8.58,90,,6.86,,,0,"percent of total billed charges ","90% of total billed charges ",8.58,90,,6.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",8.29,87,,6.63,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.67,70,,5.34,,,0,"percent of total billed charges ","70% of total billed charges ",6.67,8.86,
"BLADE SAW RECP DOUBLE SIDED",6107602,"CDM ",272,RC,,,OUTPATIENT,,,109.61,87.688,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.69,80,,70.15,,,0,"percent of total billed charges ","80% of total billed charges ",76.73,70,,61.38,,,0,"percent of total billed charges ","70% of total billed charges ",98.65,90,,78.92,,,0,"percent of total billed charges ","90% of total billed charges ",101.94,93,,81.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",93.17,85,,74.54,,,0,"percent of total billed charges ","85% of total billed charges ",98.65,90,,78.92,,,0,"percent of total billed charges ","90% of total billed charges ",98.65,90,,78.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",95.36,87,,76.29,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.73,70,,61.38,,,0,"percent of total billed charges ","70% of total billed charges ",76.73,101.94,
"BLADE SAW 12.5X79.5 X1.24",6107606,"CDM ",272,RC,,,OUTPATIENT,,,86.59,69.272,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.27,80,,55.42,,,0,"percent of total billed charges ","80% of total billed charges ",60.61,70,,48.49,,,0,"percent of total billed charges ","70% of total billed charges ",77.93,90,,62.34,,,0,"percent of total billed charges ","90% of total billed charges ",80.53,93,,64.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",73.6,85,,58.88,,,0,"percent of total billed charges ","85% of total billed charges ",77.93,90,,62.34,,,0,"percent of total billed charges ","90% of total billed charges ",77.93,90,,62.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",75.33,87,,60.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.61,70,,48.49,,,0,"percent of total billed charges ","70% of total billed charges ",60.61,80.53,
"ADAPTER VALVED TEE",6107607,"CDM ",272,RC,,,OUTPATIENT,,,13.24,10.592,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.59,80,,8.47,,,0,"percent of total billed charges ","80% of total billed charges ",9.27,70,,7.42,,,0,"percent of total billed charges ","70% of total billed charges ",11.92,90,,9.54,,,0,"percent of total billed charges ","90% of total billed charges ",12.31,93,,9.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.25,85,,9.00,,,0,"percent of total billed charges ","85% of total billed charges ",11.92,90,,9.54,,,0,"percent of total billed charges ","90% of total billed charges ",11.92,90,,9.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.52,87,,9.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.27,70,,7.42,,,0,"percent of total billed charges ","70% of total billed charges ",9.27,12.31,
"SUTURE CHROMIC 5.0 687G",6107614,"CDM ",272,RC,,,OUTPATIENT,,,23.02,18.416,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.42,80,,14.74,,,0,"percent of total billed charges ","80% of total billed charges ",16.11,70,,12.89,,,0,"percent of total billed charges ","70% of total billed charges ",20.72,90,,16.58,,,0,"percent of total billed charges ","90% of total billed charges ",21.41,93,,17.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.57,85,,15.66,,,0,"percent of total billed charges ","85% of total billed charges ",20.72,90,,16.58,,,0,"percent of total billed charges ","90% of total billed charges ",20.72,90,,16.58,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.03,87,,16.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.11,70,,12.89,,,0,"percent of total billed charges ","70% of total billed charges ",16.11,21.41,
"SUTURE CHROMIC 3.0  1638G",6107615,"CDM ",272,RC,,,OUTPATIENT,,,50.32,40.256,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.26,80,,32.21,,,0,"percent of total billed charges ","80% of total billed charges ",35.22,70,,28.18,,,0,"percent of total billed charges ","70% of total billed charges ",45.29,90,,36.23,,,0,"percent of total billed charges ","90% of total billed charges ",46.8,93,,37.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.77,85,,34.22,,,0,"percent of total billed charges ","85% of total billed charges ",45.29,90,,36.23,,,0,"percent of total billed charges ","90% of total billed charges ",45.29,90,,36.23,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.78,87,,35.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.22,70,,28.18,,,0,"percent of total billed charges ","70% of total billed charges ",35.22,46.8,
"SET NORMOTHERMIC I.V. ADMINIST",6107638,"CDM ",272,RC,,,OUTPATIENT,,,274.08,219.264,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",219.26,80,,175.41,,,0,"percent of total billed charges ","80% of total billed charges ",191.86,70,,153.49,,,0,"percent of total billed charges ","70% of total billed charges ",246.67,90,,197.34,,,0,"percent of total billed charges ","90% of total billed charges ",254.89,93,,203.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",232.97,85,,186.38,,,0,"percent of total billed charges ","85% of total billed charges ",246.67,90,,197.34,,,0,"percent of total billed charges ","90% of total billed charges ",246.67,90,,197.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",238.45,87,,190.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",191.86,70,,153.49,,,0,"percent of total billed charges ","70% of total billed charges ",191.86,254.89,
"FILTER REPLACE NORMOTHERMIC",6107639,"CDM ",272,RC,,,OUTPATIENT,,,56.05,44.84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.84,80,,35.87,,,0,"percent of total billed charges ","80% of total billed charges ",39.24,70,,31.39,,,0,"percent of total billed charges ","70% of total billed charges ",50.45,90,,40.36,,,0,"percent of total billed charges ","90% of total billed charges ",52.13,93,,41.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",47.64,85,,38.11,,,0,"percent of total billed charges ","85% of total billed charges ",50.45,90,,40.36,,,0,"percent of total billed charges ","90% of total billed charges ",50.45,90,,40.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",48.76,87,,39.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.24,70,,31.39,,,0,"percent of total billed charges ","70% of total billed charges ",39.24,52.13,
"DRESSING SOFSORB 4X6",6107674,"CDM ",272,RC,,,OUTPATIENT,,,11,8.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.8,80,,7.04,,,0,"percent of total billed charges ","80% of total billed charges ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",10.23,93,,8.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.35,85,,7.48,,,0,"percent of total billed charges ","85% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.57,87,,7.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.7,10.23,
"DRESSING KALGINATE ROPE 12""",6107675,"CDM ",272,RC,,,OUTPATIENT,,,26.28,21.024,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.02,80,,16.82,,,0,"percent of total billed charges ","80% of total billed charges ",18.4,70,,14.72,,,0,"percent of total billed charges ","70% of total billed charges ",23.65,90,,18.92,,,0,"percent of total billed charges ","90% of total billed charges ",24.44,93,,19.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",22.34,85,,17.87,,,0,"percent of total billed charges ","85% of total billed charges ",23.65,90,,18.92,,,0,"percent of total billed charges ","90% of total billed charges ",23.65,90,,18.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.86,87,,18.29,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.4,70,,14.72,,,0,"percent of total billed charges ","70% of total billed charges ",18.4,24.44,
"PUMP SINGLE ACTION",6107699,"CDM ",272,RC,,,OUTPATIENT,,,538.75,431,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",431,80,,344.80,,,0,"percent of total billed charges ","80% of total billed charges ",377.13,70,,301.70,,,0,"percent of total billed charges ","70% of total billed charges ",484.88,90,,387.90,,,0,"percent of total billed charges ","90% of total billed charges ",501.04,93,,400.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",457.94,85,,366.35,,,0,"percent of total billed charges ","85% of total billed charges ",484.88,90,,387.90,,,0,"percent of total billed charges ","90% of total billed charges ",484.88,90,,387.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",468.71,87,,374.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",377.13,70,,301.70,,,0,"percent of total billed charges ","70% of total billed charges ",377.13,501.04,
"SUTURE ANCHOR 5.657 SZ-2 BLUE",6107730,"CDM ",272,RC,,,OUTPATIENT,,,532.29,425.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",425.83,80,,340.66,,,0,"percent of total billed charges ","80% of total billed charges ",372.6,70,,298.08,,,0,"percent of total billed charges ","70% of total billed charges ",479.06,90,,383.25,,,0,"percent of total billed charges ","90% of total billed charges ",495.03,93,,396.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",452.45,85,,361.96,,,0,"percent of total billed charges ","85% of total billed charges ",479.06,90,,383.25,,,0,"percent of total billed charges ","90% of total billed charges ",479.06,90,,383.25,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",463.09,87,,370.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",372.6,70,,298.08,,,0,"percent of total billed charges ","70% of total billed charges ",372.6,495.03,
CANISTER,6107733,"CDM ",272,RC,,,OUTPATIENT,,,47.64,38.112,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.11,80,,30.49,,,0,"percent of total billed charges ","80% of total billed charges ",33.35,70,,26.68,,,0,"percent of total billed charges ","70% of total billed charges ",42.88,90,,34.30,,,0,"percent of total billed charges ","90% of total billed charges ",44.31,93,,35.45,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.49,85,,32.39,,,0,"percent of total billed charges ","85% of total billed charges ",42.88,90,,34.30,,,0,"percent of total billed charges ","90% of total billed charges ",42.88,90,,34.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.45,87,,33.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.35,70,,26.68,,,0,"percent of total billed charges ","70% of total billed charges ",33.35,44.31,
"BIOFILTER ABSOLUTE",6107734,"CDM ",271,RC,,,OUTPATIENT,,,53.34,42.672,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.67,80,,34.14,,,0,"percent of total billed charges ","80% of total billed charges ",37.34,70,,29.87,,,0,"percent of total billed charges ","70% of total billed charges ",48.01,90,,38.41,,,0,"percent of total billed charges ","90% of total billed charges ",49.61,93,,39.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",45.34,85,,36.27,,,0,"percent of total billed charges ","85% of total billed charges ",48.01,90,,38.41,,,0,"percent of total billed charges ","90% of total billed charges ",48.01,90,,38.41,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",46.41,87,,37.13,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.34,70,,29.87,,,0,"percent of total billed charges ","70% of total billed charges ",37.34,49.61,
"BAG ORTHOPAT RBC",6107744,"CDM ",272,RC,,,OUTPATIENT,,,51.5,41.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.2,80,,32.96,,,0,"percent of total billed charges ","80% of total billed charges ",36.05,70,,28.84,,,0,"percent of total billed charges ","70% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",47.9,93,,38.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.78,85,,35.02,,,0,"percent of total billed charges ","85% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.81,87,,35.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.05,70,,28.84,,,0,"percent of total billed charges ","70% of total billed charges ",36.05,47.9,
"BAG ORTHOPAT WASTE",6107745,"CDM ",272,RC,,,OUTPATIENT,,,73.5,58.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.8,80,,47.04,,,0,"percent of total billed charges ","80% of total billed charges ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",51.45,68.36,
"SET PUMP GEMSTAR",6107759,"CDM ",272,RC,,,OUTPATIENT,,,63.74,50.992,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.99,80,,40.79,,,0,"percent of total billed charges ","80% of total billed charges ",44.62,70,,35.70,,,0,"percent of total billed charges ","70% of total billed charges ",57.37,90,,45.90,,,0,"percent of total billed charges ","90% of total billed charges ",59.28,93,,47.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",54.18,85,,43.34,,,0,"percent of total billed charges ","85% of total billed charges ",57.37,90,,45.90,,,0,"percent of total billed charges ","90% of total billed charges ",57.37,90,,45.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",55.45,87,,44.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.62,70,,35.70,,,0,"percent of total billed charges ","70% of total billed charges ",44.62,59.28,
"BLADE UNI-KNEE",6107762,"CDM ",271,RC,,,OUTPATIENT,,,213.36,170.688,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.69,80,,136.55,,,0,"percent of total billed charges ","80% of total billed charges ",149.35,70,,119.48,,,0,"percent of total billed charges ","70% of total billed charges ",192.02,90,,153.62,,,0,"percent of total billed charges ","90% of total billed charges ",198.42,93,,158.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",181.36,85,,145.09,,,0,"percent of total billed charges ","85% of total billed charges ",192.02,90,,153.62,,,0,"percent of total billed charges ","90% of total billed charges ",192.02,90,,153.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",185.62,87,,148.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.35,70,,119.48,,,0,"percent of total billed charges ","70% of total billed charges ",149.35,198.42,
"PILLOW FACE PRONE DISP",6107763,"CDM ",272,RC,,,OUTPATIENT,,,90.72,72.576,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.58,80,,58.06,,,0,"percent of total billed charges ","80% of total billed charges ",63.5,70,,50.80,,,0,"percent of total billed charges ","70% of total billed charges ",81.65,90,,65.32,,,0,"percent of total billed charges ","90% of total billed charges ",84.37,93,,67.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",77.11,85,,61.69,,,0,"percent of total billed charges ","85% of total billed charges ",81.65,90,,65.32,,,0,"percent of total billed charges ","90% of total billed charges ",81.65,90,,65.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",78.93,87,,63.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.5,70,,50.80,,,0,"percent of total billed charges ","70% of total billed charges ",63.5,84.37,
"SEALER LIGASURE V 5MM",6107764,"CDM ",272,RC,,,OUTPATIENT,,,883.55,706.84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",706.84,80,,565.47,,,0,"percent of total billed charges ","80% of total billed charges ",618.49,70,,494.79,,,0,"percent of total billed charges ","70% of total billed charges ",795.2,90,,636.16,,,0,"percent of total billed charges ","90% of total billed charges ",821.7,93,,657.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",751.02,85,,600.82,,,0,"percent of total billed charges ","85% of total billed charges ",795.2,90,,636.16,,,0,"percent of total billed charges ","90% of total billed charges ",795.2,90,,636.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",768.69,87,,614.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",618.49,70,,494.79,,,0,"percent of total billed charges ","70% of total billed charges ",618.49,821.7,
"POWERSEAL CURVED 5MM x 37CM",6107768,"CDM ",272,RC,,,OUTPATIENT,,,978.06,782.448,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",782.45,80,,625.96,,,0,"percent of total billed charges ","80% of total billed charges ",684.64,70,,547.71,,,0,"percent of total billed charges ","70% of total billed charges ",880.25,90,,704.20,,,0,"percent of total billed charges ","90% of total billed charges ",909.6,93,,727.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",831.35,85,,665.08,,,0,"percent of total billed charges ","85% of total billed charges ",880.25,90,,704.20,,,0,"percent of total billed charges ","90% of total billed charges ",880.25,90,,704.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",850.91,87,,680.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",684.64,70,,547.71,,,0,"percent of total billed charges ","70% of total billed charges ",684.64,909.6,
"CAUTERY TIP COATED BLADE TEFLO",6107769,"CDM ",271,RC,,,OUTPATIENT,,,15.2,12.16,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.16,80,,9.73,,,0,"percent of total billed charges ","80% of total billed charges ",10.64,70,,8.51,,,0,"percent of total billed charges ","70% of total billed charges ",13.68,90,,10.94,,,0,"percent of total billed charges ","90% of total billed charges ",14.14,93,,11.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.92,85,,10.34,,,0,"percent of total billed charges ","85% of total billed charges ",13.68,90,,10.94,,,0,"percent of total billed charges ","90% of total billed charges ",13.68,90,,10.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.22,87,,10.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.64,70,,8.51,,,0,"percent of total billed charges ","70% of total billed charges ",10.64,14.14,
"BLADE PATELLA 29 MM",6107777,"CDM ",272,RC,,,OUTPATIENT,,,344.8,275.84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",275.84,80,,220.67,,,0,"percent of total billed charges ","80% of total billed charges ",241.36,70,,193.09,,,0,"percent of total billed charges ","70% of total billed charges ",310.32,90,,248.26,,,0,"percent of total billed charges ","90% of total billed charges ",320.66,93,,256.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",293.08,85,,234.46,,,0,"percent of total billed charges ","85% of total billed charges ",310.32,90,,248.26,,,0,"percent of total billed charges ","90% of total billed charges ",310.32,90,,248.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",299.98,87,,239.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.36,70,,193.09,,,0,"percent of total billed charges ","70% of total billed charges ",241.36,320.66,
"SUPPORT PEDI IV ARM",6107779,"CDM ",271,RC,,,OUTPATIENT,,,11.63,9.304,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.3,80,,7.44,,,0,"percent of total billed charges ","80% of total billed charges ",8.14,70,,6.51,,,0,"percent of total billed charges ","70% of total billed charges ",10.47,90,,8.38,,,0,"percent of total billed charges ","90% of total billed charges ",10.82,93,,8.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.89,85,,7.91,,,0,"percent of total billed charges ","85% of total billed charges ",10.47,90,,8.38,,,0,"percent of total billed charges ","90% of total billed charges ",10.47,90,,8.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.12,87,,8.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.14,70,,6.51,,,0,"percent of total billed charges ","70% of total billed charges ",8.14,10.82,
"DRAPE LAP CHOLE NEW",6107820,"CDM ",272,RC,,,OUTPATIENT,,,42.93,34.344,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.34,80,,27.47,,,0,"percent of total billed charges ","80% of total billed charges ",30.05,70,,24.04,,,0,"percent of total billed charges ","70% of total billed charges ",38.64,90,,30.91,,,0,"percent of total billed charges ","90% of total billed charges ",39.92,93,,31.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",36.49,85,,29.19,,,0,"percent of total billed charges ","85% of total billed charges ",38.64,90,,30.91,,,0,"percent of total billed charges ","90% of total billed charges ",38.64,90,,30.91,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",37.35,87,,29.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.05,70,,24.04,,,0,"percent of total billed charges ","70% of total billed charges ",30.05,39.92,
"BURR OPHTHALMIC 1.0 MM",6107828,"CDM ",272,RC,,,OUTPATIENT,,,45.14,36.112,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.11,80,,28.89,,,0,"percent of total billed charges ","80% of total billed charges ",31.6,70,,25.28,,,0,"percent of total billed charges ","70% of total billed charges ",40.63,90,,32.50,,,0,"percent of total billed charges ","90% of total billed charges ",41.98,93,,33.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.37,85,,30.70,,,0,"percent of total billed charges ","85% of total billed charges ",40.63,90,,32.50,,,0,"percent of total billed charges ","90% of total billed charges ",40.63,90,,32.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.27,87,,31.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.6,70,,25.28,,,0,"percent of total billed charges ","70% of total billed charges ",31.6,41.98,
"DRESSING NASOPORE 8 CM FIRM",6107833,"CDM ",272,RC,,,OUTPATIENT,,,333.51,266.808,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",266.81,80,,213.45,,,0,"percent of total billed charges ","80% of total billed charges ",233.46,70,,186.77,,,0,"percent of total billed charges ","70% of total billed charges ",300.16,90,,240.13,,,0,"percent of total billed charges ","90% of total billed charges ",310.16,93,,248.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",283.48,85,,226.78,,,0,"percent of total billed charges ","85% of total billed charges ",300.16,90,,240.13,,,0,"percent of total billed charges ","90% of total billed charges ",300.16,90,,240.13,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",290.15,87,,232.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",233.46,70,,186.77,,,0,"percent of total billed charges ","70% of total billed charges ",233.46,310.16,
"CLOSURE CARTER-THOM 10/15",6107840,"CDM ",272,RC,,,OUTPATIENT,,,258.08,206.464,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",206.46,80,,165.17,,,0,"percent of total billed charges ","80% of total billed charges ",180.66,70,,144.53,,,0,"percent of total billed charges ","70% of total billed charges ",232.27,90,,185.82,,,0,"percent of total billed charges ","90% of total billed charges ",240.01,93,,192.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",219.37,85,,175.50,,,0,"percent of total billed charges ","85% of total billed charges ",232.27,90,,185.82,,,0,"percent of total billed charges ","90% of total billed charges ",232.27,90,,185.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",224.53,87,,179.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.66,70,,144.53,,,0,"percent of total billed charges ","70% of total billed charges ",180.66,240.01,
"SUTURE VICRYL 0 J764D",6107842,"CDM ",272,RC,,,OUTPATIENT,,,43.48,34.784,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.78,80,,27.82,,,0,"percent of total billed charges ","80% of total billed charges ",30.44,70,,24.35,,,0,"percent of total billed charges ","70% of total billed charges ",39.13,90,,31.30,,,0,"percent of total billed charges ","90% of total billed charges ",40.44,93,,32.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",36.96,85,,29.57,,,0,"percent of total billed charges ","85% of total billed charges ",39.13,90,,31.30,,,0,"percent of total billed charges ","90% of total billed charges ",39.13,90,,31.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",37.83,87,,30.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.44,70,,24.35,,,0,"percent of total billed charges ","70% of total billed charges ",30.44,40.44,
"SUTURE VICRYL 2.0 J739D",6107843,"CDM ",272,RC,,,OUTPATIENT,,,43.83,35.064,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.06,80,,28.05,,,0,"percent of total billed charges ","80% of total billed charges ",30.68,70,,24.54,,,0,"percent of total billed charges ","70% of total billed charges ",39.45,90,,31.56,,,0,"percent of total billed charges ","90% of total billed charges ",40.76,93,,32.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",37.26,85,,29.81,,,0,"percent of total billed charges ","85% of total billed charges ",39.45,90,,31.56,,,0,"percent of total billed charges ","90% of total billed charges ",39.45,90,,31.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",38.13,87,,30.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.68,70,,24.54,,,0,"percent of total billed charges ","70% of total billed charges ",30.68,40.76,
"CUTTER LINEAR ETS FLEX 45MM",6107845,"CDM ",272,RC,,,OUTPATIENT,,,376.54,301.232,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",301.23,80,,240.98,,,0,"percent of total billed charges ","80% of total billed charges ",263.58,70,,210.86,,,0,"percent of total billed charges ","70% of total billed charges ",338.89,90,,271.11,,,0,"percent of total billed charges ","90% of total billed charges ",350.18,93,,280.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",320.06,85,,256.05,,,0,"percent of total billed charges ","85% of total billed charges ",338.89,90,,271.11,,,0,"percent of total billed charges ","90% of total billed charges ",338.89,90,,271.11,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",327.59,87,,262.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.58,70,,210.86,,,0,"percent of total billed charges ","70% of total billed charges ",263.58,350.18,
"RELOAD ETS FLEX 45MM WHITE",6107846,"CDM ",272,RC,,,OUTPATIENT,,,219.57,175.656,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",175.66,80,,140.53,,,0,"percent of total billed charges ","80% of total billed charges ",153.7,70,,122.96,,,0,"percent of total billed charges ","70% of total billed charges ",197.61,90,,158.09,,,0,"percent of total billed charges ","90% of total billed charges ",204.2,93,,163.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",186.63,85,,149.30,,,0,"percent of total billed charges ","85% of total billed charges ",197.61,90,,158.09,,,0,"percent of total billed charges ","90% of total billed charges ",197.61,90,,158.09,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",191.03,87,,152.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",153.7,70,,122.96,,,0,"percent of total billed charges ","70% of total billed charges ",153.7,204.2,
"RELOAD ETS FLEX 45MM BLUE",6107847,"CDM ",272,RC,,,OUTPATIENT,,,367.31,293.848,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",293.85,80,,235.08,,,0,"percent of total billed charges ","80% of total billed charges ",257.12,70,,205.70,,,0,"percent of total billed charges ","70% of total billed charges ",330.58,90,,264.46,,,0,"percent of total billed charges ","90% of total billed charges ",341.6,93,,273.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",312.21,85,,249.77,,,0,"percent of total billed charges ","85% of total billed charges ",330.58,90,,264.46,,,0,"percent of total billed charges ","90% of total billed charges ",330.58,90,,264.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",319.56,87,,255.65,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",257.12,70,,205.70,,,0,"percent of total billed charges ","70% of total billed charges ",257.12,341.6,
"RELOAD ETS FLEX 45MM GREEN",6107848,"CDM ",272,RC,,,OUTPATIENT,,,245.41,196.328,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",196.33,80,,157.06,,,0,"percent of total billed charges ","80% of total billed charges ",171.79,70,,137.43,,,0,"percent of total billed charges ","70% of total billed charges ",220.87,90,,176.70,,,0,"percent of total billed charges ","90% of total billed charges ",228.23,93,,182.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",208.6,85,,166.88,,,0,"percent of total billed charges ","85% of total billed charges ",220.87,90,,176.70,,,0,"percent of total billed charges ","90% of total billed charges ",220.87,90,,176.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",213.51,87,,170.81,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",171.79,70,,137.43,,,0,"percent of total billed charges ","70% of total billed charges ",171.79,228.23,
"BARRIER ADHESION INTERCEED",6107849,"CDM ",272,RC,,,OUTPATIENT,,,689.1,551.28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",551.28,80,,441.02,,,0,"percent of total billed charges ","80% of total billed charges ",482.37,70,,385.90,,,0,"percent of total billed charges ","70% of total billed charges ",620.19,90,,496.15,,,0,"percent of total billed charges ","90% of total billed charges ",640.86,93,,512.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",585.74,85,,468.59,,,0,"percent of total billed charges ","85% of total billed charges ",620.19,90,,496.15,,,0,"percent of total billed charges ","90% of total billed charges ",620.19,90,,496.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",599.52,87,,479.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",482.37,70,,385.90,,,0,"percent of total billed charges ","70% of total billed charges ",482.37,640.86,
"ENDOCUTTER PWRD FLEX 60MM LONG",6107850,"CDM ",272,RC,,,OUTPATIENT,,,721.49,577.192,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",577.19,80,,461.75,,,0,"percent of total billed charges ","80% of total billed charges ",505.04,70,,404.03,,,0,"percent of total billed charges ","70% of total billed charges ",649.34,90,,519.47,,,0,"percent of total billed charges ","90% of total billed charges ",670.99,93,,536.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",613.27,85,,490.62,,,0,"percent of total billed charges ","85% of total billed charges ",649.34,90,,519.47,,,0,"percent of total billed charges ","90% of total billed charges ",649.34,90,,519.47,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",627.7,87,,502.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",505.04,70,,404.03,,,0,"percent of total billed charges ","70% of total billed charges ",505.04,670.99,
"ENDOCUTTER PWRD FLEX 45MM COMP",6107851,"CDM ",272,RC,,,OUTPATIENT,,,612.93,490.344,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",490.34,80,,392.27,,,0,"percent of total billed charges ","80% of total billed charges ",429.05,70,,343.24,,,0,"percent of total billed charges ","70% of total billed charges ",551.64,90,,441.31,,,0,"percent of total billed charges ","90% of total billed charges ",570.02,93,,456.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",520.99,85,,416.79,,,0,"percent of total billed charges ","85% of total billed charges ",551.64,90,,441.31,,,0,"percent of total billed charges ","90% of total billed charges ",551.64,90,,441.31,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",533.25,87,,426.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",429.05,70,,343.24,,,0,"percent of total billed charges ","70% of total billed charges ",429.05,570.02,
"ENDOCUTTER PWRD FLEX 45MM STND",6107852,"CDM ",272,RC,,,OUTPATIENT,,,624.61,499.688,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",499.69,80,,399.75,,,0,"percent of total billed charges ","80% of total billed charges ",437.23,70,,349.78,,,0,"percent of total billed charges ","70% of total billed charges ",562.15,90,,449.72,,,0,"percent of total billed charges ","90% of total billed charges ",580.89,93,,464.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",530.92,85,,424.74,,,0,"percent of total billed charges ","85% of total billed charges ",562.15,90,,449.72,,,0,"percent of total billed charges ","90% of total billed charges ",562.15,90,,449.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",543.41,87,,434.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",437.23,70,,349.78,,,0,"percent of total billed charges ","70% of total billed charges ",437.23,580.89,
"PATCH HERNIA PROCEED MEDIUM",6107853,"CDM ",278,RC,,,OUTPATIENT,,,1004.78,803.824,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",803.82,80,,643.06,,,0,"percent of total billed charges ","80% of total billed charges ",703.35,70,,562.68,,,0,"percent of total billed charges ","70% of total billed charges ",904.3,90,,723.44,,,0,"percent of total billed charges ","90% of total billed charges ",934.45,93,,747.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",854.06,85,,683.25,,,0,"percent of total billed charges ","85% of total billed charges ",854.06,85,,683.25,,,0,"percent of total billed charges ","85% of total billed charges ",904.3,90,,723.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",874.16,87,,699.33,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",703.35,70,,562.68,,,0,"percent of total billed charges ","70% of total billed charges ",703.35,934.45,
"PATCH HERNIA PROCEED SMALL",6107854,"CDM ",278,RC,,,OUTPATIENT,,,808.13,646.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",646.5,80,,517.20,,,0,"percent of total billed charges ","80% of total billed charges ",565.69,70,,452.55,,,0,"percent of total billed charges ","70% of total billed charges ",727.32,90,,581.86,,,0,"percent of total billed charges ","90% of total billed charges ",751.56,93,,601.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",686.91,85,,549.53,,,0,"percent of total billed charges ","85% of total billed charges ",686.91,85,,549.53,,,0,"percent of total billed charges ","85% of total billed charges ",727.32,90,,581.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",703.07,87,,562.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",565.69,70,,452.55,,,0,"percent of total billed charges ","70% of total billed charges ",565.69,751.56,
"HANDPIECE THUNDERBEAT 35CM",6107857,"CDM ",272,RC,,,OUTPATIENT,,,1179.75,943.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",943.8,80,,755.04,,,0,"percent of total billed charges ","80% of total billed charges ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",1097.17,93,,877.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1002.79,85,,802.23,,,0,"percent of total billed charges ","85% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1026.38,87,,821.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",825.83,1097.17,
"HANDPIECE THUNDERBEAT 45CM",6107858,"CDM ",272,RC,,,OUTPATIENT,,,1179.75,943.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",943.8,80,,755.04,,,0,"percent of total billed charges ","80% of total billed charges ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",1097.17,93,,877.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1002.79,85,,802.23,,,0,"percent of total billed charges ","85% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1026.38,87,,821.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",825.83,1097.17,
"HANDPIECE THUNDERBEAT 10CM",6107859,"CDM ",272,RC,,,OUTPATIENT,,,1179.75,943.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",943.8,80,,755.04,,,0,"percent of total billed charges ","80% of total billed charges ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",1097.17,93,,877.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1002.79,85,,802.23,,,0,"percent of total billed charges ","85% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1026.38,87,,821.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",825.83,1097.17,
"HANDPIECE THUNDERBEAT 20CM",6107860,"CDM ",272,RC,,,OUTPATIENT,,,1179.75,943.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",943.8,80,,755.04,,,0,"percent of total billed charges ","80% of total billed charges ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",1097.17,93,,877.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1002.79,85,,802.23,,,0,"percent of total billed charges ","85% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1026.38,87,,821.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",825.83,1097.17,
"DEVICE SUCTION IRRIG W/CAUTERY",6107863,"CDM ",272,RC,,,OUTPATIENT,,,325.9,260.72,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",260.72,80,,208.58,,,0,"percent of total billed charges ","80% of total billed charges ",228.13,70,,182.50,,,0,"percent of total billed charges ","70% of total billed charges ",293.31,90,,234.65,,,0,"percent of total billed charges ","90% of total billed charges ",303.09,93,,242.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",277.02,85,,221.62,,,0,"percent of total billed charges ","85% of total billed charges ",293.31,90,,234.65,,,0,"percent of total billed charges ","90% of total billed charges ",293.31,90,,234.65,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",283.53,87,,226.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",228.13,70,,182.50,,,0,"percent of total billed charges ","70% of total billed charges ",228.13,303.09,
"RELOAD PWRD ECHELON 45MM WHITE",6107868,"CDM ",272,RC,,,OUTPATIENT,,,266.31,213.048,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",213.05,80,,170.44,,,0,"percent of total billed charges ","80% of total billed charges ",186.42,70,,149.14,,,0,"percent of total billed charges ","70% of total billed charges ",239.68,90,,191.74,,,0,"percent of total billed charges ","90% of total billed charges ",247.67,93,,198.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",226.36,85,,181.09,,,0,"percent of total billed charges ","85% of total billed charges ",239.68,90,,191.74,,,0,"percent of total billed charges ","90% of total billed charges ",239.68,90,,191.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",231.69,87,,185.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",186.42,70,,149.14,,,0,"percent of total billed charges ","70% of total billed charges ",186.42,247.67,
"RELOAD PWRD ECHELON 45MM BLUE",6107869,"CDM ",272,RC,,,OUTPATIENT,,,266.31,213.048,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",213.05,80,,170.44,,,0,"percent of total billed charges ","80% of total billed charges ",186.42,70,,149.14,,,0,"percent of total billed charges ","70% of total billed charges ",239.68,90,,191.74,,,0,"percent of total billed charges ","90% of total billed charges ",247.67,93,,198.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",226.36,85,,181.09,,,0,"percent of total billed charges ","85% of total billed charges ",239.68,90,,191.74,,,0,"percent of total billed charges ","90% of total billed charges ",239.68,90,,191.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",231.69,87,,185.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",186.42,70,,149.14,,,0,"percent of total billed charges ","70% of total billed charges ",186.42,247.67,
"RELOAD PWRD ECHELON 45MM GREEN",6107870,"CDM ",272,RC,,,OUTPATIENT,,,266.31,213.048,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",213.05,80,,170.44,,,0,"percent of total billed charges ","80% of total billed charges ",186.42,70,,149.14,,,0,"percent of total billed charges ","70% of total billed charges ",239.68,90,,191.74,,,0,"percent of total billed charges ","90% of total billed charges ",247.67,93,,198.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",226.36,85,,181.09,,,0,"percent of total billed charges ","85% of total billed charges ",239.68,90,,191.74,,,0,"percent of total billed charges ","90% of total billed charges ",239.68,90,,191.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",231.69,87,,185.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",186.42,70,,149.14,,,0,"percent of total billed charges ","70% of total billed charges ",186.42,247.67,
"DEVICE FIXATION ABSORBABLE 5MM",6107871,"CDM ",272,RC,,,OUTPATIENT,,,1014.37,811.496,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",811.5,80,,649.20,,,0,"percent of total billed charges ","80% of total billed charges ",710.06,70,,568.05,,,0,"percent of total billed charges ","70% of total billed charges ",912.93,90,,730.34,,,0,"percent of total billed charges ","90% of total billed charges ",943.36,93,,754.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",862.21,85,,689.77,,,0,"percent of total billed charges ","85% of total billed charges ",912.93,90,,730.34,,,0,"percent of total billed charges ","90% of total billed charges ",912.93,90,,730.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",882.5,87,,706.00,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",710.06,70,,568.05,,,0,"percent of total billed charges ","70% of total billed charges ",710.06,943.36,
"HANDSET VERSAJET EXACT 45 DEG",6107872,"CDM ",272,RC,,,OUTPATIENT,,,1306.8,1045.44,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1045.44,80,,836.35,,,0,"percent of total billed charges ","80% of total billed charges ",914.76,70,,731.81,,,0,"percent of total billed charges ","70% of total billed charges ",1176.12,90,,940.90,,,0,"percent of total billed charges ","90% of total billed charges ",1215.32,93,,972.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1110.78,85,,888.62,,,0,"percent of total billed charges ","85% of total billed charges ",1176.12,90,,940.90,,,0,"percent of total billed charges ","90% of total billed charges ",1176.12,90,,940.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1136.92,87,,909.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",914.76,70,,731.81,,,0,"percent of total billed charges ","70% of total billed charges ",914.76,1215.32,
"HANDSET VERSAJET EXACT 15 DEG",6107873,"CDM ",272,RC,,,OUTPATIENT,,,1306.8,1045.44,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1045.44,80,,836.35,,,0,"percent of total billed charges ","80% of total billed charges ",914.76,70,,731.81,,,0,"percent of total billed charges ","70% of total billed charges ",1176.12,90,,940.90,,,0,"percent of total billed charges ","90% of total billed charges ",1215.32,93,,972.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1110.78,85,,888.62,,,0,"percent of total billed charges ","85% of total billed charges ",1176.12,90,,940.90,,,0,"percent of total billed charges ","90% of total billed charges ",1176.12,90,,940.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1136.92,87,,909.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",914.76,70,,731.81,,,0,"percent of total billed charges ","70% of total billed charges ",914.76,1215.32,
"HANDSET VERSAJET PLUS 45 DEG",6107874,"CDM ",272,RC,,,OUTPATIENT,,,1306.8,1045.44,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1045.44,80,,836.35,,,0,"percent of total billed charges ","80% of total billed charges ",914.76,70,,731.81,,,0,"percent of total billed charges ","70% of total billed charges ",1176.12,90,,940.90,,,0,"percent of total billed charges ","90% of total billed charges ",1215.32,93,,972.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1110.78,85,,888.62,,,0,"percent of total billed charges ","85% of total billed charges ",1176.12,90,,940.90,,,0,"percent of total billed charges ","90% of total billed charges ",1176.12,90,,940.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1136.92,87,,909.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",914.76,70,,731.81,,,0,"percent of total billed charges ","70% of total billed charges ",914.76,1215.32,
"HANDSET VERSAJET PLUS 15 DEG",6107875,"CDM ",272,RC,,,OUTPATIENT,,,1306.8,1045.44,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1045.44,80,,836.35,,,0,"percent of total billed charges ","80% of total billed charges ",914.76,70,,731.81,,,0,"percent of total billed charges ","70% of total billed charges ",1176.12,90,,940.90,,,0,"percent of total billed charges ","90% of total billed charges ",1215.32,93,,972.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1110.78,85,,888.62,,,0,"percent of total billed charges ","85% of total billed charges ",1176.12,90,,940.90,,,0,"percent of total billed charges ","90% of total billed charges ",1176.12,90,,940.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1136.92,87,,909.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",914.76,70,,731.81,,,0,"percent of total billed charges ","70% of total billed charges ",914.76,1215.32,
"CLOSURE SKIN PRINEO",6107882,"CDM ",272,RC,,,OUTPATIENT,,,266.79,213.432,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",213.43,80,,170.74,,,0,"percent of total billed charges ","80% of total billed charges ",186.75,70,,149.40,,,0,"percent of total billed charges ","70% of total billed charges ",240.11,90,,192.09,,,0,"percent of total billed charges ","90% of total billed charges ",248.11,93,,198.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",226.77,85,,181.42,,,0,"percent of total billed charges ","85% of total billed charges ",240.11,90,,192.09,,,0,"percent of total billed charges ","90% of total billed charges ",240.11,90,,192.09,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",232.11,87,,185.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",186.75,70,,149.40,,,0,"percent of total billed charges ","70% of total billed charges ",186.75,248.11,
"TRAY SUPRA PUBIC LUBRI CATH",6107888,"CDM ",272,RC,,,OUTPATIENT,,,225.56,180.448,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",180.45,80,,144.36,,,0,"percent of total billed charges ","80% of total billed charges ",157.89,70,,126.31,,,0,"percent of total billed charges ","70% of total billed charges ",203,90,,162.40,,,0,"percent of total billed charges ","90% of total billed charges ",209.77,93,,167.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",191.73,85,,153.38,,,0,"percent of total billed charges ","85% of total billed charges ",203,90,,162.40,,,0,"percent of total billed charges ","90% of total billed charges ",203,90,,162.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",196.24,87,,156.99,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.89,70,,126.31,,,0,"percent of total billed charges ","70% of total billed charges ",157.89,209.77,
"RETRACTOR IRIS",6107890,"CDM ",272,RC,,,OUTPATIENT,,,116.68,93.344,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",93.34,80,,74.67,,,0,"percent of total billed charges ","80% of total billed charges ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",108.51,93,,86.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.18,85,,79.34,,,0,"percent of total billed charges ","85% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",105.01,90,,84.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",101.51,87,,81.21,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",81.68,70,,65.34,,,0,"percent of total billed charges ","70% of total billed charges ",81.68,108.51,
"AIRWAY NASO ADJ FLANGE 30FR",6107891,"CDM ",272,RC,,,OUTPATIENT,,,38.82,31.056,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.06,80,,24.85,,,0,"percent of total billed charges ","80% of total billed charges ",27.17,70,,21.74,,,0,"percent of total billed charges ","70% of total billed charges ",34.94,90,,27.95,,,0,"percent of total billed charges ","90% of total billed charges ",36.1,93,,28.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33,85,,26.40,,,0,"percent of total billed charges ","85% of total billed charges ",34.94,90,,27.95,,,0,"percent of total billed charges ","90% of total billed charges ",34.94,90,,27.95,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.77,87,,27.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.17,70,,21.74,,,0,"percent of total billed charges ","70% of total billed charges ",27.17,36.1,
"AIRWAY NASO ADJ FLANGE 34FR",6107892,"CDM ",272,RC,,,OUTPATIENT,,,38.47,30.776,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.78,80,,24.62,,,0,"percent of total billed charges ","80% of total billed charges ",26.93,70,,21.54,,,0,"percent of total billed charges ","70% of total billed charges ",34.62,90,,27.70,,,0,"percent of total billed charges ","90% of total billed charges ",35.78,93,,28.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.7,85,,26.16,,,0,"percent of total billed charges ","85% of total billed charges ",34.62,90,,27.70,,,0,"percent of total billed charges ","90% of total billed charges ",34.62,90,,27.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.47,87,,26.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.93,70,,21.54,,,0,"percent of total billed charges ","70% of total billed charges ",26.93,35.78,
"SUTURE STRATAFIX",6107898,"CDM ",272,RC,,,OUTPATIENT,,,111.61,89.288,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",89.29,80,,71.43,,,0,"percent of total billed charges ","80% of total billed charges ",78.13,70,,62.50,,,0,"percent of total billed charges ","70% of total billed charges ",100.45,90,,80.36,,,0,"percent of total billed charges ","90% of total billed charges ",103.8,93,,83.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",94.87,85,,75.90,,,0,"percent of total billed charges ","85% of total billed charges ",100.45,90,,80.36,,,0,"percent of total billed charges ","90% of total billed charges ",100.45,90,,80.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",97.1,87,,77.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.13,70,,62.50,,,0,"percent of total billed charges ","70% of total billed charges ",78.13,103.8,
"WAND AMBIENT MEGAVAC 90 DEG",6107917,"CDM ",272,RC,,,OUTPATIENT,,,527.98,422.384,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",422.38,80,,337.90,,,0,"percent of total billed charges ","80% of total billed charges ",369.59,70,,295.67,,,0,"percent of total billed charges ","70% of total billed charges ",475.18,90,,380.14,,,0,"percent of total billed charges ","90% of total billed charges ",491.02,93,,392.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",448.78,85,,359.02,,,0,"percent of total billed charges ","85% of total billed charges ",475.18,90,,380.14,,,0,"percent of total billed charges ","90% of total billed charges ",475.18,90,,380.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",459.34,87,,367.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",369.59,70,,295.67,,,0,"percent of total billed charges ","70% of total billed charges ",369.59,491.02,
"WAND AMBIENT MULTIVAC 50 DEG",6107919,"CDM ",272,RC,,,OUTPATIENT,,,1023.63,818.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",818.9,80,,655.12,,,0,"percent of total billed charges ","80% of total billed charges ",716.54,70,,573.23,,,0,"percent of total billed charges ","70% of total billed charges ",921.27,90,,737.02,,,0,"percent of total billed charges ","90% of total billed charges ",951.98,93,,761.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",870.09,85,,696.07,,,0,"percent of total billed charges ","85% of total billed charges ",921.27,90,,737.02,,,0,"percent of total billed charges ","90% of total billed charges ",921.27,90,,737.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",890.56,87,,712.45,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",716.54,70,,573.23,,,0,"percent of total billed charges ","70% of total billed charges ",716.54,951.98,
"SUTURE STRATAFIX PGA-PCL 18""",6107921,"CDM ",272,RC,,,OUTPATIENT,,,97.39,77.912,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",77.91,80,,62.33,,,0,"percent of total billed charges ","80% of total billed charges ",68.17,70,,54.54,,,0,"percent of total billed charges ","70% of total billed charges ",87.65,90,,70.12,,,0,"percent of total billed charges ","90% of total billed charges ",90.57,93,,72.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",82.78,85,,66.22,,,0,"percent of total billed charges ","85% of total billed charges ",87.65,90,,70.12,,,0,"percent of total billed charges ","90% of total billed charges ",87.65,90,,70.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",84.73,87,,67.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.17,70,,54.54,,,0,"percent of total billed charges ","70% of total billed charges ",68.17,90.57,
"SUTURE CARTRIDGE PERFECTPASSER",6107922,"CDM ",272,RC,,,OUTPATIENT,,,323.25,258.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",258.6,80,,206.88,,,0,"percent of total billed charges ","80% of total billed charges ",226.28,70,,181.02,,,0,"percent of total billed charges ","70% of total billed charges ",290.93,90,,232.74,,,0,"percent of total billed charges ","90% of total billed charges ",300.62,93,,240.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",274.76,85,,219.81,,,0,"percent of total billed charges ","85% of total billed charges ",290.93,90,,232.74,,,0,"percent of total billed charges ","90% of total billed charges ",290.93,90,,232.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",281.23,87,,224.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",226.28,70,,181.02,,,0,"percent of total billed charges ","70% of total billed charges ",226.28,300.62,
"CONNECTOR SS PERFECTPASSER",6107923,"CDM ",272,RC,,,OUTPATIENT,,,114.81,91.848,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.85,80,,73.48,,,0,"percent of total billed charges ","80% of total billed charges ",80.37,70,,64.30,,,0,"percent of total billed charges ","70% of total billed charges ",103.33,90,,82.66,,,0,"percent of total billed charges ","90% of total billed charges ",106.77,93,,85.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.59,85,,78.07,,,0,"percent of total billed charges ","85% of total billed charges ",103.33,90,,82.66,,,0,"percent of total billed charges ","90% of total billed charges ",103.33,90,,82.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",99.88,87,,79.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.37,70,,64.30,,,0,"percent of total billed charges ","70% of total billed charges ",80.37,106.77,
"NEEDLE & SUTURE CAPTURE",6107924,"CDM ",272,RC,,,OUTPATIENT,,,323.25,258.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",258.6,80,,206.88,,,0,"percent of total billed charges ","80% of total billed charges ",226.28,70,,181.02,,,0,"percent of total billed charges ","70% of total billed charges ",290.93,90,,232.74,,,0,"percent of total billed charges ","90% of total billed charges ",300.62,93,,240.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",274.76,85,,219.81,,,0,"percent of total billed charges ","85% of total billed charges ",290.93,90,,232.74,,,0,"percent of total billed charges ","90% of total billed charges ",290.93,90,,232.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",281.23,87,,224.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",226.28,70,,181.02,,,0,"percent of total billed charges ","70% of total billed charges ",226.28,300.62,
"SPEEDSCREW 5.5MM",6107925,"CDM ",272,RC,,,OUTPATIENT,,,969.75,775.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",775.8,80,,620.64,,,0,"percent of total billed charges ","80% of total billed charges ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",901.87,93,,721.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",843.68,87,,674.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",678.83,901.87,
"TUBE JEJUNAL 18FR 1.0 CM",6107926,"CDM ",270,RC,,,OUTPATIENT,,,357.19,285.752,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",285.75,80,,228.60,,,0,"percent of total billed charges ","80% of total billed charges ",250.03,70,,200.02,,,0,"percent of total billed charges ","70% of total billed charges ",321.47,90,,257.18,,,0,"percent of total billed charges ","90% of total billed charges ",332.19,93,,265.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",303.61,85,,242.89,,,0,"percent of total billed charges ","85% of total billed charges ",321.47,90,,257.18,,,0,"percent of total billed charges ","90% of total billed charges ",321.47,90,,257.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",310.76,87,,248.61,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",250.03,70,,200.02,,,0,"percent of total billed charges ","70% of total billed charges ",250.03,332.19,
"TUBE JEJUNAL 18FR 2.0 CM",6107927,"CDM ",270,RC,,,OUTPATIENT,,,357.19,285.752,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",285.75,80,,228.60,,,0,"percent of total billed charges ","80% of total billed charges ",250.03,70,,200.02,,,0,"percent of total billed charges ","70% of total billed charges ",321.47,90,,257.18,,,0,"percent of total billed charges ","90% of total billed charges ",332.19,93,,265.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",303.61,85,,242.89,,,0,"percent of total billed charges ","85% of total billed charges ",321.47,90,,257.18,,,0,"percent of total billed charges ","90% of total billed charges ",321.47,90,,257.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",310.76,87,,248.61,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",250.03,70,,200.02,,,0,"percent of total billed charges ","70% of total billed charges ",250.03,332.19,
"TUBE JEJUNAL 18FR 3.0 CM",6107928,"CDM ",270,RC,,,OUTPATIENT,,,357.19,285.752,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",285.75,80,,228.60,,,0,"percent of total billed charges ","80% of total billed charges ",250.03,70,,200.02,,,0,"percent of total billed charges ","70% of total billed charges ",321.47,90,,257.18,,,0,"percent of total billed charges ","90% of total billed charges ",332.19,93,,265.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",303.61,85,,242.89,,,0,"percent of total billed charges ","85% of total billed charges ",321.47,90,,257.18,,,0,"percent of total billed charges ","90% of total billed charges ",321.47,90,,257.18,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",310.76,87,,248.61,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",250.03,70,,200.02,,,0,"percent of total billed charges ","70% of total billed charges ",250.03,332.19,
"COVER TRACH STOMASHIELD",6107929,"CDM ",272,RC,,,OUTPATIENT,,,31.04,24.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.83,80,,19.86,,,0,"percent of total billed charges ","80% of total billed charges ",21.73,70,,17.38,,,0,"percent of total billed charges ","70% of total billed charges ",27.94,90,,22.35,,,0,"percent of total billed charges ","90% of total billed charges ",28.87,93,,23.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",26.38,85,,21.10,,,0,"percent of total billed charges ","85% of total billed charges ",27.94,90,,22.35,,,0,"percent of total billed charges ","90% of total billed charges ",27.94,90,,22.35,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",27,87,,21.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.73,70,,17.38,,,0,"percent of total billed charges ","70% of total billed charges ",21.73,28.87,
"TUBE TRANSGASTRIC JEJUNAL 16FR",6107930,"CDM ",272,RC,,,OUTPATIENT,,,678.83,543.064,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",543.06,80,,434.45,,,0,"percent of total billed charges ","80% of total billed charges ",475.18,70,,380.14,,,0,"percent of total billed charges ","70% of total billed charges ",610.95,90,,488.76,,,0,"percent of total billed charges ","90% of total billed charges ",631.31,93,,505.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",577.01,85,,461.61,,,0,"percent of total billed charges ","85% of total billed charges ",610.95,90,,488.76,,,0,"percent of total billed charges ","90% of total billed charges ",610.95,90,,488.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",590.58,87,,472.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",475.18,70,,380.14,,,0,"percent of total billed charges ","70% of total billed charges ",475.18,631.31,
SPLASHCAP,6107935,"CDM ",272,RC,,,OUTPATIENT,,,15.75,12.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.6,80,,10.08,,,0,"percent of total billed charges ","80% of total billed charges ",11.03,70,,8.82,,,0,"percent of total billed charges ","70% of total billed charges ",14.18,90,,11.34,,,0,"percent of total billed charges ","90% of total billed charges ",14.65,93,,11.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.39,85,,10.71,,,0,"percent of total billed charges ","85% of total billed charges ",14.18,90,,11.34,,,0,"percent of total billed charges ","90% of total billed charges ",14.18,90,,11.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.7,87,,10.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.03,70,,8.82,,,0,"percent of total billed charges ","70% of total billed charges ",11.03,14.65,
"RESECTOR FULL RADIUS 3.5 MM",6107949,"CDM ",272,RC,,,OUTPATIENT,,,197.63,158.104,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",158.1,80,,126.48,,,0,"percent of total billed charges ","80% of total billed charges ",138.34,70,,110.67,,,0,"percent of total billed charges ","70% of total billed charges ",177.87,90,,142.30,,,0,"percent of total billed charges ","90% of total billed charges ",183.8,93,,147.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",167.99,85,,134.39,,,0,"percent of total billed charges ","85% of total billed charges ",177.87,90,,142.30,,,0,"percent of total billed charges ","90% of total billed charges ",177.87,90,,142.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",171.94,87,,137.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",138.34,70,,110.67,,,0,"percent of total billed charges ","70% of total billed charges ",138.34,183.8,
"SUTURE PROLENE 6.0 8318H",6107955,"CDM ",272,RC,,,OUTPATIENT,,,41.77,33.416,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.42,80,,26.74,,,0,"percent of total billed charges ","80% of total billed charges ",29.24,70,,23.39,,,0,"percent of total billed charges ","70% of total billed charges ",37.59,90,,30.07,,,0,"percent of total billed charges ","90% of total billed charges ",38.85,93,,31.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",35.5,85,,28.40,,,0,"percent of total billed charges ","85% of total billed charges ",37.59,90,,30.07,,,0,"percent of total billed charges ","90% of total billed charges ",37.59,90,,30.07,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",36.34,87,,29.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.24,70,,23.39,,,0,"percent of total billed charges ","70% of total billed charges ",29.24,38.85,
"FORCEPS BIPOLAR STRAIGHT 114MM",6107965,"CDM ",272,RC,,,OUTPATIENT,,,134.59,107.672,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",107.67,80,,86.14,,,0,"percent of total billed charges ","80% of total billed charges ",94.21,70,,75.37,,,0,"percent of total billed charges ","70% of total billed charges ",121.13,90,,96.90,,,0,"percent of total billed charges ","90% of total billed charges ",125.17,93,,100.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",114.4,85,,91.52,,,0,"percent of total billed charges ","85% of total billed charges ",121.13,90,,96.90,,,0,"percent of total billed charges ","90% of total billed charges ",121.13,90,,96.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",117.09,87,,93.67,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.21,70,,75.37,,,0,"percent of total billed charges ","70% of total billed charges ",94.21,125.17,
"KIT AUTOPLEX SYSTEM",6107980,"CDM ",272,RC,,,OUTPATIENT,,,1270.5,1016.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1016.4,80,,813.12,,,0,"percent of total billed charges ","80% of total billed charges ",889.35,70,,711.48,,,0,"percent of total billed charges ","70% of total billed charges ",1143.45,90,,914.76,,,0,"percent of total billed charges ","90% of total billed charges ",1181.57,93,,945.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1079.93,85,,863.94,,,0,"percent of total billed charges ","85% of total billed charges ",1143.45,90,,914.76,,,0,"percent of total billed charges ","90% of total billed charges ",1143.45,90,,914.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1105.34,87,,884.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",889.35,70,,711.48,,,0,"percent of total billed charges ","70% of total billed charges ",889.35,1181.57,
"KIT VERTEPORT MANIFOLD",6107981,"CDM ",272,RC,,,OUTPATIENT,,,750.03,600.024,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",600.02,80,,480.02,,,0,"percent of total billed charges ","80% of total billed charges ",525.02,70,,420.02,,,0,"percent of total billed charges ","70% of total billed charges ",675.03,90,,540.02,,,0,"percent of total billed charges ","90% of total billed charges ",697.53,93,,558.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",637.53,85,,510.02,,,0,"percent of total billed charges ","85% of total billed charges ",675.03,90,,540.02,,,0,"percent of total billed charges ","90% of total billed charges ",675.03,90,,540.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",652.53,87,,522.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",525.02,70,,420.02,,,0,"percent of total billed charges ","70% of total billed charges ",525.02,697.53,
"KIT IVAS",6107982,"CDM ",272,RC,,,OUTPATIENT,,,3521.1,2816.88,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2816.88,80,,2253.50,,,0,"percent of total billed charges ","80% of total billed charges ",2464.77,70,,1971.82,,,0,"percent of total billed charges ","70% of total billed charges ",3168.99,90,,2535.19,,,0,"percent of total billed charges ","90% of total billed charges ",3274.62,93,,2619.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2992.94,85,,2394.35,,,0,"percent of total billed charges ","85% of total billed charges ",3168.99,90,,2535.19,,,0,"percent of total billed charges ","90% of total billed charges ",3168.99,90,,2535.19,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3063.36,87,,2450.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2464.77,70,,1971.82,,,0,"percent of total billed charges ","70% of total billed charges ",2464.77,3274.62,
"CANNULA CEMENT VERTEPORT",6107983,"CDM ",272,RC,,,OUTPATIENT,,,215.8,172.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.64,80,,138.11,,,0,"percent of total billed charges ","80% of total billed charges ",151.06,70,,120.85,,,0,"percent of total billed charges ","70% of total billed charges ",194.22,90,,155.38,,,0,"percent of total billed charges ","90% of total billed charges ",200.69,93,,160.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",183.43,85,,146.74,,,0,"percent of total billed charges ","85% of total billed charges ",194.22,90,,155.38,,,0,"percent of total billed charges ","90% of total billed charges ",194.22,90,,155.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",187.75,87,,150.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.06,70,,120.85,,,0,"percent of total billed charges ","70% of total billed charges ",151.06,200.69,
"KIT BONE BIOPSY IVAS",6107984,"CDM ",272,RC,,,OUTPATIENT,,,287.18,229.744,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",229.74,80,,183.79,,,0,"percent of total billed charges ","80% of total billed charges ",201.03,70,,160.82,,,0,"percent of total billed charges ","70% of total billed charges ",258.46,90,,206.77,,,0,"percent of total billed charges ","90% of total billed charges ",267.08,93,,213.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",244.1,85,,195.28,,,0,"percent of total billed charges ","85% of total billed charges ",258.46,90,,206.77,,,0,"percent of total billed charges ","90% of total billed charges ",258.46,90,,206.77,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",249.85,87,,199.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",201.03,70,,160.82,,,0,"percent of total billed charges ","70% of total billed charges ",201.03,267.08,
"DRILL HAND 10G IVAS",6107985,"CDM ",272,RC,,,OUTPATIENT,,,215.8,172.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.64,80,,138.11,,,0,"percent of total billed charges ","80% of total billed charges ",151.06,70,,120.85,,,0,"percent of total billed charges ","70% of total billed charges ",194.22,90,,155.38,,,0,"percent of total billed charges ","90% of total billed charges ",200.69,93,,160.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",183.43,85,,146.74,,,0,"percent of total billed charges ","85% of total billed charges ",194.22,90,,155.38,,,0,"percent of total billed charges ","90% of total billed charges ",194.22,90,,155.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",187.75,87,,150.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.06,70,,120.85,,,0,"percent of total billed charges ","70% of total billed charges ",151.06,200.69,
"NEEDLE MULTIFIRE SCORPION",6107989,"CDM ",272,RC,,,OUTPATIENT,,,366.35,293.08,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",293.08,80,,234.46,,,0,"percent of total billed charges ","80% of total billed charges ",256.45,70,,205.16,,,0,"percent of total billed charges ","70% of total billed charges ",329.72,90,,263.78,,,0,"percent of total billed charges ","90% of total billed charges ",340.71,93,,272.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",311.4,85,,249.12,,,0,"percent of total billed charges ","85% of total billed charges ",329.72,90,,263.78,,,0,"percent of total billed charges ","90% of total billed charges ",329.72,90,,263.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",318.72,87,,254.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",256.45,70,,205.16,,,0,"percent of total billed charges ","70% of total billed charges ",256.45,340.71,
FIBERTAPE,6107990,"CDM ",272,RC,,,OUTPATIENT,,,222.25,177.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.8,80,,142.24,,,0,"percent of total billed charges ","80% of total billed charges ",155.58,70,,124.46,,,0,"percent of total billed charges ","70% of total billed charges ",200.03,90,,160.02,,,0,"percent of total billed charges ","90% of total billed charges ",206.69,93,,165.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",188.91,85,,151.13,,,0,"percent of total billed charges ","85% of total billed charges ",200.03,90,,160.02,,,0,"percent of total billed charges ","90% of total billed charges ",200.03,90,,160.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",193.36,87,,154.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.58,70,,124.46,,,0,"percent of total billed charges ","70% of total billed charges ",155.58,206.69,
"SUTURE FIBERWIRE",6108001,"CDM ",272,RC,,,OUTPATIENT,,,97.79,78.232,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.23,80,,62.58,,,0,"percent of total billed charges ","80% of total billed charges ",68.45,70,,54.76,,,0,"percent of total billed charges ","70% of total billed charges ",88.01,90,,70.41,,,0,"percent of total billed charges ","90% of total billed charges ",90.94,93,,72.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.12,85,,66.50,,,0,"percent of total billed charges ","85% of total billed charges ",88.01,90,,70.41,,,0,"percent of total billed charges ","90% of total billed charges ",88.01,90,,70.41,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.08,87,,68.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.45,70,,54.76,,,0,"percent of total billed charges ","70% of total billed charges ",68.45,90.94,
"DEVICE FIXATION CURVED",6108022,"CDM ",272,RC,,,OUTPATIENT,,,1035.44,828.352,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",828.35,80,,662.68,,,0,"percent of total billed charges ","80% of total billed charges ",724.81,70,,579.85,,,0,"percent of total billed charges ","70% of total billed charges ",931.9,90,,745.52,,,0,"percent of total billed charges ","90% of total billed charges ",962.96,93,,770.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",880.12,85,,704.10,,,0,"percent of total billed charges ","85% of total billed charges ",931.9,90,,745.52,,,0,"percent of total billed charges ","90% of total billed charges ",931.9,90,,745.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",900.83,87,,720.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",724.81,70,,579.85,,,0,"percent of total billed charges ","70% of total billed charges ",724.81,962.96,
"SUTURE PROLENE 4.0 8871H",6108052,"CDM ",272,RC,,,OUTPATIENT,,,11.48,9.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.18,80,,7.34,,,0,"percent of total billed charges ","80% of total billed charges ",8.04,70,,6.43,,,0,"percent of total billed charges ","70% of total billed charges ",10.33,90,,8.26,,,0,"percent of total billed charges ","90% of total billed charges ",10.68,93,,8.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.76,85,,7.81,,,0,"percent of total billed charges ","85% of total billed charges ",10.33,90,,8.26,,,0,"percent of total billed charges ","90% of total billed charges ",10.33,90,,8.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.99,87,,7.99,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.04,70,,6.43,,,0,"percent of total billed charges ","70% of total billed charges ",8.04,10.68,
"SET PUMP SAPPHIRE",6108089,"CDM ",272,RC,,,OUTPATIENT,,,45.03,36.024,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.02,80,,28.82,,,0,"percent of total billed charges ","80% of total billed charges ",31.52,70,,25.22,,,0,"percent of total billed charges ","70% of total billed charges ",40.53,90,,32.42,,,0,"percent of total billed charges ","90% of total billed charges ",41.88,93,,33.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.28,85,,30.62,,,0,"percent of total billed charges ","85% of total billed charges ",40.53,90,,32.42,,,0,"percent of total billed charges ","90% of total billed charges ",40.53,90,,32.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.18,87,,31.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.52,70,,25.22,,,0,"percent of total billed charges ","70% of total billed charges ",31.52,41.88,
"CATH FOLEY SILICONE 14FR 5CC",6108099,"CDM ",272,RC,,,OUTPATIENT,,,15.9,12.72,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.72,80,,10.18,,,0,"percent of total billed charges ","80% of total billed charges ",11.13,70,,8.90,,,0,"percent of total billed charges ","70% of total billed charges ",14.31,90,,11.45,,,0,"percent of total billed charges ","90% of total billed charges ",14.79,93,,11.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.52,85,,10.82,,,0,"percent of total billed charges ","85% of total billed charges ",14.31,90,,11.45,,,0,"percent of total billed charges ","90% of total billed charges ",14.31,90,,11.45,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.83,87,,11.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.13,70,,8.90,,,0,"percent of total billed charges ","70% of total billed charges ",11.13,14.79,
"CATH FOLEY SILICONE 20FR 5CC",6108100,"CDM ",272,RC,,,OUTPATIENT,,,15.7,12.56,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.56,80,,10.05,,,0,"percent of total billed charges ","80% of total billed charges ",10.99,70,,8.79,,,0,"percent of total billed charges ","70% of total billed charges ",14.13,90,,11.30,,,0,"percent of total billed charges ","90% of total billed charges ",14.6,93,,11.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.35,85,,10.68,,,0,"percent of total billed charges ","85% of total billed charges ",14.13,90,,11.30,,,0,"percent of total billed charges ","90% of total billed charges ",14.13,90,,11.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.66,87,,10.93,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.99,70,,8.79,,,0,"percent of total billed charges ","70% of total billed charges ",10.99,14.6,
"RETRACTOR MOBIUS 17 CM",6108101,"CDM ",272,RC,,,OUTPATIENT,,,205.38,164.304,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",164.3,80,,131.44,,,0,"percent of total billed charges ","80% of total billed charges ",143.77,70,,115.02,,,0,"percent of total billed charges ","70% of total billed charges ",184.84,90,,147.87,,,0,"percent of total billed charges ","90% of total billed charges ",191,93,,152.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",174.57,85,,139.66,,,0,"percent of total billed charges ","85% of total billed charges ",184.84,90,,147.87,,,0,"percent of total billed charges ","90% of total billed charges ",184.84,90,,147.87,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",178.68,87,,142.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",143.77,70,,115.02,,,0,"percent of total billed charges ","70% of total billed charges ",143.77,191,
"RETRACTOR ALEXIS LG 9-14CM",6108102,"CDM ",272,RC,,,OUTPATIENT,,,290.63,232.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",232.5,80,,186.00,,,0,"percent of total billed charges ","80% of total billed charges ",203.44,70,,162.75,,,0,"percent of total billed charges ","70% of total billed charges ",261.57,90,,209.26,,,0,"percent of total billed charges ","90% of total billed charges ",270.29,93,,216.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",247.04,85,,197.63,,,0,"percent of total billed charges ","85% of total billed charges ",261.57,90,,209.26,,,0,"percent of total billed charges ","90% of total billed charges ",261.57,90,,209.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",252.85,87,,202.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",203.44,70,,162.75,,,0,"percent of total billed charges ","70% of total billed charges ",203.44,270.29,
"RETRACTOR ALEXIS XLG 11-17CM",6108103,"CDM ",272,RC,,,OUTPATIENT,,,344.88,275.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",275.9,80,,220.72,,,0,"percent of total billed charges ","80% of total billed charges ",241.42,70,,193.14,,,0,"percent of total billed charges ","70% of total billed charges ",310.39,90,,248.31,,,0,"percent of total billed charges ","90% of total billed charges ",320.74,93,,256.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",293.15,85,,234.52,,,0,"percent of total billed charges ","85% of total billed charges ",310.39,90,,248.31,,,0,"percent of total billed charges ","90% of total billed charges ",310.39,90,,248.31,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",300.05,87,,240.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.42,70,,193.14,,,0,"percent of total billed charges ","70% of total billed charges ",241.42,320.74,
"GUIDEWIRE PTFE .025"" X 150CM",6108118,"CDM ",278,RC,,,OUTPATIENT,,,73.65,58.92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.92,80,,47.14,,,0,"percent of total billed charges ","80% of total billed charges ",51.56,70,,41.25,,,0,"percent of total billed charges ","70% of total billed charges ",66.29,90,,53.03,,,0,"percent of total billed charges ","90% of total billed charges ",68.49,93,,54.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.6,85,,50.08,,,0,"percent of total billed charges ","85% of total billed charges ",62.6,85,,50.08,,,0,"percent of total billed charges ","85% of total billed charges ",66.29,90,,53.03,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",64.08,87,,51.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.56,70,,41.25,,,0,"percent of total billed charges ","70% of total billed charges ",51.56,68.49,
"BASKET NITINOL NO TIP 1.8FR",6108119,"CDM ",272,RC,,,OUTPATIENT,,,341.35,273.08,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.08,80,,218.46,,,0,"percent of total billed charges ","80% of total billed charges ",238.95,70,,191.16,,,0,"percent of total billed charges ","70% of total billed charges ",307.22,90,,245.78,,,0,"percent of total billed charges ","90% of total billed charges ",317.46,93,,253.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",290.15,85,,232.12,,,0,"percent of total billed charges ","85% of total billed charges ",307.22,90,,245.78,,,0,"percent of total billed charges ","90% of total billed charges ",307.22,90,,245.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",296.97,87,,237.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",238.95,70,,191.16,,,0,"percent of total billed charges ","70% of total billed charges ",238.95,317.46,
"BASKET NITINOL NO TIP 2.2FR",6108120,"CDM ",272,RC,,,OUTPATIENT,,,341.35,273.08,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.08,80,,218.46,,,0,"percent of total billed charges ","80% of total billed charges ",238.95,70,,191.16,,,0,"percent of total billed charges ","70% of total billed charges ",307.22,90,,245.78,,,0,"percent of total billed charges ","90% of total billed charges ",317.46,93,,253.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",290.15,85,,232.12,,,0,"percent of total billed charges ","85% of total billed charges ",307.22,90,,245.78,,,0,"percent of total billed charges ","90% of total billed charges ",307.22,90,,245.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",296.97,87,,237.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",238.95,70,,191.16,,,0,"percent of total billed charges ","70% of total billed charges ",238.95,317.46,
"BASKET NITINOL NO TIP 3.0FR",6108121,"CDM ",272,RC,,,OUTPATIENT,,,341.35,273.08,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",273.08,80,,218.46,,,0,"percent of total billed charges ","80% of total billed charges ",238.95,70,,191.16,,,0,"percent of total billed charges ","70% of total billed charges ",307.22,90,,245.78,,,0,"percent of total billed charges ","90% of total billed charges ",317.46,93,,253.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",290.15,85,,232.12,,,0,"percent of total billed charges ","85% of total billed charges ",307.22,90,,245.78,,,0,"percent of total billed charges ","90% of total billed charges ",307.22,90,,245.78,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",296.97,87,,237.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",238.95,70,,191.16,,,0,"percent of total billed charges ","70% of total billed charges ",238.95,317.46,
"CATH URETERAL DUAL LUMEN 10FR",6108122,"CDM ",272,RC,,,OUTPATIENT,,,155.58,124.464,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.46,80,,99.57,,,0,"percent of total billed charges ","80% of total billed charges ",108.91,70,,87.13,,,0,"percent of total billed charges ","70% of total billed charges ",140.02,90,,112.02,,,0,"percent of total billed charges ","90% of total billed charges ",144.69,93,,115.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",132.24,85,,105.79,,,0,"percent of total billed charges ","85% of total billed charges ",140.02,90,,112.02,,,0,"percent of total billed charges ","90% of total billed charges ",140.02,90,,112.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",135.35,87,,108.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.91,70,,87.13,,,0,"percent of total billed charges ","70% of total billed charges ",108.91,144.69,
"SHEATH UROPASS 12/14FR X 38CM",6108123,"CDM ",272,RC,,,OUTPATIENT,,,218.52,174.816,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174.82,80,,139.86,,,0,"percent of total billed charges ","80% of total billed charges ",152.96,70,,122.37,,,0,"percent of total billed charges ","70% of total billed charges ",196.67,90,,157.34,,,0,"percent of total billed charges ","90% of total billed charges ",203.22,93,,162.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",185.74,85,,148.59,,,0,"percent of total billed charges ","85% of total billed charges ",196.67,90,,157.34,,,0,"percent of total billed charges ","90% of total billed charges ",196.67,90,,157.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",190.11,87,,152.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.96,70,,122.37,,,0,"percent of total billed charges ","70% of total billed charges ",152.96,203.22,
"SYSTEM MANUAL IRRIGATION 12CC",6108124,"CDM ",272,RC,,,OUTPATIENT,,,145.08,116.064,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116.06,80,,92.85,,,0,"percent of total billed charges ","80% of total billed charges ",101.56,70,,81.25,,,0,"percent of total billed charges ","70% of total billed charges ",130.57,90,,104.46,,,0,"percent of total billed charges ","90% of total billed charges ",134.92,93,,107.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.32,85,,98.66,,,0,"percent of total billed charges ","85% of total billed charges ",130.57,90,,104.46,,,0,"percent of total billed charges ","90% of total billed charges ",130.57,90,,104.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.22,87,,100.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.56,70,,81.25,,,0,"percent of total billed charges ","70% of total billed charges ",101.56,134.92,
"FIBER LASER 200 MICRON",6108125,"CDM ",272,RC,,,OUTPATIENT,,,476.26,381.008,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",381.01,80,,304.81,,,0,"percent of total billed charges ","80% of total billed charges ",333.38,70,,266.70,,,0,"percent of total billed charges ","70% of total billed charges ",428.63,90,,342.90,,,0,"percent of total billed charges ","90% of total billed charges ",442.92,93,,354.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",404.82,85,,323.86,,,0,"percent of total billed charges ","85% of total billed charges ",428.63,90,,342.90,,,0,"percent of total billed charges ","90% of total billed charges ",428.63,90,,342.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",414.35,87,,331.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",333.38,70,,266.70,,,0,"percent of total billed charges ","70% of total billed charges ",333.38,442.92,
"FIBER LASER 400 MICRON",6108126,"CDM ",272,RC,,,OUTPATIENT,,,476.26,381.008,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",381.01,80,,304.81,,,0,"percent of total billed charges ","80% of total billed charges ",333.38,70,,266.70,,,0,"percent of total billed charges ","70% of total billed charges ",428.63,90,,342.90,,,0,"percent of total billed charges ","90% of total billed charges ",442.92,93,,354.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",404.82,85,,323.86,,,0,"percent of total billed charges ","85% of total billed charges ",428.63,90,,342.90,,,0,"percent of total billed charges ","90% of total billed charges ",428.63,90,,342.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",414.35,87,,331.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",333.38,70,,266.70,,,0,"percent of total billed charges ","70% of total billed charges ",333.38,442.92,
"FIBER LASER 600 MICRON",6108127,"CDM ",272,RC,,,OUTPATIENT,,,476.26,381.008,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",381.01,80,,304.81,,,0,"percent of total billed charges ","80% of total billed charges ",333.38,70,,266.70,,,0,"percent of total billed charges ","70% of total billed charges ",428.63,90,,342.90,,,0,"percent of total billed charges ","90% of total billed charges ",442.92,93,,354.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",404.82,85,,323.86,,,0,"percent of total billed charges ","85% of total billed charges ",428.63,90,,342.90,,,0,"percent of total billed charges ","90% of total billed charges ",428.63,90,,342.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",414.35,87,,331.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",333.38,70,,266.70,,,0,"percent of total billed charges ","70% of total billed charges ",333.38,442.92,
"FIBER LASER 1000 MICRON",6108128,"CDM ",272,RC,,,OUTPATIENT,,,1028.51,822.808,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",822.81,80,,658.25,,,0,"percent of total billed charges ","80% of total billed charges ",719.96,70,,575.97,,,0,"percent of total billed charges ","70% of total billed charges ",925.66,90,,740.53,,,0,"percent of total billed charges ","90% of total billed charges ",956.51,93,,765.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",874.23,85,,699.38,,,0,"percent of total billed charges ","85% of total billed charges ",925.66,90,,740.53,,,0,"percent of total billed charges ","90% of total billed charges ",925.66,90,,740.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",894.8,87,,715.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",719.96,70,,575.97,,,0,"percent of total billed charges ","70% of total billed charges ",719.96,956.51,
"GUIDEWIRE AMPLATZ .038 X 150CM",6108129,"CDM ",278,RC,,,OUTPATIENT,,,102.99,82.392,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.39,80,,65.91,,,0,"percent of total billed charges ","80% of total billed charges ",72.09,70,,57.67,,,0,"percent of total billed charges ","70% of total billed charges ",92.69,90,,74.15,,,0,"percent of total billed charges ","90% of total billed charges ",95.78,93,,76.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",87.54,85,,70.03,,,0,"percent of total billed charges ","85% of total billed charges ",87.54,85,,70.03,,,0,"percent of total billed charges ","85% of total billed charges ",92.69,90,,74.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",89.6,87,,71.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.09,70,,57.67,,,0,"percent of total billed charges ","70% of total billed charges ",72.09,95.78,
"GLIDEWIRE ANG TIP .038 X 150CM",6108130,"CDM ",278,RC,,,OUTPATIENT,,,177.44,141.952,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.95,80,,113.56,,,0,"percent of total billed charges ","80% of total billed charges ",124.21,70,,99.37,,,0,"percent of total billed charges ","70% of total billed charges ",159.7,90,,127.76,,,0,"percent of total billed charges ","90% of total billed charges ",165.02,93,,132.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",150.82,85,,120.66,,,0,"percent of total billed charges ","85% of total billed charges ",150.82,85,,120.66,,,0,"percent of total billed charges ","85% of total billed charges ",159.7,90,,127.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",154.37,87,,123.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.21,70,,99.37,,,0,"percent of total billed charges ","70% of total billed charges ",124.21,165.02,
"GLIDEWIRE STR TIP .038 X 150CM",6108131,"CDM ",278,RC,,,OUTPATIENT,,,177.44,141.952,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",141.95,80,,113.56,,,0,"percent of total billed charges ","80% of total billed charges ",124.21,70,,99.37,,,0,"percent of total billed charges ","70% of total billed charges ",159.7,90,,127.76,,,0,"percent of total billed charges ","90% of total billed charges ",165.02,93,,132.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",150.82,85,,120.66,,,0,"percent of total billed charges ","85% of total billed charges ",150.82,85,,120.66,,,0,"percent of total billed charges ","85% of total billed charges ",159.7,90,,127.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",154.37,87,,123.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.21,70,,99.37,,,0,"percent of total billed charges ","70% of total billed charges ",124.21,165.02,
"ELECTRODE HF LOOP 24F 12DEG",6108132,"CDM ",272,RC,,,OUTPATIENT,,,230.52,184.416,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",184.42,80,,147.54,,,0,"percent of total billed charges ","80% of total billed charges ",161.36,70,,129.09,,,0,"percent of total billed charges ","70% of total billed charges ",207.47,90,,165.98,,,0,"percent of total billed charges ","90% of total billed charges ",214.38,93,,171.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",195.94,85,,156.75,,,0,"percent of total billed charges ","85% of total billed charges ",207.47,90,,165.98,,,0,"percent of total billed charges ","90% of total billed charges ",207.47,90,,165.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",200.55,87,,160.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",161.36,70,,129.09,,,0,"percent of total billed charges ","70% of total billed charges ",161.36,214.38,
"ELECTRODE HF ROLLER 24-28FR",6108133,"CDM ",272,RC,,,OUTPATIENT,,,368.75,295,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",295,80,,236.00,,,0,"percent of total billed charges ","80% of total billed charges ",258.13,70,,206.50,,,0,"percent of total billed charges ","70% of total billed charges ",331.88,90,,265.50,,,0,"percent of total billed charges ","90% of total billed charges ",342.94,93,,274.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",313.44,85,,250.75,,,0,"percent of total billed charges ","85% of total billed charges ",331.88,90,,265.50,,,0,"percent of total billed charges ","90% of total billed charges ",331.88,90,,265.50,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",320.81,87,,256.65,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",258.13,70,,206.50,,,0,"percent of total billed charges ","70% of total billed charges ",258.13,342.94,
"CATH FOLEY COUNCIL 16FR 5CC",6108134,"CDM ",272,RC,,,OUTPATIENT,,,64.01,51.208,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.21,80,,40.97,,,0,"percent of total billed charges ","80% of total billed charges ",44.81,70,,35.85,,,0,"percent of total billed charges ","70% of total billed charges ",57.61,90,,46.09,,,0,"percent of total billed charges ","90% of total billed charges ",59.53,93,,47.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",54.41,85,,43.53,,,0,"percent of total billed charges ","85% of total billed charges ",57.61,90,,46.09,,,0,"percent of total billed charges ","90% of total billed charges ",57.61,90,,46.09,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",55.69,87,,44.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.81,70,,35.85,,,0,"percent of total billed charges ","70% of total billed charges ",44.81,59.53,
"CATH FOLEY COUNCIL 18FR 5CC",6108135,"CDM ",272,RC,,,OUTPATIENT,,,69.92,55.936,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.94,80,,44.75,,,0,"percent of total billed charges ","80% of total billed charges ",48.94,70,,39.15,,,0,"percent of total billed charges ","70% of total billed charges ",62.93,90,,50.34,,,0,"percent of total billed charges ","90% of total billed charges ",65.03,93,,52.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",59.43,85,,47.54,,,0,"percent of total billed charges ","85% of total billed charges ",62.93,90,,50.34,,,0,"percent of total billed charges ","90% of total billed charges ",62.93,90,,50.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",60.83,87,,48.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.94,70,,39.15,,,0,"percent of total billed charges ","70% of total billed charges ",48.94,65.03,
"CATH FOLEY COUNCIL 20FR 5CC",6108136,"CDM ",272,RC,,,OUTPATIENT,,,64.01,51.208,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.21,80,,40.97,,,0,"percent of total billed charges ","80% of total billed charges ",44.81,70,,35.85,,,0,"percent of total billed charges ","70% of total billed charges ",57.61,90,,46.09,,,0,"percent of total billed charges ","90% of total billed charges ",59.53,93,,47.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",54.41,85,,43.53,,,0,"percent of total billed charges ","85% of total billed charges ",57.61,90,,46.09,,,0,"percent of total billed charges ","90% of total billed charges ",57.61,90,,46.09,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",55.69,87,,44.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.81,70,,35.85,,,0,"percent of total billed charges ","70% of total billed charges ",44.81,59.53,
"CATH FOLEY HEMATURIA 20FR 30CC",6108137,"CDM ",272,RC,,,OUTPATIENT,,,150.42,120.336,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.34,80,,96.27,,,0,"percent of total billed charges ","80% of total billed charges ",105.29,70,,84.23,,,0,"percent of total billed charges ","70% of total billed charges ",135.38,90,,108.30,,,0,"percent of total billed charges ","90% of total billed charges ",139.89,93,,111.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",127.86,85,,102.29,,,0,"percent of total billed charges ","85% of total billed charges ",135.38,90,,108.30,,,0,"percent of total billed charges ","90% of total billed charges ",135.38,90,,108.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",130.87,87,,104.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",105.29,70,,84.23,,,0,"percent of total billed charges ","70% of total billed charges ",105.29,139.89,
"CATH FOLEY HEMATURIA 22FR 30CC",6108138,"CDM ",272,RC,,,OUTPATIENT,,,68.23,54.584,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.58,80,,43.66,,,0,"percent of total billed charges ","80% of total billed charges ",47.76,70,,38.21,,,0,"percent of total billed charges ","70% of total billed charges ",61.41,90,,49.13,,,0,"percent of total billed charges ","90% of total billed charges ",63.45,93,,50.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",58,85,,46.40,,,0,"percent of total billed charges ","85% of total billed charges ",61.41,90,,49.13,,,0,"percent of total billed charges ","90% of total billed charges ",61.41,90,,49.13,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",59.36,87,,47.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.76,70,,38.21,,,0,"percent of total billed charges ","70% of total billed charges ",47.76,63.45,
"CATH FOLEY HEMATURIA 24FR 30CC",6108139,"CDM ",272,RC,,,OUTPATIENT,,,150.42,120.336,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.34,80,,96.27,,,0,"percent of total billed charges ","80% of total billed charges ",105.29,70,,84.23,,,0,"percent of total billed charges ","70% of total billed charges ",135.38,90,,108.30,,,0,"percent of total billed charges ","90% of total billed charges ",139.89,93,,111.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",127.86,85,,102.29,,,0,"percent of total billed charges ","85% of total billed charges ",135.38,90,,108.30,,,0,"percent of total billed charges ","90% of total billed charges ",135.38,90,,108.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",130.87,87,,104.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",105.29,70,,84.23,,,0,"percent of total billed charges ","70% of total billed charges ",105.29,139.89,
"SET URETERAL DILATOR 6FR-18FR",6108145,"CDM ",272,RC,,,OUTPATIENT,,,409.45,327.56,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",327.56,80,,262.05,,,0,"percent of total billed charges ","80% of total billed charges ",286.62,70,,229.30,,,0,"percent of total billed charges ","70% of total billed charges ",368.51,90,,294.81,,,0,"percent of total billed charges ","90% of total billed charges ",380.79,93,,304.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",348.03,85,,278.42,,,0,"percent of total billed charges ","85% of total billed charges ",368.51,90,,294.81,,,0,"percent of total billed charges ","90% of total billed charges ",368.51,90,,294.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",356.22,87,,284.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",286.62,70,,229.30,,,0,"percent of total billed charges ","70% of total billed charges ",286.62,380.79,
"PACK CYCSTOSCOPY",6108149,"CDM ",272,RC,,,OUTPATIENT,,,20.31,16.248,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.25,80,,13.00,,,0,"percent of total billed charges ","80% of total billed charges ",14.22,70,,11.38,,,0,"percent of total billed charges ","70% of total billed charges ",18.28,90,,14.62,,,0,"percent of total billed charges ","90% of total billed charges ",18.89,93,,15.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.26,85,,13.81,,,0,"percent of total billed charges ","85% of total billed charges ",18.28,90,,14.62,,,0,"percent of total billed charges ","90% of total billed charges ",18.28,90,,14.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.67,87,,14.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.22,70,,11.38,,,0,"percent of total billed charges ","70% of total billed charges ",14.22,18.89,
"CATH URETERAL OPEN END 5FR",6108150,"CDM ",272,RC,,,OUTPATIENT,,,74.19,59.352,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.35,80,,47.48,,,0,"percent of total billed charges ","80% of total billed charges ",51.93,70,,41.54,,,0,"percent of total billed charges ","70% of total billed charges ",66.77,90,,53.42,,,0,"percent of total billed charges ","90% of total billed charges ",69,93,,55.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",63.06,85,,50.45,,,0,"percent of total billed charges ","85% of total billed charges ",66.77,90,,53.42,,,0,"percent of total billed charges ","90% of total billed charges ",66.77,90,,53.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",64.55,87,,51.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.93,70,,41.54,,,0,"percent of total billed charges ","70% of total billed charges ",51.93,69,
"GELPORT 120MM",6108152,"CDM ",272,RC,,,OUTPATIENT,,,1179.75,943.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",943.8,80,,755.04,,,0,"percent of total billed charges ","80% of total billed charges ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",1097.17,93,,877.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1002.79,85,,802.23,,,0,"percent of total billed charges ","85% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1026.38,87,,821.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",825.83,1097.17,
"ELECTRODE FULGURATING 5FR",6108153,"CDM ",272,RC,,,OUTPATIENT,,,204.83,163.864,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",163.86,80,,131.09,,,0,"percent of total billed charges ","80% of total billed charges ",143.38,70,,114.70,,,0,"percent of total billed charges ","70% of total billed charges ",184.35,90,,147.48,,,0,"percent of total billed charges ","90% of total billed charges ",190.49,93,,152.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",174.11,85,,139.29,,,0,"percent of total billed charges ","85% of total billed charges ",184.35,90,,147.48,,,0,"percent of total billed charges ","90% of total billed charges ",184.35,90,,147.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",178.2,87,,142.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",143.38,70,,114.70,,,0,"percent of total billed charges ","70% of total billed charges ",143.38,190.49,
"LIGACLIP TITANIUM MED",6108154,"CDM ",272,RC,,,OUTPATIENT,,,11.68,9.344,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.34,80,,7.47,,,0,"percent of total billed charges ","80% of total billed charges ",8.18,70,,6.54,,,0,"percent of total billed charges ","70% of total billed charges ",10.51,90,,8.41,,,0,"percent of total billed charges ","90% of total billed charges ",10.86,93,,8.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.93,85,,7.94,,,0,"percent of total billed charges ","85% of total billed charges ",10.51,90,,8.41,,,0,"percent of total billed charges ","90% of total billed charges ",10.51,90,,8.41,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.16,87,,8.13,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.18,70,,6.54,,,0,"percent of total billed charges ","70% of total billed charges ",8.18,10.86,
"SUTURE MONOCRYL 2.0 D8592",6108155,"CDM ",272,RC,,,OUTPATIENT,,,123.93,99.144,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.14,80,,79.31,,,0,"percent of total billed charges ","80% of total billed charges ",86.75,70,,69.40,,,0,"percent of total billed charges ","70% of total billed charges ",111.54,90,,89.23,,,0,"percent of total billed charges ","90% of total billed charges ",115.25,93,,92.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",105.34,85,,84.27,,,0,"percent of total billed charges ","85% of total billed charges ",111.54,90,,89.23,,,0,"percent of total billed charges ","90% of total billed charges ",111.54,90,,89.23,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",107.82,87,,86.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.75,70,,69.40,,,0,"percent of total billed charges ","70% of total billed charges ",86.75,115.25,
"SUTURE PDS II 4.0 Z823G",6108156,"CDM ",272,RC,,,OUTPATIENT,,,21.87,17.496,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.5,80,,14.00,,,0,"percent of total billed charges ","80% of total billed charges ",15.31,70,,12.25,,,0,"percent of total billed charges ","70% of total billed charges ",19.68,90,,15.74,,,0,"percent of total billed charges ","90% of total billed charges ",20.34,93,,16.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.59,85,,14.87,,,0,"percent of total billed charges ","85% of total billed charges ",19.68,90,,15.74,,,0,"percent of total billed charges ","90% of total billed charges ",19.68,90,,15.74,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.03,87,,15.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.31,70,,12.25,,,0,"percent of total billed charges ","70% of total billed charges ",15.31,20.34,
"SUTURE VICRYL 0 TIES 45CM",6108157,"CDM ",272,RC,,,OUTPATIENT,,,30.39,24.312,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.31,80,,19.45,,,0,"percent of total billed charges ","80% of total billed charges ",21.27,70,,17.02,,,0,"percent of total billed charges ","70% of total billed charges ",27.35,90,,21.88,,,0,"percent of total billed charges ","90% of total billed charges ",28.26,93,,22.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.83,85,,20.66,,,0,"percent of total billed charges ","85% of total billed charges ",27.35,90,,21.88,,,0,"percent of total billed charges ","90% of total billed charges ",27.35,90,,21.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.44,87,,21.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.27,70,,17.02,,,0,"percent of total billed charges ","70% of total billed charges ",21.27,28.26,
"GUIDEWIRE STR TIP .038 X 80CM",6108162,"CDM ",272,RC,,,OUTPATIENT,,,106.95,85.56,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.56,80,,68.45,,,0,"percent of total billed charges ","80% of total billed charges ",74.87,70,,59.90,,,0,"percent of total billed charges ","70% of total billed charges ",96.26,90,,77.01,,,0,"percent of total billed charges ","90% of total billed charges ",99.46,93,,79.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",90.91,85,,72.73,,,0,"percent of total billed charges ","85% of total billed charges ",96.26,90,,77.01,,,0,"percent of total billed charges ","90% of total billed charges ",96.26,90,,77.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",93.05,87,,74.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.87,70,,59.90,,,0,"percent of total billed charges ","70% of total billed charges ",74.87,99.46,
"SHEATH UROPASS 12/14FR X 54CM",6108163,"CDM ",272,RC,,,OUTPATIENT,,,218.52,174.816,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174.82,80,,139.86,,,0,"percent of total billed charges ","80% of total billed charges ",152.96,70,,122.37,,,0,"percent of total billed charges ","70% of total billed charges ",196.67,90,,157.34,,,0,"percent of total billed charges ","90% of total billed charges ",203.22,93,,162.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",185.74,85,,148.59,,,0,"percent of total billed charges ","85% of total billed charges ",196.67,90,,157.34,,,0,"percent of total billed charges ","90% of total billed charges ",196.67,90,,157.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",190.11,87,,152.09,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.96,70,,122.37,,,0,"percent of total billed charges ","70% of total billed charges ",152.96,203.22,
"ELECTRODE FULGURATING 2FR",6108164,"CDM ",272,RC,,,OUTPATIENT,,,306.13,244.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",244.9,80,,195.92,,,0,"percent of total billed charges ","80% of total billed charges ",214.29,70,,171.43,,,0,"percent of total billed charges ","70% of total billed charges ",275.52,90,,220.42,,,0,"percent of total billed charges ","90% of total billed charges ",284.7,93,,227.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",260.21,85,,208.17,,,0,"percent of total billed charges ","85% of total billed charges ",275.52,90,,220.42,,,0,"percent of total billed charges ","90% of total billed charges ",275.52,90,,220.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",266.33,87,,213.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",214.29,70,,171.43,,,0,"percent of total billed charges ","70% of total billed charges ",214.29,284.7,
"MESH VENTRALEX ST LARGE",6108196,"CDM ",272,RC,,,OUTPATIENT,,,646.5,517.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",517.2,80,,413.76,,,0,"percent of total billed charges ","80% of total billed charges ",452.55,70,,362.04,,,0,"percent of total billed charges ","70% of total billed charges ",581.85,90,,465.48,,,0,"percent of total billed charges ","90% of total billed charges ",601.25,93,,481.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",549.53,85,,439.62,,,0,"percent of total billed charges ","85% of total billed charges ",581.85,90,,465.48,,,0,"percent of total billed charges ","90% of total billed charges ",581.85,90,,465.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",562.46,87,,449.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",452.55,70,,362.04,,,0,"percent of total billed charges ","70% of total billed charges ",452.55,601.25,
"SET NEPHROSTOMY 8.3FR X 30CM",6108198,"CDM ",272,RC,,,OUTPATIENT,,,387.17,309.736,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",309.74,80,,247.79,,,0,"percent of total billed charges ","80% of total billed charges ",271.02,70,,216.82,,,0,"percent of total billed charges ","70% of total billed charges ",348.45,90,,278.76,,,0,"percent of total billed charges ","90% of total billed charges ",360.07,93,,288.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",329.09,85,,263.27,,,0,"percent of total billed charges ","85% of total billed charges ",348.45,90,,278.76,,,0,"percent of total billed charges ","90% of total billed charges ",348.45,90,,278.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",336.84,87,,269.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",271.02,70,,216.82,,,0,"percent of total billed charges ","70% of total billed charges ",271.02,360.07,
"CONE STONE RETRIEVAL 3.0FR",6108199,"CDM ",272,RC,,,OUTPATIENT,,,603.94,483.152,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",483.15,80,,386.52,,,0,"percent of total billed charges ","80% of total billed charges ",422.76,70,,338.21,,,0,"percent of total billed charges ","70% of total billed charges ",543.55,90,,434.84,,,0,"percent of total billed charges ","90% of total billed charges ",561.66,93,,449.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",513.35,85,,410.68,,,0,"percent of total billed charges ","85% of total billed charges ",543.55,90,,434.84,,,0,"percent of total billed charges ","90% of total billed charges ",543.55,90,,434.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",525.43,87,,420.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",422.76,70,,338.21,,,0,"percent of total billed charges ","70% of total billed charges ",422.76,561.66,
"MESH 3DMAX LEFT 3"" X 5""",6108200,"CDM ",272,RC,,,OUTPATIENT,,,372.82,298.256,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",298.26,80,,238.61,,,0,"percent of total billed charges ","80% of total billed charges ",260.97,70,,208.78,,,0,"percent of total billed charges ","70% of total billed charges ",335.54,90,,268.43,,,0,"percent of total billed charges ","90% of total billed charges ",346.72,93,,277.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",316.9,85,,253.52,,,0,"percent of total billed charges ","85% of total billed charges ",335.54,90,,268.43,,,0,"percent of total billed charges ","90% of total billed charges ",335.54,90,,268.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",324.35,87,,259.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",260.97,70,,208.78,,,0,"percent of total billed charges ","70% of total billed charges ",260.97,346.72,
"MESH 3DMAX LEFT 4"" X 6""",6108201,"CDM ",272,RC,,,OUTPATIENT,,,409.45,327.56,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",327.56,80,,262.05,,,0,"percent of total billed charges ","80% of total billed charges ",286.62,70,,229.30,,,0,"percent of total billed charges ","70% of total billed charges ",368.51,90,,294.81,,,0,"percent of total billed charges ","90% of total billed charges ",380.79,93,,304.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",348.03,85,,278.42,,,0,"percent of total billed charges ","85% of total billed charges ",368.51,90,,294.81,,,0,"percent of total billed charges ","90% of total billed charges ",368.51,90,,294.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",356.22,87,,284.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",286.62,70,,229.30,,,0,"percent of total billed charges ","70% of total billed charges ",286.62,380.79,
"MESH 3DMAX LEFT 5"" X 7""",6108202,"CDM ",272,RC,,,OUTPATIENT,,,452.55,362.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",362.04,80,,289.63,,,0,"percent of total billed charges ","80% of total billed charges ",316.79,70,,253.43,,,0,"percent of total billed charges ","70% of total billed charges ",407.3,90,,325.84,,,0,"percent of total billed charges ","90% of total billed charges ",420.87,93,,336.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",384.67,85,,307.74,,,0,"percent of total billed charges ","85% of total billed charges ",407.3,90,,325.84,,,0,"percent of total billed charges ","90% of total billed charges ",407.3,90,,325.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",393.72,87,,314.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",316.79,70,,253.43,,,0,"percent of total billed charges ","70% of total billed charges ",316.79,420.87,
"MESH 3DMAX RIGHT 3"" X 5""",6108203,"CDM ",272,RC,,,OUTPATIENT,,,372.82,298.256,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",298.26,80,,238.61,,,0,"percent of total billed charges ","80% of total billed charges ",260.97,70,,208.78,,,0,"percent of total billed charges ","70% of total billed charges ",335.54,90,,268.43,,,0,"percent of total billed charges ","90% of total billed charges ",346.72,93,,277.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",316.9,85,,253.52,,,0,"percent of total billed charges ","85% of total billed charges ",335.54,90,,268.43,,,0,"percent of total billed charges ","90% of total billed charges ",335.54,90,,268.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",324.35,87,,259.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",260.97,70,,208.78,,,0,"percent of total billed charges ","70% of total billed charges ",260.97,346.72,
"MESH 3DMAX RIGHT 4"" X 6""",6108204,"CDM ",272,RC,,,OUTPATIENT,,,409.45,327.56,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",327.56,80,,262.05,,,0,"percent of total billed charges ","80% of total billed charges ",286.62,70,,229.30,,,0,"percent of total billed charges ","70% of total billed charges ",368.51,90,,294.81,,,0,"percent of total billed charges ","90% of total billed charges ",380.79,93,,304.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",348.03,85,,278.42,,,0,"percent of total billed charges ","85% of total billed charges ",368.51,90,,294.81,,,0,"percent of total billed charges ","90% of total billed charges ",368.51,90,,294.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",356.22,87,,284.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",286.62,70,,229.30,,,0,"percent of total billed charges ","70% of total billed charges ",286.62,380.79,
"MESH 3DMAX RIGHT 5"" X 7""",6108205,"CDM ",272,RC,,,OUTPATIENT,,,452.55,362.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",362.04,80,,289.63,,,0,"percent of total billed charges ","80% of total billed charges ",316.79,70,,253.43,,,0,"percent of total billed charges ","70% of total billed charges ",407.3,90,,325.84,,,0,"percent of total billed charges ","90% of total billed charges ",420.87,93,,336.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",384.67,85,,307.74,,,0,"percent of total billed charges ","85% of total billed charges ",407.3,90,,325.84,,,0,"percent of total billed charges ","90% of total billed charges ",407.3,90,,325.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",393.72,87,,314.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",316.79,70,,253.43,,,0,"percent of total billed charges ","70% of total billed charges ",316.79,420.87,
"STAPLER ECHELON PVS 35MM",6108206,"CDM ",272,RC,,,OUTPATIENT,,,625.47,500.376,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",500.38,80,,400.30,,,0,"percent of total billed charges ","80% of total billed charges ",437.83,70,,350.26,,,0,"percent of total billed charges ","70% of total billed charges ",562.92,90,,450.34,,,0,"percent of total billed charges ","90% of total billed charges ",581.69,93,,465.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",531.65,85,,425.32,,,0,"percent of total billed charges ","85% of total billed charges ",562.92,90,,450.34,,,0,"percent of total billed charges ","90% of total billed charges ",562.92,90,,450.34,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",544.16,87,,435.33,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",437.83,70,,350.26,,,0,"percent of total billed charges ","70% of total billed charges ",437.83,581.69,
"RELOAD ECHELON PVS 35MM WHITE",6108207,"CDM ",272,RC,,,OUTPATIENT,,,302.95,242.36,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",242.36,80,,193.89,,,0,"percent of total billed charges ","80% of total billed charges ",212.07,70,,169.66,,,0,"percent of total billed charges ","70% of total billed charges ",272.66,90,,218.13,,,0,"percent of total billed charges ","90% of total billed charges ",281.74,93,,225.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",257.51,85,,206.01,,,0,"percent of total billed charges ","85% of total billed charges ",272.66,90,,218.13,,,0,"percent of total billed charges ","90% of total billed charges ",272.66,90,,218.13,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",263.57,87,,210.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",212.07,70,,169.66,,,0,"percent of total billed charges ","70% of total billed charges ",212.07,281.74,
"SHEARS HARMONIC 5MM X 36CM",6108208,"CDM ",272,RC,,,OUTPATIENT,,,1220.35,976.28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",976.28,80,,781.02,,,0,"percent of total billed charges ","80% of total billed charges ",854.25,70,,683.40,,,0,"percent of total billed charges ","70% of total billed charges ",1098.32,90,,878.66,,,0,"percent of total billed charges ","90% of total billed charges ",1134.93,93,,907.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1037.3,85,,829.84,,,0,"percent of total billed charges ","85% of total billed charges ",1098.32,90,,878.66,,,0,"percent of total billed charges ","90% of total billed charges ",1098.32,90,,878.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1061.7,87,,849.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",854.25,70,,683.40,,,0,"percent of total billed charges ","70% of total billed charges ",854.25,1134.93,
"SUTURE CHROMIC 0 47T",6108209,"CDM ",272,RC,,,OUTPATIENT,,,39.42,31.536,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.54,80,,25.23,,,0,"percent of total billed charges ","80% of total billed charges ",27.59,70,,22.07,,,0,"percent of total billed charges ","70% of total billed charges ",35.48,90,,28.38,,,0,"percent of total billed charges ","90% of total billed charges ",36.66,93,,29.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.51,85,,26.81,,,0,"percent of total billed charges ","85% of total billed charges ",35.48,90,,28.38,,,0,"percent of total billed charges ","90% of total billed charges ",35.48,90,,28.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",34.3,87,,27.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.59,70,,22.07,,,0,"percent of total billed charges ","70% of total billed charges ",27.59,36.66,
"SOLUTION IRRIGATION H20 1000ML",6108210,"CDM ",272,RC,,,OUTPATIENT,,,10.98,8.784,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.78,80,,7.02,,,0,"percent of total billed charges ","80% of total billed charges ",7.69,70,,6.15,,,0,"percent of total billed charges ","70% of total billed charges ",9.88,90,,7.90,,,0,"percent of total billed charges ","90% of total billed charges ",10.21,93,,8.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.33,85,,7.46,,,0,"percent of total billed charges ","85% of total billed charges ",9.88,90,,7.90,,,0,"percent of total billed charges ","90% of total billed charges ",9.88,90,,7.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.55,87,,7.64,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.69,70,,6.15,,,0,"percent of total billed charges ","70% of total billed charges ",7.69,10.21,
"SOLUTION IRRIGATION H20 3000ML",6108211,"CDM ",272,RC,,,OUTPATIENT,,,27.63,22.104,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.1,80,,17.68,,,0,"percent of total billed charges ","80% of total billed charges ",19.34,70,,15.47,,,0,"percent of total billed charges ","70% of total billed charges ",24.87,90,,19.90,,,0,"percent of total billed charges ","90% of total billed charges ",25.7,93,,20.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.49,85,,18.79,,,0,"percent of total billed charges ","85% of total billed charges ",24.87,90,,19.90,,,0,"percent of total billed charges ","90% of total billed charges ",24.87,90,,19.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",24.04,87,,19.23,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.34,70,,15.47,,,0,"percent of total billed charges ","70% of total billed charges ",19.34,25.7,
"ELECTRODE ROLLER",6108221,"CDM ",272,RC,,,OUTPATIENT,,,782.8,626.24,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",626.24,80,,500.99,,,0,"percent of total billed charges ","80% of total billed charges ",547.96,70,,438.37,,,0,"percent of total billed charges ","70% of total billed charges ",704.52,90,,563.62,,,0,"percent of total billed charges ","90% of total billed charges ",728,93,,582.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",665.38,85,,532.30,,,0,"percent of total billed charges ","85% of total billed charges ",704.52,90,,563.62,,,0,"percent of total billed charges ","90% of total billed charges ",704.52,90,,563.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",681.04,87,,544.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",547.96,70,,438.37,,,0,"percent of total billed charges ","70% of total billed charges ",547.96,728,
"ELECTRODE CUTTING LOOP",6108222,"CDM ",272,RC,,,OUTPATIENT,,,782.8,626.24,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",626.24,80,,500.99,,,0,"percent of total billed charges ","80% of total billed charges ",547.96,70,,438.37,,,0,"percent of total billed charges ","70% of total billed charges ",704.52,90,,563.62,,,0,"percent of total billed charges ","90% of total billed charges ",728,93,,582.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",665.38,85,,532.30,,,0,"percent of total billed charges ","85% of total billed charges ",704.52,90,,563.62,,,0,"percent of total billed charges ","90% of total billed charges ",704.52,90,,563.62,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",681.04,87,,544.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",547.96,70,,438.37,,,0,"percent of total billed charges ","70% of total billed charges ",547.96,728,
"TROCAR KII OPTICAL 5MM X 100MM",6108238,"CDM ",272,RC,,,OUTPATIENT,,,232.5,186,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",186,80,,148.80,,,0,"percent of total billed charges ","80% of total billed charges ",162.75,70,,130.20,,,0,"percent of total billed charges ","70% of total billed charges ",209.25,90,,167.40,,,0,"percent of total billed charges ","90% of total billed charges ",216.23,93,,172.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",197.63,85,,158.10,,,0,"percent of total billed charges ","85% of total billed charges ",209.25,90,,167.40,,,0,"percent of total billed charges ","90% of total billed charges ",209.25,90,,167.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",202.28,87,,161.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.75,70,,130.20,,,0,"percent of total billed charges ","70% of total billed charges ",162.75,216.23,
"DEVICE TOT W/HALO NEEDLE",6108246,"CDM ",272,RC,,,OUTPATIENT,,,2023.71,1618.968,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1618.97,80,,1295.18,,,0,"percent of total billed charges ","80% of total billed charges ",1416.6,70,,1133.28,,,0,"percent of total billed charges ","70% of total billed charges ",1821.34,90,,1457.07,,,0,"percent of total billed charges ","90% of total billed charges ",1882.05,93,,1505.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1720.15,85,,1376.12,,,0,"percent of total billed charges ","85% of total billed charges ",1821.34,90,,1457.07,,,0,"percent of total billed charges ","90% of total billed charges ",1821.34,90,,1457.07,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1760.63,87,,1408.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1416.6,70,,1133.28,,,0,"percent of total billed charges ","70% of total billed charges ",1416.6,1882.05,
"KIT SPEEDBRIDGE 4.75 X 19.1MM",6108256,"CDM ",278,RC,,,OUTPATIENT,,,3158.1,2526.48,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2526.48,80,,2021.18,,,0,"percent of total billed charges ","80% of total billed charges ",2210.67,70,,1768.54,,,0,"percent of total billed charges ","70% of total billed charges ",2842.29,90,,2273.83,,,0,"percent of total billed charges ","90% of total billed charges ",2937.03,93,,2349.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2684.39,85,,2147.51,,,0,"percent of total billed charges ","85% of total billed charges ",2684.39,85,,2147.51,,,0,"percent of total billed charges ","85% of total billed charges ",2842.29,90,,2273.83,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2747.55,87,,2198.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2210.67,70,,1768.54,,,0,"percent of total billed charges ","70% of total billed charges ",2210.67,2937.03,
"PROBE GAMMA TRUNODE",6108258,"CDM ",272,RC,,,OUTPATIENT,,,859.85,687.88,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",687.88,80,,550.30,,,0,"percent of total billed charges ","80% of total billed charges ",601.9,70,,481.52,,,0,"percent of total billed charges ","70% of total billed charges ",773.87,90,,619.10,,,0,"percent of total billed charges ","90% of total billed charges ",799.66,93,,639.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",730.87,85,,584.70,,,0,"percent of total billed charges ","85% of total billed charges ",773.87,90,,619.10,,,0,"percent of total billed charges ","90% of total billed charges ",773.87,90,,619.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",748.07,87,,598.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",601.9,70,,481.52,,,0,"percent of total billed charges ","70% of total billed charges ",601.9,799.66,
"PROTECTOR LEG SPAR BALL JOINT",6108259,"CDM ",272,RC,,,OUTPATIENT,,,45.64,36.512,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.51,80,,29.21,,,0,"percent of total billed charges ","80% of total billed charges ",31.95,70,,25.56,,,0,"percent of total billed charges ","70% of total billed charges ",41.08,90,,32.86,,,0,"percent of total billed charges ","90% of total billed charges ",42.45,93,,33.96,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.79,85,,31.03,,,0,"percent of total billed charges ","85% of total billed charges ",41.08,90,,32.86,,,0,"percent of total billed charges ","90% of total billed charges ",41.08,90,,32.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.71,87,,31.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.95,70,,25.56,,,0,"percent of total billed charges ","70% of total billed charges ",31.95,42.45,
"CUFF TOURNIQUIT 24"" DISP",6108263,"CDM ",272,RC,,,OUTPATIENT,,,121.13,96.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.9,80,,77.52,,,0,"percent of total billed charges ","80% of total billed charges ",84.79,70,,67.83,,,0,"percent of total billed charges ","70% of total billed charges ",109.02,90,,87.22,,,0,"percent of total billed charges ","90% of total billed charges ",112.65,93,,90.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",102.96,85,,82.37,,,0,"percent of total billed charges ","85% of total billed charges ",109.02,90,,87.22,,,0,"percent of total billed charges ","90% of total billed charges ",109.02,90,,87.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",105.38,87,,84.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.79,70,,67.83,,,0,"percent of total billed charges ","70% of total billed charges ",84.79,112.65,
"SEAL BIOPSY PORT",6108269,"CDM ",272,RC,,,OUTPATIENT,,,51.12,40.896,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.9,80,,32.72,,,0,"percent of total billed charges ","80% of total billed charges ",35.78,70,,28.62,,,0,"percent of total billed charges ","70% of total billed charges ",46.01,90,,36.81,,,0,"percent of total billed charges ","90% of total billed charges ",47.54,93,,38.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.45,85,,34.76,,,0,"percent of total billed charges ","85% of total billed charges ",46.01,90,,36.81,,,0,"percent of total billed charges ","90% of total billed charges ",46.01,90,,36.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.47,87,,35.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.78,70,,28.62,,,0,"percent of total billed charges ","70% of total billed charges ",35.78,47.54,
"COVER BACK TABLE",6108285,"CDM ",270,RC,,,OUTPATIENT,,,72.59,58.072,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.07,80,,46.46,,,0,"percent of total billed charges ","80% of total billed charges ",50.81,70,,40.65,,,0,"percent of total billed charges ","70% of total billed charges ",65.33,90,,52.26,,,0,"percent of total billed charges ","90% of total billed charges ",67.51,93,,54.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",61.7,85,,49.36,,,0,"percent of total billed charges ","85% of total billed charges ",65.33,90,,52.26,,,0,"percent of total billed charges ","90% of total billed charges ",65.33,90,,52.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.15,87,,50.52,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.81,70,,40.65,,,0,"percent of total billed charges ","70% of total billed charges ",50.81,67.51,
"COVER BACK TABLE XL",6108286,"CDM ",272,RC,,,OUTPATIENT,,,86.19,68.952,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,80,,55.16,,,0,"percent of total billed charges ","80% of total billed charges ",60.33,70,,48.26,,,0,"percent of total billed charges ","70% of total billed charges ",77.57,90,,62.06,,,0,"percent of total billed charges ","90% of total billed charges ",80.16,93,,64.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",73.26,85,,58.61,,,0,"percent of total billed charges ","85% of total billed charges ",77.57,90,,62.06,,,0,"percent of total billed charges ","90% of total billed charges ",77.57,90,,62.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",74.99,87,,59.99,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.33,70,,48.26,,,0,"percent of total billed charges ","70% of total billed charges ",60.33,80.16,
"MARKER ENDOSCOPIC SPOT",6108297,"CDM ",272,RC,,,OUTPATIENT,,,153.35,122.68,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",122.68,80,,98.14,,,0,"percent of total billed charges ","80% of total billed charges ",107.35,70,,85.88,,,0,"percent of total billed charges ","70% of total billed charges ",138.02,90,,110.42,,,0,"percent of total billed charges ","90% of total billed charges ",142.62,93,,114.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",130.35,85,,104.28,,,0,"percent of total billed charges ","85% of total billed charges ",138.02,90,,110.42,,,0,"percent of total billed charges ","90% of total billed charges ",138.02,90,,110.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",133.41,87,,106.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",107.35,70,,85.88,,,0,"percent of total billed charges ","70% of total billed charges ",107.35,142.62,
"SET FAST FIX 360 KNOT PUSHER",6108298,"CDM ",272,RC,,,OUTPATIENT,,,418.07,334.456,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",334.46,80,,267.57,,,0,"percent of total billed charges ","80% of total billed charges ",292.65,70,,234.12,,,0,"percent of total billed charges ","70% of total billed charges ",376.26,90,,301.01,,,0,"percent of total billed charges ","90% of total billed charges ",388.81,93,,311.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",355.36,85,,284.29,,,0,"percent of total billed charges ","85% of total billed charges ",376.26,90,,301.01,,,0,"percent of total billed charges ","90% of total billed charges ",376.26,90,,301.01,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",363.72,87,,290.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",292.65,70,,234.12,,,0,"percent of total billed charges ","70% of total billed charges ",292.65,388.81,
"NEEDLE CURVED FAST FIX",6108299,"CDM ",272,RC,,,OUTPATIENT,,,1076.3,861.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",861.04,80,,688.83,,,0,"percent of total billed charges ","80% of total billed charges ",753.41,70,,602.73,,,0,"percent of total billed charges ","70% of total billed charges ",968.67,90,,774.94,,,0,"percent of total billed charges ","90% of total billed charges ",1000.96,93,,800.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",914.86,85,,731.89,,,0,"percent of total billed charges ","85% of total billed charges ",968.67,90,,774.94,,,0,"percent of total billed charges ","90% of total billed charges ",968.67,90,,774.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",936.38,87,,749.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",753.41,70,,602.73,,,0,"percent of total billed charges ","70% of total billed charges ",753.41,1000.96,
"SLEEVE KII FIXATION 5X100MM",6108300,"CDM ",272,RC,,,OUTPATIENT,,,40.12,32.096,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.1,80,,25.68,,,0,"percent of total billed charges ","80% of total billed charges ",28.08,70,,22.46,,,0,"percent of total billed charges ","70% of total billed charges ",36.11,90,,28.89,,,0,"percent of total billed charges ","90% of total billed charges ",37.31,93,,29.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34.1,85,,27.28,,,0,"percent of total billed charges ","85% of total billed charges ",36.11,90,,28.89,,,0,"percent of total billed charges ","90% of total billed charges ",36.11,90,,28.89,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",34.9,87,,27.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.08,70,,22.46,,,0,"percent of total billed charges ","70% of total billed charges ",28.08,37.31,
"BLADE SAW OSCILATING SMOOTH",6108301,"CDM ",272,RC,,,OUTPATIENT,,,177.8,142.24,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.24,80,,113.79,,,0,"percent of total billed charges ","80% of total billed charges ",124.46,70,,99.57,,,0,"percent of total billed charges ","70% of total billed charges ",160.02,90,,128.02,,,0,"percent of total billed charges ","90% of total billed charges ",165.35,93,,132.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",151.13,85,,120.90,,,0,"percent of total billed charges ","85% of total billed charges ",160.02,90,,128.02,,,0,"percent of total billed charges ","90% of total billed charges ",160.02,90,,128.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",154.69,87,,123.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.46,70,,99.57,,,0,"percent of total billed charges ","70% of total billed charges ",124.46,165.35,
"RETRACTOR ALEXIS ORTHO 2.5-8CM",6108302,"CDM ",272,RC,,,OUTPATIENT,,,420.23,336.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",336.18,80,,268.94,,,0,"percent of total billed charges ","80% of total billed charges ",294.16,70,,235.33,,,0,"percent of total billed charges ","70% of total billed charges ",378.21,90,,302.57,,,0,"percent of total billed charges ","90% of total billed charges ",390.81,93,,312.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",357.2,85,,285.76,,,0,"percent of total billed charges ","85% of total billed charges ",378.21,90,,302.57,,,0,"percent of total billed charges ","90% of total billed charges ",378.21,90,,302.57,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",365.6,87,,292.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",294.16,70,,235.33,,,0,"percent of total billed charges ","70% of total billed charges ",294.16,390.81,
"TUBING MAIN PUMP",6108313,"CDM ",272,RC,,,OUTPATIENT,,,122.24,97.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",97.79,80,,78.23,,,0,"percent of total billed charges ","80% of total billed charges ",85.57,70,,68.46,,,0,"percent of total billed charges ","70% of total billed charges ",110.02,90,,88.02,,,0,"percent of total billed charges ","90% of total billed charges ",113.68,93,,90.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",103.9,85,,83.12,,,0,"percent of total billed charges ","85% of total billed charges ",110.02,90,,88.02,,,0,"percent of total billed charges ","90% of total billed charges ",110.02,90,,88.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",106.35,87,,85.08,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",85.57,70,,68.46,,,0,"percent of total billed charges ","70% of total billed charges ",85.57,113.68,
"SET OUTFLOW DW CASSETTE/TUBE",6108314,"CDM ",272,RC,,,OUTPATIENT,,,80.01,64.008,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.01,80,,51.21,,,0,"percent of total billed charges ","80% of total billed charges ",56.01,70,,44.81,,,0,"percent of total billed charges ","70% of total billed charges ",72.01,90,,57.61,,,0,"percent of total billed charges ","90% of total billed charges ",74.41,93,,59.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",68.01,85,,54.41,,,0,"percent of total billed charges ","85% of total billed charges ",72.01,90,,57.61,,,0,"percent of total billed charges ","90% of total billed charges ",72.01,90,,57.61,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",69.61,87,,55.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.01,70,,44.81,,,0,"percent of total billed charges ","70% of total billed charges ",56.01,74.41,
"APOLLO RF 90 DEGREE MULTIPORT",6108315,"CDM ",272,RC,,,OUTPATIENT,,,344.8,275.84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",275.84,80,,220.67,,,0,"percent of total billed charges ","80% of total billed charges ",241.36,70,,193.09,,,0,"percent of total billed charges ","70% of total billed charges ",310.32,90,,248.26,,,0,"percent of total billed charges ","90% of total billed charges ",320.66,93,,256.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",293.08,85,,234.46,,,0,"percent of total billed charges ","85% of total billed charges ",310.32,90,,248.26,,,0,"percent of total billed charges ","90% of total billed charges ",310.32,90,,248.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",299.98,87,,239.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.36,70,,193.09,,,0,"percent of total billed charges ","70% of total billed charges ",241.36,320.66,
"SHAVER TORPEDO 4.0MM X 13CM",6108316,"CDM ",272,RC,,,OUTPATIENT,,,348.75,279,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",279,80,,223.20,,,0,"percent of total billed charges ","80% of total billed charges ",244.13,70,,195.30,,,0,"percent of total billed charges ","70% of total billed charges ",313.88,90,,251.10,,,0,"percent of total billed charges ","90% of total billed charges ",324.34,93,,259.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",296.44,85,,237.15,,,0,"percent of total billed charges ","85% of total billed charges ",313.88,90,,251.10,,,0,"percent of total billed charges ","90% of total billed charges ",313.88,90,,251.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",303.41,87,,242.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",244.13,70,,195.30,,,0,"percent of total billed charges ","70% of total billed charges ",244.13,324.34,
"SHAVER TORPEDO 5.0MM X 13CM",6108317,"CDM ",272,RC,,,OUTPATIENT,,,348.75,279,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",279,80,,223.20,,,0,"percent of total billed charges ","80% of total billed charges ",244.13,70,,195.30,,,0,"percent of total billed charges ","70% of total billed charges ",313.88,90,,251.10,,,0,"percent of total billed charges ","90% of total billed charges ",324.34,93,,259.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",296.44,85,,237.15,,,0,"percent of total billed charges ","85% of total billed charges ",313.88,90,,251.10,,,0,"percent of total billed charges ","90% of total billed charges ",313.88,90,,251.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",303.41,87,,242.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",244.13,70,,195.30,,,0,"percent of total billed charges ","70% of total billed charges ",244.13,324.34,
"BLADE EXCALIBUR 4.0MM X 13CM",6108318,"CDM ",272,RC,,,OUTPATIENT,,,208.92,167.136,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.14,80,,133.71,,,0,"percent of total billed charges ","80% of total billed charges ",146.24,70,,116.99,,,0,"percent of total billed charges ","70% of total billed charges ",188.03,90,,150.42,,,0,"percent of total billed charges ","90% of total billed charges ",194.3,93,,155.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",177.58,85,,142.06,,,0,"percent of total billed charges ","85% of total billed charges ",188.03,90,,150.42,,,0,"percent of total billed charges ","90% of total billed charges ",188.03,90,,150.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",181.76,87,,145.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",146.24,70,,116.99,,,0,"percent of total billed charges ","70% of total billed charges ",146.24,194.3,
"BUR OVAL FLUSHCUT 5.0MM X 13CM",6108319,"CDM ",272,RC,,,OUTPATIENT,,,208.92,167.136,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.14,80,,133.71,,,0,"percent of total billed charges ","80% of total billed charges ",146.24,70,,116.99,,,0,"percent of total billed charges ","70% of total billed charges ",188.03,90,,150.42,,,0,"percent of total billed charges ","90% of total billed charges ",194.3,93,,155.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",177.58,85,,142.06,,,0,"percent of total billed charges ","85% of total billed charges ",188.03,90,,150.42,,,0,"percent of total billed charges ","90% of total billed charges ",188.03,90,,150.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",181.76,87,,145.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",146.24,70,,116.99,,,0,"percent of total billed charges ","70% of total billed charges ",146.24,194.3,
"BUR OVAL PRC 8 FLUTES 4MM",6108320,"CDM ",272,RC,,,OUTPATIENT,,,208.92,167.136,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",167.14,80,,133.71,,,0,"percent of total billed charges ","80% of total billed charges ",146.24,70,,116.99,,,0,"percent of total billed charges ","70% of total billed charges ",188.03,90,,150.42,,,0,"percent of total billed charges ","90% of total billed charges ",194.3,93,,155.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",177.58,85,,142.06,,,0,"percent of total billed charges ","85% of total billed charges ",188.03,90,,150.42,,,0,"percent of total billed charges ","90% of total billed charges ",188.03,90,,150.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",181.76,87,,145.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",146.24,70,,116.99,,,0,"percent of total billed charges ","70% of total billed charges ",146.24,194.3,
"TROCAR KII OPTIC 11MM X 100MM",6108354,"CDM ",272,RC,,,OUTPATIENT,,,271.25,217,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217,80,,173.60,,,0,"percent of total billed charges ","80% of total billed charges ",189.88,70,,151.90,,,0,"percent of total billed charges ","70% of total billed charges ",244.13,90,,195.30,,,0,"percent of total billed charges ","90% of total billed charges ",252.26,93,,201.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",230.56,85,,184.45,,,0,"percent of total billed charges ","85% of total billed charges ",244.13,90,,195.30,,,0,"percent of total billed charges ","90% of total billed charges ",244.13,90,,195.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",235.99,87,,188.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",189.88,70,,151.90,,,0,"percent of total billed charges ","70% of total billed charges ",189.88,252.26,
"SEALER LIGASURE BLUNT TIP NANO",6108357,"CDM ",272,RC,,,OUTPATIENT,,,960.91,768.728,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",768.73,80,,614.98,,,0,"percent of total billed charges ","80% of total billed charges ",672.64,70,,538.11,,,0,"percent of total billed charges ","70% of total billed charges ",864.82,90,,691.86,,,0,"percent of total billed charges ","90% of total billed charges ",893.65,93,,714.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",816.77,85,,653.42,,,0,"percent of total billed charges ","85% of total billed charges ",864.82,90,,691.86,,,0,"percent of total billed charges ","90% of total billed charges ",864.82,90,,691.86,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",835.99,87,,668.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",672.64,70,,538.11,,,0,"percent of total billed charges ","70% of total billed charges ",672.64,893.65,
"ELECTRODE LOOP SQ 10MM X 4MM",6108359,"CDM ",272,RC,,,OUTPATIENT,,,53.3,42.64,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.64,80,,34.11,,,0,"percent of total billed charges ","80% of total billed charges ",37.31,70,,29.85,,,0,"percent of total billed charges ","70% of total billed charges ",47.97,90,,38.38,,,0,"percent of total billed charges ","90% of total billed charges ",49.57,93,,39.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",45.31,85,,36.25,,,0,"percent of total billed charges ","85% of total billed charges ",47.97,90,,38.38,,,0,"percent of total billed charges ","90% of total billed charges ",47.97,90,,38.38,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",46.37,87,,37.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.31,70,,29.85,,,0,"percent of total billed charges ","70% of total billed charges ",37.31,49.57,
"SUTURE ETHIBOND 0 CXH1D",6108360,"CDM ",272,RC,,,OUTPATIENT,,,47.29,37.832,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.83,80,,30.26,,,0,"percent of total billed charges ","80% of total billed charges ",33.1,70,,26.48,,,0,"percent of total billed charges ","70% of total billed charges ",42.56,90,,34.05,,,0,"percent of total billed charges ","90% of total billed charges ",43.98,93,,35.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.2,85,,32.16,,,0,"percent of total billed charges ","85% of total billed charges ",42.56,90,,34.05,,,0,"percent of total billed charges ","90% of total billed charges ",42.56,90,,34.05,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.14,87,,32.91,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.1,70,,26.48,,,0,"percent of total billed charges ","70% of total billed charges ",33.1,43.98,
"HANDPIECE THUNDERBEAT 20CM FC",6108361,"CDM ",272,RC,,,OUTPATIENT,,,1179.75,943.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",943.8,80,,755.04,,,0,"percent of total billed charges ","80% of total billed charges ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",1097.17,93,,877.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1002.79,85,,802.23,,,0,"percent of total billed charges ","85% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",1061.78,90,,849.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1026.38,87,,821.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",825.83,70,,660.66,,,0,"percent of total billed charges ","70% of total billed charges ",825.83,1097.17,
"CANNULA TRIPLEDAM",6108363,"CDM ",272,RC,,,OUTPATIENT,,,142.24,113.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.79,80,,91.03,,,0,"percent of total billed charges ","80% of total billed charges ",99.57,70,,79.66,,,0,"percent of total billed charges ","70% of total billed charges ",128.02,90,,102.42,,,0,"percent of total billed charges ","90% of total billed charges ",132.28,93,,105.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",120.9,85,,96.72,,,0,"percent of total billed charges ","85% of total billed charges ",128.02,90,,102.42,,,0,"percent of total billed charges ","90% of total billed charges ",128.02,90,,102.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",123.75,87,,99.00,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.57,70,,79.66,,,0,"percent of total billed charges ","70% of total billed charges ",99.57,132.28,
"BOUGIE ADULT 15FR W/COUDE TIP",6108364,"CDM ",272,RC,,,OUTPATIENT,,,46.49,37.192,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.19,80,,29.75,,,0,"percent of total billed charges ","80% of total billed charges ",32.54,70,,26.03,,,0,"percent of total billed charges ","70% of total billed charges ",41.84,90,,33.47,,,0,"percent of total billed charges ","90% of total billed charges ",43.24,93,,34.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.52,85,,31.62,,,0,"percent of total billed charges ","85% of total billed charges ",41.84,90,,33.47,,,0,"percent of total billed charges ","90% of total billed charges ",41.84,90,,33.47,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.45,87,,32.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.54,70,,26.03,,,0,"percent of total billed charges ","70% of total billed charges ",32.54,43.24,
"BASKET STONE DAKOTA 8MMX120CM",6108365,"CDM ",272,RC,,,OUTPATIENT,,,836.31,669.048,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",669.05,80,,535.24,,,0,"percent of total billed charges ","80% of total billed charges ",585.42,70,,468.34,,,0,"percent of total billed charges ","70% of total billed charges ",752.68,90,,602.14,,,0,"percent of total billed charges ","90% of total billed charges ",777.77,93,,622.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",710.86,85,,568.69,,,0,"percent of total billed charges ","85% of total billed charges ",752.68,90,,602.14,,,0,"percent of total billed charges ","90% of total billed charges ",752.68,90,,602.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",727.59,87,,582.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",585.42,70,,468.34,,,0,"percent of total billed charges ","70% of total billed charges ",585.42,777.77,
"POWERPICK 45 DEGREE",6108367,"CDM ",272,RC,,,OUTPATIENT,,,348.75,279,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",279,80,,223.20,,,0,"percent of total billed charges ","80% of total billed charges ",244.13,70,,195.30,,,0,"percent of total billed charges ","70% of total billed charges ",313.88,90,,251.10,,,0,"percent of total billed charges ","90% of total billed charges ",324.34,93,,259.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",296.44,85,,237.15,,,0,"percent of total billed charges ","85% of total billed charges ",313.88,90,,251.10,,,0,"percent of total billed charges ","90% of total billed charges ",313.88,90,,251.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",303.41,87,,242.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",244.13,70,,195.30,,,0,"percent of total billed charges ","70% of total billed charges ",244.13,324.34,
"PIN DRILL TRIM IT 1.5 X 100MM",6108370,"CDM ",272,RC,,,OUTPATIENT,,,452.55,362.04,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",362.04,80,,289.63,,,0,"percent of total billed charges ","80% of total billed charges ",316.79,70,,253.43,,,0,"percent of total billed charges ","70% of total billed charges ",407.3,90,,325.84,,,0,"percent of total billed charges ","90% of total billed charges ",420.87,93,,336.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",384.67,85,,307.74,,,0,"percent of total billed charges ","85% of total billed charges ",407.3,90,,325.84,,,0,"percent of total billed charges ","90% of total billed charges ",407.3,90,,325.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",393.72,87,,314.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",316.79,70,,253.43,,,0,"percent of total billed charges ","70% of total billed charges ",316.79,420.87,
"KIT GASTROSTOMY 18FR X 3.0CM",6108374,"CDM ",270,RC,,,OUTPATIENT,,,314.81,251.848,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",251.85,80,,201.48,,,0,"percent of total billed charges ","80% of total billed charges ",220.37,70,,176.30,,,0,"percent of total billed charges ","70% of total billed charges ",283.33,90,,226.66,,,0,"percent of total billed charges ","90% of total billed charges ",292.77,93,,234.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.59,85,,214.07,,,0,"percent of total billed charges ","85% of total billed charges ",283.33,90,,226.66,,,0,"percent of total billed charges ","90% of total billed charges ",283.33,90,,226.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",273.88,87,,219.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.37,70,,176.30,,,0,"percent of total billed charges ","70% of total billed charges ",220.37,292.77,
"KIT GASTROSTOMY 20FR X 2.0CM",6108376,"CDM ",270,RC,,,OUTPATIENT,,,314.81,251.848,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",251.85,80,,201.48,,,0,"percent of total billed charges ","80% of total billed charges ",220.37,70,,176.30,,,0,"percent of total billed charges ","70% of total billed charges ",283.33,90,,226.66,,,0,"percent of total billed charges ","90% of total billed charges ",292.77,93,,234.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",267.59,85,,214.07,,,0,"percent of total billed charges ","85% of total billed charges ",283.33,90,,226.66,,,0,"percent of total billed charges ","90% of total billed charges ",283.33,90,,226.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",273.88,87,,219.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",220.37,70,,176.30,,,0,"percent of total billed charges ","70% of total billed charges ",220.37,292.77,
"KIT COBRA EMG TUBE 7MM",6108379,"CDM ",272,RC,,,OUTPATIENT,,,592.63,474.104,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",474.1,80,,379.28,,,0,"percent of total billed charges ","80% of total billed charges ",414.84,70,,331.87,,,0,"percent of total billed charges ","70% of total billed charges ",533.37,90,,426.70,,,0,"percent of total billed charges ","90% of total billed charges ",551.15,93,,440.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",503.74,85,,402.99,,,0,"percent of total billed charges ","85% of total billed charges ",533.37,90,,426.70,,,0,"percent of total billed charges ","90% of total billed charges ",533.37,90,,426.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",515.59,87,,412.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",414.84,70,,331.87,,,0,"percent of total billed charges ","70% of total billed charges ",414.84,551.15,
"KIT COBRA EMG TUBE 8MM",6108380,"CDM ",272,RC,,,OUTPATIENT,,,592.63,474.104,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",474.1,80,,379.28,,,0,"percent of total billed charges ","80% of total billed charges ",414.84,70,,331.87,,,0,"percent of total billed charges ","70% of total billed charges ",533.37,90,,426.70,,,0,"percent of total billed charges ","90% of total billed charges ",551.15,93,,440.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",503.74,85,,402.99,,,0,"percent of total billed charges ","85% of total billed charges ",533.37,90,,426.70,,,0,"percent of total billed charges ","90% of total billed charges ",533.37,90,,426.70,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",515.59,87,,412.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",414.84,70,,331.87,,,0,"percent of total billed charges ","70% of total billed charges ",414.84,551.15,
"LASSO CURVE LEFT 45 DEGREE",6108383,"CDM ",272,RC,,,OUTPATIENT,,,344.8,275.84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",275.84,80,,220.67,,,0,"percent of total billed charges ","80% of total billed charges ",241.36,70,,193.09,,,0,"percent of total billed charges ","70% of total billed charges ",310.32,90,,248.26,,,0,"percent of total billed charges ","90% of total billed charges ",320.66,93,,256.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",293.08,85,,234.46,,,0,"percent of total billed charges ","85% of total billed charges ",310.32,90,,248.26,,,0,"percent of total billed charges ","90% of total billed charges ",310.32,90,,248.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",299.98,87,,239.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.36,70,,193.09,,,0,"percent of total billed charges ","70% of total billed charges ",241.36,320.66,
"LASSO CURVE RT 45 DEGREE",6108384,"CDM ",272,RC,,,OUTPATIENT,,,344.8,275.84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",275.84,80,,220.67,,,0,"percent of total billed charges ","80% of total billed charges ",241.36,70,,193.09,,,0,"percent of total billed charges ","70% of total billed charges ",310.32,90,,248.26,,,0,"percent of total billed charges ","90% of total billed charges ",320.66,93,,256.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",293.08,85,,234.46,,,0,"percent of total billed charges ","85% of total billed charges ",310.32,90,,248.26,,,0,"percent of total billed charges ","90% of total billed charges ",310.32,90,,248.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",299.98,87,,239.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.36,70,,193.09,,,0,"percent of total billed charges ","70% of total billed charges ",241.36,320.66,
"LASSO CURVE STRAIGHT 90 DEGREE",6108385,"CDM ",272,RC,,,OUTPATIENT,,,344.8,275.84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",275.84,80,,220.67,,,0,"percent of total billed charges ","80% of total billed charges ",241.36,70,,193.09,,,0,"percent of total billed charges ","70% of total billed charges ",310.32,90,,248.26,,,0,"percent of total billed charges ","90% of total billed charges ",320.66,93,,256.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",293.08,85,,234.46,,,0,"percent of total billed charges ","85% of total billed charges ",310.32,90,,248.26,,,0,"percent of total billed charges ","90% of total billed charges ",310.32,90,,248.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",299.98,87,,239.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.36,70,,193.09,,,0,"percent of total billed charges ","70% of total billed charges ",241.36,320.66,
"KIT INSERT 2.9 MM PUSHLOCK",6108386,"CDM ",272,RC,,,OUTPATIENT,,,474.1,379.28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",379.28,80,,303.42,,,0,"percent of total billed charges ","80% of total billed charges ",331.87,70,,265.50,,,0,"percent of total billed charges ","70% of total billed charges ",426.69,90,,341.35,,,0,"percent of total billed charges ","90% of total billed charges ",440.91,93,,352.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",402.99,85,,322.39,,,0,"percent of total billed charges ","85% of total billed charges ",426.69,90,,341.35,,,0,"percent of total billed charges ","90% of total billed charges ",426.69,90,,341.35,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",412.47,87,,329.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",331.87,70,,265.50,,,0,"percent of total billed charges ","70% of total billed charges ",331.87,440.91,
"SUTURETAPE 1.33MM X 36""",6108387,"CDM ",272,RC,,,OUTPATIENT,,,155.58,124.464,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.46,80,,99.57,,,0,"percent of total billed charges ","80% of total billed charges ",108.91,70,,87.13,,,0,"percent of total billed charges ","70% of total billed charges ",140.02,90,,112.02,,,0,"percent of total billed charges ","90% of total billed charges ",144.69,93,,115.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",132.24,85,,105.79,,,0,"percent of total billed charges ","85% of total billed charges ",140.02,90,,112.02,,,0,"percent of total billed charges ","90% of total billed charges ",140.02,90,,112.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",135.35,87,,108.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.91,70,,87.13,,,0,"percent of total billed charges ","70% of total billed charges ",108.91,144.69,
"FIBERLINK BLUE 26"" W/CLSD LOOP",6108388,"CDM ",272,RC,,,OUTPATIENT,,,213.13,170.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",170.5,80,,136.40,,,0,"percent of total billed charges ","80% of total billed charges ",149.19,70,,119.35,,,0,"percent of total billed charges ","70% of total billed charges ",191.82,90,,153.46,,,0,"percent of total billed charges ","90% of total billed charges ",198.21,93,,158.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",181.16,85,,144.93,,,0,"percent of total billed charges ","85% of total billed charges ",191.82,90,,153.46,,,0,"percent of total billed charges ","90% of total billed charges ",191.82,90,,153.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",185.42,87,,148.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",149.19,70,,119.35,,,0,"percent of total billed charges ","70% of total billed charges ",149.19,198.21,
"PACK STIMULATOR NERVEANA",6108389,"CDM ",272,RC,,,OUTPATIENT,,,177.8,142.24,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.24,80,,113.79,,,0,"percent of total billed charges ","80% of total billed charges ",124.46,70,,99.57,,,0,"percent of total billed charges ","70% of total billed charges ",160.02,90,,128.02,,,0,"percent of total billed charges ","90% of total billed charges ",165.35,93,,132.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",151.13,85,,120.90,,,0,"percent of total billed charges ","85% of total billed charges ",160.02,90,,128.02,,,0,"percent of total billed charges ","90% of total billed charges ",160.02,90,,128.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",154.69,87,,123.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.46,70,,99.57,,,0,"percent of total billed charges ","70% of total billed charges ",124.46,165.35,
"BLADE SAW OSCILLATING 90X17",6108393,"CDM ",272,RC,,,OUTPATIENT,,,177.8,142.24,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.24,80,,113.79,,,0,"percent of total billed charges ","80% of total billed charges ",124.46,70,,99.57,,,0,"percent of total billed charges ","70% of total billed charges ",160.02,90,,128.02,,,0,"percent of total billed charges ","90% of total billed charges ",165.35,93,,132.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",151.13,85,,120.90,,,0,"percent of total billed charges ","85% of total billed charges ",160.02,90,,128.02,,,0,"percent of total billed charges ","90% of total billed charges ",160.02,90,,128.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",154.69,87,,123.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.46,70,,99.57,,,0,"percent of total billed charges ","70% of total billed charges ",124.46,165.35,
"TIGHTROPE ACL RT",6108402,"CDM ",272,RC,,,OUTPATIENT,,,754.25,603.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",603.4,80,,482.72,,,0,"percent of total billed charges ","80% of total billed charges ",527.98,70,,422.38,,,0,"percent of total billed charges ","70% of total billed charges ",678.83,90,,543.06,,,0,"percent of total billed charges ","90% of total billed charges ",701.45,93,,561.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",641.11,85,,512.89,,,0,"percent of total billed charges ","85% of total billed charges ",678.83,90,,543.06,,,0,"percent of total billed charges ","90% of total billed charges ",678.83,90,,543.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",656.2,87,,524.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",527.98,70,,422.38,,,0,"percent of total billed charges ","70% of total billed charges ",527.98,701.45,
"FLIPCUTTER II SHORT 8.5MM",6108403,"CDM ",272,RC,,,OUTPATIENT,,,700.38,560.304,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",560.3,80,,448.24,,,0,"percent of total billed charges ","80% of total billed charges ",490.27,70,,392.22,,,0,"percent of total billed charges ","70% of total billed charges ",630.34,90,,504.27,,,0,"percent of total billed charges ","90% of total billed charges ",651.35,93,,521.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",595.32,85,,476.26,,,0,"percent of total billed charges ","85% of total billed charges ",630.34,90,,504.27,,,0,"percent of total billed charges ","90% of total billed charges ",630.34,90,,504.27,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",609.33,87,,487.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",490.27,70,,392.22,,,0,"percent of total billed charges ","70% of total billed charges ",490.27,651.35,
"FLIPCUTTER II SHORT 9MM",6108404,"CDM ",272,RC,,,OUTPATIENT,,,700.38,560.304,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",560.3,80,,448.24,,,0,"percent of total billed charges ","80% of total billed charges ",490.27,70,,392.22,,,0,"percent of total billed charges ","70% of total billed charges ",630.34,90,,504.27,,,0,"percent of total billed charges ","90% of total billed charges ",651.35,93,,521.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",595.32,85,,476.26,,,0,"percent of total billed charges ","85% of total billed charges ",630.34,90,,504.27,,,0,"percent of total billed charges ","90% of total billed charges ",630.34,90,,504.27,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",609.33,87,,487.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",490.27,70,,392.22,,,0,"percent of total billed charges ","70% of total billed charges ",490.27,651.35,
"FLIPCUTTER II SHORT 9.5MM",6108405,"CDM ",272,RC,,,OUTPATIENT,,,700.38,560.304,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",560.3,80,,448.24,,,0,"percent of total billed charges ","80% of total billed charges ",490.27,70,,392.22,,,0,"percent of total billed charges ","70% of total billed charges ",630.34,90,,504.27,,,0,"percent of total billed charges ","90% of total billed charges ",651.35,93,,521.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",595.32,85,,476.26,,,0,"percent of total billed charges ","85% of total billed charges ",630.34,90,,504.27,,,0,"percent of total billed charges ","90% of total billed charges ",630.34,90,,504.27,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",609.33,87,,487.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",490.27,70,,392.22,,,0,"percent of total billed charges ","70% of total billed charges ",490.27,651.35,
"FLIPCUTTER II SHORT 10MM",6108406,"CDM ",272,RC,,,OUTPATIENT,,,700.38,560.304,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",560.3,80,,448.24,,,0,"percent of total billed charges ","80% of total billed charges ",490.27,70,,392.22,,,0,"percent of total billed charges ","70% of total billed charges ",630.34,90,,504.27,,,0,"percent of total billed charges ","90% of total billed charges ",651.35,93,,521.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",595.32,85,,476.26,,,0,"percent of total billed charges ","85% of total billed charges ",630.34,90,,504.27,,,0,"percent of total billed charges ","90% of total billed charges ",630.34,90,,504.27,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",609.33,87,,487.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",490.27,70,,392.22,,,0,"percent of total billed charges ","70% of total billed charges ",490.27,651.35,
"FLIPCUTTER II SHORT 11MM",6108407,"CDM ",272,RC,,,OUTPATIENT,,,700.38,560.304,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",560.3,80,,448.24,,,0,"percent of total billed charges ","80% of total billed charges ",490.27,70,,392.22,,,0,"percent of total billed charges ","70% of total billed charges ",630.34,90,,504.27,,,0,"percent of total billed charges ","90% of total billed charges ",651.35,93,,521.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",595.32,85,,476.26,,,0,"percent of total billed charges ","85% of total billed charges ",630.34,90,,504.27,,,0,"percent of total billed charges ","90% of total billed charges ",630.34,90,,504.27,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",609.33,87,,487.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",490.27,70,,392.22,,,0,"percent of total billed charges ","70% of total billed charges ",490.27,651.35,
"FIBERSNARE GREEN 26""",6108408,"CDM ",272,RC,,,OUTPATIENT,,,226.28,181.024,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",181.02,80,,144.82,,,0,"percent of total billed charges ","80% of total billed charges ",158.4,70,,126.72,,,0,"percent of total billed charges ","70% of total billed charges ",203.65,90,,162.92,,,0,"percent of total billed charges ","90% of total billed charges ",210.44,93,,168.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",192.34,85,,153.87,,,0,"percent of total billed charges ","85% of total billed charges ",203.65,90,,162.92,,,0,"percent of total billed charges ","90% of total billed charges ",203.65,90,,162.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",196.86,87,,157.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",158.4,70,,126.72,,,0,"percent of total billed charges ","70% of total billed charges ",158.4,210.44,
"FIBERLOOP BRAID POLYBLEND BLUE",6108409,"CDM ",272,RC,,,OUTPATIENT,,,222.25,177.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.8,80,,142.24,,,0,"percent of total billed charges ","80% of total billed charges ",155.58,70,,124.46,,,0,"percent of total billed charges ","70% of total billed charges ",200.03,90,,160.02,,,0,"percent of total billed charges ","90% of total billed charges ",206.69,93,,165.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",188.91,85,,151.13,,,0,"percent of total billed charges ","85% of total billed charges ",200.03,90,,160.02,,,0,"percent of total billed charges ","90% of total billed charges ",200.03,90,,160.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",193.36,87,,154.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.58,70,,124.46,,,0,"percent of total billed charges ","70% of total billed charges ",155.58,206.69,
"KIT TRANSTIBIAL ACL",6108410,"CDM ",272,RC,,,OUTPATIENT,,,312.48,249.984,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",249.98,80,,199.98,,,0,"percent of total billed charges ","80% of total billed charges ",218.74,70,,174.99,,,0,"percent of total billed charges ","70% of total billed charges ",281.23,90,,224.98,,,0,"percent of total billed charges ","90% of total billed charges ",290.61,93,,232.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",265.61,85,,212.49,,,0,"percent of total billed charges ","85% of total billed charges ",281.23,90,,224.98,,,0,"percent of total billed charges ","90% of total billed charges ",281.23,90,,224.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",271.86,87,,217.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",218.74,70,,174.99,,,0,"percent of total billed charges ","70% of total billed charges ",218.74,290.61,
"KIT BALLOON DILATION 7MM X 6CM",6108420,"CDM ",272,RC,,,OUTPATIENT,,,444.53,355.624,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",355.62,80,,284.50,,,0,"percent of total billed charges ","80% of total billed charges ",311.17,70,,248.94,,,0,"percent of total billed charges ","70% of total billed charges ",400.08,90,,320.06,,,0,"percent of total billed charges ","90% of total billed charges ",413.41,93,,330.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",377.85,85,,302.28,,,0,"percent of total billed charges ","85% of total billed charges ",400.08,90,,320.06,,,0,"percent of total billed charges ","90% of total billed charges ",400.08,90,,320.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",386.74,87,,309.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",311.17,70,,248.94,,,0,"percent of total billed charges ","70% of total billed charges ",311.17,413.41,
"TROCAR KII OPTICAL 12MMX100MM",6108422,"CDM ",272,RC,,,OUTPATIENT,,,200.03,160.024,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",160.02,80,,128.02,,,0,"percent of total billed charges ","80% of total billed charges ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",186.03,93,,148.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",174.03,87,,139.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",140.02,186.03,
"TROCAR KII OPTIC 12MM X 150MM",6108423,"CDM ",272,RC,,,OUTPATIENT,,,200.03,160.024,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",160.02,80,,128.02,,,0,"percent of total billed charges ","80% of total billed charges ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",186.03,93,,148.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",170.03,85,,136.02,,,0,"percent of total billed charges ","85% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",180.03,90,,144.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",174.03,87,,139.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",140.02,70,,112.02,,,0,"percent of total billed charges ","70% of total billed charges ",140.02,186.03,
"POUCH RETRIEVAL INZII 12/15MM",6108424,"CDM ",272,RC,,,OUTPATIENT,,,377.13,301.704,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",301.7,80,,241.36,,,0,"percent of total billed charges ","80% of total billed charges ",263.99,70,,211.19,,,0,"percent of total billed charges ","70% of total billed charges ",339.42,90,,271.54,,,0,"percent of total billed charges ","90% of total billed charges ",350.73,93,,280.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",320.56,85,,256.45,,,0,"percent of total billed charges ","85% of total billed charges ",339.42,90,,271.54,,,0,"percent of total billed charges ","90% of total billed charges ",339.42,90,,271.54,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",328.1,87,,262.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",263.99,70,,211.19,,,0,"percent of total billed charges ","70% of total billed charges ",263.99,350.73,
"TENDON GRACILIS",6108438,"CDM ",278,RC,,,OUTPATIENT,,,2041.88,1633.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1633.5,80,,1306.80,,,0,"percent of total billed charges ","80% of total billed charges ",1429.32,70,,1143.46,,,0,"percent of total billed charges ","70% of total billed charges ",1837.69,90,,1470.15,,,0,"percent of total billed charges ","90% of total billed charges ",1898.95,93,,1519.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1735.6,85,,1388.48,,,0,"percent of total billed charges ","85% of total billed charges ",1735.6,85,,1388.48,,,0,"percent of total billed charges ","85% of total billed charges ",1837.69,90,,1470.15,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1776.44,87,,1421.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1429.32,70,,1143.46,,,0,"percent of total billed charges ","70% of total billed charges ",1429.32,1898.95,
"CUFF TOURNIQUET PLC 18"" DUAL",6108440,"CDM ",272,RC,,,OUTPATIENT,,,123.66,98.928,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.93,80,,79.14,,,0,"percent of total billed charges ","80% of total billed charges ",86.56,70,,69.25,,,0,"percent of total billed charges ","70% of total billed charges ",111.29,90,,89.03,,,0,"percent of total billed charges ","90% of total billed charges ",115,93,,92.00,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",105.11,85,,84.09,,,0,"percent of total billed charges ","85% of total billed charges ",111.29,90,,89.03,,,0,"percent of total billed charges ","90% of total billed charges ",111.29,90,,89.03,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",107.58,87,,86.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.56,70,,69.25,,,0,"percent of total billed charges ","70% of total billed charges ",86.56,115,
"CUFF TOURNIQUET PLC 24"" DUAL",6108441,"CDM ",272,RC,,,OUTPATIENT,,,135.97,108.776,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.78,80,,87.02,,,0,"percent of total billed charges ","80% of total billed charges ",95.18,70,,76.14,,,0,"percent of total billed charges ","70% of total billed charges ",122.37,90,,97.90,,,0,"percent of total billed charges ","90% of total billed charges ",126.45,93,,101.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",115.57,85,,92.46,,,0,"percent of total billed charges ","85% of total billed charges ",122.37,90,,97.90,,,0,"percent of total billed charges ","90% of total billed charges ",122.37,90,,97.90,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",118.29,87,,94.63,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.18,70,,76.14,,,0,"percent of total billed charges ","70% of total billed charges ",95.18,126.45,
"RETRACTOR GYNO MALE URO",6108446,"CDM ",272,RC,,,OUTPATIENT,,,269.86,215.888,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",215.89,80,,172.71,,,0,"percent of total billed charges ","80% of total billed charges ",188.9,70,,151.12,,,0,"percent of total billed charges ","70% of total billed charges ",242.87,90,,194.30,,,0,"percent of total billed charges ","90% of total billed charges ",250.97,93,,200.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",229.38,85,,183.50,,,0,"percent of total billed charges ","85% of total billed charges ",242.87,90,,194.30,,,0,"percent of total billed charges ","90% of total billed charges ",242.87,90,,194.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.78,87,,187.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.9,70,,151.12,,,0,"percent of total billed charges ","70% of total billed charges ",188.9,250.97,
"STAYS ELASTIC SHARP HOOK 5MM",6108447,"CDM ",272,RC,,,OUTPATIENT,,,269.86,215.888,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",215.89,80,,172.71,,,0,"percent of total billed charges ","80% of total billed charges ",188.9,70,,151.12,,,0,"percent of total billed charges ","70% of total billed charges ",242.87,90,,194.30,,,0,"percent of total billed charges ","90% of total billed charges ",250.97,93,,200.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",229.38,85,,183.50,,,0,"percent of total billed charges ","85% of total billed charges ",242.87,90,,194.30,,,0,"percent of total billed charges ","90% of total billed charges ",242.87,90,,194.30,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",234.78,87,,187.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",188.9,70,,151.12,,,0,"percent of total billed charges ","70% of total billed charges ",188.9,250.97,
"NEEDLE ULTRASOUND STIM 21GAX4""",6108448,"CDM ",272,RC,,,OUTPATIENT,,,60.85,48.68,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.68,80,,38.94,,,0,"percent of total billed charges ","80% of total billed charges ",42.6,70,,34.08,,,0,"percent of total billed charges ","70% of total billed charges ",54.77,90,,43.82,,,0,"percent of total billed charges ","90% of total billed charges ",56.59,93,,45.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51.72,85,,41.38,,,0,"percent of total billed charges ","85% of total billed charges ",54.77,90,,43.82,,,0,"percent of total billed charges ","90% of total billed charges ",54.77,90,,43.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",52.94,87,,42.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.6,70,,34.08,,,0,"percent of total billed charges ","70% of total billed charges ",42.6,56.59,
"AIRWAY SUPRAGLOTTIC CUFF 5.0",6108484,"CDM ",272,RC,,,OUTPATIENT,,,59.25,47.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.4,80,,37.92,,,0,"percent of total billed charges ","80% of total billed charges ",41.48,70,,33.18,,,0,"percent of total billed charges ","70% of total billed charges ",53.33,90,,42.66,,,0,"percent of total billed charges ","90% of total billed charges ",55.1,93,,44.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",50.36,85,,40.29,,,0,"percent of total billed charges ","85% of total billed charges ",53.33,90,,42.66,,,0,"percent of total billed charges ","90% of total billed charges ",53.33,90,,42.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",51.55,87,,41.24,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.48,70,,33.18,,,0,"percent of total billed charges ","70% of total billed charges ",41.48,55.1,
"AIRWAY SUPRAGLOTTIC CUFF 4.0",6108485,"CDM ",272,RC,,,OUTPATIENT,,,59.25,47.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.4,80,,37.92,,,0,"percent of total billed charges ","80% of total billed charges ",41.48,70,,33.18,,,0,"percent of total billed charges ","70% of total billed charges ",53.33,90,,42.66,,,0,"percent of total billed charges ","90% of total billed charges ",55.1,93,,44.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",50.36,85,,40.29,,,0,"percent of total billed charges ","85% of total billed charges ",53.33,90,,42.66,,,0,"percent of total billed charges ","90% of total billed charges ",53.33,90,,42.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",51.55,87,,41.24,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.48,70,,33.18,,,0,"percent of total billed charges ","70% of total billed charges ",41.48,55.1,
"MASK LARYNGEAL ECLIPSE SZ 3",6108486,"CDM ",270,RC,,,OUTPATIENT,,,38.87,31.096,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.1,80,,24.88,,,0,"percent of total billed charges ","80% of total billed charges ",27.21,70,,21.77,,,0,"percent of total billed charges ","70% of total billed charges ",34.98,90,,27.98,,,0,"percent of total billed charges ","90% of total billed charges ",36.15,93,,28.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.04,85,,26.43,,,0,"percent of total billed charges ","85% of total billed charges ",34.98,90,,27.98,,,0,"percent of total billed charges ","90% of total billed charges ",34.98,90,,27.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.82,87,,27.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.21,70,,21.77,,,0,"percent of total billed charges ","70% of total billed charges ",27.21,36.15,
"MASK LARYNGEAL ECLIPSE SZ 4",6108487,"CDM ",270,RC,,,OUTPATIENT,,,41.17,32.936,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.94,80,,26.35,,,0,"percent of total billed charges ","80% of total billed charges ",28.82,70,,23.06,,,0,"percent of total billed charges ","70% of total billed charges ",37.05,90,,29.64,,,0,"percent of total billed charges ","90% of total billed charges ",38.29,93,,30.63,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34.99,85,,27.99,,,0,"percent of total billed charges ","85% of total billed charges ",37.05,90,,29.64,,,0,"percent of total billed charges ","90% of total billed charges ",37.05,90,,29.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",35.82,87,,28.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.82,70,,23.06,,,0,"percent of total billed charges ","70% of total billed charges ",28.82,38.29,
"MASK LARYNGEAL ECLIPSE SZ 5",6108488,"CDM ",270,RC,,,OUTPATIENT,,,38.87,31.096,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.1,80,,24.88,,,0,"percent of total billed charges ","80% of total billed charges ",27.21,70,,21.77,,,0,"percent of total billed charges ","70% of total billed charges ",34.98,90,,27.98,,,0,"percent of total billed charges ","90% of total billed charges ",36.15,93,,28.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.04,85,,26.43,,,0,"percent of total billed charges ","85% of total billed charges ",34.98,90,,27.98,,,0,"percent of total billed charges ","90% of total billed charges ",34.98,90,,27.98,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.82,87,,27.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.21,70,,21.77,,,0,"percent of total billed charges ","70% of total billed charges ",27.21,36.15,
"MASK LARYNGEAL ESSENTIAL SZ 1",6108489,"CDM ",270,RC,,,OUTPATIENT,,,39.12,31.296,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.3,80,,25.04,,,0,"percent of total billed charges ","80% of total billed charges ",27.38,70,,21.90,,,0,"percent of total billed charges ","70% of total billed charges ",35.21,90,,28.17,,,0,"percent of total billed charges ","90% of total billed charges ",36.38,93,,29.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.25,85,,26.60,,,0,"percent of total billed charges ","85% of total billed charges ",35.21,90,,28.17,,,0,"percent of total billed charges ","90% of total billed charges ",35.21,90,,28.17,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",34.03,87,,27.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.38,70,,21.90,,,0,"percent of total billed charges ","70% of total billed charges ",27.38,36.38,
"MASK LARYNGEAL ESSENTIAL SZ1.5",6108490,"CDM ",270,RC,,,OUTPATIENT,,,50.67,40.536,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.54,80,,32.43,,,0,"percent of total billed charges ","80% of total billed charges ",35.47,70,,28.38,,,0,"percent of total billed charges ","70% of total billed charges ",45.6,90,,36.48,,,0,"percent of total billed charges ","90% of total billed charges ",47.12,93,,37.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.07,85,,34.46,,,0,"percent of total billed charges ","85% of total billed charges ",45.6,90,,36.48,,,0,"percent of total billed charges ","90% of total billed charges ",45.6,90,,36.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.08,87,,35.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.47,70,,28.38,,,0,"percent of total billed charges ","70% of total billed charges ",35.47,47.12,
"MASK LARYNGEAL ESSENTIAL SZ 2",6108491,"CDM ",270,RC,,,OUTPATIENT,,,50.67,40.536,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.54,80,,32.43,,,0,"percent of total billed charges ","80% of total billed charges ",35.47,70,,28.38,,,0,"percent of total billed charges ","70% of total billed charges ",45.6,90,,36.48,,,0,"percent of total billed charges ","90% of total billed charges ",47.12,93,,37.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.07,85,,34.46,,,0,"percent of total billed charges ","85% of total billed charges ",45.6,90,,36.48,,,0,"percent of total billed charges ","90% of total billed charges ",45.6,90,,36.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.08,87,,35.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.47,70,,28.38,,,0,"percent of total billed charges ","70% of total billed charges ",35.47,47.12,
"MASK LARYNGEAL ESSENTIAL SZ2.5",6108492,"CDM ",270,RC,,,OUTPATIENT,,,53.34,42.672,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.67,80,,34.14,,,0,"percent of total billed charges ","80% of total billed charges ",37.34,70,,29.87,,,0,"percent of total billed charges ","70% of total billed charges ",48.01,90,,38.41,,,0,"percent of total billed charges ","90% of total billed charges ",49.61,93,,39.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",45.34,85,,36.27,,,0,"percent of total billed charges ","85% of total billed charges ",48.01,90,,38.41,,,0,"percent of total billed charges ","90% of total billed charges ",48.01,90,,38.41,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",46.41,87,,37.13,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.34,70,,29.87,,,0,"percent of total billed charges ","70% of total billed charges ",37.34,49.61,
"NEEDLE ASPIRATION INJECT 16GA",6108495,"CDM ",272,RC,,,OUTPATIENT,,,66.85,53.48,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.48,80,,42.78,,,0,"percent of total billed charges ","80% of total billed charges ",46.8,70,,37.44,,,0,"percent of total billed charges ","70% of total billed charges ",60.17,90,,48.14,,,0,"percent of total billed charges ","90% of total billed charges ",62.17,93,,49.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",56.82,85,,45.46,,,0,"percent of total billed charges ","85% of total billed charges ",60.17,90,,48.14,,,0,"percent of total billed charges ","90% of total billed charges ",60.17,90,,48.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",58.16,87,,46.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.8,70,,37.44,,,0,"percent of total billed charges ","70% of total billed charges ",46.8,62.17,
"SET RENAL DILATOR AMPLATZ",6108502,"CDM ",272,RC,,,OUTPATIENT,,,590.04,472.032,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",472.03,80,,377.62,,,0,"percent of total billed charges ","80% of total billed charges ",413.03,70,,330.42,,,0,"percent of total billed charges ","70% of total billed charges ",531.04,90,,424.83,,,0,"percent of total billed charges ","90% of total billed charges ",548.74,93,,438.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",501.53,85,,401.22,,,0,"percent of total billed charges ","85% of total billed charges ",531.04,90,,424.83,,,0,"percent of total billed charges ","90% of total billed charges ",531.04,90,,424.83,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",513.33,87,,410.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",413.03,70,,330.42,,,0,"percent of total billed charges ","70% of total billed charges ",413.03,548.74,
"KIT TRIMANO BEACH CHAIR",6108529,"CDM ",272,RC,,,OUTPATIENT,,,290.63,232.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",232.5,80,,186.00,,,0,"percent of total billed charges ","80% of total billed charges ",203.44,70,,162.75,,,0,"percent of total billed charges ","70% of total billed charges ",261.57,90,,209.26,,,0,"percent of total billed charges ","90% of total billed charges ",270.29,93,,216.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",247.04,85,,197.63,,,0,"percent of total billed charges ","85% of total billed charges ",261.57,90,,209.26,,,0,"percent of total billed charges ","90% of total billed charges ",261.57,90,,209.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",252.85,87,,202.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",203.44,70,,162.75,,,0,"percent of total billed charges ","70% of total billed charges ",203.44,270.29,
"TIB KEELED NON-POR SZ 6 LT",6108531,"CDM ",278,RC,,,OUTPATIENT,,,3630,2904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2904,80,,2323.20,,,0,"percent of total billed charges ","80% of total billed charges ",2541,70,,2032.80,,,0,"percent of total billed charges ","70% of total billed charges ",3267,90,,2613.60,,,0,"percent of total billed charges ","90% of total billed charges ",3375.9,93,,2700.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3085.5,85,,2468.40,,,0,"percent of total billed charges ","85% of total billed charges ",3085.5,85,,2468.40,,,0,"percent of total billed charges ","85% of total billed charges ",3267,90,,2613.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3158.1,87,,2526.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2541,70,,2032.80,,,0,"percent of total billed charges ","70% of total billed charges ",2541,3375.9,
"CS INSERT SZ 6 10MM LT",6108532,"CDM ",278,RC,,,OUTPATIENT,,,2722.5,2178,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2178,80,,1742.40,,,0,"percent of total billed charges ","80% of total billed charges ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",2531.93,93,,2025.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2368.58,87,,1894.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",1905.75,2531.93,
"PATELLA ALL POLY HIGH 28MM",6108533,"CDM ",278,RC,,,OUTPATIENT,,,1343.1,1074.48,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1074.48,80,,859.58,,,0,"percent of total billed charges ","80% of total billed charges ",940.17,70,,752.14,,,0,"percent of total billed charges ","70% of total billed charges ",1208.79,90,,967.03,,,0,"percent of total billed charges ","90% of total billed charges ",1249.08,93,,999.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1141.64,85,,913.31,,,0,"percent of total billed charges ","85% of total billed charges ",1141.64,85,,913.31,,,0,"percent of total billed charges ","85% of total billed charges ",1208.79,90,,967.03,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1168.5,87,,934.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",940.17,70,,752.14,,,0,"percent of total billed charges ","70% of total billed charges ",940.17,1249.08,
"SUTURE CHROMIC 1.0 905H",6108543,"CDM ",272,RC,,,OUTPATIENT,,,12.59,10.072,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.07,80,,8.06,,,0,"percent of total billed charges ","80% of total billed charges ",8.81,70,,7.05,,,0,"percent of total billed charges ","70% of total billed charges ",11.33,90,,9.06,,,0,"percent of total billed charges ","90% of total billed charges ",11.71,93,,9.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.7,85,,8.56,,,0,"percent of total billed charges ","85% of total billed charges ",11.33,90,,9.06,,,0,"percent of total billed charges ","90% of total billed charges ",11.33,90,,9.06,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.95,87,,8.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.81,70,,7.05,,,0,"percent of total billed charges ","70% of total billed charges ",8.81,11.71,
"MANIPULATOR UTERINE 4.5MM",6108544,"CDM ",272,RC,,,OUTPATIENT,,,122.86,98.288,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98.29,80,,78.63,,,0,"percent of total billed charges ","80% of total billed charges ",86,70,,68.80,,,0,"percent of total billed charges ","70% of total billed charges ",110.57,90,,88.46,,,0,"percent of total billed charges ","90% of total billed charges ",114.26,93,,91.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",104.43,85,,83.54,,,0,"percent of total billed charges ","85% of total billed charges ",110.57,90,,88.46,,,0,"percent of total billed charges ","90% of total billed charges ",110.57,90,,88.46,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",106.89,87,,85.51,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86,70,,68.80,,,0,"percent of total billed charges ","70% of total billed charges ",86,114.26,
"FEM CS/CR NON-POR SZ 4 RT",6108554,"CDM ",278,RC,,,OUTPATIENT,,,5263.5,4210.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4210.8,80,,3368.64,,,0,"percent of total billed charges ","80% of total billed charges ",3684.45,70,,2947.56,,,0,"percent of total billed charges ","70% of total billed charges ",4737.15,90,,3789.72,,,0,"percent of total billed charges ","90% of total billed charges ",4895.06,93,,3916.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4473.98,85,,3579.18,,,0,"percent of total billed charges ","85% of total billed charges ",4473.98,85,,3579.18,,,0,"percent of total billed charges ","85% of total billed charges ",4737.15,90,,3789.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4579.25,87,,3663.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3684.45,70,,2947.56,,,0,"percent of total billed charges ","70% of total billed charges ",3684.45,4895.06,
"PATELLA ALL-POLY HIGH 25MM",6108555,"CDM ",278,RC,,,OUTPATIENT,,,1343.1,1074.48,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1074.48,80,,859.58,,,0,"percent of total billed charges ","80% of total billed charges ",940.17,70,,752.14,,,0,"percent of total billed charges ","70% of total billed charges ",1208.79,90,,967.03,,,0,"percent of total billed charges ","90% of total billed charges ",1249.08,93,,999.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1141.64,85,,913.31,,,0,"percent of total billed charges ","85% of total billed charges ",1141.64,85,,913.31,,,0,"percent of total billed charges ","85% of total billed charges ",1208.79,90,,967.03,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1168.5,87,,934.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",940.17,70,,752.14,,,0,"percent of total billed charges ","70% of total billed charges ",940.17,1249.08,
"TIB KEELED NON-POR SZ 4 RT",6108556,"CDM ",278,RC,,,OUTPATIENT,,,3630,2904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2904,80,,2323.20,,,0,"percent of total billed charges ","80% of total billed charges ",2541,70,,2032.80,,,0,"percent of total billed charges ","70% of total billed charges ",3267,90,,2613.60,,,0,"percent of total billed charges ","90% of total billed charges ",3375.9,93,,2700.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3085.5,85,,2468.40,,,0,"percent of total billed charges ","85% of total billed charges ",3085.5,85,,2468.40,,,0,"percent of total billed charges ","85% of total billed charges ",3267,90,,2613.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3158.1,87,,2526.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2541,70,,2032.80,,,0,"percent of total billed charges ","70% of total billed charges ",2541,3375.9,
"FEM CS/CR NON-POR SZ 7 LT",6108558,"CDM ",278,RC,,,OUTPATIENT,,,5263.5,4210.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4210.8,80,,3368.64,,,0,"percent of total billed charges ","80% of total billed charges ",3684.45,70,,2947.56,,,0,"percent of total billed charges ","70% of total billed charges ",4737.15,90,,3789.72,,,0,"percent of total billed charges ","90% of total billed charges ",4895.06,93,,3916.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4473.98,85,,3579.18,,,0,"percent of total billed charges ","85% of total billed charges ",4473.98,85,,3579.18,,,0,"percent of total billed charges ","85% of total billed charges ",4737.15,90,,3789.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4579.25,87,,3663.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3684.45,70,,2947.56,,,0,"percent of total billed charges ","70% of total billed charges ",3684.45,4895.06,
"FEM CS/CR NON-POR SZ 7 RT",6108559,"CDM ",278,RC,,,OUTPATIENT,,,5263.5,4210.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4210.8,80,,3368.64,,,0,"percent of total billed charges ","80% of total billed charges ",3684.45,70,,2947.56,,,0,"percent of total billed charges ","70% of total billed charges ",4737.15,90,,3789.72,,,0,"percent of total billed charges ","90% of total billed charges ",4895.06,93,,3916.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4473.98,85,,3579.18,,,0,"percent of total billed charges ","85% of total billed charges ",4473.98,85,,3579.18,,,0,"percent of total billed charges ","85% of total billed charges ",4737.15,90,,3789.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4579.25,87,,3663.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3684.45,70,,2947.56,,,0,"percent of total billed charges ","70% of total billed charges ",3684.45,4895.06,
"TIB KEELED NON-POR SZ 7 LT",6108560,"CDM ",278,RC,,,OUTPATIENT,,,3630,2904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2904,80,,2323.20,,,0,"percent of total billed charges ","80% of total billed charges ",2541,70,,2032.80,,,0,"percent of total billed charges ","70% of total billed charges ",3267,90,,2613.60,,,0,"percent of total billed charges ","90% of total billed charges ",3375.9,93,,2700.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3085.5,85,,2468.40,,,0,"percent of total billed charges ","85% of total billed charges ",3085.5,85,,2468.40,,,0,"percent of total billed charges ","85% of total billed charges ",3267,90,,2613.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3158.1,87,,2526.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2541,70,,2032.80,,,0,"percent of total billed charges ","70% of total billed charges ",2541,3375.9,
"TIB KEELED NON-POR SZ 7 RT",6108561,"CDM ",278,RC,,,OUTPATIENT,,,3630,2904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2904,80,,2323.20,,,0,"percent of total billed charges ","80% of total billed charges ",2541,70,,2032.80,,,0,"percent of total billed charges ","70% of total billed charges ",3267,90,,2613.60,,,0,"percent of total billed charges ","90% of total billed charges ",3375.9,93,,2700.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3085.5,85,,2468.40,,,0,"percent of total billed charges ","85% of total billed charges ",3085.5,85,,2468.40,,,0,"percent of total billed charges ","85% of total billed charges ",3267,90,,2613.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3158.1,87,,2526.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2541,70,,2032.80,,,0,"percent of total billed charges ","70% of total billed charges ",2541,3375.9,
"CS INSERT SZ 7 10MM LT",6108562,"CDM ",278,RC,,,OUTPATIENT,,,2722.5,2178,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2178,80,,1742.40,,,0,"percent of total billed charges ","80% of total billed charges ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",2531.93,93,,2025.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2368.58,87,,1894.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",1905.75,2531.93,
"CS INSERT SZ 7 12 MM RT",6108563,"CDM ",278,RC,,,OUTPATIENT,,,2722.5,2178,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2178,80,,1742.40,,,0,"percent of total billed charges ","80% of total billed charges ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",2531.93,93,,2025.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2368.58,87,,1894.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",1905.75,2531.93,
"NEEDLE BIOPSY CHIBA 18G X 20CM",6108564,"CDM ",272,RC,,,OUTPATIENT,,,61.25,49,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49,80,,39.20,,,0,"percent of total billed charges ","80% of total billed charges ",42.88,70,,34.30,,,0,"percent of total billed charges ","70% of total billed charges ",55.13,90,,44.10,,,0,"percent of total billed charges ","90% of total billed charges ",56.96,93,,45.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",52.06,85,,41.65,,,0,"percent of total billed charges ","85% of total billed charges ",55.13,90,,44.10,,,0,"percent of total billed charges ","90% of total billed charges ",55.13,90,,44.10,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",53.29,87,,42.63,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.88,70,,34.30,,,0,"percent of total billed charges ","70% of total billed charges ",42.88,56.96,
"CLIP RESOLUTION 2.8MM X 235CM",6108566,"CDM ",272,RC,,,OUTPATIENT,,,561.16,448.928,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",448.93,80,,359.14,,,0,"percent of total billed charges ","80% of total billed charges ",392.81,70,,314.25,,,0,"percent of total billed charges ","70% of total billed charges ",505.04,90,,404.03,,,0,"percent of total billed charges ","90% of total billed charges ",521.88,93,,417.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",476.99,85,,381.59,,,0,"percent of total billed charges ","85% of total billed charges ",505.04,90,,404.03,,,0,"percent of total billed charges ","90% of total billed charges ",505.04,90,,404.03,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",488.21,87,,390.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",392.81,70,,314.25,,,0,"percent of total billed charges ","70% of total billed charges ",392.81,521.88,
"FEM CS/CR NON-POR SZ 3 LT",6108571,"CDM ",278,RC,,,OUTPATIENT,,,5263.5,4210.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4210.8,80,,3368.64,,,0,"percent of total billed charges ","80% of total billed charges ",3684.45,70,,2947.56,,,0,"percent of total billed charges ","70% of total billed charges ",4737.15,90,,3789.72,,,0,"percent of total billed charges ","90% of total billed charges ",4895.06,93,,3916.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4473.98,85,,3579.18,,,0,"percent of total billed charges ","85% of total billed charges ",4473.98,85,,3579.18,,,0,"percent of total billed charges ","85% of total billed charges ",4737.15,90,,3789.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4579.25,87,,3663.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3684.45,70,,2947.56,,,0,"percent of total billed charges ","70% of total billed charges ",3684.45,4895.06,
"TIB KEELED NON-POR SZ 3 LT",6108572,"CDM ",278,RC,,,OUTPATIENT,,,3630,2904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2904,80,,2323.20,,,0,"percent of total billed charges ","80% of total billed charges ",2541,70,,2032.80,,,0,"percent of total billed charges ","70% of total billed charges ",3267,90,,2613.60,,,0,"percent of total billed charges ","90% of total billed charges ",3375.9,93,,2700.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3085.5,85,,2468.40,,,0,"percent of total billed charges ","85% of total billed charges ",3085.5,85,,2468.40,,,0,"percent of total billed charges ","85% of total billed charges ",3267,90,,2613.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3158.1,87,,2526.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2541,70,,2032.80,,,0,"percent of total billed charges ","70% of total billed charges ",2541,3375.9,
"CS INSERT SZ 3 12MM LT",6108573,"CDM ",278,RC,,,OUTPATIENT,,,2722.5,2178,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2178,80,,1742.40,,,0,"percent of total billed charges ","80% of total billed charges ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",2531.93,93,,2025.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2368.58,87,,1894.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",1905.75,2531.93,
"PATELLA ALL-POLY LOW 25MM",6108574,"CDM ",278,RC,,,OUTPATIENT,,,1343.1,1074.48,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1074.48,80,,859.58,,,0,"percent of total billed charges ","80% of total billed charges ",940.17,70,,752.14,,,0,"percent of total billed charges ","70% of total billed charges ",1208.79,90,,967.03,,,0,"percent of total billed charges ","90% of total billed charges ",1249.08,93,,999.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1141.64,85,,913.31,,,0,"percent of total billed charges ","85% of total billed charges ",1141.64,85,,913.31,,,0,"percent of total billed charges ","85% of total billed charges ",1208.79,90,,967.03,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1168.5,87,,934.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",940.17,70,,752.14,,,0,"percent of total billed charges ","70% of total billed charges ",940.17,1249.08,
"FEM CS/CR NON-POR SZ 3 RT",6108575,"CDM ",278,RC,,,OUTPATIENT,,,5263.5,4210.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4210.8,80,,3368.64,,,0,"percent of total billed charges ","80% of total billed charges ",3684.45,70,,2947.56,,,0,"percent of total billed charges ","70% of total billed charges ",4737.15,90,,3789.72,,,0,"percent of total billed charges ","90% of total billed charges ",4895.06,93,,3916.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4473.98,85,,3579.18,,,0,"percent of total billed charges ","85% of total billed charges ",4473.98,85,,3579.18,,,0,"percent of total billed charges ","85% of total billed charges ",4737.15,90,,3789.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4579.25,87,,3663.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3684.45,70,,2947.56,,,0,"percent of total billed charges ","70% of total billed charges ",3684.45,4895.06,
"TIB KEELED NON-POR SZ 3 RT",6108576,"CDM ",278,RC,,,OUTPATIENT,,,3630,2904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2904,80,,2323.20,,,0,"percent of total billed charges ","80% of total billed charges ",2541,70,,2032.80,,,0,"percent of total billed charges ","70% of total billed charges ",3267,90,,2613.60,,,0,"percent of total billed charges ","90% of total billed charges ",3375.9,93,,2700.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3085.5,85,,2468.40,,,0,"percent of total billed charges ","85% of total billed charges ",3085.5,85,,2468.40,,,0,"percent of total billed charges ","85% of total billed charges ",3267,90,,2613.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3158.1,87,,2526.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2541,70,,2032.80,,,0,"percent of total billed charges ","70% of total billed charges ",2541,3375.9,
"CS INSERT SZ 3 10MM RT",6108577,"CDM ",278,RC,,,OUTPATIENT,,,2722.5,2178,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2178,80,,1742.40,,,0,"percent of total billed charges ","80% of total billed charges ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",2531.93,93,,2025.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2368.58,87,,1894.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",1905.75,2531.93,
"NEEDLE PNB 22G X 5CM",6108578,"CDM ",272,RC,,,OUTPATIENT,,,49.34,39.472,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.47,80,,31.58,,,0,"percent of total billed charges ","80% of total billed charges ",34.54,70,,27.63,,,0,"percent of total billed charges ","70% of total billed charges ",44.41,90,,35.53,,,0,"percent of total billed charges ","90% of total billed charges ",45.89,93,,36.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.94,85,,33.55,,,0,"percent of total billed charges ","85% of total billed charges ",44.41,90,,35.53,,,0,"percent of total billed charges ","90% of total billed charges ",44.41,90,,35.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.93,87,,34.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.54,70,,27.63,,,0,"percent of total billed charges ","70% of total billed charges ",34.54,45.89,
"NEEDLE PNB 21G X 9CM",6108579,"CDM ",272,RC,,,OUTPATIENT,,,49.34,39.472,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.47,80,,31.58,,,0,"percent of total billed charges ","80% of total billed charges ",34.54,70,,27.63,,,0,"percent of total billed charges ","70% of total billed charges ",44.41,90,,35.53,,,0,"percent of total billed charges ","90% of total billed charges ",45.89,93,,36.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.94,85,,33.55,,,0,"percent of total billed charges ","85% of total billed charges ",44.41,90,,35.53,,,0,"percent of total billed charges ","90% of total billed charges ",44.41,90,,35.53,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.93,87,,34.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.54,70,,27.63,,,0,"percent of total billed charges ","70% of total billed charges ",34.54,45.89,
"NEEDLE PNB 21G X 15CM",6108580,"CDM ",272,RC,,,OUTPATIENT,,,51.83,41.464,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.46,80,,33.17,,,0,"percent of total billed charges ","80% of total billed charges ",36.28,70,,29.02,,,0,"percent of total billed charges ","70% of total billed charges ",46.65,90,,37.32,,,0,"percent of total billed charges ","90% of total billed charges ",48.2,93,,38.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",44.06,85,,35.25,,,0,"percent of total billed charges ","85% of total billed charges ",46.65,90,,37.32,,,0,"percent of total billed charges ","90% of total billed charges ",46.65,90,,37.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",45.09,87,,36.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.28,70,,29.02,,,0,"percent of total billed charges ","70% of total billed charges ",36.28,48.2,
"CS INSERT SZ 6 12MM RT",6108585,"CDM ",278,RC,,,OUTPATIENT,,,2722.5,2178,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2178,80,,1742.40,,,0,"percent of total billed charges ","80% of total billed charges ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",2531.93,93,,2025.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2368.58,87,,1894.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",1905.75,2531.93,
"FEM CS/CR NON-POR SZ 6 RT",6108586,"CDM ",278,RC,,,OUTPATIENT,,,5263.5,4210.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4210.8,80,,3368.64,,,0,"percent of total billed charges ","80% of total billed charges ",3684.45,70,,2947.56,,,0,"percent of total billed charges ","70% of total billed charges ",4737.15,90,,3789.72,,,0,"percent of total billed charges ","90% of total billed charges ",4895.06,93,,3916.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4473.98,85,,3579.18,,,0,"percent of total billed charges ","85% of total billed charges ",4473.98,85,,3579.18,,,0,"percent of total billed charges ","85% of total billed charges ",4737.15,90,,3789.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4579.25,87,,3663.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3684.45,70,,2947.56,,,0,"percent of total billed charges ","70% of total billed charges ",3684.45,4895.06,
"TIB KEELED NON-POR SZ 6 RT",6108587,"CDM ",278,RC,,,OUTPATIENT,,,3630,2904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2904,80,,2323.20,,,0,"percent of total billed charges ","80% of total billed charges ",2541,70,,2032.80,,,0,"percent of total billed charges ","70% of total billed charges ",3267,90,,2613.60,,,0,"percent of total billed charges ","90% of total billed charges ",3375.9,93,,2700.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3085.5,85,,2468.40,,,0,"percent of total billed charges ","85% of total billed charges ",3085.5,85,,2468.40,,,0,"percent of total billed charges ","85% of total billed charges ",3267,90,,2613.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3158.1,87,,2526.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2541,70,,2032.80,,,0,"percent of total billed charges ","70% of total billed charges ",2541,3375.9,
"CS INSERT SZ 6 10MM RT",6108588,"CDM ",278,RC,,,OUTPATIENT,,,2722.5,2178,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2178,80,,1742.40,,,0,"percent of total billed charges ","80% of total billed charges ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",2531.93,93,,2025.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2314.13,85,,1851.30,,,0,"percent of total billed charges ","85% of total billed charges ",2450.25,90,,1960.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2368.58,87,,1894.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1905.75,70,,1524.60,,,0,"percent of total billed charges ","70% of total billed charges ",1905.75,2531.93,
"FEM CS/CR NON-POR SZ 5 LT",6108589,"CDM ",278,RC,,,OUTPATIENT,,,5263.5,4210.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4210.8,80,,3368.64,,,0,"percent of total billed charges ","80% of total billed charges ",3684.45,70,,2947.56,,,0,"percent of total billed charges ","70% of total billed charges ",4737.15,90,,3789.72,,,0,"percent of total billed charges ","90% of total billed charges ",4895.06,93,,3916.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",4473.98,85,,3579.18,,,0,"percent of total billed charges ","85% of total billed charges ",4473.98,85,,3579.18,,,0,"percent of total billed charges ","85% of total billed charges ",4737.15,90,,3789.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",4579.25,87,,3663.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3684.45,70,,2947.56,,,0,"percent of total billed charges ","70% of total billed charges ",3684.45,4895.06,
"SHEATH UROPASS 10/12FR X 38CM",6108601,"CDM ",272,RC,,,OUTPATIENT,,,378.7,302.96,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",302.96,80,,242.37,,,0,"percent of total billed charges ","80% of total billed charges ",265.09,70,,212.07,,,0,"percent of total billed charges ","70% of total billed charges ",340.83,90,,272.66,,,0,"percent of total billed charges ","90% of total billed charges ",352.19,93,,281.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",321.9,85,,257.52,,,0,"percent of total billed charges ","85% of total billed charges ",340.83,90,,272.66,,,0,"percent of total billed charges ","90% of total billed charges ",340.83,90,,272.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",329.47,87,,263.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",265.09,70,,212.07,,,0,"percent of total billed charges ","70% of total billed charges ",265.09,352.19,
"SHEATH UROPASS 10/12FR X 54CM",6108602,"CDM ",272,RC,,,OUTPATIENT,,,378.7,302.96,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",302.96,80,,242.37,,,0,"percent of total billed charges ","80% of total billed charges ",265.09,70,,212.07,,,0,"percent of total billed charges ","70% of total billed charges ",340.83,90,,272.66,,,0,"percent of total billed charges ","90% of total billed charges ",352.19,93,,281.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",321.9,85,,257.52,,,0,"percent of total billed charges ","85% of total billed charges ",340.83,90,,272.66,,,0,"percent of total billed charges ","90% of total billed charges ",340.83,90,,272.66,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",329.47,87,,263.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",265.09,70,,212.07,,,0,"percent of total billed charges ","70% of total billed charges ",265.09,352.19,
"SUTURE VICRYL 0 J346H",6108608,"CDM ",272,RC,,,OUTPATIENT,,,19.71,15.768,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.77,80,,12.62,,,0,"percent of total billed charges ","80% of total billed charges ",13.8,70,,11.04,,,0,"percent of total billed charges ","70% of total billed charges ",17.74,90,,14.19,,,0,"percent of total billed charges ","90% of total billed charges ",18.33,93,,14.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.75,85,,13.40,,,0,"percent of total billed charges ","85% of total billed charges ",17.74,90,,14.19,,,0,"percent of total billed charges ","90% of total billed charges ",17.74,90,,14.19,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.15,87,,13.72,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.8,70,,11.04,,,0,"percent of total billed charges ","70% of total billed charges ",13.8,18.33,
"POSITIONEER HEAD UNIVERSAL",6108625,"CDM ",272,RC,,,OUTPATIENT,,,88.46,70.768,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.77,80,,56.62,,,0,"percent of total billed charges ","80% of total billed charges ",61.92,70,,49.54,,,0,"percent of total billed charges ","70% of total billed charges ",79.61,90,,63.69,,,0,"percent of total billed charges ","90% of total billed charges ",82.27,93,,65.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",75.19,85,,60.15,,,0,"percent of total billed charges ","85% of total billed charges ",79.61,90,,63.69,,,0,"percent of total billed charges ","90% of total billed charges ",79.61,90,,63.69,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",76.96,87,,61.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.92,70,,49.54,,,0,"percent of total billed charges ","70% of total billed charges ",61.92,82.27,
"TENDON POSTERIOR TIBIALIS",6108678,"CDM ",278,RC,,,OUTPATIENT,,,2754.37,2203.496,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2203.5,80,,1762.80,,,0,"percent of total billed charges ","80% of total billed charges ",1928.06,70,,1542.45,,,0,"percent of total billed charges ","70% of total billed charges ",2478.93,90,,1983.14,,,0,"percent of total billed charges ","90% of total billed charges ",2561.56,93,,2049.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2341.21,85,,1872.97,,,0,"percent of total billed charges ","85% of total billed charges ",2341.21,85,,1872.97,,,0,"percent of total billed charges ","85% of total billed charges ",2478.93,90,,1983.14,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2396.3,87,,1917.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1928.06,70,,1542.45,,,0,"percent of total billed charges ","70% of total billed charges ",1928.06,2561.56,
"TENDON ANTERIOR TIBIALIS",6108682,"CDM ",278,RC,,,OUTPATIENT,,,2753.36,2202.688,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2202.69,80,,1762.15,,,0,"percent of total billed charges ","80% of total billed charges ",1927.35,70,,1541.88,,,0,"percent of total billed charges ","70% of total billed charges ",2478.02,90,,1982.42,,,0,"percent of total billed charges ","90% of total billed charges ",2560.62,93,,2048.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2340.36,85,,1872.29,,,0,"percent of total billed charges ","85% of total billed charges ",2340.36,85,,1872.29,,,0,"percent of total billed charges ","85% of total billed charges ",2478.02,90,,1982.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2395.42,87,,1916.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1927.35,70,,1541.88,,,0,"percent of total billed charges ","70% of total billed charges ",1927.35,2560.62,
"INST SOFT TISS RELEASE C-LINE",6108690,"CDM ",272,RC,,,OUTPATIENT,,,431,344.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",344.8,80,,275.84,,,0,"percent of total billed charges ","80% of total billed charges ",301.7,70,,241.36,,,0,"percent of total billed charges ","70% of total billed charges ",387.9,90,,310.32,,,0,"percent of total billed charges ","90% of total billed charges ",400.83,93,,320.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",366.35,85,,293.08,,,0,"percent of total billed charges ","85% of total billed charges ",387.9,90,,310.32,,,0,"percent of total billed charges ","90% of total billed charges ",387.9,90,,310.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",374.97,87,,299.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",301.7,70,,241.36,,,0,"percent of total billed charges ","70% of total billed charges ",301.7,400.83,
"KIT BICEPS TENODESIS DISTAL",6108769,"CDM ",272,RC,,,OUTPATIENT,,,1996.5,1597.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1597.2,80,,1277.76,,,0,"percent of total billed charges ","80% of total billed charges ",1397.55,70,,1118.04,,,0,"percent of total billed charges ","70% of total billed charges ",1796.85,90,,1437.48,,,0,"percent of total billed charges ","90% of total billed charges ",1856.75,93,,1485.40,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1697.03,85,,1357.62,,,0,"percent of total billed charges ","85% of total billed charges ",1796.85,90,,1437.48,,,0,"percent of total billed charges ","90% of total billed charges ",1796.85,90,,1437.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1736.96,87,,1389.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1397.55,70,,1118.04,,,0,"percent of total billed charges ","70% of total billed charges ",1397.55,1856.75,
"K-WIRE TROCAR TIP 1.5 X 150MM",6108820,"CDM ",270,RC,,,OUTPATIENT,,,74.01,59.208,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.21,80,,47.37,,,0,"percent of total billed charges ","80% of total billed charges ",51.81,70,,41.45,,,0,"percent of total billed charges ","70% of total billed charges ",66.61,90,,53.29,,,0,"percent of total billed charges ","90% of total billed charges ",68.83,93,,55.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.91,85,,50.33,,,0,"percent of total billed charges ","85% of total billed charges ",66.61,90,,53.29,,,0,"percent of total billed charges ","90% of total billed charges ",66.61,90,,53.29,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",64.39,87,,51.51,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.81,70,,41.45,,,0,"percent of total billed charges ","70% of total billed charges ",51.81,68.83,
"DRAPE C-ARMOR UNIVERSAL",6108830,"CDM ",272,RC,,,OUTPATIENT,,,143.66,114.928,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.93,80,,91.94,,,0,"percent of total billed charges ","80% of total billed charges ",100.56,70,,80.45,,,0,"percent of total billed charges ","70% of total billed charges ",129.29,90,,103.43,,,0,"percent of total billed charges ","90% of total billed charges ",133.6,93,,106.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",122.11,85,,97.69,,,0,"percent of total billed charges ","85% of total billed charges ",129.29,90,,103.43,,,0,"percent of total billed charges ","90% of total billed charges ",129.29,90,,103.43,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",124.98,87,,99.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",100.56,70,,80.45,,,0,"percent of total billed charges ","70% of total billed charges ",100.56,133.6,
"CS INSERT SZ 4 10MM RT",6108857,"CDM ",278,RC,,,OUTPATIENT,,,94.99,75.992,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.99,80,,60.79,,,0,"percent of total billed charges ","80% of total billed charges ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",88.34,93,,70.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",80.74,85,,64.59,,,0,"percent of total billed charges ","85% of total billed charges ",85.49,90,,68.39,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.64,87,,66.11,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.49,70,,53.19,,,0,"percent of total billed charges ","70% of total billed charges ",66.49,88.34,
"HEMOSTAT SURGICEL POWDER 3.0G",6108865,"CDM ",270,RC,,,OUTPATIENT,,,381.44,305.152,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",305.15,80,,244.12,,,0,"percent of total billed charges ","80% of total billed charges ",267.01,70,,213.61,,,0,"percent of total billed charges ","70% of total billed charges ",343.3,90,,274.64,,,0,"percent of total billed charges ","90% of total billed charges ",354.74,93,,283.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",324.22,85,,259.38,,,0,"percent of total billed charges ","85% of total billed charges ",343.3,90,,274.64,,,0,"percent of total billed charges ","90% of total billed charges ",343.3,90,,274.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",331.85,87,,265.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",267.01,70,,213.61,,,0,"percent of total billed charges ","70% of total billed charges ",267.01,354.74,
"RETRACTOR CSECTION LG 9-14CM",6109108,"CDM ",272,RC,,,OUTPATIENT,,,290.63,232.504,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",232.5,80,,186.00,,,0,"percent of total billed charges ","80% of total billed charges ",203.44,70,,162.75,,,0,"percent of total billed charges ","70% of total billed charges ",261.57,90,,209.26,,,0,"percent of total billed charges ","90% of total billed charges ",270.29,93,,216.23,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",247.04,85,,197.63,,,0,"percent of total billed charges ","85% of total billed charges ",261.57,90,,209.26,,,0,"percent of total billed charges ","90% of total billed charges ",261.57,90,,209.26,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",252.85,87,,202.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",203.44,70,,162.75,,,0,"percent of total billed charges ","70% of total billed charges ",203.44,270.29,
"RETRACTOR CSECTION XLG 11-17CM",6109109,"CDM ",270,RC,,,OUTPATIENT,,,344.88,275.904,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",275.9,80,,220.72,,,0,"percent of total billed charges ","80% of total billed charges ",241.42,70,,193.14,,,0,"percent of total billed charges ","70% of total billed charges ",310.39,90,,248.31,,,0,"percent of total billed charges ","90% of total billed charges ",320.74,93,,256.59,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",293.15,85,,234.52,,,0,"percent of total billed charges ","85% of total billed charges ",310.39,90,,248.31,,,0,"percent of total billed charges ","90% of total billed charges ",310.39,90,,248.31,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",300.05,87,,240.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",241.42,70,,193.14,,,0,"percent of total billed charges ","70% of total billed charges ",241.42,320.74,
"VOYANT FUSION OPEN 13.5CM",6109251,"CDM ",270,RC,,,OUTPATIENT,,,862,689.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",689.6,80,,551.68,,,0,"percent of total billed charges ","80% of total billed charges ",603.4,70,,482.72,,,0,"percent of total billed charges ","70% of total billed charges ",775.8,90,,620.64,,,0,"percent of total billed charges ","90% of total billed charges ",801.66,93,,641.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",732.7,85,,586.16,,,0,"percent of total billed charges ","85% of total billed charges ",775.8,90,,620.64,,,0,"percent of total billed charges ","90% of total billed charges ",775.8,90,,620.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",749.94,87,,599.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",603.4,70,,482.72,,,0,"percent of total billed charges ","70% of total billed charges ",603.4,801.66,
"VOYANT FUSION 5MM X 37CM",6109252,"CDM ",270,RC,,,OUTPATIENT,,,862,689.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",689.6,80,,551.68,,,0,"percent of total billed charges ","80% of total billed charges ",603.4,70,,482.72,,,0,"percent of total billed charges ","70% of total billed charges ",775.8,90,,620.64,,,0,"percent of total billed charges ","90% of total billed charges ",801.66,93,,641.33,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",732.7,85,,586.16,,,0,"percent of total billed charges ","85% of total billed charges ",775.8,90,,620.64,,,0,"percent of total billed charges ","90% of total billed charges ",775.8,90,,620.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",749.94,87,,599.95,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",603.4,70,,482.72,,,0,"percent of total billed charges ","70% of total billed charges ",603.4,801.66,
"TROCAR 5X100 BLADELESS OPTICAL",6109253,"CDM ",270,RC,,,OUTPATIENT,,,62.24,49.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.79,80,,39.83,,,0,"percent of total billed charges ","80% of total billed charges ",43.57,70,,34.86,,,0,"percent of total billed charges ","70% of total billed charges ",56.02,90,,44.82,,,0,"percent of total billed charges ","90% of total billed charges ",57.88,93,,46.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",52.9,85,,42.32,,,0,"percent of total billed charges ","85% of total billed charges ",56.02,90,,44.82,,,0,"percent of total billed charges ","90% of total billed charges ",56.02,90,,44.82,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",54.15,87,,43.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.57,70,,34.86,,,0,"percent of total billed charges ","70% of total billed charges ",43.57,57.88,
"TROCAR 5X100 BLADELESS OPTICAL",6109254,"CDM ",270,RC,,,OUTPATIENT,,,17.73,14.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.18,80,,11.34,,,0,"percent of total billed charges ","80% of total billed charges ",12.41,70,,9.93,,,0,"percent of total billed charges ","70% of total billed charges ",15.96,90,,12.77,,,0,"percent of total billed charges ","90% of total billed charges ",16.49,93,,13.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.07,85,,12.06,,,0,"percent of total billed charges ","85% of total billed charges ",15.96,90,,12.77,,,0,"percent of total billed charges ","90% of total billed charges ",15.96,90,,12.77,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.43,87,,12.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.41,70,,9.93,,,0,"percent of total billed charges ","70% of total billed charges ",12.41,16.49,
"TROCAR 12X100 BLADELESS",6109255,"CDM ",270,RC,,,OUTPATIENT,,,28.16,22.528,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.53,80,,18.02,,,0,"percent of total billed charges ","80% of total billed charges ",19.71,70,,15.77,,,0,"percent of total billed charges ","70% of total billed charges ",25.34,90,,20.27,,,0,"percent of total billed charges ","90% of total billed charges ",26.19,93,,20.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.94,85,,19.15,,,0,"percent of total billed charges ","85% of total billed charges ",25.34,90,,20.27,,,0,"percent of total billed charges ","90% of total billed charges ",25.34,90,,20.27,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",24.5,87,,19.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.71,70,,15.77,,,0,"percent of total billed charges ","70% of total billed charges ",19.71,26.19,
"TROCAR 5X100 BLADED SHIELDED",6109256,"CDM ",270,RC,,,OUTPATIENT,,,17.73,14.184,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.18,80,,11.34,,,0,"percent of total billed charges ","80% of total billed charges ",12.41,70,,9.93,,,0,"percent of total billed charges ","70% of total billed charges ",15.96,90,,12.77,,,0,"percent of total billed charges ","90% of total billed charges ",16.49,93,,13.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.07,85,,12.06,,,0,"percent of total billed charges ","85% of total billed charges ",15.96,90,,12.77,,,0,"percent of total billed charges ","90% of total billed charges ",15.96,90,,12.77,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.43,87,,12.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.41,70,,9.93,,,0,"percent of total billed charges ","70% of total billed charges ",12.41,16.49,
"TROCAR BALLOON BLUNT TIP",6109257,"CDM ",270,RC,,,OUTPATIENT,,,28.16,22.528,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22.53,80,,18.02,,,0,"percent of total billed charges ","80% of total billed charges ",19.71,70,,15.77,,,0,"percent of total billed charges ","70% of total billed charges ",25.34,90,,20.27,,,0,"percent of total billed charges ","90% of total billed charges ",26.19,93,,20.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.94,85,,19.15,,,0,"percent of total billed charges ","85% of total billed charges ",25.34,90,,20.27,,,0,"percent of total billed charges ","90% of total billed charges ",25.34,90,,20.27,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",24.5,87,,19.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.71,70,,15.77,,,0,"percent of total billed charges ","70% of total billed charges ",19.71,26.19,
"SLEEVE KIT 5.100 OPTICAL",6109258,"CDM ",270,RC,,,OUTPATIENT,,,8.39,6.712,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.71,80,,5.37,,,0,"percent of total billed charges ","80% of total billed charges ",5.87,70,,4.70,,,0,"percent of total billed charges ","70% of total billed charges ",7.55,90,,6.04,,,0,"percent of total billed charges ","90% of total billed charges ",7.8,93,,6.24,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7.13,85,,5.70,,,0,"percent of total billed charges ","85% of total billed charges ",7.55,90,,6.04,,,0,"percent of total billed charges ","90% of total billed charges ",7.55,90,,6.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7.3,87,,5.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.87,70,,4.70,,,0,"percent of total billed charges ","70% of total billed charges ",5.87,7.8,
"CANNULA PEDIATRIC/ADULT SM",6109617,"CDM ",270,RC,,,OUTPATIENT,,,16.05,12.84,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.84,80,,10.27,,,0,"percent of total billed charges ","80% of total billed charges ",11.24,70,,8.99,,,0,"percent of total billed charges ","70% of total billed charges ",14.45,90,,11.56,,,0,"percent of total billed charges ","90% of total billed charges ",14.93,93,,11.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.64,85,,10.91,,,0,"percent of total billed charges ","85% of total billed charges ",14.45,90,,11.56,,,0,"percent of total billed charges ","90% of total billed charges ",14.45,90,,11.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.96,87,,11.17,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.24,70,,8.99,,,0,"percent of total billed charges ","70% of total billed charges ",11.24,14.93,
"CANNULA BUTTON 8MM X 2CM",6109621,"CDM ",270,RC,,,OUTPATIENT,,,142.24,113.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.79,80,,91.03,,,0,"percent of total billed charges ","80% of total billed charges ",99.57,70,,79.66,,,0,"percent of total billed charges ","70% of total billed charges ",128.02,90,,102.42,,,0,"percent of total billed charges ","90% of total billed charges ",132.28,93,,105.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",120.9,85,,96.72,,,0,"percent of total billed charges ","85% of total billed charges ",128.02,90,,102.42,,,0,"percent of total billed charges ","90% of total billed charges ",128.02,90,,102.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",123.75,87,,99.00,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.57,70,,79.66,,,0,"percent of total billed charges ","70% of total billed charges ",99.57,132.28,
"CANNULA BUTTON 8MM X 3CM",6109622,"CDM ",270,RC,,,OUTPATIENT,,,142.24,113.792,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.79,80,,91.03,,,0,"percent of total billed charges ","80% of total billed charges ",99.57,70,,79.66,,,0,"percent of total billed charges ","70% of total billed charges ",128.02,90,,102.42,,,0,"percent of total billed charges ","90% of total billed charges ",132.28,93,,105.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",120.9,85,,96.72,,,0,"percent of total billed charges ","85% of total billed charges ",128.02,90,,102.42,,,0,"percent of total billed charges ","90% of total billed charges ",128.02,90,,102.42,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",123.75,87,,99.00,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.57,70,,79.66,,,0,"percent of total billed charges ","70% of total billed charges ",99.57,132.28,
"TRAY CATH FOLEY 16FR NON-LATEX",6109653,"CDM ",270,RC,,,OUTPATIENT,,,60.9,48.72,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.72,80,,38.98,,,0,"percent of total billed charges ","80% of total billed charges ",42.63,70,,34.10,,,0,"percent of total billed charges ","70% of total billed charges ",54.81,90,,43.85,,,0,"percent of total billed charges ","90% of total billed charges ",56.64,93,,45.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51.77,85,,41.42,,,0,"percent of total billed charges ","85% of total billed charges ",54.81,90,,43.85,,,0,"percent of total billed charges ","90% of total billed charges ",54.81,90,,43.85,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",52.98,87,,42.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.63,70,,34.10,,,0,"percent of total billed charges ","70% of total billed charges ",42.63,56.64,
"DEVICE TROCHANTERIC W/CABLES",6109935,"CDM ",278,RC,,,OUTPATIENT,,,3529.72,2823.776,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2823.78,80,,2259.02,,,0,"percent of total billed charges ","80% of total billed charges ",2470.8,70,,1976.64,,,0,"percent of total billed charges ","70% of total billed charges ",3176.75,90,,2541.40,,,0,"percent of total billed charges ","90% of total billed charges ",3282.64,93,,2626.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3000.26,85,,2400.21,,,0,"percent of total billed charges ","85% of total billed charges ",3000.26,85,,2400.21,,,0,"percent of total billed charges ","85% of total billed charges ",3176.75,90,,2541.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3070.86,87,,2456.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2470.8,70,,1976.64,,,0,"percent of total billed charges ","70% of total billed charges ",2470.8,3282.64,
"CABLE W/CRIMP 1.7MM X 750MM",6109936,"CDM ",278,RC,,,OUTPATIENT,,,1054.44,843.552,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",843.55,80,,674.84,,,0,"percent of total billed charges ","80% of total billed charges ",738.11,70,,590.49,,,0,"percent of total billed charges ","70% of total billed charges ",949,90,,759.20,,,0,"percent of total billed charges ","90% of total billed charges ",980.63,93,,784.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",896.27,85,,717.02,,,0,"percent of total billed charges ","85% of total billed charges ",896.27,85,,717.02,,,0,"percent of total billed charges ","85% of total billed charges ",949,90,,759.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",917.36,87,,733.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",738.11,70,,590.49,,,0,"percent of total billed charges ","70% of total billed charges ",738.11,980.63,
"BLD FENESTRATED HELICAL 75MM",6109943,"CDM ",278,RC,,,OUTPATIENT,,,1449.73,1159.784,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1159.78,80,,927.82,,,0,"percent of total billed charges ","80% of total billed charges ",1014.81,70,,811.85,,,0,"percent of total billed charges ","70% of total billed charges ",1304.76,90,,1043.81,,,0,"percent of total billed charges ","90% of total billed charges ",1348.25,93,,1078.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1232.27,85,,985.82,,,0,"percent of total billed charges ","85% of total billed charges ",1232.27,85,,985.82,,,0,"percent of total billed charges ","85% of total billed charges ",1304.76,90,,1043.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1261.27,87,,1009.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1014.81,70,,811.85,,,0,"percent of total billed charges ","70% of total billed charges ",1014.81,1348.25,
"BLD FENESTRATED HELICAL 80MM",6109944,"CDM ",278,RC,,,OUTPATIENT,,,1449.73,1159.784,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1159.78,80,,927.82,,,0,"percent of total billed charges ","80% of total billed charges ",1014.81,70,,811.85,,,0,"percent of total billed charges ","70% of total billed charges ",1304.76,90,,1043.81,,,0,"percent of total billed charges ","90% of total billed charges ",1348.25,93,,1078.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1232.27,85,,985.82,,,0,"percent of total billed charges ","85% of total billed charges ",1232.27,85,,985.82,,,0,"percent of total billed charges ","85% of total billed charges ",1304.76,90,,1043.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1261.27,87,,1009.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1014.81,70,,811.85,,,0,"percent of total billed charges ","70% of total billed charges ",1014.81,1348.25,
"BLD FENESTRATED HELICAL 85MM",6109945,"CDM ",278,RC,,,OUTPATIENT,,,1449.73,1159.784,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1159.78,80,,927.82,,,0,"percent of total billed charges ","80% of total billed charges ",1014.81,70,,811.85,,,0,"percent of total billed charges ","70% of total billed charges ",1304.76,90,,1043.81,,,0,"percent of total billed charges ","90% of total billed charges ",1348.25,93,,1078.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1232.27,85,,985.82,,,0,"percent of total billed charges ","85% of total billed charges ",1232.27,85,,985.82,,,0,"percent of total billed charges ","85% of total billed charges ",1304.76,90,,1043.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1261.27,87,,1009.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1014.81,70,,811.85,,,0,"percent of total billed charges ","70% of total billed charges ",1014.81,1348.25,
"BLD FENESTRATED HELICAL 90MM",6109946,"CDM ",278,RC,,,OUTPATIENT,,,1449.73,1159.784,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1159.78,80,,927.82,,,0,"percent of total billed charges ","80% of total billed charges ",1014.81,70,,811.85,,,0,"percent of total billed charges ","70% of total billed charges ",1304.76,90,,1043.81,,,0,"percent of total billed charges ","90% of total billed charges ",1348.25,93,,1078.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1232.27,85,,985.82,,,0,"percent of total billed charges ","85% of total billed charges ",1232.27,85,,985.82,,,0,"percent of total billed charges ","85% of total billed charges ",1304.76,90,,1043.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1261.27,87,,1009.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1014.81,70,,811.85,,,0,"percent of total billed charges ","70% of total billed charges ",1014.81,1348.25,
"BLD FENESTRATED HELICAL 100MM",6109948,"CDM ",278,RC,,,OUTPATIENT,,,1449.73,1159.784,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1159.78,80,,927.82,,,0,"percent of total billed charges ","80% of total billed charges ",1014.81,70,,811.85,,,0,"percent of total billed charges ","70% of total billed charges ",1304.76,90,,1043.81,,,0,"percent of total billed charges ","90% of total billed charges ",1348.25,93,,1078.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1232.27,85,,985.82,,,0,"percent of total billed charges ","85% of total billed charges ",1232.27,85,,985.82,,,0,"percent of total billed charges ","85% of total billed charges ",1304.76,90,,1043.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1261.27,87,,1009.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1014.81,70,,811.85,,,0,"percent of total billed charges ","70% of total billed charges ",1014.81,1348.25,
"BLD FENESTRATED HELICAL 105MM",6109949,"CDM ",278,RC,,,OUTPATIENT,,,1449.73,1159.784,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1159.78,80,,927.82,,,0,"percent of total billed charges ","80% of total billed charges ",1014.81,70,,811.85,,,0,"percent of total billed charges ","70% of total billed charges ",1304.76,90,,1043.81,,,0,"percent of total billed charges ","90% of total billed charges ",1348.25,93,,1078.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1232.27,85,,985.82,,,0,"percent of total billed charges ","85% of total billed charges ",1232.27,85,,985.82,,,0,"percent of total billed charges ","85% of total billed charges ",1304.76,90,,1043.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1261.27,87,,1009.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1014.81,70,,811.85,,,0,"percent of total billed charges ","70% of total billed charges ",1014.81,1348.25,
"BLD FENESTRATED HELICAL 115MM",6109951,"CDM ",278,RC,,,OUTPATIENT,,,1449.73,1159.784,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1159.78,80,,927.82,,,0,"percent of total billed charges ","80% of total billed charges ",1014.81,70,,811.85,,,0,"percent of total billed charges ","70% of total billed charges ",1304.76,90,,1043.81,,,0,"percent of total billed charges ","90% of total billed charges ",1348.25,93,,1078.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1232.27,85,,985.82,,,0,"percent of total billed charges ","85% of total billed charges ",1232.27,85,,985.82,,,0,"percent of total billed charges ","85% of total billed charges ",1304.76,90,,1043.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1261.27,87,,1009.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1014.81,70,,811.85,,,0,"percent of total billed charges ","70% of total billed charges ",1014.81,1348.25,
"BLD FENESTRATED HELICAL 120MM",6109952,"CDM ",278,RC,,,OUTPATIENT,,,1449.73,1159.784,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1159.78,80,,927.82,,,0,"percent of total billed charges ","80% of total billed charges ",1014.81,70,,811.85,,,0,"percent of total billed charges ","70% of total billed charges ",1304.76,90,,1043.81,,,0,"percent of total billed charges ","90% of total billed charges ",1348.25,93,,1078.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1232.27,85,,985.82,,,0,"percent of total billed charges ","85% of total billed charges ",1232.27,85,,985.82,,,0,"percent of total billed charges ","85% of total billed charges ",1304.76,90,,1043.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1261.27,87,,1009.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1014.81,70,,811.85,,,0,"percent of total billed charges ","70% of total billed charges ",1014.81,1348.25,
"BLD FENESTRATED HELICAL 125MM",6109953,"CDM ",278,RC,,,OUTPATIENT,,,1449.73,1159.784,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1159.78,80,,927.82,,,0,"percent of total billed charges ","80% of total billed charges ",1014.81,70,,811.85,,,0,"percent of total billed charges ","70% of total billed charges ",1304.76,90,,1043.81,,,0,"percent of total billed charges ","90% of total billed charges ",1348.25,93,,1078.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1232.27,85,,985.82,,,0,"percent of total billed charges ","85% of total billed charges ",1232.27,85,,985.82,,,0,"percent of total billed charges ","85% of total billed charges ",1304.76,90,,1043.81,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1261.27,87,,1009.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1014.81,70,,811.85,,,0,"percent of total billed charges ","70% of total billed charges ",1014.81,1348.25,
"PIN CERCLAGE POSITIONING 4.5MM",6109959,"CDM ",278,RC,,,OUTPATIENT,,,394.37,315.496,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",315.5,80,,252.40,,,0,"percent of total billed charges ","80% of total billed charges ",276.06,70,,220.85,,,0,"percent of total billed charges ","70% of total billed charges ",354.93,90,,283.94,,,0,"percent of total billed charges ","90% of total billed charges ",366.76,93,,293.41,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",335.21,85,,268.17,,,0,"percent of total billed charges ","85% of total billed charges ",335.21,85,,268.17,,,0,"percent of total billed charges ","85% of total billed charges ",354.93,90,,283.94,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",343.1,87,,274.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",276.06,70,,220.85,,,0,"percent of total billed charges ","70% of total billed charges ",276.06,366.76,
"TENDON ACHILLES SHAPED BB",6109961,"CDM ",278,RC,,,OUTPATIENT,,,3553.72,2842.976,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2842.98,80,,2274.38,,,0,"percent of total billed charges ","80% of total billed charges ",2487.6,70,,1990.08,,,0,"percent of total billed charges ","70% of total billed charges ",3198.35,90,,2558.68,,,0,"percent of total billed charges ","90% of total billed charges ",3304.96,93,,2643.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3020.66,85,,2416.53,,,0,"percent of total billed charges ","85% of total billed charges ",3020.66,85,,2416.53,,,0,"percent of total billed charges ","85% of total billed charges ",3198.35,90,,2558.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3091.74,87,,2473.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2487.6,70,,1990.08,,,0,"percent of total billed charges ","70% of total billed charges ",2487.6,3304.96,
"NEEDLE JAMSHIDI 11GA X 6""",6109962,"CDM ",272,RC,,,OUTPATIENT,,,72.26,57.808,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.81,80,,46.25,,,0,"percent of total billed charges ","80% of total billed charges ",50.58,70,,40.46,,,0,"percent of total billed charges ","70% of total billed charges ",65.03,90,,52.02,,,0,"percent of total billed charges ","90% of total billed charges ",67.2,93,,53.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",61.42,85,,49.14,,,0,"percent of total billed charges ","85% of total billed charges ",65.03,90,,52.02,,,0,"percent of total billed charges ","90% of total billed charges ",65.03,90,,52.02,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",62.87,87,,50.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.58,70,,40.46,,,0,"percent of total billed charges ","70% of total billed charges ",50.58,67.2,
"APPLICATOR SURGICEL ENDOSCOPIC",6109968,"CDM ",270,RC,,,OUTPATIENT,,,79.57,63.656,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.66,80,,50.93,,,0,"percent of total billed charges ","80% of total billed charges ",55.7,70,,44.56,,,0,"percent of total billed charges ","70% of total billed charges ",71.61,90,,57.29,,,0,"percent of total billed charges ","90% of total billed charges ",74,93,,59.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",67.63,85,,54.10,,,0,"percent of total billed charges ","85% of total billed charges ",71.61,90,,57.29,,,0,"percent of total billed charges ","90% of total billed charges ",71.61,90,,57.29,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",69.23,87,,55.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.7,70,,44.56,,,0,"percent of total billed charges ","70% of total billed charges ",55.7,74,
"SUTR STRATAFIX 2-0 SYM PDS",6109969,"CDM ",270,RC,,,OUTPATIENT,,,87.96,70.368,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.37,80,,56.30,,,0,"percent of total billed charges ","80% of total billed charges ",61.57,70,,49.26,,,0,"percent of total billed charges ","70% of total billed charges ",79.16,90,,63.33,,,0,"percent of total billed charges ","90% of total billed charges ",81.8,93,,65.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",74.77,85,,59.82,,,0,"percent of total billed charges ","85% of total billed charges ",79.16,90,,63.33,,,0,"percent of total billed charges ","90% of total billed charges ",79.16,90,,63.33,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",76.53,87,,61.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.57,70,,49.26,,,0,"percent of total billed charges ","70% of total billed charges ",61.57,81.8,
"LMA GASTRO CUFF PILOT SZ 4",6109971,"CDM ",270,RC,,,OUTPATIENT,,,158.77,127.016,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.02,80,,101.62,,,0,"percent of total billed charges ","80% of total billed charges ",111.14,70,,88.91,,,0,"percent of total billed charges ","70% of total billed charges ",142.89,90,,114.31,,,0,"percent of total billed charges ","90% of total billed charges ",147.66,93,,118.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",134.95,85,,107.96,,,0,"percent of total billed charges ","85% of total billed charges ",142.89,90,,114.31,,,0,"percent of total billed charges ","90% of total billed charges ",142.89,90,,114.31,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",138.13,87,,110.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.14,70,,88.91,,,0,"percent of total billed charges ","70% of total billed charges ",111.14,147.66,
"LMA GASTRO CUFF PILOT SZ 5",6109972,"CDM ",270,RC,,,OUTPATIENT,,,158.78,127.024,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",127.02,80,,101.62,,,0,"percent of total billed charges ","80% of total billed charges ",111.15,70,,88.92,,,0,"percent of total billed charges ","70% of total billed charges ",142.9,90,,114.32,,,0,"percent of total billed charges ","90% of total billed charges ",147.67,93,,118.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",134.96,85,,107.97,,,0,"percent of total billed charges ","85% of total billed charges ",142.9,90,,114.32,,,0,"percent of total billed charges ","90% of total billed charges ",142.9,90,,114.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",138.14,87,,110.51,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",111.15,70,,88.92,,,0,"percent of total billed charges ","70% of total billed charges ",111.15,147.67,
"FLIPCUTTER III DRILL",6109973,"CDM ",270,RC,,,OUTPATIENT,,,894.33,715.464,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",715.46,80,,572.37,,,0,"percent of total billed charges ","80% of total billed charges ",626.03,70,,500.82,,,0,"percent of total billed charges ","70% of total billed charges ",804.9,90,,643.92,,,0,"percent of total billed charges ","90% of total billed charges ",831.73,93,,665.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",760.18,85,,608.14,,,0,"percent of total billed charges ","85% of total billed charges ",804.9,90,,643.92,,,0,"percent of total billed charges ","90% of total billed charges ",804.9,90,,643.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",778.07,87,,622.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",626.03,70,,500.82,,,0,"percent of total billed charges ","70% of total billed charges ",626.03,831.73,
"FIBERTAK DR WH/BLK TT W/G/BLK",6110001,"CDM ",278,RC,,,OUTPATIENT,,,969.75,775.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",775.8,80,,620.64,,,0,"percent of total billed charges ","80% of total billed charges ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",901.87,93,,721.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",843.68,87,,674.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",678.83,901.87,
"FIBERTAK DR WH/BLK TT WH/BLK",6110002,"CDM ",278,RC,,,OUTPATIENT,,,969.75,775.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",775.8,80,,620.64,,,0,"percent of total billed charges ","80% of total billed charges ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",901.87,93,,721.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",824.29,85,,659.43,,,0,"percent of total billed charges ","85% of total billed charges ",872.78,90,,698.22,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",843.68,87,,674.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",678.83,70,,543.06,,,0,"percent of total billed charges ","70% of total billed charges ",678.83,901.87,
"ACETAMINOPH SUPP 2GR",7000151,"CDM ",637,RC,,,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,80,,8.00,,,0,"percent of total billed charges ","80% of total billed charges ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"AFRIN 0.05% NAS SPR",7000573,"CDM ",637,RC,,,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.2,80,,24.96,,,0,"percent of total billed charges ","80% of total billed charges ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"ALCAINE 0.5% 15ML",7000615,"CDM ",250,RC,,,OUTPATIENT,,,96,76.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.8,80,,61.44,,,0,"percent of total billed charges ","80% of total billed charges ",67.2,70,,53.76,,,0,"percent of total billed charges ","70% of total billed charges ",86.4,90,,69.12,,,0,"percent of total billed charges ","90% of total billed charges ",89.28,93,,71.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",81.6,85,,65.28,,,0,"percent of total billed charges ","85% of total billed charges ",86.4,90,,69.12,,,0,"percent of total billed charges ","90% of total billed charges ",86.4,90,,69.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",83.52,87,,66.82,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.2,70,,53.76,,,0,"percent of total billed charges ","70% of total billed charges ",67.2,89.28,
"ANTILIRIUM-INJ 1MG/ML 2ML",7001449,"CDM ",250,RC,,,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.4,80,,30.72,,,0,"percent of total billed charges ","80% of total billed charges ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",33.6,44.64,
"ANUSOL HC SUPP",7001530,"CDM ",637,RC,,,OUTPATIENT,,,35,28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28,80,,22.40,,,0,"percent of total billed charges ","80% of total billed charges ",24.5,70,,19.60,,,0,"percent of total billed charges ","70% of total billed charges ",31.5,90,,25.20,,,0,"percent of total billed charges ","90% of total billed charges ",32.55,93,,26.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",29.75,85,,23.80,,,0,"percent of total billed charges ","85% of total billed charges ",31.5,90,,25.20,,,0,"percent of total billed charges ","90% of total billed charges ",31.5,90,,25.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.45,87,,24.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.5,70,,19.60,,,0,"percent of total billed charges ","70% of total billed charges ",24.5,32.55,
"ANUSOL HC CREAM OZ",7001548,"CDM ",637,RC,,,OUTPATIENT,,,232,185.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",185.6,80,,148.48,,,0,"percent of total billed charges ","80% of total billed charges ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",215.76,93,,172.61,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",197.2,85,,157.76,,,0,"percent of total billed charges ","85% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",208.8,90,,167.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",201.84,87,,161.47,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",162.4,70,,129.92,,,0,"percent of total billed charges ","70% of total billed charges ",162.4,215.76,
"AMMONIA INHALANTS",7001936,"CDM ",250,RC,,,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,80,,8.00,,,0,"percent of total billed charges ","80% of total billed charges ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"ASPIRIN 300MG SUPP",7002173,"CDM ",637,RC,,,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,80,,8.00,,,0,"percent of total billed charges ","80% of total billed charges ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"BACITRACIN OINT TUBE 30GM",7002561,"CDM ",637,RC,,,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.2,80,,24.96,,,0,"percent of total billed charges ","80% of total billed charges ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"BEN-GAY OINT TUBE 28 GM",7002850,"CDM ",637,RC,,,OUTPATIENT,,,15,12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12,80,,9.60,,,0,"percent of total billed charges ","80% of total billed charges ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.95,93,,11.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.75,85,,10.20,,,0,"percent of total billed charges ","85% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.05,87,,10.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",10.5,13.95,
"CAFF/SOD/BENZ 500MG 2ML VIAL",7003494,"CDM ",250,RC,,,OUTPATIENT,,,52.5,42,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42,80,,33.60,,,0,"percent of total billed charges ","80% of total billed charges ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",48.83,93,,39.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",44.63,85,,35.70,,,0,"percent of total billed charges ","85% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",45.68,87,,36.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",36.75,48.83,
"CALAMIN LOTION 4 OZ",7003510,"CDM ",637,RC,,,OUTPATIENT,,,16,12.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.8,80,,10.24,,,0,"percent of total billed charges ","80% of total billed charges ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.88,93,,11.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.6,85,,10.88,,,0,"percent of total billed charges ","85% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.92,87,,11.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,14.88,
"CLONAZEPAM ODT 0.125MG",7004392,"CDM ",637,RC,,,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.6,80,,7.68,,,0,"percent of total billed charges ","80% of total billed charges ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"CORTISPORIN OTIC SOLN 10ML",7004997,"CDM ",637,RC,,,OUTPATIENT,,,149,119.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",119.2,80,,95.36,,,0,"percent of total billed charges ","80% of total billed charges ",104.3,70,,83.44,,,0,"percent of total billed charges ","70% of total billed charges ",134.1,90,,107.28,,,0,"percent of total billed charges ","90% of total billed charges ",138.57,93,,110.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",126.65,85,,101.32,,,0,"percent of total billed charges ","85% of total billed charges ",134.1,90,,107.28,,,0,"percent of total billed charges ","90% of total billed charges ",134.1,90,,107.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",129.63,87,,103.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.3,70,,83.44,,,0,"percent of total billed charges ","70% of total billed charges ",104.3,138.57,
"DERMOPLAST AERO 60GM CAN",7006034,"CDM ",637,RC,,,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.2,80,,24.96,,,0,"percent of total billed charges ","80% of total billed charges ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"DEXTROSE 50%ABOJECT",7006166,"CDM ",250,RC,,,OUTPATIENT,,,52,41.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.6,80,,33.28,,,0,"percent of total billed charges ","80% of total billed charges ",36.4,70,,29.12,,,0,"percent of total billed charges ","70% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",48.36,93,,38.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",44.2,85,,35.36,,,0,"percent of total billed charges ","85% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",46.8,90,,37.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",45.24,87,,36.19,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.4,70,,29.12,,,0,"percent of total billed charges ","70% of total billed charges ",36.4,48.36,
"BISACODYL 10MG SUPP",7007016,"CDM ",637,RC,,,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.6,80,,4.48,,,0,"percent of total billed charges ","80% of total billed charges ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"EDECRIN IV 50MG VIAL",7007164,"CDM ",250,RC,,,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.4,80,,30.72,,,0,"percent of total billed charges ","80% of total billed charges ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",33.6,44.64,
"EPHEDRINE AMP 50MG/ML 1ML",7007545,"CDM ",250,RC,,,OUTPATIENT,,,49.5,39.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.6,80,,31.68,,,0,"percent of total billed charges ","80% of total billed charges ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",46.04,93,,36.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.08,85,,33.66,,,0,"percent of total billed charges ","85% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.07,87,,34.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,46.04,
"EPHEDRINE 25MG 5ML 5YR",7007546,"CDM ",250,RC,,,OUTPATIENT,,,57.5,46,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46,80,,36.80,,,0,"percent of total billed charges ","80% of total billed charges ",40.25,70,,32.20,,,0,"percent of total billed charges ","70% of total billed charges ",51.75,90,,41.40,,,0,"percent of total billed charges ","90% of total billed charges ",53.48,93,,42.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",48.88,85,,39.10,,,0,"percent of total billed charges ","85% of total billed charges ",51.75,90,,41.40,,,0,"percent of total billed charges ","90% of total billed charges ",51.75,90,,41.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",50.03,87,,40.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.25,70,,32.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.25,53.48,
"ETHYL CHLOR PER USE",7007859,"CDM ",250,RC,,,OUTPATIENT,,,68.5,54.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.8,80,,43.84,,,0,"percent of total billed charges ","80% of total billed charges ",47.95,70,,38.36,,,0,"percent of total billed charges ","70% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",63.71,93,,50.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",58.23,85,,46.58,,,0,"percent of total billed charges ","85% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",61.65,90,,49.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",59.6,87,,47.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.95,70,,38.36,,,0,"percent of total billed charges ","70% of total billed charges ",47.95,63.71,
"EUCERIN CR 120GM",7007909,"CDM ",637,RC,,,OUTPATIENT,,,24,19.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.2,80,,15.36,,,0,"percent of total billed charges ","80% of total billed charges ",16.8,70,,13.44,,,0,"percent of total billed charges ","70% of total billed charges ",21.6,90,,17.28,,,0,"percent of total billed charges ","90% of total billed charges ",22.32,93,,17.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",20.4,85,,16.32,,,0,"percent of total billed charges ","85% of total billed charges ",21.6,90,,17.28,,,0,"percent of total billed charges ","90% of total billed charges ",21.6,90,,17.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.88,87,,16.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.8,70,,13.44,,,0,"percent of total billed charges ","70% of total billed charges ",16.8,22.32,
"EYE STREAM OPTH SOLU",7007941,"CDM ",637,RC,,,OUTPATIENT,,,15,12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12,80,,9.60,,,0,"percent of total billed charges ","80% of total billed charges ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.95,93,,11.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.75,85,,10.20,,,0,"percent of total billed charges ","85% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.05,87,,10.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",10.5,13.95,
"FLEET ENEMA",7008154,"CDM ",250,RC,,,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.6,80,,4.48,,,0,"percent of total billed charges ","80% of total billed charges ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"FLEET CHILD ENEMA",7008162,"CDM ",250,RC,,,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.8,80,,8.64,,,0,"percent of total billed charges ","80% of total billed charges ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"FLEET OIL ENEMA",7008170,"CDM ",250,RC,,,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.2,80,,24.96,,,0,"percent of total billed charges ","80% of total billed charges ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
FLUOR-I-STRIPS,7008253,"CDM ",637,RC,,,OUTPATIENT,,,11,8.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.8,80,,7.04,,,0,"percent of total billed charges ","80% of total billed charges ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",10.23,93,,8.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.35,85,,7.48,,,0,"percent of total billed charges ","85% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.57,87,,7.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.7,10.23,
"GARAMYCIN OPTH OINT 0.3% 3.5GM",7008717,"CDM ",637,RC,,,OUTPATIENT,,,63,50.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.4,80,,40.32,,,0,"percent of total billed charges ","80% of total billed charges ",44.1,70,,35.28,,,0,"percent of total billed charges ","70% of total billed charges ",56.7,90,,45.36,,,0,"percent of total billed charges ","90% of total billed charges ",58.59,93,,46.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",53.55,85,,42.84,,,0,"percent of total billed charges ","85% of total billed charges ",56.7,90,,45.36,,,0,"percent of total billed charges ","90% of total billed charges ",56.7,90,,45.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",54.81,87,,43.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.1,70,,35.28,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,58.59,
"GELFOAM SPONGES #100",7008782,"CDM ",637,RC,,,OUTPATIENT,,,109.5,87.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.6,80,,70.08,,,0,"percent of total billed charges ","80% of total billed charges ",76.65,70,,61.32,,,0,"percent of total billed charges ","70% of total billed charges ",98.55,90,,78.84,,,0,"percent of total billed charges ","90% of total billed charges ",101.84,93,,81.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",93.08,85,,74.46,,,0,"percent of total billed charges ","85% of total billed charges ",98.55,90,,78.84,,,0,"percent of total billed charges ","90% of total billed charges ",98.55,90,,78.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",95.27,87,,76.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.65,70,,61.32,,,0,"percent of total billed charges ","70% of total billed charges ",76.65,101.84,
"GLYCERIN ADULT SUPP",7008998,"CDM ",637,RC,,,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.6,80,,4.48,,,0,"percent of total billed charges ","80% of total billed charges ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"HEPARIN 1000U/ML CHG PER ML",7009244,"CDM ",636,RC,,,OUTPATIENT,,,52.5,42,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42,80,,33.60,,,0,"percent of total billed charges ","80% of total billed charges ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",48.83,93,,39.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",44.63,85,,35.70,,,0,"percent of total billed charges ","85% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",47.25,90,,37.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",45.68,87,,36.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.75,70,,29.40,,,0,"percent of total billed charges ","70% of total billed charges ",36.75,48.83,
"HYDROGEN PEROXIDE 480ML 3%",7009517,"CDM ",250,RC,,,OUTPATIENT,,,15,12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12,80,,9.60,,,0,"percent of total billed charges ","80% of total billed charges ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.95,93,,11.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.75,85,,10.20,,,0,"percent of total billed charges ","85% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.05,87,,10.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",10.5,13.95,
"ISOPTO TEARS 0.5% 15ML",7010143,"CDM ",637,RC,,,OUTPATIENT,,,63.5,50.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.8,80,,40.64,,,0,"percent of total billed charges ","80% of total billed charges ",44.45,70,,35.56,,,0,"percent of total billed charges ","70% of total billed charges ",57.15,90,,45.72,,,0,"percent of total billed charges ","90% of total billed charges ",59.06,93,,47.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",53.98,85,,43.18,,,0,"percent of total billed charges ","85% of total billed charges ",57.15,90,,45.72,,,0,"percent of total billed charges ","90% of total billed charges ",57.15,90,,45.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",55.25,87,,44.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.45,70,,35.56,,,0,"percent of total billed charges ","70% of total billed charges ",44.45,59.06,
"KETALAR 50MG/CC INJ",7010754,"CDM ",250,RC,,,OUTPATIENT,,,54.5,43.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.6,80,,34.88,,,0,"percent of total billed charges ","80% of total billed charges ",38.15,70,,30.52,,,0,"percent of total billed charges ","70% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",50.69,93,,40.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",46.33,85,,37.06,,,0,"percent of total billed charges ","85% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",49.05,90,,39.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",47.42,87,,37.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.15,70,,30.52,,,0,"percent of total billed charges ","70% of total billed charges ",38.15,50.69,
"LACRI-LUBE 3.5 GM OINT",7010887,"CDM ",250,RC,,,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.2,80,,24.96,,,0,"percent of total billed charges ","80% of total billed charges ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"LEVOPHED 1MG/ML 4ML INJ",7011208,"CDM ",250,RC,,,OUTPATIENT,,,49.5,39.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.6,80,,31.68,,,0,"percent of total billed charges ","80% of total billed charges ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",46.04,93,,36.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.08,85,,33.66,,,0,"percent of total billed charges ","85% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.07,87,,34.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,46.04,
"NOREDINEPHRINE NS 8MG 250ML BA",7011210,"CDM ",258,RC,,,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,100.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"EPINEPHRIN 2MG 250ML PREMX BAG",7011211,"CDM ",250,RC,,,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92,80,,73.60,,,0,"percent of total billed charges ","80% of total billed charges ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",80.5,106.95,
"NOREPI PREMIX 16MG 250ML BAG",7011212,"CDM ",250,RC,,,OUTPATIENT,,,145,116,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",116,80,,92.80,,,0,"percent of total billed charges ","80% of total billed charges ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",134.85,93,,107.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",123.25,85,,98.60,,,0,"percent of total billed charges ","85% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",130.5,90,,104.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",126.15,87,,100.92,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.5,70,,81.20,,,0,"percent of total billed charges ","70% of total billed charges ",101.5,134.85,
"LIDEX OIN 0.05% 15GM",7011281,"CDM ",637,RC,,,OUTPATIENT,,,147,117.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.6,80,,94.08,,,0,"percent of total billed charges ","80% of total billed charges ",102.9,70,,82.32,,,0,"percent of total billed charges ","70% of total billed charges ",132.3,90,,105.84,,,0,"percent of total billed charges ","90% of total billed charges ",136.71,93,,109.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",124.95,85,,99.96,,,0,"percent of total billed charges ","85% of total billed charges ",132.3,90,,105.84,,,0,"percent of total billed charges ","90% of total billed charges ",132.3,90,,105.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",127.89,87,,102.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.9,70,,82.32,,,0,"percent of total billed charges ","70% of total billed charges ",102.9,136.71,
"MAXITROL OPT SOL 0.1% 5ML",7011935,"CDM ",637,RC,,,OUTPATIENT,,,127,101.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",101.6,80,,81.28,,,0,"percent of total billed charges ","80% of total billed charges ",88.9,70,,71.12,,,0,"percent of total billed charges ","70% of total billed charges ",114.3,90,,91.44,,,0,"percent of total billed charges ","90% of total billed charges ",118.11,93,,94.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",107.95,85,,86.36,,,0,"percent of total billed charges ","85% of total billed charges ",114.3,90,,91.44,,,0,"percent of total billed charges ","90% of total billed charges ",114.3,90,,91.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",110.49,87,,88.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",88.9,70,,71.12,,,0,"percent of total billed charges ","70% of total billed charges ",88.9,118.11,
"MYCOSTATIN POWDER",7012859,"CDM ",637,RC,,,OUTPATIENT,,,79.5,63.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.6,80,,50.88,,,0,"percent of total billed charges ","80% of total billed charges ",55.65,70,,44.52,,,0,"percent of total billed charges ","70% of total billed charges ",71.55,90,,57.24,,,0,"percent of total billed charges ","90% of total billed charges ",73.94,93,,59.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",67.58,85,,54.06,,,0,"percent of total billed charges ","85% of total billed charges ",71.55,90,,57.24,,,0,"percent of total billed charges ","90% of total billed charges ",71.55,90,,57.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",69.17,87,,55.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.65,70,,44.52,,,0,"percent of total billed charges ","70% of total billed charges ",55.65,73.94,
"NEOSPORIN OPTH OINT 35GM",7013618,"CDM ",637,RC,,,OUTPATIENT,,,41.5,33.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.2,80,,26.56,,,0,"percent of total billed charges ","80% of total billed charges ",29.05,70,,23.24,,,0,"percent of total billed charges ","70% of total billed charges ",37.35,90,,29.88,,,0,"percent of total billed charges ","90% of total billed charges ",38.6,93,,30.88,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",35.28,85,,28.22,,,0,"percent of total billed charges ","85% of total billed charges ",37.35,90,,29.88,,,0,"percent of total billed charges ","90% of total billed charges ",37.35,90,,29.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",36.11,87,,28.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.05,70,,23.24,,,0,"percent of total billed charges ","70% of total billed charges ",29.05,38.6,
"NEOSPORIN OINTMENT",7013634,"CDM ",637,RC,,,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.2,80,,24.96,,,0,"percent of total billed charges ","80% of total billed charges ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"NEO-SYNEPHRINE 0.5% SPRAY 15ML",7013675,"CDM ",637,RC,,,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.2,80,,24.96,,,0,"percent of total billed charges ","80% of total billed charges ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"NEO-SYNEP NA 0.25% 15ML SYR",7013709,"CDM ",637,RC,,,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.2,80,,24.96,,,0,"percent of total billed charges ","80% of total billed charges ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"PHENERGAN SUPP 25MG",7015324,"CDM ",637,RC,,,OUTPATIENT,,,42,33.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,80,,26.88,,,0,"percent of total billed charges ","80% of total billed charges ",29.4,70,,23.52,,,0,"percent of total billed charges ","70% of total billed charges ",37.8,90,,30.24,,,0,"percent of total billed charges ","90% of total billed charges ",39.06,93,,31.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",35.7,85,,28.56,,,0,"percent of total billed charges ","85% of total billed charges ",37.8,90,,30.24,,,0,"percent of total billed charges ","90% of total billed charges ",37.8,90,,30.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",36.54,87,,29.23,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.4,70,,23.52,,,0,"percent of total billed charges ","70% of total billed charges ",29.4,39.06,
"PREMARIN VAG CREAM 45GM",7016165,"CDM ",637,RC,,,OUTPATIENT,,,423.5,338.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",338.8,80,,271.04,,,0,"percent of total billed charges ","80% of total billed charges ",296.45,70,,237.16,,,0,"percent of total billed charges ","70% of total billed charges ",381.15,90,,304.92,,,0,"percent of total billed charges ","90% of total billed charges ",393.86,93,,315.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",359.98,85,,287.98,,,0,"percent of total billed charges ","85% of total billed charges ",381.15,90,,304.92,,,0,"percent of total billed charges ","90% of total billed charges ",381.15,90,,304.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",368.45,87,,294.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",296.45,70,,237.16,,,0,"percent of total billed charges ","70% of total billed charges ",296.45,393.86,
"PREPARATION H SUPP EACH",7016173,"CDM ",637,RC,,,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.6,80,,7.68,,,0,"percent of total billed charges ","80% of total billed charges ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"SCOPOLAMINE 0.4MG/ML 1ML VIAL",7017304,"CDM ",250,RC,,,OUTPATIENT,,,20.5,16.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.4,80,,13.12,,,0,"percent of total billed charges ","80% of total billed charges ",14.35,70,,11.48,,,0,"percent of total billed charges ","70% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",19.07,93,,15.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.43,85,,13.94,,,0,"percent of total billed charges ","85% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.84,87,,14.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.35,70,,11.48,,,0,"percent of total billed charges ","70% of total billed charges ",14.35,19.07,
"SILVER NITRAT APPLIC",7017635,"CDM ",250,RC,,,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,80,,8.00,,,0,"percent of total billed charges ","80% of total billed charges ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"SOD BICARB 7.5%50MLS",7017775,"CDM ",250,RC,,,OUTPATIENT,,,44,35.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.2,80,,28.16,,,0,"percent of total billed charges ","80% of total billed charges ",30.8,70,,24.64,,,0,"percent of total billed charges ","70% of total billed charges ",39.6,90,,31.68,,,0,"percent of total billed charges ","90% of total billed charges ",40.92,93,,32.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",37.4,85,,29.92,,,0,"percent of total billed charges ","85% of total billed charges ",39.6,90,,31.68,,,0,"percent of total billed charges ","90% of total billed charges ",39.6,90,,31.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",38.28,87,,30.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.8,70,,24.64,,,0,"percent of total billed charges ","70% of total billed charges ",30.8,40.92,
"SOD BICARB 50MEQ 50ML SYRINGE",7017776,"CDM ",250,RC,,,OUTPATIENT,,,64.5,51.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.6,80,,41.28,,,0,"percent of total billed charges ","80% of total billed charges ",45.15,70,,36.12,,,0,"percent of total billed charges ","70% of total billed charges ",58.05,90,,46.44,,,0,"percent of total billed charges ","90% of total billed charges ",59.99,93,,47.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",54.83,85,,43.86,,,0,"percent of total billed charges ","85% of total billed charges ",58.05,90,,46.44,,,0,"percent of total billed charges ","90% of total billed charges ",58.05,90,,46.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",56.12,87,,44.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.15,70,,36.12,,,0,"percent of total billed charges ","70% of total billed charges ",45.15,59.99,
"SODIUM CHL100 MEQ-IN",7017791,"CDM ",250,RC,,,OUTPATIENT,,,40,32,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32,80,,25.60,,,0,"percent of total billed charges ","80% of total billed charges ",28,70,,22.40,,,0,"percent of total billed charges ","70% of total billed charges ",36,90,,28.80,,,0,"percent of total billed charges ","90% of total billed charges ",37.2,93,,29.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34,85,,27.20,,,0,"percent of total billed charges ","85% of total billed charges ",36,90,,28.80,,,0,"percent of total billed charges ","90% of total billed charges ",36,90,,28.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",34.8,87,,27.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28,70,,22.40,,,0,"percent of total billed charges ","70% of total billed charges ",28,37.2,
"SODIUM NITRITE 300MG 10ML VIAL",7017792,"CDM ",250,RC,,,OUTPATIENT,,,152,121.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",121.6,80,,97.28,,,0,"percent of total billed charges ","80% of total billed charges ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",141.36,93,,113.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",129.2,85,,103.36,,,0,"percent of total billed charges ","85% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",136.8,90,,109.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",132.24,87,,105.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.4,70,,85.12,,,0,"percent of total billed charges ","70% of total billed charges ",106.4,141.36,
"SURGICEL PAD 2X14 EACH",7018534,"CDM ",250,RC,,,OUTPATIENT,,,186,148.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.8,80,,119.04,,,0,"percent of total billed charges ","80% of total billed charges ",130.2,70,,104.16,,,0,"percent of total billed charges ","70% of total billed charges ",167.4,90,,133.92,,,0,"percent of total billed charges ","90% of total billed charges ",172.98,93,,138.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",158.1,85,,126.48,,,0,"percent of total billed charges ","85% of total billed charges ",167.4,90,,133.92,,,0,"percent of total billed charges ","90% of total billed charges ",167.4,90,,133.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",161.82,87,,129.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",130.2,70,,104.16,,,0,"percent of total billed charges ","70% of total billed charges ",130.2,172.98,
"TIGAN (100MG/ML) 200MG",7019698,"CDM ",250,RC,,,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.4,80,,30.72,,,0,"percent of total billed charges ","80% of total billed charges ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",33.6,44.64,
"TIMOPTIC 0.25% 5ML",7019730,"CDM ",637,RC,,,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.4,80,,30.72,,,0,"percent of total billed charges ","80% of total billed charges ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",33.6,44.64,
"VASELINE WHITE",7020837,"CDM ",637,RC,,,OUTPATIENT,,,15,12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12,80,,9.60,,,0,"percent of total billed charges ","80% of total billed charges ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.95,93,,11.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.75,85,,10.20,,,0,"percent of total billed charges ","85% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.05,87,,10.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",10.5,13.95,
"XYLOCAINE 2% JELL 30CC TU",7021660,"CDM ",250,RC,,,OUTPATIENT,,,53,42.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.4,80,,33.92,,,0,"percent of total billed charges ","80% of total billed charges ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",49.29,93,,39.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",45.05,85,,36.04,,,0,"percent of total billed charges ","85% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",46.11,87,,36.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",37.1,49.29,
"XYLOCAINE 5% OINT",7021686,"CDM ",637,RC,,,OUTPATIENT,,,287.5,230,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",230,80,,184.00,,,0,"percent of total billed charges ","80% of total billed charges ",201.25,70,,161.00,,,0,"percent of total billed charges ","70% of total billed charges ",258.75,90,,207.00,,,0,"percent of total billed charges ","90% of total billed charges ",267.38,93,,213.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",244.38,85,,195.50,,,0,"percent of total billed charges ","85% of total billed charges ",258.75,90,,207.00,,,0,"percent of total billed charges ","90% of total billed charges ",258.75,90,,207.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",250.13,87,,200.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",201.25,70,,161.00,,,0,"percent of total billed charges ","70% of total billed charges ",201.25,267.38,
"MVI - 12 10ML",7022049,"CDM ",250,RC,,,OUTPATIENT,,,64.5,51.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.6,80,,41.28,,,0,"percent of total billed charges ","80% of total billed charges ",45.15,70,,36.12,,,0,"percent of total billed charges ","70% of total billed charges ",58.05,90,,46.44,,,0,"percent of total billed charges ","90% of total billed charges ",59.99,93,,47.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",54.83,85,,43.86,,,0,"percent of total billed charges ","85% of total billed charges ",58.05,90,,46.44,,,0,"percent of total billed charges ","90% of total billed charges ",58.05,90,,46.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",56.12,87,,44.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.15,70,,36.12,,,0,"percent of total billed charges ","70% of total billed charges ",45.15,59.99,
"DANTRIUM 20MG VIAL",7022148,"CDM ",250,RC,,,OUTPATIENT,,,218.5,174.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",174.8,80,,139.84,,,0,"percent of total billed charges ","80% of total billed charges ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",203.21,93,,162.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",185.73,85,,148.58,,,0,"percent of total billed charges ","85% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",196.65,90,,157.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",190.1,87,,152.08,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",152.95,70,,122.36,,,0,"percent of total billed charges ","70% of total billed charges ",152.95,203.21,
"FML LIQUIFILM OP SOL 5ML 0.1%",7022288,"CDM ",250,RC,,,OUTPATIENT,,,84,67.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",67.2,80,,53.76,,,0,"percent of total billed charges ","80% of total billed charges ",58.8,70,,47.04,,,0,"percent of total billed charges ","70% of total billed charges ",75.6,90,,60.48,,,0,"percent of total billed charges ","90% of total billed charges ",78.12,93,,62.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",71.4,85,,57.12,,,0,"percent of total billed charges ","85% of total billed charges ",75.6,90,,60.48,,,0,"percent of total billed charges ","90% of total billed charges ",75.6,90,,60.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",73.08,87,,58.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.8,70,,47.04,,,0,"percent of total billed charges ","70% of total billed charges ",58.8,78.12,
"PREPARAT H OINT 30GM",7023260,"CDM ",637,RC,,,OUTPATIENT,,,25,20,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20,80,,16.00,,,0,"percent of total billed charges ","80% of total billed charges ",17.5,70,,14.00,,,0,"percent of total billed charges ","70% of total billed charges ",22.5,90,,18.00,,,0,"percent of total billed charges ","90% of total billed charges ",23.25,93,,18.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.25,85,,17.00,,,0,"percent of total billed charges ","85% of total billed charges ",22.5,90,,18.00,,,0,"percent of total billed charges ","90% of total billed charges ",22.5,90,,18.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.75,87,,17.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.5,70,,14.00,,,0,"percent of total billed charges ","70% of total billed charges ",17.5,23.25,
"HALDOL CONC 2MG/ML 15ML IM",7023468,"CDM ",250,RC,,,OUTPATIENT,,,38.5,30.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.8,80,,24.64,,,0,"percent of total billed charges ","80% of total billed charges ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,93,,28.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.73,85,,26.18,,,0,"percent of total billed charges ","85% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.5,87,,26.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",26.95,35.81,
"TRANSDERM-SCOP 1.5MG",7023807,"CDM ",637,RC,,,OUTPATIENT,,,54,43.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.2,80,,34.56,,,0,"percent of total billed charges ","80% of total billed charges ",37.8,70,,30.24,,,0,"percent of total billed charges ","70% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",50.22,93,,40.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",45.9,85,,36.72,,,0,"percent of total billed charges ","85% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",48.6,90,,38.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",46.98,87,,37.58,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.8,70,,30.24,,,0,"percent of total billed charges ","70% of total billed charges ",37.8,50.22,
"LIDOCAINE 4% TOP SOL",7023906,"CDM ",250,RC,,,OUTPATIENT,,,40,32,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32,80,,25.60,,,0,"percent of total billed charges ","80% of total billed charges ",28,70,,22.40,,,0,"percent of total billed charges ","70% of total billed charges ",36,90,,28.80,,,0,"percent of total billed charges ","90% of total billed charges ",37.2,93,,29.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34,85,,27.20,,,0,"percent of total billed charges ","85% of total billed charges ",36,90,,28.80,,,0,"percent of total billed charges ","90% of total billed charges ",36,90,,28.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",34.8,87,,27.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28,70,,22.40,,,0,"percent of total billed charges ","70% of total billed charges ",28,37.2,
"METHYLPREDNISOLONE 4 MG TAB",7024988,"CDM ",259,RC,,,OUTPATIENT,,,13,10.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.4,80,,8.32,,,0,"percent of total billed charges ","80% of total billed charges ",9.1,70,,7.28,,,0,"percent of total billed charges ","70% of total billed charges ",11.7,90,,9.36,,,0,"percent of total billed charges ","90% of total billed charges ",12.09,93,,9.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.05,85,,8.84,,,0,"percent of total billed charges ","85% of total billed charges ",11.7,90,,9.36,,,0,"percent of total billed charges ","90% of total billed charges ",11.7,90,,9.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.31,87,,9.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.1,70,,7.28,,,0,"percent of total billed charges ","70% of total billed charges ",9.1,12.09,
"CETACAINE SPRAY 10% PER SPRAY",7025174,"CDM ",250,RC,,,OUTPATIENT,,,164,131.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.2,80,,104.96,,,0,"percent of total billed charges ","80% of total billed charges ",114.8,70,,91.84,,,0,"percent of total billed charges ","70% of total billed charges ",147.6,90,,118.08,,,0,"percent of total billed charges ","90% of total billed charges ",152.52,93,,122.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",139.4,85,,111.52,,,0,"percent of total billed charges ","85% of total billed charges ",147.6,90,,118.08,,,0,"percent of total billed charges ","90% of total billed charges ",147.6,90,,118.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",142.68,87,,114.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.8,70,,91.84,,,0,"percent of total billed charges ","70% of total billed charges ",114.8,152.52,
"METHYLENE BLUE 1% 10MG/ML 1ML",7025364,"CDM ",250,RC,,,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.2,80,,31.36,,,0,"percent of total billed charges ","80% of total billed charges ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"PITRESSIN 2OU/ML 1ML VIAL",7025398,"CDM ",250,RC,,,OUTPATIENT,,,91.5,73.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.2,80,,58.56,,,0,"percent of total billed charges ","80% of total billed charges ",64.05,70,,51.24,,,0,"percent of total billed charges ","70% of total billed charges ",82.35,90,,65.88,,,0,"percent of total billed charges ","90% of total billed charges ",85.1,93,,68.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",77.78,85,,62.22,,,0,"percent of total billed charges ","85% of total billed charges ",82.35,90,,65.88,,,0,"percent of total billed charges ","90% of total billed charges ",82.35,90,,65.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",79.61,87,,63.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.05,70,,51.24,,,0,"percent of total billed charges ","70% of total billed charges ",64.05,85.1,
"SOD BICARB 8.4% SYR",7025463,"CDM ",250,RC,,,OUTPATIENT,,,23,18.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.4,80,,14.72,,,0,"percent of total billed charges ","80% of total billed charges ",16.1,70,,12.88,,,0,"percent of total billed charges ","70% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",21.39,93,,17.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.55,85,,15.64,,,0,"percent of total billed charges ","85% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",20.7,90,,16.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",20.01,87,,16.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.1,70,,12.88,,,0,"percent of total billed charges ","70% of total billed charges ",16.1,21.39,
"LOTRIMIN CR 1% 30GM",7025521,"CDM ",637,RC,,,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.2,80,,24.96,,,0,"percent of total billed charges ","80% of total billed charges ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"ZINC OXID OINT U S P",7025661,"CDM ",637,RC,,,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.2,80,,24.96,,,0,"percent of total billed charges ","80% of total billed charges ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"OCEAN SPRAY 45CC",7025703,"CDM ",250,RC,,,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.2,80,,24.96,,,0,"percent of total billed charges ","80% of total billed charges ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"SOD ACETA 40MEQ-INJ",7026032,"CDM ",250,RC,,,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.4,80,,30.72,,,0,"percent of total billed charges ","80% of total billed charges ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",33.6,44.64,
"TRIDIL 5MG/ML 10ML",7026057,"CDM ",250,RC,,,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.4,80,,30.72,,,0,"percent of total billed charges ","80% of total billed charges ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",33.6,44.64,
"AQUAPHOR 480GM OINT",7026073,"CDM ",637,RC,,,OUTPATIENT,,,46,36.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.8,80,,29.44,,,0,"percent of total billed charges ","80% of total billed charges ",32.2,70,,25.76,,,0,"percent of total billed charges ","70% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",42.78,93,,34.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.1,85,,31.28,,,0,"percent of total billed charges ","85% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.02,87,,32.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.2,70,,25.76,,,0,"percent of total billed charges ","70% of total billed charges ",32.2,42.78,
"PRED-FORTE 1% OPTH SOL 5ML",7026164,"CDM ",637,RC,,,OUTPATIENT,,,147,117.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",117.6,80,,94.08,,,0,"percent of total billed charges ","80% of total billed charges ",102.9,70,,82.32,,,0,"percent of total billed charges ","70% of total billed charges ",132.3,90,,105.84,,,0,"percent of total billed charges ","90% of total billed charges ",136.71,93,,109.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",124.95,85,,99.96,,,0,"percent of total billed charges ","85% of total billed charges ",132.3,90,,105.84,,,0,"percent of total billed charges ","90% of total billed charges ",132.3,90,,105.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",127.89,87,,102.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102.9,70,,82.32,,,0,"percent of total billed charges ","70% of total billed charges ",102.9,136.71,
"GELFOAM SIZE 12-7MM",7026222,"CDM ",637,RC,,,OUTPATIENT,,,25,20,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20,80,,16.00,,,0,"percent of total billed charges ","80% of total billed charges ",17.5,70,,14.00,,,0,"percent of total billed charges ","70% of total billed charges ",22.5,90,,18.00,,,0,"percent of total billed charges ","90% of total billed charges ",23.25,93,,18.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.25,85,,17.00,,,0,"percent of total billed charges ","85% of total billed charges ",22.5,90,,18.00,,,0,"percent of total billed charges ","90% of total billed charges ",22.5,90,,18.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",21.75,87,,17.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.5,70,,14.00,,,0,"percent of total billed charges ","70% of total billed charges ",17.5,23.25,
"MMR VACCINE 1ML VIAL",7026370,"CDM ",250,RC,,,OUTPATIENT,,,154.5,123.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",123.6,80,,98.88,,,0,"percent of total billed charges ","80% of total billed charges ",108.15,70,,86.52,,,0,"percent of total billed charges ","70% of total billed charges ",139.05,90,,111.24,,,0,"percent of total billed charges ","90% of total billed charges ",143.69,93,,114.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",131.33,85,,105.06,,,0,"percent of total billed charges ","85% of total billed charges ",139.05,90,,111.24,,,0,"percent of total billed charges ","90% of total billed charges ",139.05,90,,111.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",134.42,87,,107.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108.15,70,,86.52,,,0,"percent of total billed charges ","70% of total billed charges ",108.15,143.69,
"PHENERGA SUPP 12.5MG",7026396,"CDM ",637,RC,,,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.8,80,,8.64,,,0,"percent of total billed charges ","80% of total billed charges ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"HYDROCORTISONE CR 1% 30GM",7026511,"CDM ",637,RC,,,OUTPATIENT,,,25.5,20.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.4,80,,16.32,,,0,"percent of total billed charges ","80% of total billed charges ",17.85,70,,14.28,,,0,"percent of total billed charges ","70% of total billed charges ",22.95,90,,18.36,,,0,"percent of total billed charges ","90% of total billed charges ",23.72,93,,18.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.68,85,,17.34,,,0,"percent of total billed charges ","85% of total billed charges ",22.95,90,,18.36,,,0,"percent of total billed charges ","90% of total billed charges ",22.95,90,,18.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.19,87,,17.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.85,70,,14.28,,,0,"percent of total billed charges ","70% of total billed charges ",17.85,23.72,
"ZOVIRAX IV 500MG",7027303,"CDM ",250,RC,,,OUTPATIENT,,,56,44.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.8,80,,35.84,,,0,"percent of total billed charges ","80% of total billed charges ",39.2,70,,31.36,,,0,"percent of total billed charges ","70% of total billed charges ",50.4,90,,40.32,,,0,"percent of total billed charges ","90% of total billed charges ",52.08,93,,41.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",47.6,85,,38.08,,,0,"percent of total billed charges ","85% of total billed charges ",50.4,90,,40.32,,,0,"percent of total billed charges ","90% of total billed charges ",50.4,90,,40.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",48.72,87,,38.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.2,70,,31.36,,,0,"percent of total billed charges ","70% of total billed charges ",39.2,52.08,
"ACYCLOVIR 5% OINT 15GM",7027345,"CDM ",637,RC,,,OUTPATIENT,,,827.5,662,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",662,80,,529.60,,,0,"percent of total billed charges ","80% of total billed charges ",579.25,70,,463.40,,,0,"percent of total billed charges ","70% of total billed charges ",744.75,90,,595.80,,,0,"percent of total billed charges ","90% of total billed charges ",769.58,93,,615.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",703.38,85,,562.70,,,0,"percent of total billed charges ","85% of total billed charges ",744.75,90,,595.80,,,0,"percent of total billed charges ","90% of total billed charges ",744.75,90,,595.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",719.93,87,,575.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",579.25,70,,463.40,,,0,"percent of total billed charges ","70% of total billed charges ",579.25,769.58,
"NEOSPORIN OINT 0.9GM PKT",7027519,"CDM ",637,RC,,,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,80,,8.00,,,0,"percent of total billed charges ","80% of total billed charges ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"HEMABATE 250MCG/ML 1ML INJ",7027592,"CDM ",250,RC,,,OUTPATIENT,,,384.5,307.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",307.6,80,,246.08,,,0,"percent of total billed charges ","80% of total billed charges ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",357.59,93,,286.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",326.83,85,,261.46,,,0,"percent of total billed charges ","85% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",346.05,90,,276.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",334.52,87,,267.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",269.15,70,,215.32,,,0,"percent of total billed charges ","70% of total billed charges ",269.15,357.59,
"PROSTIN E-2 VAG SUPP",7027667,"CDM ",637,RC,,,OUTPATIENT,,,3377,2701.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2701.6,80,,2161.28,,,0,"percent of total billed charges ","80% of total billed charges ",2363.9,70,,1891.12,,,0,"percent of total billed charges ","70% of total billed charges ",3039.3,90,,2431.44,,,0,"percent of total billed charges ","90% of total billed charges ",3140.61,93,,2512.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",2870.45,85,,2296.36,,,0,"percent of total billed charges ","85% of total billed charges ",3039.3,90,,2431.44,,,0,"percent of total billed charges ","90% of total billed charges ",3039.3,90,,2431.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",2937.99,87,,2350.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2363.9,70,,1891.12,,,0,"percent of total billed charges ","70% of total billed charges ",2363.9,3140.61,
"LACOSAMIDE 100MG TAB",7027780,"CDM ",637,RC,,,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.6,80,,9.28,,,0,"percent of total billed charges ","80% of total billed charges ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"NORMODYNE 5MG/ML 20 ML VIAL",7027790,"CDM ",250,RC,,,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.2,80,,31.36,,,0,"percent of total billed charges ","80% of total billed charges ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"FERRIC SUBSULFATE 1MG/ML 30ML",7028186,"CDM ",250,RC,,,OUTPATIENT,,,38.5,30.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.8,80,,24.64,,,0,"percent of total billed charges ","80% of total billed charges ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,93,,28.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.73,85,,26.18,,,0,"percent of total billed charges ","85% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.5,87,,26.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",26.95,35.81,
"CORONA OINT 200GM",7028236,"CDM ",637,RC,,,OUTPATIENT,,,50,40,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40,80,,32.00,,,0,"percent of total billed charges ","80% of total billed charges ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",46.5,93,,37.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.5,85,,34.00,,,0,"percent of total billed charges ","85% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.5,87,,34.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",35,46.5,
"CATAPRES TTS TDSY",7028459,"CDM ",250,RC,,,OUTPATIENT,,,104,83.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.2,80,,66.56,,,0,"percent of total billed charges ","80% of total billed charges ",72.8,70,,58.24,,,0,"percent of total billed charges ","70% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",96.72,93,,77.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",88.4,85,,70.72,,,0,"percent of total billed charges ","85% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",93.6,90,,74.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",90.48,87,,72.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.8,70,,58.24,,,0,"percent of total billed charges ","70% of total billed charges ",72.8,96.72,
"CATAPRES TTS 1 TDSY",7028467,"CDM ",250,RC,,,OUTPATIENT,,,49.5,39.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.6,80,,31.68,,,0,"percent of total billed charges ","80% of total billed charges ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",46.04,93,,36.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.08,85,,33.66,,,0,"percent of total billed charges ","85% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.07,87,,34.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,46.04,
"CATAPRES TTS TDSY",7028475,"CDM ",250,RC,,,OUTPATIENT,,,75.5,60.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.4,80,,48.32,,,0,"percent of total billed charges ","80% of total billed charges ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",70.22,93,,56.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",64.18,85,,51.34,,,0,"percent of total billed charges ","85% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",67.95,90,,54.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",65.69,87,,52.55,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.85,70,,42.28,,,0,"percent of total billed charges ","70% of total billed charges ",52.85,70.22,
"HYDROCORTISONE 2.5% 30GM CR",7028574,"CDM ",637,RC,,,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.2,80,,24.96,,,0,"percent of total billed charges ","80% of total billed charges ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"THROMBO-STAT KIT",7029127,"CDM ",250,RC,,,OUTPATIENT,,,658,526.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",526.4,80,,421.12,,,0,"percent of total billed charges ","80% of total billed charges ",460.6,70,,368.48,,,0,"percent of total billed charges ","70% of total billed charges ",592.2,90,,473.76,,,0,"percent of total billed charges ","90% of total billed charges ",611.94,93,,489.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",559.3,85,,447.44,,,0,"percent of total billed charges ","85% of total billed charges ",592.2,90,,473.76,,,0,"percent of total billed charges ","90% of total billed charges ",592.2,90,,473.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",572.46,87,,457.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",460.6,70,,368.48,,,0,"percent of total billed charges ","70% of total billed charges ",460.6,611.94,
"ROBINUL 0.2MG/ML VIAL",7029564,"CDM ",250,RC,,,OUTPATIENT,,,65.5,52.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.4,80,,41.92,,,0,"percent of total billed charges ","80% of total billed charges ",45.85,70,,36.68,,,0,"percent of total billed charges ","70% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",60.92,93,,48.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",55.68,85,,44.54,,,0,"percent of total billed charges ","85% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",56.99,87,,45.59,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.85,70,,36.68,,,0,"percent of total billed charges ","70% of total billed charges ",45.85,60.92,
"AMIDATE 2MG/ML 20ML VIAL",7029572,"CDM ",637,RC,,,OUTPATIENT,,,55.5,44.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.4,80,,35.52,,,0,"percent of total billed charges ","80% of total billed charges ",38.85,70,,31.08,,,0,"percent of total billed charges ","70% of total billed charges ",49.95,90,,39.96,,,0,"percent of total billed charges ","90% of total billed charges ",51.62,93,,41.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",47.18,85,,37.74,,,0,"percent of total billed charges ","85% of total billed charges ",49.95,90,,39.96,,,0,"percent of total billed charges ","90% of total billed charges ",49.95,90,,39.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",48.29,87,,38.63,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.85,70,,31.08,,,0,"percent of total billed charges ","70% of total billed charges ",38.85,51.62,
"ATROVENT INHALER 14GM",7029713,"CDM ",637,RC,,,OUTPATIENT,,,635,508,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",508,80,,406.40,,,0,"percent of total billed charges ","80% of total billed charges ",444.5,70,,355.60,,,0,"percent of total billed charges ","70% of total billed charges ",571.5,90,,457.20,,,0,"percent of total billed charges ","90% of total billed charges ",590.55,93,,472.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",539.75,85,,431.80,,,0,"percent of total billed charges ","85% of total billed charges ",571.5,90,,457.20,,,0,"percent of total billed charges ","90% of total billed charges ",571.5,90,,457.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",552.45,87,,441.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",444.5,70,,355.60,,,0,"percent of total billed charges ","70% of total billed charges ",444.5,590.55,
"AZACTAM 1GM VIAL",7029911,"CDM ",250,RC,,,OUTPATIENT,,,81.5,65.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.2,80,,52.16,,,0,"percent of total billed charges ","80% of total billed charges ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",75.8,93,,60.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",69.28,85,,55.42,,,0,"percent of total billed charges ","85% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",70.91,87,,56.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",57.05,75.8,
"HYTONE LOTION 2.5% 60ML",7030125,"CDM ",637,RC,,,OUTPATIENT,,,172.5,138,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",138,80,,110.40,,,0,"percent of total billed charges ","80% of total billed charges ",120.75,70,,96.60,,,0,"percent of total billed charges ","70% of total billed charges ",155.25,90,,124.20,,,0,"percent of total billed charges ","90% of total billed charges ",160.43,93,,128.34,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",146.63,85,,117.30,,,0,"percent of total billed charges ","85% of total billed charges ",155.25,90,,124.20,,,0,"percent of total billed charges ","90% of total billed charges ",155.25,90,,124.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",150.08,87,,120.06,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",120.75,70,,96.60,,,0,"percent of total billed charges ","70% of total billed charges ",120.75,160.43,
"LOPRESSOR 1MG/ML 5ML AMP",7030240,"CDM ",250,RC,,,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.2,80,,31.36,,,0,"percent of total billed charges ","80% of total billed charges ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"INTAL NEB SOL 2ML",7030323,"CDM ",250,RC,,,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,80,,8.00,,,0,"percent of total billed charges ","80% of total billed charges ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"TRIDESO CR O.5% 15GM",7030992,"CDM ",637,RC,,,OUTPATIENT,,,185.5,148.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",148.4,80,,118.72,,,0,"percent of total billed charges ","80% of total billed charges ",129.85,70,,103.88,,,0,"percent of total billed charges ","70% of total billed charges ",166.95,90,,133.56,,,0,"percent of total billed charges ","90% of total billed charges ",172.52,93,,138.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",157.68,85,,126.14,,,0,"percent of total billed charges ","85% of total billed charges ",166.95,90,,133.56,,,0,"percent of total billed charges ","90% of total billed charges ",166.95,90,,133.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",161.39,87,,129.11,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.85,70,,103.88,,,0,"percent of total billed charges ","70% of total billed charges ",129.85,172.52,
"AZACTAM 2GM VIAL",7031164,"CDM ",250,RC,,,OUTPATIENT,,,82.5,66,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66,80,,52.80,,,0,"percent of total billed charges ","80% of total billed charges ",57.75,70,,46.20,,,0,"percent of total billed charges ","70% of total billed charges ",74.25,90,,59.40,,,0,"percent of total billed charges ","90% of total billed charges ",76.73,93,,61.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.13,85,,56.10,,,0,"percent of total billed charges ","85% of total billed charges ",74.25,90,,59.40,,,0,"percent of total billed charges ","90% of total billed charges ",74.25,90,,59.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",71.78,87,,57.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.75,70,,46.20,,,0,"percent of total billed charges ","70% of total billed charges ",57.75,76.73,
"TOBRADEX OINT 3.5GM",7031206,"CDM ",637,RC,,,OUTPATIENT,,,488.5,390.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",390.8,80,,312.64,,,0,"percent of total billed charges ","80% of total billed charges ",341.95,70,,273.56,,,0,"percent of total billed charges ","70% of total billed charges ",439.65,90,,351.72,,,0,"percent of total billed charges ","90% of total billed charges ",454.31,93,,363.45,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",415.23,85,,332.18,,,0,"percent of total billed charges ","85% of total billed charges ",439.65,90,,351.72,,,0,"percent of total billed charges ","90% of total billed charges ",439.65,90,,351.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",425,87,,340.00,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",341.95,70,,273.56,,,0,"percent of total billed charges ","70% of total billed charges ",341.95,454.31,
"TOBREX SOL OPTH 0.3% 3.5GM",7031248,"CDM ",637,RC,,,OUTPATIENT,,,178.5,142.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",142.8,80,,114.24,,,0,"percent of total billed charges ","80% of total billed charges ",124.95,70,,99.96,,,0,"percent of total billed charges ","70% of total billed charges ",160.65,90,,128.52,,,0,"percent of total billed charges ","90% of total billed charges ",166.01,93,,132.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",151.73,85,,121.38,,,0,"percent of total billed charges ","85% of total billed charges ",160.65,90,,128.52,,,0,"percent of total billed charges ","90% of total billed charges ",160.65,90,,128.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",155.3,87,,124.24,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",124.95,70,,99.96,,,0,"percent of total billed charges ","70% of total billed charges ",124.95,166.01,
"CELLUVISC OPTH 1% 0.4ML DRP",7031388,"CDM ",637,RC,,,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,80,,8.00,,,0,"percent of total billed charges ","80% of total billed charges ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"BACTROBAN OINT 15GM",7031487,"CDM ",637,RC,,,OUTPATIENT,,,27.5,22,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22,80,,17.60,,,0,"percent of total billed charges ","80% of total billed charges ",19.25,70,,15.40,,,0,"percent of total billed charges ","70% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",25.58,93,,20.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.38,85,,18.70,,,0,"percent of total billed charges ","85% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",23.93,87,,19.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.25,70,,15.40,,,0,"percent of total billed charges ","70% of total billed charges ",19.25,25.58,
"MTE-5 CONCENT 1ML",7032204,"CDM ",250,RC,,,OUTPATIENT,,,66,52.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.8,80,,42.24,,,0,"percent of total billed charges ","80% of total billed charges ",46.2,70,,36.96,,,0,"percent of total billed charges ","70% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",61.38,93,,49.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",56.1,85,,44.88,,,0,"percent of total billed charges ","85% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",59.4,90,,47.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",57.42,87,,45.94,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.2,70,,36.96,,,0,"percent of total billed charges ","70% of total billed charges ",46.2,61.38,
"CIPRO 400MG/200ML PREMIX IV",7032394,"CDM ",250,RC,,,OUTPATIENT,,,92,73.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.6,80,,58.88,,,0,"percent of total billed charges ","80% of total billed charges ",64.4,70,,51.52,,,0,"percent of total billed charges ","70% of total billed charges ",82.8,90,,66.24,,,0,"percent of total billed charges ","90% of total billed charges ",85.56,93,,68.45,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",78.2,85,,62.56,,,0,"percent of total billed charges ","85% of total billed charges ",82.8,90,,66.24,,,0,"percent of total billed charges ","90% of total billed charges ",82.8,90,,66.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",80.04,87,,64.03,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.4,70,,51.52,,,0,"percent of total billed charges ","70% of total billed charges ",64.4,85.56,
"NU LYTELY",7032444,"CDM ",637,RC,,,OUTPATIENT,,,63.5,50.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.8,80,,40.64,,,0,"percent of total billed charges ","80% of total billed charges ",44.45,70,,35.56,,,0,"percent of total billed charges ","70% of total billed charges ",57.15,90,,45.72,,,0,"percent of total billed charges ","90% of total billed charges ",59.06,93,,47.25,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",53.98,85,,43.18,,,0,"percent of total billed charges ","85% of total billed charges ",57.15,90,,45.72,,,0,"percent of total billed charges ","90% of total billed charges ",57.15,90,,45.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",55.25,87,,44.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.45,70,,35.56,,,0,"percent of total billed charges ","70% of total billed charges ",44.45,59.06,
"CILOXAN 5ML OPHTH 0.3% SOLN",7032600,"CDM ",637,RC,,,OUTPATIENT,,,140,112,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112,80,,89.60,,,0,"percent of total billed charges ","80% of total billed charges ",98,70,,78.40,,,0,"percent of total billed charges ","70% of total billed charges ",126,90,,100.80,,,0,"percent of total billed charges ","90% of total billed charges ",130.2,93,,104.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",119,85,,95.20,,,0,"percent of total billed charges ","85% of total billed charges ",126,90,,100.80,,,0,"percent of total billed charges ","90% of total billed charges ",126,90,,100.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",121.8,87,,97.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",98,70,,78.40,,,0,"percent of total billed charges ","70% of total billed charges ",98,130.2,
"DURAGESIC 50 MCG PATCH",7032683,"CDM ",637,RC,,,OUTPATIENT,,,71,56.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",56.8,80,,45.44,,,0,"percent of total billed charges ","80% of total billed charges ",49.7,70,,39.76,,,0,"percent of total billed charges ","70% of total billed charges ",63.9,90,,51.12,,,0,"percent of total billed charges ","90% of total billed charges ",66.03,93,,52.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",60.35,85,,48.28,,,0,"percent of total billed charges ","85% of total billed charges ",63.9,90,,51.12,,,0,"percent of total billed charges ","90% of total billed charges ",63.9,90,,51.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",61.77,87,,49.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.7,70,,39.76,,,0,"percent of total billed charges ","70% of total billed charges ",49.7,66.03,
"DURAGESIC 25MCG PATCH",7032691,"CDM ",637,RC,,,OUTPATIENT,,,35,28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28,80,,22.40,,,0,"percent of total billed charges ","80% of total billed charges ",24.5,70,,19.60,,,0,"percent of total billed charges ","70% of total billed charges ",31.5,90,,25.20,,,0,"percent of total billed charges ","90% of total billed charges ",32.55,93,,26.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",29.75,85,,23.80,,,0,"percent of total billed charges ","85% of total billed charges ",31.5,90,,25.20,,,0,"percent of total billed charges ","90% of total billed charges ",31.5,90,,25.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.45,87,,24.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.5,70,,19.60,,,0,"percent of total billed charges ","70% of total billed charges ",24.5,32.55,
"BETADINE SPRAY 3 OZ",7032956,"CDM ",250,RC,,,OUTPATIENT,,,38.5,30.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.8,80,,24.64,,,0,"percent of total billed charges ","80% of total billed charges ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,93,,28.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.73,85,,26.18,,,0,"percent of total billed charges ","85% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.5,87,,26.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",26.95,35.81,
"HABITROL 7MG/24HR",7033061,"CDM ",250,RC,,,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,80,,8.00,,,0,"percent of total billed charges ","80% of total billed charges ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"ROMAZICON 0.5/5ML CHG PER ML",7033095,"CDM ",250,RC,,,OUTPATIENT,,,50,40,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40,80,,32.00,,,0,"percent of total billed charges ","80% of total billed charges ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",46.5,93,,37.20,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.5,85,,34.00,,,0,"percent of total billed charges ","85% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",45,90,,36.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.5,87,,34.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35,70,,28.00,,,0,"percent of total billed charges ","70% of total billed charges ",35,46.5,
"MANNITOL 20% 500ML",7033145,"CDM ",250,RC,,,OUTPATIENT,,,49.5,39.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.6,80,,31.68,,,0,"percent of total billed charges ","80% of total billed charges ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",46.04,93,,36.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.08,85,,33.66,,,0,"percent of total billed charges ","85% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.07,87,,34.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,46.04,
"BEYFORTUS 50MG PFS",7033238,"CDM ",636,RC,,,OUTPATIENT,,,640.5,512.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",512.4,80,,409.92,,,0,"percent of total billed charges ","80% of total billed charges ",448.35,70,,358.68,,,0,"percent of total billed charges ","70% of total billed charges ",576.45,90,,461.16,,,0,"percent of total billed charges ","90% of total billed charges ",595.67,93,,476.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",544.43,85,,435.54,,,0,"percent of total billed charges ","85% of total billed charges ",576.45,90,,461.16,,,0,"percent of total billed charges ","90% of total billed charges ",576.45,90,,461.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",557.24,87,,445.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",448.35,70,,358.68,,,0,"percent of total billed charges ","70% of total billed charges ",448.35,595.67,
"BEYFORTUS 50MG PFS VFC",7033239,"CDM ",636,RC,,,OUTPATIENT,,,45,36,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36,80,,28.80,,,0,"percent of total billed charges ","80% of total billed charges ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.15,87,,31.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",31.5,41.85,
"NORCURON INJ 1MG/ML 10ML",7033426,"CDM ",250,RC,,,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.4,80,,30.72,,,0,"percent of total billed charges ","80% of total billed charges ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",33.6,44.64,
"BREVIBLOC 100MG VL 10MG/ML",7033442,"CDM ",250,RC,,,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.2,80,,31.36,,,0,"percent of total billed charges ","80% of total billed charges ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"ORAJEL TOOTHACHE GEL",7033624,"CDM ",637,RC,,,OUTPATIENT,,,16,12.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.8,80,,10.24,,,0,"percent of total billed charges ","80% of total billed charges ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.88,93,,11.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.6,85,,10.88,,,0,"percent of total billed charges ","85% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.92,87,,11.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,14.88,
"DDAVP NASAL SPRAY 5ML",7033897,"CDM ",637,RC,,,OUTPATIENT,,,283,226.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",226.4,80,,181.12,,,0,"percent of total billed charges ","80% of total billed charges ",198.1,70,,158.48,,,0,"percent of total billed charges ","70% of total billed charges ",254.7,90,,203.76,,,0,"percent of total billed charges ","90% of total billed charges ",263.19,93,,210.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",240.55,85,,192.44,,,0,"percent of total billed charges ","85% of total billed charges ",254.7,90,,203.76,,,0,"percent of total billed charges ","90% of total billed charges ",254.7,90,,203.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",246.21,87,,196.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",198.1,70,,158.48,,,0,"percent of total billed charges ","70% of total billed charges ",198.1,263.19,
"NIZAROL CREAM 15GM",7034184,"CDM ",637,RC,,,OUTPATIENT,,,67.5,54,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54,80,,43.20,,,0,"percent of total billed charges ","80% of total billed charges ",47.25,70,,37.80,,,0,"percent of total billed charges ","70% of total billed charges ",60.75,90,,48.60,,,0,"percent of total billed charges ","90% of total billed charges ",62.78,93,,50.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",57.38,85,,45.90,,,0,"percent of total billed charges ","85% of total billed charges ",60.75,90,,48.60,,,0,"percent of total billed charges ","90% of total billed charges ",60.75,90,,48.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",58.73,87,,46.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",47.25,70,,37.80,,,0,"percent of total billed charges ","70% of total billed charges ",47.25,62.78,
"CARDIZEM 5MG/ML 10ML VIAL",7034226,"CDM ",250,RC,,,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.2,80,,31.36,,,0,"percent of total billed charges ","80% of total billed charges ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"RIFADINE 600MG IV",7034416,"CDM ",250,RC,,,OUTPATIENT,,,245.5,196.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",196.4,80,,157.12,,,0,"percent of total billed charges ","80% of total billed charges ",171.85,70,,137.48,,,0,"percent of total billed charges ","70% of total billed charges ",220.95,90,,176.76,,,0,"percent of total billed charges ","90% of total billed charges ",228.32,93,,182.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",208.68,85,,166.94,,,0,"percent of total billed charges ","85% of total billed charges ",220.95,90,,176.76,,,0,"percent of total billed charges ","90% of total billed charges ",220.95,90,,176.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",213.59,87,,170.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",171.85,70,,137.48,,,0,"percent of total billed charges ","70% of total billed charges ",171.85,228.32,
"VASOTEC 1.25MG/ML INJ",7034424,"CDM ",250,RC,,,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.2,80,,31.36,,,0,"percent of total billed charges ","80% of total billed charges ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"ACULAR OPTHI GTTS 0.5% 5ML",7034598,"CDM ",637,RC,,,OUTPATIENT,,,222,177.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",177.6,80,,142.08,,,0,"percent of total billed charges ","80% of total billed charges ",155.4,70,,124.32,,,0,"percent of total billed charges ","70% of total billed charges ",199.8,90,,159.84,,,0,"percent of total billed charges ","90% of total billed charges ",206.46,93,,165.17,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",188.7,85,,150.96,,,0,"percent of total billed charges ","85% of total billed charges ",199.8,90,,159.84,,,0,"percent of total billed charges ","90% of total billed charges ",199.8,90,,159.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",193.14,87,,154.51,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",155.4,70,,124.32,,,0,"percent of total billed charges ","70% of total billed charges ",155.4,206.46,
"NIZORAL SHAMPOO 2% 4OZ",7034671,"CDM ",637,RC,,,OUTPATIENT,,,137,109.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.6,80,,87.68,,,0,"percent of total billed charges ","80% of total billed charges ",95.9,70,,76.72,,,0,"percent of total billed charges ","70% of total billed charges ",123.3,90,,98.64,,,0,"percent of total billed charges ","90% of total billed charges ",127.41,93,,101.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",116.45,85,,93.16,,,0,"percent of total billed charges ","85% of total billed charges ",123.3,90,,98.64,,,0,"percent of total billed charges ","90% of total billed charges ",123.3,90,,98.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",119.19,87,,95.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.9,70,,76.72,,,0,"percent of total billed charges ","70% of total billed charges ",95.9,127.41,
"TERAZOL 7 VAG. CREAM",7034887,"CDM ",637,RC,,,OUTPATIENT,,,160,128,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128,80,,102.40,,,0,"percent of total billed charges ","80% of total billed charges ",112,70,,89.60,,,0,"percent of total billed charges ","70% of total billed charges ",144,90,,115.20,,,0,"percent of total billed charges ","90% of total billed charges ",148.8,93,,119.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",136,85,,108.80,,,0,"percent of total billed charges ","85% of total billed charges ",144,90,,115.20,,,0,"percent of total billed charges ","90% of total billed charges ",144,90,,115.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",139.2,87,,111.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",112,70,,89.60,,,0,"percent of total billed charges ","70% of total billed charges ",112,148.8,
"EMLA CR/DRESSING 5GM",7035264,"CDM ",250,RC,,,OUTPATIENT,,,25.5,20.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.4,80,,16.32,,,0,"percent of total billed charges ","80% of total billed charges ",17.85,70,,14.28,,,0,"percent of total billed charges ","70% of total billed charges ",22.95,90,,18.36,,,0,"percent of total billed charges ","90% of total billed charges ",23.72,93,,18.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.68,85,,17.34,,,0,"percent of total billed charges ","85% of total billed charges ",22.95,90,,18.36,,,0,"percent of total billed charges ","90% of total billed charges ",22.95,90,,18.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.19,87,,17.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.85,70,,14.28,,,0,"percent of total billed charges ","70% of total billed charges ",17.85,23.72,
"ZEMURON 10MG/ML 5ML VIAL",7035314,"CDM ",250,RC,,,OUTPATIENT,,,51.5,41.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",41.2,80,,32.96,,,0,"percent of total billed charges ","80% of total billed charges ",36.05,70,,28.84,,,0,"percent of total billed charges ","70% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",47.9,93,,38.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",43.78,85,,35.02,,,0,"percent of total billed charges ","85% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",46.35,90,,37.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",44.81,87,,35.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.05,70,,28.84,,,0,"percent of total billed charges ","70% of total billed charges ",36.05,47.9,
"DEPO-PROVERA 150MG/ML 1ML IM",7035363,"CDM ",636,RC,,,OUTPATIENT,,,143,114.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.4,80,,91.52,,,0,"percent of total billed charges ","80% of total billed charges ",100.1,70,,80.08,,,0,"percent of total billed charges ","70% of total billed charges ",128.7,90,,102.96,,,0,"percent of total billed charges ","90% of total billed charges ",132.99,93,,106.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",121.55,85,,97.24,,,0,"percent of total billed charges ","85% of total billed charges ",128.7,90,,102.96,,,0,"percent of total billed charges ","90% of total billed charges ",128.7,90,,102.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",124.41,87,,99.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",100.1,70,,80.08,,,0,"percent of total billed charges ","70% of total billed charges ",100.1,132.99,
"TETRACAINE 0.5% OPTH SOL 5ML",7035454,"CDM ",250,RC,,,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.2,80,,24.96,,,0,"percent of total billed charges ","80% of total billed charges ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"DURAGESIC 75MCG PATCH",7035702,"CDM ",637,RC,,,OUTPATIENT,,,124,99.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.2,80,,79.36,,,0,"percent of total billed charges ","80% of total billed charges ",86.8,70,,69.44,,,0,"percent of total billed charges ","70% of total billed charges ",111.6,90,,89.28,,,0,"percent of total billed charges ","90% of total billed charges ",115.32,93,,92.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",105.4,85,,84.32,,,0,"percent of total billed charges ","85% of total billed charges ",111.6,90,,89.28,,,0,"percent of total billed charges ","90% of total billed charges ",111.6,90,,89.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",107.88,87,,86.30,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.8,70,,69.44,,,0,"percent of total billed charges ","70% of total billed charges ",86.8,115.32,
DURAGESIC100MCGPATCH,7035769,"CDM ",637,RC,,,OUTPATIENT,,,164,131.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",131.2,80,,104.96,,,0,"percent of total billed charges ","80% of total billed charges ",114.8,70,,91.84,,,0,"percent of total billed charges ","70% of total billed charges ",147.6,90,,118.08,,,0,"percent of total billed charges ","90% of total billed charges ",152.52,93,,122.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",139.4,85,,111.52,,,0,"percent of total billed charges ","85% of total billed charges ",147.6,90,,118.08,,,0,"percent of total billed charges ","90% of total billed charges ",147.6,90,,118.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",142.68,87,,114.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",114.8,70,,91.84,,,0,"percent of total billed charges ","70% of total billed charges ",114.8,152.52,
"SUFENTA 1ML AMP",7035819,"CDM ",250,RC,,,OUTPATIENT,,,33.5,26.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.8,80,,21.44,,,0,"percent of total billed charges ","80% of total billed charges ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",31.16,93,,24.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.48,85,,22.78,,,0,"percent of total billed charges ","85% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.15,87,,23.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",23.45,31.16,
"PONTOCAINE 1% 2ML INJ",7035827,"CDM ",250,RC,,,OUTPATIENT,,,62,49.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.6,80,,39.68,,,0,"percent of total billed charges ","80% of total billed charges ",43.4,70,,34.72,,,0,"percent of total billed charges ","70% of total billed charges ",55.8,90,,44.64,,,0,"percent of total billed charges ","90% of total billed charges ",57.66,93,,46.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",52.7,85,,42.16,,,0,"percent of total billed charges ","85% of total billed charges ",55.8,90,,44.64,,,0,"percent of total billed charges ","90% of total billed charges ",55.8,90,,44.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",53.94,87,,43.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.4,70,,34.72,,,0,"percent of total billed charges ","70% of total billed charges ",43.4,57.66,
"WESTCORT CR 15GM",7035926,"CDM ",637,RC,,,OUTPATIENT,,,62.5,50,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50,80,,40.00,,,0,"percent of total billed charges ","80% of total billed charges ",43.75,70,,35.00,,,0,"percent of total billed charges ","70% of total billed charges ",56.25,90,,45.00,,,0,"percent of total billed charges ","90% of total billed charges ",58.13,93,,46.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",53.13,85,,42.50,,,0,"percent of total billed charges ","85% of total billed charges ",56.25,90,,45.00,,,0,"percent of total billed charges ","90% of total billed charges ",56.25,90,,45.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",54.38,87,,43.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.75,70,,35.00,,,0,"percent of total billed charges ","70% of total billed charges ",43.75,58.13,
"BUMEX 0.25MG INJ 4ML VIAL",7036122,"CDM ",250,RC,,,OUTPATIENT,,,29,23.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.2,80,,18.56,,,0,"percent of total billed charges ","80% of total billed charges ",20.3,70,,16.24,,,0,"percent of total billed charges ","70% of total billed charges ",26.1,90,,20.88,,,0,"percent of total billed charges ","90% of total billed charges ",26.97,93,,21.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",24.65,85,,19.72,,,0,"percent of total billed charges ","85% of total billed charges ",26.1,90,,20.88,,,0,"percent of total billed charges ","90% of total billed charges ",26.1,90,,20.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",25.23,87,,20.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.3,70,,16.24,,,0,"percent of total billed charges ","70% of total billed charges ",20.3,26.97,
"ATROPINE SUL SYRINGE 10ML",7036312,"CDM ",250,RC,,,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.2,80,,31.36,,,0,"percent of total billed charges ","80% of total billed charges ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"FEVERALL 80MG SUPP",7036411,"CDM ",637,RC,,,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,80,,8.00,,,0,"percent of total billed charges ","80% of total billed charges ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"ISOPTO ATROPINE 1% 5ML",7036452,"CDM ",250,RC,,,OUTPATIENT,,,37,29.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.6,80,,23.68,,,0,"percent of total billed charges ","80% of total billed charges ",25.9,70,,20.72,,,0,"percent of total billed charges ","70% of total billed charges ",33.3,90,,26.64,,,0,"percent of total billed charges ","90% of total billed charges ",34.41,93,,27.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",31.45,85,,25.16,,,0,"percent of total billed charges ","85% of total billed charges ",33.3,90,,26.64,,,0,"percent of total billed charges ","90% of total billed charges ",33.3,90,,26.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",32.19,87,,25.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.9,70,,20.72,,,0,"percent of total billed charges ","70% of total billed charges ",25.9,34.41,
"DILATERIA THK CX DIL",7036619,"CDM ",637,RC,,,OUTPATIENT,,,65.5,52.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.4,80,,41.92,,,0,"percent of total billed charges ","80% of total billed charges ",45.85,70,,36.68,,,0,"percent of total billed charges ","70% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",60.92,93,,48.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",55.68,85,,44.54,,,0,"percent of total billed charges ","85% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",58.95,90,,47.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",56.99,87,,45.59,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.85,70,,36.68,,,0,"percent of total billed charges ","70% of total billed charges ",45.85,60.92,
"VERAPAMIL  5MG/2ML",7036627,"CDM ",250,RC,,,OUTPATIENT,,,72,57.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.6,80,,46.08,,,0,"percent of total billed charges ","80% of total billed charges ",50.4,70,,40.32,,,0,"percent of total billed charges ","70% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",66.96,93,,53.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",61.2,85,,48.96,,,0,"percent of total billed charges ","85% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",64.8,90,,51.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",62.64,87,,50.11,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.4,70,,40.32,,,0,"percent of total billed charges ","70% of total billed charges ",50.4,66.96,
"PRED MILD 0.12% OPTH SUSP 5ML",7036817,"CDM ",637,RC,,,OUTPATIENT,,,79,63.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.2,80,,50.56,,,0,"percent of total billed charges ","80% of total billed charges ",55.3,70,,44.24,,,0,"percent of total billed charges ","70% of total billed charges ",71.1,90,,56.88,,,0,"percent of total billed charges ","90% of total billed charges ",73.47,93,,58.78,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",67.15,85,,53.72,,,0,"percent of total billed charges ","85% of total billed charges ",71.1,90,,56.88,,,0,"percent of total billed charges ","90% of total billed charges ",71.1,90,,56.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",68.73,87,,54.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.3,70,,44.24,,,0,"percent of total billed charges ","70% of total billed charges ",55.3,73.47,
"FOLIC ACID 5MG ML 10ML MDV",7036890,"CDM ",250,RC,,,OUTPATIENT,,,81.5,65.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.2,80,,52.16,,,0,"percent of total billed charges ","80% of total billed charges ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",75.8,93,,60.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",69.28,85,,55.42,,,0,"percent of total billed charges ","85% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",70.91,87,,56.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",57.05,75.8,
"NITROPRUSSIDE NA50MG INJ",7037005,"CDM ",250,RC,,,OUTPATIENT,,,1177.5,942,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",942,80,,753.60,,,0,"percent of total billed charges ","80% of total billed charges ",824.25,70,,659.40,,,0,"percent of total billed charges ","70% of total billed charges ",1059.75,90,,847.80,,,0,"percent of total billed charges ","90% of total billed charges ",1095.08,93,,876.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1000.88,85,,800.70,,,0,"percent of total billed charges ","85% of total billed charges ",1059.75,90,,847.80,,,0,"percent of total billed charges ","90% of total billed charges ",1059.75,90,,847.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1024.43,87,,819.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",824.25,70,,659.40,,,0,"percent of total billed charges ","70% of total billed charges ",824.25,1095.08,
"POLYMYXIN B SUL VIAL 50,000U",7037278,"CDM ",250,RC,,,OUTPATIENT,,,43.5,34.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.8,80,,27.84,,,0,"percent of total billed charges ","80% of total billed charges ",30.45,70,,24.36,,,0,"percent of total billed charges ","70% of total billed charges ",39.15,90,,31.32,,,0,"percent of total billed charges ","90% of total billed charges ",40.46,93,,32.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",36.98,85,,29.58,,,0,"percent of total billed charges ","85% of total billed charges ",39.15,90,,31.32,,,0,"percent of total billed charges ","90% of total billed charges ",39.15,90,,31.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",37.85,87,,30.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.45,70,,24.36,,,0,"percent of total billed charges ","70% of total billed charges ",30.45,40.46,
"NOVAFERRUM IRON 15MG/1ML 120ML",7037660,"CDM ",259,RC,,,OUTPATIENT,,,33.5,26.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.8,80,,21.44,,,0,"percent of total billed charges ","80% of total billed charges ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",31.16,93,,24.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.48,85,,22.78,,,0,"percent of total billed charges ","85% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.15,87,,23.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",23.45,31.16,
"SODIUM CHLOR 0.9% 3ML NEBS",7038045,"CDM ",250,RC,,,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,80,,8.00,,,0,"percent of total billed charges ","80% of total billed charges ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"METRONIDAZOLE 250MG TAB",7038086,"CDM ",637,RC,,,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.8,80,,8.64,,,0,"percent of total billed charges ","80% of total billed charges ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"SSD CREAM 400GM",7038383,"CDM ",637,RC,,,OUTPATIENT,,,169,135.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",135.2,80,,108.16,,,0,"percent of total billed charges ","80% of total billed charges ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",157.17,93,,125.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",143.65,85,,114.92,,,0,"percent of total billed charges ","85% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",152.1,90,,121.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",147.03,87,,117.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.3,70,,94.64,,,0,"percent of total billed charges ","70% of total billed charges ",118.3,157.17,
"BACITRACIN 50000U VL",7038706,"CDM ",250,RC,,,OUTPATIENT,,,36.5,29.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.2,80,,23.36,,,0,"percent of total billed charges ","80% of total billed charges ",25.55,70,,20.44,,,0,"percent of total billed charges ","70% of total billed charges ",32.85,90,,26.28,,,0,"percent of total billed charges ","90% of total billed charges ",33.95,93,,27.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",31.03,85,,24.82,,,0,"percent of total billed charges ","85% of total billed charges ",32.85,90,,26.28,,,0,"percent of total billed charges ","90% of total billed charges ",32.85,90,,26.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",31.76,87,,25.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.55,70,,20.44,,,0,"percent of total billed charges ","70% of total billed charges ",25.55,33.95,
"DOXY 100MG VIAL 15ML",7038904,"CDM ",250,RC,,,OUTPATIENT,,,61,48.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",48.8,80,,39.04,,,0,"percent of total billed charges ","80% of total billed charges ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",56.73,93,,45.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",51.85,85,,41.48,,,0,"percent of total billed charges ","85% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",54.9,90,,43.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",53.07,87,,42.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.7,70,,34.16,,,0,"percent of total billed charges ","70% of total billed charges ",42.7,56.73,
"MONISTAT 7 VAG CR/AP",7039209,"CDM ",637,RC,,,OUTPATIENT,,,44,35.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.2,80,,28.16,,,0,"percent of total billed charges ","80% of total billed charges ",30.8,70,,24.64,,,0,"percent of total billed charges ","70% of total billed charges ",39.6,90,,31.68,,,0,"percent of total billed charges ","90% of total billed charges ",40.92,93,,32.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",37.4,85,,29.92,,,0,"percent of total billed charges ","85% of total billed charges ",39.6,90,,31.68,,,0,"percent of total billed charges ","90% of total billed charges ",39.6,90,,31.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",38.28,87,,30.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.8,70,,24.64,,,0,"percent of total billed charges ","70% of total billed charges ",30.8,40.92,
"TUCKS TAKLNG /12",7039522,"CDM ",637,RC,,,OUTPATIENT,,,15.5,12.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.4,80,,9.92,,,0,"percent of total billed charges ","80% of total billed charges ",10.85,70,,8.68,,,0,"percent of total billed charges ","70% of total billed charges ",13.95,90,,11.16,,,0,"percent of total billed charges ","90% of total billed charges ",14.42,93,,11.54,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.18,85,,10.54,,,0,"percent of total billed charges ","85% of total billed charges ",13.95,90,,11.16,,,0,"percent of total billed charges ","90% of total billed charges ",13.95,90,,11.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.49,87,,10.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.85,70,,8.68,,,0,"percent of total billed charges ","70% of total billed charges ",10.85,14.42,
"SUPRANE 2 LIMIN",7039688,"CDM ",250,RC,,,OUTPATIENT,,,10.5,8.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,80,,6.72,,,0,"percent of total billed charges ","80% of total billed charges ",7.35,70,,5.88,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,90,,7.56,,,0,"percent of total billed charges ","90% of total billed charges ",9.77,93,,7.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.93,85,,7.14,,,0,"percent of total billed charges ","85% of total billed charges ",9.45,90,,7.56,,,0,"percent of total billed charges ","90% of total billed charges ",9.45,90,,7.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.14,87,,7.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.35,70,,5.88,,,0,"percent of total billed charges ","70% of total billed charges ",7.35,9.77,
"PULMOZYME 2.5MG NEB",7039761,"CDM ",250,RC,,,OUTPATIENT,,,206,164.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",164.8,80,,131.84,,,0,"percent of total billed charges ","80% of total billed charges ",144.2,70,,115.36,,,0,"percent of total billed charges ","70% of total billed charges ",185.4,90,,148.32,,,0,"percent of total billed charges ","90% of total billed charges ",191.58,93,,153.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",175.1,85,,140.08,,,0,"percent of total billed charges ","85% of total billed charges ",185.4,90,,148.32,,,0,"percent of total billed charges ","90% of total billed charges ",185.4,90,,148.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",179.22,87,,143.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",144.2,70,,115.36,,,0,"percent of total billed charges ","70% of total billed charges ",144.2,191.58,
"GENT SULF OINT 0.1% 15G",7039951,"CDM ",637,RC,,,OUTPATIENT,,,95,76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76,80,,60.80,,,0,"percent of total billed charges ","80% of total billed charges ",66.5,70,,53.20,,,0,"percent of total billed charges ","70% of total billed charges ",85.5,90,,68.40,,,0,"percent of total billed charges ","90% of total billed charges ",88.35,93,,70.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.75,85,,64.60,,,0,"percent of total billed charges ","85% of total billed charges ",85.5,90,,68.40,,,0,"percent of total billed charges ","90% of total billed charges ",85.5,90,,68.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.65,87,,66.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.5,70,,53.20,,,0,"percent of total billed charges ","70% of total billed charges ",66.5,88.35,
"NYSTATIN CREAM 30GM",7039985,"CDM ",637,RC,,,OUTPATIENT,,,76.5,61.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.2,80,,48.96,,,0,"percent of total billed charges ","80% of total billed charges ",53.55,70,,42.84,,,0,"percent of total billed charges ","70% of total billed charges ",68.85,90,,55.08,,,0,"percent of total billed charges ","90% of total billed charges ",71.15,93,,56.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",65.03,85,,52.02,,,0,"percent of total billed charges ","85% of total billed charges ",68.85,90,,55.08,,,0,"percent of total billed charges ","90% of total billed charges ",68.85,90,,55.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",66.56,87,,53.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.55,70,,42.84,,,0,"percent of total billed charges ","70% of total billed charges ",53.55,71.15,
"LIDOCAINE JELLY 2% 20ML UROJET",7040009,"CDM ",250,RC,,,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.2,80,,24.96,,,0,"percent of total billed charges ","80% of total billed charges ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"SODIUM CHLOR 0.9% 20ML",7040041,"CDM ",250,RC,,,OUTPATIENT,,,8,6.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.4,80,,5.12,,,0,"percent of total billed charges ","80% of total billed charges ",5.6,70,,4.48,,,0,"percent of total billed charges ","70% of total billed charges ",7.2,90,,5.76,,,0,"percent of total billed charges ","90% of total billed charges ",7.44,93,,5.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6.8,85,,5.44,,,0,"percent of total billed charges ","85% of total billed charges ",7.2,90,,5.76,,,0,"percent of total billed charges ","90% of total billed charges ",7.2,90,,5.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.96,87,,5.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.6,70,,4.48,,,0,"percent of total billed charges ","70% of total billed charges ",5.6,7.44,
"SOLUTION NS 20ML INJ BACTERIO",7040058,"CDM ",250,RC,,,OUTPATIENT,,,10.5,8.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,80,,6.72,,,0,"percent of total billed charges ","80% of total billed charges ",7.35,70,,5.88,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,90,,7.56,,,0,"percent of total billed charges ","90% of total billed charges ",9.77,93,,7.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.93,85,,7.14,,,0,"percent of total billed charges ","85% of total billed charges ",9.45,90,,7.56,,,0,"percent of total billed charges ","90% of total billed charges ",9.45,90,,7.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.14,87,,7.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.35,70,,5.88,,,0,"percent of total billed charges ","70% of total billed charges ",7.35,9.77,
"WATER FOR INJ 10ML",7040066,"CDM ",250,RC,,,OUTPATIENT,,,46.5,37.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.2,80,,29.76,,,0,"percent of total billed charges ","80% of total billed charges ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",43.25,93,,34.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.53,85,,31.62,,,0,"percent of total billed charges ","85% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.46,87,,32.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",32.55,43.25,
"WATER FOR INJ 50ML",7040082,"CDM ",250,RC,,,OUTPATIENT,,,82.5,66,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66,80,,52.80,,,0,"percent of total billed charges ","80% of total billed charges ",57.75,70,,46.20,,,0,"percent of total billed charges ","70% of total billed charges ",74.25,90,,59.40,,,0,"percent of total billed charges ","90% of total billed charges ",76.73,93,,61.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.13,85,,56.10,,,0,"percent of total billed charges ","85% of total billed charges ",74.25,90,,59.40,,,0,"percent of total billed charges ","90% of total billed charges ",74.25,90,,59.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",71.78,87,,57.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.75,70,,46.20,,,0,"percent of total billed charges ","70% of total billed charges ",57.75,76.73,
"SULFACETAMIDE OPTH SOL 10%15ML",7040587,"CDM ",637,RC,,,OUTPATIENT,,,162,129.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.6,80,,103.68,,,0,"percent of total billed charges ","80% of total billed charges ",113.4,70,,90.72,,,0,"percent of total billed charges ","70% of total billed charges ",145.8,90,,116.64,,,0,"percent of total billed charges ","90% of total billed charges ",150.66,93,,120.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",137.7,85,,110.16,,,0,"percent of total billed charges ","85% of total billed charges ",145.8,90,,116.64,,,0,"percent of total billed charges ","90% of total billed charges ",145.8,90,,116.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",140.94,87,,112.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.4,70,,90.72,,,0,"percent of total billed charges ","70% of total billed charges ",113.4,150.66,
BACITR/NEOMY/POLY30G,7040637,"CDM ",250,RC,,,OUTPATIENT,,,38.5,30.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.8,80,,24.64,,,0,"percent of total billed charges ","80% of total billed charges ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,93,,28.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.73,85,,26.18,,,0,"percent of total billed charges ","85% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.5,87,,26.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",26.95,35.81,
"APLISOL 5TU/0.1ML",7040785,"CDM ",250,RC,,,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.4,80,,30.72,,,0,"percent of total billed charges ","80% of total billed charges ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",33.6,44.64,
"BETADINE SOL 10% 8 OZ",7040827,"CDM ",250,RC,,,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.2,80,,24.96,,,0,"percent of total billed charges ","80% of total billed charges ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"SOLUTION HESPAN 6% 500ML BAG",7041031,"CDM ",250,RC,,,OUTPATIENT,,,109.5,87.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.6,80,,70.08,,,0,"percent of total billed charges ","80% of total billed charges ",76.65,70,,61.32,,,0,"percent of total billed charges ","70% of total billed charges ",98.55,90,,78.84,,,0,"percent of total billed charges ","90% of total billed charges ",101.84,93,,81.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",93.08,85,,74.46,,,0,"percent of total billed charges ","85% of total billed charges ",98.55,90,,78.84,,,0,"percent of total billed charges ","90% of total billed charges ",98.55,90,,78.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",95.27,87,,76.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76.65,70,,61.32,,,0,"percent of total billed charges ","70% of total billed charges ",76.65,101.84,
"SOD BICARB INF 4.2% SYR",7041049,"CDM ",250,RC,,,OUTPATIENT,,,73,58.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.4,80,,46.72,,,0,"percent of total billed charges ","80% of total billed charges ",51.1,70,,40.88,,,0,"percent of total billed charges ","70% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",67.89,93,,54.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.05,85,,49.64,,,0,"percent of total billed charges ","85% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",65.7,90,,52.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.51,87,,50.81,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.1,70,,40.88,,,0,"percent of total billed charges ","70% of total billed charges ",51.1,67.89,
"FIXODENT CREAM 21GM",7041155,"CDM ",637,RC,,,OUTPATIENT,,,15,12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12,80,,9.60,,,0,"percent of total billed charges ","80% of total billed charges ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.95,93,,11.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.75,85,,10.20,,,0,"percent of total billed charges ","85% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.05,87,,10.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",10.5,13.95,
"GLUCOTROLXL 5MG GTTS",7041239,"CDM ",637,RC,,,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.8,80,,8.64,,,0,"percent of total billed charges ","80% of total billed charges ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"LUBRIDERM 240ML LOTION",7041353,"CDM ",637,RC,,,OUTPATIENT,,,9,7.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.2,80,,5.76,,,0,"percent of total billed charges ","80% of total billed charges ",6.3,70,,5.04,,,0,"percent of total billed charges ","70% of total billed charges ",8.1,90,,6.48,,,0,"percent of total billed charges ","90% of total billed charges ",8.37,93,,6.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",7.65,85,,6.12,,,0,"percent of total billed charges ","85% of total billed charges ",8.1,90,,6.48,,,0,"percent of total billed charges ","90% of total billed charges ",8.1,90,,6.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",7.83,87,,6.26,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.3,70,,5.04,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,8.37,
"MUCOMYST 20% 10ML",7041452,"CDM ",637,RC,,,OUTPATIENT,,,37,29.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.6,80,,23.68,,,0,"percent of total billed charges ","80% of total billed charges ",25.9,70,,20.72,,,0,"percent of total billed charges ","70% of total billed charges ",33.3,90,,26.64,,,0,"percent of total billed charges ","90% of total billed charges ",34.41,93,,27.53,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",31.45,85,,25.16,,,0,"percent of total billed charges ","85% of total billed charges ",33.3,90,,26.64,,,0,"percent of total billed charges ","90% of total billed charges ",33.3,90,,26.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",32.19,87,,25.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.9,70,,20.72,,,0,"percent of total billed charges ","70% of total billed charges ",25.9,34.41,
"MYCOGEN II CRM 15GM",7041494,"CDM ",637,RC,,,OUTPATIENT,,,38.5,30.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.8,80,,24.64,,,0,"percent of total billed charges ","80% of total billed charges ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,93,,28.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.73,85,,26.18,,,0,"percent of total billed charges ","85% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.5,87,,26.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",26.95,35.81,
"NITRO-DUR 0.2MG/HR",7041536,"CDM ",637,RC,,,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,80,,8.00,,,0,"percent of total billed charges ","80% of total billed charges ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"NITRO-DUR 0.4MG/HR",7041544,"CDM ",637,RC,,,OUTPATIENT,,,1.5,1.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.2,80,,0.96,,,0,"percent of total billed charges ","80% of total billed charges ",1.05,70,,0.84,,,0,"percent of total billed charges ","70% of total billed charges ",1.35,90,,1.08,,,0,"percent of total billed charges ","90% of total billed charges ",1.4,93,,1.12,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1.28,85,,1.02,,,0,"percent of total billed charges ","85% of total billed charges ",1.35,90,,1.08,,,0,"percent of total billed charges ","90% of total billed charges ",1.35,90,,1.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1.31,87,,1.05,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1.05,70,,0.84,,,0,"percent of total billed charges ","70% of total billed charges ",1.05,1.4,
"VASOTEC IV 1.25MG/ML",7042187,"CDM ",250,RC,,,OUTPATIENT,,,49.5,39.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.6,80,,31.68,,,0,"percent of total billed charges ","80% of total billed charges ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",46.04,93,,36.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.08,85,,33.66,,,0,"percent of total billed charges ","85% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.07,87,,34.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,46.04,
"OCUFLOX 5ML OPHTH",7042229,"CDM ",637,RC,,,OUTPATIENT,,,148.5,118.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",118.8,80,,95.04,,,0,"percent of total billed charges ","80% of total billed charges ",103.95,70,,83.16,,,0,"percent of total billed charges ","70% of total billed charges ",133.65,90,,106.92,,,0,"percent of total billed charges ","90% of total billed charges ",138.11,93,,110.49,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",126.23,85,,100.98,,,0,"percent of total billed charges ","85% of total billed charges ",133.65,90,,106.92,,,0,"percent of total billed charges ","90% of total billed charges ",133.65,90,,106.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",129.2,87,,103.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.95,70,,83.16,,,0,"percent of total billed charges ","70% of total billed charges ",103.95,138.11,
"NAFCILLIN GM1 ADVANT",7042393,"CDM ",250,RC,,,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.4,80,,30.72,,,0,"percent of total billed charges ","80% of total billed charges ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",33.6,44.64,
"NAFCILLIN 2GM ADD/VA",7042831,"CDM ",250,RC,,,OUTPATIENT,,,78,62.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.4,80,,49.92,,,0,"percent of total billed charges ","80% of total billed charges ",54.6,70,,43.68,,,0,"percent of total billed charges ","70% of total billed charges ",70.2,90,,56.16,,,0,"percent of total billed charges ","90% of total billed charges ",72.54,93,,58.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",66.3,85,,53.04,,,0,"percent of total billed charges ","85% of total billed charges ",70.2,90,,56.16,,,0,"percent of total billed charges ","90% of total billed charges ",70.2,90,,56.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",67.86,87,,54.29,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.6,70,,43.68,,,0,"percent of total billed charges ","70% of total billed charges ",54.6,72.54,
"NYSTATIN 15G OINT",7042849,"CDM ",637,RC,,,OUTPATIENT,,,56,44.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.8,80,,35.84,,,0,"percent of total billed charges ","80% of total billed charges ",39.2,70,,31.36,,,0,"percent of total billed charges ","70% of total billed charges ",50.4,90,,40.32,,,0,"percent of total billed charges ","90% of total billed charges ",52.08,93,,41.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",47.6,85,,38.08,,,0,"percent of total billed charges ","85% of total billed charges ",50.4,90,,40.32,,,0,"percent of total billed charges ","90% of total billed charges ",50.4,90,,40.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",48.72,87,,38.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.2,70,,31.36,,,0,"percent of total billed charges ","70% of total billed charges ",39.2,52.08,
"ISOSORBIDE OINT 5MG",7042864,"CDM ",637,RC,,,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.6,80,,7.68,,,0,"percent of total billed charges ","80% of total billed charges ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"MICONAZOLE 2% CRM 57MG TB",7042896,"CDM ",637,RC,,,OUTPATIENT,,,33.5,26.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.8,80,,21.44,,,0,"percent of total billed charges ","80% of total billed charges ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",31.16,93,,24.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.48,85,,22.78,,,0,"percent of total billed charges ","85% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.15,87,,23.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",23.45,31.16,
"NYSTATIN 15G CREAM",7042898,"CDM ",637,RC,,,OUTPATIENT,,,56,44.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.8,80,,35.84,,,0,"percent of total billed charges ","80% of total billed charges ",39.2,70,,31.36,,,0,"percent of total billed charges ","70% of total billed charges ",50.4,90,,40.32,,,0,"percent of total billed charges ","90% of total billed charges ",52.08,93,,41.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",47.6,85,,38.08,,,0,"percent of total billed charges ","85% of total billed charges ",50.4,90,,40.32,,,0,"percent of total billed charges ","90% of total billed charges ",50.4,90,,40.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",48.72,87,,38.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.2,70,,31.36,,,0,"percent of total billed charges ","70% of total billed charges ",39.2,52.08,
"CERVIDIL VAG INSERT",7043037,"CDM ",637,RC,,,OUTPATIENT,,,678,542.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",542.4,80,,433.92,,,0,"percent of total billed charges ","80% of total billed charges ",474.6,70,,379.68,,,0,"percent of total billed charges ","70% of total billed charges ",610.2,90,,488.16,,,0,"percent of total billed charges ","90% of total billed charges ",630.54,93,,504.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",576.3,85,,461.04,,,0,"percent of total billed charges ","85% of total billed charges ",610.2,90,,488.16,,,0,"percent of total billed charges ","90% of total billed charges ",610.2,90,,488.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",589.86,87,,471.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",474.6,70,,379.68,,,0,"percent of total billed charges ","70% of total billed charges ",474.6,630.54,
"SEVOFLURANE 2 L/MIN",7043144,"CDM ",250,RC,,,OUTPATIENT,,,9.5,7.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.6,80,,6.08,,,0,"percent of total billed charges ","80% of total billed charges ",6.65,70,,5.32,,,0,"percent of total billed charges ","70% of total billed charges ",8.55,90,,6.84,,,0,"percent of total billed charges ","90% of total billed charges ",8.84,93,,7.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.08,85,,6.46,,,0,"percent of total billed charges ","85% of total billed charges ",8.55,90,,6.84,,,0,"percent of total billed charges ","90% of total billed charges ",8.55,90,,6.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",8.27,87,,6.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.65,70,,5.32,,,0,"percent of total billed charges ","70% of total billed charges ",6.65,8.84,
"LINDANE 1% SHAMP 473 ML",7043151,"CDM ",637,RC,,,OUTPATIENT,,,231,184.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",184.8,80,,147.84,,,0,"percent of total billed charges ","80% of total billed charges ",161.7,70,,129.36,,,0,"percent of total billed charges ","70% of total billed charges ",207.9,90,,166.32,,,0,"percent of total billed charges ","90% of total billed charges ",214.83,93,,171.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",196.35,85,,157.08,,,0,"percent of total billed charges ","85% of total billed charges ",207.9,90,,166.32,,,0,"percent of total billed charges ","90% of total billed charges ",207.9,90,,166.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",200.97,87,,160.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",161.7,70,,129.36,,,0,"percent of total billed charges ","70% of total billed charges ",161.7,214.83,
"MYCOGEN II 30G OINT",7043169,"CDM ",637,RC,,,OUTPATIENT,,,38.5,30.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.8,80,,24.64,,,0,"percent of total billed charges ","80% of total billed charges ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,93,,28.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.73,85,,26.18,,,0,"percent of total billed charges ","85% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.5,87,,26.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",26.95,35.81,
"GLYCOPYRROLATE 0.2MG/ML 20ML",7043466,"CDM ",637,RC,,,OUTPATIENT,,,46.5,37.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.2,80,,29.76,,,0,"percent of total billed charges ","80% of total billed charges ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",43.25,93,,34.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.53,85,,31.62,,,0,"percent of total billed charges ","85% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.46,87,,32.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",32.55,43.25,
"TOBRADEX 2.5ML SUSP OPTH",7043540,"CDM ",637,RC,,,OUTPATIENT,,,173.5,138.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",138.8,80,,111.04,,,0,"percent of total billed charges ","80% of total billed charges ",121.45,70,,97.16,,,0,"percent of total billed charges ","70% of total billed charges ",156.15,90,,124.92,,,0,"percent of total billed charges ","90% of total billed charges ",161.36,93,,129.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",147.48,85,,117.98,,,0,"percent of total billed charges ","85% of total billed charges ",156.15,90,,124.92,,,0,"percent of total billed charges ","90% of total billed charges ",156.15,90,,124.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",150.95,87,,120.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",121.45,70,,97.16,,,0,"percent of total billed charges ","70% of total billed charges ",121.45,161.36,
"LIDEX OINT 30G 0.05%",7043771,"CDM ",637,RC,,,OUTPATIENT,,,88.5,70.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.8,80,,56.64,,,0,"percent of total billed charges ","80% of total billed charges ",61.95,70,,49.56,,,0,"percent of total billed charges ","70% of total billed charges ",79.65,90,,63.72,,,0,"percent of total billed charges ","90% of total billed charges ",82.31,93,,65.85,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",75.23,85,,60.18,,,0,"percent of total billed charges ","85% of total billed charges ",79.65,90,,63.72,,,0,"percent of total billed charges ","90% of total billed charges ",79.65,90,,63.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",77,87,,61.60,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.95,70,,49.56,,,0,"percent of total billed charges ","70% of total billed charges ",61.95,82.31,
"ATROVENT 0.03% NASAL 30ML",7044217,"CDM ",637,RC,,,OUTPATIENT,,,132,105.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",105.6,80,,84.48,,,0,"percent of total billed charges ","80% of total billed charges ",92.4,70,,73.92,,,0,"percent of total billed charges ","70% of total billed charges ",118.8,90,,95.04,,,0,"percent of total billed charges ","90% of total billed charges ",122.76,93,,98.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",112.2,85,,89.76,,,0,"percent of total billed charges ","85% of total billed charges ",118.8,90,,95.04,,,0,"percent of total billed charges ","90% of total billed charges ",118.8,90,,95.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",114.84,87,,91.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.4,70,,73.92,,,0,"percent of total billed charges ","70% of total billed charges ",92.4,122.76,
"GENTAMICIN OPH 0/3% 5ML",7044431,"CDM ",637,RC,,,OUTPATIENT,,,85.5,68.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.4,80,,54.72,,,0,"percent of total billed charges ","80% of total billed charges ",59.85,70,,47.88,,,0,"percent of total billed charges ","70% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",79.52,93,,63.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",72.68,85,,58.14,,,0,"percent of total billed charges ","85% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",74.39,87,,59.51,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.85,70,,47.88,,,0,"percent of total billed charges ","70% of total billed charges ",59.85,79.52,
"NITRO-DUR 0.1MG/HR",7044456,"CDM ",637,RC,,,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,80,,8.00,,,0,"percent of total billed charges ","80% of total billed charges ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"TAPAZOLLE 10 MG TAB",7044795,"CDM ",637,RC,,,OUTPATIENT,,,12,9.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.6,80,,7.68,,,0,"percent of total billed charges ","80% of total billed charges ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",11.16,93,,8.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.2,85,,8.16,,,0,"percent of total billed charges ","85% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",10.8,90,,8.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.44,87,,8.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,70,,6.72,,,0,"percent of total billed charges ","70% of total billed charges ",8.4,11.16,
"LEVOTHYROXINE 200MCG VIAL",7045065,"CDM ",250,RC,,,OUTPATIENT,,,267,213.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",213.6,80,,170.88,,,0,"percent of total billed charges ","80% of total billed charges ",186.9,70,,149.52,,,0,"percent of total billed charges ","70% of total billed charges ",240.3,90,,192.24,,,0,"percent of total billed charges ","90% of total billed charges ",248.31,93,,198.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",226.95,85,,181.56,,,0,"percent of total billed charges ","85% of total billed charges ",240.3,90,,192.24,,,0,"percent of total billed charges ","90% of total billed charges ",240.3,90,,192.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",232.29,87,,185.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",186.9,70,,149.52,,,0,"percent of total billed charges ","70% of total billed charges ",186.9,248.31,
"PIPERACILLIN-TAZOBACT 2.25GMVL",7045314,"CDM ",636,RC,,,OUTPATIENT,,,135,108,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",108,80,,86.40,,,0,"percent of total billed charges ","80% of total billed charges ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",125.55,93,,100.44,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",114.75,85,,91.80,,,0,"percent of total billed charges ","85% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",121.5,90,,97.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",117.45,87,,93.96,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94.5,70,,75.60,,,0,"percent of total billed charges ","70% of total billed charges ",94.5,125.55,
"IPRATROP BR .02% INH",7045545,"CDM ",637,RC,,,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,80,,8.00,,,0,"percent of total billed charges ","80% of total billed charges ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"XALATAN .005% 2.5ML OPTH SOL",7045594,"CDM ",250,RC,,,OUTPATIENT,,,250.5,200.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",200.4,80,,160.32,,,0,"percent of total billed charges ","80% of total billed charges ",175.35,70,,140.28,,,0,"percent of total billed charges ","70% of total billed charges ",225.45,90,,180.36,,,0,"percent of total billed charges ","90% of total billed charges ",232.97,93,,186.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",212.93,85,,170.34,,,0,"percent of total billed charges ","85% of total billed charges ",225.45,90,,180.36,,,0,"percent of total billed charges ","90% of total billed charges ",225.45,90,,180.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",217.94,87,,174.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",175.35,70,,140.28,,,0,"percent of total billed charges ","70% of total billed charges ",175.35,232.97,
"CARMOL UREA 20% 3 OZ CREAM",7045867,"CDM ",637,RC,,,OUTPATIENT,,,43.5,34.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.8,80,,27.84,,,0,"percent of total billed charges ","80% of total billed charges ",30.45,70,,24.36,,,0,"percent of total billed charges ","70% of total billed charges ",39.15,90,,31.32,,,0,"percent of total billed charges ","90% of total billed charges ",40.46,93,,32.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",36.98,85,,29.58,,,0,"percent of total billed charges ","85% of total billed charges ",39.15,90,,31.32,,,0,"percent of total billed charges ","90% of total billed charges ",39.15,90,,31.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",37.85,87,,30.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.45,70,,24.36,,,0,"percent of total billed charges ","70% of total billed charges ",30.45,40.46,
"SODIUM CHOLORIDE 3% 15ML VIAL",7045875,"CDM ",250,RC,,,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.2,80,,24.96,,,0,"percent of total billed charges ","80% of total billed charges ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"PROVENTIL HFA 6.7 GM INH",7045917,"CDM ",637,RC,,,OUTPATIENT,,,130.5,104.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",104.4,80,,83.52,,,0,"percent of total billed charges ","80% of total billed charges ",91.35,70,,73.08,,,0,"percent of total billed charges ","70% of total billed charges ",117.45,90,,93.96,,,0,"percent of total billed charges ","90% of total billed charges ",121.37,93,,97.10,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",110.93,85,,88.74,,,0,"percent of total billed charges ","85% of total billed charges ",117.45,90,,93.96,,,0,"percent of total billed charges ","90% of total billed charges ",117.45,90,,93.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",113.54,87,,90.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.35,70,,73.08,,,0,"percent of total billed charges ","70% of total billed charges ",91.35,121.37,
"FLONASE 50MCG/SPRAY 16GM",7046089,"CDM ",637,RC,,,OUTPATIENT,,,226.5,181.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",181.2,80,,144.96,,,0,"percent of total billed charges ","80% of total billed charges ",158.55,70,,126.84,,,0,"percent of total billed charges ","70% of total billed charges ",203.85,90,,163.08,,,0,"percent of total billed charges ","90% of total billed charges ",210.65,93,,168.52,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",192.53,85,,154.02,,,0,"percent of total billed charges ","85% of total billed charges ",203.85,90,,163.08,,,0,"percent of total billed charges ","90% of total billed charges ",203.85,90,,163.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",197.06,87,,157.65,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",158.55,70,,126.84,,,0,"percent of total billed charges ","70% of total billed charges ",158.55,210.65,
"MONISTAT-3 SUPP (3 PACK)",7046543,"CDM ",637,RC,,,OUTPATIENT,,,137.5,110,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",110,80,,88.00,,,0,"percent of total billed charges ","80% of total billed charges ",96.25,70,,77.00,,,0,"percent of total billed charges ","70% of total billed charges ",123.75,90,,99.00,,,0,"percent of total billed charges ","90% of total billed charges ",127.88,93,,102.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",116.88,85,,93.50,,,0,"percent of total billed charges ","85% of total billed charges ",123.75,90,,99.00,,,0,"percent of total billed charges ","90% of total billed charges ",123.75,90,,99.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",119.63,87,,95.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.25,70,,77.00,,,0,"percent of total billed charges ","70% of total billed charges ",96.25,127.88,
"NICODERM CQ PATCH 14MG",7046766,"CDM ",637,RC,,,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,80,,8.00,,,0,"percent of total billed charges ","80% of total billed charges ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"COMBIVENT INHALER 14.7GM",7046840,"CDM ",637,RC,,,OUTPATIENT,,,673.5,538.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",538.8,80,,431.04,,,0,"percent of total billed charges ","80% of total billed charges ",471.45,70,,377.16,,,0,"percent of total billed charges ","70% of total billed charges ",606.15,90,,484.92,,,0,"percent of total billed charges ","90% of total billed charges ",626.36,93,,501.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",572.48,85,,457.98,,,0,"percent of total billed charges ","85% of total billed charges ",606.15,90,,484.92,,,0,"percent of total billed charges ","90% of total billed charges ",606.15,90,,484.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",585.95,87,,468.76,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",471.45,70,,377.16,,,0,"percent of total billed charges ","70% of total billed charges ",471.45,626.36,
"SODIUM CHLORIDE 0.9% 50ML VIAL",7047012,"CDM ",250,RC,,,OUTPATIENT,,,64.5,51.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.6,80,,41.28,,,0,"percent of total billed charges ","80% of total billed charges ",45.15,70,,36.12,,,0,"percent of total billed charges ","70% of total billed charges ",58.05,90,,46.44,,,0,"percent of total billed charges ","90% of total billed charges ",59.99,93,,47.99,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",54.83,85,,43.86,,,0,"percent of total billed charges ","85% of total billed charges ",58.05,90,,46.44,,,0,"percent of total billed charges ","90% of total billed charges ",58.05,90,,46.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",56.12,87,,44.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.15,70,,36.12,,,0,"percent of total billed charges ","70% of total billed charges ",45.15,59.99,
"VISINE A.C. 5ML",7047061,"CDM ",637,RC,,,OUTPATIENT,,,4,3.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",3.2,80,,2.56,,,0,"percent of total billed charges ","80% of total billed charges ",2.8,70,,2.24,,,0,"percent of total billed charges ","70% of total billed charges ",3.6,90,,2.88,,,0,"percent of total billed charges ","90% of total billed charges ",3.72,93,,2.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",3.4,85,,2.72,,,0,"percent of total billed charges ","85% of total billed charges ",3.6,90,,2.88,,,0,"percent of total billed charges ","90% of total billed charges ",3.6,90,,2.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",3.48,87,,2.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",2.8,70,,2.24,,,0,"percent of total billed charges ","70% of total billed charges ",2.8,3.72,
"ASTELIN NASEL INHALER",7047111,"CDM ",637,RC,,,OUTPATIENT,,,93.5,74.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.8,80,,59.84,,,0,"percent of total billed charges ","80% of total billed charges ",65.45,70,,52.36,,,0,"percent of total billed charges ","70% of total billed charges ",84.15,90,,67.32,,,0,"percent of total billed charges ","90% of total billed charges ",86.96,93,,69.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",79.48,85,,63.58,,,0,"percent of total billed charges ","85% of total billed charges ",84.15,90,,67.32,,,0,"percent of total billed charges ","90% of total billed charges ",84.15,90,,67.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",81.35,87,,65.08,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.45,70,,52.36,,,0,"percent of total billed charges ","70% of total billed charges ",65.45,86.96,
"FLOVENT 220MCG-INHALER",7047285,"CDM ",637,RC,,,OUTPATIENT,,,719,575.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",575.2,80,,460.16,,,0,"percent of total billed charges ","80% of total billed charges ",503.3,70,,402.64,,,0,"percent of total billed charges ","70% of total billed charges ",647.1,90,,517.68,,,0,"percent of total billed charges ","90% of total billed charges ",668.67,93,,534.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",611.15,85,,488.92,,,0,"percent of total billed charges ","85% of total billed charges ",647.1,90,,517.68,,,0,"percent of total billed charges ","90% of total billed charges ",647.1,90,,517.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",625.53,87,,500.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",503.3,70,,402.64,,,0,"percent of total billed charges ","70% of total billed charges ",503.3,668.67,
"CIPRO IV 200MG/100ML PREMIX",7047582,"CDM ",250,RC,,,OUTPATIENT,,,99,79.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",79.2,80,,63.36,,,0,"percent of total billed charges ","80% of total billed charges ",69.3,70,,55.44,,,0,"percent of total billed charges ","70% of total billed charges ",89.1,90,,71.28,,,0,"percent of total billed charges ","90% of total billed charges ",92.07,93,,73.66,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",84.15,85,,67.32,,,0,"percent of total billed charges ","85% of total billed charges ",89.1,90,,71.28,,,0,"percent of total billed charges ","90% of total billed charges ",89.1,90,,71.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",86.13,87,,68.90,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.3,70,,55.44,,,0,"percent of total billed charges ","70% of total billed charges ",69.3,92.07,
SULFAMETHOXAZOLE/TRIMETHOPRIM,7047863,"CDM ",250,RC,,,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.4,80,,30.72,,,0,"percent of total billed charges ","80% of total billed charges ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",33.6,44.64,
"ELIMITE 5% CREAM 60 GM",7048069,"CDM ",637,RC,,,OUTPATIENT,,,151.5,121.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",121.2,80,,96.96,,,0,"percent of total billed charges ","80% of total billed charges ",106.05,70,,84.84,,,0,"percent of total billed charges ","70% of total billed charges ",136.35,90,,109.08,,,0,"percent of total billed charges ","90% of total billed charges ",140.9,93,,112.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",128.78,85,,103.02,,,0,"percent of total billed charges ","85% of total billed charges ",136.35,90,,109.08,,,0,"percent of total billed charges ","90% of total billed charges ",136.35,90,,109.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",131.81,87,,105.45,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",106.05,70,,84.84,,,0,"percent of total billed charges ","70% of total billed charges ",106.05,140.9,
"BACTROBAN 2% CREAM 15MG",7048564,"CDM ",637,RC,,,OUTPATIENT,,,242.5,194,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",194,80,,155.20,,,0,"percent of total billed charges ","80% of total billed charges ",169.75,70,,135.80,,,0,"percent of total billed charges ","70% of total billed charges ",218.25,90,,174.60,,,0,"percent of total billed charges ","90% of total billed charges ",225.53,93,,180.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",206.13,85,,164.90,,,0,"percent of total billed charges ","85% of total billed charges ",218.25,90,,174.60,,,0,"percent of total billed charges ","90% of total billed charges ",218.25,90,,174.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",210.98,87,,168.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",169.75,70,,135.80,,,0,"percent of total billed charges ","70% of total billed charges ",169.75,225.53,
"DIASTAT 10MG TUBE RECTAL",7048689,"CDM ",637,RC,,,OUTPATIENT,,,466,372.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",372.8,80,,298.24,,,0,"percent of total billed charges ","80% of total billed charges ",326.2,70,,260.96,,,0,"percent of total billed charges ","70% of total billed charges ",419.4,90,,335.52,,,0,"percent of total billed charges ","90% of total billed charges ",433.38,93,,346.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",396.1,85,,316.88,,,0,"percent of total billed charges ","85% of total billed charges ",419.4,90,,335.52,,,0,"percent of total billed charges ","90% of total billed charges ",419.4,90,,335.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",405.42,87,,324.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",326.2,70,,260.96,,,0,"percent of total billed charges ","70% of total billed charges ",326.2,433.38,
"AYR NASAL GEL",7048887,"CDM ",637,RC,,,OUTPATIENT,,,38.5,30.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.8,80,,24.64,,,0,"percent of total billed charges ","80% of total billed charges ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,93,,28.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.73,85,,26.18,,,0,"percent of total billed charges ","85% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.5,87,,26.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",26.95,35.81,
"NITRO-BID OIN 1GM PK 2%",7049091,"CDM ",637,RC,,,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,80,,8.00,,,0,"percent of total billed charges ","80% of total billed charges ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"LAMISIL CREAM 1% 30GM TUBE",7049133,"CDM ",637,RC,,,OUTPATIENT,,,56.5,45.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",45.2,80,,36.16,,,0,"percent of total billed charges ","80% of total billed charges ",39.55,70,,31.64,,,0,"percent of total billed charges ","70% of total billed charges ",50.85,90,,40.68,,,0,"percent of total billed charges ","90% of total billed charges ",52.55,93,,42.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",48.03,85,,38.42,,,0,"percent of total billed charges ","85% of total billed charges ",50.85,90,,40.68,,,0,"percent of total billed charges ","90% of total billed charges ",50.85,90,,40.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",49.16,87,,39.33,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.55,70,,31.64,,,0,"percent of total billed charges ","70% of total billed charges ",39.55,52.55,
"BETADINE SOL 14.8ML",7049141,"CDM ",250,RC,,,OUTPATIENT,,,16,12.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.8,80,,10.24,,,0,"percent of total billed charges ","80% of total billed charges ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.88,93,,11.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.6,85,,10.88,,,0,"percent of total billed charges ","85% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.92,87,,11.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,14.88,
"TOBRAMYCIN OPTH.SOL 0.3%",7049166,"CDM ",637,RC,,,OUTPATIENT,,,98.5,78.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",78.8,80,,63.04,,,0,"percent of total billed charges ","80% of total billed charges ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",91.61,93,,73.29,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",83.73,85,,66.98,,,0,"percent of total billed charges ","85% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",88.65,90,,70.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",85.7,87,,68.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.95,70,,55.16,,,0,"percent of total billed charges ","70% of total billed charges ",68.95,91.61,
"BACITRACIN OINTMENT 14GM",7049174,"CDM ",637,RC,,,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.2,80,,24.96,,,0,"percent of total billed charges ","80% of total billed charges ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"PULMICORT RESPULES 0.5MG 2ML",7049240,"CDM ",250,RC,,,OUTPATIENT,,,26.5,21.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.2,80,,16.96,,,0,"percent of total billed charges ","80% of total billed charges ",18.55,70,,14.84,,,0,"percent of total billed charges ","70% of total billed charges ",23.85,90,,19.08,,,0,"percent of total billed charges ","90% of total billed charges ",24.65,93,,19.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",22.53,85,,18.02,,,0,"percent of total billed charges ","85% of total billed charges ",23.85,90,,19.08,,,0,"percent of total billed charges ","90% of total billed charges ",23.85,90,,19.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",23.06,87,,18.45,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.55,70,,14.84,,,0,"percent of total billed charges ","70% of total billed charges ",18.55,24.65,
"PULMICORT RESPULES 0.25MG/2ML",7049257,"CDM ",250,RC,,,OUTPATIENT,,,25.5,20.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",20.4,80,,16.32,,,0,"percent of total billed charges ","80% of total billed charges ",17.85,70,,14.28,,,0,"percent of total billed charges ","70% of total billed charges ",22.95,90,,18.36,,,0,"percent of total billed charges ","90% of total billed charges ",23.72,93,,18.98,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",21.68,85,,17.34,,,0,"percent of total billed charges ","85% of total billed charges ",22.95,90,,18.36,,,0,"percent of total billed charges ","90% of total billed charges ",22.95,90,,18.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",22.19,87,,17.75,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.85,70,,14.28,,,0,"percent of total billed charges ","70% of total billed charges ",17.85,23.72,
"BACITRACIN OINT 0.9QM PACKET",7049562,"CDM ",637,RC,,,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,80,,8.00,,,0,"percent of total billed charges ","80% of total billed charges ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"ADVAIR DISKUS 250/50 INH",7049570,"CDM ",637,RC,,,OUTPATIENT,,,272.5,218,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",218,80,,174.40,,,0,"percent of total billed charges ","80% of total billed charges ",190.75,70,,152.60,,,0,"percent of total billed charges ","70% of total billed charges ",245.25,90,,196.20,,,0,"percent of total billed charges ","90% of total billed charges ",253.43,93,,202.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",231.63,85,,185.30,,,0,"percent of total billed charges ","85% of total billed charges ",245.25,90,,196.20,,,0,"percent of total billed charges ","90% of total billed charges ",245.25,90,,196.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",237.08,87,,189.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",190.75,70,,152.60,,,0,"percent of total billed charges ","70% of total billed charges ",190.75,253.43,
"ADVAIR DISKUS 500/50 INH",7049604,"CDM ",637,RC,,,OUTPATIENT,,,443.5,354.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",354.8,80,,283.84,,,0,"percent of total billed charges ","80% of total billed charges ",310.45,70,,248.36,,,0,"percent of total billed charges ","70% of total billed charges ",399.15,90,,319.32,,,0,"percent of total billed charges ","90% of total billed charges ",412.46,93,,329.97,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",376.98,85,,301.58,,,0,"percent of total billed charges ","85% of total billed charges ",399.15,90,,319.32,,,0,"percent of total billed charges ","90% of total billed charges ",399.15,90,,319.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",385.85,87,,308.68,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",310.45,70,,248.36,,,0,"percent of total billed charges ","70% of total billed charges ",310.45,412.46,
"FLOXIN OTIC 0.3% 5ML BR",7049638,"CDM ",637,RC,,,OUTPATIENT,,,197,157.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",157.6,80,,126.08,,,0,"percent of total billed charges ","80% of total billed charges ",137.9,70,,110.32,,,0,"percent of total billed charges ","70% of total billed charges ",177.3,90,,141.84,,,0,"percent of total billed charges ","90% of total billed charges ",183.21,93,,146.57,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",167.45,85,,133.96,,,0,"percent of total billed charges ","85% of total billed charges ",177.3,90,,141.84,,,0,"percent of total billed charges ","90% of total billed charges ",177.3,90,,141.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",171.39,87,,137.11,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",137.9,70,,110.32,,,0,"percent of total billed charges ","70% of total billed charges ",137.9,183.21,
"LIDODERM PATCH 5%",7049695,"CDM ",637,RC,,,OUTPATIENT,,,27,21.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.6,80,,17.28,,,0,"percent of total billed charges ","80% of total billed charges ",18.9,70,,15.12,,,0,"percent of total billed charges ","70% of total billed charges ",24.3,90,,19.44,,,0,"percent of total billed charges ","90% of total billed charges ",25.11,93,,20.09,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",22.95,85,,18.36,,,0,"percent of total billed charges ","85% of total billed charges ",24.3,90,,19.44,,,0,"percent of total billed charges ","90% of total billed charges ",24.3,90,,19.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",23.49,87,,18.79,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18.9,70,,15.12,,,0,"percent of total billed charges ","70% of total billed charges ",18.9,25.11,
"LUMIGAN OPHTH SOL 0.03% 2.5ML",7049703,"CDM ",637,RC,,,OUTPATIENT,,,324,259.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",259.2,80,,207.36,,,0,"percent of total billed charges ","80% of total billed charges ",226.8,70,,181.44,,,0,"percent of total billed charges ","70% of total billed charges ",291.6,90,,233.28,,,0,"percent of total billed charges ","90% of total billed charges ",301.32,93,,241.06,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",275.4,85,,220.32,,,0,"percent of total billed charges ","85% of total billed charges ",291.6,90,,233.28,,,0,"percent of total billed charges ","90% of total billed charges ",291.6,90,,233.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",281.88,87,,225.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",226.8,70,,181.44,,,0,"percent of total billed charges ","70% of total billed charges ",226.8,301.32,
"ADVAIR DISK 100/50 INH",7049836,"CDM ",637,RC,,,OUTPATIENT,,,272.5,218,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",218,80,,174.40,,,0,"percent of total billed charges ","80% of total billed charges ",190.75,70,,152.60,,,0,"percent of total billed charges ","70% of total billed charges ",245.25,90,,196.20,,,0,"percent of total billed charges ","90% of total billed charges ",253.43,93,,202.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",231.63,85,,185.30,,,0,"percent of total billed charges ","85% of total billed charges ",245.25,90,,196.20,,,0,"percent of total billed charges ","90% of total billed charges ",245.25,90,,196.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",237.08,87,,189.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",190.75,70,,152.60,,,0,"percent of total billed charges ","70% of total billed charges ",190.75,253.43,
"CORTISPORIN OTIC SUSP 10ML",7050289,"CDM ",637,RC,,,OUTPATIENT,,,119.5,95.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.6,80,,76.48,,,0,"percent of total billed charges ","80% of total billed charges ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",111.14,93,,88.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",101.58,85,,81.26,,,0,"percent of total billed charges ","85% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",103.97,87,,83.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",83.65,111.14,
"ALPHAGAN P 0.15% OPTH 5ML",7050305,"CDM ",637,RC,,,OUTPATIENT,,,295,236,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",236,80,,188.80,,,0,"percent of total billed charges ","80% of total billed charges ",206.5,70,,165.20,,,0,"percent of total billed charges ","70% of total billed charges ",265.5,90,,212.40,,,0,"percent of total billed charges ","90% of total billed charges ",274.35,93,,219.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",250.75,85,,200.60,,,0,"percent of total billed charges ","85% of total billed charges ",265.5,90,,212.40,,,0,"percent of total billed charges ","90% of total billed charges ",265.5,90,,212.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",256.65,87,,205.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",206.5,70,,165.20,,,0,"percent of total billed charges ","70% of total billed charges ",206.5,274.35,
"CIPRO HC OTIC 0.3% 5ML",7050461,"CDM ",637,RC,,,OUTPATIENT,,,284.5,227.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",227.6,80,,182.08,,,0,"percent of total billed charges ","80% of total billed charges ",199.15,70,,159.32,,,0,"percent of total billed charges ","70% of total billed charges ",256.05,90,,204.84,,,0,"percent of total billed charges ","90% of total billed charges ",264.59,93,,211.67,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",241.83,85,,193.46,,,0,"percent of total billed charges ","85% of total billed charges ",256.05,90,,204.84,,,0,"percent of total billed charges ","90% of total billed charges ",256.05,90,,204.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",247.52,87,,198.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",199.15,70,,159.32,,,0,"percent of total billed charges ","70% of total billed charges ",199.15,264.59,
"COSOPT PLUS OPTH 5ML",7050834,"CDM ",637,RC,,,OUTPATIENT,,,255,204,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",204,80,,163.20,,,0,"percent of total billed charges ","80% of total billed charges ",178.5,70,,142.80,,,0,"percent of total billed charges ","70% of total billed charges ",229.5,90,,183.60,,,0,"percent of total billed charges ","90% of total billed charges ",237.15,93,,189.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",216.75,85,,173.40,,,0,"percent of total billed charges ","85% of total billed charges ",229.5,90,,183.60,,,0,"percent of total billed charges ","90% of total billed charges ",229.5,90,,183.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",221.85,87,,177.48,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",178.5,70,,142.80,,,0,"percent of total billed charges ","70% of total billed charges ",178.5,237.15,
"QUIXIN OPTH 0.5% SOL 5ML",7050842,"CDM ",637,RC,,,OUTPATIENT,,,141.5,113.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",113.2,80,,90.56,,,0,"percent of total billed charges ","80% of total billed charges ",99.05,70,,79.24,,,0,"percent of total billed charges ","70% of total billed charges ",127.35,90,,101.88,,,0,"percent of total billed charges ","90% of total billed charges ",131.6,93,,105.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",120.28,85,,96.22,,,0,"percent of total billed charges ","85% of total billed charges ",127.35,90,,101.88,,,0,"percent of total billed charges ","90% of total billed charges ",127.35,90,,101.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",123.11,87,,98.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",99.05,70,,79.24,,,0,"percent of total billed charges ","70% of total billed charges ",99.05,131.6,
"RACEPINEPHRINE NEB 2.25% 0.5ML",7050883,"CDM ",250,RC,,,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,80,,8.00,,,0,"percent of total billed charges ","80% of total billed charges ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"SEREVENT DISKUS 50MCG INH",7051071,"CDM ",637,RC,,,OUTPATIENT,,,216,172.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",172.8,80,,138.24,,,0,"percent of total billed charges ","80% of total billed charges ",151.2,70,,120.96,,,0,"percent of total billed charges ","70% of total billed charges ",194.4,90,,155.52,,,0,"percent of total billed charges ","90% of total billed charges ",200.88,93,,160.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",183.6,85,,146.88,,,0,"percent of total billed charges ","85% of total billed charges ",194.4,90,,155.52,,,0,"percent of total billed charges ","90% of total billed charges ",194.4,90,,155.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",187.92,87,,150.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",151.2,70,,120.96,,,0,"percent of total billed charges ","70% of total billed charges ",151.2,200.88,
"VIQAMOX 0.5%OPTH SOL 5ML",7051618,"CDM ",637,RC,,,OUTPATIENT,,,305,244,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",244,80,,195.20,,,0,"percent of total billed charges ","80% of total billed charges ",213.5,70,,170.80,,,0,"percent of total billed charges ","70% of total billed charges ",274.5,90,,219.60,,,0,"percent of total billed charges ","90% of total billed charges ",283.65,93,,226.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",259.25,85,,207.40,,,0,"percent of total billed charges ","85% of total billed charges ",274.5,90,,219.60,,,0,"percent of total billed charges ","90% of total billed charges ",274.5,90,,219.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",265.35,87,,212.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",213.5,70,,170.80,,,0,"percent of total billed charges ","70% of total billed charges ",213.5,283.65,
"CIPRODEX OTIC 0.3% 7.5ML SOLN",7051667,"CDM ",637,RC,,,OUTPATIENT,,,410,328,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",328,80,,262.40,,,0,"percent of total billed charges ","80% of total billed charges ",287,70,,229.60,,,0,"percent of total billed charges ","70% of total billed charges ",369,90,,295.20,,,0,"percent of total billed charges ","90% of total billed charges ",381.3,93,,305.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",348.5,85,,278.80,,,0,"percent of total billed charges ","85% of total billed charges ",369,90,,295.20,,,0,"percent of total billed charges ","90% of total billed charges ",369,90,,295.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",356.7,87,,285.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",287,70,,229.60,,,0,"percent of total billed charges ","70% of total billed charges ",287,381.3,
"XYLOCAINE 2% JELLY 5ML",7051956,"CDM ",250,RC,,,OUTPATIENT,,,30,24,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24,80,,19.20,,,0,"percent of total billed charges ","80% of total billed charges ",21,70,,16.80,,,0,"percent of total billed charges ","70% of total billed charges ",27,90,,21.60,,,0,"percent of total billed charges ","90% of total billed charges ",27.9,93,,22.32,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.5,85,,20.40,,,0,"percent of total billed charges ","85% of total billed charges ",27,90,,21.60,,,0,"percent of total billed charges ","90% of total billed charges ",27,90,,21.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.1,87,,20.88,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21,70,,16.80,,,0,"percent of total billed charges ","70% of total billed charges ",21,27.9,
"SPIRIVA DPI 180MCG/EQ INHALER",7051972,"CDM ",637,RC,,,OUTPATIENT,,,229,183.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",183.2,80,,146.56,,,0,"percent of total billed charges ","80% of total billed charges ",160.3,70,,128.24,,,0,"percent of total billed charges ","70% of total billed charges ",206.1,90,,164.88,,,0,"percent of total billed charges ","90% of total billed charges ",212.97,93,,170.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",194.65,85,,155.72,,,0,"percent of total billed charges ","85% of total billed charges ",206.1,90,,164.88,,,0,"percent of total billed charges ","90% of total billed charges ",206.1,90,,164.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",199.23,87,,159.38,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",160.3,70,,128.24,,,0,"percent of total billed charges ","70% of total billed charges ",160.3,212.97,
"OMNICEF 300MG CAPSULE",7052319,"CDM ",637,RC,,,OUTPATIENT,,,14,11.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,80,,8.96,,,0,"percent of total billed charges ","80% of total billed charges ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",13.02,93,,10.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.9,85,,9.52,,,0,"percent of total billed charges ","85% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.18,87,,9.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",9.8,13.02,
"ZADITOR 0.025% SOL OPTH 5ML",7052327,"CDM ",637,RC,,,OUTPATIENT,,,35,28,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28,80,,22.40,,,0,"percent of total billed charges ","80% of total billed charges ",24.5,70,,19.60,,,0,"percent of total billed charges ","70% of total billed charges ",31.5,90,,25.20,,,0,"percent of total billed charges ","90% of total billed charges ",32.55,93,,26.04,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",29.75,85,,23.80,,,0,"percent of total billed charges ","85% of total billed charges ",31.5,90,,25.20,,,0,"percent of total billed charges ","90% of total billed charges ",31.5,90,,25.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",30.45,87,,24.36,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",24.5,70,,19.60,,,0,"percent of total billed charges ","70% of total billed charges ",24.5,32.55,
"CYMBALTA 30MG CAP",7052368,"CDM ",637,RC,,,OUTPATIENT,,,16,12.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.8,80,,10.24,,,0,"percent of total billed charges ","80% of total billed charges ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.88,93,,11.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.6,85,,10.88,,,0,"percent of total billed charges ","85% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.92,87,,11.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,14.88,
"BETADINE 10% SOLN 118ML BTL",7052434,"CDM ",637,RC,,,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.2,80,,24.96,,,0,"percent of total billed charges ","80% of total billed charges ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"MICARDIS 40MG TAB",7052509,"CDM ",637,RC,,,OUTPATIENT,,,17.5,14,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14,80,,11.20,,,0,"percent of total billed charges ","80% of total billed charges ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",16.28,93,,13.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.88,85,,11.90,,,0,"percent of total billed charges ","85% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.23,87,,12.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",12.25,16.28,
"CYMBALTA 20MG CAP",7052533,"CDM ",637,RC,,,OUTPATIENT,,,22.5,18,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18,80,,14.40,,,0,"percent of total billed charges ","80% of total billed charges ",15.75,70,,12.60,,,0,"percent of total billed charges ","70% of total billed charges ",20.25,90,,16.20,,,0,"percent of total billed charges ","90% of total billed charges ",20.93,93,,16.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.13,85,,15.30,,,0,"percent of total billed charges ","85% of total billed charges ",20.25,90,,16.20,,,0,"percent of total billed charges ","90% of total billed charges ",20.25,90,,16.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.58,87,,15.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.75,70,,12.60,,,0,"percent of total billed charges ","70% of total billed charges ",15.75,20.93,
"TRIAMCINOLONE ACET 0.025%  15G",7052814,"CDM ",637,RC,,,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.2,80,,24.96,,,0,"percent of total billed charges ","80% of total billed charges ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"MARINOL 2.5MG CAP",7052921,"CDM ",637,RC,,,OUTPATIENT,,,20.5,16.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",16.4,80,,13.12,,,0,"percent of total billed charges ","80% of total billed charges ",14.35,70,,11.48,,,0,"percent of total billed charges ","70% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",19.07,93,,15.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",17.43,85,,13.94,,,0,"percent of total billed charges ","85% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",18.45,90,,14.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",17.84,87,,14.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.35,70,,11.48,,,0,"percent of total billed charges ","70% of total billed charges ",14.35,19.07,
"REQUIP 1MG TAB",7052939,"CDM ",637,RC,,,OUTPATIENT,,,15,12,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12,80,,9.60,,,0,"percent of total billed charges ","80% of total billed charges ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.95,93,,11.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.75,85,,10.20,,,0,"percent of total billed charges ","85% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",13.5,90,,10.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.05,87,,10.44,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.5,70,,8.40,,,0,"percent of total billed charges ","70% of total billed charges ",10.5,13.95,
"ABREVA 10% CREAM 2GM",7052962,"CDM ",637,RC,,,OUTPATIENT,,,44.5,35.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.6,80,,28.48,,,0,"percent of total billed charges ","80% of total billed charges ",31.15,70,,24.92,,,0,"percent of total billed charges ","70% of total billed charges ",40.05,90,,32.04,,,0,"percent of total billed charges ","90% of total billed charges ",41.39,93,,33.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",37.83,85,,30.26,,,0,"percent of total billed charges ","85% of total billed charges ",40.05,90,,32.04,,,0,"percent of total billed charges ","90% of total billed charges ",40.05,90,,32.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",38.72,87,,30.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.15,70,,24.92,,,0,"percent of total billed charges ","70% of total billed charges ",31.15,41.39,
"LYRICA 75MG CAP",7052996,"CDM ",637,RC,,,OUTPATIENT,,,19,15.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.2,80,,12.16,,,0,"percent of total billed charges ","80% of total billed charges ",13.3,70,,10.64,,,0,"percent of total billed charges ","70% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.67,93,,14.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",16.15,85,,12.92,,,0,"percent of total billed charges ","85% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",17.1,90,,13.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",16.53,87,,13.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.3,70,,10.64,,,0,"percent of total billed charges ","70% of total billed charges ",13.3,17.67,
"MURO 128 5% OPTH SOL 15ML",7053069,"CDM ",637,RC,,,OUTPATIENT,,,38.5,30.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.8,80,,24.64,,,0,"percent of total billed charges ","80% of total billed charges ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,93,,28.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.73,85,,26.18,,,0,"percent of total billed charges ","85% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.5,87,,26.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",26.95,35.81,
"CILOXAN OPTH OINT 0.3% 3.5GM",7053085,"CDM ",637,RC,,,OUTPATIENT,,,195.5,156.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",156.4,80,,125.12,,,0,"percent of total billed charges ","80% of total billed charges ",136.85,70,,109.48,,,0,"percent of total billed charges ","70% of total billed charges ",175.95,90,,140.76,,,0,"percent of total billed charges ","90% of total billed charges ",181.82,93,,145.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",166.18,85,,132.94,,,0,"percent of total billed charges ","85% of total billed charges ",175.95,90,,140.76,,,0,"percent of total billed charges ","90% of total billed charges ",175.95,90,,140.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",170.09,87,,136.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",136.85,70,,109.48,,,0,"percent of total billed charges ","70% of total billed charges ",136.85,181.82,
"BELLADONNA/OPIUM 16.5/30MG SUP",7053101,"CDM ",637,RC,,,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.6,80,,9.28,,,0,"percent of total billed charges ","80% of total billed charges ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"CARDIZEM LA 180MG TAB",7053192,"CDM ",637,RC,,,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.8,80,,8.64,,,0,"percent of total billed charges ","80% of total billed charges ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"TRIAMCINOLONE 1% OINT",7053218,"CDM ",637,RC,,,OUTPATIENT,,,39,31.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.2,80,,24.96,,,0,"percent of total billed charges ","80% of total billed charges ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",36.27,93,,29.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.15,85,,26.52,,,0,"percent of total billed charges ","85% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",35.1,90,,28.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.93,87,,27.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.3,70,,21.84,,,0,"percent of total billed charges ","70% of total billed charges ",27.3,36.27,
"NITROFURANTOIN MACROC 100MG CP",7053259,"CDM ",637,RC,,,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.8,80,,8.64,,,0,"percent of total billed charges ","80% of total billed charges ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"VICKS VAPORUB",7053275,"CDM ",637,RC,,,OUTPATIENT,,,16,12.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.8,80,,10.24,,,0,"percent of total billed charges ","80% of total billed charges ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.88,93,,11.90,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",13.6,85,,10.88,,,0,"percent of total billed charges ","85% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",14.4,90,,11.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",13.92,87,,11.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,70,,8.96,,,0,"percent of total billed charges ","70% of total billed charges ",11.2,14.88,
"CHAPSTICK TUBE 4GM",7053291,"CDM ",637,RC,,,OUTPATIENT,,,7.5,6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6,80,,4.80,,,0,"percent of total billed charges ","80% of total billed charges ",5.25,70,,4.20,,,0,"percent of total billed charges ","70% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",6.98,93,,5.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6.38,85,,5.10,,,0,"percent of total billed charges ","85% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",6.75,90,,5.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.53,87,,5.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.25,70,,4.20,,,0,"percent of total billed charges ","70% of total billed charges ",5.25,6.98,
"FERROUS FUMARATE 324MG TAB",7053309,"CDM ",637,RC,,,OUTPATIENT,,,11,8.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.8,80,,7.04,,,0,"percent of total billed charges ","80% of total billed charges ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",10.23,93,,8.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.35,85,,7.48,,,0,"percent of total billed charges ","85% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.57,87,,7.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.7,10.23,
"MORPHINE CONC LIQ 10MG/0.5ML",7053408,"CDM ",637,RC,,,OUTPATIENT,,,22,17.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",17.6,80,,14.08,,,0,"percent of total billed charges ","80% of total billed charges ",15.4,70,,12.32,,,0,"percent of total billed charges ","70% of total billed charges ",19.8,90,,15.84,,,0,"percent of total billed charges ","90% of total billed charges ",20.46,93,,16.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",18.7,85,,14.96,,,0,"percent of total billed charges ","85% of total billed charges ",19.8,90,,15.84,,,0,"percent of total billed charges ","90% of total billed charges ",19.8,90,,15.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.14,87,,15.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.4,70,,12.32,,,0,"percent of total billed charges ","70% of total billed charges ",15.4,20.46,
"SYSTANE OPTH 15ML",7053424,"CDM ",637,RC,,,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.6,80,,4.48,,,0,"percent of total billed charges ","80% of total billed charges ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"OMNICEF 125MG/5ML 60ML",7053598,"CDM ",637,RC,,,OUTPATIENT,,,106,84.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.8,80,,67.84,,,0,"percent of total billed charges ","80% of total billed charges ",74.2,70,,59.36,,,0,"percent of total billed charges ","70% of total billed charges ",95.4,90,,76.32,,,0,"percent of total billed charges ","90% of total billed charges ",98.58,93,,78.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",90.1,85,,72.08,,,0,"percent of total billed charges ","85% of total billed charges ",95.4,90,,76.32,,,0,"percent of total billed charges ","90% of total billed charges ",95.4,90,,76.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",92.22,87,,73.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.2,70,,59.36,,,0,"percent of total billed charges ","70% of total billed charges ",74.2,98.58,
"BETADINE OPTH 5% SOL 5ML",7053648,"CDM ",637,RC,,,OUTPATIENT,,,44.5,35.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.6,80,,28.48,,,0,"percent of total billed charges ","80% of total billed charges ",31.15,70,,24.92,,,0,"percent of total billed charges ","70% of total billed charges ",40.05,90,,32.04,,,0,"percent of total billed charges ","90% of total billed charges ",41.39,93,,33.11,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",37.83,85,,30.26,,,0,"percent of total billed charges ","85% of total billed charges ",40.05,90,,32.04,,,0,"percent of total billed charges ","90% of total billed charges ",40.05,90,,32.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",38.72,87,,30.98,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.15,70,,24.92,,,0,"percent of total billed charges ","70% of total billed charges ",31.15,41.39,
"LYRICA 25MG CAP",7053655,"CDM ",637,RC,,,OUTPATIENT,,,16.5,13.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.2,80,,10.56,,,0,"percent of total billed charges ","80% of total billed charges ",11.55,70,,9.24,,,0,"percent of total billed charges ","70% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",15.35,93,,12.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.03,85,,11.22,,,0,"percent of total billed charges ","85% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.36,87,,11.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.55,70,,9.24,,,0,"percent of total billed charges ","70% of total billed charges ",11.55,15.35,
"ASPERCREME 10% TUBE",7053705,"CDM ",637,RC,,,OUTPATIENT,,,38.5,30.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.8,80,,24.64,,,0,"percent of total billed charges ","80% of total billed charges ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,93,,28.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.73,85,,26.18,,,0,"percent of total billed charges ","85% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.5,87,,26.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",26.95,35.81,
"TRIAMCINOLONE DENTAL PASTE 5GM",7053770,"CDM ",637,RC,,,OUTPATIENT,,,38.5,30.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.8,80,,24.64,,,0,"percent of total billed charges ","80% of total billed charges ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,93,,28.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.73,85,,26.18,,,0,"percent of total billed charges ","85% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.5,87,,26.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",26.95,35.81,
"CENTRUM LIQUID 30ML",7053796,"CDM ",637,RC,,,OUTPATIENT,,,17.5,14,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14,80,,11.20,,,0,"percent of total billed charges ","80% of total billed charges ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",16.28,93,,13.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.88,85,,11.90,,,0,"percent of total billed charges ","85% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",15.75,90,,12.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.23,87,,12.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.25,70,,9.80,,,0,"percent of total billed charges ","70% of total billed charges ",12.25,16.28,
"ULCEREASE 6% 178 ML",7053879,"CDM ",637,RC,,,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.6,80,,9.28,,,0,"percent of total billed charges ","80% of total billed charges ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"METOCLOPRAMIDE 1MG/ML 10ML SOL",7053911,"CDM ",637,RC,,,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,80,,8.00,,,0,"percent of total billed charges ","80% of total billed charges ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"MYLANTA 30ML UD",7053945,"CDM ",637,RC,,,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.6,80,,4.48,,,0,"percent of total billed charges ","80% of total billed charges ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"THAM SOL 500ML IV",7060189,"CDM ",250,RC,,,OUTPATIENT,,,518,414.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",414.4,80,,331.52,,,0,"percent of total billed charges ","80% of total billed charges ",362.6,70,,290.08,,,0,"percent of total billed charges ","70% of total billed charges ",466.2,90,,372.96,,,0,"percent of total billed charges ","90% of total billed charges ",481.74,93,,385.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",440.3,85,,352.24,,,0,"percent of total billed charges ","85% of total billed charges ",466.2,90,,372.96,,,0,"percent of total billed charges ","90% of total billed charges ",466.2,90,,372.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",450.66,87,,360.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",362.6,70,,290.08,,,0,"percent of total billed charges ","70% of total billed charges ",362.6,481.74,
"NIMBEX 2MG/ML CHG PER ML",7060262,"CDM ",250,RC,,,OUTPATIENT,,,73.5,58.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.8,80,,47.04,,,0,"percent of total billed charges ","80% of total billed charges ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",68.36,93,,54.69,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",62.48,85,,49.98,,,0,"percent of total billed charges ","85% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",66.15,90,,52.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",63.95,87,,51.16,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.45,70,,41.16,,,0,"percent of total billed charges ","70% of total billed charges ",51.45,68.36,
"SODIUM PHOSPHATES 45MM (15ML)",7060338,"CDM ",250,RC,,,OUTPATIENT,,,53,42.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",42.4,80,,33.92,,,0,"percent of total billed charges ","80% of total billed charges ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",49.29,93,,39.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",45.05,85,,36.04,,,0,"percent of total billed charges ","85% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",47.7,90,,38.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",46.11,87,,36.89,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.1,70,,29.68,,,0,"percent of total billed charges ","70% of total billed charges ",37.1,49.29,
"BACTERIOSTATIC 0.9% NS 20 ML",7060395,"CDM ",250,RC,,,OUTPATIENT,,,8,6.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.4,80,,5.12,,,0,"percent of total billed charges ","80% of total billed charges ",5.6,70,,4.48,,,0,"percent of total billed charges ","70% of total billed charges ",7.2,90,,5.76,,,0,"percent of total billed charges ","90% of total billed charges ",7.44,93,,5.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6.8,85,,5.44,,,0,"percent of total billed charges ","85% of total billed charges ",7.2,90,,5.76,,,0,"percent of total billed charges ","90% of total billed charges ",7.2,90,,5.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.96,87,,5.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.6,70,,4.48,,,0,"percent of total billed charges ","70% of total billed charges ",5.6,7.44,
"INFASURF IV 6ML(35MG/ML) SDV",7060965,"CDM ",250,RC,,,OUTPATIENT,,,1485,1188,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1188,80,,950.40,,,0,"percent of total billed charges ","80% of total billed charges ",1039.5,70,,831.60,,,0,"percent of total billed charges ","70% of total billed charges ",1336.5,90,,1069.20,,,0,"percent of total billed charges ","90% of total billed charges ",1381.05,93,,1104.84,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1262.25,85,,1009.80,,,0,"percent of total billed charges ","85% of total billed charges ",1336.5,90,,1069.20,,,0,"percent of total billed charges ","90% of total billed charges ",1336.5,90,,1069.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1291.95,87,,1033.56,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1039.5,70,,831.60,,,0,"percent of total billed charges ","70% of total billed charges ",1039.5,1381.05,
"LIDOCAINE 5% DEXTROSE 7.5% 2ML",7061021,"CDM ",250,RC,,,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.2,80,,31.36,,,0,"percent of total billed charges ","80% of total billed charges ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"GEODON 20MG/ML INJ",7061039,"CDM ",250,RC,,,OUTPATIENT,,,78,62.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",62.4,80,,49.92,,,0,"percent of total billed charges ","80% of total billed charges ",54.6,70,,43.68,,,0,"percent of total billed charges ","70% of total billed charges ",70.2,90,,56.16,,,0,"percent of total billed charges ","90% of total billed charges ",72.54,93,,58.03,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",66.3,85,,53.04,,,0,"percent of total billed charges ","85% of total billed charges ",70.2,90,,56.16,,,0,"percent of total billed charges ","90% of total billed charges ",70.2,90,,56.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",67.86,87,,54.29,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",54.6,70,,43.68,,,0,"percent of total billed charges ","70% of total billed charges ",54.6,72.54,
"SODIUM CHLORIDE 0.9% INH 15 ML",7061328,"CDM ",250,RC,,,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.6,80,,9.28,,,0,"percent of total billed charges ","80% of total billed charges ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"BREVIBLOC (10MG/ML) 250ML BAG",7061369,"CDM ",250,RC,,,OUTPATIENT,,,497,397.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",397.6,80,,318.08,,,0,"percent of total billed charges ","80% of total billed charges ",347.9,70,,278.32,,,0,"percent of total billed charges ","70% of total billed charges ",447.3,90,,357.84,,,0,"percent of total billed charges ","90% of total billed charges ",462.21,93,,369.77,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",422.45,85,,337.96,,,0,"percent of total billed charges ","85% of total billed charges ",447.3,90,,357.84,,,0,"percent of total billed charges ","90% of total billed charges ",447.3,90,,357.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",432.39,87,,345.91,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",347.9,70,,278.32,,,0,"percent of total billed charges ","70% of total billed charges ",347.9,462.21,
"ACETADOTE 200MG/ML 30ML VIAL",7061401,"CDM ",250,RC,,,OUTPATIENT,,,401.5,321.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",321.2,80,,256.96,,,0,"percent of total billed charges ","80% of total billed charges ",281.05,70,,224.84,,,0,"percent of total billed charges ","70% of total billed charges ",361.35,90,,289.08,,,0,"percent of total billed charges ","90% of total billed charges ",373.4,93,,298.72,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",341.28,85,,273.02,,,0,"percent of total billed charges ","85% of total billed charges ",361.35,90,,289.08,,,0,"percent of total billed charges ","90% of total billed charges ",361.35,90,,289.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",349.31,87,,279.45,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",281.05,70,,224.84,,,0,"percent of total billed charges ","70% of total billed charges ",281.05,373.4,
"ZYPREXA 10MG VIAL",7061518,"CDM ",250,RC,,,OUTPATIENT,,,63,50.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50.4,80,,40.32,,,0,"percent of total billed charges ","80% of total billed charges ",44.1,70,,35.28,,,0,"percent of total billed charges ","70% of total billed charges ",56.7,90,,45.36,,,0,"percent of total billed charges ","90% of total billed charges ",58.59,93,,46.87,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",53.55,85,,42.84,,,0,"percent of total billed charges ","85% of total billed charges ",56.7,90,,45.36,,,0,"percent of total billed charges ","90% of total billed charges ",56.7,90,,45.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",54.81,87,,43.85,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.1,70,,35.28,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,58.59,
"NOVOLOG 70/30 MIX 100U/ML 10ML",7061526,"CDM ",250,RC,,,OUTPATIENT,,,45,36,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36,80,,28.80,,,0,"percent of total billed charges ","80% of total billed charges ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,93,,33.48,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",38.25,85,,30.60,,,0,"percent of total billed charges ","85% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",40.5,90,,32.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",39.15,87,,31.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.5,70,,25.20,,,0,"percent of total billed charges ","70% of total billed charges ",31.5,41.85,
"ULTRAVATE 0.05% CREAM 15GM",7061542,"CDM ",637,RC,,,OUTPATIENT,,,115.5,92.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.4,80,,73.92,,,0,"percent of total billed charges ","80% of total billed charges ",80.85,70,,64.68,,,0,"percent of total billed charges ","70% of total billed charges ",103.95,90,,83.16,,,0,"percent of total billed charges ","90% of total billed charges ",107.42,93,,85.94,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",98.18,85,,78.54,,,0,"percent of total billed charges ","85% of total billed charges ",103.95,90,,83.16,,,0,"percent of total billed charges ","90% of total billed charges ",103.95,90,,83.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.49,87,,80.39,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.85,70,,64.68,,,0,"percent of total billed charges ","70% of total billed charges ",80.85,107.42,
"NS 0.9% 10ML FLUSH SYR",7061559,"CDM ",250,RC,,,OUTPATIENT,,,8,6.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",6.4,80,,5.12,,,0,"percent of total billed charges ","80% of total billed charges ",5.6,70,,4.48,,,0,"percent of total billed charges ","70% of total billed charges ",7.2,90,,5.76,,,0,"percent of total billed charges ","90% of total billed charges ",7.44,93,,5.95,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",6.8,85,,5.44,,,0,"percent of total billed charges ","85% of total billed charges ",7.2,90,,5.76,,,0,"percent of total billed charges ","90% of total billed charges ",7.2,90,,5.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.96,87,,5.57,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.6,70,,4.48,,,0,"percent of total billed charges ","70% of total billed charges ",5.6,7.44,
"SALINE FLUSH 3ML SYR",7061560,"CDM ",250,RC,,,OUTPATIENT,,,6.5,5.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.2,80,,4.16,,,0,"percent of total billed charges ","80% of total billed charges ",4.55,70,,3.64,,,0,"percent of total billed charges ","70% of total billed charges ",5.85,90,,4.68,,,0,"percent of total billed charges ","90% of total billed charges ",6.05,93,,4.84,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.53,85,,4.42,,,0,"percent of total billed charges ","85% of total billed charges ",5.85,90,,4.68,,,0,"percent of total billed charges ","90% of total billed charges ",5.85,90,,4.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",5.66,87,,4.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.55,70,,3.64,,,0,"percent of total billed charges ","70% of total billed charges ",4.55,6.05,
"XYLOCAINE-MPF 2% VIAL  5ML",7061567,"CDM ",250,RC,,,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.2,80,,31.36,,,0,"percent of total billed charges ","80% of total billed charges ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"VERSED 1MG/1ML 5ML SDV",7061609,"CDM ",250,RC,,,OUTPATIENT,,,49.5,39.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.6,80,,31.68,,,0,"percent of total billed charges ","80% of total billed charges ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",46.04,93,,36.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.08,85,,33.66,,,0,"percent of total billed charges ","85% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.07,87,,34.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,46.04,
"SODIUM PHOS 3MM/ML INJ",7061690,"CDM ",250,RC,,,OUTPATIENT,,,64,51.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",51.2,80,,40.96,,,0,"percent of total billed charges ","80% of total billed charges ",44.8,70,,35.84,,,0,"percent of total billed charges ","70% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",59.52,93,,47.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",54.4,85,,43.52,,,0,"percent of total billed charges ","85% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",57.6,90,,46.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",55.68,87,,44.54,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44.8,70,,35.84,,,0,"percent of total billed charges ","70% of total billed charges ",44.8,59.52,
"NEXIUM 40MG IV",7061708,"CDM ",250,RC,,,OUTPATIENT,,,94.5,75.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.6,80,,60.48,,,0,"percent of total billed charges ","80% of total billed charges ",66.15,70,,52.92,,,0,"percent of total billed charges ","70% of total billed charges ",85.05,90,,68.04,,,0,"percent of total billed charges ","90% of total billed charges ",87.89,93,,70.31,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.33,85,,64.26,,,0,"percent of total billed charges ","85% of total billed charges ",85.05,90,,68.04,,,0,"percent of total billed charges ","90% of total billed charges ",85.05,90,,68.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.22,87,,65.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.15,70,,52.92,,,0,"percent of total billed charges ","70% of total billed charges ",66.15,87.89,
"VALPORATE SODIUM 500MG/5ML INJ",7061765,"CDM ",250,RC,,,OUTPATIENT,,,46.5,37.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.2,80,,29.76,,,0,"percent of total billed charges ","80% of total billed charges ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",43.25,93,,34.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.53,85,,31.62,,,0,"percent of total billed charges ","85% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.46,87,,32.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",32.55,43.25,
"CYANIDE ANTIDOTE KIT",7061906,"CDM ",250,RC,,,OUTPATIENT,,,522,417.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",417.6,80,,334.08,,,0,"percent of total billed charges ","80% of total billed charges ",365.4,70,,292.32,,,0,"percent of total billed charges ","70% of total billed charges ",469.8,90,,375.84,,,0,"percent of total billed charges ","90% of total billed charges ",485.46,93,,388.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",443.7,85,,354.96,,,0,"percent of total billed charges ","85% of total billed charges ",469.8,90,,375.84,,,0,"percent of total billed charges ","90% of total billed charges ",469.8,90,,375.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",454.14,87,,363.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",365.4,70,,292.32,,,0,"percent of total billed charges ","70% of total billed charges ",365.4,485.46,
"ACETAMINOPHEN 160MG/5ML UD",7062030,"CDM ",637,RC,,,OUTPATIENT,,,7,5.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",5.6,80,,4.48,,,0,"percent of total billed charges ","80% of total billed charges ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.51,93,,5.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",5.95,85,,4.76,,,0,"percent of total billed charges ","85% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",6.3,90,,5.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",6.09,87,,4.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",4.9,70,,3.92,,,0,"percent of total billed charges ","70% of total billed charges ",4.9,6.51,
"SODIUM CHLORIDE 3% 500ML",7062086,"CDM ",250,RC,,,OUTPATIENT,,,82.5,66,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66,80,,52.80,,,0,"percent of total billed charges ","80% of total billed charges ",57.75,70,,46.20,,,0,"percent of total billed charges ","70% of total billed charges ",74.25,90,,59.40,,,0,"percent of total billed charges ","90% of total billed charges ",76.73,93,,61.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.13,85,,56.10,,,0,"percent of total billed charges ","85% of total billed charges ",74.25,90,,59.40,,,0,"percent of total billed charges ","90% of total billed charges ",74.25,90,,59.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",71.78,87,,57.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.75,70,,46.20,,,0,"percent of total billed charges ","70% of total billed charges ",57.75,76.73,
"PHENYTOIN SUSP 100MG/4ML UD",7062130,"CDM ",637,RC,,,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,80,,8.00,,,0,"percent of total billed charges ","80% of total billed charges ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"PROCTOFOAM HC 1%",7062140,"CDM ",637,RC,,,OUTPATIENT,,,228.5,182.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",182.8,80,,146.24,,,0,"percent of total billed charges ","80% of total billed charges ",159.95,70,,127.96,,,0,"percent of total billed charges ","70% of total billed charges ",205.65,90,,164.52,,,0,"percent of total billed charges ","90% of total billed charges ",212.51,93,,170.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",194.23,85,,155.38,,,0,"percent of total billed charges ","85% of total billed charges ",205.65,90,,164.52,,,0,"percent of total billed charges ","90% of total billed charges ",205.65,90,,164.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",198.8,87,,159.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",159.95,70,,127.96,,,0,"percent of total billed charges ","70% of total billed charges ",159.95,212.51,
"CEFAZOLIN 3GM 50ML BAG PREMI",7062194,"CDM ",636,RC,,,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92,80,,73.60,,,0,"percent of total billed charges ","80% of total billed charges ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",80.5,106.95,
"0.45% NS/20KCL 1000ML BAG",7062219,"CDM ",258,RC,,,OUTPATIENT,,,83,66.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.4,80,,53.12,,,0,"percent of total billed charges ","80% of total billed charges ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",72.21,87,,57.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",58.1,77.19,
"DEXTROSE 25% (INFANT) 10ML SYR",7062326,"CDM ",250,RC,,,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.2,80,,31.36,,,0,"percent of total billed charges ","80% of total billed charges ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"KCL 10MEQ/50ML WATER",7062375,"CDM ",250,RC,,,OUTPATIENT,,,91,72.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.8,80,,58.24,,,0,"percent of total billed charges ","80% of total billed charges ",63.7,70,,50.96,,,0,"percent of total billed charges ","70% of total billed charges ",81.9,90,,65.52,,,0,"percent of total billed charges ","90% of total billed charges ",84.63,93,,67.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",77.35,85,,61.88,,,0,"percent of total billed charges ","85% of total billed charges ",81.9,90,,65.52,,,0,"percent of total billed charges ","90% of total billed charges ",81.9,90,,65.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",79.17,87,,63.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.7,70,,50.96,,,0,"percent of total billed charges ","70% of total billed charges ",63.7,84.63,
"PULMICORT FLEXHALER 180MCG 120",7062650,"CDM ",637,RC,,,OUTPATIENT,,,248,198.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",198.4,80,,158.72,,,0,"percent of total billed charges ","80% of total billed charges ",173.6,70,,138.88,,,0,"percent of total billed charges ","70% of total billed charges ",223.2,90,,178.56,,,0,"percent of total billed charges ","90% of total billed charges ",230.64,93,,184.51,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",210.8,85,,168.64,,,0,"percent of total billed charges ","85% of total billed charges ",223.2,90,,178.56,,,0,"percent of total billed charges ","90% of total billed charges ",223.2,90,,178.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",215.76,87,,172.61,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",173.6,70,,138.88,,,0,"percent of total billed charges ","70% of total billed charges ",173.6,230.64,
"ONDANSETRON 4MG ODT",7062750,"CDM ",637,RC,,,OUTPATIENT,,,49.5,39.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.6,80,,31.68,,,0,"percent of total billed charges ","80% of total billed charges ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",46.04,93,,36.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.08,85,,33.66,,,0,"percent of total billed charges ","85% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",44.55,90,,35.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.07,87,,34.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.65,70,,27.72,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,46.04,
"MEGESTROL 400MG/10ML UNIT DOSE",7062760,"CDM ",250,RC,,,OUTPATIENT,,,14,11.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.2,80,,8.96,,,0,"percent of total billed charges ","80% of total billed charges ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",13.02,93,,10.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.9,85,,9.52,,,0,"percent of total billed charges ","85% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",12.6,90,,10.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.18,87,,9.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.8,70,,7.84,,,0,"percent of total billed charges ","70% of total billed charges ",9.8,13.02,
"GLUTOSE 15 ORAL GEL 37.5 GMS",7062910,"CDM ",637,RC,,,OUTPATIENT,,,18,14.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.4,80,,11.52,,,0,"percent of total billed charges ","80% of total billed charges ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.74,93,,13.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.3,85,,12.24,,,0,"percent of total billed charges ","85% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.66,87,,12.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,16.74,
"RELISTOR 12MG/0.6ML SC INJ",7063070,"CDM ",250,RC,,,OUTPATIENT,,,184.5,147.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",147.6,80,,118.08,,,0,"percent of total billed charges ","80% of total billed charges ",129.15,70,,103.32,,,0,"percent of total billed charges ","70% of total billed charges ",166.05,90,,132.84,,,0,"percent of total billed charges ","90% of total billed charges ",171.59,93,,137.27,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",156.83,85,,125.46,,,0,"percent of total billed charges ","85% of total billed charges ",166.05,90,,132.84,,,0,"percent of total billed charges ","90% of total billed charges ",166.05,90,,132.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",160.52,87,,128.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",129.15,70,,103.32,,,0,"percent of total billed charges ","70% of total billed charges ",129.15,171.59,
"VENTOLIN HFA 8GM INH AERO",7063080,"CDM ",637,RC,,,OUTPATIENT,,,58,46.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",46.4,80,,37.12,,,0,"percent of total billed charges ","80% of total billed charges ",40.6,70,,32.48,,,0,"percent of total billed charges ","70% of total billed charges ",52.2,90,,41.76,,,0,"percent of total billed charges ","90% of total billed charges ",53.94,93,,43.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",49.3,85,,39.44,,,0,"percent of total billed charges ","85% of total billed charges ",52.2,90,,41.76,,,0,"percent of total billed charges ","90% of total billed charges ",52.2,90,,41.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",50.46,87,,40.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.6,70,,32.48,,,0,"percent of total billed charges ","70% of total billed charges ",40.6,53.94,
"RANITIDINE HCL 150MG/10ML UDC",7063130,"CDM ",637,RC,,,OUTPATIENT,,,16.5,13.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.2,80,,10.56,,,0,"percent of total billed charges ","80% of total billed charges ",11.55,70,,9.24,,,0,"percent of total billed charges ","70% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",15.35,93,,12.28,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.03,85,,11.22,,,0,"percent of total billed charges ","85% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",14.85,90,,11.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.36,87,,11.49,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.55,70,,9.24,,,0,"percent of total billed charges ","70% of total billed charges ",11.55,15.35,
"INDOCIN IV 1 MG VIAL",7063300,"CDM ",250,RC,,,OUTPATIENT,,,1311.5,1049.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",1049.2,80,,839.36,,,0,"percent of total billed charges ","80% of total billed charges ",918.05,70,,734.44,,,0,"percent of total billed charges ","70% of total billed charges ",1180.35,90,,944.28,,,0,"percent of total billed charges ","90% of total billed charges ",1219.7,93,,975.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",1114.78,85,,891.82,,,0,"percent of total billed charges ","85% of total billed charges ",1180.35,90,,944.28,,,0,"percent of total billed charges ","90% of total billed charges ",1180.35,90,,944.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",1141.01,87,,912.81,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",918.05,70,,734.44,,,0,"percent of total billed charges ","70% of total billed charges ",918.05,1219.7,
"STERILE WATER 1000 ML INJ",7063340,"CDM ",250,RC,,,OUTPATIENT,,,75,60,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60,80,,48.00,,,0,"percent of total billed charges ","80% of total billed charges ",52.5,70,,42.00,,,0,"percent of total billed charges ","70% of total billed charges ",67.5,90,,54.00,,,0,"percent of total billed charges ","90% of total billed charges ",69.75,93,,55.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",63.75,85,,51.00,,,0,"percent of total billed charges ","85% of total billed charges ",67.5,90,,54.00,,,0,"percent of total billed charges ","90% of total billed charges ",67.5,90,,54.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",65.25,87,,52.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.5,70,,42.00,,,0,"percent of total billed charges ","70% of total billed charges ",52.5,69.75,
"WATER STERILE 500 ML BAG",7063341,"CDM ",250,RC,,,OUTPATIENT,,,75,60,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60,80,,48.00,,,0,"percent of total billed charges ","80% of total billed charges ",52.5,70,,42.00,,,0,"percent of total billed charges ","70% of total billed charges ",67.5,90,,54.00,,,0,"percent of total billed charges ","90% of total billed charges ",69.75,93,,55.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",63.75,85,,51.00,,,0,"percent of total billed charges ","85% of total billed charges ",67.5,90,,54.00,,,0,"percent of total billed charges ","90% of total billed charges ",67.5,90,,54.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",65.25,87,,52.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.5,70,,42.00,,,0,"percent of total billed charges ","70% of total billed charges ",52.5,69.75,
"SOD BICARBONATE 8.4% 50ML VIAL",7063380,"CDM ",250,RC,,,OUTPATIENT,,,36.5,29.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",29.2,80,,23.36,,,0,"percent of total billed charges ","80% of total billed charges ",25.55,70,,20.44,,,0,"percent of total billed charges ","70% of total billed charges ",32.85,90,,26.28,,,0,"percent of total billed charges ","90% of total billed charges ",33.95,93,,27.16,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",31.03,85,,24.82,,,0,"percent of total billed charges ","85% of total billed charges ",32.85,90,,26.28,,,0,"percent of total billed charges ","90% of total billed charges ",32.85,90,,26.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",31.76,87,,25.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",25.55,70,,20.44,,,0,"percent of total billed charges ","70% of total billed charges ",25.55,33.95,
"LUGOLS STRONG IODINE SOL 14ML",7063600,"CDM ",637,RC,,,OUTPATIENT,,,61.5,49.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",49.2,80,,39.36,,,0,"percent of total billed charges ","80% of total billed charges ",43.05,70,,34.44,,,0,"percent of total billed charges ","70% of total billed charges ",55.35,90,,44.28,,,0,"percent of total billed charges ","90% of total billed charges ",57.2,93,,45.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",52.28,85,,41.82,,,0,"percent of total billed charges ","85% of total billed charges ",55.35,90,,44.28,,,0,"percent of total billed charges ","90% of total billed charges ",55.35,90,,44.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",53.51,87,,42.81,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.05,70,,34.44,,,0,"percent of total billed charges ","70% of total billed charges ",43.05,57.2,
"AMNISURE KIT",7063670,"CDM ",637,RC,,,OUTPATIENT,,,103.5,82.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.8,80,,66.24,,,0,"percent of total billed charges ","80% of total billed charges ",72.45,70,,57.96,,,0,"percent of total billed charges ","70% of total billed charges ",93.15,90,,74.52,,,0,"percent of total billed charges ","90% of total billed charges ",96.26,93,,77.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",87.98,85,,70.38,,,0,"percent of total billed charges ","85% of total billed charges ",93.15,90,,74.52,,,0,"percent of total billed charges ","90% of total billed charges ",93.15,90,,74.52,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",90.05,87,,72.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",72.45,70,,57.96,,,0,"percent of total billed charges ","70% of total billed charges ",72.45,96.26,
"LABETALOL HCL 20MG/4ML",7063820,"CDM ",250,RC,,,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.2,80,,31.36,,,0,"percent of total billed charges ","80% of total billed charges ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"TRICOR 48MG TAB",7063870,"CDM ",637,RC,,,OUTPATIENT,,,13.5,10.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.8,80,,8.64,,,0,"percent of total billed charges ","80% of total billed charges ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.56,93,,10.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",11.48,85,,9.18,,,0,"percent of total billed charges ","85% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",12.15,90,,9.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",11.75,87,,9.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.45,70,,7.56,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,12.56,
"FUL-GLO 1MG OPTH STRIPS",7063880,"CDM ",637,RC,,,OUTPATIENT,,,40.5,32.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.4,80,,25.92,,,0,"percent of total billed charges ","80% of total billed charges ",28.35,70,,22.68,,,0,"percent of total billed charges ","70% of total billed charges ",36.45,90,,29.16,,,0,"percent of total billed charges ","90% of total billed charges ",37.67,93,,30.14,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34.43,85,,27.54,,,0,"percent of total billed charges ","85% of total billed charges ",36.45,90,,29.16,,,0,"percent of total billed charges ","90% of total billed charges ",36.45,90,,29.16,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",35.24,87,,28.19,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28.35,70,,22.68,,,0,"percent of total billed charges ","70% of total billed charges ",28.35,37.67,
"CLEOCIN/5% DEXTROSE 300MG/50ML",7064000,"CDM ",250,RC,,,OUTPATIENT,,,83.5,66.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.8,80,,53.44,,,0,"percent of total billed charges ","80% of total billed charges ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",77.66,93,,62.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.98,85,,56.78,,,0,"percent of total billed charges ","85% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",72.65,87,,58.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",58.45,77.66,
"QUETIAPINE ER 150MG TAB",7064091,"CDM ",259,RC,,,OUTPATIENT,,,11.5,9.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",9.2,80,,7.36,,,0,"percent of total billed charges ","80% of total billed charges ",8.05,70,,6.44,,,0,"percent of total billed charges ","70% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.7,93,,8.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.78,85,,7.82,,,0,"percent of total billed charges ","85% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",10.35,90,,8.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.01,87,,8.01,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.05,70,,6.44,,,0,"percent of total billed charges ","70% of total billed charges ",8.05,10.7,
"CLINIMIX 5%/20% W/LYTES 1000ML",7064130,"CDM ",250,RC,,,OUTPATIENT,,,108.5,86.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",86.8,80,,69.44,,,0,"percent of total billed charges ","80% of total billed charges ",75.95,70,,60.76,,,0,"percent of total billed charges ","70% of total billed charges ",97.65,90,,78.12,,,0,"percent of total billed charges ","90% of total billed charges ",100.91,93,,80.73,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",92.23,85,,73.78,,,0,"percent of total billed charges ","85% of total billed charges ",97.65,90,,78.12,,,0,"percent of total billed charges ","90% of total billed charges ",97.65,90,,78.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",94.4,87,,75.52,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",75.95,70,,60.76,,,0,"percent of total billed charges ","70% of total billed charges ",75.95,100.91,
"CLINIMIX 5%/20% 1000ML BAG",7064140,"CDM ",250,RC,,,OUTPATIENT,,,157,125.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",125.6,80,,100.48,,,0,"percent of total billed charges ","80% of total billed charges ",109.9,70,,87.92,,,0,"percent of total billed charges ","70% of total billed charges ",141.3,90,,113.04,,,0,"percent of total billed charges ","90% of total billed charges ",146.01,93,,116.81,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",133.45,85,,106.76,,,0,"percent of total billed charges ","85% of total billed charges ",141.3,90,,113.04,,,0,"percent of total billed charges ","90% of total billed charges ",141.3,90,,113.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",136.59,87,,109.27,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",109.9,70,,87.92,,,0,"percent of total billed charges ","70% of total billed charges ",109.9,146.01,
"AVELOX 400MG IV PREMIX 250CC",7064270,"CDM ",250,RC,,,OUTPATIENT,,,121,96.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.8,80,,77.44,,,0,"percent of total billed charges ","80% of total billed charges ",84.7,70,,67.76,,,0,"percent of total billed charges ","70% of total billed charges ",108.9,90,,87.12,,,0,"percent of total billed charges ","90% of total billed charges ",112.53,93,,90.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",102.85,85,,82.28,,,0,"percent of total billed charges ","85% of total billed charges ",108.9,90,,87.12,,,0,"percent of total billed charges ","90% of total billed charges ",108.9,90,,87.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",105.27,87,,84.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.7,70,,67.76,,,0,"percent of total billed charges ","70% of total billed charges ",84.7,112.53,
"CLINDAMYCIN PHOS/DEX 600MG/50M",7064290,"CDM ",250,RC,,,OUTPATIENT,,,93,74.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",74.4,80,,59.52,,,0,"percent of total billed charges ","80% of total billed charges ",65.1,70,,52.08,,,0,"percent of total billed charges ","70% of total billed charges ",83.7,90,,66.96,,,0,"percent of total billed charges ","90% of total billed charges ",86.49,93,,69.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",79.05,85,,63.24,,,0,"percent of total billed charges ","85% of total billed charges ",83.7,90,,66.96,,,0,"percent of total billed charges ","90% of total billed charges ",83.7,90,,66.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",80.91,87,,64.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.1,70,,52.08,,,0,"percent of total billed charges ","70% of total billed charges ",65.1,86.49,
"DOPAMINE/D5W 800MG/250ML BAG",7064310,"CDM ",250,RC,,,OUTPATIENT,,,86.5,69.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",69.2,80,,55.36,,,0,"percent of total billed charges ","80% of total billed charges ",60.55,70,,48.44,,,0,"percent of total billed charges ","70% of total billed charges ",77.85,90,,62.28,,,0,"percent of total billed charges ","90% of total billed charges ",80.45,93,,64.36,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",73.53,85,,58.82,,,0,"percent of total billed charges ","85% of total billed charges ",77.85,90,,62.28,,,0,"percent of total billed charges ","90% of total billed charges ",77.85,90,,62.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",75.26,87,,60.21,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60.55,70,,48.44,,,0,"percent of total billed charges ","70% of total billed charges ",60.55,80.45,
"AZITHROMYCIN 500MG ADV",7064320,"CDM ",250,RC,,,OUTPATIENT,,,46.5,37.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",37.2,80,,29.76,,,0,"percent of total billed charges ","80% of total billed charges ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",43.25,93,,34.60,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.53,85,,31.62,,,0,"percent of total billed charges ","85% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",41.85,90,,33.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.46,87,,32.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.55,70,,26.04,,,0,"percent of total billed charges ","70% of total billed charges ",32.55,43.25,
"NS 25ML BAG",7064390,"CDM ",250,RC,,,OUTPATIENT,,,83,66.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.4,80,,53.12,,,0,"percent of total billed charges ","80% of total billed charges ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",72.21,87,,57.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",58.1,77.19,
"ASCORBIC ACID 500MG/ML 50ML VL",7064600,"CDM ",250,RC,,,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92,80,,73.60,,,0,"percent of total billed charges ","80% of total billed charges ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",80.5,106.95,
"NYSTATIN 100,000U/ML 5ML UDC",7064730,"CDM ",637,RC,,,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,80,,8.00,,,0,"percent of total billed charges ","80% of total billed charges ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
SULFAMETHOXAZOLE-TRIMETHOPRIM,7064740,"CDM ",637,RC,,,OUTPATIENT,,,14.5,11.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.6,80,,9.28,,,0,"percent of total billed charges ","80% of total billed charges ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.49,93,,10.79,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",12.33,85,,9.86,,,0,"percent of total billed charges ","85% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",13.05,90,,10.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",12.62,87,,10.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10.15,70,,8.12,,,0,"percent of total billed charges ","70% of total billed charges ",10.15,13.49,
"LIDOCAINE 2% 10ML VIAL",7064810,"CDM ",250,RC,,,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.4,80,,30.72,,,0,"percent of total billed charges ","80% of total billed charges ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",33.6,44.64,
"LIDOCAINE HCL-MPF INJ 30ML",7064820,"CDM ",250,RC,,,OUTPATIENT,,,49,39.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",39.2,80,,31.36,,,0,"percent of total billed charges ","80% of total billed charges ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",45.57,93,,36.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",41.65,85,,33.32,,,0,"percent of total billed charges ","85% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",44.1,90,,35.28,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",42.63,87,,34.10,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.3,70,,27.44,,,0,"percent of total billed charges ","70% of total billed charges ",34.3,45.57,
"FAT EMULSION 20% 250ML BAG",7064830,"CDM ",250,RC,,,OUTPATIENT,,,121,96.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",96.8,80,,77.44,,,0,"percent of total billed charges ","80% of total billed charges ",84.7,70,,67.76,,,0,"percent of total billed charges ","70% of total billed charges ",108.9,90,,87.12,,,0,"percent of total billed charges ","90% of total billed charges ",112.53,93,,90.02,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",102.85,85,,82.28,,,0,"percent of total billed charges ","85% of total billed charges ",108.9,90,,87.12,,,0,"percent of total billed charges ","90% of total billed charges ",108.9,90,,87.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",105.27,87,,84.22,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",84.7,70,,67.76,,,0,"percent of total billed charges ","70% of total billed charges ",84.7,112.53,
"POLYMYXIN B-TRIM OPTH 10ML BTL",7064860,"CDM ",250,RC,,,OUTPATIENT,,,38.5,30.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.8,80,,24.64,,,0,"percent of total billed charges ","80% of total billed charges ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",35.81,93,,28.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",32.73,85,,26.18,,,0,"percent of total billed charges ","85% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",34.65,90,,27.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",33.5,87,,26.80,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.95,70,,21.56,,,0,"percent of total billed charges ","70% of total billed charges ",26.95,35.81,
"AMIODARONE DEXTROSE 150MG/100M",7064870,"CDM ",250,RC,,,OUTPATIENT,,,117.5,94,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",94,80,,75.20,,,0,"percent of total billed charges ","80% of total billed charges ",82.25,70,,65.80,,,0,"percent of total billed charges ","70% of total billed charges ",105.75,90,,84.60,,,0,"percent of total billed charges ","90% of total billed charges ",109.28,93,,87.42,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",99.88,85,,79.90,,,0,"percent of total billed charges ","85% of total billed charges ",105.75,90,,84.60,,,0,"percent of total billed charges ","90% of total billed charges ",105.75,90,,84.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",102.23,87,,81.78,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82.25,70,,65.80,,,0,"percent of total billed charges ","70% of total billed charges ",82.25,109.28,
"ROCURONIUM 100MG/10ML INJ VIAL",7064920,"CDM ",250,RC,,,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.4,80,,30.72,,,0,"percent of total billed charges ","80% of total billed charges ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",33.6,44.64,
"SODIUM PHOS 15MMOLE/D5W 250ML",7064960,"CDM ",250,RC,,,OUTPATIENT,,,129.5,103.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",103.6,80,,82.88,,,0,"percent of total billed charges ","80% of total billed charges ",90.65,70,,72.52,,,0,"percent of total billed charges ","70% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",120.44,93,,96.35,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",110.08,85,,88.06,,,0,"percent of total billed charges ","85% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",116.55,90,,93.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",112.67,87,,90.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",90.65,70,,72.52,,,0,"percent of total billed charges ","70% of total billed charges ",90.65,120.44,
"POTASSIUM PHOS 20MEQ/250ML NS",7064970,"CDM ",250,RC,,,OUTPATIENT,,,127.5,102,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",102,80,,81.60,,,0,"percent of total billed charges ","80% of total billed charges ",89.25,70,,71.40,,,0,"percent of total billed charges ","70% of total billed charges ",114.75,90,,91.80,,,0,"percent of total billed charges ","90% of total billed charges ",118.58,93,,94.86,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",108.38,85,,86.70,,,0,"percent of total billed charges ","85% of total billed charges ",114.75,90,,91.80,,,0,"percent of total billed charges ","90% of total billed charges ",114.75,90,,91.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",110.93,87,,88.74,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",89.25,70,,71.40,,,0,"percent of total billed charges ","70% of total billed charges ",89.25,118.58,
"POTASSIUM PHOS 15MM/22MEG",7064972,"CDM ",250,RC,,,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92,80,,73.60,,,0,"percent of total billed charges ","80% of total billed charges ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",80.5,106.95,
"SODIUM CHLORIDE 14.6% 20ML INJ",7064990,"CDM ",250,RC,,,OUTPATIENT,,,39.5,31.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",31.6,80,,25.28,,,0,"percent of total billed charges ","80% of total billed charges ",27.65,70,,22.12,,,0,"percent of total billed charges ","70% of total billed charges ",35.55,90,,28.44,,,0,"percent of total billed charges ","90% of total billed charges ",36.74,93,,29.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",33.58,85,,26.86,,,0,"percent of total billed charges ","85% of total billed charges ",35.55,90,,28.44,,,0,"percent of total billed charges ","90% of total billed charges ",35.55,90,,28.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",34.37,87,,27.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.65,70,,22.12,,,0,"percent of total billed charges ","70% of total billed charges ",27.65,36.74,
"LEVOTHYROXINE SOD 100MCG VIAL",7065130,"CDM ",250,RC,,,OUTPATIENT,,,238,190.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",190.4,80,,152.32,,,0,"percent of total billed charges ","80% of total billed charges ",166.6,70,,133.28,,,0,"percent of total billed charges ","70% of total billed charges ",214.2,90,,171.36,,,0,"percent of total billed charges ","90% of total billed charges ",221.34,93,,177.07,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",202.3,85,,161.84,,,0,"percent of total billed charges ","85% of total billed charges ",214.2,90,,171.36,,,0,"percent of total billed charges ","90% of total billed charges ",214.2,90,,171.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",207.06,87,,165.65,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",166.6,70,,133.28,,,0,"percent of total billed charges ","70% of total billed charges ",166.6,221.34,
"WATER STERILE INJ 20ML VIAL",7065210,"CDM ",250,RC,,,OUTPATIENT,,,27.5,22,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",22,80,,17.60,,,0,"percent of total billed charges ","80% of total billed charges ",19.25,70,,15.40,,,0,"percent of total billed charges ","70% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",25.58,93,,20.46,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",23.38,85,,18.70,,,0,"percent of total billed charges ","85% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",24.75,90,,19.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",23.93,87,,19.14,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",19.25,70,,15.40,,,0,"percent of total billed charges ","70% of total billed charges ",19.25,25.58,
"LIDO HCL 1% (LOCAL) 30ML VIAL",7065230,"CDM ",250,RC,,,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.4,80,,30.72,,,0,"percent of total billed charges ","80% of total billed charges ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",33.6,44.64,
"DEXTROSE 10% 250ML BAG",7065250,"CDM ",258,RC,,,OUTPATIENT,,,74.5,59.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.6,80,,47.68,,,0,"percent of total billed charges ","80% of total billed charges ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",69.29,93,,55.43,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",63.33,85,,50.66,,,0,"percent of total billed charges ","85% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",67.05,90,,53.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",64.82,87,,51.86,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.15,70,,41.72,,,0,"percent of total billed charges ","70% of total billed charges ",52.15,69.29,
"KCL 10MEQ/D5/0.45 NACL 1000ML",7065290,"CDM ",258,RC,,,OUTPATIENT,,,82.5,66,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66,80,,52.80,,,0,"percent of total billed charges ","80% of total billed charges ",57.75,70,,46.20,,,0,"percent of total billed charges ","70% of total billed charges ",74.25,90,,59.40,,,0,"percent of total billed charges ","90% of total billed charges ",76.73,93,,61.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.13,85,,56.10,,,0,"percent of total billed charges ","85% of total billed charges ",74.25,90,,59.40,,,0,"percent of total billed charges ","90% of total billed charges ",74.25,90,,59.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",71.78,87,,57.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.75,70,,46.20,,,0,"percent of total billed charges ","70% of total billed charges ",57.75,76.73,
"POVIDONE-IODINE 10% SOLN 59ML",7065300,"CDM ",637,RC,,,OUTPATIENT,,,34,27.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",27.2,80,,21.76,,,0,"percent of total billed charges ","80% of total billed charges ",23.8,70,,19.04,,,0,"percent of total billed charges ","70% of total billed charges ",30.6,90,,24.48,,,0,"percent of total billed charges ","90% of total billed charges ",31.62,93,,25.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.9,85,,23.12,,,0,"percent of total billed charges ","85% of total billed charges ",30.6,90,,24.48,,,0,"percent of total billed charges ","90% of total billed charges ",30.6,90,,24.48,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.58,87,,23.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.8,70,,19.04,,,0,"percent of total billed charges ","70% of total billed charges ",23.8,31.62,
"ACYCLOVIR SOD 1000MG/20ML VIAL",7065380,"CDM ",250,RC,,,OUTPATIENT,,,62.5,50,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",50,80,,40.00,,,0,"percent of total billed charges ","80% of total billed charges ",43.75,70,,35.00,,,0,"percent of total billed charges ","70% of total billed charges ",56.25,90,,45.00,,,0,"percent of total billed charges ","90% of total billed charges ",58.13,93,,46.50,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",53.13,85,,42.50,,,0,"percent of total billed charges ","85% of total billed charges ",56.25,90,,45.00,,,0,"percent of total billed charges ","90% of total billed charges ",56.25,90,,45.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",54.38,87,,43.50,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",43.75,70,,35.00,,,0,"percent of total billed charges ","70% of total billed charges ",43.75,58.13,
"LIDOCAINE/EPI MPF 1% 30ML VIAL",7065400,"CDM ",250,RC,,,OUTPATIENT,,,48,38.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.4,80,,30.72,,,0,"percent of total billed charges ","80% of total billed charges ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",44.64,93,,35.71,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",40.8,85,,32.64,,,0,"percent of total billed charges ","85% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",43.2,90,,34.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",41.76,87,,33.41,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",33.6,70,,26.88,,,0,"percent of total billed charges ","70% of total billed charges ",33.6,44.64,
"LIDOCAINE 1.5% W/EDI 10ML VIAL",7065402,"CDM ",250,RC,,,OUTPATIENT,,,55,44,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44,80,,35.20,,,0,"percent of total billed charges ","80% of total billed charges ",38.5,70,,30.80,,,0,"percent of total billed charges ","70% of total billed charges ",49.5,90,,39.60,,,0,"percent of total billed charges ","90% of total billed charges ",51.15,93,,40.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",46.75,85,,37.40,,,0,"percent of total billed charges ","85% of total billed charges ",49.5,90,,39.60,,,0,"percent of total billed charges ","90% of total billed charges ",49.5,90,,39.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",47.85,87,,38.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.5,70,,30.80,,,0,"percent of total billed charges ","70% of total billed charges ",38.5,51.15,
"CLINDAMYCIN PHOS D5W 900MG/50M",7065600,"CDM ",250,RC,,,OUTPATIENT,,,91.5,73.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",73.2,80,,58.56,,,0,"percent of total billed charges ","80% of total billed charges ",64.05,70,,51.24,,,0,"percent of total billed charges ","70% of total billed charges ",82.35,90,,65.88,,,0,"percent of total billed charges ","90% of total billed charges ",85.1,93,,68.08,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",77.78,85,,62.22,,,0,"percent of total billed charges ","85% of total billed charges ",82.35,90,,65.88,,,0,"percent of total billed charges ","90% of total billed charges ",82.35,90,,65.88,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",79.61,87,,63.69,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",64.05,70,,51.24,,,0,"percent of total billed charges ","70% of total billed charges ",64.05,85.1,
"HPV QUA 0.5ML IM",7065740,"CDM ",250,RC,,,OUTPATIENT,,,299.5,239.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",239.6,80,,191.68,,,0,"percent of total billed charges ","80% of total billed charges ",209.65,70,,167.72,,,0,"percent of total billed charges ","70% of total billed charges ",269.55,90,,215.64,,,0,"percent of total billed charges ","90% of total billed charges ",278.54,93,,222.83,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",254.58,85,,203.66,,,0,"percent of total billed charges ","85% of total billed charges ",269.55,90,,215.64,,,0,"percent of total billed charges ","90% of total billed charges ",269.55,90,,215.64,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",260.57,87,,208.46,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",209.65,70,,167.72,,,0,"percent of total billed charges ","70% of total billed charges ",209.65,278.54,
"AMINO ACID 4.25% D10W 1000ML",7065760,"CDM ",250,RC,,,OUTPATIENT,,,119.5,95.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",95.6,80,,76.48,,,0,"percent of total billed charges ","80% of total billed charges ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",111.14,93,,88.91,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",101.58,85,,81.26,,,0,"percent of total billed charges ","85% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",107.55,90,,86.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",103.97,87,,83.18,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",83.65,70,,66.92,,,0,"percent of total billed charges ","70% of total billed charges ",83.65,111.14,
"ERYTHROMYCIN (OPTH) 0.5% 1GM",7065780,"CDM ",250,RC,,,OUTPATIENT,,,40,32,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32,80,,25.60,,,0,"percent of total billed charges ","80% of total billed charges ",28,70,,22.40,,,0,"percent of total billed charges ","70% of total billed charges ",36,90,,28.80,,,0,"percent of total billed charges ","90% of total billed charges ",37.2,93,,29.76,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",34,85,,27.20,,,0,"percent of total billed charges ","85% of total billed charges ",36,90,,28.80,,,0,"percent of total billed charges ","90% of total billed charges ",36,90,,28.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",34.8,87,,27.84,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",28,70,,22.40,,,0,"percent of total billed charges ","70% of total billed charges ",28,37.2,
"NICARDIPINE HCL/NACL 20MG/200M",7065790,"CDM ",250,RC,,,OUTPATIENT,,,272,217.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",217.6,80,,174.08,,,0,"percent of total billed charges ","80% of total billed charges ",190.4,70,,152.32,,,0,"percent of total billed charges ","70% of total billed charges ",244.8,90,,195.84,,,0,"percent of total billed charges ","90% of total billed charges ",252.96,93,,202.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",231.2,85,,184.96,,,0,"percent of total billed charges ","85% of total billed charges ",244.8,90,,195.84,,,0,"percent of total billed charges ","90% of total billed charges ",244.8,90,,195.84,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",236.64,87,,189.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",190.4,70,,152.32,,,0,"percent of total billed charges ","70% of total billed charges ",190.4,252.96,
"NITROGLYCERIN 200MCG/ML PREMIX",7065970,"CDM ",250,RC,,,OUTPATIENT,,,85.5,68.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.4,80,,54.72,,,0,"percent of total billed charges ","80% of total billed charges ",59.85,70,,47.88,,,0,"percent of total billed charges ","70% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",79.52,93,,63.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",72.68,85,,58.14,,,0,"percent of total billed charges ","85% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",74.39,87,,59.51,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.85,70,,47.88,,,0,"percent of total billed charges ","70% of total billed charges ",59.85,79.52,
"FERRIC SUBSULFATE 8ML BTL",7066030,"CDM ",637,RC,,,OUTPATIENT,,,44,35.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.2,80,,28.16,,,0,"percent of total billed charges ","80% of total billed charges ",30.8,70,,24.64,,,0,"percent of total billed charges ","70% of total billed charges ",39.6,90,,31.68,,,0,"percent of total billed charges ","90% of total billed charges ",40.92,93,,32.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",37.4,85,,29.92,,,0,"percent of total billed charges ","85% of total billed charges ",39.6,90,,31.68,,,0,"percent of total billed charges ","90% of total billed charges ",39.6,90,,31.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",38.28,87,,30.62,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.8,70,,24.64,,,0,"percent of total billed charges ","70% of total billed charges ",30.8,40.92,
"LEECH THERAPY",7066050,"CDM ",637,RC,,,OUTPATIENT,,,655.5,524.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",524.4,80,,419.52,,,0,"percent of total billed charges ","80% of total billed charges ",458.85,70,,367.08,,,0,"percent of total billed charges ","70% of total billed charges ",589.95,90,,471.96,,,0,"percent of total billed charges ","90% of total billed charges ",609.62,93,,487.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",557.18,85,,445.74,,,0,"percent of total billed charges ","85% of total billed charges ",589.95,90,,471.96,,,0,"percent of total billed charges ","90% of total billed charges ",589.95,90,,471.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",570.29,87,,456.23,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",458.85,70,,367.08,,,0,"percent of total billed charges ","70% of total billed charges ",458.85,609.62,
"TRANEXAMIC ACID INJ 1000MG VIA",7066060,"CDM ",250,RC,,,OUTPATIENT,,,102.5,82,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",82,80,,65.60,,,0,"percent of total billed charges ","80% of total billed charges ",71.75,70,,57.40,,,0,"percent of total billed charges ","70% of total billed charges ",92.25,90,,73.80,,,0,"percent of total billed charges ","90% of total billed charges ",95.33,93,,76.26,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",87.13,85,,69.70,,,0,"percent of total billed charges ","85% of total billed charges ",92.25,90,,73.80,,,0,"percent of total billed charges ","90% of total billed charges ",92.25,90,,73.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",89.18,87,,71.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",71.75,70,,57.40,,,0,"percent of total billed charges ","70% of total billed charges ",71.75,95.33,
"SOTRADECOL 1% 2ML VIAL",7066170,"CDM ",637,RC,,,OUTPATIENT,,,50.5,40.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",40.4,80,,32.32,,,0,"percent of total billed charges ","80% of total billed charges ",35.35,70,,28.28,,,0,"percent of total billed charges ","70% of total billed charges ",45.45,90,,36.36,,,0,"percent of total billed charges ","90% of total billed charges ",46.97,93,,37.58,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",42.93,85,,34.34,,,0,"percent of total billed charges ","85% of total billed charges ",45.45,90,,36.36,,,0,"percent of total billed charges ","90% of total billed charges ",45.45,90,,36.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",43.94,87,,35.15,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",35.35,70,,28.28,,,0,"percent of total billed charges ","70% of total billed charges ",35.35,46.97,
"KETAMINE 50MG PREFILL SYR",7066200,"CDM ",250,RC,,,OUTPATIENT,,,46,36.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",36.8,80,,29.44,,,0,"percent of total billed charges ","80% of total billed charges ",32.2,70,,25.76,,,0,"percent of total billed charges ","70% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",42.78,93,,34.22,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",39.1,85,,31.28,,,0,"percent of total billed charges ","85% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",41.4,90,,33.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",40.02,87,,32.02,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",32.2,70,,25.76,,,0,"percent of total billed charges ","70% of total billed charges ",32.2,42.78,
"MINERAL OIL 30ML",7066210,"CDM ",637,RC,,,OUTPATIENT,,,12.5,10,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",10,80,,8.00,,,0,"percent of total billed charges ","80% of total billed charges ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.63,93,,9.30,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",10.63,85,,8.50,,,0,"percent of total billed charges ","85% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",11.25,90,,9.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",10.88,87,,8.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.75,70,,7.00,,,0,"percent of total billed charges ","70% of total billed charges ",8.75,11.63,
"BUMETANIDE 2.5MG/10ML VIAL",7066220,"CDM ",250,RC,,,OUTPATIENT,,,22.5,18,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",18,80,,14.40,,,0,"percent of total billed charges ","80% of total billed charges ",15.75,70,,12.60,,,0,"percent of total billed charges ","70% of total billed charges ",20.25,90,,16.20,,,0,"percent of total billed charges ","90% of total billed charges ",20.93,93,,16.74,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",19.13,85,,15.30,,,0,"percent of total billed charges ","85% of total billed charges ",20.25,90,,16.20,,,0,"percent of total billed charges ","90% of total billed charges ",20.25,90,,16.20,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",19.58,87,,15.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",15.75,70,,12.60,,,0,"percent of total billed charges ","70% of total billed charges ",15.75,20.93,
"DOXYCYCLINE 100 MG IV BAG",7066250,"CDM ",258,RC,,,OUTPATIENT,,,125.5,100.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",100.4,80,,80.32,,,0,"percent of total billed charges ","80% of total billed charges ",87.85,70,,70.28,,,0,"percent of total billed charges ","70% of total billed charges ",112.95,90,,90.36,,,0,"percent of total billed charges ","90% of total billed charges ",116.72,93,,93.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",106.68,85,,85.34,,,0,"percent of total billed charges ","85% of total billed charges ",112.95,90,,90.36,,,0,"percent of total billed charges ","90% of total billed charges ",112.95,90,,90.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",109.19,87,,87.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.85,70,,70.28,,,0,"percent of total billed charges ","70% of total billed charges ",87.85,116.72,
"POT CHL 20MEQ D5% SOD CHL",7066270,"CDM ",258,RC,,,OUTPATIENT,,,81.5,65.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.2,80,,52.16,,,0,"percent of total billed charges ","80% of total billed charges ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",75.8,93,,60.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",69.28,85,,55.42,,,0,"percent of total billed charges ","85% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",70.91,87,,56.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",57.05,75.8,
"XIFAXAN 550 MG TAB",7066280,"CDM ",637,RC,,,OUTPATIENT,,,76.5,61.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.2,80,,48.96,,,0,"percent of total billed charges ","80% of total billed charges ",53.55,70,,42.84,,,0,"percent of total billed charges ","70% of total billed charges ",68.85,90,,55.08,,,0,"percent of total billed charges ","90% of total billed charges ",71.15,93,,56.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",65.03,85,,52.02,,,0,"percent of total billed charges ","85% of total billed charges ",68.85,90,,55.08,,,0,"percent of total billed charges ","90% of total billed charges ",68.85,90,,55.08,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",66.56,87,,53.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",53.55,70,,42.84,,,0,"percent of total billed charges ","70% of total billed charges ",53.55,71.15,
"CLINIMIX E 4.25-10% 1000ML BAG",7066330,"CDM ",258,RC,,,OUTPATIENT,,,114.5,91.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",91.6,80,,73.28,,,0,"percent of total billed charges ","80% of total billed charges ",80.15,70,,64.12,,,0,"percent of total billed charges ","70% of total billed charges ",103.05,90,,82.44,,,0,"percent of total billed charges ","90% of total billed charges ",106.49,93,,85.19,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.33,85,,77.86,,,0,"percent of total billed charges ","85% of total billed charges ",103.05,90,,82.44,,,0,"percent of total billed charges ","90% of total billed charges ",103.05,90,,82.44,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",99.62,87,,79.70,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.15,70,,64.12,,,0,"percent of total billed charges ","70% of total billed charges ",80.15,106.49,
"SOL H2O MAGNESIUM SULF 6GM BAG",7066340,"CDM ",258,RC,,,OUTPATIENT,,,125.5,100.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",100.4,80,,80.32,,,0,"percent of total billed charges ","80% of total billed charges ",87.85,70,,70.28,,,0,"percent of total billed charges ","70% of total billed charges ",112.95,90,,90.36,,,0,"percent of total billed charges ","90% of total billed charges ",116.72,93,,93.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",106.68,85,,85.34,,,0,"percent of total billed charges ","85% of total billed charges ",112.95,90,,90.36,,,0,"percent of total billed charges ","90% of total billed charges ",112.95,90,,90.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",109.19,87,,87.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.85,70,,70.28,,,0,"percent of total billed charges ","70% of total billed charges ",87.85,116.72,
"ALUM PWD",7066360,"CDM ",250,RC,,,OUTPATIENT,,,125.5,100.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",100.4,80,,80.32,,,0,"percent of total billed charges ","80% of total billed charges ",87.85,70,,70.28,,,0,"percent of total billed charges ","70% of total billed charges ",112.95,90,,90.36,,,0,"percent of total billed charges ","90% of total billed charges ",116.72,93,,93.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",106.68,85,,85.34,,,0,"percent of total billed charges ","85% of total billed charges ",112.95,90,,90.36,,,0,"percent of total billed charges ","90% of total billed charges ",112.95,90,,90.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",109.19,87,,87.35,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",87.85,70,,70.28,,,0,"percent of total billed charges ","70% of total billed charges ",87.85,116.72,
"WATER IRRIG 3000ML BAG",7066370,"CDM ",250,RC,,,OUTPATIENT,,,81.5,65.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.2,80,,52.16,,,0,"percent of total billed charges ","80% of total billed charges ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",75.8,93,,60.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",69.28,85,,55.42,,,0,"percent of total billed charges ","85% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",70.91,87,,56.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",57.05,75.8,
"WATER STERILE IRRIG 1000ML",7066380,"CDM ",250,RC,,,OUTPATIENT,,,81.5,65.2,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.2,80,,52.16,,,0,"percent of total billed charges ","80% of total billed charges ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",75.8,93,,60.64,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",69.28,85,,55.42,,,0,"percent of total billed charges ","85% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",73.35,90,,58.68,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",70.91,87,,56.73,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.05,70,,45.64,,,0,"percent of total billed charges ","70% of total billed charges ",57.05,75.8,
"DOXYCYCLINE 200MG IV BAG",7066390,"CDM ",258,RC,,,OUTPATIENT,,,183,146.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",146.4,80,,117.12,,,0,"percent of total billed charges ","80% of total billed charges ",128.1,70,,102.48,,,0,"percent of total billed charges ","70% of total billed charges ",164.7,90,,131.76,,,0,"percent of total billed charges ","90% of total billed charges ",170.19,93,,136.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",155.55,85,,124.44,,,0,"percent of total billed charges ","85% of total billed charges ",164.7,90,,131.76,,,0,"percent of total billed charges ","90% of total billed charges ",164.7,90,,131.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",159.21,87,,127.37,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",128.1,70,,102.48,,,0,"percent of total billed charges ","70% of total billed charges ",128.1,170.19,
"DEXMEDETOMIDE 200MCG VIAL",7066410,"CDM ",250,RC,,,OUTPATIENT,,,79.5,63.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",63.6,80,,50.88,,,0,"percent of total billed charges ","80% of total billed charges ",55.65,70,,44.52,,,0,"percent of total billed charges ","70% of total billed charges ",71.55,90,,57.24,,,0,"percent of total billed charges ","90% of total billed charges ",73.94,93,,59.15,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",67.58,85,,54.06,,,0,"percent of total billed charges ","85% of total billed charges ",71.55,90,,57.24,,,0,"percent of total billed charges ","90% of total billed charges ",71.55,90,,57.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",69.17,87,,55.34,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",55.65,70,,44.52,,,0,"percent of total billed charges ","70% of total billed charges ",55.65,73.94,
"ETHYL ALCOHOL 98% 5ML AMP",7066490,"CDM ",250,RC,,,OUTPATIENT,,,263.5,210.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",210.8,80,,168.64,,,0,"percent of total billed charges ","80% of total billed charges ",184.45,70,,147.56,,,0,"percent of total billed charges ","70% of total billed charges ",237.15,90,,189.72,,,0,"percent of total billed charges ","90% of total billed charges ",245.06,93,,196.05,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",223.98,85,,179.18,,,0,"percent of total billed charges ","85% of total billed charges ",237.15,90,,189.72,,,0,"percent of total billed charges ","90% of total billed charges ",237.15,90,,189.72,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",229.25,87,,183.40,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",184.45,70,,147.56,,,0,"percent of total billed charges ","70% of total billed charges ",184.45,245.06,
"MELATONIN 5 MG TAB",7066530,"CDM ",637,RC,,,OUTPATIENT,,,11,8.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.8,80,,7.04,,,0,"percent of total billed charges ","80% of total billed charges ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",10.23,93,,8.18,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",9.35,85,,7.48,,,0,"percent of total billed charges ","85% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",9.9,90,,7.92,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.57,87,,7.66,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.7,70,,6.16,,,0,"percent of total billed charges ","70% of total billed charges ",7.7,10.23,
"PHENOL EZ SWAB",7066550,"CDM ",250,RC,,,OUTPATIENT,,,18,14.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",14.4,80,,11.52,,,0,"percent of total billed charges ","80% of total billed charges ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.74,93,,13.39,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",15.3,85,,12.24,,,0,"percent of total billed charges ","85% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",16.2,90,,12.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",15.66,87,,12.53,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",12.6,70,,10.08,,,0,"percent of total billed charges ","70% of total billed charges ",12.6,16.74,
"CYSTOGRAFIN 1:30 DIL 1000ML",7066620,"CDM ",250,RC,,,OUTPATIENT,,,43.5,34.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.8,80,,27.84,,,0,"percent of total billed charges ","80% of total billed charges ",30.45,70,,24.36,,,0,"percent of total billed charges ","70% of total billed charges ",39.15,90,,31.32,,,0,"percent of total billed charges ","90% of total billed charges ",40.46,93,,32.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",36.98,85,,29.58,,,0,"percent of total billed charges ","85% of total billed charges ",39.15,90,,31.32,,,0,"percent of total billed charges ","90% of total billed charges ",39.15,90,,31.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",37.85,87,,30.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.45,70,,24.36,,,0,"percent of total billed charges ","70% of total billed charges ",30.45,40.46,
"ELIQUIS 5MG TAB",7066630,"CDM ",637,RC,,,OUTPATIENT,,,17,13.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.6,80,,10.88,,,0,"percent of total billed charges ","80% of total billed charges ",11.9,70,,9.52,,,0,"percent of total billed charges ","70% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.81,93,,12.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.45,85,,11.56,,,0,"percent of total billed charges ","85% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.79,87,,11.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.9,70,,9.52,,,0,"percent of total billed charges ","70% of total billed charges ",11.9,15.81,
"BUPIVACAINE 0.5% W/EPI 50ML",7067350,"CDM ",250,RC,,,OUTPATIENT,,,43.5,34.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",34.8,80,,27.84,,,0,"percent of total billed charges ","80% of total billed charges ",30.45,70,,24.36,,,0,"percent of total billed charges ","70% of total billed charges ",39.15,90,,31.32,,,0,"percent of total billed charges ","90% of total billed charges ",40.46,93,,32.37,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",36.98,85,,29.58,,,0,"percent of total billed charges ","85% of total billed charges ",39.15,90,,31.32,,,0,"percent of total billed charges ","90% of total billed charges ",39.15,90,,31.32,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",37.85,87,,30.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",30.45,70,,24.36,,,0,"percent of total billed charges ","70% of total billed charges ",30.45,40.46,
"NICARDIPINE 25MG VIAL",7067430,"CDM ",250,RC,,,OUTPATIENT,,,132,105.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",105.6,80,,84.48,,,0,"percent of total billed charges ","80% of total billed charges ",92.4,70,,73.92,,,0,"percent of total billed charges ","70% of total billed charges ",118.8,90,,95.04,,,0,"percent of total billed charges ","90% of total billed charges ",122.76,93,,98.21,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",112.2,85,,89.76,,,0,"percent of total billed charges ","85% of total billed charges ",118.8,90,,95.04,,,0,"percent of total billed charges ","90% of total billed charges ",118.8,90,,95.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",114.84,87,,91.87,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92.4,70,,73.92,,,0,"percent of total billed charges ","70% of total billed charges ",92.4,122.76,
"POVIDONE IODINE 10% 22.5ML",7067440,"CDM ",637,RC,,,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92,80,,73.60,,,0,"percent of total billed charges ","80% of total billed charges ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",80.5,106.95,
"DEXMEDETOMIDINE 200MCG 50ML IV",7067540,"CDM ",250,RC,,,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92,80,,73.60,,,0,"percent of total billed charges ","80% of total billed charges ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",80.5,106.95,
"DEXMEDETOMIDINE 400MCG 100ML I",7067541,"CDM ",250,RC,,,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92,80,,73.60,,,0,"percent of total billed charges ","80% of total billed charges ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",80.5,106.95,
"CARBIDOPA/LEVODOPA 25/100 ODT",7067790,"CDM ",637,RC,,,OUTPATIENT,,,10.5,8.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",8.4,80,,6.72,,,0,"percent of total billed charges ","80% of total billed charges ",7.35,70,,5.88,,,0,"percent of total billed charges ","70% of total billed charges ",9.45,90,,7.56,,,0,"percent of total billed charges ","90% of total billed charges ",9.77,93,,7.82,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",8.93,85,,7.14,,,0,"percent of total billed charges ","85% of total billed charges ",9.45,90,,7.56,,,0,"percent of total billed charges ","90% of total billed charges ",9.45,90,,7.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",9.14,87,,7.31,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",7.35,70,,5.88,,,0,"percent of total billed charges ","70% of total billed charges ",7.35,9.77,
"LIDOCAINE JELLY 2% 11ML SYR",7067805,"CDM ",250,RC,,,OUTPATIENT,,,17,13.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",13.6,80,,10.88,,,0,"percent of total billed charges ","80% of total billed charges ",11.9,70,,9.52,,,0,"percent of total billed charges ","70% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.81,93,,12.65,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",14.45,85,,11.56,,,0,"percent of total billed charges ","85% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",15.3,90,,12.24,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",14.79,87,,11.83,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",11.9,70,,9.52,,,0,"percent of total billed charges ","70% of total billed charges ",11.9,15.81,
"TPN ELECTROLYTES 20ML",7067940,"CDM ",258,RC,,,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92,80,,73.60,,,0,"percent of total billed charges ","80% of total billed charges ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",80.5,106.95,
"TRANEXAMIC ACID 1GM PREMIX BAG",7068280,"CDM ",250,RC,,,OUTPATIENT,,,115,92,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",92,80,,73.60,,,0,"percent of total billed charges ","80% of total billed charges ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",106.95,93,,85.56,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",97.75,85,,78.20,,,0,"percent of total billed charges ","85% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",103.5,90,,82.80,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",100.05,87,,80.04,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",80.5,70,,64.40,,,0,"percent of total billed charges ","70% of total billed charges ",80.5,106.95,
"GI COKTAIL (LUCERO) 30ML BTL",7068290,"CDM ",637,RC,,,OUTPATIENT,,,33.5,26.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.8,80,,21.44,,,0,"percent of total billed charges ","80% of total billed charges ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",31.16,93,,24.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.48,85,,22.78,,,0,"percent of total billed charges ","85% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.15,87,,23.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",23.45,31.16,
"BUTT PASTE (LUCERO) JAR",7068310,"CDM ",637,RC,,,OUTPATIENT,,,33.5,26.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",26.8,80,,21.44,,,0,"percent of total billed charges ","80% of total billed charges ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",31.16,93,,24.93,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.48,85,,22.78,,,0,"percent of total billed charges ","85% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",30.15,90,,24.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",29.15,87,,23.32,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.45,70,,18.76,,,0,"percent of total billed charges ","70% of total billed charges ",23.45,31.16,
"SOLUTION D5-1/2 NS 500ML BAG",7400070,"CDM ",258,RC,,,OUTPATIENT,,,83,66.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.4,80,,53.12,,,0,"percent of total billed charges ","80% of total billed charges ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",72.21,87,,57.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",58.1,77.19,
"SOLUTION D5-1/2NS 1000ML BAG",7400088,"CDM ",258,RC,,,OUTPATIENT,,,83.5,66.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.8,80,,53.44,,,0,"percent of total billed charges ","80% of total billed charges ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",77.66,93,,62.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.98,85,,56.78,,,0,"percent of total billed charges ","85% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",72.65,87,,58.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",58.45,77.66,
"SOL-ADD .9% NS 50ML",7400112,"CDM ",258,RC,,,OUTPATIENT,,,83,66.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.4,80,,53.12,,,0,"percent of total billed charges ","80% of total billed charges ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",72.21,87,,57.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",58.1,77.19,
"SOLUTION NS ADVA 0.9% 100ML",7400120,"CDM ",258,RC,,,OUTPATIENT,,,83,66.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.4,80,,53.12,,,0,"percent of total billed charges ","80% of total billed charges ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",72.21,87,,57.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",58.1,77.19,
"SOLUTION  D10W 500ML",7400211,"CDM ",258,RC,,,OUTPATIENT,,,83.5,66.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.8,80,,53.44,,,0,"percent of total billed charges ","80% of total billed charges ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",77.66,93,,62.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.98,85,,56.78,,,0,"percent of total billed charges ","85% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",72.65,87,,58.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",58.45,77.66,
"DIO 1/2NS 1000 ML BAG",7400228,"CDM ",258,RC,,,OUTPATIENT,,,75,60,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",60,80,,48.00,,,0,"percent of total billed charges ","80% of total billed charges ",52.5,70,,42.00,,,0,"percent of total billed charges ","70% of total billed charges ",67.5,90,,54.00,,,0,"percent of total billed charges ","90% of total billed charges ",69.75,93,,55.80,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",63.75,85,,51.00,,,0,"percent of total billed charges ","85% of total billed charges ",67.5,90,,54.00,,,0,"percent of total billed charges ","90% of total billed charges ",67.5,90,,54.00,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",65.25,87,,52.20,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",52.5,70,,42.00,,,0,"percent of total billed charges ","70% of total billed charges ",52.5,69.75,
"SOL-D10W 1L",7400229,"CDM ",258,RC,,,OUTPATIENT,,,82,65.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.6,80,,52.48,,,0,"percent of total billed charges ","80% of total billed charges ",57.4,70,,45.92,,,0,"percent of total billed charges ","70% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",76.26,93,,61.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",69.7,85,,55.76,,,0,"percent of total billed charges ","85% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",71.34,87,,57.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.4,70,,45.92,,,0,"percent of total billed charges ","70% of total billed charges ",57.4,76.26,
"SOLUTION D5 W/LIDOCAINE 500ML",7400252,"CDM ",636,RC,,,OUTPATIENT,,,82,65.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.6,80,,52.48,,,0,"percent of total billed charges ","80% of total billed charges ",57.4,70,,45.92,,,0,"percent of total billed charges ","70% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",76.26,93,,61.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",69.7,85,,55.76,,,0,"percent of total billed charges ","85% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",71.34,87,,57.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.4,70,,45.92,,,0,"percent of total billed charges ","70% of total billed charges ",57.4,76.26,
"SOLUTIN NS 0.9% 50ML BAG",7400302,"CDM ",258,RC,,,OUTPATIENT,,,82.5,66,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66,80,,52.80,,,0,"percent of total billed charges ","80% of total billed charges ",57.75,70,,46.20,,,0,"percent of total billed charges ","70% of total billed charges ",74.25,90,,59.40,,,0,"percent of total billed charges ","90% of total billed charges ",76.73,93,,61.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.13,85,,56.10,,,0,"percent of total billed charges ","85% of total billed charges ",74.25,90,,59.40,,,0,"percent of total billed charges ","90% of total billed charges ",74.25,90,,59.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",71.78,87,,57.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.75,70,,46.20,,,0,"percent of total billed charges ","70% of total billed charges ",57.75,76.73,
"SOLUTION 1/2 NS 1000ML BAG",7400377,"CDM ",258,RC,,,OUTPATIENT,,,83,66.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.4,80,,53.12,,,0,"percent of total billed charges ","80% of total billed charges ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",72.21,87,,57.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",58.1,77.19,
"SOLUTION D5-1/4NS 500ML BAG",7400427,"CDM ",258,RC,,,OUTPATIENT,,,83,66.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.4,80,,53.12,,,0,"percent of total billed charges ","80% of total billed charges ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",72.21,87,,57.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",58.1,77.19,
"SOLUTION D5-1/3NS 500ML BAG",7400435,"CDM ",258,RC,,,OUTPATIENT,,,85.5,68.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",68.4,80,,54.72,,,0,"percent of total billed charges ","80% of total billed charges ",59.85,70,,47.88,,,0,"percent of total billed charges ","70% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",79.52,93,,63.62,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",72.68,85,,58.14,,,0,"percent of total billed charges ","85% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",76.95,90,,61.56,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",74.39,87,,59.51,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",59.85,70,,47.88,,,0,"percent of total billed charges ","70% of total billed charges ",59.85,79.52,
"SOLUTION NS W/20KCL 1000ML BAG",7400468,"CDM ",258,RC,,,OUTPATIENT,,,83.5,66.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.8,80,,53.44,,,0,"percent of total billed charges ","80% of total billed charges ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",77.66,93,,62.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.98,85,,56.78,,,0,"percent of total billed charges ","85% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",72.65,87,,58.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",58.45,77.66,
"SOLUTION NS W/40KCL 1000ML BAG",7400476,"CDM ",258,RC,,,OUTPATIENT,,,83,66.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.4,80,,53.12,,,0,"percent of total billed charges ","80% of total billed charges ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",72.21,87,,57.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",58.1,77.19,
"SOLUTION D5-1/2 NS W/20 KCL",7400492,"CDM ",258,RC,,,OUTPATIENT,,,83,66.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.4,80,,53.12,,,0,"percent of total billed charges ","80% of total billed charges ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",72.21,87,,57.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",58.1,77.19,
"SOLUTION D5-1/2NS W/40 KCL",7400500,"CDM ",258,RC,,,OUTPATIENT,,,82.5,66,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66,80,,52.80,,,0,"percent of total billed charges ","80% of total billed charges ",57.75,70,,46.20,,,0,"percent of total billed charges ","70% of total billed charges ",74.25,90,,59.40,,,0,"percent of total billed charges ","90% of total billed charges ",76.73,93,,61.38,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.13,85,,56.10,,,0,"percent of total billed charges ","85% of total billed charges ",74.25,90,,59.40,,,0,"percent of total billed charges ","90% of total billed charges ",74.25,90,,59.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",71.78,87,,57.42,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.75,70,,46.20,,,0,"percent of total billed charges ","70% of total billed charges ",57.75,76.73,
"SOLUTION D5-NS W/40 KCL 1000ML",7400617,"CDM ",258,RC,,,OUTPATIENT,,,83,66.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.4,80,,53.12,,,0,"percent of total billed charges ","80% of total billed charges ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",72.21,87,,57.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",58.1,77.19,
"SOLUTION D5-NS W/20 KCL 1000ML",7400625,"CDM ",258,RC,,,OUTPATIENT,,,83.5,66.8,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.8,80,,53.44,,,0,"percent of total billed charges ","80% of total billed charges ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",77.66,93,,62.13,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.98,85,,56.78,,,0,"percent of total billed charges ","85% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",75.15,90,,60.12,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",72.65,87,,58.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.45,70,,46.76,,,0,"percent of total billed charges ","70% of total billed charges ",58.45,77.66,
"SOLUTION POTASS CHL 20MEQ 50ML",7400658,"CDM ",258,RC,,,OUTPATIENT,,,82,65.6,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",65.6,80,,52.48,,,0,"percent of total billed charges ","80% of total billed charges ",57.4,70,,45.92,,,0,"percent of total billed charges ","70% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",76.26,93,,61.01,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",69.7,85,,55.76,,,0,"percent of total billed charges ","85% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",73.8,90,,59.04,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",71.34,87,,57.07,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",57.4,70,,45.92,,,0,"percent of total billed charges ","70% of total billed charges ",57.4,76.26,
"SOLUTION POTAS CHL 20MEQ 100ML",7400666,"CDM ",258,RC,,,OUTPATIENT,,,88,70.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",70.4,80,,56.32,,,0,"percent of total billed charges ","80% of total billed charges ",61.6,70,,49.28,,,0,"percent of total billed charges ","70% of total billed charges ",79.2,90,,63.36,,,0,"percent of total billed charges ","90% of total billed charges ",81.84,93,,65.47,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",74.8,85,,59.84,,,0,"percent of total billed charges ","85% of total billed charges ",79.2,90,,63.36,,,0,"percent of total billed charges ","90% of total billed charges ",79.2,90,,63.36,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",76.56,87,,61.25,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",61.6,70,,49.28,,,0,"percent of total billed charges ","70% of total billed charges ",61.6,81.84,
"SOLUTION D5-1/4NS W/10KCL 500M",7400716,"CDM ",258,RC,,,OUTPATIENT,,,83,66.4,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.4,80,,53.12,,,0,"percent of total billed charges ","80% of total billed charges ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",77.19,93,,61.75,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",70.55,85,,56.44,,,0,"percent of total billed charges ","85% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",74.7,90,,59.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",72.21,87,,57.77,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",58.1,70,,46.48,,,0,"percent of total billed charges ","70% of total billed charges ",58.1,77.19,
"ROOM RENT PHYSICIAN GROUP",8601090,"CDM ",510,RC,,,OUTPATIENT,,,,,,,,,,,,0,"other ","not separately reimbursment ",38.38,,,,,,0,"case rate ","pays based on per visit rate ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.38,38.38,
"NETWORK INTERNET TELEPHONE EXP",8601100,"CDM ",510,RC,,,OUTPATIENT,,,,,,,,,,,,0,"other ","not separately reimbursment ",38.38,,,,,,0,"case rate ","pays based on per visit rate ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.38,38.38,
"RENT LSS SYSTEM",8601120,"CDM ",510,RC,,,OUTPATIENT,,,,,,,,,,,,0,"other ","not separately reimbursment ",38.38,,,,,,0,"case rate ","pays based on per visit rate ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.38,38.38,
"RENT/PURCHASE EQUIPMENT",8601130,"CDM ",510,RC,,,OUTPATIENT,,,,,,,,,,,,0,"other ","not separately reimbursment ",38.38,,,,,,0,"case rate ","pays based on per visit rate ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.38,38.38,
"MIS PER HOUR",8601170,"CDM ",510,RC,,,OUTPATIENT,,,33,26.4,,,,,,,,0,"other ","not separately reimbursment ",38.38,,,,,,0,"case rate ","pays based on per visit rate ",26.4,80,,21.12,,,0,"percent of total billed charges ","80% of total billed charges ",23.1,70,,18.48,,,0,"percent of total billed charges ","70% of total billed charges ",29.7,90,,23.76,,,0,"percent of total billed charges ","90% of total billed charges ",30.69,93,,24.55,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",28.05,85,,22.44,,,0,"percent of total billed charges ","85% of total billed charges ",29.7,90,,23.76,,,0,"percent of total billed charges ","90% of total billed charges ",29.7,90,,23.76,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",28.71,87,,22.97,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",23.1,70,,18.48,,,0,"percent of total billed charges ","70% of total billed charges ",23.1,38.38,
"PHYSICIAN CLINIC MEDITECH SOFT",8601180,"CDM ",510,RC,,,OUTPATIENT,,,,,,,,,,,,0,"other ","not separately reimbursment ",38.38,,,,,,0,"case rate ","pays based on per visit rate ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.38,38.38,
"ROOM RENT - SWPP CLINIC",8601190,"CDM ",510,RC,,,OUTPATIENT,,,,,,,,,,,,0,"other ","not separately reimbursment ",38.38,,,,,,0,"case rate ","pays based on per visit rate ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.38,38.38,
"ROOM RENT 1/2 DAY OUTREACH CLI",8601200,"CDM ",510,RC,,,OUTPATIENT,,,,,,,,,,,,0,"other ","not separately reimbursment ",38.38,,,,,,0,"case rate ","pays based on per visit rate ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.38,38.38,
"ROOM RENT CANCER CENTER OF KS",8601210,"CDM ",510,RC,,,OUTPATIENT,,,,,,,,,,,,0,"other ","not separately reimbursment ",38.38,,,,,,0,"case rate ","pays based on per visit rate ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.38,38.38,
"ROOM RENT FULL DAY OUTREACH CL",8601220,"CDM ",510,RC,,,OUTPATIENT,,,,,,,,,,,,0,"other ","not separately reimbursment ",38.38,,,,,,0,"case rate ","pays based on per visit rate ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.38,38.38,
"ROOM RENT HOURLY",8601230,"CDM ",510,RC,,,OUTPATIENT,,,,,,,,,,,,0,"other ","not separately reimbursment ",38.38,,,,,,0,"case rate ","pays based on per visit rate ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.38,38.38,
"ROOM RENT PER HR - NRSG STAFF",8601240,"CDM ",510,RC,,,OUTPATIENT,,,30.5,24.4,,,,,,,,0,"other ","not separately reimbursment ",38.38,,,,,,0,"case rate ","pays based on per visit rate ",24.4,80,,19.52,,,0,"percent of total billed charges ","80% of total billed charges ",21.35,70,,17.08,,,0,"percent of total billed charges ","70% of total billed charges ",27.45,90,,21.96,,,0,"percent of total billed charges ","90% of total billed charges ",28.37,93,,22.70,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",25.93,85,,20.74,,,0,"percent of total billed charges ","85% of total billed charges ",27.45,90,,21.96,,,0,"percent of total billed charges ","90% of total billed charges ",27.45,90,,21.96,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",26.54,87,,21.23,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",21.35,70,,17.08,,,0,"percent of total billed charges ","70% of total billed charges ",21.35,38.38,
"ROOM RENT PER HR-STAFF INCLUDE",8601250,"CDM ",510,RC,,,OUTPATIENT,,,,,,,,,,,,0,"other ","not separately reimbursment ",38.38,,,,,,0,"case rate ","pays based on per visit rate ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,other,"not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.38,38.38,
"NUTRITION THERAPY-MAJ",9000050,"CDM ",942,RC,,,OUTPATIENT,,,95,76,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",76,80,,60.80,,,0,"percent of total billed charges ","80% of total billed charges ",66.5,70,,53.20,,,0,"percent of total billed charges ","70% of total billed charges ",85.5,90,,68.40,,,0,"percent of total billed charges ","90% of total billed charges ",88.35,93,,70.68,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",80.75,85,,64.60,,,0,"percent of total billed charges ","85% of total billed charges ",85.5,90,,68.40,,,0,"percent of total billed charges ","90% of total billed charges ",85.5,90,,68.40,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",82.65,87,,66.12,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",66.5,70,,53.20,,,0,"percent of total billed charges ","70% of total billed charges ",66.5,88.35,
"NUTRITION THERAPY-FOLLOWUP",9000126,"CDM ",942,RC,,,OUTPATIENT,,,55,44,,,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",44,80,,35.20,,,0,"percent of total billed charges ","80% of total billed charges ",38.5,70,,30.80,,,0,"percent of total billed charges ","70% of total billed charges ",49.5,90,,39.60,,,0,"percent of total billed charges ","90% of total billed charges ",51.15,93,,40.92,,,0,"percent of total billed charges ","93% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment",46.75,85,,37.40,,,0,"percent of total billed charges ","85% of total billed charges ",49.5,90,,39.60,,,0,"percent of total billed charges ","90% of total billed charges ",49.5,90,,39.60,,,0,"percent of total billed charges ","90% of total billed charges ",,,,,,,0,"other ","not separately reimbursment",47.85,87,,38.28,,,0,"percent of total billed charges ","87% of total billed charges ",,,,,,,0,"other ","not separately reimbursment ",,,,,,,0,"other ","not separately reimbursment ",38.5,70,,30.80,,,0,"percent of total billed charges ","70% of total billed charges ",38.5,51.15,
"HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC",1,"CDM ",100,RC,,,INPATIENT,,,,,,139232.07,100,,,,,0,"case rate","100%CMS IPPS rate",303783.35,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",303330.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",139232.07,100,,,,,0,"case rate","100%CMS IPPS rate",139232.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",139232.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",139232.07,100,,,,,0,"case rate","100%CMS IPPS rate",3630163.93,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,3630163.93,
"HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC",2,"CDM ",100,RC,,,INPATIENT,,,,,,84549.4,100,,,,,0,"case rate","100%CMS IPPS rate",150903.77,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",122655.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",84549.4,100,,,,,0,"case rate","100%CMS IPPS rate",84549.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",84549.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",84549.4,100,,,,,0,"case rate","100%CMS IPPS rate",1467900.37,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,1467900.37,
"ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES",3,"CDM ",100,RC,,,INPATIENT,,,,,,105682.98,100,,,,,0,"case rate","100%CMS IPPS rate",165113.02,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",229741.56,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",105682.98,100,,,,,0,"case rate","100%CMS IPPS rate",105682.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",105682.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",105682.98,100,,,,,0,"case rate","100%CMS IPPS rate",2749473,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,2749473,
"TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES",4,"CDM ",100,RC,,,INPATIENT,,,,,,60610.52,100,,,,,0,"case rate","100%CMS IPPS rate",104036.66,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",149927.55,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",60610.52,100,,,,,0,"case rate","100%CMS IPPS rate",60610.52,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",60610.52,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",60610.52,100,,,,,0,"case rate","100%CMS IPPS rate",1794284.69,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,1794284.69,
"LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT",5,"CDM ",100,RC,,,INPATIENT,,,,,,54257.03,100,,,,,0,"case rate","100%CMS IPPS rate",115142.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",111600.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",54257.03,100,,,,,0,"case rate","100%CMS IPPS rate",54257.03,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",54257.03,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",54257.03,100,,,,,0,"case rate","100%CMS IPPS rate",1335603,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,1335603,
"LIVER TRANSPLANT WITHOUT MCC",6,"CDM ",100,RC,,,INPATIENT,,,,,,24899.9,100,,,,,0,"case rate","100%CMS IPPS rate",53910.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",50190.89,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",24899.9,100,,,,,0,"case rate","100%CMS IPPS rate",24899.9,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",24899.9,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",24899.9,100,,,,,0,"case rate","100%CMS IPPS rate",600668.34,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,600668.34,
"LUNG TRANSPLANT",7,"CDM ",100,RC,,,INPATIENT,,,,,,61427.14,100,,,,,0,"case rate","100%CMS IPPS rate",98927.15,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",140172.96,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",61427.14,100,,,,,0,"case rate","100%CMS IPPS rate",61427.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",61427.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",61427.14,100,,,,,0,"case rate","100%CMS IPPS rate",1677544.81,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,1677544.81,
"SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT",8,"CDM ",100,RC,,,INPATIENT,,,,,,28801.3,100,,,,,0,"case rate","100%CMS IPPS rate",61498.5,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",60664.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",28801.3,100,,,,,0,"case rate","100%CMS IPPS rate",28801.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",28801.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",28801.3,100,,,,,0,"case rate","100%CMS IPPS rate",726009.49,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,726009.49,
"PANCREAS TRANSPLANT",10,"CDM ",100,RC,,,INPATIENT,,,,,,19199.98,100,,,,,0,"case rate","100%CMS IPPS rate",48786.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",33228.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",19199.98,100,,,,,0,"case rate","100%CMS IPPS rate",19199.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",19199.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19199.98,100,,,,,0,"case rate","100%CMS IPPS rate",929526.88,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,929526.88,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC",11,"CDM ",100,RC,,,INPATIENT,,,,,,26622.9,100,,,,,0,"case rate","100%CMS IPPS rate",47244.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",59035.18,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",26622.9,100,,,,,0,"case rate","100%CMS IPPS rate",26622.9,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",26622.9,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",26622.9,100,,,,,0,"case rate","100%CMS IPPS rate",706513.99,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,706513.99,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC",12,"CDM ",100,RC,,,INPATIENT,,,,,,20336.5,100,,,,,0,"case rate","100%CMS IPPS rate",35233.04,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",45633.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",20336.5,100,,,,,0,"case rate","100%CMS IPPS rate",20336.5,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",20336.5,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",20336.5,100,,,,,0,"case rate","100%CMS IPPS rate",546132.86,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,546132.86,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC",13,"CDM ",100,RC,,,INPATIENT,,,,,,14438.42,100,,,,,0,"case rate","100%CMS IPPS rate",23539.54,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",31192.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",14438.42,100,,,,,0,"case rate","100%CMS IPPS rate",14438.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",14438.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14438.42,100,,,,,0,"case rate","100%CMS IPPS rate",373303.08,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,373303.08,
"ALLOGENEIC BONE MARROW TRANSPLANT",14,"CDM ",100,RC,,,INPATIENT,,,,,,60624.74,100,,,,,0,"case rate","100%CMS IPPS rate",130483.66,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",130081.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",60624.74,100,,,,,0,"case rate","100%CMS IPPS rate",60624.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",60624.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",60624.74,100,,,,,0,"case rate","100%CMS IPPS rate",1556776.46,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,1556776.46,
"AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC",16,"CDM ",100,RC,,,INPATIENT,,,,,,31910.51,100,,,,,0,"case rate","100%CMS IPPS rate",74325.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",64183.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",31910.51,100,,,,,0,"case rate","100%CMS IPPS rate",31910.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",31910.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",31910.51,100,,,,,0,"case rate","100%CMS IPPS rate",768122.34,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,768122.34,
"AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC",17,"CDM ",100,RC,,,INPATIENT,,,,,,22915.22,100,,,,,0,"case rate","100%CMS IPPS rate",52734.9,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",52369.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",22915.22,100,,,,,0,"case rate","100%CMS IPPS rate",22915.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",22915.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22915.22,100,,,,,0,"case rate","100%CMS IPPS rate",703690.01,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,703690.01,
"CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES",18,"CDM ",100,RC,,,INPATIENT,,,,,,177095.76,100,,,,,0,"case rate","100%CMS IPPS rate",426668.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",467410.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",177095.76,100,,,,,0,"case rate","100%CMS IPPS rate",177095.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",177095.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",177095.76,100,,,,,0,"case rate","100%CMS IPPS rate",5593819.66,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",177095.76,5593819.66,
"SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS",19,"CDM ",100,RC,,,INPATIENT,,,,,,35356.06,100,,,,,0,"case rate","100%CMS IPPS rate",82677.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",71732.81,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",35356.06,100,,,,,0,"case rate","100%CMS IPPS rate",35356.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",35356.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",35356.06,100,,,,,0,"case rate","100%CMS IPPS rate",924202.84,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",35356.06,924202.84,
"INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC",20,"CDM ",100,RC,,,INPATIENT,,,,,,50503.58,100,,,,,0,"case rate","100%CMS IPPS rate",71519.99,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",85171.89,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",50503.58,100,,,,,0,"case rate","100%CMS IPPS rate",50503.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",50503.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",50503.58,100,,,,,0,"case rate","100%CMS IPPS rate",1019309.75,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,1019309.75,
"INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC",21,"CDM ",100,RC,,,INPATIENT,,,,,,36857.35,100,,,,,0,"case rate","100%CMS IPPS rate",54198.79,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",57300.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",36857.35,100,,,,,0,"case rate","100%CMS IPPS rate",36857.35,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",36857.35,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",36857.35,100,,,,,0,"case rate","100%CMS IPPS rate",685749.08,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,685749.08,
"INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC",22,"CDM ",100,RC,,,INPATIENT,,,,,,23781.6,100,,,,,0,"case rate","100%CMS IPPS rate",40178.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",33284.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",23781.6,100,,,,,0,"case rate","100%CMS IPPS rate",23781.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",23781.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",23781.6,100,,,,,0,"case rate","100%CMS IPPS rate",411594.55,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,411594.55,
"CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR",23,"CDM ",100,RC,,,INPATIENT,,,,,,27709.66,100,,,,,0,"case rate","100%CMS IPPS rate",49017.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",62024.77,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",27709.66,100,,,,,0,"case rate","100%CMS IPPS rate",27709.66,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",27709.66,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",27709.66,100,,,,,0,"case rate","100%CMS IPPS rate",742292.38,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,742292.38,
"CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC",24,"CDM ",100,RC,,,INPATIENT,,,,,,19244.41,100,,,,,0,"case rate","100%CMS IPPS rate",34041.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",42342.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",19244.41,100,,,,,0,"case rate","100%CMS IPPS rate",19244.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",19244.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19244.41,100,,,,,0,"case rate","100%CMS IPPS rate",506740.21,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,506740.21,
"CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC",25,"CDM ",100,RC,,,INPATIENT,,,,,,24581.79,100,,,,,0,"case rate","100%CMS IPPS rate",38867.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",49213.48,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",24581.79,100,,,,,0,"case rate","100%CMS IPPS rate",24581.79,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",24581.79,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",24581.79,100,,,,,0,"case rate","100%CMS IPPS rate",588971.11,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,588971.11,
"CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC",26,"CDM ",100,RC,,,INPATIENT,,,,,,15579.38,100,,,,,0,"case rate","100%CMS IPPS rate",26462.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",33653.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",15579.38,100,,,,,0,"case rate","100%CMS IPPS rate",15579.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",15579.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15579.38,100,,,,,0,"case rate","100%CMS IPPS rate",402760.02,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,402760.02,
"CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC",27,"CDM ",100,RC,,,INPATIENT,,,,,,11546.47,100,,,,,0,"case rate","100%CMS IPPS rate",21729.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",27307.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",11546.47,100,,,,,0,"case rate","100%CMS IPPS rate",11546.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",11546.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11546.47,100,,,,,0,"case rate","100%CMS IPPS rate",326811.84,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,326811.84,
"SPINAL PROCEDURES WITH MCC",28,"CDM ",100,RC,,,INPATIENT,,,,,,28481.41,100,,,,,0,"case rate","100%CMS IPPS rate",50324.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",65033.84,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",28481.41,100,,,,,0,"case rate","100%CMS IPPS rate",28481.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",28481.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",28481.41,100,,,,,0,"case rate","100%CMS IPPS rate",778304.03,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,778304.03,
"SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS",29,"CDM ",100,RC,,,INPATIENT,,,,,,15886.84,100,,,,,0,"case rate","100%CMS IPPS rate",28491.52,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",36927.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",15886.84,100,,,,,0,"case rate","100%CMS IPPS rate",15886.84,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",15886.84,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15886.84,100,,,,,0,"case rate","100%CMS IPPS rate",441932.27,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,441932.27,
"SPINAL PROCEDURES WITHOUT CC/MCC",30,"CDM ",100,RC,,,INPATIENT,,,,,,11534.92,100,,,,,0,"case rate","100%CMS IPPS rate",20367.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",23760.84,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",11534.92,100,,,,,0,"case rate","100%CMS IPPS rate",11534.92,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",11534.92,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11534.92,100,,,,,0,"case rate","100%CMS IPPS rate",284362.1,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,284362.1,
"VENTRICULAR SHUNT PROCEDURES WITH MCC",31,"CDM ",100,RC,,,INPATIENT,,,,,,10472.15,100,,,,,0,"case rate","100%CMS IPPS rate",31733.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",48496.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10472.15,100,,,,,0,"case rate","100%CMS IPPS rate",10472.15,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10472.15,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10472.15,100,,,,,0,"case rate","100%CMS IPPS rate",580395.71,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,580395.71,
"VENTRICULAR SHUNT PROCEDURES WITH CC",32,"CDM ",100,RC,,,INPATIENT,,,,,,9973.65,100,,,,,0,"case rate","100%CMS IPPS rate",19155.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",23065.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9973.65,100,,,,,0,"case rate","100%CMS IPPS rate",9973.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9973.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9973.65,100,,,,,0,"case rate","100%CMS IPPS rate",276045.85,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,276045.85,
"VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC",33,"CDM ",100,RC,,,INPATIENT,,,,,,9498.69,100,,,,,0,"case rate","100%CMS IPPS rate",14883.54,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17999.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9498.69,100,,,,,0,"case rate","100%CMS IPPS rate",9498.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9498.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9498.69,100,,,,,0,"case rate","100%CMS IPPS rate",215409.03,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,215409.03,
"CAROTID ARTERY STENT PROCEDURES WITH MCC",34,"CDM ",100,RC,,,INPATIENT,,,,,,19450.57,100,,,,,0,"case rate","100%CMS IPPS rate",28303.56,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",41896.46,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",19450.57,100,,,,,0,"case rate","100%CMS IPPS rate",19450.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",19450.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19450.57,100,,,,,0,"case rate","100%CMS IPPS rate",501403.31,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,501403.31,
"CAROTID ARTERY STENT PROCEDURES WITH CC",35,"CDM ",100,RC,,,INPATIENT,,,,,,11437.17,100,,,,,0,"case rate","100%CMS IPPS rate",16908.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",25874.77,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",11437.17,100,,,,,0,"case rate","100%CMS IPPS rate",11437.17,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",11437.17,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11437.17,100,,,,,0,"case rate","100%CMS IPPS rate",309660.91,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,309660.91,
"CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC",36,"CDM ",100,RC,,,INPATIENT,,,,,,9059.28,100,,,,,0,"case rate","100%CMS IPPS rate",13240.9,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",21028.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9059.28,100,,,,,0,"case rate","100%CMS IPPS rate",9059.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9059.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9059.28,100,,,,,0,"case rate","100%CMS IPPS rate",251666.68,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,251666.68,
"EXTRACRANIAL PROCEDURES WITH MCC",37,"CDM ",100,RC,,,INPATIENT,,,,,,16025.46,100,,,,,0,"case rate","100%CMS IPPS rate",28325.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",35633.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",16025.46,100,,,,,0,"case rate","100%CMS IPPS rate",16025.46,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",16025.46,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16025.46,100,,,,,0,"case rate","100%CMS IPPS rate",426452.52,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,426452.52,
"EXTRACRANIAL PROCEDURES WITH CC",38,"CDM ",100,RC,,,INPATIENT,,,,,,8110.25,100,,,,,0,"case rate","100%CMS IPPS rate",14335.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17563.02,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8110.25,100,,,,,0,"case rate","100%CMS IPPS rate",8110.25,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8110.25,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8110.25,100,,,,,0,"case rate","100%CMS IPPS rate",210188.6,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,210188.6,
"EXTRACRANIAL PROCEDURES WITHOUT CC/MCC",39,"CDM ",100,RC,,,INPATIENT,,,,,,4059.57,100,,,,,0,"case rate","100%CMS IPPS rate",9861.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12723.61,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4059.57,100,,,,,0,"case rate","100%CMS IPPS rate",4059.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4059.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4059.57,100,,,,,0,"case rate","100%CMS IPPS rate",152272.13,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,152272.13,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC",40,"CDM ",100,RC,,,INPATIENT,,,,,,19368.37,100,,,,,0,"case rate","100%CMS IPPS rate",33400.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",41793.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",19368.37,100,,,,,0,"case rate","100%CMS IPPS rate",19368.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",19368.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19368.37,100,,,,,0,"case rate","100%CMS IPPS rate",500172.63,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,500172.63,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR",41,"CDM ",100,RC,,,INPATIENT,,,,,,11504.26,100,,,,,0,"case rate","100%CMS IPPS rate",20306.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",23798.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",11504.26,100,,,,,0,"case rate","100%CMS IPPS rate",11504.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",11504.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11504.26,100,,,,,0,"case rate","100%CMS IPPS rate",284815.48,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,284815.48,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC",42,"CDM ",100,RC,,,INPATIENT,,,,,,9224.11,100,,,,,0,"case rate","100%CMS IPPS rate",16430.48,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18700.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9224.11,100,,,,,0,"case rate","100%CMS IPPS rate",9224.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9224.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9224.11,100,,,,,0,"case rate","100%CMS IPPS rate",223803.04,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,223803.04,
"SPINAL DISORDERS AND INJURIES WITH CC/MCC",52,"CDM ",100,RC,,,INPATIENT,,,,,,11303.44,100,,,,,0,"case rate","100%CMS IPPS rate",16018.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19275.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",11303.44,100,,,,,0,"case rate","100%CMS IPPS rate",11303.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",11303.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11303.44,100,,,,,0,"case rate","100%CMS IPPS rate",234632.37,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,234632.37,
"SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC",53,"CDM ",100,RC,,,INPATIENT,,,,,,6959.96,100,,,,,0,"case rate","100%CMS IPPS rate",9725.61,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10598.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6959.96,100,,,,,0,"case rate","100%CMS IPPS rate",6959.96,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6959.96,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6959.96,100,,,,,0,"case rate","100%CMS IPPS rate",126843.82,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,126843.82,
"NERVOUS SYSTEM NEOPLASMS WITH MCC",54,"CDM ",100,RC,,,INPATIENT,,,,,,8388.38,100,,,,,0,"case rate","100%CMS IPPS rate",11825.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16527.17,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8388.38,100,,,,,0,"case rate","100%CMS IPPS rate",8388.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8388.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8388.38,100,,,,,0,"case rate","100%CMS IPPS rate",197791.84,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,197791.84,
"NERVOUS SYSTEM NEOPLASMS WITHOUT MCC",55,"CDM ",100,RC,,,INPATIENT,,,,,,6392.14,100,,,,,0,"case rate","100%CMS IPPS rate",9027.61,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11036.15,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6392.14,100,,,,,0,"case rate","100%CMS IPPS rate",6392.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6392.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6392.14,100,,,,,0,"case rate","100%CMS IPPS rate",132077.11,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,132077.11,
"DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC",56,"CDM ",100,RC,,,INPATIENT,,,,,,17762.23,100,,,,,0,"case rate","100%CMS IPPS rate",18972.15,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",25145.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",17762.23,100,,,,,0,"case rate","100%CMS IPPS rate",17762.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",17762.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17762.23,100,,,,,0,"case rate","100%CMS IPPS rate",300929.99,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,300929.99,
"DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC",57,"CDM ",100,RC,,,INPATIENT,,,,,,11417.18,100,,,,,0,"case rate","100%CMS IPPS rate",10953.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14023.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",11417.18,100,,,,,0,"case rate","100%CMS IPPS rate",11417.18,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",11417.18,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11417.18,100,,,,,0,"case rate","100%CMS IPPS rate",167829.62,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,167829.62,
"MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC",58,"CDM ",100,RC,,,INPATIENT,,,,,,10639.21,100,,,,,0,"case rate","100%CMS IPPS rate",15018.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18503.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10639.21,100,,,,,0,"case rate","100%CMS IPPS rate",10639.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10639.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10639.21,100,,,,,0,"case rate","100%CMS IPPS rate",221445.47,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,221445.47,
"MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC",59,"CDM ",100,RC,,,INPATIENT,,,,,,6901.31,100,,,,,0,"case rate","100%CMS IPPS rate",9742.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13431.5,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6901.31,100,,,,,0,"case rate","100%CMS IPPS rate",6901.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6901.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6901.31,100,,,,,0,"case rate","100%CMS IPPS rate",160743.9,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,160743.9,
"MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC",60,"CDM ",100,RC,,,INPATIENT,,,,,,4445.22,100,,,,,0,"case rate","100%CMS IPPS rate",6226.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9955.92,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4445.22,100,,,,,0,"case rate","100%CMS IPPS rate",4445.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4445.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4445.22,100,,,,,0,"case rate","100%CMS IPPS rate",119149.19,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,119149.19,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC",61,"CDM ",100,RC,,,INPATIENT,,,,,,17693.8,100,,,,,0,"case rate","100%CMS IPPS rate",25977.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",29842.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",17693.8,100,,,,,0,"case rate","100%CMS IPPS rate",17693.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",17693.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17693.8,100,,,,,0,"case rate","100%CMS IPPS rate",357149.55,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,357149.55,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC",62,"CDM ",100,RC,,,INPATIENT,,,,,,12173.82,100,,,,,0,"case rate","100%CMS IPPS rate",17907.99,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19019.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",12173.82,100,,,,,0,"case rate","100%CMS IPPS rate",12173.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",12173.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12173.82,100,,,,,0,"case rate","100%CMS IPPS rate",227624.41,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,227624.41,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC",63,"CDM ",100,RC,,,INPATIENT,,,,,,10475.26,100,,,,,0,"case rate","100%CMS IPPS rate",14818.24,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15194.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10475.26,100,,,,,0,"case rate","100%CMS IPPS rate",10475.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10475.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10475.26,100,,,,,0,"case rate","100%CMS IPPS rate",181845.71,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,181845.71,
"INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC",64,"CDM ",100,RC,,,INPATIENT,,,,,,19182.65,100,,,,,0,"case rate","100%CMS IPPS rate",16901.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",21767.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",19182.65,100,,,,,0,"case rate","100%CMS IPPS rate",19182.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",19182.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19182.65,100,,,,,0,"case rate","100%CMS IPPS rate",260501.22,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,260501.22,
"INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS",65,"CDM ",100,RC,,,INPATIENT,,,,,,8747.82,100,,,,,0,"case rate","100%CMS IPPS rate",11061.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10935.49,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8747.82,100,,,,,0,"case rate","100%CMS IPPS rate",8747.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8747.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8747.82,100,,,,,0,"case rate","100%CMS IPPS rate",130872.44,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,130872.44,
"INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC",66,"CDM ",100,RC,,,INPATIENT,,,,,,5902.08,100,,,,,0,"case rate","100%CMS IPPS rate",8031.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7407.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5902.08,100,,,,,0,"case rate","100%CMS IPPS rate",5902.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5902.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5902.08,100,,,,,0,"case rate","100%CMS IPPS rate",89448.58,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,89448.58,
"PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC",67,"CDM ",100,RC,,,INPATIENT,,,,,,8727.38,100,,,,,0,"case rate","100%CMS IPPS rate",12268.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15897.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8727.38,100,,,,,0,"case rate","100%CMS IPPS rate",8727.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8727.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8727.38,100,,,,,0,"case rate","100%CMS IPPS rate",190252.72,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,190252.72,
"PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC",68,"CDM ",100,RC,,,INPATIENT,,,,,,5443.56,100,,,,,0,"case rate","100%CMS IPPS rate",8260.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9356.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5443.56,100,,,,,0,"case rate","100%CMS IPPS rate",5443.56,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5443.56,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5443.56,100,,,,,0,"case rate","100%CMS IPPS rate",111972.7,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,111972.7,
"TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC",69,"CDM ",100,RC,,,INPATIENT,,,,,,3225.62,100,,,,,0,"case rate","100%CMS IPPS rate",6802.25,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8646.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3225.62,100,,,,,0,"case rate","100%CMS IPPS rate",3225.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3225.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3225.62,100,,,,,0,"case rate","100%CMS IPPS rate",103475.06,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,103475.06,
"OTHER CEREBROVASCULAR DISORDERS WITH MCC",70,"CDM ",100,RC,,,INPATIENT,,,,,,10269.99,100,,,,,0,"case rate","100%CMS IPPS rate",14515.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18019.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10269.99,100,,,,,0,"case rate","100%CMS IPPS rate",10269.99,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10269.99,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10269.99,100,,,,,0,"case rate","100%CMS IPPS rate",215655.15,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,215655.15,
"OTHER CEREBROVASCULAR DISORDERS WITH CC",71,"CDM ",100,RC,,,INPATIENT,,,,,,8361.28,100,,,,,0,"case rate","100%CMS IPPS rate",8844.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11105.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8361.28,100,,,,,0,"case rate","100%CMS IPPS rate",8361.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8361.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8361.28,100,,,,,0,"case rate","100%CMS IPPS rate",132906.13,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,132906.13,
"OTHER CEREBROVASCULAR DISORDERS WITHOUT CC/MCC",72,"CDM ",100,RC,,,INPATIENT,,,,,,4724.69,100,,,,,0,"case rate","100%CMS IPPS rate",6960.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8185.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4724.69,100,,,,,0,"case rate","100%CMS IPPS rate",4724.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4724.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4724.69,100,,,,,0,"case rate","100%CMS IPPS rate",97956.76,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,97956.76,
"CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC",73,"CDM ",100,RC,,,INPATIENT,,,,,,8879.34,100,,,,,0,"case rate","100%CMS IPPS rate",12556.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17364.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8879.34,100,,,,,0,"case rate","100%CMS IPPS rate",8879.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8879.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8879.34,100,,,,,0,"case rate","100%CMS IPPS rate",207818.03,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,207818.03,
"CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC",74,"CDM ",100,RC,,,INPATIENT,,,,,,6849.33,100,,,,,0,"case rate","100%CMS IPPS rate",8806.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11157.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6849.33,100,,,,,0,"case rate","100%CMS IPPS rate",6849.33,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6849.33,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6849.33,100,,,,,0,"case rate","100%CMS IPPS rate",133527.9,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,133527.9,
"VIRAL MENINGITIS WITH CC/MCC",75,"CDM ",100,RC,,,INPATIENT,,,,,,9961.21,100,,,,,0,"case rate","100%CMS IPPS rate",14197.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",20755.02,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9961.21,100,,,,,0,"case rate","100%CMS IPPS rate",9961.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9961.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9961.21,100,,,,,0,"case rate","100%CMS IPPS rate",248389.32,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,248389.32,
"VIRAL MENINGITIS WITHOUT CC/MCC",76,"CDM ",100,RC,,,INPATIENT,,,,,,6009.16,100,,,,,0,"case rate","100%CMS IPPS rate",8511.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8105.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6009.16,100,,,,,0,"case rate","100%CMS IPPS rate",6009.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6009.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6009.16,100,,,,,0,"case rate","100%CMS IPPS rate",106894.92,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,106894.92,
"NONTRAUMATIC STUPOR AND COMA WITH MCC",80,"CDM ",100,RC,,,INPATIENT,,,,,,12815.83,100,,,,,0,"case rate","100%CMS IPPS rate",10562.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19591.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",12815.83,100,,,,,0,"case rate","100%CMS IPPS rate",12815.83,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",12815.83,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12815.83,100,,,,,0,"case rate","100%CMS IPPS rate",234464,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,234464,
"NONTRAUMATIC STUPOR AND COMA WITHOUT MCC",81,"CDM ",100,RC,,,INPATIENT,,,,,,4729.57,100,,,,,0,"case rate","100%CMS IPPS rate",7153.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9693.97,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4729.57,100,,,,,0,"case rate","100%CMS IPPS rate",4729.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4729.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4729.57,100,,,,,0,"case rate","100%CMS IPPS rate",116014.33,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,116014.33,
"TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC",82,"CDM ",100,RC,,,INPATIENT,,,,,,13833.72,100,,,,,0,"case rate","100%CMS IPPS rate",20041.89,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",24739.33,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",13833.72,100,,,,,0,"case rate","100%CMS IPPS rate",13833.72,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",13833.72,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13833.72,100,,,,,0,"case rate","100%CMS IPPS rate",296072.35,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,296072.35,
"TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC",83,"CDM ",100,RC,,,INPATIENT,,,,,,8219.55,100,,,,,0,"case rate","100%CMS IPPS rate",14075.5,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15108.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8219.55,100,,,,,0,"case rate","100%CMS IPPS rate",8219.55,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8219.55,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8219.55,100,,,,,0,"case rate","100%CMS IPPS rate",180809.28,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,180809.28,
"TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC",84,"CDM ",100,RC,,,INPATIENT,,,,,,5539.09,100,,,,,0,"case rate","100%CMS IPPS rate",10116,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10345.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5539.09,100,,,,,0,"case rate","100%CMS IPPS rate",5539.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5539.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5539.09,100,,,,,0,"case rate","100%CMS IPPS rate",123812.59,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,123812.59,
"TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC",85,"CDM ",100,RC,,,INPATIENT,,,,,,14129.63,100,,,,,0,"case rate","100%CMS IPPS rate",15265.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",24591.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",14129.63,100,,,,,0,"case rate","100%CMS IPPS rate",14129.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",14129.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14129.63,100,,,,,0,"case rate","100%CMS IPPS rate",294297.67,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,294297.67,
"TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC",86,"CDM ",100,RC,,,INPATIENT,,,,,,6279.74,100,,,,,0,"case rate","100%CMS IPPS rate",11014.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14100.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6279.74,100,,,,,0,"case rate","100%CMS IPPS rate",6279.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6279.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6279.74,100,,,,,0,"case rate","100%CMS IPPS rate",168749.27,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,168749.27,
"TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC",87,"CDM ",100,RC,,,INPATIENT,,,,,,2644.03,100,,,,,0,"case rate","100%CMS IPPS rate",7463.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9900.71,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2644.03,100,,,,,0,"case rate","100%CMS IPPS rate",2644.03,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2644.03,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2644.03,100,,,,,0,"case rate","100%CMS IPPS rate",118488.54,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,118488.54,
"CONCUSSION WITH MCC",88,"CDM ",100,RC,,,INPATIENT,,,,,,8939.76,100,,,,,0,"case rate","100%CMS IPPS rate",11897.89,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14631.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8939.76,100,,,,,0,"case rate","100%CMS IPPS rate",8939.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8939.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8939.76,100,,,,,0,"case rate","100%CMS IPPS rate",175109.6,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,175109.6,
"CONCUSSION WITH CC",89,"CDM ",100,RC,,,INPATIENT,,,,,,6501,100,,,,,0,"case rate","100%CMS IPPS rate",8976.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11891.25,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6501,100,,,,,0,"case rate","100%CMS IPPS rate",6501,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6501,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6501,100,,,,,0,"case rate","100%CMS IPPS rate",142310.55,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,142310.55,
"CONCUSSION WITHOUT CC/MCC",90,"CDM ",100,RC,,,INPATIENT,,,,,,5236.52,100,,,,,0,"case rate","100%CMS IPPS rate",6318.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8910.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5236.52,100,,,,,0,"case rate","100%CMS IPPS rate",5236.52,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5236.52,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5236.52,100,,,,,0,"case rate","100%CMS IPPS rate",106635.79,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,106635.79,
"OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC",91,"CDM ",100,RC,,,INPATIENT,,,,,,11093.28,100,,,,,0,"case rate","100%CMS IPPS rate",12890.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19009.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",11093.28,100,,,,,0,"case rate","100%CMS IPPS rate",11093.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",11093.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11093.28,100,,,,,0,"case rate","100%CMS IPPS rate",227494.9,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,227494.9,
"OTHER DISORDERS OF NERVOUS SYSTEM WITH CC",92,"CDM ",100,RC,,,INPATIENT,,,,,,7362.5,100,,,,,0,"case rate","100%CMS IPPS rate",8546.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11072.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7362.5,100,,,,,0,"case rate","100%CMS IPPS rate",7362.5,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7362.5,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7362.5,100,,,,,0,"case rate","100%CMS IPPS rate",132517.49,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,132517.49,
"OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC",93,"CDM ",100,RC,,,INPATIENT,,,,,,4342.14,100,,,,,0,"case rate","100%CMS IPPS rate",6759.9,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8619.15,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4342.14,100,,,,,0,"case rate","100%CMS IPPS rate",4342.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4342.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4342.14,100,,,,,0,"case rate","100%CMS IPPS rate",103151.17,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,103151.17,
"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC",94,"CDM ",100,RC,,,INPATIENT,,,,,,22257.21,100,,,,,0,"case rate","100%CMS IPPS rate",31439.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",38093.99,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",22257.21,100,,,,,0,"case rate","100%CMS IPPS rate",22257.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",22257.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22257.21,100,,,,,0,"case rate","100%CMS IPPS rate",455896.6,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,455896.6,
"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC",95,"CDM ",100,RC,,,INPATIENT,,,,,,15364.34,100,,,,,0,"case rate","100%CMS IPPS rate",21668.52,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",27917.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",15364.34,100,,,,,0,"case rate","100%CMS IPPS rate",15364.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",15364.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15364.34,100,,,,,0,"case rate","100%CMS IPPS rate",334104.83,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,334104.83,
"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC",96,"CDM ",100,RC,,,INPATIENT,,,,,,14283.36,100,,,,,0,"case rate","100%CMS IPPS rate",20159.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",27917.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",14283.36,100,,,,,0,"case rate","100%CMS IPPS rate",14283.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",14283.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14283.36,100,,,,,0,"case rate","100%CMS IPPS rate",334104.83,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,334104.83,
"NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC",97,"CDM ",100,RC,,,INPATIENT,,,,,,22988.97,100,,,,,0,"case rate","100%CMS IPPS rate",32498.02,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",39094.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",22988.97,100,,,,,0,"case rate","100%CMS IPPS rate",22988.97,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",22988.97,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22988.97,100,,,,,0,"case rate","100%CMS IPPS rate",467865.86,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,467865.86,
"NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC",98,"CDM ",100,RC,,,INPATIENT,,,,,,12931.8,100,,,,,0,"case rate","100%CMS IPPS rate",18256.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",24840,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",12931.8,100,,,,,0,"case rate","100%CMS IPPS rate",12931.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",12931.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12931.8,100,,,,,0,"case rate","100%CMS IPPS rate",297277.15,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,297277.15,
"NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC",99,"CDM ",100,RC,,,INPATIENT,,,,,,8559.88,100,,,,,0,"case rate","100%CMS IPPS rate",12115.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14746.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8559.88,100,,,,,0,"case rate","100%CMS IPPS rate",8559.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8559.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8559.88,100,,,,,0,"case rate","100%CMS IPPS rate",176482.78,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,176482.78,
"SEIZURES WITH MCC",100,"CDM ",100,RC,,,INPATIENT,,,,,,7960.08,100,,,,,0,"case rate","100%CMS IPPS rate",16216.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",20963.92,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7960.08,100,,,,,0,"case rate","100%CMS IPPS rate",7960.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7960.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7960.08,100,,,,,0,"case rate","100%CMS IPPS rate",250889.54,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,250889.54,
"SEIZURES WITHOUT MCC",101,"CDM ",100,RC,,,INPATIENT,,,,,,3630.38,100,,,,,0,"case rate","100%CMS IPPS rate",7677.7,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9769.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3630.38,100,,,,,0,"case rate","100%CMS IPPS rate",3630.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3630.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3630.38,100,,,,,0,"case rate","100%CMS IPPS rate",116921.12,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,116921.12,
"HEADACHES WITH MCC",102,"CDM ",100,RC,,,INPATIENT,,,,,,7055.48,100,,,,,0,"case rate","100%CMS IPPS rate",9965.29,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12132.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7055.48,100,,,,,0,"case rate","100%CMS IPPS rate",7055.48,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7055.48,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7055.48,100,,,,,0,"case rate","100%CMS IPPS rate",145199.27,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,145199.27,
"HEADACHES WITHOUT MCC",103,"CDM ",100,RC,,,INPATIENT,,,,,,3425.11,100,,,,,0,"case rate","100%CMS IPPS rate",5339.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9052.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3425.11,100,,,,,0,"case rate","100%CMS IPPS rate",3425.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3425.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3425.11,100,,,,,0,"case rate","100%CMS IPPS rate",108332.71,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,108332.71,
"ORBITAL PROCEDURES WITH CC/MCC",113,"CDM ",100,RC,,,INPATIENT,,,,,,10808.93,100,,,,,0,"case rate","100%CMS IPPS rate",14370.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",25448.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10808.93,100,,,,,0,"case rate","100%CMS IPPS rate",10808.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10808.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10808.93,100,,,,,0,"case rate","100%CMS IPPS rate",304557.12,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,304557.12,
"ORBITAL PROCEDURES WITHOUT CC/MCC",114,"CDM ",100,RC,,,INPATIENT,,,,,,7128.79,100,,,,,0,"case rate","100%CMS IPPS rate",8847.13,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14644.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7128.79,100,,,,,0,"case rate","100%CMS IPPS rate",7128.79,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7128.79,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7128.79,100,,,,,0,"case rate","100%CMS IPPS rate",175265.11,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,175265.11,
"EXTRAOCULAR PROCEDURES EXCEPT ORBIT",115,"CDM ",100,RC,,,INPATIENT,,,,,,7167,100,,,,,0,"case rate","100%CMS IPPS rate",9868.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16613.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7167,100,,,,,0,"case rate","100%CMS IPPS rate",7167,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7167,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7167,100,,,,,0,"case rate","100%CMS IPPS rate",198828.11,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,198828.11,
"INTRAOCULAR PROCEDURES WITH CC/MCC",116,"CDM ",100,RC,,,INPATIENT,,,,,,9257.43,100,,,,,0,"case rate","100%CMS IPPS rate",12332.72,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19570.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9257.43,100,,,,,0,"case rate","100%CMS IPPS rate",9257.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9257.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9257.43,100,,,,,0,"case rate","100%CMS IPPS rate",234217.87,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,234217.87,
"INTRAOCULAR PROCEDURES WITHOUT CC/MCC",117,"CDM ",100,RC,,,INPATIENT,,,,,,5123.22,100,,,,,0,"case rate","100%CMS IPPS rate",8298.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11742.96,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5123.22,100,,,,,0,"case rate","100%CMS IPPS rate",5123.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5123.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5123.22,100,,,,,0,"case rate","100%CMS IPPS rate",140535.86,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,140535.86,
"ACUTE MAJOR EYE INFECTIONS WITH CC/MCC",121,"CDM ",100,RC,,,INPATIENT,,,,,,4756.23,100,,,,,0,"case rate","100%CMS IPPS rate",8211.79,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12591.56,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4756.23,100,,,,,0,"case rate","100%CMS IPPS rate",4756.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4756.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4756.23,100,,,,,0,"case rate","100%CMS IPPS rate",150691.7,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,150691.7,
"ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC",122,"CDM ",100,RC,,,INPATIENT,,,,,,2576.05,100,,,,,0,"case rate","100%CMS IPPS rate",5632.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8505.5,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2576.05,100,,,,,0,"case rate","100%CMS IPPS rate",2576.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2576.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2576.05,100,,,,,0,"case rate","100%CMS IPPS rate",101791.14,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,101791.14,
"NEUROLOGICAL EYE DISORDERS",123,"CDM ",100,RC,,,INPATIENT,,,,,,3062.12,100,,,,,0,"case rate","100%CMS IPPS rate",6626.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8644.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3062.12,100,,,,,0,"case rate","100%CMS IPPS rate",3062.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3062.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3062.12,100,,,,,0,"case rate","100%CMS IPPS rate",103449.19,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,103449.19,
"OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT",124,"CDM ",100,RC,,,INPATIENT,,,,,,5596.85,100,,,,,0,"case rate","100%CMS IPPS rate",12116.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14321.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5596.85,100,,,,,0,"case rate","100%CMS IPPS rate",5596.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5596.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5596.85,100,,,,,0,"case rate","100%CMS IPPS rate",171391.85,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,171391.85,
"OTHER DISORDERS OF THE EYE WITHOUT MCC",125,"CDM ",100,RC,,,INPATIENT,,,,,,3342.47,100,,,,,0,"case rate","100%CMS IPPS rate",7233.48,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8310.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3342.47,100,,,,,0,"case rate","100%CMS IPPS rate",3342.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3342.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3342.47,100,,,,,0,"case rate","100%CMS IPPS rate",99459.44,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,99459.44,
"SINUS AND MASTOID PROCEDURES WITH CC/MCC",135,"CDM ",100,RC,,,INPATIENT,,,,,,6686.27,100,,,,,0,"case rate","100%CMS IPPS rate",14786.66,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22894.92,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6686.27,100,,,,,0,"case rate","100%CMS IPPS rate",6686.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6686.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6686.27,100,,,,,0,"case rate","100%CMS IPPS rate",281097.75,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,281097.75,
"SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC",136,"CDM ",100,RC,,,INPATIENT,,,,,,3921.39,100,,,,,0,"case rate","100%CMS IPPS rate",7959.96,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10989.61,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3921.39,100,,,,,0,"case rate","100%CMS IPPS rate",3921.39,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3921.39,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3921.39,100,,,,,0,"case rate","100%CMS IPPS rate",131520.08,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,131520.08,
"MOUTH PROCEDURES WITH CC/MCC",137,"CDM ",100,RC,,,INPATIENT,,,,,,4587.4,100,,,,,0,"case rate","100%CMS IPPS rate",13047.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16162.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4587.4,100,,,,,0,"case rate","100%CMS IPPS rate",4587.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4587.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4587.4,100,,,,,0,"case rate","100%CMS IPPS rate",193426.31,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,193426.31,
"MOUTH PROCEDURES WITHOUT CC/MCC",138,"CDM ",100,RC,,,INPATIENT,,,,,,2544.06,100,,,,,0,"case rate","100%CMS IPPS rate",7330.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9592.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2544.06,100,,,,,0,"case rate","100%CMS IPPS rate",2544.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2544.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2544.06,100,,,,,0,"case rate","100%CMS IPPS rate",114796.67,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2544.06,114796.67,
"SALIVARY GLAND PROCEDURES",139,"CDM ",100,RC,,,INPATIENT,,,,,,3832.09,100,,,,,0,"case rate","100%CMS IPPS rate",7994.92,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13081.89,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3832.09,100,,,,,0,"case rate","100%CMS IPPS rate",3832.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3832.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3832.09,100,,,,,0,"case rate","100%CMS IPPS rate",160070.25,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,160070.25,
"MAJOR HEAD AND NECK PROCEDURES WITH MCC",140,"CDM ",100,RC,,,INPATIENT,,,,,,9300.98,100,,,,,0,"case rate","100%CMS IPPS rate",35213.96,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",46167.61,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9300.98,100,,,,,0,"case rate","100%CMS IPPS rate",9300.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9300.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9300.98,100,,,,,0,"case rate","100%CMS IPPS rate",552519.07,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9300.98,552519.07,
"MAJOR HEAD AND NECK PROCEDURES WITH CC",141,"CDM ",100,RC,,,INPATIENT,,,,,,8858.01,100,,,,,0,"case rate","100%CMS IPPS rate",19528.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",23608.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8858.01,100,,,,,0,"case rate","100%CMS IPPS rate",8858.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8858.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8858.01,100,,,,,0,"case rate","100%CMS IPPS rate",282535.67,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8858.01,282535.67,
"MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC",142,"CDM ",100,RC,,,INPATIENT,,,,,,8435.92,100,,,,,0,"case rate","100%CMS IPPS rate",16594.48,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17279.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8435.92,100,,,,,0,"case rate","100%CMS IPPS rate",8435.92,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8435.92,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8435.92,100,,,,,0,"case rate","100%CMS IPPS rate",206794.75,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8435.92,206794.75,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC",143,"CDM ",100,RC,,,INPATIENT,,,,,,9257.43,100,,,,,0,"case rate","100%CMS IPPS rate",19873.64,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",40553.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9257.43,100,,,,,0,"case rate","100%CMS IPPS rate",9257.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9257.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9257.43,100,,,,,0,"case rate","100%CMS IPPS rate",485327.67,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9257.43,485327.67,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",144,"CDM ",100,RC,,,INPATIENT,,,,,,5902.08,100,,,,,0,"case rate","100%CMS IPPS rate",15223.18,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18756.91,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5902.08,100,,,,,0,"case rate","100%CMS IPPS rate",5902.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5902.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5902.08,100,,,,,0,"case rate","100%CMS IPPS rate",224476.69,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5902.08,224476.69,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",145,"CDM ",100,RC,,,INPATIENT,,,,,,3268.72,100,,,,,0,"case rate","100%CMS IPPS rate",7785.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13013.7,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3268.72,100,,,,,0,"case rate","100%CMS IPPS rate",3268.72,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3268.72,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3268.72,100,,,,,0,"case rate","100%CMS IPPS rate",155743.73,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3268.72,155743.73,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC",146,"CDM ",100,RC,,,INPATIENT,,,,,,8061.38,100,,,,,0,"case rate","100%CMS IPPS rate",18214.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22918.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8061.38,100,,,,,0,"case rate","100%CMS IPPS rate",8061.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8061.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8061.38,100,,,,,0,"case rate","100%CMS IPPS rate",274284.02,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,274284.02,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC",147,"CDM ",100,RC,,,INPATIENT,,,,,,5158.77,100,,,,,0,"case rate","100%CMS IPPS rate",11693.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13762.72,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5158.77,100,,,,,0,"case rate","100%CMS IPPS rate",5158.77,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5158.77,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5158.77,100,,,,,0,"case rate","100%CMS IPPS rate",164707.77,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,164707.77,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC",148,"CDM ",100,RC,,,INPATIENT,,,,,,3117.65,100,,,,,0,"case rate","100%CMS IPPS rate",8608.9,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8627.81,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3117.65,100,,,,,0,"case rate","100%CMS IPPS rate",3117.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3117.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3117.65,100,,,,,0,"case rate","100%CMS IPPS rate",103254.8,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,103254.8,
DYSEQUILIBRIUM,149,"CDM ",100,RC,,,INPATIENT,,,,,,2542.73,100,,,,,0,"case rate","100%CMS IPPS rate",6369.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8135.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2542.73,100,,,,,0,"case rate","100%CMS IPPS rate",2542.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2542.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2542.73,100,,,,,0,"case rate","100%CMS IPPS rate",97360.86,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,97360.86,
"EPISTAXIS WITH MCC",150,"CDM ",100,RC,,,INPATIENT,,,,,,5252.51,100,,,,,0,"case rate","100%CMS IPPS rate",9898.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14412.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5252.51,100,,,,,0,"case rate","100%CMS IPPS rate",5252.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5252.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5252.51,100,,,,,0,"case rate","100%CMS IPPS rate",172480.02,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,172480.02,
"EPISTAXIS WITHOUT MCC",151,"CDM ",100,RC,,,INPATIENT,,,,,,2922.16,100,,,,,0,"case rate","100%CMS IPPS rate",6381.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7944.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2922.16,100,,,,,0,"case rate","100%CMS IPPS rate",2922.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2922.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2922.16,100,,,,,0,"case rate","100%CMS IPPS rate",95081.05,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,95081.05,
"OTITIS MEDIA AND URI WITH MCC",152,"CDM ",100,RC,,,INPATIENT,,,,,,4270.17,100,,,,,0,"case rate","100%CMS IPPS rate",9337.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12796.13,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4270.17,100,,,,,0,"case rate","100%CMS IPPS rate",4270.17,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4270.17,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4270.17,100,,,,,0,"case rate","100%CMS IPPS rate",153140.03,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,153140.03,
"OTITIS MEDIA AND URI WITHOUT MCC",153,"CDM ",100,RC,,,INPATIENT,,,,,,2742.66,100,,,,,0,"case rate","100%CMS IPPS rate",6163.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7990.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2742.66,100,,,,,0,"case rate","100%CMS IPPS rate",2742.66,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2742.66,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2742.66,100,,,,,0,"case rate","100%CMS IPPS rate",95625.06,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,95625.06,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC",154,"CDM ",100,RC,,,INPATIENT,,,,,,6116.23,100,,,,,0,"case rate","100%CMS IPPS rate",12790.5,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16923.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6116.23,100,,,,,0,"case rate","100%CMS IPPS rate",6116.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6116.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6116.23,100,,,,,0,"case rate","100%CMS IPPS rate",202532.85,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,202532.85,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC",155,"CDM ",100,RC,,,INPATIENT,,,,,,3595.28,100,,,,,0,"case rate","100%CMS IPPS rate",8023.61,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9920.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3595.28,100,,,,,0,"case rate","100%CMS IPPS rate",3595.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3595.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3595.28,100,,,,,0,"case rate","100%CMS IPPS rate",118721.67,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,118721.67,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC",156,"CDM ",100,RC,,,INPATIENT,,,,,,2607.6,100,,,,,0,"case rate","100%CMS IPPS rate",6498.66,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7480.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2607.6,100,,,,,0,"case rate","100%CMS IPPS rate",2607.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2607.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2607.6,100,,,,,0,"case rate","100%CMS IPPS rate",90082.83,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,90082.83,
"DENTAL AND ORAL DISEASES WITH MCC",157,"CDM ",100,RC,,,INPATIENT,,,,,,6234.42,100,,,,,0,"case rate","100%CMS IPPS rate",13621.78,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18582.64,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6234.42,100,,,,,0,"case rate","100%CMS IPPS rate",6234.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6234.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6234.42,100,,,,,0,"case rate","100%CMS IPPS rate",222391.13,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,222391.13,
"DENTAL AND ORAL DISEASES WITH CC",158,"CDM ",100,RC,,,INPATIENT,,,,,,4066.68,100,,,,,0,"case rate","100%CMS IPPS rate",7779.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9847.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4066.68,100,,,,,0,"case rate","100%CMS IPPS rate",4066.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4066.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4066.68,100,,,,,0,"case rate","100%CMS IPPS rate",117853.77,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,117853.77,
"DENTAL AND ORAL DISEASES WITHOUT CC/MCC",159,"CDM ",100,RC,,,INPATIENT,,,,,,2600.49,100,,,,,0,"case rate","100%CMS IPPS rate",5730.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7668.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2600.49,100,,,,,0,"case rate","100%CMS IPPS rate",2600.49,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2600.49,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2600.49,100,,,,,0,"case rate","100%CMS IPPS rate",91777.82,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,91777.82,
"MAJOR CHEST PROCEDURES WITH MCC",163,"CDM ",100,RC,,,INPATIENT,,,,,,31823.88,100,,,,,0,"case rate","100%CMS IPPS rate",43269.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",48511,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",31823.88,100,,,,,0,"case rate","100%CMS IPPS rate",31823.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",31823.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",31823.88,100,,,,,0,"case rate","100%CMS IPPS rate",580564.09,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,580564.09,
"MAJOR CHEST PROCEDURES WITH CC",164,"CDM ",100,RC,,,INPATIENT,,,,,,16493.75,100,,,,,0,"case rate","100%CMS IPPS rate",25461.56,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",27319.78,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",16493.75,100,,,,,0,"case rate","100%CMS IPPS rate",16493.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",16493.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16493.75,100,,,,,0,"case rate","100%CMS IPPS rate",326954.21,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,326954.21,
"MAJOR CHEST PROCEDURES WITHOUT CC/MCC",165,"CDM ",100,RC,,,INPATIENT,,,,,,10530.8,100,,,,,0,"case rate","100%CMS IPPS rate",20364.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",20719.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10530.8,100,,,,,0,"case rate","100%CMS IPPS rate",10530.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10530.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10530.8,100,,,,,0,"case rate","100%CMS IPPS rate",247961.94,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,247961.94,
"OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC",166,"CDM ",100,RC,,,INPATIENT,,,,,,23714.07,100,,,,,0,"case rate","100%CMS IPPS rate",32179.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",40456.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",23714.07,100,,,,,0,"case rate","100%CMS IPPS rate",23714.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",23714.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",23714.07,100,,,,,0,"case rate","100%CMS IPPS rate",484174.75,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,484174.75,
"OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC",167,"CDM ",100,RC,,,INPATIENT,,,,,,11645.1,100,,,,,0,"case rate","100%CMS IPPS rate",17592.48,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19520,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",11645.1,100,,,,,0,"case rate","100%CMS IPPS rate",11645.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",11645.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11645.1,100,,,,,0,"case rate","100%CMS IPPS rate",233609.1,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,233609.1,
"OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC",168,"CDM ",100,RC,,,INPATIENT,,,,,,8569.21,100,,,,,0,"case rate","100%CMS IPPS rate",12865.48,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14789.91,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8569.21,100,,,,,0,"case rate","100%CMS IPPS rate",8569.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8569.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8569.21,100,,,,,0,"case rate","100%CMS IPPS rate",177000.91,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,177000.91,
"ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM",173,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",31937.7,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",32216.55,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",385557.34,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",31937.7,385557.34,
"PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE",175,"CDM ",100,RC,,,INPATIENT,,,,,,8311.08,100,,,,,0,"case rate","100%CMS IPPS rate",13360.79,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14867.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8311.08,100,,,,,0,"case rate","100%CMS IPPS rate",8311.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8311.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8311.08,100,,,,,0,"case rate","100%CMS IPPS rate",177933.56,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,177933.56,
"PULMONARY EMBOLISM WITHOUT MCC",176,"CDM ",100,RC,,,INPATIENT,,,,,,3985.37,100,,,,,0,"case rate","100%CMS IPPS rate",8722.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8713.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3985.37,100,,,,,0,"case rate","100%CMS IPPS rate",3985.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3985.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3985.37,100,,,,,0,"case rate","100%CMS IPPS rate",104278.21,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,104278.21,
"RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC",177,"CDM ",100,RC,,,INPATIENT,,,,,,9970.09,100,,,,,0,"case rate","100%CMS IPPS rate",18910.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16914.66,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9970.09,100,,,,,0,"case rate","100%CMS IPPS rate",9970.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9970.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9970.09,100,,,,,0,"case rate","100%CMS IPPS rate",202429.22,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,202429.22,
"RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC",178,"CDM ",100,RC,,,INPATIENT,,,,,,9495.58,100,,,,,0,"case rate","100%CMS IPPS rate",12788.25,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10564.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9495.58,100,,,,,0,"case rate","100%CMS IPPS rate",9495.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9495.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9495.58,100,,,,,0,"case rate","100%CMS IPPS rate",126429.17,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,126429.17,
"RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC",179,"CDM ",100,RC,,,INPATIENT,,,,,,9043.28,100,,,,,0,"case rate","100%CMS IPPS rate",10222.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8172.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9043.28,100,,,,,0,"case rate","100%CMS IPPS rate",9043.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9043.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9043.28,100,,,,,0,"case rate","100%CMS IPPS rate",97801.25,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,97801.25,
"RESPIRATORY NEOPLASMS WITH MCC",180,"CDM ",100,RC,,,INPATIENT,,,,,,9924.33,100,,,,,0,"case rate","100%CMS IPPS rate",18622.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19115.18,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9924.33,100,,,,,0,"case rate","100%CMS IPPS rate",9924.33,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9924.33,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9924.33,100,,,,,0,"case rate","100%CMS IPPS rate",228764.32,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,228764.32,
"RESPIRATORY NEOPLASMS WITH CC",181,"CDM ",100,RC,,,INPATIENT,,,,,,6003.38,100,,,,,0,"case rate","100%CMS IPPS rate",12640.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11592.5,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6003.38,100,,,,,0,"case rate","100%CMS IPPS rate",6003.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6003.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6003.38,100,,,,,0,"case rate","100%CMS IPPS rate",138735.31,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,138735.31,
"RESPIRATORY NEOPLASMS WITHOUT CC/MCC",182,"CDM ",100,RC,,,INPATIENT,,,,,,4217.74,100,,,,,0,"case rate","100%CMS IPPS rate",9650.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8053.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4217.74,100,,,,,0,"case rate","100%CMS IPPS rate",4217.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4217.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4217.74,100,,,,,0,"case rate","100%CMS IPPS rate",97645.87,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,97645.87,
"MAJOR CHEST TRAUMA WITH MCC",183,"CDM ",100,RC,,,INPATIENT,,,,,,8331.96,100,,,,,0,"case rate","100%CMS IPPS rate",13631.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16559.64,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8331.96,100,,,,,0,"case rate","100%CMS IPPS rate",8331.96,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8331.96,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8331.96,100,,,,,0,"case rate","100%CMS IPPS rate",198180.34,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,198180.34,
"MAJOR CHEST TRAUMA WITH CC",184,"CDM ",100,RC,,,INPATIENT,,,,,,5567.08,100,,,,,0,"case rate","100%CMS IPPS rate",9894.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11517.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5567.08,100,,,,,0,"case rate","100%CMS IPPS rate",5567.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5567.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5567.08,100,,,,,0,"case rate","100%CMS IPPS rate",137841.54,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,137841.54,
"MAJOR CHEST TRAUMA WITHOUT CC/MCC",185,"CDM ",100,RC,,,INPATIENT,,,,,,4143.54,100,,,,,0,"case rate","100%CMS IPPS rate",7400.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8513.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4143.54,100,,,,,0,"case rate","100%CMS IPPS rate",4143.54,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4143.54,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4143.54,100,,,,,0,"case rate","100%CMS IPPS rate",101881.77,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,101881.77,
"PLEURAL EFFUSION WITH MCC",186,"CDM ",100,RC,,,INPATIENT,,,,,,8265.31,100,,,,,0,"case rate","100%CMS IPPS rate",14037.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16869.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8265.31,100,,,,,0,"case rate","100%CMS IPPS rate",8265.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8265.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8265.31,100,,,,,0,"case rate","100%CMS IPPS rate",201885.22,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,201885.22,
"PLEURAL EFFUSION WITH CC",187,"CDM ",100,RC,,,INPATIENT,,,,,,5528.42,100,,,,,0,"case rate","100%CMS IPPS rate",9824.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10706.02,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5528.42,100,,,,,0,"case rate","100%CMS IPPS rate",5528.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5528.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5528.42,100,,,,,0,"case rate","100%CMS IPPS rate",128126.23,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,128126.23,
"PLEURAL EFFUSION WITHOUT CC/MCC",188,"CDM ",100,RC,,,INPATIENT,,,,,,3899.62,100,,,,,0,"case rate","100%CMS IPPS rate",7668.71,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7762.97,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3899.62,100,,,,,0,"case rate","100%CMS IPPS rate",3899.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3899.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3899.62,100,,,,,0,"case rate","100%CMS IPPS rate",92904.72,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,92904.72,
"PULMONARY EDEMA AND RESPIRATORY FAILURE",189,"CDM ",100,RC,,,INPATIENT,,,,,,6279.29,100,,,,,0,"case rate","100%CMS IPPS rate",12987.81,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13371.97,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6279.29,100,,,,,0,"case rate","100%CMS IPPS rate",6279.29,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6279.29,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6279.29,100,,,,,0,"case rate","100%CMS IPPS rate",160031.37,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,160031.37,
"CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC",190,"CDM ",100,RC,,,INPATIENT,,,,,,6729.37,100,,,,,0,"case rate","100%CMS IPPS rate",11189.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11989.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6729.37,100,,,,,0,"case rate","100%CMS IPPS rate",6729.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6729.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6729.37,100,,,,,0,"case rate","100%CMS IPPS rate",143489.34,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,143489.34,
"CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC",191,"CDM ",100,RC,,,INPATIENT,,,,,,5427.57,100,,,,,0,"case rate","100%CMS IPPS rate",8382.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9124.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5427.57,100,,,,,0,"case rate","100%CMS IPPS rate",5427.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5427.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5427.57,100,,,,,0,"case rate","100%CMS IPPS rate",109200.61,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,109200.61,
"CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC",192,"CDM ",100,RC,,,INPATIENT,,,,,,3721.9,100,,,,,0,"case rate","100%CMS IPPS rate",7223.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6949.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3721.9,100,,,,,0,"case rate","100%CMS IPPS rate",3721.9,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3721.9,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3721.9,100,,,,,0,"case rate","100%CMS IPPS rate",85434.77,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,85434.77,
"SIMPLE PNEUMONIA AND PLEURISY WITH MCC",193,"CDM ",100,RC,,,INPATIENT,,,,,,5737.69,100,,,,,0,"case rate","100%CMS IPPS rate",11999.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14227.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5737.69,100,,,,,0,"case rate","100%CMS IPPS rate",5737.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5737.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5737.69,100,,,,,0,"case rate","100%CMS IPPS rate",170264.95,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,170264.95,
"SIMPLE PNEUMONIA AND PLEURISY WITH CC",194,"CDM ",100,RC,,,INPATIENT,,,,,,5464.45,100,,,,,0,"case rate","100%CMS IPPS rate",8907.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8723.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5464.45,100,,,,,0,"case rate","100%CMS IPPS rate",5464.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5464.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5464.45,100,,,,,0,"case rate","100%CMS IPPS rate",104394.85,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,104394.85,
"SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC",195,"CDM ",100,RC,,,INPATIENT,,,,,,5204.09,100,,,,,0,"case rate","100%CMS IPPS rate",6807.04,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6802.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5204.09,100,,,,,0,"case rate","100%CMS IPPS rate",5204.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5204.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5204.09,100,,,,,0,"case rate","100%CMS IPPS rate",84156.75,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,84156.75,
"INTERSTITIAL LUNG DISEASE WITH MCC",196,"CDM ",100,RC,,,INPATIENT,,,,,,9298.31,100,,,,,0,"case rate","100%CMS IPPS rate",15056.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",20427.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9298.31,100,,,,,0,"case rate","100%CMS IPPS rate",9298.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9298.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9298.31,100,,,,,0,"case rate","100%CMS IPPS rate",244464.32,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,244464.32,
"INTERSTITIAL LUNG DISEASE WITH CC",197,"CDM ",100,RC,,,INPATIENT,,,,,,5385.8,100,,,,,0,"case rate","100%CMS IPPS rate",10001.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10273.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5385.8,100,,,,,0,"case rate","100%CMS IPPS rate",5385.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5385.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5385.8,100,,,,,0,"case rate","100%CMS IPPS rate",122944.69,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,122944.69,
"INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC",198,"CDM ",100,RC,,,INPATIENT,,,,,,3975.6,100,,,,,0,"case rate","100%CMS IPPS rate",7551.39,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7752.15,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3975.6,100,,,,,0,"case rate","100%CMS IPPS rate",3975.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3975.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3975.6,100,,,,,0,"case rate","100%CMS IPPS rate",92775.22,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,92775.22,
"PNEUMOTHORAX WITH MCC",199,"CDM ",100,RC,,,INPATIENT,,,,,,9574.22,100,,,,,0,"case rate","100%CMS IPPS rate",15469.48,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19094.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9574.22,100,,,,,0,"case rate","100%CMS IPPS rate",9574.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9574.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9574.22,100,,,,,0,"case rate","100%CMS IPPS rate",228518.18,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,228518.18,
"PNEUMOTHORAX WITH CC",200,"CDM ",100,RC,,,INPATIENT,,,,,,5757.68,100,,,,,0,"case rate","100%CMS IPPS rate",9303.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11898.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5757.68,100,,,,,0,"case rate","100%CMS IPPS rate",5757.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5757.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5757.68,100,,,,,0,"case rate","100%CMS IPPS rate",142401.32,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,142401.32,
"PNEUMOTHORAX WITHOUT CC/MCC",201,"CDM ",100,RC,,,INPATIENT,,,,,,3800.1,100,,,,,0,"case rate","100%CMS IPPS rate",6132.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7740.24,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3800.1,100,,,,,0,"case rate","100%CMS IPPS rate",3800.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3800.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3800.1,100,,,,,0,"case rate","100%CMS IPPS rate",92632.72,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,92632.72,
"BRONCHITIS AND ASTHMA WITH CC/MCC",202,"CDM ",100,RC,,,INPATIENT,,,,,,4381.69,100,,,,,0,"case rate","100%CMS IPPS rate",8702.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10512.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4381.69,100,,,,,0,"case rate","100%CMS IPPS rate",4381.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4381.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4381.69,100,,,,,0,"case rate","100%CMS IPPS rate",125807.4,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,125807.4,
"BRONCHITIS AND ASTHMA WITHOUT CC/MCC",203,"CDM ",100,RC,,,INPATIENT,,,,,,2983.47,100,,,,,0,"case rate","100%CMS IPPS rate",6532.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7252.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2983.47,100,,,,,0,"case rate","100%CMS IPPS rate",2983.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2983.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2983.47,100,,,,,0,"case rate","100%CMS IPPS rate",88085.3,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,88085.3,
"RESPIRATORY SIGNS AND SYMPTOMS",204,"CDM ",100,RC,,,INPATIENT,,,,,,3515.75,100,,,,,0,"case rate","100%CMS IPPS rate",7061.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8739.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3515.75,100,,,,,0,"case rate","100%CMS IPPS rate",3515.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3515.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3515.75,100,,,,,0,"case rate","100%CMS IPPS rate",104589.09,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,104589.09,
"OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC",205,"CDM ",100,RC,,,INPATIENT,,,,,,9010.4,100,,,,,0,"case rate","100%CMS IPPS rate",14560.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19818.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9010.4,100,,,,,0,"case rate","100%CMS IPPS rate",9010.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9010.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9010.4,100,,,,,0,"case rate","100%CMS IPPS rate",237184.34,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,237184.34,
"OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC",206,"CDM ",100,RC,,,INPATIENT,,,,,,2868.4,100,,,,,0,"case rate","100%CMS IPPS rate",7656.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10186.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2868.4,100,,,,,0,"case rate","100%CMS IPPS rate",2868.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2868.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2868.4,100,,,,,0,"case rate","100%CMS IPPS rate",121908.41,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,121908.41,
"RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS",207,"CDM ",100,RC,,,INPATIENT,,,,,,34307.96,100,,,,,0,"case rate","100%CMS IPPS rate",60424.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",69649.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",34307.96,100,,,,,0,"case rate","100%CMS IPPS rate",34307.96,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",34307.96,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",34307.96,100,,,,,0,"case rate","100%CMS IPPS rate",833539.04,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,833539.04,
"RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS",208,"CDM ",100,RC,,,INPATIENT,,,,,,14493.95,100,,,,,0,"case rate","100%CMS IPPS rate",30189.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",29751.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",14493.95,100,,,,,0,"case rate","100%CMS IPPS rate",14493.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",14493.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14493.95,100,,,,,0,"case rate","100%CMS IPPS rate",356061.53,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,356061.53,
"COMPLEX AORTIC ARCH PROCEDURES",209,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",122514.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",1466216.3,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",122514.69,1466216.3,
"CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES",212,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",111867.15,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",117701.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",1408610.7,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",111867.15,1408610.7,
"ENDOVASCULAR ABDOMINAL AORTA WITH ILIAC BRANCH PROCEDURES",213,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",61771.49,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",739261.15,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",61771.49,739261.15,
"OTHER HEART ASSIST SYSTEM IMPLANT",215,"CDM ",100,RC,,,INPATIENT,,,,,,32977.28,100,,,,,0,"case rate","100%CMS IPPS rate",102296.7,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",107774.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",32977.28,100,,,,,0,"case rate","100%CMS IPPS rate",32977.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",32977.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",32977.28,100,,,,,0,"case rate","100%CMS IPPS rate",1289811.28,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,1289811.28,
"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC",216,"CDM ",100,RC,,,INPATIENT,,,,,,60642.06,100,,,,,0,"case rate","100%CMS IPPS rate",86761.35,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",105889.03,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",60642.06,100,,,,,0,"case rate","100%CMS IPPS rate",60642.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",60642.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",60642.06,100,,,,,0,"case rate","100%CMS IPPS rate",1267245.68,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,1267245.68,
"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC",217,"CDM ",100,RC,,,INPATIENT,,,,,,32580.96,100,,,,,0,"case rate","100%CMS IPPS rate",56031.52,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",71171.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",32580.96,100,,,,,0,"case rate","100%CMS IPPS rate",32580.96,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",32580.96,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",32580.96,100,,,,,0,"case rate","100%CMS IPPS rate",851752.13,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,851752.13,
"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC",218,"CDM ",100,RC,,,INPATIENT,,,,,,25808.5,100,,,,,0,"case rate","100%CMS IPPS rate",42593.81,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",71171.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",25808.5,100,,,,,0,"case rate","100%CMS IPPS rate",25808.5,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",25808.5,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",25808.5,100,,,,,0,"case rate","100%CMS IPPS rate",851752.13,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,851752.13,
"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC",219,"CDM ",100,RC,,,INPATIENT,,,,,,35854.12,100,,,,,0,"case rate","100%CMS IPPS rate",69635.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",83109.92,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",35854.12,100,,,,,0,"case rate","100%CMS IPPS rate",35854.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",35854.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",35854.12,100,,,,,0,"case rate","100%CMS IPPS rate",994632.71,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,994632.71,
"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC",220,"CDM ",100,RC,,,INPATIENT,,,,,,32566.3,100,,,,,0,"case rate","100%CMS IPPS rate",47382.13,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",57722.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",32566.3,100,,,,,0,"case rate","100%CMS IPPS rate",32566.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",32566.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",32566.3,100,,,,,0,"case rate","100%CMS IPPS rate",690800.98,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,690800.98,
"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC",221,"CDM ",100,RC,,,INPATIENT,,,,,,22843.24,100,,,,,0,"case rate","100%CMS IPPS rate",43189.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",54555.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",22843.24,100,,,,,0,"case rate","100%CMS IPPS rate",22843.24,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",22843.24,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22843.24,100,,,,,0,"case rate","100%CMS IPPS rate",652898.15,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,652898.15,
"OTHER CARDIOTHORACIC PROCEDURES WITH MCC",228,"CDM ",100,RC,,,INPATIENT,,,,,,31188.53,100,,,,,0,"case rate","100%CMS IPPS rate",55447.55,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",53550.66,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",31188.53,100,,,,,0,"case rate","100%CMS IPPS rate",31188.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",31188.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",31188.53,100,,,,,0,"case rate","100%CMS IPPS rate",640877.01,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,640877.01,
"OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC",229,"CDM ",100,RC,,,INPATIENT,,,,,,20011.72,100,,,,,0,"case rate","100%CMS IPPS rate",36604.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",34090.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",20011.72,100,,,,,0,"case rate","100%CMS IPPS rate",20011.72,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",20011.72,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",20011.72,100,,,,,0,"case rate","100%CMS IPPS rate",407980.45,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,407980.45,
"CORONARY BYPASS WITH PTCA WITH MCC",231,"CDM ",100,RC,,,INPATIENT,,,,,,42603.93,100,,,,,0,"case rate","100%CMS IPPS rate",71860.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",91245.24,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",42603.93,100,,,,,0,"case rate","100%CMS IPPS rate",42603.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",42603.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",42603.93,100,,,,,0,"case rate","100%CMS IPPS rate",1091993.58,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,1091993.58,
"CORONARY BYPASS WITH PTCA WITHOUT MCC",232,"CDM ",100,RC,,,INPATIENT,,,,,,29597.49,100,,,,,0,"case rate","100%CMS IPPS rate",50774.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",65621.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",29597.49,100,,,,,0,"case rate","100%CMS IPPS rate",29597.49,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",29597.49,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",29597.49,100,,,,,0,"case rate","100%CMS IPPS rate",785337.88,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,785337.88,
"CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC",233,"CDM ",100,RC,,,INPATIENT,,,,,,40037.65,100,,,,,0,"case rate","100%CMS IPPS rate",70041.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",82751.64,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",40037.65,100,,,,,0,"case rate","100%CMS IPPS rate",40037.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",40037.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",40037.65,100,,,,,0,"case rate","100%CMS IPPS rate",990344.93,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,990344.93,
"CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC",234,"CDM ",100,RC,,,INPATIENT,,,,,,31150.32,100,,,,,0,"case rate","100%CMS IPPS rate",55937.7,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",59128.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",31150.32,100,,,,,0,"case rate","100%CMS IPPS rate",31150.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",31150.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",31150.32,100,,,,,0,"case rate","100%CMS IPPS rate",707628.03,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,707628.03,
"CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC",235,"CDM ",100,RC,,,INPATIENT,,,,,,30259.5,100,,,,,0,"case rate","100%CMS IPPS rate",57295.18,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",63521.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",30259.5,100,,,,,0,"case rate","100%CMS IPPS rate",30259.5,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",30259.5,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",30259.5,100,,,,,0,"case rate","100%CMS IPPS rate",760207.59,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,760207.59,
"CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC",236,"CDM ",100,RC,,,INPATIENT,,,,,,26181.27,100,,,,,0,"case rate","100%CMS IPPS rate",41597.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",45339.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",26181.27,100,,,,,0,"case rate","100%CMS IPPS rate",26181.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",26181.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",26181.27,100,,,,,0,"case rate","100%CMS IPPS rate",542609.37,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,542609.37,
"AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC",239,"CDM ",100,RC,,,INPATIENT,,,,,,24129.93,100,,,,,0,"case rate","100%CMS IPPS rate",42023.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",53272.48,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",24129.93,100,,,,,0,"case rate","100%CMS IPPS rate",24129.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",24129.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",24129.93,100,,,,,0,"case rate","100%CMS IPPS rate",637547.91,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,637547.91,
"AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC",240,"CDM ",100,RC,,,INPATIENT,,,,,,14000.34,100,,,,,0,"case rate","100%CMS IPPS rate",27861.91,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",30853.81,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",14000.34,100,,,,,0,"case rate","100%CMS IPPS rate",14000.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",14000.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14000.34,100,,,,,0,"case rate","100%CMS IPPS rate",369248.43,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,369248.43,
"AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC",241,"CDM ",100,RC,,,INPATIENT,,,,,,7985.85,100,,,,,0,"case rate","100%CMS IPPS rate",16818.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14984.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7985.85,100,,,,,0,"case rate","100%CMS IPPS rate",7985.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7985.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7985.85,100,,,,,0,"case rate","100%CMS IPPS rate",179332.62,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,179332.62,
"PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC",242,"CDM ",100,RC,,,INPATIENT,,,,,,18679.26,100,,,,,0,"case rate","100%CMS IPPS rate",39554.39,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",34558.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",18679.26,100,,,,,0,"case rate","100%CMS IPPS rate",18679.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",18679.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18679.26,100,,,,,0,"case rate","100%CMS IPPS rate",413589.36,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,413589.36,
"PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC",243,"CDM ",100,RC,,,INPATIENT,,,,,,13160.17,100,,,,,0,"case rate","100%CMS IPPS rate",25313.7,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",23064.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",13160.17,100,,,,,0,"case rate","100%CMS IPPS rate",13160.17,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",13160.17,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13160.17,100,,,,,0,"case rate","100%CMS IPPS rate",276032.83,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,276032.83,
"PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC",244,"CDM ",100,RC,,,INPATIENT,,,,,,10365.52,100,,,,,0,"case rate","100%CMS IPPS rate",21009.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19564.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10365.52,100,,,,,0,"case rate","100%CMS IPPS rate",10365.52,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10365.52,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10365.52,100,,,,,0,"case rate","100%CMS IPPS rate",234140.26,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,234140.26,
"AICD GENERATOR PROCEDURES",245,"CDM ",100,RC,,,INPATIENT,,,,,,27167.61,100,,,,,0,"case rate","100%CMS IPPS rate",49583.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",49383.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",27167.61,100,,,,,0,"case rate","100%CMS IPPS rate",27167.61,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",27167.61,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",27167.61,100,,,,,0,"case rate","100%CMS IPPS rate",591004.79,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,591004.79,
"PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC",250,"CDM ",100,RC,,,INPATIENT,,,,,,12659.44,100,,,,,0,"case rate","100%CMS IPPS rate",23407.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",23623.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",12659.44,100,,,,,0,"case rate","100%CMS IPPS rate",12659.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",12659.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12659.44,100,,,,,0,"case rate","100%CMS IPPS rate",282717.05,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,282717.05,
"PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC",251,"CDM ",100,RC,,,INPATIENT,,,,,,7565.1,100,,,,,0,"case rate","100%CMS IPPS rate",15827.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16176.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7565.1,100,,,,,0,"case rate","100%CMS IPPS rate",7565.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7565.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7565.1,100,,,,,0,"case rate","100%CMS IPPS rate",193594.69,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,193594.69,
"OTHER VASCULAR PROCEDURES WITH MCC",252,"CDM ",100,RC,,,INPATIENT,,,,,,15579.82,100,,,,,0,"case rate","100%CMS IPPS rate",30420.25,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",37757.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",15579.82,100,,,,,0,"case rate","100%CMS IPPS rate",15579.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",15579.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15579.82,100,,,,,0,"case rate","100%CMS IPPS rate",451867.97,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,451867.97,
"OTHER VASCULAR PROCEDURES WITH CC",253,"CDM ",100,RC,,,INPATIENT,,,,,,14101.64,100,,,,,0,"case rate","100%CMS IPPS rate",23688.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",28094.77,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",14101.64,100,,,,,0,"case rate","100%CMS IPPS rate",14101.64,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",14101.64,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14101.64,100,,,,,0,"case rate","100%CMS IPPS rate",336229.27,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,336229.27,
"OTHER VASCULAR PROCEDURES WITHOUT CC/MCC",254,"CDM ",100,RC,,,INPATIENT,,,,,,8739.83,100,,,,,0,"case rate","100%CMS IPPS rate",16491.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19285.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8739.83,100,,,,,0,"case rate","100%CMS IPPS rate",8739.83,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8739.83,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8739.83,100,,,,,0,"case rate","100%CMS IPPS rate",230798.14,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,230798.14,
"UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC",255,"CDM ",100,RC,,,INPATIENT,,,,,,12760.74,100,,,,,0,"case rate","100%CMS IPPS rate",21910.48,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",29196.66,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",12760.74,100,,,,,0,"case rate","100%CMS IPPS rate",12760.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",12760.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12760.74,100,,,,,0,"case rate","100%CMS IPPS rate",349416.18,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,349416.18,
"UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC",256,"CDM ",100,RC,,,INPATIENT,,,,,,8244.88,100,,,,,0,"case rate","100%CMS IPPS rate",12865.91,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18378.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8244.88,100,,,,,0,"case rate","100%CMS IPPS rate",8244.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8244.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8244.88,100,,,,,0,"case rate","100%CMS IPPS rate",219942.78,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,219942.78,
"UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC",257,"CDM ",100,RC,,,INPATIENT,,,,,,5826.11,100,,,,,0,"case rate","100%CMS IPPS rate",9414.96,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11821.97,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5826.11,100,,,,,0,"case rate","100%CMS IPPS rate",5826.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5826.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5826.11,100,,,,,0,"case rate","100%CMS IPPS rate",141481.53,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,141481.53,
"CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC",258,"CDM ",100,RC,,,INPATIENT,,,,,,16064.11,100,,,,,0,"case rate","100%CMS IPPS rate",24609.49,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",34010.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",16064.11,100,,,,,0,"case rate","100%CMS IPPS rate",16064.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",16064.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16064.11,100,,,,,0,"case rate","100%CMS IPPS rate",407021.78,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,407021.78,
"CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC",259,"CDM ",100,RC,,,INPATIENT,,,,,,10639.21,100,,,,,0,"case rate","100%CMS IPPS rate",18055.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",21887.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10639.21,100,,,,,0,"case rate","100%CMS IPPS rate",10639.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10639.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10639.21,100,,,,,0,"case rate","100%CMS IPPS rate",261939.14,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,261939.14,
"CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC",260,"CDM ",100,RC,,,INPATIENT,,,,,,17985.26,100,,,,,0,"case rate","100%CMS IPPS rate",30829.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",35208.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",17985.26,100,,,,,0,"case rate","100%CMS IPPS rate",17985.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",17985.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17985.26,100,,,,,0,"case rate","100%CMS IPPS rate",421361.6,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,421361.6,
"CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC",261,"CDM ",100,RC,,,INPATIENT,,,,,,9992.31,100,,,,,0,"case rate","100%CMS IPPS rate",14188.49,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",20462.77,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9992.31,100,,,,,0,"case rate","100%CMS IPPS rate",9992.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9992.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9992.31,100,,,,,0,"case rate","100%CMS IPPS rate",244891.83,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,244891.83,
"CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC",262,"CDM ",100,RC,,,INPATIENT,,,,,,8571.44,100,,,,,0,"case rate","100%CMS IPPS rate",14745.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17642.04,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8571.44,100,,,,,0,"case rate","100%CMS IPPS rate",8571.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8571.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8571.44,100,,,,,0,"case rate","100%CMS IPPS rate",211134.26,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,211134.26,
"VEIN LIGATION AND STRIPPING",263,"CDM ",100,RC,,,INPATIENT,,,,,,11567.79,100,,,,,0,"case rate","100%CMS IPPS rate",14411.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",33093.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",11567.79,100,,,,,0,"case rate","100%CMS IPPS rate",11567.79,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",11567.79,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11567.79,100,,,,,0,"case rate","100%CMS IPPS rate",396049.92,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,396049.92,
"OTHER CIRCULATORY SYSTEM O.R. PROCEDURES",264,"CDM ",100,RC,,,INPATIENT,,,,,,16297.37,100,,,,,0,"case rate","100%CMS IPPS rate",28118.17,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",36158.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",16297.37,100,,,,,0,"case rate","100%CMS IPPS rate",16297.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",16297.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16297.37,100,,,,,0,"case rate","100%CMS IPPS rate",432735.11,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,432735.11,
"AICD LEAD PROCEDURES",265,"CDM ",100,RC,,,INPATIENT,,,,,,16874.07,100,,,,,0,"case rate","100%CMS IPPS rate",28630.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",39163.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",16874.07,100,,,,,0,"case rate","100%CMS IPPS rate",16874.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",16874.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16874.07,100,,,,,0,"case rate","100%CMS IPPS rate",468694.88,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,468694.88,
"ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC",266,"CDM ",100,RC,,,INPATIENT,,,,,,44662.81,100,,,,,0,"case rate","100%CMS IPPS rate",61327.79,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",66333.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",44662.81,100,,,,,0,"case rate","100%CMS IPPS rate",44662.81,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",44662.81,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",44662.81,100,,,,,0,"case rate","100%CMS IPPS rate",793861.53,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,793861.53,
"ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC",267,"CDM ",100,RC,,,INPATIENT,,,,,,29783.65,100,,,,,0,"case rate","100%CMS IPPS rate",52498.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",51530.9,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",29783.65,100,,,,,0,"case rate","100%CMS IPPS rate",29783.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",29783.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",29783.65,100,,,,,0,"case rate","100%CMS IPPS rate",616705.25,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,616705.25,
"AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC",268,"CDM ",100,RC,,,INPATIENT,,,,,,34897.99,100,,,,,0,"case rate","100%CMS IPPS rate",60178.03,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",74446.39,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",34897.99,100,,,,,0,"case rate","100%CMS IPPS rate",34897.99,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",34897.99,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",34897.99,100,,,,,0,"case rate","100%CMS IPPS rate",890950.39,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,890950.39,
"AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC",269,"CDM ",100,RC,,,INPATIENT,,,,,,21650.74,100,,,,,0,"case rate","100%CMS IPPS rate",37291.84,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",45711.92,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",21650.74,100,,,,,0,"case rate","100%CMS IPPS rate",21650.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",21650.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",21650.74,100,,,,,0,"case rate","100%CMS IPPS rate",547065.52,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,547065.52,
"OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC",270,"CDM ",100,RC,,,INPATIENT,,,,,,34152.45,100,,,,,0,"case rate","100%CMS IPPS rate",44826.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",57110.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",34152.45,100,,,,,0,"case rate","100%CMS IPPS rate",34152.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",34152.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",34152.45,100,,,,,0,"case rate","100%CMS IPPS rate",683482.13,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,683482.13,
"OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC",271,"CDM ",100,RC,,,INPATIENT,,,,,,20081.47,100,,,,,0,"case rate","100%CMS IPPS rate",30812.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",38493.39,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",20081.47,100,,,,,0,"case rate","100%CMS IPPS rate",20081.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",20081.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",20081.47,100,,,,,0,"case rate","100%CMS IPPS rate",460676.5,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,460676.5,
"OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC",272,"CDM ",100,RC,,,INPATIENT,,,,,,13492.5,100,,,,,0,"case rate","100%CMS IPPS rate",23232.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",27633.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",13492.5,100,,,,,0,"case rate","100%CMS IPPS rate",13492.5,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",13492.5,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13492.5,100,,,,,0,"case rate","100%CMS IPPS rate",330710.83,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,330710.83,
"PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC",273,"CDM ",100,RC,,,INPATIENT,,,,,,14925.81,100,,,,,0,"case rate","100%CMS IPPS rate",25661.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",44654.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",14925.81,100,,,,,0,"case rate","100%CMS IPPS rate",14925.81,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",14925.81,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14925.81,100,,,,,0,"case rate","100%CMS IPPS rate",534409.6,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,534409.6,
"PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC",274,"CDM ",100,RC,,,INPATIENT,,,,,,10706.3,100,,,,,0,"case rate","100%CMS IPPS rate",28403.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",35629.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10706.3,100,,,,,0,"case rate","100%CMS IPPS rate",10706.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10706.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10706.3,100,,,,,0,"case rate","100%CMS IPPS rate",426400.64,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,426400.64,
"CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC",275,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",65931.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",77179.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",923658.82,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",65931.07,923658.82,
"CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR",276,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",58047.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",65015.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",778083.78,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",58047.58,778083.78,
"CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC",277,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",47841.64,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",49990.64,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",598271.91,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",47841.64,598271.91,
"ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC",278,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",46326.81,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",60248.55,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",721035.2,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",46326.81,721035.2,
"ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC",279,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",33242.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",39035.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",467166.33,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",33242.22,467166.33,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",280,"CDM ",100,RC,,,INPATIENT,,,,,,10026.07,100,,,,,0,"case rate","100%CMS IPPS rate",15638.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17362.78,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10026.07,100,,,,,0,"case rate","100%CMS IPPS rate",10026.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10026.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10026.07,100,,,,,0,"case rate","100%CMS IPPS rate",207792.15,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,207792.15,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC",281,"CDM ",100,RC,,,INPATIENT,,,,,,5385.36,100,,,,,0,"case rate","100%CMS IPPS rate",9719.78,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9948.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5385.36,100,,,,,0,"case rate","100%CMS IPPS rate",5385.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5385.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5385.36,100,,,,,0,"case rate","100%CMS IPPS rate",119058.57,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,119058.57,
"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC",282,"CDM ",100,RC,,,INPATIENT,,,,,,4261.73,100,,,,,0,"case rate","100%CMS IPPS rate",7703.61,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7826.83,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4261.73,100,,,,,0,"case rate","100%CMS IPPS rate",4261.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4261.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4261.73,100,,,,,0,"case rate","100%CMS IPPS rate",93669,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,93669,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC",283,"CDM ",100,RC,,,INPATIENT,,,,,,10953.33,100,,,,,0,"case rate","100%CMS IPPS rate",16115.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",21440.18,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10953.33,100,,,,,0,"case rate","100%CMS IPPS rate",10953.33,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10953.33,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10953.33,100,,,,,0,"case rate","100%CMS IPPS rate",256589.22,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,256589.22,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC",284,"CDM ",100,RC,,,INPATIENT,,,,,,4312.82,100,,,,,0,"case rate","100%CMS IPPS rate",5834.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7492.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4312.82,100,,,,,0,"case rate","100%CMS IPPS rate",4312.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4312.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4312.82,100,,,,,0,"case rate","100%CMS IPPS rate",90186.84,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,90186.84,
"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC",285,"CDM ",100,RC,,,INPATIENT,,,,,,2915.94,100,,,,,0,"case rate","100%CMS IPPS rate",4275.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6482.49,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2915.94,100,,,,,0,"case rate","100%CMS IPPS rate",2915.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2915.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2915.94,100,,,,,0,"case rate","100%CMS IPPS rate",81354.62,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,81354.62,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC",286,"CDM ",100,RC,,,INPATIENT,,,,,,12729.2,100,,,,,0,"case rate","100%CMS IPPS rate",18462.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",23951.35,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",12729.2,100,,,,,0,"case rate","100%CMS IPPS rate",12729.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",12729.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12729.2,100,,,,,0,"case rate","100%CMS IPPS rate",286642.05,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,286642.05,
"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC",287,"CDM ",100,RC,,,INPATIENT,,,,,,6585.41,100,,,,,0,"case rate","100%CMS IPPS rate",10065.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11582.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6585.41,100,,,,,0,"case rate","100%CMS IPPS rate",6585.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6585.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6585.41,100,,,,,0,"case rate","100%CMS IPPS rate",138618.82,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,138618.82,
"ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC",288,"CDM ",100,RC,,,INPATIENT,,,,,,15749.1,100,,,,,0,"case rate","100%CMS IPPS rate",23207.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",29291.91,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",15749.1,100,,,,,0,"case rate","100%CMS IPPS rate",15749.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",15749.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15749.1,100,,,,,0,"case rate","100%CMS IPPS rate",350556.09,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,350556.09,
"ACUTE AND SUBACUTE ENDOCARDITIS WITH CC",289,"CDM ",100,RC,,,INPATIENT,,,,,,9649.31,100,,,,,0,"case rate","100%CMS IPPS rate",14204.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18475.49,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9649.31,100,,,,,0,"case rate","100%CMS IPPS rate",9649.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9649.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9649.31,100,,,,,0,"case rate","100%CMS IPPS rate",221108.7,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,221108.7,
"ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC",290,"CDM ",100,RC,,,INPATIENT,,,,,,6013.16,100,,,,,0,"case rate","100%CMS IPPS rate",9726.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10063.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6013.16,100,,,,,0,"case rate","100%CMS IPPS rate",6013.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6013.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6013.16,100,,,,,0,"case rate","100%CMS IPPS rate",120431.6,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,120431.6,
"HEART FAILURE AND SHOCK WITH MCC",291,"CDM ",100,RC,,,INPATIENT,,,,,,8053.38,100,,,,,0,"case rate","100%CMS IPPS rate",13521.13,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13895.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8053.38,100,,,,,0,"case rate","100%CMS IPPS rate",8053.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8053.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8053.38,100,,,,,0,"case rate","100%CMS IPPS rate",166301.07,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,166301.07,
"HEART FAILURE AND SHOCK WITH CC",292,"CDM ",100,RC,,,INPATIENT,,,,,,5438.68,100,,,,,0,"case rate","100%CMS IPPS rate",7462.5,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9189.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5438.68,100,,,,,0,"case rate","100%CMS IPPS rate",5438.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5438.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5438.68,100,,,,,0,"case rate","100%CMS IPPS rate",109977.89,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,109977.89,
"HEART FAILURE AND SHOCK WITHOUT CC/MCC",293,"CDM ",100,RC,,,INPATIENT,,,,,,4128.88,100,,,,,0,"case rate","100%CMS IPPS rate",5634.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6126.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4128.88,100,,,,,0,"case rate","100%CMS IPPS rate",4128.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4128.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4128.88,100,,,,,0,"case rate","100%CMS IPPS rate",78240.19,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,78240.19,
"CARDIAC ARREST, UNEXPLAINED WITH MCC",296,"CDM ",100,RC,,,INPATIENT,,,,,,9368.51,100,,,,,0,"case rate","100%CMS IPPS rate",13785.99,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16906.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9368.51,100,,,,,0,"case rate","100%CMS IPPS rate",9368.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9368.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9368.51,100,,,,,0,"case rate","100%CMS IPPS rate",202325.6,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,202325.6,
"CARDIAC ARREST, UNEXPLAINED WITH CC",297,"CDM ",100,RC,,,INPATIENT,,,,,,4139.1,100,,,,,0,"case rate","100%CMS IPPS rate",7803.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6748.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4139.1,100,,,,,0,"case rate","100%CMS IPPS rate",4139.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4139.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4139.1,100,,,,,0,"case rate","100%CMS IPPS rate",84677.33,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,84677.33,
"CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC",298,"CDM ",100,RC,,,INPATIENT,,,,,,2867.96,100,,,,,0,"case rate","100%CMS IPPS rate",5344.03,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4926,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2867.96,100,,,,,0,"case rate","100%CMS IPPS rate",2867.96,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2867.96,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2867.96,100,,,,,0,"case rate","100%CMS IPPS rate",67741.78,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,67741.78,
"PERIPHERAL VASCULAR DISORDERS WITH MCC",299,"CDM ",100,RC,,,INPATIENT,,,,,,6125.12,100,,,,,0,"case rate","100%CMS IPPS rate",13244.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17672.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6125.12,100,,,,,0,"case rate","100%CMS IPPS rate",6125.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6125.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6125.12,100,,,,,0,"case rate","100%CMS IPPS rate",211496.9,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,211496.9,
"PERIPHERAL VASCULAR DISORDERS WITH CC",300,"CDM ",100,RC,,,INPATIENT,,,,,,5833.66,100,,,,,0,"case rate","100%CMS IPPS rate",9020.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11554.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5833.66,100,,,,,0,"case rate","100%CMS IPPS rate",5833.66,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5833.66,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5833.66,100,,,,,0,"case rate","100%CMS IPPS rate",138281.92,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,138281.92,
"PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC",301,"CDM ",100,RC,,,INPATIENT,,,,,,5555.53,100,,,,,0,"case rate","100%CMS IPPS rate",6421.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7790.03,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5555.53,100,,,,,0,"case rate","100%CMS IPPS rate",5555.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5555.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5555.53,100,,,,,0,"case rate","100%CMS IPPS rate",93228.61,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,93228.61,
"ATHEROSCLEROSIS WITH MCC",302,"CDM ",100,RC,,,INPATIENT,,,,,,6423.69,100,,,,,0,"case rate","100%CMS IPPS rate",9461.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12952,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6423.69,100,,,,,0,"case rate","100%CMS IPPS rate",6423.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6423.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6423.69,100,,,,,0,"case rate","100%CMS IPPS rate",155005.34,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,155005.34,
"ATHEROSCLEROSIS WITHOUT MCC",303,"CDM ",100,RC,,,INPATIENT,,,,,,3973.37,100,,,,,0,"case rate","100%CMS IPPS rate",5855.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7286.72,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3973.37,100,,,,,0,"case rate","100%CMS IPPS rate",3973.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3973.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3973.37,100,,,,,0,"case rate","100%CMS IPPS rate",88388.23,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,88388.23,
"HYPERTENSION WITH MCC",304,"CDM ",100,RC,,,INPATIENT,,,,,,7019.94,100,,,,,0,"case rate","100%CMS IPPS rate",9480.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12880.56,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7019.94,100,,,,,0,"case rate","100%CMS IPPS rate",7019.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7019.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7019.94,100,,,,,0,"case rate","100%CMS IPPS rate",154150.44,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,154150.44,
"HYPERTENSION WITHOUT MCC",305,"CDM ",100,RC,,,INPATIENT,,,,,,3686.36,100,,,,,0,"case rate","100%CMS IPPS rate",6565.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8173.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3686.36,100,,,,,0,"case rate","100%CMS IPPS rate",3686.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3686.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3686.36,100,,,,,0,"case rate","100%CMS IPPS rate",97814.25,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,97814.25,
"CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC",306,"CDM ",100,RC,,,INPATIENT,,,,,,8833.57,100,,,,,0,"case rate","100%CMS IPPS rate",13027.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17056.46,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8833.57,100,,,,,0,"case rate","100%CMS IPPS rate",8833.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8833.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8833.57,100,,,,,0,"case rate","100%CMS IPPS rate",204126.15,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,204126.15,
"CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC",307,"CDM ",100,RC,,,INPATIENT,,,,,,5101.45,100,,,,,0,"case rate","100%CMS IPPS rate",7522.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9884.48,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5101.45,100,,,,,0,"case rate","100%CMS IPPS rate",5101.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5101.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5101.45,100,,,,,0,"case rate","100%CMS IPPS rate",118294.29,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,118294.29,
"CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC",308,"CDM ",100,RC,,,INPATIENT,,,,,,8771.81,100,,,,,0,"case rate","100%CMS IPPS rate",10378.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13032.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8771.81,100,,,,,0,"case rate","100%CMS IPPS rate",8771.81,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8771.81,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8771.81,100,,,,,0,"case rate","100%CMS IPPS rate",155963.86,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,155963.86,
"CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC",309,"CDM ",100,RC,,,INPATIENT,,,,,,5480.88,100,,,,,0,"case rate","100%CMS IPPS rate",7176.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7963.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5480.88,100,,,,,0,"case rate","100%CMS IPPS rate",5480.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5480.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5480.88,100,,,,,0,"case rate","100%CMS IPPS rate",95301.18,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,95301.18,
"CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC",310,"CDM ",100,RC,,,INPATIENT,,,,,,3341.14,100,,,,,0,"case rate","100%CMS IPPS rate",5267.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6127.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3341.14,100,,,,,0,"case rate","100%CMS IPPS rate",3341.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3341.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3341.14,100,,,,,0,"case rate","100%CMS IPPS rate",78249.71,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,78249.71,
"ANGINA PECTORIS",311,"CDM ",100,RC,,,INPATIENT,,,,,,4094.67,100,,,,,0,"case rate","100%CMS IPPS rate",6036.56,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7597.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4094.67,100,,,,,0,"case rate","100%CMS IPPS rate",4094.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4094.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4094.67,100,,,,,0,"case rate","100%CMS IPPS rate",91105.1,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,91105.1,
"SYNCOPE AND COLLAPSE",312,"CDM ",100,RC,,,INPATIENT,,,,,,3487.76,100,,,,,0,"case rate","100%CMS IPPS rate",7248.18,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9434.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3487.76,100,,,,,0,"case rate","100%CMS IPPS rate",3487.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3487.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.76,100,,,,,0,"case rate","100%CMS IPPS rate",112905.49,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,112905.49,
"CHEST PAIN",313,"CDM ",100,RC,,,INPATIENT,,,,,,3876.52,100,,,,,0,"case rate","100%CMS IPPS rate",6619.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7793.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3876.52,100,,,,,0,"case rate","100%CMS IPPS rate",3876.52,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3876.52,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3876.52,100,,,,,0,"case rate","100%CMS IPPS rate",93267.49,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,93267.49,
"OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC",314,"CDM ",100,RC,,,INPATIENT,,,,,,11195.92,100,,,,,0,"case rate","100%CMS IPPS rate",18016.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22570.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",11195.92,100,,,,,0,"case rate","100%CMS IPPS rate",11195.92,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",11195.92,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11195.92,100,,,,,0,"case rate","100%CMS IPPS rate",270112.89,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,270112.89,
"OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC",315,"CDM ",100,RC,,,INPATIENT,,,,,,5259.18,100,,,,,0,"case rate","100%CMS IPPS rate",8412.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10426.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5259.18,100,,,,,0,"case rate","100%CMS IPPS rate",5259.18,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5259.18,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5259.18,100,,,,,0,"case rate","100%CMS IPPS rate",124784.12,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,124784.12,
"OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC",316,"CDM ",100,RC,,,INPATIENT,,,,,,4403.01,100,,,,,0,"case rate","100%CMS IPPS rate",6251.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7383.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4403.01,100,,,,,0,"case rate","100%CMS IPPS rate",4403.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4403.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4403.01,100,,,,,0,"case rate","100%CMS IPPS rate",89230.76,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,89230.76,
"CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION",317,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",72374.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",866156.85,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",72374.68,866156.85,
"PERCUTANEOUS CORONARY ATHERECTOMY WITHOUT INTRALUMINAL DEVICE",318,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",26217.89,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",313767.29,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",26217.89,313767.29,
"OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC",319,"CDM ",100,RC,,,INPATIENT,,,,,,21656.51,100,,,,,0,"case rate","100%CMS IPPS rate",35347.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",48306.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",21656.51,100,,,,,0,"case rate","100%CMS IPPS rate",21656.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",21656.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",21656.51,100,,,,,0,"case rate","100%CMS IPPS rate",578115.75,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,578115.75,
"OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC",320,"CDM ",100,RC,,,INPATIENT,,,,,,12262.68,100,,,,,0,"case rate","100%CMS IPPS rate",20236.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",26034.97,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",12262.68,100,,,,,0,"case rate","100%CMS IPPS rate",12262.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",12262.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12262.68,100,,,,,0,"case rate","100%CMS IPPS rate",311578.11,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,311578.11,
"PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES",321,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",33294.35,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",29449.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",352447.4,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",29449.94,352447.4,
"PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC",322,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",19622.52,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19082.71,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",228375.68,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19082.71,228375.68,
"CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC",323,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",42999.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",46839.78,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",560563.31,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",42999.06,560563.31,
"CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC",324,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",30832.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",34106.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",408174.69,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",30832.62,408174.69,
"CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE",325,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",27464.35,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",34749.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",415869.31,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",27464.35,415869.31,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC",326,"CDM ",100,RC,,,INPATIENT,,,,,,27961.13,100,,,,,0,"case rate","100%CMS IPPS rate",45944.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",53983.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",27961.13,100,,,,,0,"case rate","100%CMS IPPS rate",27961.13,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",27961.13,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",27961.13,100,,,,,0,"case rate","100%CMS IPPS rate",646058.56,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,646058.56,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC",327,"CDM ",100,RC,,,INPATIENT,,,,,,8935.76,100,,,,,0,"case rate","100%CMS IPPS rate",26296.66,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",26456.02,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8935.76,100,,,,,0,"case rate","100%CMS IPPS rate",8935.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8935.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8935.76,100,,,,,0,"case rate","100%CMS IPPS rate",316617.14,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,316617.14,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC",328,"CDM ",100,RC,,,INPATIENT,,,,,,5663.05,100,,,,,0,"case rate","100%CMS IPPS rate",14405.64,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17343.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5663.05,100,,,,,0,"case rate","100%CMS IPPS rate",5663.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5663.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5663.05,100,,,,,0,"case rate","100%CMS IPPS rate",207559.02,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,207559.02,
"MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC",329,"CDM ",100,RC,,,INPATIENT,,,,,,33567.75,100,,,,,0,"case rate","100%CMS IPPS rate",42227.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",49752.52,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",33567.75,100,,,,,0,"case rate","100%CMS IPPS rate",33567.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",33567.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",33567.75,100,,,,,0,"case rate","100%CMS IPPS rate",595422.05,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,595422.05,
"MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC",330,"CDM ",100,RC,,,INPATIENT,,,,,,12195.15,100,,,,,0,"case rate","100%CMS IPPS rate",24998.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",25947.29,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",12195.15,100,,,,,0,"case rate","100%CMS IPPS rate",12195.15,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",12195.15,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12195.15,100,,,,,0,"case rate","100%CMS IPPS rate",310528.81,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,310528.81,
"MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC",331,"CDM ",100,RC,,,INPATIENT,,,,,,7814.35,100,,,,,0,"case rate","100%CMS IPPS rate",16292.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18215.71,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7814.35,100,,,,,0,"case rate","100%CMS IPPS rate",7814.35,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7814.35,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7814.35,100,,,,,0,"case rate","100%CMS IPPS rate",217999.73,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,217999.73,
"RECTAL RESECTION WITH MCC",332,"CDM ",100,RC,,,INPATIENT,,,,,,21628.08,100,,,,,0,"case rate","100%CMS IPPS rate",35636.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",39190.46,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",21628.08,100,,,,,0,"case rate","100%CMS IPPS rate",21628.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",21628.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",21628.08,100,,,,,0,"case rate","100%CMS IPPS rate",469018.76,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,469018.76,
"RECTAL RESECTION WITH CC",333,"CDM ",100,RC,,,INPATIENT,,,,,,11131.94,100,,,,,0,"case rate","100%CMS IPPS rate",17988.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",25351.97,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",11131.94,100,,,,,0,"case rate","100%CMS IPPS rate",11131.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",11131.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11131.94,100,,,,,0,"case rate","100%CMS IPPS rate",303404.2,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,303404.2,
"RECTAL RESECTION WITHOUT CC/MCC",334,"CDM ",100,RC,,,INPATIENT,,,,,,8367.06,100,,,,,0,"case rate","100%CMS IPPS rate",13435.91,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17728.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8367.06,100,,,,,0,"case rate","100%CMS IPPS rate",8367.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8367.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8367.06,100,,,,,0,"case rate","100%CMS IPPS rate",212170.54,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,212170.54,
"PERITONEAL ADHESIOLYSIS WITH MCC",335,"CDM ",100,RC,,,INPATIENT,,,,,,20228.09,100,,,,,0,"case rate","100%CMS IPPS rate",33821.13,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",38651.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",20228.09,100,,,,,0,"case rate","100%CMS IPPS rate",20228.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",20228.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",20228.09,100,,,,,0,"case rate","100%CMS IPPS rate",462567.81,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,462567.81,
"PERITONEAL ADHESIOLYSIS WITH CC",336,"CDM ",100,RC,,,INPATIENT,,,,,,11869.92,100,,,,,0,"case rate","100%CMS IPPS rate",19801.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22824.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",11869.92,100,,,,,0,"case rate","100%CMS IPPS rate",11869.92,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",11869.92,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11869.92,100,,,,,0,"case rate","100%CMS IPPS rate",273157.11,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,273157.11,
"PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC",337,"CDM ",100,RC,,,INPATIENT,,,,,,8488.8,100,,,,,0,"case rate","100%CMS IPPS rate",14149.83,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16614.84,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8488.8,100,,,,,0,"case rate","100%CMS IPPS rate",8488.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8488.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8488.8,100,,,,,0,"case rate","100%CMS IPPS rate",198840.99,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,198840.99,
"MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC",344,"CDM ",100,RC,,,INPATIENT,,,,,,14563.27,100,,,,,0,"case rate","100%CMS IPPS rate",24357.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",27956.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",14563.27,100,,,,,0,"case rate","100%CMS IPPS rate",14563.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",14563.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14563.27,100,,,,,0,"case rate","100%CMS IPPS rate",334571.08,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,334571.08,
"MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC",345,"CDM ",100,RC,,,INPATIENT,,,,,,8203.11,100,,,,,0,"case rate","100%CMS IPPS rate",14754.99,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16286.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8203.11,100,,,,,0,"case rate","100%CMS IPPS rate",8203.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8203.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8203.11,100,,,,,0,"case rate","100%CMS IPPS rate",194915.98,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,194915.98,
"MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC",346,"CDM ",100,RC,,,INPATIENT,,,,,,6629.4,100,,,,,0,"case rate","100%CMS IPPS rate",12970.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12839.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6629.4,100,,,,,0,"case rate","100%CMS IPPS rate",6629.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6629.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6629.4,100,,,,,0,"case rate","100%CMS IPPS rate",153658.17,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,153658.17,
"ANAL AND STOMAL PROCEDURES WITH MCC",347,"CDM ",100,RC,,,INPATIENT,,,,,,12798.95,100,,,,,0,"case rate","100%CMS IPPS rate",19864.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",24847.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",12798.95,100,,,,,0,"case rate","100%CMS IPPS rate",12798.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",12798.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12798.95,100,,,,,0,"case rate","100%CMS IPPS rate",297367.77,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,297367.77,
"ANAL AND STOMAL PROCEDURES WITH CC",348,"CDM ",100,RC,,,INPATIENT,,,,,,6979.95,100,,,,,0,"case rate","100%CMS IPPS rate",11650.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14166.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6979.95,100,,,,,0,"case rate","100%CMS IPPS rate",6979.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6979.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6979.95,100,,,,,0,"case rate","100%CMS IPPS rate",169539.56,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,169539.56,
"ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC",349,"CDM ",100,RC,,,INPATIENT,,,,,,5091.68,100,,,,,0,"case rate","100%CMS IPPS rate",8463.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9423.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5091.68,100,,,,,0,"case rate","100%CMS IPPS rate",5091.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5091.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5091.68,100,,,,,0,"case rate","100%CMS IPPS rate",112775.86,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,112775.86,
"INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC",350,"CDM ",100,RC,,,INPATIENT,,,,,,12751.41,100,,,,,0,"case rate","100%CMS IPPS rate",18834.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",26972.33,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",12751.41,100,,,,,0,"case rate","100%CMS IPPS rate",12751.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",12751.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12751.41,100,,,,,0,"case rate","100%CMS IPPS rate",322796.08,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,322796.08,
"INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC",351,"CDM ",100,RC,,,INPATIENT,,,,,,7749.48,100,,,,,0,"case rate","100%CMS IPPS rate",12900.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16501.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7749.48,100,,,,,0,"case rate","100%CMS IPPS rate",7749.48,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7749.48,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7749.48,100,,,,,0,"case rate","100%CMS IPPS rate",197480.95,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,197480.95,
"INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC",352,"CDM ",100,RC,,,INPATIENT,,,,,,5735.02,100,,,,,0,"case rate","100%CMS IPPS rate",9544.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12640.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5735.02,100,,,,,0,"case rate","100%CMS IPPS rate",5735.02,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5735.02,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5735.02,100,,,,,0,"case rate","100%CMS IPPS rate",151274.58,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,151274.58,
"HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC",353,"CDM ",100,RC,,,INPATIENT,,,,,,15641.58,100,,,,,0,"case rate","100%CMS IPPS rate",26141.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",31411.25,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",15641.58,100,,,,,0,"case rate","100%CMS IPPS rate",15641.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",15641.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15641.58,100,,,,,0,"case rate","100%CMS IPPS rate",375919.65,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,375919.65,
"HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC",354,"CDM ",100,RC,,,INPATIENT,,,,,,8567.88,100,,,,,0,"case rate","100%CMS IPPS rate",15424.54,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18210.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8567.88,100,,,,,0,"case rate","100%CMS IPPS rate",8567.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8567.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8567.88,100,,,,,0,"case rate","100%CMS IPPS rate",217934.97,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,217934.97,
"HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC",355,"CDM ",100,RC,,,INPATIENT,,,,,,6007.38,100,,,,,0,"case rate","100%CMS IPPS rate",11755.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14558.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6007.38,100,,,,,0,"case rate","100%CMS IPPS rate",6007.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6007.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6007.38,100,,,,,0,"case rate","100%CMS IPPS rate",174228.83,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,174228.83,
"OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC",356,"CDM ",100,RC,,,INPATIENT,,,,,,22313.19,100,,,,,0,"case rate","100%CMS IPPS rate",37228.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",47547.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",22313.19,100,,,,,0,"case rate","100%CMS IPPS rate",22313.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",22313.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22313.19,100,,,,,0,"case rate","100%CMS IPPS rate",569035.22,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,569035.22,
"OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC",357,"CDM ",100,RC,,,INPATIENT,,,,,,9916.33,100,,,,,0,"case rate","100%CMS IPPS rate",19604.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",25171.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9916.33,100,,,,,0,"case rate","100%CMS IPPS rate",9916.33,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9916.33,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9916.33,100,,,,,0,"case rate","100%CMS IPPS rate",301240.89,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,301240.89,
"OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC",358,"CDM ",100,RC,,,INPATIENT,,,,,,6962.18,100,,,,,0,"case rate","100%CMS IPPS rate",11839.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15130.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6962.18,100,,,,,0,"case rate","100%CMS IPPS rate",6962.18,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6962.18,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6962.18,100,,,,,0,"case rate","100%CMS IPPS rate",181081.43,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,181081.43,
"PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITH MCC",359,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",37219.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",445429.88,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",37219.41,445429.88,
"PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITHOUT MCC",360,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",26132.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",312743.88,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",26132.38,312743.88,
"MAJOR ESOPHAGEAL DISORDERS WITH MCC",368,"CDM ",100,RC,,,INPATIENT,,,,,,9966.09,100,,,,,0,"case rate","100%CMS IPPS rate",16680.9,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17230.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9966.09,100,,,,,0,"case rate","100%CMS IPPS rate",9966.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9966.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9966.09,100,,,,,0,"case rate","100%CMS IPPS rate",206211.72,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,206211.72,
"MAJOR ESOPHAGEAL DISORDERS WITH CC",369,"CDM ",100,RC,,,INPATIENT,,,,,,5862.98,100,,,,,0,"case rate","100%CMS IPPS rate",9309.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10826.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5862.98,100,,,,,0,"case rate","100%CMS IPPS rate",5862.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5862.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5862.98,100,,,,,0,"case rate","100%CMS IPPS rate",129564.02,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,129564.02,
"MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC",370,"CDM ",100,RC,,,INPATIENT,,,,,,3836.09,100,,,,,0,"case rate","100%CMS IPPS rate",6749.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7585.46,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3836.09,100,,,,,0,"case rate","100%CMS IPPS rate",3836.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3836.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3836.09,100,,,,,0,"case rate","100%CMS IPPS rate",91000.96,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,91000.96,
"MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC",371,"CDM ",100,RC,,,INPATIENT,,,,,,8868.23,100,,,,,0,"case rate","100%CMS IPPS rate",14961.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19192.03,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8868.23,100,,,,,0,"case rate","100%CMS IPPS rate",8868.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8868.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8868.23,100,,,,,0,"case rate","100%CMS IPPS rate",229684.1,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,229684.1,
"MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC",372,"CDM ",100,RC,,,INPATIENT,,,,,,4837.98,100,,,,,0,"case rate","100%CMS IPPS rate",9831.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11051.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4837.98,100,,,,,0,"case rate","100%CMS IPPS rate",4837.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4837.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4837.98,100,,,,,0,"case rate","100%CMS IPPS rate",132258.49,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,132258.49,
"MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC",373,"CDM ",100,RC,,,INPATIENT,,,,,,3346.02,100,,,,,0,"case rate","100%CMS IPPS rate",6434.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7873.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3346.02,100,,,,,0,"case rate","100%CMS IPPS rate",3346.02,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3346.02,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3346.02,100,,,,,0,"case rate","100%CMS IPPS rate",94226.01,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,94226.01,
"DIGESTIVE MALIGNANCY WITH MCC",374,"CDM ",100,RC,,,INPATIENT,,,,,,10610.77,100,,,,,0,"case rate","100%CMS IPPS rate",17921.25,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",23149.29,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10610.77,100,,,,,0,"case rate","100%CMS IPPS rate",10610.77,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10610.77,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10610.77,100,,,,,0,"case rate","100%CMS IPPS rate",277043.24,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,277043.24,
"DIGESTIVE MALIGNANCY WITH CC",375,"CDM ",100,RC,,,INPATIENT,,,,,,6182.43,100,,,,,0,"case rate","100%CMS IPPS rate",10510.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13092.71,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6182.43,100,,,,,0,"case rate","100%CMS IPPS rate",6182.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6182.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6182.43,100,,,,,0,"case rate","100%CMS IPPS rate",156689.4,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,156689.4,
"DIGESTIVE MALIGNANCY WITHOUT CC/MCC",376,"CDM ",100,RC,,,INPATIENT,,,,,,4593.62,100,,,,,0,"case rate","100%CMS IPPS rate",7768.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10004.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4593.62,100,,,,,0,"case rate","100%CMS IPPS rate",4593.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4593.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4593.62,100,,,,,0,"case rate","100%CMS IPPS rate",119732.07,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,119732.07,
"GASTROINTESTINAL HEMORRHAGE WITH MCC",377,"CDM ",100,RC,,,INPATIENT,,,,,,11706.42,100,,,,,0,"case rate","100%CMS IPPS rate",15566.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19786.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",11706.42,100,,,,,0,"case rate","100%CMS IPPS rate",11706.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",11706.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11706.42,100,,,,,0,"case rate","100%CMS IPPS rate",236795.71,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,236795.71,
"GASTROINTESTINAL HEMORRHAGE WITH CC",378,"CDM ",100,RC,,,INPATIENT,,,,,,5234.3,100,,,,,0,"case rate","100%CMS IPPS rate",9144.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10615.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5234.3,100,,,,,0,"case rate","100%CMS IPPS rate",5234.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5234.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5234.3,100,,,,,0,"case rate","100%CMS IPPS rate",127038.06,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,127038.06,
"GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC",379,"CDM ",100,RC,,,INPATIENT,,,,,,3269.16,100,,,,,0,"case rate","100%CMS IPPS rate",5506.78,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6823.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3269.16,100,,,,,0,"case rate","100%CMS IPPS rate",3269.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3269.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3269.16,100,,,,,0,"case rate","100%CMS IPPS rate",84336.62,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,84336.62,
"COMPLICATED PEPTIC ULCER WITH MCC",380,"CDM ",100,RC,,,INPATIENT,,,,,,5954.51,100,,,,,0,"case rate","100%CMS IPPS rate",16304.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",21238.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5954.51,100,,,,,0,"case rate","100%CMS IPPS rate",5954.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5954.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5954.51,100,,,,,0,"case rate","100%CMS IPPS rate",254179.76,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,254179.76,
"COMPLICATED PEPTIC ULCER WITH CC",381,"CDM ",100,RC,,,INPATIENT,,,,,,5437.34,100,,,,,0,"case rate","100%CMS IPPS rate",9154.64,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11727.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5437.34,100,,,,,0,"case rate","100%CMS IPPS rate",5437.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5437.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5437.34,100,,,,,0,"case rate","100%CMS IPPS rate",140354.63,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,140354.63,
"COMPLICATED PEPTIC ULCER WITHOUT CC/MCC",382,"CDM ",100,RC,,,INPATIENT,,,,,,3942.27,100,,,,,0,"case rate","100%CMS IPPS rate",6468.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8665.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3942.27,100,,,,,0,"case rate","100%CMS IPPS rate",3942.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3942.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3942.27,100,,,,,0,"case rate","100%CMS IPPS rate",103708.18,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,103708.18,
"UNCOMPLICATED PEPTIC ULCER WITH MCC",383,"CDM ",100,RC,,,INPATIENT,,,,,,6726.26,100,,,,,0,"case rate","100%CMS IPPS rate",10106.77,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14944.7,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6726.26,100,,,,,0,"case rate","100%CMS IPPS rate",6726.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6726.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6726.26,100,,,,,0,"case rate","100%CMS IPPS rate",178853.35,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,178853.35,
"UNCOMPLICATED PEPTIC ULCER WITHOUT MCC",384,"CDM ",100,RC,,,INPATIENT,,,,,,4362.14,100,,,,,0,"case rate","100%CMS IPPS rate",7715.71,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9252.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4362.14,100,,,,,0,"case rate","100%CMS IPPS rate",4362.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4362.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4362.14,100,,,,,0,"case rate","100%CMS IPPS rate",110729.16,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,110729.16,
"INFLAMMATORY BOWEL DISEASE WITH MCC",385,"CDM ",100,RC,,,INPATIENT,,,,,,4923.29,100,,,,,0,"case rate","100%CMS IPPS rate",14020.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17126.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4923.29,100,,,,,0,"case rate","100%CMS IPPS rate",4923.29,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4923.29,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4923.29,100,,,,,0,"case rate","100%CMS IPPS rate",204968.18,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,204968.18,
"INFLAMMATORY BOWEL DISEASE WITH CC",386,"CDM ",100,RC,,,INPATIENT,,,,,,4688.7,100,,,,,0,"case rate","100%CMS IPPS rate",8599.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10567.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4688.7,100,,,,,0,"case rate","100%CMS IPPS rate",4688.7,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4688.7,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4688.7,100,,,,,0,"case rate","100%CMS IPPS rate",126468.04,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,126468.04,
"INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC",387,"CDM ",100,RC,,,INPATIENT,,,,,,4465.66,100,,,,,0,"case rate","100%CMS IPPS rate",6176.54,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7374.39,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4465.66,100,,,,,0,"case rate","100%CMS IPPS rate",4465.66,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4465.66,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4465.66,100,,,,,0,"case rate","100%CMS IPPS rate",89155.03,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,89155.03,
"GASTROINTESTINAL OBSTRUCTION WITH MCC",388,"CDM ",100,RC,,,INPATIENT,,,,,,7349.61,100,,,,,0,"case rate","100%CMS IPPS rate",13089.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15984.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7349.61,100,,,,,0,"case rate","100%CMS IPPS rate",7349.61,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7349.61,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7349.61,100,,,,,0,"case rate","100%CMS IPPS rate",191301.87,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,191301.87,
"GASTROINTESTINAL OBSTRUCTION WITH CC",389,"CDM ",100,RC,,,INPATIENT,,,,,,4007.59,100,,,,,0,"case rate","100%CMS IPPS rate",7877.99,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8548.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4007.59,100,,,,,0,"case rate","100%CMS IPPS rate",4007.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4007.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4007.59,100,,,,,0,"case rate","100%CMS IPPS rate",102309.28,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,102309.28,
"GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC",390,"CDM ",100,RC,,,INPATIENT,,,,,,3048.34,100,,,,,0,"case rate","100%CMS IPPS rate",5509.39,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5888.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3048.34,100,,,,,0,"case rate","100%CMS IPPS rate",3048.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3048.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3048.34,100,,,,,0,"case rate","100%CMS IPPS rate",76157.55,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,76157.55,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC",391,"CDM ",100,RC,,,INPATIENT,,,,,,7596.64,100,,,,,0,"case rate","100%CMS IPPS rate",10795.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13728.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7596.64,100,,,,,0,"case rate","100%CMS IPPS rate",7596.64,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7596.64,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7596.64,100,,,,,0,"case rate","100%CMS IPPS rate",164293.27,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,164293.27,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",392,"CDM ",100,RC,,,INPATIENT,,,,,,3613.94,100,,,,,0,"case rate","100%CMS IPPS rate",7171.29,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8438.39,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3613.94,100,,,,,0,"case rate","100%CMS IPPS rate",3613.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3613.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3613.94,100,,,,,0,"case rate","100%CMS IPPS rate",100987.99,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100987.99,
"OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC",393,"CDM ",100,RC,,,INPATIENT,,,,,,7730.82,100,,,,,0,"case rate","100%CMS IPPS rate",14356.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17310.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7730.82,100,,,,,0,"case rate","100%CMS IPPS rate",7730.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7730.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7730.82,100,,,,,0,"case rate","100%CMS IPPS rate",207170.39,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,207170.39,
"OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC",394,"CDM ",100,RC,,,INPATIENT,,,,,,5028.59,100,,,,,0,"case rate","100%CMS IPPS rate",8131.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10128.02,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5028.59,100,,,,,0,"case rate","100%CMS IPPS rate",5028.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5028.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5028.59,100,,,,,0,"case rate","100%CMS IPPS rate",121208.89,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,121208.89,
"OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC",395,"CDM ",100,RC,,,INPATIENT,,,,,,3333.58,100,,,,,0,"case rate","100%CMS IPPS rate",5630.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7024.78,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3333.58,100,,,,,0,"case rate","100%CMS IPPS rate",3333.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3333.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3333.58,100,,,,,0,"case rate","100%CMS IPPS rate",86097.44,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,86097.44,
"APPENDIX PROCEDURES WITH MCC",397,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",19960.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",25922.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",310230.93,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19960.19,310230.93,
"APPENDIX PROCEDURES WITH CC",398,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",12896.03,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16383.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",196068.9,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12896.03,196068.9,
"APPENDIX PROCEDURES WITHOUT CC/MCC",399,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",9762.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12390.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",148282.37,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9762.75,148282.37,
"SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL",402,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",43517.89,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",520808.03,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",43517.89,520808.03,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC",405,"CDM ",100,RC,,,INPATIENT,,,,,,20587.97,100,,,,,0,"case rate","100%CMS IPPS rate",49585.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",59212.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",20587.97,100,,,,,0,"case rate","100%CMS IPPS rate",20587.97,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",20587.97,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",20587.97,100,,,,,0,"case rate","100%CMS IPPS rate",708638.44,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,708638.44,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC",406,"CDM ",100,RC,,,INPATIENT,,,,,,10702.3,100,,,,,0,"case rate","100%CMS IPPS rate",26549.84,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",31391.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10702.3,100,,,,,0,"case rate","100%CMS IPPS rate",10702.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10702.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10702.3,100,,,,,0,"case rate","100%CMS IPPS rate",375686.53,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,375686.53,
"PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC",407,"CDM ",100,RC,,,INPATIENT,,,,,,6521.44,100,,,,,0,"case rate","100%CMS IPPS rate",18304.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",24024.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6521.44,100,,,,,0,"case rate","100%CMS IPPS rate",6521.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6521.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6521.44,100,,,,,0,"case rate","100%CMS IPPS rate",287522.82,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,287522.82,
"BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC",408,"CDM ",100,RC,,,INPATIENT,,,,,,13470.73,100,,,,,0,"case rate","100%CMS IPPS rate",32433.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",38594.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",13470.73,100,,,,,0,"case rate","100%CMS IPPS rate",13470.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",13470.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13470.73,100,,,,,0,"case rate","100%CMS IPPS rate",461881.15,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,461881.15,
"BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC",409,"CDM ",100,RC,,,INPATIENT,,,,,,7596.2,100,,,,,0,"case rate","100%CMS IPPS rate",20244.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",23567.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7596.2,100,,,,,0,"case rate","100%CMS IPPS rate",7596.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7596.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7596.2,100,,,,,0,"case rate","100%CMS IPPS rate",282043.41,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,282043.41,
"BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC",410,"CDM ",100,RC,,,INPATIENT,,,,,,5624.84,100,,,,,0,"case rate","100%CMS IPPS rate",16050.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17185.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5624.84,100,,,,,0,"case rate","100%CMS IPPS rate",5624.84,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5624.84,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5624.84,100,,,,,0,"case rate","100%CMS IPPS rate",205667.7,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,205667.7,
"CHOLECYSTECTOMY WITH C.D.E. WITH MCC",411,"CDM ",100,RC,,,INPATIENT,,,,,,13480.95,100,,,,,0,"case rate","100%CMS IPPS rate",27465.61,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",35754.92,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",13480.95,100,,,,,0,"case rate","100%CMS IPPS rate",13480.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",13480.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13480.95,100,,,,,0,"case rate","100%CMS IPPS rate",427903.31,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,427903.31,
"CHOLECYSTECTOMY WITH C.D.E. WITH CC",412,"CDM ",100,RC,,,INPATIENT,,,,,,8176.01,100,,,,,0,"case rate","100%CMS IPPS rate",19682.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22757.46,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8176.01,100,,,,,0,"case rate","100%CMS IPPS rate",8176.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8176.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8176.01,100,,,,,0,"case rate","100%CMS IPPS rate",272353.97,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,272353.97,
"CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC",413,"CDM ",100,RC,,,INPATIENT,,,,,,6220.2,100,,,,,0,"case rate","100%CMS IPPS rate",14958.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17973.25,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6220.2,100,,,,,0,"case rate","100%CMS IPPS rate",6220.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6220.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6220.2,100,,,,,0,"case rate","100%CMS IPPS rate",215098.14,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,215098.14,
"CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC",414,"CDM ",100,RC,,,INPATIENT,,,,,,13025.1,100,,,,,0,"case rate","100%CMS IPPS rate",27184.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",38561.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",13025.1,100,,,,,0,"case rate","100%CMS IPPS rate",13025.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",13025.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13025.1,100,,,,,0,"case rate","100%CMS IPPS rate",461492.64,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,461492.64,
"CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC",415,"CDM ",100,RC,,,INPATIENT,,,,,,7299.85,100,,,,,0,"case rate","100%CMS IPPS rate",17558.29,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22369.96,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7299.85,100,,,,,0,"case rate","100%CMS IPPS rate",7299.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7299.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7299.85,100,,,,,0,"case rate","100%CMS IPPS rate",267716.44,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,267716.44,
"CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC",416,"CDM ",100,RC,,,INPATIENT,,,,,,5109.45,100,,,,,0,"case rate","100%CMS IPPS rate",12291.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14756.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5109.45,100,,,,,0,"case rate","100%CMS IPPS rate",5109.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5109.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5109.45,100,,,,,0,"case rate","100%CMS IPPS rate",176599.41,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,176599.41,
"LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC",417,"CDM ",100,RC,,,INPATIENT,,,,,,7865,100,,,,,0,"case rate","100%CMS IPPS rate",20951.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",25830.39,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7865,100,,,,,0,"case rate","100%CMS IPPS rate",7865,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7865,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7865,100,,,,,0,"case rate","100%CMS IPPS rate",309129.76,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,309129.76,
"LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC",418,"CDM ",100,RC,,,INPATIENT,,,,,,6448.13,100,,,,,0,"case rate","100%CMS IPPS rate",14596.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18309.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6448.13,100,,,,,0,"case rate","100%CMS IPPS rate",6448.13,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6448.13,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6448.13,100,,,,,0,"case rate","100%CMS IPPS rate",219126.76,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,219126.76,
"LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC",419,"CDM ",100,RC,,,INPATIENT,,,,,,4863.31,100,,,,,0,"case rate","100%CMS IPPS rate",11498.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14783.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4863.31,100,,,,,0,"case rate","100%CMS IPPS rate",4863.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4863.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4863.31,100,,,,,0,"case rate","100%CMS IPPS rate",176923.16,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,176923.16,
"HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC",420,"CDM ",100,RC,,,INPATIENT,,,,,,12625.23,100,,,,,0,"case rate","100%CMS IPPS rate",30390.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",36878.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",12625.23,100,,,,,0,"case rate","100%CMS IPPS rate",12625.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",12625.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12625.23,100,,,,,0,"case rate","100%CMS IPPS rate",441349.37,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,441349.37,
"HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC",421,"CDM ",100,RC,,,INPATIENT,,,,,,6858.21,100,,,,,0,"case rate","100%CMS IPPS rate",14596.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18806.7,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6858.21,100,,,,,0,"case rate","100%CMS IPPS rate",6858.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6858.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6858.21,100,,,,,0,"case rate","100%CMS IPPS rate",225072.58,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,225072.58,
"HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC",422,"CDM ",100,RC,,,INPATIENT,,,,,,5214.3,100,,,,,0,"case rate","100%CMS IPPS rate",11658.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15148.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5214.3,100,,,,,0,"case rate","100%CMS IPPS rate",5214.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5214.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5214.3,100,,,,,0,"case rate","100%CMS IPPS rate",181288.69,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,181288.69,
"OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC",423,"CDM ",100,RC,,,INPATIENT,,,,,,15013.79,100,,,,,0,"case rate","100%CMS IPPS rate",31783.02,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",44952.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",15013.79,100,,,,,0,"case rate","100%CMS IPPS rate",15013.79,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",15013.79,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15013.79,100,,,,,0,"case rate","100%CMS IPPS rate",537971.84,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,537971.84,
"OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC",424,"CDM ",100,RC,,,INPATIENT,,,,,,8196.89,100,,,,,0,"case rate","100%CMS IPPS rate",17649.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",23681.83,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8196.89,100,,,,,0,"case rate","100%CMS IPPS rate",8196.89,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8196.89,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8196.89,100,,,,,0,"case rate","100%CMS IPPS rate",283416.44,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,283416.44,
"OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC",425,"CDM ",100,RC,,,INPATIENT,,,,,,5544.42,100,,,,,0,"case rate","100%CMS IPPS rate",12629.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16239.25,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5544.42,100,,,,,0,"case rate","100%CMS IPPS rate",5544.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5544.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5544.42,100,,,,,0,"case rate","100%CMS IPPS rate",194346.09,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,194346.09,
"MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE",426,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",119293.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",1427665.82,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",119293.47,1427665.82,
"MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC",427,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",78134.13,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",935084.05,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",78134.13,935084.05,
"MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC",428,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",60852.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",728263.44,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",60852.53,728263.44,
"COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC",429,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",97519.91,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",1167086.86,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",97519.91,1167086.86,
"COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC",430,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",62423.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",747059.41,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",62423.09,747059.41,
"CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC",432,"CDM ",100,RC,,,INPATIENT,,,,,,10256.67,100,,,,,0,"case rate","100%CMS IPPS rate",16254.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",21303.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10256.67,100,,,,,0,"case rate","100%CMS IPPS rate",10256.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10256.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10256.67,100,,,,,0,"case rate","100%CMS IPPS rate",254956.9,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,254956.9,
"CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC",433,"CDM ",100,RC,,,INPATIENT,,,,,,5002.37,100,,,,,0,"case rate","100%CMS IPPS rate",10071.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11432.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5002.37,100,,,,,0,"case rate","100%CMS IPPS rate",5002.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5002.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5002.37,100,,,,,0,"case rate","100%CMS IPPS rate",136818.12,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,136818.12,
"CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC",434,"CDM ",100,RC,,,INPATIENT,,,,,,2100.21,100,,,,,0,"case rate","100%CMS IPPS rate",6544.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7712.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2100.21,100,,,,,0,"case rate","100%CMS IPPS rate",2100.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2100.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2100.21,100,,,,,0,"case rate","100%CMS IPPS rate",92295.96,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2100.21,92295.96,
"MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC",435,"CDM ",100,RC,,,INPATIENT,,,,,,9296.53,100,,,,,0,"case rate","100%CMS IPPS rate",15153.18,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19880.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9296.53,100,,,,,0,"case rate","100%CMS IPPS rate",9296.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9296.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9296.53,100,,,,,0,"case rate","100%CMS IPPS rate",237922.74,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,237922.74,
"MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC",436,"CDM ",100,RC,,,INPATIENT,,,,,,5941.18,100,,,,,0,"case rate","100%CMS IPPS rate",9692.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12243.03,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5941.18,100,,,,,0,"case rate","100%CMS IPPS rate",5941.18,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5941.18,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5941.18,100,,,,,0,"case rate","100%CMS IPPS rate",146520.56,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,146520.56,
"MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC",437,"CDM ",100,RC,,,INPATIENT,,,,,,4744.24,100,,,,,0,"case rate","100%CMS IPPS rate",7742.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9236.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4744.24,100,,,,,0,"case rate","100%CMS IPPS rate",4744.24,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4744.24,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4744.24,100,,,,,0,"case rate","100%CMS IPPS rate",110534.91,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,110534.91,
"DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC",438,"CDM ",100,RC,,,INPATIENT,,,,,,8510.57,100,,,,,0,"case rate","100%CMS IPPS rate",13808.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17645.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8510.57,100,,,,,0,"case rate","100%CMS IPPS rate",8510.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8510.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8510.57,100,,,,,0,"case rate","100%CMS IPPS rate",211173.14,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,211173.14,
"DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC",439,"CDM ",100,RC,,,INPATIENT,,,,,,4320.37,100,,,,,0,"case rate","100%CMS IPPS rate",7304.35,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9105.15,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4320.37,100,,,,,0,"case rate","100%CMS IPPS rate",4320.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4320.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4320.37,100,,,,,0,"case rate","100%CMS IPPS rate",108967.49,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,108967.49,
"DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC",440,"CDM ",100,RC,,,INPATIENT,,,,,,3238.06,100,,,,,0,"case rate","100%CMS IPPS rate",5829.55,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6726.03,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3238.06,100,,,,,0,"case rate","100%CMS IPPS rate",3238.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3238.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3238.06,100,,,,,0,"case rate","100%CMS IPPS rate",83484.56,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,83484.56,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC",441,"CDM ",100,RC,,,INPATIENT,,,,,,10466.38,100,,,,,0,"case rate","100%CMS IPPS rate",16242.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19425.83,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10466.38,100,,,,,0,"case rate","100%CMS IPPS rate",10466.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10466.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10466.38,100,,,,,0,"case rate","100%CMS IPPS rate",232482.07,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,232482.07,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC",442,"CDM ",100,RC,,,INPATIENT,,,,,,4970.38,100,,,,,0,"case rate","100%CMS IPPS rate",8641.61,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10448.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4970.38,100,,,,,0,"case rate","100%CMS IPPS rate",4970.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4970.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4970.38,100,,,,,0,"case rate","100%CMS IPPS rate",125043.13,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,125043.13,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC",443,"CDM ",100,RC,,,INPATIENT,,,,,,3515.3,100,,,,,0,"case rate","100%CMS IPPS rate",5731.48,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7573.55,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3515.3,100,,,,,0,"case rate","100%CMS IPPS rate",3515.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3515.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3515.3,100,,,,,0,"case rate","100%CMS IPPS rate",90896.82,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,90896.82,
"DISORDERS OF THE BILIARY TRACT WITH MCC",444,"CDM ",100,RC,,,INPATIENT,,,,,,8850.9,100,,,,,0,"case rate","100%CMS IPPS rate",14446.24,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18085.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8850.9,100,,,,,0,"case rate","100%CMS IPPS rate",8850.9,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8850.9,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8850.9,100,,,,,0,"case rate","100%CMS IPPS rate",216445.3,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,216445.3,
"DISORDERS OF THE BILIARY TRACT WITH CC",445,"CDM ",100,RC,,,INPATIENT,,,,,,5711.03,100,,,,,0,"case rate","100%CMS IPPS rate",9311.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11845.79,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5711.03,100,,,,,0,"case rate","100%CMS IPPS rate",5711.03,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5711.03,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5711.03,100,,,,,0,"case rate","100%CMS IPPS rate",141766.54,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,141766.54,
"DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC",446,"CDM ",100,RC,,,INPATIENT,,,,,,4328.81,100,,,,,0,"case rate","100%CMS IPPS rate",7057.18,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8954.7,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4328.81,100,,,,,0,"case rate","100%CMS IPPS rate",4328.81,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4328.81,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4328.81,100,,,,,0,"case rate","100%CMS IPPS rate",107166.94,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,107166.94,
"MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE",447,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",72321.64,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",865522.08,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",72321.64,865522.08,
"MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC",448,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",45902.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",549345.33,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",45902.42,549345.33,
"SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE",450,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",57687.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",690386.47,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",57687.59,690386.47,
"SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC",451,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",34965.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",418460.02,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",34965.85,418460.02,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC",456,"CDM ",100,RC,,,INPATIENT,,,,,,30921.95,100,,,,,0,"case rate","100%CMS IPPS rate",74322.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",90958.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",30921.95,100,,,,,0,"case rate","100%CMS IPPS rate",30921.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",30921.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",30921.95,100,,,,,0,"case rate","100%CMS IPPS rate",1088560.85,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,1088560.85,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC",457,"CDM ",100,RC,,,INPATIENT,,,,,,29020.34,100,,,,,0,"case rate","100%CMS IPPS rate",52319.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",64544.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",29020.34,100,,,,,0,"case rate","100%CMS IPPS rate",29020.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",29020.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",29020.34,100,,,,,0,"case rate","100%CMS IPPS rate",772448.84,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,772448.84,
"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC",458,"CDM ",100,RC,,,INPATIENT,,,,,,19802.01,100,,,,,0,"case rate","100%CMS IPPS rate",39869.48,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",45164.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",19802.01,100,,,,,0,"case rate","100%CMS IPPS rate",19802.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",19802.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19802.01,100,,,,,0,"case rate","100%CMS IPPS rate",540510.79,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,540510.79,
"BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC",461,"CDM ",100,RC,,,INPATIENT,,,,,,25244.68,100,,,,,0,"case rate","100%CMS IPPS rate",53069.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",58023.13,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",25244.68,100,,,,,0,"case rate","100%CMS IPPS rate",25244.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",25244.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",25244.68,100,,,,,0,"case rate","100%CMS IPPS rate",715439.14,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,715439.14,
"BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC",462,"CDM ",100,RC,,,INPATIENT,,,,,,13062.86,100,,,,,0,"case rate","100%CMS IPPS rate",31596.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",28791.84,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",13062.86,100,,,,,0,"case rate","100%CMS IPPS rate",13062.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",13062.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13062.86,100,,,,,0,"case rate","100%CMS IPPS rate",344571.39,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,344571.39,
"WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC",463,"CDM ",100,RC,,,INPATIENT,,,,,,22291.42,100,,,,,0,"case rate","100%CMS IPPS rate",46411.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",61691.39,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",22291.42,100,,,,,0,"case rate","100%CMS IPPS rate",22291.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",22291.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22291.42,100,,,,,0,"case rate","100%CMS IPPS rate",738302.63,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,738302.63,
"WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC",464,"CDM ",100,RC,,,INPATIENT,,,,,,12358.2,100,,,,,0,"case rate","100%CMS IPPS rate",27869.29,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",33713.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",12358.2,100,,,,,0,"case rate","100%CMS IPPS rate",12358.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",12358.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12358.2,100,,,,,0,"case rate","100%CMS IPPS rate",403472.42,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,403472.42,
"WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC",465,"CDM ",100,RC,,,INPATIENT,,,,,,7659.73,100,,,,,0,"case rate","100%CMS IPPS rate",20312.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19739.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7659.73,100,,,,,0,"case rate","100%CMS IPPS rate",7659.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7659.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7659.73,100,,,,,0,"case rate","100%CMS IPPS rate",236238.69,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,236238.69,
"REVISION OF HIP OR KNEE REPLACEMENT WITH MCC",466,"CDM ",100,RC,,,INPATIENT,,,,,,22206.56,100,,,,,0,"case rate","100%CMS IPPS rate",46198.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",56343.25,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",22206.56,100,,,,,0,"case rate","100%CMS IPPS rate",22206.56,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",22206.56,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22206.56,100,,,,,0,"case rate","100%CMS IPPS rate",674297.83,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,674297.83,
"REVISION OF HIP OR KNEE REPLACEMENT WITH CC",467,"CDM ",100,RC,,,INPATIENT,,,,,,16457.76,100,,,,,0,"case rate","100%CMS IPPS rate",32261.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",38171.92,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",16457.76,100,,,,,0,"case rate","100%CMS IPPS rate",16457.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",16457.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16457.76,100,,,,,0,"case rate","100%CMS IPPS rate",456829.25,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,456829.25,
"REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC",468,"CDM ",100,RC,,,INPATIENT,,,,,,10680.53,100,,,,,0,"case rate","100%CMS IPPS rate",25393.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",29744.35,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10680.53,100,,,,,0,"case rate","100%CMS IPPS rate",10680.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10680.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10680.53,100,,,,,0,"case rate","100%CMS IPPS rate",355970.76,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,355970.76,
"MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT",469,"CDM ",100,RC,,,INPATIENT,,,,,,11215.46,100,,,,,0,"case rate","100%CMS IPPS rate",29496.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",32831.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",11215.46,100,,,,,0,"case rate","100%CMS IPPS rate",11215.46,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",11215.46,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11215.46,100,,,,,0,"case rate","100%CMS IPPS rate",392915.07,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,392915.07,
"MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC",470,"CDM ",100,RC,,,INPATIENT,,,,,,8979.75,100,,,,,0,"case rate","100%CMS IPPS rate",22152.04,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",20878.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8979.75,100,,,,,0,"case rate","100%CMS IPPS rate",8979.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8979.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8979.75,100,,,,,0,"case rate","100%CMS IPPS rate",249866.12,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,249866.12,
"CERVICAL SPINAL FUSION WITH MCC",471,"CDM ",100,RC,,,INPATIENT,,,,,,20843,100,,,,,0,"case rate","100%CMS IPPS rate",43381.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",52265.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",20843,100,,,,,0,"case rate","100%CMS IPPS rate",20843,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",20843,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",20843,100,,,,,0,"case rate","100%CMS IPPS rate",625500.76,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,625500.76,
"CERVICAL SPINAL FUSION WITH CC",472,"CDM ",100,RC,,,INPATIENT,,,,,,11164.81,100,,,,,0,"case rate","100%CMS IPPS rate",26390.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",31888.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",11164.81,100,,,,,0,"case rate","100%CMS IPPS rate",11164.81,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",11164.81,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11164.81,100,,,,,0,"case rate","100%CMS IPPS rate",381632.34,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,381632.34,
"CERVICAL SPINAL FUSION WITHOUT CC/MCC",473,"CDM ",100,RC,,,INPATIENT,,,,,,8045.38,100,,,,,0,"case rate","100%CMS IPPS rate",21942.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",26424.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8045.38,100,,,,,0,"case rate","100%CMS IPPS rate",8045.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8045.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8045.38,100,,,,,0,"case rate","100%CMS IPPS rate",316241.5,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,316241.5,
"AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC",474,"CDM ",100,RC,,,INPATIENT,,,,,,16921.17,100,,,,,0,"case rate","100%CMS IPPS rate",35226.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",46466.35,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",16921.17,100,,,,,0,"case rate","100%CMS IPPS rate",16921.17,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",16921.17,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16921.17,100,,,,,0,"case rate","100%CMS IPPS rate",556094.29,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,556094.29,
"AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC",475,"CDM ",100,RC,,,INPATIENT,,,,,,10437.05,100,,,,,0,"case rate","100%CMS IPPS rate",18980.79,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",24632.18,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10437.05,100,,,,,0,"case rate","100%CMS IPPS rate",10437.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10437.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10437.05,100,,,,,0,"case rate","100%CMS IPPS rate",294789.93,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,294789.93,
"AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC",476,"CDM ",100,RC,,,INPATIENT,,,,,,6129.56,100,,,,,0,"case rate","100%CMS IPPS rate",12373.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12774.48,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6129.56,100,,,,,0,"case rate","100%CMS IPPS rate",6129.56,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6129.56,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6129.56,100,,,,,0,"case rate","100%CMS IPPS rate",152880.89,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,152880.89,
"BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",477,"CDM ",100,RC,,,INPATIENT,,,,,,13946.58,100,,,,,0,"case rate","100%CMS IPPS rate",24196.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",37392.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",13946.58,100,,,,,0,"case rate","100%CMS IPPS rate",13946.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",13946.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13946.58,100,,,,,0,"case rate","100%CMS IPPS rate",447502.45,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,447502.45,
"BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",478,"CDM ",100,RC,,,INPATIENT,,,,,,9791.93,100,,,,,0,"case rate","100%CMS IPPS rate",20381.7,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",26618.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9791.93,100,,,,,0,"case rate","100%CMS IPPS rate",9791.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9791.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9791.93,100,,,,,0,"case rate","100%CMS IPPS rate",318560.2,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,318560.2,
"BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",479,"CDM ",100,RC,,,INPATIENT,,,,,,7517.11,100,,,,,0,"case rate","100%CMS IPPS rate",15638,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",20120.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7517.11,100,,,,,0,"case rate","100%CMS IPPS rate",7517.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7517.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7517.11,100,,,,,0,"case rate","100%CMS IPPS rate",240798.46,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,240798.46,
"HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC",480,"CDM ",100,RC,,,INPATIENT,,,,,,12565.69,100,,,,,0,"case rate","100%CMS IPPS rate",27990.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",31522.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",12565.69,100,,,,,0,"case rate","100%CMS IPPS rate",12565.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",12565.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12565.69,100,,,,,0,"case rate","100%CMS IPPS rate",377253.95,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,377253.95,
"HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC",481,"CDM ",100,RC,,,INPATIENT,,,,,,11507.37,100,,,,,0,"case rate","100%CMS IPPS rate",20667.02,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22670.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",11507.37,100,,,,,0,"case rate","100%CMS IPPS rate",11507.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",11507.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11507.37,100,,,,,0,"case rate","100%CMS IPPS rate",271317.69,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,271317.69,
"HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC",482,"CDM ",100,RC,,,INPATIENT,,,,,,6618.29,100,,,,,0,"case rate","100%CMS IPPS rate",14304.79,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17653.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6618.29,100,,,,,0,"case rate","100%CMS IPPS rate",6618.29,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6618.29,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6618.29,100,,,,,0,"case rate","100%CMS IPPS rate",211276.77,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,211276.77,
"MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES",483,"CDM ",100,RC,,,INPATIENT,,,,,,10094.05,100,,,,,0,"case rate","100%CMS IPPS rate",20803.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",30003.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10094.05,100,,,,,0,"case rate","100%CMS IPPS rate",10094.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10094.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10094.05,100,,,,,0,"case rate","100%CMS IPPS rate",359066.73,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,359066.73,
"KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC",485,"CDM ",100,RC,,,INPATIENT,,,,,,14157.62,100,,,,,0,"case rate","100%CMS IPPS rate",29466.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",34930.13,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",14157.62,100,,,,,0,"case rate","100%CMS IPPS rate",14157.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",14157.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14157.62,100,,,,,0,"case rate","100%CMS IPPS rate",418032.5,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,418032.5,
"KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC",486,"CDM ",100,RC,,,INPATIENT,,,,,,8925.99,100,,,,,0,"case rate","100%CMS IPPS rate",18575.48,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22634.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8925.99,100,,,,,0,"case rate","100%CMS IPPS rate",8925.99,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8925.99,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8925.99,100,,,,,0,"case rate","100%CMS IPPS rate",270877.17,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,270877.17,
"KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC",487,"CDM ",100,RC,,,INPATIENT,,,,,,6814.67,100,,,,,0,"case rate","100%CMS IPPS rate",14174.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16952.55,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6814.67,100,,,,,0,"case rate","100%CMS IPPS rate",6814.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6814.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6814.67,100,,,,,0,"case rate","100%CMS IPPS rate",202882.62,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,202882.62,
"KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC",488,"CDM ",100,RC,,,INPATIENT,,,,,,8204,100,,,,,0,"case rate","100%CMS IPPS rate",17074.33,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16491.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8204,100,,,,,0,"case rate","100%CMS IPPS rate",8204,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8204,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8204,100,,,,,0,"case rate","100%CMS IPPS rate",229139.95,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,229139.95,
"KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC",489,"CDM ",100,RC,,,INPATIENT,,,,,,5393.36,100,,,,,0,"case rate","100%CMS IPPS rate",11389.54,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12088.24,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5393.36,100,,,,,0,"case rate","100%CMS IPPS rate",5393.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5393.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5393.36,100,,,,,0,"case rate","100%CMS IPPS rate",144668.27,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,144668.27,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC",492,"CDM ",100,RC,,,INPATIENT,,,,,,14409.09,100,,,,,0,"case rate","100%CMS IPPS rate",29988.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",39741.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",14409.09,100,,,,,0,"case rate","100%CMS IPPS rate",14409.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",14409.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14409.09,100,,,,,0,"case rate","100%CMS IPPS rate",475612.22,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,475612.22,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC",493,"CDM ",100,RC,,,INPATIENT,,,,,,9727.06,100,,,,,0,"case rate","100%CMS IPPS rate",20099.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",27450.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9727.06,100,,,,,0,"case rate","100%CMS IPPS rate",9727.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9727.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9727.06,100,,,,,0,"case rate","100%CMS IPPS rate",328521.63,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,328521.63,
"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC",494,"CDM ",100,RC,,,INPATIENT,,,,,,5588.41,100,,,,,0,"case rate","100%CMS IPPS rate",16002.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",21718.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5588.41,100,,,,,0,"case rate","100%CMS IPPS rate",5588.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5588.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5588.41,100,,,,,0,"case rate","100%CMS IPPS rate",259918.32,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,259918.32,
"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC",495,"CDM ",100,RC,,,INPATIENT,,,,,,15098.65,100,,,,,0,"case rate","100%CMS IPPS rate",31473.92,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",39244.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",15098.65,100,,,,,0,"case rate","100%CMS IPPS rate",15098.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",15098.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15098.65,100,,,,,0,"case rate","100%CMS IPPS rate",469666.41,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,469666.41,
"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC",496,"CDM ",100,RC,,,INPATIENT,,,,,,8249.32,100,,,,,0,"case rate","100%CMS IPPS rate",13883.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19525.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8249.32,100,,,,,0,"case rate","100%CMS IPPS rate",8249.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8249.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8249.32,100,,,,,0,"case rate","100%CMS IPPS rate",233673.85,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,233673.85,
"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC",497,"CDM ",100,RC,,,INPATIENT,,,,,,6060.25,100,,,,,0,"case rate","100%CMS IPPS rate",9443.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12466,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6060.25,100,,,,,0,"case rate","100%CMS IPPS rate",6060.25,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6060.25,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6060.25,100,,,,,0,"case rate","100%CMS IPPS rate",156520.88,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,156520.88,
"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC",498,"CDM ",100,RC,,,INPATIENT,,,,,,10736.95,100,,,,,0,"case rate","100%CMS IPPS rate",16571.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",32653.84,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10736.95,100,,,,,0,"case rate","100%CMS IPPS rate",10736.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10736.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10736.95,100,,,,,0,"case rate","100%CMS IPPS rate",390790.63,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,390790.63,
"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC",499,"CDM ",100,RC,,,INPATIENT,,,,,,4980.16,100,,,,,0,"case rate","100%CMS IPPS rate",8302.91,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",21808.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4980.16,100,,,,,0,"case rate","100%CMS IPPS rate",4980.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4980.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4980.16,100,,,,,0,"case rate","100%CMS IPPS rate",260993.48,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,260993.48,
"SOFT TISSUE PROCEDURES WITH MCC",500,"CDM ",100,RC,,,INPATIENT,,,,,,13103.3,100,,,,,0,"case rate","100%CMS IPPS rate",27564.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",34255.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",13103.3,100,,,,,0,"case rate","100%CMS IPPS rate",13103.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",13103.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13103.3,100,,,,,0,"case rate","100%CMS IPPS rate",409962.38,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,409962.38,
"SOFT TISSUE PROCEDURES WITH CC",501,"CDM ",100,RC,,,INPATIENT,,,,,,8409.71,100,,,,,0,"case rate","100%CMS IPPS rate",15159.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18921.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8409.71,100,,,,,0,"case rate","100%CMS IPPS rate",8409.71,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8409.71,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8409.71,100,,,,,0,"case rate","100%CMS IPPS rate",226445.62,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,226445.62,
"SOFT TISSUE PROCEDURES WITHOUT CC/MCC",502,"CDM ",100,RC,,,INPATIENT,,,,,,5528.87,100,,,,,0,"case rate","100%CMS IPPS rate",11518.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14568.02,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5528.87,100,,,,,0,"case rate","100%CMS IPPS rate",5528.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5528.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5528.87,100,,,,,0,"case rate","100%CMS IPPS rate",174345.33,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,174345.33,
"FOOT PROCEDURES WITH MCC",503,"CDM ",100,RC,,,INPATIENT,,,,,,8779.81,100,,,,,0,"case rate","100%CMS IPPS rate",18020.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",30210.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8779.81,100,,,,,0,"case rate","100%CMS IPPS rate",8779.81,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8779.81,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8779.81,100,,,,,0,"case rate","100%CMS IPPS rate",361553.96,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,361553.96,
"FOOT PROCEDURES WITH CC",504,"CDM ",100,RC,,,INPATIENT,,,,,,8361.73,100,,,,,0,"case rate","100%CMS IPPS rate",15339.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",20232.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8361.73,100,,,,,0,"case rate","100%CMS IPPS rate",8361.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8361.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8361.73,100,,,,,0,"case rate","100%CMS IPPS rate",242132.76,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,242132.76,
"FOOT PROCEDURES WITHOUT CC/MCC",505,"CDM ",100,RC,,,INPATIENT,,,,,,7963.63,100,,,,,0,"case rate","100%CMS IPPS rate",15339.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19405.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7963.63,100,,,,,0,"case rate","100%CMS IPPS rate",7963.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7963.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7963.63,100,,,,,0,"case rate","100%CMS IPPS rate",232235.93,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,232235.93,
"MAJOR THUMB OR JOINT PROCEDURES",506,"CDM ",100,RC,,,INPATIENT,,,,,,6130.9,100,,,,,0,"case rate","100%CMS IPPS rate",9851.33,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12984.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6130.9,100,,,,,0,"case rate","100%CMS IPPS rate",6130.9,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6130.9,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6130.9,100,,,,,0,"case rate","100%CMS IPPS rate",174772.84,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,174772.84,
"MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC",507,"CDM ",100,RC,,,INPATIENT,,,,,,8402.16,100,,,,,0,"case rate","100%CMS IPPS rate",17810.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19552.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8402.16,100,,,,,0,"case rate","100%CMS IPPS rate",8402.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8402.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8402.16,100,,,,,0,"case rate","100%CMS IPPS rate",233997.74,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,233997.74,
"MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC",508,"CDM ",100,RC,,,INPATIENT,,,,,,5874.53,100,,,,,0,"case rate","100%CMS IPPS rate",11729.77,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16391.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5874.53,100,,,,,0,"case rate","100%CMS IPPS rate",5874.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5874.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5874.53,100,,,,,0,"case rate","100%CMS IPPS rate",196172.53,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,196172.53,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC",510,"CDM ",100,RC,,,INPATIENT,,,,,,11345.2,100,,,,,0,"case rate","100%CMS IPPS rate",17649.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",32693.89,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",11345.2,100,,,,,0,"case rate","100%CMS IPPS rate",11345.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",11345.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11345.2,100,,,,,0,"case rate","100%CMS IPPS rate",391269.89,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,391269.89,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC",511,"CDM ",100,RC,,,INPATIENT,,,,,,9550.67,100,,,,,0,"case rate","100%CMS IPPS rate",17002.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22507.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9550.67,100,,,,,0,"case rate","100%CMS IPPS rate",9550.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9550.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9550.67,100,,,,,0,"case rate","100%CMS IPPS rate",269361.62,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,269361.62,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC",512,"CDM ",100,RC,,,INPATIENT,,,,,,6465.45,100,,,,,0,"case rate","100%CMS IPPS rate",13434.24,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17918.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6465.45,100,,,,,0,"case rate","100%CMS IPPS rate",6465.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6465.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6465.45,100,,,,,0,"case rate","100%CMS IPPS rate",214437.5,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,214437.5,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC",513,"CDM ",100,RC,,,INPATIENT,,,,,,6477.01,100,,,,,0,"case rate","100%CMS IPPS rate",13585.48,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17040.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6477.01,100,,,,,0,"case rate","100%CMS IPPS rate",6477.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6477.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6477.01,100,,,,,0,"case rate","100%CMS IPPS rate",203931.91,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,203931.91,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC",514,"CDM ",100,RC,,,INPATIENT,,,,,,4130.66,100,,,,,0,"case rate","100%CMS IPPS rate",6946.25,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11065.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4130.66,100,,,,,0,"case rate","100%CMS IPPS rate",4130.66,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4130.66,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4130.66,100,,,,,0,"case rate","100%CMS IPPS rate",132426.86,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,132426.86,
"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC",515,"CDM ",100,RC,,,INPATIENT,,,,,,13033.1,100,,,,,0,"case rate","100%CMS IPPS rate",27858.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",34495.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",13033.1,100,,,,,0,"case rate","100%CMS IPPS rate",13033.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",13033.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13033.1,100,,,,,0,"case rate","100%CMS IPPS rate",412825.09,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,412825.09,
"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC",516,"CDM ",100,RC,,,INPATIENT,,,,,,9836.8,100,,,,,0,"case rate","100%CMS IPPS rate",22050.83,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22493.35,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9836.8,100,,,,,0,"case rate","100%CMS IPPS rate",9836.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9836.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9836.8,100,,,,,0,"case rate","100%CMS IPPS rate",269193.24,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,269193.24,
"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC",517,"CDM ",100,RC,,,INPATIENT,,,,,,8231.99,100,,,,,0,"case rate","100%CMS IPPS rate",14467.33,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16633.24,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8231.99,100,,,,,0,"case rate","100%CMS IPPS rate",8231.99,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8231.99,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8231.99,100,,,,,0,"case rate","100%CMS IPPS rate",199061.25,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,199061.25,
"BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR",518,"CDM ",100,RC,,,INPATIENT,,,,,,14891.6,100,,,,,0,"case rate","100%CMS IPPS rate",30998.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",40452.54,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",14891.6,100,,,,,0,"case rate","100%CMS IPPS rate",14891.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",14891.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14891.6,100,,,,,0,"case rate","100%CMS IPPS rate",484122.87,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,484122.87,
"BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC",519,"CDM ",100,RC,,,INPATIENT,,,,,,8133.36,100,,,,,0,"case rate","100%CMS IPPS rate",16938.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",21650.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8133.36,100,,,,,0,"case rate","100%CMS IPPS rate",8133.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8133.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8133.36,100,,,,,0,"case rate","100%CMS IPPS rate",259102.16,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,259102.16,
"BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC",520,"CDM ",100,RC,,,INPATIENT,,,,,,5888.75,100,,,,,0,"case rate","100%CMS IPPS rate",12357.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16169.97,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5888.75,100,,,,,0,"case rate","100%CMS IPPS rate",5888.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5888.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5888.75,100,,,,,0,"case rate","100%CMS IPPS rate",193517.08,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,193517.08,
"HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC",521,"CDM ",100,RC,,,INPATIENT,,,,,,12800.73,100,,,,,0,"case rate","100%CMS IPPS rate",29060.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",31067.04,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",12800.73,100,,,,,0,"case rate","100%CMS IPPS rate",12800.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",12800.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12800.73,100,,,,,0,"case rate","100%CMS IPPS rate",371800.4,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12800.73,371800.4,
"HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC",522,"CDM ",100,RC,,,INPATIENT,,,,,,12191.15,100,,,,,0,"case rate","100%CMS IPPS rate",20766.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22921.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",12191.15,100,,,,,0,"case rate","100%CMS IPPS rate",12191.15,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",12191.15,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12191.15,100,,,,,0,"case rate","100%CMS IPPS rate",274322.9,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12191.15,274322.9,
"FRACTURES OF FEMUR WITH MCC",533,"CDM ",100,RC,,,INPATIENT,,,,,,9338.74,100,,,,,0,"case rate","100%CMS IPPS rate",15780.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16968.78,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9338.74,100,,,,,0,"case rate","100%CMS IPPS rate",9338.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9338.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9338.74,100,,,,,0,"case rate","100%CMS IPPS rate",203077.01,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,203077.01,
"FRACTURES OF FEMUR WITHOUT MCC",534,"CDM ",100,RC,,,INPATIENT,,,,,,5213.42,100,,,,,0,"case rate","100%CMS IPPS rate",8765.04,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8725.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5213.42,100,,,,,0,"case rate","100%CMS IPPS rate",5213.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5213.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5213.42,100,,,,,0,"case rate","100%CMS IPPS rate",104420.72,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,104420.72,
"FRACTURES OF HIP AND PELVIS WITH MCC",535,"CDM ",100,RC,,,INPATIENT,,,,,,8156.46,100,,,,,0,"case rate","100%CMS IPPS rate",10654.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13876.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8156.46,100,,,,,0,"case rate","100%CMS IPPS rate",8156.46,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8156.46,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8156.46,100,,,,,0,"case rate","100%CMS IPPS rate",166067.94,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,166067.94,
"FRACTURES OF HIP AND PELVIS WITHOUT MCC",536,"CDM ",100,RC,,,INPATIENT,,,,,,5101.01,100,,,,,0,"case rate","100%CMS IPPS rate",6863.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8741.46,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5101.01,100,,,,,0,"case rate","100%CMS IPPS rate",5101.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5101.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5101.01,100,,,,,0,"case rate","100%CMS IPPS rate",104614.97,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,104614.97,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC",537,"CDM ",100,RC,,,INPATIENT,,,,,,6169.55,100,,,,,0,"case rate","100%CMS IPPS rate",7568.13,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10329.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6169.55,100,,,,,0,"case rate","100%CMS IPPS rate",6169.55,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6169.55,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6169.55,100,,,,,0,"case rate","100%CMS IPPS rate",123618.2,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,123618.2,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC",538,"CDM ",100,RC,,,INPATIENT,,,,,,4769.12,100,,,,,0,"case rate","100%CMS IPPS rate",5290.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7796.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4769.12,100,,,,,0,"case rate","100%CMS IPPS rate",4769.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4769.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4769.12,100,,,,,0,"case rate","100%CMS IPPS rate",93306.37,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,93306.37,
"OSTEOMYELITIS WITH MCC",539,"CDM ",100,RC,,,INPATIENT,,,,,,12833.16,100,,,,,0,"case rate","100%CMS IPPS rate",16832.35,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",21320.03,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",12833.16,100,,,,,0,"case rate","100%CMS IPPS rate",12833.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",12833.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12833.16,100,,,,,0,"case rate","100%CMS IPPS rate",255151.29,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,255151.29,
"OSTEOMYELITIS WITH CC",540,"CDM ",100,RC,,,INPATIENT,,,,,,8563.44,100,,,,,0,"case rate","100%CMS IPPS rate",11248.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14031.15,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8563.44,100,,,,,0,"case rate","100%CMS IPPS rate",8563.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8563.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8563.44,100,,,,,0,"case rate","100%CMS IPPS rate",167920.24,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,167920.24,
"OSTEOMYELITIS WITHOUT CC/MCC",541,"CDM ",100,RC,,,INPATIENT,,,,,,5557.3,100,,,,,0,"case rate","100%CMS IPPS rate",7287.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8350.72,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5557.3,100,,,,,0,"case rate","100%CMS IPPS rate",5557.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5557.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5557.3,100,,,,,0,"case rate","100%CMS IPPS rate",101998.4,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,101998.4,
"PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC",542,"CDM ",100,RC,,,INPATIENT,,,,,,11934.79,100,,,,,0,"case rate","100%CMS IPPS rate",15272.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19120.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",11934.79,100,,,,,0,"case rate","100%CMS IPPS rate",11934.79,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",11934.79,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11934.79,100,,,,,0,"case rate","100%CMS IPPS rate",228829.06,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,228829.06,
"PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC",543,"CDM ",100,RC,,,INPATIENT,,,,,,6897.31,100,,,,,0,"case rate","100%CMS IPPS rate",9032.78,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11127.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6897.31,100,,,,,0,"case rate","100%CMS IPPS rate",6897.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6897.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6897.31,100,,,,,0,"case rate","100%CMS IPPS rate",133165.27,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,133165.27,
"PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC",544,"CDM ",100,RC,,,INPATIENT,,,,,,5131.67,100,,,,,0,"case rate","100%CMS IPPS rate",6721,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8167.79,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5131.67,100,,,,,0,"case rate","100%CMS IPPS rate",5131.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5131.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5131.67,100,,,,,0,"case rate","100%CMS IPPS rate",97749.51,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,97749.51,
"CONNECTIVE TISSUE DISORDERS WITH MCC",545,"CDM ",100,RC,,,INPATIENT,,,,,,16524.41,100,,,,,0,"case rate","100%CMS IPPS rate",19380.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",26861.92,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",16524.41,100,,,,,0,"case rate","100%CMS IPPS rate",16524.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",16524.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16524.41,100,,,,,0,"case rate","100%CMS IPPS rate",321474.78,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,321474.78,
"CONNECTIVE TISSUE DISORDERS WITH CC",546,"CDM ",100,RC,,,INPATIENT,,,,,,7976.96,100,,,,,0,"case rate","100%CMS IPPS rate",10439.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12484.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7976.96,100,,,,,0,"case rate","100%CMS IPPS rate",7976.96,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7976.96,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7976.96,100,,,,,0,"case rate","100%CMS IPPS rate",149409.28,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,149409.28,
"CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC",547,"CDM ",100,RC,,,INPATIENT,,,,,,5507.1,100,,,,,0,"case rate","100%CMS IPPS rate",7204.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9051.03,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5507.1,100,,,,,0,"case rate","100%CMS IPPS rate",5507.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5507.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5507.1,100,,,,,0,"case rate","100%CMS IPPS rate",108319.85,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,108319.85,
"SEPTIC ARTHRITIS WITH MCC",548,"CDM ",100,RC,,,INPATIENT,,,,,,13417.86,100,,,,,0,"case rate","100%CMS IPPS rate",14625.17,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",20900.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",13417.86,100,,,,,0,"case rate","100%CMS IPPS rate",13417.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",13417.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13417.86,100,,,,,0,"case rate","100%CMS IPPS rate",250125.26,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,250125.26,
"SEPTIC ARTHRITIS WITH CC",549,"CDM ",100,RC,,,INPATIENT,,,,,,8243.1,100,,,,,0,"case rate","100%CMS IPPS rate",10801.84,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13066.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8243.1,100,,,,,0,"case rate","100%CMS IPPS rate",8243.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8243.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8243.1,100,,,,,0,"case rate","100%CMS IPPS rate",156378.52,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,156378.52,
"SEPTIC ARTHRITIS WITHOUT CC/MCC",550,"CDM ",100,RC,,,INPATIENT,,,,,,5835.44,100,,,,,0,"case rate","100%CMS IPPS rate",6416.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9461.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5835.44,100,,,,,0,"case rate","100%CMS IPPS rate",5835.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5835.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5835.44,100,,,,,0,"case rate","100%CMS IPPS rate",113229.24,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,113229.24,
"MEDICAL BACK PROBLEMS WITH MCC",551,"CDM ",100,RC,,,INPATIENT,,,,,,10730.29,100,,,,,0,"case rate","100%CMS IPPS rate",14064.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18142.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10730.29,100,,,,,0,"case rate","100%CMS IPPS rate",10730.29,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10730.29,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10730.29,100,,,,,0,"case rate","100%CMS IPPS rate",217118.81,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,217118.81,
"MEDICAL BACK PROBLEMS WITHOUT MCC",552,"CDM ",100,RC,,,INPATIENT,,,,,,4523.86,100,,,,,0,"case rate","100%CMS IPPS rate",8153.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10405.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4523.86,100,,,,,0,"case rate","100%CMS IPPS rate",4523.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4523.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4523.86,100,,,,,0,"case rate","100%CMS IPPS rate",124524.99,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,124524.99,
"BONE DISEASES AND ARTHROPATHIES WITH MCC",553,"CDM ",100,RC,,,INPATIENT,,,,,,8384.83,100,,,,,0,"case rate","100%CMS IPPS rate",10778.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14031.15,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8384.83,100,,,,,0,"case rate","100%CMS IPPS rate",8384.83,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8384.83,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8384.83,100,,,,,0,"case rate","100%CMS IPPS rate",167920.24,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,167920.24,
"BONE DISEASES AND ARTHROPATHIES WITHOUT MCC",554,"CDM ",100,RC,,,INPATIENT,,,,,,5225.41,100,,,,,0,"case rate","100%CMS IPPS rate",7253.39,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8985,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5225.41,100,,,,,0,"case rate","100%CMS IPPS rate",5225.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5225.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5225.41,100,,,,,0,"case rate","100%CMS IPPS rate",107529.57,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,107529.57,
"SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",555,"CDM ",100,RC,,,INPATIENT,,,,,,9009.52,100,,,,,0,"case rate","100%CMS IPPS rate",11826.79,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14307.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9009.52,100,,,,,0,"case rate","100%CMS IPPS rate",9009.52,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9009.52,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9009.52,100,,,,,0,"case rate","100%CMS IPPS rate",171223.48,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,171223.48,
"SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC",556,"CDM ",100,RC,,,INPATIENT,,,,,,4289.72,100,,,,,0,"case rate","100%CMS IPPS rate",5434.29,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8990.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4289.72,100,,,,,0,"case rate","100%CMS IPPS rate",4289.72,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4289.72,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4289.72,100,,,,,0,"case rate","100%CMS IPPS rate",107594.31,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,107594.31,
"TENDONITIS, MYOSITIS AND BURSITIS WITH MCC",557,"CDM ",100,RC,,,INPATIENT,,,,,,9215.23,100,,,,,0,"case rate","100%CMS IPPS rate",10912.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16094.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9215.23,100,,,,,0,"case rate","100%CMS IPPS rate",9215.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9215.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9215.23,100,,,,,0,"case rate","100%CMS IPPS rate",192610.29,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,192610.29,
"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC",558,"CDM ",100,RC,,,INPATIENT,,,,,,5225.41,100,,,,,0,"case rate","100%CMS IPPS rate",7444.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9668,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5225.41,100,,,,,0,"case rate","100%CMS IPPS rate",5225.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5225.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5225.41,100,,,,,0,"case rate","100%CMS IPPS rate",115703.45,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,115703.45,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",559,"CDM ",100,RC,,,INPATIENT,,,,,,11824.6,100,,,,,0,"case rate","100%CMS IPPS rate",16120.24,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",20185.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",11824.6,100,,,,,0,"case rate","100%CMS IPPS rate",11824.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",11824.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11824.6,100,,,,,0,"case rate","100%CMS IPPS rate",241575.74,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,241575.74,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",560,"CDM ",100,RC,,,INPATIENT,,,,,,11261.67,100,,,,,0,"case rate","100%CMS IPPS rate",9298.96,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12188.91,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",11261.67,100,,,,,0,"case rate","100%CMS IPPS rate",11261.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",11261.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11261.67,100,,,,,0,"case rate","100%CMS IPPS rate",145872.92,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,145872.92,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",561,"CDM ",100,RC,,,INPATIENT,,,,,,10725.4,100,,,,,0,"case rate","100%CMS IPPS rate",6848.04,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8701.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10725.4,100,,,,,0,"case rate","100%CMS IPPS rate",10725.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10725.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10725.4,100,,,,,0,"case rate","100%CMS IPPS rate",104135.71,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,104135.71,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC",562,"CDM ",100,RC,,,INPATIENT,,,,,,9308.53,100,,,,,0,"case rate","100%CMS IPPS rate",12201.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15422.04,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9308.53,100,,,,,0,"case rate","100%CMS IPPS rate",9308.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9308.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9308.53,100,,,,,0,"case rate","100%CMS IPPS rate",184565.91,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,184565.91,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC",563,"CDM ",100,RC,,,INPATIENT,,,,,,3087.89,100,,,,,0,"case rate","100%CMS IPPS rate",7537.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9692.89,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3087.89,100,,,,,0,"case rate","100%CMS IPPS rate",3087.89,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3087.89,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3087.89,100,,,,,0,"case rate","100%CMS IPPS rate",116001.48,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,116001.48,
"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC",564,"CDM ",100,RC,,,INPATIENT,,,,,,5690.59,100,,,,,0,"case rate","100%CMS IPPS rate",11499.46,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16707.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5690.59,100,,,,,0,"case rate","100%CMS IPPS rate",5690.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5690.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5690.59,100,,,,,0,"case rate","100%CMS IPPS rate",199955.01,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,199955.01,
"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC",565,"CDM ",100,RC,,,INPATIENT,,,,,,5419.57,100,,,,,0,"case rate","100%CMS IPPS rate",8722.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10546.91,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5419.57,100,,,,,0,"case rate","100%CMS IPPS rate",5419.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5419.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5419.57,100,,,,,0,"case rate","100%CMS IPPS rate",126221.92,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,126221.92,
"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC",566,"CDM ",100,RC,,,INPATIENT,,,,,,5161.43,100,,,,,0,"case rate","100%CMS IPPS rate",5479.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8110.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5161.43,100,,,,,0,"case rate","100%CMS IPPS rate",5161.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5161.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5161.43,100,,,,,0,"case rate","100%CMS IPPS rate",97062.99,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,97062.99,
"SKIN DEBRIDEMENT WITH MCC",570,"CDM ",100,RC,,,INPATIENT,,,,,,10801.38,100,,,,,0,"case rate","100%CMS IPPS rate",24558.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",31834.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10801.38,100,,,,,0,"case rate","100%CMS IPPS rate",10801.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10801.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10801.38,100,,,,,0,"case rate","100%CMS IPPS rate",380984.57,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,380984.57,
"SKIN DEBRIDEMENT WITH CC",571,"CDM ",100,RC,,,INPATIENT,,,,,,6217.98,100,,,,,0,"case rate","100%CMS IPPS rate",14133.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18287.15,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6217.98,100,,,,,0,"case rate","100%CMS IPPS rate",6217.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6217.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6217.98,100,,,,,0,"case rate","100%CMS IPPS rate",218854.62,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,218854.62,
"SKIN DEBRIDEMENT WITHOUT CC/MCC",572,"CDM ",100,RC,,,INPATIENT,,,,,,4199.08,100,,,,,0,"case rate","100%CMS IPPS rate",9544.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12407.55,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4199.08,100,,,,,0,"case rate","100%CMS IPPS rate",4199.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4199.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4199.08,100,,,,,0,"case rate","100%CMS IPPS rate",148489.63,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,148489.63,
"SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC",573,"CDM ",100,RC,,,INPATIENT,,,,,,21087.37,100,,,,,0,"case rate","100%CMS IPPS rate",28626.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",70912.35,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",21087.37,100,,,,,0,"case rate","100%CMS IPPS rate",21087.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",21087.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",21087.37,100,,,,,0,"case rate","100%CMS IPPS rate",848656.16,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,848656.16,
"SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC",574,"CDM ",100,RC,,,INPATIENT,,,,,,12370.2,100,,,,,0,"case rate","100%CMS IPPS rate",20306,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",37574.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",12370.2,100,,,,,0,"case rate","100%CMS IPPS rate",12370.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",12370.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12370.2,100,,,,,0,"case rate","100%CMS IPPS rate",449678.77,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,449678.77,
"SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC",575,"CDM ",100,RC,,,INPATIENT,,,,,,6708.49,100,,,,,0,"case rate","100%CMS IPPS rate",11525.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17682.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6708.49,100,,,,,0,"case rate","100%CMS IPPS rate",6708.49,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6708.49,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6708.49,100,,,,,0,"case rate","100%CMS IPPS rate",232780.07,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,232780.07,
"SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC",576,"CDM ",100,RC,,,INPATIENT,,,,,,19235.08,100,,,,,0,"case rate","100%CMS IPPS rate",31984.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",53050.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",19235.08,100,,,,,0,"case rate","100%CMS IPPS rate",19235.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",19235.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19235.08,100,,,,,0,"case rate","100%CMS IPPS rate",634892.33,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,634892.33,
"SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC",577,"CDM ",100,RC,,,INPATIENT,,,,,,9725.73,100,,,,,0,"case rate","100%CMS IPPS rate",15297.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",28691.18,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9725.73,100,,,,,0,"case rate","100%CMS IPPS rate",9725.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9725.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9725.73,100,,,,,0,"case rate","100%CMS IPPS rate",343366.74,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,343366.74,
"SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC",578,"CDM ",100,RC,,,INPATIENT,,,,,,6209.98,100,,,,,0,"case rate","100%CMS IPPS rate",10163.02,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17387.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6209.98,100,,,,,0,"case rate","100%CMS IPPS rate",6209.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6209.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6209.98,100,,,,,0,"case rate","100%CMS IPPS rate",208090.04,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,208090.04,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC",579,"CDM ",100,RC,,,INPATIENT,,,,,,11149.71,100,,,,,0,"case rate","100%CMS IPPS rate",27178.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",35053.52,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",11149.71,100,,,,,0,"case rate","100%CMS IPPS rate",11149.71,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",11149.71,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11149.71,100,,,,,0,"case rate","100%CMS IPPS rate",419509.3,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,419509.3,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",580,"CDM ",100,RC,,,INPATIENT,,,,,,5945.62,100,,,,,0,"case rate","100%CMS IPPS rate",14940.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18703.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5945.62,100,,,,,0,"case rate","100%CMS IPPS rate",5945.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5945.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5945.62,100,,,,,0,"case rate","100%CMS IPPS rate",223841.91,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,223841.91,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC",581,"CDM ",100,RC,,,INPATIENT,,,,,,5070.35,100,,,,,0,"case rate","100%CMS IPPS rate",11898.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15620.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5070.35,100,,,,,0,"case rate","100%CMS IPPS rate",5070.35,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5070.35,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5070.35,100,,,,,0,"case rate","100%CMS IPPS rate",186936.49,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,186936.49,
"MASTECTOMY FOR MALIGNANCY WITH CC/MCC",582,"CDM ",100,RC,,,INPATIENT,,,,,,6229.53,100,,,,,0,"case rate","100%CMS IPPS rate",14046.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",20853.52,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6229.53,100,,,,,0,"case rate","100%CMS IPPS rate",6229.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6229.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6229.53,100,,,,,0,"case rate","100%CMS IPPS rate",249568.24,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,249568.24,
"MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC",583,"CDM ",100,RC,,,INPATIENT,,,,,,5856.76,100,,,,,0,"case rate","100%CMS IPPS rate",10669.54,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18664.91,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5856.76,100,,,,,0,"case rate","100%CMS IPPS rate",5856.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5856.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5856.76,100,,,,,0,"case rate","100%CMS IPPS rate",223375.51,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,223375.51,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC",584,"CDM ",100,RC,,,INPATIENT,,,,,,6947.52,100,,,,,0,"case rate","100%CMS IPPS rate",15873.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",23170.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6947.52,100,,,,,0,"case rate","100%CMS IPPS rate",6947.52,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6947.52,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6947.52,100,,,,,0,"case rate","100%CMS IPPS rate",277302.25,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,277302.25,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC",585,"CDM ",100,RC,,,INPATIENT,,,,,,6613.41,100,,,,,0,"case rate","100%CMS IPPS rate",15033.92,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",20880.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6613.41,100,,,,,0,"case rate","100%CMS IPPS rate",6613.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6613.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6613.41,100,,,,,0,"case rate","100%CMS IPPS rate",249892,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,249892,
"SKIN ULCERS WITH MCC",592,"CDM ",100,RC,,,INPATIENT,,,,,,7727.71,100,,,,,0,"case rate","100%CMS IPPS rate",11002.35,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",20947.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7727.71,100,,,,,0,"case rate","100%CMS IPPS rate",7727.71,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7727.71,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7727.71,100,,,,,0,"case rate","100%CMS IPPS rate",250695.15,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,250695.15,
"SKIN ULCERS WITH CC",593,"CDM ",100,RC,,,INPATIENT,,,,,,5208.08,100,,,,,0,"case rate","100%CMS IPPS rate",9857.25,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12840.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5208.08,100,,,,,0,"case rate","100%CMS IPPS rate",5208.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5208.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5208.08,100,,,,,0,"case rate","100%CMS IPPS rate",153671.04,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,153671.04,
"SKIN ULCERS WITHOUT CC/MCC",594,"CDM ",100,RC,,,INPATIENT,,,,,,3750.78,100,,,,,0,"case rate","100%CMS IPPS rate",5586.64,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9382.24,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3750.78,100,,,,,0,"case rate","100%CMS IPPS rate",3750.78,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3750.78,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3750.78,100,,,,,0,"case rate","100%CMS IPPS rate",112283.72,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,112283.72,
"MAJOR SKIN DISORDERS WITH MCC",595,"CDM ",100,RC,,,INPATIENT,,,,,,9218.34,100,,,,,0,"case rate","100%CMS IPPS rate",15012.18,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22954.46,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9218.34,100,,,,,0,"case rate","100%CMS IPPS rate",9218.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9218.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9218.34,100,,,,,0,"case rate","100%CMS IPPS rate",274711.55,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,274711.55,
"MAJOR SKIN DISORDERS WITHOUT MCC",596,"CDM ",100,RC,,,INPATIENT,,,,,,4531.86,100,,,,,0,"case rate","100%CMS IPPS rate",8596.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11716.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4531.86,100,,,,,0,"case rate","100%CMS IPPS rate",4531.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4531.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4531.86,100,,,,,0,"case rate","100%CMS IPPS rate",140224.98,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,140224.98,
"MALIGNANT BREAST DISORDERS WITH MCC",597,"CDM ",100,RC,,,INPATIENT,,,,,,4861.53,100,,,,,0,"case rate","100%CMS IPPS rate",14207.72,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18044.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4861.53,100,,,,,0,"case rate","100%CMS IPPS rate",4861.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4861.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4861.53,100,,,,,0,"case rate","100%CMS IPPS rate",215953.04,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,215953.04,
"MALIGNANT BREAST DISORDERS WITH CC",598,"CDM ",100,RC,,,INPATIENT,,,,,,4630.05,100,,,,,0,"case rate","100%CMS IPPS rate",9617.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12245.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4630.05,100,,,,,0,"case rate","100%CMS IPPS rate",4630.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4630.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4630.05,100,,,,,0,"case rate","100%CMS IPPS rate",146546.43,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,146546.43,
"MALIGNANT BREAST DISORDERS WITHOUT CC/MCC",599,"CDM ",100,RC,,,INPATIENT,,,,,,4409.23,100,,,,,0,"case rate","100%CMS IPPS rate",6035,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7936.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4409.23,100,,,,,0,"case rate","100%CMS IPPS rate",4409.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4409.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4409.23,100,,,,,0,"case rate","100%CMS IPPS rate",99666.7,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,99666.7,
"NON-MALIGNANT BREAST DISORDERS WITH CC/MCC",600,"CDM ",100,RC,,,INPATIENT,,,,,,4561.63,100,,,,,0,"case rate","100%CMS IPPS rate",8615.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11274.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4561.63,100,,,,,0,"case rate","100%CMS IPPS rate",4561.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4561.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4561.63,100,,,,,0,"case rate","100%CMS IPPS rate",134926.94,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,134926.94,
"NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC",601,"CDM ",100,RC,,,INPATIENT,,,,,,3150.09,100,,,,,0,"case rate","100%CMS IPPS rate",5913.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6548.52,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3150.09,100,,,,,0,"case rate","100%CMS IPPS rate",3150.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3150.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3150.09,100,,,,,0,"case rate","100%CMS IPPS rate",81932.17,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,81932.17,
"CELLULITIS WITH MCC",602,"CDM ",100,RC,,,INPATIENT,,,,,,6581.86,100,,,,,0,"case rate","100%CMS IPPS rate",12531.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15384.15,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6581.86,100,,,,,0,"case rate","100%CMS IPPS rate",6581.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6581.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6581.86,100,,,,,0,"case rate","100%CMS IPPS rate",184112.52,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,184112.52,
"CELLULITIS WITHOUT MCC",603,"CDM ",100,RC,,,INPATIENT,,,,,,3854.75,100,,,,,0,"case rate","100%CMS IPPS rate",8017.56,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9426.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3854.75,100,,,,,0,"case rate","100%CMS IPPS rate",3854.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3854.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3854.75,100,,,,,0,"case rate","100%CMS IPPS rate",112814.74,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,112814.74,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC",604,"CDM ",100,RC,,,INPATIENT,,,,,,6832.45,100,,,,,0,"case rate","100%CMS IPPS rate",12772.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15934.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6832.45,100,,,,,0,"case rate","100%CMS IPPS rate",6832.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6832.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6832.45,100,,,,,0,"case rate","100%CMS IPPS rate",190693.11,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,190693.11,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC",605,"CDM ",100,RC,,,INPATIENT,,,,,,3818.31,100,,,,,0,"case rate","100%CMS IPPS rate",7811.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9914.78,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3818.31,100,,,,,0,"case rate","100%CMS IPPS rate",3818.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3818.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3818.31,100,,,,,0,"case rate","100%CMS IPPS rate",118656.92,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,118656.92,
"MINOR SKIN DISORDERS WITH MCC",606,"CDM ",100,RC,,,INPATIENT,,,,,,6922.64,100,,,,,0,"case rate","100%CMS IPPS rate",10550.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16378.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6922.64,100,,,,,0,"case rate","100%CMS IPPS rate",6922.64,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6922.64,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6922.64,100,,,,,0,"case rate","100%CMS IPPS rate",196017.16,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,196017.16,
"MINOR SKIN DISORDERS WITHOUT MCC",607,"CDM ",100,RC,,,INPATIENT,,,,,,4795.77,100,,,,,0,"case rate","100%CMS IPPS rate",7157.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9810.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4795.77,100,,,,,0,"case rate","100%CMS IPPS rate",4795.77,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4795.77,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4795.77,100,,,,,0,"case rate","100%CMS IPPS rate",117413.39,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,117413.39,
"ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC",614,"CDM ",100,RC,,,INPATIENT,,,,,,9741.28,100,,,,,0,"case rate","100%CMS IPPS rate",24961.55,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",23724.04,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9741.28,100,,,,,0,"case rate","100%CMS IPPS rate",9741.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9741.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9741.28,100,,,,,0,"case rate","100%CMS IPPS rate",283921.72,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,283921.72,
"ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC",615,"CDM ",100,RC,,,INPATIENT,,,,,,6424.58,100,,,,,0,"case rate","100%CMS IPPS rate",15730.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15146.02,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6424.58,100,,,,,0,"case rate","100%CMS IPPS rate",6424.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6424.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6424.58,100,,,,,0,"case rate","100%CMS IPPS rate",181262.66,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,181262.66,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",616,"CDM ",100,RC,,,INPATIENT,,,,,,16279.6,100,,,,,0,"case rate","100%CMS IPPS rate",34276.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",37747.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",16279.6,100,,,,,0,"case rate","100%CMS IPPS rate",16279.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",16279.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16279.6,100,,,,,0,"case rate","100%CMS IPPS rate",451751.34,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,451751.34,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",617,"CDM ",100,RC,,,INPATIENT,,,,,,9574.22,100,,,,,0,"case rate","100%CMS IPPS rate",17541.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",20244.13,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9574.22,100,,,,,0,"case rate","100%CMS IPPS rate",9574.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9574.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9574.22,100,,,,,0,"case rate","100%CMS IPPS rate",242275.12,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,242275.12,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",618,"CDM ",100,RC,,,INPATIENT,,,,,,5317.83,100,,,,,0,"case rate","100%CMS IPPS rate",11774.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15351.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5317.83,100,,,,,0,"case rate","100%CMS IPPS rate",5317.83,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5317.83,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5317.83,100,,,,,0,"case rate","100%CMS IPPS rate",183724.01,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,183724.01,
"O.R. PROCEDURES FOR OBESITY WITH MCC",619,"CDM ",100,RC,,,INPATIENT,,,,,,12493.27,100,,,,,0,"case rate","100%CMS IPPS rate",24912.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",31253.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",12493.27,100,,,,,0,"case rate","100%CMS IPPS rate",12493.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",12493.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12493.27,100,,,,,0,"case rate","100%CMS IPPS rate",374028.47,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,374028.47,
"O.R. PROCEDURES FOR OBESITY WITH CC",620,"CDM ",100,RC,,,INPATIENT,,,,,,7010.61,100,,,,,0,"case rate","100%CMS IPPS rate",16192.64,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17321.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7010.61,100,,,,,0,"case rate","100%CMS IPPS rate",7010.61,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7010.61,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7010.61,100,,,,,0,"case rate","100%CMS IPPS rate",207299.88,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,207299.88,
"O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC",621,"CDM ",100,RC,,,INPATIENT,,,,,,5655.94,100,,,,,0,"case rate","100%CMS IPPS rate",14326.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16326.92,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5655.94,100,,,,,0,"case rate","100%CMS IPPS rate",5655.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5655.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5655.94,100,,,,,0,"case rate","100%CMS IPPS rate",195395.38,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,195395.38,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",622,"CDM ",100,RC,,,INPATIENT,,,,,,14744.98,100,,,,,0,"case rate","100%CMS IPPS rate",31240.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",38524.78,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",14744.98,100,,,,,0,"case rate","100%CMS IPPS rate",14744.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",14744.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14744.98,100,,,,,0,"case rate","100%CMS IPPS rate",461052.13,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,461052.13,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",623,"CDM ",100,RC,,,INPATIENT,,,,,,10105.16,100,,,,,0,"case rate","100%CMS IPPS rate",16173.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19417.17,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10105.16,100,,,,,0,"case rate","100%CMS IPPS rate",10105.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10105.16,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10105.16,100,,,,,0,"case rate","100%CMS IPPS rate",232378.44,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,232378.44,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",624,"CDM ",100,RC,,,INPATIENT,,,,,,4466.1,100,,,,,0,"case rate","100%CMS IPPS rate",9047.13,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13550.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4466.1,100,,,,,0,"case rate","100%CMS IPPS rate",4466.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4466.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4466.1,100,,,,,0,"case rate","100%CMS IPPS rate",162168.81,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,162168.81,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC",625,"CDM ",100,RC,,,INPATIENT,,,,,,11595.79,100,,,,,0,"case rate","100%CMS IPPS rate",19223.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",32689.56,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",11595.79,100,,,,,0,"case rate","100%CMS IPPS rate",11595.79,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",11595.79,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11595.79,100,,,,,0,"case rate","100%CMS IPPS rate",391218.14,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,391218.14,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC",626,"CDM ",100,RC,,,INPATIENT,,,,,,6743.59,100,,,,,0,"case rate","100%CMS IPPS rate",14284.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16229.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6743.59,100,,,,,0,"case rate","100%CMS IPPS rate",6743.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6743.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6743.59,100,,,,,0,"case rate","100%CMS IPPS rate",194229.46,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,194229.46,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC",627,"CDM ",100,RC,,,INPATIENT,,,,,,4823.32,100,,,,,0,"case rate","100%CMS IPPS rate",10221.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14377.52,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4823.32,100,,,,,0,"case rate","100%CMS IPPS rate",4823.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4823.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4823.32,100,,,,,0,"case rate","100%CMS IPPS rate",172065.5,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,172065.5,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC",628,"CDM ",100,RC,,,INPATIENT,,,,,,15092.87,100,,,,,0,"case rate","100%CMS IPPS rate",31798,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",40338.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",15092.87,100,,,,,0,"case rate","100%CMS IPPS rate",15092.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",15092.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15092.87,100,,,,,0,"case rate","100%CMS IPPS rate",482762.7,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,482762.7,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC",629,"CDM ",100,RC,,,INPATIENT,,,,,,9577.78,100,,,,,0,"case rate","100%CMS IPPS rate",20268.49,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",23583.33,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9577.78,100,,,,,0,"case rate","100%CMS IPPS rate",9577.78,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9577.78,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9577.78,100,,,,,0,"case rate","100%CMS IPPS rate",282237.65,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,282237.65,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC",630,"CDM ",100,RC,,,INPATIENT,,,,,,5742.13,100,,,,,0,"case rate","100%CMS IPPS rate",12179.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15797.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5742.13,100,,,,,0,"case rate","100%CMS IPPS rate",5742.13,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5742.13,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5742.13,100,,,,,0,"case rate","100%CMS IPPS rate",189060.92,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,189060.92,
"DIABETES WITH MCC",637,"CDM ",100,RC,,,INPATIENT,,,,,,8202.22,100,,,,,0,"case rate","100%CMS IPPS rate",11896.81,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15550.84,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8202.22,100,,,,,0,"case rate","100%CMS IPPS rate",8202.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8202.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8202.22,100,,,,,0,"case rate","100%CMS IPPS rate",186107.46,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,186107.46,
"DIABETES WITH CC",638,"CDM ",100,RC,,,INPATIENT,,,,,,4677.59,100,,,,,0,"case rate","100%CMS IPPS rate",7997.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9700.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4677.59,100,,,,,0,"case rate","100%CMS IPPS rate",4677.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4677.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4677.59,100,,,,,0,"case rate","100%CMS IPPS rate",116092.09,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,116092.09,
"DIABETES WITHOUT CC/MCC",639,"CDM ",100,RC,,,INPATIENT,,,,,,3301.59,100,,,,,0,"case rate","100%CMS IPPS rate",5796.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6723.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3301.59,100,,,,,0,"case rate","100%CMS IPPS rate",3301.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3301.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3301.59,100,,,,,0,"case rate","100%CMS IPPS rate",83465.67,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,83465.67,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",640,"CDM ",100,RC,,,INPATIENT,,,,,,6655.17,100,,,,,0,"case rate","100%CMS IPPS rate",10636.77,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14456.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6655.17,100,,,,,0,"case rate","100%CMS IPPS rate",6655.17,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6655.17,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6655.17,100,,,,,0,"case rate","100%CMS IPPS rate",173011.17,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,173011.17,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",641,"CDM ",100,RC,,,INPATIENT,,,,,,4250.62,100,,,,,0,"case rate","100%CMS IPPS rate",7060.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8423.24,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4250.62,100,,,,,0,"case rate","100%CMS IPPS rate",4250.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4250.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4250.62,100,,,,,0,"case rate","100%CMS IPPS rate",100806.6,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100806.6,
"INBORN AND OTHER DISORDERS OF METABOLISM",642,"CDM ",100,RC,,,INPATIENT,,,,,,7111.02,100,,,,,0,"case rate","100%CMS IPPS rate",8740.84,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15392.81,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7111.02,100,,,,,0,"case rate","100%CMS IPPS rate",7111.02,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7111.02,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7111.02,100,,,,,0,"case rate","100%CMS IPPS rate",184216.14,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,184216.14,
"ENDOCRINE DISORDERS WITH MCC",643,"CDM ",100,RC,,,INPATIENT,,,,,,9186.35,100,,,,,0,"case rate","100%CMS IPPS rate",14412.55,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17817.39,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9186.35,100,,,,,0,"case rate","100%CMS IPPS rate",9186.35,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9186.35,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9186.35,100,,,,,0,"case rate","100%CMS IPPS rate",213232.7,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,213232.7,
"ENDOCRINE DISORDERS WITH CC",644,"CDM ",100,RC,,,INPATIENT,,,,,,5019.26,100,,,,,0,"case rate","100%CMS IPPS rate",8813.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11094.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5019.26,100,,,,,0,"case rate","100%CMS IPPS rate",5019.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5019.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5019.26,100,,,,,0,"case rate","100%CMS IPPS rate",132776.62,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,132776.62,
"ENDOCRINE DISORDERS WITHOUT CC/MCC",645,"CDM ",100,RC,,,INPATIENT,,,,,,4240.4,100,,,,,0,"case rate","100%CMS IPPS rate",6642.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8316.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4240.4,100,,,,,0,"case rate","100%CMS IPPS rate",4240.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4240.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4240.4,100,,,,,0,"case rate","100%CMS IPPS rate",99524.19,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,99524.19,
"KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC",650,"CDM ",100,RC,,,INPATIENT,,,,,,21732.49,100,,,,,0,"case rate","100%CMS IPPS rate",49420.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",50887.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",21732.49,100,,,,,0,"case rate","100%CMS IPPS rate",21732.49,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",21732.49,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",21732.49,100,,,,,0,"case rate","100%CMS IPPS rate",609010.62,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",21732.49,609010.62,
"KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC",651,"CDM ",100,RC,,,INPATIENT,,,,,,17786.22,100,,,,,0,"case rate","100%CMS IPPS rate",40449.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",40111.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",17786.22,100,,,,,0,"case rate","100%CMS IPPS rate",17786.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",17786.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17786.22,100,,,,,0,"case rate","100%CMS IPPS rate",480042.5,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17786.22,480042.5,
"KIDNEY TRANSPLANT",652,"CDM ",100,RC,,,INPATIENT,,,,,,15322.13,100,,,,,0,"case rate","100%CMS IPPS rate",36950.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",34956.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",15322.13,100,,,,,0,"case rate","100%CMS IPPS rate",15322.13,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",15322.13,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15322.13,100,,,,,0,"case rate","100%CMS IPPS rate",418343.38,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,418343.38,
"MAJOR BLADDER PROCEDURES WITH MCC",653,"CDM ",100,RC,,,INPATIENT,,,,,,26239.91,100,,,,,0,"case rate","100%CMS IPPS rate",47179.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",56245.83,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",26239.91,100,,,,,0,"case rate","100%CMS IPPS rate",26239.91,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",26239.91,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",26239.91,100,,,,,0,"case rate","100%CMS IPPS rate",673132.04,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,673132.04,
"MAJOR BLADDER PROCEDURES WITH CC",654,"CDM ",100,RC,,,INPATIENT,,,,,,13965.68,100,,,,,0,"case rate","100%CMS IPPS rate",25086.5,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",30299.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",13965.68,100,,,,,0,"case rate","100%CMS IPPS rate",13965.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",13965.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13965.68,100,,,,,0,"case rate","100%CMS IPPS rate",362616.1,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,362616.1,
"MAJOR BLADDER PROCEDURES WITHOUT CC/MCC",655,"CDM ",100,RC,,,INPATIENT,,,,,,10016.3,100,,,,,0,"case rate","100%CMS IPPS rate",17978.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22910.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10016.3,100,,,,,0,"case rate","100%CMS IPPS rate",10016.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10016.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10016.3,100,,,,,0,"case rate","100%CMS IPPS rate",274180.39,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,274180.39,
"KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC",656,"CDM ",100,RC,,,INPATIENT,,,,,,15802.42,100,,,,,0,"case rate","100%CMS IPPS rate",28440.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",34461.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",15802.42,100,,,,,0,"case rate","100%CMS IPPS rate",15802.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",15802.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15802.42,100,,,,,0,"case rate","100%CMS IPPS rate",412423.58,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,412423.58,
"KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC",657,"CDM ",100,RC,,,INPATIENT,,,,,,9313.42,100,,,,,0,"case rate","100%CMS IPPS rate",18076.18,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19807.92,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9313.42,100,,,,,0,"case rate","100%CMS IPPS rate",9313.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9313.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9313.42,100,,,,,0,"case rate","100%CMS IPPS rate",237054.84,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,237054.84,
"KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC",658,"CDM ",100,RC,,,INPATIENT,,,,,,7603.75,100,,,,,0,"case rate","100%CMS IPPS rate",15007.91,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16796.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7603.75,100,,,,,0,"case rate","100%CMS IPPS rate",7603.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7603.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7603.75,100,,,,,0,"case rate","100%CMS IPPS rate",201017.31,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,201017.31,
"KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC",659,"CDM ",100,RC,,,INPATIENT,,,,,,12831.83,100,,,,,0,"case rate","100%CMS IPPS rate",23061.33,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",27502.7,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",12831.83,100,,,,,0,"case rate","100%CMS IPPS rate",12831.83,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",12831.83,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12831.83,100,,,,,0,"case rate","100%CMS IPPS rate",329143.41,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,329143.41,
"KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC",660,"CDM ",100,RC,,,INPATIENT,,,,,,5284.06,100,,,,,0,"case rate","100%CMS IPPS rate",14414.35,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14306.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5284.06,100,,,,,0,"case rate","100%CMS IPPS rate",5284.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5284.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5284.06,100,,,,,0,"case rate","100%CMS IPPS rate",171210.61,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,171210.61,
"KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC",661,"CDM ",100,RC,,,INPATIENT,,,,,,4926.84,100,,,,,0,"case rate","100%CMS IPPS rate",12018.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11207.17,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4926.84,100,,,,,0,"case rate","100%CMS IPPS rate",4926.84,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4926.84,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4926.84,100,,,,,0,"case rate","100%CMS IPPS rate",134123.79,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,134123.79,
"MINOR BLADDER PROCEDURES WITH MCC",662,"CDM ",100,RC,,,INPATIENT,,,,,,14108.3,100,,,,,0,"case rate","100%CMS IPPS rate",22976,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",33137.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",14108.3,100,,,,,0,"case rate","100%CMS IPPS rate",14108.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",14108.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14108.3,100,,,,,0,"case rate","100%CMS IPPS rate",396581.08,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,396581.08,
"MINOR BLADDER PROCEDURES WITH CC",663,"CDM ",100,RC,,,INPATIENT,,,,,,7680.17,100,,,,,0,"case rate","100%CMS IPPS rate",11572.35,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16454.64,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7680.17,100,,,,,0,"case rate","100%CMS IPPS rate",7680.17,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7680.17,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7680.17,100,,,,,0,"case rate","100%CMS IPPS rate",196923.93,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,196923.93,
"MINOR BLADDER PROCEDURES WITHOUT CC/MCC",664,"CDM ",100,RC,,,INPATIENT,,,,,,5702.59,100,,,,,0,"case rate","100%CMS IPPS rate",9501.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11331.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5702.59,100,,,,,0,"case rate","100%CMS IPPS rate",5702.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5702.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5702.59,100,,,,,0,"case rate","100%CMS IPPS rate",135613.46,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,135613.46,
"PROSTATECTOMY WITH MCC",665,"CDM ",100,RC,,,INPATIENT,,,,,,14622.8,100,,,,,0,"case rate","100%CMS IPPS rate",23923.81,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",33783.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",14622.8,100,,,,,0,"case rate","100%CMS IPPS rate",14622.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",14622.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14622.8,100,,,,,0,"case rate","100%CMS IPPS rate",404314.44,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,404314.44,
"PROSTATECTOMY WITH CC",666,"CDM ",100,RC,,,INPATIENT,,,,,,8351.51,100,,,,,0,"case rate","100%CMS IPPS rate",13393.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18934.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8351.51,100,,,,,0,"case rate","100%CMS IPPS rate",8351.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8351.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8351.51,100,,,,,0,"case rate","100%CMS IPPS rate",226601.13,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,226601.13,
"PROSTATECTOMY WITHOUT CC/MCC",667,"CDM ",100,RC,,,INPATIENT,,,,,,4790.89,100,,,,,0,"case rate","100%CMS IPPS rate",8333.91,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11973.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4790.89,100,,,,,0,"case rate","100%CMS IPPS rate",4790.89,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4790.89,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4790.89,100,,,,,0,"case rate","100%CMS IPPS rate",143295.09,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,143295.09,
"TRANSURETHRAL PROCEDURES WITH MCC",668,"CDM ",100,RC,,,INPATIENT,,,,,,13266.8,100,,,,,0,"case rate","100%CMS IPPS rate",19111.46,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",31606.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",13266.8,100,,,,,0,"case rate","100%CMS IPPS rate",13266.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",13266.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13266.8,100,,,,,0,"case rate","100%CMS IPPS rate",378251.36,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,378251.36,
"TRANSURETHRAL PROCEDURES WITH CC",669,"CDM ",100,RC,,,INPATIENT,,,,,,5114.78,100,,,,,0,"case rate","100%CMS IPPS rate",13512.03,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16798.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5114.78,100,,,,,0,"case rate","100%CMS IPPS rate",5114.78,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5114.78,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5114.78,100,,,,,0,"case rate","100%CMS IPPS rate",201043.18,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,201043.18,
"TRANSURETHRAL PROCEDURES WITHOUT CC/MCC",670,"CDM ",100,RC,,,INPATIENT,,,,,,4702.03,100,,,,,0,"case rate","100%CMS IPPS rate",6770.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10578.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4702.03,100,,,,,0,"case rate","100%CMS IPPS rate",4702.03,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4702.03,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4702.03,100,,,,,0,"case rate","100%CMS IPPS rate",126597.68,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,126597.68,
"URETHRAL PROCEDURES WITH CC/MCC",671,"CDM ",100,RC,,,INPATIENT,,,,,,8555.44,100,,,,,0,"case rate","100%CMS IPPS rate",12366.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19429.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8555.44,100,,,,,0,"case rate","100%CMS IPPS rate",8555.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8555.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8555.44,100,,,,,0,"case rate","100%CMS IPPS rate",232520.94,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,232520.94,
"URETHRAL PROCEDURES WITHOUT CC/MCC",672,"CDM ",100,RC,,,INPATIENT,,,,,,5542.2,100,,,,,0,"case rate","100%CMS IPPS rate",9072.77,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11684.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5542.2,100,,,,,0,"case rate","100%CMS IPPS rate",5542.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5542.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5542.2,100,,,,,0,"case rate","100%CMS IPPS rate",139836.48,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,139836.48,
"OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC",673,"CDM ",100,RC,,,INPATIENT,,,,,,18399.35,100,,,,,0,"case rate","100%CMS IPPS rate",29973.64,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",45478.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",18399.35,100,,,,,0,"case rate","100%CMS IPPS rate",18399.35,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",18399.35,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18399.35,100,,,,,0,"case rate","100%CMS IPPS rate",544267.41,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,544267.41,
"OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC",674,"CDM ",100,RC,,,INPATIENT,,,,,,10560.12,100,,,,,0,"case rate","100%CMS IPPS rate",20596.02,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",25313.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10560.12,100,,,,,0,"case rate","100%CMS IPPS rate",10560.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10560.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10560.12,100,,,,,0,"case rate","100%CMS IPPS rate",302937.95,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,302937.95,
"OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC",675,"CDM ",100,RC,,,INPATIENT,,,,,,8436.37,100,,,,,0,"case rate","100%CMS IPPS rate",15164.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17766.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8436.37,100,,,,,0,"case rate","100%CMS IPPS rate",8436.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8436.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8436.37,100,,,,,0,"case rate","100%CMS IPPS rate",212623.94,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,212623.94,
"RENAL FAILURE WITH MCC",682,"CDM ",100,RC,,,INPATIENT,,,,,,7539.33,100,,,,,0,"case rate","100%CMS IPPS rate",14041.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16030.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7539.33,100,,,,,0,"case rate","100%CMS IPPS rate",7539.33,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7539.33,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7539.33,100,,,,,0,"case rate","100%CMS IPPS rate",191846.01,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,191846.01,
"RENAL FAILURE WITH CC",683,"CDM ",100,RC,,,INPATIENT,,,,,,5003.71,100,,,,,0,"case rate","100%CMS IPPS rate",9762.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9479.66,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5003.71,100,,,,,0,"case rate","100%CMS IPPS rate",5003.71,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5003.71,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5003.71,100,,,,,0,"case rate","100%CMS IPPS rate",113449.51,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,113449.51,
"RENAL FAILURE WITHOUT CC/MCC",684,"CDM ",100,RC,,,INPATIENT,,,,,,3346.47,100,,,,,0,"case rate","100%CMS IPPS rate",7015.17,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6497.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3346.47,100,,,,,0,"case rate","100%CMS IPPS rate",3346.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3346.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3346.47,100,,,,,0,"case rate","100%CMS IPPS rate",81487.18,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,81487.18,
"KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC",686,"CDM ",100,RC,,,INPATIENT,,,,,,10455.71,100,,,,,0,"case rate","100%CMS IPPS rate",16206.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19523.25,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10455.71,100,,,,,0,"case rate","100%CMS IPPS rate",10455.71,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10455.71,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10455.71,100,,,,,0,"case rate","100%CMS IPPS rate",233647.98,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,233647.98,
"KIDNEY AND URINARY TRACT NEOPLASMS WITH CC",687,"CDM ",100,RC,,,INPATIENT,,,,,,5848.77,100,,,,,0,"case rate","100%CMS IPPS rate",9649.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11341.39,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5848.77,100,,,,,0,"case rate","100%CMS IPPS rate",5848.77,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5848.77,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5848.77,100,,,,,0,"case rate","100%CMS IPPS rate",135730.1,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,135730.1,
"KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC",688,"CDM ",100,RC,,,INPATIENT,,,,,,3825.42,100,,,,,0,"case rate","100%CMS IPPS rate",6881.64,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8554.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3825.42,100,,,,,0,"case rate","100%CMS IPPS rate",3825.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3825.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3825.42,100,,,,,0,"case rate","100%CMS IPPS rate",102374.02,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,102374.02,
"KIDNEY AND URINARY TRACT INFECTIONS WITH MCC",689,"CDM ",100,RC,,,INPATIENT,,,,,,6920.42,100,,,,,0,"case rate","100%CMS IPPS rate",9629.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12559.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6920.42,100,,,,,0,"case rate","100%CMS IPPS rate",6920.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6920.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6920.42,100,,,,,0,"case rate","100%CMS IPPS rate",150303.05,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,150303.05,
"KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC",690,"CDM ",100,RC,,,INPATIENT,,,,,,3836.53,100,,,,,0,"case rate","100%CMS IPPS rate",7499.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8762.03,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3836.53,100,,,,,0,"case rate","100%CMS IPPS rate",3836.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3836.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3836.53,100,,,,,0,"case rate","100%CMS IPPS rate",104861.11,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,104861.11,
"URINARY STONES WITH MCC",693,"CDM ",100,RC,,,INPATIENT,,,,,,7082.14,100,,,,,0,"case rate","100%CMS IPPS rate",11541.61,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14552.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7082.14,100,,,,,0,"case rate","100%CMS IPPS rate",7082.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7082.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7082.14,100,,,,,0,"case rate","100%CMS IPPS rate",174164.08,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,174164.08,
"URINARY STONES WITHOUT MCC",694,"CDM ",100,RC,,,INPATIENT,,,,,,4070.68,100,,,,,0,"case rate","100%CMS IPPS rate",7650.48,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8461.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4070.68,100,,,,,0,"case rate","100%CMS IPPS rate",4070.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4070.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4070.68,100,,,,,0,"case rate","100%CMS IPPS rate",101260,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,101260,
"KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC",695,"CDM ",100,RC,,,INPATIENT,,,,,,6342.83,100,,,,,0,"case rate","100%CMS IPPS rate",9430.15,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12380.49,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6342.83,100,,,,,0,"case rate","100%CMS IPPS rate",6342.83,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6342.83,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6342.83,100,,,,,0,"case rate","100%CMS IPPS rate",148165.74,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,148165.74,
"KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC",696,"CDM ",100,RC,,,INPATIENT,,,,,,3849.86,100,,,,,0,"case rate","100%CMS IPPS rate",5979.52,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7457.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3849.86,100,,,,,0,"case rate","100%CMS IPPS rate",3849.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3849.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3849.86,100,,,,,0,"case rate","100%CMS IPPS rate",89883.91,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,89883.91,
"URETHRAL STRICTURE",697,"CDM ",100,RC,,,INPATIENT,,,,,,5565.3,100,,,,,0,"case rate","100%CMS IPPS rate",7944.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11666.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5565.3,100,,,,,0,"case rate","100%CMS IPPS rate",5565.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5565.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5565.3,100,,,,,0,"case rate","100%CMS IPPS rate",139616.22,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,139616.22,
"OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC",698,"CDM ",100,RC,,,INPATIENT,,,,,,10474.37,100,,,,,0,"case rate","100%CMS IPPS rate",13919.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17907.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10474.37,100,,,,,0,"case rate","100%CMS IPPS rate",10474.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10474.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10474.37,100,,,,,0,"case rate","100%CMS IPPS rate",214307.86,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,214307.86,
"OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC",699,"CDM ",100,RC,,,INPATIENT,,,,,,6424.13,100,,,,,0,"case rate","100%CMS IPPS rate",8875.49,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10986.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6424.13,100,,,,,0,"case rate","100%CMS IPPS rate",6424.13,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6424.13,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6424.13,100,,,,,0,"case rate","100%CMS IPPS rate",131481.2,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,131481.2,
"OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC",700,"CDM ",100,RC,,,INPATIENT,,,,,,4157.32,100,,,,,0,"case rate","100%CMS IPPS rate",6782.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7467.48,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4157.32,100,,,,,0,"case rate","100%CMS IPPS rate",4157.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4157.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4157.32,100,,,,,0,"case rate","100%CMS IPPS rate",89969.16,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,89969.16,
"MAJOR MALE PELVIC PROCEDURES WITH CC/MCC",707,"CDM ",100,RC,,,INPATIENT,,,,,,5824.33,100,,,,,0,"case rate","100%CMS IPPS rate",19602.96,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",21651.25,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5824.33,100,,,,,0,"case rate","100%CMS IPPS rate",5824.33,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5824.33,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5824.33,100,,,,,0,"case rate","100%CMS IPPS rate",259115.17,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,259115.17,
"MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC",708,"CDM ",100,RC,,,INPATIENT,,,,,,4522.97,100,,,,,0,"case rate","100%CMS IPPS rate",14590.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16606.18,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4522.97,100,,,,,0,"case rate","100%CMS IPPS rate",4522.97,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4522.97,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4522.97,100,,,,,0,"case rate","100%CMS IPPS rate",198737.36,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,198737.36,
"PENIS PROCEDURES WITH CC/MCC",709,"CDM ",100,RC,,,INPATIENT,,,,,,7011.05,100,,,,,0,"case rate","100%CMS IPPS rate",20014.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",25188.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7011.05,100,,,,,0,"case rate","100%CMS IPPS rate",7011.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7011.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7011.05,100,,,,,0,"case rate","100%CMS IPPS rate",301448.14,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,301448.14,
"PENIS PROCEDURES WITHOUT CC/MCC",710,"CDM ",100,RC,,,INPATIENT,,,,,,4851.76,100,,,,,0,"case rate","100%CMS IPPS rate",13438.15,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15166.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4851.76,100,,,,,0,"case rate","100%CMS IPPS rate",4851.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4851.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4851.76,100,,,,,0,"case rate","100%CMS IPPS rate",181508.8,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,181508.8,
"TESTES PROCEDURES WITH CC/MCC",711,"CDM ",100,RC,,,INPATIENT,,,,,,6460.57,100,,,,,0,"case rate","100%CMS IPPS rate",18421.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22555.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6460.57,100,,,,,0,"case rate","100%CMS IPPS rate",6460.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6460.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6460.57,100,,,,,0,"case rate","100%CMS IPPS rate",269931.65,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,269931.65,
"TESTES PROCEDURES WITHOUT CC/MCC",712,"CDM ",100,RC,,,INPATIENT,,,,,,3206.96,100,,,,,0,"case rate","100%CMS IPPS rate",9249.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11903.15,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3206.96,100,,,,,0,"case rate","100%CMS IPPS rate",3206.96,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3206.96,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3206.96,100,,,,,0,"case rate","100%CMS IPPS rate",142453.06,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3206.96,142453.06,
"TRANSURETHRAL PROSTATECTOMY WITH CC/MCC",713,"CDM ",100,RC,,,INPATIENT,,,,,,4523.42,100,,,,,0,"case rate","100%CMS IPPS rate",12906.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16272.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4523.42,100,,,,,0,"case rate","100%CMS IPPS rate",4523.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4523.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4523.42,100,,,,,0,"case rate","100%CMS IPPS rate",194747.6,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,194747.6,
"TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC",714,"CDM ",100,RC,,,INPATIENT,,,,,,2815.97,100,,,,,0,"case rate","100%CMS IPPS rate",8115.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11445.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2815.97,100,,,,,0,"case rate","100%CMS IPPS rate",2815.97,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2815.97,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2815.97,100,,,,,0,"case rate","100%CMS IPPS rate",136973.63,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2815.97,136973.63,
"OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC",715,"CDM ",100,RC,,,INPATIENT,,,,,,6122.45,100,,,,,0,"case rate","100%CMS IPPS rate",17471.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",24216.54,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6122.45,100,,,,,0,"case rate","100%CMS IPPS rate",6122.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6122.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6122.45,100,,,,,0,"case rate","100%CMS IPPS rate",289815.65,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,289815.65,
"OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC",716,"CDM ",100,RC,,,INPATIENT,,,,,,3871.19,100,,,,,0,"case rate","100%CMS IPPS rate",11025.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15922.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3871.19,100,,,,,0,"case rate","100%CMS IPPS rate",3871.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3871.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3871.19,100,,,,,0,"case rate","100%CMS IPPS rate",190550.59,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,190550.59,
"OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC",717,"CDM ",100,RC,,,INPATIENT,,,,,,5454.23,100,,,,,0,"case rate","100%CMS IPPS rate",15561.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",20462.77,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5454.23,100,,,,,0,"case rate","100%CMS IPPS rate",5454.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5454.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5454.23,100,,,,,0,"case rate","100%CMS IPPS rate",244891.83,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,244891.83,
"OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC",718,"CDM ",100,RC,,,INPATIENT,,,,,,3749,100,,,,,0,"case rate","100%CMS IPPS rate",10669.61,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14537.71,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3749,100,,,,,0,"case rate","100%CMS IPPS rate",3749,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3749,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3749,100,,,,,0,"case rate","100%CMS IPPS rate",173982.7,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,173982.7,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC",722,"CDM ",100,RC,,,INPATIENT,,,,,,8462.14,100,,,,,0,"case rate","100%CMS IPPS rate",14800.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19588.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8462.14,100,,,,,0,"case rate","100%CMS IPPS rate",8462.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8462.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8462.14,100,,,,,0,"case rate","100%CMS IPPS rate",234425.12,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,234425.12,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC",723,"CDM ",100,RC,,,INPATIENT,,,,,,5392.91,100,,,,,0,"case rate","100%CMS IPPS rate",10149.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12368.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5392.91,100,,,,,0,"case rate","100%CMS IPPS rate",5392.91,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5392.91,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5392.91,100,,,,,0,"case rate","100%CMS IPPS rate",148023.24,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,148023.24,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",724,"CDM ",100,RC,,,INPATIENT,,,,,,3215.4,100,,,,,0,"case rate","100%CMS IPPS rate",6996.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6621.04,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3215.4,100,,,,,0,"case rate","100%CMS IPPS rate",3215.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3215.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3215.4,100,,,,,0,"case rate","100%CMS IPPS rate",86731.7,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,86731.7,
"BENIGN PROSTATIC HYPERTROPHY WITH MCC",725,"CDM ",100,RC,,,INPATIENT,,,,,,6347.27,100,,,,,0,"case rate","100%CMS IPPS rate",11109.5,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12666.24,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6347.27,100,,,,,0,"case rate","100%CMS IPPS rate",6347.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6347.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6347.27,100,,,,,0,"case rate","100%CMS IPPS rate",151585.46,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,151585.46,
"BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC",726,"CDM ",100,RC,,,INPATIENT,,,,,,3680.58,100,,,,,0,"case rate","100%CMS IPPS rate",6435.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7814.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3680.58,100,,,,,0,"case rate","100%CMS IPPS rate",3680.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3680.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3680.58,100,,,,,0,"case rate","100%CMS IPPS rate",93526.49,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,93526.49,
"INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC",727,"CDM ",100,RC,,,INPATIENT,,,,,,7021.72,100,,,,,0,"case rate","100%CMS IPPS rate",12399.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16050.91,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7021.72,100,,,,,0,"case rate","100%CMS IPPS rate",7021.72,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7021.72,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7021.72,100,,,,,0,"case rate","100%CMS IPPS rate",192092.15,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,192092.15,
"INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC",728,"CDM ",100,RC,,,INPATIENT,,,,,,3978.71,100,,,,,0,"case rate","100%CMS IPPS rate",6962.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8780.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3978.71,100,,,,,0,"case rate","100%CMS IPPS rate",3978.71,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3978.71,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3978.71,100,,,,,0,"case rate","100%CMS IPPS rate",105081.36,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,105081.36,
"OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC",729,"CDM ",100,RC,,,INPATIENT,,,,,,4975.27,100,,,,,0,"case rate","100%CMS IPPS rate",8706.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11459.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4975.27,100,,,,,0,"case rate","100%CMS IPPS rate",4975.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4975.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4975.27,100,,,,,0,"case rate","100%CMS IPPS rate",137142.01,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,137142.01,
"OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC",730,"CDM ",100,RC,,,INPATIENT,,,,,,2801.31,100,,,,,0,"case rate","100%CMS IPPS rate",4916.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7273.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2801.31,100,,,,,0,"case rate","100%CMS IPPS rate",2801.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2801.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2801.31,100,,,,,0,"case rate","100%CMS IPPS rate",88274.7,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,88274.7,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC",734,"CDM ",100,RC,,,INPATIENT,,,,,,8609.2,100,,,,,0,"case rate","100%CMS IPPS rate",19222.78,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",23055.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8609.2,100,,,,,0,"case rate","100%CMS IPPS rate",8609.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8609.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8609.2,100,,,,,0,"case rate","100%CMS IPPS rate",275916.2,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,275916.2,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC",735,"CDM ",100,RC,,,INPATIENT,,,,,,5474.66,100,,,,,0,"case rate","100%CMS IPPS rate",12216.56,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14563.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5474.66,100,,,,,0,"case rate","100%CMS IPPS rate",5474.66,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5474.66,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5474.66,100,,,,,0,"case rate","100%CMS IPPS rate",174293.58,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,174293.58,
"UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC",736,"CDM ",100,RC,,,INPATIENT,,,,,,5758.57,100,,,,,0,"case rate","100%CMS IPPS rate",36821.7,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",38690.39,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5758.57,100,,,,,0,"case rate","100%CMS IPPS rate",5758.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5758.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5758.57,100,,,,,0,"case rate","100%CMS IPPS rate",463034.06,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,463034.06,
"UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC",737,"CDM ",100,RC,,,INPATIENT,,,,,,5483.99,100,,,,,0,"case rate","100%CMS IPPS rate",17786.46,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22303.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5483.99,100,,,,,0,"case rate","100%CMS IPPS rate",5483.99,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5483.99,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5483.99,100,,,,,0,"case rate","100%CMS IPPS rate",266926.3,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,266926.3,
"UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC",738,"CDM ",100,RC,,,INPATIENT,,,,,,5223.19,100,,,,,0,"case rate","100%CMS IPPS rate",12754.97,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15895.04,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5223.19,100,,,,,0,"case rate","100%CMS IPPS rate",5223.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5223.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5223.19,100,,,,,0,"case rate","100%CMS IPPS rate",190226.71,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,190226.71,
"UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC",739,"CDM ",100,RC,,,INPATIENT,,,,,,14801.85,100,,,,,0,"case rate","100%CMS IPPS rate",33047.66,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",38168.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",14801.85,100,,,,,0,"case rate","100%CMS IPPS rate",14801.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",14801.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14801.85,100,,,,,0,"case rate","100%CMS IPPS rate",464109.23,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,464109.23,
"UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC",740,"CDM ",100,RC,,,INPATIENT,,,,,,6971.51,100,,,,,0,"case rate","100%CMS IPPS rate",15569.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19587.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6971.51,100,,,,,0,"case rate","100%CMS IPPS rate",6971.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6971.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6971.51,100,,,,,0,"case rate","100%CMS IPPS rate",234412.26,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,234412.26,
"UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC",741,"CDM ",100,RC,,,INPATIENT,,,,,,4955.72,100,,,,,0,"case rate","100%CMS IPPS rate",11061.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15436.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4955.72,100,,,,,0,"case rate","100%CMS IPPS rate",4955.72,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4955.72,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4955.72,100,,,,,0,"case rate","100%CMS IPPS rate",184734.28,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,184734.28,
"UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC",742,"CDM ",100,RC,,,INPATIENT,,,,,,6323.72,100,,,,,0,"case rate","100%CMS IPPS rate",14848.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19859.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6323.72,100,,,,,0,"case rate","100%CMS IPPS rate",6323.72,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6323.72,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6323.72,100,,,,,0,"case rate","100%CMS IPPS rate",237676.61,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,237676.61,
"UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC",743,"CDM ",100,RC,,,INPATIENT,,,,,,4873.08,100,,,,,0,"case rate","100%CMS IPPS rate",10217.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13429.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4873.08,100,,,,,0,"case rate","100%CMS IPPS rate",4873.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4873.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4873.08,100,,,,,0,"case rate","100%CMS IPPS rate",160718.02,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,160718.02,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC",744,"CDM ",100,RC,,,INPATIENT,,,,,,6948.41,100,,,,,0,"case rate","100%CMS IPPS rate",15516.15,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22179.46,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6948.41,100,,,,,0,"case rate","100%CMS IPPS rate",6948.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6948.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6948.41,100,,,,,0,"case rate","100%CMS IPPS rate",265436.62,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,265436.62,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC",745,"CDM ",100,RC,,,INPATIENT,,,,,,4533.64,100,,,,,0,"case rate","100%CMS IPPS rate",10111.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12312.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4533.64,100,,,,,0,"case rate","100%CMS IPPS rate",4533.64,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4533.64,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4533.64,100,,,,,0,"case rate","100%CMS IPPS rate",147349.58,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,147349.58,
"VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC",746,"CDM ",100,RC,,,INPATIENT,,,,,,6233.53,100,,,,,0,"case rate","100%CMS IPPS rate",13926.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18802.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6233.53,100,,,,,0,"case rate","100%CMS IPPS rate",6233.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6233.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6233.53,100,,,,,0,"case rate","100%CMS IPPS rate",225020.7,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,225020.7,
"VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC",747,"CDM ",100,RC,,,INPATIENT,,,,,,3633.04,100,,,,,0,"case rate","100%CMS IPPS rate",8767.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9086.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3633.04,100,,,,,0,"case rate","100%CMS IPPS rate",3633.04,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3633.04,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3633.04,100,,,,,0,"case rate","100%CMS IPPS rate",111363.94,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,111363.94,
"FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES",748,"CDM ",100,RC,,,INPATIENT,,,,,,5222.3,100,,,,,0,"case rate","100%CMS IPPS rate",11646.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15016.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5222.3,100,,,,,0,"case rate","100%CMS IPPS rate",5222.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5222.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5222.3,100,,,,,0,"case rate","100%CMS IPPS rate",179708.25,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,179708.25,
"OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC",749,"CDM ",100,RC,,,INPATIENT,,,,,,10486.37,100,,,,,0,"case rate","100%CMS IPPS rate",23453.13,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",27791.7,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10486.37,100,,,,,0,"case rate","100%CMS IPPS rate",10486.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10486.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10486.37,100,,,,,0,"case rate","100%CMS IPPS rate",332602.15,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,332602.15,
"OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC",750,"CDM ",100,RC,,,INPATIENT,,,,,,5677.71,100,,,,,0,"case rate","100%CMS IPPS rate",12650.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15974.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5677.71,100,,,,,0,"case rate","100%CMS IPPS rate",5677.71,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5677.71,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5677.71,100,,,,,0,"case rate","100%CMS IPPS rate",191172.36,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,191172.36,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC",754,"CDM ",100,RC,,,INPATIENT,,,,,,6760.47,100,,,,,0,"case rate","100%CMS IPPS rate",15782.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19934.56,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6760.47,100,,,,,0,"case rate","100%CMS IPPS rate",6760.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6760.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6760.47,100,,,,,0,"case rate","100%CMS IPPS rate",238570.38,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,238570.38,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC",755,"CDM ",100,RC,,,INPATIENT,,,,,,4186.19,100,,,,,0,"case rate","100%CMS IPPS rate",9636.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11774.35,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4186.19,100,,,,,0,"case rate","100%CMS IPPS rate",4186.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4186.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4186.19,100,,,,,0,"case rate","100%CMS IPPS rate",140911.65,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,140911.65,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",756,"CDM ",100,RC,,,INPATIENT,,,,,,3401.12,100,,,,,0,"case rate","100%CMS IPPS rate",7306.13,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10396.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3401.12,100,,,,,0,"case rate","100%CMS IPPS rate",3401.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3401.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3401.12,100,,,,,0,"case rate","100%CMS IPPS rate",124421.36,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,124421.36,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC",757,"CDM ",100,RC,,,INPATIENT,,,,,,5651.05,100,,,,,0,"case rate","100%CMS IPPS rate",11662.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15498.89,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5651.05,100,,,,,0,"case rate","100%CMS IPPS rate",5651.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5651.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5651.05,100,,,,,0,"case rate","100%CMS IPPS rate",185485.69,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,185485.69,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC",758,"CDM ",100,RC,,,INPATIENT,,,,,,3382.01,100,,,,,0,"case rate","100%CMS IPPS rate",7966.77,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10596.7,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3382.01,100,,,,,0,"case rate","100%CMS IPPS rate",3382.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3382.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3382.01,100,,,,,0,"case rate","100%CMS IPPS rate",126817.8,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,126817.8,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",759,"CDM ",100,RC,,,INPATIENT,,,,,,2770.65,100,,,,,0,"case rate","100%CMS IPPS rate",5512.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7182.81,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2770.65,100,,,,,0,"case rate","100%CMS IPPS rate",2770.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2770.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2770.65,100,,,,,0,"case rate","100%CMS IPPS rate",87479.47,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,87479.47,
"MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC",760,"CDM ",100,RC,,,INPATIENT,,,,,,3425.11,100,,,,,0,"case rate","100%CMS IPPS rate",6485.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10905.18,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3425.11,100,,,,,0,"case rate","100%CMS IPPS rate",3425.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3425.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3425.11,100,,,,,0,"case rate","100%CMS IPPS rate",130509.67,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,130509.67,
"MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC",761,"CDM ",100,RC,,,INPATIENT,,,,,,2190.4,100,,,,,0,"case rate","100%CMS IPPS rate",3851.46,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6165.35,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2190.4,100,,,,,0,"case rate","100%CMS IPPS rate",2190.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2190.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2190.4,100,,,,,0,"case rate","100%CMS IPPS rate",78666.15,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2190.4,78666.15,
"VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C",768,"CDM ",100,RC,,,INPATIENT,,,,,,4184.86,100,,,,,0,"case rate","100%CMS IPPS rate",9434.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11599,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4184.86,100,,,,,0,"case rate","100%CMS IPPS rate",4184.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4184.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4184.86,100,,,,,0,"case rate","100%CMS IPPS rate",138813.07,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4184.86,138813.07,
"POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES",769,"CDM ",100,RC,,,INPATIENT,,,,,,5444.01,100,,,,,0,"case rate","100%CMS IPPS rate",12826.13,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18290.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5444.01,100,,,,,0,"case rate","100%CMS IPPS rate",5444.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5444.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5444.01,100,,,,,0,"case rate","100%CMS IPPS rate",218893.5,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,218893.5,
"ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",770,"CDM ",100,RC,,,INPATIENT,,,,,,2706.68,100,,,,,0,"case rate","100%CMS IPPS rate",6140.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10853.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2706.68,100,,,,,0,"case rate","100%CMS IPPS rate",2706.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2706.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2706.68,100,,,,,0,"case rate","100%CMS IPPS rate",129887.91,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2706.68,129887.91,
"POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES",776,"CDM ",100,RC,,,INPATIENT,,,,,,3115.43,100,,,,,0,"case rate","100%CMS IPPS rate",5868.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7086.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3115.43,100,,,,,0,"case rate","100%CMS IPPS rate",3115.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3115.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3115.43,100,,,,,0,"case rate","100%CMS IPPS rate",86636.92,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,86636.92,
"ABORTION WITHOUT D&C",779,"CDM ",100,RC,,,INPATIENT,,,,,,4922.4,100,,,,,0,"case rate","100%CMS IPPS rate",4933.24,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7718.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4922.4,100,,,,,0,"case rate","100%CMS IPPS rate",4922.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4922.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4922.4,100,,,,,0,"case rate","100%CMS IPPS rate",108980.5,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,108980.5,
"CESAREAN SECTION WITH STERILIZATION WITH MCC",783,"CDM ",100,RC,,,INPATIENT,,,,,,7229.65,100,,,,,0,"case rate","100%CMS IPPS rate",16935.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",26574,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7229.65,100,,,,,0,"case rate","100%CMS IPPS rate",7229.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7229.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7229.65,100,,,,,0,"case rate","100%CMS IPPS rate",318029.05,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7229.65,318029.05,
"CESAREAN SECTION WITH STERILIZATION WITH CC",784,"CDM ",100,RC,,,INPATIENT,,,,,,5597.29,100,,,,,0,"case rate","100%CMS IPPS rate",9993.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11474.52,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5597.29,100,,,,,0,"case rate","100%CMS IPPS rate",5597.29,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5597.29,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5597.29,100,,,,,0,"case rate","100%CMS IPPS rate",137323.4,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5597.29,137323.4,
"CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC",785,"CDM ",100,RC,,,INPATIENT,,,,,,4458.99,100,,,,,0,"case rate","100%CMS IPPS rate",7703.66,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10367.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4458.99,100,,,,,0,"case rate","100%CMS IPPS rate",4458.99,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4458.99,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4458.99,100,,,,,0,"case rate","100%CMS IPPS rate",124071.6,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4458.99,124071.6,
"CESAREAN SECTION WITHOUT STERILIZATION WITH MCC",786,"CDM ",100,RC,,,INPATIENT,,,,,,7601.97,100,,,,,0,"case rate","100%CMS IPPS rate",15012.29,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17854.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7601.97,100,,,,,0,"case rate","100%CMS IPPS rate",7601.97,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7601.97,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7601.97,100,,,,,0,"case rate","100%CMS IPPS rate",213673.22,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7601.97,213673.22,
"CESAREAN SECTION WITHOUT STERILIZATION WITH CC",787,"CDM ",100,RC,,,INPATIENT,,,,,,5054.8,100,,,,,0,"case rate","100%CMS IPPS rate",9755.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12088.24,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5054.8,100,,,,,0,"case rate","100%CMS IPPS rate",5054.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5054.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5054.8,100,,,,,0,"case rate","100%CMS IPPS rate",144668.27,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5054.8,144668.27,
"CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC",788,"CDM ",100,RC,,,INPATIENT,,,,,,4386.57,100,,,,,0,"case rate","100%CMS IPPS rate",8167.17,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10378.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4386.57,100,,,,,0,"case rate","100%CMS IPPS rate",4386.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4386.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4386.57,100,,,,,0,"case rate","100%CMS IPPS rate",124201.23,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4386.57,124201.23,
"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",789,"CDM ",100,RC,,,INPATIENT,,,,,,1297.8,100,,,,,0,"case rate","100%CMS IPPS rate",15602.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19507.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",1297.8,100,,,,,0,"case rate","100%CMS IPPS rate",1297.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",1297.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",1297.8,100,,,,,0,"case rate","100%CMS IPPS rate",233453.59,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",1297.8,233453.59,
"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",790,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",49019.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",64332.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",769909.88,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,769909.88,
"PREMATURITY WITH MAJOR PROBLEMS",791,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",33478.03,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",43934.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",525795.33,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,525795.33,
"PREMATURITY WITHOUT MAJOR PROBLEMS",792,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",20200.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",26510.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",317264.77,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,317264.77,
"FULL TERM NEONATE WITH MAJOR PROBLEMS",793,"CDM ",100,RC,,,INPATIENT,,,,,,6697.82,100,,,,,0,"case rate","100%CMS IPPS rate",36097.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",45131.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6697.82,100,,,,,0,"case rate","100%CMS IPPS rate",6697.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6697.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6697.82,100,,,,,0,"case rate","100%CMS IPPS rate",540122.29,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,540122.29,
"NEONATE WITH OTHER SIGNIFICANT PROBLEMS",794,"CDM ",100,RC,,,INPATIENT,,,,,,1786.97,100,,,,,0,"case rate","100%CMS IPPS rate",12687.66,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15975.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",1786.97,100,,,,,0,"case rate","100%CMS IPPS rate",1786.97,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",1786.97,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",1786.97,100,,,,,0,"case rate","100%CMS IPPS rate",191185.37,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",1786.97,191185.37,
"NORMAL NEWBORN",795,"CDM ",100,RC,,,INPATIENT,,,,,,894.38,100,,,,,0,"case rate","100%CMS IPPS rate",1648.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2162.64,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",894.38,100,,,,,0,"case rate","100%CMS IPPS rate",894.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",894.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",894.38,100,,,,,0,"case rate","100%CMS IPPS rate",43573.84,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",894.38,43573.84,
"VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC",796,"CDM ",100,RC,,,INPATIENT,,,,,,5132.11,100,,,,,0,"case rate","100%CMS IPPS rate",13763.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12631.61,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5132.11,100,,,,,0,"case rate","100%CMS IPPS rate",5132.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5132.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5132.11,100,,,,,0,"case rate","100%CMS IPPS rate",151170.96,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5132.11,151170.96,
"VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC",797,"CDM ",100,RC,,,INPATIENT,,,,,,4887.74,100,,,,,0,"case rate","100%CMS IPPS rate",7945.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10828.33,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4887.74,100,,,,,0,"case rate","100%CMS IPPS rate",4887.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4887.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4887.74,100,,,,,0,"case rate","100%CMS IPPS rate",129589.89,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4887.74,129589.89,
"VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC",798,"CDM ",100,RC,,,INPATIENT,,,,,,4654.93,100,,,,,0,"case rate","100%CMS IPPS rate",7642.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10359.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4654.93,100,,,,,0,"case rate","100%CMS IPPS rate",4654.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4654.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4654.93,100,,,,,0,"case rate","100%CMS IPPS rate",123980.97,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4654.93,123980.97,
"SPLENIC PROCEDURES WITH MCC",799,"CDM ",100,RC,,,INPATIENT,,,,,,25367.31,100,,,,,0,"case rate","100%CMS IPPS rate",44484.71,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",49020.81,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",25367.31,100,,,,,0,"case rate","100%CMS IPPS rate",25367.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",25367.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",25367.31,100,,,,,0,"case rate","100%CMS IPPS rate",586665.28,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,586665.28,
"SPLENIC PROCEDURES WITH CC",800,"CDM ",100,RC,,,INPATIENT,,,,,,14554.82,100,,,,,0,"case rate","100%CMS IPPS rate",23887,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",30408.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",14554.82,100,,,,,0,"case rate","100%CMS IPPS rate",14554.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",14554.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14554.82,100,,,,,0,"case rate","100%CMS IPPS rate",363924.39,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,363924.39,
"SPLENIC PROCEDURES WITHOUT CC/MCC",801,"CDM ",100,RC,,,INPATIENT,,,,,,8302.19,100,,,,,0,"case rate","100%CMS IPPS rate",16869.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",20661.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8302.19,100,,,,,0,"case rate","100%CMS IPPS rate",8302.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8302.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8302.19,100,,,,,0,"case rate","100%CMS IPPS rate",247275.42,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,247275.42,
"OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC",802,"CDM ",100,RC,,,INPATIENT,,,,,,18289.61,100,,,,,0,"case rate","100%CMS IPPS rate",31716.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",43123.9,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",18289.61,100,,,,,0,"case rate","100%CMS IPPS rate",18289.61,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",18289.61,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18289.61,100,,,,,0,"case rate","100%CMS IPPS rate",516092.89,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,516092.89,
"OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC",803,"CDM ",100,RC,,,INPATIENT,,,,,,9295.2,100,,,,,0,"case rate","100%CMS IPPS rate",17005.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",20120.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9295.2,100,,,,,0,"case rate","100%CMS IPPS rate",9295.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9295.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9295.2,100,,,,,0,"case rate","100%CMS IPPS rate",240798.46,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,240798.46,
"OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC",804,"CDM ",100,RC,,,INPATIENT,,,,,,6727.59,100,,,,,0,"case rate","100%CMS IPPS rate",12509.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14677.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6727.59,100,,,,,0,"case rate","100%CMS IPPS rate",6727.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6727.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6727.59,100,,,,,0,"case rate","100%CMS IPPS rate",175653.75,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,175653.75,
"VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC",805,"CDM ",100,RC,,,INPATIENT,,,,,,4419.01,100,,,,,0,"case rate","100%CMS IPPS rate",10987.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11681.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4419.01,100,,,,,0,"case rate","100%CMS IPPS rate",4419.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4419.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4419.01,100,,,,,0,"case rate","100%CMS IPPS rate",139797.6,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4419.01,139797.6,
"VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC",806,"CDM ",100,RC,,,INPATIENT,,,,,,3589.06,100,,,,,0,"case rate","100%CMS IPPS rate",7786.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8161.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3589.06,100,,,,,0,"case rate","100%CMS IPPS rate",3589.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3589.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3589.06,100,,,,,0,"case rate","100%CMS IPPS rate",97671.76,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3589.06,97671.76,
"VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC",807,"CDM ",100,RC,,,INPATIENT,,,,,,3068.34,100,,,,,0,"case rate","100%CMS IPPS rate",5594.39,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7297.54,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3068.34,100,,,,,0,"case rate","100%CMS IPPS rate",3068.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3068.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3068.34,100,,,,,0,"case rate","100%CMS IPPS rate",88482.98,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3068.34,88482.98,
"MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC",808,"CDM ",100,RC,,,INPATIENT,,,,,,9109.04,100,,,,,0,"case rate","100%CMS IPPS rate",18890.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",23898.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9109.04,100,,,,,0,"case rate","100%CMS IPPS rate",9109.04,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9109.04,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9109.04,100,,,,,0,"case rate","100%CMS IPPS rate",286007.28,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,286007.28,
"MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC",809,"CDM ",100,RC,,,INPATIENT,,,,,,4968.61,100,,,,,0,"case rate","100%CMS IPPS rate",10572.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13702.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4968.61,100,,,,,0,"case rate","100%CMS IPPS rate",4968.61,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4968.61,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4968.61,100,,,,,0,"case rate","100%CMS IPPS rate",163982.38,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,163982.38,
"MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC",810,"CDM ",100,RC,,,INPATIENT,,,,,,4018.25,100,,,,,0,"case rate","100%CMS IPPS rate",8311.17,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11328.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4018.25,100,,,,,0,"case rate","100%CMS IPPS rate",4018.25,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4018.25,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4018.25,100,,,,,0,"case rate","100%CMS IPPS rate",135574.59,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,135574.59,
"RED BLOOD CELL DISORDERS WITH MCC",811,"CDM ",100,RC,,,INPATIENT,,,,,,6570.31,100,,,,,0,"case rate","100%CMS IPPS rate",11920.13,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15200.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6570.31,100,,,,,0,"case rate","100%CMS IPPS rate",6570.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6570.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6570.31,100,,,,,0,"case rate","100%CMS IPPS rate",181910.45,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,181910.45,
"RED BLOOD CELL DISORDERS WITHOUT MCC",812,"CDM ",100,RC,,,INPATIENT,,,,,,4010.25,100,,,,,0,"case rate","100%CMS IPPS rate",7607.7,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9938.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4010.25,100,,,,,0,"case rate","100%CMS IPPS rate",4010.25,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4010.25,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4010.25,100,,,,,0,"case rate","100%CMS IPPS rate",118941.93,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,118941.93,
"COAGULATION DISORDERS",813,"CDM ",100,RC,,,INPATIENT,,,,,,3161.19,100,,,,,0,"case rate","100%CMS IPPS rate",13353.02,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16509.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3161.19,100,,,,,0,"case rate","100%CMS IPPS rate",3161.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3161.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3161.19,100,,,,,0,"case rate","100%CMS IPPS rate",197584.58,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,197584.58,
"RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC",814,"CDM ",100,RC,,,INPATIENT,,,,,,7908.1,100,,,,,0,"case rate","100%CMS IPPS rate",16507.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",23019.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7908.1,100,,,,,0,"case rate","100%CMS IPPS rate",7908.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7908.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7908.1,100,,,,,0,"case rate","100%CMS IPPS rate",275488.82,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,275488.82,
"RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC",815,"CDM ",100,RC,,,INPATIENT,,,,,,4151.09,100,,,,,0,"case rate","100%CMS IPPS rate",9134.64,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10975.54,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4151.09,100,,,,,0,"case rate","100%CMS IPPS rate",4151.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4151.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4151.09,100,,,,,0,"case rate","100%CMS IPPS rate",131351.71,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,131351.71,
"RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC",816,"CDM ",100,RC,,,INPATIENT,,,,,,2764.43,100,,,,,0,"case rate","100%CMS IPPS rate",7475.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6840.77,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2764.43,100,,,,,0,"case rate","100%CMS IPPS rate",2764.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2764.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2764.43,100,,,,,0,"case rate","100%CMS IPPS rate",84488.08,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,84488.08,
"OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC",817,"CDM ",100,RC,,,INPATIENT,,,,,,6113.12,100,,,,,0,"case rate","100%CMS IPPS rate",22404.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18270.91,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6113.12,100,,,,,0,"case rate","100%CMS IPPS rate",6113.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6113.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6113.12,100,,,,,0,"case rate","100%CMS IPPS rate",295554.22,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,295554.22,
"OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC",818,"CDM ",100,RC,,,INPATIENT,,,,,,5822.11,100,,,,,0,"case rate","100%CMS IPPS rate",12139.78,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11410.66,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5822.11,100,,,,,0,"case rate","100%CMS IPPS rate",5822.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5822.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5822.11,100,,,,,0,"case rate","100%CMS IPPS rate",150160.56,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,150160.56,
"OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC",819,"CDM ",100,RC,,,INPATIENT,,,,,,5544.86,100,,,,,0,"case rate","100%CMS IPPS rate",8531.54,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9307.56,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5544.86,100,,,,,0,"case rate","100%CMS IPPS rate",5544.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5544.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5544.86,100,,,,,0,"case rate","100%CMS IPPS rate",111389.81,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,111389.81,
"LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC",820,"CDM ",100,RC,,,INPATIENT,,,,,,28047.33,100,,,,,0,"case rate","100%CMS IPPS rate",59971.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",63480.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",28047.33,100,,,,,0,"case rate","100%CMS IPPS rate",28047.33,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",28047.33,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",28047.33,100,,,,,0,"case rate","100%CMS IPPS rate",759715.32,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,759715.32,
"LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC",821,"CDM ",100,RC,,,INPATIENT,,,,,,10628.1,100,,,,,0,"case rate","100%CMS IPPS rate",21697.83,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",24230.61,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10628.1,100,,,,,0,"case rate","100%CMS IPPS rate",10628.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10628.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10628.1,100,,,,,0,"case rate","100%CMS IPPS rate",289984.03,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,289984.03,
"LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC",822,"CDM ",100,RC,,,INPATIENT,,,,,,6172.22,100,,,,,0,"case rate","100%CMS IPPS rate",11517.84,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13032.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6172.22,100,,,,,0,"case rate","100%CMS IPPS rate",6172.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6172.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6172.22,100,,,,,0,"case rate","100%CMS IPPS rate",155963.86,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,155963.86,
"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC",823,"CDM ",100,RC,,,INPATIENT,,,,,,22177.68,100,,,,,0,"case rate","100%CMS IPPS rate",41851.1,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",49625.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",22177.68,100,,,,,0,"case rate","100%CMS IPPS rate",22177.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",22177.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22177.68,100,,,,,0,"case rate","100%CMS IPPS rate",593906.52,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,593906.52,
"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC",824,"CDM ",100,RC,,,INPATIENT,,,,,,11651.77,100,,,,,0,"case rate","100%CMS IPPS rate",21418.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",24522.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",11651.77,100,,,,,0,"case rate","100%CMS IPPS rate",11651.77,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",11651.77,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11651.77,100,,,,,0,"case rate","100%CMS IPPS rate",293481.65,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,293481.65,
"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC",825,"CDM ",100,RC,,,INPATIENT,,,,,,6907.53,100,,,,,0,"case rate","100%CMS IPPS rate",12747.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14605.91,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6907.53,100,,,,,0,"case rate","100%CMS IPPS rate",6907.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6907.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6907.53,100,,,,,0,"case rate","100%CMS IPPS rate",174798.72,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,174798.72,
"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC",826,"CDM ",100,RC,,,INPATIENT,,,,,,24839.48,100,,,,,0,"case rate","100%CMS IPPS rate",45765.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",50632.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",24839.48,100,,,,,0,"case rate","100%CMS IPPS rate",24839.48,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",24839.48,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",24839.48,100,,,,,0,"case rate","100%CMS IPPS rate",605953.51,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,605953.51,
"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC",827,"CDM ",100,RC,,,INPATIENT,,,,,,12316.88,100,,,,,0,"case rate","100%CMS IPPS rate",15668.81,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",25016.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",12316.88,100,,,,,0,"case rate","100%CMS IPPS rate",12316.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",12316.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12316.88,100,,,,,0,"case rate","100%CMS IPPS rate",299388.58,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,299388.58,
"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC",828,"CDM ",100,RC,,,INPATIENT,,,,,,8273.75,100,,,,,0,"case rate","100%CMS IPPS rate",14969.89,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18441.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8273.75,100,,,,,0,"case rate","100%CMS IPPS rate",8273.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8273.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8273.75,100,,,,,0,"case rate","100%CMS IPPS rate",220707.05,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,220707.05,
"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC",829,"CDM ",100,RC,,,INPATIENT,,,,,,15809.08,100,,,,,0,"case rate","100%CMS IPPS rate",31386.66,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",34203.84,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",15809.08,100,,,,,0,"case rate","100%CMS IPPS rate",15809.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",15809.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15809.08,100,,,,,0,"case rate","100%CMS IPPS rate",409340.47,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,409340.47,
"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC",830,"CDM ",100,RC,,,INPATIENT,,,,,,7281.63,100,,,,,0,"case rate","100%CMS IPPS rate",14074.97,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16290.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7281.63,100,,,,,0,"case rate","100%CMS IPPS rate",7281.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7281.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7281.63,100,,,,,0,"case rate","100%CMS IPPS rate",194954.86,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,194954.86,
"OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC",831,"CDM ",100,RC,,,INPATIENT,,,,,,5125,100,,,,,0,"case rate","100%CMS IPPS rate",9974.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13015.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5125,100,,,,,0,"case rate","100%CMS IPPS rate",5125,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5125,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5125,100,,,,,0,"case rate","100%CMS IPPS rate",155769.61,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,155769.61,
"OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC",832,"CDM ",100,RC,,,INPATIENT,,,,,,3079.44,100,,,,,0,"case rate","100%CMS IPPS rate",6726.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7810.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3079.44,100,,,,,0,"case rate","100%CMS IPPS rate",3079.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3079.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3079.44,100,,,,,0,"case rate","100%CMS IPPS rate",93474.75,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,93474.75,
"OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC",833,"CDM ",100,RC,,,INPATIENT,,,,,,2592.93,100,,,,,0,"case rate","100%CMS IPPS rate",4682.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5659.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2592.93,100,,,,,0,"case rate","100%CMS IPPS rate",2592.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2592.93,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2592.93,100,,,,,0,"case rate","100%CMS IPPS rate",74160.17,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,74160.17,
"ACUTE LEUKEMIA WITH MCC",834,"CDM ",100,RC,,,INPATIENT,,,,,,42116.09,100,,,,,0,"case rate","100%CMS IPPS rate",53456.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",59422.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",42116.09,100,,,,,0,"case rate","100%CMS IPPS rate",42116.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",42116.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",42116.09,100,,,,,0,"case rate","100%CMS IPPS rate",711151.38,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,711151.38,
"ACUTE LEUKEMIA WITH CC",835,"CDM ",100,RC,,,INPATIENT,,,,,,11147.49,100,,,,,0,"case rate","100%CMS IPPS rate",21063.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22576.7,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",11147.49,100,,,,,0,"case rate","100%CMS IPPS rate",11147.49,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",11147.49,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11147.49,100,,,,,0,"case rate","100%CMS IPPS rate",270190.65,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,270190.65,
"ACUTE LEUKEMIA WITHOUT CC/MCC",836,"CDM ",100,RC,,,INPATIENT,,,,,,6168.22,100,,,,,0,"case rate","100%CMS IPPS rate",11931.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13199.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6168.22,100,,,,,0,"case rate","100%CMS IPPS rate",6168.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6168.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6168.22,100,,,,,0,"case rate","100%CMS IPPS rate",157971.81,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,157971.81,
"CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC",837,"CDM ",100,RC,,,INPATIENT,,,,,,17141.54,100,,,,,0,"case rate","100%CMS IPPS rate",48776.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",52001.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",17141.54,100,,,,,0,"case rate","100%CMS IPPS rate",17141.54,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",17141.54,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17141.54,100,,,,,0,"case rate","100%CMS IPPS rate",622340.03,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,622340.03,
"CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT",838,"CDM ",100,RC,,,INPATIENT,,,,,,16325.36,100,,,,,0,"case rate","100%CMS IPPS rate",19044.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22594.02,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",16325.36,100,,,,,0,"case rate","100%CMS IPPS rate",16325.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",16325.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16325.36,100,,,,,0,"case rate","100%CMS IPPS rate",270397.91,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,270397.91,
"CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC",839,"CDM ",100,RC,,,INPATIENT,,,,,,15548.28,100,,,,,0,"case rate","100%CMS IPPS rate",9579.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15628.77,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",15548.28,100,,,,,0,"case rate","100%CMS IPPS rate",15548.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",15548.28,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15548.28,100,,,,,0,"case rate","100%CMS IPPS rate",187040.11,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,187040.11,
"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC",840,"CDM ",100,RC,,,INPATIENT,,,,,,16959.38,100,,,,,0,"case rate","100%CMS IPPS rate",27832.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",35014.56,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",16959.38,100,,,,,0,"case rate","100%CMS IPPS rate",16959.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",16959.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16959.38,100,,,,,0,"case rate","100%CMS IPPS rate",419042.91,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,419042.91,
"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC",841,"CDM ",100,RC,,,INPATIENT,,,,,,8547.89,100,,,,,0,"case rate","100%CMS IPPS rate",14014.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17658.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8547.89,100,,,,,0,"case rate","100%CMS IPPS rate",8547.89,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8547.89,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8547.89,100,,,,,0,"case rate","100%CMS IPPS rate",211328.52,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,211328.52,
"LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC",842,"CDM ",100,RC,,,INPATIENT,,,,,,5776.34,100,,,,,0,"case rate","100%CMS IPPS rate",9480.47,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10936.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5776.34,100,,,,,0,"case rate","100%CMS IPPS rate",5776.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5776.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5776.34,100,,,,,0,"case rate","100%CMS IPPS rate",130885.31,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,130885.31,
"OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC",843,"CDM ",100,RC,,,INPATIENT,,,,,,10035.85,100,,,,,0,"case rate","100%CMS IPPS rate",13691.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",21591.72,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10035.85,100,,,,,0,"case rate","100%CMS IPPS rate",10035.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10035.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10035.85,100,,,,,0,"case rate","100%CMS IPPS rate",258402.64,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,258402.64,
"OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC",844,"CDM ",100,RC,,,INPATIENT,,,,,,6225.98,100,,,,,0,"case rate","100%CMS IPPS rate",9133.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13177.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6225.98,100,,,,,0,"case rate","100%CMS IPPS rate",6225.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6225.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6225.98,100,,,,,0,"case rate","100%CMS IPPS rate",157699.66,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,157699.66,
"OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC",845,"CDM ",100,RC,,,INPATIENT,,,,,,4469.21,100,,,,,0,"case rate","100%CMS IPPS rate",6539.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9217.72,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4469.21,100,,,,,0,"case rate","100%CMS IPPS rate",4469.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4469.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4469.21,100,,,,,0,"case rate","100%CMS IPPS rate",110314.66,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,110314.66,
"CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC",846,"CDM ",100,RC,,,INPATIENT,,,,,,14080.76,100,,,,,0,"case rate","100%CMS IPPS rate",23099.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",28061.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",14080.76,100,,,,,0,"case rate","100%CMS IPPS rate",14080.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",14080.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14080.76,100,,,,,0,"case rate","100%CMS IPPS rate",335827.63,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,335827.63,
"CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC",847,"CDM ",100,RC,,,INPATIENT,,,,,,6521.88,100,,,,,0,"case rate","100%CMS IPPS rate",12005.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14159.96,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6521.88,100,,,,,0,"case rate","100%CMS IPPS rate",6521.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6521.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6521.88,100,,,,,0,"case rate","100%CMS IPPS rate",169461.8,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,169461.8,
"CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC",848,"CDM ",100,RC,,,INPATIENT,,,,,,5426.68,100,,,,,0,"case rate","100%CMS IPPS rate",8661.46,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9193.91,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5426.68,100,,,,,0,"case rate","100%CMS IPPS rate",5426.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5426.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5426.68,100,,,,,0,"case rate","100%CMS IPPS rate",110029.64,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,110029.64,
RADIOTHERAPY,849,"CDM ",100,RC,,,INPATIENT,,,,,,13118.85,100,,,,,0,"case rate","100%CMS IPPS rate",12251.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",29327.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",13118.85,100,,,,,0,"case rate","100%CMS IPPS rate",13118.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",13118.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13118.85,100,,,,,0,"case rate","100%CMS IPPS rate",350983.62,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,350983.62,
"ACUTE LEUKEMIA WITH OTHER PROCEDURES",850,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",93730.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",1121735.53,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",93730.43,1121735.53,
"INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC",853,"CDM ",100,RC,,,INPATIENT,,,,,,32637.39,100,,,,,0,"case rate","100%CMS IPPS rate",42932.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",53455.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",32637.39,100,,,,,0,"case rate","100%CMS IPPS rate",32637.39,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",32637.39,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",32637.39,100,,,,,0,"case rate","100%CMS IPPS rate",639737.1,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,639737.1,
"INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC",854,"CDM ",100,RC,,,INPATIENT,,,,,,10472.15,100,,,,,0,"case rate","100%CMS IPPS rate",18340.4,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",21627.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10472.15,100,,,,,0,"case rate","100%CMS IPPS rate",10472.15,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10472.15,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10472.15,100,,,,,0,"case rate","100%CMS IPPS rate",258830.16,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,258830.16,
"INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC",855,"CDM ",100,RC,,,INPATIENT,,,,,,9452.48,100,,,,,0,"case rate","100%CMS IPPS rate",13261.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16205.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9452.48,100,,,,,0,"case rate","100%CMS IPPS rate",9452.48,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9452.48,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9452.48,100,,,,,0,"case rate","100%CMS IPPS rate",193944.45,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,193944.45,
"POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC",856,"CDM ",100,RC,,,INPATIENT,,,,,,28741.32,100,,,,,0,"case rate","100%CMS IPPS rate",40306.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",49235.13,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",28741.32,100,,,,,0,"case rate","100%CMS IPPS rate",28741.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",28741.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",28741.32,100,,,,,0,"case rate","100%CMS IPPS rate",589230.11,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,589230.11,
"POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC",857,"CDM ",100,RC,,,INPATIENT,,,,,,12865.15,100,,,,,0,"case rate","100%CMS IPPS rate",18169.29,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",23179.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",12865.15,100,,,,,0,"case rate","100%CMS IPPS rate",12865.15,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",12865.15,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12865.15,100,,,,,0,"case rate","100%CMS IPPS rate",277405.87,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,277405.87,
"POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC",858,"CDM ",100,RC,,,INPATIENT,,,,,,8525.67,100,,,,,0,"case rate","100%CMS IPPS rate",11749.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15076.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8525.67,100,,,,,0,"case rate","100%CMS IPPS rate",8525.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8525.67,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8525.67,100,,,,,0,"case rate","100%CMS IPPS rate",180433.65,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,180433.65,
"POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC",862,"CDM ",100,RC,,,INPATIENT,,,,,,9001.52,100,,,,,0,"case rate","100%CMS IPPS rate",16391.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19739.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9001.52,100,,,,,0,"case rate","100%CMS IPPS rate",9001.52,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9001.52,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9001.52,100,,,,,0,"case rate","100%CMS IPPS rate",236238.69,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,236238.69,
"POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC",863,"CDM ",100,RC,,,INPATIENT,,,,,,5370.25,100,,,,,0,"case rate","100%CMS IPPS rate",8740.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10801.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5370.25,100,,,,,0,"case rate","100%CMS IPPS rate",5370.25,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5370.25,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5370.25,100,,,,,0,"case rate","100%CMS IPPS rate",129266.14,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,129266.14,
"FEVER AND INFLAMMATORY CONDITIONS",864,"CDM ",100,RC,,,INPATIENT,,,,,,2379.23,100,,,,,0,"case rate","100%CMS IPPS rate",7574.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9608.46,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2379.23,100,,,,,0,"case rate","100%CMS IPPS rate",2379.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2379.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2379.23,100,,,,,0,"case rate","100%CMS IPPS rate",114991.06,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,114991.06,
"VIRAL ILLNESS WITH MCC",865,"CDM ",100,RC,,,INPATIENT,,,,,,8428.37,100,,,,,0,"case rate","100%CMS IPPS rate",11455.29,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16217.6,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8428.37,100,,,,,0,"case rate","100%CMS IPPS rate",8428.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8428.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8428.37,100,,,,,0,"case rate","100%CMS IPPS rate",194086.96,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,194086.96,
"VIRAL ILLNESS WITHOUT MCC",866,"CDM ",100,RC,,,INPATIENT,,,,,,2828.86,100,,,,,0,"case rate","100%CMS IPPS rate",7250.77,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9412.55,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2828.86,100,,,,,0,"case rate","100%CMS IPPS rate",2828.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2828.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2828.86,100,,,,,0,"case rate","100%CMS IPPS rate",112646.35,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,112646.35,
"OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC",867,"CDM ",100,RC,,,INPATIENT,,,,,,12706.09,100,,,,,0,"case rate","100%CMS IPPS rate",19333.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22656.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",12706.09,100,,,,,0,"case rate","100%CMS IPPS rate",12706.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",12706.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12706.09,100,,,,,0,"case rate","100%CMS IPPS rate",271149.17,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,271149.17,
"OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC",868,"CDM ",100,RC,,,INPATIENT,,,,,,6031.82,100,,,,,0,"case rate","100%CMS IPPS rate",9280.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11160.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6031.82,100,,,,,0,"case rate","100%CMS IPPS rate",6031.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6031.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6031.82,100,,,,,0,"case rate","100%CMS IPPS rate",133566.78,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,133566.78,
"OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC",869,"CDM ",100,RC,,,INPATIENT,,,,,,4137.32,100,,,,,0,"case rate","100%CMS IPPS rate",6847.97,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7898.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4137.32,100,,,,,0,"case rate","100%CMS IPPS rate",4137.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4137.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4137.32,100,,,,,0,"case rate","100%CMS IPPS rate",94524.03,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,94524.03,
"SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS",870,"CDM ",100,RC,,,INPATIENT,,,,,,41939.7,100,,,,,0,"case rate","100%CMS IPPS rate",55646.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",74813.32,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",41939.7,100,,,,,0,"case rate","100%CMS IPPS rate",41939.7,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",41939.7,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",41939.7,100,,,,,0,"case rate","100%CMS IPPS rate",895341.79,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,895341.79,
"SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC",871,"CDM ",100,RC,,,INPATIENT,,,,,,10954.22,100,,,,,0,"case rate","100%CMS IPPS rate",17192.89,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",21025.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10954.22,100,,,,,0,"case rate","100%CMS IPPS rate",10954.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10954.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10954.22,100,,,,,0,"case rate","100%CMS IPPS rate",251627.8,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,251627.8,
"SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC",872,"CDM ",100,RC,,,INPATIENT,,,,,,4898.85,100,,,,,0,"case rate","100%CMS IPPS rate",9753.29,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11076.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4898.85,100,,,,,0,"case rate","100%CMS IPPS rate",4898.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4898.85,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4898.85,100,,,,,0,"case rate","100%CMS IPPS rate",132556.37,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,132556.37,
"O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS",876,"CDM ",100,RC,,,INPATIENT,,,,,,16083.22,100,,,,,0,"case rate","100%CMS IPPS rate",25645.9,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",41833.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",16083.22,100,,,,,0,"case rate","100%CMS IPPS rate",16083.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",16083.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16083.22,100,,,,,0,"case rate","100%CMS IPPS rate",500652.03,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,500652.03,
"ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION",880,"CDM ",100,RC,,,INPATIENT,,,,,,2696.01,100,,,,,0,"case rate","100%CMS IPPS rate",9066.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10393.2,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2696.01,100,,,,,0,"case rate","100%CMS IPPS rate",2696.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2696.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2696.01,100,,,,,0,"case rate","100%CMS IPPS rate",124382.48,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,124382.48,
"DEPRESSIVE NEUROSES",881,"CDM ",100,RC,,,INPATIENT,,,,,,2271.26,100,,,,,0,"case rate","100%CMS IPPS rate",8411.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10184.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2271.26,100,,,,,0,"case rate","100%CMS IPPS rate",2271.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2271.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2271.26,100,,,,,0,"case rate","100%CMS IPPS rate",121882.39,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,121882.39,
"NEUROSES EXCEPT DEPRESSIVE",882,"CDM ",100,RC,,,INPATIENT,,,,,,2056.22,100,,,,,0,"case rate","100%CMS IPPS rate",8637.98,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11622.81,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2056.22,100,,,,,0,"case rate","100%CMS IPPS rate",2056.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2056.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2056.22,100,,,,,0,"case rate","100%CMS IPPS rate",139098.08,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2056.22,139098.08,
"DISORDERS OF PERSONALITY AND IMPULSE CONTROL",883,"CDM ",100,RC,,,INPATIENT,,,,,,2902.17,100,,,,,0,"case rate","100%CMS IPPS rate",16590.03,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",21283.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2902.17,100,,,,,0,"case rate","100%CMS IPPS rate",2902.17,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2902.17,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2902.17,100,,,,,0,"case rate","100%CMS IPPS rate",254710.9,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,254710.9,
"ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY",884,"CDM ",100,RC,,,INPATIENT,,,,,,3471.76,100,,,,,0,"case rate","100%CMS IPPS rate",15179.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17414.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3471.76,100,,,,,0,"case rate","100%CMS IPPS rate",3471.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3471.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3471.76,100,,,,,0,"case rate","100%CMS IPPS rate",208413.92,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,208413.92,
PSYCHOSES,885,"CDM ",100,RC,,,INPATIENT,,,,,,3013.69,100,,,,,0,"case rate","100%CMS IPPS rate",12998.91,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15118.96,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3013.69,100,,,,,0,"case rate","100%CMS IPPS rate",3013.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3013.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3013.69,100,,,,,0,"case rate","100%CMS IPPS rate",180938.92,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,180938.92,
"BEHAVIORAL AND DEVELOPMENTAL DISORDERS",886,"CDM ",100,RC,,,INPATIENT,,,,,,1700.78,100,,,,,0,"case rate","100%CMS IPPS rate",12958.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22463.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",1700.78,100,,,,,0,"case rate","100%CMS IPPS rate",1700.78,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",1700.78,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",1700.78,100,,,,,0,"case rate","100%CMS IPPS rate",268830.47,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",1700.78,268830.47,
"OTHER MENTAL DISORDER DIAGNOSES",887,"CDM ",100,RC,,,INPATIENT,,,,,,2593.82,100,,,,,0,"case rate","100%CMS IPPS rate",11325.02,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11591.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2593.82,100,,,,,0,"case rate","100%CMS IPPS rate",2593.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2593.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2593.82,100,,,,,0,"case rate","100%CMS IPPS rate",138722.45,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,138722.45,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA",894,"CDM ",100,RC,,,INPATIENT,,,,,,2969.26,100,,,,,0,"case rate","100%CMS IPPS rate",5702.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6677.33,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2969.26,100,,,,,0,"case rate","100%CMS IPPS rate",2969.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2969.26,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2969.26,100,,,,,0,"case rate","100%CMS IPPS rate",83058.6,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,83058.6,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY",895,"CDM ",100,RC,,,INPATIENT,,,,,,7998.29,100,,,,,0,"case rate","100%CMS IPPS rate",16609.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15322.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7998.29,100,,,,,0,"case rate","100%CMS IPPS rate",7998.29,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7998.29,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7998.29,100,,,,,0,"case rate","100%CMS IPPS rate",183374.25,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,183374.25,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC",896,"CDM ",100,RC,,,INPATIENT,,,,,,7715.27,100,,,,,0,"case rate","100%CMS IPPS rate",18490.64,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18888.96,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7715.27,100,,,,,0,"case rate","100%CMS IPPS rate",7715.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7715.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7715.27,100,,,,,0,"case rate","100%CMS IPPS rate",226056.98,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,226056.98,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",897,"CDM ",100,RC,,,INPATIENT,,,,,,4409.68,100,,,,,0,"case rate","100%CMS IPPS rate",8589.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9555.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4409.68,100,,,,,0,"case rate","100%CMS IPPS rate",4409.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4409.68,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4409.68,100,,,,,0,"case rate","100%CMS IPPS rate",114356.3,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,114356.3,
"WOUND DEBRIDEMENTS FOR INJURIES WITH MCC",901,"CDM ",100,RC,,,INPATIENT,,,,,,23584.78,100,,,,,0,"case rate","100%CMS IPPS rate",36890.83,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",45424,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",23584.78,100,,,,,0,"case rate","100%CMS IPPS rate",23584.78,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",23584.78,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",23584.78,100,,,,,0,"case rate","100%CMS IPPS rate",543619.78,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,543619.78,
"WOUND DEBRIDEMENTS FOR INJURIES WITH CC",902,"CDM ",100,RC,,,INPATIENT,,,,,,10859.14,100,,,,,0,"case rate","100%CMS IPPS rate",16975.81,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",20722.55,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10859.14,100,,,,,0,"case rate","100%CMS IPPS rate",10859.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10859.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10859.14,100,,,,,0,"case rate","100%CMS IPPS rate",248000.82,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,248000.82,
"WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC",903,"CDM ",100,RC,,,INPATIENT,,,,,,6277.07,100,,,,,0,"case rate","100%CMS IPPS rate",8626.89,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12659.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6277.07,100,,,,,0,"case rate","100%CMS IPPS rate",6277.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6277.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6277.07,100,,,,,0,"case rate","100%CMS IPPS rate",151507.85,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,151507.85,
"SKIN GRAFTS FOR INJURIES WITH CC/MCC",904,"CDM ",100,RC,,,INPATIENT,,,,,,20592.42,100,,,,,0,"case rate","100%CMS IPPS rate",32209.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",39757.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",20592.42,100,,,,,0,"case rate","100%CMS IPPS rate",20592.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",20592.42,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",20592.42,100,,,,,0,"case rate","100%CMS IPPS rate",475806.61,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,475806.61,
"SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC",905,"CDM ",100,RC,,,INPATIENT,,,,,,9085.49,100,,,,,0,"case rate","100%CMS IPPS rate",10622.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15497.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9085.49,100,,,,,0,"case rate","100%CMS IPPS rate",9085.49,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9085.49,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9085.49,100,,,,,0,"case rate","100%CMS IPPS rate",192156.89,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,192156.89,
"HAND PROCEDURES FOR INJURIES",906,"CDM ",100,RC,,,INPATIENT,,,,,,9926.11,100,,,,,0,"case rate","100%CMS IPPS rate",10514.89,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19076.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9926.11,100,,,,,0,"case rate","100%CMS IPPS rate",9926.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9926.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9926.11,100,,,,,0,"case rate","100%CMS IPPS rate",254451.77,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,254451.77,
"OTHER O.R. PROCEDURES FOR INJURIES WITH MCC",907,"CDM ",100,RC,,,INPATIENT,,,,,,21896.88,100,,,,,0,"case rate","100%CMS IPPS rate",34121.02,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",41556.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",21896.88,100,,,,,0,"case rate","100%CMS IPPS rate",21896.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",21896.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",21896.88,100,,,,,0,"case rate","100%CMS IPPS rate",497335.79,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,497335.79,
"OTHER O.R. PROCEDURES FOR INJURIES WITH CC",908,"CDM ",100,RC,,,INPATIENT,,,,,,11290.55,100,,,,,0,"case rate","100%CMS IPPS rate",17719.9,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",21596.04,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",11290.55,100,,,,,0,"case rate","100%CMS IPPS rate",11290.55,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",11290.55,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11290.55,100,,,,,0,"case rate","100%CMS IPPS rate",258454.52,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,258454.52,
"OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC",909,"CDM ",100,RC,,,INPATIENT,,,,,,7608.19,100,,,,,0,"case rate","100%CMS IPPS rate",11848.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14208.66,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7608.19,100,,,,,0,"case rate","100%CMS IPPS rate",7608.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7608.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7608.19,100,,,,,0,"case rate","100%CMS IPPS rate",170044.69,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,170044.69,
"TRAUMATIC INJURY WITH MCC",913,"CDM ",100,RC,,,INPATIENT,,,,,,3440.21,100,,,,,0,"case rate","100%CMS IPPS rate",14161.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17692.91,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3440.21,100,,,,,0,"case rate","100%CMS IPPS rate",3440.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3440.21,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3440.21,100,,,,,0,"case rate","100%CMS IPPS rate",211743.02,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,211743.02,
"TRAUMATIC INJURY WITHOUT MCC",914,"CDM ",100,RC,,,INPATIENT,,,,,,3276.27,100,,,,,0,"case rate","100%CMS IPPS rate",7753.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9584.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3276.27,100,,,,,0,"case rate","100%CMS IPPS rate",3276.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3276.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3276.27,100,,,,,0,"case rate","100%CMS IPPS rate",114706.05,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,114706.05,
"ALLERGIC REACTIONS WITH MCC",915,"CDM ",100,RC,,,INPATIENT,,,,,,7360.27,100,,,,,0,"case rate","100%CMS IPPS rate",14687.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18201.64,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7360.27,100,,,,,0,"case rate","100%CMS IPPS rate",7360.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7360.27,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7360.27,100,,,,,0,"case rate","100%CMS IPPS rate",217831.35,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,217831.35,
"ALLERGIC REACTIONS WITHOUT MCC",916,"CDM ",100,RC,,,INPATIENT,,,,,,2849.74,100,,,,,0,"case rate","100%CMS IPPS rate",5689.99,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7212.03,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2849.74,100,,,,,0,"case rate","100%CMS IPPS rate",2849.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2849.74,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2849.74,100,,,,,0,"case rate","100%CMS IPPS rate",87735.08,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,87735.08,
"POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC",917,"CDM ",100,RC,,,INPATIENT,,,,,,7241.65,100,,,,,0,"case rate","100%CMS IPPS rate",12777.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16976.36,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7241.65,100,,,,,0,"case rate","100%CMS IPPS rate",7241.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7241.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7241.65,100,,,,,0,"case rate","100%CMS IPPS rate",203167.63,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,203167.63,
"POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC",918,"CDM ",100,RC,,,INPATIENT,,,,,,2958.59,100,,,,,0,"case rate","100%CMS IPPS rate",7180.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9277.25,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2958.59,100,,,,,0,"case rate","100%CMS IPPS rate",2958.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2958.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2958.59,100,,,,,0,"case rate","100%CMS IPPS rate",111027.19,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,111027.19,
"COMPLICATIONS OF TREATMENT WITH MCC",919,"CDM ",100,RC,,,INPATIENT,,,,,,7953.41,100,,,,,0,"case rate","100%CMS IPPS rate",15937.02,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",19816.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7953.41,100,,,,,0,"case rate","100%CMS IPPS rate",7953.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7953.41,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7953.41,100,,,,,0,"case rate","100%CMS IPPS rate",237158.48,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,237158.48,
"COMPLICATIONS OF TREATMENT WITH CC",920,"CDM ",100,RC,,,INPATIENT,,,,,,4574.07,100,,,,,0,"case rate","100%CMS IPPS rate",8854.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10848.9,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4574.07,100,,,,,0,"case rate","100%CMS IPPS rate",4574.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4574.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4574.07,100,,,,,0,"case rate","100%CMS IPPS rate",129836.02,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,129836.02,
"COMPLICATIONS OF TREATMENT WITHOUT CC/MCC",921,"CDM ",100,RC,,,INPATIENT,,,,,,2997.69,100,,,,,0,"case rate","100%CMS IPPS rate",6031.37,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7451.24,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",2997.69,100,,,,,0,"case rate","100%CMS IPPS rate",2997.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",2997.69,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2997.69,100,,,,,0,"case rate","100%CMS IPPS rate",89827.21,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,89827.21,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC",922,"CDM ",100,RC,,,INPATIENT,,,,,,6883.54,100,,,,,0,"case rate","100%CMS IPPS rate",13725.49,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18935.51,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6883.54,100,,,,,0,"case rate","100%CMS IPPS rate",6883.54,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6883.54,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6883.54,100,,,,,0,"case rate","100%CMS IPPS rate",226614,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,226614,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC",923,"CDM ",100,RC,,,INPATIENT,,,,,,4033.8,100,,,,,0,"case rate","100%CMS IPPS rate",8121.9,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11015.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4033.8,100,,,,,0,"case rate","100%CMS IPPS rate",4033.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4033.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4033.8,100,,,,,0,"case rate","100%CMS IPPS rate",131830.97,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,131830.97,
"EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT",927,"CDM ",100,RC,,,INPATIENT,,,,,,103715.17,100,,,,,0,"case rate","100%CMS IPPS rate",120068.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",199488.48,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",103715.17,100,,,,,0,"case rate","100%CMS IPPS rate",103715.17,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",103715.17,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",103715.17,100,,,,,0,"case rate","100%CMS IPPS rate",2765704.14,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,2765704.14,
"FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC",928,"CDM ",100,RC,,,INPATIENT,,,,,,32149.55,100,,,,,0,"case rate","100%CMS IPPS rate",41557.09,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",77637.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",32149.55,100,,,,,0,"case rate","100%CMS IPPS rate",32149.55,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",32149.55,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",32149.55,100,,,,,0,"case rate","100%CMS IPPS rate",929138.24,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,929138.24,
"FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC",929,"CDM ",100,RC,,,INPATIENT,,,,,,14838.73,100,,,,,0,"case rate","100%CMS IPPS rate",18025.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",34861.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",14838.73,100,,,,,0,"case rate","100%CMS IPPS rate",14838.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",14838.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14838.73,100,,,,,0,"case rate","100%CMS IPPS rate",417216.48,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,417216.48,
"EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT",933,"CDM ",100,RC,,,INPATIENT,,,,,,11178.59,100,,,,,0,"case rate","100%CMS IPPS rate",19677.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",41311.96,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",11178.59,100,,,,,0,"case rate","100%CMS IPPS rate",11178.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",11178.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",11178.59,100,,,,,0,"case rate","100%CMS IPPS rate",504447.39,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,504447.39,
"FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY",934,"CDM ",100,RC,,,INPATIENT,,,,,,9592.88,100,,,,,0,"case rate","100%CMS IPPS rate",16773.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",23927.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9592.88,100,,,,,0,"case rate","100%CMS IPPS rate",9592.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9592.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9592.88,100,,,,,0,"case rate","100%CMS IPPS rate",286357.04,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,286357.04,
"NON-EXTENSIVE BURNS",935,"CDM ",100,RC,,,INPATIENT,,,,,,9572.89,100,,,,,0,"case rate","100%CMS IPPS rate",16704.45,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",22297.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9572.89,100,,,,,0,"case rate","100%CMS IPPS rate",9572.89,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9572.89,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9572.89,100,,,,,0,"case rate","100%CMS IPPS rate",266848.55,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,266848.55,
"O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC",939,"CDM ",100,RC,,,INPATIENT,,,,,,16699.46,100,,,,,0,"case rate","100%CMS IPPS rate",29163.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",39274.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",16699.46,100,,,,,0,"case rate","100%CMS IPPS rate",16699.46,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",16699.46,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16699.46,100,,,,,0,"case rate","100%CMS IPPS rate",470029.17,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,470029.17,
"O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC",940,"CDM ",100,RC,,,INPATIENT,,,,,,10936.44,100,,,,,0,"case rate","100%CMS IPPS rate",19193.39,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",25294.61,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10936.44,100,,,,,0,"case rate","100%CMS IPPS rate",10936.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10936.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10936.44,100,,,,,0,"case rate","100%CMS IPPS rate",302717.69,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,302717.69,
"O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC",941,"CDM ",100,RC,,,INPATIENT,,,,,,9491.58,100,,,,,0,"case rate","100%CMS IPPS rate",16619.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",21947.82,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",9491.58,100,,,,,0,"case rate","100%CMS IPPS rate",9491.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",9491.58,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9491.58,100,,,,,0,"case rate","100%CMS IPPS rate",262664.53,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,262664.53,
"REHABILITATION WITH CC/MCC",945,"CDM ",100,RC,,,INPATIENT,,,,,,8507.01,100,,,,,0,"case rate","100%CMS IPPS rate",18626.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16762.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8507.01,100,,,,,0,"case rate","100%CMS IPPS rate",8507.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8507.01,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8507.01,100,,,,,0,"case rate","100%CMS IPPS rate",200602.8,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,200602.8,
"REHABILITATION WITHOUT CC/MCC",946,"CDM ",100,RC,,,INPATIENT,,,,,,6240.19,100,,,,,0,"case rate","100%CMS IPPS rate",10871.53,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12412.96,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6240.19,100,,,,,0,"case rate","100%CMS IPPS rate",6240.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6240.19,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6240.19,100,,,,,0,"case rate","100%CMS IPPS rate",148554.38,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,148554.38,
"SIGNS AND SYMPTOMS WITH MCC",947,"CDM ",100,RC,,,INPATIENT,,,,,,8016.06,100,,,,,0,"case rate","100%CMS IPPS rate",10318.75,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13739.99,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8016.06,100,,,,,0,"case rate","100%CMS IPPS rate",8016.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8016.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8016.06,100,,,,,0,"case rate","100%CMS IPPS rate",164435.77,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,164435.77,
"SIGNS AND SYMPTOMS WITHOUT MCC",948,"CDM ",100,RC,,,INPATIENT,,,,,,6304.62,100,,,,,0,"case rate","100%CMS IPPS rate",6802.25,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8664.61,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",6304.62,100,,,,,0,"case rate","100%CMS IPPS rate",6304.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",6304.62,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6304.62,100,,,,,0,"case rate","100%CMS IPPS rate",103695.33,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,103695.33,
"AFTERCARE WITH CC/MCC",949,"CDM ",100,RC,,,INPATIENT,,,,,,12467.06,100,,,,,0,"case rate","100%CMS IPPS rate",9591.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12877.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",12467.06,100,,,,,0,"case rate","100%CMS IPPS rate",12467.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",12467.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12467.06,100,,,,,0,"case rate","100%CMS IPPS rate",154111.57,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,154111.57,
"AFTERCARE WITHOUT CC/MCC",950,"CDM ",100,RC,,,INPATIENT,,,,,,4883.3,100,,,,,0,"case rate","100%CMS IPPS rate",6334.83,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6794.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4883.3,100,,,,,0,"case rate","100%CMS IPPS rate",4883.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4883.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4883.3,100,,,,,0,"case rate","100%CMS IPPS rate",84081.01,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,84081.01,
"OTHER FACTORS INFLUENCING HEALTH STATUS",951,"CDM ",100,RC,,,INPATIENT,,,,,,3689.02,100,,,,,0,"case rate","100%CMS IPPS rate",5943.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",6018.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",3689.02,100,,,,,0,"case rate","100%CMS IPPS rate",3689.02,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",3689.02,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3689.02,100,,,,,0,"case rate","100%CMS IPPS rate",77293.49,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,77293.49,
"CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA",955,"CDM ",100,RC,,,INPATIENT,,,,,,40345.99,100,,,,,0,"case rate","100%CMS IPPS rate",55699.11,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",72857.43,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",40345.99,100,,,,,0,"case rate","100%CMS IPPS rate",40345.99,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",40345.99,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",40345.99,100,,,,,0,"case rate","100%CMS IPPS rate",871934.15,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,871934.15,
"LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA",956,"CDM ",100,RC,,,INPATIENT,,,,,,24695.08,100,,,,,0,"case rate","100%CMS IPPS rate",41445.87,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",40730.71,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",24695.08,100,,,,,0,"case rate","100%CMS IPPS rate",24695.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",24695.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",24695.08,100,,,,,0,"case rate","100%CMS IPPS rate",487451.97,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,487451.97,
"OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC",957,"CDM ",100,RC,,,INPATIENT,,,,,,47614.3,100,,,,,0,"case rate","100%CMS IPPS rate",60442,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",82477.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",47614.3,100,,,,,0,"case rate","100%CMS IPPS rate",47614.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",47614.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",47614.3,100,,,,,0,"case rate","100%CMS IPPS rate",987067.73,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,987067.73,
"OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC",958,"CDM ",100,RC,,,INPATIENT,,,,,,26983.23,100,,,,,0,"case rate","100%CMS IPPS rate",36346.38,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",45611.25,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",26983.23,100,,,,,0,"case rate","100%CMS IPPS rate",26983.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",26983.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",26983.23,100,,,,,0,"case rate","100%CMS IPPS rate",545860.72,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,545860.72,
"OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC",959,"CDM ",100,RC,,,INPATIENT,,,,,,17543.63,100,,,,,0,"case rate","100%CMS IPPS rate",25578.89,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",31866.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",17543.63,100,,,,,0,"case rate","100%CMS IPPS rate",17543.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",17543.63,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17543.63,100,,,,,0,"case rate","100%CMS IPPS rate",381373.21,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,381373.21,
"OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC",963,"CDM ",100,RC,,,INPATIENT,,,,,,13488.95,100,,,,,0,"case rate","100%CMS IPPS rate",24127.23,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",29590.65,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",13488.95,100,,,,,0,"case rate","100%CMS IPPS rate",13488.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",13488.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13488.95,100,,,,,0,"case rate","100%CMS IPPS rate",354131.33,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,354131.33,
"OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC",964,"CDM ",100,RC,,,INPATIENT,,,,,,7370.05,100,,,,,0,"case rate","100%CMS IPPS rate",15856.81,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",16588.86,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7370.05,100,,,,,0,"case rate","100%CMS IPPS rate",7370.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7370.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7370.05,100,,,,,0,"case rate","100%CMS IPPS rate",198530.1,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,198530.1,
"OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC",965,"CDM ",100,RC,,,INPATIENT,,,,,,4520.31,100,,,,,0,"case rate","100%CMS IPPS rate",10739.77,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10179.97,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",4520.31,100,,,,,0,"case rate","100%CMS IPPS rate",4520.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",4520.31,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",4520.31,100,,,,,0,"case rate","100%CMS IPPS rate",121830.65,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,121830.65,
"HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC",969,"CDM ",100,RC,,,INPATIENT,,,,,,28540.94,100,,,,,0,"case rate","100%CMS IPPS rate",55509.57,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",66256.95,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",28540.94,100,,,,,0,"case rate","100%CMS IPPS rate",28540.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",28540.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",28540.94,100,,,,,0,"case rate","100%CMS IPPS rate",792941.89,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,792941.89,
"HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC",970,"CDM ",100,RC,,,INPATIENT,,,,,,14524.17,100,,,,,0,"case rate","100%CMS IPPS rate",24428.76,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",28547.22,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",14524.17,100,,,,,0,"case rate","100%CMS IPPS rate",14524.17,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",14524.17,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14524.17,100,,,,,0,"case rate","100%CMS IPPS rate",341643.94,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,341643.94,
"HIV WITH MAJOR RELATED CONDITION WITH MCC",974,"CDM ",100,RC,,,INPATIENT,,,,,,15699.78,100,,,,,0,"case rate","100%CMS IPPS rate",25195.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",31238.06,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",15699.78,100,,,,,0,"case rate","100%CMS IPPS rate",15699.78,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",15699.78,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",15699.78,100,,,,,0,"case rate","100%CMS IPPS rate",373847.09,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,373847.09,
"HIV WITH MAJOR RELATED CONDITION WITH CC",975,"CDM ",100,RC,,,INPATIENT,,,,,,7477.12,100,,,,,0,"case rate","100%CMS IPPS rate",12025.18,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",14017.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7477.12,100,,,,,0,"case rate","100%CMS IPPS rate",7477.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7477.12,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7477.12,100,,,,,0,"case rate","100%CMS IPPS rate",167751.86,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,167751.86,
"HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC",976,"CDM ",100,RC,,,INPATIENT,,,,,,5547.97,100,,,,,0,"case rate","100%CMS IPPS rate",8337.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",9682.07,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5547.97,100,,,,,0,"case rate","100%CMS IPPS rate",5547.97,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5547.97,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5547.97,100,,,,,0,"case rate","100%CMS IPPS rate",116934.13,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,116934.13,
"HIV WITH OR WITHOUT OTHER RELATED CONDITION",977,"CDM ",100,RC,,,INPATIENT,,,,,,7721.05,100,,,,,0,"case rate","100%CMS IPPS rate",11775.08,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",13720.5,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",7721.05,100,,,,,0,"case rate","100%CMS IPPS rate",7721.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",7721.05,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",7721.05,100,,,,,0,"case rate","100%CMS IPPS rate",168101.62,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",2263.16,168101.62,
"EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC",981,"CDM ",100,RC,,,INPATIENT,,,,,,27316.9,100,,,,,0,"case rate","100%CMS IPPS rate",39879.3,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",50784.04,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",27316.9,100,,,,,0,"case rate","100%CMS IPPS rate",27316.9,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",27316.9,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",27316.9,100,,,,,0,"case rate","100%CMS IPPS rate",607767.07,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,607767.07,
"EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC",982,"CDM ",100,RC,,,INPATIENT,,,,,,10128.71,100,,,,,0,"case rate","100%CMS IPPS rate",21921.73,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",26610.8,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",10128.71,100,,,,,0,"case rate","100%CMS IPPS rate",10128.71,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",10128.71,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",10128.71,100,,,,,0,"case rate","100%CMS IPPS rate",318469.58,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,318469.58,
"EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC",983,"CDM ",100,RC,,,INPATIENT,,,,,,8764.71,100,,,,,0,"case rate","100%CMS IPPS rate",14871.46,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",18552.34,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8764.71,100,,,,,0,"case rate","100%CMS IPPS rate",8764.71,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8764.71,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8764.71,100,,,,,0,"case rate","100%CMS IPPS rate",222028.36,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,222028.36,
"NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC",987,"CDM ",100,RC,,,INPATIENT,,,,,,17277.94,100,,,,,0,"case rate","100%CMS IPPS rate",28310.88,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",37109,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",17277.94,100,,,,,0,"case rate","100%CMS IPPS rate",17277.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",17277.94,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17277.94,100,,,,,0,"case rate","100%CMS IPPS rate",444108.59,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,444108.59,
"NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC",988,"CDM ",100,RC,,,INPATIENT,,,,,,8551.44,100,,,,,0,"case rate","100%CMS IPPS rate",15928.59,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",17790.33,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",8551.44,100,,,,,0,"case rate","100%CMS IPPS rate",8551.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",8551.44,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",8551.44,100,,,,,0,"case rate","100%CMS IPPS rate",212908.94,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,212908.94,
"NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC",989,"CDM ",100,RC,,,INPATIENT,,,,,,5910.52,100,,,,,0,"case rate","100%CMS IPPS rate",10238.48,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",12980.14,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",5910.52,100,,,,,0,"case rate","100%CMS IPPS rate",5910.52,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,100,,,,,0,"per diem","pays based on per day rate",,,,,,,0,"other ","not separately reimbursment",5910.52,100,,,,,0,"case rate","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",5910.52,100,,,,,0,"case rate","100%CMS IPPS rate",155342.09,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",3487.92,155342.09,
"PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS",998,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",24659.8,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",24659.8,24659.8,
UNGROUPABLE,999,"CDM ",100,RC,,,INPATIENT,,,,,,,,,,,,0,other,"not separately reimbursment",,,,,,,0,other,"not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",,,,,,,0,"other ","not separately reimbursment",24659.8,100,MSDRG,,,,0,"case rate ","100%CMS IPPS rate",,,,,,,0,"other ","not separately reimbursment",24659.8,24659.8,